Worried about my neighbor- how can I help?

[Rivka P]

I am worried about my downstairs neighbor. She is a sweet elderly lady from Hungary/Russia and a survivor of the holocaust. This woman is a tzadekes and a great grandmother Baruch Hashem. Recently, she has begun to notice that she has been a lot more forgetful. She will forget to buy an ingredient for her baking, or forget her wallet that she prepared to bring out with her. Once she thought she forgot to bring her key, but it was in a pocket she hadn't checked. She called me the other day for baking soda, but she had some right on the table. I guess at the age of 85 Baruch Hashem, some forgetfulness can be expected, but it bothers her.
More important, is that I noticed the other day that her face looked thin. I asked her, did you lose weight? She said, "Yeh, but not because I wanted to." She told me she lost about 22 lbs. recently. From 140 lbs to now, 118 lbs. I begged her to drink some ensure, but she said it's gross and she won't drink it. She told me her daughters are also concerned about her weight, and encourage her to eat. It seems she just has a decreased appetite.
An aside, a number of years ago, she was hit by a car while crossing the street. Since then, she has had chronic back pain and takes advil for it. I don't think this is really working for her and wish that she didn't have to deal with constant pain. I am wondering why no one prescribed lyrica or something like it.
The last thing is that her hearing is decreasing, and I wish she would get hearing aids. There have been a few misunderstandings because she cannot hear, and it's just frustrations that are unnecessary.

To sum up, really the thing I am most concerned about is her nutrition. If you have any suggestions of how I can help her, please let me know. Thanks!

[malkieh]

Try to get her to eat more smaller meals.. instead of 3 meals a day maybe 5-6 small meals?

something our professor suggested for the elderly, because they tend to eat less. And feel full faster. See if you can find another protein shake that she does like, sometimes there are better tasting ones that come in powders.

[medic09]

I'll ask the obvious? When's the last time she had a full, long health assessment with a good Family Practice doc?

Is she neglecting her nutrition, or is there another reason for weight loss? She needs a really thorough primary care assessment.

Will she come up to you for a Shabbat meal, if you can handle the guest?

[Rivka P]

She has a primary MD whom she has been seeing for years and years. He is also getting on in age, and frankly, I think it would do her good to switch to a more modern professional. When I asked about the weight she did mention taking vitamins, but that her MD does not "believe in" vitamins. He tells her to eat and walk. Oh and not to fight with cars anymore, in reference to her aforementioned car accident. I truly believe that she has a decreased appetite, not neglected nutrition, because her daughters bring her food and she loves to bake and cooks for others, so I think it's more an issue of not really being very hungry and only eating when she is hungry.
She cannot come to us for a meal because it is extremely difficult for her to make it up the stairs. We have hosted her on succot, though. Even if we are by her and brought the food etc, I don't think she would eat very much.

[achot]

Sounds like either the begining signs of Alzheimers, but could be medication poisoning (like Dig.), B12 deficiency, UTI, etc.
Unintended weight loss could be a sign of cancer, thyroid disorder, diabetes etc.
If you really care, take her to the doctor for a full physical and blood work, EKG, etc. She might need immunizations like Pneumovaccine,
It is important to get in touch with her family. Explain that if it is early Alzheimers, there might be treatment that can delay the progress and slow the loss of memory.
What you are describing is clearly more than normal forgetfulness.
I dont think lack of food is the issue, if she were hungry she would eat. Poor apetite could mean different things but we cant diagnose this way.
Please have some one get her to a doctor or NP for a full exam.
Tizkee LeMitzvot

[Rivka P]

update: the Thursday before pesach she fell outside and a neighbor helped her up. I was the only one she told and I told her daughter, but I don't know if they ever went to the doctor. She's in so much pain. :-(

[achot]

Lots of questions.....How is she managing with her ADL's and IADL's? If she is in pain there might be a serious injury or disease process. Was the daughter's response appropriate? Would you like to refer the situation to a Social Worker ? Why wont she seek medical attention? Is she at risk for another fall?
Perhaps there is a local Rav you can speak to about the situation who might know of how to get your neighbor to accept the help she needs...

[Rivka P]

She went to the MD and he told her to take advil... she says that this just decreases the pain but it does not go away. She thinks because she is getting older, this is normal. I guess if it's acceptable to her, I shouldn't interfere, but it bothers me, because she could be living with much less pain. She could use a patch or something that would control her pain better than advil.

I think she managing alright with her ADLs and she has people come in to help her often. Not really with bathing etc, more with keeping house.

I think she is definitely at risk for another fall, but she insists on being as independent as possible. I'm not sure if I want to get a rav involved, but it's a possibility.

[achot]

Apr 11, 2010 23:23:41 GMT -5 Rivka P said:

She went to the MD and he told her to take advil... she says that this just decreases the pain but it does not go away. She thinks because she is getting older, this is normal. I guess if it's acceptable to her, I shouldn't interfere, but it bothers me, because she could be living with much less pain. She could use a patch or something that would control her pain better than advil.

I think she managing alright with her ADLs and she has people come in to help her often. Not really with bathing etc, more with keeping house.

I think she is definitely at risk for another fall, but she insists on being as independent as possible. I'm not sure if I want to get a rav involved, but it's a possibility.

Sounds like she is well cared for, the truth is most people would prefer to put up with some pain than deal with the side effects of stronger medications. I hope she knows to take Advil with food and never on an empty stomach.
Regarding the risk for falling, if you want to suggest to her family to put in security rails or bars by the bathroom or other appropriate places then you can, but not everyone wants them. I guess you have to daven for the best.
Kol tuv and tizkee lemitzvot!

[cganz1]

Just a quick comment on the pain control issue - although there are many drugs that are prescribed for chronic pain, I think that Lyrica is only for Fibromyalgia (it actually works well for fibromyalgia) and might not help in this case. The Dr. might be wary of prescribing something stronger (ie: narcotics) due to her age and the huge risk of side effects.

[achot]

Lyrica is great for fibromyalgia but not only- its also good for diabetic neuropathy, and most neuropathic pain. I agree about not wanting to prescribe something stronger, there are such side effects that might create worse problems or even contribute to another fall. In addition, my understanding is that she is not a complainer and would understate the pain to her doctor. Maybe she could use a topical pain killer- or better yet- warm compresses. In our facility a Phys Therapist uses this massage oil with lavender that the patients swear is heaven sent.

[achot]

Mar 19, 2010 15:39:33 GMT -5 malkieh said:

Try to get her to eat more smaller meals.. instead of 3 meals a day maybe 5-6 small meals?

.

Malkie, 6 smaller meals- that is actually good advice for almost anybody!
Regarding the protein shakes, also a great idea but I would want to know her kidney function and protein levels before starting this- if she is in kidney failure it could be a problem. If her protein levels are normal, she might just need more carbs ...
But you are right, there are Kosher tasty protein powders that make nice shakes for those who need it.

[cganz1]

" Maybe she could use a topical pain killer" - They also make some really cool topical patches like lidoderm or voltaren gel that aren't as intimidating as taking a pill.

[Rivka P]

A nurse practitioner who has seen her before is beginning to visit again. I hope she recommends something like a lidoderm patch. Maybe I can catch her and suggest it.

thanks everyone for your comments and suggestions.