Reducing stress in later life and end of life

18th May 2018
Mental health in later life
Mental health in later life

This content mentions death and bereavement, which some people may find triggering.

Death. It's a pretty dark topic isn't it? Not many of us want to talk about our own or loved ones' deaths before they happen.

Last month, my Grandma passed away at the age of 87 after an increasingly difficult struggle with dementia.

Throughout her life, she was incredibly active in her local community in north Manchester. She was a teacher at her local primary school, ran choirs and flower clubs, played the piano at a local nursery school and had a leading role in the Mothers' Union.

Sadly, dementia made it harder for her to do these things in her last few years. She became unable to drive, and then had problems with mobility and looking after herself, so she moved into a care home.

A notorious chatterbox, dementia significantly reduced her processing speed, so she found maintaining conversation more and more difficult in her final months, no matter how hard she tried.

Imagine having your independence and so many of the things that matter most to you taken away by such a challenging illness over which you have no control. It sounds like quite a stressful experience.

First-class care

But we can ease the stress on the 850,000 people in the UK who have dementia (a figure that will rise to 1 million by 2025 and 2 million by 2051).

Initially, my Grandma had carers coming into her home a few times a day, to help her wash, go to the bathroom and cook her meals.

She had also experienced several falls, resulting in a number of trips to A&E for treatment to head wounds. Despite having an alarm around her neck, she often forgot to wear it, meaning there were occasions when she had to wait for carers to arrive before being taken to the hospital.

My Grandma hated the idea of leaving her home to go into a care home with new surroundings and other people doing tasks for her that, not long before, were second nature to her.

But the reality was that she needed round-the-clock care provided by professionals in a care home. She got that care, and more.

Now, I know care homes are a controversial topic and I'm not going to defend or argue the case for care homes in general. Every case is unique and should be treated as such. What I will say, however, is that care homes can be a huge help for a lot of people and should never be automatically discounted.

Lyndhurst Care in Middleton, north Manchester, provided a home for my Grandma for her last two years. Despite not initially being keen, she settled in rather quickly.

She was allowed to hang pictures on the walls and bring ornaments and pieces of furniture, so in some ways, her room was reminiscent of her house in which she’d lived for nearly 60 years.

She had family and friends visit her on most days – all of whom were made to feel welcome enough to want to go again. We know how maintaining positive relationships and connections is vital for good mental health (something we focused on as part of our Standing Together project), and this was important in helping my Grandma stay as mentally healthy as possible.

She looked forward to and took great joy from visits from her children, grandchildren and, in her last 18 months, her great-grandson.

Emotional memory

One thing to remember if you do have a relative with dementia is that visiting them is really important. We are lucky that my Grandma never reached the stage where she didn’t recognise her family but she did often forget our previous visits and details of them. However, 'emotional memory' means that people with dementia can feel the powerful and positive impacts of connection with friends and family even if they don’t remember the event itself.

And then there was the team at Lyndhurst, who were magnificent. They not only provided great-quality care – they provided social interaction, humour and love on a day-to-day basis that was priceless. The care home treated my Grandma like a much-loved member of a family.

This was evident throughout her stay, but especially at her funeral, where four carers gave up their day off to join two 'on duty' colleagues at the funeral and were as emotional as anybody in the congregation.

All of these touches, which may seem small individually, combined to help reduce the impact of what could have been a seriously stressful situation for my Grandma and helped her to smile and laugh despite her condition.

End of life

So, back to death. It's not something we talk about much. But maybe we should. Different people have different wishes for the end of their life and, where possible, we should strive to carry them out.

It was obvious when my Grandma went into the care home that she would spend her last days there. How long that would be, we weren't sure, but it wasn't likely to be longer than a couple of years.

After Christmas, it was clear that her health was deteriorating and that she didn't have too long left. The care home and medical professionals helped my family decide that palliative care was the best option.

How to help elderly relatives avoid and reduce stress

Later life expert and our Standing Together project lead Jolie Goodman gives her top tips:

  1. Be supportive and attentive during major life transition points, such as moving into a care home
  2. Be flexible in your response when an older relative is confused - contradicting someone can make their confusion worse
  3. Be helpful and prepared to calmly explain a stressful situation a number of times
  4. Spend time regularly with an older relative. People may not remember particular events, but they do remember how those events make them feel
  5. Learn about people's lives - it's a fun way to value and validate your relative while taking them away from current stresses. Our work with the Rotherhithe Babes is a wonderful example of this and may give you some conversation starters

Palliative care has been in the news recently with the high-profile and tragic Alfie Evans case. The Alfie case was very different to that of my Grandma but it raised some important questions about end-of-life care.

End-of-life care should never become a 'never event'. Instead, it is seeing the reality that someone is extremely unwell and will pass away at some point in the near future. With my Grandma, the palliative care option allowed her to stay comfortable, peaceful and, therefore, relatively stress and worry-free in her final days and hours.

So, despite the sadness and loss that I feel since my Grandma died, I also feel comforted and thankful that the inevitable event of her passing was peaceful and dignified, just as she would have wanted.

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