Older Adult Patient & Family Education

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Table of Contents

Caring for the Older Adult ........................................................ 3

Cognition.................................................................................. 4

Differentiating Delirium, Dementia and Depression ............... 4

Delirium 101 .............................................................................7

Managing Your Medications .................................................... 8

Advance Care Planning .......................................................... 11

Transitioning Home Safely ..................................................... 15

Fall Prevention ..................................................................... 17

Holding a Family Meeting..................................................... 19

Hiring Help at Home ............................................................ 21

Driving Safety ...................................................................... 24

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• Access for a trusted family memberis also available.

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Caring for the Older AdultAt WakeMed, we understand that we all have different needs throughout the stages of life.The purpose of this booklet is to educate you and your family members about ensuring yoursafety and meeting your specific care needs. Some of the topics we cover in this book include:

• How the brain changes as we age • How to ensure the right medications are taken at the right times• Understanding advance care planning to help make future decisions less stressful• Learning how to transition home safely after a hospital stay• How to prevent falls

COGNITION

Differentiating Delirium, Dementia and DepressionThis section explains the different ways thinking may change in older adults and howconfusion, lack of attention and behavior changes may be important signals that familymembers should share with the older adult’s health care professionals.

Delirium A sudden change in brain function that causes a person to be confused. Deliriumdevelops quickly over hours or days.

Signs/Symptoms• Confusion• Disorientation• Difficulty paying attention• Difficulty thinking clearly• Impaired memory• Symptoms can change throughout the day

Causes • Medical illness (ex: infection)• Medical conditions (ex: dehydration)• Medications• Substance misuse• Alcohol withdrawal• Problems with the brain (ex: stroke)

Next Steps• Watch for changes in mental state and notify health care staff if you notice anything

unusual.• Bring a current list of medications and supplements to the hospital.

How You Can Help• Stay with the person as much as possible to provide comfort and familiarity.• Keep glasses, hearing aids and dentures available and encourage use.• Create a familiar environment by bringing in familiar objects from home.• Encourage physical activity and conversation. • Provide simple explanations of what is happening.• Support sleep/wake cycle by turning on lights during the day and off at night.

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Dementia Dementia is a change in memory, language or other thinking skills that interferes with functioningindependently. There are many types of dementia.

Signs/SymptomsMay have difficulty with the following:

• Retaining new information • Managing finances or complex tasks• Making decisions• Using good judgement • Finding common words• Recognizing familiar places & gets lost• Behavior changes – sometimes unexpected

Causes Typically, dementias are caused by physical changes to the brain over time, such as months to years.

Next Steps• Contact a health care provider if you notice these changes occurring with a loved one.• Additional testing may include cognitive evaluation, lab tests and brain imaging.

How You Can Help• Create a familiar environment by bringing photos and favorite items from home.• Keep clocks and calendars visible.• Discuss current events. • Encourage physical activity.• Limit overstimulation.• Watch for triggers that cause behavior changes and tell

health care staff.• Use simple, clear, concise language.• Share important personal information (ex: preferred name,

interests) with the care team to help individualize care

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Is It Normal Aging or Something More?

WakeMed Memory Assessment Services

A memory assessment with a WakeMed neuropsychologist will help determine if thinking skills are ageappropriate and diagnose potential causes for cognitive decline. Our neuropsychologist then works withthe patient’s physician to develop a treatment plan. WakeMed Memory Assessment Services are availableby physician referral. Call 919-350-7878 or visit www.wakemed.org/neuropsychology andwww.wakemed.org/memory-assessment to learn more. 

Depression Severe sadness that interferes with function,pleasure and interest in activities.

Signs/Symptoms• Depressed, sad mood• Decreased pleasure in activities• Feelings of worthlessness• Difficulty thinking or concentrating• Thoughts or attempts of suicide• Fatigue/loss of energy• Changes in appetite and weight• Sleep disturbances

Causes Many factors can contribute to the developmentof depression, such as death of a loved one,reduced income, chronic illness, loss ofindependence or social isolation.

Next Steps• Contact a health care provider if you notice

these symptoms.• Additional evaluation, screening and testing

may be needed to determine a diagnosis.

How You Can Help• Provide emotional support.• Assist with problem solving.• Encourage participation in activities that

cause pleasure.• Enhance social support.• Encourage physical activity.

Resources

Delirium• Hospital Elder Life Program For Prevention

of Deliriumwww.hospitalelderlifeprogram.org/for-family-members

• Health in Agingwww.healthinaging.org

Depression• Alliance Behavioral Health Care Access and

Information Line: 800-510-9132,www.alliancebhc.org

• National Institute on Aging: 800-222-2225www.nia.nih.gov

• National Suicide Prevention Lifeline:800-273-8255suicidepreventionlifeline.org

Dementia• Alzheimer’s Association in Eastern NC:

www.alz.org/nc, 919-803-8285• Dementia Alliance of North Carolina:

www.dementianc.org, 919-832-3732 • Alzheimer’s Disease Education and Referral

Center (ADEAR):www.nia.nih.gov/alzheimers, 800-438-4380

• National Institute on Aging:www.nia.nih.gov, 800-222-2225

• National Institute on Aging:www.nia.nih.gov, 800-222-2225

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DELIRIUM 101

What is Delirium?Delirium is a sudden change in brain function that causes a person to be confused.

Delirium Overview

Delirium can be caused by many different sources, such as infections, medications, dehydrationor alcohol withdrawal. Older adults are at an increased risk for developing delirium. Deliriumcan slow recovery and lengthen hospitalization. It can also be a scary experience for the person.You can play an important role in helping to prevent delirium by recognizing the developmentof delirium.

Signs/Symptoms of Delirium• Confusion• Disorientation• Difficulty paying attention• Difficulty thinking clearly• Impaired memory• Visual/auditory hallucinations, such as seeing or hearing things that don’t exist

These symptoms can develop quickly, in hours or days and can change throughout the day.

Delirium Prevention and Support TipsThese techniques can be helpful in preventing the onset of delirium and can be used to helpsupport the person experiencing delirium.

• Watch for changes in mental state. Notify health care staff if you notice anything unusual.• Bring a current list of medications, including over-the-counter medications, supplements

and vitamins to the hospital. • Bring glasses, hearing aids and dentures to the hospital. These items are important for

orientation, interaction with others and promoting nutritional intake.• Keep a normal sleep/wake schedule by turning on lights during the day and off at night.• When possible, stay with the person to provide comfort, reassurance and a familiar face. • Discuss with hospital staff opportunities for the person to walk or sit in a chair. If

appropriate, encourage these activities to promote mobility. • To make the environment feel more comfortable, bring familiar items or photos from home.• Provide simple explanations of what is happening and orient the person to the time of day. • If the person appears overstimulated, try playing calming music and limit stimulation.

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MANAGING YOUR MEDICATIONS

Managing your medications is a key part of keeping you healthy. When you go home, it isimportant you know about your medications. Follow these tips for managing your medicationswith your health care team.

Keep a List of All of Your MedicationsA list of medications should include the following information:

• Name of medication • Reason for medication • Dose • Frequency (how often you take it)• Important instructions • Doctor who prescribed the medication • Date started• Over-the-counter (OTC) medications and supplements

The list could look like the following:

Medication Reason Dose Frequency Instructions Prescriber Start Stop Date Date

Metoprolol High 25mg Morning Do not take if Dr. Smith 1/2019 N/A blood and night lightheaded or dizzy pressure

Tylenol Headaches 650mg As needed OTC N/A

Calcium Osteoporosis 600mg Once daily Take with food OTC 6/2019 N/A prevention at breakfast

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Review Your Medications with Your Care TeamTaking multiple medications can lead to drug interactions that can cause problems such asmaking you overly sleepy or increasing your risk of falling. Your health care provider orpharmacist can help you decrease your risks of side effects or drug interactions.

Be Prepared to Ask Them the Following Questions• Why do I need this medication? How will I know if it is working?• Will this medication cause any problems with other medications I am taking?• Do I need any special monitoring or considerations while I am on this medication?

(Examples: blood drawn, blood pressure, diet modification)• Are there any medications on my list that I should stop taking?

Talk to Your Care Team about Any Special Considerations If you experience difficulty taking medications, the health care team can find ways to help you.

Tell your health care provider and pharmacist if you have problems with • Swallowing• Vision changes• Decreased hand movement (dexterity)• Medication cost

The health care team may be able to• Use easy to open bottles• Provide instructions in larger print• Find cheaper options

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Take Your Medications Safely• Mixing medication and alcohol can make side effects worse. Discuss safe alcohol

consumption with your provider.• Talk to your health care provider if you have trouble avoiding alcohol.• Do not skip doses of your medication. • Ask your health care provider or pharmacist what to do if you accidentally miss a dose.• Do not stop taking a medication because you feel better. • Ask your health care provider when you should stop taking a medication. Write that date on

your medication list. • Store your medications in a safe place in your home, keeping them out of reach of children

and pets. • Dispose of medications in a safe way. See Resources for additional information.

ResourcesFDAHelpful tips for managing your medications as you age.www.fda.gov/Drugs/ResourcesForYou/Consumers/TipsforSeniors/default.htm

NeedyMeds Resources to help you and your caregiver manage your medications safely.www.bemedwise.org/medication-safety/medication-therapy-management-for-seniors

Resources for Seniors of Wake CountyInformation on two programs related to medication management: Medication Education forDrug Safety and Medication Assistance Plan for Seniors.www.resourcesforseniors.com/meds.php(919) 872-7933

FDAHow to safely dispose of unused medications.www.fda.gov/ForConsumers/ConsumerUpdates/ucm101653.htm

Wake County Human ServicesWake County medicine drop box locationswww.wakegov.com/humanservices/publichealth/Pages/dropbox.aspx

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ADVANCE CARE PLANNING

Talking with your loved ones about your wishes for end-of-life care before a serious, unexpectedmedical event is very important. Sharing your desires with people you trust helps themunderstand what matters most to you in case you become unable to express your wishes.Although these conversations can be difficult, they are important to discuss before a seriousillness occurs. If you become unable to make or communicate health care decisions because of aserious illness or accident, your advance care documents become a guide to your family as theymake decisions for your care. You should also have this conversation with your health careprovider. Communicating your wishes in an advance directive, which is a legal document, willhelp your health care team honor your desires in the event that you are unable to make orcommunicate health care decisions. This section defines common terms and providessuggestions for planning your future medical desires.

GlossaryAdvance Care PlanningAdvance care planning is the process of making plans for your future care when you are sick andunable to make decisions. This planning can include discussions with your family and healthcare provider regarding end of life decisions so that your wishes are known. This planning mayalso include creating legal documents, such as advance directives, so that your wishes are inwriting.

Advance Directives • A document that defines the limits of care or names someone to make decisions in the event

that you lack the capacity to make or communicate decisions about medical care foryourself.

• Most advance directives do not go into effect until you are unable to make or communicateyour own decisions.

Types of Advance Directives Recognized in North Carolina

Living Will• A Living Will expresses your desire to withhold or withdraw life-prolonging measures in

certain situations in which you are unable to make or communicate your own decisions. • Two physicians must confirm that you meet certain criteria in order for the Living Will to go

into effect.

Health Care Power of Attorney (HCPOA)• Document that appoints a Health Care Agent to make important health care decisions in

the event you cannot make or communicate your own decisions.• You and your Health Care Agent should discuss all possibilities and desires so that your

desires are expressed accordingly in the HCPOA.

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• The Health Care Agent cannot make medical decisions for you until you are unable to makeor communicate your own decisions.

• An HCPOA is not the same as a Durable Power of Attorney. The Health Care Agentappointed by an HCPOA does not have authority to manage legal or financial matters.

Do Not Resuscitate (DNR)• A legal medical order that states no cardiopulmonary resuscitation (CPR) or life sustaining

measures will be performed if your heart stops and/or you stop breathing. • The DNR order goes into effect immediately, but you can withdraw it at any time.

Medical Order for Scope of Treatment (MOST Form)• A legal medical order filled out by you and your health care provider that lists exact

instructions related to medical interventions. • Includes specific instructions related to IV fluids and hydration, antibiotics, feeding tubes

and nutrition, mechanical ventilation and desires related to CPR. • This form is intended for specific circumstances such as a terminal illness and is not

applicable for everyone.

Advance Instruction for Mental Health Treatment • A legal document that states instructions on future mental health treatment if you become

incapable of making or communicating decisions.• This may not be withdrawn if you are found incapable by a physician or other authorized

mental health treatment provider.

All of these documents can be created prior to hospitalization and while in the hospital.Case managers, social workers, chaplains, nurses and physicians can help facilitate therequested paperwork. You do not need a lawyer to complete an advance directive, but itshould be witnessed by two people who meet the requirements listed on the documentand notarized by a notary public. Forms may be accessed on the internet. See theResources section for details. If you have an advance directive, please provide copies tothe hospital so they can be kept in your medical record.

Palliative Care Medical care to relieve pain, discomfort or symptoms from a serious illness. The goal ofpalliative care is to improve quality of life for both the patient and the family. Palliative care canbe provided at any time during an illness to alleviate symptoms or pain. It can be provided at afacility, hospital, long-term care facility, in your home or at a hospice facility.

Hospice Care Hospice provides health care services and support for those with advanced illnesses expected tolive six months or less. Hospice focuses on comfort, pain relief, symptom management, patientand family support and end-of-life education. Hospice can be provided in your home, at ahospice home, in the hospital and in some skilled nursing facilities.

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Preparing to Have the Conversation about Your End-of-Life Medical Care WishesIt’s never too early to have the conversation. In preparation, here are some questions to consider.

• What will make you feel ready to have the conversation?

• Are there specific concerns that you would like to discuss?

• How would you like to live at the end of your life? What do you value most?

• What are three important wishes that you would like your loved ones and health care providers to understand at the end of your life?

Once you have thought about these questions, consider who you want to share your wishes with, when it’s a good time to talk and where it is most comfortable.

Talking with Your Health Care Team • If possible, let your health care provider know in advance that you would like to discuss

your wishes related to end-of-life care.• It may be helpful to write down your thoughts and questions to have available during your

discussion. • Consider bringing a family member or friend that is familiar with your wishes so he/she can

provide support and take notes.• Ask your health care provider to explain your current state of health and what the future

may hold.• Discuss your preferences and most important desires regarding end-of-life care.

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Next Steps • Complete a Living Will to document your end of life wishes.• Complete an HCPOA which appoints a Health Care Agent to make medical decisions for

you in case you become unable to communicate or make decisions. • Notaries are available at some hospitals, most banks and in the community. You may search

the internet to locate a Notary Public near your location.• Keep the original for yourself and in a place where your Health Care Agent or next of kin

can locate it if necessary.• Provide notarized copies to your primary care provider, hospital, Health Care Agent and a

family member.• Consider registering your advance directive with the Advance Health Directive Registry

managed by the North Carolina Secretary of State.

ResourcesNorth Carolina Secretary of StateInformation on the Advance Health Directive Registry, forms and frequently asked questionshttps://www.sosnc.gov/divisions/advance_health care_directives919-814-5400

The Conversation ProjectGuides and tools on discussing advance directivestheconversationproject.org/

Begin the ConversationResources on how to prepare and begin theconversation. Advance care planning guide.www.begintheconversation.org(877) 473-4103

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TRANSITIONING HOME SAFELY

Home Safety & ModificationTake a Good Look Around

Looking at your home and critically evaluating a few key areas can make a big difference in yourlong-term safety and independence.

Use a room-by-room safety checklist available on aarp.org/homefit or cdc.gov/steadi, or haveyour home professionally assessed by hiring an occupational or physical therapist or certifiedaging in place specialist (CAPS).

Don’t Trip Yourself Up!• Arrange furniture to allow clear, wide passageways throughout your home.• Remove all throw/scatter rugs. • Put rubber-suction mats or anti-slip strips in the tub and shower.• Place electrical cords along the wall and out of the way.• Wear sturdy, well-fitting shoes/sneakers with non-slip soles.

Light the Way• Install brightest bulb wattage allowed in lamps and light fixtures for best visibility.• Keep a rechargeable, plug-in flashlight.• Install sensor nightlights in the bathroom and hallways. • Install light/motion activation sensors at outside entryways.

Stay Safe• Keep a lightweight fire extinguisher in the kitchen.• Test the batteries in all your smoke detectors and replace if needed.• Set your hot water heater at 120ºF or LESS.

Make a Plan• Clearly mark your street number on your home for emergency personnel.• Know your emergency exit plan if you need to get out of your home fast. • Place current health information in a folder that can be grabbed in a hurry.

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ResourcesAARPRoom safety checklistaarp.org/homefit assets.aarp.org/www.aarp.org_/articles/families/HousingOptions/200590_HomeFit_rev011108.pdf

CDC (Centers for Disease Control and Prevention)Room safety checklistcdc.gov/steadi

National Association of Home Builders “Certified Aging in Place”www.nahb.org/en/consumers/homeownership/aging-in-place-vs-universal-design/learn-about-aging-in-place-and-what-a-professional-can-do-for-you.aspx

North Carolina Independent Living ncsilc.org/centers919-715-0543

NC Baptist Aging Ministry www.ncbam.org 877-506-2226

Resources for Seniors www.resourcesforseniors.com919-872-7933

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FALLS PREVENTION

Falls are quite common in older adults and can sometimes have significant negativeconsequences. In fact, falls among older Americans are the #1 cause of injury and death frominjury. But falls are NOT just a normal part of getting older! They are often preventable andthere are simple steps you can take to stay independent longer.

There Are Four Things YOU Can Do to Lower Your Risk of Falling

1. Speak Up and talk to your Health Care Provider!

Tell your health care provider if you have fallen or if you feel unsteady and are afraidof falling. Together you can review your medications and discuss side effects thatmight cause dizziness or sleepiness. You can also see if taking a vitamin supplementto improve bone or muscle health is right for you.

2. Keep Moving

Doing activities that strengthen your legs and help you balance is one of the mostimportant ways to lower your risk of falling. Some appropriate activities includewalking, yoga and Tai Chi. Exercise makes you stronger and improves coordinationand balance.

3. Check Your Eyes

Poor vision can increase your chance of falling. Have your eyes examined once a yearand update your glasses if recommended.

4. Make Your Home Safe

Most falls happen at home, so complete a room-to-room evaluation of your home andput into place some simple fixes that will help you lower your risk. Also considerkeeping a charged phone with you or using an affordable Personal EmergencyResponse (Medical Alert) System so that you can notify someone if you fall and needhelp.

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Caregiver Role in Reducing Falls RiskFalls prevention is a team effort! Don’t beafraid to talk with the person you are caringfor about your concerns. Consider thefollowing strategies:

• Be considerate with the words you use.For example, “I am worried about youand want to help.”

• Be clear about the things you have noticedthat worry you. Repeat that your main concernis your loved one’s safety and wellbeing.

• Keep your body language and tone of voice positive.• Suggest going to health care provider’s visit together to discuss falls risk.• Do some online research about falls prevention programs in your area.

ResourcesCDC (Centers for Disease Control and Prevention)Overview of adult falls. Includes facts, resources and fall prevention tips.www.cdc.gov/homeandrecreationalsafety/falls

AARP Falls prevention tips.www.aarp.org/health/conditions-treatments/info-2018/falls-injury-death-prevention.html

National Council on AgingFalls prevention fact sheet and awareness campaigns.www.ncoa.org/wp-content/uploads/Falls-Prevention-Fact-Sheet-2018.pdf

Consumer Reports on Personal Emergency Response (Medical Alert) SystemsInformation on choosing a medical alert system.www.consumerreports.org/medical-alert-systems/how-to-choose-a-medical-alert-system

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HOLDING A FAMILY MEETING

Planning ahead for your care or the care of a loved one can be a helpful tool in reducing stressand avoiding a crisis should care needs arise suddenly. Here are some suggestions you may findhelpful in preparing to have a family meeting.

Who Should the Meeting Include?When Discussing Your Own Care• Consider involving relatives, trusted friends, members of your faith community and

neighbors. Family can be whatever it means to you. Use the topic to be discussed to guidewho you will invite.

• Use technology like conference calling to involve loved ones who are working or reside outof state.

When Discussing the Care of a Loved One• Consider how your loved one can be involved in decision-making about his or her care. • In cases where your loved one has significant memory difficulties, it may be best to meet

without the care recipient first.

When Family Strain or Disagreement Is a Factor• Consider involving a social worker, faith community member, family counselor or elder

care consultant to help organize and mediate the meeting. • Try to keep a current and future

focus. It may not be productive to discuss old disagreements.

• Use “I” statements when sharing your point of view or concerns. Let others speak for themselves.

• Recognize that care planning involves a degree of uncertainty.

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Tips to Making Family Meetings Successful• Set a firm start and end time for the meeting. Keeping the meeting relatively brief.• Prepare a list of topics to help keep everyone focused. • You may need to have multiple meetings if there are many things to discuss or if the topic

pertains to chronic illness where needs are expected to change. +Driving, home modification and management, caregiving and managing a chronic or life

limiting illness are good topics for a family meeting. • Make sure everyone has a chance to speak. • Allow for flexibility.

+Though you may want loved ones to offer care in a certain way, this may not be possible.+People can assist with care in many different ways.

• At the end of the meeting, make a list of next steps. • Provide a written summation of the meeting to family and keep a copy for your records.• Often, the family members involved in planning and helping with care for you or a loved

one are also working and caring for children. In these cases, it is helpful to privately pay foran elder care consultant or care manager to help with resource coordination.

ResourcesFamily Caregiver AllianceAdditional tips on care planning.www.caregiver.org800-445-8106

Resources for SeniorsListing of elder care consultants in theTriangle area.www.resourcesforseniors.com919-872-7933

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HIRING HELP AT HOME

Hiring help at home is one option for keeping you or your loved one safe. Hiring help may alsoprovide a needed break for the primary caregiver. Before hiring help, think about the type ofhelp that is most needed. Looking at the things that are the most difficult or take the mostenergy is a good way to determine your needs. Below are several different areas of care needs toconsider:

• Personal Care: Getting dressed, eating, bathing, help with bathroom care and movingaround the house.

• Household: Chores, laundry, vacuuming, preparing meals.• Health Care:Managing medication, medical appointments, occupational, physical or

speech therapies.• Emotional Care: Companionship and support, outings, break for primary caregiver.

Whom Should I Hire?Homemakers or CompanionsProvide help with supervision or companionship but do not provide direct help with physicalneeds. They may assist with household chores, meal preparation and transportation. This careis not covered by insurance.

Home Health Aides or Certified Nursing AssistantsCaregivers to provide “hands on” personal care.

Skilled Home CareTherapeutic care provided by a registered nurse, physical therapist, occupational therapist orspeech therapist in order to help the older adult regain strength or mobility following an illnessor injury. Skilled home care typically lasts only a few weeks. Home care visits are intermittentand brief. The older adult must be homebound to receive this care. Services must be ordered bya health care provider to be covered by insurance. A small amount of home health aide servicesare covered when skilled care is being given.

CoverageNo insurance covers 24-hour in home care. Insurance coverage of in-home services are verylimited and do not provide for help with homemaking, supervision or companionship.

Medicare and Medicare Advantage PlansCover a very small amount of home aide services only while receiving skilled home therapyservices. The majority of people typically receive just a few hours per week on a short-termbasis.

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MedicaidMedicaid covers a greater amount of aide services through the Medicaid Personal Care Servicesprogram (PCS). A health care provider must request an evaluation for aide services. Forinformation contact Liberty Health Care at 855-740-1400 or www.nc-pcs.com.

Long-Term Care InsuranceSome older adults have paid privately for an insurance policy that covers some home healthaide services. To use this benefit, a health care provider must complete insurance formsdocumenting that personal care is needed.

VA Aid and Attendance BenefitThis is a program for veterans who served and their spouses. To find out if you qualify, contactthe Veterans Benefits Officer in your county or the VA Caregiver Support line at 855-260-3274.

Program of All-Inclusive Care for the Elderly (PACE)PACE is a managed care program for older adults who need a lot of extra support at home. For more information on eligibility, contact Senior Community Care of North Carolina at 919-425-3000 or www.seniorcommunitycarenc.org.

Private PayMost older adults needing help at home pay out-of-pocket for these services. Typically, anhourly rate is charged for care which will depend on the type of care needed.

Options for Hiring CareThere are two ways to hire care:

Home Care Agencies• Agencies providing home care are licensed and must meet state regulations.• Charge an hourly rate with a required minimum number of care hours. • Can provide caregivers that address physical needs, supervision or chores.• Typically require an in-home assessment by a nurse before care can be started.

Privately Hired Care• Sources of recommendations may include friends, neighbors, faith communities or online

listings. • May cost less than care hired through an agency.• May allow for more personalized care or flexibility with scheduling.• Amount of formal training the caregivers have varies.

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Ways to Protect Yourself When Hiring Care• Make sure to interview the agency or caregiver before hiring. • If you are hiring through an agency, ask about the screening and background checks they

require. If you are hiring care privately, have a background check done.• Have a trusted friend or family member take part in the interview process.• Write a list of expected tasks the caregiver would assist with prior to the interview. • Ask for several current references.• Make sure you are clear and comfortable with payment arrangements before hiring care.

ResourcesFamily Caregiver AllianceA national organization focused on caregiver education and caregiver advocacy. Website has multiple helpful articles on caregiving and hiring care. www.caregiving.org

Wake County Resources for SeniorsWake County information and referral listing of home care agencies, suggested questions to ask when hiring help and a registry of trained companions.www.resourcesforseniors.com919-713-1556

Johnston County Community and Senior ServicesJohnston County caregiver support, information and referral.www.cssjohnston.org919-934-6066

Transitions Guiding Lights Caregiver Support CenterCaregiver support, information and referral.www.guidinglightsnc.org919-371-2062

Center for Volunteer CaregiversWake County - provides volunteers to offer friendly visits, assistance with errands and brief caregiver respite services - based on availability.www.volunteercaregiving.org919-460-0567

From Hospital to Home to HealthyWakeMed Home HealthSome of our services include:

• Skilled nursing• Home health aide• Physical therapy• Occupational therapy• Speech-language pathology• Vestibular rehab for

dizziness/balance issues• Parenteral/enteral nutrition• Clinical social work• Infusion services• Pain management

information

Need home care services? Ask about WakeMed HomeHealth at the hospital. Pleasecall 919-350-7990 withquestions.

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DRIVING SAFETY

The Aging Process and DrivingThe physical changes of aging occur at different rates depending on many factors. Driving is a complex task involving both physical and mental abilities; it is smart to be aware of typical age-associated changes that could impact safe driving.

Vision Changes• Peripheral vision, depth perception and ability

to judge distance are affected. • Light and color perception decrease.

+Judging whether a light is yellow or red can take more time. Driving at night becomes more challenging.

• Refocusing from one object to another takes longer. +Looking at a street sign far away and then glancing at the speedometer is harder.

Hearing Loss• The inner ear changes with age and leads to hearing loss. A driver may not hear the sirens

of emergency vehicles until they are very close.

Motor Skills • Reaction time increases. It takes longer to react.• Muscles weaken with age and flexibility decreases.

Memory LossWhen an individual has been diagnosed with dementia or has observed memory loss, drivingmust be addressed. Some individuals with memory loss voluntarily make the choice to give uptheir license before their driving ability comes into question. Very often, an individual withmemory loss is unaware that their driving skills are impaired or unwilling to give up theindependence that driving offers. In these cases, family and friends must be vigilant to signsthat driving is no longer safe.

Evaluating Memory ChangesFormal testing by a neuropsychologist can help determine if changes in memory are normalaging or memory loss. WakeMed Neuropsychology offers this formal testing. Talk to yourphysician first and request a referral to WakeMed Neuropsychology at 919-350-7878.

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Signs that Memory Is a Problem• A decrease in coordination• Getting lost in familiar places• Increasing forgetfulness (ex: Not just losing the keys but forgetting what keys are for).• Difficulty paying attention• Impulsive behavior or poor judgement

Keeping Safe on the RoadRegularly assessing your driving skills is an important way to keep yourself and others safe. Thiscan involve informal input from family and friends or formal assessments by healthprofessionals or the DMV.

• Get a comprehensive screening of your vision and hearing. If changes in vision are noted,they can often be corrected with proper eyewear.

• Get a comprehensive physical exam. +Ask if current medications could cause drowsiness or other side effects that impair

driving.• Check with the NC DMV and be aware of the required screenings for license renewal. • Ask a trusted friend or family member if they have any concerns about your driving ability. • Explore local options for driving courses aimed at the mature driver.

+AAA offers defensive driving courses specifically for people over age 55. • Consider having a formal driving evaluation, which is often conducted by an occupational

therapist. After evaluation, suggestions can be made based on your particular skills andneeds.

• Look into vehicle modifications such as broader mirrors or seat boosters.

Getting around without DrivingGiving up the keys can be a very hard decision. Many older people fear the loss of freedom andindependence. If driving is no longer an option, there are some options to consider:

• Look into local ride services. If you have a regular appointment, many ride services willallow you to book in advance.

• Consider using county or city transportation services for older and disabled adults. You mayalso find that your faith community offers assistance with transportation for older adults.

• Many grocery stores and pharmacies offer delivery services, sometimes without cost. • Make a list of the family, friends and neighbors who may be able to help with transport to

the places you regularly frequent. • The NC DMV will provide a free state issued photo ID to those who have given up their

driver’s license due to illness or disability. See the DMV website for additional details.www.ncdot.gov/dmv/license-id.

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ResourcesResources for Seniors Information and Referral Program Provides information on available transportation services for older adults in Wake County. www.resourcesforseniors.com/infref.php919-872-7933

GoRaleigh Access Program for Triangle area residents with disabilities that prevent them from riding the bus.Application process required.www.raleighnc.gov/services/content/PWksTransit/Articles/AccessibleRaleighTransportation.html919-996-3459

GoCary Access Door-to-door transportation for older adults and those with disabilities in the Cary area. Fixedroute service also offered. Routes often connect with the GoTriangle Access program.gocary.org/applying-door-door-service919-485-7468

GoWake Access (formerly Tracs)Public reduced fee van service for Wake County residents. Those who are disabled, elderly,Medicaid recipients, live in a rural Wake County area or who require work-relatedtransportation are eligible to use this service based on availability. www.wakegov.com/humanservices/social/transportation919-212-7005

Johnston County Area Transit System (JCATS) Provides reduced fee wheelchair accessible transportation to older Johnston County residents.www.cssjohnston.org/wwwjcatsorgservices919-934-6066

Driver Rehabilitation Services Clinical and behind the wheel evaluation of driving skills by an occupational therapist. Servicesthe state. www.driver-rehab.com336-697-7841

Center for Volunteer Caregivers Provides volunteers when able to assist the elderly or disabled with occasional rides to medicalappointments or for errands. Those eligible must be unable to use public transportationservices. volunteercaregiving.org919-460-0567

Notes

www.wakemed.orgRaleigh Campus • Cary Hospital • North Hospital • Apex Healthplex • Brier Creek Healthplex

Garner Healthplex • Raleigh Medical Park • Outpatient Rehabilitation FacilitiesHome Health • Physician Practices

© WakeMed, January 2020