Caring for someone with osteoporosis is no easy task. You must constantly be on your guard against anything that could contribute to a fracture, the worst-case scenario for the osteoporosis patient. Because of the degenerative nature of the disease, you and your loved one are far more likely to experience setbacks rather than advances as bones become more brittle, perhaps despite onerous medication regimens. And possibly most frustrating, in many cases an older person with advanced osteoporosis may not be receptive toward, let alone appreciative of, the care you are trying to provide.
It’s difficult to pinpoint exactly when my mother and I became caregivers for my grandmother Lila Lery, whose osteoporosis became painfully evident in 1988 when she fell in a wet bathroom while bathing our cocker spaniel. The accident resulted in a broken hip and fractured wrist. After a long recovery and intense physical therapy, she was able to walk again, and capable of taking lamentable risks. Despite our best efforts, she suffered a broken shoulder in 1996 (picking up dog poop); a broken pelvis and other wrist in 2004 (tripping over oxygen tubing); and broken ribs and numerous compression fractures in her spine all along. She has not been able to walk unassisted since a 2005 fall - bending to pick up a plastic cup - resulted in a broken nose, dislocated shoulder and other medical problems. Despite her declining independence, her stubbornness remains fully intact, requiring the nursing home where she resides to maintain an alarm to alert the staff of any ill-advised attempt to head for the bathroom on her own.
I share these experiences because I understand what you are up against if you are a caregiver for someone with osteoporosis. Sometimes the worst challenge is not the disease itself, but the mindset of the patient. This article provides advice as to how to sensitively, and even lovingly, care for both the person and his or her condition. By doing so, you can make a great difference in the quality of life for the osteoporosis patient.
Dr. Mark Bridges, an orthopedic surgeon in Miami, Fla., has witnessed in his practice the importance of a devoted caregiver. "Patients who don’t have support end up doing more for themselves than they should be," says Dr. Bridges.
When possible, caregivers can play a role helping out with household chores that require exertion. For example, Dr. Bridges notes, lifting heavy objects can cause compression fractures in the spine for those with advanced osteoporosis. Caregivers can help not only by taking over routine tasks, but by trying to influence the osteoporosis patient’s judgment and discourage him or her from taking unnecessary risks. If the patient, for instance, has been advised to use a stabilizer such as a cane or walker, the caregiver can try to convince a loved one to comply. Or they can intervene if the loved one is trying to do something dangerous like get up on a footstool, as my grandmother often did.
"That’s a big deal," Dr. Bridges says. Otherwise, all too often, "they’re reaching for something and they fall and they have a broken hip or wrist."
As much as possible, the caregiver must stay attuned to the patient’s overall health and nutrition. The caregiver should see that the loved one is eating right for two reasons. As Dr. Bridges points out, "if you’re not eating properly, the supplements are not as effective." In addition, a reduced appetite can serve as an indicator of difficulty swallowing, abdominal difficulties or other medical problems.
A caregiver, even one who is not living in the same house, or even the same area, as the osteoporosis patient, can be helpful in ensuring that medication prescribed by a physician is taken appropriately. Since several bisphosphonate regimens are taken once weekly (such as Fosamax and Actonel) or once monthly (such as Boniva), an older person may have trouble remembering when it’s due. Dr. Bridges says a patient is more likely to be compliant if a family member reminds her of the scheduled dose, perhaps by writing it in a calendar.
The caregiver can also encourage the osteoporosis patient to take daily doses of calcium and Vitamin D. The National Osteoporosis Foundation now recommends that individuals 50 and older take 1200 mg of calcium daily, along with 800 to 1000 units of Vitamin D, but check with the patient’s doctor about the right amount for your loved one.
Many doctors recommend weight-bearing exercise to stave off osteoporosis, and if this is the case, nothing can motivate like an exercise partner - even if the workout is as simple as taking a walk. (And the outdoors presents an excellent opportunity for sunshine, which promotes Vitamin D in the body.) But even light aerobics and stretching, perhaps along with videos geared especially for seniors, can be helpful, says Dr. Bridges, who is also a specialist in sports medicine. Be sure to consult with your loved one’s personal physician before starting any exercise program, however. Some studies have shown that vigorous fitness programs are more likely to be harmful than helpful for certain osteoporosis patients, especially those who are very frail.
Another crucial priority for many caregivers for osteoporosis patients is preventing a fall. A number of studies have shown falls are the most common cause of injuries and hospital admissions in people over 65, and they are especially dangerous for individuals with osteoporosis. Falls account for a staggering 87% of fractures in older people and can lead to severe complications, loss of independence and even death.
As a caregiver, you should take the time to review the home of the osteoporosis patient and try to eliminate potential hazards. There should be no clutter in the walkways or along stairs. Adequate lighting is a must, including nightlights for after dark. Look for loose rugs or rickety railings, and consider installing grab bars in the bathroom or anywhere else your loved one may change positions or be prone to losing balance.
Although one can never guarantee a place will be "fall-proof" - and there is no substitute for constant vigilance and care - taking precautionary steps will help make a home "fall-safe." Dr. Susan Nayfield, chief of the Geriatrics Branch at the National Institute on Aging in Bethesda, Md. and an expert on falls in older people, notes that studies have shown that correcting several factors that could contribute to a fall can have a big effect on reducing the total risk.
A caregiver can make a huge difference in the quality of life of an osteoporosis sufferer by ensuring that fall hazards in the home are at a minimum. But even the most thorough safety intervention can be insufficient if not followed up. Dr. Nayfield points out that as the years pass, older people may have increasing difficulty keeping up their homes they way they once did. Caregivers can make an ongoing contributions to their loved ones by following up on the fall-safe measures. For example, new lamps may need light bulbs replaced; grab bars installed in the bathroom may loosen.
"It’s not doing it one time, but rather doing it from time to time," Dr. Nayfield says. "The changes need to be maintained - they don’t last forever - and the needs of older persons may also change over time."
For these reasons, ongoing and open lines of communication between an osteoporosis caregiver and a loved one are vital. Even the most dedicated caregiver cannot anticipate every conceivable scenario, and when possible, the osteoporosis patient needs to be honest about his or her physical limitations as they change. If the loved one is mentally capable, the caregiver may be the best person to initiate a frank discussion about living wills and other serious end-of-life issues.
But even those osteoporosis patients who are otherwise intellectually sound can insist on making decisions contrary to their best interests.
"One can feel helpless," says Sebring, Fla. psychiatrist and osteoporosis caregiver Dr. Lila Segade-Lugaro, who also happens to be my mother. She remembers the frustration of trying to convince my grandmother not to climb the circular staircase in their home unnecessarily. But as soon as she was out the door, my grandmother would trek up there, often laden with freshly washed laundry.
Dr. Segade also points out that if the person you are caring for is a blood relative, you will need to be especially vigilant about the risk of developing osteoporosis yourself. A 2004 study in the Journal of the American Geriatrics Society found that maternal hip fracture after age 50 was a risk factor for hip fracture in the subsequent generation. In fact, my mother was recently diagnosed with osteopenia herself.
"When the caregiver is giving someone calcium and Vitamin D, then that person should also be taking it," she advises.
It is essential that a caregiver, as well as providing care for the osteoporosis patient, safeguard his or her own physical and emotional well being. This can be tough to do when you as a caregiver are focused on another person. But the intense challenge of providing continual care can take its toll. In order to give your loved one the best care possible, you need to be healthy yourself. This is probably the most important, but also the most difficult, obligation a caregiver has to his or her loved one and entire family.