When Carol Teoh read about three cases of senior citizens who had gone missing in just one week recently, she got a sinking feeling in the pit of her stomach. She called her 78-year-old mother and told her that she was not to drive out on her own, especially to places that are far from her home in Kelana Jaya, Petaling Jaya.
"My mother sometimes likes to drive to the nurseries in Sungai Buloh or to visit her sisters in Ampang. I suddenly had nightmares about her getting disoriented and lost and not having her phone with her because, believe me, that happens way too often. It's safe if my siblings or I take her wherever she wants to go, I think," says Teoh, a pysiotherapist, who lives with her family just a few doors away from her mother, Kate.
Family caregivers often walk a thin line between wanting to keep their loved ones safe and preserving their independence. However, curtailing their movements may not be the best solution for them, says Universiti Malaya Medical Centre consultant geriatrician Prof Dr Tan Maw Pin.
"All of us would have lost our car at some point in multi-storey carparks because we were preoccupied and forgot to take down the number on the pillar, or simply forgot which floor we parked the car. In this day and age, it is really easy to get disoriented at spaghetti junctions and end up somewhere we have never been before.
"(Keeping them home) would be deprivation of liberty and is actually against the law. And it is counter productive, as what they need is to keep going to the same places regularly so they don’t forget how to go there. Restricting (their movements) may end up coming back to bite you, as when they finally get away, finding them is then challenging.
"It is really worth it making sure they are able to stick to a routine, go with them as often as you can so that people in those place are familiar with you too and are able to get in contact with you if they figure out that your parent is having difficulties," says Dr Tan.
A sense of purpose
Seniors need to feel useful to enjoy a high quality of life. They maintain a sense of purpose by sticking to their everyday routines and engaging in activities and hobbies they enjoy. But for those whose bodies and sometimes minds seem to betray them more each day, this can become an issue.
"A person with dementia is less likely to be able to work out how to get to back to their car. For instance, they will go to the security guard for help but is then unable to furnish the registration plate, colour or make of the car. They will also have difficulty working out how to get home, for instance they stop at a petrol station and asks the attendant to show them the way home, but are unable to give the attendant their address.
"It is actually about keeping them oriented as much as possible. Set routines, taking them out on familiar routes so they won’t forget them, and take the trouble to get to know neighbours and people at places they frequent. Don’t be embarrassed to discuss your parent’s memory issues, and leave your contact details ‘just in case’. It seems like a lot of trouble, but you will find that making time actually saves you a lot more time in the future. Being proactive and staying one step ahead is the name of the game," says Dr Tan.
Gerontologist and founder of Seniors Aloud, an online community for older persons Lily Fu agrees.
"Older people thrive on activities and meeting up with friends. Not being allowed to do so over a period of time can be depressing for them. Arrange for them to be picked up or be driven to the venue. Or accompany them. Think of how as young parents we would arrange for our children to go to school or go for activities, and do the same for our elderly parents. Often a little ingenuity goes a long way in keeping the elderly safe. We know our elderly parents best. Adopt and adapt. Learn from trials and observations at home.
"However, not all elderly are frail or have dementia. If you suspect your parent is showing signs of dementia, get him diagnosed by a GP or a geriatrician. Many older adults remain mentally fit well into their 80s and beyond. It would be an injustice to stop the healthy elderly from going out to enjoy activities for fear they may come to some harm or danger. All that we need is to take sensible precautions to ensure the safety of the elderly both at home and out of home," says Fu.
Dr Tan suggests safeguards such as alert bracelets or other wearable safety devices instead.
"There are additional safeguards such as alert bracelets or necklaces with emergency contacts. You can also sew tags with an emergency contact onto their clothing. Ensuring the older person is able to use the phone and that they have the phone with them at all times also helps," she says.
We are now actively trying to educate the public about dementia so everyone can get involved in keeping persons living in dementia in our communities safe. In addition, caregivers should understand the symptoms of dementia and what comes next so they are prepared.
Fu also suggests having neighbours or friends and relatives check up on older persons who are living on their own.
"There are wearables that can track an elderly’s movements but it can be a challenge to convince them to wear it and not remove it. Install CCTV or an alarm system at the door that alerts the family when an elderly parent steps out of the house. Make sure the house is age-friendly, for example, no carpets or cables that can trip an elderly.
"Never leave an elderly alone. I came home a day earlier than planned from a workshop in Johor Bharu. I found my mother lying on the floor outside the bathroom. She had fallen and broken her hip. I dread to think what could have happened if I had returned the next day as planned.
"If you do have to be out, get someone, a neighbour, friend or relative to come over. Alternatively, leave your parent at a daycare. There are more daycare centres now that charge per day or hour. Or engage home care service," she concludes.