Maybe it was turning 70 myself that increased my awareness of aging issues and, how as a nurse, I could continue to make a difference in my life and that of others. Now with the extended implications of avoiding the COVID-19 virus, the tendency to want to protect oneself from forecasted warnings is even better understood and a good idea. But, what can I listen for in conversations or see in actions that suggest unnecessary decline? What if a nurse could intervene with positive strategies for healthier behaviors?
I know we now classically ask in an intake interview, ”Have you fallen in the past year?” But perhaps there needs to be broader questions about behaviors that suggest changes, like “Other than for the virus concerns, have you needed to cut back on things like going out of the house as often as you used to?” or “Have you changed what you usually like to eat for some reason?” The nursing assessment might draw out the “fear and worry” words indirectly from the patient but be loud and clear to me if I am listening for underlying rationales to address.
When I listen more closely, I hear:
- “I am afraid I will fall so I don’t go out much anymore, especially in light of the virus and the mask I must wear. I can’t breathe well with the mask on and when it slips down, I am afraid I won’t be able to pull it up quickly either.”
- “I worry that I won’t be able to hear talking around me so I stopped going to my favorite club even though it’s reopened following safety guidelines. It is harder for me to hear voices through the masks and I worry that people won’t repeat things if I ask.”
- “I am afraid to eat some of my favorite foods because I had a few stomach upsets.”
- “I worry that people will think I am feeble if I use my cane.”
- “I don’t want to go to see anyone about my complaints because I worry that something will be bad so I just endure them. And I do not understand how to visit my doctor through a computer.”
What if we, as nurses, responded like this, outside of the standard questions?
- “Are there entrances to places you like to go that do not involve stairs? Let me see what mask you are using and make sure it fits well and will stay in place when you are out.”
- “Are you willing to get your hearing evaluated if I help you make that appointment? Then you can still go to the club and enjoy your time there!”
- “What foods have you stopped eating? We might be able to consider substitutes and also explore your ‘stomach upsets.’”
- “Let’s talk more about your worry that people will judge you for your use of a cane. You can always choose not to accept your provider’s advice about a health problem, but let’s consider the benefits of knowing how you might be helped and feel better in the long run.”
- “Is there a family member or friend who could help you have a computer visit with your doctor when you have a question or need?”
Likely, fear and worry are visible in some way as adaptations to usual behavior, and they might not always be safe alternatives. If the older person lives alone or a partner does not process the impacts of change, much can go on behind closed doors. A nurse’s attentiveness to discovery can be vital for better directing actions to avoid exactly what the person fears or worries about most. In the time of COVID-19, rules have changed for everyone, and nurses may find that the elderly need even more support when this “fear and worry” has been added to the list.
Simply put, better questions equal better answers.
There are small regressions that I have made in each decade and, quite frankly, they sneak up and surprise me! For example, my two sisters live about six hours from me by car and that has become too far for me to drive alone. Last time, I flew to see them but I “worry” that even that might become too much at some point. I hope when the time comes that I will take a taxi to the airport, arrange for a wheelchair transport on both ends of the trip, and just do it!
Small regressions can quickly become big regressions, however insidiously, and slowly capacities can be lost. I want to listen to others, encourage them to explore their fears and worries in order to find reasonable strategies to overcome them, and follow my own advice! Perhaps the “courage” of Sigma’s values takes on new meaning as one grows older: the courage to acknowledge change with aging, figure out other safe ways to accomplish goals we have, and make the very best of the new tomorrows even as defined by this pandemic.
Once a nurse, always a nurse—at least in my thinking and action. Perhaps that is more timeless, and I like that!
Dee Welk, PhD, RN, is Professor Emeritus at Bloomsburg University in Bloomsburg, Pennsylvania. She is a member of Sigma’s Theta Zeta Chapter and Eta Chapter. She served as the Region 11 Coordinator, as Chair of the Regional Coordinators, and was on the Sigma International Board of Directors. She is a mentor in the Global Leadership Mentoring Community.