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Fun-guarding: Involving the family

Dr David Attwood

This article was written by Dr David Attwood, Honorary Secretary British Geriatrics Society.

David is a GP with a specialist interest in Older People, particularly in change management surrounding their proactive and unplanned care.

This article was first published on 1st October 2019

We have all been there, having a conversation with an older person and their families - asking a general open question about how we can help, patient goals, etc.

The older person insists there is nothing wrong and that they are fine, while the family member (looking slightly gobsmacked and vigorously shaking head) insists they really are not fine, and provides a list of highly significant problems.

When we all stop and think about it, what are the happiest moments in our lives? They are times spent with family. Seeing our children walk their first steps, the first successful wee on a potty, swimming the first time, that first day at school, weddings, witnessing the arrival of the next generation, and the next generation. For those that do not have children, time with their partners or close friends are just as important.

Our lives are awash with fond memoirs of the past, happiness in the present, and hope for the future. To love and be loved. That is true happiness and the essence of fun-guarding.

Older people are no different and life in a care home can (and does) provide much merriment and mirth. Just like previous memories, these new life experiences are best shared with the family.

I recently had a consultation with an older lady who was living in a care home with severe frailty and rheumatoid arthritis. Her hands had the classic deformities of the pre-disease-modifying antirheumatic drugs (DMAD) era. Her son and daughter-in-law had been called in for this consultation - they were a close family and were only too happy to attend.

What struck me most was how homely her room looked. There were heaps of photos scattered around the room from four generations of family. She smiled warmly as I looked at the photo of her great grandchildren and started telling me all about them.

The conversation moved to what her goals were and what mattered to her. She glanced at the beaker in a straw on her table and then flashed a smile “I miss a cup of tea. I really wish that my hands could hold a cup and I could sip from it like a normal person.”

A referral to an OT was not needed as the care home staff came up with some cunning solutions to this problem, and before long she was drinking from a modified long-handled mug.

Another key issue that caused her sadness was that she had four brothers and sisters, all of whom were in care homes up and down the country. Tears filled her eyes and she shook her head “I know I will probably never see them again.” She lifted her head up, her tears replaced by the typical stoicism that we see in the eyes of older people “I’ve said my goodbyes in my heart. I suspect they have too…”

I looked at her son. “Do you have a laptop?”

“Yeah” he replied quizzically.

“Are you good with internet and apps? Things like that?”

“Yeah” his quizzical stare in his eyes suddenly gave way to a ‘eureka’ moment. He explained to his mother how he could arrange things so that she could video call her brothers and sisters using Skype.

“It’s not perfect, Mom, but it could be really good fun and you would all be able to see each other…”

She cried with happiness and thanked him (and her other children not present) for being so kind and thoughtful.

“You have always taken care of us, Mom.” He blinked back his tears.

“Now it’s our turn.”

So when I think of fun-guarding, I think of the family. We need to change our mindset. Older people in care homes are people first. They are still living, still in need of fun and happiness, which is bred from love and being loved.

Family are crucial to ensuring the memories of yesteryear are not lost, and the memories of tomorrow are successfully created today.

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