American Red Cross Text-Book on Home Hygiene and Care of the Sick by Isabel McIsaac (best affordable ebook reader txt) 📕

patients in particular, are peculiarly susceptible to pressure sores. If a patient is able, it is extremely important for him to sit up in a chair part of the day. Sitting up should never be omitted because it involves the expenditure of time and trouble for the attendant.

It is often said that for most people some personal experience of sickness is beneficial; it can safely be said, however, that no one benefits from spending any considerable portion of his life in a state of helplessness and suffering. Behavior and character itself are determined by influences constantly coming into the mind from daily surroundings and associations with other people: one who recalls this fact needs only a moment's reflection to realize how ill adapted to healthy development of mind and character are the limited lives of the sick. Especially unfortunate is the situation of chronic invalids, shut off as they are from the objective interests and activities of normal life, deprived of all practice in making the salutary small adjustments and sacrifices required in every day living with other people, and self-centered as they necessarily tend to become from the inevitable focusing of attention upon their own discomforts and pain.

On the whole, a surprisingly large number of invalids successfully resist the disintegrating effects of sickness upon character. But it is nevertheless true, as Dr. Weir Mitchell says, that "Sickness ennobles a few but debases many." A selfish invalid has more than once destroyed the happiness of an entire family, or spoiled the life of one member of it by monopolizing her whole time and attention. Families should remember that their injudicious sacrifices seldom bring enduring happiness or contentment to the patient himself; indeed, in the long run such sacrifices generally injure him even more than they injure his victims. Clearly much must and should be sacrificed by members of a family to the needs of an invalid; but in general it may be said that a sacrifice is injudicious if it relieves the patient of activity or responsibility that he can support without injury, if it makes him more dependent in mind or body, if it results in restricting his attention to himself and his affairs, or if it increases his tendency to make demands on others.

Purposeful activity of some sort and the necessity for contributing to the welfare of others are essential parts of a wholesome life. If these essentials are entirely eliminated from the life of an invalid, the patient's greatest needs are probably left unsatisfied, even though the physical care he receives may be perfect in every detail. All that was said in regard to occupations for invalids applies with particular force to occupations for chronic patients, since however valuable manual occupations may be as a means to bring about recovery, they are still more valuable in furnishing interest and purpose in a life whose only prospect is a succession of weary, useless years. Handicapped patients sometimes learn occupations that yield a financial return, and ability to earn even a little stimulates self respect and mental health, whether the money is needed or not. The important point, however, is that the finished product should have a recognized use.

In addition to enabling the patient to make things with his hands, a way should be found if possible by which he may contribute to the group of people with whom he lives. If a way can be discovered for him to do so, the opportunity should not be denied him nor should his service fail to be noted and appreciated, even if it is nothing more than telling a story to a restless child.

CARE OF THE AGED

At the end of life, as at its beginning, every individual especially needs the interest and protection of his own family. In ordinary circumstances neither a baby nor an aged person can be cared for so fittingly or so successfully in any other place as he can be in his own home.

With advancing years is to be expected a general slowing down of all the powers. In old age both body and mind show characteristic changes, and particularly changes causing lowered resistance and diminished vigor. If the manner of living is adapted to these changes, both happiness and usefulness may be prolonged. But so gradually do the changes often come that they may escape notice for a long time, and the younger generation in looking back sometimes realizes with regret how much earlier measures might have been taken to prolong the usefulness and to mitigate the discomforts of aged parents and friends.

Old people are keenly sensitive to cold, since the circulation gradually becomes less vigorous and they take little exercise. Keeping them warm both in bed and out adds more perhaps to their comfort than any other one measure. They should have warm underclothing and soft shawls and other extra wraps. A real service will be rendered by the person who invents a suitable and dignified wrap for old or feeble men, who dislike the informality of sweaters and feel disgraced by shawls. Old persons should and can be kept warm in bed, by providing them with hot water bags, with warm night clothes including stockings, by using woollen or outing flannel sheets if necessary, and by providing a sufficient number of light but warm bed covers. It is not always understood that many covers do not remedy the deficiencies of a thin mattress. If a thick mattress or two thin mattresses cannot be provided, a thick comforter or even many layers of newspaper should be placed between the mattress and the springs, and another thick comforter should be placed between the mattress and the lower sheet. Rubbing the body with warm olive oil often affords great comfort, by improving the circulation and thus increasing the sensation of warmth, and also by relieving the tendency of the skin to become dry and cracked. Poor circulation at night may cause cramps in the muscles of the legs; the cramps can usually be relieved by warmth and gentle rubbing.

Old people frequently wish their rooms to be very hot, both by day and by night, even as hot as 80° or 85°, but if it is possible to keep them warm in any other way the temperature of the room should be kept at 70°. Well ventilated rooms are highly important for old people as for all others of low resistance, and it is entirely possible for their rooms to be warm and yet well ventilated. Aged persons should be carefully guarded from chill, exposure, crowds, and infected persons. Like little children they are peculiarly susceptible to the respiratory diseases, which cause many of the deaths commonly attributed to old age.

Digestion usually becomes weaker than in earlier years, and less food is needed. It should be simple, hot, and divided into four or five meals rather than three. Old people often wake at an early hour, and hot nourishment will prevent them from growing weak and faint while waiting for the family breakfast. Both constipation and looseness of the bowels are common ailments in old age. So far as possible the bowels should be regulated by means of diet; but muscular weakness resulting in inability to control the bowels should not be mistaken for and treated as diarrhœa.

It is unwise for old people to undertake unaccustomed or sudden muscular exertion, since the muscular system including the heart muscle grows weak and is generally unable to endure great strain. The bones, moreover, grow brittle and heal with difficulty if broken, so that persons of advanced years no matter how active should avoid walking on icy pavements, climbing on chairs to reach high shelves, and placing themselves in other insecure positions. Assistance must be tactfully given, however, as active old people are inclined to resent it. On the other hand, old people should be encouraged to continue moderate and safe activities, and to take regular exercises suited to their strength. Although increasing muscular weakness tends to make most old people indolent, it is far better for them both in mind and in body to remain as active as they can without danger of too great fatigue. At all events, they should be prevented if possible from becoming bedridden.

Since in old age sight, hearing, and other special senses become less acute, one should remember that an old person may not notice the odor of escaping gas, the light of a smouldering match, or the sound of an approaching motor car, and that he must be specially guarded from such dangers of every day life. On account of their dulled perceptions old people are sometimes unjustly considered to be less intelligent than they really are. Young people moreover should be told, if an aged person is untidy and careless in personal habits, that the apparent negligence is caused by dulled perceptions and diminished muscular control for which old people are no more responsible than they are for failing eyesight or for inability to hear.

Families should also realize that changes in mind and character are beyond an aged person's control and that they should not be made the cause for remonstrance or arguing. Just as the arteries harden with advancing years, as the bones become brittle and as other tissues become less flexible, so changes are likely to occur in the nervous system. It is not surprising when the brain substance like other tissues is becoming less flexible, that the powers of attention should weaken, that memory for recent events should diminish, or that other mental powers should fail. Changes in disposition are not uncommon: previously controlled persons sometimes become querulous and exacting, while excitable and irritable persons become more placid. With most old people emotions become less intense; feeble old people hardly realize great joy or great sorrow, and seldom look forward to death with apprehension.

Among the most important changes that occur in the nervous system is its gradual loss in power to respond to new demands. New habits are difficult or impossible to form, and old habits are hard to break. Attempts to break the habits of a life time are therefore dangerous, and radical changes in old people's ways of living are attended by risk as well as by unhappiness. Such loss of adaptability in the nervous system makes it increasingly difficult for old people to assimilate new ideas and to understand new points of view. The feeling that the world is strange and that the next generation has gone on without them accounts for the tragic loneliness of many old people. Clearly it is for those who are younger and more flexible to bridge the gulf between the generations by their understanding and their sympathy.

Physical care to whatever extent it is needed should be given to all old people as soon as they are unable to care for themselves, and thought should be given to adapting their surroundings and ways of living to their strength and needs, just as they should be adapted to the strength and needs of chronic patients. But a warning should be given against managing old people too much. It is hard for people who have managed their own lives successfully for many years to be managed, even for their own good. Indeed, it is questionable kindness to deprive old people of all freedom of action, even if following their own inclinations occasionally has disastrous results. Few persons would wish to prolong their lives if long life involved being thwarted in every desire, and sometimes real kindness consists in allowing old people to do certain things that are not good for them. Keeping them warm and letting them do as they please will go far to make old people