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My grandmother is 95 with CHF, atrial fibrillation and now pneumonia. She is in the hospital receiving care since she was having heavy palpitations, again. They discovered the pneumonia. She lives on her own, still drives without a license, is a stubborn woman, and has been able to manage on her own for the past three years since her 95 year old husband passed. Her doctor tells her she's amazing. Many of us believe she puts herself under a lot of stress by doing too much, entertaining others, constant housework... and this leads to exhaustion. Does the activity actually help her or hurt her? She just had a 2-day visit with family, a grandson, and a few dogs, which resulted in two days of obsessive house cleaning after they left, and now she's in the hospital five days later. Any suggestions? And what likely is her prognosis now that she's in hospital with CHF and pneumonia at 95 with heavy palpitations? Many thanks for your thoughts.

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Found my post in a screen that's been frozen for over an hour; at least I could copy the message.

Kudos to your grandmother - she sounds like a very strong woman with a determined will. My father is much like her, with a similar medical history, so I hope sharing what insight I have will not only provide comfort to you but encouragement as well.

1. Moderate, and I emphasize that moderate, work and/or activity is helpful to keep limbs more flexible, bodily functions working more normally, and perhaps most importantly, maintain a positive attitude toward life at any age, especially in the 90's when it's so much more of a challenge than when younger.

2. I think some moderation would be helpful though, especially the 2 days of obsessive house cleaning after the guests left. That's really too much. It should be spread out, one section of a room at a time, rest, eating well, but cleaning not continued until she feels quite rested . Compulsive cleaning isn't helpful, especially since she'll presumably be dusting, raising dust compounds in the air, pushing a vacuum, etc.

To compensate, I would:

a. Consider helping her, either with family support or agency support, just for the cleaning. It can be in lieu of a birthday or Christmas present, or gratitude from the visiting family members. If you're artistic, make up a nice little gift certificate expressing appreciation for her company and for the visit.

b. Consider getting a HEPA air cleaner which can be run on 3 different cycles, higher to lower, and helps clean the dust that becomes airborne during cleaning. My father and I both have them. If I didn't have mine on when just dusting, I'd feel the effects later.

c. Consider trying to encourage her to wear masks while cleaning. She doesn't have to wear a respirator, but just one of the dust masks available at Home Depot or Lowe's would work to minimize the amount of dust inhaled.

d. Plan small outings, such as taking her to lunch, during what would be obsessive cleaning frenzies, to provide a "forced" break. If family are local, I'd work out arrangements to step in as soon as the visiting family leave and plan activities for her, even while a hired agency staff comes in to clean.

3. Pneumonia has various sources, including bacteria. If she hasn't gotten a pneumonia shot, I'd suggest that. Dad had one and it's reduced his incidence of pneumonia, but he's still susceptible to varieties for which the vaccination doesn't provide coverage.

4. In my experience, CHF often accompanies pneumonia, but they don't always occur simultaneously. I would raise the issue of CHF and pneumonia relation with a doctor who can tell you specifically what kind of pneumonia she has.

For an older person with a compromised cardiac function, exposure to and expelling of household pollutants can put extra stress on the heart, compromising its ability to function normally. Exhaustion could be just as much of a side effect as pneumonia.

5. I think the direct correlation between the two could be a result of her activity, but I wouldn't advise ceasing that activity. I'd just work on trying to get her to moderate it. If she's obsessive about cleaning, focus on that. I'm not really sure what could be done about an obsession though, other than as stated above - i.e., getting outside help and redirecting her attention to more family activities, out of the house so they don't generate more work for her.

6. When you next visit, hold her wrist and you can feel the arrhythmias caused by A-fib. It's hard to get a heartbeat as there's so much flutter. That puts strain on the heart, which renders it less able to deal with other medical issues. It'll give you an idea how hard it is to overexert oneself with all that fluttering taking place.

7. As to prognosis, only a doctor is qualified to make that projection. I will share though that my father had pneumonia last year at 96, and is still around, cautiously getting through winter but still able to walk w/o a walker (although he does use a rollator for longer excursions).

Prognosis depends as well as Grandma's determination, feistiness, strength, resilience, which she seems to have in abundance.

8. Suggestions:

a. Ask her doctor or the discharging doctor to recommend home care, which can just providing monitoring service for a few weeks or longer. That'll help identify any recurrence of pneumonia, or episodes of A-fib. And the nurse can provide some gentle lectures on moderation.

b. Ask the treating pulmonologist about use of a nebulizer. It helps clear the airways and is easy to use, although I suspect Grandma won't use it and someone from the family will have to help.
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There are a few other ways to view persistence in doing things that are too challenging for an older person:

He/she can view him/herself no longer as a “doer”, but rather a manager and delegator. Apply management principles; someone who climbs the business ladder might start at the bottom but as progression occurs, so does responsibility, and chores that can be delegated are in fact delegated.

Your grandmother could see herself as having climbed the family corporate ladder; now she can delegate cleaning and chores to others, and spend more time relaxing and enjoying herself.

Doing things that aren’t healthy doesn’t prove just that someone can still do them; it reflects that the person isn’t willing to make a good assessment of his/her skills, and isn’t thinking wisely. I've seen others who feel they need to "prove they can still do it."

Sure, she can still clean in 2 days, but at what price? And it doesn’t mean much if it compromises her health or endangers others. Nor does it demonstrate a realistic assessment of what "proving" means.

Accepting help graciously isn’t an overnight achievement. If the pros and cons are weighed, the con is not that she’s admitting she can’t do it. It’s rather that she’s recognizing others can do it more easily and efficiently (variation of a basic economics principle), and that it frees her up for other activities that aren’t as challenging or health threatening.

More importantly, it’s a recognition that in order to maintain the health she wants, it’s important to be realistic. And sometimes being realistic is one of the hardest things to be.

I've had a hard time accepting help clearing the walk. I've always enjoyed snow shoveling - it was a quiet, peaceful time. But as I grew older, it became more of a burden. It wasn't peaceful, it was cold, noisy as traffic increased on the street, and eventually I recognized that help from a neighbor not only made him feel good about helping an old lady, but it also meant more time for me to read or do something which had become less pleasurable.
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GardenArtist,
Thank you so much for your time in responding. Your reply IS incredibly helpful in helping me understand the progression. As I sit here and think about things, I began to see this post is also about my anxiety with my grandmother's lifestyle and choices.

Let me share a bit about my grandmother as others might also relate. She was born in 1920, part of the war generation, quite miserly yet well off, extremely stubborn, and doesn't want to lose her independence!

I can only hope that she will slow down a bit. Her obsession with cleaning and over-exertion of entertainment activities seems to get the best of her. Her doctor asks her to do things in moderation to avoid injury, but she doesn't hear him or really listen. I think her cleaning OCD is so strong that it really works against her and anything I suggest to slow down or pace herself just seems to upset her. She is slowly losing her independence with the disease, an inability to do things the way she used to do things, and I know this is frustrating. I know this myself as I'm aging. I try to help her in the ways I'm allowed to as she is a very controlling person and this is difficult in and of itself. It's challenging to help a person who seemingly knows what's best for them by playing doctor, when you know they're slowly killing themselves, not respecting themselves or others, not following doctor's orders, etc. I think some people can relate to these issues. She's recently canceled her MedicAlert after three years because she resents paying $39/mo when there are less expensive companies and she has a phone to call 911. I've already been around and around with her why it's important to keep it, but she just doesn't want it. Now she "feels free again."

I noticed that she's been sniffling much the last month or so and this is also Spring time. She's never really had any particular pollen/ allergy problem yet the runny nose seems apparent. She refuses to take an allergy medicine believing it will interfere with her Coumadin levels. Her house is so clean, yet the house cleaner did come this week and your recommendations are great. She does notice her breathing is affected after the cleaner leaves. Perhaps she could run the HVAC system as well filtering out some additional irritants. She tried a nebulizer 3 years ago but didn't believe that helped her. She went off an inhaler a year ago for a COPD diagnosis because it wasn't a covered Med with a zero co-pay because she didn't believe it was doing her any good. She never went back to her pulmonary specialist because she was afraid he was going to report her to the DMV. By the way, she's still driving with an expired license which everyone disapproves of. She is a stubborn woman and she's made up her mind about her health, even as she lays in the hospital now denying the pneumonia.

We all want what's best for our loved ones. We want them to do what's best for themselves, but I realize that we have to understand that they have to make choices for themselves while they can still do it. She still seems very capable of living her life. She's chosen to live an independent life and wishes to continue to do so on "her terms." I wish my grandmother could slow down as I see this as truly causing her some of physical ailments that are now complications from the CHF. From back pain, exhaustion, to breathing troubles and now pneumonia.

Thank you so much for your input. You are very kind and thoughtful.


I will respond to some of the replies below. This has not been an easy road for me as you can imagine.
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several things here I can relate to.
My mom ended up in the hospital with CHF and pneumonia.. 10 days there and a month in rehab, with follow up home monitoring/aide for about a month. She was 82, and still chugging along.
She is also still cleaning, but she does only do part of the house at a time. If your Gma is OCD about her cleaning, a service will not cut it...LOL My mom used to clean before they came, and reclean after because "they didn't do it right".. Never ended! This is just the way she is.
She may have some years ahead of her yet, don't give up!! And the offer to the visitors to clean up before they leave is good. just don;t expect her to "not clean" anyhow.
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I just typed what I consider to be a thorough answer, the site froze, and I lost all of it. I'll be back later with some advice from someone else who's been through this, after I get some chocolate fortification.
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Apparently the problem was that the post was too long and there was an excess of characters, causing the entire screen to freeze. That's odd, as I've written longer posts. Or maybe it's the usual pre-holiday computer glitches and website attacks.

Continued...


c. Is Grandma on oxygen at home? If not, ask if she qualifies. Medicare has very, very, very specific criteria by which it pays for home oxygen at night and more criteria for oxygen during the day.

I'm sure she won't want to use it - that does take some acclimation, but it WILL enhance her ability to work and breath much more easily.

d. Speak with the family that just left and suggest that when they visit, they provide assistance in cleanup before they leave.

e. Or have a cleaning party during which the family in the area come over and help Grandma clean up after a visit, ensuring that periodic breaks are taken and that she rehydrates and feeds herself well. Then celebrate afterward, whether it's going out for dinner, just having a family get together to discuss family events, or whatever.

So, turn what could be a precipitating hospital event into something positive, reinforcing her strong character and stamina.
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All her doctors have asked her not to drive. Even a close family friend, a priest has politely admonished her about driving. All of her friends and family are supportive in offering to help her, so that is not a problem. She simply doesn't want to give up that independence. I tried discussing Uber with her, and she would not hear of it. She is difficult and not the first person to drive without a license. She related a story to me about a woman in church who told her she's doing the same thing! They giggled and that was that! The DMV, police department and insurance companies really needs to coordinate to crack down on this abuse.
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GardenArtist,
Thank you for the discharge instructions -- very helpful. That is extremely helpful to me. I live two hours away and from what I'm reading she'll need some assistance. She's refusing any rehab facility at this time as well.
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Lucky, I'm thinking that perhaps you or another family member might casually let it slip to one of her treating doctors (privately) that she's still driving. They might admonish her, but they're also mandated reporters. I don't know, however, if that includes illegal driving. If it does, they would contact the DMV or the agency responsible for issuing licenses, possibly even local law enforcement.

I completely missed this when I first read your post but am glad that Golden caught it.

The stubbornness could gradually diminish, once alternate plans are put in place and she's begun to accept them. But, in my experience, this is more like a longer period of time (monthly or yearly) rather than quickly.

If finances are an issue, someone should explain to her that all of hers could be lost to a lawsuit judgment if she causes an accident and is sued.

Sometimes elders segue into a stage in which they have to prove to themselves that they can still do what they've done for years, and just refuse to accept that they can't.
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DDDuck, Good advice for us all. We always tell each other we love each other. She's been especially good with this in recent years, and that has allowed us to become closer. No issues there. When the doctor tells her "she's amazing," they are referring to her overall health, her blood panel always near perfect --- everything except her CHF, of course. To look at her you would not see a 95 year old woman, and she puts on a good face when not feeling great.. Her internal drive remains so strong, it just keeps her going, going, going, like an Energizer Bunny! I'm glad saying we love each other has brought us closer together through our challenging times -- it's not always been this way. It will be less difficult when she does pass.
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