Recognising Medical Conditions

If you are caring for someone, the sooner you recognise any medical conditions and get treatment, the better. Robin Dynes provides useful advice in his latest article...

Recognising Medical Conditions 18 May

Although the person you are caring for may have some memory problems or mobility difficulties, they may otherwise appear reasonably healthy. But, as we grow older, we all become more vulnerable to medical conditions. This may not happen suddenly, but instead have a stealthy onset. The sooner you recognise these conditions and get treatment for your loved one the better. It is very easy, in a busy life, caring for your family and an elderly relative to miss early signs. The basic information below does not replace medical advice but is intended to help you spot the onset of some common conditions at an early stage and take preventative action.

Stroke

Many people visualise having a stroke with a picture of it happening suddenly. The person stops speaking or moving, falls down, their face may distort on one side and they may lose the use of an arm and leg on one side. This type of stroke is caused by a blood clot which prevents blood reaching part of the brain.

This is not always the case. Often a stroke can be so mild that it can go unnoticed. The person may complain of an intense headache which is not helped by normal painkillers. They may start to move slowly, slur their words and be unable to understand what you say. Possibly they may vomit. Or the stroke may be so mild that they just say they feel tired or dizzy, that their arm or leg feels heavy, they have tingling or pins and needles in a limb. This type of stroke may be caused by a bleed in the brain.

Other indications can include:

  • Sudden loss or blurring of vision
  • Confusion
  • Problems with balance or co-ordination
  • Difficulty swallowing
  • Loss of consciousness

Sometimes the characteristics may last only a few minutes or a short time before disappearing. Also, be aware that these symptoms can also have causes other than a stroke.

What to do

People who experience a mild or mini stroke, may recover completely or retain some minor impairments. Even through the symptoms disappear quickly you should not ignore them. It is an indication that something could be wrong with the blood supply to the person’s brain and puts them at increased risk of having a more severe stroke in the future.

If you suspect your loved one has had a mini stroke contact your GP or out of hours service as soon as possible.  If the symptoms indicate that they are actually having a stroke, phone 999 immediately and ask for an ambulance. Prompt treatment is essential to improve the chances of recovery.   

For further information visit The Stroke Association website www.stroke.org.uk  

Diabetes

If the person you are caring for is a diabetic you will be aware of the treatment – tablets, injections, diet, exercise, etc. However, in some older people diabetes comes on gradually. It is helpful to be aware of the common signs. These are:

  • Excessive thirst. Feeling more thirsty than usual may be a sign they are neglecting themselves and have become dehydrated.  However, if they drink more than one glass of fluid and want more in ten minutes or so then you might look for other indicators. 
  • Going to the toilet more often than normal. Although this can be caused because the bladder has become weaker with age or they are taking a diuretic.
  • Feeling more tired than is normal for them at their current age.
  • Weight loss. But bear in mind weight loss is unusual in type 2 diabetes which usually occurs in people who are overweight.   
  • Genital itching or Thrush
  • Skin infections such as boils, abscesses, sore feet and legs
  • Cuts and wounds taking longer than normal to heal
  • Experiencing blurred vision

None of these signs on their own indicate diabetes but the combination of two or more suggest further investigation is necessary. Type 1 diabetes can develop quickly over a short period of days or weeks. Because early symptoms are general, people can have type 2 for years without being aware of it. 

What to do

Arrange a visit to their GP as soon as possible. Having the symptoms doesn’t necessarily mean the person has diabetes. The Doctor will diagnose by checking a urine sample and arranging a blood test to check blood sugar levels. He will then prescribe any necessary medications and advise on diet and exercise to manage the condition. He will also arrange regular blood tests to make sure blood glucose levels stay balanced.  

For further information about Diabetes visit the Diabetes UK website www.diabetes.org.uk

Heart Attack

A major heart attack is usually obvious. It occurs when there is a loss of blood flow to the heart. There is severe chest pain, often radiating to the arm, jaw, neck back or abdomen. There may be blueness of the skin and the person might collapse.

A minor heart attack may not be so obvious. Much milder symptoms may be experienced. For example, my wife experienced some shortness of breath when swimming and only very mild chest discomfort. Luckily she saw her doctor, was referred for immediate treatment (stents inserted) and avoided a serious heart attack. It is very easy to dismiss these mild symptoms and assume they are just an indication of age.

Symptoms can include:

  • Minor chest pain, similar to indigestion. Often older people often do not experience any pain at all.
  • Feeling nauseous
  • Feeling lightheaded or dizzy
  • Shortness of breath
  • Coughing or wheezing
  • Overwhelming sense of anxiety (similar to a panic attack)

When there is little or no pain and the person recovers quickly it is very easy to dismiss mild symptoms and assume they are just an indication of ageing. They may also have had several incidences which they have ignored or not mentioned to you.

Symptoms of heart failure occurs when the heart is unable to perform its usual functions adequately and, in the early stages, can include:

  • Lethargy
  • Regular swelling of the ankles and lower legs
  • Needing to sleep sitting up to breathe easily

In later stages:

  • The hands may swell
  • The person may become breathless on exertion
  • Lips, ears or fingernails may have a blue tinge

What to do

Heart failure can be treated. If you suspect it, the person you are caring for should see a doctor as soon as possible. 

If you think someone is having a heart attack phone 999 immediately for an ambulance. The person must sit and rest while waiting for help to arrive. If you have an adult aspirin (300mg) available get the person to chew on it, unless they are allergic to aspirin or have been told not to take it. 

A cardiac arrest occurs when the heart stops pumping blood around the body – the person will be unconscious and won’t be breathing normally. In this instance phone 999 immediately and, if you don’t have access to an automated external defibrillator, give hands only CPR. This will increase the person’s chance of survival. To view a video of someone giving CPR go to

 www.nhs.uk/video/Pages/vinnie-jones-how-to-perform-cpr.aspx

For further information visit the British Heart Foundation website www.bhf.org.uk   

Arthritis

Roughly half of the ageing population aged 65 and over have problems with arthritis. If they complain about joint pain and stiffness in any part of the body, it could be arthritis.  Many cases are mild and people cope with it. Some forms (there are many types) cause changes you can see – swelling, warmth, and redness in joints. Sometimes the pain and swelling only last a short time but can be very bad. Chronic pain caused by arthritis can lead to depression and sleep disturbance.

Symptoms vary depending on the type that has developed and may include:

  • Lasting joint pain
  • Pain or swelling in one or more joints
  • Warmth and redness in a joint
  • Pain and stiffness after activity such as gardening or housework
  • Weakness and muscle wasting
  • Restricted joint movement

What to do

There is no cure for arthritis but there are many treatments to slow down the condition, relieve the pain, and help the person live with it. The first step is to see a GP to get a diagnosis. The doctor will then recommend - depending on the type and severity of the condition - the best approach to managing it.  There are a range of options which can include:

  • Painkillers and other medications
  • Physiotherapy
  • Regular exercise
  • Surgical procedures such as joint replacement or joint fusion in severe cases

For further information about living with arthritis and to download their managing pain booklet https://www.arthritiscare.org.uk/living-with-arthritis/managing-pain

Concussion

Elderly people are prone to falling over – they can trip on a mat or simply lose their balance. The person may be living alone or have been on their own for a short period while you are out shopping. They could have a fall and bang their head leading to concussion but be unaware that they are concussed.

Having recovered they may have no memory of the event. You are the first person to visit or see them.  They may or may not have obvious physical injuries that show something has happened. Other signs to look out for are:

  • Persistent headaches
  • General confusion
  • Slurred or confused speech
  • Visible injury to the head or face
  • Injury to parts of the body that might indicate a fall
  • Problems with vision – double vision
  • Loss of balance or problems walking
  • Difficulty in understanding what you say to them
  • Drowsiness that occurs when they would normally be alert
  • Vomiting
  • Memory loss that is not normal for the person

What to do

If you find your loved one unconscious or they are having difficulty staying awake, speaking, understanding what you are saying, bleeding from one or both ears, or anything that makes you suspect a serious head injury ring 999 for an ambulance immediately.  If you suspect a minor bump take them to the nearest A&E department or call their doctor. People may look or think they are fine even though they are acting or feeling differently.  It is wise to get it checked out.  

For further information about concussion go to http://www.nhs.uk/Conditions/Concussion/Pages/Symptoms.aspx    

Pressure Sores

Pressure sores can cause serious infections, some of which can be life threatening. They are usually associated with someone who is bed-ridden but they frequently occur when the person does not move around much and spends long periods sitting or lying in one position – perhaps with their back against a cushion or feet resting on a foot-stool. Different parts of the body can be affected:

  • The back of arms or legs where they rest against the chair in which the person sits
  •  Heels and ankles
  •  Buttocks or lower back
  •  Sides of the head, ears
  •  Shoulder blades.

Suspect and look for a pressure sore if the person complains of pain in one area.

The person may sit in the same chair in one position for long periods. They should shift body position every ten or fifteen minutes. People at increased risk are those with:

  • Mobility problems – perhaps due to painful arthritis they like to stay in one position
  • A poor diet – they often have insufficient fluid in the body or difficulty swallowing food
  • Health conditions such as type 1 or type 2 diabetes, heart or kidney failure, or incontinence.   

Warning signs that pressure sores are developing include:

  • Changes in the colour of the skin
  • Swelling
  • An area of skin that feels cooler or warmer to the touch than other areas
  • Tender areas

What to do

Prevent sores by encouraging your loved one to move around more – perhaps use different chairs to sit in at different times. Keep skin clean and dry – especially important if the person experiences any incontinence. If you suspect a sore is developing, make sure the person changes position to relieve pressure on that area. If you don’t see improvement within a couple of days contact their doctor. Immediate medical care is needed if there are any signs of infection such as drainage from a sore, increased redness, warmth or swelling around affected area.  

For further information about pressure sores go to http://www.nhs.uk/conditions/Pressure-ulcers/Pages/Introduction.aspx

Finally

Unfortunately suffering from one condition does not give immunity to others.  There is the added complication that your loved one may have difficulty communicating what is happening to them. So, being aware and alert to early signs of different medical conditions is essential to maintaining their well-being.


This article was written for Carewatch by Robin Dynes. Robin also wrote our Activity guides for people with dementia to help carers enrich the lives of those they support.

Robin has worked in the National Health Service, Social Services and Adult Education for over 30 years as a counsellor and trainer. His main role has been to develop innovative services to meet the needs of older people and others who are vulnerable.

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