Caregiver Communication Guide

Caregivers of older adults in the community can use this information to:

Change in condition means that there is something going on with the older adult that is not usual for them. It’s important for the caregiver to recognize and report a change of condition (especially a sudden one). If the caregiver sees any of the changes listed below, they should try to answer the questions provided, and relay that information to the medical professional.

Call 911 immediately if the situation appears to be life threatening. Remember, older adults may not have the same symptoms a younger person would have such as the symptoms during a heart attack. When in doubt call 911.

In an emergency:

1. Call 911
2. Call the older adult's primary care practitioner
3. Call family or other important responsible parties

Every caregiver needs to know how to contact a medical professional regarding the older adult’s change of condition no matter what the hour or day of the week.

When reporting a change, always include:

1. Older adult’s name
2. Age
3. Current medications and recent (new) changes
4. Allergies
5. Sex of the older adult (male or female)
6. Responsible party for the older adult or nearest relative
7. Advanced directives, if any
8. Past medical history and current diagnoses (e.g., diabetes, high blood pressure, had a stomach ulcer last year)

To use this guide:
The conditions are listed alphabetically. There are questions to answer which are related to each condition. This will provide guidance to the caregiver so that she or he will be able to provide good information to the person they are reporting the change to.

A caregiver is a very special person. They are able to make a difference in each person’s life they care for. By following the recommendations in this guide, you will be able to take even better care of those you look out for.

Here is an example:
“Dr. Jones, my name is Tara and I am a caregiver for Mr. Alex Lightfoot, age 68, who lives at home with his wife. I went to get him for dinner and found him on the floor in his bathroom. It looks like he may have hit his head on the vanity. He has a one inch gash on his forehead with dried blood. There is an area of drying blood the size of a dollar on the floor. Other than that he seems to be OK, but we are sending him to the ER for evaluation. He has been falling a lot recently since he started on a new medication, Lisinopril. I will send his medication list with him to the Emergency Room. He has an allergy to penicillin. His wife is his responsible party and we have called her and she is meeting him at the ER. He does not have advanced directives. He has high blood pressure and Alzheimer’s disease. His vital signs have been checked by the paramedics and they have said they are normal.”

Unfortunately, falls in the elderly are common, due a variety of issues such as muscle weakness, poor vision (especially in low light), and balance problems. Multiple falls is a big problem. Make sure you let the patient's practitioner know if they have fallen multiple times. The practitioner will want to know:

1. Did the older adult have a recent fall? (See: Falls)
2. Ask the older adult why they have changed their activity.
3. Is something emotional happening in the older adult’s life? (For example, the daughter is out of town or someone close to the older adult just passed away.)
4. Does the older adult have cold symptoms? (See: Cold Symptoms)
5. Does the older adult say they are in pain? (See: Pain)
6. Describe the change in activity [Occurring for more than one day]. (For example, the older adult is not doing the daily care for themselves that they usually do; or they are not attending their usual daily activities.)
7. Is the older adult not eating or drinking the amount they usually do?
8. Is the older adult staying in bed?
9. Has the older adult lost or gained weight? (For example, do clothes fit differently; tight or loose?)

1. Describe what they are doing that makes you think they have a behavior change or are agitated.
2. When did the problem begin?
3. Did this change in behavior happen quickly or has the change taken place over a few days?
4. Is the older adult taking any new medication(s)?
5. Has the older adult had a change in bowel or bladder habits? (Describe)
6. Has the older adult fallen recently?
7. Is there a change in the older adult’s intake of food and fluid?
8. H as the older adult recently been in the hospital, urgent care center, emergency room, or been recently sick?
9. Has the older adult been drinking alcohol?
10. Has there been a change in the older adult’s sleep pattern?
11. Sleeping more during day
12. Sleeping less at night
13. Sleeping all day & all night
14. Awake all night without sleep

15.  

16. Did any particular event start this behavior?
17.  
18. Does the older adult have diabetes?
19.  
20. If the older adult does have diabetes, what is their fingerstick reading?
21.  
22. What is the older adult’s blood pressure (See: Blood Pressure)
23.  
24. Is the older adult less alert, hyper-active, etc?
25.  

1. Where is the older adult bleeding from?
2. How much blood has been lost? (Describe amount – dime size,nickel, quarter, one cupful).
3. Document color of blood. (Dark or bright red).
4. If vomiting blood, does it look like coffee grounds or bright red? If bright red, call 911.
5. If the older adult has a cut, can you stop the bleeding with direct pressure and ice? (A slow ooze of blood may be normal in these situations). If there is a cut that is bleeding fast - call 911.
6. Is the older adult taking a medication called an anticoagulant (e.g., warfarin, aspirin, Plavix) or a medicine that can increase a risk for bleeding (e.g., ibuprofen)?

It is important to know what the older adult’s normal blood pressure should be. It is also important to find out when the primary care practitioner (PCP) wants to be notified regarding an older adult’s blood pressure. For example, the PCP states they want you to call them if the older adult’s top blood pressure number goes over 160. You can get this information from the older adult’s PCP.

Low Blood Pressure:
Top number less than or equal to 90; or a number the PCP tells you what is low for that older adult.

1. Is the older adult having trouble walking that is not normal for them? (For example, are they holding on to the walls and doors?)
2. Is the older adult confused? If so, is their confusion more than usual?
3. Has the older adult’s energy level changed from their normal energy level?
4. Does the older adult say they feel “light headed” or “dizzy”?

Orthostatic Low Blood Pressure:
To check for an orthostatic low BP (a drop in blood pressure when a person stands up), have the older adult lie flat, and take the BP. Next, have them stand up and take a BP. This has to be done within 1 minute of the BP you took with them lying flat. You can also measure a person’s BP while they are sitting or reclining, in addition to lying down, then measure upon standing. A drop from lying to standing of 20 points systolic (upper number) or diastolic (lower number) would be a sign of orthostatic low BP. (For example, when lying down the BP is 110/90, but when standing up the BP is 90/70.) Check this again in 3 minutes then report findings. Does the older adult say they feel “light headed” or “dizzy”?

High Blood Pressure:
Blood pressure goals for older persons are higher than for younger persons. The goal for older persons is to lower the BP to less than 140/90. However, in older persons with diabetes or kidney disease, the goal is to lower the BP to less than 130/80. The National Kidney Foundation suggests blood pressure targets of 125/75 for people with kidney disease. Therefore a BP of 130/80 for older adults with diabetes or kidney disease, or 140/90 for an older adult without diabetes or kidney disease is considered a high blood pressure.

If you know the older adult has a high BP, as the following questions:

1. Does the older adult have chest pain? Where is the pain? Do they describe it as crushing? If so, call 911.
2. Does the older adult have a headache? If so:
3. What part of the head is hurting (front, back, top)?
4. Is it pounding, throbbing, sharp pain or pressure?
5. Is there a change in how the older adult talks?
6. Does the older adult have blurred vision or any vision changes?
7. I s the older adult short of breath?
8. Is the older adult vomiting?
9. Does the older adult have a change in alertness?
10. Does the person have sudden weakness or loss of movement of limbs, slurred speech or unresponsiveness? These are a sign of a stroke - if you see this call 911 right away.

1. Is the older adult wheezing (high pitched whistling sound)?
2. Is the older adult having trouble catching their breath? (Is this a change from their regular breathing pattern?)
3. Can the older adult talk to you normally or is their breathing causing a problem with talking? Ask the older adult to recite the alphabet. They should be able to reach the letter G without stopping for a breath.
4. Is it harder for the older adult to breathe when dressing, walking, doing activities, etc?
5. Is the older adult breathing fast or slow?
6. How many breaths per minute is the older adult taking?
7. Is the older adult experiencing a change of color in their face? (For example, is the older adult: paler than usual; more flushed than usual; lips look blue or grey.)
8. Is the older adult coughing?
9. Did the older adult have a recent cold or flu?
10. Is the older adult using more pillows than usual in bed to sleep?
11. Does the older adult seem uncomfortable when lying flat in the bed?
12. Has the older adult been sitting up in a chair during the night? (Is this new?)
13. Does the older adult regularly use oxygen?
14. Are the older adult's feet or ankles swollen? Is this new or has it gotten worse?

Call 911 when a person has any of the following:

These signs may not be present in every situation and the person could still be having a heart attack. Don’t wait more than 5 minutes to call 911 (American Heart Association).

If any signs of chest pain, call 911. (see Chest Pain)

1. Ask the older adult if the pain feels like indigestion.
2. Is the older adult sick in stomach or vomiting?
3. How long ago did they eat and what did they eat?
4. Is the older adult burping?
5. Is the older adult lying down or sitting up?
6. Ask the older adult what makes the pain worse.
7. Ask the older adult what makes the pain better.
8. Does the older adult have an order for Mylanta or another antacid?
9. Has the older adult ever experienced this kind of pain before?

1. Ask the older adult if they know:
2. Their name
3. The date
4. Where they are
5. Who you are
6. What is the older adult doing that is making you think they are confused? Describe what they are doing.
7. When did the problem begin? Is the confusion getting worse?
8. Is the older adult taking any new medication(s)?
9. Has the older adult had a change in bowel or bladder habits? (Describe)
10. Has the older adult fallen recently?
11. Is there a change in the older adult’s intake of food and fluid?
12. Has the older adult recently been in the hospital, urgent care center, emergency room, or recently sick?
13. Has the older adult been drinking alcohol?
14. Has there been a change in the older adult’s sleep pattern?
15. Sleeping more during day
16. Sleeping less at night
17. Sleeping all day & all night
18. Awake all night without sleep

1. Describe the cough (dry, wet, hacking, congested, hard, etc.).
2. Is the cough constant or occasional?
3. How long has the older adult had cough or cold symptoms?
4. Is there drainage from their nose? If so, what color?
5. Is the older adult coughing anything up? (Describe the color: green, yellow, clear, red, other?)
6. Does anything make the cough better or worse?
7. Is there any pain with the cough?
8. Is the cough associated with eating?
9. Does the older adult have a sore throat?

1. Is the older adult having bowel movements more often than their normal pattern?
2. What is the number of times the older adult has had bowel movements over the last day?
3. Is the older adult incontinent of bowel? If yes, how many times have they been changed?
4. Is there a change in the older adult’s food and fluid intake?
5. Does the older adult have stomach pain?
6. Is the stool loose, watery with flecks of stool, or is it a formed stool?
7. Does anyone else have diarrhea in the community?
8. Has the older adult recently been hospitalized?
9. Has the older adult had infectious diarrhea previously within the last 3 months?
10. Was there a recent change in the foods they have been eating? (For example, rich dessert like chocolate cake, candy, ice cream, etc.; more fruit than usual, sugar free foods and snacks.)
11. Were there any changes to the older adult’s medication?
12. Is the older adult taking a laxative? If so, when was the last time they took it?
13. Do you notice any over the counter medications in the older adult’s room? (For example, Milk of Magnesia, Pepto-Bismol, Epson salts.)
14. Look in the older adult’s room and check for items such as old food.
15. Is the older adult on antibiotic medications?
16. Is there any bleeding with bowel movement? (For example, black, dark, red or “tarry” stool?)

If someone fainted, call 911.

1. Describe how the older adult says they feel.
2. Ask the older adult if the room is spinning or if they feel like they are spinning.
3. Ask the older adult if this dizziness is a new symptom and if so, when did it start.
4. What is the older adult’s blood pressure? (See: Blood Pressure)
5. Has the older adult started on a new medication?
6. Has the older adult’s hearing gotten worse?
7. What is the older adult’s heart rate?
8. Has there been a decrease in how much the older adult is drinking?
9. Does the older adult have diarrhea, are they vomiting; or are they urinating a lot?
10. Is the older adult taking a fluid pill?
11. If the older adult has diabetes, what is their fingerstick blood sugar?
12. Has the older adult changed the amount of fluids they usually drink?
13. Did the older adult recently go out for a meal?
14. Has the older adult been drinking alcoholic beverages?
15. Has the older adult’s recent activity changed from their normal routine? (See: Activity Change)
16. Was the older adult lying down, standing or sitting when the dizziness occurred?

1. Describe the change in eating/appetite.
2. How long have you noticed this change in eating/appetite?
3. When was the older adult’s last bowel movement?
4. Has the older adult been moving their bowels in the way they normally do or in their normal pattern?
5. Does the older adult have dentures? If so, is the older adult wearing his/her dentures, and do the dentures fit?
6. Does the older adult have pain in their mouth or teeth problems? (For example, broken or missing teeth.)
7. Is the older adult complaining of a stomach ache or pain? (See: Stomach Ache)
8. Is the older adult complaining of indigestion, heartburn? (See: Chest Discomfort)
9. Does the older adult have a sore throat?
10. Is the older adult saying that they don’t feel well? (If yes, ask them to describe what they mean by “they don’t feel well.”) Has the older adult lost or gained weight? (For example, do clothes fit differently; tight or loose?)

1. How is the older adult describing the problem?
2. Describe the change(s) to the eye that you can see.
3. Is there redness in the eye?
4. Is there drainage?
5. Is there a ring around the iris?
6. Does the older adult say they are having pain in the eye? Explain how the older adult describes the pain.
7. Does the older adult say there is itching in the eye(s)?
8. Has the older adult had any eye surgeries or trauma or falls?
9. Ask the older adult if there are any vision changes. If so, was the vision change sudden or gradual?

Multiple falls is a big problem. Make sure you let the primary care practitioner know right away if the older adult has fallen multiple times.

1. Did you find the older adult on the floor? If Yes, was the older adult sitting on floor when you found them?
2. Describe what you heard and what you saw.
3. Does the older adult have any injuries that you can see? (For example, bruising, rubbing the area, cuts, swelling.)
4. Does the older adult say they are in pain? (See: Pain)
5. Can the older adult walk? If so, is this how they normally walk? (For example, can they walk as far as they usually do?)
6. Did the older adult say they hit their head?
7. Does the older adult appear more confused than usual?
8. Did the older adult recently start any new medications, or have a change in a dose, or have any medications discontinued?
9. Is the older adult taking a medication called an anticoagulant (e.g., warfarin, aspirin, Plavix)?
10. Has the older adult been drinking alcohol? (In the last 24 hours)
11. Are any new devices (for example, canes, walkers, wheel chair) being used?
12. If there is any doubt about older adult’s safety call 911.

1. What is the older adult’s temperature and how did you obtain it (mouth, underarm, etc)? Do you know what the older adult’s usual temperature is?
2. Does the older adult have cold/flu symptoms? (See: Cough or Cold Symptoms)
3. Does the older adult have any complaints of not feeling well? (Describe what they mean by “they do not feel well”.)
4. Does the older adult have any pain? (See: Pain)
5. Is there a change in urine odor, amount of times they urinate, or have they suddenly wet themselves?
6. Is there a change in the older adult’s food and fluid intake?
7. Is the older adult having diarrhea or vomiting?
8. Are there any open areas or sores on the older adult’s skin?
9. Has the older adult recently taken aspirin or ibuprofen or Tylenol?

1. What is the older adult’s blood pressure? (See: Blood Pressure)
2. Describe the headache. (For example, do they describe the headache as throbbing, pounding, sharp or constant pain and where is it located?)
3. Any changes in how the older adult usually speaks?
4. When did it start and how long has it been going on?
5. Does the older adult have/had a change in vision? (For example, double vision or blurred vision)
6. Does it hurt on one side of the head more than anywhere else?
7. Is the older adult leaning to one side or the other? Is this a new behavior?
8. Ask the older adult if they recently had a fall and hit their head.

1. Is the older adult talking louder?
2. Is the TV or radio very loud when they listen to it?
3. Does the older adult normally wear a hearing aid? If so, are they wearing it? Did you check the batteries?
4. Is there a wax buildup on the hearing aid?

1. What makes you think the older adult is having a memory problem?

1. Does the older adult have broken teeth?
2. Does their breath have a bad odor? (Bad odor often means that the teeth are bad).
3. Do the older adult’s gums bleed when they brush their teeth?
4. Does the older adult have blisters inside their mouth?
5. Are the older adult’s dentures fitting poorly or rubbing the gums?
6. Is there a white coating on the tongue?
7. Is the inside of the mouth red?
8. Are there sores in the mouth?

1. Does the older adult feel warm? (See: Fever)
2. Does the older adult have a stomach ache? (See: Stomach Ache)
3. When was the last bowel movement?
4. If the older adult vomited:
5. How much have they vomited? (Cup, ½ cup)
6. What color is it?
7. What does the vomit look like? (For example, food, spit, coffee grounds)
8. How many times have they vomited?
9. What did the older adult eat before they vomited?
10. What was the older adult doing before they vomited? (For example, were they eating or coughing?)

1. Ask the older adult to describe the pain:
2. Where is the pain?
3. On a scale from 1-10, with 10 being the worst pain imaginable, what is their number on the scale?
4. Is it an ache, throb, sharp, dull, burning, radiating, etc.?
5. Is it a new pain?
6. Is it a worsening of a previous pain?
7. What makes it better?
8. What makes it worse?
9. How long has the pain been like this?
10. Is the older adult on pain medicine? If so, when was the last time they took it and what did they take?
11. Did the older adult have a recent fall? (See: Fall)
12. What was the older adult doing before the pain started?

1. Describe the seizure (body movements, eye movement, etc.) and how long it lasted.
2. Has the older adult ever had a seizure before?
3. If so, when was the last one and is this seizure different from the seizures they have had before?
4. Describe how the older adult was after the seizure. (For example, sleepy, anxious, do they know who they are and where they are, etc.)
5. Is the older adult on any medication(s) for seizures?
6. Has the dose(s) been changed?
7. Have they missed any dose(s)?
8. What is the last drug level? (if known)
9. Did the older adult experience any injury after the seizure?

If this is a new seizure or if the older adult was injured, call 911.

1. Description of the change:
2. Blister
3. Bruise
4. Burn
5. Change in skin color
6. Cut
7. Rash
8. Redness
9. Skin tear
10. Wound(s)
11. Other
12. How big is the area affected? (For example, dime, quarter, etc.)
13. Where is it located on the body?
14. Is it hot or cold?
15. Is it red around the area?
16. Is it bleeding?
17. Is there any drainage? (If yes, what is the color, is there any odor?)
18. Is the older adult having pain and if so, can they describe it? (See: Pain)
19. Is it swollen?
20. Does it itch?

1. Is the older adult sleeping more or less than usual?
2. Is the older adult sleeping at a different time than usual? (For example, are they sleeping during the day and awake at night?)
3. Has a new medication been started?
4. Has a medication dose been changed?
5. Does the older adult drink caffeine or alcoholic beverages late afternoon, early evening?
6. Is the older adult concerned about this sleep change?
7. Ask the older adult why they think they:
8. are having a sleeping problem?
9. feel tired when they wake up and feel like they have not had enough rest?
10. have pain interfering with their sleep?
11. are going to the bathroom at night that is interfering with sleep?

1. Is the older adult holding their stomach?
2. Does the older adult have a fever?
3. When was the older adult’s last bowel movement?
4. How long ago did the older adult eat and what did they eat?
5. How long has the older adult had the stomach pain?
6. On a scale from 1-10, with 10 being the worst pain imaginable, what is their number on the scale? (See: Pain)
7. Has the older adult vomited? If so, describe it. (See: Nausea & Vomiting)
8. Does the older adult complain of heartburn or indigestion? (See: Chest Discomfort)
9. Is the older adult burping or passing excessive gas?
10. 10. Are any areas of abdomen sensitive/painful to touch?

1. How is the older adult having problems swallowing?
2. Does the older adult sound “gurgled” or “wet” after they finish eating?
3. Does the older adult need to cough or have to clear their throat after they take a bite of food or drink?
4. Does the older adult have difficulty swallowing dairy products (e.g., ice cream, milk)?
5. Does the older adult’s nose run when they eat?
6. Does the older adult cough when they eat?
7. Does it take the older adult a long time to chew and/or swallow? Do they hold food in their mouth?
8. If you give the older adult a drink, is the drink coming or “drooling” out on one side of their mouth?
9. Is neck pain or trouble moving their neck keeping them from putting their head back giving them problems with swallowing food or liquids?
10. Has the older adult’s eating habits changed? (See: Eating/Appetite Change)

1. Where is the swelling? (Ankle, feet, hands, etc.)
2. Is the swelling on one or two sides of the body?
3. Is there pain, redness, warmth, cold, or wetness where the swelling is?
4. Is the swollen area bruised?
5. If the older adult normally has swelling, is the swelling worse than normal?
6. Was the older adult sleeping with their feet and legs hanging over the bed?
7. Was the older adult sleeping or sitting in a recliner all night with leg(s) down?
8. Does the older adult wear special stockings for swelling (For example, TEDs) and did they have them on?
9. Is the older adult having trouble breathing?
10. Does the older adult take multiple doses of ibuprofen on a daily basis? (Too much ibuprofen can cause kidney problems.)

1. Is it new or worsening?
2. When is it happening, is it more during the day or night?
3. Are the older adult’s feet swollen? (See: Swelling)
4. Is the older adult having any discomfort when urinating? (For example, burning, pain.)
5. How often is the older adult urinating? Is this more or less then their usual amount of times to the bathroom?
6. Have there been any recent changes in how the older adult moves about and walks?
7. Is the older adult on a fluid pill? (Diuretic)

1. Is there bleeding? (See: Bleeding)
2. Is there a discharge from the vagina?
3. Did the older adult have a bowel movement before it happened?
4. Can you see any sores or a rash by the vagina?
5. Ask the older adult if this problem happened before and if so, what caused it?

See: Eye Problems.

1. Describe the change.
2. Is the older adult “favoring” their leg, foot, or hip?
3. Do you see bruising or swelling on the older adult’s body like hip, back, buttocks or legs, etc?
4. Has the older adult had a recent fall? (See: Fall)
5. Is the older adult having any pain? (See: Pain)
6. Does the older adult normally use an assistive device (e.g., walker or a cane) and if so, are they using it now?
7. Is the older adult leaning on any thing (for example, furniture) to help them walk?
8. Is the older adult leaning to one side?
9. Is the older adult saying they are dizzy? (See: Dizziness)
10. Does the older adult have diabetes? If so, do you know what their blood sugar finger stick is?
11. Has the older adult been drinking alcohol recently?
12. Has the older adult recently taken medications for pain, or sleeping medications?

1. Describe what has changed with the older adult to make you think they are weak.
2. Is there a change in their activities?
3. Have there been changes in what they can do for themselves? (For example, can they still dress, bathe, and feed themselves?)
4. Is this a sudden change or did it happen over time?
5. Is one side weaker than the other?
6. Does the older adult have a fever or were they recently sick?

See: Eating/Appetite Change