Trail Gatekeeper Program: Reasons to Refer

Observation of an older person's appearance or behavior, and changes in a person's routine patterns may alert you as a Gatekeeper that the person is in trouble or potentially at-risk. There are a number of situations and symptoms which would indicate a need for referral. The most common indications are listed in this section. Anyone or combination of these could be directly observed by the Gatekeeper or someone calling in on their behalf.

Personal Appearance

Neglect in the area of self care is often a sign that the older person is experiencing difficulties. Gatekeepers may notice the following:

1. Unkempt appearance
2. Dirty or uncombed hair
3. Unshaven
4. Dirty clothes
5. Inappropriate clothing for weather
6. Body odors

Condition of the Home

The appearance of an older person's residence may reflect an inability to care for self or loss of interest. Gatekeepers' may observe:

1. Exterior and / or interior of home in poor repair
2. Old newspapers lying around
3. Calendar on wrong month or year
4. Little or no food
5. Strong odors
6. Many pets-animals appear neglected
7. Garbage or litter
8. Walks not shoveled

Mental or Emotional State / Health

The majority of people experience mental or emotional problems for the first time after the age of 60. Problems in these areas can seriously undermine an older person's ability to cope and function. Gatekeepers should note the following concerns:

Mental State

1. Confusion
2. Disorientation
3. Inappropriate responses
4. Forgetfulness
5. Repetitiveness while talking
6. Seeing, hearing, smelling, tasting, feeling things that are not there
7. False irrational beliefs which persist but are not real or true
8. Suspiciousness, lack of trust
9. The suspicion or unwarranted belief that one is being harmed or mistreated
10. Alcohol abuse

Emotional State

1. Complains of not eating
2. Complains of difficulty sleeping or early morning awakening
3. Exhibits anger, irritability, hostility toward you, self or others
4. Appears nervous or fidgety
5. Suspected abuse, neglect or exploitation of the older person
6. Recently suffered a loss through separation or death from friends or family members
7. Appears sad or blue. May state "I don't care anymore, there's no use going on"

Physical Losses

Physical changes or losses, and chronic or acute illnesses can sometimes affect the older person's emotional or mental status and impair ability to function. Indications may include:

1. Loss of hearing or sight
2. Chronic or acute physical illnesses
3. Many medicine bottles
4. Inability to move easily
5. Loss of bowel and bladder control

Social Problems

Isolation can profoundly affect an older person's well-being. Areas of concern include:

1. Homebound
2. Lack of social relationships
3. No mention of family or friends

Personality Changes

Personality changes may indicate the onset of physical, mental or emotional problems. Gatekeeper's may notice:

1. Marked change, gradual or sudden in the person's overall ability to function
2. Increased withdrawal or isolation
3. Disheveled appearance
4. Suspiciousness–anger
5. Unusual or bizarre behavior

Economic Problems

Economic problems can create a variety of hardships for elderly people. Significant examples may include:

1. Inability to manage finances
2. No means of support
3. Low income

Caregiver Stress

There is often a natural resistance on the part of a care giver to accept help for a spouse or relative suffering from diseases such as Alzheimer's. Trying to handle this burden and responsibility alone can be overwhelming and lead to depression or physical problems. The care giving role can be particularly difficult for older men. Indications of stress may include:

1. An increase in use of alcohol or alcohol abuse by the care giver.
2. Caregivers may convey the message that a loved one's condition is getting worse in spite of their best efforts.
3. Caregiver is becoming impatient, irritable and frustrated with the person they are caring for.
4. Caregiver has no support system providing assistance or relief from care giving.
5. Caregiver may complain of feeling exhausted or overwhelmed by the burden of care, but unwilling to reach out for help.
6. Caregiver may state –"I should be able to handle this alone –it's selfish to think of my own needs."

Suicide

The actual number of people who complete suicide is higher in the 60 and over age group than any other group. Subtle statements or direct threats to harm oneself should be reported immediately. Men over 60 and living alone are of particular concern. Indicators of risk include:

1. Multiple and / or recent losses
2. An elderly person may state "There's no use going on–everyone would be better off without me."
3. Alcohol abuse
4. Increased isolation
5. Talk of giving personal possessions away
6. Putting person and business affairs in order
7. Exhibits any of the symptoms presented in Emotional State section.

Financial Abuse

Financial Abuse is the misuse of a senior's funds and assets: obtaining property and funds without that person's knowledge and full consent, or in the case of a senior who is not competent, not representing or acting in that person's best interest. The abuser is usually a spouse or partner, family member (often adult children) caregiver, friend or trusted person in the senior's life. Financial abuse if often accompanied by other abuses. Examples are as follows:

1. Theft of cash, credit or bank cards, mail
2. Unpaid loans, or repeated borrowing
3. Selling senior's property or possessions without permission
4. Forcing senior to change Will or Power of Attorney
5. Cashing in person's RRSP without permission
6. Taking or withholding pension, etc
7. Forcing senior to sign over house / car
8. Establishing "joint account" and using money without seniors knowledge / permission
9. Believing a parent's assets, money, property should be yours.

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