When caring for an elderly person with atrial fibrillation, you’ll need to keep close tabs on their medication schedule and keep an eye out for stroke symptoms.

Perhaps like Pat Warrick and nearly 30 percent of the United States population, you’re caring for a chronically ill, disabled, or elderly family member or friend. Pat, a full-time data analyst, looks after her widowed mother, Marge, in Issaquah, Washington. Marge is 84 and has atrial fibrillation.

In atrial fibrillation, the upper heart chambers quiver rapidly and irregularly. This increases the chance of blood clots in the heart, which can break off and cause a stroke. People with atrial fibrillation often have symptoms of fatigue, shortness of breath, and palpitations. However, not everyone has symptoms. Some people remain unaware that the upper chambers of their heart are fibrillating.

The likelihood of having atrial fibrillation increases with age. Approximately 11 percent of people over 80 years of age have this condition. John D. Day, MD, a Utah-based cardiologist who specializes in treating patients with atrial fibrillation, emphasizes that in the elderly, risk of having a stroke from atrial fibrillation is much higher. 

Early detection of a stroke is critical. As a caregiver, you are well placed to spot a stroke and get help F-A-S-T, as per the American Stroke Association’s signs:

  • Face drooping
  • Arm weakness
  • Speech difficulty
  • Time to call 9-1-1 

Check if Heart Rate and Rhythm Are Under Control

Two primary approaches to treating atrial fibrillation are making sure the heart rate is not too fast, and trying to keep the heart in normal rhythm — out of atrial fibrillation. 

If you’re caring for someone being treated with heart rate control using medication like beta blockers or calcium channel blockers, ask arrhythmia clinic staff to teach you how to take a manual radial pulse check. This helps to identify whether treatment is controlling the heart rate. Alternatively, if they are being treated with rhythm control using antiarrhythmic drugs, then checking to see if the pulse is regular or irregular helps determine if the treatment is working. An irregular pulse indicates ongoing atrial fibrillation.

Know the Risks of Anticoagulation Therapy 

Treatment to control stroke risk is very important in atrial fibrillation. It usually involves blood thinners, also called anticoagulants, to prevent blood clots in patients with moderate to high risk for stroke. Day points out that older people are also much more likely to have a life-threatening bleed while on anticoagulant therapy.

As a caregiver, be alert to signs of bleeding, such as bruising. While bright red blood in stool is clearly a sign of internal bleeding, Day cautions, “If stool suddenly turns very dark or black, that can also be an indication that you're bleeding somewhere.” 

Day points to newer anticoagulant options like apixaban (Eliquis) and rivaroxaban (Xarelto). Although expensive, these lower the risk of bleeding, particularly in the brain. 

If you accompany the patient to the arrhythmia clinic, ask a healthcare provider to explain the risks, benefits, and side effects of current anticoagulant treatment. That way, the patient can make an informed decision about how to best treat the risk of stroke associated with atrial fibrillation, while limiting the risk of bleeding as much as possible. 

Avoid Medication Overload

Caregivers are often responsible for helping patients keep up with their medications. But this task can be challenging. Michelle Mead-Sally, RN, nurse coordinator at the Atrial Fibrillation Center of William Beaumont Hospital in Royal Oak, Michigan points out that patients with atrial fibrillation often take prescription medications for other conditions too, like diabetes or hypertension. 

Mead-Salley suggests the following measures to help avoid the risk of dangerous drug interactions: 

  • Keep a detailed list of the patient’s medications, including information about dose and frequency.
  • Report any drug side effects to the patient’s healthcare practitioner. 

RELATED: A Skipping Heart Rate Led to Stroke

Keep up With Lifestyle Adjustments

Many factors influence treatment for atrial fibrillation. Day stresses that some foods like green leafy vegetables, and common supplements like fish oil, as well as medications including antibiotics — all limit the anticoagulation effect with warfarin, a common blood thinner used in atrial fibrillation. Experts suggest preparing healthy foods that maintain a steady vitamin K level, rather than a large variation in greens from one day to the next.

The American College of Cardiology recommends the following lifestyle adjustments for people with atrial fibrillation that caregivers can support:

  • Avoid or reduce alcohol and caffeine intake 
  • Reduce or maintain weight
  • Follow a low sodium and low fat diet, like the DASH diet 
  • Be as active as possible 
  • Engage in activities that reduce stress, like yoga, breathing exercises, since stress is also a trigger for atrial fibrillation
  • Stop smoking 

Day emphasizes that as a caregiver, you should also be alert for falls in people with atrial fibrillation because of the increased risk of bleeding when taking blood thinning medications. Also, caregivers can often be the first to identify changes in symptoms such as signs of dizziness that may increase the risk of falls. As a caregiver, you can encourage the patient to install safety features, especially in the bathroom, such as non-slip suction mats in the bath or shower, and grab bars.

Look After Yourself

Pat spends a lot of her caregiving time transporting her mother to anticoagulation clinic appointments. A disrupted schedule is one of the most difficult things to deal with as a caregiver for a patient with atrial fibrillation. Mead-Salley recommends that caregivers talk with the scheduling staff at the clinic, who will try to accommodate caregivers’ other obligations. 

Caregiving can take an emotional toll. Some arrhythmia clinics have a dedicated nurse specialist, like Mead-Salley, who can answer questions or coordinate a support group that provides a place to exchange and keep up to date with information. If there is an atrial fibrillation support group near you, consider joining.