Kristen Mauk

With the birth of my daughter’s second child, I began to reflect on the important role that grandparents can play in the lives of their grandchildren. Here are five essential tips for older adults who want to have a lasting influence in the lives of their children and grandchildren.

Visit often.  For those of us fortunate enough to live near our children and grandchildren, it is easy to see them often. Grandparents may even be the caregivers while parents are working. Visits don’t always have to be planned. Sometimes the best family time is a spontaneous invitation to dinner and a movie. However, sometimes distance can prevent regular visits. Some grandparents make it a goal to see their distant grandchildren once every 6 weeks or every few months. Be sure to take advantage of technology for your time together. Set a regular time to Skype or do Face-time. Don’t miss out on the subtle changes in those early years while babies are growing. Exchanging pictures may help, but they don’t replace the in-person experience. You may even think of relocating to be closer to family. For older grandchildren, be sure to have their cellphone number. Text them often and exchange pictures to stay involved in their lives and let them know you are available to them. Even small connections throughout the week (but without being annoying to teenagers of course) can make a difference in your relationship with your grandchildren.

Offer to help in practical ways. Working parents with young children will need a break at times. Ask how you can best help. Offer to keep the children for an overnight while mom and dad have a special dinner or weekend getaway. Many grandparents like to take their grandchildren on trips without the parents. Places like amusement parks, the zoo, or day trips to the water park or national forest all provide good diversion and quality time with Grandma and Grandpa while giving parents a rest. For even more quality time, take the older grandchildren on a cruise, camping in the mountains, or to a resort without their parents. For the mom with a newborn, take meals to the house (if you live close), do her grocery shopping or laundry, or send her a new bathrobe to show you are thinking of her. A favorite role model of mine sends the grandchildren a “baby shower in a box” with all sorts of goodies when she can’t be present due to distance or health concerns.

Plan special activities. Special activities need not be expensive. This could mean a trip to the park with Grandma or a special morning walk each week with Grandpa. My father used to take every grandson on a bow-hunting trip when they turned 12 years old. This was a rite of passage for every boy in the family. Grandpa would mount their first deer head for them and buy them a special hunting knife to commemorate the occasion. The girls in the family would take a trip to a Disney resort while the men were hunting. Grandchildren remember these events forever.

Attend special events. How fortunate are the kids whose grandparents are able to attend basketball and volleyball games, swimming tournaments, and Grandparent’s Day at school! Take advantage of being able to attend those dance recitals and school plays. If you live far, plan your visits to be able to attend some significant events like graduations, wedding showers, or school performances. This makes lasting memories with your family.

Be a constant in their lives. My parents divorced when I was 9 years old, and my paternal grandparents were the one constant in my life at that time. When a child’s world is jolted by change, grandparents can be that steadying influence that doesn’t change. They provide stability and security in an unsteady world for a child. The most important thing to remember is to be there. You don’t have to be the all-star parent or grandparent, but your children will remember that you were there for them when it counted the most.

Background

There are three major types of skin cancer: basal cell, squamous cell, and malignant melanoma (MM). Basal cell carcinoma is the most common skin cancer, accounting for 65–85% of cases (Kennedy-Malone et al., 2000). According to the American Cancer Society (2013), more than 3.5 million cases of basal cell and squamous cell skin cancer are diagnosed every year. Squamous cell carcinoma is more common in African Americans and is also less serious than malignant melanoma. Malignant melanoma accounts for only 3% of all skin cancers, but it is responsible for the majority of deaths from skin cancer. Older adults are 10 times more likely to get MM than adults under age 40 (Johnson & Taylor, 2012). About 8,420 people were estimated to die from malignant melanoma in 2008. The American Cancer Society (2013) estimated that in 2013 there would be over 76,000 new cases of malignant melanoma in the United States.

Risk Factors

Older adults are more susceptible to skin cancers because of a variety of factors. These include exposure to carcinogens over time (such as through sunburn or tanning booths) and immunosenescence, or a decline in immune function. Family history of skin cancers, multiple moles (more than 100), and pale skin also put a person at higher risk. The major risk factor for all types of skin cancer is sun exposure.

Warning Signs

The ABCDE method can help people remember the warning signs of skin cancer:
A = Asymmetry (if a line is drawn down the middle of the lesion, the two sides do not match)
B = Border (the borders of the lesion tend to be irregular)
C = Color (a variety of colors is present; the lesion is not uniform in color)
D = Diameter (MM lesions are usually larger)
E = Evolving (note any changes in shape or size, or any bleeding)

Diagnosis

Annual physical examinations should include inspection of the skin for lesions. Older adults should be taught to report any suspicious areas on their skin to the physician. Persons should particularly look for changes in shape, color, and whether a lesion is raised or bleeds.

Basal Cell Carcinoma

Basal cell carcinoma (BCC) is the most common kind of skin cancer. It is often found on the head or face, or other areas exposed to the sun. Although there are different forms of BCC, the nodular type is most common, and appears as a raised, firm, papule that is pearly or shiny with a rolled edge. (Johnson & Taylor, 2012). Patients often complain that these lesions bleed and scab easily. When treated early, it is easily removed through surgery and is not life threatening, though it is often recurring.

Squamous Cell Carcinoma

Squamous cell carcinoma (SCC) also appears as lesion on areas of the body exposed to the sun, or from other trauma such as radiation. HPV is a risk factor of SCC, and metastasis is more common than with BCC. The lesions of SCC appear scaly, pink, and thicker than BCC. Their borders may be more irregular and the lesions may look more like an ulceration.

Malignant Melanoma

Malignant melanoma MM has a more distinctive appearance than other types of skin cancer. The areas appear asymmetric with irregular borders, a variety of colors (including black, purplish, and pink), and size greater than 6 mm. Malignant melanoma MM is often identified with the ABCDE method and MM accounts for the vast majority of deaths from skin cancer. The good news is that MM is almost always curable when found early. A skin check should be part of an older person’s yearly physical.

Treatment

The best treatment for skin cancer in the elderly is prevention. All older persons, especially those with fair skin who are prone to sunburn, should wear sunblock and protective clothing. Most skin cancers, when treated early, have a good prognosis.

All skin lesions larger than 6 mm, or those with any of the ABCDE signs, should be referred for biopsy. There are many nonsurgical interventions. These include cryotherapy, radiotherapy (for superficial BCC or SCC), electrodessication and curettage, and topical treatments. Topical treatments are generally not as effective as more aggressive interventions, but research is ongoing in this area.

The prognosis for MM depends on the extent and staging of the tumor, but when caught very early, the cure rate is nearly 100%. Malignant melanoma MM presenting in older adults is often more advanced and aggressive. Malignant melanoma MM metastases sites are typically the lymph nodes, liver, lung, and brain (Johnson & Taylor, 2012). Surgical treatment is required in malignant melanoma, with chemotherapy and radiation. Adjuvant treatments for MM are also often used.

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I remember when my father retired at the age of 62 from a busy career as a pediatric surgeon. I thought he would be bored, but he had already compiled a notebook full of chores to do around the house, places he wanted to go, and a bucket list of other accomplishments that had been put on hold. Shortly after his retirement, my Mom confided in me that it was a bit of an adjustment having Dad home all the time. Suddenly, Mom said she seemed to no longer be able to cook right after about 40 years of doing this on her own. Dad had a better way to do things, after all. Once I saw Mom trying to wrap a gift and the wrapping paper seemed too small for the size of present. Dad was trying to give her step by step instructions and after snapping at her, Mom let him wrap the gift himself. Now, while I do concede that Dad was able to wrap the gift absolutely perfectly with the allotted paper, Mom and I gave each other a knowing glance and smiled. Ah, retirement.

So, when my own husband announced that he was going to retire and sell his share of the business at the age of 51, I knew I had to take some action to give our marriage the best chance to survive and thrive against this new challenge. After all, when my father-in-law retired, my mother-in-law had to encourage him to get a part-time job so she could have some “peace”. Even she was a bit concerned when my husband decided to take early retirement. Here I offer my short bit of wisdom, gleaned not only from my own experience but also from many wise women who gave me their sage advice to prepare for this season of life: when your husband retires.

Set the ground rules. I had fortunately learned during a brief period when my husband was working from home that there were certain things that would have to be agreed upon before he ever retired if we were to live peaceably. For example, he was not allowed to take over any of my former responsibilities unless I asked him to. Driving the kids around to activities can be helpful, but trying to wash the shrinkable clothes was not. Taking us out to eat after I worked all day was fine, but trying to take over the kitchen was off limits. Helping the kids with business math (not my area of expertise) was great, but trying to be the full-time homeschool Dad was not going to work for any of us.

Have separate work spaces. Jim and I cannot share a computer. I teach partially online and spend lots of time working from home with consulting. We agreed early on that he would set up a separate place in a different part of the house for his computer and desk. This has created much harmony over sharing the work space.

Allow everyone time to adjust to the change. I must admit that it took me several weeks, maybe even months, to realize that my husband was truly going to retire. Once he was home all the time, the reality gradually set in, but I kept reminding myself to give us all an adaptation period as if we were starting a new job orientation, because things were definitely going to change. Our two teenagers were the most leery of Dad being home all the time. For them, the ground rules (i.e. “please just let us do our work and don’t change our routine”) were particularly essential.

Accept your differences. My husband is a problem-solver and savior. He likes a challenge and wants to fix everything for everyone if he can. While I admire this about him, I didn’t want him to fix the nice structure and functionality by which our home was already running. I learned to embrace his strengths and encourage him to accept my weaknesses (like overindulging in carbs and worrying about things I can’t control). He likes to exercise every day, watch sports, and spend time on the landscaping. I would rather take the kids to the movies and go shopping. And that had to be ok.

Embrace the positives. While I was a bit skeptical about how our lives would change with my husband retiring so soon, there are so many things to celebrate that I am daily embracing the wonderful opportunities and blessings that his retirement has brought to our family. We are free to travel more. He accompanies me on business trips, even to China twice! He is much more relaxed and pleasant. It makes our family happy to see him have the time and resources to do what he enjoys. Jim keeps busy all of the time and yet does not have the daily pressure of work-related stress. We spend more time with family and have plans to move nearer to the grandchildren and to a better climate.

For all the women who are warily facing their husband’s retirement, take heart. I can honestly say that with some forward and deliberate planning, my husband’s retirement is one of the best things that has ever happened to us!

Background

Although gastroesophageal reflux disease (GERD) is common among older adults, the true prevalence is not known. Many patients with GERD-related symptoms never discuss their problems with their primary care provider. GERD is thought to occur in 5–7% of the world’s population, with 21 million Americans affected (International Foundations for Functional Gastrointestinal Disorders, 2008). It is found in both men and women.

Signs and symptoms

Pathophysiological changes that occur in the esophagus, hiatal hernia, and certain medications and foods increase the risk for GERD. Obesity (Corely , Kubo, Levin et al., 2007) and activities that increase intra-abdominal pressure such as wearing tight clothes, bending over, or heavy lifting have also been linked to GERD (MedlinePlus, 2005a). The cardinal symptom of GERD is heartburn; however, older adults may not report this, but rather complain of other symptoms such as pulmonary conditions (bronchial asthma, chronic cough, or chronic bronchitis), a hoarse voice, pain when swallowing foods, chronic laryngitis, or non-cardiac chest pain (Pilotto & Franceschi, 2009). The chronic backflow of acid into the esophagus can lead to abnormal cell development (Barrett esophagus) that increases the risk for esophageal cancer.

Diagnosis

Older adults often have atypical symptoms, making the diagnosis of GERD very challenging. As people age, the severity of heartburn can diminish, while the complications, such as erosive esophagitis, become more frequent. Therefore, endoscopy should be considered as one of the initial diagnostic tests in older adults who are suspected of having GERD (Pilotto & Franceschi, 2009). Examination of the esophagus, stomach, and duodenum through a fiber-optic scope (endoscopy) while the person receives conscious sedation, allows the gastroenterologist to visualize the entire area, identify suspicious areas, and obtain biopsies as needed. Helicobacter pylori (H. pylori), a chronic bacterial infection in humans, is a common cause of GERD, affecting about 30% to 40% of the U.S. population. Testing for H. pylori can be done during the endoscopy or by other tests (Ferri, 2011).

Treatments

The objectives of treatment for GERD include: (1) relief of symptoms, (2) healing of esophagitis, (3) prevention of further occurrences, and (4) prevention of complications (Pilotto & Francheschi, 2009). Lifestyle and dietary modifications are important aspects of care. It is widely recommended that persons with GERD should stop smoking, limit or avoid alcohol, and limit chocolate, coffee, and fatty or citrus foods. Medications should be reviewed and offending medications modified, since certain medications decrease the lower esophageal sphincter (LES) tone, allowing acid to backflow into the esophagus. These include anticholinergic drugs, some hormones, calcium channel blockers, and theophylline. Avoidance of food or beverages 3–-4 hours prior to bedtime, weight loss, and elevation of the head of the bed on 6-to-8 inch blocks are some other interventions that may help alleviate symptoms. Pharmacological treatments with antacids in conjunction with histamine 2 (H2) -blockers (Tagmet, Zantac, Axid, and Pepcid) are used for mild GERD. If these are ineffective in controlling symptoms, then the proton pump inhibitors (PPIs) are the next drugs of choice. These include medications like Nexium and Dexilant. With lifestyle modifications and appropriate medications, older adults can manage their GERD symptoms so that quality of life is maintained.

Adapted from Mauk, K. L., Hanson, P., & Hain, D. (2014). Review of the management of common illnesses, diseases, or health conditions. In K. L. Mauk’s (Ed.) Gerontological Nursing: Competencies for Care. Burlington, MA: Jones and Bartlett Publishers. Used with permission.

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