Kristen Mauk

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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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

One of the common health complaints of the elderly is chronic sinusitis. About 14.1% of Americans 65 and older report suffering from chronic sinusitis; for those 75 years and older, the rate is slightly lower at 13.5% (American Academy of Otolaryngology, 2012). Age-related physiological and functional changes that occur can cause restrictions to the airflow. This results from irritants blocking drainage of the sinus cavities, leading to infection.

Warning Signs

Symptoms include a severe cold, sneezing, cough (that is often worse at night), hoarseness, diminished sense of smell, discolored nasal discharge, postnasal drip, headache, facial pain, fatigue, malaise, and fever (Kelley, 2002). The person may complain of pain around the sinus areas, and swelling and redness of the nasal mucosa may be evident.

Diagnosis

Allergies, common cold, and dental problems should be ruled out for differential diagnosis. When symptoms continue over a period of weeks and up to 3 months and are often recurring, chronic sinusitis should be suspected. A CT scan of the sinuses will likely show areas of inflammation.

Treatment

Treatment for chronic sinusitis is with antibiotics, decongestants, and analgesics for pain. Inhaled corticosteroids may be needed to reduce swelling and ease breathing. Irrigation with over-the-counter normal saline nose spray is often helpful and may be done two to three times per day. The person with chronic sinusitis should drink plenty of fluids to maintain adequate hydration and avoid any environmental pollutants such as cigarette smoke or other toxins. Chronic sinusitis is a condition that many older adults wrestle with their entire life. Avoidance of precipitating factors for each individual should be encouraged.

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. Sudbury, MA: Jones and Bartlett Publishers. Used with permission.

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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.