Kristen Mauk

About Kristen Mauk

President/CEO - Senior Care Central, LLC

The 6-Step Process of Stroke Recovery

Caring For Husband

 

According to the CDC, nearly 800,000 persons in the United States have a stroke each year. This is about one every 4 minutes, resulting in over 130,000 deaths annually. Stroke is simply defined as an interruption to the blood supply to the brain and is caused by a clot or hemorrhage. It can be a devastating problem for survivors, resulting in changes in mobility, cognition, speech, swallowing, bowel and bladder, self-care, and general functioning to varying degrees.  Some people recover completely after a stroke, but others experience lifelong challenges.

The good news is that there is hope and quality of life after stroke. In my research with stroke survivors, I discovered 6 phases that survivors reported as they made the journey through rehabilitation towards recovery. These steps can be used to see where a person is in the recovery process, help us understand how they may be feeling, and help guide the way we interact with them.

Agonizing:  In this first phase of the process, stroke survivors are in shock over what has happened to them. They can’t believe it, and may even deny the warning signs of stroke. The important task during this time is survival from the stroke itself.  Call 911 if you see the warning signs of facial droop, arm weakness, or speech difficulties.

Fantasizing:  In the second phase of the stroke process, the survivor may believe that the symptoms will all go away. Life will return to normal, and there is a sense of the problem being unreal. Time takes on a different meaning. The way to help is to gently help them recognize reality, and without taking away hope for recovery.

Realizing: This is the most important phase that signals a turn in the recovery process. This is when the survivor realizes that he/she may not fully recover from the effects of the stroke and that there is work to be done to rehabilitate and reclaim life. Common feelings during this phase of realizing are anger and depression. The way to help is to encourage the person to actively engage in rehabilitation. The real work of recovery is just beginning.

Blending: These last 3 phases in the process of stroke recovery may be occurring at much the same time. This is where the real work of adaptation to life after stroke begins. The survivor begins to blend his “old life” before stroke with his new life as a stroke survivor. He/she may start to engage in former activities even if it requires adaptations to be made. He/she will be actively engaged in therapy and finding new ways to do things. The way to help is to promote education. This is a time when survivors are most ready to learn how to adjust to life after stroke. Listen to your rehab nurses, therapists, and physician. Be active in the recovery process.

Framing: During this phase, the individual wants to know what caused the stroke. Whereas in the Agonizing phase they were asking “why me?”, now they need to the answer to “what was the cause?”  Stroke can be a recurring disorder, so to stop a subsequent stroke, it is important to know the cause. Interestingly, if the physician has not given the survivor a cause for the first stroke, patients often make up a cause that may not be accurate. Help the survivor to learn from the health care provider what the cause of his/her own stroke was. Then steps can be taken to control those risk factors.

Owning:  In this final phase of stroke recovery, the survivor has achieved positive adaptation to the stroke event and aftermath. The survivor has accomplished the needed grief work over the losses resulting from the stroke. He/she has realized that the effects may not go away and has made positive adjustments to his/her life in order to go on. Survivors in this phase have blended their old life with the new life after stroke and feel better about their quality of life. While they still may revisit the emotions of the prior phases at times, they have accepted life as a survivor of stroke and made good adjustments to any changes that resulted. They feel that they have a more positive outlook on life. At this point, survivors can use their experience to help others cope with life after stroke.

For more information about stroke recovery, visit www.seniorcarecentral.net and view Dr. Mauk’s model for stroke recovery.

By |2018-10-29T13:59:48+00:00October 29th, 2018|Dr. Mauk's Boomer Blog, News Posts|Comments Off on The 6-Step Process of Stroke Recovery

Bladder Cancer Risk Factors and Treatment

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Background

This type of cancer occurs mainly in older adults, with an average age at diagnosis of 73 years, with 9 out of 10 cases of bladder cancer diagnosed in persons over age 55. The American Cancer Society (ACS)(2012) reported that over 73,000 cases were diagnosed in 2012 and that this diagnosis rate has been relatively stable over the last 20 years. Men are three times as likely to get cancer of the bladder as women (American Foundation for Urologic Disease, 2008) and the incidence increases with age.

Risk Factors

Risk factors include chronic bladder irritation and cigarette smoking, the latter contributing to over half of cases. Male gender and age are also risk factors.

Warning signs

The classic symptom of bladder cancer is painless hematuria (blood in the urine). Older adults may attribute the bleeding to hemorrhoids or other causes and feel that because there is no pain, it must not be serious.

Diagnosis

Assessment begins with a thorough history and physical. Diagnosis may involve several tests including an intravenous pyelogram (IVP), urinalysis, and cystoscopy (in which the physician visualizes the bladder structures through a flexible fiber-optic scope). This is a highly treatable type of cancer when caught early. In fact, the ACS (2012a ) estimates that there were more than 500,000 survivors of this cancer in 2012.

Treatment

Once diagnosed, treatment depends on the invasiveness of the cancer. Treatments for bladder cancer include surgery, radiation therapy, immunotherapy, and chemotherapy (ACS, 2012). Specifically, a transurethral resection (TUR) may involve burning superficial lesions through a scope. Bladder cancer may be slow to spread, and less invasive treatments may continue for years before the cancer becomes invasive or metastatic, if ever. Certainly chemotherapy, radiation, and immune (biological) therapy are other treatment options, depending on the extent of the cancer.

Immune/biological therapy includes Bacillus Calmette-Guérin (BCG) wash, an immune stimulant that triggers the body to inhibit tumor growth. BCG treatment can also be done after TUR to inhibit cancer cells from re-growing. Treatments are administered by a physician directly into the bladder through a catheter for 2 hours once per week for 6 or more weeks (Mayo Clinic, 2012a). The patient may be asked to lay on his/her stomach, back, and or sides throughout the procedure. The patient should drink plenty of fluids after the procedure and be sure to empty the bladder frequently. In addition, because the BCG contains live bacteria, the patient should be taught that any urine passed in the first six 6 hours after treatment needs to be treated with bleach: One cup of undiluted bleach should be placed into the toilet with the urine and allowed to sit for 15 minutes before flushing (Mayo Clinic, 2012a).

If the cancer begins to invade the bladder muscle, then removal of the bladder (cystectomy) is indicated to prevent the cancer from spreading. Additional diagnostic tests will be performed if this is suspected, including CT scan or MRI. Chemotherapy and/or radiation may be used in combination with surgery. When the cancerous bladder is removed, the person will have a urostomy, a stoma from which urine drains into a collection bag on the outside of the body, much like a colostomy does. Bleeding and infection are two major complications after surgery, regardless of type, whether a TUR or cystectomy is performed. Significant education of the patient related to intake/output, ostomy care, appliances, and the like is also indicated.

For more information on Bladder Cancer, visit National Cancer Institute at:
http://www.cancer.gov/cancertopics/wyntk/bladder/

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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By |2018-10-19T15:26:03+00:00October 21st, 2018|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Bladder Cancer Risk Factors and Treatment

The Sandwich Generation: Make it a Triple Decker!

We have all heard of the “sandwich generation” – those middle-aged adults who are still caring for their own children and also an aging parent. Well, here is an emerging trend that I will call the Triple Decker Sandwich generation: Baby Boomers who help care for aging parents, who still have children at home of their own, and who find themselves also taking on full time care of their small grandchildren. Yes, that is a sandwich of an entirely different kind. That is a Triple Decker.

Pew Social Trends (2013) revealed that many adults in their 30s and 40s were caring for ailing older parents and also providing some type of financial support for grown children. This resulted in reports from the sandwich generation in feeling in a hurry, rushed, and not having enough time for all of their expected duties. Now, add to those statistics another emerging trend: grandparents caring for grandchildren. I am not referring to the occasional or even regular hour babysitting or childcare that loving grandparents provide. Instead, this is the 24/7 responsibility for grandchildren who live with them, or whom they have adopted. The 2015 Profile of Older Americans from the Agency on Aging found that “in 2014, about 554,579 grandparents aged 65 or more had the primary responsibility for their grandchildren who lived with them”. Now, please note that this is only those grandparents aged 65 an over. What about all the others in their 50s and early 60s doing the same? I imagine that each person reading this can think of at least one or two grandparents who are raising small grandchildren. The implications of this on the health of aging persons is enormous. So, here are some tips to survive the Triple Decker Sandwich generation.

Pace yourself

If you have this many people in your life to care for, you must pace yourself. Avoid the temptation to give 100% all the time. It isn’t possible. Something in your life will suffer – and often this is your own health. Think of this task of caring for multiple generations as running a marathon. Develop skills, train, get into a good rhythm that you can maintain for the long haul.

Set priorities

You might have been able to juggle 4 kids and a job when you were in your late 20s or early 30s, but maybe now you are in your 50s with aging parents, teenagers, and a grandbaby to care for. Flexibility is a key to success. You just can’t do everything the same way if you are caring for small children again. Decide what is most important. Set reasonable and attainable goals. Make small goals for each day and celebrate those accomplishments.

Accept help

Even if you were used to being able to do it all yourself when you were younger, the amount of care that a Triple Decker generation person takes on requires some help at times. Let your adult children watch that baby to give you a break. Let the teens in the house help with the childcare. It is a good time for them to learn these skills for when they are parents. Tag team with your spouse to share the burden if you have a little one in the home. Church friends are happy to help if you need a night out.

Take time to rejuvenate

Being part of a Triple Decker sandwich is tough. Take time to rejuvenate to avoid burnout. You can’t care for anyone if you become ill or incapacitated yourself. For each person, renewal comes in different forms. For men, this might mean playing a sport or watching games on TV without interruption, or having a quiet private place in the house that is off limits from the noise of the household. For moms, this might be shopping alone or getting a manicure or pedicure. Sometimes talking on the phone, or meeting with friends for lunch provides a needed break. Know what you personally need to recharge and refocus and then allow yourself this (without guilt) on a regular basis. You may not be able to change your circumstances, but you can change how you deal with them.

Don’t expect too much

Chances are, if you find yourself in the Triple Decker mode, you are aging yourself. You can remember how you balanced work, life, kids, and higher education by yourself years ago. Now you wonder how you did it all. Well, you were 20 or 30 years younger then, so cut yourself some slack. Be sure to get enough sleep. Take breaks as needed. Exercise and eat right. Cut out the unnecessary things you did before to fill time and focus on those priorities that you set, without neglecting your own health.

Triple Decker Sandwich persons are tough and resilient. Congratulate yourself that you have been able to make it all work and care for your many loved ones. You sacrifice many things such as an easy and comfortable retirement and the ability to travel. But, you have given a great gift to those you love by sharing your care for them. In the end when you reflect back on your life accomplishments, you might very well find that this was one of the greatest.

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By |2018-10-15T18:28:35+00:00October 15th, 2018|Dr. Mauk's Boomer Blog, News Posts|Comments Off on The Sandwich Generation: Make it a Triple Decker!

Grandparents Raising Grandchildren: A Growing Trend

A Profile of Older Americans (2012) revealed that over 480,000 grandparents had primary parenting responsibility for their grandchildren who lived with them.  AARP cited that over 2.5 million grandparents are helping with the responsibility of raising their grandchildren, and 7.8 million children live in homes owned by their grandparents. These statistics represent a growing trend in American culture.

I have several friends who have raised or are raising their grandchildren in their own home. Some have formally adopted their grandchildren. Others share parenting responsibilities with one or both parents. All of them share the common feeling that this is a blessing, not a burden, but that raising grandchildren in later life does have its challenges.

Whatever the circumstances that brought grandchildren into the home of their grandparents to be raised, it can come as a shock to the older adults who find themselves in this situation.

Here are some beginning considerations to raising your grandchildren in your own home.

Impact of aging

Older adults who are assuming primary responsibility for children should “cut themselves some slack”. Don’t feel that you have to do everything as if you were a first-time parent in your 20’s. Remember that you may be parenting, but your body knows that you are still a grandparent. You may have to limit the children’s activities because keeping up with the driving and multiple schedules is too difficult. The good news is that many grandparents in this situation are retired, so both Grandma and Grandpa can help with the kids. This teamwork might not have been possible with your own children because one or both of you were working, but now you can share the duties such as driving kids to school or sports practices, helping with homework, and taking them to doctor appointments. If the children are school age, allow yourself extra time to rest and relax during the day so that after school you have the energy required for these new-again activities with the grandkids. If needed, enlist the help of other family members or friends to help by giving you a break on occasion.  Keep in mind that maintaining your own health is especially important if you have young ones depending on you.

Expenses and Education

Many older adults are on a fixed income and may not have planned to care for grandchildren. Your financial plan for retirement might need an overhaul with additional family members in the household. Several organizations have worked cooperatively to compile resources for grandparents in this situation. National and state fact sheets have been developed to link grandparents with key resources in their area. You can find out about resources available to help you at http://www.aarp.org/relationships/friends-family/grandfacts-sheets/ .These helpful fact sheets list local programs, public benefits, key state laws, and contact information for national resources. There may be funding or tax breaks to help with living or educational expenses.

Records and immunizations

It’s important to keep important documents together in one safe place. This includes birth certificates, legal papers, report cards, baptismal papers etc… Keeping a log or journal of important events is also a good strategy, especially when caring for multiple children. There are a number of immunizations for children today that were not available or required when you parented your own children. Immunizations are often free at your county health department, but can be very expensive at the doctor’s office. The health department can tell you what your child needs and when, and will help you by providing an immunization record that will need to be kept up for school. The CDC has a helpful chart of recommended immunizations for birth to 6 years that can be found at http://www.cdc.gov/vaccines/parents/downloads/parent-ver-sch-0-6yrs.pdf  A summary of vaccinations for birth to age 18 can be found at http://www.immunize.org/catg.d/p2010.pdf

Enjoy your Grand Family

Despite the obvious challenges of raising grandchildren in your older years, most grandparents describe the many joys that come with this new adventure. Grandparents share a special bond with their grandchildren, and when sharing a home together, that bond can be strengthened. Grandparents can share the wisdom of their experience with this younger generation and have the opportunity to shape their lives for the better. If you are new to this second round of parenting, AARP offers a helpful guide with tips to GrandFamilies, as they call them. These can be found at Grandparents Raising Grandchildren: A Growing Trend

 

 

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By |2018-10-08T09:24:17+00:00October 8th, 2018|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Grandparents Raising Grandchildren: A Growing Trend

Pneumonia Information


According to the CDC (2010), chronic lower respiratory disease and pneumonia with influenza are the third and ninth leading causes of death, respectively, among older adults. Older adults 65 and older are more often affected by these disorders than younger adults, and the risk of death from pneumonia increases with age. In 2005, there were 651,000 hospital discharges of males diagnosed with pneumonia and 717,000 discharges of females, with greater than 62,000 deaths attributed to pneumonia (American Lung Association [ALA], 2008). The majority of these cases occurred in those age 65 and older, with the elderly having 5–10 times the risk of death from pneumonia as younger adults (Kennedy-Malone, Fletcher, & Plank, 2004).

Pneumonia is an infection of the lung that can be caused by bacteria, viruses, or mycoplasmas. The two most common ways to get pneumonia are through inhalation of droplet particles carrying infectious germs and aspiration of secretions of the nose or mouth areas. Older adults are at higher risk for pneumonia and can get a more serious infection if they also have other chronic diseases such as COPD, heart failure, a suppressed immune system, cerebrovascular disease, and poor mobility (ALA, 2012). The incidence of community-acquired pneumonia (CAP) among people age 65 and older is about 221.3 per 10,000 (ALA, 2008). Streptococcus is the most common bacterial cause, with about 50% of people with CAP requiring hospitalization (Weinberger, 2004). When hospitalized, older people are at risk for poor health outcomes, including respiratory failure requiring ventilator support, sepsis, and longer length of hospitalization, duration of antibiotic therapy and other supportive treatment (ALA, 2012).

Warning signs

The onset of bacterial pneumonia can be sudden or gradual; however, older adults may not present with the typical symptoms of chills, fever, chest pain, sweating, productive cough, or shortness of breath. Instead, they may have a sudden change in mental status (confusion/delirium). Cases of viral pneumonia account for about half of all types of pneumonia and tend to be less severe than bacterial pneumonia. Symptoms of viral pneumonia include fever, nonproductive hacking cough, muscle pain, weakness, and shortness of breath.

Diagnosis

Diagnosis is made through chest x-ray, complete blood count, and/or sputum culture to determine the type and causal agents (if bacterial). A thorough history and physical that includes assessment of swallowing ability and eating (watch for coughing while eating) to evaluate for aspiration risk should be done. Crackles may be heard in the lungs through a stethoscope, and chest pain with shortness of breath may be present.

Treatment

Bacterial pneumonia can often be treated successfully when detected early, and viral pneumonia generally heals on its own (antibiotics are not effective if pneumonia is caused by a virus), though older adults may experience a greater risk of complications than younger adults. Oral antibiotics will significantly help most patients with bacterial pneumonia.

Aspiration pneumonia is caused by inhalation of a foreign material, such as fluids or food, into the lungs. This occurs more often in persons with impaired swallowing. For older adults receiving tube feedings, care must be taken to avoid having the person in a laying position during and immediately after tube feeding because aspiration can occur; it is important to note that tube feedings do not reduce the risk of aspiration. Having the head of the bed elevated or, even better, the person in a sitting position when eating or receiving nutrition through a feeding tube, helps to avoid the potential complication of pneumonia related to aspiration.

When recovering from pneumonia, one should get plenty of rest and take adequate fluids to help loosen secretions (with accommodations made to support the added need to urinate due to the increased fluid intake, a common reason why older adults may not drink adequate fluids). Tylenol or aspirin (if not contraindicated by other conditions) can be taken to manage fever as well as aches and pains. Exposure to others with contagious respiratory conditions should be avoided. Respiratory complications are often what lead to death in the older adults, so they should be cautioned to report any changes in respiratory status such as increased shortness of breath, high fever, or any other symptoms that do not improve. It is important to follow up with the physician or nurse practitioner and get a chest x-ray if ordered, since symptoms may improve with treatment before the pneumonia is actually completely gone.

Prevention of pneumonia is always best. Adults over the age of 65 are advised to get a pneumonia vaccine. Persons younger than age 65 who have higher risk (those with respiratory problems or persons in nursing homes) should get the vaccination. A yearly flu vaccine is also recommended for older adults, because pneumonia is a common complication of influenza in this age group. Medicare will cover these vaccines for older persons.

By |2018-08-19T17:39:36+00:00August 23rd, 2018|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Pneumonia Information