Glaucoma is a group of degenerative eye diseases with various causes that leads to progressive optic neuropathy, in which the optic nerve is damaged by high intraocular pressure (IOP), resulting in blindness. Glaucoma is a leading cause of visual impairment and the second leading cause of blindness in the United States; it occurs more often in those over 40, with an increased incidence with age (3% to 4% in those over age 70) (Fingeret, 2010; Kennedy-Malone et al., 2000; Podolsky, 1998).
Unlike cataracts, there are some ethnic distinctions with the development of glaucoma. African Americans tend to develop it earlier than Caucasians, and females more often than males. Glaucoma is more common in African Americans, adults over age 60 (especially Mexican Americans), and people with a family history (NIH, 2013). Other contributing factors include eye trauma, small cornea, small anterior chamber, cataracts, and some medications.
Signs and symptoms
Although the cause is unknown, glaucoma results from blockage that limits the flow of aqueous humor, causing a rise in intraocular pressure (IOP). Two major types are noted here: acute and chronic. Acute glaucoma is also called closed angle or narrow angle. Signs and symptoms include severe eye pain in one eye, blurred vision, seeing colored halos around lights, red eye, headache, nausea, and vomiting.
Symptoms may be associated with emotional stress. Acute glaucoma is a medical emergency and persons should seek emergency help immediately. Blindness can occur from prolonged narrow angle glaucoma.
Chronic glaucoma, also called open angle or primary open angle, is more common than acute (90% of cases are this type), affecting over 2 million people in the United States. One million people probably have glaucoma and don’t know it, and 10 million people have above normal intraocular pressure that may lead to glaucoma if not treated (University of Washington, Department of Ophthalmology, 2008). This type of glaucoma occurs gradually. Peripheral vision is slowly impaired. Signs and symptoms include tired eyes, headaches, misty vision, seeing halos around lights, and worse symptoms in the morning. Glaucoma often involves only one eye, but may occur in both.
Since there is no scientific evidence of preventative strategies, early detection in those at risk is important. Treatment is essential to prevent loss of vision, because once vision has been lost to glaucoma, it cannot be restored. Diagnosis is made using a tonometer to measure IOP. Normal IOP is 10–21 mm Hg. Ophthalmologic examination will reveal changes in the color and contour of the optic nerve when glaucoma is present. Gonioscopy (direct exam), which is performed by an optometrist or ophthalmologist, provides another means of evaluation. Older persons and those at higher risk should have a yearly eye exam to screen for glaucoma.
Treatment is aimed at reducing IOP. Medications to decrease pressure may be given, and surgical iridectomy to lower the IOP may prevent future episodes of acute glaucoma. In chronic glaucoma, there is no cure, so treatment is aimed at managing IOP through medication and eye drops. Consistent use of and correct administration of eye drops is important. Older adults should be assessed for safety related to visual changes and also reminded to schedule and attend regular visits with their ophthalmologist.
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.
Have you heard? A new government study has revealed that falls among adults over 65 rose over 30% in the past 10 years! While a fall every now and then may feel like no big deal, it is important for seniors to recognize that even seemingly harmless falls can lead to dangerous complications like hip fractures and head trauma.
If you or the person you care for hasn’t fall-proofed one of the most dangerous spots in the home, the shower, yet, don’t miss this essential list of helpful safety tools:
Are you still struggling with slippery bars of soap and hard-to-grip shampoo and conditioner bottles in the shower? Get an easy-to-install toiletry dispenser instead which can stay fixed to the wall under your shower head and dole out toiletries in your hand as needed with the push of a button.
Experts recommend installing grab bars both inside and outside the shower on walls that are easy to reach and can fully support your weight when you brace against them. Similar products like bathtub bars which sit fixed on the side of a bathtub and provide a raised support to hold and steady yourself are great too for notoriously hard-to-navigate tub showers.
Non-slip Shower Mat
Not all shower mats are created equal, and for seniors taking fall prevention measures in the shower, finding one that stays in place and offers a textured non-slip surface to stand on is critical. Additional features like being antimicrobial and machine-washable also prevent the buildup of contaminants and mildew which are common to humid areas like the shower.
Even if you have no mobility issues at all, a shower chair may be a good investment if your space allows for it. Shower chairs make it easy to sit and rest in the shower if you suddenly feel weak or unbalanced. And specialty transfer chairs help caregivers easily get a loved one in and out of the shower without over-exerting themselves or putting their loved one’s safety at risk.
Handheld Shower Head
Quit trying to twist, turn, and contort your body when bathing yourself. A removable, handheld shower head is a must for easy, thorough washing that won’t leave you with a muscle strain in your back. Experts recommend getting one with at least 5 feet of maneuverable cord to allow for enough slack to raise and move it around your body with ease.
Outside of the shower, additional upgrades that can improve your safety and bathroom experience include automatic lights that provide consistent, bright lighting without having to flip a switch, non-slip bathroom mats, and raised toilet seats with handles.
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!
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.
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).
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.
Stroke, also known as cerebrovascular accident (CVA) or brain attack, is an interruption of the blood supply to the brain that may result in devastating neurological damage, disability, or death. Approximately 795,000 people in the United States have a new or recurrent stroke each year (American Stroke Association [ASA], 2012a). Stroke accounts for 1 in 18 deaths, making it the fourth leading cause of death in the United States. A death from stroke occurs every 4 minutes and the cost of stroke treatment and disability was over $73 billion dollars in 2010. Death from stroke is generally higher among females, with higher rates in Black males (67.7/100,000) and females (57.0/100,000) than in Caucasians (ASA, 2012a). In Canada, stroke is the fourth leading cause of death, affecting 50,000 people each year (Heart and Stroke Foundation of Canada, 20059).
There are two major types of stroke: ischemic and hemorrhagic. The vast majority of strokes are caused by ischemia (87%), usually from a thrombus or embolus (ASA, 2012a). The symptoms and damage seen depend on which vessels in the brain are blocked. Carotid artery occlusion is also a common cause of stroke related to stenosis
Some risk factors for stroke are controllable and others are not. The most significant risk factor for stroke is hypertension. Controlling high blood pressure is an important way to reduce stroke risk. Those with a blood pressure of less than 120/80 have half the lifetime risk of stroke as those with hypertension (ASA, 2012a). Smoking 40 or more cigarettes per day (heavy smoking) increases the stroke risk to twice that of light smokers. If a person quits smoking, their risk after 5 years mirrors that of a nonsmoker, so older adults should be particularly encouraged to stop smoking.
Several warning signs are common. These include:
SUDDEN numbness or weakness of face, arm or leg – especially on one side of the body.
SUDDEN confusion, trouble speaking or understanding.
SUDDEN trouble seeing in one or both eyes.
SUDDEN trouble walking, dizziness, loss of balance or coordination.
SUDDEN severe headache with no known cause (National Stroke Association, 2013)
There are several tools for assessing for signs and symptoms of stroke. One easy acronym is FAST:
F stands for facial droop. Ask the person to smile and see if drooping is present.
A stands for arm. Have the person lift both arms straight out in front of him. If one is arm is drifting lower than the other, it is a sign that weakness is present.
S stands for speech. Ask the person to say a short phrase such as “light, tight, dynamite” and check for slurring or other abnormal speech.
T stands for time. If the first F-A-S checks are not normal, then one is to remember F-A-S-T that Time is important and the emergency medical system should be activated (National Stroke Association, 2012).
Older adults experiencing the warning signs of stroke should note the time on the clock and seek immediate treatment by activating the emergency response system in their area calling 911 (American Stroke Association, 2012). Transport to an emergency medical facility for evaluation is essential for the best array of treatment options. A history and neurological exam, vital signs, as well as diagnostic tests including electrocardiogram (ECG), chest Xx-ray, platelets, prothrombin time (PT), partial thromboplastin time (PTT), electrolytes, and glucose are routinely ordered. Diagnostic testing imaging may include computed tomography (CT) without contrast, magnetic resonance imaging (MRI), arteriography, or ultrasonography to determine the type and location of the stroke. The CT or MRI should ideally be done within 90 minutes so that appropriate emergency measures may be initiated to prevent further brain damage.
The first step in treatment is to determine the cause or type of stroke. A CT scan or MRI must first be done to rule out hemorrhagic stroke. Hemorrhagic stroke treatment often requires surgery to evacuate blood and stop the bleeding.
The gold standard at present for treatment of ischemic stroke is t-PA (tissue plasminogen activator). At this time, t-PA must be given within 3 hours after the onset of stroke symptoms. This is why it is essential that older adults seek treatment immediately when symptoms begin. Only about 3 – 5% of people reach the hospital in time to be considered for this treatment (ASA, 2012d). t-PA may be effective for a select group of patients after the 3-hour window (up to 4.5 ½ hours), and this treatment window has been approved in Canada (Heart and Stroke Foundation of Canada, 2009). The major side effect of t-PA is bleeding. t-PA is not effective for all patients, but may reduce or eliminate symptoms in over 40% of those who receive it at the appropriate time (Higashida, 2005). Other, much less common procedures such as angioplasty, laser emulsification, and mechanical clot retrieval may be options for treatment of acute ischemic stroke.
To prevent recurrence of thromboembolic stroke, medications such as aspirin, ticlopidine (Ticlid), clopidogrel (Plavix), dipyridamole (Persantine), heparin, warfarin (Coumadin), and enoxaparin (Lovenox) may be used to prevent clot formation. Once the stroke survivor has stabilized, the long process of rehabilitation begins. Each stroke is different depending on location and severity, so persons may recover with little or no residual deficits or an entire array of devastating consequences.
The effects of stroke vary, and some persons may recover with no residual effects. But more often, stroke survivors may have problems that include hemiplegia or hemiparesis (paralysis or weakness on one side of the body), visual and perceptual deficits, language deficits, emotional changes, swallowing dysfunction, and bowel and bladder problems. Ninety percent of all dysphagia (swallowing problems) results from stroke (White, O’Rourke, Ong, Cordato, & Chan, 2008).
Rehabilitation after a stroke focuses on several key principles. These include maximizing functional ability, preventing complications, promoting quality of life, encouraging adaptation, and enhancing independence. Rehabilitation emphasizes the survivor’s abilities, not disabilities, and helps him or her to work with what he or she has while acknowledging what was lost.
Stroke survivors go through a unique recovery process. This model shows the process of stroke recovery where forward progress after stroke lead to acceptance and adaptation:
If significant functional impairments are present, evaluation for transfer to an intensive acute inpatient rehabilitation program is recommended. Inpatient rehabilitation units offer the survivor the best opportunity to maximize recovery, including functional return. An interdisciplinary team of experienced experts, including nurses, therapists, physicians, social workers, and psychologists, will help the survivor and the family to adapt to the changes resulting from the stroke. Outcomes for geriatric stroke survivors are enhanced by intensive rehabilitation programs, whether offered in rehabilitation units or in skilled nursing facilities (Duraski, Denby, Danzy & Sullivan, 2012; Jett, Warren, & Wirtalla, 2005).
A large amount of teaching is often done by stroke rehabilitation nurses who work with older survivors and their families. These include knowing the warning signs of stroke and how to activate the emergency response system in their neighborhood, managing high blood pressure, understanding what medications are ordered as well as how often to take them and why, the importance of regular doctor visits, preventing falls and making the home environment safe, available community education and support groups, and the necessity of maintaining a therapeutic regimen and lifestyle to decrease the risk of complications and recurrent stroke. All survivors will need assistance in re-integrating into the community. This is generally begun in the rehabilitation setting.
Do mobility issues have your aging parent down in the dumps? Losing the ability to get around independently can definitely strike a blow to confidence and wellbeing levels. Mobility issues don’t need to stifle a senior’s sense of purpose or enjoyment of life though. Don’t miss these 8 fun activity ideas for seniors with mobility issues:
Board games – bring on the board games and give your loved one a cognitive boost. Everything from cards to Scrabble to Monopoly, Dominos, and Checkers is a great place to start. Stock up on gently used board games from local re-stores like Goodwill and invite friends and family to join in on the fun.
Puzzles – putting puzzles together stimulates critical thinking and problem-solving skills as well as engages spatial awareness and concentration. Don’t reserve your fun to jigsaw puzzles either; games like Sudoku and Jenga have similar brain-boosting effects too!
Cooking – maybe standing at the stove to stir a big pot isn’t feasible, but mixing a green salad at a lower table is. Or helping scoop cookie dough onto a baking sheet. Cooking with your aging parent not only gives them something fun to do but helps them feel like a productive contributor in the home too.
Chair exercises – routine workouts are critical for all older adults, even people who are limited to canes, walkers or wheelchairs. Physical fitness helps prevent unwanted weight gain and lifestyle diseases like diabetes and heart disease. Guides to chair exercises and exercises for those recovering from injuries like fractured hips can be found online.
Art project – get the creative juices flowing and find an art project geared towards your loved one’s interests. Perhaps it is painting on a canvas, collaging, knitting, coloring, making jewelry, or even simply framing family photos – the act of creating something can is truly invigorating.
Planting – potting plants is easy and accessible when your loved one can sit in a chair at a table. Mixing soil, placing plants inside pots, and even snipping dead leaves or picking herbs are monthly activities that your loved one can do with minor assistance.
Reading – Nothing beats a good book. If your loved one is unable to hold a book or see words on a page, audiobooks are a great alternative (and can be borrowed for free at your local library).
Video chatting – for seniors with mobility limitations, social isolation is a very prevalent and dangerous reality. Technology makes it easy, however, to connect with friends and family near and far via free services like Skype, Google Hangouts or Facetime. You simply need a smartphone or webcam with speakers for your computer.