In the wake of the sad news about the suicide death of beloved actor Robin Williams, discussions about depression, its recognition and treatment seem appropriate. Depression is common in American society, with 10% of men and 18% of women over the age of 65 in the United States reporting current symptoms associated with clinically significant depression. These statistics have been relatively stable since about 1998. Severe depression is one of the major causes for suicide attempts.
Sometimes it is hard to understand why a person would become so depressed that suicide seems like the only option. There are many reasons that depression occurs. These may include losses of various types such as outliving a spouse, friends, or loved ones. There may have been loss of health, financial difficulties, loss of a job, or a drastic unwanted change in living situation. Maybe the person has experienced a trauma that was life-changing. For some people, these losses can be overwhelmingly painful and persons may lack the support or coping mechanisms to successfully deal with their extreme feelings.
Men and women may display depression differently. Men express depression in the form of irritability, anger, agitation, controlling behavior, blaming others, or expressions of despair. In contrast, women may appear anxious, scared, apathetic, and express feelings of worthlessness.
Other common signs of depression include:
• No interest or pleasure in enjoyable activities
• No interest in sexual activities
• Feeling sad or numb
• Crying easily or for no reason
• Feeling slowed down
• Feeling worthless or guilty
• Change in appetite; unintended change in weight
• Trouble recalling things, concentrating, or making decisions
• Problems sleeping, or wanting to sleep all of the time
• Feeling tired all of the time
• Thoughts about death or suicide
While depression can be associated with suicide, persons with depression may not actually want to die. They simply feel they cannot live with the pain they feel and may express wanting that pain to end. This pain can be physical or emotional or both. In the United States, the highest rate of suicide is among white males over the age of 85. These men often visit their doctors within the month prior to their suicide, and give few other signs of their suicidal thoughts. They most often use lethal means to carry out suicide such as hanging or firearms. In women, suicide attempts are more often by nonlethal means such as taking pills, and should be considered a cry for help. If you have a loved who is at high risk for depression or suicide, be sure to take special note of the warning signs listed here.
The good news is that depression can be successfully managed and treated with the right help. Early recognition and treatment of depression is important and generally includes medication therapy and counseling. Talk to your doctor if you or your loved one is feeling depressed. Your primary care provider can assist you in diagnosing depression and can refer you to a reliable mental health professional to help address your symptoms and promote a better quality of life.
Tips for helping your loved one who is experiencing depression are provided on SCC’s care page that can be found at http://senior-care-central.com/category/dr-mauks-boomer-blog/
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.
Today’s technology is not only for the young. The digital age has brought with it innovations which aim to benefit seniors. A new age of Internet of Things (IoT) devices has made senior care better, more efficient and less costly. It aims to eliminate isolation, which has been a major concern for many years. It has provided caregivers in the healthcare industry a tool to allow seniors to be more independent and remain connected with friends and family.
When it comes to senior care, the IoT is revolutionizing the way seniors are living their lives. Assisted living communities are using the internet to connect and humanize senior care. Communities such as the K4Community leverage technology to make seniors’ life simpler, healthier and happier. These communities integrate IoT wearables such as watches or belt clips. They also have floor sensors that provide real-time monitoring to prevent falls and other injuries. Other types of sensors monitor heart rate, blood pressure and oxygen levels to immediately alert caregivers when there’s an emergency.
To lead a healthy, active lifestyle, IoT devices go beyond the standard activity trackers. Devices are more targeted towards the individual’s needs, alerting them when to rest, whether they’re standing up or down too fast and when to give their knees a break. Food and hydration is also considered, with wearables reminding seniors when it’s time to eat and how often to drink to maintain proper hydration. When it comes to sleep, sensors can also alert caregivers whether a senior needs help getting in and out of bed. With the internet being all about connection, keeping seniors in contact with friends and family is one of the best things the IoT can provide to improve senior health. Seniors are spending more time online, using social networks and other platforms to connect with loved ones.
This trend is only going to get more prevalent. Research shows that using the internet makes people happier and increases life satisfaction, especially for seniors. A study published in the Journal of Computers in Human Behavior shows that life satisfaction was much higher among seniors who use the internet than those who don’t. The ability to keep in touch and prevent the cycle of loneliness and isolation in an advanced age has done more for senior health than any medication. It is no wonder then that internet use among seniors rose from 8% to 34% between 2003 and 2012, as cited by the Journalist’s Resource. The empowerment that the internet and technology have given seniors is invaluable to their health. Such developments revolutionized the way society and healthcare providers care for the elderly.
With Baby Boomers contributing to an increasingly aging population, the need for caregivers and connected assisted living communities is becoming greater than ever. In order to provide quality healthcare to seniors, healthcare is not just about technology but also about the people who provide it. Maryville University details how general healthcare workers can specialize in senior services to provide care for an aging population. Healthcare and senior care are becoming two of the fastest-growing industries. Boosted with the aid of technology and IoT devices, they provide a way to create a better quality of life for seniors, while reducing the costs of healthcare at the same time.
Article submitted by Tanya Olivers
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.
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.
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)
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 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.
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.
Kristen L. Mauk, PhD, DNP, RN, CRRN, GCNS-BC, GNP-BC, ACHPN, FAAN
Dr. Mauk has been a Professor of Nursing for 26 years. Prior to moving to Colorado, she was a Professor of Nursing at a large private university in Indiana for nearly 25 years, and there she held the first Kreft Endowed Chair for the Advancement of Nursing Science, a position dedicated to gerontological nursing. She earned a BSN from Valparaiso University, an MS in Adult Health from Purdue University, a PhD from Wayne State University, a Post-Master’s GNP certification from University of Virginia, and a Doctor of Nursing Practice (DNP) degree from Valparaiso University.
Dr. Mauk has more than 35 years of experience in chronic illness nursing, rehabilitation, and gerontological nursing, and teaches in these specialties at both the graduate and undergraduate levels. She is certified in rehabilitation, as a gerontological nurse practitioner and clinical nurse specialist, and as an advanced palliative care and hospice nurse. She has authored or edited eight books, including two that were recognized with an AJN Book of the Year Award. She has served on editorial boards for Rehabilitation Nursing and Geriatric Nursing, and has written numerous articles and book chapters. Dr. Mauk is a frequent presenter at conferences at the regional, national, and international levels. She is the Co-Founder and President of Senior Care Central/International Rehabilitation Consultants, providing educational, clinical, and legal nurse consulting in rehabilitation and senior care in the U.S. and internationally. Dr. Mauk is also a recent past president of the Association of Rehabilitation Nurses (ARN) and has served ARN in many roles, most significantly including the Council of Leaders, Editor of the 5th edition of the Core Curriculum, PRN course faculty, and the task force to develop the ARN Professional Rehabilitation Nursing Competency Model, and current Editor in Chief of Rehabilitation Nursing.
Some of Dr. Mauk’s recognitions include: Nominee for the 2016 National Robert Foster Cherry Award for Great Teachers, three AJN Book of the Year Awards (2017, 2010 & 1999), CASE/Carnegie Indiana Professor of the Year (2007), VU Caterpillar Award for Excellence in Teaching (2007), ARN Educator Role Award (2007), and the ARN Distinguished Service Award (2005). Dr. Mauk has taught nurses and students in China over the past few years. She has a passion for helping other countries to develop rehabilitation nursing into a strong specialty to promote quality care for their aging population and those with disabilities.
You may have heard of rehabilitation nursing, but are you familiar with what rehabilitation nurses do and their essential role in health care? According to the Association of Rehabilitation Nurses (ARN), there are four major domains within the new competency model for professional rehabilitation nursing (ARN, 2016) that can help us understand what rehabilitation nurses do. In this blog, we will look at the ARN model from a layperson’s viewpoint to help explain the role of the rehabilitation nurse. Rehabilitation nurses:
Promote successful living
Rehabilitation nurses do not only care for people, but they promote health and prevent disability. This means that rehab nurses engage in activities that help patients, families and communities stay healthy. Proactively, you might see rehab nurses helping with bike safety (such as promoting the wearing of helmets), car seat fairs (to keep children safe from injury), or stroke prevention through community screenings and teaching about managing risk factors. As rehab nurses, we also help patients towards self-management of existing chronic illness or disability, teaching them how to be co-managers with their health providers so they can maintain independence and have a good quality of life. Another key activity is facilitating safe care transitions. This means that rehabilitation nurses have a special skill set to know which setting of care is best for the patient to move to next and how to make this happen smoothly. For example, if Mrs. Smith has had a stroke and finished her time in acute rehabilitation in the hospital, but she lives alone and is not quite ready to go home, what is the best care setting or services for her to receive the help she needs? Many errors, such as those with medications, happen when patients go from one place to another in the health system. Rehabilitation nurses can help persons successfully navigate these complexities and be sure that clients get the continuity of care they need and deserve.
Give quality care
The interventions or care that rehabilitation nurses provide to patients and families is based on the best scientific evidence available. Part of being a rehab nurse is staying current on the latest technology, strategies for care, and best practices. This is to ensure that all patients receive the highest standard of care possible. We stay current in many ways, including reading journal articles, attending conferences, obtaining continuing education, and maintaining certification in rehabilitation. Research shows that having more certified rehabilitation nurses on a unit decreases length of stay in the hospital. In addition, all of rehab care focuses on the patient and family as the center of the interdisciplinary team. To this end, rehabilitation nurses teach patients and families about their chronic illness or disability across many different areas including: how to take medications; managing bowel and bladder issues; preventing skin breakdown; dealing with behavioral issues that might be present with problems such as brain injury or dementia; coping with changes from a disabling condition; sexuality; working with equipment at home; and ways to manage pain.
Collaborate with a team of experts
Rehabilitation nurses are part of an interprofessional team of physicians, therapists, psychologists, nutritionists, and many others who work together for the best patient outcomes. For persons who have experienced a catastrophic injury or illness, the work of this team of experts sharing common goals will provide the best care, and rehab nurses are the ones who are with the patient 24/7 to coordinate this process. Through effective collaboration, excellent assessment skills, and communication with the rest of the team members, rehab nurses ensure that patient and families are getting well-coordinated care throughout the rehabilitation process. Remember that rehabilitation takes place in many settings, whether on the acute rehab unit, in skilled care, long-term care, or the home. The nurse’s role is to be sure that the holistic plan of care is followed by all staff and that the physicians overseeing medical care are continually informed of patient progress for the best decision-making possible.
Act as leaders in rehabilitation
Not only do rehabilitation nurses provide direct patient care, they are also leaders in the rehabilitation arena. You might be surprised to learn that rehabilitation nurses advocate at the highest level for legislation surrounding funding and policy for those with disabilities and chronic illness, talking with Senators and Congressmen about key issues. ARN has professional lobbyists that continually watch health policy movement in Washington and keep rehab nurses informed. Rehab nurses help patients to advocate for themselves in holding government and communities accountable for needed care services. Lastly, rehab nurses share their knowledge with others. This is done in a variety of ways through conducting and publishing research, presenting at conferences, serving on local and national committees, and serving in public office. All of the leadership activities done by nurses in rehabilitation are to promote the best quality of care for patients with chronic illness and disability.