Boomer’s Blog

Boomer’s Blog 2018-02-06T23:01:56+00:00

Dr. Mauk’s Boomer Blog

Each week, Dr. Kristen Mauk shares thoughts relevant to Baby Boomers that are aimed to educate and amuse.

Dr. Kristen L. Mauk, PhD, DNP, RN, CRRN, GCNS-BC, GNP-BC, FAAN

What is COPD?

Background

COPD Chronic obstructive pulmonary disease (COPD) refers to a group of diseases resulting in airflow obstruction due to smoking, environmental exposures, and genetics. However, smoking is clearly the most common cause of COPD. The two disorders most commonly included under the umbrella of COPD are emphysema and chronic bronchitis. Although the disease mechanisms contributing to airflow obstruction is different in these two disorders, most patients demonstrate features of both emphysema and chronic bronchitis.

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In 2008, the CDC recently released a report naming COPD as the third leading cause of death in the United States (National Vital Statistics Reports [NVVS], 2010). There are more than 12 million people in the United States U.S. diagnosed with COPD. However, due to the under diagnosis of the disease, only estimations of the prevalence of COPD are available, which suggest that approximately 24 million people are living with COPD (ALA, 2012). Slightly more females than males are affected, with female smokers having a 13 times greater chance of death from COPD than nonsmoking females (ALA, 2004).

 

Chronic Bronchitis

Chronic bronchitis is a common COPD among older adults. It results from recurrent inflammation and mucus production in the bronchial tubes. Repeated infections produce blockage from mucus and eventual scarring that restricts airflow. The American Lung Association (2012) stated that about 8.5 million Americans had been diagnosed with chronic bronchitis as of 2005. Females are twice as likely as males to have this problem.

Emphysema

Emphysema results when the alveoli in the lungs are irreversibly destroyed. As the lungs lose elasticity, air becomes trapped in the alveolar sacs, resulting in carbon dioxide retention and impaired gas exchange. More males than females are affected with emphysema, and most (91%) of the 3.8 million Americans with this disease are over the age of 45 (ALA, 2004).

Risk Factors

The major risk factor for COPD is smoking, which causes 80–90% of COPD deaths. Alpha-1-antitrypsin deficiency is a rare cause of COPD, but can be ruled out through blood tests. Although “COPD is almost 100% preventable by avoidance of smoking” (Kennedy-Malone et al., 2003), environmental factors play a strong role in the incidence of COPD. Approximately 19.2% of people with COPD can link the cause to work exposure, and 31.7% have never smoked (ALA, 2008).
Warning Signs

The signs and symptoms of chronic bronchitis include increased mucus production, shortness of breath, wheezing, decreased breath sounds, and chronic productive cough. Chronic bronchitis can lead to emphysema. Signs and symptoms of emphysema include shortness of breath, decreased exercise tolerance, and cough.

Diagnosis

Persons with COPD often experience a decrease in quality of life as the disease progresses. The shortness of breath so characteristic of these diseases impairs the ability to work and do usual activities. According to a survey by the American Lung Association, “half of all COPD patients (51%) say their condition limits their ability to work [and] . . .” and “. . . limits them in normal physical exertion (70%), household chores (56%), social activities (53%), sleeping (50%), and family activities (46%)” (2004, p. 3). Diagnosis is made through pulmonary function and other tests, and a thorough history and physical.

Treatments

Although there are no easy cures for COPD, older adults can take several measures to improve their quality of life by controlling symptoms and minimizing complications. These include lifestyle modifications such as smoking cessation, medications (see below), oxygen therapy, and pulmonary rehabilitation. Older adults should have influenza and pneumonia vaccinations (National Heart Lung and Blood Institute, [NHLBI], 2010). Oxygen therapy may be required for some people.

Medications are used to help control symptoms, but they do not change the downward trajectory of COPD that occurs over time as lung function worsens. Typical medications given regularly include bronchodilators through oral or inhaled routes. Antibiotics may be given to fight infections and systemic steroids for acute exacerbations.

In extreme cases, lung transplantation may be indicated. Older persons with severely impaired lung function related to emphysema may be at higher risk of death from these procedures and have poorer outcomes.
Reducing factors that contribute to symptoms, use of medication usages, alternating rest and activity, energy conservation, stress management, relaxation, and the role of supplemental oxygen should all be addressed. Many older adults with COPD find it helpful to join a support group for those who are living with similar problems.

For more information on COPD, visit the American Lung Association:
http://www.lung.org/lung-disease/copd/resources/facts-figures/COPD-Fact-Sheet.html

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.

By | February 14th, 2018|Categories: Dr. Mauk's Boomer Blog, News Posts|Tags: |Comments Off on What is COPD?

The Role of the Rehabilitation Nurse

 
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:
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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.

 

 

 

 

 

 

 

 

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By | February 14th, 2018|Categories: Dr. Mauk's Boomer Blog, News Posts|Comments Off on The Role of the Rehabilitation Nurse

Grandparents Raising Grandchildren Series: When Grandma Becomes Mama

 

Being a Grandmother is a wonderful benefit of aging. The experience is truly all that your friends told you it would be. When you didn’t think you could love anyone as much as your own children, your grandchildren come along and prove you wrong. You can spoil them and send them home, feed them junk food and cookies for dinner, snuggle and take time to play like you didn’t have time for when you raised your own kids. And the best part is that all those things that would have made you a bad parent then, make you an awesome, fun Grandma now.

But what happens when, for reasons beyond your own control, your find yourself moving from the role of Grandma to Mom? According to the Profile of Older Americans (2016), “approximately 1 million grandparents age 60 and over were responsible for the basic needs of one or more grandchildren under age 18 living with them in 2015. Of these caregivers, 593,495 were grandmothers and 429,377 were grandfathers” (pg. 15). The role change from Grandma to Mama is a significant one. The little one you have spoiled and coddled is now yours to raise for the next 20 years into adulthood. This can be a shocking transition, but also a tremendous blessing.

This surprise happened to me at the age of 57. My husband had just retired and we had relocated to a more relaxing place in our life. We already had 7 children between us with an age span of 15 – 34 years of age, the last two of whom were adopted from Russia. So, when our teenagers were ready to graduate from high school, we were looking forward to being empty nesters, having raised children for many years.

Then, along came JJ. Substance abuse, which our pediatrician calls “the scourge of our community”, was the culprit that led to our current situation. This is a common problem, although not all children of substance abusers are fortunate enough to be placed in a loving home out of the influence of parents who use drugs. Our journey started when we offered to take our 6 week old grandson for a few hours so his parents could enjoy some free time together. Those hours turned into several days when the parents didn’t show up to get their son and nobody could find them. They didn’t call to check on him and seemed not to mind that they didn’t contact us for days. It wasn’t long before CPS removed little JJ from his birth parents due to their substance abuse and neglect of their infant and placed him with both sets of grandparents sharing temporary kinship care. Unable to break free of the chains of drugs, even with unlimited free resources and counseling provided by the community, JJ’s parents lost custody of him permanently and we became new parents again through adoption of our precious grandson.

The process of adapting to this life-changing event affects everyone differently. If you find yourself in a similar life-altering stage, then you may benefit from this series on Grandparents Raising Grandchildren. Today’s tips are for Grandmas who are now Moms again:

Some things have changed

If you are anything like me, your last biological child may be in his/her 30’s, so raising a little one might be a bit intimidating. Lots has changed in 30 years! There is so much more technology to help children learn and play. But this means we have become more tech savvy and not avoid the latest cellphones, computers, or apps. (Any teenager is happy to help you learn to be more techie). Toys are more fun now. Clothes are cuter. There are great innovations like disposable diapers, better bottles, and on-the-go baby food. Kids go to preschool and all-day kindergarten now. But, there are negatives too, like many more immunizations to keep track of. The world doesn’t seem as safe in the big cities as it did long ago when we let our children play outside without as much fear of gang violence, guns, or being kidnapped. Yet, there are more guidelines for child-rearing, research on how to educate kids, and better job opportunities for when they are grown. While all these changes may be daunting, you can use them to your benefit and to make your life easier when raising children in your later years.

Some things never change

Fortunately for us, some things never change. Babies are babies, kids are kids, and teenagers are still teenagers. Changing diapers, bathing a baby, suctioning a nose with the blue bulb syringe, putting clothes on a wiggly toddler, and rocking a little one to sleep are still the same. Strategies for teaching math have changed, and maybe kids don’t always have books in high school, but the major concepts of the major subjects are ones you will remember. Don’t worry – this will all come back to you and you might be surprised how much better you are at parenting now than when you raised your first set of children. You are more relaxed and comfortable because you have decades of experience to draw on.

Your experience is a plus

One of your best assets as a new Grammy Mama (as I like to call this role) is your experience. For me, I raised or help raise 7 children before JJ, so I am way ahead of the new mother learning curve. We already know what works and doesn’t work in raising kids. We are not novices, but seasoned experts! So, when you are tempted to feel you are not up to this new challenge, remind yourself that this is not your first rodeo.
You are not too old
It is a normal feeling to think you might be too old to raise another child. Let me assure you that you are not, and you are not alone. There are more than a million other grandparents in America just like you who are doing it, and many are older than you are. Your age gives you wisdom and experience. If you were in another job, you would be a Senior Executive, VP, or CEO – that is what you are in this new job. Embrace your Grammy Mama role. There is a reason why this child (or children) has been entrusted to you. You have been chosen for a remarkable task: to nurture a child who will later thank you for not giving up on him. You are never too old to undertake such a legacy as that.

By | February 13th, 2018|Categories: Dr. Mauk's Boomer Blog, News Posts|Comments Off on Grandparents Raising Grandchildren Series: When Grandma Becomes Mama

Alzheimer’s: Signs & Symptoms

 

Alzheimer’s disease (AD) is the most common type of dementia seen in older adults. An estimated 5.4 million Americans of all ages had Alzheimer’s disease in 2012. Nearly half (45%) of people over the age of 85 have AD. By 2050, the number of individuals age 65 and over with Alzheimer’s could range from 11 million to 16 million unless science finds a way to prevent or effectively treat the disease. One in eight older adults has AD, and it is the sixth leading cause of death in the United States (Alzheimer’s Association, 2012). Those affected with AD may live from 3–20 years or more after diagnosis, making the life span with this disease highly variable.

Risk factors

Advanced age is the single most significant risk factor for AD (Alzheimer’s Association, 2012). More women than men have AD, but this is because women live longer than men, not because gender is a risk factor. Family history and heredity are also identified risk factors for AD, as are head trauma and poor cardiac health.

Warning Signs

Alzheimer’s disease is characterized by progressive memory loss. The person affected by AD is gradually less able to remember new information and memory lapses begin to affect daily function. It is a terminal disease that over its course will eventually leave a person completely dependent upon others for care.

Diagnosis

Initially, the clinical progression of the disease is slow with mild decline; however, deterioration increases the longer the person lives, with an average life span of 8 years after diagnosis (Cotter, 2002; Fletcher, Rapp, & Reichman, 2007). The underlying pathology is not clear, but a growth of plaques and fibrillary tangles, loss of synapses, and neuronal cell loss are key hallmarks of AD that interfere with normal cell growth and the ability of the brain to function. Absolutely definitive diagnosis is still through autopsy, although clinical guidelines make diagnosis easier than decades ago when less was known about the disease. Primary care physicians generally make the diagnosis through a thorough history, physical exam, cognitive testing, and labs. New criteria for diagnosis include staging the disorder and biomarkers (beta amyloid and tau in the cerebrospinal fluid and blood) (Alzheimer’s Association, 2012b). An MRI of the brain may be ordered to rule out other causes of symptoms.

The clinical course of AD is divided into several stages, depending on the source consulted. In the early course of AD, the person may demonstrate a loss of short-term memory. This involves more than common memory loss, such as where the keys were put, and may involve safety concerns such as forgetting where one is going while driving. The inability to perform math calculations and to think abstractly may also be evident. In the middle or moderate phase, many bodily systems begin to decline. The person may become confused as to date, time, and place. Communication skills become impaired and personality changes may occur. As cognitive decline worsens, the person may forget the names of loved ones, even their spouse. Wandering behavior as well as emotional changes, screaming, delusions, hallucinations, suspiciousness, and depression are common. The person with AD is less able to care for her- or himself and personal hygiene suffers. In the most severe and final phase, the person becomes completely dependent upon others, experiences a severe decline in physical and functional health, loses communication skills, and is unable to control voluntary functions. Death eventually results from body systems shutting down and may be accompanied by an infectious process. Although there is no single test, and the diagnosis may be one of exclusion, early diagnosis is important to maximize function and quality of life for as long as possible. Persons experiencing recurring and progressing memory problems or difficulties with daily activities should seek professional assistance from their physician.

Treatment

Treatment for AD is difficult. There are several medications (such as Aricept, Namenda, Razadyne, and Exelon) that may help symptoms (such as memory), but they do not slow the course of the disease. There is currently no cure; however, research continues to occur in pharmacology, nonpharmacology, and the use of stem cells to manage symptoms and perhaps one day eradicate the disease.

Treatment will focus on symptom management, particularly in the areas of behavior, safety, nutrition, and hygiene. Behavioral issues such as wandering and outbursts pose a constant challenge. Many long-term care facilities have special “memory care” units to care for Alzheimer’s patients from the early to late stages of the disease. These units provide great benefits such as consistent and educated caregivers with whom the patient or resident will be familiar, a safe and controlled environment, modified surroundings to accommodate wandering behaviors, and nursing care 24 hours a day. Additionally, nurses are present to manage medications and document outcomes of therapies. However, many family members wish to care for their loved ones at home for as long as possible.

Thus, another important aspect of care in AD is care for the caregivers. Howcroft (2004) suggested that “support from carers is a key factor in the community care of people with dementia, but the role of the caregiver can be detrimental to the physical, mental, and financial health of a carer” (p. 31). She goes on to say that the caregivers of persons with AD would benefit from training in how to cope with behaviors that arise in these patients and how to cope with practical and legal issues that may occur.

Research has shown that ongoing skills are needed by family caregivers to deal with the progressive decline caused by AD. In fact, “a 63% greater risk of mortality was found among unpaid caregivers who characterized themselves as being emotionally or mentally strained by their role versus noncaregivers” (National Conference of Gerontological Nursing Practitioners & National Gerontological Nursing Association, 2008b, p. 4). Adapting to stress, working on time management, maximizing resources, and managing changing behavior were all skills caregivers needed to develop in order to successfully manage home care of their loved ones. When interventions and resources were not used by caregivers in the early stages of the care recipient’s AD, the risk of a healthy patient being institutionalized due to caregiver burden was higher (Miller, Rosenheck & Schneider, 2012). Caregivers needed not only to acquire knowledge and skills, but also to make emotional adjustments themselves to the ever-changing situation.

Such findings suggest that nurses should focus a good deal of time on educating caregivers of persons with AD to cope with, as Nancy Reagan put it, “the long good-bye.” Scientists continue to explore the causes of AD and hope in the near future to be able to isolate the gene that causes it. In the meantime, results from a fascinating longitudinal study (called the Nun study) on aging and AD, which used a group of nuns who donated their brains to be examined and autopsied after death, has suggested that there is a connection between early “idea density” and the emergence of AD in later life. That is, essays the nuns wrote upon entry to the convent were analyzed and correlated with those who developed AD. It was found that those with lower idea density (verbal and linguistic skills) in early life had a significantly greater chance of developing AD (Grossi, Buscema, Snowdon, & Antuono, 2007; Snowdon, 2004). The nun study has allowed researchers to examine hundreds of brains so far in nuns who died between 75 and 107 years of age and discover other important facts such as a relationship between stroke and the development of AD in certain individuals, and the role of folic acid in protecting against development of AD (Snowdon, 2004). Scientists from a number of fields continue to research the causes and possible treatments for AD and the Nun study project is continuing at the University of Minnesota. Snowdon’s research suggests that early education, particularly in verbal and cognitive skills, may protect persons from AD in later life.

For more information on Alzheimer’s disease, visit the Alzheimer’s Association website at: http://www.alz.org/

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 | February 12th, 2018|Categories: Dr. Mauk's Boomer Blog, News Posts|Tags: , , |Comments Off on Alzheimer’s: Signs & Symptoms
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