Dr. Mauk’s Boomer Blog
Each week, Dr. Mauk shares thoughts relevant to Baby Boomers that are aimed to educate and amuse.
When seniors develop diseases affecting cognition, like the various kinds of dementia, caregivers typically make an effort to make their living environment as safe and comfortable as possible. Sometimes caregivers make lots of changes to a senior’s living space, with the best intentions of helping them. However, this can have a two-sided effect, because seniors with mentally deteriorating illnesses can find change to be a confusing or frightening thing. Caregivers might change the entire layout of a house, remove everything that could be a hazard, or add numerous locks to provide security. Changes like these can actually prove to be disorienting for a senior, in addition to being helpful. So the question becomes, how much change can seniors with Alzheimer’s handle?
It’s typical to find instances where seniors have lived in the same home for decades, and have a curious ability to navigate the living space with a sort of muscle memory after memory-harming diseases like Alzheimer’s set in. Routine is very important to the delicate psyche of an elder with dementia, so finding the perfect balance of what to change for their own good can be tricky. Making abrupt overwhelming makeovers to their home’s layout can make them flustered and end up actually making it more difficult for them to get around, adding to their impaired cognition. So it is best to maintain an environment that is familiar as much as possible. And make any alterations subtly and slowly over time.
The necessity to make changes will depend of the severity of a senior’s individual case. If the Alzheimer’s is in the mid to late stages and a senior is wandering out of the home constantly, then immediate action to prevent hazard is surely appropriate. Installing door alarms or adding locks can be great helps. If a senior with dementia typically kept a messy household, then the mess may add to their unease or make it easier to trip and fall. De-cluttering their living space can be advantageous in these cases.
Thus, change will surely be necessary at times. Though it is advisable to make changes as gradually and calmly as possible, to avoid overwhelming or distressing what was comfortable, normal, and assuring to the mind of a loved one with dementia. Routine is key for security in these instances. It may also be helpful to make sure you let them see when you move something, or set their things some place, to help then more easily adapt to the change.
Guest Blog: Lindsay Munden, DNP, RN, FNP-BC
Psoriasis is a lifelong disease that causes scaling and inflammation of the skin. The condition starts beneath the skin’s surface and is triggered by an overactive immune system, which causes skin cells to be over-produced and accumulate on the skin’s surface faster than normal. This process is called cell turnover, and in psoriasis may take a few days instead of weeks. This causes the formation of thick, red, itchy, flaky patches with silvery scales known as plaques. While any part of your body can be affected, psoriasis most often occurs on the elbows, knees, scalp, back, face, palms, and feet.
According to the American Academy of Dermatology (2015) about 7.5 million people in the United States have psoriasis. Anyone can get the disease, but it occurs more often in adults.
- Age: Adult men and women are affected equally. The two peak ages at onset are during the late teens to early 20s and in the late 50s to early 60s.
- Genetics: Psoriasis has a strong genetic influence, with one-third of patients with psoriasis reporting having a family member with the disease.
- Environmental Factors: Trauma to normal skin, repeated friction, infections, stress, fatigue, warm humid climates, changes in weather that dry the skin, and certain medications may trigger psoriasis flare-ups.
The primary cause of psoriasis remains unknown. Research has indicated that psoriasis is caused by genetic influences and a dysfunction of the immune system. Although, psoriasis plaques may look contagious, you cannot get the condition from someone that has the disease.
Symptoms can range from mild to severe and are often recurring. Itchy, red, inflamed and dry scaly plaques distributed symmetrically over areas of bony prominences such as the elbows and knees are characteristic of the disease. The joints, nails and scalp may also be affected. As with other chronic conditions, symptoms may flare or worsen for a few months and then subside for a period of time.
Psoriasis may be hard to diagnose because it can be confused with other skin diseases. Usually your healthcare provider will make a diagnosis based on a thorough skin examination. Biopsy is seldom necessary because the clinical features of psoriasis are so distinctive. Plaque psoriasis is the most common form, but patients typically have one or more types.
The goal of therapy is to control the symptoms and clear the plaque lesions.
For mild to moderate psoriasis, topical medications (those applied directly to the skin) and phototherapy (light therapy) are the mainstays of treatment. For severe psoriasis, systemic treatments are recommended. Sometimes, combining topical, light and systemic treatments leads to the best results.
Topical Medication Options:
- Topical steroids are widely used because they help reduce inflammation. Generally, a very potent topical corticosteroid preparation is applied two to three times daily for 2 weeks and then decreased to a lesser potency for maintenance therapy long term.
- Coal tar works by causing the skin to shed dead cells from its top layer and slow down the growth of new skin cells. This effect decreases scaling and dryness. Coal tar is applied once or twice daily and is not well favored due to the potential for staining of the clothes and skin.
- Anthralin works by slowing down the production of skin cells. This type of medication is applied to the skin for a prescribed period of time and then rinsed away, with increased increments until the skin is healed which may take a couple of weeks.
- Topical immunomodulators are medications which work by decreasing the body’s immune system to help slow down the growth of the psoriasis plaques.
- Vitamin D3 derivatives regulate cell growth and decrease lymphocyte (cells which play a role in the regulation of the immune system) activity. The medicine comes in a form of an ointment which is typically applied twice daily.
Phototherapy with ultraviolet-B (UVB) light is effective in the treatment of psoriasis lesions. This type of treatment reduces DNA synthesis of skin cells. Phototherapy can produce symptom-free periods of up to 2-4 months. UVB therapy units are often available at dermatologist offices and the use of commercial tanning beds (with both UVA and UVB lights) is not recommended. Dermatologists may recommend consistent light therapy 3-5 days a week for 2 to 3 months.
Systemic therapy is reserved for patients that have severe or incapacitating disease. These medications are prescribed by expert specialists such as dermatologists or rheumatologists because they have a risk for serious side effects.
National Psoriasis Foundation www.psoriasis.org
National Institute of Arthritis and Musculoskeletal and Skin Diseases www.niams.nih.gov
American Academy of Dermatology https://www.aad.org/
It can be difficult to see your parent or relative age. At one time, he could do anything. Now, it seems as though age has gotten the best of him. If you’ve seen changes in your loved one due to age, he may need extra help at home. The following are some of the most common signs of someone who is in need of a nurse or senior caregiver.
#1: Unkempt Home
If there has been a drastic change in the way that your loved one keeps his home that may be a sign he lacks the energy or physical ability to pick up and clean. Extra support at home can ensure that your loved one lives in a healthy, safe environment.
#2: Missed Medications
Forgetfulness is common in older individuals. Missing medications can lead to withdrawal and the return of symptoms of medical problems. It can lead to more serious problems as well – stroke, heart attack, etc. Help at home can remind your loved one to take medications as prescribed.
#3: Missed or Canceled Medical Appointments
Forgetfulness and the inability to drive to appointments can lead to failing health. A senior care worker can provide transportation and encouragement to attend all medical appointments.
#4: Body Odor
Just as cleaning and picking up the home can be physically demanding, taking a shower or bath is too. With someone in the home, your loved one can get the assistance needed to get into the shower and out of it to keep him clean and feeling refreshed.
#5: Sudden Change in Weight
Medical problems can cause lost pounds, but not being able to cook healthy meals can be the reason as well. Since it can be difficult to cook when feeling tired or lacking energy, someone in the home can make sure that he has meals ready or set up a meal program that gets food delivered on a schedule.
#6: Problems with Mobility
Balance and walking can be hard as people age, and this can lead to falls causing serious injuries. Help with completing daily tasks can reduce the risk of falls.
#7: Confusion or Uncertainty
This can cause a lot of distress for your loved one. Have someone there to lend an ear or explain something that doesn’t make much sense can calm the anxiety of your loved one to improve his quality of life.
Losing interests in hobbies or activities he used to enjoy could be a sign of depression that can lead to many other problems. Having a caregiver provide support and encouragement can help your loved one feel better or get the mental health he needs.
#9: Mail Piling Up or Unpaid Bills
It can be easy to forget to pay a bill from time to time, but if it becomes a habit, it might be a good idea to have someone help with going through mail and managing bills. This is one of the services that senior care workers provide in addition to helping with other daily tasks.
#10: Diagnosis of an Age-Related Medical Problem
Alzheimer’s or dementia can cause a loved one to forget or engage in risky behaviors. Having someone by your loved one’s side most of the day can help minimize the risk of him hurting himself.
Your parent or relative may have taken care of you for many years. Now, it’s your turn to care for him. Home care can help you do that. Look into the many options available if your loved one exhibits any of these symptoms.
About the Author:
Kendall Van Blarcom is a licensed marriage and family therapist providing personal consulting to seniors who need someone to talk with to improve the quality of their lives. More information can be found about personal consulting at http://www.kvanb.com.
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
As you grow older, you are going to notice some changes in your brain’s ability to remember things. You go to the kitchen and cannot remember why, or keep forgetting where you place your keys. Sometimes, you miss an important appointment or a loved one’s birthday because it just slipped your mind. Memory lapses can occur at any age. However, as you grow older, you will find that the memory lapses keep increasing which will invariably upset you. Most people tend to relate memory loss with conditions such as dementia.
In some cases, memory loss may indicate such chronic illnesses. However, in most cases, it just reflects regular shifts in the functioning of the brain. Age tends to slow certain cognitive processes thus making it harder for an individual to learn new things and to get rid of distractions that tend to interfere with memory. While these changes may be frustrating, there is hope. Years of research and studies have yielded fruits. There are now certain things you can do to help keep your mind sharp and protect yourself from memory loss.
Stimulate your brain continuously
Sure, you got your degree years ago, got your dream job, married the love of your life and your life is seemingly amazing, you still need to keep learning. According to researchers, advanced education helps to keep your brain active and thus allows you to have a sharper memory. By being active intellectually, you can stimulate the communication among your brain cells. Going to school is not the only way to stimulate your brain, jigsaw puzzles, traveling around the world and learning a new dance can help you keep your mind active. If you have no idea what you can do to achieve this, play a video game. Studies have shown that computer-based brain exercises have managed to promote brain function by increasing the attention span, improving problem-solving, knowledge retention, reasoning and information processing. These studies showed that areas such as an executive control that were not targeted in the exercises also improved meaning that general cognitive health also enhanced through brain exercises.
The doctor always mentions that a healthy diet and regular exercises are what you need to stay healthy and active. Well, they are right. According to a review done in 2008 of more than 50 studies by Kirk Erickson and Arthur Kramer, your brain functions can improve when you engage in regular aerobic exercises. Of course, some people will not work out even if they know that it is good for their body. If you are one of those people, then do it for the sake of your cognitive health. The studies found that regular workouts improved brain functions such as multi-tasking, problem-solving and planning. Even the slightest exercises like a brisk walk twice or thrice a week over a six-month period will reveal great results. One of the studies reviewed showed that patients with early signs of Alzheimer’s disease who exercised regularly had less brain atrophy.
How does it work? Well, the brain’s neuroplasticity is improved by exercises. This means that the brain can grow new neural and blood flow pathways as a response to stimulation by learning new things and exercises. The higher the number of neural pathway reserves in the brain, the better it will be at handling strokes, head traumas and Alzheimer’s disease which are more likely as you grow older.
Use all your senses
If you are learning a new dance, concentrate all your senses into it. The more senses you use, the more active your brain will be in preserving the memory. A study was conducted to find out how memory retention worked. One group was shown images without any emotional implications, and another was shown images with scents associated with them. The pictures with odor were remembered by most of the participants. Therefore, ensure you engage all your senses even when speaking to nurses and friends at the stroke rehab home. It will go a long way in boosting your memory.
It is now possible for you to remember experiences without having to take medication. Learning how to take care of your general health will help stabilize your mental health.
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.