News Posts

/News Posts

Recent news and updates

Seizures

Doctor - Taking Notes

Background

Once thought to be mainly a disorder of children, recurrent seizures or epilepsy is thought to be present in about 7% of older adults (Spitz, 2005) and is usually related to one of the common comorbidities found in older adults (Bergey, 2004; Rowan & Tuchman, 2003). Epilepsy affects up to 3 million Americans of all ages (Velez & Selwa, 2003). Davidson & Davidson (2012) summarized findings of most studies on epilepsy in older adults with these main points:
Seizures can be caused by a variety of conditions in older persons, but “the most common cause of new-onset epilepsy in an elderly person is arteriosclerosis and the associated cerebrovascular disease” (Spitz, 2005, p. 1), accounting for 40–50% of seizures in this age group (Rowan & Tuchman, 2003). Seizures are associated with stroke in 5–14% of survivors (Spitz, 2005; Velez & Selwa, 2003). Other common causes of epilepsy in the elderly include Alzheimer’s disease and brain tumor.
There are three major classifications of epilepsies, although there are many additional types. Generalized types are more common in young people and associated with grand mal or tonic-clonic seizures. A number of cases have an un¬determined origin and may be associated with certain situations such as high fever, exposure to toxins, or rare metabolic events. In older adults, localized (partial or focal) epilepsies are more common, particularly complex partial seizures (Luggen, 2009). In contrast to young adults, Rowan and Tuchman (2003) cite other differences in seizures in the elderly: low frequency of seizure activity, easier to control, high potential for injury, a prolonged postictal period, and better tolerance with newer antiepileptic drugs (AEDs). Additionally, older adults may have coexisting medical problems and take many medications to treat these problems.

Risk Factors/Warning Signs

Risk factors for seizures in older adults include cerebrovascular disease (especially stroke), age, and head trauma. The most obvious signs and symptoms of epilepsy are seizures, although changes in behavior, cognition, and level of consciousness may be other signs. Also, note that exposure to toxins can cause seizures that are not epilepsy. Complex partial seizures in older adults may include symptoms such as “confusion, memory loss, dizziness, and shortness of breath” (Davidson & Davidson, 2012, p. 16). Automatism (repetitive movements), facial twitching with following confusion, and coughing are also signs of the more-common complex partial seizure (Luggen, 2009).

Diagnosis

Diagnosis is made by careful description of the seizure event, a thorough history, and physical. Eyewitness accounts of the seizure incident can be quite helpful, although many community-dwelling older adults go undiagnosed because their seizures are never witnessed. In addition, complete blood work, neuroimaging, chest X-ray, electrocardiogram (ECG), and electroencephalogram (EEG) help determine the cause and type of seizure (National Institute for Health and Clinical Excellence {NICE}, 2012).

Treatment

Treatment for epilepsy is aimed at the causal factor. The standard treatment for recurrent seizures is antiepilepsy drugs (AEDs). The rule of thumb, “start low and go slow,” for medication dosing in older adults particularly applies to AEDs. The elderly tend to have more side effects, adverse drug interactions, and problems with toxicity levels than younger people.
Research has suggested that older adults may have better results with fewer side effects with the newer AEDs than the traditional ones, though about 10% of nursing home residents are still medicated with the first-generation AEDs (Mauk, 2004). The most common older medications used to treat seizures include barbiturates (such as phenobarbital), benzodiazepines (such as diazepam/Valium), hydantoins (such as phenytoin/Dilantin), and valproates (such as valproic acid/Depakene) (Deglin & Vallerand, 2005; Resnick, 2008).
Several newer drugs are also used, depending on the type of seizure. Second-generation AEDs, including gabapentin (Neurontin), lamotrigine (Lamictal), oxcarbazepine (Trileptal), levetiracetam (Keppra), pregabalin (Lyrica), tiagabine (Gabitril), and topiramate (Topamax), are generally recommended over the older AEDs; however, older AEDS such as phenytoin (Dilantin), valproate (Depakote), and carbamazepine (Tegretol) are the most commonly prescribed treatment options (Resnick, 2008). Each of these medications has specific precautions for use in patients with certain types of medical problems or for those taking certain other medications. Regarding side effects in older patients, watch for potential stomach, kidney, neurological (especially poor balance or incoordination), and liver problems. Additionally, some newer extended-release AEDs are thought to be better tolerated and have a lower incidence of systemic side effects (such as tremors) (Uthman, 2004).

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.

 

By | 2017-12-04T11:03:13+00:00 December 4th, 2017|News Posts|Comments Off on Seizures

Clinical Nurse Specialist Profile – Dr. Kristen Mauk

Clinical Nurse Specialist Profile

Kristen Mauk has never been one to stop learning. The clinical nurse specialist has nearly 30 years of experience in rehabilitation and gerontology, a handful of degrees, and has authored or edited seven books. She now helps train the future generation as a professor of nursing at Colorado Christian University in Colorado. She also recently launched her own business, Senior Care Central/International Rehabilitation Consultants, which provides nursing and rehabilitation education throughout the world.

Question: What drew you to nursing? What do you enjoy about it?

Mauk: “I grew up in a medical family. My father was a pediatric surgeon and my mom was a nurse, so I was always around the healthcare professions. However, nursing offered so many opportunities for growth and change while doing what I loved — helping others. There are many aspects of nursing that I enjoy, but feeling like I help make peoples’ lives better has to be the best perk of the job. Nursing is a versatile profession. I started off my career as an operating room nurse, worked for a decade in med-surg, geriatrics, and rehabilitation, then eventually went back to school for additional education so that I could make a greater impact on healthcare through teaching nursing students.”

Question: You have an impressive education. Why did you continue to pursue advanced degrees in the field? How has that benefited you?

Mauk: “First, I am a life-long learner, something that was instilled by my father who was always encouraging his children to explore the world and have an inquiring mind. Dinners at my house were filled with learning activities such as, ‘How does a flashlight work?,’ ‘What is a group of lions called?,’ or ‘For $20, who can spell hors d’oeuvres?’ (By the way, I got that $20!) So, continuing my education through studying for advanced degrees seemed a natural progression when you love to learn and love your work. I felt a need to know as much as possible about my areas of interest, gerontology and rehabilitation, so that I could provide better care to patients and be a better teacher for my students. My advanced education has?opened many doors in the professional nursing world, such as the opportunity to write books, conduct research to improve the quality of life for stroke survivors, or hold national positions in professional organizations.”

Question: What’s one of the most memorable experiences you’ve had, either as a student, educator or in your practice?

Mauk: “There are many memorable experiences I’ve had both as an educator and in practice. One of the most memorable from practice was early in my career working on a skilled/rehab unit in a little country hospital in Iowa. There was an older man who couldn’t find a radio station that played his favorite hymns and one of my co-workers knew that I had a musical background and asked me to sing to him at the bedside. I timidly held his hand as he lay in his hospital bed, and with the door closed because it was late at night, I softly sang all the old hymns I could remember. He closed his eyes and smiled, clasping my hand for nearly an hour of singing. The next evening, I heard him excitedly tell his family members that ‘an angel visited me last night. She had the sweetest voice I’ve ever heard. She held my hand and sang all of my favorite hymns!’ Hearing that outside the door, I smiled, but was later surprised when I stopped in to see him that he truly didn’t seem to remember me. One day later, he died unexpectedly. I often look back and wonder on that experience. In the many years of nursing experience that followed, I have learned that there are sometimes angels where we least expect them.”

Question: What advice do you have for people just starting their education or their professional career?

Mauk: “Nursing is a great profession! Learn all that you can while you are in school and continue to be a lifelong learner. The need for nurses who specialize in care of older adults and rehabilitation is only going to continue to grow because of the booming aging population. There is currently, and will continue to be, a shortage of skilled professionals to meet the demand that is looming with the graying of America. Gain skills that will make you a specialist and afford you additional opportunities. Always give the best care to those you serve. Set yourself apart by building a professional reputation for excellence through advanced education, publication, scholarship, clinical practice, and community service. Then, go and change the world!”

CLINICAL NURSE SPECIALIST PROFILE FOR KRISTEN MAUK

Save

Save

Save

By | 2017-11-27T10:36:23+00:00 November 27th, 2017|News Posts|Comments Off on Clinical Nurse Specialist Profile – Dr. Kristen Mauk

The 6-Step Process of Stroke Recovery

Caring For Husband

 

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

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

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

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

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

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

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

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

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

By | 2017-11-13T14:07:05+00:00 November 13th, 2017|Dr. Mauk's Boomer Blog, News Posts|Comments Off on The 6-Step Process of Stroke Recovery
X
- Enter Your Location -
- or -