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The 6-Step Process of Stroke Recovery

 

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 |2020-02-02T15:55:50-05:00February 17th, 2020|Dr. Mauk's Boomer Blog, News Posts|Comments Off on The 6-Step Process of Stroke Recovery

Keeping In Contact With Loved Ones Who Live Far Away

guidelines-for-introducing-use-of-technology-to-older-adults

Human contact is essential to our health and well-being, especially as we age. Lack of human contact has been associated with depression, loss of appetite, increased cognitive impairment, and even hypertension. Human contact is so important, in fact, that according to the National Institutes of Health, loneliness and isolation are predictors of “declining health and poor quality of life in the elderly.

As we age, it can be hard to maintain the social contacts we need, simply because health problems and mobility issues make reaching out to the community around us increasingly difficult. This makes interactions with loved ones that much more important. They can provide that essential human contact we all need to thrive.

Unfortunately, not every family enjoys the luxury of living close enough to their aging loved ones to visit as often as they would like. Do you live too far away from your loved one to provide the face-to-face contact he or she needs to stave off the effects of loneliness and isolation? Don’t worry. Below are three easy ways you can stay in touch with your elderly loved one, even when you live far away:

 

  • Make use of good, old-fashioned snail mail. Most of us don’t even think of sending a letter these days. After all, phone calls and text messages are right there at our fingertips and just so easy to use. However, many older people still remember when snail mail was the primary means of keeping in touch with friends and family far away, and they often love checking the mailbox every day, hoping to find a hand-written treasure. Consider sending letters and cards as a way of staying in touch with your loved one. Your messages don’t have to be long or complex. Even a quick, “Thinking of you!” can brighten your loved one’s day. Knowing that a letter might come in the mail will also give your loved one something to look forward to, and a reason to get dressed and out of the house — even if it’s just for a trip down the driveway to the mailbox.

 

  • Pick up the phone. Phone calls are a great way to connect with older loved ones. Not only will they be pleased to hear from you, but you will be able to check on their well-being by noticing how fast they answer the phone and listening to how they sound. Don’t plan to just try to call “when you can,” either. If you’re like most people with a busy life, that extra hour of time simply won’t materialize. Instead, make a “phone date” with your loved one: A specific day and time when you will call each week. Coordinate with other family members, as well. You can each call on a different day, so your loved one will get some needed attention throughout the week.

 

  • Don’t underestimate technology. Technology is not just for the young. According to the Pew Research Center, 56 percent of online users over age 65 have Facebook accounts, and 31 percent of all seniors use the Internet. If your loved one is comfortable with a computer, use it as a means to stay in touch. Send emails or short, cheerful text messages on a regular basis. Use Skype, as well, for a real face-to-face conversation. If your loved one has problems configuring or using computer technology, try to be sure he or she is set up with computer, camera and mic the next time you visit. You can also enlist the help of the younger generation. The grandkids could be asked to volunteer to be their grandparent’s own, private tech-support team, available over the phone to answer any computer questions or problems that arise.

Staying in touch doesn’t have to be complicated or time consuming; it just needs to be heartfelt. Taking the time to reach out to elderly loved ones is a simple gesture that will greatly improve their quality of life.

Author Bio: Michele Teter is the co-founder of Alliance Homecare, a home care provider located in the New York area. At Alliance Homecare, Teter and her team provide a range of services to match every client’s individual wants and needs.

 

 

 

 

 

By |2020-02-02T15:57:13-05:00February 16th, 2020|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Keeping In Contact With Loved Ones Who Live Far Away

Guest Blog: Spotting the Signs of Substance Abuse in the Elderly

Those who are at the twilight of their lives are vulnerable not just to illnesses but also to addiction, as well. This is especially true for the elderly who are residents of various healthcare facilities as the prevalence rate of alcohol abuse disorder jumps up to 22%.

Sadly, most symptoms of substance abuse are misinterpreted for depression, natural signs of aging, and other unrelated causes.

Here are just some of the warning signs that would tell you to get some help:

1. Lack of hygiene – People with substance abuse problems hardly care about their hygiene as the priority is when they can have their next fix.

2. Slurred speech – This is quite obvious and when you see them slurring their speech every time you check up on them, chances are they have an alcohol problem.

3. Extreme mood swings – The addicted individual becomes emotionally unstable. They can lash out at you for no reason at all.

4. Hyperactivity – Stimulants like meth and cocaine trigger hyperactivity.

5. Lethargy and excessive sleeping – Prescription opioids are the most commonly abused drugs by the elderly. Abusing their medications can take a toll because of their slowed metabolism.

6. Sudden weight loss – Addicted individuals are not really eating right because, again, their priority is sustaining their addiction. Instead of buying food, they buy drugs instead.

7. Alienation – They will isolate themselves from everybody else because they don’t want to be answering questions about their physical appearance and behavior.

8. Constant lying – When they do get confronted, they lie and lie. They will also feign illnesses in order to trick their doctors into adding into their dosage of prescription opioids.

9. Frequent accidents – Their motor skills will depreciate as they grow older and that’s understandable. However, when they fall more times than usual, it could be a sign that they have an alcohol abuse disorder.

10. Mental health issues – Over time, abusing drugs and alcohol will mess up with the chemistry in their brains. They may develop depression, feeling of isolation, extreme anxiety, among others.

Senior living facilities are not equipped to deal with substance abuse. However, they do have protocols on how to deal with these situations. However, if your parents and grandparents are living on their own and you think they need help, you can search for the rehab facilities in Colorado.

By |2020-02-02T15:54:49-05:00February 14th, 2020|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Guest Blog: Spotting the Signs of Substance Abuse in the Elderly

Parkinson’s Disease

 

Background

Parkinson’s disease (PD) is one of the most common neurological diseases, affecting at least 1.5 million people in the United States (American Parkinson Disease Association {APDA}, 2010). The average age of onset is about 59 years of age (APDA, 2010), and the likelihood of developing PD increases with age (National Institute of Neurological Disorders, 2008). It affects both men and women, particularly those over the age of 60 years (American Parkinson Disease Foundation, 2012). Parkinson’s disease was first described by Dr. James Parkinson as the “shaking palsy,” so named to describe the motor tremors witnessed in those experiencing this condition.

Parkinson’s disease is a degenerative, chronic disorder of the central nervous system in which nerve cells in the basal ganglia degenerate. A loss of neurons in the substantia nigra of the brainstem causes a decrease in the production of the neurotransmitter dopamine, which is responsible for fine motor movement. Dopamine is needed for smooth movement and also plays a role in feelings and emotions. One specific pathological marker is called the Lewy body, which under a microscope appears as a round, dying neuron.

Signs and Symptoms

Parkinson’s disease has no known etiology, though several causes are suspected. There is a family history in 15% of cases. Some believe a virus or environmental factors play a significant role in the development of the disease. A higher risk of PD has been noted in teachers, medical workers, loggers, and miners, suggesting the possibility of a respiratory virus being to blame. More recent theories blame herbicides or pesticides. An emerging theory discusses PD as an injury related to an event or exposure to a toxin versus a disease. Interestingly, coffee drinking and cigarettes are thought to have a protective effect in the development of PD (Films for the Humanities and Sciences, 2004).

The signs and symptoms of PD are many; however, there are four cardinal signs: bradykinesia (slowness of movement), rigidity, tremor, and gait changes such as imbalance or incoordination. A typical patient with PD symptoms will have some distinctive movement characteristics with the components of stiffness, shuffling gait, arms at the side when walking, incoordination, and a tendency to fall backward. Not all patients exhibit resting tremor, but most have problems with movement, such as difficulty starting movement, increased stiffness with passive resistance, and rigidity, as well as freezing during motion (NINDS, 2012). Advanced PD may result in Parkinson’s dementia.

Diagnosis

Diagnosis of PD is made primarily on the clinician’s physical examination and thorough history taken from the patient and/or family. Several other conditions may cause symptoms similar to PD, such as the neurological effects of tremor and movement disorders. These may be attributed to the effects of drugs or toxins, Alzheimer’s disease, vascular diseases, or normal pressure hydrocephalus, and not be true PD. There is no one specific test to diagnose PD, and labs or X-rays rarely help with diagnosis.

Treatment

Management of PD is generally done through medications. Levodopa, a synthetic dopamine, is an amino acid that converts to dopamine when it crosses the blood–brain barrier. Levodopa helps lessen most of the serious signs and symptoms of PD. The drug helps at least 75% of persons with PD, mainly with the symptoms of bradykinesia and rigidity (NINDS, 2008). One important side effect to note is hallucinations. A more common treatment, and generally the drug of choice, involves a medication that combines levodopa and carbidopa (Sinemet), resulting in a decrease in the side effect of nausea seen with levodopa therapy alone, but with the same positive control of symptoms, particularly with relation to movement. Patients should not be taken off of Sinemet precipitously, so it is important to report all of a patient’s medications if they are admitted to either acute or long-term care. Dopamine agnoists trick the brain into thinking it is getting dopamine. This class of medications is less effective than Sinemet, but may be beneficial for certain patients. The most commonly prescribed dopamine agonists are pramipexole (Mirapex) and ropinirole (Requip) (Parkinson’s Disease Foundation, 2012). Medications such as Sinemet show a wearing-off effect, generally over a 2-year period. During this time, the person must take larger doses of the medication to achieve the same relief of symptoms that a smaller dose used to bring. For an unknown reason, if the medication is stopped for about a week to 10 days, the body will reset itself and the person will be able to restart the medication at the lower dose again until tolerance is again reached. This time off from the medication is called a “drug holiday” and is a time when the person and family need extra support, because the person’s symptoms will be greatly exacerbated without the medication. The earliest drugs used for PD symptom management were anticholinergics such as Artane and Cogentin, and these medications are still used for tremors and dystonias associated with wearing-off and peak dose effects (Parkinson’s Disease Foundation, 2012).

There are many other treatments for Parkinson’s disease being explored. These include deep brain stimulation (DBS), with electrode-like implants that act much like a pacemaker to control PD tremors and other movement problems. The person using this therapy will still have the disease and generally uses medications in combination with this treatment, but may require lower doses of medication (NINDS, 2012). Thalamotomy, or surgical removal of a group of cells in the thalamus, is used in severe cases of tremor. This will manage the tremors for a period of time, but is a symptomatic treatment, not a cure. Similarly, pallidotomy involves destruction of a group of cells in the internal globus pallidus, an area where information leaves the basal ganglia. In this procedure, nerve cells in the brain are permanently destroyed.

Fetal tissue transplants have been done experimentally in Sweden with mild success in older adults and more success among patients whose PD symptoms were a result of toxins. Stem cell transplant uses primitive nerve cells harvested from a surplus of embryos and fetuses from fertility clinics. This practice, of course, poses an ethical dilemma and has been the source of much controversy and political discussion.

A more recent development includes the use of adult stem cells, a theory that is promising but not yet well researched. Cells may be taken from the back of the eyes of organ donors. These epithelial cells from the retina are micro-carriers of gelatin that may have enough cells in a single retina to treat 10,000 patients (Films for the Humanities and Sciences, 2004). In addition, cells modified from the skin of patients with PD can be engineered to behave like stem cells (NINDS, 2012). Both of these alternatives present a more practical and ethically pleasing source of stem cells than embryos.
Other research includes areas include those related to alternative therapies. For example, Tai Chi has been shown to be effective in improving balance and reducing falls for PD patients (NINDS, 2012). Rehabilitation units have been using Tai Chi for similar benefits in other patients with neurological deficits. Simple interventions such as using Wii games to promote activity and exercise may be explored. The role of caffeine in PD is also being examined. In a small randomized control study of 61 patients with PD, caffeine equivalent to 2–3 cups of coffee per day was given to subjects and compared with a control group of those taking a placebo. Those patients receiving the caffeine intervention showed little improvement in daytime sleepiness, but modest improvement in PD severity scores related to speed of movement and stiffness (Postuma et al., 2012). Further study with larger groups was recommended by the researchers.

Much of the nursing care in PD is related to education. Because PD is a generally chronic and slowly progressing disorder, patients and family members will need much instruction regarding the course of the disease and what to anticipate. Instruction in the areas of medications, safety promotion, prevention of falls, disease progression, mobility, bowel and bladder, potential swallowing problems, sleep promotion, and communication is important. Most of the problems seen as compli¬cations of PD are handled via the physician as an outpatient, but certainly complications such as swal¬lowing disorders as the disease progresses may require periods of hospitalization. When persons suffer related dementia in the final phases of the disease, they are often cared for in long-term care facilities that are equipped to handle the challenges and safety issues related to PD dementia. In ¬addition, access to resources and support groups is essential.

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.

For more information on Parkinson’s Disease, visit the Michael J. Fox Foundation Website:
https://www.michaeljfox.org/

 

By |2020-02-02T15:54:03-05:00February 12th, 2020|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Parkinson’s Disease