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Parkinson’s Disease

Caring For Husband

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 | 2017-11-06T10:31:41+00:00 November 6th, 2017|News Posts|Comments Off on Parkinson’s Disease

Seniors: How to Cope and Manage Hearing Loss

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Hearing loss is a disability that affects over 36 million American adults; 30 percent of those afflicted are 65-74 years old and 47 percent are 75 or older.

The Hearing Loss Association of America cites three types of hearing loss:

1.    Conductive hearing loss is due to ear canal, ear drum, or middle ear problems. Most causes of conductive hearing loss can be treated with surgery or hearing aids, particularly bone conductive hearing aids.
2.    Censorial hearing loss (nerve-related hearing loss) is due to inner ear problems. Depending upon the cause, treatments include medications or, in some cases, surgery.
3.    Mixed hearing loss is when there is damage in the outer or middle ear as well as the inner ear or auditory nerve. The conductive hearing loss is usually treated first, then the censorial.

Hearing loss can have a profound impact on our work and social interactions. People with this disability may experience depression and as a result, anger at others or withdrawal from occasions where their hearing loss will be noticeable. Unfortunately, there is no cure to hearing loss, although, there are effective ways to manage it and be proactive. Learn about your disability and seek assistance to help cope.

  • Hearing aids –Purchase your hearing aids from an auditory or medical professional who specializes in hearing, not someone who specializes in selling hearing aids. Hearing Denial suggests booking with ones that are able to offer evaluations and custom hearing aid fittings all within one supplier.
  • Cochlear implants – You will need an evaluation by an audiologist and an implant-affiliated physician to determine if you are eligible for cochlear implants.
  • Hearing Assistive Technology is available at most performing arts venues, including most movie theaters. Amplified and captioned phone systems, smoke detectors and doorbells are also available.

Responding to Others

Communication is still a two-way. There are ways you can help maintain your end of communication with others. Some suggestions include:

  • Do your best to focus and concentrate.
  • Admit it when you don’t understand.
  • Watch for visual clues and ask for written clues if necessary.
  • Maintain your sense of humor and positive attitude.

 

 

 

By | 2017-11-01T11:31:37+00:00 November 1st, 2017|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Seniors: How to Cope and Manage Hearing Loss

Guest Blog: Strategies for fostering cooperation when caring for the elderly

When caring for the elderly, it can be tempting to feel as though you’re always in charge, and this can lead to treating those in your care like children. This can make what is already a difficult time even more so, as the elderly in your care will gradually feel as though they are losing any of the agencies they once had. Rather than approach care as though you lead, and they follow, why not tries an alternative view – a strategy based on cooperation.

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It can be difficult to foster cooperation whilst caring for the elderly – many people are resentful of having to rely on someone else for help, and can actively reject what little you aim to do for them. No matter where you work or where your elderly relatives may be in care – whether it’s somewhere like Forest Healthcare or a simple food run once a week – it can be difficult work. There are some strategies you can use to deal with this, however.

Take an Interest

Firstly, take an active interest in those in your care. Get to know them as people. Remembering a couple of small details – whether it’s that their son is on holiday, or that they’re writing a letter to a cousin – and making the effort to ask about them will go a long way towards creating a sense of cooperation. If you’re treating them as an equal to you, and taking an interest in their life, then you are no longer some aloof figure, but a potential confidante. It doesn’t have to be a friendship by any means – but getting to know them as more than just one of many older people you help on a daily basis can go a long way.

Validate Them

Never make them feel stupid, or as though something you’ve discussed is irrelevant. Whilst some things the elderly people in your care might think desire or discuss may seem strange, it’s important to remember the huge difference in life experiences you’ve had. For instance, if they bring up something that’s bothering them that you might consider minor, treat it with the respect they deserve. Allowing the people in your care to remain autonomous is a vital step towards a working partnership.

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Expect Resistance

You will be resisted. This is just a fact, and the sooner you accept it, the easier it is to deal with. Rather than being surprised and allowing you to get annoyed about it, treat it as what it is – just one step in a larger process? Try to figure out the root causes of the resistance – is it coming from a place of fear, perhaps of medical intervention? Or perhaps it’s resentment at their inability to do something themselves. Each person will be different, and treating resistance on an individual basis will make it easier to deal with in the long run.

Use ‘Trial Runs’

Imposing a particular routine, or type of medical care, on an elderly person can lead to them feeling as though they have no control. Instead, try to make use of trial runs – set a length of time for them to try something, and then meet to discuss it. This way they can make active, informed decisions about their own care – and you’ll often find that, given this opportunity, they’ll be happy to go along with what you suggested in the first place!

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In general, what caring for the elderly mostly comes down to is remembering how things are from their point of view. To them, a move into care – no matter how great the care! – is a move away from independence, towards a more constructive way of life. In order to work towards cooperation, the best methods involve validating these feelings, acknowledging the difficulties, and trying to work around them. Therefore, anything that increases the autonomy and agency of those in your care is a great place to start. If you’re based somewhere like Forest Healthcare, then those decisions will be in your hands most of the day, but even in smaller, less frequent contact based care, it’s worth employing. If anything, the sooner you start working towards a cooperative strategy, the easier it will be for both of you in the long run.

 

 

 

 

 

By | 2017-10-26T09:51:27+00:00 October 26th, 2017|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Guest Blog: Strategies for fostering cooperation when caring for the elderly
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