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Resources 2018-05-18T09:03:15+00:00

Glaucoma Symptoms

Glaucoma Symptoms

Background

Glaucoma is a group of degenerative eye diseases with various causes that leads to progressive optic neuropathy, in which the optic nerve is damaged by high intraocular pressure (IOP), resulting in blindness. Glaucoma is a leading cause of visual impairment and the second leading cause of blindness in the United States; it occurs more often in those over 40, with an increased incidence with age (3% to 4% in those over age 70) (Fingeret, 2010; Kennedy-Malone et al., 2000; Podolsky, 1998).

Risk factors

Unlike cataracts, there are some ethnic distinctions with the development of glaucoma. African Americans tend to develop it earlier than Caucasians, and females more often than males. Glaucoma is more common in African Americans, adults over age 60 (especially Mexican Americans), and people with a family history (NIH, 2013). Other contributing factors include eye trauma, small cornea, small anterior chamber, cataracts, and some medications.

Signs and symptoms

Although the cause is unknown, glaucoma results from blockage that limits the flow of aqueous humor, causing a rise in intraocular pressure (IOP). Two major types are noted here: acute and chronic. Acute glaucoma is also called closed angle or narrow angle. Signs and symptoms include severe eye pain in one eye, blurred vision, seeing colored halos around lights, red eye, headache, nausea, and vomiting.

Symptoms may be associated with emotional stress. Acute glaucoma is a medical emergency and persons should seek emergency help immediately. Blindness can occur from prolonged narrow angle glaucoma.

Chronic glaucoma, also called open angle or primary open angle, is more common than acute (90% of cases are this type), affecting over 2 million people in the United States. One million people probably have glaucoma and don’t know it, and 10 million people have above normal intraocular pressure that may lead to glaucoma if not treated (University of Washington, Department of Ophthalmology, 2008). This type of glaucoma occurs gradually. Peripheral vision is slowly impaired. Signs and symptoms include tired eyes, headaches, misty vision, seeing halos around lights, and worse symptoms in the morning. Glaucoma often involves only one eye, but may occur in both.

Treatment

Since there is no scientific evidence of preventative strategies, early detection in those at risk is important. Treatment is essential to prevent loss of vision, because once vision has been lost to glaucoma, it cannot be restored. Diagnosis is made using a tonometer to measure IOP. Normal IOP is 10–21 mm Hg. Ophthalmologic examination will reveal changes in the color and contour of the optic nerve when glaucoma is present. Gonioscopy (direct exam), which is performed by an optometrist or ophthalmologist, provides another means of evaluation. Older persons and those at higher risk should have a yearly eye exam to screen for glaucoma.

Treatment is aimed at reducing IOP. Medications to decrease pressure may be given, and surgical iridectomy to lower the IOP may prevent future episodes of acute glaucoma. In chronic glaucoma, there is no cure, so treatment is aimed at managing IOP through medication and eye drops. Consistent use of and correct administration of eye drops is important. Older adults should be assessed for safety related to visual changes and also reminded to schedule and attend regular visits with their ophthalmologist.

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.

Glaucoma Symptoms

For more information on Glaucoma, visit the NIH:
http://www.nlm.nih.gov/medlineplus/tutorials/glaucoma/htm/index.htm

 

By | June 23rd, 2018|Categories: Dr. Mauk's Boomer Blog, News Posts|Comments Off on Glaucoma Symptoms

Guest Blog: Tools to Make Your Shower Safer

Have you heard? A new government study has revealed that falls among adults over 65 rose over 30% in the past 10 years! While a fall every now and then may feel like no big deal, it is important for seniors to recognize that even seemingly harmless falls can lead to dangerous complications like hip fractures and head trauma.

If you or the person you care for hasn’t fall-proofed one of the most dangerous spots in the home, the shower, yet, don’t miss this essential list of helpful safety tools:

Toiletry Dispenser

Are you still struggling with slippery bars of soap and hard-to-grip shampoo and conditioner bottles in the shower? Get an easy-to-install toiletry dispenser instead which can stay fixed to the wall under your shower head and dole out toiletries in your hand as needed with the push of a button.

Grab Bars

Experts recommend installing grab bars both inside and outside the shower on walls that are easy to reach and can fully support your weight when you brace against them. Similar products like bathtub bars which sit fixed on the side of a bathtub and provide a raised support to hold and steady yourself are great too for notoriously hard-to-navigate tub showers.

Non-slip Shower Mat

Not all shower mats are created equal, and for seniors taking fall prevention measures in the shower, finding one that stays in place and offers a textured non-slip surface to stand on is critical. Additional features like being antimicrobial and machine-washable also prevent the buildup of contaminants and mildew which are common to humid areas like the shower.

Shower Chair

Even if you have no mobility issues at all, a shower chair may be a good investment if your space allows for it. Shower chairs make it easy to sit and rest in the shower if you suddenly feel weak or unbalanced. And specialty transfer chairs help caregivers easily get a loved one in and out of the shower without over-exerting themselves or putting their loved one’s safety at risk.

Handheld Shower Head

Quit trying to twist, turn, and contort your body when bathing yourself. A removable, handheld shower head is a must for easy, thorough washing that won’t leave you with a muscle strain in your back. Experts recommend getting one with at least 5 feet of maneuverable cord to allow for enough slack to raise and move it around your body with ease.

Outside of the shower, additional upgrades that can improve your safety and bathroom experience include automatic lights that provide consistent, bright lighting without having to flip a switch, non-slip bathroom mats, and raised toilet seats with handles.

By | June 22nd, 2018|Categories: Dr. Mauk's Boomer Blog, News Posts|Tags: , |Comments Off on Guest Blog: Tools to Make Your Shower Safer

Five Tips to Surviving Your Husband’s Retirement

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I remember when my father retired at the age of 62 from a busy career as a pediatric surgeon. I thought he would be bored, but he had already compiled a notebook full of chores to do around the house, places he wanted to go, and a bucket list of other accomplishments that had been put on hold. Shortly after his retirement, my Mom confided in me that it was a bit of an adjustment having Dad home all the time. Suddenly, Mom said she seemed to no longer be able to cook right after about 40 years of doing this on her own. Dad had a better way to do things, after all. Once I saw Mom trying to wrap a gift and the wrapping paper seemed too small for the size of present. Dad was trying to give her step by step instructions and after snapping at her, Mom let him wrap the gift himself. Now, while I do concede that Dad was able to wrap the gift absolutely perfectly with the allotted paper, Mom and I gave each other a knowing glance and smiled. Ah, retirement.

So, when my own husband announced that he was going to retire and sell his share of the business at the age of 51, I knew I had to take some action to give our marriage the best chance to survive and thrive against this new challenge. After all, when my father-in-law retired, my mother-in-law had to encourage him to get a part-time job so she could have some “peace”. Even she was a bit concerned when my husband decided to take early retirement. Here I offer my short bit of wisdom, gleaned not only from my own experience but also from many wise women who gave me their sage advice to prepare for this season of life: when your husband retires.

Set the ground rules. I had fortunately learned during a brief period when my husband was working from home that there were certain things that would have to be agreed upon before he ever retired if we were to live peaceably. For example, he was not allowed to take over any of my former responsibilities unless I asked him to. Driving the kids around to activities can be helpful, but trying to wash the shrinkable clothes was not. Taking us out to eat after I worked all day was fine, but trying to take over the kitchen was off limits. Helping the kids with business math (not my area of expertise) was great, but trying to be the full-time homeschool Dad was not going to work for any of us.

Have separate work spaces. Jim and I cannot share a computer. I teach partially online and spend lots of time working from home with consulting. We agreed early on that he would set up a separate place in a different part of the house for his computer and desk. This has created much harmony over sharing the work space.

Allow everyone time to adjust to the change. I must admit that it took me several weeks, maybe even months, to realize that my husband was truly going to retire. Once he was home all the time, the reality gradually set in, but I kept reminding myself to give us all an adaptation period as if we were starting a new job orientation, because things were definitely going to change. Our two teenagers were the most leery of Dad being home all the time. For them, the ground rules (i.e. “please just let us do our work and don’t change our routine”) were particularly essential.

Accept your differences. My husband is a problem-solver and savior. He likes a challenge and wants to fix everything for everyone if he can. While I admire this about him, I didn’t want him to fix the nice structure and functionality by which our home was already running. I learned to embrace his strengths and encourage him to accept my weaknesses (like overindulging in carbs and worrying about things I can’t control). He likes to exercise every day, watch sports, and spend time on the landscaping. I would rather take the kids to the movies and go shopping. And that had to be ok.

Embrace the positives. While I was a bit skeptical about how our lives would change with my husband retiring so soon, there are so many things to celebrate that I am daily embracing the wonderful opportunities and blessings that his retirement has brought to our family. We are free to travel more. He accompanies me on business trips, even to China twice! He is much more relaxed and pleasant. It makes our family happy to see him have the time and resources to do what he enjoys. Jim keeps busy all of the time and yet does not have the daily pressure of work-related stress. We spend more time with family and have plans to move nearer to the grandchildren and to a better climate.

For all the women who are warily facing their husband’s retirement, take heart. I can honestly say that with some forward and deliberate planning, my husband’s retirement is one of the best things that has ever happened to us!

By | June 21st, 2018|Categories: Dr. Mauk's Boomer Blog, News Posts|Comments Off on Five Tips to Surviving Your Husband’s Retirement

GERD

Background

Although gastroesophageal reflux disease (GERD) is common among older adults, the true prevalence is not known. Many patients with GERD-related symptoms never discuss their problems with their primary care provider. GERD is thought to occur in 5–7% of the world’s population, with 21 million Americans affected (International Foundations for Functional Gastrointestinal Disorders, 2008). It is found in both men and women.

Signs and symptoms

Pathophysiological changes that occur in the esophagus, hiatal hernia, and certain medications and foods increase the risk for GERD. Obesity (Corely , Kubo, Levin et al., 2007) and activities that increase intra-abdominal pressure such as wearing tight clothes, bending over, or heavy lifting have also been linked to GERD (MedlinePlus, 2005a). The cardinal symptom of GERD is heartburn; however, older adults may not report this, but rather complain of other symptoms such as pulmonary conditions (bronchial asthma, chronic cough, or chronic bronchitis), a hoarse voice, pain when swallowing foods, chronic laryngitis, or non-cardiac chest pain (Pilotto & Franceschi, 2009). The chronic backflow of acid into the esophagus can lead to abnormal cell development (Barrett esophagus) that increases the risk for esophageal cancer.

Diagnosis

Older adults often have atypical symptoms, making the diagnosis of GERD very challenging. As people age, the severity of heartburn can diminish, while the complications, such as erosive esophagitis, become more frequent. Therefore, endoscopy should be considered as one of the initial diagnostic tests in older adults who are suspected of having GERD (Pilotto & Franceschi, 2009). Examination of the esophagus, stomach, and duodenum through a fiber-optic scope (endoscopy) while the person receives conscious sedation, allows the gastroenterologist to visualize the entire area, identify suspicious areas, and obtain biopsies as needed. Helicobacter pylori (H. pylori), a chronic bacterial infection in humans, is a common cause of GERD, affecting about 30% to 40% of the U.S. population. Testing for H. pylori can be done during the endoscopy or by other tests (Ferri, 2011).

Treatments

The objectives of treatment for GERD include: (1) relief of symptoms, (2) healing of esophagitis, (3) prevention of further occurrences, and (4) prevention of complications (Pilotto & Francheschi, 2009). Lifestyle and dietary modifications are important aspects of care. It is widely recommended that persons with GERD should stop smoking, limit or avoid alcohol, and limit chocolate, coffee, and fatty or citrus foods. Medications should be reviewed and offending medications modified, since certain medications decrease the lower esophageal sphincter (LES) tone, allowing acid to backflow into the esophagus. These include anticholinergic drugs, some hormones, calcium channel blockers, and theophylline. Avoidance of food or beverages 3–-4 hours prior to bedtime, weight loss, and elevation of the head of the bed on 6-to-8 inch blocks are some other interventions that may help alleviate symptoms. Pharmacological treatments with antacids in conjunction with histamine 2 (H2) -blockers (Tagmet, Zantac, Axid, and Pepcid) are used for mild GERD. If these are ineffective in controlling symptoms, then the proton pump inhibitors (PPIs) are the next drugs of choice. These include medications like Nexium and Dexilant. With lifestyle modifications and appropriate medications, older adults can manage their GERD symptoms so that quality of life is maintained.

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 GERD, visit the Mayo Clinic Website:
http://www.mayoclinic.com/health/gerd/DS00967

 

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By | June 19th, 2018|Categories: Dr. Mauk's Boomer Blog, News Posts|Comments Off on GERD

Heart Failure Warning Signs and Treatment

Background

Heart failure (HF) happens when the heart is not strong enough to pump the needed blood with oxygen to the rest of the body. The CDC estimated that 5.7 million people in the U.S. have heart failure. The incidence of congestive heart failure (CHF) varies among races and across age groups. It is the cause of 55,000 deaths each year (CDC, 2012). The lifetime risk for someone to have CHF is 1 in 5.

Risk Factors

The major risk factors for HF are diabetes and MI. African American males are at higher risk than Caucasians. The risk of CHF in older adults doubles for those with blood pressures over 160/90. Seventy-five percent of those with CHF also have hypertension (AHA, 2012). Congestive heart failure often occurs within 6 years after a heart attack.

Warning Signs

Signs and symptoms of heart failure include shortness of breath (that also worsens when lying down), weight gain with swelling in the legs/ankles, and general tiredness. It is essential that older adults diagnosed with HF recognize signs of a worsening condition and report them promptly to their healthcare provider. Older adults may not have the typical symptoms but complain of other things like decreased appetite, weight gain of a few pounds, or insomnia (Amella, 2004).

Diagnosis

For in-home monitoring, daily weights at the same time of day with the same clothes on the same scale are essential. The physician or primary care provider will give guidelines for the person to call if the weight exceeds his or her threshold for weight gain. This is usually between 1 and 3 pounds. The decision regarding when to call the primary care provider is made based upon the severity of the HF and the relative stability/frailty of the person.

Treatment

Treatment for HF involves the usual lifestyle modifications discussed for promoting a healthy heart, as well as several possible types of medications. These include ACE inhibitors, diuretics, vasodilators, beta-blockers, blood thinners, angiotensin II blockers, calcium channel blockers, and potassium. Lifestyle changes, per recommendation of the primary care provider, may include (AHA, 2009):
Maintaining an appropriate weight
Limiting salt intake
Limiting caffeine and alcohol intake
Managing stress
Getting adequate rest
Engaging in physical activity as prescribed
Quitting smoking
Eating a heart-healthy diet
To minimize exacerbations, patient and family counseling should include teaching about the use of medications to control symptoms and the importance of regular monitoring with a health care provider (Agency for Healthcare Research and Quality [AHRQ], 2012; Hunt et al., 2009). With the proper combination of treatments such as lifestyle changes and medications, many older persons can still live happy and productive lives with a diagnosis of heart failure and minimize their risk of complications related to this disease.

For additional information on heart failure visit the American Heart Association website at:
target=”_blank”>http://www.heart.org/HEARTORG/Conditions/HeartFailure/Heart-Failure_UCM_002019_SubHomePage.jsp”

 

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 | June 17th, 2018|Categories: News Posts|Comments Off on Heart Failure Warning Signs and Treatment

Cataract Warning Signs and Treatment

Cataracts are responsible for 51% of world blindness, representing about 20 million people (World Health Organization [WHO], 2010). More than 90% of cataracts are age-related. Cataracts are so common in older adults that some almost consider them an inevitable consequence of old age and often fail to report to the doctor. According to the University of Washington, Department of Ophthalmology (2008), 400,000 new cases of cataracts are diagnosed each year, over 3 million visits to a doctor are related to cataracts each year, and 5,500,000 people have some impaired vision due to cataracts. Although about half of people between 65 and 75 years of age have cataracts, they are most common in those over age 75 (70%), and there are no ethnic or gender variations (Trudo & Stark, 1998).

Risk Factors

Advancing age is the biggest risk factor for the development of cataracts. Other risk factors include diabetes, tumor, long-term use of medications such as corticosteroids, excessive exposure to sunlight, blunt or penetrating trauma, and excessive exposure to heat or radiation. Tobacco use, family history of cataracts, high alcohol intake, diabetes, and lack of dietary antioxidants also puts the person at risk for cataract development (Gerzevitz, Porter, & Dunphy, 2011).

Warning Signs/Diagnosis

Cataracts cause no pain or discomfort and may be manifested by gradual opacity of the lens, which affects the ability to see clearly. This causes decreased visual acuity, sensitivity to glare, and altered color perception. Older adults may not be aware of the problem until visual changes occur. They may report blurred or distorted vision or complain of glare when driving at night. The person may present with a fall due to visual changes. Some older adults will disclose that their reading vision has improved and they no longer need reading glasses, something called “second sight”. Eventually the pupil changes color to a cloudy white. Generally, the most common objective finding is decreased visual acuity, such as that measured with a Snellen eye chart. The patient should be referred to an ophthalmologist for further evaluation and consideration of surgery.

Treatment

Although changes in eyeglasses are the first option, when quality of life becomes affected, the most effective treatment for cataracts is surgery. Surgery is relatively safe and usually is done as an outpatient procedure. The opaque lens is removed through an incision in the eye and an intraocular lens is inserted. The surgical incision is either closed with sutures or can heal itself. This is the most common operation among older adults, and more than 95% of them have better vision after surgery (Trudo & Stark, 1998). After surgery, patients will need to avoid bright sunlight; wear wrap-around sunglasses for a short time; and avoid straining, lifting, or bending. They may need to use eye drops as instructed by the doctor (National Eye Institute, 2013). The benefits of surgery include improved visual acuity, depth perception, and peripheral vision, leading to better outcomes related to ADLs, quality of life, and reduced risk of falls. Complications associated with surgery are rare but include retinal detachment, infection, and macular edema. Cataract surgery today offers a safe and effective treatment to maintain independence and improve quality of life for older adults.

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 | June 15th, 2018|Categories: News Posts|Comments Off on Cataract Warning Signs and Treatment