Resources

Resources 2016-12-16T23:03:20+00:00

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 | December 4th, 2017|Categories: 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

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By | November 27th, 2017|Categories: 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 | November 13th, 2017|Categories: Dr. Mauk's Boomer Blog, News Posts|Comments Off on The 6-Step Process of Stroke Recovery

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 | November 6th, 2017|Categories: 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 | November 1st, 2017|Categories: 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 | October 26th, 2017|Categories: 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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