Dan Easton

By Dr. Nanette J. Davis, Ph.D.

Caregiving has often been compared to a roller coaster ride, with its inevitable ups and downs. This is especially true as your loved one deteriorates and faces the end of life. If you’re one of the 65 million family caregivers who has been feeling overwhelmed for too long, “burnout” may have set in.

Take that first step. Identify and claim the full range of your emotions—the anger, indifference, anxiety. In a recent study, 50% of family caregivers confessed to feeling depressed and some 69% admitted that frustration drove them to place their loved one in care. You may be experiencing the following, as well:

• Fatigue
• Confusion over role reversal
• Loss of interest
• Withdrawal or isolation from friends and other support persons
• Irritability
• Illness
• Poor sleep
• Desire to harm self or others

These unwanted reactions can also be compounded by the guilt and shame about feeling this way. Here are a few suggestions that might make a big difference.

1. Make a point to engage in outside activities for maintaining a sense of health and well-being. Sure, it could feel like “one more thing” to do. But if you choose your outside activities wisely—staying away from demanding people or events—you could feel surprisingly refreshed.
2. Seek and accept outside help. Once you admit to yourself and others that you can’t do it alone, the burden suddenly lifts. Good starting points are: local organizations, social service agencies and faith communities. Don’t overlook family, friends and neighbors who may be able to lend a hand.
3. Allow your loved one plenty of opportunities to practice functional skills—as hard as it may be. Feeling as independent as possible satisfies a basic human need, even for a seriously ill person.
4. Consult with a geriatric specialist, pastor or counselor about the right course of action if your loved one has become overly dependent or has exhausted your resources—physical, emotional or financial.
5. Admit that you are juggling multiple roles, and engaging in an ever-so-delicate dance of support. The dance can go on as long as you allow the role of who leads and who follows to shift as circumstances change.
6. Pay attention to your own needs. You can achieve balance when you include time to sleep, exercise, eat and attend to your own medical needs. Time spent with family, friends or just being alone helps you bounce back, too.
7. Practice saying—maybe even forcefully—“no” when appropriate, and “yes” when someone offers to help.
8. Seek out quality respite care.
9. Enjoy an occasional movie or lunch with a supportive friend.
10. Don’t expect too much from yourself.

Continue to recognize, acknowledge and accept your difficult emotions, so you can then work on setting boundaries, letting go of control and developing coping skills. For example, meditation and yoga can be incredibly relaxing.

Your commitment to your loved one can be a renewable resource if you take the right steps and are willing to change strategies when the “same ol’, same ol’” isn’t working anymore.

You can visit Dr. Nanette’s ABCs of Caregiving blog at http://www.abcsofcaregiving.com/

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

While many seniors enjoy leaving the workforce and retiring after years of hard work, some find the transition a difficult and lonely experience, especially those who live alone or far away from family members. It can be hard to get used to filling up the days without work — and co-workers — to help pass the time, and at times it’s equally difficult to create new friendships.

While it can be daunting at first, taking on a new job is a great way to form new bonds and friendships, stay active, and keep living a fulfilling life after a big change. Here are five great jobs for seniors who want to fill their days with people and activity.

Dog-walking

Chances are there are dozens of pet owners nearby who are in dire need of a responsible caretaker for their pets. Rover.com can help you find jobs in your area and will set you up with pet owners for a meet-and-greet. Once you find the job that’s right for you, the site will even handle the financial end of things. And for extra cuddle time with a sweet creature, you can also sign up to be a pet sitter.

Greeter/Hospitality

Restaurants, hotels, and retail stores are just three businesses that require greeters and hospitality, and while the duties vary, this can be a wonderful job for active seniors. It allows you to work with people while maintaining flexible hours, and many stores offer an employee discount on some of their items.

Tour Guide

Museums, hotels, and historical buildings are a few of the businesses that require tour guides, and these will likely offer flexible hours while still giving you the chance to socialize.

Tutor/Music Teacher

If you have experience in education, art, or music, you might consider tutoring or teaching lessons. Check Craigslist.org for job posts and consider advertising your services on social media, or even on a flier at your local supermarket.

Going through such a huge life change can be difficult at first, but there are plenty of jobs available for seniors who need flexible schedules and want to keep loneliness at bay.

Jenny Wise is a stay-at-home mom and home educator. She and her husband decided to homeschool when their oldest was four years old. During their journey, they’ve expanded their family and have faced many challenges. But they’re happy to have overcome each one. Jenny writes about her family’s experiences and homeschool, in general, on her new blog, SpecialHomeEducator.com.

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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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