About Kristen Mauk

President/CEO - Senior Care Central, LLC

Thanksgiving is Good for Your Health

Close-up of Fresh Vegetables and Fruits

This time of year, many people pause to give thanks for the good things in their life, but did you know that giving thanks is good for your health?

Having an optimistic outlook on life and using positive coping skills to manage stress has been linked in numerous studies to a longer and happier life. One of the common themes among people over age 85 who report very good to excellent health (in spite of dealing with chronic illnesses) is just that – thinking positive. Norman Vincent Peale, in his famous book, “The Power of Positive Thinking” said:

The way to happiness: Keep your heart free from hate, your mind from worry. Live simply, expect little, give much. Scatter sunshine, forget self, think of others. Try this for a week and you will be surprised.

But what if you are not naturally a positive thinker, but more of a “the glass is half empty” kind of person? The good news is that you can begin to change your thinking to improve your health. If you are not sure where to start, consider some of these suggestions as a place to begin:

Count your blessings. There is an old hymn that was sung when I was girl. When I felt down and discouraged, I would sing this song. It went like this:

When upon life’s billows you are tempest-tossed. When you are discouraged thinking all is lost. Count your many blessings every doubt will fly. Then you will be singing as the days go by. Count your blessings. Name them one by one. Count your many blessings. See what God has done.

Sometimes it helps to list what you are grateful for on paper. If you need a place to start, an excellent resource is the book “One Thousand Gifts: Reflections on Finding Everyday Graces” by Ann VosKamp. Through a series of 60 short devotionals, the author walks you through a journey to greater appreciation and thankfulness for all that you have.

Learn to be content with what you have.  At the holidays, especially, it is easy to get caught up in thinking about what we wish we had and those things we don’t have. Try looking at it the other way- even in relationship to your health. For example, several years ago I had a catastrophic skiing accident, breaking my leg and tearing all of my knee ligaments. A subsequent blood clot complication meant that I couldn’t have surgery to repair the knee right away. After being in a wheelchair, on crutches, and in awful pain for months, with the help of countless hours of painful therapy and surgery a year later, I was finally able to walk almost normally again. Every day since then, when I am tempted to complain that I will never ski again, cannot kneel or squat, or do not have complete range of motion in that knee, I remind myself of those months when I couldn’t walk at all without help and how it felt to be completely dependent on others for everything. Each step I take, each walk in the sunshine, each little jaunt to the car, and the ability to ride a bicycle is a blessing. Every movement without pain is a bonus I never thought I would have again. Take time to recall when your situation was worse, and express joy that things are better than they were then.

Help others.  One of the best ways to stop feeling sorry for yourself and cultivate an attitude of gratitude is to serve others, especially those who are less fortunate than you. Volunteer to help serve food at the community Thanksgiving dinner or participate in Operation Christmas Child by making a shoebox for a boy or girl in a developing country who would otherwise have no gifts. Take food to your local food pantry. Mow the lawn or shovel snow for your widowed neighbor. Invite the single and lonely person to share Thanksgiving dinner with your family. Buy gifts through the Angel Tree Ministry for children of those in prison. Adopt a needy family. Even if you are homebound, you can encourage others by simple but meaningful tasks such as sending birthday or holiday cards to the people in your church or community group. A simple encouraging phone call can change a person’s day. By giving to others, you focus on positive parts of life and meaningful activities that in turn promote your positive mental health.

So, this Thanksgiving, push the pause button for a little while and take a moment to reflect on what you are grateful for. You may just find that Thanksgiving is good for your health.

 

By |2021-11-08T12:27:00-05:00November 25th, 2021|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Thanksgiving is Good for Your Health

Urinary Tract Infection

bigstock-bladder-cancer-6900693

Background

Urinary tract infections (UTIs), also called cystitis (inflammation of the bladder), are common among older adults and are more frequent in women. They are a primary cause of urinary incontinence and delirium. Catheter-associated urinary tract infections (CAUTIs) are more common among older adults (Fakih et al., 2012) and is mainly attributed to the use of indwelling urinary catheters. Many indwelling catheters are thought to be unnecessary (Cochran, 2007) and one study noted that physicians were often not aware of the purpose for which their patients had a catheter inserted (Saint, Meddings, Calfee, Kowlaski, & Krein, 2009). UTIs have been show to increase morbidity and mortality, length of hospital stay, and cost of hospitalization (Kleinpell, Munro, & Giuliano, 2008). CAUTI is considered preventable and is not reimbursed by Medicare. Therefore, hospitals will largely assume the financial costs for preventable infections of this type.

Risk factors/Signs and symptoms

Several risk factors are associated with UTIs in general. These include being female, having an indwelling urinary catheter, the presence of urological diseases, and hormonal changes associated with menopause in women. Signs and symptoms of UTIs include urinary frequency and burning or stinging felt during voiding. Pain may be felt above the pubic bone, and a strong urge to void but with small amounts of urine expelled. The most significant risk factor for CAUTI is prolonged use of an indwelling catheter. In hospital-acquired UTIs, 75% are associated with the use of an indwelling catheter (CDC, 2012). In women, signs and symptoms of CAUTI may be more severe than those reported by women by patients in the community who do not have an indwelling catheter. Lethargy, malaise, onset or worsened fever, flank pain, and altered mental status have been associated with CAUTI (Hooton et al., 2010).

Diagnosis

A thorough assessment should be done of the patient’s urinary output, including amounts, color, odor, appearance, frequency of voiding, urgency, and episodes of incontinence. A urine specimen should be obtained if UTI is suspected. Laboratory results will show the type of organism causing the infection, and the sensitivity will tell what medication the organism is susceptible to. These results should be reported promptly to the physician or nurse practitioner caring for the patient and so that a diagnosis and treatment plan can be made.

Treatments

Prevention of UTIs is considered a primary nursing strategy. Elderly female patients can be instructed to make lifestyle modifications such as: increasing their fluid intake; emptying the bladder after sexual intercourse; practicing good perineal hygiene, including wiping front to back after toileting; getting enough sleep; and avoiding stress (PubMed Health, 2011). Although many of these common sense strategies are recommended by primary care providers, there is a lack of scientific evidence to support some of them. Many UTIs will clear up on their own, particularly if the person increases oral fluid intake during early symptoms. However, with many older adults, antibiotic treatment may be needed. In general, a course of three 3 days for healthy adults is thought to be sufficient, but for more resistant bacteria, a longer course more than five 5 days may be needed (PubMed Health, 2011). For those with repeated or chronic UTIs, a low dose of antibiotics taken for 6– 12 months may be indicated (Hooton et al., 2010). If the underlying cause is CAUTI, treatment will be more aggressive. Monitor the patient’s temperature at least every 24 hours (Carpenito, 2013). Encourage fluids. Evaluate the necessity of continuing an indwelling catheter if one is in place.

Alternatives to indwelling catheters should be considered for appropriate patients. Intermittent catheterization, if appropriate, is preferred over indwelling catheter use, especially for long- term maintenance of bladder management (CDC, 2009; Hooton et al., 2010). Condom catheters may be an appropriate choice for some males. If an indwelling urinary catheter is necessary, the catheter should be removed as soon as possible, per the physician or nurse practitioner’s orders, to reduce the risk of CAUTI.

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.

 

Save

By |2021-11-08T12:26:21-05:00November 22nd, 2021|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Urinary Tract Infection

Sometimes We Just Need a Little Grace

2013-09-01 03.53.39

This is my dog. Her name is Grace. We fondly call her Gracie.

Gracie is a miniature pinscher, born just over 9 years ago, the last of a six-puppy litter. She was barely 3 inches long at birth and a third the size of the other puppies. We doubted she would survive. Her mother rejected her and tried to throw her out of “the nest” because she was different than the other puppies.

But my children and I believed in Gracie’s survival. We fed her by hand with an eyedropper as we cradled her in our palms, and we gave her the love and nurture she didn’t get from her own family of dogs. I had to lay her mother on my lap so that Gracie could be nursed apart from the others. When she was too weak to nurse, the kids and I took shifts to feed her around the clock and speak encouraging words of survival to her. Soon she became the strongest and most dominant of the pack, although still the smallest. She could fend off her five littermates from the food bowl with a fierce growl and scary glance. And Gracie repaid our faith in her will to live by returning the care and comfort she received from us with a lifetime of love and companionship.

Now that she is an older adult dog, she shows those signs of aging that we all do: gray hair, hearing loss, cataracts, stiff joints, and some excess weight around the middle. But like so many of us Baby Boomer humans, Gracie has the heart and soul of her younger years. She will still chase a chipmunk, but no longer catches it. She can still jump around with excitement, but then promptly falls asleep on the couch. Even in her old age, she continues to teach us about another kind of grace.

When I return from a business trip, Gracie is the first to greet me. Long before my husband or kids make it to the door, she hears my footsteps and comes running. You would think I was the most important person on earth as she jumps and whines and licks me, climbing in my lap for some affection. She makes me feel like a queen. It doesn’t matter to Gracie if I am in a grumpy mood, if I’m overweight, or if my hair is gray. She doesn’t care if I’m smart or not, or if others find me attractive. I am her person! She loves me the same in the morning, noon, or night and she never holds a grudge. In fact, I think that my dog seems to know more about unconditional love than many people do. She doesn’t hold my faults against me and she loves me just the way I am. She always shows it no matter what else has happened in the day. Gracie is the one at my feet in every room of the house. She sleeps next to me when I watch TV. She follows me everywhere. She is always at the door to protect me from strangers. She would give her life for mine in an instant if she could, and without a thought for herself. I sometimes find myself wishing that I had her strength of character.

It is a wonder to me that an ordinary, common, little runt of a dog without the powers of human reasoning could possess qualities that we so seldom see in people. The judgment and unforgiveness of others, sometimes even among our own families, is outshone by the loyalty and companionship that little Grace gives me every day.

So, maybe today we can learn a lesson from the simplest of God’s creatures. Show your enthusiasm for life and each other. Be a loyal companion. Take time to show affection. Miss each other terribly when you are apart. Be happy when you are together again. Forget past mistakes and harsh words. Practice forgiveness. And above all, love unconditionally.

By |2021-10-08T11:51:19-05:00November 16th, 2021|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Sometimes We Just Need a Little Grace

Shingles (Herpes Zoster)

Commonly known as shingles, herpes zoster is the reactivation of the varicella virus that causes chicken pox. Older persons may be infected with this latent virus after initial exposure to it in the form of chicken pox. The virus then lays dormant in the neurons until it is reactivated, often due to immunosuppression, when it appears in the form of painful vesicles or blisters along the sensory nerves. This reactivation tends to occur once in a lifetime, with repeat attacks occurring about 5% of the time (Flossos & Kostakou, 2006). Herpes zoster occurs in both men and women equally, with no specific ethnic variations, but is more common in the elderly.

Risk Factors

Risk factors for developing shingles are age over 55 years, stress, and a suppressed immune system. For many older women particularly, emotional or psychological stress can trigger recurrence.

Warning Signs

Signs and symptoms of herpes zoster include painful lesions that erupt on the sensory nerve path, usually beginning on the chest or face. They may appear as initially as a rash, looking much like chicken pox, often wrapping around the chest area in a band-like cluster. These weepy vesicles get pustular and crusty over several days, with healing occurring in 2-5 weeks (Kennedy-Malone et al., 2004; NINDS, 2013).

Diagnosis

Diagnosis is usually made by viewing the appearance of the lesions and a history of onset. A scraping will confirm some type of herpes virus. The most common complaint of those with herpes zoster is the painful blisters that usually subside in 3–5 weeks (NINDS, 2013). Postherpetic neuralgia, a complication of herpes zoster, may last 6–12 months after the lesions disappear and may involve the dermatome, thermal sensory deficits, allodynia (the perception of pain where pain should not be), and/or severe sensory loss, all of which can be very distressing for the patient (Flossos & Kostakou, 2006).

Prevention

Zostavax, a vaccine for shingles, has become available, and it is recommended for all persons age 60 or older who have already had the chicken pox. A person can still get shingles even after having the vaccine, but the symptoms and complications would be less severe. The vaccine has also been approved for persons age 50 – 59, and research has shown that receiving the vaccine significantly decreases the rate of shingles in the population (NINDS, 2013; PubMed Health 2012).

Treatment

Antiviral medications (such as Acyclovir) are used to treat shingles, but must be given within 48 hours of the eruption of the lesions. Topical ointments may help with pain and itching. Pain medications, particularly acetaminophen (Tylenol), are appropriate for pain management in older adults. If a fever is present, rest and drinking plenty of fluids is suggested. Persons with pain that lasts past 6 weeks after the skin lesions are gone and that is described as sharp, burning, or constant require re-evaluation by a physician. Postherpetic neuralgia may be a long-term complication lasting years (PubMed Health, 2012).

The person should be advised to seek medical attention as soon as he or she suspects shingles, in order to receive the best results from Acyclovir. The virus will run its course, but the person is contagious while vesicles are weepy. Persons should not have direct contact (even clothing) with pregnant women, people who have not had chicken pox, other elderly persons, or those with suppressed immune systems. The older person with shingles may experience concerns with pain management and feel a sense of isolation, particularly if they live alone. Arranging for a family member or friend who does not have a high risk of infection to check on the older person at home is advisable.

Visit the National Institute of Neurological Disorders and Strokes (NINDS) for an informational page on Shingles at: http://www.ninds.nih.gov/disorders/shingles/shingles.htm

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.

Save

By |2021-10-08T11:49:52-05:00November 6th, 2021|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Shingles (Herpes Zoster)

Total Knee Replacement

 

Background

Similar to hip replacement, knee replacement is done when a person is experiencing decreased range of motion, trouble walking or climbing stairs, and increased degeneration of the joint so as to impair quality of life. This most often occurs as a result of arthritis.

Treatment

Total knee replacement (TKR) surgery involves resurfacing or removing the distal portion of the femur that articulates with the end of the shin bone. The prosthesis consists of metal and plastic or similar materials that are cemented onto the newly resurfaced areas of the articulating bones. Although often done under general anesthetic, this surgery can also be performed under spinal anesthesia. Sometimes blood loss is significant, so patients may be asked to donate their own blood ahead of time to be given back to them in the event it is needed. In addition, a growing trend is toward bilateral knee replacement in those persons requiring both knees to be surgically repaired. The benefits of this are the one-time operative anesthetic and room costs, and many physicians feel recovery from bilateral replacement is similar to single replacement. However, the pain and lack of mobility, as well as the significant increase in the assistance needed after surgery when a bilateral replacement is done, may make this less than ideal for older patients. Surgical procedures for TKR have not evolved quite as rapidly as total hip arthroplasty.

Discomfort after knee surgery is generally severe in the first few days. Complications after surgery may occur, including pain, infection, and blood clots. Patients may use cold packs on the operative area and take pain and sleeping medications as ordered. In addition, alternative therapies such as guided imagery have been shown to help with pain management (Posadzi & Ernst, 2011). Many joint replacement patients feel a loss of control and independence.

Therapy will begin immediately in the acute care hospital. Although weight bearing does not usually occur until 24 hours after surgery, sitting in a chair and using a continuous passive motion machine (CPM) (if ordered), will ease recovery. The use of a CPM is generally based on the surgeon’s preference. There is research to support it, as well as studies indicating that walking soon after surgery has an equal effect and makes the CPM unnecessary. However, in cases of an older person who may not have the mobility skills initially after surgery that a younger person would, a CPM may be beneficial to keep the joint flexible and decrease pain.

Dr. Zann (2005) indicated that “patients undergoing total knee replacement do not achieve their maximum improvement until 2–4 years” (p. 1). This is attributed to the lack of muscular structures that surround and protect the knee and the need for the ligaments and tendons to adapt to the indwelling prosthesis. Recovery times vary and depend upon a number of variables, including the patient’s overall health, age, other preexisting health issues, and motivation. Patients report that the new knee joint never feels normal even years after the surgery, but that they experience an increase in function and generally much less pain than before.

Patients should be educated about signs and symptoms of infection, care of the surgical site (if staples are still present), pain management, and expectations for recovery. A range of motion from 0–90 degrees is the very minimum needed for normal functioning. Normal knee flexion is 140 degrees, but few older persons would get this amount of flexion after surgery, and may not have had full flexion even prior to the operation. After discharge, a walker is usually used in the first few weeks, followed by light activities 6 weeks after surgery. In addition, the patient’s spouse may experience feelings of being overwhelmed due to role transitions that occur after surgery and during the recovery period (Walker, 2012 ). Newer knee prosthetics are still going strong for the majority of patients 15 years after surgery.

 

By |2021-10-08T11:48:23-05:00October 29th, 2021|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Total Knee Replacement