Kristen Mauk

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About Kristen Mauk

President/CEO - Senior Care Central, LLC

Skin Cancer in Older Adults

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Background

There are three major types of skin cancer: basal cell, squamous cell, and malignant melanoma (MM). Basal cell carcinoma is the most common skin cancer, accounting for 65–85% of cases (Kennedy-Malone et al., 2000). According to the American Cancer Society (2013), more than 3.5 million cases of basal cell and squamous cell skin cancer are diagnosed every year. Squamous cell carcinoma is more common in African Americans and is also less serious than malignant melanoma. Malignant melanoma accounts for only 3% of all skin cancers, but it is responsible for the majority of deaths from skin cancer. Older adults are 10 times more likely to get MM than adults under age 40 (Johnson & Taylor, 2012). About 8,420 people were estimated to die from malignant melanoma in 2008. The American Cancer Society (2013) estimated that in 2013 there would be over 76,000 new cases of malignant melanoma in the United States.

Risk Factors

Older adults are more susceptible to skin cancers because of a variety of factors. These include exposure to carcinogens over time (such as through sunburn or tanning booths) and immunosenescence, or a decline in immune function. Family history of skin cancers, multiple moles (more than 100), and pale skin also put a person at higher risk. The major risk factor for all types of skin cancer is sun exposure.

Warning Signs

The ABCDE method can help people remember the warning signs of skin cancer:
A = Asymmetry (if a line is drawn down the middle of the lesion, the two sides do not match)
B = Border (the borders of the lesion tend to be irregular)
C = Color (a variety of colors is present; the lesion is not uniform in color)
D = Diameter (MM lesions are usually larger)
E = Evolving (note any changes in shape or size, or any bleeding)

Diagnosis

Annual physical examinations should include inspection of the skin for lesions. Older adults should be taught to report any suspicious areas on their skin to the physician. Persons should particularly look for changes in shape, color, and whether a lesion is raised or bleeds.

Basal Cell Carcinoma

Basal cell carcinoma (BCC) is the most common kind of skin cancer. It is often found on the head or face, or other areas exposed to the sun. Although there are different forms of BCC, the nodular type is most common, and appears as a raised, firm, papule that is pearly or shiny with a rolled edge. (Johnson & Taylor, 2012). Patients often complain that these lesions bleed and scab easily. When treated early, it is easily removed through surgery and is not life threatening, though it is often recurring.

Squamous Cell Carcinoma

Squamous cell carcinoma (SCC) also appears as lesion on areas of the body exposed to the sun, or from other trauma such as radiation. HPV is a risk factor of SCC, and metastasis is more common than with BCC. The lesions of SCC appear scaly, pink, and thicker than BCC. Their borders may be more irregular and the lesions may look more like an ulceration.

Malignant Melanoma

Malignant melanoma MM has a more distinctive appearance than other types of skin cancer. The areas appear asymmetric with irregular borders, a variety of colors (including black, purplish, and pink), and size greater than 6 mm. Malignant melanoma MM is often identified with the ABCDE method and MM accounts for the vast majority of deaths from skin cancer. The good news is that MM is almost always curable when found early. A skin check should be part of an older person’s yearly physical.

Treatment

The best treatment for skin cancer in the elderly is prevention. All older persons, especially those with fair skin who are prone to sunburn, should wear sunblock and protective clothing. Most skin cancers, when treated early, have a good prognosis.

All skin lesions larger than 6 mm, or those with any of the ABCDE signs, should be referred for biopsy. There are many nonsurgical interventions. These include cryotherapy, radiotherapy (for superficial BCC or SCC), electrodessication and curettage, and topical treatments. Topical treatments are generally not as effective as more aggressive interventions, but research is ongoing in this area.

The prognosis for MM depends on the extent and staging of the tumor, but when caught very early, the cure rate is nearly 100%. Malignant melanoma MM presenting in older adults is often more advanced and aggressive. Malignant melanoma MM metastases sites are typically the lymph nodes, liver, lung, and brain (Johnson & Taylor, 2012). Surgical treatment is required in malignant melanoma, with chemotherapy and radiation. Adjuvant treatments for MM are also often used.

For more information on Skin Cancer, visit the American Cancer Society at:
http://www.cancer.org/cancer/skincancer-melanoma/detailedguide/

 

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By |2020-06-22T11:42:37-05:00July 5th, 2020|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Skin Cancer in Older Adults

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 |2020-06-15T13:14:51-05:00June 15th, 2020|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Total Knee Replacement

The Sandwich Generation: Make it a Triple Decker!

We have all heard of the “sandwich generation” – those middle-aged adults who are still caring for their own children and also an aging parent. Well, here is an emerging trend that I will call the Triple Decker Sandwich generation: Baby Boomers who help care for aging parents, who still have children at home of their own, and who find themselves also taking on full time care of their small grandchildren. Yes, that is a sandwich of an entirely different kind. That is a Triple Decker.

Pew Social Trends (2013) revealed that many adults in their 30s and 40s were caring for ailing older parents and also providing some type of financial support for grown children. This resulted in reports from the sandwich generation in feeling in a hurry, rushed, and not having enough time for all of their expected duties. Now, add to those statistics another emerging trend: grandparents caring for grandchildren. I am not referring to the occasional or even regular hour babysitting or childcare that loving grandparents provide. Instead, this is the 24/7 responsibility for grandchildren who live with them, or whom they have adopted. The 2015 Profile of Older Americans from the Agency on Aging found that “in 2014, about 554,579 grandparents aged 65 or more had the primary responsibility for their grandchildren who lived with them”. Now, please note that this is only those grandparents aged 65 an over. What about all the others in their 50s and early 60s doing the same? I imagine that each person reading this can think of at least one or two grandparents who are raising small grandchildren. The implications of this on the health of aging persons is enormous. So, here are some tips to survive the Triple Decker Sandwich generation.

Pace yourself

If you have this many people in your life to care for, you must pace yourself. Avoid the temptation to give 100% all the time. It isn’t possible. Something in your life will suffer – and often this is your own health. Think of this task of caring for multiple generations as running a marathon. Develop skills, train, get into a good rhythm that you can maintain for the long haul.

Set priorities

You might have been able to juggle 4 kids and a job when you were in your late 20s or early 30s, but maybe now you are in your 50s with aging parents, teenagers, and a grandbaby to care for. Flexibility is a key to success. You just can’t do everything the same way if you are caring for small children again. Decide what is most important. Set reasonable and attainable goals. Make small goals for each day and celebrate those accomplishments.

Accept help

Even if you were used to being able to do it all yourself when you were younger, the amount of care that a Triple Decker generation person takes on requires some help at times. Let your adult children watch that baby to give you a break. Let the teens in the house help with the childcare. It is a good time for them to learn these skills for when they are parents. Tag team with your spouse to share the burden if you have a little one in the home. Church friends are happy to help if you need a night out.

Take time to rejuvenate

Being part of a Triple Decker sandwich is tough. Take time to rejuvenate to avoid burnout. You can’t care for anyone if you become ill or incapacitated yourself. For each person, renewal comes in different forms. For men, this might mean playing a sport or watching games on TV without interruption, or having a quiet private place in the house that is off limits from the noise of the household. For moms, this might be shopping alone or getting a manicure or pedicure. Sometimes talking on the phone, or meeting with friends for lunch provides a needed break. Know what you personally need to recharge and refocus and then allow yourself this (without guilt) on a regular basis. You may not be able to change your circumstances, but you can change how you deal with them.

Don’t expect too much

Chances are, if you find yourself in the Triple Decker mode, you are aging yourself. You can remember how you balanced work, life, kids, and higher education by yourself years ago. Now you wonder how you did it all. Well, you were 20 or 30 years younger then, so cut yourself some slack. Be sure to get enough sleep. Take breaks as needed. Exercise and eat right. Cut out the unnecessary things you did before to fill time and focus on those priorities that you set, without neglecting your own health.

Triple Decker Sandwich persons are tough and resilient. Congratulate yourself that you have been able to make it all work and care for your many loved ones. You sacrifice many things such as an easy and comfortable retirement and the ability to travel. But, you have given a great gift to those you love by sharing your care for them. In the end when you reflect back on your life accomplishments, you might very well find that this was one of the greatest.

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By |2020-05-27T11:58:30-05:00June 1st, 2020|Dr. Mauk's Boomer Blog, News Posts|Comments Off on The Sandwich Generation: Make it a Triple Decker!

Guest Blog: Inexpensive, Fun Activities For Seniors

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Whether you’ve recently retired, are planning to retire soon or are facing an unknown future where retirement seems virtually impossible, when you’re living on a fixed or tight income, you’re always looking for ways to save money. Plus, since one of the first areas to get cut when the budget is tight is entertainment, you may wonder how can you still have fun, without spending a fortune. To answer that question, here’s a list of inexpensive activities that could be perfect for you!

Attend Free Events. From free nights at the museum to local art gallery showings in town, keep your radar on for free activities in the area that you might enjoy. Most cities will host free lectures, concerts, movie nights and other activities from time to time.

Start a Club or Discussion Group.

    1. Start a book club, movie group or discussion group with a handful of friends, hosted either at your home or rotating homes month to month. Getting together will cost little more than making some snacks — and it will still be a fun night for everyone.

Take Advantage of Community Centers and Libraries. Rent movies or check out books at the library, and go for walks at the local community center track. Within your specific city or town, find what other amenities are available to you and decide to make the most of them, either on your own or with a friend.

Volunteer in the Community. Volunteering not only makes you feel good about helping others, but it also connects you with people in the community and often qualifies you for some cool, cash-saving perks. Whether it’s free food when you’re volunteering at the local school district or a place to socialize when you’re serving as a greeter at the hospital, volunteering helps you reach outside yourself and have fun in the process.

Host Potlucks. Rather than always going out to eat with friends, try hosting potlucks where everyone brings a dish to pass. You’ll only need to make one dish, still have the fun of socializing with friends or loved ones, and save a bundle in the process.

Enjoy the Outdoors. Go to the park, take walks on trails at the forest preserve, plan a picnic or watch a local Little League game. Getting outside is not only good for your spirits, it’s usually inexpensive too!

Mark Westerman is the Chief Marketing Officer for CareOne, Inc., a provider of debt relief services nationwide.

By |2020-05-27T11:58:12-05:00May 31st, 2020|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Guest Blog: Inexpensive, Fun Activities For Seniors

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 |2020-05-19T08:43:03-05:00May 26th, 2020|Dr. Mauk's Boomer Blog, News Posts|Comments Off on GERD