Kristen Mauk

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About Kristen Mauk

President/CEO - Senior Care Central, LLC

End of Life: Palliative Care and Hospice

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The human survival instinct is strong and our spirits are made to embrace life. But what happens when your loved one is diagnosed with a terminal illness that has no cure? How do you reconcile the certain death of your spouse, parent, or child? Where can you turn when death is close or imminent?

We are fortunate to live in a society that supports excellent care for those who are coming towards the end of their life. As difficult as this journey is for persons and their family members, the appropriate level of service can provide the needed care and comfort to make the end of life a time of peace and reflection rather than pain and suffering.

Two major services are readily available to bring comfort and promote quality of life even until the end of life. These are palliative care and hospice.

Palliative care is a consultative service for those with life-limiting illnesses who may not yet meet the criteria for hospice or who do not wish to enter hospice yet. The focus of palliative care is comfort and symptom management, but patients may still continue treatments such as radiation, chemotherapy, dialysis, home health, or other therapy.  Palliative services can be provided in the acute hospital setting, in the home, or in a long-term care facility. A new program called PRIME (Progressive Illness Management Expertise) by AseraCare, focuses on symptom management, goals of care planning, medication management, and transition management. PRIME provides palliative care through nurse practitioners and social workers who coordinate care with your regular medical providers. For persons with serious chronic illnesses who experience recurring rehospitalizations, palliative care management can provide care coordination and smooth transitions to other settings, including hospice, at the appropriate time.

Hospice is a supportive and comprehensive service for those who are dying. The National Hospice and Palliative Care Organization states that the foundation of hospice and palliative care is the belief that “each of us has the right to die pain-free and with dignity, and that our families will receive the necessary support to allow us to do so”. Generally, to qualify for hospice a patient is expected to live 6 months or less. Hospice uses an interdisciplinary team of physicians, nurses, social workers, home health aides, chaplains, bereavement counselors, trained volunteers and others to provide comfort and support to the dying patient and family. These services are covered by Medicare, Medicaid, and most private and commercial insurances. Hospice care can be provided wherever a patient lives, with 24-hour on-call availability.

End of life decisions are often difficult for families to discuss, but palliative care and hospice programs provide the help that is needed to have these conversations. Their aim is to help provide quality of life until death, helping people “live until they die”. If your loved one may qualify for assistance, don’t delay in seeking this support. It may be the best way you can help your family member have a peaceful end of life.

 

 

 

 

 

By |2022-07-30T11:45:36-05:00August 27th, 2022|Dr. Mauk's Boomer Blog, News Posts|Comments Off on End of Life: Palliative Care and Hospice

Five tips for Grandparents to stay connected with family

bigstock-grandma-with-your-grandson-12149147

With the birth of my daughter’s second child, I began to reflect on the important role that grandparents can play in the lives of their grandchildren. Here are five essential tips for older adults who want to have a lasting influence in the lives of their children and grandchildren.

Visit often.  For those of us fortunate enough to live near our children and grandchildren, it is easy to see them often. Grandparents may even be the caregivers while parents are working. Visits don’t always have to be planned. Sometimes the best family time is a spontaneous invitation to dinner and a movie. However, sometimes distance can prevent regular visits. Some grandparents make it a goal to see their distant grandchildren once every 6 weeks or every few months. Be sure to take advantage of technology for your time together. Set a regular time to Skype or do Face-time. Don’t miss out on the subtle changes in those early years while babies are growing. Exchanging pictures may help, but they don’t replace the in-person experience. You may even think of relocating to be closer to family. For older grandchildren, be sure to have their cellphone number. Text them often and exchange pictures to stay involved in their lives and let them know you are available to them. Even small connections throughout the week (but without being annoying to teenagers of course) can make a difference in your relationship with your grandchildren.

Offer to help in practical ways. Working parents with young children will need a break at times. Ask how you can best help. Offer to keep the children for an overnight while mom and dad have a special dinner or weekend getaway. Many grandparents like to take their grandchildren on trips without the parents. Places like amusement parks, the zoo, or day trips to the water park or national forest all provide good diversion and quality time with Grandma and Grandpa while giving parents a rest. For even more quality time, take the older grandchildren on a cruise, camping in the mountains, or to a resort without their parents. For the mom with a newborn, take meals to the house (if you live close), do her grocery shopping or laundry, or send her a new bathrobe to show you are thinking of her. A favorite role model of mine sends the grandchildren a “baby shower in a box” with all sorts of goodies when she can’t be present due to distance or health concerns.

Plan special activities. Special activities need not be expensive. This could mean a trip to the park with Grandma or a special morning walk each week with Grandpa. My father used to take every grandson on a bow-hunting trip when they turned 12 years old. This was a rite of passage for every boy in the family. Grandpa would mount their first deer head for them and buy them a special hunting knife to commemorate the occasion. The girls in the family would take a trip to a Disney resort while the men were hunting. Grandchildren remember these events forever.

Attend special events. How fortunate are the kids whose grandparents are able to attend basketball and volleyball games, swimming tournaments, and Grandparent’s Day at school! Take advantage of being able to attend those dance recitals and school plays. If you live far, plan your visits to be able to attend some significant events like graduations, wedding showers, or school performances. This makes lasting memories with your family.

Be a constant in their lives. My parents divorced when I was 9 years old, and my paternal grandparents were the one constant in my life at that time. When a child’s world is jolted by change, grandparents can be that steadying influence that doesn’t change. They provide stability and security in an unsteady world for a child. The most important thing to remember is to be there. You don’t have to be the all-star parent or grandparent, but your children will remember that you were there for them when it counted the most.

By |2022-06-21T11:36:42-05:00July 24th, 2022|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Five tips for Grandparents to stay connected with family

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 |2022-06-21T11:35:41-05:00July 18th, 2022|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Seizures

Five Tips to Surviving Your Husband’s Retirement

bigstock-Mature-Couple-In-A-Playful-Moo-5106837

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 |2022-06-21T11:33:53-05:00July 8th, 2022|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Five Tips to Surviving Your Husband’s Retirement

Five tips for Grandparents to stay connected with family

bigstock-grandma-with-your-grandson-12149147

With the birth of my daughter’s second child, I began to reflect on the important role that grandparents can play in the lives of their grandchildren. Here are five essential tips for older adults who want to have a lasting influence in the lives of their children and grandchildren.

Visit often. For those of us fortunate enough to live near our children and grandchildren, it is easy to see them often. Grandparents may even be the caregivers while parents are working. Visits don’t always have to be planned. Sometimes the best family time is a spontaneous invitation to dinner and a movie. However, sometimes distance can prevent regular visits. Some grandparents make it a goal to see their distant grandchildren once every 6 weeks or every few months. Be sure to take advantage of technology for your time together. Set a regular time to Skype or do Face-time. Don’t miss out on the subtle changes in those early years while babies are growing. Exchanging pictures may help, but they don’t replace the in-person experience. You may even think of relocating to be closer to family. For older grandchildren, be sure to have their cellphone number. Text them often and exchange pictures to stay involved in their lives and let them know you are available to them. Even small connections throughout the week (but without being annoying to teenagers of course) can make a difference in your relationship with your grandchildren.

Offer to help in practical ways. Working parents with young children will need a break at times. Ask how you can best help. Offer to keep the children for an overnight while mom and dad have a special dinner or weekend getaway. Many grandparents like to take their grandchildren on trips without the parents. Places like amusement parks, the zoo, or day trips to the water park or national forest all provide good diversion and quality time with Grandma and Grandpa while giving parents a rest. For even more quality time, take the older grandchildren on a cruise, camping in the mountains, or to a resort without their parents. For the mom with a newborn, take meals to the house (if you live close), do her grocery shopping or laundry, or send her a new bathrobe to show you are thinking of her. A favorite role model of mine sends the grandchildren a “baby shower in a box” with all sorts of goodies when she can’t be present due to distance or health concerns.

Plan special activities. Special activities need not be expensive. This could mean a trip to the park with Grandma or a special morning walk each week with Grandpa. My father used to take every grandson on a bow-hunting trip when they turned 12 years old. This was a rite of passage for every boy in the family. Grandpa would mount their first deer head for them and buy them a special hunting knife to commemorate the occasion. The girls in the family would take a trip to a Disney resort while the men were hunting. Grandchildren remember these events forever.

Attend special events. How fortunate are the kids whose grandparents are able to attend basketball and volleyball games, swimming tournaments, and Grandparent’s Day at school! Take advantage of being able to attend those dance recitals and school plays. If you live far, plan your visits to be able to attend some significant events like graduations, wedding showers, or school performances. This makes lasting memories with your family.

Be a constant in their lives. My parents divorced when I was 9 years old, and my paternal grandparents were the one constant in my life at that time. When a child’s world is jolted by change, grandparents can be that steadying influence that doesn’t change. They provide stability and security in an unsteady world for a child. The most important thing to remember is to be there. You don’t have to be the all-star parent or grandparent, but your children will remember that you were there for them when it counted the most.

By |2022-06-13T12:13:17-05:00June 26th, 2022|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Five tips for Grandparents to stay connected with family