Guest Blog: What is Assisted Living?
Assisted living is a long-term care facility that provides housing, support, health care, and most importantly, a sense of community to senior citizens. These facilities make it possible for the elderly to continue living on their own, with occasional assistance now and again. The benefits of living in an assisted living community are immeasurable for seniors and their families alike. Learn more about the multitude of benefits the elderly receive when they move into an assisted living facility.
- Proper, Healthy Meals: Daily meals are provided at assisted living facilities. This helps senior citizens to get the proper nutrition in their daily diet, and also lets family members feel assured that their loved ones are eating enough. Any and all dietary needs are taken into consideration. For instance, if a senior has diabetes, this is of course taken into consideration when creating their meal plan. The utmost care is used when serving seniors their meals at assisted living facilities.
- Help with ADLs (Activities of Daily Living): An assisted living facility will provide its residents with assistance completing a number of day-to-day tasks that one might not be able to do on their own. This includes dressing, eating, mobility, hygiene, bathing, toileting, using the phone, and personal shopping. Take, for example, patients with dementia or other types of memory loss who might find it difficult to remember doing the simplest of tasks. Assisted living facilities make it possible for these types of patients to continue living on their own with minimal help.
- Medication Management: This is perhaps the most important benefit of living in an assisted living community. More than 50% of senior citizens make a mistake when administering their own medication. This rate is shockingly high, and of a major concern due to potential life-threatening consequences. Assisted living staff not only ensure the right medications are being taken at the right times, but they also help to educate seniors on the importance of their medication.
- Transportation: Many seniors do not have the ability to drive anymore. In some cases, a senior simply no longer possess a car. Whatever the case may be, assisted living facilities handle any and all of the transportation necessary for senior citizens. Most of the time, transportation is needed for doctor’s visits. A senior who resides in an assisted living facility will have transportation to and from their appointments, as well as to activities outside of the facility, like shopping trips. When a family member can’t be there to take a senior citizen out and about, assisted living staff is.
- Social Interaction: Assisted living facilities are a great place for senior citizens to socialize. Like-minded individuals in similar situations are all around, and with plenty of activities to choose from, your loved one is sure to make a new friend or two. Many of the activities that take place at assisted living facilities are moderated by staff to ensure that healthy interactions are occurring at all times.
Assisted living may be the right choice for your aging loved one. Discuss this option with them, and share the numerous benefits that this type of facility can offer.
Byline: Ruth Folger Weiss is a blogger for Skyview Rehabilitation and Healthcare Center, a post acute rehabilitation and long-term care center in Croton-on-Hudson, NY.
Bladder Cancer Risk Factors and Treatment
Background
This type of cancer occurs mainly in older adults, with an average age at diagnosis of 73 years, with 9 out of 10 cases of bladder cancer diagnosed in persons over age 55. The American Cancer Society (ACS)(2012) reported that over 73,000 cases were diagnosed in 2012 and that this diagnosis rate has been relatively stable over the last 20 years. Men are three times as likely to get cancer of the bladder as women (American Foundation for Urologic Disease, 2008) and the incidence increases with age.
Risk Factors
Risk factors include chronic bladder irritation and cigarette smoking, the latter contributing to over half of cases. Male gender and age are also risk factors.
Warning signs
The classic symptom of bladder cancer is painless hematuria (blood in the urine). Older adults may attribute the bleeding to hemorrhoids or other causes and feel that because there is no pain, it must not be serious.
Diagnosis
Assessment begins with a thorough history and physical. Diagnosis may involve several tests including an intravenous pyelogram (IVP), urinalysis, and cystoscopy (in which the physician visualizes the bladder structures through a flexible fiber-optic scope). This is a highly treatable type of cancer when caught early. In fact, the ACS (2012a ) estimates that there were more than 500,000 survivors of this cancer in 2012.
Treatment
Once diagnosed, treatment depends on the invasiveness of the cancer. Treatments for bladder cancer include surgery, radiation therapy, immunotherapy, and chemotherapy (ACS, 2012). Specifically, a transurethral resection (TUR) may involve burning superficial lesions through a scope. Bladder cancer may be slow to spread, and less invasive treatments may continue for years before the cancer becomes invasive or metastatic, if ever. Certainly chemotherapy, radiation, and immune (biological) therapy are other treatment options, depending on the extent of the cancer.
Immune/biological therapy includes Bacillus Calmette-Guérin (BCG) wash, an immune stimulant that triggers the body to inhibit tumor growth. BCG treatment can also be done after TUR to inhibit cancer cells from re-growing. Treatments are administered by a physician directly into the bladder through a catheter for 2 hours once per week for 6 or more weeks (Mayo Clinic, 2012a). The patient may be asked to lay on his/her stomach, back, and or sides throughout the procedure. The patient should drink plenty of fluids after the procedure and be sure to empty the bladder frequently. In addition, because the BCG contains live bacteria, the patient should be taught that any urine passed in the first six 6 hours after treatment needs to be treated with bleach: One cup of undiluted bleach should be placed into the toilet with the urine and allowed to sit for 15 minutes before flushing (Mayo Clinic, 2012a).
If the cancer begins to invade the bladder muscle, then removal of the bladder (cystectomy) is indicated to prevent the cancer from spreading. Additional diagnostic tests will be performed if this is suspected, including CT scan or MRI. Chemotherapy and/or radiation may be used in combination with surgery. When the cancerous bladder is removed, the person will have a urostomy, a stoma from which urine drains into a collection bag on the outside of the body, much like a colostomy does. Bleeding and infection are two major complications after surgery, regardless of type, whether a TUR or cystectomy is performed. Significant education of the patient related to intake/output, ostomy care, appliances, and the like is also indicated.
For more information on Bladder Cancer, visit National Cancer Institute at:
http://www.cancer.gov/cancertopics/wyntk/bladder/
http://www.cancer.gov/cancertopics/wyntk/bladder/
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.
Pneumonia Information
According to the CDC (2010), chronic lower respiratory disease and pneumonia with influenza are the third and ninth leading causes of death, respectively, among older adults. Older adults 65 and older are more often affected by these disorders than younger adults, and the risk of death from pneumonia increases with age. In 2005, there were 651,000 hospital discharges of males diagnosed with pneumonia and 717,000 discharges of females, with greater than 62,000 deaths attributed to pneumonia (American Lung Association [ALA], 2008). The majority of these cases occurred in those age 65 and older, with the elderly having 5–10 times the risk of death from pneumonia as younger adults (Kennedy-Malone, Fletcher, & Plank, 2004).
Pneumonia is an infection of the lung that can be caused by bacteria, viruses, or mycoplasmas. The two most common ways to get pneumonia are through inhalation of droplet particles carrying infectious germs and aspiration of secretions of the nose or mouth areas. Older adults are at higher risk for pneumonia and can get a more serious infection if they also have other chronic diseases such as COPD, heart failure, a suppressed immune system, cerebrovascular disease, and poor mobility (ALA, 2012). The incidence of community-acquired pneumonia (CAP) among people age 65 and older is about 221.3 per 10,000 (ALA, 2008). Streptococcus is the most common bacterial cause, with about 50% of people with CAP requiring hospitalization (Weinberger, 2004). When hospitalized, older people are at risk for poor health outcomes, including respiratory failure requiring ventilator support, sepsis, and longer length of hospitalization, duration of antibiotic therapy and other supportive treatment (ALA, 2012).
Warning signs
The onset of bacterial pneumonia can be sudden or gradual; however, older adults may not present with the typical symptoms of chills, fever, chest pain, sweating, productive cough, or shortness of breath. Instead, they may have a sudden change in mental status (confusion/delirium). Cases of viral pneumonia account for about half of all types of pneumonia and tend to be less severe than bacterial pneumonia. Symptoms of viral pneumonia include fever, nonproductive hacking cough, muscle pain, weakness, and shortness of breath.
Diagnosis
Diagnosis is made through chest x-ray, complete blood count, and/or sputum culture to determine the type and causal agents (if bacterial). A thorough history and physical that includes assessment of swallowing ability and eating (watch for coughing while eating) to evaluate for aspiration risk should be done. Crackles may be heard in the lungs through a stethoscope, and chest pain with shortness of breath may be present.
Treatment
Bacterial pneumonia can often be treated successfully when detected early, and viral pneumonia generally heals on its own (antibiotics are not effective if pneumonia is caused by a virus), though older adults may experience a greater risk of complications than younger adults. Oral antibiotics will significantly help most patients with bacterial pneumonia.
Aspiration pneumonia is caused by inhalation of a foreign material, such as fluids or food, into the lungs. This occurs more often in persons with impaired swallowing. For older adults receiving tube feedings, care must be taken to avoid having the person in a laying position during and immediately after tube feeding because aspiration can occur; it is important to note that tube feedings do not reduce the risk of aspiration. Having the head of the bed elevated or, even better, the person in a sitting position when eating or receiving nutrition through a feeding tube, helps to avoid the potential complication of pneumonia related to aspiration.
When recovering from pneumonia, one should get plenty of rest and take adequate fluids to help loosen secretions (with accommodations made to support the added need to urinate due to the increased fluid intake, a common reason why older adults may not drink adequate fluids). Tylenol or aspirin (if not contraindicated by other conditions) can be taken to manage fever as well as aches and pains. Exposure to others with contagious respiratory conditions should be avoided. Respiratory complications are often what lead to death in the older adults, so they should be cautioned to report any changes in respiratory status such as increased shortness of breath, high fever, or any other symptoms that do not improve. It is important to follow up with the physician or nurse practitioner and get a chest x-ray if ordered, since symptoms may improve with treatment before the pneumonia is actually completely gone.
Prevention of pneumonia is always best. Adults over the age of 65 are advised to get a pneumonia vaccine. Persons younger than age 65 who have higher risk (those with respiratory problems or persons in nursing homes) should get the vaccination. A yearly flu vaccine is also recommended for older adults, because pneumonia is a common complication of influenza in this age group. Medicare will cover these vaccines for older persons.
Diabetes Risk Factors and Treatments
Background
Diabetes mellitus is a common metabolic disorder that affects carbohydrate, lipid, and protein metabolism. It is estimated that about 4.4 to 17.4% percent of adults in the United States have diabetes mellitus (Cory , Ussery-Hall, Griffin-Blake et al., 2010). It is estimated that 11.5 million women and 12.0 million men over the age of 60 have diabetes, but many do not know it. The Indian Health Service reported via the National Diabetes Survey of 2007 that of the 1.4 million Native Americans and Alaska Natives in the United States, 14.2% age 20 years or older have diagnosed diabetes. Rates vary by region, from 6.0% of Alaska Natives to 29.3% of the Native Americans in southern Arizona (CDC, 2007). There are two major types of diabetes, type 1 (T1DM) and type 2 ( T2DM). T1DM is characterized by autoimmune destruction of the insulin-producing beta cells of the pancreas, leading to a deficiency of insulin. New-onset of adult T1DM in older adults rarely happens; however, due to better treatment of T1DM, older adults who have been diagnosed at an earlier age are living longer. About 90% of older adults with diabetes have T2DM, which is often related to obesity. T2DM is characterized by hyperglycemia and insulin resistance; however, impaired insulin secretion may also be present. Diabetes mellitus is a major cause of disability and death in the United States, and is the seventh leading cause of death among older adults.
Risk Factors
The risk of diabetes increases with age (45 years and older). Other risk factors include family history, obesity, race (African Americans, Hispanics, Native Americans, Asian Americans, Pacific Islanders), hypertension, less “good” cholesterol (less than 35 mg/dl), lack of exercise, having a history of delivering large babies (≥9 pounds), personal history of gestational diabetes, and pre-diabetes in men and women (Laberge, Edgren, & Frey, 2011). Type 2 is the most common type in older women (CDC, 2007). The risk of death from DM is significantly higher among older ¬Mexican American, African American, and Native American women when compared to Whites. The Centers for Disease Control CDC (2005) names obesity, weight gain, and physical inactivity as the major risk factors for DM among women.
Diagnosis
The most common presentation for older adults with T1DM is hyperglycemia (high blood sugar). Older adults may not have the classical symptoms such as polydipsia, polyuria, polyphagia, and weight loss. Instead, they may have an atypical presentation (Halter Chang & Halter, et al., 2009). They may first present with falls, urinary incontinence, fatigue, or confusion. Because older adults may have T2DM for years before it is diagnosed, they often have macrovascualar and microvascular complications at the time of diagnosis, so evaluation of these should be considered at that time.
Treatment
Prevention is the best approach to care, which involves identifying those at risk and encouraging lifestyle change. Older adults with diabetes mellitus have a high risk for complications related to macrovascular disease, microvascular disease, and neuropathy. Macrovascular diseases include coronary heart disease, stroke, and peripheral vascular disease, which can lead to amputation. Microvascular diseases are chronic kidney disease, which is the most common cause of end-stage renal disease, and diabetic retinopathy, that which can lead to blindness. Peripheral neuropathy presents as uncomfortable, painful sensations in the legs and feet that are difficult to treat. A lack of sensation may also be present and contribute to the risk of falls. There is no cure for peripheral neuropathy, and it tends to be a complication for which patients experience daily challenges trying to manage the symptoms. A combination of medication to address pain and interventions by a physical therapist seems to be the best current treatment.
Treatment is aimed at helping patients to achieve and maintain glycemic control to decrease risk of complications. The initial treatment approach is to work with the older adult to establish treatment goals aimed at reducing long-term complications. This often requires working within an interprofessional team. Aggressive treatment may be appropriate for most older adults; however the risk of hypoglycemia (low blood sugar) is higher in older adults. Older adults with hypoglycemia may have an atypical presentation with acute onset of confusion, dizziness, and weakness instead of tremors or sweating. The best measure of good blood glucose management and controlled blood sugars is HgbA1c levels (glycosylated hemoglobin). This measure of hemoglobin provides insight into the previous 3 months of blood sugar control. If HgbA1c is elevated, it indicates that the blood sugar has been high over time. For most people, a HgbA1c ≤ 7% indicates optimal glycemic control; however, due to poor health outcomes, for frail older adults or those with a life expectancy ≤ 5 years this may not be the best, and a Hgb A1c of 8% might be more appropriate.
Management is successful when a balance is achieved among exercise, diet, and medications. Medications may be oral hypoglycemics or insulin injection. Insulin injection is used in T1DM and may be prescribed for T2DM because as the person ages, beta-cell function declines. If insulin is needed, it is important to consider if there are visual problems and or hand arthritis that limits the dexterity that is necessary to prepare and inject the medication. For some, a simple regimen, such as premeasured doses and easier injection systems (e.g.,insulin pens with easy-to-set dosages) is the best.
Thorough evaluation of readiness to learn and of the ability of an older person to manage his or her medications must be done. Older adults who need to give themselves insulin injections may experience anxiety about learning this task. Demonstration, repetition, and practice are good techniques for the older age group. Adaptive devices such as magnifiers may help if the syringes are hard to read. A family member should also be taught to give the insulin to provide support and encouragement, although the older adult should be encouraged to remain independent in this skill if possible. Williams and Bond’s (2002) research suggested that programs that promote confidence in self-care abilities are likely to be effective for those with diabetes. A plan for times of sickness and the use of a glucometer to monitor blood sugars will also need to be addressed. Additionally, the dietician may be consulted to provide education for the patient and family on meal planning, calorie counting, carbohydrate counting, and nutrition. Many patients benefit from weight loss, so the nutritionist can assist with dietary planning in this regard also.
Due to the increased risk of infection and slow healing that result from diabetes, foot care is an essential component in teaching older adults to manage DM. Some experts believe that good preventive foot care would significantly reduce the incidence of amputation in the elderly. Older persons with DM should never go barefoot outside. Extremes in temperature should be avoided. Shoes should be well fitting and not rub. Socks should be changed regularly. Elders should be taught to inspect their feet daily, with a mirror if needed. Corns and ingrown toenails should be inspected and treated by a podiatrist, not by the patient. Older persons should see their podiatrist for a foot inspection at least yearly. Patients should be cautioned that even the smallest foot injury, such as a thorn or blister, can go unnoticed and unfelt—and often results in partial amputations that lead to a cascade of lower extremity problems.
For more information on living with Diabetes, visit the American Diabetes Association:
http://www.diabetes.org
http://www.diabetes.org
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.