Kristen Mauk

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.

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.

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.

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Background

Stroke, also known as cerebrovascular accident (CVA) or brain attack, is an interruption of the blood supply to the brain that may result in devastating neurological damage, disability, or death. Approximately 795,000 people in the United States have a new or recurrent stroke each year (American Stroke Association [ASA], 2012a). Stroke accounts for 1 in 18 deaths, making it the fourth leading cause of death in the United States. A death from stroke occurs every 4 minutes and the cost of stroke treatment and disability was over $73 billion dollars in 2010. Death from stroke is generally higher among females, with higher rates in Black males (67.7/100,000) and females (57.0/100,000) than in Caucasians (ASA, 2012a). In Canada, stroke is the fourth leading cause of death, affecting 50,000 people each year (Heart and Stroke Foundation of Canada, 20059).
There are two major types of stroke: ischemic and hemorrhagic. The vast majority of strokes are caused by ischemia (87%), usually from a thrombus or embolus (ASA, 2012a). The symptoms and damage seen depend on which vessels in the brain are blocked. Carotid artery occlusion is also a common cause of stroke related to stenosis

Risk Factors

Some risk factors for stroke are controllable and others are not. The most significant risk factor for stroke is hypertension. Controlling high blood pressure is an important way to reduce stroke risk. Those with a blood pressure of less than 120/80 have half the lifetime risk of stroke as those with hypertension (ASA, 2012a). Smoking 40 or more cigarettes per day (heavy smoking) increases the stroke risk to twice that of light smokers. If a person quits smoking, their risk after 5 years mirrors that of a nonsmoker, so older adults should be particularly encouraged to stop smoking.

Warning Signs

Several warning signs are common. These include:
SUDDEN numbness or weakness of face, arm or leg – especially on one side of the body.
SUDDEN confusion, trouble speaking or understanding.
SUDDEN trouble seeing in one or both eyes.
SUDDEN trouble walking, dizziness, loss of balance or coordination.
SUDDEN severe headache with no known cause (National Stroke Association, 2013)

Diagnosis

There are several tools for assessing for signs and symptoms of stroke. One easy acronym is FAST:
F stands for facial droop. Ask the person to smile and see if drooping is present.
A stands for arm. Have the person lift both arms straight out in front of him. If one is arm is drifting lower than the other, it is a sign that weakness is present.
S stands for speech. Ask the person to say a short phrase such as “light, tight, dynamite” and check for slurring or other abnormal speech.
T stands for time. If the first F-A-S checks are not normal, then one is to remember F-A-S-T that Time is important and the emergency medical system should be activated (National Stroke Association, 2012).
Older adults experiencing the warning signs of stroke should note the time on the clock and seek immediate treatment by activating the emergency response system in their area calling 911 (American Stroke Association, 2012). Transport to an emergency medical facility for evaluation is essential for the best array of treatment options. A history and neurological exam, vital signs, as well as diagnostic tests including electrocardiogram (ECG), chest Xx-ray, platelets, prothrombin time (PT), partial thromboplastin time (PTT), electrolytes, and glucose are routinely ordered. Diagnostic testing imaging may include computed tomography (CT) without contrast, magnetic resonance imaging (MRI), arteriography, or ultrasonography to determine the type and location of the stroke. The CT or MRI should ideally be done within 90 minutes so that appropriate emergency measures may be initiated to prevent further brain damage.

Treatment

The first step in treatment is to determine the cause or type of stroke. A CT scan or MRI must first be done to rule out hemorrhagic stroke. Hemorrhagic stroke treatment often requires surgery to evacuate blood and stop the bleeding.
The gold standard at present for treatment of ischemic stroke is t-PA (tissue plasminogen activator). At this time, t-PA must be given within 3 hours after the onset of stroke symptoms. This is why it is essential that older adults seek treatment immediately when symptoms begin. Only about 3 – 5% of people reach the hospital in time to be considered for this treatment (ASA, 2012d). t-PA may be effective for a select group of patients after the 3-hour window (up to 4.5 ½ hours), and this treatment window has been approved in Canada (Heart and Stroke Foundation of Canada, 2009). The major side effect of t-PA is bleeding. t-PA is not effective for all patients, but may reduce or eliminate symptoms in over 40% of those who receive it at the appropriate time (Higashida, 2005). Other, much less common procedures such as angioplasty, laser emulsification, and mechanical clot retrieval may be options for treatment of acute ischemic stroke.
To prevent recurrence of thromboembolic stroke, medications such as aspirin, ticlopidine (Ticlid), clopidogrel (Plavix), dipyridamole (Persantine), heparin, warfarin (Coumadin), and enoxaparin (Lovenox) may be used to prevent clot formation. Once the stroke survivor has stabilized, the long process of rehabilitation begins. Each stroke is different depending on location and severity, so persons may recover with little or no residual deficits or an entire array of devastating consequences.
The effects of stroke vary, and some persons may recover with no residual effects. But more often, stroke survivors may have problems that include hemiplegia or hemiparesis (paralysis or weakness on one side of the body), visual and perceptual deficits, language deficits, emotional changes, swallowing dysfunction, and bowel and bladder problems. Ninety percent of all dysphagia (swallowing problems) results from stroke (White, O’Rourke, Ong, Cordato, & Chan, 2008).

Poststroke Rehabilitation

Rehabilitation after a stroke focuses on several key principles. These include maximizing functional ability, preventing complications, promoting quality of life, encouraging adaptation, and enhancing independence. Rehabilitation emphasizes the survivor’s abilities, not disabilities, and helps him or her to work with what he or she has while acknowledging what was lost.
Stroke survivors go through a unique recovery process. This model shows the process of stroke recovery where forward progress after stroke lead to acceptance and adaptation:

If significant functional impairments are present, evaluation for transfer to an intensive acute inpatient rehabilitation program is recommended. Inpatient rehabilitation units offer the survivor the best opportunity to maximize recovery, including functional return. An interdisciplinary team of experienced experts, including nurses, therapists, physicians, social workers, and psychologists, will help the survivor and the family to adapt to the changes resulting from the stroke. Outcomes for geriatric stroke survivors are enhanced by intensive rehabilitation programs, whether offered in rehabilitation units or in skilled nursing facilities (Duraski, Denby, Danzy & Sullivan, 2012; Jett, Warren, & Wirtalla, 2005).
A large amount of teaching is often done by stroke rehabilitation nurses who work with older survivors and their families. These include knowing the warning signs of stroke and how to activate the emergency response system in their neighborhood, managing high blood pressure, understanding what medications are ordered as well as how often to take them and why, the importance of regular doctor visits, preventing falls and making the home environment safe, available community education and support groups, and the necessity of maintaining a therapeutic regimen and lifestyle to decrease the risk of complications and recurrent stroke. All survivors will need assistance in re-integrating into the community. This is generally begun in the rehabilitation setting.

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