Kristen Mauk

About Kristen Mauk

President/CEO - Senior Care Central, LLC

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.

By |2023-03-01T16:01:35-05:00March 28th, 2023|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Pneumonia Information
Read More

Diabetes Risk Factors and Treatments

Diabetes mellitus type 2

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

 

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.

By |2023-03-01T16:01:15-05:00March 26th, 2023|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Diabetes Risk Factors and Treatments
Read More

Stroke Warning Signs and Risk Factors

Portrait of Worried Senior Couple

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.

For more information on Stroke, visit American Stroke Association at:
http://www.strokeassociation.org/

 

Save

Save

By |2023-03-01T16:00:18-05:00March 20th, 2023|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Stroke Warning Signs and Risk Factors
Read More

The 6-Step Process of Stroke Recovery

Caring For Husband

 

According to the CDC, nearly 800,000 persons in the United States have a stroke each year. This is about one every 4 minutes, resulting in over 130,000 deaths annually. Stroke is simply defined as an interruption to the blood supply to the brain and is caused by a clot or hemorrhage. It can be a devastating problem for survivors, resulting in changes in mobility, cognition, speech, swallowing, bowel and bladder, self-care, and general functioning to varying degrees.  Some people recover completely after a stroke, but others experience lifelong challenges.

The good news is that there is hope and quality of life after stroke. In my research with stroke survivors, I discovered 6 phases that survivors reported as they made the journey through rehabilitation towards recovery. These steps can be used to see where a person is in the recovery process, help us understand how they may be feeling, and help guide the way we interact with them.

Agonizing:  In this first phase of the process, stroke survivors are in shock over what has happened to them. They can’t believe it, and may even deny the warning signs of stroke. The important task during this time is survival from the stroke itself.  Call 911 if you see the warning signs of facial droop, arm weakness, or speech difficulties.

Fantasizing:  In the second phase of the stroke process, the survivor may believe that the symptoms will all go away. Life will return to normal, and there is a sense of the problem being unreal. Time takes on a different meaning. The way to help is to gently help them recognize reality, and without taking away hope for recovery.

Realizing: This is the most important phase that signals a turn in the recovery process. This is when the survivor realizes that he/she may not fully recover from the effects of the stroke and that there is work to be done to rehabilitate and reclaim life. Common feelings during this phase of realizing are anger and depression. The way to help is to encourage the person to actively engage in rehabilitation. The real work of recovery is just beginning.

Blending: These last 3 phases in the process of stroke recovery may be occurring at much the same time. This is where the real work of adaptation to life after stroke begins. The survivor begins to blend his “old life” before stroke with his new life as a stroke survivor. He/she may start to engage in former activities even if it requires adaptations to be made. He/she will be actively engaged in therapy and finding new ways to do things. The way to help is to promote education. This is a time when survivors are most ready to learn how to adjust to life after stroke. Listen to your rehab nurses, therapists, and physician. Be active in the recovery process.

Framing: During this phase, the individual wants to know what caused the stroke. Whereas in the Agonizing phase they were asking “why me?”, now they need to the answer to “what was the cause?”  Stroke can be a recurring disorder, so to stop a subsequent stroke, it is important to know the cause. Interestingly, if the physician has not given the survivor a cause for the first stroke, patients often make up a cause that may not be accurate. Help the survivor to learn from the health care provider what the cause of his/her own stroke was. Then steps can be taken to control those risk factors.

Owning:  In this final phase of stroke recovery, the survivor has achieved positive adaptation to the stroke event and aftermath. The survivor has accomplished the needed grief work over the losses resulting from the stroke. He/she has realized that the effects may not go away and has made positive adjustments to his/her life in order to go on. Survivors in this phase have blended their old life with the new life after stroke and feel better about their quality of life. While they still may revisit the emotions of the prior phases at times, they have accepted life as a survivor of stroke and made good adjustments to any changes that resulted. They feel that they have a more positive outlook on life. At this point, survivors can use their experience to help others cope with life after stroke.

For more information about stroke recovery, visit www.seniorcarecentral.net and view Dr. Mauk’s model for stroke recovery.

By |2023-03-03T20:48:33-05:00March 3rd, 2023|Dr. Mauk's Boomer Blog, News Posts|Comments Off on The 6-Step Process of Stroke Recovery
Read More

Be informed about Stroke

Consider these facts about stroke from the American Stroke Association (2013): Be informed about stroke.

• Nearly 800,000 Americans annually suffer a new or recurrent stroke.
• A stroke occurs about once every 40 seconds. About every 4 minutes, someone dies of a stroke.
• Stroke is the 4th leading cause of death in the United States, killing more than 137,000 people a year.
• Risk of stroke death is higher for African American males and females than for whites. Females have a higher rate of death from stroke than males.
• In 2010, Americans paid about $73.7 billion for stroke-related medical costs and disability.

Stroke is simply defined as an interruption of the blood supply to the brain. It is most often caused by a clot that either originated in the brain or traveled from another part of the body. Warning signs of stroke include (National Stroke Association, 2013):
• Sudden weakness or paralysis, usually on one side of the body
• Sudden confusion, speaking or understanding
• Sudden changes in vision
• Sudden dizziness, incoordination, or trouble walking
• Sudden severe headache with no known cause

If you or someone you love experiences any of these symptoms, call 911 immediately. Do not delay. New medical treatments may be able to reverse the effects of stroke, but time is critical. Note the time that the symptoms started so that you can inform the medical professionals who are providing treatment.
The effects of stroke depend on the area of the brain that is damaged. Some common results of stroke are weakness or paralysis on one side of the body, difficulty walking or dressing oneself, aphasia, trouble eating or swallowing, bowel and bladder changes, cognitive changes such as memory problems, and emotional issues such as depression and mood swings. Stroke affects the entire family, so be sure to seek out resources and support in your community if a stroke has touched your family.

For stroke survivors, treatment in an acute rehabilitation facility with an interdisciplinary team approach is highly recommended and results in more positive outcomes. The rehabilitation team works together with the survivor and family to accomplish personal goals and achieve the highest level of function possible. Although some of the effects of stroke may be long-lasting or permanent, there is hope of continued progress and good quality of life after stroke.

By |2023-01-09T11:14:08-05:00January 17th, 2023|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Be informed about Stroke
Read More

Senior Care Central, LLC
Ridgway CO. 81432
Phone: 970-626-4225

© 2019 - Senior Care Central, LLC. All rights reserved
Go to Top