Dr. Mauk’s Boomer Blog
Each week, Dr. Kristen Mauk shares thoughts relevant to Baby Boomers that are aimed to educate and amuse.
Dr. Kristen L. Mauk, PhD, DNP, RN, CRRN, GCNS-BC, GNP-BC, FAAN
Guest Blog: A Solid Rehab Approach for the Elderly
Unfortunately, addiction doesn’t just stop in one place and stay there. It can affect many people across all walks of life. It happens to any person, of any age, in any area, in any place of their life. This is why it is important to note those rehabs that specialize in rehab care for the elderly.
With over 40 million seniors aged 65 or older living in the country, it is no wonder that some of them do have an addiction issue. With so many seniors, many of them have taken prescription pills for one health issue or another. As a leading cause of substance abuse in the country, seniors are not exempt from this addiction.
In fact, seniors are more likely to be prescribed these medications and more likely to abuse them than any other age group. This is because they are oftentimes forgetful, may feel like they haven’t taken enough, do not realize they are taking too much, or any number of other reasons.
Rehab for these seniors addicted to these medications will be needed.
Addiction in Seniors
Many find it surprising that so many seniors are addicted to medications. Isolation and loneliness tend to be the most common issues for addiction in older adults, especially those abusing alcohol or other drugs.
This type of addiction needs to be addressed in a specific setting and in a specific way. Not only should the root of the problem, such as the loneliness, be addressed, but the specific person should understand that they have a problem. Even though they are older, it doesn’t mean that they shouldn’t get help.
An addiction rehab with specialists that are trained in senior rehab is required. This is a rehab center that can speak with the senior, understand why they are using or abusing the substance, and then find the best course of action to take regarding their treatment plan.
Seniors, just like the rest of us, are susceptible to addiction. Due to this, it is important to check in on those that are close to you to make sure that they do not feel the need to use. You want to help them when it is needed, visit with them, and let them know you are there. Rehabs for seniors, and others that have drug abuse issues are out there, but it shouldn’t have to get this far.
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.
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.
Guest Post: How to Reduce Loneliness for the Elderly in Your Life
Reaching the golden age does not always come only with a great life experience but also with reasons to make you feel lonelier than ever. Years have passed by and many of those people you encountered and loved so much may have passed away over time. This is something that remains in your heart forever.
Feeling lonely is not something to be ashamed of but also not something to control your life. Discover below the best ways in which to reduce loneliness for the elderly in your life. They deserve to live happy during this new stage in their existence. Help them rediscover the joy of living!
Develop a Strategy to Defeat Seclusion
If you have elder people you love, you must engage more in their life. It is unavoidable for them to feel lonely from time to time. This is why they need your love and support more than ever. Make them feel loved and an important part of your life. Offer them reasons to smile and continue every day. Do not forget about them or ever leave them feeling like no one has time for them anymore.
Allow Them to Feel Useful
Feeling like there is nothing left for you to do in life is the worst possible feeling. Older people should be treasured because they have a life experience to share. Learn to listen to them more often, spend more time with them and allow these amazing people to teach you what they know. Engage with them in activities that are suitable for their age and help them keep themselves active. Never leave them alone for too much time and always advise them on how to stay clear of sadness and depression.
New Bridge for the Generation Gap
The generation gap between young people and older ones is obvious. However, there should always be a bridge built with love, compassion, and respect or understanding to help keep these two generations together. Teach your children to appreciate the elderly. If they have grandparents, guide them towards building close relationships with them. Spending time together and sharing experiences will be a great way in which to reduce loneliness for the elderly in your life. It will also be a great life lesson for your children.
To ensure a better life experience for them at this stage you can also consider professional help in care homes in Maidstone. The main stages of life are the same for all of us. We may go through them differently and face varied challenges, but we all get to the same place sooner or later. Let’s treasure the amount of experience and life stories these amazing people have to share. We will learn more from them than from any other experience in our life.
Stroke Warning Signs and Risk Factors
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.
http://www.strokeassociation.org/
Guest Blog: Choosing the Right Security System for Seniors
White clock with words Time for Action on its face
The market today offers a wide variety of security systems for home safety and it can be confusing to choose the right one. For seniors in search of the right security system, it’s important to find one that works reliably but is also easy to use. Thankfully, there are options out there that no only offer a secure feeling for the home, but that are also simple to use which not only ensures a safe home, but also cuts down on the unnecessary confusion of trying to work with a system that requires frequent handling or has many codes to remember to engage or disengage the system.
Another issue with choosing the right security system for seniors is finding a system hat does not require a hefty monitoring fee or a long-term contract. Unfortunately, there are some unscrupulous people in the world who will prey on seniors in order to convince them they must have their services. They often do this by elevating fear with tales of crime in the area and convincing the senior that they need the system that is being offered.
Home invasion and burglary is a crime that is worrisome to all people and not just seniors. For many seniors however, strict budgets or health issues or physical barriers can be a deterrent to some of the security systems available today. Even memory loss associated with dementia can be a deterrent.
Seniors who need a little help can consider the following when it is time to choose the right security system.
The Easier to Use, The Better
The best security system for seniors will be one that is easy to use and won’t cause confusion. A security system should have the following options:
• Crafted to automatically contact emergency services
• Simple on and off
• Wearable emergency button is advisable
• 24/7 live monitoring
• Not easy to accidentally set the alarm off
• Monitoring in all rooms of the home
When choosing a security system, it is important to read all documentation carefully. If you have a trusted family member to assist in the search, that can be beneficial. Checking out several systems is a good idea in order to find the perfect one. A good security system can not only help prevent crime, but it can also give seniors and their family peace of mind when they know the home is protected.
Guest Blog:The Advantages Of Hiring A Home Care Consultant For Your Business
Hiring a home care consultant for your business can make a huge impact on the credibility
of the services you provide. Home care professionals are highly sought after by people who need help with caring for their aging loved ones. As a business owner, you can build authority as a home care provider and subject matter expert by collaborating with a consultant.
Of course, not just any consultant will work for your business and its home care goals. There are different skills you want to look for in the person that you hire. But the skills that you settle on will ultimately depend on your business size, the breadth of your services, and obviously, your bottom line. That’s why you’ll want to properly vet your potential home care consultants before you bring them onto your team.
In this article, we will cover the benefits of hiring a home care consultant for your business. We’ll also make sure you’re clear on what to look for in a candidate and their background. Read on
to discover how a home care consultant can positively impact your business and the home care services it provides.
You Decide What Background You’re Looking For
There is no one-size-fits-all background to look for when hiring a home care consultant. In fact,
It’s a common misconception that home care professionals need to all have extensive medical backgrounds. This is not at all the case, although some quality home care consultants may come from a health-related background.
If you want to take a deeper dive into your candidate’s background, you can get in touch with your local licensing board that certifies home care professionals. Many of these licensing boards, what they ask for from a person looking to become certified, and their criteria to meet change, based on what state you’re in.
Whatever your candidate’s background looks like, though, there are still some key things to look for above all else. These qualities will ultimately benefit your company and your clients’ experience with your services. Good communication, empathy, patience, and dedication — these are just a few attributes in a candidate that will make a huge impact on your clients. Interview your clients – multiple times, if you’d like – to make sure that they have these essential qualities.
You Can Build Relationships with Consultants
Simply put, it’s easier to build a relationship with someone on-one-one, rather than indirectly or through a third-party like home care staffing agencies. Home care consultants bring personal-level traits like loyalty and empathy, without the bureaucratic baggage and extra steps that you deal with when hiring through an agency. Building a relationship with a consultant early-on is a great way to get a sense of their experience and quality of service.
Once you’ve gotten to know a consultant well, it’ll be much easier to introduce them to your potential and existing clients. It’ll be obvious that you have a trusted relationship with your consultant when you can introduce them naturally while still providing a lot of detail about what they can offer.
Another advantage of working with an individual consultant is meting out more manageable pay. It tends to cost a lot more to hire home care consultants through an agency or other third party. Since you’re only negotiating pay and setting rates with one person, the time from sourcing candidates to hiring them is usually much quicker. Think carefully about how much you can budget for hiring home care professionals — chances are, a consultant will make much more sense for your business’s bottom line.
You Can Easily Evaluate Performance
The last thing that you want is for your home care services to suffer without you knowing about it. When you hire a home care consultant, it’s much easier to evaluate their performance and track their growth than it is when working with an agency. With a home care consultant, you can coordinate a performance tracker with them to make sure they know how to satisfy your business needs.
You can start this process during the hiring phase when you outline with your consultant what your requirements for their performance are. After your consultant understands what your business needs are and what your clients expect from them, they can closely work with you to make sure they’re meeting your expectations. Remember, if you’re not clear with your consultant about what’s required of them early on, they’ll struggle to meet your performance standards.
A huge benefit to setting a one-on-one performance plan and schedule with a consultant is reducing your risk of time lost. It’s much more difficult to plan performance expectations through an agency, evaluate them as having met your standards, and confirm with the person being cared for that they’re satisfied. With a consultant, your business doesn’t risk wasted time, effort, and money on a home care professional that isn’t on the same page as you.
It Helps Make a Name For Your Business and its Services
Hiring a home care consultant of your own simply gives your business more credibility than hiring through an agency. When you work with a consultant, you directly coordinate the way they behave with your client, which means you’re responsible for determining what your client needs are, and making sure they’re met one-hundred percent of the time. If you go with the agency route, you’ll never be sure that you’ll have the same caregiver for any real length of time, which hurts your clients’ overall experience.
Go with a home care consultant to increase your chances of having someone reliable who can stick around for the long haul. All too often, hiring through an agency means you’ll get a rotating door of individuals with varying levels of experience and skills.
A home care consultant with whom you build up trust and a relationship will make a world of difference in the quality of care your business offers in the longer-term. Your clients will recognize your business as a reliable source of expertise, rather than an outsourcing agency that doesn’t understand what its clients really want from their home care.