Presbycussis, or age related hearing loss is very common in the over sixties. However because it is a gradual loss of hearing over many years it is difficult to notice at first. Most people with age related hearing loss are unaware of the problem until they cannot follow conversations or misunderstand what is being said to them.
The inability to understand those around them can make a vulnerable person feel as through they are losing their mind. Having to concentrate hard whenever someone is talking can cause extreme tiredness which can make a person very forgetful. Worries about memory loss create stress and make the problem worse.
Tinnitus is a common symptom of hearing loss. It is usually described as a ringing noise in the ears, but in reality it can be any tone or buzzing noise. It may sometimes increase in volume until it drowns out normal speech sound, it can also change tone and sound musical. Someone may be reluctant to talk about the strange sounds they are hearing in case people think they are going a bit mad, or, if they are already concerned about their mental health they may think it is a hallucination.
The thought of becoming ill and losing independence is something many older people fear. The thought of having dementia and being unable to care for yourself is very frightening.
Problems in the ear can also lead to balance problems, making a person more likely to fall over. Vertigo is also common and can make it feel like the floor is moving as you are sitting still or walking along. This is very scary if you don’t know what it is.
To an observer, some of the symptoms of hearing loss may seem similar to those of dementia. They may be easily confused or not seem to know what is going on. A simple question may be met with a blank look or they may say something random in the middle of a conversation.
Age related hearing loss is caused by the slow decline of the delicate hair cells in the inner ear. Because certain sound frequencies are lost before others, they may only hear half sentences or miss the beginning sounds from words. The brain can compensate for this by automatically filling in the blanks so that the sentence makes sense, but this can cause lots of confusion when the person doesn’t realise they have misheard something. After all, it sounded right to them.
Everyone has different speech patterns and voice frequencies which makes some people harder to understand if the listener has hearing loss. Tiredness can also affect a person’s ability to hear well. This inconsistency in hearing ability can make others think they are sometimes being ignored or that hearing is ‘selective’. It can also make the person believe that there is no problem with their hearing because sometimes they can hear everything. This in turn, can increase the concern about mental health problems.
A hearing check can determine if there is a hearing problem as well as looking for any signs of disease or illness in the ear. A specialist can also give advice about coping with tinnitus and vertigo. These symptoms can be made worse by stress, so having as much information as possible about how to cope and being assured that there are no other causes can help immensely. Having hearing checked regularly will allow the audiologist to tell if there is rapid deterioration and whether the hearing loss is age related or due to other causes.
Modern hearing aids are much more discrete than they used to be and can be programmed to compensate for a person’s exact hearing loss. If they have been without good hearing for a while the hearing aid may seem too loud and they will be tempted not to use it. However it is important to encourage them to wear it as much as possible so that they can get used to normal hearing volumes again. The more they use it, the easier it will be to set the controls and get the most benefit.
Arrange some follow up appointments with the audiologist so they can make any alterations needed to the hearing aid programs.
Some hearing aids also come with a remote control so that the volume or program can be changed easily and discretely. This is ideal if the buttons on the hearing aid itself are too small and fiddly.
There is plenty of specialist equipment which can help them to stay independent. A pager alert system which vibrates or flashes can tell them if their doorbell or telephone rings. It can also be linked to a smoke alarm and pillow shaker to give them, and you, peace of mind at night.
These alert systems can also be linked to doors or floor mats so they know if someone has come through the front door or gone into certain rooms. This is ideal if they are caring for their partner or have a shared entrance to their flat or apartment.
Telephones are available with extra loud ring tones and flashing lights to make sure they do not miss your calls. These are hearing aid compatible and have volume controls so that they can turn the speaker’s voice up. Being able to use the telephone again can help them stay in touch with friends and family and feel connected to everyone again.
In social situations, make sure the person is sitting where they can see everyone’s faces and that background noise is kept to a minimum. Be aware that when you are outside, or in a large room with a high ceiling, it will be harder to hear what is said.
Even when a hearing loss is diagnosed and they have a hearing aid, a person may need time to come to terms with their hearing loss. If they start to avoid social occasions or they seem withdrawn, they may be suffering from stress or depression and might need extra support.
About the Author: Paul Harrison has been in the hearing aid industry for over 15 years working at both manufacturer level and retailer level. He now operates a UK online hearing aid business www.yourhearing.co.uk which offers all the major hearing aid manufacturer hearing aids.
Constipation is the most common bowel problem in older adults. The definition varies by patients and health care providers, but generally it means less frequent bowel movements than usual, and those which are hard, dry, and difficult to pass. Constipation is a preventable and treatable problem. Changes that occur with normal aging, such as peristalsis in the gut slowing down or decreased physical activity, predispose older persons to constipation.
Risk Factors/Warning Signs
Constipation is often due to a combination of causes. Some of the risk factors include decreased activity, medications (such as certain pain pills, iron supplements, and calcium supplements), depression, neurological conditions (dementia, Parkinson’s disease, stroke, diabetes mellitus, and spinal cord injury), dehydration, low dietary fiber, metabolic disturbances (such as hypothyroidism), undergoing dialysis, obstruction, and decreased access to the toilet (Halter et al., 2009). The range of “normal” for bowel movements is three times per day to three times per week. A decrease in number of stools that is “normal” for the person and the occurrence of hard, dry stools that are difficult to expel are typical signs of constipation.
If constipation is severe enough for the person to seek medical care, the patient may complain of abdominal pain and even have symptoms similar to other problems such as an appendicitis or diverticulitis. These more serious ailments can be ruled out through x-rays, CT scan or MRI. The diagnosis is based on clinical presentation, history, and physical examination. It is important to determine the onset and duration of the constipation, along with functional and nutritional status.
Before starting a bowel program to prevent constipation, the existing problem should be dealt with. A physician may prescribe laxatives, suppositories, and/or enemas to get the stool moving and eliminated. Many such products can be obtained over the counter as home remedies, but severe and recurrent problems should be referred to the primary care provider for further examination of the cause. After starting with a clean bowel, interventions should focus on lifestyle and dietary modifications. All natural means should be tried first before adding medication to the regimen. This includes regular exercise, establishment of a regular routine for toileting (assure privacy), and encouragement of a high-fiber diet with adequate fluid intake (unless contraindicated)(Joanna Briggs Institute, 2008). Medications may be considered for those who do not respond to lifestyle changes. Residents of nursing homes appear to respond to stimulant laxatives (e.g., senna, bisacodyl) or Miralax. Enemas should not be used on a regular basis because they promote lazy bowel function. Most older persons can avoid constipation if they remain active, have proper nutrition high in fiber, and drink plenty of fluids.
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 Radha at Inspire
Inspire is a leading social network for health that connects patients and caregivers in a safe permission-based manner
Mastering your medical paperwork: Tips from a professional organizer
Who knew getting sick could require the combined skills of a librarian and an archivist? For most of us, managing the paperwork that comes with medical care can be an overwhelming task.
“In so many ways, you’re powerless,” said J.J. Jackson, an organization professional in the Washington D.C. area and owner of PaperworkMaven.com. “Especially people who have a lot of doctor’s appointments, they’re really sick and just don’t have the energy to do all this stuff… It’s so frustrating and it takes emotional time.”
Getting on top of medical paperwork – mainly, knowing where things are, what is complete, and what is not – can help people reclaim some power.
“It definitely empowers me,” Jackson said, because tracking her information gives her a complete picture of her medical and financial situation and she can speak with confidence about tests, needs, and money paid and owed.
Organized medical paperwork can also reduce stress and even save money. If you’re struggling to keep medical paperwork organized, here are 5 easy tips from a professional organizer.1. Put everything in one place
1. Put everything in one place
At minimum, having everything together is critical, Jackson said. This could be the point where some people stop; it might be a starting point for others to organize further. But as long as everything is in one spot – a box, a folder, a digital file – you can get to it later.
2. Set aside time for paperwork (it’s probably less than you think)
Time is the number one thing that Jackson said gets in her way.
For someone who has regular medical appointments and a paperwork backlog of several months, Jackson estimated about three hours of concentrated work to organize paperwork into a system. However, once the system is in place, it may require less than 30 minutes per week to log and file new information. In her experience, Jackson said calling insurance companies takes up the most time.
3. A Table of Contents is your best friend
Ideally, a system for paperwork would have an easy-to-skim main document to which related materials like receipts, Explanation of Benefits statements, medical reports, and images can be traced. This also makes it easy for others to figure out your medical picture, if necessary. It can be physical or digital.
Through her personal and professional experience, Jackson created a simple spreadsheet to track claims, a few claim details, and payments. Each line item corresponds to one day. Jackson labels related documents with the same line-item, so she knows what claim they correspond to. She won’t check off a line item until each task and payment associated with it is resolved.
“It’s about making sure you have enough detail to track things needing attention and things that are done,” she said,
Many people don’t realize they can and should delegate paperwork-related tasks. But, Jackson said, consider that having your medical paperwork in order is important enough to devote resources to it.
“I think people think they ought to be able to do it themselves,” she said. “It’s ok if you don’t want to do it. If someone is sick, I think it would be such a gift to them. If they just don’t have time or energy or the emotional capability doing that, as a family member or friend, that is an excellent gift to give.”
Expert resources from organizations like the National Association of Productivity and Organizing Professionals and the American Association of Daily Money Managers could be of use said Jackson, who enlists help for medical tasks herself. And depending how comfortable you are letting others see sensitive personal health information, hiring someone to sort, log, file, and do general paperwork-related tasks could also help.
5. Physical vs digital systems
Digital organization and cloud storage will be the way of the future, Jackson said. The challenge right now is that medical information is spread over multiple locations and multiple types (paper receipts and reports, emails, digital image files, audio recordings, and personal notes, to name a few) and there aren’t good ways to integrate these in one system.
Jackson has separate locations for physical and digital materials but sticks to the same labeling system that corresponds to her main chart. If you’re really committed to a paperless system, a good scanner is essential, Jackson said. A robust organization system should accommodate how you like to store and track your materials and adapt to changes in health needs over time.
Except for those who enjoy detailed organization work, Jackson admits getting medical paperwork organized is not fun. Rather, it’s a means to an end.
“The feeling I get when I’m done is really satisfying,” she said. “I feel accomplished and I feel empowered and like I have peace of mind.”
A 2015 survey revealed that Americans fear to get broke during retirement. 55% of the 1000 respondents confessed they fear not having enough money for their needs. It is a fear many newly retired folks experience hence the need to adapt to a frugal lifestyle. Here are some tips how:
1. Do Away with Unnecessary Insurance Policies
While car and homeowner’s insurance policies remain vital for many retirees, other types may not be worth renewing after retirement. A life insurance policy is not as important, especially if you are debt-free.
2. Track Your Expenses
It is essential to keep track of all your expenses after retiring. A budget helps avoid dipping into your retirement savings more than you need to. You also get to control your spending habits in terms of choices. The more effort you put into tracking your spending, the easier it gets to determine areas you need to cut back on spending.
3. Identify Ways to Reduce Property Taxes
Retirees can keep their property taxes from increasing to grow their monthly disposable income. Some states offer property tax rebates for older residents. You should do your research so you can take advantage of these opportunities.
4. Shop Smart
Some hotels, drugstores and other services offer senior discounts. The qualifying age may vary from one company to another, but it’s worth a try.
5. Vacation Less
It’s natural to treat yourself to a vacation. Sadly, these costs add up pretty fast cutting into one’s retirement savings. Retirees receive discounts and special offers for travel and local outings, giving them more cash to spend without dipping into their savings excessively.
The tips discussed should help you formulate strategies for frugal living after retirement. According to Jane Byrne of FirstCare Kildare, always be realistic about whether your finances will allow you to maintain the same standard of living. Whether you have saved a reasonable amount, living on a fixed income requires you to reduce spending.
You may have heard of rehabilitation nursing, but are you familiar with what rehabilitation nurses do and their essential role in health care? According to the Association of Rehabilitation Nurses (ARN), there are four major domains within the new competency model for professional rehabilitation nursing (ARN, 2016) that can help us understand what rehabilitation nurses do. In this blog, we will look at the ARN model from a layperson’s viewpoint to help explain the role of the rehabilitation nurse. Rehabilitation nurses:
Promote successful living
Rehabilitation nurses do not only care for people, but they promote health and prevent disability. This means that rehab nurses engage in activities that help patients, families and communities stay healthy. Proactively, you might see rehab nurses helping with bike safety (such as promoting the wearing of helmets), car seat fairs (to keep children safe from injury), or stroke prevention through community screenings and teaching about managing risk factors. As rehab nurses, we also help patients towards self-management of existing chronic illness or disability, teaching them how to be co-managers with their health providers so they can maintain independence and have a good quality of life. Another key activity is facilitating safe care transitions. This means that rehabilitation nurses have a special skill set to know which setting of care is best for the patient to move to next and how to make this happen smoothly. For example, if Mrs. Smith has had a stroke and finished her time in acute rehabilitation in the hospital, but she lives alone and is not quite ready to go home, what is the best care setting or services for her to receive the help she needs? Many errors, such as those with medications, happen when patients go from one place to another in the health system. Rehabilitation nurses can help persons successfully navigate these complexities and be sure that clients get the continuity of care they need and deserve.
Give quality care
The interventions or care that rehabilitation nurses provide to patients and families is based on the best scientific evidence available. Part of being a rehab nurse is staying current on the latest technology, strategies for care, and best practices. This is to ensure that all patients receive the highest standard of care possible. We stay current in many ways, including reading journal articles, attending conferences, obtaining continuing education, and maintaining certification in rehabilitation. Research shows that having more certified rehabilitation nurses on a unit decreases length of stay in the hospital. In addition, all of rehab care focuses on the patient and family as the center of the interdisciplinary team. To this end, rehabilitation nurses teach patients and families about their chronic illness or disability across many different areas including: how to take medications; managing bowel and bladder issues; preventing skin breakdown; dealing with behavioral issues that might be present with problems such as brain injury or dementia; coping with changes from a disabling condition; sexuality; working with equipment at home; and ways to manage pain.
Collaborate with a team of experts
Rehabilitation nurses are part of an interprofessional team of physicians, therapists, psychologists, nutritionists, and many others who work together for the best patient outcomes. For persons who have experienced a catastrophic injury or illness, the work of this team of experts sharing common goals will provide the best care, and rehab nurses are the ones who are with the patient 24/7 to coordinate this process. Through effective collaboration, excellent assessment skills, and communication with the rest of the team members, rehab nurses ensure that patient and families are getting well-coordinated care throughout the rehabilitation process. Remember that rehabilitation takes place in many settings, whether on the acute rehab unit, in skilled care, long-term care, or the home. The nurse’s role is to be sure that the holistic plan of care is followed by all staff and that the physicians overseeing medical care are continually informed of patient progress for the best decision-making possible.
Act as leaders in rehabilitation
Not only do rehabilitation nurses provide direct patient care, they are also leaders in the rehabilitation arena. You might be surprised to learn that rehabilitation nurses advocate at the highest level for legislation surrounding funding and policy for those with disabilities and chronic illness, talking with Senators and Congressmen about key issues. ARN has professional lobbyists that continually watch health policy movement in Washington and keep rehab nurses informed. Rehab nurses help patients to advocate for themselves in holding government and communities accountable for needed care services. Lastly, rehab nurses share their knowledge with others. This is done in a variety of ways through conducting and publishing research, presenting at conferences, serving on local and national committees, and serving in public office. All of the leadership activities done by nurses in rehabilitation are to promote the best quality of care for patients with chronic illness and disability.
Alzheimer’s disease (AD) is the most common type of dementia seen in older adults. An estimated 5.4 million Americans of all ages had Alzheimer’s disease in 2012. Nearly half (45%) of people over the age of 85 have AD. By 2050, the number of individuals age 65 and over with Alzheimer’s could range from 11 million to 16 million unless science finds a way to prevent or effectively treat the disease. One in eight older adults has AD, and it is the sixth leading cause of death in the United States (Alzheimer’s Association, 2012). Those affected with AD may live from 3–20 years or more after diagnosis, making the life span with this disease highly variable.
Advanced age is the single most significant risk factor for AD (Alzheimer’s Association, 2012). More women than men have AD, but this is because women live longer than men, not because gender is a risk factor. Family history and heredity are also identified risk factors for AD, as are head trauma and poor cardiac health.
Alzheimer’s disease is characterized by progressive memory loss. The person affected by AD is gradually less able to remember new information and memory lapses begin to affect daily function. It is a terminal disease that over its course will eventually leave a person completely dependent upon others for care.
Initially, the clinical progression of the disease is slow with mild decline; however, deterioration increases the longer the person lives, with an average life span of 8 years after diagnosis (Cotter, 2002; Fletcher, Rapp, & Reichman, 2007). The underlying pathology is not clear, but a growth of plaques and fibrillary tangles, loss of synapses, and neuronal cell loss are key hallmarks of AD that interfere with normal cell growth and the ability of the brain to function. Absolutely definitive diagnosis is still through autopsy, although clinical guidelines make diagnosis easier than decades ago when less was known about the disease. Primary care physicians generally make the diagnosis through a thorough history, physical exam, cognitive testing, and labs. New criteria for diagnosis include staging the disorder and biomarkers (beta amyloid and tau in the cerebrospinal fluid and blood) (Alzheimer’s Association, 2012b). An MRI of the brain may be ordered to rule out other causes of symptoms.
The clinical course of AD is divided into several stages, depending on the source consulted. In the early course of AD, the person may demonstrate a loss of short-term memory. This involves more than common memory loss, such as where the keys were put, and may involve safety concerns such as forgetting where one is going while driving. The inability to perform math calculations and to think abstractly may also be evident. In the middle or moderate phase, many bodily systems begin to decline. The person may become confused as to date, time, and place. Communication skills become impaired and personality changes may occur. As cognitive decline worsens, the person may forget the names of loved ones, even their spouse. Wandering behavior as well as emotional changes, screaming, delusions, hallucinations, suspiciousness, and depression are common. The person with AD is less able to care for her- or himself and personal hygiene suffers. In the most severe and final phase, the person becomes completely dependent upon others, experiences a severe decline in physical and functional health, loses communication skills, and is unable to control voluntary functions. Death eventually results from body systems shutting down and may be accompanied by an infectious process. Although there is no single test, and the diagnosis may be one of exclusion, early diagnosis is important to maximize function and quality of life for as long as possible. Persons experiencing recurring and progressing memory problems or difficulties with daily activities should seek professional assistance from their physician.
Treatment for AD is difficult. There are several medications (such as Aricept, Namenda, Razadyne, and Exelon) that may help symptoms (such as memory), but they do not slow the course of the disease. There is currently no cure; however, research continues to occur in pharmacology, nonpharmacology, and the use of stem cells to manage symptoms and perhaps one day eradicate the disease.
Treatment will focus on symptom management, particularly in the areas of behavior, safety, nutrition, and hygiene. Behavioral issues such as wandering and outbursts pose a constant challenge. Many long-term care facilities have special “memory care” units to care for Alzheimer’s patients from the early to late stages of the disease. These units provide great benefits such as consistent and educated caregivers with whom the patient or resident will be familiar, a safe and controlled environment, modified surroundings to accommodate wandering behaviors, and nursing care 24 hours a day. Additionally, nurses are present to manage medications and document outcomes of therapies. However, many family members wish to care for their loved ones at home for as long as possible.
Thus, another important aspect of care in AD is care for the caregivers. Howcroft (2004) suggested that “support from carers is a key factor in the community care of people with dementia, but the role of the caregiver can be detrimental to the physical, mental, and financial health of a carer” (p. 31). She goes on to say that the caregivers of persons with AD would benefit from training in how to cope with behaviors that arise in these patients and how to cope with practical and legal issues that may occur.
Research has shown that ongoing skills are needed by family caregivers to deal with the progressive decline caused by AD. In fact, “a 63% greater risk of mortality was found among unpaid caregivers who characterized themselves as being emotionally or mentally strained by their role versus noncaregivers” (National Conference of Gerontological Nursing Practitioners & National Gerontological Nursing Association, 2008b, p. 4). Adapting to stress, working on time management, maximizing resources, and managing changing behavior were all skills caregivers needed to develop in order to successfully manage home care of their loved ones. When interventions and resources were not used by caregivers in the early stages of the care recipient’s AD, the risk of a healthy patient being institutionalized due to caregiver burden was higher (Miller, Rosenheck & Schneider, 2012). Caregivers needed not only to acquire knowledge and skills, but also to make emotional adjustments themselves to the ever-changing situation.
Such findings suggest that nurses should focus a good deal of time on educating caregivers of persons with AD to cope with, as Nancy Reagan put it, “the long good-bye.” Scientists continue to explore the causes of AD and hope in the near future to be able to isolate the gene that causes it. In the meantime, results from a fascinating longitudinal study (called the Nun study) on aging and AD, which used a group of nuns who donated their brains to be examined and autopsied after death, has suggested that there is a connection between early “idea density” and the emergence of AD in later life. That is, essays the nuns wrote upon entry to the convent were analyzed and correlated with those who developed AD. It was found that those with lower idea density (verbal and linguistic skills) in early life had a significantly greater chance of developing AD (Grossi, Buscema, Snowdon, & Antuono, 2007; Snowdon, 2004). The nun study has allowed researchers to examine hundreds of brains so far in nuns who died between 75 and 107 years of age and discover other important facts such as a relationship between stroke and the development of AD in certain individuals, and the role of folic acid in protecting against development of AD (Snowdon, 2004). Scientists from a number of fields continue to research the causes and possible treatments for AD and the Nun study project is continuing at the University of Minnesota. Snowdon’s research suggests that early education, particularly in verbal and cognitive skills, may protect persons from AD in later life.
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.