Each week, Dr. Mauk shares thoughts relevant to Baby Boomers that are aimed to educate and amuse.
Caregiver Tips: Planning for Long-Term Cancer Care
Caregivers for long-term cancer care
Long-term cancer care supports cancer patients throughout their treatment journey. Patients diagnosed with cancer may choose a friend or family member as their cancer caregiver. When taking on the role of caregiver, make sure to understand how to best assist them. Here are some tips below to help get you started.
Tip 1: Understand the diagnosis of your cancer patient and how it affects them
Aggressive Cancers
Being a cancer caregiver opens up new responsibilities and challenges. There are many types of caregiving that provide help for the general health and wellbeing of patients. With cancer caregiving, patients often require specialized help. You may be familiar with senior or disability caregiving, but certain cancers are more difficult to manage. For example, breast cancer is common but involves a different caregiving approach than mesothelioma cancer. Mesothelioma is an aggressive cancer of the lungs that typically targets older adults.
There is currently no available cure for mesothelioma. This results in a 79 percent, 1-year survival rate, even with multimodal treatment—which combines one or two cancer treatments. Cancer patients and caregivers may have many questions surrounding treatment. For this reason, caregiver resources help plan and ease long-term mesothelioma cancer care. Take time to understand the type of cancer your patient has and how mesothelioma will affect them physically, mentally, and socially. The decision to have long-term cancer care is hard on the patient, too. Caregivers relieve some of the burdens patients will have. With this in mind, preparing for your patients will help you fully grasp this role.
It’s also crucial to work with the doctors and cancer teams to provide quality care. Depending on what type of caregiver you are, your responsibilities could change. More qualified caregivers may have to administer medications. Connecting with the doctor will help the cancer team with their prognosis strategy and your patient’s long-term cancer care. This will also help you better understand the patient’s needs.
Tip 2: Keep the patient, family and friends involved
It can be devastating when a loved one is diagnosed with cancer. Putting in the effort to work with your patient and their family will make them feel included and comfortable during this difficult time. Caregivers spend a lot of time with patients. By creating healthy relationships with them, you can give them the support and encouragement they need. Often, treatment is hard on patients and takes long recovery times. You will be one of their biggest advocates.
Tip 3: Pay attention to how you feel
Amidst the distress you and your patient will undergo, it’s vital to check in on yourself. It may seem as though your feelings aren’t as valid as those you are helping, but that isn’t the case. You won’t be able to fully care for your patient if you’re not caring for yourself as well. To avoid burnout, dedicate time for yourself to process your emotions and feelings, especially because of how draining long-term cancer caregiving can be.
If you are taking a cancer caregiver position, keep these tips in mind. Caregiving is not babysitting. Patients and their families rely on caregivers to handle what they cannot. Taking on this role is both an immense commitment and a privilege.
Alzheimer’s Disease
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.
Risk factors
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.
Warning Signs
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.
Diagnosis
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
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.
For more information on Alzheimer’s disease, visit the Alzheimer’s Association website at: http://www.alz.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 Blog: How to Choose the Right Mattress for Seniors
When you’re a caregiver for a senior citizen, you know how critical it is to find chairs, beds, and couches that are comfortable for your patients. Choosing the right mattress is especially crucial for the elderly. People in the 65+ age range often suffer from chronic pain related to sore, tender muscles, arthritis, and old injuries that have worsened as the years have passed.
A poor mattress can make even a teenager wake up feeling sore and tired, but for seniors, the effects of a poor mattress can cause debilitating pain and worsen inflammation. Senior citizens need a supportive mattress that cradles sensitive areas that are prone to soreness and stiffness, such as the hips, neck, shoulders, and the lower back. It’s also a good idea to choose a mattress with a comfortable top that cushions the heels and elbows, which will lessen inflammation and irritation.
There are tons of different mattress materials, thicknesses, and designs to choose from, but how do you know which one is going to give your senior patients a comfortable night’s rest? Below, we’ve broken down the different types of mattresses and how they can help seniors sleep well and wake up free from discomfort and pain.
What types of mattresses are the most comfortable for seniors?
When searching for a good mattress for an older individual, manufacturers won’t advertise that it’s the best for senior citizens. What you’ll need to do is look for certain traits and design features that will most likely work for an elderly sleeper.
Typically, seniors need a bed that will retain minimal body heat and will sleep cool. Beds that minimize and isolate movement or motion transfer, and are quiet are usually the best choices for seniors, too. You’ll also want to purchase a bed that is supportive and won’t sag or compress too much. Mattresses that are too soft don’t support spinal alignment and can cause someone to wake up in the morning with a sore back and hips.
Most importantly, a mattress for senior citizens needs to support arthritic joints. As people age, the cartilage that naturally cushions and supports the joints wears away, so seniors need a little more support from their beds than a younger individual.
Gel Memory Foam Mattress
Gel memory foam mattresses are some of the most popular choices for seniors. Gel memory foam is denser and more supportive than traditional memory foam, offering a slightly firmer bed that does an excellent job of supporting the joints and the spine. In mattress lingo, gel memory foam is also referred to as Tempur foam. Gel memory foam mattresses are also cooler than a regular memory foam mattress. Loom and Leaf is one of the more popular gel memory foam mattresses this year.
Memory Foam Mattresses
Memory foam is a mattress favorite, and it’s been around for decades. First used by NASA, memory foam is a high-quality material that offers superior comfort and cushioning. While memory foams aren’t typically as supportive as a gel memory foam mattress, some models are firmer than others.
Memory foam mattresses cradle and cushion the body, so elbows and heels aren’t resting on a surface that can cause skin irritation. Seniors who are side sleepers can most benefit from a traditional memory foam mattress. Memory foam cradles the shoulder joint and allows it to rest comfortably while keeping the shoulder disk in proper alignment.
However, if a person has never slept on a memory foam mattress, the new bed may take some getting used to. Memory foam beds have a particular and distinct feel to them. Also, be sure to check the bed’s cool rating. Memory foam beds tend to run hot. Nectar memory foam beds are some of the highest rated bed-in-a-box mattresses.
All-natural Latex Foam
A natural, latex foam mattress is an excellent alternative to memory foam mattresses for older sleepers. Latex is a springier material than either gel or memory foam. Latex doesn’t cradle the body, so for sleepers who switch positions a lot, a latex mattress can be ideal. However, all natural latex mattresses are sometimes too soft for people with severe arthritis. A high-quality all natural latex foam mattress for seniors is the Santa Cruz Natural Mattress.
What about innerspring mattresses?
Innerspring mattresses don’t always offer enough consistent support for seniors who need cushioning for aching joints. But adding a pillowtop to an otherwise decent innerspring mattress can offer enough softness and support for senior citizens. Boxtop and pillowtop mattresses are suitable for sleepers who are light or medium weight. But these mattresses won’t provide enough support or last very long for heavier sleepers.
Can you choose a mattress that uses different types of materials?
It’s possible to find a mattress that uses different technologies. For example, manufacturers who specialize in innerspring mattresses often have products that use a top layer of natural latex foam, or memory foam for added support and comfort. If you’re worried that your senior patients won’t be able to get used to a full memory foam mattress, an innerspring memory-foam hybrid can be a good compromise.
As always, it’s essential to thoroughly research different mattress types, product ratings, and what’s going to work best for an individual patient.
Tips for Nursing Students: The Successful Interview
The National League for Nursing and the National Students Nurses’ Association (NSNA)(2012) stated that “although there is a shortage of registered nurses, the economic recession has flooded the RN market with experienced nurses who were retired, planning to retire, or went from part-time to full-time employment. The need for RNs has declined due to low hospital census”. Nursing students graduating today face a competitive employment market. Much of your success at getting the position you want will depend on how well you interview for the job. Follow these steps to be better prepared and increase your chances for a successful interview.
Be prepared
Submit your resume and application in advance, but do not assume that the person interviewing you has read them carefully. Before the interview, think about how you can highlight important aspects of your experience or education. Do some background research on the organization or place to which you are applying.
Familiarize yourself with the key people in authority, especially focusing on the person who will interview you. During the interview you can use this information to establish some common ground. Consider some key areas such as: How large is the organization and/or the unit where you are applying? What population and geographic area do they serve? What expertise do you have to offer that might be valuable to them? For example, if you are applying for a job on an inpatient rehabilitation unit, did you have a course in rehabilitation or do clinical rotations in rehab? If so, be sure to mention this during the interview.
Look professional
Paul Walden, writing on the NSNA website, stated, “appearance and attitude are everything. Dress in professional attire and smile. Make sure you arrive promptly”. Although professional attire may be more casual than it has been in years past, employers still expect an interviewee to look his/her best. This means no blue jeans, shorts, cut-offs, flip-flops, low-cut blouses, miniskirts, overbearing jewelry, or other extremes in attire. Business casual is usually acceptable, but when in doubt, err on the side of dressing more formally in business attire than casual.
Start with a good beginning
Introduce yourself and offer to shake hands with the interviewer while making direct eye contact. Do not sit down until directed to do so. The interviewer controls the interview. Express enthusiasm for the interviewer taking time to speak with you and make a positive comment about the surroundings or reputation of the facility. Smile and convey friendliness, approachability, and confidence. Most nurse managers are looking for a “good fit” in a new employee with their existing staff and unit milieu. Your personality may be as important to the manager as your skill set. Listen for comments made by the interviewer that suggest he/she is seeking someone who will be a team player and then be sure to share ways in which you have successfully blended with similar groups in the past.
Ask thoughtful questions
Have a few thoughtful questions ready to ask. For example: How does the open position fit within the organizational chart? Is there opportunity for gaining additional education? What type of orientation or mentoring do they provide for new nurses? Are there opportunities for advancement? These types of questions show that you are interested in a long-term relationship with the organization and are willing to learn and increase your professional skills. Asking deliberate questions can also help you assess whether or not this job is the right one for you.
Be memorable
You want the person conducting the interview to remember you in a positive light. What sets you apart from others who might be applying for this job? Answering that question in advance will point you in the direction where you need to shine. This might be your engaging personality, strong evaluations from clinical professors, your flexibility or willingness to learn, your experience in another country with service-learning projects, or your good academic performance.
End the interview well
If you were fortunate enough to be given a tour of the unit or facility, be sure to take advantage of any opportunities to greet or interact with staff or patients. The interviewer may be watching to see if you display positive interpersonal skills. Before you leave the interview, be sure that you know how you will be notified if they wish to hire you. Thank the interviewer and shake hands again (if appropriate), expressing your enthusiasm for this wonderful opportunity. If possible, send a follow-up email or thank you note to the interviewer for his/her time and attention. Be sure to continue to display warmth and cordiality as you leave the facility. You never know who may be watching.