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Background

Similar to hip replacement, knee replacement is done when a person is experiencing decreased range of motion, trouble walking or climbing stairs, and increased degeneration of the joint so as to impair quality of life. This most often occurs as a result of arthritis.

Treatment

Total knee replacement (TKR) surgery involves resurfacing or removing the distal portion of the femur that articulates with the end of the shin bone. The prosthesis consists of metal and plastic or similar materials that are cemented onto the newly resurfaced areas of the articulating bones. Although often done under general anesthetic, this surgery can also be performed under spinal anesthesia. Sometimes blood loss is significant, so patients may be asked to donate their own blood ahead of time to be given back to them in the event it is needed. In addition, a growing trend is toward bilateral knee replacement in those persons requiring both knees to be surgically repaired. The benefits of this are the one-time operative anesthetic and room costs, and many physicians feel recovery from bilateral replacement is similar to single replacement. However, the pain and lack of mobility, as well as the significant increase in the assistance needed after surgery when a bilateral replacement is done, may make this less than ideal for older patients. Surgical procedures for TKR have not evolved quite as rapidly as total hip arthroplasty.

Discomfort after knee surgery is generally severe in the first few days. Complications after surgery may occur, including pain, infection, and blood clots. Patients may use cold packs on the operative area and take pain and sleeping medications as ordered. In addition, alternative therapies such as guided imagery have been shown to help with pain management (Posadzi & Ernst, 2011). Many joint replacement patients feel a loss of control and independence.

Therapy will begin immediately in the acute care hospital. Although weight bearing does not usually occur until 24 hours after surgery, sitting in a chair and using a continuous passive motion machine (CPM) (if ordered), will ease recovery. The use of a CPM is generally based on the surgeon’s preference. There is research to support it, as well as studies indicating that walking soon after surgery has an equal effect and makes the CPM unnecessary. However, in cases of an older person who may not have the mobility skills initially after surgery that a younger person would, a CPM may be beneficial to keep the joint flexible and decrease pain.

Dr. Zann (2005) indicated that “patients undergoing total knee replacement do not achieve their maximum improvement until 2–4 years” (p. 1). This is attributed to the lack of muscular structures that surround and protect the knee and the need for the ligaments and tendons to adapt to the indwelling prosthesis. Recovery times vary and depend upon a number of variables, including the patient’s overall health, age, other preexisting health issues, and motivation. Patients report that the new knee joint never feels normal even years after the surgery, but that they experience an increase in function and generally much less pain than before.

Patients should be educated about signs and symptoms of infection, care of the surgical site (if staples are still present), pain management, and expectations for recovery. A range of motion from 0–90 degrees is the very minimum needed for normal functioning. Normal knee flexion is 140 degrees, but few older persons would get this amount of flexion after surgery, and may not have had full flexion even prior to the operation. After discharge, a walker is usually used in the first few weeks, followed by light activities 6 weeks after surgery. In addition, the patient’s spouse may experience feelings of being overwhelmed due to role transitions that occur after surgery and during the recovery period (Walker, 2012 ). Newer knee prosthetics are still going strong for the majority of patients 15 years after surgery.

If you have a senior loved one in need of assisted senior care, it’s time to look around for a good assisted living facility. There are several factors to consider, so the ideal thing to do is arrange for a tour of the facilities on your list.

It would help if you also asked questions. Getting the answers you need will determine which facility is ideal for your loved one. Here are some of the most vital questions you should be asking.

1. Questions about the staff.

You have to get all the information you can about the assisted living facility’s staff. You will be leaving the care of your senior loved one to them, so it is vital to ensure that they’re well-trained and experienced. Here are some helpful questions.

-What is the staff’s training and experience?

-What is the estimated number of staff members? What is your staff-resident ratio?

-Do you have staff working at night?

-Is there a nursing assistant or a nurse available 24/7?

2. Questions about living spaces, food, and activities.

After ensuring that your loved one is in good hands, you’d want to be sure their living spaces are comfortable, safe, and equipped with the necessary amenities.

-What are the room options we can choose from?

-Do they come with bathrooms, kitchens, and furnishings?

-Can residents decorate their apartments and bring in extra furniture?

-Is housekeeping part of the package?

-Do the rooms come with Wi-Fi connectivity and cable TV?

-Are residents allowed to bring pets?

-Are there common spaces for residents?

-What kind of activities can residents participate in?

-How are meals served to residents?

-Is there a nutritionist or dietician in the facility?

3. Questions about admissions and medication.

It is also essential to gather all the information you need about admissions requirements. Likewise, if your loved one needs medication, you also have to ask all the questions you can think of.

-Is an assessment test required before aspiring residents can be admitted?

-Do you have a waitlist for seniors who need to be transferred or relocated right away?

-How is medication administered and managed?

-How is healthcare provided? Are healthcare visits allowed?

-How much is the monthly fee?

-What’s the billing and payment process?

The answers to these questions will help you choose the best assisted living facility for your loved one.

About the Author

Melissa Andrews is the Content Marketing Strategist for Paradise Living Centers, an assisted living center for seniors with locations in Paradise Valley and Phoenix, Arizona. In her spare time, she enjoys cooking and going on hiking trips with her siblings and cousins.

Being a Grandmother is a wonderful benefit of aging. The experience is truly all that your friends told you it would be. When you didn’t think you could love anyone as much as your own children, your grandchildren come along and prove you wrong. You can spoil them and send them home, feed them junk food and cookies for dinner, snuggle and take time to play like you didn’t have time for when you raised your own kids. And the best part is that all those things that would have made you a bad parent then, make you an awesome, fun Grandma now.

But what happens when, for reasons beyond your own control, your find yourself moving from the role of Grandma to Mom? According to the Profile of Older Americans (2016), “approximately 1 million grandparents age 60 and over were responsible for the basic needs of one or more grandchildren under age 18 living with them in 2015. Of these caregivers, 593,495 were grandmothers and 429,377 were grandfathers” (pg. 15). The role change from Grandma to Mama is a significant one. The little one you have spoiled and coddled is now yours to raise for the next 20 years into adulthood. This can be a shocking transition, but also a tremendous blessing.

This surprise happened to me at the age of 57. My husband had just retired and we had relocated to a more relaxing place in our life. We already had 7 children between us with an age span of 15 – 34 years of age, the last two of whom were adopted from Russia. So, when our teenagers were ready to graduate from high school, we were looking forward to being empty nesters, having raised children for many years.

Then, along came JJ. Substance abuse, which our pediatrician calls “the scourge of our community”, was the culprit that led to our current situation. This is a common problem, although not all children of substance abusers are fortunate enough to be placed in a loving home out of the influence of parents who use drugs. Our journey started when we offered to take our 6 week old grandson for a few hours so his parents could enjoy some free time together. Those hours turned into several days when the parents didn’t show up to get their son and nobody could find them. They didn’t call to check on him and seemed not to mind that they didn’t contact us for days. It wasn’t long before CPS removed little JJ from his birth parents due to their substance abuse and neglect of their infant and placed him with both sets of grandparents sharing temporary kinship care. Unable to break free of the chains of drugs, even with unlimited free resources and counseling provided by the community, JJ’s parents lost custody of him permanently and we became new parents again through adoption of our precious grandson.

The process of adapting to this life-changing event affects everyone differently. If you find yourself in a similar life-altering stage, then you may benefit from this series on Grandparents Raising Grandchildren. Today’s tips are for Grandmas who are now Moms again:

Some things have changed

If you are anything like me, your last biological child may be in his/her 30’s, so raising a little one might be a bit intimidating. Lots has changed in 30 years! There is so much more technology to help children learn and play. But this means we have become more tech savvy and not avoid the latest cellphones, computers, or apps. (Any teenager is happy to help you learn to be more techie). Toys are more fun now. Clothes are cuter. There are great innovations like disposable diapers, better bottles, and on-the-go baby food. Kids go to preschool and all-day kindergarten now. But, there are negatives too, like many more immunizations to keep track of. The world doesn’t seem as safe in the big cities as it did long ago when we let our children play outside without as much fear of gang violence, guns, or being kidnapped. Yet, there are more guidelines for child-rearing, research on how to educate kids, and better job opportunities for when they are grown. While all these changes may be daunting, you can use them to your benefit and to make your life easier when raising children in your later years.

Some things never change

Fortunately for us, some things never change. Babies are babies, kids are kids, and teenagers are still teenagers. Changing diapers, bathing a baby, suctioning a nose with the blue bulb syringe, putting clothes on a wiggly toddler, and rocking a little one to sleep are still the same. Strategies for teaching math have changed, and maybe kids don’t always have books in high school, but the major concepts of the major subjects are ones you will remember. Don’t worry – this will all come back to you and you might be surprised how much better you are at parenting now than when you raised your first set of children. You are more relaxed and comfortable because you have decades of experience to draw on.

Your experience is a plus

One of your best assets as a new Grammy Mama (as I like to call this role) is your experience. For me, I raised or help raise 7 children before JJ, so I am way ahead of the new mother learning curve. We already know what works and doesn’t work in raising kids. We are not novices, but seasoned experts! So, when you are tempted to feel you are not up to this new challenge, remind yourself that this is not your first rodeo.
You are not too old
It is a normal feeling to think you might be too old to raise another child. Let me assure you that you are not, and you are not alone. There are more than a million other grandparents in America just like you who are doing it, and many are older than you are. Your age gives you wisdom and experience. If you were in another job, you would be a Senior Executive, VP, or CEO – that is what you are in this new job. Embrace your Grammy Mama role. There is a reason why this child (or children) has been entrusted to you. You have been chosen for a remarkable task: to nurture a child who will later thank you for not giving up on him. You are never too old to undertake such a legacy as that.