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Resources2018-05-18T09:03:15-05:00

Guest Blog: Adjusting to Life After a Stroke

In America, stroke is the third leading cause of death. The brain and heart rely on each other to sustain basic functionality of the human body. The brain controls a large portion of the body’s range of capabilities and nerve signaling. Your brain has multiple purposes, but a single stroke can put those critical functions at risk. Communication, memory, emotional activity, and physical capabilities can all be affected when the brain is not operating at its utmost potential.

Difference Between a Stroke and a Heart Attack

A stroke and a heart attack may seem similar but are very different. Both ailments occur due to a shortage of oxygenated blood and blood flow, except strokes primarily affect the brain while heart attacks mainly target the heart. When the body’s blood flow to the heart is blocked, sometimes due to a blood clot, it can cause a heart attack. A stroke, on the other hand, can cause possible brain tissue to decay and long-term disability or death.

Stroke Causes

The leading cause of strokes is anything that leads to blocked blood supply or a burst blood vessel, cutting off the oxygen flow to the brain. A number of risk factors for a stroke, such as high cholesterol and obesity, can be medically managed or treated. Nevertheless, as with certain terminal conditions, particular risk factors are more challenging to address.

An individual’s lifestyle has a considerable effect on their health. Harmful choices can lead to chronic illnesses with detrimental long-term consequences. Nearly everything that goes into the body has the potential to affect your physical and emotional well-being. For example, eating highly processed fast food can possibly make the person feel groggy and lethargic, while a plant-based diet can help support a healthy immune system.

Controllable risk factors for a stroke are:

  • Diabetes
  • Lack of exercise
  • High blood pressure
  • High cholesterol
  • Excessive alcohol or drug use
  • Smoking

Uncontrollable risk factors include:

  • Age: The risk of having a stroke doubles every ten years after the age of fifty-five.
  • Race: Black and nonwhite Hispanic Americans are affected more than white Americans.
  • Gender: Although strokes occur more regularly in men, women are more prone to suffer one later in life, placing them at higher danger of nonrecovery.
  • Family history: Strokes are more likely to occur within families that carry genetic disorders.

Even if someone is taking good care of their body and do not carry any genetic risk factors, they can still be at risk due to:

  • Geography: Strokes happen more in southeastern America than in the rest of the country, perhaps due to elements of the regional culture such as diet.
  • Climate: Extreme temperatures increase the risk of a stroke.
  • Economic and social circumstances: Particular evidence suggests that stroke cases are more prevalent in low-income communities.

Stroke Treatment

To properly treat a stroke, doctors must first determine the causes of the symptoms through a CT scan or other stroke tests. Stroke tests vary from simple physical analysis and blood analysis to more involved procedures such as echocardiograms, cerebral angiograms, MRI scans, or carotid ultrasounds. About a quarter of stroke survivors will suffer a second stroke, making immediate treatment vital.

Some steps to help stroke patients recover include seeking support and therapy, monitoring medications, being on the lookout for dizziness or imbalance, ensuring a healthy diet, and keeping the brain active. It is crucial to remember that recovering from a traumatic brain injury such as a stroke takes time and patience.

Recovery can be a long-term process. Hence, it is imperative to understand how the body and brain are affected. Refer to the following infographic made by Family Home Health Services for further information on brain recovery as well as stroke-prevention practices to incorporate into everyday life.

By |January 27th, 2021|Categories: Dr. Mauk's Boomer Blog, News Posts|Tags: , |Comments Off on Guest Blog: Adjusting to Life After a Stroke

Hypothyroidism Warning Signs and Treatment

 

bigstock-Thyroid-gland-19336097

Background

Hypothyroidism results from lack of sufficient thyroid hormone being produced by the thyroid gland. Older adults may have subclinical hypothyroidism, in which the TSH (thyroid-stimulating hormone) is elevated and the T4 (thyroxine or thyroid hormone) is normal; 4.3–9.5% of the general population has this problem (Woolever & Beutler, 2007). In this condition, the body is trying to stimulate production of more thyroid hormone. Some older adults with this condition will progress to have primary or overt hypothyroidism. This is when the TSH is elevated and T4 is decreased. Hashimoto’s disease is the most common cause and represents 90% of all patients with hypothyroidism (American Association of Clinical Endocrinologists [AACE], 2005; Woolever & Beutler, 2007), though certain pituitary disorders, medications, and other hormonal imbalances may be causal factors.

Warning Signs

Older adults may present an atypical picture, but the most common presenting complaints are fatigue and weakness.

Diagnosis

Diagnosis should include a thorough history and physical. Bradycardia and heart failure are often associated factors. Lab tests should include thyroid and thyroid antibody levels (common to Hashimoto’s), and lipids, because hyperlipidemia is also associated with this disorder.

Treatment

Treatment centers on returning the thyroid ¬hormone level to normal. This is done through oral thyroid replacement medication, usually L-thyroxine. In older adults with coexisting cardiovascular disease, starting with the usual doses may exacerbate angina and worsen the underlying heart disease, so it is important to start low and go slow. Titration should be done cautiously, with close monitoring of the older adult’s response to the medication. The does should be adjusted on 6- week intervals until normal levels of thyroid hormone are achieved. Once the TSH is within normal limits, then checking the TSH should be done every 6 to 12 months to monitor effectiveness and blood levels, because hyperthyroidism is a side effect of this therapy and can have serious implications on the older person’s health.

Patients need to learn the importance of taking thyroid medication at the same time each day without missing doses. Sometimes older adults have other problems associated with hypothyroidism, such as bowel dysfunction and depression. Any signs of complicating factors should be reported to the physician, and doctors’ appointments for monitoring should be religiously kept. Strategies for managing fatigue and weakness should also be addressed, because some lifestyle modifications may need to be made as treatment is initiated.

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.

For more information on Hypothyroidism, visit the NIH:
http://www.nlm.nih.gov/medlineplus/ency/article/000353.htm

 

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By |January 26th, 2021|Categories: Dr. Mauk's Boomer Blog, News Posts|Comments Off on Hypothyroidism Warning Signs and Treatment

Guest Blog: Hiring an In-Home Caregiver: What You Need to Know

 

When looking for an in-home caregiver for your loved one, it’s a given you would prefer someone they can get along with really well and will do a great job of taking care of them. However, finding this home care option for your senior loved one can be challenging at times.

Fortunately, there is no shortage of tips you can follow to ensure you find the perfect person for the job. The following tips should get your search off to a fantastic start:

Create a clear job description

To come up with a clear job description, identify what your elderly loved one’s needs are. A clear and specific job description can help you determine the flexibility needed, the number of hours they’ll be looking after your loved one, and how much you are likely to pay.

Be flexible when hiring independently

If you want to find great candidates, you need to be flexible about the pay. It is also recommended that you offer the going rate in your area. Otherwise, you might not find applicants with the care skills you are looking for.

Conduct multiple interviews and a trial period

To get more insights about a candidate, consider conducting three interviews:

  • A short screening interview over the phone to ensure they meet the necessary requirements.
  • An in-person interview if they pass the phone screening.
  • An in-person interview where the top 2 candidates can also meet your elderly loved one.

Ask all the important questions during the interview

Asking all the right questions can help you find someone responsible, compassionate, and trustworthy. It would also be a good idea to ask what they’ll do in a specific situation. For instance, what they would do if your elderly loved one refuses medications or does not cooperate.

Check their references

Even if you find a candidate very impressive, it is ideal that you still do a background check. You can do this by calling the work references they have provided. You can ask if they do a good job and if they’ll hire the candidate again.

Conclusion

While finding the best in-home caregiver can be challenging, it can be done. As long as you prepare accordingly and cover all the essential bases, you’ll find the right person for the job with ease.

 

 

By |January 25th, 2021|Categories: Dr. Mauk's Boomer Blog, News Posts|Tags: , , |Comments Off on Guest Blog: Hiring an In-Home Caregiver: What You Need to Know

Seizures

Doctor - Taking Notes

Background

Once thought to be mainly a disorder of children, recurrent seizures or epilepsy is thought to be present in about 7% of older adults (Spitz, 2005) and is usually related to one of the common comorbidities found in older adults (Bergey, 2004; Rowan & Tuchman, 2003). Epilepsy affects up to 3 million Americans of all ages (Velez & Selwa, 2003). Davidson & Davidson (2012) summarized findings of most studies on epilepsy in older adults with these main points:
Seizures can be caused by a variety of conditions in older persons, but “the most common cause of new-onset epilepsy in an elderly person is arteriosclerosis and the associated cerebrovascular disease” (Spitz, 2005, p. 1), accounting for 40–50% of seizures in this age group (Rowan & Tuchman, 2003). Seizures are associated with stroke in 5–14% of survivors (Spitz, 2005; Velez & Selwa, 2003). Other common causes of epilepsy in the elderly include Alzheimer’s disease and brain tumor.
There are three major classifications of epilepsies, although there are many additional types. Generalized types are more common in young people and associated with grand mal or tonic-clonic seizures. A number of cases have an un¬determined origin and may be associated with certain situations such as high fever, exposure to toxins, or rare metabolic events. In older adults, localized (partial or focal) epilepsies are more common, particularly complex partial seizures (Luggen, 2009). In contrast to young adults, Rowan and Tuchman (2003) cite other differences in seizures in the elderly: low frequency of seizure activity, easier to control, high potential for injury, a prolonged postictal period, and better tolerance with newer antiepileptic drugs (AEDs). Additionally, older adults may have coexisting medical problems and take many medications to treat these problems.

Risk Factors/Warning Signs

Risk factors for seizures in older adults include cerebrovascular disease (especially stroke), age, and head trauma. The most obvious signs and symptoms of epilepsy are seizures, although changes in behavior, cognition, and level of consciousness may be other signs. Also, note that exposure to toxins can cause seizures that are not epilepsy. Complex partial seizures in older adults may include symptoms such as “confusion, memory loss, dizziness, and shortness of breath” (Davidson & Davidson, 2012, p. 16). Automatism (repetitive movements), facial twitching with following confusion, and coughing are also signs of the more-common complex partial seizure (Luggen, 2009).

Diagnosis

Diagnosis is made by careful description of the seizure event, a thorough history, and physical. Eyewitness accounts of the seizure incident can be quite helpful, although many community-dwelling older adults go undiagnosed because their seizures are never witnessed. In addition, complete blood work, neuroimaging, chest X-ray, electrocardiogram (ECG), and electroencephalogram (EEG) help determine the cause and type of seizure (National Institute for Health and Clinical Excellence {NICE}, 2012).

Treatment

Treatment for epilepsy is aimed at the causal factor. The standard treatment for recurrent seizures is antiepilepsy drugs (AEDs). The rule of thumb, “start low and go slow,” for medication dosing in older adults particularly applies to AEDs. The elderly tend to have more side effects, adverse drug interactions, and problems with toxicity levels than younger people.
Research has suggested that older adults may have better results with fewer side effects with the newer AEDs than the traditional ones, though about 10% of nursing home residents are still medicated with the first-generation AEDs (Mauk, 2004). The most common older medications used to treat seizures include barbiturates (such as phenobarbital), benzodiazepines (such as diazepam/Valium), hydantoins (such as phenytoin/Dilantin), and valproates (such as valproic acid/Depakene) (Deglin & Vallerand, 2005; Resnick, 2008).
Several newer drugs are also used, depending on the type of seizure. Second-generation AEDs, including gabapentin (Neurontin), lamotrigine (Lamictal), oxcarbazepine (Trileptal), levetiracetam (Keppra), pregabalin (Lyrica), tiagabine (Gabitril), and topiramate (Topamax), are generally recommended over the older AEDs; however, older AEDS such as phenytoin (Dilantin), valproate (Depakote), and carbamazepine (Tegretol) are the most commonly prescribed treatment options (Resnick, 2008). Each of these medications has specific precautions for use in patients with certain types of medical problems or for those taking certain other medications. Regarding side effects in older patients, watch for potential stomach, kidney, neurological (especially poor balance or incoordination), and liver problems. Additionally, some newer extended-release AEDs are thought to be better tolerated and have a lower incidence of systemic side effects (such as tremors) (Uthman, 2004).

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.Burlington, MA: Jones and Bartlett Publishers. Used with permission.

 

By |January 25th, 2021|Categories: Dr. Mauk's Boomer Blog, News Posts|Comments Off on Seizures

Guest Blog: What is Psoriasis?

Guest Blog: Lindsay Munden, DNP, RN, FNP-BC

Psoriasis

Psoriasis is a lifelong disease that causes scaling and inflammation of the skin. The condition starts beneath the skin’s surface and is triggered by an overactive immune system, which causes skin cells to be over-produced and accumulate on the skin’s surface faster than normal. This process is called cell turnover, and in psoriasis may take a few days instead of weeks. This causes the formation of thick, red, itchy, flaky patches with silvery scales known as plaques. While any part of your body can be affected, psoriasis most often occurs on the elbows, knees, scalp, back, face, palms, and feet.

Risks

According to the American Academy of Dermatology (2015) about 7.5 million people in the United States have psoriasis. Anyone can get the disease, but it occurs more often in adults.

  • Age: Adult men and women are affected equally. The two peak ages at onset are during the late teens to early 20s and in the late 50s to early 60s.
  • Genetics: Psoriasis has a strong genetic influence, with one-third of patients with psoriasis reporting having a family member with the disease.
  • Environmental Factors: Trauma to normal skin, repeated friction, infections, stress, fatigue, warm humid climates, changes in weather that dry the skin, and certain medications may trigger psoriasis flare-ups.

Causes

The primary cause of psoriasis remains unknown. Research has indicated that psoriasis is caused by genetic influences and a dysfunction of the immune system. Although, psoriasis plaques may look contagious, you cannot get the condition from someone that has the disease.

Symptoms

Symptoms can range from mild to severe and are often recurring. Itchy, red, inflamed and dry scaly plaques distributed symmetrically over areas of bony prominences such as the elbows and knees are characteristic of the disease. The joints, nails and scalp may also be affected. As with other chronic conditions, symptoms may flare or worsen for a few months and then subside for a period of time.

Diagnosis

Psoriasis may be hard to diagnose because it can be confused with other skin diseases. Usually your healthcare provider will make a diagnosis based on a thorough skin examination. Biopsy is seldom necessary because the clinical features of psoriasis are so distinctive. Plaque psoriasis is the most common form, but patients typically have one or more types.

Treatment

The goal of therapy is to control the symptoms and clear the plaque lesions.

For mild to moderate psoriasis, topical medications (those applied directly to the skin) and phototherapy (light therapy) are the mainstays of treatment.  For severe psoriasis, systemic treatments are recommended. Sometimes, combining topical, light and systemic treatments leads to the best results.

Topical Medication Options:

  • Topical steroids are widely used because they help reduce inflammation. Generally, a very potent topical corticosteroid preparation is applied two to three times daily for 2 weeks and then decreased to a lesser potency for maintenance therapy long term.
  • Coal tar works by causing the skin to shed dead cells from its top layer and slow down the growth of new skin cells. This effect decreases scaling and dryness. Coal tar is applied once or twice daily and is not well favored due to the potential for staining of the clothes and skin.
  • Anthralin works by slowing down the production of skin cells. This type of medication is applied to the skin for a prescribed period of time and then rinsed away, with increased increments until the skin is healed which may take a couple of weeks.
  • Topical immunomodulators are medications which work by decreasing the body’s immune system to help slow down the growth of the psoriasis plaques.
  • Vitamin D3 derivatives regulate cell growth and decrease lymphocyte (cells which play a role in the regulation of the immune system) activity. The medicine comes in a form of an ointment which is typically applied twice daily.

Phototherapy:

Phototherapy with ultraviolet-B (UVB) light is effective in the treatment of psoriasis lesions. This type of treatment reduces DNA synthesis of skin cells. Phototherapy can produce symptom-free periods of up to 2-4 months. UVB therapy units are often available at dermatologist offices and the use of commercial tanning beds (with both UVA and UVB lights) is not recommended. Dermatologists may recommend consistent light therapy 3-5 days a week for 2 to 3 months.

Systemic Medications:

Systemic therapy is reserved for patients that have severe or incapacitating disease. These medications are prescribed by expert specialists such as dermatologists or rheumatologists because they have a risk for serious side effects.

More Information:

National Psoriasis Foundation   www.psoriasis.org

National Institute of Arthritis and Musculoskeletal and Skin Diseases www.niams.nih.gov

American Academy of Dermatology https://www.aad.org/

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By |January 24th, 2021|Categories: Dr. Mauk's Boomer Blog, News Posts|Comments Off on Guest Blog: What is Psoriasis?