Amputation
Background
Amputation is an acquired condition that results in the loss of a limb, typically from disease, injury, and/or surgery. There are approximately 278,000 new amputees each year in the United States (Amputation statistics, 2012). Seventy-seven percent of these cases are from circulatory problems, particularly peripheral vascular disease (PVD) related to diabetes, while most of the rest are due to trauma.
Warning Signs
Most amputations involve the lower limbs, above or below the knee. The greatest risk factor for amputation is diabetes with peripheral vascular disease, with African American men having a 2.3 times greater rate of amputation than Whites with diabetes. Advanced age and the incidence of diabetes in the elderly make this a potential problem in the older age group. Additionally, a recent study showed that HgbA1c level was a significant predictor of foot amputation (Palmer, et al,et al., 2011).
Diagnosis
In the acute phase of recovery after surgery, it is important to prevent contractures of the knee joint and maintain normal muscle power and range of motion in remaining joints. The limb should not be hung over the bedside or placed in a dependent position. Both in acute care and rehabilitation, the stump should be conditioned to prepare for the wearing of a prosthesis (an artificial limb). In certain cases, an older person may choose, after speaking with the doctor, not to wear a prosthesis. But, this is usually only when there are other health problems, such as poor balance from another disease or disorder that would make falling and injury more likely with the use of an artificial limb.
Treatment
Initially, there may be drainage from the surgical site, and a sterile dressing will be kept in place and changed at least daily. Eventually, the staples or sutures will be removed and a thick, black eschar (like a hard, dark scab) will form at the amputation site and gradually come off. An Ace wrap or stump shrinker sock (elastic) is used to help prepare the stump for wearing a prosthesis. Several factors should be considered when preparing the stump to wear this artificial limb. These include a movable scar, lack of tenderness/sensitivity, a cone shape, firm skin, and minimizing any swelling. All of these can be achieved by proper wrapping of the stump. The prone position (laying on the stomach), if tolerable, is an excellent way to promote full extension of the residual limb.
It is also important for the person to begin therapy right away. Persons wearing a prosthesis use more energy to walk. An older person with an artificial leg generally has a 40% decrease in speed but uses 80% more energy to walk than the average healthy adult (Chinn et al, 2005).
When using the prosthesis at first, an older adult may tire easily. Be sure to take into account any coexisting problems, such as heart of lung disease, when considering energy expenditure. However, the newest technologies allow prosthetics to be light, durable, and more comfortable.
Patients and families will need to learn about stump care, mobility, adaptation, coping, and self-care. Home maintenance, dealing with complications and/or additional health problems, wear and tear on non-weight-bearing joints, adapting to the environment, accessibility, stigma, depression, role changes, decreased energy, and chronic pain are all issues to be aware of related to amputation. It is likely that the person with a leg amputation will experience some shoulder problems over time due to the additional stress on the non-weight-bearing joints. Phantom limb pain, or pain sensations in the nonexistent limb, is more common after traumatic amputations and may last for weeks after amputation. Massage and medications may help with this type of pain control (Beers, 2005). Additionally, proper wrapping of the stump (in a figure-eight wrap) may help decrease the chance of phantom limb pain later (Kalapatapu, 2012). Also, people with an amputation may struggle with difficult feelings about the changed appearance of their body. They might worry if their spouse or loved ones will see them differently. They might fear what others will think and worry about getting their life back to what feels normal.
In general, older persons with amputation may return to a normal quality of life with some adaptations. The care provided by nurses and physicians in rehabilitation after amputation may make the difference in the person’s ability to cope with the changes that result after surgery. Nurses can help with the transition back into the community after amputation by educating patients and families about resources to assist with adaptation.
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.
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How to Find the Best Healthcare for Assisted Living
In the world of healthcare, the quality of assisted living can vary in any given location. That’s why it’s critical you do the correct homework while implementing strategies to find out the situation. There will be some potentially shocking things discovered along the way when you notice the differences between facilities. Many do not offer you the optimal care you deserve, but the price tag is also a variable. Generally, more expensive locations will have more accommodations and higher-level care.
Choosing Based on a Good Location
You might be wondering, “where can I find an assisted living near me?” Well, there are many viable locations to start exploring right now. It’s better to view this as an important journey rather than an arduous chore. Things can get challenging when it comes to making the final decision. Location is incredibly important because you want them to feel safe. According to Diamond Willow, they have a service that “covers a wide range of communities as Minnesota’s premier senior care provider, specializing in unmatched memory care and assisted living services.” They are giving you a wider range of options to make effective assisted living healthcare more convenient and accessible.
Use a Comprehensive Assisted Living Directory
One of the ways to get acquainted with the options in your area is through consulting with a directory. Here, you will discover some interesting options and can view the important details without even visiting. From there, you can compare and contrast which ones would be more suitable for your loved one. These directories have valuable information about living conditions and perks that come with each facility. You may also learn about the history of any given building and details like the age and qualifications. These are especially important if you have someone who needs intensive care and constant monitoring. Assisted living directories make the process of finding stable and safe healthcare opportunities more manageable.
Consult with Your Healthcare Provider
There are many tips to find assisted living facilities that will serve as a guide towards a successful decision. If you’re worried about regretting any given decision, then it would be a wise idea to consult with your healthcare practitioner to shed light on the subject. They will be well-acquainted with the dynamics of many local facilities because of their job working with people. This can be a significant advantage for discovering certain realities that you wouldn’t have discovered otherwise. For instance, if a facility has behavioral issues or problems with crime in a bad area then the doctor will know this. They will also be able to tailor your decision based on your personal medical history with better results!
Ask Friends and Family about their Experience
Another great way to gain insight into any assisted living facility is to speak with others who have gone through the experience themselves. One of the advantages of this is you’ll get transparent honesty from a friend or family member who experienced the current staff. This can be a variable that people often overlook when searching for good spots, and patient satisfaction is important. Reviews can also be found online which may enlighten you as to whether or not a care facility treats their elderly folks well. They can give you critical details about their experience and you can decide if certain elements are deal-breakers. Taking notes when they describe their experience is good for comparing spots later. Also, when someone speaks about their assisted living stories you’ll be able to get the general vibe which is better than reading reviews. Simply reach out and ask people about their time and see how you feel later when you deliberate.
Doing the Right Research Will Pay Off
It is possible to establish a good middle-ground without emptying your wallet in search of an assisted living location. When conducting your own research you must keep your budget in mind along with the smaller details of each location. It’s imperative you communicate effectively with the individual to ensure their needs are fully met across different atmospheres. The new spot should feel like home in a safe location that is accessible to the family. This helps because it’s easier to visit!
Shingles (Herpes Zoster)
Commonly known as shingles, herpes zoster is the reactivation of the varicella virus that causes chicken pox. Older persons may be infected with this latent virus after initial exposure to it in the form of chicken pox. The virus then lays dormant in the neurons until it is reactivated, often due to immunosuppression, when it appears in the form of painful vesicles or blisters along the sensory nerves. This reactivation tends to occur once in a lifetime, with repeat attacks occurring about 5% of the time (Flossos & Kostakou, 2006). Herpes zoster occurs in both men and women equally, with no specific ethnic variations, but is more common in the elderly.
Risk Factors
Risk factors for developing shingles are age over 55 years, stress, and a suppressed immune system. For many older women particularly, emotional or psychological stress can trigger recurrence.
Warning Signs
Signs and symptoms of herpes zoster include painful lesions that erupt on the sensory nerve path, usually beginning on the chest or face. They may appear as initially as a rash, looking much like chicken pox, often wrapping around the chest area in a band-like cluster. These weepy vesicles get pustular and crusty over several days, with healing occurring in 2-5 weeks (Kennedy-Malone et al., 2004; NINDS, 2013).
Diagnosis
Diagnosis is usually made by viewing the appearance of the lesions and a history of onset. A scraping will confirm some type of herpes virus. The most common complaint of those with herpes zoster is the painful blisters that usually subside in 3–5 weeks (NINDS, 2013). Postherpetic neuralgia, a complication of herpes zoster, may last 6–12 months after the lesions disappear and may involve the dermatome, thermal sensory deficits, allodynia (the perception of pain where pain should not be), and/or severe sensory loss, all of which can be very distressing for the patient (Flossos & Kostakou, 2006).
Prevention
Zostavax, a vaccine for shingles, has become available, and it is recommended for all persons age 60 or older who have already had the chicken pox. A person can still get shingles even after having the vaccine, but the symptoms and complications would be less severe. The vaccine has also been approved for persons age 50 – 59, and research has shown that receiving the vaccine significantly decreases the rate of shingles in the population (NINDS, 2013; PubMed Health 2012).
Treatment
Antiviral medications (such as Acyclovir) are used to treat shingles, but must be given within 48 hours of the eruption of the lesions. Topical ointments may help with pain and itching. Pain medications, particularly acetaminophen (Tylenol), are appropriate for pain management in older adults. If a fever is present, rest and drinking plenty of fluids is suggested. Persons with pain that lasts past 6 weeks after the skin lesions are gone and that is described as sharp, burning, or constant require re-evaluation by a physician. Postherpetic neuralgia may be a long-term complication lasting years (PubMed Health, 2012).
The person should be advised to seek medical attention as soon as he or she suspects shingles, in order to receive the best results from Acyclovir. The virus will run its course, but the person is contagious while vesicles are weepy. Persons should not have direct contact (even clothing) with pregnant women, people who have not had chicken pox, other elderly persons, or those with suppressed immune systems. The older person with shingles may experience concerns with pain management and feel a sense of isolation, particularly if they live alone. Arranging for a family member or friend who does not have a high risk of infection to check on the older person at home is advisable.
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: Money-Saving Tips for Senior Living and Care
Many people are looking for ways to save money these days, especially for senior living and care. Many seniors live on a fixed income that may not cover all their expenses at home or assisted living facilities. This article will provide you with some helpful tips to help you save money while also giving your loved one the best possible care.
Stay Informed about the Costs of Senior Living and Care
By staying informed, you can help to save money. For example, if your loved one is considering a care facility or an assisted living community, be sure that they have researched costs. If possible, try to get as many competing bids as possible before deciding where your loved one will live. This way, you will find the best care and living situation at a price that fits your budget.
Keep Track of All Essential Expenses Related to Senior Living and Care
A critical element of saving money is keeping track of all expenses related to senior housing services, such as meals, hygiene products, or other needs. For example, it might be helpful to create an excel spreadsheet with columns where essential items can be tracked so that there are no surprises when bills come in each month. Include sections for medicine since many seniors need prescriptions regularly. They may also have high costs attached depending on what medications your loved one requires for their health.
Do Not Overlook Small Necessities that are Often Forgotten about When Budgeting for Senior Care Expenses
Often, there might be small things like a magazine subscription or basic cable television service. Most seniors will not consider including them when budgeting their monthly expenses because they do not see them as necessary. However, these costs can add up over time, and you want your loved ones to have everything they need at an affordable price.
Supplement with Home-Delivered Meals and Other Services that can Help to Save Money on Senior Living Costs
Consider home-delivered meals or help with daily activities like bathing, cooking, and cleaning. These types of services might be too expensive for you. But if your loved one already has these items included in their monthly expenses, or they will pay extra. You can help them save money by having a local service come to the house instead of taking your loved one out for food each day. This way, they will not have additional transportation costs attached, which could cut into their budget. If possible, try looking around locally since it may cost less than other options depending on where you live geographically.
Find Additional Savings Opportunities by Volunteering at a Local Senior Living Facility
One way to save money is to find ways where you can help for free. One option might be to volunteer at local senior living facilities each week or month in exchange for helping the staff complete their daily tasks, such as cleaning rooms, organizing supplies in storage closets, or assisting with administrative work like filing paperwork. Thus, they may allow you access to amenities that would need an additional fee if paying customers were using them. This could include swimming pools, hot tubs, or other entertainment options that residents enjoy during some of their downtimes.
Ask About Additional Senior Living and Care Options to Save Money on Expenses
Another way of finding additional savings opportunities is to ask about senior living options beyond what your loved one currently has in their current budget. For example, if they are paying for meals but do not need them. Why? Because they have friends or family that come over every day that provide food, you could inquire with the staff at the facility about moving into a private room instead. Thus, your loved one can save money by having more space without needing another person sharing it with them all the time. Alternatively, if an assisted living environment is too expensive, your loved one needs help because of chronic pain or difficulty moving around. Then you could ask about having a private nurse come by to assist them instead of hiring someone on staff at the facility.
Make Sure Your Loved One is Receiving All Senior Care Benefits Which Are Available to Them
Even if they have already moved into senior living services. For instance, you can consult with an estate planning law firm in Los Angeles for assistance. Additional benefits may include property tax exemptions, energy assistance programs, and financial planning services available through local government agencies. This could help your loved ones save money on their monthly expenses, even if it’s not something that they need at the moment. You may take advantage of these benefits for them by helping with paperwork or verifying eligibility requirements before filing a claim form so that there are no delays in receiving assistance when needed later down the road.
Final Thought
One of the best ways to save money as a caregiver is by being proactive and continuing to look around. Whether asking new questions about their senior living options, check with local government agencies for additional financial relief programs. There are always more opportunities out there waiting to be discovered to allow them to live comfortably without breaking the bank.
Guest Blog: 5 Things You Should Never Expect From Assisted Living Facilities
Eldercare homes are all about the care and comfort of senior citizens. The best ones, like Whittier, assisted living offers physical and mental treatment to their elder residents, which is always lacking in other places.
Regardless, there are some things you should know before you consider visiting or living in assisted living facilities (ALFs). Here are five things that these facilities should never give you:
1) False promises
Most older people have a certain set of the idea when it comes to assisted living. They expect warm bedding, lavish meals, a luxurious atmosphere, expert doctors on call at any time of the day, 24/7 security services, along with so many other benefits. But in reality, ALFs can provide nothing more than regular nursing homes do.
The fact is that assisted living homes are not here to make false promises. They put down everything in writing, so you know what to expect from the place before moving in. Look for an ALF that has all its promises documented with legal documents.
2) Flowers and chocolates on your birthday
We all like flowers and chocolates on our birthdays, who doesn’t! But residents of ALFs don’t receive these things as often as they might like because it’s simply not practical. It does happen now and then, but nothing more than that.
ALFs provide basic amenities like food, water, electricity, clothes, etc., but they do not spend money on frivolous things like providing flowers and chocolates on your birthday. So if you are looking for a place that cares for the tiny details, ALFs might not be the best choice.
3) Luxurious furnishings throughout
Another misconception about assisted living homes is that they provide residents with luxurious furniture throughout the facility. But nothing could be further from the truth. It’s just not possible to have luxury furniture in all parts of an assisted living home. Some places might have it, but that’s just because their owners are very generous.
You should know that older people find it challenging to move around, so having luxury furniture everywhere in an ALF makes no sense. Leave expensive things like designer chairs, couches, etc., at home or buy them for yourself if you need them. ALFs provide basic amenities, and you must get the things you think are essential.
4) A daily visit from a doctor or nurse
When you check into an assisted living facility, one of the most significant benefits is round-the-clock security with trained staff members who can help whenever they are needed. But this does not mean that there will be a full-time medic on duty.
ALFs employ doctors who come in on a weekly or monthly basis, depending on their availability and the requirement of residents. So make sure to find out how often a doctor will visit before finalizing any place for yourself. If it isn’t made clear, ask questions till you get all of the answers.
5) 24-hour internet connection
The idea of ‘wired town’ cannot be implemented in ALFs because it’s simply not possible to do so. Some places might have a wifi facility, but it won’t work throughout the day; there will be certain timings when it works and times when it doesn’t.
Even if you get a place where the wifi does work, then you should know that there is no guarantee that everyone in your family will be able to use it at all times. So before you decide for yourself, make sure to ask these questions: What time of the day will I be able to use the internet? Will my children also be able to access the net? Will I be able to use it after 8 pm?
Wrapping Up!
The only important thing is that you should check every facility and promise through legal documentation. DO NOT take any verbal promises for granted; there might be a miscommunication that can cost you your money and peace of mind.
If you think about it, there’s no way that a care facility can be perfect all the time because they’re dealing with older adults who cannot always do things by themselves. Like we mentioned above, your loved one will probably never become a completely different person due to the aging process. However, even if they do, there’s still bound to be problems when it comes to them doing what they’re told (i.e., not eating when it’s time for dinner).
I’m not saying that every facility out there provides atrocious care – most of them do try their best to make life comfortable for their residents – but keep in mind that humans are only human. Mistakes will be made, accidents will happen, and sometimes they’ll be forced to cut corners when they can’t afford something – it’s just the way life is, so don’t expect perfection.