Total Knee Replacement
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.
Tips for Talking About Mental Health With a Loved One
According to the latest statistics from the National Institute of Mental Health Disorders, 1 in 4 adults in the U.S. face a diagnosable mental health condition. Sadly, many refrain from seeking help. When it comes to having a discussion about mental health with a loved one, it can be difficult to find a place to start. For the listener, it’s often difficult to find the right words to say or determine the best way to offer support. For the individual seeking help, it can be hard to describe just how they are feeling or even find the best course of action to do so. That is why we have compiled some advice to help you begin a conversation about mental health with your loved one.
Actively Listen
It’s a meaningful step for a loved one to open up about their mental health, so having an open ear to actively listen is key to understanding how you can best offer support. Being engaged in the conversation can be made easier by limiting distractions. Leave electronic devices turned off and put away when possible, and avoid bustling spaces like eateries or parks. Find somewhere private and comfortable. This will put you both at ease and also allow you to focus on what your loved one is expressing.
Don’t Judge
It’s also important to listen without judgment or comparison. It’s okay to share experiences that offer insight into coping mechanisms or that build trust and relatability, but try to refrain from making it a competition of who has it worse. This may make the individual seeking help feel as if their experience is not valid. Try your best as the listener to set opinions or biases aside to allow your loved one to express themselves without fear of disappointing you or feeling judged or embarrassed. Instead, listen with an open mind to learn and offer insight based on their specific mental health experience.
Do Your Research
When a loved one comes forward to discuss their mental health, it may be a challenge to really understand just what they are going through on a day-to-day basis. This is where ample research can help you as the listener. Find relevant online resources, like this example from WebMD, that give a digestible overview of specific mental health disorders that your loved one may be struggling with. Bring this research to the conversation and make note of their unique mental health experience and how it applies to what you have learned. This can allow you to be a better resource for next steps and set plans of action to help them cope with their mental health.
Be a Resource
Once you’ve determined the next steps based on the discussions you have had with your loved one about their mental health, set those steps in motion. Review everyday habits they can instill in their routine to feel a better sense of control over their mental health. Be present enough as well to know when to seek help that you, as the listener, can not provide yourself. This may include suggesting the need for professional help. Online psychiatry resources make it easier than ever to commit to routine help from professionals, all while staying in the comfort of your own space. As the listener, this can be a difficult topic to broach, but don’t be afraid to push your loved one to seek professional help if needed and reassure them that you will be with them every step of the way.
Pets Provide Significant Health Benefits
Pets Provide Significant Health Benefits By Rachel Blankmeyer, DVM
Some of our closest companions, especially as we age, are our four-legged friends. The human-animal bond provides many benefits to people who may otherwise be isolated due to emotional, behavioral, or physical problems. Research shows several health benefits of pet ownership for older adults, including lower blood pressure, triglycerides, and cholesterol levels. A study by Friedmann & Thomas in 1995 showed that pet ownership actually resulted in increased survival rates after a heart attack. Other studies have shown that pets may provide social support similar to that of a family member for older adults. Consider additional general health benefits such as weight control and stress reduction, and pet ownership seems like a win-win situation!
You may have heard of the Alzheimer’s patient study performed by Edwards & Beck in 2002, where persons with Alzheimer’s disease observed a facility fish tank and demonstrated improved relaxation, alertness, and eating habits. This is a huge deal for patients dealing with dementia because at least 50% experience weight loss, increasing the mortality rate and progression of disease. Stroke survivors may also specifically benefit from animal companionship through improved communication, dexterity, mobility and balance. As a veterinarian, I may be biased, but the facts don’t lie: animals help all of us have a more active daily life, and can enrich our lives emotionally! So, consider the cost-benefit ratio:
Adopting your new forever friend from your local shelter…$35
Pet food for one month…$10
Years of companionship and improved health…priceless.
Guest Blog: Common Skin Conditions Affecting the Elderly
No matter how well we take care of ourselves, advancing age eventually takes its toll – especially on our skin. Over time, the various components that make up our bodies gradually become less able to resist the onset of decay. The epidermis, which is the body’s largest organ, is no exception. As we age, it dries out, grows thinner, and becomes more vulnerable to disease. These naturally-occurring difficulties are compounded when an elderly patient is confined to a long-term care facility.
In some cases, a skin problem may indicate an underlying condition that has gone undetected. Skin conditions can also arise from problems in positioning for patients who are confined to a bed or a wheelchair for an extended period. Once the wound has been healed, the caregiver should make sure that its cause is determined and addressed, and nothing else is being overlooked.
While there are many possible skin disorders that can affect the epidermis of an elderly patient, not all of them will require treatment. Some do, however, and the following are a few of the more common conditions and their possible treatments.
Allergic Reactions
It has been estimated that approximately 5-10% of people 65 or older suffer from an allergic disease. In addition to those who suffer from allergies throughout their lives, some individuals only develop allergies once they reach an advanced age. Underlying medical conditions, memory issues, the use of several medications simultaneously, and overall poor health, can also contribute to the late appearance of an allergy problem in an elderly patient.
Prescription medications are often the culprit when a geriatric patient develops a systemic allergic reaction. Because of this, anyone who does have allergies should be asked about any recent new medications he or she may have begun taking. However, there are other potential causes, including exposure to detergents or mites. Allergic reactions can present in a wide array of symptoms, making it difficult to sometimes narrow down a specific cause.
Allergic reactions should always be treated with topical steroids for one to two weeks. The caregiver should also make sure that the cause of the reaction has been addressed.
Fungal Infections
The most common fungal infection, regardless of a patient’s age, is candidiasis, which is a yeast infection that tends to appear on occluded regions of the epidermis, such as in the folds of the skin or under dressings. It’s most dangerous to older patients and most transmittable to patients who are confined to bed or a wheelchair. In geriatric patients, candidiasis presents with chills, fever, pustular skin lesions, and in some cases, symptoms indicating sepsis.
Fortunately, candidiasis can be prevented by applying miconazole powder to at-risk patches of skin. When it does appear, it should be treated by applying clotrimazole or nystatin cream to the affected areas. If it becomes a recurring problem for patients, bowel eradication using nystatin pastilles should be considered. The provider should also be sure to check the patient for signs of retinal lesions, as many elderly patients suffer from cataracts.
Another common fungal problem is seborrheic dermatitis, which is caused by infection from a different type of yeast, malassezia furfur. It presents as red and scaly patches of skin typically found in areas where hair is present; particularly the head, neck, and chest. It can be treated with ketoconazole (nizoral) 2% shampoo or selenium sulfide 2.5% (Selsun Blue).
Staph and Strep infections
Staph and strep infections are also among the most common problems health professionals will face in patients at a long-term care facility. Studies have estimated that, at any given time, 30-40% of long-term care residents are experiencing a fungal infection.
A staph infection typically results when bacteria enter the epidermis through a sore or a cut (including in areas where a patient may be attached to a catheter or other medical device). The infection presents painfully as a red, swollen patch on the skin. This may be accompanied by pus drainage, a skin abscess, warmth in the area, and a fever as well. In more severe cases, patients may even experience shortness of breath, chills, chest pain, fatigue, muscle aches, headaches, and rashes.
When a geriatric patient is suffering from a staph or strep infection, it should first be treated with a topical antibiotic such as mupirocin (bactroban). If this does not cure the infection and it enters the surrounding tissue, a tissue culture should then be taken to determine what organism is causing the problem. Depending on the results, a systemic antibiotic – usually augmentin, bactrim, ciprofloxacin, or tetracycline – should be given to the patient.
Guest Blog: 5 Signs of Mental Health Issues for Seniors
When you’ve started to notice changes in an elderly relative, you may wonder if a mental health issue is the cause. While it is important a mental health professional diagnoses these issues, some signs exist indicating that the time has come to make an appointment.
Depression
Depression can occur for a host of reasons. Elderly individuals may be suffering from the loss of a loved one, or they may feel alienated, isolated or otherwise separated from their friends or from their interests outside of the house. Individuals who seem filled with sadness and negative emotions or who are hinting about emotional turmoil may need outpatient or inpatient treatment for depression.
Anxiety Issues/Bipolar Disorder
You may also notice that your loved ones are having heightened periods of elevation followed by periods of deep sadness. They could be suffering from bipolar disorder. Serious anxieties could begin to manifest at this age too. For example, you may notice that your elderly relatives always seem to be thinking about their own death or about expected loss of other loved ones.
Memory Loss
As people age, you may think that it is a normal occurrence for them to forget information that they would have once remembered. However, these early slips could be signs of a more serious problem that is coming into fruition. Your loved ones might now be forgetting about certain dates or social events, but these struggles could turn into failures to take medication or complete other necessary medical tasks.
Personal Care
If you notice that your loved ones are not taking care of themselves as they used to, this situation could also be a sign of mental health issues. For example, you may have noticed that your relatives are no longer brushing their teeth or bathing on a regular basis. Seeking professional help can uncover the root of the issue so that a plan of treatment can be devised.
Social Withdrawal
Your loved ones might also seem to not want to participate in social activities anymore. Whether they are constantly declining invites to attend family functions or they do not want to participate in community activities any longer, these decisions could be signs that a mental health issue is present.
As your loved ones age, you may be the lookout for physical health issues. While addressing these problems is imperative, so is watching for signs of mental health struggles. May is mental health awareness month, get involved to help bring awareness to this important cause!
Guest Blog: Why The Golden Years Are the Best Years of Your Life
Portrait of a happy old couple sitting on quay by sea
For seniors, getting old is the new black. You can ask them yourself. Because according to a recent survey, 68% of seniors never feel offended for being treated like one, while 70.3% feel being called ‘old’ is hardly offensive. The truth is, getting old is blessing – not a curse.
For starters, age brings wisdom. By the time the grey hairs start popping up, you’ve had your fair share of experiences. You’ve likely travelled around a bit, held a few jobs, been through good and bad relationships, started a family, and made some life-changing decisions. But when it comes down it, you’re all the wiser for it. Going forward you can make better, more informed decisions, and even give your two cents to the younger generation.
As you mature, so too will your relationships. You’ll likely cut out the friendships that didn’t mean much, and work on the ones that do. Essentially, you’ll start seeking quality, not quantity, across all areas of your life – which isn’t a bad philosophy to live by. Plus, who said getting old isn’t fun?
Take LATA 65 for example, an art organisation in Portugal that’s destroying age stereotypes in the street art scene. By giving senior citizens the tools and knowledge to create their own stencils, the organisation’s goal is to connect the older and younger generations through art, as well as help the elderly get out and about to engage in contemporary culture.
But that’s just one example of how seniors are making the most of their retirement. What else are they getting up to?
How Aussies are living it up in their golden years
Gone are the days of knitting, card games and staying put. Seniors these days are proving to be one the most lively and radical bunch of seniors to date. According to the Golden Years Report, 85% of seniors consider themselves happy, while 80% are doing the things they really want to do.
In fact, most feel younger than they actually are. This can be attributed to being more physically active, learning new things, travelling to new places, having new experiences, being sociable, and having hobbies.
Seniors are also busting ‘old age’ stereotypes. For example, as technology becomes more prominent in our lives, Aussie seniors are no longer relying on others to show them the ropes. Instead, many are now technically savvy and spend plenty of time online. They also have no problem dressing like younger generations, speaking the same lingo (#YOLO), or even getting tattoos.
While they might not be huge spenders, today’s retirees are also spending more money than earlier generations. So instead of slowing down and disappearing modestly into retirement, they’re choosing to fork out just as much money (sometimes more) on their later lifestyles. And why not? Retirement isn’t an expiry date – it’s an excuse to live life to the fullest.
It’s safe to say, Australian seniors are reinventing the concept of ‘getting older’. They’re not confined to the activities and stereotypes usually associated with old age, and are instead open-minded, tech-savvy and progressive. They’re not just comfortable with the modern world, they’re enthusiastically making the most of it. So if there’s one take home message here, it’s this – there’s still plenty to look forward to.