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Guest Blog: Managing Family Dynamics with Geriatric Patients: A Guide for Nurse Practitioners

 

Gerontology nurse practitioners face a unique set of challenges within their field. It comes with the territory of caring for older adults that issues such as death, dying, terminal illness, and chronic illness are commonly addressed.

Common Challenges

There are many challenges families face when caring for an older relative. For example, the loss of independence a geriatric patient may have. Families may need to step in and care for the aging patient, which, unfortunately, can add stress to their daily lives. This buildup of stress can lead to caregiver burnout, depression, anxiety, tension within the family, and even anger or resentment.

Another possible challenge is the imbalance of perceived “power” within the family. A scenario for this would be if an elderly patient moves in with their adult child and their family. For many years, the patient was the head of household; the one who made decisions and ran the home. Now, the adult child is the head of household, while the aging parent/ family member is an occupant. The family may experience a “power struggle” which can lead to conflict and strife within the home.

Dealing with chronic illness is another prominent challenge – possibly one of the most significant. Dementia, for example, is a condition which does not improve over time. Dementia affects almost half of adults over age 85. The early stages are the most difficult, as patients experience forgetfulness which could lead to safety concerns (i.e., wandering away from home, leaving the stove on, etc.). Family members may become frustrated easy, but as the disease progresses, they may experience a prolonged “mourning” of the patient.

Along with situational components, there are other factors that contribute to a family’s dynamic. Socioeconomic level, education level, cultural differences, and even something as basic as personalities all contribute to how a family interacts with each other and deals with stress.

Tips for Geriatric Nurse Practitioners

When dealing with geriatric patients and their families, it’s important to first acknowledge that each family unit has unique dynamics. From there, utilizing the nursing process is a great way to address the individual needs of the patient and family. Below are some tips, using the nursing process, that can help geriatric NPs manage the sometimes-complicated dynamics within families.

Assess

The first thing geriatric NPs should do is assess the family’s interactions and communication skills. Ideally, meeting with both the family and patient is ideal. Assessing communication skills such as active listening, non-confrontational statements, and body language will help the NP determine how effective communication is within the family, and what needs to be improved. Geriatric NPs can also assess the patient and family’s knowledge base, readiness to learn, and if anyone is experiencing any of the stages of grief.

Diagnosis

After assessing the family dynamics and interactions, geriatric NPs can create a “diagnosis” of what they may need. For example, if the daughter of an elderly patient with dementia can no longer care for the patient, the NP will need to take action in terms of finding a suitable living arrangement. Another example is if the son of an elderly patient with a chronic disease becomes easily frustrated and angry with them. The NP would have to develop a plan to address the issue.

Planning

After assessing the family and patient’s needs and determining what is needed, the geriatric NP must create a plan to meet their individual needs. Because the needs of the patient and family are unique, breaking apart the needs of each family member will help tailor a plan to help create a healthy family dynamic. For example, using the first scenario above, the NP can create a plan to help the family find a care home for the patient, while assisting to help them manage the emotions involved with possible feelings of loss of control and fear. In the other example, the NP can consider arranging appointments for the son to see a counselor to deal with his feelings regarding his parent’s chronic illness, and how to communicate in a positive manner.

Implementation

The implementation phase of the nursing process is putting the plans into process. For the geriatric NP, this means arranging appointments, providing resources, and collaborating with the rest of the care team. Using the examples above, that could mean providing a list of care homes, putting the family in touch with a social worker, and/or recommending a counselor for the significant life change of transitioning to a care home. In the second example, the NP can recommend family counseling as well, and possibly provide tips for stress management for caregivers.

Evaluation

Evaluating a patient and family’s response to the recommended plan is one of the most essential pieces of dealing with altered family dynamics. This phase is a delicate process, as the NP needs to ensure the family has not only followed through with the treatment plan, but that it was effective as well. If not, the planning and implementation phase would need to be re-structured. In the examples used above, that would mean making follow-up calls to see how the elderly patient is doing in the care home, how the family and patient are doing with the transition, and if there are any other needs. In the second example, the NP can follow up with the elderly patient’s son to see how he is dealing with his parent’s chronic illness. It may also mean working to help manage the chronic illness as well.

Conclusion

Working with families is not unique to nurses and nurse practitioners. However, working with aging patients and their families presents a different set of challenges. While it’s impossible to provide tips on every potential challenge geriatric NPs may face, going back to basics using the nursing process will help identify each individual need so that a plan can be developed to address them. One of the most important things to remember is to include the family whenever possible in the decision-making process, and to maintain as much dignity and independence as possible for the geriatric patient.

By |2020-11-14T12:22:53-05:00November 28th, 2020|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Guest Blog: Managing Family Dynamics with Geriatric Patients: A Guide for Nurse Practitioners

Guest Blog: 4 Healthy Aging Routine Tips

It is never too late to adopt a healthy aging routine into your everyday life. Healthy aging isn’t necessarily about looking or feeling younger, but rather optimizing opportunities for overall good health. Making a simple skincare switch, keeping a balanced diet and getting at least 8 hours of sleep are simple things that can make you feel more energized and give your outer appearance a natural glow. To begin your anti-aging regimen on a positive note, check out these tips for some inspiration!

Skincare
Changing your skin care routine may seem like a daunting task at first. It’s difficult to break from the products you have used for a long time, but once you establish a new routine that works for you, you will see the benefits in a short amount of time. Skin hydration, regeneration, and protection are all essential for seniors. Without these, and the use of an exfoliator weekly, your entire body, will lack smoothness and shine from the accumulation of dry or dead skin.
Remember, skin care isn’t only about facial products. It’s essential to moisturize your arms, hands, legs, and feet too!

Nutrition
Various diseases and illnesses form as a result of inadequate or unbalanced nutrition and poor dieting. Once you reach a certain age, it is critical that you eat more fruits and vegetables to prevent illness and nutritional deficiencies. Substitute processed foods for whole foods to ensure your body is receiving the nutrients necessary for a healthy life. According to the USDA, foods that are high in antioxidants (high Orac) can protect cells from oxidative damage. Kale, spinach, blueberries, and blackberries are all great options! Try implementing a few of these high Orac foods listed below into your diet to slow aging down: Visit here for more information.

Vitamins and Supplements
Many seniors rule out food they aren’t willing to consume depending on their current health status or personal dislikes. Their pallets are fully developed, and for the most part, they aren’t in the mindset to try new foods. However, avoiding certain foods can result in a lack of minerals, nutrients, and vitamins that aid in preventing deficiencies and diseases. Take vitamins such as calcium and zinc to help boost brain power, along with Vitamin E, B3 and B5 help support skin elasticity. Furthermore, don’t leave out supplements that can help cellular health such as probiotics and products like Basis by Elysium Health.

Sleep
Sleep may come easier to some more than others. It is important to know that disrupting your circadian rhythm with poor rest can lead to metabolic disorders. Many seniors have insomnia which limits their hours of sleep. Exercise, sticking to a sleep schedule and establishing a bedtime routine can help aid seniors in gaining the rest they need at night or throughout the day.

Remember, it is never too late to make improvements to your current routine, especially if it will benefit you in the long run. Take the time to appreciate your body and embrace the natural process!

 

By |2020-11-02T13:08:52-05:00November 13th, 2020|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Guest Blog: 4 Healthy Aging Routine Tips

Simple Ways to Find Purpose as you Age

Having a purpose in life impacts its quality regardless of our age. A recently published study on Purpose of Life (PIL) in older adults found that people with purpose experienced fewer disability problems and chronic conditions. PIL is defined as a life with goals, direction, and meaning. People with a high PIL were found to be resilient, healthy and with social support, faith, and good knowledge of health-related matters. Here are some simple ways of keeping these factors in your life as you age.

1. Join an Age-Friendly Gym
Find a gym that has programs for elders. If you don’t know many fitness centers that offer such programs, use an online tool like this facility locator on the International Council of Active Aging website. The map shows the available options in a city by name, number, address, and allowed gender. Next to the name of the center, there are icons to show what type of services they offer. Besides fitness centers, you can use the tool to find other services as well, including recreation centers, retirement living facilities, YMCA, community services, etc. Here are 5 places you can visit to stay in shape and find new friends.

2. Become a Volunteer
Consider becoming one of the many elderly who volunteer. Some popular forms of volunteering include fundraising, teaching, mentoring, and preparing/distributing food. Retired individuals are a good fit for volunteering programs because they come from a variety of businesses and sectors. For instance, your input can be valuable for a fundraiser if you have spent your career in marketing and have a strong connection in the community that takes years to develop. Sites like Volunteer Match list opportunities in a variety of areas and for people of different age groups.

You can also offer your services as a mentor to young people in general or in your field of expertise. For food related jobs, check at your local food banks and at any local food service companies. Volunteering can offer both physical and mental benefits. When choosing a form of volunteering, make sure that it engages you, so you don’t find the work to be tedious and boring.

3. Visit Your Favorite Places
Start signing off the places you have on your travel bucket list. Hit the road, take the plane, rail, or ship. Don’t allow a limited budget to come in your way – look for discounts. A variety of discounts are available, including airfare, dining, clothing, grocery, and entertainment discounts. Here is a list of some of these discounts. Go through them to plan your trip for less. If your travel appliance have gone out of shape, use a home warranty to fix or replace them for free.

4. Learn Something New
Join a class at your library or senior center to stay mentally agile and find people who share the same interests. Check courses at your community college as well. Take a driving course if you feel like your driving skills need a little sharpening. Continue the process of learning.

By |2020-10-03T14:11:32-05:00October 28th, 2020|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Simple Ways to Find Purpose as you Age

Guest Blog: Reasons The Elderly Benefit From Aging in Place

In the movie classic, The Wizard of Oz, little Dorothy knew then what has become a staple in the lives of elderly seniors today; “there is no place like home!” Dorothy, the main character in the movie, was swept away by a tornado from her home to a far away fantasy land. The only way back home was for her to follow the directions of the Good Witch Glenda’s magic spell which required Dorothy to click her red shoes together three times and think of the phrase, “there’s no place like home, there’s no place like home, there’s no place like home!” Afterwards, she woke up from a deep sleep in her own bed and in her own home.

 

Today, roughly 90 percent of older adults aged 65 and over prefer aging in place rather than moving to an assisted living facility or nursing home according to a study conducted by AARP. Like Dorothy, these older people know what Dorothy knew then, that “there is no place like home”, and they plan to stay in their homes as opposed to living in a long term care facility.

What Does Aging In Place Really Mean?

The Centers for Disease Control and Prevention (CDC) defines aging in place as “The ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level.” Although aging in place is the new trend for senior living, changes to an elderly senior’s body due to aging, may pose a problem. However, with a few low-cost home modifications, the goal to age in place is easily achieved and the benefits from doing so are rewarding.

There are however, some seniors living with medical conditions and other limitations that may prevent them from performing normal activities of daily living on their own. If this is the case, they may need to seek assistance from a home care provider or a family member. With in-home care assistance for routine daily life activities, aging in place is still achievable in spite of those limitations.

3 Common Reasons Elderly Seniors Should Age In Place

Elderly seniors choosing to age in place are doing so for any number of reasons. Even though assisted living facilities have been on the rise since 1979, over a million Americans are opting out of that option. Here are five common reasons why:

1.    The growing high cost of living in an assisted living facility!

According to LongTermCare.gov, the average cost for a one bedroom at an assisted living facility is over $3,000 a month. Of course, this price may increase if additional services beyond the basic ones mentioned in the contract are needed. For example, if the resident requires assistance from a healthcare provider or home health aid. This service could add an additional $1,600 a month. Therefore, staying in your own home will definitely save money, even if you had to hire a personal care provider. In most cases, an elderly person’s medicare will cover part or all of the cost of home healthcare.

2.    Aging in place is more comfortable!

Living in your own home is much more comfortable. All the treasures you hold dear are in your long term home. In fact, the American Society On Aging found that 56 percent of seniors 65 to 74 years old and 63 percent of those 75 years old and older reports that the “emotional” value of their home is worth more to them than the sales value. This is most likely because their home may be the same home they raised their children in and the memory recall is priceless.

3.    Aging in place offers more independence!

Maintaining an independent lifestyle is very important to the elderly population. The ability to go where you want, when you want is a very liberating feeling and doesn’t diminish your quality of life. Responsible adults do not like being told what they can or cannot do. In assisted living facilities, meals are served at a certain time of day, activities are scheduled around their schedules and outside visitors are monitored which can be intrusive.

Just like little Dorothy, “there is no place like home” for today’s elderly seniors choosing to age in place. The benefits for doing so are very rewarding. Aging in place offers elderly seniors an opportunity to save money to enjoy life’s extra pleasures as well as allows them to enjoy the comforts of living at home. In addition, aging in place allows elderly seniors to maintain their independence.

 

By |2020-10-17T15:14:57-05:00October 19th, 2020|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Guest Blog: Reasons The Elderly Benefit From Aging in Place

Alzheimer’s: Signs & Symptoms

 

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.

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By |2020-08-16T19:20:42-05:00September 10th, 2020|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Alzheimer’s: Signs & Symptoms