Archive for May, 2009

Posted on May 29, 2009 - by Nurse Virginia

Aging: Why is it more difficult for the elderly to resist infection and what should you look for?

6 – Reasons the elderly are more susceptible to infection:

• Their immune system has aged and is not as effective
• The skin is the first line of defense against infection and the aging skin is thinner
• The elderly are usually less hydrated – especially their skin
• Many elderly retain urine – increasing the likelihood of urinary track infection
• The elderly have decreased ability to cough up secretions
• The use of medications that can suppress the elder’s ability to fight infection

The elderly don’t always show signs of infection the way a young healthy person might, with an increase in temperature and increased white cell.

8 – Changes in condition in the elderly that may indicate an infection:

• Increase in confusion
• Becoming incontinent of urine
• No longer being able to do a task they normally do with no problem
• Having problems walking
• Falling
• Breathing faster
• A change in their appetite
• Worsening of a medical condition they already have

As is always the case – prevention is so much more important when working with the elderly. Washing hands and avoiding highly congested areas where the chance of acquiring an infection is higher are the caregiver’s greatest opportunity for defense.

Posted on May 29, 2009 - by Nurse Virginia

Caregiver Tips: Helping your elder with Aging Vision and Alzheimer’s disease. (Part Three)

Aging vision needs much more light:

“Why are you turning the lights on already” Carl’s wife asked. “Oh, it’s going to get dark soon” He replied. This from the man who went behind her for years turning off lights when she just stepped out of a room for a minute. He wasn’t even aware of his vision problems, but he needed three times more light now than she did.

Natural sun light is always the best source of light for aging vision problems. Carl had always enjoyed wood carving, and could now be found carving in the most unusual places around the house “following the sun.” Just like a household pet that lies in the sun during the day and repositions as the sun moves through the home, Carl now follows the sun through the day.

6 Ways to help persons with diminished vision:

• Do as many errands as possible during the daylight hours.
• When you go from bright light to lower light it takes awhile for older eyes to adjust – grab a grocery cart outside the store so the elder has something to hold onto when they go from one level of light to another.
• In the home use bright lighting that reflects off of ceiling and walls to reduce shadows and dark spots.
• Be aware of providing contrasts in colors to help the elder see – white foods like mashed potatoes, cauliflower and fish on a white plate, placed on a white table cloth is a much harder meal to see than the same meal on a red plate.
• A home with a color on the windows and doorways that contrasts from the color of the walls makes it much easier for the confused person with vision loss to understand their environment.
• Avoid patterns on upholstered furniture; it’s much easier to see a solid colored piece of furniture on different colored flooring.

If the elder had a disease process that warrants the use of a white cane (see part two). The elder with Alzheimer’s disease may not be able to learn the correct use of a white cane, the sweep of the environment as they walk. But the cane can be a good visual when in public, to identify the elder as someone with decreased safety awareness and thereby increase courtesy and understanding from strangers.

A great source for information is the American Foundation for the Blind at: www.afb.org

Posted on May 22, 2009 - by Nurse Virginia

Caregiver Tips: Aging Vision, do you know what your elder with Alzheimer’s disease sees? (Part Two)

 

When you elder is confused poor vision may increase confusion.

A person with Alzheimer’s disease or another dementia will be much more confused, if they cannot see. Caregivers often take for granted being able to see what or who is around them and what is going on. But if you don’t know what your elder is seeing you are, and they are at a huge disadvantage. The person will either withdraw or behaviors will escalate.

Diseases of the eye; cataracts, glaucoma and macular degeneration are usually not painful and come on slowly. Picture walking around all day with heavy Vaseline smeared on one lens of your glasses and trying to see through that cloudy mess. That is what it is like seeing through a cataract. Add a yellow film to the lens and that is what the eye of an elderly person might look like. Add confusion to that frustration of not seeing clearly and you can have a pretty unhappy elder.

Normal aging changes of the eyes:

• clouding of vision in one or both eyes
• blurring vision in the center of the eye
• problems with focusing
• problems with night vision and the glare of headlights

Make sure when it starts to get dark you turn on adequate lighting. Make sure the elder is wearing their glasses and that they are clean. Make use of products for the elderly with vision loss.

• clocks with large numbers
• books with large print
• telephone with large numbers
• playing cards, board games with large print
• puzzles with large pieces

Regular eye exams are so important. Call the eye doctor’s office and explain that the person is elderly and what kind of dementia they have. Ask if the doctor has experience with patients with dementia. Have a clear understanding when you talk to the doctor of what the elder can see and where there may be problems with their vision.

Posted on May 22, 2009 - by Nurse Virginia

Caregiver Tips: Aging Vision, when there is a problem – looking beyond the Alzheimer’s disease. (part one)

Blaming the memory loss.

“I can’t help it, she just keeps walking away from her walker,” the caregiver said to the nurse.

She was Edna a small, 82 year old white haired woman with Alzheimer’s disease. We had tried everything – putting her name on the walker, tying ribbons to the walker, telling her all day long “Edna, don’t forget your walker.” Sometimes she remembered it, sometimes she didn’t.

We attributed all of the time she was “forgetting” to her Alzheimer’s disease. It wasn’t until the staff noticed Edna eating with her fingers, and only the food on the left side of her plate, that we became aware that something else was going on.

Sometimes the problem is aging vision as well as confusion.

The answer was there all along in her chart under the “consult” tab. Edna had been seen by her eye doctor and had Hemiopia a condition where:

• Both eyes are affected and you can see only on the right side or left side.
• One eye is affected and you can see only on the right or left with that eye
• Your vision is affected horizontally and you can only see on the top of the vision field or bottom.

Edna couldn’t see on the right side of either eye. So when utensils were put on the table on her right side she didn’t see them and she ate with her hands. Edna couldn’t see the food on the right side of the plate so she didn’t eat it. Edna didn’t see her walker when it was put on the right side of her and so she just walked away from it.

Letting the staff Get to Know Edna, changed life for her. Instead of constant reminders, that she couldn’t understand or remember the staff were now using cues to make her life easier. Now White Ribbons were hanging from the right side of the walker and they weren’t for Edna anymore, they were there to remind the staff, which side Edna couldn’t see from. Now when Edna stood up and her walker was where she could see it, on her left side, she no longer “forgot” it.

Sometimes getting to really know the elder you care for, is as simple as knowing what the doctor said.

Posted on May 20, 2009 - by Nurse Virginia

Aging: Check your expectations at the door, when you visit the elderly in the Nursing Home

Visiting the Nursing Home

Mom seldom had her familiar ear to ear smile of greeting anymore. I’m not sure when we started to realize the change. But in going to see her every Sunday, I had somewhat gotten used to it. But not so much my sister Ruth. When Ruth came she had over a 3 hour drive one way and could only come once a month. And in the winter months coming from Northern Wisconsin, she usually couldn’t come at all for months at a time.

So when Ruth came, she kind of expected to see that look of surprise and delight that she was used to. Many times when she came she would find Mom dozing in her wheelchair and wake her up. Upon seeing Ruth, Mom would immediately share her most recent concern “My feet hurt, could you get the nurse to put on my foot crème.” Or maybe “My back hurts I need to lie down for a nap.” “But, Mom I just got here don’t you want to stay up for awhile?” Ruth would ask.

Posted on May 15, 2009 - by Nurse Virginia

Caregiver Tips: Does the confused elder think you steal from them?

Sympathize, Reassure, Distract

 
“You took my money,” Janet accused the caregiver. The caregiver responded, “No, I didn’t, I just came into the room. I would not take your money. I didn’t even know you had money. You just lost your money because you can’t remember where you put it.”

This kind of response never helps and many times makes the anxiety worse and in this case Janet angry. The caregiver should have said something like:
“I’m sorry you cannot find your money, that must be pretty scary for you to lose money. Let me help you look for it and we can straighten these drawers out at the same time.” This distraction of cleaning out drawers gives Janet an activity to do and forget about her anxiety over money.

9 Things to do when the confused elder insists on a persistent thought or fear, whether real or imagined:

1. Simplify expectations.
2. Change the way you provide care or the environment as little as possible.
3. Do not argue or disagree with a confused elder.
4. Do not attempt to explain.
5. Give reassurance with a kind caring tone of voice.
6. Offer to help look for the item.
7. Learn the person’s favorite hiding places.
8. Make yourself the trusted “helper” in times of trouble.
9. Listen to the elder you care for.

Distraction, distraction, distraction – substitute something positive to do, for a negative behavior.

Posted on May 13, 2009 - by Nurse Virginia

Caregiver Tips: “THE ALZHEIMER’S STORE” catalogue probably has what you need.

No more 911 calls from confused elderly:

I absolutely love my new edition of The Alzheimer’s Store Catalogue. As I skim through it I can see, in my mind, those people from the past that would have benefited so much from some of these innovative products. Right from the first few pages – imagine a telephone that you can receive calls from and can’t call out! No, more 911 calls that try the patience of your local law enforcement.

My mother had a roommate who would call the police every time a caregiver didn’t come fast enough for the call light. Many a time, my Mother would be wakened during the night to some officers in her room, because of course they had to respond. No more calls in the middle of the night to family asking for the 30th time, when do I go to the Doctor or the Dentist?

The Alzheimer’s Store carries so many products – many that I have personally seen used effectively.

• The stop sign – can really stop a person and turn them around.
• The door murals are used successfully in many nursing communities to make an exit door disappear.
• Exercise Videos – a real must for anyone caregiving for some one with Alzheimer’s disease – start using an exercise program before the person stops initiating independent movement and before the chance of developing painful contractures begins.
• Products for every day dressing, eating, bathing

They also have a great system to indicate what level of disease process this item would benefit.

If you are taking care of someone with a dementing illness in the home, you will need some help. They really have it all!

I know the first thing I am ordering is Richard Taylor’s Alzheimer’s From The Inside Out.

Go to: www.alzstore.com or call 800-752-3238 for your copy of this catalogue.
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Posted on May 12, 2009 - by Nurse Virginia

Caregiver Tips: What does a pretty word like sundowning have to do with the confused elderly?

 

Increased confusion in the late afternoon:

 
Sundowning, a pretty word for the less than pretty behavior of an agitated person with Alzheimer’s disease. Sundowning, occurs in the mid to late afternoon and early evening. It can be identified by behavior as:

• Pacing, restlessness
• Increased confusion, paranoid, disorientation
• Combativeness, demanding, yelling
• Being insecure, fearful, impulsive

5 Things that can increase afternoon confusion:

• Fatigue – sometimes an easy fix can be a nap in the afternoon.
• Too noisy environment – this would be the time to turn off TV, radio (especially trouble ling news and crime shows) and have some quiet time.
• Too many people – visiting might not be so good in the afternoon for some people with a dementing disease, or limit the number of visitors.
• Problems with vision due to darkness.
• Maybe just brain changes due to the disease process.

If the person you are for has these behaviors, try to balance the amount of activity and quiet time. Do not argue with the person. Urge the person to drink fluids through the day to avoid dehydration which can cause increased confusion. Offer normal activities for the person to help with – like folding wash. This might be a good time to read out loud – the human voice can be very comforting to babies, young children as well as the elderly.

Posted on May 7, 2009 - by Nurse Virginia

Caregiver Tips: When the caregiver in the Nursing Home is too involved.

The Caregiver’s story:

 
Her name was Beverly, she was a middle age woman of short stature with dark brown curly hair cut short. This was her first night on the 11-7 and she told me how she had worked for over 20 years at her previous nursing facility where she had just been let go. She appeared more than willing to tell of the unfairness that had fallen on her after her years of service.

The story spilled out of her. Seems she had for the last several years cared for a lady in the late stages of Alzheimer’s disease. This was the nicest, sweetest lady she had ever cared for. As time went on she became aware that this lady had no visitors. She helped herself to the woman’s medical record and saw that she had a son and family living in the next town.

This information bothered Beverly and eventually she built up her courage and went to the son’s home, rang the doorbell and confronted him about what she saw as his neglect of his mother. And for this she was fired.

The Family’s story:

I asked her if during this time when Beverly had taken care of the mother: had the son provided for his mother? Oh, yes! Did she have clothes? Oh, yes he always brought her things and left them at the front desk, but didn’t go to see his Mom. Did, he support her? Oh, yes she had noticed ( again while looking the chart) that the son was the guardian and bills were sent to him.

So then I asked her why she felt that she was in the position to judge him.

So often over the years, I have heard healthcare workers be judgmental of family members. Who would want someone taking a magnifying glass to our family dynamics and judging us? For all of us there will someday be a judging, but till that time, Let Go – Let God.

Posted on May 5, 2009 - by Nurse Virginia

Caregiver Tips: When a family member cannot accept that their parent is now confused

“Dad would never do that, he has too much respect for food to throw it

 
“Dad”, is 87 and now in a nursing community, his three daughters share the responsibility of guardianship. It’s the youngest, Amy who is having the most trouble accepting the changes in Dad.

Instead of spending time during her daily visits doing something with her father she spends it in confrontation with the staff over the minutia of the day. Whether it is exactly what time he got up in the morning, exactly what he ate for breakfast, who said what and who did what – all is repeated again and again to every person in administration available to listen.

The latest point in question is, Dad likes to stay in bed in the morning and doesn’t want breakfast. Person centered care means that if a person always slept in, they don’t follow a facility routine, we follow theirs. If they never ate breakfast, they continue to follow their routine. However this Dad:
• is diabetic and needs to eat something in the morning.
• has a history of vomiting and so cannot be left in his room in bed eating independently or after eating.
• when given breakfast in his room and monitored, has thrown the food and dishes against walls and windows.

Talking out these problems with Amy prompted “Dad would never do that, he has too much respect for food to throw it.”

Behaviour Tracking

The solution turned out to be behavior tracking. For one week the staff documented Dad’s behavior whether it was throwing something, verbalizing a confused thought, demonstrating an unsafe behavior. Everything was tracked by day, time, and the behavior and then most important the approach the staff took to intervene.

Seeing the documentation helped Amy see her Dad as he now is. Many families have this issue, where one member doesn’t see what everyone else sees. Helping them in a non-hurtful, non-confrontational way is always the goal.