Archive for March, 2010
Posted on March 31, 2010 - by Nurse Virginia
GRIEF – REMEMBERING DAD, BECOMING MORE LIKE YOUR LOVED ONE, KEEPS THEM WITH YOU
Many examples are in the news of people who have turned pain into purpose. The individuals who start charitable organizations usually do so after a loss. That is true with people who march to honor the memory of a loved one, with marches for breast cancer, Parkinson’s and Alzheimer’s diseases. My way of memorializing my Dad was to try to become more like him.
Dad knew how to share himself and his life with other
Even during the time of experiencing his mental losses related to Alzheimer’s disease, Dad continues to gravitate to people, and they moved toward him. Whenever I went to visit, people came up to him in the dining room, or greeted him when they passed us in the hall. Whether they were other residents or staff members, Dad knew them. He didn’t remember their names, but he knew their “story.” Dad had a way of lighting up when he saw anyone coming and acted as if talking to each one was the high point of his day. Everyone seemed to have spent some time with him, and he knew them.
At the luncheon following Dad’s funeral, it amazed us that everyone in attendance knew so much about him. They knew about his lifelong love affair with chocolate. Almost everyone who had come in contact with him knew his favorite sports and favorite teams. His love of interesting neckties and his tie collection was legendary.
Becoming more like Dad brings comfort
In the months that followed his death, I realized the comfort that could follow a loss by trying to emulate the qualities I had admired in my father. And in some ways, I tried to become more like Dad. I started to share more of myself with co-workers and friends the way Dad had. I made an effort to be more attentive to others while they told me about their problems. I thought of the times when Dad talked to people and he was totally in the moment and really with them. Sharing my faith with others seemed to come up more frequently in conversations, just as it had with Dad.
Dad – a Witness till the end
We lost Dad in March of 2005, after a massive stroke. In the emergency room, as Dad slipped deeper and deeper into a coma and could no longer identify what he heard or what he saw, he prayed as long as he could talk. The last two words he ever spoke were Jesus and Heaven.
Book excerpt from: Please Get to Know Me – Aging with Dignity and Relevance
By: Virginia Garberding and Cecil Murphey
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
www.pleasegettoknowme.com
Posted on March 29, 2010 - by Nurse Virginia
THE STROKE – THE FALL WITH FRACTURE – LIFE CHANGES WHEN THE ELDER CAN NO LONGER WALK
Barbara is 82, and has chronic respiratory problems. Her daughter says “Mom does just fine walking with the therapist at home, but when she leaves, Mom can’t walk again.” The ability to walk is so often the difference between staying in your home, and going to a Nursing Home.
A friend of mine just had back surgery, and the doctors told him, there was a 10% chance of his being paralyzed following the surgery. As he lay in bed recovering, he gave quite a bit of thought to those words and how close he had come. His surgery was a success, but what if?
Research and practical experience and observation tell us the tragic consequences of no longer being able to walk are:
- Physical – muscle loss – 3-5% a day
- Physical – Increased risk of edema, decreased blood flow
- Physical – Decrease in appetite
- Physical – Increase in frailty
- Physical – Increase in incontinence and constipation
- Physical – shortening of muscles
- Physical – weakened body functions – decrease in lung capacity
- Physical – Loss of bone density (increase in possible fracture)
- Mental – Experience negative attitude toward people in wheelchair
- Mental – Loss of confidence
- Mental – Increased feelings of uselessness
- Mental – Decreased quality of life
LIFE CAN CHANGE FOR THE CAREGIVER AS WELL
Life will change for the caregiver as well, if the elder can no longer walk. There is increased danger of injury to the home caregiver, who needs to support an elder’s weight when they walk. The caregiver can sustain pulled muscles, back injuries from lifting the elder. A change in socialization, if the elder is too difficult to take out, do to inability to walk.
Do what the Nursing Home does
When the elder needs the assistance of one caregiver to walk, they can continue to walk safely and independently while re-building strength, in an ambulation device. A good one is the Merry Walker, an all American made product. Merry Walker makes walkers for the home as well as Nursing facilities. If the elder maintains the ability to stand up from a seated position and walk with one caregiver, they may be a candidate for a Merry Walker Ambulation Device.
The Merry Walker is made from tubular steel for strength, and is black powder coated to help the person with visual impairment. The tubing design, creates four sides of support for the elder. Each walker has a padded seat and casters so the elder can roll independently wherever they wish, with the security of the seat right behind them at all times. No longer do they need to turn around before they sit. Elders who continue to walk will be stronger, more independent and happier.
Go to: www.merrywalker.com to see the wide variety of supportive walkers the experts use.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on March 26, 2010 - by Nurse Virginia
GRIEF-WHEN LIFE CHANGES IN A MOMENT AND WILL NEVER BE THE SAME
I dedicate this blog to my niece Debby who is trying to “hold things together”, following the accident causing her husband Mike’s extensive burns.
Book excerpt:
For days after Liz’s husband, Davey, died, it seemed all anyone could say to Liz was, “What can I do for you?”
If only they had realized that she had no idea what she needed. If I don’t know what to do for myself, she thought, how can I know what you can do for me? She admitted that there were times she barely even knew her own name, much less what someone else could do for her.
Even though her friends and family meant well, their questions became a constant reminder of how lost she felt within herself during this time of insumountable grief. Instead of asking what they could do for her, Liz realized that she needed someone to help her figure out what she did need and how friends and loved ones could help. “I wanted someone to say, ‘Here is how I can help you.’ I wanted someone to take over my life, to get inside my head and help me know what I needed,”
Liz wanted to mourn, but with all that needed to be done, this was becoming increasingly difficult to do. What she really wanted was her husband back. She wanted her life back the way it was before the accident. But the one thing she knew she wanted was the one thing no one could give her.
In looking back, Liz realizes her friends and loved ones only wanted to help but really didn’t know how to, which made them feel inadequate. They cared deeply and tried to express in their own way their kindness and sympathy. Perhaps asking her what they could do made them feel as if they had at least tried and somehow helped her.
By contrast, two days after she buried Davey, she had a rare period of quiet time. She felt totally vulnerable, and fear filled her mind. What will I do without Davey? How can I raise two children on my own? Who will take care of me? Tears rolled down her cheeks.
A dear friend was in the other room and must have heard her crying. She came to her side and took her hand. The friend spoke one sentence to her. She said, “I’ll pray for you.” Just one sentence-and she had no idea what that did for Liz.
That one thing-that one simple thing-was the first true healing moment in Liz’s recovery.
The friend didn’t ask if she could pray. She just did it. Liz hardly heard the words, but her emotions surfaced, and she felt as if her soul had been poured out. When the friend had finished praying, Liz said it was as if her tears had washed away all the immediate pain. “I couldn’t even whisper a word of thanks. All energy had been drained from my body. I was at peace for the first time in days.”
Liz knew there would be other days with more pain and more tears, but none like that one. On that day Liz learned an invaluable lesson: When people are grieving, they rarely know what they want or need.
Perhaps you’re where Liz was that day. Your friends obstruct your grief by asking questions you can’t answer. If only they would trust their instincts and do what they know they can do-like Liz’s friend. She did that one simple, yet powerful, thing and brought peace in the midst of grief-she prayed.
Excerpt from my dear friend and mentor’s new book:
Words of Comfort for Times of Loss by Cecil Murphey and Liz Allison
Harvest House Publishers – www.harvesthousepublishers.com
Virginia Garberding, R.N.
Author: Please Get to Know Me – Aging with Dignity and Relevance
with New York Times Best Selling author, Cecil Murphey
www.pleasegettoknowme.com
Posted on March 25, 2010 - by Nurse Virginia
VOLUNTEERING – 2010 EDITION OF THE CHURCH LADY ONLY LOOKS A LITTLE DIFFERENT
As I walked into my mother’s room on Sunday morning, I immediately recognized the smile I received from the woman visiting with Mom. “Hi Mom, I see you have company.” Mom turned, in her wheelchair, smiled and said “It’s the Church Lady.”
The consummate Church Lady
When I was growing up, I remember well one of my Mom’s best friends. I don’t remember her as being an especially good conversationalist, she wasn’t known for being clever, she needed help coordinating her clothes and decorating her home.
But for what she did, I remember her so well. Grace was so selfless, visiting all the sick in her church on a regular basis. There was a woman living down the street from Grace that had MS, she went to her home for years helping get the woman’s children off to school, and getting her up and dressed for the day. All this with no pay, just because of her spirit of volunteerism.
The Church Lady 2010
The Church Lady said, “I have been having such a nice visit with your Mom, we were just going to have our closing devotions.” I gave them some privacy and waited in the sitting area. The visit of the Church Lady caused me think about my Dad who was so devoted to his “shut-ins.”
Dad, and his relationship with his shut-ins, probably had a greater influence on us in our formative years, than we realized. He probably had more than a little to do with my going into Geriatrics. My brother Marty followed in his footsteps becoming a Lutheran Minister and now has shut-ins of his own. Sister Ruth is developing a visiting reading program for elderly shut-ins, which she plans on doing in her retirement.
Time the great equalizer
The church lady doesn’t have anymore time than anyone else. Volunteers don’t have anymore time than anyone else. We are all given 24 hours a day. It all comes down to how you use those hours. My mother’s friend Grace wore silky dresses, nylons rolled right under her knees, a pill hat and gloves. Today’s Church Lady, wears a sweatshirt, jeans and running shoes. But that is where the differences end. The smile is the same; her joy in Christ that she shares with Mom is the same.
Virginia Garberding, R.N.
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com
Posted on March 23, 2010 - by Nurse Virginia
WHEN THE ELDERLY HAVE A SUDDEN ONSET OF CONFUSION, IS ITS DEMENTIA OR DELIRIUM?
(Part II)
Delirium is a medical emergency pointing to an abnormal physical condition or response. It is characterized by the sudden onset and rapid fluctuations in change of mental status. It may be a response to:
- An infection – post surgery, urinary, urinary or bowel retention
- A head injury/trauma – fall
- Elevated temperature
- Metabolic problem – highest incident – 20-40% of cases of delirium result from a organ failure (liver, kidney) diabetes, hyperthyroidism, hypothyroidism
- Medications – antipsychotics, sedatives, anti-inflammatory, antihistamines, anti-depressants ( most common cause of reversible delirium)
- Acute vascular incident
- Alcohol withdrawal
While there are many possible causes of delirium. What is known is that the elderly population not only experiences the highest incident of delirium, but also the poorest outcomes. Studies indicate that around 50% of the elderly transferred from a hospital setting to a nursing home setting are suffering from delirium.
The hospital tells the family that they must discharge the elder, and the family thinks how can we possibly take care of Dad at home, he is so confused. So the elder may go prematurely to a nursing home, only to have the staff there begin to medicate him for the various behaviors they witness. This can create an added burden on the already confused elder suffering from delirium.
There is no simple test for delirium
Dementia is not an illness, but rather a group of symptoms associated with an illness. Likewise delirium is not an illness itself, but also a group of symptoms associated with the illness. The symptoms of dementia are very much like the symptoms of delirium.
- Memory loss
- Hallucinations (only visual – hearing voices would not indicate delirium)
- Highly distracted
- Confused thinking
- Disoriented to time, date and place
- Not capable of new learning – will ask the same questions over and over – not retaining the answers
However the elderly suffering from delirium will have newly acquired language difficulties. Less coherent communication skills as well as be less able to name objects correctly and suffer from a decrease in writing skills.
The family – very important part of the health-care team
The family is there to communicate the elder’s history. Even, if you find yourself telling the same story over and over to everyone who comes into the elder’s room. It is of most importance that the health-care team knows that this is a sudden change in condition. And also what is normal for this elder.
The family member is there to provide support, as I needed to do for my Dad when he experienced bouts of delirium. The elder needs a supportive presence to provide repeated orientation cues. Monitor the environment to reduce distractions (especially when the elder is in the hospital). Use clear language, avoiding pronouns while introducing staff to the elder by their name. The elder needs explanation and reassurance until their normal level of function returns.
See also Blogs: Auguste Deter, First Person Diagnosed with Alzheimer’s Disease
(January 3, 2010)
What is Dementia? Reversible Dementia, Irreversible Dementia, Vascular Dementia and Alzheimer’s Disease? (December 17, 2009)
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com
Posted on March 22, 2010 - by Nurse Virginia
WHEN THE ELDERLY HAVE A SUDDEN ONSET OF CONFUSION IS IT DEMENTIA OR DELIRIUM?
(Part I)
“Dad’s in the hospital.” Those words, for the last ten years of his life, would get me moving. But first I would call the hospital and ask for his nurse. I would explain that my Dad had a history of delirium when hospitalized and that I was on my way and would stay with him. But most of all “Don’t medicate him for any behaviors.”
Many elderly hospital patients develop delirium while hospitalized or are admitted due to delirium. Because delirium can look so similar to dementia the family is a very important member of the care team. The family knows what is “normal” for the elder. When did they start to see changes? The key here is how fast the changes in behavior, memory loss, hallucinations came about. With dementia it is a slow process, over months/years. With the elderly and delirium, it is a sudden and noticeable change.
The reassuring presence
When I arrived at the hospital I would immediately station myself directly in front of Dad. Close enough to make very good direct eye contact. Then I let nurses and tech people walk around me. I smiled at Dad; spoke in a reassuring way no matter what he would be telling me. It usually had something to do with snakes on the wall. He would be highly distracted, by what he was hallucinating at the moment and it was necessary to maintain that close connection to reality. We kept the curtains open and when it got dark – had all the lights on in the room to decrease the chance of shadows.
After awhile Dad would start to say that he knew there weren’t things crawling on the walls, but he could still see them. When a nurse came in to check an IV or wound (delirium is very common in the elderly after surgery) I would introduce myself and Dad. I would call the staff member by name and create a friendly connection between Dad and his caregivers.
I would always talk about Dad’s condition to the staff, in the room, in front of him to avoid any chance of creating feelings of suspicion in him. I would explain that Dad was having some problems with confusion just now, but that this wasn’t normal for him. All the while I would be talking to them, but maintain that eye contact with him, and continue to smiling.
Change in condition
The consistent message I had for the hospital staff was, “This is not normal for Dad.” The elder’s normal level of orientation is so important. If the family member is not there the staff might medicate an agitated elder or worse restrain them. On one such occasion, when I arrived Dad was sitting at the nurses station with a vest restraint on, tied to a wheelchair. He had kept trying to get out of bed and the staff was afraid he would fall.
Dad never forgot the indignity of being tied. For many months after the hospitalization he would refer to how I saved him when I came and untied him. He wouldn’t really remember my sitting there with him, but he sure remembered that release from restraints.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com
Posted on March 18, 2010 - by Nurse Virginia
GOOD OLD “KEDS” – BEST SHOES FOR CONFUSED ELDERLY – REALLY
Feet tell you where you are
Many elderly people like to go barefoot. Why wouldn’t they? We are constantly getting information about where we are through the bottom of our feet. When babies first start to walk, you can actually see their feet curl a little on the floor, as they try to grip the floor with their feet when they walk. They are learning to feel where they are, through the messages they are getting from the bottom of their feet.
When I see a confused elder with heavy athletic shoes, I think of how years ago we forced baby feet into these hard, heavy, clunky, high top tie shoes that they couldn’t possibly have been able to feel the floor through. Now the best baby shoes have thin, soft cushiony soles where the baby can still get information about the floor surface through their feet.
What information are the elderly trying to get through their feet?
Elderly many times lose sensation in the bottom of their feet due to a disease process, such as diabetes. Added to that loss, are the complications of perception for a person with Alzheimer’s disease. The lack of depth perception and ability to see the changes in the surface of the floor. A scatter rug of a dark color can look to the confused elder like a big gaping hole in the floor. Walking from one surface, a smooth surface like a tiled floor, to a carpet area can cause problems.
What’s so great about “Keds”
The “Keds” brand first came out in 1916, over 90 years ago. They still carry the first design they started with, the basic Champion. They have the same thin rubber sole they started with. Improvements came over the years in increased ability to absorb shock to protect the foot from jars and jolts, with the same thin sole. That sole is what is so great about Keds for the elderly.
(You now can even design your own “Champion” go to: www.keds.com)
The confused elder many times just doesn’t pick up their feet as well when they walk. The heavy athletic shoe, with the industrial strength grip sole can grip too much for the elder and cause a fall. Especially when catching on a thick carpet with soles that have a super grip bottom. The elder certainly can’t feel the floor and understand better where they are through, those thick soles designed for the athlete.
Increase the feeling in the bottom of your feet
A simple exercise while you watch TV can be to roll an old tennis ball back and forth under your bare feet. Just put a tennis ball on the floor and roll it forward and backward under the bottom of one foot at a time with your foot. This can increase the flexibility of the foot as well as increase the sensation, on the bottom of the foot.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com
Posted on March 16, 2010 - by Nurse Virginia
FOR THE ELDER WITH ALZHEIMER’S DISEASE WHEN THE “CARE” SEEMS MORE LIKE AN ASSAULT
The day shift is coming in at Pleasant Acres Nursing Home and Amy has Mrs. Thompson to get up today. “I’d be careful if I were you” says her co-worker Joyce. “She really did a job on Grace yesterday. She had her for a shower and Mrs. Thompson fought so much, she couldn’t give her the shower.”
Yesterday morning – from Mrs. Thompson’s view
I’m sure I heard a knock at the door, but before I can even get out of bed, someone is opening the door and walking into my house. Oh, that light in my eyes is really bright, I can’t see anything.
Who is that standing over me, I don’t know her, why is she in my house? What is she saying? Something about me and taking a shower? Why I see her now and she is just a little girl!
I don’t take showers, I take baths and I certainly don’t need any help from a little girl. I am trying to tell her so, but she doesn’t seem to understand what I am saying.
Why is she pulling at my covers? What is that she is saying about a mess in the bed? I don’t make “messes” in my bed.
What went wrong?
Grace is a new nursing assistant and learned how to give a shower and get someone dressed. Grace did learn how to do the tasks related to her job, and she also attended the classes in dementia. But Grace never really put into practice what she learned about taking care of a person with dementia.
This morning – Amy goes in to get up Mrs. Thompson
Amy knocks on the door to room 102 and says “Good morning Mrs. Thompson, as she enters the room. Amy goes right to the curtains and opens them half-way. She knows Mrs. Thompson is really up in age, and it takes some time for her eyes to adjust to the light.
While Mrs. Thompson is waking up, Amy starts setting thing up for her. She puts everything out in the bathroom to be ready for Mrs. Thompson’s shower. Her favorite soap, Dove, brought in by the family because Amy asked them what her favorite soap is. Several wash cloths and towels, the favorite soap and underwear.
Amy knows Mrs. Thompson is very private and she will need several towels to cover her private parts during the shower.
Amy gets two sets of clothes out so Mrs. Thompson has a choice, which gives her a feeling of being in control of her life.
All the while Amy is getting ready she is talking to Mrs. Thompson, helping her to wake up, get used to her and the sound of her voice. Creating with her voice, a very normal, relaxed environment in the room. (the human voice is known to be very comforting to children, babies and the confused) When Amy is all set up she is ready to approach Mrs. Thompson, who is now wide awake.
“Good morning, Loretta.” Amy is close enough now to make eye contact with Mrs. Thompson. Amy is smiling and continues, “I’m Amy and I’m going to help you this morning.”
See also blogs: January 30, 2009 – Words that help
February 4, 2009 – The senior’s name is so important
July 29, 2009 – When the caregiver of the confused elderly wants to know – how can I help you understand more?
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com
Posted on March 12, 2010 - by Nurse Virginia
FAMILY MEMBERS OBSERVATIONS NOT ALWAYS WELCOMED BY NURSING HOME STAFF
Family members aren’t always the recognized authorities on their loved one’s condition. Yet they are an invaluable resource for the nursing staff. Family and friends have that one-on-one time, usually for hours, that the facility staff isn’t able to provide. The best time for the staff to catch a change in condition is when they assist an elder to get up for the day or help her get into bed.
However, that is when problems occur because the staff member may:
Not be the usual caregiver
Be a caregiver who’s not perceptive
Be the caregiver who sees a change but assumes that “everyone already knows”
Be someone with poor communication skills
Be a new nursing assistant or one with little experience
Such a situation places responsibility on the front-line workers who have the least amount of education. Such workers may think of their job primarily in terms of the tasks they have to accomplish. When asked, they usually have the information, but didn’t realize they needed to pass it on to the nurse.
That isn’t an uncommon problem, and questions naturally arise. For what should the family watch and listen? What is the most effective way to communicate observations without seeming confrontational or judgmental?
Book excerpt from: Please Get To Know Me – Aging with Dignity and Relevance
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com
Posted on March 10, 2010 - by Nurse Virginia
WHEN CLUTTER/HOARDING CREATES A UNSAFE ENVIRONMENT FOR THE ELDER
Part 2 of 2
What about the elder who has lived with clutter for decades?
Sally came to us late one September evening, straight from what the police called her “Collyer Mansion.” (Collyer brothers, famous for hoarding, died March 1947 in their home in Manhattan.) Sally’s hair was matted, she and her clothes were well past –dirty. She was in her early eighties and clutching a pocket book. We soon found out the pocket book held personal papers and bank books. As well as some raw hamburger that appeared to have been in her pocket book for some time.
Sally moved in with a large number of boxes that she had refused to part with; a live mouse was residing in one of them. Sally immediately began “collecting” in the nursing facility. As she was cruising around the facility picking up newspapers, paper clips, magazines, anything lying around – the facility housekeeping staff was retrieving from her room the “collection” from the previous day. It was very important to keep up with Sally on a daily basis. Many times Sally could be found hanging around the employee exit because of her need to get out to the facility dumpster.
Is it a housekeeping issue or is it really a hoarding behavior? The elder who hoards, is not the elder who just has housekeeping problems, many times brought about because of a health condition making it difficult for them to perform the necessary cleaning routines. As with Sally, when someone addresses the housekeeping issues for them, as the facility did. The behavior continues, despite all attempts to change it.
The hoarder is not someone who is so indecisive that they can’t make that decision to throw something away. It is not the person who procrastinates and avoids thinking about the items that are stacking up. The hoarder intentionally “collects” things.
What do people hoard?
Research tells us that of the ten people who hoard, two of those are hoarding animals.
Gift bags, boxes, containers, things that they tell themselves they might need in the future and regret if they got rid of
Things they might want to keep in sight for when they will need them – so nothing is ever put away – or is given “it’s place”
Things that they may tell themselves are rare or one of a kind and must be saved
The most common things for people to hoard are paper, bags, rubber bands, paper clips, food, clothing
Characteristics of the hoarder:
· will resist all offers or attempts at assistance in disposing of saved items
· May voice the opinion that hoarded items are of great value
· Elder is living in small space – living area overtaken by clutter
· Many times all that is available to the hoarder is a small path through the clutter causing very hazardous conditions (this week a friend confided to me that her mother is a hoarder and tripped in her home breaking her ankle on the clutter – resulting in multiple future surgeries)
· Hoarders of animals will verbalize their delusion, that the animals are beloved pets that they can’t part with, (many times when the pet dies they continue to keep the dead animal) they fail to see that they are not providing good care for the animals
A team approach is necessary to assist a true hoarder, consisting of:
· Landlord if applicable.
· Legal representative
· Representative from Social Services
· Mental health professional
· Someone may be present from the County Building and Zoning Office as well as Fire and Safety if the property has been reported to them
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com
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