Archive for April, 2010
Posted on April 29, 2010 - by Nurse Virginia
THE MIND, THE BRAIN AND ALZHEIEMER’S DISEASE
Brain cells need a constant supply of glucose to live
Brain cells live on oxygen and glucose supplied by the bloodstream. Cut these off and the cell dies. (Stroke) The supply of glucose has to be constant because even when the individual is sleeping, those cells keep working and need food. Brain cells use twice the amount of energy than other cells use. A healthy person has few problems providing this delivery of glucose. Stress and a high level of focus and concentration will easily deplete levels of glucose. Even a young college student can attest to the fact that intense concentration takes a lot of energy and is tiring.
Persons living with Alzheimer’s disease are always trying to understand their environment, understand what people are saying to them and trying to fit in. This mental stress also requires a large amount of energy available to brain cells.
The key to feeding brain cells is eating foods that give a constant flow of glucose. A quick surge of high sugar foods or beverages produce the opposite effect. They may make the individual feel very alert but when insulin kicks in to compensate for the sugar surge. Insulin brings the glucose down starving the brain cells. Diabetes is very hard on brain cells due to the constant high and lows of blood sugar that eventually take their toll.
The Mediterranean diet is strongly encouraged for heart health. For the brain those complex carbs from large amounts of vegetables and whole grains combined with healthy fat obtained from oil, create a constant flow of safe glucose to the brain as well as the heart, avoiding those highs and lows.
(A “Glycemic Index” can be easily found on line, to find the foods that will regulate blood sugar as well as those that will more easily cause sugar surges)
Brain cell need challenges and stimulation to grow new branches
Brain cells (or neurons) look like little trees; they have branches at one end of the cell, called dendrites. When a baby is born they have all their brain cells, but few “branches” or connections. As the baby learns, they grow more and more branches. It is through these branches that the cells talk to each other. A person with Alzheimer’s disease is losing those branches, and those cells have a harder and harder time talking or connecting to each other. The individual with Alzheimer’s goes through this disease process of dying brain cells. In the late stage of the disease, their brain cells will resemble a very young baby’s who is just starting to grow connections.
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 April 26, 2010 - by Nurse Virginia
THE MIND, THE BRAIN AND ALZHEIMER’S DISEASE
(Part I)
The brain, three pounds of tissue
It is at times hard for people to see that when a person is losing their mind as in Alzheimer’s disease, this is really a case of dying tissue in the brain. The cells of the brain are called neurons and we have about 100 billion of them. Those neurons use about 20% of our oxygen coming from our circulatory system. This is where the saying comes from, “What is good for the heart is good for the brain.”
When a person does a cardiovascular exercise they are bringing more oxygen to their brain. The best cardio exercise is dancing because it combines the cardio with thinking. A cardio exercise like walking on a treadmill doesn’t have that extra element of thought. But taking a walk outdoors combines exercise, fresh air and enjoyment and thought while enjoying the scenery. All the while bringing more oxygen to the brain.
The reptilian brain – the brain stem
At the base of the scull, where the brain is connected to the spinal cord you find the brain stem. It is referred to as the reptilian brain because that is all a reptile has. The brain stem regulates all the automatic functions of the body. Breathing, maintaining body temperature, heartbeat, sweating, consciousness, all the functions needed for basic survival.
The brain stem is not attacked by Alzheimer’s disease until the very advanced stage. This is very important for a family to know. If the family chooses to put a feeding tube in their loved one when they can no longer eat and swallow safely. The family needs to understand that the ability to digest will continue and therefore the person could live much longer. In the person with advanced Alzheimer’s disease they could have only these automatic responses functioning and continue to live for sometime.
The cerebellum – balance, coordination and movement
The cerebellum looks like a large bulge just above the spinal cord. This area also is not greatly affected by Alzheimer’s disease until the very late stages. Because it is responsible for balance, adjusting your posture and coordination, it is very important in walking. Many people are put into wheelchairs not because they no longer walk, but because they have reached a time when they no longer walk with awareness. The person with late stage Alzheimer’s disease, who retains the physical ability to walk, will walk without a sense of destination, purpose, direction or safety awareness.
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 April 22, 2010 - by Nurse Virginia
TELLING THE GRANDCHILD THAT THE ELDER HAS ALZHEIMER’S DISEASE
Grandma doesn’t seem to know me anymore, and why is she calling me by my Mom’s name? Grandpa just told that story, oh no, is he starting it again? Why does Grandpa keep saying he is going to the microwave to have his back checked out?
When the elderly person with Alzheimer’s disease acts in unusual ways
For so many years no one really knew what to call this memory loss, much less how to explain the changes in Grandma to the Grandchild. But now we know and depending on the age of the child, need to explain at an age appropriate level.
Children sense the anxiety of those around them. As the elder with Alzheimer’s disease changes and the family discusses the changing symptoms, it may be distressing for a child. Many times a child will think they are in some way responsible when there is unhappiness in the family. Talking it out, on the child’s level of understanding is so important.
The fear for young children – can they “catch” it
Explaining to children that Grandma is acting in a different way because she has a disease, requires clarification that this is a disease when you get old and they can’t catch. If the child’s knowledge of illness includes that they need to cover their mouth when they cough, wash their hands often because of getting colds, etc. Then they need to know that unlike the flu or a cold, this disease can’t be passed from one person to another. And most of all they won’t catch it.
The problem for children is the same as for adults; you can’t see Alzheimer’s disease. When a person has a cast on or is using a walker or wheelchair, it is something that can be seen. Often the person with Alzheimer’s disease looks so good, they just act different.
The fear for the older child – that their parent might have it
It is important to reassure older children that the person they depend on, is just fine. The older child may feel some anger that things have changed. Especially if the confused elder lives with them, in the family home. If the teenager is asked at times to “Keep an eye on Grandma.” They could well start to resent the changes in their lives.
The older child may be is grieving the loss of the Grandparent, they remember so well. They may have feelings of embarrassment at how Grandpa now acts. Whatever the problem, you can only know if you ask.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Wwww.pleasegettoknowme.com
Posted on April 21, 2010 - by Nurse Virginia
ELDERLY WITH MEMORY LOSS NEED CAREGIVER WITH SENSE OF HUMOR
No one could remember what they ordered and the waitress was getting impatient
They were five for lunch, four elderly ladies with significant memory loss and their caregiver. The caregiver read the menu and ordering went just fine. Chicken salad, BLT sandwich with fries a cheeseburger, all the usual lunch at the diner orders. The problem came when the waitress returned with the order and said “Who ordered the BLT with fries,” and no one remembered.
At first there was an awkward moment while the group was feeling some pressure from the waitress to claim their meals. Then the caregiver started to giggle and pretty soon all the ladies were giggling and then laughing out loud. A moment that could have been difficult, hurtful and embarrassing was not only averted, but turned into a comfortable bonding moment for the group. Even the ladies who did not realize what the “joke” was, could join in the laughter of the group at the table.
The significant person in this scenario was the thoughtful and aware caregiver. The giggle was the cue to the ladies that, we aren’t going to take this too seriously. The giggle said to the ladies “No harm done, if this is the worst thing that happens today, what a great day.” And all the ladies were looking to the caregiver for many cues that day in the diner. Cues can come in the form of smiling while you engage in pleasant table conversation. Cues can be related to dining and the right utensils to use and where to put your napkin. But the cue the elder with memory loss needs the most, is how to react when something goes wrong.
Laughter is said to be a great “self-care tool” for caregivers
The role of caregiver is so difficult that a caregiver with a great sense of humor will be less stressed by the little things. Laughter can fight off the effects of stress and create a more positive attitude towards life. As an unknown author once said:
“To understand a man you should walk a mile in his shoes. If what he says still bothers you that’s ok because you’ll be a mile away from him and you’ll have his shoes.”
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on April 20, 2010 - by Nurse Virginia
PAST HISTORY OF FALLS WILL PREDICT FUTURE FALLS WHEN ELDERLY REFUSE TO BE ACTIVE
(Part III)
When an elderly person falls it creates fear in the elder, resulting in a decrease in activity. Just the opposite should be the reaction. The elder should instead do more; get out more and joining exercise groups that focus on strength and balance.
Everyone wants a magic pill – the magic pill just might be exercise
It might not come in an easy to swallow capsule, and might require self-discipline and effort. But the benefits of exercise can seem like magic for the elderly. How does reduced risk of heart disease, lower blood pressure, reduce risk of osteoporosis, better sleep, and reduced risk of falls and injury sound? These are all documented benefits of exercise in the elderly. And it doesn’t seem to matter how old you are when you start. Every one, no matter what age can improve their strength and endurance through exercise.
There are so many opportunities for the elderly to join exercise classes at their Church, local Senior Center, Health and Fitness Centers even some Libraries offer programs. Balance programs combined with strengthening are the best. For the person that wants or needs to exercise at home, The National Institute on Aging offers some great exercises for balance and increased strength.
Go to: www.nia.nih.gov/healthinformation/publications/exerciseguide/chapter04.htm
A Prescription for exercise
For the elder who needs a little extra convincing that exercise would be good for them and help them reduce the incident of falls. It will help to have the physician write a “prescription” on a regular prescription pad. A prescription for walking could be – Take a walk every day for 20 minutes, seven days a week.
Trip to Nursing Home a blessing in disguise
When the elder has a fall that sends them to a Nursing Home to recover, this is an opportunity for the elder to have evaluations and assessments done.
See Blog: July 28, 2009 – Caregiver Tips: When Seniors come into the Nursing Home, get better and go Home
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 April 16, 2010 - by Nurse Virginia
FALLS IN THE ELDERLY ARE PREDICTABLE EVENTS – RELATED TO FEAR OF FALLING
Fear is your enemy, not the floor
Fear of falling can keep you from thinking clearly. Fear of falling can cause you to over react to a slight difficulty, stiffen your body and lose your balance. Fear of falling can make you walk in an un-natural way, more hesitant and irregular. Fear of falling can make you walk contantly looking at the floor and shuffling your feet.
Fear of falling can make you tighten your muscles and joints and make contact with the floor ever so much more jarring.
Falling could be embarassing – fear of making a scene
Falling may mean injury,making a scene in public, being on the floor and unable to get up. Falling in public could require someone helping you up and then they getting hurt themselves. Elderly people are very concerned about causing problems or difficulties for others.
Fear of falling causes an elderly person to restrict their activities
Betty is a 83 year old woman with diabetes, she fell outside six months ago and and she has subsequently fallen multiple times since. Betty has restricted her outside activities because of her fear of falling.
Since becomeing housebound Betty has developed muscle weakness from disuse. Due to Bett’s muscle weakness she has now begun falling from the toilet and she is becoming depressed.
Fear of falling usually leads to decline in function and strength
Living with fearfulness causes feelings of dissatisfaction with life, a depressed mood and increased frailty. As the elder experiences decreased mobility and participates in fewer social events they become more frail. Diminished agility, muscle strength and balance often contribute to more falls and related injuries.
Increase activity not decrease (Part III of Predictable Falling)
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 April 15, 2010 - by Nurse Virginia
FALLS IN THE ELDERLY ARE PREDICTABLE EVENTS RELATED TO RISK FACTORS – PERSONAL AND ENVIRONMENTAL
(PART I )
Environmental Factors
“Mom fractured her ankle in three places.”
“I didn’t know your mother was still living,” I replied to my friend. “You never mention her.”
“Well, we don’t go to see her very often,” she replied. “Why is that?” I asked.
“Because there is no place for us to sit” she said.
Now I understood, Mom was a hoarder and fell over her clutter and fractured her ankle. Yes, that’s what it was. Mom was in her early 70’s and this could have been a predicted fall because of the cluttered environment she lived in.
Personal Factors
Marge is 80 years young, lives alone and still drives. She has decreased ability to focus her eyes due to aging. It is a bright sunny day and Marge drives herself to the grocery where she walks into the store and immediately falls. With age it takes eyes longer to re-focus to different levels of light. Most falls in stores are at the entrance due in part to wet surfaces, change in surfaces. (Environmental factors) But many times due to personal factors and the reduced ability for elderly eyes to adjust to different levels of light. (The elderly shopper can easily fix this by grabbing a shopping cart when they park and pushing it into the store with them. This way they have something to hold onto.)
History of Falls
In 1900 the average life expectancy was 49 years. At that time people were dying from infectious diseases; TB, pneumonia, influenza etc. Advances in public health, with improved sanitation, antibiotics, and vaccines increased the age expectancy to 68 yrs by the 1940’s.
Now that there was an older population, there also was an increase in falls. Over the years since then, the thinking regarding the cause of falls in the elderly has changed.
Previous thinking on the cause of falls in the elderly:
- The first thinking was “this is an act of God” a chance event with no explanation
- That turned into “Falls are purely accidental” it happened to you, so you had some bad luck.
- Then, its “normal” to fall,” look at your age, what can you expect?”
- Falls are a matter of personal negligence – “You should have been more careful.”
Falls Today
Now falls are no longer considered normal or just part of aging. They are considered to be predictable events related to environmental and personal factors.
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 April 12, 2010 - by Nurse Virginia
A “LIVING WILL” IS FOR THE LIVING
(Part III)
Dad handed out copies of his “Living Will” almost twenty years before we needed it. When he wrote it he didn’t know someday he would have early signs of Alzheimer’s disease. He didn’t know someday he would be living in a senior retirement community. He didn’t know one day he would stroke, and it would be just a week before he would have turned 87.
What Dad did know was:
- he didn’t want a feeding tube or any artificial or invasive form of nutrition or hydration
- he didn’t want kidney dialysis
- he didn’t want to be put on a respirator
- he didn’t want CPR
- he didn’t want treatment that would only prolong his dying
While a Living Will gives clear directives (Advance Directives) as to thinking and wishes of the writer, it never means – do not do everything to keep me comfortable and as pain free as possible. The Living Will was created in 1969 and is the oldest form of Advance Directives.
One of the benefits is that writing a Living Will starts the conversation. This can lead to the choosing of a Health Care Power of Attorney to oversee health care directives. Having a DNR ( Do Not Resuscitate form) in place, all of these things that people put off, but are better done when the individual is of sound mind.
So many times families have a difficult time coming to terms even when death is imminent. Our current President announced at an AARP meeting last summer that he and his wife both have “Living Wills.” Not so surprising since they frequently share the fact that they are people of faith. They live the meaning of
1 John 3:13 Do not love the world or anything in the world ….. (Don’t get too attached to this world or your things, that you are afraid to die)
The Living Will comes in all sizes and shapes. From the simple form that some one can easily downloaded from the internet, to long and lengthy documents full of legal jargon. The important thing is to start the conversation so everyone in the family knows the individuals wishes.
DNR forms and bracelets are also easily available on the internet with the guidelines, from individual States and countries.
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 April 9, 2010 - by Nurse Virginia
DNR – COMATOSE – THEY CALL IT A VEGETATVE STATE
(Part II)
Her skin was still quite lovely, and why shouldn’t it be, Carolyn wasn’t yet 50. Yet she had been our resident for the last four years. Carolyn had been out boating with her family, that day four years ago.They told us Carolyn was out of the boat swimming when another boat hit her, causing her brain damage.
The nursing staff now took care of her every physical need. She had a feeding tube in her stomach, with feeding running slowly 24/7. We washed her hair, her body, brushed her teeth, dressed her and cleaned her when she was incontinent. With never any sign of awareness from Carolyn. We got to know her, or the her that she now was, but she never got to know us.
Carlyn had a busy growing family, her children now teenagers. Carolyn’s husband and children didn’t come so much anymore but her mother came regularly. Carolyn’s Mom felt strongly that her daughter was still there, even though any number of Psycologists were called in, who told her otherwise. They studied her for hours, the conclusion always was the same, there was no discernable pattern to the blinking of her eye lids. She wasn’t answering “yes” or “no” as her mother thought she was.
WHEN EVERYONE IS IN SHOCK
The worst time for the family, is right after an accident. Everyone is in shock as the medical community starts sharing all the wonderful things that now can be done. The technology to prolong life under the most dire of cirumstance is still very new. No one volunteers to take the family to see someone in a nursing home, who had the same prognosis.
I still remember the doctor words following my Dad’s major stroke. He spoke very clearly of the negative prognosis, no hope, will never regain consiousness, brain dead.
Then the doctor asked the most unbelievable question “Do you want a feeding tube?”
“No, absolutely not, no.” We all were in agreement, because we knew Dad’s wishes.
Most of all we knew – once you put in a feeding tube and start the feeding, it is very difficult to have it stopped. Studies say that we now have about 30,000 people alive and comatose, living in a permanently vegetative condition. I know I have seen and cared for more that my share of these tragic individuals.
Studies also tell us that almost 95% of people polled would refuse aggressive medical interventions if they expected such a poor outcome.
(Part III – THE “LIVING WILL” IS FOR THE LIVING)
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 April 7, 2010 - by Nurse Virginia
DNR – DO NOT RESUCIUTATE – CAN GIVE THE ELDER DEATH WITH DIGNITY
(Part I)
Earl had been such a dignified and respected man in life. Now in death, he lay there in the middle of the living room floor in his old man sleeveless undershirt and diaper. While three young healthy men worked to revive him. How could this happen?
He was ready for death, his family just wasn’t
Earl was in his upper eighties when he died. He had a caregiver for the last six years due to a severe respiratory condition. He lived 24 hours a day in an up right recliner, only leaving it to walk to the bathroom with his caregiver.
Earl was born on a farm in Iowa and was raised a devout Christian. In his old age he often spoke about being ready to die and be with Christ. The day he died he had told his caregiver “Don’t call my son until I am gone.” Somehow, on a day so much like all the others, Earl had known it was his last and he was ready.
His son and family had seen to his every need in his last years. Earl lived in a beautiful retirement community, in a two bedroom apartment where every window overlooked the lake. The caregiver had worked tirelessly keeping Earl clean, fed and happy.
But Earl’s family didn’t know about the retirement community’s policy to call the Para-medics when the resident didn’t have a DNR on file. And so even though everyone knew Earl’s wishes, a rescue team was called.
A Do Not Resuscitate order can give death with dignity
Earl wasn’t revived that day. But the time that was meant for just sitting together as a family and remembering Earl, was taken away. Instead, the time was spent in chaos, with strangers walking in and out of his apartment. Family members were pleading with these fine young men to stop their resuscitation efforts. Calls were made to Earl’s physician to make them stop. Earl never wanted it this way.
Virginia Garberding, R.N.
Director of Education. The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me- Aging with Dignity and Relevance
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