Archive for July, 2010
Posted on July 29, 2010 - by Nurse Virginia
HOW THE NURSING HOME TAKES CARE OF THE ELDER WITH PARKINSON’S DISEASE
(PART I)
Parkinson’s medications
Medications for Parkinson’s disease need to be given on time. In the nursing profession, State guidelines give the nurse a leeway, of one hour before – to – one hour after the time of a scheduled medication, for it to be given. So a medication that is ordered for 9am may be given as early as 8am or as late as 10am and still be considered “on time.” But not so with a medication for neurological functions, such as a Parkinson’s medication. In order for that person to function at their highest level they need to have a continuous delivery of the medication. Blood levels rise and fall after every dose of the medication. The goal is to have the most constant level in the blood of the medication.
When the elderly person with Parkinson’s disease depends so immensely on their medication in order to move and function. That “need” may create anxiety in the elder, if they don’t feel they can depend on always getting that medication on time. Giving the person constant reassurance through verbalizing your understanding of this importance will be helpful. Saying, “It is 5 o’clock, here is your 5 o’clock medication for your Parkinson’s disease,” will help reinforce that the elder is getting their medication on time.
For the elder with Parkinson’s disease, after taking medication for many years, while their disease progresses, the medication will not be as effective. To have a clear report on symptoms for the physician, you do not want to have any issues or statements about medication timing side track the discussion. Such as, “I know I would be much better if she just gave me my pills on time.” Giving the elder that clarity during every dose of medication, helps keep the focus on the change or deterioration of condition, instead of it being someone’s fault.
This small effort can provide the elder the comfort of being able to count on having this important medication, in a timely way. It would be difficult to calculate how much anxiety can impact a person’s function. But for the person with a neurological disorder it certainly becomes important to give that extra bit of reassurance, that indeed the caregiver is doing everything right.
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 July 26, 2010 - by Nurse Virginia
WHEN THE ELDERLY PARENT SHOULD NO LONGER DRIVE – TAKING AWAY THE CAR KEYS
(Part III)
No matter how difficult the conversation, when it is the family who observes the changes in the elder’s ability to drive, it becomes the family’s responsibility to face the situation. Waiting for the State to pass a law mandating regular testing of elders is not an option. Not when the family knows the elder should no longer be granted the privilege of driving a car. A very effective way is to gather people who are significant and considered credible by the elder. This could be family members, friends, clergy, physicians, any one who has a close relationship to the elder and is valued by the.
Holding a family intervention.
- Set the rules for the intervention – if someone in the group doesn’t know when to let someone else talk – set time limits
- Give facts about the elder’s driving – Identify driving behaviors that members of the family have witnessed:
- Crossing over the lane lines
- Going off the road
- Getting lost going to a familiar place
- Other drivers honking at the elder
- Asking passengers to read signs
- Not yielding to other cars
- All driving behaviors that are contrary to “Rules of the Road” conduct.
(See part II of this series for bad driving behaviors)
- Don’t become distracted with other issues – stick to the subject of driving
- Give driving facts:
- In accidents that involve an elderly driver – the elder is most likely to be injured
- Describe how the elder’s life would change following an injury; pain, disability and increased dependence
- How upset the elder would be if their actions driving would cause injury to someone else, especially a child
- Offer solutions:
- Identify who will now take the elder to; doctor, dentist, pharmacy, barber/beauty parlor, dry cleaner, Church, clubs, hardware store, grocery, visit friends, etc.
- Avoid saying things like “Someone from the Church will be glad to come and get you,” or “I’m sure we will all help out driving you.” These statements are way to general – this situation calls for specifics, so the elder does not worry.
- If appropriate – suggest the elder take a driver’s course developed just for seniors.
- If appropriate – suggest an eye exam and have the elder’s physician check reflexes.
- If the problem might be the car – suggest someone take a good look at the car – is it easy to drive, are the controls easy to use, does the elder have a good field of vision when sitting in the car.
- Re-state what everyone learned in this intervention and most important what everyone promised to do including the elder.
If the elder will not cooperate with a family intervention or discussion of the driving issue – a last resort can always be to disable the car – especially in the case of a very confused elder who is dangerous on the road.
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 July 22, 2010 - by Nurse Virginia
WHEN THE ELDERLY SHOULD NO LONGER DRIVE, HOW TO TAKE AWAY THE CAR KEYS
(Part II)
As people age they start to change their driving habits. The elderly start driving slower, drive during daylight hours while most people are working, and try to avoid left hand turns and crossing traffic. (Even so statistics tell us that 28% of accidents involving elderly drivers were due to left-hand turns) Taking these self imposed adjustments into consideration, when you study statistics it is surprising that there is such a high amount of accidents involving the elderly.
The reported statistics could also be skewed by the under reporting of accidents by the elderly. One need only drive around an area like Boca Raton, Florida, to see the many fender benders on cars driven by an elderly person, that haven’t been fixed. Crash statistics are generated from reports by the DMV as well as insurance companies. Many people can attest to the elderly person who has hit their car and begged them not to report it, so it won’t go against the elder’s insurance. And, the elder who decided to pay for the damage on the other person’s car then forgoes having their own car fixed.
Added to this is the fact that when the elderly driver is in an accident they are three times more likely to be the one hit, then the one to hit someone else. This of course due to incorrect turns, changing lanes inappropriately or just weaving back and forth in their own lane, slow reflexes and generally doing something unsafe in front of another moving auto, causing the elder to be hit.
Why is it so difficult for family members to stop their elder from driving? Giving up the privilege of driving represents a very hurtful change for both the elder as well as the family. No one wants to see their parent get old. This is the person who taught you to drive and probably helped you buy your first car.
I read recently where a woman said of her father-in-law. “My father-in-law can hardly walk, has trouble following a conversation, falls asleep at the drop of a hat, has serious reaction time issues and yet he is still driving. Frankly I am afraid he is going to kill himself or someone else.” But as she continues, she seems to be looking to the government to step in with some regulations that will stop him from driving. Some kind of new law mandating driving tests for the elderly. Who should bear this responsibility?
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegetoknowme.com
Posted on July 21, 2010 - by Nurse Virginia
WHEN THE ELDERLY PARENT SHOULD NO LONGER DRIVE, HOW TO TAKE AWAY THE CAR KEYS
(Part I)
A friend came up to me recently and said her father had failed his drivers test and was so angry. He was now refusing to stop driving, what should they do? Family members have such a difficult time telling their parent they should no longer drive. Driving is such an emotionally charged subject. This is the person who taught you to drive and now you are telling them they are unsafe.
When my Dad needed to stop driving we knew. He had gone into a ditch that winter while driving after dark. When you rode with him as a passenger, you were aware that other drivers were honking their horns at him, and you assumed he wasn’t staying in his lane. We asked his physician to intervene and he notified the state. Dad was then notified of a need to take a driver’s test. Even though I got him a copy of “Rules of The Road” that he studied, and then I tested him on those “rules” every Sunday when I visited. When the fateful day came Dad, failed the test.
(Book excerpt)
When Dad went through his journey with Alzheimer’s disease, we started where most families start-the awareness that Dad was no longer safe to drive his car. “How can we get him off the road?’ we asked each other.
Mother had already had a stroke and lived in a nursing community. The plan was to move her to a place where Dad could also have an apartment and no longer had to drive. That plan worked out very well, and soon after the move we got rid of the car.
Dad recruited a little band of volunteers on whom he called when he needed transportation. Although the loss of his independence was a serious adjustment for him, he joked that it took a village to get him to church, the Bible class that he still taught at another nursing community, his barber, the grocery store, and the doctor. Dad wasn’t shy about asking for help. (After his death, those volunteers introduced themselves to us at the funeral as Dad’s drivers. Each told us how much he or she had enjoyed the time spent with him.)
(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 July 19, 2010 - by Nurse Virginia
HOW TO TAKE CARE OF THE ELDERLY PERSON’S SKIN THE WAY THE NURSING HOME NURSE WOULD-AND PREVENT WOUNDS
Nurses know when the elderly person no longer moves independently, they will need to be extra vigilant in their skin care.
Nurses know:
- Preventing wounds is much easier than healing them
- An elderly person can develop a pressure wound in 2-6 hours of not changing position
- A pressure wound is painful
- Healing a pressure wound is costly
- Pressure wounds can develop anywhere there is a bone under the skin – elbows, heels, hips, buttocks and even the face if the elder has been lying in the same position for a very long time on their face
- Moisture makes the skin breakdown faster
- Chair positioning is as important as positioning an elder in bed – slouching in a chair can cause wounds on the spine and the elbow
- If the elder is sitting in a wheelchair for long periods of time, a well made cushion not only will provide better weight distribution, sitting balance and pressure redistribution but also provide a more stable surface for the elder to sit on and prevent the “sling-seat” so common in wheelchairs.
Things to look for in the products you choose:
- Is the fabric soft?
- Is the fabric one that will wick moisture away from the skin- such as cotton – and not an airtight fabric that will create moisture?
- Is the fabric or product washable (very important for infection control)?
- Does the product come with a gel insert?
- If preventing skin breakdown on the elder’s heel – does the product provide for an air cavity under the heel as if floating?
- If the elder is incontinent of urine or stool – choose an incontinent product that wicks away the moisture from the elder’s skin
An investment in pressure relieving products is an investment in pain prevention, saves time and money.
Virginia Garberding, R.N.
Director of Education, The Wilshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on July 15, 2010 - by Nurse Virginia
VERBAL ABUSE – WHEN THE FAMILY MEMBER RAISES THEIR VOICE TO AN ELDER
“If you decide to become a zombie, that’s going to be up to you. Go ahead and sit in your room watching court TV all day, that’s on your head.”
“You can’t take care of anything. How old is the oldest chicken in your refrigerator? Nothing in there has a date on it.”
“You don’t need any money. What do you need any money for? Poof, it’s gone, now you don’t have to talk about it anymore.”
“I make all the decisions for you now, stop asking me the same question all the time.”
These statements were all made in anger to an elderly parent, when the child couldn’t take it anymore. Taking care of an elderly parent is certainly not for the faint of heart. It takes so much patience and understanding to answer the same question over and over. Sometimes it takes an outsider to identify for the family that the way they are talking to the elder is abusive.
The first time something inappropriate is said in anger, the child feels just terrible. However as with so many things that are shocking the first time you hear it. After that first time it becomes easier and easier to vent your frustration verbally at the elder. It’s not only the angry words that are said, it also can be:
- Tone of voice
- Volume of speech
- Body language
When words like “don’t”, “stop”, “no” or “can’t” are said with a negative tone and body language showing disgust, anger, or impatience, it is abusive. It is abusive, when the elder is made to feel like a naughty child that is being scolded. The elder then begins to feel even more fragile, needy and dysfunctional.
A clear sign that the elder may be suffering from verbal abuse is when an elderly person seems to be hesitant to talk openly. Especially, if the caregiver is present and the elder is able to respond but seems fearful to do so.
The elderly still need to be asked their opinion, make some decisions, and be able to voice their concerns.
If you would never stand by and listen to someone berate a child, you realize the need to step in when someone is talking inappropriately to the elderly.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on July 14, 2010 - by Nurse Virginia
WHEN THE ELDER IS SO ANXIOUS THEY JUST CAN’T STOP WORRYING
“Your Mother has been waiting for you; she needs to talk to you right away.” Said the nursing assistant, when she saw May’s daughter walk into the nursing home. When the daughter arrived at her mother’s room there was the church lady visiting as usual. “Oh good, your Mother has been waiting to talk to you, she thinks they want her to leave,” said the church lady, who left soon after the daughter’s arrival.
May told her daughter her whole story about “someone” telling her “you can leave whenever you want to.” May said she doesn’t have anywhere to go, she needs to get her things together, she needs her pictures off the walls and someone is going to have to arrange for a new apartment.
May’s daughter tried to reassure and then to reassure again, but it wasn’t taking, the subject kept coming up. The daughter called for the nurse, and asked that May’s medical chart be checked to see if there was any plan for her to move. The nurse returned with the reassuring report that everything is good and “No, there are no plans for you to move.”
Yet after the nurse left, May showed her concern on her face with a wrinkled brow and the question “Where should I go?”
It is not uncommon for the elderly to be very anxious when in a nursing home. Their concern usually involves “who is going to pay for this?” Especially during meal time if the staff puts the meal ticket on the table. The elder will think the dining room is a restaurant and the meal ticket is the check. And they don’t have the money to pay, so they just don’t eat.
For the elderly with Alzheimer’s disease anxiety can be created by the environment, negative caregiving (being repeatedly corrected and argued with), the frustration of forgetting how to do something and so many other situations that are no long understood. For the elder with Alzheimer’s disease, the distress will be felt long after the situation that caused it is forgotten.
I am not a proponent of using a drug instead of an explanation, diversion or distraction being tried first. But when the elder is truly worried, anxious, concerned and upset. Sometimes it is a great comfort that we have a drug like Xanax that can take that worry away.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on July 12, 2010 - by Nurse Virginia
WHEN THE CONFUSED ELDER HAS TO GO TO THE HOSPITAL
“We sent your Mom to the hospital this morning for tests” said the nurse on the phone. “We tried to get in touch with you.” Oh no, no time to talk, I had better get going. On the way to the hospital I couldn’t help thinking about the last admission, and how that went.
Last hospital admission.
Mom went to the closest hospital, which had many systems in place that just didn’t work for my Mom. Mom had a stroke several years ago, which had left her left arm without any function. Yet there Mom was in the hospital bed, with the bedside table on her left side. It was supper time, yet there was no tray on the bedside table.
I read the “Welcome” packet on the bedside table which gave the hospital directions for using the phone to call the kitchen, and order your meals. You needed to call for each meal and place an order. Mom wasn’t able to reach the phone, or use it independently. I went out to the nurse’s station and asked if anyone had ordered a tray for my Mom. No, no one had. I asked if anyone had removed any trays from her room, again no one had. I phoned down to the kitchen and asked if my Mom, who had arrived around eight that morning had received any food. It was now 6pm and there was no record of her eating or drinking anything, and no one had noticed.
I then asked if she had gone to the bathroom and was told that she hadn’t called. Once again the nurse’s call light was built into the side rail of the bed on her left side, which she couldn’t use. So she had soiled herself in the bed and was just waiting for someone to come along.
Confused elderly in the hospital
The best possible solution for the confused elderly in the hospital is to have a family support team that takes turns staying with the elder. Mom knew she was in the hospital; she wouldn’t be able to tell anyone the name of the hospital. But she was totally unable to find out for herself how to function in this setting. She needed some one to speak for her and answer any questions about her history. She needed someone to explain to her what tests they were doing and why. And ok, maybe several times. She needed someone to get her things that she didn’t want to “bother anyone” for. Maybe a box of tissue, please put on the TV, close the curtains, and adjust the temperature. And maybe just keep her company. I remember those times well, keeping either my Mom or my Dad “company” when they were in the hospital. Not a bad way to spend your time.
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 July 8, 2010 - by Nurse Virginia
SIGNS AND SYMPTOMS OF HEAT STROKE IN THE ELDERLY
Heat stroke is a medical emergency. Often the problem is that elderly people don’t want to be a problem and so they don’t want someone called. They will say they will be just fine even when they are feeling very poorly. The old movies had it right when we saw someone collapse and then a bystander went to get a cool cloth, gave a cool drink, and fanned the person to give them air circulation. They were really doing the right thing.
Signs and symptoms of heat stroke:
- Fast heart beat
- Fast / shallow breathing
- Hot dry skin – (can be cold clammy skin if the person is going into shock)
- Confusion – altered mental state
Elderly at risk for heat stroke:
- Elderly who are socially isolated
- Elderly on diuretics
- Elderly with decreased ability to sweat (diagnosis of hypothyroidism, on a stimulant or one of the many medications that contribute to dehydration by altering salt to water balance)
- Elderly who drink alcohol in warm or hot weather – alcohol is a diuretic
- Elderly who are obese
- Confused Elderly
- Elderly without air-conditioning
- Elder in large crowds where there is little air circulation
Ways to reduce incident of heat stroke:
- Reduce physical activity in hot or humid weather
- Stay well hydrated
- Do outdoor activities during cool time of day
Elderly least likely to develop heat stroke:
- Elderly who are well hydrated – the color of a person’s urine should be light yellow – dark urine is a sign of dehydration
- Elderly who has the ability to sweat
- Elderly who has a good social network
- Elderly who have access to air conditioning
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 July 6, 2010 - by Nurse Virginia
HOW TO BRUSH THE ELDERLY CONFUSED PERSON’S TEETH
As with all care issues for a person with Alzheimer’s disease or any confusion, the most important step is to have all of your equipment together before you begin.
Steps for brushing a confused elder’s teeth:
- Set out all supplies: toothpaste, glass, toothbrush and towel. (many times the best toothbrush for a person with dementia will be a children’s toothbrush, especially if they are not willing to open their mouth wide enough for an adult size brush – for the elder who is no longer able to rinse their mouth and spit out the toothpaste, the best toothpaste will be a children’s toothpaste – adult toothpaste is not made to be swallowed – and can be harmful)
- Have elder wash and dry hands.
- Have elder pick up toothbrush with the hand they normally use and hold the brush for a few seconds to get the feel of it.
- Instruct/guide elder to put toothpaste on brush, if necessary put your hand over their hand to assist them in doing this.
- Instruct/guide elder using same, your hand-over-their hand technique to bring brush to their mouth.
- Instruct/guide elder to brush gums and teeth, help the elder start brushing with your hand over theirs if needed.
- Encourage elder to spit out toothpaste. (if you need to sip some water yourself and demonstrate – this might be helpful)
- Instruct/guide elder to rinse toothbrush and replace in holder.
- Instruct/guide elder to pick up glass and bring to mouth.
- Instruct elder to rinse mouth and spit, as well as they are able – once again- if unable to rinse and spit out toothpaste a better alternative would be to use a children’s toothpaste.
- Instruct elder to pick up towel and wipe face as necessary
It is important for everyone to brush their teeth in the morning and evening. For the elderly with Alzheimer’s disease, an added benefit to brushing in the evening is that it can ensure the elder doesn’t go to bed with any food left in their mouth. This could present a choking hazard when lying down?
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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