Archive for August, 2010
Posted on August 31, 2010 - by Nurse Virginia
HOW TO TALK TO THE ELDERLY CONFUSED PERSON WITH DELUSIONS
“It is getting harder and harder to visit. Mom keeps saying Dad divorced her.” the visiting daughter said to the nurse. No matter how much reassurance the daughter provided that Dad never would have divorced her, and that he has passed away and is now in heaven. The elderly mom keeps coming back to the same topic of “the divorce.”
Reoccurring false ideas that are unshakable in the confused elder may be delusions. It can become very frustrating to try to visit with a person who keeps repeating the same delusional thought.
Delusions in the elderly can be a way of explaining their life to themselves now. In this case the elderly woman’s husband had died several years ago. He had been very attentive and at her side ever since her stroke. Now mom is trying to make sense of his absence and her mind is trying to find an answer.
The daughter giving reassurances based on knowledge of her parents past, just doesn’t compete with the mother’s internal voice telling her this story that she believes is more probable. Because the mother has this fixed belief she finally tells the daughter “You always did take his side.” And so it ends, because mom isn’t going to let go of this fixed idea, and it is best just to change the subject.
The best response the daughter can have is to remain calm and not react dramatically to what is said. It isn’t always necessary to agree or disagree; sometimes it is just important to be there. If it is an ongoing thought or worry that could be checked out – offer to do so and get back to the elder.
If the daughter would become adamant and even angry stating that the mother is wrong and “it just isn’t so.” The mother would most likely shut down and not think it safe to confide in the daughter her worries and concerns.
This situation would not be considered a particularly bizarre delusion because it is not unusual for people to get divorced. A bizarre delusion would be an ongoing thought that couldn’t possibly have happened. A bizarre delusion could be that the elder, states that the President doesn’t like them, or that they are personally responsible for some large disaster. Some idea so impossible, that it enters the category of bizarre.
Any change in level of confusion or increase in confused thoughts needs to be reported to the elder’s physician. When visiting the best thing to do is offer reassurances by holding the elder’s hand, making eye contact, use a low soothing tone of voice and if able redirect the conversation to a safe topic.
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 August 26, 2010 - by Nurse Virginia
FOR THE ELDER WITH ALZHEIMER’S DISEASE, OR A DISABILITY – SMALL IMPROVMENTS CAN MAKE AN AMAZING DIFFERENCE
It was the end of a typical support group meeting for caregivers, when the speaker asked as always “Are there any questions?” And from the back of the room an elderly man said “Tell us some amazing stories, of someone who had your therapy.”
The truth is in healthcare many times the change or improvement isn’t “amazing” by most standards. For the elderly man Carl, who had lost control of his neck and head, so his head was facing down and he was always looking at the floor. Then the therapist started working with Carl, and his neck became stronger and he is now able to hold his head up. This is “amazing” for Carl and his quality of life.
Now when Carl is walking down the hall with his walker, he can smile at people and see who is greeting him. Carl can see where he is going and enjoy the environment around him. Carl is much safer in his movements around the Nursing Facility and can make new friends.
For the man with Parkinson’s disease who hears the music playing during music therapy. And then for some unknown reason is able to stand for the first time in a long time and dance with his wife for even a few steps, this is “amazing.” Even though it took two caregivers to assist him back to his chair to sit down. For him, those few steps when they danced were amazing.
These aren’t the moments that you will see in a TV special or in a movie theatre. People are so used to seeing things on a grand, larger than life scale. But sometimes it is the small success that is so rewarding for people who work in healthcare.
While the man at the support group meeting probably didn’t want a story about someone like Carl now able to raise his head and say “Hi” to people. It might not be splashy, but for Carl it really is amazing.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Ne – Aging with Dignity and Relevance
www.pleasegettoknowme.com
Posted on August 24, 2010 - by Nurse Virginia
TAKE CARE OF SKIN PROBLEMS FOR THE ELDER THE WAY THE NURSING HOME DOES
Taking care of skin problems the way the nursing home does means being proactive, and documenting all abnormal skin areas. When the elder has a bruise or abrasion, write down where it is, what size it is and how it looks. Something like – dark purple bruise the size of a quarter above the right elbow.
This kind of tracking protects the family or caregiver from false accusations of poor care. This also protects the family if the elder has to go to the hospital or a nursing home. When there is a controversy over skin problems acquired during transport or in a nursing facility your record keeping will prove invaluable.
Nursing facilities do a skin assessment every time the elder has a shower or bath. Every skin tear, wound, bruise or abrasion is documented at that time. If the elder has a bruise that is healing, writing – the bruise above the right elbow is now the size of a nickel and light brown shows, that it is in fact the same bruise healing.
Prevent Infections by being Pro-Active
When the elder has their toe nails cut – immediately applying a small amount of a Triple-Antibiotic Ointment to the area can prevent an infection. Always having some form of Antibiotic Ointment on hand, whether it is a Polysporin product or a natural product can prevent infection.
The natural product I like is Tea Tree Oil, which is an antiseptic product that can be used in the same way as the ointment but is applied with a cotton swab, since it is in an oil form. Any time there is a reddened area in the skin there is potential for a nasty infection. Something as simple as a reddened belly button area, (navel to some) because it is covered and could be moist and warm is the perfect scenario for an infection gone wild. Applying a small amount of an ointment or antiseptic oil at the first sign of redness could clear it up the same day.
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 August 23, 2010 - by Nurse Virginia
ALZHEIMER’S DISEASE OR VASCULAR DEMENTIA? MAYBE IT REALLY IS BOTH – THE MIXED DEMENTIA
(PART II)
When the elder is showing signs of an increase in their confusion it is time to have a baseline cognitive assessment. There are many types of cognitive assessment as well as many different healthcare practitioners who give them. From psychologists and neuropsychologists, to speech therapists many professionals conduct this testing. The testing will include:
- History – what was normal for the elder as far as their intellectual functioning?
- How are they functioning now intellectually?
- Attention span will be tested as well as concentration.
- Short-term memory
- Long-term memory
- The ability to recognize things
- The ability to recall – maybe a list of unrelated items.
The family or caregiver will be asked the level of self-care abilities. Are there changes in hygiene, socially appropriate behaviors, dressing inappropriately for season, weather or wearing the same clothes all the time.
What is really important in the testing is the elder’s self-reporting of problems they are having. This includes how they feel about the losses they are reporting. Testing should always be done if possible when the elder is not taking any form of antipsychotic medication to mask any symptoms.
While losses due to Vascular Dementia are the same for the elderly as losses due to Alzheimer’s disease, becoming familiar with the stages of Alzheimer’s disease can be very helpful. By the caregiver knowing the stages of Alzheimer’s disease, they can better identify whether the cognitive losses are following a pattern or are more random.
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 August 17, 2010 - by Nurse Virginia
ALZHEIMER’S DISEASE OR VASCULAR DEMENTIA? MAYBE IT REALLY IS BOTH – THE MIXED DEMENTIA
(Part I)
Mixed dementia, is when the elder has vascular dementia and now is also demonstrating signs of Alzheimer’s dementia. Researchers are now finding on autopsy of the elderly who have had a stroke, almost 45% also have the plaques and tangles associated with Alzheimer’s disease.
Alice had a stroke eight years ago, and her family was told that she has Vascular Dementia. For several years after the stroke, Alice’s level of confusion stayed constant. Alice, who could no longer walk, would “forget” she couldn’t walk. Alice would talk about how during the night in the nursing home her roommate would call out for something. Alice would then tell how she had gotten up and went to help the roommate. It was simple during those years to talk through those reoccurring false ideas. Alice would agree, that what she thought happened couldn’t have happened.
But for the most part Alice was still the Alice everyone knew. She still had a dry sense of humor, recognized everyone, and had her short term as well as long-term memories. Due to the severity of the stroke Alice could no longer take care of herself physically. But mentally she was the sharpest elder at any activity and the staff counted on her many times for trivia answers.
However for the last six months her family and her nursing home family have been concerned about her occasional lapses into an extremely confused state. Mini-strokes (also known as TIAS, transient ischemic attacks) result in partial blockage of blood flow to the brain and will appear as a decline in a step pattern. The elder will decline and then stay at that level of function for some time until another “Mini stroke” and then a further decline.
These declines can be in areas of memory loss, ability to think and reason, increased confusion, slowed thinking as well as declines in function and changes in behavior. But the declines do not follow a pattern; it remains very individualized depending on where the blockage is and how much damage has been done.
Alzheimer’s dementia follows a distinct pattern of losses or stages of decline. From; Stage 1, no cognitive impairment through to Stage 7, very severe cognitive and functional decline, or total care.
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 August 16, 2010 - by Nurse Virginia
WHAT A PRIVILEDGE TO WORK IN HEALTHCARE AND TAKE CARE OF THE GREATEST GENERATION
It was a memorable event at the Nursing Home. The Boy Scouts came in carrying the flag, and all the elders able to stand, pulled themselves to their feet. The elderly men assembled who had “served” saluted, and everyone said the pledge. The high point of the event was when the elderly residents of the Nursing Home each told their story of the war. One elderly man had received a medal from President Reagan for his contribution in the landing depicted in “Saving Private Ryan.” Having a picture of himself with the president helped those scouts to really see what this man had done.
This is a wonderful time to work in health care. We have the opportunity to take care of “The Greatest Generation.” This was the generation born from 1901 through about 1924. They lived through the Great Depression and served in WWII, or supported the war effort on the home front. These are the elderly who knew how to do without, and knew how to save. These are the people who did the right thing, just because it was the right thing to do.
While these elders are still with us, we still have time to get their stories. What was it like to live through the depression? How did you get by? My mother has told me she thought it was easier doing without during the depression, because no one had anything. You can see the look of pride on her face when she tells people she lived through the depression.
The Greatest Generation was united in the war effort. It was a time when the country was all in agreement about the necessity of the war. Everyone was supporting, serving and praying together, that’s just how they were.
Saving those stories from The Greatest Generation
There is a free Life Story Book on my web site: www.pleasegettoknowme.com – where you will find guidelines on how to write an elder’s story.
Memories of the depression and WWII are more accessible for the elderly because those times were so very emotional. Emotion reinforces a memory. When something emotional happens we tend to:
- Make a conscious decision to remember it.
- Relive the event over and over in our minds.
- Tell others what happened and in so doing hear the story again and again, reinforcing it in our memory.
- Think about the memory, analyze it and even cherish it.
We who are working with these survivors of The Greatest Generation owe it to them to get their stories while we can. Just imagine, one of those Boy Scouts could live to 100, and in 2080 tell his great-grandchildren, he knew someone who served in World War II.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com
Posted on August 12, 2010 - by Nurse Virginia
BRACE YOURSELF – NOT FOR THE FLU, BUT FOR YET ANOTHER OPPORTUNITY FOR THE MEDIA CARNIVAL
Summer isn’t even over and it seems that many apparently can’t wait to scare the pants off the population with words like “pandemic.”
This comes under the heading of:
Fool me once, shame on you! Fool me twice, shame on me!
The real flu pandemic – 1918
Yes, the so called “Spanish Flu” killed millions of people world wide. They still haven’t found where that flu originated, yet they call it “the Spanish Flu.” It circled the globe several times from 1918 through the middle of 1920. Some say 20 million died, some say as many as 100 million. The interesting thing was, it wasn’t the very young or old who died it was the young, healthy adult.
They now blame it on an over reaction of the immune system in healthy people called, a cytokine storm. If you weren’t that robust or healthy, your body didn’t have such a strong reaction when you got the flu and it followed a normal course. Although many deaths were the direct result of the flu, as usually is the case, it was the resulting bout of pneumonia that was actually the killer.
Again with the pandemic.
The signs are still out in front of the corner drugstore “H1N1 Shots Available” from the last pandemic forecast. And now the news is out that new vaccines coming out will protect against 3 influenza strains including the 2009 pandemic flu.
Every time I hear this kind of “news”, I have a mental picture of men in suits giving each other a high “5” – someone will be making big money. I will do the same thing I do every flu season – wash my hands, avoid people who are obviously sick and should have stayed at home and up the amount of D3 I take. (I have a reputation for never being sick, go figure)
Virginia Garberding, R.N.
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com
Posted on August 11, 2010 - by Nurse Virginia
HOW THE NURSING HOME TAKES CARE OF THE ELDER WITH PARKINSON’S DISEASE
(Part V)
It is never too late for a Therapy base line assessment. If it wasn’t done at the start of symptoms, it can be done now. As with every other discipline in the Nursing Home, the key here is a “change in condition.” If you have not written down what the current level of; walking, transferring from a wheelchair to bed/car, independent dressing, etc. you will not clearly know when there is a change. Do what we do in the Nursing Home, write everything down.
What Physical Therapy does for the elder with Parkinson’s disease in the Nursing Home?
- Works with problems with walking and balance
- Provides strengthening exercises especially for lower extremities
- Improves elder’s range of motion in joints
- Reviews any history of falls – works to reduce risk of falls
- Improves standing balance
- Teaches use of assistive devices
What Occupational Therapy does for the elder with Parkinson’s disease in the Nursing Home?
- Teaches the elder how to conserve energy and simpler ways to do things
- Teaches safe transfers from wheelchair to bed, to car, to dining chair, etc.
- Assists in bathing, dressing, grooming – all normal activities of daily life.
- Teaches use of assistive devices
Why Massage Therapy for elderly with Parkinson’s disease?
The gentle pressure of massage with hands-on manipulation reduces muscle spasms, decreases muscle rigidity, improves circulation and promotes comfort. Massage therapy brings sensory stimulation to those who may otherwise feel extremely disconnected. It relieves the loneliness of the disease, nurtures and provides one-on-one attention and can provoke pleasant memories. Massage fulfills that basic need for human touch.
How can a warm water pool exercise program help an elder with Parkinson’s disease?
While it is difficult to find a Parkinson’s Aquatic program, Arthritis pool programs are relatively common. Arthritis pools are warm water pools which aid in reducing muscle rigidity. Elders with Parkinson’s are buoyed by the force of the water and are able to engage in activities at an increased level. Elders with Parkinson’s disease have told me they enjoy increased energy, better balance and more independence since enrolling in a pool program.
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 August 10, 2010 - by Nurse Virginia
HOW THE NURSING HOME TAKES CAREOF THE ELDER WITH PARKINSON’S DISEASE
(Part IV)
What would Speech Therapy in the Nursing Home do?
The speech therapist would focus on a complete assessment with the goals of:
- Improving voice volume
- Reducing hoarseness of speech
- Improve speech articulation
- Work on improving pitch patterns and thereby reduce the monotonous tone
- Reduce drooling and improve the control of saliva
- Assess, identify and treat swallow problems
- Work with cognitive changes and deficits
When the elder with Parkinson’s disease is working with a speech therapist on better communication. The therapist will:
- Give the elder plenty of time to respond (counting to 10 in your head is a good amount of time to wait) because the elder with Parkinson’s disease has a slower response time, and may even have slower thought processes.
- Don’t ask questions that require a lengthy response, keep the communication to short responses
- Be very careful of your tone of voice that you are not expressing impatience
- Make sure you are on eye level with the elder
- Don’t sit in a circle staring at Grandma while you are waiting for her to respond. I am an advocate of “doing something” when you are visiting. If you are sitting together doing a puzzle or looking at pictures, conversation can come much more comfortably than when facing someone and asking one question after another. The long pause between responses can seem so much more natural while you are doing something together.
Think about joining a “Laughter Club” or create your own opportunities for laughter:
Among the most notable characteristics of Parkinson’s disease is the mask like facial expression and loss of voice strength. A “Laughter Club,” engages in facial exercises by laughing combined with breathing exercises. A laughter club provides the exercise for the face and lungs through laughing that is difficult to otherwise receive. Laughter is also a great workout for the cardio and elimination systems.
The idea of laughter clubs was the brain child of Dr. Madan Katarie, physician and author in India. Dr. Katarie knew the benefits of laughter to affect the physical, mental, social and spiritual well-being of the sick. Laughter is said to reduce the effects of stress, support the immune system and creates a positive outlook on life.
Rent a funny movie and just sit back together and laugh!
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 August 10, 2010 - by Nurse Virginia
HOW THE NURSING HOME TAKES CARE OF THE ELDER WITH PARKINSON’S DISEASE
(Part III)
When you take care of the elderly in a Nursing Home, every department is involved in that person’s care. For the elder with Parkinson’s disease, a therapeutic approach addresses both symptomatic as well as restorative interventions. When care is divided into specific areas in the home, this also helps the caregiver be able to put together a plan.
The Admission Process:
Start with a comprehensive written history of the elder’s experience with Parkinson’s disease. When did anyone notice stiffness, tremors, memory loss, change in the way they walked, talked, swallowed, all the changes identified with this disease. Having this documentation creates a very unique and complete history of the progress of this disease for any future use.
What would the Nursing Department Do?
- Timely administration of medication. (See part I of this series)
- Have a written statement of the elder’s current ability to function in areas of walking, dressing, washing/bathing, eating, grooming and how much assistance they now need to transfer from a chair or bed.
- Start keeping a record of how often the elder falls (also all of the circumstances of the fall-see Part II of the series on safety)
- Watch for changes in the elder’s abilities as described above and report any changes to the doctor.
- Coordinate the taking of medication with participation in any therapies to enable the elder to participate to their fullest.
- Monitor elder for any signs of constipation and provide immediate intervention.
What would the Dietary Department Do?
- Focusing the diet on providing sufficient fiber and fluids to prevent constipation.
- Creating a history of the elder’s normal weight and then documenting changes in weight.
What would the Social Service Department Do?
- Obtain professional support when needed due to the impact of the Parkinson’s diagnosis as well as issues associated with a chronic condition.
- Participate in a local Parkinson’s support group for elder as well as family
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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www.pleasegettoknowme.com
