Archive for September, 2010

Posted on September 30, 2010 - by Nurse Virginia

CONSTIPATION – NOT ALWAYS JUST A SIGN OF AN AGING ELDER

(Part I)

Statins (Cholesterol Drugs) cause muscle weakness – the colon is a muscle

Charles was 85 that year. His family was aware of his constipation problem. He, like many other elderly people incorporated prunes into his morning routine. Charles came up with his own solution of a hot cup of coffee first thing in the morning with ginger snap cookies heaped in the coffee like a hot cereal and prunes. One of his daughters’ brought him apples, encouraging one a day, which he faithfully complied with. Everyone was coming up with suggestions for a “fix” to this problem of constipation.

Yet Charles ended up in the hospital with a painful and unnecessary bowel obstruction. The first thing the hospital physician did was to review his medications and discontinue the statin drug that caused the problem.

Charles’ daughter was told by the physician that they were getting elderly patients in every month with bowel constipation related to a statin drug.

Signs of muscle weakness.

Now after the fact, Charles’ family could see the signs of weakness they had just assumed were the effects of aging. How he had started to complain of no longer being able to walk as far as he used to and had to sit down frequently because he felt weak. How now when walking in his retirement community he was holding on to the rail along the wall and using his cane. Previously, he had never used a cane and could keep pace with his much younger children when walking the halls.

The 22 foot muscle.

When people reference their muscles they rarely mention the digestive tract. The colon in an adult will be anywhere from 12 ft. to 22 ft. long depending on its musculature tone. Food is digested by enzymes and moved through the colon by involuntary muscle contractures. The tone of the muscular walls of the colon is very important to how fast food travels through the digestive system.

Any drugs that have the potential for causing muscle weakness should be suspect when constipation is an issue.

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 September 28, 2010 - by Nurse Virginia

ELDERSPEAK – HONEY, SWEETIE, GRANDMA – WHEN THE CAREGIVER JUST DOESN’T TAKE THE TIME TO LEARN THE ELDER’S NAME

Everyone’s name is important to them. There can be power in a name. There is power in the name “Jesus”. I remember when it was in the news that Elvis was in a concert and a row of girls held up a banner saying “Elvis is King.”  Elvis stopped the concert and said “No, Jesus is King.”

A person’s name and title are important to them. Does it become unimportant just because you are now old? Andy Rooney was just on 60 Minutes saying he doesn’t like the nickname Andy. He ended the piece saying “Just call me Andrew.”

When a caregiver hasn’t taken the time to learn an elder’s name (or like Andrew Rooney their preferred name) and calls that elder “sweetie,” the caregiver is indulging in ageism. They would not call that elder’s visiting daughter or son “sweetie.” It just wouldn’t sound right, or be right. But somehow once you reach a certain age – or enter a nursing home – all of a sudden it’s OK to call everyone by some generic term assigned to the elderly.

How much more dignity would be directed to an elder when you use their title – Mr., Mrs., Pastor, Doctor, Judge, – whatever title they have earned. When you see elders lined up in a row of wheelchairs, how is the elder supposed to still feel like an individual? When staff know, and use each elder’s name and title, every woman goes from “Grandma” to Mrs. Peterson, or Mrs. Jones.

My Dad told me once it was hard for him when he moved into Assisted Living to have everyone there call him Martin. He was only “Pastor” to a few visitors and when he attended Church from then on. He felt badly losing that title he had carried for over 60 years.

I can imagine a day when it just doesn’t sound right to call every elder “sweetie.” When caregivers take the time to learn an elder’s name.  When the elder feels empowered to say, “Just call me Mike, that’s what everyone calls me.”

When you hear someone using elderspeak – be proactive – stop the concert – and tell them how important a name is.

Virginia Garberding, R.N.

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

Posted on September 22, 2010 - by Nurse Virginia

WHEN THE CONFUSED ELDER YOU CARE FOR HAS DEMANDING BEHAVIORS

(PART II)

We have all heard it – the demanding person acts that way because they are insecure. Some how that doesn’t make the caregiver feel better or become sympathetic just because they are told this. When caring for a demanding person, who just is never satisfied no matter what you do. You start to feel as though they are draining the very life out of you. The demanding elder doesn’t have to always raise their voice with constant complaints or requests. Other behaviors are just as demanding as anger.

Demanding behaviors:

• Using self pity to make you feel sorry for them and get what they want.
• Use tears to get your sympathy.
• Verbally attack the caregiver.
• Act weak and pitiful.
• Whine and complain.
• Use anger and cause a real upset to get their way.
• Use a mixture of several manipulations at one time.

Can the demanding elder be “spoiled” if we do everything he asks?

The confused elder has a long history of using this behavior and may not even be aware of what he is doing. Which ever of the demanding behaviors they use to get their way this has become very comfortable for them. Doing things differently would make the elder literally uncomfortable and not likely to change. The only one we have the ability to change is ourselves.

If the caregiver finds themselves becoming angry or frustrated, it is time to step back and reassess what you can realistically expect to change and what you can’t.  Taking a break and getting some rest is certainly Biblical.

Virginia Garberding, R.N.

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

Posted on September 20, 2010 - by Nurse Virginia

WHEN YOU ARE TAKING CARE OF THE DEMANDING ELDER A REAL CHANCE TO BE CHRIST LIKE

(PART I)

The call light went off, and the argument started. “You go”,”No I went last time,” “You go,” and so it went every shift. Lois was a very demanding person to care for, once you went in that room you knew you wouldn’t be out for some time.

10 things to keep in mind when taking care of the demanding elder:

• Don’t take anything personally, it really isn’t about you. It is about a personality that was formed many years ago and isn’t going to change now. This is a wonderful opportunity to be Christ like in showing the elder patience.
• Get to know the elder, their likes and dislikes so you can meet their needs before they ask.
• Be the good listener the elder is looking for – this might not be the person you would chose to be special to – but the elder may surprise you.
• Give the demanding elder as much control in the everyday decisions as possible.
• Be a good observer; see if you can identify some of the triggers that cause the demanding behavior.
• Be very clear in your communication and don’t make promises you can’t keep.
• Think about your body language when you care for the elder. Are your expressions and body language saying – I can’t wait to get away from you?
• Smile, when you don’t feel like smiling. Find humor, tell a joke, laugh even if you are the only one laughing. Be happy, don’t let anyone take away your joy.
• Don’t expect changes you make to make a huge difference in the elder’s behavior. The only person you have the control to change is yourself.
• Pray. Take your problems to the one who is always there for you.

The demand doesn’t have to make sense. Lois asked everyone who came in her room to check the temperature. She had a piece of red tape at the exact point the heat/cool unit should be on. No one had a reason to change the temperature but that didn’t stop Lois from asking many times a day to check that temperature, to make sure no one had changed it.

How many times would be too many times for Jesus?

Virginia Garberding, R.N.

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

Posted on September 16, 2010 - by Nurse Virginia

WHEN THE CONFUSED ELDER HAS DELUSIONS

(PART II)

Hallucinations are hearing, seeing, smelling, feeling, tasting something that is real to the person experiencing them, and no one else is experiencing it. Delusions are fixed false thought or ideas that the person has despite all evidence to the contrary.

Not everything an elder says that seems strange is always a delusion. Sometime elders can misinterpreted their environment due to hearing loss or poor vision and their comments may seem delusional. Having hearing tested, hearing aids on, batteries working, regular eye exams and clean glasses on will go a long way in avoiding delusions.

What to do or not do if the elder is experiencing a delusion:

• Remain calm no matter how strange or bazaar the delusion maybe.
• Do not deny the idea or experience to the elder.
• Do not agree or disagree.
• Do not argue (your voice is not as loud or convincing as their own delusional thought)
• Do not play along with the delusion as though you believe this false idea also.
• Do not let this frustrate you the caregiver, it can be upsetting having an elder unable to remember so many things, when this false idea they are not forgetting
• Don’t let negative body language speak for you – the confused elder is aware of body language, and can read it very well.
• Reassure the elder that you are taking care of everything.
• Notify the elder’s physician of this symptom, but do not let the physician dismiss this as unimportant.

Fred our elderly driver from part I, over heard his daughter talking about him failing his driver’s exam. He became convinced his daughter was talking to the people at the DMV and telling them they shouldn’t let him drive. The daughter intervened immediately telling Fred that now only didn’t she report him, but that she never would do such a thing.

Her quick reaction probably averted Fred from becoming distrustful of his daughter and going from delusional to paranoid.

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 September 15, 2010 - by Nurse Virginia

WHEN THE CONFUSED ELDER HAS DELUSIONS

(PART I)

Fred is just so adamant that he is going to drive his car again, that he talks about it all the time. The facts are that he failed his driving test, had his license taken away, is now in his mid-eighties, has cataracts in both eyes, needs hands on assistance to walk, and has periods of great confusion. Yet he persists in talking about where he is going to drive to and people he will visit. He has agreed to have his cataract surgeries just because he believes he will then be able to drive.

The real problem is that the family feeds into this. This has become “the” topic in the family. Fred will make untrue statements about driving and then the family member will be explaining, just why that won’t be happening. What the family is missing is that Fred’s ability and probability of his ever driving again has become a delusion for him. A delusion is a false idea or belief that facts and explanations cannot change.

Fred’s internal voice, that is reinforcing this false idea, is so much stronger than the voice of his wife or daughters. They are not going to be able to outshout that strong internal voice that we all have.  So Fred is telling himself as well as everyone else that, yes he will be driving again soon.

What we know about delusions:

• It is a false fixed belief.
• It will not change despite evidence to the contrary.
• It will not change because everyone else believes otherwise.
• A belief is thought delusional if it causes the person distress.
• A belief is thought delusional if it is obviously bizarre.
• A belief is thought to be delusional if it preoccupies the person.

Fred knows everyone in his family thinks he shouldn’t drive. Fred is presented with the evidence but the thought of driving continues to preoccupy his thoughts and conversation. Talking him out of this idea or convincing him just isn’t going to work.

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 September 13, 2010 - by Nurse Virginia

HOW TO GIVE THE ELDERLY AN OLD FASHIONED BACK RUB

Many years ago the back rub was an important part of the nurse’s bag of tricks. Before we became such a high tech society, there were few options for patient comfort. But the back rub still serves an important function to:

• Calm an upset confused elderly person.
• Provide some comfort and relaxation for any one.
• Create customer satisfaction with the most anxious of elderly people.

Back rub basics:

• Make sure you have short smooth finger nails.
• Lotion can provide an added benefit of a pleasant or therapeutic fragrance (aromatherapy) however room temperature lotion will feel cool on the skin, warm up the lotion either in putting container in warm water or warm a small amount of lotion in your hands – rubbing them together.
• Do Not massage legs – there are too many possible complications massaging an elder’s legs – Do Not use any lotion between toes, this is a moist area that can harbor a fungus.
• Do Not massage over any swollen, reddened or open areas over bony prominences.
• Use gloves for your protection as well as your patients if the patient has any open areas on their skin – otherwise ungloved hands give the most effective backrubs.

Giving the Old Fashioned Backrub:

• Gently wash and dry the person’s back.
• Protect the caregiver’s back – have the bed at waist height – avoid bending at the waist – caregiver’s feet positioned one slightly ahead of the other – knees bent slightly – caregiver rocks back and forward slightly as they use long smooth strokes.
• Long strokes are relaxing – Small circular strokes increase circulation.
• Start with long strokes with one hand on both sides of spine – stroking up toward the elder’s head.
• Right hand circles to the right and left hand circles to the left – around the shoulder blades and down the sides of the back – continue across lower back till hands once again go up on both sides of spine.
• Every other time you descend on sides of back – add small circular strokes going down the person’s sides.

An Old Fashioned Backrub can be so soothing for the elder, refreshing for sore muscles, and prevent skin breakdown by providing needed circulation.

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 September 9, 2010 - by Nurse Virginia

KEEPING TRACK OF THE CONFUSED ELDER’S HEALTH RECORDS

(PART III)

As the area of healthcare changes, the population will be forced to take a more active role. More responsibility will fall on the individual to monitor their own condition. Sorry to say, hospitals will no longer be so eager to admit, especially the elderly on Medicare.

Hospitals will now be asked to prove that they have had a successful outcome before they get paid. An elderly person who is re-admitted to the hospital within 30 days of their last discharge, for the same condition, will not be considered a successful outcome.

Medicare will suggest the person was;

• Discharged to soon from the hospital on the previous admission.
• Hospital did not teach the elder or their family about the condition before the discharge.
• The hospital did not teach the elder or the family about the correct use of the medication.

The right physician will be very important.

As these changes begin, it will be of the most importance to have a physician for the elder that is a good listener and communicator.

Questions to ask yourself about your physician:

• Are you ever afraid to ask a question because the physician may make you feel foolish?
• Does your physician seem really interested in the elder?
• Is the physician a good listener?
• Does the physician give you the time to voice your observations and opinion?
• Does the physician act as though you are all a team taking care of the elder?

Record keeping – an on-going process.

Having records as; current diagnosis, current medications, DNR, Healthcare Power of Attorney,  Medicare & Insurance information as well as phone numbers of all physicians in a convenient location will provide peace of mind.

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 September 8, 2010 - by Nurse Virginia

KEEPING TRACK OF THE CONFUSED ELDER’S HEALTH RECORDS

GETTING IT RIGHT (PART II)

How to get good, clear, usable information.

When a healthcare professional (physician, nurse hospital tech. etc.) is giving information, they may have given this information many times before. But for you this is the first time you are hearing this, so the responsibility falls on you to listen. It is best to have your questions written down so you can really listen and aren’t distracted by thinking about what you want to say. Great listening involves repeating back what the person has just said, so you are sure you have it right.

Re-stating, “If I understood you right doctor, Mom should take this medication on an empty stomach, first thing in the morning with juice, is that right?”

Signs and symptoms of possible problems.

Following any surgery you will want to be very clear about:

• What is usual and can be expected
• What is unusual and not expected
• What could really be a potential problem and should make you concerned.
• Follow-up appointments – it may be your responsibility to schedule this.

Medications:

• How does the elder swallow – if they need their medications crushed, can this be crushed?
• If this needs to be mixed in order for the elder to swallow – what could it be mixed in?
• Re-state any allergies the elder has – in case that information has become lost.
• Re-state what other medications the elder takes – could there be any toxic reactions due to the similarity of different drugs?

Medications are reviewed several times – when the physician gives the order, the office nurse transcribes the order, the pharmacist reviews the order while dispensing the medication, and then the caregiver reviews the medication before giving it to the elder. 

Never get side tracked when receiving information. It is all too easy to get caught up in social conversation, especially if you have acquaintances in common. Remember the time you are chatting, is your time with this professional. Every health care professional does not necessarily communicate well with their tone or body language the importance of information. It remains the listener’s responsibility to hear, repeat, and repeat again until they understand.  Healthcare is just too important to get it wrong.

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 September 7, 2010 - by Nurse Virginia

KEEPING TRACK OF THE CONFUSED ELDER’S HEALTH RECORDS

(PART I)

It is going to become more and more important for the family member of the elderly to keep accurate and current health records. This will require the family not only to keep written documentation but also to ask the right questions about a disease process, signs and symptoms of problems and have a full understanding of the medications for that disease process or diagnosis.

What is a current diagnosis?

If the elder fell and broke their right arm 5 years ago, it healed as expected and is as “good as ever.” That fractured right arm is not a current diagnosis. Cancer that has been in remission and is now considered cured, is also not a current diagnosis.

Diagnosis are recognized by disease categories:

• Cancer
• Heart/Circulation
• Gastrointestinal
• Genitourinary
• Infections
• Metabolic
• Musculoskeletal
• Neurological
• Nutritional
• Psychiatric/Mood Disorder
• Pulmonary
• Vision

Hypothyroidism is a condition in the disease category of metabolic diseases. Heart failure is a condition in the disease category of Heart/Circulation. For the elder’s current list of diagnosis you want to write down any diagnosis they are taking medication for. Once a person has been diagnosed as a Diabetic (Metabolic diagnosis) and using insulin – as long as they are on insulin this is a current diagnosis. If the elder is taking a medication for high blood pressure – than they have a current diagnosis of Hypertension.

In any emergency situation; paramedics, emergency room personnel, new specialist, hospital admission any of these healthcare situations require the most current information you can produce. Having all the pertinent information at your finger tips makes the situation easier on everyone, especially the elder.

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