Author Archive
Posted on February 3, 2012 - by Nurse Virginia
WHEN THE ELDER WITH ALZHEIMER’S DISEASE NO LONGER RECOGNIZES THEIR FAMILY
WHEN THE ELDER WITH ALZHEIMER’S DISEASE NO LONGER RECOGNIZES THEIR FAMILY
Now it has happened to me my mother doesn’t always recognize me. After visiting my mother Verona in a nursing home, where she has lived for the past 12 years, at times she looks at me with a blank stare. She tries and struggles with the information I give her to try to tweak her memory. But if I turn and talk to anyone else in the room, I have lost her and have to start all over. “Hi, Mom, it’s Ginny,” always said with a big smile.
Sometimes she will smile as though this is the first she has seen me, having forgotten already that I have been sitting next to her for the last hour talking, singing and reading to her. It is like I just walked in, and this is the first she saw me, and we start all over trying to remember who I am.
(Book excerpt from: Please Get To Know Me – Aging with Dignity and Relevance)
It was a winter’s afternoon, and I felt the need for a little sugar rush to get me through the rest of the day. I went down to the vending area in the employee cafeteria. There sat the son of one of our elders, who was a frequent visitor. I asked if he was coming or going.
“I’m trying to come,” he said.
It seemed as though every time he visited, he had to go to the cafeteria for a few minutes and emotionally ready himself for the visit with his mother, whom he loved dearly. “She’s in the late stage of Alzheimer’s disease and no longer recognizes me,” he said. It was obvious that hurt him deeply.
Many books have been written about the long, painful loss of a person to Alzheimer’s disease. But while that is certainly true, it is also true that during this time of loss the ongoing life of the person continues. Visiting with a person afflicted with Alzheimer’s disease becomes more of a connection than a “visit.”
Even elders in the late stage of dementia can usually recognize someone as a friend. Make eye contact, get on the same level as the elder, and speak the person’s name and smile while you communicate. Even something as simple as touching the elder’s hand while you talk can bring his or her attention to the speaker.
While communicating, incorporate as many senses as you can; hearing, seeing, and touching will make a connection even in the late stages of the disease. Although the elder may no longer recognize you as a spouse or child, your body language will communicate to the elder that she knows you. (End of book excerpt)
I find myself more and more grateful for the wonderful staff that take care of my Mom. The people, who say her name, tell her who they are and what they are going to do to help her. The staff that always smile at her and give her the comfort of knowing that she is with people who know her.
One day a couple of years ago when she was having trouble remembering something, out of the blue she turned to me and said, “I’ll never forget you, Ginny”
But there is one she never forgets. Just say the name of “Jesus” to her, and the staff will tell you, Verona remembers.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on January 31, 2012 - by Nurse Virginia
STRESS RELATED CONDITIONS IN THE ELDERLY – ALOPECIA/SHINGLES
(PART III)
Louise could just as easily have developed Shingles after her emotional stress. (See part I) All of the potential was there. Louise had had Chickenpox as a child. Only people who have had Chickenpox get shingles, as it is the same virus. After having Chickenpox the virus lies dormant in your nervous system, near your nerve endings. It can be many years later that something triggers the virus to come back down the nerve, to the skin, and erupt again into a painful pustule or a “shingle.”
Louise is also well over 60 years old, most people who develop shingles are over sixty. All the possible triggers that bring on a case of shingles are not known. However, being exposed to a child with chickenpox is certainly one. And having a severe emotionally stressful event can bring about an attack of shingles as well.
Shingles may start out with an elder just feeling under the weather, or it might begin with intense pain. A few days later the red rash will appear. This rash develops fluid filled pustules, just as with chickenpox. You do not want to break these pustules. They will open and drain on their own. Opening any encapsulated blister or pustule provides an opportunity for infection to begin.
Using an antibiotic ointment as the pustules open and drain prevents against the possibility of infection. This fluid that drains is extremely itchy and very problematic for the confused elder who forgets not to scratch.
An elder who is confused and unable to express their feelings of pain, should be medicated as well as monitored for signs of pain. Keeping in mind that the pain of shingles can be present long after the last pustule has drained and healed. Pain management may be indicated for up to a year after the shingles event, especially if it was a severe case and involved the eyes.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on January 24, 2012 - by Nurse Virginia
STRESS RELATED CONDITIONS IN THE ELDERLY – ALOPECIA/SHINGLES
(PART II)
Frank also had significant hair loss; however it happened over so many years that he really didn’t notice until the hair started coming back. Because of his high blood pressure (he was on 5 medications) and his weight gain his physician advised Frank to stop eating wheat products. After going gluten free for several months, Frank noticed that at the age of 68 he was now growing a remarkable amount of hair on his arms and legs.
Frank did lose 55 pounds going gluten free and the edema in his legs was totally gone as well. But what he hadn’t expected was to see the re-growth of all that hair on his extremities. He had had Alopecia and hadn’t even realized it.
A person usually has only 80 – 90% of their hair shafts growing at a time. The rest are somewhat dormant for periods of about two months at a time. When the individual is impacted by one of the previously mentioned conditions, (see Part I) more hair shafts go dormant than normal and that is Alopecia.
Hair loss may be only noticed in one location or in patches. But in many extreme cases of Alopecia it may include all the hair on the body including pubic, eyebrows, eye lashes and so forth.
While stress may be the cause of this disorder, having Alopecia can also be a large source of stress. Usually time is the great healer here. As previously noted a dormant area of hair will start re-growth after two months. Many people with a spontaneous case of Alopecia will regain their hair in a year.
While the resulting baldness on your head will be stressful it will not be painful, susceptible to infection or potentially life threatening as Shingles may be. (See Part III Shingles)
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on January 23, 2012 - by Nurse Virginia
STRESS RELATED CONDITIONS IN THE ELDERLY – ALOPEIA/SHINGLES
(PART I)
The elderly couple was shopping at the mall, “their mall,” they had been there many times. Louise was getting tired, her knees hurt as they often did walking those hard floors. Charles told her to sit down for awhile and he would bring the car to the door. “Take your time,” he told her, “I’ll just wait.”
Which door? The problem came when they went to different doors. No one would ever know who was right, they just didn’t communicate before he left for the car. Louise went to the exit she thought Charles would be at, stood and waited on those sore tired knees till she was crying and still he didn’t come.
Charles was waiting at another door and because of the frustration of waiting, he became angry. Finally Charles started circling the mall checking all the doors and found Louise. Seeing Louise standing there crying, Charles became even angrier and began yelling at her. The situation had scared him and he reacted poorly.
Louise was in severe pain by this time and being yelled at in an enclosed car, where she couldn’t even walk away, didn’t help. When she got home she was beyond crying.
Soon her hair started falling out in large clumps. That episode at the mall was still so painful to remember, Louise being the mild mannered, meek person she was, she never said anything, she just kept going over it in her mind.
The loss of hair or Alopecia can occur because of medications, cancer treatments, fungal infections, hypothyroidism, hormonal changes – as after giving birth and many other environmental causes. Hair loss may be temporary or permanent. However this kind of hair loss was probably due to stress. The stress might be a significant illness, a crash diet, physical trauma as in an accident, or a shock to the system.
This episode probably would not have cause the hair loss in a younger person, but because of Louise’s age, close to 80 at this time, she suffered major hair loss for the next six months and had to wear a wig.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on January 16, 2012 - by Nurse Virginia
EARLY STAGE DEMENTIA – LOSS OF JUDGEMENT AND REASONING
Part I
“It’s an American Eskimo,” Ray said with a big smile as he showed his daughter the new puppy he had just bought. “I know Dad, that’s what Sugar was, the dog I had growing up, I know all about that dog.” Ray’s expression turned blank, as his daughter realized that Ray no longer remembered the family dog.
Ray had been giving signals to his wife that he was thinking of getting a dog. Beth had tried to have a conversation with Ray about the kind of dog he might want Ray had been retired now for 11 years, since he was fifty-seven. Beth thought a dog would be a good idea for Ray and over the last months she had suggested several options.
Beth still worked full-time and thought a dog would be good company for Ray and give him a reason to get out of bed and take a walk every day. Beth looked into adopting a “war Dog.” She thought a mature dog who had served the country would be just perfect for the very patriotic Ray, who had never had the chance to serve himself. No, Ray said that’s not what he wanted. Ray started getting dog magazines and spent considerable time poring over these magazines.
Whenever Beth asked what kind of dog Ray was thinking of, Ray would shut her down with his usual, “It’s none of your business, and I’ll do what I want.” Now here he was with his impulse purchase because he went to a pet store and saw this dog that looked “just like a wolf.” He thought it would be great to have a dog that looked like a wolf, and even named it “wolf.” Completely forgetting that family dog, that also had “looked just like a wolf.”
Ray’s daughter reminded him that this was a very energetic dog. This was a dog for a young family with a lot of energy to match the dog’s needs. That this was the breed of dog that had been so hard to train that she became a junior dog trainer when she was just thirteen because of all the time she spent, working with this breed of dog. She told Ray that November was a bad time to buy a puppy in the Midwest, that this puppy would need regular trips outside during the winter months to housebreak.
Ray was no longer able to use reason or logic in this life changing purchase. All he could say was, how this dog looked just like a wolf, and that seemed to be enough for him.
Ray missed going to his daughter’s out of state for Thanksgiving a week later, because he had forgotten all about the trip, and how that daughter’s family had allergies and could not have pets. He also missed going there several weeks later for the Christmas holiday
Ray is no longer able or interested in learning about his new pet. He is just in the moment, while he is trying to understand why the dog seems nervous and unable to sit still, always wanting to go somewhere, and now dragging Ray behind.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on January 4, 2012 - by Nurse Virginia
MALNUTRITION IN THE ELDERLY – ESPECIALLY IN THOSE WITH ALZHEIMER’S DISEASE
“I never lived so well,” said Grace as dinner was served in her assisted living facility. Fortunately, there are some elderly who feel this way. But they seem to be the in the minority, the vast majority of the elderly have signs of malnutrition for a variety or reasons. As people age, the risk of malnutrition increases. Signs of malnutrition are: weight loss, nausea, illness, muscle wasting which results in frequent falls, dizziness and fatigue.
The causes of malnutrition can involve a large range of challenges for the elder especially the confused elder.
- They may have a loss of appetite sometimes due to medication or lack of exercise.
- Food may no longer taste good to them because of a loss in the ability to taste or smell.
- Their metabolism has slowed down and they just aren’t hungry.
- They may no longer have the equipment to make the food they like.
- They may not have the money to buy the food they like.
- They may not have the strength or transportation to go get the food they like.
- They start to develop poor eating habits related to these issues.
Encouraging an elder to eat can be at times a challenge. The best approach is to address these issues in the reverse. Make sure the elder does get some exercise everyday, so they can build up an appetite. Provide a balanced diet with foods that are familiar and that are favorites of the elder. Make sure the foods are easy to chew and that the elder chews food well to aid in digestion.
Provide a pleasant dining experience. Even the simplest meal can seem a treat when served on the “good” dishes with relaxing music. Assist the elder in the purchase of food, remembering that the confused elder may be having difficulty using money, transportation and equipment.
Bon Appétit!
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on December 20, 2011 - by Nurse Virginia
GOING TO HOLIDAY CHURCH SERVICES WITH THE ELDER WHO HAS ALZHEIMER’S DISEASE
ELDERLY CHRISTIANS WITH ALZHEIMER’S DISEASE STILL HAVE EXACTLY THE ABILITIES THEY NEED TO PARTICIPATE AT CHURCH
Carl, an elderly member of the congregation for 92 years, is no longer attending because of behaviors related to his dementia. Just when he and his family need the support of their church family the most, someone thinks Carl shouldn’t be there.
Elderly with Alzheimer’s disease have abilities for church
The truth is that Carl, like many other seniors with Alzheimer’s disease, actually continues to have the very abilities he needs to be an active part of the congregation’s worship.
The universal ability to recognize facial expressions and body language continues in a person with Alzheimer’s disease. In any country you visit, a smile is greeted with a smile, a frown is recognized as a frown and the person with Alzheimer’s disease is able to read positive or negative facial expressions as well. But because the elder with Alzheimer’s disease is so aware of their confusion and of making mistakes, the need for a smiling welcome is more important than ever.
The response to touch is universal. When someone is touched, a chemical is released in the brain that is referred to as the “care and connection” transmitter. This transmitter makes us feel comfortable and open to each other. Indeed, that old friend at Church with the warm handshake is just the medicine Carl needs now.
Music, (and we all know how much Christians love to sing), is the most recognized of universal languages. Music triggers reminiscing and creates a sense of comfort and feelings of well-being for the elder with Alzheimer’s disease. Music, unlike language skills is located in several parts of the brain. Elderly who have lost their words will often continue to be able to sing. I remember a woman who, in her last days, when she was no longer able to recognized her family or herself in a mirror and was in need of total care, continued to sing “Jesus Loves Me” every day. Singing together with the congregation produces feelings of being connected to others and the ability to enjoy music continues throughout life regardless of the dementing illness.
Help elderly with Alzheimer’s disease with environmental cues
What Carl needs now is cues to help him understand what is going on. Coming into Church after the music has started will help provide the environmental cue he needs to recognize that he is in a familiar place of worship. This worshipful atmosphere with the organ playing should help with unwanted behaviors. Having Carl wear a name tag that says “Hi, my name is Carl” can help cue other people to smile and greet Carl by name, creating a warm and comfortable environment for him.
Beverly wanted to continue worshipping with her husband John, who had Alzheimer’s disease. Every time the congregation would stand John would exit the pew. Beverly wanted to give him a cue as to when it was time to go. She told him to watch her purse and when she picked up the purse they would go. Well of course John kept a keen eye on that purse, and when Beverly picked up her purse, John was the first one down that isle. But that cue helped him continue to be part of the congregation worship service for some time.
They are calling the aging of America “The Silver Tsunami”, but coupled with that will be another wave – the “Dementia Tsunami.” As congregations, the time is now to educate the flock while encouraging your families with confused elders to continue to come to church and give the congregation the opportunity to be part of keeping the faith.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on December 14, 2011 - by Nurse Virginia
HOME SAFETY CHECK – ALWAYS A GOOD IDEA FOR THE CONFUSED ELDER BEFORE THEY RETURN HOME AFTER A STAY AT THE NURSING HOME
Bertha had been so sure she was ready to “go home.” Why anyone could see she had lost a considerable amount of weight since being in the nursing home. Even her doctor was calling the changes in her nothing short of amazing.
Bertha had come to the nursing home from the hospital following a fall at home. She lived alone, said she had been doing so “for years” and enjoyed it. Bertha had a small dog that was now with friends until Bertha returned home.
When Bertha arrived at the nursing home, she was a familiar face, having been a resident about 3 months earlier. At that time Bertha insisted on going home against medical advice and now because of her recent fall, was back in the nursing home.
So this time the staff didn’t want any discharge to home, to come too early, before Bertha was ready. So a trip home was planned for Bertha and two of her therapists, to hopefully see her in her home environment. Some of the things Bertha said about her home were technically true, however not totally accurate.
Bertha’s home environment:
- Bertha did have an elevator that ran along the stairway to the second floor; however it didn’t work, and hadn’t worked for some time.
- Bertha could now walk with a walker. She did have carpeting; however her carpeting was covered with small throw rugs and had electric wires running everywhere.
- Bertha did have a path from room to room, but it was just a path, the rest of the floor area was covered with ‘stuff.” Bertha wasn’t a true hoarder, but she did have a large amount of clutter to walk around.
- She did have a back door where she could easily let the dog out, but the evidence all over the floor in the spare bedroom told another story.
- Bertha did say that she needed some work done in the bathroom, grab bars and so forth. However what Bertha filed to mention was that her town house did not have a shower, only one small bathtub. She was going to need a large renovation, not just a few grab bars.
Now Bertha had a plan with goals. No, she wouldn’t be going home for some time, but when she does, with the help of the nursing home, she will be successful.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on December 7, 2011 - by Nurse Virginia
URINARY INFECTIONS MAY LEAD TO INCREASED CONFUSION IN THE ELDERLY
(Part II)
In the past when an elderly person experienced changes in behavior or increased confusion, the health care community collectively thought that this was normal; after all you’re getting old. How many times has a doctor said to a family member “What do you expect at his age, he’s getting old.”
Addressing the behavior or the increased confusion was the focus, not the underlying physical change in condition. Identifying that physical or pathological change will require the persistence to search for a cause and the ability to clearly communicate your findings.
Signs of a urinary tract infection:
- Going to the bathroom more frequently
- Complaining of a burning sensation on urination
- Increased temperature
- Bladder or kidney pain
- Blood or pus in the urine
- Concentrated, dark/cloudy urine
- Rambling talk, disorganized thinking
- Unstable emotions
- Increased problems with judgment or thinking
The elderly with dementia are more likely to be hospitalized for a fracture, lower respiratory infection, urinary infection or a head injury than an elder without dementia. Once admitted, the elder with dementia will usually remain in the hospital twice as long an elder without dementia. The elder with dementia will also be more likely to be re-admitted within 90 days after discharge than an elder without dementia.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on December 5, 2011 - by Nurse Virginia
URINARY INFECTION MAY LEAD TO INCREASED CONFUSION IN THE ELDERLY
(PART I)
Marty was holding on to the handle of the car door threatening to “jump.” No matter what his wife Betty said, nothing seemed to be able to quiet Marty down. He had been pacing the small home they had lived in for the past 40 years, till Betty said, “Let’s go for a drive.” Thinking the car ride would be soothing for whatever was bothering Marty these last few days. He seemed to have a problem that he didn’t seem to be able to put into words. And now here he was threatening to jump from the car.
Marty had always been a very calm, dependable sort of man. Even when he started getting confused, he laughed it off never showing frustration or anger. This kind of outrageous behavior was so unlike the normal manner of this 78year old man. Not knowing what to do, Betty drove directly to their doctor’s office and luckily they took Marty right into an examination room. Marty would not have been good at waiting, not today.
Marty was well known to the doctor and his staff and after what seemed only a short time to Betty the doctor started writing notes. Betty could just make out the doctor’s note reading it upside down. It read, Altered Mental Status, increased confusion probable cause urinary tract infection.
Urinary tract infections are the most common infections in the elderly and the most likely to lead to increased confusion. The second most likely infection to result in increased confusion is an upper respiratory infection or pneumonia. However just about any infection in an elderly individual may result in increased confusion. Many times the increase in confusion is the symptom that leads the caregiver or physician to the cause which may be infection.
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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