Author Archive
Posted on March 6, 2012 - by Nurse Virginia
TAKING CARE OF THE ELDERLY PARENT LIKE THE NURSING HOME DOES WITHOUT RESTRAINTS
Lily was 89 and the last thing her family wanted was a call from the nursing home saying Lily had just had a fall. And so, bending to pressure from the daughter, the nursing home reluctantly put a belt restraint on Lily’s wheelchair to keep her in the chair.
Many years ago it was common to see every elderly person not only in a wheelchair but many with a restraint tied around their waist to keep them in that chair. Now before you can tie a person to a wheelchair, you must have tried other alternatives. These alternatives focus on the need of the elderly person.
Is the person anxious and just wants to keep going all the time? Develop a regular routine of walking, having snacks and meals, rest periods or naps, creative activities as well as regular exercise.
The confused elder who keeps trying to walk when forgets he needs assistance could need a consistent routine. I recently heard from a daughter who was the caregiver for her father, who has Alzheimer’s disease, for part of the year and then he goes to live with her sister for the rest of the year. Each time he moved he had to relearn the environment. However if the father’s routine was kept in both homes the adjustment would be smooth.
If the elder has weakness in their legs the nursing home would have the person seen by a physical therapist. The therapist would create a specific program of exercises for the elder to build strength. The elder living at home can still have their physician write an order for therapy as well. Many therapy companies now offer home visits under Medicare.
Having a change of seating helps a lot with a confused elder who is unaware that they now need assistance to walk. Alternate between stuffed chairs and hard surfaces, the problem arises when the elder is asked to just sit in the same wheelchair all day. I wouldn’t like that too much myself.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on February 28, 2012 - by Nurse Virginia
HOW TO MAKE A COMFORT THROW WITH OPPORTUNITIES FOR TACTILE STIMULATION FOR THE CONFUSED ELDER WITH ALZHEIMER’S DISEASE
For the confused elder who spends their day in a wheelchair or reclined in a geriatric chair, their opportunities to touch and explore things with their hands is often limited. Creating a comfort throw with “touching opportunities” can give the elder the gift of something to do.
Creating a Comfort Throw:
- Select a material that is soft, feels good, and is not slippery so that it won’t keep sliding off the elder’s lap. A knit or crocheted throw can work just as well as a quilted material, as long as the tactile attachments are added.
- Is this going to be used for a man or a woman, this will determine the colors as well as fabrics used.
- Small pieces of material may be found in the clearance or remnant section of a fabric store
- A comfort throw for a man might have squares of different textured materials such as wool, denim, terry cloth, corduroy, a plaid flannel and so forth.
- A comfort throw for a woman might have squares of velvet, satin, soft knits, terry cloth, chenille, and so forth.
- Buttons should be added to both a man’s or woman’s throw.
- Ribbons come in a variety of colors, widths and textures They can be attached in small bunches by sewing a piece of yarn through the material, leaving a loop for the ribbons and tied on the back side of the throw.
Let your imagination run rampant.
A comfort throw can also say something to the elder’s care takers about their lives and interests. My Dad had a very extensive tie collection and could have had neck ties and bow ties attached. A Christian could have crosses made out of a texturized ribbon on their comforter. A breast cancer survivor could have pink ribbons on their comforter. Pictures may be scanned and added to fabric as well, to personalize the comforter.
Make a comforter and give an elder the gift of something to touch and to do.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on February 22, 2012 - by Nurse Virginia
SOMETHING TO TOUCH – TACTILE STIMULATION FOR THE CONFUSED ELDER WHO IS IN THE LATE STAGE OF DEMENTIA
She had her stroke twelve years ago now, years that Verona hasn’t walked or had the use of her left arm. Now semi-reclined in a geriatric chair, Verona needs total assistance for all of her activities of daily living. But that still usable right hand searches over her lap blanket for something, anything to touch.
The sense of touch is felt by sensors all over your skin, but even more so through your finger tips. Nerve endings in the skin inform the body of temperature, pain, movement and texture. When the elder is no longer given things with different textures to touch, they will become disengaged and lose interest in life.
Research has shown the effects of stroking a baby in an incubator can improve growth, neural activity and development.
Research in the Netherlands revealed that elders who received tactile stimulation had decreased depression, were less nervous, displayed better mood and were more alert. They found that personal level of orientation improved as well as their orientation to the environment through increased tactile stimulation.
The answer for Verona came in a comfort quilt her grand-daughter made for her. Because of Verona’s interest in sewing, different size buttons were sewn on the quilt. The edge of the quilt was covered with a soft silky edging and over that a ruffled grosgrain ribbon to add texture. Scattered over the quilt were small bunches of ribbons as well as more textured ribbon. Not only is the quilt a conversation piece and a work or art, but now when Verona’s hand searches it will find something fun to explore, and remember through the sense of touch.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on February 13, 2012 - by Nurse Virginia
4 REASONS WHY VALENTINES DAY IS A PERFECT HOLIDAY FOR SOMEONE WITH ALZHEIMER’S DISEASE TO ENJOY
- A person with Alzheimer’s disease continues to give and receive love. When a person has Alzheimer’s disease, every day can be Valentines Day. When you love to give as well as receive hugs, love to hold hands, and you live “in the moment” everyday can be a special occasion.
- A person with Alzheimer’s disease still has a spirit. The elder, whether he can still express himself verbally or not, he still can; enjoy a sunset, a walk outside, listening to good music, looking at art, as well as going to church.
- A person with Alzheimer’s disease is still a person with feelings. The elder feels the same emotions that every one else feels; loneliness, sadness, joy, fear, anger, worry, embarrassment. So the elder with Alzheimer’s disease is more than ready to enjoy a happy occasion and what could be happier than Valentines Day.
- A person with Alzheimer’s disease can still enjoy all their senses. The elder can taste and enjoy chocolates, see a bright red Valentine, smell some memorable perfume or cologne.
My Dad had an unusual way of celebrating Valentines Day. He had bought my Mom a beautiful card years ago, which they kept it in their china cabinet in the dining room. Every Valentines Day, Dad would get that card out and present it once again to Mom. He was happy to give it and she was happy to get it.
Since Dad is gone, it is our honor to remember the day for Mom. So she has a card and a beautiful flowered plant at her bedside. When the staff at her Nursing Home, are talking about Valentines Day, they can include her by commenting on her beautiful flowers.
Give elders the opportunity to celebrate; they might not remember past Valentines Days, but they will certainly know today is a special day.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on February 9, 2012 - by Nurse Virginia
DENTAL CARE FOR THE ELDER WITH DEMENTIA
I recently received this letter from a reader who really describes so well the problems she faced with her father’s dental care.
Dear Virginia,
My Dad must have fallen, unnoticed by us, and when he had a visitor, I noticed from the wide smile he gave the visitor, he had chipped his tooth. May all other care takers make routine observations of the mouth and teeth. We had waited too long to get my Dad to the Dentist. His plaque is so thick, and permanent now, that to remove it would hurt him too much. The woman who worked on my Dad was very gentle, and told him to raise his hand when the pain was too much to bear. He did and I was happy she suggested that.
The dentist’s daughter who cleaned my Dad’s teeth suggested we get him a Spin toothbrush. I ran out and bought one. I could never get him to try it; it was noisy and vibrating, and he “knew better” than to put that object into his mouth! Instead, he turned it on and off, impressed with the battery – so, buyer and caretaker beware, most folks who have never been a caretaker have good intentions, but they just don’t get it. Someone who has never used a spin Brush before sure won’t start if they have dementia.
Dad still needs to get a cap for the front tooth, and had 3 cavities! My family had neglected his dental needs for 4 years. Sad but true. There is a product called Biotene, which some caretakers may find helpful, also.
Please keep him in your prayers.
May our all-loving and merciful God, who created our bodies, bless our loved ones bodies as we care for each of their needs. Continue Lord, to help us.
A family member,
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on February 6, 2012 - by Nurse Virginia
HOW TO PROVIDE DENTAL CARE TO THE ELDER WITH ALZHEIMER’S DISEASE
- Practice really good oral care as frequently as possible during the early stage of the dementia process, so that the elder is able to understand what is going on, gets used to the routine and will be more cooperative later in their disease process.
- Have all of your supplies laid out before you bring the elder to the bathroom. Because the elder is in the moment, if an activity takes too long to start, the elder’s attention is distracted.
- Yawning in the elder’s face or asking the elder to “say Ah,” may help to facilitate the confused elder to open his mouth during care.
- Use a small tooth brush or children’s toothbrush, as a large brush may be uncomfortable.
- Apply the tooth paste to the brush, using a children’s toothpaste which is made to be safe if swallowed.
- Standing behind the elder to assist with brushing may be acceptable as it is generally the same strategy the dentist uses.
- Oral swabs soaked in mouthwash, can be used if a brush is rejected.
- A washcloth, soaked in mouthwash, may be the only acceptable means of oral care.
- The caregiver can try “mirroring” the oral care by carrying his or her own toothbrush and demonstrating in front of the elder. Mirroring: The caregiver models the expected response hoped for from the elder. For example, the caregiver pretends to brush his or her own teeth so the elder can reflect back, or “mirror,” the activity by brushing his or her own teeth. The caregiver drinking from a glass may be the clueing needed for the elder to take a sip from the glass and rinse his mouth.
- If removing the elder’s dentures is a problem, the bridging strategy may work. Give the elder something to hold as a distraction (it must be something they enjoy and grabs their attention) while the caregiver carefully removes the dentures.
- Check the elder’s mouth after mealtimes if she/he is at risk for:
- Removing partials or dentures while or after eating and wrapping them up, where they might be lost.
- The elder has a history of pocketing food in his/her cheeks.
- Elder has a history of getting food caught in teeth that might cause irritation, pain and agitation.
When the confused elder needs a dental appointment, inform the Dentist before the appointment, of the elder’s current dental health. (Bleeding gums, etc) Share with the Dentist the most effective approach with the elder, as well as the elder’s ability to cooperate.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
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
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