Friday, January 17, 2014

Medical Alert Systems Bring Peace of Mind

Living safe and independent is an important factor for our ever growing senior population.  However statistically speaking, one out of three people over age 65 will fall this year causing life threatening injuries.  Great suffering occurs when injuries prevent a person from getting to a phone to call for help; this can last for several days and even cause death.  Despite all the fall prevention interventions we can take, some falls are unfortunately inevitable. A medical alert system acts as a safety net to get immediate help when falls or other emergencies occur so that early intervention minimizes complications and facilitates recovery.  These systems are available locally or nationwide to give seniors and their families peace of mind knowing that with just a push of a button, they will receive immediate help.  In doing so, Medical alert systems can support seniors to remain at home for longer periods of time with increased safety.

  • Decreased anxiety of being alone
  • Decreased dependence on others
  • Enhanced well-being and quality of life
  • Easy to operate with just pushing a button
  • Psychologically reassuring by maintaining control
Operating the Medical Alert System:
Typically the system includes a help button worn around the neck or wrist allowing the user to request help when there is a medical emergency.  The lightweight, waterproof pendent allows freedom of movement within the home without the need to reach a phone.  The base unit simply plugs into a telephone jack and electrical outlet.  No special wiring is needed. 

A 24hour staffed monitoring service receives calls from the base unit when its activated by the button on the pendent.  Once activated, two way voice communication is established as the live monitoring staff will attempt to speak to the user over the base unit speaker; if the user does not answer, they will contact designated family/friends or alert emergency medical personnel.  If the user responds, the monitoring staff can determine the type of help needed and appropriate action. 

What to look for when choosing a Medical Alert System:
  • UL listed 5 diamond certified 24 hr monitoring service
  • Waterproof pendants that are not easily activated in error
  • Base unit battery back-up
  • Low installation costs with no long term contract
  • Low monthly fees

Medical Alert systems are not just for frail elderly, but for anyone living alone who wants to have peace of mind and increased safety from unexpected medical emergencies or falls.  Families can also be confident their loved ones are in good hands while still allowing them their freedom and independence.  No more frequent wellness check calls to loved ones, everyone can have peace of mind when medical alert systems are in place.

Thursday, December 5, 2013

Age Related Health Changes and 12 Things We Can Do

Pronounced health changes are more obvious in advanced ages of 85 and older but there is also a great variability among all individuals depending on the impact of genetics, lifestyle factors, response to illness and even stress.  It is always a pleasure to see an active, vibrant, high functioning person in their 90's enjoying quality of life in their community; they serve as a positive role model for us all, giving us hope to join the growing number of healthy centurions in our current population.  Sadly, others in their 50's and even younger succumb to a lesser ability to function and must manage a poor quality of life often in a medical institution.  Normal aging brings causes the following normal changes:

Cardiovascular system: Arteries and heart valves become thicker and less pliable; diminished peripheral pulses and circulation. A decline in body temperature is noted as the baseline oral temperature in older adults is 97.4F versus 98.6F in younger adults.  There is a higher risk for fluctuations in Blood Pressure, arrhythmias, or syncope.

Pulmonary system: Respiratory muscle strength becomes weaker, mucus membranes drier and cough reflexes begin to diminish.  Our bodies are less tolerant for exercise, higher risk for aspiration, night time breathing issues and ability to fight upper respiratory infections.

Genitourinary system: Overall a decrease in creatinine clearance due to changes in kidney mass, blood flow and drug clearance.  Decreased bladder muscle tone, capacity and hormones cause higher urine residuals post voiding and increased night time urination.  There is a higher risk for adverse drug reactions, renal injury, dehydration, hypo/hypernatremia, hyperkalemia, volume overload causing heart failure, urinary urgency or incontinence, urinary tract infections and even potential for falls.  For men, a higher risk of enlarged prostate.

Integumentery system: Loss of collagen causes thinner, drier skin with less elasticity which is more prone to sunburn, cuts, tears and abrasion.  Overexposure to the sun earlier in life can cause skin melanoma later in life.

Musculoskeletal systems: Muscle mass and strength decline throughout the whole body.  Lean body mass is replaced with fat and redistributed.  Bone loss especially in women causes osteoporosis; tendons and ligaments become tighter, less flexible.  Intervertebral discs shrink and degenerate, cartilage erosion and changes in posture  may occur with a reduction in height or posture.  These changes not only limit our joint flexibility and range of motion but also increase our risk of falls, unsteady gait, bone fracture, joint inflammation and arthritis.

Oral-Gastrointestinal systems: Even the oral muscles of mastication become weaker along with dental changes cause difficulty chewing or receiving adequate nutrition.  Our perception of taste and thirst becomes impaired.  There is decreased motility throughout the gastrointestinal system causing slower stomach emptying, impaired defecation and malabsorption of nutrients.  The liver has a decreased ability to metabolize medications.  This places us at higher risk for adverse drug reactions, constipation, GERD, or NSAID-induced ulcers.

Nervous system and Cognition: Aging causes a decline in the number of neurons, support cells, synapses and neurotransmitter chemicals produced.  This contributes to overall muscle weakness, decline in reflexes, slowed motor skills and potentially impaired balance and coordination.
Temperature sensitivity is diminished and there may be a blunted or absent fever response.  Cognitive processing is slowed and some decline is common but not universal.  There is a lesser need for sleep time but a higher risk for sleep disorders, delirium and neurological diseases.

Immune system:  Dysfunction of the immune system will increase the susceptibility to infection while increasing the risk of chronic inflammatory diseases.  There may even be a reduced efficacy of vaccinations. 

  1. Get annual wellness dental and medical check-ups to monitor age related changes, obtain early intervention/prevention which will minimize risk factors that could be corrected. Obtain annual preventative testing for early detection of disease: i.e.. Mamography, lab tests.
  2. Consider lifestyle changes that will promote healthy successful aging. ie stop smoking, minimize alcohol intake, reduce stress.
  3. Keep immunizations current.
  4. Emphasize weight bearing exercise, strength and overall fitness: walking, weight training are the best, while swimming, cycling and aerobics are good too.
  5. Emphasize stretching all joints and maintaining an erect posture: Yoga is great!
  6. Exercise your brain cells with memory and analytical games: Puzzles, Crosswords, Word finding, mathematics, reading and other intellectual stimulation.
  7. Eat a well balanced, high fiber diet along with vitamin supplements.  Monitor and maintain a healthy weight.  Women should supplement their diet with 12-1500mg Calcium and 1000 Vitamin D daily.  Check with your doctor regarding recommended vitamin supplements specific to your needs.
  8. Stay well hydrated with water.  Minimize soda, caffeine, alcohol consumption.
  9. Remove household trip hazards such as area carpets, long cords and keep a safe pathway from bed to bathroom especially for night time toileting; consider night lights along this path.
  10. Practice good sleep hygiene. 
  11. Monitor skin for changes that may require medical attention, use daily body lotion.
  12. Know and examine your body from head to toe; question if changes seem to be normal or abnormal.  Question if suggested medications are right for you.  Keep a record of your personal health history and current medications readily available for doctor visits or in case of any emergency.

Tuesday, October 8, 2013

Determining what Elder care is needed & considerations for placement

Caring for an aging parent, spouse, partner or close friend presents difficult challenges – especially when a crisis hits and you are suddenly faced with the responsibilities of elder care. Perhaps your  mother fell, is hospitalized with a broken hip and needs to go to a skilled nursing facility to recover.

Caregiving can also begin as a result of unsettling warning signs that indicate a need for some sort of intervention.   Perhaps your elderly spouse has wandered off and gotten lost. Or a friend has lost a lot of weight and rarely leaves home. You may be the only person to step in and become the caregiver. Or, you may be the key in a network of family members and friends willing to help. Whatever the situation, you may not be sure of the next step to take.
What kind of help does your loved one need? Perhaps there are underlying undiagnosed causes that can be corrected.  For example, prescription drugs interactions/side effects, Vitamin B12 deficiency, dehydration, low thyroid, urinary infection and other treatable problems are often mistaken for Alzheimers  or  dementia. According to Consumer Reports on Health, "Any new health problem in an older person should be considered drug induced until proven otherwise." A visit to the primary care physician is critical to rule out any underlying causes and determine the best approach to care.

If the problem is not correctable, what living arrangements are available for your loved one? What nursing care plans are most appropriate? If they are able to remain in their own home, what kind of services can be arranged? Is assisted living preferred over a nursing home? What challenges does your loved one's condition pose? How will both parents get their needs met when they both need different levels of care?  What community resources are available? How will you manage it all – and still maintain a life of your own? Who will make all these decisions? 

Hopefully, the individual has made good life preparations by having a POLST and durable power of attorney for healthcare and financial matters already established.  If not, these documents should be formulated as soon as possible.  The primary care physician will assist in obtaining the POLST form which indicates the person's personal preference for resuscitate or Do Not resuscitate.  Family members often self-designate one responsible person to make the financial and healthcare decisions, or, they may utilize group consensus. 

Of course, each elder care situation is unique. Your loved one's medical condition, financial resources, personality, personal wishes, relationships with potential caregivers, geographic proximity to services and other factors all determine what best approach to take. There is no place like home or maintaining one's usual routine, but when a change of medical condition occurs compromises must be made in order to provide optimal care within your loved one's financial constraints.  If the condition has potential to improve, it is wise to consider temporary measures that can easily transition to permanent if needed.  Conditions requiring daily skilled nursing and/or therapies should be cared for in a Skilled Nursing Facility.  If nursing and therapy is required on an intermittent or several days/week basis, then return to home with home health support services could be considered. 

Meeting one's daily needs at home despite not needing a nurse or therapist can be challenging.  There are meals to prepare, housekeeping, bills to pay, medicine to refill and dispense, personal care to manage and transportation to arrange.  Those who are alone could be monitored with safety monitors or periodic visits and phone calls, but often times isolation becomes problematic.  If care and supervision needs are overwhelming for family/ friends or other providers to safely accomplish within your loved one's budget, then placement out of the home should be considered.

 RCFE's (Residential Care Facilities for the Elderly) can be large communities, or small 6 bed homes; many offer dementia and hospice care.  Those key people who are involved in placement decisions should weigh future needs (depending on the disease process) to minimize the trauma of any future transfers.  Physical and mental needs as well as compatibility with others are important when looking at any communal living situation.  Look closely to the daily program, menu and services to determine if there is enough structure and flexibility to meet your loved one's current and future needs.  Meet the administrator and staff; are they loving, caring, patient, consistent and communicative?  Don't be tempted to make your decision based solely on the look of the room or the building.  Ask how your loved one will get to medical appointments or receive hair/nail care.  Will the program satisfy all the physical, mental, social, emotional and spiritual needs?

Minimizing the institutional nature of a facility while maximizing dignity, choices and quality individualized care can be challenging when caring for those with complex medical conditions including dementia.  When your loved one's condition requires a higher level of care that cannot be safely or appropriately managed in an RCFE, placement in a skilled nursing facility will be necessary.  Another close look at the daily program, menu, services and staff in addition to the environment and activities will help you decide if the facility will be compatible for the patient as well as the family.  Make sure the location is convenient for family and fiends to easily visit, and that your preferred physician will be able to continue providing care.

Please note that referral agencies may be timesaving and helpful in narrowing your choices, but they do not guarantee personal knowledge of the properties and may engage in unfair commission practices or have a conflict of interest with preferred properties.  Facility or healthcare insurance social workers may be more fair and accurate in their suggestions; asking local agencies on aging or recommendations from other friends/family members can also assist in guiding you. Take your time, tour more than three facilities and meet with as many staff and administrators before making your decision; you will be establishing a new relationship with the facility & staff that will hopefully last for many years. 

Please feel free to visit my website to compare what RCFE small 6 bed facilities can provide for your loved one.  We provide service with personal attention and dignity, loving caring staff and the facility is managed with program structure/customized approach to aging in a home environment.  We cultivate an atmosphere of friendship, comfort and consideration of our residents, visitors and neighbors.  We encourage an independent lifestyle for those with even complex medical conditions so that our residents can maintain their independence while leaving the difficult tasks of daily living to our dedicated and competent staff.  This is the standard you should seek when determining what care is needed for your own loved one.


Friday, September 27, 2013


Anyone with acute or chronic confusion may become more confused, restless, agitated and anxious in the late afternoon and especially after dark when the sun goes down or seasonally when there are fewer hours of sunlight.  This may happen whether the person is living at home ore in a facility.  The sundowning behavior can worsen following a move or change in routine.  Individuals with sundowning behavior become more demanding, upset, suspicious, disoriented and see, hear, believe things that aren't real or pace/wander.

Those with Alzheimer's Disease act as if their biological clocks are "reset."  These individuals may stay up all night alert and full of energy despite all interventions to encourage them to sleep in bed; then, they will continually doze on/off during the day.  The reasons for these changes in the sleep-wake cycle in Alzheimer's Disease is not known.

The reason for sundowning behavior is also not known. One theory is that there are fewer environmental clues at night when daylight and eyesight is diminished.  Some scientists believe it may be related to the biological clock in the brain which regulate the amount of hormones and other chemicals important for brain function.  If the biological clock is not properly functioning, the brain itself may not be able to properly function as well.

What can be done for those with abnormalities to the sleep-wake cycle?  It can be a very frustrating problem to deal with, but the following suggestions may be worth a try:

1) ACCOMODATE TO THEM.  Granted, this may be the most difficult and costly approach.  Accommodating to the person's new routine must include keeping them in a locked/secured environment and awake night staff for full supervision as well as ongoing stimulation during their awake periods. They could rest and snooze throughout the day to insure they are adequately rested.

2) MEDICATIONS.  It may be appropriate for the doctor to review all medications to consider discontinuing any non-essential medications which may have an effect on sleep.  Other medications that may reduce anxiety, relax muscles or induce sleep may be considered.

3) ASSESS PAIN.  Pain keeps people from sleeping, or may wake them up from sleep.  With some forms of dementia, communicating or expressing one's pain may be impaired.  Those with complex medical problems in addition to dementia may also be affected by musculoskeletal or other source of pain.  In some cases, a trial of a relatively benign pain medication such as Tylenol may be justified.  If sleep problems are in part due to arthritic pain, aspirin or Tylenol may decrease musculoskeletal pain so that the person can sleep more comfortably.

4) ADDRESS NIGHT TIME TOILETING.  Many older persons awaken many times a night to urinate and then are unable to return back to sleep.  Identify if there might be a urinary infection, provide a bedside urinal or commode to minimize walking through the house activity.  With less physical activity involved to manage night time urination, individuals may fall back to sleep more easily.

5) UTILIZE NIGHT LIGHTS.  Elderly individuals may also have low vision which is exacerbated at night.  A small night light helps to orient and minimize agitation if the individual wakes up and becomes frightened by strange surroundings.  Night lights can also be placed to mark the pathway to the bathroom.

6) KEEP A STANDARD, DAILY ROUTINE.  While caregivers may change from day to day, it is helpful to keep a standard daily routine for any individual with dementia.  A standard daily program for wake-up time, meals, medications, toileting and bedtime routines should be followed by all caregivers to provide consistency.  The daily routine should also include physical activity and other mentally stimulating activities which will help to reset the awake-sleep cycle as well as maintain optimal function. A consistent program reduces anxiety so that an individual will also learn to anticipate what will happen next rather than begin to worry or become anxious wondering when they will eat, get their meds, toilet or go to bed.  Make a written program which is followed by all caregivers 7 days/week.

Wednesday, September 18, 2013

Dementia: When to worry

Have you ever gone to the pantry to get something then can't remember why you went there?  Can't remember where you put your phone or keys?  Have trouble remembering someone's name?  Are you worried about your memory?  Then join the crowd and perhaps worry less.  The type of memory problems described above are entirely consistent with normal brain function in someone over 55 (or younger) and are in no way indicative of dementia.  Many people consult doctors about their poor memory and are concerned they may be in the early stages of dementia.  If YOU ALONE are concerned about your memory, there is most likely less concern about dementia than if close family members are concerned.

True dementia does involve short term memory loss with retention of long term memories, but it's more than just that.  In general it can be said that dementia involves memory impairment PLUS some inability to function independently in one's daily routine, social activities, or relationships.  These independent functions might include:
  • Impairment of complex tasks such as balancing a checkbook
  • Impairment of reasoning such as difficulty dealing with new and unfamiliar situations
  • Impaired spatial functions (Dementia testing often will involve asking the subject to draw a clock face with a given time on it, or copy a pattern on paper)
  • Impaired language such as using the wrong words to describe things
Of those who have  dementia, about 70% have Alzheimer's disease, 10-20% have Vascular (stroke related) dementia and 10-15% have Lewy body dementia (an accelerated form of Alzheimer's).  Other diseases such as Parkinson's or brain tumors can also result in related dementias.

Dementia-like symptoms that can appear to be similar in behavior (but are not) can include age related mild cognitive impairment (MCI), delirium or depression.  Those with simple age related cognitive impairment may have some memory difficulty and they may think a little more slowly, but the ability to function with day to day activities remains intact.  Patients with delirium have a sudden onset of new mentation symptoms and this is usually reversible. On the contrary, the onset of dementia is gradual and will worsen with time.   Depression can also mimic dementia-like symptoms.  Depressed individuals may perform poorly on standardized dementia tests due to lack of motivation and/or poor effort.  Medications can also create brain function changes that simulate dementia; alcohol, antihistamines, psychiatric medications, sedatives and others can impair memory and cognitive function.

Getting evaluated for dementia first involves talking to your primary care physician about your symptoms.  Then a brief brain function screening test can be administered.  If the screening test score results in a cause for concern, then blood testing for reversible causes like vitamin B12 deficiency or thyroid deficiency can be performed.  The value of brain imaging in diagnosing early dementia is controversial since the most common causes of Alzheimer's disease and Lewy Body disease will show no abnormality on imaging tests.  Neuropsychological testing is frequently valuable in anyone who is having a new brain function problem.  This testing involves several standardized cognitive skills tests administered by a neuropsychologist. 

At best, medication treatment for dementia can provide a modest improvement in symptoms and can slow down the rate at which dementia progresses.  Dementia is frequently accompanied by depression so antidepressant medication can be beneficial as well as other stimulating activities such as Physical, Occupational and Recreational therapies aimed at cognitive rehabilitation, exercise and mental stimulation. 

The benefits of social support for all individuals, families and caregivers affected by dementia related disease cannot be emphasized enough.  The prognosis from early symptoms to morbidity may last as long as ten years or more.  Joining support groups, dividing up caregiving duties and finding proper medical care or placement is imperative for the well-being of the affected individual as well as their loved ones.

Staying at home with support, placement in Skilled Nursing, Dementia Care Units or Board and Care facilities are all choices families may make for their loved ones.  Please visit the Villa Care Homes website to see how small board and care facilities can manage residents with dementia with a regimented daily program and high level of care/supervision.

Monday, September 2, 2013

Stroke Recovery: Alternative Treatments: Acupuncture

Stroke is the second most common cause of death (after coronary heart disease) and the leading cause of adult disability in the US today.  Approximately 700,000 strokes occur each year in the US leaving 500,000 survivors with residual disability.  Forty percent of those survivors have moderate impairment and functional limitations related to motor function and basic mobility, while 15-30% are severely disabled.  Physical therapists and other professionals focus recovery on relearning normal patterns of movement or facilitating a rebalance of muscle tone.  In an attempt to further improve outcomes of stroke rehabilitation alternative treatments such as acupuncture or electroacupuncture (EA) are being evaluated for their efficacy in improving functional recovery after stroke.  Acupuncture/EA has been used in eastern medicine for thousands of years to enhance stroke recovery.  It has only been in the last decade that studies of brain function with computed tomography (CT) scan and magnetic resonance imaging (MRI) has substantially expanded our understanding of neuronal recovery and their modulation by various rehabilitation interventions.

The mechanism by which acupuncture increases cerebral blood flow is not fully understood but immunohistochemical analysis in animals suggests an enhanced expression of vascular endothelial growth factor.  Clearly, post stroke outcome is dependent on stroke severity in the acute phase and that patients with intact cortical function have an advantage to better participate with motor recovery.  The location of the lesion site plays a significant role in the responsiveness to any therapeutic intervention as does the type of stroke: ischemic vs. hemorrhagic.    During the functional reorganization of  neural pathways following a stroke, therapeutic techniques rely on the neuroplasticity of the brain to achieve improved motor abilities and functional outcomes

Current evidence for clinical efficacy of acupuncture/EA for stroke recovery is promising but still controversial; it's efficacy as an adjunct to standard post-stroke rehabilitation programs can be demonstrated with accurate treatment intervention using electrical stimulation over acupuncture points, proper selection of patient and functional outcomes measures.  Additionally, acupuncture/EA may be helpful in treating pain, sleep disturbance, anxiety, depression, or other conditions which are common in stroke and often a barrier to recovery.

Sunday, September 1, 2013

92 Million Older Americans Expected by 2060

Over one in eight Americans is age 65 or older, according to the latest statistics from the U.S. Census Bureau.  The number of "older Americans" is approximately 41.4 million - an 18 percent increase from 2000.  The 65 and older population is also expected to more than double to 92 million in 2060, according to a new report from the U.S. Department of Health and Human Services entitled, "A Profile of Older Americans 2012."  The report also states that the population of those 85 years and older is projected to nearly triple from 5.7 million in 2011 to 14.1 million in 2040.

The report also provides the latest national demographic information on issues ranging from health care and health insurance coverage to disability and activity limitations for older Americans.  More information is at: Statistics/Profile/2012/docs/2012profile.pdf

The Villa Care Homes are poised to care for those with disabilities associated with advanced aging.  Our program is successful because of the consistency in care, anticipation of needs and knowledgeable, loving caregivers.  We strive to coordinate the physical, emotional, psychological and spiritual needs of each of our residents.  We collaborate as a team together with the physician, resident and family members.  Please call to arrange a tour at any time.