Role Reversal

Some of the toughest days for families can be the initial stages of the realization that their aging loved one doesn’t need to be alone.  Maybe it’s Dad’s reoccurring falls that are frightening or the scare of an ER trip because Mom accidentally took too much medication.  Whatever the cause for concern, don’t beat yourself up. As human beings, the aging process is difficult.  Watching our parents or other loved ones’ deal with this is altogether more trying. It becomes at times a battle of wills. It is what many refer to as role reversal.   And while it may seem like you are being paid back for your hard-headed childhood days…you must be strong and use good judgment.

First, you must come to terms with the role reversal.  It is hard for us to wrap our heads around the idea that we are now the decision maker. Now, with this in mind…tread lightly and respectfully.  We still respect our elders.  But we must respect them enough to CARE for them and make tough decisions.  It’s a difficult conversation when they don’t seem to want our help or don’t want to be a bother.  But stay strong.  It can be so trying to see our parents or aging loved ones become so vulnerable. If you have siblings try not to allow this time to be one where you pull apart or old sibling rivalries rear their heads.  Pull together rather than away from each other.  Regardless if you are an only child or have siblings, find a way to talk things out with a trusted friend.  This role reversal is tough!

STAY STRONG!  This can be hard when a parent becomes angry over independence issues but you are concerned for their safety.  Don’t cave in or just put a literal band-aid on a gaping wound.  Address the tough issues.  Avoid letting them shut you out or try and convince you that everything is fine when you know clearly it is not.  Don’t wait until you are in crisis mode before you address the issues that are at hand.

Talk to them with their physician.  Go to those appointments and help be an advocate.  Many parents welcome time with their children.  It may be that during these appointments there is information that family members are not getting the full story.  It also could be that the physician may need some information as to what is “really” going on.  Your loved ones may not always remember or understand everything their physicians tell them either.  As a complete CARE TEAM…you and your parent in conjunction with their primary care physician can make good sound choices.

Role reversal is no walk in the park.  But much like raising children can be so incredibly tough…tending to aging parents in role reversal can be gut-wrenching because we view them as well…the parent.  Remind them how much you love them.  Be nurturing and be kind.  Let them know that you want to help take care of them just as they took care of you. Maybe it wasn’t perfect.  But life just isn’t.  Do the right thing and seek guidance from a physician and trusted friends along the way.

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Sneezing Season

Tis the season for SNEEZING!  Many are already in the thick of it!  But allergies can be more than just a simple achooo!!!  Being attentive and proactive is key when it comes to seniors and allergies.  Check out this list from Christopher Randolph, MD, a member of the American Academy of Allergy, Asthma, and Immunology’s Asthma & Allergic Diseases in the Elderly Committee be informed and ready to conquer allergy season.

  1. Randolph offers the following suggestions to help caregivers make allergy season more bearable for their loved ones:
  2. Look for the signs.Allergies don’t discriminate between the young and the old. Dr. Randolph says that people falsely assume the elderly do not get seasonal allergies when they are just as likely as anyone else to be affected when spring blooms begin to appear. In fact, adult-onset allergies are not unusual. Caregivers should be on the lookout for the traditional signs like sneezing, a runny nose, and itchy eyes so they can nip them in the bud.
  3. Inform their doctor. Randolph points out that it can be difficult for a physician to diagnose allergies in older individuals, especially when they’re focused on catching and managing larger health issues. Allergy symptoms can easily take a backseat to more weighty symptoms, like pain, depression, and changes in memory.
  4. Be aggressive.“Allergies have a larger impact on the lives and health of the elderly,” explains Dr. Randolph. It makes sense; allergy symptoms, such as a nasal congestion and an irritated throat can be extremely dangerous for seniors with pre-existing cardiovascular problems or lung disease. This is why Dr. Randolph feels that allergies in the elderly should be treated as rapidly and aggressively as possible.
  5. Avoid traditional antihistamines.Antihistamines, the class of drug most commonly prescribed to treat allergies, can be dangerous to seniors. Potential side effects from these medications, especially older varieties, include confusion, drowsiness, urine retention, dry mouth and eyes, and dizziness. In addition to these symptoms being irritating, they can contribute to dangerous falls and even urinary tract infections (UTIs). Furthermore, Dr. Randolph says that antihistamines can potentially cause changes in mood or behavior in the elderly and may lead to dangerous interactions with other commonly prescribed medications.
    Instead of reaching for an over-the-counter antihistamine, speak with your loved one’s doctor or pharmacist about alternative allergy treatments. They will likely recommend a nasal steroid or some form of topical medication.
  6. Try drug-free solutions.Seasonal allergies are triggered by increases of pollen and mold in the environment. Minimizing exposure to these allergens is an obvious way to avoid bothersome reactions. This is not always easy, but a few lifestyle changes can help.
    Getting outside to breathe in the fresh air, exercise and soak up a little sun is very important for seniors, but doing so during allergy season can leave them feeling worse afterward. Weather forecasts these days typically include a pollen count or allergy forecast. Use this to your advantage and try to avoid planning outdoor activities for when outdoor allergens are particularly high. If you and your loved one must go outside, remember to wear sunglasses to avoid eye irritation. As soon as you come home, make a point of washing your hands, showering and changing into fresh clothes to avoid introducing allergens into the house. If you and your loved one enjoy opening the windows for fresh air, try to do so only on low pollen days as well.
    Make sure that your air conditioning unit is serviced regularly and equipped with a High-Efficiency Particulate Air (HEPA) filter that can remove allergens from outside air to keep them from entering and circulating around the house. If your loved one also has indoor allergies to things like dust and pets, they may benefit from using an air purifier.

 

 

Dealing With Diabetes

Both average life expectancy and the prevalence of diabetes are continuing to rise.

For seniors, type 2 diabetes is a growing problem, and a larger proportion of newly diagnosed diabetics are older in age. Treating and diagnosing diabetes amongst the elderly can be a challenge. Since April is National Defeat Diabetes Month, let’s look at how this impacts seniors specifically.

So, what are some differences in diagnosing diabetes among the elderly when compared to diabetes in the young?

1. Elderly people who are at risk of developing diabetes, or who have already developed the disease, may not exhibit the classic symptoms expected.

2. Age-related changes can mean that some symptoms will be masked, or harder to spot.

All diabetes complications can occur amongst older patients. Cognitive complications are more common amongst the elderly. Further problems may include pre-existing or co-existing health problems. Many elderly diabetic patients are pre-disposed to hypoglycemia. Understanding diabetes is an important step. Education, of both the patient and caregiver, can be important in recognizing warning signs before a crisis occurs.

According to the American Diabetes Association, “Diabetes is a common disease, yet every individual needs unique care. We encourage people with diabetes and their families to learn as much as possible about the latest medical therapies and approaches, as well as healthy lifestyle choices. Good communication with a team of experts can help you feel in control and respond to changing needs.” It is important to have regular checkups with your primary care physician and communicate any concerns. Dealing with diabetes will be so much easier when you have a team approach.

Epidemic Proportions

Recently I was helping a young lady prepare an answer for a pageant onstage question.  The question was, “What is a news story that you are following and what is your opinion on the matter?”  After digging into the headlines, I landed on a topic that for me hit a little close to home.  The topic…opioid addiction.  I have typed this out and backspaced and stared at the words more times than I care to admit.  Years ago, I went to great lengths to make sure that absolutely no one knew that opioid addiction was a subject I knew anything about.  But sadly, I know all too well.  Not on a personal level.   But I guess observing the effects of addiction ravage your father’s body and mind are a bit personal.  My Dad died in 2001 at the age of 56 years old.  Now that I am 42 years old…I realize just how young he was when we lost him.  His official cause of death was renal carcinoma (kidney cancer).  But I know that his life was cut short due in part to the large amount of prescription pain killers he took every day.  He was an addict and he knew it.  We all knew it and it wreaked havoc on our lives.  Opioid addiction is an epidemic that affects many different age groups and the elderly are not immune to this problem.

Agingcare.com reports that 40 percent of the prescription drugs sold in the United States are used by the elderly, often for problems such as chronic pain, insomnia, and anxiety. According to the National Clearinghouse for Alcohol and Drug Information, as many as 17 percent of adults age 60 and over abuse prescription drugs. Narcotic painkillers, sleeping pills, and tranquilizers are the most commonly abused medication types.  When drugs come from a doctor’s prescription pad, misuse is harder to identify. We assume that pharmaceutical drugs are only used for treating legitimate medical conditions, and this is typically how seniors begin using these drugs. Doctors often prescribe older patients medications to help them cope with age-related physical and mental changes, such as depression, limited or painful mobility, and shorter, more irregular sleep cycles. Over time, seniors may develop a tolerance to a drug, so achieving the same “coping” effect requires larger and/or more frequent doses. The result is an inadvertent addiction to a specific medication.

Questions to Ask if You Suspect Prescription Misuse or Abuse

  • How much are they taking? If Mom used to take one or two pills a day, but now she is taking four or six, that’s a red flag. Looking at the dosing instructions on the pill bottle or container can give you a clue whether they are abiding by the prescriber’s instructions.
  • Has their behavior or mood changed? Are they argumentative, sullen, withdrawn, secretive or anxious?
  • Are they giving excuses as to why they need their medication?
  • Do they ever express remorse or concern about taking their medicine?
  • Do they have a “purse supply” or “pocket supply” in case of an emergency?
  • Have they recently changed doctors or drug stores?
  • Have they received the same prescription from two or more physicians or pharmacists at approximately the same time?
  • Do they become annoyed or uncomfortable when others talk about their use of medications?
  • Do they ever sneak or hide their meds?

 

How to Help a Loved One Manage Their Prescriptions Responsibly

  • Stay as connected as you can and make sure you know what medications your loved one is taking and why.
  • Check that they are following the prescribed dosage(s).
  • Encourage them to use painkillers and sedatives only when necessary and to taper off as soon as they can.
  • Look for alternative treatments. If a senior has an ongoing problem with pain, for example, a pain management specialist may be able to suggest strategies for controlling it without drugs.
  • Remind them to always avoid alcohol when taking painkillers or sedatives.
  • Encourage them to bring all their medications to their doctor when they go for their annual checkups, so the physician has an up-to-date record of exactly what they are taking.

If you suspect your loved one may be misusing or abusing their medications, consult with their prescribing physician to devise a solution. It may be useful to inquire about psychological tests to check for mood or behavior disorders and research treatment facilities that specialize in programs specifically for seniors. Many insurance plans cover stays at in-patient addiction centers.  It is difficult to face these problems, but the repercussions of sticking your head in the sand is worse for them and you.  Addiction is not something that happens only to the addict.  It affects the entire family.  Don’t just try to sweep problems under the carpet.

Need help???  Get help!!

The Substance Abuse and Mental Health Services Administration (SAMHSA’s) (National Helpline, 1-800-662-HELP (4357),(also known as the Treatment Referral Routing Service) is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations. Callers can also order free publications and other information.

 

 

 

 

 

 

 

Tick, Tock…Time to Move that Clock!

Spring forward sounds so chipper.  My last blog detailed the fact that I don’t sleep very well. I’m not so sure how much “pep in my step” I will have when we lose that hour of sleep this coming weekend either.  But it’s not just the grogginess that comes with the time change.  According to statistics, due to the loss of sleep and increased stress from exhaustion, automobile accidents and heart attacks increase dramatically. Scientists have found that on the Monday after Daylight Savings Time begins heart attack rates increase by an astonishing 24 percent.  But take heart! These practical tips can help avoid knocking your natural circadian rhythm completely out of whack.

Tips for adjusting to daylight saving time from agingcare.com

  • Get some sun: Exposure to natural sunlight helps regulate your body’s natural rhythms. Depending on where you live, the weather may be too cold to spend too much time outside, but you can at least pull up the shade and sit in front of the window for a few minutes.
  • Work up a sweat: Engaging in some form of cardiovascular exercise (walking, jogging, biking, swimming) in the late afternoon or early evening may help you fall asleep easier.
  • Develop an appetite for good sleep: Eating and drinking can actually disrupt your sleep. Plan to finish meals and snacks 2 to 3 hours before bedtime because digestion wakes up your body. Alcohol and caffeine are also “sleep interrupters” when consumed before bed. Limit caffeine to the morning and finish your alcohol consumption by early evening. Smoking before bed can also stimulate your body and make it hard to sleep.

It’s important to keep in mind that seniors may need more time to adjust to the transition. What is a minor annoyance for most adults could present a significant obstacle in the routine of older adults, particularly those living with dementia or other cognitive impairments.  Be sure to check on these individuals and make sure that they are getting adequate sleep and seek medical advice if you notice a problem.  Take small steps to prepare for the change for you and your loved ones and enjoy the longer hours of daylight and the warmer days.

 

 

Tea Party Treat

Across the state at our communities we are making time for tea to celebrate!  We are planning these tea parties to toast our excellent communities and the residents, staff and families that make them so special.  In honor of this Tea Time, this week the blog will feature a recipe that is a must for your party menu.  Many thanks to Donna Burch the daughter of our resident Opal Newsome for sharing this delicious recipe with us.

STRAWBERRY PRETZEL SALAD

2 C. pretzels, coarsely crushed                       ¾ c. melted butter or margarine

3 T. sugar (for crust)                                       1 (6-oz.) pkg. strawberry Jello

1 c. sugar                                                        2 (10-oz.) pkgs. Frozen strawberries

1 c. boiling water

1 (8-oz.) ctn. Cool Whip

1 (8-oz.) pkg. cream cheese, softened

 

Mix crushed pretzels, butter and sugar; press into bottom of a 9X13-inch pan.  Bake at 400 degrees for 8 minutes.  Cool completely.  In another bowl beat cream cheese and sugar until well blended.  Stir in carton of Cool Whip.  Then spread onto cooled crust.  Dissolve Jello in 1 cup of bowling water.  Then stir in strawberries and let stand 10 minutes.  Pour this mixture on top of cream cheese mixture in pan.  Chill in refrigerator.  Makes about 12 servings.

Opal and family

Pictured are Mr. Charles Burch, our resident, Mrs. Opal Newsome and her daughter Mrs. Donna Burch

Preparation for the Situation

When it comes to emergency room visits, I probably have been more times than the average person due to the nature of my job.  But this year with the flu hitting near epidemic levels not only just in Alabama but also nationwide, emergency room visits have been experienced by many.  Trips to the ER can be a scary situation at any age.  The ER can prove particularly challenging for the elderly.  Here are some suggestions to help you keep it cool when you find yourself in the hot seat taking a senior loved one to the ER.

Emergency Files

The first week on the job as a brand-new administrator I found myself headed to the ER following an ambulance with one of my residents who I had obviously just met that week.  Now mind you, I had called their family and notified the proper folks of the situation.  But for a short time, it was just me and this resident (who was experiencing chest pains) in a room in the ER as they were being seen by the doctors and nurses.  I was grateful for a paperwork process that was in place in our community so I had the answers to the questions that were being asked by hospital personnel.   We use what we call an Emergency Red File for each resident in our community for such an occasion.  Inside we keep copies of the residents’ most recent medical exam and plan of care, insurance cards and other ID as well as advance directives and Power of Attorney documentation if they have them.  It is called a red file because well, it’s red in color.  Our local hospital staff has gotten very acclimated to our “red files” and it makes registration and getting medical staff some initial information on the resident so much easier.  It also helps keep the resident calm because they aren’t having to give answers to so many questions.  Our families appreciate this as well. They are usually a barrel of nerves at the call that their loved one is being taken to the ER anyway.  It is a relief for us to go ahead and have all of this information readily available.  Most regulations require assisted living communities to have this as part of the chart and way.  It is so much easier to have this type of file ready to go at a moment’s notice versus stopping to make copies.  We just make sure to secure them in a safe location, update them as appropriate and add the most recent medication list at an emergency occurrence.

Pack like a Pro

In addition to an emergency file, having a small bag packed is a huge help. I have been in situations where family members couldn’t get to the hospital that day due to travel outside the country, illness and more.  I’m typically going to ensure that the resident has someone with them to be there and comfort them and so that I can get the information to pass along to the family.  That is why having a bag packed and ready is a huge help.  Now, this bag doesn’t need to be big and bulky or loaded down and cumbersome.  But there are a few items I would suggest to take to help the resident and you be set up for as smooth “as possible” visit to the ER.  Some things to consider packing include:

  • Depends (pads, etc) for residents that require them
  • Snacks (for both you and the resident)
  • Phone charger
  • Small blanket
  • Water bottle(s)
  • Wipes
  • Ziplock bag

Now I know that most hospitals can provide you with many of these items.  But it doesn’t take much preparation to have these things ready to go. Sure, there are some emergency situations that emotions will be high and some of these items will be the last thing on your mind. But if you make gathering this and your emergency file part of your process, they can make a tough situation a little more bearable.  Remember that these items may be necessary for your resident and you.  So, pack accordingly.  I suffer from migraine headaches.  My triggers for them include multiple things.  But ranking up pretty high include:  stress, dehydration and skipping meals.  I’m no good to anyone else and can’t take care of them if I don’t take care of myself.  I say all of this to say that proper planning can help you be more effective to your residents and their families.

Blog note*

At present date, the Alabama Department Health has made the following recommendations regarding visiting the ER or doctor’s office for FLU RELATED ISSUES:

“For people with mild to moderate flu or flu-like symptoms, please do not go to your doctor’s office without calling first and do not go to the emergency room. Please call your doctor to see if you are eligible for antivirals without an appointment. Many insurance companies now have a “call a provider” service to help with mild to moderate illnesses; please take advantage of this service before going to doctor or hospital.  Mild to moderate cases of the flu usually do not require a hospital visit. Patients who do visit an emergency department or outpatient clinic should be aware of long wait times.” 

As with all emergency situations use your best judgment, especially when it comes to an elderly person who may have a reduced immune system.

 

Understanding SADness

Depression is a condition that affects many people of all ages around the world.  Over the years, I have experienced within our community just how difficult and debilitating it can be for some of our elderly in the winter months. Winter SADness…or Seasonal Affect Disorder is not just a bad or sad mood.  It is a real health issue and as with any type of depression, it is important to be aware and seek medical intervention when necessary.  The National Institute of Mental Health gives this explanation and as well as symptoms and treatments:

Seasonal Affective Disorder (SAD) is not considered as a separate disorder. It is a type of depression displaying a recurring seasonal pattern. To be diagnosed with SAD, people must meet full criteria for major depression coinciding with specific seasons (appearing in the winter or summer months) for at least 2 years. Seasonal depressions must be much more frequent than any non-seasonal depressions.

Symptoms of the Winter Pattern of SAD include:

  • Having low energy
  • Hypersomnia
  • Overeating
  • Weight gain
  • Craving for carbohydrates
  • Social withdrawal (feel like “hibernating”)

Treatments and Therapies:

There are four major types of treatment for SAD:

  • Medication
  • Light therapy
  • Psychotherapy
  • Vitamin D

These treatments may be used alone or in combination.  Along with the difficulties that a chronic illness can bring, seniors are also likely to experiences losses in the social networks, which can contribute to the formation of clinical depression.  Not everyone who experiences Seasonal Affect Disorder is clinically depressed, but SAD can increase the effects of those who do live with chronic depression. Families and caregivers should be on the lookout for indicators of SAD in their older loved ones during the winter months.

It is important to talk with your loved ones if you have concerns about their mental health and seek medical attention when necessary.  Be supportive, be loving and help them remain calm as they cope.

hold hands

Special Letter to Santa

Dear Santa,

Who are you? Why do you always show up at Christmas celebrations?  We don’t see much of you any other time.

As a child, I saw you as the maker of every kind of wonderful toy in the world.  Creations from baby dolls and teddy bears, to roller skates, scooters, bicycles and balls of every shape and size.

You kept a complete list on every child reminding you of our every deed, both good and bad.  Nothing could make me angry faster than those “smart aleck” kids who claimed you did not exist.

At our house we started a “wish list” early… teaching us not to expect instant gratification, which in some instances allowed us to change our minds!  When the winter nights were getting longer we found ourselves glancing out the window if we saw any movement or strange light.  We knew it was Santa watching us, making sure we were doing as we should.

We got many gifts, but there were always a few things we didn’t find in our stocking or under the tree. This made us wonder if it was because of something we had done wrong, or if you simply ran out before you got to our house.

It took years and a family of my own for me to realize who you really are and why you were created.

The cookies and milk which have kept you “rotund” all these years taught us to show appreciation to those who gave to us.  As children we set them out just before bedtime as our thank you for what we were expecting to receive.  Parents were able to help us develop our imaginations and enjoy “make believe”. They could show surprise and help us enjoy some of the new toys and games.

Most of us, through the little birthday parties we would attend, soon realized that we bring gifts so that other kids will bring gifts to our party, if we bring one to theirs.  That’s the way the big world works.

Jesus’s birthday is so much different.  Jesus’s birth taught us that it is more blessed to give than to receive! In man’s way of trying to figure out how to accomplish this idea of giving, someone came up with a jolly, round fellow dressed in a red suit trimmed in white fur.  He has been given several names including St. Nicholas, Father Christmas and finally Santa Claus. This is the name we have given the “Christmas Spirit”.  It’s much more exciting than just calling it a gift from an unknown source.

WE all get the joy when we finally recognize who Santa is and God gets all the glory!  I like to think that the idea of Santa always giving gifts without the expectation of a gift in return…is in a small way the essence of Jesus.  Isn’t that why we celebrate Christmas…to give God the glory!  This is my point of view as a great-grandmother looking up from my rocking chair.

Thank you for sharing your love and our joy!

Marguerite Klages

Klages Santa 2017

Pt for Me?

It’s been about four years since I had my shoulder surgery.  It was by far not my first surgery, but it was the first procedure that I recall having intensive physical therapy.  Now granted, I’m in my 40s, but I truly believe that the success that I experienced with my shoulder recovery was due largely in part to my “buy in” to doing physical therapy. October is National Physical Therapy Month.  Physical therapy for the elderly can be such an important part of the healing process as well as a factor in continued health.

The following is helpful information for seniors and the advantages of physical therapy interventions per medicine.jrank.org:

  • Physical TherapyPhysical therapy has an important role in healthcare delivery and relates to maximizing function, preventing decline, decreasing pain, and treating physical illnesses. For elderly individuals, who often have decreased physical reserve, any medical illness or injury can lead to decline. Inactivity and bedrest, a common consequence of illness or injury, contributes to and intensifies muscle weakness, causing deterioration in walking and loss of function.

 

  • Illnesses, such as Parkinson’s disease, fracture, or stroke, can affect walking and balance directly. Chronic diseases, such as arthritis, may cause pain or restriction of movement. Exercise, activity, and other physical therapy interventions can, therefore, have a profound effect on overall health, restoring an individual’s ability to perform the daily activities required to live independently in the community.

 

  • The physical therapist typically works closely with other healthcare professionals, such as nurses, physicians, social workers, and occupational therapists, to refine both diagnosis and treatment. This interdisciplinary approach allows for the integration of all domains of health to more fully address the needs of the elderly.

 

If you or someone you know can benefit from physical therapy for strength and healing contact your primary care physician to see what options may be best for you.