Friday, September 30, 2011

Caregiver Meltdown

by Amy Goyer

There I was in the middle of Sky Harbor Airport in Phoenix, when I was told I was 8 minutes too late to check my bag for the flight. I was trying to get to Indianapolis for a memorial service for my uncle. Missing a flight would upset any traveler, but my reaction surprised even me.
Total and complete meltdown.
You know the kind — sobbing uncontrollably to the point where the airline attendant had no idea what to do.
I sat down on one of those hard plastic chairs, but people began to stare, so I went into the bathroom, locked myself in a stall and sobbed with great abandon.
As I cried (and it was an all out snort-cry as my friend, Mary, calls it) and talked to my sister on the phone, I knew people could hear me far and wide. I didn't care. I was way past the point of embarrassment.
How did I get to this point? Can you say "stress?" Oh yes. Let me tell you about the prior week…..
As you know, I am caregiving for my parents. Shortly before my airport meltdown, I'd been on a business trip that kept me away for two nights. During that time, my Mom fell and my Dad developed an abscessed tooth. On top of all that, Mom developed a bad intestinal flu AND shingles!
I had stayed with them almost 24/7 all week, and we had two more emergency squad visits because my mom fell two more times, both with transport to the hospital, one at midnight and the other at 3 am. Both trips resulted in all-night ER stays and no sleep. Thankfully, no broken bones or hematoma for Mom!
One of her falls happened literally 1 minute after I left her alone in the bathroom after having gone over and over the use of her walker, always holding on to something etc. But she had gone to get something out of her closet and didn't use the walker…and fell as she turned.

Mom – always a good sport even in the ER
I felt terrible! I think I was so tired that I didn't make the best choice at that moment…a typical caregiver's lament.
She said she'd done it so many times before and it was automatic — she just didn't think about her walker. And she was so tired and depleted it's no wonder she wasn't thinking well either.
Well the good news is, I finally stopped crying at the airport, got a flight the next day…and got some sleep.
Mom is getting better, and I arranged for help from my niece and sister and my wonderful concierge, Debbie. So I went off on another business trip…so far no more falls or ER visits! Mom is gaining strength and Dad is minus 3 teeth now. He's still got a great grin.
And I am a whole lot lighter after my big meltdown!
My experience brings home the point that as caregivers we need to take care of ourselves…if we don't, we will drive ourselves to the breaking point…and perhaps cause a bit of a stir in an airport!
Next time we go through a crisis week like that (and I'm sure there will be more of them), I will do things a bit differently…especially prioritizing getting more sleep – and more help!

http://blog.aarp.org/2011/07/20/caregiver-meltdown/

"Learn About Senior In Home Health Care in Tarpon Springs and New Port Richey Florida Senior Helpers Provides Many services in The Tarpon Springs and New Port Richey Florida area. We provide a full array of Home Care services for seniors and the elderly living in the beautiful Suncoast area. Our Home Care Services are provided by bonded and insured employees and all employees pass a National Background check. If you need Home Care services in Tarpon Springs, New Port Richey, Hudson, Holiday, Spring Hill, East Lake and the surrounding areas we are an excellent choice with impeccable references. Home Health Care for your elderly loved ones is never an easy choice but we can promise we will do our best to make it as painless as possible. From our family to yours we sincerely thank you for considering Senior Helpers of Tarpon Springs Home Health Care Company. "

Friday, September 2, 2011

National Research Council Wants Better Training for Home Caregivers

National Research Council Wants Better Training for Home Caregivers
By Kathleen Doheny

Home health care is a growing trend, allowing many people in need of medical services to avoid hospitalization and nursing homes. But improvements are needed to be sure that care at home is safe and effective, according to a new report from the National Research Council.

"There is a great opportunity to provide quality health care in the home for any of a variety of people in our population, from the very young to the very old," says David H. Wegman, MD, emeritus professor of work environment at the University of Massachusetts, Lowell. He chaired the National Research Council committee which issued the report.
"But to do this safely and effectively, we need better management and information about technologies as they are used in the home, and better training for both formal health care providers and the large informal pool for how to use these technologies in the home safely and effectively," Wegman tells WebMD.
Wegman says he is talking about medical devices from as seemingly simple as a home blood pressure monitor to more complicated oxygen delivery systems and other devices.
The report, "Health Care Comes Home: The Human Factors," was released today.
One in four U.S. adults, or more than 61 million Americans, cared for an adult family member, partner, or friend with a medical condition or disability in 2009, according to another report, also issued today, by AARP. It put the value of all this care at $450 billion in 2009. That is up 21% from the total in 2007. The AARP report is titled "Valuing the Invaluable: The Growing Contributions and Costs of Family Care giving, 2011 Update."

Recommendations for Home Health Care

The National Research Council report was requested by the Agency for Healthcare Research and Quality. The National Research Council is the principal operating agency of the National Academy of Sciences and National Academy of Engineering.
The National Research Council committee sought out experts. It also conducted a workshop on human factors in home health care before issuing the report.
Among the recommendations:

The FDA should promote the development of new standards for labels on medical devices for home use. They should set new standards for the instructions that accompany the devices. The instructions should be easily understood.
The FDA and the Office of the National Coordinator for Health Information Technology should work together to regulate, certify, and monitor devices and health information technologies. For instance, they should work together on a device such as a blood pressure monitor and the technology that relays the results to doctors and patients.
The FDA should improve its existing reporting system for medical device problems. The system is known as MAUDE (manufacturer and user facility device experience). Wegman cites problems, including being poorly used.
Training of home caregivers, both formal and informal, should be improved. Advocacy groups and professional practice organizations should take on this task, the committee says.
Research is needed in many areas, including how to better coordinate caregivers and support services.
Federal agencies such as the Department of Health and Human Services should help people who need home health care to modify their homes for caregiving when needed.

Wegman says the hope is that the FDA and others involved will read the recommendations and begin to implement them.
The recommendations are applauded by AARP, says Susan Reinhard, PhD, RN, AARP's senior vice president of public policy. She wrote the AARP report.
"We call it the new normal, this caregiving," she tells WebMD. And it is not simple.
In its report, AARP finds that home caregivers are asked to do more complicated services. This includes bandaging and wound care, tube feedings, managing catheters, and giving injections and operating medical devices.
"Some of the things that family caregivers do would make a first-year nursing student shudder," Reinhard says in a news release.
In an interview with WebMD, she says that the National Research Council report "supports our overall goal of helping people to live at home independently if that is their choice."

"Learn About Senior In Home Health Care in Tarpon Springs and New Port Richey Florida Senior Helpers Provides Many services in The Tarpon Springs and New Port Richey Florida area. We provide a full array of Home Care services for seniors and the elderly living in the beautiful Suncoast area. Our Home Care Services are provided by bonded and insured employees and all employees pass a National Background check. If you need Home Care services in Tarpon Springs, New Port Richey, Hudson, Holiday, Spring Hill, East Lake and the surrounding areas we are an excellent choice with impeccable references. Home Health Care for your elderly loved ones is never an easy choice but we can promise we will do our best to make it as painless as possible. From our family to yours we sincerely thank you for considering Senior Helpers of Tarpon Springs Home Health Care Company. "

Tuesday, July 12, 2011

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Friday, May 27, 2011

Older drivers make mistakes, even when healthy

Older drivers make mistakes, even when healthy

Decline in brain functioning ability could affect driving skills for healthy, older population, study finds
By Amanda Chan
Aging is associated with an increase in crucial driving mistakes, even among healthy people with safe driving records, according to a new study.

The oldest people in the study, who were between ages 85 and 89, made four times as many critical errors in a driving test than the youngest people in the study, who were between ages 70 and 74, the study said.

Overall, 17 percent of the elderly drivers in the study made mistakes such as veering or failing to use check blind spots that caused the professional driving instructor accompanying them to hit the emergency brake or grab onto the steering wheel.

Aging

causes declines in brain functioning ability, which could affect driving skills and the ability to ignore distractions while on the road, said researchers from Australian National University.
The study was published online this week in the journal Neuropsychology.
Testing driving skills
Researchers had 266 volunteers between the ages of 70 and 88 take some tests measuring how well their brain functions. None of the volunteers had any signs of dementia, they all lived independently and they all drove at least once a week

Then, the volunteers were taken out for a 12-mile drive. A professional driving instructor rode in the car with them and had access to a brake on the passenger's side of the vehicle, while an occupational therapist rode in the backseat to note critical errors, including speeding, veering, tailgating, sudden braking without cause and failing to check blind spots.
Among those who made the driving mistakes, the adults ages 70 to 74 made, on average, less than one critical error. But adults ages 85 to 89 made, on average, nearly four critical errors, according to the study. And the volunteers who had had an accident in the last five years were also the most likely to make a critical driving error.
Men and women made the same number of mistakes in the study. The most common mistake was failing to check blind spots, followed by veering across lanes of traffic and failing to use turn signals, the study said.
The finding shows that older drivers may need extra training or screening tests to ensure they can be safe on the road, said study researcher Kaarin J. Anstey, a psychologist who directs the Aging Research Unit at Australian National University.
Tips for elderly drivers
Elderly drivers ages 75 and older made up 7.5 percent of fatal car crashes and 3.1 percent of all car accidents in the United States in 2008. There were 30 fatal accidents for every 100,000 licensed drivers for people ages 75 and older, while there were only 20 fatal accidents for every 100,000 licensed drivers for people between ages 65 and 74, and 19 fatal accidents for every 100,000 licensed drivers for people between 55 and 64, according to the U.S. Census Bureau.
As the Baby Boom generation grows older, the more elderly drivers there will be on the roads. In 2009, there were 33 million people age 65 and older with a driver's license, according to the Centers for Disease Control and Prevention (CDC).
The CDC has some tips for older drivers to make sure everyone has a safe driving experience :

Review medications with your doctor or pharmacist to make sure there are no side effects that can impair your driving ability.
Get your eyes checked at least once a year, and always wear glasses or contact lenses while driving, if needed.
Plan your driving route before you start driving.
Don't tailgate; leave a large distance between you and the car in front of you.
Avoid distractions such as cellphones, loud radios and eating.
Consider public transportation if you don't feel safe driving.

Pass it on: Aging's effect on brain functioning could impact the ability of elderly people to drive.

http://www.msnbc.msn.com/id/43065601/ns/health-aging/

Tuesday, May 10, 2011

Mean old girls: Seniors who bully

Bullying doesn't always end in high school — it also happens in retirement communities

By Diane Mapes
When Nancy Murphy moved into a retirement community near Portland, Ore., she didn't realize she'd actually traveled back in time.
"I came into breakfast one morning and this woman sitting at a nearby table sees me and says, 'Well, would you look at the new girl? She has WET HAIR!'" says Murphy, a 75-year-old retired schoolteacher. "She did this three mornings in a row. Then I found a flyer in my mailbox with a copy of the house dress rules. I know she tucked it in there."
Murphy, who's lived at the facility just under two months, says she ignores the woman's jabs — "I refer to her as Harriet High School" — but others at the nursing home have confided they're afraid of her.

"I had dinner with two gentlemen the other night and they said she terrifies them," she says. "That she's dictatorial, demanding, critical — classic bully behavior."
While much scrutiny and study has been devoted to bullying in grade school and high school these last few years, less attention has been paid to another category of bullies: those with gray hair, false teeth, hearing aids

and canes. But according to experts, gray-haired bullies do exist and, as with their younger counterparts, their behavior can run the gamut from verbal intimidation to physical violence.
"It's kind of an institutional thing," says gerontology expert Robin Bonifas, an assistant professor at Arizona State University School of Social Work, who's currently researching senior-to-senior bullying. "It tends to take place in senior centers or nursing homes or assisted living facilities, places where they're spending a lot of time and need to share resources, whether it's chairs or tables or TV stations or staff attention."
Mary Noriega, a 64-year-old from Phoenix, says she has had run-ins with a group of "mean girls" at the senior complex where she and her husband moved a year and a half ago.
"I've endured a lot of bullying," she says. "There's a clique here of probably 20 women and they feel they control the property. I'm their kicking stone."
Story: Mickey Rooney gets order against bullying stepson
Noriega says the women in the group gossip about her ("One piece of gossip that went around was that we'd been evicted from our last apartment," she says); spread lies about her; discourage other residents from befriending her and give her dirty looks whenever she tries to use community facilities, like the rec room.
"No one should have to deal with the harassment I've endured," she says. "The first six months I lived here, I used to sit in my apartment and just cry. I've never dealt with anybody like this before."
These days, Noriega is gathering evidence ("I've got a briefcase crammed full of information about the harassment I've endured") and is turning to outside agencies like the local city council and ASU's School of Social Work in order to get help for her — and other residents — with the bullying problem.
Age-old problem
This kind of problem is nothing new to Gina Kaurich, an executive director at FirstLight HomeCare, who previously worked as a director of nursing at an assisted living facility outside of Dayton, Ohio, for several years.
"There is, in some regard, a caste system among residents," Kaurich says. "There would be an elitist type of table in the dining room where you had people who could eat and drink and carry on conversations very well together. And if an individual who had trouble eating tried to sit with them, they would ignore them or say, 'Why do you always seem to drop your fork?' They'd speak meanly to them. It was like high school."
Kaurich says even fun activities like singing weren't immune from bully behavior.
"In the recreation room, if somebody didn't participate the way somebody else thought they should, you'd see them get into that person's face," she says. "They'd be literally shaking their finger and saying, 'How dare you call out Bingo when you don't have a Bingo!' or 'How dare you sing that hymn that way!' Even if the person was in a wheelchair, they'd be looking down at them, shaking their finger in their face."
Story: Elderly drivers' brains may be distracted by irrelevant data
Doris Lor, a 76-year-old retired secretary, told the Arizona Republicthat when she moved to an age-restricted retirement community in Chandler, Ariz., her new neighbors yelled at her whenever she walked into the recreation center and refused to let her sit at the club's card tables or community pool.
The bullies were part of a "clique … that is meaner than mean," she says.
Estimated 10 to 20 percent of seniors bullied
There's little published research on elderly bullying, but Bonifas estimates about 10 to 20 percent of seniors have experienced some type of senior-to-senior aggression in an institutional setting, much of it verbal abuse.
Both men and women can bully, she says, but women tend towards passive-aggressive behavior like gossiping and whispering about people when they enter a room while men are more "in your face".
"With men, it's more negative comments directly to the person," she says "With women, it's more behind your back."
But it doesn't always stop at back-biting and bickering. Seniors have also been the victims of violence, she says, sometimes over something as trivial as a coveted spot at the dinner table.
"At one facility where I worked, there wasn't assigned seating so residents would tend to claim ownership at certain tables," she says. "And one time, a woman was sitting at a table having a cup of coffee and another resident came in and saw her seated at 'his' table and started yelling at her. She yelled back. And then he hit her — with his fist."
According to Bonifas, incidents like these are all part of a pattern of behavior.
Dementia and violence
"There's kind of a continuum to this aggressive behavior," she says. "Bullying would be on the lower end of the spectrum and at the higher end, you'll have actual incidents of violence between seniors. They could be hitting each other, kicking each other; there have actually been deaths."

Friday, April 22, 2011

5 Things to Look For in Long-term Care

5 Things to Look For in Long-term Care
by Molly Edmonds
When we're looking for our dream home, we usually have a list of must-have features in mind. Some people can't live without walk-in closets, natural light and built-in bookcases, while others require two-car garages and big backyards. When it comes to long-term care options for ourselves or a loved one, however, we often don't know exactly what we're looking for. And because the decision that an aging adult needs long-term care can already be difficult in and of itself, we may let emotions get in the way of an objective search.
As it turns out, we can consider long-term care facilities with the same critical eye we bring to crown molding or skylights. First, there are some basic decisions to be made regarding the level of care and supervision needed, the financial resources available to pay for the care -- and location, location, location. Once you have a list of places that fit those criteria, how do you pick? Take a look at the five things on this list for some must-have features in long-term care.
5: Your First Impression
Feel free to trust your first impression when you walk into the doors of a long-term care facility. Use all your senses -- does the place smell pleasant, or is there an industrial or unpleasant odor in the air? Is it well-lit and pleasingly decorated? Is there a television blaring, serving as a babysitter for residents, or are there spaces for quiet and for conversation?
As you walk through the facility, you should get a sense that this is a home, not an institution. It's important to see the rooms to determine if the layout, lighting and sense of security are adequate. Privacy is important to many people, so find out if there are single rooms or if sharing will be required. Do residents live in long, anonymous rows of rooms, or are they grouped into small households or living units? Will there be opportunities for residents to make their spaces their own, such as bringing in their own furniture and decoration? What rules regarding noise and visiting are in place?
While people tend to focus on their own rooms, take time to visit common areas as well. You might inquire if there are outside areas where residents congregate, or in which activity rooms residents tend to spend a lot of time. Evaluate these areas for homeyness and cleanliness.
You'll also want to get a sense of the eating facilities -- more information on that can be found on the next page.
4: The Food
When you're touring a nursing home or assisted living facility, you'll likely be provided with a long list of social activities available to residents -- everything from bingo to swim classes. And while a long list of activities is a good way to pick a summer camp, there's no guarantee that the aging adult in question will want to spend a Tuesday afternoon making lanyards. That's why it's more important to focus on the one social engagement on everyone's calendar: meals.
Even if assisted living residents insist on spending all of their free time parked in front of the television, they're usually required to show up for meals. Since meals are often the primary activity of the day, take time to visit the dining areas and have a meal there. Consider whether the food is tasty enough to eat every day, and request a week's worth of menus to see if there's a variety of options.
Two other things to check are how dietary restrictions and preferences, such as keeping kosher, are handled, and whether a resident can get extra food or a snack throughout the day. These last two considerations will give you a clue as to whether the facility sees its residents as numbered mouths to feed or as distinct individuals with their own needs and desires. If the residents are given special attention when it comes to meals, then that standard of care usually carries over into other spheres as well.
3: Staff-to-patient Ratio
Most long-term care facilities strive to maintain residents' independence and autonomy as much as possible. However, that doesn't mean that residents should be deprived of care and help when they need it. For that reason, it's important to consider the staff-to-patient ratio of any care facility. In particular, you'll want to investigate the number of personal care aides, as they provide the bulk of resident care; a good ratio would be one aide to every five or six residents during the day and 1-to-15 at night [source: Matthews].
Good patient care is more than just numbers, though. Residents aren't likely to feel comfortable if they never see the same person twice, and if caregiving is merely a revolving door of who's available. A resident's transition into a long-term care facility will likely be made smoother by receiving individualized care from a trusted caregiver. Ideally, as you tour a long-term care facility, you'd observe positive interactions between caregivers and residents, such as staff greeting residents by name and staff quickly and cheerfully responding to residents' needs and requests.
We're not done judging other people yet -- on the next page we'll do some more spying.
2: The Other People
While scoping out the environment of the long-term care facility is important, so too is observing how people fit into that environment. That means taking a look at the current residents to see if they seem happy and engaged. They should look clean and well-groomed, because this will indicate that someone has taken care of them recently. Are there people moving around, taking part in activities, or are most people staying in their rooms by themselves?
To truly get the vibe of other people, you should visit more than once. Your formal visit, with the facility's tour guide, will obviously be the residence's attempt to show you the best of the best. Stop by at least twice more, unannounced, to see how people behave when tours aren't going on. By checking into common rooms and dining areas at different points in the day, you'll get a sense of what a full 24-hour period might be like in the home.
1: Report Card
While visiting a residence can give you a sense of all that goes well there, you may have to do some digging to find out what goes poorly there. If a facility receives Medicare or Medicaid funding, it is inspected every 15 months by a state surveyor. The surveyor's most recent findings are required to be kept onhand and shown to anyone who asks to see them. On this report, you'll learn what violations have been reported, such as physical abuse or health violations. Some of the violations may be minor, and no facility has a perfect record, but by asking staff members about these shortcomings, you might get a sense of whether they take complaints seriously or whether complaints are routinely blown off.
Another good resource is your state's long-term care ombudsman (some communities also have local ombudsmen). The ombudsman acts as an advocate for long-term care residents and their families and visits facilities regularly. He or she will have a good idea of the issues and problems at certain facilities, as well as a sense of what residences might particularly suit a certain type of person. The ombudsman's services are provided for free.

Friday, April 15, 2011

For Elderly Diabetics, Questions About Aggressive Care

By PAULA SPAN

The more I talk to researchers about caring for older people, the more a couple of themes emerge. Namely:
a) Sometimes less really is more. Overtreatment can create big problems, as a recent post on prescribing antibiotics for common urinary tract infectionsreported, and it happens frequently.
b) Older bodies respond differently from younger ones, a reality health care providers don't always take into consideration. A routine that includes a few late-day cocktails, to take one of many examples, can be a pleasure for a 40-year-old but a danger for an 80-year-old.
The latest conversation I've had along those lines, with Dr. Sei J. Lee, a geriatrician at San Francisco's V.A. Medical Center, concerned diabetes, a huge health issue for seniors. More than a quarter of adults over 65 have diabetes, according to the American Diabetes Association.
Should the elderly respond to Type 2 diabetes in the same way as younger patients? Maybe not, Dr. Lee suggested in a recent commentary in The Journal of the American Medical Association.
People with Type 2 diabetes hear a lot about "glycemic control," keeping their blood sugar levels down through diet and exercise and, when necessary, medications. The target number, for most adults under most guidelines, is 7 percent on the commonly used A1C hemoglobin test.
"For younger patients, if we can get them down to near-normal levels, then over the long term — 10 or 20 years — the risk of severe complications, like the need for kidney dialysis, are lower," Dr. Lee explained. Lower blood sugar substantially reduces the odds of diabetics' developing blindness and kidney disease, research shows; it also appears to help ward off heart attacks, strokes and amputations, though that's less well documented.
Maintaining that number — what's called "tight glycemic control" — can be an arduous undertaking, Dr. Lee acknowledged, but "for someone who's 30, we expect many years of life, so it's absolutely worth doing."
However, it takes years of tight glycemic control — at least eight, probably closer to 10 — to produce those benefits. For frail old people, Dr. Lee believes the risk-benefit equation works out differently.
"They have so many other health conditions that the chances they will survive long enough to benefit from these reductions are very low," Dr. Lee said. "The average life span of people in nursing homes is less than three years, which reflects how sick they are."
Moreover, stringent adherence to glycemic guidelines may prove quite difficult for frail elders. If their blood sugar levels slip too low, for example, they can sink into hypoglycemia, more dangerous for them than for younger diabetics. Seizures, coma and brain damage are among the scarier consequences.
But even if that doesn't happen, "tight control imposes a major burden on how people live their lives," Dr. Lee said. "We have to resort to stronger medicines and more monitoring" — finger sticks several times a day, perhaps insulin injections at least daily, dietary restrictions for people who may already not be eating well.
"In nursing homes, patients tell me, 'I used to enjoy so many things that I can't do anymore. Food is one of the few pleasures I still have, and now you're going to take that away from me?'" Dr. Lee said. "Some patients don't care, but some care a lot."
A tough regimen for lots of older patients, tight control can be particularly problematic for those with dementia, who have a terminal disease and who may not be able to understand the reason behind all the needles and constraints.
"Let's be a bit more balanced," Dr. Lee suggested. "In the frail elderly, trying to get to near-normal blood sugar levels doesn't make sense."
Frail elders can still benefit from treatment, he hastened to add. Uncontrolled diabetes can exacerbate incontinence, for instance, and it can increase falls.
Moreover, age itself is not the criterion. "If your parent is 70 and playing tennis three times a week, he or she should be treated like a younger patient," Dr. Lee said. Someone that healthy and active might well survive long enough to reap the benefits of a stringent approach to lowering blood sugar.
But for someone who is 85 and frail, has other chronic diseases and already takes lots of medications, who lives in a nursing home or needs that level of care, aggressive treatment for diabetes is unlikely to pay off in better health, Dr. Lee said. Looser glycemic goals might serve better.
"The focus should be less on long-term outcomes, more on what's important for each person," Dr. Lee said. That would involve deeper discussions between physicians and patients, he acknowledged, rather than doctors' reflexively urging patients to maintain a number more logical for 40-year-olds.
But he suspects that many doctors already see that the push for lower blood sugar levels can prove troublesome for their older patients. "I wrote the commentary," he said, "to give them a rational reason to do what they already felt, in their guts, is right."