My best friend’s father (Bob) died about three weeks ago, just 10 days after his 95th birthday. He left behind three sons, two daughters and his 91-year-old wife. His memory and his ability to walk had been failing gradually for several years, but a few months ago a stroke left him wheelchair-bound and unable to carry on a coherent conversation. Because his wife and my single friend who lives with her parents could no longer care for him, he spent the remainder of his days in a VA care center. Because of their belief in a better life after death, the family considered his death a blessing, but still it is not hard to see that they are each grieving in different ways.
My friend and her mom were Bob’s primary caregivers. Judy Tatelbaum, MSW, says in an article titled After Caregiving Ends, “There is a natural sense of loss when the need for our caregiving is over. We must often face the double sorrow of losing a loved one and our purpose or role in their lives. The aftermath can be a very difficult time that leaves us feeling lost, lonely, and useless…..It is possible that we’ll feel relief that we don’t have to work so hard any longer, and then feel a sense of guilt for feeling such relief…. All of these are natural reactions. It is important to express our sadness, anger, loneliness, regret, and whatever else we may feel. It is also important that we listen to ourselves and appreciate what we feel as we go through the mourning process.” (We will cover the topic of Caregiver Grief more completely in a future blog.)
Stages of Grief
In 1969, psychiatrist Elisabeth Kübler-Ross wrote about the “five stages of grief.”
- Denial:“This can’t be happening to me.”
- Anger:“Why is this happening? Who is to blame?”
- Bargaining:“Make this not happen, and in return I will ____.”
- Depression:“I’m too sad to do anything.”
- Acceptance:“I’m at peace with what happened.”
Authors Melinda Smith and Jeanne Segal said in an article titled, Coping with Grief and Loss, “Contrary to popular belief, you do not have to go through each stage in order to heal. And if you do go through these stages of grief, you probably won’t experience them in a neat, sequential order, so don’t worry about what you ‘should’ be feeling or which stage you’re supposed to be in…. Kübler-Ross, herself, said of the five stages of grief: ‘They were never meant to help tuck messy emotions into neat packages. They are responses to loss that many people have, but there is not a typical response to loss, as there is no typical loss. Our grieving is as individual as our lives.’”
Help for Coping with Grief
Because Grief is made up of many different emotions that can be different for each individual, meaningful advice on how to cope with grief is difficult to give. If you or a loved one is grieving, you will have to pick and choose between a myriad of suggestions. The important thing is to Do Something that helps you. As my friend’s mom wisely said, “I’m trying not to wallow in it.” Here are some widely accepted ideas from a variety of sources. (See Resources below.)
- Acknowledge your pain and actively grieve and mourn. Trying to avoid feelings of sadness and loss only prolongs the grieving process and can lead to depression, anxiety and other problems.
- Look to and accept the support of loved ones and others. Now is the time to lean on the people who care about you, even if you take pride in being strong and self-sufficient.
- Don’t make major decisions while grieving. Don’t decide to do things like move, change your profession, make major purchases or give up possessions until you are more emotionally stable.
- Take care of your physical and emotional needs. If you feel good physically, you’ll also feel better emotionally. Combat stress and fatigue by getting enough sleep, eating right, and exercising.
- Draw comfort from your faith. If you’re questioning your faith in the wake of the loss, talk to a clergy member or others in your religious community.
- Write about your loss in a journal or a letter saying the things you never got to say. Make a scrapbook or photo album celebrating the person’s life.
- Your grief is your own. Don’t let anyone else tell you when it’s time to “move on” or “get over it.” It’s okay to be angry, to cry or not to cry. It’s also okay to laugh and to find moments of joy.
- Plan ahead for grief “triggers.”Anniversaries, holidays, and milestones can be painful. Be prepared for an emotional wallop, and know that it’s completely normal.
- Contact a grief counselor or professional therapist if you:
- Feel like life isn’t worth living
- Wish you had died with your loved one
- Blame yourself for the loss or for failing to prevent it
- Feel numb and disconnected from others for more than a few weeks
- Are having difficulty trusting others since your loss
- Are unable to perform your normal daily activities
Many different aspects of losing a loved one can cause one to experience grief. My friend is grieving for the loss of her father and her role as his caregiver, for her mother as she struggles to cope with the loss of her husband, for the “new normal” of caregiving she and her mother have to work out together, and for the losses that are making change necessary in both of their lives. Your grief also may be coming from a variety of sources. Even though others have not experienced exactly what you are going through, now is the time to put pride aside and reach out for support and comfort from any source that is available.
My 97-year-old dad has lived in a very nice assisted/senior-living center apartment for nearly two years. Now, when we drive up to it together, he says, “There’s my home!” But he also says, “This is a lovely place, but I’m very lonely.” He has outlived two wives. He married a third time when he was 86 because, he said, “I don’t like living alone.” His current wife is 9 years younger than Dad and doesn’t want to leave her home to live with him. She comes to visit him for a couple of hours four days a week. We make sure that at least one of his children also is there for a visit every day of the week. We often wonder what else we can do!
The center offers several activities each day, and they are good to remind him to participate, but his dementia has kept him from developing any satisfying friendships. Because he aspirates food and chokes if he tries to talk and eat at the same time, mealtime conversations are difficult. I’ve encouraged my four siblings who live out of town to call or write. Sometimes they do, but often Dad doesn’t answer the phone, and when he does, it’s hard for them to know what to say to him. They wonder if a call or a visit is worthwhile, especially when after an hour or two, he can’t remember it even took place. I try to encourage them by saying that even if he doesn’t remember it later, at least for the time he is on the phone or with a visitor, he is happy. Keeping Dad active and trying to prevent him from feeling lonely takes a lot of effort.
A Health Risk of Epidemic-Proportion
Loneliness is said to be an “invisible epidemic” that affects 60 million Americans. A recent New York Times article states, “Researchers have found mounting evidence linking loneliness to physical illness and to functional and cognitive decline. As a predictor of early death, loneliness eclipses obesity.” Dr. Carla M. Perissinotto, a geriatrician at the U. of CA, San Francisco, adds, “The profound effects of loneliness on health and independence are a critical public health problem. It is no longer medically or ethically acceptable to ignore older adults who feel lonely and marginalized.” During 6 years of follow-up, the lonely adults she studied had significantly higher rates of declining mobility, difficulty in performing routine daily activities and death.
John T. Cacioppo, professor of psychology at the U. of Chicago and director of the university’s Center for Cognitive and Social Neuroscience, has been studying loneliness since the 1990s. His research has shown that chronic loneliness can raise blood pressure and decrease blood flow to vital organs. “Loneliness doesn’t just make people feel unhappy, it actually makes them feel unsafe — mentally and physically.” It also affects the production of white blood cells, which can decrease the immune system’s ability to fight infection. An article by Dr. Sanjay Gupta in Everyday Health explains why you should treat loneliness as a chronic illness. It goes on to say, “On the other hand, people who have strong ties to family and friends are as much as 50 percent less at risk of dying over any given period of time than those with fewer social connections.”
What to Do for Yourself or Your Loved One
If you, a loved one or someone you care for is lonely, here are some suggestions that may help, depending on current health and mobility:
- Don’t text. Use the phone and talk to someone.
- If you leave a message and don’t get a return call, call back.
- Plan a low-key activity with someone, like a walk.
- Practice simple acts of social interaction, like saying “hello” to everyone.
- Make the effort to meet new people.
- Check out the resources at your local senior center.
- Contact a friend with whom you’ve lost touch and meet for lunch.
- Volunteer to help others as much as you can.
- Take up a new hobby that fits your current abilities.
- Adopt a pet, if you have the ability to care for one.
- Provide transportation for a short excursion or just a drive.
If You or Your Loved One Is Homebound
Being social can be difficult if you are homebound. Area agencies on aging, places of worship or providers like Dakota Travel Nurse Home Care may be able to offer home-visitation services, companionship or respite care. Help prevent illness by lessening loneliness. Call DTN Home care today for a personal consultation on how we can help. 701.663.5373
Maintaining good oral and dental health can get more and more complicated as your loved one ages. At the same time, it becomes more and more important, and caregivers must assume more responsibility. It should not be neglected, because oral health is necessary for good overall health.
At first, regular trips to the dentist and simple reminders to brush twice a day and to floss daily might suffice. Other tips include drinking tap water that contains fluoride and making smart choices about diet. As dementia or other diseases such as arthritis, Parkinson’s, and movement problems progress, it becomes more difficult physically and mentally for an elderly person to take care of their mouth and teeth on their own. Tasks that were once simple to do become challenging or impossible, and help from a caregiver is required.
Several lifestyle changes also can make it more difficult to keep teeth healthy. As the number of medications increase, so can the side-effect of dry mouth, which can be damaging to tooth enamel. Teeth can become less sensitive to pain, making it more difficult for the elderly person to detect cavities and other mouth problems. When you’re caring for someone with a number of health problems, it’s easy to overlook oral health. This can be dangerous, because bacteria from the mouth can be inhaled into the lungs and cause pneumonia.
Medications, Dry Mouth and Cavities
As we age, we become more cavity prone. A frequent cause of cavities in older adults is dry mouth. Dry mouth is not a given in aging. However, it can be a side-effect for more than 500 medications, including those for allergies or asthma, high blood pressure, high cholesterol, pain, anxiety or depression, Parkinson’s and Alzheimer’s. Tell the dentist about any medications your loved one is taking. These are some common recommendations dentists make to help relieve dry mouth and prevent cavities:
- Consult with a physician on whether to change a medication or dosage.
- Drink more water. Have water nearby, and don’t wait until you’re thirsty to drink. (The elderly may have trouble recognizing that they are thirsty.) Your mouth needs constant lubrication.
- Use sugar-free gum or lozenges to stimulate saliva production.
- Get a humidifier to help keep moisture in the air.
- Avoid foods and beverages that irritate dry mouths, like coffee, alcohol, soft drinks, fruit juices.
- Ask the dentist about applying a fluoride gel or varnish to protect teeth from cavities.
Many elderly adults develop gum, or periodontal disease, caused by the bacteria in plaque. Gum disease can be painless until the advanced stages. If untreated, gums pull away from the teeth and form pockets where food particles and more plaque collect. Advanced gum disease will eventually destroy the gums, bone and ligaments that support teeth, leading to tooth loss. With regular dental visits, gum disease can be treated or prevented.
People with diabetes are twice as likely to develop gum disease. When blood sugars aren’t well controlled, it is harder to fight infections, including infections in the mouth and gums. Infected gums make it harder to control blood sugar. Oral health, blood sugar control and the ability to fight infections are closely related.
Dementia and Dental Care
In the early stages of dementia, focus on regular care and preventing the need for extensive procedures later on. During the middle and late stages of dementia, oral health becomes more challenging. The person may forget what to do with toothpaste or how to rinse, or may be resistant to help from others. Try these tips from the Alzheimer’s Association:
- Provide short, simple instructions. Explain dental care by breaking directions into steps. “Brush your teeth” by itself may be too vague. Instead, walk the person through the process. Say: “Hold your toothbrush.” “Put paste on the brush.” Then, “Brush your teeth.”
- Use a “watch me” technique. Hold a toothbrush and show the person how to brush his or her teeth. Or, put your hand over the person’s hand, gently guiding the brush. If the person is agitated or uncooperative, postpone brushing until later.
- Keep the teeth and mouth clean. Brush the person’s teeth at least twice a day, with the last brushing after the evening meal and any nighttime liquid medication. Gently place the toothbrush in the person’s mouth at a 45 degree angle so you massage gum tissue as you clean the teeth.
- Try different types of toothbrushes. You may find that a soft bristled children’s toothbrush works better than a hard bristled adult’s brush. Or that a long handled or angled brush is easier to use than a standard toothbrush. Experiment until you find the best choice. Be aware that electric dental appliances may confuse a person with Alzheimer’s.
If the person you are caring for wears dentures, check with the dentist for specific instructions as to their care. Be aware of any signs of mouth discomfort during mealtime. Refusing to eat or pained facial expressions while eating may indicate mouth pain or dentures that don’t fit properly.
This blog is not intended to be medical advice, only to make you aware of the importance of good oral and dental health in yourself and your loved ones. Always consult a dentist or oral specialist if you suspect problems or encounter difficulties with maintaining good oral hygiene.
The assisted living center where my dad lives provides each resident with an emergency alert button that they can push when they need help. It also senses when the person wearing it falls and alerts a staff member to come running. At first, Dad had trouble remembering that he could push the button when he needed help, but after a while he got the hang of it. Now the only problem is he has no sense of how much time has passed since he pushed it, so he’s either unhappy that it “took so long” for help to come, or he forgets why he pushed it in the first place. When he still lived at home, we rented a similar button for him, but neither he nor his wife would push it to summon help! You will have to determine whether the following types of devices, jewelry and related services could be a help to your elderly loved one.
A DTN Home Care client recently purchased a MedicAlert bracelet for her mom through the MedicAlert Foundation featured on the Alzheimer’s Association website. In the event that her mom gets lost, which happened recently, there is an 800 number on the back that the person who finds her can call. The emergency response personnel then calls from a list of loved ones to notify the family.
In partnership with the Alzheimer’s Association, MedicAlert has created a specialized program to provide 24/7 wandering protection and emergency response services for individuals living with Alzheimer’s or other types of dementia, who are at risk for wandering and becoming lost or having a medical emergency. If an individual with dementia wanders and doesn’t return, caregivers can call the 24-hour emergency response line to report it. A community support network is activated to help find the person who wandered and return them to the caregiver. The service also provides emergency responders with complete medical information. You can learn more about this jewelry and related services here.
If you want to compare providers and services, a list of the 2016 Best Medical Alert Companies can be found here.
Medical ID Bracelets
Another option is an engravable medical ID bracelet with no services included. The person’s name, a phone number and medical condition—for example, diabetes, asthma, hemophilia, dementia—can be engraved on the back. You can search online for “Medical ID Bracelets.” One example can be found here. (DTN Home Care does not recommend a specific provider.)
Emergency Alert Systems
In an article on agingcare.com entitled How to choose an emergency alert system, author Marlo Sollitto informs us, “More than 33 percent of accidents and falls involving people over age 65 occur at home, according to the CDC….There are many devices available that will instantly summon help in the event of an emergency. Sometimes called Personal Emergency Response System, Medical Alert, or Medical Emergency Response Systems, all systems work in essentially the same way: When emergency help (medical, fire, or police) is needed, the senior presses the transmitter’s button. The elderly person wears the transmitter around their neck, on their wrist, belt buckle or wheelchair. In case of emergency, the senior calls for help by simply pressing the alert button, without needing to reach the telephone.”
What to Look for in an Emergency Response System
An article titled “Home Alone” (Nov 2005, Good Housekeeping magazine) lists tips to help you shop for an emergency response system:
- Price: Compare pricing, features and servicing of each system. ask if the price will increase.
- Hidden Costs: The system should be included in the monthly fee with no up-front costs.
- Contracts: Don’t sign a long-term contract.
- Experience: How long has the company been in business?
- Portability: Can the system be used when away from home?
- Ease of Use: Try out the system and make sure it is easy to use and easy to see.
- Waterproof: Can emergency button can be worn in the bath or shower?
- Trained Operators: In an emergency, you need qualified specialists to assist your parent.
- Hours: Make sure the monitoring center is available 24/7 and also has 24/7 customer support.
- Testing: Ask what procedures the center uses to test systems in your home.
- Repairs: Your system should include repair and replacement service.
What Is the Best Option for Your Loved One?
Before you purchase a wearable safety device &/or bracelet, you will have to consider the special needs of your elderly loved one, including whether or not they will remember to wear it and how to use it. Be sure that your service provider allows a trial period, and that you or your loved one’s caregiver will give the user some time to get used to wearing the jewelry or button and to learn how and when to use it. Once that has been accomplished, you will have more peace of mind that your loved one will be cared for when lost or alone.
Dakota Travel Nurse Home Care is pleased to announce that in July of 2016, we began a unique collaboration with Proximal 50, a comprehensive wellness center committed to making positive changes in health and quality of life for clients. They provide customizable health and wellness services, including physical therapy in the home for DTN Home Care clients who are home-bound. They are our exclusive, recommended provider of in-home physical therapy.
This partnership allows us to tailor our physical therapy services more effectively, especially in the area of tools and resources. We also are expanding our combined services to include post-surgical clients and tailored programs for clients with various disease states such as MS, Parkinson’s and dementia. We are excited about the additional support system that Proximal 50 provides, in addition to our blending of services.
DTN HC works with Proximal 50 to ensure that clients get the physical therapy they need. Required documentation and open and easy communication help us work together for the good of our clients. Proximal 50 shares our philosophy of keeping home an option for our clients. “P50 does not have members…we have clients. This means that all clients will get individual attention and guidance throughout their lifelong wellness journey, to ensure safety and effectiveness.” Our collaborative services are a blending of good people providing good services. We also share a common goal of reaching the community through education, wellness programs and advocacy.
VA clients require a physician’s order to receive physical therapy benefits. Clients who choose to participate in therapy classes or to be evaluated by a licensed physical therapist do not need a physician’s referral. When they see a need, our care givers will recommend physical therapy by Proximal 50 to their clients, who should then check with a physician before beginning any exercise program. P50 notifies a client’s physician of their evaluation and provides updates on the care plan, as needed. Their care plans are a part of our overall care plans for patients who can benefit from this kind of therapy.
We believe in Proximal 50’s philosophy that “Pain is not normal. You shouldn’t have to just ‘live with it’ or ‘work through it.’ Our therapists strive to improve mobility, restore function, prevent injury, and provide less invasive treatment options while reducing overall healthcare expenses and offering an individualized and custom treatment plan.”
If you or your loved one wants to take advantage of in-home physical therapy opportunities made possible by our unique partnership with Proximal 50, please call our office at 701-663-5373. We will be happy to answer any questions you have regarding the benefits of in-home physical therapy.
Dakota Travel Nurse Home Care is licensed by the North Dakota Department of Health to provide in home healthcare services. We are locally owned and operated in Mandan, ND. We provide in home nursing care, home health aide care and at home companion care.
Call (701) 663-5373 today for a free consultation!
My 96-year-old father has had pneumonia 7 times! That is just one of the medical conditions that can result in the pulmonary fibrosis he suffers from now. Because of the condition of his lungs, Dad requires supplemental oxygen 24/7. He has a concentrator that provides oxygen in his room, and he must take a portable oxygen bottle with him whenever he goes more than 50 feet from the concentrator. The refillable bottles must be constantly rotated on to and off of the self-fill portion of the system.
Pulmonary fibrosis is just one lung disease that can require constant or occasional oxygen therapy. One you might hear more about is COPD, a group of lung diseases that includes emphysema, chronic bronchitis, and in some cases asthma. In older people, especially those with memory problems, oxygen use must be closely monitored. Many patients strenuously resist being tethered to an oxygen supply, and loved ones and caregivers sometime have an uphill battle just to keep the oxygen on the patient. If your loved one is able to move around on his own, remembering to change from home to portable oxygen and then back again can be a struggle. As many lung diseases are progressive, the flow of oxygen must be adjusted from time to time. This should only be done under a doctor’s supervision.
Dakota Travel Nurse Home Care serves clients that are on oxygen. They do competency checks with their caregivers to ensure that they know when and how to adjust the oxygen and how to manage the equipment to ensure that there is a steady supply. Family caregivers must also ensure that oxygen equipment is being used correctly and consistently.
2016 Changes to Medicare Laws
A new challenge with my dad’s oxygen needs occurred when I received a letter from his supplier on May 17, 2016, stating: “This is to notify you that changes in the law have altered the way Medicare pays for your oxygen equipment and supplies. The new rules become effective July 1, 2016.” The “bottom line” said in bold, “You have two options: you can continue service with [us] and pay out of pocket for the equipment or you will need to find another supplier….If we do not hear from you, we will be picking up your oxygen equipment on June 30, 2016.”
When I told Dad’s doctor about the letter, his first response was, “Oh, no!” Apparently, he knew something about the difficulties facing us in finding a new “Medicare Competitive Bid” supplier in the ZIP Code where Dad resides. Yes! Your ZIP Code makes a difference. Because the changes are so new, one of the difficulties we encountered was that not everyone at every company knew what equipment they could provide under the new law. The two-page list of suppliers on the Medicare Website was at least 75 percent inaccurate, and when I called Medicare’s direct line, I was read the same list over the phone. On a first call to one company, I was assured that they did provide the Medicare-covered equipment we needed. During a follow-up call, a second person told me that the first person was wrong—that they did not cover Dad’s ZIP Code. We had already sent paperwork from the doctor.
From start to finish, it took more than 6 weeks of continuous effort with 3 different suppliers and many failed attempts to get Dad set up with the prescribed equipment. Even when we got to the point of delivery, the first truck brought the wrong equipment and the next one brought a low-flow concentrator that did not have adequate capacity to also fill portable tanks. I had to accept this one, because the original equipment had already been picked up, and I was desperate. The third supplier I found would not accept the documentation the doctor had provided to the first two, and so we began the whole process again. When all of the documentation had finally arrived and been approved, the company said we had exceeded the 30-day limit from when Dad recertified by the doctor as qualified to received oxygen so we would have to begin again!
With Dad limping along on less oxygen than prescribed and portable tanks we were unable to keep full, I began looking into renting or buying equipment on a self-pay basis. At this point, the low-flow concentrator ceased to function! The supplier reluctantly—because we were trying to replace them—agreed to schedule a next-day delivery of another low-flow system. They told me after the first delivery that they didn’t carry the type of high-flow concentrator Dad needed.
Dad went without any oxygen for more than 24 hours, but when the truck finally arrived, miraculously the high-flow concentrator we’d been searching for was on it! I don’t know where it came from, and I didn’t ask. I was able to tell supplier #3 that we wouldn’t be starting the documentation process again, and we have able to meet Dad’s oxygen needs once again!
If you have a loved one or a client who is on oxygen that is currently covered by Medicare, and you receive a letter like I did, consider these things that I had to find out the hard way:
- The list of medical equipment suppliers who provide oxygen equipment on a Competitive Bid basis, if required in your area, might be short. Don’t wait to start looking for one.
- Save time by first telling the companies you call what the delivery/use Zip Code is and by asking if they service Medicare patients in that area.
- The documentation suppliers require from the doctor is extensive, but they might not tell you exactly what that documentation needs to be until you’ve failed to provide all of it more than once.
- The documentation must contain the exact wording required by Medicare for such things as the type of equipment and the reasons why it is needed. One of my forms was rejected because I left out the word “system.”
- Anything handwritten, such as a date, must be deemed legible by the supplier. I had one document returned as illegible because the bottom part of a 6 was not completely closed.
- The doctor’s oximeter test and the resulting report and all other documentation must be returned to the supplier and approved by Medicare within 30 days of the required testing.
- You may think your doctor and the suppliers you talk to will know everything they need to know about what to provide and how, but because of the recent changes to the law, they might not.
There is some very detailed information online about Medicare requirements that you might not want to read but you probably should. Some links you can follow are at the bottom of this blog. If you know a professional who can help you wade through all of this bureaucracy, take advantage of their expertise!
We all need the right amount of oxygen for our minds and bodies to function at their full capacity. The difficulty of getting that oxygen from a mechanical source that is covered by Medicare just might take Your breath away!
by Marti Lythgoe, Writer/Editor
My 96-year-old father easily aspirates liquids, unless they are thickened. Keeping him hydrated is a challenge. He will eat fruit and ice cream, but he refuses most vegetables and soup, so he doesn’t get a lot of water from his food. His lack of mobility is also an issue. You may have other difficulties hydrating your elderly loved one or client.
Dehydration can be difficult to detect, especially in older people. However, its effect on your client or loved one’s health can be dramatic and even life-threatening. Usually, humans can’t survive more than four days without water. Because body water content decreases with age, especially in women, dehydration can occur fairly quickly. Although knowing the symptoms of dehydration and its damaging effects can be important (see below), having a strategy for prevention is the most important thing for the elderly and their caregivers to focus on.
10 strategies to prevent dehydration in yourself and others:
Staying hydrated is more difficult the older you get. You can’t rely on feeling thirsty and it’s often more difficult to get up and get something to drink.
- Include foods with high water content in your diet, e.g., fresh fruits and vegetables, soup, dairy products.
- Keep a water bottle or glass of water within easy reach.
- Drink a glass of water or another beverage with every meal. Offer a choice.
- Schedule other consistent times when a glass of water is offered, e.g., after going to the bathroom or brushing teeth.
- Drink more than just a swallow or two of liquid with medications.
- Avoid getting overheated. Drink more when you do.
- Drink small amounts frequently throughout the day and less at bedtime.
- Drink liquids regularly, even when you’re not thirsty.
- Consume caffeinated drinks in moderation. Too much can be dehydrating.
- Monitor weight loss. A sudden loss of 2 pounds or more signals dehydration in people over 60.
Signs that you or your loved one might be dehydrated:
Keeping an elderly person hydrated requires constant monitoring. Some of these symptoms my signal other serious conditions. Check with your doctor.
- Low urine output or dark-colored urine
- Dry mouth
- Inability to sweat or produce tears
- Dizziness or difficulty walking
- Rapid heart rate
- Low blood pressure
- Sunken eyes
Dangers of dehydration:
These and other health problems can be the result of dehydration.
- Urinary tract infections
- Bedsoresin bed-ridden patients
- Kidney stones
- Medicine toxicity
- Increase in falls
- Longer stays in rehab facilities.
Some of the risk factors that heighten the chance of developing dehydration include:
- Swallowing disorderscaused by aging, stroke, Parkinson’s disease or dementia
- Patientsover 85 years old
- Diarrhea,vomiting or excessive sweating
- Having5 or more chronic diseases
- Taking5 or more prescription medications
- Diminished drinking due tofear of incontinence
Learning more about staying hydrated, or how to keep your patient or loved one hydrated, and then developing a strategy to prevent dehydration can be very important to overall health and even longevity.
by Marti Lythgoe, DTNHC Writer/Editor
Obstructive sleep apnea—when a person briefly stops breathing multiple times during the night—can lead to health and cognitive issues at any age, but it can be even more of a problem in older adults. They are more likely to have obstructed breathing at night, but are less likely to be properly diagnosed.
My husband did not think he had sleep apnea, but in order to rule that out as the cause of some cognitive problems he was having, he spent a night in a sleep lab. He was able to sleep long enough for the technicians to discover that he stopped breathing about 28 times an hour! He was told that he needed to wear a mask to keep his airways open at night—a treatment known as Continuous Positive Airway Pressure (CPAP). He is still struggling to get used to sleeping with the head gear, but when he does have a good night, I think there is an obvious difference in his mood and cognitive abilities. For those who go untreated, often no amount of sleep means feeling well-rested.
According to a 2009 article in the Internet Journal of Internal Medicine and quoted in The Beaver County Times, sleep disordered breathing affects between 20 percent and 50 percent of older adults, and the prevalence of sleep disorders increases with age—adults age 70 to 80 are twice as likely to be affected than those around age 40. Obstructive sleep apnea has been linked to numerous other diseases, including hypertension, congestive heart failure, stroke and coronary artery disease. The dangers of sleep apnea increase with age.
A large neck, obesity, extra tissue in the back of the airway and loss of muscle tone that helps to keep the airways open are only some of the reasons obstructive sleep apnea can occur. Loud snoring or gasping during sleep and issues such as memory loss, daytime fatigue or sleepiness are some of the most common signs.
Without treatment, the blocked breathing of sleep apnea can force the heart to pump harder to get oxygen. Low oxygen levels in the blood can affect the oxygen supply to the brain, causing cognitive issues, stress to the body and a variety of other symptoms:
- Restless sleep, night sweats, choking, snoring
- Daytime drowsiness, lack of concentration
- Moodiness, anxiety and depression
- Leg swelling
A 2010 article in the New York Times titled “When Sleep Apnea Masquerades as Dementia,” explains, “Most of the time, cognitive problems won’t evaporate when seniors are treated for sleep apnea. But researchers find that with C.P.A.P., many older patients see marked improvement. ‘They’re not dozing off during the day, they’re not dragging,’ said Dr. Bradley Boeve, a neurologist at the Mayo Clinic. ‘Quality of life improves.’
”Life gets easier for their caregivers, too, a key concern in trying to keep people out of nursing homes….And, as Dr. Ancoli-Israe, professor of psychiatry at the U. of CA, San Diego, pointed out, ‘If you’re waking up hundreds of times a night and you’re not getting enough oxygen to the brain, of course you’ll see the effect.’ ….But when someone with apnea does stick with the treatment, ‘you’ll see the effects within a month or so,’ Dr. Boeve said. ‘Sometimes even within a week.’
“Now Dr. Ancoli-Israel is investigating whether C.P.A.P. therapy might help reduce the cognitive damage from Parkinson’s disease. ‘This isn’t just Alzheimer’s,’ she said. ‘Any time there are symptoms of dementia, you should think about sleep apnea and discuss it with your doctor.’”
Elderly people may have other medical issues that sleep apnea only makes worse, causing them to not be as independent as they could be or to suffer in other ways. In diabetics, for example, sleep apnea can make it very difficult to control blood glucose levels at night, and like having very high blood pressure or cholesterol, it can even cause death.
If you think you, a loved one or anyone you’re caring for might have sleep apnea, we encourage you to talk to a specialist in sleep disorders. Getting treatment could make life easier and more enjoyable for everyone concerned.
- To find treatment centers, consult the American Academy of Sleep Medicine or the National Sleep Foundation.
It’s still not possible to say definitively that an older person’s progressive dementia is caused by Alzheimer’s disease—until they’re dead and an autopsy is performed on the brain. However, specialists are becoming more confident that behavioral symptoms, neurological testing and the results of brain scans (MRI) can be narrowed down enough to diagnose the disease on a living person, even in its early stages. Because of this progress, on March 3, 2016, my 77-year-old husband and I sat with a neuropsychiatrist who felt he could tell us with a high degree of surety that Dennis’s cognitive and neurological issues were characteristic of both early-stage Alzheimer’s and Vascular dementia.
Arriving at this diagnosis had taken more than a year. Because there can be value in knowing early that one has Alzheimer’s and also vascular reasons for cognitive decline, I asked Beverly if I could share a summary of the process with our readers. The hope is that both families and caregivers will learn something that could help put a name to disturbing symptoms and provide some guidance on how to proceed with the highest degree of hope and understanding. At first Dennis didn’t want to know, but now that he does, we’re both glad that he went through the whole process. Every case is different, so please do not take this account as medical advice.
We first started paying close attention to physical and mental changes in February of 2015, when Dennis had 3-4 unexplained falls, after which he had difficulty getting back up. It seemed like for a few minutes the signal to move couldn’t get from his brain to his legs and feet. Other symptoms noticed mostly by me included (not in any particular order):
- A progressively slower, shuffling, short-stepped gait (observed even before the falls)
- Slower speech and less participation in conversations
- More difficulty thinking of specific words and concepts
- Sometimes talking “around in a circle” while trying to arrive at the meat of a story
- 2-3 incidents of getting lost when driving by himself in what should have been a familiar area
- A decrease in driving skills in general
- Lessened ability to follow instructions, especially those with more than 1 step
- Decreased ability to perform some household tasks, such as cooking
- Sleep deprivation
Process of Elimination
Dennis first saw his PCP about the falls. The Dr. recommended that he see a neurologist, which he did in March 2015. He was given a variety of short tests, some related to walking and balance and others to mental acuity. I accompanied Dennis on this visit and was able to report on behaviors that Dennis was not fully aware of. Because several serious diseases begin with falls, i.e., Alzheimer’s, MS, Parkinson’s, ALS, etc., it was determined that additional testing and a process of elimination of possible reversible causes of both physical and mental issues were needed. Over the course of several months, the following took place:
- An MRI
- Multiple consultations and short testing with a neurologist
- Withdrawal from a medication known to affect memory
- Two rounds of rehab/physical therapy (PT) for balance and walking issues
- An oral and on-road driving test
- An overnight sleep test in a sleep lab
- A 3-hr. neurological/psychological test; results were compared to others his age and education level; my input was sought during the first 30 minutes; test included a variety of combined mental and physical skills
During the course of a year of tests and therapy, MS, Parkinson’s and ALS were eliminated as possible causes. The MRI results were typical of a mild cognitive decline: Dennis’s brain was smaller than other men his age and also showed micro-vascular changes, possibly due to mini strokes. The PT greatly improved balance and walking issues and has prevented recent falls. The driving test was passed by a small margin. The sleep test revealed moderate to severe sleep apnea, currently being treated with C-PAP and on-going evaluation. All of the tests and their results were analyzed by the University of Utah Neurological team and the neuropsychiatrist we met with on March 3, 2016. He showed us slides of Dennis’s brain, and he explained the results of the MRI, as well as the scores on the neuro/psych test. The overall test performance was judged to be poor (worse in some areas than others). The combined MRI and test results determined the diagnosis of early-stage Alzheimer’s and vascular dementia. He was prescribed the drug Aricept to increase the brain chemicals involved in storing memories, and he was told that because of the early-stage diagnosis he could also participate in clinical drug trials.
Because Dennis’s symptoms seem to have progressed minimally over the past year, and because of his improvement in some areas, we were told that with regular physical and mental exercise and social interaction, his mental abilities could possibly stay close to the same for several years. A repeat of the neuro/psych test is recommended in a year to judge degree of decline, if any. We were told to watch for changes in the following common symptoms:
- cognitive ability (both memory and reasoning)
- ability to initiate/plan activities
- inability to recognize abnormal behavior (not the same thing as denial)
I was also given some good advice to help me cope with the above-noted changes in behavior (some easier said than done!):
- Give him time to form and verbalize his thoughts; don’t speak for him.
- Don’t say “I already told you that.” Just repeat without comment.
- Only repeat things that are important for him to understand and to stay safe.
- Give help with everyday tasks only as needed.
- Initiate and plan activities, especially those that may slow the progression of the disease.
- Do most of the driving and encourage him to only drive to familiar destinations—not at night or on the freeway.
- Take over the finances.
- Take advantage of available written information and counseling/support group opportunities.
No one wants to hear the words Alzheimer’s or dementia as part of a personal diagnosis. It is a lifestyle change that affects the whole family. We were told to tell our children so that they can plan for who will care for Dennis if I should pass on first, and so that they will be able to react to his changing behavior in the most positive ways. You may think YOU don’t want to know, but remember that an early diagnosis can be a very good thing that helps the whole family to cope and prepare for the future. New discoveries are being made about Alzheimer’s every day. Taking part in trials can not only help you and your loved ones, but also the many others who have or will have the disease.
by Marti Lythgoe, NL Editor