Dakota Travel Nurse Home Care

Keeping home an option!

End-of-Life Comfort Care

Comfort careWhen a patient can no longer benefit from curative treatment, comfort care allows them a better quality of life. Comfort care does not seek to cure or aggressively treat illness or disease. It focuses on relieving symptoms and optimizing comfort as patients near the end of life.

Comfort care can be given at home and nursing facilities. Most patients and family members prefer home to hospitals. Hospice care is one source of comfort care delivery. Comfort care is sometimes called palliative care, but the terms “palliative care” and “hospice care” cannot be used interchangeably. Hospice can be provided in the last six months of life. Palliative care can be offered anytime in the course of an illness.

Loved ones with a wide range of health conditions can benefit from comfort care. This includes cancer, heart disease, chronic obstructive pulmonary disease, and dementia or Alzheimer’s disease. Sometimes loved ones oppose stopping aggressive treatment for a condition and moving to comfort care. They may feel that there is still hope and not realize how much discomfort the treatment is causing their loved one. It to know and ensure the patient’s needs and wishes are honored. Many people approaching death make their own choice to stop treatments that cause significant side effects, preferring treatments that improve comfort. Your loved one also may prefer to die free from the life-support, such as ventilators and dialysis.

Choosing Where to Die In Comfort

Your loved one might have preferences for end-of-life care and where to receive it. Try to clarify which type of care your loved one wants. Options might include:

  • Home care — Most people prefer to die at home or in the home of a family member. You can assume the role of caregiver or hire home care services for support.
  • Hospice care — services that help ensure the highest quality of life for whatever time remains , can be provided at home as well.
  • Inpatient care. Some people might prefer round-the-clock care at a nursing home, hospital or dedicated inpatient hospice facility.

Comfort Measures for Specific Types of Discomfort:

If your loved one:

  • Feels tired and has little or no energy, keep activities simple. A bedside commode can be used instead of walking to the bathroom. A shower stool or switching to sponging off in bed can save a person’s energy.
  • Is no longer eating or drinking but wants to eat, you can help with feeding. Try offering favorite foods in small amounts. Or, serve frequent, smaller meals rather than three big ones.
  • Has shortness of breath or labored breathing, turn the head to the side and place pillows beneath it. Open a window or turn on a fan. Oxygen or a cool-mist humidifier also might help. Ask the medical team if medication is indicated. Sometimes, morphine or other pain medications can help relieve the sense of breathlessness.
  • Is agitated or confused, try to be calm and reassuring. Remind the person where they are and who also in the room.
  • Seems to be in pain, ask the medical team to adjust medication. Focus on relieving pain without worrying about possible long-term problems of drug dependence or abuse. Pain is easier to prevent than to relieve, and severe pain is hard to manage. Don’t wait too long to give medication. Try to make sure that the level of pain doesn’t get ahead of pain-relieving medicines.
  • Has skin irritation, gently applying alcohol-free lotion can relieve dry skin. Dryness on parts of the face, such as the lips and eyes can be eased by a lip balm, a damp cloth placed over closed eyes, ice chips, or a specially treated swab. A heavy cream can be used on heels and elbows.
  • Has bed sores or pressure ulcers, turning the person from side to back and to the other side every few hours may help prevent more sores or heal existing ones. Try putting a foam pad under an area like a heel or elbow to raise it off the bed and reduce pressure. Ask if a special mattress or chair cushion might help. Keep the skin clean and moisturized.
  • Has cold hands and feet, make sure there isn’t a draft in the room. Turn up the heat and provide warm blankets .People who are dying may not be able to tell you that they are too hot or too cold, so watch for clues. Someone who is too warm might repeatedly try to remove a blanket. A person who is hunching their shoulders, pulling the covers up, or even shivering is giving signs of being cold. Avoid electric blankets because they can get too hot. 

Mental and Emotional Needs

End-of-life comfort care also includes helping the dying person with mental and emotional distress. Depression and anxiety are common. Conversations about their feelings or medication may help. Holding hands, a touch, or a gentle massage can be soothing and make a person feel connected to those he or she loves. Just being present and listening can make a difference. Music at a low volume and soft lighting can improve mood, help with relaxation, and lessen pain. Listening to music might also bring back memories that the person can share with those who are there.

Spiritual Issues

Many people nearing the end of life have spiritual needs as important as their physical concerns. Spiritual needs might include:

  • Finding meaning in one’s life
  • Ending disagreements with others and resolving unsettled issues with friends or family
  • Struggles with their faith or spiritual beliefs

Praying together, talking with someone from one’s religious community (such as a minister, priest, rabbi, or imam), reading religious texts, or listening to religious music may bring comfort. Family and friends can talk about the importance of their relationship and share memories of good times. Those who can’t be present could send a recording of what they would like to say or a letter to be read out loud. Your loved one might also find it comforting to have help with leaving a legacy — such as creating a recording about his or her life or writing letters to loved ones, especially concerning important future events.

Comfort care isn’t just about tending to a patient’s physical needs but to a patient’s mental, emotional and spiritual needs as well. Successful comfort care providers find ways to offer emotional as well as physical support. They also know when to ask for help.

Every situation is different. Dakota Home Care assigns an experienced registered nurse to visit your home, to evaluate and assess the patient’s and family’s needs. We work with the patient, family and home care staff to draft and implement an individualized plan of comfort care, including hospice care, for your loved one. Call us today at 701.663.5373 to schedule an appointment.

Resources:

Advertisements

Ardys Olson, RN, Reaches 50-Year Milestone in Her Nursing Career

ardysDakota Home Care is proud to announce that one of our skilled nurses, Ardys Olson, RN, has reached a milestone of 50 years dedicated to the profession of nursing! She recently was recognized in a North Dakota nursing publication, and we are thrilled to recognize her as one of our own!

 Becoming a Nurse

As a high school graduate, Ardys first thought she would go into accounting. Then a bout of appendicitis and a stay in the hospital to have her appendix removed helped her to change course and decide that nursing was her calling. She had always been interested in nursing, but actually being in a hospital setting peaked her interest even more. That and knowing that she wanted to help people turned her life around.

Ardys attended what was then Bismarck Hospital School of Nursing for a 12-months-a-year, 3-year program. (Nursing is now a 4-year program with summers off.) Too far from home to commute, she lived in the dorms and “had a blast.” She started dating her husband, Gerald, during her last year, graduated in May and got married in September. They recently celebrated their 50th wedding anniversary with a trip to Tahiti. Ardys and Gerald have 3 children and 6 grandchildren.

Raising a Family

Not long into her career, Ardys became a military wife. Gerald was drafted into the Vietnam War. When he left for basic training, she stayed in North Dakota and worked. After that, she went with him whenever she could. “Wherever we were, there was always a job,” Ardys said. They were married for three years before they started a family. When the children came along, nursing gave her the flexibility to take a 6-month maternity leave each time and then work part-time.

“It’s a beautiful thing for mothers to have a nursing career. I was able to work evening hours while my husband worked days. We required minimal child care. As a mother, it also helped to understand injuries and sickness and how our bodies function. I can’t imagine going through life not thinking how a nurse thinks or understanding what a nurse does!”

Thriving on Chaos

The majority of her career, Ardys worked in Emergency Care. She started her emergency career in a small hospital in a small South Dakota town, but for 30 years she managed the Emergency Department in MedcenterOne, a 200-bed hospital in Bismarck. “I thrive on chaos and the unknown”, Ardys said. “My job was always interesting and never routine. I had a very good staff. We were like a family.” The patient load varied from 40 – 80 patients a day, keeping Ardys and her staff of nurses very busy.

Specializing in Everything

Ardys explained that emergency departments specialize in “everything,” and there is a lot of on-the-job learning. “It’s only been about the last 15 years that nurses are required to have continuing education as part of licensing renewal. “The practice of nursing is overwhelmingly different now. When I started, nursing was mostly about comfort care. Nursing practice is now assessment, intervention, and planning.  Nurses coordinate with other disciplines such as social services, nutritional services, and the therapies to provide patients the best opportunity for a positive outcome and a return to their home environment.”

Challenging and Rewarding

When asked what was the most challenging part of her fulltime job, without hesitating Ardys replied, “The weather! The weather in ND can be difficult! Even in a big snowstorm or below zero temperatures, somehow the patients managed to show up and we had to be staffed!  Our department had to be available for emergency care.”

One memory that stands out in her career is when 8 patients who had been in a car accident in the middle of the night came to that small hospital where she first worked. “That put us in disaster mode!” She also remembers life-threatening events where things went well, patients with end-of life issues that could be helped to feel a little better so they could attend a special event, and an ill groom-to-be who was made well enough to attend his wedding.

Retiring—for a Year

Ardys retired from her full-time job in 2012 and didn’t work for a year. “I didn’t realize how stressful my job was until after I’d retired. It took me a year to recover!” After a year, Ardys started back to work part-time. “It’s healthy for me to feel like I can help other people and that I still have a purpose in life. I would like to continue to help others as long as I’m able to do the job and enjoy it. I like the in-home environment and the relationships.”

Going Beyond 50 Years

Currently, Ardys works partime doing pediatric nursing for Dakota Home care. She goes into the home to care for a child with identified medical needs. “It makes me feel good to help the parents and give them the freedom to go out from time to time. Parenthood is a 24/7 commitment. I feel like I’m helping the family as well as the child.”

When she’s not working, Ardys enjoys cooking, baking, reading and taking care of a 3-year-old granddaughter. She and her husband go to a warmer climate for a few weeks in the winter. We’re very happy that she enjoys spending a little time being part of the Dakota Home Care family and that she will continue her career beyond 50 years by working for us!

Congratulations Ardys!

Facing a Hard Choice: Saying Yes or No to Artificial Nutrition & Hydration (ANH)

accounting series- confusing tax formsIt can be difficult to have a conversation with your family about whether or not an elderly family member should be put on artificial nutrition and hydration (ANH) when he or she is nearing the end of life. However, it’s usually much easier to make that decision while the elderly person can still give informed consent and include their wishes in an advanced health directive. Providers need to be aware of the goals of all concerned and families must be informed as to whether ANH can realistically achieve these goals.

Have the Conversation

A few months before my 97-year-old father died, he and I sat down with a kind doctor who explained the risks and benefits of ANH. Dad was able to state unequivocally that he did not want ANH or any other extreme measures, including hospitalization, if he developed a life-threatening illness. We made contact with a hospice service that sprang into action immediately when he developed aspirational pneumonia. Within three days, he died peacefully in his own bed.

For some families the choice is not so easy. Each situation is different. Some people consider it an ethical matter and feel they must prolong life as long as possible. Others worry that their loved one will suffer needlessly without nourishment or fluids. Your spiritual advisor and doctor can help you make the decision that is right for the patient and family, including informing you of the risks and benefits of ANH and alternative treatments and interventions.

Possible Side-Effects of ANH

When a person has a curable illness and can’t swallow, ANH can help him or her recover. For a patient who has a life-threatening illness and is dying, ANH may not be beneficial. These patients may live a little longer with ANH, but not always. In either case, there are side-effects to consider.

  • Requires the patient to undergo uncomfortable, and at times painful, procedures when the treatment is started
  • Serious infections,
  • Nausea, vomiting and diarrhea
  • Skin breakdown due to constant moisture from urine and/or feces on the skin
  • Electrolyte and mineral imbalance

Dehydration and Poor Nutrition Common in the Elderly

According to the Journal of the American Geriatrics Society, the elderly are at a high risk for dehydration due to a decreased sense of thirst, fear of being incontinent, swallowing difficulties and gastrointestinal disorders, etc. See our blog on Strategies to Prevent Dehydration in the Elderly. They also often suffer from a loss of appetite or for other reasons don’t want to eat, putting them at risk for nutritional deficiencies. See our blog on Why Seniors Don’t Want to Eat and What you Can Do About it.

 Alternatives to ANH

ANH does not prevents aspiration pneumonia in a person who has difficulty swallowing; it may actually increase episodes. There also is evidence that ANH actually causes more harm than good in people with advanced Alzheimer’s disease. In both cases, careful feeding by hand is a better alternative.

Dehydration in dying patients is not painful. Increased sleepiness and less mental alertness occur without other signs of distress. The majority don’t experience thirst, and any initial thirst that occurs can be alleviated by small amounts of fluids or ice chips given by mouth, and by lubricating the lips.

When a person with advanced age or a terminal illness stops eating, usually it is because they are no longer able to process food and fluids. Forcing this person to eat, or starting artificial nutrition and hydration usually does not help the person to live longer or feel better. For those who experience hunger, small amounts of food and fluids, offered whenever the person wants, will relieve the hunger.

We often think of giving food and water as a form of comforting or nurturing. For a dying person, more helpful forms of nurturing can be expressed by gentle presence, touch, talking with the person (regardless of his/her ability to respond), keeping the person’s lips and mouth moist, gently massaging the skin using lubricants, praying with the person, or playing favorite music.

Call Dakota Home Care for assistance in managing the care of a loved one who is facing this difficult choice: 701.663.5373.

Resources:

It’s spring! Why is my elderly loved one still depressed?

sad senior womanEven though spring flowers are starting to bloom, cool, rainy or even sunny spring days still can bring on feelings of sadness, depression and a lack of desire to do much of anything. While the rest of us can start doing some favorite outdoor activities and more easily get out to see family and friends, our loved ones may still feel homebound and missing the increased mobility they used to look forward to in spring. Consider one of these as a possible causes of depression in your loved one:

Less Socializing & the Technology Gap: During any time of the year, depression can be caused by social isolation. Help your senior to spend more time with family, friends and neighbors, and when unpredictable spring weather makes visiting difficult, call them for a chat or write a letter that can be read over and over.

While the younger generations are staying well connected with all of today’s high tech gadgets, the elderly are often left out. Older family members need to feel connected, wanted, and loved, too. Some training in electronic ways to connect may help bridge the gap, but many elderly people are incapable of mastering email, Facebook or Skype. Friends can play a vital role in socialization, and new friends can be found at senior centers, church activities or even the library.

Loneliness: Older people are particularly vulnerable to loneliness. Loss of a spouse, friends, family, mobility or income can all play a part. Studies show that being lonely is a leading cause for poor physical and mental health among the elderly and can even lead to early death. When loneliness sets in, it can increase the risk of high blood pressure, over-eating, under-eating, excessive drinking, depression, heart disease and other debilitating diseases, such as arthritis, osteoporosis and glaucoma. People who are lonely are twice as likely to become less involved in daily activities. Alleviating loneliness often can be achieved by more one-on-one contacts of any kind—with friends, family, community &/or assisted living activities and other group services.

Lack of Exercise: Exercise has proved to be almost as effective as medication for some in relieving the symptoms of depression. It produces natural endorphins that act like a drug to increase happiness. Even a short walk or chair exercises can give an elderly person a feeling of accomplishment and self-esteem. Exercise is one of the few things that has been proved to slow the advance of some forms of dementia, such as Alzheimer’s.

Sometimes just a reminder to exercise or being part of a group that exercise regularly can help to create a habit. A family member or home health aide can “spot” an elderly person to be sure that there is no danger of falling or hurting oneself. Exercise is so good for our bodies in so many different ways that everyone should be encouraged to do what they can. Exercise has so many positive effects that we can see how lack of exercise can contribute to depression anytime of the year. Sometimes, Dr. prescribed in-home physical therapy can get your loved one moving again.

Boredom: Often, the elderly gradually have more difficulty planning and initiating a healthy variety of activities. Caregivers may have to take the initiative when it comes to suggesting and planning things to do and opportunities to be with friends and family members.

Boredom that leads to depression is a major concern and can be a danger to seniors. No matter what their physical problems may be, meaningful activities and opportunities to socialize are vital in helping them to maintain their ability to live independently and even to live longer, happier lives.

Summary: Isolation and loneliness, lack of exercise and boredom pose health challenges for seniors all during the year, but with planning and some help, they can be healthier and happier when spring finally arrives.

Dakota Home Care helps aging adults maintain their emotional and physical health and their independence by providing companionship and transportation services. Visits with family, lunch with a friend, an evening out, or being able participate in running errands can be a real mood elevator. For more information, call 701.633.5373. Also see our blog on Courier and Transportation Services.

Is It Spring Yet? Weather-Related Depression in the Elderly

An elderly woman sadly looking out the window.Winter weather can keep seniors homebound and isolated. After all, biting cold and snowy days can make anyone want to stay in a warm bed or just sit all day wrapped up in a quilt. A day or two of the “winter blues” can be normal, but when symptoms of depression become debilitating for more than a week or two, caregivers should start looking for a deeper or treatable cause.

Although falls and hypothermia are likely to top the list of caregiver concerns during winter months, seniors are also at risk for these health hazards:

Seasonal Affective Disorder (SAD) 

A lack of natural light can cause depression in both young and old alike. We don’t know for sure why less sunlight causes depression. One theory is that the seasonal changes interfere with an important amino acid in our bodies called Melatonin, which regulates our sleep-wake cycles and may play a role in mood and appetite.

The main difference between SAD and general depression is that SAD only occurs during certain times of the year. Signs of SAD include a loss of energy, changes in appetite and sleeping habits, irritability, and loss of interest in socializing and other activities. These changes in behavior can be worse if a person cannot or does not want to regularly spend time outdoors. This especially impacts the elderly, who are more likely to be housebound or want to stay indoors.

Like other forms of depression, SAD can be treated with antidepressant medications. A drug-free option is light therapy. It requires a “light box,” a fluorescent lamp that emits a spectrum of light that simulates natural sunlight. A more natural alternative to light therapy is daily exposure to sunlight. If time, physical health, and weather conditions permit, it is beneficial for a person with SAD to go outside for a few minutes on sunny days. In any case, keep lights on, open curtains and blinds to let in natural light, and encourage the person to sit close to a window.

Vitamin D Deficiency

Our skin needs direct contact with the ultraviolet rays of the sun to make one type of Vitamin D. A deficiency of this important nutrient is related to both depression and obesity. Seniors are more likely to have a Vitamin D deficiency for three reasons: 1) elderly skin is less efficient at producing this nutrient, 2) they are usually outside less during cold weather and 3) aging bodies have more difficulty converting and absorbing vitamin D from foods. Also, certain medications, such prednisone, can inhibit the ability to produce and metabolize vitamin D.

A simple blood test can diagnose vitamin D deficiency. The safest way to treat or prevent it is to ensure a senior eats food naturally high in vitamin D, like beef liver, egg yolks, cheeses, mushrooms and fatty fish like salmon. Certain varieties of milk, yogurt, cereals and juice are fortified to contain extra vitamin D. 

Check with a Doctor

If you believe an aging loved one may be experiencing something more serious than a short case of the winter blues, encourage them to meet with their doctor to determine if SAD or vitamin D deficiency may be to blame. The physician will work with you both to consider all possible causes and devise an appropriate course of treatment. This may include light therapy, a change of diet or Vitamin D supplements.

Winter can be a hard time to find fun things to do. Anything you can do to help your senior socialize or laugh a little will help fight depression. Arranging visitors may help. If health and mobility allow it, small outings or mini-trips to regional attractions are also a way to break up the monotony of a long winter. The doctor may prescribe companionship care to help your loved one feel more like themselves again.

Winter poses challenges for seniors, but with awareness and planning they can stay healthy and be ready for spring. Dakota Home Care can help aging adults maintain health and independence by providing companionship, meal preparation and personal care. For more information, call 701.633.5373.

10 Tips for a More Heart-Healthy Diet

Healthy food in heart shaped bowlFebruary is Heart Health Month. Though heart disease risks increase with age, it doesn’t have to be an inevitable part of getting older. A more heart-healthy diet is an important step you can take to help your elderly loved one minimize those risks. February is a great time to take an inventory of the foods you and your loved ones are eating.

It is always wise to check with a doctor before starting a whole new way of eating. However, anyone is more likely to succeed with gradual diet changes, making meals healthier, but still appealing. It’s also okay to occasionally treat yourself or your loved one to a favorite but not-so-healthy food.

In March of 2017, we wrote a blog titled, “Why Seniors Don’t Want to Eat & What You Can Do About It.” If your loved one doesn’t want to eat, no matter what is on the menu, you should check out the causes and strategies discussed there. If bad habits or simply lack of awareness are the problem, consider these 10 tips:

10 Heart-Healthy Guidelines Almost Everyone Can Follow

  1. Eat more colorful fruits and vegetables. Low in calories, high in vitamins, minerals and fiber older adults should eat at least five servings per day. Colors indicate a concentration of a specific nutrient, so try to choose a variety. Some ideas are to eat salads every day; make snacks of raw veggies like carrots, celery, pepper strips, and cucumbers; make a meal of a vegetable soup, especially if it is low in sodium.
  2. Select Whole Grains. Avoid overly-processed foods made from white flour. When you have a choice, go for the whole grain version in pastas, breads, and other types of foods. When possible, skip the bread and eat grains whole, for example oatmeal or brown rice.
  3. Eat less high-fat dairy or meat. Look for skinless cuts of lean meat with the least amount of visible fat. Ground meats should have less than 20% fat, whether it’s chicken, turkey, pork or beef. Foods like bacon or cheeseburgers should be eaten infrequently and in small portions. Yogurt, milk, cheese and other dairy products should also be low in fat — 2% “reduced fat” or less. Consider replacing butter with a more healthful spread that has healthy fats that may help lower bad cholesterol.
  4. Have two servings of fish a week. The one kind of fat you and your loved ones should get plenty of is fatty fish: two servings a week of salmon, trout, or other oily fish can help lower the risk of heart disease and increase your body’s level of healthy omega-3s.
  5. Add high fiber foods to meals. You can find fiber in fruits, vegetables, beans, whole-grains and nuts. A study at the Loma Linda University School of Medicine found that Seventh Day Adventist patients who ate nuts at least five times per week cut their risk of heart disease in half.
  6. Choose Dark Chocolate. The darker and more pure the chocolate, the better it is for your heart. Chocolate is high in other not-so-good things like fat, so limit intake to an ounce or so a day.
  7. Replace sugary drinks like soda or fruit juice with herbal teas. The jury is out on caffeine. Some studies show that high caffeine intake can cause heart rhythm issues and other studies show it has a protective effect. Green and black tea may be a good choice since they contain flavinols that are believed to protect and maintain a healthy heart.
  8. Limit salt intake. “Most seniors need around 500 mg of sodium per meal, or 1500 mg per day. If one serving of any particular item has more than 250 mg of sodium, you may want to search for a product that has less.
  9. Stock the kitchen with healthy items. Don’t even buy tempting junk food.
  10. Stay Hydrated. Often, seniors don’t feel thirsty, and it may be a big effort to get up and get a drink of water. Keep a water glass or bottle within reach of where he or she frequently sits. It’s still a good rule of thumb to try to drink eight 8-oz glasses of water a day. Soups or juicy fruits can also help with hydration.

Your senior can be heart healthy no matter what their age, but it does take effort. By maintaining a healthy diet along with regular physical exercise and other good habits, seniors not only feel better, but can live longer, too. Everyone wants to stay healthy and vital for as long as possible. It’s never too late to start living a healthy lifestyle and get heart disease risks in check.

For seniors who live alone and find it difficult to prepare nutritious food for themselves, there are services available to help ensure they’re getting the foot they needs. For example, Dakota Home Care provides aides who can shop and cook and sit with your senior during meals. Services can be for as little as one hour per visit or up to 24-hours-per-day. Home Health Aides can assist with meals and companionship and a whole list of other things. Call us today at 700.663.5373 for a free consultation.

Making Caregiving a Family-Group Effort

Carer and Family Thumbs upIf you are the oldest daughter living in the same city as an aging parent, the chances are very high that your family will expect you to be the primary caregiver, or to at least coordinate caregiving efforts. I am the oldest of 9 siblings and the oldest of the 3 daughters in my family, and yet for more than 10 years, until he passed away on Jan. 4, 2017, I had to struggle to get family to help with caring for my dad. Four of my siblings, a sister and 3 brothers, lived 5 or more hours away from dad. They all said they “wished” they could do more, but I saw very few responses to my suggestion of making phone calls or sending letters, if only to let Dad know they were thinking about him or to give him more social interaction. A sister who lived nearby felt estranged from Dad and would do nothing. Two brothers were willing to pay Dad a visit once a week. When she retired, a sister-in-law (brother deceased), helped more than all of my other siblings combined.

A Common Experience

Unfortunately, my experience is not unusual. A new Alzheimer’s Association survey reveals that almost all agree (91%) that caregiving should be a group effort, yet two in three caregivers feel alone. “American families are unprepared to face the looming Alzheimer’s caregiving, financial crisis [and a] lack of appreciation and support stress family relationships, especially among siblings.”

Far too many caregivers are doing it alone. Two out of three caregivers (64%) felt isolated or alone in their situation, and more than four in five caregivers (84%) would have liked more support with caregiving tasks, particularly from their family.

The No. 1 reason people said they did not help with providing care for someone with Alzheimer’s or another form of dementia was they felt as though another family member had already taken on the responsibility (74%), followed by their not living in the same area (62%).

The Importance of Planning Ahead

“There are currently 15 million Americans providing unpaid care for someone with Alzheimer’s or dementia, and this survey shows that we must alleviate the weight on the shoulders of these individuals,” said Ruth Drew, Director of Family and Information Services for the Alzheimer’s Association. She stressed the importance of planning for the devastating toll this disease may have on people and their families. Survey respondents were less likely (20%) to have discussed their wishes with a spouse or other family member than they were to have made financial plans (24%). A lack of communication can contribute to family tensions, but it’s also something that can be improved upon.

The university neurological center that diagnosed my husband with Alzheimer’s has provided some valuable family support that other families could duplicate. They arranged for my husband and I and our 5 grown children to meet with a social worker. The purpose was two-fold: to educate our children about the disease and its possible progression, and to help us plan as a group for the types of assistance both my husband I might need from them. We also discussed what the children would have to do for their dad if I were to die first. They recommended and we held a follow-up meeting at home to discuss what was learned and what steps would need to be taken when and by whom. Everyone reported feeling relieved to know that we are all on the same page and willing to do what we can to help when more help is needed. We also shared information about our financial situation.

Strength vs. Strain

Findings from the survey show that in some families, Alzheimer’s caregiving enhances family strength and support, while in others, it can tear relationships apart. Relationships between siblings were found most likely to be strained, caused by the feeling of not having enough support in providing care (61%) along with the overall burden of caregiving (53%). Among all caregivers who experienced strain in their relationships, many felt like their efforts were undervalued by their family (43%) or the person with the disease (41%). Conversely, 35% of survey respondents said caregiving strengthened their relationships with other family members, with two out of three of these reporting that they felt like the experience gave them a better perspective on life.

Relationships between spouses/partners were strengthened the most from the experience, with 81% believing that “being emotionally there for each other” was a source of strength they drew upon for caregiving. “Having the support of family is everything when you’re dealt a devastating diagnosis such as Alzheimer’s,” said, a Forked River, New Jersey, resident who has been living with younger-onset Alzheimer’s for two years. “My wife, has been my rock as we navigate the challenges of Alzheimer’s. It’s easy to want to shut down following a diagnosis, but that’s the time when communication within families is needed most.”

Whether you are in the process of caring with a family member with Alzheimer’s or simply wondering whether the disease will strike your family, it’s never too soon or too late to recognize the need to plan for and give family support. In addition to help from family members, home health care organizations like Dakota Home Care can ease the stress of caring for a loved one with dementia. Call us today at 701-663-5373 for a free assessment of what we can do to help.

Resources for Families

The Alzheimer’s Association can help people learn how to navigate changes in their relationships with family members and friends. In addition to its 24/7 Helpline (800-272-3900), the Association offers various resources for families including:

Reference: http://alz.org/documents_custom/2017_abam_natl_pr_060117.pdf

Courier & Transportation Services Help Keep Home an Option

Transport serviceWhen you or a loved one can no longer drive or move around outside the home safely, a myriad of challenges present themselves. Who will do the shopping or go to the pharmacy? How will I visit my friends or enjoy an evening out? How can I keep my Doctor, hair or other appointments?

Dakota Home Care is pleased to announce that we now offer Courier and Transportation Services throughout the Bismarck/Mandan area as another way to “Help keep home an option.”

Our Courier Service will do your shopping and runs other errands for you or your loved ones, delivering them right to your door.  Examples include grocery, birthday or Christmas shopping; trips to the pharmacy, taking clothes to the cleaners or running other errands.

Our Companion Transportation Service provides door to door service to and from your home for shopping, Dr. appointments, or other errands as needed.   Visits with family, lunch with a friend or an evening out are available. Our drivers are able to assist passengers with outings such as grocery shopping with bagging and delivery back to your home.

Seniors in the Bismarck/Mandan area can now enjoy the independence and freedom of carefree transportation or have supplies and gifts picked up and delivered to their doors. Services are available Monday through Saturday from 8:00 AM to 5:00 PM, or evenings upon request. Rates are by the hour or half-hour. To make reservations, call Dakota Home Care at 701.663.5363  

Dakota Home Care is licensed by the ND State Health Department. We are locally owned and operated. Contact us at 701.663.5373 for a free consultation regarding any of our quality healthcare services.

Can Lifestyle Changes Affect the Onset or Progress of Alzheimer’s Disease?

Life style concept: pixelated words Change for Improvement on di”Dementia is not a condition that’s ever going to be such that a single drug can be considered a cure for the illness,” said Professor Lon Schneider, co-author of the Lancet Report presented at the 2017 Alzheimer’s Assoc. International Conference. Alzheimer’s is now thought to be a disease like Cancer or heart disease, which also can’t be prevented or cured by a single drug. Thus, over the past decade, scientists and doctors are increasingly studying and testing the results of how controllable lifestyle changes made early in life, before the onset of the disease, or even after a person diagnosed with Alzheimer’s could affect the severity and progression of any type of dementia.

The Lancet Report also boldly claimed that “up to one-third of the world’s dementia cases could be prevented by certain lifestyle changes.” The report has met with some opposition, but it surely can’t hurt to be aware of the findings and to try to attempt as many of the changes as we and/or our loved ones are able to make. Professor Schneider added: “The potential magnitude of the effect on dementia of reducing these risk factors is larger than we could ever imagine the effect that current, experimental medications could have. Mitigating risk factors provides us a powerful way to reduce the global burden of dementia.”

Nine Lifestyle Risk Factors

The report identifies nine lifestyle risk factors for Alzheimer’s over a person’s life span that can have an accumulating effect, including:

  • Childhood before Age 15: years of education
  • Middle Age: hypertension, hearing loss and obesity
  • Late Life: a smoking, depression, physical inactivity, social isolation and diabetes

The Lancet team considered each factor separately and also looked at how they related to one another to calculate how much modification of each could potentially affect a person’s dementia risk. Only by modifying all nine factors could the risk be reduced by 35 percent.

Dr. Doug Brown, director of research at the charity Alzheimer’s Society, said: “The revelation that over a third of dementia cases worldwide are, in theory, entirely preventable is cause for celebration. But to achieve even close to this kind of reduction in cases we need to consider two important challenges – firstly how risk factors like education, obesity and depression apply not just at a population level, but to individual people who all have their own unique genetic risk profiles, and secondly how we can motivate people in mid to late life to change their behavior and adopt healthier lifestyle choices.”

Dr. Brown points out not all of the nine risk factors identified are easily modifiable:

  • Difficult to change: poor education and social isolation
  • Easier to improve: cardiovascular factors like lowering blood pressure and not smoking
  • Need for further study: links between hearing loss and dementia not really known
  • Healthy habits: difficult to motivate people to make healthier choices, like a better diet and more exercise, as measures they can take to reduce the risk of dementia

He added: “While this report rightly highlights measures we can take to reduce our risk of dementia, it also serves as a reminder that even if every risk factor identified here could be eliminated, we do not yet have a surefire way to prevent dementia. Alongside prevention research, we must continue to invest in research to find a life-changing treatment for people with this devastating condition.”

Three Interventions

At the same conference, A report by the National Academies of Sciences, Engineering and Medicine took a more cautious approach to the effects of lifestyle modification. Its testing methods found that just three types of intervention offered “encouraging but inconclusive” evidence:

  • Cognitive training,
  • Blood pressure management for hypertension
  • Increased physical exercise.

2016 Alzheimer’s Conference

Lifestyle choices that were considered at the 2016 Alzheimer’s Conference included:

  • Work that involves complex thinking
  • Interaction with other people

Both seem to help protect against the onset of Alzheimer’s. One startling conclusion was that while a “Western” diet (red and processed meats, white bread, potatoes, pre-packaged foods and sweets) is associated with cognitive decline, people who ate such food could offset the negative effects and experienced less cognitive decline if they also had a mentally stimulating lifestyle.

Occupations that afforded the highest levels of protections included lawyer, teacher, social worker, engineer and doctor. The key seemed to be working primarily with other people, rather than with things or data. “You can never totally forget about the importance of a good diet, but in terms of your risk of dementia, you are better able to accommodate some of the brain damage that is associated with consuming this kind of (unhealthy) diet,” said Matthew Parrott, of the Rotman Research Institute in Toronto, who presented the study.

Hope for the Future

There are large trials that are ongoing or forthcoming that could provide more evidence to support the effects of lifestyle intervention. We recommend that you check regularly for the latest news on www.alz.org. And start NOW to eliminate as many risk factors as you can from your lifestyle and to encourage those close to you to do the same.

Resources:

 

Driving with Dementia: When Is It Time to Stop?

Out for a driveMy husband is still driving, even though it’s been 17 months since I last blogged about “When Is It Time to Give Up the Car Keys,” and I reported how on a road test he had just squeaked past the minimum score required to keep his license. In that time he hasn’t had an accident or been pulled over for any kind of moving violation. Whenever we’re going someplace together, I drive. He doesn’t drive at night and he rarely drives anywhere that he hasn’t been before. The few times I have been with him, the only problem I’ve noticed is that he doesn’t always notice speed limit signs and tends to drive under, rather than over the limit. (This IS a warning sign.) He seems to have learned from the things the person testing him warned him about.

Alzheimer’s Association Positions

That my husband is doing so well—so far—seems to support the Alzheimer’s Association positions that:

  • A diagnosis of Alzheimer’s disease is never by itself a sufficient reason for loss of driving privileges.
  • They do not support mandatory reporting as a solution to the driving and dementia issue because it can have unintended consequences, including an unwillingness for individuals to seek early diagnosis; risk to the relationship between the physician and patient; and even an unwillingness of physicians to appropriately diagnosis Alzheimer’s disease. California and some other states do require reporting a probable diagnosis to the DMV.
  • They recommend that the person with dementia, along with his or her family and friends, are educated about the need to plan and address the issue of driving with dementia.

Normal Aging vs. Dementia

Normal aging does cause physical problems that may affect driving, such as diminished visual and auditory acuity, slower reflexes and lack of flexibility. However, we all age at different rates, and even the onset of dementia occurs differently in every affected person. Dementia patients have additional deficiencies in perception and visual processing; ability to pay attention for extended periods of time; ability to respond to multiple stimuli at once; ability to make correct judgments (such as which drivers have the right of way); and ability to react appropriately when pressured in a traffic situation.  Studies have shown that even though people in the early stages of dementia may be capable of driving under normal conditions, they have difficulty responding to new or challenging circumstances, and they are also at risk to becoming lost while driving. As dementia progresses into the middle stages, the ability to drive safely becomes highly compromised.

The Alzheimer’s Association does stress that, “The declining cognitive abilities of a person with Alzheimer’s disease will ultimately lead to the need for the individual to stop driving….At some point in the progression of the disease, driving-performance errors will present a safety risk to both the individual and the public.” So if, as they suggest, we are to involve the person with dementia in the decision making process to determine when it’s time to stop driving, what warning signs should we and they be looking for, and what restrictions can reasonably put on their driving? We don’t want to wait, as many people do, until there has been an incident involving an accident, getting lost while driving or other driving crisis.

Warning signs of unsafe driving:

  • Driving at an inappropriate speed
  • Stopping for no reason
  • Making turns from the wrong lane
  • Turning in front of other cars
  • Backing up or changing lanes without looking back or checking mirrors
  • Unexplained dings and dents around the vehicle
  • Forgetting how to locate familiar places and getting lost
  • Failing to observe traffic signs or traffic lights
  • Making slow or poor traffic decisions
  • Becoming angry or confused while driving
  • Near misses
  • Delayed response to unexpected situations

Recently, my husband wanted to be the one to take my car in for the emissions testing and safety inspection required annually by the Utah DMV. Even he recognized it was not a good sign that he took His car instead of mine and had to come back home and start over again.

Examples of Restrictions

  • Driving only in the daytime hours
  • Limiting driving to certain areas
  • Installing a GPS device to help locate the individual if he or she becomes lost or travels outside a specified area
  • Limiting distractions such as the radio or talking while driving
  • Abide by a third party driving evaluation, conducted by an occupational therapist or other trained professional
  • Limited driving on the freeway

Risks of Self-Assessment

A majority of older drivers decide by themselves to give up driving — over 600,000 a year, according to the American Journal of Public Health. Dementia however, also compromises the ability of self-assessment, and most drivers with dementia fail to realize that their driving is unsafe. Consequently, drivers with Alzheimer’s dementia often continue driving after they have been advised to stop or even after they have had a crash.  If allowed to continue driving, 30 percent of drivers with dementia would have a crash under normal driving circumstances at the middle stages of the disease, as estimated by Researchers at Washington University in St. Louis.

Let Physicians and Driving Assessment Centers Take the Rap

If a physician determines it is no longer safe for a person to drive, the physician should recommend that the person “retire” from driving. The physician also should assesses the person who “retires from driving” to determine if he or she is depressed. Families and friends should be prepared to provide alternative ways of transportation and emotional support for when driving is no longer possible, to address feelings of lost autonomy or depression. The decision to take away driving privileges doesn’t have to be contentious for families. Physicians and driving assessment centers can play a key role on taking pressure off family members.

Giving-up driving is reportedly the most difficult decision a person can make, and it will affect their whole way of life. But be aware, giving-up driving is never too inconvenient when compared to the tragedy of a fatal accident. Watch for the signs of impaired driving, and Be Safe!

by Marti Lythgoe, Dakota Home Care Writer/Editor 

Resources: