ElderCare Solutions

Geriatric Care Management Services

The Gift of Time 

By Leave a Comment

I hear so many people pondering over what to give to their older loved ones for the holidays. I’ve even had my children ask me what I want for Christmas and was at a loss. There is nothing I need; and most things I might want I usually get myself. When my son called recently and asked me what I would like for Christmas, I told him we should plan to go out for a movie night after the holidays are over. That is when I realized that what I want most from my family and close friends, not just at the holidays but all year long, is to spend time with them. 

We live in a society where materialism and commercialism have taken over the holiday season. The average American spends $700.00 at Christmas. It seems that the real meaning of Christmas has been replaced by things, resulting in mounting debt. And every parent can likely remember spending time and money to find the “toy of the year” for a child, only to have the toy forgotten by mid-January.  

In Dr. Seuss’s How the Grinch Stole Christmas, we see a sad, lonely, Christmas-hating guy try to squelch the joy of the people of Whoville by stealing all their Christmas gifts and decorations, thinking it will ruin the holiday for them. What he finds, instead, is summed up in this passage: “And the Grinch, with his Grinch-feet ice cold in the snow, stood puzzling, and puzzling, how could it be so? It came without ribbons, it came without tags, it came without packages, boxes or bags. And he puzzled and puzzled ‘til his puzzler was sore. Then the Grinch thought of something he hadn’t before. What if Christmas, he thought, doesn’t come from a store? What if Christmas, perhaps, means a little bit more.” 

Often our elderly friends, neighbors, and relatives become more isolated as they age due to physical and mobility changes. Just losing the ability to drive can cause one to feel like a prisoner in their own home. I am met with this reality regularly when I do home visits. My clients love the social aspect of our visits, often asking about the weather, my family, or how many people were walking dogs in their neighborhood. Imagine how much they would love having regular visits from people they don’t get to see too often! Imagine how much it would improve their mood and quality of life! Of course, people who have jobs have limited time. But all of us also have limited time on earth. And I have never attended a funeral or memorial service where anyone said they regretted spending TOO MUCH time with someone. I have, however, heard the opposite.  

Make a promise to yourself this holiday season to spend your time with no regrets and make it a gift to others. Perhaps, like the Grinch, you will feel your heart grow three sizes by living the real meaning of the holiday season and giving the gift of time. 

Just my two cents, 

Penny 

Celebrating Gratitude  

By Leave a Comment

The role of a care manager is varied. Often, I operate as a professional problem-solver. Some days I feel more like a house manager. On my best days, I am a support person. But there are also days I feel like a one-woman complaint department; a bottomless repository for a client’s negative thoughts and feelings. Those days are more frequent than I would like, especially since I tend to be an optimist by nature.  Several years ago I decided to direct my clients’ negativity in more positive directions and began recommending keeping a gratitude journal. 

Journaling has long been used as a tool to encourage individuals to view and work through feelings by writing or even drawing about them. While this can be effective for some, it can also be an exercise in frustration if not guided and analyzed in some meaningful way. A gratitude journal, on the other hand, is a simple and straightforward way to encourage positive thoughts.  

The directives I use with clients is to spend a few minutes at the end of each day listing the things that they were grateful for that day. I often have them start with a list of three things and guide them through the process if they are having a hard time on their own. The list may include something as simple as a cold glass of water, a phone call from a friend, or getting outside to feel the sun on their face. Some clients start slowly but eventually are able to write exhaustive lists that include both simple pleasures and more complex events. 

Although it may seem like a simplistic way to change the direction of someone’s thoughts, research has shown that gratitude can affect us mentally and physically. An article from envivehealthcare.com lists seven health benefits of gratitude. These include lower blood pressure, lower risk of depression, better sleep, reduced stress, increased energy, improved self-care, and improved mental strength. Other articles listed benefits of gratitude as improved productivity, decreased anxiety, a more positive general outlook, and improved self-esteem. 

Although some articles did list the pitfalls of gratitude journal, namely avoiding dealing with the feelings associated with loss or conflicts, the literature touting the positive aspects far outweighs the negative.  

During the month of November when we celebrate Thanksgiving as one day to focus on gratitude, why not try to make gratitude a regular practice and see if it makes a difference in our outlook of the world and our circumstances?  

Just my two cents, 

Penny 

Senior Exercise: Better than Medicine

By Leave a Comment

Though not always addressed at routine medical appoints, regular exercise tailored to the ability of the elder maintains and even restores health. No matter what age a person is, inactivity causes physical decline.

Whether your parent is in good health or bedridden, it is important to encourage or begin an exercise regimen. Ideally, exercise incorporates an aerobic component to strengthen the heart and lungs, as well as movement to develop flexibility. Most importantly, exercise should be tailored to your elder’s strengths and limitations. While exercise should never cause pain, a good pain management program should incorporate some eerie.

How do you get an elder parent to exercise?

  • General expectations play a role. If your elder is able to perform a task, allow him or her to do it. Be patient, not overprotective. Allow elderly persons to help themselves. Doing so gives a feeling of competence despite physical loss.
  • Incorporate exercise into your regular visits. Take a walk, use an exercise DVD or YouTube video, or sit across from your elder and practice some gentle movements as you visit. Playing music can help the movement come more naturally.

Consider these safety guidelines:

  • If your elder has a serious medical problem, inform his or her medical provider of the exercise regimen. Ask the provider to recommend appropriate exercise if you’re in doubt.
  • Good routines take effort, but shouldn’t cause shortness of breath or pain.
  • Start slowly and build endurance gradually.
  • Avoid rapid or abrupt changes in position.
  • Take frequent rests and focus on slow, even breathing.

For those elders able to move about freely, many formal and informal exercise programs exist. Nearly every community has elderly exercise programs through churches, senior centers or park districts. Libraries are a rich source of video or DVDs covering gentle aerobics, yoga and tai chi.

Encourage elders to continue normal daily activity and housework. It may be tempting to relieve a parent of a task, but don’t. Combing one’s hair flexes shoulders and upper arms. Sweeping the kitchen floor provides movement that maintains physical strength and mobility.

For an elder confined to a chair, numerous exercises can be done from a sitting position. Bedridden individuals can exercise actively or passively, with someone moving or assist-ing the elder to move body parts.

If you are considering housing options, observe their activity programs. Does the staff patiently allow the elder to participate in care or do they do for the elder to save time? If an elder is bed bound, discuss with the staff how the care plan incorporates movement and exercise into daily care.

Updated from an original post in 2010.

An Advocate and an Ally

By 1 Comment

“Here’s your medicine, honey,” the nurse said as she handed Mrs. Smith her morning medicine. Mrs. Smith politely took the medicine and then turned to me and commented, “I’ve been taking that medicine for longer than she’s been alive.” Her nurse was distracted by grey hair and a diminutive frame and did not allow for a capable and intelligent 84-year-old woman in the bed.

No one should face aging and illness alone. Too often older adults find themselves without an ally or advocate when they are most vulnerable. It is not uncommon for an ill or hospitalized older adult to appear more confused, frail, and incapable than they actually are. Family members may accede to the advice or pronouncements of professionals without questioning assumptions made with limited information and thoughtful consideration of the individual. Illness and infirmity can diminish the best of us. This diminishment is more dramatic for older adults.

Informed advocacy plays a critical role in ensuring the needs, desires and values of a disabled or older adult are recognized, respected and protected. It can be easy and expedient to make assumptions or assign a label to an older adult. Too often deficits are the focus with little acknowledgment of individual strengths and capabilities. Likewise a deficit in one area does not translate to deficiencies in other domains. An older adult who does not know the date may be well able to express wishes regarding treatment. It is tempting to globalize limitations and not give strength and capabilities their full weight as short and long-term decisions are made.

Advocates advance the best interests of the individual whom they are serving. That charge is not always so straightforward. Many of us, no matter our age, choose unhealthy or unwise practices. One can be foolish without being incompetent. Likewise, professionals and institutions – hospitals, nursing homes and housing facilities – may have interest or values that are at odds with the interest and values of the older individual.

When an individual is voiceless and/or seen with a limited perspective, the advocate gives a voice and a full sense of the person on their behalf.

Effective advocacy involves:

  • Willingness to listen to and learn about the individual
  • Willingness and ability to intelligently investigate and even unearth options ask questions and, when needed, challenge assumptions and conclusions
  • Being an active participant in decisions and bring the individual into the discussion to the full extent possible

Health care advocacy requires both fearlessness – identifying and confronting conclusions that are at odds with the best interest of the individual – and humility – openness to ongoing learning about the person and how to best discern and advance his/her needs. Health care advocacy is not for the faint hearted. It involves an effort to acquire the required skills and the sensibilities to ensure that vulnerable individual are well served. That, in the end, is a service to us all.

A Reason to Wake Up

By Leave a Comment

“Did the staff tell you what you COULD do?” the nurse asked Leo as he outlined all the prohibitions given to him after suffering a stroke. Indeed, without assistance in how he might creatively adapt previous activities to his new physical limitations, he felt that “my life is over.” With a singular focus on safety, Leo’s caregivers neglected to see that he was given a prescription for a life he didn’t see as worth living.

All of us, no matter how what our circumstances, need a reason to wake up in the morning. In a rush to a remedy, well meaning family members and professionals can overlook an exploration of what brings meaning to an individual’s life.

How do we reconcile the reality of necessary limitations with a desire to maintain a sense of self, a sense of competency and worth? An older adult facing a loss in function and abilities may cling to “what was”, disconnected from the caregivers and providers who, with good intent, offer encouragement and support to “move on.” The challenge is to bridge that disconnect.

In the opening of A Poisonwood Bible, author Barbara Kingsolver reminds us “one has only a life of one’s own.” An extension of that obvious statement is the often-overlooked consideration that we all learn and grow in our own way and at our own pace. Coping with grief and loss is, in many ways, a solitary and individual experience. Caring for another who is in emotional pain because of a loss of health and function includes acknowledging the experience and its pain. When we see another suffer, we may too quickly look for a remedy to make it “better”. Support often involves simply being with the other, allowing time and space for grief before urging the individual to “go forward.”

Meaning in life, it seems, comes from authentic encounters. No one can create meaning for another, but perhaps in care giving we can make a contribution. How do we help an older adult continue to look for and find meaning as opportunities seem increasingly denied? Some suggestions for opening an exchange that can help the older adult find their own answers and their own sense of meaning:

  • Offer a large dose of listening before giving a small dose of advice.
  • Ask questions, rather than giving answers:
    • “What are you afraid of?”
    • “You seem sad, are you?”
    • “If we could change one thing to make you feel better, what would that be?”
    • “What would you like?”
    • “What did you like?”
  • Acknowledge feelings, resist labeling them as “good” or “bad”.
  • Express confidence, rather than pity.
  • Take time, not control.
  • Look to possibilities, rather than prohibitions.

Resiliency is a gift of aging — older adults don’t achieve longevity without a significant spirit of resolve. As we care for older adults and help them accept life losses with grace and a sense of meaning, we are well advised to look to our elders for that store of resiliency and take our cues.

Holiday Tips for Families Visiting Elderly Relatives

By 1 Comment

After many months of separation, the holiday season brings families together to celebrate and catch up. For families with older relatives, it is an opportunity to check in and make sure that all is well. Using your visit to be a thoughtful observer will help you assess an elder relative’s well being and, if necessary, take early steps to insure that small problems do not become large ones.

ElderCare Solutions, Inc., a Chicagoland area geriatric care management practice that assists families in managing the care needs of elder relatives, suggests families consider the following questions to alert them to subtle changes that may warrant professional investigation and medical intervention:

  • Is household maintenance up to established standards?
  • Does your relative tolerate activity as he/she used to? Does he/she get out of breath, easily fatigued?
  • Is your elder relative interested in participating in the family’s traditional holiday activities, such as visits to other relatives or friends or preparing special foods.
  • Does your elder have meaningful outside activity during your absence that he/she readily talks about?
  • Is your elder able to identify friends with whom he/she has regular contact?
  • Is your elder able to move around the house easily — climb stairs, get in and out of furniture — and use household equipment without difficulty?
  • Can your elder recall significant people and events?
  • Is there an adequate supply of food and household necessities in the house?
  • Has your elder had a significant, unexpected weight loss over the past year?
  • Is your elder keeping up with health care and finances?
  • Does your elder seem somehow “different”?

“Very often, problems that surface may be easily remedied with early and simple interventions,” says Signe Gleeson, a registered nurse and co-founder of ElderCare Solutions. “With support, most of our relatives age easily and gracefully, learning to adapt to the changes that are part of normal aging. The most meaningful holiday gift you give your elder may be a caring and observant visit to insure they are healthy and happy and remain so during the New Year.”

For more information on caring for your elderly relatives, call the nurses of ElderCare Solutions at 630-416-2140.

Medication Can be a Blessing and a Curse

By Leave a Comment

Please note: Two recent New York Times articles on this subject are noted at the end of this blog post:

Prescription medications offer the elderly an improved quality of life. But, with medications, as with so many things in life, very often less is more.

Individuals over 65 years old receive a full one-third of all prescription medications and purchase about 70% of all over-the-counter medications. Because of physiological changes, the elderly are at higher risk for adverse drug reactions. Taking numerous medications for one or more chronic conditions increases the risk even further. In fact, studies show that when taking 10 or more medications, the risk of side effects is 100%. While adverse drug reactions are estimated to occur in 2-10% of younger adults that number soars to 20-25% in the elderly.

Among the most common side effects of medications are: cognitive changes, such as confusion, memory loss and sedation; changes in blood pressure; and incontinence or other changes in bladder and bowel functioning. Taking more than three different medications increases the risk of a fall. Some of the changes that may be dismissed as part of aging are in fact the result of the adverse effects of medications.

There are inherent risks in every medication. How does one ensure the greatest benefit from medications with the fewest side effects? ElderCare Solutions suggests taking the following steps:

  1. Bring a list of all medications to every physician visit, ask that it be reviewed and keep the list updated. Inform all physicians of all medications that have been prescribed. An increasing problem in medication management has resulted from multiple medications being prescribed by different specialists for concurrent problems.
  2. Find out what each drug is intended to do and if there are non-medicinal ways to treat a problem, such as a change in diet or exercise.
  3. Ask about possible side effects. Are there any foods, medications or activities that should be avoided when taking a medication, and conversely, can foods or activities enhance a medication’s effectiveness? How long will the medication be needed? How will you know if it is effective in treating the problem?
  4. Use one pharmacy and establish a relationship with the pharmacist, often an untapped wealth of information. Make sure pharmacy records are up to date regarding allergies and drug reactions. Ask your pharmacist about prescription drug interactions with over-the-counter medications.
  5. Review medications with physicians and pharmacists each time a new medication is prescribed to ensure that the new medication does not adversely interact with others. Review all medications with the physician at each visit and ask if each is still necessary or if a “drug holiday” for one is possible. Medications are frequently added, but not often eliminated.
  6. Don’t stop medications without consulting your physician. Some medications need to be gradually reduced to prevent detrimental side effects.

Medical doctors are like all of us and are not immune to marketing. Certain older medications can be just as effective and much less expensive that newer medications. Ask your doctor about generic medication that may be cheaper and /or other medications that may be less costly than the “new and improved” (and more costly) brand.

Of special note is the growing use of “off label” medications. That is, medications prescribed for purposes/illnesses for which the medication was not originally intended and for which its effects and side effects have not been studied in clinical trials. If uncertain, ask the doctor if the medication prescribed has been studied in older adults and for the condition it is prescribed to treat.

Many older individuals ask few questions of their doctor for fear the doctor will think they are “questioning” his or her judgment. Let your elder know you want to be involved to ensure their well-being and your peace of mind.

Responses to medications vary from individual to individual. They are life saving and life preserving in many instances, but they do not come without risks. Family and elder involvement in medication management creates a healthy relationship with your health care provider and in turn can be an important safeguard to ensure against health-threatening drug reactions.

Two recent New York Times articles on this subject include:

September 30, 2010
Novartis Pays $422.5 Million in Settlement
By DUFF WILSON
http://prescriptions.blogs.nytimes.com/2010/09/30/novartis-pays-422-5-million-in-settlement/

October 2, 2010
Antipsychotic Drugs: Side Effects May Include Lawsuits
By DUFF WILSON
http://www.nytimes.com/2010/10/03/business/03psych.html