Are Older Adults Prescribed Inapproppriate Medications?
04 Apr 2011 Leave a Comment
Rates of inappropriate medications prescribed to older adults vary between 29% and 75% of older adults. For example in a study of older adults in HMO’s 29% received medications defined as ‘inappropriate’ and 5% received medications defined as treatments that older adults should ‘always avoid”. Approx. two fifth (40%) of frail elderly hospitalized patients had one or more potential adverse effects of medications. Studies conducted within the Veteran’s Health Care System found that between 44% and 75% of older adults were prescribed at least one unnecessary medication. Among the most common drugs involved in ADE’s include anticholinergic medications (e.g. Benedryl), digoxin, calcium channel blockers, antiarrhythmics, oral hypoglycemic agents, psychoactive medications, warfarin phenytoin and theophylline.
January is the most hectic month for home care!
09 Jan 2011 Leave a Comment
It never fails, in January each year we becomev overwhelmed with families requesting our home care services. We love to help so many but it really can become overwhelming when your trying to educate so many on the options and special consideration when hiring caregivers in the home or in their parents assisting living facility.
The Holiday Caregiver
10 Dec 2010 Leave a Comment
The holidays are always a wonderful time of year for family gatherings, reflection on what we have and the spirit of giving. The television is packed with specials showing relationships and families coming together for the holidays.
But the holidays can also be a time of stress and sadness for those who are caring for family members that are struggling with health problems, frailty, dementia and loss. Those who care for these individuals may feel overwhelmed, frustrated, depressed or resentful as they watch “perfect” families enjoying the holidays. There are many surveys and documents that show that caregivers are highly susceptible to these feelings. If you are a caregiver, there are measures you can take to avoid this.
First; Remember, that you are not alone.
If you are new to caregiving or have been caring for someone for a very long time, remember that the perfect family on television is not reality for many Americans. You are not the only one with these challenges. A recent study by the National Alliance for Caregiving and AARP found that 44.4 million Americans age 18 or older are providing unpaid care to an adult. In fact according to the survey provided by the National Family Caregivers Association:
- The typical caregiver is a 46-year-old Baby Boomer woman with some college education who works and spends more than 20 hours per week caring for her mother who lives nearby.
- Female caregivers provide more hours of care and provide a higher level of care than male caregivers.
- Almost seven in ten 69%) caregivers say they help one person.
- The average length of caregiving is 4.3 years.
- Many caregivers fulfill multiple roles. Most caregivers are married or living with a partner (62%), and most have worked and managed caregiving responsibilities at the same time (74%).
Second; Find help.
There are many resources available to a caregiver. Some of these include family members, friends, a local religious group, elder care agencies and homecare providers. The internet provides many great resources and help. The National Private Duty Association www.npda.org offers many articles, brochures and local referrals to help caregivers find the help that they need.
“When my husband’s stepfather was released from the hospital in December of 2009, he called us to give him a ride home. Once he was home, we quickly realized that he was not able to care for himself at all. He lived alone and we found ourselves driving back and forth three or four times a day to assist all of his needs. It was overwhelming and frightening to suddenly become a caregiver to a man we weren’t even that close to. With my husband working full time days, I became his primary caregiver. I would pack up my two little girls every day to come with me to take him to the doctor, do his laundry and feed him his meals, do his grocery shopping and help him with his bills. I had no idea what his finances were like or how to pay his medical bills. He was too sick to care or even understand what I was saying to him. I quickly realized I was going to have to find help. First I called his children. They were sympathetic, but gave all kinds of excuses as to why they could not help. Next, I went to the internet. I went to the website for National Care Planning Council www.longtermcarelink.net and found and contacted a Care planner in my area. The Care Planner came to my stepfather’s house and met with the two of us. They helped me get organized and set up time to meet with someone to explain his Medicare services and what my next steps would be. It was such a relief to have a plan and to know what to do.” MH- Salt Lake City, Utah
Most family members are willing to help, but just don’t know what to do. Many caregivers feel that they are the only one who can give the best care. It is important to communicate with other family members about what kind of help you need and let them know specifically what they can do.
A number of organizations and private companies will give you advice and guidance — many for free. If your care recipient has a very low income, you might get free help from your local Area Agency on Aging. A lot depends on available funds.
A good source for professional advice is the rapidly growing non-medical home care agents. Most will offer free consultations and will provide paid aides to help you with your loved-one with such things as bathing, dressing, shopping, household chores, transportation, companionship and much more. These people may also help you coordinate adult daycare or other community services.
You may wish to pay for a formal assessment and care plan from a professional geriatric care manager. Even though it may cost you a little money to hire a care manager, this could be the best money you will ever spend. Care managers are valuable in helping find supporting resources, providing respite, saving money from care providers, finding money to pay for care, making arrangements with family or government providers and providing advice on issues that you may be struggling with.
Lastly; it is important to take care of yourself first in order to give effective and loving care.
Stephen Covey tells a story in his book The Seven Habits of Highly Effective People about a man who is sawing a tree. A woman approaches and asks the obviously exhausted man how long he has been sawing the tree. He tells her that he has been there for hours.
She says “Well, I see that your saw is dull, if you would just sharpen your saw you would be able to saw it much faster and with less effort.”
He replies, “I don’t have time to stop and sharpen my saw, I need to chop this tree down now!”
It seems pretty silly that the man just doesn’t stop for a few minutes to make the work easier. It is common for caregivers to do the same thing. They focus on caring for their loved one and run themselves down instead of stopping to “sharpen their saw”.
Covey states that “sharpening the saw” is to take care of yourself by keeping your physical, mental, emotional and spiritual self balanced. There is joy and respite in balancing all of these areas in our life. This is what makes us efficient and happy. Here are some ways for you as a caregiver to sharpen your own saw:
- Maintain a positive attitude. Take time to be grateful for everything that is good in your life. There is always something. Adjust your expectations for the holiday season. If you aren’t expecting that perfect holiday family picture, then you won’t be angry and frustrated that it isn’t something you have right now. It is always possible to change your attitude and perceptions, but it is not always possible to change your circumstances.
- Eat healthy food and be sure to get some exercise. Do this in small increments if it is too overwhelming to plan menus. Drink more water, cut down on sugary snacks, pick up some vegetables and fruit to grab. Walk or do marching in place. Run or walk up and down stairs if that is all the time you have right now.
- Forgive and let go of frustrations, anger, resentment and guilt. These are common feelings for caregivers. The best thing a caregiver can do for their own emotional health is to clear out these negative thoughts and feelings. Get counseling, talk to a friend or family member or simply write down the negative feelings to get them out of your system. Never take your anger and frustrations out on those you care for.
- Take time to do something you enjoy and give yourself a little bit of rejuvenation everyday. Laughter is a great stress reliever. Find something funny to read or get on the internet and find a funny video to watch.
- During the holidays, be easy on yourself. If you enjoy holiday activities, then get out there and do them. Ask someone to help with your caregiving duties even if it is just for an hour or two to shop or to see a concert or movie. There are day care facilities or home care services available for short term care. (Call Susan at Home Care Assistance for a list of day care facilities in Albuquerque)
Being a “perfect” caregiver during the holidays does not have to look like the perfect on-screen holiday family. How you handle your circumstance will be the key to creating your own peace, happiness and cheer during the holiday season. The holidays can be a time of reflection on good things. Your attitude and a little care for yourself can make a big difference in the care that you give in the coming year.
Vitamin D Deficiency Rampant in Patients for Orthopedic Surgery, Damaging Recovery
18 Oct 2010 Leave a Comment
I read an alarming article that talks about how an increasing number of patients are having slower recovery rates from orthopedic surgery because of vitamin D deficiencies. Researchers from the Hospital for Special Surgeries found that 50% of people that come in for orthopedic surgery have a low recovery rate because of the vitamin D deficiency.
Dr. Joseph Lane, M.D., professor of Orthopedic Surgery and chief of the Metabolic Bone Disease Service at HSS, who led the study, says that, “people undergoing a procedure that involves the bone or the muscle should correct their vitamin D if they want to have an earlier faster, better, result.”
For their study, investigators conducted a retrospective chart review of 723 patients who were scheduled for orthopedic surgery between January 2007 and March 2008 at HSS. Problems were more prevalent in younger patients, men and individuals with dark skin — African Americans and Hispanics.
The bottom line is that if we want to heal faster from orthopedic surgery, we need to make sure we are getting our Vitamin D!
Aging Population Needs to Plan for Care
06 Jul 2010 Leave a Comment
Elder law experts say medical decision documents, wills and powers of attorney should be in place for anyone over age 18, especially seniors.
In 2011, baby boomers, estimated to reach 78.2 million, will turn 65 and the need for long-term care and the potential for illnesses will also rise. According to caregiver studies, by 2020, 12 million Americans will need long-term care, with most cared for by family members.
Anita Phillips is her mother’s guardian and remembers life before her mother’s memory faded.
She remembers how proud her mother, Angeline Scoggins, 79, was of the home she owned north of San Antonio. She still sees the woman who raised four children and doted on her grandchildren. She remembers her tending to her garden, the smell of her baked cakes and the yo-yo quilts she made of small rosettes, collected in clusters of fabric.
That was before doctors diagnosed dementia. Six years of worrying and mishaps led Phillips and her family to gather for the hardest talk they’d ever had with their mother.
“We know you need some help,” she told her mother. “This is really difficult for you. It would help if I were put in a position to help you.”
Phillips made an appointment with elder law attorney Carol Bertsch, who explained how Phillips could become a guardian for her mother. Bertsch went with Phillips before a judge in Seguin, who approved the request. At the end of the year she has a review of care with the judge, who also approves or denies changes to the agreement.
“I find it to be a way of giving assistance to my mother for her safety,” Phillips said “and just for her well-being.”
A March 2010 report, from the British Medical Journal, said advance-care planning “improves end-of-life care and patient and family satisfaction, and reduces stress, anxiety and depression in surviving relatives.”
Bertsch said conversations about long-term care still rank in the often-put-off family talks and people still continue to put their heads in the sand.
“What’s at stake is peace of mind,” the lawyer said. “What people tell me is ‘You’ve given me peace of mind.’”
That’s the feeling Michelle Bussone has about arrangements for her 93-year-old father, Mike Bussone.
Bussone’s father still has his mental capacity, but needs lot of support. She has a financial and medical power of attorney for her father, a former underground miner who worked at the same company for 40 years.
“It’s absolutely mandatory,” she said about talking to family members about long-term plans. “Seniors will always say they’re fine, but fine is a very relative term. You need to ask enough questions and be with them long enough to see how they really are, as opposed to how they say they are.”
Phillips is thinking about considerations she should have in place for her later years — dementia runs in her family.
“I think at a minimum, I need to start conveying to my sons how I feel,” Phillips said. “I know they see what I’m going through and they have some idea of what I’ve gone through with my mom. But, I think it’s important to let them know I may get there, and these are some things that you are probably going to have to consider.”
Bertsch said the topic could be something a family member has wanted to bring up for a long time
“It could be good things that could come from it,” Bertsch said. “It will pay off in the end.”
Guarding Against Senior Falls – the #1 Killer of Seniors
05 Jul 2010 Leave a Comment
Guarding against falls—the #1 killer of seniors
With the coming of shorter days, frosty nights and falling snow, late fall marks the beginning of the peak season for accidental falls, especially for older people. Falls and fall-related injuries are the leading cause of death in people 65 years and older—more than 15,800 deaths per year. For people 85 and older, one in five falls results in death. Contrary to the myth that falls are unavoidable accidents, most falls are the result of manageable or preventable risks.
Physical changes that come with aging make seniors more prone to falling. Changes in muscles and joints make movement more difficult and make it harder to correct for a sudden loss of balance. Vision changes make it tough for older eyes to adjust to varying levels of light or perceive depth and distance. Many medications, depression, stress or lack of sleep can also affect judgment, balance and coordination.
Seniors who stay physically active improve their balance, flexibility and strength. Exercise and socialization also reduces stress and depression, increases alertness and strengthens the heart and circulatory system. Regular eye exams will help correct vision problems and detect possible diseases, like glaucoma, that make it hard for seniors to see hazards. Sturdy shoes and walking equipment such as a cane will improve balance.
A senior’s own home presents risks, too. There should be plenty of light in every room and along hallways and in stairways. Motion-activated or timer lights can be particularly helpful, especially as days get shorter. Emergency lighting or a flashlight should also be within easy reach. You can improve bathroom safety by having grab bars installed in the tub or shower and by the toilet. Non-slip strips and a bath bench in the tub or shower and a raised toilet seat are valuable additions. In kitchens, countertops should be kept glare-free. All rugs should be tacked down or secured with nonskid pads. Rugs with highly-contrasting dark and light patterns can interfere with seniors’ depth perception and should be avoided or replaced. To reduce glare, only no-wax cleaners should be used on floors. Firmly secure handrails are a necessity on both sides of stairways and outside steps. Steps should also have non-skid treads. Furniture should not block walking areas. Make sure all electrical cords are out of the way.
Hiring an in-home caregiver can also help prevent falls, especially if you’re a senior who is living alone at home or you are caring for a older loved one. In addition to handling risky household activities, a caregiver can provide constant supervision. Supervision is especially important for older people with dementia that makes them get up and wander at night. Susan Bruketta, case manager and owner of Home Care Assistance of New Mexico offers to conduct a free Fall Prevention Assessment of your home, with recommendations for ensuring safety.
Hospital Sitters are New Members of the Hospital Team
03 Jul 2010 Leave a Comment
Sitters are New Members of the Hospital Team!
Albuquerque, New Mexico., June 28 2010 – A hospital is no place to be left alone. Even with nurses and monitoring equipment all around, it only takes an instant for a dangerous accident to happen. Just the loneliness of a hospital stay can slow recovery and even increase the pain a patient suffers.
The solution is a hospital sitter, a specialized caregiver who provides round-the-clock companionship and monitoring for a patient. Sitters help by keeping watch, running errands, waiting for unconscious patients to wake up, reading aloud or just keeping the patient company.
In-hospital falls are especially common for elderly patients. Ten percent of fatal falls for seniors occur in hospitals. Disoriented or medicated patients can accidentally injure themselves by falling or removing IVs. With only one or two nurses working long shifts and handling many patients, they can’t provide continuous individual monitoring. It often seems like ages from the time you push the nurse call button until anyone responds. While safety is critical, hospital sitters do more than help prevent falls and alert nurses. “Companionship makes great medicine,” says Dr. Jim Johnson of Home Care Assistance, www.HomeCareAssistance.com, a leading provider of hospital sitters and other caregivers. “Knowing another person is in the room watching over them makes a hospital more human.”
Hospital sitters cannot assist in any patient care or physical contact and must stay out of the way of hospital staff. They are under the direction of the nurse. If the patient has an urgent need or a medical emergency, the sitter will immediately summon the nurse in charge.
Hospital sitters help lower accident risks, so some hospital administrators hire sitters to watch over their patients who are at risk for falling out of bed. Physicians sometimes order a continuous, one-to-one sitter for patients who have an impaired ability to understand or follow directions or who don’t realize they could harm themselves.
Some sitters even keep a journal for the patient’s family members, to record every doctor visit and describe any procedures done and the expected and actual outcomes. Sitters can also hold onto a copy of the patient’s Advanced Directives.
Hospital sitters provide peace of mind. Their vigilance ensures safety. Their companionship reduces boredom and depression. Families can go home and rest, knowing the patient will never be alone. For more information about hospital sitters, contact Home Care Assistance at 1-866-454-8346, or visit http://www.HomeCareAssistance.com.
6 Super Snacks for Seniors
29 Jun 2010 Leave a Comment
When it comes to healthy snacks, the age of the baby carrot is over. Sure, raw carrots are great for you, but so are plenty of other delicious foods. These ten delicious snacks are also “superfoods” – not only are they not bad for you, they have health-boosting properties to boot. Whether you crave something sweet, something salty, something crunchy, or something creamy, there is a superfoods snack for you. Note the serving sizes mentioned and enjoy all snacks in moderation for a healthy, varied diet.
- Almonds have been shown to lower cholesterol and help maintain a healthy weight. About a ¼ cup of almonds is a beneficial serving. Enjoy them plain or roasted, whole or slivered. Almond butter – just a tablespoon or two – is a healthy treat, too. Try some on a whole grain cracker and a cup of green tea for a late afternoon energy boost.
- Blueberries are as full of cancer- and disease-fighting antioxidants as any food around, so much so that they have been even shown to restore antioxidant levels. Also, like cranberries, they can help prevent urinary tract infections. Note that wild blueberries tend to have even more antioxidants than cultivated ones. Fresh berries are delicious all on their own or with a bit of Greek yogurt (see #5). Frozen berries can be used in smoothies or put on top of low-fat frozen yogurt. Use about ½ cup fresh or frozen berries as a serving.
- Broccoli eaten either raw or lightly steamed contains tons of soluble fiber and antioxidants, as well as folic acid, calcium, ion, and potassium. Broccoli has even been shown to have the power to reduce diabetic damage. Don’t throw away the stalk/stem! Cut off the thick, fibrous darker green peel to reveal the tender, pale green vegetable underneath – it has the crunch of celery and a mild broccoli flavor. Try broccoli florets or peeled stems with a little drizzle of soy sauce or a simple dip made from fat-free Greek yogurt (again see #5) – stir in minced garlic and herbs, lemon zest and minced rosemary, or a sprinkle of cumin and cayenne to taste. About ½ cup of florets or peeled stem is a serving.
- Cherries, tart ones in particular, have similarly insanely high antioxidant levels as blueberries, putting them in the position to fight memory loss, heart disease, and diabetes. They’ve also been shown to help reduce inflammation, helping alleviate arthritic and gout pain. Fresh, frozen, or dried (unsweetened) tart cherries make a great snack on their own or combined with other nuts (almonds, walnuts, pumpkins seeds) and fruits (blueberries, raisins). Count ½ cup fresh cherries or ¼ cup dried cherries as a serving.
- Greek yogurt is thick and creamy in a way regular yogurt can only dream of. It’s high in calcium, of course, and contains good levels of probiotics, which aid healthy digestion. But did you know low-fat and fat-free versions contain twice as much protein as regular yogurt? The texture of Greek yogurt makes it a great snack – especially when topped with dried fruits like blueberries, tart cherries, or raisins – as well as a good substitute for fatty sour cream. Include in it your three servings (1/2 cup each) of low-fat dairy a day.
- Dark chocolate – saving the best for last. Dark chocolate has tons of antioxidants, magnesium, manganese, copper, zinc, and phosphorous. Look for chocolate that contains over 70% cocoa to get the full benefit of chocolate’s antioxidant powers and limit your intake to about an ounce a day.
If you have an aging parent and you’re concerned about his or her ability to maintain -healthy diet choices, a Home Care Assistance caregiver can help. We are available 24/7 to provide experienced, trustworthy caregivers to help with meal preparation, companionship, activities, transportation, socialization and more. Visit www.HomeCareAssistance.com for more information.
Taking the car keys away from elderly parents
28 Jun 2010 Leave a Comment
Taking the car keys away from elderly parents
Overall, many older adults are capable of driving safely, even into their seventies and eighties. But people age differently. Several factors place seniors at much greater risk for road accidents. More importantly, a person 70 or older who is involved in a car accident is more likely to be seriously hurt, require hospitalization or die than a younger person involved in the same crash. Knowing the risk factors and warning signs of an older loved one who has become unable to safely operate a vehicle will help you gauge when it’s time to take away the keys. There are also strategies to help you talk to seniors sensitively about giving up driving and present them with practical transportation alternatives.
Changes that can adversely affect driving ability:
- Visual decline—including poor depth perception, narrowed peripheral vision, poor judgment of speed and poor night vision, along with increased sensitivity to bright sunlight, headlights and glare.
- Hearing loss—especially the ability to hear important warning sounds while driving.
- Limited mobility and decreased flexibility—which increases response time slows pedal selection and steering control, and limits the ability to turn one’s head to look for hazards.
- Chronic conditions—such as rheumatoid arthritis, Parkinson’s disease, sleep apnea, heart disease or diabetes can impair driving skills, even suddenly.
- Medications—as older people often take more medications, which, in combination or taken with alcohol, can result in risky unpredictable and dangerous side-effects and drug interactions.
- Drowsiness—is often due to medication side-effects or sleep difficulties that come with age, resulting in daytime tiredness and an increased tendency to doze off during the day (or while driving).
- Dementia or brain impairment—makes driving more dangerous and more frustrating. It can also cause delayed reactions and confusion on the road.
Warning signs that say stay off the road:
According to the National Institute on Aging, there are several critical indications that a senior may be losing the judgment or ability to drive.
- Incompetent driving at night, even if competent during the day.
- Drastically reduced peripheral vision, even if 20/20 with corrective lenses.
- Struggling to drive at high speed even if he or she drives well locally at slow speeds
- Erratic driving, such as abrupt lane changes, braking or acceleration, hitting curbs, missing turns or scaring pedestrians.
- Getting lost frequently, even while driving on familiar roads. Trouble reading street signs or navigating directions.
- Frequently startled, claiming that cars or pedestrians seem to appear out of nowhere.
- At-fault accidents or more frequent near-crashes or dents and scrapes on the car or on fences, mailboxes, garage doors, curbs, etc.
- Failing to use turn signals or keeping them on without changing lanes.
- Drifting into other lanes or driving on the wrong side of the road.
- Range-of-motion issues, such as failing to look over the shoulder, trouble shifting gears or confusing gas and brake pedals.
- Increased traffic tickets or “warnings” by traffic or law enforcement officers
When it’s time to hang up the keys:
Talking to a relative about his or her need to stop driving is one of the most difficult discussions you may ever face. However, it’s better if it comes in the form of advice from you or someone he or she knows rather than by an order from a judge or the DMV. One of the main reasons seniors are reluctant to give up driving is that it is one of the few ways they can continue to feel self-sufficient. The discussion becomes even more difficult when the person still maintains most of his or her faculties, just not those that enable safe driving.
How to approach “The Talk:”
It helps to have a thoughtful, caring plan in place before saying anything, says Harriet Vines,
author of “Age Smart: How to Age Well, Stay Fit and Be Happy.” She suggests:
- Be empathetic. “Imagine how you would feel if you were in your parent’s place,” Vines says. Ask others to join in the meeting. It helps to involve other family members in the discussion—to help, but not to confront.
- Keep the conversation non-accusatory, honest and between “adults,” not “child and parent.” Say things like, “We’re concerned,” “We care” or “We don’t want you to get hurt or to hurt others.” Once you’ve both come to an agreement, you can continue to support your loved one in ways beyond just offering rides.
- Encourage the senior to use positive language to describe their situation to others and help them gain comfort in asking for assistance.
- Help the senior make a schedule. He or she can plan activities and combine trips on oneday when a caregiver can drive them.
Home Care Assistance, Inc.
Home Care Assistance quoted in recent Smart Money magazine
28 Jun 2010 Leave a Comment
We’re quoted in the latest published issue of Smart Money magazine! It is great to see “Home Care Assistance” in such a well-circulated publication. Click on the below link to view the article.
http://www.smartmoney.com/Personal-Finance/Retirement/why-centenarians-are-so-content/
