It’s That Time of Year Again

Summer Means High Temperatures and High Humidity–even in Minnesota

We know it’s hot when it’s in the 90’s, but when the dew point is higher than 57, the effect of the temperature is greater than the numbers.  For instance, on June 23 in the Twin Cities, we were told to expect temperatures of 96 0r 97 degrees.  With the dew point around 70, it felt like around 108 degrees–a very dangerous temperature that resulted in heat warnings for Hennepin and Ramsey counties (Minneapolis and St. Paul and suburbs.)

As we age, we are less able to respond to heat and cold.  During hot and humid weather, a buildup in body heat can cause heat stroke or heat exhaustion.  This is especially true for people with heart and circulatory disease, stroke or diabetes.

Heat Stroke is a medical emergency requiring immediate attention and treatment by a doctor.  Among the symptoms are:  faintness, dizziness, headache, nausea, loss of consciousness, body temperature of 104 degrees F. or higher, rapid pulse, and flushed skin.

Heat Exhaustion takes longer to develop than other heat-related illnesses.  It results from a loss of body water and salt.  Symptoms include:  weakness, heavy sweating, nausea, and giddiness.  Heat exhaustion is treated by resting in bed away from the heat and drinking cool liquids.

Protective Measures include remaining indoors in an air-conditioned room.  If the home is not air-conditioned, you might take your loved one to a cool public place (library, movie theater or store) during the hottest hours.

Other ways to cool off include taking cool baths or showers, placing ice bags or wet towels on the body and using electric fans (being careful to avoid an electrical shock.)

Remember that persons with memory loss and the other cognitive impairments that go along with dementias like Alzheimer’s disease often lack good judgement.  You may need to make sure that those you care for wear appropriate hat, sunglasses and sun screen.

It’s the Fourth of July–Celebrate the Holiday

Celebrate our Freedom, but Keep it Simple

The Fourth of July can be such a fun holiday–picnics, music, fireworks, family get-togethers.  But for the person with dementia,  it can be a trying, sometimes even frightening time.  For people in the early stages of the disease, celebrating can be pretty much the way it’s always been, but as people progress into the middle and later stages of Alzheimer’s or other related dementias, keeping the day simple is the best choice.

For some people with significant memory loss, leaving home, wherever that may be–home, apartment, assisted living, skilled facility–may be difficult.  For some it may be something as simple as the comfort of the place that is most familiar.  I’ve often thought that for people with incontinency issues, it may just be remaining in a place where they know where the bathroom is.   So one solution is to bring the celebration to the person’s place of residence.

Don’t plan for a whole day; if your celebration is go on for more than two hours, try to have a quiet place available for a short rest time.

Other ideas about keeping it simple are to limit the number of people who will join in the celebration.  Sometimes the over-stimulation of a lot of people is overwhelming and too tiring.   Food choices should be kept to a minimum of familiar favorites, and for those who are having difficulty with meals, finger foods would be a good choice.

Fireworks may be fun for the kids, but Grandpa may not understand exactly what is happening and may be frightened by what sounds like gunshots to him.  Music is usually a source of great enjoyment for people with memory loss, but include music that is familiar and that the person enjoyed in the past, and limit the volume and the amount of time devoted to it.

Celebrate our freedom and have a wonderful weekend.

CPR for Caregivers

Reviving  Caregivers

Everyone knows what CPR in the medical world is–Cardiopulmonary Resuscitation.  Perhaps you know of someone who has taken a CPR class, or maybe you even know of someone on whom the life-saving technique has been used.  But now I’d like to tell you about another kind of CPR, one you can use to help revive yourself.

CPR for caregivers is a set of principles for healthy communication.  By communicating with yourself and with others in a healthy manner, you can avoid burnout and gain energy to care for a loved one who needs you.

Caregiver communication is based on three principles:  Connect, Project, and Reflect (CPR.)

Connect–Giving effective care depends on establishing a mutual bond with the person for whom you are caring.  This bond is built on trust, acceptance, and respect.  The necessary foundation for developing this bond is connecting with yourself.

Project–the way you communicate with others (what you project,) whether verbally or non-verbally, can enhance or obstruct the connection.  Be aware of what you project so that the connection remains strong.

Reflect–your positive or negative thoughts.  Reflections determine how you project to others Learn to keep your reflections positive.

By using these principles you will have energy to become your own renewable resource and avoid caregiver burnout.

Used with permission from the author, Grant Watkins at:  www.grantwatkins.com.

Validation Therapy Continued

Ten Principles of Validation

The following principles are the basis for Validation Therapy as developed by Naomi Feil and listed in the Validation Training Institute website:

www.vfvalidation.org/whatis.

Jan Allen, CSW, MSE gives more information about Validation Therapy along with some interesting examples of conversations with disoriented patients n her website/blog:

www.ec-online.net/community/Activist/difficultbehaviors

1. All people are unique and should be treated as individuals.
2. All people are valuable, no matter how disoriented they are.
3. There is a reason behind the behavior of disoriented old people.
4. Behavior in old age is not only a function of changes in the brain, but reflects physical, social and psychological changes that take place during the whole lifespan.
5. Behaviors of older people can be changed only if the person wants to change them.
6. Old people should be accepted non-judgmentally.
7. Each stage of life has particular life tasks to be completed.  Failure to complete these tasks may lead to psychological problems.
8. When recent memory fails, older adults restore balance to their lives by retrieving memories from the past.
9. Painful feelings that are expressed, acknowledged and validated by a trusted listener will diminish.  Painful feelings that are ignored will gain strength.
10. Empathy builds trust, reduces anxiety and restores dignity.

Gratitude: It Can Be a Way of Life

“Let us be grateful to people who make us happy, they are the charming gardeners who make our souls blossom.  –Marcel Proust

During some of the darker days of my life, I found myself trying a technique recommended by  Sarah Breathnach , author of a wonderful little book that was popular some years ago, Simple Abundance. The author recommends at the end of each day, write down 5  things for which you are grateful.  After a few days I was drawn to doing this in the morning, reflecting on the previous day.  I soon found that I was spending some time each day looking for things for which I was grateful.  It changed my whole outlook.

Take a look at Simple Abundance at your local library.  I’m a great library fan.  At my age I have very little interest in buying books (I rarely read them more than once; I seem to be more inclined to be thinning out my possessions than I am adding to them.)  The book is a sort of daybook with inspirational thoughts for each day of the year.  One of my favorite parts is at the beginning of each month, there is a list of simple, inexpensive pleasures/activities suggested.  If you like the book, it is one I have purchased (however, I have loaned it out, and have no idea where it is now,) you might want to own it.

The website www.abebooks.com is great for finding cheap used books and out-of-print books.  Even Amazon.com has used books for sale now.

I think I’m feeling  especially grateful today, because my shoulder replacement surgery went so well (my definition of that is that I had considerably less pain than I expected, the wound was smaller than I thought it would be, and it healed very quickly, I was out of the hospital in less than 24 hours and back to work in a week.  I’m feeling like some sort of fraud still wearing this classy sling, but I should be done with that this week.)   Life is good.

Validation Therapy: A Case for Empathy

Webcast interview with Naomi Feil

Last week I had the privilege of viewing a webcast  interview with Naomi  Feil, MS, ACSW, Executive Director of the Validation Training Institute, Cleveland, Ohio and founder of the Validation Method.  Ms. Feil was interviewed by Joyce M. Konczyk, LSW, Geriatric Care Manager/Virtual Media Consultant.  Ms. Feil’s compelling, compassionate technique of communicating with persons with dementia is practiced around the wold.  You can view the archived webcast at:

http://www.helloworld.com/joycek

then:

*   Click on the broadcast tower icon (upper middle of page, hover to see “joycek’s shows”)

*   Look on the left column “Past Shows” and click on the photo/graphic to the left of the text

Ms. Feil started her work in the 60’s and has continued to refine and improve it.  Some years ago, I read her book called The Validation Breakthrough and found it so interesting.   I never took the opportunity to go through the training program she initiated, but did refer to it in a very simplistic way during the time that I was an educator and trainer for the Alzheimer’s Association.

Feil’s theory advocates validating the emotions that underlie patient concerns that do not appear to be based on reality (it is common for a disoriented person to insist to staff they he or she is waiting for his/her mother to come to the nursing home to visit when the parent has been dead for 30 years) or when the patient’s communication skills are impaired to the pointed that he or she appears to be talking gibberish.

In the first instance, it is tempting to tell the person that  his/her mother has been dead for 30 years and she surely will not be coming to visit today.  This would be very harsh and unkind, and, for a person with memory loss, may be a shock and lead to grieving the death every time someone “sets him/her straight.”   Feil’s work with severely disoriented elders has led her to believe that a better response would be based on the emotion you see the person showing with the words.  If the person appears to be happily anticipating the visit, you might say, “Oh, Martha, you look so happy when you talk about your mother; tell me what she was like.”    If the person appears distraught, one might say, “Martha, you seem very sad when you talk about your mother, do you miss her?”

In the second example, where the person’s speech does not make sense, one can still look at the emotion under the nonsense sounds and comment about what their facial expression tells you.  By using yes and no questions, you can keep the person engaged.

Feil believes that “communicating with the very old is a moral imperative of our time.”  She says that when we keep people engaged and communicating, even non verbally (with a nod of the head or a gesture,) that person is alive.  A basic principle of Validation Therapy is that when feelings are expressed to someone who is listening with empathy, the difficult struggles can be resolved.

Ms. Feil believes that all of us have to deal with life struggles at the time they occur or they will come out later in life.  Her experience with behavior problems in nursing home patients led her to believe that many times the behaviors were the result of these old, unresolved struggles.

For more information about Naomie Feil and the Validation Method, see the following:

www.vfvalidation.org

www.memorybridge.org.  (On the Memory Bridge site, under “watch video clips,” click on the 2nd and 3rd videos to see Naomi Feil in action.)

There are also some videos available that illustrate how Validation Therapy works.  Fortunately for us all, Ms. Feil’s husband has filmed some of her work or dramatizations of it with her portraying the patient.  One of my favorites is called  Myrna, the Mal-Oriented.  In this touching video, 86 year old Myrna deteriorates physically and mentally, blaming her family and friends for her losses. She thus drives away her friends and frightens her family. Terrified of losing her identity, she accuses her caregiver of stealing her things.

Part Two:
Myrna refuses help. Sally Ames, a Validation^® worker slowly builds trust, makes mistakes and learns thereby. Myrna comes to trust the worker, and expresses some buried emotions. Her hostility lessens, and she develops a measure of peace.

Video-graphics are used to pin-point Validation^®principles and techniques.

I will be taking a short leave of absence from blogging while I have my left shoulder replaced.   Since I will be in a sling for about 4 weeks post-op, my keyboarding will be limited.   I will be checking e-mails and responding (briefly.)  My work e-mail address is:

crseniors@usfamily.net

Think good thoughts,

Marilyn Christenson

Seniors Choice at Home

Plymouth, Minnesota

Quality of Life for Individuals With Dementia

“Quality of Life” (QOL)–an Important Goal for All Who Care For Those With Memory Loss

When a person is suffering from any form of memory loss, it is very difficult to achieve the goal of care that offers quality of life, mainly because the the diminishing cognitive capabilities of the dementia patient.  QOL is also difficult to measure because part of the disease process involves difficulty with communication.  So how can we determine if a client with dementia has QOL?

There are a few QO: models for dementia patients.  Below there are examples of two of the models:

1.  M.P. Lawton’s (Alzheimer Disease Association Disorders, 1994) definition of QOL: encompasses four (4) domains:

A.  Psychological well being

B.   Behavioral competence

C.   The objective environment

D.   Perceived QOL

2.   L. Volicer (Clin. In Geriatric Medicine) developed another model for patients with severe dementia:

A.   Provision of meaningful activities

B.  Treatment of medical conditions

C.  Management of behavioral symptoms.

Even with these models there are no set guidelines for ensuring QOL for those with dementia.  However, Sandy Burgener (1998) has developed QOL guidelines and interventions that are very helpful in caring for those individuals with dementia.  They focus on patient experience and are as follows:

I.   Pain and Comfort Status

Intervention: A.)  Observe nonverbal pain expressions;  B.) Inform those caring for patient about his/her expression of pain; C.)  Integrate pain assessment into care giving routine.

II.  Individual Touch Experiences

Intervention:  A.)  Observe verbal and nonverbal responses to touch;  B.)  Employ touch based on patient’s response.

III.  Structural Care Routine:

Intervention: A.)  Follow familiar pattern of care; B.)  Build pattern of care around “routinized” behaviors.

IV.  Low-Stimulus Environment

Intervention: A.)  Reduce extraneous noise;  B.)  Reduce crowding or unfamiliar persons or objects;  C.)  Avoid misleading or distracting stimuli.

V.   Health

Intervention: A.)  provide palliative (comfort care and pain relief as apposed to restorative treatments) care interventions.

VI.  Time Use and Social Behavior

Interventions: A.)  Help family and friends who visit understand the nature of the disease and the person’s need for contact;  B.)  Encourage visiting by close family members and friends.

From a hospice perspective, it is important to note the reference made to addressing the pain and comfort status of the dementia patient.  It is also important to note that two of the dementia experts cited, Volicer and Burgener, address the need to take care of the patient’s medical needs to maintain QOL while avoiding unnecessary aggressive or restorative treatments.

Thank you to Linda Debner of Hospice of the Twin Cities in Plymouth, Minnesota for permission to use information from her newsletter of March, 2009.  The website for Hospice of the Twin Cities is:

www.hospiceofthetwincities.com

References:

Burgener SC:  Quality of Life in Late-Stage Dementia in Hospice Care for Patients with Advanced Progressive Dementia.  Edited by Volicer, L, Hurley A.   New York:  Springer, 1998, pp 88-113.

Lawton MP:  Quality of life in Alzheimer’s Disease.  Alzheimer Dis Assoc Disorders. 1194;8 Suppl 3:138-50.

Volicer, L:  Management of severe Alzheimer’s disease and end-of-life issues.  Clin in Geriatric Medicine. 2001; 17 (2): 377-391.

Hospice Care for Persons With Dementia

Do You Know That Hospice Care is Available for Dementia Patients?

Hospice is a program that offers specialized care for end-of-life situations.  Most people think of Hospice in connection with cancer, but Hospice care is available for people of all ages with many terminal diagnoses including Alzheimer’s disease and other related dementias when the patient meets the established criteria for Hospice care.  Hospice programs operate in the home, in assisted livings, in nursing homes and/or in established in-patient Hospice residential facilities.

Both of my parents were hospice patients at the end of their lives.  My father died at home with Hospice care after a very short bout with an aggressive cancer; mom died in a  nursing home with complications secondary to Alzheimer’s disease.  Mom met the Hospice criteria because of significant weight loss.

The criteria for Hospice Appropriateness : END STAGE DEMENTIA

* Patients with dementia must show all of the following characteristics:

1.  Stage seven (7) or beyond according to the Functional Assessment Staging Scale (FAST.)

2.  Unable to ambulate without assistance.

3.  Unable to dress without assistance.

4.  Unable to bath without assistance.

5.  Urinary and fecal incontinence, intermittent or consistent.

6.  No meaningful verbal communication, stereotypical phrases only, or ability to speak is limited to six (6) or fewer intelligible words.

7.  Patients must have had one of the following within the past 12 months:

*  Aspiration pneumonia

*  Pyelonephritis or other upper urinary tract infection

*  Septicemnia

*  Decubitus ulcers, multiple, stages 3-4

*  Fever, recurrent after antibiotics

*  Inability to maintain sufficient fluid and caloric intake with 10% weight loss during the previous six months or serum albumin greater than 2.5 gm/dl.

If you think your loved one is eligible for Hospice care you may request an order for care from your physician, or call a local Hospice for an assessment.  Most people make the mistake of waiting too long to call.  To make the best use of Hospice services call as soon as you think it may be appropriate.

In Minnesota, you can learn more about Hospice care by contacting Hospice of the Twin Cities, 763-531-2424.  Their website is:  www.hospiceofthetwincities.com

More Foot Care Facts

Take Foot Care Seriously!

• Your two feet may be different sizes.  Buy shoes for the larger one.
• About 5% of Americans have toenail problems in a given year.
• About 60-70& of people with diabetes have mild to severe forms of diabetic nerve damage, which in severe forms, can lead to lower limb amputations.  Approximately 56,000 people a year lose their foot or leg to diabetes.
• There are 250,000 sweat glands in a pair of feet.  Sweat glands in the feet excrete as much as a half-pint of moisture in a day.
• Walking barefoot can cause plantar warts.  The virus enters through a cut.
• The average person takes 8,000-10,000 steps a day, which adds up to about 114,000 miles over a lifetime.  That’s enough to go around the circumference of the earth four times.
• A pedicure is a wonderful thing.  Make sure the shop you go to practices good sanitizing procedures.  For many older clients, it is best to have a nurse who is skilled at foot care provide that service.
• You can make your own foot care lotion with an unscented, pure lotion (no petroleum ingredients, please) and oil of peppermint.

Foot Care: A Vital Component of Senior Care

Include a Foot Check as Part of Routine Senior Care

Did you know that three out of 4 Americans experience serious foot problems in their lifetime?  Seniors have an especially difficult time with as simple a task as clipping toenails.  With diminished eyesight and reduced flexibility and balance, seniors may neglect needed foot care.  There are nurses who have businesses devoted to foot care for seniors.  When in doubt, see a podiatrist.

*  The foot contains 26 bones, 33 joints, 107 ligaments and 19 muscles.

*  One-Fourth of all the bones in the human body are in your feet.  When these bones are out of alignment, so is the rest of the body.

*  Only a small percentage of the population is born with foot problems.

*  It is neglect and a lack of awareness of proper care, including ill-fitting shoes, that cause most problems.

*  Women have about four times as many foot problems as men.  High heels are partly to blame.

*  Walking is the best exercise for your feet.  It also contributes to general health by improving circulation, contributing to weight control, and promoting all-around well-being.

*  Your feet mirror your general health.  Conditions such as arthritis, diabetes, nerve and circulatory disorders can show their initial symptoms in the feet.  So, foot ailments can be a first sign of more serious medical problems.

*  Arthris is the number one cause of diability in America, It limits everytday dressing, climbing stairs, getting in and out of bed and walking for about 7 million Americans.

Care givers in non-medical home care agencies like Seniors’ Choice at Home cannot clip nails, give baths/showers, or provides any hands on care.  But they can provide a stand-by assist for showers (an arm for balance, set water temperature, hand products and towels, soap a wash cloth) and observe toenails that need trimming and alert family to the need.

For more information about Seniors’ Choice at Home in Minnesota, call 763-546-1599, or check out our website at:  www.seniorschoicemn.com.