Vitamin D and your Elder

There has been more and more evidence from research lately about Vitamin D levels and good health. This recent article (click on the title of this post to be directed to the article) talks about cognitive function and vitamin D levels. Elders with low levels of Vitamin D can experience worsening cognitive problems. So, if your Elder already suffers with dementia, a low Vitamin D level can make it worse. And even if your Elder does not have dementia, adequate levels of Vitamin D can promote good memory and cognitive function as well as prevent cancer and promote cardiovascular health.

To find out whether this is a problem for your Elder, just ask his/her physician to do a blood test for a Vitamin D level. A level below "25" is considered a deficiency.

Or, you can give your Elder a supplement pill with Vitamin D. If you choose a supplement with more than 400 units of Vitamin D, make sure to talk to your Elders physician about it first. But, more and more, people are being informed by their physicians that they should be taking up to 1000 units per day.

Normally, we get Vitamin D from sun exposure on bare skin. Your body will manufacture Vitamin D with only 15 to 20 minutes of sun exposure (without sunscreen). However, Elders have a diminshed ability to produce Vitamin D that gets worse with increasing age. So, most Elders will need a Vitamin D supplement.

Just a small thing that, hopefully, can help you and your Elder have more Pleasant Days.

( Clicking the picture will take you to the publisher's page and photo on Flickr)

Good News! in the news this month.

Don't we all need to hear some good news. Well, this month while perusing all the medical and nursing "news" that I do---you'll never guess what!

There has finally been a couple of studies done that may benefit our Elders.

The first study was done for chronic stroke victims to see if more therapy would be beneficial. The study found that intense therapeutic exercises can help stroke patients regain some function, even long after the stroke has occurred. The results of this study were "unveiled" at the 2010 International Stroke Conference in San Antonio, Texas. Up until now, the medical community in general has believed that function could not be regained after a year post-stroke. Now, hopefully, the results of this small study will open the way for more research to be done so that our Elders can have their extra rehab paid for by insurance.

For now, just know that if your Elder has had a stroke, it is never too late to get more exercise to improve function and quality of life. If you want to read the article from Medscape Nurses, click here.

The second study shows that exercise can reduce anxiety levels in sedentary people with chronic illnesses (which would describe many of our Elders that we care for). Rather than using medications with all the side effects the elderly are so susceptible to, routine exercise was found to have a therapeutic effect on reducing anxiety levels, as well as reducing fatigue and problems with cognition. You can see this article, if you like, from Medscape Nurses, by clicking here.

The articles, being about research and studies, are very boring. But the messages are exciting. More exercise can give you both more Pleasant Days. I know, we already knew that---but now it's official.

(photo from Flickr.com)

Insomnia in the Elderly (and You)

Sleep, for both you and your Elder, is essential for good health and quality of life. If your Elder does not sleep at night, your lives will quickly become very unpleasant. You will become fatigued, irritable, cranky and feel sick all the time, finding it difficult to concentrate and complete daily tasks. Your Elder may become more confused, delusional and generally become much more difficult to deal with. This can lead to a lack of appetite, and before you know it, your Elder is spiraling down into a pit of poor health and dementia. You don't want this to happen, so what can you do to stop it.

Drugs seem to be the "magic" that will fix this whole scenario if you talk to your Elder's physician. However, an occasional sleep aid might be OK for you, but will have unwanted effects on your Elder---more confusion, more lack of appetite, and most often the Elder will still get up even though sedated with more confusion and tendency to do crazy and unsafe things during the night while no one is watching. You can't take anything because you want to be easily awakened in case your Elder should need you. And if you are one of the really unlucky people caring for an Elder, your situation is that you must be ready to "rescue" your Elder at night because that's when s/he is most confused and unsafe, constantly trying to get out of bed and to the bathroom, at risk for falls and hip fractures, prowling through the house and engaging in unsafe activities, and the most feared: trying to leave the house.

You have to get this situation under control. Otherwise, your and your Elder's days will quickly become UnPleasant. This is how to work on it:

First and foremost, you need to rule out some obvious things that can keep your Elder from sleeping.
---The bed is not comfortable for "old bones". This will make your Elder keep waking up to reposition, and make it hard to fall back to sleep. If you can't purchase a new mattress that is ultra soft but supportive, try a thick foam mattress overlay. You can find these at various department stores, or specialty stores for bedding.
---Chronic pain is the worst at night. Even if your Elder "does alright" during the day, treating the pain at night will result in a sounder sleep. Most Elders, especially those that require assistance to maintain any quality of life will have chronic pain. Start with plain acetaminophen (unless your Elder has liver disease or damage), and consult with the physician if this is not effective.
---Make sure the sleeping environment is quiet and dark. If your Elder needs lighting for safety or feeling secure, provide very dim night lights.

If this does not solve your problem, here are some ideas to work on.
1. Establish and maintain a regular daily routine. This includes a regular bedtime routine as well. Your Elder should arise and go to bed at the same times every day. Make sure the routine allows for at least an hour of relaxing in dim light prior to going to bed.
2. The daily routine should also include some exercise to tolerance, even if this is just walking. The more energy you Elder uses during the day, the better sleep will be at night.
3. Avoid caffeine after noon. And avoid alcohol after 4pm. Contrary to popular belief (especially in Elders, who back in "the day" used alcohol for its "medicinal properties"), alcohol does not make you sleep better. It will make you drowsy so you fall asleep quicker, but in a few hours when the initial sedative effects wear off, you are wide awake and unable to get back to sleep. Also, if your Elder finds sugar and chocolate stimulating, avoid these several hours before bed as well.
4. Avoid large meals several hours before bedtime. Its best for Elders to have the large meal at midday, and a lighter meal in the evening. A light snack including some milk and carbohydrate at bedtime is more conducive to a good night's sleep.
5. Try to establish what your Elder will do when s/he can't sleep. Think of something safe and relaxing. A comfy chair in the bedroom (keeping it out of the walkway to the bathroom) might be nice with a dim reading lamp alongside, with some books for reading that is soothing and calming when unable to sleep. Or, even one of those "coffee table books" with lots of pictures that inspire peaceful and happy thoughts. Sitting up to watch T.V. is another option.
6. If a noisy environment is a problem, try some "white noise" to block out unwanted sounds. Some people who have ringing of the ears use this to relax. There are different types of white noise, like ocean waves, whale song, wind through trees, etc. Or, your Elder might enjoy music instead. There are many stations that offer the "oldies, but goodies" type of tunes so you can find music from the right era. Most people get pleasant thoughts from music they enjoyed during their young adult life.
7. Encourage a hot bath before going to bed, to soak away the day's troubles and some of those muscle and joint aches. Try some aromatherapy with the bath---a small amount of lavendar essential oil can be very calming.
8. The day should include some time outside in bright, natural sunlight.
9. Melatonin is a natural sleep aid that has few side effects, and does not interact with other medications. It is a hormone that is found naturally in the body, that regulates the wake/sleep cycle and other daily biorhythms. As we age, our levels of melatonin can decrease, making the normal rhythm of the day more problematic to maintain. A dose of 2 to 3mg at bedtime may work to promote sleep. Use a much lower dose if you are taking it every night, or if this amount causes too much grogginess in the morning.
10. Many Elders become uneasy at night for a variety of reasons. Providing a dim night light can make trips to the bathroom easier, as well as providing some reassurance when the elder awakens during the night by being able to orient themselves. Another cause of worry is that s/he may need assistance and will be unable to tell you. You can easily remedy this, and put her/his fears to rest by providing a wireless "door bell" that you can get inexpensively at a hardware store (or places like Walmart). You give your Elder the button to push; and you keep the bell. This works for most distances between bedrooms in the same house. The biggest problem is making sure you have enough batteries for both the button and the bell. This will give you both enough reassurance to get some rest at night.

Heres to many peaceful and restful nights, so that you and your Elder can have more Pleasant Days.

(to acknowledge photographer for image in this post, click here)

Dry, Itchy Skin Rashes are NOT Pleasant

This image is called
"Stop and Smell the Flowers".

(clicking on the picture links to the photographer's page on Flickr)

Dry skin can be a big problem for your Elder. It's miserable, itchy, flaky, and leaves your Elder wide open for infection. This is not what we want in our ever-constant pursuit of Pleasant Days.

I know, the picture has nothing to do with dry, itchy skin. Just thought it was cute.

The dry skin that affects elders is very much like "winter dry skin" that affects people of all ages when the air becomes very dry. People who have lived through winters where it is very cold and snowy, or in arid deserts know what I'm talking about.

In Elders, the skin very often does not make its own oils any longer, which makes it impossible for the skin to retain any moisture at all. After some time, the skin becomes flaky, inelastic, will become reddened, rashy, itchy. The Elder tends to scratch---this breaks the skin, fissures develop, bacteria invades and then you have a really big problem.

Many times people will seek help from their doctor or dermatologist, most of whom try to treat this condition medically, which will sometimes not help or worsen the problem. Don't get me wrong---many dermatologists are very good, will recognize the problem for what it is and be able to help you. But the idea here is to take care of the aging skin so that it does not become any drier than it has to be, and you don't end up with a miserable Elder needing expensive treatment or worse.

Even with these steps in skin care, you may still notice dryness. But hopefully proper skin care can prevent itching, then scratching, then damage to the skin.

1. Bathing more than twice a week is usually not necessary for your Elder. And then, showers are much better than baths as the skin is in the water for much less time. Use warm, never hot water---hot water will strip precious oils from the skin and cause damage. Keep in mind your Elder may prefer hot water because of aging circulation and peripheral nervous function, s/he may not feel the warmth of the water. You have to try to explain the reasoning behind avoiding use of very hot water. You might try placing a heater in the bathroom for a time before showering so the room is very warm. (Bad for you, but good for your Elder who won't complain so much about bathing). A note here as well about comfort of showering: because of problems with the peripheral nerves, your Elder may complain that the shower spray is painful or uncomfortable---try using a very fine gentle spray. You may even have to go shopping for a new nozzle, but this is well worth the effort if your Elder has this problem; plus it will be much gentler on the old skin.
2. Never use anything but extra moisturizing body wash and shampoos. Generic body washes are OK, but tend to be less moisturing than others. Dove, Caress and the like are good ones. WalMart makes an Equate brand that is very good (it says "extra-moisturizing). Keep in mind shampoos can also be irritating to scalp and skin if they are too harsh.
3. Always apply an extra-moisturizing lotion to the skin that is still warm and damp from the shower. There are plenty to choose from. Some that smell great, some that are hypoallergenic. Just make sure it is very moisturizing.
4. Pat dry with a towel, do not rub. Here again, the bathroom needs to be very warm to encourage air drying of the skin. So, you don't want your Elder to freeze in an unheated bathroom. Just remember---you may feel like you are in a sauna, but this will be more comfortable for your Elder. (unless your Elder has difficulty breathing because of COPD, emphysema or congestive heart failure with fluid on the the lungs).
5. Keep your Elder well hydrated. Skin needs water to stay moist and supple. Many Elders are on the borderline of dehydration because they don't feel thirsty, they don't like to drink too much because then they have to pee too much, and most don't like plain water. You need to have scheduled hydration for these problems. Make sure your Elder drinks with meals, between meals, and a full cup of water minimum with medication. About 1.5 to 2 quarts of fluids a day (half of which should be water or herbal teas) is good, unless the Elder's doctor has said otherwise.
6. A well-balanced diet with 5-6 servings of protein foods (meats, eggs, nuts, legumes); 2-3 servings of milk products (low or non fat milk, hard cheeses, yogurt); 5-6 servings of whole grains; 5-6 servings of fruit and vegetables and use of fats such as olive oil and avocados will provide all the necessary vitamins, minerals and nutrients to keep the skin well nourished and functioning as well as it can.
7. For very, very dry flaky skin, use of a barrier cream might be needed. You can use plain petroleum jelly---a thin layer rubbed into the skin will keep moisture from escaping. Some people will even use Crisco for this.
8. Reapply lotion every day between showers. This is easily accomplished during the "partial bath" on days not showering (you know--face, pits and privates). When the lotion smells wonderful, it can be an enticement to doing this mini-bath. Yeah, I keep going on about how Elders hate to bath---but it's true, many do. Anyway, there is something to be said for "aromatherapy".

So there it is in a "nutshell". I hope this helps, if this has been a problem for you. Just trying to help everyone have more Pleasant Days.

Getting Serious about a Low Sodium Diet

Many people realize that reducing their salt intake would be good for them; many people even go so far as to say "I'm trying to cut back on the amount of salt I eat." This is fine for young people, though a low sodium diet now would likely prevent health problems in the future when their bodies are not as well equipped to handle large amounts of salt, or sodium.

For people with chronic conditions like hypertension, fluid retention, swelling of hands and feet, kidney problems, and heart failure, being serious about sodium intake is crucial. It is likely that your Elder has at least one of these conditions. Too much salt or sodium in the diet can adversely affect quality of life for these people. Medicines can only do so much. With most chronic conditions, it's up to the person to decide to help themselves. Or maybe in your case, it's up to you to decide to help your Elder.

I have spent a lifetime advising people on the sensibility of a low salt diet. But, I am ashamed to say, I wasn't really serious about it myself until I developed hypertension at a relatively young age (40). We also have to take into account that medical science has decided that what we used to think of as normal blood pressure "for your age", is now considered high and in need of treatment. By the time we finally realize the problem, the damage has been done. Still, reducing sodium in your diet can help you have less symptoms, and be able to control the condition with a minimal amount of medication, which also means you have fewer side effects to deal with. All of this translates into greater quality of life, and many more Pleasant Days.

So, I am here to tell you----do yourself a favor and cut back on the salt you are eating now. You will get used to it, believe me. And in the long run, you will be a much healthier person for it which will allow you to enjoy your later years.

To do this, you need some basic knowledge about salt. Keep in mind that sodium in an essential nutrient, very important in the proper functioning of the body. But too much can be as harmful as too little. Also keep in mind that you will get an adequate amount of sodium from natural foods without adding any salt at all. Here's what you need to know:

• Salt is a mixture of sodium and chloride. This is different from plain sodium, but we can think of it as the same. Note, however, labels will list the amount of sodium in food.
• You should not eat more that 2300 mg of sodium everyday. That's about a teaspoon of table salt.
• Be aware of monosodium glutamate in foods you buy (almost everything in a package) on top of the salt that is also added. This can include foods with "hydrolyzed proteins", "flavor enhancers" and "natural flavors".
  
• Also watch for any ingredients with the words "disodium", or "trisodium".
• Baked goods have quite a bit of sodium, not only from salt but from baking soda and baking powder. This will be true even if you make them at home.
• Prepackaged or canned foods listed as "Low Sodium" on the label will still have sodium in them that you need to be aware of. Always read the label so you know exactly what you're getting.
• Sources of extra sodium: Frozen dinners, Ready-to-eat cereals, Vegetable juices, Canned vegetables, Deli meats, Pre-made soups (can or box), Marinades, Flavorings, Pre-made Sauces, Prepackaged rice, potato or pasta dishes with a flavor packet, Condiments, some OTC medicines, Restaurant Food, Fast Food.
  

Read the Label, and know what certain terms about sodium content mean. This information is from WebMD:

• Sodium-free: Less than 5 mg of sodium per servingVery low-sodium: 35 mg or less per serving
  
• Low-sodium: Less than 140 mg per serving
• Reduced sodium: Sodium level reduced by 25%
• Unsalted, no salt added, or without added salt: Made without the salt that's normally used, but still contains the sodium that's a natural part of the food itself.
  

The best way to reduce salt in your diet is to measure what you use, and use fresh ingredients to cook with. Frozen is great, just make sure there are no added flavorings. Use herbs, spices without added salt or sodium, and fresh peppers, onions, garlic, shallots, etc. Even adding celery and carrots to sauces and soups will add extra flavor. When you cook your own cereal, rice, pasta you can decide whether to use some of your teaspoon of salt to cook it with or not. Replace bouillons with sodium free stocks to make soups, sauces and gravies. Make your own stock and freeze it for use later. Make your own gravy.

The idea here is not to totally abolish salt from your diet, unless that's what you want to do. The whole idea is for you to decide how much salt you want to eat without having to guess.

Be aware of additives when buying frozen foods. Buy plain rice, barley, pasta etc, rather than buying boxes of pre-seasoned rice or pasta mixes. Cooking your own food, and deciding how much salt you want to add to it, can be just as simple as relying on prepackaged and processed foods. You only need to change your grocery shopping habits.

Measure the salt you're going to use everyday. If you want to use only 1 teaspoon of salt, then measure out this amount into a small container for the day. You decide how to use it, whether you cook with it, or add it after the food is cooked. When it's gone, don't eat anymore. After some time, you will find that you may not need to use the whole amount in a day. You will find yourself becoming more creative in ways to flavor your food without salt.

I tell people not to use salt substitutes. Salt substitute is made from potassium rather than sodium. Eating too much potassium is just as bad as eating too much sodium, although this is not likely because potassium chloride has a bitter flavor. Extra potassium can be very detrimental to people with certain diseases affecting the kidneys, heart, or diabetes. Salt substitutes should also not be used with certain medications. Always check with your doctor before using a salt substitute.

If you are a real stickler for the amount of sodium you want to eat, or you want your Elder to eat, try keeping a food diary. Then look up the amount of sodium in each food naturally. Then add the amount of sodium in the salt you used. You will probably find that the naturally occuring sodium in foods is plenty without the added salt. If you're interested, here is the USDA National Nutrient Database for Content of Sodium in mg.

Do yourself, your loved ones, and especially your Elder a favor. Reduce the salt in your diet, and teach your family to do the same. You won't regret it.

Wishing you and your Elder Pleasant Days.

"Living with Congestive Heart Failure"

In case you don't follow the blog "Bill Boushka Retires" (one of the blogs I follow), I just wanted to point out that he has noted a very good video on YouTube about congestive heart failure. Since this is a common chronic condition that many of our Elders have to deal with, I thought the video valuable. It was very informative and understandable to lay people, with information about symptoms, risk factors, current diagnostic tests and treatments, how to prevent CHF if you have risk factors, what to do if you suffer from CHF as far as diet, exercise and OTC drugs to avoid, and what to watch for and report to your doctor.

The video is presented by UCSF's (University of California San Francisco) Osher Lifelong Learning Institute.

Dr. Michael Harper, Director of the Geriatrics Fellowship Program and Associate Clinical Professor of Medicine at UCSF, discusses living with congestive heart failure. I thought him to be a very interesting speaker.

If you or your Elder have risk factors or suffer from heart failure it is well worth the time to see the video. One can still have Pleasant Days even with CHF. Check it out. Here's the link:

"Living with Congestive Heart Failure"

How do You Know When Your Elder needs Help?

I came across this picture, titled "Father's Hands", in my perusings, and the story linked to it touched my heart. But among other things, it made me think about the conversations I have had with others about the topic of this post:

Just how do you know when your Elder needs help? Most Elders try very hard to hide the fact that they are "slipping", being fearful of what may happen if someone decides they are no longer independent. So it's usually unlikely that your Elder will just ask you for help. There are many emotional tags that go between parents and children (or grandparents and grandchildren, or whatever your relationship is). Your Elders do not want to be dependent on you, the younger. They do not want you to tell them how to live their lives. They do not want to bother you, after all you now have a pretty full life, and probably a family, of your own. They have been independent all their lives, and want to stay that way. They are proud and may be in denial about the fact that they need help. And the biggest fear: if they let on they need help, they will end up in a nursing home.

So, you need to be keen to the subtle signs, and the not so subtle signs:

• Your Elder is suddenly less social, or exhibits very reclusive behavior.
• The house isn't kept up the way it always was before; laundry isn't done; grocery shopping hasn't been done; the yard is not being maintained.
  
• Tasks that used to be routine or easy are now difficult to accomplish.
• Your Elder is not eating as well, and/or has suddenly lost weight.
• It looks like your Elder has problems taking medications properly, missing doses or taking too many. Maybe prescriptions have not been refilled, or your Elder has missed doctor appointments.
• The bills have not been paid, and/or checks have not been deposited.
• Personal hygiene is not being done; showers not being taken, oral hygiene not done, clothing hasn't been changed; hair is not being washed.
• The pet is not being cared for properly.
• Your Elder's driving skills are slipping.
• Friends and hobbies have been dropped.
• Your Elder seems confused or depressed.
• There is difficulty with stairs, maybe falling is a problem.
• Loss of bowel or bladder control.
• Anything that seems very unusual for the person that you have known can be a sign that things are not quite right. Maybe your Elder's neighbors are reporting things to you that just don't sound like your Elder at all.

So, now what. You talk to your Elder, and you ask questions. But your Elder denies needing help, makes excuses, or explains away your concerns. Be careful here. Don't push too hard, or you might risk putting a wall up between you and your Elder. Above all, the lines of communication must remain open.

Whatever you think, your Elder will be better off in their own environment as long as possible, and with the least amount of intrusive "help" as possible. But there are ways to help that could actually improve the Elder's quality of life.

Start by making sure your Elder's medical needs have been attended to. Go with her/him to a doctor's appointment and discuss your concerns. Very likely there will be things the doctor can suggest, or may refer the Elder to a professional that can further assess the situation. There may be medication changes that need to be made, or conditions that need to be treated that will improve your Elder's strength and cognitive function.

If the Elder's medical needs are under control, make sure medications are being taken properly. This is easy to accomplish as long as you have the Elder's cooperation. Very often it only takes someone to organize the medications in a pill box, so the Elder doesn't need to sort through numerous bottles several times a day. For Elders with very poor memory, you might try putting the medications in an envelope with the date and time to be taken written on it. Leave out only one days supply at a time to prevent more confusion. Your Elder can mark the envelope when the meds are taken to remind them later when they have forgotten whether the medicines were taken or not. Take a look at my post about managing medications.

Make sure the Elder's home environment is safe. Start in the bathroom. By installing some simple grab bars in strategic places, you can greatly enhance your Elder's independence in bathing and toileting. Many times simple things can fix a big problem. Maybe your Elder doesn't bathe as often as they used to because of the fear of falling.

Try to get at the bottom of the problem, then it will be much easier to work on.

• What is the real problem. (eg: not showering; not eating right)
  
• Why is this a problem (eg: fear of falling in the bathroom; shopping is too confusing and too tiring)
  
• How can we help this the easiest way possible (eg: install grab bars in the bathroom; deliver groceries/meals to your Elder)
  

Then, if your "fix" doesn't work, try something else. Always include your Elder in the decision making process. You will be likely to get much more cooperation this way.

This is just a basic idea of where to start. If you are able to notice when your Elder needs help, and are able to provide it before things get out of hand, you will be able to keep your Elder home and independent much longer. And this makes for more Pleasant Days for your Elder and you.