"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.

A Guide to the Safe Use of Pain Medication

Click on the title of this post if you would like to see the new posting by the FDA about the safe use of pain medication.

I thought this was important to post, since we all know most of our Elders are dealing with pain issues on a daily basis (and, probably at least half of us).

Of note for Elders in particular:

1. Be careful of acetaminophen (tylenol) if your Elder is taking a prescription pain medication. Many prescription pain meds have some acetaminophen in them, so by giving more acetaminophen you are risking an overdose. Acetaminophen overdose can be deadly, impairing liver function.
2. If your Elder is taking acetaminophen as needed for pain relief, and s/he is doing this without your assistance, please make sure s/he is not taking more than the label says to take. It is very common for Elders to think they can take as much tylenol as they want, thinking it won't hurt them. Even at normal dosages, acetaminophen can cause liver damage in Elders who already have liver problems, or are taking medicines that put undue strain on the liver. If you are in doubt about any of this, consult the Elder's doctor about how much acetaminophen is OK for your Elder to be taking on a daily basis.
   
3. With NSAID's (non-steroidal anti-inflammatory drugs) such as ibuprofen or naproxen, be mindful of the risk of stomach bleeding especially in Elders, and especially in those already taking blood thinners. NSAID's can also cause impairment of kidney function.
4. Use opiods (prescription narcotic pain medicines, such as codeine, morphine, oxycodone or hydrocodone) with caution in the Elderly. Opiods can cause drowsiness, and in Elders can cause confusion, unsteadiness and a higher risk of injuries from falls. Also, while taking opiods be careful not to mix them with alcohol, antihistamines, or other prescription medicines that cause sedation or drowsiness such as medicines for anxiety or for sleep.
5. Be aware of the active ingredients in all medicines your Elder is taking to avoid harmful interactions or accidental overdose.

That's it in a nutshell, along with some of my own experience. As always, this information is to ensure that you and your Elder have many Pleasant Days.

FDA's Health News for Older Adults

The FDA has posted the latest edition of "Maturity Health Matters". (just click to view the webpage).

This is the FDA Health News for Older Adults, their Families and Caregivers. There is information about food safety in regards to importing foods, and irradiating foods like iceburg lettuce and spinach for greater safety, with a FAQ section.

I have probably said before, you can't be too careful with your Elders and food to prevent foodborne illnesses. Elders (along with small children) tend to be extremely susceptible to contaminated foods. Infections like salmonella can hospitalize and Elder and cause an untimely death.

Speaking of which....you still need to be careful of peanut products.

Wishing you all Pleasant Days!

Peanut Butter Recall Widget

I found this on the FDA recall website for the current salmonella outbreak. Since many of our Elders love the things that peanut paste is a big part of----check out your products with this widget.

Safety Concerns for your Elder

While perusing the web as usual, I found something quite useful to many of you who are caring for Elders with safety problems. This device can be found at 1-800wheelchair.com
and looks fairly priced. The site has alot of things available for activities of daily living problems and mobility problems as well.

We have used similar devices while caring for our Elders, and they are a "God-send". You will be doing yourself and your Elder big favors by preventing accidents, falls from bed or from a chair with the resulting possibility of horrid injuries that your Elder may not be able to recuperate from.

If your Elder tried to get up without assistance with this device in place, an alarm will sound to let you know. For Elders with poor balance or coordination, combined with poor memory or confusion, that try to get up without your assistance and risk falls and fractures, this is ideal. You will also realize some peace of mind, knowing you can leave your Elder unattended for awhile.

Just trying to help you create some "Pleasant Days" for yourself and your Elder.

Is It Dementia, or Is It Depression?

Often, an Elder suffers with the symptoms of depression needlessly, because the signs of depression in an Elder can be very different than in a younger adult. Statistically, clinical depression affects about 6 million Elders, but only 10% get treatment. Depression late in life is more common than we like to think about, and makes for very Un-"pleasant days".

The main reason it is hard to recognize is because Elder Depression is often accompanied by other common problems of "old age":

• chronic illness
• medications treating those diseases
  
• loss of physical ability
• loss of mental capabilities, and along with this the ability to cope with change and stress
  
• loss of social support systems through death of relatives
• relocations

Not only is depression unpleasant, but it also can increase the risk of heart attacks, increase the risk of death from illnesses, increase the risk of suicide, and slow the convalescence from illness or injury.

In short, this is something that your Elder and you should not have to deal with. So, pay attention, look for these symptoms:

• increased confusion or memory problems (the most common sign, in my experience)
  
• less energy, sleeping more (or insomnia)
• restlessness, irritability
• loss of appetite (more common in Elders than eating more)
• loss of interest in things that used to hold the Elders attention, or things that were enjoyable.
• increased pain, or more physical complaints
  
• sad facial expression most of the time
• verbalizing negative, pessimistic, hopeless type things more often
  
• unable to be "cheered up"

If your Elder exhibits even 1 or 2 of these, have her/his physician evaluate for depression.

For an article on Depression in the Elderly on WebMD click (here).

This will explain risk factors and treatment options. And there are links to other articles on WebMD that explain how different treatments work.

There are many ways to treat depression for your Elder, and it is worth the effort to diagnose and treat this problem.

I would recommend that you work closely with the Elder's physician rather that trying home remedies, herbal remedies and such. Your Elder is likely taking other prescription medications that may interact badly with homeopathic remedies. And the risk factors for a depressed Elder are too great to try to deal with this problem without medical guidance.

Wishing you and your Elder Pleasant Days!