Information from the FDA about Drug Interactions

I just received this in my mailbox today. I thought it was worth mentioning and passing on since Elders are so sensitive to medications and may have more problems with interactions than others. Here is the link for Avoiding Drug Interactions by the FDA. It includes information about drug to drug interactions as well as some foods with certain medications.

Wishing all of you and yours Pleasant Days.

Preventing Urinary Tract Infection and Unnecessary Hospitalization for your Elder

I recently spoke with a friend who was concerned about her mother. Her mother had become so ill she required hospitalization for treatment of a urinary tract infection. She then had to spend some time in a skilled nursing facility to finish recovery before returning to her assisted living facility.

The concern involved prevention of a similar occurrence in the future. My friend was amazed that something as simple as a bladder infection could make someone so ill.

Our conversation made me realize that there are probably many people caring for, or concerned about, their Elders becoming severely ill for the same reason.

Maybe some people don’t even realize there is such a great risk.

So, I thought I would talk about prevention of UTI’s (urinary tract infections).

UTI’s (or bladder infections) are actually quite common in elders, women more than men. The reasons for this are:

• Elders don’t like to drink enough fluids (makes them want to go to the bathroom too often).
• Elders often don’t feel thirsty.
• Elders, especially women, are often incontinent of urine.
• Incontinent elders may not want the fuss and bother (or expense) of changing incontinent briefs as often as they should.
• Elders very often have difficulty with hygiene after toileting, thus encouraging the growth of bacteria.
• Elders often have an impaired immune system due to degenerative diseases, and/or poor nutrition.

The solution, or rather the prevention, of bladder infections is really simple, as long as your Elder will cooperate.

Nutrition and hydration (I know, I keep harping about this) is important to keep the immune system functioning, and the kidneys functioning so that the urinary tract is flushed out. Bacteria won’t have a chance to sit around and multiply, thereby causing the infection. Some simple preventatives:

• 8 oz. of water at least 3 times per day (given with medications is perfect).
• 8 oz. of orange juice daily. Better yet, eating one orange (or grapefruit) every day.
• 8 oz. of cranberry juice (unsweetened is best, or sweeten with apple juice) once or twice a day has been known to be helpful in keeping bacteria from “sticking” to the walls of the bladder and urethra. Plus it also has Vit. C.
• Before eating grapefruit or drinking grapefruit juice, please check the link (on the left side of the blog) “List of meds that interact with grapefruit juice.
• Total fluids, including coffee, tea, milk, juice, beer (whatever) should total around 2000 cc (or 2 quarts) at least (unless the Elder’s physician has specified another amount).
• Someone needs to actually give or offer these fluids to your Elder. Don’t rely on your Elder to remember to drink that much on her/his own. Work it into a daily routine.
• Your Elder needs to eat enough protein, vegetables and fruits to get adequate amounts of protein, carbs, vitamins and minerals to be able to maintain an immune system and heal damaged tissues. If you are unsure if your Elder is eating enough, check out “MyPyramid.gov” (listed in “Links for your Assistance” at the left side of the blog).

Incontinent Care: cleanliness is everything. Elders don’t change often enough, and are unable usually to clean well enough after toileting. Also, most elders don’t bathe every day. So, keep mindful of 1) growing bacteria 2) spreading bacteria, and 3) prevention. Bacteria growing in disposable briefs, underwear, or on your Elder’s skin can easily travel up the urethra to the bladder. The bacteria usually responsible for causing infection come from the bowel.

• Help your Elder develop a sensible toileting schedule. She/he should be toileting 5 to 6 times a day. Most common: upon arising in the morning, mid-morning, mid-afternoon, after dinner, before going to bed at night. Then again about 2-3 hours after going to bed (kidneys work better for lots of elders when lying down; this can help with night time incontinence).
• Even if your Elder is fully incontinent, toileting regularly will also help to get her/him moving around; get cleaned and changed often; and encourage some continent episodes. If the Elder is not able to get onto a toilet, then changing the incontinent brief and good cleansing is essential soon after the incontinent episode.
• Allowing an Elder to wear a wet (and especially soiled) incontinent brief for any length of time can encourage the growth of bacteria that can travel up the urethra into the bladder. This is especially true for women. So change the brief if wet or soiled at all (yes, even a little bit) every time the Elder toilets.
• Use baby wipes to cleanse your Elder after toileting. It’s much more effective for you to do it. Wear gloves, stand behind the Elder and ask her/him to lean forward, then cleanse from (their) front to back.
• Wash your Elder’s “periarea” with soap and water at least once per day, twice is better. You need 3 washcloths, disposable gloves, moisturizing body wash.
• Wear gloves
• Wet 2 washcloths with warm water.
• Use a small amount of body wash on 1 washcloth to wash (you from the back, elder leans forward while sitting on the toilet) from front to back.
• Use 2^nd wet wash cloth to rinse. You may need 2 to rinse thoroughly.
• Then pat dry with the 3^rd dry washcloth.
• Wash any linens used for pericare with laundry soap and some bleach.

All of this accomplishes a few things: your Elder feels better and cleaner, smells better, hopefully has more continent episodes, and no worries of unnecessary infection, all of which add up to greater dignity, more peace of mind, and hence Pleasant Days.

Symptoms of a UTI in an Elder:

• More frequent urination than usual.
• Feeling of low abdominal cramping, or urgency (feeling like you have to go, but hardly anything comes out)
• Unusual confusion/disorientation or delusions. A drastic change in the Elders cognitive ability is sometimes the only clue that she/he is sick.
• Burning on urination
• Cloudy and/or very smelly urine
• Fever is hardly ever present unless the infection is severe.

If drinking more fluids doesn’t help in one day, call the Elder’s physician. If the Elder has fever, severe pain or blood in the urine, call the physician right away.

Antibiotics are not always needed, but if the infection is causing fever, blood in the urine or severe pain, or your Elder is not able or willing to drink enough fluids to flush out the bladder, treatment is necessary to prevent a more serious infection higher in the urinary tract (the kidneys) and a possibly life-threatening situation.

So there it is. Maybe not so easy, but far better than lengthy hospitalizations, risk of kidney infections that could be painful and life-threatening, and a real risk of even longer stays in a skilled nursing facility with the inevitable declines in function and cognitive ability than result. Very Unpleasant.

Wishing all of you and your Elders Pleasant Days!!

Consumer Information from the FDA

The FDA has published a site to help consumers choose over-the-counter (OTC) medications. There are several links that provide important information for people who are purchasing OTC medications for themselves or others.

For advise about self-care, reading drug labels, and being aware of drug interactions, click here.

For a checklist for choosing OTC medications for adults, click here.

To learn how to read a drug label, click here.

For information in Spanish, click here.

By clicking on the title of this post, you will be taken to the entire publication by the FDA "Consumer Education: Over-the-Counter Medicine".

I have also included this link under "Links for your assistance".

It is very important to keep yourself informed about all medications your Elder is, or might ever, be taking. OTC medications can be just as potent, some even more so, than prescription medications. And with Elders, side effects and adverse reactions to any medicine, whether OTC or not, are always more problematic than with anyone else. Also, remember to inform your Elders physician about any OTC medicines your Elder is taking.

Paying attention to all medicines your Elder takes can help you both have more Pleasant Days.

Dealing with the madness of Dementia

Dementia in your Elder can be maddening for you for many reasons: the Elder doesn't know s/he is confused or forgetful; you can't reason with her/him; s/he is very stubborn and doesn't understand the word "no"; there is no rhyme or reason to the things a demented elder can come up with; you are afraid to leave her/him alone because of her/his altered reasoning.

How does the Elder deal with it, and is it as maddening for her/him? I've never been able to get this answer. I can only imagine.

In all my years of working with elders dealing with dementia, I always wondered how and what they thought of the world and the people around them. I mean, think about it. How do many people act when relating to a demented person? They may roll their eyes a lot. They often throw up their hands, or at least make a lot of hand gestures. They keep repeating phrases like "I already told you.....", or "why can't you remember......?" They tend to become very frustrated and angry. They think the Elder is doing this "on purpose". They tend to think the elder is lazy, and sometimes even stupid. Then they start treating the elder like they are lazy or stupid. They can even start yelling, cursing, and name-calling. They begin to feel very guilty about this behavior, but seem powerless to stop it.

If you are caring for a demented loved one, sometimes this behavior comes out of the blue. You never knew you had it in you to be this way. Your behavior then becomes an issue, along with the dementia your Elder is trying to deal with.

So, how do you deal with this. First, promise yourself to never feel guilty. If you are caring for a beloved Elder, take heart. You are doing a very important and loving thing.

Start a new day. Take a deep breath and try to relax. Your Elder may still be demented, and still be doing, saying and thinking some weird stuff. But you do have the power to deal with it.

Remember this. Your Elder can't help it. Brain damage is devastating for everyone. And if there was any way your Elder could think and act normally, s/he would. It's not personal, so never take it that way.

If you are lucky, your Elder may be "pleasantly confused". This is often not the case. Very often elders know there is something wrong and try very hard to fight it, or hide it. And sometimes the harder they try, the worse their behavior can get. You need to be able to reassure your Elder that you understand, you are there to help, you will never judge or make fun of her/him, and that it's not her/his fault.

Here are some simple pointers that may help you, and your Elder, maintain some sanity:

• Establish a daily routine and stick to it, always. Everything needs to be done the same way, at the same time, everyday. Some things can be on certain days (like showers, since most elders don't need a full shower every day). Some days can be different because there is a necessary event going on, like a doctor's appointment. These things should be talked about and prepared for days in advance. Give your Elder plenty of time to adjust to the new event. Infrequent visits from friends and family can be handled the same way. Contact everyone and ask them for no surprises, please.
• During the days activities, whether eating, dressing, toileting or bathing, constantly give cues and reminders to assist your Elder. This is also a good time to give reminders about safety also. An example would be: "I'll be right back, remember not to get up from the toilet by yourself." You need to always use the same words. It may get boring for you, but this will help your Elder more than anything else.
  
• As much as possible, have people come to you and your Elder rather than taking your Elder out. Haircuts and manicures can be handled this way, as an example.
  
• Away from home activities are great if your Elder enjoys them. With dementia, the Elder will enjoy them more if they are part of the routine, which doesn't necessarily mean every day.
• Be very careful about changing any medications. Talk to the Elders doctor about this at length when changes are necessary.
• Keep your Elder well nourished and well hydrated.
• Anticipate your Elder's needs, and take care of the need before your Elder actually needs it. (examples would be toileting, extra clothing or blankets, drink of water, etc). A demented person may forget to ask, or forget how to ask. After a while the need can become an emergency in the mind of the Elder and odd behavior may result.
• Validate your Elder's feeling. This is especially true when your Elder is delusional. There is a fine line between the need for reality orientation and the need for validation of feelings. Try to know the difference. There are times when delusional thinking is difficult or impossible to alter, and trying to do so will only result to anger and confuse the Elder further, which in turn could result in problem behavior. Try to "agree" a lot, and "understand" how your Elder feels. You may even need to play along with the delusion to steer your Elder away from it with distraction. An example would be a belief of your Elder that s/he is getting ready to go on a trip. If it doesn't hurt anything, let her/him "pack" or whatever. While playing along, distract her/him with another idea (like playing a favorite game, going for a walk, having a cup of tea) and more than likely the delusion will be forgotten about. A note here: if your Elder is frequently delusional and especially if these delusions are distressing, you need to talk to the Elder's doctor.
  
• Try to keep the surroundings clean, uncluttered, relaxing.
• When you do need to have an important discussion with your Elder, plan to do it during the time of the day when your Elder is at her/his best. For most elders, this would be in the morning, probably after eating. Demented people tend to get more forgetful and confused as the day wears on.
  
• Always, no matter what is said, done or thrown: treat your Elder in a respectful manner. Sometimes you need to pretend that it is perfectly normal for everyone to be forgetful and confused. Give your Elder cues and reminders in a respectful manner so s/he never feels belittled or stupid. Your Elder will probably depend on you to be the "rememberer", which can be challenging at times. (I take notes) :)
• If your Elder becomes very angry, starts yelling and/or cursing, or other things, try to back out of the situation quietly and let the Elder calm down. If you can not leave the Elder safely, then just stop talking. Trying to talk your way out of the Elder's anger will only make it worse. Distraction sometimes helps, but you need to try this well before the person becomes irate.
  

If you do well, you and your Elder will have many pleasant days with less confusion, less distress, and less problem behavior. Your Elder will come to trust you to just take care of things. At least most of the time.

An Article from the NY Times

This is a great article about dignity for the elderly. (click on the title of this article). As caregivers, we often fall into this mode of "caring" that is very much like the care we give our children. We don't mean to demean by using terms of endearment (or "elderspeak" as the article terms it) but according to this article, maybe more elders are upset by it that we think.
The article does mention that professional caregivers are often not taught how to address elders they care for. This is actually not the case. Nursing home employees across the country are taught to address an elder by the surname unless the elder specifies otherwise. Some like to be addressed by their first name, some by their surname, and some by a nickname. Whether each employee follows that rule is another matter. And elders, trying to be polite, will often not complain.
At any rate, I felt this was a good article to share so we can all be enlightened in yet another way to help our Elders have Pleasant Days.

Managing your Elder's Medication Maze

I’ve been going on and on about nutrition. And, I’m probably not done with that. After caring for elders in a medical type of mind-set for so long, it still astounds me how much more important nutrition is to medical science. But, that doesn’t mean we should forget about the medical science.

If you have contemplated managing an elder’s medication regimen, and looked around for your Elder’s supplies and medications, you probably have already encountered my sentiments about the issue. It’s scary. No, that’s not the right word, really. More like Horrifying.

Elders, more often than not, require several different types of medications to manage several different disease processes. And then a few more, to manage the effects of the original medications. It can be very confusing, even if you aren’t demented.

Imagine trying to manage your medications if you are even mildly confused and/or forgetful:
• What do you take?
• Why do you take it?
• When do you take it?
• Should you take it with food, or on an empty stomach?
• Where do you go to get more?
• Are you supposed to take it forever, or just for a short time?
• Did you take it this morning? Maybe you should take it now?
• Will you remember to order more when you run out? (or will you forget about it and not take it anymore?)
• Will you remember what to ask your doctor if you have concerns?
• What are the side effects, and what should you do about them if you have them?
• If you have side effects, will you recognize it as a side effect, or just think you have developed another disease process?
• Where did you put that new bottle of medication?
• If you feel worse, does that mean you should take more of the medication?...or maybe none at all?

This list could go on and on and on…..in ever widening circles. Many times, elders have ended up having more problems with chronic diseases because of the medications they are not taking properly. The physician would call it “noncompliance with the medication regimen.” This can be disastrous to an elder, causing hospitalizations, acute confusional states with changes in behavior, or worsening of existing dementia. It could even result in death due to drug overdose or exacerbation of the disease process not being treated properly.

So, all that being said (and maybe, but hopefully not, experienced), now you have decided you want to manage your Elder’s medications.

There is a little bit of complexity involved in managing another person’s medications. But if you do all your homework and keep some records, keeping track can be easy to do.

You need to tackle this very large task one step at a time:
1. Find and gather up all the medications your Elder takes.
2. Attempt to determine if these are in fact the actual medications your Elder is supposed to take.
3. Become well informed about the health status of your Elder.
4. Become well informed about the medications your Elder is taking.
5. Organize the medications.
6. Dispense the medications to your Elder.
7. Monitor the effects the medications have on your Elder.

Ok, looks simple enough. Now, lets go into some detail.

1) Gather together all the medications your Elder takes. This includes herbal and vitamin supplements, and over-the-counter medications. Keep in mind that your Elder, especially if s/he is a little forgetful or confused at times, may not keep all the medications in one place. Some elders have a “gift” for finding new places to put things so they won’t forget. It may make you think your Elder used to be the Easter Bunny in a past life. Anyway, good luck.

2) Attempt to determine if these are in fact the actual medications your Elder is supposed to take. The easiest way to do this is to ask the Elder’s physician. Keep in mind, your Elder may have several physicians, and hopefully they all communicate with one another. But this is not always the case. Another way is to ask the pharmacist that fills your Elders prescriptions. Again, your Elder may go to more than one pharmacy, and/or use a mail type pharmacy service. The bottles of medications you find will have the name of the prescribing physician and the dispensing pharmacy. So that would be a start. And of course, this is all assuming your Elder can’t just tell you all of this.

3) Become well informed about your Elder’s health status. That is, you need to know what diagnoses the physician(s) are treating your Elder for, as well as those not being treated. This may necessitate you going to the physician’s office with your Elder and getting the Elder’s permission to access information about her/his health status, as all of this is confidential. Once you have determined what diseases and conditions your Elder is dealing with, educate yourself about these. There are plenty of resources online to help you. WebMD as well as Medline Plus are good resources for information about health conditions.

4) Become well informed about the medications your Elder is taking. Again, there are lots on online resources for you. The sites listed above have excellent information regarding medications, as well as herbal remedies and supplements. Your pharmacist can also give you informational pamphlets or printouts about each medication. You need to know:
• What condition/disease process is being treated with the medications.
• How does the medication work.
• What effect is the medication supposed to have on your Elder’s condition.
• How is the medication best administered (with food, without food, not in combination with certain meds, vitamins or foods, etc) and why.
• If your Elder can’t swallow pills, can you safety crush this medication (some meds, like time-release compounds should not be crushed), and mix it in applesauce or ice cream or some such thing. And if not, can you get it in a liquid form.
• What to monitor while your Elder is taking it (such as changes in behavior, appetite, blood pressure, pulse rate, etc).
• And most importantly, know what the side effects or adverse reactions are likely to be, and watch for these. Elders are very prone to side effects and/or toxic levels of medications because they are not able to metabolize and/or excrete chemicals efficiently.
• Last, know what to do if you notice adverse effects or side effects. Some medications cannot be stopped abruptly, and some you must.

5) Obtain a pill organizer box that will handle the amount of medications you
need to organize. There are all kinds available. Use whatever makes the most sense for you and your Elder. Basically, you want to be able to organize medications by dose and by day. Example:
Monday am, noon, pm, bedtime
Tuesday am, noon, pm, bedtime…..etc
An example would be a pill organizer box with 7 days, and four dosing slots for each day. Or, obtain four pill organizer boxes with one dose every day for 7 days. Then label each box for the dose with an indelible pen. So you will have one box for “AM” Sunday through Saturday, one for “NOON” Sunday through Saturday, etc.


The organization depends on whether you will be dispensing the meds to your Elder, or whether the Elder will be choosing the box and dosing slot to get the meds from.
Set up the medications for a week at a time. To prevent mistakes, do this during a time when you will not be interrupted.

While you are setting up the medications the first time, count how many doses there are, and determine on a calendar when you will need to reorder. Give yourself at least a week, or however much time you think you need. Write this down. Keep this information on all the medications in one place, on one calendar, on one piece of paper, or on an internet calendar. Reference this every week when you set up the medication organizer.

The easiest way for me is to reorder when there are less than 7 days of medication doses left in the bottle after I have just set up a week's supply. So, I always have at least 7 days worth of doses before the bottle needs to be replaced. Plenty of time to get a refill.

On your ongoing medication list, you may also want to include information that may be needed later, if something happens, like a hospitalization. The hospital staff should be able to get medical information from the Elder’s physician, but they always rely on the family members anyway.
So on your list you will need to have
• Date to reorder (keep this is pencil, so you can update it when you get a new bottle of pill).
• Medication, dose, frequency
• Condition treated
• Date it was first ordered
• Any dosing changes, why and date
• Date it was discontinued, and why (this information can be important for a physician that is not familiar with the Elder’s ongoing treatment plan).

It easiest for me to keep a table with the above headings across the top, and then list each medication with the information as it comes up.

Use a highlighter to cross off a medication that has been changed or discontinued. This way, you can still read it, but when you set up medications you know it is no longer an active order. This information can be invaluable when you are managing medications for an elder that has frequent changes in doses and drugs. Keep this with you when you visit your Elder’s physician, and especially when your Elder needs hospitalization.

6) Now that all the hard work is done, all you have to do is make sure your Elder takes the medication correctly. I prefer to dispense the meds and watch the Elder swallow them. That way, there are no mistakes. The meds are not forgotten, thrown away, put down somewhere and a child, a pet, or another confused person takes them. No telling what can happen!!

7) There’s just a little more. Monitoring the effects of a medication is important for several reasons:
• You want to make sure it’s doing what is expected, and if not, you need to tell your Elder’s physician.
• You want to monitor for side effects, and if you notice any, tell your Elder’s physician.
• You want to monitor for allergic reactions, and if there is a reaction, tell your Elder’s physician.
• And finally, if the medication is not helping, you may wonder why your Elder should continue taking it and risk side effects or drug toxicity. You probably want to discuss this with your Elder’s physician.

You will probably need to watch your Elder's blood pressure and pulse rate on a weekly basis, at least. Your physician should tell you, along with parameters for when s/he should be called. For a diabetic, maybe you need to monitor blood sugars. These things are for obvious reasons. What is not so obvious, are things that may signal intolerance of the medication, toxic levels, or side effects. Watch for changes in appetite, bowel habits, behavior, cognitive function, ability to sleep, and functional ability (walking, toileting, eating, dressing, etc.) Elders quite frequently will become more confused and forgetful, and stop eating when a medication does not agree with them.

There are certain medications that must be handled very carefully with the elderly. But more about that at a later time. This article is already pretty long.

By managing your Elder's medications for them, you can avert disastrous and unpleasant moments, and maybe even hospitalizations. It does take some time and research initially, but it is well worth the effort.

As always, wishing you and your Elder Pleasant Days.

image by basykes
www.flickr.com

Concentrating Nutrients for Elders (or, Pleasant Days start with Good Nutrition, Part 2)

For the vast majority of elders, being on “a diet” is not a good thing. Even if your elder is over- weight it can be very detrimental for them to lose weight too fast, or even at all. It is far more important for the elder to get the nutrients they need than to lose weight. Younger people can “diet” because most will have nutritional reserves in their bodies to draw from. Elders usually don’t have these reserves. So always think about nutrition first, then worry about being overweight later. Of course, the elder’s physician may have some dietary concerns. These would probably only be to limit cholesterol for someone who’s cholesterol is too high; to limit calories and/or sugar for a diabetic with uncontrolled blood sugar; or to limit salt intake for someone with fluid retention problems.
It’s often hard to get an elder to eat enough protein and/or calories, which will lead to malnutrition, and lots of problems leading to very unpleasant days. These suggestions are for people who eat very small portions, don’t finish their meals, or skip meals.
Some examples:

• Use three different fruits cut into manageable pieces for your elder and mixed together with a tablespoon of lime or lemon juice as a side salad for lunch. Add a little sugar and let it sit for about an hour to make it more enticing. Fresh fruit seems to "go down" better than raw vegetable salads.
  

• Jello: exchange half of the water for orange juice. Not only does this give extra nutrients that count for part of the fruit group, but it tastes sweeter, too.

• Top fruit or jello with flavored yogurt instead of whipped topping (counts as milk, rather than just extra sugar).

• Pancakes: add an extra egg for more protein. If using a mix that calls for water, use ½ milk and ½ water.

• Mashed potatoes: use milk, sour cream or yogurt rather than just water or broth when mashing.

• Cook hot cereal with milk instead of just water.

• Add milk to coffee instead of non-dairy creamer.

• When making meatloaf, hamburgers, or meatballs: use oatmeal (the “one-minute” kind) instead of bread crumbs. (whole grain)

• Dessert: make a fruit and yogurt parfait by layering fresh fruit (which has been “marinated” in a little sugar for ½ - 1 hour) and vanilla yogurt. (Fruit ½ - 1 cup; yogurt = milk ½ - 1 cup)

• For a sandwich filling: add ½ cup of minced vegetables to tuna, diced meat or shredded cheddar cheese. It will make the sandwich more moist, easier to chew, and you don’t have to use much mayonnaise. Use pickles, olives, onions, cucumbers, lettuce, peppers, shredded carrot, celery, avocado, even pineapple.

• Offer fruit preserves (less sugar here is OK, but usually not necessary unless the elder is diabetic) and encourage liberal use for whole wheat toast at breakfast. (Fruit, up to ¼ cup for 2 slices of toast).

• Put gravies, sauces, cheese sauces on food. This will boost calories and make the food easier to chew and swallow as well. If you use cheddar cheese in the sauce it will also serve to get more dairy nutrients in, which are rich in protein and calcium.

The other problem with having to concentrate nutrients, is having to choose wisely when feeding someone who has a small appetite. It may be fun to have an ice cream cone at midday, but if this takes the place of a meal it probably isn’t worth it. If your elder likes a lot of sweets and goodies but then will not eat a meal; I would suggest having a “goody” day one day a week where one meal can be replaced with choice sweets. For most people it doesn’t hurt to have sensible desserts every day after dinner. You be the judge. Most people can get enough nutrients out of a 1600 calorie diet, and it won’t hurt them to have an extra 200 to 300 calories for dessert. You would need to use some judgment if your elder is diabetic and on a strict diet. In which case, check with your doctor about speaking with a nutritionist for a specific plan to allow some sweets into the elder’s diet. If the elder is not on a strict diet, then plan desserts made from wholesome food. Rather than cake, try fresh fruit with flavored yogurt. Low cal jello desserts with fruit and topped with low cal whipped cream, or vanilla yogurt. Even ice cream is better, since it has milk in it and not just sugar and flour.

Some elders I have cared for have had poor appetites for various reasons, mostly having to do with chronic diseases and prescription medications. One lady in particular used to make me laugh. She would always remind me not to make her meals too large. When I assured her I would try to keep the meal small, but that she needed to eat enough protein, she would smile at me and say "Oh, I know you'll sneak it in somehow." Sneaking it in was alot easier than arguing about it, which led to yet another Pleasant Day.
Here's wishing you and your Elder "Pleasant Days."

image above by serenejournal
www.flickr.com photos