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!

New "Links" section Added

Just wanted to let you all know that I have added a new section for your assistance. Occasionally I run across news articles that are pertinent, helpful, informative, etc. When I do, I will post a link under "Links to Helpful, Informative, Interesting Articles."

Happy New Year to all:
May all of you and your Elders have Pleasant Days throughout the New Year.

We're Right in the Middle of Flu Season

(Side note: Sorry, I've been away, getting everybody ready for Christmas).

Winter is not my favorite season. Even here on the bay, where the sun shines most of the time, it still gets cold and damp during a few months in winter. It does, however, make for spectacular sunsets and sunrises.

Here we are, having a wonderful Holiday Season, Christmas being the most important time for many people, especially our Elders, and now we are suddenly struck with the threat of severe illness. It happens every year.

Flu season for our Elders can be a life threatening time. This is serious stuff. Many Elders, especially those who are very old, and those with chronic illnesses are especially vulnerable. Illness can come on even when others in the household appear well. Influenza by itself is not usually life-threatening if you are healthy, but it can cause a series of problems that the Elder can not handle physically.

First, the FDA has a wonderful article called "Get Set for Winter Illness Season". So, I will not state again what is already in the article. If you are a caregiver for an Elder, please read this article and follow the advise. It will keep you and yours well.
But, I would like to remind everyone of the special concerns for the Elders.

Many Elders have poorly functioning immune systems, whether caused by chronic illness, physical deterioration, poor nutrition, or the types of medications that have to be taken. This puts them at higher risk than anyone, even around people who "appear" to be well.

Many cold medicines sold over the counter are laden with drugs that many Elders should not take because of chronic illness, or because of possible interactions with prescription medicines. There have been several articles about this problem. Here is one of them, called "A Prescription for Problems".

Many Elders are particularly prone to respiratory complications when suffering from viruses like a cold or influenza. This puts them at risk of life-threatening pneumonia, worsening heart conditions, and long hospitalizations.

Along with all the other physical problems Elders may have, there is often a problem with nutritional and fluid intake. This can become worse when your Elder is sick and not willing to eat or drink, quickly becoming a serious dehydration, malnutrition problem. Now you have a virus, dehydration, and more strain on all body systems. It's a downward cycle that soon requires hospitalization to correct.

Then there are all the other complications that come along with poor nutrition, poor hydration, respiratory viruses, and the resulting bedrest and/or hospitalization: like loss of the ability to walk, incontinence, weight loss, skin breakdown, and acute confusion. Your Elder ends up having to go to a nursing home after a lengthy hospitalization, and now we all have very unpleasant days.

So, a little prevention can go a long way. Check out the articles above, and arm yourself with the information you need.

Wishing your Elder and you many Pleasant Days during the Holiday and Winter Season.

Wishing You and Your Elder a Pleasant Christmas Season

The season is upon us once more. And for many of our Elders, it comes with many memories, and a few problems.

Many of you that care for Elders realize by now that most memories our Elders have of past holiday seasons are good but may be painful. Memories of cherished family members that have passed on; the 'good old days' and traditions of Christmas and the holiday season that have passed on with a world that no longer exists for them outside of their memories; many have lost spouses along the way; some have lost children. These memories can be bittersweet. And invariably, these memories seem the strongest around the holiday season.

Some of us would prefer 'not to go there' when it comes to painful memories. But often, it really is much better to just go with it. Dig out the old family photo albums, the old Christmas cards, and if you don't have any of these, just talk about those 'good old days'.
It doesn't matter how many times you have already heard it -- hear it again. Talking about lost loved ones and the cherished old traditions is healing, therapeutic, and can be uplifting. Encourage your Elder to remember as much as s/he can. Try to emphasize the good stuff, but be sure to validate the bad stuff, too. In this way, you can acknowledge and validate your Elder and her/his past life. Let her/him know how you feel, and that you understand how important these people and these times were (are) to her/him, and that they are important to you as well because (even though you may not have been there) it is all part of you and your heritage.

Realize that very old Elders will often have far clearer memories of the long past, back to their childhood. They will surely have memories of your childhood, but the people of their own childhood are often all gone and the ones causing the 'bitter' part of the memories, because it all happened 50, 60, 70+ years ago (you know: long, long ago in a galaxy far, far away). This is where the saying "you can never go home again" likely came from. So, you want to try and help your Elder 'go home again' at least in her/his memory.

On to other concerns:

It's winter time. In most places it's cold, and if it's not snowing where you are, it's at least colder than the rest of the year.

Keep in mind that your Elder is probably very 'cold-blooded'. Keep your Elder cozy by adding extra soft underclothing, layers of clothing, thick socks, even a soft knit scarf around your neck can keep you much warmer than you would think. (Yeah, you people that live in snow country know about that. I'm a California native; wearing scarves when it's cold is probably the best lesson I learned from living 3 winters in Maine about 14 years ago.) Anyway, you get the point. Lots of soft fluffy clothing will keep the chill off for your Elder, and hopefully you won't have to sit outside on the porch because it's too hot in the house.

You do want to keep the house at around 70 - 75 degrees. I know this may be a problem if you are living in the same house. Most of us baby boomers (I'm talking mostly women here) are in that part of our lives when hormones don't know what to do anymore, and we are hot and flashing most of the time. Me, I like 60 degrees, 55 is just fine. But the Elders I care for can't do that. This is serious stuff. Your Elder may still feel cold at 70 - 75 degrees, but at least s/he won't get hypothermic. It takes energy to stay warm, and being too cold all the time will cause stress that your Elder can't handle, resulting in more illness, worsening of chronic ailments, behavior problems, trouble sleeping, inability to eat, more pain from arthritic problems.... All kinds of things you do not want to deal with, and will surely cause 'unpleasantness'. If you try to heat the house higher than 75 degrees, you may be drying out the air too much, which will cause problems of it's own.

Dry skin is a major problem with most Elders. And wintertime is worse. Make sure to use an extra moisturizing body wash for bathing and showers. Then add an extra moisturizing lotion right out of the bath or shower when the skin is still warm and damp.

Dry eyes is more common than people realize. Dry eyes can cause itching, burning, redness, and eye discharges that are bothersome. Over-the-counter eye drops to moisturize the eyes are inexpensive and well worth the effort. Make sure the drops are for moisture only.

Remember to keep your Elder hydrated. Cold weather tends to make people, especially Elders, drink less. Try hot tea, there are many nice herbal teas to choose from, and will also serve to warm up your Elder. If your Elder likes black or green tea, don't be afraid of the caffeine (unless the Elder's doctor says no caffeine). It can be good to help stimulate circulation and brain activity.

Many family members and friends may call you to ask what to give your Elder for Christmas. This is usually hard for most people to figure out. Remember that Elders grew up with a Christmas that was much different from our own. It wasn't commercialized yet. And giving during the season was heartfelt and out of a loving spirit. Very unlike the now commercialized season where we must get something for everyone in our life.... and it must cost enough to be considered a good gift.... and the name of the game is SALES for the market place.... and we all have to go out and spend to save our country's economy.

Anyway, the best gifts for most Elders are

• wearables that provide comfort (soft clothing, robes, lap blankets, small pillow, poofy slippers, soft warm scarves); Fleece clothing is great and there are so many different products made from fleece--pj's, t-shirts, slippers, jackets, blankets, you name it.
  
• goodies to eat (fancy little soft candies, cookies, cakes); homemade or not.
  
• pictures of family (enlarge a nice photo and frame it; enlarge a photo from long ago of loved ones and frame it; a small photo album with favorite photos enlarged; even a scrapbook type thing with family and comments.
• scented lotions
• large print books (predominately pictures for those who don't read).
• magazine subscriptions: some good ones are Reader's Digest (large print version), National Geographic, Reminisce Magazine, Good Old Days Magazine, American Heritage Magazine, America in WWII Magazine, and many many others to choose from (just put 'magazine subscriptions' into your search engine to find several sites that sell discounted subscriptions).
• DVDs of old favorite movies or TV series
• Flowers
• Music favored by your Elder (CD's, satellite radio subscriptions, you could even download favorites to an iPod)
• Sound amplifier with headset (for those Elders that don't wear hearing aids but have trouble hearing the television, radio, sermons at church, birds singing outside, whatever)
• accessories for wheelchairs or walkers: there are special bags and totes that fit onto the w/c or walker; there are special cushions for more comfortable seating in a w/c.
• I could go on and on...so here's a site with more gift ideas for the elderly, just click. There are plenty more like it.
• Here's another site with some good ideas for gifts at SeniorStore.com
  

So, I once again have gone on and on long enough. Just wanted to give some ideas about wintertime and Elders in the hopes that you and your Elder will continue to have Pleasant Days.

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.