Sundowning is a term meaning increased confusion, agitation, anxiety, restlessness, and/or aggressive behavior in the Alzheimer’s patient, usually starting at around dusk and lasting into the night. As many as 20% of AD patients experience Sundowning. This syndrome is a challenge for family caregivers and institutions. Approximately 6 in 10 people with AD will wander […]
Difficulty using the telephone can be an early sign of mild cognitive impairment or early Dementia.
Today’s telephones are more difficult to use than in days gone by as society is increasingly relying on technology for every day living whether using a coffee pot, a telephone or alarm clock.
Have you noticed these problems when your family member uses the phone?
- Misdials phone numbers they always knew from memory
- Misdials phone numbers even when referring to their address book or telephone book
- Will talk to people if the phone rings, but reluctant to place calls themselves
- Confused by special features such as voice mail, speed dial buttons, answering machine or Caller ID
- Tells you they can’t reach the doctor by phone because the office always seems to be closed
What can you do to help prevent isolation, inability to communicate and depression when the person with dementia can’t reliably make a phone or receive a phone call anymore? How will they stay connected to family and friends? You will need to choose a different kind of phone that uses photos or pictures to jog the memory. The mind remembers what a person looks like longer than it can remember a string of numbers or what the symbol of a red phone means. The photo memory phone is ideal for this need. You insert a small photograph of the person on their short call list, children, grandchildren, doctors, best friend for example. It may also be better to use a little younger photograph than the way the family member looks like now, as the mind seems to remember people that way longer. If you don’t have a photo of the doctor, you could just write the word doctor for example, but avoid using a medical symbol for a doctor.
If the family member with cognitive impairment or dementia is calling 911 and you don’t want them calling 911 without good reason, you can usually program the photo memory phone’s 911 emergency button to call another number, such as a family member. If the phone is going to be used in a nursing home or assisted living setting again, you can program the 911 button to call a particular family member or not to call anyone.
Memory photo phones can be superior to a regular phone with numbered buttons because the number buttons are all the same size and color, causing confusion. You will want to reduce the number of visual similarities as object perception is a problem for those with cognitive impairment. When looking to purchase a photo memory phone it is best to find a phone with the least buttons to help prevent confusion, and to only purchase a phone with the least number of features. It should be extremely simple. Then once you get the phone enroll the telephone number in the National Do Not Call List to help prevent fraudulent/scam calls as seniors/elderly are more prone to being scammed.
Typically when using a photo memory phone you would just pick up the handset and push the photo of the person you want to call – no numbers to remember, no memory buttons. The simpler the better.
Swallowing is simple, right? Take a drink and it goes down automatically, or so you think. But, it is actually a complex process that requires several levels of the central and peripheral
nervous system to cooperate. If a person has had a stroke, the throat may be affected and they only be able to take small sips without choking. When you eat or drink the substance goes down the esophagus to the stomach, if you swallow “wrong” it may go down the trachea into the lungs causing aspiration pneumonia, a dangerous situation.
Swallowing difficulties, also called Dysphagia may be caused by several medical conditions including stroke, Alzheimer’s Disease, Parkinson’s Disease, Cerebral Palsy, ALS and after chemotherapy. Research indicates that Dysphagia has been underestimated in neuromuscular disorders. Alzheimer’s patients may ultimately develop swallowing difficulties, and may even forget to swallow. Some Alzheimer’s patients have been known to hold the fluid in their mouths because they have forgotten that they need to swallow. In this instance, it is suggested by some authorities that the Alzheimer’s patient should be told to swallow after taking a sip and needs to be monitored carefully by the caregiver. Dysphagia is common after a stroke, it occurs in up to 65 percent of stroke victims. Normally when a person feels something going down “the wrong way” they will have a very strong coughing spell, but stroke victims often lose this feeling and ability to cough. Thin liquids can be very difficult for the stroke victim with Dysphagia as thin liquids move quickly through the mouth, and there isn’t enough time to allow the sequence of events of the voice box to lift, close and then to move forward to protect the individual’s airway, making it difficult to swallow safely. The above medical conditions may necessitate the need for special drinking aids and feeding aids for Dysphagia, or even feeding tubes.
It is estimated by researchers that up to 52 percent of Parkinson’s patients eventually end up with some amount of Dysphagia, resulting in aspiration pneumonia, dehydration or malnourishment. Motor swallowing exercises may help promote not only maintenance of the ability to swallow, but also improvement of the patient’s oral function in the independent elderly with Parkinson’s Disease. These swallowing exercises are specifically designed to increase the strength and the range of the patient’s mouth, larynx and pharyngeal structures.
Always consult your doctor when swallowing problem present themselves. There are also swallowing exercises and swallowing techniques that are available that may help with some swallowing problems. Always ask your doctor before starting any swallowing exercises or swallowing techniques. Ask your specialist about drinking at a 45 degree angle (reclining sitting posture) rather than the customary 90 degree angle – some research suggests it may be beneficial, depending on the swallowing diagnosis. You may want to learn more about finding a swallowing specialist at the Swallowing Disorder Foundation: http://www.swallowingdisorderfoundation.com/finding-the-right-swallowing-specialist/ and also at The Stroke Association http://www.strokeassociation.org/STROKEORG/LifeAfterStroke/RegainingIndependence/PhysicalChallenges/Difficulty-Swallowing-After-Stroke_UCM_310084_Article.jsp
Ask your doctor about Dysphagia drinking aid cups when there is the danger of aspiration pneumonia or choking when drinking thin liquids. There are cups that give out a measurement of 5cc (1 teaspoon) or 10cc (2 teaspoons) of thin fluid with each drinking motion and are angled to allow proper chin position. These special needs drinking aids may allow the patient more independence, better hydration and nutrition. The doctor should be able to tell you if these would be right for the medical condition under discussion.
Dysphagia Cups are available at: http://www.modernseniorproducts.com/drinking-aids-s/16296.htm
This article is not meant as medical advice, it is informational only. Always contact your physician before starting anything new when under a physician’s care.
The bedroom should be a place of sleep, peace and quiet. But, all too often, an elderly person will fall out of bed due to using too small of a bed, medical conditions such as movement disorders such as Parkinson’s or that cause agitation and restlessness such as Alzheimer’s Disease, medications that cause restless sleep and nightmares that may cause the individual to fall out of bed. (PHOTO: H.W of Arizona fell out of a full sized bed, causing a lot of bruising.)
My first suggestion is to be sure the bed is large enough. Back in the day, 30 to 40 years ago, the full size or standard size bed was the customary size for couples, however, the full size bed gives each person about 27 inches of sleeping space, equivalent to sleeping on a baby crib mattress. The full size bed measures 54” by 75”. The queen size, the next step up, on the other hand, measures 60” by 80”. Today, most hotels use queen or king size beds for the comfort of their patrons.
If a person sleeps on a very small bed, or has medical conditions such as mentioned above, I recommend either purchasing a larger bed or buy small safety bed rails for adults. Many of these safety bed rails are also portable and may be used when visiting and staying at a relative’s or friend’s home, or when at a hotel.
Next, consider the emergency phone call at night. If the person is hearing impaired, they will remove the hearing aid when going to bed. When a call comes in, or they need to call 911 for example, they will be using the phone without the assistance of the hearing aid. In this case it is a good idea to have an easy to use and understand amplified phone next to the bed so they can hear medical personnel and follow necessary directions.
Motion sensitive night lights are very useful for the bathroom or near the bathroom door. This will help prevent tripping over anything on the floor. Also, a regular nightlight that you turn on and off can be useful for safely lighting the way to the bathroom.
If the individual has GURD, also known as Acid Reflux Disease, consider using either two pillows for sleep or purchase a special acid reflux pillow that raises the head sufficiently to help prevent GURD. Chronic Acid Reflux over a period of time can cause damage to the esophagus, making surgery sometimes necessary.
Make sure the bedspread or bed linens/blankets aren’t hanging onto the floor causing a trip hazard too. Inspect the area going to the bathroom, and to the bedroom door – make sure these areas are open enough to allow safe movement. If the person has a significant fall risk, consider safety hand rails on the walls.
Use a Wander Alarm or similar device to notify others in the home if the bedroom occupant has Alzheimer’s and tends to have Sundowning Syndrome, meaning they wander during the night, leaving the bedroom and causing a potential dangerous situation. The Wander Alarm emits an alarm if the person opens the door.
In the past, hearing aid wearers had interference problems when using digital cordless telephones. A cordless phone has a wireless handset that communicates with the base station by radio waves. The base is plugged into the telephone line jack and the phone is powered by an ac adapter. Many of the cordless phones are expandable, meaning they have additional handsets that will “talk” to the base unit and they can be placed around the home or office without needing a telephone jack. Even though the best quality sound still comes from a corded telephone, cordless phones have improved greatly and have proven convenient for many people.
Interference issues cropped up with the cordless digital phones, as they can cause interference with hearing aids – creating an audible buzz. The older type analog hearing aids are even more affected by cordless phones than the newer digital hearing aids.
The TIA-1083 is a newer telephone standard that was developed by the Telecommunications Industry Association (TIA) and Gallaudet University, Entymotic Research and Motorola to help solve the problem of the electromagnetic fields that are created by the handset that causes cordless phone interference with hearing aids. A telephone complies with TIA-1083 if it meets the requirements of the new standard. Meeting this standard means that hearing aid users will have significantly reduced interference when using their TIA Compliant cordless phone, making their conversations higher quality with less static or buzz. TIA-1083 Compliant is a higher standard for cordless phones than just being hearing aid compatible. This standard applies to cordless phones and is especially important when purchasing cordless phones for seniors, as many seniors wear hearing aids.
Bet you’ve never heard of Dupuytren’s contracture. You might think that curving finger you have is osteoarthritis, but it could be Dupuytren’s contracture. This condition is a type of fibromatosis that causes a shortening and thickening of the fibrous tissue in the hand. In this condition, a knot of tissue forms under the skin of the palm, then a taunt cord forms which pulls the finger toward the palm. This condition can come on gradually over many years and progress to the point where the finger is pulled back all the way to the palm, or its progress may be quick and then it can also stop. This condition is usually painless, with just some sensitivity with touch.
Dupuytren’s contracture can occur in both hands, but usually one hand is affected more than the other. Men are usually more affected then women. This condition can make daily activities more difficult. Putting on gloves, putting the hands in the pockets, or putting the hands into a purse to retrieve an item can be difficult and it can affect your ability to open your hand fully and to grasp large objects, it can also make writing and shaking hands awkward, and causes difficulty with face washing and combing the hair. Typing would also be difficult.
How do you know if you have Dupuytren’s contracture? Ask your doctor. Usually tests aren’t necessary, the doctor will probably have you put your palm on a table top and see if it can lay flat, if you can’t lay your palm flat you may have Dupuytren’s contracture. Often times you will see the thick knot of tissue under the skin of your palm, and the cord in the palm may actually protrude and be easily seen and may actually go up your affected finger, but this is in more severe cases. This cord tightens and pulls the finger down.
Some studies suggest that Dupuytren’s contracture may be associated with cigarette smoking, epilepsy, diabetes and genetics. If you have this condition, it is a good idea to stretch your fingers. Place your fingers on the edge of a table, placing your palm down, and then slowly lift the palm upward while keeping your fingers flat on the table. You will feel the stretch when done correctly. For an even better stretch, warm your hands first with a microwavable heat pack and massage your palms.
There are a number of options for treatment including needling, enzyme injections, surgery , INF gamma & shockwave therapy and radiotherapy.
For some reason we just don’t see grandma and grandpa using much alcohol, but the use of alcohol can actually increase in some elderly people because of isolation, loneliness or depression.
The elderly are quite often on a number of drugs, some of which don’t mix with alcohol. Also, some of the prescription drugs they are on are hard on the stomach and even over the counter NSAIDS taken for arthritis such as ibuprofen can cause stomach and intestinal bleeding. Alcohol can just irritate the stomach making the problem worse. Alcohol can affect drug absorption, impairs liver function and enhanced drug metabolism. Alcohol is metabolized and removed from the aging body differently. Elderly people on anti-depressants like Trofanil or Prothiaden can actually increase their depression when using alcohol. The elderly who are more likely to be on Coumadin (warfarin) to prevent clotting are also more affected by alcohol, as well as those taking anti-convulsants.
Besides the drug interactions, affecting digestion and the faster affect on the brain, alcohol can lead to falls and general confusion in the elderly. It might not be a bad idea to check the pantry when visiting your elderly mom or dad to see if there are bottles of alcohol. Depending on their health and condition a little can be ok, but you need to have a conversation on just how much they consume in ALL forms, including their Irish coffee.
If you go to doctor visits with your elderly parent make sure the doctor asks them about alcohol use. Usually the way doctors phrase the question, “do you use alcohol” makes some elderly folks think this refers to being an alcoholic and then of course deny much alcohol use. Many elderly people don’t view the whiskey in their cappuccino or that Long Island Ice Tea as alcohol use. I know of an instance of a lady in her mid eighties who was having stomach problems and after testing found out she had a bleeding stomach. Her doctor asked her about alcohol use and she said just an occasional glass of wine when out for dinner. She neglected to mention the whiskey in the cappuccinos she and her elderly husband were making almost every evening.
Also, alcohol use does not lend itself well to driving and the elderly. Older drinkers age 50 or more are more impaired by moderate alcohol consumption. As few as 2 drinks can slow the reaction rate of the older driver. Alcohol tolerance also drops off as we age and alcohol has a faster affect on the aging brain making driving more dangerous for the elderly person after consuming alcohol. The elderly should be encouraged to eat more and wait longer after consuming alcohol before driving.
Family caregivers may be a spouse taking care of their husband or wife, or adult children caring for their parent(s). Often times there is a debilitating illness such as Alzheimer’s Disease, dementia, disability due to stroke, cancer, multiple sclerosis, physical handicaps and many other conditions.
The family caregiver may feel overwhelmed at times due to physical and mental stress, sleep deprivation, depression and even physical injury may result such as back injury. The family caregiver needs to remember to take care of themselves too, for the sake of their own health and if they get sick, who will take care of their loved one. Aids for daily living can help save the caregiver time and protect their back, frequently allowing the individual with a medical condition to function more independently.
1. Take care of YOUR back. Transfers from bed or wheelchair can require lifting, giving the caregiver an aching back at the least, and the possibility of a back injury. Checkout transfer boards and gait belts for safer transfers
2. Sleep deprivation. This is a big one. If your loved one has Alzheimer’s Disease or dementia, there may be frequent night awakenings causing the caregiver to be sleep deprived. When sleep deprived you are harming your own health, also possibly causing you to be more irritable and even to be more likely to make mistakes with medications, or have an accident while driving a vehicle. Consider getting them out in the sunlight during the day, weather permitting, for a walk, or even just sitting on the porch or in the yard, this helps reset their Circadian clock and helps them feel more tired for a better night’s sleep, which will help you get a better night’s sleep.
3. Getting Ready for Bed. If getting your loved one ready for bed is difficult, then start earlier in the evening or even in the afternoon with the bathing and getting into the night clothes. This way you will be less tired and more able to handle difficult situations.
4. Assistive Clothing. If getting your family member dressed and undressed is difficult consider assistive clothing – this is clothing designed to be easy-on-easy-off.
5. Difficulty Getting To Sleep. Getting to sleep can be difficult if there hasn’t been much activity during the day or if an Alzheimer’s patient. Play a soothing and restful CD or tape of rain, ocean waves or a brook to help lull your loved one to sleep, or help quiet them if agitated.
6. Have a routine. This keeps the day running more smoothly and everyone knows what to expect
7. Ask family and friends for help. Ask if they could occasionally take over for night duty once in awhile, bring over a meal, take over for a couple of hours once in a while so you can run a personal errand or just come over for a visit to socialize and give you a mental break. Tell them, they probably don’t know what you need – don’t be afraid to ask.
8. Join a support group if only on-line. This way you will have people sharing their experiences as caregivers and you will have people who understand what you are going through.
9. Flu-Shots. Make sure both you and your loved one get a flu shot every fall – this will help prevent both you and them from a hospitalization. There is a new influenza shot called FluZone High Dose which is stronger and may be better for those 65+, ask your doctor.
10. Check out your local community organizations. Ask what kind of help is available locally. Also talk to a social worker – ask the doc to recommend one. See what help is available through your local senior center.
11. Take advantage of modern technology. There are inexpensive warning notification products available to let you know if your loved one with dementia has wandered into an unsecure area or left the house.
12. Feel more secure. If there is a risk of falling out of bed consider buying adult safety bed rails. Alzheimer’s and dementia patients may be at a higher risk. But, sometimes certain medications can cause “night terrors” which may cause them to fall out of bed also. Be sure there isn’t enough room for head entrapment, or too much space between the rail and bed that would allow body entrapment.
13. Control the Stress. If your loved one is hard of hearing and the tv is turned up really loud all day causing you or others in the household stress, consider getting your loved one a hearing aid, or at least a tv amplifying system with headphones that allows them to hear the tv at the volume they need, yet keeps the rest of the house or apartment quiet.
14. Medications. If there are a lot of prescribed medications, consider wearing an alarm watch or other reminder system that gives an alarm sound or vibrates to give you the reminders you need. There are also pill containers that lock and have reminder alarms, or just set an alarm clock for the time of the next medication dose.
15. Make it easy on yourself. If your loved one has early Alzheimer’s Disease, Dementia or just memory issues due to age and has trouble with the television such as changing the channel, or volume control and requires your assistance frequently during the day, consider tv remotes designed specifically to be senior friendly and very easy to use. Two very easy brands are Flipper and Doro 321rc. There are probably other brands available if you look. This may keep you from having to manage the tv frequently during the day, saving you time and frustration.
There are big differences between Original Medicare, Medicare Advantage Plans and Medicare Supplements Plans (Medigap) First of all, the Federal Government provides the coverage in Original Medicare (Parts A & B). Medicare Advantage (Part C) coverage is provided by private insurance companies, and Medicare supplements (Medigap) coverage is provided by private insurance companies.
The way they are funded is also different, Original Medicare (Parts A & B) is funded by payroll taxes. Medicare Advantage (Part C) receives “a fixed amount per enrollee per month from Medicare” plus the beneficiary’s Part B premium. It is also allowed to charge a premium to the member. In Medicare Supplement Plans (Medigap) the premiums are paid by the policy holder.
It is also VERY IMPORTANT to know that your coverage is GUARANTEED, and can’t be cancelled with Original Medicare through the Federal Government. However, you should know that your policy can be cancelled under Medicare Advantage which is provided by private insurance companies. Medicare Supplement Plans (Medigap) can’t be cancelled unless you don’t pay your premiums on time or you misrepresented something on your application.
It is also important to note that Original Medicare does NOT require pre-certification. But, Medicare Advantage (Part C) generally does require pre-certification. Also, Medicare Supplement Plans (Medigap) does not require pre-certification.
NOTE: Modern Senior Products does not recommend any Medicare plan. This information is only for your information. Be sure to learn about all three kinds, Original Medicare, Medicare Advantage, and Medicare Supplement (Medigap) to see which is best for you. Remember, you can start signing up for Medicare 3 months before your 65th birthday.
You’ve probably heard of traveler’s diarrhea and wonder why this is the bane of traveler’s who venture out of the U.S. There is a bacteria called E. coli which is the usual suspect in water or food contamination outside of the U.S. There are also other parasites, bacteria and viruses that can cause this too. Here are tips to prevent traveler’s diarrhea.
- Its best not to buy food from street vendors in other countries, you don’t know how the food has been handled or if any sanitation measures were used at all
- Make sure the seafood or meat is fully cooked – never eat it raw. Be especially careful not to eat undercooked pork – you can get a parasite from this too
- Don’t eat raw fruits or vegetables unless you peel them yourself – they could have been rinsed in contaminated water too, or unapproved farming chemicals
- Stay away from tap water, ice and non pasteurized dairy products
- Avoid farmer’s markets and small restaurants
- You will be the safest if you drink bottled beverages, hot tea or coffee, beer and wine. If you must drink the water make sure it is boiled or treated with iodine or chlorine
- Never brush your teeth with the tap water, use bottled water
- When taking a shower avoid getting water in your mouth
- Carry a hand sanitizer with you and use after using public restrooms and before meals
Can you take a preventive medication? Yes, ask your doctor about taking Pepto-Bismal or Kaopectate to prevent traveler’s diarrhea. He will need to tell you the correct dosage and how long to take it and if it would be appropriate for you. Also, these medications can cause your tongue to be coated with a black substance – it won’t hurt you.