Thursday, July 11, 2013

Challenges of Aging in Place

"Aging in place" is a trend or buzz word phrase you may or may not have heard about. The basic idea is to allow older people to remain in their own home, community and environment and maintain as much independence as they safely can for as long as they can. It's not as simple as all that however.

As a member of the Baby Boom generation, I haven't yet hit 65, but I'm getting there. Perhaps not welcoming the fact, but kicking and screaming as I go along. Years back I had a discussion with a friend about considering moving to a single story home before the knees give out. And every day that I climb up and down those stairs I think about it more and more. Yes, it's good exercise, but some days it can be a very painful and unpleasant experience as well.

My mother has complained for years that we don't have a railing for our 2 front steps up to our porch. So we hold her hand and assist her up and down when she visits. But of late, I'm beginning to REALLY understand her concerns. When my knees want to act up, it's not so easy to get up and down those 2 short steps, and sometimes I don't feel all that safe anymore.

Another friend just remodeled her bathroom and her contractor talked her in to adding in some aging/safety considerations. She fought him on it at first and then conceded it would be economically sound to add them in now so that she can indeed age in place in her own home. SO she now has a beautiful walk in shower. Now it's not a gorgeous one like you see on HGTV, but it has all the amenities she can choose to use now and enjoy as she begins to need them way down the road.

Chances are good that when your home and the homes of your aging loved ones were built, there wasn't even a thought by the builder that an old person might live there someday. Picking up throw rugs and installing a hand-held shower device and a few well-placed grab bars may be relatively painless to do, but what about walk-in bathtubs and showers? Are your hallways and doorways wide enough to accommodate a 4-wheeled walker much less a scooter chair or wheel chair? Is there any place in your kitchen where you can sit and rest while preparing a meal or waiting for the microwave to finish heating? Can you rest anywhere while you move laundry from the washer to the dryer in short frequent steps? And on that subject, how far is it to the laundry area from where you hang and house your clothes? Energy conservation is a great tool to learn, but if you don't have the space to make it work well, it's not going to be an easy solution to shortness of breath, lack of energy and just plain feeling too old to do that today!

Even the housing in 55+ communities and assisted living facilities don't meet all of the challenges our aging populations presents today. They don't have the latest and best devices installed. They may not even have adequate ramps or elevators. As a result, some of these places are beginning to take a stance against aging in place. Many have always had specific guidelines as set by state laws, but now they are really enforcing them. For instance, residents have to be independent. They may be allowed to use a walker, but not the newer ones with the wheels and a seat that resemble a light weight wheelchair. These can be quite useful for those who can walk, but tire easily or who need to transport an oxygen tank with them. These are considerations you need to take into account if you're planning to move mom and dad. They may not be able to stay in that place the rest of their lives; opening up multiple challenges and scenarios you may not have ever considered as they age.

If for example, dad has a stroke and needs assistance with his activities of daily living you might have to place him somewhere else with a higher level of care. This leaves mom in one place and dad in another. The rent just doubled and now you have to get mom over to see dad on a regular basis. Transportation time and costs! Then if dad eventually needs hospice, the place you thought was excellent may not be able to let him stay there and you'll find yourself hunting for another place to move him.

Staying in their own home and having help may be the most economical factor of all, but some communities especially condominium and townhouse associations are balking at having people age in place in their communities. They don't want to deal with all of the changes needed such as ramps and railings that may degrade the property values if they stick out from the decor. Dealing with the annoyance of having emergency responders called at all hours of the day and night because dad slipped out of bed and needs assistance to get off the ground. Yes, this is age discrimination. But that's a whole issue unto itself. When you're faced with a situation where mom and dad need their situation handled right now, dealing with the politics of how wrong this is isn't a battle you can deal with and win in record time.

Be aware, and make informed decisions. Know that there will be obstacles even as you age as well. Take a deep breath and when your contractor suggests some aging in place modifications, be grateful you have the time and opportunity to be proactive.

Thursday, May 9, 2013

Grapefruit Interactions with Many Drugs Should NOT be Ignored

 “DO NOT TAKE WITH GRAPEFRUIT”  This or similar grapefruit warnings on medication labels can be a common sight, but how often are these warnings actually heeded? Are you or your aging parents at risk for not heeding the warnings? You can be at serious risk.

According to a recent article in the May issue of Nursing 2013, a recent study found that there are over 85 prescription and over -the-counter medications that interact with grapefruit. Of those, 43 can have serious adverse reactions such as GI (intestinal tract) bleeding, or can be toxic to the kidneys (nephrotoxocity).


Serious Consequences
Grapefruit interactions can also have serious cardiac affects such as torsades de pointes which is a type of ventricular tachcardia (very rapid heart rate) with dangerous potential for fatal consequences. Another potential interaction can result in rhabdomyolysis which is the rapid destruction of skeletal muscles.

Only a small amount of grapefruit is required to cause these interactions. Just 2 segments of a grapefruit or one cup of grapefruit juice is sufficient to cause effects. It is important to read the labels on foods and juices or sodas as they can contain grapefruit and should be avoided. Grapefruit is a healthy and nutritious fruit, but must be avoided by those taking medications that can interact.

Actions Altered by Grapefruit
Medication actions can be significantly altered by the grapefruit by increasing or decreasing the absorption of the medication or even delaying the action of the drugs.

One of the most common clasification of drugs that can interact with grapefruit is the statins which are cholesterol lowering drugs. Look for the warning label on these if you or your parents are on thses drugs. If in doubt, ask the pharmacist.

Some other common drugs that can be affected by grapefruit include oxycodone (i.e. Percocet, Oxycontin)  cyclosporin (immunosuppresant drugs used in Crohn's diseases or after organ transplant),  buspirone (Buspar),  nifedipine (Lisinopril), clopidogrel (Plavix) and fexofenadine (Allegra).

Anticancer agents, Erythromycin, Quinidine, and amyodorone (i.e. Nextarone or Cordarone) can have the tosades de pointes effect with potential fatal heart rate issues.

Always ask your pharmacist about food and drug interactions.  If possible, use one pharmacy so all of your medications and history can be overseen by a pharmacist. Be safe!

For further reading:

Friday, March 22, 2013

Keeping Your Aging Parents Healthy and Safe

Maintaining independence is legitimate goal for anyone, but for aging parents it takes on even greater importance. Independence means many things including privacy, dignity, and a long and productive life. A healthy lifestyle and safety are two important factors in maintaining that independence.

Prevention of chronic illness that can rob us all of our goal of independence in our older years is important. But when chronic illness is a factor, following medical advice and having regular check ups is essential. Understanding the illness, what medications, diet and activities will work best, how to avoid complications and what signs and symptoms need to be reported to your physician are key points to establish with your medical team.Helping your loved one set up a med box can be beneficial to ensure they take their medications as directed on a daily basis. Electronic medication delivery devices can ensure reminders and delivery of the exact amount if additional accuracy is needed.

Proper nutrition is one of the most important issues for older people. They don't often require the caloric intake of someone younger and more active. Sometimes 2 healthy meals a day can suffice, but they need to be nutritious. Small frequent meals and snacks can actually be better, but it all requires planning ahead and portioning out foods.

Grocery stores and especially big box stores sell in large portions. For instance, an older person is more likely to make 3-4 meals out a typical steak as it comes packaged from the grocery store. If they don't then divide that meat into portions and take care to store the portion they aren't eating today, they are not only likely to have food spoilage, but if they then consume the spoiling meat are susceptible to consequences such as nausea or diarrhea at the least.

Frugality Doesn't Always Pay Off
The elder generation today grew up during or shortly after the Great Depression and are less likely to throw something out that has spoiled. They will be frugal to a fault and ofetn suffer the consequences. Grocery shopping for your aging parent becomes more than just picking up a few items for them. Helping them to safely portion out the food and meal plan is important.

Frozen foods that can be easily microwaved are a great option when cooking is difficult, and leaving the stove on is a distinct possibility. However, be alert to the salt content especially if your loved one has heart or kidney issues, or is prone to some swelling in the lower extremities.

Read the labels. Some of these meals can also be high in sugar content. Often times manufacturers increase the sugar content particularly when the reduce the fat content. And watch the calorie counts. Grocery stores are packed with low calorie meals in the frozen food aisle. Your loved one may need more than 200 calories at a meal especially if they don't have additional food or snacks. Fresh fruits and vegetables in small portions make nutritious snacks.

Ensure, Boost, Instant Breakfast and other nutritious meal supplements help increase the calories and provide nutrients they may be otherwise missing. These tend to be sweet tasting and many people balk at drinking them. The contents can be poured into freezer safe containers and frozen for an ice cream-like snack. This is often more palatable.

Work with your loved ones to establish meal plans and help them package food safely so that they receive proper nutrition. It will go a long way in keeping them healthy, safe and living productive lives.

Thursday, February 28, 2013

Blog Post Nominated for Award

My blog post,  Important Terms Affecting End-of-Life Decisions, has been nominated for an award from Assisted Living Today as one of the Best Senior Finance and Legal Issues Articles for 2013.

You can vote (no registration required) for this article daily until March 7, 2013 . I greatly appreciate the honor and the recognition it brings to my work on this site.

Thanks to all.

Many Thanks-- We were named Runner UP
2013 ALTY Awards Runner Up

Monday, January 21, 2013

A Worse Than Average Flu Season

Health officials in the U.S. are now reporting that the flu is active in 48 states and they are calling this a "worse-than-average flu season;" especially for the elderly.

The very young and the elderly are often the most susceptible to complications from flu such as dehydration and pneumonia which can be fatal if not treated quickly.

Flu can quickly spread in assisted living settings, board and care homes and skilled nursing facilities. Often these facilities will quarantine their residents and limit outside visitors in an effort to stop the spread and allow the ill to recover.  Please observe the warnings and don't make a bad situation worse.

Flu vaccine is a must for the elderly, even those who live alone and rarely venture outside their home. Visitors can bring the virus in if they are ill or have been recently exposed. The germs can be passed along on surfaces of things such as newspapers, mail, and groceries. The virus can live on surfaces like doorknobs, counter tops, grocery carts, toilet handles, etc. Hand washing and wiping down surfaces can help contain the virus.

Hand washing is an absolute necessity!! Those visiting or caring for any older person need to be vaccinated and take precautions. Cough into your elbow. Toss tissues after a single use. Wear a mask in public. And wash your hands frequently!

The flu is a respiratory illness composed of any combination of sore throat, cough, runny nose, elevated temperature, chills and body aches. It will typically last 4-10 days.  Nausea, vomiting and diarrhea may also accompany these symptoms, but by themselves don't constitute true flu virus. There are several GI viruses active at this time as well.

There are antivirals such as Tamiflu available, but they must be started in the first 48 hours. Often people don't recognize they have the flu until much later and the antivirals will be ineffective. This year's strain seems to be resistant to the antivirals as well.

Contact your primary care provider or seek medical care at an urgent care or mini-clinics if your symptoms worsen, you're over 50, you have a compromised immune system, or have chronic diseases such as diabetes or heart disease. Try not to go to an Emergency Room for flu symptoms. It is far more costly and ER's need to be available for true emergencies. There are plenty of other options for care.

If you experience difficulty breathing, chest pain, a fever of 102 degrees F or more, or are unable to consume liquids, seek immediate medical care.

Plenty of liquids are essential to avoid dehydration and to improve flu symptoms by flushing your system. Fluids can take many forms such as popcycles, ice chips, soups, broths, Jell-o, electrolyte solutions like Gatorade or Pediasure. Even just frequent sips of cold or warm water will help hydrate. This is especially important in the presence of fever and chills when the body will perspire and lose fluids through the skin. Crackers and toast can help keep the tummy calm and able to tolerate medications.

Chicken soup is often one of the best tolerated foods for colds, sore throats and flu. It can be mild, or even spiced up with a little black or white pepper to aid in decongestant efforts. Hot or warm liquids may go down much easier for severe sore throats. If not, try icy liquids which may actually offer a numbing effect.

Tylenol (acetaminophne) or ibuprofen (Advil or Motrin)  in age appropriate doses, will help reduce fever and body aches. Many cough, cold and flu formulas available over the counter also contain acetaminophen or ibuprofen, so be sure to account for this dose and don't overdose. Tylenol should not exceed 3000mg per 24 hours! Some formulas contain alcohol and/or high levels of sugar which may not be good for some.  Read the labels or ask the pharmacist for assistance.

Cough medicines can cause nausea. Hot tea with honey and lemon may be more effective and easier on the stomach. Keep your mouth moist with sips of liquids and perhaps some hard candies to suck on. 

The cough may actually linger for about 3 weeks after other symptoms are gone. Be patient. However, if you start to feel better and then get worse again, seek immediate medical attention.

Rest and sleep are essential to recovery. Stay in bed. Don't venture out in public and expose others. Quarantine yourself from the rest of the household as well to minimize exposure.

Remember, prevention is the best medicine. Get a flu shot. Wash your hands frequently. Avoid crowds and anyone who is ill. Take care and stay well!



Monday, December 24, 2012

Happy Holidays!

Wishing each of you and your families and friends the very best and safe holidays!

photo © Kathy Quan

Monday, November 26, 2012

What is Caregiver Fatigue?

Those of us who are tasked with caring for aging parents and other loved ones can become overextended very quickly. Caring friends and family can even believe they are helping by "delegating" to us so that our loved one doesn't have to do it. All too often these well-meaning people wouldn't dream of stepping in and helping. And they have a long list of reasons why not such as not wanting to interfere or step on toes!!

See the bits of frustration and anger growing in that paragraph? No matter HOW much you love the person you're caring for, it can be come too much more often than you'd like to admit.

Caregiving is one of the most demanding roles ever invented. And when caregivers don't set some limits and replenish themselves, the task reaches "impossible" very quickly. They simply burn out and can't function in that role.

Learn to prioritize, organize and delegate what you can. The more you can control, the easier things will be. Schedule tasks and don't procrastinate the ones you don't like. That just adds to your stress. Ask for help before it becomes overwhelming and have a spouse, friend or other loved one with whom you can vent as often as needed to release these feelings.