National Healthcare Decisions Day

It's only fitting yesterday was Tax Day and today we need to talk about Dying. The only two guarantees in life: Death and Taxes. National Healthcare Decisions Day is hugely important to each of us not only for our own decisions but for our friends and family as well.

I recently participated in a Blog Carnival on my nursing blog about End-Of-Life Decisions. It's a wonderful conglomeration of experiences from a variety of nurses and from many different points of view. You might be well served to check these out as it's obvious even nurses struggle with discussing death and dying. My blog post talks to the point that these decisions empower us. 

As nurses, we've seen it from many points of view as the loved ones, the friends, and from the healthcare professional vantage point. We've seen our own families and friends struggle to make heart wrenching decisions when their loved ones did not tell them their wishes, and had to support others deal with the decisions their loved ones did make that don't always make sense in the moment.

As nurses we've also seen families fight amongst themselves over which way to proceed once it becomes clear the person isn't going to recover from the event or illness. One thing comes through loud and clear is that when the patient has not made decisions and has not discussed wishes even on a very hypothetical basis, it's even harder to have to make decisions for them. And when no one person or persons is made the DPOAHC (durable power of attorney for health care), families can completely destruct over who's making the decision and why? All this at a time when they need the love and support of each other.

Caution: Graphic Explanation Follows
A common conversation among nurses is often, "where shall I tattoo NO CPR? On my forehead or my chest?" Let's get some facts straight. Resuscitation is painful both physically and emotionally!! And the pain can last for a very long time and hinder any possible recovery. Ribs can easily be broken and organs punctured which complicate the process. Even without that possibility, it's painful to have a 200+ pound paramedic pouncing on your chest for any length of time! Using paddles to shock the body sends a painful electrical shock wave through your whole body.

And there are risks depending on how long the patient has been "down" prior to the CPR as well as the effectiveness of the CPR to circulate blood and oxygen to the brain and vital organs. What will the outcome be if the patient is brought back? Will there be tubes needed? A ventilator to support breathing? What extent of brain damage has been done? Has the heart suffered major damage? How will all of this affect the quality of life? Will there be anger or regrets?

What if I Want Everything Done?
YES, you and your loved ones have every right to demand that everything possible be done under any circumstances. And those decisions have to be honored as much as any other end-of-life decision. They can be faith based, fear based, ignorance based as well as based on your own desire to live forever. But they need to be made known to your loved ones and healthcare team as much as any other take on the subject to ensure they are followed.

On the other hand, if you do NOT wish to have heroic measures taken, you have the right to have those wishes followed as well. Advance Directives can be made as specific and complex as you desire. Or they can be vague and give your proxy to your an agent of your choosing to make the best decision based on the situation at hand.

These decisions need to be made and discussed with your loved ones LONG BEFORE there is a need to implement them. This is not just for those who are old or are in poor health. If you got hit by a bus crossing the street and complications set in, what path do you want your health care team to take?  And is your family prepared to comply with your wishes? Have that discussion with your loved ones Today. Make informed choices. There are NO right or wrong answers, but the questions and options need to be discussed.


Further Reading:
Today's the Day to Talk About How You Want to Die
Advanced Care Planning Resources
End of Life: Helping with Comfort and Care

TRAYBL the Perfect Addition to Your Wheelchair or Walker

Have you ever wished you could have just a little pace to put things on your walker or wheelchair so they don't have to be in your lap and falling off all the time?

Well a nurse I know (through Facebook) has invented and patented a fabulous idea called the TRAYBL. It has multiple uses from medical equipment to outdoor furniture.

I have one of those handy baskets attached to my mom's walker, but there have been so many times I wished we had a surface to set things down on that wasn't the bottom of that basket. This item will be ideal!

Check out the Facebook page and purchase from the website: From Damron-Harrell Technologies, LLC.

Wondering If There's an Alzheimer's Epidemic?

We hear so much about Alzheimer's disease and dementia these days, could it be an epidemic or just information overload? Here's a great graphic with facts you may need to know.

Embedded from Bluebird Care

http://bluebirdcare.ie/2015/01/07/is-there-an-alzheimers-epidemic/

Is the TV Always Loud Enough to Hear a Block Away?

One of the more difficult issues in caring for aging loved ones is the loss of hearing. Vision usually declines earlier with a need for bifocals in the 40' or 50's, but hearing can be Ok much longer without noticeable decline. At some point you will begin to notice the TV gets louder and louder. You insist you can hear it a block away! You may also notice that your loved one seems to ignore you when you speak. If you point it out, they accuse you of being mistaken or of speaking so that NO ONE can hear you. "You mumble!!"

Googleimages.com

Stigma of Hearing Loss
Denial is a huge hurdle to face in dealing with the loss of hearing. Being hard of hearing or deaf still carries a huge stigma for much of this aging generation. And if they do admit it, they dig their heals in about any sort of assistive device such as hearing aids. They just want you to speak louder and turn up the TV!

When you can't hear yourself think for all the noise in the house, it's very frustrating and yet probably too late to make much difference.

Get Hearing Tested Early
If you can get them to an audiologist to test the hearing and even give in to buying hearing aids it may be too late for them to actually work very well. But the sales person won't tell you that. In fact they will keep selling them more expensive yet more sensitive models to try to improve what little "hearing" there is. For some people this will work, but for some it's just another frustration and a device that will be found in a drawer and not in the ears.

These sophisticated devices are very sensitive to moisture and any amount of wax in the ears. Tiny holes quickly become clogged and render the devices useless until they are cleaned. And to do so requires tiny, nimble fingers and a few tiny tools. Not something your average aging loved one can do themselves.

To have the best outcomes, the object is to get the hearing tested early on and make decisions before the brain has time to lose much of it's ability to distinguish and understand sounds. As the hearing declines, the brain compensates by trying to distinguish sounds, but actually begins to lose the ability to recognize certain sounds as words. It just becomes a jumbled group of sounds and syllables that make no sense. Amplifying these jumbled sounds with expensive hearing aids doesn't help the brain recognize words it has long sense forgotten the sound of. It's imperative to do something at the first signs if you want to have the best options.

Don't SHOUT!
When someone can't hear us, our first instinct is to SHOUT, but just as turning the TV up louder and louder, it really doesn't help. All we do again is amplify the jumbled sounds. It is far more effective to reduce any extraneous noise and speak slightly louder, facing the person directly. Enunciate clearly and speak SLOWLY; giving the person time to try to read your lips, and time for the brain to compute the sounds into words.

Change the Pitch
With the TV, if you have the capability of adjusting the treble and bass with internal or external speakers, you may be able to significantly lower the decibel level. Again it's not about hearing the sound so much as being able to distinguish the words. This can be especially helpful when your loved one's favorite TV shows include Downton Abbey, Doc Martin and Call the Midwife. The British repertoire on PBS seem to be some of the worst at mumbling in that tone of voice that sadly cannot be easily distinguished. Raising or lowering the pitch may help this process. You can do this with your own voice as well. Either by speaking in a higher pitch, but not quite Minnie Mouse. Or tuck your chin, take a deep breath and speak in a lower tone. Another possibility is to turn on the Closed Captioning to help them find some of the words to follow the plot without blasting the sound.

Acoustics for hearing speech are improved when there are rugs in the room, padded furniture, and no other conversations or background noises to interfere. Try sitting in a high backed booth in a quiet restaurant. Suddenly your loved one thinks the sound has been turned on! But choose a large noisy place and all they can hear is a conversation 2 tables over and nothing from the person shouting directly in to their hearing aid.

Written Communication Works!
When all else fails, be sure to have pads of paper handy, or a white board or chalk board. They can still read. And unless dementia has also set in, they should be able to carry on a conversation and perhaps even begin to recognize the spoken words because they stop trying so hard! Use your smart phone apps if you have none of these handy. Stock the house in as many rooms as possible and see if this can help reduce some of the anxiety!

Growing old sucks, but the alternative????? Adaptation is required!

Here's some interesting facts about hearing aids.

Happy New Year 2015

As this year comes to a close, we often reflect back and make resolutions for the new year. Being the caregiver in a sandwich generation will probably be one of the hardest roles you will encounter in a lifetime. Take a deep breath and keep going! Remember to take time for YOU!

Make new memories with loved ones and set in motion plans for your own future to make the burden on your children less as you age. Take time to smell the roses every day and enjoy life. Remember this is not a dress rehearsal; it's the real deal. Enjoy. Happy 2015!

Never Forget

In September, 2004 we visited NY and I shot this picture. There was nothing quite so sobering as standing at Ground Zero and surveying the damage and feeling the impact this heinous act has imposed on all of us for a lifetime.

Never Forget.

Need to Have a Realistic Discussion About the Consequences of Falling?

Dealing with an elderly parent or other loved one is a challenge to say the least.  Sometimes it seems like you're dealing with a toddler or small child with an old soul. They want to do things they can no longer safely do and they can get cantankerous and downright obstinate. It's like dealing with a teenager who thinks he is invincible. They want to remain independent and are argumentative about almost everything! It can be most frustrating to deal with.

Safety is one huge issue as balance and gait changes begin to set in with the normal aging process. Chronic diseases such as arthritis, and Parkinson's can complicate the situation because they severely limit joint mobility and cause the gait to shuffle and scissor almost uncontrollably. Dizziness and vertigo play havoc when trying to ambulate and not feel like you're drunk or impaired.

The Fear of Falling

Google Images

A fear of falling can cause a person to tense and to make sudden sharp movements as they gain seconds of confidence. Ask your loved one if s/he is afraid of falling and the answer is likely YES! Yet where is that assistive device? The walker is probably back in the bedroom. The cane is next to the door so s/he might remember to take it if s/he ventures outside. And the lifeline device? Oh it's hanging on the lampshade or a doorknob.

Falling is the leading cause of death due to injury among seniors. This is due to complications such as head injury, fractures and immobility related pneumonia. Sometimes if your loved one falls and can't get up it could be considerable time before anyone discovers they are down. This can lead to all sorts of complications such as muscle breakdown that begin in 30-60 minutes, dehydration and hypothermia which can be life threatening or even fatal.

Fifty Percent of Seniors Will Fall Annually
So how do you get this proud, determined, elderly person to actually USE their assistive device and keep that lifeline around their neck?!!  By age 80, 50% of seniors will fall at least once a year. One fall can be too many.  Once a person falls they are more likely to fall again.

Sometimes you have to use the same type of reality scare tactics they used on you when you were that invincible young person. It's also important to remember your job is not to become the parent although it seems like that's what is happening. This makes your job incredibly more difficult and challenging!

These elderly loved ones, no matter how childlike they become, are still our parents, aunts, uncles, grand parents and friends. We need to be respectful while guiding them in the direction of making safe and sane decisions on their own if they are capable of doing so. Alzheimer's and other dementia can take this option off the table quickly.

Discuss Care Options if They Do Fall
But as long as your elder is capable of making decisions, try to have a hypothetical or logical and harshly realistic discussion about what they would want done in case they were injured in a fall. Do they really want to do something to jeopardize their current lifestyle? A typical fall for an elderly person doesn't just result in a skinned knee or bruises. All too often these falls result in broken bones (hips, wrists, shoulders), major skin tears requiring sutures, or head injury.

Would they want surgery to repair a broken hip, wrist, or other joint? Or would they prefer to spend weeks in bed hoping for the fracture to heal so they could eventually be pivoted to a chair or commode for a few hours each day? Would they want to be intubated if they ended up with a very bad case of pneumonia and couldn't breathe?

What if they hit their head and ended up with a brain injury? Would they want to have a feeding tube inserted and possibly need to be sustained on life support devices?

How would they feel about a long rehabilitation process? With a broken wrist for instance they will probably find themselves in need of assistance to dress, bathe, eat and even wipe their own bottom for several weeks! Who would they like to have helping them?

In the course of this conversation, you'll hopefully plant the seed to help them take stock in their own safety and actually use the devices, but you'll also gain some insight into their feelings about general end-of-life desires. It might just open the door to having that conversation soon too.

What Would Help Make the Device More Effective?
Meanwhile, help them to decide which devices they will use. Perhaps a cane needs some sprucing up or decoration to fit their lighthearted personality. Or the walker needs to be outfitted with a basket or tray so they can carry their clothes to the bathroom or bring their coffee cup and cereal bowl to the easy chair.

The device may not feel like it's the right height or doesn't give them the same feeling of stability that hugging the walls or furniture does. Perhaps it's too heavy, or feels flimsy. Maybe they need something different. Sometimes there's a completely logical explanation for leaving the device behind.And sometimes it's just a change they need to vent about and begin to accept.

Be gentle, be kind and be supportive. Change is NEVER easy. And growing old is not fun! But this is for their own good, and your piece of mind. Ahh you are giving them back all the same reasons they gave you growing up for worrying about your safety. Life is a circle and someday you'll be having these conversations with your adult children over your care and safety.  Start making plans to decorate your cane now!

When the Best Plans Fall Apart....

We plan and we think we are ready for anything and then life happens…. Even with the best laid plans, expect that you are going to be knocked for a loop and totally discombobulated, if only for a little while.

In my observances and my experience, the best possible scenario for caring for aging parents doesn't always just happen. How many times I've heard, "Mom's the one in bad health and she'll die first….." And how many times it just doesn't happen that way.

Dad is a very young 80 and perfectly healthy as well as a good caregiver to Mom, but he needs a little assistance to make things easier. So you hire someone to help with Mom's personal care and a little housekeeping. Things should be OK for a while. Then suddenly Dad has a fatal heart attack and everything is turned upside down.

Mom has lived alone for 20 years and then she had to stop driving. She almost hit someone in her shared driveway and she surrendered the keys. Your friends are envious because it was so easy. You work out ways to assist her and help her stay in her own home. Then suddenly Mom has a small stroke and can no longer live alone. She has no savings. Her income is fixed and low. Her house has a reverse mortgage and the equity was eaten up long ago. Now what?

Suddenly you need to make decisions on a dime that will become permanent and impact your own life more than you ever expected. You thought this was in the bag and you would know what to do when more care was necessary. But life took cruel turns and you aren't prepared for what has to happen.

SCREAM!!
It will be overwhelming. You will have anger and fear and confusion and be somewhat paralyzed in trying to find solutions. You will want your life back more than you can imagine! And you will find yourself wanting to SCREAM!

My best advice: SCREAM!! Find somewhere where you can do so without scaring a neighbor or summoning the police. A train track can be ideal when the freight train passes by. Or a deserted beach. If all fails, turn on the shower, raise the volume on the TV or stereo, smother yourself into your pillow, and let go!

You will feel better. And you may find that over the course of the next months and years you need to do this regularly. It will help to save your sanity and your marriage. Teach your spouse your tricks and tips.

Prioritize and Delegate
Then you make lists and determine what you can and must do right away and then how you will sort through and find ways to make things work. Enlist your siblings and children to help with necessary tasks. They may not be willing or able to provide any direct care but they CAN help with other tasks so that you can do what has to be done. Don't let them off the hook and stop trying to do it all. It isn't easier to do it yourself now. And your sister won't do things exactly as you would, but she can do it and you can relax a bit. Learn to give up control and delegate.

Learn to Take Care of You
Slowly your wits will come back and your brain will begin to function again. You will find a semblance of routine and settle in to a new life. It won't be the one you had, but it won't be as awful as you recently imagined, at least not every day. You will see new options and make new plans.

Most of all take time for YOU! Don't lose yourself completely. Hang on and climb away from that knot at the end of your rope. Say NO to caregiver fatigue. Reward yourself with a few minutes of "me time" and take advantage every chance you get.

Happy Holidays!

Wishing each of you a very happy holiday season as we close out the year. May the New year bring you renewed spirit and ways to accomplish new goals.

As caregivers remember to take time for YOU so that you can continue to be the caregiver. Reflect on how you have made a difference and know that things are better because you care. Noting is ever going to be perfect so don't become paralyzed trying to make it be.

Enjoy the beauty of all the decorations around us whether or not they are your culture. Warm glowing lights can help to lift all of our spirits. Take time to enjoy the aromas of the season. Close your eyes, breath them in and take a mini vacation.

Take time to make new memories with family and friends. Capture them on film, and in your mind. 

Set measurable and reasonable goals for the New Year and examine them often to be sure you are on path and reward your accomplishments along the way.

photo: http://www.flickr.com/photos/paulbrigham/

The Art and Struggles of Caregiving

Caregiving is an art, and it's not something any of us comes to naturally. Not even nurses. It's something we learn over the course of time and through a variety of classes or experiences. We bring to each patient or loved one our own set of standards, beliefs and abilities as well as a desire to help others. We have the best of intentions and hope for the best possible outcomes.

We struggle to hold on to our own identity and to provide the very best care we can under whatever the circumstances present to us. Caregiving is never easy, and often you must reap your own rewards of knowing you made a difference. We can come to this role once or many times in our lives as children, parents, other relative or health care professional. The basic rule is to give it your best shot and to do no harm to anyone.

I received an email quite some time ago from a young man who has cared for his wife who is now a cancer survivor. He blogs about his experiences and he his bluntly honest about his feelings, emotions and everyday occurrences. I share this with you because there is always something to learn from someone else's journey and struggles. I hope you can gain some insight and find some tips to help you survive your own journey with your aging parents and loved ones.

View the video about their journey: http://www.mesothelioma.com/heather/

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.

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).

from morguefile.com

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:
http://www.fda.gov/Drugs/ResourcesForYou/SpecialFeatures/ucm341437.htm

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.

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

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!

Sources:
http://consumer.healthday.com/Article.asp?AID=672663
http://www.cdc.gov/flu/

photo: http://www.sxc.hu/profile/cwcav