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Showing posts with label SLC CNA. Show all posts
Showing posts with label SLC CNA. Show all posts
Wednesday, November 28, 2012
Improving the Odds
Fall 2008
Improving the Odds
By James P. Firman, EdD Aging Well Vol. 1 No. 4
In 2030, the youngest of today’s 78 million baby boomers in the United States will be 66 years old, and the oldest will be 85. I’ll be 79.
But what will the rest of our lives actually be like? Will we be healthy, active, enjoying life, and looking forward to living well into our 90s, if not to 100? Or will we be beset with multiple illnesses, need to fight the devastating effects of dementia or Alzheimer’s disease, and finish our lives in an institution?
Most of us don’t want to think about growing older. We are frightened by estimates that as many as 70% of baby boomers will need some form of long-term care. We feel helpless in terms of changing our own future. Like most people, we believe that whether our later years are good or bad is largely a matter of genes or luck, and there isn’t much we can do about it.
But nothing could be further from the truth.
Whether America’s largest generation experiences good or bad health in old age—individually and collectively—depends largely on what individuals do over the next 20 years to maintain good health and manage common chronic medical conditions that many either already have or eventually will need to deal with as they age.
The fact is that most baby boomers could probably double their chances of having a long and healthy old age if they would do the following:
• avoid smoking;
• exercise regularly (at least three times per week but preferably five) and lose weight, especially if they are obese;
• avoid falls;
• actively manage high blood pressure, diabetes, or other chronic conditions;
• practice yoga, tai chi, or other forms of meditation and gentle movement; and
• continue to access good medical care.
Just because these behaviors are simple doesn’t mean they are easy. And even if individuals faithfully follow all six of these practices, some will still get sick or need long-term care or die prematurely. However, if most baby boomers would practice these basic healthy behaviors, the generation’s collective health would improve dramatically by 2030.
The National Council on Aging (NCOA) has created evidence-based programs such as chronic care disease self-management, fall prevention, and physical activity best practices that help community-based organizations and those they serve to maintain or improve individuals’ health.
The NCOA also seeks to raise awareness of chronic diseases such as diabetes and hypertension that can lead to serious problems if older adults don’t take care of themselves. In addition, the NCOA offers help to vulnerable and disadvantaged elders to find and enroll in benefits programs that can assist them in better affording their medication or other healthcare needs.
The NCOA believes that emphasizing these types of services can forestall the need for long-term care and promote healthy aging for millions of Americans, including baby boomers.
The 19th-century French philosopher Auguste Comte wrote that “demography is destiny.” He was only partially right. The baby boomer generation will inevitably and inexorably grow old. But individual boomers can dramatically increase their own chances of enjoying a long and healthy old age if they practice these simple behaviors.
— James P. Firman, EdD, is president and CEO of the National Council on Aging. For more than 25 years, he has been a force for innovation in services and programs for older adults. He’s the founder and former CEO of the United Seniors Health Cooperative, a nonprofit consumer organization, and he previously served as a senior program officer at the Robert Wood Johnson Foundation, where he helped develop initiatives in aging and healthcare finance.
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What’s in a Name?
Spring 2010
What’s in a Name?
By Ira Rosofsky, PhD
Aging Well
Vol. 3 No. 2 P. 34
By Ira Rosofsky, PhD
Aging Well
Vol. 3 No. 2 P. 34
As a graduate student, I was with a group interviewing elder psychiatric patients at a state hospital when our advisor admonished us not to address any of them familiarly by their first names. “These people are old enough to be your grandparents or even your great-grandparents. So it’s Mrs. Smith. Never Sally,” he said.
We may have been the first people in ages to call a patient Mrs. Smith, not Sally, and that message of personal respect has stuck with me in the decades of professional practice since my student days.
In my work in eldercare settings, I have tried to stay true to my professor’s simple call for respect, even as I remain one of the few people in the life of a present-day Sally to address her as Mrs. Smith. I try to do this when I speak to the staff. “Where can I find Mrs. Smith? She’s not in her room,” even as the staff may respond, “Oh Sally, she’s in the rec room.”
If Mrs. Smith asks me to call her Sally, I’ll respect that request. For similar reasons, I speak only of residents, never patients. Hospitals have patients; nursing homes have residents.
More generally, respect means we should not slip into “elderspeak,” the old-age analog of baby talk. A resident is not a “sweetie,” “honey,” or “dear.”
Kristine Williams, RN, PhD, a gerontologist at the University of Kansas, and her colleagues looked at taped interactions in a skilled nursing facility between staff and residents with moderate dementia. Using a scale measuring resistance to care, Williams found greater resistance among residents when they were addressed with elderspeak and more compliance and cooperation when they were addressed with normal adult conversation.
Although the caregivers may think they are showing affection and nurturance, the residents hear condescension and infantilization. This is not a difficult problem to manage. Williams found that a brief education session—simply increasing staff awareness—reduces elderspeak and increases compliance and cooperation.
Williams’ work is just one example of the power of language and, specifically, naming in contexts other than nursing homes. In one study by Harari and colleagues, teachers read and graded essays by fictionally named students. For the same essay, if the essay’s author had a popular name (like David or Jennifer), it received higher grades than when it was supposedly written by an author with an unpopular name (like Boris or Bertha).
Other studies have concluded that attractive names are associated with academic achievement and even perceptions of personal attractiveness.
Patronizing, condescending, and infantilizing language is only one of the many factors affecting the personal dignity of nursing home residents. It’s important to keep elders’ dignity in the forefront of our thoughts.
Most of us have at least one door we can close to the world. Older adults in nursing homes have lost that door. They live their lives in public. When a resident closes his or her door, it’s often viewed with some suspicion. Sometimes it’s even a cause for a referral to me. “Mr. Jones is isolating himself. He closes his door and just sits there all day.”
So I go and have a chat with Mr. Jones. “It’s kind of noisy with the PA system going off all the time. It makes it difficult for me to catch up on my reading,” he says. If Mr. Jones were still independent, some might not approve of him sitting in his house all day reading, but I doubt it would prompt a psychiatric referral.
We must remember that a skilled nursing facility may be our place of employment but for the residents, it’s their home and we are their personal staff. If you put that spin on it, then we could think of them as rich folk who are complaining about how hard it is to find good help.
I joked to my wife that if I wind up in a nursing home, I too would finally be able to catch up on all my reading with nobody telling me to walk the dog or take out the garbage, to which she replied, “Since when did you walk the dog or take out the garbage?”
— Ira Rosofsky, PhD, is a psychologist who works in nursing homes and assisted living centers. He is the author of Nasty, Brutish, and Long: Adventures in Old Age and the World of Eldercare, a narrative of his professional life and the personal caregiving he provided for his own elder parents.
What Is Old Age For?
january/February 2009
What Is Old Age For?
By William H. Thomas, MD
Aging Well
Vol. 2 No. 1
By William H. Thomas, MD
Aging Well
Vol. 2 No. 1
When we are young, we look forward to leaving adolescence and entering into adulthood. The tempting fruit of adult freedom has led many teenagers to wish away the years until they can be independent. There is no similar rush to enter old age, as it is punctuated by death, not the signing of a lease for one’s first apartment. Put old age and youth on a ballot and the former will lose in a landslide of historic proportions. People want to be young.
The vigorous pursuit of youthfulness includes a healthy diet, physical exercise, and an optimistic attitude. People who are attentive to such things age more gracefully than those who pay little heed to the legitimate needs of body and mind. The development of age-related diseases and disabilities can and should be delayed, but aging itself will not be denied. It may come sooner or it may come later—but it will come.
Human strength, vitality, and reproductive vigor peak before an individual’s 30th birthday. Even the conservative historic standard of a life expectancy of three score and 10 leaves 40 or more years of decline to follow the tender blossom of youth. It hardly seems right that the majority of a normal human life should be lived in a state of decline. The data that quantify our declining bodily functions are not all we have to contend with, as society’s celebration of youth gleefully rubs salt into the wounds of old age.
When I wrote a book titled What Are Old People For? How Elders Will Save the World, my publisher was wary of putting the words “elderhood” and “old age” into the title. There was a legitimate fear that seeing those words on the cover would discourage people from buying the book or even taking it off the shelf for further examination. Reminding people of old age (and their eventual death) always makes a product less attractive to consumers. More comforting is the multitude of books that actively and energetically deny the inevitability of old age. They preach a new gospel of immortality joined with eternal youth.
Talking about, reading about, or even just thinking about the changes that accompany late life is difficult for most people. This reluctance is the product of the declinism that dominates our culture. Although the contemporary aversion to old age pervades every aspect of our society, it should not be mistaken for a universal human phenomenon. The development of a new perspective on age and aging is both necessary and possible. Given the importance of aging in our lives and the impact of aging on our families and society, a new openness and even curiosity about human aging would seem more than warranted. The time has come for our wondrous longevity to emerge from the long shadow cast by the vigor and virtues of youth.
Imagine gathering a group of your friends for a fine meal and good conversation. After dessert is served, you linger over tea or coffee. A break in the conversation allows you to make an announcement: “I have discovered an ancient path to human development that is all natural, subtle but transformative, and requires decades to experience fully. Only mature adults may sign on; the young are unprepared to accept what it has to offer.” A murmur of general approval is likely to follow. “Tell us more!” And so you tell them about aging:
• Aging requires life. When we speak of the aging of machines, buildings, or cities, we are employing a metaphor. Inanimate objects can and will decay, but they cannot age. Aging is an active process that requires the force of life. A building does not live and thus cannot age, though its human occupants must. Being alive is a continuing prerequisite for growing old. The challenges of longevity are insistent; they cannot be set aside by those who find them unpleasant. Given a choice between growing old or remaining young, there is hardly a soul alive who wouldn’t choose youth. Life, however, offers us a different set of options. Given a choice between aging and death, we choose to grow old.
• Aging is natural. Aging is within us, not imposed on us. While environmental conditions can accelerate or retard aging, the process itself is part of the human being. How a species ages is one of its defining characteristics. A mouse lives two years, not 200. An oak tree grows to maturity in 50 years, not five. So it is with Homo sapiens—when and how we age is written into our very being.
• Aging is gradual. We don’t have to think about breathing in order to breathe, and we age whether or not we wish to do so. Aging is a gradual, rhythmic, highly choreographed process. It holds no surprises, as its course and consequences are well known to all of us. No one goes to bed at the height of vitality and wakes up old. Like water on stone, this is the source of aging’s power.
Remember Tithonus? In the palace of his lover, Eos, he enjoyed perfect health, was protected from all harm, and feasted on the nectar of the gods. Still, he aged. It is because illness and injury so often occur with the process of aging that we confuse them as being part of aging. While illness and injury can and do complicate the aging process, they are distinct from it. When a young man breaks his neck in a fall, he is not aged; he is injured. When an old woman falls and breaks her hip, the fracture is unfortunate and fraught with danger but is not itself a manifestation of aging. Orthopedic wards host young and old alike.
• Aging requires maturity. Some movies, CDs, DVDs, and even books are available only to “mature audiences.” We label these products out of concern that the ideas and images they contain may overwhelm younger, less mature people. We restrict access to tobacco and alcohol for similar reasons. There are many things best reserved for people with the good judgment that comes with age. Old age gives us access to a collection of experiences and insights that are beyond the capacity of the young to understand or fully appreciate.
Scientific theories about how we age nearly all accept without question the doctrine of youth’s perfection. They focus on decline and pay little heed to the steady emergence of new gifts and capacities. This tunnel vision is the root cause of their failure to fully explain aging. They fail because they are the products of a culture mired in a misunderstanding of age and aging.
If aging is truly a catastrophic prelude to death, an alien rot imposed on an unwilling adult, it deserves the dread it currently engenders. But what if aging is better understood as a normal, natural ripening? If aging and old age do include important affirmative elements needed for a normal, healthy human life, then we have to ask: What is old age for? Does it serve a distinctive purpose, or is it a leftover from youth’s vitality, unconnected to the central purposes of life? Even a brief examination of the world around us would offer support for an optimistic outlook. Aging is everywhere. Far from being some dreadful anomaly, it works its way into the lives of millions of species and hundreds of billions of creatures each and every day. This ubiquity suggests that nature finds aging to be very useful, even essential.
If we are ever to understand the purpose of aging, we must explore the origins of the human being’s unprecedented longevity.
— William H. Thomas, MD, is founder of the Eden Alternative and Green House and is a professor of aging studies at the Erickson School at the University of Maryland, Baltimore County.
Tuesday, November 27, 2012
Utah Certified Nurse Aide Training
I'm his boogity boo:)
I have a favorite patient. I know we shouldn't have favorites but I can't help it. I love this guy. He has Alzheimer's and he reminds me so much of my dad. He's a picker and a pacer just like my dad. He will stop, bend over and pick up a piece of lint and roll it around in his fingers for an hour. He will stack and unstack magazines and play with the light switches. He also goes into other people's rooms and pees on their stuff. He doesn't talk but has the cutest smile.
Last week the Golden Age Jazz band was playing at the nursing home. I went over to Earl who was pacing in the activity room. He's not really able to sit. I put my arm around him and started dancing. At first he just looked confused then he started to move. After a few minutes he was actually doing the fox trot. Before long he fox trotted me to the front of the room and we were in front of the band. His hand slipped down to my bum and he grabbed it and said "you're my boogity boo!" He had the most mischievous grin on his face and it totally cracked me up.
I have a favorite patient. I know we shouldn't have favorites but I can't help it. I love this guy. He has Alzheimer's and he reminds me so much of my dad. He's a picker and a pacer just like my dad. He will stop, bend over and pick up a piece of lint and roll it around in his fingers for an hour. He will stack and unstack magazines and play with the light switches. He also goes into other people's rooms and pees on their stuff. He doesn't talk but has the cutest smile.
Last week the Golden Age Jazz band was playing at the nursing home. I went over to Earl who was pacing in the activity room. He's not really able to sit. I put my arm around him and started dancing. At first he just looked confused then he started to move. After a few minutes he was actually doing the fox trot. Before long he fox trotted me to the front of the room and we were in front of the band. His hand slipped down to my bum and he grabbed it and said "you're my boogity boo!" He had the most mischievous grin on his face and it totally cracked me up.
Creating Age-Friendly Environments
Fall 2010
Creating Age-Friendly Environments
By Cynthia Stuen, PhD, LCSW Aging Well Vol. 3 No. 4 P. 34
What makes a city age friendly or a community livable? It is a comprehensive mix of innovations that address improvements in housing, mobility, and the environment. And they’re not just about improvements aimed at older adults but those that also benefit parents with small children and individuals with disabling conditions. It’s about making the environment in which we live, work, and play the most accessible to all with the ultimate goal of improving the quality of life across the ages.
Having recently celebrated the 20th anniversary of the signing of the Americans With Disabilities Act, it is interesting to reflect on something like a curb cut in a sidewalk. It not only helps an older adult using a wheelchair to safely cross the street but also enables a mother pushing a stroller to easily do the same thing. Making sure the curb cut has a different texture to enable a blind person using a cane to determine it exists and is different from the sidewalk surface is another dimension of factors to be considered factors when designing universal access.
And just as it’s essential to consider mobility, convenience, and safety issues that make function and navigation easier in outdoor settings, it’s equally important to exercise the same considerations in developing or adapting interior environments.
Have you ever entered a restaurant on a bright sunny day and discovered it to be very dimly lit? For a brief interlude, you could not see much. After the impatient host showed you to your table, having waited for your eyes to adjust to the changing light level, you are handed a menu printed in elegant italic font with gray lettering on light gray paper. You reach for the candle to provide more light so you can decipher the menu.
The adjustment to changing levels of light, whether going from dark to light or light to dark, is called accommodation. As we age, beginning with each decade of adulthood, the accommodation process takes a little longer. In addition, as we age, we need more light to accomplish the same tasks we could previously accomplish with less. This isn’t serious; it’s just the normal processes of the aging eye, just as presbyopia (which means “aging eye”) manifests itself some time in our middle years, resulting in the need for glasses to read or do computer work.
Despite a restaurant’s ambience or allure, subdued lighting can make reading the menu and even walking across the room challenging in poorly lit establishments. Thoughtful consideration could make such an environment significantly easier to navigate, particularly for older adults with failing eye sight.
In 2007, the World Health Organization challenged cities around the world to make urban centers models where older adults could live longer, healthier, and better lives. In New York City, Mayor Michael R. Bloomberg’s administration joined with the City Council and the New York Academy of Medicine to launch the Age-Friendly New York City project. I was fortunate to serve on the steering committee to address issues of aging and those of individuals with vision loss. New York City has identified 59 initiatives involving city agencies and community partners to address enhancements to community and civic participation, housing, public spaces and transportation, and health and social services. One initiative, for example, involves utilizing school buses during the day to transport older adults for shopping, and another links struggling artists with studio space in existing senior centers in exchange for art instruction.
The key is always asking individuals of all ages what could improve their lives in a particular environment. Conducting town hall and focus group forums provides the innovative ideas. In this time of economic downturn, there are not enough resources to do everything, so we do what can with what we have to enhance the quality of life for individuals of all ages. It is important to remember that it is not “us vs. them.”
Wouldn’t it be nice if the restaurant mentioned above, when redesigning its menu, used a sans-serif font in 12-point type and were educated on the use of good color contrast for aging eyes?
As the late Robert N. Butler, MD, quoted the fifth-century Greek poet Pindar in the foreward of his book The Longevity Revolution, “Do not yearn after immortality, but exhaust the limits of the possible.” It is possible with innovation, technology, and environmental and behavioral approaches to create age-friendly cities and communities that benefit all ages. What an opportunity for aging well in the 21st century.
— Cynthia Stuen, PhD, LCSW, is senior vice president for policy and education at Lighthouse International and immediate past chair of the American Society on Aging.
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Utah Nurse Aide Training
A very nice letter from a CNA student:)
So, I don't really know what to tell you about me but I will tell you why I wanted to go into medical field.
I didn't want to be a CNA always at first I wanted to be a Vet technician 19.00 dollars an hour, who wouldn't.
My first experience in a nursing home was beehive home in South Jordan by Bingham high school, My great grandpa Claude Bell was there.
There were about 10 residents, 2 people I wasn't sure who was the RN or CNA, if there was a RN maybe not.
Anyways, they left my grandpa alone in a dark room blinds were always shut. Never really understood.
I guess at that point not knowing what I do now, that was normal. Long story short. He died there at 92 yrs age.
I remember one thing about my grandpa " Wee Wee said the little Bumblebee."
I want to make a difference.
Everything about abuse to elderly people or even children, it hurts.
I know how it feels, and the last thing I would want to do is put someone else through that.
I have tattoos each of them ARE apart of something tremendous to something simple but yet symbolic.
Parents tattooed on the shoulders. To remind even though they are alive but I mean when they leave,
they are always with me. :) my dads is a guitar with his name really rough edge kinda thing, he is a metal head.
My mom's is in calligraphy writing to promote the graceful yet sometimes confusing person.
the roses on my wrist is a cover up of a name, the thorn of the rose where in order to get a rose you need to let it grow,
mature then you get a blossomed Rose.
the heart on the other side is pretty much the greatest day of my life it was a hemp tattoo, I got it with my mom and 2 sisters
at the women's convention in Sandy. It was a fun experience.
the stars on my leg is pretty much for myself I am a star in my eyes maybe someday to someone else Plus I have 5 people
in my family not including in laws, immediate family yes. :) there are 5 stars and that represents my family as well.
I loved doing my Clinicals @ Sandy regional and St. Joseph Villa. I meant some really amazing people. My CNA's were incredible.
A man talked about his wife whom passed 3 days before I was there, I sat at his lunch table and I sat in his room with my CNA listening.
He had no sense of life, I knew that if he had passed that moment he would be better and happier then he was, he wanted, missed his wife.
Another story a lady I watched her @ breakfast, she wasn't able to eat on her own. I didn't see her till lunch, I help her eat.
I was putting a spoon up to her mouth and she took it from me, she started eating herself. She kept telling me she wanted to just go home,
why won't them just let me go home.
First clinical was very emotional roller coaster I guess you would say, I was happy at times and others I felt as if I couldn't do anything.
Second clinical I really didn't show the sadness I went, more confident then the first clinical. I knew how to handle certain situations better this time.
I won't forget either Clinicals, cause it was a sense of accomplishment for me. Accomplishment that on the
1st clinical a lady I gave a shower to said to me, they don't listen to us.
2nd I felt home... And at that moment I realized this is what I want to do!
From my background that felt amazing. to finally know what I wanted to do and Finally go for a career that I absolutely can't see myself NOT doing.
And I thank you Carol & Claudia and Linda And all of you at CCCNA for helping me.
I'm the first one to further my education past highschool withing of getting out of highschool.
All of you have made my dream come true. :)
I WILL be a CNA that will listen, care, be there, but also take full advantage of what you all have taught me.
So, I don't really know what to tell you about me but I will tell you why I wanted to go into medical field.
I didn't want to be a CNA always at first I wanted to be a Vet technician 19.00 dollars an hour, who wouldn't.
My first experience in a nursing home was beehive home in South Jordan by Bingham high school, My great grandpa Claude Bell was there.
There were about 10 residents, 2 people I wasn't sure who was the RN or CNA, if there was a RN maybe not.
Anyways, they left my grandpa alone in a dark room blinds were always shut. Never really understood.
I guess at that point not knowing what I do now, that was normal. Long story short. He died there at 92 yrs age.
I remember one thing about my grandpa " Wee Wee said the little Bumblebee."
I want to make a difference.
Everything about abuse to elderly people or even children, it hurts.
I know how it feels, and the last thing I would want to do is put someone else through that.
I have tattoos each of them ARE apart of something tremendous to something simple but yet symbolic.
Parents tattooed on the shoulders. To remind even though they are alive but I mean when they leave,
they are always with me. :) my dads is a guitar with his name really rough edge kinda thing, he is a metal head.
My mom's is in calligraphy writing to promote the graceful yet sometimes confusing person.
the roses on my wrist is a cover up of a name, the thorn of the rose where in order to get a rose you need to let it grow,
mature then you get a blossomed Rose.
the heart on the other side is pretty much the greatest day of my life it was a hemp tattoo, I got it with my mom and 2 sisters
at the women's convention in Sandy. It was a fun experience.
the stars on my leg is pretty much for myself I am a star in my eyes maybe someday to someone else Plus I have 5 people
in my family not including in laws, immediate family yes. :) there are 5 stars and that represents my family as well.
I loved doing my Clinicals @ Sandy regional and St. Joseph Villa. I meant some really amazing people. My CNA's were incredible.
A man talked about his wife whom passed 3 days before I was there, I sat at his lunch table and I sat in his room with my CNA listening.
He had no sense of life, I knew that if he had passed that moment he would be better and happier then he was, he wanted, missed his wife.
Another story a lady I watched her @ breakfast, she wasn't able to eat on her own. I didn't see her till lunch, I help her eat.
I was putting a spoon up to her mouth and she took it from me, she started eating herself. She kept telling me she wanted to just go home,
why won't them just let me go home.
First clinical was very emotional roller coaster I guess you would say, I was happy at times and others I felt as if I couldn't do anything.
Second clinical I really didn't show the sadness I went, more confident then the first clinical. I knew how to handle certain situations better this time.
I won't forget either Clinicals, cause it was a sense of accomplishment for me. Accomplishment that on the
1st clinical a lady I gave a shower to said to me, they don't listen to us.
2nd I felt home... And at that moment I realized this is what I want to do!
From my background that felt amazing. to finally know what I wanted to do and Finally go for a career that I absolutely can't see myself NOT doing.
And I thank you Carol & Claudia and Linda And all of you at CCCNA for helping me.
I'm the first one to further my education past highschool withing of getting out of highschool.
All of you have made my dream come true. :)
I WILL be a CNA that will listen, care, be there, but also take full advantage of what you all have taught me.
An Ounce of Prevention — Fall-Proofing Elders
An Ounce of Prevention — Fall-Proofing Elders
By Diane A. Klein, PhD, and Sandra L. McGuire, EdD
By Diane A. Klein, PhD, and Sandra L. McGuire, EdD
As we age, both the risk and incidence of falls increase. But taking steps to assess risk and foster prevention can diminish the potential for devastating falls.
For older adults, falls are common and often life-altering events. Each year in the United States, more than one third of community-dwelling adults aged 65 and older experience falls, according to the Centers for Disease Control and Prevention (CDC). More than one half of those who fall have multiple fall episodes. Approximately 20% to 30% of falls result in moderate to severe injuries, including fractures, soft tissue and internal organ injury, dislocations, traumatic brain injury (TBI), and spinal injury. Many of these injuries impair elders’ mobility, reduce their ability to maintain independence, and frequently lead to early death. In more than 90% of elders whose hip fractures have been caused by falls, 25% die within six months to one year after the fall. It is estimated that each year nearly 16,000 older adults aged 65 and older die from fall-related injuries, with more than one half of those deaths due to TBI. Adults aged 75 and older account for nearly 85% of fall fatalities.
Every year, more than 1.6 million older adults visit emergency departments for treatment of fall-related injuries. The direct costs of fall injuries in older adults exceed $19 billion per year, and they are expected to increase to $54.9 billion by 2020. These costs don’t include the long-term effects from fall injuries leading to disability, loss of independence, lost time from activities at work and home, and reduced quality of life. TBI and injuries to hips, legs, and feet account for 78% of fall fatalities and 79% of the costs.
Women are more likely to fall—both fatal and nonfatal—and costs from falls in women are two to three times higher than those in men. According to the CDC, men have a 49% higher fall fatality rate than women, and women have a 67% higher nonfatal fall injury rate than men. In addition, those aged 75 and older are four to five times more likely to be admitted to long-term care for one year or longer following hospitalization due to a fall.
A 1995 study determined the likelihood of various settings contributing to injurious falls. These included standing or walking (63%), standing up and/or just standing after standing up (7%), sitting down (9%), risky tasks (4%), other known causes (15%), and unknown circumstances (2%). Among the other known causes are medications, chronic illnesses (Parkinson’s disease, diabetes mellitus, arthritis, previous myocardial infarction, stroke, or cancer), issues with activities of daily living, as well as vision, hearing, blood pressure, balance, and body mass.
Evaluating Risk
Falls don’t occur simply due to aging. However, the risk of falls increases with age. Individuals aged 75 and older, white non-Hispanic, housebound, and living alone are at greatest risk. Contributing factors include personal medical history and physical deficiencies, as well as environmental risks.
Falls don’t occur simply due to aging. However, the risk of falls increases with age. Individuals aged 75 and older, white non-Hispanic, housebound, and living alone are at greatest risk. Contributing factors include personal medical history and physical deficiencies, as well as environmental risks.
Personal aspects placing an older adult at greater risk for falls are the use of a cane or walker, a history of previous falls, acute illness (e.g., pneumonia and urinary tract infection), and certain chronic conditions. Pain and neuromuscular disorders also play a role. Medications are a factor too, particularly if the individual is using four or more prescription drugs where the risk of side effects and interactions increases. Cognitive impairment, reduced vision and vision changes, difficulty rising from a chair, foot problems, neurological changes (including postural stability, reaction time, and sensory awareness), gait and balance changes, and hearing and speech impairments are all fall risks. Those with poor balance or walking difficulty are more likely to fall. Further contributing to fall risk is the fear of falling. Individuals who have a history of falls and/or fall-related injury have a higher rate of repeat fall episodes. This occurs because older adults with a fear of falling may limit their activities, reducing mobility and physical capability, leading to an increased risk for falling.
Assessing for Falls
Regardless of whether an individual has a fall history, assessing fall risk is essential. Individuals who have fallen repeatedly or have had near-fall episodes may be reluctant to share the details. They may be embarrassed by the circumstances surrounding the fall or may be concerned about loss of independence. Among the many assessment techniques available, some of the more useful ones are: POEMS, SPLATT, the “up-and-go” test, and the Tinetti Gait and Balance Assessment.
Regardless of whether an individual has a fall history, assessing fall risk is essential. Individuals who have fallen repeatedly or have had near-fall episodes may be reluctant to share the details. They may be embarrassed by the circumstances surrounding the fall or may be concerned about loss of independence. Among the many assessment techniques available, some of the more useful ones are: POEMS, SPLATT, the “up-and-go” test, and the Tinetti Gait and Balance Assessment.
In addition to evaluating medical history, the POEMS assessment should include evaluating a Performance-Oriented Environmental Mobility Screening, and a clinical evaluation. The individual’s living environment needs to be assessed for fall risks. Evaluation focuses on visual impairments, postural hypotension, reduced lower extremity strength, impaired gait and balance, impaired mobility, use of ambulation devices, bladder dysfunction, altered cognition, polypharmacy, and the use of sedatives, psychotropics, hypnotics, and antihypertensive drugs. POEMS assesses balance maintained in sitting and rising from a bed, chair, and toilet; standing balance; ability to bend down from a standing position; and ability to ambulate in the bedroom and bathroom. Transfers and ambulation maneuvers should be tested with and without assistive devices. By testing capacity in various locations, POEMS accounts for the dissimilarity of space limitations, ground surfaces, and illumination of space, and the differences in risk.
When reviewing fall history, employ the SPLATT acronym for evaluation. Consider Symptoms experienced at the time of the fall(s); number of Previous falls; Location of the fall(s); Activity at the time of the fall(s); Time of day the fall(s) occurred; and physical or psychological Trauma associated with the fall(s). This evaluation helps determine how falls might be prevented and what interventions are appropriate.
The modified up-and-go test, a quick and easy method of determining fall risk, examines dynamic balance through a performance-oriented test. Directions for scoring and setup of this test can be found in Section 10 at here.
Another relatively easy set of tests for fall risk is the Tinetti Gait and Balance Assessment. Assessment sheets, directions, and safe administration protocols can be found at here and here. Using the gait and balance assessment sheets provides a means of recording observations and scoring the results. The assessment sheet guides the scoring for each component for gait and balance. Higher scores indicate less fall risk.
Reducing Risk
Regular exercise is one of the most important ways to reduce fall risk because it builds strength and helps elders feel better, both physically and mentally. Tai chi and other exercises focused on improving balance and coordination are most helpful, but any exercise increasing strength, endurance, and flexibility provides improved physical function for balance and coordination. The use of a cane or walker may be necessary for balance and security. Elders should use handrails on stairs for guidance and support. Wearing rubber soled, low-heeled shoes that support feet and are not slippery adds to the security of walking with reduced fall risk.
Regular exercise is one of the most important ways to reduce fall risk because it builds strength and helps elders feel better, both physically and mentally. Tai chi and other exercises focused on improving balance and coordination are most helpful, but any exercise increasing strength, endurance, and flexibility provides improved physical function for balance and coordination. The use of a cane or walker may be necessary for balance and security. Elders should use handrails on stairs for guidance and support. Wearing rubber soled, low-heeled shoes that support feet and are not slippery adds to the security of walking with reduced fall risk.
Reviewing prescription and over-the-counter medications enables identification of potential interactions and adverse effects. As individuals age, the way their bodies metabolize medications changes, affecting medications’ impact. Side effects of medications can affect coordination and balance. Check blood pressure in both lying down and standing positions to detect orthostatic hypotension, which can make a person dizzy and prone to falls.
Vision changes occur over time for everyone. Annual eye examinations may prevent wearing the wrong eyeglasses or detect conditions such as glaucoma or cataracts that limit visual acuity. Poor vision contributes to balance problems and increases the likelihood of falls.
Since more than 60% of all falls occur in the home, a home safety assessment can limit falls due to obstacles, loose carpet or rugs, slipping on slick surfaces, or falling from step ladders or stools. It’s important to ensure proper lighting, provide grab bars, and remove cords and wires from traffic areas. Also, chairs with arms are much easier for elders to use.
Osteoporosis increases an elder’s risk for falls and fractures. Keeping bones healthy is an important part of fall prevention. Osteoporosis makes bones thin and more porous, diminishing bone mineral density and creating microarchitectural deterioration of bone. Spontaneous fractures due to osteoporosis may actually cause a fall or bone thinning from osteoporosis may increase the fracture outcome after a fall. DEXA and ultrasound exams can diagnose osteoporosis and its precursor, osteopenia. An estimated 28 million Americans are affected by osteopenia or osteoporosis. Current medications for osteoporosis can help to rebuild and maintain bone mineral density, making bones stronger and preventing bone fractures. Mild weight-bearing exercise and supplemental calcium intake can aid in slowing bone loss due to osteoporosis.
Proactive Professionals
Numerous resources exist for healthcare professionals’ evaluations and interventions related to falls. The Falls Free Coalition includes more than 455 organizations using a collective approach to promote a national fall-prevention action plan. The Fall Prevention Center for Excellence works to identify best practices in fall prevention and help communities offer fall-prevention programs to older adults who are at risk of falling. Local health departments and Area Agencies on Aging may participate in fall-prevention activities or know of additional resources that can be helpful to your clients.
Numerous resources exist for healthcare professionals’ evaluations and interventions related to falls. The Falls Free Coalition includes more than 455 organizations using a collective approach to promote a national fall-prevention action plan. The Fall Prevention Center for Excellence works to identify best practices in fall prevention and help communities offer fall-prevention programs to older adults who are at risk of falling. Local health departments and Area Agencies on Aging may participate in fall-prevention activities or know of additional resources that can be helpful to your clients.
Health professionals can explore locally available programs or become the lynchpin for developing such programs. The CDC offers grants, and working with other stakeholders to create community programs presents the opportunity to become an active advocate.
— Diane A. Klein, PhD, is a gerontological health education and exercise program consultant for Klein Consulting in Knoxville, TN. She previously taught and coordinated the interdisciplinary programs in gerontology at the University of Tennessee in Knoxville.
— Sandra L. McGuire, EdD, is a gerontological nurse practitioner and a professor and the chair of the Master of Science in Nursing Program at the University of Tennessee in Knoxville, where she teaches in the interdisciplinary gerontology mino
Careful Attention to Aging Skin
Careful Attention to Aging Skin
By Jaimie Lazare
Aging Well
Vol. 5 No. 5 P. 18
Aging Well
Vol. 5 No. 5 P. 18
Aging makes skin more susceptible to dryness. Dry skin in older adults can be simply a sign of age-related skin changes or signify underlying medical problems. Because dry skin can lead to other skin complications, it’s important to monitor carefully.
If older adults’ skin appears rough, scaly, flaky, or cracked, this can indicate xerosis, or dry skin. Although dry skin can affect anyone, it’s particularly common among older adults. Age-related dermal changes such as a thinner epidermal layer, a reduction in skin cell turnover, and the skin’s limited capacity to retain moisture contribute to xerosis.1 Over time, skin loses its suppleness, yet such physiological changes alone don’t determine whether a patient will develop dry skin. Other factors such as the environment, genetics, and ethnicity are also contributing factors.
Skin loses its elasticity as the production of collagen and elastin decreases. Additionally, hyaluronic acid isn’t produced at the same rate as in earlier stages of life, creating an imbalance between the production of hyaluronic acid and its breakdown by enzymes. Because of these changes, skin becomes progressively thinner, more fragile, less elastic, and drier. Even the natural oil-producing sebaceous glands gradually lose their ability to moisturize the skin. All of these physiologic changes contribute to the development of drier skin as people age, says Charles E. Crutchfield, III, MD, a clinical professor of dermatology at the University of Minnesota Medical School and medical director of Crutchfield Dermatology.
Even as early as the age of 40, the skin becomes more susceptible to drying. Lipids primarily act by preventing evaporation of the natural moisture in the skin, providing a barrier to water loss. Without adequate lipids, people simply lose too much water from the skin and it dries out, according to Jamie B. MacKelfresh, MD, an assistant professor in the dermatology department and director of the Dermatology Residency Program at Emory University School of Medicine in Atlanta.
Underlying Causes
In addition, older adults often have comorbidities for which they take many medications. Multiple conditions and numerous medications can contribute to dry skin in older adults, MacKelfresh says. Diuretics as well as renal, cardiovascular, and thyroid problems can contribute to xerosis, she says.
In addition, older adults often have comorbidities for which they take many medications. Multiple conditions and numerous medications can contribute to dry skin in older adults, MacKelfresh says. Diuretics as well as renal, cardiovascular, and thyroid problems can contribute to xerosis, she says.
Crutchfield notes that older adults’ skin has an increased tendency toward dryness because of the decreased production of moisturizing sebaceous oils. As a result, the practice of taking long hot baths or showers without the application of a moisturizer or emollient immediately afterward is a common contributor to drying out older adults’ skin. Also, some older adults were raised to do a lot of scrubbing, washing, and extra cleansing of the skin, but exfoliants, harsh cleansers, and alcohol-based products such as astringents further dry aging skin that’s already predisposed to dryness, MacKelfresh says. These products remove more of the essential skin oils necessary to help keep the skin moist and retain water.
It’s also important to warn patients against using a lot of waterless antibacterial cleansers since these also contain alcohol that can dry out the skin. Even over-the-counter antiaging creams can be quite drying and actually harsh on the skin.
Assessing Xerosis
Physicians should use a three-pronged approach when assessing older adults’ skin for signs of xerosis. Find out how long a patient has been experiencing problems with dry skin, determine whether the dry skin is widespread or concentrated, and ask whether a patient uses moisturizing lotions or creams and if so, whether they help or worsen the dry skin.2 A focused history is key for identifying and treating xerosis appropriately and reducing the risk of infection or sequela brought on by pruritic symptoms associated with dry skin.3
Physicians should use a three-pronged approach when assessing older adults’ skin for signs of xerosis. Find out how long a patient has been experiencing problems with dry skin, determine whether the dry skin is widespread or concentrated, and ask whether a patient uses moisturizing lotions or creams and if so, whether they help or worsen the dry skin.2 A focused history is key for identifying and treating xerosis appropriately and reducing the risk of infection or sequela brought on by pruritic symptoms associated with dry skin.3
“A common symptom of dry skin is itching, and severe itching can lead to an itch-scratch-rash-itch cycle. The skin may become thickened in these areas from rubbing, and repeated skin rubbing in the same area may lead to chronic skin conditions called lichen simplex chronicus and prurigo nodularis,” says Rita Pichardo-Geisinger, MD, an assistant professor of dermatology at Wake Forest University in Winston-Salem, North Carolina.
Crutchfield stresses the importance of asking patients how long they have been dealing with dry skin. Assessing the duration of the skin dryness is important because it may be a condition called ichthyosis, which is a congenital defect that can develop with time and aging. If the dry skin appears to be severe or has occurred suddenly, it would require further investigation, he says.
MacKelfresh agrees on the importance of identifying the time of onset. “If somebody comes on with brand new dry skin that sort of came out of nowhere, then that is a clue that we might want to look into other things. For instance, heat stroke could be an underlying disease that is causing dry skin. Also, fungal infections of the skin can be a common cause, particularly in nursing homes and other care settings. So if it’s new and different, we definitely need to pay attention to make sure we’re not missing something else,” she says.
Many older adults may not be bothered by their dry skin. While performing a general exam, physicians will likely see dry skin on the legs. After looking at the legs, be sure to examine a patient’s arms. Ask whether he or she is experiencing flaking, itchy, irritated, or even sore skin, MacKelfresh says.
Crutchfield notes that while assessing dry skin is fairly easy, there are some rare issues physicians need to be aware of, especially in patients of color. On the lower leg, a condition called ichthyosiform sarcoidosis can occur, also with generalized exfoliating dermatitis, which can be confused with dry skin. Under these circumstances it’s appropriate to look for internal malignancy, according to Crutchfield.
While studies addressing the differences in ethnic skin are limited, one study has reported greater transepidermal water loss and desquamation in African American skin.4 Pichardo-Geisinger says that while transepidermal water loss appears to occur more in African Americans due to the characteristics of the stratum corneum and reports have pointed out that people of Anglo-Saxon origin have more fair, dry thin skin, the clinical focus doesn’t rely heavily on such factors. “I believe dry skin is due more to internal or external factors than race or ethnicity,” she says.
Conservative Treatment to Start
“We almost always start patients on a nonprescription approach because treating xerosis is pretty simple, and it doesn’t have to be expensive,” MacKelfresh says. Thicker moisturizers work better because the thinner water-based lotions won’t help skin retain its moisture. Suggest that patients keep a moisturizer in the bathroom and apply a thick moisturizer within three minutes of taking a bath or shower and apply it more than once per day, she says.
“We almost always start patients on a nonprescription approach because treating xerosis is pretty simple, and it doesn’t have to be expensive,” MacKelfresh says. Thicker moisturizers work better because the thinner water-based lotions won’t help skin retain its moisture. Suggest that patients keep a moisturizer in the bathroom and apply a thick moisturizer within three minutes of taking a bath or shower and apply it more than once per day, she says.
“If that’s still not working, then there are some other products that contain alpha-hydroxy acids, which will help break down some of those thickened, dry skin cells. And you can find some of those over the counter. Beyond that … there are sometimes areas where you actually need to calm the skin inflammation with a cortisone-based cream,” MacKelfresh says.
Crutchfield recommends that his patients gently pat dry their skin with a cotton towel after a bath or shower, then apply a liberal amount of emollient moisturizing lotion. “The most important thing in preventing dry skin is using a gentle cleanser that does not contain harsh detergents, such as Vanicream cleansing bar and a good moisturizing emollient such as CeraVe cream or AmLactin XL lotion,” he says.
“For my patients who have extremely dry skin, I suggest they use AmLactin XL lotion once a day in addition to another moisturizer. AmLactin XL contains ammonium lactate that functions as a humectant, and it also causes the production of moisturizing oils in the skin,” Crutchfield adds.
“For my patients who have extremely dry skin, I suggest they use AmLactin XL lotion once a day in addition to another moisturizer. AmLactin XL contains ammonium lactate that functions as a humectant, and it also causes the production of moisturizing oils in the skin,” Crutchfield adds.
“I recommend a fragrance-free regimen,” Pichardo-Geisinger says, “which consists of mild soaps and moisturizing lotions on a regular basis, particularly over-the-counter products with ceramides, such as Cetaphil Restoraderm or CeraVe, and products with oatmeal, like Aveeno Eczema Therapy; Vaseline Clinical Therapy is also excellent. A lactic acid lotion will improve the skin condition. Excellent over-the-counter products such as AmLactin 12% or Aqua Glycolic, which restore the skin’s adequate moisture balance, are recommended. In some cases a topical steroid cream needs to be used.”
As a precaution, only mild corticosteroid creams such as hydrocortisone should be applied to sensitive skin areas, which include the face, underarm, and groin. Using strong corticosteroid creams such as clobetasol for a long period of time may lead to skin problems such as thinning, stretch marks, and skin breakdown.5
Pichardo-Geisinger recommends that older adults avoid strong soaps and detergents, wear cotton and natural fiber clothing, avoid wool clothing, drink plenty of water, use a humidifier in the home when necessary, and limit sun exposure.
Special Cases
MacKelfresh recalls the case of an 85-year-old woman who was wheelchair bound. The woman’s daughter brought her to the office with a complaint of a severe itch and flaking skin on her shins that had recently developed during the winter. An examination revealed dry skin on various parts of the patient’s body but significant erythema, xerosis, and fissuring over her shins. The skin also displayed evidence of scratching in those areas.
MacKelfresh recalls the case of an 85-year-old woman who was wheelchair bound. The woman’s daughter brought her to the office with a complaint of a severe itch and flaking skin on her shins that had recently developed during the winter. An examination revealed dry skin on various parts of the patient’s body but significant erythema, xerosis, and fissuring over her shins. The skin also displayed evidence of scratching in those areas.
MacKelfresh concluded that her patient’s condition was caused by the seasonal change, and her xerosis had transformed into dermatitis. She prescribed a topical steroid cream and provided the patient with careful instructions to use only gentle soap, take short warm (never hot) baths or showers, and apply a thick moisturizer within three minutes of bathing. By her four-week follow-up appointment, the patient’s skin had improved dramatically, and she no longer needed the steroid cream.
It’s important to carefully evaluate patients’ dry skin, particularly those with preexisting conditions such as diabetes or dementia. For those patients, be sure to do a thorough exam by looking for dry skin areas before they become problematic. “In a diabetic patient, if it’s left too long and they’re already having foot ulcers, more dry skin could just make them more prone to dermatitis and ulcers,” MacKelfresh says. “Make sure the caregiver in the situation of a patient with dementia or the physician who’s caring for a diabetic is also on board with your plan. So utilizing multiple members of the team is going to be key in those scenarios as well.”
Whether or not older adults are able-bodied and mobile, Crutchfield suggests using triamcinolone cream twice per day for one week to control itching in dry skin with an inflammatory component.
As the number of baby boomers in the United States grows, it is becoming increasingly important for clinicians to recognize and treat elder patients for skin problems. While prevention is key, treating dry skin is fairly easy and affordable.
— Jaimie Lazare is a freelance writer based in Brooklyn, New York.
Advice for Patients
Rita Pichardo-Geisinger, MD, an assistant professor of dermatology at Wake Forest University, offers some practical advice to help patients and their caregivers prevent and reduce the risk of developing dry skin:
Rita Pichardo-Geisinger, MD, an assistant professor of dermatology at Wake Forest University, offers some practical advice to help patients and their caregivers prevent and reduce the risk of developing dry skin:
• Wash gently. Avoid hot baths, frequent showering or bathing, and excessive skin scrubbing. Keep the water warm because hot water tends to strip away the natural oils produced by the skin. Use mild cleansers for the face and body such as Dove unscented, Cetaphil Restoraderm, CeraVe, or Aveeno. Avoid overwashing with harsh soaps and overusing alcohol-based products such as sanitizers and cleansing agents that are drying to the skin.
• Hydrate skin. Keeping dry skin hydrated is the best way to avoid potential problems such as itchiness and cracking. The best recommendation is to use a fragrance-free moisturizer. Among the effective products available over the counter are Cetaphil Restoraderm, CeraVe, Aveeno Eczema Therapy, Vaseline Clinical Therapy, AmLactin 12%, and Aqua Glycolic.
• Prevent itch. Elderly skin care is all about preventing dry skin. Aging skin requires special attention because it’s prone to dryness, which leads to itch and scratching. Moisturizing the skin will keep it hydrated and help to prevent the itch-scratch-rash-itch cycle.
• Pay attention. Examining elderly patients should always include evaluating their skin for signs of cancer or other conditions. Be sure to look for new growths or moles that appear to be changing. Identify skin changes such as peeling, chapped, red, or pruritic skin.
• Check patients’ feet. In older individuals the skin of the feet often gets dry and becomes susceptible to corns, calluses, warts, and fungal infections. Inspect patients’ feet and remind them (or their caregivers) to examine their feet. It is important to check the feet regularly, especially in patients with diabetes.
— JL
References
1. Pons-Guiraud A. Dry skin in dermatology: a complex physiopathology. J Eur Acad Dermatol Venereol. 2007;21 Suppl 2:1-4.
1. Pons-Guiraud A. Dry skin in dermatology: a complex physiopathology. J Eur Acad Dermatol Venereol. 2007;21 Suppl 2:1-4.
2. White-Chu EF, Reddy M. Dry skin in the elderly: complexities of a common problem. Clin Dermatol. 2011;29(1):37-42.
3. Lazare J. Ambiguous itching. Aging Well. 2011;4(3):22-24.
4. Wesley NO, Maibach HI. Racial (ethnic) differences in skin properties: the objective data. Am J Clin Dermatol. 2003;4(12):843-860.
5. Cole GW. What is the treatment for dry skin? http://www.medicinenet.com/dry_skin/page5.htm. Last reviewed January 18, 2012. Accessed July 1, 2012.
Hope for an Alzheimer’s Cure?
Hope for an Alzheimer’s Cure?
By Diane Walker, RN, MS
By Diane Walker, RN, MS
Promising advancements for diagnosing Alzheimer’s disease provide researchers with optimism related to better treatments options.
November, which is National Alzheimer’s Disease Awareness Month, is a time of optimism among professionals working to find a cure for Alzheimer’s disease (AD) and other forms of dementia. New reports detail the research and clinical trials being conducted to find a cure and slow the progression of AD, using new forms of treatment earlier in the course of the disease.
November is also National Family Caregivers Month, and AD-related advances give hope to the millions of caregivers affected by this illness.
AD is the most common form of dementia, currently affecting more than 5 million Americans. Dementia, characterized by memory loss, confusion, and cognitive decline, usually develops in adults aged 65 or older, affecting about 10% of older adults. That percentage increases to about 50% of adults over the age of 85.
The number of people diagnosed with dementia is rising dramatically, and new estimates indicate the number of people affected will triple to more than 16 million by 2050. In the United States, someone develops AD every 70 seconds and by 2050, this number will increase to every 33 seconds. An AD diagnosis will disrupt the lives of millions of family members and close friends, and the impact is projected to severely inhibit Medicare, the nation’s healthcare system, and the country’s economy. Projected costs are estimated to reach $627 billion.
Although we still do not know its cause or how to treat it effectively, our understanding of AD has increased greatly as many studies, both completed and currently under way, are giving us new hope and insight.
“We have a greater understanding of the biology of the disease now,” says Carol Lippa, MD, director of the Memory Disorders Program at Drexel University in Philadelphia. “We have a much clearer picture of the proteins at work in the brain that kill brain cells and generate the formation of plaque which disrupts the neurotransmissions we observe as the hallmark signs of the disease: memory loss and confusion.”
A major focus of the research at Drexel is to prevent the formation of amyloid plaques using vaccines. The initial trials were generally unsuccessful, although this was largely due to the side effects caused by the removal of these proteins. However, Lippa sees a positive indication, observing that researchers learned from those studies, and she remains optimistic that the current phase 2 and 3 trials will be more successful.
Some of researchers’ optimism is related to two recent developments. First, new diagnostic tests will enable clinicians to identify asymptomatic individuals who are at risk of developing AD and test potential treatments on asymptomatic middle-aged adults. This breakthrough occurred as part of the Alzheimer’s Disease Neuroimaging Initiative at the National Institute on Aging (NIA). Studies have identified differences or biomarkers in the blood, spinal fluid, and PET scans of individuals with the disease and those unaffected by it. There is growing hope that treating AD early in its course, before extensive damage occurs in the brain, will lead to ways to slow the disease or prevent its development altogether.
The second development is a change in the way AD is diagnosed. The NIA and the Alzheimer’s Association are encouraging physicians to define three distinct groups of individuals with AD: those at high risk who remain asymptomatic, those with mild cognitive impairment, and those with AD and other forms of dementia. While the early diagnosis of AD can help prepare future “victims” for the challenges to come, the severity of the diagnosis raises many questions about the best way to proceed for both physicians and their patients. Lippa says, “We want to be sure before we tell someone they have this diagnosis—it’s like a death sentence—but as painful as it is, it will be better because we can work with the client and their family to be proactive.”
If a diagnosis is made early in the course of the disease, or even decades before the first symptoms surface, affected adults will be able to take part in the decision-making process and decide whether to enroll in clinical trials that may assist in slowing or preventing the disease.
According to the Shriver Report, 90% of Americans who know someone with AD are concerned that they or someone close to them will be afflicted. However, planning ahead for this possibility is difficult, and family members—primarily women—assume the burden of day-to-day care.
More than 65 million Americans are actively involved in caregiving and provide up to 80% of the required personal care for individuals who need assistance with the basic activities of daily living. Becoming a caregiver is a transition that often requires a restructuring of personal goals, daily activities, and responsibilities. For some caregivers, this role can cause stress and feelings of burden. Caregivers need to consider the implications of long-term caregiving and ensure family and community resources are in place to support their caregiving activities.
As anyone who has been a caregiver will tell you, caring for a person with AD is deeply challenging due to the responsibility of managing difficult behaviors such as wandering, agitation, aggression, and social isolation. A caregiver’s reaction to these challenges must be levelheaded and sensitive to avoid the escalation or exacerbation of such behaviors. Elizabeth Gonzalez, PhD, PMHCNS-BC, an associate professor of nursing at Drexel University, has developed a program to help caregivers enhance their resourceful skills in dealing with chronic stress and handling challenging behaviors of loved ones with AD.
“Caregivers are at risk for negative health outcomes because of chronic stress that alters immune function, slows wound healing, and leads to mild hypertension and coronary heart disease,” Gonzalez says. The program provides caregivers with skills enabling them to adapt to the multitude of challenges associated with caring for someone with AD. “Caregivers have little time for self-care, recreational activities, or a social life,” she says. “We designed the program to occur in a group setting so caregivers can socialize and develop a support network.”
Family caregivers who intend to provide care at home for their loved one for as long as possible need a great deal of support if they want to avoid personal burnout, depression, illness, and the premature institutionalization of their care recipient. As the number of individuals providing care to loved ones increases dramatically over the next 20 years, healthcare providers will need to be especially vigilant in detecting the “hidden patients” they work with. If we are able to diagnose the disease years before symptoms appear, the acceptance and use of respite will be critical for caregivers maintaining their health. Healthcare professionals can work with caregivers to plan ahead with a qualified home care agency to maintain loved ones in the community with their family and friends.
Experience has taught us that professional caregivers are invaluable partners to families on their AD journey. As we celebrate efforts of professional and family caregivers and dedicated research and health practitioners this month—and throughout the year—we look forward with great hope and even greater understanding of how best to serve this population.
— Diane Walker, RN, MS, is vice president of learning and performance systems at Griswold Special Care and the editor of CaringTimes, a publication and website for family caregivers and healthcare professionals (www.caringtimes.org).
Sexuality in Nursing Homes: Preserving Rights, Promoting Well-bein
Sexuality in Nursing Homes: Preserving Rights, Promoting Well-being
By Jennifer Sisk, MA
By Jennifer Sisk, MA
Sexual desire does not disappear with age. Professionals play a key role as advocates for the rights of nursing home residents to express their sexuality.
For many older Americans, entering a long-term care facility means giving up their independence, their homes, their livelihood, and many of their favorite possessions. Often adding to these major losses is the perception that the freedom and privacy to express their sexuality has also been lost. Because society tells us that sex is for the young and healthy, it is mistakenly assumed that sexual desire dwindles after a certain age. Sexual expression by residents in long-term care facilities is often misinterpreted as a behavioral problem, but it may be a sign that an important basic need—the need for human touch, closeness, and intimacy—has been overlooked.
Legally, residents of long-term care facilities are entitled to express themselves sexually as long as sexual expression is not a public display, is consensual between residents, and does not harm the resident or others. However, barriers remain, and for many residents, appropriate sexual expression may be prevented by lack of privacy, physical and mental health status, lack of institutional policies and procedures, and staff or family intervention.
Responsibility for Residents’ Rights
In response to the often-sensitive issue of geriatric sexual expression, some facilities have established firm policies and procedures to ensure that staff supports residents’ rights.
In response to the often-sensitive issue of geriatric sexual expression, some facilities have established firm policies and procedures to ensure that staff supports residents’ rights.
In the early 1990s, the research department at the Hebrew Home for the Aged in Riverdale, NY, decided that it needed to formalize resident rights to sexual expression and created a sexuality workgroup composed of social workers, psychiatric nurses, therapeutic recreation specialists, researchers, residents’ family member representatives, and religious representatives to establish policies and procedures related to sexual expression and residents’ rights. The current policy specifically outlines residents’ rights to privacy, sexual expression, and intimate relationships, as well as delineates staff and facility responsibilities in upholding these rights. With the aid of a $250,000 grant from the New York State Department of Health, the Hebrew Home also produced a training video, “Freedom of Sexual Expression: Dementia and Resident Rights in Long-Term Care Facilities,” which presents both appropriate and inappropriate sexual expression and has since been sent to all long-term care facilities in New York State. The video introduces the importance of each facility having residents’ rights policies related to sexual expression and the responsibility of staff in upholding them.
The rights of residents in a long-term care facility to engage in appropriate sexual activities have not always been clear cut and supported by staff. According to Robin Dessel, LMSW, assistant director of social services at the Hebrew Home, supporting the sexual rights of geriatric residents is keeping with the relatively recent movement to deinstitutionalize long-term care facilities. This holistic movement involves changes in facility design, creative programming, and individualization of resident care. For example, at the Hebrew Home, a patient floor previously referred to as “The Alzheimer’s Unit” is now called a “Special Care Neighborhood.” The Hebrew Home recently constructed a new resident-centered pavilion with private rooms and bathrooms called households. This change in the culture and philosophy of long-term care has the ultimate goal of making the end-of-life experience more appealing, says Dessel, and the new attention to residents’ rights to sexual expression is part of the overall change in philosophy. “The facility is now viewed as the resident’s home. The term home implies a place of choice, a place of pleasure,” says Dessel, where appropriate sexual expression can occur.
Additionally, the health benefits of sexual expression and intimate relationships for geriatric residents are being realized. “As people age, they do not lose their need for intimacy, and in fact, because of losses due to nursing home placement, declining health, and lifestyle changes, the need for intimacy may even be greater,” notes Catherine C. Bradley, MSW, LCSW, ACSW, a long-term care social work consultant for nine years. “An intimate relationship with another resident can enhance self-esteem and well-being.”
The resident’s happiness and quality of life is important. Dessel adds, “Warmth, closeness, and touching with another resident can alleviate the profound loneliness that affects many long-term care residents.”
And, residents are not necessarily seeking only sexual gratification. “They are seeking comfort, companionship, and human touch to combat feelings of loss and isolation,” says Janis Lyons, LCSW, a geriatric social worker at the Motion Picture & Television Fund (MPTF) long-term care facility in Woodland Hills, CA. “This expression is vital for their emotional and mental health. It enhances the quality of the remainder of their life.”
As more facilities realize that sexual expression is essential to their residents’ quality of life, the role of the geriatric social worker has grown to include daily interaction about this issue with both nursing home residents and staff.
Professionals as Advocates
When an appropriate consensual relationship develops between two residents, professional staff can support the residents by monitoring the relationship to make sure that it remains consensual and residents do not become agitated or upset. In many cases, simply spending time together, holding hands, kissing, and hugging are the extent of sexual expression. When a relationship between residents progresses to sexual activities that require privacy, social workers can often help arrange private space and time for the couple. “It is important to make sure that both residents are able to consent and have been counseled on safe sexual practices and understand that sexual activity should be in private,” says Bradley.
When an appropriate consensual relationship develops between two residents, professional staff can support the residents by monitoring the relationship to make sure that it remains consensual and residents do not become agitated or upset. In many cases, simply spending time together, holding hands, kissing, and hugging are the extent of sexual expression. When a relationship between residents progresses to sexual activities that require privacy, social workers can often help arrange private space and time for the couple. “It is important to make sure that both residents are able to consent and have been counseled on safe sexual practices and understand that sexual activity should be in private,” says Bradley.
In most nursing homes, rooms are double occupancy, and private room time is difficult with a roommate. “There are limited options for privacy in such a structured environment,” says Doreen Delgado, MSN, ANP, a nurse practitioner and educator at the MPTF. At the Hebrew Home, Dessel says, “When possible, we will find a private room for one member of the couple. If that is not possible, we can arrange private time in a shared room when the roommate is participating in a chosen recreational activity elsewhere.”
“Ongoing staff education is needed to ensure rights to sexual expression in the geriatric population,” Bradley says. Clinical staff may view nursing home residents more as patients, focusing primarily on their medical needs rather than personal and emotional needs. “Clinical staff need to understand that elderly long-term care residents have very real sexual needs that might exceed what staff would consider their clinical needs,” Dessel observes. “These are people, not just patients,” she emphasizes at regular monthly orientation meetings for new staff.
Personal beliefs about sex can also influence how clinical staff deal with sexual expression. At the MPTF, staff members enjoy seeing companionship between residents, but they often find it difficult to deal with sexual expression, Lyons notes. “On a consistent basis, our staff are distressed about resident sexual behavior, even when it is appropriate. Their religious and cultural beliefs affect how they view sexual expression between residents,” says Delgado. Same-sex relationships and residents who are still legally married to a spouse outside MPTF are especially problematic for most staff members, even though residents have the right to engage in such sexual expression, according to Delgado. “Some staff members remain uncomfortable with residents’ sexual behavior,” she says, “mostly due to their own cultural issues related to sexuality.” In the Hebrew Home’s “Freedom of Sexual Expression” video, the narrator says, “A hundred staff members can have 100 different personal, moral, and religious approaches to sex, but there can only be one institutional approach.”
When the Hebrew Home introduced its policy on sexual expression, Dessel and a psychiatric nurse did multiple in-service trainings to introduce the new policy and its importance to all staff members—from nurses to housekeeping staff. “We explained that we were not looking to challenge or change a staff member’s personal beliefs or to offend them. We are simply asking them to uphold the rights of residents and not deny them appropriate sexual pleasures,” Dessel explains. At the in-service trainings, methods of dealing with different sexual expression scenarios should be discussed. Often, simple, non-threatening, and nonconfrontational actions—such as discreetly closing a resident’s room door or privacy curtain if they see a resident or residents engaged in appropriate sexual activity—are effective, says Bradley. However, in many cases, clinical staff cannot determine whether sexual expression is appropriate or beneficial to the resident(s). The geriatric social worker then acts as a resource for staff members.
While the staff of a nursing home may consider certain sexual behaviors to be aberrant or perverted, as long as the behaviors are safe for the resident or others and are not performed in public areas, residents have the right to engage in those behaviors. These rights are no different from those of older individuals who live in their own homes and engage in such sexual expression privately. For example, a staff member may be personally offended by homosexuality or masturbation while viewing sexually explicit materials. However, staff members do not have the right to impose their sexual preferences and views on any resident. Frequently, male residents, especially those with dementia, can become less inhibited in public. How does a staff member handle a situation where a male resident begins masturbating while watching television in a public area with other residents? Moving the resident to his own room, where he can view pornographic materials and masturbate in private, supports the resident’s right to sexual expression without offending other residents. “The sexual expression is not wrong, only its public display,” says Dessel.
Progress for the Future
Based on communications and questions from staff at other facilities, Dessel believes there is a greater recognition of geriatric sexuality, and a move toward understanding that sexual expression is a reality in long-term care. “It is prudent to acknowledge resident sexuality to plan for these situations,” she says.
Based on communications and questions from staff at other facilities, Dessel believes there is a greater recognition of geriatric sexuality, and a move toward understanding that sexual expression is a reality in long-term care. “It is prudent to acknowledge resident sexuality to plan for these situations,” she says.
Bradley says most facilities she works in do not have specific policies for residents’ sexual expression. Delgado and Lyons both note that there has been a rise in consciousness about residents’ rights to sexual expression at MPTF, but there is also continued embarrassment and discomfort among the clinical staff. “We are not anywhere close to actively promoting sexual expression,” says Delgado. “For residents to thrive in long-term care, we do need to look at every aspect of well-being, and that includes intimacy with other residents,” she adds.
— Jennifer Sisk, MA, is a suburban Philadelphia-based freelance writer with 15 years of experience as a writer and a research analyst in the healthcare field. She has written on depression, attention-deficit/hyperactivity disorder, schizophrenia, mental wellness, and aging.
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