Pneumonia is called an old man’s friend because it is often the case that the patient will drift into a state of reduced consciousness, slipping peacefully away in their sleep and providing a dignified end to life.

Pneumonia is common in the elderly. In an article written by Dr B Tipping (1), the estimated rates of hospitalisation for a primary diagnosis of influenza or pneumonia per 100 000 person years were:

• 6.8 in the age group 5 to 49 years
• 219.5 in the age group 75 to 79 years
• Over 600 in the age group 85 years and older

It is important to recognise the context within which pneumonia occurs, because the management differs between each one. The most important contexts are:

• Community-acquired pneumonia (CAP) in fit elderly persons can be managed according to standard guidelines.
• CAP in persons with additional diseases or poor nutrition often produces a mortality up to 30 percent.
• Aspiration pneumonia occurs in frail institutionalised persons and is associated with stroke or vascular dementia.
• Nursing home-acquired pneumonia also occurs in institutionalised elderly persons, making preventative strategies particularly important.

What are the symptoms of pneumonia?

• Coughing, fever and difficulty in breathing may be present in most cases.
• Falls, confusion, new or worsening incontinence, or deteriorating ability to carry out daily activities.
• Respiratory rate > 30 breaths per minute, heart rate > 90 beats per minute, blood pressure < 90 mmHg, temperature < 36.5˚C or > 38.1˚C

When some of these symptoms are present, ensure that the patient is admitted to hospital as soon as possible. It is not easy to identify pneumonia in the elderly, because they may not suffer classic symptoms like fever, chills and cough, so look out for weakness, confusion, dizziness or delirium. Since pneumonia can originate from bacteria or viruses, washing hands regularly will help to prevent the spread. Help your loved one by screening them from visiting others who are ill with colds, flu or respiratory infections. Give encouragement for them to be vaccinated against pneumonia and keep themselves in good general health.

Reference:

1. Pneumonia in the elderly – diagnosis and treatment in general practice Tipping B, MBChB, FCP(SA) Senior Registrar, Division of Geriatric Medicine, University of Cape Town De Villiers L MBChB, FCP(SA) Specialist, Division of Geriatric Medicine, University of Cape Town

Firstly, let us understand what a stroke is.

• A stroke can be the result of a blockage in an artery, which carries blood from the heart to the body.
• It can also be the result of a rupture in an artery, which interrupts blood flow to the brain.

In either case, brain cells become starved and brain damage occurs. Separate areas of your brain control distinct areas of your body, so the area of damage will show up as loss of functionality in the section of your body that this area controls. Take note of the signs and symptoms of the patient to help medical staff to identify the location and extent of the damage. Use the acronym FAST:

• F is for face: If the patient is conscious, as them for a smile, and check if one side of the face droops.
• A is for arms: Ask the patient to lift both arms and check if one side drifts downwards.
• S is for speech: Ask the patient to repeat a sentence and check for slurring of words.
• T is for time: If you observe any of the above, call for an ambulance immediately.

How else could you have identified the stroke?

• Sudden numbness down one side of the body
• Sudden confusion or loss of understanding
• Sudden blurred vision
• Sudden trouble with balance or muscle coordination
• Sudden severe headache without any known reason

Was there anything you could have suggested beforehand to prevent a stroke?

Yes, age is a significant contributor, and we cannot control that, but there are other risks that can be controlled:

• High blood pressure is a big contributor. An increase in the force with which your blood is pushed through your blood vessels can weaken them and produce an aneurism or bulge in an artery, which could rupture.
• Diabetes is caused when the pancreas does not generate enough insulin, which is designed to combine with glucose in the blood stream in order to feed the body’s cells. Too much sugar around the cells, where the sugar has not joined up with insulin, will hinder the normal functions of the cells.
• Drinking large amounts of alcohol has been shown in studies as increasing risk.
• Nicotine from smoking clogs lung walls, speeding up the process of clogging.
• Atrial fibrillation, where the upper chambers of the heart beat rapidly, can produce pools of blood in the heart, which can then form clots. This is treatable if it becomes a repeated problem.
• Atherosclerosis is a problem my father had. It is a progressive accumulation of fatty deposits and other cells, on artery walls. The clogging can produce the same result as a blockage.
• Cholesterol is a fatty substance in the blood stream, often caused by eating too much fatty foods.
• Obesity is linked to high cholesterol, high blood pressure, and diabetes, so encouraging healthy eating and physical activity, such as walking, can reduce the risk of a stroke.

So if you are brave enough, give your parent this advice, that treating the above health conditions or managing unhealthy lifestyle risk factors could enable them to get around and enjoy life a whole lot longer!

“You never know when that will come in handy” is one of my favourite expressions when something is slightly broken. It can be difficult to throw things away and then to buy a replacement. A move to a new residence, either in order to be closer to medical attention or for financial reasons, could illicit the same emotion, except this time it needs to be managed.

There may be less storage space in the new residence, which could result in a resistance to the downsize, because getting rid of possessions that have been accumulated over a lifetime is the same as losing cherished memories, or is it? If you are facing this situation at the moment, there is a mental process that you can follow to make the moving process easier.

Studies have confirmed that compulsive hoarding is strongly familial and that it involves a different pattern of glucose metabolism in the brain as opposed to the pattern of non-hoarding patients. Families that showed hoarding tendencies showed a unique pattern of chromosome 14 as opposed to chromosome 3 in other families, in a sample of 999 obsessive-compulsive disorder patients at the John Hopkins School of Medicine. The advice given is for parents and their children to be open and honest about the issue, because people who can talk about the problem are much more able to control their compulsive hoarding than those who cannot do so. Biology is not destiny.

One possible solution to compulsive hoarding that will reduce the distress is to encourage the donation of goods to local charities, because it should then be replaced by a logic that the things had not really been useful and that other people might get more use out of them.

Enlisting friends and family to help in the physical process would make it go faster, and if you can separate the special mementos, it will be less overwhelming and time consuming. Letting family members choose their own mementos will help with the thought of keeping it in the family.

Diogenese syndrome is the medical term given to extreme cases of hoarding, where the home or office becomes unusable, extreme self-neglect and domestic squalor is present and social withdrawal occurs. Miss Havisham in Great Expectations is a good example of this, when she would sit at her dressing table in a rotting and never used wedding dress.

The suggestion above that it could be a medical condition, together with known causes and symptoms, should help you and a possible caregiver from Senior Support to get the help needed.

References:

The Genetics of Compulsive Hoarding – Jane Collingwood
Great Expectations – Charles Dickens

Lewis Carroll wrote in Alice in Wonderland:

Hatter: (tossing his head contemptuously) I dare say you never even spoke to Time!

Alice: Perhaps not, but I know I have to beat time when I learn music.

Hatter: Ah! That accounts for it. He won’t stand beating. Now, if you only kept on good terms with him, he’d do almost anything you liked with the clock. For instance, suppose it were nine o’clock in the morning, just time to begin lessons, you’d only have to whisper a hint to Time, and round goes the clock in a twinkling! Half-past one, time for dinner!

 

The perception of the passage of time can vary from one person to another and from one situation to another. We may have a watch on our wrist, but our own perception of time is made up by our senses. This internal timepiece enables us to measure the length of events of the day by comparing the experience of each event with similar ones in memory. In the process we build up a knowledge bank of the flow of time and an assessment of the passage of time.

 

Our level of focus and mood will make a huge difference. If you are tense because you are in a hurry, but are waiting for the toaster to pop up the toast, it can seem to take forever. If the activity you are involved in is boring, time seems to drag. Most parents will have heard the phrase “Are we there yet?” from the back seat of the motor car. When you are multi-tasking, however, the passage of time seams to speed up, because our attention is divided. A reduction in our ability to focus on any one task as we get older may produce the same result.

 

An event that creates an adrenaline rush from fear will cause our internal timepiece to seem to run more slowly. This may be linked to survival, providing you with enough perceived time to take evasive action or react to danger. Times of enjoyment seem to be over in a flash. I can remember saying “Do we have to go already? Just one more wave?” when we had a day at the beach. Perhaps we have more fun as we get older!

 

Our most definitive memories appear to be between the ages of 15 and 25, and if our frame of reference is from memories of this time, while the vividness of our memory may be on the wane, this could account for a change in our perception of its passage. If we develop various clinical conditions such as autism, attention deficit hyperactivity disorder, Alzheimer’s or Parkinson’s disease, our accuracy in estimating time is also affected.

 

Can we maintain our hold on the judgement of the passage of time? Yes, if we can improve attention and memory, we can keep our internal timepiece in check. Completing puzzles such as Sudoku, reading thought provoking books, meditation and mindfulness can help. Television is a great way to switch off from the troubles of the day, but it has been proven to slow down the cognitive processes significantly, so the more you can avoid it, the better.

 

For more interesting articles, please visit the library at Senior Support.

 

Reference:

The Conversation

Authors:

Muireann Irish, Senior Research Officer at Neuroscience Research Australia

Claire o’Callaghan, Clinical research fellow, Behavioural and Clinical Neuroscience Institute at University of Cambridge

Just over a month ago, one of our cats was diagnosed with insulin deficiency. The vet spoke for quite a time about the consequences of taking on the caregiving duties myself, as opposed to putting the cat down, because it would otherwise be in terminal decline. Insulin molecules join hands with glucose molecules to knock on the door of the cells of your body, and are not allowed in on their own. So with insufficient amounts of insulin, the body will atrophy until it can no longer continue without being able to absorb food. It took me a little while of thought, but I am glad in retrospect, because I am at peace with the commitment to providing two injections a day, possibly for as long as she lives. Her recovery has been steady and totally rewarding.

There is clearly no connection with putting your parent down! The connection is whether you are ready to become a caregiver for your elderly parent and understanding the consequences. Given the rising cost of nursing homes, this is most likely going to become your role.

1. You need to ask yourself whether you will have the available time while filling your roles at home, at work and in the community, to coordinate providers, assist with communication, mediate with medical professionals and respond to disasters that my occur in the life of your parent. You may need to provide transport and food, manage prescription medicines and medical appointments and perhaps provide shelter in the future.
2. Ask yourself whether you are physically capable of taking care of your parent, taking into account the possibility of lifting and bathing. Do you need to ask for help from an organisation such as Senior Support?
3. If your parent has dementia, are you prepared for the possible symptom of their not being able to filter their behaviour? Being able to cope with hurtful words or actions is not as easy as it sounds, given your family connection.
4. The commitment to caregiving is bound to affect your physical and mental health. If you find that you are not prepared for this, then you can talk to Senior Support.
5. You will not always be available, and if life throws a curved ball, do you have the social support who can stand in for you? Would you allow yourself to accept help to be able to take a break?
6. Are you ready for the financial costs of caregiving, when your parent finds their resources dwindling?
7. Does your employer allow you time away from work to attend to the requirements of your responsibilities?

If you are still ready to become a caregiver, you should always remember that there is only so much that you can do yourself, and that Senior Support specialises in this field.

It is well known that the sleep you get tonight will affect the type of day you have tomorrow. Senior loved ones tend to require less sleep, but if they are having trouble getting to sleep, it could impact your day as well. Preparing a bed time snack of the right ingredients can help to calm the body and relax the mind.

Sleep friendly foods:

1. Healthy, unsaturated fats will increase your serotonin levels and make you drowsy. Almonds contain plenty of protein and magnesium, so they are good for muscle relaxation. Avocados, walnuts, cashew nuts or peanut butter also improve the health of you heart.
2. “What about a nice glass of warm milk before you go to bed?” a lot of mothers will say. The calcium in the milk helps to regulate melatonin and a spoonful of honey makes it more soothing.
3. I once drew a picture of my brother’s foot, which was facing me when he fell asleep after a family Christmas meal. Lean meat, such as turkey or fish, which are high in tryptophan, a banana, a rice cake or an egg can all increase serotonin levels. Tryptophan is an amino acid needed for nitrogen balance in adults. It cannot be produced by the body, so has to come from your diet.
4. Bananas are also known for their potassium and magnesium, which relax the muscles. Magnesium can also be found in nutrient rich fruits like apples, apricots and peaches.
5. Whole grain biscuits, a bowl of oatmeal or cereal, or mashed sweet potato can provide you with complex carbohydrates, with the bowl of oatmeal containing calcium, magnesium, silicon and potassium.

Not so friendly foods:

1. Forget the addition of coffee to your toddy, because caffeine can prevent sleep altogether, and too much chocolate can too.
2. Alcohol may put you to sleep, but there are no guarantees on the quality of that sleep!
3. Spicy or greasy foods will argue with your stomach and keep you awake.
4. An insulin release to cope with high volumes of refined sugar as in sweets, can cause indigestion, as can large amounts of protein.
5. Over eating in general will also lead to indigestion, and too much liquid within about 90 minutes of bedtime will get you up in the middle of the night.

So, get these right and it should be a good night’s sleep for everybody!

The health benefits of Animal Assisted Therapy (AAT)

The link between humans and animals, providing health benefits to the mind, body and spirit are well documented. [1] The role that animals play to create optimal healing environments is known as animal assisted therapy, and normally refers to the use of dogs and cats, but fish and guinea pigs have also been successful. The bond that forms induces relaxation by reducing cardiovascular reactivity to stress.

In each therapy case, the animal was either owned by the patient, or took part in visits. During visits, patients would show significant decreases in blood pressure, artery pressure and anxiety. AAT has been associated with slowed respiratory rate, lower temperature and reduced pain. These are all brought about as a result of a response of relaxation or distraction from their pain or situation. [2]

Dawn Marcus and colleagues [3] conducted a study at an outpatient clinic, with patients sitting in a waiting room or in a room with a therapy dog in it. It was found that there were significant improvements in pain, mood, and other distressful measures in the room with the therapy dog. The study took place over a two month period and its findings have encouraged many nursing homes and hospitals to elicit the help of cats and dogs as a comfort for patients in their time of need.

Paws for People® Therapy Dogs was founded in 1997 by Lesley de Klerk. It is a South African based non-profit organisation that currently offers Animal Assisted Therapy and Animal Assisted Activity programs in Gauteng, Free State and KwaZulu Natal and has a sister unit in Cape Town, called Paw Pals. They are available at Paws for People or Paw Pals, and their mission is to make a positive difference in the lives of the patients, residents and children with whom they interact during the course of the various programs that they support.

 

References:

1. Griffin JA, McCune S, Maholmes V, Hurley K (2011). Human-animal interaction research: An introduction to issues and topics. In McCardle P, McCune S, Griffin JA & Maholmes V (Eds.). How animals affect us (pp. 3-9). Washington D.C.: American Psychological Association.
2. Stoffel J, Braun C. Animal-assisted therapy: analysis of patient testimonials. J Undergrad Nurs Scholarsh. 2006; 8(1).
3. Marcus, Dawn; Berstein, C.; Constantin, J.M.; Kunkel, F.A.; Breuer, P.; Hanlon, R. (2012). “Animal-assisted therapy at an Outpatient Pain management clinic”. Pain Medicine 13 (1): 45–57

Stability when you are on your feet becomes more important as you get older. I recall seeing my father teetering backwards down our driveway and seeing the grazes on my mother’s face after she had taken a tumble on a pavement and telling myself “You are not going to follow a sedentary lifestyle if this is what happens”. Attending a gym is great fun, but there are many exercises you can follow without going anywhere.

1. Muscle maintenance can be achieved using squats. Lower body strength can be promoted by squatting in front of a sturdy chair, holding on to the sides of the chair and slowly bending down to a sitting position. Make sure you do not extend your knees past your toes but hold the position for a few seconds before standing straight. Repeat in sets of ten, with a breather in between sets.
2. Bicep curls with light weights. Hold the weights down at your sides with palms facing up and elbows tucked in, then bend the elbows to lift the weights towards your chest. If you hold the weights for a second, then lower the arms and use sets of ten, with a breather in between sets, you will retain your ability to do the daily lifting tasks easily.
3. Push-ups will improve arms, chest and shoulders. Your back will need to stay straight, by balancing on your toes and hands below your chest. You could use a wall to begin with, by standing an arm’s length away, leaning towards the wall and pushing yourself away. Use sets of 10 repetitions with rest between each.
4. Arm raises improve upper body strength. Raise light weights from shoulder height and straight arms to above your head, hold and lower again. Do two sets of 10 repetitions from a forward and side starting position, with rest in between.
5. To improve balance and to strengthen hips, buttocks, thighs and lower back muscles, use leg raises. Stand behind a chair and hold on for better balance. For side leg raises, lift a leg out to the side, while keeping it straight, and with a straight back, then lower it. For back leg raises, do not bend the lifted leg or point the toes. Do two sets of 10 repetitions for each leg.
6. A good balance exercise is a chair stand, where you start in a seated position, extend your arms parallel to the ground and slowly stand up, without support from your hands. Toe stands require you to stand behind the chair and repeatedly raise yourself onto your toes, holding the position for a moment before lowering again.
7. To stretch your lower body, stand behind a chair, while holding on with the right hand. Bend your left leg behind you and grab your foot with the left hand. Keep the left leg perpendicular to the floor and stretch for around 30 seconds. Release and swap sides.

Make sure you do not exceed your target heart rate, which is 220 less your age, then multiplied by 70 percent. Drink plenty of fluids before, during and after exercise and include warm-up and cool-down periods. Skip workouts if you are ill or over tired. Keep a level of exercise that retains your enthusiasm, because this has to be a lifestyle.

This may save you from learning the hard way, how to communicate successfully with elderly parents. Parents who once looked after you will be looking for your support and care more and more as they age. The roles are reversed, but there are techniques that can reduce tension and enable you to cope.

1. Accept that there may be differences of opinion. People from different generations are bound to see things in their own way. Respect each other’s differences rather than disregarding them, and reach decisions together whenever you can.
2. Speak distinctly. I know I don’t always catch everything people say to me, which leads to interesting conversations, but not everybody will admit to failing hearing. Identify which pitch of your voice is more audible to your parent and try to focus on using that pitch. Face the person you are talking to, because lip movement plays an important part in guessing what is being said.
3. Don’t give the impression of being condescending. Being patronising is a sure way to ignite an argument. Stay calm and be prepared to repeat yourself.
4. Only play the advisor when you are asked to do so. Role reversal will not be an easy journey for your parent. If possible, ask a person that is not a member of your family to make the suggestions, and take on the role of encouragement and support yourself.
5. Listen fully to what your parent is trying to convey. There may be subtleties in the speech that you may need to respond to. Allow for passages of silence, and show the respect of not interrupting. I found that a game of Scrabble with my mother was an ideal way to use our time together.
6. Avoid competition with other noises. Ambient sounds such as a radio, a group of people or the television may cause your parent to withdraw, because differentiating voice patterns amongst them becomes difficult. Try to ensure that your parent is between people talking to each other, if possible.
7. Try to put yourself in their position. I remember my parents becoming interested in the hatch, match and dispatch columns of the newspapers. A series of losses during later years is bound to cause a sense of loneliness on their part.
8. Laughter is the best medicine. It cements relationships, can clear the air and reduce tension.
9. Don’t sweat the small stuff. The challenges as you get older would include decreased physical fitness, mobility limitations and shortage of memory. Giving way at times may seem to be losing, but trust in the fact that you may gain a lot in the relationship.

Senior Support hopes that these tips can prove helpful in improving effective communication with your parents.

Senior medication safety suggestions

Are you concerned about the amount of prescription medications that are on your parent’s medication list and whether or not the continued use of chronic medication is appropriate? It is a reasonable thought, considering the possible side effects when you take medications. Research has shown that “inappropriate prescribing” is common in older adults. Some medications have risks that may be greater than their benefits for people aged 65 or more.

As we get older, our bodies change, and since elderly people generally take more medications than younger people, the chance of drug to drug interactions increases. With increasing numbers of people waiting to see doctors, it is possible for a doctor to miss the identification of a risk, and this is where you could help. The American Geriatrics Society has created a list of drugs that have potentially inappropriate medication risks in older adults, called the Beer’s Criteria.

To help your doctor spot oversights, there are five things you can do:

1. List all medications your parent is taking, together with their reason for needing them. A pharmacist will be able to help you check for medications that serve more than one purpose.
2. If the purpose of the medication was to control a symptom, it may be that the symptom needs to be checked again. If use of the medication has not caused an improvement, then the dosage or the medication itself may need to be changed. Auto pilot is fine for aircraft, but keeping to a dosage should be a conscious decision.
3. Check the medications are not on the above Beer’s Criteria by using your browser’s search feature. If you do find it on the list, ask the doctor about any non-drug techniques that may be used as an alternative.
4. Check for any signs of over-treatment. Conditions such as high blood pressure and diabetes need to be monitored to ensure that the dosage remains appropriate. Over-treatment of high blood pressure can cause a blood pressure that is too low, resulting in dizziness, which could cause a fall.
5. Check for signs of interaction between drugs. There are free online drug interaction checking web sites that can help.

HealthCare works best when it is a partnership between patients, family caregivers and medical practitioners, and requesting a medication review will ensure that your parent is handled in the best possible way. Senior Support is an organisation that can help with call centre support and emergency call out support if that is what you require.

Reference:

Senior medication safety checklist by Leslie Kernisan MD, a practicing geriatrician.