When it hits home

They say, “Practice makes perfect.”

As a nurse, it’s my job to connect with older adults and their families. I read and hear their stories all day. I've been trained to "speak doctor" and understand the weight of the conversation down to the numbers. My professional career is all about aging – the good, the bad, and the ugly. 

Nothing could have prepared me for being a caregiver. 

I’ve written before about my grandfather and the day both our lives changed. At the end of the story though, our lives did go back to normal--a new normal. Physically, he rebounded. Time in an assisted living with daily physical therapy brought back most of his strength. We were all looking forward to having him back home when...

I walked into my grandmother’s hospital room. She was there after she fell backwards onto the concrete sidewalk while fixing the garden. As I leaned over to give her a hug, she yelled, “Don't you touch me! I saw you kissing that other man. What are you going to tell John!?”

Her hallucinations only increased as she sat in an empty room speaking with her "visitors".  I'd walk in quietly, not to interrupt, and shortly after get blamed for "scaring away friends". As she slept, my eyes would darn between her heart monitor, to her, to the number on the IV pump, back to her. The two roles inside me, all nurse yet all granddaughter, drove both into over drive.    

I fought to catch my breath and hold back the tears, all the while trying to keep a smile on face for Grandma. Why wasn’t I prepared for this? I knew what to expect. I knew how to handle this. Yet the thousands of stories, the countless talks with the doctors, and all my research and training, could have never prepared me for the emotions of actually being a caregiver.

Today,  I applaud you caregivers as a nurse and I empathize with you as a caregiver. Our journey may differ greatly, but now when I look into the eyes of another caregiver to teach them about their "new normal", I allow them to look into my eyes. With just a glance, those who have been there, know. The dreaded call, the late night in the emergency room, the torture of waiting for that result or that doctor, that shred of hope that still holds on.

Fellow caregivers and healthcare workers, I'd like to invite you personally to join me Monday nights on twitter. I'll be hosting a TweetChat at #Nurseup at 4pm PST or 7pm EST. Topics will center around caregiving and available resources.

Our first meeting, Monday November 18th, will cover challenges of being a caregiver and helpful resources. I would like to partner with you to bring to light the true role of a caregiver and put the best resources into the right hands.

Looking forward to meeting you and hearing your story. 

Nursing Home vs Assisted Living

Recently, PBS came out with a chilling report that looking deeper into the Assisted Living cooperation Emeritus and found horrific cases of wrongful placement of seniors within it's facilities that lead to tragic endings. It's well worth your time to watch the 53 minute report, here.

It's an impasse that leads to big decisions and uncomfortable conversations, and yet so many families are struck with the fact that they can no longer care for their mom, dad, or loved one. 

Lots of emotions surround this topic; namely guilt. 

I've been there. 

Usually people turn to group homes of some kind. “That’s everyone’s first thought,” said Lisa Gwyther, the veteran social worker who directs the Duke Family Support Program in Durham, N.C. “Everyone says, ‘My mom doesn’t belong in a nursing home,’ so they think assisted living, regardless of her medical needs or prognosis.”

But assisted living is not for everyone, either. Ms. Gwyther and Dr. Hawes are now speaking out to give guidance on which older people are likely to do well at such facilities and which will need the greater supervision and higher staff ratios that nursing home can offer.

“Nursing homes have gotten a bad rap,” Ms. Gwyther said. There are good ones, and there are seniors who need them.

For instance, “anyone with moderate to severe cognitive impairment and problem behaviors like resisting care or becoming alarmed if someone tries to help them shower generally belongs in either a dementia unit with well-trained staff or in a nursing home,” Dr. Hawes said. In assisted living, “there’s not enough staff to help.”

This also goes for seniors with complicated medical conditions that require frequent monitoring. Assisted living doesn’t provide much health care, so residents risk becoming what Ms. Gwyther calls “frequent fliers — they’re going in and out of hospitals for conditions that could perhaps be treated in a nursing home.” This not only increases costs for the family, but also increases the change of their loved on being  exposed to the harmful bugs (various contagious illnesses, antibiotic resistant bacteria, etc.) within the hospital. 

Assisted living can pose a problem for seniors with incontinence as well. Although most assisted living facility will accept someone who’s incontinent, what they mean is 'as long as they can change their own briefs'. Dr. Hawes cautions against assisted living,  "(If) what you mean is, ‘She needs help getting changed four times a day and needs the sheets changed every other day.’” Housekeeping staff in assisted living typically change linens weekly.

Furthermore, federal regulation provides greater protection for nursing home residents. State regulations govern assisted living but they vary widely. 

Nevertheless, assisted living can work well for people with mild cognitive problems, who particularly cherish privacy, and who are sociable and alert. They usually offer interactive programs that create an environment for socializing and the creation of new hobbies. 

I urge you, for the sake of your loved one, regardless of their location (including home) don't ignore the warning signs. If you notice that they smell of urine or feces, if they're becoming increasingly (and unusually  anxious or lethargic for a length of time, or simply just not themselves; speak up.

It won't hurt to ask questions. It certainly won't hurt to get a second opinion. If anything, it may even prolong their life or save it.     

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Share this report and increase the awareness of the differences between assisted living and nursing homes. This post is not intended to discourage or encourage one or the other. It's purpose is to simply inform, so your loved ones don't become like one of the grim stories from the PBS report. 

To your wellness, 
Leah Korkis, BSN, RN

Reduce Depression Symptoms in Elderly and Adult Grandchildren

The number of grandparents raising grandkids surged during the Great Recession. In 2011, according to a Pew Research Center report, grandparents were the main caregivers for more than 3 million children. There are still many reasons why this is necessary today – military service, untimely death, incarceration, substance abuse, mental illness or problems with layoffs and foreclosures.



The second Sunday in September is always Grandparents’ Day. But every day is a good time to celebrate caring across the generations. For many of us growing up, our grandparents were the ones who gave us whatever we wanted, as long as we didn’t tell our parents. And as the grandma of five grandsons, I’d say that still applies today.

There’s a buzz about Granny leave for women caring for elderly parents. American businesses stand to lose close to $34 billion a year due to employees taking time off to care for aging loved ones. As the number of family members available to care for loved ones decreases and the number of those in need increases, our society is facing serious social issues. 

How do we honor intergenerational relationships, highlight aging with dignity and demonstrate the growing need to support caregivers?

Lots of Millennials, with huge student loans and no jobs are boomeranging back home. As the first generation to grow up with terrorism, the Internet and globalization, they’ve developed a thoughtful approach to navigating a chaotic world. According to the 2011 Millennial Impact Report, three quarters of them donate money to charitable causes and almost two thirds volunteer their time.

So how about reconciling the growing need for caregiving by pairing available millennials with grandparents who would love the emotional connection. The bonus? A new study shows that a good relationship between grandparents and their adult grandkids may bring emotional benefits – specifically fewer depressive symptoms – to both.

Grandparents in the study who were able to give back tangible support had the biggest boost in mental wellbeing. Of course, we all like to have a sense of purpose and feel needed, worthwhile, and independent.

So let grandma share her best recipes, write a birthday check, give you that family heirloom. Ask grandpa about life and learn as he tells you stories about his successes and failures. You’ll see that a two-way supportive relationship can be a win/win for everyone.

Post by: Phyllis Goldberg, Ph.D. and Rosemary Lichtman, Ph.D. are consultants in family dynamics. Whether you're coping with marital stress, acting out teens, aging parents, boomerang millennials or difficult in-laws, we have practical solutions. Log on to http://www.HerMentorCenter.com - sign up for a free ezine, “Stepping Stones,” and download complimentary eBooks, “Reaching Your Goals” and “Taking Control of Stress.”

9 Tips For Moisturizing Your Feet

Skin is an important barrier that prevents infections in the body. Skin that is dry is more prone to itchiness, rashes and infection. Extremely dry skin, especially in the heel area, can develop painful cracks called fissures. These fissures are susceptible to bleeding and becoming infected.

Source: McDermott Footcare

Dry skin is also more prone to developing painful calluses.

For these reasons, moisturizing the feet is very important. Here are 9 tips for adding much needed moisture to the skin:

1. Wash feet daily with a mild soap and warm water.

2. While feet are still damp use a pumice stone to gently scrub areas that are dry and flaky, especially the heels and callused areas.

3. Dry the feet and immediately apply moisturizer. For moderately dry skin, a regular moisturizer is effective. For extremely dry skin, including skin that has cracks (fissures), use an extra rich moisturizer that contains urea. These moisturizers are available over-the-counter in well-stocked drug stores and department stores.

4. Do not apply moisturizer between the toes. Excess moisture that builds up between the toes encourages the development of athlete’s foot fungal infection.

5. Soaking the feet once to three times a week in a solution of 1/4 cup white vinegar in a shallow basin of lukewarm water helps to improve the condition of the skin. Soak for only 10 -15 minutes since soaking for long periods dries out the skin. Apply moisturizer after towel drying.

6. For an effective night treatment try this: apply a rich emollient moisturizer to your feet and put on breathable cotton socks. The heat from the socks will help skin soak in the moisture.

7. For people who have difficulty reaching the feet, try this trick: put some moisturizer on a plate or other suitable tray. Move your feet around the plate or tray being careful to rub the moisturizing cream into the feet. Step on a towel and gently blot your feet to wipe off excess cream.

8. Alternatively, apply moisturizer to feet using a long-handled paint brush. Wipe off excess cream.

9. Ask your certified foot care nurse to recommend an effective moisturizer.

Related posts:
Vinegar is GOOD for your feet?
8 Tips for Dry, Cracked Heals


Post by: Terry McDermott, RN, Certified Advanced Nursing Foot Care and Diabetic Foot Care Owner of McDermott Footcare

Live in the Toronto area? McDermott Footcare nursing foot care offers clients a moisturizing foot rub as part of their services. 

5 Silent Heart Symptoms You Should Know

You may know the well-publicized signs of heart attack. But are other forms of heart disease creeping up on you or a loved one?

"When we think about heart disease, most people jump right to heart attack -- waking up clutching the chest with chest pains. But that's only the tip of the iceberg when it comes to heart disease," says cardiologist Lawrence Phillips, MD, assistant professor in the Leon H. Charney Division of Cardiology at NYU Langone Medical Center in New York.

It's a myth that all symptoms of heart disease are obvious. The following stealthy symptoms might seem far from your heart, but they way warrant a trip to your doctor.

1. New Aches and Pains

You've probably said to yourself, "I used to be able to....(fill in the blank), but now I have to stop because I get (fill in the blank)." Though this sounds benign, this could be your body's way of telling you something.

A change in function from what's normal for you is one of the key symptoms of heart trouble. Look at it this way: Your heart is your body's engine, pumping blood to fuel all your movements. If you notice a different reaction to an everyday activity, consider it like a warning light on your car dashboard, but in this case a sign of something potentially amiss with your heart's valves or electrical system.

Next steps: Don't dismiss a change in your response to physical exertion by saying, "Oh, I'm getting old" or "I must be out of shape." Find out for sure what the cause is. Especially if you see a pattern, get a physical exam. "There has to be a reason for the change," says Dr. Phillips.

2. Erectile Dysfunction

Trouble getting an erection is often blamed on age or disinterest. Often, however, the problem is an issue of adequate blood flow. Men who have this symptom are far more likely to have another kind of artery problem concerning the heart.

In 2013 a study done in Australian tracked more than 90,000 men. The study found that the worse the erectile dysfunction, the more heart disease and risk of early death a man had. Even those with mild or moderate erection problems were found to be at greater risk of heart attack or early death. Other studies have echoed this: Men with erectile dysfunction are twice as likely to also have cardiovascular disease or to die of a heart attack, according to a study of more than 1,500 men published in the journal Circulation in 2010.

"Arteries are arteries -- problems with blood vessels can affect blood flow to the heart as well as the penis," says cardiologist Lawrence Phillips.

Next steps: Don't be shy about getting erectile problems checked out by your doctor. Viagra treats the symptom but doesn't resolve the underlying issue. (Women: Unfortunately there is less research on sexual response and heart health.)

3. Holiday-Heart Syndrome 

Many people notice a sudden jump in heart rate during exercise, which is normal. However, have you ever had that feeling of a fluttery heart following a bout of drinking? So-called "holiday heart syndrome" -- overdrinking, overeating, and getting too little sleep -- can lead to atrial fibrillation or an irregular heart beat. 

"You might feel it that same evening, or within the next 12 hours," Langone Medical Center's Lawrence Phillips says. Atrial fibrillation is an irregular heartbeat that can cause fluttering in the chest and dizziness that lasts more than a few seconds.

Next steps: If you notice this happening repeatedly, mention it to your doctor. Try to find a pattern of when the symptoms start and report that to your doctor as well. 

4. Swelling Feet and Ankles 

Notice puffy ankles and feet after a long day at the office? Do your shoes seem tighter than they were earlier in the day? The accumulating fluid is an excess that is being pushed out from your vessels and into the skin.

While the swelling can be a temporary problem caused by things like hormonal changes (including pregnancy), a salty diet, or medications, it may also reflect faulty pumping action of the heart. When blood can't be pushed forward, it tends to back up into the veins. Gravity then brings it to the legs.

Next steps: Keep an eye out. If swelling is a change for you and you aren't sure why, get it checked by your doctor. People with diabetes should take special caution; since diabetics are at increased risk for heart disease.

5. Dizziness

While feeling dizzy can happen for many reasons, heart disease is actually close to the top of the list. An irregular heart beat or more advanced valve disease may be the cause. The valves of the heart need to open and close to move blood, however when calcium deposits narrow the aortic valve it can't open more than a crack. This lack of sufficient blood to the brain can lead to feeling light-headed.

Some people feel especially feel dizzy when they stand up (a rapid drop in blood pressure called "orthostatic hypotension"). People with orthostatic hypotension are more likely to develop heart disease, according to research in the journal Hypertension in 2012.

Next steps: Pay close attention to whether you're also having these other symptoms along with your dizziness. Things like shortness of breath, feeling faint with physical exertion, passing out, or having chest pain. Although a one time bout may not be any cause for worry, an ongoing pattern is worth a visit to the doctor. 

As Grandpa said, "What was once wet is now dry, and what was dry now leaks"

Although this may seem like an uncanny expression of the decline of the human body, there is a silver lining. Between ears that don't hear as well, nose sensors that seem blunted, and aches that just don't want to move to their next victim, I am happy to report one thing baby boomers may find they do as well as well as ever: urination. 

In fact, not only are they still doing it, they might be doing it more often than ever. 
A lot more actually.

Now that the kids are grown up, it may surprise you that you are now the one asking to pull over for a pit stop. Although you have trained your kids well, this simply just means that they may have better kidneys, said Dr. Sharon A. Brangman, a professor of medicine at SUNY Upstate Medical University.

People may urinate more as they get older for multiple reasons, including medical problems like diabetes or high blood pressure. Some medicines can be the cause as well. However, it may also be a sign of infection; “That’s often the first thing we look at when people complain of frequent urination,” said Dr. Tomas Griebling, vice chairman of urology at the University of Kansas and a spokesman for the American Urological Association. 

Getting older, Dr. Griebling pointed out, does not necessarily mean more trips to the restroom.  Although many people do notice that they have to go more often, the explanation usually lies with the normal changes of the body.

As people age, their kidneys may become less proficient at concentrating urine and therefore may draw in more water from elsewhere in the body. This means more urine is produced and sent on to the bladder which, as it happens, may be losing some of its ability to stretch. The urethra, the pathway through which the urine exits, may also be shortening and its lining thinning.

Adding to the problem is that with age our bodies produce less of a hormone called aldosterone, that help retain fluid. In women, estrogen levels may also drop, a change associated with increased urination. As for men, the prostate may become bigger making it harder to urinate.

Increased urination knows no time of day, but people seem to notice it more at night due to the inconvenience. In fact, the National Sleep Foundation surveyed people ages 55 to 84, and found that two-thirds of them lost sleep at least a few times a week because of the problem. 

On the up side, talking with your doctor about your increased pit stops may lead to finding an easy fix or get you a stamp for a normal bill of health.