Don't Regret

This is a good read.

Top 5 Regrets of the Dying

Something to keep in mind as we converse with the ill and elderly.

Thankful

A survey of THANKFULNESS as told by the elderly...

The girls (aka, nurse aids) who work hard
Happy times
A great birthday party earlier this month
New hearing aids, to better hear all of the gossip
Kids, Grandkids, Greatgrandkids, Spouses, Brothers, and Sisters
Fun we have upstairs (therapy gym) with that boy (the token male in our dept)
Unannounced visits from family
Late sleeping days, at that age no one HAS to wake early unless by choice
Not being confined to a wheelchair
Eating delicious food
Styled and washed hair
Still having a good mind at 91

There were a few others, as I learned I am a best friend, the ability to obtain oatmeal creme pies and cheesy puffs becomes invaluable, and even something as simple as seeing a smile from a caregiver gives our elderly patients a reason to be thankful.

Don't sweat the small stuff. Don't get bogged down by the big stuff. It appears that everything SIMPLIFIES in the end.

Why Therapy?

Right now my blog posts are sparse, and this is because the thoughts around the chosen topic of awayfromthemind are few and far between. I am so overwhelmed with the logistics of providing therapy these days. By that I mean, minutes, RUGS, case-mix, skilled service justification, third party payers, medicare cut-backs, productivity, blah, blah, blah, blah, blah. I am normally much more positive, an idealist, a therapist who will fight for what she believes in, but right now elder-care (at least in my world) kind of sucks.

Now this doesn't mean I love my patients any less, or provide less effective therapy, in fact the contact with the people, the patients, those moments where I feel like I have made a difference in function or quality of life are the ones that keep me plugging along. Sound like burnout? I'd say it's a strong possibility!

For now, I'll laugh at the jokes made by my favorite seniors, try to help keep communication and swallowing up to par, and smile when they remember my name but have no idea where they are. I will know that long after the billing systems are revamped, the documentation standards are modified again and again and again, and the things that make therapy stink right now are sorted out, I will be left with a compassion for humanity, a love for the elderly, and the desire to make their lives as fulfilling as possible.

Ahhhhh. There it is. I found the optimist again :-)

Aging and Eating

If you have met me, heard a seminar, or read something I have written you know that I am a big proponent of keeping a thorough check on the nutrition of my elderly patients. What are they eating? Is it just caloric intake, or quality caloric intake? Vitamin deficiencies cause issues with clarity in thinking, mental speed, focus, concentration, just to name a few. The risk exists for the average person whose diet is not generally filled with all of the nutrition needed, but it’s even greater for the geriatric population. Watch out for the most common B12 and D.

So what can be done when the elderly person starts losing weight, begins eating less and less?

• · Don’t try to change an elderly person’s eating habits completely. This will often be met with strong resistance.

• · Work with nutritive supplements in between meals, and hope that “real food” intake will also increase once overall health improves.

• · Provide small meals with few items. A huge amount of food presented in one setting can seem overwhelming.

• Eat with the person who is having trouble. We all like to have a nice meal with the ones we care about.
  

Last, but most certainly not least, I have to say it... keep quality of life in mind. Make sure the supplements you give taste great! If you wouldn’t drink or eat it don’t expect them to.

Travel Time

Airplanes, airports, flight schedules, delays, and diversions; they all make for interesting traveling. As I sat in the airport last night I watched an elderly couple make their way through the madness.

We enter the security checkpoint at approximately the same time. I am in no rush, so behind the couple I stay, watching as they fumble around with their bags. I have it down to a science now, so it baffles me when others enter with no clue. The wife removes liquids and proceeds to dig through her purse taking out some makeup items. She can't maneuver her luggage. Pulling the bag is ok, but when it's time to lift, her companion takes over. Good thing he's there with the muscle I think to myself. The husband removes some items, and to his dismay he has to ditch the Sam's Club size Barbasol. Then their bags go through the scanner, they move one duffle type bag forward and back, repeat, call another agent over to look. Coins are the culprit. One gallon size zip-lock storage bag and one quart size, filled to the brim with coins. Off to the corner searching station they go and I lose sight for a moment, but can hear the man exclaiming that he can't possibly comprehend why coins pose a problem. Ok, so now I'm thinking that confusion with the whole security process could happen to anyone, but I am keeping my eyes and ears peeled in case they run into problems. These seniors aren't too savvy in the traveling department.

Delays and cancellations keep arising. I see the couple sitting at another gate. By this time the lady is sitting, her husband is pacing. He walks to the monitors, back to his wife, and to the monitors again. There are no attendants at the counter. Status change announcements blare over the intercom. Out of desperation the man walks my direction. I suppose I appear elderly friendly. He can't understand what is happening or what's going to come of his itinerary. They need to get to a larger airport and with the delays he won't make his connection. So he shows me the tickets, and when I begin to explain he asks that I talk to his wife as well. We venture across the room, and I launch into a discussion of time zones, standby lists, etc. I am fortunate that the wife understands fully. Her husband is relying on her reasoning skills to make this trip happen.

All flights were cancelled last night, so they went home to rest, while I tried not to think about the possibility that they were driving around in the foggy, dark, stormy weather. I imagine he drove & she navigated. The brawn and the brains had to work as a team. This morning I didn't see them, but hopefully with improving weather this man and wife will experience a flawless trip, much like myself.

So this brings me to my point. We take for granted the ease at which we can problem solve, shift gears and come up with an alternative. Airports can be pretty unfriendly, and I have seen some moments of terrible customer service when flying. I wonder how many elderly would report that flying is difficult for them? What might make it a more pleasant event? What services could benefit the aging population in the industry of travel?

End of Life: So Many Questions

For years I have known the devastation that comes about when making decisions regarding death and planning for end of life care. When do you opt for treatment? When is it time to just live the rest of your life? When do we as clinicians, nurses, doctors, stop fighting to fix the problem, and resolve to lend a hand for finding peace? Throughout personal experience, encounters with families, and interactions with dying patients I have come to realize that there is no consistency in ensuring that a dying person’s wishes are conveyed and carried out. Extreme variability exists in discussions about dying and one’s end of life wishes. Talk about death is complicated, dealing with death is difficult, and when you add in factors such as multiple medical conditions that take away communication, thinking, or weaken the patient to a point of compromise, it becomes essential to start the dialogue long before the disease takes over.


In the last year or so this specific notion of dealing with death has crept into my life time and time again. First in multiple encounters of working with elderly patients with dementia, or some other illness, who did not “have their ducks in a row” so to speak, left families with critical choices on their plate. Many times a person will have laid out the basics, but when critical moments arise it is much more complicated, emotions of family member take over, not wanting to “lose” their loved one, etc. Resuscitate or don’t? Ventilator or none? Feeding tube or pneumonia? So many intricate questions crop up. Also, I have spent time talking with friends and members of my own family who don’t work in the medical field and they have dealt with similar issues. They ask for guidance from medical professionals, but find it lacking. All of these end of life determinations in the midst of an emotionally trying time. Hoping they will know the right thing to do, while keeping with the wishes of their loved one.


Wouldn’t it be nice if we talked about these decisions with the one who really is responsible for making the call long before the time comes?


The following is a guide designed to be used in conjunction with Bill Moyers’ PBS series On Our Own Terms.

http://www.pbs.org/wnet/onourownterms/community/pdf/discussionguide.pdf



Use with the series is beneficial, but the guide alone also serves as an superb resource for topics of conversation, decisions to be considered, suggestions for dealing with death, and even how to make sure our needs are thoroughly document so no confusion arises.


Initiate the conversations and listen intently. Learn how your parents, grandparents, spouses, and patients what to live out their last months and days, and how they want to die. In spite of a distressful event, you won’t be sorry.

Healthcare Reform

No matter which side of the fence you fall on, it is important to attempt to get some unbiased knowledge about just what health reform will mean. So much of what we hear in the media is distorted. With the important issue of obtaining health care for elderly loved ones, our families of all ages, and ourselves, it is absolutely necessary to find some objectivity and review the facts.

http://www.kff.org/

The Kaiser Family Foundation does a nice job of reporting information without inserting opinion. This type of resource is hard to locate regarding a topic which holds so much political charge. KFF also provides updates frequently so you may want to bookmark this site as well.