Talk to the person you are caring for EVEN in they are noncommunicative!

During a recent visit to a friend on hospice, she was extremely agitated.  She kept saying that people were coming in her room, whispering or talking about her but not TO her.  She asked that I talk to her like I use to talk to my mom.

Picture a world where everything is happening around you but you are not participating in it.  That would be frustrating.  You could feel or see things but have no input.  It is hard to know how our loved ones feel.  You know them best so you can decide whether they would rather be left in silence or not.

I think it becomes a routine when you are a long term caregiver to “Get the job done“.  We become so focused on all the things that we have to get done that we tend to do it automatically. Sometimes it almost becomes impersonal, not that we mean it to but caregivers can get overwhelmed.

As Mom was declining, I made it a point to talk to her as if she was able to communicate back.  I would discuss what the weather was doing, plans for the day, or anything else I thought might stimulate her.  When she became wheelchair bound, I would move her with me around the house when I could.  She would come in the kitchen and I would talk to her while making meals.  We listened to music.  I read books aloud.

We have plenty of grandkids around so I would encourage them to talk to mom too.  I think it made them uncomfortable at first but after I explained that she would like to know what is going on, they went along with me.  My one granddaughter thought it was totally normal to sit beside great grandma and help her play with her toys.

I would love to know what Mom thought.  She might have preferred me to shut up but I will never know.  I like to think that after talking with my friend that Mom did want to be included.

I have heard that hearing is one of the last senses to go.  So, just talk.  It doesn’t have to be earth shaking.  Talk about the news, life, family, friends, etc.  Just include them.

Perhaps it is too soon to write this as I just lost my friend today but in honor of Pam, start a conversation today.  Even if it is one sided!

 

Food and Drug Interactions – Some surprised me.

Most people are very careful when starting medications to watch for possible problems with current medications.  Pharmacies automatically check for interactions if you stay with only one pharmacy.  But what about reactions between your meds and your food or drink?

How to avoid food and drug interactions

Below is a list of COMMON food-medication interactions for blood pressure, for instance – and common food ingredients, like calcium or grapefruit.  But, there are many more.  As always, talk to your doctor about any concerns you have.

Who knew that salads could be bad with blood thinners?

Taking medications such as warfarin or  Coumadin ® in combination with large amount foods high in vitamin K – such as leafy greens – may cause the medication to not work as well. Watch the amount of this type of food you are eating to get the best results with blood thinners..

Alcohol and some medications can be toxic

Avoid taking massive doses of Tylenol and Tylenol-containing products with alcohol, as it may result in liver toxicity. Avoid taking metronidazole for infections with alcohol, which may result in flushing, vomiting, and increased heart rate.

Don’t take antidepressant, arrhythmia, transplant, seizure, high blood pressure, and high cholesterol medications with grapefruit juice.  

Studies have shown that mixing certain medications with grapefruit juice can cause dangerously high blood levels, which leads to an increase of potentially life-threatening side effects. These medications include

  • Lipitor ®
  • Zocor ®
  • Plendil ®
  • Valium ®
  • Tegretol ®
  • Pacerone ®
  • Prograf ®

Potential potassium overdose

When taking ACE-inhibitors like Altace ® or lisinopril and potassium diuretics – such as spironolactone or triamterene – be careful when eating foods rich in potassium such as bananas, apricots, raisins, and lima beans. The combination causes the body to retain too much potassium.

(I did not know the above one and encouraged mom to eat a banana a day while she was on spironolactone and diuretics.)

Osteoporosis medications and some antibiotics shouldn’t be taken with calcium

Taking osteoporosis medications and some antibiotics with calcium-fortified foods and drinks such as milk, orange juice, bread or antacids will make the medications less effective. Be sure to take your medication two hours before or four hours after eating calcium-rich foods and drinks. Aspirin and other over-the-counter pain medications taken without food can cause stomach bleeding.

Never take aspirin on an empty stomach

Aspirin and other over-the-counter pain medications taken without food can cause stomach bleeding.

Thyroid Medication

Certain thyroid medications cannot be taken at the same time as calcium, grapefruit juice, magnesium, antacids as it will change the result.

There is a great site to type in the drug names and see what interactions there are.  It can be as simple as juice causing problems.  Check out all the drugs your loved one is taking to see if you need to set up the medication differently based on which ones can go together.

It is www.drugs.com.

What drug interactions have you learned?  Let us know.

 

Dehydration – What to Watch For

Dehydration – It’s is easier than you think

I always thought that it would hard to get dehydrated.  After all, you get thirst, you drink, right?

Not so.  In fact, in elderly it is very easy.  It occurs when the body has lost too much fluid AND electrolytes (mineral compounds the body needs to keep the correct temperature and maintain the fight fluid balance.

In elderly, they may not want to have to run to the bathroom all the time or wake in the night to go to the bathroom so they limit their fluid intake.  Although it makes sense to them, it can be deadly.  Certain illnesses make elderly more sensitive to this.  For example, Parkinson’s can make it difficult for someone to swallow or hold a glass to drink from.

It can go on for a while without becoming serious but severe dehydration can  be fatal and is a common  reason of hospitalization of elderly.

Dehydration can be caused as a side effect of medications like diuretics or laxatives or illness  such as diarrhea, vomiting, heat stroke, high blood sugar (hyperglycemia) , infections or excessive exercise.

The most common signs of dehydration in the elderly are thirst (although some elderly have a decreased sense of thirst), confusion, irritability and poor skin elasticity.

It is difficult to detect dehydration until the condition is moderate or severe in nature.

Things to watch for:

(The following can also be signs of many other medical problems but it will give you an idea of what to look for)

  • Thirst – some people have a decreased thirst as they age
  • Dry mouth, dry tongue with thick saliva – can be heard sometimes when talking
  • Headaches
  • Difficulty passing urine or reduced amounts that are dark yellow
  • Dizziness that becomes worse on standing
  • Weakness
  • Sleepiness
  • Urinary tract infections
  • Dry, warm skin
  • Flushed face
  • Fever
  • Irritability
  • Malaise
  • Constipation – fluid is used to soften and move stools
  • Cramping in arms or legs

 

Possible Treatments for Mild Dehydration

  • Drinking lots of fluids – make sure there are fluids available wherever they sit and perhaps some on their bedstand.
  • Eat food and drink with sodium and potassium to restore electrolytes: broths or soups (contain sodium); fruit juice, soft fruits, vegetables (contains potassium); sports drinks like Gatorade that contain electrolytes

Caution – Be aware of any dietary restrictions when adding food or drink as certain medications can interact with certain foods/drinks.  Potassium  needs to be monitored  in certain people.

Signs to watch for in severe dehydration

  • Signs and symptoms of mild dehydration become worse
  • Confusion
  • Irritability
  • Lethargy
  • Poor skin elasticity
  • Decreased consciousness/ fainting
  • Lack urine output
  • Shrunken eyes
  • Moist, cool extremities (arms, legs, etc.)
  • Severe muscle contractions in the arms, legs, stomach, back
  • Rapid and faint pulse
  • Low blood pressure
  • Rapid breathing
  • Convulsions
  • Bloated stomach
  • Heart failure

Possible Treatments for Moderate to Severe Dehydration

  • Severe dehydration is a medical emergency and should be treated at the hospital
  • Replenishment of water and electrolytes through intravenous therapy or oral rehydration therapy (solution of salts and sugars taken by mouth; this treatment is most often for dehydration caused by excessive diarrhea)

Tips to Avoid Dehydration

  • Encourage them to drink appr. 6-8 glasses of fluid a day (Water is best).  Of course this depends on exercise and temperature.  If they are reluctant to drink a big glass, try several smaller glasses.
  • Check body weight regularly, fluctuations of 2-3 lbs per day may indicate irregular fluid intake
  • Avoid being in the hot sun for long periods and ensure extra hydration for longer exposure
  • Keep a water bottle on hand and  try to drink often
  • Broths or soups (contain sodium); fruit juice, soft fruits, vegetables (contains potassium) as part of general diet.
  • Make sure the glasses they use are appropriate for them.  Perhaps they need a straw or a cup with a lid to avoid spills.

Bottom line, dehydration can be serious but is usually easy to avoid.  It just takes being aware of liquid intake.

Do you have any tips on how to avoid dehydration in elderly?

Human Touch – As Important As Air?

That may sound a little dramatic to most people but if you stop to think of it, we all need the human touch.  Think back to a time when you were hurting, either physical or emotionally, and someone came along and either touched you on the shoulder or held your hand and things seemed to get better.

There have been many studies done on this with a good deal of articles written on it but I prefer to just tell you my thoughts on it.

Everyone likes to be touched in a friendly manner.  Babies are cuddled for a reason.  It helps to establish a sense of safety and peace.  In some hospitals, preemie babies are held by women hired to just do that…they rock the babies and cuddle with them.  It has been proven to help them.

Senior citizens or other people that require caregivers are just the same. I believe the need for touch increases when people age or are sick.  They need to feel a connection to the world.  They tend to receive the least amount of touching of any age group.  Seniors are most likely to live by themselves and have less physical contact with the outside world.  But, as people age, they tend to be more likely to need touch and be touched than younger people.

Having someone take their hand, stroke their arm, or rub their feet can make them feel loved and reassure them that they are valued and not alone.   Isolation can be swept away with a single stroke of the hand. It helps with other problems as well such as depression, feelings of isolation, lack of self-esteem, and anxiety. 

Bottom line, we need to be touching the people we are taking care of.  Below are several ways you can touch someone without it being obvious.

  1.  Put lotion on either the hands or the legs.  Mom had dry skin as she aged so I would just put lotion on every day or two.
  2. Holding hands.  When Mom was in bed, we would watch tv until she fell asleep.  I would just lightly hold her hand.
  3. Massage.  Although Mom never got a massage and I am not sure she would have, a massage is a safe way for someone to get the touch needed.  It can be as simple as a neck rub or as much as a full body massage.
  4. Brushing their hair.  Mom loved to have her hair brushed and I can remember as a child I did too.  One of the perks of going to get a haircut for women is the great shampoo that goes along with it.
  5. Just resting your hand on their shoulder or knee while in a seated position can be reassuring.

I really believe that touch is critical.  Seniors sometimes only have one or two people they see on a regular basis and in most cases, they are busy and do not have the time to spend quality time.

If you are a caregiver, please take the time to touch your loved one in some way every day.  It does both of you good.