Apr 302012

Caregiver’s of elderly parents are stressed. Emotionally, physically, mentally and in some cases spiritually. Even in the best of situations, it is hard. As a result, caregivers are at high risk for burnout. Burnout is much easier to prevent than to treat and today I am going to introduce you to two people who can help you reduce your stress: Cherie Miranda and Annie Born. But first, a little information on burnout.

Signs of Burnout

  • Changes in your sleep or eating habits
  • Increase in use of sugar, alcohol, drugs or tobacco products
  • Increase in back aches or headaches and resulting increase in use of over-the-counter or prescription pain killers
  • Irritability, impatience, increase in fear or anxiety
  • Inability to handle problems or crisis
  • Overreacting to criticism or everyday annoyances and accidents
  • Excessive anger toward parents, spouse or children
  • Feelings of withdrawal, alienation, being trapped, hopelessness
  • Wanting to run away or disappear
  • Inability to laugh or feel joy, loss of compassion
  • Withdrawal from activities and from interaction with others
  • Feeling alone even with family and friends
  • Resentment towards your parents, spouse, or children
  • Neglecting or mistreating your parents
  • Wishing it would just be over with or wishing your parents would “hurry up and die”

If you are experiencing any of these symptoms it is time for a break and some help. Depending on the severity of your reaction, you may need to physically remove yourself from the situation and seek local professional guidance.

What To Do

As stated previously it is much easier to prevent burnout than to treat it. Why wait until you are miserable to seek help?

Annie Born has a gift for helping the caregiver (You) take care of yourself. She has a blog where she gives you the information and inspiration you need to take care of yourself. You should check out her site. You will be glad you did!

Cherie Miranda is a very astute lady.  She also has a great blog where she explains about meditation, what it is and what it is not, how to do it and the benefits.

After watching a few online conversations she realized that caregiver stress is different from normal stressors. She knew she could help and she came up with the idea to make a special meditation just for caregivers! I am excited about it and even though it is not ready yet it is just something I think is very much-needed. I will let you know when it is ready! In the meantime check out her site. There is a lot of good stuff there.

Apr 292012

All those pill bottles on your parent’s counter or kitchen table are seldom all prescription medications. Vitamins, minerals, herbs, botanicals, amino acids, enzymes, animal extracts and the magic fruit/vegetable/supplement of the month, the nutritional supplement industry has gotten ridiculous in the United States. Elderly people who fuss about taking medication will pop a handful of pills if they are vitamins, herbs, etc.

While some supplements are good for you and necessary, I am reminded of a point someone from another country once made, “Americans have the most expensive urine in the world.” This was said because excess vitamins and minerals are often excreted through the kidneys and Americans have made supplements into a multi-billion dollar industry. (Many of your prescription medications are also excreted through your kidneys as recent studies of our water have shown.) We literally flush those supplements down the toilet.

Having said that let me state that I take supplements, recommend them to others and have even given them to my pets (on the recommendation of my veterinarian). They are often necessary in a country where a majority of the food consumed is over processed and deficient in nutritional value. Add to that the added stress we live under, especially caregivers, our bodies may have need for additional supplements. There are scientific studies that verify some of these needs for supplementation. With the decrease in nutritional status that many in our elderly population suffer from, supplementation can be a necessity.

My problem is not with the taking of supplements but rather the ‘take a pill to fix it’ thinking that we seem to all suffer from. The pharmaceutical and supplement industries both encourage this mentality. Yet nutritional supplements are not without side effects and can interact negatively with many medications. Unfortunately many people, especially the elderly, believe that if it is a supplement or ‘natural’ it must be good for you.

Before you take or give any supplement or vitamin, please get the facts from an unbiased resource such as the National Institutes of Health Office of Dietary Supplements.

You should always talk with your pharmacist and physician because many vitamins and herbs interfere with prescription medications. You should also know that vitamins A, D, E, and K are stored in your fat and can build up to toxic levels. Even vitamins that are not stored can interfere with medical treatments, such as some forms of chemotherapy.

Of consideration for older adults is that many are on some form of blood thinner such as Coumadin or aspirin. This is a problem because some supplements also act as blood thinners which can lead to hemorrhage, or counteract the medication which can lead to clot formation, stroke or heart attack. (Even certain foods interfere with Coumadin.)

Also, be alert to the fact that some supplements can have unwanted effects before, during and after surgery. Please discuss this with your healthcare professional before scheduled surgeries. Pharmaceutical manufacturers list known supplement interactions but there honestly is no way to test all the supplements or foods available for potential interaction. Consider stopping all supplements two to three weeks before surgery unless your doctor and anesthetists gives you the okay.

Another consideration is the supplementation added to many of our foods such as milk, bread, cereals, sports drinks, vitamin waters, nutritional shakes, etc. You could end up getting more of a certain supplement than you realize or at least wasting money on something you do not need.

The Institute of Medicine of the National Academy of Sciences has developed recommended Dietary Reference Intakes (DRI) for vitamins and minerals. Dietary Reference Intakes is the general term for a set of reference values used for planning and assessing nutrient intake for healthy people. Three important types of reference values included in the DRIs are Recommended Dietary Allowances (RDA), Adequate Intakes (AI), and Tolerable Upper Intake Levels (UL). Be careful not to go over the UL as toxicity can occur.

When buying supplements you should know that the Food and Drug Administration has established quality standards for identity, purity, strength and composition of dietary supplements.

You might want to look for quality seals of approval from independent companies such as U.S. Pharmacopeia (USP), Consumer Lab.com, and NSF International. These are voluntary testing and auditing programs to ensure the quality of production. This ensures you are getting what you are buying, in safe levels, manufactured according to FDA guidelines and that it is safe from contamination.

This is not to say that other supplements do not meet the same guidelines just that these have gone through the headache and expense of testing and verification. The FDA regulations have done much to reduce some of the problems that have occurred in the past.

Some other resources you might find helpful:
The United States Department of Agriculture’s Food and Nutrition Information Center

The USDA Nutritional Evidence Library

USDA Healthy Meals Resource System

Apr 282012

Are your elderly parents still driving? Driving is one of the hardest things to give up in our society. Getting your license was more than a rite of passage. It was your ticket to freedom and independence. With a set of wheels you could go anywhere and if you live outside of a major metropolitan area then driving is necessary for getting to work, shopping and going to medical appointments. Is it any wonder our elders hate to give it up? It is one more sign that they are getting old and raises the specter of decline and dependency on others.

For families and caregivers it can be a tricky situation. They may not live close enough or have the time to drive their parents to doctor appointments, the grocery store and other activities. Bringing up concerns about an elder person’s ability to continue to drive can lead to arguments and hurt feelings.

According to a National Highway Traffic Safety Administration(NHTSA) study, older drivers are second only to the very youngest drivers for their rate of accidents and fatalities. It is a serious situation.

Some factors to consider are the facts that aging tends to result in a decline in strength, coordination, flexibility, slowed ability to process, problems with memory, decline in hearing and vision, slowed reflexes, and decreased range of motion. Some medications and illnesses also make driving a hazard.

So what should you do if you are concerned about your parent’s ability to drive? First of all, be respectful. Express your concern that maybe something is compromising their ability to drive safely. Maybe they need to have their vision or hearing checked. Maybe you have noticed they cannot turn their head far enough to check for traffic or they might not have enough strength or coordination to switch between the gas and the break. Be specific with your concerns and suggest a checkup with the appropriate health care professional.

Consider an evaluation by an occupational therapist. There might be some modifications that can be made to allow your parent to continue driving such as a knob on the steering wheel, hand controls for gas and brakes, etc. It might also be that limitations may need to be placed such as daytime driving only. Caregivers might also suggest a senior driving program or an evaluation by Driver Rehabilitation Specialist.

If it is no longer safe for your elderly parent to drive you will have an easier time convincing them if professionals confirm this for you and they know you have made every effort to help them keep the privilege. Also, there is strength in numbers so partner with family members or close friends. Help them find viable alternative transportation such as public transportation, elder transportation or even hiring someone to drive them around.

What do you do when they still refuse?

If appropriate evaluations and recommendations have been made and there is fear for the safety of you loved one and/or others, there are other steps you can take. Make an anonymous call to the Department of Motor Vehicles, have a law enforcement official talk with them, take their keys, disable the vehicle or perhaps sell the vehicle.

These steps may be hard for you to take but not nearly as hard as the consequences that could occur should your parent kill or injure themselves or someone else.

Apr 272012

Drinking alcohol is very much a part of our culture but if your parent takes medication you should know if there are any adverse interactions. Some medications, whether prescribed or over-the-counter, do not mix well with alcohol.

Caregivers should also be aware that as we age, the way our body handles alcohol changes. Alcohol is broken down by the liver for removal from the body. So are many medications (acetaminophen comes to mind) and this can lead to permanent liver damage or even death. Slower circulation may keep medications and alcohol in the blood stream longer. The liver and kidneys may see slower function causing medications to stay in your body longer and creating a greater chance of interaction.

Caregivers should educate themselves on any medication their parents take. Read the instructions carefully, especially the interactions and precautions. Look for pictures or statements that tell you to avoid alcohol while taking this medication.

Drinking alcohol while taking medication for sleep, pain, anxiety or depression can lead to coma or death. Please check with your parent’s doctor or pharmacist, as even one drink may be too much. It might be another medication would be less dangerous.

All your parent’s healthcare providers should know their drinking habits as well as any medications, prescribed and over-the-counter, and dietary supplements such as vitamins and herbal preparations. You should go over this information with them at least once a year.

Alcoholic drinks should be limited to one a day for anyone over the age of 65. One drink is defined as 12 ounces of beer, 1 and a half ounces of distilled spirits or 5 ounces of wine.

Medicine and alcohol misuse can happen unintentionally.

Here are some signals caregiver’s should watch for that may indicate an alcohol or medication-related problem:

  • Memory trouble after having a drink or taking medicine
  • Loss of coordination (walking unsteadily, frequent falls)
  • Changes in sleeping habits
  • Unexplained bruises
  • Being unsure of yourself
  • Irritability, sadness, depression
  • Unexplained chronic pain
  • Changes in eating habits
  • Wanting to stay alone a lot of the time
  • Failing to bathe or keep clean
  • Having trouble finishing sentences
  • Having trouble concentrating
  • Difficulty staying in touch with family or friends
  • Lack of interest in usual activities

Some of these signs may indicate a problem with drug or alcohol addiction. If caregivers suspect there is a problem and there is no previous history of addiction, they should talk with their parent’s healthcare provider first. There could be an underlying medical condition.

If there is a history of addiction, make sure everyone involved in the care of your parent knows that, especially physicians and pharmacists. Encourage your parent to seek treatment for their addiction and at the very least get some help yourself so that you can more effectively help them without harming yourself.

Source: FDA

Apr 262012

Elderly Parent AsleepSleep often becomes more difficult as we get older. For some people the problem is getting to sleep, for others it is staying asleep. Either way, lying in the dark while the rest of the house is sleeping is not only frustrating; it can be hard emotionally as the mind seems to race in directions beyond control.

While sleeping pills might seem like a quick fix they can be more of a problem than a help, especially in the elderly. They may leave a person feeling sluggish and “hung over” the next day. They increase the risk of falls. And if sleep apnea is a problem, they may prevent your parent from waking up to breathe.

The very first thing to do is talk to your parent’s physician and treat any medical problems that might be interfering with sleep such as pain, sleep apnea or restless leg syndrome. This includes reviewing any medications that might interfere with sleep.

If you have eliminated the medical reasons or treated them and sleep is still a problem here are some things to try:

Environment: While cooler temperatures make sleeping easier for most of us, many older people sleep better with a little warmth. Socks, tee shirts, an extra blanket or long-sleeved shirts will help. A hot water bottle or “bed buddy” as my grandma called her warmed, rice filled bag that we placed at her feet, is often soothing. Avoid electric heating pads as these increase the risk for burns, especially with the elderly. Some people like to sleep with a pet for warmth and to snuggle with.

The room should be dark or semi-dark, though if your parent is prone to get up for toileting make sure there is enough light to prevent falls.

Sound: As they age, many people find they sleep lighter and any noise will wake them up. White noise from a fan, window air conditioner or even a sound machine that plays different sounds such as the ocean or crickets chirping may be helpful. Soft music, guided meditations, or a radio will help block noise from the home. Some people like to fall asleep to a television but I only recommend this if you can put it on a timer. The flickering light produced by televisions can interrupt sleep patterns.

Routine: Establishing a bedtime routine will help train the body to get ready for sleep. Many people find reading a relaxing way to unwind just before bed. Other’s like to go to sleep just after the late news or a favorite show. Try to go to bed at the same time every evening. A warm bath or shower may help or a gentle back rub.

Get Natural Sunlight: Open the blinds or curtains. Sunlight stimulates the body’s natural internal clock and helps reduce depression. Exercise as tolerated. Sit outside if weather permits.

Avoid: Exercising should be done during the day to avoid over stimulation near bed time. Alcohol close to bedtime interferes with sleep patterns. Snacks at bed time should be light. Avoid foods that cause heartburn, especially at supper time. Decrease fluids in the evening to avoid toileting interrupting sleep. Naps during the day should be limited to no more than 20 minutes. Nicotine is also a stimulant and some people will wake up at night to smoke. Caffeine should be avoided in the evening.

Warm milk: Milk, dairy and protein-rich foods contain an amino acid called tryptophan that might help you fall asleep but it needs to be taken with a carbohydrate such as crackers. Here is an article that gives a little more insight (This can be your excuse for milk and cookies at bedtime).

Two things I have found that will help with sleep without making me feel groggy the next day are melatonin and magnesium. Melatonin is a hormone naturally produced by your body and regulates your sleep cycles. Light, especially sunlight, helps determine how much your body produces. Before trying it, or any supplement, your healthcare professional should be consulted. For best effect, melatonin should be taken an hour or two before bedtime and no more than 3 mg. In some people it may cause changes in blood pressure, vivid dreams and daytime grogginess.

Magnesium is a mineral found in a variety of foods and is essential for body function and bone growth. According to the National Institutes of Health Office of Dietary Supplements, “Dietary surveys suggest that many Americans do not get recommended amounts of magnesium, symptoms of magnesium deficiency are rarely seen in the US. However, there is concern that many people may not have enough body stores of magnesium because dietary intake may not be high enough. Having enough body stores of magnesium may be protective against disorders such as cardiovascular disease and immune dysfunction.”

What does this have to do with insomnia? Too much magnesium has two side effects: diarrhea and drowsiness. (For some people we can solve two problems with one treatment!) Usually 500 mg at bedtime is enough, though it may have to be taken for a day or two if your parent’s level is a bit low. Definitely decrease the amount if diarrhea occurs and don’t take this long-term without discussing it with your doctor. It is rare to see magnesium toxicity but it does happen. Do not try this if there are kidney problems without discussing it with your parent’s doctor first due to increase risk of toxicity.

Finally, if sleep continues elusive after 20 minutes, get up. Read, write a letter, knit, crochet, watch television, listen to music or some other relaxing activity, until sleepy.

Reference: http://ods.od.nih.gov/factsheets/magnesium/