May 252012
 

“Nothing has any taste anymore. Not even ice cream, if you can believe that!” Granny is 92 years old and that is also what she weighs, which is not enough. My granny and I share a love of ice cream, especially Blue Bell Homemade Vanilla! So when she told me yesterday that not even ice cream had any taste, I knew things were serious!

Like many people as they age, my grandmother is losing her sense of taste. For some, the sense of smell also declines decreasing their ability to taste. Granny also has macular degeneration, which is slowly causing her to go blind, so she has a hard time even seeing her food. Living alone, she often feels like cooking is too much effort, especially a few weeks ago when she was temporarily using a walker.

Having given up driving over the last year, she still has not adjusted to having to ask others to take her to the store or go for her. Many of our elders also have dental problems that make eating difficult, dementia which causes them to forget to eat, and depression which can lower the appetite. I have had more than one elderly person tell me they could afford medications or food but not both.

What can a caregiver do when their parents are not eating enough?

Make sure they have food. Actually look in the pantry, refrigerator and freezer. Many elderly parents are too proud to tell their children they do not have enough money for food. Or they do not want to bother you, so if you do not ask them if they need anything from the store, they will just do without.

If they live alone, are they able to cook? There might be assistive devices that they can use to make cooking easier, such as a walker with a seat so they can sit down as needed. If cooking is still too hard for them, it might be time to look into Meals On Wheels in your community. Also, when you cook, make extra and take to them.

Socializing while eating is a large part of the American culture and many of our senior citizens are missing this interaction. They are eating meals in front of the television, the local news keeping them company for their meal. Call your elderly parent and ask them what they had for lunch or supper. It reinforces the need to eat without nagging, serves as a reminder to eat and anticipating you are asking when you call may actually motivate them to eat. So try to have a meal with them as often as you can.

Also, have a medical evaluation. There could be a medical reason your parent is not eating. It could be depression or a digestion problem. There are also medications available that help to stimulate the appetite.

Those are the easy problems to fix. The lack of taste is a bit harder. Here are a few suggestions:

Serving

Put less food on the plate. A large amount of food can be overwhelming to someone who already is not really hungry.

Serve only one or two foods. Fewer choices may be less intimidating.

Make the food as attractive as possible. Even when she is eating alone my granny puts out a placemat, cloth napkin and coaster on her dining room table. “There’s no sense in losing your civility,” she quipped when I teased her about it.

Serve small snacks between meals such as cheese and fruit, crackers and peanut butter, or half a sandwich on a small attractive plate.

If using replacement shakes put them in a glass rather than serve them from the bottle or can.

Specifically adapted utensils, plates, mats and cups may make self-feeding easier and promote greater intake.

Flavor

Add extra herbs and spices to enhance the flavor.

Ask them what foods that can taste. In the same conversation where she complained about not eating, granny mentioned that she hoped my aunt would bring her some desert from the church function she was at and mentioned making a pitcher of sweet tea. Ah, ha! She still tastes sugar. My grandma had more of a taste for salt. Using sweeteners such as Fructevia sprinkled lightly on foods might enhance the tastes. Instead of regular salt, try using small amounts of Sea Salt which tends to have a stronger taste.

Timing

Allow plenty of time to eat. Lingering at the table, talking and snacking may increase intake.

What is traditionally the time they eat the biggest meal? For my grandma it was lunch, with granny it is supper. Plan the main meal at their traditional time.

Have afternoon tea and a snack

Food

Let them eat what they want. Seriously. You have to start somewhere. Certainly if they have dietary restrictions you may have to limit some of their choices but you can talk with a dietician to help you. Or ask their doctor about bending the restrictions a little.

Serve their favorite foods

Nutritional shakes such as Boost, Ensure or Glucerna for diabetics can be used as meal replacement or between meal snacks.

Adding Nutrition to Shakes

If your elderly parent needs more calories and nutrition you can supplement commercial shakes by adding an extra scoop or two of protein powder and mixing it in the blender with ice cream and syrup or honey.

Add fruit and frozen yogurt to commercial shakes, along with protein powder.

Add different flavored extracts to enhance the taste.

Peanut butter or other nut butters can be added to shakes.

Powdered milk added to shakes will increase calories and protein without increasing fat.

For added carbohydrates add some Polycose Powder to shakes and foods such as mashed potatoes, cottage cheese, yogurt, oatmeal, cereals and soups. It is tasteless and odorless.

And finally, do not nag. Gentle reminders are okay but avoid making mealtimes into a fight-time.

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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.

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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/

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Apr 162012
 

“Mama has had diarrhea all night and she refused to take anything for it,” was the greeting I received at the door from Mrs. Jeter’s exhausted daughter. We had just started working with Mrs. Jeter a week ago and I knew she had a history of constipation. When I walked in house Mrs. Jeter was sitting in the living room, looking miserable. Her stomach was swollen and firm.

“I’m compacted, aren’t I,” Mrs. Jeter asked, as I completed my assessment? I resisted the urge to automatically correct her misuse of the term. I knew what she meant and I suspected she was right. “I’ve been this way before and it feels the same.”

“It sounds like it but I’ll have to check,” I informed her.

“Oh, lovely,” she intoned sarcastically and I could not help but smile. I did not blame her because this would be far from fun for either of us, but Mrs. Jeter had a great sense of humor. “Come on and I’ll show you my butt.”

We went to her bedroom where I examined her and told her, “Yes, you’re impacted. I’m afraid I’m going to have to remove it. Sorry.”
“What’s that mean,” her daughter asked? I explained that sometimes feces becomes very hard and blocks the bowel and has to be manually removed by a physician or nurse.

“But she’s having diarrhea,” she argued.

I explained how the liquid was going around the hard feces and silently thanking Mrs. Jeter for having the good sense to refuse to take anything for diarrhea. “It’s a common mistake,” I continued, “but her abdomen is swollen and you can feel how firm it is.”

The elderly and their bowels. Not exactly your typical blog topic, but if you are taking care of an older parent, you probably are well aware of their constant worry about whether their bowels have moved today. It is the bane of every home care nurse’s existence.

One of the most common problems seen with the elderly is constipation and it can be more than just uncomfortable, it can also be dangerous. I have actually seen someone die because of severe constipation that completely blocked their bowel.

If constipation becomes severe enough, the feces will become hard and cause an impaction. The person may then have watery stools around the impaction, leading one to think they have diarrhea. If your prent’s stomach is large, rounded, firm to touch and they are having watery diarrhea then it is a safe bet that they have a fecal impaction and it needs prompt treatment. Please consult you healthcare professional.

I worked to remove Mrs. Jeter’s misery and followed up with an enema. I knew she was feeling better when she complained that the smell was making it hard to breathe and comically making gagging noises.
“Do you have any matches,” I asked the daughter?

We burned a few matches and I had now gone from being the “Angel of Mercy” to near Goddess status as the sulfur dioxide from the matches took over the scenting of the room.

I reviewed the causes of constipation again and her bowel program. Some causes include lack of fluid intake, decrease mobility, lack of fiber, change in routine or diet, too much cheese, stress, some illnesses and some medications. Long term laxative and/or enema use is also associated with decline in intestinal muscles, leading to, constipation.

Some things caregivers can do to prevent constipation include:

  • Increase fluid intake including prune juice and a couple of cups of coffee. Note that too much caffeine can dehydrate and milk constipates some people.
  • Warm beverages.
  • Increase fiber by including a diet rich in whole grains, fruits, vegetables, and legumes.
  • Increase exercise. Walking is best but anything helps.
  • Use the bathroom when the urge is felt.
  • Place a low stool under their feet when toileting to promote comfort.
  • Establish a routine toileting time.
  • Allow privacy.
  • Use a raised toilet seat to make it easier for them to get up and down.
  • Treat hemorrhoids.
  • Ask them what has worked in the past.
  • If a medication is suspected, talk with your physician about alternatives.
  • Try to increase the non-saturated fats in the diet. Sometimes a little greasing helps but avoid old remedies such as castor oil and mineral oil.

If these methods do not work, talk to your doctor or home health nurse to help establish a bowel regime and retrain the bowel.

A note about fiber laxatives: if sufficient fluids are not taken, these types of laxatives will cause constipation.

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