Month: May 2017

The body starts to slow down as we age. The brain can also slow down. You may start noticing that it takes mom a little longer to remember things. She might have a little more difficulty learning and retaining new information. However, actual memory loss is not a normal part of aging but is usually accompanied by disease.

At some point in our lives, we probably have all walked into a room only to have forgotten what we went after. The thought that might flash through our minds is “am I getting dementia”? The truth is, something as simple as stress might be the cause of occasional forgetfulness. Memory loss and forgetfulness are not dementia.

So, what is dementia in the elderly? Dementia isn’t a disease, but a group of symptoms that can develop due to a variety of possible diseases. These symptoms can include memory impairment, a decline in judgment, behavior, reasoning, communication, and the ability to plan and initiate complex behavior. There must be at lease two types of impairments that significantly interfere with everyday life to have a diagnosis of dementia.

Symptoms of Dementia

The symptoms of dementia progressively worsen over time, and it’s possible to hide some of these symptoms in the early stages of dementia. The first symptom you might notice is subtle short term memory loss. As dementia progresses, you may see a personality shift or change in mood such as depression, agitation and sometimes even aggression.   You might notice a loss of interest in hobbies or a lack of desire to spend time with family and friends.

Other symptoms you could see are a difficulty finding the right words when trying to communicate, apathy, trouble exercising judgment, not keeping up personal care like grooming and bathing, or difficulty completing normal tasks like following a recipe, balancing the checkbook, or writing a letter. Confusion, a decreased sense of direction, difficulty following storylines (both in conversation and on tv), repetitiveness, and struggling to adapt to changes are also symptoms that may appear.

Causes of Dementia

The cause of dementia can be related to disease, infection, stroke, head injuries, drugs, or nutritional deficiencies which create a dysfunction in the cerebral cortex of the brain. The cerebral cortex controls perception, language, memory, language, thoughts, and consciousness. Dementia can have a combination of causes such and vascular dementia and Alzheimer’s dementia.

Some irreversible causes of dementia are; Alzheimer’s, Lewy bodies, vascular dementia, multiple sclerosis, Parkinson’s disease, Huntington’s disease, Wernicke-Korsakoff syndrome, and Creutzfeldt-Jakob disease. Chronic traumatic encephalopathy can be another cause of dementia seen in athletes with a history of repetitive brain trauma.

There are some potentially treatable causes of dementia, and their ability to be treated depends on the severity of the cause. Some of these treatable causes of dementia are; brain tumors, hormone disorders, poor oxygenation, infection, normal pressure hydrocephalus, simple hydrocephalus, metabolic disorders, nutritional deficiencies, chronic alcoholism, and drug reactions, overuse, or abuse.

Diagnosing Dementia

If you start noticing some symptoms of dementia in a loved one, the first course of action should be an evaluation by a doctor. The doctor will probably review her medical history, medications, and symptoms. It is helpful to have someone go with her who knows what her symptoms and behaviors are.

Diagnosing dementia can’t be done with a single test. The doctor will probably conduct a physical exam and may perform some tests that measure thinking, memory, orientation, reasoning, judgment, language skills, and attention. He may also order tests such as a brain scan, CT scan, MRI, or PET scan that could help find or rule out possible causes of dementia.

The doctor may order blood work for lab tests that could rule out problems such as B₁₂ deficiency or problems with the thyroid. In some cases, he may order a spinal tap to check for possible diseases that would show up in the spinal fluid.

It can be a challenge to care for someone with dementia. In future posts, we will address ways to communicate with and care for the older person with dementia.

 

There are activities that we perform every day. These daily activities are often referred to as activities of daily living and include feeding, toileting, dressing, transferring, walking, bathing and grooming. We usually complete these activities without even having to think about it. However, each of these activities can be challenging for the elderly.

How often is too often?

It’s likely that the older adult didn’t take daily baths growing up.  For most people, two to three baths a week is sufficient. The older adult may have decreased activity levels, and therefore require fewer baths. Good hygiene is still important, however. Keeping skin clean prevents odor, urinary tract infections, rashes, skin irritation and skin diseases.

While bathing is not necessary every day, I do recommend washing the face, hands, underarms and groin daily. You can do a sponge bath of these areas while they are sitting on the toilet or lying in bed.

While there is no right answer for all seniors, being prepared is the key to success when it comes to bathing!

Prepare for Resistance

Bathing the elderly is a task that can be difficult and can be made more complicated by dementia. Confusion may cause your parent to think that she has already taken a bath today. Or, she might be resistant to bathing because she is afraid of the water or afraid of falling. For someone with Alzheimer’s dementia, the feeling of water falling on them in the shower can lead to sensory overload.

Embarrassment may also be a factor in resisting bathing. Seniors were raised to be modest. Asking them to take their clothes off in front of us can violate that modesty. We must maintain their dignity during the bathing process. They may be more comfortable and therefore more cooperative with a home health aide bathing them.

Prepare for Safety

The bathroom can be a dangerous place. There are more accidents happening in the bathroom than in any other room in the house. Safety must be a priority. Many older adults have difficulty with vision, so before bathing, check to be sure lighting is adequate.

Using an in-the-tub mat with a suction base can decrease the risk of slipping in the tub. These mats are usually more effective than the non-slip stickers that you can apply to the bottom of the tub. A non-slip area rug beside the tub may be helpful.

The older adult may tire easily, experience shortness of breath, or have difficulty standing when bathing or showering. For this reason, shower chairs or benches are useful devices. A hand-held shower head is helpful for rinsing, especially when seated. Grab bars on the wall, as well as safety handles on the tub, can provide a sense of security and give stability during transferring in and out of the tub or shower.

Prepare for Chaos

As with everything else in life, the bath process may not go according to plans. You might have planned for baths on Monday and Thursday, but it’s Tuesday, and mom woke up wet and needs a bath today. Not every day is a good day – for you or your family member. Be flexible. Save bathing for days when mom is more alert, has more energy, or is more agreeable. She may not want to bathe today, but you might be able to encourage her by having her get ready for a favorite activity. If she likes going out to lunch, tell her she needs to get her bath and get dressed to go out. You may have to be creative. You must be flexible.

Prepare the Environment

The older adult gets chilled easily, so be sure the bathroom is warm before bathing. Turn off the television and leave your cell phone in the other room. Remove any other noise and distractions.

If bathing, you probably only need about two to three inches of water in the tub. The water temperature should not be over about 100 degrees. If the water is too hot, it can burn the skin, but it can also dilate blood vessels, drop blood pressure, and cause dizziness or fainting. They should not stay in the tub more than about 20 minutes because longer than that can cause fatigue and dry skin.

If showering, check water temperature on the inside of your wrist and let them feel water temperature on their hand before allowing the water to wash over the body.

Prepare Supplies

Be sure to gather all the supplies you will need for bathing before getting started. It’s easier if you have the supplies set up in the order that you will need them. You will want a mild liquid soap with moisturizers, a soft washcloth or sponge, towels, and any clothing they will wear. A bath blanket is helpful to prevent chilling after the shower or bath.

Prepare Yourself

As I mentioned above, you want to choose a good day for both of you. Calm yourself before getting started. Think of fun topics to talk about during the bath. The process of bathing will take time. Allow for unanticipated delays. Don’t try to rush; this will only increase the risk of injury and increase the stress level for everyone involved.

Remember that the person with dementia or physical problems is not trying to be difficult, they are sick and are doing the best they can. Try to make the experience a happy one. Offer reassurance. “You’re doing a great job.” Continue to offer encouragement. Doing this will help decrease tension, fear, and embarrassment.

Prepare for Success

It is helpful to start the bathing experience by having them use the toilet before getting into the shower or bath. Doing this allows time to empty their bladder, as well as giving you the chance to remove their clothing while they are sitting down. Use care when transferring into the tub and be ready to give assistance. Assist by holding their weak side if they have one. Have them step into the tub using their strong side.

Allow them to wash as they are able and assist when needed. Explain what you are doing before doing it. Use gentle pressure when washing, don’t scrub. Pay close attention to those hidden areas like skin folds, the area beneath the breasts, tummy folds, and genitals.

Break the job into smaller, simple tasks. Instead of saying “take a bath,” you may need to say “wash your face, wash your arms,” etc. Give simple choices; “Would you like to wear the green dress or the red one?” Give simple instructions. The person with dementia will usually only remember to do the last thing you say. If you give several instructions at the same time, it will only be confusing. Keep it simple.

 

 

 

The skin is the largest as well as the fastest growing organ in the body. It would span about 20-22 square feet if you stretched it out. The skin’s job is to protect and to serve as a barrier. It protects from impact, pressure, micro-organisms and chemicals. The skin helps regulate body temperature and permits the sensations of touch, heat, and cold.

In this post, we discuss how to prevent pressure sores. But first, some information about what a pressure ulcer is. Pressure sores develop when there is continuous pressure on areas of the skin over boney areas such as the lower back, the coccyx, heels, buttocks, hips, elbows, knees, ankles, toes, and the back of the head. The pressure blocks the flow of blood to the area, which damages the skin and tissue causing redness, blisters or open sores.

The elderly are at increased risk for pressure sores because their skin is thin and their circulation is weak. The good news is that most skin sores are preventable. One basic practice to get in the habit of is looking at the skin at least daily. Look for redness, darkening, cracking, blisters, bruises, cracking, dry areas, scraped areas, redness, swelling, heat or warmth to an area.

One way to determine if a reddened area is becoming a pressure sore is to apply pressure to the site with your finger. The area should go white. When you remove pressure, the area should go back to red or pink. If the area stays white (blanching), blood flow has been impaired. Keep off the area and notify your nurse or doctor right away. Skin sores can worsen and go down to the bone. They can be a source of infection and can even be life-threatening if not treated.

NOTE: In darker skin, there may not be visible blanching even when it is healthy. Check for other signs of damage like changes in color or hardness compared to surrounding areas.

Now, how to prevent pressure sores. First, you need to keep the skin healthy. Keep it clean and dry (but not too dry).  Be sure to clean skin folds and under breasts. Use a moisturizing lotion on areas of dryness. There are also skin protectants that you can apply to the skin. Your doctor can provide these.

Good nutrition and fluid intake are very important. Eating the proper diet and getting enough protein (especially plant-based protein) is essential. The elderly have decreased fat under the skin, and this can increase the risk of pressure areas. Dehydration is also a factor. Most sources say that we should drink eight glasses of water a day. The amount of fluid needed can vary with exercise or illness.

Since pressure sores are caused by pressure, we obviously need to minimize the amount of time spent on bony areas of the body. Frequently changing position is a good way to accomplish this. If your parent is confined to bed and cannot turn themselves, they should be turned every two hours. When sitting in a wheelchair, weight needs to be shifted every 15-30 minutes for at least 30-90 seconds.

There is a vast multitude of cushions, mattresses, pads and pillows available to decrease pressure on the body. No two skin areas should be against each other. Place pillows between knees when lying on the side. Don’t cross legs or ankles.

 

When changing a loved one’s position, lift, don’t slide. Sliding can cause shearing which injures the skin. Don’t raise the head of the bed too high as this can also cause shearing of skin.

Be sure their clothing fits properly. Wrinkles and buttons can cause pressure and skin irritation. Improperly fitting shoes can rub on toes and cause sores. Check for wrinkles or items that might have fallen in bed. All of these can cause pressure on the skin.

A light massage to an area increases blood flow. But, do not massage an area after it has become red because the friction can damage the skin further.

Finally, if able, have them wiggle toes, move legs, and flex arms. Movement keeps the blood flowing and helps prevent pressure sores as well as blood clots.