Aftercare Tips for Elderly Patients Checking Out of the Hospital

Readmission into the hospital after surgery or another procedure is extremely common, costly and time consuming. Since it is one of our main priorities to keep our clients healthy and living at home rather than in the hospital, I wanted to share this article from The New York Times as it provides great tips for hospital checkout and avoiding readmission.
In 2009,The New England Journal of Medicine reported “one in five Medicare patients returns to the hospital within 30 days of being discharged.” Dr. Mark V. Williams, who worked on this study, suggests that part of the issue is due to the fact that doctors place much of their focus on the admission process, when the patient is most sick. When the patient leaves the hospital, they often have more medications and treatments to worry about than when they first entered. Some doctors suggest that this problem may also occur because it may benefit the hospital financially for patients to be readmitted.
Dr. Eric A. Coleman, professor of medicine at the University of Colorado Denver, has developed a program called Care Transitions Intervention to help seniors take initiative in their care after leaving the hospital. The steps of the program include taking charge of your care, checking the medication list for errors, making a comprehendible discharge plan and contacting your primary physician if you have any questions or concerns. To further help the cause, some medical centers are providing financial incentives for lowering readmission rates and are providing guidance for improving the discharge process.

Recognizing Symptoms of Dementia

By Anne Pagnoni

The Brown family reunion has always been an event everyone looks forward to. Family visits, games, stories and everyone's favorite foods are always on the agenda. On the top of the menu is Grandma's Lemon Coconut Cake. Grandma always makes the traditional cake from her old family recipe. This year, however, the cake tasted a little on the salty side - perhaps a half cupful of salty.

Though the family was disappointed over the cake, of more concern was Grandma's confusion with the recipe and her similar confusion about the loved ones around her. Could something be wrong with grandma's mental state?

One might say that for an older adult a little forgetfulness or confusion is normal, but when do you know if there is a serious problem, such as dementia? An online article from FamilyDoctor.org outlines some common symptoms in recognizing dementia:

"Dementia causes many problems for the person who has it and for the person's family. Many of the problems are caused by memory loss. Some common symptoms of dementia are listed below. Not everyone who has dementia will experience all of these symptoms.

• Recent memory loss. All of us forget things for a while and then remember them later. People who have dementia often forget things, but they never remember them. They might ask you the same question over and over, each time forgetting that you've already given them the answer. They won't even remember that they already asked the question.
• Difficulty performing familiar tasks. People who have dementia might cook a meal but forget to serve it. They might even forget that they cooked it.
  Problems with language. People who have dementia may forget simple words or use the wrong words. This makes it hard to understand what they want.
• Time and place disorientation. People who have dementia may get lost on their own street. They may forget how they got to a certain place and how to get back home.
• Poor judgment. Even a person who doesn't have dementia might get distracted. But people who have dementia can forget simple things, like forgetting to put on a coat before going out in cold weather.
• Problems with abstract thinking. Anybody might have trouble balancing a checkbook, but people who have dementia may forget what the numbers are and what has to be done with them.
• Misplacing things. People who have dementia may put things in the wrong places. They might put an iron in the freezer or a wristwatch in the sugar bowl. Then they can't find these things later.
• Changes in mood. Everyone is moody at times, but people who have dementia may have fast mood swings, going from calm to tears to anger in a few minutes.
  Personality changes. People who have dementia may have drastic changes in personality. They might become irritable, suspicious or fearful.
• Loss of initiative. People who have dementia may become passive. They might not want to go places or see other people."

Dementia is caused by change or destruction of brain cells. Often this change is a result of small strokes or blockage of blood cells, severe hypothyroidism or Alzheimer's disease. There is a continuous decline in ability to perform normal daily activities. Personal care including dressing, bathing, preparing meals and even eating a meal eventually becomes impossible.

What can family members do if they suspect dementia? An appointment with the doctor or geriatric clinic is the first step to take. Depending on the cause and severity of the problem there are some medications that may help slow the process. Your doctor may recommend a care facility that specializes in dementia and Alzheimer's. These facilities offer a variety of care options from day care with stimulating activities to part or full-time live-in options. Sometimes if patients tend to wander off, a locked facility is needed.

In the beginning family members find part time caregivers for their loved one. At first, loved ones need only a little help with remembering to do daily activities or prepare meals. As dementia progresses, caregiving demands often progress to 24 hour care. Night and day become confused and normal routines of sleeping, eating and functioning become more difficult for the patient. The demented person feels frustrated and may lash out in anger or fear. It is not uncommon for a child or spouse giving the care to quickly become overwhelmed and discouraged.

Family gatherings provide an excellent opportunity to discuss caregiving plans and whole family support. It is most helpful if everyone in the family is united in supporting a family caregiver in some meaningful way.  "The first step to holding a family meeting, and perhaps the most difficult one, is to get all interested persons together in one place at one time. If it's a family gathering, perhaps a birthday, an anniversary or another special event could be used as a way to get all to meet. Or maybe even a special dinner might be an incentive. The end of the meeting should consist of asking everyone present to make his or her commitment to support the plan. This might just simply be moral support and agreement to abide by the provisions or it is hoped that those attending will volunteer to do something constructive. This might mean commitments to providing care, transportation, financial support, making legal arrangements or some other tangible support." The Four Steps of Long Term Care Planning

 Professional home care services are an option to help families in the home. These providers are trained and skilled to help with dementia patients.

The National Care Planning Council supports caregiving services throughout the country. Visit www.longtermcarelink.net for more information.

Why Any and All Activity Matters

By Anne Pagnoni

The health benefits of exercise are extraordinarily well documented. Regular exercise lowers your risk of a stroke by 27%, reduces instances of both high blood pressure and Alzheimer's disease by 40%, cuts your chance of developing diabetes by 50%, and lowers your risk of developing colon cancer by a whopping 60%. As well, it obviously helps maintain a healthy weight. Plus, exercise has been shown to be just as effective at fighting depression as both SSRIs (like Prozac) and therapy.

A recent study from the Appalachian State University's Human Performance Lab even showed that people who took a brisk walk five days a week had fewer and less severe colds and flus than sedentary control subjects. So it's not just long-term chronic and fatal conditions that being fit staves off – regular exercise actually helps you battle the common cold, too!

Beyond full-on exercise, however, a recent study out of Australia also shows the health risk of being inactive. The study from the physical activity lab at the Baker IDI Heart and Diabetes Institute in Victoria, Australia found that the more television its subjects watched, the greater risk they had of dying at a younger age, particularly from heart disease.

Subjects in the study who watched four hours or more of television per day were 80% more likely to die from heart disease and 46% more likely to die from all causes, even when factors such as: education levels, overall health, age, past smoking, waist circumference, cholesterol levels, and blood pressure of the subjects was taken into account.

The study concluded that the real problem with television watching is that it is done while sitting, and sitting with extraordinarily little muscle movement. Such "extreme" inactivity affects metabolism overall, not just during the time spent inactive. A study from July 2008 showed that standing engages muscles and promotes the distribution of lipase, a fat-absorbing enzyme that triggers the body to process fat and cholesterol. Most important, the benefits of this regular, unremarkable movement are independent from the amount of time subjects spent exercising.

That same study found that the health consequences that develop from too much sitting are very different and independent from those that result from too little exercise. Along with the recent Australian study, it found that the negative health consequences of prolonged periods of sitting – larger waistlines, higher bad cholesterol levels, lower good cholesterol levels, heart disease risks – were not fully counteracted by regular exercise.

In other words, regular exercise – beneficial as it is – doesn't counteract the negative effects of long periods of inactivity.

Part of the issue is that television watching is fundamentally inactive. Harvard Health Publications estimates that, when it comes to calories burned, watching television (56 calories per hour) is closer to sleeping (46 calories per hour) than it is to sitting and reading (84 calories per hour), which itself is more akin to standing in line (94 calories per hour) than it is to watching television. (Note: calorie counts are for a 155-pound person.) In other words, watching television is an inactive as a person can get without sleeping.

Along with limiting television watching, these studies point to the importance of remaining active throughout the day. The good news is that it ends up that the simple physical movements of standing and moving between rooms has significant health benefits. When watching television, standing up during commercial breaks, going to get a glass of water, or even putting down the remote control and getting up to change channels and adjust volume the old-fashioned way can help people from staying in one extremely inactive position for extended periods of time.

Light household tasks and self-care – activities encouraged by the Balanced Care Method™ whenever clients are physically able – can help keep people moving. Not only does such daily activity help keep people physically active longer, we now know it also can help fight heart disease and other health risks.