Caregivers Need Sleep!

Caregivers Need Sleep!

 

 

 

Adequate sleep is essential to staying healthy and functioning well. You need sleep to do your daily work safely, to cope with emotional stress, and to carry on giving care.

Yet if you are caring for someone at home or sitting with someone round the clock in a care facility, you likely are not getting enough sleep.

 

Researchers have found that 95% of family members who provide palliative care have serious sleep problems. These problems are becoming better understood, and increased attention is being given to caregivers’ sleep problems, especially in those caring for people with cancer, dementia, Parkinson’s disease, or children with illnesses or disabilities.

Family caregivers often minimize their sleep problems and hesitate to talk about them with the health care team. You may feel your sleep is less important than what is happening with the person in your care. You may think you can get by with limited sleep and catch up in the future. Unfortunately, this lack of sleep is more likely to catch up with you.

 

What is sleep disturbance?

 

Sleep disturbance is any change from the way you usually sleep. It may be a change in how long or how well you sleep, and may include one or more of the following:

 

  • difficulty falling asleep
  • difficulty staying asleep through the night
  • waking early in the morning
  • feeling tired in the morning
  • being sleepy during the day

 

Factors that contribute to caregiver sleep disturbance

 

Many factors contribute to poor sleep for caregivers. It may be one or a combination of the following factors:

 

Changes in routine
When you care for someone, you have less time for fresh air, exercise or relaxation, which promote sleep, and you may consume more caffeine (e.g. coffee, tea, coca cola, chocolate), which inhibits sleep.

 

Change in sleeping environment
You may sleep on a couch or temporary bed to be near the person you are looking after. You may be disturbed by the nighttime noise made by special equipment, such as an oxygen concentrator, alternating pressure mattress, or even a baby monitor you may use to listen for calls for help.

 

Worry
You may have trouble falling asleep or may wake up in the night because your mind is busy thinking about your concerns. Some caregivers talk about wanting a remote control to ‘shut it off’ or ‘change the channel’.

 

 

Lack of help with overnight care
The programs and services in your area may be limited, which makes it difficult to find respite care at night. You may find it hard to hand over responsibility or trust the care provided by others. The person who is ill may not be willing to accept outside help.

 

Needs of the person who is ill
As the person in your care becomes weaker, he or she will need help during the night as well as during the day. Your sleep may be interrupted because you need to help with toileting, repositioning or medications. The person may have trouble sleeping if symptoms such as pain,  shortness of breath or restlessness are not well controlled. If the person in your care is unable to sleep, chances are you will be unable to sleep as well.

 

Grief
You may have trouble sleeping after the death of a loved one. This may be due to poor sleeping habits developed while caregiving, or it may be part of the mental and emotional sifting that happens during the grieving process.
 

 

Effects of Sleep Disturbance

 

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Regardless of the cause, your lack of sleep has consequences for you and for the person in your care. These are some of the common consequences:

 

  • Your overall physical health may change. Your body may not be able to fight off a cold or flu as usual, or you may experience flare-ups of an existing health problem, such as high blood pressure.
  • Your overall mental health may change. You may feel less able to cope with the emotional ups and downs and stresses of providing care. You may have memory problems, or trouble thinking clearly. Also, sleep disturbance has been linked with depression. 
  • Your lack of sleep may change the way you relate to the person you are caring for, You may be impatient, angry or resentful towards the person who is ill, or act in a way you later regret.
  • You may feel sleepy or exhausted during the day, and question your ability to carry out day-to-day activities or to provide care safely.

 

Managing Sleep

 

It is important to talk to the health care team about any sleep difficulties, either yours or those of the person you are caring for. In each case, it is important to ask for the team for help for both your sakes.

Assume that the health care team can control the symptoms of the person you are caring for.

Symptoms such as pain, shortness of breath, confusion or restlessness need to be controlled so both of you can sleep. The team needs to hear about difficult symptoms so they can treat them.

  

Also talk to the health care team about the type and amount of sleep you are getting. Try to be as specific as possible about these points:

 

  • how much sleep you are really getting between the time you go to bed in the evening and the time you wake up in the morning,
  • how often you are up in the night as a caregiver,
  • how much you rest during the day.

 

Together, you and the health care team can explore ways to promote sleep and rest. It may help to talk to someone. A hospice volunteer, social worker, spiritual care provider or counselor may help you find ways to reduce your worries and link you to services and supports.

 

 

 

 

Medication

 

Many caregivers do not like to take sleep medication, because they worry about not hearing the person they are caring for, or being too sleepy to be provide care in the night.

Talk to a doctor about the possibility of taking a sleep medication if other attempts to promote sleep have failed.

 

Recommended: LUNA Natural Sleep Aid

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  • Do you suffer from insomnia, sleep deprivation, or simply just can’t get a good sleep at night? Can you get to sleep but can’t stay asleep? Do you sleep fine but never wake up feeling refreshed or energized? LUNA is the answer to your prayers and will give you the best sleep of your life. Stay asleep and wake up feeling refreshed & energized – 100% guaranteed! NATURAL, DRUG-FREE, NON-HABIT FORMING INGREDIENTS
  • LUNA is made with safe, natural, scientifically backed ingredients that are non-habit forming (unlike prescription medications) that will encourage a healthy and balanced sleep schedule. You’ll get deep, restful sleep without the side effects of harsh chemical alternatives.

 

 

Don’t be afraid to ask for help with caregiving. Asking for help is not a sign of failure. You do not have to do everything on your own. Sometimes it makes a big difference to ask for even a small bit of help. For example, you can ask someone to cover for you while you take a nap or sleep overnight two or three times a week.

 

Other Than Medication,What Can You Do?

 

These are some things that may help you improve your sleep:

 

  • Try to maintain a regular sleep-wake schedule as much as possible.
  • Try to grab even a few minutes every day for exercise and fresh air if at all possible.
  • Cut down on caffeine (e.g. coffee, tea, chocolate, coca cola) and nicotine (e.g. smoking) during the day, and especially before bedtime.
  • Nap when you can, but try to avoid the late afternoon and evening, unless you know you will be awake during the night to provide care.
  • Minimize nighttime noise or light around you. Remove clocks also, unless you need to set an alarm.
  • As much as possible, identify, talk about and find ways to address worries and concerns before bedtime. Even small things such as making a list before bed can help clear the mind for sleep.
  • Set up a bedtime routine that lets you unwind a bit before you turn out your light. It may help to have a bath, wash your face and hands, change into pajamas, brush your hair and apply lotion to your face and hands.
  • Notice what helps you relax, and make that part of your routine. You might listen to soft music, read a bit, watch a funny TV show, or pray.
  • Have something warm to drink or eat before bed.
  • Go to bed when you feel drowsy in the evening, rather than making yourself stay up until a set time. This helps you avoid lying awake in bed.

 

If you are having difficulty sleeping due to your role as a caregiver, be proactive. 

Lack of sleep can negatively affect your health and your thinking in many ways.  Try some of the tips listed here, and seek medical advice if necessary. 

 

 

Thanks for visiting and reading … I hope this article provided you some helpful ideas.  I welcome your comments below.

-Laurie

 

 

 

 

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Giving a Sponge Bath in Bed

Giving a Sponge Bath in Bed 

 

 

 

If you’re a caregiver learning how to give an effective bed bath is essential.

 For a frail older person showering can be painful and distressing, especially when it involves heavy lifting equipment or weight bearing on painful limbs.
 
A sponge bath is a quick and easy way to attend to an older person’s hygiene needs between showering and bathing. A family member who is unwell, unconscious or recovering from an illness will usually require a sponge bath in bed.
 
Offering a person a sponge bath every second day can also be an alternative to showering. Not everyone requires a shower everyday. A ‘quick wash’ is often enough.

Depending on an individual’s level of care, the equipment available and how much a person can help themselves a sponge bath can usually be done by one person.
  
Giving a bed bath requires you to wash the person’s front, sides, and back, not to mention crevasses and folds — while she’s lying down. Depending on her condition, merely touching or moving her body may cause discomfort. If she weighs a lot, it can be strenuous for you. Not to mention the challenge of keeping the mattress dry.
 
For older people who cannot roll or have difficulty changing their position a second caregiver will be needed to ensure a person’s safety and comfort. 
 
Caregivers should also keep in mind that sponging a person in bed can still place strain on a caregiver’s back and ensure they practice safe lifting and transfer techniques.

 

 

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Don’t worry! People have been giving bed baths for centuries: They’re a standard of hospital and home healthcare. All this practice has produced practical techniques that make giving a bed bath much easier.

   

 

 

 

 

7-Pack: 27" x 52" 100% Cotton Extra-Absorbent Bath Towels

Beginning the Bed Bath

 

Before you begin a bed bath, make sure you have a huge pile of clean, dry bath towels and clean, dry washcloths, at least a dozen of each.
 
Wash Cloth Towels by Royal, 24-Pack, 100% Natural Cotton, 12 x 12, Commercial Grade, Appropriate for use in Bathroom, Kitchen, Nursery and for Cleaning, Soft and Absorbent, Machine Washable, White
  
 

 

Also, there should be a table or shelf within easy reach to hold a water container and supplies. A wheeled cart — such as a basic TV or kitchen cart like this Whitmor Supreme Cart — is ideal.

Finally, adjust the room temperature so it’s toasty warm.

Get Started

 

  • Lay thick bath towels under the person from head to toe. These are to absorb water, protecting the bedding and mattress. You might want to also use a waterproof sheet under the cloth sheet to ensure that the mattress stays dry.
  • Undress her but keep her under a blanket or large towel. This covering stays on during the whole bath for both warmth and privacy.
  • Fill two large bowls with warm water, one for washing and one for rinsing. Put the bowls within easy reach.
  • Stand at her shoulder. You’ll be washing down one side of her body, section by section, lifting the cover away only as much as necessary. It helps to tilt her up on the side a little, facing away from you, so you can reach underneath her body. Start with her shoulder, then her arm and hand, including the fingers. Move to the side of her torso and hips, then wash her thigh, lower leg, foot, and toes.
Johnson's Baby Bedtime Moisture Wash, 15 Ounce (Pack of 2)
  • The washing itself is straightforward: Soap then rinse, using a different washcloth for each. Rinse sufficiently to get all the soap off. (Soap residue is drying to the skin, and elderly skin is prone to dryness.)
  • Refill the water bowls as needed. Make sure the temperature of the water stays warm to the touch. When washing, stroke in the direction of the heart , toward the torso, to help blood circulation.

 

 

  • After a section is rinsed, pat it dry with a towel and lay the cover down as quickly as you can for warmth.
Ableware 764302000 Easy Shampoo Basin, White
  • After you’ve finished one side of the body, start at the other shoulder and work down. Afterward, move to the head and neck. This is a great time to shampoo, which is easiest with a soft plastic bed bath shampoo bowl, sold at medical supply stores and on Amazon.

 

 

 

 

 

Recommended: Ableware Easy Shampoo Basin

  • Simplifies shampooing a person while in bed
  • Supports the head, neck and shoulders during shampooing
  • High, double tube design helps prevent splashing
  • Compact, Comfortable, Convenient
  • Inflates and deflates quickly

 

Johnson's Baby Shampoo, Calming Lavender, 20 Ounce (Pack of 3)
  • The shampoo bowl can be placed right on the mattress, and all you need to do is lift or edge your family member’s head into it. (Don’t leave her unattended for even a few seconds when a bowl of water is near her head.)
  • If you don’t have a shampoo bowl, lay dry towels under her head and do the best you can with your bowls of water, soaping and rinsing. Consider using baby shampoo, which rinses out easily.

  Recommended: Johnson’s Baby Shampoo in Calming Lavender

  • Save the privates for last. Do these quickly, lifting the cover only as much as necessary to soap and rinse. With a man, you’ll need to wash under his testicles. With a woman, wash the labia; there’s no need for a deep cleaning. To reach the rear, tilt the person’s body to the side as much as you need to or can. Or you can bend her knees and reach under from the front.
  • When you’re done, the person’s entire body should remain covered with the blanket or towel. If it’s damp, exchange it for a dry one. You may need to add another layer. Slowly pull the wet towels from under her body.
  • Take a deep breath and relax before dressing her.
  • Giving a bed bath is a bona fide workout, and you’ve earned a break.


 

Alternative bed bath techniques:

through-the-towel, the chair bath, and more

 

In addition to the standard bed bath described above, there are variations on the theme. You may very well discover your own useful adaptations as you gain experience.

One alternative method of giving a bed bath is to wash and rinse through a towel, never touching the person’s skin. Using a washcloth, you soap and rinse through the layer of towel, which acts as a sort of second skin. This is one way around modesty concerns, which can be extremely uncomfortable for you and her.

This technique for giving a bed bath minimizes the need to rub or stroke. Instead, you pat or gently massage the wet towel t hat covers a section of her body. When you’re done with that section, take off the wet towel and quickly replace it with a dry one or a blanket to avoid a post-bathing chill.

 

Drive Medical Premium Series Shower Chair with Back and Arms

Another twist on giving a bed bath: Keep several washcloths in large plastic zip-close bags of warm water, one clean and the other soapy, and take them out as needed. This eliminates the need to rinse washcloths in bowls of water. As soon as a washcloth gets dirty, stop using it and get a clean one from the bag. Check the bags regularly to make sure the water remains warm.

Then there’s the chair bath. If the person you’re caring for feels comfortable sitting up in a chair, this may be the best position for bathing. The routine is pretty much the same as for a bed bath.

 

Recommended: Drive Medical Premium Series Shower Chair with Back and Arms

 

 

AquaSense Adjustable Bariatric Bath Bench with Non-Slip Seat and Back Rest

 

 

If you require a heavy duty bariatric shower chair, I recommend the AquaSense Adjustable Bariatric Bath Bench, which has excellent safety features and a 700 lb weight capacity.  Read reviews.

If you don’t have a shower chair, you’ll need to protect the chair from water. Vinyl-covered chairs can work, or you can get creative with plastic garbage bags or a tarp.

 

 

 

 

 

Tips for giving a bed bath to overweight or sensitive people

 

 

If the person you’re bathing is resistant to a bath or particularly sensitive to water, try using no-rinse soaps and shampoos. You rub them in and towel them off — the dirt comes off in the toweling.

No-rinse bathing products can be a huge help, but they do leave a residue, so you’ll need to rinse with water every now and then.

Recommended: No Rinse Body Bath and No Rinse Shampoo Cap

 

No-Rinse Body Bath, 16 oz
No-Rinse Shampoo Cap 12/Case

 

 

 

 

Giving a good bed bath requires a lot of movement on your part — lifting, holding, and tilting the person’s body.

If she’s overweight or heavy, a bath may be a two-person job. The same is true if she’s easily irritated or feels pain when touched.

“You may need other people to help, like a relative or home health aide,” says Jennifer Serafin, a registered nurse and geriatric nurse practitioner at the Jewish Home for the Aged in San Francisco.

You can hire a home health worker to assist you, enlist relatives or friends, or try a combination of the two. Hiring a professional for a one-time crash course on giving a bed bath could also be extremely helpful.

You won’t need to give a full-body bed bath daily. Ask the medical team, but in most cases a full bath once or twice a week should be sufficient.

 

Comfort Bath Personal Cleansing, Ultra-Thick Disposable Washcloths, 8 ea pack of 2

It’s recommended that you clean the private areas and under any skin folds daily. You’ll need to wash under the testicles, breasts, armpits, and tummy rolls, which are more of an issue with overweight people.Once-a-day washing can be done efficiently with a wipe or damp washcloth. If the person in your care uses the toilet, take this opportunity for a quick cleaning. 

Recommended: Comfort Bath Personal Cleansing Ultra-Thick Disposable Washcloths

 

 

 

Remember that in addition to cleansing, the bed bath, or sponge bath, has important health benefits: in addition to maintaining hygiene, it improves circulation and eases some of the discomfort and stress associated with prolonged immobility. It acts as a minor form of exercise too.

Bathing also provides an opportunity for the caregiver to observe the person’s general well being, and note any changes or concerns that may need medical attention.

In particular, bathing is a good time to check for reddening of the skin that may indicate that a pressure sore (bed sore) is developing. Pressure points such as the buttocks, spine, elbows and hips are likely areas for bed sores to occur.

If you are providing bed baths, make sure you have everything you need before you begin, and develop a routine that works for both you and the person you are caring for.  Please share any thoughts or experience below.

 

Thoughts, questions, tips?  Feel free to comment below.

 

 

 

 

 

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About Me

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Brain Disease Swallowing Problems

 

Brain Disease Swallowing Problems

 

 

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Swallowing problems in degenerative brain diseases

People who have degenerative brain diseases, such as Alzheimer’s, other dementias, Parkinson’s disease and Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s disease), often develop swallowing problems (dysphagia) as their disease progresses. This is because the degeneration of the nerves and their complex connections often spreads throughout a person’s nervous system.

 

Why does swallowing become a problem?

We take swallowing for granted until we have trouble doing it. Most of us have experienced an episode of choking when food or fluids enter the trachea (windpipe). This is called aspiration, and our lungs respond with a fit of coughing to clear our airway.

Swallowing is a complex action that requires the sensory and motor parts of our brain to work together. When we eat and drink, the brain senses food and fluids in our mouth, moves them safely into the esophagus, and protects the trachea at the same time. Food or fluid then moves down the esophagus into the stomach. Swallowing requires 40 muscles working together with both the sensory and motor parts of the brain. A degenerative brain disease can affect a person’s ability to swallow in different ways, depending on which parts of the brain are affected and how quickly the disease progresses.

 

Swallowing problems are serious

When swallowing begins to fail, it signals that a person’s degenerative brain disease is at an advanced or life-threatening stage. Serious infections (pneumonia and lung abscess) develop in the lungs when food and fluids are aspirated into the airways. Almost half of patients with dementia who develop “aspiration pneumonia” will die within the next six months. 

Oral or intravenous antibiotics may cure pneumonia, but the more frequently infections occur, the more likely antibiotics will be ineffective. This is because the person is repeatedly aspirating either food and fluids or saliva, which is an indication that the disease is progressing. In order to clear pneumonia, antibiotics need the help of an effective cough and a strong immune system, both of which are lacking in this phase of illness. Also, with each infection, the person becomes weaker and can harbor more resistant organisms. Complications such as a C. difficile infection in the bowel can arise from repeated courses of antibiotics.

 

How can the risk of infection be reduced?

To reduce the risk of aspiration, a speech language pathologist (speech therapist) or occupational therapist with training in this area first conducts a swallowing assessment. Once the specific swallowing problem is identified, the pathologist or therapist recommends strategies for preventing aspiration.

 

 

Ensuring that the person is awake, sitting upright and concentrating on eating or drinking is essential for reducing the risk of aspiration regardless of the swallowing problem. Avoiding foods that are particularly difficult to swallow can prevent choking.

Changing the texture of other foods (for example, by mincing or pureeing) and thickening fluids can make them easier to swallow safely.

Try Thick-It Instant Food and Beverage Thickener

 

Thick-It 36 OZ
Feeding a person in this way has been called “feeding at risk” but a better name for it is “careful hand feeding.”

Despite these measures and vigilant feeding by family or staff in a facility, aspiration and infection can still occur. This is because swallowing problems worsen over time and a person’s chest muscles become too weak to cough. As a result, he or she cannot expel fluid or food, and the airway is unprotected. When this occurs, it is called “silent aspiration.” Saliva too can be aspirated, and bacteria in the mouth can cause infections in the lungs.

 

Is a feeding tube helpful?

Recurring infections and more trouble swallowing signal advanced degenerative brain disease. Often by this stage, the person is no longer able to understand his or her medical issues. Family members are often asked to step in to decide whether their loved one would accept a feeding tube.


 

What is a feeding tube?

A temporary feeding tube is passed through the nose and into the stomach. Rarely is a temporary tube used for more than a few days, because it is uncomfortable and easily pulled out. 

 

 

A long-term feeding tube called a PEG tube (percutaneous gastrostomy tube) is surgically inserted. A scope is passed through the mouth and into the stomach. It presses the stomach against the abdominal wall and a tube is passed from outside the patient’s body into the stomach.

With PEG tubes, there is a one-in-ten chance of painful ulcers, infection or tube leakage at the abdominal wall. There is a three-in-a-hundred chance of severe complications, such as serious bleeding, perforation of the bowel, secondary pneumonia, or breakdown of the abdominal wall.

 

How effective are feeding tubes?

Many family members feel a feeding tube may prolong life, improve its quality, and possibly reverse their loved one’s degenerative brain disease. However, multiple studies show that people who have degenerative brain diseases do not live any longer with a feeding tube than a similar group of people who are fed carefully by hand. Studies also show that a feeding tube does not reduce the risk of aspiration. It is still possible to aspirate saliva and develop a serious pneumonia. 

The progressive weakness related to degenerative brain disease isn’t because of lack of intake. It is the outcome of the natural progression of the illness. The tube does not affect the progression of the disease nor does it improve a person’s quality of life. 

Many family members want a feeding tube for their loved one because they do not wish him or her to feel hunger. However, a person’s desire to eat lessens as end of life approaches. As well, many people with advanced degenerative brain diseases are not very active. They do not need as many calories as they did when they were mobile.

See End of Life Nutrition

 

Complications

While the feeding tube can get food safely to a person’s stomach, it cannot prevent aspiration of saliva into the lungs. As well, the feeding tube cannot prevent aspiration of food into the lungs if the person has gastric reflux (food passing from the stomach back into the esophagus because of a leaky stomach valve). 

 

Advantages of careful hand feeding

 

 

 

Careful hand feeding has many advantages over tube feeding. It allows the person to still experience the taste of food and interact with others. Preserving these important parts of eating may result in a higher quality of life for a loved one. Careful hand feeding reduces the use of medications needed to treat the discomfort of the tube.

 

 

Careful hand feeding is the simplest and most satisfying way for a person to continue eating. The recommended approach is small amounts of favorite foods. If the person refuses food, then basic mouth care is offered.

 

 

How do you make the best decisions?

Dealing with complex decisions in advanced disease can be very stressful for the family. So it is important for family members to support each other through these times.

It also is not uncommon for family members to have differing opinions about what is best for their loved one. This is when it is essential for family members to focus on what they believe their loved one would prefer rather than on what they would wish to see happen. The health care team can help support families through these difficult conversations.

Decisions at this time are best made with the health care team and family working together. The health care team can explain the options available for a loved one, given his or her stage of illness. The health care team can also outline what is and isn’t medically possible and appropriate. The family can give insight into what their loved one would prefer if he or she were able to speak for themselves.

Adapted from an article by Romayne Gallagher MD, CCFP

 

Recommended Reading:

The Dying Process – A Hospice Social Worker’s Perspective On End Of Life Care: A helpful guide for coping and closure during end of life care

The Dying Process – A Hospice Social Worker’s Perspective On End Of Life Care provides a detailed exploration of issues pertaining to patient and family grief reactions, the duration and preparation for death, closure support needs, understanding pain, pain management and avenues to create a positive death experience for both the patient and family.

Over a decade of work in the hospice field, author and social worker, Dana Plish offers professional insight regarding his experiences with patients and families who are in the dying process.

 He elaborates on the process of death which impacts family coping, patient and family closure, barriers to acceptance, and examines negative and positive death processes. He concludes with ways in which family can aid the patient during life to death transition and support ongoing bereavement and grief needs. Dana comments on patient grief related to the loss of pets and supporting patient closure with their pets when possible.

Dana has worked in the social services field for 30 years and he presents the subject matter in a simple, easy to read and understand format which serves as a practical guide for anyone who has a loved one in the dying process.

 

 

Thanks for visiting and reading …

I hope this article provided you some helpful ideas.  I welcome your comments below.

-Laurie

 

 

 

You may also be interested in:

End of Life Nutrition

Make a Living Will/Health Care Directive

Dying Process – Dehydration

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Dying Process – Dehydration

Dying Process – What to do about Dehydation

 

 

Image result for personal note

When my mother was in hospice, our family was always concerned about her diminished capacity to eat and drink.  The medical staff had to remind us (many times) that Mom was at the stage where eating and drinking was for comfort only (not for hydration or nutrition). 

This was a very difficult concept to accept emotionally, because it goes against our instinct to care for our loved one by insisting that they continue ingesting food and water as an ill person “should.”

It is heart-wrenching to watch someone you care for slow down, and then stop eating and drinking.  One of the most difficult, I think.  I really had to fight a sense of panic as time passed without seeing my mother eat or drink.

 

 

What is Dehydration?

Image result for hospice dehydration

 

Dehydration is a condition that results from the excessive loss of water from the body. Diarrhea and vomiting are two of the most common causes of dehydration. Some medications can also reduce body water by increasing urine production. These drugs are called diuretics and are sometimes referred to as ‘water pills’.

When people are nearing death, it is quite common for them to drink smaller and smaller amounts of fluid.

Dehydration may occur even without being caused by any specific complication or medication. Many health care providers specializing in end-of-life care believe that people can be comfortable with small sips of fluid or ice chips, and may not experience thirst in the same way that healthy individuals do.

 

Causes of Dehydration

 

Water is a vital component of the body. It plays a critical role in the proper functioning of the different body systems, such as the production of urine in order to remove toxins. There are many complex processes involved in maintaining the proper balance of body water. The body can sense how much fluid needs to be taken in to keep this balance, and the sensation of thirst is triggered when more fluids are needed.

Generally, dehydration is part of the normal process of the body shutting down at the end of progressive serious illness, and is a factor in the natural cycle of changes that occur as death nears.

 

 

What Happens When People Become Dehydrated?

 

  • People become weak, and take in less fluid. They become even weaker, and tend to sleep more, resulting in even less fluid intake. This cycle continues over a matter of days or weeks, and is part of the dying process.
  • Because the mechanism that triggers the sensation of thirst is often weakened in advanced serious illness, people generally do not feel thirsty as long as the mouth is kept moist. So although dehydration is a common and natural part of the dying process, “dying of thirst” is not.
  • Normally, the kidneys try to save water when a person is dehydrated. Less urine is produced, and the urine becomes darker and more concentrated. If the body cannot spare enough water to allow the kidneys to remove toxins from the body, then the kidneys will start to fail and shut down.
  • The toxins, which are the normal by-products of the ongoing functioning of the body, will build up and contribute to the overall weakness and sleepiness of the person.

 

Sorting Out Symptoms

 

To determine possible causes of dehydration, the health care team will often ask questions, conduct a physical examination, or order some tests. This will help them to make decisions about how best to manage the dehydration.

 

Questions You’ll be Asked by the Health Care Team

 

The medical team may ask some of the following questions in order to understand to what extent the patient is dehydrated, and what might possibly be causing it:

 

Has there been a change in the amount of fluid (water, juice, popsicles or ice chips) that the person is drinking?

  • If so, when did that change happen?
  • Is less fluid being taken in, or is there increased thirst and drinking?

 

 

If there have been difficulties drinking fluids, what are they related to?

  • Too weak to drink or suck from a straw?
  • Too sleepy to drink safely?
  • Can’t seem to swallow well. Just holds fluid in the mouth, or chokes and coughs when trying to swallow?
  • Tries to swallow, but everything seems to get stuck on the way down?

 

Is there nausea and/or vomiting?

 

Has the urine changed?

  • Less urine or more urine?
  • Has the colour changed (darker and more concentrated, or lighter)?

 

How have the bowels been functioning?

  • Is there diarrhea? Constipation?
  • Has there been any output at all… stool or gas?
  • Is there bloating?
  • Is there any pain or discomfort in the abdomen?

 

What medications are being taken?

  • Diuretics? (“water pills”, which can increase water loss)
  • Laxatives? (which can cause diarrhea)
  • Steroids? (such as dexamethasone, prednisone, which can cause blood sugar to rise, and which may result in increased urination and water loss)
  • Opioids? (may have by-products that build up when someone is dehydrated)

 

What are the effects of the person drinking less fluid?

  • Have there been any disagreements between the patient and family members about fluid intake?
  • Are there feelings of depression, sadness, or frustration because of the amount of fluids being taken in?
  • Sometimes family and friends are more concerned about this lack of fluid intake than the person who is experiencing it. How much concern does the patient have about not drinking much?

 

 

Physical Examination

 

Certain physical clues (such as dry mouth) can help determine if dehydration is present, and how severe it is. Since dehydration can be caused by many different problems, the health care professional will usually do a general physical examination. The exam may provide some ideas about what could be causing the problems, and will help guide decisions about tests that may be needed.

 

Tests

 

Usually, blood tests are done to help confirm that dehydration is present, and to help assess how severe it is. Other tests may be considered, depending on what is suspected after asking questions and the physical examination.

 

Managing Dehydration

 

The topic of dehydration and its management is one of the more controversial issues in palliative care.

 

  • Some consider dehydration a normal part of the dying process that should be left to run its natural course, and that treating dehydration only serves to prolong dying.
  • Others may view dehydration as an easily treatable condition, whose correction may improve alertness, communication and interaction with loved ones, and general well-being.
  • Still others consider it unethical to withhold fluids, even if it means that fluids must be given by administering fluids continuously into a vein (intravenous) or under the skin (hypodermoclysis) in a person who is near death.

 

 

There are different reasons for these conflicting approaches to dehydration:

 

  • There is no clear and strong scientific evidence to guide an overall approach to dehydration in the palliative care setting.
  • Cultural, religious, and ethical/moral considerations may influence the views of patients, families, and health care providers about whether withholding fluids is ever appropriate.

 

As with most decisions about care in advanced illness, each situation should be approached individually, reviewing the wishes of the patient and family, the overall goals of care, the scientific evidence for different treatment choices, and potential burdens and benefits of the existing options.

 

 

When Treating Dehydration May Help

 

There are specific circumstances in which treating dehydration has the potential to significantly improve quality of life and overall well-being.

 

  • Confusion (delirium)
    Dehydration can result in a build-up of toxins and medications when there is not enough water to help the kidneys remove them from the bloodstream. This can result in delirium, which is upsetting and difficult for everyone involved. Giving fluids may allow increased alertness and more clear thinking, and improved ability to interact with others.

 

  • Opioid side effects
    Opioid medications can build up in the body, particularly when someone is dehydrated. This can result in delirium, and irritation of the nervous system which may cause muscle twitching and possibly seizures. Giving fluids sometimes helps the kidneys clear these medications.

 

  • Nausea, vomiting and diarrhea
    These digestion problems can often be helped once the cause of the symptom is found and treated, but in the meantime, the symptoms may lead to dehydration. Dehydration often makes nausea and vomiting worse, resulting in a cycle of further dehydration. When the health care team is trying to reverse the problem that is causing nausea, vomiting or diarrhea, giving fluids by infusion intravenously or under the skin should be considered early.

 

  • High calcium levels in the blood
    Sometimes cancer causes a high level of calcium in the bloodstream, which results in increased sleepiness and confusion. High levels of calcium can eventually be fatal. There are times where, through discussion with the patient and/or family of all factors involved, a decision is made to not treat the high calcium. However, if treatment is chosen, administering fluids is an important part of the management of high calcium.

 

Tip: Let your health care team know if your loved one is experiencing nausea, vomiting or diarrhea. Early treatment of these symptoms can help to reduce the severity of dehydration.

 

When the Benefits of Treating Dehydration Are Unclear

 

There are a couple of situations where the evidence is not clear as to whether fluids are helpful or harmful.

 

  • Thirst
    It is not clear from studies whether dehydration in people with advanced illness causes thirst. In those who are unconscious, it is very unlikely that a sensation of thirst can be felt. In people who are awake but unable to drink, it is generally thought that maintaining a moist mouth with vigilant mouth care is the most effective approach to relieving thirst. However if this is not effective, it is reasonable to try administering fluid into a vein intravenously or under the skin.

 

  • Congestion in the lungs when death is near (“death rattle”)
    Some health care providers may feel uncomfortable administering fluids when congestion is present. They may argue that fluids will only worsen the build-up of secretions in the lungs. However, there is no strong evidence to support this concern. The secretions are the result of pooled collections of mucus rather than water, except in the circumstance of heart failure. There are times when such secretions can be quite substantial even though no fluids have been given for many days.

 

Some families (and health care providers) feel that it is never ethical to withhold fluids, or perhaps doing so is not consistent with their faith. These concerns may be very strongly held. Heath care teams involved in decision-making have every reason to respect differing points of view on this question, as there is not sufficient evidence that administering fluids worsens congestion.

 

What You Can Do

 

When someone who is dying is drinking poorly and becoming dehydrated, family and friends often feel helpless and want to “fix” the problem by improving the person’s fluid intake. We hope the sick person will feel better, get better, and even live longer as a result of drinking more.

However, towards the end of serious illness, it is quite common for people to drink smaller and smaller amounts of fluid. Dehydration may occur even without being caused by any specific complication or medication. Many health care providers specializing in end-of-life care believe that people can be comfortable with small sips of fluid or ice chips, and may not experience thirst in the same way that healthy individuals do.

 

Talk to the Health Care Team

 

When discussing concerns about fluid intake with your health care team, it may be helpful to consider these questions:

 

  • Who is actually concerned? Often the person who is ill is less concerned about fluid intake than family and friends. The wishes and goals of the patient should direct the approach to care.
  • What do you think the patient would want?
  • What will happen with and without fluids being given?
  • What can be done to ensure comfort and relief of the sensation of thirst, no matter which choice is made?
  • Are there safety concerns about swallowing? Your health care team may be able to suggest ways to help swallowing to reduce the risk of aspiration into the lungs (“going down the wrong way”).
  • How complicated and burdensome will it be to treat dehydration? For example, would transfer to hospital from home be required?
  • What is the evidence that giving fluids will help the problem at hand or achieve the goals of care?

 

If possible, the best approach to drinking is to let the person with the illness make the decisions about what to drink, when to drink or whether to drink at all.

Family members are sometimes asked to decide whether or not fluids should be given to a loved one who is dying, can no longer swallow, and cannot direct the health care team in what to do. This decision is made even more difficult if there is no health care directive or living will,  and if the wishes of the patient to guide the decision are unknown.

This can be a very challenging and distressing situation, as it may feel that the choice is between letting death occur without doing anything – not even giving a drop of water and perhaps prolonging the dying. Neither seems like a good option.

There is actually no evidence that giving fluids to a person who is imminently dying will prolong the dying process. If family members are unsure about the decision to give fluids, it is usually best to lean towards giving rather than withholding; there seems to be less likelihood of looking back with regret for what might have been done.

 

 

Make Taking Fluids Easier

 

  • Offer people fluids they enjoy – water, juice, jello, popsicles or ice chips. Avoid juices high in acid, such as orange juice, as they may irritate the mouth.
  • Have a variety of fluids available. People may change their fluid preferences often.
  • Offer a straw for drinking. One advantage of drinking from a straw is that straws are less likely to cause choking than cups, as they can more easily deliver small amounts.
  • Do not give fluids to people who are not able to swallow safely.
  • Do not force someone to drink.
  • Offer small, frequent sips of fluid rather than a whole cup at one time.
  • When someone is too weak to swallow, provide mouth care to keep the person’s mouth moist and comfortable.

 

 

Care For the Mouth

 

How often should the mouth be checked for dryness?
Mouth care should be done at least three or four times a day, or even every hour or two if the mouth is very dry. People taking medication under the tongue should have their mouths moistened frequently; otherwise, the medication may not be properly absorbed.

 

How often should the mouth be checked for dryness?
Mouth care should be done at least three or four times a day, or even every hour or two if the mouth is very dry. People taking medication under the tongue should have their mouths moistened frequently; otherwise, the medication may not be properly absorbed.

 

You could try a swabstick like Dynarex Lemon-Glycerin Swabsticks – have a pleasant taste, while soothing and refreshing dry mouths of patients with restricted oral intake, lemon flavor.

Dynarex Lemon Glycerin Swabs, 75 Count

 

Other factors that may contribute to dry mouth
Sometimes people are only able to breathe comfortably through the mouth. These people may find that their mouths are especially dry. Certain medications can also be very drying to the mouth.

 

 

 

What Your Health Team Can Do

 

Giving fluids (rehydration or sometimes simply hydration)

The health care team will consider several different options for giving fluids:

 

Intravenous
Fluids can be given through a small plastic catheter placed into a vein. This is the most common route of fluid administration in hospitals if the oral route is not used. This option may or may not be available in other settings (for example at home, in a hospice or personal care home).

Personal note: This option was not available in the hospice facility where my mother was being cared for; they had a “no intravenous” policy (which I believe is common).  They did however, keep my mother comfortable with any fluids or popsicles she was able to take by mouth, and by regular mouth care.
 

 

By Mouth


Oral rehydration can be effective if fluids can be swallowed and ‘kept down’. Giving frequent sips of water or a commercial preparation such as Gatorade®, Powerade®, or Pedialyte® can maintain hydration.

If the medical staff think these products might be helpful, but are not available at the hospital or hospice, you can bring them with you when visiting.

 

Gatorade Frost Thirst Quencher, Glacier Freeze, 32 ozPOWERADE, Strawberry Lemonade, 32 Fl oz BottlePedialyte, Strawberry Flavored, 1 qt 1.8 Fl Oz. (33.8 oz)  Pedialyte Freezer Pops - Assorted Flavors - 2.1 oz - 16 ct
 
Generally, the goal is to drink one to two litres per day but it is important not to ‘force fluids’ if a person does not feel like taking them.

 

Under the Skin (Subcutaneously)

Using small needles known as butterfly needles, or, preferably, using small plastic catheters placed under the skin, fluids are administered by continuous infusion into the tissues under the skin, which are then absorbed into the rest of the body. This method is called hypodermoclysis, (or simply clysis). This method can be useful when it is difficult to find veins for intravenous infusions and may be more readily available in settings outside of the hospital.

 

Care  When Fluids Are Not Given

 

Health care providers have noted that patients can be very comfortable even if they drink very little fluid. These people may experience a dry mouth, or the occasional feeling of thirst. However, such symptoms are usually easily managed with sips of fluid, ice chips, and regular mouth care.

When someone is nearing death, dehydration is inevitable as the person loses the desire and ability to take in fluids.  This is a very challenging time for family members.  It may help to remember that the goal of treatment at this stage is to promote comfort (not to hydrate for recovery).

 

Final Thoughts

Personal note: When I was upset over my mother’s lack in fluid intake, nurses would ask me “what is the goal of treatment now?” This would lead to a reminder that hydration (or nutrition, for that matter) could not prolong my mother’s life at this late stage of the disease process.

 

 

 

Recommended Reading:

   

A doctor on the front lines of hospital care illuminates one of the most important and controversial social issues of our time.

It is harder to die in this country than ever before. Though the vast majority of Americans would prefer to die at home—which hospice care provides—many of us spend our last days fearful and in pain in a healthcare system ruled by high-tech procedures and a philosophy to “fight disease and illness at all cost.”

 

Dr. Ira Byock, one of the foremost palliative-care physicians in the country, argues that how we die represents a national crisis today. To ensure the best possible elder care, Dr. Byock explains we must not only remake our healthcare system but also move beyond our cultural aversion to thinking about death. 

The Best Care Possible is a compelling meditation on medicine and ethics told through page-turning life-or-death medical drama. It has the power to lead a new national conversation.

 

 

 

 

Thanks for visiting and reading …

I hope this article provided you some helpful ideas.  I welcome your comments below.

-Laurie

 

 

 

You may also be interested in:

Make a Living Will/Health Care Directive

End of Life Nutrition

Introduction to Palliative and Hospice Care

10 Myths About Hospice

 

Prevent Bed Sores

How to Prevent and Treat Bed Sores

 

 

http://m.patient.media/images/pressure-sore1.jpg

 

Anyone who remains lying or sitting in one position for more than a couple of hours is at risk for skin breakdown. This can lead to pressure sores, which are also known as pressure ulcers or bedsores. These skin problems can be painful and decrease a person’s quality of life. 

 

 

 

Causes of Bed Sores

 

Someone who cannot change position in bed or is limited to sitting in a chair needs to be helped to change position every hour or two.

 

Repositioning, pressure reduction, and good skin care are all necessary to prevent skin problems and to keep small problems from getting worse.

 

Bedsores are caused by pressure against the skin that limits blood flow to the skin and nearby tissues. Other factors related to limited mobility can make the skin vulnerable to damage and contribute to the development of pressure sores.

 

 

 

Three primary contributing factors of bed sores are:

 

  • Sustained pressure. When your skin and the underlying tissues are trapped between bone and a surface such as a wheelchair or a bed, the pressure may be greater than the pressure of the blood flowing in the tiny vessels (capillaries) that deliver oxygen and other nutrients to tissues. Without these essential nutrients, skin cells and tissues are damaged and may eventually die.
  • This kind of pressure tends to happen in areas that aren’t well-padded with muscle or fat and that lie over a bone, such as your spine, tailbone, shoulder blades, hips, heels and elbows.
  • Friction. Friction is the resistance to motion. It may occur when the skin is dragged across a surface, such as when you change position or a care provider moves you. The friction may be even greater if the skin is moist. Friction may make fragile skin more vulnerable to injury.
  • Shear. Shear occurs when two surfaces move in the opposite direction. For example, when a hospital bed is elevated at the head, you can slide down in bed. As the tailbone moves down, the skin over the bone may stay in place — essentially pulling in the opposite direction. This motion may injure tissue and blood vessels, making the site more vulnerable to damage from sustained pressure.

 

 

Risk of Bed Sores

 

People are at risk of developing pressure sores if they have difficulty moving and are unable to easily change position while seated or in bed. Immobility may be due to:

 

  • Generally poor health or weakness
  • Paralysis
  • Injury or illness that requires bed rest or wheelchair use
  • Recovery after surgery
  • Sedation
  • Coma

 

Other factors that increase the risk of pressure sores include:

 

  • Age.  The skin of older adults is generally more fragile, thinner, less elastic and drier than the skin of younger adults. Also, older adults usually produce new skin cells more slowly. These factors make skin vulnerable to damage.
  • Lack of sensory perception. Spinal cord injuries, neurological disorders and other conditions can result in a loss of sensation. An inability to feel pain or discomfort can result in not being aware of bedsores or the need to change position.
  • Weight loss. Weight loss is common during prolonged illnesses, and muscle atrophy and wasting are common in people with paralysis. The loss of fat and muscle results in less cushioning between bones and a bed or a wheelchair.
  • Poor nutrition and hydration. People need enough fluids, calories, protein, vitamins and minerals in their daily diet to maintain healthy skin and prevent the breakdown of tissues.
  • Excess moisture or dryness. Skin that is moist from sweat or lack of bladder control is more likely to be injured and increases the friction between the skin and clothing or bedding. Very dry skin increases friction as well.
  • Bowel incontinence. Bacteria from fecal matter can cause serious local infections and lead to life-threatening infections affecting the whole body.
  • Medical conditions affecting blood flow. Health problems that can affect blood flow, such as diabetes and vascular disease, increase the risk of tissue damage.
  • Smoking. Smoking reduces blood flow and limits the amount of oxygen in the blood. Smokers tend to develop more-severe wounds, and their wounds heal more slowly.
  • Limited alertness. People whose mental awareness is lessened by disease, trauma or medications may be unable to take the actions needed to prevent or care for pressure sores.
  • Muscle spasms. People who have frequent muscle spasms or other involuntary muscle movement may be at increased risk of pressure sores from frequent friction and shearing.

 

 

Stages of Bed Sores and Pressure Sores

 

Bedsores fall into one of four stages based on their severity. The National Pressure Ulcer Advisory Panel, a professional organization that promotes the prevention and treatment of pressure ulcers, defines each stage as follows:

 

 

Stage I Bed Sores

 

  • The beginning stage of a pressure sore has the following characteristics:
  • The skin is not broken.
  • The skin appears red on people with lighter skin color, and the skin doesn’t briefly lighten (blanch) when touched.
  • On people with darker skin, the skin may show discoloration, and it doesn’t blanch when touched.
  • The site may be tender, painful, firm, soft, warm or cool compared with the surrounding skin.

 

Stage II Bed Sores

 

  • The outer layer of skin (epidermis) and part of the underlying layer of skin (dermis) is damaged or lost.
  • The wound may be shallow and pinkish or red.
  • The wound may look like a fluid-filled blister or a ruptured blister.

 

Stage III Bed Sores –  the ulcer is a deep wound:

 

  • The loss of skin usually exposes some fat.
  • The ulcer looks crater-like.
  • The bottom of the wound may have some yellowish dead tissue.
  • The damage may extend beyond the primary wound below layers of healthy skin.

Stage IV Bed Sores –  ulcer shows large-scale loss of tissue:

 

  • The wound may expose muscle, bone or tendons.
  • The bottom of the wound likely contains dead tissue that’s yellowish or dark and crusty.
  • The damage often extends beyond the primary wound below layers of healthy skin.

 

Unstageable Bed Sores

 

A pressure ulcer is considered unstageable if its surface is covered with yellow, brown, black or dead tissue. It’s not possible to see how deep the wound is.

  • Deep tissue injury
  • A deep tissue injury may have the following characteristics:
  • The skin is purple or maroon but the skin is not broken.
  • A blood-filled blister is present.
  • The area is painful, firm or mushy.
  • The area is warm or cool compared with the surrounding skin.
  • In people with darker skin, a shiny patch or a change in skin tone may develop.

 

Common Sites of Bed Sores and Pressure Sores

 

 

 

 

For people who use a wheelchair, pressure sores often occur on skin over the following sites:

 

  • Tailbone or buttocks
  • Shoulder blades and spine
  • Backs of arms and legs where they rest against the chair

 

 

For people who are confined to a bed, common sites include the following:

  • Back or sides of the head
  • Rim of the ears
  • Shoulders or shoulder blades
  • Hip, lower back or tailbone
  • Heels, ankles and skin behind the knees

 

When to See a Doctor for Bed Sores or Pressure Sores

 

If you notice early signs or symptoms of a pressure ulcer, change your position to relieve the pressure on the area. If you don’t see improvement in 24 to 48 hours, contact your doctor. Seek immediate medical care if you show signs of infection, such as fever, drainage or a foul odor from a sore, or increased heat and redness in the surrounding skin.

 

Complications of Pressure Ulcers

 

  • Sepsis. Sepsis occurs when bacteria enter the bloodstream through broken skin and spread throughout the body. It’s a rapidly progressing, life-threatening condition that can cause organ failure.
  • Cellulitis. Cellulitis is an infection of the skin and connected soft tissues. It can cause severe pain, redness and swelling. People with nerve damage often do not feel pain with this condition. Cellulitis can lead to life-threatening complications.
  • Bone and joint infections. An infection from a pressure sore can burrow into joints and bones. Joint infections (septic arthritis) can damage cartilage and tissue. Bone infections (osteomyelitis) may reduce the function of joints and limbs. Such infections can lead to life-threatening complications.
  • Cancer. Another complication is the development of a type of squamous cell carcinoma that develops in chronic, nonhealing wounds (Marjolin ulcer). This type of cancer is aggressive and usually requires surgery.

 

Treatment for Bedsores

 

Stage I and II bedsores usually heal within several weeks to months with conservative care of the wound and ongoing, appropriate general care. Stage III and IV bedsores are more difficult to treat.

 

Addressing the many aspects of wound care usually requires a multidisciplinary approach. Members of your care team may include:

 

  • A primary care physician who oversees the treatment plan
  • A physician specializing in wound care
  • Nurses or medical assistants who provide both care and education for managing wounds
  • A social worker who helps you or your family access appropriate resources and addresses emotional concerns related to long-term recovery
  • A physical therapist who helps with improving mobility
  • A dietitian who monitors your nutritional needs and recommends an appropriate diet
  • A neurosurgeon, orthopedic surgeon or plastic surgeon, depending on whether you need surgery and what type

Reducing Pressure to Heal Bed Sores

 

The first step in treating a bedsore is reducing the pressure that caused it. Strategies include the following:

 

  • Repositioning. If you have a pressure sore, you need to be repositioned regularly and placed in correct positions. If you use a wheelchair, try shifting your weight every 15 minutes or so. Ask for help with repositioning every hour. If you’re confined to a bed, change positions every two hours.
  • If you have enough upper body strength, try repositioning yourself using a device such as a trapeze bar. Caregivers can use bed linens to help lift and reposition you. This can reduce friction and shearing.
  • Using support surfaces. Use a mattress, bed and special cushions that help you lie in an appropriate position, relieve pressure on any sores and protect vulnerable skin. If you are in a wheelchair, use a cushion. Styles include foam, air filled and water filled. Select one that suits your condition, body type and mobility.

 

Cleaning and Dressing Bed Sore Wounds

 

Care that helps with healing of the wound includes the following:

 

Cleaning. It’s essential to keep wounds clean to prevent infection. If the affected skin is not broken (a stage I wound), gently wash it with water and mild soap and pat dry. Clean open sores with a saltwater (saline) solution each time the dressing is changed.

 

Applying dressings. A dressing promotes healing by keeping a wound moist, creating a barrier against infection and keeping the surrounding skin dry. Dressing choices include films, gauzes, gels, foams and treated coverings. A combination of dressings may be used.

 

Your doctor selects a dressing based on a number of factors, such as the size and severity of the wound, the amount of discharge, and the ease of placing and removing the dressing.

 

Removing Damaged Bed Sore Tissue

 

To heal properly, wounds need to be free of damaged, dead or infected tissue. Removing this tissue (debridement) is accomplished with a number of methods, depending on the severity of the wound, your overall condition and the treatment goals.

 

  • Surgical debridement involves cutting away dead tissue.
  • Mechanical debridement loosens and removes wound debris. This may be done with a pressurized irrigation device, low-frequency mist ultrasound or specialized dressings.
  • Autolytic debridement enhances the body’s natural process of using enzymes to break down dead tissue. This method may be used on smaller, uninfected wounds and involves special dressings to keep the wound moist and clean.
  • Enzymatic debridement involves applying chemical enzymes and appropriate dressings to break down dead tissue.

 

 

Other interventions that may be used are:

 

  • Pain management. Pressure ulcers can be painful. Nonsteroidal anti-inflammatory drugs — such as ibuprofen (Motrin IB, Advil, others) and naproxen (Aleve, others) — may reduce pain. These may be very helpful before or after repositioning, debridement procedures and dressing changes. Topical pain medications also may be used during debridement and dressing changes.
  • Antibiotics. Infected pressure sores that aren’t responding to other interventions may be treated with topical or oral antibiotics.
  • A healthy diet. To promote wound healing, your doctor or dietitian may recommend an increase in calories and fluids, a high-protein diet, and an increase in foods rich in vitamins and minerals. You may be advised to take dietary supplements, such as vitamin C and zinc.
  • Management of incontinence. Urinary or bowel incontinence may cause excess moisture and bacteria on the skin, increasing the risk of infection. Managing incontinence may help improve healing. Strategies include frequently scheduled help with urinating, frequent diaper changes, protective lotions on healthy skin, and urinary catheters or rectal tubes.
  • Muscle spasm relief. Spasm-related friction or shearing can cause or worsen bedsores. Muscle relaxants — such as diazepam (Valium), tizanidine (Zanaflex), dantrolene (Dantrium) and baclofen (Gablofen, Lioresal) — may inhibit muscle spasms and help sores heal.
  • Negative pressure therapy (vacuum-assisted closure, or VAC). This therapy uses a device that applies suction to a clean wound. It may help healing in some types of pressure sores.

 

Surgery for Bed Sores and Pressure Sores

 

A pressure sore that fails to heal may require surgery. The goals of surgery include improving the hygiene and appearance of the sore, preventing or treating infection, reducing fluid loss through the wound, and lowering the risk of cancer.

 

If you need surgery, the type of procedure depends mainly on the location of the wound and whether it has scar tissue from a previous operation. In general, most pressure sores are repaired using a pad of your muscle, skin or other tissue to cover the wound and cushion the affected bone (flap reconstruction).

 

 

Preventing Bed Sores at Home

 

 

 

  • Look at the person’s skin daily. Tell the health care team about any changes you notice, such as red areas. These are the first signs of skin breakdown, and will lead to sores if left untreated.
  • Clean skin daily.

 

 

Calmoseptine Ointment Tube 4 Oz (3 Pack)
 
Recommended: Calmoseptine Moisture Barrier Ointment helps to protect and heal skin irritations from incontinence, minor burns, scrapes, diaper rash or wound drainage; temporarily relieves discomfort and itching; and provides multipurpose moisture barrier. Contains calamine, zinc oxide, menthol and lanolin.
 
  • Use mild cleansing products.
  • Avoid using hot water to clean the skin.
  • Use moisturizers for dry skin.
  • Check to make sure clothing and bed linens are clean, dry and free of wrinkles. Wrinkles increase friction and may lead to skin discomfort or pain.

 

Bedsore Pressure Reduction

 

http://www.tomiturn.com/wp-content/uploads/2015/04/Woman_Turned_In_Bed2-1024x521.jpg

 

  • Relieve any constant pressure on areas at greatest risk for skin breakdown. These include the site of existing pressure sores, the site of previously healed sores, scars, and bony areas.

 

  • If the person is in bed, remind, or help, the person to change position every two hours.

 

  • If the person is in a chair or wheelchair, remind, or help, the person to change position every hour. If possible, help the person stand briefly, or alternate between sitting and lying. It is best if the person avoids sitting for long periods.

Positioning Wedge

 

 

  • Use pillows like this repositioning wedge between legs, under arms or elsewhere. This separates bony areas, prevents direct skin-on-skin contact, and may make swollen legs and ankles feel better.

 

 

 

 

 

The Med Aire Alternating Pressure Pump and Pad System with Low Air Loss by Drive Medical provides alternating pressure and is designed to be used in the prevention, treatment and management of Pressure Ulcers.
 
 

 

 

  • Have the person avoid lying directly on the side, that is, with the front of the body facing sideways, at right angles to the mattress. A better position is to lie slightly sideways, that is, using supporting pillows to help the front of the body tilt about thirty degrees to the mattress.

 

  • Avoid using air rings or other donut-shaped cushioning devices.

 

  • Ask your local home care or palliative care program if they have a loan program for pressure-reducing mattresses.

How to Move Someone in Bed

 

 

Some people may find it uncomfortable to be moved, but staying in the same position for more than a couple of hours may lead to even greater pain or discomfort.

 

Changing positions is important, except in cases when someone may not live more than a few hours. These are some general tips for moving someone in bed.

 

If possible, watch a member of the care team do a move, so you can see how it is done.

 

If the person finds it painful to be moved, talk to the health care team about giving the person pain medication beforehand. They can tell you the best type of medication to use for this purpose, and explain how and when to give it.

 

Moving someone from one position to another is easier with two people, with each standing on opposite sides of the bed.

 

Take care to keep your knees slightly bent (not locked) when you do any sort of lifting. This gives your back proper support.

 

When moving a person, lift the person off the surface below, rather than dragging the person in direct contact with the surface.

 

Moving someone is much easier if the person is lying on a turning sheet or a cloth absorbent pad.

 

Turning sheets are small sheets that run from the person’s head to buttocks.

 

Any sheet can be made into a turning sheet by folding it in half and laying it over the full sheet. The sheet or pad allows two people to grab onto the corners to lift or move the person on the bed.

 

Recommended: SafetySure MovEase Under Pad

 SafetySure MovEase Under Pad

 
 

After the move, pull on the sheet or pad from top to bottom, to smooth out wrinkles.

 

Before starting a move, lower the bed to a flat position, or recline the bed as far as the person’s condition allows. Lower the bed slowly, as rapid movements can cause discomfort.

 

 

Moving Someone From Their Back Onto Their Side

 

Place a pillow under the person’s head before starting the turn and have pillows ready to place under legs, arms, and behind the back.

 

If the person is going to be turned onto the right side, take the left arm, bend it gently at the elbow, and place it over the stomach.

 

Bend the left leg at the knee, and place a pillow between the person’s legs.

 

Place one hand behind the person’s buttocks and the other underneath the shoulder.

 

Roll the person in the direction of your helper, and have the helper hold the person in place.

 

Once the helper is holding the person, place your hands under the person’s buttocks to move the body back toward the center of the bed.

 

You may need to pull the right (bottom) shoulder forward if it looks uncomfortable. This places the person in more of a fetal position rather than lying completely straight.

 

Arrange the pillows comfortably between the person’s shoulder and head, and also between the legs. When you return the person onto their back later, place a pillow under the head and one under each shoulder, positioned to make the person as comfortable as possible.

 

 

Raising Someone in Bed With a Turning Sheet

 

People who are sitting up in bed will naturally slide down over time. Before you raise the person, lower the bed until it is flat, or as flat as the person’s condition allows.

 

If possible, ask the person to tuck their chin into their neck during the move, so their head is protected.

 

Take hold of a bottom and top of the turning sheet on your side, and have your helper do the same on the other side.

 

On a signal, such as the count of three, gently lift the person toward the head of in bed.

 

Once the bed is raised again to a comfortable position, you can place a pillow under the person’s knees to prevent slipping.

 

 

Raising Someone in Bed Without aTurning Sheet

 

Stand near the person’s shoulder, with your helper on the opposite side.

 

Look toward the head of the bed, and place one of your arms under the person’s shoulder closest to you.

 

Use your free arm to support yourself by leaning into the bed.

 

On a signal, such as the count of three, lift the person toward the head of bed.

 

If possible, ask the person to bend their knees and dig into the bed with their heels to help with the move.

 

Once the bed is raised again to a comfortable position, you can place a pillow under the person’s knees to prevent slipping.

 

 

Remember, it is much easier to prevent bedsores with proper care at home, than to treat a bedsore once it has developed. 

 

 

Watch for signs of pressure points and reduce pressure with regular turning and moving, and examine the skin for signs of pressure.

 

 

If you have had experience dealing with bedsores, please share your thoughts below.

 

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Painkiller Induced Constipation

 

 

Help For Painkiller Induced Constipation – OIC

 

 

 

Many prescription and nonprescription medicines can cause constipation.

 

Examples include:

  • Antacids.
  • Antidepressants.
  • Some blood pressure medicines.
  • Cold medicines (antihistamines).
  • Calcium and iron supplements.
  • Narcotic pain medicines.

 

If you think that the constipation is caused by a medicine:

  • For prescription medicines, call the doctor who prescribed it to see whether you or your child should stop taking the medicine or take a different one. An appointment may not be needed.
  • For nonprescription medicines, stop using the medicine. Call your doctor if you feel that you or your child still needs to take the medicine.

 

Opioid (Painkiller) Induced Constipation

 

 

 

What are Opioids?

 

Opioids are a class of drugs that are commonly prescribed for their analgesic, or pain-killing, properties. They include substances such as morphine, codeine, oxycodone, and methadone. Opioids may be more easily recognized by drug names such as Kadian, Avinza, OxyContin, Percodan, Darvon, Demerol, Vicodin, Percocet, and Lomotil.

 

Opioids may be classified as natural, semi-synthetic, fully synthetic, or endogenous. Natural opioids such as codeine and morphine are derived from opiate alkaloids contained in the resin of the opium poppy. Semi-synthetic opioids such as oxycodone and hydrocodone are created by chemically altering the natural opioids. Fully synthetic opioids such as methadone are synthesized from non-opioid substances in laboratories. Endogenous opioids are naturally produced by the body and include substances such as endorphins.

 

 

How Do Opioids Work?

 

 

Opioids bind to specific proteins called opioid receptors that are located in the brain, spinal cord, and gastrointestinal tract. Through this mechanism, opioids are able to block the brain’s ability to perceive pain. Instead, opioids tend to stimulate the pleasure centers of the brain, inducing euphoria.

 

 

When Are Opioids Used?

 

Opioids are used in medicine because they can block the perception of pain. Patients receiving palliative care frequently report pain as one of the most distressing factors as they approach the end of life. About 70% of patients with advanced cancer and 65% of patients dying from other non-malignant diseases commonly complain of pain. Opioid-based medicines are prescribed to these patients to reduce their pain and increase their quality of life. The vast majority of patients receiving long-term opioid pain medication are in advanced stages of their disease.

 

 

What are the Side Effects of Opioids?

 

 

Opioid use carries several side effects. These include drowsiness, nausea, slower breathing, and a general depression of the respiratory system. Further, opioids often cause constipation, or opioid-induced constipation (OIC). OIC is an uncomfortable side-effect that occurs in many patients who receive opioid treatments to relieve pain.

 

 

How Do Opioids Cause Constipation?

 

 

 

Opioids are effective pain relievers, but often have the side effect of constipation. These medicines affect the gastrointestinal tract in a variety of ways. Opioids increase the amount of time it takes stool to move through the gastric system. They increase nonpropulsive contractions in the middle of the small intestine (jejunum) and decrease longitudinal propulsive peristalsis – motions critical to moving food through the intestines. This results in food that fails to travel through the digestive tract.

 

 

 

Opioids are also able to partially paralyze the stomach (gastroparesis) so that food remains in the digestive organ for a longer period of time. Additionally opioids reduce digestive secretions and decrease the urge to defecate.

 

 

Symptoms of OIC

 

 

Several physical and other symptoms are prevalent in sufferers of opioid-induced constipation (OIC). Physicians usually will gather patient history information to check for standard problems associated with constipation such as too little fiber and fluid intake, too little exercise, underlying medical problems, and current medications. Be prepared for a physical assessment that requires oral, abdominal, and digital anorectal examinations.

 

Common physical symptoms of OIC include:

 

  • Stools that are hard and dry
  • Difficulty such as straining, forcing, and pain when defecating
  • A constant feeling that you need to use the toilet
  • Bloating, distention, or bulges in the abdomen
  • Abdominal tenderness

 

Other symptoms of OIC include:

 

  • Feeling and being sick
  • Tiredness and lethargy
  • Appetite loss
  • Feeling depressed

 

Treatment Options for OIC

 

Although opioids are very effective for treating and managing pain, their use frequently results in opioid-induced constipation (OIC). Treatment options for OIC may be as simple as changing diet or as complicated as requiring several medicines and laxatives.

 

Lifestyle Changes

Changing lifestyle factors is usually the first recommendation that physicians make for the prevention or treatment of constipation. This includes:

 

 

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  • Increasing dietary fiber
 
 
 
 
 
 
 
 
 
 
 
 

 

  • Increasing fluid intake
  • Increasing exercise or physical activity
  • Increasing time and privacy for toileting

 

 

Cure Constipation Now

 

Changes in lifestyle, however, may not be possible for many patients. In addition, these changes may be ineffective in treating OIC.

 

If there is a concurrent underlying disease or medicine that is causing constipation, the disease may need to be treated separately or another treatment regimen may have to be considered.

Drugs and Medications to Treat OIC

 

OIC treatment usually requires additional medicines to be prescribed along with the opioid painkillers that are causing the constipation. Withholding the opioid treatment is ill-advised because it results in a decrease in the patient’s quality of life. Often, laxatives and/or cathartics are prescribed at the same time as the opioid painkillers so that treatment for the constipation beings immediately. A cathartic accelerates defecation, while a laxative eases defecation, usually by softening the stool; some medicines are considered to be both laxatives and cathartics.

 

For the treatment of OIC, doctors may prescribe:

 

Osmotic laxatives – increase the amount of water in the gut, increasing bulk and softening stools.

Recommended: ClearLax Osmotic Laxative

 

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  • Emollient or lubricant cathartics – soften and lubricate stools.

 

Recommended: Phillips’ Stool Softener

 

Phillips' Stool Softener Liquid Gels, 60-Count
 
 
  • Bulk cathartics – increase bulk and soften stools.
  • Stimulant cathartics – directly counteract the effect of the opioid medications by increasing intestinal motility, helping the gut to push the stools along.

 

Recommended: Ex-Lax Stimulant Laxative

Ex-Lax Stimulant Laxative, Maximum Strength, 25 mg, 90 Count Box

 

  • Prostaglandins or prokinetic drugs – change the way the intestines absorb water and electrolytes, and they increase the weight and frequency of stools while reducing transit time.
  • Other medicines block the effects of opioids on the bowel to reverse opioid-induced constipation.

 

Although the treatments listed above are usually successful in treating OIC, sometimes a physician will recommend rectal intervention. As discussed, prophylaxis with laxatives are/or cathartics is considered usual – as some clinicians assume [constipation] to be virtually universal in patients who are prescribed opioid analgesics.

 

Rectal interventions are indicated if the appropriate oral measures have been ineffective.

 

Rectal intervention means the following treatments:

 

  • Suppositories

 

Recommended: Dulcolax Medicated Laxative Suppositories

 

Dulcolax Laxative Suppositories, 28 Count

 

  • Enemas (micro and larger volume)

 

 

Enema Bag Kit

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  • Rectal irrigation (sometimes known as colonic irrigation)
  • Manual evacuation

 

The first choice rectal intervention for uncomplicated constipation is glycerine suppositories.

 

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Fleet Glycerin Suppositories Laxative

 

If these are ineffective, then a stimulant enema might be administered. Oral and rectal stimulant laxatives should be avoided if there is possible or proven bowel obstruction.

 

Gentle rectal measures can sometimes be effective in emptying the rectum and lower colon. Oral softening agents are useful if the obstruction is incomplete. It should be remembered that constipation can cause bowel obstruction.

 

If none of the rectal laxatives above prove adequate to remove impacted feces, rectal irrigation with normal saline can be performed. Manual evacuation should be used as a last resort when all other methods of bowel management have been shown to be ineffective.

 

Combination Therapy Treatment for OIC

 

Constipation is a known side effect of opioid analgesics and should be addressed before opioid therapy begins. As opioid-induced constipation can be severe and adversely impact quality of life and compliance with therapy, prophylaxis with laxatives is considered to be the best approach.

 

Concurrent management on initiation of opioids frequently includes recommending certain lifestyle or dietary adjustments (as listed above) and initiating a scheduled regimen of laxatives. Laxative and cathartic therapy may be needed throughout opioid therapy and beyond. Effective management requires a composite of strategies, including behavioral and lifestyle changes (diet, activity, and fluid intake, as appropriate).

 

However medications used to manage opioid-induced constipation, such as laxatives, do not address the underlying opioid receptor-mediated cause of constipation and are often ineffective.

 

Newer Therapies for OIC

 

Methylnaltrexone (available as Relistor(R)) helps restore bowel function in patients who have advanced illness and receive opioids for pain relief. Methylnaltrexone is delivered via subcutaneous injection and specifically targets opioid-induced constipation. When given alongside opioid therapy, it is designed to displace the opioid from binding to peripheral receptors in the gut, decreasing the opioid’s constipating effects and inducing laxation.

 

Methylnaltrexone is a peripherally acting mu-opioid receptor antagonist that decreases the constipating effects of opioid pain medications in the gastrointestinal tract without diminishing their ability to relieve pain.

 

Methylnaltrexone blocks peripheral opioid receptors in the gut and unlike other opioid antagonists has restricted ability to cross the blood-brain barrier. As a result, it antagonizes only the peripherally located opioid receptors in the GI tract, so it’s action reverses opioid-induced constipation without precipitating withdrawal symptoms or affecting or reversing the central analgesic effects of opioids.

 

Another new medication for severe pain (long-term pain that can be experienced as a result of conditions such as back pain, arthritis and osteoarthritis) are tablets combining prolonged release oxycodone, an opioid which treats pain, and prolonged release naloxone, a compound which counteracts the potential negative effects of the opioid on the GI function (available as TarginactTM).

 

 

TarginactTM has been proven to provide equivalent pain relief to oxycodone alone, whilst significantly improving bowel function. Naloxone is an opioid receptor antagonist that, when taken orally, has negligible systemic bioavailability providing a full inhibitory effect on local opioid receptors in the gut – counteracting opioid-induced constipation – without impacting on the centrally acting analgesic efficacy of oxycodone.

 

 

If someone you care for is experiencing opioid induced constipation, start on the lifestyle changes in this article and speak to your doctor about other treatment options.  This is a condition that can be managed.

 

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Don’t Ignore Sleep Apnea

Don’t Ignore Sleep Apnea

 

Image result for sleep apnea

 

 

If Left Untreated, Sleep Apnea Can Be Life Threatening

 

 

Sleep apnea is a disorder in which people have one or more pauses in breathing while they sleep.

Breathing pauses can last from a few seconds to minutes. They often occur 5 to 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.

Sleep apnea usually is a chronic ongoing condition that disrupts your sleep. You often move out of deep sleep and into light sleep when your breathing pauses or becomes shallow.

 

 

Obstructive Sleep Apnea

 

The most common type of sleep apnea is obstructive sleep apnea. This most often means that the airway has collapsed or is blocked during sleep.

The blockage may cause shallow breathing or breathing pauses. When you try to breathe, any air that squeezes past the blockage can cause loud snoring. Obstructive sleep apnea is more common in people who are overweight, but it can affect anyone.

 

 

 

 

Central Sleep Apnea

 

Central sleep apnea (CSA) is caused by irregularities in the brain’s normal signals to breathe. Most people with sleep apnea will have a combination of both types.

Untreated sleep apnea can:

  • Increase the risk of, or worsen, heart attack and heart failure
  • Make arhythmias or irregular heartbeats, which  increase the chance of having work-related or driving accidents

 

What Happens if Sleep Apnea Goes Untreated

 

 

Sleep apnea is a chronic condition that requires long-term management. Lifestyle changes, mouthpieces, surgery, and/or breathing devices can successfully treat sleep apnea in many people.

Untreated, sleep apnea can be life threatening. Excessive daytime sleepiness can cause people to fall asleep at inappropriate times, such as while driving.

Sleep apnea also appears to put individuals at risk for stroke and transient ischemic attacks (TIAs, also known as “mini-strokes”), and is associated with coronary heart disease, heart failure, irregular heartbeat, heart attack, and high blood pressure. Although there is no cure for sleep apnea, recent studies show that successful treatment can reduce the risk of heart and blood pressure problems.

 

 

Treatments for Sleep Apnea

 

There are a variety of treatments for sleep apnea, depending on an individual’s medical history and the severity of the disorder.

Most treatment regimens begin with lifestyle changes, such as avoiding alcohol and medications that relax the central nervous system (for example, sedatives and muscle relaxants), losing weight, and quitting smoking.

Some people are helped by special pillows or devices that keep them from sleeping on their backs, or oral appliances to keep the airway open during sleep.

 

 

If Conservative Methods Don’t Work

 

If these conservative methods are inadequate, doctors often recommend continuous positive airway pressure (CPAP) machine, in which a face mask is attached to a tube and a machine that blows pressurized air into the mask and through the airway to keep it open.

 

Also available are machines that offer variable positive airway pressure (VPAP) and automatic positive airway pressure (APAP).

A BiPAP machine has settings for both inhaling and exhaling to make it easier for people who have higher pressure settings to exhale. This unit also has a built-in humidifier.

There are also surgical procedures that can be used to remove tissue and widen the airway. Some individuals may need a combination of therapies to successfully treat their sleep apnea.

 

 

How to Pick the Right CPAP Machine For Sleep Apnea

 

If your loved one has been diagnosed with sleep apnea, and your doctor has prescribed use of a continuous positive airway pressure, or CPAP, machine, it can be difficult to decide which one will best suit your needs.

A CPAP is not always covered by insurance, and the elder will need it for a long time, so think of the purchase as an investment.

Do your research and compare the available models before you purchase a CPAP machine. Here are a few factors to consider:

 

Comfort

Because pressurized air requires a closed seal for it to be effective, CPAP machine users are required to wear specialized masks when sleeping.

 However, an uncomfortable mask or chin strip is usually what causes people to stop wearning their CPAP.

 

It is absolutely vital that the CPAP chin strap and mask fit properly.

If the mask and chin strap don’t fit properly, it can cause:

  • Skin irritation, chafing, rashes, sores
  • Leaks from a mask that is the wrong size, causing the pressurized air to escape, reducing the effectiveness of your nasal CPAP machine.
  • Dry mouth, red, swollen eyes or conjunctivitis from a mask that it too tight, which can increase the pressure on the apnea sufferer’s eyes

 

Look for straps that come in different sizes, to accommodate the user’s head, as well as soft, stretchable straps.

Straps extend around your face and over your head to hold the nasal cushion in place while the breathing tube extends up over your head to allow sleep in any position. Unfortunately, many users find the straps on their face to be uncomfortable, especially when initially trying to fall asleep.

 

Sleep Position

It is difficult to get used to wearing a CPAP mask every night, but there are a variety of CPAP accessory options that can make the machines easier to adjust to.

For example, users can choose between a mask that covers the entire face, or one with tubes that seal inside the nostrils. There are CPAP masks that work best for people who lie on their stomachs and others for people who toss and turn. Experiment with CPAP mask accessories to find the one that is most comfortable for your elderly parent.

 

Portability

If you find yourself frequently traveling for business or pleasure, be sure to choose a model that is portable, compact, and easy to take with you. Some machines are available with an optional DC power supply for you car’s cigarette lighter, or can be run with an optional integrated battery, making it the ideal choice for traveling by airplane.

 

Heated Humidifier

Clinical research has shown that CPAP patients tend to be more compliant with the addition of heated humidity to their CPAP program.

A CPAP humidifier can prevent a dry mouth and the sinus problems caused by the stream of pressurized air.

A CPAP humidifier works by using a fine mist of warm or room-temperature distilled water to keep your nasal passages moist. When choosing a CPAP machine with the heated humidifier, keep in mind how much space the machine will take up with the humidifier attached.

 

Adjustable Ramp and Exhalation Pressure Relief

The ramp is used to temporarily lower the air pressure initially to allow the CPAP machine user to fall asleep more easily. The pressure then gradually increases to the prescribed level.

Adjustable ramp settings allow the user to set the amount of time it takes for the CPAP machine to reach the prescribed level. Some CPAP machines, include a feature the decreases the air flow pressure when you exhale. Exhalation pressure relief is usually not a necessary feature, and most CPAP machines that include it are much more expensive.

 

Sound Level

All newer CPAP machines are very quiet, but some are more quiet than others. Although the majority of noise you hear while using CPAP therapy is the sound of air rushing through the tube, the quietness of the motor is an important factor to consider.

 

APAP or CPAP

Some CPAP users find it more pleasant to breath with APAP than with CPAP because the pressure automatically changes as needed to deliver the minimal pressure needed. With a CPAP, on the other hand, the pressure is set at the highest necessary to keep the airway open, even though the high pressure is needed only a fraction of the time.

The bottom line: Before purchasing a CPAP machine, be sure to look at all of the options and features available.

 

 

 

Final Thoughts

If someone you care for is suffering from sleep apnea, don’t ignore it;  it’s not likely to go away on it’s own, and it could lead to serious complications.  See your doctor to discuss treatment options, including the use and care of a CPAP machine.

 

 

Stop Alzheimer’s Wandering

Stop Alzheimer’s Wandering

 

 

 

 

Wandering is quite common among people with dementia and can be very worrying for those concerned for their safety and well-being.

The person’s failing memory and declining ability to communicate may make it impossible for them to remember or explain the reason they wandered.

Currently over 100 million people require oversight due to various forms of memory impairment.

That number is expected to increase to 277 million by 2050, according to The 2013 World Alzheimer’s Report.

 

  • 60% of them will become “lost” at least once.
  • 70% of those will become “lost” 3 or more times.
  • 46% of wanders not found within 24 hours may die.

 

 

Reasons for Wandering

 

Changed Environment

A person with dementia may feel uncertain and disoriented in a new environment such as a new house or day care center. Wandering may stop once they become used to the change. The person may also want to escape from a noisy or busy environment.

 

Loss of memory

Wandering may be due to a loss of short-term memory. A person may set off to go to the shop or a friend’s house, and then forget where they were going or why. Or they forget that their partner has told them that they were going out for a while and set off in search of them.

Excess energy

Wandering can be a way of using up excess energy, which may indicate that the person needs more regular exercise.

Searching for the past

As people become more confused, they may wander off in search of someone, or something, relating to their past. This may be a partner who has died, a lost friend or a house they lived in as a child.

 

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Expressing boredom

As dementia progresses people find it harder and harder to concentrate for any length of time. Wandering may be their way of keeping occupied.

Confusing night with day

People with dementia may suffer from insomnia, or wake in the early hours and become disoriented. They may think it is daytime and decide to go for a walk. Poor eyesight or hearing loss may mean shadows or night sounds become confusing and distressing.

Continuing a habit

People who have been used to walking long distances may simply wish to continue doing so.

Agitation

Changes that have occurred in the brain may cause a feeling of restlessness and anxiety. Agitation can cause some people to pace up and down or to wander off with no apparent purpose. They may fail to recognize their own home and insist on leaving.

Discomfort or pain

Walking may ease discomfort, so it is important to find out if there is any physical problem or medical condition and try to deal with it. Tight clothing, excessive heat or needing to find a toilet can all cause problems.

A job to perform

Sometimes people leave the house because they believe they have a job to do, or are confused about the time of day, or the season. This may be related to a former role such as going to work in the morning or being home for the children in the afternoon.

Dreams

An inability to differentiate dreams from reality may cause the person to respond to something that they dreamed, thinking that this has happened in real life.

 

Take Precautions

 

 

The precautions you take will depend on the personality of the person with dementia, as well as how well they are able to cope, their reasons for wandering and whether they live in a potentially dangerous or in a safe and secure environment.

 

Speak to your doctor – A physical check-up will help identify whether illness, pain or discomfort has triggered the wandering. Discuss the side effects of medication with the doctor. Try to avoid medication which may increase confusion and cause drowsiness and possibly incontinence.

 

Ensure the person is identifiable – It is important to ensure that the person carries some form of identification in case they do get lost (this is especially important on holidays). An identity bracelet with name, address and telephone number can be very helpful when a person is missing or found. Another option is wearing a Medic Alert bracelet that gives a telephone number. You can also find custom ID items on Amazon.

Similarly it may be helpful to sew a name tag into every garment the person wears regularly. In some areas services are available where a person’s photo and profile is electronically recorded and easily accessed to alert authorities should the person be missing.

Medic ID Bracelet - Custom Engraved - Hypo-allergenic Stainless Steel - Choice of engraving and chain length
Recommended: Medic ID Bracelet – Custom Engraved – Hypo-allergenic Stainless Steel – Choice of engraving and chain length
Identify any wandering pattern – Some people find it helpful to keep a record or diary so that they can see if there is a pattern to the wandering behavior. It may occur at certain times of the day or in response to certain situations which can then be more carefully controlled.
 
 
Remove key triggers – Try to reduce the number of objects in sight which may act as a reminder to the person to wander. Handbags, coats, mail for posting and work clothing may encourage a person with dementia to wander.
 
 
Involve neighbors and local business owners – It often makes sense to tell neighbors and local shopkeepers about the problem. Most people are very helpful once they understand the situation and may offer to keep a friendly eye on the person.
 
 
Make it more difficult to wander – Sometimes it is sufficient simply to relocate door locks where the person will not think to look for them. Otherwise you may want to consider bells and buzzers which sound when external doors are opened.
 

 

Give them a safe place to walk – Make part of the property secure so that it becomes a safe place to walk around.

 

What to do if a person with dementia goes missing?

 

  • Stay calm.
  • Make a thorough search of the house and out buildings.
  • Write down what the person was wearing.
  • Notify your neighbors.
  • Walk or drive around the block and immediate area and to any places the person may regularly visit. If possible, have somebody stay at home in case the person comes home and so that the telephone can be answered.
  • Contact your local police. Tell them the person has dementia and of any concerns you have for their safety.
  • The police will require details and a description of the person and of the clothes being worn. It is always useful to have a recent color photo.
  • The police may also ask about familiar or favorite places for the person.

 

 

 

When the Alzheimer’s missing person returns home

 

 

  • Notify the police immediately.
  • Do not scold or show anxiety no matter how worried or inconvenienced you have been. They may have been confused and frightened themselves.
  • Provide reassurance and get back into a regular routine as quickly as possible.

 

 

Suggested Reading:

Thanks for visiting and reading …

I hope this article provided you some helpful ideas.  I welcome your comments below.

-Laurie

 

 

 

 

Coping With Incontinence

Coping With Incontinence – A Guide for Caregivers

 

 

 

Many family and partner caregivers say that heavy incontinence would tip their decision towards moving a loved one to a nursing home.

What makes this such an emotionally difficult turning point?

 

Incontinence can be the last straw in a stressful caregiving situation.  Providing for the personal care needs of someone with bladder or bowel control issues will always be an unwelcome task, but there are many effective solutions to managing incontinence that can result in increased dignity and improved quality of life for your loved ones, and less frustration and difficulty for you.

 

Below are some of the issues that make incontinence so difficult to deal with, and tips on how to cope with these concerns.

 

 

Resistance

 

What should you do when your loved one is resistant to using pads or protective underwear?

 

An individual asked to use incontinence products daily may feel that they are no longer capable of taking care of themselves at the most basic level. Their response to you might be one of denial, anger, refusal or passive inaction.

 

 

Coping: It is important to talk with your loved one in a calm, understanding, and honest way about how their incontinence is affecting you and your ability to provide the best possible care for them. This can make acceptance easier—of the incontinence as well as the incontinence products.  If the care receiver lives with a mental or cognitive condition like dementia, learn the best approaches by taking a class or attending a support group where you can learn useful tools for more successful communication.

Be tactful; walking in and saying the house smells may offend the care receiver and cause a defensive response rather than one of cooperation.

Embarrassment

 

You might feel a sense of embarrassment not only for yourself but also for the care receiver. It’s hard to be responsible for caring for someone, like your parent, in this very personal and often invasive way. If you are caring for someone of the opposite sex, it can be awkward having to see, touch and care for their private areas. If you are caring for a parent of the same sex, it may still feel like you’re invading their privacy.  And finally, there is compassion for the loss of dignity felt by a loved one who now needs care at this level.

Coping:  Talking it out with supportive family, friends, or professionals can be helpful. Acknowledge your uncomfortable feelings. Hire a home care worker or recruit another family member or friend to provide care when is too hard for you to do.

Reactions

 

Caregivers are often not at their best when dealing with incontinence.  It might feel like the care receiver allowed an incontinence episode to occur on purpose to punish you. You might find yourself getting angry or impatient, especially if help is needed at an inconvenient time, such as when preparing dinner or sleeping. The cost of incontinence supplies can be a concern in the budget of the caregiver/care receiver. And if the care receiver is not cooperative, it puts even more strain on your relationship with them. Some people may also have physically reactions and discomfort to bodily fluids and odors.

 

Coping: Admitting to your discomfort is a good first step.  Pretending this is not an issue for you, if it is, only makes matters worse for both you and the care receiver.  Know that the care receiver is not trying to make your life harder; they have no control over what is happening.  This is difficult for them, also. Seek out help through an in-person or online support groups, from a friend or family member who has had a similar experience, or from a Social Worker, Nurse, Occupational Therapist or other health professional.

Emotions

 

You might find yourself getting angry or resentful for having to deal with this situation. Maybe it’s just too hard for you to do. Sometimes it may feel easier to just not clean someone up, but this is neglectful of the care receiver and puts the care receiver at risk for skin breakdown and infections, particularly urinary tract infections.

 

 

Coping: Acknowledge the many feeling you might have about dealing with incontinence and ask for help.  Support groups, either in-person or online, can offer you both emotional encouragement and tried and true practical strategies. No doubt other caregivers will share their research and experience with various products. Get product recommendations from your doctor, pharmacist or an occupational therapist.

 

Seek out products that make it easier for you and the care receiver. Having the right product for the right situation can make a big difference.

 

 

Consider hiring a personal care aide or allowing other family members help whenever they can. You don’t have to do it all.

 

Physical Limitations

 

Mismatched body types, physically disability, or age or disease related physical weakness may make providing incontinence care for your loved one difficult.   A small person trying to help a much larger person out of bed might risk hurting their back or straining other muscles.

You might be at risk for falling when roused in the middle of the night to aid the care receiver in getting to the bathroom or using a urinal.  And the lack of sleep that results from getting up several times during the night will definitely affect your functioning and capacity to cope the next day.

Coping: If you are caring for someone with a physical disability, such as paralysis or weakness, make sure you have a physical therapist or occupational therapist teach you how to use your body so that you don’t hurt yourself while trying to help the care receiver. Work with your physician to make sure any plan of care includes what YOU need as well as what the care receiver needs.  It’s okay to acknowledge your own limits and set limits when something might be harmful to you.

Planning

Going out with someone who is incontinent takes some advanced planning. Caregivers and care receivers often become socially isolated because of concerns about dealing with incontinence outside of the home setting.

 

Coping: Prepack two small shoulder bags with everything you might need such as incontinence pads, wipes, gloves, change of underwear and other supplies you require. Be sure to include a couple of plastic bag to stash soiled products.  Keep one bag with you and one in the car, just in case.

If traveling, look for a family/companion bathroom that allows two people to go in together. Or carry a laminated flyer that you can affix to the entrance of a public bathroom that says, for example, “wife caring for disabled husband inside”.


Know that in some states, like California, a state law allows a family caregiver or paid attendant of either sex to assist a care receiver in a public bathroom. Arrange to have a seat near the bathroom in an airplane or on other transportation. 

Keep in mind where bathrooms are on an outing, which will reduce anxiety for both of you. Stop by a rest room frequently, even if the care receiver has not said they need to go.

Time and Resources

 

Incontinence makes the caregiver’s job harder in many ways. Incontinence product leaks, their inconsistent usage, or even lack of use when called for, will result in more loads of laundry and more time consumed cleaning up the bathroom and around the house. Additional time is required if help is needed to bathe your loved one after a urine or bowel accident.

 

 

As personal care takes more and more time, you may find yourself growing less patient and more frustrated.  These feelings are only compounded if cleaning and bathing demands occur throughout the night leaving the caregiver without adequate sleep. Increasing time demands needed for incontinence care will influence when more help is needed, e.g. recruiting another family member or hiring an attendant, and possibly if it’s time to look into residential care placement.

 

One additional factor that cannot be overlooked is the cost of incontinence care products and keeping track of having enough stock on hand to meet the need.

 

Coping: Hiring help can take some of the strain off of the caregiver.  Many caregivers suggest searching online to find the best price for incontinence supplies and for finding coupons to help reduce the cost at the store.  Don’t hesitate to ask another caregiver – in person or on an online caregiver support groups – for their suggestions on the best places to buy products. 

 

You may ultimately decide that placement is the best choice both for you and the care receiver – even if you promised never to move then to a nursing home. Then the caregiver can return to being a partner, adult child, friend, sibling and not the personal care attendant. The change from loving partner to caregiver can result in grief, guilt and depression. Taking care of your own needs is most important in being able to care for someone else.

You are not alone . . .

 

It will be easier for you, as a caregiver, as well as for the care receiver if you can make incontinence care as natural as possible. It is, after all, very common—25% of women and 15% of men experience incontinence at some point in their lives.  It is also a symptom common to many advanced diseases.

 

 

Get a medical evaluation to see if there is something that can be done to decrease the urgency of needing to use the bathroom and to find out if it’s a treatable condition,  such as a urinary tract infection or prostate problem. Discuss with the care receiver’s physician if medication or bladder training would be effective in this situation.  Above all, seek out and get help from family, friends and paid help if possible so it is not all on you to do all of the care.

Important Tips for Caregivers Dealing With Incontinence

 

 

There are many things you can do to help a person manage incontinence. In some cases you can help decrease the number of incontinence episodes by making a few simple changes about the home.

 

Focus on identifying ways you can facilitate easy access to the toilet, transferring on and off the toilet and faster removal of clothes.

 

Things you can try:

 

  • Ensure the bathroom is easily accessible, relocating a bedroom to be close to the toilet can help
  • Install grab rails or bars in the bathroom and by the toilet if a person is unsteady on their feet
  • Keep lights on in the bathroom at night

 

 

Final Thoughts

 

If you are caring for someone with incontinence, you may find it to be one of the most difficult aspects of caregiving. 

Incontinence can be unpredictable, add dramatically to your workload and be very costly.  Follow the tips above and seek further advice from a healthcare professional.  Having the right products, the right advice and support can help make this aspect of caregiving more manageable.

 

 

 

Thanks for visiting and reading … I hope this article provided you some helpful ideas.  I welcome your comments below.

-Laurie

 

 

Incontinence Care Products at Northshore Care!

 

 

 

 

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About Me

Create Your Own Blog

 

 

Hiring In-Home Help

Introduction to Hiring In-Home Help

Most family caregivers reach a point when they realize they need help at home. Tell-tale signs include recognizing that your loved one requires constant supervision and/or assistance with everyday activities, such as bathing and dressing. Caregivers also find that certain housekeeping routines and regular errands are accomplished with great difficulty or are left undone. It may become apparent that in order to take care of any business outside the home, more than one caregiver is required.

Assessing Your Home-Care Needs

A number of options are available for finding help at home. It is often best to start by assessing both your needs as a caregiver and the needs of the person you are caring for. There are a variety of checklists to help you evaluate what types of help are needed. In general, consider the following areas:

Personal Care: bathing, eating, dressing, toileting

Household Care: cooking, cleaning, laundry, shopping

Health Care: medication management, physician’s appointments, physical therapy

Emotional Care: companionship, meaningful activities, conversation

 

It is also important to evaluate the values and preferences of the person receiving care. He or she may be more comfortable with a home care worker who shares his or her cultural background and/or language.

The care recipient may also have a preference between male and female caregivers, particularly if the worker will be helping with personal care.

This assessment may also enable you to include alternative (and possibly less expensive) approaches to care such as adult day care, friendly visiting services, home grocery delivery, pharmacy delivery services and meals-on-wheels programs.

 

Checklists

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A number of checklists are available to help in evaluating what types of help are needed. Here are some recommended ones:

 

Writing a Job Description

 

Once you have identified the types of help you need, writing a job description can be fairly straightforward. In addition to including the tasks you have identified from your assessment, be sure to include the following when and if appropriate:

  • Health care training (what level and what type Care Aide, LPN, RN)
  • Driving (car needed or only valid driver’s license)
  • Ability to lift care recipient and/or operate special equipment
  • Experience with people with memory impairments and/or other disabilities
  • Language skills
  • Any other special skills needed

 

At this point, you have the option of hiring an individual or going through a home care or home health care agency. In some states, publicly- funded programs may allow you to hire another family member to assist you in providing care at home. In making that decision, consider the following:

 

Home Care Agency

 

Pros:

  • Screening, hiring/firing, pay and taxes are handled by the agency. (Note: There are also some agencies that will handle the paperwork (taxes, social security, etc.) if you hire a home care worker on your own.
  • If the worker is sick, a substitute can be sent
  • Can provide individuals with a variety of skills to meet varying needs (e.g., skilled nursing care, physical therapy, occupational therapy etc.).
  • May be partially covered by Medicaid or private insurance.

 

Cons:

  • Often several workers are used which can be confusing or distressing for the person receiving care.
  • Less individual choice in workers.
  • More expensive than privately hiring an individual.

 

Privately Hired Home-Care Worker

 

Pros:

  • A strong one-on-one relationship can develop between the worker and the person receiving care, although this can also happen through an agency when there is a commitment to continuity.
  • Usually less expensive than going through an agency.
  • You get to choose the person you think will be the best to provide care to your loved one.

 

Cons:

  • If the home care worker is sick, no substitute is readily available.
  • Screening, hiring/firing, pay and taxes must be handled by you.
  • May not be covered by Medicaid or private insurance.

 

Developing a Job Contract

 

The job contract is based upon the job description. It formalizes the agreement between you, the employer, and the employee, and is signed by both of you. Should questions or problems come up later, either party can refer to the written agreement. A good work contract should include the following:

  • Name of employer and”household employee”
  • Wages (including tax withholding—see section on Employer’s Responsibilities) and benefits (e.g., mileage, meals, vacation, holidays)
  • When and how payment will be made
  • Hours of work
  • Employee’s Social Security number
  • Duties to be performed (i.e., the job description)
  • Unacceptable behavior (e.g., smoking, abusive language, tardiness, etc.)
  • Termination (how much notice, reasons for termination without notice, etc.)
  • Dated signatures of employee and employer

 

Finding The Right Home-Care Worker

Set aside some time as you approach this critical next step: finding the appropriate person to fit the job description. One of the best ways to find a helper is to get a personal recommendation from a trusted relative or friend.

Churches, synagogues, senior centers, Independent Living Centers and local college career centers, especially those which have nursing or social work programs, are good places to advertise for in-home help. Listings for these places can be found in your local phone book.

 

Locating Resources in Your Community

One place to begin your search is with your local Area Agency on Aging (AAA). To find the AAA nearest to you, call the Eldercare Locator at (800) 677-1116 or visit the AAA website.

Your AAA can provide the following:

  • Information about attendant registries
  • Lists of Home Care Agencies
  • Tax help for seniors
  • Suggestions for places to advertise in your community

Most communities have attendant registries that can be an excellent resource for finding in-home help because they typically provide some initial screening of applicants. When calling an attendant registry (generally listed under Nurses and Nurse Registries in the phone book), it is important to inquire about their particular screening process and/or training requirements as well as about any fees charged. While some are free, fees for using a registry can vary greatly.

It is a good idea to shop around and obtain the best service at an affordable. There are also nonprofit community agencies (generally listed under Social & Human Services for Individuals & Families in the phone book) that maintain lists of individuals available to perform all kinds of household tasks, from cleaning and laundry to repairs and gardening.

If all of the above sources fail to produce an in-home worker, you may choose to advertise in the “Help Wanted” classified section of a community college, local paper or neighborhood newsletter.

The advertisement, at the minimum, should include hours, a brief description of duties, telephone number and best time to call, e.g.: “Home Care Assistant needed to provide supervision and companionship to older adult with memory loss. Must be compassionate, reliable and able to assist with bathing, dressing and eating. References required. Call to apply.”

 

Interviewing the Applicant

 

You do not have to hold a face-to-face interview with every person who applies for the job. Some screening over the telephone is appropriate. In screening applicants over the telephone, caregivers should describe the job in detail and state specific expectations listed in the work contract as well as information about the hours and wages.

At this time, it is also important to ask about the applicant’s past experience and whether he/she has references. If the applicant sounds acceptable, then an interview should be scheduled. Consider having another family member, the care recipient (if appropriate) or friend sit in on the interview to provide a
second opinion.

In preparation for the interview, the caregiver should have a list of questions pertinent to the job description and a sample work contract ready for the applicant to read. The following are some suggested questions for the interview:

  • Where have you worked before?
  • What were your duties?
  • How do you feel about caring for a disabled person? Or a person with memory problems?
  • Have you had experience cooking for other people?
  • How do you handle people who are angry, stubborn, fearful?
  • Do you have a car? Would you be able to transfer someone from a wheelchair into a car or into a bed?
  • What days and hours would you be available? How many hours per week?
  • Is there anything in the job description that you are uncomfortable doing?
  • Can you give me two work-related and one personal reference?

 

Consider what qualities/skills you require and what you can train a good candidate to do.

Be sure that you have a chance to watch the interactions between the in-home worker and the family member for whom he or she will be providing care. You may want to do this at the end of the interview with individuals you feel are good candidates, or you may want to invite the top two candidates back to meet with your family member.

If your family member is able, he or she should be included in the interview process and in making the final decision.

Immediately after the interview, it is important for you to write down first impressions, and if possible, discuss these with another family member or friend.

Consider the person most qualified for the job and with whom you feel most comfortable. Always check the references of at least two final applicants. Don’t wait too long to make an offer, as good applicants may find another job.

If the job offer is accepted, you and the in-home helper should set a date to sign the contract and begin work. Both employer and employee should keep a copy of the contract.

 

What are the Employer’s Responsibilities?

As an employer of a “household employee,” there are several legal considerations. First, household employers should verify that their household insurance (renter’s or homeowner’s) covers household employees in case of an accident. It is also imperative that the employer be fully informed of the legal responsibility of paying taxes for household employees.

As the employer, you may also be responsible for withholding Social Security taxes, Medicare taxes and/or federal unemployment tax and filing them with the Internal Revenue Service annually or quarterly. Social Security taxes are owed by both the employer and the employee. Rules governing the amount(s) to be withheld and payment schedules can change annually. For information on paying federal taxes for household employees, call (800) TAX-FORM and ask for Publication 926.

There are also state regulations.

Some states require that employers pay state tax and/or state disability insurance. To find out the regulations in your state, call the state employment department listed in the government section of your local phone book. The penalties for not paying taxes on household employees include paying the back taxes and paying interest and penalty fines.

There is one other requirement that every employer should know. Each employee is required to fill out an Employment Eligibility Verification form I-9 and a record of this should be kept on file. This form verifies that the person is legally entitled to work in the United States. The form can be ordered by calling (800) TAX-FORM.

Household employers and employees should stay informed and comply with state and federal tax laws.

There are often local services available to seniors who need assistance in filing tax statements for household employees.

 

Making Your Home-Care Situation Work

The relationships between the family, the person who requires assistance and the in-home worker are very important. Consequently, it is imperative that you take the time to go carefully through the selection process. Good communication is essential for a good relationship.

Schedule regular times to meet and discuss concerns, problems and/or changes. It is also important to make expectations clear and to provide adequate training to meet those expectations. If you hire a home care worker on your own, it is important you feel comfortable both providing training and firing the worker if necessary. If the person you have hired is doing a great job, be sure to tell him or her. A smile and well-deserved praise can make a big difference. None of us likes to feel to feel that our work is not appreciated.

I’d love to hear from you if you have gone through the process of hiring a home-care worker.  Please share your experience below.

 

Related:

Preparing For Your Elderly Parent to Move In

Convincing Your Parents to Transition to Assisted Living

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