New Hope For Dementia

It's expected that about half of the North American population will develop dementia and although regular vigorous mental and physical activity can delay and possibly halt onset, until recently there was little hope for those currently suffering. Most adults fear losing their mental faculties far more than they fear death, so any hope is exciting; particularly if it's safe, inexpensive and non pharmaceutical.

The onset of dementia including Alzheimer's may be influenced by a number of factors; the effects of anesthetics, nutrient deficiencies, a lifetime of struggles with anxiety and/or depression and as is now known, an inability for brain cells to utilize glucose effectively. Essentially, diabetes of the brain.

Brain cells are heavy users of blood glucose, but those with dementia seem often unable to process this abundant blood sugar. Happily, there is an alternate source of energy for these critical cells-Ketones.

Ketones are typically produced in the liver in response to fasting, to provide an effective energy source from body fat. In fact, putting epilepsy patients on a fast for a period of time is a medical option for epilepsy going back many decades. It is now known that therapeutic blood level of Ketones can quickly be obtained through the use of dietary medium chain fatty acids (MCTs) of which coconut oil is one of the best sources; being over 60% MCTs.

Coconut oil is unique in safety profile, health benefits, and its property of not causing weight gain since the MCTs are used so differently in human metabolism. If my parents were still alive and suffering from dementia, I'd first have their serum ferritin levels checked to ensure their iron levels weren't an issue, then start slowly with 1-2 teaspoons of coconut oil/day, titrating up daily as tolerated to 6-8 teaspoons/day spread out over 3-4 doses. I'm very conservative, so I always prefer to add anything new, step by step.

If not seeing a significant benefit within a couple of weeks, I would consider adding a nutritional supplement to provide the non Ketone nutritional components in highly bio-available forms. Many years ago, a pilot program was done in a nursing home where this nutrient regime was administered for two months. The administrator's report was that anxiety and agitation levels and medication levels were reduced for many of their clients.

There are no magic bullets, and nothing will work 100% of the time for 100% of the people, but this seems a no-brainer. A high degree of safety, known health benefits and some reasonable degree of hope for improvement.

TBI Basics - What Is a TBI, and Who Gets It?

What is Traumatic Brain Injury?

A traumatic brain injury occurs when a sudden, forceful blow to the head damages the brain. If the blow does not penetrate the skull, the injury is called a closed head injury. If an object such as a bullet or a piece of shrapnel pierces the skull and actually enters the brain, the injury is called a penetrating head injury. The damage to the brain from either a closed or a penetrating injury can be located in a single area. This is called a focal injury. When multiple areas of the brain are affected, the injury is called a diffuse injury.

How are TBI's caused?

Among the civilian population, about 35 percent of all TBI's are the result of falls. Children under 14 and adults over 75 have the highest rates of TBI's associated with falls. Car, truck, and motorcycle and bicycle crashes, especially those involving pedestrians account for about 18 percent of TBI's. Another 20 percent of TBI's are caused by violence, especially involving guns, and child and spousal abuse. Nearly eight percent result from sports injuries. The sports with the highest rate of TBI's are bicycling, football, hockey, and soccer.

Military personnel have far higher risks and rates of TBI. The chief causes of TBI's for military are bombs, mortars, grenades and other explosive devices, gunfire, and a far higher incidence of motor vehicle accidents.

How common are TBI's?

The US Centers for Disease Control (CDC) states that every year about 1.7 million people in the US civilian population sustain a TBI. Of these, 1.3 million are evaluated and treated in ER's, and more than one fifth, some 275,000, require hospitalization for their TBI. Fifty-two thousand people die each year of traumatic brain injury.

Who gets Traumatic Brain Injuries?

Several age groups have increased risk for Traumatic Brain Injuries. The elderly, especially after age 75, are at higher risk for falling, and the majority of TBI's in this group are caused by falls. People over 75 also have the highest rate of hospitalization from their TBI, and the highest percentage of death caused by their TBI. Children under the age of 4 are another high risk group, with falls also the principal cause of their TBI's. Children age 0 to 14 years account for almost 500,000 ER visits per year for TBI's. Adolescents 15-19 years old are another high risk group. Adolescents traumatic brain injuries are most frequently caused by motorcycle and other vehicle crashes, including bicycles, by episodes of violence, and in contact sports such as football and hockey. For people in all age groups, males are at higher risk for TBI's than females.

To learn more about how the brain is affected in a traumatic brain injury, see "TBI Basics - What Happens to the Brain in a TBI."

If you or a loved one has suffered a Traumatic Brain Injury, and you believe that the negligence of another party contributed to the injury, you will want to talk with an experienced brain injury lawyer about your situation, to determine whether you may have a claim.

Nursing Home Staffing Levels: How Much Is Enough?

During the week of February 17, 2002, headlines screamed the news - more than 92% of US nursing homes fail to have an adequate number of staff to provide quality care for elderly residents. Newspapers and radio programs based their stories on the new study the Health Care Financing Administration (HCFA) recently provided to the Senate's Special Committee on Aging.

Interesting findings led us to reexamine our current data set of nursing home deficiencies. What we found may surprise you; there was no relationship between the level of staffing and the number of deficiencies reported for nursing homes. However, there was a relationship between level of staffing and percent of residents with pressure sores and physical restraints.

This article is provided to you so you'll have a greater understanding of what these findings mean.

The HCFA Study

Purpose - HCFA's study was performed at the request of the Senate's Special Committee on Aging to determine what minimum level of nursing home staffing was required in order to provide quality care.

Findings - The study reported that a minimum level of staffing, determined to be 2.9 hours of Certified Nursing Aide (CAN) time per resident was required for quality care. A number of measures went into this finding. Among them, a time and motion study examined the time required for basic services such as dressing and toileting.

A correlational study that examined the relationship between pressure (bed) sores and staffing found that a higher level of staffing was related to lower levels of pressure sores. This study was somewhat limited by the fact that homes with very low levels of staffing refused to participate; it may be inferred that the correlational findings would have been stronger with the participation of these homes.

In addition, the HCFA study examined the accuracy of reported level of staffing in survey and cost reports. They found that cost reports were more accurate than survey results in reflecting an accurate level of staffing as determined by nursing home payrolls.

Limitations - The report was limited by the extent of the data gathered (3 states included) and may not be generalizable across all states.

When Should Staffing Concern You

When the best is yet.net began examining long-term care, we attempted to gather data on staffing and found that it was extremely difficult to acquire accurate information. Then a well-respected administrator advised us that while staffing was important, it was not as good as measure of quality as the level of care residents actually received. We have learned through experience how right his advice was.

So what should you look for when determining the quality of care residents receive?

• Look for residents who are well groomed and not lethargic.



• Look for residents actively engaged in activities; although each nursing home is required to have an activities director, this does not mean that scheduled activities actually occur.



• Check the latest survey ratings for the percent of residents with pressure sores. Look for a rating close to zero. We also suggest that you examine the percent of residents with physical restraints because physical restraints may be used as a substitute for staff. Again, look for a rating close to zero.



• Look for the quality of interactions between staff and residents. Even though a minimum level of staffing is required for quality care, merely having staff at that level does not guarantee quality care. Homes may have high numbers of staff that do not interact appropriately with residents.



• Listen for reactions to resident complaints. Staff who ignore requests and complaints are not providing quality care.

What You Can Do to Find Good Care

• Check nursing home ratings and visit only those with few or, still better, no deficiencies.



• Call your state's long-term care ombudsman to get information on resident/family complaints. Although these complaints are not standardized and may include wide variations in severity, a large number of complaints should warn you away from homes receiving them.



• Consider non-profit care first. In general, non-profit homes have fewer reported deficiencies and higher levels of staffing than do for-profit homes.

What Else Can You Do?

The current growth in an aging population means that more and more people will require long-term care unless we do something about it now. That something becomes very personal for those of us in the Baby Boomer generation who will, within a few years, be part of the generation potentially needing nursing home care.

So, how's your health? Do what you can to ensure that your later life will not be complicated by any of the three leading causes of nursing home stays: heart disease, stroke and cancer.

Holiday Gifts For Nursing Home Residents

The holiday season is again approaching. Every year, as the calendar inches closer to the Big Day, the dilemma of what to give someone in a nursing home resurfaces. Birthdays and Mother's Day/Father's Day bring up the same questions. It's challenging to find the right gift for someone in a nursing home.

Take this list with you when you shop for any occasion. Pick up one or two items for simple gifts, or bundle several together in a decorative container for a custom gift basket that is certain to delight your favorite nursing home resident.

Entertainment:

Subscriptions on meaningful topics. Sports magazines, news magazines, womens' publications, the local newspaper, large print digests

Large print fiction or non-fiction books

Large print crossword or word-find books

CDs of favorite music from the 30s, 40s or 50s

DVDs of favorite television shows or movies

A radio, CD player, CD player or even a new television

Games such as checkers, chess, parcheesi, pokeno, dominoes and card decks

Photo album with dates and names clearly labeled

Clothing and Toiletries:

Sweat suits, cardigan sweaters, robes and pajamas. Look for items that have stretchy fabrics and loose arms so that they are easy to get on and off

Slippers or shoes with backs and rubber soles

Hand or body lotion

Facial tissues with lotion

Brush and comb with long handles for those with limited arm mobility

Hands-free pedestal mirror

Electric razor

Gift certificate for the nursing home gift shop or beauty/barber shop

For The Room:

Framed family photographs

New afghan or lap robe

Large number clock

Small lockbox for securing personal treasures

Earphones for television or radio

Large number amplified phone

New large print calendar with important dates marked

Large print address book with addresses and phone numbers already written in

Greeting cards for all occasions and stamps

For loved ones in a nursing home avoid highly fragranced gifts such as cologne, perfume or after shave. These can be annoying to other residents even if your loved one enjoys them. Residents with dementia may accidentally swallow these, too.

Food items can be difficult because of dietary restrictions. If you are certain your loved one will be able to enjoy them, remember to avoid anything that might be difficult to eat with dentures, such as caramels.

If the person you are shopping for has a roommate who gets few visitors (or none at all) consider "adopting" him or her. A little something from you may be the only recognition this lonely person gets on an important day.

Do your best to deliver your gifts in person. Most nursing home residents appreciate visits much more than gifts of things.

Pressure Sore Wound Care: Caring for a Person With Bed Sores - Everyday Tips From a Caretaker

Pressure Sore Care... Practical, non-medical advice on dealing with a loved one that is suffering from pressure sore wounds (bed sores). Some quick Facts and Tips coming from an at-home caretaker.

Taking care of an incapacitated person that is suffering from bed sores is hard on its own. Imagine if that person has additional medical conditions like a weak heart, diabetes, high blood pressure, to name a few... All of that just adds another level to the challenge of trying to prevent new pressures sores from surfacing while simultaneously looking after existent pressure ulcer problems.

As a caretaker, I've heard various opinions from people that were not overly supportive towards me and what I'm doing. Here is a small sample of what I heard:

• "You basically baby sit your grandma all day.. " You get to rest at home all day?"


• ..."Being a full-time caretaker does not replace having a full-time job that pays well. Real jobs are from 8 to 5, Monday till Friday".

The real story is that if I had a choice, I would choose for my grandmother be healthy, and not need me to stay home all day to care after her. The bottom line is that being stay at home care giver is a REAL job that demands hard work, prior planning, research, and follow-up. To me, that's what you call a REAL job! Here is a short list of tips and pointers to make it easier for you to care for a person with these conditions:

1. This is not an 8 to 5 job, your day starts and ends every two hours. That's the interval that you should be moving the your loved one around that way pressure is not sustained on the same location for periods over 2 hours.


2. Make sure that you eat healthy foods that are rich in protein, vitamins, and nutrients that will keep you healthy and strong. Good nutrition (and exercise if possible) is essential in dealing with stress and irregular working hours.


3. Purchase a dry-erase board and use it to write down notes that come to mind throughout you day. This you won't forget things that come to mind!


4. It may become psychologically exhausting to be in this position, to see your loved one suffering. Maintain a positive attitude at ALL time. Be positive and stay the course.


5. It's essential to include an up-to-date list of all of the medication that the patient is currently consuming. Also include notes about any possible allergies that the patient has.


6. Put together a small carrying case that contains essentials to care for the pressure sores. If you're using a wound vacuum, wound dressing, cleaning solution, or anything else that you might think is useful for your particular situation. This carrying case will play an essential roll if the patient gets transported from place to place and might need certain supplies that are not readily available in certain places. The idea is to be proactive and ready for any situation.


7. The more you know, the better you are! Conduct your own research about everything that is related to pressures sores. The more education you get about the subject, the better prepared you will be to ask your health care professional detailed questions that will be essential in saving your loved ones' life.

You might face individuals at the health institutions that may not be too friendly to elderly people. But don't worry. Never give up no matter what. Always ask your health care professional the right questions. They are the only qualified individuals to give you sound advice... and if in doubt, ask for a second opinion.

Fighting Ageism - The Role of the Activity Professional

While waiting in line at the post office, I stood behind a small elderly woman who was at the counter taking care of her postal needs. She had a very large purse with lots of zippers and a variety of smaller change purses. She had many questions for the postal worker and kept moving money and items in and out of her purse, zipping and unzipping her purses. She was a little hard of hearing and had to ask the postal worker to repeat her answers. The postal worker showed in her tone of voice and actions that she had no patience for this older person. At one point, she looked over the head of this elderly woman - at me and the line behind me, rolling her eyes in exasperation.

If the person in front of me had been a person of different national origin or race or practiced a specific religion or had a physical disability - would this postal worker have shown the same disrespect or impatience? Most likely not as she would fear being accused of discrimination. It is unfortunate in our society that treating the elderly differently or discriminating against them for their advanced years, is accepted practice. Discrimination against the elderly is known as ageism. The term ageism was coined by US gerontologist Robert N. Butler in 1969. At that time, it was added to the list of specific discriminations of racism and sexism. Ageism includes treating the elderly in a negative way as well as perpetuating negative stereotypes of aging. In today's advertising, the elderly are often characterized as grumpy, unkempt, dependent, self absorbed, a little daffy and eccentric. The activity professional and others who work in long term care have a more humanistic perspective regarding aging and the lifestyles of the elderly. We work tirelessly to provide individual opportunities to each person to live life to the fullest and in the manner they choose to live life, regardless of age.

To begin changing society's negative perspective toward aging and to promote positive images of aging, the activity professional can introduce the following tasks or actions:

1. Have the most amazing and dynamic activity program possible. A solid therapeutic activity program which includes group, individual and 1-1 programs is the best antidote against the negative stereotype of the elderly sitting in a rocking chair, watching life go by.

2. Develop a viable and working Resident Council. Empowering your residents to have a voice and use their voice to speak out about life in the facility and the community is essential in showing others that the elder cares about others and not just about themselves.

3. Embrace person centered care and the culture transformation movement. The philosophies and principles of these models of care emphasize new attitudes toward aging and what it means to get older. These concepts stress the individual nature of each person and living life to the fullest, as each person would like to live life.

4. Keep your residents engaged in life in the community through trips and outings. If you facility has a van or bus, make active use of that van. Make sure the van has the name of the facility painted brightly on the side so everyone sees you out and about. If your community/town has an annual parade, with floats and decorated trucks, think about entering your facility van. Think of the positive impact you will have with a group of smiling elders waving from a facility bus in the local Columbus Day or Independence Day Parade.

5. Develop an active and contributing community role for your residents. Fundraising for local charities, participating in Senior Citizen day at the mall, adopting the local animal shelter and visiting local schools are community oriented tasks which demonstrate the elder is an active and viable member of the community.

6. Take advantage of community awareness days of any kind. National Senior Fitness Day, National Nursing Home Week, National Nurses Day, and National Good Neighbor Day to name a few, would be opportunities for your residents to sponsor a community event and invite community members into their home. This would show the community how life goes on within and outside the walls of your facility.

7. Initiate facility chapters of organizations for your residents to join, while inviting local community members to be a part of your chapter. The Red Hat Society, The Gray Panthers, the VFW, the local Garden Club and other groups can be initiated and conducted at your facility. Integrating your elders with members of the community breaks down the age barriers.

8. Re-define aging for yourself. No matter your personal chronological age, your outlook has an impact on others. Purge yourself of any negative ageist attitudes which may be lurking in the back of your mind. Be true to the rights of all individuals, regardless of age.

9. Assume the role of a positive aging advocate. Whenever you encounter a negative attitude or action, don't be afraid to speak out in a positive and constructive way.

Are you wondering what happened when I approached the counter at the Post Office, after the elderly woman finished her business? The postal worker saw the anger in my eyes and mistakenly thought I was equally annoyed with the older woman. She suggested the woman should stay at home and get someone else to do her errands for her. I told the postal worker I couldn't disagree with her more and we should all be so lucky as that woman - to be out and about doing errands at her age. The postal worker retorted with a bit of a snort and stated she'd rather be dead than a nuisance to others. My parting comment to the postal worker was "be careful what you wish for". As I left, I heard a few chuckles and at least one "bravo" from the line of people behind me.

Age is opportunity no less,
than youth itself, though in another dress.
And as the evening twilight fades away,
The sky is filled by the stars invisible by the day. -
Henry Wadsworth Longfellow

Celebrate National Activity Professionals Week January 20-26

Activities for the elderly are essential especially for people with dementia. Find out why, and find out why those providing the activities are important.

Who are the people providing the activities?

The leader of the activity department is a certified activity director(ADC), a certified, licensed, occupational therapy assistant(COTA/L), or a
registered occupational therapist(OTR). However besides this, these directors are passionate about helping those in need.

Working with the activity directors are the activity assistants. They are, at the very least, high school graduates with a strong desire to help people.
Both directors and assistants are highly creative and caring. They gently encourage residents, especially those with dementia, clients, or even family
members to join in the fun and opportunity, the activities bring.

Where do these activities take place?

All nursing homes, assisted living facilities and adult day care centers provide activities for their residents or clients. Families, choosing to keep their loved ones with a disability such as dementia, at home also offer their loved one(s) activities.

What kinds of activities are made available?

Before discussion of this, let us discover how the kinds of activities presented, are determined. The current thinking is that activities are person centered.Group activities are designed for the interests of the majority, but one to one activities are offered to those who would rather "do their own thing". "Activities purpose is not just to kill time, but rather to make time live" unknown author. For some, it may be engaging in a group activity. For others solitary activities are more their preference. Of course, there are individuals who sometimes like groups and sometimes prefer to be alone.

Even prior to determining the type of group and and individual activities offered, activity staff assess the needs and strengths of all the residents or clients.Activities promote the highest level of physical and mental functioning. Activities are success oriented. Figuring all this out can be tricky, but activity professionals are special people.

Offered are old favorites, like bingo, sing a longs, exercise, entertainment, current events, religion, and trivia. However, creative staff think of new and exciting activities that may put a new twist on an old favorite. Often activities are adapted and modified so that each person can participate if he so chooses.

When do these activities take place?

Activities can take place any time of the day or night.People with dementia and other diseases often need activities at night because their sleep wake pattern may be altered.

Why are activities important?

As mentioned earlier activities help to preserve the highest level of mental and physical functioning. Activities also bring fun and purpose into one's life. Activities raise self esteem and prevent depression.Activities keep people calm or alert depending on their need. Activities help keep individuals connected. Yes, activities do many thing besides theobvious.

So this activity professionals week, January 20-26 be sure to say, "Thank you" to anyone you know who does activities. Visit a local nursing home, assisted
living facility, adult day care center, or a person who provides activities to their loved ones at home.