Continence is a part of Activities of Daily Living. Fifteen percent to 30% of adults living in the community and almost 50% of nursing home residents are affected by urinary incontinence. The prevalence in older women is twice that of prevalence in older men. Pregnancy, childbirth, menopause, and the anatomy of a woman’s urinary tract are all factors that increase the likelihood of incontinence.
Despite the fact that incontinence is common in aging, it should never be considered a normal condition of aging. Various methods of managing and reducing incontinence have been developed, and many older persons have been assisted with incontinence so that the quality of their lives is not so greatly affected.
Because of embarrassment and worry about appearance and odor, an older person may not report incontinence unless asked directly. Incontinence can be isolating and has a major impact on quality of life. It also increases the risk of falls in older persons. Rushing to the bathroom to avoid urge incontinent episodes most likely increase the risk of falling, which then results in falls and fractures. The development of incontinence is often the final factor influencing family caregivers to institutionalize those they care for.
Assessing fall risk is a big part of assessing client mobility. Every year, approximately 30% of older persons living at home fall. In fact the Center for Disease Control says every year 1 in 3 older adults has a fall . Getting more information about where falls occur is vital. A practical mnemonic for reviewing the actual fall is as follows:
S ‑Symptoms experienced at the time of fall
P ‑Previous number of falls or near-falls
L ‑Location of falls
A ‑Activity engaged in or attempted at time of fall
T ‑Time (hour) of fall
T ‑Trauma (e.g., physical or psychological) associated with falls
Prevention of falls is of utmost importance because after a fall the fear of another fall can become a vicious cycle. Fear leads to inactivity that then results in decreased strength that then leads to increased risk of another fall.
Many falls by older persons occur in the bathroom, the most dangerous room in the house. Adaptations in the environment can decrease the risk. If your client is falling at night, ask about the use of sedating medications at bedtime. Or perhaps does the person fall because he or she ambulates slowly and needs to rush to answer the only phone in the home, which is located on the kitchen wall? Getting a portable telephone may decrease the risk of another fall. Was the person experiencing specific symptoms secondary to medical problems, for example, dizziness or postural hypotension? Reviewing these symptoms with the physician can result in treatment or change in medications that will reduce the risk of a repeat fall.
Changes in the environment, attention to adaptations, and medical evaluation will make it safer for a person with impaired mobility to get around the home. In addition, with the goal of improved mobility and balance, the care manager should think about the possibility of physical therapy for strength training, personal trainers who can come to the home or the assisted living facility to do light exercise, or even a membership at a local senior-friendly gym that offers tai chi classes, which are known to improve balance. In addition, for clients in nursing homes the care manager needs to advocate for needed therapies and medical evaluations to improve mobility and decrease falls.
The holidays are upon us. Although joyful for most- they herald a miserable month for dysfunctional families. Any ritual gathering punches these clans in the gut
A Christmas Carol
If you attended Hanukah celebration or are going to Christmas event in the next few days – with dread of the drama – the sibling snipes, drunken digs, mom theatrics and ultimately ruined meal- look to Dickens
Dickens classic is the best tale of the chains that will clank through all generations without forgiveness
The Christmas Carol has old Scrooge, parsimonious and downright mean, sleeping in his gloomy bedchamber. He has spent the day browbeating his employee Bob Cratchit, complaining that he will have to pay him for the holiday, ignoring the penurious plight of Bob’s family and little son, poor crippled Tiny Tim.
In the middle of the night the cellar door creaks, an ominous bell starts to toll, and the ghost of his old counting house partner, Marley, lurks into his crypt-like bedchamber.
Marley, clanking his loud chains made of cash boxes, ledgers and very bad deeds, drags toward Scrooge, now awakened and terrified. Warning Scrooge about the consequences of his miserable behavior, rattling the padlocks and metal chains that bind him, Marley says he has been lugging these painful shackles since he died, wandering the earth as punishment for his ungenerous life.
He says he has come to save old Scrooge from that same fate. Scrooge will be in those irons in his next life if he doesn’t give up the past and live a more humane life in the present, and see his way to changing his foul behavior and learning to live a kinder much more openhanded life in the here and now.
Scrooge is made to look back at what started this life of anger and penury. He travels to his childhood with the ghost of Christmas past to see the once sweet little Scrooge who had a nasty father who left the child alone at Christmas in his dilapidated boarding school, reading by a flickering fire.
We forward through the three ghost stories to a kind of Dickensian life review, where Scrooge can see that there was also good in his life in old Fezziwig and Scrooge’s sister Fan. His life did have joy, but poor Scrooge kept retreating to his gloomy self, the lonely, neglected child who inhabited Victorian England’s broken-down boarding school system.
Scrooge has an epiphany. He calls all three ghosts—the past, present, and future—together and finds redemption. He discovers, as his nephew Fred says, a holiday season that wants to be a “forgiving, charitable time.”
The next morning he throws opens the window of his bleak London brownstone and yells for all to hear. He has transitioned into the here and now, lets the past go, and sees a happier family future. He rushes out to buy that mammoth turkey for the Cratchit family, and has a great holiday dinner with his nephew’s family.
Take that story as a warning tale. Family members, especially adult children and elders who pass on their anger, hurt, resentment, and scars to the next generation are dooming those family members, like poor old Scrooge, to a future in Marley’s chains. Forgiving your aging parents can release you from being bound by childhood neglect, or cruel behavior, that gets passed on from one generation to the next. Plus if your parent needs care as they age forgiveness can be the best tool to help your offer care.
If you this comes up over the holidays consider calling a geriatric care manager in your area. They specialize in dysfunctional families. Make a meeting with one a 2013 resolution.
Give a great Holiday Gift to Your Elderly Parent- Check the medicine cabinet.
What are some signs of prescription drug abuse problems that geriatric care managers and families should look for during holiday visits? One-third of all drugs prescribed in the United States are intended for patients who are 65 or older. The risk of prescription drug abuse and addiction is a major danger in the elderly. elderly. Loneliness, chronic pain and the wide availability to get and abuse of prescription dregs make them very dangerous. Not only that poly pharmacy is all to easy two types of drugs are musts abused, pain med and psychoactive drugs for depression and anxiety . Medication problems in the elderly, which include prescription drugs abuse, stoke hospital readmission.
Symptoms can include
• Loss of coordination (walking unsteadily, frequent falls)
• Changes in sleeping habits
• Unexplained bruises
• Being unsure of yourself
• Irritability, sadness, depression
• Unexplained chronic pain
• Changes in eating habits
• Wanting to stay alone much of the time
• Failing to bathe or keep clean
• Having trouble concentrating
• Difficulty staying in touch with family or friends
• Lack of interest in usual activities.
Signs to look for
Signs of a problem include:
Requesting refills more rapidly than prescriptions permit
Having multiple prescribing physicians who are unaware of the others’ prescriptions,
Having a doctor who is unaware of certain symptoms that another specialist is treating,
What to do
Check the medicine cabinet.
1. Over-the-counter meds aren’t free of serious side effects, and those problems are often magnified when older adults mix them with alcohol.
2. Using laxatives on a regular basis can cause chronic diarrhea, leading to a sodium and potassium imbalance that can threaten your heart. Antihistamines can cause confusion, and cold medicine can cause a spike in blood pressure, which can lead to a stroke.
3. Make sure your senior knows how to safely use any OTC meds in his or her possession.
4. Are there out of date prescriptions
5. Are there prescriptions for the same drug from multiple doctors?
6. Is there prescription for the same drug from multiple pharmacies?
What to do.
7. Call a geriatric care manager after your holiday visit.You should locate one in the area where your older relative lives. Give the gift that keeps on giving, a professional to guide your elderly family member to a safer happier life.