Wound healing is often difficult for older adults.
Remember as a child scraping your knee on the playground, when all it took was a hug from mom and a band-aid to have you back up on your feet, good as new? When older adults experience a wound, however, achieving complete healing is often a much more complicated process, for a variety of reasons, including:
Less skin elasticity. The natural process of reduced elasticity in the skin as we grow older makes it harder for skin to heal – in fact, the U.S. National Library of Medicine estimates that senior wound healing can take up to four times as long in comparison to younger people.
Longer inflammatory response time. Our blood vessels expand when a wound occurs, so that white blood cells and nutrients can more quickly reach the wound area. Yet this inflammatory response is markedly slower in the elderly.
Diabetic effects. Those with diabetes (and over 11 million seniors in the U.S. are diabetics) often experience problems with hardened arteries and narrowed blood vessels, both of which can contribute to delayed wound healing. Additionally, neuropathy can inhibit a diabetic from sensing the pain of a wound, enabling it to worsen.
Interestingly, there is one key factor that helps older adults experience enhanced wound healing: regular exercise. Ohio State University conducted a recent study among healthy seniors between the ages of 55 and 77 in which some engaged in regular physical activity, while the others did not. A small puncture wound was then given to each senior, and the healing process was monitored. Those who had participated in the exercise program healed a full ten days faster than those who did not.
We are familiar with the best products for specific types of wounds, and incorporate additional measures to expedite healing, such as ensuring seniors are receiving proper nutrition and hydration, relieving pressure, and preventing infection.
Contact Nightingale Homecare any time for more tips and resources related to effective wound healing for seniors, or to arrange for a free in-home consultation with one of our Scottsdale senior home care professionals to find out how we can help your loved one more heal more quickly and get back to enjoying life! You can reach us at (602) 504-1555.
Learn everything you need to know about taking vital signs at home from Nightingale Homecare.
If you are a caregiver for a loved one who has a medical condition that requires monitoring, chances are his or her physician has asked you to keep an eye on a measurement or two in order to detect a change in condition. Learning to monitor vital signs is a necessity for caregivers of people with chronic conditions.
It is an important skill to learn, because it tells us how the person’s body is functioning, helping us to monitor current conditions and alerting us to changes in health status. It can also give us clues to possible medical conditions that have yet to be diagnosed. The four main vital signs that are measured to give us an overview of your loved one’s health status are:
Heart rate (pulse)
The Scottsdale senior home care team at Nightingale Homecare shares the following instructions on how to correctly monitor vital signs:
No individual has the exact same temperature reading throughout the day, as body temperature naturally fluctuates. Normal body temperature measured orally ranges from 97.6 to 99.6 degrees Fahrenheit (36.4 to 37.5 degrees Celsius) for a healthy adult. Of course, normal temperature variation depends on recent activity, food and fluid intake, time of day, etc.
Body temperature may be abnormal due to fever (high temperature) or hypothermia (low temperature). According to the American Academy of Family Physicians, a fever is indicated when body temperature rises one degree or more over the normal temperature of 98.6 degrees Fahrenheit. Hypothermia is defined as a drop in body temperature below 95 degrees Fahrenheit.
There are four different ways to measure body temperature:
Orally: At Nightingale, we ask that our caregivers and clinicians use a digital thermometer to measure oral temperature over glass thermometers due to safety reasons. If you do not have this piece of equipment to monitor your loved one’s temperature, you should make the investment; they are inexpensive and reliable.
Rectally: If your loved one’s doctor asks you to take a rectal temperature, you should use a digital thermometer over a glass thermometer for safety reasons. Rectal temperatures tend to be 0.5 to 0.7 degrees F higher than when taken by mouth.
Axillary: Temperatures can be taken under the arm using a digital thermometer. Temperatures taken by this route tend to be 0.3 to 0.4 degrees F lower than those temperatures taken by mouth.
By ear: A special thermometer can quickly measure the temperature of the ear drum, which reflects the body’s core temperature (the temperature of the internal organs). An ear temperature is between 0.5 -1.0 degrees F higher than an oral temperature.
By skin: A special thermometer can quickly measure the temperature of the skin on the forehead. A skin temperature is between 0.5 -1.0 degrees F lower than an oral temperature.
Taking Body Temperature Using a Digital Thermometer:
Wash your hands.
Cover thermometer mouth tip with a clean plastic shield.
Press button to set the thermometer.
Place the thermometer under the tongue and instruct your loved one to close his or her lips around the probe.
Wait several minutes and remove thermometer when beeping indicates the reading is complete.
If you are taking a record for your loved one’s physician, write down the temperature, including the date, time and method used as follows: “O” for oral, “R” for rectal, “E” for ear, “A” for axillary.
Remove the plastic shield.
Clean and sterilize the thermometer following manufacturer’s instructions, or with an alcohol prep pad wiping from the top to the tip.
Note: Oral thermometers are not indicated for some individuals, such as those with a history of seizures, or people unable to close their mouth fully. Digital thermometers can be used to take an axillary temperature by being placed under the armpit, against dry skin, and following the instructions noted above.
Pulse rate, also called heart rate, indicates the number of times the heart beats per minute. As the heart pushes blood through the arteries, the arteries expand and contract with the flow of the blood. Taking a pulse not only measures the heart rate, but also can give us information on the strength and rhythm of the heart.
Normal pulse for healthy adults ranges from 60 to 100 beats per minute. The pulse rate may fluctuate and increase with exercise, illness, room temperature, injury, and emotions. It is not uncommon for athletes, who do a lot of cardiovascular conditioning, to have a heart rate of nearly 40 beats per minute and experience no problems.
Taking a Pulse Rate:
Wash your hands.
Make sure that your loved one is at rest before you begin.
The easiest place to find a pulse to measure is at the radial artery found on the inside of the wrist at the base of the thumb. Alternatively, you can find the pulse on the inside of the elbow (brachial artery), or neck (carotid artery).
Note: If you use the neck, be sure not to press too hard, and never press on the pulses on both sides of the lower neck at the same time to prevent blocking blood flow to the brain.
Use your first and second fingertips (never the thumb, because it has a pulse and will interfere with an accurate assessment of your loved one’s heart rate) to press firmly but gently on the wrist (or otherwise) until you feel a pulse
With an analog clock or watch, wait until the second hand is on the 12 to begin counting.
Begin counting the beats of the pulse
Count pulse for 60 seconds until the second hand returns to the 12. Or, you may also count for 15 seconds and multiply by 4 to calculate beats per minute. Note: The physician may request for you to take the loved one’s heart rate for a full minute, if he/she has an irregular heart rate.
When counting, do not watch the clock continuously, but concentrate on the beats of the pulse.
If your loved one’s physician asks for a record, write down the heart rate, including the date, time, and if you notice any irregularities.
Respiration rate, also referred to as breathing rate, is the number of breaths taken over a minute. This measurement is always taken when the person is at rest and involves how many times the chest rises per minute. One respiration count is equal to the chest rising (inhaling) and falling (exhaling) once. The normal range for an adult is 12 to 20 respirations per minute. Factors like age, fever, agitation, activity, illness and sleeping can alter breathing and therefore the respiratory rate. When a person is acutely ill, respiratory rate fluctuations and patterns are monitored as a warning sign for further decline.
Taking Respiratory Rate:
You can keep your fingers on the radial pulse after you have stopped counting pulse rate, and use the next minute to count the person’s respiratory rate.
With an analog clock or watch, wait until the second hand is on the 12 to begin counting.
Count breaths (inhale + exhale = 1 respiration) for one minute. You may also count for 15 seconds and multiply by 4 to calculate breaths per minute.
If your loved one’s doctor wants a record, write down respiration rate, noting any observations (such as irregularity, increased effort or wheezing).
Blood pressure is the force of the blood pushing against the artery walls during contraction and relaxation of the heart. Each time the heart beats, it pushes blood into the arteries, resulting in the highest (top) number of pressure reading. This is called “systolic.” The bottom number, lowest reading or “diastolic” is when the heart is totally relaxed before the next beat. The blood pressure measurement is recorded in millimeters of mercury or mm Hg and written as systolic/diastolic.
A blood pressure reading identifies how effectively the oxygenating blood is moving through the blood vessels of the circulatory system. In healthy adults, the systolic pressure should be less than 130 and the diastolic pressure should be less than 85. High pressure is called hypertension and low pressure is called hypotension. Many health conditions can affect blood pressure. Cardiac patients, and those afflicted with hypertension, are instructed to monitor their blood pressure, as it can directly lead to life-altering conditions like heart attack, heart failure and stroke.
At Nightingale, all of our staff use manual or android cuffs, as electronic blood pressure machines can be unreliable and false readings could lead to devastating consequences for your loved one. You will need to have a stethoscope, blood pressure cuff with inflatable balloon (sphygmomanometer) with a numbered pressure gauge called a digital monitor or aneroid monitor.
Before you measure your loved one’s blood pressure:
The American Heart Association recommends the following guidelines for home blood pressure monitoring:
Have your loved one refrain from smoking or drinking coffee for 30 minutes before taking blood pressure.
Have your loved one go to the bathroom before the test.
Your loved one should relax for 5 minutes before taking the measurement.
Taking Blood Pressure
Have your loved one sit with the back supported (he or she shouldn’t sit on a couch or soft chair). Your loved one’s feet should be on the floor and uncrossed.
Wash your hands.
Place your loved one’s arm on a solid flat surface (like a table) with the upper part of the arm at heart level.
Place fingers on the underside of the elbow to locate the pulse (called the brachial pulse).
Wrap and fasten the deflated cuff snugly around the upper arm at least one inch above where you felt the strong and steady brachial pulse.
Position the stethoscope diaphragm directly over the brachial pulse and insert the earpieces.
Turn the knob on the air pump clockwise to close the valve.
Pump air, inflating the arm cuff until the dial pointer reaches 170.
Gently turn the knob on the air pump counter-clockwise to open the valve and deflate the cuff.
As the dial pointer falls, watch the number and listen for a thumping sound.
Note the number shown where the first thump is heard (systolic pressure).
Note the number shown where the last thump is heard (diastolic pressure).
Deflate and remove cuff.
If your loved one’s doctor asked you to take multiple readings during one sitting, take the readings one minute apart and record all the results.
It is best to take blood pressure at the same time every day.
If your loved one’s doctor asks for a record, write down the date, time, and blood pressure reading.
When blood pressure reaches a systolic (top number) of 180 or higher OR diastolic (bottom number) of 110 or higher, this could require emergency medical treatment, so call your loved one’s doctor for further instruction.
The Scottsdale senior home care team at Nightingale Homecare shares senior socialization tips.
Isolation in older adults is more prevalent than we’d like to admit, and the effects can be devastating. The other side of the coin, however, is that the benefits of senior socialization are tremendous, including a reduced risk of cognitive decline, better physical and emotional health, and even the potential for a longer lifespan.
With life as busy and hectic as it is for families, and with many seniors experiencing mobility issues and other health problems, how can we ensure that the older adults we love have ample opportunities for socialization?
Seek out senior centers. With as many as 15,000 senior centers throughout the U.S., it’s likely there’s at least one in close enough proximity for your loved one to enjoy. Places of worship and other non-profit organizations often host groups of seniors more informally as well, and transportation is typically provided to and from the center, providing opportunities for shared meals, conversations, activities, exercise programs, outings and more. Currently 60% of older adults surveyed report that visiting the senior center is their only source of daily interaction with others.
Learn something new. Lifelong learning helps protect cognitive ability, and the ideas for continued education for seniors are limitless! Local community colleges often offer low-cost classes for seniors, but also look into courses offered through the library, craft and hobby stores, religious organizations, and more.
Take time to play! Everyone loves games, regardless of age. Invite neighbors in for board and card games, locate a bridge club, or investigate bowling groups, senior swim teams, or golfing get-togethers.
Help another. Nothing is more rewarding than knowing you’re making a difference in someone else’s life, and there are plenty of ways within Scottsdale and the surrounding area to do so! Whether the senior is passionate about pets, children, veterans, or the homeless, there are bound to be volunteer opportunities available for your loved one.
Pick up a new hobby. Help the senior discover or rediscover an interest such as painting, drawing, photography, knitting, playing a musical instrument, singing in the choir, scrapbooking, etc. and then search online for local gatherings of others who share that interest.
Most importantly, partner with the Scottsdale senior home care team at Nightingale Homecare! It’s our mission to ensure that older adults thrive and enjoy life to the fullest. We’re always on hand to provide the friendly companionship that brightens each day for seniors, whether that involves sharing a cup of tea and conversation together at home, playing games and engaging in exercise programs together, providing transportation and accompaniment to any of the fun outings mentioned above, and so much more.
Call us at (602) 604-1555 to find out more about how we can boost senior socialization for someone you love with our full range of customized in-home care services!
Discover how to help seniors stay independent and safe.
It’s a common struggle among family caregivers: deciding when to step in and help, and when to step back and allow an older loved one to accomplish as much as possible independently. It requires a delicate balancing act. On the one hand, we need to ensure safety is never compromised; yet on the other hand, we never want to do anything to damage a senior’s self-worth and self-esteem.
So the question becomes, how can we help seniors stay independent, while ensuring safety? The Sun City home health care experts at Nightingale Homecare have several key recommendations:
Remember: You’re a team! Changing the mindset from working for a senior to working with a senior can make a world of difference in your approach. Talk with the older adult in an open and honest way about the challenges and concerns he or she is facing, and how you can best provide needed support. Naturally, these needs will change over time; and when cognitive issues come into play, communication strategies will need to be modified as well. But we all appreciate being asked for our input, and to know that value is placed on our feelings.
Allow time before jumping in to help seniors. It may seem more efficient to take care of tasks yourself, but doing so may be at the expense of your loved one’s self-image. Instead, factor in plenty of extra time for tasks, allowing the senior ample opportunities to tackle them independently whenever possible.
Focus on the senior’s strengths. If certain tasks prove to be too challenging for your loved one, shift the focus to those he or she is able to manage more easily. For instance, if preparing an entire meal is too difficult, ask the senior to manage creating her special dessert recipe while you work on the main course.
Remind the senior that helpful workarounds are a positive. A senior may balk at the idea of using a walker or wheelchair initially, or in having grab bars installed in the bathroom. And many times older adults are resistant to the idea of needing someone to help with everyday activities that they’ve been managing their entire lives. Providing a reminder that assistance and home modifications are empowering, allowing the senior to accomplish more independently and to remain in the comfort of home throughout aging, can be beneficial.
At Nightingale Homecare, it’s our mission to deliver the highest quality in-home care help for seniors with the respect and dignity that allow for maximum independence and autonomy at all times. Never coming in and taking over, we work together with seniors and their families to develop a plan of care that addresses all needs – including those for personal freedom. Contact our Sun City home health care team at (602) 504-1555 to request a free in-home consultation and discover how we can improve life for a senior you love.
Learn the 7 main types of elder abuse and how to keep seniors safe.
Elder abuse is a serious issue that involves the abuse or neglect of people age 60 and older. The signs of abuse are often not recognized, leading to gross under-reporting of the problem. In fact, the limited research available suggests that only one in 14 cases of abuse are actually reported to the authorities. Sometimes the abuse is a continuation of existing dysfunctional family dynamics. More often, however, the abuse is a result of changes brought about by the stress of illness, dependency and need for increased care.
Adult children and spouses are the most frequent abusers of the elderly, followed by other family members. The National Center on Elder Abuse defines the following seven different types of elder abuse:
Physical abuse involves the use of physical force that may result in bodily injury, physical pain, or impairment. Persons who have been physically abused may have bruises, welts, lacerations, rope marks, black eyes, wounds, cuts, or untreated injuries in different stages of healing. Dislocations, sprains, internal injuries, broken eyeglasses or frames, and medication overdosing or under-dosing can also be the result of physical abuse. The elder being physically abused is often withdrawn, anxious, depressed, and fearful around a family member or caregiver. A red flag that physical abuse may be occurring is a caregiver’s refusal to let the patient have visitors without the caregiver being present.
Sexual abuse includes non-consensual sexual contact of any kind with another person. Bruising around the breasts or genital area, sexually transmitted diseases, vaginal or anal bleeding, and torn or bloody undergarments are signs of sexual abuse.
Emotional or psychological abuse involves infliction of anguish, pain, or distress through verbal or non-verbal acts. Emotionally abused persons may appear agitated, upset, withdrawn, non-communicative, or unresponsive. Emotional abuse often accompanies other types of abuse. In the elderly, unusual behavior often attributed to dementia, such as sucking, biting, or rocking behavior, can also be signs of emotional or psychological abuse.
Financial exploitation is a common form of abuse that occurs in the elderly and involves illegal or improper use of an elder’s funds, property, or assets. Financial abuse can include cashing an elder’s checks without permission; forging an elderly person’s signature; stealing money or possessions; coercing or deceiving the elder into signing a contract or will; or improperly using a power of attorney, guardianship, or conservatorship. Other indications of financial abuse include the disappearance of financial papers, checkbooks, and legal documents; a sudden change in banking habits or a change in banking locations; the withdrawal of large sums of money by a person who accompanies the elder; additional names added to an elder’s bank signature card; unauthorized use of an ATM or credit card; the unexplained transfer of assets to a family member or person outside the family; or the unexplained disappearance of funds or possessions.
Additionally, substandard care, even though financial resources are available, can be an indication of financial abuse. Exploitation may also occur in the form of fraud schemes by strangers.
Neglect is the most common type of elder abuse. Neglect may be intentional, such as withholding nourishment, or it may be unintentional, resulting from ignorance or from a genuine inability to provide care. Neglect can also take the form of failure to fulfill an obligation, such as failing to pay for necessary home care services or the failure of a caregiver to provide necessary care. Persons who have been neglected may appear dehydrated and malnourished, have untreated bedsores, lice, a flea infestation, a urine or fecal smell, be inadequately clothed, or live in hazardous, unsafe, or unsanitary conditions.
Abandonment is an extreme form of neglect that involves desertion of a person by an individual who has physical custody or by a person who has assumed responsibility for providing care to the individual. An example would be a caregiver who leaves a dependent elderly person alone for several days while traveling.
Self-neglect abuse primarily occurs in the elderly and includes behaviors or absence of behaviors that threaten a person’s health or safety. This definition does not apply to a mentally competent person who makes the voluntary decision to engage in behavior that threatens his or her safety and who understands the consequences of that decision. Self-neglect can include behaviors such as:
Failure to take essential medications or refusal to seek medical treatment for serious illness
Leaving a burning stove unattended
Not wearing suitable clothing for the weather
Poor living conditions or the inability to attend to housekeeping
Self-neglect accounts for the majority of elder abuse cases reported to adult protective services. Oftentimes, the problem is paired with declining health, isolation, Alzheimer’s disease or dementia, or drug and alcohol dependence. In some of these cases, self-neglecters will be connected to support systems within the community that can assist the person to continue living independently. Conditions like depression and malnutrition may be successfully treated through medical interventions. If the problems are severe enough, a guardian may be appointed or alternate living conditions arranged.
A combination of individual, relationship, community, and societal factors contribute to the risk of becoming a victim or perpetrator of elder abuse. In many situations, the same risk factors may be shared by both the perpetrator and the victim.
In the elderly population, studies suggest that those at risk are most likely to be female, widowed, frail, cognitively impaired, and chronically ill. Social isolation and mental impairment, such as dementia or Alzheimer’s disease, are two factors that may make an older person more vulnerable to abuse. A history of domestic violence may also make a senior more susceptible to abuse. Particularly in the case of adult children, abusers often are dependent on their victims for financial assistance, housing, and other forms of support. Frequently, these individuals need this support because of personal problems, such as mental illness, alcohol or drug abuse, or other dysfunctional personality characteristics. The risk of elder abuse is particularly high when these adult children live with the elder.
Home care clinicians, such as the professional Sun City home health care staff at Nightingale Homecare, are in an ideal position to detect situations for potential abuse and to connect the patient and caregiver with community resources that may prevent escalation of the problem. Stressed caregivers can be put in contact with social organizations and support groups and connected with referrals for adult day care, delivered meals, and respite care. Providing resources for caregiving assistance can be a lifesaver. Clinicians should also teach family caregivers to recognize situations that cause increased stress, as well as appropriate ways to handle difficult patient behaviors like violence, combativeness, and verbal abuse. Identifying actions that can deflate stressful situations is critical to preventing abuse.
Home health providers are mandated to report suspected abuse. Mandated reporters are required by law to report allegations of abuse to law enforcement and regulatory agencies. In most states, Adult Protective Services are the public agencies responsible for investigating reports of elder abuse and for providing victims and families with treatment and protective services. In most situations, the suspicion of abuse is grounds for reporting. Proof is generally not necessary, and the reporter has the option to remain anonymous. Even if a situation has already been investigated, circumstances that seem to be getting worse should continue to be reported and documented by the clinician. If the patient is in immediate danger or a life-threatening situation, it’s important to call 911 or the local emergency authorities.
A trusted home care team, like Nightingale Homecare, is instrumental in reducing the chance for elder abuse and neglect. Contact our Sun City home health care experts to learn how we can help a senior you love stay safe, healthy, and well, in the comfort of home.
A Nightingale representative would be happy to answer your questions or help you arrange for home care that is custom-fit to your needs.