The Scottsdale home care experts share 5 conditions that can be improved with speech therapy.

The ability to communicate effectively is crucial to our feelings of independence and self-esteem, and for older adults, there are certain diagnoses that can inhibit the ability to speak clearly. Even the most social and outgoing senior can become reclusive and refrain from joining in conversations when speech difficulties are in place.

To help seniors gain back their confidence, we at Nightingale Homecare are pleased to provide professional in-home speech therapy services, in addition to our full range of medical and non-medical Scottsdale home care services. Since May is designated as Better Hearing & Speech Month, what better time to highlight the benefits a speech therapist can provide?

Just a few of the conditions that can be improved with speech therapy include:

• Apraxia: Often resulting from a stroke, apraxia is diagnosed in seniors who use words in an incorrect sequence. It can also cause difficulty in puckering the lips. A speech therapist will help older adults speak at a slower pace, allowing for more time to form words together correctly, and to practice repeating sounds in a particular order to master forming those sounds together into words.
• Dysarthria: Common in Parkinson’s disease, dysarthria results from weakened or paralyzed muscles. Speech therapy helps seniors through breathing techniques, articulation exercises, and adopting a slower speech pattern.
• Aphasia: When a senior leaves words out of sentences when speaking, it’s typically a result of one of several types of aphasia. Recovery is possible within a period of months as speech therapists help the senior with concentration exercises and to re-learn how to appropriately respond to verbal/vocal cues.
• Dysphagia: Dysphagia results from difficulties with swallowing, which can occur commonly in seniors due to changes in aging such as reduced saliva production, breathing changes, and dental issues. The speech therapist will help with modifications to eating and drinking to overcome these challenges.
• Dementia: With the progression of a dementia such as Alzheimer’s disease, communication becomes increasingly difficult. Speech therapy focuses on minimizing distractions, speaking more slowly, and utilizing nonverbal cues to maximize speaking ability to the greatest extent possible.

If a senior loved one struggles with any of these conditions, Nightingale Homecare’s speech therapists are available to provide an in-depth evaluation, create a personalized treatment plan, and work with the senior to improve functionality. Call our Scottsdale home care team at (602) 504-1555 to arrange for a free in-home consultation or to request additional resources to help improve quality of life for the older adults in your life.

earn the facts about incontinence from the Scottsdale home care team at Nightingale.

Urinary incontinence refers to the accidental or uncontrolled leaking of urine from the bladder. It is something an estimated two thirds of all elder Americans struggle with, and it not only affects the individual medically, but also has social, emotional and psychological consequences. Many people with incontinence are afraid to be too far from the toilet, and retreat from normal activities and enjoying life. It is often assumed that urinary incontinence is a normal part of aging, but it is not. Incontinence can be managed or treated.

The Scottsdale home care team at Nightingale Homecare are here to help you better understand the facts about incontinence and how to best help a loved one (or yourself) to manage it.

Risk Factors

• Pregnancy in past, especially multiple pregnancies
• Menopause
• Weak bladder or pelvic muscles
• Overactive bladder muscles
• Prostate problems
• Certain medications
• Damage to nerves that control the bladder
• Diabetes
• Parkinson’s disease
• Multiple sclerosis
• Pelvic organ prolapse
• Stroke
• High blood pressure
• Smoking
• Obesity
• Urinary tract infections
• Vaginal infections
• Constipation

Types of Urinary Incontinence 

There are four types of urinary incontinence:

• Stress Urinary Incontinence (SUI): This is the most common cause of urinary incontinence and is much more common in women than in men. SUI occurs when the muscles in the pelvic floor have stretched. With physical activities such as exercise, walking, bending, lifting and even sneezing and coughing, leaking may occur. This is especially common in women around the time of menopause.
• Overactive Bladder or Urgency Incontinence: This occurs when the patient has a sudden urge to urinate and cannot hold the urine.
• Mixed Incontinence: This is a combination of stress incontinence and overactive bladder.
• Overflow Incontinence: This occurs when small amounts of urine leak from a full bladder. This can occur with an enlarged prostate, diabetes, or spinal cord injuries.

Diagnosis 

The first step in identifying and treating incontinence is seeing a doctor for an exam. Come ready with your questions, a diary of your (or your loved one’s) incontinence, list of symptoms, past medical history and any medications currently being taken. The doctor will take some blood and urine tests in addition to tests that measure urine output and how well the bladder is emptying. The doctor may also suggest seeing a urologist, a doctor who specializes in urinary problems.

Treatment

The doctor will choose a treatment based on the type of bladder control issue and how serious it is. There are multiple treatments available, and the doctor will begin with the simplest and safest treatment first. Treatment options include:

• Kegel or pelvic muscle exercises: These exercises work the muscles used to stop urinating and help make them stronger.
• Biofeedback: This treatment uses sensors to make the patient aware of the body’s signals. Biofeedback can be helpful when learning Kegel exercises.
• Timed voiding: A schedule is set up for urination; for example every hour or two. The goal is to slowly extend the time between voidings to help control urge and overflow incontinence.
• Lifestyle changes: Losing weight, preventing constipation, avoiding heavy lifting, stopping smoking, avoiding alcohol and caffeine can all make a difference. Choosing water instead of other drinks and limiting fluids before bedtime can also help.
• Medications: There are medications that can help empty the bladder, and some medications are used to help tighten muscles.
• Injections: The doctor may use a substance injected around the urethra to help thicken and close the area around the urethra to prevent leaking.
• Urethral and vaginal insert: A small disposable device may be used for women, inserted in either the urethra or the vagina.
• Surgery: Surgery may be used to change the position of the bladder or to reduce the blockage due to an enlarged prostate.
• External catheters: There are external catheter products for both men and women. External catheters work well for men and are applied much like a condom, with tubing attached to collect the urine in a drainage bag. External catheters don’t work well for all women as these funnel-like pouches don’t always adhere perfectly to the labia, and leaking can occur.
• Straight catheters: These catheters are inserted intermittently to drain the bladder 3-5 times a day on a set schedule.
• Indwelling catheters: This type of catheter is inserted into the bladder, either through the urethra or through a surgical opening above the pubic bone. These catheters are for long-term use and are kept in 24/7. A home care nurse can assist with the maintenance and changes every month.
• Absorbent products: There are numerous products that can help protect clothing and bedding from urine leakage, ranging from pads to adult diapers. These products absorb urine leakage and offer some protection to the skin. When choosing a product, consider the ease of use and whether the patient will need to fully remove outer clothing to change the product. Also, consider absorbency and the materials they are made of. Some products have plastic components and can irritate the skin.

Skin Care

Even after treatment, some patients continue to leak urine or have episodes of incontinence. Over time, urine leakage can cause skin breakdown, rashes and redness. Urine on the skin can also lead to bacteria growth and infection. Soaps, skin products and cleansers can help if used properly. Overuse of soap and water, however, can dry out the skin and lead to breakdown. There are special rinses and cleansers made specifically for incontinence, and barrier creams are effective in keeping urine away from the skin and preventing breakdown. If the patient uses adult diapers and incontinent pads, it is important to check and change them frequently to avoid a UTI, skin breakdown and skin infections.

Incontinence and Alzheimer’s Disease

In the later stages of Alzheimer’s disease, patients often experience urinary incontinence. This can be an issue of not realizing the need to urinate, forgetting to use the bathroom, or not being able to locate a toilet.

There are things you can do to avoid incontinence in someone with Alzheimer’s disease. They include:

• Avoid coffee, teas and sodas and other drinks containing caffeine; but don’t limit water
• Keep pathways clear and the bathroom clutter-free
• Post signage that directs the person to the toilet
• Keep a light on in the bathroom
• Provide a consistent bathroom schedule
• Make certain underwear is easy to remove

Nightingale Homecare’s team of fully trained and experienced Scottsdale home care professionals are available to help reduce the discomfort of urinary incontinence with a full range of nursing and non-medical in-home care. Contact us at (602) 504-1555 to learn more!

Try these tips from Nightingale, the top providers of senior care Scottsdale families need, for better outcomes following a stroke.

Experiencing a stroke in and of itself is traumatic, both for the stroke survivor and his or her loved ones. Yet for many, the real challenge starts after the stroke, as the recovery process begins, and a variety of obstacles remain to be overcome. The key to maximizing recovery is in developing effective strategies to address each of these challenges, which typically fall into one of three categories.

The professional home care team at Nightingale Homecare, providers of the highest quality senior care Scottsdale and the surrounding area have to offer, highlights tips for each of these areas of recovery:

Physical

Physical changes are often most apparent, and vary based upon the area of the brain that was impacted by the stroke. Some of the more common challenges, with tips to help with each, include:

• Dysphagia (trouble swallowing): Cut food into smaller portions, or puree foods. Talk with the doctor to determine if liquid thickeners may be beneficial.
• Hemiparesis (weakness on one side of the body): Along with rehab and exercise, try in-home modifications and assistive devices, such as grab bars, specialized eating utensils, and a tub bench, as recommended by the physician.
• Pain: As many as 50% of stroke survivors experience some level of pain – sometimes several weeks or even months post-stroke. Tips to help include keeping bath/shower water at a temperate level, utilizing a shoulder support when ambulating, and remaining as physically active as possible. Talk with the physician for more pain management tips if the problem is severe or chronic.

Emotional

While the emphasis is often on physical recovery, it’s important to understand that emotional changes are also quite common, and require just as much attention, care and treatment. While some degree of sadness, anger, frustration, and fear are to be expected as a result of undergoing a stroke, make certain your loved one’s emotional health does not descend into post-stroke depression, which may display as:

• Feeling helpless, hopeless, worthless
• Ongoing, excessive feelings of sadness, anxiety, emptiness
• Disinterest in previously enjoyed activities
• Isolation
• Concentration/memory problems
• Fatigue and/or difficulty falling or staying asleep
• Thoughts of suicide

Another common condition to watch for during stroke recovery is PBA (pseudobulbar affect), in which the individual experiences outbursts of uncontrollable laughing or crying.

Both of these conditions are treatable, and should be brought to the attention of the physician immediately.

Cognitive

Tasks that were once completed without a second thought may now be a struggle, such as speaking, reading, writing, reasoning, and planning. Additionally, short-term memory is often impacted. It can be helpful to implement communication modifications, such as drawing/writing if speaking is difficult, or creating a communication book with common pictures and symbols (such as a cup of water, plate of food, blanket, toilet, etc.) to allow the person to point to a specific need. Be sure to remain calm and patient as your loved one struggles through these challenges.

Whatever your loved one is facing post-stroke, Nightingale Homecare is on hand to help. With our in-home occupational, speech, and physical therapy services, plus a full range of both medical and non-medical care, we can ease the difficulties of stroke recovery. Contact us at (602) 504-1555 for more helpful stroke resources and to request an in-home consultation to discover the many ways we can help.

Discover the importance of learning life stories when providing dementia care.

When we are working with those diagnosed with Alzheimer’s, it is important to know their stories. What is their history? Where did they live? Who comprised their family? What are some of their most powerful memories? What did they do for a living? And what were their hobbies? If you’re not getting the picture, you might wonder why all of this matters.

It matters because those with Alzheimer’s increasingly live in the past, so that the “old memories” are new again. This applies to so many things in their reality. For instance, a gentleman I remember would become very agitated when it snowed and fret that the animals would freeze if they weren’t protected. At first the family thought that Dad was having a psychotic episode since he had never talked about animals before. Then one day his children discovered a very old picture of their dad when he was a little boy. It was probably taken in the 1920s and showed their dad standing in a field surrounded by cattle. This was right before the Great Depression, when his family lost their farm and the gentlemen lost his dad. He would have been a great-grandfather to the current children, who knew nothing about these losses. Their dad had never talked about what he’d been through, but now he was reliving it. Once the family realized what was happening, they would reassure their father whenever there was bad weather that every animal was locked safely in the barn. He continued to ask about the animals when it snowed, but he was able to relax after hearing they were safe.

Another gentleman had been a wood carver all his life and now lived in North Carolina with his son and daughter-in-law. They were concerned about his failing memory and had him evaluated by a geriatric neurologist, who diagnosed the man with Alzheimer’s at Stage 4-5 on the FAST scale. The family worried that it was no longer safe for Dad to carve wood, but the doctor assured them that wood carving was second nature to their father. They just needed to watch him and they would know when this hobby was no longer safe for him. They did this over the course of several years as his Alzheimer’s continued to grow worse. Finally, they decided assisted living was the safest place for him.

When he was admitted to the facility, the daughter-in-law told the staff how important carving was to Dad and supplied him with bars of Ivory soap and plastic picnic knives every week. The old man would sit in a chair with a trash can between his knees, lean forward, and carve the Ivory soap. Did he carve the beautiful woodland figurines that he had once carved? No, but he continued to carve. His family knew how important this was to their father’s well-being, so they made it happen in a very safe way.

The stories of our patients are like valuable, buried treasures. When caregivers can unlock the past and dig up these stories, it is a transformative experience for the story teller and the listener, too.

The Scottsdale home care team at Nightingale Homecare is always thinking creatively when it comes to enhancing quality of life for those with Alzheimer’s disease. Our Connections Dementia Care Program, staffed by Alzheimer’s Whisperers®, helps those with dementia better manage a full range of challenging behaviors: wandering, repetition, nutritional concerns, sundowning, and much more. Contact us for a free in-home consultation to allow us to offer care solutions for your loved one by calling (602) 504-1555 any time.

About the Author: Verna Benner Carson, P.D., PMHCNS-BC, is president of C&V Senior Care Specialists and Associate Professor of Nursing at Towson University in Baltimore, MD. Dr. Carson can be reached at vcars10@verizon.net.

Occupational therapy can a great addition to the care team when managing diabetes.

Those with diabetes, and those who provide care for them, know the importance of proper management of the disease: routine monitoring of blood glucose levels, carefully adhering to dietary restrictions, exercising and maintaining regular checkups with the doctor. But what might come as a surprise is the role occupational therapy can play in diabetes management.

Occupational therapists can – and should – be a vital part of a diabetic’s care team, bringing a full range of knowledge and expertise in addressing all of a patient’s needs: emotional, social, sensory and cognitive, as well as physical.

The American Association of Diabetes Educators has compiled the AADE 7^TM Self-Care Behaviors, all of which can be enhanced through occupational therapy services:

1. Healthy eating
2. Remaining active
3. Monitoring the disease
4. Taking medications
5. Solving problems
6. Healthy coping skills
7. Reducing risks

Here are just a few of the many ways a professional occupational therapist can improve diabetes management as well as the overall health and wellbeing for the person diagnosed:

• Provide recommendations for safe, appropriate physical activity
• Educate on appropriate meal choices and cooking techniques
• Assist with medication tracking and organization
• Share tips for effective blood glucose monitoring
• Utilize strategies and compensations for those with sensory loss
• Help alleviate anxiety and depression through daily lifestyle changes
• Recommend assistive devices as needed
• And much more

Nightingale Homecare is the perfect care partner for those with diabetes, or any other chronic condition. Our Pathlink Chronic Disease Management Program empowers patients with the education, strategies, technology, and self-management skills to better manage complex care needs. Additionally, our full range of customized home health services can also include occupational therapy and many other care professionals such as physical therapists, speech therapists, nurses, and caregivers, right in the comfort of home.

Whether the need is simply for a little extra help with housework, meals, and personal care, or if a chronic disease calls for skilled medical care, Nightingale Homecare is on hand with the right level of care at the right time. Contact us at (602) 504-1555 for a free in-home consultation where we’ll listen to the challenges being faced and create a plan of care to address those needs, monitoring over time as needs change. Discover how our Scottsdale senior home care services can improve quality of life and make each day the very best it can be!