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
• Sexual abuse
• Emotional abuse
• Financial exploitation
• Neglect
• Abandonment
• Self-neglect

Physical 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 The elder being physically abused is often withdrawn, anxious, depressed, and fearful around a family member or caregiver.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

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 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 Emotionally abused persons may appear agitated, upset, withdrawn, non-communicative, or unresponsive.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

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

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

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

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:

• Hoarding
• Failure to take essential medications or refusal to seek medical treatment for serious illness
• Leaving a burning stove unattended
• Poor hygiene
• 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.

Risk Factors

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.

Prevention

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.

Reporting 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.

Family caregiver tips: learn the ins and outs of ADLs.

Activities of daily living, often termed ADLs, include the basic skills typically needed to manage the physical needs of a person. Providing assistance with the activities of daily living for someone in your care is one of the most important responsibilities you have as a family caregiver. It can be challenging, and you may feel awkward at times, but becoming informed on these vital tasks will help to make it easier.

The ability to perform ADLs is dependent on cognitive, motor and perceptual abilities. Assisting someone with their ADLs comes down to knowing how you can help. Understanding what your loved one’s level of function is in the following five areas of ADLs will help you determine what level of care or assistance you will be providing.

GROOMING, BATHING AND PERSONAL HYGIENE

Grooming, bathing and hygiene are very personal activities. It will be important for you to provide as much privacy and independence as possible during these activities. Minimizing how physically exposed your loved one is during a task can help him or her feel more comfortable. You may wrap a towel around private parts and uncover only during cleaning.

A specific task may be done more quickly if you just do it yourself, but you should always try to let the person you are caring for perform the task whenever possible – although only if it is safe to do so. Your loved one may be able to take a bath independently and may just need your help to wash his or her back. Remember to take your lead from the person as to how much or how little to help.

DRESSING

Make certain your loved one has clean, dry clothing available to wear. Pick out a couple of clothing options and allow him or her to choose the desired outfit for the day, when possible. Make sure the choices you have selected are in good repair and weather-appropriate. Allowing your loved one to choose what to wear encourages independence and minimizes the hassle for your loved one of choosing between too many options.

TOILETING

If your loved one requires assistance with toileting, it can be an uncomfortable or embarrassing task for both of you. Try to be very matter-of-fact when talking about toileting and provide toileting assistance in the same way you would provide any other kind of help.

Your loved one may feel a big loss of privacy and independence. You can help to keep his or her dignity intact by allowing as much privacy as possible. For example, if the senior is able to use the toilet independently, help the senior to get settled, and then leave the room and wait outside the door until you are called back in to help.

Your loved one may require extra assistance in clean-up. Again, approach matter-of-factly and provide quick but thorough clean-up. As you spend more time with your loved one, it will become part of the regular routine, making it easier for both of you.

Keep a regular bathroom schedule to ensure there are no accidents. In between bathroom breaks, look for signs your loved one may need to use the restroom.

TRANSFERING AND AMBULATING

Keeping safety at the top of mind when you assist a loved one with transferring or ambulating is a priority. It may be necessary to use a gait belt, transfer board or Hoyer lift to help your loved one move from point A to point B. An assistive device, such as a walker, cane or wheelchair, may be necessary. You will need to be familiar with all of these devices in order to ensure the safety and well-being of your loved one. Keep in mind, your loved one’s tolerance level may change from day to day or hour to hour, so you will need to be prepared for the potential that your loved one may experience weakness in the middle of a transfer or while walking. Keep this in the back of your mind at all times so that you can safely assist your loved one to rest during the activity. Your loved one’s physical therapist can help create an exercise plan tailored to his or her physical limitations and strength in order to help regain or maintain mobility. 

EATING

Your loved one may have challenges with any or all of the tasks associated with eating: shopping, preparing, and eating food. As a caregiver, you will be responsible for ensuring all of these needs are managed and met. Check with your loved one’s physician regarding any dietary restrictions or considerations. It will be important to ensure your loved one receives the necessary food and fluids to maintain strength and nutrition. If you are ever uncertain about your loved one’s nutritional needs or if you are concerned about his or her nutrition and hydration status, speak with the physician about getting a dietician consultation.

If meeting all of your loved ones ADL needs seems overwhelming, never fear – Nightingale Homecare is here! We offer a wide range of highly personalized in-home care services for seniors, from meeting personal care needs, help with household tasks and running errands, and companionship, to specialized dementia care, skilled nursing care, and so much more. Contact us for the best senior care Phoenix, AZ and the surrounding area have to offer at (602) 504-1555.

Take these steps to lower your cholesterol.

If your doctor has warned you that your cholesterol is creeping upward, there are lifestyle changes you can make to help improve it before trying cholesterol-lowering medication. And if you already take medication, the tips below can actually improve the cholesterol-lowering qualities of your medication.

It’s helpful to understand what cholesterol is, and how it can affect your health. Cholesterol is manufactured in your liver and has several important functions. It helps to keep the walls of your cells flexible and is necessary in the production of several hormones. But, like anything else…too much of it can create problems.

Cholesterol is transported in the body by molecules called “lipoproteins” which carry cholesterol and fat-soluble vitamins in the blood. Lipoproteins levels in the blood are used to determine cholesterol levels. You may have heard that low-density lipoproteins (LDL) are bad. This type of lipoprotein carries cholesterol to deposit it on blood vessel walls, leading to clogged arteries, hypertension, stroke, kidney failure and heart attack. So, it is important to lower this level. High-density lipoproteins (HDL) are the good lipoproteins, helping to carry cholesterol away from vessel walls and preventing artery-clogging disease. So, it is important to raise this level.

Your hereditary influence is something you won’t be able to change, but how you manage other high-risk influences can make a difference. Listed below are lifestyle changes that can help you lower your cholesterol while improving health and quality of life, courtesy of the Phoenix senior care experts at Nightingale Homecare:

WATCH YOUR FATS

1. Focus on Monounsaturated Fats

Your doctor may recommend a low-fat diet for weight loss, but often a diet low in fats can reduce not only your harmful LDLs, but may also reduce the beneficial HDLs. In contrast, a diet high in monounsaturated fats will reduce harmful LDLs but also protect higher levels of healthy HDLs. A few good sources of monounsaturated fats:

• Olive oil and olives
• Avocado
• Nuts: almonds, pecans, hazelnuts, walnuts and cashews
• Canola oil

2. Use Omega-3 Polyunsaturated Fats

Studies show that polyunsaturated fats reduce LDL cholesterol and decrease the risk of heart disease and type 2 diabetes. Some good sources are:

• Fish oil supplements
• Seafood with high fatty content: salmon, mackerel, herring, bluefin and albacore tuna
• Seeds and tree nuts (not peanuts)

3. Eliminate Trans Fats

Trans fats are handled differently by the body than other fats. They can increase total cholesterol and LDLs, and also decrease the beneficial HDLs. Use of trans fats leads to heart attack and stroke. In the US, food companies are required to list trans fats on nutrition labels. However, they are allowed to round down when the amount of trans fat per serving is less than 0.5 grams. This means some foods contain trans fats even though their label says “0 grams.” Read further on the nutrition label. If a product contains “partially hydrogenated” oil, avoid it, as it contains trans fat! Foods that contain trans fat include:

• Margarine
• Store-bought cookies and crackers
• Fried fast food
• Vegetable shortening
• Microwave popcorn
• Non-dairy creamer

INCREASE SOLUABLE FIBER 

Soluble fiber actually reduces the absorption of cholesterol into your bloodstream by increasing probiotics or “good bacteria” in your intestine. These bacteria will reduce harmful lipoproteins and LDLs. The best sources for soluble fiber include:

• Beans
• Peas and lentils
• Fruit: apples and pears
• Oats and whole grains: not the quick-cooking oats, which have the fiber processed out
• Fiber supplements like psyllium

ADD WHEY PROTEIN 

Whey protein found in dairy products can help lower both LDL and total cholesterol levels as well as blood pressure. Foods containing whey protein include:

• Milk
• Ricotta cheese
• Yogurt
• Whey protein powder

AVOID SUGAR 

If you see sugar, corn syrup or any word containing “ose” at the top of the ingredient list, avoid it.

EXERCISE

Moderate exercise every day can not only combat obesity, it can also help raise good cholesterol levels. Be sure and check with your doctor before you start any exercise program. Try to work up to at least 30 minutes of aerobic activity at least 5 times a week. Some exercises to consider:

• Brisk walking
• Riding a bike
• Resistance exercise
• An exercise class
• Playing a favorite sport

QUIT SMOKING

Smoking increases the risk of heart disease by changing the way cholesterol is handled in the body and results in the faster development of clogged arteries. Quitting smoking helps improve your HDL cholesterol levels. This will lower your blood pressure, improve your liver function, and reduce your risk of heart and lung disease.

LOSE WEIGHT

Carrying a few extra pounds contributes to high blood cholesterol. Weight loss will reduce your total cholesterol by decreasing the creation of new cholesterol in the liver.

As mentioned, sometimes healthy lifestyle changes aren’t enough to lower cholesterol to optimal levels. If your doctor orders medication to help lower your cholesterol, take it as prescribed along with continuing your lifestyle changes.

Call on the Phoenix senior care team at Nightingale Homecare for more healthy living tips, and for the professional in-home care assistance that ensures older adults are living life to the fullest! Contact us any time at (602) 504-1555 to learn more.

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.

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.