Learn more about the importance of hydration for seniors.

The importance of hydration for seniors cannot be overstressed. In an older loved one, dehydration can occur rapidly and be life-threatening. Many older people often are not as quick to feel thirst as younger people are, so they may not be drinking enough fluids to begin with. This, combined with health concerns that might cause your loved one to reduce her fluid intake, puts the older person at high risk for dehydration.

When you are caring for an elder loved one, offer a drink of water every time you interact with him or her, and make sure she always has fresh water within reach. However, be aware that even when offered water, many older people will say, “I’m not thirsty” or, “I’ve already had too much to drink today.” You may need to be persistent in encouraging your loved one to regularly drink water.

Fluid Balance

Fluid balance occurs when the amount of fluids a person takes in equals the amount of fluids the person loses. Each day, we lose fluid in the form of urine, sweat, bowel movements and breath vapor. To maintain a state of fluid balance, we must take in enough fluid each day to equal, or balance, these losses. When fluid balance is not maintained, your loved one may develop either dehydration (too little fluid in the body) or edema (too muc  h fluid in the body).

Dehydration

Dehydration can result from conditions such as vomiting, diarrhea, fever or severe blood loss. A very common cause of dehydration, however, is simply not drinking enough fluids. Many elderly people have conditions that put them at risk for becoming dehydrated. For example, a person who has problems with mobility or other disabilities may have a difficult time getting up to get a drink. Your loved one may also cut back on fluids because she is trying to reduce the number of times she needs to get up and go to the bathroom, or she is afraid that she will not be able to make it to the bathroom in time. Some seniors who are incontinent may also reduce their fluid intake because they think this will lower their risk for having an episode of incontinence. However, it is important to know that decreasing fluid intake does not decrease incontinence, nor does it decrease trips to the bathroom. In fact, the opposite may be true. As the urine becomes more concentrated, it irritates the bladder and may increase the urge to urinate, resulting in the need to urinate more frequently.

As your loved one’s caregiver, you will play an important role in helping to ensure that she takes in enough fluids. Here are some tips to encourage fluids:

• Frequently offer fluids that your loved one likes at the temperature she prefers.
• Encourage her to drink plenty of fluids with each meal.
• Frequently provide your loved one with a pitcher of clean, fresh water. Encourage her to drink each time you enter the room.
• Be sure she has a clean drinking glass or cup within easy reach. Refill the glass if she cannot do it. A drinking straw or a plastic water bottle with a screw-on lid and a straw may make it easier for some people to drink independently.
• If she frequently refuses beverages, offer fluid-rich foods instead, such as ice cream, popsicles, gelatin or fruit.

If your loved one becomes dehydrated, her physician may give an order to “encourage fluids” or “push fluids.” This means that she should be urged to drink as much fluid as possible. Encourage her to drink each time you enter the room and again on your way out. Keep a record of the amount of fluid your loved one drinks and record the total for the day on the flow sheet for her physician and for your reference.

Be on the Lookout! 

Dehydration is a serious condition. If you suspect that your loved one is dehydrated, contact her physician immediately. Signs and symptoms of dehydration include the following:

• Confusion
• Poor skin turgor (the skin does not return to its normal shape when gently squeezed or pinched)
• Passing of small amounts of dark-colored urine
• Constipation
• Drowsiness
• Very dry skin or chapped lips
• Elevated temperature

Edema

Edema, or the state of retaining too much water, can result from medical conditions (such as chronic heart failure or kidney disease) that make it hard for the body to rid itself of excess water. Your loved one’s physician may place restrictions on the amount of fluid she is allowed to have each day.

When you are caring for a loved one and fluid restrictions are in place, the physician will tell you how much fluid she is allowed to have over the course of the day. Offer small amounts of fluid at regular intervals. This will help to prevent your loved one from becoming too thirsty.

Measuring and Recording Fluid Intake

When orders to encourage or restrict fluids are in place, you will need to measure and record your loved one’s fluid intake. A person’s fluid intake includes all of the liquids she drinks, as well as foods that are primarily liquid (such as soups) or that are liquid at body temperature (such as ice cream or popsicles).

Although in everyday life fluids are usually measured in ounces (oz), in health care, fluids are measured and recorded in milliliters (ml) or cubic centimeters (cc). A milliliter (ml) is equal to a cubic centimeter (cc). One ounce equals 30 milliliters or 30 cubic centimeters.

With prepackaged items, printed information on the container indicates how much it holds. For example, a small prepackaged milk container contains 8 ounces, or 240 ml (remember, there are 30 ml in an ounce). In other cases, you will need to determine how much fluid the container holds. When you are caring for your loved one and need to measure fluid intake, you can determine the amount of fluid your cups, glasses and bowls hold by filling them with water and then pouring the water into a measuring cup.

To measure and record fluid intake, observe how much fluid your loved one consumes at each meal and in between meals. For example, if she had 8 oz (240 ml) of milk, 4 oz (120 ml) of coffee and 12 oz (360 ml) of soup with lunch, you would record her fluid intake at lunch time as 720 ml. Then, if she had another 8 oz (240 ml) of tea in between lunch and dinner, you would record her fluid intake as 240 ml.

Sometimes your loved one may not consume all of the fluid in the container. In this case, estimate how much of the total was consumed. For example, if she only drank about half of her coffee at lunch, you would estimate the amount to be 2 oz (60 ml) instead of the full 4 oz (120 ml).

Remember the Importance of Hydration for Seniors – Nightingale Homecare Can Help!

As the top providers of elderly care Scottsdale and the surrounding area offer, our home health care team is always here to provide the resources you need to help older loved ones remain hydrated and healthy. Contact us at (602) 504-1555 for a free in-home consultation to learn more about our professional in-home care services  and the importance of hydration for seniors.

Learn everything you need to know to protect seniors from shingles.

Back in the day, getting chickenpox as a child was a rite of passage. Parents would often even throw “chickenpox parties” – inviting the neighborhood kids over when one was contagious with the disease! The thinking was that since everyone was going to catch it anyway, why not get it over with?

Thankfully, we now have effective vaccines that allow for the prevention of chickenpox. But for those who were stricken with the disease at some point, the lingering effects can manifest later in life as shingles – a condition that can lead to significant pain and discomfort that can last for weeks. There are also a number of serious complications that can arise in older adults who develop shingles, including:

• Blindness
• Infection
• Neuralgia (nerve pain)
• Hearing loss
• Encephalitis
• Facial paralysis
• And more

Although contagious, it’s important to note that it is the chickenpox virus that will be passed on from the person infected with shingles – not shingles itself.

Shingles typically displays as a rash of blisters that wrap around one side or the other of the upper body, with pain, burning, tingling, or numbness, sensitivity when touched, itching, and sometimes fatigue, headache, fever, and light sensitivity.

Additional risk factors, over and above being a senior, include taking certain prescription medications (prolonged use of steroids, for instance, as well as medications taken to ensure transplanted organs are not rejected), diseases such as HIV/AIDS and cancer, and any other condition or treatment that leads to a weakened immune system.

There is a silver lining in all of this, however! Two types of shingles vaccines are available and recommended for everyone age 60 and older: Zostavax and Shingrix. Talk with a doctor to determine which is right for your senior loved one, but the basic differences include:

• Zostavax: A live vaccine that provides protection for five years, given as a single injection.
• Shingrix: Often preferred over Zostavax, Shingrix is a nonliving vaccine that provides protection beyond the five-year mark. Shingrix requires two injections given six months apart.

Although neither vaccine provides 100% protection, the risk of contracting the disease is reduced, and if a vaccinated senior does develop shingles, it’s typically less severe and of a shorter duration, with fewer complications.

For more information about shingles or any other concerns of aging, contact the Scottsdale senior home care experts at Nightingale Homecare. Our nursing team is always on hand to help provide the resources seniors and their families need to optimize health and wellbeing, and our customized in-home care services ensure that older adults are living life to the fullest, each and every day.

Contact us at (602) 504-1555 to learn more or to schedule a complimentary in-home consultation and discover a better quality of life for a senior you love!

Senior 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? A senior 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.

At Nightingale Homecare, our Scottsdale senior home care experts are proficient in senior wound healing, and offer a specialized wound and ostomy care program to provide better management and faster healing of wounds, ostomies, and other skin problems such as:

• Surgical wounds
• Bed sores
• Diabetic, arterial, or venous stasis ulcers
• Colostomies
• Urostomies
• Fistulas
• Incontinence skin concerns
• And more

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.

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:

1. 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.
2. 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.
3. 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.
4. 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
• 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.