Discover how urinary tract infections can display differently in older adults.

Chances are, your elderly parent or grandparent has experienced a urinary tract infection, or “UTI,” at some point during his or her life. In a healthy adult, a UTI can be an annoyance, but is generally pretty straightforward in symptoms and in treatment. The hallmark signs of a UTI are burning pain with urination, frequency of urination, back pain, fever, and cloudy, foul-smelling urine. When UTIs are diagnosed early, antibiotics and fluids are prescribed and recovery lasts just a few days. Yet, the presence of a UTI in an elderly, frail person can be deceptive, and left undetected, can potentially lead to hospitalization and even death.

A UTI generally refers to a bacterial infection in any of the four parts of the urinary tract system: urethra, bladder, ureters or kidneys. An un-checked UTI can eventually migrate into the circulatory system, resulting in sepsis. This is why early detection is so critical.

In the elderly population, UTI’s are the most common, yet often most hidden infection they can suffer from.  Because elders often lack the normal symptoms of a UTI, the infection may become septic before an infection is even suspected or diagnosed.  This is why a UTI in an elder requires immediate attention and treatment.  So, if you are caring for an elder loved one, it will be important to differentiate a UTI from other illness and get your loved one immediate medical attention in order to eliminate the infection.

Causes and Risk Factors

Most often, about 85% of the time, a UTI is caused by Escherichia coli, or E. coli bacteria. This bacteria is naturally found in the GI tract, but especially for women, E. coli can easily sneak into the urinary tract. Although women have a higher risk for developing UTIs and generally acquire them much more frequently, men are much more likely to develop severe UTIs, requiring hospitalization. It is important to note the common causes and risks associated for developing a UTI:

• Poor hygiene habits
  • Wiping back-to-front after a bowel movement
  • Wearing soiled underwear
  • Wearing incontinent briefs
• Incontinence
• Not urinating frequently enough
• Not relaxing and emptying the bladder with urination
• Post-menopausal thinning and weakening of the urinary tract (in women)
• Enlarged prostate, leading to retention of urine in the bladder (in men)
• Catheterization
• Immobility
• Dehydration
• Diabetes
• Kidney stones
• Bladder prolapse
• Diabetes
• Certain medications

Seniors in general are more susceptible to UTIs due to the above mentioned factors; however, the biggest culprit to developing UTIs is a weakened immune system. Your loved one may also have a diminished ability to take care of herself/himself for physical and cognitive reasons. These factors lead to decreased attention to hygiene overall. Seniors also tend to limit their fluid intake in an effort to avoid the embarrassment and inconvenience caused by bladder control issues. As urine pools in the bladder longer, it leads to urinary retention and a greater incidence of infection.

If your loved one wears incontinent briefs, there’s a very high probability of developing a UTI. No matter how often briefs are changed, fecal matter can enter the urinary tract very easily, even with minimal contact.

Signs and Symptoms

Detecting the symptoms of a UTI in an elder can be tricky. Your loved one may show all of the classic signs, yet often, because the immune system is not functioning optimally, the normal symptoms we have all come to know are not exhibited. Along with the more typical signs, be alert for these signs and symptoms:

• Confusion
• Dizziness
• Disorientation
• Agitation
• Poor motor skills
• Falling
• Shortness of breath
• Cough
• Blood in urine
• Malaise
• Fever and chills
• Nausea and vomiting

Confusion and UTIs

The symptom of confusion deserves special mention, as this is a frequent sign in an elder suffering from a UTI. Confusion will usually come on abruptly with a UTI, or for those already experiencing memory challenges, will increase dramatically. An infection will weigh down the immune system and lead to an increase in temperature and brain inflammation, which then leads to dehydration. The combination of these factors leads to mental changes in an elder with a UTI. The most important take-away from this: if your elder loved one show signs of a sudden increase in confusion, seek urgent medical attention to rule out a possible UTI or another cause.

UTIs and Dementia

As noted, with the onset of a UTI, confusion can increase rapidly in your loved one living with dementia. It can also worsen other behaviors such as agitation, hallucinations, insomnia and aggression. You may also notice sundowning symptoms becoming worse. It may be even more difficult to narrow down the cause when your loved one has difficulty communicating other symptoms. If you notice your loved one’s symptoms suddenly accelerating, it is better to be safe than sorry, and seek immediate medical attention.

Treatment and Prevention 

The good news is, once diagnosed by a simple urine test, treatment of a UTI in an elder is relatively straightforward. The majority of UTIs are treated with fluids and antibiotics. Once the infection is cured, prevention should be the primary focus. Here are some simple tips to encourage urinary tract health:

• Stay hydrated: water is best, but any fluids your loved one enjoys should be offered
• Bladder training: encourage toileting to empty the bladder every two hours
• Offer a bedside commode or bedpan, if the person is worried about incontinence
• Practice good perineal hygiene: wipe from front to back, clean the perineal area with soap and water and pat dry
• If incontinence briefs are used, change frequently and clean the perineum between each change
• If a catheter is necessary, clean around the insertion site twice daily, and after each bowel movement, with soap and water and pat dry
• Wear and change loose, breathable cotton underwear daily and when soiled
• Provide clean linens and towels; even a drop of urine or stool on linens should be changed
• Avoid perfumed soaps, deodorants, toilet papers and douches
• Provide wet wipes to make clean-up easier after toileting

The Scottsdale senior home care professionals at Nightingale Homecare are always on hand to provide education, helpful resources, and hands-on assistance in the comfort of home to help older adults remain healthy, comfortable, safe, and thriving. Call us any time at (602) 504-1555 to learn more!

Eating habits change for a number of reasons as we grow older.

We all know how important it is to establish and maintain healthy eating habits, but sadly, a full 25% of older adults suffer from malnutrition, according to the National Resource Center on Nutrition, Physical Activity, and Aging. Whether the problem is eating too little, too much, or the wrong types of foods, poor nutrition for seniors can result in weakened bones and muscles, an increased risk of serious health concerns like diabetes, and more.

The reasons for these nutritional struggles are as varied as the individuals experiencing them. For some, medication side effects impact appetite. For others, dental problems make chewing difficult. And for many, the loss of a spouse results in a lost desire to prepare healthy meals for just herself.

At Nightingale Homecare, our Phoenix, AZ home care specialists offer the following suggestions to help your senior loved ones maintain optimal health by ensuring his or her nutritional needs are met:

• Fiber up! Consuming plenty of foods high in soluble fiber will help keep cholesterol in check and prevent constipation and other health problems. Older adults should strive to include at least one of the following types of foods with each meal:
  • Beans or lentils
  • Whole grains, oats or oat bran
  • Seeds or nuts
  • Fruits and vegetables
• Convenience doesn’t have to mean fast food! For seniors who prefer the convenience of ready-made foods, there are a number of healthy options to consider over fast food or prepackaged foods that are high in salt, sugar, and fat, such as:
  • Bags of fresh chopped veggies for salad, coleslaw, or steaming
  • Instant oatmeal
  • Fully cooked rotisserie or grilled chicken or turkey
  • Canned or frozen low-sodium/low-sugar fruits and vegetables
  • Low-sodium cans of soup or stew
• Find a friend! Preparing meals (and eating them) in isolation transforms mealtimes from something enjoyable to something to dread. Share as many meals with your loved one as possible, and seek out other companions for your loved one – neighbors, other family members, friends from religious organizations, etc.

At Nightingale Homecare, we can help implement all of these ideas, and more. Whether the need is for shopping for healthy, convenient foods, preparing nutritious meals, or providing friendly companionship during mealtime, partner with the Phoenix, AZ home care team at Nightingale Homecare and ensure that your senior loved one stays as healthy and happy as possible! Take the first step by calling us at (602) 504-1555 to request a free in-home consultation and discover the difference our professional in-home care services can make in your senior loved one’s life.

Proper oral care is crucial for those with Alzheimer’s disease. Learn tips here.

Maintaining good oral health is essential to everyone’s wellbeing. For a person struggling with Alzheimer’s disease or dementia, daily attention to oral health can prevent problems like painful cavities, infections, digestive problems and eating difficulties. Your loved one may not be able to express the pain of a toothache or gum problems, and without proper attention, this can lead to tooth decay, untreated lesions, possible abscess and serious health complications.

When a person suffers from Alzheimer’s disease or another type of dementia, attention to oral care often gets overlooked. As the disease progresses, those with memory challenges need varying levels of support to keep up with their oral hygiene routine. In the early stages of the disease, your loved one may just need reminders on how to brush and why it is important; however, as the disease progresses, your hands-on attention to this important daily routine is critical in maintaining your loved one’s oral health and overall wellbeing.

Try these tips to help ensure your loved one with Alzheimer’s disease maintains healthy teeth and gums, courtesy of the professionals in in-home care Paradise Valley, AZ seniors need and trust at Nightingale Homecare:

Keep the teeth and mouth clean. Very gently brush the person’s teeth, gums, tongue and roof of the mouth at least twice a day, with the last brushing after the evening meal (see below for instructions).

Try different types of toothbrushes. Experiment until you find the right choice for your loved one. You may find that a children’s toothbrush works best, as the head is smaller and the bristles are softer. You may also want to try a long handled or angled brush, which can be easier to use than a standard toothbrush. Be cautious with using an electric toothbrush on a person with Alzheimer’s disease, as this can create fear and agitation.

Floss regularly. Take the time to floss daily. Flossing can be distressing to a person with Alzheimer’s, so try using a “proxabrush” to clean between teeth. A Waterpic is another option, if the person can tolerate it, which is gentler on the gums and much easier than trying to manipulate string floss. As when using an electric toothbrush, remember to proceed slowly and calmly, letting your loved one know what you are going to do next. Monitor the water temperature, pressure setting and the angle of the nozzle while working. Instead of using only water in the reservoir of the appliance, add a small amount of anti-cavity mouthwash.

Be aware of potential mouth pain. Investigate any signs of mouth discomfort during mealtime. Refusing to eat or strained facial expressions while eating may indicate mouth pain or dentures that don’t fit properly.

Monitor sugar intake. As we know, sugar can cause tooth decay, especially when it’s frequently eaten. If your loved one with dementia is in need of a snack, try to avoid giving too many sugary foods. Tooth-friendly foods and snacks include:

• Vegetables
• Fresh fruit
• Yogurt
• Bread with sugar-free spreads
• Crackers and cheese
• Pita bread with hummus
• Rice cakes

Keep your loved one hydrated. Proper hydration helps keep the mouth moist and inhibits bacterial growth. Saliva is meant to serve this purpose, but may older adults suffer from dry mouth caused by a wide range of medications. There are several over-the-counter mouth rinses specifically for dry mouth that aid in keeping the mouth moist. The last step to any meal should be using water to wash everything away.

Timing foods for oral care. Offering fruit at the end of each meal can go a long way in helping break down the sugar and starch from a meal. Crunchy fruits and veggies help remove plaque from the teeth.

Brushing Your Loved One’s Teeth

Everyone should have their mouth cleaned twice a day, so make sure your loved one continues to keep up this routine, and provide assistance when needed. You may find that some days you can just direct the steps, and other days you may have to actually perform the care. Keep these pointers in mind as you accomplish the task of brushing.

• Provide short, simple and clear instructions, broken into steps, such as, “Hold your toothbrush. Now put toothpaste on the brush.”
• Use a “watch me” technique. Hold a toothbrush and demonstrate to your loved one what to do.
• You may need to guide by putting your hand over the person’s hand, gently guiding the brush.
• If your loved one seems agitated or uncooperative, postpone brushing until later in the day.
• Observe your loved one for signs of discomfort: grimacing, bleeding gums or sensitivity to hot or cold. These are signs your loved one may need to see the dentist.

If you need to brush your loved one’s teeth:

• Support the person’s jaw to keep the teeth together to help clean the outer surfaces of the teeth.
• Encourage the senior to open wide to help you clean the inside and biting surfaces of the teeth.
• Use a pea-sized amount of toothpaste.
• Use gentle, circular movements, paying extra attention to the area where the tooth meets the gum.
• Encourage your loved one to spit out the toothpaste rather than rinse it out. The fluoride in the toothpaste will continue to protect their teeth.
• Clean the teeth from the outer surfaces to the biting surfaces and finally to the inner surfaces.
• Replace the toothbrush when it begins to show wear, or every three months.
• If you notice your loved one’s gums are bleeding, this means there is some residual plaque in the mouth, which is irritating the gums. Continue to brush the person’s teeth, but if the bleeding continues more than a week, make an appointment with a dentist.

Dealing with Dentures

Many people living with Alzheimer’s disease have dentures, and it’s important to ensure they are cleaned daily and replaced when necessary. Follow these tips to ensure your loved one’s dentures are cared for:

• Rinse dentures with plain water after meals and brush them daily to remove food particles.
• Clean dentures with a special denture brush and denture paste or non-perfumed liquid soap and water to remove all food and plaque deposits.
• Each night, remove the dentures and soak in a denture cleanser or mouthwash.
• Ensure your loved one cleans remaining teeth and/or gums before going to bed. Use a soft-bristled brush or moistened gauze if there are no natural teeth.

Dental Appointments

Most dental insurance plans cover a teeth cleaning (prophylaxis) every six months. Since it can be extremely difficult getting a person living with Alzheimer’s disease to comply with brushing and flossing twice a day, you may want to consider increasing dental visits to every three months. This can help combat plaque and tartar buildup on the teeth. Additional cleanings also help to prevent serious gum conditions like gingivitis and periodontitis, which contribute to decay and tooth loss.

As the disease progresses, those with Alzheimer’s/dementia may become increasingly agitated and noncompliant during cleanings. Finding the right dentist with experience working with the elderly and persons with dementia is critical. Difficult dementia behaviors and diminishing capacity will eventually make regular cleanings too traumatic for your loved one. At that point, assisting your loved one with flossing, brushing and rinsing as often as possible is the best way to maintain oral health.

If providing oral care for someone with Alzheimer’s disease (or meeting any other care needs) is overwhelming, please know that you always have a trusted partner in care with Nightingale Homecare. As the top provider of in-home care Paradise Valley, AZ and the surrounding area has to offer, we can provide a full range of professional Alzheimer’s care services through our specialized Connections Dementia Care program. Call us at (602) 504-1555 to learn more.

Common foot issues of aging are outlined here, with tips to help.

Our feet certainly take a beating! For years they’ve enabled us to walk, run, hop, jump, kick, balance, and more, and as we grow older, all of that activity begins to take a toll, leaving our feet vulnerable to a number of problems. As one of the highest rated providers of home care in Paradise Valley and the surrounding area, the care team at Nightingale Homecare has the information you need to address these concerns and help improve senior foot health:

• Edema: Poor circulation can cause fluid to build up in the feet and ankles, resulting in swelling (edema). This is particularly common in those with congestive heart failure, diabetes, and liver or kidney disease.
  • Try: Drink plenty of water, elevate the legs as often as possible, soak feet in cool water, and ask the doctor to recommend foot and leg exercises.
• Osteoarthritis: Most commonly affecting joints in the ankles and feet, osteoarthritis is diagnosed in as many as 16 out of every 100 seniors. Risk factors include previous injury to the foot or ankle, obesity, bunions, and hammertoe.
  • Try: Physical therapy, canes or braces that provide support to the joints, customized shoes or shoe inserts, or medications/steroid injections at the direction of the doctor.
• Flat feet: The ligaments in the feet often stretch as we grow older, resulting in pain and swelling. Flat feet can cause problems with balance and mobility, as well as an enhanced risk of sprains to the foot or ankle.
  • Try: Proper fitting shoes and/or shoe inserts to relieve pressure on the arch of the foot.
• Thickening of the toenails: As hormone production decreases, keratin production also decreases, leading nails to thicken and become more brittle.
  • Try: Have toenails cut regularly and keep them clean and dry. The doctor may also prescribe a cream or ointment to help.
• Seborrheic keratosis: Although they mimic warts, these lesions can appear on the top (never the soles) of the feet, and may itch or cause irritation when shoes are worn.
  • Try: See the doctor to have the lesions tested to ensure they aren’t cancerous, and then depending upon the level of irritation, the doctor may opt to remove them.
• Shortened Achilles tendon: Water loss in the tendons through aging can cause the Achilles tendon (which connects the heel bone to the calf muscle) to shorten, impacting gait and flexibility.
  • Try: Some stretching exercises may help; check with the doctor for specific recommendations.

Nightingale Homecare’s full range of skilled nursing, non-medical care, and orthopedic rehabilitation services can all help those struggling with issues related to foot problems. Working in conjunction with a senior’s medical team, we can provide the care and resources needed to optimize health, right in the comfort of home.

To learn more about how Nightingale Homecare, the top providers of home care in Paradise Valley and the surrounding area, can help, and to request a free in-home consultation to learn more, call us any time at (602) 504-1555.

Chronic pain is described as any persistent or intermittent pain that lasts more than three months. Depression is described as a psychological state that causes fatigue, appetite changes, sadness, lack of motivation, slowed response times, difficulty sleeping, feelings of helplessness and thoughts of suicide. Studies have revealed that up to 50% of patients suffering from chronic pain are also affected by severe depression.

It can be difficult to assess whether depression has led to chronic pain, or vice versa. Depression can frequently cause unexplained pain, such as back pain and headaches, and people who are experiencing chronic pain can develop increased stress or feelings of guilt and helplessness, often leading to a depressive state. These effects can create a cycle that is difficult to break. Those patients that have chronic pain-induced depression have a poorer prognosis than those suffering from chronic pain without depression. It seems pain and depression create a vicious cycle in which pain worsens the symptoms of depression, and the resulting depression worsens the feelings of pain. Suffering from both conditions tends to promote their own severity.

One of the reasons depression and chronic pain are so intertwined is because of the way stress works on the body. Chronic pain turns on the “fight or flight” stress signals in the brain, preparing the body to fight off whatever is causing the pain. The nervous system is in a high state of alert, and eventually this wears the body down, leaving the person vulnerable to depression. Finding ways to deal with stress and cope with chronic pain can give you an edge in the battle against developing depression.

Chronic pain-induced depression can keep you from enjoying life, such as spending time with your children and grandchildren, engaging in hobbies, exercising and traveling. It can also lead to isolation, exacerbate other health conditions, and can be emotionally draining.  It can quickly lead you in a downward spiral, and without treatment and attention, can gravely affect your quality of life.

ASSEMBLING YOUR TEAM

Those patients suffering from chronic pain-induced depression benefit most when a team of professionals is involved in their care. This team may include a:

Physician: Thorough exams and evaluations are of primary importance in the diagnosis and treatment of pain and depression. Physicians may also include psychiatrists to help manage depression, and pain specialists to help manage the pain. When necessary, both pain and psychiatric medications may be prescribed.

Therapist: Anxious and negative thinking patterns can be alleviated during regular sessions with a trained therapist. Coping skills and behavioral therapy skills can be taught to reduce the symptoms of pain and depression. A therapist can also work with the patient’s family to help them understand this complex disease process.

Physical Therapist: A physical therapist can be invaluable in their instruction on exercise and muscle relaxation techniques to help improve mobility and reduce pain. The added benefit is that regular movement can help improve mood.

Other Health Professionals: Occupational therapists, nutritionists and acupuncturists can also help alleviate the symptoms of chronic pain-induced depression.

TREATMENT

Catching chronic pain and depression in its early stages can help you get your life back. Early treatment of chronic pain and/or depression can help fight this downward spiral.

Medications

Often, when patients present with chronic pain to their physician, they may be prescribed antidepressants, even if the patient’s mood seems fine. While this may seem odd, the use of low dose antidepressants for pain control is well-studied and has been a standard practice for many years. In low doses, antidepressants cause chemical changes in the brain that alter the way pain is perceived. Of course, another reason they are prescribed is that they can stop the cycle that leads to depression prior to it starting.

Standard analgesics are often prescribed to treat chronic pain. For severe chronic pain, opioids are the most effective medications. Several studies have found that opioids may help achieve antidepressant effects by regulating neurotransmitters; however, the use of opioids in chronic pain-induced depression has been controversial due to patients’ dependence and addiction to them. The long-term use of opioids (over 30 days) has actually been shown to increase the risk of depression. Be sure and thoroughly discuss their use and risks with your physician.

Talk Therapy

Also called psychological counseling or psychotherapy, talk therapy can be very effective in treating both depression and chronic pain by changing patterns of thinking and application of coping skills. Look for a therapist who applies Cognitive Behavioral Therapy, which can provide real-life coping skills that are greatly beneficial to patients.

Stress-Reduction Techniques

Many patients suffering from chronic pain and depression find great relief from utilizing stress-reduction techniques. Many of these techniques are taught in therapy sessions, but many more can be learned on your own. Meditation and journaling can both be extremely helpful in coping with chronic pain and depression. Gentle physical activity such as yoga and tai chi are also very healing. Sometimes, just getting out into nature can help those suffering from chronic pain and depression.

Pain Rehabilitation Centers

In these centers, a team approach is provided to treat both the medical and psychiatric aspects of chronic pain-induced depression. These centers offer outpatient or inpatient programs and can provide immediate and long-term support when chronic pain and/or depression is severe. These programs are effective because they involve a combination of treatments. The Comprehensive Pain Rehabilitation Center at the Mayo Clinic is one such program.

Peer Support

Many people suffering from chronic pain and depression find that support groups can be irreplaceable. Peer support groups offer emotional support through caring, encouragement, reassurance and avoidance of criticism. These groups can also offer information support in terms of advice, suggestions, problem-solving and dissemination of facts. The families of patients suffering from chronic pain often have a difficult time relating or understanding, and these groups provide an outlet where the patient is heard without judgment.

The PAINS Project is a great resource for finding more support.

If you are in crisis and need immediate emotional support:

• Call your or your loved one’s health professional
• Call 911 for emergency services
• Go to the nearest hospital emergency room
• 1-800-273-TALK (1-800-273-8255) National Suicide Prevention Hotline
• 1-800-442-HOPE (1-800-442-4673) Kristin Brooks Hope Center National Hotline
• 1-877-Vet2Vet (1-877-838-2838) Veterans peer support line or chat online
• 1-800-SUICIDA (1-800-784-2432) Spanish-speaking suicide hotline
• IMALIVE.org (volunteers are trained and certified in crisis intervention)

If you think you might be suffering from depression in addition to chronic pain, be honest with your health care team and seek the support that will help you regain control over your mind, body and spirit. Nightingale Homecare, top providers of the best home care in Paradise Valley and the surrounding area have to offer, can serve as an invaluable resource to you as well, with a full range of customized skilled and non-medical in-home care services. Contact us for a free in-home consultation at (602) 504-1555to discover how we can help enhance joy, comfort, and overall wellbeing and quality of life.