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Eating Challenges with Alzheimer’s and Dementia

Phoenix, AZ home care

Overcome the challenges of getting proper nutrition with dementia with these tips.

Alzheimer’s and dementia often present numerous eating challenges. Regular, nutritious meals are important to maintain, as poor nutrition and eating habits can aggravate confusion and lead to physical decline. These tips will help you understand what causes eating challenges in your loved one with Alzheimer’s/dementia, and how you can encourage good nutrition in each stage of the disease.

In the early stages of Alzheimer’s/dementia, your loved one may forget to eat and lose the skill needed to plan for and prepare nutritious meals. As the disease progresses, your loved one may experience a diminished sense of smell and taste, which can cause a loss of interest in eating. Your loved one may also lose the ability to effectively use utensils necessary to eat. Agitation and distraction may affect mealtime greatly, so it will be important to plan for a distraction-free and consistent mealtime. In the later stages of the disease, your loved one will experience difficulty chewing and swallowing, which will challenge your ability to ensure proper nutrition.

Tips to Improve Nutrition

  • Maintain familiar routines.
  • Don’t rush mealtime.
  • Don’t worry about messes!
  • Offer favorite foods and drinks.
  • Check food temperature before offering.
  • Offer vegetables, fruits, whole grains and lean proteins.
  • Cut down on refined sugars, high saturated fats, high salt and cholesterol.
  • Provide foods that are calorie-dense and dementia-friendly: peanut butter sandwiches, milkshakes with added protein supplement, pudding cups, ice cream, pureed fruit and sweetened yogurt.
  • Keep distractions to a minimum; use a soothing voice and turn off the TV and cell phones. Calming music may be helpful.
  • Be sure your loved one is in a seated position at 90 degrees to prevent choking.
  • Serve meals on bright, solid-colored dishes. A color contrast between the tableware or placemat and the dinnerware serves as a visual cue for self-feeding.
  • Your loved one may need assistance at meals to increase caloric intake. If she says that she does not want to eat more, allow her to rest, and then try to get her to eat more with your assistance.
  • Be mindful of textures that she is most responsive to.
  • Place a beverage directly in front of your loved one, not off to the side.
  • Be sure dentures are in place for all meals and secure with denture adhesive if necessary. If your loved one is refusing to wear his or her dentures, it may be dental issues or it may be necessary to modify the diet.
  • Bowls are easier than plates. Spoons are easier than forks.
  • Bowls with suction cups are helpful.
  • Use straws or lidded cups for liquids.
  • Offer one or two types of food at a time, in small portions.
  • Offer three meals and snacks, or smaller meals throughout the day.
  • Provide the major caloric meal early in the day.
  • Add butter, syrup and dipping sauces to increase calories.
  • Offer foods that are easy to chew and swallow. Avoid popcorn, nuts, raw vegetables and other foods that are difficult to chew.
  • Remind your loved one to thoroughly chew and swallow carefully throughout the meal.
  • Cut food into bite-sized portions. Finger foods are even easier: pieces of fruit, cheese, crackers and other snacks.
  • Eating your meal with your loved one often improves intake.
  • Your loved one’s physician may add supplements if weight loss and nutrition are a problem. You may consider adding an instant breakfast drink mixed with ice cream.

Staying Hydrated

Staying hydrated can be one of the bigger challenges in your loved one with Alzheimer’s/dementia. Offering small cups of water and fluids throughout the day is very important. Be sure adequate amounts of liquids are consumed at meals. Generally, your loved one may not request something to drink—you need to provide it to her. A health shake between meals may be a way to hydrate her as well as provide added calories. Offer other foods with high water content, such as fruit, soups and smoothies. It may be necessary to offer fluids every two hours to maintain hydration.

Watching for signs of dehydration will be imperative in maintaining your loved one’s overall health: 

  • Weight loss of two pounds or more in a 24-hour period
  • Increased confusion
  • Dizziness or headaches
  • Dry mouth
  • Sunken eyes
  • Inability to sweat or produce tears
  • Rapid heart rate
  • Low blood pressure

Staying Alert for Swallowing Difficulty

“Dysphagia,” or difficulty swallowing, often occurs in the late stages of Alzheimer’s disease when the patient loses the gag reflex and has decreased levels of consciousness. Ensure that your loved one is sitting up straight with her head slightly forward when eating. At the end of every meal, be sure and check your loved one’s mouth to ensure that all food has been chewed and swallowed. Aspiration pneumonia is a leading cause of death in those with Alzheimer’s, so it is critical you watch for the signs of dysphagia and refer to a speech therapist when you notice these signs:

  • Coughing or choking at meals
  • Wet vocal quality during or after meals
  • Decrease in the amount of food eaten
  • Increasing time and effort spent at mealtime
  • Food, liquids or saliva leaking out of the mouth
  • ‘Cheeking,’ or holding foods in the mouth instead of swallowing them
  • Spitting out food
  • Difficulty swallowing medications
  • Unexplained weight loss
  • Excessive drooling
  • Eating too fast, or cramming food into the mouth
  • Extended chewing before swallowing
  • Clearing throat frequently during a meal
  • Dehydration
  • Chest congestion
  • Aspiration pneumonia

Combating Swallowing Challenges

Using all of the techniques mentioned above will help combat swallowing challenges in your loved one. In the later stages, offering pureed foods and a soft diet will help aid in swallowing. Using a commercial thickener like “Thick-It” in thin liquids may also be recommended for your loved one with swallowing challenges. Thickened liquids won’t trickle down the throat as readily as thin liquids and are less likely to cause coughing, choking and aspiration. Your loved one’s physician, speech therapist or nurse will recommend the thickness necessary, depending upon the patient’s ability to chew and swallow. If your loved one is on thickened liquids, then ALL liquids provided must be thickened to the recommended consistency.

The clinician will recommend the minimal level of thickness needed for swallowing safety. As with anything, there are benefits to these thickening agents, but there are also risks. These preparations don’t work for everyone, and in some cases, they can lead to dehydration. They may also reduce the effectiveness of medications when taken together with the thickening agent.

Things to be Alert to When Feeding Your Loved One

In the later stages of the disease, it may become necessary for you to feed your loved one in order to maintain safety and nutrition. When it comes to this, be sure to follow the above pointers on eating and maintain a relaxed, comfortable environment, sticking to a routine. It will be very important for you to take your time with feeding, to avoid choking and agitation. Never rush your loved one when it comes to feeding.

Follow these additional pointers to ensure feeding success!

  • Be sure that the last bite has been swallowed before the next is provided.
  • Give only small bites of food on a spoon.
  • You may need to be prepared to give the next bite after your loved one swallows the last bite, to maintain her interest in eating.
  • If your loved one has difficulty opening her mouth for food entry, you may brush a spoon against the lips, to aid in opening her mouth.
  • You may gently brush her cheeks and neck to encourage swallowing.
  • Place food well into the mouth to assist with chewing.
  • Frequent cueing may be necessary, i.e.: “Open your mouth, chew the food, and now swallow.”
  • Alternating liquids with solids may assist with swallowing each bite.
  • Check for pocketing. Food must be cleared before adding the next bite.
  • It’s best to end with liquids.

For more helpful resources to assist in caring for a loved one with Alzheimer’s, or to learn more about our highly specialized Connections Dementia Care Program, contact the Phoenix, AZ home care experts at Nightingale Homecare at (602) 504-1555.

Make Life Easier with Parkinson’s: Tips from the Scottsdale Home Care Experts

Scottsdale Home Care

Learn tips to improve life with Parkinson’s.

For those living with Parkinson’s disease, many challenges present throughout the day. The symptoms of Parkinson’s (tremors, stiffness, balance problems and slow movement) tend to worsen over time, making all activities of daily living more difficult. Ongoing evaluations performed by your loved one’s physician, nurses and occupational and physical therapists are necessary in order to maximize independence and improve safety.

The Scottsdale home care team at Nightingale Homecare offers tips and information on assistive devices below that may lessen the frustrations and safety issues that often accompany this disease.

WALKING

Unsteadiness, poor balance and shuffling gait are hallmarks of Parkinson’s disease and produce many challenges with walking safely. In the early stages of Parkinson’s, a straight cane is often helpful. These often work better than a quad cane or tripod cane for those with Parkinson’s. Proper fit is essential as the height of the cane will need to support proper posture. Once your loved one has progressed to a walker, four-wheeled walkers offer more stability than walkers that need to be lifted. In late-stage Parkinson’s, a wheelchair or electric scooter may be necessary.

EATING

Probably one of the more frustrating and isolating activities those with Parkinson’s suffer is that of eating. There are several remarkable breakthroughs to make eating easier for people with tremors. The utensils have larger, weighted handles that make gripping easier. There are also utensils that are self-stabilizing and self-leveling and designed to counteract tremors by up to 70%. Many people with Parkinson’s also find it helpful to use travel cups with the lid and straw attached as well as plates with scooped edges to avoid accidents.

GETTING DRESSED

A few adaptations can help remove the frustrations that someone with Parkinson’s may experience in dressing him/herself. These devices include:

  • Magnetic buttons, with buttons on the outside that close with magnets on the inside.
  • Zipper pulls which are attached rings to the tiny handles on zippers that make them easy to zip up and down.
  • Weighted button aides with a large grip handle with a loop on the other end. You simply thread the loop through the eyelet, hook the loop around the button, then pull the button through the eyelet.
  • Shoes with Velcro or elastic shoelaces are much easier to put on and off than shoes with regular shoelaces.

BATHROOM ACTIVITIES

Your loved-one’s occupational therapist can help make specific recommendations for the bathroom, but devices that make the bathroom safer and more manageable for those with Parkinson’s disease include:

  • Bars or handrails added to tubs/showers and toilet areas
  • Non-skid bathmats or decals on the tub floor
  • Tub chairs or benches
  • Raised toilet seats
  • Electric toothbrushes and razors
  • Touch faucets

WRITING

The fine motor skills lost with Parkinson’s can make holding a writing instrument difficult. There are many writing devices that are easier to grip. Other writing utensils are designed to improve shaky penmanship.

For more resources and specialized in-home care services for those with Parkinson’s disease, contact the Scottsdale home care team at Nightingale Homecare. We’re always on hand to make life easier, safer, and more comfortable with a full range of home health care services. Call us any time at (602) 504-1555 to learn more.

Posted in Blog, Home Safety, Senior Safety on December 21st, 2018 · Comments Off on Make Life Easier with Parkinson’s: Tips from the Scottsdale Home Care Experts

Balancing Act: Lifestyle Changes that Can Improve Balance & Prevent Falls

Scottsdale home care

Improve balance and prevent falls with these tips from our Scottsdale home care experts.

From adulthood onward, all of life can seem like a balancing act. We balance work, family, friends, community, etc. But then there comes a time later in life when, for the sake of our safety and independence, we have to consider our actual balance. As we age, our bodies naturally change, and there are many things that can affect a senior’s balance, including:

  • Low vision
  • Poor muscle tone
  • Medications
  • And more

Luckily, there are several simple, common-sense lifestyle changes that can help seniors improve balance and prevent falls.

Exercise

Exercise is an essential part of a healthy lifestyle, and research shows that following a regular exercise routine can help older adults build muscle tone that can improve balance and reduce the risk of falling. Consider working the following types of exercise into your daily routine:

  • Tai chi
  • Yoga
  • Dance
  • Water aerobics
  • Strength and resistance training

Adjust your diet

Generally, eating a well-balanced diet and avoiding alcohol in excess is key for a healthy lifestyle. However, some seniors may need to make adjustments to their diets in order to get the nutrition needed to improve balance. For example, seniors who have low levels of vitamin D are at an increased risk of having balance problems, falling down, and breaking bones.

Additionally, if the senior has a condition like Meniere’s disease that affects the inner ear, his or her doctor may suggest dietary changes such as:

  • Avoiding caffeine as caffeine may make symptoms like tinnitus worse
  • Eating six small meals daily rather than three large ones
  • Reducing daily salt intake to less than 1,500 mg, to reduce fluid retention
  • Avoiding monosodium glutamate (MSG), as it may cause fluid retention

Use corrective devices as needed

Often, poor balance is caused by physical changes in the body, such as reduced vision, hearing or mobility. Hearing aids and prescription eyeglasses can help reduce symptoms of dizziness and disequilibrium, and seniors should get treatment for cataracts, glaucoma, and macular degeneration if needed.

Also, walking aids, such as canes, walkers, and wheelchairs, can help seniors live safely and independently when they are properly used.

If a dizzy spell occurs…

It may not always be possible to prevent a dizzy spell, even if you take all the precautions listed above. In order to prevent loss of balance when feeling dizzy, follow these steps:

  • Sit or lie down as soon as you feel dizzy
  • Move slowly and try not to change the position of your head
  • Rest as much as you can and don’t try to go back to your regular activities before you are ready
  • Don’t smoke
  • Avoid exposure to things that may cause sinus congestion
  • Try to manage your stress and anxiety levels

At Nightingale Homecare, we strive to help seniors stay safe, happy, and healthy in the comfort of home by offering a full range of Scottsdale home care services that can allow them to live the lives they want. To help ensure the home is a safe place, we are always happy to provide a home safety assessment and make recommendations on how to reduce the risk of falls in the home. Additionally, our Paces Fall Prevention Program incorporates the expertise of our professional therapists, dieticians, social workers, home health aides and others to provide a well-rounded fall prevention plan that can be implemented to enhance safety even further.

Contact our Scottsdale home care team today to learn more about how we can help seniors prevent falls in the home.

Posted in Blog, Senior Health, Senior Safety on December 5th, 2018 · Comments Off on Balancing Act: Lifestyle Changes that Can Improve Balance & Prevent Falls

Antibiotic Resistant Bacteria: Are You at Risk?

local in home senior care

Are you at risk for infection from antibiotic resistant bacteria?

Antibiotic resistant bacteria, also known as multiple drug resistant organisms (MDROs), are germs that have developed resistance to multiple antibiotics over the years due to overuse of antibiotics – when antibiotics are taken longer than necessary, or taken when they are not needed. These MDROs then develop and can go on to infect others.

New MDROs are constantly developing. They are mainly found in hospitals and long-term care facilities, typically affecting the elderly and patients who are severely ill.

MDROs are commonly spread from patient to patient at the hands of a healthcare worker, or when people come in contact with an infected person, such as touching a draining wound.  These germs can also be spread when a patient comes in contact with an object contaminated with the organism, such as on bedrails or IV poles.

So, are you at risk? The care team at Nightingale Homecare, your local in home senior care experts, identifies the top risk factors of becoming infected with antibiotic resistant bacteria:

  • People on long-term use of antibiotics
  • People with a severe illness or underlying disease such as diabetes, kidney disease or wounds
  • People who have invasive procedures such as dialysis, catheter insertions, drain tube insertions or IV therapy
  • People who have had repeated hospitalizations or a long hospital stay
  • People who are elderly or immune-suppressed

Serious MDROs have developed from common skin and intestinal organisms which have developed antibiotic resistance:

  • Staphylococcus aureus germs, including:
    • MRSA: Methicillin-resistant staph aureus
    • CA-MRSA: Community-acquired MRSA
    • VISA: Vancomycin intermediate-resistant staph aureus (very dangerous, rare)
    • VRSA: Vancomycin resistant staph aureus (very dangerous, rare, most difficult to treat)
  • Enterococcus germs, a family of intestinal organisms, including:
    • VRE: Vancomycin resistant enterococcus

All the organisms above can be spread by direct or indirect contact. To avoid the spread, follow these precautions:

  • In general, contact precautions should be used when patients have been identified with one of the MDROs listed above
  • Full long-sleeved isolation gowns should be worn by all those caring for the infected patient
  • You will need to assure that clothes do not come in contact with items that would likely contain a lot of germs (e.g., bathroom, bed linens)
  • The most important part of contact precautions is appropriate hand washing and wearing gloves

Contact precautions are indicated as long has the patient has symptoms (e.g. unhealed
infected wound, watery stools several times a day).

MDROs are difficult to treat because they do not respond to many common antibiotics, even the most powerful ones. There are some antibiotics that can help control MDROs in most people, and the doctor will try to find the best antibiotic for the MDRO.

To help lessen the impact of antibiotic resistant bacteria, everyone should advocate for antibiotic best practices and antibiotic stewardship. Only use an antibiotic for a true bacterial infection. A lot of infections are caused by viruses. Antibiotics do not work on viruses, and use of antibiotics in these instances can contribute to the problem of antibiotic resistant organisms.

For more information visit the CDC Antibiotic Resistance website or contact your local in home senior care experts at Nightingale Homecare any time at (602) 504-1555.

The Elderly Mental Health Concern We’d Rather Not Think About: Senior Suicide

senior home care Phoenix  son with senior father looking depressed

Learn the signs of senior suicide and how to help.

Suicidal thoughts can affect anyone regardless of gender, background or age.However, while the elderly account for just 13% of the population, they account for nearly 16% of all suicides. The statistics are shocking, especially knowing the elderly are the fastest growing segment of our population, making this elderly mental health concern – senior suicide – a public health priority.

Caucasian men aged 65 to 84 are at an even higher risk, accounting for 14.9 out of every 100,000 suicide deaths – and the number rises even higher in men over aged 85. It is estimated that suicide deaths in the elderly may be under-reported by over 40%.

These figures do not include the “silent suicides” – deaths from self-starvation, dehydration, accidents and overdoses. The elderly also have a higher than average rate of completing a suicide, as they are often deaths by firearms, hanging and drowning. And, there is a higher incidence of double suicide involving a spouse among the elderly population.

Senior suicide is often the result of an untreated elderly mental health condition. Although common, suicidal thoughts should not be considered normal and often indicate more serious issues.Health care providers often report that the elderly have an exceedingly difficult time in talking with others, especially mental health professionals, about their feelings or challenges. This is largely due to the stigma surrounding mental health issues and makes missed detection the biggest contributor in the high suicide rates among the elderly.

Those at Risk

It is very difficult to identify individuals at risk for suicide, even for professionals. However, there are some risk factors to keep in mind:

  • Being a white male over the age of 65
  • Prolonged, chronic or terminal illness
  • Pain, especially if pain is severe, chronic
  • Depression
  • Alcohol abuse and/or dependence
  • Financial difficulties
  • Recent loss of a spouse, loved one, or pet
  • Feelings of hopelessness
  • Physical, social and emotional Isolation/loneliness
  • Loss of role or stature in family or community
  • Recent change in living situation or employment status or productive activities

Warning Signs

The following are common warning signs that an elderly person may be contemplating suicide:

  • Crying and sad mood; typical signs of depression
  • Weight loss and poor appetite
  • Feeling trapped in a situation and unable to see a way out
  • Statements about death and suicide
  • Statements about being a burden
  • Reading material about death and suicide
  • Statements of hopelessness, helplessness and worthlessness
  • Disruption of sleep patterns (insomnia or over-sleeping)
  • Loss of interest in hobbies or activities
  • Giving away possessions
  • Increased alcohol or prescription drug use
  • Failure to take care of self or follow medical orders
  • Stockpiling medications
  • Sudden interest in firearms
  • Withdrawal of social interactions or elaborate good-byes
  • Rush to complete or revise a will

How to Help

As many as 50% to 75% of elders considering suicide will give someone a warning sign. However, not everyone who is considering suicide will say something, and not everyone who threatens suicide will make an attempt, though every threat of suicide should be taken seriously. Remaining aware of the risk factors and warning signs and talking openly to your loved one about your concerns are critical in preventing elder suicide.

It is also important to identify the mental health professionals in the community who can provide assistance. Remember, you never have to be alone in seeking help for your loved one, and if you are unsure whether your loved one is immediately at risk for suicide, get help by taking the individual to the nearest emergency room for evaluation and treatment.

One great resource is the Institute on Aging’s 24-hour toll-free Friendship Line for elder adults in crisis: 800-971-0016. Their trained professionals are available to support seniors who are struggling with depression, loneliness and suicidal thoughts. The Veteran’s Crisis Line is also available toll-free 24 hours a day for senior veterans and their families to receive counselling and support: 800-273-8255.

At Nightingale Homecare, the top providers of senior home care Phoenix families trust, we offer a program devoted to elderly mental health and safety: Transitions. Our team of experts (nurses, social workers, and therapists) can provide an assessment to determine if depression, anxiety, coping skills and other emotional concerns are in place, and determine what resources would be most beneficial. Contact us at (602) 504-1555 any time to learn more.

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