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Medical Marijuana and Seniors, Part 1: An Introduction

When you begin to dig into the origins of cannabis in the United States, you don’t expect to so quickly run afield of “the known.” And yet, for a drug so storied and culturally significant, its emergence into our public consciousness is perplexingly murky—like the wisps of smoke its name brings to mind, impossible to pin down.

“The known” (or its abundant lack thereof, rather), seems something of motif when it comes marijuana, but one particular detail is accepted as a certainty: senior citizens are turning to its medicinal varietals in record numbers. According to a national survey by the Center for Disease Control, marijuana use by seniors (age 65+) rose 333% between 2002-2014, and by 455% among baby boomers (age 55-64).

What was once “that thing curious teenagers experimented with,” or a substance vilified as a dangerous gateway drug (see: Reefer Madness), has since been embraced as the newest frontier in the field of geriatric medicine. While clinical studies on cannabis have been limited in the U.S., given its federal status as a Schedule I controlled substance, they are being done elsewhere.

A recent prospective study published in the European Journal of Medicine, and performed by researchers at Israel’s Cannabis Clinical Research Institute Ben-Gurion University of the Negev, found that “therapeutic use of cannabis is safe and efficacious in the elderly population.”

Throughout the six month study period, 2736 patients aged 65 years or older received cannabis therapy for a variety of ailments, with the most common indications for use being pain and cancer (66.6% and 60.8% of patients, respectively) according to a questionnaire administered at the start.

At the end of the study, a whopping 93.7% of patients reported that their condition had improved, and that their reported pain level had been “reduced from a median of 8 on a scale of 0-10 to a median of 4.”

By the time the study came to a close, 18.1% of those treated with cannabis had either reduced their dose of opioid analgesics, or had quit taking them entirely.

With opiate addiction on the rise among baby boomers and seniors, the information gleaned here presents cannabis as a viable and non addictive alternative for pain management among America’s aging population.

With seniors being one of the fastest growing demographics showing a curiosity for cannabis, assisted living facilities — in states where medical marijuana is legal — are taking note.

In Orange County, each month about 50 seniors from Laguna Woods Village board a free shuttle to a local dispensary in Santa Ana. Some of the spritely folks taking the bus were detailed in an April article from CNN, including the 79-year-young Christy Diller.

“I’ve got rheumatoid arthritis really bad. That’s why I’m taking the marijuana,” Diller said. She eats a marijuana brownie every night, about two hours before she goes to bed. Before marijuana, she’d get about only two hours of sleep a night. “I was like a walking zombie, and that was almost every day.” Now, with her brownies, she gets a full night’s rest.

Like a number of the patients on the aptly nicknamed “cannabus,” the primary concern expressed by some seniors and their caregivers is that they might get high. One of the most common misconceptions about marijuana is that it always has a psychotropic component — the compound THC. This may have been true in the past, as the industry has grown, so have the options available to the curious. As cultivators and producers of medicinal pot continue to innovate, they’ve developed new strains with all the therapeutic benefits and none of the high.

The compound (or cannabinoid) responsible for many of these medicinal benefits is Cannabidiol, or CBD for short. It’s effectiveness in the treatment of epilepsy is one of its most remarkable qualities. Because CBD can be extracted from the cannabis plant, its benefits can be reaped without its users ever having to light up. And since CBD is not psychotropic, it’s now being safely used as seizure medication in children.

But the benefits of CBD don’t just extend to epilepsy. From glaucoma, to chronic pain, to Parkinson’s disease, there are dozens of conditions that the aging population lives with on a daily basis — conditions whose symptoms are tempered or completely treatable through therapeutic doses of medical marijuana.

We will explore these benefits in greater detail in Part Two of our series about Medical Marijuana and Seniors, where we will also discuss several things caregivers and seniors should know before they consider cannabis as a treatment.

On The Importance Of: Parkinson’s Awareness

Within the next nine minutes, someone will receive a new diagnosis of Parkinson’s disease. In the time it takes you to finish this article, one more life will have forever been changed.

It could be that this life belongs to someone already in your care, or to an individual you’re soon to meet. But more than likely, it will belong to neither—the life of someone you’ll never be aware of, except in your knowledge of what this past month meant. Perhaps he’s an aging, heartland farmer who wouldn’t give up his tractor for all the soybeans in McLean County, or a 20-something bride-to-be who never knew the white of a wedding dress could be trimmed with early onset uncertainty: grey, the color of the Parkinson’s awareness ribbon.

April was Parkinson’s Awareness Month, and by the time it came to a close, nearly 5,000 more Americans learned that they had PD. That adds up to an estimated 50,000 to 60,000 new diagnoses every year, each joining the already 1,000,000 individuals affected in the United States, and the nearly 10,000,000 persons worldwide.

April was Parkinson’s Awareness Month, but for the individuals living with the disease on a daily basis, so is every month. So as we move into May, and June, and on into next year, we’d like to reflect on this vital call to action, and the unique role caregivers and nurses can play on the front-lines of awareness.

Currently, there is no known way to halt or reverse the effects of this neurological disease, although there are medications individuals can take to manage their symptoms. Part of the problem is that scientists still aren’t sure what causes PD. The lack of answers providing a direction only makes targeting the disease more difficult, and therefore more expensive.

Thus, the main intent of Parkinson’s awareness is to foster a sense of public urgency. With an increase of attention, comes an increase in those providing money that researchers can draw upon in their push towards a cure.

In an effort to raise the public profile of PD, the United States Congress designated April as Parkinson’s Disease Awareness Month in 2010. Since then, what was once just a national campaign has grown into a multi-national mission each year, with a push for awareness in Canada, too, and throughout the rest of the world.

But Parkinson’s Awareness Month isn’t solely about driving fundraising efforts. It’s also about raising the overall public understanding of the disease.

Though many people have at least heard of PD, few know just how prevalent it is. Parkinson’s disease is the 14th leading cause of death in the United States, according to the Center for Disease Control, and more people currently live with it than those with multiple sclerosis, muscular dystrophy, and ALS combined.

What’s worse, though, is that ever fewer would know the symptoms of PD well recognize it in a family member, their friends, or even themselves. But you can help change that.

As caregivers and nurses, we are afforded the unique opportunity of interacting with dozens of persons in assisted living each day, as well as their family members and friends. In a sense, as we care for these individuals, we also help to provide care and peace of mind to anyone in his or her orbit. Though we may not yet have a cure at hand, what we do have at our disposal is knowledge, and an ability to educate anyone with an open ear. Our experiences on the floors of hospitals and assisted living facilities provide a unique point of view within the discussion of Parkinson’s disease.

But our voices shouldn’t just be adding to the conversation; they should be starting them. If we take up the secondary mantle of teacher, we can raise the flag of awareness to previously unseen heights. We know how Parkinson’s disease manifests, and what the common (and uncommon) symptoms are. In the battle for a cure, we can arm those around us with knowledge, and a newfound ability to recognize the beginning stages of Parkinson’s in their friends, their families.

Care doesn’t always take the form of one-on-one treatment. In the form of awareness, like a pebble in a lake, it will ripple outward to serve the greater whole.

Let it start with you.

For additional reading about Parkinson’s disease, check out our special feature about Michael J. Fox and PD.

Brain Injury Awareness in the Elderly

It’s a given that seniors are more susceptible to injuries from falls than younger individuals. Many believe the most pressing concern is the damage caused by a broken hip or another bone injury. However, both men and women over the age of 70 are three times as likely to suffer a potential brain injury than a younger individual.

While something as mundane as tripping on the curb or missing a stair may seem harmless, these falls can lead to serious brain injuries in the elderly. Seniors make up a significant portion of all concussion patients in the U.S, and falls are one of the leading causes of these traumatic brain injuries. That is why it is so important to keep yourself, your staff, and your patients educated on the most common causes and signs of a brain injury, as well as having a plan in place to handle them as quickly as possible. A fast and appropriate response can make all the difference.

Since March is Brain Injury Awareness month, Assisted Living Education would like to review why seniors are at a higher risk of head injuries, and what you can do to prevent them.

What Increases the Risk of Brain Injury?

Medications

Even the most self-reliant seniors can be at a higher risk of sustaining a traumatic head injury. Many of your residents may be on various medications that can undermine the user’s balance, coordination, reflexes, muscle strength, or spatial reasoning. Even seemingly harmless drugs such as aspirin, Motrin or fish oil supplements can have unintended side effects such as dizziness or diminished coordination. These side effects can make the resident more likely to stumble.

Those who do suffer a fall while on blood thinners have a higher potential for damage to the brain because these medications raise the chance of blood pooling in the head. Residents who take multiple prescriptions or use over the counter medications on a daily basis are going to run a higher risk of experiencing these side effects. It’s essential that the healthcare team is aware of the possible side effects of medications that their residents are on, and keep an eye out for those who may be more vulnerable to those side effects.

Past Injuries

Individuals who have suffered from a hip or joint injuries in the past, those with a history of nerve damage, or those with weakened bones may also be more likely to fall due to strenuous activities. It can be difficult for some individuals to remember their limits as they age and it’s not uncommon for someone to push themselves too far and fall as a result. Guide your residents through more physically challenging tasks and when in doubt encourage them to take it easy.

Poor eyesight can also be a factor. Ensure your residents have proper lighting and prevent tripping hazards. If your resident wears glasses, regular visits with the optometrist can ensure their prescription is up to date. Some individuals might be aware of their worsening eyesight but unwilling to speak up. If you recognize any sign of a struggle seeing, such as: sitting closer than usual to the TV, or difficulty with reading, etc. If the resident is able to articulate any issues they are having, it would be worth inquiring if they are having difficulties with their sight. If they are not able to articulate, gather your observations and present them to the attending physician for review.

What to Look For and Do if You Suspect a (Traumatic) Head Injury Has Occurred

The most important thing to remember is to treat any potential head injury as if it is one. Be aware of the signs such as slurred speech, loss of memory, or poor balance. Look out for any visible injuries such as bumps or cuts on the head or neck, but don’t assume that an injury isn’t present just because you can’t see it. Alert the resident’s physician whenever a head injury is suspected. Urge the patient to remain still to prevent further damage or complications and call 911. The faster you identify a head injury, the sooner the resident can receive treatment. Every second matters. It’s also important to treat every fall as if there might have been an injury. For residents who have been aware, it is appropriate to conduct an orientation assessment (e.g., what year it is, the date, etc.). If the resident was not presenting this kind of cognitive awareness prior to the incident, close behavioral monitoring, a physical exam and possibly further testing may be appropriate, depending on the suspected severity of the incident.

Prevention

The best way to keep your residents safe from head injuries is to take steps to prevent them in the first place. One of the easiest ways to do this is through movement and exercise. If the residents are independent and/or ambulatory, encouraging them to take short walks and stretch is helpful. Some residents may be enlisted in a physical therapy program if they require assistance or rehabilitation to maintain or improve their physical health. A proper diet and regular exercise can help your residents improve their muscle and bone strength to diminish the likelihood of secondary injuries that can lead to brain trauma. Remember to always check with your resident’s physician before making a change to their diet or exercise routine.

Another key to prevention is to make their surroundings as safe as possible. Look out for slippery surfaces or tripping hazards such as loose cords or rugs. Move frequently used items, so they are within easy reach. Work with your residents and other staff to make sure the environment they live in does everything it can to keep them safe.

Assisted Living Education is committed to providing the most up-to-date information possible. Our passion for helping caregivers enrich the lives of their residents is what led us to become a premier source for education, resources, and certifications in the industry. Explore our website, or reach out to us via our contact page with any questions you might have on RCFE certification, our online courses, or other assisted living-related services.

Common Types of Arthritis Seen in Elderly Residents

Arthritis is one of the most common diseases associated with aging. Nearly half of Americans over the age of 65 have been diagnosed with arthritis by their healthcare provider.

Many believe they are fully educated about the signs and symptoms of arthritis, but what you might not realize is that there are more than 100 different types of the disease, and each one has its own causes, symptoms, and treatments.

Some variations of the disease can affect more than just your joints. It’s important to stay informed about the different types of arthritis to provide the best care possible for your residents.

What is Arthritis?

The word arthritis comes from the Greek word athron meaning “joint”. Arthritis is not actually one single disease, but encompasses a host of issues that often present most obviously in the joints. It takes numerous forms and has just as many causes.

Surveys show that arthritis is the most common disability in the United States. Every day more than 50 million Americans have to cope with this degenerative disorder. It limits the ability to walk, climb stairs, bend over, kneel, etc. Over time, arthritis can be restrict the capacity of an individual to participate in every day tasks, which can potentially lead to subsequent emotional health problems.

The Most Common Types of Arthritis

Osteoarthritis

The most common type, osteoarthritis, occurs commonly in the elderly due to the result of years of wear and tear on the joints. Past injuries or excessive physical activity (such as from a physically strenuous job) are often to blame.

To help residents relieve or manage pain from osteoarthritis, alternating hot and cold packs on the affected joints is one non-medicinal way. Hot packs help increase blood flow to relieve joint stiffness whereas cold packs can diminish swelling. Over the counter pain medications can also provide relief, but the attending physician and possibly other members of the team will decide to administer these medications. For chronic pain, a doctor or physical therapist may recommend the use of a brace or splint.

Rheumatoid Arthritis

Rheumatoid Arthritis (RA) is an autoimmune disease and the second most common form of arthritis. Normally our immune systems protects us from viruses, and bacteria. However in those suffering from RA, the immune system goes on the offensive against healthy tissue. The immune system attacks the synovial membrane that lines the joints. The continuous inflammation eventually breaks down the joint beyond repair. Sufferers of RA also cite muscle pain, pain in the skin, chest, bones and ligaments.

Sleep is important for everyone, but for those suffering from RA, it is especially critical. That’s why it’s recommended you ensure your residents have the necessary atmosphere to get proper, uninterrupted sleep at night.

Naps during the day and regular exercise can also help alleviate RA pain, but always verify with the attending physician about any modifications to a resident’s sleep schedule, or exercise routine. In some residents, napping during the day can be enough to disrupt their sleep patterns at night.

Gout

While gout is often associated with middle-age, it is actually the most common inflammatory form of arthritis in the elderly with numbers increasing every year in both men and women. It is caused by a buildup of uric acid crystals within the joint, and often affects one or a few joints such as the ankle or big toe, and causes intense swelling and redness.

Although it’s often seen as mundane, gout can still have a devastating effect. A study of patients over the age of 65 in the United States found that those suffering from gout on average spent as much as $3,000 per year or more on medical costs than the control group. The expenses largely went towards treatment, doctors visits, and pain management.

To help relieve your residents’ gout-related pain, it’s important to ensure they consume plenty of fluids. Dehydration can often lead to an increased build up of uric acid crystals and worsen the affected areas. Avoiding high fat protein sources (such as red meat) can also decrease gout symptoms. The dietician on staff should be looped in to the resident’s medical issues so they can be sure to accommodate their nutritional and dietary needs.

Infectious Arthritis

In some cases, a bacterial, viral, or fungal infection can spread to the joints and trigger inflammation. Some infections that can cause infectious arthritis include salmonella, chlamydia, gonorrhea, and hepatitis C. With this kind of arthritis, receiving timely antibiotic treatment is key to preventing the infection from becoming chronic.

It’s important to make sure you have regular communication with your residents so that problems are addressed quickly to provide the best opportunity for recovery. Additionally, for those who may not be able to express their problems or needs, good observation skills are key to noting physical or behavioral changes that may suggest an underlying problem.

Our number one priority at Assisted Living Education is providing the highest quality education and educational resources for those caring for our senior population. We offer RCFE courses & certification, as well as online courses and continuing education. We believe that experience is critical to success, which is why we only employ instructors with extensive experience in the industry and have a reputation for creating engaging and real-world learning environments. Explore our website, or visit our contact page to learn more!

Special Feature: Michael J. Fox and Parkinson’s Disease

In the 1980s and ‘90s, Michael J. Fox became a household name in the U.S. His success in the TV series “Family Ties,” and cult classics including the Back to the Future series, Teen Wolf, Doc Hollywood and others made him a popular actor; a young guy full of energy and a lifetime of roles ahead of him.

However, it was his Parkinson’s diagnosis and drive to support further research that has really cemented the path toward his legacy. At the early age of 29, he struggled with his Parkinson’s diagnosis for seven years before he went public with the news in 1998. He began his mission to bring awareness and advance more funding and support for a much-needed area of research.

In assisted living environments, a Parkinson’s diagnosis is not uncommon. Assisted Living Education will review the characteristics of Parkinson’s Disease, as well as developments from Michael J. Fox and The Michael J. Fox Foundation for Parkinson’s Research.

Parkinson’s Disease: Basic Facts

Parkinson’s Disease (PD) is a neurodegenerative disorder recognized by many from its distinctive features, such as tremoring, slowed movement, changes in posture, speech, and more. Often times, many people are more familiar with the classic motor symptoms of the disease, but The Michael J. Fox Foundation does a great job of highlighting both the motor and non-motor attributes:

Motor Symptoms:

Bradykinesia – a slow-down and loss of spontaneous and voluntary movement.
Rigidity – unusual limb stiffness or in other body parts
Resting Tremor – an uncontrollable movement affecting a limb when it’s at rest and stops for the duration of voluntary movement.
Postural instability – difficulty standing or walking, or impaired balance and coordination
Other Physical Symptoms, including gait problems and reduced facial expression

Non-Motor Symptoms

Cognitive Impairment – a decline in the ability to multi-task/ concentrate and possible decline in intellectual functioning
Mood Disorders – depression and anxiety
Sleep Disorders – REM Sleep disorders, in which individuals act out their dreams
Low blood pressure when standing
Constipation
Speech and swallowing difficulties
Unexplained pains, drooling, and loss of smell

Prevalence

It’s estimated that about one million Americans live with Parkinson’s Disease, with men being 1.5 times more likely to develop the disease than women. Most diagnoses come later in life, typically between the ages of 60-80, though symptoms can begin appearing around 50 years old.

However, as in the case of Michael J. Fox, there are people who are diagnosed much earlier in life. If diagnosed before the age of 50, it is considered Young-Onset Parkinson’s Diagnosis (YOPD). There are varying estimates as to the incidence of YOPD, but it may be around 10% of all Parkinson’s diagnoses.

Daily Life

Depending on the progression of the disease, therapies, and medicinal treatments are in place, some Parkinson’s symptoms are manageable. However, as the disease progresses, managing the symptoms can require more intensive treatments.

When Michael J. Fox makes his public appearances, he still appears to have the same vitality as he always has. Obviously, his physical manner have changed with the effects of Parkinson’s and medications he’s on, but his drive and intensity are clearly still present.

Despite this, what strikes many who have PD is the level of fatigue they experience. There are physical and mental roots to this fatigue. The Michael J. Fox Foundation describes this fatigue as existing on a “cellular level” since the body is putting more effort into completing tasks that many other individuals take for granted. Additionally, coping with these changes in an individual’s body is mentally and emotionally taxing.

DYSKINESIA

Some individuals with Parkinson’s develop dyskinesia, which are abnormal, uncontrolled, involuntary movements. The Michael J. Fox organization describes its appearance as fidgeting, writhing, head bobbing, or body swaying.

Dyskinesia does not manifest in all individuals with Parkinson’s. There are a few factors which contribute to its development, which include early-onset PD and complications of Levodopa use, which has been the primary medication used in the treatment and management of Parkinson’s. Parkinson’s develops in part to the loss of dopamine production in the brain.

Levodopa facilitates dopamine production in the brain and helps reduce the motor symptoms commonly associated with the disease. (Side note: Levodopa is also combined with Carbidopa, which helps enhance Levadopa’s effectiveness, in addition to curbing the nausea and vomiting side effects.) However, because the effect only lasts so long, Carbidopa-Levodopa must be taken several times throughout the day to help maintain the dopamine levels. Even so, a fluctuation in dopamine levels still occurs, which is commonly referred to as an “on/off” period; the “on” being when the medication is still working, and “off” when it’s worn off, typically before the next dose is due.

The Future of Parkinson’s Disease

There is no cure for Parkinson’s Disease yet, but Michael J. Fox has truly spearheaded efforts to bring awareness, funding, and more research towards developing new treatments. Since its inception in 2000, the Michael J. Fox Foundation has funded more than $750 million into research to expedite a cure for Parkinson’s Disease. He’s hosted annual galas with celebrity guests, done numerous interviews, and of course, provides numerous educational tools through the foundation’s website.

In the meantime, much of the research being conducted in the field is producing new results in early intervention and factors in predicting or accurately diagnosing PD, as sometimes the symptoms can resemble other conditions in its early stages.

Assisted Living Education will continue to post developments in newer treatments or therapies involved with Parkinson’s Disease.

Assisted Living Education is a premier provider of classroom-based and online coursework for professionals in assisted living. We offer RCFE licensing, continuing education, and consulting in specific areas like compliance, staff training and licensing. Please visit our contact page to reach us for any inquiries.

Diabetic Eye Disease in Elderly Residents

In the general population, about 9.4% of people have a diabetes diagnosis. Among seniors, that percentage jumps to 25%.

Along with the concerns for diabetes itself, a closely related issue is diabetic eye disease. There are four conditions that fall under this category, which may be seen in elderly residents. Assisted Living Education discusses diabetic eye disease and the complications associated with it.

Diabetic Eye Disease

Diabetic retinopathy, diabetic macular edema (DME), cataract, and glaucoma are the big four of the eye conditions that fall under diabetic eye disease. Individuals who have diabetes are at risk of developing these conditions, and the risk only increases with age. Fortunately, early detection, treatment, and careful management of diabetes can prevent or delay the onset of vision loss caused by diabetic eye disease.

The Big Four – Types of Diabetic Eye Disease

Diabetic Retinopathy

Diabetic retinopathy is caused by maintained high blood glucose levels over time which can eventually damage the retina’s blood vessels. These vessels may swell, leak, or bleed and subsequently become blocked, leading to a distortion in vision. The individual may start to see spots floating across their vision. As the condition worsens, irregular blood vessels begin forming on the surface of the retina as a work-around for the blood vessels that are no longer able to transport blood due to swelling and distortion. Left untreated, the irregular blood vessels will continue to proliferate and grow into the vitreous fluid in the center of the eye and leak or bleed. Scar tissue is frequently present at this advanced stage, which poses another risk: retinal detachment. A retinal detachment is an emergency situation; this left untreated can lead to an irreversible loss in vision.

Diabetic macular edema (DME)

DME goes hand-in-hand with diabetic retinopathy; it is the accumulation of fluid in the macula (the center of the retina crucial to our central field of vision) due to diabetic retinopathy. This can occur at any stage of diabetic retinopathy.

As the macula is crucial to our central vision, it is the most sensitive area of the retina. The accumulation of fluid causes swelling and results in blurry vision. Of the individuals who already have diabetic retinopathy, about half of them will experience DME.

Cataract

Many are familiar with this term and may understand its basic meaning; that there is a cloudiness in the lens of the eye. The lens of the eye is clear and composed of mostly water and proteins. In a normal or healthy eye, the proteins do not much get in the way of the light, allowing it to pass through the lens. If an individual has a cataract, this means there is a build-up of those proteins in the lens, making it difficult for light to pass. Cataracts are typically removed with surgery.

In individuals with diabetes, they are two to five times more likely to develop cataracts than individuals without diabetes. Additionally, they are more likely to develop at a younger age for those with diabetes.

Glaucoma

Glaucoma is actually a broad term for a group of diseases that can cause damage to the optic nerve, which sits at the back of the eye and connects to the brain. Increased pressure in the eye is the most prevalent cause of glaucoma. There is a potential for fluid to build up in the eye if it is not able to drain quickly enough. If severe enough, the pressure can cause damage to the optic nerve. Individuals with glaucoma who experience vision loss begin to lose their peripheral vision first. Eventually, they will be left with just their central vision before entire vision loss is present.

Currently, there is no cure for glaucoma, but there are treatments which can slow its progression. Medication, laser treatment, and surgery have been proven to slow the process.

Unfortunately for individuals with diabetes, their risk of developing glaucoma is two times more than a person without diabetes.

Preventing or Delaying Diabetic Eye Disease

As with any medical or health condition, it is important to catch it early and intervene as soon as possible. Individuals with diabetes should also receive a comprehensive eye exam, which includes dilation of the eyes, at least once a year. The comprehensive dilated eye exam allows the doctor to look for changes in the lens or blood vessels to detect possible vulnerabilities, as well as nerve tissue damage, or swelling of the macula. Despite seeming asymptomatic, the early stages of eye disease may be present in an individual, which is why it is important to be seen by a professional.

Any changes in vision, such as blurriness or floating spots warrants an eye exam, especially in elderly residents. Those already diagnosed with diabetic retinopathy should receive eye exams more frequently, depending on the stage of the condition.

Diet is also key in delaying the onset of diabetic eye disease. Keeping blood sugar levels under control and within a normal range, as well as blood pressure and cholesterol can help reduce the risk of diabetic eye disease.

Assisted Living Education is committed to the top care and services for the assisted living community. We are a premier provider in RCFE classes, continuing education, products, licensing, and other services for assisted living. Explore our website for more information, visit our contact page, or give us a call (714) 747-0725 or Toll Free 1-855-200-0188 for immediate assistance.

Reducing Fall Incidents in Elderly Residents

For elderly residents, falls are a major concern. Not only are individuals more fragile in general, with reduced bone density and other compromised body defenses, but recovery periods are often longer, more grueling, and a more delicate process in general.

A reported one third of the population 65+ will fall each year, and those 80+ years increase to over half of these incidents – note that these are only the reported facts. Falls commonly result in hip fractures and other injuries. On top of that, approximately half of the adults who experienced a hip fracture from a fall will likely fall again in another 6 months. The concern for elder falls is so great that Congress passed the Elder Fall Prevention Act (H.R. 3513) back in 2003 to support more widespread research, education, and services on this issue.

Assisted Living Education provides some common and typical precautions taken in residential care facilities to prevent falls and injury in elderly residents.

Understanding the Context – What Causes a Fall

For the average person, it seems like an obvious answer: we lose our footing or balance, we trip, and we fall. This is true to an extent, but there are so many more variables to consider with an elderly person as well. Here are some factors that can contribute to the risk of falling in elderly:

Weakened muscle tone, gait problems – Those who are not as active as their peers or have sustained an injury that reduces their activity may experience a decrease in muscle tone. This decrease in strength can cause parts of the body to give out more easily. Arthritis, joint, and other issues can also compromise an individual’s balance.

Blood pressure fluctuation – ‘Postural hypotension,’ or a decrease in blood pressure due to rising too quickly from a sitting or lying position can occur more easily in elderly, sometimes with dizziness. Causes for this may be dehydration, side effects from medication, or another underlying disease like diabetes.

Slowed reflexes – With age comes reduced reflexes and a delay in reaction time. Elders may not physically be able to react quickly enough to prevent a fall.

Sensory issues – Some individuals experience a loss of sensation in the extremities. When this occurs in the feet, it can be difficult to detect changes in the terrain or how you are stepping, leading to a trip or fall.

Poor vision – Vision problems can make it difficult to see a clear (or unclear) pathway, or cause a slower adjustment time to changes in light. Poor depth perception can also cause problems around stairs or unfamiliar environments.

Confusion – Moments of disorientation itself or fear/panic from the confusion can cause a misstep. Also, wheelchair or bed-bound residents may forget that they cannot walk and attempt to get up.

Medications – Some medications can cause dizziness or low blood pressure, causing instability and loss of balance.

Fall and Injury Prevention

Residents in a care facility typically have more compromised health conditions than the ‘outside’ elderly community and can require vigilance to ensure their safety. Familiarity with your residents, their conditions, and risks can help you and your facility think proactively in taking and enforcing preventative measures.

Some common preventative measures often taken in a facility include:

Maintain clear pathways
Avoid the use of carpeting or rugs to prevent tripping from uneven surfaces. If there is a carpeted surface, commercial-grade is best for the short fibers and extra durability.
Use textured adhesives on sloping floors for extra grip
Use ramps in place of any steps
Install grab bars in shower spaces and bathrooms
Use raised toilet seats or commodes
Use a shower seat or bench for bathing
Lower bed heights for especially at-risk residents
Install handrails along the hallways

Also be sure residents’ call buttons are easily accessible, and a timely response also encourages residents to request for assistance.

Individual Concerns & Major Fall Risks

Some residents may use walking aids such as a cane or a walker to help with mobility. Frequent checks that these implements are properly adjusted for the individual helps prevent misuse that could lead to a fall. Ill-fitted clothing can also become a problem, especially with the use of walking aids. If the family is involved, ask them to ensure pants or skirts are properly fitting, or even hemming them slightly can be helpful. Reviewing these types of precautions during the admissions process or a debriefing meeting can help the family become more involved and further assist with the care of their family member.

Residents who repeatedly attempt to get up unassisted can be considered a major fall risk. This can happen in stubborn individuals or those with dementia, especially if they have been bed or wheelchair-bound only a short time. They may forget that they are not supposed to get up unassisted, or are determined to reclaim their independence.

The following are extra preventative measures that can be employed for those who present an elevated fall risk.

Bed or personal alarms – Bed alarms detect when there is a major shift in weight or movement, as in a person attempting to sit up and get out of bed. These alarms help alert a staff member to come quickly and check on the resident. Personal alarms work similarly for use in the wheelchair. One type hangs off the back of the wheelchair and clips on to the back of the resident’s clothing. If the resident leans too far forward in an attempt to rise, the device separates and the alarm is engaged. Another type is a pad which fits on their seat, and when a significant shift/decrease in weight is detected, the alarm will sound.

Room placement – Assigning a high risk fall resident to a room near the nurse’s station can help keep eyes on any independent attempts to get up.

Extremely lowered bed heights – Any time a high risk resident is in bed, adjust their bed height to the lowest setting possible so they are closer to the ground in case of any attempts to get up.

Floor mat – For residents persistent in their attempts, a floor mat placed next to the bed during the night, in addition to the lowered bed height, can also offer added protection.

Hip pads are also an option in an attempts to reduce the impact from elder falls, but they’ve received mixed reviews. Some studies reveal no significant statistical data in their favor. Additionally, many hip fractures can occur not just from an impact, but because of an abnormal movement or rotation of the hip during a fall.

Other Precautions

For residents who have little or no issues with cognitive or memory functions, they may benefit from extra education from an occupational or physical therapist to review safety and fall precautions. Those recovering from a procedure or injury should have already received instruction on how to accommodate their new (i.e. limited) range of movement. If the resident has limited mobility and uses a walker or wheelchair the majority of the time, physical and/or occupational therapy generally covers how to safely and properly transfer from bed to standing position/wheelchair and vice versa, as well as commode and shower seat/bench transfers.

Other residents can benefit from such education as well, but may require frequent prompts and assistance due to difficulty in recalling steps and sequences.

Keeping the residents active as much as possible is not only good for their overall health, but can help keep muscle tone and prevent stiffness or muscle atrophy, which can contribute to a fall. Non-ambulatory residents can still exercise to maintain strength in their arms and hands.

The Big Picture

Looking at the overall health of the resident is crucial to their care. Information from the initial comprehensive health examinations, mental & cognitive evaluations, fall risk assessments, and review of resident’s health or care history all help in designing an individualized care plan. This information can also be useful in planning for future changes or adjustments to the facility itself, for additional precautions or measures throughout the campus.

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Assisted Living Education is committed to providing the best in quality education for assisted living services. Our professional instructors have years of real, hands-on, and practical experience that enrich our already-extensive courses. We offer RCFE classes, licensing, and other products and services for assisted living, plus RN, LVN, and SNF continuing education through our online classes. Explore our website for more information, visit our contact page, or call 1-855-200-0188 for immediate service. We look forward to working with you!

Holidays Can Trigger Elderly Depression

For many, the holidays are the time of year for family get-togethers, traditions, friends and fun. However, for others, the holidays can be an upsetting or difficult time of year, with feelings of sadness, resentment, and can even initiate a depressive episode. For elderly residents in facilities with little or no family who visit, this can be an especially painful time of year for them.

Assisted Living Education reviews symptoms to look for, and also how to help elderly residents cope with depression during the holidays.

Spotting the Signs

The key to any effective individual care plan is in simply knowing your residents. Familiarity with their personalities and ‘baseline’ behaviors, disposition, and temperament are crucial in detecting any kind of change.

The following are typical depressive symptoms presenting in an elderly resident around the holidays:

Subdued or irritable mood; sadness

Fatigue, or difficulty sleeping

Anxiety

Loss of interest in daily activities

Change in appetite

Lack of attention to personal care, hygiene

Even if your residents already present some of these symptoms, it’s important to note if they become more severe or if additional symptoms arise.

How To Help

With proper planning and program design, it may be possible to shift a resident’s attitude and reaction towards the holidays. Well before the holiday season or particular event arrives, try to make an extra effort to engage with those residents who may be at risk for experiencing a depressive episode. One simple way to start is with a conversation.

Have Meaningful Interactions With Your Residents

Regular, casual engagements with your residents can turn into lasting relationships, with positive benefits for the residents. These relationships can help toward stabilizing emotional highs and lows that may be experienced during particular times of year, like the holidays, where residents can tend to feel more isolated and lonely.

Initiating daily conversations with each and every resident may sound like a daunting and time-consuming task, but even keeping it short and sweet can brighten a resident’s day. It’s not necessary to have a long, sit-down conversation, but try to create an ongoing dialogue whenever you see your resident either in passing, during medications administration, therapy sessions, mealtimes, or other times you may have scheduled contact with them.

Obviously, the first priority is to complete your tasks and serve your residents’ medical needs, but sprinkling questions or encouraging comments to engage them can help them feel more at ease and welcome. A simple wave and a smile or a brief question/answer can carry on to the next positive interaction you can make with them.

Not every individual will be responsive, for various reasons. They may have a shy personality, trust issues, or they may have a disorder or cognitive issue that makes it difficult for them to openly interact or easily communicate with people.

These individuals may take awhile to warm up to you, or you may need to change your approach. Gauge how the individual reacts to conversation; you may need to back off and take small steps for them to open up. Start simply, maybe compliment them on their appearance, or make general conversation, comments, or make small jokes if appropriate. You may be doing most of the conversing at first, but over time, it may balance out to an even exchange. Start inviting them to group activities or outings. Never push a resident into something they are not interested, but let them know they are welcome to join if they want. These relationships can take longer to develop, but are truly meaningful.

Even for residents who have advanced dementia/Alzheimer’s or other cognitive or verbal limitations, making an effort to reach them can make all the difference. Singing to them, or talking/signing with them helps them feel connected to other people. Their responses may be different, but pay close attention to their behaviors and body language for positive or negative feedback.

These are all important components of trust-building, and can help you with other times in the long-run. As a trusted staff member, the resident may look to you in times of difficulty or even non-compliance, to help keep calm or de-escalate a situation if necessary.

Involve Everyone in the Festivities

Most facilities decorate and have events correlating with the major holidays, which is a great start to creating a warm and festive environment. If possible, find out which holidays in particular your residents like to celebrate throughout the year, and make an effort to have those represented if they aren’t part of the mainstream/regular celebrations. Even decorating a common area or the hall near their room can help bring some cheer. If the resident(s) are able, they can help explain the traditions with which they’re familiar and stories they recall from their past.

The winter holidays are also a great time of year to invite people from the community to interact with residents. Local religious organizations, youth musicians, choirs, a capella or other community groups, and even schools can come sing and/or engage with residents and fill their holiday experience. Youth or children’s groups are often welcome ways to enliven everyone’s spirits. Musicians are most appreciated when they play familiar holiday songs or songs from the era when many of the residents were young.

Reaching out to the community and requesting greeting cards for the residents is a simple way to add a little cheer to the holidays as well.

If possible, outings to local community events, or even driving around looking at holiday lights in the neighborhood are great excursions as well.

Recuperation Time is Important

With all of the activities and bustle of the holiday season, down time or quiet time is just as crucial, if not more so. Even if elderly residents are enjoying themselves with all of the festivities, it is a change from their daily routine, and may be more physically and emotionally demanding on them as well. As we age, it can take us longer to recover from activities, especially those out of our norm, whether we realize it or not. Additionally, a tired or stressed individual can have a lower immune response, and be more susceptible to illnesses, which also run rampant during the holiday season.

Partial or half-day activities, and having ‘regular’ days in between can help with recovery time and the extra stress.

Assisted Living Education & You

Assisted Living Education is an outstanding provider of products and services for assisted living, as well as RCFE classes and licensing. Our instructors draw from years of experience and up-to-date training to provide an engaging and informative learning experience to our students. We also offer online and continuing education courses. Visit our contact page to reach out to us for any inquiries!

Be Aware of Seasonal Affective Disorder (SAD) Symptoms

Seasonal Affective Disorder is a form of depression prompted by the time of year and relative to the amount of light present due to the change in seasons. Many of us may have heard of SAD, but may not fully understand its condition, or its counterpart, Reverse SAD.

ALE discusses both kinds of SAD and also how to help our elderly residents diagnosed with this condition.

What Does SAD Look Like?

Seasonal Affective Disorder type of depression whose onset is triggered by changes in seasons. The most common form of SAD occurs in fall through winter, but there are some cases in which the condition affects an individual in the spring/summer months. This is sometimes referred to as Reverse SAD.

In either form, there are marked changes in mood and disposition, starting out mildly with the initial stages when the season starts, and becomes more severe as the season progresses. The fall/winter manifestation resembles the more classic symptoms of depression, but the spring/summer expression presents more like a manic depressive episode.

Fall/Winter SAD

Irritability, trouble getting along with others
Fatigue, lethargy, low energy
Emotionally hypersensitive
Change in appetite, especially craving for high carbohydrate foods
Oversleeping

People living in regions with distinct weather changes or with limited sunlight (e.g., further up in latitude) are more likely to develop symptoms SAD. However, even in places such as California where the weather may not change as dramatically, cooler temperatures can reduce frequent visits outside, especially for elderly residents, and therefore less exposure to sunlight.

Does the Amount of Sunlight Really Make a Difference?

The reduced sun exposure can lead result in deficiencies or imbalances in the body. For example, serotonin production drops with a lack of sunlight, and this chemical imbalance causes an individual to feel depressed. The cravings for high carbohydrate foods are the body’s way of attempting to increase serotonin levels. Vitamin D also plays an important role in our health, including supporting bone health, preventatives with certain cancers & conditions, as well as help with incontinence. However, Vitamin D is also found naturally in certain foods and also via dietary supplements. Sleep patterns can also be thrown off as well, since the body’s circadian rhythms depend on regular sun exposure. The disrupted sleep prevents the resident from getting quality rest, which can result in depressive symptoms.

For individuals with Fall/Winter SAD, symptoms persist for more than two weeks.

Spring/Summer SAD (also referred to as ‘Reverse SAD’)

Out of the entire U.S. population, 4%-6% of people are affected by SAD and of that population, about 10% experience a reverse of the winter symptoms.

Depression
Problems staying asleep, insomnia
Poor appetite
Agitation
Anxiety

The cause of Reverse SAD is unknown but thought to possibly result from the excessive heat, or even too much light. Whereas fall/winter SAD sufferers are more lethargic and depressed, those with spring/summer SAD tend to be more agitated and angry. The manic type of behavior presents as irritability, agitation, and restlessness. Adults with Reverse SAD are more inclined to feel suicidal as a result of the agitated mood.

What Can You do for SAD / Reverse SAD?

During the ‘active period’ when the resident is suffering from SAD symptoms, antidepressants can be helpful, especially if the condition’s pattern is known. The antidepressant regimen can begin prior to the expected onset of either winter or summer SAD to be most effective.

Light therapy is another proven effective and useful strategy for fall/winter SAD, especially for those who dislike taking medications or do not want to add to their medications list. Light therapy is also helpful for elderly or those with limited mobility who are not as able to access the outside or natural light.

For residents with executive cognitive functioning within normal range, Cognitive Behavioral Therapy (CBT) is another possible treatment as well.

Residents suffering from Reverse SAD may also benefit from staying in cooler or air-conditioned environments during the warmer months, as well as avoiding rooms or areas that are too brightly lit. If residents are outside or are in areas that may be too bright, dark sunglasses can help, especially the wrap-around type that can block out light from all angles.

Let the Team Make the Decisions

Don’t forget, any change in a resident’s individual health care plan must be approved by the team or the attending psychiatrist and/or physician before they are put in place. They or the team together will be able to determine the best course of action or treatment with the patient’s medical needs, cognitive capabilities, and other symptoms in mind.

Any care prescribed by one of the resident’s team must be communicated to the rest of the team to maintain consistency and treatment efficacy.

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Assisted Living Education is a premier provider in education, services, and licensing for the assisted living field. We specialize in RCFE education and licensing, continuing education, and other online coursework. Our instructors have years of industry and field experience, and bring their expert knowledge to the classroom with engaging and practical instruction techniques. Learn more by exploring our website or reaching out to us via our contact page. We look forward to hearing from you!

Assisted Living Education addresses elderly hoarding and how to cope with residents.

Understanding Elderly Hoarding and How to Cope

Hoarding has long been documented, but has only been systematically studied just within the last decade. Hoarding Disorder was only added to the most recent DSM update in 2013, when the DSM-V was released. This is the extreme side of hoarding where it interferes with normal daily activities such as cooking, sleeping, moving through spaces, as well as relationships with family, friends, or loved ones. It can even become a health or safety hazard either because of restricted movement or as a result of the items themselves (possible decomposition or attracting critters, etc.).

Self-Neglect

A component that often distinguishes pathological hoarding is self-neglect. Self-neglect can appear as a lack of care in personal hygiene and/or appearance, or the lack of care toward an individual’s personal space, such as their room or their home. The individual may no longer experience shame and not maintain typical grooming practices, brush their teeth, shower regularly, wear torn, old, or dirty clothes, for example. In addition to the excess clutter, their home or space may have dirty dishes, accumulated trash, or serious disrepair (e.g., mold problems, bug infestations, unresolved plumbing issues, etc.).

Sometimes this condition coupled with extreme hoarding is called Diogenes Syndrome and often affects seniors late in life.

Why Does this Happen?

For those who are fortunate enough to make it to old age, it can come with difficult consequence as well. Loss of social interactions is prevalent, either due to deaths of family & friends, or illness/injury making it more difficult to connect with others or participate in regular activity. This can leave an individual feeling lonely or isolated, for which they try to fill other things to satisfy that void. Sometimes this turns into hoarding, and can become such a strong behavior/compulsion that it spirals out of control. A strong compulsion develops in the individual to save something that they “may need for later,” but in reality has little or no value.

A specific traumatic event(s) can also trigger hoarding behavior. It may be an extreme expression of the mind attempting to compensate for a perceived loss of control in the individual.

It is also suggested that compulsive hoarding is associated with anxiety and OCD, with some research indicating that a pre-Alzheimer’s personality can contribute to the development of hoarding disorder.

Why Is it a Problem?

Many people have specific collections, or even numerous material items in their home to the point of clutter. The problem reaches a pathological threshold when the individual is saving things that have no value (junk mail, plastic bags beyond reuse, etc.) and feelings of anxiety and anguish arise at even the thought of throwing away or parting with such items. As mentioned previously, these accumulations of items can prevent ease of movement throughout the home or space, and even become physical or health hazards, yet the individual feels more compelled to hoard than to remedy the situation.

Additionally, as individuals are moved into an assisted living situation, there is literally and figuratively little space for hoarding behaviors. Health code is obviously stricter and does not allow for a collection of excess materials to accumulate, as it presents major health & safety code violations, as well as preventing personnel from safely accessing the residents, health supplies, or perform daily or necessary tasks properly.

Helping Individuals with Strong Hoarding Behaviors

The worst way to deal with another individual’s hoarding behavior is to go through their belongings without permission and throw everything away. Even with permission, deep anxiety can arise in the individual just addressing the thought of parting with their item(s), despite any kind of logic or benefit presented.

A study conducted by Boston University School of Social Work revealed that trust is essential in effectively helping an individual with hoarding behaviors. To clarify, trust isn’t solely based on the length of time an individual knows someone. Many of us even have family members that we love, but may not trust enough or feel entirely comfortable when placed in a vulnerable situation. The same applies to people with hoarding disorders. A strong, genuine rapport must be carefully established; the study indicated that individuals were more receptive to social workers with whom they had developed a trusting relationship.

Obviously, these relationships take time to cultivate and even under the best possible circumstances, mitigating strong hoarding behaviors will continue to be an arduous process.

For the short-term, it might seem too time consuming and even frustrating trying to develop this relationship. However, the long-term benefits in investing in this strong foundation will ultimately help in future problems or crises that may arise, and the resident can feel more secure in knowing they have someone they feel is ‘safe’.

Avoid the Power Struggle

One important thing to remember is to keep the individual involved in the process. While an outsider may view them as impeding the process with possible setbacks and a slower timeline in remedying a ‘problem space’, this will ultimately help resolve the underlying problem instead of hastily applying a band-aid.

Part of the hoarding disorder is rooted in control; completely taking the situation away and handling it for them can send the individual into distress and further aggravate their symptoms. By including them in the process, their feelings and concerns are validated, which helps build trust and increases the chances of compliance.

Ways to Support Residents with Hoarding Behaviors

Though it will take time to curb the hoarding behavior, there are other ways in which to provide support that may help the discourage the behavior indirectly.

A study from the University of California, San Francisco found that 15% of older adults with depression also exhibited extreme hoarding behaviors, versus 2-5% of the older population exhibiting extreme hoarding without the depression comorbidity.

Because a snowball effect can exacerbate hoarding behaviors (loneliness or loss of independence leading to depression, depression manifesting into hoarding), providing elderly residents with outlets for social interaction, creativity, movement (exercise, dance, etc.), music, and more can ideally replace hoarding as behaviors used to fill a void. These activities or a combination thereof can really help to inspire confidence, engage the resident, and possibly ease them from their extreme compulsion to hoard.