Assisted Living Education discusses Glen Campbell's journey with Alzheimer's, how performance kept him going, and how music can access memories and skills.

Assisted Living Education Special Feature: Glen Campbell, Music & the Alzheimer’s Condition

On March 20th, 2017, Kim Campbell announced that her beloved and famous husband, Glen Campbell could no longer play guitar due to his advancing Alzheimer’s condition.

Glen Campbell revealed his early-stage AD diagnosis at 75 years in 2011 at the same time his last work, Ghost on Canvas was released. He launched a world “Goodbye Tour” serving as his finale to live performance. Live shows a few years before his diagnosis were “train wrecks” according to his daughter, Ashley. She joined her father along with her two brothers to make up his band for the Goodbye Tour. With the knowledge of his AD diagnosis, his fans welcomed him enthusiastically at sold-out shows for this final farewell. They cheered him compassionately even as certain moments on stage made it clear that AD was overtaking the Rhinestone Cowboy with its classic symptoms of confusion, memory lapses, and disorientation.

Documented conversations and interactions seen in I’ll Be Me revealed a mix of Glen Campbell’s usual wit plus non sequitur sentences or behaviors characteristic of AD. Still, music and live performance seemed to be Campbell’s compass, orienting him back to the talent and persona everyone knew and loved.

Through Glen Campbell’s open story, Assisted Living Education discusses the unique challenges seen with individuals and families dealing with dementia diseases like Alzheimer’s. We also discuss how music can reach people and seemingly revive their memories and cognition, even if just for a brief time.

Alzheimer’s: The Silent Thief

Glen Campbell’s Alzheimer’s journey can be eye-opening to some, but is painfully familiar to those with experience in dementia conditions. The 2014 documentary “Glen Campbell: I’ll Be Me” presents a glimpse into how Campbell’s family dealt and interacted with him on his final tour. It also reveals the everyday struggles with this debilitating disease, which can elicit anger, frustration, and depression in the individual, punctuated with moments of surprising wit and clarity. For families and friends, it is a disease that deeply affects more than just the one diagnosed.

The certain prognosis for dementia conditions such as Alzheimer’s Disease (AD) is a significant, cognitive decline eventually leading to waning physical abilities as well. This degenerative condition unravels years of solidly ingrained skills, knowledge, capabilities, language, and even motor skills that many of us take for granted. AD and other dementia conditions are unforgiving, dragging everyone down a heartbreaking path as the individual succumbs to the detriments of the disease.

Fortunately, music can offer a surprising reprieve, which Glen Campbell’s story highlights. In the early to mid-stages of the disease, though day-to-day functioning can be challenging, music has a unique way of speaking to the mind and bringing the individual back to their element. Glen, his family, and his fans were able to enjoy Glen Campbell as Glen Campbell when the music flowed, and his charming voice filled the air.

How is Music Able to ‘Wake Up’ the Brain?

Many people working with dementia or Alzheimer’s residents know that music can work as an amazing time warp. It can take the individual back to a time and place where they are cognizant again, with astounding precision matching a beat, singing, or even playing along to the music. This is what Glen Campbell’s family and many of his fans witnessed, even as his AD progressed.

One of Glen Campbell’s doctors had referred to these abilities as ‘overlearned skills’, but also apply to other memories as well. These skills, abilities, or memories were so well mastered or left such an impression that they were ‘recorded’ in more than one area of the brain. Because of this, the individual may be able to recall certain memories or skills if the disease has not affected the other areas of the brain that information was stored in.

In fact, Glen’s doctor encouraged him to keep playing and singing, with the idea that keeping the brain engaged with these skills would help prolong the positive effects and strengthen the remaining neural circuits. The brain is often compared to a muscle; keeping it active and engaged helps it remain strong and operational. Lack of stimulation leads to neural atrophy, further advancing degeneration and decline.

During breaks in his “Goodbye Tour,” Campbell would attend physical or occupational therapy as well as other doctors’ visits to check in on his condition; some of these visits were featured in I’ll Be Me. One of his neurologists commented that while he noticed a decline in Glen’s memory, he was impressed with his ability to perform and communicate. Disorientation issues Glen had the year prior seemed to resolve itself, according to his wife, Kim. The neurologist noted that the key to preserving much of Glen’s intellectual ability was due to indulging in the activities Glen loves so dearly: music and performance.

“It’s just something that’s in your system. That’s… I really don’t know what it is. I wish – I wish I knew.”
Glen Campbell, I’ll Be Me

It is now three years since I’ll Be Me was made. Glen Campbell was moved to a long-term care facility in 2014, but returned home in 2015. In 2016, Campbell became a resident at a Nashville memory care facility as he takes on the final stages of Alzheimer’s Disease. At that point, aphasia, the inability to understand or express speech, had settled in. Campbell could no longer communicate or understand words, but his family says his disposition remained content and cheery.

When Kim released the news that Glen could no longer play guitar, she shared that he still enjoys playing ‘air guitar’ and singing, but the music he makes now is unrecognizable to others. She did add that whatever tune he was singing seemed like a happy one.

Making Glen Campbell’s diagnosis public helped Glen prolong his abilities, but also helps others who are faced with the challenges of AD or dementia. Glen and his family have become advocates for Alzheimer’s awareness and demonstrated that this disease has no discretion for race, class, or status. Though heartbreaking to watch, Glen Campbell’s journey can help families and others better understand what can happen to a person afflicted with Alzheimer’s or dementia.

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Assisted Living Education is a premier provider of education, continuing education, and certifications for the assisted living community. Our compassionate team is dedicated to providing a quality experience, with instructors possessing extensive, real-world and research-based knowledge in their respective fields. Learn more about RCFE certifications, online coursework, and continuing education units, or visit our contact page to reach us directly.

 

Communicating With Residents Suffering From Hearing Loss

Caring for elderly residents is a rewarding career path, but it comes with many challenges. One common source of confusion and frustration can happen when trying to speak with residents that are hard of hearing. It’s important to be patient and flexible in these situations and to understand the specifics of their condition and treatment. That way you can customize your communication style based on their needs and limitations and, as always, address concerns with the attending physician or specialist before making changes to a resident’s individual health care plan.

Causes of Hearing Loss

One of the most common forms of hearing degradation in the elderly is a condition known as presbycusis. This just refers to the age-related loss of hearing that gradually occurs as people get older. It is unknown why presbycusis affects some individuals more than others, but research suggests a genetic component.

Noise-induced hearing loss is the condition where hearing worsens from repeated exposure to excessively loud noises. People who work in jobs with constant loud noises tend to suffer from hearing problems much earlier than is normal. Those jobs include construction workers, farmers, musicians, airport workers, yard and tree care workers, and individuals in the armed forces.

Viral or bacterial infections, heart conditions, head injuries, tumors, and certain medicines can sometimes lead to hearing loss. The severity, treatment, and type of hearing loss that someone suffers from are different with each case. There are some types of hearing loss that affects a particular range of sounds which might make it harder for an individual to hear rings or whistles, but doesn’t affect how they hear human speech.

Electronic Aides

Hearing aids are probably the most popular treatment for hearing loss. However, there are quite a few misconceptions about the devices that should be clarified. Hearing aids intake sound through a microphone, amplifies the noise, and plays it through a speaker in the wearer’s ear. Hearing aids don’t increase all sounds equally and often need to be adjusted by an audiologist based on feedback from the individual.

Unlike a hearing aid, a cochlear implant is a small device surgically implanted in the inner ear. This treatment method is for individuals with a severe hearing disability. These devices are similar in their effectiveness and limitations as hearing aids, and the same guidance can be applied when working with residents that have them.

When considering a resident for a cochlear implant, the positive and negative consequences should be heavily weighed before moving forward. Surgical procedures can have greater effects on the elderly individual. Changes in the body’s metabolism can prolong the effects of anaesthesia, magnify potential reactions to pain medications during the healing process, and potentially increase recovery time from the general stress of the surgery on the body.

Even so, sounds can get muddled and garbled together through either device, similar to having a call on speaker phone. Be aware that some residents with electronic device assistance still struggle with normal conversation volume, while others could have the sensitivity turned up and be annoyed by shouting. If you’re unsure, be direct with the resident and confirm they’re comfortable with the manner you speak.

Customized Solutions

If your residents continue to struggle with everyday tasks, there are assistive listening devices that can help. Some apps and devices exist for telephones, cell phones, tablets, TVs and other electronic devices to increase the volume beyond what the standard functions would allow. Headphones may be an option, too, to direct the sound to their ears and also cause less of a disturbance with other residents.

Places of worship, theaters, and cinemas often offer wirelessly transmitting audio devices that provide a clearer sound to those in need. Another increasingly popular device is an induction coil loop which allows for the event to be broadcast directly to the viewers hearing aid or cochlear implant. If you are planning outings or events on the premises for your residents, consider coordinating in advance to ensure these devices will be made available.

Sign Language and Lip Reading

If one of your residents is dependent on sign language for communication, it’s recommended you learn a few key phrases. This gesture will go a long way in alleviating stress from your resident’s life and will take a lot of frustration out of the day to day interactions. There are many online resources available for teaching the basics.

Individuals with hearing impairments often learn to read lips to understand conversations better. With practice, it’s possible to gauge a great deal based on lip movement and body language. When used in conjunction with hearing devices or sign language it can make communication much more seamless. Be aware whether or not a resident uses this technique; further, be aware of your own body language and the tone/attitude you are conveying. You can go a long way towards assisting them by ensuring you face them, have a relaxed or open body posture (indicating a welcoming or neutral attitude) and enunciating your words.

Residents With Reduced Cognitive Abilities

Hearing loss is just one barrier to communicating with your residents. Combine this with reduced cognitive function due to dementia or other health issues, and the challenge is compounded significantly.

Still, dealing with a resident affected by dementia and hearing loss can be similar to dealing with a resident possessing no cognitive impairment.  Approach them gently and use their name to address them verbally. If they don’t hear you, gently place your hand on their shoulder or arm to get their attention. Make sure they are looking directly at your face when communicating. Speak in simple sentences, again, enunciating clearly and at a voice level above normal, but not shouting. Simple gestures can also help convey a message, e.g., making motions that mimic eating then pointing at them, as if to ask, “Do you want food? Are you hungry?”

In fact, research suggests that hearing loss is a contributing factor to dementia and Alzheimer’s. The earlier an individual receives treatment for hearing loss, the more they reduce their risk of developing dementia later in life.

The Ultimate Goal

If you need to communicate to a group of residents at once, make sure you’re aware of their limitations and take the time to address those who struggle the most, individually and in a respectful manner. Often those with hearing troubles will feel embarrassment or shame and not ask for clarification. They may feel as if they’re drawing attention to themselves or feel like a nuisance. Go out of your way to make sure everyone is treated well based on their needs.

The bottom line is to ensure you’re direct and open with residents about their hearing requirements. Treat them with respect and practice patience when misunderstandings happen. Ask them about their communication preferences. They will more than likely appreciate your honest interest in their well-being.

Assisted Living Education’s Promise

At Assisted Living Education, our number one priority is providing the highest quality education and educational resources for those who care 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!

 

Elderly Residents and their Nutritional Needs

As we age, our body’s nutritional requirements change. One of our goals in caring for elderly residents is ensuring a higher quality of life by minimizing potential health problems before they arise. Though the attending dietician is responsible for creating a dietary plan for each individual, it is still important for others involved in the direct care of our residents to be cognizant of the basic nutritional requirements that increase with aging.

Assisted Living Education discusses how the nutritional requirements of our body change as we age.

Nutritional Absorption

The aging process diminishes our bodies’ ability to absorb various nutrients. The body secretes less hydrochloric acid which reduces our ability to break down food and acquire the same amount of nutrients that a younger body can. Additionally, hormonal changes may result in more nutrients, such as calcium, being excreted through the kidneys. Because of these changes, vitamin deficiencies can be common among residents. Side effects of nutritional deficiencies include cognitive impairment, anemia, muscle loss, heightened susceptibility to infections, insomnia, and a weakening of the immune system.

To prevent these problems and alleviate others, it’s especially important that the senior diet is rich in the following nutrients.

Calcium

Calcium is one of the primary nutrients our bodies require in increasing amounts as we age. Unfortunately, some individuals may become lactose intolerant as a natural part of the aging process. As dairy products become harder to digest, your residents may eat less of them. It’s generally recommended that adults over the age of 50 increase their daily calcium intake from 1000 mg to 1200 mg. Incorporating non-dairy foods rich in calcium is one way to supplement this nutrient. Broccoli, kale, edamame, oranges, salmon, white beans, tofu, and almonds are all great sources.

Vitamin D

Because calcium is such a vital nutrient to bone and overall body health, Vitamin D intake is also important as it helps our bodies absorb calcium. Conditions such as osteoporosis and rheumatoid arthritis are common results of Vitamin D or calcium deficiencies. Egg yolks, cheese, mushrooms and fatty fish such as salmon or tuna are good sources of naturally-occurring vitamin D. Additionally, many foods these days are fortified with it Vitamin D:  cereals, milk, some yogurts, and juices. For residents up to age 70, a daily intake of 15 mcg is recommended. An increase to 20 mcg is recommended for individuals over 70.

Iron

Iron is a required nutrient for our body to create hemoglobin, the protein cells that carry oxygen through your blood. The average woman over  age 50 should consume 50 mg of iron a day whereas the average man only needs 10 mg. Unfortunately, most foods contain very little iron. The best source is red meat, but some residents might have dietary restrictions limiting their red meat intake due to cholesterol and high blood pressure concerns. Incorporating poultry and fish are good substitutes for red meat. Fish such as halibut, salmon, and tuna are all excellent sources of iron. Non-meat options include lima beans, red kidney beans, chickpeas, apricots, broccoli, spinach, and baked potatoes. Brown rice, enriched bread and cereals, or those made with whole grains are good options as well.

To improve our body’s ability to absorb iron, it’s important to limit the amount of caffeine your residents consume.

Fiber

Constipation and other intestinal problems are more common in the elderly due to reduced intestinal contractions; this is often caused by inactive lifestyles and diets low in fiber. A diet high in fiber stimulates intestinal motility and prevents constipation. Some studies also suggest that dietary fiber can lower cholesterol levels and regulate blood-glucose levels. It is recommended that total fiber intake for adults older than 50 should be at least 30 grams per day for men and 21 grams for women. Insoluble fiber absorbs water, so make sure residents stay hydrated to avoid compounding existing intestinal problems. Insoluble and soluble fiber can be found in most whole grains, vegetables, fruits, and legumes. Multi-grain bread, spinach, brown rice, celery, broccoli, apples, carrots, pears, zucchini, baked potatoes (with the skin), chickpeas, almonds, pecans, lentils, beans, and even popcorn are great sources of dietary fiber.

Magnesium

A proper supply of magnesium is important for a wide range of reasons. Magnesium plays a vital role in good heart health, bone density, and keeping immune systems  top notch. In fact, magnesium is a critical component of over 300 physiological functions. As we age, our body’s ability to absorb this all-important nutrient decreases. In general, seniors tend to consume less of it as their ability to cook and prepare their own foods decreases. Much of the essential nutrients have already been stripped away if the food is consumed in processed form. A diet rich in fresh fruits and vegetables, nuts, whole grains, beans, and seeds can help maintain adequate magnesium levels. On average, men over the age of 50 are advised to consume 420 mg of magnesium a day, and women are advised to consume 320 mg.

Vitamin B12

Between 10%-15% of seniors over the age of 60 have some degree of  B12 deficiency. Because of its vital function in maintaining the health of our blood cells and nervous system, the first sign of a Vitamin B12 deficiency is fatigue and muscle weakness. If a resident appears to be more tired than usual in the afternoon or seems weaker than normal, they might need a supplement to their diet such as B12. Other signs can include diarrhea, depression, mouth sourness, and tingling in the hands and feet. The recommended intake for individuals over the age of 50 is 2.4 mcg of vitamin B12 per day. B12 is a vitamin found naturally in animal products and is especially high in beef liver, mackerel, sardines, salmon, red meat and dairy products. Vegan and vegetarian residents may require B12 supplements or other foods fortified with B12.

Consult the Team First

Any kind of change to a resident’s individual health care plan should receive the approval of the attending physician, dietician, and/or the rest of the team prior to implementation. However, any observations in behavioral or physical changes are crucial and should be noted to help the entire team make informed decisions about the resident’s overall health care plan.

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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.

 

FOOT CARE & ISSUES FOR SENIOR RESIDENTS

Despite many of us relying on our feet to get around, it is often one of the more neglected areas of body care. Unless an acute problem arises, we tend to ignore or push through minor aches and pains that may develop as we age. However, years of these minor inconveniences can turn into big problems. Some of these you may encounter with your assisted living residents, whether or not they are ambulatory.

Assisted Living Education (ALE) discusses common causes and problems of foot issues experienced in elderly residents.

Common Problems in Elderly Feet

Aches & Pains – Our bodies naturally incur more wear and tear as we age, especially if we’ve been active in our youth. Our cushy, youthful soles wear thin as fat and collagen begin to degenerate in the body. This is why we start noticing more aches and pains as we hit middle age.

Arthritis – Osteoarthritis (OA) and rheumatoid arthritis (RA) are common diagnoses in elderly residents and can make mobility difficult with painful joints. This could ultimately impact their mental health and well-being as they may withdraw from activities and exercise to avoid the pain.

Bunions, Corns, Spurs, Hammertoes – Most of these are caused by poor-fitting or non-supportive shoes and can become painful. The next section discusses the importance of a well-fitting shoe.

Secondary Conditions Some individuals develop other problems due to the body compensating for the initial ailment. Hip and knee problems are common secondary issues to walking on painful feet. Our natural reaction to walking on aching feet is to shift our weight/load to give relief to the sore spot. However, this throws your natural bone and joint alignment off, especially over long periods of time.

Ill-Fitting Shoes

Residents who have a long history of wearing heels or other shoes that were ill-fitting are likely to have foot problems in their senior years. Make sure their current pair of shoes are comfortable, the correct size, and provide proper support if necessary. Even if the resident does not walk around much or is not ambulatory, it is still important that whatever they wear is best suited for their body. A poor-fitting or too-tight shoe on a non-ambulatory person will still cause irritation and problems down the line, especially if blood flow is already reduced to the extremities.

Additionally, ill-fitting shoes can increase the risk of falls in the elderly. Though there are a lot of things to consider in shoes for the elderly, finding that Goldilocks or Cinderella fit (i.e., “just right”) is essential for their foot health.

Be careful of:

  • Too flexible or worn-out shoes: These shoes will not provide enough support or stability
  • Too tall shoes: Extra height can cause instability and increase the chances of a fall
  • Heavy shoes: Extra weight or bulk can be cumbersome and also increase the chance of a fall or injury.
  • Worn tread or heavy tread: No tread can increase the chance of slipping, while too much tread can catch on a surface and cause an individual to trip.

Podiatrist or Pedicurist?

Because elderly foot health can be compromised in a variety of ways, it’s best to consult with a podiatrist or even the attending physician first before a regular visit to the nail salon.

While the exfoliation and foot soaks at regular nail salons are very relaxing for most of us, it could exacerbate health conditions for elderly residents. Elderly skin is not as resilient as it once was, and the scrubbing could be too abrasive. Additionally, individuals with diabetes, circulatory issues, or other conditions that weaken the immune system could be susceptible to infections if they happen to visit a salon that is less meticulous with the cleaning of their facility, tools, or equipment.

A podiatrist can properly care for ingrown toenails, excess nail growths, and are and skilled in caring for individuals on blood-thinners.

Tips for Healthy Foot Maintenance

There are some basic, everyday things you can do as you visit your residents that will help in overall foot and general healthcare. Even if you are not involved in the direct care of the resident, your observations and rapport can help in detecting problems that the resident may neglect or not know how to express.

Take Note of New Developments

Notice your resident stepping more gingerly or favoring one side? Make note of this and similar observations and bring it to the attention of the attending physician. Even if it seems inconsequential or the resident tries to brush it off, detecting any physical or behavioral change at its earliest can help tremendously in preventing bigger problems down the line.

Basic Foot Care

Those involved with the daily care of the residents should keep an eye on nail lengths for both fingers and toes. Keeping toenails regularly trimmed can help with ingrown nail problems, as well as prevent any pain, irritation, or further problems due to impeding a proper shoe fit. Make sure the resident’s skin and feet are well-moisturized to prevent dryness or cracking which, if left untreated, can lead to discomfort and greater potential for infection.

Keep Warm

Thick socks or bedtime socks are good for the cooler months of the year. Many residents suffer poor circulatory problems due to diabetes or other conditions. Ensuring they are warm encourages blood vessel dilation and helps with oxygen & nutrient flow to the extremities.

Caveats:

  • Make sure the resident is warm and comfortable, but not overheating. Overheating can cause a different array of problems.
  • Be sure to check whether their shoes can accommodate thicker socks; cramping their foot will defeat the purpose.

 

If your residents have friends or family who regularly visit, help keep them educated and informed of what they can do to help. Be sure to consult with your supervisor first to ensure HIPAA compliance.

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Assisted Living Education is committed to offering the best quality training and services for serving the elderly community. Our classroom and online courses provide invaluable education and skills from instructors with extensive of field experience. Explore our courses on RCFE certification, continuing education, and more! Visit our contact page to reach us directly.

Talking to Residents with Dementia / Alzheimer’s

In our previous blog, Assisted Living Education addressed how to effectively interact with elderly residents. In this blog, we discuss specifically how to better interact with residents diagnosed or presenting symptoms of dementia or Alzheimer’s.

Although the Journal of American Medical Association (JAMA) reports that overall incidence of dementia has declined from 11.6% in 2008 to 8.8% in 2012, it is still one of the most common conditions we see in assisted living. This is largely because people with the condition can no longer live independently, and it can be quite demanding to care for someone with dementia/Alzheimer’s at home, especially if they have dual or multiple illness diagnoses.

Since people with dementia can have a delicate cognitive or behavioral disposition, here are some useful strategies in aiding interactions with residents who may have dementia or Alzheimer’s.

Help Guide the Interaction

Because dementia can leave residents with cognitive deficits, make sure the resident is focused on you when interacting with them, and vice versa. You may want to gently place a hand on their shoulder or arm and look directly at their face while speaking their name in order to ensure you have their full attention. Maintain eye contact, again, so you know they are focused on you. Avoid giving instructions or chatting in places with ambient or sharp noises, as those can be distracting and confusing for the resident.

Our previous blog, Respect Your Elders: How to Effectively Interact With an Elderly Resident also provides some great generic tips as well.

Managing and De-escalating Outbursts

Much of a resident’s executive cognitive functioning is lost to dementia as the condition progresses. This includes losing capabilities such as extended thought processes and coping skills. Their mood and disposition may change because their coping mechanisms and thought processes have deteriorated, in addition to an increase in confusion.

Delusions, Paranoia, & Hallucinations

Some residents with dementia may have delusions and paranoia as well. When a person with an average mind cannot entirely remember something, their mind attempts to fill in the gaps with information. In individuals with dementia, this is especially true, although the information filled in is often grossly incorrect, even though it might make sense to them. Sometimes this can lead the resident to false conclusions, such as pairing the arrival of a staff member with the arrival of darkness (night time), and thinking that the staff member hides the sun, for example.

Sometimes in the later stages of the disease, residents may experience hallucinations. This is a result of the changes occurring in the deteriorating brain. More often, hallucinations are seen in residents with Dementia with Lewy Bodies or even Parkinson’s Dementia, but also those with Alzheimer’s as well.

Be sure to distinguish between a hallucination and a delusion: A hallucination is seeing or hearing something that is not actually occurring, and a delusion is a false belief usually derived from paranoia or suspicious feelings.

Further, be careful to distinguish a hallucination from poor eyesight. Poor eyesight can make the resident think they are seeing something, and with decreased cognitive capacity, they may not be able to deduce that what they think they are seeing is incorrect. For example, strange shadows may appear to be a monster or creature, and a shiny floor could appear wet. Make sure the resident’s eyesight has been checked recently, schedule them for an appointment, or make sure they are wearing the proper lenses before assuming they are hallucinating.

Useful Strategies & Phrases

It is pointless to argue or offer logical/lengthy explanations to a resident with dementia. They may no longer possess the cognitive capacity to understand or make sense of what you are saying. Instead, the following strategies and tips can help get through a challenging conversation.

Validate their Feelings and Provide Reassurance

It is helpful to validate their feelings and keep things simple. Be compassionate and build that trust with them; this can help keep things calmer and de-escalate a situation. If they are upset over a lost item, offer to help them find it. Avoid negativity on your side of the conversation; keep it neutral or positive. Instead of, “Don’t you remember? You always keep it in your drawer!” or “Why do you always lose things?” try encouraging and reassuring statements, “Let’s have a look in your drawer,” or, “I’m sure it’ll turn up, let’s just have a look around.” If there are items that seem to be misplaced frequently, it might be wise to keep a spare on hand, just in case.

Additionally, if accusations arise and are directed against you, don’t take it or make it personal. The resident is often caught up and reacting to their present upset state and might direct emotions at you simply because you are there, or you’re someone they see frequently.

Divert their Attention

Some situations may benefit from a diversion. For example, if a resident begins saying or doing inappropriate things, instead of chastising them, a better solution can be to divert their attention. Unlike the average person who can be taught or socialized to what is/is not appropriate language or behavior, these cognitive faculties have been altered beyond learning and understanding consequence. Impulse control has deteriorated. Try broaching a completely different topic, “Do you know who’s playing Super Bowl this year?” or, “Let’s get ready for lunch.”

This can also help in situations which are threatening to escalate, in an attempt to take their mind off the present problem. Engage them in an activity they enjoy, such as singing or dancing: “I heard my favorite song on the radio the other day…” but choose a song you know they’re familiar with so they can join in. Music and song are unique anomalies that seem to be spared from the grasp of dementia; it can bring back memories and musical skill ingrained in an individual.

Keep it Positive or Neutral

Nobody enjoys hearing, “Don’t do that!”, “Don’t go there!”, “Stop doing that!” or other negatively commanding phrases. Residents with dementia are no different. In fact, these kinds of phrases can frustrate and possibly agitate a resident and escalate into further problems.

Instead Of … Try…
“Don’t do that!” / “Stop!”“Let’s try this instead…”
“Don’t go there!”“Let’s go this way.”
“Relax, calm down!”“Let’s take a break.”
“That’s wrong!” / “No, not like that!”“Here, let me help you.”
“Hurry up!”Anticipate and verbalize the next step. “Do you need your shoes?”
“Don’t you remember? You put it away.”“I thought we put it in your drawer. Let’s check.”
“Remember? Like this.”“This is how we stretch before exercise.”

Use gentle reminders and keep your tone neutral and positive. Be specific when you can and use familiar words, but keep your phrases simple. Additionally, it can be useful to phrase things in a way that suggests working together, instead of you always having to help or do it for them. This can help an individual feel that they are not completely dependent, thus improving/maintaining their self-esteem and dignity.

Keep In Mind

These residents are adults and many of them were fully-functioning, independent people at one point in their lives. They may even have had an established or esteemed career and held highly respected positions, or they may have been masters at their trade or craft for years. Maybe they were the driving cornerstone of their family, and still are, but with fewer capabilities. Their newer, dementia-shrouded world is confusing, scary, and can be nonsensical. It is difficult at times for the resident (and others) to cope with this degenerative condition. Any anger or frustration may sometimes derive from not being used to this new dependence on others, or not being able to perform basic tasks as they used to in the past.

Make sure to keep that in mind and even help family members understand if they seem to have difficulty as well. First, consult with your supervisor or head of the facility to ensure that this conversation is permissible, or what specifically is allowed in conversation with family members, friends, or conservators of the resident.

Assisted Living Education is a premier provider for assisted living services, education, and educational resources. We offer RCFE courses & certification, as well as online courses and continuing education. Our instructors have extensive experience in the field and are known for making their classes highly engaging and practical. Explore our website, or visit our contact page to reach out to us personally!

 

Respect Your Elders: How to Effectively Interact with an Elderly Resident

As people age, some of the physical, emotional, & cognitive capacities that once existed in full force begin to wane. There are elderly individuals capable of interacting within normal parameters, but for many residents in an assisted living situation, there can be complications in having a normal, everyday interactions. Some residents make take longer to complete activities or tasks, or take longer to process or produce information. Others even need various levels of prompting, which can range from a simple verbal prompt to physically assisting the individual through a task.

Sometimes caretakers can get frustrated in dealing with residents for various reasons. Perhaps the resident doesn’t seem to understand, is being non-compliant, or is repeatedly performing a different task than what was asked of them. Not to mention that any type of caretaking job can be very demanding and at times difficult to keep it together. However, any feelings of frustration, exhaustion, or other negative energy must not be taken out on the resident. It is part of our professional duty to maintain a positive or neutral composure so as not to negatively affect the resident, which just creates problems for future engagements with them.  If certain interactions are handled inappropriately, this only escalates to a power struggle, achieving nothing except more frustration and maybe even a potential risk of injury.

Assisted Living Education reviews how to effectively communicate with your residents, and some methods and techniques to keep in mind in your daily conversations.

Clarity & Tone of Voice

You may notice some caretakers speaking to their residents in an elevated pitch and using simple phrases, resembling the way one would speak to a child. Depending on the resident and their needs, simple phrases or directions may be best in order to help them process the request easier. However, it is inadvisable to speak to any adult as if they are an adult child. It is a matter of respect and dignity, and although they may seem unaware or not completely cognizant, certain things are still understood and internalized.

Speaking in a clear, kind or neutral tone is always best, especially when giving directions or addressing an issue. Speaking slower, but not hyperbolically slow can also help with residents who need an extra moment to help process information. Avoid shouting or an excessively raised voice, even if you are trying to communicate with someone hard of hearing. It can be misinterpreted as anger. Learn to increase the volume of your voice without shouting when speaking with someone hard of hearing.

Environment & Approach

Just as in regular conversation with anyone, the way in which you approach someone and the environment you’re in can affect how the interaction goes. Think about trying to have a conversation in a loud restaurant or other venue. It’s hard to hear the other person over loud ambient or sharp noises, and trying to get their attention if they’re facing away from you can be difficult.

For residents with dementia or that are hard of hearing, this challenge can be the daily norm. When interacting with residents with these known conditions, especially when trying to give directions, make sure you’re in a space where there aren’t other noises that could distract the individual from hearing or understanding you clearly.  It is also helpful if you speak to the resident face-to-face to better keep their attention as well as help them understand what you are saying if they can see your mouth forming the words.

Body language is crucial as well. Your posture should be relaxed and open, and be aware of the expression on your face. A frown or closed body posture, a hand on the hip or forceful movements can indicate anger or aggression, which the resident can pick up on and respond to negatively.

If possible, make sure you approach your residents from the front, while gently yet clearly and audibly addressing them, especially if the resident also has vision problems. Startling a resident, particularly one with dementia, may cause them to react physically and inadvertently inflict an injury upon themselves or others.

One last note: Also make sure you ask the resident or someone who can speak on their behalf what they prefer to be called. A first name or a personal nickname may be fine, but some residents may be more traditional and prefer Mr./Mrs./etc., or even a title earned from their career, such as Dr., Col., Professor, and so on. Unless you have built rapport with the resident, avoid calling them ‘honey,’ ‘dear,’ or other generic nicknames as it can sound patronizing. It is also a vague form of address, so the resident may not realize to respond to it. A person’s own name will always get their attention.

Listening & Being Present

Although our work in an assisted living facility is demanding and often busy, sparing a moment (if possible) can make all the difference with our residents. The most time-efficient way of doing this is to making the most of your interactions with them. Whether you are a nurse administering their medications or a CNA caring for them, engaging with the resident in a positive fashion can help establish a good rapport and make the resident feel comfortable and even validated. This rapport can also help in future interactions that may present a challenge. A resident is more likely to comply or respond better to a trusted figure in their reality, and a potential situation can de-escalate more quickly.

When with your residents for a task, session, or other activity, be sure the focus is on them, and not others, i.e., casually chatting with other staff members nearby. Unless it’s urgent or relevant to the resident’s care, the chit-chat can be saved for later.

Some residents may be lonely or feel like no one wants to be around them, and having that human contact can brighten their day. However, some residents may be especially chatty, so learning how to tactfully excuse yourself is important as well. Offering to catch up with them next time is a gentle way to move along without getting caught up and delayed in your own tasks.

Additionally, when asking residents a question, allow enough wait time for a response. In getting to know the individual, you’ll figure out what is appropriate before you may have to ask again or rephrase the question. It may take longer for a resident to process the information or ‘find the right words’ to respond appropriately. Rushing or interrupting them can cause frustration and upset. After the appropriate wait time has been allowed, you may need to ask/rephrase, and possibly offer a prompt to help them.

As is the case with most things in assisted living, knowing your residents as well as being aware of their medical and personal history, etc. is crucial to effectively caring for and treating each individual.

Assisted Living Education is dedicated to training and educating people genuinely interested in this field of healthcare, and molding highly skilled, competent, & compassionate professionals. We offer RCFE courses, CEU & online courses, as well as other services and products for the assisted living field. Explore our website or visit our contact page for more information.

 

Seasonal Affective Disorder (SAD)

Many of us are familiar with the term Seasonal Affective Disorder (SAD), but may not fully understand its condition, or even that there are different kinds of SAD.

Assisted Living Education discusses both types of SAD and also how to help our elderly residents diagnosed with this condition.

Symptoms

Seasonal Affective Disorder is a kind 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 both cases, there is marked change in mood and disposition, which start out mildly when the season is in its initial stages, but become 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 who live in regions with distinctive weather changes or where sunlight can be very limited are more likely to develop symptoms SAD. However, even in places such as California where the weather may not change as dramatically, the cooler temperatures can prevent more frequent visits outside, especially for elderly residents, and therefore less exposure to sunlight.

The Effects of Reduced Sunlight

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

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.

Treatments for SAD

For the period that 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 has been proven effective and useful for fall/winter SAD, especially for those who dislike taking medications or are already on multiple medications. Light therapy is also helpful for elderly who are not as able to go outside for natural exposure to 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.

The resident’s attending or personal psychiatrist/psychologist can determine the best course of treatment, depending on the individual’s needs, cognitive capabilities, and severity of symptoms. Even if the resident is receiving specific treatment from their psychiatrist/psychologist, it is pertinent to keep all doctors, therapists, dieticians, and other caretakers abreast of any adjustments to the resident’s routines, medical or otherwise. This helps maintain consistency and effectiveness of the treatment and resident care.

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!

 

Distinguishing the Signs of Dementia and Depression

As we get older, it’s expected that our bodies won’t act the same as they used to. We may experience a decrease in stamina, bone and joint problems, increased recovery time from activities, among other things.

However, there are some symptoms typically associated with old age that are actually worth paying more attention to in elderly individuals. Memory loss, decreased appetite, or a decline in activities’ participation could just be side effects of elderly conditions, but significant changes could signal other underlying issues as well. Depending on the symptoms and their severity, certain changes could suggest depression or possibly the onset of dementia as well.

The presentation of dementia and depression can appear similar in elderly residents. ALE discusses the distinguishing features and the differences in these conditions.

Depression Vs. Dementia

Depression in the Elderly

It’s estimated that over 6 million Americans 65 and older experience late-life depression (National Alliance on Mental Illness, or NAMI). The causes are often related to the shift in purpose, abilities, or other events common in later life, such as a decline in physical health as well as loss of family, friends, or a spouse. People are often eager to retire, but sometimes lose a sense of purpose without the structured schedule of working life. This can be especially hard on people who either don’t have children, have children and grandkids who live far, or don’t have hobbies or a regular social life to keep them occupied. In some cases, retirement can be stressful with a reduced income but increased medical care costs. Specific medical conditions that may take away an individual’s independence can also trigger depression as well.

In assisted living, depression is noted as one of the top five ranked health concerns, according to the CDC. In addition to the aforementioned triggers, feelings of despair and loss of independence may be heightened, especially if families and friends fail to make regular visits, or the resident no longer has any social connections. A resident realizing they are no longer capable of living independently in their own home anymore can be crushing to their self-image as well.

Symptoms

Symptoms of depression in the elderly are similar to general symptoms of depression and can include:

  • Persistent feelings of unhappiness, anxiousness, hopelessness, pessimism
  • Feelings of guilt or worthlessness
  • Increased irritability or restlessness
  • Insomnia, early-morning wakefulness, or excessive sleeping
  • Fatigue and decreased energy
  • Unexplained aches, pains, headaches, or digestive problems that do not resolve with treatment
  • Difficulty concentrating, remembering details, or making decisions
  • Appetite loss or overeating
  • Loss of interest in activities that were previous enjoyable

Source: Geriatric Nursing Journal

Medical conditions that tend to induce depression or make depression worse are typically chronic conditions (Parkinson’s, cancer, diabetes, etc.) or acute medical events such as a stroke, heart attack, and even hip fracture. Despite the advances in medical technologies and therapies to aid in an individual’s recovery, there can be complications and setbacks. Even the prospect of dealing with these life-changing events in later life can be overwhelming and core-shaking for an individual.

Certain medications can also cause or exacerbate symptoms of depression, some of which include medications for blood pressure, tranquilizers, beta-blockers, steroids, estrogens, and more. Elderly adults are also more susceptible to the side effects of particular medications. Check out our previous blogs, Effects of Medications on the Senior Body Part I, and also Part II.

Dementia and How it Differs from Depression

The symptoms of depression and dementia sometimes appear similarly, and it’s important to distinguish the two in order to find the right treatment or accommodations for the individual.

Additionally, just because an individual is beginning to show some form of memory loss, it is inappropriate to immediately conclude they have dementia. There are other aspects of cognitive function that enter in a dementia diagnosis.

Common Dementia Symptoms

  • Subtle short-term memory changes
  • Struggling to find the right words
  • Changes in mood / Sundowner’s Syndrome
  • Change in sleep pattern
  • Apathy
  • Difficulty completing normal tasks
  • Confusion
  • Difficulty following story lines or completing stories

Distinguishing the Differences Between Dementia & Depression

Memory: Memory issues are a common problem in old age, dementia, and depression. However, the distinguishing features are the kinds of memory loss or lapses we see in individuals.

Old age – Includes occasional forgetfulness or trouble remembering specific information right away, but can still continue their thought processes, finish sentences, and are able to carry on with their daily schedule and tasks independently.

Depression – Individuals with depression have trouble focusing or concentrating, and can experience some lapses in memory. Coupled with any anxiety or preoccupation in thought, this can distract the mind from properly recalling information.

Dementia – Memory loss starts slowly, but as the condition advances, the loss is consistent and apparent. Individuals with dementia frequently struggle to pull up the right words or phrases in conversation and can have trouble finishing sentences. Learning new tasks can become increasingly difficult as short-term memory deteriorates. They may not remember what they did during the day, what they ate for breakfast, etc. Tasks they’ve done most of their life, such as writing a check or completing basic math problems can become confusing.

Orientation: Generally, elderly individuals with or without medical conditions not affecting cognitive function are aware of the day, year, where they are, and so on. Likewise with elderly residents with depression. Individuals with dementia lose their sense of time and place and may not be able to answer correctly if asked. They may not be able to answer what year it is, in which city they live, etc.

Language: An average elderly individual with normal cognitive function (barring individuals who have had a stroke affecting the language area of the brain) and an elderly individual with depression should be able to properly use their native language, even if it may be at a slower pace. Those with dementia have increased problems with language, either forgetting common words (cat, window, desk), misusing or making up words. Sentences may be incomplete or not appropriate for the context. They may also have difficulty following multiple-step directions, complex or abstract thoughts. Advanced dementia residents may have trouble expressing their needs (e.g., hunger, tiredness, restroom needs).

Those with vascular dementia, the second most prevalent form of dementia after Alzheimer’s, may even resemble someone affected by a stroke because the condition is a result of reduced blood flow to the brain. In fact, vascular dementia can develop after a stroke.

Mood: The average elderly individual presents with their normal affect. Elderly residents with depression have a persistent ‘blue,’ sad, or empty mood all day most days, which doesn’t change much with interactions, activity, or environment.

Individuals with dementia tend to present normally, but can be hypersensitive or reactive at times. Feelings of frustration and agitation can come easily as well.

In the evening and night, some dementia residents experience Sundowner’s Syndrome, an increase in agitation, anxiety, restlessness, fear, crying, or even physical outbursts. Some may experience hallucinations or paranoia, or wander, pace or rock back and forth. There is no solid explanation yet for what specifically causes Sundowner’s but doctors and researchers surmise it might be due to hormone changes, or even fatigue.

Elderly dementia and depression are common in assisted living facilities. This is why it’s important to know your resident and note any change in behavior, disposition, and even physical changes. The elderly body is more sensitive to change and any deviation from the norm can have a cumulative effect on their health and well-being.

Assisted Living Education is committed to providing the best education and resources for the assisted living community. We offer RCFE classes and certification, continuing education and online coursework. Explore our website for other products and services we offer as well, or reach out to us via our contact page for more information!

 

Coping with Elderly Depression During the Holidays

For most of the population, the holidays are the time of year for family get-togethers, traditions, friends and fun. However, for other people, the holidays can stir up feelings of sadness, resentment, or 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.

Recognizing the Signs

The key to effectively helping your residents through a potentially painful time of year is knowing who they are. Like any other preventative preparation, being familiar with a person’s ‘baseline’ behaviors, disposition, and temperament is crucial in detecting any changes, for better or worse.

These are typical symptoms associated with holiday blues in the elderly:

 

  • Subdued or irritable mood; sadness
  • Fatigue, or trouble sleeping
  • Anxiety
  • Loss of interest in daily activities
  • Change in appetite
  • Lack of attention to personal care, hygiene

 

Though your residents may already exhibit some of these symptoms, knowing their baselines can also help determine the difference between their established behaviors or new ones that seem to surface out of nowhere. For example, do they already have a cranky personality, or have they been extra snappy and sensitive lately? Are they able to independently tend to their personal hygiene and care, or have they really been letting themselves go? Do they have an existing anxiety disorder, or has your resident been particularly on edge or asking repetitive questions about future events or possibilities? Distinguishing these behaviors are important factors in your residents’ care.

Anticipate and Be Proactive

With proper planning and program design, it may be possible to interrupt a resident’s descent into a holiday depressive episode. 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.

Converse & Interact Meaningfully With Your Residents

Regular, casual engagements with your residents can build lasting relationships. These relationships can help toward stabilizing emotional highs and lows that may be experienced during certain times of year, like the holidays, where residents can feel isolated and lonely if they have infrequent or even no visits from family or friends.

Having a daily conversation with each and every one of your residents may sound like a daunting task, but really, there are plenty of opportunities to make each interaction a more personal and meaningful one. Conversations don’t have to be a one-time, drawn-out event, but they can be 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. Though the priority is to complete certain tasks, intersperse questions or comments to get to know them better and help them feel more at ease and welcome in the environment. A simple wave and a smile or a brief question/answer can carry on to the next positive interaction you can make with them.

Conversations and dialogue can come easy for some residents, but others may need a little prompting or encouragement out of their shell, for a variety of reasons. They may have a shy personality, there could be trust issues, or they may have a disorder or cognitive issue that makes it harder for them to openly interact with people. Or, they may present as an ornery curmudgeon who has difficulties getting along with people. In any case, don’t be too invasive too fast; they may shut down on you. A slow approach tends to work best with more reserved or aloof individuals. Start simply, maybe compliment them on their appearance, or make general conversation, comments, or make small jokes if the timing is right. You may have to uphold most of the conversation in the initial stages. Try to get a sense of what kinds of topics or interests they’re willing to open up to, and go from there. Start inviting them to group activities or outings. These relationships may take longer to develop, but are truly meaningful to both you and them once they feel comfortable with you.

Even for residents who have advanced dementia/Alzheimer’s, or other cognitive or verbal limitations, making an effort to personalize their care can make all the difference as well. Find ways to reach them, or engage in their world with them as long as it is safe and harmless. Sing to them, or talk/sign with them; whatever appropriate method of communication seems to work best. Their responses may be different than others because of those verbal or cognitive capabilities, but pay close attention to their behaviors and body language for positive or negative feedback.

This trust-building can also help during times where residents may be having an especially rough moment/day and exhibit noncompliance or act out in some way. Sometimes having a staff member with whom they feel particularly close to can help calm or even de-escalate a situation that may arise.

Get Everyone Involved in the Festivities

Most facilities will decorate and have events correlating with the major holidays, which is a great start to creating a festive environment. If possible, find out which holidays in particular your residents like to celebrate throughout the year, and make an effort to represent those holidays if they aren’t part of the mainstream/regular celebrations. Even just decorating an area where they frequent (a communal room, or even just their hall or 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 folks 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 enrich their holiday experience. Reaching out to youth groups or schools is a great way to enliven everyone’s spirits. Whether it’s an in-person visit, or having children write greeting cards for the residents adds a special cheer to the holidays.

If possible (and weather permitting), plan outings to see or participate in holiday events or plays, tree lightings, or even drive them around to see the lights and decorations around the local neighborhood.

Don’t Forget The Down Time

With all of the activities and bustle of the holiday season, down time or quiet time is just as important, 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 taxing 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. Planning activities for just part or half the day, and also having “normal” days in between allows for better recovery and less stress on the elderly body.

Assisted Living Education & You

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Effects of Medications on the Senior Body: Part II

In our previous blog, we discussed some of the effects of medications on the senior body, with regard to how drugs are effectively processed throughout the body systems on a cellular level.

Because of age-related changes, elderly people are more susceptible to the effects of drugs. In our last blog, we reviewed how pharmacodynamics and pharmacokinetics are concerns with how the body interacts with and metabolizes a drug. Many drugs tend to stay in the older body for prolonged periods as well. Though some of the side effects discussed in this blog may seem less serious or even inconsequential, because a drug can have a larger or stronger effect on the senior body, these symptoms can actually cause undue stress or even harm to their body.

Assisted Living Education continues the discussion of drug-related side effects in the elderly, finishing up our two-part series on this topic.

Adverse Drug Reaction (ADR)

A serious, negative response to a drug is called an adverse drug reaction or ADR. The World Health Organization (WHO) defines an ADR as “A response to a drug which is noxious or unintended, and which occurs at doses normally used in a man for the prophylaxis, diagnosis, or therapy of disease, or for the modification of physiological function.” This is considered an ‘injury’ from taking medications, and can be from a single dosage or a prolonged exposure to a drug.

Sometimes the term Adverse Drug Event (ADE) is also used, but to clarify, ADE encompasses a broader definition including any injury incurred while the drug was administered, whether or not the drug was identified as the cause of the injury or not. An ADR identifies the drug as the direct cause, and is a type of ADE.

ADRs can be further classified into categories:

Type A: Most ADRs (about 80%+) fall into this category and are expected to some degree due to the drug’s known pharmacological properties. The drug may have a low therapeutic index (TI), meaning that the drug’s efficacy is quite close to the threshold of the drug’s toxicity.  A common example used is warfarin. The drug is specifically designed and prescribed as an anticoagulant; however, some individuals may respond too well and experience excessive bleeding.

Type B: These are less common and unpredictable. The nature of these reactions suggests that they are more individual-specific, such as a hypersensitivity or an allergy.

Some literature lists additional subtypes, but check with your individual assisted living facility for their protocol, if necessary, in classifying ADRs.

Manifestations of Adverse Effects

Reviewing a more basic definition, Merck Manual describes adverse drug effects as any that are “unwanted, uncomfortable, or dangerous.”

Some of the more common manifestations of adverse effects are oversedation, constipation, confusion, hallucinations, falls, and bleeding. As we mentioned in our previous blog post, many of these problems are due to overdosage, underdosage, and other drug interactions, since many elderly residents are on multiple medication regimens.

There are certain classes of drugs in particular that are frequently involved with elderly ADR cases. Merck Manual lists antipsychotics, anticoagulants, antiplatelet agents, hypoglycemic drugs, antidepressants, and sedative-hypnotics as common culprits of ADRs.

Additionally, some medications are also highly discouraged for use by elderly residents, due to their side effects or common presentation of symptoms. For example, “first-generation antihistamines” including brompheniramine (found in some Dimetapp and Robitussin Allergy & Cough) are suggested as ones to avoid because of the negative effects they wreak on the elderly body, either immediately or cumulatively. However, 2nd and 3rd generation antihistamines, like the popular Claritin and Aleve, tend to be safer for elderly residents**.

Close monitoring of residents’ physiological mechanisms, disposition, and temperament are especially important during periods when a new medication or change is introduced to the resident.

**Please note that ANY change or deviation from an already-prescribed health care regimen, whether it’s the addition or removal of a prescribed medication, an OTC drug/medication, nutrition supplement, diet-related, or therapy-related change must be authorized through the appropriate channels (the resident’s personal/attending physician/s, dietician, etc.), as well as communicated to anyone involved in the resident’s care. Please refer to your specific facility’s guide for proper protocol on these types of procedures.

Prevention

Adverse effects from medications are a risk factor with any patient, but again, the elderly context is a much more complicated situation. An estimated 90% of elderly ADR cases are thought to be preventable, versus 24% of younger ADR cases. Hospitalization rates are also 4 times higher at 17% over 4% in younger patients.

As we mentioned in Part I of this series, the best way to prevent much of these adverse effects is through careful resident-monitoring and open, effective communication. Any authorized changes must be updated with other health care professionals or family involved in the resident’s immediate care.

Getting to know your residents and their ‘baseline’ dispositions, conditions, and behaviors are crucial for detecting any changes that might suggest an adverse drug reaction or even an acute medical event, which could have a subtle or unassuming presentation to the untrained or unfamiliar eye.

These seemingly simple practices can have a profound effect in terms of resident and individual care, as well as sharpening your own professional skills and approach.

Assisted Living Education

Assisted Living Education is a premier source for education, resources, and certifications in the industry. Our popular services include RCFE Certification, Staff Training, continuing education, and other Assisted Living Education products or online coursework. Explore our website, or reach out to us via our contact page for direct inquiries.