Talking to Residents with Dementia / Alzheimer’s

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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

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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)

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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

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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

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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

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!

Effects of Medications on the Senior Body: Part II

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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

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Effects of Medications on the Senior Body: Part I

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Side effects are well-known and even expected with most prescription and over-the-counter medications. However, many don’t realize that these consequences have a more profound effect in the elderly body. As caretakers in the assisted living industry, it is important to know your clientele and note any physical changes, changes in disposition or behavior that may be a result of medications they are taking.

Assisted Living Education covers some common concerns for elderly residents and their medications in a two-part blog series.

Pharmacodynamics & Pharmacokinetics

Elderly residents are particularly susceptible to the effects of pharmacodynamics and pharmacokinetics for several reasons. Pharmacodynamics refers to how the drug interacts with the body and body systems once it’s ingested. This includes the chain of bodily responses, from the effectiveness of the body’s drug receptors, to the body’s own homeostasis, or even the functionality of the body’s organs. Pharmacokinetics refers to the movement of the drug through the body, e.g., how it’s metabolized, absorbed, and ultimately eliminated from the body.

The older the body gets, the more these particular effects become a concern when taking medication. Because the aging body is declining in various aspects, any part of these pharmacokinetic or pharmacodynamic processes could be less effective. Thus, certain medications could become either less effective or potentially riskier, especially when taken with other medications.

Anticholinergic Drugs

Many elderly residents respond with anticholinergic effects. This means that particular drugs block the neurotransmitter acetylcholine from absorbing in the central nervous system (CNS) and peripheral nervous system (PNS). Because of their effects on such critical body systems, there is evidence that links these types of drugs to poorer cognitive function, including executive functions of the brain, loss of memory, and increased risk of dementia, or worsening of dementia symptoms.

Higher Risk of Contraindications

Most elderly residents are on multiple prescriptions due to varying health issues, age-related or otherwise. Because of this, doctors and even caretakers need to be vigilant about ensuring these residents are well-monitored and don’t ingest any other medications or even foods that could combine negatively with one of their existing prescriptions.

Drug-Disease Interactions

As a CNA, nurse, or other assisted living facility staff member, we cannot emphasize enough how important it is to get to know your residents as well as thoroughly noting any observations of behavior/disposition change, physical changes, or anything else that might seem out of the ordinary for a particular resident. These little red flags can be a sign of something more serious, but more importantly, potentially preventable.

This open communication among caretakers, the resident’s attending doctor, plus any other specialists is crucial for several reasons. Keeping everyone in the loop helps better resolve any issues that might occur, and to help distinguish between any new symptoms due to a new health development, or if it might actually be a side effect from one of their current medications.

Merck Manual warns against a prescribing cascade in which a side effect of a drug is incorrectly identified as a sign or symptom of a new disorder, and thus a new drug is prescribed to remedy it. For example, some antipsychotic medications can cause symptoms that present similarly to Parkinson’s Disease, and an uninformed physician may prescribe a medication to reduce effects commonly seen in Parkinson’s patients.

Adverse Drug Effects

Common adverse drug effects seen in elderly residents are oversedation, confusion, hallucinations, dizziness/falls, and bleeding. According to Merck Manual, 17% of elderly individuals are hospitalized due to adverse reactions, as opposed to only 4% of younger individuals. 90% of these hospitalizations are preventable just by opening the lines of communication between residents, their caretakers, and other healthcare providers.

Drug Ineffectiveness

Because elderly individuals have a higher risk of complications, some physicians are more hesitant to prescribe stronger doses of medication. As such, medications may then seem ineffective.

Additionally, if elderly individuals are left to self-administer their medications, adherence and consistency may be poor for a couple of reasons. They may forget a dosage because their memory isn’t as sharp, or they may avoid medications because the cost is too high for their budget or fixed income. Some individuals may not like to take their medications, either because of the side effects, or because they’re just stubborn. It’s possible their behavioral resistance is due to frustration, or even effects of dementia or Alzheimer’s. In these cases, medications may have to be mixed into food to make it more palatable or tolerable to the individual.

In an assisted living facility, this is another reason why communication among staff members is crucial. If a resident is beginning a new medication, communicating their tolerance or intolerance is essential for deciding whether to continue the medication or not. Additionally, facilities can help the individual or individual’s family in making choices when it comes to medication if it is unaffordable. Communicating whether a resident refused their medication is absolutely noteworthy as well.

Assisted Living Education

Assisted Living Education is committed to the highest level of education and services for people in the assisted living community. We offer RCFE Certification, Staff Training, online coursework, including continuing education, and so much more. Our instructors have years of professional, industry experience and teach their courses with engaging, hands-on material and a real-world perspective. Visit our contact page for any inquiries, or give us a call at 1-800-200-0188 for immediate assistance.

Balance Disorders in the Elderly

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As we age, we are more likely to encounter health and wellness challenges, but also experience more serious repercussions from these challenges. In particular, dizziness and balance disorders, including vertigo, are a cause for concern. These kinds of disorders are a strong predictor of falls in the elderly, which is the leading cause of death in people 65 years and older.

Assisted Living Education reviews some common balance disorders and treatments, as well as precautions we can take to ensure our elderly residents’ safety.

Balance Disorders

Balance disorders cause people to feel dizzy, faint, or unsteady on their feet.  Some people can even experience sensations of movement, spinning, or floating while sitting or lying down.  In general, balance disorders often stem from medical conditions relating to the heart, nerves, bones and joints, muscles, vision, and the inner ear. However, most problems with balance are related to problems with the inner ear, also called the vestibular system.

The Basic Structure of the Inner Ear
The inner ear contains fluid-filled semicircular canals; inside these canals are tiny, hair-like sensors.  These sensors monitor the rotation of a person’s head.  The inner ear also contains otolith organs; these organs monitor the up/down, left/right, and back/forward movements of the head.  The otolith organs contain calcium crystals that allow for sensitivity to gravity.

Vertigo and Benign Paroxysmal Positional Vertigo

Vertigo is a term that refers specifically to the sensation of spinning, or the sensation that the inside of one’s head is spinning.  It is associated with a variety of conditions, but the most common cause of vertigo is a condition called Benign Paroxysmal Positional Vertigo (BPPV.) BPPV occurs when the calcium crystals in the otolith organs become dislodged from their regular positions and move to another location in the inner ear.  For example, when a person is lying down, the crystals can move into the semicircular canals.  As a result, the semicircular canals might respond differently than they normally would to a change in head position.  This leads to a feeling of vertigo and/or dizziness.  BPPV is usually triggered by specific changes in the position of the head – usually a person will notice a sensation of vertigo after his or her head makes a particular head movement, such as tilting the head up or down, or turning over in bed.

In addition to vertigo, BPPV also causes episodes of mild to severe dizziness, unsteadiness, nausea, vomiting, and nystagmus (abnormal rhythmic movements of the eyes.)  Typically, symptoms are brief in duration, usually lasting a minute or less.  Symptoms can also disappear for a long time and then recur.

Benign Paroxysmal Positional Vertigo in the Elderly

Most of the time, BPPV is not serious and its occurrences are short-lived, but in older people, it can increase the risk of falls.  It also tends to be more common in women than in men.  There are precautions that vertigo sufferers as well as assisted living facilities can take to prevent a fall:

  • Resident can use a cane for support when walking.
  • Facilities can ensure that common areas and resident living environments are well lit at night.
  • The resident should be educated to sit down as soon as possible if vertigo or dizziness arises, or notify nearest staff member.
  • Residents should avoid positions and situations that would likely cause a loss of balance. Facility staff should be able to anticipate a precarious situation in order to prevent an accident.
  • If possible, susceptible residents should discuss symptoms with attending doctors or personal physicians for management or further treatment.

Other Causes of Vertigo

Other causes of vertigo include migraine headaches, head injuries, motion sickness, or more rarely, Meniere’s Disease (vertigo accompanied by fluctuating hearing loss and ringing of the ears,) Acoustic Neuroma (a benign tumor on the auditory vestibular nerve,) Vestibular Neuritis (inflammation of the vestibular nerves,) or Ramsay Hunt Syndrome (a shingles infection affecting the facial nerve near one of the ears.)

Treating BPPV

BPPV can sometimes go away without treatment in a few weeks or months, but it is generally recommended that an individual see a doctor for unexplained vertigo that happens periodically for more than a week, or for episodes that last longer than a minute.  A doctor may recommend one of the following treatments:

  • Canalith repositioning – This procedure involves slowly maneuvering the patient’s head into different positions.  In effect, these maneuvers move the particles inside the inner ear from one area to another.  The doctor moves the patient’s head into a particular position, waits for the patient’s symptoms to cease, then continues to hold the head in that position for about 30 seconds.  This procedure is often effective after the first or second treatment, and patients can learn how to perform the procedure on themselves at home.
  • Surgery – When canalith repositioning is not effective, the doctor may suggest a procedure in which a plug made of bone is surgically placed to block the section of the inner ear that is causing the patient to have vertigo or be dizzy.  When this plug is in place, the semicircular canal is then no longer able to react to movements of the head.  This surgery is 90% effective at resolving symptoms.
  • Medication – Sometimes doctors may prescribe medications for dizziness or vomiting stemming from vertigo that lasts for hours.

As with any concern, symptoms, or disorder, the resident’s attending or personal physician should be consulted before proceeding with any treatment or management program. Nurses, CNAs and other facility staff should note any acute physical or behavioral changes observed and relay them at shift changes. This is especially important since some of our elderly residents have lost the ability to effectively communicate even basic needs, and may have trouble articulating their symptoms.

Assisted Living Education is committed to the highest quality education and services for the assisted living community. Our instructors are industry professionals with years of real-world experience, and teach their courses with engaging and meaningful methods. Assisted Living Education offers courses in RCFE Certification, Staff Training classes, online RN, LVN, and SNF courses, and more! Visit our contact page for any inquiries or give us a call at 1-855-200-0188 for immediate assistance.

Eye Conditions Complicated by Diabetes

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In our previous blog, we discussed various eye conditions that can affect our elderly population. In addition to those conditions, having diabetes only further complicates eye health. Because diabetes in itself is such a prevalent disease, Assisted Living Education has devoted an entire blog to diabetic eye disease and some preventative measures we can take to maintain good eye health for our elderly residents.

Diabetic Eye Disease

Diabetic eye disease refers to a group of four eye conditions caused by diabetes:  diabetic retinopathy, diabetic macular edema (DME), cataract, and glaucoma.  People who have diabetes are at risk for developing diabetic eye disease, which can lead to extreme vision loss or blindness, and the risk increases as they age.  To prevent loss of vision, it is very important for people with diabetes to have a dilated eye exam at least once per year.  According to the National Eye Institute (NEI), somewhere between 40%-45%  of diabetic Americans already have diabetic retinopathy, but only 50% of those people are aware they have it.  In fact, the most common cause of blindness in American adults with diabetes is diabetic retinopathy.  Fortunately, early detection, treatment, and careful management of diabetes can prevent or delay the onset of vision loss caused by diabetic eye disease.

Types of diabetic eye disease

  • Diabetic retinopathy affects the blood vessels of the retina, a light-sensitive tissue that lines the back of the eye. It is the most commonly occurring form of diabetic eye disease, and it is initially asymptomatic.  By the time symptoms emerge, the eyes have already sustained a significant amount of damage.  Diabetic retinopathy is caused by consistently high blood glucose levels, which, over time, damage the retina’s blood vessels.  These blood vessels may swell, leak, or bleed; eventually they can become blocked.  This typically distorts vision; the patient may see spots that appear to be floating across their path of vision.  As the condition advances, irregular blood vessels begin to form on the retina’s surface in order to compensate for the other blood vessels that have become unable to transport blood due to swelling and distortion.  If the condition remains untreated, these irregular blood vessels will become more abundant; they begin to grow into the vitreous fluid in the center of the eye and leak or bleed.  Scar tissue is often also present at this advanced stage, posing a risk of retinal detachment, which results in an irreversible loss of vision.
  • Diabetic macular edema (DME) is an accumulation of fluid in the macula that occurs as a result of diabetic retinopathy. The macula is the most sensitive area of the retina, and it is associated with the kind of highly accurate, central vision that allows a person to see straight ahead, recognize faces, read and write, etc.  This accumulation of fluid produces swelling, which results in blurry vision.  Of all patients who already have diabetic retinopathy, half of them will experience DME (NEI,) and it can occur during any stage of diabetic retinopathy.
  • Cataract is a condition of cloudiness in the lens of the eye.  The lens is clear and composed mainly of water and proteins.  Those proteins are positioned in such a way that light can pass through the lens.  Cataract forms when, over time, some of the proteins bunch up together in the lens. This makes it difficult for light to pass through.  Cataract is typically removed with surgery.  For an adult who has diabetes, developing cataract is two to five times more likely than for adults who do not have diabetes.  Cataract also tends to appear at an earlier age for people with diabetes.
  • Glaucoma refers to a group of diseases that cause damage to the optic nerve, which sits at the back of the eye and connects to the brain.  Increased eye pressure causes most types of glaucoma.  When fluid inside the eye builds up but is not able to drain quickly enough, the resulting pressure can damage the optic nerve.  People with glaucoma lose their peripheral vision first; their vision will become more and more centralized over time and eventually be lost. There is no cure for glaucoma, but its progression can be slowed with medication, laser treatment, and surgery.  People who have diabetes have two times the risk of developing glaucoma than people who do not.

What can be done to prevent or delay the onset of diabetic eye disease?

The most effective way to prevent or delay the onset of diabetic eye disease is for people with diabetes to have a comprehensive dilated eye exam at least once a year.  Exams are crucial for early detection, because early stages of diabetic eye disease do not always exhibit symptoms right away.  If diabetic retinopathy has already been diagnosed, patients should have eye exams more frequently, depending on how advanced their diabetic retinopathy is.  People who experience any changes in vision, particularly blurred vision or floating spots, should see a doctor as soon as possible.  In a comprehensive dilated eye exam, the doctor looks for changes in the lens or blood vessels, leaking of the blood vessels, nerve tissue damage, and swelling of the macula.

Also effective in preventing or delaying the onset of diabetic eye disease is keeping blood sugar levels within a normal range as much as possible (according to the Diabetes Control and Complications Trial, NEI.)  Keeping blood pressure and cholesterol under control can also help lessen the risk of diabetic eye disease in people with diabetes.

Working together as a team in an assisted living facility can help ensure that we stay on top of our residents’ health. For those diagnosed with diabetes or other health conditions, frequent visits with the attending doctor or the residents’ physicians or specialists can help catch any new developments in their early stages. Dieticians are also helpful in monitoring the residents’ diets and making the appropriate accommodations are made for their nutritional health. It is important for CNAs, nurses, and other staff to develop good rapport with their residents, and get to know their ‘normal’ or baseline disposition to make any changes in behavior or physical appearance easier to note and subsequently evaluated.

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.

 

Vision Loss and Eye Degeneration in Elderly Residents

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As we age, it’s natural to experience a deterioration in body systems, to a certain extent. In particular, vision problems are prevalent, especially in the 60+ crowd. As early as age 40, many people tend to notice a change in their vision or eye health. For our elderly residents in assisted living facilities, many of them will have age or disease-related eye issues. Assisted Living Education has compiled a list of common conditions and expectations experienced in elderly eye health.

Age-related Macular Degeneration (AMD)
Age-related Macular Degeneration is actually the most common form of vision loss among people 50 and older. The macula is a small area located near the center of the retina, and is essential for sharp, central vision. It’s unclear exactly what leads to the breakdown of the macula, but it tends to occur over time.

AMD can be broken down into three stages, Early AMD, Intermediate AMD, and Late AMD, and further classified as dry AMD or wet AMD. Most people experience dry AMD. Early dry AMD is noted by the presence of drusen, which are waste deposits that build up in the macula. Typically, individuals are not yet experiencing vision loss. Those with intermediate dry AMD have larger drusen, and may also have pigment changes in the retina. There may be some vision loss present, but otherwise no symptoms. Late AMD individuals experience vision loss because of damage to the macula. Late AMD can be classified into two types, geographic atrophy and neovascular, or ‘wet AMD’.

Geographic Atrophy
Many tend to interchange the terms ‘dry AMD’ and ‘geographic atrophy,’ but they do refer to different stages in AMD. Geographic atrophy is the advanced form of dry AMD, and specifies the deterioration of the deepest retinal cells. This damage affects the photoreceptor cells (rods and cones) of the eye, and thus interferes with how the brain interprets visual information.

Neovascular AMD (also, Wet AMD)
Neovascular AMD occurs when tiny blood vessels develop under the macula. Often times, these blood vessels develop in the wrong place and can leak blood and fluid into the eye, causing scarring and damage to the macula. It is thought that the blood vessels develop in an attempt to clear drusen from the eye. While those with neovascular AMD may only account for 10% of AMD cases, it is the more severe type, and a bigger threat to vision loss.

Because individuals with early and intermediate AMD tend to be asymptomatic, it is important that elderly residents have their eyes examined regularly. While there is no reversing early stage AMD, adopting healthier habits can help slow the process. Exercise, eating plenty of leafy greens, increasing omega-3 fatty acid and antioxidant intake are all suggested.

Intermediate and Late AMD individuals may be able to take certain supplements to slow the advancement of the degeneration. Vitamins C & E, zinc oxide, cupric oxide, beta-carotene or lutein and zeaxanthin are some vitamins & minerals which have been proven effective in delaying the progression of AMD. Of course, the resident’s attending physician should approve any changes to their individual care plan, diet, or medications.

There are more intensive treatments for advanced neovascular AMD, including injections, photodynamic therapy, and laser surgery, all with the intention of slowing the progression and advancement of vision loss.

Dry Eyes
While exact statistics are not clear, dry eye is a common condition seen in elderly residents, despite its ability to develop at any age. Dry eye is a result of either an inadequate amount of tears, or poor tear quality. Tear production tends to decrease with age, and windy or dry climates can aggravate the condition. Poor tear quality happens when one or more of the three components of a tear (oil, water, and mucus) is not sufficient and does not properly nourish the eye.

Dry eye can be a temporary or a chronic condition, with numerous causes, some as simple as a side effect of a medication, allergies, incorrect vitamin dosages, infrequent blinking, or more severe such as disease of the glands in the eyelids, immune system disorders, chronic inflammation of the conjunctiva, or skin disease.

Treatment for dry eye commonly involves the use of medicated eye drops, although a small surgical procedure can be performed to block the tear duct if the goal is to conserve tears. If dry eye is due to eyelid or ocular irritation, the doctor may recommend the individual receive ointments, a warm compress, or other eyelid cleaners to relieve inflammation around the eyes.

Cataracts
Cataract occurs due to an accumulation of proteins on the lens. This clouds the lens and prevents light from clearly passing through to the retina, where it is transformed into nerve signals and then sent to the brain.

Most cataracts are due to aging, but there are other types of cataracts:

Secondary Cataract – These can form due to other health problems, or even after surgery from other eye issues like glaucoma.

Traumatic Cataract – Cataracts that develop from a traumatic injury.

Congenital Cataract – Some individuals are born with cataracts, but they may not even affect their vision. However, those with affected vision usually have their lenses removed.

Radiation Cataract – Certain types of radiation exposure can cause cataracts.

Individuals with early stage cataracts can rely on environmental changes to help with vision, such as anti-glare sunglasses, treated eye-glass lenses, brighter lighting, and even magnifying lenses. Those whose daily tasks are affected by cataracts find greater benefit in surgery to remove the cataracts. Cataract surgery removes the cloudy lens and replaces it with a new, artificial one.

Glaucoma
There are several types of glaucoma, all of which cause damage to the eye’s optic nerve and typically result in vision loss or blindness.

One of the most common types of glaucoma is open angle glaucoma. In a normal-functioning eye, there is fluid continuously flowing in and out of a space in the front of the eye (anterior chamber). This helps bring nourishment to nearby tissues. The movement of this fluid occurs at the open angle where the cornea and iris meet. However, when the fluid does not move or drain properly, it causes a build-up and creates pressure, which, if not treated, can damage the optic nerve.

People are typically asymptomatic initially, but as the damage increases, peripheral vision loss begins to fade. If still left untreated, people can experience ‘tunnel vision’ as their sight deteriorates, and eventually, total vision loss.

Other types of glaucoma include low or normal tension glaucoma; angle closure glaucoma; congenital glaucoma; secondary glaucomas, as a result of a primary medical condition; pigmentary glaucoma; and pseudoexfoliation glaucoma. Angle closure glaucomas are a medical emergency; a sudden increase in pressure builds up within the eye because part of the iris is blocking the fluid drainage. In these cases, people do experience severe pain and nausea, blurry vision, and their eye appears red.

There is no cure for glaucoma, however, there are medicinal and surgical treatments, or a combination thereof, that can delay disease progression if the condition is detected early on.

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With these potential eye conditions, or any health concerns in general, it is important for our elderly residents to have regular check-ups and visits with the attending doctors, or their primary care doctor or other specialists. Early detection is key, as well as strict maintenance for any conditions already diagnosed. Establishing good relationships with the residents can also help in detecting any physical or behavioral changes which might indicate an underlying health issue. Each resident’s individualized healthcare plan will outline any current diagnoses or things to keep an eye on.

Assisted Living Education is proud to offer classes, licensing, products, and other services for assisted living. Our instructors are industry professionals with years of experience, and teach their classes in engaging and meaningful methods. For more information, please explore our website, and note that we do offer RCFE Certification, Staff Training classes, RN, LVN, and SNF online courses, and much more! Visit our contact page for any inquiries, or call us at 1-855-200-0188 for immediate assistance.