Crawford Care Management

General Health

There are many Internet sites that provide health information on specific diseases such as Alzheimer's and Parkinson's Disease, Heart Failure, Diabetes, and Arthritis. The following is more general day-to-day health information that can help the caregiver maintain optimal daily lives for their elderly loved ones.

  • Skin care starts at birth, but it's never too late to take care of this important "organ." Putting moisturizer on hands, especially around the fingernails as well as shoulders and elbows, will reduce the incidence of skin breakdown especially in the young and elderly. And providing Victoria's Secret skin cream for a nursing home resident may increase the probability of it being used regularly by the staff caring for the elder!
  • Providing books on tape to an elderly loved one with impaired vision or blindness will provide hours of entertainment to the homebound or lonely.
  • A trip to the ophthalmologist is in order when your loved one either squints or holds reading material further from their eyes.
  • Ensure that dentures fit right. Poorly fitting dentures can cause irritation of the gums and can contribute to weight loss, reluctance to socialize, depression, and communication problems.
  • Make sure shoes/slippers are safe. Backless, slip-on slippers contribute to many falls. Rubber soled well fitting slippers or slipper socks are safest.
  • Provide easy-to-use phones. Phones with large buttons and amplifiers are available at most discount stores including Target and Walmart.
  • Make sure the elder has plenty of drinking water and drinks it to avoid dehydration. Hot summer days are especially high risk for the elderly. Try to avoid excessive outside time, sun exposure, and strenuous activity.
  • Cognitive impairment can lead to inappropriate sexual behavior. Using same-sex caregivers and getting the doctor involved are only two of the steps you can take to improve the situation. Read on...

Abuse/Exploitation

  • Oftentimes the elderly will be reluctant to report abuse or exploitation if the caregiver/aide is involved. The abusive person may be the only person they see regularly.
  • Physical appearance is an indicator of how well an individual is cared for. On unannounced visitation, the person should be clean, dressed in matching and appropriate clothing, fed, and seated in a comfortable part of the residence where they can request attention as necessary.
  • Weight loss can be a sign of abuse.
  • Be conscious of signs of skin breakdown which can lead to bedsores especially if the elder is bed bound and not being turned frequently in their bed. Note: bruises are sometimes medication related (blood thinners, for example), however make sure that the elder isn't being treated roughly or abused in any other way.
  • If you are suspicious of abuse by a caregiver, stop by without an appointment, tell the elder that they can confide in you, observe the interaction between caregiver and elder, note any discomfort or reluctance on the part of the elder. Report suspected abuse immediately.

Cognitive Impairment Can Lead to Inappropriate Sexual Behavior
She was described as a normally sweet older lady with Victorian mannerisms: high morals, reserved demeanor, and proper grammar. But at times, she would trade her proper grammar for lewd verbal outbursts. Then there was the confused male nursing home resident who was caught in bed with another woman just minutes before his wife's visit. He did not realize he was cheating on his beloved: "This is my wife," he told the Broadspire Care manager who had entered the room to prepare him for his spouse's visit.

These situations happened to real-life clients who were born decades before "Make Love, Not War" was coined to signify the sexual revolution of the 1960s and '70s. In fact, these elderly folks came from a generation that didn't talk about such things. These two Broadspire clients don't have loose morals. Instead, they suffer from cognitive impairment that leads them to act with inappropriate sexual behavior.

Sexual feelings and expressions are normal -whether you are 16, 35, or 80. But some people with cognitive impairment try to gratify these feelings in ways that can anger their caregivers, shame their family members, and cause them to be ostracized.

Inappropriate sexual situations are a difficult subject to broach, but they happen. Older men and women, confused because of brain deterioration, can make unwanted advances; at home health care aides, nursing home employees, family members, or other residents of extended-care facilities.

Such behavior can start fights and lead to lawsuits. And if inappropriate sexual behavior cannot be harnessed or even altered, a person could be discharged from a care facility or dropped from a home health agency's client list, leaving family members without care for their relative.

The following steps can help improve such situations:

  • Use same-sex caregivers
    Send a caregiver of the same sex if there has been a problem with a client's sexual behavior. Tony Bryan, former gerontology counselor for Westminster-Thurber, a Columbus, Ohio retirement community, said he sent a female home health aide after a female client undressed in front of the male aide who cleaned her home and brought groceries. "The aide was not sure what to do about this," Bryan said. "Every time he went to her home, it happened."
  • Redirect unwanted advances
    "We try to redirect them to get their mind on other activities,"said Angie Brown, director of resident care at Eden Gardens of Atlanta. Get the person to talk about a favorite hobby, or take him or her to another location, if possible. "I also tell them not to do the unwelcome behavior," she said, admitting it does not always help.
  • Get a doctor involved
    "If it's cognitive impairment, you need to get a doctor involved," said Brown. A good geriatric doctor can assess the person, get him or her started on medications that can suppress inappropriate behavior, and even recommend a therapist.
  • Be patient
    Seeing a loved-one act out in an inappropriate sexual manner is difficult to watch and understand. Why is mom behaving this way? Has my father become a dirty old man? Realize that this is not the loved-one's normal conduct. "It is important to remember that inappropriate sexual behavior is just a behavior," reports an article from the Brain Injury Association entitled, Sexuality is a Family Matter. "It should be viewed as such and managed as any other unwanted behavior."
  • Make sure caregivers dress appropriately
    Beth Leber, a Broadspire care manager in Philadelphia, has counseled housekeepers on their dress. They should look neat and professional and not dress provocatively. "If a job entails spending the night at a client's home, then the caregiver should always put a bathrobe on."
  • Try not to be embarrassed
    "We recognize that sexual situations often happen with the elderly," Leber said. "It's unspoken, but it goes on. And it is something that we deal with." 
     
    Leber has dealt with several situations that involved clients and family members. A Pennsylvania client and his wife, both in their late 70s, had an active, healthy sex life before the woman died from a heart attack. The husband, who suffered from dementia, mistakenly turned his affections toward his daughter. "Needless to say, she was very uncomfortable that her father did this," Leber explained. "To get him to stop, the daughter would change the subject and talk about her deceased mother. She would constantly remind him who she was within the context of the conversation."

    At the same time, Leber warns that the daughter had to be careful not to overdo the reminders. If her father understood the advances he was making, he might have been so embarrassed that he could have ended the relationship.
  • Privacy is sometimes appropriate
    If the situation warrants it, Leber suggests giving clients their privacy. "When it's appropriate, allow them to do whatever they want to do. For some people, sex is a very important part of their lives." 

    Depression has a profound effect on sexual behavior. For someone who has had a good sex life, lack of activity can make them depressed. "Talking about it does not have to be taboo," Leber said. "And in a lot of families, it is."
     
    Sexuality is an area that is often difficult for families to discuss within and outside the family circle. By communicating about inappropriate sexual behavior, family members and caregivers can help alleviate possible problems, and embarrassing and unsafe situations.

Exercise - Physical & Mental
Not using a muscle or an organ is just like not using a machine. In time, it will become unusable. Not exercising your muscles or your brain will cause it to become unusable. Caregivers should pay particular attention to an elderly person whose lifestyle and social opportunities limit the amount of overall stimulation the person experiences on a regular basis

No physical exercise program should be implemented without the physician's advise. A sedentary lifestyle over many years cannot be repaired in short time, and may not be able to improve to any great degree, even over a long period of time. However, even limited exercise will improve circulation, improve the person's mood and may even result in better judgment and clearer, more capable memory.

  • Walking is one of the best exercises. In good weather, a stroll through a park can be relaxing and pleasurable while it increases the heart rate and improves circulation. Inclement weather or too cool temperatures may make the park uninviting, but the mall or the local museum would be another option.
  • Swimming is the most attractive exercise option, particularly in the hot, Southern summers. It is low impact, comfortable, and refreshing. Many Southern seniors participate in water aerobics in group sessions.
  • Crossword puzzles have long been an enjoyable pastime for many seniors. Doing new crosswords or other word finding puzzles keeps the mind stimulated and the person feeling accomplished.
  • Card games are another social and enjoyable activity for the young and old. Caregivers can pass the time with an individual while helping to keep their mind active.

Nutrition Training
The caregiver should be trained to shop, prepare food, and serve an appropriate combination and portion at mealtime. Depending on the elderly person's diagnosis, the care manager will train the caregiver in what food to provide and how to provide it. Following is an example to be followed for cardiac patients.

  • Shopping should include checking labels. Since 1995 the American Heart Association has provided consumers with an easy way to identify heart-healthy food. Look for foods bearing the red heart with the white check mark to spot those low in saturated fat and cholesterol.
  • The care manager will instruct the caregiver regarding cholesterol:
    What is LDL cholesterol? Low-density lipoprotein is the major cholesterol carrier in the blood. If too much LDL cholesterol circulates in the blood, it can slowly build up in the walls of the arteries feeding the heart and brain. Together with other substances it can form plaque, a thick hard deposit that can clog those arteries. This condition is known as atherosclerosis. A clot that forms near this plaque can block the blood flow to part of the heart muscle and cause a heart attack. If a clot blocks the blood flow to part of the brain, a stroke results. A high level of LDL cholesterol reflects an increased risk of heart disease.
     
    What is HDL cholesterol? About one-third to one-fourth of blood cholesterol is carried by HDL. Medical experts think HDL tends to carry cholesterol away from the arteries and back to the liver, where it's passed from the body. Some experts believe HDL removes excess cholesterol from plaques and thus slows their growth. HDL cholesterol is know as "good" cholesterol because high HDL levels seems to protect against heart attack. The opposite is also true: a low HDL level indicates a greater risk. A low HDL level also may raise the risk of a stroke.
       
    What about cholesterol and diet? Typically the body makes all the cholesterol it needs, so people don't need to consume it. Saturated fatty acids are the main culprit in raising blood cholesterol, which increases your risk of heart disease. The American Heart Association recommends that you limit your average daily cholesterol intake to less than 300 milligrams. Everyone should remember that by keeping their intake of saturated fats low, they can significantly lower their dietary cholesterol intake. Remember, cholesterol is in all foods from animal sources, do not eat more than 6 ounces of lean meat, fish and poultry per day and use fat-free and low-fat dairy products.
  • Managing weight - Not everyone can be thin, but you can maintain your best weight. It is possible. Though genes affect your susceptibility to obesity, some people eat too many calories. Plan your menus to include healthy, low fat meals.
  • Portion control
    Grains - Serving size is 1 slice of bread, ½ cup of cooked cereal, rice or pasta, 1 cup of ready-to-eat cereal.

    Vegetables - Serving size is ½ cup chopped raw or cooked veggies, 1 cup of leafy raw veggies. 1 cup = your fist.

    Fruits - Serving size is 1 medium apple, orange or banana, ½ cup of juice, canned fruit or dried fruit. Medium piece of fruit = a baseball.

    Dairy - Serving size is 1 cup of milk or yogurt, 2 ounces of cheese. 2 ounces of cheese = a pair of dominos.

    Protein Foods - 3 ounces cooked lean meat, poultry or fish, ½ cup dry beans, 1 egg counts as 1 ounce of lean meat, 2 tablespoons of peanut butter. 3 ounces of meat or fish = palm of your hand.

    Fats - Serving size is 1 teaspoon of butter, 1 teaspoon of oil. 1 teaspoon of butter = tip of your thumb.

Safe Lifting Instructions
As people age, or when they become disabled, it may be increasingly difficult to transfer from a bed to a chair, or to stand from a seated position without assistance. There is a variety of equipment available including specially designed chairs that aid in standing, elevated toilet seats, even a hoyer lift to aid with a total transfer. Lifting incorrectly can result in a variety of injuries. Back strain is a very common one. It results from over-stretching certain muscles, but it can be avoided by practicing safe lifting techniques. Hernias are another injury associated with lifting. A hernia does not generally result from a single lifting effort; it is usually the result of continued extreme exertion, especially done contrary to the structure of the body. However, there are also lifting techniques that protect the elderly as well as the caregiver from injury. These tips should be followed when lifting a person or an object.

  • Before lifting, make sure your pathway is clear of objects that could be in your way. Be sure the floor is clear and dry so you won't trip or slip.
  • Bend your knees and keep your back straight. Lift with your legs, not your back. Be sure you have a good grip on the person.
  • Bring the person close to your body.
  • Lift in a slow, even motion.
  • Don't twist your body. If you must turn, move your feet. Keep your balance with footwork.
  • Keep your back straight when putting the person down.
  • Get help when you need it. If the person is too heavy or has fallen to the floor, don't try to lift them. Get help.

The care manager will role-play the technique with the caregiver, acting as the disabled or elderly person, then observe the caregiver with the elderly person.

Skin Care
As the body ages, the skin becomes thinner and very fragile and easy to tear. There are some simple remedies that can help. They won't repair the damage from sun exposure or refresh the skin to younger conditions, but they can be helpful in making the skin more durable and the individual more comfortable.

  • Hydration - Be sure the older person maintains a healthy habit of drinking plenty of fresh water every day. The elderly can become dehydrated easily and the effects of dehydration can be devastating. The AMA recommends drinking 8 - 8oz glasses of water per day. Use the "skin pinch test" to test for dehydration.
  • Moisturizing - Healthy skin is soft and pliable. As we age our skin loses moisture and benefits from adding a topical moisturizer. There are many products available for softening and moisturizing dry skin. Using a cream or lotion and massaging dry skin on the hands, elbows, heels and other dry or cracking areas will reduce the risk of cracking, infection and other skin breakdown problems.
  • Irritations - Often aging individuals who have difficulty moving without assistance, receive personal care like bed baths. It is extremely important to check the skin for irritations, pressure point areas that are warm to the touch, and other indications of potential problems.
  • Sagging - As skin becomes less elastic, it also becomes drier. Underlying fat padding begins to disappear. With loss of underlying support by fat padding and connective tissues, the skin begins to sag.

Sleep
A good night's sleep is extremely important to good health. It helps us stay healthy. Although sleep patterns change as we age, disturbed sleep is not a part of normal aging. It is often the sign of emotional or physical illness. Repeatedly having a poor night's sleep should be reported to the physician.

Here are some steps you can take to help to get a good night's sleep:

  • Make bedtime and waking time a routine. Altering bedtime and getting up much earlier or later than normal interferes with the "body clock" and can make it difficult to fall asleep or leave you waking up tired.
  • Don't take frequent or prolonged naps. You will be less tired at bedtime and take much longer to fall asleep.
  • Keep your bedroom dark and quiet so that you can relax and easily fall asleep.
  • Don't use your bedroom as a TV room. Get into the habit of watching TV and reading in another room and use your bedroom for sleep only.
  • Don't drink excessive beverages late at night, especially those with caffeine. Also nicotine is a stimulant so don't smoke cigarettes at night.
  • Hours of sleep required varies by individual. Sacrifice sleep and you sacrifice peak performance. It's noticeable in rates of traffic accidents and work injuries.
  • Not enough sleep will impact your learning potential, your moods, your alertness, and may compromise your health.

If you aren't getting a good night's sleep and are having trouble functioning normally during the day because you are tired, see your physician.