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  • Care Issues

    Bone Density
    Falls/Safety Awareness
    Falling Stars
    Wound Care/Healing/Pain

    Bone Density

    Decreased bone density can lead to an increased risk of serious injuries, such as broken bones, caused even by simple movement. Bones become more porous as we age, and slower to heal in the event of an injury. Women are four times more likely to develop fragile bones, but men can suffer from it as well. Taking such steps as consuming adequate calcium and exercising can slow the loss of bone density, but the decrease is a natural effect of aging, and as bones become more porous they are more prone to breaking. Such fractures can be caused even by simple movement and can heal slowly or not at all, depending on the age and the health of the individual.Osteoporosis is a condition that causes thinning and weakening of normal bone. More than half of all Americans 50 and older have low bone mass, which puts them at increased risk of developing osteoporosis and related fractures. The percentage increases drastically, especially among women, as people age.Source: National Osteoporosis Foundation

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    Falls/Safety Awareness

    A simple fall is not normally considered a health risk. But among the elderly – especially those who have reduced muscle mass and brittle bones due to osteoporosis – falls can be serious and even disabling. Falls are common among those 65 and over, whether or not they live at a nursing home. Each year over 30% of seniors are reported to fall at home. There are several reasons:

    • a decrease in safety awareness as we age
    • changes in vision, hearing, muscle strength, coordination and reflexes
    • health disorders – diabetes, heart condition – that affect balance
    • disorienting effects of some medications

    In a nursing home, a fall can often result from a resident's impatience or reluctance to ask for assistance in walking or getting up to use the restroom. While no program can prevent all falls, our Falling Stars program is aimed at minimizing the number of falls and the severity of any resulting injuries. Ways loved ones can help include:

    • reporting changes in the resident's stability, strength or gait to the staff
    • encouraging the resident to take it slowly
    • expressing empathy; a common reaction to a fall is fear of falling again

    Source: www.cdc.gov/ncipc/factsheets/adultfalls.htm

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    Falling Stars

    How We Can Help Our Falling Stars program is designed to alert staff members about residents who are at special risk for falling. We research specific patterns, situations and behaviors associated with falls, and we use colorful symbols to establish a common method of communication to alert staff about who is at risk for falls. Unfortunately, the only way to avoid falls would be through the use of restraints that severely restrict independence. In assessing the best approach to reduce the risk of falls, we strive to achieve a balance of the resident's independence, freedom of movement, dignity and safety. For more information on Falling Stars, contact the executive director of your nursing home. In 2003, more than 1.8 million seniors were treated in emergency departments for fall-related injuries and 460,000 were hospitalized. The chance that a fall will cause a severe injury requiring hospitalization greatly increases with age.

    Source: www.cdc.gov/ncipc/factsheets/adultfalls.htm

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    Although every effort is made to keep residents fed and hydrated, the ability to take nourishment is affected by the desire to eat and drink and the perception of whether someone is hungry or thirsty. Several factors can influence appetite:

    • sadness, grief or depression
    • tooth loss or ill-fitting dentures
    • reduced ability to feed oneself
    • certain medications that can mask hunger or contribute to dehydration

    Hydration is especially important in aiding the body's ability to recover, and dehydration is not always easy to recognize or diagnose. Many symptoms do not appear until significant fluid has been lost. In addition, if a resident becomes dehydrated, the cause may also be related to medication, illness or swallowing problems. Loved ones can play an important role in helping a resident by:

    • Alerting the staff to any risk factors such as swallowing problems
    • informing the staff about a resident's beverage and food preferences
    • keeping fluids within the resident's reach
    • continuously encouraging the resident to eat or drink
    Dehydration is one of the most frequent causes of hospitalization for the elderly. One-third of people over age 65 are affected by nutritional deficiencies. The incidence of protein-calorie malnutrition is higher among the elderly than any other segment of the population.

    Sources:Columbia University Medical Center www.unce.unr.edu/publications/files/hn/other/fs9930.pdf*
    * - This document requires the Adobe Acrobat Reader. Click here to download it.

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    Wound Care/Healing/Pain

    As the body ages, it undergoes changes that affect its ability to heal. Our skin becomes drier and less elastic, and the layer of fat under the skin decreases, resulting in increased bruising or tearing. Diseases such as diabetes can increase the risk of skin problems and wounds. Pressure ulcers (bedsores) can develop, especially in elderly bed-bound people who are unable or unwilling to move. At the same time, it's more difficult to tell if a treatment regimen is working because recovery time slows from wounds or other injuries. Nutrition also has an impact – without proper food and hydration, the body's ability to heal is affected. It's also important to remember that since older adults may suffer from multiple medical problems, they can have different types of pain. Loved ones can help residents and caregivers in several ways:

    • Encourage the resident to participate in physician-ordered therapies and physical activities.
    • Report observations to the staff about skin tears, rashes, discolored areas or bruises.
    • Assist with skin-care prevention measures such as turning the resident, massage, range of motion exercises or bathing. Of course, any assistance should be done in close coordination with staff to avoid injuries.
    • Support residents as they recover, with the awareness that they may not return to their prior level of functioning.

    There is a growing emphasis on pain management, including more detailed assessments and plans of care. It is estimated that a third of all Americans will have severe chronic pain at some point in their lives, but that it often goes unrecognized or under-reported. You can help by becoming aware of the resident's verbal and non-verbal responses to pain, including grinding of teeth or resistance to being moved. Kindred is participating in a demo project with the federal government to better address pain in the long-term care facility.About 9 percent of residents in healthcare centers have pressure sores.An estimated 50 million Americans live with chronic pain caused by disease, disorder or accident. An additional 25 million people suffer acute pain resulting from surgery or accident.Source: U.S. Department of Health and Human Services

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    Although many mental changes are a normal part of the aging process – including decreased memory and slower thinking – depression, dementia and Alzheimer's disease are examples of more severe mental changes that can be stressful, frustrating and frightening. And, experts estimate that as many as two-thirds of nursing home residents have some sort of dementia. In addition, many of the medical and physical problems discussed on these pages are complicated by cognitive impairment. 

    Alzheimer's Disease
    It's important to note that Alzheimer's disease is not a part of normal aging. It is a disease that affects the brain, specifically nerve cells, or neurons, which send messages through the body. Alzheimer's disease disrupts normal brain function and affects memory, communication and personality. Alzheimer's is an irreversible, progressive brain disease. Although no cure is known for Alzheimer's, progress is being made on almost a daily basis to find its cause and cure. A therapeutic environment such as a healthcare center is supportive rather than curative. Special measures can be taken to help lessen the impact of Alzheimer's and give the resident a feeling of comfort and safety. Here's how loved ones can help:

    • Alert the staff to any changes, no matter how subtle, that you notice.
    • Inform the staff of a resident's historical information – likes and dislikes, former occupations.
    • Encourage the resident to take ordered medications and participate in planned activities.
    • Seek assistance from outside support groups.
    Dementia occurs when a person's mental state deteriorates. It can take as many different forms as there are individuals, but one common form is multi-infarct dementia. Multi-infarct dementia is caused by a series of small strokes that disrupt blood flow and damage or destroy brain tissue. A person may have several small strokes before noticing serious changes in memory or other signs of multi-infarct dementia.

    No treatment can reverse brain damage caused by a stroke, but treatment is available to help prevent further strokes, including medication to control high blood pressure, heart disease and diabetes. Also, medication that causes confusion, such as sedatives, antihistamines or strong painkillers may be changed or stopped.

    Depression is a less tangible but no less important concern. Any major change in life brings emotional stress, and when a loved one is admitted to a nursing home those stresses affect loved ones as well. If a resident develops depression, physical health can often be affected, especially if the resident refuses to eat, drink or accept medication.

    Of course, many forms of depression may be treated with medication. Beyond that, however, regular family visits and involvement in the resident's care is also important. Loved ones are valuable resources in alerting caregivers to any health, behavioral or cognitive changes they may notice in the resident.

    Scientists think that up to 4 million Americans suffer from Alzheimer's disease. The disease usually begins after age 60, and risk goes up with age. About 3 percent of men and women ages 65 to 74 have Alzheimer's disease, and nearly half of those age 85 and older may have the disease.

    Source: Alzheimer's Disease Education and Referral Center

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    Problems with control of one's bowel or bladder are widespread in the elderly. The reason may be muscle weakness or a decreased awareness of bodily function. Whatever the reason, however, incontinence can be embarrassing as well as uncomfortable.

    Incontinence is an emotional as much as a physical issue – the fear of losing bladder or bowel control can keep a loved one from participating in social events or even from normal daily interaction. Fortunately, there are protective and preventive measures to help deal with incontinence, such as absorbent undergarments and scheduled toileting.

    Two nursing home studies have identified a 45% to 47% prevalence of fecal incontinence among residents. Studies suggest that incontinence contributes to the decision to institutionalize elderly patients.

    Source: International Foundation for Functional Gastrointestinal Disorder

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