Pleasant Days for Elders

Vitamin D and your Elder

noreply@blogger.com (Valarie) — Sun, 18 Jul 2010 15:03:00 +0000

There has been more and more evidence from research lately about Vitamin D levels and good health. This recent article (click on the title of this post to be directed to the article) talks about cognitive function and vitamin D levels. Elders with low levels of Vitamin D can experience worsening cognitive problems. So, if your Elder already suffers with dementia, a low Vitamin D level can make it worse. And even if your Elder does not have dementia, adequate levels of Vitamin D can promote good memory and cognitive function as well as prevent cancer and promote cardiovascular health.

To find out whether this is a problem for your Elder, just ask his/her physician to do a blood test for a Vitamin D level. A level below "25" is considered a deficiency.

Or, you can give your Elder a supplement pill with Vitamin D. If you choose a supplement with more than 400 units of Vitamin D, make sure to talk to your Elders physician about it first. But, more and more, people are being informed by their physicians that they should be taking up to 1000 units per day.

Normally, we get Vitamin D from sun exposure on bare skin. Your body will manufacture Vitamin D with only 15 to 20 minutes of sun exposure (without sunscreen). However, Elders have a diminshed ability to produce Vitamin D that gets worse with increasing age. So, most Elders will need a Vitamin D supplement.

Just a small thing that, hopefully, can help you and your Elder have more Pleasant Days.

( Clicking the picture will take you to the publisher's page and photo on Flickr)

Good News! in the news this month.

noreply@blogger.com (Valarie) — Thu, 11 Mar 2010 00:22:00 +0000

Don't we all need to hear some good news. Well, this month while perusing all the medical and nursing "news" that I do---you'll never guess what!

There has finally been a couple of studies done that may benefit our Elders.

The first study was done for chronic stroke victims to see if more therapy would be beneficial. The study found that intense therapeutic exercises can help stroke patients regain some function, even long after the stroke has occurred. The results of this study were "unveiled" at the 2010 International Stroke Conference in San Antonio, Texas. Up until now, the medical community in general has believed that function could not be regained after a year post-stroke. Now, hopefully, the results of this small study will open the way for more research to be done so that our Elders can have their extra rehab paid for by insurance.

For now, just know that if your Elder has had a stroke, it is never too late to get more exercise to improve function and quality of life. If you want to read the article from Medscape Nurses, click here.

The second study shows that exercise can reduce anxiety levels in sedentary people with chronic illnesses (which would describe many of our Elders that we care for). Rather than using medications with all the side effects the elderly are so susceptible to, routine exercise was found to have a therapeutic effect on reducing anxiety levels, as well as reducing fatigue and problems with cognition. You can see this article, if you like, from Medscape Nurses, by clicking here.

The articles, being about research and studies, are very boring. But the messages are exciting. More exercise can give you both more Pleasant Days. I know, we already knew that---but now it's official.

(photo from Flickr.com)

Insomnia in the Elderly (and You)

noreply@blogger.com (Valarie) — Mon, 08 Mar 2010 22:20:00 +0000

Sleep, for both you and your Elder, is essential for good health and quality of life. If your Elder does not sleep at night, your lives will quickly become very unpleasant. You will become fatigued, irritable, cranky and feel sick all the time, finding it difficult to concentrate and complete daily tasks. Your Elder may become more confused, delusional and generally become much more difficult to deal with. This can lead to a lack of appetite, and before you know it, your Elder is spiraling down into a pit of poor health and dementia. You don't want this to happen, so what can you do to stop it.

Drugs seem to be the "magic" that will fix this whole scenario if you talk to your Elder's physician. However, an occasional sleep aid might be OK for you, but will have unwanted effects on your Elder---more confusion, more lack of appetite, and most often the Elder will still get up even though sedated with more confusion and tendency to do crazy and unsafe things during the night while no one is watching. You can't take anything because you want to be easily awakened in case your Elder should need you. And if you are one of the really unlucky people caring for an Elder, your situation is that you must be ready to "rescue" your Elder at night because that's when s/he is most confused and unsafe, constantly trying to get out of bed and to the bathroom, at risk for falls and hip fractures, prowling through the house and engaging in unsafe activities, and the most feared: trying to leave the house.

You have to get this situation under control. Otherwise, your and your Elder's days will quickly become UnPleasant. This is how to work on it:

First and foremost, you need to rule out some obvious things that can keep your Elder from sleeping.
---The bed is not comfortable for "old bones". This will make your Elder keep waking up to reposition, and make it hard to fall back to sleep. If you can't purchase a new mattress that is ultra soft but supportive, try a thick foam mattress overlay. You can find these at various department stores, or specialty stores for bedding.
---Chronic pain is the worst at night. Even if your Elder "does alright" during the day, treating the pain at night will result in a sounder sleep. Most Elders, especially those that require assistance to maintain any quality of life will have chronic pain. Start with plain acetaminophen (unless your Elder has liver disease or damage), and consult with the physician if this is not effective.
---Make sure the sleeping environment is quiet and dark. If your Elder needs lighting for safety or feeling secure, provide very dim night lights.

If this does not solve your problem, here are some ideas to work on.
1. Establish and maintain a regular daily routine. This includes a regular bedtime routine as well. Your Elder should arise and go to bed at the same times every day. Make sure the routine allows for at least an hour of relaxing in dim light prior to going to bed.
2. The daily routine should also include some exercise to tolerance, even if this is just walking. The more energy you Elder uses during the day, the better sleep will be at night.
3. Avoid caffeine after noon. And avoid alcohol after 4pm. Contrary to popular belief (especially in Elders, who back in "the day" used alcohol for its "medicinal properties"), alcohol does not make you sleep better. It will make you drowsy so you fall asleep quicker, but in a few hours when the initial sedative effects wear off, you are wide awake and unable to get back to sleep. Also, if your Elder finds sugar and chocolate stimulating, avoid these several hours before bed as well.
4. Avoid large meals several hours before bedtime. Its best for Elders to have the large meal at midday, and a lighter meal in the evening. A light snack including some milk and carbohydrate at bedtime is more conducive to a good night's sleep.
5. Try to establish what your Elder will do when s/he can't sleep. Think of something safe and relaxing. A comfy chair in the bedroom (keeping it out of the walkway to the bathroom) might be nice with a dim reading lamp alongside, with some books for reading that is soothing and calming when unable to sleep. Or, even one of those "coffee table books" with lots of pictures that inspire peaceful and happy thoughts. Sitting up to watch T.V. is another option.
6. If a noisy environment is a problem, try some "white noise" to block out unwanted sounds. Some people who have ringing of the ears use this to relax. There are different types of white noise, like ocean waves, whale song, wind through trees, etc. Or, your Elder might enjoy music instead. There are many stations that offer the "oldies, but goodies" type of tunes so you can find music from the right era. Most people get pleasant thoughts from music they enjoyed during their young adult life.
7. Encourage a hot bath before going to bed, to soak away the day's troubles and some of those muscle and joint aches. Try some aromatherapy with the bath---a small amount of lavendar essential oil can be very calming.
8. The day should include some time outside in bright, natural sunlight.
9. Melatonin is a natural sleep aid that has few side effects, and does not interact with other medications. It is a hormone that is found naturally in the body, that regulates the wake/sleep cycle and other daily biorhythms. As we age, our levels of melatonin can decrease, making the normal rhythm of the day more problematic to maintain. A dose of 2 to 3mg at bedtime may work to promote sleep. Use a much lower dose if you are taking it every night, or if this amount causes too much grogginess in the morning.
10. Many Elders become uneasy at night for a variety of reasons. Providing a dim night light can make trips to the bathroom easier, as well as providing some reassurance when the elder awakens during the night by being able to orient themselves. Another cause of worry is that s/he may need assistance and will be unable to tell you. You can easily remedy this, and put her/his fears to rest by providing a wireless "door bell" that you can get inexpensively at a hardware store (or places like Walmart). You give your Elder the button to push; and you keep the bell. This works for most distances between bedrooms in the same house. The biggest problem is making sure you have enough batteries for both the button and the bell. This will give you both enough reassurance to get some rest at night.

Heres to many peaceful and restful nights, so that you and your Elder can have more Pleasant Days.

(to acknowledge photographer for image in this post, click here)

Dry, Itchy Skin Rashes are NOT Pleasant

noreply@blogger.com (Valarie) — Mon, 29 Jun 2009 23:59:00 +0000

This image is called
"Stop and Smell the Flowers".

(clicking on the picture links to the photographer's page on Flickr)

Dry skin can be a big problem for your Elder. It's miserable, itchy, flaky, and leaves your Elder wide open for infection. This is not what we want in our ever-constant pursuit of Pleasant Days.

I know, the picture has nothing to do with dry, itchy skin. Just thought it was cute.

The dry skin that affects elders is very much like "winter dry skin" that affects people of all ages when the air becomes very dry. People who have lived through winters where it is very cold and snowy, or in arid deserts know what I'm talking about.

In Elders, the skin very often does not make its own oils any longer, which makes it impossible for the skin to retain any moisture at all. After some time, the skin becomes flaky, inelastic, will become reddened, rashy, itchy. The Elder tends to scratch---this breaks the skin, fissures develop, bacteria invades and then you have a really big problem.

Many times people will seek help from their doctor or dermatologist, most of whom try to treat this condition medically, which will sometimes not help or worsen the problem. Don't get me wrong---many dermatologists are very good, will recognize the problem for what it is and be able to help you. But the idea here is to take care of the aging skin so that it does not become any drier than it has to be, and you don't end up with a miserable Elder needing expensive treatment or worse.

Even with these steps in skin care, you may still notice dryness. But hopefully proper skin care can prevent itching, then scratching, then damage to the skin.

Bathing more than twice a week is usually not necessary for your Elder. And then, showers are much better than baths as the skin is in the water for much less time. Use warm, never hot water---hot water will strip precious oils from the skin and cause damage. Keep in mind your Elder may prefer hot water because of aging circulation and peripheral nervous function, s/he may not feel the warmth of the water. You have to try to explain the reasoning behind avoiding use of very hot water. You might try placing a heater in the bathroom for a time before showering so the room is very warm. (Bad for you, but good for your Elder who won't complain so much about bathing). A note here as well about comfort of showering: because of problems with the peripheral nerves, your Elder may complain that the shower spray is painful or uncomfortable---try using a very fine gentle spray. You may even have to go shopping for a new nozzle, but this is well worth the effort if your Elder has this problem; plus it will be much gentler on the old skin.
Never use anything but extra moisturizing body wash and shampoos. Generic body washes are OK, but tend to be less moisturing than others. Dove, Caress and the like are good ones. WalMart makes an Equate brand that is very good (it says "extra-moisturizing). Keep in mind shampoos can also be irritating to scalp and skin if they are too harsh.
Always apply an extra-moisturizing lotion to the skin that is still warm and damp from the shower. There are plenty to choose from. Some that smell great, some that are hypoallergenic. Just make sure it is very moisturizing.
Pat dry with a towel, do not rub. Here again, the bathroom needs to be very warm to encourage air drying of the skin. So, you don't want your Elder to freeze in an unheated bathroom. Just remember---you may feel like you are in a sauna, but this will be more comfortable for your Elder. (unless your Elder has difficulty breathing because of COPD, emphysema or congestive heart failure with fluid on the the lungs).
Keep your Elder well hydrated. Skin needs water to stay moist and supple. Many Elders are on the borderline of dehydration because they don't feel thirsty, they don't like to drink too much because then they have to pee too much, and most don't like plain water. You need to have scheduled hydration for these problems. Make sure your Elder drinks with meals, between meals, and a full cup of water minimum with medication. About 1.5 to 2 quarts of fluids a day (half of which should be water or herbal teas) is good, unless the Elder's doctor has said otherwise.
A well-balanced diet with 5-6 servings of protein foods (meats, eggs, nuts, legumes); 2-3 servings of milk products (low or non fat milk, hard cheeses, yogurt); 5-6 servings of whole grains; 5-6 servings of fruit and vegetables and use of fats such as olive oil and avocados will provide all the necessary vitamins, minerals and nutrients to keep the skin well nourished and functioning as well as it can.
For very, very dry flaky skin, use of a barrier cream might be needed. You can use plain petroleum jelly---a thin layer rubbed into the skin will keep moisture from escaping. Some people will even use Crisco for this.
Reapply lotion every day between showers. This is easily accomplished during the "partial bath" on days not showering (you know--face, pits and privates). When the lotion smells wonderful, it can be an enticement to doing this mini-bath. Yeah, I keep going on about how Elders hate to bath---but it's true, many do. Anyway, there is something to be said for "aromatherapy".

So there it is in a "nutshell". I hope this helps, if this has been a problem for you. Just trying to help everyone have more Pleasant Days.

Getting Serious about a Low Sodium Diet

noreply@blogger.com (Valarie) — Sat, 21 Mar 2009 21:00:00 +0000

Many people realize that reducing their salt intake would be good for them; many people even go so far as to say "I'm trying to cut back on the amount of salt I eat." This is fine for young people, though a low sodium diet now would likely prevent health problems in the future when their bodies are not as well equipped to handle large amounts of salt, or sodium.

For people with chronic conditions like hypertension, fluid retention, swelling of hands and feet, kidney problems, and heart failure, being serious about sodium intake is crucial. It is likely that your Elder has at least one of these conditions. Too much salt or sodium in the diet can adversely affect quality of life for these people. Medicines can only do so much. With most chronic conditions, it's up to the person to decide to help themselves. Or maybe in your case, it's up to you to decide to help your Elder.

I have spent a lifetime advising people on the sensibility of a low salt diet. But, I am ashamed to say, I wasn't really serious about it myself until I developed hypertension at a relatively young age (40). We also have to take into account that medical science has decided that what we used to think of as normal blood pressure "for your age", is now considered high and in need of treatment. By the time we finally realize the problem, the damage has been done. Still, reducing sodium in your diet can help you have less symptoms, and be able to control the condition with a minimal amount of medication, which also means you have fewer side effects to deal with. All of this translates into greater quality of life, and many more Pleasant Days.

So, I am here to tell you----do yourself a favor and cut back on the salt you are eating now. You will get used to it, believe me. And in the long run, you will be a much healthier person for it which will allow you to enjoy your later years.

To do this, you need some basic knowledge about salt. Keep in mind that sodium in an essential nutrient, very important in the proper functioning of the body. But too much can be as harmful as too little. Also keep in mind that you will get an adequate amount of sodium from natural foods without adding any salt at all. Here's what you need to know:

Salt is a mixture of sodium and chloride. This is different from plain sodium, but we can think of it as the same. Note, however, labels will list the amount of sodium in food.
You should not eat more that 2300 mg of sodium everyday. That's about a teaspoon of table salt.
Be aware of monosodium glutamate in foods you buy (almost everything in a package) on top of the salt that is also added. This can include foods with "hydrolyzed proteins", "flavor enhancers" and "natural flavors".
Also watch for any ingredients with the words "disodium", or "trisodium".
Baked goods have quite a bit of sodium, not only from salt but from baking soda and baking powder. This will be true even if you make them at home.
Prepackaged or canned foods listed as "Low Sodium" on the label will still have sodium in them that you need to be aware of. Always read the label so you know exactly what you're getting.
Sources of extra sodium: Frozen dinners, Ready-to-eat cereals, Vegetable juices, Canned vegetables, Deli meats, Pre-made soups (can or box), Marinades, Flavorings, Pre-made Sauces, Prepackaged rice, potato or pasta dishes with a flavor packet, Condiments, some OTC medicines, Restaurant Food, Fast Food.

Read the Label, and know what certain terms about sodium content mean. This information is from WebMD:

Sodium-free: Less than 5 mg of sodium per servingVery low-sodium: 35 mg or less per serving
Low-sodium: Less than 140 mg per serving
Reduced sodium: Sodium level reduced by 25%
Unsalted, no salt added, or without added salt: Made without the salt that's normally used, but still contains the sodium that's a natural part of the food itself.

The best way to reduce salt in your diet is to measure what you use, and use fresh ingredients to cook with. Frozen is great, just make sure there are no added flavorings. Use herbs, spices without added salt or sodium, and fresh peppers, onions, garlic, shallots, etc. Even adding celery and carrots to sauces and soups will add extra flavor. When you cook your own cereal, rice, pasta you can decide whether to use some of your teaspoon of salt to cook it with or not. Replace bouillons with sodium free stocks to make soups, sauces and gravies. Make your own stock and freeze it for use later. Make your own gravy.

The idea here is not to totally abolish salt from your diet, unless that's what you want to do. The whole idea is for you to decide how much salt you want to eat without having to guess.

Be aware of additives when buying frozen foods. Buy plain rice, barley, pasta etc, rather than buying boxes of pre-seasoned rice or pasta mixes. Cooking your own food, and deciding how much salt you want to add to it, can be just as simple as relying on prepackaged and processed foods. You only need to change your grocery shopping habits.

Measure the salt you're going to use everyday. If you want to use only 1 teaspoon of salt, then measure out this amount into a small container for the day. You decide how to use it, whether you cook with it, or add it after the food is cooked. When it's gone, don't eat anymore. After some time, you will find that you may not need to use the whole amount in a day. You will find yourself becoming more creative in ways to flavor your food without salt.

I tell people not to use salt substitutes. Salt substitute is made from potassium rather than sodium. Eating too much potassium is just as bad as eating too much sodium, although this is not likely because potassium chloride has a bitter flavor. Extra potassium can be very detrimental to people with certain diseases affecting the kidneys, heart, or diabetes. Salt substitutes should also not be used with certain medications. Always check with your doctor before using a salt substitute.

If you are a real stickler for the amount of sodium you want to eat, or you want your Elder to eat, try keeping a food diary. Then look up the amount of sodium in each food naturally. Then add the amount of sodium in the salt you used. You will probably find that the naturally occuring sodium in foods is plenty without the added salt. If you're interested, here is the USDA National Nutrient Database for Content of Sodium in mg.

Do yourself, your loved ones, and especially your Elder a favor. Reduce the salt in your diet, and teach your family to do the same. You won't regret it.

Wishing you and your Elder Pleasant Days.

"Living with Congestive Heart Failure"

noreply@blogger.com (Valarie) — Sat, 14 Mar 2009 20:28:00 +0000

In case you don't follow the blog "Bill Boushka Retires" (one of the blogs I follow), I just wanted to point out that he has noted a very good video on YouTube about congestive heart failure. Since this is a common chronic condition that many of our Elders have to deal with, I thought the video valuable. It was very informative and understandable to lay people, with information about symptoms, risk factors, current diagnostic tests and treatments, how to prevent CHF if you have risk factors, what to do if you suffer from CHF as far as diet, exercise and OTC drugs to avoid, and what to watch for and report to your doctor.

The video is presented by UCSF's (University of California San Francisco) Osher Lifelong Learning Institute.

Dr. Michael Harper, Director of the Geriatrics Fellowship Program and Associate Clinical Professor of Medicine at UCSF, discusses living with congestive heart failure. I thought him to be a very interesting speaker.

If you or your Elder have risk factors or suffer from heart failure it is well worth the time to see the video. One can still have Pleasant Days even with CHF. Check it out. Here's the link:

"Living with Congestive Heart Failure"

How do You Know When Your Elder needs Help?

noreply@blogger.com (Valarie) — Tue, 03 Mar 2009 23:41:00 +0000

I came across this picture, titled "Father's Hands", in my perusings, and the story linked to it touched my heart. But among other things, it made me think about the conversations I have had with others about the topic of this post:

Just how do you know when your Elder needs help? Most Elders try very hard to hide the fact that they are "slipping", being fearful of what may happen if someone decides they are no longer independent. So it's usually unlikely that your Elder will just ask you for help. There are many emotional tags that go between parents and children (or grandparents and grandchildren, or whatever your relationship is). Your Elders do not want to be dependent on you, the younger. They do not want you to tell them how to live their lives. They do not want to bother you, after all you now have a pretty full life, and probably a family, of your own. They have been independent all their lives, and want to stay that way. They are proud and may be in denial about the fact that they need help. And the biggest fear: if they let on they need help, they will end up in a nursing home.

So, you need to be keen to the subtle signs, and the not so subtle signs:

Your Elder is suddenly less social, or exhibits very reclusive behavior.
The house isn't kept up the way it always was before; laundry isn't done; grocery shopping hasn't been done; the yard is not being maintained.
Tasks that used to be routine or easy are now difficult to accomplish.
Your Elder is not eating as well, and/or has suddenly lost weight.
It looks like your Elder has problems taking medications properly, missing doses or taking too many. Maybe prescriptions have not been refilled, or your Elder has missed doctor appointments.
The bills have not been paid, and/or checks have not been deposited.
Personal hygiene is not being done; showers not being taken, oral hygiene not done, clothing hasn't been changed; hair is not being washed.
The pet is not being cared for properly.
Your Elder's driving skills are slipping.
Friends and hobbies have been dropped.
Your Elder seems confused or depressed.
There is difficulty with stairs, maybe falling is a problem.
Loss of bowel or bladder control.
Anything that seems very unusual for the person that you have known can be a sign that things are not quite right. Maybe your Elder's neighbors are reporting things to you that just don't sound like your Elder at all.

So, now what. You talk to your Elder, and you ask questions. But your Elder denies needing help, makes excuses, or explains away your concerns. Be careful here. Don't push too hard, or you might risk putting a wall up between you and your Elder. Above all, the lines of communication must remain open.

Whatever you think, your Elder will be better off in their own environment as long as possible, and with the least amount of intrusive "help" as possible. But there are ways to help that could actually improve the Elder's quality of life.

Start by making sure your Elder's medical needs have been attended to. Go with her/him to a doctor's appointment and discuss your concerns. Very likely there will be things the doctor can suggest, or may refer the Elder to a professional that can further assess the situation. There may be medication changes that need to be made, or conditions that need to be treated that will improve your Elder's strength and cognitive function.

If the Elder's medical needs are under control, make sure medications are being taken properly. This is easy to accomplish as long as you have the Elder's cooperation. Very often it only takes someone to organize the medications in a pill box, so the Elder doesn't need to sort through numerous bottles several times a day. For Elders with very poor memory, you might try putting the medications in an envelope with the date and time to be taken written on it. Leave out only one days supply at a time to prevent more confusion. Your Elder can mark the envelope when the meds are taken to remind them later when they have forgotten whether the medicines were taken or not. Take a look at my post about managing medications.

Make sure the Elder's home environment is safe. Start in the bathroom. By installing some simple grab bars in strategic places, you can greatly enhance your Elder's independence in bathing and toileting. Many times simple things can fix a big problem. Maybe your Elder doesn't bathe as often as they used to because of the fear of falling.

Try to get at the bottom of the problem, then it will be much easier to work on.

What is the real problem. (eg: not showering; not eating right)
Why is this a problem (eg: fear of falling in the bathroom; shopping is too confusing and too tiring)
How can we help this the easiest way possible (eg: install grab bars in the bathroom; deliver groceries/meals to your Elder)

Then, if your "fix" doesn't work, try something else. Always include your Elder in the decision making process. You will be likely to get much more cooperation this way.

This is just a basic idea of where to start. If you are able to notice when your Elder needs help, and are able to provide it before things get out of hand, you will be able to keep your Elder home and independent much longer. And this makes for more Pleasant Days for your Elder and you.

A Guide to the Safe Use of Pain Medication

noreply@blogger.com (Valarie) — Mon, 23 Feb 2009 18:10:00 +0000

Click on the title of this post if you would like to see the new posting by the FDA about the safe use of pain medication.

I thought this was important to post, since we all know most of our Elders are dealing with pain issues on a daily basis (and, probably at least half of us).

Of note for Elders in particular:

Be careful of acetaminophen (tylenol) if your Elder is taking a prescription pain medication. Many prescription pain meds have some acetaminophen in them, so by giving more acetaminophen you are risking an overdose. Acetaminophen overdose can be deadly, impairing liver function.
If your Elder is taking acetaminophen as needed for pain relief, and s/he is doing this without your assistance, please make sure s/he is not taking more than the label says to take. It is very common for Elders to think they can take as much tylenol as they want, thinking it won't hurt them. Even at normal dosages, acetaminophen can cause liver damage in Elders who already have liver problems, or are taking medicines that put undue strain on the liver. If you are in doubt about any of this, consult the Elder's doctor about how much acetaminophen is OK for your Elder to be taking on a daily basis.
With NSAID's (non-steroidal anti-inflammatory drugs) such as ibuprofen or naproxen, be mindful of the risk of stomach bleeding especially in Elders, and especially in those already taking blood thinners. NSAID's can also cause impairment of kidney function.
Use opiods (prescription narcotic pain medicines, such as codeine, morphine, oxycodone or hydrocodone) with caution in the Elderly. Opiods can cause drowsiness, and in Elders can cause confusion, unsteadiness and a higher risk of injuries from falls. Also, while taking opiods be careful not to mix them with alcohol, antihistamines, or other prescription medicines that cause sedation or drowsiness such as medicines for anxiety or for sleep.
Be aware of the active ingredients in all medicines your Elder is taking to avoid harmful interactions or accidental overdose.

That's it in a nutshell, along with some of my own experience. As always, this information is to ensure that you and your Elder have many Pleasant Days.

FDA's Health News for Older Adults

noreply@blogger.com (Valarie) — Sat, 21 Feb 2009 00:26:00 +0000

The FDA has posted the latest edition of "Maturity Health Matters". (just click to view the webpage).

This is the FDA Health News for Older Adults, their Families and Caregivers. There is information about food safety in regards to importing foods, and irradiating foods like iceburg lettuce and spinach for greater safety, with a FAQ section.

I have probably said before, you can't be too careful with your Elders and food to prevent foodborne illnesses. Elders (along with small children) tend to be extremely susceptible to contaminated foods. Infections like salmonella can hospitalize and Elder and cause an untimely death.

Speaking of which....you still need to be careful of peanut products.

Wishing you all Pleasant Days!

Peanut Butter Recall Widget

noreply@blogger.com (Valarie) — Thu, 12 Feb 2009 20:53:00 +0000

I found this on the FDA recall website for the current salmonella outbreak. Since many of our Elders love the things that peanut paste is a big part of----check out your products with this widget.

Safety Concerns for your Elder

noreply@blogger.com (Valarie) — Wed, 04 Feb 2009 18:16:00 +0000

While perusing the web as usual, I found something quite useful to many of you who are caring for Elders with safety problems. This device can be found at 1-800wheelchair.com
and looks fairly priced. The site has alot of things available for activities of daily living problems and mobility problems as well.

We have used similar devices while caring for our Elders, and they are a "God-send". You will be doing yourself and your Elder big favors by preventing accidents, falls from bed or from a chair with the resulting possibility of horrid injuries that your Elder may not be able to recuperate from.

If your Elder tried to get up without assistance with this device in place, an alarm will sound to let you know. For Elders with poor balance or coordination, combined with poor memory or confusion, that try to get up without your assistance and risk falls and fractures, this is ideal. You will also realize some peace of mind, knowing you can leave your Elder unattended for awhile.

Just trying to help you create some "Pleasant Days" for yourself and your Elder.

Is It Dementia, or Is It Depression?

noreply@blogger.com (Valarie) — Fri, 30 Jan 2009 18:48:00 +0000

Often, an Elder suffers with the symptoms of depression needlessly, because the signs of depression in an Elder can be very different than in a younger adult. Statistically, clinical depression affects about 6 million Elders, but only 10% get treatment. Depression late in life is more common than we like to think about, and makes for very Un-"pleasant days".

The main reason it is hard to recognize is because Elder Depression is often accompanied by other common problems of "old age":

chronic illness
medications treating those diseases
loss of physical ability
loss of mental capabilities, and along with this the ability to cope with change and stress
loss of social support systems through death of relatives
relocations

Not only is depression unpleasant, but it also can increase the risk of heart attacks, increase the risk of death from illnesses, increase the risk of suicide, and slow the convalescence from illness or injury.

In short, this is something that your Elder and you should not have to deal with. So, pay attention, look for these symptoms:

increased confusion or memory problems (the most common sign, in my experience)
less energy, sleeping more (or insomnia)
restlessness, irritability
loss of appetite (more common in Elders than eating more)
loss of interest in things that used to hold the Elders attention, or things that were enjoyable.
increased pain, or more physical complaints
sad facial expression most of the time
verbalizing negative, pessimistic, hopeless type things more often
unable to be "cheered up"

If your Elder exhibits even 1 or 2 of these, have her/his physician evaluate for depression.

For an article on Depression in the Elderly on WebMD click (here).

This will explain risk factors and treatment options. And there are links to other articles on WebMD that explain how different treatments work.

There are many ways to treat depression for your Elder, and it is worth the effort to diagnose and treat this problem.

I would recommend that you work closely with the Elder's physician rather that trying home remedies, herbal remedies and such. Your Elder is likely taking other prescription medications that may interact badly with homeopathic remedies. And the risk factors for a depressed Elder are too great to try to deal with this problem without medical guidance.

Wishing you and your Elder Pleasant Days!

New "Links" section Added

noreply@blogger.com (Valarie) — Tue, 30 Dec 2008 17:43:00 +0000

Just wanted to let you all know that I have added a new section for your assistance. Occasionally I run across news articles that are pertinent, helpful, informative, etc. When I do, I will post a link under "Links to Helpful, Informative, Interesting Articles."

Happy New Year to all:
May all of you and your Elders have Pleasant Days throughout the New Year.

We're Right in the Middle of Flu Season

noreply@blogger.com (Valarie) — Tue, 23 Dec 2008 16:37:00 +0000

(Side note: Sorry, I've been away, getting everybody ready for Christmas).

Winter is not my favorite season. Even here on the bay, where the sun shines most of the time, it still gets cold and damp during a few months in winter. It does, however, make for spectacular sunsets and sunrises.

Here we are, having a wonderful Holiday Season, Christmas being the most important time for many people, especially our Elders, and now we are suddenly struck with the threat of severe illness. It happens every year.

Flu season for our Elders can be a life threatening time. This is serious stuff. Many Elders, especially those who are very old, and those with chronic illnesses are especially vulnerable. Illness can come on even when others in the household appear well. Influenza by itself is not usually life-threatening if you are healthy, but it can cause a series of problems that the Elder can not handle physically.

First, the FDA has a wonderful article called "Get Set for Winter Illness Season". So, I will not state again what is already in the article. If you are a caregiver for an Elder, please read this article and follow the advise. It will keep you and yours well.
But, I would like to remind everyone of the special concerns for the Elders.

Many Elders have poorly functioning immune systems, whether caused by chronic illness, physical deterioration, poor nutrition, or the types of medications that have to be taken. This puts them at higher risk than anyone, even around people who "appear" to be well.

Many cold medicines sold over the counter are laden with drugs that many Elders should not take because of chronic illness, or because of possible interactions with prescription medicines. There have been several articles about this problem. Here is one of them, called "A Prescription for Problems".

Many Elders are particularly prone to respiratory complications when suffering from viruses like a cold or influenza. This puts them at risk of life-threatening pneumonia, worsening heart conditions, and long hospitalizations.

Along with all the other physical problems Elders may have, there is often a problem with nutritional and fluid intake. This can become worse when your Elder is sick and not willing to eat or drink, quickly becoming a serious dehydration, malnutrition problem. Now you have a virus, dehydration, and more strain on all body systems. It's a downward cycle that soon requires hospitalization to correct.

Then there are all the other complications that come along with poor nutrition, poor hydration, respiratory viruses, and the resulting bedrest and/or hospitalization: like loss of the ability to walk, incontinence, weight loss, skin breakdown, and acute confusion. Your Elder ends up having to go to a nursing home after a lengthy hospitalization, and now we all have very unpleasant days.

So, a little prevention can go a long way. Check out the articles above, and arm yourself with the information you need.

Wishing your Elder and you many Pleasant Days during the Holiday and Winter Season.

Wishing You and Your Elder a Pleasant Christmas Season

noreply@blogger.com (Valarie) — Tue, 02 Dec 2008 19:13:00 +0000

The season is upon us once more. And for many of our Elders, it comes with many memories, and a few problems.

Many of you that care for Elders realize by now that most memories our Elders have of past holiday seasons are good but may be painful. Memories of cherished family members that have passed on; the 'good old days' and traditions of Christmas and the holiday season that have passed on with a world that no longer exists for them outside of their memories; many have lost spouses along the way; some have lost children. These memories can be bittersweet. And invariably, these memories seem the strongest around the holiday season.

Some of us would prefer 'not to go there' when it comes to painful memories. But often, it really is much better to just go with it. Dig out the old family photo albums, the old Christmas cards, and if you don't have any of these, just talk about those 'good old days'.
It doesn't matter how many times you have already heard it -- hear it again. Talking about lost loved ones and the cherished old traditions is healing, therapeutic, and can be uplifting. Encourage your Elder to remember as much as s/he can. Try to emphasize the good stuff, but be sure to validate the bad stuff, too. In this way, you can acknowledge and validate your Elder and her/his past life. Let her/him know how you feel, and that you understand how important these people and these times were (are) to her/him, and that they are important to you as well because (even though you may not have been there) it is all part of you and your heritage.

Realize that very old Elders will often have far clearer memories of the long past, back to their childhood. They will surely have memories of your childhood, but the people of their own childhood are often all gone and the ones causing the 'bitter' part of the memories, because it all happened 50, 60, 70+ years ago (you know: long, long ago in a galaxy far, far away). This is where the saying "you can never go home again" likely came from. So, you want to try and help your Elder 'go home again' at least in her/his memory.

On to other concerns:

It's winter time. In most places it's cold, and if it's not snowing where you are, it's at least colder than the rest of the year.

Keep in mind that your Elder is probably very 'cold-blooded'. Keep your Elder cozy by adding extra soft underclothing, layers of clothing, thick socks, even a soft knit scarf around your neck can keep you much warmer than you would think. (Yeah, you people that live in snow country know about that. I'm a California native; wearing scarves when it's cold is probably the best lesson I learned from living 3 winters in Maine about 14 years ago.) Anyway, you get the point. Lots of soft fluffy clothing will keep the chill off for your Elder, and hopefully you won't have to sit outside on the porch because it's too hot in the house.

You do want to keep the house at around 70 - 75 degrees. I know this may be a problem if you are living in the same house. Most of us baby boomers (I'm talking mostly women here) are in that part of our lives when hormones don't know what to do anymore, and we are hot and flashing most of the time. Me, I like 60 degrees, 55 is just fine. But the Elders I care for can't do that. This is serious stuff. Your Elder may still feel cold at 70 - 75 degrees, but at least s/he won't get hypothermic. It takes energy to stay warm, and being too cold all the time will cause stress that your Elder can't handle, resulting in more illness, worsening of chronic ailments, behavior problems, trouble sleeping, inability to eat, more pain from arthritic problems.... All kinds of things you do not want to deal with, and will surely cause 'unpleasantness'. If you try to heat the house higher than 75 degrees, you may be drying out the air too much, which will cause problems of it's own.

Dry skin is a major problem with most Elders. And wintertime is worse. Make sure to use an extra moisturizing body wash for bathing and showers. Then add an extra moisturizing lotion right out of the bath or shower when the skin is still warm and damp.

Dry eyes is more common than people realize. Dry eyes can cause itching, burning, redness, and eye discharges that are bothersome. Over-the-counter eye drops to moisturize the eyes are inexpensive and well worth the effort. Make sure the drops are for moisture only.

Remember to keep your Elder hydrated. Cold weather tends to make people, especially Elders, drink less. Try hot tea, there are many nice herbal teas to choose from, and will also serve to warm up your Elder. If your Elder likes black or green tea, don't be afraid of the caffeine (unless the Elder's doctor says no caffeine). It can be good to help stimulate circulation and brain activity.

Many family members and friends may call you to ask what to give your Elder for Christmas. This is usually hard for most people to figure out. Remember that Elders grew up with a Christmas that was much different from our own. It wasn't commercialized yet. And giving during the season was heartfelt and out of a loving spirit. Very unlike the now commercialized season where we must get something for everyone in our life.... and it must cost enough to be considered a good gift.... and the name of the game is SALES for the market place.... and we all have to go out and spend to save our country's economy.

Anyway, the best gifts for most Elders are

wearables that provide comfort (soft clothing, robes, lap blankets, small pillow, poofy slippers, soft warm scarves); Fleece clothing is great and there are so many different products made from fleece--pj's, t-shirts, slippers, jackets, blankets, you name it.
goodies to eat (fancy little soft candies, cookies, cakes); homemade or not.
pictures of family (enlarge a nice photo and frame it; enlarge a photo from long ago of loved ones and frame it; a small photo album with favorite photos enlarged; even a scrapbook type thing with family and comments.
scented lotions
large print books (predominately pictures for those who don't read).
magazine subscriptions: some good ones are Reader's Digest (large print version), National Geographic, Reminisce Magazine, Good Old Days Magazine, American Heritage Magazine, America in WWII Magazine, and many many others to choose from (just put 'magazine subscriptions' into your search engine to find several sites that sell discounted subscriptions).
DVDs of old favorite movies or TV series
Flowers
Music favored by your Elder (CD's, satellite radio subscriptions, you could even download favorites to an iPod)
Sound amplifier with headset (for those Elders that don't wear hearing aids but have trouble hearing the television, radio, sermons at church, birds singing outside, whatever)
accessories for wheelchairs or walkers: there are special bags and totes that fit onto the w/c or walker; there are special cushions for more comfortable seating in a w/c.
I could go on and on...so here's a site with more gift ideas for the elderly, just click. There are plenty more like it.
Here's another site with some good ideas for gifts at SeniorStore.com

So, I once again have gone on and on long enough. Just wanted to give some ideas about wintertime and Elders in the hopes that you and your Elder will continue to have Pleasant Days.

Information from the FDA about Drug Interactions

noreply@blogger.com (Valarie) — Fri, 28 Nov 2008 22:57:00 +0000

I just received this in my mailbox today. I thought it was worth mentioning and passing on since Elders are so sensitive to medications and may have more problems with interactions than others. Here is the link for Avoiding Drug Interactions by the FDA. It includes information about drug to drug interactions as well as some foods with certain medications.

Wishing all of you and yours Pleasant Days.

Preventing Urinary Tract Infection and Unnecessary Hospitalization for your Elder

noreply@blogger.com (Valarie) — Fri, 14 Nov 2008 17:19:00 +0000

I recently spoke with a friend who was concerned about her mother. Her mother had become so ill she required hospitalization for treatment of a urinary tract infection. She then had to spend some time in a skilled nursing facility to finish recovery before returning to her assisted living facility.

The concern involved prevention of a similar occurrence in the future. My friend was amazed that something as simple as a bladder infection could make someone so ill.

Our conversation made me realize that there are probably many people caring for, or concerned about, their Elders becoming severely ill for the same reason.

Maybe some people don’t even realize there is such a great risk.

So, I thought I would talk about prevention of UTI’s (urinary tract infections).

UTI’s (or bladder infections) are actually quite common in elders, women more than men. The reasons for this are:

Elders don’t like to drink enough fluids (makes them want to go to the bathroom too often).
Elders often don’t feel thirsty.
Elders, especially women, are often incontinent of urine.
Incontinent elders may not want the fuss and bother (or expense) of changing incontinent briefs as often as they should.
Elders very often have difficulty with hygiene after toileting, thus encouraging the growth of bacteria.
Elders often have an impaired immune system due to degenerative diseases, and/or poor nutrition.

The solution, or rather the prevention, of bladder infections is really simple, as long as your Elder will cooperate.

Nutrition and hydration (I know, I keep harping about this) is important to keep the immune system functioning, and the kidneys functioning so that the urinary tract is flushed out. Bacteria won’t have a chance to sit around and multiply, thereby causing the infection. Some simple preventatives:

8 oz. of water at least 3 times per day (given with medications is perfect).
8 oz. of orange juice daily. Better yet, eating one orange (or grapefruit) every day.
8 oz. of cranberry juice (unsweetened is best, or sweeten with apple juice) once or twice a day has been known to be helpful in keeping bacteria from “sticking” to the walls of the bladder and urethra. Plus it also has Vit. C.
Before eating grapefruit or drinking grapefruit juice, please check the link (on the left side of the blog) “List of meds that interact with grapefruit juice.
Total fluids, including coffee, tea, milk, juice, beer (whatever) should total around 2000 cc (or 2 quarts) at least (unless the Elder’s physician has specified another amount).
Someone needs to actually give or offer these fluids to your Elder. Don’t rely on your Elder to remember to drink that much on her/his own. Work it into a daily routine.
Your Elder needs to eat enough protein, vegetables and fruits to get adequate amounts of protein, carbs, vitamins and minerals to be able to maintain an immune system and heal damaged tissues. If you are unsure if your Elder is eating enough, check out “MyPyramid.gov” (listed in “Links for your Assistance” at the left side of the blog).

Incontinent Care: cleanliness is everything. Elders don’t change often enough, and are unable usually to clean well enough after toileting. Also, most elders don’t bathe every day. So, keep mindful of 1) growing bacteria 2) spreading bacteria, and 3) prevention. Bacteria growing in disposable briefs, underwear, or on your Elder’s skin can easily travel up the urethra to the bladder. The bacteria usually responsible for causing infection come from the bowel.

Help your Elder develop a sensible toileting schedule. She/he should be toileting 5 to 6 times a day. Most common: upon arising in the morning, mid-morning, mid-afternoon, after dinner, before going to bed at night. Then again about 2-3 hours after going to bed (kidneys work better for lots of elders when lying down; this can help with night time incontinence).
Even if your Elder is fully incontinent, toileting regularly will also help to get her/him moving around; get cleaned and changed often; and encourage some continent episodes. If the Elder is not able to get onto a toilet, then changing the incontinent brief and good cleansing is essential soon after the incontinent episode.
Allowing an Elder to wear a wet (and especially soiled) incontinent brief for any length of time can encourage the growth of bacteria that can travel up the urethra into the bladder. This is especially true for women. So change the brief if wet or soiled at all (yes, even a little bit) every time the Elder toilets.
Use baby wipes to cleanse your Elder after toileting. It’s much more effective for you to do it. Wear gloves, stand behind the Elder and ask her/him to lean forward, then cleanse from (their) front to back.
Wash your Elder’s “periarea” with soap and water at least once per day, twice is better. You need 3 washcloths, disposable gloves, moisturizing body wash.

Wear gloves
Wet 2 washcloths with warm water.
Use a small amount of body wash on 1 washcloth to wash (you from the back, elder leans forward while sitting on the toilet) from front to back.
Use 2^nd wet wash cloth to rinse. You may need 2 to rinse thoroughly.
Then pat dry with the 3^rd dry washcloth.
Wash any linens used for pericare with laundry soap and some bleach.

All of this accomplishes a few things: your Elder feels better and cleaner, smells better, hopefully has more continent episodes, and no worries of unnecessary infection, all of which add up to greater dignity, more peace of mind, and hence Pleasant Days.

Symptoms of a UTI in an Elder:

More frequent urination than usual.
Feeling of low abdominal cramping, or urgency (feeling like you have to go, but hardly anything comes out)
Unusual confusion/disorientation or delusions. A drastic change in the Elders cognitive ability is sometimes the only clue that she/he is sick.
Burning on urination
Cloudy and/or very smelly urine
Fever is hardly ever present unless the infection is severe.

If drinking more fluids doesn’t help in one day, call the Elder’s physician. If the Elder has fever, severe pain or blood in the urine, call the physician right away.

Antibiotics are not always needed, but if the infection is causing fever, blood in the urine or severe pain, or your Elder is not able or willing to drink enough fluids to flush out the bladder, treatment is necessary to prevent a more serious infection higher in the urinary tract (the kidneys) and a possibly life-threatening situation.

So there it is. Maybe not so easy, but far better than lengthy hospitalizations, risk of kidney infections that could be painful and life-threatening, and a real risk of even longer stays in a skilled nursing facility with the inevitable declines in function and cognitive ability than result. Very Unpleasant.

Wishing all of you and your Elders Pleasant Days!!

Consumer Information from the FDA

noreply@blogger.com (Valarie) — Thu, 06 Nov 2008 19:43:00 +0000

The FDA has published a site to help consumers choose over-the-counter (OTC) medications. There are several links that provide important information for people who are purchasing OTC medications for themselves or others.

For advise about self-care, reading drug labels, and being aware of drug interactions, click here.

For a checklist for choosing OTC medications for adults, click here.

To learn how to read a drug label, click here.

For information in Spanish, click here.

By clicking on the title of this post, you will be taken to the entire publication by the FDA "Consumer Education: Over-the-Counter Medicine".

I have also included this link under "Links for your assistance".

It is very important to keep yourself informed about all medications your Elder is, or might ever, be taking. OTC medications can be just as potent, some even more so, than prescription medications. And with Elders, side effects and adverse reactions to any medicine, whether OTC or not, are always more problematic than with anyone else. Also, remember to inform your Elders physician about any OTC medicines your Elder is taking.

Paying attention to all medicines your Elder takes can help you both have more Pleasant Days.

Dealing with the madness of Dementia

noreply@blogger.com (Valarie) — Sun, 26 Oct 2008 21:55:00 +0000

Dementia in your Elder can be maddening for you for many reasons: the Elder doesn't know s/he is confused or forgetful; you can't reason with her/him; s/he is very stubborn and doesn't understand the word "no"; there is no rhyme or reason to the things a demented elder can come up with; you are afraid to leave her/him alone because of her/his altered reasoning.

How does the Elder deal with it, and is it as maddening for her/him? I've never been able to get this answer. I can only imagine.

In all my years of working with elders dealing with dementia, I always wondered how and what they thought of the world and the people around them. I mean, think about it. How do many people act when relating to a demented person? They may roll their eyes a lot. They often throw up their hands, or at least make a lot of hand gestures. They keep repeating phrases like "I already told you.....", or "why can't you remember......?" They tend to become very frustrated and angry. They think the Elder is doing this "on purpose". They tend to think the elder is lazy, and sometimes even stupid. Then they start treating the elder like they are lazy or stupid. They can even start yelling, cursing, and name-calling. They begin to feel very guilty about this behavior, but seem powerless to stop it.

If you are caring for a demented loved one, sometimes this behavior comes out of the blue. You never knew you had it in you to be this way. Your behavior then becomes an issue, along with the dementia your Elder is trying to deal with.

So, how do you deal with this. First, promise yourself to never feel guilty. If you are caring for a beloved Elder, take heart. You are doing a very important and loving thing.

Start a new day. Take a deep breath and try to relax. Your Elder may still be demented, and still be doing, saying and thinking some weird stuff. But you do have the power to deal with it.

Remember this. Your Elder can't help it. Brain damage is devastating for everyone. And if there was any way your Elder could think and act normally, s/he would. It's not personal, so never take it that way.

If you are lucky, your Elder may be "pleasantly confused". This is often not the case. Very often elders know there is something wrong and try very hard to fight it, or hide it. And sometimes the harder they try, the worse their behavior can get. You need to be able to reassure your Elder that you understand, you are there to help, you will never judge or make fun of her/him, and that it's not her/his fault.

Here are some simple pointers that may help you, and your Elder, maintain some sanity:

Establish a daily routine and stick to it, always. Everything needs to be done the same way, at the same time, everyday. Some things can be on certain days (like showers, since most elders don't need a full shower every day). Some days can be different because there is a necessary event going on, like a doctor's appointment. These things should be talked about and prepared for days in advance. Give your Elder plenty of time to adjust to the new event. Infrequent visits from friends and family can be handled the same way. Contact everyone and ask them for no surprises, please.
During the days activities, whether eating, dressing, toileting or bathing, constantly give cues and reminders to assist your Elder. This is also a good time to give reminders about safety also. An example would be: "I'll be right back, remember not to get up from the toilet by yourself." You need to always use the same words. It may get boring for you, but this will help your Elder more than anything else.
As much as possible, have people come to you and your Elder rather than taking your Elder out. Haircuts and manicures can be handled this way, as an example.
Away from home activities are great if your Elder enjoys them. With dementia, the Elder will enjoy them more if they are part of the routine, which doesn't necessarily mean every day.
Be very careful about changing any medications. Talk to the Elders doctor about this at length when changes are necessary.
Keep your Elder well nourished and well hydrated.
Anticipate your Elder's needs, and take care of the need before your Elder actually needs it. (examples would be toileting, extra clothing or blankets, drink of water, etc). A demented person may forget to ask, or forget how to ask. After a while the need can become an emergency in the mind of the Elder and odd behavior may result.
Validate your Elder's feeling. This is especially true when your Elder is delusional. There is a fine line between the need for reality orientation and the need for validation of feelings. Try to know the difference. There are times when delusional thinking is difficult or impossible to alter, and trying to do so will only result to anger and confuse the Elder further, which in turn could result in problem behavior. Try to "agree" a lot, and "understand" how your Elder feels. You may even need to play along with the delusion to steer your Elder away from it with distraction. An example would be a belief of your Elder that s/he is getting ready to go on a trip. If it doesn't hurt anything, let her/him "pack" or whatever. While playing along, distract her/him with another idea (like playing a favorite game, going for a walk, having a cup of tea) and more than likely the delusion will be forgotten about. A note here: if your Elder is frequently delusional and especially if these delusions are distressing, you need to talk to the Elder's doctor.
Try to keep the surroundings clean, uncluttered, relaxing.
When you do need to have an important discussion with your Elder, plan to do it during the time of the day when your Elder is at her/his best. For most elders, this would be in the morning, probably after eating. Demented people tend to get more forgetful and confused as the day wears on.
Always, no matter what is said, done or thrown: treat your Elder in a respectful manner. Sometimes you need to pretend that it is perfectly normal for everyone to be forgetful and confused. Give your Elder cues and reminders in a respectful manner so s/he never feels belittled or stupid. Your Elder will probably depend on you to be the "rememberer", which can be challenging at times. (I take notes) :)
If your Elder becomes very angry, starts yelling and/or cursing, or other things, try to back out of the situation quietly and let the Elder calm down. If you can not leave the Elder safely, then just stop talking. Trying to talk your way out of the Elder's anger will only make it worse. Distraction sometimes helps, but you need to try this well before the person becomes irate.

If you do well, you and your Elder will have many pleasant days with less confusion, less distress, and less problem behavior. Your Elder will come to trust you to just take care of things. At least most of the time.

An Article from the NY Times

noreply@blogger.com (Valarie) — Fri, 10 Oct 2008 18:32:00 +0000

This is a great article about dignity for the elderly. (click on the title of this article). As caregivers, we often fall into this mode of "caring" that is very much like the care we give our children. We don't mean to demean by using terms of endearment (or "elderspeak" as the article terms it) but according to this article, maybe more elders are upset by it that we think.
The article does mention that professional caregivers are often not taught how to address elders they care for. This is actually not the case. Nursing home employees across the country are taught to address an elder by the surname unless the elder specifies otherwise. Some like to be addressed by their first name, some by their surname, and some by a nickname. Whether each employee follows that rule is another matter. And elders, trying to be polite, will often not complain.
At any rate, I felt this was a good article to share so we can all be enlightened in yet another way to help our Elders have Pleasant Days.

Managing your Elder's Medication Maze

noreply@blogger.com (Valarie) — Sun, 28 Sep 2008 23:58:00 +0000

I’ve been going on and on about nutrition. And, I’m probably not done with that. After caring for elders in a medical type of mind-set for so long, it still astounds me how much more important nutrition is to medical science. But, that doesn’t mean we should forget about the medical science.

If you have contemplated managing an elder’s medication regimen, and looked around for your Elder’s supplies and medications, you probably have already encountered my sentiments about the issue. It’s scary. No, that’s not the right word, really. More like Horrifying.

Elders, more often than not, require several different types of medications to manage several different disease processes. And then a few more, to manage the effects of the original medications. It can be very confusing, even if you aren’t demented.

Imagine trying to manage your medications if you are even mildly confused and/or forgetful:
• What do you take?
• Why do you take it?
• When do you take it?
• Should you take it with food, or on an empty stomach?
• Where do you go to get more?
• Are you supposed to take it forever, or just for a short time?
• Did you take it this morning? Maybe you should take it now?
• Will you remember to order more when you run out? (or will you forget about it and not take it anymore?)
• Will you remember what to ask your doctor if you have concerns?
• What are the side effects, and what should you do about them if you have them?
• If you have side effects, will you recognize it as a side effect, or just think you have developed another disease process?
• Where did you put that new bottle of medication?
• If you feel worse, does that mean you should take more of the medication?...or maybe none at all?

This list could go on and on and on…..in ever widening circles. Many times, elders have ended up having more problems with chronic diseases because of the medications they are not taking properly. The physician would call it “noncompliance with the medication regimen.” This can be disastrous to an elder, causing hospitalizations, acute confusional states with changes in behavior, or worsening of existing dementia. It could even result in death due to drug overdose or exacerbation of the disease process not being treated properly.

So, all that being said (and maybe, but hopefully not, experienced), now you have decided you want to manage your Elder’s medications.

There is a little bit of complexity involved in managing another person’s medications. But if you do all your homework and keep some records, keeping track can be easy to do.

You need to tackle this very large task one step at a time:
1. Find and gather up all the medications your Elder takes.
2. Attempt to determine if these are in fact the actual medications your Elder is supposed to take.
3. Become well informed about the health status of your Elder.
4. Become well informed about the medications your Elder is taking.
5. Organize the medications.
6. Dispense the medications to your Elder.
7. Monitor the effects the medications have on your Elder.

Ok, looks simple enough. Now, lets go into some detail.

1) Gather together all the medications your Elder takes. This includes herbal and vitamin supplements, and over-the-counter medications. Keep in mind that your Elder, especially if s/he is a little forgetful or confused at times, may not keep all the medications in one place. Some elders have a “gift” for finding new places to put things so they won’t forget. It may make you think your Elder used to be the Easter Bunny in a past life. Anyway, good luck.

2) Attempt to determine if these are in fact the actual medications your Elder is supposed to take. The easiest way to do this is to ask the Elder’s physician. Keep in mind, your Elder may have several physicians, and hopefully they all communicate with one another. But this is not always the case. Another way is to ask the pharmacist that fills your Elders prescriptions. Again, your Elder may go to more than one pharmacy, and/or use a mail type pharmacy service. The bottles of medications you find will have the name of the prescribing physician and the dispensing pharmacy. So that would be a start. And of course, this is all assuming your Elder can’t just tell you all of this.

3) Become well informed about your Elder’s health status. That is, you need to know what diagnoses the physician(s) are treating your Elder for, as well as those not being treated. This may necessitate you going to the physician’s office with your Elder and getting the Elder’s permission to access information about her/his health status, as all of this is confidential. Once you have determined what diseases and conditions your Elder is dealing with, educate yourself about these. There are plenty of resources online to help you. WebMD as well as Medline Plus are good resources for information about health conditions.

4) Become well informed about the medications your Elder is taking. Again, there are lots on online resources for you. The sites listed above have excellent information regarding medications, as well as herbal remedies and supplements. Your pharmacist can also give you informational pamphlets or printouts about each medication. You need to know:
• What condition/disease process is being treated with the medications.
• How does the medication work.
• What effect is the medication supposed to have on your Elder’s condition.
• How is the medication best administered (with food, without food, not in combination with certain meds, vitamins or foods, etc) and why.
• If your Elder can’t swallow pills, can you safety crush this medication (some meds, like time-release compounds should not be crushed), and mix it in applesauce or ice cream or some such thing. And if not, can you get it in a liquid form.
• What to monitor while your Elder is taking it (such as changes in behavior, appetite, blood pressure, pulse rate, etc).
• And most importantly, know what the side effects or adverse reactions are likely to be, and watch for these. Elders are very prone to side effects and/or toxic levels of medications because they are not able to metabolize and/or excrete chemicals efficiently.
• Last, know what to do if you notice adverse effects or side effects. Some medications cannot be stopped abruptly, and some you must.

5) Obtain a pill organizer box that will handle the amount of medications you
need to organize. There are all kinds available. Use whatever makes the most sense for you and your Elder. Basically, you want to be able to organize medications by dose and by day. Example:
Monday am, noon, pm, bedtime
Tuesday am, noon, pm, bedtime…..etc
An example would be a pill organizer box with 7 days, and four dosing slots for each day. Or, obtain four pill organizer boxes with one dose every day for 7 days. Then label each box for the dose with an indelible pen. So you will have one box for “AM” Sunday through Saturday, one for “NOON” Sunday through Saturday, etc.

The organization depends on whether you will be dispensing the meds to your Elder, or whether the Elder will be choosing the box and dosing slot to get the meds from.
Set up the medications for a week at a time. To prevent mistakes, do this during a time when you will not be interrupted.

While you are setting up the medications the first time, count how many doses there are, and determine on a calendar when you will need to reorder. Give yourself at least a week, or however much time you think you need. Write this down. Keep this information on all the medications in one place, on one calendar, on one piece of paper, or on an internet calendar. Reference this every week when you set up the medication organizer.

The easiest way for me is to reorder when there are less than 7 days of medication doses left in the bottle after I have just set up a week's supply. So, I always have at least 7 days worth of doses before the bottle needs to be replaced. Plenty of time to get a refill.

On your ongoing medication list, you may also want to include information that may be needed later, if something happens, like a hospitalization. The hospital staff should be able to get medical information from the Elder’s physician, but they always rely on the family members anyway.
So on your list you will need to have
• Date to reorder (keep this is pencil, so you can update it when you get a new bottle of pill).
• Medication, dose, frequency
• Condition treated
• Date it was first ordered
• Any dosing changes, why and date
• Date it was discontinued, and why (this information can be important for a physician that is not familiar with the Elder’s ongoing treatment plan).

It easiest for me to keep a table with the above headings across the top, and then list each medication with the information as it comes up.

Use a highlighter to cross off a medication that has been changed or discontinued. This way, you can still read it, but when you set up medications you know it is no longer an active order. This information can be invaluable when you are managing medications for an elder that has frequent changes in doses and drugs. Keep this with you when you visit your Elder’s physician, and especially when your Elder needs hospitalization.

6) Now that all the hard work is done, all you have to do is make sure your Elder takes the medication correctly. I prefer to dispense the meds and watch the Elder swallow them. That way, there are no mistakes. The meds are not forgotten, thrown away, put down somewhere and a child, a pet, or another confused person takes them. No telling what can happen!!

7) There’s just a little more. Monitoring the effects of a medication is important for several reasons:
• You want to make sure it’s doing what is expected, and if not, you need to tell your Elder’s physician.
• You want to monitor for side effects, and if you notice any, tell your Elder’s physician.
• You want to monitor for allergic reactions, and if there is a reaction, tell your Elder’s physician.
• And finally, if the medication is not helping, you may wonder why your Elder should continue taking it and risk side effects or drug toxicity. You probably want to discuss this with your Elder’s physician.

You will probably need to watch your Elder's blood pressure and pulse rate on a weekly basis, at least. Your physician should tell you, along with parameters for when s/he should be called. For a diabetic, maybe you need to monitor blood sugars. These things are for obvious reasons. What is not so obvious, are things that may signal intolerance of the medication, toxic levels, or side effects. Watch for changes in appetite, bowel habits, behavior, cognitive function, ability to sleep, and functional ability (walking, toileting, eating, dressing, etc.) Elders quite frequently will become more confused and forgetful, and stop eating when a medication does not agree with them.

There are certain medications that must be handled very carefully with the elderly. But more about that at a later time. This article is already pretty long.

By managing your Elder's medications for them, you can avert disastrous and unpleasant moments, and maybe even hospitalizations. It does take some time and research initially, but it is well worth the effort.

As always, wishing you and your Elder Pleasant Days.

image by basykes
www.flickr.com

Concentrating Nutrients for Elders (or, Pleasant Days start with Good Nutrition, Part 2)

noreply@blogger.com (Valarie) — Sat, 20 Sep 2008 17:04:00 +0000

For the vast majority of elders, being on “a diet” is not a good thing. Even if your elder is over- weight it can be very detrimental for them to lose weight too fast, or even at all. It is far more important for the elder to get the nutrients they need than to lose weight. Younger people can “diet” because most will have nutritional reserves in their bodies to draw from. Elders usually don’t have these reserves. So always think about nutrition first, then worry about being overweight later. Of course, the elder’s physician may have some dietary concerns. These would probably only be to limit cholesterol for someone who’s cholesterol is too high; to limit calories and/or sugar for a diabetic with uncontrolled blood sugar; or to limit salt intake for someone with fluid retention problems.
It’s often hard to get an elder to eat enough protein and/or calories, which will lead to malnutrition, and lots of problems leading to very unpleasant days. These suggestions are for people who eat very small portions, don’t finish their meals, or skip meals.
Some examples:

Use three different fruits cut into manageable pieces for your elder and mixed together with a tablespoon of lime or lemon juice as a side salad for lunch. Add a little sugar and let it sit for about an hour to make it more enticing. Fresh fruit seems to "go down" better than raw vegetable salads.

Jello: exchange half of the water for orange juice. Not only does this give extra nutrients that count for part of the fruit group, but it tastes sweeter, too.

Top fruit or jello with flavored yogurt instead of whipped topping (counts as milk, rather than just extra sugar).

Pancakes: add an extra egg for more protein. If using a mix that calls for water, use ½ milk and ½ water.

Mashed potatoes: use milk, sour cream or yogurt rather than just water or broth when mashing.

Cook hot cereal with milk instead of just water.

Add milk to coffee instead of non-dairy creamer.

When making meatloaf, hamburgers, or meatballs: use oatmeal (the “one-minute” kind) instead of bread crumbs. (whole grain)

Dessert: make a fruit and yogurt parfait by layering fresh fruit (which has been “marinated” in a little sugar for ½ - 1 hour) and vanilla yogurt. (Fruit ½ - 1 cup; yogurt = milk ½ - 1 cup)

For a sandwich filling: add ½ cup of minced vegetables to tuna, diced meat or shredded cheddar cheese. It will make the sandwich more moist, easier to chew, and you don’t have to use much mayonnaise. Use pickles, olives, onions, cucumbers, lettuce, peppers, shredded carrot, celery, avocado, even pineapple.

Offer fruit preserves (less sugar here is OK, but usually not necessary unless the elder is diabetic) and encourage liberal use for whole wheat toast at breakfast. (Fruit, up to ¼ cup for 2 slices of toast).

Put gravies, sauces, cheese sauces on food. This will boost calories and make the food easier to chew and swallow as well. If you use cheddar cheese in the sauce it will also serve to get more dairy nutrients in, which are rich in protein and calcium.

The other problem with having to concentrate nutrients, is having to choose wisely when feeding someone who has a small appetite. It may be fun to have an ice cream cone at midday, but if this takes the place of a meal it probably isn’t worth it. If your elder likes a lot of sweets and goodies but then will not eat a meal; I would suggest having a “goody” day one day a week where one meal can be replaced with choice sweets. For most people it doesn’t hurt to have sensible desserts every day after dinner. You be the judge. Most people can get enough nutrients out of a 1600 calorie diet, and it won’t hurt them to have an extra 200 to 300 calories for dessert. You would need to use some judgment if your elder is diabetic and on a strict diet. In which case, check with your doctor about speaking with a nutritionist for a specific plan to allow some sweets into the elder’s diet. If the elder is not on a strict diet, then plan desserts made from wholesome food. Rather than cake, try fresh fruit with flavored yogurt. Low cal jello desserts with fruit and topped with low cal whipped cream, or vanilla yogurt. Even ice cream is better, since it has milk in it and not just sugar and flour.

Some elders I have cared for have had poor appetites for various reasons, mostly having to do with chronic diseases and prescription medications. One lady in particular used to make me laugh. She would always remind me not to make her meals too large. When I assured her I would try to keep the meal small, but that she needed to eat enough protein, she would smile at me and say "Oh, I know you'll sneak it in somehow." Sneaking it in was alot easier than arguing about it, which led to yet another Pleasant Day.
Here's wishing you and your Elder "Pleasant Days."

image above by serenejournal
www.flickr.com photos

Pleasant Days start with good Nutrition

noreply@blogger.com (Valarie) — Fri, 12 Sep 2008 02:52:00 +0000

After caring for several elders in our home here on the beach in Punta Banda, I am convinced that successful caregiving (meaning the elder has Pleasant Days, and so do you) starts with good nutrition.

I know, everyone says everything starts with good nutrition, right?

Nutrition for elders is somewhat different from nutrition for everyone else, for lots of different reasons.
1) Many elders don't have an appetite.
2) They don't have the energy it takes to shop for, and then prepare food for themselves let alone clean up afterwards.
3) It's common for elders to live alone (spouse has passed on and children are grown), so eating has become a chore rather than a pleasant social experience.
4) Food just doesn't taste, or smell, the same anymore. Many elders can taste "sweet" more than anything else, so all they want to eat is sweet stuff with no nutritional value.
5) Medications either destroy the elder's appetite, or interfere with absorption, or cause the body to lose valuable nutrients.
6) Many elders have difficulty chewing foods because of poor dental care.
7) Some elders have difficulty swallowing for various reasons ranging from neurological problems, to cognitive problems.
8) Degeneration of the digestive tract, and it's blood supply, from the mouth all the way through to the colon prevents adequate digestion and absorption of nutrients.
9) Many elders don't have the cognitive ability, and/or the desire, to plan out nutritious meals. They may not even remember if they have eaten or not.
10) Many elders can't physically handle much salt in their diet. Prepared foods, the kind that most elders will eat due to ease of preparation, are over-laden with salt.
11) Some elders have severe endurance problems because of heart or lung disease and just don't have enough energy or oxygen to get through the physical act of eating a meal.
12) Some elders use food, and their eating of it (or not), as a control issue when dealing with family members.

Most elders have at least one, more likely many of the above problems.

It may not seem like a big deal to some. But inadequate nutrition can be disastrous for the elderly. I'm also talking about hydration here. Ensuring your elder gets enough food (with nutritional value) and fluids is the best way to help her/him feel their best.

"Best" means:
--the elder is more energetic and able to do more for her/himself;
--s/he is less likely to become immobile because of poor endurance, so you don't end up having to lift her/him around;
--s/he feels physically better and gets sick less often;
--her/his skin remains intact with less chance of life-threatening infection;
--s/he is in a better mood and tends to be much less grouchy;
--s/he has fewer problems with memory and reasoning skills;
--s/he retains body weight and fluid so medications don't become toxic and cause horrid side effects;
--s/he is more likely to have better bowel and bladder control;
--s/he can cope with pain issues much easier;
--and s/he is more likely to have the ability to enjoy a positive social life.

I'm sure there are some things I forgot. But you get the idea. You may not believe eating food can do all that. So here's a real life example:

We once cared for an elderly man who could not walk when he came to us. His family had been at a loss when trying to care for him, and he became progressively weaker, falling frequently, until he just couldn't get up by himself anymore, and his family was considering nursing home placement because they could not care for him. After he had been with us for a week, he was walking. Not only to the bathroom and all over the house, but down the road with my husband for walks everyday. His confusion cleared, and he was able to play his favorite card game (Rummy) with us in the evenings, and write poems again. Amazing! And no, there had been no changes in his medications. It was simply the food and fluids he was getting everyday in regular meals.

Here's another likely example:

If an elder takes a diuretic for retention of fluids caused by heart problems (which is extremely common), s/he needs to eat adequate amounts of potassium to offset the potassium the diuretic will cause the kidneys to excrete. The best sources are fruits and some vegetables. The easiest way to get in enough potassium is a glass of OJ everyday, and/or a fruit salad. Everyone should eat at least 1.5 cups of fruit (includes juice) everyday.

So what happens if s/he doesn't. This:
--muscle twitches, then muscle cramps
--loss of strength in muscles
--frequent falls
--"bad mood", with grouchy outbursts
--inability to remember things and reason properly
--delusional thinking leading to paranoia
--poor judgment leading to behavior problems
--nausea
--diarrhea
--intestinal cramping
--lack of energy
--severe potassium deficit can cause problems with the heart contracting, and lead to death.

So, you really want your elder to avoid all that. But, getting an elder to eat can be a problem all by itself.

First, you need to fix any of the "reasons" for poor nutritional intake listed above that you possibly can. Simply being there to prepare the right foods and provide encouragement will remedy many of the problems.

Second, you need to get your elder to eat a balanced, nutritious diet. If you need information about what a balanced, nutritious diet consists of, go to my list of links ("Links for your assistance") and click on MyPyramid.com. The site is very easy to navigate around and has all the information you need to be able to put together a good diet. This could be helpful to you, and anyone else in your family as well. Good nutrition for yourself will go a long way to prevent overwhelming stress from being a caregiver. When I first started caring for elders in my home, I knew about basic nutrition concepts (we have 5 grown children), but when I was working in institutions I always had the benefit of a dietician to call on. This site was a fantastic find. It makes being your own nutritionist so simple.

Third, you need to provide this diet in small meals with concentrated nutrients, that are appealing and easy to eat. Examples would be a breakfast consisting of:
--oatmeal 1/2 cup with 1/2 cup milk in it,
--coffee (2 cups with 1/4 cup milk in each cup), and
--2 scrambled eggs
--1 cup of OJ.
This is soft, not too much to eat, and provides 1 of the 6 oz. of whole grain (in an 1800 cal diet), 1 of the 3 cups of milk, 1 of the 1.5 cups of fruit, and 2 of the 6 oz of protein. I would cook the oatmeal with sugar or sweetner instead of salt. You can always add whole wheat toast, each slice being another 1 oz of grain. If you need more fiber, eat whole fruit instead of drinking juice. Juice is just easier to get down for an elder who has appetite problems.

Every morning I decide what we are going to eat during the day. I write it down on a slip of paper, split up by nutritional categories (meat, milk, fruit, grain, veg) and by meals, and tack it to the refrigerator. So if I get in a big hurry or have some sort of "emergency", or the elder I'm caring for is in a particular mood that day, I don't lose track of what I'm cooking.

I don't mean to suggest that you put your elder on a calorie count "diet". Most elders don't need calorie restricted diets unless they are diabetics that have a hard time controlling their blood sugar. What you do want to pay attention to is ensuring that your elder gets enough of each food group. This will prevent any nutritional deficiencies that cause problems. And if your elder can't eat all the food listed in the diet, cut down the portions proportionately in each food group rather than leaving some out. This way s/he will get as close to a balanced and nutritious diet as you can get. As time goes on, maybe s/he will feel better and be able to eat more. And don't forget the fluids. Dehydration can cause nausea and unwillingness to eat along with all the other "miserable-ness".

A note about fluid intake before I quit. In general, the amount of fluids you need should be about the same amount of cc's (or ml's, if you prefer)as calories you ingest. So most people would need about 1800cc to 2000cc per day. This is where the "8 cups of water" idea comes from. 1000cc is a liter, or basically a quart which is 4 cups. But remember, all that does NOT need to be water. Water is good, but there is water in everything you eat as well as drink. So count all the "drinkable" fluids you take and you'll be fine. For elders, many can't handle too much fluid, especially at first. Elders are notorious for not drinking enough fluid, and being slightly dehydrated. So, if you are just beginning to care for an elder, go easy on the fluids and gradually bring her/him up to the needed amount. (gradually meaning over about a week's time). You will find out, over about a month, what your elder can handle or not. Watch for signs of fluid overload, especially for elders with heart or kidney problems. Signs of for an elder would be obvious: rapid weight gain, edema (or swelling) of extremities, higher blood pressure and/or difficulty breathing. If this happens, back off on the fluid a bit and call the elder's physician.

More about concentrating nutrients and meal planning later.

I hope I haven't bored anyone. But this is so important to your elder. It's hard enough to be old--hard for the elder, and hard for the caregiver. In my humble opinion, nutrition and hydration are more important than most prescription medications. It is the easiest way to help your elder, and yourself, have Pleasant Days.

Links for your assistance in elder care

noreply@blogger.com (Valarie) — Thu, 11 Sep 2008 15:40:00 +0000

I spend a lot of time on the web researching things about elder care for myself and for others. See "links for your assistance". There is a list of a few of the sites I found most helpful. I thought it would be good to give you a brief explanation of what these sites contain.

Caring Connection is a site by the National Hospice and Palliative Care Organization (NHPCO) that gives you information and free resources for Advance Directives and "end of life" care issues.

Senior Citizen's Resources: from the U.S. government, a variety of sites for information and resources. From the home page, at the top click on "seniors".

Elder Care Search posted by the U.S. Health and Human Services Department. This is a public service of the U.S. Administration on Aging. There are lists of resources and explanations of services available from the federal government and your local area. Just enter your city or zip code.

FDA Consumer Education: Ensuring Safe use of Medications: This site has several consumer education articles about the safe use of medications. It gives you information about what questions to ask your health care provider, how to weigh the risks and benefits of medication use, and information regarding seniors and medications.

American Academy of Orthopedic Surgeons (AAOS): this link will take you to their page on prevention of injury information. There is a helpful article on prevention of back injuries for care givers. There are also some other useful articles on prevention of different kinds of orthopedic injuries that may help for your elder as well.

My Pyramid.gov is the official site from the USDA (United States Department of Agriculture) with all the information you need to easily provide a healthy and nutritious diet for your elder and you. This is one of my secrets for successful elder care. Nutrition is everything. From the Home page click on "My Pyramid Plan" on the right side of the page. It will ask for height, weight and age of the person, then it will give you the information you need to know about nutritional requirements.

This will get us started. There will be more links added as time goes on.

My own style of managing anger and frustration

noreply@blogger.com (Valarie) — Thu, 11 Sep 2008 14:35:00 +0000

I was reading something from another blog about caring for the elderly. Someone brought up the issue of anger management. This person found that his anger would seep into his life unexpectedly and cause problems.

Managing anger and frustration is important throughout your life, but can be especially important when you are caring for elderly people, especially your parents. I am not caring for my parents any longer, but on occasion will take care of other people's parents. After years of caring for others, I found myself depressed, resentful and angry after a serious illness. Then, I was angry at myself for allowing this to happen to me. I finally realized that you can't just forget about the feelings you have. You need to deal with it somehow.

First of all, you have to know (deep inside yourself) that it really is OK to have feelings of anger, frustration, resentment, evil thoughts, etc., when you are in a care giving role. You don't need to feel guilty about this. It's natural. Adding guilt to the whole mess will only hurt you further. What counts is how you act upon these feelings. One thing you do not want to do is keep it buried within you. That negative energy will work on you and change you in ways you really don't want to think about. You need to find a preferrably physical outlet. Mental outlets, and distractions (like hobbies, social activities) are OK, but don't seem to work as well for most people.
Here is my current outlet:
After all these years, I am now lucky enough to live on the beach, so anger/frustration management for me is fairly simple.

I give it to the ocean.

You can cry, yell, scream, throw things, or simply stand with your feet in the water and close your eyes. The waves come in, you give all your negative energy, frustration, anger, whatever to them, and they leave with all that energy and it's gone. The ocean doesn't care. It will take anything you have to give it. All it leaves in return is a soothing spray of positively charged sodium ions that gently wash over you to soothe and nourish your wounded soul.

It's great. Wish you all could do it daily. But if you can't, find your own special bit of nature you can relate to. Then pour your heart out where only you, Mother Nature, and your Creator can hear you. You will be understood, and be uplifted. Be at peace.