Saturday, January 12, 2008

Staying Warm This Winter: Special Considerations for the Elderly




Cold weather is very risky for older people. Almost everyone knows about winter dangers such as broken bones from falls on ice or breathing problems caused by cold air. But the winter chill can also lower the temperature inside an older body. That can be deadly if not treated quickly. This drop in body temperature, often caused by staying in a cool place for too long, is hypothermia. A body temperature below 96°F may seem like just a couple of degrees below the body’s normal temperature of 98.6°F. It can be dangerous. It may cause an irregular heartbeat leading to heart problems and death.

When you think about being cold, you probably think of shivering. That is one thing the body does when it gets cold. This warms the body. Muscles shiver in response to messages sent by the nerves. Shivering increases muscle cell activity that, in turn, makes heat. But, shivering alone does not mean hypothermia. So, how can you tell if someone has hypothermia? It can be tricky because some older people may not want to complain. They may not even be aware of how cold it is.

Look for the “umbles”—stumbles, mumbles, fumbles, and grumbles—these show that the cold is affecting how well a person’s muscles and nerves work. Watch for:
■ Confusion or sleepiness
■ Slowed, slurred speech or shallow breathing
■ Weak pulse or low blood pressure
■ A change in behavior during cold weather or a change in the way they look; alot of shivering or no shivering; stiffness in the arms or legs
■ Chilly rooms or other signs that they have been in a cold place, or
■ Poor control over body movements or slow reactions.

If you think someone could have hypothermia, take his or her temperature with a thermometer. Make sure you shake the thermometer so it starts below its lowest point. If the temperature doesn’t rise above 96°F, call 911. The only way to tell for sure that someone has hypothermia is to use a special thermometer that can read very low body temperatures. Most hospitals have such thermometers. The person must be seen by a doctor. If possible, the doctor should know about hypothermia and work in a well-equipped hospital emergency room. There, the health care team will warm the person’s body from inside out. For example, they may give the person warm fluids directly into a vein using an I.V. Whether the person gets better depends on how long he or she was exposed to the cold and his or her general health. While you are waiting for help to arrive, keep the person warm and dry. Move him or her to a warmer place, if possible. Wrap the person in blankets, towels, coats—whatever is handy. Even your own body warmth will help. Lie close, but be gentle. You may be tempted to rub the person’s arms and legs. This can make the problem worse. The skin of an older person may be thinner and more easily torn than the skin of someone younger.

Some things that put any older person at risk for hypothermia and some things you can do to avoid it include:
■ Changes in the body that come with aging can make it harder to feel when someone is getting cold. It may be harder for his or her body to warm itself. Pay attention to how cold it is where you are.

■ If a person doesn’t eat well, you might have less fat under the skin. Fat can protect the
body. It keeps heat in. Make sure your loved one is eating enough food to keep his or her weight up.

■ Some illnesses may make it harder for the body to stay warm. These include:
➤ Disorders of the body’s hormone system such as low thyroid (hypothyroidism),
➤ Any condition that interferes with the normal flow of blood such as diabetes, and
➤ Some skin problems such as psoriasis that allow the body to lose more heat than normal. Regular doctor visits can keep any illness under control.

■ Other health problems might keep a person from moving to a warmer place or putting on more clothes or a blanket. For example:
➤ Severe arthritis, Parkinson’s disease, or other illnesses that make it harder to move around
➤ Stroke or other illnesses that can leave a person paralyzed and make clear thinking more difficult
➤ Memory disorders or dementia
➤ A fall or other injury.


■ Some medicines often used by older people also increase the risk of accidental hypothermia. These include drugs used to treat anxiety, depression, or nausea. Some over-the-counter cold remedies can also cause problems. Ask the doctor how the medicines your loved one is taking affect body heat.

■ Alcoholic drinks can also make a person lose body heat faster. Encourage your loved one to use alcohol moderately, if at all. He or she should not drink alcohol before bedtime when it gets colder outside—and maybe inside, too.
■ Clothing can make a person colder or help keep warm. Tight clothing can keep the blood from flowing freely. This can lead to loss of body heat. Encourage your loved one to wear several layers of loose clothing when it is cold. The layers will trap warm air between them.

Maybe you already knew that a person's health, age, what they eat or drink, even clothes can make it hard for a person to stay warm enough wherever they are. What you might not realize is that people can also get cold enough inside a building to get very sick. In fact, hypothermia can even happen to someone in a nursing home or group facility if the rooms are not kept warm enough. People living there who are already sick may have special problems keeping warm.


If someone you know is in a group facility, pay attention to the inside temperature there and to whether that person is dressed warmly enough. Homes or apartments that are not heated enough, even with a temperature of 60°F to 65°F, can lead to illness. This is a special problem if they alone because there is no one else to comment on the chilliness of the house or to notice if a person are having symptoms of hypothermia. Set the thermostat for at least 68°F to 70°F. If a power outage leaves him or her without heat, move him or her to stay with family or friend.


Avoid using space heaters if the home seems cold or if they want to keep the thermostat set lower to keep heating costs down. Some types are fire hazards, and others can cause carbon monoxide poisoning. The U.S. Consumer Product Safety Commission has information on the use of space heaters, but here are a few things to remember:

Make sure the space heater has been approved by a recognized testing laboratory.
■ Choose the right size heater for the space being heated.
■ Keep substances that can catch fire like paint, pets, clothing, towels, curtains, and papers away from the heating element.
■ Keep the door to the rest of the house open for good air flow.
■ Turn the heater off when unattended such as when leaving the room or going to bed.
■ Make sure smoke alarms are working.
■ Put a carbon monoxide detector near where people sleep.
■ Keep the right type of fire extinguisher nearby.

Don’t forget the need to stay warm when it’s cold outside. Remember that this means knowing if weather forecasts are for very cold temperatures or for windy and cold weather. Your loved one may lose more body heat on a windy day than a calm day. Weather forecasters call this the wind-chill factor. They often suggest, even when the outside temperature itself is not very low, that the wind-chill factor is cold enough for people to stay indoors. If your loved one must go out, they must dress correctly. Be sure to wear a hat and gloves, as well as warm clothes.

Sometimes older people need help making sure their home will keep them warm enough. Some help is available. If the home doesn’t have enough insulation, contact the state or local energy agency or the local power or gas company. They can give information about weatherizing the home. This can help keep the heating bills down. It is also important to think about only heating the rooms in use in the house. For example, shut the heating vents and doors to any bedrooms not being used. Keep the door to the basement closed. If your loved one has a limited income, he or she may qualify for help paying your heating bill. State and local energy agencies or gas and electric companies have special programs that he or she may qualify for. Another possible source of help is the Low Income Home Energy Assistance Program (LIHEAP). This program supports some people with small incomes who need help paying their heating and cooling bills. The Area Agency on Aging has information on programs such as these.

Thursday, January 10, 2008

Advice for New Family Caregivers

When you're starting out as a family caregiver, it's hard to know where to begin. Perhaps you've only recently realized that a loved one needs assistance, and is no longer as self-sufficient as he or she once was. Or perhaps there has been a sudden change in a loved one's health. Now it's time to take action, and take stock of the people, services and information that will help you care for your loved one. The earlier you find support, the better.

1. Start with a diagnosis. If your loved one is forgetful at times or has gone through a noticeable personality change, take him or her to a neurologist or diagnostic clinic. A thorough evaluation will rule out any reversible causes of dementia symptoms, such as depression, nutritional deficiencies, reactions to medication or infection. An early diagnosis of Alzheimer's disease, or another disease that causes cognitive impairment, has many benefits. First, treatment for Alzheimer's disease is most effective in the earlier stages and can buy more independence for your loved one. Second, knowing your loved one's diagnosis can help you plan ahead realistically.
Learn as much as you can about your family member's condition. This information will confirm that you are not imagining things or exaggerating your loved one's behavior. Especially when you're dealing with dementia, learning about the diagnosis will help you keep in mind that it's the disease that is causing your loved one to gradually lose control over his or her behavior. Many books, videos and classes are available to inform you about what you can expect as your loved one's disease progresses.

2. Talk with your loved one about his or her finances and health care wishes. If your relative is able to complete a Durable Power of Attorney for finances and health care, assist her or him in meeting with an elderlaw specialist to draw up these documents. This planning can help relieve your immediate anxiety and make you better prepared for the future. It can also start important discussions with your family members. If your loved one doesn't have the capacity to execute these documents, you will need further legal advice to learn about your options.

3. At this stage, consider inviting family and close friends to come together and discuss your loved one's care. If possible, your loved one should be included in the meeting. List the tasks that are needed so they can be more easily divided up. Let everyone discuss their concerns, as well as how much and what kind of help each person can offer. As the primary caregiver, it's best for you to focus on accepting what assistance your friends and family are offering, even if it's not exactly what you had in mind.

4. Check into programs such as Meals on Wheels and adult day care programs. These resources are available so that you don't have to do everything yourself'and to give you a break. You can also see if there are caregiver classes and workshops offered in your community by the Area Agency on Aging. These education programs will help you feel more confident and make the time you spend caregiving easier for both you and your loved one.

5. After all of this planning, don't forget what's most important: finding support for yourself. Caregivers often feel isolated as they take on more responsibility, and as their social lives move into the background. A support group is a good place to meet other family caregivers who have really "been there". You can attend support groups in your community, as well as through the Internet.

Tuesday, January 08, 2008

What Stressors Do You Feel As A Caregiver?

Caring for your older relative or coordinating services for them through community agencies can be overwhelming. Feelings of frustration, depression, anger or guilt are not uncommon. Many caregivers decide to join a support group to provide emotional comfort. These groups allow people to share feelings and information and relieve stress, resentment and anxiety. Others seek help from their clergy or call their local agency on aging for assistance.

The following questionnaire will help you to become more aware of the stresses that you may be under. For each statement, answer for yourself whether each statement describes you or does not describe your situation.

I find I can't get enough rest.
I don't have time for myself.
I feel frustrated or angry.
I feel guilty about my situation.
I don’t get out much anymore.
I argue with the person I am caring for.
I argue with other family members.
I don't feel I know enough to be an effective caregiver.

If the response to one or more of these statements is "describes me," it may be time to begin looking for help with caring for your older relative and help in taking care of yourself.


Signs of Too Much Stress
PHYSICAL: headache, muscle aches, sleeping and eating problems, getting sick frequently.
EMOTIONAL: guilt, anger, loneliness, depression, and anxiety.
MENTAL: forgetfulness, difficulty making decisions, attention wandering.
INTERPERSONAL: withdrawal, blaming, irritability, impatience, and sensitivity to criticism.
SPIRITUAL: feelings of alienation, loss of hope, purpose, and meaning.


What caregivers need most, say professionals, is a clear sense of their own limits as caregivers. This means you may want to try to:
· Talk openly with your aging relative and other family members.
· Assess the problems.
· Figure out where to get help.
· Decide how much help you can realistically supply.


As you begin to assess your own situation keep in mind:
(1) Caring for yourself is a priority.
(2) Know and respect your limits.
(3) Arrange for time for yourself (to be alone).
(4) Arrange for time with a spouse, other family and friends.
(5) Give yourself credit for things you do well.
(6) Caregiving can be a partnership in which you share responsibilities with others.

Fortunately there are some things that you can do to help manage caregiving stresses. The first step is to reflect on how you spend your time each day. Imagine a "typical" day. Ask yourself, "How much time do I spend?" (estimate the number of minutes or hours each day)
EATING _____
SLEEPING _____
GIVING CARE TO AN OLDER PERSON _____
TAKING PART IN FAMILY ACTIVITIES _____
WORKING AT MY JOB _____
ACTIVITIES WITH FRIENDS & NEIGHBORS _____
SPIRITUAL ACTIVITIES _____
BEING ALONE _____
OTHER _____
Total Hours _____

Now that you have sketched out how you spend your time, you can determine how much time you have for yourself and how much time you have with friends or other family members.

Case Study:
Nan Harris felt guilty about asking someone to stay with her father while she did errands but she couldn't find time to go food shopping or keep her own doctors' appointments. Even more troubling, she realized that the only person she was regularly talking to was her sister. Somehow, the challenges of arranging care for dad had taken a priority over keeping up with friends and her own interests. The second step may be to arrange for a substitute caregiver for short periods of time so that you can get some time away from your caregiving responsibilities.

Nan called her Area Agency on Aging for information about eldercare services. She was fortunate because there was a respite program near her which provides trained volunteers to act as substitute caregivers for short (2-4 hours) periods of time once a week. Nan later related that the "time I spent alone revitalized and recharged me."

Listening to music, reading, taking walks and other forms of exercise, can help you to better handle the stresses you may experience during the day. Taking care of personal business also can help you feel more in control of daily pressures. While most caregivers feel that they can, should or must provide all the care to their family member, carrying the total burden is not helpful and probably impossible in the long run.The third step is to ask for other assistance from family, friends, churches, in-home aide services and community agencies.

Before you dismiss the idea of seeking help consider these three points:
1. Additional help allows you to be a more effective caregiver by giving you time away from the person you are caring for.
2. Your spouse or older relative benefits by seeing and being with someone other than you.
3. Community-based services often allow the older family member to postpone using a nursing home by providing the more difficult and/or skilled care that is needed and can be provided in the home.

Sunday, January 06, 2008

Osteoporosis: Not Just a Women's Disease


Oseteoporosis is a disease in which the bones become weak and can break easily. Often people don't know that they have osteporosis until a bone actually breaks or fractures. Any bone can be affected by osteoporosis, but the most common bones that break are in the hip, back, and wrist. The condition is quite serious because fractures can lead to pain, hospitalizations, surgery, disability, and even death.


Bones are made up mostly of proteins and minerals. Two minerals that are especially important in bone are calcium and phosphorus. Bones are living tissues and old bone cells are always being replaced by new ones. There are special cells that build up new bone (osteoblasts) while other cells (osteoclasts) break down old bone. As people get older, their bodies don't replace all the
bone that has been broken down, and bones tend to become more porous, weaker and more likely to break.

Osteoporosis is not just a woman’s disease. Not as many men have it as women do, but men need to worry about it as well. This may be because most men start with more bone density than women and lose it more slowly as they grow older. Millions of Americans have osteoporosis.They are mostly women, but more than 2 million men also have this disease. White and Asian women are most likely to have osteoporosis.

Other women at great risk include those who:
✦ have a family history of the disease,
✦ have broken a bone while an adult,
✦ had surgery to remove their ovaries before their periods stopped,
✦ had early menopause,
✦ have not gotten enough calcium throughout their lives,
✦ had extended bed rest
✦ used certain medicines for a long time, or
✦ have a small body frame

Experts don’t know as much about this disease in men as they do in women. However, many of the things that put men at risk are the same as those for women:
✦ family history
✦ not enough calcium or vitamin D
✦ too little exercise
✦ low levels of testosterone
✦ too much alcohol
✦ taking certain drugs
✦ smoking

It is best to prevent osteoporosis before it starts, and there are many steps that everyone can take to decrease the risk of bone loss. If your loved one is at high risk of osteoporosis or is already experiencing bone loss, talk to the doctor about testing and treatments. The test used to diagnose osteoporosis is called a bone density test. This test is a measure of how strong -- or dense -- bones are and can help your doctor predict risk for having a fracture. Bone density tests are painless, safe, and requires no preparation. Bone density tests compare bone density to the bones of an average healthy young adult. The test result, known as a T-score, tells how strong the bones are, whether a person has osteoporosis or osteopenia -- low bone mass -- and risk for having a fracture. Some people may be unaware that they have already experienced one or more spine fractures. Height loss of one inch or more may be the first sign that someone has experienced spine fractures due to osteoporosis. Multiple spine fractures can cause a curved spine, stooped posture, back pain, and back fatigue.
The goal of treatment is to prevent fractures. A balanced diet rich in calcium, adequate vitamin D, a regular exercise program, and fall prevention are all important for maintaining bone health. There are medications that can slow the rate of bone loss and even help rebuild bone. Several medications are approved by the Food and Drug Administration for the treatment of osteo-porosis. Since all medications have side effects, it is important to talk to the doctor about which medication is right for your loved one.

When bones are weak, a simple fall can cause a broken bone. This can mean a trip to the hospital and maybe surgery. It might also mean being laid up for a long time, especially in the case of a hip fracture. So, it is important to prevent falls.
Some things you can do are:
✦ Make sure your loved one can see and hear well. Encourage them to sse glasses or a hearing aid if needed.
✦ Ask the doctor if any of the drugs he or she is taking can make him or her dizzy or unsteady on their feet.
✦ Encourage your loved one to use a cane or walker if walking is unsteady. A physical therapist can make recommendations for the most appropriate walking device and train your loved one to use it properly.
✦ Wear rubber-soled and lowheeled shoes.
✦ Make sure all the rugs and carpeting in the house are firmly attached to the floor, or don’t use them.
✦ Keep the rooms of the home well lit and the floor free of clutter.
✦ Use nightlights.