MAY IS NATIONAL STROKE AWARENESS MONTH

By Pam Gennings, Executive Director Special Projects*

Every 40 seconds someone in the United States has a stroke. A stroke occurs when a blockage stops the flow of blood to the brain or when a blood vessel in or around the brain bursts. Strokes are the leading cause of long-term disability in the U.S. and according to the CDC (Centers for Disease Control and Prevention) it is the fourth leading cause of death. A stroke can strike people of all ages, in fact the CDC reports that nearly a quarter of all strokes occur in people younger than 65.
Strokes are largely PREVENTABLE.
• According to the American Stroke Association, one in three Americans has high blood pressure, which is the number one controllable risk factor for stroke. It is important to keep your blood pressure under control.
• Cigarette smoking contributes to one in every five strokes in the country. Exposure to second hand smoke can also contribute to a higher stroke risk.
• Exercise regularly. To help lower or control blood pressure, get 40 minutes of moderate to vigorous physical activity three to four times a week.
• Prevent or control diabetes.
• Get your cholesterol checked regularly and manage it with diet/physical activity or medication if needed.
• Eat a healthy diet. Watch your sodium intake.
• Limit your alcohol intake.
• Ask your doctor if taking aspirin is right for you.
Strokes are TREATABLE, but every second counts. The sooner a patient receives medical treatment, the lower the risk of death or disability.

As an easy way to remember the sudden signs of stroke, the American Stroke Association wants everyone to learn F.A.S.T. When you spot the signs you will know to call 9-1-1 immediately.

F = Face Drooping – Does one side of the face droop or is it numb? Ask the person to smile. Is the person’s smile uneven?
A = Arm Weakness – Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downwards?
S = Speech Difficulty – Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence, like “The sky is blue.” Is the sentence repeated correctly?
T= Time to call 9-1-1 – If someone shows any of these symptoms, even if the symptoms go away, call 9-1-1 and get the person to the hospital immediately. Check the time so you will know when the first symptoms appeared.

Beyond F.A.S.T., other warning signs include:
• Sudden numbness or weakness of face, arm, or leg.
• Sudden confusion
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headaches with no known cause

Remember getting immediate medical attention for stroke is crucial to prevent disability and death.
For more information go to www.strokeassociation.org

*Pam Gennings has a Bachelor’s of Arts and has worked in the field of Geriatric Social Work and Care Coordination for more than 30 years. She started working for Oxford HealthCare in 1993. During the course of her career she has helped thousands of people find resources to remain in their homes as well as provided guidance to families that were facing difficulties with their aging loved ones.

Why Go If My Loved One Can’t Remember My Visit?

By Carol Combs, MSW, Oxford’s Memory Care Coordinator

When a loved one has Alzheimer’s disease, it changes the way friends and family interact with the person. Knowing what to say, or even how to act, can be challenging. The individual may not remember those who come to visit or remember prior visits.

When visiting a loved one with Alzheimer’s you may hear questions such as, “Why don’t you ever visit?” or “Who are you?” Such questions, as well as behavioral changes that accompany the disease, can make visiting difficult and uncomfortable.

However, there are some things you can do to help ease the discomfort and make your visit more pleasant for you and your loved one.

  • Focus on feelings – the content of the conversation doesn’t matter. The feelings and sense of contentment created will make a difference. Emotion lasts longer than memory. The emotion resulting from a positive visit can improve a person’s mood and influence the rest of the day.
  • Accept the person’s reality- don’t correct your loved one, just go along with it. If the person insists the grass is blue, agree. Telling the individual it’s really green can create agitation. Instead, offer reassurance and distraction.
  • Introduce yourself- avoid saying “Don’t you remember me?” because if the person doesn’t, it can be embarrassing. Introduce yourself with “Hi Mom, this is Susan.”  Save her the embarrassment or awkward moment.
  • Be respectful- don’t talk to Alzheimer’s patients like they are children. They have a lifetime of experiences, so show them the respect they deserve.
  • Bring an activity – long-term memory is often still intact. Reminiscing with pictures or photo albums can be comforting and encourage conversation. Play music or sing. Consider Music Therapy. Music can stir positive emotions, and individuals may be able to remember lyrics even though their ability to communicate has declined. Exercise improves brain circulation. Encourage movement of arms and legs, or toss a beach ball. Introduce your loved one to a GeriJoy Companion, a special tablet which provides social interaction, helps decrease loneliness and has shown remarkable success with Alzheimer’s and dementia patients.
  • Touch – hold a hand, stroke hair, hug. Touch is a powerful way to communicate when words fail. People with dementia recognize a caring touch, even in the late stages of the disease.
  • Minimize distractions – it will be more difficult to have a meaningful visit if there is too much noise or activity. Over stimulation can cause agitation. Try to find a quiet place or take a walk outside.

If you know someone with Alzheimer’s and are hesitant to visit, remember that the benefit of your visit may last long after you’ve gone.

For additional support or information, contact Oxford HealthCare. Oxford offers numerous programs that provide the help and relief you need—so you can enjoy time with your loved one and continue to provide care at home. For your peace of mind, advanced technology like Lifeline and GeriJoy helps provide added security when you can’t be with your loved one. To find out more about all Oxford has to help families, contact a Care Coordinator, today.

 

 

 

“When words fail, music speaks” Hans Christian Anderson

By Carol Combs, MSW – Oxford’s Memory Care Program Coordinator

While working in a skilled nursing facility, I had the opportunity to witness remarkable things. I was amazed to see individuals with dementia who could not put together a sentence, but could sing an entire song. Their faces would brighten, and I could see mood changes along with toe tapping and smiles. Soon, others would join in. Although the disease had taken so much away from them, music was a wonderful way to engage and encourage them.

The language area of the brain is impacted early in the Alzheimer’s disease process, but music touches a different part of the brain. The area of the brain linked to music is relatively unaffected by Alzheimer’s disease; so musical memories are often preserved. Rhythmic responses require little to no cognitive processing; so, a person’s ability to engage in music—particularly rhythm playing and singing—remains intact late into the disease process. Some individuals will respond to music when nothing else seems to reach them.

Music can provide emotional and behavioral benefits for dementia sufferers. Listening to music or singing can relieve stress and reduce agitation, anxiety or depression. For caregivers, music is a way to connect with loved ones who have difficulty communicating. Most people associate music with important events and emotions, and selections from a person’s young adult years—ages 18-25—are more likely to elicit a strong response. As an individual progresses into later stage dementia, music from childhood works well. Although individuals may not be able to verbalize or demonstrate affection with loved ones, they can still move with the beat of a favorite piece of music until very late in the disease process.

Caregiver Tips:

  • Experiment with different types of music to see which evoke the best reaction.
  • Play music or sing as the individual is walking to improve balance or gait.
  • Choose relaxing music, a familiar, non-rhythmic song to reduce sun downing or bedtime issues.
  • Compile a musical history of favorite recordings to help with reminiscing and recalling memories.
  • Encourage movement with the music —clapping or tapping feet, or dancing if possible.
  • Play or sing soothing songs to calm someone during mealtime or personal hygiene care.
  • When playing music, eliminate competing noises such as television or outdoor sounds.

Singing is associated with safety and security from early life. When caregivers engage in singing with their loved ones, it provides an opportunity to connect, even when the disease has deprived them of traditional forms of closeness.

“Music is the literature of the heart; it commences where speech ends.”
Alphonse de Lamartine

Oxford Hospice provides numerous home care programs—including music therapy—to help caregivers and their loved ones. Oxford HealthCare is dedicated to helping families enjoy time together and remain at home. If you have questions about Oxford Hospice, Oxford’s Memory Care Program or receiving help at home, please contact a Care Coordinator, today.

 

Source: Alzheimer’s Foundation of America

 

November is National Hospice Month and National Alzheimer’s Awareness Month

By Elizabeth Lee, RN, BA, CHPN Oxford’s Hospice and Palliative Specialist and Carol Combs, MSW Oxford’s Memory Care Program Coordinator

Hospice is a wonderful and caring option for people who are facing end of life illness. The primary goal of hospice care is to help maintain the highest quality of life in the last stages of an illness.

Hospice serves individuals with any terminal illness, including Alzheimer’s disease. The Hospice Interdisciplinary Care Team includes the physician, nurse, social worker, chaplain, aide and grief services. This team works together with the patient and family to help manage the unique needs of end stage Alzheimer’s disease and other related dementias.

Hospice focuses on comfort, support and managing pain rather than providing treatment. People with Alzheimer’s disease become more disabled over time; and with advanced dementia, individuals can no longer communicate their wants and needs. Focusing on the senses—touch, hearing and sight—can bring comfort when verbal communication cannot.

An Alzheimer’s patient could be eligible for Hospice care if they:

  • Are unable to ambulate without assistance
  • Are unable to dress or bathe without assistance
  • Are unable to swallow
  • Are unable to speak or communicate meaningfully
  • Have urinary and fecal incontinence
  • Have UTI’s (urinary tract infections), decubitus ulcers and/or aspiration pneumonia

The end of life path of hospice patients can be divided into one of three typical patterns:

  1. A short period of obvious decline at the end (typical for most cancers)
  2. Long-term disability with periodic intensification and unpredictable timing of death (typical for a patient with chronic organ system failure)
  3. Steadily declining function with a slowly dwindling course to death (typical for a patient with frailty, dementia or Alzheimer’s)

End of life decisions become more complicated if wishes have not been or cannot be expressed by the dying person. Families then have to speak for the person based on their knowledge of the individual’s values and beliefs.

What is the current quality of life, and how will the on-going treatment potentially impact quality of life?

Patients and families need to understand benefits versus burdens before treatment continues or is introduced. This requires truth telling and explanations in a language the patient and family are able to understand.

Family members caring for a dying loved one with Alzheimer’s often express relief—for the patient and themselves—when death comes. It is important to understand that these feelings are normal.

Hospice can help the patient and caregiver deal with the challenges faced in the patient’s final months, and offer grief support both before and after the loved one dies. Hospice helps ensure the highest quality of life while being treated with dignity and respect.

For more information about Oxford’s Hospice or Memory Care Programs, please contact one of our Care Coordinators, today.

 

The Stages of Alzheimer’s

By: Carol Combs, MSW, Oxford’s Memory Care Program Coordinator

Don'sBackyard_Faded_pathAlzheimer’s disease is an irreversible, progressive brain disease causing a slow decline in memory, language, reasoning, judgment, and daily functioning. It typically develops gradually and worsens over the course of several years. This progression is often referred to as stages, but not everyone will experience the same symptoms at the same rate. There are common patterns of symptom progression and a person’s abilities will change through the course of the disease.

Stages are typically referred to as early, middle and late or mild, moderate and severe. It is important to recognize these stages are a rough guide based on averages; each stage could be as brief as a year or as long as ten years. The stages can help patients and families understand what they might expect and plan accordingly.

Early stage symptoms

  • Increased forgetfulness, memory loss for recent events
  • Poor concentration
  • Repetitiveness: telling the same story over and over
  • Difficulty with word finding, expressing thoughts
  • Difficulty with decision making, problem solving or complex tasks
  • Misplacing objects or getting lost in familiar places
  • Mood or personality changes, less tolerance
  • Slower to react or learn something new
  • Needs support/supervision to continue living alone

In the early stage, most people can still live alone and carry out daily tasks, but may need assistance with finances, appointments, meal planning or cooking. This is a good time to organize and simplify daily routines and assess the home for safety. Depression and withdrawal from social activities is not uncommon in this stage and the person may try to hide the memory losses he/she is experiencing.

Middle stage symptoms

  • Increased memory loss, may not recognize family
  • Communication difficulties
  • Problems with reading, writing and numbers
  • Loss of impulse control, poor judgment
  • Difficulty with dressing, bathing, toileting
  • Aggression as a response to frustration
  • Inappropriate behaviors including resisting care, agitation, wandering
  • Delusions or hallucinations
  • Abnormal sleep/wake cycles
  • Needs full time supervision

In the middle stage, the patient may be more unpredictable and daily activities will be more challenging. Inability to perform tasks such as cooking and driving may lead to unsafe situations. At this stage, many will need full time supervision to remain in their home. Behaviors such as suspicion, wandering, resisting care, agitation and sleep disturbance may be displayed. Frustration is common because the person cannot make sense of the world around them. The behaviors are not intentional and are best dealt with by staying calm, using redirection or distraction, reminiscence and reassurance.

Late stage symptoms

  • Needs to be bathed, dressed, fed, turned
  • Loses ability to verbalize; may yell, groan or grunt
  • Loss of bodily functions, incontinent
  • Flat affect; where their faces show very little emotion
  • Unable to recognize others or themselves
  • Immobility
  • Appears apathetic, lethargic
  • Requires total care, may be appropriate for nursing home placement

With the increased cognitive losses, the patient will become calmer; less distressed by the changes happening to them and appear more apathetic.  Physical losses increase with incontinence, immobility, diminished speech and inability to perform any daily functions.  Physical wellbeing and comfort care become the primary concern. When the patient reaches this final stage additional in-home care including Hospice care may be needed to assist the caregiver.

In all stages, family and caregivers need to obtain available in-home care, seek support, utilize community resources and ensure that legal and financial affairs are in order.

If an individual has not been diagnosed with Alzheimer’s but is displaying any of these symptoms, he or she should seek a medical assessment promptly. If you have questions or concerns our Memory Care Program Coordinator would be glad to assist you.  Additional information is also available through the Alzheimer’s Association at www.alz.org.