What Is COPD?

According to the Centers for Disease Control, Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death among Americans. As its name implies, this is an ongoing condition that obstructs airflow through the lungs, and there is no cure. The good news is that oftentimes it can be prevented through lifestyle changes, and symptoms can be alleviated through inhalers, nebulizers and oxygen therapy.

Under the heading COPD fall asthma, chronic bronchitis and emphysema. Asthma is the one condition that isn’t preventable and typically has a genetic component. Interestingly, the National Institutes of Health have a theory that modern advances in hygiene and reduced exposure to infections have made children more sensitized and less resistant to allergens and other particulates that can trigger an asthma attack. Of course, this doesn’t mean we should stop immunizing our children and quit cleaning the house, but it is an interesting trade-off when it comes to childhood illness.

Chronic bronchitis and emphysema are preventable conditions. Chronic bronchitis is a persistent inflammation of the lungs with a productive cough lasting for at least three months over a two-year period. In a healthy lung, little hair-like cells called cilia keep particles moving through the airway; with increased and constant mucus, these cells wear away and are replaced by goblet cells that seem to attract mucus and do nothing to clear it out. Of course, the warm, moist environment of a compromised lung is the ideal breeding ground for bacteria and acute lung infections. When the lungs are constantly inflamed over time, the airway can constrict permanently; at this point it becomes COPD.

One of the most telling symptoms of emphysema is “smoker’s cough,” but this condition is insidious and can be brewing for many years of poor lifestyle choices before you sound like a freight train. Shortness of breath is the first sign; you may start avoiding physical activity or exercise that leaves you out of breath. Rapid heartbeat is another symptom, indicating that your heart is working harder to accommodate the lungs’ insufficiency. In its end stage, emphysema shows up as bluish and/or clubbed fingers due to lack of oxygenated blood flow, pursed-lip rapid breathing and a barrel chest since the rib cage must expand to accommodate lung expansion.

As stated above, there is no cure for COPD, but you can reduce its severity by:

• Not smoking. Your doctor can explain the wide range of smoking cessation programs out there, from prescription medication to over-the-counter nicotine patches. This is the best prevention against COPD. In fact, according to Dr. Norman Edelman of the American Lung Association, “the lungs will get better in weeks to months. Breathing will get better. Exercise capacity will get better. Paradoxically, people find that they cough a little more right after they stop smoking, but that's natural. That's the lungs cleaning themselves out.”
  
  
• Breathing exercises. Your doctor may set you up with a respiratory therapist who can instruct you on breathing exercises to strengthen your lungs and diaphragm muscles. Your lung function can be determined by an incentive spirometer that measures the volume of air in your lungs and gives you a goal to shoot with an adjustable indicator. Pursed lip breathing and breathing from the diaphragm are two ways COPD patients can get more air with less effort.
  
  
• Medications. Again, your doctor can recommend treatment options, including fast-acting inhalers for exercise or strenuous activities, and long-acting inhalers for daily use. This won’t cure the condition, but they will make it easier to deal with. Nebulizers are also used for acute episodes: these are portable machines that deliver an aerosolized mist of medication into the airway.
  
  
• Oxygen therapy. As the disease progresses, patients require supplemental oxygen to maintain their activity level and sleep better at night. Oxygen therapy can be delivered through portable units or set up in the home with a concentrator device. Some patients will also experience sleep apnea, where they stop breathing episodically. In this case, they will need a CPAP (Continuous Positive Airway Pressure) unit that offers restful sleep, as opposed to waking up after each apnea episode.

What Is CHF?

Congestive Heart Failure (CHF) is the leading cause of hospitalizations in the elderly, with over three million Americans each year diagnosed with the disease. When you think “congested,” you might have the visual of a stuffed-up nose. The heart can get “congested” two ways: either the heart muscle can’t efficiently pump out all the blood in its chambers and it gets clogged up, or the chambers can’t effectively fill with blood due to increased thickening and stiffness. When the blood has nowhere to go, it begins to pool, either in the lungs, causing shortness of breath, or in the legs, causing peripheral insufficiency and swollen legs.

CHF doesn’t come out of the blue. It generally comes as a result of other, chronic diseases. These include:

·         Coronary Artery Disease, i.e., clogged arteries due to high levels of fat and cholesterol.

·         High blood pressure, where the chambers in the heart gradually thicken to accommodate the increased pressure in the blood vessels.

·         Diabetes, particularly Type II, where high blood pressure and obesity are typically seen.

As our population ages and becomes increasingly more sedentary, we see more prescriptions being written for high blood pressure and high cholesterol. You’ve heard the TV commercials beginning with the disclaimer, “When diet and exercise aren’t enough,” which should trigger the thought, “Shouldn’t diet and exercise be enough?”  

Sometimes CHF occurs in patients with certain genetic factors, such as an enlarged heart or valvular heart disease, seen in young adults. There are even the very rare viral infections of the heart muscle that can lead to CHF. But by and large, it has to do with the patient’s lifestyle.  Of course, we can always point to the untimely death of Jim Fixx, the fellow who popularized recreational running in the 1970s and ironically dropped dead of a heart attack after his morning jog, but he had an enlarged heart and a his father dies in his 40s of the same thing.

So, incorporating healthy fats (olive oil) and healthy sugars (fruit) into your diet, along with 20 minutes of some form of cardio exercise daily can reduce your chances of developing CHF later on in life.  The American Heart Association notes that there are four stages of CHF, with four corresponding symptoms and treatment options.

·         Stage A: A family history of heart disease and/or alcoholism, or a diagnosis of diabetes, high blood pressure or a long-term smoker. Treatment options include beta blocker medications, along with diet and exercise and discontinuing alcohol and cigarette use.

·         Stage B: A prior heart attack, and/or a diagnosis of valvular heart disease or cardiomyopathy are indicators of this stage. Along with diet and exercise, beta blockers and ACE inhibitors are prescribed, along with diuretics to reduce fluid retention and going easy on the salt some times. A pacemaker or an implantable cardiac defibrillator may be required.

 

·         Stage C: Symptoms include increased breathlessness, fatigue and weakness. The same treatment options apply as in Stage B.

·         Stage D: This is the end stage of the disease, and at this point, a heart transplant, infusion drug therapy and/or clinical research trials may be the only treatment options. Patients may choose palliative care or hospice after all other options have been investigated.

Since there is no cure for CHF, taking responsibility for your care is the soundest course of action to take when it comes to keeping the disease at bay. Monitor your blood pressure and keep it under control. Keep your fluid intake consistent and check your weight daily; a gain of three pounds in one day or five over a week is definitely a reason to call your doctor. This goes along with limiting your salt intake as well as keeping an eye on your weight in general. Getting some form of exercise, whether a 20-minute walk with your pet or water aerobics at the local Y, is recommended, and there’s really no good reason to continue smoking or drinking. Implementing these recommendations early on can help you live longer with the disease and enjoy quality of life.   

Personal Hygiene & the Elderly

Taking a shower is second nature to most of us and can become an automatic response once the alarm clock goes off every day. In the very young and the very old, though, they may have to be reminded, cajoled and finally nagged to get the job done. While this is expected of children, you may have trouble reconciling yourself to the fact that mom or dad just don’t have this habit anymore, whether because they don’t get out as often and feel the need to bathe and change their clothes or other issues, such as safety concerns, memory loss or just a diminished sense of smell.

You may be surprised that something that comes as second nature to most people is suddenly a battleground issue. Consider the fact that a shower may not be part of your elderly parent’s daily routine: they don’t have a job to go to, and the only reason they may have to bathe and look presentable is a doctor’s appointment or social engagement. If your parent has dementia, that throws an added element of memory into the mix: people with Alzheimer’s have long-term memory but very little in the short term; and if they only took a bath once a week in their childhood, this routine may replace the daily baths established in their adult years.  

Although dry skin is common in the elderly, which may reduce the need for a daily bath or shower, hygiene is still part of keeping mom or dad healthy and happy. In the skin folds of unwashed areas, yeast cells can develop, which can lead to scaly, red patches under the armpits or in the groin area, with the potential to break down the skin and become sources of infection. Poor hygiene may also be keeping someone, who was formerly social and assiduous in keeping their medical or hair appointments, increasingly isolated from activities they once relished or that were essential to their well-being. At this point personal hygiene becomes a question of physical, as well as mental health, to maintain one’s independence.

Broaching this topic to your elderly parent may be a source of embarrassment to you, and you may have put it off for this reason. Or if the subject was raised, it was considered nagging by your mom or dad, a definite role reversal, especially for those in the “sandwich generation,” who are suddenly confronted with two sets of dependents: their children and their parents. Those with Alzheimer’s or age-related dementia may have distorted reasoning when it comes to taking a bath: they may be afraid that  they’ll melt once the water hits them or be sucked down the drain. If this is the case, you can’t reason with them sensibly as you would a child: “Gosh, when’s the last time you had a bath?  Phew, you’re a little stinkie. Let’s go get you a shower.”

This is when an outside party, such as a home care agency, can come in handy. Caregivers who work primarily with the elderly understand the disease process of age-related dementia and what may or may not work to engage this type of client. Gradually introducing the patient to the idea of a gentle foot bath, perhaps in a non-threatening location such as a sunny seat outside, may get the patient more open to the idea of adding more personal care.  Consistency is also a factor: just like children, those with dementia need a schedule and predictability to give reason to an often bewildering pattern of daily events. Even if a client can’t remember the name of the person who shows up every other day or why the lady is there, if the patient associates that person as a kind and caring individual, the interaction can be a nurturing and open one, as opposed to an encounter with a stranger.  Then getting a shower or a sponge bath becomes a warm and friendly interaction, and your parent can maintain a consistent regimen of hygiene and personal care for the best outcome.

"Ghosting" -- A Scary Type of Identity Theft

Preying upon the elderly is unforgivable but what can you say about the latest tactics of identity thieves: stealing from the dead? As it becomes easier to find information over the Internet, an identity thieve in Florida can easily get a few, easily pieces of information from an obituary in California, and the next thing you know, your elderly parent is on the hook for $50,000 worth of credit card charges made by your dad who died six months ago. How is this possible and what can you do to keep it from happening?

“Ghosting” is stealing the personal information from a dead person and applying for credit cards, cell phones and even filing tax returns under their name and Social Security number. Identity thieves have become aware that it can take up to six months for banks, Social Security and credit reporting agencies to realize that someone has died; in this time and with information readily available online, they can open up charge cards and go on a spending spree.

The first thing you can do is be careful what you disclose in the obituary notice, such as birth date and birthplace.  It’s scary to think but if the identity thief has this information, along with the deceased’s mailing address, all he needs is $10 to get the decedent’s Social Security number online. The obits are the first place these vultures go; and when family members place these notices, they may be unaware of the potentially damaging information they’re disclosing.

Notifying the decedent’s financial institutions and sending them each a copy of the death certificate is the best defense against identity thieves, according to the Identity Theft Resource Center. They advise getting at least 12 copies, three of which need to go to the top credit reporting agencies: Experian, Equifax and TransUnion. They also recommend sending everything via certified mail, along with a return receipt. If there are accounts with a surviving spouse, make sure the decedent is taken off. Remember that anyone listed as an account holder is ultimately responsible for any legitimate debts of the decedent.

Be sure to call Social Security at 800-772-1213, as well as the VA if applicable. Basically, a good rule of thumb is to go through the decedent’s wallet or purse and cancel any cards or IDs with their name on them. Remember that even if the decedent stopped driving years ago, there may still be a valid license on file with the DMV, so make sure it gets cancelled.

Follow up is key to prevent identity theft so be sure to request a free copy of the decedent’s credit report from annualcreditreport.com to check for any unauthorized activity. There should be nothing there besides a “deceased alert.” You can request free reports from each of the three major credit reporting agencies; do that every two months to make sure the account is free from malicious activity and to avoid any potential headaches.

Avoid Letting Your Fingers Do the Walking To Look for a Home Health Care Agency

When we’re sick or under the weather, this is not the best time to make important decisions for ourselves, especially when it comes to financial, medical or personal issues. Viewed from that vantage point, throw in the fact that you’re alone, depressed and elderly, and you have the perfect storm when it comes to making bad decisions. There are people out there who bill themselves as “care providers” or “companions,” offering their services on an hourly or per-diem basis. They may offer references from previous employers and seem to be above-board – they can cook, clean and have a nice-looking car to take you grocery shopping and to doctor’s appointments.  They may even offer “medication management” since they’ve been caring for people for years and know all the drugs they take. But how do you really know that everything is on the up and up? Are these references bona fide and not just friends acting like former clients when you call up? If you’re on a special diet, will they be able to prepare meals that fit your dietary needs? Does that car have insurance or do they even have a valid driver’s license? And if they’re offering “medication management,” where’s their nursing license? And what happens if they hurt their back while they’re working for you? Will your homeowner’s insurance cover their medical bills and any potential lawsuits? These questions can be daunting for anyone; but if you’re elderly, have some memory loss and just want someone to take care of you, this scenario can be a recipe for disaster.

At this point you need to put down the phone book and consider the services of a state-licensed, home health agency, where clients are overseen by a staff of registered nurses with multiple years of experience in the home care field. The state-licensing component is especially critical in California, where there are no such requirements for non-medical or custodial services. You should also be aware that even if you enlist the services of a full service agency, which is required to perform criminal background checks, DMV and reference checks on its employees, there are no consumer protection laws in place in the state, no minimum standards of care nor official state oversight, unless the agency is state-licensed. Therefore, it may seem like the wild west when it comes to finding a trusted agency to handle you or your loved one’s needs. This is why it is so important that the agency you choose be state-licensed and not the nicest looking graphic in the phone book.

A state-licensed agency runs background checks on its employees, verifies their certifications if applicable and ensures that they meet all requirements in terms of bonding and insurance, along with required health exams.  The best home health agencies strive to match the caregiver’s personality to  the client’s  and provide continuity of care so that just a few caregivers are involved and familiar with the patient’s care.

Another distinction between a state-licensed agency and one that is not is the RN oversight component, along with the care plans that are mandated by the state of California. When asking whether or not an agency is licensed, you have to be specific in questioning the type of license: business vs. state. A state-licensed agency can work in conjunction with Medicare agencies to provide continuity of care upon discharge from a Medicare company.  RN case management is important as the nurse can assess the patient for any lifestyle changes that could be symptomatic of disease processes and contact the client’s physician for follow-up. Nursing oversight can also offer education to the family, advise on dietary guidelines, as well as supervise  medication compliance and be the first defense when it comes to any contraindications.  

Here at Home Health Care, Inc. our nursing staff works hand in hand with our caregivers for the best patient outcome. This includes monthly visits to each client’s home to assess their medical and psychological needs and note any changes. Our caregivers also chart their patients’ condition with progress notes and report any changes to our nursing staff. We provide the oversight and level of care that is not guaranteed if you let your fingers do the walking. 

Can You Hear Me Now?

According to the National Institutes of Health, age-related hearing loss is primarily due to changes in the inner ear because of genetics or repeated exposure to loud noise. Many Baby Boomers may be regretting all of those rock concerts or looking at their parents as a cause of their hearing loss, but the good news is that technology is on their side.

Typically, your first sign of hearing loss will be others’ frustration with having to repeat themselves. You may have been compensating for it by turning up the volume on your TV and radio, but you obviously can’t do the same with your friends and family. If you accuse your grandchildren of mumbling but everyone else can hear them clearly, this is a sign of presbycusis, or age-related hearing loss, as higher pitched sounds are the first to go. Take comfort in the fact that you’re not alone.

Presbycusis occurs in about 35 percent of individuals between the ages of 65-75, and this figure rises to nearly half of those over the age of 75. This condition may be accompanied by tinnitus, that persistent ringing in the ears, which, in itself, is an indicator of hearing loss and may make it harder to hear competing, higher-pitched sounds. The source of the problem is most likely damage to the cilia, fibers located in the inner ear responsible for converting sound into electrical signals which travel to the brain. Unfortunately, cilia do not have the ability to regenerate, so the damage is done.

However, before you run to an audiologist for a hearing test, consider some other reasons for your hearing loss. A build-up of ear wax (cerumen) could be the culprit, and we may think that cotton swabs are the answer which, of course, they’re not, tending to push the wax farther into the ear canal and pose the potential risk of rupturing the eardrum. (Mom was right when she said, “Never put anything bigger than your elbow in your ear.”) Your doctor can perform an ear lavage to irrigate the ear canal and flush out any solids but don’t try this at home. A recent sinus infection or chronic allergies could also be to blame so ask your doctor.

Once your doctor has made a diagnosis of age-related hearing loss, you -- and your friends and family members -- can either live with it or contact an audiologist who can fit you with a hearing aid. Many people fight the idea of this type of device, whether because of the cost or out of sheer vanity.  Hearing tests and hearing aids are generally not covered by Medicare unless your doctor makes a disease- or injury-related diagnosis; however, some Medicare supplements do cover the hearing exam and  devices, and it’s recommended that you check with the plan’s explanation of benefits for this type of coverage.

Hearing aids have made great advancements due to microprocessors and other computerized technology. And with the amount of people wearing Bluetooth headsets these days, your hearing aid may be easily mistaken for one of them.  Some models still generate feedback if you’re on the phone, but the usual complaints, such as background noise or obtrusive appearance, have diminished. As your hearing loss becomes more profound, you may require a more expensive model, so it’s suggested that you come in and see an audiologist as soon as you’re ready.

Other assistive devices to consider that are a little easier on the pocketbook and don’t require a doctor’s order include TTY machines for the telephone, closed captioning for TV shows and wireless headsets when closed captioning is not an option. Check with your telephone provider to see what kind of TTY devices are offered: a QWERTY keyboard allows you to communicate with callers, and their conversations are captured and displayed on an analog readout.  You can set up closed captioning from the menu on your television, and many online companies sell wireless headsets where you can adjust the volume as loud as possible without disturbing the person next to you or your next-door neighbors. You’ll be surprised by all the options out there.

Being Sociable Isn't Just Good Manners

It’s a known fact: humans are social animals. Studies have shown that married men have a lower mortality rate than their single counterparts. While this could be due to the fact that men, on their own, typically don’t seek medical help until they’re sick, there’s also a social component to human health that operates on the emotional level, whether male or female.

In times of need, seeking out a friendly ear to bend with our troubles can help alleviate the stressful symptoms that accompany crises, such as rapid heart rate, high blood pressure and sleep disturbances. And having someone there to be a sounding board, when things go wrong or the thinking process is overwhelmed, can give you a more optimistic view of things or just a better coping strategy in general.

The nursing industry began in response to this need for caregivers in the home environment, particularly for the very old and the very young who were not appropriate in a hospital setting but needed outside assistance. This continues to this day: when patients are discharged from the hospital but can’t get by on their own, family members or friends are called upon for assistance.  As a home health care agency, we often receive calls from discharge planners on Friday afternoon asking for a caregiver in lieu of friends or family in the area, who are either unavailable or just aren’t there. So companionship becomes more of a safety issue at this point, but the presence of a caregiver can provide the positive emotional support for the patient’s ultimate well-being and best outcome.

Even the most extroverted people need some “alone time” to get away from the distractions of everyday life, and some individuals just aren’t “people persons” and would prefer a good book to a good conversation. Indeed, surrounding yourself with dramatic types may cause your blood pressure to rise and bring to mind Will Rogers’ admonition: “Never miss a chance to shut up.” Alternatively, pets can bring that sense of bonding that people crave; as Mark Twain noted, “The more I know about people, the better I like my dog.” However, pets aren’t very good at making dinner, reminding you to take your medication or driving you to a doctor’s appointment. That’s when you need a social support system.