Category Archives: Caregivers in Crisis

Recovering From Total Joint Replacement

Joints are vital for movement, whether that involves reaching, bending, walking or engaging in other activities – functions that are fundamental to everyday life.  As we get older rheumatoid arthritis, traumatic injury or osteoarthritis can affect joints which may lead to a need for joint replacement surgery.

Assistance Throughout Recovery
Normally, a smooth layer of cartilage, which allows frictionless and pain-free movement, covers a joint’s bone ends. However, when the cartilage is damaged or worn, movements become stiff and painful. When a joint is worn to the point where bone is rubbing on bone, even daily activities — walking, going up and down stairs and bending — become difficult. The pain and lack of mobility associated with joint problems can be debilitating.

When total joint replacement surgery is a viable solution, the goal is to relieve joint pain by replacing the damaged cartilage with metal and/or plastic surfaces. This replacement restores joint movement and function, and in turn, increases mobility. Patients undergoing joint replacement surgery improve their quality of life with greater independence and healthier, pain-free activity.

After surgery, a proactive home health routine, including rehabilitation and physical therapy, is required to ensure the best function of a new joint. Each person will vary in how quickly they recover and regain mobility, however, “All patients returning home from any joint replacement surgery can expect to need the help and support of family, friends, and/or an outside agency for a period of at least a few weeks,” Nan Davidson, clinical nurse specialist in surgery services at Porter Center for Joint Replacement in Denver, explains. If surgery is the best option for you, then knowing what to expect afterwards will help you prepare — and set you up for success!

Knee Replacement
According to the National Association of Orthopedic Nurses, each year, more than 581,000 Americans undergo knee replacement surgery. A successful knee replacement and recovery period can give you not only a new knee, but also a new lease on life!

Knee Replacement Recovery Basics
Most people can stand and move around the day of, or shortly after knee replacement surgery. “It is a wonderful boost in patient confidence to actually stand on the new knee the evening of surgery, or very soon after. It sets the stage for a strong recovery,” explains Davidson. Temporary use of walking devices, such as crutches, a walker or a cane, will most likely be necessary to support full body weight, with the duration depending completely on the surgery and individual home health recovery progress.

Most patients return to home from the hospital and begin a home health regime just a few days after surgery. Once home, physical therapy and rehabilitation will continue for six to eight weeks to restore strength and motion of the new knee and the muscles that support it. Upon completion, patients can return to enjoying most activities.

Many patients return to work soon after surgery, and can resume home duties and low impact activities seven to 12 weeks after surgery. When recovering from knee replacement, it’s important to be realistic and remember that you’ll progress at your own pace, as your body is ready to!

Recommended Lifestyle Adjustments for Knee Replacements
Although on the road to recovery, patients still need to take care of their new knee. Setting practical goals with your doctor or physical therapist for bending and straightening the affected knee, climbing stairs, and walking certain distances can help you push for recovery without over-doing it.

Upon returning home, keep the space safe and accessible by removing loose rugs, clutter and furniture that’s difficult to move around. An elevated toilet seat or toilet safety rails, a shower bench or chair, grab bars, and other assistive equipment, such as long-handled reaching tools and sponges may be helpful.

After full rehabilitation, patients can return to normal household and work routines. Participation in low-impact activities, such as walking, dancing, golfing, hiking, swimming, bowling and gardening are encouraged. It’s important to avoid high-impact activities, such as running and basketball, as these can cause undue stress on the knee.

Hip Replacement
According to the National Association of Orthopedic Nurses, each year, more than 193,000 Americans undergo hip replacement surgery. A successful hip replacement and home health recovery period can not only repair the hip and minimize pain, but also creates a path of healthier being!

Hip Replacement Recovery Basics
The first step to recovery from a hip replacement is putting weight on the leg. Depending on the type of replacement you’ve received, this can take anywhere from four to eight weeks. Leading up to this, mobility will require an assistive device, such as a walker or cane, that will enable mobility to build strength and encourage healing.

Physical therapy is essential to a full recovery from hip replacement surgery. Most people are able to return directly to their own home after surgery, and can therefore continue exercises at home or in an outpatient rehabilitation setting. Light housework can be resumed within two weeks post-surgery — however, heavier home duties, like shoveling snow or moving furniture, should wait until seven to 12 weeks, or as suggested by your doctor. Depending on the speed of recovery, as well as the type of work a patient does, it may be six weeks until returning to work is advised.

Recommended Lifestyle Adjustments for Hip Replacement
During the recovery period, certain precautions should be taken to ensure a new hip heals properly. Although exercise is an important piece to the recovery process, consult a doctor, home health nurse or physical therapist for specific instructions on bending, crossing your legs, and lifting or twisting the affected leg.

It’s also important to make necessary changes to your home to ensure a safe recovery environment. “Just as with knee replacement surgery, patients need to make sure their home environment is clear of anything that they may trip on or fall over,” says Davidson. “Preparing for the return home after hip replacement surgery will entail getting an assistive device for walking, and other equipment to ensure safety, like a shower chair and/or grab bars.” Your doctor and physical therapist will provide specialized suggestions based on your unique situation.

As the rehabilitation process continues, patients will be able to resume most daily activities, work and exercise. However, high-impact activities, such as running, jumping rope and jogging should be avoided. Substitute physical activities like swimming, cycling, walking, dancing and golfing. These are safe for a new hip.

Shoulder Replacement
Although far less common than hip and knee replacements, shoulder joint replacement surgery is becoming more prevalent. The American Academy of Orthopedic Surgeons cites that each year, 23,000 Americans have this surgery. Approaching recovery and rehabilitation with information and realistic expectations will ensure that it’s a successful process.

Shoulder Replacement Recovery Basics
After shoulder replacement surgery, most patients are able to complete limited basic personal care tasks in two weeks, with more complex tasks taking up to six weeks to resume. Patients typically have to wear an arm sling to support the shoulder during this time after surgery. “Again, arranging support for the temporary limitation in your arm can limit or avoid frustrations. Prepare your home, plan meals ahead of time — having things in order makes for a smoother rehabilitation period,” notes Davidson. Talk with a doctor, home health nurse or physical therapist to ensure that you’ll have what’s needed upon arrival at home.

Recommended Lifestyle Adjustments for Shoulder Replacement
Short-term, patients recovering from shoulder replacement cannot use the affected arm to lift their body weight in bed or up from a chair. Patients in recovery should always avoid placing the affected arm in extreme positions, and ask for assistance when needed. It’s important not to overdo it — lifting anything heavier than a glass of water isn’t recommended. However, it is essential that patients engage in exercises during therapy sessions and at home, as advised by a physical therapist.

The only long-term limitations resulting from shoulder joint replacement are that recovered patients refrain from heavy lifting and participation in contact sports.

Grieving Alzheimer’s Disease

When a diagnosis of Alzheimer’s is received the impact for family members and loved ones is immense, however it is all too often overlooked. The thought of losing a loved one to the progressive disease has damaging effects on caregivers, family and friends.  This can manifest in sleeplessness, loss of appetite or overeating, low energy, tension and exhaustion.  Emotional responses can also manifest, such as loneliness, guilt, anger, isolation and depression. The extent of these symptoms can vary and the experience of caregiving is different and unique for everyone.

Allow Yourself to Grieve

Often, family caregivers feel they shouldn’t burden others with their feelings; however, this thinking keeps us from healing. However, giving yourself and others permission to process and grieve is the best way to heal. Find support through family, friends, members of your faith-based community, or a counselor. Support Groups can also be very helpful. If you’re not ready to talk about your feelings quite yet, journal or write about them. This is a great first step towards venting, rather than keeping your feelings bottled up. Find time for yourself each day, whether it’s to cry, relax, or to let go of the day’s stress, anxiety and the responsibilities of care giving.

Give Yourself Time

When working to overcome grief, give yourself time. It’s easy to think that just because we can be logical about our grief and pain, we can overcome it quickly. After you’ve begun to talk about your grief, time will help you to accept and cope with it — which can slowly lead you to move forward. The memories will remain, but painful feelings will lessen in intensity. Give yourself time to pass through each stage of grief, and understand that grief very personal, and will be experienced differently.

The stages of grief include: denial, turmoil, anger/fear, depression, anticipation and acceptance. You may or may not experience each of these stages fully, and not necessarily in this order, so be flexible with yourself. You may also bounce between the stages or return to some. If you feel stuck in any of the stages, seek a counselor. Oftentimes, grief leads to depression, which can be especially difficult to recognize and recover from without outside help. Grieving is a normal process, but should be temporary.

More About Homewatch CareGivers

Homewatch CareGivers is a premier caregiver agency, providing home care for all ages. We invite you to visit www.homewatchcaregivers.com, where you can read articles related to home health, Dementia Care Tips and home care news; or download PDF home care resources. From health care coordination and hospital discharge planning to home care transportation and daily living assistance, let our family of caregivers care for yours.

 

Does Your Parent Need Nutritional Help? Simple Tips for Identifying and Solving Nutritional Issues

As an in home caregiver to your mother or other loved one, it can be hard to notice when your parent is getting enough to eat.

Dr. Miriam Rodin, MD and PhD and associate professor of geriatrics at the University of St. Louis, said that the first clue is weight loss.

“Mostly I find patients who have depression or dementia who have lost their appetite,” she said. “If they have depression they have no appetite and if they have dementia they forget to eat or don’t recognize that they are hungry—that’s why they wander at night a lot.”

She suggests eating meals together and making it a social occasion.

Dr. Rodin said that someone taking numerous medications might also eat less. “The more pills you take, the more likely it is that something is killing your appetite,” she said. She recommends that patients, with the help of medical professionals, minimize the number of drugs they consume to improve their appetite.

For people in their 80s and older, Dr. Rodin said that restrictive diets can be harmful to their health and actually deprive them of nutritional benefits. “Give people what they want to eat,” she said, adding that she often recommends patients eat ice cream before bed. “The issue is to get the calories in, so eat what tastes good. They should have a lot of protein like hard-boiled eggs and cheese cubes.”

Often people cannot safely move around in their own kitchen anymore, and that can prevent them from eating enough. The Homewatch CareGivers’ Guide to In-Home Senior Safety covers home care and safety for every room of the house—including the kitchen.

The kitchen is a high-risk area of the home since appliances and stovetop burners can be left on; your mother may not feel steady enough to use a cutting knife; vision problems might prevent your mother from being able to see expiration dates; foods out of reach in a high cupboard might keep your loved one from being able to reach everything they need.

“They are pretty much like children,” Dr. Rodin said of very elderly people.

For caregivers who do not live with their mother or loved one, Dr. Rodin said that she often hears people wonder why they have delivered the groceries and still see weight loss in their parent. “You have to ask yourself where the food is going,” she said. “If you buy things that require a lot of cooking and she is not eating it, then you have to make changes.”

The in home caregiver may need to have an honest talk with their loved one about their comfort level in the kitchen. Suggest grocery shopping together, the option of a service such as Meals on Wheels deliver nutritional food regularly and make sure that they are involved in the process of rearranging the kitchen and selecting new foods.

More About Homewatch CareGivers

Homewatch CareGivers is a premier caregiver agency, providing home care for all ages. We invite you to visit www.homewatchcaregivers.com, where you can read articles related to home health, Dementia Care Tips and home care news; or download PDF home care resources. From health care coordination and hospital discharge planning to home care transportation and daily living assistance, let our family of caregivers care for yours.

Tips for Communicating with a Person Who Has Dementia

We often think of communication in the context of words or other sounds (singing or shouts for example) and we assume that the goal of communication is to share a particular message. But in fact, there are two types of communication: verbal and nonverbal. Nonverbal communication — the use of body language – is conveyed with our eyes, touch, facial expressions, gestures, hand movements, body posture and position. What’s more, the actual message, or content of our communication plays a lesser role in overall communication.

According to research, nonverbal (body language) comprises 55% of overall communication, compared to vocal tone, which comprises 38% of communication and content, which comprises only 7% of communication. Keep this in mind when interacting with your loved one.  Just because they may have trouble understanding the content of your message, does not mean that they can’t pick up on frustration, fear, happiness, sadness, anger and other communication through body language.

Tip 1: Effective Non-Verbal Communication

Maintain a calm pleasant approach.  The person with dementia will mirror your mood.  If you act rushed or tense the dementia person may react by becoming more anxious or agitated. Approach the person from the front to minimize the startle effect.  Always establish eye contact.  Speak at eye level whenever this can be done.  Point or demonstrate what you are trying to get across.

Tip 2: Effective Verbal Communication

Use a calm gentle voice. Use short simple sentences.  Speak slowly. Call the person by name and introduce yourself if necessary.  Answer a frequently asked question like it was the first time they have asked it.  Eliminate distracting noises.  Give one instruction at a time.  Do not overwhelm them.  Remember you are speaking to an adult.  Allow enough time for the person to respond and repeat yourself if necessary.  Use words that are familiar to them.

Tip 3: Things Not to Say

Do not try to argue with someone who has dementia, talk louder when they do not understand you, use a demanding tone or ask questions that rely on the use of memory if they are experiencing a disoriented moment.  You should treat them the way you would want to be treated under the same circumstances.  Basically, try to put yourself in their shoes.

Tip 4: Alleviating Barriers

Be a good listener. Encourage nonverbal types of communication and be patient and supportive. Show interest in what they are saying and do not criticize.  Focus on feelings and not the facts and offer comfort and reassurance.  Limit distractions, offer a guess when they can’t find the word and give them time to express their thoughts. Use cue cards to help with communication barriers. Do not make fun of their  lack of abilities or tease them at any time.

Tip 5: Coping with Reality

Communication with someone with Alzheimer’s can be a difficult task. Alzheimer’s disease damages parts of the brain that control communication and it may be difficult for your loved one to find the right words. They may have difficulty following conversations or they may be able to still read but not comprehend what they are reading. Memory loss may cause the person to repeat himself or herself or to develop “automatic speech”, where a simple phrase like “thank you” is repeated. Curse words may be used more frequently due to the disease process. Keep in mind when communicating to enter their reality instead of bringing them into yours.

As you learn to communicate with some who has dementia, stay flexible. Remember that it is a trial and error process and what works today may not work tomorrow. Use your own skills and implement your own ideas

Deanna Lueckenotte experienced Alzheimer’s at a personal level with her grandmother who is now no longer with us.  She has spent almost 13 years working in geriatric healthcare with an emphasis on Alzheimer’s.  She is the author of Alzheimer’s Days Gone By: For Those Caring For Their Loved Ones.

Two Easy Steps to Developing a Care Plan

Help to ensure continued good health for your aging loved one by creating a geriatric care plan.  Taking the time to go through these quick and easy steps to creating a plan will help your loved one avoid hospitalization, enable them to live independently, and improve their overall quality of life.  Putting a care plan in place enables family caregivers, aging loved ones and health care professionals to be on the same page regarding health care and living arrangements.  This also ensures that each person knows their role in managing the needs of the patient or loved one.

Step One:  The Geriatric Assessment

A geriatric assessment is performed by a geriatric care manager or licensed social worker.  The goal of the geriatric assessment is to evaluate the current and future medical, social and emotional needs of the aging individual.  A geriatric assessment should include:

  • A complete physical, mental and psycho-social evaluation
  • An assessment of the individual’s personal care competencies, known as actvities of daily living (ADLs)
  • Identification of existing problems
  • Listing of anticipated problems

Step Two:  Developing a Care Plan

The geriatric assessment should give families and caregivers all of the information needed to develop a solid, comprehensive care plan for their loved one.  According to the American Association of Retired Persons (AARP), a care plan “assesses an individual’s medical and social service needs, and then coordinates assistance from paid service providers and unpaid help from family and friends to enable persons with disabilities to live with as much independence as possible.” Such a plan should include:

  • Help managing personal care responsibilities, medication delivery, and general physical, mental and psycho-social issues.  For some families, a home health aide or an assisted living environment addresses these issues.
  • Anticipate changes needed in living arrangements developed to ensure the continued safety and health of the aging individual.  Sometimes, simple attention to geriatric home safety is all that a family needs to ensure the continued health and safety of their loved one.  Other times it may be necessary for the older individual to be moved to a smaller housing unit, apartment or other one-level living arrangement (including assisted living options and/or nursing homes).
  • Managing the connections between support services, healthcare providers and the aging individual to ensure that the loved one receives the necessary care and monitoring.
  • A plan for ongoing monitoring and reassessment.  Families, especially those who don’t live nearby their aging parents, should make sure that they receive periodic reports about their loved ones.  Regular reassessments should be scheduled to address any changes in the older person’s physical, mental or psycho-social needs.  Special attention should be paid to the need for immediate modification in the event of a drastic change in the older person’s health.

Republished with permission from Parent Giving. Parentgiving.com was created to help time-starved caregivers provide better care for their aging parents by providing in-depth information and helpful checklists about a variety of caregiving topics.