Dementia and the Holidays

As fun as the coming holidays can be, they can be packed with hazards for people with dementia. It means caregivers and families need to be especially vigilant about the safety.

Many decorations look like food and may even smell like the real thing.  For instance, a Christmas tree decoration that looks like a gingerbread man may be even scented with gingerbread smell—making doubly appealing to try to eat.  Other small decorations can be choking hazards.  Artificial fruits, vegetables and nuts can look very real.

Candles that smell like pumpkin or apple pie can be a fire hazard if tipped over if a person reaches into it.  Poinsettia leaves, contrary to popular belief, are not poisonous—but they will make a resident nauseated if he or she eats them.

People with dementia need routines—the same activities, in the same place, at the same time.  Families should consider this carefully before deciding to take a loved one home for a holiday.  The excitement, the car ride, change in surroundings and many people talking can cause the confused person with dementia to become agitated or upset.

Here are some tips for family members planning to take a loved one home for a holiday.

Planning

• Plan ahead.  Let the facility staff know several days ahead so they have time to obtain medications and clothes.
• Allow extra time for everything, don’t rush the person.
• Try to keep as much as possible to their daily routine.

Decorations

• Use ribbon instead of sharp hooks when hanging decorations.
• Holly and mistletoe can be poisonous and berries pose a choking hazard.

Festivities

• Begin new traditions by letting another family be the host but try to go to a place familiar to your loved one.  
• Assign tasks to other family members so you do not become overloaded and stressed, which in turn causes your loved one to be stressed.
• Provide a nap before festivities. If you know the day will be long, you may want to attend only the most important part of the event.
• Plan for a quiet place for your loved one to go to if he or she becomes overwhelmed.
• Avoid alcohol.
• Be aware of their diet and diet restrictions. Cut up food into small bites.

Visitors

• Let your loved one know who is coming to visit.
• Have visitors and family call ahead to determine best time to visit.
• Small groups of visitors or family is advisable. Have them wear name tags as this might help with recognition.
• Reintroduce yourself as necessary. “Mary, my name is Betty.” And when she asks, “Are you my granddaughter?” say “yes” and shake her hand and act very comfortable about this introduction.
• If your loved one begins talking about the past, try not to reorient him or tell him he is wrong.  Enter his reality and live his truth.  Ask about the past memory.

Activities

• Reminisce about the past.
• Play holiday music familiar to your loved one.
• Read holiday cards aloud.
• Stuff stockings, watch a holiday video, look at family slides or pictures or albums, read scriptures, etc.

The Kitchen

• Monitor your loved one while in the kitchen.
• Give your loved one task to help with baking or decorating. Try baking cookies, making pudding, folding napkins, polishing silver, etc.
• Always check the microwave before turning on in case something was put in that is flammable.
• Check all trash cans before throwing out garbage

Shopping

• Don’t leave your loved one in the car or in the front of the store.  If you can’t take them in with you, try to arrange for someone to stay with your loved one.
• Shop during hours when stores are less crowded.
• Dress your loved one in a bright yellow shirt which is easy to see if you become separated. Be sure they have a purse or wallet with identification.
• Shop in smaller stores rather than the mall.

Travel

• People with dementia should never travel alone.  Hire a personal care aid to travel if a family member is unable to accompany the resident.
• Be aware of balconies and other hazards in hotels.
• Travel may not be appropriate even with a companion if the person has:

1. Consistent disorientation or agitation in familiar settings
2. Wanting to go home when away from home on short visits
3. Delusional, paranoid, aggressive or disinhibited behavior
4. Problems managing continence
5. Teary, anxious, withdrawn behavior in crowded, noisy settings
6. Agitated or wandering behavior

Please visit our website to download additional resources for Caregivers.

Walker Safety

Walkers are valuable tools that promote mobility.  They can help when a resident has poor balance (like after some strokes) or is weak.  But incorrect use can have disastrous results.  Here are some simple guidelines for helping residents use their walkers safely.

Right Walker

First, make sure the resident has the right walker.  There should be rubber hand grips and non-skid rubber tips or wheels on the legs.  A lightweight walker allows the resident to easily lift it over bumps or stairs.  Some have wheels on the front legs if the resident has trouble lifting the walker while walking.  Sturdy wheels are a must.  Other options are hand brakes, baskets for carrying and legs that are adjustable to varying heights. If the resident has a tendency to tip backwards, the height of the walker can be adjusted down slightly to redistribute his weight.

Starting Out

When getting up from a chair, put the walker directly in front of the chair.  Then have the resident slide forward in the chair, keeping the feet directly under him.  Then have the resident use the arms of the chair to slowly stand.  The resident should grasp the walker handles firmly and move forward into the center of the walker.  When walking, watch the resident to be sure he does not put the walker too far ahead of this body.

Sitting

When the resident is ready to sit down, have him back up to the chair such that he can feel the chair on the back of his legs.  If one leg is weaker than the other, have the resident put his weight on the stronger leg.  The resident should keep one hand on the walker while the other reaches for the arm of the chair.  When he has a firm grasp, he should move the other arm to the chair, then lower himself down.

Remember, to be safe using a walker:

• the resident must take small steps
• he should never tilt or pull on the walker when getting up from a sitting position
• chairs should have armrests
• walkers should be examined routinely to be sure wheels and tips are secure and not worn down. 

This article was originally published in Pathways Residential Care Journal - Issue 3.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

Selecting & Using a Cane

When a resident has limitations in balance, joint motion, coordination or strength, a cane can sometimes be a useful tool in restoring mobility.  The first key is having the right ambulation aid for the user’s needs and abilities.  The second is gait training to achieve the safest walking pattern.

Considerations

The resident’s vision, balance and stability need to be considered, as well as his or her ability to learn new things and use good judgment.  If a cane is the right aid for the resident, it can provide support, balance, stability, safety, independence and relieve stress on the legs and feet.

A quad cane with four feet is the appropriate choice for a resident who is weaker on one side than another, such as after a stroke.

Measuring

Here’s one way to determine the right height for the cane:  Turn it upside down with the handle on the floor.  With the resident’s arms at his side the tip of the can should be level with the wrist.  Wooden canes can be shortened by removing the rubber tip and cutting with a saw.  Aluminum canes have holes and pins to adjust height by the inch; there are extenders for very tall people. 

Using a Cane

To use a cane, the resident should hold it on his or her stronger side.  When walking, the resident should move the cane and the weaker leg together.  When climbing up stairs, the resident should first step up with the stronger leg, then push to move the cane and the weaker leg up.  To go down stairs, the resident should first step down with the weaker leg and the cane.  Then, using the cane for support, he or she can lower the stronger leg down.

How Common Are Medical Errors?

Researchers at the University of Utah led by Dr. David Classen found that about one of every three patients hospitalized in the US will experience some sort of mistake during their stay.  The findings indicate the error rate may be as high as 10 times greater than estimated using older methods. 

“It’s clear that we still have a great deal of work to do in order to achieve a health care system that is consistently high-quality -- that is, safe, effective, patient-centered, efficient, timely, and devoid of disparities based on race or ethnicity,” said Susan Dentzer, editor-in-chief of Health Affairs, a peer-reviewed journal that explores health policy issues of current concern that published the research.

The medical errors found ranged from decubitus ulcers and staph infections to objects left in the body after surgery.  It is estimated that medical errors that cause harm to patients annually cost $17.1 billion in 2008 dollars.

“A key challenge has been agreeing on a yardstick for measuring the safety of care in hospitals,” the researchers wrote.  To find the best yardstick, the team tested three methods of tracking errors on the same set of medical records from three different hospitals.

Among the 795 patient records reviewed, voluntary reporting detected four problems, the Agency for Healthcare Research’s (AHR) quality indicator found 35, and the Institute for Healthcare Improvement’s tool detected 354 events -- 10 times more than AHR’s method.

“Our findings indicate that two methods commonly used by most care delivery organizations and supported by policy makers to measure the safety of care ... fail to detect more than 90% of the adverse events that occur among hospitalized patients,” the team wrote.

The research was supported by the Robert Wood Johnson Foundation, which focuses on U.S. healthcare issues.

Dental Hygiene Related to Heart Disease

New Evidence

You may not be a dentist, but get those patients to brush their teeth! People who brush their teeth less than twice a day run a higher risk of heart disease. These are the findings of a recent study published in the British Medical Journal.*

This is the first study of its kind and confirms the established fact that inflammation in the body (including mouth and gums) plays a significant role in the formation of atherosclerosis. Researchers analyzed health data from 11,000+ adults. After adjustment for established risk factors, the study found those with poor oral hygiene also had increased levels of C-reactive protein and fibrinogen. 

Personal Care Services at Pathways 

Pathways Private Duty provides care to assist older adults and the chronically ill in their activities of daily living, as well as with meal preparation, exercises and medication reminders.  Our caregivers can also help with personal care such as bathing, grooming, and oral hygiene.  

When it's time for care in your home, Pathways is here to help.  Give us a call today at 1.888.600.2273 to arrange for an evaluation and assessment of your needs.

*Published online May 27, 2010 in BMJ; corresponding author is Prof Richard Watt (University College London, UK.)

Vitamin D May Reduce Falls in the Elderly in SNFs

Dietary Supplements

Recent studies indicate that adding Vitamin D supplements to the diets of nursing home residents may reduce the frequency of falls, a leading cause of death and disability in the elderly.

Vitamin D deficiency is associated with muscle weakness, which can contribute to falls and fractures. Nursing home residents are especially vulnerable to falling due to advanced age, health problems, and weakened eyesight. In fact, approximately 50% of nursing home residents fall every year, and those who are injured become even more prone to future falls.

Although exercise, appropriate equipment, adequate staffing and a risk-free environment are important, research done at the Sydney Medical School at the University of Sydney in Ryde, Australia found that Vitamin D was a effective measure, although they are not sure why. 

Fall Prevention Resources, Available Online

In an effort to increase awareness about fall prevention hazards the Fall Improvement Taskforce (FIT) at Pathways created colorful flyers that can be printed and used as check-off lists to ensure your environment remains safe and to minimize the risk of falls.

Topics include: “Did you know that clothing can contribute to falls?”; “Medications can increase the risk of falls”’; and “People with vision deficits are twice as likely to fall”.

These helpful resources can be downloaded via our website at www.pathwayshealth.org/resources.