Wednesday, 24 April 2019

Care Partner Wednesday--Sign Up for the Newsletter


It's new, practical and full of ideas you can use as you navigate the tricky world of the care partner. Click the link above and sign up for my new monthly newsletter.

Each newsletter will contain links to three blog posts, five quick tips for some aspect of your care partner journey, and a recipe. Something healthy, quick and easy that a busy care partner can put together in no time.

Here we go:
                 5 Reasons to Sign Up for the 5 Tips Newsletter

1. Valuable information for care partners from someone who has "learned in the trenches," probably made every mistake possible, and grown.

2. A wide variety of topics covering every aspect of eldercare.

3. A sound philosophy. Care should be person-centred, respectful, reciprocal and creative. Elders need purpose and given the opportunity to contribute.

4. Practical advice that can be applied easily.

5. A sense of humour maintained in every situation. Being a care partner is hard some days and impossible others. Uphold your sanity through the ability to see the funny side of the ridiculous. Learn to not take yourself or today too seriously.

The first volume will come out the end of this week. Make sure you sign up to receive the newsletter monthly.  Do you know someone who is walking the care partner journey? Tell them about it.

Here's the link again, because you don't want to miss this!

 Care Partner Wednesday--Sign Up For the Newsletter

Wednesday, 17 April 2019

Care Partner Wednesday--"But I Don't Drink Water!"

"She's dehydrated."
The hospital nurse's tone spoke volumes and her message was clear. The resident we sent to the hospital was suffering from dehydration on our watch, so obviously we gave terrible care. The judgement was in her voice, the look on her face and the stance of her body.

I wanted to punch her. Hey, I'm human, too.

She didn't see the multiple times a day we encouraged fluids. The various attempts to hydrate.

Dehydration among the elderly is a huge problem, and it causes multiple problems in the body.
Why does it happen?
  • Because of problems with incontinence, elders are reluctant to drink enough in case they can't make it to the bathroom in time. This is especially true later in the day.
  • Many people suffering from heart disease require diuretics to control excess fluid retention. This results in urinating more, which can result in incontinence. See above.
  • Some elders don't experience thirst, even in warm weather, like they did when they were younger.
  • Memory issues can make it difficult to remember to drink.
  • Illnesses such as vomiting or diarrhea can cause dehydration quickly if a person is borderline, to begin with. Many elders live verging on dehydration.
  • Some elders in the latter stage of several diseases have swallowing difficulties, which makes drinking difficult.
How do you know if your elder is dehydrated or verging on this state? Blood work will indicate immediately if someone is dehydrated, but certain signs are signposts to indicate a problem.

Signs of dehydration
  • dark coloured urine is a sure indicator. If urine is concentrated, there isn't enough fluid going in.
  • infrequent urination
  • dizziness or weakness
  • low blood pressure
  • sunken eyes, or skin, when pinched, that holds the shape of the pinch rather than plumping back
  • increased confusion
  • increased heart rate
Of course, the difficulty is that most of these symptoms could be indicators of any number of problems. But if you suspect, push fluids and see if the symptom disappears.

What problems does it cause?
  • constipation
  • urinary tract infections
  • dizziness and weakness can lead to falls
  • kidney stones
  • increased confusion in people with dementia
How much is enough?
Seven cups of water a day is suggested for elders.

How do I do that?
It sounds daunting, doesn't it? Here are a few tips:
  • It doesn't have to just be water. Some people detest water and refuse to drink it. Any fluid that is enjoyed (tea, coffee, juice, milk etc. counts toward your total fluid intake. Alcohol has a diuretic effect and should only be consumed on occasion, and soda should be limited (although this generation generally doesn't enjoy soda.)
  • Try adding flavouring to water, which can be bought at the grocery store in multiple flavours. Or make "fruity water" as pictured above with cucumber, mint, strawberries etc. It's remarkably flavourful and refreshing.
  • Any fluid counts. Soup, pudding, ice cream.
  • Try offering fluids of choice on a regular basis, and toileting regularly if this is a concern.
  • Go outside. There's nothing like fresh air and sunshine to work up a thirst. 
  • Set the example. Have a drink together several times a day.
I have no scientific research to back this, just anecdotal. When I get used to being hydrated, I get thirsty more frequently. It feels as if my body enjoys the feeling of being well hydrated and sends out signals more quickly, telling me to drink. 

As warmer weather approaches, keep hydration always on your radar.

Care Partner Wednesday--"But I Don't Drink Water!"


Wednesday, 10 April 2019

Care Partner Wednesday--"But I Love Chocolate Bars!"

When George came to us, he'd spent several months in the hospital. A tall man, he looked severely undernourished. "He's a small eater," his wife said. That's when I discovered his diet in the hospital consisted of sandwiches his family brought in and his favourite chocolate bar. I opened the drawer of his nightstand to look for something for him, and found it full of chocolate bars!

Nutrition and the elderly is a minefield of choices and difficult decisions. Meals should be a pleasant experience and not a tug-of-war. In the end, it comes down to choice, and your elder has the right to make that choice.

Let's look at a place to start and a question to ask.

In looking at nutrition, the place to start is to identify any gaping deficits. The best way to do this is to have your doctor perform a comprehensive blood workup. Simple blood work can easily identify which areas need attention. This should always include a fasting blood sugar to identify diabetes, B12 levels, and tests to check liver and kidney function. If a deficiency is discovered, it may be necessary to take a supplement to address it, but you can also look at nutritional answers.

Next is the question: What is your goal? Weight loss? Weight gain? Diabetes control? Improved nutrition? Bone health? There are so many reasons to look at nutrition, and you may be tempted to say, "All of the above." The truth is, you need to pick your battles. Choose one primary goal, look at a few simple changes that might be made and strategise how to make them.

Let's look at weight loss. Many elders have a decreased appetite. Perhaps they are bound to bed or a wheelchair and aren't moving enough to feel hungry. It's possible some of the medications they take suppress their appetite,  and taste buds don't work as well as they used to. Another factor is texture. If they have difficulty swallowing, they may need their food minced or pureed. It may be exactly the same food, but I refer to this as "mush," and there's no way to make it as appetizing. All these factors combined can lead to significant and even dangerous weight loss.

How do you promote weight gain as a goal?

  • Even people bound by wheelchairs benefit from fresh air and a change of scenery. Whenever possible, take them outside. Even if they aren't exercising, they may feel more hungry after a dose of fresh air and sunshine. If you are feeling adventurous, have the next meal outside.
  • Speak to your doctor about the problem, and ask if any of their medications could be part of the problem. Ask for his/her suggestions.
  • What do they like? Flexibility is important. Maybe you made a lovely chicken dish, but what they really want is a fresh omelette or a grilled cheese sandwich. What are they more likely to eat? Be willing to change the plan at the last minute.
  • Be creative. One lady in my neighbourhood was extremely thin and losing weight. She loved her soup, but it was almost a clear broth, and she'd fill up on just a few calories and not be able to eat the protein portion of the meal. We started adding pureed food to her soup to make a thick broth. She still enjoyed her soup but got the benefit of the whole meal. Lots of healthy ingredients can be hidden in porridge, soup and spaghetti sauce. Just saying.
  • Sometimes the doctor will order a supplement. Make sure this is given after the meal, so your elder gets the benefit of real food first.
  • The social aspect of a meal is paramount. People eat more and better when they participate in an interesting and fun conversation. At work, I chat with those I am assisting, even if they can't talk back. It improves digestion.
  • Don't focus on the goal. For the most part, your elder doesn't need to be aware that there is a goal. Keep meals and snack times fun and flexible.
  • Keep it flavourful. Lemon, fresh herbs, a hint of garlic--use whatever you think you'll get away with to make your meals taste appealing.
All of these principals can be adapted to any nutritional problem. And don't forget to throw in an occasional chocolate bar!


The 5 Tips Newsletter Debut Edition is Coming Soon! 
Watch for it!

Wednesday, 3 April 2019

Care Partner Wednesday--"But I Hate Broccoli."

Do you remember trying to encourage your toddlers to eat broccoli? I dared my son, "I bet you can't eat a whole tree." He'd stuff it in his mouth and munch away, and I'd pretend to faint with the wonder of it all. When he got older that ploy didn't work, and I tried to spice it up with various sauces, or ground it and hide the evidence in spaghetti sauce. At one point during his teenage years, the only vegetable he ate was the "sweet 100" cherry tomatoes that grew like grapes in the back yard. As a diehard health nut, I worried about stunted growth and early death. I'm happy to report that in his twenties his dietary bent turned toward the vegetable aisle, and now he cooks and eats wonderful meals.

Elders have challenges when it comes to nutrition. This week we'll examine some of the difficulties, and the following week we will look for solutions.

Micronutrient deficiency is rampant among elders. Why? So many reasons.

  • Many suffer from some form of a disease, which depletes their bodies of nutrients or makes it difficult for them to get proper nutrition from their food.
  • The treatment for some diseases (such as various forms of cancer) can leave the body drained of certain nutrients.
  • Some diseases such as Parkinson's disease or arthritis can make the handling of utensils difficult.
  • Medications can lead to certain deficiencies or loss of appetite. Some side effects, such as nausea or constipation discourage eating.
  • Common pain relievers cause constipation, leading to bloating and uncomfortable bowel movements. Someone who is constipated is seldom hungry.
  • Elders living alone often need a ride to a grocery store. 
  • Finances may be a problem, causing them to shun more expensive fresh foods.
  • Missing teeth or ill-fitting dentures can make eating difficult and painful.
  • Some elders experience swallowing difficulties and need their food minced or pureed.
  • Cognitive impairment can lead to forgetting meals, or not remembering how to prepare them.
  • Depression, common among the elderly, can lead to a lack of appetite.
  • Stubbornness. Stubbornness?? Yes, Many have eaten a certain way all their lives and aren't about to change now. Often this "certain way" includes unhealthy habits that overindulge in breads and sugars and don't include enough fresh foods. 
  • Elders are notoriously dehydrated. Without enough water, every system in the body has difficulty functioning correctly.
A discouraging list! With all this, is there a well-nourished, hydrated elder on the planet?

Next week we'll look at nutrition basics and how to make them possible and even desirable.
Stay tuned!

Care Partner Wednesday--"But I Hate Broccoli."