BEDSORES

(DECUBITI)

Bedsores (decubiti) may occur when your patient is confined to bed for long periods of time.  These are caused by the blood supply being interrupted to part of the body, such as sleeping on one side all the time with the elbow on the sheets.  Usually the sores will appear in the skin areas over the body prominences of the body that come in contact with the bedclothes.  First the skin breaks down and a red spot will appear.  You must take care of these red spots before they become bedsores, which are very difficult to heal.

     Many factors can contribute to bedsores, including moisture, especially urine.  Even wrinkles in the bedclothes can irritate the skin sufficiently to create sores.  The skin is very delicate and care should be taken not to pull or tug on the skin, such as by removing the bedpan too fast.

     When you bathe your patient, you should watch for red spots that could turn into bedsores.  When you press on a red spot or pressure point, it will turn white and as you release your pressure it will return to red.  As it progresses to a bedsore, the skin turns a purplish red color and becomes rough, like a chapped area.  If not treated, the skin will break and become a sore.

     To prevent this from happening, a bedridden patient should be turned every two hours to a new position, so the pressure is changed to a different part of the body.  Gently rubbing the affected area with alcohol or lotion will help to stimulate circulation, thereby bringing needed nutrients to the affected area.  If your patient is large or obese, especially a woman with large breasts, special care should be given to these portions of the body.  When bathing the patient, be sure to get between the folds of skin and dry them carefully, then apply powder to relieve friction.

     It also helps to have an “egg-crate” mattress placed on the patient’s bed in ease pressure.  This is a piece of sponge rubber formed like an egg carton.  It keeps air in spots and doesn’t let the body settle completely onto the mattress.

     Sheepskin placed on the mattress also makes the patient more comfortable.  Anything soft and cushioned under the sore areas will relieve the pressure and assist the body to repair the damaged areas.

     A good back massage before retiring will also help with the circulation and relax the patient for a more comfortable sleep.  Be sure to report any red areas to the doctor, so  he can check them before they go too far.

DEPRESSION CONTINUED

     Other things also contribute to depression: the winter blues, low self-esteem, being too passive and dependent on others, moving away from your family members, dissatisfaction with your lot in life.  So you see, there are a great many things that can cause, trigger, or contribute to a depressed state of mind.  If you know what the cause is you can deal with it a little better.

     With health problems and the normal aging process, it is difficult to recognize depression in older people.  Then, some older people just can’t seem to talk about their feelings or discuss the pain they feel.  They will go to great lengths to hide it, putting up a facade of happiness when they are really very depressed.

     These are some of the things to look for to recognize depression:

• Difficulty falling asleep or staying asleep
• Waking up too early in the morning and not getting back to sleep
• Sleeping too long in the morning
• Nightmares or crazy dreams
• Loss of appetite
• Heartburn, nausea, vomiting, or indigestion
• Negative thinking, as if nothing matters anymore
• Loss of self-esteem
• Difficulty concentrating or paying attention when talking with someone
• Always feeling sad
• Tiredness all the time
• Mood swings

     Emotions play a large part in physical complaints.  When an older person cannot express their emotions, they manifest them in physical complaints.  They may complain of headaches, shortness of breath or chest pains--nothing specific, but vague aches and pains.  Of course, you want to check with the doctor about any complaints, but keep in mind the possibility that these complaints are connected with a depressed state of mind.

     What can we do as caregivers to help our patient overcome this depression?  We can use touch as a beginning.  Everyone enjoys and needs human touch.  We all need to feel loved and needed.  A bit hug will go a long way toward helping our patient feel loved.  The human body needs a gentle, caring touch often.  It has been proven in studies that the lack of touch and warm support can lead to forgetfulness, confusion and dullness in the elderly.  Remember that your touch, as a caregiver, can help your patient manage the depression they feel.  Show affection by touching and hugs, show your acceptance and your love.  It can reassure your patient and reduce those feelings of loneliness.

     In some cases of depression, professional treatment is necessary.  If your patient is depressed for ore than two weeks, they may need more help than you can give.  If they have problems functioning in their daily routine, if their health is being threatened by the depression, or if they begin talking about dying, those are signs they may need professional help.  Discuss this with their doctor and he will provide you with the names of professional that can help.

     There are two ways to treat depression psychotherapy and medications.  They are often used together.

     Counseling with a psychiatrist or social worker is effective with patients who are moderately depressed.  It can help elderly people adjust to their condition.

     Drugs are effective with patients who are severely depressed.  They can help to improve their appetite, help them to sleep, and ease the brain chemical balance causing the  the depression.  Your doctor may prescribe medication such as Elavil, Prozac, Zoloft, or one of many others.  If these drugs are prescribed, be sure to watch out for side effect.  Ask your pharmacist about the side effects for any of these drugs; they will give you a printout listing all of them.

THREE BASIC TYPES OF DEPRESSION

     There are three basic types of clinical depression, according to the mental health community: major or severe depression, chronic or dysthymic depression, and bipolar disorder or manic depression.  

     Major Depression---This depressed state will last for two weeks or more, bringing on sadness, frustration, plus intense pessimistic feelings.  The person is so down that they feel that things are hopeless and this feeling will last forever.

     Chronic Depression---With chronic depression the down feeling will come and go.  If your patient is depressed more than half the time, it is considered chronic depression.  If your patient is severely depressed and that depression goes untreated, it can become chronic depression.

     Manic Depression---In this type of depression the patient’s mood swings from one extreme to the other.  They will have periods of high energy and excitability, then swing to periods of depression and low energy.

     Sometimes depression follows a loss of a loved one or some crisis in your life.  It is a normal reaction to be depressed when a crisis befalls you.  It will pass.  Usually, it will last a couple of weeks or even a month, but not much longer.  It might incapacitate you for a while, but you will snap out of it.  This depression is called reactive depression.  You are reacting to a personal crisis or loss, even the loss of a job.  This type of depression is common with older people as they lose their health, their spouse, or their home when they have to move.  But this type of depression is not likely to cause a person to lose weight, concentration, memory, or attention.

     Depression can also well up from within. Again the person will lose his appetite, have problems concentrating or remembering, may have heart palpitations, and may have trouble making decisions.  Personal grooming will suffer and the person may feel guilt and be full of self-doubt about everything.  Mood swings are common.  The person may feel worse in the morning and then as the day goes on, feel a little better.  It is hard to distinguish between this depression (endogenous) and the other type of depression (reactive).  Both make the patient feel terrible.

     It is hard to say what causes depression.  If there is a family history of depression, chances are greater that it will continue with other family members.  Some families keep this a deep, dark secret because they feel ashamed.  Therefore, it can be difficult to gather this information.

     With the many changes that occur as we get older, including the loss of loved ones, moving from the old neighborhood, and retirement, many older people feel unneeded, unwanted, and useless.  This can certainly make them depressed.  Sometimes they wonder if this is all there is to life or if their being on Earth has really made a difference in the world.  These questions are asked by many elderly people.

     Depression can be triggered by medications as well.  One side effect of many medications is depression.  That is why it is so important to know the side effects of all the medications that your patient is taking.

     As we get older our bodies change, we get illnesses that are related to age, we slow down and the simplest task seems to be a chore.  Our bodies are changing, and the brain chemicals are also changing.  There is a delicate balance of chemicals in the brain that can be thrown off by certain illnesses.  These changes can cause depression.

     

CONTINUATION OF DEPRESSION

     Mom woke at 4 a.m.  She was too restless to go back to sleep and she didn’t want to stay in bed and look at the spots on the ceiling.  She shuffled around the house in her nightgown and bare feet.  She made a cup of coffee and stared out the window into the dark until the sun came up.  I heard her moving downstairs and went down to see what was wrong.  She looked up at me and said, “It’s going to be  a long day.”  Se looked so hopeless so unhappy.

     Depression can do that to you--make you feel that you are not needed by anyone--alone--forgotten.  This is one of the most common mental health problems faced by older people.  They find themselves feeling sad, empty, alone, and they don’t know why.  Sometimes it is because they don’t feel that society needs them any longer.  They will withdraw from friends, family, and all the activities they used to enjoy.  Sometimes they will sit around all day in their nightgown or pajamas and robe, sleeping on and off.

     Depression is more than just a sad feeling for the elderly.  It can be a serious threat to their health.  When an elderly person is depressed, they are more prone to illness and infections, and when they do get sick, they don’t recover as quickly.

     As a caregiver, this can pose problems for you.  You are already overwhelmed and exhausted by the added responsibilities and you may be feeling a little resentful about the heavy demands put upon you.  You try to keep everyone else happy, but all your plans and fun activities must be put on hold.  You may be feeling a little depressed yourself.  Watch out for depression--it can sneak up on you fast.  If you have been feeling constantly tired, or having difficulty sleeping, watch out. You may also be uninterested in the things that used to bring you pleasure.  These are all clues that you may be depressed.

CONTINUING ALZHEIMERS AND PARKINSON'S DISEASE

     Some of the symptoms, such as paranoia, delusions, depression, agitation, sleeplessness and anxiety, can be managed with a variety of medications.  It is also important to see that the patient gets physical exercise and social activities, which are vitally important to good physical and mental health.  Of course, good nutrition is also very important for the patient.

     Big Crosby died after eighteen holes of golf in Spain.  He had a massive heart attack--he died quickly with dignity.  He died after doing what he enjoyed most in life---playing golf.  What a way to go!

     This is not, however, how an Alzheimer’s patient goes.  Most Alzheimer’s patients will progressively get worse for seven years, sometimes as long as fifteen years.

     Alzheimer’s and Parkinson’s diseases both viciously attack the body.  Alzheimer’s ravages the brain and Parkinson’s attacks the nervous system.  Both conditions can reduce a big strapping man to a bent over, doddering old man with urine-stained pants.  The one thing we all dread can strike the ones you love so quickly, and there is little we can do about it.

     One and a half million elderly Americans are afflicted with Parkinson’s disease and four million with Alzheimer’s and these groups are growing.  Serious illness means that their “golden years” aren’t so golden anymore.

     Taking a loved one who suffers from either condition into your home can trap you between compassion and frustration.  Your life is disrupted by an incontinent person who is almost childlike, but one that you love dearly.  What do you do?

     You take them in and do the best you can for them.  If you have small children as well it makes the job even harder.  But at least you know they are safe.

     If you are lucky there is an adult day care center in your community that can help you during the day, and maybe a friend or two to take your patient on an outing once-in- awhile, to ease the day for them and for you.

     When the time comes that you can no longer give the care they need, then a special home becomes a place in which they are placed to spend their last months or years, away from everyone they love.  It may tear your heart right out of you, but at least you have the satisfaction of knowing you did everything you could for your loved one, no matter how difficult it was at the time.

     No matter whether the problem is Alzheimer’s, Parkinson’s disease, or simply old age, we are not responsible for the happiness of our aging parents any more than we are responsible for the happiness of our children, spouses, or siblings.  People are responsible for their own happiness. You can provide for some of their needs, but you can’t turn back the clock and make them young again.

     It is too bad we can’t all go like Bing Crosby did, quickly and with dignity.

ALZHEIMER’S AND PARKINSON’S

     Sitting in the chair next to the window, with the sunlight warming her wrinkled face, she looks like she might be sleeping.  But, the only thing sleeping is her mind.  She is in the late stages of Alzheimer’s disease.  Forgotten are all of life’s beautiful memories that should be comforting her in her declining years.  Gone are the visions of her children playing in the yard as they grew up.  Even her husband is a stranger now.  She looks at him with vacant eyes, a prisoner in her own mind.  She just sits alone in her room day after day, unable to care for her own needs, waiting for the inevitable---death.

    It’s a devastating picture to paint, but it is true all too often with Alzheimer’s patients.  This insidious disease tears your heart out, as you watch someone you love sink deeper and deeper into themselves, until there is nothing left of a once vibrant individual.

     Alzheimer’s disease does strange things to people.  In the early stages, it can be difficult to distinguish from ordinary forgetfulness.  But, eventually it will rob your loved one of all memory, even of the day-to-day routine of living.  They will forget how to dress, wash, pay bills, or even how to figure our what that bill is for.  They won’t remember how to write a check to pay the bill.  They will ask the same question over and over again, forgetting that they already asked it once.  They will forget how to tie their shoes, or they may even forget to wear their shoes.  They will misplace things, or hide them in strange places.

     These once dynamic people are shut down by the slow deterioration of their brains.  What is Alzheimer’s disease?  It is a progressive, degenerative disease that attacks the brain and results in impaired memory, thinking and behavior.  It affects an estimated four million adults in American.

     When the first case of Alzheimer’s was diagnosed in 1907 by a German physician named Alois Alzheimer, it was considered to be a rare disorder.  However, today it is recognized as the most common cause of dementia.

     According to Merriam Webster’s Collegiate Dictionary, dementia is a condition of deteriorated mentality often coupled with emotional apathy.  My Home Medical dictionary calls it a deterioration of intelligence.  Dementia is not a disease in itself, but a group of symptoms that characterize diseases and condition.  There are other conditions that mimic dementia, such as alcoholism, drug reactions. Thyroid disease, nutritional deficiencies, brain tumors, head trauma, and infections.

     Alzheimer’s disease is most likely to occur in an older person.  Approximately 10 percent of people sixty-five years or older are affected by Alzheimer’s disease.  As a person reaches eighty-five or above, the percentage rises to 47.2 percent.

     The families of Alzheimer’s patients feel the effects of the disease too.  The emotional cost, not to mention the social and financial cost, of care for Alzheimer’s patients is very high.  Family members work hard to keep them at home, until they can no longer deal with the problems inherent to the disease.  They risk their own health just to keep them at home, instead of placing them in an Alzheimer’s unit where they are more comfortable and easier to manage.

     There is no single test for Alzheimer’s.  It takes a complete physical, psychiatric and neurological evaluation by a team of physicians to come to a diagnosis of Alzheimer’s disease.  These tests should include a complete medical history, a test of mental status, a complete blood work-up, a urinalysis a chest X-ray, an electroencephalogram (EEG), a computerized tomography (CT scan), and an EKG (electrocardiogram).  This should tell the physicians if it is indeed Alzheimer’s or if the dementia is caused by some other, treatable condition.  They can make a diagnosis that is 90 percent accurate.

     Although there is no cure for Alzheimer’s disease at this time, there are reasons to hope.  New research is ongoing and promising breakthroughs are expected.  With the pharmaceutical companies testing and working to develop new medicines to fight this debilitating disorder, there is hope that Alzheimer’s will be a more treatable disease soon.

Stoke continued

     When the right side of the brain is damaged, the left side of the body is paralyzed and the patient has difficulty with judging distance, size, position, and rate of movement.  Sometimes we tend to overlook our other abilities because we put such emphasis on speaking.  If stroke victims can talk and understand speech, we assume they are unimpaired, but it might still be difficult for them to care for themselves.

     Remember a time when you were preoccupied while walking up the stairs, and you thought there was another stair but there wasn’t?  You were jarred when there wasn’t a place to put your foot.  Or, have you ever been reading and tried to put your coffee cup on the end table and missed the edge?  These are some of the common mishaps of a right-brain-damaged victim, because their perception is impaired.  They may not be able to get their wheelchair through a large doorway without bumping the frame, or read a newspaper or add a column of figures, because they lose their place on the page.  It’s important to know their limitations so you don’t misjudge your patient or think that they are being uncooperative, unmotivated, or confused.

     Right brain damage may also cause the stroke patient to overestimate their ability to perform easy tasks.  Sometimes they are unaware of their limitations and dive right in.  However, if they act too fast they can fall or hurt themselves.

     If you suspect this overconfidence, ask them to demonstrate their task before you let them go forth.  If they can handle the task, fine, but sometimes they can’t and you have to prove it to then.

     If you are having trouble teaching them a task, slow down and talk them through it.  Words are more effective than hand motions.  Take it slow and easy.

     Stroke patients can also have visual field defects.  Perhaps their vision is only half there and they may have difficulty seeing to one side or another.  Make sure their room isn’t cluttered, since they could fall over something in their way.

     My husband had a unique problem with his vision.  One of his eyes reversed itself.  Before his stroke it was nearsighted and now it is farsighted.  He also had a cataract develop on the right eye, but even after it was removed he couldn’t see peripherally, so it made it difficult for him to read.  He would lose his place because of his tunnel vision.

     There will be more problems with behavior, depression, brooding, forgetfulness and many other things to numerous to mention.  Each stroke victim is different.  A mild-mannered man may begin cursing and an extrovert may become introverted.  It is up to us to evaluate the problems and deal with them as best we can.  Use your ingenuity.  Be sure to discuss anything you don’t understand with your physician.  He can suggest ways to deal with each unique situation as it comes up.

     Stroke leaves an enormous impact: memory is lost, routine is forgotten, emotions surface, crying is not unusual, there is sensory loss, and depression often results.

     Healing comes from within, not just healing of the body, but healing of the mind with determination and hard work. The doctors take care of the body, but the mind is a different story.  It may snap back or it may take years to bring back even normal responses.  Be patient...it’s worth all the work you do.