Living With Care

Overmedication of older adults — how many pills are too many?

Wed, 16 May 2012 15:50:35 GMT

Writing in her New York Times blog, Jane Brody states, “Overmedication of the elderly is an all too common problem, a public health crisis that compromises the well-being of growing numbers of older adults.”

Many of these elderly patients are the victims of polypharmacy or the accumulation of medications over time, often from different prescribers, to treat side effects of prior drugs. Some polypharmacy may be appropriate, such as the use of a stimulant laxative to treat the constipation from opioid narcotics used for chronic pain.

However, polypharmacy is often inappropriate, especially in the elderly, who are more sensitive to the drug burden created by the side effects and drug interactions of these medications. This drug burden is a major cause of physician and emergency room visits, hospitalizations, and even death in older adults.

One of my favorite quotes on this topic is from geriatrician Jerry Gurwitz MD, “Any symptom in an elderly patient should be considered a drug side effect until proved otherwise.”

Monitoring for and correcting overmedication and inappropriate medication is a major focus at Golden Living.

I was recently consulted to review the medications of a 78 year old woman who was taking 17 medications routinely and eight medications on an as-needed basis. Some of her issues with polypharmacy included:

• Two of her medications are well known to cause constipation for which she was taking three different laxatives

• Two of her medications were potentially causing upset stomach and bruising

• She was taking several medications to help her sleep that were causing significant morning-after drowsiness and difficulty walking, greatly increasing her fall risk

• She was taking a drug to treat urinary incontinence, which is a known side effect of a drug she was taking to treat her dementia. Also, one drug can decrease the effectiveness of the other

• She was taking a drug to treat nausea, which is a known side effect of the three pain medications she was taking

To address issues like this, Golden Living employs clinical pharmacists who are part of the interdisciplinary care team for our LivingCenter patients. These pharmacists work to provide consultations to our patient care teams to reduce the incidence of inappropriate polypharmacy, reduce hospitalizations due to adverse drug events, and improve medication outcomes for all our patients.

Specially trained geriatric pharmacists are available in many communities to assist elderly patients living at home with similar services. Many of these pharmacists are board certified in geriatric pharmacy. These geriatric pharmacy specialists can be found at http://www.ccgp.org/consumer/locate.htm#usmap or https://www.ascp.com/find-senior-care-pharmacist.

Celebrating National Nurses Week

Mon, 07 May 2012 11:58:29 GMT

As a registered nurse, I hold the nursing profession near and dear to my heart. So it is with great joy that I congratulate the 2.7 million registered nurses practicing in the United States during National Nurses Week. Nursing is our nation’s largest healthcare profession, and these men and women meet the diverse and emerging healthcare needs of our population in a wide range of settings.

We celebrate National Nurses Week May 6-12, ending on Florence Nightingale’s birthday. During this week, we recognize the indispensable role that nurses play in the safety and quality care of millions of people every year.

This profession is set to see growth for several reasons. First, the American population is getting older. By 2030, the U.S. Administration on Aging reports that there will be about 72.1 million persons age 65 and older, more than twice the number in 2000. Second, medical technology is continuing to improve and develop life-sustaining advancements. Third, home healthcare services are seeing huge growth. Finally, we’re seeing a renewed emphasis on primary and preventive healthcare, with demands for lower costs, that will require the better utilization of all of our country’s nursing resources. All of these factors call for more skilled nursing care to support them.

On behalf of everyone at Golden Living, thank you to nurses everywhere for your service and professionalism.

Did you know?
Florence Nightingale believed she was called to be a nurse and became known because of her pioneering nursing work during the Crimean War. She established nursing as a professional vocation by setting up a school at St. Thomas’ Hospital in London. Many nurses take the following pledge when they are ready to enter the profession:

The original Nightingale pledge
I solemnly pledge myself before God and presence of this assembly;
To pass my life in purity and to practice my profession faithfully.
I will abstain from whatever is deleterious and mischievous and will not take or knowingly administer any harmful drug.
I will do all in my power to maintain and elevate the standard of my profession and will hold in confidence all personal matters committed to my keeping and family affairs coming to my knowledge in the practice of my calling.
With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care.

Taking care of the caregiver

Mon, 30 Apr 2012 11:40:12 GMT

Taking care of a loved one is a great act of devotion and sacrifice. In the United States, there are about 66 million unpaid caregivers, men and women who are looking after the needs of another person, often a family member. This represents one in three households that care for another person or family member.

According to a 2009 study by the National Alliance for Caregiving, the average caregiver has been in his or her role for 4.6 years and spends 20.4 hours per week providing care.

Caring for another person is like having a second job. About 17% of caregivers feel their health has gotten worse as a result of caregiving, and three in ten rate their experience “emotionally stressful.”

So the question becomes, who is taking care of the caregiver? The answer is that caregivers have to learn how to practice excellent self care, and create a support network in order to maintain physical and emotional health and avoid burnout.

Taking responsibility for self care

When an airplane loses cabin pressure and the oxygen masks drop, airline employees always give instruction to place your own mask on first before helping anyone else with theirs. Taking care of someone with a chronic or progressive illness or a debilitating injury is a labor of love. With proper coping strategies, the caregiver can not only survive, but thrive; but they’ve got to have their oxygen mask on first.

Here are some ways a caregiver can get his or her needs met:

1. Ask for help when it is needed.

2. Make time for fun. Half of caregivers (53%) say that caregiving takes time away from friends and other family members. Try to make time for your other relationships and outside activities, finding alternative care options for your loved one.

3. Learn how to relax. Deep breathing, regular exercise, meditation, prayer and laughter are all good places to start.

4. Learn and practice good communication skills. These reduce misunderstandings and conflict, thereby reducing possible stress.

5. If you are unhappy, don’t wear a happy face. It’s better to share the truth of the situation with the appropriate people.

6. Realize that total self sacrifice will not make a loved one better. But good self care can make the caregiver better.

7. Go to bed early, eat well and exercise regularly. Often, mental stress can follow physical breakdown.

8. Keep a light heart and look for humor in situations. Bring in a funny movie from time to time and laugh with your loved one.

9. Make time for hobbies and interests.

10. Seek professional help if there are feelings of anxiousness, guilt, anger, or you experience symptoms of depression.

In order to contribute to the well-being of those you care for, you need to take time to care for yourself. This will allow you to return to caregiving renewed, recharged and ready to share valuable time with those in your care.

Finding hope during Cancer Control Month

Wed, 18 Apr 2012 09:35:19 GMT

Most people have been touched by cancer in some way in their lives, be it personally or through a spouse, parent, sibling or child. In this year alone, about 1.5 million Americans will be diagnosed with some form of cancer, but with new research and treatments, there is more hope than ever for a positive outcome.

In my family, I have four cancer survivors: my spouse, mother, aunt and cousin. Twelve years ago, my 40-year-old cousin died from colon cancer. It turned out it was a hereditary form of cancer and through his death, his mother and younger brother were diagnosed and are survivors.

During April, which is National Cancer Control Month, those of us touched by this disease take a moment to commemorate those who have lost their lives, champion the progress of those fighting cancer and confirm our commitment toward effective cancer control in the future.

The two most important steps we can take in our fight against cancer are prevention and screening. The basics of risk reduction include eating a healthy diet, engaging in regular physical exercise, avoiding excessive sun exposure, limiting alcohol consumption and avoiding tobacco in all its forms.

Screening is critical in the fight against cancer because its leads to early detection, when cancer is often more treatable. Colonoscopies for colorectal cancer and mammograms for breast cancer are two examples of common screenings. Visit your healthcare professional regularly and ask what screenings you should schedule to protect your health.

Congress first recognized this as National Cancer Control Month in 1938, and the disease landscape has changed drastically since then. Our government funds millions of dollars of research into cancer prevention, diagnosis and treatment. As a result, many forms of cancer that were once untreatable now have successful treatment protocols. In their search for more ways to fight this disease, scientists and researchers are looking at the molecular basis of cancer as well as discovering innovative procedures that can reduce mortality.

None of us knows what the future holds, but there are so many reasons to have hope in our fight against cancer in all its forms. Whatever happens, live your life to the fullest. It is the only one that you have to share.

To learn more about cancer prevention, screening and treatment, please contact one of the following organizations and visit their websites listed here:

The American Cancer Society
800-ACS-2345
www.cancer.org

American Institute for Cancer Research
800-843-8114
www.aicr.org

Cancer Support Community
202-659-9709
www.cancersupportcommunity.org

Lance Armstrong Foundation (multiple cancers)
877-236-8820
www.livestrong.org

National Cancer Institute
800-4-CANCER
www.cancer.gov

National Center for Chronic Disease Prevention and Health Promotion
800-311-3435
www.cdc.gov/nccdphp

National Institutes of Health
301-496-4000
health.nih.gov/category/Cancers

How safe is Benadryl for older adults?

Thu, 12 Apr 2012 15:08:48 GMT

Joe Smith is an 84-year-old retired university professor living independently in his own home. He still drives and enjoys golf and university activities. He is in excellent health and does not take any prescription or non-prescription drugs or herbal supplements.

Two weeks ago he developed an itchy rash on his arm after removing his golf ball from the rough. He self-medicated with diphenhydramine (Benadryl), 25mg, for a total of six doses over two days. Because of the itching, he also had trouble sleeping, so he took a non-prescription sleep-aid pill containing diphenhydramine, 25mg, at bedtime for two days.

Joe did not realize that the antihistamine capsule and the sleep-aid pill contained the same active ingredient. On day three he woke up with severe pain in his lower abdomen and the urge to urinate, but was unable to empty his bladder. He called his golfing buddy complaining that his vision was blurry and the buddy noticed that he sounded very confused. His buddy drove to Joe’s house and took him to the emergency room where a urinary catheter was inserted to empty his bladder.

Joe was diagnosed with drug-induced urinary retention, blurred vision and delirium. He was told to avoid sedating antihistamines like diphenhydramine in the future.

Benadryl—known generically as diphenhydramine—is an antihistamine that has drying and sedating effects, and is used to treat symptoms of allergies and colds. It is also used to treat insomnia, and is contained in several over-the-counter sleep preparations.

It can have serious, life-threatening effects in some populations. According to the drug packaging, diphenhydramine can cause serious adverse effects in older adults and persons with conditions such as narrow-angle glaucoma, enlarged prostate, blockage of the stomach or intestines, difficulty urinating, heart disease, high blood pressure, and thyroid disease. It can worsen or cause constipation, drowsiness, urinary retention, mental confusion or delirium, blurred vision and dry mouth. As described in this case, these serious side effects can occur with recommended dosing. This is especially true in older adults.

One other concern about diphenhydramine is its connection to “driving under the influence,” or DUI, cases. Would it surprise you to know that antihistamines, including diphenhydramine, are one of the top 10 categories of drugs most frequently seen in DIU arrests, according to an article by J. Michael Walsh and colleagues in the August 2008 journal Addiction? Benadryl's manufacturer advises against using the drug with alcohol or while engaging in activities that require alertness, such as driving. In my opinion, this is another reason to avoid diphenhydramine.

So just how safe is diphenhydramine? As a pharmacist, I don’t recommend it for older adults because of the potential adverse effects described above. I always suggest that they consult their physician or pharmacist before taking any preparation containing diphenhydramine, especially in combination with other medications.

Saying thank you to our doctors

Fri, 30 Mar 2012 11:01:40 GMT

As a physician and Chief Medical Officer of Golden Living, I’m committed to the idea that one of our greatest treasures is our health and well-being. As Mahatma Gandhi said, “It is health that is real wealth and not pieces of gold and silver.”

Today is National Doctors' Day , a perfect time to pause and recognize the doctors who serve the residents and patients in our Golden LivingCenters nationwide. This is a perfect time to thank these men and women who have dedicated their professional lives to helping others live fuller, longer, and more productive lives.

Our doctors offer vital diagnoses, treatment, and care through a full spectrum of integrated health and wellness programs, services, and products. They support wellness , help restore health to those who are sick, and are vital players in the health of their communities.

National Doctors’ Day was first celebrated March 30, 1933, when Eudora Brown Almond, wife of Dr. Charles B. Almond, set a day aside to honor physicians in Widner, Georgia. In 1990, the U.S. House and Senate proclaimed Doctor’s Day as an official celebration.

There are a myriad of ways you can observe National Doctors' Day: write a thank you note to your personal doctor or email a message; bring a small bunch of flowers to a nearby medical office; or visit your local Golden LivingCenter and just say hello to a doctor there. Your small token of appreciation will likely be met with gratitude and happiness.

Every day, I see our physicians providing extraordinary experiences for all of our patients and residents. They honor and value the uniqueness of every person in their care. For that, I, and every employee at Golden Living, say thank you and congratulations for a job well done.

Ten nutrition tips to power up the golden years

Tue, 27 Mar 2012 11:17:52 GMT

Nutrition is important throughout our life, but it is especially important as we age. During National Nutrition Month, we want to take a look at how the foods we eat can help us stay healthy and strong.

In general, older adults burn fewer calories due to changes in their metabolism. As a result, many older individuals may tend to lose some interest in food. However, a decreased interest in eating may be due to a lack of companionship during meals or having dental issues that create problems chewing. Decreased mobility may be another source of apathy toward eating, because it may more difficult to go to the grocery store to buy food or to restaurants for dining out.

Because of this, every calorie counts in older adults and needs to be packed with as much nutrition as possible.

Ten tips for great nutrition for those over 65

1. Avoid empty calories found in foods with lots of calories but few nutrients, such as snack crackers, sweets, sodas and alcoholic drinks.

2. Choose foods that are low in cholesterol and fat, especially saturated and trans fats.

3. Read the Nutrition Fact Label on packaged food and make sure it is full of fiber, potassium, vitamin A, calcium and vitamin D. Consumers should also look for food that is low in fat, sugars, cholesterol and sodium.

4. The ingredient list on packaged foods goes in order from most to least. Skip the ones with sugars, refined flours or saturated fats in the first few ingredients.

5. A high consumption of dietary fiber will help fight diabetes, heart disease, diverticulosis and hemorrhoids. Fruits, vegetables, whole grains and high-fiber bran cereals are a good source of dietary fiber.

6. Drink lots of water, at least eight 8-oz. glasses spaced evenly throughout the day. Dehydration is a frequent cause of hospitalizations among older people.

7. Think in color. Fresh foods that are bright colors, like yellow bell peppers, leafy greens, apples, oranges and carrots are dense in nutrients and low in calories.

8. Take a fish oil/omega 3 supplement every day. Fish oil is linked to better bone, heart, prostate and mental health, among other benefits.

9. Get at least 400 micrograms of folic acid and 1.7 mg of vitamin B6 daily. They help reduce blood levels of the amino acid homocysteine, a known risk factor for heart disease and stroke.

10. Choose a variety of healthy foods. The more varied a person’s diet, the more likely he or she is to get needed nutrients. Supplements are often beneficial, but the body best absorbs vitamins and minerals when they’re in fresh food.

Good nutrition is a cornerstone for good health as we age. It can reduce risk of common diseases, such as cancer, heart disease, high blood pressure, diabetes and obesity. Nutrition can also help manage symptoms of these diseases. People over 65 should talk to their physicians about their eating habits and see if they’re getting everything they need to power up their golden years.

Honoring our administrators during Long Term Care Administrator's Week

Tue, 20 Mar 2012 10:59:00 GMT

It’s Long Term Care Administrator’s Week and with over 300 locations in 21 states, Golden Living has hundreds of men and women to thank for their daily commitment to delivering quality, patient-centered care as well as creating a positive work environment for the staff. Their professionalism and dedication to their patients and LivingCenters is an example of leadership in our industry.

Since 1994, our industry has paused each March for this observance, sponsored by the American College of Health Care Administrators. During this week, we —the staff, residents, families, volunteers and co-workers—have an opportunity to extend a heart-felt thank you to all of our administrators who contribute to the success of our Golden LivingCenters.

Administrators must undertake a rigorous internship, followed by state and national board exams, and ongoing educational requirements that must be fulfilled in order to be entrusted with the care of our most vulnerable population. Administrators must be masters of multi-tasking, taking into account every aspect of a person's lifestyle, not just medical needs, on a 24/7 basis. On behalf of Golden Living, we commend, salute and thank those LivingCenter administrators who provide excellent quality of care and quality of life for our patients.

Congratulations on a job very well done!

Vitamin D helps from head to toe

Thu, 15 Mar 2012 10:55:02 GMT

Do a quick search on the Internet about vitamin D and the health claims will astound you. Low blood levels of the “sunshine vitamin,” as it is called, are associated with increased mortality.

We’re also seeing links between vitamin D and a lowered risk of breast cancer, depression, multiple sclerosis, certain infections, inflammation and other illnesses. In addition, researchers are looking at possible links between vitamin D and brain function among older adults.

Vitamin D has been shown to significantly reduce the risk of the following conditions:

1. Heart disease

2. High blood pressure

3. Peripheral artery disease (poor circulation in the legs and feet)

4. Osteoporosis and fractures

5. Decreased immunity

6. Increased autoimmune disorders like diabetes, rheumatoid arthritis and Crohn’s disease

7. Pain of diabetic neuropathy

8. Muscle weakness and pain

9. Falling – one study found that elderly women who received 800 units of vitamin D3 and 1,200 mg of calcium daily for three months increased their muscle strength and decreased the risk of falling by almost 50% compared to supplementation with calcium alone. In another study of 124 nursing home residents (average age of 89 years), those taking 800 units of vitamin D daily had a 72% lower fall rate.

10. Infection – one study in veterans who were admitted into intensive care units with a vitamin D deficiency showed a doubled risk for mortality and for a longer stay of three or more days in the unit.

While much of the research around the vitamin is ongoing, talk to your doctor and ask if you should be taking a vitamin D supplement. Most geriatricians recommend that persons over 65 receive supplemental oral vitamin D3 at a dose of 800 units daily, especially if they have one or more of the risk factors for vitamin D deficiency.

Factors that may increase the risk of vitamin D deficiency include:

1. Dark skin – A study of African-American women aged 15-49 found that 42% were vitamin D deficient, compared to only 4% of Caucasian women.

2. Lack of exposure to direct sunlight on bare skin of face and arms (no sunscreen) for 5-10 minutes, three times a week. People living in northern latitudes are unlikely to have sufficient exposure in the winter (mid-October to mid-March). Older residents of nursing homes are at high risk for vitamin D deficiency due to lack of exposure to direct sunlight.

3. Aging – the elderly have a decreased ability to synthesize vitamin D on exposure to sunlight (UVB radiation) and are more likely to stay indoors or use sunscreen, which blocks vitamin D synthesis.

4. Cystic fibrosis and liver disease impair the ability to absorb vitamin D.

5. Inflammatory bowel disease like Crohn’s Disease especially in those who have had a small bowel resection.

6. Obesity increases the risk of vitamin D deficiency, as more vitamin D is stored in fat and not available for use by the cells.

7. Decreased nutritional intake of vitamin D. Vitamin D is found naturally in very few foods including fatty fish (mackerel, salmon, sardines) and fortified milk. Cheese and yogurt are not always fortified with vitamin D.

Research is ongoing to see what other health benefits can be derived from vitamin D. Several universities including Brigham and Women's Hospital and Harvard Medical School in Boston are conducting the VITAL study. To conduct the study, 20,000 men and women across the U.S. are taking daily dietary supplements of vitamin D3 (2000 IU) or omega-3 fatty acids to see if the vitamin helps to reduce the risk of developing cancer, heart disease and strokes. While recruitment is complete, results are expected to take several years.

Researchers have been studying vitamin D for years, but these new areas of exploration hold great promise for science in the coming years.

Colorectal Cancer Screenings Can Save Lives

Mon, 05 Mar 2012 11:39:09 GMT

One of the great health triumphs of our time is colorectal cancer screenings. In the majority of cases, colorectal cancer grows from precancerous polyps (abnormal, grape-like growths on the wall of the intestine) in the colon or rectum. A colorectal screening can discover precancerous polyps and remove them, before they become cancerous. In addition, if cancer is already present, screening tests can find it early, when treatments are most effective. Experts estimate that 60% of deaths from this cancer could be avoided if everyone 50 and older were screened regularly.

March is National Colorectal Cancer Awareness Month and we want to shine the light of awareness on screenings, a vital medical tool.

Know the facts
Colorectal cancer is one of the most commonly diagnosed cancers in the United States. It is also the second leading cause of cancer-related deaths (after lung cancer). According to the American Cancer Society, almost 150,000 people will be diagnosed with colorectal cancer in 2012 and an estimated 50,000 will die of the disease.

The primary risk factor is age. More than 90% of cases are found in men and women over 50.

Know your risk
There are many studies on risk factors for colorectal cancer. Some show that higher levels of physical activity and a healthy weight may decrease the risk. However, the scientific evidence is less straightforward on other methods of prevention.

As it stands today, doctors don’t have consensus on the role of the Western diet in colorectal cancer, although there are markedly more cases in Western cultures. There does seem to be a correlation between a lower colorectal cancer risk and a diet that is low in animal fats and high in fruits, vegetables, and whole grain products.

Current research is examining the role of aspirin, calcium, vitamin D and selenium, in preventing colorectal cancer. Even if they determine that these supplements can lower risk, the most effective prevention is to get regular colorectal cancer screening tests after age 50.

Know when to get screened
Screening for colorectal cancer should begin at 50 and continue until at least age 75, according to the U.S. Preventive Services Task Force (USPSTF). Regardless of your age, ask your doctor if you should be screened, especially if you think you might be at an increased risk.

You’re considered a higher-risk population if you or a close relative have had colorectal polyps or colorectal cancer or if you have inflammatory bowel disease (IFD), like Crohn's disease or ulcerative colitis.

Know about the screening tests
The USPSTF recommends the following tests, either alone or in combination. During National Colorectal Cancer Awareness Month, ask your doctor more about:

* Colonoscopy (every 10 years).

* High-sensitivity fecal occult blood test (every year).

* Flexible sigmoidoscopy (every five years).

There are some health groups that also recommend the double contrast barium enema as a screening test (every five years). The USPSTF is looking at other possible screening methods, including CT colonography (also known as “virtual colonoscopy”) and stool DNA testing.

Occupational Therapists Help Prevent Falls

Tue, 28 Feb 2012 09:17:34 GMT

For Americans who are 65 years and older, falls are a real danger. In fact, falls are the leading cause of injury, accidental death and disability. The statistics are alarming: More than 40% of those hospitalized from hip fractures, for example, can’t return home and are unable to live independently again.

The good news is that occupational therapists can help prevent falls because of their training and expertise.

There are quite a few common causes of falls and an occupational therapist can help identify them. New or unfamiliar locations, inappropriate footwear, oversized or misplaced furniture and interruptions while walking can all contribute to a patient’s falling. An occupational therapist can help people implement prevention practices to decrease their risk of falling.

How can occupational therapists help prevent falls?

* Help patients stay fit and active to maintain overall vigor and endurance.

* Check a home’s lighting, making sure all areas are adequately illuminated, especially dark hallways and bathrooms, where throw rugs can cause trips and falls.

* Remove throw rugs or secure them carefully to the floor.

* Install nightlights in dark areas, like the hallway, kitchen and bathrooms.

* Help patents identify distractions that could cause a fall while walking, like talking on the phone or carrying bulky items and walking at the same time.

* Advise on proper footwear. Wearing flat, nonslip shoes are especially important in unfamiliar or dark locations.

* Arrange the home’s furniture so that there is a clear walking path.

* Ensure that doorways and hallways are large enough to get through with walking aids, if any are used.

* Install railings in hallways and stairs and grab bars in the bathroom and shower to prevent slipping.

* Install nonslip strips or a rubber mat on the floor of the tub or shower.

* Help patients recognize their limitations. If there are tasks they can’t complete with ease, encourage them get help and avoid completing tasks without proper assistance to prevent falls.

Coping with Age-Related Hearing Loss

Tue, 14 Feb 2012 18:15:12 GMT

Almost 35 million children and adults in the U.S. have hearing loss and many of them do not know that a Speech-Language Pathologist (SLP) can help them adjust to this new condition and have a life full of meaningful communication.

Aging-related hearing loss, called presbycusis, is common. The National Institutes of Health reports that about one-third of people in the U.S. between the 65 and 75 have some degree of hearing loss. For those over 75, that number is closer to half.

An SLP is trained in this kind of rehabilitation and generally focuses on five areas: helping the person adjust to hearing loss, learn about possible use of hearing aids, explore helpful assistive devices, manage conversations for maximum efficacy and take charge of communication. These five areas can be addressed one-on-one, in small groups or a combination.

An SLP can help in these ways:

Understanding the patient’s hearing loss. An SLP will help get the specifics of the situation, like what noises are more difficult to understand? When is hearing loss better and worse? Knowing this can help the patient and SLP establish goals.

The family's understanding of the hearing loss. Because age-related hearing loss is gradual, it can sneak up on a patient and many withdraw from social situations or do not actively participate. This can be frustrating for the family who wants to communicate with their loved one. An SLP helps them understand the degree of impairment, perhaps by playing a recording that simulates the patient’s hearing loss. This can create empathy and understanding and smooth relations as the patient works with the SLP to improve the situation.

Getting a hearing aid. It is estimated that four of five Americans with hearing loss do not use hearing aids, which can cost from $500 to $6,000 or more, depending on the technology level, fitting fees and style chosen. This likely has something to do with the fact that most private American healthcare providers don’t cover them, although these devices have the potential to make a tremendous difference in quality of life and treat a medical condition.

There are myriad types and styles, from behind-the-ear aids to surgically implanted bone-anchored hearing aids. Some even connect wirelessly to a mobile phone! An SLP can help navigate the decision-making process to find the hearing aid that best fits the patient’s lifestyle and budget. The SLP will also help him or her create realistic expectations and learn how to care for an aid.

Learning to listen again. For the patient who has lost hearing gradually over the years, getting a hearing aid means re-entry into a long-absent noisy world. An SLP can assist help patients good listening skills, cope with noise overstimulation and increase communication efficacy.

Assistive listening devices. For some people, hearing loss is mainly a concern in certain places, like listening in church or watching TV. There are devices that can assist in these situations, with or without a hearing aid present: TV listening devices, personal FM systems to use during lectures, conference microphones and telephone amplifiers. An SLP will help the patient get acquainted with all the options.

Using visual clues. Much of what we are communicating is not said through words. Nonverbal communication can be sent through hand and body gestures, touch, body language, posture, facial expression and the level of eye contact. Social psychologists actually believe that two-thirds of communication between people is nonverbal, be it one-on-one or with one speaker and an audience.

Pretty good news for people who have lost some of their hearing! This means they can “read” mood, gauge interest in a conversation and get clues about what another person is saying. In fact, many report that their hearing loss has heightened this ability.

With the assistance of an SLP and patience, people with hearing loss can adjust beautifully to their condition and improve their communication skills. Golden LivingCenters employs many professionals in the field and can help you or your loved one if hearing loss is an issue. Contact us today by e-mailing ask@goldenliving.com or calling 877-823-8375.

Is Acetaminophen Safe?

Tue, 07 Feb 2012 15:46:52 GMT

Every year, there are a growing number of cases of liver failure related to acetaminophen that require a visit to the emergency department. Doctors see 56,000 of these cases and with 100 deaths related to this common drug.

Acetaminophen is the most widely used medication in the United States. It is supplied as a single ingredient in such brands as Tylenol and as generics (also known as APAP) and in combination with many other non-prescription and prescription drugs. Acetaminophen is safe and effective when used as directed for mild to moderate pain from arthritis to headaches and to reduce fever in children and adults.

In fact, acetaminophen is arguably the safest pain reliever on the market in the United States. Other pain relievers such as ibuprofen (Motrin, Advil), naproxyn (Aleve, Naprosyn), and similar drugs may have significant side effects on blood pressure and kidney and heart function, especially in the elderly. Recent guidelines from the America Geriatric Society recommend that these drugs be used only rarely in the elderly and then only at the lowest effective dose for the shortest possible duration.

However, when total daily doses of acetaminophen exceed 4,000 mg, liver damage can occur. In patients with liver disease or a history of significant alcohol use, the maximum tolerated dose of acetaminophen may be much lower (around 2,000 mg per day). Adults over 65 are also advised to limit their daily intake of acetaminophen from all sources to 3,000 mg per day unless their physician has prescribed higher doses.

Because of the number of extra strength and combination products containing acetaminophen and its availability in both non-prescription and prescription drugs, many consumers and some health care providers fail to recognize that the total daily doses are exceeding these recommended daily maximum doses.

Three FDA advisory committees have made several recommendations including:

1. Reduce the maximum recommended daily intake of acetaminophen from 4,000 mg per day to around 2,600-3,200 mg per day

2. Reduce the maximum recommended single dose from 1,000 mg per day (two extra strength Tylenol) to 650 mg per day (two regular strength Tylenol)

3. Require that only one concentration of liquid acetaminophen be marketed to avoid confusion and accidental overdose, especially in children

4. Reduce the amount of acetaminophen in combination prescription drugs (i.e. Percocet, Vicodin) to no more than 325 mg per tablet or capsule by January 2015

Consumers with questions about products containing acetaminophen including safe doses and the best medication for their conditions should seek the advice of their physician or pharmacist.

Making the Most of Your Mammogram

Wed, 18 Jan 2012 10:12:16 GMT

Mammograms save lives. But do you know how they work, what they’re looking for, when to get one and how to make the most of your exam? We’ve rounded up all that information for you below, so read on to learn more.

Basically, a mammogram is a low-energy x-ray of breast tissue, with the goal of identifying any early signs of cancer, like characteristic masses and microcalcifications. It both screens for cancer and is used to diagnose it. One of the reasons mammograms are important is because the x-ray can detect cancer at a very early stage—much sooner than it can be felt as a lump in the breast.

This brings us to the use of mammograms as a screening tool—they are the modality of choice along with self breast examination. Breast tissue changes can be detected up to two years before a woman or her doctor can physically feel them in the tissue. Early detection and treatment generally offer greater chances of full remission.

The other use of mammograms is as a diagnostic tool. This usually occurs when a woman or her medical care provider have found a lump or lumps and want them evaluated. Mammograms are also used to follow-up from an abnormal screening mammogram—something in the first one needed further investigation by a radiologist, who reads the results of the x-rays.

When should I get a mammogram?
Opinions very widely on this question for women. It should be a decision you make with your physician, taking into account your risk for breast cancer, family and personal history. Those with higher risk might be counseled to start earlier than those without.

The U.S. Department of Health and Human Services, American Cancer Society, American Medical Association and American College of Radiology recommend a screening mammogram for all women beginning at age 40.

The U.S. Preventive Services Task Force recommends that women younger than 50 should decide with their physicians when they start regular screening mammograms every two years. For women older than 50, mammograms are recommended every two years until age 74. Some organizations say this schedule should continue as long as you are healthy. Others recommend that after 75 years of age, the decision should be made between you and your physician.

If you are at risk for breast cancer (genetic history, family history), your doctor may recommend that you start screening at an earlier age.

How to I prepare for a mammogram?
This is a low-preparation procedure, but consider these things before your mammogram:

* Discuss any new findings or problems with your breasts with your doctor.

* Inform your physician of any prior surgeries, hormone use, and family or personal history of breast cancer.

* Do not wear talcum powder, deodorant, or lotion under your arms or on your breasts. This can cause areas to appear as calcium spots on the film.

* Let the technologist know of any breast symptoms or problems you are having.

* If you have implants, ask if the facility uses special techniques designed to accommodate them when you make your appointment. Also, the day of the exam, make sure the technologist is experienced in performing mammograms on patients with breast implants.

* If you have had mammograms at other centers, obtain them and make them available to the radiologist for comparison at the time of your current exam.

* Always ask when your results will be available (usually within 10 days); do not assume that your results are normal if you do not hear from your physician or the facility – be sure to follow-up with them if the allotted time has passed for the results to be ready.

* If you still have menstrual periods, the procedure will be more comfortable if done within 2 weeks after your period ends especially if your breasts become tender before your period starts.

Tell your doctor:

* If you are or might be pregnant. Although the radiation is at a very low dose, a routine screening mammogram is not done during pregnancy.
* If you are breastfeeding, as the results may not be clear in breasts that contain milk
* Have previously has a breast biopsy. Knowing the locations of scar tissue will help the radiologist read your mammogram accurately.

Although the mammogram is the gold standard for medical detection of breast cancer and is the best screening tool available today, it does not detect all breast cancers. Also, a small percentage of these x-rays give “false positives,” indicating that cancer could be present when it is not.

And remember, most abnormalities found during a mammogram are not breast cancer. However, many women who have regular screening mammograms need more tests to investigate any abnormalities found such as calcifications during the test. If this occurs, other tests such as an ultrasound may be done to evaluate the area and determine if any invasive procedures need to be done. Follow-up tests are often the best way to see if a treatment is working or is an area of concern is stable over time.

Roasted Brussels Sprouts with Bacon

Tue, 20 Dec 2011 10:38:46 GMT

Many people are hesitant to try Brussels sprouts, but adding some bacon is the perfect way to get them to change their minds! Brussels sprouts are high in vitamin C, vitamin A, vitamin K and fiber. They’ll also add a pop of color to your holiday plate.

Ingredients

• 1-½ pounds Brussels sprouts, trimmed and halved
• 3 tablespoons extra virgin olive oil
• ¾ teaspoon kosher salt
• ½ teaspoon black pepper
• 4 slices of thick-cut, nitrate-free bacon

Directions

1. Preheat oven to 400 degrees F.
2. Mix Brussels sprouts in a bowl with olive oil, salt and pepper.
3. Roast them on a sheet pan for 35-40 minutes, stirring occasionally.
4. While the Brussels sprouts are roasting, cook the bacon in a skillet over medium heat until crispy. Let cool and chop roughly.
5. Once Brussels are cooked, toss with bacon and serve.

Serves 6

Green Beans with Almonds

Wed, 14 Dec 2011 12:20:44 GMT

Many traditional holiday dishes are quite heavy. This year, skip the green bean casserole and add some fresh green beans to your table for a pop of color. Green beans are a very good source of fiber, vitamin A and vitamin C. Enjoy!

Ingredients

• 1 pound of fresh green beans, trimmed

• 2 tablespoons extra virgin olive oil

• 2 cloves of garlic, minced

• ½ cup sliced or slivered almonds

Directions

1. Steam the green beans in a steamer until tender, about seven minutes

2. While the green beans are steaming, heat olive oil in a skillet over medium heat. Add garlic and sauté until fragrant.

3. When green beans are done, add them to the skillet, tossing them with the oil and garlic until covered.

4. Add almonds, toss and serve.

Sweet Potato Mash

Mon, 05 Dec 2011 15:29:28 GMT

Mashed potatoes have long been a Thanksgiving comfort food. However, sweet potatoes offer much more nutritional bang for your buck than white potatoes. They’re packed with calcium, potassium, vitamin A and vitamin C. Plus, the beautiful orange hue is perfect to brighten up any holiday meal! So enjoy this nutritious meal with your family this December.

Ingredients

5-6 large sweet potatoes, peeled and cut into 1-inch chunks

5 tablespoons butter

2 teaspoons cinnamon

Salt and pepper to taste

1 tablespoon real maple syrup (optional)

Directions

1. Bring large pot of salted water to a simmer. Add potatoes and simmer for 20 minutes or until tender.

2. Drain potatoes and return to pot.

3. Add butter and stir until melted. Mash potatoes using a fork or potato masher.

4. Add cinnamon, salt and pepper, and continue mashing to fully incorporate.

5. If a sweeter mash is desired, you may add a tablespoon of real maple syrup.

Makes about 4 servings.

Curried Turkey Salad

Mon, 28 Nov 2011 11:53:19 GMT

Need a delicious way to use your leftover turkey? Try this recipe as a unique alternative to traditional turkey sandwiches. Serve over salad for a healthy, protein-packed lunch.

Ingredients

• 2/3 cup mayonnaise
• 3-4 teaspoons curry powder, to taste
• ¼ cup celery, chopped
• 1 cup fresh grapes, halved
• 1 tablespoon chopped shallot
• 2 tablespoons chopped pecans (optional)
• 1 ½ cups diced turkey
• Salt and pepper to taste

Directions

1. Combine mayonnaise and curry powder in a small bowl.
2. Combine mayonnaise mixture and remaining ingredients.
3. Serve over salad greens.

Serves 4

Recognizing American Diabetes Month

Mon, 21 Nov 2011 09:23:18 GMT

In the U.S., nearly 26 million adults and children live with diabetes every day. Alarmingly, another 79 million are at high risk for developing type 2 diabetes, a disease that is taking a harmful physical, emotional and financial toll on families and individuals of all walks of life.

Diabetes mellitus, often simply known as diabetes, is a set of metabolic diseases. The primary problem caused by the diseases is high blood sugar from two causes: the body isn’t producing enough insulin, or because cells are not responding to the insulin that is produced.

There are three primary kinds of diabetes:

Type 1 diabetes: the body fails to produce insulin with this type, also referred to as insulin-dependent diabetes mellitus and juvenile diabetes. People with this must inject insulin.

Type 2 diabetes: the body fails to use insulin properly with this condition, and it may be combined with an absolute insulin deficiency. It is formerly referred to as non-insulin-dependent diabetes mellitus and adult-onset diabetes.

Gestational diabetes: a pregnant woman who may have never had diabetes before has high blood glucose level during pregnancy. It may come before development of type 2 diabetes.

Recent numbers from the Centers for Disease Control and Prevention paint a grim picture of the prevalence of diabetes and its ravaging effects:

* Every 17 seconds, someone is diagnosed with diabetes.
* Diabetes kills more people each year than breast cancer and AIDS combined.
* Recent estimates project that as many as one in three U.S. adults will have diabetes in 2050.

November is American Diabetes Month, a time to rally individuals, communities and families to join the millions in the movement to Stop Diabetes. This year, the American Diabetes Association is asking individuals to take a pledge and raise their hand to Stop Diabetes.

Beginning November 1, the public can take action by taking the American Diabetes Month pledge on Facebook.

Here are other ways you can become involved:

* Attend an American Diabetes Month event in your area.
* Visit www.stopdiabetes.com.
* Call 1-800-DIABETES
* Text JOIN to 69866 (standard data and message rates apply).

New World Chili in a Crock Pot

Wed, 16 Nov 2011 11:59:28 GMT

New World Chili in a Crock Pot

The tomatoes, cranberries, corn, peppers and squash make this a healthy and super satisfying, stick-to-your-ribs meal on a cold autumn day.

Prep: 25 minutes
Cook: 10 hours on low or 5 hours on high

• 1 pound turkey breast tenderloin, cut into 1-inch pieces

• 1 28-ounce can diced tomatoes

• 1 15-ounce can black beans, rinsed and drained

• 1 8-ounce can tomato sauce

• 1 cup peeled, seeded and cubed butternut squash or pumpkin

• 1 medium onion, chopped

• 1 cup chicken broth, divided

• 1/2 cup frozen whole kernel corn

• 1/2 cup dried cranberries

• 1 fresh jalapeño pepper, seeded and finely chopped

• 2 tablespoons chili powder

• 1/2 tablespoon ground cumin

• 2 cloves garlic, minced

• 2 cups chopped fresh spinach

• 4 ounces Monterey Jack cheese with jalapeño peppers or cheddar, shredded

1. In a 5-quart slow cooker (crock pot) combine turkey, un-drained tomatoes, beans, tomato sauce, squash, onion, 1/2 cup chicken broth, corn, cranberries, jalapeño pepper, chili powder and garlic.

2. Cover and cook on low-heat setting for 10 to 12 hours or on high-heat setting for five to six hours. If desired, stir in additional broth to reach desired consistency. Stir in spinach just before serving. Sprinkle each serving with cheese. Makes six servings.