Posted by Hotel Recovery Blog Manager on Sun, Aug 29, 2010 @ 05:34 PM
A recent study about the benefits of palliative care gained much attention in the media, as it suggests that patients facing a serious illness may feel better and even live longer if they receive palliative care.
The Center to Advance Palliative Care defines palliative care as “the medical specialty focused on improving overall quality of life for patients and families facing serious illness.” Palliative care is coordinated with their other health care providers and focuses on communication and pain and symptom management.
Research published in the most recent edition of the New England Journal of Medicine showed that patients suffering from a form of fast-growing lung cancer reported a better quality of life when they received early palliative care in addition to regular cancer treatment as opposed to cancer treatment alone.
Patients participating in the study who received palliative care self-reported better quality of life including less pain, less nausea, less worry and more mobility. The palliative care group also were less frequently diagnosed with clinical depression and ended up living close to three months longer than those who did not receive palliative care.
The increase in life expectancy comes even though patients receiving palliative care were less likely to choose aggressive treatment at the end of life. Researchers hypothesize that this is because aggressive treatment can be painful, interrupt sleep, and force patients into a hospital where infections or bedsores shorten their life span.
Caring for a loved one with a serious illness is never easy, but palliative care can be an important component of treatment. By minimizing symptoms and helping a seriously ill person remain independent, palliative care can be instrumental in improving overall quality of life.
Posted by Hotel Recovery Blog Manager on Sat, Aug 21, 2010 @ 08:31 AM
A good night’s sleep is essential to feeling good throughout the day. Sleep habits can change with age, however, and special attention must be paid to the elderly to ensure they’re getting enough rest. A hospital stay can disrupt sleep, and recovering from an acute medical event at home may help to restore natural sleep patterns.
According to the National Sleep Foundation, older adults can have trouble falling asleep and staying asleep. This can be exacerbated by medications and schedule disruptions, the kind that can occur after a hospital stay or an acute injury.
The National Institutes of Health offers some helpful information on how older adults can get a good night’s rest.
- Follow a regular schedule each day, going to sleep and waking up at the same time. Don’t try to nap during the day, try to get some natural light during the afternoon and develop a routine at bedtime.
- Exercise during the day, and watch what you eat. Don’t drink caffeine during the afternoon, and remember that nicotine is a stimulant. Alcohol can disrupt sleeping patterns, making it harder to stay asleep.
- Make sure a bedroom is both safe and comfortable. Darkness and quiet can help sleep. Use a bedroom only for sleeping.
Sleeping too little is associated with serious health consequences. According to the National Sleep Foundation, too little sleep can lead to an increased risk of diabetes, heart problems, or psychiatric conditions.
When recovering at home, home care workers can ensure that you or your loved one adheres to a schedule and has a comfortable place to sleep. This is especially important for older adults receiving care, for whom getting enough rest may already be hard enough.
Posted by Hotel Recovery Blog Manager on Sat, Aug 14, 2010 @ 12:23 PM
After surgery or an acute medical event, a doctor may recommend a cane or walker for safe mobility. Last week, as part of a two part series, we looked at how to choose a walker. This week, we will examine how to choose and use a cane.
A cane can support up to 25% of a user’s weight, and can assist in mobility and confidence. Typically, walkers are recommended for people who are recovering from injuries to the foot or leg, who have a mild balance disorder or who have arthritis of the knees or hips.
The correct height for a cane is measured from the wrist to the floor. The American Geriatric Society offers some recommendations for how to choose a cane:
- Wear your normal shoes and hold your arm with a 20-degree to 30-degree bend in the elbow.
- Ask someone else to measure the distance from your wrist to the floor. This measurement should be about equal to the distance from the point where your leg bone fits into the hip socket to the floor.
- If necessary, adjust the cane to match your measurement. Too-short canes can upset balance, while too-long canes are harder to pick up.
- Aluminum canes can be adjusted with a spring-loaded lock button that allows the tube length to be adjusted, while wooden canes must be cut to the desired length. Talk to a physician or physical therapist if, after adjustment, a cane still doesn’t feel right.
In addition, the Mayo Clinic recommends that cane users who need to bear weight choose a model with four tips, while single-tip canes can be used for balance. Numerous kinds of grips are available to fit any hand.
If using a cane for stability, either hand can be used to grip the cane. If recovering from an injury or if a particular leg is disabled, the cane is usually placed in the opposite hand from the affected leg unless a physician recommends otherwise. In either case, the cane should be moved in unison with the leg opposite the hand holding the cane.
A cane can be an important tool in keeping or regaining mobility after an injury or when having trouble with balance. Choosing the right cane can help you or a loved one remain independent and mobile.
Posted by Hotel Recovery Blog Manager on Sat, Aug 07, 2010 @ 01:30 PM
When you or a loved one is coming home for a recovery, a doctor may recommend the use of a walker or a cane to safely move around the house. In a two part series, we will look at how to choose and use a walker and how to use a cane.
A walker is used to provide support and balance while in motion and may help improve confidence. Typically, walkers are recommended for people with severe arthritis of the knees or hips, weakness in legs or hips or a balance or gait disorder that is moderately severe.
The correct height for a walker is measured from the wrist to the floor. The American Geriatric Society offers some recommendations for how to choose a walker:
- Wear your normal shoes and hold your arm with a 20-degree to 30-degree bend in the elbow. (If your upper arm is at 12 o’clock, your hand points to 5 o’clock.)
- Ask someone else to measure the distance from your wrist to the floor. This measurement should be about equal to the distance from the point where your leg bone fits into the hip socket to the floor.
- If necessary, adjust the walker to match your measurement. Most walkers are adjusted by pushing in buttons on each side and sliding the tubing to the new length until the buttons lock in place.
- If your walker doesn't feel right, ask your physician or physical therapist to check the fit.
In addition, the Mayo Clinic recommends that walker users select a comfortable grip that encourages a steady hand. Some grips are comfortable but become slippery if hands are sweaty, while other grips are too small for people who have trouble grasping things tightly.
The tips of a walker should have non-skid rubber tips that keep the walker from moving too far forward. Check tips and replace them if they’re worn. If you are using a walker on carpeted surfaces, a tennis ball cut and placed over the tips of the walker can ease movement.
A walker can be an important tool in keeping or regaining mobility while in your home or in the community. Choosing the right walker can help the user feel comfortable enough to remain independent.
Posted by Hotel Recovery Blog Manager on Sat, Jul 31, 2010 @ 08:12 AM
Preventing falls is extremely important in ensuring that elderly loved ones can remain safe and at home. Falls are the leading cause of death of people over 65, resulting in over 9,500 deaths each year. One third of those 65 and older will fall each year and two thirds of those who fall one time will fall again within six months. Half of elders who sustain a fall will never return home, spending the rest of their lives in nursing care.
According to researchers at Colorado State University, some of the risk factors for falls include:
- Osteoporosis. A decrease in bone density can cause stressed bones to break and make a person fall, and brittle bones are more likely to break during a fall.
- Lack of Physical Activity. Without exercise, elders lose muscle tone, bone mass and flexibility, meaning that they’re less likely to recover from starting to fall, and are more likely to be injured in a fall.
- Poor Vision. Lack of depth perception, sensitivity to light and blurred vision can lead elders to trip over obstacles and misjudge stairs.
- Medications. The side effects of some medications impair balance and can cause low blood pressure.
- In-home hazards. One third of falls are due to preventable in-home hazards such as torn carpets, footwear without proper treads and slippery floors.
To prevent falls, the American Academy of Family Physicians offered some guidelines for the elderly, which include:
- Wearing shoes with non-skid soles
- Ensuring that a home is well-lit with lamps and night-lights
- Fix uneven surfaces, tack down carpets, remove throw-rugs, get rid of electrical cords that cross pathways and don’t wax floors
- Have grab bars installed in bathrooms and make sure there are handrails on both sides of stairways
- Ask for help reaching high places instead of using stepladders and chairs
- Have your eyes, hearing and feet checked regularly
- If you have fallen, or if you feel confused or dizzy, see a doctor right away
- Tell a doctor if you suspect a medication is causing you to feel dizzy or lose your balance
- When getting out of bed, sit on the side of the bed for a minute or two to give your blood pressure a chance to adjust so that you don’t feel dizzy
Technology can help, too. Eldergadget.com featured some innovative products that keep elders on their feet, including rolling walkers, canes that help people stand up from a sitting position, bed rails and cushioned bath mats.
When elders receive care at home, they can get help in bathrooms or navigating stairways. Loved ones can relax knowing that someone is there making sure that home is a safe place and that elders are staying in shape and taking their medication properly.
Posted by Hotel Recovery Blog Manager on Tue, Jul 27, 2010 @ 07:18 PM
When family members choose home care for an elderly relative, it is often because they want their loved one to recover in the comfort of their own home. Since most homes are usually not designed for someone with cognitive or physical impairment, recovering at home may require some easy, simple modifications to a home in order to keep elders safe.
Recently, the New York Times’ New Old Age blog outlined some good recommendations for keeping elders safe while recovering at home. These recommendations come from the Visiting Nurse Service of New York and were compiled by case manager Cathy Castronova.
These guidelines are especially helpful for those with dementia or Alzheimer’s, but are useful for anyone who is recovering at home with some impairment:
- Create a “wander loop” in your home, a safe pathway that allows the patient to safely roam.
Use reflector tape to create a path to the bathroom.
- Cover radiators and electrical outlets with guards.
- Lock doors that lead to places like basements and garages.
- Lock cabinets that contain liquor, medications, household chemicals and any other toxic substances that could be swallowed.
- Get rid of firearms, or store them in a locked cabinet with bullets in a separate locked cabinet.
- Install safety locks and alarms on exit doors and gates.
- Cover smooth or shiny surfaces to reduce confusing glare.
- Eliminate shadows with a lamp that reflects off the ceiling.
- Cover or remove mirrors if they are upsetting to a person with hallucinations.
- Store car keys in a locked container; disable the car.
- Do not allow unattended smoking.
- Make sure an I.D. bracelet is being worn at all times.
Castronova recommends that patients with Alzheimer’s and dementia who are receiving home care should be treated by home care workers who are specifically trained to work with each disease. Most importantly, she recommends constantly re-assessing a loved one’s abilities with the help of a nurse or physician.
Recovering at home can be a comfortable way for an elderly person or a person with Alzheimer’s or dementia to receive medical care. Family members can have peace of mind knowing that the home where their loved one is recovering is a safe environment.
Posted by Hotel Recovery Blog Manager on Mon, Jul 26, 2010 @ 08:50 PM
In this week's New Yorker, Dr. Atul Gawande addresses an important medical service that is under-appreciated by many physicians and patients.
http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande
Posted by Hotel Recovery Blog Manager on Sun, Jul 25, 2010 @ 02:34 PM
Patients who are immobilized after an injury are at risk for pressure ulcers, also known as bed sores or decubitus ulcers. The painful sores result from pressure that restricts blood flow, causing tissue damage.
Up to 22 percent of nursing home patients and up to 32 percent of hospital patients will experience a pressure ulcer, the severity of which may range from irritated, red skin to deep craters that leave bone and muscle exposed. Patients receiving care at home are between 7 and 21 percent less likely to develop a new pressure ulcer than those in a long-term care or acute care setting, respectively, one of the benefits of receiving at-home care.
Among those at risk for pressure ulcers include those who have suffered an immobilizing injury who are unable to relieve pressure by moving themselves, and the elderly who have reduced skin elasticity. Patients who are incontinent or who have a neurological disorder such as Parkinson’s disease or Alzheimer’s disease are also at higher risk for developing pressure ulcers.
The Centers for Disease Control and Prevention (CDC) define the severity of pressure ulcers as follows:
- Stage 1: A persistent area of skin redness (without a break in the skin) that does not disappear when pressure is relieved.
- Stage 2: A partial thickness is lost and may appear as an abrasion, blister, or shallow crater.
- Stage 3: A full thickness of skin is lost, exposing the subcutaneous tissues--presents as a deep crater with or without undermining adjacent tissue.
- Stage 4: A full thickness of skin and subcutaneous tissue are lost, exposing muscle or bone.
While more than 70 percent of Stage 2 ulcers heal within six months, only 50 percent of Stage 3 and 30 percent of Stage 4 ulcers heal within half a year. Patients with a pressure ulcer can develop blood and bone infections and can suffer from low blood pressure, fever, a fast heart rate and confusion. Serious infections are often fatal.
The National Institutes of Health offers recommendations for health care providers to prevent pressure ulcers in at-risk patients. These recommendations include conducting a full daily assessment of a patient’s skin, changing a patient’s position every two hours, exercising a patient ever y day, keeping skin clean and dry especially after a patient goes to the bathroom, and using special medical supplies such as foam cushions and sheepskin blankets.
Patients who have limited mobility or who are recovering from an injury that leaves them with restricted motion can benefit from in-home care providers who will ensure they have a lower chance of developing a pressure ulcer.
Posted by Hotel Recovery Blog Manager on Sat, Jul 17, 2010 @ 05:06 PM
Patients who are hospitalized for surgery or who become incontinent will often receive a urinary catheter. While many catheterizations are unavoidable, studies show that up to 50 percent of catheterizations are not medically necessary. Further, a new survey shows that fewer than half of health care facilities are following recommended guidelines to decrease catheter-associated urinary tract infections (CAUTIs).
One in four patients who enters a hospital will receive an indwelling catheterization, the kind of catheter that is inserted into and remains in the bladder for an extended period of time. Unfortunately, nearly the majority of those catheters are unnecessarily placed and many catheterizations can last longer than medically necessary. According to Infection Control Today, that’s in part because of overworked hospital staff who may not have the time to respond to complex care needs.
As a result, urinary catheters are the most frequent cause of hospital acquired infection (HAI) in the United States. According to an article published in the Annals of Internal Medicine, infection frequently occurs after the placement of a catheter, and the presence of bacteria in the urine increases five percent every day a patient is catheterized. With proper infection control measures, between 17 and 69 percent of CAUTIs could be prevented. That translates to the prevention of up to 380,000 infections and 9000 deaths each year.
To decrease the number of CAUTIs, in 2009 the Centers for Disease Control and Prevention (CDC) adopted guidelines that health care facilities should follow. The guidelines addressed who should receive catheters, how they should be cared for, when they should be removed, and surveillance strategies to ensure the guidelines are followed. Unfortunately, a survey conducted last week showed that fewer than forty percent of health care facilities report that at least three quarters of their providers are applying CDC guidelines.
Patients and their loved ones can do their part to decrease the chance of contracting a CAUTI. While in the hospital, patients are advised to ask their health care provider every day if the catheter is still necessary. The CDC also has guidelines for patients, and recommends that patients do the following when coming home from the hospital with a catheter still inserted:
- Make sure to ask questions so as to understand how to care for a catheter once home from the hospital
- Contact a doctor or nurse immediately if any symptoms of a urinary tract infection develop, such as a burning pain in the lower abdomen, fever, or an increase in the frequency of urination
- Always clean hands before and during catheter care
- Keep urine bags below bladder level
- Do not tug or pull on the tubing, or twist or kink the tubing
While a catheterized patient is recovering at home, highly-trained health care providers will be able to monitor a patient’s catheter, preventing infection and giving peace of mind to patients and their families.
Posted by Hotel Recovery Blog Manager on Tue, Jul 06, 2010 @ 07:24 PM
After an injury or illness, patients are often told they need peace, quiet and relaxation. Unfortunately, the activity in a modern hospital can keep patients up all night listening to staff pages, alarms and blaring televisions. In addition to interrupted sleep, noise can cause stress and anxiety in patients who are already suffering from confusion and pain. In some situations, extraneous noise can even lead to staff errors.
Recovering at home is one way for patients to receive care while avoiding the loud noise that is often present in a hospital setting.
A Johns Hopkins study found that the average noise level of a hospital was equal to that of a sporting event or busy freeway, with sound levels rising from 57 decibels to 72 decibels over the past 50 years. A British study found that peak noises – a dropped tray or a doctor being paged – could exceed 108 decibels, more than a chainsaw or a car horn.
Unfortunately, environmental noise is a fact of life in most hospitals. Alarms alert staff to the conditions of multiple patients on a floor, doctors and nurses conference in hallways and at nurses’ stations and laundry and food carts rumble by. Worse, sometimes food trays are dropped, doctors are paged in the middle of the night and urgent alarms pierce the usual din of beeping and whirring machines. These noises are often magnified when they bounce off linoleum floors and bare walls.
All of these sounds are vital to the operation of a hospital, but taken together can also delay a patient’s recovery. Environmental noise can disturb a patient’s sleep, leading to increased anxiety and fatigue. Loud, unexpected noises can startle a patient, increasing blood pressure and heart rate. Long-term exposure to noise levels found in most hospitals can actually induce stress-induced symptoms such as altered memory, increased agitation and lower pain tolerance. All these problems are of special concern for elderly patients.
Hospital staff members are not immune to the problem of environmental noise. At the very least, a noisy hospital makes staff members speak more loudly and feel more stress. Sensitive patient information is often shared in less-than-hushed tones, potentially breaching patient privacy. At worst, extraneous noise can lead to misunderstood directions and even medical errors.
Hospitals are working to reduce noise by installing new ceiling tiles that dampen sound, decentralizing nurses’ stations and fixing squeaky wheels on transport carts. Still, it’s impossible to completely eliminate noise from a hospital environment.
Recovering at home allows patients to relax in a quieter setting, undisturbed by late-night alarms or a roommate’s loud television. Patients are able to sleep without unnecessary interruption, and natural noise barriers such as carpeting and curtains reduce the impact of noise while patients recover at home.
Hospitalization for an acute event can be disruptive enough to a patient’s life without the added stress and missed sleep of a noisy hospital room. Recovering from a medical event in a more peaceful setting such as one’s home can reduce the amount of noise a patient experiences during the recovery process.