Melatonin Nightmares?

December 28, 2011 at 10:30 am | Posted in Joanne Jordan, Office Manager | Leave a comment
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Melatonin has received a lot of press coverage in the last few years, as a supplement which may help improve sleep. It is a natural hormone secreted by the pineal gland in the brain, which regulates other hormones and maintains the body’s circadian rhythm, or “body clock.”

Several of our clients use melatonin supplements (with their doctors’ supervision, of course) to combat insomnia. Recently, the caregiver for one of them reported that our client has been having increasingly frequent vivid nightmares or hallucinations, including the very scary belief that a stranger has entered her home in the middle of the night.

In our weekly case review meeting, our care management team brainstormed possible explanations for this change in her behavior. Is the client struggling with increased anxiety which manifests itself in her dreams? Is this behavior evidence of a new or worsening physical condition such as an infection, or a different form of dementia? Could she be experiencing a drug interaction from the many prescriptions she is on? Could it be simply a side effect of one or more medications she takes? Melatonin is known to produce nightmares in some patients at higher doses.

All of these, and more, are plausible explanations for our client’s change in behavior. These will be explored by her Distinctive Care Geriatric Care Manager, who works closely with her physicians to monitor her care.

If it turns out to be melatonin at fault, discontinuing it or adjusting the dosage should provide prompt relief from the nightmares. And this case illustrates the importance of discussing all supplements with your physician, whether or not they are “all natural” or sold over the counter.

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York. We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care. Please contact us at 201-587-5283 to schedule a consultation in our Ramsey or Ridgewood offices.

Freedom to Choose

November 9, 2011 at 10:30 am | Posted in Joanne Jordan, Office Manager | Leave a comment
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Recently, we received a call from a concerned daughter whose mother is recuperating in a skilled nursing facility following a recent hospitalization. She called Distinctive Care for advice on managing her mother’s plan of care, including possible options for her care upon discharge from the facility.

When we heard which nursing home her mother is in, we were concerned, because it is not a facility we would ever recommend for our clients. Its reputation has suffered for years due to various ongoing deficiencies, and there are better options in the same market area. We asked why the family selected the facility and learned that they went along with the suggestion of the hospital discharge planner, not really understanding that they could choose from many facilities. Of course, bed space and appropriate levels of care must be available, but clients and their families should always be able to make their preferences known.

As geriatric care managers, we pride ourselves on serving as advocates for our elderly clients. We always tailor our referrals to the facilities and professionals who can best care for the individual client’s needs. We encourage family members to take an active role in evaluating facilities and offer guidance on what to look for in a quality skilled nursing or assisted living community. We continually re-assess facilities in our service area to stay abreast of any changes, and our proposed care plans always include several choices of facilities that we believe are best-suited to meet that individual’s needs.

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York. We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care. Please contact us in our Ridgewood Office at 201-587-5283 to schedule a consultation.

Open Enrollment Begins October 1

September 29, 2011 at 10:30 am | Posted in Joanne Jordan, Office Manager | Leave a comment
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During the summer, I received a call from the daughter of one of our clients. She wanted to get a jump on reviewing her mother’s Medicare coverage, as she knew that open enrollment (the annual period in which changes in coverage can be made) would be coming up soon.

In fact, this window of opportunity is coming earlier—and ending earlier—this year. Details on coverage options for 2012 will be available on October 1, and changes to existing coverage may be made between October 15 and December 7, 2011.

Even though our client has an existing Medicare plan in place, her daughter is wise to review the plan each year, especially the Part D prescription drug coverage. Changes in her mother’s medications since last year can have a significant impact on out-of-pocket expenses and may warrant a switch to a different Part D plan to minimize drug costs. For some budget-conscious seniors, having good prescription coverage can mean the difference between compliance with doctors’ orders and being unable or unwilling to continue the care they need.

The daughter of our client was feeling somewhat overwhelmed at the prospect of analyzing all of the plans and making the best selection to meet her mother’s needs. I referred her to our Certified Senior Advisor, who is helping her to understand the available options and make an informed decision.

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York. We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care. Please contact us in our Ridgewood Office at 201-587-5283 to schedule a consultation.

Yoga – For the Young at Heart!

July 27, 2011 at 10:30 am | Posted in Joanne Jordan, Office Manager | Leave a comment
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When my dad turned eighty, he decided to take up yoga. This came as no surprise to me, coming from a man who took up pairs figure skating on roller skates in his sixties. This is not to say that he didn’t have his own share of aches and pains. He just chose not to let them slow him down much.

Dad was interested in trying yoga for its many health benefits including stress reduction, lower blood pressure and heart rate, increased flexibility, concentration and energy levels and improved posture. Some people think yoga is only for those people who can contort themselves into pretzel-like positions, but the truth is that yoga is beneficial for all ages and all levels of fitness.

I had mentioned to him that my yoga instructor, who teaches at a local college as well as the county senior citizens’ center, teaches an adaptive yoga class for seniors which is tailored to their physical abilities. Many of her students practice yoga from a comfortable seated position on a chair or in a wheelchair.

When I mentioned chair yoga to my dad, he was very interested, but decided he would save that for when he got old. No seniors class for him! He preferred to join me in my regular yoga class, where he was 40 years older than any of the other students. He did a very admirable job of following along. And yoga is such a personal experience; there is no need to worry about “keeping up” with everyone else. Its benefits are accessible to everyone!

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York. We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care. Please contact us in our Ridgewood Office at 201-587-5283 to schedule a consultation.

Today’s Hot Topic: Dehydration

July 20, 2011 at 10:30 am | Posted in Joanne Jordan, Office Manager | Leave a comment
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Okay, you know it’s hot outside when your fit-as-a-fiddle landscaper passes out from the heat.

It is hot here in North Jersey. Really hot. Blistering-tar-in-the-driveway hot. It is 6 p.m. and my thermometer in the shade still reads 104 degrees. And this heat wave is expected to continue for the next few days.

I’m sitting here in my air-conditioned office, thank heavens, with a nice cool drink, but I’m still thinking about the heat and the risks of dehydration, heat exhaustion and heat stroke. I’m taking mental inventory of the people in my life – family, friends and neighbors – who might benefit from a reminder to make an extra effort to stay well hydrated during a heat wave. The elderly are especially at risk and may not recognize the warning signs of dehydration. These include dark or malodorous urine, decreased urine output, dry mouth, decreased sweating and tear production, muscle cramps, nausea and vomiting, constipation, heart palpitations, lightheadedness (especially when standing), increased fatigue, confusion and weakness.

Many medications used by seniors to treat a variety of ailments have diuretic properties, which increase the need for fluids. At the same time, some aging adults experience difficulty sleeping through the night and/or increased frequency of bathroom trips, so they purposely cut down on their fluid intake. These two situations leave them at higher risk of dehydration.

A quick test for dehydration is to gently pull up the skin on the back of the hand and release it. If the skin does not return to its normal state within a second or two, the person is likely dehydrated.

While water is best, a variety of fluids may be best for encouraging increased fluid intake. Contrary to popular belief, the diuretic properties of coffee and tea are modest compared to the amount of fluid consumed, so moderate consumption of coffee and tea (once or twice a day) is generally okay, as long as there are no other medical reasons to avoid them. Increased intake of fruits and vegetables are a wonderful way to combat dehydration and improve nutrition.

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York. We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care. Please contact us in our Ridgewood Office at 201-587-5283 to schedule a consultation.

Speaking from Experience: Stroke

July 6, 2011 at 10:30 am | Posted in Joanne Jordan, Office Manager | Leave a comment
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Last week I had the opportunity to attend a very interesting talk given by Dr. Oriana Cornett at the Valley Hospital in Ridgewood, NJ. A promising young physician, Dr. Cornett was two months shy of becoming an Endovascular Neurosurgeon when she suffered an ischemic stroke at the age of 37.

Her lecture, entitled “Stroke Inside Out,” provided an overview of what happens to the brain during a stroke, types of stroke, methods to improve patient outcome, complications of stroke and more. What was most fascinating was her insight into what it was like to actually experience a stroke, combined with her considerable knowledge of stroke as a physician who was specializing in treating stroke victims.

Like my dad, Dr. Cornett suffered left side hemiparesis and sensory loss and left side spatial neglect. But as her stroke was occurring, she did not recognize what was happening to her. In fact, she reports that it was not as if she couldn’t control her left side, but rather, her entire left side ceased to exist. How could you recognize you were having a stroke, if you’re not even aware that part of you exists?

Days later, as realization of the magnitude of her situation dawned upon her, depression began to set in. Dr. Cornett credits two of the nurses who attended to her with giving her hope. Their names were Mercy and Faith. They told her “You will get better. You won’t always be this way.” She says those are the words she needed to hear, far more than any concrete timeline or medical jargon. She points out that doctors are not trained to say such things, but if she returns to practicing medicine, she will never underestimate the power of those words.

Good advice for all of us to remember.

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York. We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care. Please contact us in our Ridgewood Office at 201-587-5283 to schedule a consultation.

Prescription Drug Disposal

June 29, 2011 at 10:30 am | Posted in Joanne Jordan, Office Manager | Leave a comment
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Over the past year I’ve been encouraging everyone to practice safe disposal methods to keep outdated or unneeded prescription and OTC meds out of the wrong hands. Reckless use of prescription drugs by teens and young adults is already a huge, and growing, problem across the country. And as geriatric care managers, we know all too well the risk of mistakes being made as aging seniors manage their own medications. It is so easy to confuse similar looking pill containers, or similar sounding drug names, leading to accidental overdose or possibly fatal drug interactions. So we encourage clients to properly dispose of leftover and expired medications instead of hanging on to them.
The FDA recommends flushing, while the state DEP is against flushing and recommends mixing drugs with an undesirable substance such as kitty litter, and disposing of it in the trash. Both of these methods may prevent the drugs from being intentionally consumed, but they do nothing to keep them out of our water supply. What is most troubling is the fact there is currently little or no testing– or effective filtration systems– in place to screen for, or remove, the thousands of pharmaceutical compounds which may be present in our water supplies. Most water treatment facilities are equipped to filter out only conventional pollutants like small solids and biodegradable organic compounds.
What to do? A few pharmacies in North Jersey will take back medications free of charge and ensure they are incinerated. These include Miller’s Pharmacy in Wyckoff, Pascack Pharmacy in Hillsdale, and Hometown Pharmacy in Bloomingdale. At this time, they are not able to accept injectable meds, or those labeled controlled substances, although a new federal law signed by President Obama will soon permit pharmacies to dispose of controlled substances. Until then, they can only be handled by police or other law enforcement personnel.
Another option is to purchase a special $3 shipping envelope from Rite Aid or Walgreens, designed for sending medicine to a facility where it will be incinerated. Or ask if your local hospital pharmacy offers a disposal program. Take Back programs run by the Drug Enforcement Agency and local police departments offer another opportunity, but are held infrequently.
Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York. We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care. Please contact us in our Ridgewood Office at 201-587-5283 to schedule a consultation.

U.S. in 37th Place

June 22, 2011 at 10:30 am | Posted in Joanne Jordan, Office Manager | Leave a comment
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I read an interesting article this week in The Record about life expectancy in the U.S. – specifically, that life expectancy here ranks 37th in the world, far short of other industrialized nations. And we lag further behind each year.

A baby girl born in the U.S. in 2007 can expect to live to almost 81; a boy, 75½ . Had those babies been born and raised in Japan or Iceland, they could expect to live about 5 years longer.

Within the United States, there are enormous variations in life expectancy if you compare it at the county level. For men, there’s a 15 year range—from a low of 65.9 years in Holmes County, Alabama to a high of 81.1 years in Fairfax County, Virginia. For women, the range is more than 12 years, with a low 73 ½ in Holmes County, Alabama and a high of 86 in Collier County, Florida.

The life expectancy of black males in two-thirds of the counties in the U.S. in 2007 was the same as that of the top 10 industrialized countries more than 50 years ago.

With 30 to 40 million uninsured people in the U.S., lack of preventive care and high rates of chronic illness account for some of America’s poor performance. Across the country, men and women could add at least four years to their life expectancy by addressing four key health problems: smoking, high blood pressure, diabetes and obesity.

Here in Bergen County, NJ, the picture is not quite as bleak. Bergen County ranked 22nd out of 2300 counties for men’s and women’s life expectancy in 2007. In fact, males here are ahead of those in the top 10 healthiest countries worldwide.

My best explanation for this good fortune is a combination of factors, including our proximity to top-notch medical facilities and providers, and higher per capita income and education than many areas. But it is appalling how many people right in our own backyard do not have access to quality medical care. How can that be, in the country that spends more money on health care than any other country in the world?

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York. We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care. Please contact us in our Ridgewood Office at 201-587-5283 to schedule a consultation.

Validation Therapy

June 15, 2011 at 10:30 am | Posted in Joanne Jordan, Office Manager | Leave a comment
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Yesterday, I had the opportunity to attend another one of Sophia Heftler’s continuing education programs, this one on Alzheimer’s Disease and Dementia Care. She is certified to teach this program by the National Council of Certified Dementia Practitioners (NCCDP). I would highly recommend it for any health care professionals who care for patients with dementia.

Among many points covered was the importance of using validation therapy, versus reality orientation, when dealing with a client with dementia. It is better to “enter their reality” and show empathy and respect for their feelings than to continually try to correct them. If we can help a person identify and describe the feelings behind difficult behavior, we acknowledge and validate their thoughts and feelings. By allowing negative thoughts to be expressed and respected, and then redirecting the conversation toward a more positive outlook, the interaction will have lasting beneficial effects.

In our rushed world, I am sometimes quick to set the facts straight when my parents are confused about something, instead of trying to understand the concerns which lurk behind their statements. Now I have a refreshed determination to apply the validation approach to them, as well as other older adults I encounter.

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York. We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care. Please contact us in our Ridgewood Office at 201-587-5283 to schedule a consultation.

Baffled

June 8, 2011 at 10:30 am | Posted in Joanne Jordan, Office Manager | Leave a comment
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Despite how much we know about the human brain, there is still so much to be learned.

My dad has suffered from a seizure disorder since his stroke, which occurred two and a half years ago. We have struggled to control these seizures with medication, with only partial success. The frequency of his seizures has been reduced, but we haven’t succeeded in preventing them.

Over time, however, we’ve noticed a very strong correlation between his seizures and his cognitive abilities. Dad has exhibited some decline in cognitive function since his stroke. The seizures he’s had are physically exhausting and upsetting to witness. But strangely enough, once he recovers from the residual fatigue, my Dad’s cognitive function seems to return to his normal baseline. It’s as if someone pressed a reset button in his brain.

To date, I’ve found no explanation for this from his doctors or any other resource. We’re left with more questions than answers.

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York. We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care. Please contact us in our Ridgewood Office at 201-587-5283 to schedule a consultation.

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