How Much Is Too Much?

December 29, 2011 at 10:30 am | Posted in Amy Shein, GCM | Leave a comment
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New Year’s Eve is approaching us very soon.  With that, I sometimes think of alcohol and why people consume too much of it on that particular day, or any day for that matter.  I have attended educational programs and have learned that drug and alcohol abuse is becoming more common in the elderly population.  The fact is, many family members, friends, and health care professionals often overlook their concerns about older adults’ drinking habits.  Sometimes trouble with alcohol in older people is mistaken for other conditions that happen with age.  Alcohol use deserves special attention, because the aging process affects how the body handles alcohol; the same amount of alcohol can have a greater affect as a person grows older.  Over time, someone whose drinking habits have not changed may find that he or she has a problem.

Facts about Alcohol and Aging

  • It has been shown that as people age they become more sensitive to alcohol’s effects.  The same amount of alcohol can have a greater affect on an older person than on someone who is younger.
  • Some medical risks, such as high blood pressure, ulcers and diabetes can worsen with alcohol use.
  • Both prescription and over the counter medications can be dangerous or even deadly when mixed with alcohol.  This is a worry for older people, because the average person over the age of 65 takes at least two medicines a day.  Examples: aspirin can cause bleeding in the stomach and intestines.  If you mix with alcohol, the risk of bleeding is much higher.  Cold and allergy medicines (antihistamines) often make people sleepy and when combined with alcohol, it can make drowsiness worse and driving even more dangerous.  Alcohol used with large doses of acetaminophen (Tylenol) can raise the risk of lever damage.  If you are taking any over the counter or prescription medications, ask your doctor of pharmacist if you can safely drink alcohol.

Effects of Alcohol

Even drinking a small amount of alcohol can impair judgment, coordination, and reaction time. It can increase the risk of work and household accidents, including falls and hip fractures. It also adds to the risk of car crashes.  Heavy drinking over time also can cause certain cancers, liver cirrhosis, immune system disorders & brain damage.

Alcohol can make some medical concerns hard for doctors to find and treat. For example, alcohol causes changes in the heart and blood vessels. These changes can dull pain that might be a warning sign of a heart attack. Drinking also can make older people forgetful and confused. These symptoms could be mistaken for signs of Alzheimer’s disease.

How to Know if Someone Has a Drinking Problem

There are two types of problem drinkers: early and late onset. Some people have been heavy drinkers for many years. But, as with great Uncle George, over time the same amount of liquor packs a more powerful punch. Other people, like Grandma Betty, develop a drinking problem later in life. Sometimes this is due to major life changes like shifts in employment, failing health, or the death of friends or loved ones. Often these life changes can bring loneliness, boredom, anxiety, and depression.

Not everyone who drinks regularly has a drinking problem, and not all problem drinkers drink every day. You might want to get help if you or a loved one:

  • Drink to calm your nerves, forget your worries, or reduce depression.
  • Lose interest in food.
  • Gulp down drinks.
  • Frequently have more than three drinks in one day. (A standard drink is one 12-ounce bottle or can of beer or a wine cooler, one 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled spirits.)
  • Lie about or try to hide drinking habits.
  • Drink alone.
  • Hurt yourself, or someone else, while drinking.
  • Were drunk more than three or four times last year.
  • Need more alcohol to get high.
  • Feel irritable, resentful, or unreasonable when not drinking.
  • Have medical, social, or financial worries caused by drinking.

Resources for Help

The National Institute on Alcohol Abuse and Alcoholism, part of the National Institutes of Health, recommends that people over age 65 who choose to drink have no more than one drink a day. Drinking at this level usually is not associated with health risks.

National Institute on Alcohol Abuse and Alcoholism (NIAAA)
6000 Executive Boulevard
Bethesda, MD 20892-7003
Phone: 301-443-3860
Website: www.niaaa.nih.gov

National Drug and Treatment Referral Routing Service
National Clearinghouse for Alcohol and Drug Information
Substance Abuse and Mental Health Services Administration
Phone:
Website: http://www.niaaa.nih.gov/Resources/RelatedWebsites/Referral.htm

Alcoholics Anonymous (AA)
Grand Central Station
P.O. Box 459
New York, NY 10163
Phone: 212-870-3400
Website: www.aa.org

National Council on Alcoholism and Drug Dependence, Inc. (NCADD)
20 Exchange Place, Suite 2902  New York, NY 10005

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 Ramsey or Ridgewood Offices at 201-587-5283 to schedule a consultation.

Signs of Sepsis

November 18, 2011 at 10:30 am | Posted in Deborah Varisco, GCM | Leave a comment
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Sepsis is a condition in which the body is fighting a severe infection that has spread through the body via the bloodstream. The individual will have low blood pressure which will lead to poor circulation and shock. In severe cases one or more organs may fail, such as the lungs, kidneys and liver. The elderly population, especially those with weak immune systems, are at increased risk. Others at risk include the very young, those taking an immunosuppressant and steroids, individuals being treated with chemotherapy, and individuals with long-standing diabetes and AIDS. Many different microbes can cause sepsis. Infections such as pneumonia, urinary tract infections, cellulitis and appendicitis can lead to sepsis.

If an individual is septic, they will probably have a fever. In addition, they may have chills, decreased urination, increased heart rate, rapid breathing, confusion, agitation, dizziness, a possible rash and pain in their joints. One should call a doctor if they have any signs or symptoms of sepsis, particularly if they are being treated with chemotherapy, have had an organ transplant, or have diabetes or AIDS. Sepsis may be diagnosed with blood work, and samples of sputum, urine, spinal fluid or drainage from a wound. If an individual is diagnosed with sepsis, they will be admitted to the hospital and treated with intravenous antibiotics and fluids. Oxygen is also given to maintain normal blood oxygen.

The individual’s prognosis relies on age, health history, health status, how quickly diagnosis was made and the specific type of organism causing the sepsis. The earlier that treatment is started for sepsis, the better the outcome.

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.

Healthy Weight in the Geriatric Patient

November 10, 2011 at 10:30 am | Posted in Amy Shein, GCM | Leave a comment
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As a Geriatric Care Manager who is a registered nurse and holds a bachelor’s degree in nutrition, I can offer a lot to my individual clients.  I try to use preventative medicine through the use of food.  I have always felt that a person’s weight can determine the effects on their health. Being overweight can lead to diabetes, heart disease, hypertension and certain cancers.  Being underweight can lead to malnutrition, and also a decreased immune system.  Recently, one of  my clients  had been losing weight due to being so cautious of her cholesterol and sodium intake in her diet.  We went to her doctor and received a clean bill of health.  We were able to problem solve, and found she was  mainly eating salads, fish and all low fat dairy products.  Her calorie intake was not supporting a healthy weight for her. She looked and felt rather weak.  She had been on Ensure Plus three times per day, but was not enjoying the taste and necessary amount that she needed to consume for the extra calories.  I knew that we had to change her diet and add more healthy calories from higher fat proteins and dairy into her diet.  She was thrilled about eating her taylor ham and whole milk once again.

One of my fellow Geriatric Care Managers from DC spoke to me about a “Magic Milk Shake” with the use of Carnation Instant Breakfast, ice cream, whole milk and what ever else that would taste good(fruit, even a cupcake).  Most of these shakes can be up and over 600 calories for 8oz.  My client usually has one to two a day and sips it throughout the day.  She is eating higher calorie foods and really enjoying the taste and texture of these foods.  Her weight has gone up nice and slow, about 1 pound per week.  This weight gain has been a very positive one for my client. She has been feeling stronger and able to do more of her daily activities that she was not able to do with her decline in weight.

Always check with your doctor before you make any changes to your diet or medication. You may want to have your doctor check for any underlining reason for recent weight gain or loss.

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.

Seizures

October 28, 2011 at 10:30 am | Posted in Deborah Varisco, GCM | Leave a comment
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Seizures are a symptom of a brain problem. They occur because of sudden abnormal electrical activity in the brain. Seizures are different from person to person. There are many types of seizures with different symptoms, and not all include convulsions where the body shakes rapidly and uncontrollably. Some have only slight shaking of a hand and one does not lose consciousness. Some briefly lose touch with their surroundings and stare into space. Although awake, the person does not respond normally. After the event, they do not remember the episode. A small number of people will have only one seizure in a lifetime. Most seizures last thirty seconds to two minutes. It is a medical emergency if a seizure lasts longer than five minutes.

Seizures can be a symptom of another health problem. A seizure can be a result of a rapidly increasing fever, an extremely low blood sugar in a diabetic patient, damage to the brain from a stroke or head injury, withdrawal from alcohol and drugs, an infection or a brain tumor. Seizures are divided into two categories, generalized and partial. Generalized seizures are produced by electrical impulses throughout the entire brain, while partial seizures are produced by electrical impulses in a small part of the brain. There are six types of generalized seizures. In the most common type, the Grand-mal seizure, an individual usually loses consciousness and can collapse. Partial seizures are divided into simple and complex.

Seizure symptoms include unconsciousness, convulsions and muscle rigidity. No matter what type of seizure, it is important to protect a person during a seizure. During a seizure, protect the individual from injury by keeping them from falling, guide them to the floor and move objects near them that may cause injury. Do not force anything into their mouth and turn them onto their side. Stay calm and do not hold the person down or try to move them. After the seizure check the individual for injuries and loosen tight clothing. Do not give them anything to eat or drink until they are fully awake and alert. It is best to stay with them until they are familiar with their surroundings, as most can be sleepy or confused after a seizure.

There is no way to prevent all seizures. To help control them always take prescribed medication as instructed, get plenty of sleep, reduce stress, exercise and eat a healthy diet. If you have uncontrolled seizures you should avoid activities such as climbing ladders or other high places, biking, swimming and driving.

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.

Foodborne Illness

September 23, 2011 at 10:30 am | Posted in Deborah Varisco, GCM | Leave a comment
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One in six Americans will have food poisoning this year according to the Center for Disease Control and Prevention. In additionm, 128,000 will be hospitalized and 3,000 people will die as a result. There are thirty-one organisms that are known causes of food poisoning, but 38.4 million will be sickened by unknown pathogens.

Typical symptoms include nausea, vomiting, abdominal cramping, and diarrhea that occur within 48 hours, or as quickly as thirty minutes, after consuming a contaminated food or drink. Fever and chills, bloody stools, dehydration and nervous system damage may follow depending on the pathogen. More than 250 diseases can be transmitted through food. Norovirus and Salmonella are the two most common infectious forms of food borne illness. Salmonella is the cause of most deaths.

Food usually becomes contaminated from poor sanitation or preparation. Food handlers who do not wash their hands after using the bathroom or have an infection themselves can cause contamination. Improperly packaged food stored at the wrong temperature can promote contamination. Mild cases of food poisoning can be safely treated at home. Do not eat solid food while vomiting, but drink plenty of fluids. Small sips of clear liquids are the best way to remain hydrated. Avoid alcohol, caffeinated beverages or sugary drinks. When nausea and vomiting have stopped, begin to slowly reintroduce plain foods in small amounts. You should contact your doctor if the nausea, vomiting, or diarrhea lasts more than two days, if the symptoms are associated with a low-grade fever, you cannot keep any liquids down, cannot take medications due to vomiting, or if you exhibit any symptoms such as slurred speech, muscle weakness, or difficulty swallowing.

To prevent food borne illness, safe measures in handling food, cooking, and storage are essential. Bacteria cannot be seen, smelled, or tasted. Here are some safety guidelines to follow:

  • Buy cold foods last during your shopping trip and refrigerate as soon as they come home from the store.
  • Keep raw meat and poultry separate from other foods.
  • Before preparing food,wash your hands with warm water and soap for twenty seconds.
  • Sanitize cutting boards and countertops often with a bleach solution.
  • Never leave food out for more than two hours, as bacteria that can cause food poisoning grows rapidly at room temperature.
  • Do not consume at any time, food made with raw eggs, undercooked poultry or ground meat, or unpasteurized milk.

The Center for Disease Control and Prevention have strict inspection standards, but are not always able to keep the food supply and public safe. It is important for the public to understand the risks with food and protect themselves. When in doubt, throw it out!

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.

The Most Dangerous Room in the House

September 2, 2011 at 10:30 am | Posted in Deborah Varisco, GCM | Leave a comment
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As we age, the incidence of sustaining an injury in the home increases, especially after age 85. The higher rate of injury is the result of decreased mobility, decreasing eyesight and decreased strength. Studies show that most of these injuries occur in the bathroom, around the tub or shower, and more than half near the toilet. Many emergency room visits are the result of injuries sustained in the bathroom, and a large percent of these have to be hospitalized.

Women have a higher rate of bathroom injury than men. The most dangerous activity for both men and women, though, is bathing or showering. Injuries can occur either getting out of the bathtub or shower, or getting into the tub or shower. A large percent seem to be suffered while getting out of the shower. Another large percentage of injuries occurring in the bathroom are related to getting on or off the toilet.

Injuries in the bathroom can be the result of slipping, tripping, or fainting. The head and neck make up the greatest percent of bodily injuries, followed by the lower torso, the upper torso, and the leg and foot. The least amount of injuries are to the arm or hand. Injuries in the bathroom can never be totally eliminated, but they can be reduced by the installation of grab bars by the toilet or shower. Other helpful hints to prevent injuries in the bathroom are to place nonslip mats in the bath or shower, to prevent slipping; remove throw rugs in the bathroom, to prevent tripping; and installing a shower chair or bath benches, which assist an individual to get into the tub itself.

There are many agencies which will also come into your home and provide an assessment and offer suggestions on how to make your bathroom and home safer. At Distinctive Care Geriatric Care Management, part of the client’s assessment evaluation involves assessing the individuals living environment and performing a home safety evaluation. The client’s individualized care plan will include suggestions on ways to make their living environment safer. Included in the care plan may also be the recommendation to have an evaluation from a home safety specialist such as Back Home Safely, with Gregg Frank, 973-489-7790. So watch your step while in the bathroom.

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.

Safe Storage of Medications

August 26, 2011 at 10:30 am | Posted in Deborah Varisco, GCM | Leave a comment
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Where do you store your medications? Do you know what extreme heat or cold can do to your medications? No drug should be exposed to temperatures greater than 80 degrees or below freezing. Extreme temperatures will affect both over the counter medications and prescription drugs. The pharmaceutical companies recommend most medications be stored at a temperature of 68 to 77 degrees. Medications can physically change, lose their potency, and threaten your health if stored in locations that go over and below these ranges. One should be particularly cautious during heat waves and cold snaps.

Medicine cabinets are probably not the best place to store your medications. The high humidity in a bathroom can damage many medications. It can cause medications to dissolve or degrade. Storing medications over a sink can increase the chance of losing a dose down the drain. The best place to store medications is a cool, dry place like a hallway linen closet, bedroom closet, or even a cabinet in the kitchen which is away from the stove. Make sure all medications, prescription and over the counter, are also out of the reach of children and pets.

If you have a chronic disease, such as diabetes or heart disease, a damaged dose of a crucial medication can be life threatening. Insulin can lose its effectiveness if it freezes. Antibiotics can decay and cause stomach upset and kidney damage. Hydrocortisone cream can separate and become useless if exposed to increased heat. If medications need to be refrigerated, do not place in door of refrigerator as the repeated opening and closing may cause temperature variations. Other medications affected by temperature changes are thyroid medications, birth control, and other hormones. They are protein based and prone to temperature changes.

When traveling, it is best to keep medications in a separate bag and do not leave in a car or allow to be transported in a baggage compartment in an airplane. These compartments can become too hot or freezing cold. Keeping your medications stored properly will keep them in the condition that helps them work the best. Never take medications that have changed color, consistency, smell, or expired. Medications that are stored properly and not expired will work the best for you. If medications are damaged, disposed of them properly. Do not flush them down the toilet, as they can end up in our water supply and harm the environment. To dispense of them properly, mix them with coffee grounds or kitty litter and put them in an empty can or sealed bag before placing them in the trash. Some pharmacies will also collect unused medications and may even replace medications damaged free of charge.

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.

Don’t Forget the Sunscreen!

July 29, 2011 at 10:30 am | Posted in Deborah Varisco, GCM | Leave a comment
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Sun protection is essential to skin cancer prevention. About 90 percent of non-melanoma skin cancers, and 65 percent of melanomas, are associated with exposure to UV radiation from the sun. Skin cancers are of three major types: basal cell carcinoma, squamous cell carcinoma and melanoma. The vast majority of skin cancers are basal cell carcinoma and squamous cell carcinoma. While malignant, these are unlikely to spread to other parts of the body. Melanoma’s are a highly aggressive cancer that tend to spread to other parts of the body. Basal cell and squamous cell are more common in older adults.

A basal cell carcinoma usually looks like a raised, smooth, pearly bump on the skin of the head, neck or shoulders. A squamous cell carcinoma is commonly a well-defined, red, scaling, thickened patch on the skin. Older adults, especially those with fair colored skin and have had increased sun exposure, should periodically check their skin for signs of any moles or spots that look suspicious. Any mole or lesion in question will need to be checked by a primary care physician or dermatologist, and may require a biopsy, where a small sample of skin is taken and examined under a microscope. Once identified, treatment can be prescribed.

Be active in preventing skin cancer. Avoid exposure to direct sunlight, especially between 10 a.m. and 2 p.m., and tanning booths, and wear sunscreen daily. Use a sunscreen with sun protection factor of at least 15, both before and during sun exposure. Select a product that blocks both UVA, the aging rays, and UVB, the burning rays. Reapply every two hours or immediately after swimming or strenuous activity. In addition, wear protective clothing, such as a wide-brimmed hat and sunglasses. Sunscreens not only protect the elderly against skin cancer, but also help to prevent premature aging, such as wrinkles, leathery skin, and age spots, brown spots that appear on sun exposed parts of the body.

So, put on that sunscreen!

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.

July is National Eye Injury Prevention Month

June 23, 2011 at 10:30 am | Posted in Amy Shein, GCM | Leave a comment
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Protecting your eyes from injury is one of the most basic things you can do to keep your vision healthy throughout your lifetime. There was a national study published in 2005 showing that there are about 2 million serious eye injuries in the United States every year, or seven per 1,000 people. It has been noted that ninety percent of these injuries could have been prevented if the individual had been wearing appropriate protective eyewear. According to a national survey by the American Academy of Ophthalmology, only 35 percent of people said they always wear protective eyewear when performing home maintenance/repairs or when on the job.

National Eye Injury Prevention Month begins July 1st.

Eye Injury Facts:

  • Men are more likely to sustain an eye injury than women.
  • Most people believe that eye injuries are more commonly to occur on the job, especially more at factories and construction sites. Fact of the matter is that nearly half (44 percent) of all eye injuries occur while in the home (research was conducted by the American Academy of Ophthalmology and American Society of Ocular Trauma).
  • Eyes can be damaged by sun exposure, not just chemicals, dust or other objects.
  • Nearly a dozen ophthalmology organizations are working together to help reduce the rate of eye injuries by encouraging people to wear protective eyewear.
  • During the early 1990s, the U.S. Eye Injury Registry studied 4,575 serious eye injuries of all causes, including 274 fireworks-related injuries. Victims ranged in age from 4 to 63, and 77 percent were male. The largest proportion, 45 percent, were bystanders; 35 percent were fireworks operators, the status of 20 percent was unknown.

Protecting Yourself From Serious Eye Injury By A Few Simple Precautions:

  • Wear safety goggles when working in the yard or workshop, on your car or working with cleaning products or chemicals.
  • Always wear appropriate protective eyewear during sports and recreational activities. You can receive excellent recommendation from your own eye doctor.
  • Fireworks can cause devastating injuries to users and bystanders. Never use them at home, attend only professional fireworks displays.

If You Happen To Get An Eye Injury, Seek Medical Assistance Immediately:

  • Injuries such as cuts, chemical burns or foreign bodies stuck in the eye are emergencies. Do not try to treat these yourself. Just gently cover and then contact your eye doctor or emergency room for help immediately.
  • Even a seemingly light blow can cause a serious eye injury. If a black eye, pain or visual problem occur after a blow, contact your eye doctor or emergency room right away.
  • In case of a chemical burn to the eye, flush the eye with clean water and seek emergency medical treatment immediately.

If you are interested in learning more about eye injury prevention month, you can look at these two helpful sites from American Academy of Ophthalmology or Get Eye Smart.

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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