Resources For Aging Well

Like many pain clinics, we sometimes prescribe opioids as part of an overall patient treatment plan. While opioids sometimes play a role in managing chronic pain, we strive to find safer and more effective pain management alternatives for our patients.Nura is a multidisciplinary interventional pain clinic- this means that if we prescribe opioid medication, we also require you to participate in physical therapy, behavioral health services and interventions like injections/nerve blocks/etc. We are here to provide alternatives to high-dose opioids. If you are only interested in opioid medication management and nothing else, Nura is probably not the clinic for you.Nura provides medication management to help manage and reduce pain. We take into account the intensity and duration of pain, along with other factors such as age, other medical challenges, and other medications being taken. We may prescribe one or more medications as part of a comprehensive pain management plan.For these patients, we offer specialized therapy programs tailored to long-term opioid users. The programs are structured to reduce dependence on narcotic pain medications and minimize healthcare visits by promoting effective self-management.COMP Chronic Opioid Management ProgramAt Nura, we will undertake a thorough medical history, perform a complete physical examination, and make recommendations for treatment.Nura providers may or may not agree to prescribe opioids to the patient during the first visit. If we choose to continue prescribing the patients opioid medications, we may do so on a limited basis for a defined time period while we attempt to precisely diagnose and treat their pain with therapeutic injections, nerve ablation techniques and implantable pain control options coordinated with physical therapy and psychology treatments as appropriate.The chronic opioid pain management program provides a set structure for long-term opioid prescribing which includes:Formal, signed Opioid AgreementMonthly medical evaluations at which time prescriptions are dispensedParticipation in prescribed physical therapyParticipation in prescribed psychology evaluations and treatmentsRandom urine drug testing at least twice per yearCOMPASS: An Ongoing Structure for SuccessNuras Compass program is designed to support long-term patients who use opioids to manage pain, and who may have a history of abuse or difficulty adhering to expectations.  In addition to the features of COMP, this highly-structured program also involves monthly, same-day appointments with the caregiver team:Medical care delivered by a CNP or PA-CBehavioral assessment and treatment by a licensed mental health professionalPhysical assessment and treatment delivered by a licensed Physical TherapistChronic Pain ProgramNuras comprehensive four-week Chronic Pain Program offers patients an empowering environment for learning pain management strategies and coping skills. Better yet, you will work alongside fellow patients under the compassionate guidance of expert staff. Learn how the Chronic Pain Program can help you get back into life!  Contact us for help at 763-537-6000 or visit www.nuraclinics.com

Dementia: Improving Communication with Improv | Mirroring Technique is part of a six-part series. Dementia is a degenerative neurological condition that affects millions of people worldwide. As the disease progresses, individuals with dementia may experience difficulties with communication, including problems with memory, language, and understanding. This can make it challenging for caregivers and family members to connect with their loved ones and provide the best possible care. However, there is a promising solution to this challenge: improv. In this six-part series, we will explore how improvisational theater techniques can be used to improve communication and connection with individuals with dementia. By tapping into the power of improv, caregivers can learn how to communicate more effectively, build rapport, and create meaningful experiences with their loved ones.Dementia is a debilitating condition that affects millions of people around the world. It is a progressive disease that affects memory, thinking, behavior, and the ability to perform daily tasks. As the disease progresses, individuals with dementia may have trouble communicating and may become withdrawn and isolated. However, with the right approach and support, individuals with dementia can still achieve good quality of life.One approach to supporting individuals with dementia is to meet them where they are at. This means that care providers should strive to understand the individual~s unique perspective, experiences, and needs. This approach can help to reduce frustration, confusion, and anxiety and promote a sense of well-being and connectedness.To meet individuals with dementia where they are at, care providers can use a range of strategies. One of these strategies is the Mirroring technique. Learning the Mirroring technique can ultimately improve the quality of life for individuals with dementia and their caregivers.Mirroring techniqueThe mirroring technique is an improvisation technique that involves reflecting the body language, facial expressions, and verbal communication of another person to build rapport and establish a connection. The goal is to create a safe and comfortable space for communication by demonstrating empathy and understanding.When using the mirroring technique, the caregiver or healthcare provider closely observes the person with dementia and mirrors their movements, posture, facial expressions, and vocal patterns. This technique can help the person with dementia feel validated and understood, even if they are unable to express themselves verbally.The mirroring technique involves the following steps:Observe the person with dementia: Watch the person carefully, paying attention to their movements, facial expressions, and vocal patterns. Take note of any gestures or expressions that seem to communicate an emotion or a need.Mirror the person~s body language: Mirror the person~s movements, posture, and gestures. For example, if the person is leaning forward, the caregiver may lean forward as well. If the person is using hand gestures, the caregiver may use similar gestures.Mirror the person~s facial expressions: Mirror the person~s facial expressions, such as smiling, frowning, or raising eyebrows. This can help the person feel understood and validated.Mirror the person~s vocal patterns: Mirror the person~s tone of voice, volume, and pacing. This can help the person feel that they are being heard and understood.Gradually introduce communication: Once a connection has been established through mirroring, the caregiver or healthcare provider can gradually introduce communication, such as asking questions or making statements that reflect the person~s emotions or needs.By using the mirroring technique, caregivers and healthcare providers can establish a connection with the person with dementia, creating a safe and comfortable space for communication and building trust. This technique can help improve communication and reduce feelings of frustration or anxiety for the person with dementia.Teaching The Mirroring TechniqueTeaching someone to use the mirroring technique can be a helpful way to improve communication with someone with dementia. Here are some steps you can follow to teach someone how to use the mirroring technique:Explain the concept: Start by explaining what the mirroring technique is and how it can be used in communication. Explain that the goal is to repeat what the other person is saying, using the same tone of voice and body language. Emphasize that this can help the other person to feel heard and understood.Model the technique: Demonstrate the technique by having a conversation with the person and using the mirroring technique. Start by saying something and then repeat what the other person says, using the same tone of voice and body language. For example, if the person says, "I~m feeling confused," you might respond, "You~re feeling confused." Make sure to emphasize the importance of using the same tone of voice and body language.Practice the technique: Give the person the opportunity to practice the technique. Start by having them say something and then repeat what they say, using the same tone of voice and body language. Encourage them to focus on the other person~s words and emotions and to reflect those back to them.Provide feedback: As the person practices the technique, provide feedback and encouragement. Help them to identify areas where they can improve and emphasize the importance of using the same tone of voice and body language.Reinforce the technique: Encourage the person to use the mirroring technique in their daily communication. Reinforce the technique by reminding them to repeat what the other person says, using the same tone of voice and body language.Example of how the mirroring technique can be used with someone with advanced dementia:Imagine a caregiver is visiting a person with advanced dementia in a care facility. The person with dementia is sitting in a chair, looking down and not engaging with the caregiver. The caregiver wants to try the mirroring technique to build rapport and help the person feel more comfortable.The caregiver approaches the person and sits down in a chair across from them. The caregiver notices that the person is frowning, so they mirror this facial expression by furrowing their own brow. The caregiver then slowly begins to shift their facial expression to a more neutral one, and they notice that the person with dementia begins to relax their own facial expression as well.The caregiver continues to mirror the person~s body language and facial expressions as they interact. When the person leans back in their chair, the caregiver does the same. When the person leans forward, the caregiver follows suit. As they continue to mirror each other, the person with dementia begins to make eye contact with the caregiver and smile.The caregiver then uses this positive engagement to begin a conversation with the person, asking open-ended questions and using the "yes, and" technique to build on their responses. Using the mirroring technique, the caregiver was able to build rapport and create a positive and engaging environment for the person with advanced dementia.Using the mirroring improv technique in caregiving can greatly enhance the caregiver~s relationship with their loved one with dementia. By accepting and validating the individual~s experience, caregivers can build trust, improve communication, and increase their loved one~s sense of safety and comfort. Improv also allows for creative problem-solving and flexibility, which can be crucial in adapting to the individual~s changing needs and abilities. Ultimately, incorporating improv as a form of communication can lead to a more positive, meaningful, and fulfilling relationship between the caregiver and their loved one with dementia.Read all of the articles in this six-part series on Dementia: Improving Communication with Improv Dementia: Improving Communication with Improv | OverviewDementia: Improving Communication with Improv | "Yes and..." TechniqueDementia: Improving Communication with Improv | Mirroring TechniqueDementia: Improving Communication with Improv | Storytelling TechniqueDementia: Improving Communication with Improv | Role-playing TechniqueDementia: Improving Communication with Improv | Musical Improvisation techniqueAuthor: Kathleen Warshawsky, BSN, RN | Publisher Seniors Blue Book Greater Dallas | https://www.linkedin.com/in/kathleenwbsnrn/References:Alzheimer~s Association. (2021). Communication and Alzheimer~s. Retrieved from https://www.alz.org/help-support/caregiving/daily-care/communicationsGoldsmith, L., & Goldsmith, J. (2019). Communication and dementia. American Family Physician, 99(11), 684-691.Graff, M. J., Adang, E. M., Vernooij-Dassen, M. J., Dekker, J. H., Jnsson, L., Thijssen, M., ... & Rikkert, M. G. (2006). Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study. BMJ, 333(7580), 1196.Guzmn, A., & Hegarty, J. (2018). A systematic review of drama therapy interventions for dementia care. Aging & Mental Health, 22(10), 1309-1319.Hsu, M. H., Flowerdew, R., Parker, M., Fachner, J., & Odell-Miller, H. (2018). A thematic analysis exploring group music psychotherapy for people with dementia in the UK. Journal of Applied Arts & Health, 9(1), 75-87.Kales, H. C., Gitlin, L. N., & Lyketsos, C. G. (2015). Assessment and management of behavioral and psychological symptoms of dementia. BMJ (Clinical research ed.), 350, h369.Raglio, A., Bellelli, G., Traficante, D., Gianotti, M., Ubezio, M. C., Villani, D., ... & Stramba-Badiale, M. (2015). Efficacy of music therapy in the treatment of behavioral and psychiatric symptoms of dementia. Alzheimer Disease and Associated Disorders, 29(2), 158-163.Raglio, A., Gianotti, M., Manzoni, V., Bolis, S., Ubezio, M. C., Villani, D., & Stramba-Badiale, M. (2016). Effects of improvisational music therapy vs enhanced standard care on symptom severity among patients with Alzheimer disease: The IMT-ALZ randomized clinical trial. JAMA Neurology, 73(7), 797-805.Van~t Leven, N., Prick, A. E., Groenewoud, J. G., Roelofs, P. D., de Lange, J., Pot, A. M., & Van~t Leven, N. (2013). Communication enhancement between dementia care professionals and dementia patients during daily care. Aging & Mental Health, 17(5), 555-568.

Dementia: Improving Communication with Improv | "Yes and..." Technique is part of a six-part series. Dementia is a degenerative neurological condition that affects millions of people worldwide. As the disease progresses, individuals with dementia may experience difficulties with communication, including problems with memory, language, and understanding. This can make it challenging for caregivers and family members to connect with their loved ones and provide the best possible care. However, there is a promising solution to this challenge: improv. In this six-part series, we will explore how improvisational theater techniques can be used to improve communication and connection with individuals with dementia. By tapping into the power of improv, caregivers can learn how to communicate more effectively, build rapport, and create meaningful experiences with their loved ones.Dementia is a debilitating condition that affects millions of people around the world. It is a progressive disease that affects memory, thinking, behavior, and the ability to perform daily tasks. As the disease progresses, individuals with dementia may have trouble communicating and may become withdrawn and isolated. However, with the right approach and support, individuals with dementia can still achieve good quality of life.One approach to supporting individuals with dementia is to meet them where they are at. This means that care providers should strive to understand the individual~s unique perspective, experiences, and needs. This approach can help to reduce frustration, confusion, and anxiety and promote a sense of well-being and connectedness.To meet individuals with dementia where they are at, care providers can use a range of strategies. One of these strategies is the "Yes and..." technique. Learning the "Yes and..." technique can ultimately improve the quality of life for individuals with dementia and their caregivers."Yes and..." techniqueThe improv - yes and is a communication technique that can be particularly effective when communicating with someone with dementia. This technique involves accepting what the person is saying and building on it, rather than correcting or contradicting them. Here are a few ways in which improv - yes and can be useful when communicating with someone with dementia:Validation: By using improv - yes and, you are validating the person~s experience and showing that you are listening and accepting what they are saying. This can help to reduce frustration and increase a sense of connection and understanding.Building on the conversation: Rather than trying to correct or redirect the conversation, using improv - yes and can help to build on what the person is saying and keep the conversation flowing. This can be particularly helpful when the person is struggling to find the right words or is experiencing memory loss.Encouraging creativity and imagination: Improv - yes and can also encourage creativity and imagination. By accepting and building on what the person is saying, you are creating a safe and supportive environment where they can express themselves freely and without fear of judgement.Reducing anxiety: Communication can be stressful and anxiety-provoking for individuals with dementia. Using improv - yes and can help to reduce anxiety by creating a positive and supportive atmosphere, where the person feels heard and understood.Using improv - yes and can be a powerful tool when communicating with someone with dementia. By validating their experiences, building on the conversation, encouraging creativity and imagination, and reducing anxiety, you can help to create a positive and supportive communication environment that can benefit both the person with dementia and their care provider.Teaching someone the improv - yes and communication technique: Explain the concept: Start by explaining what the improv - yes and technique is and how it can be used in communication. Explain that the goal is to accept what the other person is saying and build on it, rather than correcting or contradicting them.Model the technique: Demonstrate the technique by having a conversation with the person, using improv - yes and. Start by saying something and then build on what the other person says. For example, you could say, "I love to dance" and the other person could respond, "Yes, and I love to sing while you dance." Make sure to emphasize the importance of accepting and building on what the other person says.Practice the technique: Give the person the opportunity to practice the technique. Start by having them say something and then respond with improv - yes and. Encourage them to be creative and build on what the other person says.Provide feedback: As the person practices the technique, provide feedback and encouragement. Emphasize the importance of accepting and building on what the other person says and help the person to identify areas where they can improve.Reinforce the technique: Encourage the person to use the improv - yes and technique in their daily communication. Reinforce the technique by reminding them to accept and build on what the other person says, rather than correcting or contradicting them.Teaching someone the improv - yes and communication technique can be a fun and engaging process. By explaining the concept, modeling the technique, practicing, providing feedback, and reinforcing the technique, you can help the person to improve their communication skills and create a more positive and supportive communication environment.Example of using the "yes and" technique with someone with advanced dementia:Caregiver: "Hi there, it~s such a beautiful day outside, isn~t it?"Person with advanced dementia: "I don~t know. I can~t see it from in here."Caregiver: "Yes, it~s true that we can~t see outside from in here, but maybe we can imagine what it looks like. Do you remember a time when you enjoyed being outside?"Person with advanced dementia: "I used to love going for walks with my dog in the park."Caregiver: "That sounds like a wonderful way to enjoy being outside. What kind of dog did you have?"Person with advanced dementia: "She was a black lab. Her name was Sadie."Caregiver: "Oh, I love labs! They are such loyal companions. What did you and Sadie enjoy doing on your walks?"Person with advanced dementia: "We used to play fetch and run around in the park. It was so much fun."Caregiver: "Yes, that sounds like it was a lot of fun. It~s great that you have those happy memories to think about. Thank you for sharing them with me."In this example, the caregiver uses the "yes and" technique to validate the person~s feelings and experiences, even though they may be experiencing some confusion or disorientation due to their advanced dementia. By acknowledging the person~s memories and encouraging them to share more, the caregiver can create a positive and engaging communication environment that helps the person with advanced dementia feel heard and understood. The caregiver also reinforces the person~s memories by acknowledging the positive experiences they had with their dog Sadie, which can help to promote a sense of well-being and connection.Using the "Yes and..." improv technique in caregiving can greatly enhance the caregiver~s relationship with their loved one with dementia. By accepting and validating the individual~s experience, caregivers can build trust, improve communication, and increase their loved one~s sense of safety and comfort. Improv also allows for creative problem-solving and flexibility, which can be crucial in adapting to the individual~s changing needs and abilities. Ultimately, incorporating improv as a form of communication can lead to a more positive, meaningful, and fulfilling relationship between the caregiver and their loved one with dementia.Read all of the articles in this six-part series on Dementia: Improving Communication with Improv Dementia: Improving Communication with Improv | OverviewDementia: Improving Communication with Improv | "Yes and..." TechniqueDementia: Improving Communication with Improv | Mirroring TechniqueDementia: Improving Communication with Improv | Storytelling TechniqueDementia: Improving Communication with Improv | Role-playing TechniqueDementia: Improving Communication with Improv | Musical Improvisation techniqueAuthor: Kathleen Warshawsky, BSN, RN | Publisher Seniors Blue Book Greater Dallas | https://www.linkedin.com/in/kathleenwbsnrn/References:Alzheimer~s Association. (2021). Communication and Alzheimer~s. Retrieved from https://www.alz.org/help-support/caregiving/daily-care/communicationsGoldsmith, L., & Goldsmith, J. (2019). Communication and dementia. American Family Physician, 99(11), 684-691.Graff, M. J., Adang, E. M., Vernooij-Dassen, M. J., Dekker, J. H., Jnsson, L., Thijssen, M., ... & Rikkert, M. G. (2006). Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study. BMJ, 333(7580), 1196.Guzmn, A., & Hegarty, J. (2018). A systematic review of drama therapy interventions for dementia care. Aging & Mental Health, 22(10), 1309-1319.Hsu, M. H., Flowerdew, R., Parker, M., Fachner, J., & Odell-Miller, H. (2018). A thematic analysis exploring group music psychotherapy for people with dementia in the UK. Journal of Applied Arts & Health, 9(1), 75-87.Kales, H. C., Gitlin, L. N., & Lyketsos, C. G. (2015). Assessment and management of behavioral and psychological symptoms of dementia. BMJ (Clinical research ed.), 350, h369.Raglio, A., Bellelli, G., Traficante, D., Gianotti, M., Ubezio, M. C., Villani, D., ... & Stramba-Badiale, M. (2015). Efficacy of music therapy in the treatment of behavioral and psychiatric symptoms of dementia. Alzheimer Disease and Associated Disorders, 29(2), 158-163.Raglio, A., Gianotti, M., Manzoni, V., Bolis, S., Ubezio, M. C., Villani, D., & Stramba-Badiale, M. (2016). Effects of improvisational music therapy vs enhanced standard care on symptom severity among patients with Alzheimer disease: The IMT-ALZ randomized clinical trial. JAMA Neurology, 73(7), 797-805.Van~t Leven, N., Prick, A. E., Groenewoud, J. G., Roelofs, P. D., de Lange, J., Pot, A. M., & Van~t Leven, N. (2013). Communication enhancement between dementia care professionals and dementia patients during daily care. Aging & Mental Health, 17(5), 555-568.

Downsizing is an inevitable part of life. Eventually, a home can feel too large to keep up with, or perhaps its time to transition into a senior community. Whatever the reason, most people will downsize their home at least once in their life. But what do you do when you think its time for your parents or loved ones to downsize? No one wants to be seen as pushy or nosey, but if you genuinely believe it would be for the best, discussing options is a great place to start.Before you talk to your parents about downsizing, it is beneficial to be able to recognize the type of relocation they may need. Several telltale signs can indicate someone is struggling with their current space. One of the first things you should consider is if your parents need to downsize or if they need to move into Assisted Living. If you notice multiple warning signs, it might be time to sit down and have an honest conversation with your parents. The signs that someone may need to downsize are:Do your parents mention the desire to lower monthly housing costs?Do your parents talk about relocating?Are there signs that upkeep is becoming difficult? (Untended yards, dirty rooms, etc.)Are your parents starting to think of plans for their future?Are your parents looking for more independence and fun?Any of the above signs can indicate that now is the time to start considering downsizing. Once someone downsizes, they will have fewer monthly expenses, less to clean, and less to worry about! This can provide more freedom for your parents to explore new things and experiences.The signs that someone may need to downsize into Assisted Living:Are your parents eating balanced meals regularly? Are your parents still able to get around safely? (Keep an eye out for bruises or minor injuries that may indicate recent falls/accidents)Are they wearing fresh, clean clothes each time your visit? Are they laundering towels and linens regularly?Are they able to manage their medications appropriately? (Look for stockpiled or expired medications)Do they have difficulty moving around their home? (Are there blocked walkways or stairs that are causing issues?)If you notice that your parents are struggling to stay safe and healthy in their home, then it is time to consider discussing assisted living. Keeping an eye out for warning signs can give you time to talk about moving before they have an accident. Once you decide that your parents should downsize, what do you do? The best way to broach the subject is to have an open and honest conversation with your parents. Explain your feelings and concerns but let them know that the decision is theirs.Giving your parents the CHAT:Communicate openly. Explain your concerns and why you believe that downsizing would be beneficial. If you are worried about their safety or if you want them to be closer to you, be direct and say so. Have an open mind. Your parents may have different opinions and feelings towards the situation. Respect their position and listen when they talk.Ask questions. Ask how your parents are feeling about the conversation and about downsizing. If they have concerns, address them.Talk to an expert. Reach out to your local Senior Move Manager and ask questions about the downsizing process. If your parents have any questions, pass them along.The hardest part of the process is having an open and honest conversation. Something to keep in mind is that this process takes time! There will be strong feelings and deep emotions; you will most likely need several sessions of talking with your parents before any decision is made. Don~t be tempted to rush your parents into a choice they are not 100% on board with. But if you start the process and take the time to have meaningful conversations, both your parents and yourself will feel more confident about a transition to a new space. More tips about helping your parents decide to downsize and transition can be found in our book, Chronological Order: The Fine Print for a Large Life.