Oral Care, Monitored Meals, and Aspiration Pneumonia: “What We Don’t Know We Don’t Know” in Health Care:

Introduction: I felt strongly compelled to write this blog on heart failure as it is such a pertinent issue in the aging population today. Before I go into details on this, Id like to address the definition of this disease process. Heart failure occurs when the heart doesnt pump well and fails to deliver adequate oxygen to the body. As a result, fluid builds up in the body and vital organs dont get the blood that they need. This can make it harder for individuals to perform everyday tasks and can lead to eventual overall decline. Problem:Heart failure is the number one reason for hospital admissions in older adults, and often leads to multiple readmissions (Agarwal et. al., 2021). As a cardiac nurse for many years, I can attest to the fact that heart failure is the biggest reason for multiple hospitalizations in seniors. Patients come in and out for problematic symptoms, sometimes coming into the hospital as often as every month. The three biggest symptoms I see that result in hospital admissions are shortness of breath (particularly when lying flat), weight gain, and swelling in the legs.One reason for such frequent admissions is the complexity of heart failure itself. It is a complicated clinical syndrome and is notoriously difficult to manage. A lot is put on patients to manage their heart failure at home, and this can be a challenge. In addition, individuals may have some level of cognitive impairment or multiple other comorbidities, making it even more challenging to perform the extensive monitoring needed to prevent heart failure from worsening. The importance of education:Education is also important in the treatment of heart failure. Unfortunately, this often does not get done. When I first started working in acute care back in 2004, every patient received extensive education in managing their heart failure prior to discharge. Nurses would provide lengthy verbal education on the importance of medication adherence, daily weights, low salt diet, and other factors, in addition to providing the patient with a heart failure educational pamphlet prior to discharge. Over the years, however, hospitals have increasingly faced staffing shortages and high nurse turnover. As a result, a lot of important patient education is not getting addressed. A lack of awareness and understanding in patients on how to manage their heart failure is definitely a key reason for worsening heart failure and repeated hospitalizations. Management:From a clinician standpoint, the goal in addressing heart failure is twofold: we want to reduce symptoms and prevent mortality. The best way to do this is through patient/family education and implementation of a treatment plan. A proper treatment plan will include such lifestyle modifications as a low salt diet, quitting smoking, and getting regular physical activity. A low salt diet can be incredibly helpful in preventing further fluid build up in the body. The American Heart Association recommends that all individuals consume no more than 2,300 mg of sodium per day (AHA, 2024). In todays era of processed and packaged food, a majority of the American population consumes much more than that, and it comes in the food itself rather than the saltshaker. Maintaining a low sodium diet has one other priceless benefit that I often do not see emphasized enough in heart failure: it can help reduce blood pressure. Almost half of all heart failure patients have uncontrolled hypertension (Heart Failure, 2022). It is a major risk factor in the development of heart failure and managing it can greatly reduce heart failure symptoms and decrease stress on the heart. Current guidelines recommend maintaining a systolic blood pressure of less than 130. Medication management is another important factor in the management of heart failure. This often includes the use of diuretics, beta blockers, and other medication classes that I will not go into detail on. I wanted to discuss diuretics and beta blockers because these are the two medications in heart failure that I see non-compliance with the most. I witness individuals often not taking one or the other for two main reasons:  they either dont understand the importance of them or they dont like the side effects. Seniors can often have difficulty getting up to go to the restroom. Diuretics cause frequent trips to the restroom because their purpose is to get excess fluid off the body. Many individuals do not comply with their prescribed diuretic because of the hassle of frequent bathroom trips. Unfortunately, ineffective diuresis causes heart failure to worsen and puts further stress on the heart. I often see non-adherence to beta blockers due to their side effects. The two biggest symptoms that get reported to me are fatigue and dizziness. As in the diuretic, a beta blocker can also help reduce the stress on the heart, and heart failure symptoms can worsen if the prescribed dose is not adhered to. Its important to maintain prescribed medication regime and if any negative symptoms are experienced to discuss them with the doctor. One final thing:I wanted to touch on one final monitoring recommendation for heart failure because it so often gets missed: daily weights. Weighing oneself daily is of tantamount importance in heart failure and can identify early on if heart failure is worsening. This can lead to early intervention, thus decreasing potential hospitalization. Adherence to this all too often does not occur. I see patients come into the hospital for large amounts of weight gain often 20 or more lbs. Many patients report that they never stepped on the scale to assess for weight gain and often do not get admitted to the hospital until symptoms are severe such as severe weakness and shortness of breath. In heart failure its recommended to contact the doctor if weight goes up by more than 2 pounds in a day or greater than 4 pounds in a week. The doctor can make modifications in the treatment regime and hence reduce potential hospitalizations and mortality. Conclusion:Heart failure is complex but manageable. Early action can prevent hospital admissions, reduce mortality, and optimize quality of life. Having ongoing guidance from an experienced clinician can be of great benefit if you or your loved one is having difficulty managing heart failure and other disease processes. Please do not hesitate to reach out to me if you have any further questions. I want to help and make the process of aging as stress free as possible while promoting positive health outcomes.  My name is Laura Carson and I have been a Registered Nurse (RN) for over 20 years and have witnessed firsthand the challenges and complications that aging presents. It affects not only the aging themselves but also their families and loved ones. Health care is complex, and in this increasingly fragmented and overburdened system, it can be extremely helpful to have a professional oversee all aspects of care. As your eldercare manager, I will comprehensively assess the needs of your loved one and we will work together in establishing a care plan. I will assist you and your family with difficult decisions and help promote healthy communication on issues that are often difficult to address and navigate. Contact me for a 20 minute free consultation at 714-403-7040.  References:Blood Pressure and Glycemic Control Among Ambulatory US Adults With Heart Failure: National Health and Nutrition Examination Survey 2001 to 2018 (April 28, 2022). Heart Failure. Almost half of heart failure patients have uncontrolled hypertension and diabetesAgarwal, M., Fonarow, G., & Ziaeian, B. (February 10, 2021). National Trends in Heart Failure Hospitalizations and Readmissions From 2010 to 2017. https://pmc.ncbi.nlm.nih.gov/articles/PMC7876620/Weber, C. (May, 2023). Heart Failure Pharmacology.  How much sodium should I eat per day? (2024). American Heart Association. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sodium/how-much-sodium-should-i-eat-per-day  

Visit any critical care unit, childrens hospital, or other specialty inpatient facility, and youll find a common feature: therapy dogs. For decades, healthcare practitioners have understood the surprisingly positive effects on patients of time spend with cute and cuddly dogs. Therapy dogs reduce stress, improve mood, and can help patients reframe their outlook on whatever condition ails them. The positive effects of patient interactions with therapy dogs are a well-documented fact of the medical world. Senior citizens with limited mobility and other health conditions also benefit from the companionship of dogs. Owning a pet reduces feelings of loneliness among seniors living at home or in a retirement facility, which in turn greatly reduces the risk of diseases associated with loneliness and isolation. Pets can also decrease the number of stress hormones in a persons blood, lower blood pressure, and contribute to a more positive outlook on life. Dogs and other pets, it seems, have tremendous healing powers!Since Alzheimers patients cannot adequately care for a pet, owning one is out of the question. Considering the nature of Alzheimers dementia, it is easy to assume that a loved one may not benefit from a pet since they will not remember the interaction. Researchers, convinced therapy dogs would have a positive effect on Alzheimers patients, put this question to the test: Do Therapy Dogs Help Alzheimers Dementia Patients?Short-Term Benefits of Therapy Dogs for Patients with Alzheimers Dementia.A study conducted in the early 2000s looked carefully at the subject of therapy dogs and Alzheimers dementia patients. They measured the incidence of behavioral disturbances among patients in a nursing home for a period of four weeks, then introduced therapy dogs. Their initial findings showed that the dogs helped to reduce behavioral disturbances in the short term, meaning they helped to immediately calm patients. The short-term effects proved that therapy dogs do have a positive effect on patients with Alzheimers disease, particularly in regards to anxiety, anger, and changes in behavior associated with the disease.Long-Term Benefits of Therapy Dogs for Patients with Alzheimers Dementia.The same study did not stop at the short-term effects of therapy dogs on Alzheimers patients. Previous assumptions suggested that since patients would not remember their encounters with the therapy dogs, the effects of spending time with them would vanish from one day to the next. Not true, the study authors found. Although most of the patients did not remember their interactions with the therapy dogs (some did), the behavioral disturbances noted in the four weeks prior to the study reduced. In fact, the longer and more frequently patients interacted with the therapy dogs, the less they exhibited behavioral disturbances.Therapy Dogs As A Long-Term Therapy.The study findings confirmed what clinicians suspected all along: dogs are an excellent long-term therapy for persons with Alzheimers dementia to reduce the incidence of behavioral disturbances. Therapy dogs also had the same effect on Alzheimers patients as they do on other kinds of patients, including reduced stress and anxiety, lower blood pressure, better appetite, and fewer feelings of loneliness. These effects continued to increase the longer and more frequently patients interacted with the dogs.What Makes Dogs Such Good Therapy?Dogs are wired to give unconditional love and devotion. They can provide physical and social contact where it is missing, and they are not picky. what sets dogs apart, particularly those trained as therapy dogs, is that they will approach anyone regardless of their physical or mental deterioration, and initiate contact. Patients can pet, hug, and cuddle dogs unlike any other kind of pet. These positive interactions provide a distraction to the other goings-on around them and provide relief for those suffering from sadness, anger, or angst.The Takeaway.Dogs have a tremendous healing power. While studies have focused specifically on Alzheimers dementia patients, their positive effects will benefit anyone suffering from general dementia. Families of patients will feel relief that their loved ones have fewer outbursts of anger, sadness, or angst. While dementia impairs memory, it does not interrupt the long-term benefits of regularly interacting with a therapy dog. In fact, the more they interact with a therapy dog, the fewer behavioral problems they exhibit.

Loss and grief are inevitable parts of life, but for our beloved seniors, navigating through these emotions can be particularly challenging. As they journey through their golden years, they often face the loss of spouses, friends, siblings, and sometimes even their own health. In such times, compassionate support becomes of utmost importance. Here, we discuss how we can extend a caring hand to our seniors as they cope with loss and grief.First and foremost, it's crucial to understand that everyone experiences grief differently. Some may openly express their emotions, while others may prefer to grieve in solitude. As caregivers and loved ones, our role is not to impose how they should grieve but rather to create a safe space where they feel heard and supported.One of the most powerful ways to support seniors in their time of grief is through active listening. Sit with them, hold their hand, and let them share their memories, stories, and feelings. Even if they repeat themselves or express anger or sadness, offer them your undivided attention without judgment. Sometimes, all they need is someone to validate their emotions and reassure them that it's okay to feel the way they do.Encourage them to reminisce about the good times they shared with their loved ones. Sharing fond memories can be therapeutic and help seniors find solace amidst their grief. Look through old photo albums together, watch home videos, or simply engage in heartfelt conversations about the moments that brought them joy.It is important to respect boundaries and not force them to engage in activities they're not ready for. Grieving is a deeply personal journey, and pushing them too hard may only exacerbate their pain. Instead, let them take the lead and offer gentle encouragement along the way.Practical assistance can also alleviate some of the burdens they may be facing. Offer to help with daily tasks such as grocery shopping, meal preparation, or household chores. By easing their responsibilities, you may allow them the time and space to focus on their emotional well-being.In addition to providing emotional and practical support, connecting seniors with resources and support groups can be immensely beneficial. Many communities offer grief counseling services specifically tailored to seniors, providing them with a safe environment to share their experiences with others who understand what they're going through.Encourage them to participate in activities that bring them comfort and joy, whether it's joining a book club, attending religious services, or taking up a new hobby. Engaging in meaningful activities can provide seniors with a sense of purpose and fulfillment, helping them navigate through their grief more effectively.Above all, be patient and empathetic. Grieving is a process that takes time, and there is no set timeline for healing. Reassure them that you're there for them every step of the way, and remind them that it's okay to seek professional help if they're struggling to cope. Helping seniors deal with loss and grief requires patience, empathy, and a willingness to listen. By providing unwavering support and understanding we can help ease their burden as they navigate through life's inevitable challenges with grace and resilience.