Building Healthy Hydration Habits for Older Adults

By Faith Protsman, MD, Regional Medical Director, VITAS HealthcareTwo recent studies highlight how sepsis impact often extends well beyond the acute event that led to a patients hospitalization. The studies emphasize two particular points that should inform physicians and clinicians as they consider referring these patients to specialized care: Medicare patient data gathered between 2012-2017 shows that sepsis patients face considerably poorer health outcomes following hospital discharge when compared to non-sepsis patients, including elevated risk for death and increased use of advanced healthcare services. Sepsis survivors exhibit strong indicators of persistent inflammation and immunosuppression for up to a year after hospital discharge, increasing their risk of readmission or death. Both studies indicate a significantly elevated risk of death among sepsis patients after they have been discharged and ostensibly cured. Of course, sepsis patientsparticularly those of the Medicare cohort, who are largely of advanced agerarely leave the hospital in better condition than they entered.The Yende study, in particular, shows that neuroendocrine and inflammatory responses to sepsis can continue long after the patient survives a septic episode. For patients with advanced or chronic diseasesas was the case with nearly 78% of participants in the studythese biomarkers are associated with decline.Post-sepsis Discharge: A Critical JunctureIn many cases, these individuals life expectancies upon discharge will be less than six months. This is a critical juncture: While comfort-focused hospice care could provide an ideal source of support for the eligible patient, their family, and their caregiver(s), most sepsis patients are simply sent home without even a discussion about palliative end-of-life care and its benefits.Frankly, such an oversight is a disservice to everyone involved. The sepsis patient is left with physical and/or cognitive dysfunction, often without significant options for symptom management. Their partner or family will either need to assume caregiving duties or turn to costly private services. And the physician and hospital staff will likely see the patient again following another acute event, a readmission that impacts performance scores, strains resources, and unnecessarily fills beds.By no means do I intend to lay the blame for these unfortunate circumstances on physicians. Timely hospice referrals require ongoing education about end-of-life care, and open, ongoing communication between hospice providers and referral sources.More Help: How to Talk About Hospice Care >Those of us in hospice are working hard to bridge the gap, but even as our healthcare system transitions to a value-based model, the mentality of fee-for-service still permeates our nations acute-care facilities, and many hospitalists see a discharge home as a success.Hospice: A New Way Of Judging SuccessIn hospice, we judge our successes on the patients quality of life and the fulfillment of their goals and wishes near lifes end. Usually, that means going home with 24/7 support from an interdisciplinary hospice team. Whether home is a traditional residence, an assisted living facility, or nursing home, the hospice team will assist caregivers (and/or facility staff) with direct clinical care and education, integrative services, bereavement support, and delivery of medication, equipment, and supplies.In other cases, improving quality of life means remaining in a general inpatient setting with hospice support, taking the burden off hospital staff until the patient is able to transition home or until the patient dies. Hospice offers complex modalities in any setting, so patients who would otherwise be confined to an ICU can usually return home to be among loved ones.With support from hospice, a sepsis patient and their family are more likely to report higher satisfaction of care and greater quality of life. The patients emotional and spiritual needs can be met alongside their physical needs, thanks to care from chaplains, social workers, music and massage therapists, and other integrative specialists. Finally, the patient is more likely to die at home, surrounded by loved ones, rather than in the hospital.Because sepsis is most common in patients with advanced or chronic diseases that indicate hospice eligibility, acute incidences of sepsis should always trigger a hospice eligibility assessment. We owe it to our patients, their loved ones, and our colleagues in healthcare, all of whom can benefit from the support that timely end-of-life care offers. 

By Faith Protsman, MD, Regional Medical Director, VITAS HealthcareVietnam War veterans face unique obstacles throughout the twilight of advanced illness. For hospice care providers to tailor care to meet the needs of veterans who have served in this theater of war, they must consider the tribulations these patients face as they reach the end of their lives.The Vietnam War era was a very tumultuous time to be a soldier. The United States' prolonged involvement in a war of questionable motivation left society with disdain toward the government and its institutions, especially the military.Coupled with horrific images shown on television, constant controversy was a new reality and negative public opinion formed around this conflict, of which those serving the nation were not spared.Careful consideration is necessary when treating patients facing these traumas.Tours of duty proved to be traumatizing in many ways. Young soldiers, some having just turned 18, were drafted into a war that many of them did not believe in. They were not fighting for love of country and God; rather, they were fighting for survival and out of fear for their lives.Intimate battles in the dense jungle led many to be subjected to the horrors that come with fighting in a foreign land that was only familiar to the elusive guerilla enemy soldiers.Servicemembers did not receive a warm welcome when returning home from Vietnam, often being judged and labeled as cruel and even inhumane.Moral Injury Can Impair Mental HealthThis perfect storm of trauma led to lasting moral injury that plagues many veterans for their entire lives. Veterans returning from the war were marginalized and pushed into isolation, often turning to alcohol and substance abuse, which worsened their anxiety and exacerbated their strife.Questions like Ive never spoken about the war, can I now? Was the war moral or immoral? and Was I a good soldier? come bubbling to the surface later in life as their illnesses intensify and their defenses weaken.Careful consideration is necessary when treating patients facing these traumas.The restlessness that can result from post-traumatic stress disorder (PTSD) is often treated with benzodiazepines. In most cases, these medications can bring relief through calming the patient.Yet, there is a common trend amongst veterans who cope with trauma that results in the opposite effect.Benzodiazepines can lower the walls that Vietnam veterans have built up throughout a lifetime of suppressing trauma and negative memories. This class of medications can exacerbate the symptoms of PTSD as traumatic experiences and feelings of regret resurface. Benzodiazepine-induced inhibition of neurotransmission can even lead to agitated toxic psychosis, increased anxiety, hostility, and rage.1The Value of Compassion Along with Clinical CareRemaining considerate does not end with simply staying mindful during the planning of clinical solutions. Providing care for Vietnam veterans requires a high level of empathy.A key to an empathetic approach is taking the time to listen nonjudgmentally. Though seemingly simple, practicing nonjudgmental, open communication with patients facing trauma from war can help avoid the all-too typical responses of Its okay and You did what you had to do.These patients do not need sympathy, because they have been judged enough throughout their lives. When care teams approach them without judgment, they honor the sacrifices these heroes have made.VITAS hospice care provides compassionate care approaches that are tailored to meet the distinctive needs of Vietnam veterans. With the Veterans Administration (VA) offering hospice care as part of its medical package, VITAS team members can provide empathetic psychosocial support, while utilizing clinical solutions that help manage symptoms.The qualifications for veterans to receive hospice benefits include: A life-limiting illness Treatment goals that focus on comfort, rather than curative treatments A life expectancy of 6 months or less, if their illness runs its normal course Veterans also benefit from the option to receive concurrent care through the VA. The VA can provide curative treatments as the patient simultaneously receives symptom-managing comfort care administered by the hospice care provider of their choosing.Offering solace, while remaining compassionate when patients need it most, is too often overlooked in the busy practice of healthcare. Acknowledging the adversity that Vietnam War veterans have had to face throughout their lifetimes and adapting care approaches to meet their needs is the best way for healthcare providers to give back to those who have sacrificed so much for the preservation of freedom.1Paton, C. (2018, January 2). Benzodiazepines and disinhibition: A review: Psychiatric bulletin. Cambridge Core. Retrieved November 2, 2022, from https://www.cambridge.org/core/journals/psychiatric-bulletin/article/benzodiazepines-and-disinhibition-a-review/421AF197362B55EDF004700452BF3BC6

Maintaining proper nutrition is a crucial aspect of healthy aging, especially for seniors who wish to continue living independently and enjoying their golden years. By stocking your pantry with the right combination of nutrient-dense foods, you can empower yourself to prepare wholesome, energizing meals that support your overall well-being. In this article, well explore the top pantry essentials that should be on every seniors radar.The Importance of a Well-Stocked PantryA thoughtfully curated pantry is the backbone of a balanced diet. When you have a variety of healthy ingredients on hand, it becomes significantly easier to whip up nutritious meals on the fly, without the need for multiple trips to the grocery store. This not only saves you time and money but also helps you avoid the temptation of less-than-ideal food choices that can compromise your health.Pantry Essentials for SeniorsNow, lets delve into the specific pantry items that should be on every seniors radar. These versatile and nutrient-dense foods will serve as the foundation for countless delicious and nourishing meals.Whole GrainsWhole grains, such as brown rice, quinoa, and whole-wheat pasta, are powerhouses of fiber, vitamins, and minerals. These complex carbohydrates provide sustained energy and can help regulate cholesterol levels and blood pressure, reducing the risk of chronic conditions. Oatmeal, a classic breakfast staple, is another excellent whole-grain option that can be easily customized with fresh fruit, nuts, and a touch of honey.Beans and LegumesBeans and legumes are true nutritional superstars, offering a potent combination of protein, fiber, and antioxidants. From kidney and black beans to chickpeas and lentils, these versatile ingredients can be incorporated into soups, stews, and even meatless chili, providing a satisfying and filling base for your meals.Nuts and SeedsNuts and seeds are nutrient-dense snacks that can also be used to enhance the flavor and texture of various dishes. Almonds, pistachios, walnuts, and pumpkin seeds are all excellent sources of healthy fats, protein, and essential minerals. Keep a variety of these on hand for quick and nourishing between-meal bites or to sprinkle on top of salads, oatmeal, and yogurt.Canned GoodsCanned goods, such as tuna, salmon, and a variety of fruits and vegetables, are convenient and cost-effective pantry staples. These items often have a long shelf life, making them ideal for seniors who may not have the time or energy to frequent the grocery store regularly. When selecting canned goods, opt for low-sodium or no-added-salt options to keep your sodium intake in check.Spices and HerbsElevating the flavor of your meals is not only enjoyable but can also encourage healthier eating habits. Spices and herbs, such as garlic, ginger, turmeric, and basil, are not only packed with antioxidants but can also help reduce the need for salt, sugar, and unhealthy fats in your cooking. Experiment with different flavor combinations to keep your taste buds engaged and your meals exciting.Healthy Fats and OilsIncorporating healthy fats into your diet is crucial for maintaining overall health. Olive oil, avocado oil, and coconut oil are excellent choices for cooking, dressings, and marinades. Additionally, consider keeping a bottle of apple cider vinegar on hand, as it can be used to add a tangy twist to a variety of dishes, from salads to stir-fries.Dried Fruits and NutsFor a quick and satisfying snack, keep a selection of dried fruits and nuts in your pantry. Raisins, apricots, and cranberries provide a natural sweetness, while nuts like almonds, walnuts, and cashews offer a crunchy texture and a boost of healthy fats and protein. These shelf-stable items can also be used to add texture and flavor to baked goods, oatmeal, and trail mixes.Honey and Maple SyrupWhen it comes to satisfying your sweet tooth, opt for natural sweeteners like honey and maple syrup. These alternatives to refined sugar can be used in baking, drizzled over yogurt or oatmeal, or even incorporated into marinades and dressings. Not only do they provide a touch of sweetness, but they also offer additional health benefits, such as antioxidants and anti-inflammatory properties.Whole-Wheat Flour and Baking EssentialsFor any of your baking needs, keep a supply of whole-wheat flour, baking soda, baking powder, and spices like cinnamon and nutmeg. These ingredients can be used to create healthier versions of your favorite baked goods, from muffins and breads to cookies and scones. Experiment with natural sweeteners like honey or maple syrup to reduce your intake of refined sugars.Putting It All TogetherBuilding a well-stocked pantry takes time and effort, but the benefits are well worth it. Start by gradually incorporating these essential items into your shopping routine, and dont be afraid to try new recipes and flavor combinations. Remember, healthy eating is a journey, and by embracing these nutrient-dense pantry staples, youre taking a significant step towards nourishing your body and supporting your overall well-being in the golden years!