Laughter is the Best Medicine

What We Dont Know We Dont Know in Health Care: September 24, 2024 -Oral Care, Monitored Meals, and Aspiration PneumoniaProper oral care is crucial for maintaining optimal health. Keeping the mouth clean not only helps maintain the protective properties of saliva but also reduces bacteria in the mouth which can be a source of infection in aspiration pneumonia. In addition, monitoring meals and assisting with feeding for those at high risk for aspiration is also a necessity. The process of swallowing involves dozens of muscles that start in the mouth and include the pharynx, larynx, and esophagus. These muscles can become weakened with age and from various, often age-related diseases.  The aging population is especially at risk for aspiration pneumonia due to comorbidities, frailty, and conditions that can impair swallowing.  As a result, aspiration pneumonia is one of the leading causes of death from infection in individuals over the age of 65. One study shows that 1 in 10 deaths from pneumonia in elderly nursing home residents may be prevented by improving oral hygiene (Sjogren et al., 2008). Unfortunately, proper oral care and monitoring of meals is often overlooked in the health care setting.  Perhaps the greatest reason for this is the challenge that almost every health facility faces today: adequate staffing. When I started working in acute care as an RN over 20 years ago, nursing assistants (these are the staff generally responsible for proving oral care in an acute care setting) were typically responsible for 5-7 patients. Nurses had 3-5 patients (this was on a step down cardiac unit). Between the nurse and the assistant, we were able to provide oral care at every meal and offer one-on-one assistance to any patient that was at risk for aspiration. This is no longer the case.  RNs oftentimes look after upwards of 8 patients, and there is generally either no nursing assistant on the floor or only 1 for a patient load that can exceed 20.  Consequently, proper oral care is neglected.  I have often seen patients that are aspirating during meals, but do not have adequate staffing on hand to provide them with the supervision and monitoring that they need. This presents a hazardous catch-22: the aging individual needs to eat to maintain nutritional needs yet he/she needs assistance with eating to prevent aspirating pneumonia.   How can this be remedied? If the family is present, they can provide oral care and meal monitoring. If meal monitoring is required for an at-risk individual, its recommended to touch base with the health care team to inquire as to what the specific aspiration precautions are (every individual may have a different need and/or recommendation). A care companion can also be hired to provide the needed care. I hired a companion for my father when he was in a skilled nursing facility. He was not getting his teeth brushed or flossed regularly, and I was seeing a decline in his dentition. Having this extra support provided him with much needed assistance and the care companion had the added benefit of encouraging him to eat more at every meal, something that was a bonus as he was not meeting his nutrient needs. Touching base with staff to request that oral care and meal monitoring be done can also be helpful. Having an advocate to ensure necessary care is getting done can also be very effective in the health care setting.  What is proper oral care and effective meal monitoring?  Proper oral care includes brushing the teeth for at least 1 minute after every meal. It also includes using a soft bristle brush, fluoride toothpaste, flossing daily. A final component of oral care that is often not discussed is denture care. Dentures should be cleaned at least once per day and removed at bedtime. Removing them prior to sleeping can greatly reduce the risk of pneumonia (Iinuma et al. 2014). Effective meal monitoring includes adequate supervision during mealtime for those at risk of aspiration. Such supervision includes ensuring the individual is properly positioned for a meal (head of bed as high as can be tolerated and supine position), takes small bites, eats slowly, swallows a couple times in between each bite, and intermittently takes a sip of liquid to clear the mouth of food particles. The use of straws is generally not recommended for an individual at risk for aspiration as it propels the food to the back of the throat and hence can increase risk. I recall when I was working as a Registered Nurse (RN) in acute care that I was constantly removing straws from the bedside of at risk individuals and often reminding them to eat slowly and swallow at least twice between each bite to ensure food clearance. Individuals at risk for aspiration often require a modified texture diet as it can further prevent the aspiration of food and liquids.   This is a brief summary of the attention to detail needed in addressing oral hygiene and meal monitoring amongst the aging population. Both measures can play a significant role in reducing aspiration pneumonia.  If you would like more information on understanding proper oral care or any other questions that you may have regarding aging life care, please feel free to reach out to me.    Sources:1.      Sjogren P, Nilsson E, Forsell M, Johansson O, Hoogstraate J. 2008. A systematic review of the preventive effect of oral hygiene on pneumonia and respiratory tract infection in elderly people in hospitals and nursing homes: effect estimates and methodological quality of randomized controlled trials. J Am Geriatr Soc. 56:21242130. 2.      Iinuma T, Arai Y, Abe Y, Takayama M, Fukumoto M, Fukui Y, et al. 2014. Denture wearing during sleep doubles the risk of pneumonia in the very elderly. J Dent Res. doi: 10.1177/0022034514552493 3.      F Muller, 2015. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4541086/#   

By the time you read this, the reported deaths from COVID-19 and its variants in the U.S. will be close to 900,000. As staggering as that statistic is, its 400,000 short of the number of Americans killed by Heart Disease in the same time period. Heart disease is the leading cause of death for men and women of most racial and ethnic groups.Lets not allow the topic to overwhelm the fact theres a miracle inside your chest. Weighing about as much as a grapefruit, the heart is a powerful pump that drives five to six quarts of blood to every microscopic part of your body every second. And if it fails for even a second, the body is very unforgiving. Even though its the one piece of machinery driven by the brain, we tend to treat the heart like a kitchen appliance that we take for granted. Rarely serviced, rarely cleaned, and overworked until it burns out. Although heart bypass and transplant have become routine since the pioneering operations in the 1960s, its not like replacing the coffee maker you neglected too long. One Thing at a TimeThe better way to treat your heart with the respect it deserves is to start with changing just small habits. That way, youll avoid the relapse from trying to change everything at once and falling back to unhealthy heart habits inside of a month. The most obvious: if youre a smoker or heavy drinker, work on that first. Imagine a small team of remodelers arriving at your heart to do a makeover. The first thing theyre going to say is, Well, we cant do anything with the plumbing until we clear the smoke. Look for Help During Heart MonthQuitting smoking and reducing alcohol is never easy, but this is probably as good a time as any during the year to start a cessation program with help. February is American Heart Month, so youre likely to be reminded frequently of heart health and offered tips on modifying your routine to help your heart and prolong a happy life. If you only look to one place, trust the American Heart Association  www.heart.org. Prediabetes and Heart DiseaseWhats your blood sugar level? If you dont know, you should find out from your doctor if youre not already monitoring it yourself. You could be pre-diabetic without knowing it or showing any symptoms. Theres a good chance you could avoid becoming diabetic and reverse your pre-diabetic blood sugar to normal with relatively little change to your diet and a slight increase inyour activity. Diabetes has long been linked to heart disease, but recent studies suggest that reversing prediabetes is also linked to fewer heart attacks and strokes. [Reversing Prediabetes linked to fewer heart attacks, strokes, heart.org, Jan. 26, 2021.]While youre at it, get your cholesterol tested and routinely monitor your blood pressure.If youre worried you might be at risk for heart disease, ask your doctor to perform a simple cholesterol test to let you know if youre at risk and should adjust your diet. Home blood pressure monitors are not expensive, theyre digital, and theyre easy to use. Blood pressure stations are common in supermarkets now, and you can also check your weight and pulse. Womens Heart HealthWhy the emphasis on womens heart health? The American Heart Association tells us that cardiovascular disease is the No. 1 killer of women, causing 1 in 3 deaths each year about one woman every minute. They devote an entire website to womens heart health: Go Red for Women (www.goredforwomen.org). Here are just a few of the common misconceptions about womens heart health:Myth: Heart disease is for men, and cancer is the real threat for womenFact: Heart disease is a killer that strikes more women than men and is more deadly than all cancer forms combined. While one in 31 American women dies from breast cancer each year, heart disease is the cause of one out of every three deaths.Myth: Heart disease is for old peopleFact: Heart disease affects women of all ages. For younger women, the combination of birth control pills and smoking boosts heart disease risks by 20 percent. Heart defects are more common than you might think: 1.3 million Americans alive today have some form of congenital heart defect and at least nine of every 1,000 infants born each year have a heart defect. Even if you live a completely healthy lifestyle, being born with an underlying heart condition can be a risk factor.Myth: I run marathons no way I could be at risk.Fact: Factors like cholesterol, eating habits, and smoking can counterbalance your other healthy habits. You can be thin and have high cholesterol. The American Heart Association says to start getting your cholesterol checked at age 20. Earlier, if your family has a history of heart disease. Age and Heart HealthMany things, like wine and most people, grow better with age. The heart, however, takes more tending than a glass of fine wine. Avoid things that weaken your heart beyond the normal aging process. These are the usual suspects: smoking and tobacco use, lack of exercise, diet, alcohol, overeating, and stress. Some preexisting conditions you cant control: irregular heartbeat, congenital (inherited) heart defects, sleep apnea (although this may be a product of obesity or alcohol consumption).Viruses and MyocarditisMyocarditis is an inflammation of the heart muscle mostly caused by a virus, including COVID-19, and can lead to left-sided heart failure. The left ventricle of the heart is the part that pumps oxygen-rich blood back to the body. This valve tends to stiffen with age. Thats one of the many reasons why age combined with a preexisting condition puts you at greater risk of death from COVID-19. Even survivors of the novel coronavirus infection can sustain permanent heart damage. All people must protect themselves and others from COVID-19 by observing precautions, not just because of its immediate lethality but also because of its impact on the heart, known and unknown. How to Start with Your HeartThe factors involved in heart health and the onset of heart disease are many, varied, and complicated. But the common preventions (listed here, from the Mayo Clinic) are simple. You probably already know them by heart, so to speak:Not smokingControlling certain conditions, such as high blood pressure and diabetesStaying physically activeEating healthy foodsMaintaining a healthy weightReducing and managing stress Those may seem like six significant challenges, especially if you take on all six. But you should notice something else about them. Almost every one of them can affect the other five. So, if you pick one, youll find it easier to take on the next one. People who quit smoking usually discover that they have more energy within the first week, and exercise becomes easier. A little exercise and switching out one unhealthy food will help with weight, stress, blood pressure, and diabetes. Easy does it, especially if youre 65 and older. Youve spent a whole life learning one way. You can take your time. Learn to enjoy your healthier heart. But start today.First, Get a Checkup!Most of the questions this article has raised in your mind (Whats my blood sugar level? Whats my blood pressure? I used to smoke am I at risk?) can all be answered in a single doctors visit with simple lab work done a few days before. Schedule it now, before you start a program of exercise and diet. And schedule a regular exam per your doctors recommendation. Relieving the stress of not knowing will be a good start on your way to a healthier heart.

Around this time of year, virtually all religions celebrate significant events of birth, new beginnings, festivals of everlasting light and sacred histories, our identity as a people who we are. Also universal is the tradition of gift-giving to one another. The tradition may symbolize the spiritual gifts we all enjoy without condition. One of these is Independence. As the founders expressed it in our Declaration of Independence, we are endowed by [our] Creator with certain unalienable Rights, meaning they are given to us at birth.  Independence is at the very core of our identity as human beings, whatever our cultural origins. To be deprived of it is to take away our identity. To get it back is one of the greatest gifts we can get. We made Independence the core of our mission at Legend Senior Living. Its the first word in our three key values for a seniors quality of life: Independence, Dignity and Purpose. Independence was also the cornerstone principle when Legend founder Tim Buchanan pioneered the very concept of Assisted Living more than 30 years ago. At the time, seniors and their families just could not reconcile the love of their lifelong homes, and their personal freedom and dignity with living in a place that seemed opposed to the very notion of independence: the nursing home. It took a fiercely independent entrepreneur to say, Youre right. Thats just not good enough. There has to be a way. And if there was no way, then we would make one.But what would this look like? We had to throw out all of the conventional notions about aging and write a new history that provided for the particular needs of seniors and independent senior lifestyles where the necessary care or new solutions for memory-related disease and cognitive challenges could be provided for by modern, effective, compassionate methods.The first innovation was private apartment living, but as part of a residence that saw to all of the requirements of the complete individual lifestyle. The very idea of the Individuality of aging was a revelation. Before this, the organization was designed to serve the facility, not the resident. No matter ones level of mobility or cognitive functioning, everyone lived in the same, sterile surroundings. No wonder seniors compared it to warehousing. Who cares what the merchandise feels like?This history is important because it tells the story of how the proper mission with the right innovations can grow and evolve. The more we know about medical science and cognitive functioning, the more we can apply that knowledge to assisted living and memory care. And weve seen those innovations at Legend. They have shaped our architecture, our therapy, our hiring and training, even our management structure. When you look at Legend and any other senior living company, youre looking at two very different approaches inside and out. And the difference all begins with the concept of Independence.Physical IndependenceWhen you hear the two words together, the mind may leap to being able to get around. We tend to think of that as the measurement of the end of independence. Moms not able to get around on her own anymore. Mobility is one aspect of physical independence, one that plays a big part in the purposeful design of our residences. Wider halls, numerous resting and conversation places, handrails, strategically designed apartments, abundant natural light and well-designed color schemes all aid mobility.Mental IndependenceSome people seem born to be caregivers. Others acquire a sensitivity and understanding over years of paying attention. Youve known these people. They always know what to say. They put you at ease. They seem to be able to calm and heal with a look. If we were not making the most of having more than thirty years of experience in caregiving and senior living, wed be ignoring one our greatest assets, the rich insight into how we live as we age and how we cope with loss and change, what simply keeps us going and what truly brings us joy.We thrive as a senior living provider on our dedication to the science of aging and cognitive research. The difference that human understanding brings sets us apart. We look for and cultivate this innate talent in our Legend Associates, who earn their status as Legend Experts in Senior Living and Legend Experts in Memory Care with training, mentorship and through a work culture that encourages friendship and love of community.So, what does all that have to do with mental independence? Ironically, mental independence relies greatly on others. The first thing to understand is that being independent does not mean being alone. A caring, skilled Associate can tell that someone may still be dealing with the loss of a spouse not long before theyve made the move to a senior living residence. They can tell the difference between someone who thrives in privacy with their reading or crafts and shares the experience and another who is more socially active.  For either resident, we always work to draw the person out into the broader community. Naturally, Legend is endowed with entertainment and exercise amenities, theaters and game spaces, but we also dedicate a management professional to Life Enrichment. The single focus of this position is growth, socially, culturally and spiritually. Residents choose their interests and explore them in activities, outings and events.They live their independence through expression, communication, volunteerism and by simply being recognized for who they are.Legend Senior Living owns and operates over 40 Legend and Windsor senior living residences in six states. This article may have been an unusual way to describe them. We havent described a single piece of furniture or told you about the patios and bistros, after all. But that would not be describing what Legend is. Not at our heart. Every residence has its own character and is reflective of the locale and the culture, whether its Jacksonville, Florida or Oklahoma City, Oklahoma. In that, were a lot like the individuals who make their homes here. You should meet them. The description should come from them. It will be as individual as their own happiness, their own experience of Dignity, Purpose and Independence.Independence is not a decoration to hang on a tree, a keepsake we take out once a year and look at with nostalgia. It is the shining light of individuality we are endowed with at birth, that which makes us who we are, and that shines on, everlasting. It should grow brighter with age, and never dim. That is life at Legend. Visit the living room just off the entrance at any Legend residence this time of year. There, next to the glowing fireplace, a towering tree stretches its branches heavenward, populated with many shining lights. Many lights, one tree, a perfect symbol of Independent, happy individuals coming together as a community. May your season be as bright as our hearts this year.