Low Impact Exercises

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/#   

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.Contact us at Acti-Kare Responsive In-Home Care North Pittsburgh to learn more at 412-810-6595.

As we age, many of us will require assistance with daily living activities. While some seniors opt to move into assisted living facilities or nursing homes, many prefer to receive care in the comfort of their own homes. In-home care has become increasingly popular over the years, but many people are unsure about the cost. In this blog, well take a closer look at the cost of in-home care and what factors can impact the price.What is In-Home Care?In-home care refers to a range of services that are provided to seniors in their own homes. This type of care can include assistance with daily living activities, such as bathing, dressing, and meal preparation, as well as medical services like medication management and wound care. In-home care can be provided by trained professionals, such as home health aides or licensed nurses, or by family members or friends.The Cost of In-Home CareThe cost of in-home care can vary widely depending on a number of factors. According to the Genworth Cost of Care Survey, the national median cost of in-home care in 2020 was $24 per hour for homemaker services and $24 per hour for home health aide services. However, the cost can be higher or lower depending on where you live, the type of services you need, and the amount of care required.One of the biggest factors that can impact the cost of in-home care is the level of care needed. Seniors who require only minimal assistance with daily living activities may only need a few hours of in-home care per week, while those who require more intensive care may need around-the-clock assistance. The more care that is required, the higher the cost will be.Another factor that can impact the cost of in-home care is the type of services needed. Homemaker services, which include tasks like cleaning, cooking, and running errands, are typically less expensive than home health aide services, which provide more hands-on care like medication management and assistance with personal hygiene.Finally, the cost of in-home care can also vary depending on where you live. In some parts of the country, the cost of in-home care may be higher due to a higher cost of living or a shortage of trained professionals in the area.Paying for In-Home CareMany seniors and their families are concerned about how they will pay for in-home care. Fortunately, there are a number of options available to help cover the cost.One option is to use personal savings or retirement funds to pay for in-home care. Another option is to use long-term care insurance, which can help cover the cost of in-home care as well as other long-term care expenses.Medicare may also cover some of the cost of in-home care if certain criteria are met, such as if the senior is homebound and requires skilled nursing care. Medicaid may also cover the cost of in-home care for seniors who meet certain income and asset requirements.Finally, some seniors may be eligible for assistance from nonprofit organizations or community groups that provide financial assistance for in-home care.Choosing In-Home CareIf you or a loved one is considering in-home care, its important to choose a provider that meets your needs and budget. Look for a provider that is licensed, bonded, and insured, and that has a reputation for providing high-quality care.Its also a good idea to ask for references and to check online reviews from other clients. Finally, be sure to ask about the cost of services upfront and to get a detailed breakdown of all fees and charges.In-home care can be a great option for seniors who want to receive care in the comfort of their own homes. While the cost of in-home care can vary depending on a number of factors, there are a variety of options available to help cover the cost.