McKenney Home Care

Atrial fibrillation (A-fib) and heart failure are increasing in prevalence worldwide and often associated with poor outcomes. However, some people are not aware they have atrial fibrillation until it is detected when a doctor is listening to the heart with a stethoscope. If you have difficulty breathing, or have chest pains lasting more than a few minutes, it is recommended to seek medical help.  Someone with A-fib can still live a long and active life with treatment from their doctor and self-management.Treatment may include medications, therapy, surgery, or catheter procedures, in order to reset the heart rhythm, control heart rate, and prevent blood clots that can lead to strokes.Self-management includes following a heart-healthy lifestyle with changes such as:Eating heart-healthy foodsExercising regularlyQuit smokingMaintain a healthy weightLimit alcoholKeep blood pressure and cholesterol under controlGet follow-up careLearn more:Atrial fibrillation [Internet] Mayo Clinic. Available from: https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/diagnosis-treatment/drc-20350630  

While most people are winding down or relaxing as the day comes to an end, those with sundowners syndrome are becoming increasingly active.  Late afternoon and early evening can be difficult for some people with Alzheimers disease. Sundown syndrome, or sundowning as its often called, can produce a range of behaviors, including confusion, anxiety, and aggression. This can be distressing for both the individual as well as the family or caregivers. While there is no cure for sundowners, there are ways to lessen its effects.According to the Alzheimers Society, sundowning may continue for several months and often happens in the middle and later stages of dementia. Here are some of the triggers that may cause sundowning:Disturbance to the body clock that tells our bodies when to sleepToo much or too little lightToo little or disturbed sleepLots of noiseMedications wearing offThe National Institute on Aging suggests a few tips to help prevent sundowning:Try to distract the person with a favorite snack, object or activityPlay soothing music Close curtains or blinds at dusk to minimize shadowsAvoid caffeine late in the dayDont plan too many activities during the day, as they can be tiringIf sundowning continues to be a problem, seek medical advice. While sundowning may simply be occurring alongside dementia, there may be other causes such as pain, sleep disorders, or other illnesses.

According to the United States Census Bureau, by the year 2030, the number of individuals in the United States 65 years and over will reach 70 million, and all baby boomers will be over 65.It is important to note that muscle mass decreases as we age. Declining muscle mass means declining balance and weakening bones. It is essential to work on increasing exercise to maintain muscle mass because, without it, we can lose mobility and thereby independence.  Good news is that muscle mass can be increased at any age with exercise.Older adults need to participate in strength building exercises at least two days of the week.[1]  The exercises can include walking, running, working out with exercise stretch bands, or light weights. The activity should be relative to physical ability and intensity should increase over time.Learn more:Older People Projected to Outnumber Children for First Time in U.S. History [Internet] United States Census Bureau. Available from: https://www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html

Today, about half of all American adults 117 million people have one or more preventable chronic disease. Seven out the ten most common diseases are influenced by regular physical activity. Yet nearly 80% of adults are not meeting the physical fitness guidelines.[1]The good news is that regular physical activity can help prevent and may improve chronic conditions.  Barriers to physical activity can be small or large. If you are not active, most likely there is at least one barrier or reason why.Have you thought about what is keeping you from being active? Here are some of solutions to the most common barriers to physical activity.Not enough time in the day to exercise Try to create a 30-minute slot of time or even (2) 15 minutes slots.Ive never been active You maybe more active than you realize.  Housekeeping and mowing the lawn counts towards daily activity.Are you too tired after work? May be take a brisk walk during lunch breaks a few days a week.Afraid of getting sore muscles?  Start slow and enjoy. 

Studies suggest a large portion of seniors with dementia have unrecognized, severe pain. A recent study out of the University of Rochester suggests that nearly a third of severe pain cases go unrecognized when seniors have dementia.1-3 Pain in dementia can lead to other problems such as agitation, aggression, hallucinations, delusions, depression, impaired physical function, and increased mortality risk. What can we do?It can be difficult for family caregivers to recognize pain, even severe pain, when loved ones have dementia. Doctors and nurses often rely on reports from family caregivers. When it comes to questions about pain, clinicians should take a moment to try to engage a patient directly. They also need to do observational assessments. Tools such as the Pain Assessment in Advanced Dementia (PAINAD) scale can be used to standardize, quantify, and rate pain assessments. Importantly, tools such as these can guide clinicians in observation techniques that can improve the detection of pain among patients with dementia. Family caregivers can try free tools such as these themselves. Moreover, they can prompt their clinicians to use a pain assessment scale specifically designed for patients with dementia.Pain Assessment in Advanced Dementia Scale (PAINAD): http://dementiapathways.ie/_filecache/04a/ddd/98-painad.pdfReferencesWang J, Monroe TB, Simning A, Conwell Y, Caprio TV, Cai X, Temkin-Greener H, Muench U, Yu F, Ge S, Li Y. Pain management in home health care: relationship with dementia and facility admissions. Pain Management Nursing. 2021 Feb 1;22(1):36-43.Paulson CM, Monroe T, Mion LC. Pain assessment in hospitalized older adults with dementia and delirium. Journal of Gerontological Nursing. 2014 Jun 1;40(6):10-5.Wu N, Miller SC, Lapane K, Roy J, Mor V. Impact of cognitive function on assessments of nursing home residents pain. Medical Care. 2005 Sep 1:934-9.   

According to research at UCLA, changes in a section of the brain that is critical for memory are associated with sitting too much.[1] The study involved people ages 45 to 75. An MRI of each person provided a look at the region of the brain involved with the formation of new memories. The study did not conclude that sitting causes thinner brain structures, but that it is associated with having thinner regions.Growing evidence from research suggests that physical exercise is a promising intervention for delaying the onset of dementia and Alzheimers disease.[2]It is recommended to move for three minutes every 30 minutes to improve both physical and mental health. Some of the simple ways to encourage movement are:Park farther away from the store entrance in the parking lot.Stand up and do jumping jacks.While on the phone, walk around.Walk on a lunch break.Take a break every commercial while watching TV. Get up and clean or put something away.Do more gardening or yard work.Dance to a favorite tune.Skip the elevator; take the stairs.At the office, stand or walk while reading.[1] Siddarth P, Burggren AC, Eyre HA, Small GW, Merrill DA (2018) Sedentary behavior associated with reduced medial temporal lobe thickness in middle-aged and older adults. PLoS ONE 13(4): e0195549. https://doi.org/10.1371/journal.pone.0195549[2] Beckett MW, Ardern CI, Rotondi M. A meta-analysis of prospective studies on the role of physical activity and the prevention of Alzheimers disease in older adults. BMC Geriatr. 2015;15:17   

Anybody whos ever weeded a row of turnips, planted petunias, or mowed a thriving lawn knows that gardening can be hard work. That hard work pays off in more ways than having the best roses on the block or a tasty salad. Gardening in its various forms has a multitude of benefits:Increase hand strength, body strength, and flexibility[1]Improve hand-eye coordination[2]Burn calories. If it makes you sweat, it counts as exercise.Promote mental and physical stimulation and may help preserve cognitive health[3]One of the biggest benefits is if youre a vegetable gardener, you get to eat what you sowGardening is a way to socially connect across generations and with the great outdoors. Introducing children or grandchildren to gardening with their own little plot or even just helping with the watering (what kid doesnt like to play with the garden hose?) can create a bond.While gardening, people also need to keep safety in mind by rotating garden tasks to avoid repetitive movements. An example might be after 15 minutes of raking, change to pruning for a while. This helps to prevent aggravating muscles by using the same ones over and over. Grab a trowel and get growing![1] Park, S., & Shoemaker, C.  Observing body position of older adults, while gardening for health benefits and risks.  Activities, Adaptations & Aging, 33; 31-38.[2] DAndrea, S. J., Batavia, M., & Sasson, N. (2007). Effect of horticultural therapy on preventing the decline of mental abilities of patients with Alzheimers type dementia. Journal of Therapeutic Horticulture, 18, 917.[3] Infantino, M. (2004). Gardening: A strategy for health promotion in older women. Journal of the New York State Nurses Association, 35(2), 1017.  

Younger people may perceive urinary tract infections (UTIs) as a nuisance, but for the elderly, it can be a serious condition with unexpected symptoms.  It is important to seek medical attention promptly.The urinary system is the bodys drainage system for removing wastes and extra water. It includes two kidneys, two ureters, a bladder, and a urethra. UTIs are the second most common type of infection in the body.In some elderly people, mental changes and confusion may be the only signs of a UTI. Older adults with a UTI are more likely to be tired, shaky, and weak or have muscle aches and abdominal pain.Many things can affect bladder health. We cant control everything that affects bladder health, but there are many bladder health behaviors that can be controlled. Here are some things that may affect bladder health.DiabetesBeing OverweightLow Physical ActivitySome MedicinesGetting a UTI diagnosed and treated quickly in the elderly is essential otherwise there can be serious consequences.

Thirty-five percent of people report getting less than the recommended seven to nine hours of sleep nightly.[1] People who dont get enough sleep are prone to health problems, including type 2 diabetes. How sleep or lack of it affects diabetes is still being investigated, but its possible that for some people, preventing or controlling diabetes is as simple as getting an extra hour or two of zs each night. People who suffer from sleep disturbances are at risk for obesity, diabetes, and coronary artery disease, according to research from the Perelman School of Medicine at the University of Pennsylvania. The research analyzed data of over 130,000 people and indicated that general sleep disturbances such as difficulty falling asleep, staying asleep, or sleeping too long may play a role in the development of cardiovascular and metabolic disorders.[2] The study discovered a clear relationship between sleep disturbance and diabetes. The findings suggest that getting a better nights sleep may lead to better blood glucose control. Researchers at Cedars-Sinai Medical Center found that just one night of sleep deprivation can decrease insulin sensitivity equal to the effect of six months of a high-fat diet.[3] This could mean that for type 2 diabetics, getting enough rest could contribute significantly to managing blood sugar. Diabetes and sleep have a complicated relationship. The better we can manage the symptoms of diabetes the better our sleep should be. Exercise, healthy eating habits, proper rest, and regular doctor visits could be part of the process in managing the symptoms of type 2 diabetes.[1] Centers for Disease Control and Prevention. (2016, February 16). 1 in 3 adults dont get enough sleep. Retrieved July 15, 2020, from https://www.cdc.gov/media/releases/2016/p0215-enough-sleep.html[2] Grandner MA, Jackson NJ, Pak VM, Gehrman PR. Sleep disturbance is associated with cardiovascular and metabolic disorders. J Sleep Res. 2012;21(4):427-433. doi:10.1111/j.1365-2869.2011.00990.x[3] Obesity Society. Insulin sensitivity: One night of poor sleep could equal six months on a high-fat diet, study in dogs suggests. ScienceDaily. ScienceDaily, 4 November 2015. www.sciencedaily.com/releases/2015/11/151104134039.htm.

Good nutrition is important for all ages. It provides energy and can helps control weight. It may also help prevent some diseases, such as osteoporosis, high blood pressure, heart disease, type 2 diabetes, and certain cancers. But as we age, our bodies and life changes, and so does what we need to stay healthy. For example, we may need fewer calories, but we still need to get enough nutrients and usually older adults need more protein in order to maintain muscle.Some changes that can happen as we age can make it harder to eat healthy. Some of these changes may include: Home life, such as suddenly living alone or having trouble getting around Health, which can make it harder to cook or feed oneself Medicines, which can change how food tastes, causing a dry mouth, or causing lack of appetite Sense of smell and taste Problems chewing or swallowing foodAs we age, we should eat foods that promote good health and provide lots of nutrients without the extra calories. Some of these may include: Fruits and veggies of bright colors Whole grains, like oatmeal, whole-wheat bread, and brown rice Fat-free or low-fat milk and cheese, or soy or rice milk that has added vitamin D and calcium Seafood, lean meats, poultry, and eggs Beans, nuts, and seedsAvoid foods that are high in calories but contain few nutrients such as candy, baked goods, soda, and alcohol. NIH:National Institute on Aging

nsufficient or low-quality sleep may be more than an annoyance. It can be a major health concern meriting a visit to your general practitioner or a sleep specialist. Difficulty sleeping that impairs activities of daily living and lasts greater than three months meets the clinical definition of insomnia. One of the more prevalent causes of insomnia is obstructive sleep apnea, which is a major reason for snoring. Obstructive sleep apnea (OSA) means an obstructive episode resulted in respiratory effort and at least a 30% decrease in airflow for 10 seconds or greater resulting in oxygen desaturation in the blood of 4% of greater.The problems from OSA are associated with a host of negative health, social, and occupational consequences, some of which include:Daytime sleepinessReduced work productivityReduced concentrationSocial isolation and lonelinessRisk factor for DementiaExercise has long been associated with better sleep. [1] Despite surprisingly little experimental research involving patients with significant sleep disturbance or sleep disorders, the available evidence suggests that exercise holds promise as a nonpharmacologic therapy for adults with poor or disordered sleep. [2]Exercise seems to improve sleep quality and sleep continuity. Even in the case of OSA, exercise can reduce the symptoms. If chronic problems with sleep are an issue, please consider getting evaluated. Remember that exercise is good medicine.[1] Youngstedt SD, Kline CE. Epidemiology of exercise and sleep. Sleep Biol Rhythms. 2006; 4:215221.[2] Buman MP, King AC. Exercise as a treatment to enhance sleep. Am J Lifestyle Med. 2010; 4:500514.  

Wonder Woman is a fictional super heroine, published by DC Comics since 1941. She is based on Diana of Themyscira, a warrior princess of the Amazons of Greek mythology who is gifted with a wide range of superhuman powers and superior combat skills.Wonder Woman has left her mark on the psyche of many of us, especially those who have a desire to be all things to all people and to do it all by ourselves. Caregivers are particularly susceptible to this syndrome, as loved ones become increasingly reliant on them. We caregivers, without superhuman powers, are at a high risk of burnout and illness; yet we often have difficulty asking for assistance.Researchers have long known that caregiving can have serious negative effects on the caregivers themselves. Here are some facts:43.5 million adult family members care for someone 50+ years of age and 14.9 million of them care for someone who has Alzheimer or other dementia.The close relationship between caregiver and recipient is a shared relationship with involved emotions, experiences, and memories, which can place a caregiver at high risk for psychological and physical illness. (2011 Alzheimer's Disease Facts and Figures, Alzheimer's and Dementia, Vol. 7, Issue 2) 17% of caregivers feel their health has gotten worse as a result of their caregiving.Among working caregivers, 69% report having to rearrange their work schedules, decrease working hours or take unpaid leave in order to meet their care-giving responsibilities. (AARP Public Policy Institute Valuing the Invaluable: 2008 Update)Caregivers, regardless of employment status, report that positive activities in their daily life are reduced by 27.2% as a result of caregiving, and the effect on their personal life is 3 times more than the effect on employment.(Coughlin, J., (2010). Estimating the Impact of Caregiving and Employment on Well-Being: Out-comes & Insights in Health Management, Vol. 2; Issue 1)None of us are blessed with Wonder Woman's superhuman abilities; how-ever, we can take steps to make caregiving a positive and healthy part of our lives.Spread the load, share the joy!Develop a team approach to caregiving.Give yourself the gift of time to take care of yourself, thereby allowing you to embrace your caregiving activities with the spirit of love and devotion that inspired you to take on the role in the first place.Contact ccc to start building your team at 239-325-2273 or info@mckenneyhomecare.com.

Many older adults have spent decades raising families in their homes where theyve created so many cherished memories. While it may not be possible for a loved one to live independently forever, making a few home modifications can keep the home safe and comfortable.Home modifications for older adults reduce fall risk and help loved ones stay in their homes for as long as possible. Falls are one of the top reasons why many lose their independence and mobility. Many home modifications are easy and can likely be done without needing to call in a professional, while others require careful planning to install.Basic Home Modifications: Remove anything thats a trip hazard Install an elevated toilet seat Add extra lighting Add traction slips to the bathroom floorAdvanced Modifications: Install grab bars Install a bathroom heat lamp Add a stairlift Install a walk-in tub Install a rampAssistive Technology: Medical Alert Systems Smart Home Devices including cameras Assistive seating including lift chairsWhile some home modifications can be expensive, they can help save money overall in comparison to the cost of health expenses associated with a fall or nursing home. Proper home modifications provide peace of mind knowing that loved ones are safe in their own home.

Well drink to this: according to research, hot chocolate makes us smarter and faster thinkers. A study finds drinking cocoa is not just a popular choice, but it may also be a smart choice as well. A team at the University of Birmingham discovered that people given a cocoa drink containing high levels of flavanols were able to complete cognitive tasks more efficiently than when drinking a non-flavanol drink.The study examined 18 healthy men between 18 and 40 years old. The participants underwent a standard procedure to challenge the brains circulation that involved breathing 5% carbon dioxide about 100 times the normal concentration found in the air. This produces an effect called hypercapnia. The men were subjected to a non-invasive method which uses light to see changes in the blood oxygenation levels. The researchers tracked how the group responded to the carbon dioxide after drinking flavanols. Each man received these tests twice, before and after having their cocoa.The study revealed that the participants drinking a flavanol-enriched beverage had the highest levels of blood oxygenation after experiencing hypercapnia. The cognitive exams revealed flavanol-enriched cocoa helped people perform better in mental challenges. The study found improvements in speed and accuracy when flavanol-enriched drinks were consumed over regular cocoa.So, sit back, relax, and enjoy a cup of hot chocolate. But for a fun note: as for the tiny, little marshmallows that so many of us dump into our hot chocolate, they do not factor into the health benefit.Source: Socci V, Tempesta D, Desideri G, De Gennaro L, Ferrara M. Enhancing human cognition with cocoa flavonoids. Frontiers in Nutrition. 2017 May 16;4:19.Can drinking cocoa make you smarter? [Internet]. Birmingham.ac.uk. [cited 21021, Dec 02]. Available from: https://www.birmingham.ac.uk/news/latest/2020/11/can-drinking-cocoa-make-you-smarter.aspx

Adopting a pet comes with some surprising health benefits for the new owner. For those who truly consider a dog to be mans best friend, it helps to know the health benefits dogs can bestow on a human being. In fact, some studies show that dog ownership during a health crisis can be just what the doctor ordered.[1] Studies have shown that human-animal interaction increases the oxytocin levels in the brain. [2] Oxytocin levels in the brain cause many physiological changes, such as:a slower heart rate and breathing,lower blood pressure,inhibits stress hormones, andcreates a sense of calm, comfort, and focus.One study published in the journal Hypertension analyzed the effects of pet ownership on cardiovascular responses with people in high-stress positions and suffering from hypertension. The results showed that those who owned pets have a less dramatic response to stress than those who did not own pets. The study measured heart rate, blood pressure, and stress levels. The researchers hypothesized that owning pets helps people to understand what matters in life and put problems into perspective.The presence of animals and the need for their care produces psychological stimulation to induce people to take better care of themselves.Having a dog really can improve our health according to science. Whether its boosting our mood, giving us a reason to go outside, or simply keeping us on schedule. Your dogs got your back!Sources:Allen K, Shykoff BE, Izzo Jr JL. Pet ownership, but not ACE inhibitor therapy, blunts home blood pressure responses to mental stress. Hypertension. 2001 Oct 1;38(4):815-20.[1] Odendaal, J. S. J. Animal-assisted therapymagic or medicine? Journal of Psychosomatic Research 49.4 (2000): 275-280.[2] Miller, Suzanne C., et al. An examination of changes in oxytocin levels in men and women before and after interaction with a bonded dog. Anthrozos 22.1 (2009): 31-42.    

A study finds that half of people who suffer with a heart attack fail to immediately call an ambulance for help. This delays the diagnosis which could potentially worsen their odds of survival. People who found another way to the hospital or delayed calling an ambulance increased their average diagnosis time from 81 minutes to 119 minutes. The researchers analyzed treatment timelines for about 450 people suffering a severe heart attack caused by a prolonged period of blocked blood supply that affects a large area of the heart. Among the study participants who didnt immediately call for an ambulance, 30 percent didnt think they were sick enough to go to the hospital.  The study authors believe the reluctance to call an ambulance comes from uncertainty about whether the symptoms are really a heart attack.Heart attack and stroke are life-and-death emergencies. Every second counts. It is important to quickly assess the symptoms and immediately call 911. The symptoms of heart attacks are: Chest pain or discomfort Feeling weak, light-headed, or faint Pain and discomfort in the jaw, neck, or back Pain or discomfort in one or both arms or shoulders Shortness of breathOther symptoms may include unexplained tiredness and nausea or vomiting.Calling 911 is one of the fastest ways to get lifesaving treatment. Minutes matter!Sources:Thylen I, et al. First medical contact in patients with STEMI and its impact on time to diagnosis. BMJ Open, 2015: e007059 doi:10.1136/bmjopen-2014-007059.Centers for Disease and Prevention. Heart Attack Symptoms, Risk, and Recovery. Retrieved 28, October 2020. https://www.cdc.gov/heartdisease/heart_attack.htm.

Doctors at Northwestern Medicine and others have been working with Google to develop ways to apply artificial intelligence (AI) to improve many areas of health screening and subsequently, overall improved health. Future health screening could be as simple as using your phone.Imagine the ability to use AI to check for:heart rate and respirations ordiabetic retinopathy, a complication of diabetes that can cause blindness if undiagnosed and untreated.Someday, these could be real possibilities that could result in more timely diagnoses and better healthcare outcomes.Using the smartphone does not give a diagnosis but can let someone know if there is an elevated risk. This enables people to know better when to talk with their healthcare provider. It could also aid the provider in giving patients more background information to understand better how things have been progressing.With increasing health checks that might be monitored using a smartphone and AI, it could help close the challenging gap regarding where people live and access to routine healthcare. The unified goal is to develop a number of disease detection monitoring programs, using methods that are less invasive, accurate, cheaper, and more readily available.Learn more:The Check Up: Our Latest Health AI Developments. [Internet] Available from: https://blog.google/technology/health/check-up-ai-developments-2022/Using AI to Prevent Blindness. [Internet] Available from: https://health

Cheese lovers can celebrate! According to a recent, decade-long study, cheese was associated with a reduction in all-cause mortality. Yes, cheese.Cheese is a food thats full of contradictions. Most everyone can agree that it is one of the most delicious foods known to man. Whether its a creamy slice of American cheese melted over a burger or freshly grated Romano over a favorite pasta, cheese adds flavor to any dish. For a long, time cheese has been seen as a fattening, calorie-filled ingredient, but is cheese considered healthy or is it the kind of thing that should be enjoyed occasionally? A recent study had surprising findings on the health benefits of cheese.According to a study led by Dr. Maciej Banach of the Medical University of Lodz, Poland, cheese was found to protect from total mortality. Banach and colleagues analyzed national survey data from the 1999-2010 National Health and Nutrition Examination Survey, conducted by the Centers for Disease Control and Prevention (CDC). The researchers found eating any kind of dairy was associated with a 2% lower rate of total mortality. The study also found a 4% lower rate of stroke from dairy intake, along with a 7% lower rate for stroke with milk alone. Cheese reigned supreme with an 8% decrease in total mortality risk.To those of who live and breathe cheese, rejoice. Study authors suggest that recommendations to limit cheese consumption be relaxed.Break out the Brie! Its time to celebrate.

It probably comes as no surprise that people find themselves to be wider at the age of 40 or 60 than they were at the age of 20. What may surprise us is why. A study published by the Journal of Orthopaedic Research shows that hip bones continue to grow with agein both women and men. By age 20, most people have achieved their maximum height. But researchers at the University of North Carolina at Chapel Hill School of Medicine have now found that while people dont grow taller after age 20, they do grow widerwell into their 70s. This growth is not fueled simply by an increase in body fat, as was previously thought.The researchers randomly selected 246 male and female patients in various age groups ranging from age 20 to age 79.  Using CT scans, they determined that the width of peoples pelvises continued to grow after skeletal maturity was reached at age 20.  Specifically, the pelvic inlet widenedevidence of actual pelvic growth.The results: on average, the pelvic width of the oldest people in the study was nearly 2.5 cm larger than the youngest patients. This one-inch increase in pelvic diameter could lead to an approximately 7.6 cm increase in waist size from age 20 to age 79, whether or not body fat increases.While its nice to be able to blame expanding girth on your bones, it is still important to maintain a healthy weight through diet and exercise. We cant stop our pelvises from growing, but we can prevent an unhealthy increase in body fat.  Excess body fat raises the risk for illnesses ranging from diabetes to heart disease.  Source: Berger AA, May R, Renner JB, Viradia N, Dahners LE. Surprising evidence of pelvic growth (widening) after skeletal maturity. Journal of Orthopaedic Research. 29(11):1719-23. 

Studies suggest a large portion of seniors with dementia have unrecognized, severe pain. A recent study out of the University of Rochester suggests that nearly a third of severe pain cases go unrecognized when seniors have dementia.1-3 Pain in dementia can lead to other problems such as agitation, aggression, hallucinations, delusions, depression, impaired physical function, and increased mortality risk. What can we do?It can be difficult for family caregivers to recognize pain, even severe pain, when loved ones have dementia. Doctors and nurses often rely on reports from family caregivers. When it comes to questions about pain, clinicians should take a moment to try to engage a patient directly. They also need to do observational assessments. Tools such as the Pain Assessment in Advanced Dementia (PAINAD) scale can be used to standardize, quantify, and rate pain assessments. Importantly, tools such as these can guide clinicians in observation techniques that can improve the detection of pain among patients with dementia. Family caregivers can try free tools such as these themselves. Moreover, they can prompt their clinicians to use a pain assessment scale specifically designed for patients with dementia.Pain Assessment in Advanced Dementia Scale (PAINAD): http://dementiapathways.ie/_filecache/04a/ddd/98-painad.pdfReferencesWang J, Monroe TB, Simning A, Conwell Y, Caprio TV, Cai X, Temkin-Greener H, Muench U, Yu F, Ge S, Li Y. Pain management in home health care: relationship with dementia and facility admissions. Pain Management Nursing. 2021 Feb 1;22(1):36-43.Paulson CM, Monroe T, Mion LC. Pain assessment in hospitalized older adults with dementia and delirium. Journal of Gerontological Nursing. 2014 Jun 1;40(6):10-5.Wu N, Miller SC, Lapane K, Roy J, Mor V. Impact of cognitive function on assessments of nursing home residents pain. Medical Care. 2005 Sep 1:934-9.

Hoarders, clutterers, pack rats, and collectors are a few terms used to describe people with a lot of items in their home, office, car, storage unit, and maybe overflowing into the yard.  The accumulation of objects can become a safety and health problem, often interferes with daily living and/or violation of housing codes that can lead to eviction or homelessness.  It can be difficult to know if a loved one is truly hoarding or merely attached to their personal possessions. According to a study published in Journal of Affective Disorders, about 2.5% of the general population falls into the criteria for hoarding disorder.[1]  Hoarding behaviors often emerge during adolescence or early adulthood, and tend to worsen with age. Hoarding behavior may focus on items such as books, papers, clothing, and even pets.The reasons why someone begins hoarding are not fully understood according to the National Health Service.  Mental health problems such as depression, psychotic disorders or obsessive-compulsive disorder (OCD) have been associated with hoarding. Other possible reasons for hoarding may be associated with self-neglect such as living alone, family history of hoarding, and growing up in a cluttered home environment.Hoarding can create significant health and safety risks for older adults. Clutter can cause falls or fire hazards. The inability to access the kitchen can lead to problems with nutrition and food contamination. Medication is easily lost. In addition, there are infestations of insects and rodents.Hoarders are emotionally attached to their belongings and lack the ability to set priorities and make informed decisions. People who hoard can comprise their own safety and relationships just because they are afraid to throw anything away. If a family member or loved one is experiencing hoarding tendencies, contact a general practitioner or mental health professional. In many communities, public health agencies can help address problems of hoarding and get help for individuals affected.[1]  Postlethwaite A, Kellet S, Mataix-Cols D. Prevalence of Hoarding Disorder: A systematic review and meta-analysis. Journal of Affective Disorders. 2019 Jun. doi.org/10.1016/j.jad.2019.06.004.