1. You find medications that have not been taken as prescribed
2. Yours family member is unkempt and not dressed appropriately
3. The home is in disarray and not kept as it used to be.
4. Food is past the best before date and rotting in the fridge.
5. Frequent or increased falls leading to minor or substantial injury.
6. A decline in health has left your family member in a weakened state and unable to care for themselves
7. Your loved one is being discharged from hospital and needs to monitored and cared for until admission to a facility.
8. You are spending most of your time worried about and caring for your loved one and it is affecting your work, family and your health.
9. You live in another city or province and providing care and support for you family member is difficult a best.
10. Your family member is opposed to moving out of their home into a residence and you want to support them to stay there.

At Alert Best Nursing we can respond quickly to an emergency.  Are you in crisis because of a discharge from hospital, fall or a new medical diagnosis? We are here to help. Contact us!!

As we age we face many losses including retirement, loss of loved ones, health issues and increased isolation.  These losses are a normal part of aging but can lead to depression.  Depression leads to decreased enjoyment of life, but can also affect your appetite, sleep, energy level, and physical health.  Depression is not a part of aging and can be remedied.
                                                   
Depression is a problem for many older adults
Have you lost interest in former activities that you enjoyed?  Do you feel hopeless?
You are not alone.
 
Depression is a common problem in older adults.
 
The symptoms of depression affect every aspect of your life. Including appetite, energy, sleep, relationships, hobbies and work.
 
Depression is often overlooked in seniors because they either fail to recognize the symptoms of depression or don’t take steps to get the help they need.
Reasons:

1. Depression is a normal part of aging
2. Isolation can lead to depression and there is no one to notice the changes
3. You do not relate your physical symptoms to depression
4. Reluctance to seek help

Depression can happen to anyone at any stage of life.  The challenges of aging don’t have to stop you from enjoying your life.  Whether young or older you don’t have to suffer with depression.  Depression can be treated with medication; the right support and self-help strategies and can lead to a happy and fulfilling life. 

Causes of depression in older adults
 
Many life changes related to aging can lead to depression:

• Health problems- chronic pain, physical limitations, cognitive decline, changes in body image
• Loneliness- smaller social circle due to death or relocation, decreased mobility, loss of drivers license
• Loss of purpose- loss of identity related to retirement
•  Decline in physical abilities and/or mental abilities

 
Medical conditions can psychologically or directly cause depression in the elderly.
Parkinson’s disease,                           Stroke
Diabetes                                              Heart Disease                                                             
Cancer                                                 Thyroid Disorders,
Lupus                                                   Multiple Sclerosis
Arthritis                                                Alzheimer’s disease and Dementia
Seniors often have more multiple chronic illnesses.
 
Prescription Medications can result in depression of the elderly.  It is a common side effect, particularly when multiple medications are taken.
Drugs to treat blood pressure, heart disease, ulcer medications, steroids, sleeping pills, painkillers, cholesterol drugs and tranquilizers all can have a depressive effect.
 
Alcohol can be a coping mechanism to deal with physical and emotional pain.  Alcohol may interact with other medications and impair brain function, sometimes worsening the symptoms of depression.

Is it Grief or Depression?
 
Grief is a normal reaction to loss.  Everyone is different and there is no time limit on grieving.  During this process there are still times that we feel some joy and happiness. 
Depression however leaves one with a constant sense of emptiness, despair and hopelessness.
 
Signs of Depression in the Elderly
 
Despite denial seniors may still have depression.  Signs of depression may include:

• Neglect of personal care such as hygiene, skipping meals, not taking medication, poor housekeeping
• Irritability
• Anxiety and worry
• Lack of motivation, energy
• Unexplained physical symptoms
• Unable to sleep
• Memory Issues
• Loss of interest in socializing

 
​Getting over depression
 
It’s never too late to develop a new skill or hobby.  Keep the brain fit by learning new things and finding new enjoyment.

​

• Exercise has many benefits including lifting mood and gaining physical strength.  Small changes like taking the stairs instead of the elevator or parking your car further from the store can make a difference.
• Join some social clubs such as a seniors club or have someone come in to visit, or connect by phone
• Try some yoga or other breathing techniques to relieve stress.

 
Self Care

• Proper diet with an added vitamin supplement
• Get enough rest and sleep
• Get involved in your community, volunteer or join a church group
• Pursue a new hobby or learn a new skill
• Laugh, it’s good for you and provides a mood boost

 
Getting Help for a Loved one or Friend
 
The nature of depression interferes with a senior person seeking help.  You can help by offering emotional support.  Listen with compassion and patience and offer hope.  You can also ensure that your loved one seeks and gets appropriate treatment.  Attend medical appointments and offer hope and support.

​

If you or someone you know has had a serious accident or debilitating illness, the result can be unsettling and devastating for everyone involved. Loss of mobility, cognition and the ability to provide self-care can leave a person frustrated, confused, and in a crisis situation. Fortunately, there are many nursing and home care companies available to help with a person’s recovery, rehabilitation and ongoing support.
 
Nursing – Private nursing care is available in a variety of care settings such as hospital, long-term care, retirement home, assisted living residence, and in a client’s home. A registered staff person is required when a client requires treatment, which is not within the scope of practice of a support worker. Registered nursing staff generally oversee care attendants, do assessments when there is a change in medical condition, and administer medications and treatments.
 
Support Workers, Caregivers – Theses days, many baby boomers find themselves caught in the middle of caring for aging or ill parents, supporting their children and careers. (This is often referred to as “the sandwich generation.”) Having someone oversee the care and well-being of their parents is often a welcome relief. Home support can involve everything from assisting with the activities of daily living to activation to attending medical appointments to end of life care.
 
Care Attendants – An auto accident, stroke, sports injury or anoxia can cause serious brain and physical limitations. Attendants are specifically trained to care for clients who are quadriplegic or hemiplegic and are also trained in the area of brain injury rehab.
 
Dementia Care – Support workers who work with Alzheimer clients require specialized training for dealing with this type of client. Many home care agencies work with the Alzheimer Society to ensure that their support workers are trained to provide optimal care for Alzheimer and dementia clients.
 
Palliative Care – Whether it’s in a hospital, nursing home, retirement home or one’s home, clients can remain where they are most comfortable at end of life. Nurses and support workers are there to support the client and family, whether it be physical needs, pain relief, emotional or spiritual care. They can be reassured they are not alone at this difficult time.
 
Nursing and home care companies vary in the types of services they deliver. It’s important that health employees are well-trained professionals, insured and have experience in the area of care that is required. The care they provide can ease the burden today and tomorrow.
 
 --
Yvonne Griggs is CEO of Alert Best Nursing & Senior Home Care – a leading provider of staff for private-duty nursing hospitals, long-term care facilities and retirement homes. For more information on their services, call 905.524.5990, email info@abnursing.ca or go to www.abnursing.ca.

Supporting Burlington, Hamilton, Ancaster, Stoney Creek, Dundas Brantford and Oakville.

It's important to know that angry, agitated behavior is the result of unmet needs in people with Alzheimer Disease and those with other types of Dementia. There are numerous possible causes.
 
Physiological or medical causes:
 

• Physical discomfort such as constipation, pain, or illness can be expressed as anger
• Adverse effects of medications such as sedatives or psychotropic drugs
• Sleep deprivation
  
• Impaired vision and/or hearing may cause misunderstanding
  
• Sensory overload – too much activity, too many people, too much noise, over stimulation
  
• Feeling lost, insecure, forgotten. Person may feel abandoned when surrounded by unfamiliar people
  
• Difficulty adjusting from lit to darkened areas and vice versa
• Sudden movements or noise
• Feeling hot or cold in environment

 
Other Causes
 

• Response to caregiver impatience, stress or irritability
• Activity perceived as insulting
• Surprised or frightened by unexpected physical contact
• Person scolded, confronted or contradicted
• Responding to conflict around them
• Change in schedule or routine
• Being asked to respond to multiple questions at once
• Attention span to short for requested task
  
• Instructions unclear or too complicated
  
• Task not broken down into manageable steps
  
• Inability to perform what was once a simple task, e.g. putting on shirt
  

 
Coping Strategies for Caregivers
 

• Medical assessment to rule out physical problems/medication problems
  
• Discuss drug side effects or possible interactions with physician
  
• Have vision and hearing checked
  
• Dental visit, possible tooth decay or poor fitting dentures
  
• Make sure person is comfortable – clothes fit properly, shoes fit properly
  
• Alternate quiet times with active periods
  
• Plan activities when person is rested and plan for periodic rests during activity.
  
• Keep daily routines consistent. For some people with dementia, even a slight change in routine can cause confusion and disorientation.
  
• When a change of routine is necessary try to gradually accustom the person to the change.
  
• Simplify the environment by reducing the number of people, noise, and clutter.
  
• Do not move furniture or familiar items.
  
• Person may lose sense of time. Orientate with calendars and large clocks.
  
• Remove sharp utensils and items from environment to prevent injuries.
  
• Exercise to help reduce stress. Walking or dancing are helpful.
  
• Calm or familiar music, massage, or readings are ways of calming a person.
  
• Using gentle physical touch may be calming, hugging or holding hands may be comforting to some and perceived as restraining by others.
  

 
Communication Strategies
 

• Have the person’s attention before speaking and touching.
  
• Avoid questions that rely on memory.
  
• Try not reason with the person, as they may not be able to think logically. This frequently ends in frustration.
  
• Do not express anger or frustration with physical gestures. Body language is easily sensed and can lead to increased agitation and confusion.
  
• Speak clearly and slowly using simple, short sentences.
  
• Always approach the person from the front. Approaching from behind may startle or frighten the person.
  
• Use repetition. Frequent, clearly stated reminders are needed to reassure persons with dementia.
  

 
 
The Alzheimer Society in your community will provide you with advise, education, support, and information about day programs available in your area. 
Remember to take care of yourself, so that you can take care of them.

With an aging population and changes in health care, such as shorter hospital stays, care is being provided by people who aren’t healthcare professionals. These people are caregivers.
A caregiver is anyone who provides help to another person in need whether that’s a spouse, partner, friend or neighbor.
 
Care giving is rewarding but stressful caregiver stress is the emotional and physical strain of care giving. Being there for your loved ones when they need you is a core value for many. Caregivers who experience the most stress are most venerable to changes in there own health.
 
As a caregiver you may be focused on your loved one. You may not realize that your own health and well-being are at risk.
 
Watch for these signs:
 

• Feeling tired often
• Feeling overwhelmed and irritable
• Sleeping too little or too often
• Gaining or losing excessive weight
• A loss of interest in the things you used to enjoy

 
Too much stress, especially over time, can harm your health. As a caregiver, you are more likely to experience depression and /or anxiety. In addition, with out enough physical activity, a balanced diet, social activity and time for relaxation your risk for serious medical problems increases.
 
Dealing with caregiver stress
 

• The emotional and physical demands of care giving can strain even the most resilient person.
• Accept help. Don’t be afraid to ask.
• Join a support group a great source of encouragement and a way to make new friends in similar situations.
• Set personal health goals. Set a goal to get physically active, eat healthy and be sure to get some quality sleep time to let your body heal.
• See your doctor. Make sure he is aware that you are a caregiver

 
After many years of living the journey, I understand the meaning of caregiver stress.

At the AGM of The Canadian Gerontological Nursing Association, Hamilton, Greg Cresman, MSc. (Nursing) spoke about the research project for his thesis on the subject of ALC “Stories of the Experience”. These are some of the findings of the study.

Alternative Level of Care is defined as the use of hospital beds for clients who are deemed to no longer require acute care beds, but are stuck in the hospital system. ALC is a system problem relating to the care for older adults (OHQC, 2010) indicating problems of access and efficiency. This problem results in increased wait times for surgery, emergency and unnecessary expensive care. The average client is eighty years of age, 23% have dementia and 43% are awaiting a long-term care bed, (Canadian Institute for Health Information, 2009).

Themes that surfaced that gave clients a feeling of uncertainty:

• Problems with communication. I don’t know. Clients were unaware of medical assessment, diagnosis and prognosis.  Clients were unaware of the hospital process, placement process and didn’t know what questions to ask.

• Waiting in limbo.  Waiting for care, waiting to be more mobile, waiting for activity, waiting for reunification with my partner and waiting for placement. 

• I didn’t think I would end up like this.  In the past I was active, now I’m here. What is there to look forward to at my age?

Implications:

• Lack of interaction with healthcare providers and clients/families
• Barriers to inter-organizational collaboration
• Barriers to collaboration at the federal, provincial and regional level of government

Implications for Policy Change:

• Reduce the number of ALC cases
• Allocate activity and mobility resources.  Lack of physical activity leads to a decline in mobility in older adults, leading to an inability to perform ADL’s. 
• Review policies re: ALC copayment, couple reunification and LTC wait lists
• Review of discharge planning 
• Use a humanistic approach when informing and communicating with client/family

Caregiver Stress: Tips for Taking Care of Yourself

With an aging population and changes in health care, such as shorter hospital stays, care is being provided by people who aren’t healthcare professionals. These people are caregivers. 

A caregiver is anyone who provides help to another person in need whether that’s a spouse, partner, friend or neighbor.


Care giving is rewarding but stressful Caregiver stress is the emotional and physical strain of care giving. Being there for your loved ones when they need you is a core value for many. Caregivers who experience the most stress are most venerable to changes in there own health.

Signs of caregiver stress As a caregiver you may be focused on your loved one. You may not realize that your own health and well-being are at risk. 

Watch for these signs:

• Feeling tired often 
  
• Feeling overwhelmed and irritable 
  
• Sleeping too little or too often 
  
• Gaining or losing excessive weight 
  
• A loss of interest in the things you used to enjoy 

Too much stress, especially over time, can harm your health.
As a caregiver, you are more likely to experience depression and /or anxiety. In addition, with out enough physical activity, a balanced diet, social activity and time for relaxation your risk for serious medical problems increases.

Dealing with caregiver stress

1. The emotional and physical demands of care giving can strain even the most resilient person.  
2. Accept help. Don’t be afraid to ask.
3. Join a support group a great source of encouragement and a way to make new friends in similar situations.
4. Set personal health goals. Set a goal to get physically active, eat healthy and be sure to get some quality sleep time to let your body heal. 
5. See your doctor. Make sure he is aware that you are a    caregiver

After many years of living the journey, I understand the meaning of Caregiver Stress.

What Does ”Brain Rest” Really Mean?
By: Yvonne Griggs, Owner, Alert/Best Nursing & Home Care, Inc.

Concussion, also known as “mild traumatic brain injury”has been highlighted in the news lately, with coverage of the long-term effects of these injuries on professional athletes.  This has brought awareness and concern to health care professionals and parents.

Pediatric healthcare providers know that people of all ages can suffer concussions. Adolescents are most at risk for negative consequences.  In addition to sports, automobile accidents are the leading cause of concussion in youth.

It is known that concussion is a functional rather than structural injury, therefore radiograph or MRI cannot be used to diagnose injury and the signs of concussion are often overlooked.

“Prompt recognition of the concussion within the first forty-eight hours of a head jolt or blow and treatment with immediate cognitive, or brain and physical rest are crucial to preventing prolonged symptoms of concussion.”

When there has been a concussive injury, the brain needs an influx of glucose energy in order to heal, but cerebral blood flow fuel energy is actually decreased when there is an injury.  Physical and mental activity will divert the limited brain energy supply from the injury site and will prolong symptoms. The brain needs to rest.

What does rest entail?  There should not be any physical activity that causes perspiration, no computer or social media activity, no schoolwork, and no video games or texting.  Short periods of watching TV or reading for pleasure may be permitted as long as they don’t cause any symptoms such as headache.

Red Flags:

• Symptoms remain after three weeks of rest
  
• The patient has a history of concussions
  
• The patient has a seizure or migraine disorder
  
• The patient has preexisting attention-deficit/hyperactivity disorder, or other physiological issue
  
• The patient undergoes an initial neuropsychological evaluation that reveals persistent problems
• The patient has difficulty with returning to school and their symptoms reappear

If any of the above red flags above are observed be sure to follow up with medical care.

* Information for this article originally from Dr. Flaura Winston, Pediatrician and doctorally trained bioengineer at the Children’s Hospital of Philadelphia.

What is Advance Care Planning?
April 16 is Advance Care Planning Day 
By: Yvonne Griggs, Owner, Alert/Best Nursing & Home Care, Inc.

Advance care planning is the process by which we reflect on our values and beliefs and communicate our wishes in the event that we are unable to communicate health and personal care preferences and wishes. It means discussing those wishes with family, friends, financial planners, lawyers and substitute decision makers, who will speak for you, if you cannot. 

Recent surveys indicate that 80% of Canadians believe that the health care system will not be able to manage the tremendous increase in demands of an aging population. Seniors in the 80+ age group are the second fastest growing age group. Seventy percent of Canadians have not prepared an advanced care plan and 47% have not designated a substitute decision maker to make health care decisions if they are unable to do so. Forty-four have not discussed end-of-life care with a family member.

Research indicates that clients who have end-of-life discussions with their doctors and family members will be more satisfied with their care, require fewer interventions, place less strain on care givers and are more likely to use hospice services or die at home.

• A 2008 study found that the absence of advance care planning was associated with poor client and family satisfaction with end-of–life care and bereavement.
  
• A 2010 study indicated that advance care planning and support would have a positive impact on end-of-life care in Canada.

Start the Discussion is a campaign designed to educate, provide resources and facilitate this discussion.

For more information go to advancecareplanning.ca.

2,3
1 Ipsos Reid. 10th Annual Report Card on National Health Care. www.cma.ca, last accessed Aug. 28, 2010 2 Wright, AA, et al. Associations between end-of-life discussion, health care expenditures, JAMA, 2008, 300 (14) 1665-1673

Drugs Offer Promise for Treating Brain and Spinal Cord Injuries
By: Yvonne Griggs, Owner, Alert/Best Nursing & Home Care, Inc.

Brain Injury
The New England Journal of Medicine recently found that Amantadine, a drug commonly used after the 1960’s to treat nursing home patients for the flu, and then used to treat patients with Parkinson symptoms, does improve recovery speed, of slow to recover (vegetative, or minimally conscious) brain injury clients.

The Associated Press reports that researchers found Amantadine affects the dopamine system of the brain, which controls alertness and movement.  It has been used to treat brain injuries since.  The study conducted to determine whether or not there were side effects of Amantadine use for Brain Injured clients. The conclusion indicated that, neither the test group, nor placebo group, of 184 patients in total, four to sixteen weeks post trauma, had any differences in side effects.

Spinal Cord Injury
ABC News reported that researchers in Japan, searching for a drug to treat Multiple Sclerosis, have developed a drug, known as FTY720 or Gilenya. The drug tested on mice, allowed mice to “recover some motor function”, when treated with the drug immediately after injury.

According to researchers, the drug suppresses the immune response, which decreases inflammation after an injury.  Inflammation can actually worsen the damage to the nervous system.  Studies will continue on this drug as a treatment for spinal cord injuries.

Motor vehicle accidents are still the main cause of spinal cord and acquired brain injuries.  According to the CDC 46% of spinal cord injures and 17.3% of brain injuries are related to motor vehicle crashes.  This is despite efforts to improve vehicle and road safety, drinking and driving programs and driver safety awareness programs.

Although these drugs require further studies, it does provide hope for those living with these life altering injures.