BEWARE OF GRAPEFRUIT DRUG INTERACTIONS

Grapefruit and grapefruit juice are good for you -- unless you're on one of an increasingly wide range of medications that interact with them. A report published by CMAJ (Canadian Medical Association Journal) indicates the number of drugs affected by grapefruit juice is on the rise.  More than 85 drugs are now identified as problematic -- and many are commonly used by people over age 45.

The problem centered around compounds in grapefruit called furanocoumarins, which can block an enzyme in the gut that metabolizes certain drugs. This can lead to higher-than-normal levels of certain oral drugs getting into the bloodstream. Less frequently, grapefruit can block drug transporters, leading to an insufficient dose of medication. Just one whole grapefruit or an 8-ounce glass of juice can interact with drugs up to three days after consumption.

Effects vary from person to person. Serious adverse effects can include acute kidney failure, respiratory depression, rhabdomyolysis (muscle breakdown that can lead to kidney damage), gastrointestinal bleeding and torsade de pointes - a potentially fatal increase in heart rhythm.

Current advice from experts is to avoid consuming grapefruit and its juice if you're on a drug that interacts with it. The same recommendation goes for Seville oranges (often used in marmalade), limes, pomelos and tangelos, which have also been found to interfere with drug metabolism. (Sweet oranges, such as navel and Valencia, don't contain furanocoumarins and remain safe to eat.)

In addition, the Food and Drug Administration advises you to:

·     Ask your pharmacist about potential interactions when you fill a prescription.

·    Read the patient information that comes with your prescription and over-the-counter drugs.

·   Check the labels of fruit juices and other drinks to make sure they don't contain grapefruit juice, if you're on one or more drugs that interact.

(Source:  John Hopkins Health Alert, Posted in Healthy Living on 8 January 2014)

WHAT IS GERIATRICS?

Caring for Older Adults

Older adults have special healthcare needs that can make their medical care more complicated.  More than half of adults age 65 and older have 3 or more medical problems, such as heart disease, diabetes, arthritis, Alzheimer’s disease, or high blood pressure.

Caring for older people with multiple health problems can be tricky, even for healthcare professionals who specialize in GERIATRICS, the medical care of older adults. 

For example, prescribing medications for a patient with multiple health problems is more complex.  A drug that might be useful in treating one health problem can make another problem worse, and taking multiple medications can cause problematic drug interactions and side effects. 

Who Provides Geriatric Care?

A GERIATRICIAN is a doctor who is specially trained to evaluate and manage the unique healthcare needs and treatment preferences of older people.

Geriatricians are board-certified internists or family physicians who have additional training and certification in geriatrics. 

Because of their special training, geriatricians typically provide care for frail older people who have the most complicated medical and social problems.

Who Needs to See a Geriatrician?

While primary care physicians - general internists and family physicians - care for most old people, geriatricians frequently provide the primary care for older adults who have the most complicated medical and social problems.  Also, because of their unique qualifications and training, geriatricians are often sought to provide consultations for the frailest of older persons.

A Geriatrician should be consulted when:

·      An older person’s condition causes considerable impairment and frailty. These patients tend to be over the age of 75 and have a number of diseases and disabilities, including cognitive (memory) problems.

·      Family members and friends are under considerable stress as caregivers.

·      Family members and patients have trouble following complex treatments, or dealing with many healthcare professionals for their multiple health problems.

Geriatrics: The Team Approach

Geriatrics is known for its team approach to caring for older people and supporting their families and other caregivers.  The geriatrics care team may include but not be limited to any or all of the following professionals:

·           Geriatrician

·           Nurse

·           Physician assistant

·           Social worker

·           Consultant pharmacist

·           Nutritionist

·           Physical therapist

·           Occupational therapist

·           Speech and hearing specialist

·           Geriatric psychiatrist

These professionals evaluate the older person’s medical, social, emotional, and other needs. The team also focuses on health concerns common in older people such as incontinence, falls, memory problems, and managing multiple chronic conditions and medications.

The Geriatrics Team:

·      Evaluates the patient’s social supports and living situation.

·      Considers the person’s ability to perform daily activities such as bathing, dressing and eating.

Gives special attention to patient preferences and values in care planning.

(Source:  Helthinaging.org)

SHADOWING IN ALZHEIMER'S : WHAT IS SHADOWING AND HOW CAN YOU COPE WITH IT?

What Is Shadowing?

Shadowing is when people with Alzheimer's disease or another type of dementia constantly follow their caregivers around. They may mimic him, walk wherever he goes, and become very anxious if the caregiver tries to spend any time away from them.

Why Do People with Dementia Shadow Their Caregivers?

Often, shadowing appears to be driven by the person's anxiety and uncertainty. They may feel like their caregiver is the one safe and known aspect of life, almost like a life preserver. The minute the caregiver walks into a different room, goes outside or shuts a door to use the bathroom, the person with Alzheimer's may become afraid, unsure and upset.

Why Is Shadowing Thought of as a Challenging Behavior?

While shadowing isn't one of the more typical challenging behaviors such as aggressiveness or paranoia, it can present a significant challenge. Caregivers dealing with shadowing often report a feeling of claustrophobia, where they're constantly with their loved one and never allowed to do anything alone. Even taking a shower without interruption can be a challenge for a caregiver.

How Can Caregivers Cope with Shadowing?

One way to reduce the frustration of being constantly followed around is to remind yourself that your family member is afraid and anxious. How you interpret their behavior (as a result of fear instead of as purposely trying to irritate you) can make all the difference.

For example, one gentleman I knew felt like his wife was trying to control his every action and interaction because she was continuously following him around and wouldn't even let him work in the garage alone. While this behavior was extremely frustrating, his perception of her acting this way in order to control him made things worse.

Recognizing shadowing as a reaction to anxiety and confusion can help provide extra energy to respond to it.

Additionally, it is imperative that you as a caregiver find a way to escape periodically. Even the most dedicated, loving and patient caregiver needs a break. To protect your emotional well-being, allow yourself some private time to take a shower or take some deep breaths. You can set a timer and remind your loved one that you'll be back when the timer sounds.

Maybe a neighbor will take a walk with your loved one, or a respite caregiver can spend a couple of hours with your loved one while you go to a support group. Is there another family member or friend who can regularly visit? You may also want to check on adult day care centers that have programs for people with dementia. Whatever it is, taking some kind of time off can refill your emotional energy and allow you to continue to care for your loved one well.

How Can Shadowing Be Reduced?

1.   Meaningful Activities

One way to reduce shadowing is to involve your loved one in engaging and meaningful activities. These don't have to be structured activities with a group of people in a facility setting. Rather, they can be right in your own home, and can be part of a reassuring daily routine. The key is for the activities to be meaningful for that person so that they capture her attention, thus reducing her obsession with you. For example, your loved one could fold clothes or towels daily, or work on a jigsaw puzzle.

For more information about meaningful activities, here's an article that lists several ideas: Ideas for Meaningful Activities for People with Dementia

2.   Snacks

The Alzheimer's Association in New York recommends "cereal therapy" or "gum therapy"- where you give the person some food to snack on or gum to chew to occupy them. Of course, make certain the snack you choose is not one that would be likely to cause choking.

3.   Music

You can also give the person headphones with a recording of their favorite musical selections to listen to, or even make a recording of yourself speaking to your loved one to reassure them. Music benefits many people with Alzheimer's, and the familiarity can be calming and relaxing.

You are invited to visit the online Forum to share ideas with other caregivers for coping with some of the challenging behaviors of dementia.

(Source:  about.com, Alzheimer’s/Dementia)

IDEAS FOR MEANINGFUL ACTIVITIES FOR PEOPLE WITH DEMENTIA

While there’s nothing wrong with bingo as an activity, there are many reasons to think creatively when it comes to activities for those with Alzheimer’s disease and other kinds of dementia.

One of the keys is that the activity should be meaningful for the person. Often, meaning is tied to past occupation or hobbies, so what’s meaningful for one person might not be so for another.

Whether you’re caring for a loved one in your own home or for a patient at a facility, consider the person’s interests, occupation and passions. If you work in a facility and don’t know the person’s history, ask their family members or observe their reaction to different activities. Then, choose a few activities they've responded well to and note the areas of interest. Here are a few types of people and corresponding activities to consider.

1.  The Homemaker

For those individuals who primarily took care of a home, you might offer a cloth to dust dressers or handrails, or to wash the table. They might enjoy folding a basket of washcloths and towels, or the task of setting the table. The object here is not to have the individual do large amounts of work, but rather to give the person something familiar and meaningful to do.

Just a note here. If you’re using this idea in a facility, you may want to ask the physician for an order that allows therapeutic work and receive permission from the family as well.

2.  The Fix It Individual

Was your loved one the fixer, the handyman, or the go-to guy? Maybe he’d like to sort through and match up nuts and bolts, or tighten screws into pieces of wood. Perhaps he’d like to connect smaller PVC pipes together. There are also activity boards with lots of “to do” things attached that you can purchase.

3.  The Mechanic

If his passion is cars, maybe he’d enjoy looking at pictures of old cars or tinkering with smaller engine parts. Some towns hold car events where older cars are displayed or driven down a road; if yours does, consider bringing him to that event. He also may be able to help you wash the car.

4.  The Pencil Pusher

For the person who sat at a desk and worked with papers, pens and pencils, she might love having a pile of papers to file, an adding machine or calculator to use, forms to complete or documents to read. Some people might like carrying a notebook and pen around to write down information.

5.  The Musician

If music is her thing, offer her opportunities to use this gift. People in the early to mid-stages of Alzheimer’s may be able to sing in a choir or play the piano. I know one woman with dementia whose leads a sing-along almost daily because of her musical gifts. She’ll even take requests for which songs to play, and despite her poor memory, plays songs almost faultlessly.

If he enjoys listening to music rather than performing it, make recordings of his favorite songs and play them for him.

6.  The Parent / Caregiver

Have you ever noticed how people with dementia often brighten up and take note when babies and children are around?   A child can often get a response when adults fail. Interactions with children and babies have been a normal part of many people’s lives. Sometimes when a person is living in a facility with other people of similar age or living at home and not getting out often, they no longer interact regularly with kids. Create opportunities for interaction with kids, whether that’s arranging for a visiting time, going on a walk together or bringing by your new baby to a facility near you.

Some older adults, particularly women, may also enjoy holding and caring for a baby doll. Often, the person connects with that baby doll and enjoys the sense of a familiar role in caregiving for the doll.

7.  The Animal Lover

If your family member loves pets, consider having him walk the dog with you or brush the dog’s hair. If he’s not able to do these things, he might enjoy having a bird or two in a cage or a fish aquarium to watch.

In the middle to late stages of Alzheimer’s, some people are comforted by holding a stuffed kitten or puppy. I’ve often observed them stroking the fur and holding it close.

8.  The Gardener

Is she an accomplished gardener? Provide her with a place to plant seeds, water them and watch them grow. She might also enjoy flower arranging or harvesting and preparing vegetables.

9.  The Puzzler

Although people with dementia typically have impaired memories, some of them are still quite capable of doing crossword puzzles, word searches and jumbles. Others might enjoy simple jigsaw puzzles as well. Have some different puzzle opportunities sitting out for your loved one to do.

10.  The Engineer

If he collected trains growing up, or is simply fascinated by them, consider setting up an electric train so he can help arrange the tracks or simply watch the activity. You can also gather a book collection or movies about trains.

11.  The Sports Fan

Provide the avid sports lover the chance to mini put, do WI bowling, play the beanbag tossing game or watch a Little League baseball game. You can also arrange for several people to get together to watch the big game on television and eat some junk food, or, I mean healthy alternatives. Or, perhaps he’d get a kick out of sorting through and organizing baseball cards.

12.  The Artist

Art provides a creative outlet to make something, so it provides a purpose and a task. Gather some non-toxic clay, watercolor paints, washable markers, colored pens or pencils, and paper. You can use these materials in a directed way (i.e. “Here’s some clay for you. Today let’s try to make a flower vase” or a non-directed way (“There’s art supplies laid out on the table. Feel free to choose any color of paint to get started.” Clay and paint are great for tactile stimulation and they provide a way to occupy and strengthen the hands as well.

13.  The Faithful

Don’t neglect this important area. For many people, as they age, the importance of spiritual nurturing increases. Offer them books of faith in keeping with their tradition, times of prayer or meditation, or singing together.

(Source:  about.com, Alzheimer’s/Dementia)

NON-DRUG INTERVENTIONS FOR DEMENTIA: 6 STEPS TO DECREASING CHALLENGING BEHAVIORS

Perhaps you're interested in trying some non-drug interventions with a patient or a loved one who has dementia. Although some medications can be helpful in treating the challenging behaviors of Alzheimer's or another dementia, approaches that don't involve medicines should always be the first line of defense. But, do you know where to start?

Some Nursing Professors from Johns Hopkins University are here to help. They published a set of guidelines that outline six steps to take when using non-pharmacological approaches to address behavior challenges in dementia. These guidelines include the following:

1.   Screen for Behavioral Symptoms Early

Try to catch the symptoms in the early stages. You might think that a bout of restlessness is just a short phase, but after someone starts wandering out the door is not a good time to start trying interventions for the first time.

2.   Identify Symptoms.

This may seem like an obvious step, but it's an important one. Taking the time to specifically label behaviors is helpful, especially when the person has more than one challenging behavior.

3.   Delineate the Triggers and Risk Factors for the Symptoms

Look at what precedes the behavior and could be causing it. Consider the following triggers:

•     Environmental Causes

•     Psychological/Cognitive Causes

•     Physical Causes

Also, identify the possible outcome of the behavior.

4.   Choose the Proper Interventions

According to the Johns Hopkins School of Nursing, "an individual with dementia might wake repeatedly each night, voicing fear of being alone in the dark, despite continuous calming efforts. An intervention might mean simply using a nightlight in the patient’s room, or adding long family walks in the evening, to help promote better sleep."

5.   Evaluate the Intervention to make sure that it’s working.

Documenting the behavior and the intervention, as well as the effectiveness of the intervention can prevent you from errors in recall. For example, remembering the one time the intervention didn't work because that stands out in your mind but not the five times it was effective can warp your accuracy and cause you to discontinue an approach that actually may be quite helpful. You can also note the time of day that the behaviors occurred to determine if there's a pattern in the timing.

6.   Follow the Patient’s Progress Over Time

The behaviors of people with dementia often change over time, necessitating a re-evaluation of the above steps. As Alzheimer's disease progresses through the different stages, new behaviors can emerge and previous ones may resolve.

Remaining committed over time to the primary use of non-drug approaches requires an intentional switch in perspective. Rather than thinking immediately about which medication might be effective, train yourself to think about these six steps and make changes in the environment or care of the person first.

Finally, it's important to note that there are some symptoms or circumstances that may necessitate the use of medications, such as the continual presence of distressing hallucinations, delusions, or paranoia. The goal in dementia care is the care and comfort of the person, so if non-drug interventions aren't facilitating that, medications may need to be utilized and then carefully monitored.

(Source:  about.com, Alzheimer’s/Dementia)

PARANOIA AND DELUSIONS IN ALZHEIMER'S DISEASE

What Is Paranoia?

Paranoia is an unrealistic fear or concern that harm is imminent or that others are out to get you. A paranoid person does not generally accept other explanations and may blame you if you try to use logic to reason away their fears.

Some people experience paranoia if they have a psychological disorder like schizophrenia. Others develop it in relation to different medical conditions, including Alzheimer’s, other dementias or delirium.

What Are Delusions?

Delusions are fixed (not easily changed) false beliefs. Dementia often results in paranoid delusions, where there may be a fixed belief that someone is poisoning the food or stealing money. Other delusions, infrequently experienced by those with dementia, include delusions of grandeur, where there is the false belief that one has extra power or a higher position in society or the world.

An Example of Paranoia and Delusions in Alzheimer’s

Alzheimer’s can change the way others are perceived. For example, you may have always had a good relationship with your father and are trying to help him with his finances. Instead of being grateful for your assistance, your father, who has Alzheimer's, might accuse you of trying to take his money or "pull one over" on him.

Common Delusions in Dementia:

·         Spouse/partner is being unfaithful.

·         Someone else is living in their home.

·         Their belongings/money are stolen.

·         Others are out to get them.

·         Food is poisoned.

·         Prevalence of Delusions in Alzheimer’s Disease

Approximately 30% to 40% of people with Alzheimer’s will develop delusions at some point during the disease, many of them being paranoid delusions. The incidence may be increased in those who have a history of abuse or trauma.

Delusions appear to be more common in Parkinson’s-related dementia, vascular dementia and Lewy Body disease (LBD), with up to 70% of people with LBD experiencing delusions or hallucinations.

Could Paranoia or Delusions Be a Sign of Delirium?

If paranoia or delusions are a new behavior for your loved one or someone you’re caring for, consider the possibility that she might be experiencing delirium. Delirium is a sudden change in thinking and orientation, usually quite reversible, brought on by a physical condition such as an infection, surgery or other illness.

How Can You Decrease the Likelihood of Paranoid Delusions in Alzheimer’s?

Be careful what television shows are playing in the background. To you, it might just be background noise, but to a person who’s confused, violent or fear-provoking shows may trigger fear and paranoia for that person. For the person with Alzheimer’s, the line between reality and fantasy can easily become blurred.

Ensure that your loved one is receiving the correct medication doses. Too much or too little medication can affect a person’s mental and emotional stability.

If you’re providing care for someone in a facility, try to keep the routine as consistent as possible. A regular rhythm of the day and familiar, consistent caregivers help reduce anxiety and stress for people.

Responding to Paranoid and Delusional Behavior in Alzheimer’s:

·         Provide reassurances.

·         Remain calm.

·         Explain any procedures before performing them.

·         Avoid laughing or whispering near the person.

·         Don’t agree with the person that you did something that you didn’t do.

·         Use a behavior log (a way to track behaviors) to identify triggers and times of day they occur.

·         Don’t argue.

·         Use distraction.

·         Enter into their world. Put yourself in their shoes.

·         Help them look for things they think are stolen or missing.

·         Have duplicates of things they lose and think are stolen.

You may also need to consider the possibility that their fears are accurate - that someone is actually taking advantage of them. Older adults can be vulnerable to different types of abuse, including financial and physical. Most delusions in dementia really are delusions, but a healthy awareness (not constant suspicion) of others is the better part of wisdom.

(Source:  about.com, Alzheimer’s/Dementia)