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Ask Kurt, Home Care 101: How to cope with Sundowning

Ask Kurt: Is a new column by Professional Homecare expert Kurt Leggard, a registered Nurse Chief Clinical Officer -Director of Patient Services for a Licensed Home Care Services Agency in NYS. Each week Kurt will be answering your questions regarding Home Care.

Home care, is supportive care provided in the home. Care may be provided by licensed healthcare professionals who provide medical care needs or by professional caregivers who provide daily care to help to ensure the activities of daily living(ADL’s) are met. Also, very similar to RIGHT ACCORD HOME HEALTH CARE, In-home medical care is often and more accurately referred to as “home health care” or formal care. If you’re looking for an elderly care facility, The Hermitage of Northern Virginia has very nice assisted living facilities in Alexandria VA.

This weeks question is from Stephanie in Sag Harbor, NY

Question: My question is this: What do you recommend to cope with “sundowning” , a condition of extreme irritability of older people between 5pm and 7pm…hard time for caregivers to handle.

ASK KURT:

Kurt: Thank you for the question Stephanie. As defined, ‘Sundowning’ is characterized as a spectrum of behaviors of individuals with a diagnosis of Instant Coupons!“>Alzheimer’s Disease or other dementias with the individual presenting as agitated, extremely confused and sometimes combative beginning toward the end of the afternoon to early evening sometimes extending through the entire night. Basically, when the sun goes down.

I tend to begin any recommendations with addressing ‘Sundowning’ as a condition that is very stressful for the caregiver as well as a potential safety risk for the sufferer. It is imperative that the caregiver takes care of their own health care and emotional needs and gets appropriate rest and respite to handle the rigors of caring for the individual suffering with ‘Sundowning.’ Please get support if you can.

The immediate things you can do for the sufferer is to ensure that a recent medical examination has been conducted to determine if there are any medical conditions that may be the underlying cause for the ‘Sundowning.’ If an individual is in pain, this may cause ‘Sundowning’ to start or become more pronounced as will severe constipation, Urinary Track Infections, poor nutrition, dehydration and many other conditions.

If the sufferer tends to wander (a possible secondary affect), it is very important to conduct a complete environmental review of the client’s home. Remove safety hazards (loose carpets or rugs, telephone or lamp wires, use night lights, etc) to prevent falls. If the client is at risk for wandering out of the home, safety door locks should be installed out of the reach of the client but easily accessible to the caregiver. Visible signs inside and outside of the door to identify where the lock is located can be helpful if there is a need for an emergency evacuation, as in the case of fire.

There is nothing more frightening than a love-one wandering outside and lost. Safety locks can prevent this. Do not lock a sufferer indoors without appropriate supervision. If a lock is needed, then there is a great chance that ongoing supervision is indicated (consider the many Homecare options available but be cautious to consider caregiver compatibility and costs).

The following are my recommended interventions: Maintain a routine for the sufferer. Stress will exacerbate ‘Sundowning’ and routines reduce stress. Maintain or increase the activity status of the sufferer during the day and avoid naps if possible. Naps can tend to disrupt the clients nighttime sleeping pattern. As the sun light in the sufferer’s home decreases through the afternoon to the evening, increase the amount of lighting used in the home. The use of lights will reduce one of the triggers of ‘Sundowning.’ Reduce foods that have caffeine and sugar during dinner and snacks. Keep snacks light prior to going to sleep. Ensure that the sufferer has had adequate hydration during the day (the elderly are prone toward dehydration) but reduce fluids at night to minimize nighttime urination (nocturia). Minimize disturbances during the night This seems pretty reasonable but is sometimes difficult to manage, depending on outside traffic, neighbors, etc.

I read in Healthline.com (http://www.healthline.com/ ) that each sufferer has triggers that lead to ‘Sundowning’ and they recommend keeping a journal, recording all triggers to be avoided. Great recommendation!

A final or perhaps initial intervention may be to medicate the sufferer based upon their symptoms and behaviors. Interestingly, some medications may themselves be the cause (trigger) for what appears to be ‘Sundowning’ but may actually be causing medically induced insomnia and confusion. Review all medications the sufferer is taking with their physician or nurse practitioner to determine if medication may be the cause of the problem.

Ultimately, this is a very difficult and challenging circumstance for caregivers to handle. It can be very exhausting and frustrating for everyone involved. A combination of the recommendations offered will hopefully provide some answers and work for you. Get plenty of rest and support if possible. (please review Web MD (http://www.webmd.com) and the Alzheimer’s Association ( http://www.alz.org/nyc/ ) for excellent information.

Each week I will be answering your Home Care Questions: Email your questions to HamptonsMouthpiece@gmail.com

Homecare is Expensive! Greeting’s Hamptons Mouthpiece Readers…Most of my Sag Harbor friends know me as a photographer but my profession, I am a Registered Nurse with a background in elder care. My responsibilities include running one of the larger Medicaid Homecare service agencies in NYC. So I thought that I would talk to you about…. Estate Planning.

While I am no expert in this field, I have first hand seen the devastation thatcan impact families that do not plan for the inevitable health declines in our parents and significant others as aging and subsequent health issues arise. It is an important part of life that we all have to contend with soon or later, so a support plan may be worth looking into such as where to find a good homecare, you may want to begin with somewhere similar to GYC Senior Care – see more at gycseniorcare.com. It is imperative that well in advance of these calamities, you seek an Elder Lawyer who can help you prepare your family’s finances to protect your wealth.There are many legal vehicles that will allow you to shelter your loved ones assets such as Pooled Trusts, which will allow for you to provide the care and services that the sick and frail will need in their declining years while simultaneously protecting and allocating assets for this purpose.

elder2Homecare is EXPENSIVE and can quickly overtake any savings that have been accumulated. You should invest in a Long Term Health insurance policy that will provide some limited coverage for homecare if those services are required. Please conduct your due diligence in researching the insurance company that you chose to join. It is imperative that you investigate the financial health of the company you choose. The most unfortunate thing that could happen is that you contribute toan insurance company that goes belly up because THEIR financials were not in order. BEWARE!!! Carefully read your policy to understand what you are entitled to regarding homecare. Some simple math will illustrate what can happen to your finances if you will need homecare from an aide. 8 hours of service per day x 7 days weekly x 52 weeks at $15 per hour for a home health aide will cost $43,680 per year. Multiply this by 5 years and you get $218,400. What you should know is that the risk for health status to decline and the elderly needing more services than 8 hours daily…well, you get the picture. Please take my advice. Plan ahead.

Here’s to your good health!

Kurt H. Leggard, RN**Contributor

Program Director

Personal-Touch Home Health Services

October is “National breast cancer awareness month” This is a cause that is near and dear to my heart because 26 years ago my mother was diagnosed with breast cancer and underwent both chemotherapy and radiation. September 2017 she made 25 years cancer free, she was very happy about that, unfortunately she died from complications of Heart Disease, but not before celebrating her anniversary of being cancer free. I thought it was very important to discuss breast cancer, know the facts, the risks, and the signs.

According to “Cancer.org” In 2015, it was estimated that there would be 1,658,370 new cancer cases diagnosed and 589,430 cancer deaths in the US.

In 2018 it is estimated that there will be 1,735,350 new cancer cases diagnosed and 609,640 cancer deaths in the United States. Breast Cancer awareness is helping.

These are staggering numbers and of particular concern to me since I am a high risk woman given that my mother did have breast cancer. When my mother was going through breast cancer and had to have Chemo and surgery she was so sick and she lost her hair…I was so scared about getting the disease because all I could think about was losing my hair and my breast, how superficial I was. I defined my beauty to my hair and breast like many other women. Seeing how strong my mother was and how beautiful she looked bald, I realized I could not allow my breast and hair to define who I am as a person. Don’t get me wrong I like my hair and I complain about bad hair days just like 95% of the total female population but I don’t stress about it. No need to stress on things you can purchase…if you lose your hair, you can buy a wig…you lose your breast you can buy new ones…problem solved. Focussing on the disease is all that matters, that is why it is important to know the risk, recognize the signs and to take action on prevention care.
Everyone is at risk for breast cancer.

  • Being a Woman
  • Overweight
  • Increased Age
  • a family history of breast cancer or a personal history of breast or ovarian cancer

There are some factors that can increase a person’s risk, but some people develop breast cancer when the risk factor is not present. I would like to also add that there are men that develop breast cancer and younger women as well. Recognizing the signs are very important to early detection and being cured. Performing breast self-exam will help you know your body and what is normal and not normal. If you notice a change, you should see your doctor immediately. Here are some possible warning signs:

  • Lumps, a hard knot or thickening in any part of the breast
  • Swelling, warmth, redness or darkening that does not go away
  • pulling in of the nipple or other parts of the breast
  • New Pain in one spot that does not go away

Early detection is key in diagnosing breast cancer. Many cases of breast cancer are found by monthly breast self-exams…an annual mammogram is one of the single most effective methods of early detection. No one looks forward to having a very uncomfortable mammogram, especially women like myself who are well-endowed and you feel like your breast has just been smashed like a pancake. The sooner a problem is found, the more treatment options are available and the better chance you have of beating the disease and living a full healthy life. Once breast cancer has been detected, that is when all energy can be focused into enjoying life and defeating the disease. If somebody close to you is battling breat cancer, then it is imperative that you do whatever you can to help them enjoy every second as much as possible. Whether this be through gifting breast cancer flowers or any other methods, its crucial that they know how much we love them. I hope this reaches someone and you decide to take action, your life is important so you must take care of yourself. If health insurance is an area of concern, there are many services that offer FREE mammograms, all you have to do is ask. I am grateful that I have not been diagnosed I continue to do monthly BSF and I have yearly mammograms, no one knows why and how many women get breast cancer but if I am meant to get I will have a better chance of survival because I do partake in preventive care. I need to be around to nag my husband, drive my girls completely crazy and plan all of my friends birthday celebrations…until next time read Hamptons Mouthpiece….always keeping you in the know!!!! October is National Breast Cancer Month

According to New York State Breast Cancer Services: “Breast cancer is the most common cancer among women in New York. It is also the second leading cause of cancer-related death in New York women. The best protection against breast cancer is early detection and diagnosis. Governor Andrew Cuomo has increased awareness and screening for breast cancer, including a public awareness campaign, community outreach programs, patient navigators, and mobile mammography vans.”

  • Require 210 hospitals and hospital extension clinics to offer extended hours of screening for at least four hours per week to help women who have difficulty scheduling mammograms during the typical 9 a.m. to 5 p.m. workday.
  • Eliminate annual deductibles, co-payments, and co-insurance payments (“cost-sharing”) for all screening mammograms, including those provided to women more frequently than current federal screening guidelines such as annual mammograms for women in their forties
  • Eliminate cost-sharing for diagnostic imaging for breast cancer, including diagnostic mammograms, breast ultrasounds, and breast MRIs for women at high risk for breast cancer.
  • Adds public employees of cities with a population of one million or more, to the population of public employees in New York State who are currently allowed four hours of leave for screening for breast cancer each year.
  • The NYS Cancer Services Program offers free breast cancer screening and diagnostic services for uninsured, eligible New Yorkers.

Click on link to read more about New York’s new legislative agreement: READ MORE

For more detailed data click on link to see the Breast Cancer facts and Figures 2017, read more at www.cancer.org

Cancer.org

Schedule your routine mammogram at one of The Ellen Hermanson Breast Center’s three locations on the East End:

Stony Brook Southampton Hospital
631-726-8285

240 Meeting House Lane
Southampton, NY
Monday, Wednesday, Friday 8:00 AM – 4:00 PM
Tuesday, Thursday 8:00 AM – 5:30 PM

Stony Brook Southampton Hospital Radiology at the Atrium
631-723-1232

Hampton Medical Atrium
182 West Montauk Highway, Building B
Hampton Bays, NY
Monday – Friday 8:00 AM – 4:00 PM

Stony Brook Southampton Hospital Laboratory & Imaging East
631-329-8543

East Hampton Healthcare Center
200 Pantigo Place
East Hampton, NY
Monday – Friday 7:30 AM – 3:15 PM
Saturday 8:00 AM – 11:45 AM

 

Hamptons Teen: CALL ME OLD-FASHIONED, but I’m Just a DAD
I have become increasingly aware and worried about the relaxed attitude of illicit drug use among teens in the Hamptons and beyond. But what are our teenagers to think? They see a more relaxed and accepting attitude regarding the use of marijuana due to the reduction of legal penalties and the sale of marijuana for recreational use in multiple states. This is in the news and has become a part of their realities.Happy Group Of People
What our teenagers do not realize is the increased documentation about the effects of marijuana on the teenage brain. We know that the development of the brain is very fluid until or between the ages of 21-25 years old. The way in which the brain is wired is open to impact by this and other drugs. I am not a prude nor am I unaware of the opportunities, interest, curiosity and pressure to smoke weed. A lot of us did it when we were young. But this isn’t our father’s (and mother’s) weed no more. Things like the juicy fruit strain are a lot different to what was being smoked back in the day. The THC (active ingredient that produces the high) content is many times more concentrated in today’s marijuana than in the weed our generation smoked. Many ‘brands’ of weed are genetically improved to the form of designer status. I’ve also recently heard that there are different ways that you can smoke weed these days, like through a helix pipe for example. Apparently it’s a cool thing to do. Consenting adults should have the option of doing whatever they want to do but it is imperative to fully inform our teenagers of the risks inherent in smoking pot.
I have the same concerns about smoking cigarettes and underage drinking that I have towards smoking weed and I feel to some extent, these are a more insidious and risky behavior that is impacting our teenagers. I cannot tell you what is the percentage of teenagers smoking and drinking but I feel it is over 50% of the population. Maybe I’m old-fashioned but if you were to ask both of my daughters (18 and 25), I still harp on the need to show restraint and to use some forward thinking concerning their future plans and how use and abuse can derail their goals. Believe me, they get tired of ‘the talk’ but I continue just the same. Am I being successful… I don’t know but I hope so. They lead their own lives, much of the time out of my view but I do what I do anyways because I must! I have no illusions, I can’t protect them all the time, nor should I or will I try. I will tell them the real deal, give them the tools to make good decisions and pray for the best.
EVERYONE has my permission to warn me if they think my child’s behavior is a risk to them and I do not care if they don’t like it. If your kids have come to my house, they may have heard some rendition of ‘the talk’ as a natural inclination of mine to be protective and proactive towards the friends of my children. My kids have probably warned them to expect it sometimes. AGAIN, I don’t care. I will not preach or teach but this is a part of the way we conduct business in our home. I will not stop!
Now don’t get me wrong, I remember being a teenager and doing LOTS OF STUFF. I will not be a hypocrite and tell them to ‘do as I say and not as I do’. But the risks of life long impacts secondary to social media and ‘selfies’ of illicit behavior that can follow them FOREVER…there are no do-overs anymore. Society can be very unforgiving. We did not have to face these risks. Remember, the definition of a teenager is filled with doing DUMB THINGS. But it is this risk taking and feelings of invincibility that makes them so powerful and dynamic. It will be hard to convince them of the dangers because they LIKE danger!
One more trend that I am seeing; the use of illegal performance enhancing drugs (PED’s). The use of Human Growth Hormone and steroids among teenage athletes has increased exponentially. Kids want to look better and perform better and they are getting access to and using these drugs more and more. The lifelong effects of these PED’s and the health impacts are so pronounced and damaging that it is imperative that parents and adults of teenage athletes inform them of the risks. Encourage your school teams to educate their athletes of the dangers and make it part of their athletic curriculum.
From me to you….JUST BEING A DAD

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Hamptons Wellness: The Benefits of Ginger: Ginger is widely used throughout the world for treating loss of appetite, nausea and vomiting after surgery, nausea resulting from cancer treatment, flatulence,stomach upsetcolicmorning sickness and motion sickness.

Some people find ginger helps them with the symptoms of upper respiratory tract infection, bronchitis, cough, menstrual cramps, arthritis and muscle pain.

In some parts of the world, ginger juice is applied to the skin to treat burns

GINGER: Nausea, upset stomach…When I was pregnant with both of my daughters I have really bad morning sickness and I was nauseous all the time, literally until they were born. This is why they are 6 1/2 years apart and why I only have 2.

Some say drink Ginerale & Saltine Crackers but the sugar from the gingerale made me feel sicker…Ginger Tea is the Best..Treat yourself to a cup of piping hot ginger tea, a healthy drink that’s great for digestion. Why go out and buy old tea bags when you can easily make your own homemade ginger tea at home using fresh ginger? Here’s how to make the tastiest ginger tea you’ve ever had!

Home-made Ginger Tea
Recipe Type: Tea
Cuisine: Liquid
Author: Vanessa Leggard
Prep time:
Cook time:
Total time:
Home-made ginger Tea…piping hot ginger tea, a healthy drink that’s great for digestion
Ingredients
  • 4-6 thin slices raw ginger
  • 1 1/2 – 2 cups water
  • juice from 1/2 lime, or to taste
  • 1-2 tbsp honey or agave nectar, or to taste
Instructions
  1. Peel the ginger and slice thinly to maximize the surface area. This will help you make a very flavorful ginger tea.
  2. Boil the ginger in water for at least 10 minutes. For a stronger and tangier tea, allow to boil for 20 minutes or more, and use more slices of ginger.
  3. Remove from heat and add lime juice and honey (or agave nectar) to taste.

9 Terrific Benefits of Ginger

  •  Eat fresh ginger just before lunch to stoke a dull appetite and fire up the digestive juices.
  • Ginger improves the absorption and assimilation of essential nutrients in the body.
  • Ginger clears the ‘microcirculatory channels’ of the body, including the pesky sinuses that tend to flare up from time to time.
  • Feeling airsick or nauseous? Chew on ginger, preferably tossed in a little honey.
  • Ginger helps reduce flatulence!
  • Ginger helps with Tummy moaning and groaning under cramps? 
  •  Ginger, with its anti-inflammatory properties—can bring relief. Float some ginger essential oil into your bath to help aching muscles and joints.
  •  Chewing ginger post-operation can help overcome nausea.
  • Stir up some ginger tea to get rid of throat and nose congestion. And when there’s a nip in the air, the warming benefits of this tasty tea are even greater

Hamptons Wellness: The Benefits of Ginger: