Month: June 2021

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Depression & Anxiety in the Elderly

Depression

What it is: Depression is a mental disorder marked by a sad or irritable mood lasting more than two weeks.

What it is not: Everyone gets sad or irritable from time to time, but for most people these moods only last for a few hours or a few days. When these feelings last for several weeks without improving, a person’s way of thinking can be altered, and the person may become clinically depressed.

Who gets it: About 5% of the population suffers from depression, but this number increases with age, disability, or illness. Depression is four times more likely to strike individuals over age 65 than younger people. Fifteen percent of older adults are depressed. People with disabilities or illness, and those who take care of them, have depression rates ranging from 20% to 50%.

What causes it: Depression has many different causes, such as

• Medication side effects, particularly from drugs used to treat arthritis, heart problems, high blood pressure, or cancer.

• Illnesses such as Alzheimer’s disease, Parkinson’s disease, stroke, hormonal disorders, and others.

• Genetics—it may run in families.

• A traumatic event, such as a death in the family.

• Changes or differences in brain chemistry.

Depression is Not a Normal Part of Growing Older | Alzheimer’s Disease and Healthy Aging | CDC

Anxiety

What it is: Anxiety is a feeling of concern or worry, and it includes increased alertness or

awareness. It can be mild, moderate, or severe; when very severe, it can become a state of panic.

What it is not: Mild to moderate anxiety is a normal part of living and can even be helpful when we must focus on something urgent or important. As a normal reaction to a stressful situation, it helps us act. When anxiety becomes a long-term condition, or becomes severe, the person becomes overly focused on specific details and cannot think of anything else. In this case, most of the individual’s behavior is directed toward relieving the anxiety.

Who gets it: From 3% to 8% of the population have severe anxiety, with about 15% of people experiencing it at some point in their lives. It is a very common disorder in the elderly and is more common in women than men.

What causes it:

Some of the many causes of anxiety are:

• Persistent stress.

• Extreme change.

• Illness, particularly cancer, heart disease, and chronic illnesses.

• Chemical changes in the brain.

• Abnormal brain functioning.

• Medication side effects.

• Drug abuse or withdrawal.

Anxiety in Older Adults | Mental Health America

Signs and Symptoms of Depression and Anxiety

Signs of Depression

If a person has four or more of these symptoms lasting two weeks or more, he or she may be depressed.

• Sad, depressed, or apathetic mood. May cry a lot or complain of feeling empty.

• Irritability, agitation, grumpiness.

• Disturbed sleep—either difficulty sleeping or sleeping more than usual.

• Fatigue and loss of energy.

• Changes in appetite and weight either increased or decreased.

• Loss of interest or pleasure in normal activities, such as self-care or social activities. Withdrawal from others.

• Feelings of worthlessness, guilt, helplessness, hopelessness, or self-reproach.

• Thoughts of death or suicide, or attempted suicide.

• Difficulty thinking, concentrating, focusing, or remembering.

• Slowed or agitated movements or speech.

• Complaining of aches and pains, dizziness, blurred vision, racing heart, anxiety, or vague discomforts.

• Constant complaining.

• Mood swings.

• Excessive alcohol use.

Signs of Anxiety

There are five main types of severe anxiety, and each has different symptoms.

• Generalized anxiety disorder: This condition involves excessive and unreasonable anxiety and worries lasting at least six months. Signs include restlessness, fatigue, difficulty concentrating, irritability, muscle tension, shaking, crying, pacing, sweating, rapid breathing, rapid heartbeat, fearfulness, and sleep problems.

• Panic disorder: People with this condition have recurring attacks of panic. They may have dizziness, faint feelings, sweating, trembling, chills, flushes, nausea, numbness, heart palpitations, or chest pain. These attacks occur suddenly and last several minutes.

• Obsessive-compulsive disorder: This disorder causes recurrent and persistent thoughts, impulses, or images that are unwanted and inappropriate. The person performs repetitive behaviors in response to these thoughts.

• Phobias: These irrational, intense fears of certain things or situations interfere with normal functioning.

• Posttraumatic stress disorder: This occurs after a person experiences or witnesses a traumatic event. Symptoms include recurring memories, nightmares, and flashbacks.

What should be done?

Even though depression and anxiety are common, they are NOT normal, even among the disabled, ill, or elderly. These signs should always be reported to a physician. Other diseases can cause some of these symptoms, so the doctor will have to decide on a diagnosis and a treatment. Never assume that these signs are a normal part of disability, illness, or aging.

Preventing Depression and Anxiety

Although many types of depression and anxiety cannot be prevented, there are some general things that everyone can do to lower the risk of developing these conditions.

1. Keep and maintain friendships and social activities.

2. Develop enjoyable interests or hobbies.

3. Stay physically active. Exercise and stay physically fit.

4. Stay mentally active. Read, take classes, and learn new things.

5. Maintain contact with family members.

6. Eat a balanced and nutritious diet. Avoid sugar, caffeine, and alcohol.

7. If you take medicines that might have depression or anxiety as side effects, follow the doctor’s directions on using the medicines to lower the risk of those side effects.

Caring for people with Depression or Anxiety

Depression: The goal of care is to lift the person’s mood.

• Encourage depressed people to express their feelings. Listen to what they say. Accept them as they are without making judgments. Give them time to get their thoughts together and to tell you what they are thinking and feeling. Help them feel valued.

• Brighten the environment by hanging pictures, posters, or family pictures. Make family photo albums easily available. Keep the environment neat and clean.

• Encourage pleasant activities, such as listening to music or performing a hobby.

• Encourage socialization. Start with one-to-one conversations, and gradually help them participate in larger social events.

• Encourage daily exercise or activity. Even the disabled can usually move a few body parts.

• Encourage as much self-care as possible. Help the person gain a sense of control by letting them make as many independent decisions as possible.

• Pay attention if someone talks of self-injury or suicide. Always report this talk to a

supervisor.

• Be sure that the person takes his or her medications in the correct way and at the correct time.

Anxiety: The goal of care is to lower the person’s anxiety level.

• Listen to a person’s fears and anxieties. Respond with reassurance and support.

• The environment should be quiet and less stimulating than normal.

• Many people will never become completely free from anxiety. Help them learn to accept and tolerate a certain level of worry and anxiety. If they believe that you will assist them with their problems and keep them safe, their anxiety may be relieved.

• Sometimes an anxious person can be distracted if you help them think about something pleasant or relaxing or have them picture a peaceful image.

• Help the person relax each muscle, guiding him or her to relax every muscle consciously and progressively from head to toes. Instruct him or her to breathe slowly and deeply.

• Help anxious people recognize that, although their feelings are real, their fears are not based on reality. Gently point this out: “You’re feeling anxious, but you are really okay.”

• Ensure that medications are taken as prescribed.

The Warning Signs of Suicide

Sometimes anxiety and depression occur together, or one may lead to the other. People suffering from either of these illnesses may decide they want to end their life. It is important to be alert to things that might indicate a person is seriously considering suicide. The suicide rate is twice as high in people over age 65 as it is in younger age groups. Untreated or mistreated depression can lead to suicide.

Pay attention to these warning signs and report them:

• Talking about suicide. Statements such as “I have no reason to go on living” are danger signs.

• Being preoccupied with death.

• Giving things away.

• Stockpiling pills or obtaining some sort of weapon.

• Refusing to follow doctor’s orders about medications or diet.

• Making unusual visits or calls to family and friends and saying goodbye to loved ones.

• Getting affairs in order or making funeral arrangements.

• Losing interest in things or people that used to be important.

• Suddenly becoming happier and calmer after a period of depression or anxiety.

• Talking about how worthless or helpless they are, saying that they have no hopes or plans.

Suicide Prevention

Here are some things you can do to help prevent someone from taking their own life:

1. Recognize anxiety and depression in others and help them get appropriate treatment.

2. Remove any weapons and be sure the environment is safe and secure.

3. If you suspect that someone is thinking about suicide, ask them if they are. Do not be afraid that you will be giving them ideas. If they tell you they are having these thoughts, report it.

4. Be sure a depressed or anxious person is seeing the doctor as ordered and getting their medications.

5. Reassure a suicidal person of how much you care. Explain that depression is no one’s

fault, that it can be treated, and that suicidal thoughts are temporary and will go away.

6. Do not try to minimize the individual’s problems. Don’t tell him or her how hurt his or her family will be or that he or she has everything to live for, because doing so just makes him or her feel guilty and even more hopeless.

7. If you suspect that someone is thinking about suicide, always report your suspicions to the appropriate person. Do not think that you are imagining things or getting worried for nothing. It is much better to be cautious in this situation.

6/24/2021 Emalee Walton

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The Importance of Movement

Why is Motion Important?

Most people take free, comfortable movement for granted. Motion is meant to be smooth and painless. The ligaments, tendons, muscles, and joint capsules that surround each joint in the body work best if they are used regularly. As people get older, however, muscles gradually lose their strength, endurance, and flexibility. We experience a progressive loss of muscle mass at an average rate of 4% per decade from 25 to 50 years and 10% per decade thereafter. In addition, the joints in older people change, often becoming stiff and difficult or painful to move. Tissues in the joints sometimes become swollen or inflamed, hindering movement, and making the joints more prone to injury. As a result, people tend to move less as they age. This is the worst thing we can do. Lack of activity worsens the changes that occur with aging. Research confirms that regular exercise can slow or reverse many changes associated with the age-related loss of strength, endurance, and flexibility.

When people are not physically active, every cell and system in the body is affected. The body’s cells and systems begin to lose the ability to perform their specialized functions. When movement is difficult, people experience a general decline in quality of life. Self-image often suffers. Lack of activity and exercise can lead to heart disease, diabetes, stroke, and other health problems. Decreased mobility hinders one’s ability to feed and clothe oneself, to grocery shop, and to attend to personal hygiene. It promotes mental deterioration and loss of independence. In addition, when muscles are not used, they continue to weaken. Muscle weakness increases the risk of falls, and, therefore, of fractures. The risk of falling increases with age. Falls are the leading cause of injury death for people ages 65 and older. 9 Enjoyable Activities for Seniors with Limited Mobility – DailyCaring

What kinds of Motions are Best?

There are four types of exercise:

→ Strength

→ Stretching

→ Endurance (also known as Cardiovascular)

→ Range of Motion

Exercise benefits people of all ages. Regular exercise can slow or reverse the decrease in mobility that contributes to disease and disability in the elderly.

Strength: Even a small change in muscle size can make a big difference in strength. That is why strength exercises are so important. Improving muscle size by lifting small weights helps people build their capacity to do such things as walk, climb stairs, and carry a package. These kinds of activities can mean the difference between keeping one’s independence and relying on others.

Stretching: Stretching exercises that gently stretch the muscles and tendons help ensure flexibility. Stretching exercises do not build strength or endurance. Clinical research has demonstrated that most elderly, even the frail, benefit from a combination of flexibility and strengthening exercises. It helps them maintain function and mobility, prolong independence, and improve their quality of life.

Endurance: Walking, Running, Bicycling, and Swimming are examples of endurance exercise. By spending time in motion, the body and muscles become able to endure for longer periods of time, and the heart and lungs become stronger.

Range of Motion: Range of Motion exercises are designed to increase flexibility. Range of motion (ROM) is the normal amount a person’s joints can be moved in certain directions, or the range in which you can move a body part around a joint. Limited range of motion is a reduction in the normal distance and direction through which a joint can move. When a joint is not fully extended on a regular basis, over time it will become permanently unable to extend beyond a certain fixed position. To keep the joints, tendons, ligaments, and muscles loose and flexible, ROM exercises are used. These exercises move the joints through a full range of motion, helping to prevent stiffening.

Getting Started

Get started by doing a little exercise regularly, even in small ten-minute increments several times a week, it is possible to offset a variety of health problems. Exercise can help produce new red blood cells, strengthen the immune system, and improve bone density. Physical Activity, even at low intensity in short sessions, may reduce the risk for certain chronic diseases. Exercise also helps relieve depression.

Exercise Tips

→ Move joints through their full range of motion 1–2 times a day.

→ Do each exercise 3–10 times.

→ Move slowly. Do not bounce.

→ Breathe while you exercise. Count aloud.

→ Begin exercises slowly, doing each exercise a few times and

gradually building up.

→ Try to achieve full range of motion by moving until you feel a slight stretch, but don’t force a movement.

→ Stop exercising if you have severe pain.

→ Encourage clients with limited mobility to bear weight during transfers from bed to chair, and to walk whenever possible.

Range of Motion exercises that can be done while seated.

• Neck (Breathe with the movements, breathing out when the head moves down, breathing in when it moves up. Don’t let the shoulders or upper body sway to the side.)

1. Turn head slowly to the right, then to the left. Repeat three to four times.

2. Tilt head toward one shoulder, then toward the other shoulder. Repeat 3–4 times.

• Arms and Shoulders

1. Raise shoulders up toward ears and hold. Make full circles: up, forward, down, and back.

2. Take a deep breath, extend arms overhead. Exhale slowly, dropping arms.

• Hands and Fingers

1. Massage each hand, one at a time. Take your time; go in between each finger.

2. Raise hands up and back. Slowly rotate hands down and around in circles.

3. Close hand in a fist. Open hands fully, stretching fingers and thumbs out wide.

• Chest and Upper Body

1. With hands on waist, tilt to the right, return to center, then tilt to the left and return to center. Exhale as the movement goes down; inhale as the movement comes up. Don’t allow upper body to tilt forward. Don’t try to hold head up; instead, let it relax to the side.

2. Sit straight in chair with hands on your hips. Gently rock hips from side to side.

• Legs

1. Raise right leg up and forward. Repeat with left leg.

2. Sit up straight, knees together, with legs extended forward as far as possible, keeping feet on floor. Slowly stretch forward, sliding both hands down to ankles.

Hold 10–15 counts.

3. Grasp one knee with both arms, pull to chest, and hold for five counts. Repeat with opposite leg.

• Ankle and Foot

1. Point toes toward floor. Point toes toward ceiling. Slowly rotate feet in circles.

2. Cross right leg over left knee. Rotate foot slowly, making large complete circles—ten rotations to the right, ten to the left. Repeat for left leg.

Passive Range of Motion Exercises

When an individual can perform range of motion exercises with minimal assistance, the person is doing active range of motion. When an individual is unable to perform range of motion exercises, a caregiver should move the person’s joints in passive range of motion exercises at least once or twice a day.

Know these Terms!

Flexion: Forward Bending

Extension: Straighten Out

Hyperextension: Backward Bending

Lateral flexion: Sideways Bending

Internal Rotation: Turn toward the body.

External Rotation: Turn away from the body.

Circumduction: Move in a circle

Abduction: Move away from the body. (Think of “abduct,” or “take away”)

Adduction: Move toward and/or across the body. (think “add to the body”)

Inversion: Move or twist inward

Eversion: Move or twist outward

Supination: Turn or lie upward; face up

Pronation: Turn or lie downward; face down

Positioning:

Everyone positions themselves when they sit, stand, move, and lie down. The position we use for these activities affects circulation, joint pressure, and muscle use. People with limited mobility who sit or lie down for long periods of time are prone to skin breakdown and deterioration of muscles or nerves. Using correct positioning can prevent these problems. It is important to limit pressure over bony parts of the body by changing positions. Use pillows to keep knees and/or ankles from touching each other. Clients who are bedridden should avoid lying directly on their hipbones when on their sides. Help clients to use positions that spread weight and pressure evenly, with pillows placed to provide support and comfort. A person in a chair or wheelchair should use a cushion. Avoid donut-shaped cushions because they reduce blood flow and cause tissue to swell. People sitting in chairs or wheelchairs should change positions every hour. Good posture and comfort are both important.

Some Basic Rules of Positioning

→ Always be familiar with a client’s plan of care. Specific issues such as fractures, skin integrity, and health condition will determine the type of positioning that should be done.

→ Turn individuals who cannot turn themselves at least every two hours when in bed. A person in a wheelchair should change positions at least every hour. External pressure from staying in one position compresses the skin’s blood vessels and obstructs circulation, especially over the bones, leading to skin breakdown.

→ When moving a client, lift rather than drag. Dragging creates friction and heat, which can lead to skin breakdown.

→ Straighten sheets and clothing to remove wrinkles.

Bed Positioning Tips

→ Position the spine in alignment.

→ Position the hips straight without

leg rotation.

→ Position the upper extremities away from the body.

→ Support the arms when the client is lying on his side.

→ Keep the knee joints flexed 15 degrees when the client is supine (lying on the back).

→ Turn the client from side to side and prone (lying face down) on a scheduled basis.

→ Keep the head in a straight, midline position.

Positions

Supine (on back)

→ Place a pillow under the head.

→ Place pillows under both arms. When bedridden clients lie on their back with forearms and palms facing down, pressure can damage wrist nerves.

→ Place pillows under legs from midcalf to ankle to keep heels off the bed. Do not put a pillow under the knees only, as doing so will cause the heel to rub against the bed.

→ Hand rolls (Roll washcloths and place in hands to prevent freezing of finger joints).

→ Use foot-positioning devices such as shoes, boots, and footboards.

Lying on Side

→ Position client up in bed if needed.

→ Position client to one side of bed. Turn client by sliding arm under the shoulders and head; lift upper body over, then move hips and legs.

→ Cross the client’s top ankle over the bottom ankle or flex top knee.

→ Turn the client by placing one hand on the shoulder and one hand on the hip.

→ Place pillow under head and another behind client’s back.

→ Support flexed extremities with pillows and positioning devices.

→ Ensure proper body alignment.

Prone (On Stomach)

→ Lift client toward you.

→ Bend arm up around head.

→ Place other arm at side.

→ Place pillow under abdominal muscles.

→ Roll client on stomach.

→ Support ankles with pillows.

Positioning While Seated

→ Seat client in a chair that supports the back.

→ Keep ears in line with the hips.

→ Support the curve of the lower back with a rolled-up towel or lumbar roll.

→ Knees should be level with the hips.

→ Feet should be flat on the floor or on a footrest.

Positioning While Standing (To help clients learn balance when using walkers or canes.)

→ Position the feet a few inches apart.

→ Position the hips in front of the ankles.

→ Position the shoulders over the hips.

→ Keep the head balanced over the hips.

→ Keep the spine straight.

Range of Motion exercises and proper positioning can help prevent permanent disabilities and life-threatening complications that often result from immobility. Caregivers need to intervene to prevent physical decline and deterioration. We can accomplish this by keeping clients moving!!