Memory loss

Geriatric nursing can be so delightful and full of surprises. Each senior is different and has a story to tell. I had a pleasant elderly lady call me this week. If fact she has called me at least three times. She never remembers my name or that she has called me. She was concerned about the government being charged for protective undergarments when her insurance is paying for the supplies. I explained that this type of issue is handled by the Medicaid Fraud Unit and often takes an extended amount of time to complete an investigation. She continued on with her story and listed people she has talked to, she couldn't remember their names but knew they worked in the government. I continued to visit with her and asked her how I could help her. She wanted to know when she would be receiving a report about what was found out. I replied I was sorry, but that I do not work at the Medicaid Fraud Unit so do not know that information. I asked her if she was getting the supplies she needed and she said yes. I asked her if anyone was mistreating her she said oh no, of course not, she was just wondering about what had been done about the government being charged for the protective undergarments. We visited a little more. I thanked her for calling and said if I could be of assistance please call back. She thanked my for my time and for listening. I suppose I will get another call next month and my friend and I will visit again.

Vulnerable Adult?

Who is defined as a vulnerable adult?An adult who:

*is 60 years or older who cannot take care of him or herself and/or

* has a developmental disability and/or* has a legal guardian and/or

* lives in a facility (adult family home, boarding home, nursing home, or soldier's home) and/or

* receives services from a licensed health, hospice or home care agency and/or

* receives personal care or health services from an individual who is paid for providing the service.

What is abuse?Abuse is an action (that is not an accident) that injures, intimidates, punishes or unreasonably confines a vulnerable adult. Abuse can be physical, mental, sexual, or coercive. Types of abuse include abandonment, neglect, self-neglect, and financial exploitation. Some professions are automatically mandated reporters such as nurses, teachers, psychologists, and employees of any adult family home, boarding home or nursing home. I'm sure there are others that I have missed.

Light verses Sunlight@

read an interesting article this week titled "Brighter lighting Improves Symptoms in Patients with Dementia". The study is published in the June 11 issue of the Journal of the American Medical Association. Researchers were studying the effects of light and melatonin in elderly patients. Light exposure was manipulated by installation of large number of ceiling-mounted fixtures with glass diffusers in the common living rooms of group-care facilities increasing the residents exposure to brighter light. The results of the study showed that light therapy attenuated cognitive deficits and reduced symptoms of depression. In combination with bright light, melatonin also improved sleep efficiency, reduced nocturnal restlessness, and reduced the average duration of brief nocturnal awakenings.
In assessing a patient's environment I try to determine if there is adequate light. I've interpreted this to be is there enough light in which to read. After reading this article perhaps adequate light should be redefined.

Share Experience

Geriatrics can be so delightful. Some of the clients I have the privilege to interview are so engaging, witty and surprising. I spent an hour today with a young lady of 87 years that was so charming I was sad to leave. One of her opening statements was so profound "I grew old too fast and smart too late". We shared thoughts about children, the bible, sad state of affairs of the country and her worry that she will outlive her money and have to accept state assistance. She said she was a writer and had stories she would like to write before she dies. I hope she gets that chance.

Depression

Today I was reminded how fragile life is when a colleague phoned to tell me one of our seniors in our community had jumped from a building committing suicide. My friend was devastated. According to the National Institute of Mental Health, in the year 2000, 5,306 persons aged 65 and older died by suicide. There is great concern about the alarming numbers of older adults who suffer from depression and thoughts of suicide, and -because they are too often undiagnosed and untreated- may go on to take their own lives. The years I worked in the psychiatric hospital gave me an appreciation for the seriousness of the situation when an individual makes a statement or exhibits behavior indicating they are considering taking their life. If you encounter an individual who you think my be thinking about suicide, take that next step and ask the tough question "Are you thinking about harming yourself, are you thinking about suicide?" Asking the question is not planting the idea of suicide, the idea was already there. If the individual admits to thoughts of suicide, get help. Call the mental health services in your area, they would be listed in the yellow pages under mental health, do not delay.

Sincerity

Sometimes when I have a geriatric client that I'm interviewing and they seem cautious or hesitant, I will talk for a little while about something I saw in the news or if I notice something in their home that is important to them I will ask them if they would tell me about the item. If they continue to be cautious or hesitant I will ask them what they had for breakfast and then follow the question with how are you feeling today? Geriatric patients respond to sincerity and sometimes it is a little bit before they can make the determination that you are sincere.

Interview

Once a rapport is developed with the individual, begin the questioning with inquiries that are the less intrusive, less threatening. Have a process by which you methodically interview so that you obtain all the pieces of information. Your process will be structured according to the goal of the interview. For example in the operating room as a circulating nurse I needed to verify, the patient's name with his name band. This was accomplished by introducing myself, then the patient would respond by telling me who he was. I needed to know if the patient had eaten anything in the previous 12 hours, so I would ask when did you last eat or drink? This would be followed up with when did you last have water? That question would be followed up with do you smoke, chew tobacco or chew gum? You get the idea, very direct questions for specific pieces of information. When interviewing a geriatric patient the questioning needs to go at a slower pace for two reasons. Sometimes the patient takes more time to process what you are asking or they may need more time to formulate an answer or you as the interviewer may need additional time to listen for clues in the response to determine what the next question needs to be. The skilled interviewer learns through experience when to stick with the interview plan and when to venture to secure additional information.