Dr. Mauk’s Boomer Blog

When caring for the elderly, it can be tempting to feel as though you’re always in charge, and this can lead to treating those in your care like children. This can make what is already a difficult time even more so, as the elderly in your care will gradually feel as though they are losing any of the agencies they once had. Rather than approach care as though you lead, and they follow, why not tries an alternative view – a strategy based on cooperation.

It can be difficult to foster cooperation whilst caring for the elderly – many people are resentful of having to rely on someone else for help, and can actively reject what little you aim to do for them. No matter where you work or where your elderly relatives may be in care – whether it’s somewhere like Forest Healthcare or a simple food run once a week – it can be difficult work. There are some strategies you can use to deal with this, however.

Take an Interest

Firstly, take an active interest in those in your care. Get to know them as people. Remembering a couple of small details – whether it’s that their son is on holiday, or that they’re writing a letter to a cousin – and making the effort to ask about them will go a long way towards creating a sense of cooperation. If you’re treating them as an equal to you, and taking an interest in their life, then you are no longer some aloof figure, but a potential confidante. It doesn’t have to be a friendship by any means – but getting to know them as more than just one of many older people you help on a daily basis can go a long way.

Validate Them

Never make them feel stupid, or as though something you’ve discussed is irrelevant. Whilst some things the elderly people in your care might think desire or discuss may seem strange, it’s important to remember the huge difference in life experiences you’ve had. For instance, if they bring up something that’s bothering them that you might consider minor, treat it with the respect they deserve. Allowing the people in your care to remain autonomous is a vital step towards a working partnership.

Expect Resistance

You will be resisted. This is just a fact, and the sooner you accept it, the easier it is to deal with. Rather than being surprised and allowing you to get annoyed about it, treat it as what it is – just one step in a larger process? Try to figure out the root causes of the resistance – is it coming from a place of fear, perhaps of medical intervention? Or perhaps it’s resentment at their inability to do something themselves. Each person will be different, and treating resistance on an individual basis will make it easier to deal with in the long run.

Use ‘Trial Runs’

Imposing a particular routine, or type of medical care, on an elderly person can lead to them feeling as though they have no control. Instead, try to make use of trial runs – set a length of time for them to try something, and then meet to discuss it. This way they can make active, informed decisions about their own care – and you’ll often find that, given this opportunity, they’ll be happy to go along with what you suggested in the first place!

In general, what caring for the elderly mostly comes down to is remembering how things are from their point of view. To them, a move into care – no matter how great the care! – is a move away from independence, towards a more constructive way of life. In order to work towards cooperation, the best methods involve validating these feelings, acknowledging the difficulties, and trying to work around them. Therefore, anything that increases the autonomy and agency of those in your care is a great place to start. If you’re based somewhere like Forest Healthcare, then those decisions will be in your hands most of the day, but even in smaller, less frequent contact based care, it’s worth employing. If anything, the sooner you start working towards a cooperative strategy, the easier it will be for both of you in the long run.

Have you felt like your increasing age is taking a toll on you? As men increase in age, their normal hormone levels decrease and result in different types of male hormone imbalances. One of which is andropause or “male menopause” – a decline in a man’s levels of testosterone, their primary male sex hormone.

A gradual but significant decline in a man’s testosterone begins at age 30 at a rate of 1 to 2% per year. By about  age 70, a man’s testosterone levels may have declined by 50%. Because testosterone plays a huge role in a man’s overall health, low T levels may produce different adverse effects.

Andropause and senior health

Here are the most common symptoms and changes you can expect from andropause in your senior years:

• Sleep disturbances: Sleeping difficulties or disturbances in andropause men include insomnia, sleep apnea, night sweats, and restless leg syndrome (RLS).
• Emotional changes: Different changes in emotions during andropause often result to a lack of motivation, depression, forgetfulness, and lack of concentration.
• Sexual dysfunction: During andropause, a man’s sexual function also weakens and lays low, which may result in low sex drive, infertility, and erectile dysfunction.
• Osteoporosis: With declining testosterone levels, men become more susceptible to osteoporosis. Low levels of testosterone lead to loss of bone tissue and mass.
• Physical changes: Other physical manifestations of andropause in men include increased abdominal fat, decreased muscle mass, hair loss, and swollen breasts.

Dealing with andropause

Although andropause can’t be escaped, it can be managed. Men can deal with the different symptoms and risks brought about by andropause with these simple steps:

• Weight management: Stored extra fat, especially in the belly, can convert testosterone to estradiol. Healthier lifestyle choices such as proper diet and regular exercise are greatly recommended.
• Physical activity: Engaging in physical activities can help alleviate unpleasant symptoms of andropause, such as mood swings and sleeping difficulties, while helping manage your weight.
• Proper nutrition: Practice eating healthier food choices including fiber-rich foods, omega-3 fatty acids, lean meat, and fruits and vegetables for overall health, increased energy, and strength.
• Getting checked for depression: Depression is one of the symptoms of andropause that you should keep an eye on. Beware of signs of depression or have your primary care provider screen you for possible depression.
• Expert consultation: The best way to deal with andropause is through an expert doctor’s help. Be honest about your symptoms for proper diagnosis and treatment. For some, testosterone replacement therapy can be given as an effective treatment.

Get equipped and be ready for the andropause battle!

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Guest Blog: Lindsay Munden, DNP, RN, FNP-BC

Psoriasis

Psoriasis is a lifelong disease that causes scaling and inflammation of the skin. The condition starts beneath the skin’s surface and is triggered by an overactive immune system, which causes skin cells to be over-produced and accumulate on the skin’s surface faster than normal. This process is called cell turnover, and in psoriasis may take a few days instead of weeks. This causes the formation of thick, red, itchy, flaky patches with silvery scales known as plaques. While any part of your body can be affected, psoriasis most often occurs on the elbows, knees, scalp, back, face, palms, and feet.

Risks

According to the American Academy of Dermatology (2015) about 7.5 million people in the United States have psoriasis. Anyone can get the disease, but it occurs more often in adults.

• Age: Adult men and women are affected equally. The two peak ages at onset are during the late teens to early 20s and in the late 50s to early 60s.
• Genetics: Psoriasis has a strong genetic influence, with one-third of patients with psoriasis reporting having a family member with the disease.
• Environmental Factors: Trauma to normal skin, repeated friction, infections, stress, fatigue, warm humid climates, changes in weather that dry the skin, and certain medications may trigger psoriasis flare-ups.

Causes

The primary cause of psoriasis remains unknown. Research has indicated that psoriasis is caused by genetic influences and a dysfunction of the immune system. Although, psoriasis plaques may look contagious, you cannot get the condition from someone that has the disease.

Symptoms

Symptoms can range from mild to severe and are often recurring. Itchy, red, inflamed and dry scaly plaques distributed symmetrically over areas of bony prominences such as the elbows and knees are characteristic of the disease. The joints, nails and scalp may also be affected. As with other chronic conditions, symptoms may flare or worsen for a few months and then subside for a period of time.

Diagnosis

Psoriasis may be hard to diagnose because it can be confused with other skin diseases. Usually your healthcare provider will make a diagnosis based on a thorough skin examination. Biopsy is seldom necessary because the clinical features of psoriasis are so distinctive. Plaque psoriasis is the most common form, but patients typically have one or more types.

Treatment

The goal of therapy is to control the symptoms and clear the plaque lesions.

For mild to moderate psoriasis, topical medications (those applied directly to the skin) and phototherapy (light therapy) are the mainstays of treatment.  For severe psoriasis, systemic treatments are recommended. Sometimes, combining topical, light and systemic treatments leads to the best results.

Topical Medication Options:

• Topical steroids are widely used because they help reduce inflammation. Generally, a very potent topical corticosteroid preparation is applied two to three times daily for 2 weeks and then decreased to a lesser potency for maintenance therapy long term.
• Coal tar works by causing the skin to shed dead cells from its top layer and slow down the growth of new skin cells. This effect decreases scaling and dryness. Coal tar is applied once or twice daily and is not well favored due to the potential for staining of the clothes and skin.
• Anthralin works by slowing down the production of skin cells. This type of medication is applied to the skin for a prescribed period of time and then rinsed away, with increased increments until the skin is healed which may take a couple of weeks.
• Topical immunomodulators are medications which work by decreasing the body’s immune system to help slow down the growth of the psoriasis plaques.
• Vitamin D3 derivatives regulate cell growth and decrease lymphocyte (cells which play a role in the regulation of the immune system) activity. The medicine comes in a form of an ointment which is typically applied twice daily.

Phototherapy:

Phototherapy with ultraviolet-B (UVB) light is effective in the treatment of psoriasis lesions. This type of treatment reduces DNA synthesis of skin cells. Phototherapy can produce symptom-free periods of up to 2-4 months. UVB therapy units are often available at dermatologist offices and the use of commercial tanning beds (with both UVA and UVB lights) is not recommended. Dermatologists may recommend consistent light therapy 3-5 days a week for 2 to 3 months.

Systemic Medications:

Systemic therapy is reserved for patients that have severe or incapacitating disease. These medications are prescribed by expert specialists such as dermatologists or rheumatologists because they have a risk for serious side effects.

More Information:

National Psoriasis Foundation   www.psoriasis.org

National Institute of Arthritis and Musculoskeletal and Skin Diseases www.niams.nih.gov

American Academy of Dermatology https://www.aad.org/

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