Tuesday, July 23, 2019

Helping Homebound Seniors Stay Safe in the Heat

Health News- Tips to Beat the Heat in Heatwave

By Constance Washington, RN, VNSNY CHOICE Health Plans

It’s July and the summer’s extreme heat is about to kick temperatures up a notch. When that happens we all need to keep a few important guidelines in mind. 

Oppressive humidity combined with temperatures in the high 80s and low 90s puts older and more vulnerable New Yorkers at increased risk of heat-related health issues. Many elders may not realize the dangers that can arise upon stepping out into hot weather unprepared. 

When taking into consideration additional factors such as air quality and cloud cover, temperatures can often feel much hotter than they actually are, posing hazardous conditions for those already at elevated risk of health problems. Now more than ever, it makes sense to stay mindful of hot weather health cautions.

My colleagues and I at VNSNY CHOICE Health Plans coordinate care for homebound seniors so they can live safely and independently in their own homes for as long as possible. Because the weather may slow down or prevent friends and family from visiting homebound seniors, it is important to ensure that they are safe and comfortable at home amidst high temperatures. 

Below are a few easy ways in which New Yorkers—old and young alike—can stay feeling their best as they brave the heat.

1. Drink up
One of the most important ways to maintain health during the summer is by drinking enough fluids to avoid dehydration. Drink plenty of water and eat foods containing water, such as fruits, vegetables, gelatin (Jell-O) and ice pops. Aim for 6 to 8 glasses of fluid a day (this amount includes the water in foods). Beware of coffee, caffeine and alcohol, which can actually dehydrate, rather than replenish, the body of fluids.

2. Keep a healthy appetite

Though your appetite may decrease in summer months, it is important to continue to eat well. Be sure your daily meals contain protein (lean meats, like chicken and fish) and carbohydrates (vegetables and whole grains). Salad, fruit and other small, cool meals can be eaten throughout the day to maintain strength. 

3. Cool down the body

Take cool baths and showers to keep your body temperature from rising too high (Be sure that the bathtub has a slip-resistant mat or safety bars to help with transfers and prevent slips and falls). Simply cooling the feet in a bowl of cold or iced water may also help sustain bring your temperature down. Having a damp cloth to wipe down your face and arms is convenient as well.

4. Seek out cool places

Visit your local library, shopping center, movie theater, community center, or anyplace with air conditioning. New York City opens cooling centers in air-conditioned places like these when the weather is deemed dangerously high, call 311 to locate your nearest cooling centers. You may also qualify for a free air conditioner through the Home Energy Assistance Program (HEAP); Call 1-800-692-0557 or 311 for more information.

Make sure you can get to important sites like the police station, fire station, pharmacy or hospital in case of emergency as well.

5. Consider a temporary care for an at-risk loved one 

For elderly people who are home bound or living alone, regular visits from friends, family or caregivers offer welcome companionship when excessive heat outdoors forces you to stay inside for long periods of time. 

A home health aide can also be arranged for a few hours to provide peace of mind for family members who can’t reach loved ones or check in when the heat is on to make sure they are getting fluids and staying safe at home.

6. Get it delivered

If possible, have something brought to your home rather than make the trek outside yourself. With many eateries offering delivery, and services like Postmates or Amazon Prime able to bring almost anything to your door, you can save yourself the trouble of carrying extra things around in the heat.

7. Skip the sun’s peak hours

The hottest time of the day is between 10 AM and 2 PM. Avoid cooking or spending time outdoors during this period. If you must leave the house during a heat wave, wear sunscreen, as well as loose, light-colored clothing and a wide-brimmed hat. Always keep a fresh bottle of water in the refrigerator and bring it with you when you leave the house. Be careful to avoid burns on metal, especially on walkers, wheelchairs or benches.

Constance Washington, RN, is a Care Coordinator with VNSNY CHOICE Health Plans. To learn more, visit www.vnsnychoice.org or call 1-855-AT CHOICE (1-855-282-4642).

Monday, July 1, 2019

Lewy Body, The ‘Other’ Dementia

Questions to Ask When a Loved One Receives a Diagnosis of Dementia

By Susan Northover, RN, MHA, SVP Patient Care Services, Visiting Nurse Service of New York

When Alissa’s father was diagnosed with dementia after exhibiting cognitive, behavioral and physical impairment, his family assumed it was Alzheimer’s disease, the most common form of dementia. It was only when he ended up in the hospital, with severe psychiatric symptoms and a frightening reaction to medication, that the family received another diagnosis: What Alissa’s father actually had, the doctors informed them, was Lewy body dementia.

The second-most common form of dementia, Lewy body dementia (LBD) affects an estimated 1.3 million Americans, but few people have heard of it. Caused by an abnormal buildup of deposits (Lewy bodies) in the brain, LBD is closely related to Parkinson’s disease and is often accompanied by problems with gait and movement.

Like Alzheimer’s disease, LBD is progressive and irreversible, with palliative treatment and medications for symptom management recommended to help people maximize quality of life. But there are differences between the two illnesses, including which medications should be prescribed. For people with LBD, traditional antipsychotics should be avoided, as should a number of other medications, according to the Lewy Body Dementia Association (LBDA).

Alissa’s father was originally prescribed a medication contraindicated for LBD, which caused him great psychiatric distress.

“If my Dad had been correctly diagnosed, he wouldn’t have displayed such nightmare behavior or been hospitalized – which caused all of us a great deal of concern and stress,” says Alissa.

Unfortunately, there are no specific diagnostic screens—no definitive brain imaging or blood tests—for dementia and its associated illnesses, such as Alzheimer’s or LBD. Rather, doctors make a clinical diagnosis based on medical history, a physical examination, lab tests that might suggest one diagnosis or another, and a finding of marked changes in cognitive and behavioral function. Once you or a loved one receive such a life-changing diagnosis, you should seek referral to a specialist to learn more about what to expect day to day and in the long run, and what the latest treatments are (as well as what to avoid), says Dr. Ritchell Dignam, Medical Director for VNSNY Hospice and Palliative Care. Because LBD overlaps many specialties, she recommends visiting a neurologist, psychiatrist, geriatric specialist and/or movement specialist.

Three Differences

While both forms of dementia are characterized by significant cognitive and behavioral decline, there are three key areas of difference between the presentation of Lewy body dementia and Alzheimer’s.

Fluctuations in Cognitive Ability

With LBD, a person’s alertness and attention can fluctuate quickly, often leaving family members confused and alarmed. “You could be having a discussion with them, but then sounds become unintelligible,” says Dr. Samuel Weisblatt, a VNSNY Hospice Team physician. “Fifteen seconds later, they’ll have no recollection that they were unintelligible.”

People with Alzheimer’s, on the other hand, tend to experience a more steady cognitive and functional decline.

Difficulties with Movement and Gait

Much more so than with Alzheimer’s, patients with LBD often show a physical decline from the beginning of their illness that grows more pronounced over time. This may include difficulty walking, frequent falling, stiffness and tremors (resembling Parkinsonian movements). Physical therapy may help people with LBD, notes Dr. Dignam.

With Alzheimer’s, movement and gait disorders typically present very late in the trajectory of the illness, if at all.


People with LBD, even in early stages, often have vivid hallucinations. Alissa’s father saw animals—a horse, dog, and cat—and could describe in great detail what they were doing. Such vivid hallucinations are not a typical symptom of Alzheimer’s, although they may appear in late stages of the illness.

For more differences and similarities, see this LBDO reference chart

Coping Day to Day

Despite these distinctions, what the two dementias have in common—a progressive and profound loss of the ability to remember, think, and perform daily activities—outweighs their differences.

Behavioral health nurses offer the following advice for caregivers dealing with any type of dementia, no matter the diagnosis. The goal with all of these approaches is to keep your loved one safe and comfortable, manage his or her symptoms, and keep yourself, the caregiver, healthy.

Repeat, Repeat, Repeat.

“Know that they are going to ask the same questions over and over,” says behavioral health nurse Joel Genaw, who works with people with all types of dementia. “Try to keep them oriented, but you also need to be prepared to be patient about answering and explaining again and again.”

Keep Calm and Carry On

Always keep your tone and facial expressions calm, no matter the crisis. This is not easy. While you would be forgiven for getting agitated the hundredth time you explained something or the twentieth time you attempted help with showering, a visible rise in your stress quickly magnifies your loved one’s stress and makes the situation much worse. Caregivers can learn over time what increases their loved one’s agitation—including unfamiliar surroundings—and try to minimize those situations.

Join them in their Reality

This is especially helpful when caring for someone with LBD. Remember that their hallucinations are exquisitely real to them, brought on by the physical changes in their brain. While you don’t see the horses running through the fields or their mother sitting on the couch in the living room, never try to convince the person otherwise. Be patient and let them tell their story.

Don’t Take it Personally

It can be upsetting to see and live with such profound changes in your loved one, who might lash out at you in frustration or anger. But remember that it is the disease causing the personality changes. As an organization of professional caregivers, we know how difficult and how incredibly important caregiving is, and we extend thanks to family members and other informal caregivers whenever we have the chance. We also recommend connecting to caregiver support resources, because you cannot give care to others if you don’t take care of yourself.

Through all stages of the illness, it can be helpful for caregivers to be able to manage expectations. And when it comes to the especially challenging task of caring for a loved one with dementia, knowing what to expect can be aided—at least a little—by having the right diagnosis. 

For Alissa’s family, the deterioration of their beloved father and husband was heartbreaking. But once they received the diagnosis of Lewy body dementia, they found a small measure of comfort in knowing they were taking the right steps. 

“We could see him decline before our eyes,” she said. “But once we understood exactly what it was, we had a better idea what was going to happen next. That helped.”