Living With Care

Tips for dealing with summer heat

Wed, 14 Jul 2010 16:48:51 GMT

Summer’s warm temperatures and long days offer us plenty of chances to enjoy the sun and spend time outdoors with family and friends. But it’s also important to be careful during those fun times. After all, spending too much time in the heat, especially when temperatures exceed 90°F, can be dangerous.

With that in mind, here are some suggestions to follow when you’re out in the sun this summer and want to avoid the onset of heat-related illness.

Avoid strenuous activity during the hottest part of the day. If such activity is unavoidable, drink plenty of fluids and take frequent breaks in air-conditioned or shaded areas. Consider monitoring body weight and oral temperature. A weight loss of more than 2 lbs. or an oral temperature above 99° F is cause for concern.
Do not leave anyone — children, disabled individuals, pets — in cars for even brief periods. Temperatures can rise to life-threatening levels in a matter of minutes.
Frequently check on the elderly or ill relatives or neighbors. If necessary, move them to an air-conditioned environment during the hottest part of the day.
To avoid dehydration, make a conscious effort to drink more fluids. Rapid weight loss may be a sign of dehydration. Don't drink liquids that contain caffeine, alcohol or large amounts of sugar — these actually cause you to lose more body fluid.
Take cool showers, baths and sponge baths to reduce body temperatures. Or dampen your clothes with clean water -- wet clothing has a cooling effect.

Exposure to extreme heat can lead to many health problems, especially heat stroke and heat exhaustion. If severe enough, it can even result in death. Both of these can strike quickly, so it’s important to be aware of their symptoms.

Heat exhaustion occurs when the body loses large amounts of water and salt through excessive sweating, such as during hard labor or physical exercise. The loss of water and salt can disturb circulation and interfere with brain function. Individuals with heart problems or on low-sodium diets are particularly at risk for this illness.

Heat stroke occurs when the body fails to regulate its own temperature and body temperature continues to rise. Symptoms of heat stroke include accelerated heart rate, unconsciousness, seizures, difficulty breathing, heavy sweating, reddened skin, severe vomiting and diarrhea.

Remember, get cool or get help if you feel dizziness, headache, muscle cramps, weakness, nausea or vomiting. Call 9-1-1 if you experience hot, dry skin, confusion, unconsciousness, chest pains or shortness of breath.

As long as you understand and can recognize the symptoms of heat-induced illness, you can act appropriately and get the help you need.

Golden Living Joint Educational Program Nurtures the Next Generation of Senior Caregivers

Wed, 26 May 2010 11:23:50 GMT

As a registered nurse and the National Director of Clinical Education for Golden Living, I have always been an advocate for nurses choosing a career in long-term care. It takes a special kind of person to specialize in senior healthcare, and Golden Living is active in addressing the shortage of nurses, physicians and other healthcare professionals who specialize in treating seniors.

Golden LivingCenter – Greenville in North Carolina has teamed up with the East Carolina University School of Medicine to help do just that. Over the past 28 years, Golden Living and its predecessors have donated more than $2 million to help fund the school’s groundbreaking Teaching Nursing Home Project. The project allows medical professionals to participate in a four-week rotation at the LivingCenter, which includes intensive lectures and hands-on experience with health issues such as falls, pressure ulcers, vision/hearing impairment, dementia, delirium, and depression, as well as interactions that may result from multiple medications. Participants include primary care and geriatric physicians, as well as pharmacists, physician assistants, nurse practitioners, and other medical professionals trained to treat elderly patients.

Golden LivingCenter - Greenville patients benefit by having access to the knowledge and expertise of East Carolina School of Medicine’s geriatrics faculty and physician fellows. The medical professionals get to learn geriatric medicine on-site at a skilled nursing facility where real patients offer an array of learning opportunities. To date, more than 1,000 medical professionals have participated in the program and are now incorporating what they learned into their medical practices around the world.

Stroke awareness: Time lost is a brain lost

Thu, 27 May 2010 10:47:56 GMT

May is Stroke Awareness Month, and as the third greatest cause of death for individuals in the United States it has become increasingly important to recognize the typical signs and symptoms of a stroke.

More and more, strokes are being referred to as “brain attacks.” A stroke occurs when there is a blockage of blood flow to the brain. This blockage can be caused by a clot, a narrowing of the blood vessels, or -- less likely -- bleeding within the brain (also known as cerebral hemorrhage).

Time is of the essence when an individual experiences a stroke. It is estimated that in one second 32,000 brain cells die; after one minute, an ischemic stroke will have killed 1.9 million brain cells. When a stroke is suspected, the individual should seek medical attention immediately. The faster you can be medically treated, the better your outcome. Unfortunately, only one in every five individuals detects the signs and symptoms of a stroke before it’s too late.

As a means to spread stroke awareness, the National Stroke Association has encouraged the usage of the new F.A.S.T. test to help assess individuals if they are having a stroke. Please click here to view its steps.

If an individual is having a stroke and is medically evaluated within a four-to-six-hour window, certain treatments are possible to help limit the severity of the stroke’s complications. If an individual cannot be examined within that time limit, treatment options become considerably limited and the consequences can be permanently disabling.

To limit the chances of developing a stroke for yourself and loved ones, please follow these steps:

Control your cholesterol, diabetes and blood pressure, even if it means taking multiple medications to keep things stable. Continue to communicate with your practitioner and establish realistic goals.
Maintain a healthy weight.
Stop smoking.
If prescribed, take your blood thinners on a consistent basis.
Incorporate activity into your daily schedule.

Don’t allow time to be a factor in not pursuing treatment for a stroke. When in doubt, have questionable stroke symptoms evaluated at your clinician’s office or in the emergency room. Together, we can reduce the severity of strokes in our families and neighborhoods. Every moment counts. Time lost is a brain lost.

Nutrition, exercise can prevent onset of osteoporosis

Tue, 11 May 2010 13:24:33 GMT

May is National Osteoporosis Awareness and Prevention Month.

That makes this a perfect time to review what can be done to prevent this disease.

As many of you may already know, osteoporosis is a disease in which bones become fragile and more likely to break.

According to the National Institutes of Health (NIH), approximately 10 million Americans currently suffer from this condition.

Risk factors for osteoporosis include the following:

Gender (women get it four times as often as men, though that doesn’t mean men shouldn’t take precautions)
Age (the older you are, the greater the risk)
Body size (small, thin women have the greatest risk)
Ethnicity (white and Asian women have the highest potential risk)

Additionally, osteoporosis can also be passed on hereditarily. Often, if you have a family member who has osteoporosis, there is a high chance you may get it as well.

While there is no surefire cure for osteoporosis, you can take measures to potentially thwart its onset.

First and foremost, eat a diet rich in calcium and vitamin D, since these elements are needed to produce strong bones.

Good sources of vitamin D and calcium include:

Common dairy items like low-fat milk, yogurt and cheese
Proteins like egg yolks and fatty fish (tuna, mackerel and salmon)
Foods with added calcium, such as orange juice, cereals and breads

Most people over the age of 65 should consume approximately three servings each day of foods rich in calcium and vitamin D.

If you are lactose intolerant or cannot consume such foods, consider supplementing your diet with calcium from calcium-fortified foods and beverages, such as vitamin D-fortified orange juice, or take dietary supplements. (Check with your doctor first, of course.)

In addition, consider incorporating weight-bearing and muscle strengthening exercises, such as weight training, walking and running, into your exercise regiment, as this will also help strengthen bone mass.

For more information, please visit the National Osteoporosis Foundation website at www.nof.org.

Easy and fun ways seniors can stay fit and healthy

Tue, 11 May 2010 13:17:01 GMT

May 26 marks the seventeenth annual National Senior Health and Fitness Day. According to the event’s official website (www.fitnessday.com), this year more than “100,000 older adults will participate in health promotion events at more than 1,000 local organizations” across the country.

Don’t fret if you can’t make it to an organized event, however, or if activities are not being planned in your area. Anyone can participate in the comfort of his or her own home, or even in his or her neighborhood.

Here are some suggestions for activities that can help keep you fitter and healthier, along with their benefits:

Use the Nintendo Wii^TM. The various games available on the Wii — such as bowling and boxing —help improve balance, core muscle strength, hand coordination, range of motion and visual scanning. Also, people can participate in a seated or standing position, depending on their abilities and conditions.
Attend healthy cooking classes. Diets that are low in fat and sugar, and high in fiber and fresh fruit, can give you more energy, a sharper mind and a slimmer waistline. By taking healthy cooking classes, you not only learn how to prepare healthier dishes but also learn how to make smarter overall eating choices inside and outside the kitchen.
Participate in activities focusing on balance, flexibility and range of motion. According to statistics, more than one third of people over the age of 65 experience a fall each year. Activities focusing on balance, flexibility and range of motion, such as Tai Chi, can help reduce the risk of falls dramatically.
Get out and socialize. Sadly, many seniors slip into a lifestyle of isolation as time passes. But getting out of one’s room and socializing with others, even on a limited basis, can significantly reduce depression and mental instability.
Walking groups and/or senior games. While these activities and groups may not be found everywhere, they are worth seeking out – particularly at senior citizen centers, which tend to hold a variety of planned activities like these. Participation can boast a healthful spirit of competition, create fun social settings and provide some necessary encouragement for those looking to start a regular exercise routine.

Influenza Season?

Fri, 09 Apr 2010 14:28:00 GMT

In the past, “influenza season” typically ran from November through March. Vaccination clinics for this seasonal influenza are conducted each year during September and October and target the elderly, those with chronic respiratory and heart conditions, and health care workers. This seasonal vaccine changes every year to target the prevalent influenza strains thought to be dominant during the coming flu season.

And then along came H1N1 pandemic influenza.

This new pandemic influenza does not know how to read a calendar. It hit in the United States last summer and appeared to peak last fall. By this spring, most areas of the country are reporting few new cases of this H1N1 pandemic influenza. So we are out of the woods and all those extra doses of pandemic H1N1 vaccine are going to go to waste – right?

Well, maybe not.

The Los Angeles Times (3/30, Maugh) reports, although H1N1 flu activity is still low in most of the country, there is continuing activity of pandemic H1N1 influenza in the Southeast, which is raising fears of a third wave of swine flu cases, according to federal officials. Specifically, Georgia, Alabama and South Carolina all report an increase in regional flu activity, while local clusters of cases have been reported in Arkansas, Louisiana, Mississippi, North Carolina, Tennessee and Virginia, USA Today (3/30, Sternberg) reports. Thus, state and federal disease detectives...converged in Georgia to investigate a late-season flurry of people hospitalized with H1N1 flu.

During the first two weeks of March, the Atlanta Journal-Constitution (3/29, Schneider) reported, Georgia had 80 and 72 hospitalizations, respectively, according to data compiled by the state Department of Community Health. In contrast, the first week of February saw 17 hospitalizations. "They've had more than 40 hospitalizations in this past week, and for the third week in a row, Georgia had more hospitalizations than any other state in the country from laboratory-confirmed H1N1 influenza," Dr. Anne Schuchat of the CDC told Reuters (3/30, Allen). According to Bloomberg News (3/30, Randall), “Georgia was among states with fewer-than-average vaccinations, which may have contributed to the late surge in cases, Schuchat said."

While Dr. Schuchat called the "situation in Georgia...critical," CNN (3/29, Falco) noted, adding that Surgeon General Dr. Regina Benjamin, "who participated in a CDC press conference for the first time," said, "We're seeing higher rates of disease in adults who have chronic conditions like diabetes, cancer, heart disease, asthma, COPD [chronic obstructive pulmonary disease] and other lung illnesses." Accordingly, "she reiterated a common theme heard from CDC and other health officials since the H1N1 flu virus emerged nearly a year ago: 'Vaccination is the single best protection against H1N1.'"

Similarly, University of Michigan flu expert Dr. Arnold Monto maintains that "if a third wave of illness occurs, it likely would be in pockets where few people were previously infected or got flu shots," the AP (3/30, Stobbe) reports. Notably, "about 86 million Americans have been vaccinated in a campaign that began in October."

So, have you and your loved ones been vaccinated against the pandemic H1N1 influenza? If not, now is the “season.”

Nintendo Wii® Makes Exercise Therapy Fun at Golden LivingCenters

Tue, 06 Apr 2010 16:06:51 GMT

As a Therapeutic Programs Consultant, I’m always looking for new, exciting ways to get the patients and residents at Golden LivingCenters interested and engaged in their therapy programs. For some time now, I’ve been a fan of the Nintendo Wii® and all the possibilities it offers for therapy options.

You may think that it’s just for kids, but it’s not. The Nintendo Wii video game system, which uses controllers activated by arm, wrist and body movements, has become a popular and effective therapy tool at many Golden LivingCenters.

Aegis therapists at the LivingCenters make use of Wii as an adjunct to traditional therapy. The various games available on the Wii — such as bowling, tennis, boxing and golf — enable it to be personalized to patients and their individual therapy needs. Aegis therapists use Wii to help patients improve balance, core muscle strength, hand coordination, range of motion, and visual scanning. Patients can participate in a seated or standing position, depending on their abilities and conditions.

LivingCenters use the Wiis for entertainment, too. In fact, 68 LivingCenters are even participated in a “March Madness Wii Bowling Tournament.” This is a great way for LivingCenter staff to connect with the patients and residents because each resident has been paired with a staff member for the tournament.

I see that patients respond well to Wii, finding it a fun experience where they can laugh and enjoy the social aspect of the games as well as the benefits of physical movement. In many cases, patients appreciate being able to participate — albeit virtually — in favorite sports they have not been able to play in years.

Perhaps the primary reason for the Wii’s popularity is that patients do not consider Wii exercise therapy to be “rehab.” Patients who may be averse to the thought of therapy often are big fans of the Wii system.

The Wii system is providing important benefits to patients and is proving to be a valuable addition to traditional therapy programs.

Improving the Quality of Life Through Life’s Simple Pleasures

Tue, 23 Mar 2010 13:44:28 GMT

As the National Director of Alzheimer’s Care and Quality of Life for Golden Living, part of my focus is on the comfort and quality of life for the patients and residents at our Golden LivingCenters. When people are away from home, they still want to enjoy the little things that they treasure in their normal, day-to-day lives. Whether it’s reading the morning paper with a cup of coffee, taking a leisurely stroll through the garden every afternoon, soaking in a bubble bath in the evenings, or sipping a cup of hot cocoa before bed each night, we believe our patients and residents should feel at home during their stay with us.

Thanks to a unique program called “Life’s Simple Pleasures,” patients at Golden LivingCenters do not have to forego these simple but important parts of their day. The goal of the program is to foster compassionate relationships between caregivers and patients and create a sense of community “Community is the antidote to institutionalization,” as stated in the guiding principles of the Pioneer Network, an organization committed to changing the culture of aging.

When a patient is admitted to one of our LivingCenters, the staff identifies at least one simple pleasure the patient enjoyed prior to making Golden Living his or her home. A simple pleasure is defined as anything that brings happiness to or enhances the quality of life of a resident. Golden Living staff then ensure that the patient is able to enjoy his or her simple pleasure while at the LivingCenter.

For example, when the staff at one Golden LivingCenter learned that a new patient had a special place in his heart for baseball, they arranged for him to attend local high school games, where he was honored as a special guest. For another patient with dementia who loved gardening, caregivers “planted” artificial flowers each night by a sign reading “George’s Garden” for him to pick the next day.

The Life’s Simple Pleasures program has been implemented at every Golden LivingCenter and has proven extremely popular with both patients and caregivers. I believe that it has been a key factor in improving the quality of daily life for all patients and creating community.

Improve Your Nutrition from the Ground Up!

Wed, 10 Mar 2010 10:39:53 GMT

March is National Nutrition Month®! This annual event focuses on the importance of making healthy food choices and maintaining positive eating and exercise habits. This year’s theme is “Nutrition from the Ground Up.”

Golden Living encourages our patients and their families to make informed food choices as a way to help improve their overall health and well-being. Good nutrition doesn’t have to mean a diet overhaul; it can start small with little changes. Below are some suggestions for improving your nutrition from the ground up.

1. Eat more fruits and vegetables: Consider your daily eating habits and think about where more fruits and vegetables can be added. You can start by adding just one serving each day (whether fresh or frozen) to one meal or snack and increase it every few weeks. The addition of fiber and vital nutrients will carry you a long way towards better health.
2. Make calories count: Too often, people think of foods as good or bad and that only those on the ‘good foods’ list are okay. All foods are good in moderation. You should consider portion size and how the foods fit into a balance for the day. Read the label for all nutrients - not just carbohydrates or sugars, but also for fats and salt. Items that claim to be low in sugar are often high in fat to compensate and vise versa. A small amount of the real thing is often better and more economical. If you have a sweet tooth, have fruit and yogurt for dessert. For a snack in the afternoon, have some trail mix or nuts. There is no reason to go hungry just because you are making healthful changes. To figure out how many calories you need to achieve a healthy weight, visit a dietitian, or for general guidance visit www.mypyramid.gov.
3. Test the taste buds: Expand your horizons! A healthy eating plan emphasizes fruits, vegetables, whole grains, low-fat or fat-free dairy and includes lean meats, poultry, fish, beans and nuts. Try a fish you’ve never eaten or find a new vegetable recipe. A diverse menu with new items forces us to think about our food, and therefore, we tend to make better choices.
4. Exercise: Exercise is a must in order to properly use the nutrition you consume to build and maintain lean body mass. Whether it’s walking or some other physical activity, aim for 20 minutes of exercise five times a week, or 30 minutes three times a week.

For more tips on building your healthful diet from the ground up, during National Nutrition Month and all year long, visit www.eatright.org/nnm.

Spinach Salad with Avocado, Blueberries, Feta and Lemon-Balsamic Vinaigrette

Wed, 10 Feb 2010 15:49:40 GMT

This beautiful salad is loaded with good and good-for-you ingredients. The list of nutrients in this salad is too large to list, but some of the key players are calcium, potassium, B-complex vitamins, omega-3 fatty acids, iron and Vitamin C. In fact, the vitamin C in the lemon juice will even help your body absorb the iron in the spinach!

Ingredients:

4 cups baby spinach (4 oz.)
1/8 cup mint leaves
1/8 cup Basil leaves
Juice of 1/2 lemon
2 teaspoons balsamic vinegar
1 teaspoon chopped shallot
1/2 teaspoon salt
2 tablespoons extra-virgin olive oil
Freshly ground black pepper
1 /2 cup crumbled feta cheese
1/2 cup fresh blueberries, or 1/4 cup dried
1 ripe yet firm avocado
2 oz.. toasted sliced almonds

Directions:

Place the spinach in a large mixing bowl. Stack the mint and Basil leaves and cut them crosswise into thin strips. Toss the mint and basil with the spinach.
For the dressing, combine the lemon juice, vinegar, shallot, and salt in a small bowl. Whisk in the oil. Season the dressing to taste with pepper.
Pour the dressing over the greens, tossing to coat lightly. Divide the dressed spinach among 4 salad plates. Sprinkle the blueberries and 1/4 of the feta crumbles over the spinach.
Cut the avocado into quarters. Peel and cut each quarter into 3 slices. Arrange the slices on top of each salad and add a sprinkle of almonds. Serve immediately.

Makes 4 servings

Mediterranean Sauteed Broccoli and Grape Tomatoes

Wed, 10 Feb 2010 15:48:03 GMT

This dish of sautéed broccoli and tomatoes is tossed with healthy Mediterranean ingredients just before serving. Broccoli is loaded with beta-carotene, vitamins C and E and calcium. The tomato will supply you with beta carotene, vitamin C, lycopene and fiber
Olive oil’s health benefits are due to both its high content of monounsaturated fat and its high content of antioxidants. Studies have shown that olive oil offers protection against heart disease by controlling LDL ("bad") cholesterol levels while raising HDL ("good") cholesterol levels.

Ingredients:

8 ounces broccoli crowns, trimmed and cut into bite-size florets
1 cup grape tomatoes, cut in half
1 tablespoon extra virgin olive oil
2 cloves garlic, minced
1/4 teaspoon salt
1/2 teaspoon freshly grated lemon zest
1 tablespoon lemon juice
10 pitted Kalamata (Greek) olives, sliced
1 teaspoon dried oregano
A pinch of black pepper

Preparation:

Preheat an 8-inch or 12-inch skillet over medium-high heat.
Toss broccoli, tomatoes, oil, garlic and salt in a large bowl until evenly coated. Pour into the hot skillet and sauté, 10 to 13 minutes.
Meanwhile, combine lemon zest, lemon juice, olives, oregano and pepper in a large bowl. Add the hot sautéed vegetables and stir to combine. Serve warm.

2 servings, about 3 to 4 oz. each

Roasted Garlic Mashed Sweet Potatoes

Wed, 10 Feb 2010 15:45:43 GMT

The oft-overlooked sweet potato has risen to star status thanks to its healthful benefits. This sweet treat packs a powerful punch: vitamins A,C,E, loads of fiber and beta-carotene. The garlic in this recipe will be sweet to the taste and not pungent, so kissing your honey after eating these spuds will be a sweet experience.

Ingredients:

8 cloves of garlic, peeled and trimmed
2 tablespoons (1 fl.oz.) olive oil
Pinch of salt
1/2 lb. sweet potatoes, scrubbed, peeled and diced medium
2 tablespoons (1 oz.) butter
1/4 cup plus 2 tablespoons (3 fl. oz.) milk
Salt and fresh ground black pepper to taste
A pinch of nutmeg.

Preparation:

Preheat oven to 375
Peel and trim the cloves of garlic
Place garlic in foil with olive oil and kosher salt. Seal and place on a small baking sheet
Bake garlic until soft and sweet, about 30 minutes
After baking, place roasted garlic on a small plate. Mash garlic and olive oil with a fork to make a paste
In a sauce pan, cover potatoes with cold water season with salt. Bring the water to a boil and simmer until potatoes are fork tender. Drain the potatoes and return to pot.
In a separate sauce pan heat the milk and butter until butter is melted.
Pour milk and butter mixture on top of potatoes. Add roasted garlic paste, nutmeg and salt and pepper to taste. Mash with a fork just until incorporated

Makes 4 servings.

Green Tea Chocolate Truffles

Wed, 10 Feb 2010 15:45:12 GMT

This is a simple recipe to make white chocolate balls with the delicious flavor of green tea. The sweetness of white chocolate is well-balanced by the bitterness of green tea powder. The truffles will be light green in color and will look simply outstanding when served with some fresh raspberries as a garnish.

Your heart and blood vessels will benefit from the antioxidants found in the green tea. Additionally, dark chocolate may help lower blood pressure if you choose a chocolate with a 70 percent or higher cocoa content.

Ingredients:

1/2 lb. white chocolate, finely chopped
2 teaspoons green tea powder (maccha), plus more for coating
1 tablespoon milk
1/4 cup heavy cream
Fresh raspberries for garnish

Preparation:

Finely chop white chocolate and put in a medium bowl. Put 2 teaspoons of green tea powder in a small bowl.
Warm milk in microwave and pour over green tea powder. Stir well.
Put heavy cream in a small pan. Heat the cream on medium heat and stop the heat before cream starts to boil. Stir in the milk mixture.
Pour the hot cream over white chocolate. Stir well until the chocolate melts. Cool the chocolate mixture until it reaches room temperature, about one hour. Scoop the chocolate into about 1 1/2 inch balls and place them on a sheet of parchment paper.
Cool them in the refrigerator for about one hour, or until firm. Round chocolate balls by hand and roll in green tea powder to coat. Cool green tea chocolate balls until firm.
Serve 3 truffles on a plate with a few fresh raspberries for color and a flute of champagne for the bubbles.

Makes 12 balls

Celebrate Valentine's Day With These Heart-Healthy Recipes

Wed, 10 Feb 2010 15:44:13 GMT

February is American Heart Month! According to the American Heart Association, cardiovascular diseases, including stroke, are America’s number one killer. The goal of American Heart Month is to educate the public and raise awareness about heart disease and stroke.

At Golden Living, we want our patients, residents and their families to be educated about the healthy lifestyles that help maintain healthy hearts. Maintaining a healthy lifestyle involves good nutrition, managing your weight and exercising.

With Valentine’s Day just around the corner, we want you to know that good nutrition doesn’t have to mean boring food.

In celebration of American Heart Month, Golden Living’s Chef Peter has put together a Valentine’s Day menu that you can enjoy while still getting important nutrients that are part of a heart-healthy diet.

Fruits and vegetables are important for getting vitamins and fiber in your diet. B-complex vitamins can protect against blood clots and hardening of the arteries, while fiber can help lower cholesterol. Try the Spinach Salad with Avocado, Blueberries and Feta, the Mediterranean Sautéed Broccoli and Grape Tomatoes or the Roasted Garlic Mashed Sweet Potatoes.
Fatty fish delivers omega-3 fatty acids, which helps protect against heart attacks. Try the Pan-Seared Salmon and Tuna Duet.
Antioxidants can help protect your heart and blood vessels. Try the Green Tea Chocolate Truffles.

You can learn more about American Heart Month and heart health at www.americanheart.org.

Pan-Seared Salmon and Tuna Duet with a Pineapple-Avocado Relish

Wed, 10 Feb 2010 15:49:17 GMT

I highly recommend using a wild-caught fresh salmon instead of farm raised fish. This will give you the best flavor. However, both fish are known for their omega-3 fatty acids and other healthy attributes. The relish adds an element of freshness that makes for a light, vibrant dish. Enjoy!

Ingredients:

1/2 cucumber, peeled, seeded, quartered lengthwise and thinly sliced crosswise
1 cup small diced fresh pineapple
1/2 red bell pepper, seeded and julienned into 1-inch strips
2 tablespoons chopped shallot or red onion
1 tablespoons chopped fresh cilantro
1 tablespoons lime juice
1 1/2 teaspoons canola oil
1 teaspoon honey
1/2 teaspoon red pepper flakes or minced Serrano chile
1 teaspoon salt
2 salmon fillets, and 2 tuna fillets, each 3 oz. and about 1 inch thick
1/4 teaspoon freshly ground black pepper
Lime wedges for garnish

Preparation:

In a bowl, combine the cucumber, pineapple, bell pepper, shallot and chopped cilantro. Toss gently to mix.
In a small bowl, whisk together the lime juice, 1 teaspoon of the canola oil, honey, red pepper flakes, and 1/2 teaspoon of the salt. Pour the lime mixture over the cucumber mixture and toss gently to mix and coat evenly. Set aside.
Sprinkle the salmon and tuna fillets on both sides with the remaining 1/2 teaspoon salt and the black pepper. In a large nonstick frying pan, heat the remaining ½ teaspoon canola oil over medium-high heat.
Add the fish to the pan and cook, turning once, until opaque throughout when tested with the tip of a knife, 4-5 minutes on each side.
Transfer the salmon and tuna fillets to warmed individual plates and top each filet a tablespoon of the relish. Garnish the plates with the lime wedges. Serve immediately.

Makes 2 servings

Pharmacy Services in Nursing Homes are Highly Specialized

Tue, 05 Jan 2010 14:54:06 GMT

Providing medications and pharmacy services to nursing homes has become highly specialized. Most pharmacies that provide these services are closed-door, or closed to the public, operating more like a hospital pharmacy than a retail pharmacy.

It is necessary that the long term care facility contract with a consultant pharmacist to review the medication use of each resident monthly, and to assure that the facility is complying with all state and federal regulations for the safe and appropriate use of medications. This includes medication receipt, storage, administration and disposal.

The consultant pharmacist also serves as a member of the facility’s quality assurance committee, and provides advice to management regarding infection control, preventing medication errors and improving medication use systems. Finally, they provide education to the facility staff to improve safe and effective medication use. Consultant pharmacists have specialized training in geriatrics, and many are board certified geriatric pharmacists (CGP).

The Centers for Medicare and Medicaid Services (CMS) lists the following minimum Long-Term Care (LTC) Pharmacy Performance and Service Criteria for Medicare Part D network pharmacies:

The pharmacy has a pharmacist and delivery services available 24 hours a day, seven days a week
The pharmacy provides same-day delivery for new orders which will satisfy the state and federal conditions for participation requirements for medication availability in nursing facilities
The pharmacy provides timely delivery of refills
The pharmacy provides timely emergency medications when necessarys
The pharmacy has a licensed pharmacist available to review new medication orders for possible drug interactions and notify the facility if problems or potential problems are noted
The pharmacy has a licensed pharmacist available to provide interim Medication Regimen Reviews requested by the nursing facility within 72 hours of receipt of such request
The pharmacy provides intravenous (IV) medications and supplies when necessary
The pharmacy provides compounded/alternative forms of drug composition to meet the needs of residents
The pharmacy agrees to continue to maintain or immediately obtain any necessary technology required to be compatible with the ordering/receiving/administering electronic systems that this living center may use currently or in the future
The pharmacy assures accurate and complete labeling consistent with all federal and state rules and regulations, including expiration dates and lot numbers; and provides medications in unit-of-use packaging, and in quantities appropriate for long-term institutional care*

*CMS Long Term Care Guidance March 16, 2005

Proper Medication Disposal

Fri, 11 Dec 2009 13:59:03 GMT

Medicines play an important role in treating certain conditions and diseases, but they must be taken with care. Additionally, unused portions of these medicines must be disposed of properly to avoid harm. Almost all medicines can be thrown away in the household trash after mixing them with some unpalatable substance (e.g., coffee grounds) and sealing them in a container.

However, certain medicines may be especially harmful and, in some cases, fatal in a single dose if they are used by someone other than the person the medicine was prescribed. For this reason, a few medicines have special disposal directions that indicate they should be flushed down the sink or toilet after the medicine is no longer needed. If you dispose of these medicines down the sink or toilet, they cannot be accidently used by children, pets, or anybody else.

It is important to note that disposal by flushing is not recommended for the vast majority of medicines. Unused or expired medicines that do not have flushing directions in the label can be disposed of safely in the household trash by:

Mixing them with something that will hide the medicine or make it unappealing, such as kitty litter or used coffee grounds.
Placing the mixture in a container such as a sealed plastic bag.
Throwing the container in your household trash.

Drug take-back programs for disposal can be another good way to remove unwanted or expired medicines from the home and reduce the chance that someone may accidentally take the medicine. You should contact your city or county government’s household trash and recycling service to see if there is a take-back program in your community and if there are any rules about which medicines can be taken back. You can also talk to your pharmacist to see if he or she knows of other medicine disposal programs in your area.

Does flushing the medicines on the list down the toilet or sink drain pose a risk to human health and the environment?

Recent reports have noted trace amounts of medicines in the water system. However, the majority of medicines found in the water system are a result of the body’s natural routes of drug elimination (in urine or feces). Scientists, to date, have found no evidence of harmful effects to human health from medicines in the environment.

Disposal of these select, few medicines by flushing contributes only a small fraction of the total amount medicine found in the water. The FDA believes that any potential risk to people and the environment from flushing this small, select list (see below) of medicines is outweighed by the real possibility of life-threatening risks from accidental ingestion of these medicines.

Medications Recommended for Disposal by Flushing (21kb)

Enabling Freedom: Alzheimer’s Care Units as Therapeutic Settings

Wed, 09 Dec 2009 15:33:55 GMT

The concept of “Enabling Freedom” came about at Golden Living in recognition of the ever shrinking world of people with Alzheimer’s disease and related dementias. While assessing potential residents in home settings, our clinicians would hear comments like: “mom can’t go outside unattended, she would wander away and get lost,” or “we don’t let dad in the kitchen, it’s too dangerous.”

We found that persons with AD were becoming prisoners of the living room. Through the concern of well-meaning caregivers, their world had shrunk to one room in the house where they could be constantly observed and protected. We wanted to give them back their freedom.

Our Enabling Freedom program begins with the premise that mostly wandering for persons with dementia is not a problem. Our Alzheimer care units have been designed to accommodate wandering. By constructing spaces that are familiar to residents, such as kitchens, living rooms, laundry rooms, chapels, and diners, we created an environment that nurtures, accommodates behavior, promotes safety, and embraces independence. By allowing residents access to all secured indoor and outdoor areas, the “problem” of wandering was no longer a problem.

By simply allowing safe, unimpeded wandering, we expanded their world, and according to family members, decreased agitation and in some cases improved cognition. A process we call “normalization.” We also encourage our staff not to use words such as: no, don’t’ touch, you can’t etc., words many were used to hearing, with all good intent, before they came to us.

Another benefit of “Enabling Freedom,” is the reduction in the use of psychotropic medication, in particular, the atypical antipsychotics. We found that many residents coming from home or other facilities were already on these medications. During our initial assessment, we determine why these medications were initiated. If it was due to behaviors “typical” of AD, we recommend dose reduction or discontinuance if possible. Our environment, our staff and our programming are designed to accommodate those behaviors.

We choose not to be bound within the limits of traditional long term care, instead we seek out and adapt new knowledge in the art of caring. I believe that those we care for are our greatest teachers. What we learn from them will result in an enhanced quality of life through all stages of the disease. Our secured environment enables residents to wander safely, with or without an agenda. We believe that wandering is not a “problem behavior” within a prosthetic environment that cues the residents and allows interaction with their “home.”

Our Alzheimer’s Care Directors attend 3 days of training and our CNA’s receive 20 hours of specialized education, all geared to giving them a greater understanding of the abilities and social needs of persons with AD.

Our programming is based on assessed interests and needs and is delivered in homogeneous groupings that we call “family groups.” The direct care staff follows that family group throughout their shift and leads the activities for the group. Similar cognitive and functional abilities allow everyone to participate. Activities are designed along the lines of Montessori principles that encourage residents to be successful at each task. The programs are designed to maximize residents’ abilities and assist in maintaining cognitive and functional skills for as long as possible.

Through a partnership of caring, we create an environment that nurtures, accommodates behavior, promotes safety and embraces independence.

Do I really need all of these medications?

Wed, 09 Dec 2009 14:35:59 GMT

As we age, we tend to accumulate more doctors and pills. This is due in part to the fact that we also tend to accumulate chronic diseases such as osteoporosis, high cholesterol, high blood pressure, etc. With more diseases to treat, this often times leads us to more specialists, and more pills to take.

Although multiple medications may be necessary to treat multiple disease states, it’s important that the use of multiple medications is done appropriately. Simply, the benefits of a medication should exceed the risks, including the actual or potential side effects. A good example of the appropriate use of multiple medications is when a laxative, such as senna capsules or bisacodyl, is taken to prevent or treat constipation from opiod pain drugs such as morphine. This side effect is very common with morphine and similar drugs, and typically does not resolve without the use of laxatives. Another example is the use of Vitamin D to improve the absorption of calcium to help strengthen our bones.

However, the use of multiple medications can be inappropriate, such as when a drug is used to treat the avoidable side effect of another drug. An example of this is using Celebrex to treat muscle pain caused by taking Lipitor. Muscle pain is a well-known side effect of Lipitor and other statin drugs, and if severe, is typically treated by lowering the dose or changing to a different type of drug to lower cholesterol. Adding a drug such as Celebrex is typically not very helpful for this type of muscle pain, and may actually cause other side effects such as fluid retention and elevated blood pressure. If another drug is then added to treat the fluid retention or elevated blood pressure, it is known as a prescribing cascade, which can have devastating consequences, especially for older adults.

In fact, a study in 1997 found that “for every $1 spent on drugs, $1.33 is spent managing the complications of drug therapy!!!”*

How can you avoid the inappropriate use of multiple medications?

Ask your doctor if there are non-drug treatments that may be appropriate.
If you see multiple doctors, take a current list of medications including non-prescription and herbal remedies so they are informed about all your treatments.
Know what each drug is being used to treat and how it should be taken.
Ask your doctor or pharmacist to review your medications periodically to assure that they are still needed, are not causing significant side effects, and the benefit exceeds the risk.
Ask your doctor how long each medication should be taken. i.e. is treatment long-term or for a limited duration?
Never start taking a non-prescription or herbal treatment without consulting your doctor or pharmacist who knows your health history and current medications.

*Bootman JL, Harrison, DL, Cox E “The health care cost of drug-related morbidity and mortality in nursing facilities” Arch Intern Med 1997 157 2095.

Bringing Life’s Simple Pleasures to Our Residents

Wed, 09 Dec 2009 14:27:51 GMT

We are committed at Golden Living to patient-centered care. Our goal is to create a home, not a “home-like” environment for all of our LivingCenter residents. One step we have taken in this initiative is called “Life’s Simple Pleasures.” A pleasure is defined as anything identified by the resident or responsible party that enhances the quality of life and brings joy to the resident. It might be: a newspaper delivered with a hot cup of coffee when they wake up, or, an English muffin and cup of tea at 10:00 A.M or, a walk outside, or, a beer or glass of wine before dinner.

The staff at the participating LivingCenters singles out a simple pleasure for each resident, and then provides for that pleasure at least five times a week. The entire LivingCenter staff is involved in it one way or another.

Since many of these “simple pleasures” revolve around food, we have liberalized some diets. We’ve also found we sometimes need to rearrange schedules to accommodate the wishes of our residents. Response to this program has been very favorable from both residents and staff.

At Golden Living we have taken to heart the words of Rose Marie Fagan, the executive director of the Pioneer Network. “When we transform nursing homes into human communities, places for living and growing, we will ultimately change the very nature of aging in America.”

Our commitment at Golden Living to patient-centered care has led us to adopt the following values and principles of the Pioneer Network:

• Know each person
• Each person can and does make a difference
• Relationship is the fundamental building block of a transformed culture
• Respond to spirit as well as mind and body
• Risk taking is a normal part of life
• Put person before task
• All elders are entitled to self-determination wherever they live
• Community is the antidote to institutionalization
• Do unto others as you would have them do unto you—yes, the Golden Rule
• Promote the growth and development of all
• Shape and use the potential of the environment in all its aspects: physical, organizational, psycho/social/spiritual
• Practice self-examination, searching for new creativity and opportunities for doing better
• Recognize that culture change and transformation are not destinations but a journey, always a work in progress