Author Archives: Maryjo L. Cleveland, MD

“The Four M’s” of Caring for an Older Adult with Dementia

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Cleveland, MaryJo 4x6Maryjo L. Cleveland, MD
Medical Director, Post Acute & Senior Services
Chief, Division of Geriatric Medicine
Summa Health System
Akron, Ohio

Your older relative has just been diagnosed with dementia. Your head is spinning with questions, concerns, fears, and yes, disbelief.  Still, you want to know all you can. If you are going to be a caregiver, you want to be a good one. So, where to start?

Start with the things that, if not managed well, have the greatest chance of getting your relative into trouble! Start with “The Four M’s.”

 

Meals
From planning to shopping to preparing, meal preparation is a very complicated task—for someone with a memory problem. You may notice that the older person is losing weight, that they eat little at home but eat well when they go out to eat, or that there is spoiled food in the refrigerator.

Try: Have simple foods – especially your relative’s favorite ones – around the house, such as sandwiches, soup, and cereal. Bring in ready meals that just need to be microwaved. Consider arranging for home delivered meals. Try to make meal time a social time when possible. Ask friends, church and family members to stop in and stay during meals.

Medicine
Medication management can also be overwhelming and older adults are often taking 10 or more medications, including over-the-counter ones.

Try: Discuss simplifying the regimen with the primary healthcare provider. Are all medications still necessary, and how many can be given just daily? Set up the medicine in a “days of the week” pill box and monitor if they are being taken. Call daily to remind. Consider hiring help for in-person reminders. Take over the refill tasks. Continue reading →

It’s Not Normal: Urinary Incontinence

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Cleveland, MaryJo 4x6Maryjo L. Cleveland, MD
Medical Director, Post Acute & Senior Services
Chief, Division of Geriatric Medicine
Summa Health System
Akron, Ohio

 

This month we are going to talk about one of those problems that no one wants to talk about. Urinary Incontinence. There, I said it. Now you can too.

Urinary incontinence is the involuntary loss of urine and boy, is it common. Probably 50% of older women and 15% of older men suffer from this problem. But most older adults don’t tell their healthcare provider about it. Why? If you have followed this blog at all, you already know the answer. Because people think it’s normal, and that nothing can be done about it. Fortunately, this thinking is wrong!

If you have episodes of involuntary loss of urine, please talk to your healthcare provider. Your healthcare provider should begin to ask you questions about your experience. Don’t be embarrassed to answer these frankly!  Honest answers will help determine the cause and the approach to treatment.

Some of the questions will likely include:

  • How frequently is it happening?
  • Is it affecting your work, social life, or sex life?
  • Do you lose small amounts or do you soak your clothing or pad?
  • Is it worse when you cough or sneeze?
  • Do you have to rush to the bathroom to avoid and accident?

There are basically five types of incontinence:

1.  Stress incontinence – also called stress urinary incontinence, this is not caused by emotional stress or being nervous.  This type of incontinence is the loss of small amounts of urine when you exert pressure on your abdomen and bladder-coughing, sneezing, laughing, lifting heavy objects. This happens because the muscle that keeps the bladder closed has weakened over time. In women, this is usually due to pregnancy and childbirth and in some men it can happen after their prostate has been removed.

2.  Urgency urinary incontinence – also called urge incontinence or overactive bladder, this type is the loss of larger amounts of urine with little or no warning. You may have seen television commercials for this type of incontinence.  This is often caused by infections, bladder irritants, or brain diseases such as Alzheimer’s disease or strokes.

3.  Overflow incontinence – this is a frequent dribble of small amounts of urine and the inability to completely empty the bladder. This is often a complication of diabetes and is more common in men due to prostate problems.

4.  Mixed incontinence – this is combination of the above types.  It is mostly a combination of stress and urgency urinary incontinence.

5.  Functional incontinence – this is incontinence due to something outside of the bladder. In older adults it is because of physical or mental impairments that prevent them getting to the bathroom in a timely manner. Continue reading →

Safe Today. Healthy Tomorrow.

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Cleveland, MaryJo 4x6

Maryjo L. Cleveland, MD
Medical Director, Post Acute & Senior Services
Chief, Division of Geriatric Medicine
Summa Health System
Akron, Ohio

May is Older Americans Month and this month the Health in Aging Foundation is focusing on injury prevention with the theme “Safe Today. Healthy Tomorrow”. For this reason, we are going to take a slight detour from our “It’s Not Normal” series and go into more detail on how seniors can keep free from injury. In a sense, it is a continuation of last month’s entry on preventing falls.

 

So, what do you think of when you hear the phrase “Safe Today”? Here are the 5 things that came to my mind first.

1.  Wear seatbelts! Most seniors will continue to drive into their 80’s and want to be safe drivers. The single most important thing you can do to prevent injury or death in the event of an accident is to wear seatbelts. The National Safety Council estimates that wearing your seatbelt will reduce your chance of injury by 50%! Yes, sometimes they are uncomfortable and wrinkle our clothes. Wear them anyway. And while you’re at it, require that everyone else in the car wear theirs too.

2. Don’t wear high heels! (Gentlemen, you can skip this paragraph.) I have no data to present here; this is purely an anecdotal observation. I have seen beautifully dressed, well-made-up women totter precariously into my office in 2-3 inch heels complaining of balance problems! They are clearly setting themselves up for trouble. Appropriate footwear is key to comfort and safety. Fortunately, ballet-style shoes are popular and tennis shoes are now made in every color imaginable. So, set a new fashion trend by putting a stable gait ahead of vanity and wear sneakers with your skirts.

Continue reading →

It’s Not Normal: Falls

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Cleveland, MaryJo 4x6Maryjo L. Cleveland, MD
Medical Director, Post Acute & Senior Services
Chief, Division of Geriatric Medicine
Summa Health System
Akron, Ohio 

It is the middle of winter here in Cleveland and we have experienced an unusual amount of snow, sleet and ice. In fact, if you live anywhere with winter, I’ll bet this weather has been challenging. One problem that we see more of in the winter is falls. I ask all of my patients if they have experienced a fall.  Can you  guess the most common answer I get? It isn’t “no”— it’s “not yet.”  Isn’t that interesting? That answer means that they expect to fall sometime. In other words, they think it’s normal. But we are here to find out otherwise!

Falls are certainly common. Most people can tell you about friends or family members who have fallen and suffered a serious injury from a fall, such as a broken hip. Most people also tell me that falling is one of the things they fear the most. The good news is that while falls are common, they are not inevitable. There are well defined risk factors that make it more likely for someone to fall.   And there are also recommendations on how to prevent falls. These recommendations will require you and your healthcare professional to work closely together.

Continue reading →

It’s Not Normal: Persistent Pain

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Maryjo L. Cleveland, MD
Medical Director, Post Acute & Senior Services
Chief, Division of Geriatric Medicine
Summa Health System
Akron, Ohio 

There are many issues facing older adults that are common, but should not be considered inevitable. This blog will launch a series for 2014, all bundled under the general heading of “It’s Not Normal”.  Over the next year, I intend to cover a variety of topics that include dementia, incontinence, falls and depression. If you have suggestions for this series, please leave a comment.

The kick-off for this series is pain. While pain is common as we age, it should never be considered “normal”.  Pain should always be discussed with your healthcare provider, so that he or she can help determine the cause (or causes).  Your healthcare provider can then help you figure out an approach to remove or reduce both the pain and the affect it has on your life.

Acute pain is pain that has happened recently and usually has a known cause. An example of this is a sprained ankle. A few weeks of ice, rest and over the counter pain medications (such as acetaminophen) is usually all that is required for relief to occur.

Chronic or persistent pain, however, is more of a problem. You may have had this pain for some time and the direct cause may not be known.  There are different kinds of chronic pain. These include:

  • pain from nerves, such as diabetic neuropathy or pain from a stroke
  • joint or bone pain such as arthritis or gout
  • some kinds of internal pain, such as abdominal pain from Irritable Bowel Syndrome