Move your Body!

Maryanne M. Giuliante, DNP, RN, GNP, ANP-C

Maryanne M. Giuliante, DNP, RN, GNP, ANP-C

It is well known that exercising is good for all of us, but this article in today’s NY Times reveals that exercising is not just healthy for our physical being. It may also prevent cognitive deterioration, such as Alzheimer’s Diseases. As a Geriatric Nurse Practitioner, I am often asked what one can do to stave off these type of dreaded diseases, which rob patients of their cognitive abilities. This article suggests that there IS something. And the best part? It benefits not just the brain, but the body too! For patients to reap the benefit of this relatively easy intervention, the amount of exercise suggested is “briskly walking for 20 or 25 minutes several times a week”. We can all do that, right?

What are the challenges that you can anticipate in trying to integrate this intervention into your daily routine? Of course, any alteration in our day-to-day activities is somewhat difficult to first adopt, but often comes easier over time. Can you find a way to break these barriers down, in the name of better health?

Before beginning a new exercise routine, we should first check with our health care provider to ensure that it is done in the safest way possible.

http://well.blogs.nytimes.com/2015/08/12/the-right-dose-of-exercise-for-the-aging-brain/?ref=health

Older Adults: Putting Wheels on Their Home!

RV’ing appears to be the new “in thing.” As adults grow older, their need to be tied to their traditional home decreases. Along with this new-found freedom come creative ideas to spend time and money. Many older adults are being found at campgrounds throughout the United States. Offering a sense of freedom while still maintaining many of the comforts of home, an RV (recreational vehicle) is becoming more popular among older adults.

Several years ago, my parents (who are in their late 60’s) decided to buy an RV. They even named it!! The name of their RV is a combination of all of their grandkids names: Joseph, Gabriella, Daniella, Ariana, and Sophia were combined to create “Jogada Arso,” a name which they proudly display on the side of their RV. They have traveled all over the country and have met so many wonderful friends this way. My mom, who cannot stand the thought of dirt, unsanitary conditions, and other people’s messes, has wholeheartedly embraced the idea of creating a kind of “home on wheels.” They can pack it up and roam without a destination in mind. How lovely to have this freedom!

As older adults are living longer, RV’ing provides a method of becoming mobile while still recognizing that many (like my parents) are set in their ways!

maryannes parents

– Dr. Maryanne Giuliante, DNP, RN, GNP, ANP-C

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Exciting news from the Hartford Institute!

Tara Cortes, PhD, RN, FAAN, Executive Director of the Hartford Institute for Geriatric Nursing at NYU College of Nursing, was recently awarded a 3-year, $2.55 million Health Resources and Services Administration (HRSA) grant through the newly launched Geriatrics Workforce Enhancement Program (GWEP). HIGN was one of 44 organizations in 29 states awarded a total of $35.7 million in awards.
 
Partnering HIGN with the Montefiore Health System and Regional Aid for Interim Needs, Inc. (RAIN), a community services organization in the Bronx, GWEP aims to improve the quality of healthcare for older Americans by: 
 
  • Changing clinical training environments into integrated geriatrics and primary care delivery systems. 
  • Training providers who can assess and address the needs of older adults and their families or caregivers at the individual, community, and population levels. 
  • Delivering community-based programs that will provide patients, families, and caregivers with the knowledge and skills to improve health outcomes and the quality of care for older adults. 
The HIGN grant, entitled the “Community/Clinical Primary Care of Older Adults program (CC-PCOA)”, will build the geriatric capacity of the primary care workforce in clinical and community settings to address gaps in health care for older adults and maximize patient and family engagement. Specifically, this project will create a paradigm shift from the traditional perception of primary care as a visit to a doctor to one where primary care is provided by professionals and lay people throughout a continuum of locations extending from the doctor to services in the community where care plans can be enhanced to attain better health outcomes through non – traditional interventions. Using the National Prevention Strategy’s goal of increasing the number of Americans who are healthy at every stage of life through a multidisciplinary approach, this program will provide an interprofessional, multi-modal educational intervention aimed at creating a culture which values the health of our aging population.
 
Visit the Geriatrics Workforce Enhancement Program webpage to learn more: http://bhpr.hrsa.gov/grants/geriatricsalliedhealth/gwep.html
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Nursing in an Aging America

Thank you to NursingSchoolHub.com for this wonderful infographic that underscores the indispensable value of nurses in caring for a rapidly aging America.

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Battling Until the End

I remember my grandfather as a smart, proud, spunky bald-headed Italian man who prided himself in neatness, proper manners, reading, and cherished time with his family. As one of the architectural draftsman who worked on the George Washington Bridge back in 1957, he loved teaching my brother and me how to draw. I remember his “Italian temper” would flare a bit if we did not strive for perfection as much as he did when we were “strong-armed” into routine drawing lessons. We had to completely erase every noticeable pencil mark and not wrinkle the paper as we did so. In summary, he was neat, organized, strong-willed, smart, and proper.

What a stark contrast to how he died. TowaGiulianteGrandpards the end of his life, he was unable to care for himself and relied on the staff of the nursing home to change his adult-sized diaper and feed him with a spoon that could have easily been mistaken for a baby spoon. I choose to forget these memories, as they do not begin to represent the person he was. Alzheimer’s Disease slowly stole his ability to speak, write, and care for himself over several years. Towards the end of his life in late 2000, we grappled with meeting his basic needs while trying to maintain whatever dignity he had left. That was a formidable task!

As a relatively new RN and the only medical professional in my family, I took on the overwhelming task of translating medical jargon into terms that my family could understand as he moved in and out of the hospital with complications from Alzheimer’s (aspirating, falling, etc). I felt somewhat relieved when doctors simply doled out next steps in his care and we obediently followed. I was grateful (back then) that we were not asked what HE would want (I had no idea, and neither did my grandmother). Papa Louis ended up in a nursing home for the last several months of his life, after being transferred out of an acute-care hospital following a bout of pneumonia. The pneumonia had left him weakened and unable to walk, so being discharged home was not an option. As his body began to “shut down”, he starting eating and drinking less and his “awake hours” became few and far-between. I remember a doctor telling me and my family that the institution could not support patients “not eating” and he would be forced to have a nasogastric (feeding tube) placed. I was horrified! Even back then, I knew that this was an improper intervention for this man who was clearly dying, and placing such a tube would rob him of whatever dignity he had left. Unfortunately, the tube was placed despite my family’s plea to not intervene in this manner. And the tube was forcefully and barbarically replaced every time he pulled it out. His screams could be heard down the hall. Ultimately, his hands were restrained so that even his movement was restricted. He developed pressure ulcers from the lack of movement and was medicated so he would not try to wiggle his way out of the restraints. Horrible!

As a geriatric Nurse Practitioner, even now (15 years later), I reflect on that experience with a heavy heart. I wish I had the knowledge, the empowerment, and courage to have done something…anything… other than what we did. We were captured in the claws of a health care system designed to meet the mandates of doctors and the institutions that employed them and not the wishes of their patients. In order to understand where we are, we need to reflect on where we came from. We have come a long way, but there is more work still to be done. The concept of the patient and their family being a critical part of the health care team would have been swiftly dismissed two decades ago. Thankfully, patient-centered care has replaced physician-centered care. This paradigm shift has supported improved clinical outcomes, enhanced patient and caregiver satisfaction, as well as decreased health care associated costs. As patient advocates in any capacity, we need to continuously and tirelessly support models of care that embrace patient and caregiver-centered approaches. Yes, we have come a long way, but it’s not yet time to sit! We have to continue on the path towards providing care that integrates the needs and interests of our patients across all health care systems.

I truly wish I could have done more to make his final days more dignified.

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Dr. Maryanne Giuliante, DNP, RN, GNP, ANP-C

To Forget a Lifetime

Have you ever forgotten the name of something or someone and it is at the tip of your tongue? Seconds or maybe minutes later, you remember it. Well, for individuals diagnosed with Alzheimer’s disease, often that forgotten word is never remembered and forgetting the name of something becomes more and more frequent as the disease progresses.

Alzheimer’s disease is said to be one of the most frustrating and heartbreaking nightmares an individual and his or her family will live through. My family is currently living this nightmare. This past year, my aunt, who I refer to as Zia Maria, was diagnosed with Alzheimer’s disease. Week after week when we visit her, she appears to be slowly disappearing before our eyes. The once cheerful, loud Italian woman, who would cook homemade pizza for us every Sunday in her outdoor brick oven, is now quiet and unable to recognize many of her family members. The memories we all once shared remain with us, but are becoming lost to her. The blank stare we often encounter when we go visit her in the nursing home leaves our hearts heavy with sadness.

Trying to look on the bright side of things is often difficult with this debilitating disease. While there are treatments to slow this disease, there is no cure for Alzheimer’s. This is when I began to get involved with the Alzheimer’s Association and learned about the Longest Day, which will be held this year on June 21st, 2015. The Longest Day is a team event to raise funds and awareness for the Alzheimer’s Association. Each year it is held on the summer solstice, the period of time from sunrise-to-sunset, symbolizing the challenging journey of individuals living with Alzheimer’s disease and their caregivers. Teams are encouraged to generate their own experience as they raise money and participate in an activity they truly enjoy to honor someone facing the disease. This year my family will be participating in a brick oven pizza party with all of our friends and family to honor my Zia Maria. We may not be able to cure my Zia from this debilitating disease, but we can do our part by raising money and awareness to provide future generations with a cure. Please do your part.

For more about the Longest Day and how you can get involved, click here.

AlyssaAlyssa Coppa is a nursing student in the third sequence of the accelerated baccalaureate program at NYU College of Nursing. She is a member of the Hartford Institute Geriatric Undergraduate Scholars Program and the Geriatric Student Interest Group. Her first degree is in Biology with a minor in Psychology. She plans on becoming an Adult Acute Care Nurse Practitioner specializing in geriatrics.

Suffering in Silence…

Tara Cortes, PhD, RN, FAAN, Executive Director of the Hartford Institute for Geriatric Nursing, NYU College of Nursing

Tara Cortes, PhD, RN, FAAN, Executive Director of the Hartford Institute for Geriatric Nursing, NYU College of Nursing

Today is World Elder Abuse Awareness Day. We should pause and consider how many older people are subject to abuse and what really constitutes abuse. The IOM in 2014 reported that  as many as 1 in 10 older adults and 47% of persons with dementia living at home experience some form of mistreatment (IOM 2014).This number is simply an estimate because so much of elder abuse is unrecognized and unreported.  Elder abuse or neglect is defined as intentional actions that cause harm or create a serious risk of harm (whether or not harm is intended) to a vulnerable older person by a caregiver or other person who stands in a trust relationship to that person. This includes failure by a caregiver/family member to satisfy the older adult’s basic needs or to protect that person from harm.2

If someone has bruises, abrasions, or burns anywhere on the body including the breast or genitalia, we can see the signs of abuse. It is the unseen signs of abuse, which are as harmful as physical and sexual abuse, that cause depression, physical ailments and overall sadness in older adults and are often not detected by health care professionals or caring family members. Abuse can be self-neglect in which the older person cannot perform essential self-care and that failure threatens his/her own safety or health. Neglect is when those responsible to provide food, shelter, health care or protection fail to do so. Abandonment occurs when someone who has assumed the responsibility for a person, deserts them. Emotional abuse is through verbal or nonverbal acts that are humiliating, threatening or intimidating. And finally exploitation is the stealing, misuse or concealment of one’s property such as money, property or assets.

I remember sitting behind an older couple in a concert one night and the woman kept falling asleep. Every time her head nodded downward, her spouse jammed her as hard as he could with his elbow to wake her up.  This is elder abuse and perhaps just a sign of a bigger problem. Any behavior such as belittling, threatening and other uses of power and control by spouses or caretakers  are signs of emotional and verbal abuse. Strained or tense relationships with frequent arguments between an older person and an adult child or a caretaker are also a sign of elder abuse.

Be aware – so many of our older adults suffer in silence. They do not want to make trouble and they are afraid of what might happen if they say anything. This is our vulnerable population – our older adults who are dependent on others to meet their basic needs. We need to be vigilant and alert. If you notice changed in an older adult’s personality – depression, sadness, and decrease in verbal communication – ask questions and watch interactions with the caregiver or family member. Remember you may not see physical signs of abuse, but there may be tremendous internal pain. This is why World Elder Abuse Awareness Day should remind us that elder abuse is a bigger problem than we think and that more than 1 in 10 of our older citizens are abused every day. Be alert and alert others if you think abuse is occurring. We need to work together to keep our aging population safe.

1IOM (2014). Forum on global violence prevention: Elder abuse and Its prevention, pp. 1-1 and 2-8. Washington, DC:  National Research Council.

2Bonnie, R, & Wallace, R (Eds.). (2003). Elder mistreatment: Abuse, neglect and exploitation in an aging America. Washington, DC: National Academies Press.

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