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Eldercare Planning: Family Meetings

It is standard practice for businesses to tackle tough issues through meetings with concerned parties. Similarly, meetings with family members and caregivers for the purpose of coordinating the care of an elderly family member and addressing problems as they arise is a crucial element in elder care planning.

Overcoming Barriers to Holding a Family Meeting

There can be various barriers to meetings, both real and imagined. Geography is a big one—often families are widely dispersed across the country. Lives are already busy and often overscheduled without adding yet another commitment. Paid caregivers might not want to donate their time, and families may feel it is too expensive to pay them for meeting time.

Why Hold a Meeting?

Whether or not there are specific problems to solve, sharing information and airing thoughts will be productive. Caring for a frail older person is never easy. Holding a meeting is almost always going to improve the situation if it is well-planned, well-attended, and conducted appropriately.

Who to Invite

It is best to keep the meeting numbers between about 3 and 10. It is important to include the loved one concerned, even if it means holding the meeting in a hospital room. Some families may consider it inappropriate to include the loved one, perhaps because the disabilities of that person make it difficult to discuss the situation in front of him or her, or for cultural reasons. Each family is different, so you must decide what works within your family dynamic, but including the elder can often make a profound difference in success of both the process and the decision-making that can come out of such a meeting.

Professional caregivers are sometimes overlooked and can often provide important information. It’s possible that a caregiver may know the most about relevant issues, such as incontinence or other health problems the elder may be reluctant to speak of with the family. You may also wish to invite neighbors and close friends. For family out of the area who may not be able to travel, conference calling and video calling options such as Skype are now commonly used. Depending on your family’s spiritual beliefs, it can be helpful to include a religious advisor. Every family is unique. The most important consideration is to be as inclusive as possible and not overlook resources to help your family.

Prior to the Meeting

Develop and review the elder care planning agenda in advance with all concerned. Use whatever communication method is most convenient for the majority of your group.

Be sure to assign a neutral person to the role of facilitator. Another person might be designated to be the note taker. Arrange a comfortable physical environment with food and beverages and comfortable seating where everyone can make eye contact.

What to Cover

If there is a specific issue to address that requires “buy-in” of all concerned, make sure it is approached as diplomatically as possible. The family members may have divergent ideas of what is important. For example, if the main topic of your meeting is that your mom may need to move out of her home and she resists this, you might start the process discussing “pros and cons of mom moving.” This might lead to a discussion of “why we want you to move.” Be frank: “We are afraid you’ll fall and not be able to get up.” This might lead to a discussion of all the possible solutions, including personal alert systems, cell phones, a daily phone call or visitor, as well as the benefits and potential drawbacks of an actual move.

Next Steps

Distribute the notes to all concerned, even people who could not attend but wanted to be there. Honor and follow up on what was decided at the meeting. Be flexible in case the situation changes. Your loved one may be fine at home now with the new support systems set in place as a result of the meeting, but even without saying so, families usually recognize that the situation will most likely change.

Whatever the outcome of the family meeting, try to remember that it may not solve every problem. Sometimes just being able to mitigate some dilemmas and clear the air is a step in the right direction.

By Jeannette Franks, PhD

Pain Management for Seniors

Up to 88% of older adults report some form of chronic pain. Seniors are more vulnerable to chronic pain for a number of reasons, including greater joint and muscle wear, the presence of other medical conditions and a general decrease in activity levels. Chronic pain also leads to a greater risk of accidents such as falls. Older adults who have chronic joint pain or muscle aches, especially in the legs, are 50% more prone to falling than seniors without it. The most common types of chronic pain in seniors are: Arthritis / joint pain, peripheral neuropathy (often associated with diabetes), lingering pain from injuries (such as a rotator cuff tear or hip fracture), Cancer pain and depression-associated pain.

Nevertheless, chronic pain should not be an accepted part of life for older adults. Seniors working with their healthcare providers can learn to manage their conditions and live a full life in spite of pain, no matter what their age. However, dealing with chronic pain in seniors can be a challenge for caregivers because it is often harder to diagnose and treat. Older adults are less likely to be forthcoming about their pain when speaking with their doctors. This could be out of fear of potential illness or because they do not want to appear weak. Seniors often feel that pain comes with age, and that reporting it is unnecessary. Some may also have trouble communicating their pain because of compromised abilities associated with a stroke or even dementia. The result can leave many seniors trying to cope with chronic pain unguided, leaving them open to anxiety and depression.

Pain Treatments
Because of the reticence of many seniors to acknowledge their pain, the most important first step to pain management is for caregivers to carefully monitor and communicate with the senior about the pain he or she might be experiencing. Good communication is the critical first step to effective treatment. A thorough evaluation by the senior’s doctor to determine the causes of pain should follow, along with recommendations for treatment. Here are some treatment options the National Institute of Aging recommends.

Drug Therapy

Pain medications are the most common form of pain management, however they also pose risks for a variety of complications. Older adults tend to have more adverse reactions to pain medications, so all medications need to be monitored closely in seniors, and medication changes may require more time.

Some seniors simply won’t take pain medications because they do not want to suffer the side effects. Additionally, since seniors may have medical conditions that require regular medications, such as heart disease, lung disorders, diabetes and blood pressure problems, caregivers must be vigilant about possible drug interactions. The following are the major pain medication categories:

  • Analgesics such as Acetaminophen are effective for mild to moderate pain. It is not habit-forming but can be dangerous to your liver if taken in high doses.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) include aspirin and ibuprofen. These over-the-counter pain relievers can be unsafe for people who have high blood pressure.
  • Opioid pain relievers (narcotics) are powerful prescription drugs used to treat moderate to severe pain. They are often prescribed for pain after surgery. They can cause side effects like nausea, constipation, and sleepiness. Several examples are codeine, morphine, oxycodone, and hydrocodone. While these can be very effective, they can also lead to addiction.

Other Pain Therapies 

  • Transcutaneous electrical nerve stimulation (TENS) uses electrical impulses to stimulate nerves in order to relieve pain.
  • Cognitive behavior therapy teaches you how to reduce your reaction to pain.
  • Acupuncture uses tiny needles to stimulate and relieve pain from specific parts of your body.
  • Massage therapy can release the tension in tight muscles.
  • Chiropractic treatment primarily manipulates the spine to address a variety of pain, most commonly lower back pain.
  • Exercising (physical therapy) such as weight training, stretching, walking, yoga and Pilates can complement other pain management therapies.Often a combination of these modalities ends up being most effective, so it can be useful to test a variety of treatment options with the supervision of your doctor.No senior should have to settle for living with pain. With the assistance of a support team of caregivers and medical professionals, and the range of pain treatment options now available, seniors should be able to experience aging with dignity and in comfort.

    By Caren Parnes

    Contributor for Sheridan Care Desert Cities, a proud member of The Seniors Choice

Top 3 Summer Safety Tips for Seniors

The heat of the desert summer is here, so this is a good time to review some vital safety tips for seniors.  Elderly persons are more prone to the effects of heat and at greater risk for dehydration. Make sure you or someone you can trust is checking in on your elderly family members.

  1.  Try to plan activities that require going outside during non-peak hours when it might be a little cooler.  Move exercise indoors.  Consider exercising at a gym, walking on a treadmill, or “mall walking” instead of outdoor walks or activities. Swimming and water aerobics are good options as well.
  2. Drink plenty of fluids (non-alcoholic, caffeine-free as these ingredients have a diuretic effect). Talk with your doctor if you take medications that affect fluid intake, such as Lasix.  Be aware of signs of dehydration, heat exhaustion and heat stroke. The most common signs of dehydration in the elderly are thirst, confusion, irritability and poor skin elasticity. Keeping hydrated on a regular basis is the most important preventative measure, and individuals should be encouraged to drink fluids even when not thirsty as thirst may not be triggered until already dehydrated.
  3. Check your loved one’s air-conditioning system, and do a maintenance review. If electricity goes out, or your loved one does not have air conditioning, consider alternative arrangements when heat is at dangerous levels.

Heat and dehydration may make seniors more prone to dizziness and falls and can cause or increase confusion.

Heat exhaustion is the more mild form of heat-related illness. Warning signs may include the following: Heavy sweating; Paleness; Muscle Cramps; Fatigu Nausea or vomiting; Fainting. Skin may be cool and moist. Pulse rate may be fast and weak. Breathing may be fast and shallow.

Heat stroke is the most serious heat-related illness. It occurs when the body becomes unable to control its temperature: the body’s temperature rises rapidly, the body loses its ability to sweat, and it is unable to cool down. Body temperatures rise to 106°F or higher within 10 to 15 minutes. Heat stroke can cause death or permanent disability if emergency treatment is not provided. Warning signs may include the following: An extremely high body temperature (above 103°F); Red, hot, and dry skin (no sweating); e; Weakness; Dizziness; Headache;     Rapid, strong pulse; Throbbing headache; Dizziness; Nausea.

Any indication of heat stroke is a medical emergency. Seek immediate medical attention.

Be aware of other summer dangers. Talk with your loved one about alternatives if he/she handles maintenance around the home, such as yard work or cleaning gutters. This may be especially dangerous in the heat, but may also pose general risks for falling and safety. Be vigilant about sunscreen and protect against insect bites. If you or someone you know has a bite that seems abnormal or you notice any unusual symptoms, seek medical attention.  

—By Caren Parnes, for The Senior’s Choice

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