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Is twice a night too much?

Many older adults complain of having to get up several times in the night to pee. Some of this is a normal part of aging. Our bladder capacity gets smaller, so we need to void more often.

But frequent trips to the toilet can have a serious impact on sleep. Nocturia—the medical name for getting up more than once a night—and insomnia are intimately related. Getting up often understandably leads to fatigue. But your loved one is also at higher risk of depression, falls, and car accidents because of the insomnia.

If the person you care for complains of getting up often in the night, have him or her

  • stop drinking fluids 2–3 hours before bedtime. Kind of obvious, but a good first step.
  • halt caffeine consumption after noon and limit or stop alcohol in the evening. Both drinks have a diuretic effect, stimulating urination.
  • take any prescribed diuretics in the morning. Ask the doctor or pharmacist about optimal timing for “water pills.”
  • watch for fluid buildup at ankles. Fluid that gathers at the feet all day gets processed by the kidneys at night because lying down returns it to the upper body. Compression socks during the day and raising the feet a few hours before bed can help.

Suggest your relative keep a log for a week, such as the one offered by the National Association for Continence ( You may observe patterns. Plus, it’s helpful information for a doctor.

Nocturia can be a symptom of many conditions, from diabetes to sleep apnea or an enlarged prostate. For someone over 65, getting up twice a night is not uncommon. Consult a doctor if it’s more often or is disrupting sleep or mood. And definitely seek medical attention if there is burning, blood in the urine, fever, or urgency with small output. This could be a sign of an infection.

Is interrupted sleep becoming an issue?
As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice know how vexing nocturia can be. And potentially tricky to resolve. There are things we can do to help. (And sometimes it’s just easier for your loved one to discuss this with someone who is not a family member.) Give us a call at 1-800-897-3052, toll-free.

Cooling down to make a decision

Our fight-flight-or-freeze reactions are deeply embedded in our body and brain. In intense situations, they take over. As a family caregiver, it’s easy to feel overwhelmed by the many decisions that must be made. And the responsibility. This is especially true in times of great stress and uncertainty. We become emotionally flooded and enter a reactive “hot” state of mind. It’s not the best for making wise decisions for yourself or for loved ones you care for.

Fortunately, we can use our mind to bring ourselves from a physical “red zone” into a cooler mental state. Even if time is of the essence, a few minutes to find calm in the center of the storm can give you confidence and mental clarity. Decisions made in this state are more robust and stand the test of time.

The first step is to notice and recognize that you are revved up, emotionally “hot.” Then, make the internal commitment to shift to a calmer state. Here’s how:

  • Breathe in for four counts and exhale for eight. Repeat this for 5–10 breath cycles. Feel your heart slowing down. This type of prolonged exhale engages your parasympathetic—calming—nervous system.
  • Imagine a situation where you felt supported, that you deeply belonged. Kindle that feeling inside. Let it glow and become stronger. You’ve felt this before. You can feel it again, generated now from within, simply by remembering.
  • Relax your body. Notice specific tight places. Give them a stretch and breathe the tension out with each breath.
  • Address your basic physical needs. When was the last time you ate? Had some water? Went to the bathroom?

Feel the difference? Ah. Now that you’re out of the red zone, you are better able to take the broad perspective on your dilemma and focus on what most needs to be done. Such calm will also extend to others around you.

Are you a primary decision maker?
Decision making is integral to family caregiving. From the big decisions to the little daily ones, you will make wiser choices if you consciously leave the hot zone and teach yourself to operate from that calmer inner knowing. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice can be part of your team so you don’t have to feel so alone. Give us a call at 1-800-897-3052, toll-free.

Coronavirus scams

Scammers thrive in crises. The Federal Trade Commission is reporting a surge in fraud complaints. Bad actors are leveraging fear and shortages to bilk consumers out of millions and to harvest information for identity fraud.

Help your loved one avoid scammers by following these tips. 

Research requests for donations. Verify the nonprofit on, the registry that provides financial reporting on all registered 501c3 organizations. Be especially wary if the request is “urgent” and for payment by gift card or prepaid debit card.

Ignore social media ads, texts, or emails selling

  • cures or vaccines. Relief is months, maybe a year or more away. Look for an announcement from the Centers for Disease Control and get a prescription from the doctor.
  • hard-to-find supplies. From gloves to toilet paper, surgical masks to hand sanitizers. Amazon and Facebook are working hard to block gougers and bogus sellers. Pay attention to the star ratings of sellers and look for complaints of supplies never being received.
  • stock deals. Many fraudsters offer great investment deals on stock that is “going to take off” with the latest cure, test, or vaccine. Unfortunately, they have bought the stock already. When demand drives the price up, they sell. The price then plummets and investors get stuck with the loss.

Hang up on robocalls asking for money or information. The federal government never uses this method of communication. Neither do other credible organizations. It’s the medium of scammers. 

Do not click on emailed links or download files from organizations you do not know. Many fraudsters are looking to insert malware on your computer to harvest information for identity theft. Even if the email seems genuine and the website looks like a government or reputable organization, do a Google search to find the real domain name. (Cybercriminals set up a mirror site at, for instance. The actual address for the Red Cross is

Is the person you care for vulnerable to elder fraud?
June is National Elder Abuse Awareness Month. If you have concerns about a loved one’s judgment, give us a call at 1-800-897-3052, toll-free. Financial abuse of elders is on the rise. As the Iowa City, Muscatine and Cedar Rapids experts in aging and family caregiving, we at Iowa City Hospice can help you determine optimal ways to keep your relative safe.

Removing “junk stimulation”

If you were asked to name the stresses in your life, you might think first about all the tasks and responsibilities you are juggling. Or challenging relationships. Or financial difficulties.

Less obvious are the stressors in your environment that can tax your nervous system behind the scenes. “Junk stimulation,” like junk mail, simply overwhelms the brain for no real purpose.

Clutter and noise are two stimulants that create unnecessary stress.

  • Clutter. Studies clearly show a link between physical clutter and stress. Clutter distracts. It calls for our attention and limits our ability to focus. Getting rid of clutter is like changing any bad habit. Start small with an area where you can see noticeable improvement. Consider five minutes to declutter one shelf or one drawer each day. Or dedicate an hour or two on a Saturday to declutter one room. Arm yourself with three boxes or sturdy bags: Trash, recycle, and give away. Remember the guideline: If you haven’t used it in a year, you don’t need it. (Or, following the advice of Marie Kondo, if it doesn’t spark joy, let it go.) You’ll be surprised at how clear your mind feels when you are not tripping on clutter, searching for “lost” items, or bombarded with overly abundant visual input.
  • Noise. Stop and listen. Do the sounds you hear really add to your well-being? Loud noises. Unpredictable noises. Noises we can’t control. Noises with negative content. These are the sounds that distract our attention and disturb our ability to think or remember well. If traffic noise is irritating, can you open a different window to let in less street noise? Turning down the ringer on your phone can reduce that jangled feeling when the phone rings. If the TV is blaring, will the viewer wear headphones? Use closed captioning? Or could the TV be relocated to a room with a door? Eliminating unwelcome sounds is a great way to give your nervous system a rest.

Feeling overwhelmed?
These are stressful times for family caregivers. You don’t have to do this alone! As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice can help you sift the wheat from the chaff and prioritize what needs to be done. Give us a call at 1-800-897-3052, toll-free.

Signs of osteoporosis

Does the person you care for seem to have shrunk a bit? Pants are too long? Can’t reach items on their regular shelf? You can see the top of their head? It could be that their bones have become more porous with age. This is called “osteoporosis.”

With osteoporosis, bones are less dense and easily develop cracks and fractures that may or may not be painful. When cracks occur in the spinal column, the spine compresses, resulting in shortened height. In some people, the compression produces a hump or curve at the neck and shoulders. In other parts of the body, such as the hips, poor bone density is not obvious until a bone is broken.

Osteoporosis is serious, but underdiagnosed. Every year, about 2 million people over age 50 break a bone because of osteoporosis. For those who break a hip, the consequences are

  • 50% will need to use a walker or cane, at least temporarily
  • 25% will require some form of care assistance long term
  • 25% will not recover (the broken bone leads to a cascade of problems that ultimately results in death within a year).

Those most at risk are

  • women older than age 50. One out of two is likely to break a bone because of osteoporosis. (One in four men over 50 will break a bone. More for those over 70.)
  • people of slight build
  • people of Caucasian and/or Asian descent
  • those with a family history of osteoporosis

There are lifestyle risks as well, including smoking, drinking alcohol, and not exercising.

Getting tested
If your loved one complains about back pain, seems shorter, or has any of the known risk factors, ask the doctor about doing a bone density test. This specialized x-ray test (often called a “DEXA scan”) measures the thickness of the hip and sometimes other bones. Some cases might require an MRI. Medicare will usually pay for these tests if a doctor orders them.

Are you worried about osteoporosis?
As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice congratulate you for taking this condition seriously. Addressing the problem and preventing falls and broken bones can do much to reduce pain and promote independence. Want help? Give us a call at 1-800-897-3052, toll-free.

When broccoli is bad for you

“Kale smoothie, anyone?” Maybe not…. Good nutrition has always been a mainstay of good health. Indeed, there is growing awareness of the power of food to support healing for a wide variety of conditions. What is less well known is the fact that even very healthy foods can cause health problems when combined with specific medications.

As you care for your family member, be alert to these common food–drug interactions.

Broccoli, kale, spinach, cabbage, collards. These nutrient-rich vegies are high in Vitamin K. This vitamin supports blood clotting. It’s essential to stopping the flow of blood when we get cut. Some blood-thinning drugs, particularly warfarin, block vitamin K’s clotting action. Anyone taking warfarin must balance the amount of vitamin K in the diet. Not too much. Not too little. Talk to the doctor or pharmacist for guidance.

Coffee. Nothing like a good cup of joe to boost one’s energy! But the caffeine in coffee can also super-charge the breakdown of some drugs. This includes antibiotics and drugs for asthma, depression, and irregular heart rhythms. The result can be toxic. Separately, the stimulating effects of coffee can interfere with antianxiety medicines and sleep medications.

Grapefruit. Either fresh or juiced, grapefruit is potent, interacting with at least 45 drugs. People who take statins can develop side effects, such as muscle and joint pain. Medications for blood pressure, erectile dysfunction, and some antihistamines are among other drugs negatively affected by grapefruit.

Milk. A glass of milk may be recommended before taking some medications. It coats the stomach and prevents nausea. With many antibiotics, however, the calcium and proteins in milk bind with the drug’s active ingredients, reducing its effectiveness.

New food–drug interactions are being discovered all the time. To be safe, when a new medication is prescribed or a shift in diet occurs, ask the doctor or pharmacist about specific foods to avoid.

Concerned about a loved one’s medications?
With so many older adults taking so many medications, it’s hard to keep up with all the do’s and don’ts. Let alone navigate the relationship minefield of dietary choices! Give us a call at 1-800-897-3052, toll-free. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice can help ensure your loved one is staying safe.

Avoiding regret

Family caregivers are often thrust into the role of making decisions for a loved one. Some decisions are relatively small: Purchase a walker with wheels or one without? Others are large and may have life-changing ramifications. Approve that surgery? Initiate a move to assisted living or set up care at home?

Rarely is there a single “right” answer. Your intention is to make the best decision you can with the available information. Sometimes the outcome is as envisioned. Other times, not so much.

Tips to help you avoid regret

  • Gather all the information you can. Ideally from a variety of sources. Learn the facts, and perhaps seek out others’ experiences. Being well informed supports your confidence in your process.
  • Evaluate the sources for credibility. Is any information coming from someone who might personally benefit (a salesperson)? As for stories from others, consider how closely their situation matches your loved one’s. Similar temperament, lifestyle, and values? They may have very different priorities.
  • Ask yourself, “Is this a ‘hot’ decision?” When we are anxious or in pain, we tend to be reactive and rush. We want things settled—FAST! We may downplay an option’s risks. Or overestimate the benefits or likelihood of success. It’s precisely when we’re most upset that we need to hit “pause” before choosing.
  • Acknowledge the pull to do nothing. If there is no urgency, it’s natural to put off a decision. Sometimes waiting, doing nothing, or “letting nature take its course” is the best decision. Just be sure you have made the choice consciously.

Regret is a natural response to a decision that yields an unexpected outcome. Using these strategies, you are more likely to avoid the sting of blame and self-recrimination. Or at least arrive sooner at the more constructive state of accepting with disappointment that things didn’t turn out as it seemed they would.

Feeling burdened by so many decisions?
As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice notice that decision fatigue and regret are rampant among families caring for aging relatives. You don’t have to do this alone! Give us a call at 1-800-897-3052, toll-free. Let’s talk.

Common misconceptions about hospice

Many families caring for a seriously ill loved one struggle alone unnecessarily. They miss out on vital support services because they don’t understand what hospice can provide.

  • Home visits by a nurse to manage pain and other difficult symptoms.
  • Home visits by a nursing assistant to bathe your loved one and shampoo hair.
  • Free prescriptions as needed for keeping your relative comfortable and out of pain.
  • A volunteer to come give family members a break now and then.
  • Access to a social worker to talk about emotional worries or concerns.

Would these services be helpful?

Perhaps it’s time to consider hospice.

Here are some common misconceptions.

  • Hospice is for someone in the last few days of life. Hospice is for the last six months of life, with more time available if it is needed. Ask the doctor if he or she would be surprised if your loved one were to die in the next year. If the doctor says no, then it’s time to consider hospice. (No one can predict for sure one way or the other.)
  • Hospice means you are giving up. Hospice focuses on patient comfort and quality of life. Although a “cure” is no longer the goal, research shows that people getting “comfort care” often live longer than they would without it!
  • The doctor will call for hospice when it’s time. Doctors don’t like to “scare” patients. And, understandably, they don’t like to give bad news. Unless your relative has asked his or her doctor for candid feedback, the doctor may avoid bringing up hospice until death is very near.
  • Hospice means you can no longer see your doctor. Your relative’s existing doctor is still involved, collaborating with hospice in a team approach to care.
  • Hospice is a place someone goes. Some hospices have facilities where patients can move in. But the mainstay of hospice is service in the patient’s own home. Medical professionals make “home visits” to the patient, wherever the patient lives.
  • Hospice is only for people with cancer. Hospice is for people with any type of disease, as long as the condition is incurable and in the advanced stage. This includes people in late stages of chronic diseases such as dementia, heart disease, and COPD.

If your loved one has Medicare, 100% of hospice services are covered provided he or she meets the eligibility requirements.

Would you like to explore this kind of support?
If so, give us a call at 1-800-897-3052, toll-free and let us help you determine if hospice is the right fit for your situation. As the Iowa City, Muscatine and Cedar Rapids experts in aging, we at Iowa City Hospice can explain the eligibility requirements and answer your questions so you can decide as a family. Let’s start the conversation.

Harnessing stress

Stress has gained a dirty name during the past decades. It’s something we talk about needing to getting rid of, as if it were wholly bad. While chronic stress can be damaging to our health, recent research demonstrates that stress isn’t always a threat to our well-being.

In fact, the very things that bring greatest meaning and joy to our lives are often the same activities that cause us stress. Being a parent. Work. Caring for a loved one.

People who handle stress well seem to have a particular “stress mindset.” They view stress as a challenge rather than something to be always feared. For instance, if they find themselves tense or revved up, they interpret their reaction as a sign that something important is at risk. Rather than flee from it or fight it, they get curious and look for opportunities to work with it.

To harness your stress constructively, try these three steps

  • Acknowledge the stress as a sign that something precious to you is threatened. Know your personal signs of stress (tight shoulders, headaches, overeating). Remind yourself that you are stressed because something important to you is endangered. Complete this sentence: “I’m stressed because I care deeply about ….” This will help you focus on the next step.
  • Create a strategy for working with the stress. The hormonal responses to stress, such as adrenaline and endorphins, provide extra energy and focus. Harness those responses to help you seek information, resources, or support from others to address the problem you care about. As you make changes, look for solutions that directly support the core values that are important to you.
  • Evaluate the outcomes and revise. Do your actions seem to be improving the situation? Is watching the news several times a day helping you to move forward with your plans, or would once-a-day be just as productive and a lot less stressful? When this is all over, reflect on what you’ve learned. Actively reviewing how you’ve handled a situation builds confidence and skills for navigating future episodes of stress in a healthier way.

Would you like help harnessing your stress?
We at Iowa City Hospice know these are incredibly stressful times. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we can help. Give us a call at 1-800-897-3052, toll-free.

Return to a good night’s sleep

If your older loved one snores loudly, he or she likely has sleep apnea: A collapsing of the airways while sleeping that results in mini-suffocations 5–30 times an hour. And, left untreated, this serious condition is a strong contributor to heart-related deaths, type 2 diabetes, dementia, depression, and car accidents. It’s also a huge problem for any bed partners! Sleep apnea is important to address.

Lifestyle changes can help. Losing weight, quitting smoking, and treating allergies are key steps. Refraining from alcohol at night is also effective, because alcohol relaxes the throat muscles. Learning to sleep on one’s side is another strategy to reduce apnea episodes.

There are several possible treatments. Some require a doctor’s prescription. Not all treatments work for everyone.

  • CPAP (continuous positive airway pressure). Through a strapped-on facial mask, a CPAP machine pushes air into the airways and down into the lungs. While a CPAP is the most reliable treatment, it admittedly takes some time to get accustomed to wearing the mask. Medicare covers the CPAP, based on the device’s recording of usage. If your relative does not use it for at least four hours a night, 70% of the nights in the first three months, Medicare will take it back.
  • Dental device that thrusts the lower jaw forward. Worn only at night, this device opens the throat. It is easy to use, easy for traveling, and does not require electricity. Talk with the dentist. Note: Medicare will not pay for a dental device.
  • Nasal plugs. Inserted into the nostrils, these devices create counterpressure in the airways, often enough to keep the airways open. Ask for a prescription.
  • Nasal dilators. These over-the-counter devices can be as simple as a strip resembling a Band-Aid with a wire in it. Placed below the bridge of the nose, the wire causes the nostrils to flare, increasing airway capacity.

Is your relative resisting treatment?

As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice understand how hard it can be to get a loved one to do the sleep test and then follow through with therapy. But the stakes are high. We can help you explore all the options. Give us a call at 1-800-897-3052, toll-free. Let’s talk.