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What is an occupational therapist?

Eating, dressing, getting in and out of a chair. In the course of daily life, we use many skills to accomplish even “simple” tasks. Walking or using a fork is surprisingly complex. Nerve signals and muscles have to coordinate in a very specific order. A healthy body is a marvel!

We take these skills for granted until something interrupts our abilities. Arthritis, for instance, can make it hard to grasp a fork. A stroke may require a right-handed person to learn to do things with the left hand. The tremor of Parkinson’s can make dressing a challenge.

Occupational therapy can be used to help your loved one

  • remain at home despite a chronic condition;
  • recover from a surgery or other health event;
  • improve the ability to accomplish specific tasks or activities.

Occupational therapists have special training to help people overcome new challenges with the daily tasks of living. A therapist might show your loved one some exercises for better coordination. They might recommend special equipment or supplies. Maybe all that’s needed is a rearrangement of furniture in the house. Or a slightly different approach to doing the same thing.

Occupational therapy can be provided at home or in an outpatient clinic. It usually starts with a home visit. The therapist will

  • watch your loved one perform various tasks;
  • evaluate the home for safety and convenience;
  • recommend exercises and/or home modifications;
  • consider best options for transportation;
  • develop goals based on your relative’s abilities, interest, and budget.

Participate in the visit if you can. That way you learn what might help your family member live to the fullest in spite of limitations.

Ask the doctor for a referral
If you think your loved one would benefit from knowledgeable guidance, ask the doctor for a referral. Occupational therapy is covered by Medicare. Also by Medicaid and most private insurances.

Does life seem harder than it was?
If you notice your loved one struggling to do things that used to be a simple part of daily life, he or she might benefit from the services of an occupational therapist. As the Iowa City, Muscatine and Cedar Rapids expert in family caregiving, we at Iowa City Hospice have seen firsthand how much a simple device or a change in approach can transform an elder’s self-sufficiency. If you are concerned about a loved one, give us a call at 1-800-897-3052, toll-free.

When language falls apart

One common outcome of a stroke or other brain injury is the sudden loss of ability to process language. This disability is called “aphasia” (ah-FAY-zya).

Depending on which part of the brain has been damaged, the affected person may have trouble speaking or trouble understanding. Or may have difficulty with reading or writing.

Needless to say, this is frustrating—for the injured person and family members too!

Aphasia does not change intelligence
People often assume that someone with aphasia can no longer think clearly. Or that hearing is affected. As a result, those with aphasia frequently have others yelling at them. Or acting as if they have dementia. Not true! Hearing remains the same. And unless the stroke or trauma affected the logical thinking portion of the brain, your loved one is just as “smart” as they ever were.

Aphasia does affect relationships and self-esteem
Talking is how we express our personality. It’s also how we interact with those we love. Without full language capabilities, your relative may feel “less than” and withdraw. This can lead to isolation and depression.

Work with the rehab team
It’s important to engage speech and occupational therapists soon after the stroke or trauma to better understand the full impact. They will identify strengths and weaknesses and develop exercises and strategies to help your relative live fully. Don’t get discouraged! Therapy takes practice and time, but it makes a big difference.

Stay engaged
When a loved one struggles with speaking, it’s tempting to want to “help” by doing things for him or her. Help your loved one stay involved with friends, hobbies, and activities, as well as with family discussions and decision making. You may need to get creative and be patient. But staying engaged will help the person you care for regain as much language ability as possible.

Does aphasia have you down?
We at Iowa City Hospice notice that aphasia is one of the more challenging outcomes of a stroke or brain injury. It affects family relationships and your loved one’s feelings of self-worth. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we can help you find optimal strategies. Give us a call at 1-800-897-3052, toll-free.

Aging and the self-fulfilling prophecy

“Whether you think you can, or you think you can’t—you’re right.”
—Henry Ford

It turns out this truism applies to the ways we perceive the aging process itself. Research shows that older adults who view aging as a time of continued learning and development are physically more resilient. They seem to weather a setback and regain their mobility and independence more readily. They stay healthier and live longer than their peers who view aging primarily as a time of decline.

As a society we tend to hold aging in a negative light. But studies have found that advanced years do indeed bring many benefits. When compared to younger generations, for instance, older adults generally are more able to

  • focus on the positives
  • tune out the negatives
  • relax and accept who they are

The wisdom of aging may be that older adults recognize life is too short to “sweat the small stuff.” And with accumulated years, they have developed more coping skills for life’s inevitable rough spots.

Get this self-fulfilling prophecy working in your loved one’s favor! Try asking some of these questions to help him or her identify the special strengths of aging:

  • If you were suddenly 20 again, what skills or wisdom would you miss?
  • What has helped you through hard times in the past? Look for ways to emphasize these skills or resources.
  • What people, activities, or situations tend to leave you feeling positive? Consider ways to emphasize these resources. For many older adults, family and social interactions bring the greatest joy.
  • What is the ‘gift’ in your situation right now? With aging, we frequently come to realize that in every situation the good coexists with the bad. Even people with incurable diseases can usually identify something positive they have learned as a result of their condition.

Is the glass looking half empty?
Let our strengths-based approach give everyone a fresh perspective. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice can help with a realistic picture of the glass-half-full side of the equation. Give us a call at 1-800-897-3052, toll-free.

Fighting Parkinson’s with exercise

If your loved one has Parkinson’s disease, you have likely observed physical symptoms such as tremors, slowed movement, and poor balance. In addition to treatment with medication, evidence is mounting that exercise itself can reduce or delay progression of these symptoms. Even as little as 2.5 hours of physical activity a week.

Benefits and types of exercise
The benefits of exercise include smoother and quicker movements and improved balance and coordination. Plus, exercise can ease depression, which is so common in Parkinson’s. It’s not a cure for Parkinson’s. But overall your relative will simply feel better. 

There is no one “best” exercise for Parkinson’s. The goal is to get going on some kind of activity and keep going over the long term. Have your relative talk with his or her doctor and get a referral to a physical therapist specializing in Parkinson’s. The therapist can suggest exercises best suited to your loved one’s likes and needs, such as

  • boxing. Punching a bag reinforces confidence and fast, coordinated movements. No hitting of others!
  • dance. Allows for creativity while also promoting agility.
  • rowing or tandem cycling. Doing itwith others can help ensure a pace that builds stamina. A stationary bike with a forced pace may work as well. 
  • tai chi, qi gong, and yoga. These activities support better balance.

Reach a bit, push a bit
Your loved one may prefer to start with something more familiar, such as walking or swimming. The key is to get moving! With Parkinson’s, movements gradually become more restricted. Research indicates that a “forced-pace” activity that feels to the person a little harder than they can do is more likely to extend ease of motion. A physical therapist can design and monitor a program that strikes the balance between too much and too little.

Trouble getting your loved one to exercise?
You are not alone. And nagging won’t help! As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice can help you navigate the balance between pushing and support. Give us a call at 1-800-897-3052, toll-free.

Keeping your marbles: reducing dementia risk

If you have a relative with Alzheimer’s or one of many other dementia conditions, it’s natural to wonder about your own risk.

While there is no cure as yet, there is increasing evidence that lifestyle changes in middle age may do a lot to delay the onset of memory loss. The plaques and tangles of Alzheimer’s, for instance, appear to start accumulating in the brain decades before symptoms show up.

All right, that’s scary! But there is plenty that you can do. One of the foremost findings of prevention research is that heart health and brain health are strongly related.

  • Get physical. Brain cells need lots of oxygen to fire properly. This is probably why 20% of the blood pumped by the heart goes to the brain. Aerobic exercise keeps the blood circulating well. This supports overall brain function and reduces high blood pressure and the chance of stroke or vascular dementia.
  • Guard your sleep. Evidence is mounting that sleep is essential to brain health. It’s when our brains do important cleanup, getting rid of the daily buildup of sludge. While it’s tempting to squeeze more hours out of the day, your brain needs you to sleep!
  • Take depression seriously. Mental health also affects brain health. Depression is very common in middle age, and it’s treatable. If you find yourself feeling blue and apathetic, talk with your doctor.
  • Learn new things. “Use it or lose it” applies to our brains and thinking capacity too. Continue to learn new skills, especially in social settings. Taking classes seems to delay the onset of memory and thinking problems. Challenge yourself!

It looks like it’s never too early to start your own risk reduction program. And it’s also never too late. The benefits accrue no matter when you start, but get going now for the best advantage.

Do you have a relative with dementia?
We can help. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice know how stressful it can be. Give us a call at 1-800-897-3052, toll-free.

“Spiritual” advance directive

Every adult needs to complete an advance directive (and that means you, too!). It is the health care planning document that medical professionals follow if a patient becomes too ill to speak for him or herself. It gives your loved one the option to name someone as decision maker. And it is the place he or she can state preferences regarding life-sustaining treatment.

More than medicine
Death and dying is more than a medical event, however. Like birth, a family member’s death is a profound part of a family’s life journey. Just as an expectant mom might contemplate where to give birth and the emotional tone of the environment, your loved one may have thoughts about where to die and those surroundings. This may involve his or her religious or spiritual beliefs and preferences. Or may simply reflect personal rituals and symbols. The advance directive is a vehicle for your relative to describe these wishes, but you might need to start the conversation.

Some questions you might ask:

  • Is there anything you would like us to do that is rooted in your faith? Tell us everything you can about what you might like. Any faith leader you would like us to call?
  • Where would you prefer to pass? At home? Somewhere else?
  • How do you envision the room? Special photos or prayers? Poems or music?
  • To provide a sense of who you are, how shall we describe you to the doctors, nurses, or other helpers who may not have met you before? “Above all, he/she was a person who _____.”

A final gift
Capture your relative’s wishes on paper. Have him or her sign the document and attach it to the advance directive. Knowing your loved one’s spiritual wishes enables you to give him or her a final gift of comfort and dignity.

Is this an uncomfortable topic?
We at Iowa City Hospice understand this is not always an easy discussion. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we can help you and your loved one get started on an advance directive and even explore these more personal, very meaningful aspects—”spiritual planning.” Give us a call at 1-800-897-3052, toll-free.

When the worrying won’t stop

Worry is useful when it calls us to action. But it’s a problem when it becomes an ongoing state of mind. It can become a habit, bringing tension and stress.

If you’re a worrier, you may have mixed feelings. It may seem that worry

  • keeps you on your toes, yet it
  • makes you edgy and distracted, interfering with your sleep and peace of mind.

Relieving the stress of worry doesn’t mean you have to stop worrying. Here are some strategies to harness the positives of worry and keep the rest in balance:

  • Don’t try to give it up. Instead, do it consciously and take notes! Schedule a 45-minute “worry time” for yourself every day. If a worry pops up at another time, write it down for review during your next worry period.
  • Clarify what is fact and what is emotion. Hint: Facts are in the present tense. (“Dad seems tired and is coughing a lot.”) Emotional concerns often have a “future” component involving a problem that might happen (“What if it’s lung cancer?”).
  • Create a strategy for action. Unproductive fears are usually based in uncertainty. Create a list of action steps to answer the unknowns. (“Look up the symptoms of lung cancer. Find out how many risk factors he has. Make an appointment with the doctor.”)
  • Write out a balanced perspective. While completing the action steps, your mind is unlikely to just “let go” of the worries. For each worry, write down evidence in its support and evidence against it. For instance, “Dad spent the afternoon in bed today. Then again, just last week he played a full round of golf with his buddies, and no coughing.” When the worry reappears, you can respond to it with this alternative, fact-based thought.

Seek professional help if your worrying feels unmanageable.

Want help with the source of your worries?
You may be worried because there is simply more to do than you can handle by yourself. Or you don’t know the spectrum of normal aging, so you don’t know whether a situation is dire or not. You don’t need to do this alone. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice can provide that perspective. Give us a call at 1-800-897-3052, toll-free.

Managing chronic pain

“Chronic pain” is pain that lasts for 12 weeks or more. The cause is usually nervous system misfiring, like a faulty car alarm system. Often there is no specific trigger, which makes treatment difficult.

Chronic pain is common, affecting 50%–66% of adults age 50 and older. Opioid drugs are recommended for pain control in serious illnesses such as cancer. For those with chronic pain, however, a mix of pain relief strategies is better. 

With chronic pain, a full recovery to “no pain” may not be realistic. Instead, it’s a matter of finding ways to help your loved one adjust so he or she can continue activities that bring meaning to life despite the pain. 

Pain is physical, and the experience of pain can be reduced with physical changes. Pain is also highly affected by mental perception. In other words, how negatively we think about it. These two qualities open the door for many nondrug strategies of pain management. For instance:

  • Physical therapy. Exercises to gain strength and flexibility can improve overall comfort.
  • Occupational therapy. Learning new ways to accomplish daily tasks may reduce pain.
  • Exercise. Low-impact physical activity—walking, swimming—releases endorphins, the body’s natural pain killer.  
  • Quality sleep. Lack of sleep makes pain worse. Good rest supports resilient coping with pain.
  • Relaxation techniques. Special techniques can train the mind and body to interrupt the pain cycle (in which pain triggers fear and tension, which brings more pain).
  • Meditation. Mindfulness practice can help your loved cope by “seeing” the pain from a new perspective.
  • Counseling. Counseling can help your relative identify and change the thoughts, feelings, and actions that amplify pain. Cognitive behavioral therapy is often the most helpful. It can also address depression and anxiety, which then lowers pain.

Looking for pain management strategies?
Of course the first step is to talk with a doctor to get a diagnosis and find out about nonnarcotic, nonaddictive sources of relief. At Iowa City Hospice we have seen that a combination of therapies works best. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we know how difficult it is to care for a loved one in pain. We also understand your concerns about opioids and other drugs. Give us a call at 1-800-897-3052, toll-free. You don’t have to navigate this alone.

Dementia: safety and independence

Everyone with a memory loss condition deserves the opportunity to stay engaged in life for as long as possible. Early in the disease, your loved one will continue to do many things quite well. Your challenge is to balance respect for your relative’s independence with the need to ensure safety. All this while preserving a trusting relationship.

In the beginning, just keep an eye on things. Encourage engagement and support self-esteem. Over time, you may need to provide some assistance. Not to do things “for” him or her, but “with.” As abilities decline, suggest alternative approaches. And when you notice risky and unwise decisions, transition into taking over. Respectfully.

Finances
Managing mail and doing calculations can become confusing early on. Watch for unopened bills, an unbalanced checkbook, utility shut-off notices, or difficulty calculating the tip at a restaurant. Offer to “make life easier” by putting bills on autopay. At tax time, suggest doing it together. Or that you take it on, as he or she has “done that chore long enough.” Poor judgment may leave your relative open to scams. Look for odd purchases or erratic spending. Work with your loved one’s financial advisors to talk about money management options. Eventually, if you have power of attorney, you may need to activate that.

Driving
If your loved one is still driving, be the passenger frequently to check his or her capability. Dementia affects reaction time, spatial judgment, and decision making under pressure. Typical problems include

  • not following right-of-way rules, for example at stop signs or when making a left turn.
  • getting flustered at intersections or stopping midstreet when feeling uncertain.

You might suggest driving simpler routes and when traffic is less busy. Or facilitate rides from friends, public transit, etc. Eventually, call the doctor and ask for a driving evaluation.

Is your loved one in the early stages of dementia?
Such a delicate balance! We can help. We at Iowa City Hospice see families struggle with the natural temptation to protect their loved one by taking over, only to be met with anger and resistance. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we can help you navigate the need for safety AND independence. Give us a call at 1-800-897-3052, toll-free.

Smartwatches for seniors

The makers of smartwatches are now designing products for older adults. And they just may have come up with an acceptable alternative to the standard “I’ve fallen and I can’t get up” pendant. Perhaps you’ve tried to get your loved one to wear a personal emergency response system (PERS) pendant—only to hear, “No. I don’t like it.” Many older adults consider the pendants ugly and stigmatizing.

The new smartwatches offer advantages:

  • Unlike home-based emergency response systems, they work anywhere there is a cell signal.
  • They are easy and natural to wear.
  • GPS features enable using the watch as a locator device for persons with dementia.
  • They can do dual duty as fitness trackers, measuring heart rate, number of steps, etc.
  • They send and receive text messages. Some even handle phone calls.
  • Apps are available for things like setting a timer for pill reminders, or scheduling appointments. Soon even EKGs for heart monitoring.
  • They tell time!

On the downside:

  • Will your loved one use all these features? Or will the apps just be confusing? The options are likely too much for those with memory problems.
  • How useful is the watch in an emergency? Screens are small and several steps may be required. Practice may be necessary ahead of time.
  • So far, the automatic fall detection apps still have a few bugs to work out.
  • Not all smartwatches offer a companion service for 24/7 connection to a trained professional who can triage the need for help.
  • Those with hearing loss may have difficulty hearing a respondent if the device isn’t held close to the ear.
  • While smartwatches are definitely more stylish, they are still big. They seem to appeal more to men than to women.
  • These devices need to be regularly charged.

Meeting resistance to a PERS device?
Many family members find their loved one simply won’t wear the device. A smartwatch may be the solution, but they aren’t for everyone. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice can help you determine the best ways to protect your relative in the case of a fall. Give us a call at 1-800-897-3052, toll-free.