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Monday, February 19, 2018

Post-Traumatic Stress Disorder (PTSD): Symptoms, Treatment (Research, Video 3:56)

Post-traumatic stress disorder (PTSD) can often go undiagnosed because people are not aware of the symptoms or do not know that treatment is available. Veterans are often associated with this disorder because of the trauma many experience while serving the country. One of my hospice patients, a Viet Nam veteran, described his symptoms to me with these words:

“I’ve seen and done things you couldn’t imagine. Some of them were horrible, I mean really horrible. Don’t ask me to tell you what they were. I can’t talk about it. They say time heals all wounds, but it’s a lie. I left Viet Nam, but Viet Nam never left me. I carry it with me everywhere I go. All these years later, I still have nightmares like you wouldn’t believe. The doctor says it’s post-traumatic stress disorder or PTSD. I wake up shaking, gasping for breath with tears in my eyes. In my dreams, I’m always running hard trying to escape. Sometimes my enemies are close enough for me to touch. I almost stop breathing to keep them from hearing me. I’m constantly thinking I’m not going to make it. Some nights they kill me before I wake up. My dreams are so raw, so real they turn my soul inside out.”

Many people who never served in the military suffer these symptoms and more. They may not recognize the PTSD disorder in themselves and others. In an online PTSD survey assessing PTSD trauma, symptoms, and treatments, PTSD participants included 301 adults (50% veterans). They were asked to identify PTSD related items from a list. They were better at identifying traumatic events and symptoms than they were at knowing about effective PTSD treatments. This is important because people may not seek treatment if they don’t know it is available.

All wounds are not visible. What can PTSD look like? This video features people sharing their traumatic experiences that caused their PTSD and what can “trigger” or generate symptoms in various degrees, even to the point of having “lost days” that are so scary they have difficulty functioning. Personal and group therapy are encouraged.



Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.
Hospice and Nursing Homes Blog

Monday, February 12, 2018

Volunteer, Patient First Meeting

Pointing her out to me, the nurse aide said, "That's Henrietta sitting by herself at the table." I followed her finger to a caramel-colored woman who sat humming. She had just finished eating and still hadn't wiped her mouth. A light coating of chicken grease looked like high-priced lip gloss when I walked closer to her.

Henrietta was going to be my new hospice patient, my first at this particular nursing home. Later, she would become my first patient whose health improved so much she was discharged from hospice care. For now, she knew nothing about me, including the fact that I was coming that day to serve as her hospice volunteer. I only knew she was seventy-nine and declining mentally with dementia. I pulled up a chair next to her and said, "Hi, Henrietta. I'm Frances Shani Parker.”

Looking me straight in the eyes like she'd known me all her life, she responded, "Girl, I know who you are, long as we've been friends. I've been waiting for you all day. I kept wondering when you were coming. I hoped you hadn't forgotten me, and here you are. What took you so long to get here?"

"Well, actually I got lost," I stammered, processing these new details concerning my whereabouts.

"Shucks, I get lost all the time. When you get lost, go to the lady at that desk over there. She'll tell you where you are. She'll tell you where you want to go. She knows everything. I'm surprised you didn't go to her before. We all do. How about some dinner? The chicken is something else, nice and tasty, just the way I like it. And I ought to know because I just had a wing that almost made me fly," she laughed.

"No, thanks. I'm not too hungry now. I'll eat when I go home. Some leftovers are waiting for me. I just came to visit you. I want to know if it will be okay with you if I come see you every week."

"Okay with me? Of course, it's okay. Look at all the years you've been coming to see me. If you stopped coming, I'd be wondering where you were just like I did today. So much is on the news, I'd be worried something happened to you. Keep on coming. I don't ever want you to stop."

"I'm looking forward to seeing you, Henrietta. We can talk together, and I can take you on wheelchair rides when I come. We'll get to know each other better. That is, better than we already know each other," I added, remembering our extensive "history."

"Sounds good to me. It's been working for us a long time. I think what you need to do now is eat something. You must be hungry after being lost all that time. Call the waitress over here and order some food. Don't worry about the money. Just put it on my tab. They know me at this restaurant. I eat here a lot."

So, this was Henrietta, an interesting oasis of serendipity. What would the future hold for us as patient and volunteer? I smiled to myself, buckled my mental seat belt, and prepared for another fascinating ride.
© Frances Shani Parker (excerpt from my book Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.
Hospice and Nursing Homes Blog

Monday, January 29, 2018

LGBT Older Adult Dementia (Research, Video 4:48)


Varied forms of dementia and other cognitive impairments include unique concerns for those who are lesbian, gay, bisexual, and transgender (LGBT).  These concerns center around social isolation, discrimination, barriers to health care access, limited availability of and support for caregivers, and higher rates of certain chronic illnesses. The increasing size of this older adult population further escalates the need to find more researched based solutions to these problems.

This LGBT dementia research examines their unique risk factors and outlines key competencies for health care and human service providers to ensure culturally relevant care for those in need of help. This kind of care is also needed for their caregivers, families, and communities. Emphasized are the importance of early detection and support, as well as the development of policies and practices that promote community-level advocacy and education.

In Australia, the Commonwealth Government uses the initials LGBTI to refer collectively to people who are lesbian, gay, bisexual, trans, and/or intersex. This video features a gay couple named Tony and Paul. Paul was diagnosed with early onset dementia before the age of 65. Paul serves as his caregiver. Together they explain how they have adjusted in their relationship to accommodate Alzheimer’s disease.



Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.
Hospice and Nursing Homes Blog

Monday, January 22, 2018

Complicated Grief: Food, Thought Solutions (Research, Video 2:14

Sometimes grief doesn’t wind down like a slowly moving stream reminding us of loss. For some, the death of a loved one can become a threatening ocean of turbulent thought waves that disorder lives with chaotic confusion. Complicated grief involves traumatic symptoms such as disruptive flashbacks, overwhelming fear, and extreme anxiety. Everyday tasks of living such as basic meal planning and eating seem impossible to navigate in a mental state of aloneness and pain. These symptoms require cognitive behavioral therapy to assist the griever with irrational beliefs, depression or anger in adapting to life without a loved one.

Hospice programs include family bereavement counseling assistance after a loved one has died. In an effort to support those who were having difficulty with adjusting to meal planning, grocery shopping, and cooking for one, Heather Nickrand of Alexian Brothers Hospice, Laura Lerdal and David Kramer of College of DuPage started the Culinary Grief Therapy: Cooking for One Series. This series includes interactive therapy demonstrations and hands-on experiences for participants in hospice bereavement counseling.

Results of this culinary grief therapy have been very positive with participation increasing with each workshop session. This unique way of providing quality of life in a person-centered manner with meal planning, grocery shopping, and cooking for one is commendable.

Complicated grief is an under-recognized mental health problem that many people experience, particularly older adults. General therapy for depression may not be successful in resolving this form of grief. Dr, Katherine Shear of Columbia University has lead a successful study using another form of therapy in which patients “relive the loss.” In this CBS video, Dr.Max Gomez, Dr. Shear, and patient Iris Palley explain how it works.


Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.
Hospice and Nursing Homes Blog

Monday, January 1, 2018

Physician Bias: Sexual Dysfunction, Obesity (Research, Video 3:12)

More and more research continues to show that patients are too often diagnosed through biases of their physiciansOne example that involves older adults vs. younger adults focuses on sexual dysfunction. This age bias includes diagnosis, causation, proposed treatment and perceived prognosis.

An on-line survey was given consisting of one of two, randomly administered, case vignettes, which differed only by the age of the patient (28 or 78). In both cases, the patient was described as suffering from occasional erectile dysfunction with a clear psychosocial indication. A total of 236 physicians responded to the survey. Overall, 110 physicians received an "old" vignette and 126 physicians received a "young" vignette.

Biases were reflected in these results:

1)   The "older" vignette was more likely to be diagnosed with erectile dysfunction, whereas the "younger" vignette was more likely to be diagnosed with performance anxiety.

2)   The "older" vignette's dysfunction was more likely to be attributed to hormonal changes, health problems and decreased sexual desire.

3)   Physicians were more likely to recommend testosterone replacement therapy and inhibitors, as well as a referral to urology to the "older" vignette.

4)   In contrast, the "younger" vignette was more often referred to a sexologist and received a more positive prognosis than the older patient.

Another researched-based bias that many people experience in general in society, including the healthcare professions is bias against people who are obese. One-third of American adults are considered obese, In this video, Sheila Gray goes to medical school to see how future doctors are learning to keep bias out of the exam room.




Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.
Hospice and Nursing Homes Blog

Monday, December 11, 2017

Mortality: Church and Religious Service Attendance Impact (Research, Video 1:39)

Have you ever thought about attending church or religious services as a means of extending your life? Apparently, others have in the past. Unfortunately, previous studies on the association between attendance at church and religious services and mortality often have been limited by inadequate methods for reverse causation, inability to assess effects over time, and limited information on mediators and cause-specific mortality. This particular study, which is focused on women, evaluates the associations between attendance at religious services and subsequent mortality. 

Using a self-reported questionnaire over a period of 20 years, participants numbering 74,534 women in the Nurses' Health Study who were free of cardiovascular disease and cancer at baseline. Among the 74,534 participants, there were 13,537 deaths. Data analysis was conducted from returns of 11,996 questionnaires. After adjustment for major lifestyle factors, risk factors, and attendance at religious services, attending a religious service more than once per week was associated with 33% lower all-cause mortality compared with women who had never attended religious services.

The research concluded that “frequent attendance at religious services was associated with significantly lower risk of all-cause, cardiovascular, and cancer mortality among women. Religion and spirituality may be underappreciated resources that physicians could explore with their patients, as appropriate.”

The following video explains research on church attendance regarding “middle-aged (ages 40 to 65) adults who attended church (or other houses of worship) and reduced their risk for mortality by 55 percent.” Research is explained by Marino Bruce, associate director of the Center for Research on Men's Health at Vanderbilt University and main author of the study with Keith Norris, professor of medicine at the David Geffen School of Medicine at UCLA. There are also nine other co-authors.



Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.
Hospice and Nursing Homes Blog

Monday, December 4, 2017

Unbefriended Patients (Research, Video 3:02)

“Unbefriended” is a word most people rarely hear or use. The very thought of being unbefriended carries a sadness that makes people dread experiencing it. Unfortunately, too many people are heading in that direction.

In the healthcare arena, unbefriended patients are those who have no surrogates to represent them in making medical decisions for self-determination. Being unbefriended jeopardizes a fundamental concept of American healthcare. Even more complicated both legally and ethically is an unbefriended patient who also happens to be in a vegetative state.

The process for making decisions on behalf of unbefriended patients is complicated and varies throughout the country. An example is this case of an unbefriended hospital patient admitted with cardiac arrest. The patient suffered significant brain damage and was in a vegetative state. This case occurred in a state where, unless an unbefriended patient will imminently die despite medical therapy, all measures must be taken to prolong the patient's life. With no surrogate with whom healthcare professionals could have a goals-of-care discussion, they were obligated to continue aggressive management despite knowing it would prolong, but not improve the patient’s condition. Prolonging life included a feeding tube and being transferred to a long-term care facility.

The importance of having early healthcare discussions regarding treatment and written advance directives including a surrogate (durable power of attorney) to make medical decisions cannot be stressed enough. If you were dying right now, would you be unbefriended? Would you be protected from overtreatment or undertreatment? Dr. Eric Widera explains solutions to this problem in this video brought to you by members of the American Academy of Hospice and Palliative Medicine.




Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Monday, November 27, 2017

Loneliness: Let Someone Know You Care (Research, Video 3:57)

Loneliness, an unpleasant emotional response to isolation, is a topic that is often avoided, even though everyone has probably experienced it at some time. As a hospice volunteer, I have seen many lonely older adults. Research on loneliness suggests that not having positive social relationships in one’s life is a significant risk factor in terms of “broad-based morbidity and mortality.” An important factor is how the person perceives social isolation. Being alone is not the same as being lonely. As the older adult population continues to age and decline in health, perceived loneliness can impair executive functioning, sleep, and mental and physical well-being.

The following includes an excerpt from my book from a chapter exploring the importance of being remembered and other emotional nourishment patients need to feel whole.

“Everybody at the senior citizen center asks about you all the time,” I read aloud to Jeannine from a letter she had received earlier that week. “We still meet every week to play bridge and gossip. It’s not the same without you. People say you were the best bridge player. These days, even I’m winning games. Last week, we had our annual spring party. The last time you came, the two of us ate most of the cookies and didn’t feel embarrassed at all (smile). We sure had some good times together.”

Jeannine stopped me to explain everything, just in case I hadn’t understood what I had read. “See, I learned how to play bridge a long time ago when hardly anybody I knew was playing. My friend Laura taught me because she needed a partner to play with her. I learned as a favor to her and to make new friends. I guess I caught on fast. Next thing I knew, I was teaching her a few things. I remember eating those cookies, too. And they were delicious. We played pranks all the time. We were just a bunch of overgrown kids having a ball cracking jokes whenever we got together.”

Jeannine had been going to the center for sixteen years. Now, she was in a nursing home away from the buffet of fun they had created. But none of that mattered today. What mattered was that they still cared about her, and she had this cherished letter to prove it. She experienced a mental feast of enjoyment. I smiled, knowing her satisfaction was caused by something she had eaten, something called love food.”

© Frances Shani Parker

This video explores a resident's loneliness and the importance of being remembered.


Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.
Hospice and Nursing Homes Blog

Sunday, November 5, 2017

Alzheimer’s Dementia Doll Therapy (Research, Video 3:05)

Dementia affects more than 47.5 million people worldwide, and the number is expected to increase as the population ages. Doll therapy has often been used as a management strategy for people with advanced dementia to decrease stress while adding responsibility, caring and structure to their lives. However, for too long, there was no protocol or official record of scientific experimentation of doll therapy success. A review of 12 studies reports that dementia doll therapy usually improves cognitive, behavioral and emotional symptoms along with overall well-being. Doll therapy is recommended because it helps many people with dementia relate better to their external environments.

Doll therapy continues to be a source of interesting discussion. These are two considerations people sometimes have before presenting a doll to someone with dementia. Will the doll be viewed as an added responsibility the person doesn’t want to assume? Will the person resist playing with a doll known not to be a real baby? The adult daughter in the video below shares her mother's reactions to the doll she gave her.

“This is my Mom. She’s 84 years old and was diagnosed with Alzheimer’s about three years ago. She will be moving into a home this weekend and has been depressed and crying for days. I learned that doll therapy is now being widely used with seniors. I fell in love with this particular doll’s smile and realistic appearance and ordered her right away, hoping she’d give Mom something to make her feel less alone during her transition.”

Did the doll gift work? Draw your own conclusions. 


Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.
Hospice and Nursing Homes Blog

Monday, October 30, 2017

Aging in Place Planning (Research, Video 1:50)

Many older adults view aging in place as the gold star of living well during declining years. It means having the health, social, and physical support you need to live safely and independently in your home or community. Aging in place is an advanced life event that supports independence and well-being. But planning ahead for aging in place has to be done with the same commitment as planning for any important life event. A lack of planning can greatly impede the realization of this life event for many older adults.

What do older adults perceive as their roles in planning for aging in place? Focus groups with 68 older adults over age 65 and living in the communities (rural, urban, and suburban) answered open-ended questions about their perceptions of future health events, needs, and planning. Three investigators analyzed and identified these five emerging advanced life events that impacted their ability to remain at home:

1) Hospitalizations
2) Falls
3) Dementia
4) Spousal Loss
5) Home upkeep issues


Many subjects reported a lack of planning for aging in place and perceived that life events such as those listed above simply would not happen to them. Other reasons for not planning ahead included these:

1) Uncertainty in future
2) Being too healthy/too sick
3) Offspring influences
4) Denial/procrastination
5) Pride
6) Feeling overwhelmed
7) Financial concerns


Although many older adults had not communicated their needs to their offspring, they still expressed reliance on offspring for taking care of their future advanced life events. If life events such as aging in place are to happen in increasing numbers, the reasons for older adults not planning ahead must be addressed vigorously to prepare them for future home needs and a voice in their care along with their offspring and/or other advocates.

Aging in place takes planning. Preparing for future needs is the key. The following video offers helpful resources to improve living while aging at home. Keep in mind that, while aging in place is what many older adults say they want, aging at home until the end of their lives is no guarantee of a high quality of life. Each situation has unique needs to be considered that may include other living options such as retirement communities.



Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.