Monday, January 28, 2019

Patients in a Vegetative (Unresponsive Wakefulness) State: Nurse-Family Research, Video 5:43

Some people are uncomfortable referring to another human being as being in a vegetative state. That is probably why more doctors and neuroscientists prefer to call this state of consciousness an unresponsive wakefulness syndrome. A patient in this state experiences a disorder of consciousness in which severe brain damage is experienced.

About 50% of persons who are in this state one month after traumatic brain injury eventually recover consciousness. They are likely to have a slow course of recovery and usually have some ongoing cognitive and physical impairments and disabilities. In this state, the person is still unconscious, breathing, and able to feel pain.

Family and healthcare caregivers have important roles to play with these patients, especially when the patient is allowed to go home. In this research study on nurses, family caregivers and vegetative patients, 14 patients and caregivers participated. Data were gathered using face-to-face in-depth interviews at discharge time and during home care, helping families in providing care, and supporting them during care process.
Research concluded that nurses can play an effective role in improving the caregivers' well-being by considering the importance of training at discharge time and during home care, helping families in providing care, and support during the care process.

This video shares the story of Juan Torres, who was declared to be in a permanent unresponsive wakefulness syndrome state. What makes his story so special is that he surprised everyone one day and woke up. He even remembered what had happened while he was not awake.

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, January 21, 2019

Bullying, Loneliness, Mortality in Older Adult Senior Communities (Research, Bullying Link)

Solitude can be a good friend at any age for those who have learned to embrace its opportunities. Loneliness, on the other hand, is another story. While every age experiences some level of loneliness, older adults are often assumed to experience loneliness more as their peers die. People often imagine older adults living at home alone in a house where they have few visitors or other forms of engaging contact while life happens. They also may not make the connection that ongoing loneliness can negatively impact health, particularly in the form of depression, a risk factor for other serious healthcare issues.

Ironically, older adult housing communities are often viewed as solutions to the loneliness problems of those living alone at home. But aging in place at home can be a good thing when all the caregiving, social, security and enrichment pieces are in place. These same factors should also be in place in excellent housing communities. Sometimes they aren’t available in either location.

While few studies have examined the effects of loneliness and social isolation on older adult health, this study, which included a nationally representative sample of middle-aged and older adults with a follow-up period of up to 20 years, did. Results show that effects of loneliness and social isolation interact with each other: The higher the social isolation, the larger the effect of loneliness on mortality. The higher the loneliness, the larger the effect of social isolation.

Preventing social isolation in older adult communities includes important components involving mental, spiritual, and physical stimulation provided by various experiences such as exercise and other classes, entertainment, clubs, trips, games, movies, dining experiences, etc. This buffet of well-rounded choices from which residents decide how to live their daily lives should be grounded in an institutional culture supporting each resident’s right to be treated with equality and respect at all times.

I could not end this post without addressing bullying, an under-reported and too often unaddressed problem in many older adult communities. Bullying often plays a role in older adults isolating themselves to avoid contact with bullies who target them or others. Being excluded from seating in dining areas, movie theater rooms, etc., to which they are entitled on a first-come, first-served basis, as well as verbal, mental, and physical abuse are all forms of bullying. No one should have to age while being mistreated regularly by selfish neighbors who justify their actions that negatively impact victims' health. Studies indicate that one in five older adults are bullied. Senior communities must have ongoing assessment, implementation, monitoring, and staff inservice training supporting equality and respect in the culture of their communities. 

You can read my post on bullying, which includes detailed examples, solutions, and a brief video explaining some of the legal and legislative senior bullying issues here:

Bullying in older adult senior communities continues to escalate. More information and solutions can be found at this AARP site:

Frances Shani Parker
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 14, 2019

Dementia Doll Therapy and Caregivers (Research, Video 3:05)

“Does this baby have a heartbeat?”

I have served several years as a hospice volunteer in Detroit, MI nursing homes where I have interacted with many residents who had dementia. They often needed various stimuli to become engaged in approaches that were more likely to be successful with them from a person-centered perspective. Doll therapy was often successful. This excerpt from my book Becoming Dead Right is an example :

“What’s your baby’s name?” I asked while exploring the reality of a hospice resident who had dementia. Susan, who was the resident, and her doll stared at each other, grinning as if they knew secrets from ancient times. And maybe they did. She looked at me, pointed to her doll and said, “She’ll tell you her name when you come back with cookies.” (Very clever baby!)

Doll therapy research focused on reducing behavioral and psychological

symptoms of dementia has increased in clinical practice. The aim of the research discussed in this post was to measure the impact of doll therapy on people with severe dementia and the related distress and impact on everyday behavior of formal caregivers. Twenty-nine nursing home residents aged from 76 to 96 years old and who had severe dementia (Alzheimer's or vascular dementia), took part in the experiment. They were randomly assigned to an experimental group that used dolls or an active control group that used hand warmers with sensory characteristics equivalent to the dolls. Effects of doll therapy on caregivers’ everyday abilities such as eating behavior were also examined. 

This research concluded that only the doll therapy group showed a reduction in behavioral and psychological symptoms of dementia scores and related caregiver distress. Doll therapy did not benefit eating behavior of caregivers, however. 

As a hospice volunteer, I observed how easily many residents with dementia enjoyed their close relationships with dolls and stuffed or robotic animals. In this video, a caregiving daughter does doll therapy with her mother who is past middle stage dementia. I found this video particularly interesting because, unlike many residents I have observed, this mother seems to know her doll is not a real baby. But she still enjoys nurturing the doll. She also continues to question if the doll really isn't real. The daughter wonders if the doll therapy is truly appropriate for her mother. This video shares the mother’s response. (Do you remember playing with dolls as if they were real when you knew they weren’t? I do. )

If you liked the video above, you'll appreciate this one with a man enjoying his pet therapy cat:

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, January 7, 2019

Ending Negative Older Adult Stereotypes (Video 4:08)

You can’t teach an old dog new tricks. Does this ageism stereotype sound familiar when people refer to themselves this way? We should all be very careful about the words we use regarding ourselves and others. Words can be very powerful, so powerful that we may not realize that saying them helps us form our own positive and negative opinions about ourselves, even when we are joking.

Many of the words we say, the thoughts we imagine, such as those related to negative aging stereotypes, often creep into our belief systems and become a part of who we are. This process is demonstrated with children as early as the age of three who have already started believing negative stereotypes about aging that they have learned through the media and other people, including older adults living in the age cage with stereotypes they have internalized about themselves. Of course, positive concepts about aging have the opposite effect by improving lives.

These are just a few examples of how our lives can be impacted by verbalizing these stereotypes on aging that affirm a prejudice against ourselves as we age.

Negative Stereotypes:

I’m having a senior moment.

You know I’m old and can’t remember anything.

You can’t teach an old dog new tricks.

Negative Consequences:

Memory can decrease, and we can become less interested in engaging in healthy preventive or new behaviors that we are capable of doing at our age.

Negative Stereotypes:

When you age, everything hurts, and what doesn't hurt doesn't work.

After a certain age, you can forget about having sex.

When you’re old, you need your false teeth and your hearing aid before you can ask where you left your glasses.

Negative Consequences:

Negative age stereotypes have significant negative effects on the physical well-being of older persons. Recovery from illness is impaired, reactions to stress are increased, and longevity is decreased.

Sure, it would be great if employers, politicians, healthcare workers, and everybody else in society treated older adults with more dignity and respect without stereotyping them negatively. Unfortunately, many of these people are simply embracing the same negative stereotypes that too many older adults perpetuate about themselves. Shouldn’t we all just affirm our own healthy aging by promoting positive images about ourselves? Shouldn’t we just live our best lives and not limit ourselves based on our age numbers?

Millennials are people who reached young adulthood around the year 2000. This video demonstrates how many of them have already internalized negative stereotypes about aging that may become self-fulfilling if they do not change. 

Children start believing stereotypes early. You can read research our school fourth graders did on older adult stereotypes here:

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