Deep brain stimulation (DBS) is a surgical treatment that involves the implantation of a brain pacemaker that can send electrical impulses to specific parts of the brain. DBS is an accepted therapy for advanced Parkinson disease, but little is known about how it compares to medical treatment. According to a new study published in the January 7, 2009 issue of the Journal of the American Medical Association, DBS may be more effective than best medical therapy for advanced Parkinson patients.

Researchers from the Hines VA Hospital in Illinois and their colleagues studied 255 patients with advanced Parkinson disease for six months in order to compare outcomes of DBS versus best medical therapy. They found that patients treated with DBS experienced significant improvements in motor function and quality of life compared to those treated with medical therapy. However, they also found that DBS was associated with an approximately 4-fold increased risk of serious adverse events, most related to the surgical procedure. It was also noted that most of these events resolved during the 6-month follow-up period.

Although this study suggests that DBS is effective in reducing the movement-related symptoms of Parkinson disease, further research is needed to determine the best timing and the best candidates for DBS pacemaker implantation.

Caring for the elderly is one of the most challenging and rewarding jobs in nursing. Demanding a great deal of tact and care, looking after elderly patients is a trying and testing job, although it is one of the most necessary and most sought after positions in modern times. Elderly patients require care for a number of reasons, and these each carry their own complexities and challenges which must be met by the carer.

For some elderly patients, care is a round the clock affair, and this means you also have to be dedicated to patient’s well being. On top of that, patients require genuine attention, which extends beyond the hours of the job. A carer for the elderly must be a genuinely caring person, willing to commit to a career in people. At times it can be a demoralising and depressing job, but at the end of the day, the difference good care can make to quality of life is substantial.

Amongst other things, elderly patients need human company and companionship, and a good carer should have the ability to listen and interact on many different levels. It is a good idea to come with plenty anecdotes, and a good knowledge of current affairs to keep your patients amused whilst you provide them with essential care to improve the quality of their lives. Additionally, it requires patience. Elderly patients can, at times, be set in their ways, and can find it hard to accept help and treatment from someone younger than themselves. However, it is essential to remember that the patients are people too, with their own opinions and dignity. In nursing the elderly, it is a case of striking a balance between offering care and assistance and understanding the mindset of the patient, and this is arguably one of the most difficult things about the job.

Caring for the elderly is not a job for everyone, but it is a job that many would find appealing. Working with the elderly can be very rewarding, and the loyalty and respect you can expect in return for your help is heart-warming. Furthermore, many patients will adopt you and care for you as their own, creating a uniquely bonded two-way relationship. It is this relationship which makes caring a job that is worth far more than any wage, and is something which can provide the real sense of job satisfaction which can’t be found anywhere.
]]> http://healthyseattleelderly.wordpress.com/2009/01/10/caring-for-the-elderly/feed/ 0 healthyseattleelderly elderly-care-1 http://healthyseattleelderly.wordpress.com/2009/01/08/seattle-womans-tenacity-builds-clinic-for-poor-in-ethiopia/ http://healthyseattleelderly.wordpress.com/2009/01/08/seattle-womans-tenacity-builds-clinic-for-poor-in-ethiopia/#comments Thu, 08 Jan 2009 21:05:45 +0000 healthyseattleelderly http://healthyseattleelderly.wordpress.com/?p=252 ]]> A clinic for the poor is rising in Ethiopia because of the persistent efforts of Selamawit Kifle, a South Seattle woman who grew up there.

By Jack Broom

Seattle Times staff reporter

A lot of people would have given up by now.

Many would have surrendered to the hassles of coordinating a project 11 time zones from home, or been choked by the red tape of dealing with a foreign government.

Still others would have succumbed to the difficulty of raising money for something most donors will never see.

But Selamawit Kifle, a South Seattle woman who grew up in Ethiopia, does not give up.

And because she does not, a clinic is rising from the red clay soil of her native land. Later this year, some of the poorest residents in one of the world’s poorest countries may be receiving treatment for malaria, tuberculosis, leprosy, complications of HIV/AIDS and other ailments.

“When I started, I had no idea what it would take,” said Kifle. “I just knew I had to help.”

Already, 63 Ethiopian orphans are receiving the basic necessities of life, along with school supplies and a chance at a better future, thanks to donors — nearly all in the Seattle area — who give $30 a month to sponsor a child through the Blue Nile Children’s Organization, which Kifle created in 2001.

“She is a very quiet, unassuming woman, but she is just a lion in terms of what she can accomplish. It’s amazing,” said Deacon Mary Shehane of St. Mark’s Episcopal Cathedral, which made Blue Nile one of its “Church in the World Ministries.” Next month, St. Mark’s will host a dinner and auction for the group; a similar event last year raised $20,000 toward the clinic construction.

The desperately poor Ethiopia which Kifle, 48, sees on her twice-yearly trips these days is not the country she remembers from childhood, when her upper-middle-class family had homes and property under Emperor Haile Selassie.

But a Marxist military regime that toppled Selassie in 1974 confiscated privately held property, including her family’s. In subsequent years, thousands of people were killed or simply disappeared, including a teenage brother and sister of Kifle’s. “The government took them away and we never saw them again.”

Kifle left Ethiopia in 1982 at age 22, following an older sister first to Germany and then to the United States.

Thirteen years later, Kifle, who then operated an import-export company, made her first trip back to Ethiopia, and was heartbroken by the plight of the country’s children.

“When you walk down the street, they follow you, begging for bread. If you go out early in the morning to church, you see them sleeping outside, piling up with each other to be warm,” she said. “I know I can’t help all of them, but if I can help even 100 kids, I’ll know I’ve done something.”

According to the U.S. Centers for Disease Control, more than 1 million children in Ethiopia alone have been orphaned by the AIDS epidemic sweeping through sub-Saharan Africa, and that total is expected to rise.

Setback alters goal

Kifle, with a growing core of supporters, proposed to create an orphan village in Bahir Dar in northwest Ethiopia. The local government granted the group five acres of land in 2001, and assigned it responsibility for 28 orphans.

Wherever they could find an audience, Kifle and her backers spoke of their dream to house up to 150 children in family-style cottages, with a school, a clinic and a farm that eventually could earn most its revenue through selling crops and goods produced there.

The entire project would cost about $1 million, but a first phase, they figured, could be done for about $250,000.

And that’s where reality stepped in. Although Blue Nile gradually increased its number of sponsors, allowing it to assist more orphans, it was unable to raise the additional funds needed to keep the village project alive.

“We tried so hard and so long, but we just couldn’t get the money,” said Kifle. In 2004, with Blue Nile unable to make sufficient progress, the government took the land back, though Blue Nile continues to sponsor the children.

Despite the setback, Kifle persisted, trusting that God has a reason for everything, and buoyed by the words of a friend who reminded her, “You only fail if you stop trying.”

She draws encouragement from the fact that eight of the group’s sponsored children have made it into college or technical school, and one has graduated from nursing school. Ultimately, Kifle said, Ethiopia’s best hope for the future lies in its next generation, not in dependence on outsiders.

In 2005, a Blue Nile board member and one of its first proponents, Richard Oslund of Seattle, died, leaving the organization $47,000 in his will.

With the orphan village still out of reach, Blue Nile backers chose a more realistic project, construction of a clinic in Ethiopia’s capitol, Addis Ababa, which will be named in Oslund’s honor.

Plans call for the 3,550-square-foot clinic, which will cost about $75,000 to build, to be staffed by an Ethiopian physician and two assistants, whose work would be supplemented by doctors and other health-care workers visiting from the U.S.

Maegan Ashworth, a Blue Nile project coordinator, is currently recruiting up to 15 medical professionals and trainees for a 10-day mission in November.

Kifle, who now operates a service in Seattle sending health-care and chore-service workers to people’s homes, anticipates that about a third of the Ethiopia clinic’s patients will be able to pay for medical services, helping subsidize the care of the less fortunate.

Admittedly, the clinic, which will serve patients of all ages, is a smaller project than Kifle originally conceived, but it’s desperately needed, she said, in a country with one physician for 100,000 residents.

A captivating smile

Most important, it is actually happening. “It’s coming out of the ground like a mushroom. It’s wonderful to see,” said David Hornett, the Blue Nile board member directing the project.

Hornett, a contractor from the Vancouver, B.C. area, was in Ethiopia last month as trenches for the clinic’s foundation were filled with rocks and mortar. He keeps in touch via e-mail with an African foreman on the job.

It was a chance encounter outside an African airport in 2004 led to Hornett’s volunteer work with Blue Nile. At the time, he was backpacking through Africa on his own, making his first visit to Ethiopia.

At the Bahir Dar airport, Hornett was boarding a hotel van when he noticed a woman who was catching the same van loading package after package into the vehicle.

“I had never seen anyone with so much stuff in my life,” said Hornett. The woman was Kifle, taking school supplies and gifts to Blue Nile’s sponsored children. On the ride to town, she told him about Blue Nile and invited him to stop by its office the following day and help hand out the gifts.

He went, largely out of curiosity. But as the session broke up, a young girl with polio, who needed the help of two friends just to walk, flashed him a smile he’ll never forget.

“To see that she could smile, while so many of us in the Western world find more things to grimace about every day, that did it for me,” said Hornett. “I knew I had to get involved.”

Selamawit Kifle :206-551-1300 or 206-760-2873

Jack Broom: 206-464-2222 or jbroom@seattletimes.com

The Alzheimer’s Association estimates that the state had 17,000 Alzheimer’s cases in 2000. The organization projects that number to be 21,000 by 2025, an increase of 24 percent.

The disease, which most often strikes the elderly, is the sixth-leading cause of death in the United States.

By 2050, the Alzheimer’s Association predicts about 14 million people in the nation will be living with the illness.

Alzheimer’s is a progressive brain disease that impairs memory and other cognitive functions.

As Parkinson’s disease progresses, patients may experience what is called ‘Parkinson’s Psychosis,’ in which they experience changes in thought, behavior and judgment. In more advanced stages these symptoms include hallucinations where patients see, hear or feel things that aren’t really there, and paranoid delusions where they become distrustful of even their closest friends and family members. The emergence of these symptoms represents a major turning point in the course of the patient’s disease.

“While the physical manifestations of Parkinson’s disease are difficult to deal with, the changes in thought, behavior and judgment strain the bonds between patients and their caregivers and families,” said Dr. Bernard Ravina, Director of the Movement and Inherited Neurological Disorders Unit at the University of Rochester in New York.

According to an on-line survey recently conducted by MediciGlobal, a global patient recruitment and retention specialty firm, over one-third of Parkinson’s caregivers are unaware that changes in thought, behavior, and judgment can accompany the disease. “As a registered nurse, I was prepared for the physical problems with my husband’s Parkinson’s disease but, despite my job as a RN, I was totally unprepared for the psychiatric issues,” said Carol McLain, a caregiver who took the survey.

According to Dr. Ravina, “It’s the non-physical symptoms of the disease that are often most devastating for both the patient and caregiver. As the patient’s mental health deteriorates, the family often has to make the painful and expensive decision of moving the patient into a nursing home.”

There are currently no FDA-approved treatments for these particular non-physical symptoms of Parkinson’s disease. Nevertheless, doctors often resort to the use of potent antipsychotic drugs to treat these symptoms even though these drugs sometimes have serious side effects, particularly in the elderly, including worsening of motor skills, excessive sleepiness, increased infections, stroke, and sudden death in some patients. As a result, there is a large unmet medical need for new and improved treatment options.

When an elderly woman with dementia drooled while under the care of two teenage nursing home assistants, one of the young women allegedly spit into her mouth. When residents screamed or hit, the two would clamp a hand over their mouths or poke them in the back or genitals.

At one point, one of the assistants crawled into bed with a Good Samaritan Society resident and simulated having sex with her, according to a criminal complaint.

The young women thought of their actions “as a joke,” a co-worker told investigators from the state Department of Health, which produced a report detailing the abuse in numbing detail.

But Brianna Marie Broitzman, 19, and Ashton Michelle Larson, 18, each face up to a year in jail and $3,000 fine if convicted of all the charges against them. Prosecutors say the two inflicted humiliating physical, emotional and sexual abuse on 15 residents suffering from Alzheimer’s disease, dementia or both.

“I’ve been in the business for 30 years. I have never seen anything like what we’re dealing with here,” said Renae Peterson, the nursing supervisor at Good Samaritan. “Why would anybody do this? I don’t know.”

Four other teenage girls who worked as aides have been charged in juvenile court with failing to report the abuse.

Broitzman, who faces 11 charges, and Larson, who faces 10, are to be arraigned in Freeborn County District Court on Jan. 21. The charges include assault, abuse of a vulnerable adult by a caregiver, abuse of a vulnerable adult with sexual contact, disorderly conduct and failing to report suspected maltreatment.

Broitzman’s attorney, Larry Maus, said Thursday that neither he nor the Broitzman family would comment.

Larson apparently has not hired an attorney, prosecutors said. Neither she nor her family responded to repeated attempts for comment. Her father, Michael Larson, told NBC’s “Today” show last week that the allegations against his daughter have been distorted by the media.

The abuse allegedly went on for several months in early 2008, until one teenage nursing assistant told a nursing home administrator about it during an exit interview, prosecutors allege. Follow-up interviews by state investigators and local police found that Broitzman and Larson “would talk and laugh about the incidents” with others, including young co-workers who sometimes witnessed incidents.

Prosecutors say Broitzman and Larson considered the abuse “something fun to do at work.” The two were confident they wouldn’t get caught because “residents did not have their minds,” a co-worker told investigators

The U.S. Centers for Medicare and Medicaid Services imposed the $3,500 fine against the Capitol Care Center.

Capitol Care Center administrator Cynthia Schaaf says she did not know whether the facility would dispute the fine.

The fine stems from an incident on Sept. 24. Eighty-six-year-old Alfred “Stan” Catherwood was in a wheel chair when fell down eight stairs, breaking bones in his face and neck.

The state report says the 228-bed facility did not provide adequate supervision or maintain a hazard-free environment.

Neighbor asks, “Say, Ed, what was the name of the instructor of that memory course you liked so much?”

Ed replies, “Well, it was…hmmm…let me think a minute… What’s the name of that flower, you know, the one that smells so nice, but has thorns on the stems…?

Neighbor says, “You mean a rose?”

Ed replies, “Yeah, that’s it!…(shouting toward house) Hey, Rose, what was the memory course instructor’s name?

Things that can make “aging in place” — the current term for staying in one’s own home as one ages — problematic are tasks such as cooking, cleaning, toileting, shopping, doing laundry, and driving, as well as falls, which for frail elders could initiate a downward spiral.

Support systems

• Help could come from family members, friends, or neighbors, who take care of the specific thing the elder has trouble with — such as doing laundry or shopping.
• Or, some elders turn to their religious community, as often there are volunteers willing to enable a senior to age in place.

• Home care agencies can be hired to provide the extra help needed for the senior to be able to age in place. In some cases, expenses will be reimbursed by Medicare, but seniors will need to check with the home care agency to find out about this possibility.

New technology can help seniors

• Electronic devices are now available to help monitor whether or not a senior has taken his or her medication — and if not, to remind the senior — or to determine whether a senior has opened the refrigerator.
• Emergency buttons can be worn around the neck and pressed if a health or other emergency should occur, in which case a person will speak to the senior through the device, assess the situation, and call for appropriate help.
• Cameras can be installed to track a senior’s movements, allowing adult children to monitor the senior and be assured that he or she is functioning well.
• New devices are constantly being invented, and they can make an enormous difference in a senior’s ability to age in place.

With all of these options available, aging in place is an increasingly viable choice. Seniors and their loved ones need to assess whether this alternative is indeed best, the risk being that the senior may become too socially isolated despite being in familiar neighborhoods and homes.

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