Should Hospice Patients Get the Seasonal Flu Vaccine?

This just posted by Angela Morrow, R.N., www.About.com a wonderful resource to learn about Palliative Care.  Many Hospice and Palliative Care patients need flu vaccines perhaps more than any other group of people.  

The CDC recommends that the following people get annual flu shots:

• Children 6 months to 18 years of age
• Adults over 50
• Anyone living in a nursing home assisted-living facility, rehab facility
• Anyone with a weakened immune system
• People who have frequent contact with the general public (health care, teachers, police, etc)
• Pregnant women
• Anyone with a chronic medical condition
• Caregivers, family members, friends of individuals that are at high risk.

Because Hospice and Palliative care patients are often over 50 years old, have chronic medical conditions and weakened immune systems, and may live in long term care facilities, this makes Hospice and Palliative care patients very high risk for contracting the flu virus.  The risk of death from the flu is increased in people whose immune system cannot effectively combat the illness.  Therefore it's very important for Hospice and Palliative care patients, their caregivers, and their loved ones to get the seasonal flu vaccine.  

Who should not get the Seasonal Flu Vaccine?

• Those with allergies to eggs
• Anyone who's had a previous adverse reaction to a flu vaccine
• Anyone with a current infection or fever
• Those with a history of Guillain-Barre Syndrome
• Infants under six months old.

Remember, normal reactions to the flu shot include redness, tenderness, and swelling at the injection site.  It is also normal to experience a low-grade fever (under 101) and decreased energey.

Not normal reactions include:

• Dizziness, high fever, disorientation, difficulty breathing or wheezing, rapid heartbeat.
• If you experience any abnormal reactions, contact your health care provider. 

Share your comments here.

H1N1 Vaccine Guidelines

October 08,2009.....Just released today by Dr. Steven Chang of the Daily Dose column, the World Health Organization just reported the number of cases of H1N1 influenza has increased by at least 24,000 in just the past two weeks.  With the new H1N1 vaccine just recently being distributed to the public, the CDC (Center for Disease Control) is reaffirming the current vaccination guidelines. The groups most at risk, and therefore should be vaccinated are:

Pregnant women

People who live with or care for chidren yonger than 6 months of age

Health care and emergency medical services personnel

Persons between the ages of 6 months through 24 years of age

People from ages 25 through 64 years who are at higher risk for novel H1N1 because of chronic health disorders or compromised immune systems

Also to be noted is that the H1N1 vaccine is not intended to replace the seasonal flu vaccine.  The seasonal flu and H1N1 vaccines may be administered on the same day.  
Please share your comments here.

Demystifying "ObamaCare"

With uncertainties surrounding the health care reform bill and with the Medicare Annual Enrollment date approaching November 15th, you might feel like you have more questions than answers. Until a health care reform bill is passed, it is uncertain how the final product will affect Medicare, but here’s what we do know:

• The Future of Medicare Advantage
  
  Don’t be overwhelmed by some of the proposals to reduce Medicare Advantage reimbursements. While there may be changes to MA plans down the road, the 1997 Balanced Budget Act includes a provision assuring Medicare beneficiaries a smooth and uninterrupted transition in their healthcare coverage should Congress mandate any program changes in the future.
  
  
  
• Separate Fact from Rumor
  
  Many senior citizens have been deeply upset set regarding the end-of-life counseling proposed as part of the Obama health care reform. This voluntary counseling has proved extremely controversial and may not be part of a final reform package. Currently there is no legislation to make the end-of-life counseling mandatory and seniors are increasingly making their opinions on the subject known to their elected representatives.
  
  
  
• Decreasing the “Doughnut Hole”
  
  The “Doughnut Hole” is reached when the full retail cost of covered medication purchased for a Medicare beneficiary exceeds $2,700 during one year. At this point, beneficiaries are forced to pay 100% of drug costs during this calendar year until they have surpassed $4,350 in covered out-of-pocket drug expenses or a new calendar year begins. Some health care reform proposals would gradually close the gap of this “doughnut hole” with a 50 percent price cut for brand-name drugs if a Medicare patient reaches the donut hole in coverage.
  
  
  
• A Focus on Preventative Care
  
  The proposals by Senator Max Baucus and others call for expanded preventative care benefits, including a free annual wellness visit for Medicare recipients. As stated in The Wall Street Journal article “Q&A: How Baucus’s Health Bill Would Impact Consumers”, Medicare beneficiaries also would not pay out-of-pocket fees for recommended services. Some proponents of health care reform have suggested instating a new Medicare commission that would control costs, but rest assured – they would not be allowed to change eligibility or benefits.
  
  
  

It is hard to say what will be in the final bill, but for now the best thing you can do is stay informed and let your representative know what your opinions are.

This article, was written by Jenny Rose of PlanPrescriber at 800-819-6906

Anxiety Disorders

Many of us have suffered from anxiety from time to time due to the pressures we may experience, managing family and professional lives so we understand that anxiety disorders are fairly common.  But there are some anxiety disorders that can give symptoms which are intense and create a painful experience of anxiety, often accompanied by feelings of guilt or worthlessness.  The person with this type of anxiety disorder typically feels nervous and afraid, and may appear frightened or terrified for no apparent or logical reason.  Persons with these disorders may try to defend against the anxiety by denying, rejecting, fixating or repeating behaviors.  One of my elderly clients just recently went through a combination of depression and anxiety disorders right after the passing of her spouse of 60 years.  She cancelled every appointment both socially and professionally.  Her neighbors finally decided to take matters in their own hands and contacted me for help when she began experiencing physical symptoms such as trouble breathing, headaches, bowel distress, stomach upset, and insomnia. But hyperactivity, fatigue, trembling, palpitations and dizziness may also be experienced.  Individuals with anxiety disorders may additionally experience flushes or chills, sweating, frequent urination, and / or sleep problems.

Anxiety disorders include conditions such as panic attacks, obsessive-compulsive disorder (OCD), post-traumatic stress disorder, and generalized anxiety disorder, as well as general and specific phobias.  When a person has a panic attack, he/she experiences intense fearfulness and terror which is often associated with feelings of impending doom. 

We've all seen the Monk TV show (left) which depicts the recurrent obsessions of this detective character which are intrusive and cause distress to his co-workers.  The person with OCD may respond to such compulsions aimed at either preventing an event or situation, or directly in response to the obsessive thoughts.  For example, a person may have intrusive thoughts or images about whether or not he/she has locked all the windows and doors in the house.  In response to these thoughts, the person gets up hourly during the night to check all the windows and doors. 

Post-Traumatic Stress Disorders (PTSD) follow psychologically disturbing events that are beyond the usual human experience.  Veterans of combat and victims of childhood sexual abuse often experience this type of disorder.  This disorder typically creates intense fear, helplessness, avoidance of reminders of the event, and increased arousal.  Individuals with PTSD may have difficulty falling asleep, may re-experience the event (flashbacks), or have recurring nightmares, and often maintain a state of watchfulness.  They may also startle easily and unexpectedly.  In addition, they may have difficulty concentrating and often become depressed.  

Someone with a generalized anxiety disorder may experience persistent and excessive anxiety and can worry about a number of events for at least six months.  Minor tranquilizers often are used to help reduce anxiety, agitation, aggression, and hyperactivity associated with anxiety disorders.  Several practical techniques may be also used to help reduce anxiety such as: providing a calm and quiet environment where a person can go and sit quietly, listen to music or relaxation tapes; establishing daily routines that are structured as much as possible, scheduled every day at the same time to alleviate some of the anxiety; using non-threatening affirmations of worth or recognition of positive personality traits or accomplishments; acknowledging fears or anxieties experienced and never dismissing them as "silly"  or unsubstantiated; and using activities to divert attention.  Soothing music or massage may reduce a person's fears and anxiety.  Others may benefit from involvement in a focused activity such as gardening or arts and crafts.  Yoga and deep breathing exercises are also helpful as well as participating in insight and/or behavior therapy modes. In my client's case, we formed a team, collaborating with the psychiatrist, psychotherapist, medical doctor, and care manager to match competent, compassionate and professional caregivers to the client's personality.  Once the right medication was prescribed and with good nutrition and counseling, she rejoined her neighbors in daily activities.  Sometimes it just takes a village. 

More Than 35 Million People Have Alzheimer's - World Alzheimer's Report

According to a press release issued two days ago by Alzheimer's Disease International (ADI), a London-based, nonprofit, international federation of 71 national Alzheimer organizations, more than 35 million people worldwide will have dementia in 2010.  This report was released on World Alzheimer's Day to raise awareness for this disease that will have a dramatic impact on individuals and healthcare systems globally.  Methadology used to prepare the 2009 World Alzheimer's Report is explained in the full printed report and can be found online at: http://www.alz.co.uk/worldreport 

The report contains eight recommendations for the World Health Organization and national governments.  The research shows that the number of people with Alzheimer's and other dementias is rising substantially worldwide and that the impact on families, governments, and national health care systems will be immense.  Following are their recommendations:

1. The World Health Organization (WHO) should declare dementia a world health priority.
2. National governments should declare dementia a health priority and develop national strategies to provide services and support for people with dementoia and their families.
3. Low and medium income countries should create dementia strategies based first on enhancing primary healthcare and other community services.
4. High income countries should develop national dementia action plans with designated resource allocations.
5. Develop services that reflect the progressive nature of dementia.
6. Distribute services with the core principle of maximizing coverage and ensuring equity of access, to benefit people with dementia regardless of age, gender, wealth, disability, and rural or urban residence.  
7. Create collaboration between governments, people with dementia, their caregivers and their Alzheimer Associations, and other relevant Non-Governmental Organizations and professional healthcare bodies.
8. More research needs to be funded and conducted into the causes of Alzheimer's disease and other dementias, pharmacological and psychosocial treatments, the prevalence and impact of dementia, and the prevention of dementia.  

Examining Bipolar Disorder

LaFave: I don't want to blur the lines between doing something as heinous as what I did, and being bipolar. But, yes, symptoms of bipolar [disorder] definitely contributed to my mind frame.  These were her words during the Sept 12, 2006 exclusive interview by Matt Lauer on the Today Show regarding a 2004 criminal case making Debra LaFave one of the most infamous school teachers in  America after a sexual affair with her 14 year old student in Florida.  

Bipolar disorder (formerly called manic-depression) is an affective disorder which involves alternating mood swings of depression and mania.  A person with bipolar disorder experiences episodes of mania and depression, usually with periods of relative stability in between.  The symptoms of this disorder may range from very mild to severe. Some of these symptoms are depressive episodes very similar to those found in clinical depression.  The difference is that depressive episodes alternate with manic episodes separated by intervals of relatively normal behavior.  In the manic periods, a person's mood is elevated or irritable.  Manic periods may begin suddenly, and involve an increase in talkativeness and activity and a decreased need for sleep.  A person may be able to get by with only a few hours of sleep or go days without sleep (without loss of energy). Another symptom you may encounter is the person's speech may become loud, rapid and difficult to interrupt.  

Mania often involves occasional outbursts of irritability, particularly in disagreements with others.  Someone who is in the manic phase may experience an inflated sense of self esteem or grandiosity, and tends to engage in activities that have a high potential for risk or undesirable consequences (for example, shopping sprees, extreme exercise, sexual indiscretions, and/or reckless driving.  Knowing that, would you agree that behind her good looks, Debra LaFave was a deeply troubled woman suffering from bipolar disorder, or was it a too convenient excuse  used in court systems these days?  

Lithium carbonate is one of the most commonly used medications for treating manic depression.  This medication is generally effective in stabilizing mood swings and lessens the severity of the cycling between manic and depressive episodes.  This medication however is not effective for all persons who have manic-depression and some persons who do get symptom relief do not like the side effects because of the tendency to blunt emotions.  Some persons with bipolar disorder miss the emotional highs which they experience during their manic episodes. A medication review by a psychiatrist is advisable if the side effects are intolerable to the person.  

Following are some practical strategies that may help someone with the manic episodes:  Reduce activity and/or movement around the individual.  Bright lights should be dimmed and extra noise should be eliminated; use a non-threatening approach by watching your own speech and body language; be careful of placing undue restrictions on their behavior (unless harmful to the person or others); and observe the person's behavior and language in order to detect any increase in risk-taking behaviors which could be harmful to them or others.  As a family member or professional caregiver, you will learn that as you become familiar with the person's disorder you will anticipate their mood swings into depression and mania, adjusting your behavior accordingly.  

What are Mood Disorders?

Mood disorders are also known as "affective disorders" usually occurring when the mood (affect) of an individual is impaired usually involving extremes of two basically normal moods, happy and sad.  Abnormally low moods are called "depression" and abnormally high moods are called "mania".


There are three main types of depression.  The first (situational) is temporary, usually caused by an event, such as the loss of a loved one, stress, or an illness.  This type of depression typically lasts only a short time and is resolved when the situation returns to normal.  But be aware that this may also turn into clinical depression.  Clinical depression is more enduring and /or recurring and requires treatment.  This type of depression is usually not triggered by external event but if associated with situational factors, the emotional reaction to the event may be exaggerated.  Individuals with clinical depression often withdraw from their usual activities and may become passive and dependent.  In addition, such persons may have difficulty experiencing or expressing pleasure, may become preoccupied with physical health, may frequently report difficulty concentrating or making decisions and thoughts of death are common.  Dysthmia is a low grade, chronic depression.

A person with depression may experience considerable lethargy and fatigue or engage in pacing, wringing their hands, and/ or pulling or rubbing their hair, body, or clothing.  A stooped posture and slow gait can also be a sign of depression.  Sometimes the person who is depressed may speak in a low voice and in a slow or monotonous manner.  In addition, he or she may not talk very much or may pause significantly before responding to questions from others. Sleep difficulties are common as well as problems falling asleep, staying asleep, sleeping too much or waking early.  Changes in appetite are also common.  Weight loss or weight gain often accompanies clinical depression.  Sometimes they may report a decrease or increase in their sexual drive.  In extreme cases, a person may exhibit a history of self mutilation.  Individual and group therapy are most commonly used for treating depression.  Antidepressants are used in the treatment of clinical depression and are often effective in stabilizing mood swings.

Some of the symptoms of depression and dementia are similar but be aware that significant differences do exist.  A person who exhibits dementia-like symptoms should be thoroughly evaluated.  With the elderly patient, geriatric care managers routinely assess their clients for depression using a tool known as the "geriatric depression scale".  On another post, we will explore the symptoms of depression which mimic dementia. Stay tuned....

Schizophrenia

When I think of Schizophrenia I think of  Nancy Spungen girlfriend of Sid Vicious (Sex Pistols) who on October 12, 1978 died at New York's Chelsea Hotel. Sid and Nancy became the stuff of tragedy, the punk Romeo and Juliet.  As a child, Nancy who by age 11, had been expelled from public school and was receiving psychotherapy, reportedly attempted suicide numerous times before the age of fourteen and suffered from some form of mental illness, mostly paranoid schizophrenia disorder.

Schizophrenia is the disorder that most frequently comes to mind when one thinks of mental disorders.  Schizophrenia is a general name for a group of mental disorders where symptoms include disturbances in thinking, behavior and mood.  Persons with schizophrenia may experience major distortions of reality, along with disorganized and fragmented thoughts, perceptions and emotions.  They also may experience delusions or hallucinations which, in addition to other severe symptoms, can affect their ability to complete daily activities, relate to other people, and cope with difficult situations.  Many people with schizophrenia recover and lead normal lives however.

Schizophrenia typically originates in childhood, although symptoms may not become clearly evident until the teens or early twenties.  Schizophrenic disorders are not usually diagnosed for the first time beyond middle age.  However, persons with schizophrenia do grow old and may become or remain residents in sheltered environments.  Symptoms can range from mild in some, to severe in others.  Primary symptoms include delusions of grandeur, delusions of persecution, delusions of beliefs that other people or events have a particular significance, usually negative, delusions of control, and delusions of sin or guilt.  Pych professionals believe it is best to avoid talking to the person about the delusions.  Debating or arguing about delusional ideas is likely to increase the person's anxiety.  Some people will readily share their delusional ideas, while others will only share these ideas with a few people they trust.  It is important that families working with someone experiencing delusions communicate using active listening skills and attend to their concerns.

Some persons experience hallucinations, if they are hearing voices. Some people are reassured when you inform them you cannot hear the voices, while others may react in a fearful or hostile manner.  If hallucinations are a new symptom, they should be communicated immediately to the person's health care provider, and if applicable, case manager.  Not all persons with schizophrenia have delusions and /or hallucinations and not all persons who have these symptoms are schizophrenic.  It is the disturbance of thinking which is central to this disorder.  Individuals with schizophrenia typically have distorted perceptions, false ideas, and lack clarity and logic in their thoughts.

Today, when schizophrenia is mentioned in the news, it is almost always in connection with some alarming crime. Some stories that have been popular in the media and which have added to the public view that schizophrenics are violent and dangerous include the case of Andrea Yates, who drowned her five children in a bout of postpartum psychosis, David Berkowitz, the serial killer infamously known as the Son of Sam who claimed his dog spoke to him and urged him to kill, Mark David Chapman, the man who killed Beatle John Lennon, and John Hinckley, who attempted to assassinate President Ronald Reagan. Symptoms of schizophrenia vary greatly and may come and go over the course of a person's life.  However, for some people, their symptoms can completely disappear.

The most common treatment for schizophrenia is drug therapy.  Antipsychotic drugs are often used to help individuals manage their symptoms.  Unfortunately, many antipsychotic drugs have unpleasant and/or serious side-effects.  Consequently, individuals may not want to take their medications.  But persons need to be encouraged to take their medications as prescribed, especially when it is critical to their ability to live successfully in the community.

Tomorrow, we'll look at depression.....