April/May 2013 Print - Transitions Care Management

Do you know their wishes?

Suppose your loved one was in a coma or unable to speak. If you had to make healthcare decisions for him or her, would you know what to say? Making the choices that are right for your relative requires knowing his or her preferences in advance. But starting the conversation can feel awkward.

Use a soft approach. Make it about your need to know versus their being frail. Choose a place that is comfortable and quiet. And allow plenty of time. Some possible starters:

“Dad, you’re doing great now. But you know me, I like to be prepared. I want to be able to speak your mind if you can’t.”
“Mom, my friend just went through a horrible time having to guess what her mom would like. It’s important for me to know so I’m not left guessing.”

Don’t be upset if your loved one does not want to respond at first. Sometimes people need time to think about these important topics.

Plan on several conversations. There is a lot to explore.

Preferred setting. Would your relative want to be at home? Or in a setting with professional care 24/7? Get details about favorite wishes and dreaded scenarios.
Treatment and pain. Would he or she want treatment to stay alive as long as possible? Or are comfort and quality of life more important?
Breathing. Would your relative want help to breathe through a machine? On a temporary basis only? “Forever?”
Eating and drinking. Would he or she want food and liquid mechanically supplied if eating was not possible? Only temporarily? “Forever?”

Let your relative know that you’re aware their wishes may change with time. Plan to check in occasionally to stay up to date.

Return to top

Preventing C. difficile: A very difficult germ

C. difficile is one of many bacteria living in the air, water, and soil. And from there, it is often swallowed into the human gut. This is no problem when other, “good” bacteria outnumber it. But when this germ dominates, it becomes toxic. Even deadly.

C. difficile infections are on the rise, especially among elders. Risk is highest among people:

age 65 or older and female. Advanced age increases risk tenfold.
on antibiotics in the past 30 days. These drugs typically wipe out good bacteria, allowing other bacteria to thrive.
with a weakened immune system. Chronic illness depletes the immune system. So does treatment for cancer.
receiving treatment for heartburn. The drugs that cure heartburn decrease acid in the stomach, removing a key deterrent to bacteria growth.

C. difficile occurs mostly in hospitals and nursing homes. Many patients and residents are in the high-risk group for infection. Traces of bacteria from an infected person can live on surfaces for weeks and months, making it easy to spread to others.

Prevention is the best approach. C. difficile can be difficult to cure.

To reduce your relative’s risk of C. difficile infection, limit antibiotic use. If an antibiotic is necessary, ask the doctor to avoid a broad-spectrum drug.

If your loved one is in the hospital or a nursing home:

Be assertive about cleanliness. Ask EVERYONE entering the room to wash their hands with soap and water. Facility employees especially. It’s not personal. It’s just good medicine. Also request that medical staff use gloves and disposable thermometers.
Clean surfaces, door handles, and bedrails. Bring a solution based on chlorine bleach and do a quick wipe-down each time you visit.

Watch for symptoms:

watery diarrhea three or more times a day for two days, and
mild stomach discomfort and cramping.

Tell the doctor immediately! C. difficile can quickly become a serious condition.

Return to top

Stress and overeating

Caring for an ill family member is emotionally taxing. Ever use food for comfort? Sure, we all do. Eating favorite foods is a pleasure! And eating sugary or fatty foods appears to actually calm stress centers in the brain.

But it’s fleeting comfort. Such “emotional eating” may in fact ultimately add to your stress by leaving you feeling guilty. And it can certainly leave you with a few extra pounds!

Consider these warning signs of emotional eating. Do you habitually
• seek food for solace or as a reward when you are stressed?
• serve yourself seconds even though you’re already full?
• find you never really tasted your food because you were too preoccupied while eating?
• get mad at yourself for eating too much or for eating the wrong things?
• stash treats away with the thought that they’ll “help” later when you’re upset?

Try these steps to break the stress-eating cycle.
• Recognize a craving. A sudden urge to eat (and right now!) isn’t real hunger. It’s an emotional reaction. Physical hunger is a growl in your belly that you don’t have to answer right away.
• Know your triggers. Boredom? Uncertainty? Interactions with specific people? Be on the lookout for those situations that prompt emotional eating.
• Identify your emotion. Pausing to consider your mood helps eliminate mindless munching. Are you sad? Frustrated? Confused? Clueing in to your emotions puts you on the path to better options besides eating.
• Strategize to do something different. If you’re lonely, pick up the phone and call a pal. If you’re anxious, write out your thoughts and respond as if talking to a friend. If you’re bored, put on some music and dance or challenge yourself at a crossword puzzle. Experiment with activities other than eating.

Learn to comfort yourself consciously. You’ll be happier and healthier.

Return to top