Month: May 2022

Signs it is Time to Hire an In-home Caregiver

A Wednesday, like any other Wednesday, you go for a visit to your mom’s house for a mid-week visit and to take her a few groceries and you need to pee before you leave. You go to the hall bathroom, turn on the light and the toilet does not look like it has been cleaned in a month. There is a ring around the bowl, dirt on the floor, the countertops are visible soiled and there is soap scum and mineral deposits in the sink.

You know what happens next, don’t you? You start reasoning things away. “Oh, she must not clean this bathroom every week, since she does not use it.” “She must not feel good or she may be tired.” “She is missing a lot of dirt, dust and grime, we probably need to get her to the eye doctor.”

May 25, 2022

Observe the home conditions

All of those things may be true. But, there could be other reasons. Do you ask about the hall bathroom or do you just observe, make a mental note to check on it next week? Are you brave enough to check out the master bedroom and bathroom?

What do you see in the kitchen? What do the countertops look like? Is the sink full of dirty dishes or are the dirty dishes placed into the dishwasher – but not washed? What does the refrigerator look like? Expired food? Old leftovers, that are growing mold.

How many excuses do you hear? “Oh, I’ll get to it this weekend.” I was sick last week.” “It looks good, to me.” “I’ll do it later.”

Maybe, they are just getting older and they need a little help with the cleaning. Arthritis is a bitch. Low back pain can have you down and out. Look for clutter or things not put away. Look for clothes in a pile or basket, clean, but not folded. Look for garbage not taken out regularly. What does the house smell like?

Can you determine if there are physical limitations that make house cleaning hard, if not impossible now? Hire a housekeeper or clean it for them.

Check-in again 6 months later

Let’s go 6 months to a year or so down the road. You begin to notice other things …

    • They wear the same outfit multiple days in a row.

    • Their hygiene is noticeably in need of attention.

    • They are telling you they can’t find important items or you notice they are regularly missing must-haves like glasses, hearing aids, etc.

    • They are missing trash day, and trash is accumulating at the house.

    • They are not opening their mail and may have overdue bills.

    • They seem more quiet or lonely.

    • They have unruly hair

    • They look scruffier, more so than usual

    • They have lost or gained weight (due to frozen meals or junk food)

    • Unexplained bruises (usually due to falling)

    • They are forgetting appointments

    • They are forgetting words or repeating themselves

    • They have a personality change

When you notice some of the things listed above, it is time for an assessment and a plan of action for in-home care. They will not usually volunteer any information. They will, however, deny any problems exist. They may or may not realize they are forgetting things. When they do become aware that things are not “right,” or that they really are forgetting things, watch out. They can get really uptight and angry. The goal is not to set off the dynamite, it is to diffuse it.

ADLs (Activities of Daily Living) 

You may hear the phrase Activities of Daily (ADL’s) living, which are self-care tasks that can no longer be performed or are very hard for them to do now.

    • Get into/out of bed or chair

    • Toilet hygiene

    • Bathing or Showering

    • Getting Dressed

    • Personal hygiene

    • Eating

    • Walking / Climbing Stairs

    • Safety /emergency responses

IADLs (Instrumental Activities of Daily Living)

Another phrase is Instrumental Activities of Daily Living (IADL’s). These are the activities related to living independently by themselves.

    • Shopping/ Getting Groceries

    • Transportation (Driving/Public)

    • Preparing meals

    • Managing Medication

    • Using Phone/Technology

    • Cleaning / Maintaining home

    • Running Errands / Appointments

    • Managing Finances

dADLs (Domestic Activities of Daily Living)

A less common phrase is Activity Assistance or Domestic Activities of Daily Living (dADL’s). A person is no longer physically able to do ____.

    • Companionship/Socialization

    • Mental exercise

    • Hobbies requiring dexterity or fine motor skill

    • Care of others

    • Care of pets

    • Activities in the community

    • Lite exercise

    • Exertive exercise

Sometimes, it gets to the point that your loved one needs 24/7 care or a skilled nursing facility.

SIgns it is time for an in-home caregiver 24/7

10 Signs your loved one needs 24/7 care.

    1. Frequent falls or compromised balance

    1. Confusion between day and nighttime 

    1. Difficulty eating or drinking without assistance

    1. Fainting or confusion due to dehydration

    1. Wandering from home or getting lost

    1. An increase in bathroom accidents

    1. Sleepwalking or wandering during the night

    1. After surgery, a hospitalization, or stay in a rehab facility

    1. Bedbound and/or developing bedsores

    1. Family caregivers are suffering sleep deprivation or have chronic stress that interferes with their own health, wellness, and quality of life

What Care Needs are Needed?

What type of in-home care would be best for your loved one and you?

    • Companionship – they are fairly independent but they are isolated or lonely

    • Help with ADL’s

    • Help with IADL’s

    • Mobility assistance – getting in and out of chairs or bed; toilet sitting and rising

    • Memory or Cognitive decline/impairments

    • Personal care

    • Preparing meals

    • Pet care

    • Taking them to Dr. appts, visit friends or family

    • Light housekeeping

Let’s go ahead and get in the housekeeping arena. What is light housekeeping? Light housekeeping is a task that the care giver does to help provide better care for the client. NOT the entire family!

What IS and IS NOT Light housekeeping

Light housekeeping duties DO include:

    • Clearing away dishes after meals

    • Preparing/cooking meals

    • Drawing baths and setting out towels

    • Hang up towels and washcloths to dry or place in laundry

    • Cleaning sink, bath tub and toilet after use

    • Wiping down spills and sanitizing surfaces

    • Spot mopping

    • Changing bed linens

    • Dusting off surfaces

    • Tending to house plants

    • Taking out trash

    • Pet care – feeding, a walk and general cleanup

    • Cleaning up clutter

    • Sweeping and vacuuming floors

    • Organizing closets and drawers

Light housekeeping duties DO NOT include:

    • Moving furniture

    • Washing windows

    • Scrubbing carpets and floors

    • Shoveling snow

    • Mowing the grass

    • Raking leaves

    • Scrubbing shower or tub

The caregivers do not bring supplies with them. They are not housekeepers. They are people helpers and companions.

It is a good idea to write down what your loved one needs and wants. Write down what the family wants, too. Look at the lists. Do you need an in-home caregiver or do you need a housekeeper? Some of you need an in-home caregiver, but you want to use them as an in-home caregiver AND a housekeeper or a maid. That is NOT going to happen. So, to prevent any misunderstandings, anger or frustration, everyone needs to be clear on what will and will not be done. Never assume, always ask and write it down. There are a few caregivers that want to sit around and play on their phone or watch TV. That is not a caregiver. It isn’t a companion either. Whoever is there to help your loved one needs to be engaging with them and helping them. 


When is overthinking bad?

Calling all perfectionists and overachievers …

If you have a tendency to ruminate, excessively worry, second guess your decisions or even struggle to make decisions, you may be an overthinker. I would even bet that you have some OCD tendencies. The quirky kind, not the disabling kind.

May 18, 2022

Paralysis, Rumination, Overthinking

My overthinking tendency is rumination. Sometimes, I recognize it and sometimes, I don’t. Yes, I have the quirky OCD tendencies. My paper money has to be in a certain order and turned all the same way. My shoes have to be placed next to each other and in the correct L/R order. Not just kicked off in any old way. I have to eat an even number of cookies. Enough about me. What are your tendencies? Are you able to recognize them? Can you recognize your triggers? Do you know what your analysis paralysis is? Do you know what you overthink? 

When does overthinking cause problems?

When does overthinking cause problems? When it paralyzes you from taking action? When it keeps you stuck? When you realize that you have spent hours on a problem/issue with nothing to show for it? Have you noticed that your mind will always come up with another “worry question?” There will always be another “what if,” or “if this, then that.”

Our brains go in to analysis mode, which is good. However, it is not good to stay there. At some point we do have to make a decision and move forward. One of the problems with overthinking is that we stay in the analysis mode even to the point of becoming paralyzed. You have heard the phrase, “analysis paralysis.” It most commonly happens when we have too much information or we “feel” that we do not have enough good information to make a decision. We want to make the best decision possible. That is always my main objective and I am sure it is yours too. What we don’t realize is that we keep looking for the answers that we cannot know until we make a decision. The real reason we keep searching, is because we must not fail. We cannot fail, it is too important. We get afraid when we have important decisions to make. 

I get it. I want to know all of the possible scenarios and the possible outcomes too. But, that is not the way the world works. Look at it this way, if you are in a competition, whether it is sports, band, game night, or whatever, you can play a perfect, errorless game and still lose. You did your best and you did not make any errors, but you still lost. We cannot know every outcome. 

Stop overthinking and use 3 trusted resources

Use three trusted resources and allow appropriate time for research, reflection and choosing. I wish that I could tell you it was two hours, but maybe you need more or less time. Realize that your choice will not be perfect, but strive for “good enough, for now.” You can always make adjustments later. Maybe the best thing for you is two hours of research, discovering three possible options and then you take a day or two to think about those options (or you need to meet with others to flesh it out). Then it is time to make a decision.

Your brain(thoughts) will fight you. It will throw up all the “what ifs, buts, worst outcomes.” You can quiet it down. You can still make a decision. You can move forward. Mindfulness meditation really will help you calm your mind. 

Sometimes, thoughts are just thoughts

Your thoughts are just that, thoughts. They are not reality. In fact, they may be lies. Learn to challenge your thoughts. Sometimes, you will have to throw the bullshit flag on your thoughts. We all want to control situations, outcomes and consequences. We are not that powerful. The reality is that we can make the best decision possible with the information that we have, at this moment in time. We cannot choose the consequences. We cannot choose the outcome. It sucks. We beat ourselves up too much for things we have absolutely no control over.

Is it possible to stop overthinking?

Find your pattern of overthinking. What moments or situations cause you to go in to the overthinking mode? Note – write them down when you find yourself in an overthinking situation

You will find your pattern. Then when you are aware of it, that is when you are able to notice your triggers and will then be able to work on your strategy or plans of action. For example, you will give yourself, two hours of research from trusted resources. You will develop two or three options. You give yourself time to think about the positives and possibilities of the options. (1 to 2 days) Our brains go to the worst-case scenario, so be prepared for that. Understand that the probability of that worst-case scenario will probably NOT happen. Of course, it could, but really how likely is it? Make a decision and implement the steps to move forward. Set a time for evaluation (2 weeks – 2 months). Make updates or changes, if needed. Re-evaluate in 2 weeks to 2 months, etc.

You do not have to believe everything that your thoughts are telling you. What is the evidence in this situation? What are the logical and reasonable possibilities? If a thought is not logical, reasonable or helpful, then tell it so. I know that this sounds crazy, but you do need to talk to yourself out loud or at the very least write down the conversation. Do not have the conversation in your head. It will just keep going around and around.

Talk with a trusted friend. They may be able to see things that you can’t. They may have a different perspective than you and can see other options or possibilities. They can also give you a kick in the butt, when you need it.

Do some kind of physical activity

Walk, run, work out, do something physical. You need to burn off that cortisol energy. It will help your brain too.

If you find yourself overthinking in most situations, you may need to do some talk therapy. Talk therapy is a great tool, to help you see patterns, and how to make adjustments to move forward. Overthinking causes a great deal of stress and if you do not deal with stress, it can cause anxiety, depression, fatigue, headaches, stomach problems, etc.

How can you tell if you are overthinking?

When you find yourself focusing on the problem, you are probably overthinking.

The goal is to get in to the problem-solving or solution finding mode of thinking.

If you find yourself ruminating about the past or worrying about the future you are probably in the overthinking mode. If you are dwelling on how bad you feel or you are thinking about all the things that you have no control over, you are probably overthinking. Overthinking does nothing to prevent or to solve problems. Irrational fears often lead to overthinking.

Manage your energy, you only have about 4 hours of focused energy per day.

You only have so much energy every day anyway, so why not use it for solution finding or problem-solving rather than ruminating or staying stuck on the problem. Practice quicker decision making. Start with dinner choices or dessert choices. Read your options and decide in 3-2-1- choice. This is the biggie, choose where to go for dinner. If you need to, have 3 choices, then pick. You can do this.

Sometimes, you just have to declare it DONE!


Is it a psychiatric illness, psychosis, or a drug-induced problem?

First, what is psychosis? Psychosis is a term used to describe when a person interprets or perceives reality in a different way than those around them. Psychosis may be a symptom of mental illness, but that is not always the case. Nobody knows exactly what causes psychosis. May 11, 2022 Observations

Typical story of a psychosis

Suzi visited her mom, Val Thursday after work. Suzi checks in on her about twice a week. Val is 70, active with high cholesterol, high blood pressure. arthritis, and mild depression. Val takes her medication regularly and as directed. Suzi notices that her mom is not quite herself. Val cannot follow the conversation and does not seem to be able to concentrate. The first thing Suzi thinks is, an UTI. Possible dehydration. They go to the Dr., but the urine test comes back clean. No infection and her electrolytes are all in the normal range. Hmm. Now what? Nobody seems to know what to do next, but wait and see. It is now a week later and Val is not better and in fact she is a little worse. She cannot remember if she has taken her meds or not. She is unsure of what has happened over the last three days. Suzi is getting more and more concerned. This is not normal and her mom has never been this way before. Suzi wonders if her mom is developing dementia, Alzheimer’s disease or mild cognitive impairment. In this particular case, her physician looked at her medications and had a consult with her pharmacist. They determined that most likely it was her blood pressure medication and/or her arthritis medication. Outside chance it could be anti-depressant med, but not likely. They began a withdrawal of HBP medication and started a different one. Val was some better, but not back to normal. It was not her arthritis medication; it was her anti-depressant medication. She was slowly weaned off of that and they did a wait-and-see approach to see if she needed to be on an anti-depressant anymore. Her mind cleared and she was back to her normal self.

Too often, we fail to look for signs and symptoms of drug-induced psychosis

While this case was a success, many more are not. No one thinks to check the medications. Why? Well, their thought processes go along these lines – She has been on these meds for three years or more. It came on suddenly, it must be a UTI or dehydration or she does indeed have the beginnings of mild cognitive impairment or a dementia. Medications are not without risks and problems over time. As we age, our metabolization and kidney function decrease. We cannot clear meds as quickly or as easily as we once did. You know when your loved one is “not right.” You may not know what it is, but you know that something is wrong. Push for answers, never accept it is “just old age,” dementia, or other assumptions. Blood tests and urine tests need to be done. Medications need to be checked. Hydration and nutrition need to be addressed. We want to rule out any fixable problems.

Psychosis can be:

    • Due to stressful life experiences or trauma
    • Part of a neurological condition such as dementia. Alzheimer’s disease, or Parkinson’s disease
    • Triggered due to a brain injury
    • Medication side effects
    • Effects of illicit or illegal drugs such as marijuana or cannabis
    • Effects of alcohol withdrawal
    • Triggered by menopause
    • Triggered during times of severe stress or anxiety
As you can see, it is not black and white. Many things can trigger a psychosis. By the way, marijuana is not the gateway drug to addiction. Trauma is the gateway to addiction. The self-medication, whether it is alcohol, marijuana, cocaine, hydrocodone, heroin, etc., becomes the problem due to another problem. We have to deal with the primary problems first! Yeah, I know, we chased a rabbit there. We don’t think about medications as causing a psychosis or a psychotic episode, but they sure can. Too often, we assume that it is a mental health issue. Maybe it is, but, we need to find out and rule out other fixable causes. Understand that some classes of drugs can cause psychosis.

Classes of meds that may cause psychosis:

    • Muscle relaxants
    • Antihistamines
    • Antidepressants
    • Cardiovascular medications
    • Antihypertensive medications
    • Analgesics
    • Anticonvulsants
    • Antiparkinsonian medications
    • Chemotherapy agents
    • Corticosteroids
    • Stimulants
From the list above, you can see that the possibility is real that the psychosis is from a medication and not mental illness. Alcohol abuse or misuse is another inducer of psychosis. Drug-induced psychosis usually only lasts until the medication/drug has cleared the body. Depending on the drug, the metabolization and clearing may take from 1 day to several weeks (if it is from a stimulant medication). A healthcare professional needs to be contacted. They can decide where the safest place to “come-off” the medication will be. Drugs can affect different people in different ways. What causes a psychotic episode in one person may not cause a psychotic episode in another person. Genetics plays a part. Life experiences play a part. Pre-disposition to mental illness plays a part. Remember, mental health disorders can cause substance use or misuse on its own. The mental health disorder can be exacerbated or intensified by medication use, abuse or misuse, but it is not caused by the meds. We should note that schizophrenia is not caused by drug use, abuse or mis-use. It may trigger schizophrenia symptoms in those people susceptible to schizophrenia.

Common signs and symptoms of psychosis includes:

Hallucinations – when you see, hear, feel or taste things that other people don’t
    • Hearing voices or sounds that others don’t
    • Seeing things that others do not see
    • Tasting things when you haven’t had or eaten anything
    • Feeling someone touching you who is not there
    • Smelling things which other people cannot smell
Delusions – unusual beliefs that other people in your “community” do not share, even though they feel real to you You may worry:
    • That you are being followed by secret agents or members of the public
    • People are out to get you or to kill you (may be strangers or people that you know)
    • That a chip has been implanted in your brain to monitor your thoughts
    • That your food or water is being poisoned
    • That you are a powerful person or God
Cognitive impairments – these relate to mental action (learning, remembering, functioning)
    • Problems concentrating
    • Memory problems
    • Difficulties understanding new information
    • Having a difficult time making decisions
Alcohol, amphetamines, phencyclidine (PCP), cocaine, and hallucinogens are among the most common causes of drug-induced psychosis. Symptoms of drug psychosis include:
    • Hallucinations. A person might see, smell, or hear things that aren’t there.
    • Delusions. A person may adopt demonstrably false beliefs, such as that a demon is pursuing them.
    • Dangerous behavior. A person might attempt to fly, harm themselves because a voice told them to do so, or become a danger to others. Some people who experience psychosis become aggressive.
    • Disconnection from other people or from reality. A person may appear catatonic or totally withdrawn.

Drug-related psychosis is distinct from other forms of psychosis in a few ways:

    • It appears while under the influence of or withdrawing from a drug.
    • It comes on suddenly.
    • It is typically more intense than other forms of psychosis.

Illicit/Illegal Drugs that most commonly cause substance-induced psychosis:

Methamphetamine Cocaine Marijuana LSY Peyote Mushrooms Ketamine (this is a Rx drug, but is used illicitly) PCP Ecstasy This overview is so that you know and understand that medications can cause psychotic episodes. What signs and symptoms to look for? Contact your healthcare provider for withdrawal and monitoring needs. Pat

Medication Overload – Another Drug Problem

Too much medication, too many medications (polypharmacy), overprescribing, inappropriate prescribing, & the body’s decline in metabolization and excretion. Whew! It is a lot, isn’t it? May 4, 2022 Medications will not fix everything. Medications are not without risks. Over-the-counter medications are not always safe. Vitamins, supplements, herbs, or essential oils are not without risks and they are not always safe either.

What I look for is medication overload

I am on the lookout for unnecessary medications, potentially inappropriate use of medications., or multiple medications used for the same thing. I look for appropriate medication usage and benefits vs risks treatment regimens. Just because a medication may help, does not mean it should be used because the risks or side effects will be worse than the treatment. Treatment may be indicated, but it will not be beneficial. A medication may no longer be necessary. Medication is not necessary at all. We have to get over this, “a pill for every ill,” kind of thinking. Let’s be honest, a lot of folks want “my rights” or “my choices,” but they do not want the responsibilities that come along with those things. It is each of our responsibilities to take care of our bodies, as best we can. Eating better, drinking our water, doing physical activity, taking care of our mental health, and even sleeping well. Progress over perfection. Be consistent. Then if you need meds, take only what you need in the lowest amount you need. Medication overload isn’t really talked about very much. When 750 people aged 65+ are admitted to the hospital Every Day, due to medication problems … that is significant. Not all of these folks survive. 7,000 people die every year due to preventable adverse drug events. It is unknown how many dies, due to worsening of their current diagnoses.

If you are 65+ and take 5 or more prescription medications, you are at risk of an adverse drug event.

Possible side effects of overmedication include:
    • Mental health concerns
    • Addiction
    • Substance misuse or abuse disorders
    • Drug reactions that are dangerous
    • Adverse side effects
    • Increase in physical health problems

Common signs of overmedication in seniors include:

    • Fatigue and energy depletion
    • Pressure in the abdomen
    • Aches and pains in the body
    • Problems with balance and motor skills
    • Fatalities and falls
    • Rashes and flushing of the skin on a regular basis
    • Weight gain or loss that is not clarified
    • Mood swings are frequent, and there is a lack of personal hygiene.
    • Concentration problems
    • Impairment of memory
    • Confusion or cloudiness of mind
    • Delayed decision-making
    • Inability to think rationally
    • Psychosis, hallucinations, and delusions
    • Symptoms of withdrawal when not using

How can we decrease or eliminate medication overload in the older adult?

Take time to discuss medications during office visits. Find out what is still necessary and needed. Find out what can be stopped or tapered off. Work with your physician. Discuss the benefits vs harm and what are the alternatives. You doctor will probably be thrilled that you want to decrease the number of medications that you are taking. Be open to the possibility that your medications are hurting you rather than helping you. Maybe, you feel so bad, not because of your diagnoses, but because of some of your medications. Your goal is to reduce medication overload. Could you be on a potentially inappropriate or harmful medication for you? One or more medications that you are taking may cause you to feel bad or may even cause a hospitalization. You are the one inside your body and you are the expert on how you feel and how you are really doing. Consider, just consider, that taking less medication (in number or dosage) may benefit you. Pat