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Old 04-22-2018, 11:32 AM
'M'
 
Location: Glendale Country Club
1,858 posts, read 2,862,708 times
Reputation: 2584

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I'm a professional caregiver. One of my clients is an 89 y/o female with severe aortic stenosis, that was just diagnosed this year. The doctors have put her on a myriad of prescription meds like diuretics and blood pressure meds - which I have no problem with, obviously. The problem is that this particular batch of meds has severe side effects. The two side effects that drastically reduce her quality of life are extreme tiredness and insomnia. Yes, and the stenosis can cause exhaustion, too.

When I check medication side effects I google "patient reviews of side effects for..(name of the medication" because then the real story comes out about what problems the medications actually cause the patient.

My client is used to being somewhat active, but she has no desire to be active when her meds make her want to stay in bed, and even sleep all day. She knows that something is wrong, but she doesn't really talk to her family about solutions. Her dementia prevents her from cognitively connecting with them unless they make it a point to ask probing questions, like I do. And take the time to REALLY listen to what she has to say. When she makes comments to me about what she doesn't like about her life, I listen to her and we discuss solutions.

The family of 9 kids isn't savvy about medical issues or doctors...or about healthy ways of eating. They could easily discuss the medication issues with the doctors and request some different meds. I have a medical background, so I know this well. I also make it a point to study nutrition, both for myself, and for my clients. But, they go to the doctor for her check ups and never say one word, letting the doctor know their expectation is for their mother to be able to sleep at night, and to have a different med where the tiredness side effect is less.

Her diastolic blood pressure reading is often near 100.....even on blood pressure meds.. Still they buy and feed her high sodium packaged food...every single week.

She also is severely constipated. That really has an easy solution - eat more fiber like whole prunes, high fiber whole grain bread, and high fiber hot cereals. She won't eat most vegetables, so that isn't in the picture for her. But the granddaughter who is here during the week continues to feed her a low fiber diet, then complains - every single week - that her grandmother is constipated, and comments about her high diastolic pressure readings. Meanwhile, I buy high fiber bread and high fiber hot cereal...they have around 7 grams of fiber per serving. I turn in my receipts, feed her high fiber while I'm here. The granddaughter goes back to processed food when she's here. One week, I made homemade mashed potatoes without salt and left them in 'fridge. I showed them to granddaughter on a Monday. They were still in 'fridge when I returned the end of the week, Friday. My client had been fed high sodium all week long.

The American Heart Association recommended daily requirement for potassium, for people aged 50 and older, is 4,700 mg of potassium. This a lot of potassium given our processed food way of life in the USA. If she ate more food from the produce section of grocery store, she would have no problem getting at least 1/2 of the 4,700 mg of potassium every day. But they continue to buy high sodium bagels, high sodium frozen waffles, high sodium bread. And make no effort to find out which foods in produce section will give her more potassium. Also, they don't really want to know that information. I think they have a lot of apathy about life.

I, myself, shoot for the 4,700 mg/potassium in my daily meals. The more potassium I consume in a day definitely helps me sleep much better. I don't take any prescription meds currently and I am 70 years old. My blood pressure is normal when I eat high potassium, take magnesium supplements, and lay off the boxes, bags, and packages of processed food. If I start eating processed food, my BP rises. You can see I practice what I "preach".

The bagels on the kitchen counter this week have 460 mg sodium!! She eats 1/4 to 1/2 of a bagel, but the family gives her the bagels. I do not when I'm here. She barely gets 2-300 mg when I'm not here...which is about 2-1/2 days out of the week. When I'm here I give her HIGH POTASSIUM juices: pomegranate juice, watermelon juice, beet juice...all juice gets diluted with water and mixed with O.J. - plus banana, melons,

The second issue is the family knows nothing about nutrition and food. They feed her very high sodium foods, and also don't even try to feed her potassium-rich foods. Unfortunately, my client will not eat avocados. I buy food for my client and turn in the receipts because it is pointless to ask them to buy healthy foods for Grandma. The granddaughter often comments about the insomnia and the constipation. Each time she does, I remind her that potassium-rich foods will help tremendously with insomnia. More prunes for fiber.

The daily recommended sodium intake for people aged 50 and older is 1,500 mg per day. You can see that if we eat only processed food, we can barely eat 3 meals a day without going way over the 1,500 mg daily recommendation. One bagel - depending on the bakery - is nearly 500 mg sodium.

Ethically, I can't feed her the high sodium, low potassium, low fiber foods during my shift from 7PM Friday evening until 9AM Monday morning. I know what those foods are harmful to her in her condition and age bracket. My client is a very lovely lady who has been holistic all her life....she hasn't been a "go to the doctor" type of person.

She has enough dementia now that she isn't able to be her own advocate. Yet she and I have very intelligent conversations about her nutrition. She expresses her wishes to me and I follow her wishes. The way she likes to eat is more "fruitarian". She is a very finicky eater...meaning no vegetables except maybe corn, peas, potatoes, tomatoes......she refuses to eat the high potassium veggies/fruits like zucchini, sweet potato, beets, avocado....you get the picture. So I have to be very creative in getting potassium into her diet. I buy better quality food (produce and high fiber foods), and turn in the receipts.

I leave the foods I buy here, let the granddaughter know they are here, and she never feeds any of them to her. She gives her processed food all week long. To her credit, she had an ATV accident that caused a brain injury. She looks normal and I have no idea how severely her brain was injured, but do know her recovery took a while. Suspect the brain injury was pretty severe. She wasn't working when her grandmother became ill...so suspect it's possible she couldn't hold down a regular job (?).

Another thing - the granddaughter's live-in boyfriend is a narcissist, which she volunteered to me the first day I worked here. It is very clear to me that the only reason they live together is to benefit the boyfriend....she goes home and cleans all day long, because he doesn't clean up after himself all week. I also just happen know a lot about narcissists, who lead very drama-filled lives, which they pass along to anyone they are in relationship with. They are very bad news, and especially for a brain-injured person. This guy puts her through heck on the weekends, and then she is emotionally off kilter when she comes to work. In fact, she doesn't come to work when she is scheduled, so that puts me off work later than what I have agreed to. That is starting to get old quickly.

I am thinking that my solution is to move on from this client and family. She and I have grown very close, which isn't that unusual. We are so much alike, the two of us. She will be devastated if I leave. This weighs heavily on me, but I can't continue watching her family show little concern for what she is going through --- especially with the insomnia and needless constipation. The thing is --- the insomnia and the constipation have relatively easy solutions....more potassium-rich foods and fiber-rich foods. Easy-peasy. I am done explaining anything to them any longer. I think the son who buys her groceries every week has a personality disorder, so expecting a helpful response from him is a dead-end proposition. I wish they would just assign the grocery shopping to me...which most of my clients do.

My purpose in starting this thread is two-fold: One....I'd like to get helpful feedback from family members, and also patients. Two....I want to post this health information in case it could be helpful to families and patients.
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Old 04-22-2018, 01:36 PM
 
668 posts, read 477,441 times
Reputation: 1415
I feel for you, and for your client. Could you tell the family that you will be able to continue working for them only if you are allowed to do the grocery shopping for the grandmother? But then you would have to prepare it even for the times you aren't there so that the granddaughter would feed it to her.
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Old 04-22-2018, 04:34 PM
'M'
 
Location: Glendale Country Club
1,858 posts, read 2,862,708 times
Reputation: 2584
Thanks, Jesseco, it will be worth it for me think about what you've suggested - the granddaughter is 33 y/o and she does not cook. The extent of her cooking is boiling water and chopping fruit. And opening packages of processed high sodium, low fiber food. I see no signs - or comments - of her thinking about learning to cook.
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Old 04-22-2018, 05:41 PM
Status: "I'm not young enough to know everything." (set 23 days ago)
 
Location: Wonderland
58,963 posts, read 47,625,394 times
Reputation: 85073
I appreciate your concern for the family and for your client, but what you are describing - to me, anyway - doesn't really constitute abuse at all - it's just a mindset when it comes to nutrition basically (more on the doctor visits in a bit). And your client probably has the same basic mindset. I think about my mom and frankly, it wouldn't matter what I bought or fixed her, or what I told her - as you probably know, dementia affects taste and appetite as well, and I've watched my mom (and watched my MIL too) get more and more limited - on her own - regarding foods she will eat. Now it's to the point where she has zero "balanced diet" and basically wants sweets and starches, period. She's malnourished at this point and has had Ensure prescribed to try to meet her basic vitamin and mineral requirements but even getting her to drink those is hit or miss.

My mom gets constipated due mostly to a very limited diet, very little fiber, and very little activity. But she - on her own - will not eat what she needs to eat, and won't get up and get more active.

Honestly, an 89 year old, very ill woman with dementia, dealing with side effects from meds - well, that sounds like constipation in the making. I hate to say it but you're lucky that the family reimburses you for the groceries you buy - some families wouldn't even want you to be that involved with planning her meals, and might even resent what they would consider your "intrusion."

It sounds like several family members are involved with your client and her care on a very regular, consistent basis, which is more than what some elderly people get from their families. You seem to know - and guess - a lot about their family, personalities, etc. and I think they may begin to resent what will probably feel like meddling in their business over time. Like I said, whether you agree or disagree with their mindset about nutrition, or their relationships outside your employer/employee situation, it doesn't sound like your client is being abused or neglected by her family. THAT would be alarming, but it sounds to me like she is tended to in a regular, consistent manner.

To me, it sounds like you should stay around if you can manage the hours (I understand that sometimes the granddaughter is late and that bothers you - you may need to address that and establish some healthy boundaries in that regard) because it sounds like you have a good relationship with your elderly client, and surely some of what you are doing nutrition wise is helping her. I take it you're getting paid for the hours you work, and you seem like a caring person who has a good relationship with your client. So if the job isn't keeping you from other jobs or from having your own life outside of work, and if you can get the "these are the hours I work - period" thing straight - then why not stay? You can only do what you can do, and you are not going to be able to change the way the family thinks about nutrition, but there are many worse scenarios out there than this, believe me. If you care so much about your client, why leave her? Disengage from the family dynamics and keep things on a professional level - that's my advice.

As for the family and the medical appointments, ask if you can be added as a HIPAA contact. You can also email the doctor and report your observations without getting info about the client FROM the doctor - then he or she can bring up the concerns about meds with the family the next time and possibly change her medication. You state that they accompany her to the doctor appointments - once again, that's more than some families do, so honestly, they sound engaged and caring.
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Old 04-22-2018, 05:45 PM
 
Location: Northern California
80,324 posts, read 6,687,751 times
Reputation: 26634
If the clients family is upsetting you or making you feel too frustrated with the job, maybe it is time to move on. Caring for patients is a good thing, but only up to a point.
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Old 04-23-2018, 12:13 PM
'M'
 
Location: Glendale Country Club
1,858 posts, read 2,862,708 times
Reputation: 2584
I've given each of you posters a "rep"....thanks for your comments. Had a discussion yesterday with the "caring son" who is the most aware about nutrition. He is making a sample potassium-filled smoothie and bringing it to her tomorrow. He does understand about potassium. She has a very narrow range of foods she will eat, so the smoothie will be pushing it. But, if there is enough good tasting fruit for her, in the smoothie, she will slug it down.

The son has a DASH blender, I think he said, that can blend the greens into very fine particles, like a Vita-Mix. Spinach and kale, for example, are high in potassium. They blend up with very little discernible bitter taste, if at all.

Since she was a health-nut for most of her adult life, she does respond well to our conversations about what will help her insomnia and her constipations...but the dementia does prevent her from "remembering" what we talk about. Usually, I repeat what we've discussed any time she's upset about being constipated or from not being able to sleep the entire night. She is receptive to that, but the cycle repeats because she doesn't remember until the next time she's frustrated with her body

We will see what happens now that he is taking an active interest. She isn't doing real well right now, she's slowing way down and is extra tired, so we all need to focus on her wellness - the wellness she has remaining - as much as possible. Any time a person's health is severely compromised, it never hurts to focus on their wellness. I've had many patients whose bodies respond well to high nutrition. Thankfully, they had families who were 100% supportive and had a pretty good knowledge of nutrition, themselves.

It is just short of miraculous how simple things like fresh fruit and vegetables, adequate protein, high quality fats, along with good hydration, and quality sleep, maybe 1,000 mg Vitamin C, will improve someone's health, and help them feel better over time.
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Old 04-23-2018, 02:54 PM
 
668 posts, read 477,441 times
Reputation: 1415
You sound like such a good caregiver - I hope it works out that you can stay with this lady!
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Old 04-23-2018, 03:03 PM
 
Location: Minnesota
1,484 posts, read 3,662,628 times
Reputation: 2420
Wow. thats really sad to read.. yet your doing so much for the lady thats good.. Pat yourself on the back "M" for being the best caregiver she could have right now .

I would like to comment on the food issues .. I prefer to eat "clean" foods ie:: no prossessed or pre made junk.. I can taste the salt and the unwanted extras in that crap so I refuse it .. I also have a caretaker 3x a week that comes in helps with food shopping and does a great deal of my cooking for me .. she helps me with the fresh foods cooking or blending and it is always tastey to eat or drink.. but she isnt here on weekends when my son who I live with is home and HE cooks .. he doesnt see the problems with the pre made or junk foods .. so thats how we eat on weekends .. oh and bbq /grilled meats .. He is good about making sure I have real juices and such but man.. he doesnt taste the diffrence !....am I picky.. yes to a point .. and thats where he is glad theres a caregiver to help with stuff.. I guess my words to you are Keep feeing her all the good stuff you can.. maybe get her blender/juicer going and start sliding fresh V8 style juices down her.. apple juice/white grape juices can be just sweet enough to hide the taste of prunes and of other high potasiomn drinks.. I like slushies .. and will drink those alot .. ice is a safe mixer with some stuff LOL
Good luck and thank you for being a good caregiver .. that lady is lucky to have you
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Old 04-23-2018, 03:05 PM
 
Location: Northern California
80,324 posts, read 6,687,751 times
Reputation: 26634
I am glad the son is now helping out with the nutrition aspect, which is so important & often overlooked.
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Old 04-23-2018, 04:50 PM
'M'
 
Location: Glendale Country Club
1,858 posts, read 2,862,708 times
Reputation: 2584
Quote:
Originally Posted by evening sun View Post
I am glad the son is now helping out with the nutrition aspect, which is so important & often overlooked.
thank you
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