January 28, 2020

Caregiver Disconnect

Forty caregivers of stroke survivors reported they often felt abandoned (1).  This may sound surprising unless you know therapists usually do not talk to caregivers.  Lutz found that "during rehabilitation many of these caregivers still hoped and expected that the stroke survivor would return to pre-stroke function (p. 8)."  Talking to caregivers only at discharge meetings has serious consequences.  Caregivers reported not knowing how to help when their loved one went home.  One caregiver said when her husband struggled with a task she helped by doing it for him.  This solution produces muscle weakness and mental decline which increases the caregiver's burden.

As an OT I was oblious to the stress that caregivers experience.  They have to: 1) take on their partner's chores, 2) be a therapist, and 3) be a case manager.  A wife may take out the garbage and change the batteries in smoke detectors.  A husband may clean toilets, do laundry, and cook.  When caregivers are therapists, they may help with self-care like bathing, set up home exercises, and deal with a stroke survivor's bad moods.  When caregivers are case managers, they schedule doctor and therapy appointments, arrange transportation, deal with insurance companies, and make multiple trips to the drug store to pick-up medication.  Many caregivers do this without professional psychological support or respite care.  Now I see that caregivers are angels.

If I were still treating clients I would do things differently.  I would ask caregivers to identify one goal I could work on that would make their job easier.  This request may not produce a goal, but it is one way to open a dialogue with caregivers which can change the trajectory of recovery.

(1).  Lutz B et al. Improving stroke caregiver readiness for transition from inpatient rehabilitation
        to home. The Gerontologist. 2016; Vol 00:No.00,1-10. doi10.1093/geront/gnw135.

January 19, 2020

A Magic Bullet

One of Dean's posts led me to a magic bullet.  A study found that women age 60 and over who do not drink enough water have impaired cognition.  "As we age, our water reserves decline due to reductions in muscle mass, our kidneys become less effective at retaining water, and hormonal signals that trigger thirst and motivate water intake become blunted."  The worst performance for women who did not drink enough water was attention, processing speed, and working (short-term) memory.  In the morning I have been having trouble remembering a clue I just read on a crossword puzzle so I thought it would not hurt to drink more water.

It does not help if I wait to sip water until I start working on the crossword puzzle.  However,
I noticed an immediate improvement in remembering what I just read IF I drank water before I started to make coffee and take my medicine - about a 10 minute activity.  The authors of the study call this effect a mystery, but I call it amazing.  Unfortunately there was no correlation between hydration and mens' cognition.   homeafterstroke.blogspot.com

January 11, 2020

Before My Stroke I Just Used To

A story in Elderhood showed me stroke survivors are not the only people who have to work hard to have a life worth living (1).  Anderson's 87 year old mother has to jump through a lot of hoops to be a docent at a museum.  Her mother said "There are just so many things I have to do in the morning.  I have to put the drops in my dry eyes.  I have to take my thyroid medicine right away so it's on an empty stomach but I can still have breakfast at a reasonable hour.  I have to do the neti pot with my nose or it runs all day and I cough.  I have to put the cream on my face for rosacea.
I have to do my stretches and exercises to loosen up my parts and get them going for the day.
I have to get my hearing aids in and then pin back my hair because I can't put it behind my ears anymore with my glasses and hearing aides already there.  It's incredible to think I used to just get up, wash my face and start my day."

Another story in Elderhood illustrates how differently people may respond to challenges (1).  Anderson wrote "Two patients of mine had to start using using a walker.  Neither was particularly happy about it.  Helena refused to go out.  She didn't want to be seen as old (something that seemed obvious to me, walker or not).  Esther asked if we could reschedule our appointment.
She was going to the movies with a friend; it took her a bit longer to get around, and she wanted to be sure to leave enough time.  Later she told me she now needed an aisle seat with a wall nearby to prop her walker and that I should definitely go see the movie."

Without a good WHY the how-tos are just a burden.  homeafterstroke.blogspot.com

1.  Anderson L. Elderhood  Redefining Aging, Transforming Medicine, Reimagining Life.
     NY: Bloomsbury Publishing; 2019.

January 3, 2020

Socially Acceptable Strategy Coming Soon

I recently went to a Christmas eve church service and alarmed a friend when I kept falling back onto my chair when I tried to stand up to sing a carol.  It has been 3 months since my knee replacement surgery, but I still struggle to stand up at night when I am tired.  At home I solve this problem by putting my hand on the seat of the couch to help push myself up.  The chair at the church was so narrow that I would have had to put my hand an my friend's thigh.

Now during the day I stand up by leaning my trunk forward and putting my hands on my thighs to remind my muscles to generate a big contraction.  This helped me discover that weakness was not my only problem.  When I looked down at my feet before standing up I saw one toe farther forward than the other.  It is hard to stand up when both feet are not tucked under my body.  I still cannot stand up at night without using my sound hand, but I am determined to find a socially acceptable way to stand up in the evening that family and friends do not find alarming.  homeafterstroke.blogspot.com