Let Them Eat Cake!

I read an article in McKnight's Long Term Care News in regards to the effectiveness of dietary restrictions in people over the age of 75 and I'd like to share some thoughts on it. Based on a study conducted by Penn State & Geisinger Healthcare, the conclusion was that after a person reaches 75 years old, changes to diet are not likely to be effective. The damage has already been done and trying to eat "healthy" is not going to change the likelihood of acquiring Cardiovascular Disease, Diabetes, and Hypertension. Eating healthy throughout your early lifetime is the first line of defense, keeping yourself happy, in my opinion, is the second. 

Our residents health and nutrition is very important to us, that is why we spend quite a bit of time with families at our round table meetings when a new resident is joining us asking about preferences, allergies & special dietary needs. Hearing what our new resident has been eating since a diagnosis of dementia is just as important as hearing about what they grew up eating and allowing our residents to have a choice in what they eat. I am in no way suggesting cotton candy as a steady diet for a diabetic, I am simply re-applying the age old saying "you are what you eat." By allowing our residents to be happy with the quality and presentation of the food they are served, we are giving them additional moments of happiness. 

While some foods may have a higher value than others, nutritional value can be found in almost all foods. We strive to encourage the foods that do the most good, however, as taste buds change and diminish the list of those foods will also change. A resident who once ate only bland oatmeal throughout most of his life for breakfast now prefers brown sugar and cinnamon added in or will now only eat french toast with strawberries and bananas on top. It is not our intention to over-sugar or super saturate foods with salt, but if that simple addition keeps your loved one consistently taking in some nutrition that in itself is far better than not receiving any nutrition at all. At the end of the day what it all comes down to is a variation of the age old saying "Let them eat cake" - which in our setting means that when bread is refused, it may be better to let your loved one eat cake rather than eat nothing at all. 

About the Author:

Stephanie Muhlbach is the Activity Director at Pacifica Senior Living Paradise Valley in Phoenix, AZ.

World Health Day 2013 - Take Control of Your Blood Pressure

Yesterday was World Health Day. World Health Day is celebrated every year on April 7^th to mark the anniversary of the establishment of the World Health Organization. Each year a new theme is chosen to raise awareness of the world’s major health issues. This year’s theme is focused on addressing the problem of Hypertension, also known as high blood pressure. High blood pressure and other related conditions (such as obesity, poor nutrition, and lack of physical activity) are risk factors for chronic diseases, including cancer.

It is important on this World Health Day to raise awareness of the growing burden of non-communicable diseases (NCDs) on the world population. NCDs kill more than 36 million people each year, and almost 80% of these deaths occur in low and middle-income countries. In 2012, the World Health Assembly decided to adopt the target to reduce premature deaths from non-communicable diseases by 25 percent by 2025. The Member States are finalizing global targets for 2025.

“Early detection of high blood pressure and lowering heart attack and stroke risk is clearly far less expensive for individuals and governments than heart surgery, stroke care, dialysis, and other interventions that may be needed later if high blood pressure is left unchecked and uncontrolled,” says Dr Shanthi Mendis, Acting Director of the World Health Organization Department for Management of Noncommunicable Diseases.

Cut the risks of high blood now pressure by:

-Eating a balanced diet incl. consuming less salt

 (This following link provides some great tips on Lowering your Salt Intake )

-Engaging in regular physical activity

-Avoiding tobacco use

-Avoiding or minimizing harmful use of alcohol

According to the WHO, the prevalence of hypertension is highest in Africa with 46% of adults being affected, while the lowest prevalence it found in the Americas with 35% of adults affected. Overall, high-income countries have a lower prevalence of hypertension (35% of adults) than low -and -middle income groups (40% of adults) – thanks to successful multi-sectoral public policies, and better access to health care.

 Source: World Health Organization

Nutrition for a Healthy Brain

You are what you eat. Who hasn’t heard this old saying? Our diet affects every bodily function including brain function and health. Certain foods such as refined sugars, increase inflammation and reduce blood flow to the brain. World renowned neurologist Dr. Majid Fotuhi said “Food can affect the brain in minutes”, during interviews with CNN and the Dr. Oz show. The “Superfoods” and supplements listed below do the opposite, reducing inflammation and increasing blood flow to the brain helping keeping it strong:

Brain Superfood  1: Elderberries

Elderberries are packed with quercetin, a flavonoid that’s critical to your brain’s health. Like blueberries and strawberries, the flavonoids found in elderberries help reduce harmful inflammation at a cellular level. Additionally, quercetin increases the activity of your cells’ mitochondria, which you can think of as the “powerhouses” within each of your cells. By boosting your mitochondrial activity, you’ll boost your overall energy level, too.

Brain Superfood 2: Pecans

Pecans are high in omega-3s, which are vital for a healthy brain. In fact, pecans are the most antioxidant-rich tree nut, and are ranked by the USDA among the top 15 foods with the highest antioxidant capacity. A brand new study shows consumption of omega-3 rich foods like pecans can dramatically reduce the risk of neural degeneration.

 Brain Superfood 3: Chicken Giblets or Clams

Most of us make the mistake of throwing chicken giblets (the neck, kidneys, gizzard, heart and liver that come bundled inside a whole chicken) directly into the trash. Even though they may not look appealing at first, fight the urge to toss them! Not only can the giblets be delicious as an addition to a chicken stock or prepared on their own (you’ll find plenty of recipes online), but they’re a great sources of vitamin B12, which is crucial for brain health. In fact, just a cup of giblets provides 228% of your recommended daily dose of B12. If you can’t bring yourself to eat them, however, clams are another terrific source. They also contain zinc and iron, which have been associated with the brain’s ability to stay focused and recall information.

Brain Superfood 4: Vegetable Juice

Vegetables are like heath gold mines, providing all the vitamins and antioxidants our hearts and brains need. Juiced vegetables are a convenient and delicious way to get all those vital nutrients. If you’re buying vegetable juice at the market, look for bottles labeled all-natural with no added sugar. Of course, the best way to enjoy vegetable juice is freshly juiced at home, with no added sugar or preservatives. Whether store-bought or homemade, be sure to limit your intake to 8 ounces a day to avoid excess sugars.

Brain Superfood 5: Beets

Nosh on this root vegetable to boost your brainpower. As we age, poor blood flow contributes to cognitive decline. Research has determined, however, that the natural nitrates found in beets (as well as cabbages and radishes) can actually increase blood flow to the brain, thereby improving mental performance. Be sure to make beets and all the superfoods listed above a part of your diet. You’ll send your brain capacity through the roof, and tip the scales in the battle against Alzheimer’s.

Brain Booster Supplement: DHA

If you’re only going to take one supplement, DHA is the one you need. DHA, or docosahexaenoic acid, is an omega-3 fatty acid that makes up a significant portion of your brain tissue. Lower DHA levels are associated with a smaller brain size, so it’s important to supplement your natural DHA intake (which comes primarily from cold-water seafood). Taking a DHA supplement reduces inflammation, combats the plaque buildup associated with Alzheimer’s, and increases blood flow to your brain. In fact, studies have shown that taking 600mg of DHA supplement daily for 6 months boosts your brain so much that it functions as though it were 3 years younger!

(Source)

Traveling with Food Memories

By Steven Mattingly

I’ve created a BIG problem for myself in a couple of weeks.  Our community throughout 2012 has participated in something we call the “Passport Dining Series”.  Each month we have created a unique dining experience by visiting different parts of the world.  Among others we have had Breakfast in Paris, dined on the varied cuisine of Italy, and celebrated Bosnian cuisine.  Bet you didn’t see that one coming now did you?

The next place that we will visit doesn’t exist in the real world and that is the problem that I have created for myself.  Many who read this blog know that I am a former chef who realized early in his career that I wasn’t going to be the next Wolfgang Puck or even a mediocre executive chef.  I left the 90 hour work week of food and beverage when I came to my senses and began a career in the world of senior housing.  But the urge to prepare food for the masses never really leaves you.  My family will attest to that as does my expanding waistline.   So every now and then (it’s usually around the holidays) I have the hair brain idea that I will cook a meal for the community and that is what I am doing in two weeks.  The place I want to visit doesn’t exist anymore; it’s mealtime at my mother’s kitchen table located in the house that she and my father built on Rural Route 2, Saint Mary’s Road, Lebanon, KY  40033 more than 50 years ago. 

How can I tell the story of that place in the foods that I prepare?  Do I cook the fried chicken that my wife recalls my Mother lovingly showed her how to make when she was a very new bride more than 30 years ago or do I make the Sunday Dinner Pork Chops that she made just like her mother, my Memmaw.  I could make the Cincinnati style chili that was a cold night favorite or my all-time favorite of beef hash with fried cornpone (who knew she was ahead of her time frying polenta cakes).  I could make the 60’s favorite tuna Noodle Casserole from which I picked out all those little bits of mushrooms or the other 60’s dish of Macaroni and Cheese made with Velveeta.  I remember orange Jell-O cubes served as dessert with real whipped cream as much as I remember the chocolate birthday pies that she made for me each year.  Or the divinity fudge that was a Christmas staple along with the regional black walnut cake made with black berry jam. I could make her most famous disasters, the pickled bologna that eventually sat in the refrigerator until it truly turned green.  So many ways I could get to that special place.  It’s overwhelming to consider it all.

I committed to taking our community to this special place more than a month ago. It’s only a couple of weeks away and I still am trying to decide on the perfect menu that will be transport our community to the place that I called home.  What I have to remember is that just like when we all were growing up, the meal will happen, the warm hands and hearts of our care giving team will make sure that we get where we need to be at just the right time, and I will somehow just like my Mom did each and every day I ate at her table, create a memory for the community albeit a fleeting one for many.

As I get older and my vision of my life as a senior become clearer, I see how those little journeys that we have taken this year really are important to our community.  If even for a brief moment a special smell or taste or atmosphere provokes a memory, it’s a good thing.

Contributing author Steven Mattingly is the Executive Director of Pacifica Senior Living in San Leandro, CA.

Winter Holiday Season Caregiving Tips for Families with Loved Ones with Dementia

'Tis the season to be jolly. Or is it?

While those facing Alzheimer's disease or a related illness in their family might question the sentiment, experts say that it is possible to not only keep the cheer in the holidays, but also to savor them.

Some suggestions you might want to consider from the Alzheimer’s Support Organization:

·  Communicate concerns. In advance of the holidays, be candid with family and friends about your loved one's condition and your concerns, and enlist their support. In cases where resentment brews because one family member assumes the primary caregiving role, use this season of giving as an opportunity to discuss sharing family responsibilities and to strive for family togetherness.

·  Set realistic expectations. Consider both what the individual with dementia is capable of and what you, as a caregiver, can handle given your demanding role. Then, put celebrations into manageable proportions. This can help decrease stress and head off feelings of depression that stem from unrealistic expectations, both for you and your loved one.

·  Select appropriate activities. Be mindful of the individual's current mental condition and do special things that they can still appreciate. Engage your loved one in singing and dancing since these abilities tend to remain intact longer. Involve them in some rituals—whether it is lighting the menorah, decorating the tree or baking cookies. Try to spark memories by bringing out family photographs or heirlooms. But do not demand mental performance by asking them to name people, places or other facts. Rather, help stimulate memories by offering descriptions as you present each object.

·  Pare down traditions. With round-the-clock caregiving, it may not be feasible to juggle all of your religious and ethnic observances. You can still keep traditions alive; just reduce their number to avoid feeling overwhelmed and frustrated. Ask your loved one which traditions to choose; it is another way to involve them. Even though they may not recall later on, making the effort reinforces the fact that you care what is important to them and will make you feel better as a caregiver.

·  Adapt family gatherings. Since crowds, noise and altering routines can aggravate confusion and other behavioral problems, revising your get-togethers may be in order. For example, instead of entertaining the whole clan, limit the number of attendees at a holiday dinner or spread out several smaller gatherings on different days. Mark a calendar with upcoming visits to make your loved one feel special.

·  Stick with familiar settings. Because new environments can increase disorientation and pose safety concerns, discard restaurants or relatives' houses in favor of your own home. Likewise, if Mass is still important to your loved one, consider how they can participate. For example, take your loved one to an earlier, less crowded service; if they are unable to go to church, watch a Mass on TV or ask clergy to make a house call.

·  Head off problems. Avoid alcohol, which may cause depression, increase the risk of falls and add to the loss of brain cells. Try to schedule holiday activities or visits earlier in the day before the potential for sundowing - behavioral problems that typically occur toward dusk among those in the middle stages of dementia. And, in preparing for holiday celebrations, do not re-arrange furniture or create obstacles-both are accidents waiting to happen.

·  Limit holiday decorations. Decorations can still adorn your home, but in moderation. Hang cheerful ones that recall memories and family traditions. Do not overdo the ornaments on a Christmas tree. Remember that hauling out a lifetime of garlands, religious items and wall decorations can clause clutter and over stimulation, which can intensify disorientation and agitation. Ensure, even more than usual, that decorations do not block pathways or pose potential fire hazards.

·  Re-think gift giving. Devise ways to include your loved one, depending on their capabilities. You might take them to a store to buy presents, and offer extra guidance. Or, you can buy the gifts for them and wrap them together since many individuals with dementia like handling paper. In giving presents, pick ones appropriate for someone with the disease. Instead of something material, try things that are simple, personal and sentimental. For example, photographs and heirlooms provide the opportunity to reminisce—a gift in itself.

·  Welcome youngsters. While it is important to include children, it is just as vital to consider their feelings. Address the fear factor by helping them have special moments with their relatives. If their loved one uses inappropriate language or easily becomes angry during the visit, explain that this behavior is not personal or intentional; it is part of the disease. Youngsters' excitement about the holidays can be contagious. Singing songs together can strike a chord for someone with dementia. Or having an elder teach dominoes to children is a good way to foster interaction and make your loved one feel they have something to offer.

·  Join a support group. A forum to express feelings and socialize can help overcome sadness for both caregivers and individuals in the early stages of dementia. Unfortunately, the incidence of depression ranks high during and after the holidays. Consult with a healthcare professional if you detect warning signs of depression: tearfullness, poor eating habits, withdrawal, inability to sleep, and physical complaints.

·  Enjoy yourself. The greatest giftat the holidays: time. Ask a family member, friend or healthcare professional to keep your loved one company so you can relish some respite—time for some holiday shopping, a walk in the park, checkers with an old friend or whatever present you want to give yourself.

Contributing author Steven Mattingly is the Executive Director of Pacifica Senior Living in San Leandro, CA.

Mother Most Often Knows Best

By Steven Mattingly

Our community hosted an event this week titled “Don’t Be Afraid of the H Word; Hospice 101”.  An element that made the event very personal was a touching video tribute put together by Annemarie Lorenzini and her sister in honor of their late grandmother.  Annemarie has for the past couple of weeks asked me to review the tribute because she felt it had a message that was important to the subject of the program that night.  I repeatedly avoided doing so which frustrated my co-worker.  It’s time for me to come clean to Annemarie and myself as to why I put off watching her tribute for so long.

It’s been over twenty years since my father died and over five since my mother died.  My father was diagnosed with lung cancer fifteen years after successfully beating cancer of the larynx.  He and my mother were told that he had between eighteen months to two years to live as the cancer was not treatable.  My father died in less than three months.  At that time I lived more than a 10 hour drive from my family home.  My wise mother kept me informed of my father’s rapid decline but she also knew me much better than I thought.  In the southern community where I grew up there is a long standing custom of the gathering of the family whenever there is an imminent death.  I recall when each of my grandparents died there were between thirty and forty people present at the hospital waiting for death.  My mother remembered how much I struggled as a small child and even as a teenager with this custom.  She did not allow my older sister to call me until she knew that I could not get there in time due to the travel time needed.  Once I got the call, I immediately headed to the airport to get a flight to the airport nearest to my family’s home.  When I arrived, my younger sister and her husband met me and I knew by the look on their faces my father had died while I was in transit.  It was a somber and mostly silent ninety minute drive to what was now my mother’s home.

My mother was unable or perhaps once again was a wise woman as she allowed her four children to make the funeral arrangements.  We were somewhat surprised that knowing the cancer was fatal that my parents had not made any plans.  While we have often been discordant as adults we were able to discuss the things that we felt would be important to honor my father’s wishes as well as provide the quiet dignity that we knew would be comforting to my mother.  Simple little details became extremely important all of a sudden.  The casket had to be a certain kind, the flowers had to look a certain way, and we all knew that my father would be buried with his favorite putter.  All of this was accomplished without a raised voice or even a harsh word between the four of us.  While each of us had a very different relationship with my father we realized that this was a time to put aside all the jealousy and individual anger that usually swirled around my father and put the family first.

As is often said about southern funerals, it was a lovely service.  Perhaps the most painful thing about the entire sequence of events occurred after the funeral service.   My very emotionally strong and dignified mother came back to her home, retired to what had been my parent’s bedroom and for almost an hour we listened to her cry.  We assume she then fell asleep.  After a couple of hours we heard the bedroom door open, my mother appeared and immediately asked if we had eaten and she went about putting a meal together from all the food that had been brought to the house.  She never again slept in what had been my parent’s bedroom just as she never again mentioned my father’s death.

My mother spent the next fifteen years doing all the things that she felt my father would want done such as refurbishing the interior of their home for what she labeled the last time, buying a smaller and dependable car, and after many years of unpleasantness with his family that was directed to her, became friends with most of my father’s surviving siblings.  She sewed, made great dresses for her granddaughters, cross stitched quilt tops for each of her children, and made Raggedy Ann and Andy dolls for an increasing number of great nieces and nephews, and all the while, consistently losing at cards.

In her last summer my mother undertook painting the second story deck on her home.  While painting she fell off the ladder and ended up in the hospital.  She went into sepsis shock from what we later learned was an undiagnosed bleeding ulcer and died three days after her fall. 

This time the harmony my siblings and I found when my father passed away was nowhere to be seen.  This instance it seemed even the smallest things caused tension.  We were indeed grateful to find out that my mother once again in her wisdom had left little to be done insofar as her funeral arrangements were concerned.  The casket, the flowers, the music at church, even the outfit in which she was buried was all outlined and to protect the fragile family unit we followed it without exception.  We even took the daring and controversial step to honor her request for a closed casket, something that was just not done in the small town that we all had called home. 

Over the next few months the estate was settled, the house was sold, and our family unit slowly came unglued.  From my somewhat distance outpost, the telephone calls stopped, the updating on our children’s successes and failures were not shared, and we all mourned our loss.  As the family member that everyone referred to as the cruise director I still don’t know what to do to find a connection with my siblings.  My older sister and I stay in touch sporadically (I do wish it were more often).  I haven’t heard much from my younger sister or brother other than what I see about them or their children on Facebook or what my older sister tells me.

I find some reassurance in knowing that for both of my parents their siblings drifted away when the last parent died but in each family there was a coming together again once the various cousins were out of the house and on their own.  Perhaps it is the normal ebb and flow for any child to have a certain period of adjustment to being the head of their own families.  It’s tough to find the right balance.  I hope that my siblings and I find a point in time where we once again can converge as a family and provide that support we found when my father died.

So Annemarie - I knew that your video would be a reminder of a lot of things, many of which still make me uncomfortable.  I was right.  When I saw your short family tribute I didn’t see your Nona, I instead was picturing my parents who were contemporaries of your Nona.  The grainy pictures, snazzy bathing suit poses, and other funny looking clothing were all too familiar reminders for me of similar things for my own parents.  I think that the message of grace and acknowledging a life well lived for your Nona and her loving family is absolutely the right tone to set before a discussion of hospice. Had I had the benefit of hospice for either of my parent’s death I believe I would not feel as strongly something wasn’t whole following their deaths.

Death is inevitable for everyone, it’s how we and the loved ones who surround us near or far, face it that can make turn it into a positive setting for the one who is dying and their loved ones.  Bravo for a job well done last night and thank you for not noticing or at least pretending not to notice how emotional I became. 

Contributing author Steven Mattingly is the Executive Director for Pacifica Senior Living in San Leandro.

Music For The Ages

By Steven Mattingly

In our community, we regularly have a gentleman who sings the standards of the heyday of most of our residents accompanied by a karaoke machine.  My office is in a space adjoining our main floor living room and whenever he performs I have to close my door as his performance grates on my ears.  For the most part I am not able to carry a tune but with guidance from my wife who sings in two choral groups I have learned what a well-trained voice can do.  This particular performer sings up to the notes most often but I have to say his performances are always well attended and he just exudes charm.  He’s a big hit with the ladies; he uses his vocal stylings to shamelessly flirt in the innocent way of the 1950’s.

There has been an array of articles in recent weeks about the benefits of music for seniors and in particular those with more advanced dementia. I’ve seen firsthand the benefits that music therapy can provide to individuals with more advanced dementia.  It goes beyond the calming effect that everyone assumes will happen, in the right setting with the right music choice and the right encouragement.  I’ve seen even the most withdrawn residents exhibit what I can only describe as the greatest of human emotion - a simple smile.  Increasingly the many experts in dementia research are telling us that even though we are unable to discern a visible or verbal response, studies of brain waves before during and after musical programming clearly indicate the resident is processing the information.  They have compared that response against voices of loved ones, normal sounds of daily life, and even sounds from a favorite pet and the studies consistently show that the greatest response is to music.  An interesting facet is that it's music overall, not to a specific genre.  Does that translate to suggesting that you play Led Zeppelin when you visit mom or grandmom?  That I think is more of a personal choice but hearing some old fashion rock and roll or some twangy country music would be interesting and perhaps more appropriate for some of our residents.  Not everyone loves Glenn Miller or Tommy James.  My mother was a big Elvis fan. 

In our community when I come in first thing in the morning I put on my favorite classical station to get us off to what I see as a gentle and easy start in the morning.  About mid-morning we change to a Singers and Swing station that plays songs that many of our residents listened to when they were growing up or dating that is more up tempo.  Can you imagine in a few years when assisted living communities program the songs that the next generation grew up listening to or when they were dating.  Are we ready for “Let’s Get Physical” by Olivia Newton-John, or “Bohemian Rhapsody” by Queen?  Can you picture a spandex clad, baggy sweatshirt and leg warmer wearing  70+ year old demanding more Disco music at 7:00 a.m.  Or does the image of an 80 year old tattoo covered deadhead make you sit upright?

What do you listen to on a regular basis?  Can you imagine the faces of your children when you are in your 80’s and they chide you for still listening to Phil Collins or even worse Donny and Marie?

Contributing Blog Author Steven Mattingly is the Executive Director of Pacifica Senior Living in San Leandro, CA.