Category Archives: Tips

Driving whenever and wherever you need or want to is an important part of independence. For older adults, it is very common for changes related to aging to interfere with safe driving.

Because of this, it’s also very common for families to question whether an older loved one should continue to drive. This can be a difficult conversation to have and an even more difficult decision to make.

An older adult who continues to drive should consider any physical limitations that could make it more dangerous for them, and take extra precautions to avoid unsafe conditions. They should also carefully weigh whether driving is becoming an unsafe activity for them to participate in.

Age-related factors that impact safe driving

Age by itself is a risk factor for serious outcomes from car accidents. According to the Centers for Disease Control (CDC), adults 70 and older have higher death rates per 1,000 accidents than adults age 35-54. 1 The National Institute on Aging identifies these factors that contribute to unsafe driving in older adults: 2

• Vision problems- eyesight can change with aging, making it difficult to see things clearly and causing problems with glare at night. And eye diseases like cataracts, glaucoma, and macular degeneration are more common in older adults.

• Hearing impairment- age-related changes to hearing can affect your ability to hear horns, sirens, or even sounds your own car might be making that indicate a problem.

• Stiff muscles and joints- being flexible and able to move quickly and without pain is important when driving. If arthritis or other physical limitations are affecting the ability to look over your shoulder, brake quickly, or steer, it can cause unsafe driving conditions.

• Delayed reaction time and slower reflexes- older adults often have slower reaction times and shorter attention spans. The combination can equal difficulty on the road. Altered sensation in hands or feet due to nerve problems such as neuropathy can make this even worse.

• Complications due to medical conditions- for people who’ve had a stroke or who are experiencing problems like Parkinson’s disease, it may be difficult to maintain the coordination necessary for safe driving.

• Memory problems- older adults with dementia or Alzheimer’s disease will have difficulty with decision-making, especially at driving speeds. They can also begin to forget how to drive, or how to get to familiar places. These older adults should prepare for alternatives to driving.

• Medications- side effects of medication such as drowsiness or feeling light-headed can negatively impact driving. It’s important to discuss the possibility of this with your doctor and to report side effects right away.

How do you spot signs of trouble?

Even though the above risk factors do exist for older adults, they are actually overall safer drivers (and more experienced) than other age groups. So how can you tell if an older adult is really having trouble with safe driving?

Some key warning signs to watch for according to the National Highway Traffic Safety Administration (NHTSA) are: 3

• Decreased physical abilities, including increased falls and trouble walking
• Cognitive problems such as loss of short-term memory, and difficulty concentrating
• Failing to use turn signals appropriately when driving
• Difficulty with staying in the correct lane
• Trouble with turning the steering wheel and making turns
• Judging the distance between cars and upcoming exits incorrectly
• Accidentally hitting curbs
• Stopping inappropriately in traffic
• Missing stop signs, traffic lights, or other road signs
• Driving at incorrect speeds for the weather or traffic
• Traffic violations, warnings, or minor accidents
• Not noticing activity along the roadside, such as construction

It’s important to have a conversation about driving if you are an older driver that has experienced these red flags, or if you have observed them as the concerned family or friend of an older adult. It can be helpful to talk to your doctor about these concerns as well, so they can advise you on your fitness and any possible limitations when it comes to safe driving.

How to have a conversation if you’re worried

A conversation about whether an older adult should continue to drive can be an emotionally charged one. Understandably, older adults don’t want to lose the independence that driving allows, or make the huge lifestyle changes necessary if they have to stop driving.

Once you’ve noticed warning signs of a safety issue, however, it’s important to talk, rather than wait until a serious accident happens. The NHTSA recommends the following approach: 4

If you suspect unsafe driving, investigate further

There are a few ways you can build a case that driving is truly a danger and not just a concern based solely on age:

• Ride along with the driver, or travel separately and observe the driving for any of the red flags listed above. Asking others who spend time with the older adult and have observed their driving recently can be helpful feedback as well.
• Ask AAA about their assessment tool called “Roadwise Review” which can be used to check for potential problems.
• The American Association of Retired Persons (AARP) has a Driver Safety Program that also offers assessments and classes to help improve driving safety.

Work together to make a plan to increase safety

Once you’re able to clearly show that your concerns are valid, you can use the information you’ve collected to have a conversation. Older adults may be aware of their own limitations and may be willing and able to take steps to reduce risk. If not, figuring out alternatives to driving is important. Some tips for a productive conversation include:

• Express empathy about the importance of maintaining driving abilities as long as possible
• Use “I” instead of “you” messages- “I’m worried about you,” rather than “You shouldn’t be driving”
• Recruit people in the older adult’s life who they respect and are close to for the conversation
• Remember that negative reactions to the conversation are normal
• Focus on positives: ways that they might continue to drive safely, or ways they can still do activities they love regardless of whether they are still driving
• Is there another older adult in their life that has reduced or stopped driving that can share their story? This can be reassuring.

Be sure to follow through on planning

After you’ve worked together to plan the best course of action, be sure you proactively help with transportation needs the older adult has identified. And periodically check back in, too– needs can change over time. For example, an older adult who agrees to limit driving now may need to stop altogether in 6 months or a year.

Safe driving tips for older adults

There are some strategies older drivers can use to limit their risk of an accident if they continue to drive:

• Drive during low-traffic times of day- avoiding rush hour can reduce the need for quick decisions.

• Choose an alternate route- avoid busier roads and highway travel if possible.

• Don’t drive in bad weather- heavy rain, snow, and other hazardous weather conditions are dangerous for any driver but add to the challenge for an older driver.

• Limit distractions- if concentrating has become more difficult, eliminating noise like the radio, audiobooks, phone calls, and conversation while driving can help.

• Don’t drive at night- nighttime driving adds to vision challenges, including glare from oncoming lights. Driving during daytime hours may be a safer choice.

• Avoid mixing some medications with driving- talk with your doctor about whether any of your medications could affect driving.

• Stay up to date on your vision exam- the CDC recommends an annual exam to ensure your glasses are the correct prescription for driving. 5

• Follow the basics- standard driving rules always apply, like wearing a seat belt, not eating while driving, and never mixing alcohol with getting behind the wheel.

Older adults can also consult a Driver Rehabilitation Specialist for an assessment of coordination, reaction time, and decision-making skills. They can even recommend adaptive devices to make driving safer. The American Occupational Therapy Association’s driver search tool can help you locate one of these specialists.

Alternatives to driving

Ultimately, the time may come when the decision to stop driving is the safest option. In that case, there are ways older adults can still get around and enjoy activities that are important to them.

Consider the following options:

• Volunteer drivers- family and friends may be able to pitch in for some rides, especially for regularly planned activities like church. Faith-based organizations and local nonprofits may also have a network of people who offer rides to people who need them.

• Public transportation- older adults living in areas with easy access to public transit may be able to get around easily on the bus or other modes of transit.

• Taxis and similar services- companies like Uber and Lyft offer paid rides using an app to order rides to anywhere someone needs to go, but this may be a more expensive option.

• Paratransit services- these door-to-door services can be pre-arranged through public transportation or local aging organizations and are usually small buses or minivans.

Additionally, services like Meals on Wheels and grocery delivery can eliminate the need to make shopping trips, eliminating some transportation challenges.

Being proactive can avoid dangerous driving

By considering age-related changes that can affect driving, watching out for warning signs of a problem, and taking steps to improve safe driving, older adults can ensure they are not putting themselves in a dangerous situation.

It’s important to have conversations around this and provide alternatives to driving if it’s no longer safe for older adults to continue driving themselves. Often, the need for help with driving will correlate with the need for extra assistance in other areas of life, too.

Lifestyle changes such as moving into an assisted living facility that provides regular transportation services can also be a way to ensure any personal care needs are met along with getting around.

The majority of older adults wish to avoid leaving their own homes, however. Using in-home care can not only avoid a move away from home, but it can also mean access to professional caregiving services that include transportation when you need it.

The important takeaway is that each situation and each person’s circumstances are different. Working together with family and other trusted friends and loved ones can ensure that individual needs are met, leading to a higher quality of life.

If you are considering in-home care as an option to help meet transportation needs, Caresify’s team is available to help you meet your goals. You can read more here, or call 888-799-5007.

References

1. https://www.cdc.gov/transportationsafety/older_adult_drivers/index.html
2. https://www.nia.nih.gov/health/older-drivers
3. https://www.nhtsa.gov/sites/nhtsa.gov/files/812228-cliniciansguidetoolderdrivers.pdf
4. https://www.nhtsa.gov/older-drivers/how-understand-and-influence-older-drivers
5. https://www.cdc.gov/transportationsafety/older_adult_drivers/index.html

It’s not an uncommon scenario: as your mom, dad, aunt, uncle, or other friend or family member ages, they begin to struggle with everyday tasks. You might worry about their health and safety. Maybe they even have a fall or two, or you notice they’re forgetting important things and seem confused at times.

When this happens, there may be some disagreement between you and your loved one on the best choices to ensure their well-being. Older adults understandably want to maintain their independence as long as possible. Their family may have concerns that difficulties with daily living will get worse and lead to serious problems.

If you’ve come to the conclusion that the older adult in your life needs regular help with activities of daily living, but they are resistant to long-term care, how can you help them understand their options and have a meaningful conversation about planning for their safety and care?

Let’s take a look at helpful ways you can discuss long-term care with someone who is resistant to taking this big step in their life.

Step one: recognize autonomy

Autonomy is, simply put, the ability to act on one’s own interests and values. 1 This is important to people across all stages of life. For older adults, autonomy can often be threatened by multiple factors. Loss of income, decreased physical and mental abilities and other challenges with independence can slowly take away autonomy.

When an older adult moves to a long-term care facility, they often lose their autonomy and ability to make decisions for themselves. 2 Think about some ways that we normally have autonomy:

• Control over what, where, and when to eat
• The ability to choose when to go to bed, and when to wake up in the morning
• The choice of who sees our bodies without clothing
• Personal hygiene choices – even simple things like water temperature
• Freedom to move about, to drive, and to decide when and where to go places of our own choosing
• Choice of leisure activities and daily routines

Thinking about these ideas, it’s easy to understand why an older adult may be resistant to long-term care.

There are two ways you can incorporate an understanding of autonomy in your conversation about care needs. To start, it’s important to acknowledge fears about loss of autonomy. You can let your loved one know that you are aware of their potential concerns, and ask them to share what worries them the most.

Secondly, there may be ways you can offer to support their autonomy. Is in-home care an option? Are there any tasks you can help with, like driving them for weekly trips to go shopping? What is the least restrictive care option- could there be a choice other than a nursing home, for example, with private living quarters?

Allowing your loved one to express their concerns and participate in the decision-making process often goes a long way toward overcoming resistance. You may even be able to come to some compromises along the way- like opting for a temporary stay at a care facility to test it out, or finding ways to schedule regular visits to take them out for meals or other activities.

Don’t Navigate the Conversation Alone

Enlisting help from other trusted people in your loved one’s life is another key to discussing long-term care when someone is resistant.

It can be helpful to have a conversation with your siblings ahead of any discussion with the older adult in your life. The more you are all on the same page, the less conflicting opinions will be shared when it comes to big talks. This reduces confusion in making the best decision.

Sometimes you may find that others outside of your family circle share some of your concerns for the safety and well-being of your loved one. These people may include close family friends, or clergy if you’re part of a religious community. Asking them to join in a discussion can help add weight to the concerns being shared.

And finally, healthcare providers can be an excellent resource when contemplating long-term care. If you’re able to join your loved one at an appointment, you can bring up these concerns with a trusted physician or another healthcare provider. They can advise on medical concerns, memory issues, and physical limitations, and help explain why (and whether) long-term care is a good option.

Other key conversation tips

It’s easy to emphasize the worries you have about the difficulties your loved one may be having, especially if they are trying to brush them off. Instead of making the focus of the conversation all about their problems, keep these approaches in mind as well:

• Talk about your feelings- your experience counts too, and when things are left unsaid, it’s easy for the other person to misunderstand the situation. Are you having difficulty juggling childcare and helping your loved one at the same time? They may not have considered this angle. Maybe respite care is a good compromise.

• Don’t push- sometimes giving a person time to think about big life decisions is helpful. You may not agree after the first conversation you have, but simply saying “will you talk with me about this another time?” can leave the door open without the person feeling too pressured.

• Focus on positives- what are some of the benefits of long-term care for your loved one? Maybe they are lonely and having companionship would help. Is it hard for them to manage household tasks? What if someone else did it for them?

• Talk about the future- it can be easy to focus on the present, but sometimes that can leave older adults feeling like they’re about to be left out and left behind. Remind them about ways you’re looking forward to connecting, for example, plans for holiday gatherings and how they can participate.

Remember that solutions aren’t one-size-fits-all

Conversations with your loved one about long-term care can help you determine their unique needs and wishes. There are many options for care, and it’s also important to remember that needs can change over time.

The majority of older adults- as many as 90%- prefer to stay in their own homes as long as possible. 3 Because in-home care can be tailored to different needs, this may be an especially helpful way to give you peace of mind that your loved one is safe and cared for while allowing them the autonomy that staying in their own home brings.

If you’re not able to come to a decision and your loved one continues to resist the idea of long-term care, there’s another conversation worth having, if you haven’t already. If anything unexpected happens, who will make decisions on your loved ones’ behalf? Ensuring that at a minimum, advance directives have been created, can help plan for care needs in the future even if you’re not able to agree in the present.

The biggest takeaway? Ongoing, open communication is important, no matter what the outcome is. By keeping the conversation going, you’ll maintain a close relationship and you may have the opportunity to help the older adult in your life eventually make the leap from being unsure about long-term care to open to new possibilities.

If you would like to pursue in-home care as a solution, Caresify’s professional caregivers can work with you and your loved ones to create a plan of care that is tailored to their needs. You can learn more here, or call 888-799-5007.

References

1. https://www.ifamilystudy.eu/what-is-autonomy-and-why-does-it-matter/
2. https://journals.sagepub.com/doi/full/10.1177/0969733020948115#body-ref-bibr3-0969733020948115
3. https://gero.usc.edu/students/current-students/careers-in-aging/the-value-of-aging-in-place/

At any stage of life, taking charge of own our healthcare is a big part of successfully managing health concerns. For older adults, who often face chronic health conditions, this can become an overwhelming tangle of problems, solutions, goals, questions, and tasks. It’s never too late to learn how to organize and advocate for your own healthcare, though. And it’s a skill that strongly supports healthy aging practices as well!

As part of September’s National Healthy Aging month, in this article, we’ll take a look at ways that you can promote your health and well-being by effectively advocating for your care.

What does it mean to be your own healthcare advocate?

Being an advocate for your healthcare means that you know what you need to get well or stay well and that you speak up and make those needs known to the people who are part of your care.

This may sometimes pose a challenge for older adults, who may be hesitant to speak up in healthcare settings. For some older adults, it may feel like bad manners to question a doctor’s advice. But doctors, nurses, and others involved in treating health problems need to hear your wishes, needs, and input to give you the best care. Studies have shown that good communication between a patient and their doctor improves health outcomes. 1

Several strategies are part of this process of advocating for your health. Let’s take a closer look.

Six tips to advocate for your healthcare

To begin having conversations with your healthcare providers, there are some important skills to put into practice. These include:

• Understand your health conditions- if you have a chronic health condition and don’t understand the diagnosis or treatment, it’s difficult to advocate for changes to your care. In other words, if you don’t know what to expect, you can’t tell your doctor that your treatment isn’t working.

• Organize your medication- do you know what each medication you take is for? Do you know what possible side effects they can have? If you have side effects, do you discuss them with your doctor? How often do you review all medications with your healthcare team to make sure you are taking them correctly? In one study, adults age 65 and over had a rate of drug errors that is seven times higher than those under 65. 2

• Keep a list of concerns- it’s easy to lose track of changes and symptoms over time. By the time you see your doctor for a scheduled visit, you may not remember how long a symptom lasted, or forget to mention it. By writing them down as they happen, you can be sure nothing is missed.

• Understand your insurance and how to locate care- finding the best specialists and understanding which doctors and services are covered can be challenging, but if routine care isn’t answering your questions, getting a second opinion can sometimes help you find new treatment options.

• Write down any questions- appointments with your doctor can feel too short, and sometimes new information can make it even harder to fit in or remember questions you’ve had since your last visit. Keeping a running list and bringing it with you to appointments can help keep you on track.

• Establish your advance directives- documenting your wishes for end-of-life care now can help you focus on and share your values and treatment goals. Is a particular treatment hindering your quality of life, and not in line with those goals?

If changes in the future unexpectedly change your care needs and you aren’t able to express them yourself, who will be your advocate at that time? You can designate this person in your advance directives. Only 1 in 3 adults in the U.S. have completed this important documentation. 3

Boost your self-advocacy skills

As mentioned above, understanding your health conditions is important to advocate for your care. Learning more about them is a great way to boost your self-advocacy skills. Some ways you can do this include:

• Online health condition support groups
• Health seminars through your local hospital or health department
• Printed materials available through your doctor’s office (ask about large print if you have vision impairment!)

Sharing details with your doctor matters

As you begin thinking about how to advocate for your health needs with your providers, consider the following:

• Don’t be shy about embarrassing details- concerns about physical problems like changes in bowel habits, new problems with sexual function, frequent falls, new memory loss, or frequent alcohol use can be hard to share. But the more your doctor knows, the more he or she can do to help with your overall health.

• Be sure to mention any mood changes- depression is often overlooked in older adults. Feeling sad all the time, losing interest in activities you’ve enjoyed, sleeping more, appetite changes, and difficulty concentrating are not a normal part of aging.

• Tell your doctor what matters most- the best care for you may not be the same care that the next person chooses. “This is what is most important to me,” is a powerful phrase. A great healthcare provider can factor that into their care recommendations.

• If you don’t understand, speak up- it’s not unusual for healthcare providers to unintentionally use language that is hard to understand. And it’s also common for patients to feel embarrassed when they can’t understand, or to assume their doctor “knows what they’re talking about anyway” and just nod their head. Sometimes this means important information is overlooked by both the patient and the doctor because of misunderstandings.

Recruiting others to help you be your own healthcare advocate

The steps described above can be a lot to manage, especially if you aren’t feeling well or are overwhelmed with new information. This is where having help from others can have a huge impact.

The support of a trusted family member, friend, caregiver, or even professional advocate can help you stay organized, remind you to ask questions at appointments, plan follow-up care, and remember important details your doctor has shared with you.

Qualities of a good healthcare advocate

When you are choosing the person who will be most involved in supporting your healthcare advocacy, there are some qualities that make a great partner in these goals:

• They know you well, including your wishes and preferences for care. This may be the same person you have chosen as your healthcare power of attorney (HCPOA) in your advance directives.
• They are organized, detail-oriented, and don’t mind asking questions on your behalf.
• They understand your chronic health conditions or are willing to learn as much about them as possible to help you know what questions to ask.
• They have good follow-through and are responsible for making sure your needs are addressed and resolved.

How to find a professional advocate

Professional healthcare advocates are available as well, many times at low or no cost, but many patients aren’t aware of them or don’t know how to find them. Some places they can be found include:

• Through your insurance plan- many times these are nurse case managers and part of programs offered by insurance. They may be related to specific health conditions or medications you are taking.

• Through your hospital- this includes both inpatient and outpatient services, so even if you’re not admitted to the hospital there may be programs that help. Sometimes these are nurse navigators that help with specific health conditions, and other times hospital social workers or even chaplains are called on to assist people with coordinating their care.

• Through private advocacy organizations- these advocates are usually paid for out of pocket. Some of these organizations include the National Association of Healthcare Advocacy, the Alliance of Professional Health Advocates, and the Patient Advocate Foundation.

These professional advocates often can help you to find resources to support your treatment as well. They can even work with you and a family advocate to help with your goals. Resources that advocates have information on include copay assistance programs to help with medication costs, financial aid information to help with the cost of care, and educational information related to health conditions.

Barriers to being your own healthcare advocate

Along with organizing and keeping track of your care and any questions about it, there is the simple fact that for older adults, memory challenges and physical challenges can get in the way of being proactive about your health.

Vision and hearing impairment due to aging can make reading or hearing information difficult. Mobility struggles can make it hard to get to appointments regularly. And memory problems can further affect your ability to plan or to remember important information you’ve been told or want to share.

All of these are additional reasons to involve family or caregivers in the process of your care. They can help you with transportation to appointments, read information to you, and make phone calls on your behalf along with helping you to remember important information.

By being proactive about improving these barriers and taking the steps discussed here to successfully become your own healthcare advocate, you can enjoy healthier aging and live a more full and rewarding life.

If you need extra support with daily tasks like the ones discussed above, Caresify offers professional caregivers who understand how to give older adults personalized support. You can read more about these services here, or call 888-799-5007.

References

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1337906/
2. https://cahealthadvocates.org/seniors-experience-higher-rate-of-medication-errors/
3. https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0175

Older adults often experience chronic health conditions, in part because of a combination of lifestyle habits and the aging process. Type 2 diabetes is a very common chronic health problem in older adults. As many as 33% of adults age 65 and older have this diagnosis. 1 Controlling type 2 diabetes is critical to your overall health.

If your doctor has told you that you are pre-diabetic or have type 2 diabetes, there are ways you can improve your health and reduce your risk of complications due to diabetes. It requires commitment and new healthy habits, but with consistent effort, you can live a full and active life.

What is type 2 diabetes?

In type 2 diabetes, the pancreas, which is responsible for making insulin, does not do it well. Usually, in response to blood sugar increases, insulin is released to control these spikes. With type 2 diabetes, blood sugar remains too high. This can cause several complications, some of them serious.

Older adults are at higher risk of diabetes due to a combination of changes in the pancreas due to aging, as well as inactivity and sometimes, being overweight. 2

Symptoms of type 2 diabetes

Type 2 diabetes can develop slowly, and it’s easy to overlook symptoms or dismiss them as part of getting older. The Centers for Disease Controls (CDC) lists the following symptoms: 3

• Increased thirst
• Frequent urination, especially at night
• Increased hunger
• Losing weight without trying to
• Blurry vision
• Dry skin
• Fatigue
• Numbness and tingling in the hands or feet
• Sores that heal slowly
• More frequent infections than usual

Complications of type 2 diabetes

Type 2 diabetes is known to cause several other health complications. Because it can be overlooked for some time before it’s discovered, sometimes these complications are already happening when type 2 diabetes is diagnosed.

These complications are linked to type 2 diabetes: 4

• Blindness
• Kidney failure
• Non-traumatic amputation of toes, feet, or legs
• Heart disease
• Stroke
• Nerve damage
• Decreased blood flow
• Risk of death due to extremely high blood sugar (hyperglycemia) or extremely low blood sugar (hypoglycemia)

Older adults especially are at higher risk of these common complications. They have the highest rates of lower extremity amputation, heart attack, end-stage kidney disease, visual impairment, and death of any age group with diabetes. 5

Overall, diabetes is a leading cause of death in the United States, ranked number 7 in 2019. 6

Treating and controlling type 2 diabetes

Controlling type 2 diabetes involves a combination of lifestyle changes and medical care. These steps aren’t always easy to take, but the result of sticking with them is worth it. There are three key areas to focus on to control your diabetes: physical activity, diet, and following your doctor’s recommendations.

Increase your physical activity

The American Diabetes Association (ADA) states that regular physical activity is critical for blood glucose control and overall health for people with diabetes, and reduces A1C (a measure of blood glucose control), cholesterol, blood pressure, and insulin resistance. 7 Their exercise recommendations for type 2 diabetes include:

• Daily exercise, or at least not skipping more than 2 days of exercise
• A combination of aerobic and resistance training is best
• At least 150 minutes per week of physical activity

You can work with your doctor on the best exercise options for you. Walking, yoga, swimming, water aerobics, and other similar activities can be a regular part of your routine. If you have physical limitations, these activities can be modified for you, such as using chair yoga.

Along with improving diabetes, there are other benefits to exercise, too: the ADA found that group exercises like resistance and balance training, and tai chi classes, can reduce falls by 28%−29%. 8

Practice balanced eating

The ADA recommends following the Diabetes Plate method to help control your diabetes: ½ of your plate should be non-starchy (high fiber) vegetables, ¼ should be a protein choice, and ¼ carbohydrates, with water as a drink.9

Fiber, protein, and healthy fats (like poly and monounsaturated fats) all help to keep you full for longer and have less impact on your blood sugar. Some “superstar” foods recommended by the ADA include: 10

• Beans
• Dark leafy green vegetables
• Citrus fruit
• Berries
• Tomatoes
• Fish high in omega-3 fatty acids
• Nuts
• Whole grains
• Milk and yogurt

If you’re overweight, the combination of exercise and healthy eating can help you achieve weight loss, which has been shown to reduce rates of diabetes in people with pre-diabetes, and in some cases can even help people with diabetes achieve remission. 11,12

Follow your doctor’s recommendations

Along with diet and exercise, one of the most important parts of controlling type 2 diabetes is working closely with your doctor and following their recommendations. They will check things like your blood pressure, cholesterol, and blood sugar levels and suggest medications like insulin as needed to help control any problems.

Know your hemoglobin A1C

This blood test is crucial to controlling type 2 diabetes. It is a measure of how well blood sugar has been controlled over time. For people who have not been diagnosed with diabetes, it is an important test to screen for undetected diabetes.

A normal A1C is 5.7% or below, and the goal for people with diabetes is less than 7%. The CDC recommends having your A1C checked twice yearly if you have diabetes. 13

Recognizing an emergency due to diabetes

Two basic emergencies can happen due to diabetes: hyperglycemia and hypoglycemia. In these situations, blood sugar either becomes dangerously high or dangerously low. Untreated, they can lead to coma and death.

Signs of hyperglycemia

Hyperglycemia involves blood sugar that is too high. This can happen because someone has not taken enough insulin, has eaten too much sugar, or during illness. Symptoms of hyperglycemia include: 14

• Warm, dry skin
• Dry mouth
• Rapid breathing or heartbeat
• Fruity, sweet breath
• Excessive thirst
• Vomiting
• Abdominal pain
• Drowsiness, confusion, or unresponsiveness

If you suspect hyperglycemia, check your blood sugar and follow any instructions your doctor has given you for insulin dosing for high blood sugar. If your blood sugar remains high, or if a person in your care with diabetes is confused or drowsy, seek medical care right away.

Signs of hypoglycemia

Hypoglycemia involves blood sugar that is too low. When blood sugar falls below 70 mg/dl, you must take action. The CDC recommends following the 15/15 rule: 15

• For blood sugar between 55-69 mg/dl, consume 15 grams of carbs and recheck blood sugar in 15 minutes. Examples of carbs include 3-4 glucose tablets, 4 oz. of juice or regular soda, 1 tablespoon of sugar, honey, or syrup, 1 dose of glucose gel (usually 1 tube), or hard candies or jelly beans (follow the label for the amount that equals 15 grams).

• For blood sugar below 55 mg/dl, injectable glucagon can help correct the low blood sugar. This comes in a prescription kit, and your medical team will have to give you instructions and training on its use. It’s also important that caregivers know how to use this injection, since you might not be able to treat yourself if your blood sugar falls this low.

When in doubt, call 911. It’s also important to wear a medical ID so that first responders are aware of your diabetes if an emergency happens and you can’t relay important details to them.

Symptoms of hypoglycemia include: 16

• Fast heartbeat
• Shaking
• Nervousness or anxiety
• Irritability or confusion
• Sweating
• Dizziness
• Hunger

Well-controlled type 2 diabetes is possible

By following the above recommendations, and maintaining an A1C below 7%, your risk of long-term complications due to diabetes will be greatly decreased. One way you can have success with this is to involve your family and caregivers in your lifestyle change goals.

Family and professional caregivers can help you prepare healthy meals, get regular activity, take your medications as directed, and attend regular doctor’s appointments.

If you’ve been considering in-home care as a way to help you manage your diabetes and other health concerns, Caresify can work with you to provide care that meets your needs at home. You can read more here, or call 888-799-5007.

References

1. https://www.endocrine.org/patient-engagement/endocrine-library/diabetes-and-older-adults
2. https://diabetesjournals.org/care/article/35/12/2650/38582/Diabetes-in-Older-Adults
3. https://www.cdc.gov/diabetes/basics/symptoms.html
4. https://www.endocrine.org/patient-engagement/endocrine-library/diabetes-complications
5. https://diabetesjournals.org/care/article/35/12/2650/38582/Diabetes-in-Older-Adults
6. https://diabetes.org/about-us/statistics/about-diabetes
7. https://diabetesjournals.org/care/article/39/11/2065/37249/Physical-Activity-Exercise-and-Diabetes-A-Position
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6908414/
9. https://diabetes.org/healthy-living/recipes-nutrition/eating-well
10. https://diabetes.org/healthy-living/recipes-nutrition/eating-well/diabetes-superstar-foods
11. https://www.cdc.gov/diabetes/basics/prediabetes.html
12. https://www.niddk.nih.gov/health-information/professionals/diabetes-discoveries-practice/achieving-type-2-diabetes-remission-through-weight-loss
13. https://www.cdc.gov/diabetes/managing/managing-blood-sugar/a1c.html
14. https://www.mayoclinic.org/diseases-conditions/hyperglycemia/symptoms-causes/syc-20373631
15. https://www.cdc.gov/diabetes/basics/low-blood-sugar-treatment.html
16. https://www.cdc.gov/diabetes/basics/low-blood-sugar.html

Most people don’t expect to become medical experts on equipment used to treat health concerns, but if you’ve been sent home after a procedure with a feeding tube or drain, it can feel more than a little intimidating.

Even after you’ve been shown how to use them, knowing how to care for tubes and drains at home isn’t always second nature. When you start the process you might suddenly feel stuck, or run into a problem you don’t remember discussing with your doctor or nurse at the hospital.

Let’s take a look at the common tubes and drains that can be seen in the home, and then at basic use and how to troubleshoot problems. With this guide as a handy reference, you can feel like a pro in no time.

What are some common tubes and drains?

Older adults who are experiencing complications of a health condition or surgery may require tubes and drains for various reasons. These can be temporary until a wound or surgical site heals or a condition improves or they may be a more permanent device.

Common tubes and drains include:

• Feeding tubes- these are used to help someone who can’t eat or drink get nutrition and hydration. They can be temporary, like nasogastric (NG) tubes, or permanent, like gastric (G) tubes (also sometimes called PEG tubes) that connect directly to the stomach, or jejunostomy (J) tubes that connect directly to the small intestine.

• Surgical drains- these are placed under the skin during surgical procedures to allow excess fluid or infection to drain from a wound or surgical repair. They can be connected to a collection bag, bulb (such as with a Jackson-Pratt, or JP drain), or small pump called a wound vacuum (wound vac). They are removed by your doctor as the area heals and they are no longer needed.

• Urinary catheters- when the bladder can’t drain well on its own, a urinary catheter may be used to help. There are three common types that can be inserted into the body:

• • A straight catheter, which is single-use

• • A foley (or indwelling) catheter, which enters the bladder through the urethra

• • A suprapubic catheter, which is inserted through the skin on the abdomen just above the pubic area and directly into the bladder.

• Nephrostomy tubes- inserted through the skin and into one or both kidneys, these drain urine in cases where there is damage to the bladder, the bladder has been removed, or urine cannot travel from the kidneys to the bladder. They can be temporary or permanent depending on the situation.

• Biliary drains- the bile duct empties bile produced by the liver into the small intestine. If it becomes blocked, bile will build up in the liver. To help with this, a biliary drain that connects to a drainage bag outside of the body is sometimes placed in the bile duct.

How do I care for tubes and drains at home?

There are some basics to keep in mind when caring for tubes and drains. Anytime a device enters the body through the skin or another opening, there is a risk for infection, so it’s important to keep these devices clean and dry and to report signs of infection such as redness, heat, swelling, pain, abnormal drainage, or fever to your doctor right away.

Along with knowing the signs and symptoms of infection, here are some tips for each device:

Caring for feeding tubes at home

Things to know include: 1

• Follow your doctor’s instructions for skin care around the tube
• Wash your hands before handling the tube or feeding solution
• Keep formula refrigerated and never use formula that has been at room temperature longer than your doctor’s recommendation
• Don’t put anything in the tube that your doctor hasn’t instructed you to use
• Flush the tube with plain water between feedings and medications to keep it from getting clogged
• For feedings that go into the stomach, keep the person sitting up or their head up during the feedings and for 30-60 minutes afterward
• If the feeding is causing nausea, cramps, or diarrhea, slow the rate. You can work with your doctor on the best rate to avoid problems.
• If the tube comes out or is blocked, call your doctor right away. Don’t try to reinsert it yourself.

Caring for surgical drains at home

Things to know include: 2

• Empty and measure the collection bag or bulb for your drain as instructed by your doctor
• Report any changes in drainage (amount, color, or smell) to your doctor right away
• Fever, redness, swelling, pain, heat, or drainage at the insertion site of the drain need immediate attention
• If you’ve been given instructions on milking the tubing, be sure you follow them- skipping this step can cause the drain to clog
• Always wash your hands before handling the drain, tubing, or changing any dressings
• Change dressings as directed and keep the site clean
• If the tube falls out, stitches become loose, or the drainage bulb loses suction, notify your doctor

Caring for urinary catheters at home

By caring for a urinary catheter correctly, you can help reduce your risk of developing a urinary tract infection. Here are some things to know about urinary catheters: 3

• Always wash your hands before touching the catheter or the skin around the insertion site
• Keep the drainage bag below the level of your bladder, so urine does not flow backwards into the bladder
• Empty the drainage bag regularly, before it becomes overly full
• Avoid touching the spout of the drainage bag to anything
• Report the following to your doctor right away:

• • Changes in the color, amount, or smell of your urine
  • Pain in your abdomen, back, or in your urethra
  • Redness, swelling, pain, or drainage at the insertion site
  • Fever
  • You notice the drainage bag is no longer filling with urine
  • The catheter falling out- with suprapubic catheters, the opening can close if the catheter is not replaced quickly

Caring for nephrostomy tubes at home

Follow these basics when caring for your nephrostomy tube(s): 4

• Always wash your hands before handling the site, tube(s), or a drainage bag
• Change the dressing and clean around the insertion site as directed by your doctor. This includes when it is soiled. Missing this step can lead to infection!
• Follow your doctor’s instructions for flushing the tube regularly
• Report the following to your doctor right away:

• • Fever
  • Urine or drainage leaking from the insertion site
  • Red, irritated, or painful skin at the insertion site
  • Nausea or vomiting
  • Back or flank pain
  • Foul-smelling urine
  • A tube that falls out
  • Difficulty flushing the tube
  • A drainage bag that stops filling with urine

Caring for biliary drains at home

To care for a biliary drain, there are some basic things to know: 5

• Always wash your hands before handling the drain, bag, or touching the insertion site or dressing
• Change the dressing as directed by your doctor, and when it is soiled
• Flush the drain as directed by your doctor
• Record any output from the drain as directed by your doctor
• Report the following to your doctor right away:

• • Fever
  • Redness, swelling, pain, or discharge at the insertion site
  • Your skin or the whites or your eyes have a new or worsening yellow tint
  • The color or smell of the drainage from the biliary drain changes
  • The tube starts to come loose or falls out from the insertion site
  • New or worsening belly pain
  • New or worse nausea or vomiting
  • Inability to pass stools or gas

Caring for tubes and drains at home is a team effort

With all of the above devices, it’s important to remember that you are part of a team when it comes to caring for them at home. If you’re not sure if something is a problem, it’s best to contact your doctor as soon as possible.

Avoiding infection is critical to caring for any tube or drain. Washing your hands, keeping the site and the tube or drain clean, and reporting signs of infection to your doctor immediately can help you avoid complications of infection.

It is equally important to follow up with your doctor as directed. Be sure to keep a record of any drain output if they have asked you to, and bring it to your appointments. If the drain is temporary, this can help them decide when it is safe to remove it.

Involving family and caregivers in the care of your tube or drain at home can help make the process easier. They can watch for signs and symptoms of a problem and sometimes see the site more clearly than you can. Always be sure that anyone else touching your skin near the insertion site while helping you with personal care and hygiene has washed their hands.

By following these simple rules, you can more easily manage the care of a tube or drain at home and continue your regular activities as much as possible.

Professional caregivers through Caresify can help you with personal hygiene and transportation to follow-up appointments if you require assistance with these activities. To learn more, you can read about care services here, or call 888-799-5007.

References

1. https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.home-tube-feeding-care-instructions.uh4017
2. https://www.lahey.org/article/caring-for-your-surgical-drains/
3. https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=ut2057
4. https://healthcare.utah.edu/radiology/preparing-appointment/interventional-radiology/percutaneous-nephrostomy-tube-care.php
5. https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=abq1886