#1: Why should people express their wishes about health care? Isn’t that for their doctor to decide?

Today’s health care technologies are pretty amazing. They can keep us alive even if we are suffering from a serious illness. People have different ideas about the treatments they would want to have. If they are able to state their wishes, they can say yes or no to questions like these:

• Would you want CPR or other resuscitation if your heart were to stop beating?
• Would you want to be put on a ventilator if you could no longer breathe on your own?
• Would you wish to have tube or needle feeding if you lost the ability to swallow?
• If you had a life-limiting illness, would you wish to receive antibiotics that might prolong life?
• If you had progressive dementia, what health treatments would you want?
• Would you want to be an organ donor?
• At what point would you want palliative care (care that focuses on pain control and quality of life) rather than aggressive treatment?

We like to think that we will always be capable of making these kinds of health care decisions. Sometimes, however, it doesn’t work like that. A stroke, an automobile accident, Alzheimer’s disease—any number of circumstances might limit or take away our immediate ability to make these decisions. The Gerontological Society of America reports that nearly one in four older

Americans today receives “excessive or unwanted medical treatment” because they had not earlier made their wishes known.

Creating advance directives makes it more likely that our wishes would be met, even if we could not speak for ourselves.

#2: What are advance directives?

These are documents that include statements about:

• What you would want. A health care directive or living will is a document that says what kinds of care—including the life-sustaining measures mentioned above—you would or would not want if you were nearing the end of your life. In some states, you can also create a document that would make it less likely that first responders would perform CPR or other procedures on you if you don’t want it. This is called a Physician Orders for Life-Sustaining Treatment (POLST) or something similar.

• Who you would want to speak for you. A durable power of attorney for health care, medical power of attorney or health care proxy is a document saying who you would like to make health care decisions for you, if a time were to come when you couldn’t speak for yourself.

#3: Who should I choose to serve as my health care proxy/durable power of attorney for health care?

This person would most likely be a relative or close friend. Think about the person you would most trust to make those decisions for you if you weren’t able to do so. That is the person you should appoint as your health care representative. If for some reason the person who would be your first choice were not available to act for you, who would be your second choice? Most forms designating a health care representative allow you to name an alternate.

#4: What should I tell my health care representative?

If you wish to name an individual as your health care representative, ask the person if he or she is willing to take on that responsibility. If the person agrees, then you should sit down with him or her and have a frank, detailed conversation about your feelings and values concerning health care and the kinds of treatment you would or would not want. Along with this conversation, be sure to give your health care representative copies of your health care directive.

#5: Why are these conversations so important?

Yale University researchers conducted a study of 349 older patients and their health surrogates. They asked the seniors about what treatment they would prefer if they had a serious illness. Then they asked the health surrogates what they thought the patient would prefer. They found that while the surrogates rated themselves as “extremely confident” that they knew their loved one’s wishes, in fact only 21% of their answers matched up with the patient’s!

Even though you’ve stated your wishes in writing, talking about your thoughts with your health care representative and other family members is important. The better understanding those close to you have about your wishes, the more likely it is that you will spend the end of your life in peace and comfort, and that your family will be spared anguishing decisions and conflict during a time that they would rather be focusing on saying goodbye. It is a loving legacy to leave.

#6: Where can I get these forms?

You can ask your doctor for the correct forms to use. Various organizations, including the AARP, offer free advance directive forms for the state in which you live.

#7: Who should have a copy of my health care directive?

Give a signed and witnessed copy to your primary physician, your health care representative, your hospital, your senior living community, and any other major health care institution or organization with which you are connected. It is also wise to share the information with all family and close friends. Doctors and hospitals report that family members are sometimes surprised by their loved one’s wishes as stated in a living will. Family members may disagree with the patient’s wishes, or among themselves. You can make it easier for everyone by talking openly with your loved ones about what you would want.

#8: What if I don’t know what I want?

Many people hesitate to express their health care wishes because they’re just not sure about what they think! They don’t feel qualified to decide. This is another time when having conversations is a big help. Talk to friends and family. Find out about presentations and discussion groups held at your faith community, senior center, local hospice or senior living community. Consult with a counselor, your spiritual advisor or a professional Life Care Manager.

#9: What if I change my mind?

Your right to complete advance directives includes your right to change your mind. In most states, you may cancel an advance directive any time and in any way that clearly shows your intent—for example, by tearing it up, marking it “revoked,” or telling someone you have changed your mind. It’s always a good idea to review your advance directives from time to time to be sure they reflect your current thinking. If you decide to update, let your representative and doctor know.

#10: Can my doctor talk to me about advance care planning?

Yes! And Medicare now covers advance care planning. Your doctor can counsel you as you make these decisions, and help you fill out the necessary forms. You can ask your doctor about the prognosis if you have health problems. It’s best to have these conversations well ahead of time. The American Academy of Family Physicians reports stories about “very sick patients who were admitted to the hospital and had end-of-life conversations in the midst of a crisis with unfamiliar doctors.” Said Dr. Nancy Shoenborn, a professor at Johns Hopkins University School of Medicine, “Wouldn’t it be better for patients to have these discussions earlier upstream with their regular doctor who knows them better?”

The professional Life Care Managers at Holistic Aging can help older adults and families as they navigate the health care system and put advance directives into place.

Source: IlluminAge AgeWise

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Yet even during cooler times of the year, older adults are at risk of having a less than optimal level of fluid in their bodies. Dehydration can cause heart problems, low blood pressure, digestive disorders, confusion, and heat-related illness. It raises the risk of infections, especially of the urinary tract. It makes seniors more likely to sustain a fall injury. A study from the American Physiological Society even shows that while exercise gives us a memory boost, we don’t reap those benefits if we’re dehydrated.

Why are older adults at higher risk of dehydration? PET scans show that a region of the brain called the mid-cingulate cortex, which tells our bodies that we need water, often malfunctions in older adults. Older brains might not only fail to send signals that we need to drink but might even in effect say “OK, that’s enough” even if we’ve only taken a few sips.

Other factors compound the problem. Health challenges, including Parkinson’s disease, dementia, the effect of a stroke, and arthritis, can make it harder for a senior to stay well-hydrated. Certain medications, such as laxatives or those to treat congestive heart failure and high blood pressure, cause our bodies to excrete more fluid. Infections and fevers can dehydrate us. Some people with incontinence choose to refrain from drinking fluids, especially at night. And a person’s doctor might recommend restricting fluids if they have certain health conditions, such as heart failure or kidney disease.

Be alert for the signs of dehydration, which include extreme thirst, dry mouth, headache, lethargy, and hallucinations. It can be harder to recognize dehydration in seniors because they may not feel thirsty, and some of the symptoms of dehydration can be confused with other common conditions.

Here are eight common questions older adults have about proper hydration:

1. How much fluid should I drink each day? This varies from person to person, depending in part on their height, weight, activity level, and health conditions. For most people, around 64 ounces a day (eight glasses) is recommended. Ask your doctor about how much fluid you should be consuming.
2. What should I drink? Water is the very best choice! Because of their reduced thirst mechanism, seniors should drink before they feel parched. Get in the habit of sipping small amounts throughout the day. Keep a water bottle full and nearby. Add a slice of citrus fruit, cucumbers, or strawberries—appealing to look at, and delicious to sip.
3. What other fluids are good? Water is the very best way to hydrate, but there are other good sources of fluid, such as milk or non-dairy alternatives, 100% fruit juices, soup, veggies, and fruits. Watermelon, for example, is well-named, containing more than 90% water.
4. Is soda a good choice? Only in small amounts. Sugary drinks are linked with an increased risk of heart disease, obesity, and diabetes. A recent study from the University of Michigan even showed that consuming a lot of sugary beverages is associated with chronic liver disease.
5. What about sparkling waters? These can be an acceptable and tasty alternative, but read the label first—some have added sodium or sugar.
6. What about coffee and tea? These can have a mild diuretic effect, increasing our output of urine, but experts reassure us that we’ll still gain more liquid than we lose, so unless your doctor tells you otherwise, enjoy. Use sugar sparingly—and remember that those fancy sugary coffee drinks and even some tea concoctions are more of a dessert than a beverage.
7. What about alcoholic beverages? Beer, wine, and spirits may seem to quench our thirst, but in fact, alcohol has enough of a diuretic effect that it can dehydrate the body. Don’t drink more than your doctor advises, and have some water shortly before and after drinking alcohol.
8. What if I’ve been advised to limit fluids? People with heart failure and certain other conditions may be advised to limit their fluid intake and may take medications that cause the body to get rid of extra fluid. Have regular checkups and follow your doctor’s recommendations carefully.

The information in this article is not intended to replace the advice of your healthcare provider. Talk to your doctor about the ideal fluid consumption for you.

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1.Observe and LISTEN:

• People are more likely to take advice from those who listen to them. Are you really hearing what your aging parent has to say? Regular conversations can build trust. Your loved one will appreciate the fact that you’ve taken an interest in the things that matter to him/her.

• Before jumping in with suggestions, take the time to observe your parent. What are they still capable of doing? What do they have trouble with? How do they think of themselves? Knowing these strengths and weaknesses and which of these are tied to their identity can help you figure out an approach to take in suggesting services from an Aging Life Care Manager.  An Aging Life Care Manager will analyze this on their assessment, develop a customized plan of care that maximize the strengths of the person and offer suggestions to address the trouble areas that match each individual person. 

• Have the person who is the best communicator, listener and most influential to have this discussion with your parent. Most families will know who this person is. This could be the oldest male in the family, the youngest daughter, a doctor, an attorney, a friend who has used our service – every family is different but tapping the most influential person is a good source to move forward.

2. Choose your words carefully:

• Appeal to the values that matter most to your parent and stress your desire to enable them to maintain and enjoy what independence they still have. Aging Life Care Managers increase the older persons autonomy. We always have the best interest of the client in mind with all our suggestions/recommendations.

• Avoid emphasizing your loved one’s weaknesses and forbidding them from doing things. Each person places different value on qualities like respect, self-reliance and a sense of purpose

• The refusal of the aging parent to accept help is typically based in fear: no one want to lose control over one’s life. Hiring an Aging Life Care Manager could be perceived as the beginning of loss of control; it actually increases the amount of autonomy a parent has.

• Just about every adult child tries to use logical means to get an aging parent to change; it just doesn’t work unless there is a crisis. Don’t wait for a crisis!

• Consider the approach of asking the parent to do this for you. You don’t have the time, cannot afford to be away from work, live too far away, have children to care for, etc. Most parents do not want to burden their children.

• Your best course of action might be to tell your parent how their refusal is affecting you personally. Let them know how it would make you feel if she/he accepted the service of an Aging Life Care Manager. Would it give you peace of mind? Would you be more relaxed during the workday? Why not express these feelings?

Older adults with dementia are another story, though. Since they are often incapable of acknowledging the true extent of their cognitive and physical decline.  It often falls to the Medical Power of attorney to make this decision, to ensuring their health, safety and quality of life.

In Summary:

Be sensitive to the fears and insecurities that are causing your parent’s resistance. Once you understand your parent’s motivations, you can frame your suggestion for an Aging Life Care Manager service in a way that’s more likely to lead to productive discussion. Losing a bit of independence by getting help from others doesn’t have to equate with becoming a devalued and marginalized member of society. Everybody ages; you can’t stop that. But what Aging :Life Care Managers can and adult children can do is respond to someone’s limitations in a way that preserves dignity and value

You can be confident that once we are in the door, meet with them and they sense our sincerity, expertise and customized approach helping them to become more independent, this becomes the least of your worries.

You can contact Holistic Aging @ 412-486-6677 or info@holisticaging.com for Aging Life Care Management services in and around Pittsburgh, PA

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A plethora of medical studies (see Shinrin-Yoku web site/) describes the significant health advantages that Shinrin-Yoku Therapy for Alzheimer’s can yield :

• Decreased Blood Pressure
• Decreased Blood Cortisol Levels (stress hormone)
• Improved Breathing
• Increased Vigor
• Decreased Stress
• Improved Concentration

But one of the biggest benefits may come from breathing in chemicals called phytoncides, emitted by trees and plants. Women who logged two to four hours in a forest on two consecutive days saw a nearly 40 percent surge in the activity of natural killer white blood cells (NK cells), thereby improving immunity to disease. “Phytoncide exposure reduces stress hormones, indirectly increasing the immune system’s ability to kill tumor cells,” says Tokyo-based researcher Qing Li, MD, PhD, who has studied Shinrin-Yoku.

Preparing for a Shinrin-Yoku stroll

Come prepared to silently, deliberately engage with nature using all five senses; listening to the birds chatter, feeling the movement of the wind on your cheeks, breathing in the fresh air, experiencing the varying textures of nature to your touch, and taking in all visual splendor the woods has to offer. The practice of Shinrin Yoku is about slowing down, connecting and immersing our senses in the beauty of nature allowing healing to occur naturally. Upon reaching the woods, you will be asked to shut off your cell phone and remain silent through out the experience.

Bobbi Kolonay RN MS is a Certified Holistic Nurse, Nature Lover, and Owner of Holistic Aging – Options For Elder Care: A Holistic Care Management Practice in Pittsburgh PA that helps families provide the opportunity for aging relative to AGE WELL. Shinrin-Yoku walks are offered by Holistic Aging to Seniors (and their caregivers) on a weekly basis guided by Bobbi – check our web site Holistic Aging Programs for dates and fees.

References:

Shinrin-Yoku web site

Huffington Post Article

Healing Body and Soul Through the Japanese Art of Shinrin Yoku

Research Article: Phytoncides (Wood Essential Oils) Induce Human Natural Killer Cell Activ

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This study, conducted by JAMA, demonstrates “as the population ages, a greater number of hospitalized older adults will have impaired cognition due to a rising prevalence of Alzheimer disease,1 delirium,2 and other related disorders. Such patients often face major decisions about their medical care at a time when they cannot communicate their preferences or participate in decision making. Prior research examining hospitalized adult patients of all ages has shown that between 25%3 and 40%4 lacked the capacity to make medical decisions based on standardized assessment, and 1 study of hospitalized older adults report that 43% had some degree of cognitive impairment.5

When patients cannot make decisions, clinicians turn to surrogate decision-makers. The surrogate decision making should be is most commonly a close family member who in some cases has been chosen by the patient as a health care power of attorney.”

From our experience, these surrogate decision-makers are overwhelmed and not prepared to make the critical, frequently life threatening or at the least life altering decisions demanded quickly by health care professionals in a hurry.  Family members, frequently living at a distance and doing this telephonic, are trying their best to fulfill this role. The use of  “Dr. Google” seems to lead most families into a state of overwhelming inadequacy when they realize how complex the health care system has become to the average consumer, let along a older adult who is use to deferring to the doctor on all health care decisions. This is where a Geriatric Care Manager comes into place to guide and direct the cleint and families through this process. Geriatric Care Managers are typically licensed by another profession such as Registered Nurses or Social Workers and have advanced degrees in their speciality along with the required certification in Care Management. Most have worked in the field in another capacity for over 20 years and are viewed as experts.Unfortunately, we have seen others trying to capitalize on this need by claiming to be “Patient Navigators” or “Health Care Navigators” . Caveat emptor! Please review the education, qualifications and years of experience of anyone you are choosing to fulfill this role.

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If you are lucky enough to work with an Aging Life Care Manager, they can help direct you through this maze of decisions, provide medical support when your parent enters the facility and help you understand the limitations of an assisted living.

Consumers should fully know what you are and are not getting when in an Assisted Living environment.

Where Assisted Living Fails

1. Assisted Living Environments have a social model of care vs. a medical model of care.

They are a provider of housing, not healthcare.

During the day time hours you may be fortunate to have a Licensed Practical Nurse (LPN) on staff. Now, there’s no point in denying that there are major differences in the scope of practice between LPNs and Registered Nurses (RNs.) An LPN works under the supervision of an RN or physician. They are not allowed to assess a patient. They may collect data such as vital signs, including pain and blood glucose levels, and keep the supervising RN or physician informed. LPNs may also note how the patient looks and acts, or responds to stimuli, and report this information accordingly. However, under this license, the LPN cannot interpret data, or make decisions for the patient. They have to report these findings to the RN or MD who will then make the decisions and delegate care.

Many Assisted Living Facilities, however, don’t even have an LPN on staff the majority of the time, if ever. Instead, personal care technicians with no medical education tend to residents.

Most residents of assisted living programs take several medications and visit more than one prescribing doctor. This makes medication management a challenge as the medications are being managed and distributed by unlicensed assisting personnel, uneducated in monitoring for side effects, giving the right medicine at the right time to the right patient, and knowing how to document it thoroughly. Medication technicians have completed only four hours of training. Poly-pharmacology and improper use of medications is in epidemic proportions in assisted living.

2. Your parent, even if cognitively impaired, is sent to the Emergency Room alone.

During the evening and night shifts, when emergencies typically happen, there is no one on staff that has the medical knowledge to decipher what a true emergency is. As a result, your parent may have needless admissions to the Emergency Room. Staying out of an emergency room unless absolutely necessary is always in the older adult’s best interest not only financial but also for their health.

The facility will typically call you once the person is safely in the ambulance, on their way to the hospital.  An older person, especially one with a cognitive disorder, should never be alone in an emergency room. Emergency rooms are designed to save lives, without knowing all the details of the people they are trying to care for. Someone needs to be there to medically advocate for the older adult. Aging Life Care Managers can jump in and assume this role as the older adult medical advocate.

Dr. Robert Kane, a geriatrician in health policy and someone who had a personal dreadful experience with his own mother’s trips to the emergency room. He described his experience as “neither fish nor fowl” and “the grayest of options.”

3. A limited capacity for assisting increasing care needs

Residents need more help as time goes on. Note the term “assisted” meaning they help with the Activities of Daily Living or ADLs. The components of each level of care vary from facility to facility. However, most use a point system to determine a resident’s required level of care. Prices increase with the amount of assistance your loved one needs. Once you reach the highest level, some facilities will allow private pay caregivers in to assist in the ADL’s to allow them to remain aging in place; some don’t.

In his book, It Shouldn’t Be This Way, Dr. Kane writes about his mother’s money “hemorrhaging” in assisted living due to the ever-increasing add-ons. An Aging Life Care Manager can help  predict how much care, what kind of care, and for how long that care may be necessary so that you can budget accordingly. We also work with Elder Law attorney’s who can offer recommendations on sustaining the wealth of each individual.

4. No wheelchairs or assistance with feeding

Where will your parent go when they move from a walker to a wheelchair? Those with macular degeneration may need help with feeding, but otherwise be very independent in their ADLs. The majority of assisted livings require transfer to a Skilled Nursing Facility in both these instances. They simply don’t have the skilled staff to care for residents who need this type of assistance. Life Care Managers can offer alternatives directed towards each individuals physical and financial needs.

5. No Relief from day to day responsibilities and care

Do not assume moving into an assisted living will relieve your family of the daily responsibilities of managing a loved one’s life. You still need to shop, monitor food intake (or lack of it due to the poor quality of food), purchase clothing, supervise medications, schedule/coordinate/transport to doctor appointments, and show up anytime that would be considered an emergency. If you are the financial POA, you also have the additional responsibility to manage their finances and assure it lasts their lifetime. Assisted Living Facilities don’t help you manage these inevitable pieces of aging care.

6. Bullies in assisted livings

Maybe it is due to cognitive decline or physical illnesses, but just like in high school, assisted living residents can have its share of cattiness and aggressive tendencies. Derogatory comments made loud enough for other residents to hear, saving seats in the dining room so a certain resident can’t sit at a table, or all-out shouting matches can occur. Oftentimes, it’s a personality conflict between the assisted living caregiver and the resident who believes they are being bossed around. The staff to client ratio in most facilities don’t have the tools or time to deal with this kind of conflict appropriately.

7. Residing in an Assisted Living is increasing less cost effective

They design these facilities for people with extensive funds. The average national cost is $6000.00/month and that doesn’t include the extra services mentioned above. Medicare and Medicaid (indigent elderly) typically will not cover these cost. Looking at this kind of price tag, you realize that gorgeous looking Assisted Living facility is not worth it when it lacks the quality of care your parent needs.

In short, What are you really getting when choosing Assisted Living?

• Congregated meals
• Light housekeeping
• Planned Social Activities
• Light supervision
• Pooled care for many people who need little to no assistance

Need a Quality Solution?

Making the decision for a family member who needs assistance can be tough.  Deciding on what kind of services you need can be overwhelming for families.  But now that you know what assisted livings can and cannot provide, you have the tools to make a educated decision.

The best way to ensure quality care for your loved one is to research and find a quality Aging Life Care Manager. They can help you through every life change, emergency, and unexpected obstacle. Their education in the medical field as well as their extensive knowledge on caring for aging adults will save you time, money, and the frustration of inadequate services.

If you would like assistance from an educated, licensed, and certified professional, you can refer to the Aging Life Care Association or, if you are in the Pittsburgh, PA area, feel free to contact us directly for help @ 412-486-6677 or through our ‘Contact Us’ form.

Bobbi Kolonay RN MS is Certified Care Manager, Certified Holistic Nurse and president of Holistic Aging – Options For Elder Care, providing Aging Life Care Management services for over 15 years in Pittsburgh, PA. She also serves on the Board of Directors of the Aging Life Care Association.

We are Holistic Aging, a small private care management practice located Hampton Township.  We are always  looking for Concierge Caregiver Companions for Seniors, Senior Care Consultant, to assist the Life Care Manager and family manage the care of their aging, dignified parent. Our small company is proud to say we all love our jobs and we are looking for someone with the same passion we have.

The post The Assisted Living “Healthcare” Myth appeared first on Holistic Aging.

Through my international travels I have found that aging effects different geographical population groups differently. Our Western world view of individualism in which one financially self-sufficient, living alone, and in control, makes accepting help from others a challenge. On the other hand, many Eastern countries in the world do not subscribe to our Western ideal of individualism. Rather, they place greater value on long-term bonds with family and local community. When people grow into old age they are cared for by younger members of the family and community throughout the entire process. These adults are much better off. Consequently, we need to recognize the value of that thought process in the Western world and that it is nearly impossible to age alone and remain healthy.

What we all have in common is the need to implement a system that strengthens the autonomy of the older person, assure their active involvement and participation in all spheres of life to improve their well-being, and quality of life. As a result, we need to examine closely our current method of institutional care in assisted livings and skilled nursing facilities, move away from a disease centered and functional dependence approach, but rather to care that promotes independence and dignity of the older person. Medicine is only one part of the picture; as people are transitioning into an older person, we need to look at a whole host of solutions that can keep them healthier and happier for their entire lives.

Through our care management practice, we have had the unique opportunity to identify best practices that allow our older clients to transition into a holistic way of aging well. I believe these concepts can provide a framework for future aging models of care.

Our Aging Model of Care:

• Working through expected Life transitions with a predetermined plan
• Creating an autonomous environment that encourages the older person to accept help
• Helping to decrease dependence on medication; eliminating the unnecessary or duplicate
• Treating food as medicine and moving the person into healthy eating
• Recommending alternative and less invasive treatment for many age related conditions
• Determining the root cause of an issue, rather than treating the symptom
• Bringing the “disease” back into balance using a gentile approach
• Following all transitions of care in the current healthcare system
• Acting as the liaison in all areas such as medical, psycho-social, spiritual, cognitive, environmental
• Encouraging and allowing for participation in meaningful life events
• Spending time and enjoying nature as much as possible
• Some type of daily physical and cognitive exercise
• Social interactions and involvement of family and friends
• Multi-generational interactions

I had the opportunity to visit a “Dementia Village” in Amsterdam. Due to their revolutionary approach, the majority of residents achieved the simple goal of trying to make life as normal as possible. As a result of visiting this village, I have strengthened my belief in holistic care.  If you’d like to learn more about it you can read a descriptive article here.

When we look at our elders transitioning, we need to stop seeing aging as a disease that needs a cure. Instead, let us bring about a revolution in which future elder care will encourage a return to a natural way of living. We will be close to nature and the things we love. We will walk in the woods, sing songs and appreciate the bounty of the planet and we will AGE WELL.

The post Transitioning into an “Older Person” appeared first on Holistic Aging.

Arnica is a perfect example of a natural remedy and gentile topical treatment to soothe muscles, reduce inflammation and heal wounds. Arnica (Arnica montana) is a perennial herb found in East Asia, Europe, the northern United States, and Canada and has been used for medicinal purposes since the 1500s.

Medicinal Uses and Indications

Arnica is used topically for a wide range of conditions, including:

• Bruises
• Fevers
• Inflammation
• Osteoarthritis
• Pain
• Skin disorders
• Sprains
• Burns
• Sore muscles

“Rejuvenated in my recovery I praise this herb most highly, yet in truth it is nature who praises herself, she who is truly inexhaustible, who creates this flower with its healing powers, and in doing so once more proclaims herself to be eternally procreative.” – Johann Wolfgang von Goethe, on Arnica after it relieved his severe chest pains (due to a heart condition which eventually took his life). Goethe credited Arnica with saving his life so that he could write the second volume of his autobiography.

In his book, Homeopathic Treatment of Sports Injuries, Dr. Lyle Morgan states: “Arnica should be considered first in all cases of physical injury.” He lists Arnica’s benefits throughout the book, including: “Arnica works quickly to repair damaged blood vessels, to reduce swelling at the site of the injury, and to eliminate pain.”

In his book, Musculoskeletal Healing, homeopath Asa Hershoff states:“Arnica is the most renowned trauma remedy, and is without equal as the primary remedy for injury of any kind whatsoever.”

Post fall older adult leg, all x rays were negative and RICE was the only treatment prescribed. This is prior to Arnica treatment.

Anyone working with older adults can confirm the devastating effects a simple fall with post bruising can cause for an older adult. They become non-ambulatory,  often leading to staying in a wheelchair for safety and institutionalized. In searching for a remedy to prevent this decline, I discovered Arnica, and decided to make a salve of organic, chemical free Arnica for our older adult clients. Bruises (or what medical doctors call “contusions”) occur when you get injured and break tiny blood vessels in the skin. These blood vessels or “capillaries”, leak into the surrounding tissue and as red blood cells gather, you can see discoloration in the area. What starts off as a red-purple injury becomes green or yellow as the body works to heal the region and metabolize or gobble up the mass of escaped red blood cells.

2 weeks post Arnica treatment 2 times a day, within a month there was no signs of bruising or hard tissue

Despite all their falls, young children bruise less readily as they have resilient blood vessels that don’t break easily.  Older people, especially those on certain medications, have delicate vessels; some find black and blue marks so frequently that they are forever wondering where the injuries come from and what it was they last bumped into. Medications that prevent blood clotting (like Coumadin) and prescription drugs that make blood vessels more fragile (like Prednisone) often contribute to the number of bruises one has.  Frequently,  the body will wall off the region instead of sending cells in to do the clean up work. When this occurs the blood pools and the area swells and becomes tender. If calcium is deposited, a bony condition called myositis ossificans can occur and the tissue becomes sensitive to touch and hard.The natural chemicals found in Arnica help to heal or prevent these unwanted complications. Flavonoids decrease the permeability of the blood vessels and polysaccharideas stimulate the process by which helper-cells clean the tissue of unwanted debris.

Even with the utmost caution, accidents will happen at home, on the field, in the gym, and in the workplace. However, with Arnica on hand and these tips in mind, you can speed the healing and prevent long-term disability that often accompanies bruises and physical trauma. So be sure to have a supply of Arnica in your kitchen cabinet, desk drawer, purse and gym bag. Then, you too will be able to experience the beneficial healing effects that Arnica has provided since mountain climbers discovered it centuries ago.

Organic Dried Arnica Montana

How I prepare Arnica – Pain Remedy From Nature

I purchase organic Arnica Montana, since it is native to the Mountains of Europe and Asia preferring higher elevations and  not able to be grown in my backyard in Pittsburgh.

Organic Coconut oil for mixing

For mixing other remedies, I always have on hand Organic Coconut oil.

Step 1:

Heat the organic coconut oil to melt; I use a small electric fondue pot to make all my salve’s.

Step 2:

Add the Arnica Montana dried flowers and leave to cook for 48-72 hours. The Arnica flowers will diffuse into the coconut oil, changing it to a light brown color. The oil is a solvent for the medicinal properties of the herb and provides a healing, emollient base.

 Step 3:

After 72 hours, I allow the Arnica infused oil to cool so that I can touch it. Then I use a cheesecloth draped over a pan to strain out the arnica infused coconut oil, squeezing the excess oil out and discarding the flowers into my compost heap.

Step 4:

I then place the arnica infused coconut oil back into the electric fondue pot and slowly add the organic Beeswax pellets which adds a soothing, protective quality and provides the firmness needed to form a salve. This is heated until the beeswax is completely melted. To check for proper consistency, I dip a spoon into the mixture and pull it out immediately to test the consistency. If it is too soft, I add more beeswax.

Step 5:

Once the consistency is just right, I allow the Arnica infused organic coconut oil mixed with the beeswax to cool for about 5 minutes. I then add 2 types of organic essential oils  that also have anti inflammatory properties and blend them into the mixture. I then infuse each container with Reiki energy from the universe to offer additional healing properties. Next,  I pour the mixture into 2 oz. and 4 oz. containers and place a lid on immediately. It will form into a salve consistency in less than 5 minutes. If placed in a cool environment (like air conditioning) the salve will form a harder consistency. Just remove some of of the salve and warm it in your hand to regain the salve consistency.

This organic Arnica is available for purchase at our office. The 2 oz. container is $10 and the 4 oz. is $15. Shipping and handling charges adds an additional $5 – $7.

This article was written by Barbara Kolonay RN BSN MS, Certified Care Manager, Certified Holistic Nurse, Certified Clinical  Aromatherapist, Herbalist, Reiki, and owner of Holistic Aging  where we recognize the importance of caring for the whole person, offering alternative and non-invasive methods to encourage natural healing. Our older adult and disability LIFE CARE MANAGEMENT division – Options For Elder Care – guides and offers solutions to families allowing their family member to age well.

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In my 35 year career as a nurse, I have participated in many types of codes. One such code, “Code Blue,” is when a cardiopulmonary arrest is happening to a patient in a hospital or clinic. It requires a team of providers (“code team”) to rush to the specific location and begin immediate resuscitation efforts. Similar to “Code Blue” alerts, the Cleveland Clinic has coined “Code Lavender” alert. This alert responds to a need for emotional and spiritual support for the caregiver, family, or hospital staff. The nurses who respond to these codes train in varying modalities.  The use of essential oils to ease symptoms, aromatherapy, is one modality in their knowledge base. (Johnson, 2014)

Code Lavender is becoming increasingly important as more and more elderly require caregivers, many of which are overwhelmed.

Jean Watson, a nursing theorist of the Human Caring Model, describes finding sacredness in the act of caring and human relationships. Essential Oils used via Aromatherapy is the perfect modality to foster a sense of harmony and calm. This easily works within a caring environment that supports basic comfort and release of blocked energy.

“As a symphony integrates disparate instruments and their tones into a harmonic piece, so do essential oils vibrate with the human field to support the emerging natural order of healing. Essential oils represent a powerful methodology to impact the release of blocked energy in the mind-body-spirit system.” (Smith & Kyle-Pounds, 2008)

Caregiver Aromatherapy

For this article, a caregiver is defined as any person who is responsible for attending to the needs of a child or dependent adult. A caregiver can be anyone including husbands, fathers, wives, mothers, sons, daughters and even professionals such as nurses, social workers and doctors. The list is actually quite extensive.

When providing care to another individual, a caregiver can often neglect their own needs. This neglect, over time, can exact a heavy toll on the overall well-being of a caregiver, causing an emotional and physical strain. To prevent burnout and ward off compassion fatigue, you need to put yourself first, treat yourself, and acknowledge that you deserve it! You must acknowledge yourself and your needs to keep balance within your life. An unbalanced, inharmonious situation will lead you or your loved ones to unhappiness.  Using essential oils is the perfect method to address and treat the psychological, emotional, social, physical and spiritual toll of care-giving.

What is Aromatherapy?

Aromatherapy is the use of therapeutic oils from natural plant matter in order to encourage good health, equilibrium, and well-being. Essential oils are chemicals that plants produce naturally as part of their defense system. Some have antibacterial, antiviral and anti-fungal properties, others repel insects and herbivores while others attract insects and birds for pollination. The aromatic oils are found in various parts of the plant including leaves, twigs, stems, roots, flowers, blossoms or fruit. The material used and the art of extraction has developed slowly over the course of time but the origins reach back to the heart of the earliest civilizations.

The Vedic literature of India dating to around 2000 BC lists over 700 plant substances used for healing including cinnamon, ginger, myrrh, and sandalwood. The Chinese system of medicinal plant usage is evident in the Yellow Emperor’s Book of Internal Medicine  which dates back to 2000 BC, along with the great classic Pen ts’ao kang-mou, which lists over 8,000 thousand plant-based formulas used for healing and wellness even today.

Perhaps the richest association concerning the first aromatic materials used for medicinal purpose are those surrounding the ancient Egyptian civilization. Papyrus manuscripts, dating back to 2800 BC speak of ‘fine oils and choice perfumes, and the incense of temples, where by every god is gladdened’. Aromatic gums and oils such as Frankincense, Cedar and Myrrh, are still detectable 1000 of years later when tombs were exhumed. Even Hippocrates, the father of medicine, who was born in Greece about 460 BC, also prescribed fumigations and refers to a vast number of medicinal plants in his writings.

Smell and the Limbic System 101

This complex v-shaped structure sits on top of the brain stem and is made up of the hippocampus, amygdala, part of the thalamus and the hypothalamus and several regions of the cerebral cortex. It is one of the earliest parts of the brain to develop in terms of evolution with 34 structures and 53 pathways, and since aromas, emotions, and memories all meet here you see why smell can trigger specific memories and emotions. When essential oils are use in the treatment of certain conditions either through inhalation, via massage or used in the bath, they cause various parts of the limbic system to spring into action. This triggers the release of neurochemicals and hormones that will slow the heart rate, regulate blood pressure, and stimulate the immune system making one less susceptible to disease or illness.

Recommended Essential Oils for the Caregiver

1. Lavender (lavendula angustifolia)

One of the most versatile and widely recognized of all the essential oils. Most commonly known for its ability to relax the body, therapeutic-grade lavender benefits the skin. It may be used to cleanse cuts, bruises and skin irritations. The fragrance is calming, relaxing and balancing – physically and emotionally. This essential oil can be used directly on the skin. When applying the oil, I always recommend the bottom of the feet for best absorption and therapeutic outcome. You can also place a drop or two on a cotton ball and inhale it as needed.

2. Frankincense (boswella sacra)

This is my all-time favorite essential oil. Comfort tired and achy joints by massaging with Frankincense Sacred Essential Oil mixed with a carrier oil such as olive or coconut oil. Frankincense Oil is very effective as a sedative, because it induces a feeling of mental peace, relaxation, satisfaction and spirituality. It also awakens insight, makes you more introspective and lowers anxiety, anger and stress. When feeling anxious or if you anticipate a stressful episode, add frankincense oil to a diffuser or a vaporizer. Frankincense Sacred, which enhances deep meditation, also helps balance emotions, lessening feels of loneliness, frailty, and grief. Use of the oil encourages you to live in the moment while balancing everyday tension and stress.

3. Roman chamomile (chamaemelum nobile)

Chamomile tea is one many commonly prescribe for relaxation and sleep – and, of course, chamomile essential oil can offer much of the same, only more. It not only offers relaxing and calming properties, but it can help lessen anxiety and dispel lingering anger. A calming scent, the aroma of chamomile encourages inner harmony while reducing anxiety, irritability and the tendency to overthink everything. A study out of the University Of Pennsylvania School Of Medicine on the antidepressant activities of chamomile essential oil showed that it “may provide clinically meaningful antidepressant activity that occurs in addition to its previously observed anxiolytic activity.”

4. Valerian (valeriana officinalis)

Valerian is well-known for its ability to help induce sleep. While it’s aroma isn’t exactly pleasing it’s outstanding when it comes to the ability to relieve anxiety and stress. Science has shown that valerian raises the amount of a compound known as GABA (gamma animobutyric acid) in the brain. GABA regulates nerve cells and calms anxiety. Common pharmaceutical drugs like valium and xanax work by increasing the amount of this chemical in the brain. Valerian contains valerenol and valerenic acids which acts in the same way as these anti-anxiety medications, all without the side effects that commonly come with prescription drugs. I recommend mixing Valerian with Lavender

“Caveat Emptor” when Purchasing Essential Oils

Since we use our essential oils for medicinal purposes, we only purchase our essential oils from a vetted organic supplier. Our office carries over 30 different essential oils. We can also order ones we do not carry for your use directly. Visit our store: https://holisticaging.com/holistic-health-store/ or contact us directly at info@holisticaging.com

When ordering independently – please assure your supplier has listed:

• Common name, Latin name (exact genus and species)
• Country of origin, Part of plant processed
• Type of Extraction (distillation or expression)
• How it was grown (organic, wild-crafted, traditional)

Supplier qualities:

• One who is dedicated to supplying essential oils to the aromatherapy practitioner market and educated public
• Owned by an aromatherapy practitioner or essential oil specialist
• Who has relations with his/her distillers, if possible
• Who can readily supply a batch-specific GC/MS spec report on each essential oil it sells
• Readily able to provide material safety data sheets (MSDS) as needed
  • this is most often needed for individuals who are practicing in a medical facility
• Who has a strong ethical reputation in the field
• Who has preferably been in the field for a number of years
• Well known to other aromatherapy practitioners and/or educators  

A “Code Lavender” is as serious as a “Code Blue”! Only when you first help ourselves can you effectively help others. Self care is one of the most important and often forgotten things you can do as a caregiver. Take care of your needs and the person you care for will benefit, too.

The author, Bobbi Kolonay RN MS CCM is certified as a clinical aroma therapist and holistic nurse. She has been using essential oils medicinally in her Aging Life Care Management practice Holistic Aging-Options For Elder Care for the past 10 years.

Bibliography

Johnson, B., RN, ADN, RM, HTPA. (2014, April). Code Lavender: Initiating Holistic Rapid Response at the Cleveland Clinic. Beginnings, 10-11.

Smith, M., & Kyle-Pounds, L. (2008). Holistic foundations of aromatheraphy for nursing. Holistic Nursing Practice, 22 (1), 3-9.

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However, a new study led by Carnegie Mellon University’s J. David Creswell offers the first evidence that mindful meditation reduces loneliness in older adults. Published in “Brain, Behavior & Immunity,” the researchers also found that mindful meditation — a 2,500-year-old practice dating back to Buddha that focuses on creating an attentive awareness of the present moment — lowered inflammation levels, which is thought to promote the development and progression of many diseases. These findings provide valuable insights into how mindfulness meditation training can be used as a novel approach for reducing loneliness and the risk of disease in older adults.

“We always tell people to quit smoking for health reasons, but rarely do we think about loneliness in the same way,” said Creswell, assistant professor of psychology within CMU’s Dietrich College of Humanities and Social Sciences. “We know that loneliness is a major risk factor for health problems and mortality in older adults. This research suggests that mindful meditation training is a promising intervention for improving the health of older adults.”

For the study, the research team recruited 40 healthy adults aged 55-85 who indicated an interest in learning mindful meditation techniques. Each person was assessed at the beginning and end of the study using an established loneliness scale. Blood samples also were collected.

The participants were randomly assigned to receive either the eight-week Mindfulness-Based Stress Reduction (MBSR) program or no treatment. The MBSR program consisted of weekly two-hour meetings in which participants learned body awareness techniques — noticing sensations and working on breathing — and worked their way toward understanding how to mindfully attend to their emotions and daily life practices. They also were asked to practice mindfulness meditation exercises for 30 minutes each day at home and attended a daylong retreat.

The researchers found that eight weeks of the mindfulness meditation training decreased the participants’ loneliness. Using the blood samples collected, they found that the older adult sample had elevated pro-inflammatory gene expression in their immune cells at the beginning of the study, and that the training reduced this pro-inflammatory gene expression, as well as a measure of C-Reactive Protein (CRP). These findings suggest that mindfulness meditation training may reduce older adults’ inflammatory disease risk.

“Reductions in the expression of inflammation-related genes were particularly significant because inflammation contributes to a wide variety of the health threats including cancer, cardiovascular diseases and neurodegenerative diseases,” said study collaborator Steven Cole, professor of medicine and psychiatry and biobehavioral sciences at the UCLA School of Medicine.

While the health effects of the observed gene expression changes were not directly measured in the study, Cole noted that “these results provide some of the first indications that immune cell gene expression profiles can be modulated by a psychological intervention.”

Creswell added that while this research suggests a promising new approach for treating loneliness and inflammatory disease risk in older adults, more work needs to be done. “If you’re interested in using mindfulness meditation, find an instructor in your city,” he said. “It’s important to train your mind like you train your biceps in the gym.”

In addition to Creswell and Cole, the research team included UCLA’s Michael R. Irwin, Lisa J. Burklund and Matthew D. Lieberman and the Cousins Center for Psychoneuroimmunology’s Jeffrey Ma and Elizabeth Crabb Breen.

For more information, watch this short video of Creswell explaining the research:http://youtu.be/OWpsZvOsZDA.The National Institutes of Health, the Cousins Center for Psychoneuroimmunology at UCLA

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