Caregiver Tips

  The following strategies can decrease the risk of falling in patients with vision-related deficits: 

• Make sure rooms are well-lit with light in the blue spectrum (fluorescent).
• Use night lights in bedrooms, hallways, bathrooms, and the kitchen to make it easier to navigate in the dark.
• Paint step edges, transitions in walking paths, door frames, and light switches a contrasting color from surrounding areas so they can be seen more clearly.
• Use matte paint on walls to reduce glare.
• Keep eyeglasses within easy reach of the bed.
• Obtain frequent vision screenings to ensure that glasses are the proper strength and to detect other vision related problems that may be corrected.
• Keep walkways free from clutter
• Use non-skid rug
• Wear well-fitting non-skid shoes
• Clean up spills on the floor promptly to keep floor surface dry
• Use non-skid mats or strips in the tub/shower
• Do not use towel bars for support
• Have grab bars professionally installed in the bathroom & shower
• Do not use lotion or oil in the tub/shower
• Ensure steps, floor surfaces and hand rails are in good repair and not loose
• Use Assistive Devices properly (canes, walkers, bedside commode, raised toilet seats etc…)
• Assist patients to transfer by assisting their weak side

• Encourage mobile persons to shift position every 15 minutes, especially when sitting upright.
• For wheelchair-bound persons, encourage them to sit upright. Sitting with good posture helps to switch positions frequently.
• Bedbound or immobile persons should be turned and repositioned every 2 hours unless healthcare providers say otherwise. “Turn clocks” are especially useful reminders in home-care situations where multiple family members and caregivers contribute to the person’s care.
• Encourage alert persons to help inspect their own bodies with a hand mirror.
• Encourage persons to drink at least two quarts of water every day for optimal skin health – unless they are on a fluid restriction.
• Encourage to eat extra protein, extra calories and fruit for energy.
• Avoid “sheet burn” by NOT dragging a person across the bed. Ask the person to help, if possible, or get a caretaker or family member to help move the person. Always move on the count of three so that you are all working together.
• Try to keep the person’s bed clean, dry and free from wrinkles. Lying on wrinkled sheets for a prolonged period may cause a pressure ulcer to develop. Wet linens can also increase the risk.
• Keep incontinent persons as dry and clean as possible. Wet skin can become brittle, making it tear more easily. Soiled or wet clothing can rub against the skin, creating an ulcer. Also, be aware that while a catheter may prevent urine from irritating the skin, it is not the best solution for preventing pressure ulcers.
• Whenever you reposition persons, take the opportunity to check their skin for any changes. Keep an eye out for dry patches, redness, tenderness, or bruises.
• Use pillows and pads to help position persons comfortably in their bed or chairs. Place the pillows so that they minimize pressure on bony parts of the body.
• When bathing a person, pat the skin dry with a towel instead of rubbing it. The friction from rubbing could irritate the skin and/or make a developing pressure sore worse.
• If a person has an adjustable bed, make sure the incline is as low as possible. The straighter a person sits in bed, the more pressure there is on the tailbone and lower back.
• Make sure persons are getting the proper amount of support from mattresses and beds.
• Discourage persons from lying directly on their hips when in bed. Since the hip bones are prone to bed sores, keeping pressure on this area can be very dangerous.
• Many pressure ulcers on knees and ankles occur from the legs rubbing together. To prevent this, try putting a pillow between the person’s legs to keep them apart while in bed.

Only nurses or physicians can directly treat a bed sore/pressure ulcer, however your careful attention the person’s skin can help prevent your loved one from getting dangerous bed sores.

Before attempting to move a person from a bed to a wheelchair by yourself, stop and consider:

• The size of the person – Ask yourself if the person is smaller than you.
• Mobility – How well can the person move? Can he or she assist you?
• Equipment – Is the person hooked up to equipment such as an IV or a catheter bag?

If you can answer those questions satisfactorily – and if the person can stand – below are steps for moving a person from a bed to a chair:

• Help the person sit up and adjust slowly to the change of position. Allow legs to dangle while you help put on non-skid slippers or shoes.
• Be sure the bed is at its lowest position.
• Position the chair near the bed. If the person has a weak side, place the chair on the stronger side. If the chair has wheels, lock them. If there are footrests, put them up.
• Now, support the person’s knees by putting your knees right in front of them. And keep the person’s feet from sliding by putting your feet in front of them. Do not lock your knees.
• If recommended by the person’s healthcare provider, apply a gait belt. Ask the person to lean forward and push off the bed at the count of three. Or, rock the person forward to a standing position.
• It’s OK to have a person hold onto your shoulders or waist, but never around your neck.
• Bend your knees slightly. First, pivot your feet. Then, turn your body, along with the person.
• Make sure the chair seat touches the back of the person’s legs before he or she begins to sit. He or she should also reach back for the armrests, if able.
• Lower the person slowly to the chair without rounding your back.

Note: If the person cannot stand, it is best to transfer with a mechanical lift.

 Remember to:

• Lock the wheelchair brakes and to move the footrests out of the way of the feet.
• Help the person scoot to the front of the chair so his or her feet are flat on the floor.
• Assist the person to lean forward over his or her feet. Ask him or her to use their hands to push up, if able.
• Slowly sit the person back down.

 There are two main types of pain: acute pain and chronic pain. Pain is considered acute when it is temporary, lasting for a few hours or, at most, up to six months. Pain is considered chronic when it is long term – lasting for six months or more. 

 Pain is not:

• A normal part of getting older.
• Necessary to “build character.”
• Something that can’t be measured with a blood text or an x-ray.
• All in people’s heads.
• Always well-managed for people over age 65.

Identifying and Addressing Pain

As a caregiver, you have a crucial role in helping the medical team understand the level of pain experienced by your loved one.

Here are some signs to look out for in patients with dementia or those who are nonverbal and may be experiencing pain:

- Repetitive movements, such as rapid blinking or rocking.

- Repeated words or phrases like “Help!”, “Get away!”, or “Don’t touch me!”

- Physical signs of pain, such as restlessness, rubbing a body part, or tightly closing the eyes.

- Changes in behavior, such as a loud person suddenly becoming quiet, a quiet person suddenly crying, or someone who suddenly stops eating or sleeping.

- Moaning, groaning, repeated calling out.

- Facial grimacing.

- Body curled in fetal position, tense, or clenched fist(s).

- Striking out.

- Labored breathing.

You play a vital role in ensuring the medical team is aware of your loved one's pain. Inform them if patients:

- Complain that their pain is not relieved after taking pain medication.

- Describe a new type of pain or pain in a new location.

- Show nonverbal signs of being in pain, such as restlessness, rubbing or holding a body part, crying, rocking, or moaning.

- Walk or move differently due to pain.

- Suffer from nausea or vomiting, constipation, or any other side effects of pain medication.

- Talk about not wanting to live anymore. (People who suffer from chronic pain can become so depressed that they feel suicidal.)

- Stop eating or drinking.

- Complain about being unable to sleep.

4 Types of Pain that Require Immediate Attention

While pain should never be ignored, there are 4 types of pain that require prompt medical attention:

1. Intense headache: Serious headaches in seniors may indicate a brain disorder such as a stroke or an aneurysm.

2. Chest pain: Elderly individuals are at risk for heart disease and pneumonia, both of which can cause chest pain. If the pain is cardiac in nature, it may radiate to the throat, jaw, left arm, or abdomen.

3. Severe abdominal pain: Elderly individuals taking narcotics for pain are at risk of developing constipation, which can lead to impacted stool and/or bowel obstruction if severe.

4. Burning feet or legs: As people age, their risk of developing type 2 diabetes increases. Burning in the feet or legs may be the first sign of diabetes for some individuals.