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Physical and Mental Well-being for Older Adults

Written by Brittni Peterson, RN
Resource Nurse, Empira

When it comes to setting goals, never say never. With an outstanding time of just under four hours, Harriette Thompson became the oldest woman to run a half marathon in 2017. Can you guess her age when she crossed over that finish line? 94. People tend to believe the older we become, the more fragile our body becomes… but that doesn’t have to be the case.

Exercise for older adults is just as important as exercise is for children, adolescents, teens and adults. There is no doubt that the older we get the more our body starts to have aches and pains, which may make it more difficult to get up and get moving. However, according to the Better Health Channel, regular exercise may help decrease some of those aches and pains by strengthening the bones and muscles in our body. Individuals over the age of 65-years-old should spend approximately 20 minutes/day on aerobic exercise or 10 minutes/day anaerobic exercises.

Aerobic vs. anaerobic

The word aerobic means “with oxygen”. The amount of oxygen intake, while performing an aerobic exercise is adequate enough to fuel the physical activity. Running, brisk walking, cycling, or swimming are all examples of aerobic exercise. Your body is burning the carbohydrates and fats that are stored in your body to fuel your muscles while increasing your heart rate and breathing. Since your body is slowly burning the carbs and fats, aerobic can be done for a long time (like a marathon) because energy is slowly being released and the demand for oxygen is not high.

The word anaerobic means “without oxygen”. For this type of exercise, regular oxygen supply is not adequate enough to fuel the activity, so the body needs to rely on other means of fuel like carbohydrates, amino acids and lactate. Anaerobic exercise cannot be done for a long time because of the limited supply of energy. Some examples of anaerobic exercise are weight lifting, sprints and box jumps.

Benefits of physical exercise for aging adults

According to the Centers for Disease Control and Prevention in 2017, approximately 3 million older adults were seen in the emergency department due to injuries that were sustained from a fall and more than 95% of hip fractures are caused by falling. When we become older, our bone density decreases, as well as, our muscle mass. How can we change that? Simple. Exercise.

Weight bearing exercises, like walking or lifting weights, helps to improve balance by strengthen your bones and increasing your muscle mass. This will help decrease falls and bone fractures by providing your body with strength and stability. Exercise will also benefit your joints by keeping them in regular use. Physical activity can also help improve the function of your heart and lungs. Aerobic exercises help to strengthen your heart which will help decrease your risk for illnesses like heart disease, hypertension and diabetes.

Let’s do an overview on the benefits of exercise.

  • Improves our mood and sleep while reducing stress and anxiety by releasing those feel good chemicals.
  • Increases stability and balance by strengthening our bones and increasing muscle mass.
  • Improves our health and lowers our risk for diseases like hypertension, heart disease and diabetes by strengthening our heart and lowering bad cholesterol.
  • Decreases joint pain by regularly moving and keeping them from stiffening
  • Improves brain function by reducing inflammation and extending the existence of new brain cells.

Is physical activity the only type of activity we need?

When we think of exercise we typically only think about how it helps our bones, muscle, heart, and lungs… but what about our most essential muscle, the brain? Just like any muscle in our body, the brain can lose its muscle tone, making it more susceptible to memory loss and decreased cognitive function. This may make it difficult to independently perform activities of daily living that mean that most to you, upholding conversations and can even make it more difficult to learn new skills.

Author Heidi Godman, writes that exercise helps the brain directly by reducing inflammation and promoting growth of new brain cells, blood vessels in the brain and extending the survival of new brain cells. Exercise helps the brain indirectly by improving mood, sleep and by decreasing episodes of anxiety and stress. When we get our body moving and increase our heart rate, our brain releases good chemicals known as endorphins and serotonin.

Here are some inexpensive ways to exercise your brain:

  • Word games help improve word association and memory recall.
  • Board games integrate problem solving skills and create opportunities for socialization.
  • Jigsaw puzzles incorporate fine motor skills.
  • Crafts promote autonomy for creativeness while combining fine motor skills.
  • Cooking utilizes critical thinking and helps improve memory (recipes) while encouraging creativeness.
  • Gardening stimulates the brain with planning and provides sun exposure, a great source of vitamin D.

Integrating meaningful activities in nursing communities

An F-number, called a tag number (F-tag), corresponds to a specific regulation within the Code of Federal Regulations that governs long term care facilities. F-tag 248 states that ”the facility must provide for an ongoing program of activities designed to meet, in accordance with the comprehensive assessment, the interests and the physical, mental, and psycho-social well-being of each resident.” This F-tag is overseen by federal regulations with the hope of providing residents with activities that fit their individualized interest to provide them with purpose and increase their overall well-being. There is even a federal regulation that emphasizes the importance of both physical and mental activities for residents.

How do we know which activities will spark interest in residents? I’m glad you asked. Empira’s fourth signature program, ResoLute, helps by supporting “residents and loved ones as they embrace the process of aging with purpose, determination and an unwavering commitment to uphold what matters most in the late stages of life.” Supporting the resident is done with meaningful conversations to determine what matters most to them. By asking those important questions, we can begin to plan focused activities around their personal goals. Purposeful living has already been linked to other aspects of well-being, like a longer life, lower risk of disease, better sleep and healthier behavior.

I’m not saying everyone has to be like Harriette and run a marathon to live a purposeful life, but if you can find what sparks your resident’s joy, you will make their world a better place to be.

References:
Better Health Channel. (2020). Physical activity for seniors. https://www.betterhealth.vic.gov.au/health/HealthyLiving/physical-activity-for-seniors

Boren, C. (2017, June 4). At 94, Harriette Thompson becomes the oldest woman to run a half-marathon.

In The Washington Post. https://www.washingtonpost.com/news/early-lead/wp/2017/06/04/now-94-harriette-thompson-is-trying-to-become-the-oldest-woman-to-run-a-half-marathon/

Cirillo, A. (2019, June 24). Nursing homes and assisted living activities. In Nursing Homes. https://www.verywellhealth.com/nursing-home-and-assisted-living-activities-197763

Empira. (2020). Our signature approaches. http://empira.org/programs/our-programs

Godman, H. (2018, April 5). Regular exercise changes the brain to improve memory, thinking skills. In

Harvard Health Blog. Retrieved from https://www.health.harvard.edu/blog/regular-exercise-changes-brain-improve-memory-thinking-skills-201404097110

MacMillan, A. (2017, August 16). People age better if they have a purpose in life. In Time. https://time.com/4903166/purpose-in-life-aging/

Sun Health Communities. (2016, July 7). 7 exercises for older adults.
https://www.sunhealthcommunities.org/resource-center/articles/7-brain-exercises-older-adults/

World Health Organization. (2020). Physical activity and older adults. In Global Strategy on Diet, Physical Activity, and Health. https://www.who.int/dietphysicalactivity/factsheet_olderadults/en/

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Moai: It’s written into our DNA!

Written by Heather Johnson, RN
Resource Nurse, Empira

Would you agree that we live in a world consumed by convenience and technology?

With a global population nearing 7.7 billion people, one would like to think that there would be no loneliness, no lack of human contact and certainly plenty of opportunities for social connectedness in our world. Yet, social isolation, loneliness and lack of social connections are the stark reality for many, especially older adults in the United States.

Recently, in an article that I read, an 80-year-old woman refers to herself and those in her age group, as glass people. She explains that she feels invisible even though she resides in a senior apartment building and is constantly surrounded by others. She shared that, even in a complex that brings people in close proximities to each other, there is a lack of social connection, a nonexistent sense of community and a stigma about productivity in elders. She’s not alone in her thinking.

Social connectedness is defined as the feeling that you belong to a group and generally feeling very close to other people. In fact, scientific evidence strongly suggests that social connectedness is a core psychological need, which is essential to feeling satisfied with your life. As humans, we have a drive to connect with others, it’s embedded within our DNA and it begins at birth with our connection to those who cared for us. This same relationship exists throughout our lifespan. Studies often conclude that when a person is well cared for as a child they are more likely to have healthy and happy relationships as they get older.

In recent months, I have been researching more and more about the multiple blue zones that exist across the globe. Blue zones are areas identified by experts as having environments and traditions that support one in living a much longer and happier life. Five such zones are identified and they include:

  • Okinawa (Japan)
  • Sardinia (Greece)
  • Nicoya (Costa Rica)
  • Icaria (Greece)
  • Loma Linda, California (USA)

Teams of experts have found nine common denominators, often referred to as the power of nine, among blue zones and they include the following:

  • Move naturally: People live in environments that nudge them to move
  • Purpose: In Japan it’s known as “Ikigai” which translates to why I wake up in the morning
  • Down shift: Taking time each day to slow down (praying, meditating, resting)
  • 80% rule: In Japan this is known as “hara hachi bu” which means to stop eating when you feel your stomach is 80% full
  • Plant slant: Beans and plant sources are the cornerstone of your daily diet
  • Wine at 5pm: Drinking 1-2 glasses per day with friends and/or with food
  • Belong: Be a part of a faith-based community or organization
  • Loved ones first: Families are put first and a priority in one’s life, invest time with your partner and time with children
  • Right tribe: Being part of a group of 5 or more people that are committed to one another for life, cultivating a strong social network, this group is known a your moai

Do you notice that four of the nine definitely involve social connectedness?

Elders in Okinawa, Japan, one of the original blue zones longevity hotspots, live extraordinarily better and longer lives than almost anyone else in the world. Moai, one of their longevity traditions are social support groups that start in childhood and extend into the 100s. This term originated hundreds of years ago as a means of a village’s financial support system. Originally, moais were formed to pool the resources of an entire village for projects or public works. If an individual needed financial resources to buy land or take care of an emergency, the only way was to pool money locally. Traditionally, these groups of five or more children were brought together with the expectation that they would be committed to one another for life. Today this idea has expanded to become more of a social support network, a cultural tradition for built-in companionship and is often known as one’s “second family.”

Half of the Okinawans population still participates in the moai traditions and some belong to more than one. Statistics show that when people share similar values, healthy habits and life goals, they are much more likely to experience less stress, are happier and live longer. The average life expectancy in Japan is 86.3 years of age, while here in the United States; average life expectancy is 78.9 years of age.

What can we learn from Japan?

Research and life stories confirm the value of being socially connected. Take inventory of your life for social connectedness. Take notice of the social connectedness of those you care for and about, no matter what age. Understand and appreciate that a person can still feel lonely, useless and like a glass person in a crowd. Then take measures to enhance those lives by helping to find meaningful ways to really connect.

Resources:
Blue Zones: retrieved from bluezones.com on January 4, 2020
Buettner, D.B., (2012). The blue zones (2nd edition): 9 lessons for living longer from the people who’ve lived the longest. National Geographic Partners LLS.
Weil, A., (2005). Healthy aging: A lifelong guide to your physical and spiritual well-being. Knopf.

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You Ain’t Cool Unless You Pee Your Pants

Written by Sarah Brown, BS, RN, LNHA
Executive Director, Empira

“You ain’t cool unless you pee your pants!” – Billy Madison

Some of you may remember this classic line from the 1995 comedy movie, Billy Madison. Adam Sandler plays the role of an adult, Billy Madison, who has to complete all of grade school over starting with Kindergarten. While on a school field trip in 3rd grade, Billy notices his classmate had an “accident”. Sensing his classmate’s embarrassment, Billy pretends to pee his pants too to save the boy from embarrassment. Because the rest of the class looks up to Billy as an older cool kid they accept his claims and the boy is saved from embarrassment. Part of this scene includes a cut to an elderly woman who says, “If peeing your pants is cool… consider me Miles Davis.” Fun Fact (Miles Davis was influential Jazz musician with a record titled Birth of the Cool in 1957.)

Although incontinence is common, it is not a normal part of aging.

With stereotypes like the one in the movie and daily exposure to the widespread prevalence of incontinence observed in care centers, it is very easy to normalize and expect incontinence with aging. In the United States, incontinence is common for older adults and according to the National Association for Contienence (NAFC), incontinence is second, only to falls, as the reason for nursing home placement.

Incontinence affects on average 70% of residents in the Empira consortium. We have learned through the Empira Falls Prevention & Reduction program that incontinence is a common contributing cause of falls and toileting schedules also have a major influence on several other nursing home care plan areas including sleep, nutrition, hydration, skin integrity and mobility.

One thing the movie portrayed accurately is the social impact of incontinence. Through conversations with residents Empira became increasing aware of the impact it has on quality of life in our care centers. We have learned that resident don’t feel like Miles Davis, the king of cool. Residents have shared the following statements about what it is like. As you read the comments you will see they feel more like the embarrassed school mate:

  • “Because I have so many accidents I prefer not to go to my social engagements.”
  • “I buy two of every outfit because I got tired of explaining to my friends why I changed clothes.”
  • “I am limited in my ability to venture too far from bathrooms for fear of accident and embarrassment.”
  • “Going to the bathroom becomes all consuming and takes over my whole day’s schedule.”
  • “I was surprised how quickly incontinence products were suggested and it was presented as my only option.”
  • “I was living at home until I began to have incontinence issues. It was the reason I had to move to a nursing home”
  • “I don’t attend family events outside of the nursing home because my bathroom needs are more trouble than it is worth.”
  • “Bathroom routines are embarrassing and distract from living life.”

I am not saying we should all start peeing our pants.

We as aging service providers need to acknowledge that we are not helping older adults feel cool or understood as Billy Madison did with his empathetic gesture. I am not saying we should all start peeing our pants but I am saying we should all start with empathy and understanding of the impact incontinence issues has on those we care for. Our current status quo of continence care in nursing homes has normalized incontinence to the point where we don’t even see it as a problem that deserves investigating. The resident comments above convey that our actions say, this is normal, there is nothing more we can do other than offer incontinence products and a 2 hour toileting schedule.

We need more thorough understanding and more options for treatment and management besides the house special standard incontinence product. I want to encourage us as aging service providers to keep learning and to create new standards that give incontinence the time it deserves. This will allow for discovering root causes, preventative measures and alternative options for residents.

Starting January 2020, the Empira collaborative has created and deployed a new approach to incontinence titled STREAM (Strategies Targeting Resident Elimination and Assessment Management). This program will be in 25 skilled nursing homes in metro and rural Minnesota.
STREAM was made possible by PIPP funding through the MN Department of Human Services.

STREAM was developed after listening to residents share the negative impact toileting and incontinence has on their everyday life. This program will challenge current assessment practices that do not accurately reflect the resident’s condition and replace it with technology-based assessments to improve accuracy and efficiency. STREAM funding provides each community with a Clinical Informatics Specialist (CIS) who will utilize the technology based assessments and data to strengthen resident care plans for a holistic approach to individualized care.
We believe improved understanding of the root cause will lead to better options for prevention, treatment, and management and ultimately resulting in higher quality of care.

Stay tuned to follow the STREAM journey. If you are interested in learning more about continence and emerging best practices visit http://www.nafc.org/

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Grandpa Paul’s Letter and Legacy; A Gift from Heaven

Written by Heather Johnson, RN
Resource Nurse, Empira

Last year, my oldest son, Nicholas Pete Johnson, graduated with a degree in Law Enforcement; a proud moment for me, my husband and our extended family and friends. Nick, from a very young age had shared his desire, to anyone that would listen, that he wanted to be a police officer. He accomplished this goal at the young age of 19. Unbeknownst to me, my mother not only came to observe and take in this moment with all of us, but she came carrying a gift in the form of a letter to hand deliver to Nicholas. It was a letter that her father (my Grandpa Paul/Nick’s great-grandfather) had penned in the days following Nick’s birth; a letter that was to be given to Nick later in life. Just a few short months after he’d written the letter, Grandpa Paul died suddenly of cardiac arrest.

In a quiet moment following the graduation ceremony and subsequent traditional hubbub, with tears in her eyes, a big hug (something my grandpa was famous for) and with extreme pride for having kept this letter preserved for close to 19 years, my mother presented the letter to my son. In his letter, addressed directly to Nicholas Pete, my grandfather shared information about his lineage, how extremely proud he is to have been able to meet and hold his great-grandson, and his specific hopes to see him graduate from college one day. Grandpa wrote about my strengths, and those of my mother, and how proud he was to be part of our lives. He wrote about his hopes for Nicholas as he grows and becomes a man and how he will one day take his place in this world and will do amazing things. True to Grandpa’s prediction of Nick’s responsible and respectful character, Nick, without reservation, silently and solemnly took in every word from Grandpa Paul. Needless to say, my heart was full and my eyes were more than misty as I witnessed this moment.

You see, in my eyes as a child, and then into adulthood, my grandfather was larger than life; not only in his tall and somewhat massive stature, but in his presence and how he lived life. His nickname to those that knew him well was the “Grizz.” He identified me as his “Little Blond Girl”, a nickname that I proudly wore. We had this connection, he and I. When he spoke at my wedding, he revealed that it was my words, as a child that convinced him to quit smoking after many years: “Grandpa, I want you to see me graduate, to be at my wedding, and to know my babies. Smoking is bad for you and I want you to stop.” It was with his encouragement and support, and being welcomed to temporarily live with him and Grandma, that I was able to have attended and graduated from college for nursing. He taught me to be brave, to work harder than those around me, to display integrity, and to always lead by example.

Grandpa Paul, Valedictorian of his class and the only son in his farm family, denied himself a full-ride scholarship for college to stay on the farm during the war. My grandfather was a husband, father to six, farmer, lumber yard manager, pilot, gardener, caregiver to his parents, avid reader, and also a very prolific and poignant writer. As a child, and as his houseguest during my college years, I can recall watching and hearing him plug away at a typewriter (never a computer) with his eye glasses on the tip of his nose and cup of coffee close by. Grandpa wrote personal and professional letters, letters to the editor, and a newsletter column that he called “The Old Filosopher” that served also as his personal journal. He was known for his ability to formulate and pen speeches that were informative and motivating. He often could be found speaking in front of large and small groups; a duty that he seriously enjoyed as the mayor of Clarks Grove, MN, the Minnesota State Elks President, and the unquestionable family spokesman. No matter the number of people in front of him, I, with others, learned to listen to the power of his messages.

While searching for advice from my grandfather, and, as I was trying to figure out my life’s plan as a young adult, I recall him telling me “Look, the best advice I can give you is this kiddo… when you are needing to make a very important decision in life and are questioning your path, go to the cemetery. Go there and look around you, it is there that you can truly see the opportunity that you have in front of you, seize that opportunity.” It was here that he admitted that he wished he would have said, “I loved you” more often.

Nick was too young to remember meeting Grandpa Paul. He has seen photos and heard stories. On his college graduation day, Nick personally experienced the power of Grandpa’s legacy, his wisdom, and the power of his words.

Grandpa closed his letter to Nicholas Pete with:

“I couldn’t be prouder that “Petey Johnson” will carry on and make his community proud of him in the future years- I just know it will happen and always know that no matter what, you will always carry your great grandfather’s love with you!”

Signed,

Your Great Grandfather Paul E. Hanson (The Grizz)

Through his own words that surfaced at a pivotal point in Nick’s life, my Grandpa Paul was able to share his deep love of family and offer words of advice directly to my son, his great-grandson, through this letter. Since receiving the letter, we have shared this writing with family members and friends as a priceless gift to all that knew my grandfather and for those that may have wished they had. There are healing words contained in his writing, words of hope, and words of optimism, of a strong work ethic, and sharing of family traits and experiences. But most of all, words of pure love from a grandfather to his great- grandson. What better legacy can there be? Words are healing and stories are best told by those that have the wisdom and experience to draw from.

Signed,

Grandpa’s Little Blond Girl

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The Risk is Worth the Reward

Written by Sarah Brown, BS, RN, LNHA
Executive Director, Empira

Have you ever wondered why some conversations are harder than others? Like when people get nervous for a marriage proposal…even when they know the person is going to say yes. Or, on the other hand, people get nervous to break up with someone. These conversations are difficult because they are important to us and we think:

  • What will the other person think or say?
  • What if they get emotional?
  • What if I offend them?
  • What if I get emotional?
  • What if they think less of me?
  • What if I get don’t get the answer I hoped for?

The similarity in these scenarios is vulnerability and uncertainty. Our brain is wired to protect us from these feelings so we might start to rehearse over and over in our head or we might talk to a trusted and close confidant to gain the courage for the conversation. If we are unable to face the vulnerability and uncertainty, we might decide to skip the conversation all together or put it off for another day…

The longer we hold back these important conversations with our loved ones we miss opportunities for connection. We also carry the weight of things unsaid. Overtime it can cost us our peace and if we wait too long, we regret never having the conversation. However, when we do find the courage to speak up the risk is often worth the reward.

Brené Brown, a research professor at the University of Houston, found that “staying vulnerable is a risk we have to take if we want to experience connection.” Even though conversations may be difficult if we avoid them, we avoid connection. Connection is required for relationships and relationships are among the most important things in life. It is probably no surprise research overwhelming demonstrates relationships have a positive impact on the aging experience. In fact, relationships have been found to be one of the strongest determinants of health and wellness for older adults.

As an aging service professional, I have seen how facing late life can be a very vulnerable time for older adults and their loved ones. I have seen how avoidance of vulnerable conversations has led to disconnection, damaged relationships, stress, depression, anxiety, shame, regret, difficult deaths, and tarnished memories of lives well lived. I have also seen how courage to have vulnerable conversations can strengthen and enrich relationships. I have seen it heal broken relationships. I have seen it unleash an urgency for meaningful and purposeful living. I have seen how it has provided a sense of hope, peace, and acceptance.

I believe we can transform the aging experience by increasing the resources and opportunities to drive meaningful connection throughout the lifespan, all the way to end. In order to do this, we need to challenge the status quo that avoids vulnerable conversations about inevitable aging and mortality, perhaps it is where we might find our deepest connections and wisdom about what really matters.

Empira is currently working to increase opportunities for connection through vulnerable late life conversations in a grant project titled ResoLute. ResoLute proactively provides a sacred space, time, and guided resources for conversations and reflections to confront and talk about vulnerable topics related to aging and inevitable mortality such as health condition, life story, purpose, relationships, spirituality, end of life wishes, and legacy. We have titled these conversations the Work of Aging. It is called work for a reason; getting older is difficult and it takes courage to work through these conversations.

One way to help promote the courage needed to have Work of Aging conversations is to normalize them. As the older adults in your life start to bring up these kinds of topics, give them space and even encourage them to keep talking.

If you are interested in having Work of Aging conversations but still not sure how to bring up the questions check out our Connection and Reflection journal.

Check out the Empira Connection Journal and Reflection Journal

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What can a pineapple upside down cake teach us about grief?

Written by Kelly Klund, LPN
Resource Nurse, Empira

I am blessed with a loving, big, fun, boisterous family. The kind of family that is too loud, uses colorful language, picks on each other mercilessly and ends every visit and phone call with the word LOVE.  We shortened the more common phrase I love you. Why use three words when one will do?  My Uncle Harry started that.

Harry is responsible for a lot of things in our family like our love of agate hunting and the outrageous card games we play every holiday.  He is our patriarch (even though we have never used that word). When we are having a get together the first thing anyone asks is “What time is Harry coming?”

I grew up without a father. Harry is not just my uncle but also my father figure, friend and feels like a brother to me. He has been my go-to for all things male and he even walked me down the aisle at my wedding.

One of his favorite foods is pineapple upside down cake and I make it for him any time he asks. I don’t know if he loves it as much as I think he does, but he lets me believe that my pineapple upside down cake is the best thing ever made. Pineapple-post.png

Oh, and another thing about Harry…he is dying. Not dying in the way we are all dying, he is actively dying.  He is at the end of a courageous battle with liver cancer.  He asked that we all gather together today, to have one final time together as a family. Knowing what the answer would be, I asked him if there was anything special he wanted me to bring. We made eye contact, his voice was weak and he said, “Pineapple upside down cake”. Through tears that I was trying my hardest not to let him see, I nodded yes.

According to Christopher Hall, grief can be defined as the response to the loss in all of its totality – including its physical, emotional, cognitive, behavioral and spiritual manifestations – and as a natural and normal reaction to loss.   Loss and grief are fundamental to human life.

Historically, we have understood grief as progressive and predictable.  A widely recognized example of this model is the work done by Kübler-Ross in her text “On death and dying” which provides the framework for five stages of grief:   (1) shock /denial; (2) anger, resentment /guilt; (3) bargaining; (4) depression; and (5) acceptance.  This model suggested that inability to move through any of these stages would result in a variety of complications.

“Beyond Kübler-Ross: recent developments in our understanding of grief and bereavement” shifts away from the idea that successful grieving requires ‘letting go’, and instead moves us towards a recognition of the potentially healthy role of maintaining continued bonds with those who have passed away.

It is said that grief is the price we pay for love.  If that is true, I will happily “pay my bill”  every time I make  a Pineapple upside down cake and remember the gifts of my Uncle Harry’s infectious laugh, his generous spirit and the lessons he selflessly taught our family.

As you think about a loved one who is no longer living, instead of letting go, is there a way that you can express your grief by maintaining a bond?

—————————————————————————————————————————–

Hall C (2014) Bereavement theory: recent developments in our understanding of grief and bereavement

DOI: 10.1080/02682621.2014.902610

Beyond Kübler-Ross: recent developments in our understanding of grief and bereavement. InPsych 33(6), https://www.psychology.org.au/publications/inpsych/2011/december/hall/

Kübler-Ross, 1969

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Top Ten Sleep Disturbances – #10 Food

Written by Heather Johnson, RN
Resource Nurse, Empira

FOOD for Thought: the impact of diet on sleep.

Young man is sitting in bed and eating chicken

What we eat and drink can have a huge impact on more than just our waistlines. In fact, certain foods and drinks can help promote wakefulness during the day or encourage sleep at night. What might first come to mind is caffeine consumption and the benefits of drinking caffeinated beverages earlier in the day. For those who enjoy coffee, starting the day with a regular cup of coffee and switching to decaf late afternoon till bed time is a great beginning! However, we are talking about more than just that “cup of Jo.”
Foods that help promote wakefulness (Wake foods):

  • Caffeinated foods and drinks: Coffee, teas, and chocolate
  • Protein rich foods: Meats, fish, cheese, yogurt
  • Foods that are higher in sodium: Sausage, bacon
  • Vitamin C rich foods: Oranges, strawberries, kiwis, cantaloupe
  • Sugary foods; earlier in the day is better than later in the day

Foods that help promote sleep (Sleep foods):

  • Whole grain foods: Popcorn, oatmeal, whole-grain crackers with a nut butter (Complex Carbohydrates)
  • Nuts: a great source of heat healthy fats. Almonds and walnuts (both contain melatonin)
  • Lean proteins: Lean meats and cheese (specifically cottage cheese)
  • Eggs: Great source of tryptophan
  • Sleepy time teas: Chamomile and ginger containing teas
  • Warm milk: Due to the tryptophan and melatonin it can improve sleep and there is a psychological link (comfort) often associated from childhood
  • Fruits: tart cherry juice and whole tart cherries, bananas, pineapple, grapes, and dried fruit all contain melatonin

In the United States, we often start our day with diets rich in simple carbohydrates and eat most of our protein later in the day. This is completely opposite of what we should be doing to help support our internal clocks. Start your day with protein-rich and foods, those rich in Vitamin-C, and any caffeinated foods. Reserve the carbs, those serotonin and tryptophan rich foods, for later in the day and evening. Per that National Sleep Foundation, an ideal bed time snack is foods that contain carbohydrates and a protein (2018). When eating carbohydrates, our brain produces serotonin; a chemical that will cause our bodies to calm and promote a pleasant mood. In turn, this allows for tryptophan to be more readily available to brain. Tryptophan in the brain then causes grogginess. Think now of how tempting a nap sounds following that Thanksgiving dinner!
What we eat, and when we eat it, is important. How much we eat in one sitting is as important. Another reason you may feel so tired after that tasty holiday meal, is the over-consumption of foods. The body now has to reroute more of its blood supply to the digestive system to help move the food through the system, making less blood and nutrients available to brain. To prevent this brain-drain, eat smaller portions of food more frequently throughout the day, still targeting the evening hours for those sleep-promoting foods.

Sleep and wakefulness are affected by diet.

You are not only what you eat, but when you eat, and how much you eat.

That is FOOD for Thought.

Resources:
Evidence-Based Design Meets Evidence-Based Medicine: The sound sleep study. The Center for Health Design Research Coalition. Harvard Medical School, 2010. Retrieved from: https://www.healthdesign.org/sites/default/files/Validating%%20Acustic%20Guidelines%20for%20HC%20Facilities_Sound%20Sleep%20Study.pdf
National Sleep Foundation: What is sleep hygiene? Retrieved from: https https://sleepfoundation.org on Feb. 15, 2019.

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Top Ten Sleep Disturbances – #9 Activity/Inactivity

Written by Heather Johnson, RN
Resource Nurse, Empira

How Does Activity Affect Sleep?

Regular physical activityHave you made the connection yet between how improving your exercise and physical movement during the day can positively, and significantly, improve your ability to sleep well at night? Some may think that is a no-brainer connection, however, it is worth exploring how that connection works.

  • Being more physically active, requires energy. Expending energy helps a person feel more tired and ready to fall asleep at the end of their day. In fact, our bodies produce a hormone called Adenosine, and this hormone acts as a neurotransmitter as it continues to build up during the day when a body is more and more physically active. Ultimately, it is the buildup of this hormone that will “drive” our bodies to sleep at night.
  • Physical activity during waking day time hours increases our time spent in the deep sleep phase at night. This deep stage is where the majority of our physical healing takes place and where our immunity is built and restored.
  • Regular physical activity and exercise can also help in our body’s ability to reduce stress levels. Stress is often a common cause of sleep issues when it comes to falling asleep, resulting in restlessness and bouts of wakefulness during the night.

The National Sleep Foundation offers that as little as 10 minutes of aerobic exercise, such as walking or riding a cycling, can dramatically improve your sleep quality, especially when it is done on a routine basis. Research indicates and supports that early morning and afternoon exercise helps to reset the sleep wake cycle by raising body temperature slightly and then allowing it to drop later in the day. Exercise promotes increased sleep efficiency and duration regardless of the mode and intensity of the activity, especially in the middle-aged and elderly adults and those suffering from disease.

What can we do?

  • Determine what activities and physical movement are of interest to you or your loved one. If you are a person who enjoys walking, by all means, walk and when possible do this outside and expose yourself to the outdoors and sunlight. Do what you enjoy!
  • Create opportunities for purposeful movement throughout the day. Even 5-minute increments of exercise, scattered throughout the day, are beneficial.
  • Incorporate movement with something fun! Example: Playing your favorite music while you fold laundry, wash dished, or clean.
  • Create a routine to ensure that activity and movement happens.
    Find a Buddy or two to move with you.
  • Know your physical limitations and the limitations of your loved one. Find opportunities and be creative.

Not only does physical movement and exercise have a positive impact on our sleep, physical movement promotes a sense of well-being, self-worth, improves mood, reduces the risk of several diseases, promotes stronger bone and muscle health, lowers the risk of falls, and provides an opportunity to socialize.
Regular physical activity and exercise can help you to fall asleep faster, get better sleep, deepen your sleep, and improve your over-all sense of well-being! It’s a good thing.

References:

Dolezol, B.A., Neufeld, E.V., Cooper, C.B. Interrelationship between sleep and exercise: a systematic review. (2017). Adv Prev Med. 2017; 1364387. doi: 10.1155/2017/1364387.
Mayo Clinic: Exercise: 7 benefits of regular exercise. (2018). Retrieved on Feb. 17, 2018 from: https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/exercise/art-20048389

National Sleep Foundation: The Science of Sleep & Your Lifestyle: How exercise impacts sleep quality. (2018). Retrieved on Feb 17, 2018 from: https://www.sleepfoundation.org/articles/how-exercise-impacts-sleepquality

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Top Ten Sleep Disturbances – #8 Positioning

Written by Heather Johnson, RN
Resource Nurse, Empira

Sleep like a baby

Most of us have a favorite sleeping position, and this typically the first position that we lay in when we first go to bed for the night. This is the same position that you have probably enjoyed for a number of years. Now, imagine not sleeping in your regular bed and being unable to physically assist yourself into that favorite position? Imagine not being able to articulate to someone how they can assist you into that comfortable position? How well would you sleep? Or, better yet, would you be able to sleep?
According to Rachel Salas, M.D. and Associate Professor of Neurology at Johns Hopkins Medicine, sleep position is less important for a young and healthy person. But, as we age, the older we become, and with the addition of medical issues, sleeping positions can have positive or negative effects on our sleep and on our health.
Positioning suggestions from Sleep.org:

  • If you have back or neck pain, sleeping on you back may not be the answer. If you have soreness in your back and neck, consider experimenting with different sleep positions and pillows to find what works best for you. Some people find sleeping on their back with a pillow supporting their legs helps to ease low back pain. Sleeping on your back makes it easy for your spine, neck, and head to maintain a neutral position, as there is no extra pressure on these areas.
  • If you suffer from snoring or sleep apnea, position yourself on your side (side-lying) or sleeping on your stomach to help your airway to stay open which may reduce snoring and mild apnea.
  • If you experience reflux and heartburn, sleeping on your right side can, in fact, make your symptoms worse. Try sleeping on your left side to prevent symptoms.
  • Consult your medical provider for suggestions.

Bed Of Nails Isolated

Additionally, if your loved one is unable to communicate their desired sleep position, take note as to what their most comfortable sleep position is or had been. And, assist in communicating this to their care team in helping your loved one receive restorative and comfortable sleep.
When it comes to your bed and bed placement and environment:

  • Replace old mattresses and pillows; check on the manufacturer’s recommendations for longevity. The firmness for both pillows and mattresses is a matter of preference, but do find those that are supportive, minimize pressure on prominent body parts, and that provide the means to keep your spine and neck in alignment.
  • Extra pillows, properly placed for body support, can be helpful.
  • Clean and comfortable sheets matter. Washing sheets and vacuuming the dander and dust from a mattress can help impede allergic reactions that often contribute to impaired sleep.
  • Close your blinds or drapes to prevent street lights or moonlight from disrupting your sleep.
  • Position your bed so that you are not facing distractions (blinking lights from a computer or alarm clock, a desk that is piled high with task that need to be completed, or light shining under your bedroom door) that may prevent you from falling asleep.

While habits can be difficult to change, if one chooses to alter their routine sleeping position. The National Sleep Foundation suggests to break this habit; one can try to sleep on the opposite side of the bed (2017).
The choice you make on your sleep position and posture can have a potential impact on your back and neck, fatigue, sleep apnea, muscle cramping, impaired circulation, headaches, heartburn, stomach problems, and even premature wrinkles. Choose your position wisely, and, when caring for others, make their choice for sleep position a priority.

Resources:
National Sleep Foundation: What is sleep hygiene? Retrieved from: https https://sleepfoundation.org on January 2 , 2019.
Sleep.org. : Which sleep position is best? Retrieved from http://www.Sleep.org/articles/best-sleep-postion on January 2, 2019.

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Top Ten Sleep Disturbances – #7 Pain

Written by Heather Johnson, RN
Resource Nurse, Empira

A Serious Intruder on Restorative Sleep

Donna distesa a letto con dolore alla schiena

A recent poll of the American public, found that 21% of Americans experience chronic pain and 36% had had acute pain in the past week. Combine those totals, and it equates to 57%, leaving only 43% of Americans who report being pain free. Pain ranks as number seven in the Top Ten Sleep Disturbances.

People with pain often report feeling less control over their sleep. They report being worried about lack of sleep and its effects on their health. Worry leads to stress. Stress and poor health, often go hand-in-hand and can often be linked to fragmented sleep. Fragmented sleep translates to interrupted sleep which prevents a person from receiving 7-9 hours. Seven to nine hours of uninterrupted sleep is necessary for restorative sleep. Restorative sleep is needed for physical and emotional healing. Sleep loss is known to contribute to feelings of depression and fatigue, which in turn can increase a person’s pain perception. Research indicates that if a person experiences poor sleep due to pain one night, they are more likely to experience pain the next night, and the next night, and so on. We know that pain can be a serious intruder on restorative sleep.

Pain, depression, and fatigue are interrelated. Further, pain often is linked to insomnia, and, when both of these problems coexist, the perfect recipe for additional problems has been created. Additionally, evidence suggests that sleep loss increases reports of pain, when you don’t sleep well you have a heightened sensitivity to pain. This vicious cycle of poor sleep due to pain affects multiple areas of a person’s day to day life.

What can a person do?

  • Determine the source of the pain. Is it physical pain? Is it emotional pain? Get to the root of the problem, identify the root cause. Once you’ve identified the source, address the source with the right solution or intervention.
  • Seek direction from your medical provider.
  • Exercising or stretching of sore muscles by stimulating blood flow and easing pain
  • Evaluate your positioning in bed; your pillow, mattress, and environment.
  • Retrain you brain to think of something positive as you head to bed for the night.
  • Research non-pharmacological interventions such as, relaxation techniques (focus on your breathing), guided imagery, aroma therapy, heat/cold, and massage.
    If it’s physical pain, consider a longer acting pain reliever, one that will last throughout the night.

Don’t let pain rob you from a good night of sleep!

References:
Cosio, D., Lin, E; PPM: Practical Pain Management. Disturbed Sleep: Causes and Treatments. 2018. https://www.google.com/amp/s. Accessed November 20, 2018.
National Sleep Foundation. Recommended Sleep. 2015. https://sleepfoundation.org/how-sleep-works/how-much-sleep-dowe-really-need. Accessed November 20, 2018.
Onen, SH., Alloui, A., Gross, A., Eschallier, A., Dubray, C. 2001. The effects of total sleep deprivation, selective sleep interruption and sleep recovery on pain tolerance thresholds in healthy subjects. J Sleep Res. 10, 35-42. doi:10.1046/j.1365-2869.2001.00240.x