Tag Archives: pneumonia

Why hydration is crucial, especially during the pandemic

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Glass of waterAdipsia is the fancy name for the loss of the sense of thirst. As we get older, our sense of thirst diminishes, just as our sense of smell and taste diminish. Chronic dehydration  is one of the most common problems among seniors and the elderly who reside in care facilities.

If you have a loved one at home with dementia or in a care facility it’s important that you learn the signs of dehydration (below) and offer water or another beverage to your patient every hour and throughout the day.

Many older adults often limit their fluid intake because they may be incontinent or fear accidents. Those who have limited mobility may try to avoid another trip to the toilet. Individuals who have aphasia (inability to speak due to dementia or brain damage from  stroke, etc.) may not be able to express their thirst.

Better monitoring of fluid intake is needed at care facilities

Studies have shown that nearly all nursing home residents suffer from inadequate hydration. Additionally, in one study, 25 out of 40 participants suffered from diseases that may have been caused or exacerbated by their being dehydrated.

If your loved one is in a care facility now—during the COVID-19 pandemic–it is more important than ever to try to encourage them to drink. Ask the staff to put signs up in their room as a reminder. It’s especially important if your loved one has dementia and forgets to drink or is not thirsty.

What happens when you are dehydrated?

Your blood begins to thicken, which interferes with normal blood flow and viscosity. This is one of the reasons why, especially during the  pandemic, it’s crucial to stay hydrated. There have been many reports of blood clots and other cardiovascular episodes in patients with COVID-19. The kidneys, liver, pancreas and other organs can be severely affected from dehydration, and severe dehydration can lead to acute pancreatitis in some individuals.

Dehydration can interfere with brain function

This is a good example of what happens when our brains are dehydrated. My mom wasn’t able to walk the last two years of her life, and was dependent upon two private caregivers. She also drank thickened water, which is a disgusting thickened pudding-like liquid that substitutes for water. The reason?  She aspirated water and food into her lungs, which caused her to cough. Sometimes, the result was pneumonia. She may have felt thirsty and not wanted to bother with the thickened water, or maybe she wasn’t thirsty. But she ended up being severely dehydrated on more than one occasion.

When Mom was admitted to the hospital for a UTI (urinary tract infection), she developed delirium. A psychiatrist called me to report that my mom was exhibiting full-blown dementia. I had just spoken to Mom a day before and she sounded fine. I refused the offer of an antipsychotic drug for her, knowing well the high risk of putting an older adult on those drugs. (see Why you should throw away that antipsychotic drug prescribed for your loved one). As it turned out, my mom was severely dehydrated. After a couple days on a hydrating intravenous solution she returned to her normal self.

It’s important to learn the signs of dehydration in everyone, but especially in seniors and young children. The physical symptoms are usually clear:

  • dry lips and sticky or dry mouth
  • no tears when crying
  • dry, papery skin that tents when it is pressed
  • decreased urine output
  • sunken eyes
  • headache
  • lethargy
  • dark urine
  • extreme thirst
  • unable to sweat
  • fast breath rate
  • low blood pressure
  • the mental symptoms are not as obvious, but can result in mental confusion, irritability, delirium
  • extreme cases of dehydration can lead to loss of consciousness, coma, kidney failure, and seizures.

Ways to stay hydrated

If you are a caregiver (and that includes caring for yourself!) here are some helpful guidelines:

The rule of thumb is to have 48 to 64 ounces of non-sweetened, non-artificially sweetened drinks. Hydration keeps the body in proper pH (how acidic or alkaline your body is) and protects it from getting dehydrated, which is a cause of inflammation and other kinds of imbalances. Dehydration can also contribute to urinary tract infections (UTIs).

  • Encourage and remind your care partner to drink.
  • Drinking healthy fluids is important as eating healthy foods. Water is the top choice, followed by herbal teas, milk, vegetable and fruit juices. Remember that juices contain a lot of sugar, both natural and added, so don’t overdo them. Soups are nourishing and hydrating but be aware of the sodium content. Avoid carbonated and caffeinated drinks which have a diuretic effect.
  • Serve liquids at a temperature that your care partner likes. Not everyone enjoys ice water.
  • Flavor water with lime or lemon.
  • Remind your care partner not to wait until s/he is thirsty. By then s/he is already dehydrated.
  • Serve juicy fruits such as watermelon, which contain lots of water.
  • Offer healthy popsicles as an addition to drinks and to those who refuse water.
  • Smoothies and shakes are nourishing and filling.

The next time your mind is muddled, drink a tall glass of water and notice the difference. Drink plenty of water, fresh juices, and herbal teas to stay hydrated, flush out toxins and enjoy mental clarity. It is especially important now as we head into summer and during the COVID-19 pandemic. But it’s just as important all year round.

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Support your lungs with deep breathing exercises

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Healthy Human Lungs 2d illustrationThe World Health Organization says about 80% of people with COVID-19 recover without needing any special treatment. But one person in six becomes seriously ill and develops difficulty breathing.

Professor John Wilson, president-elect of the Royal Australian College of Physicians and a respiratory physician says that people develop a fever and cough when the infection reaches the air passages that conduct air from the lungs to the outside. If it gets worse, the infection moves to the end of the air passages. In an article in “The Guardian,” Wilson explains “If they become infected they respond by pouring out inflammatory material into the air sacs that are at the bottom of our lungs.”

If the air sacs then become inflamed, the lungs fill up with fluid and inflammatory cells, which results in pneumonia. This condition severely impacts the body’s ability to take in oxygen and get rid of carbon dioxide. And coronavirus pneumonia affects all of the lungs, instead of just small parts.

I don’t know whether the condition of a relatively healthy person’s lungs is a factor in whether or not you would get pneumonia from the COVID-19 virus, but it certainly wouldn’t hurt to paying attention to how you breathe. It’s always a good idea, but it’s more important now than ever.

Breathing is something most of us take for granted.  In fact, the average person breathes 1,261,440,000 (one and a quarter billion) times in a lifetime without thinking about it.  Breathing is so vital to your overall health and well-being that Dr. Andrew Weil, best-selling author, educator and practicing M.D. says: “If I had to limit my advice on healthier living to just one tip, it would be simply to learn how to breathe correctly.”

“Slow, deep breathing is probably the single best anti-stress medicine we have, ” says James Gordon, a clinical professor of psychiatry at the Georgetown University School of Medicine and director of the Center for Mind-Body Medicine in Washington.”  When you bring air down into the lower portion of the lungs, where oxygen exchange is most efficient, everything changes.  Heart rate slows, blood pressure decreases, muscles relax, anxiety eases and the mind calms.  Breathing this way also gives people a sense of control over their body and their emotions that is extremely therapeutic,” says Gordon.1

Most of us do not breathe correctly.  Typically our “normal” breathing is shallow. “The result is a vicious cycle, where stress prompts shallow breathing, which in turn creates more stress,” says Gordon.2

Abdominal breathing and pranyama (yoga breathing exercises) are natural, easy ways to increase your energy and feel more relaxed because they accelerate the intake of oxygen.

Here are some breathing exercises that might just help strengthen your lungs and help you to relax during this stressful time.

Abdominal Breathing

Abdominal breathing is done from the depths of the belly, rather than breathing from your chest and nose.  It is a simple method of relaxation that can be done anywhere, at any time.

  1. Sit or lie down with your hands on your stomach.
  2. Inhale slowly through your nose, filling your stomach and then your chest.  Your abdomen should rise as if you’re inflating a balloon.  Allow it to swell and return to normal.  Your chest should move only slightly.
  3. Try to get a rhythm going, counting to 4 on the in-breath and to 8 on the out-breath.
  4. Exhale as slowly as possible through slightly parted lips.
  5. Practice this for about 10 minutes.

Alternate nostril breathing (pranyama)

You’ll notice that one of the nostrils is more open than the other.  Don’t mind this, it’s normal.

  1. Close the right nostril with your thumb.
  2. Breathe in through your left nostril.
  3. Close the left nostril with your third and fourth fingers.
  4. Breathe out through your right nostril.
  5. Close the right nostril with your thumb.
  6. Breathe in through your left nostril.
  7. Repeat the entire sequence and continue for 3-5 minutes.

The effects from these breathing exercises are cumulative, so try to practice them a few minutes each day.  You’ll experience a more settled feeling immediately, and after a week or two you may realize that the mind chatter has quieted down, and that physical tension has diminished too.

Reverend Sharon Shanthi Behl wrote a chapter called “Breath Work” for my book Calmer Waters: The Caregiver’s Journey Through Alzheimer’s and Dementia. This excerpt includes a breathing exercise you can do with a care partner who gets agitated, as well as for yourself.

“When we say we are tired and have no energy, what we are really saying is that our energy is blocked. We need to breathe to live, and how we breathe can profoundly affect our degree of physical well-being; it can regulate our emotions, and it can deplete, sustain, or increase our experience of aliveness.

“Prana is constantly fluctuating and moving throughout the universe. According to yoga philosophy, it flows throughout the living body in exquisitely determined whirlpools and currents. The wonderment of the yogic system is asana and pranayama practice allows our innate energy currents to flow as nature intended.

Here is a lovely pranayama practice to use with an agitated individual who is “sundowning.” You may be familiar with this phenomenon. Mayo Clinic clinical neuropsychologist, Glenn Smith, Ph.D., describes sundowning as a state of confusion at the end of the day and into the night. Sundowning isn’t a disease, but a symptom that often occurs in people with dementia, such as Alzheimer’s disease. Smith lists several factors that may aggravate late-day confusion including fatigue, low lighting, increased shadows, and the disease’s disruption of the body’s internal clock. You might find that focusing your loved one’s attention on this practice calms them, and you. ”

Read these instructions slowly out loud as you demonstrate the movement.

  1. Let us do the Butterfly Breath together.  
  2. Face palms toward the heart center at center of the chest.  Interlace the fingers with thumb pointing up to the ceiling.  Place hands on the chest and keep your awareness at this heart center as you breathe deeply and slowly in and out the nose.
  3. Can you feel your heart beating? Can you feel how much you are loved?
  4. Notice the rise and fall of your breath. Feel the warmth of your hands on your chest.  

Add this option for yourself:

  1. Notice any feelings or thoughts as you breathe naturally.
  2. As you breathe in, see your feelings and thoughts like bubbles of air rising from the bottom of a lake.
  3. Breathe out and imagine the bubbles silently bursting as they reach the water’s surface.

If you are a caregiver, please remember to take care of yourself so you can take care of your loved one(s).

References

  1. Krucoff, Carol. “Doctors Empowering Patients by Promoting Belly Breathing,” Washington Post, June 2000.
  2. Ibid

Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”—Winner of the 2018 Book Excellence Award in Self-Help—in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at Amazon, Barnes & Noble, Boulder Book Store, Tattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.

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12 ways to ensure end of life peace for our loved ones and ourselves

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White Bird in Clouds

A couple of years ago, Mom and I talked about facing the end of her life. I asked her if she had a good life and she said, “yes.” I asked her if she had regrets and she said, “yes.” But she didn’t want to talk about that. I told her I would do my best to be with her at the time of her passing. I was, and I am thankful that I fulfilled my mother’s wish and my promise to her.

Just two weeks ago my beloved mother passed away from pneumonia. Pneumonia has traditionally been called “the old man’s friend” because a frail elderly person typically loses consciousness and passes fairly easily in sleep. Although it was not easy watching my mother drown in her own fluid, she appeared to not be in pain. Her breathing was labored for hours, and then she sank into a state of peaceful acceptance as her last breaths came in whispers until the last tiniest breath sealed the finality of her life. 

I’m relieved that I had made the funeral arrangements with my brother a year ago. At least I didn’t have to deal with that on the day that the earth stopped spinning and I forgot to drink water as I faced a new reality of living in a world without a mother. I am also relieved that I made arrangements with Chevre Kadisha, the Jewish Sacred Burial Society. Many religions have complex codes of conduct for survivors and very specific rituals and customs that have been carried out for centuries. Harvey Lutske writes in The Book of Jewish Customs that the practices and customs rabbis established for survivors to observe following the death of a loved one help the survivors “cope with their loss, continue with their lives, recover emotionally, pay respect to the dead, and perpetuate the memories of those who have gone before us.”

Final gift of love

My mother’s body was lovingly washed by a group of women in a ritual called Taharah. This cleansing requires several people because the entire body must be washed and moved from side to side in a specific way according to Jewish law. Afterwards, a huge amount of water is poured over the body and passages are read from the Song of Songs. The people performing the Taharah ask for forgiveness in case they performed some indignity. The body is then dressed in a cotton or linen shroud and put into an unadorned, pine coffin. Typically, someone sits with the body or “met” until internment. This is called sitting Shimira, and it is often done in two-hour shifts around the clock. The person reads psalms or prayers silently or out loud, or meditates while a candle burns continuously at the head of the coffin.

Buddhists also incorporate a cleansing of the body and a vigil into their mourning ritual. Families are often invited to wash the body of their deceased loved one. Washing a corpse enables you to become intimate with death in a way no other thing does. It’s hard work, but it’s an important way to honor the dead, said one Buddhist minister.

Death is the great equalizer

To the question, “What is the value of death?” the Jewish rabbis answered, “If nothing ever died, we, the human race, would not learn how to value time. Life’s finiteness is earmarked, and ended, by death. And learning to face death may be life’s greatest challenge.”

As hard as it is, we can take control and manage the death and dying of our loved ones. We can do things that make sense to us and provide us with comfort. Kim Mooney, the Board President of Conversations on Death, and Director of Community Education for Tru Community Care, Colorado’s first hospice, says, “The more you’re involved in the death and grieving process, the more we’re able to be in touch with that innate place in ourselves that tells us how to live. It’s the fear of death that makes us live. And it’s the terror of death that makes us run from the experiences that will teach us.”

As painful as it is,’ says Mooney, grief work and dealing with the death of a loved one guides how you’re going to live your own life. “We’ve skewed our relationship to death in this society,” she says, “but we can’t walk away from it. If you don’t do the work around it, you will somehow diminish the quality of your life. Grieving is a life-long process. Our lives are a series of gains and losses. Learning how to grieve, and incorporating a loss and moving on is critical to being able to become a mature, spiritual person because it implies an acceptance of what life is.”

I am an expert at grieving because of my significant losses. But this time will be different because I lost my mother, my primary connection to the world. This time is especially profound because no one can replace a mother. It will take time before I don’t have the thought to call her, to check in with her, to make sure she is okay. And even though I have children and grandchildren, I will always ponder the profoundly unique love that binds a mother and child in remembering my own sacred relationship with my mother.

In listening to the sweet words and stories that so many people told me after learning of my mother’s passing, I am reminded that it is how we make people feel—not what we accomplished—that is what we remember about a person. Death once again serves as a teacher to remind me that we are here temporarily, and that as my teacher loved to say, “Do not trust the time. Life is short, make it sweet.”

These personalized rituals can provide comfort and ease the intense pain that accompanies death, dying and grieving:

  1. Have a heart-to-heart talk with your loved ones before they get too ill. The Five Wishes is an easy-to-read end-of-life document that helps makes the difficult discussion about what you would like your end of life to look like.
  2. Hospice is a free palliative service offered by Medicare/Medicaid that supports the dying patient as well as the family
  3. Play music that the dying person loves, sing hymns, chant, etc.
  4. Dress and wash the deceased and dress the body in a white linen shroud
  5. Muslims typically share their prayers with the person who is dying before encouraging the dying person, if possible, to say or listen to the words, “I bear witness that (there is) no god except Allah; One is He, no partner hath He, and I bear witness that Muhammad is His Servant and Messenger. Once the person has passed away, the next step is to perform the ghusl, (similar to the Jewish taharah) or the washing of the deceased’s person body. The ghusl can can be done by most adult family members of the same sex as the deceased. After the body is washed, it is then enshrouded, typically in plain, white cloth.
  6. Have a meaningful farewell service
  7. Honor the loved one at different times during the year
  8. Build memory books
  9. Finish what the deceased person didn’t
  10. Write letters to the deceased and writing them back to yourself
  11. Donate a toy for the age of a baby or child who died to “Toys for Tots
  12. Write a life story