The Aging Brain

September 2005 – Geriatric Nurse Practitioner

I am enjoying my new job immensely working as a Geriatric Nurse Practitioner in a 500-bed nursing home providing primary care to 64 patients currently. It is like a breath of fresh air compared to working for the insurance company in the same facility. I am also feeling much better physically since I only work four days per week again and have every Friday off. I volunteered to work the late shift so my hours are 9:30 a.m. to 6 p.m. The rest of the providers leave between 4 and 5 p.m. so I cover the entire home for emergencies until the night shift doctor arrives at 6 p.m. I like these hours better because I don’t need to get up as early, avoid driving in rush hour, eat lunch and dinner in the cafeteria, and get out in time to attend evening activities at my church. The food in the cafeteria is healthy and inexpensive so it also cuts down on my grocery bills.

I cover one dementia unit, and two long-term care units that are not locked. I share an office with three other nurse practitioners which works well. It’s nice to be able to discuss our most difficult patients and get input from others with more experience. I also like the dictation which is much easier than typing into the insurance company laptop. They have live transcriptionists that type our notes and put them in the cue for us to proofread and correct any mistakes before it goes into the electronic record permanently. In general, the typists are very accurate. The nursing home is so large that it also has a small restaurant, gift shop, auditorium for programs, boardroom, and beautiful grounds for walking at lunchtime on good weather days. They have monthly continuing education for all the providers which is also helpful. I work with three different physicians and they all enjoy sharing their expertise with me.

Dr. R., the medical director, meets with each provider privately once a month to review our productivity goals and discuss any concerns we may have. He is the kindest and best boss I have ever had. This preventive type management style works so much better than the authoritarian critical style I have had for much of my career. So far, he said I’m doing a good job and meeting all my monthly goals. How I thank God for giving me this job and giving me this schedule.

“Giving thanks always for all things unto God and the Father in the name of our Lord Jesus Christ.” Ephesians 5:20 (KJV)

The Aging Brain

One of the benefits of this job is that they give me 4 days per year and $1200 annually to attend continuing education outside of the facility. I attended a seminar yesterday entitled “The Aging Brain” that was very interesting taught by a geriatrician. The research shows that people who keep their brains active, exercise, socialize, and eat a healthy diet helps prevent Alzheimer’s disease (memory loss). Since my grandmother died of Alzheimer’s, this is of particular interest to me. Daily, I sadly witness the decline of my patients with end-stage dementia.

Ways to keep one’s brain active is to travel because you are constantly problem solving and meeting new people. Learning a new language, playing a musical instrument, teaching, doing aerobic exercise, and working jigsaw or crossword puzzles stimulate the brain. If a person lives alone, it’s also important to participate in regular social activities so as not to isolate. Eating healthy foods like blueberries, salmon, sweet potatoes, and other colorful fruits and vegetables is important.

After hearing this seminar, I will definitely continue to travel, keep up with my painting, and try and play my violin more often. I’m glad I see my friends at church several times weekly. Since I live alone, guarding against isolation is my biggest challenge.

Reflection

I continued to work in geriatrics for the remainder of my career and witnessed the use of Aricept and Namenda, two medications which slow down the progression of dementia. When I was a home care Nurse Practitioner for the federal government, I took care of our veterans who had early dementia and were being managed by their family members at home. I had many conversations with the caregivers who were usually a spouse or adult child about keeping the veteran safe at home as long as possible while preventing caregiver burnout. I guided them in making the difficult decision of when to place the person on home hospice, when to hire help, or when it was best to transfer the patient to a nursing home for 24-hour care.

Frequently I took young physicians with me on my visits. One doctor from India told me that there is no Alzheimer’s disease in India and people live long lives. I asked her how that can be? She attributes it to the daily consumption of curry in their foods. The main spice in curry is turmeric. So I began taking a turmeric capsule daily and adding curry powder to my vegetable juice every morning.

When my dear Dad came to help me after I had surgery, I noticed that he was having trouble remembering things and driving me to appointments. I asked him if he was willing to go to the geriatric assessment center where I worked and have his memory checked? He willingly agreed since he recalled how his mother died of dementia, and he had to place her in a nursing home the last year of her life. Dr. R., my boss and the director of the geriatric assessment center, did a full 4-hour assessment with the team including a CT scan of my Dad’s brain. Since my dad was an inventor and probably at the genius level, Dr. R. said it was difficult to assess his memory because he was so good at covering up his memory deficits. Their conclusion was that Dad had Mild Cognitive Impairment (MCI) which means it could stay at that level or progress to dementia. Dr. R. did not recommend starting my Dad on Aricept or Namenda as they were not recommended to prevent dementia.

As the years progressed, my dad did progress to dementia, had to stop driving, and moved to a retirement center with his wife to be closer to my sister. As Nancy Reagan said about President Reagan after he was diagnosed with dementia, “It’s the long goodbye.” My stepmother became his caregiver. Sometimes he wandered around the large building or got lost walking to the dining room. He stopped reading and slept most of the day. He needed a home health aide to help him with his shower. After his wife broke her hip and had to go to rehab, Dad also had to be transferred to the nursing home. He began having trouble swallowing which is common with dementia patients, and food went into his lungs and caused pneumonia. He died quietly alone in the nursing home from pneumonia at the age of 89, nine years after he was diagnosed with Mild Cognitive Impairment. It was sad to see such a brilliant man slowly lose his mental capacities.

That is why it is so important, dear Reader, to receive the Lord Jesus Christ as your personal Savior now, while you still have your mental capacities. No one knows how many days he has left here on earth. The 29-year-old son of one of my doctors suddenly passed on last week. Thankfully, he had received Christ as his Savior and is now rejoicing in God’s presence.

For God so loved the world, that He gave His only begotten Son, that whoever believes in Him should not perish, but have everlasting life. For God sent not His Son into the world to condemn the world, but that the world through Him might be saved. John 3:16-17

For God has not given us the spirit of fear, but of power, and of love, and of a sound mind. 2 Timothy 1:7