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, board room, and beautiful grounds for walking at lunch time 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 are 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

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 stimulates 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.

Eating healthy foods like blueberries is good for your brain.

 

Solving puzzles stimulates brain function.

 

Traveling and using other languages is great brain stimulation!

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 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.

It was sad to see my brilliant Dad slowly decline from dementia. He had 19 patents in paper products at the conclusion of his career.

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 good-bye.” 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

 

Advertisements

Geriatric Nurse Practitioner

April 25, 2005

I thank God for carrying me through the first three weeks of working as a geriatric Nurse Practitioner at the 500 bed nursing home. The insurance company assigned me to provide medical care for 32 residents who have enrolled in their program as an alternative to Medicare. Judy has worked for the company for awhile and is my excellent preceptor. After she orients me, they will move her to another facility in the state. I need to do an complete physical examination on each of my patients, type it into the insurance computer in their format, and then call the family member to introduce myself. I only have nine more physicals to finish by the end of the month. In May, I will do a shorter assessment on each patient and call the family with a quick update. If the patient has a new problem, the nursing staff calls me to assess the resident that day and treat the problem as quickly as possible.

So far, the only downside is that there is no air conditioning because the home was built in 1935. I feel sorry for the patients in the heat, especially on the top floors which are the hottest. My office doesn’t have any windows or air conditioning, so the medical director said I could do my charting in the doctor’s night shift room which is empty during the day and has a window air conditioner. I have enjoyed working with Dr. R. who is a board certified geriatrician and likes to teach me about geriatrics. My biggest adjustment is assessing the patients with advanced dementia (memory loss) who are unable to communicate their needs. I have to depend on the nurse’s assessment and input from family in addition to my physical assessment. The staff is wonderful in giving the residents activities to stimulate their memory.

May 3, 2005

“I press on toward the goal for the prize of the upward call of God in Christ Jesus.” Philippians 3:14

I have a bad head cold after being at the nursing home for just one month and have already used up my sick time. We are not permitted to work with a respiratory infection because the elderly are susceptible to catch it resulting in serious complications. I’m just not sure I can work full-time anymore. God comforted me with I Peter 5:7, “Casting all your care upon Him, for He cares for you.”

Dear Lord, Thank You that this cold is a very little thing in light of eternity. Help me keep the big picture. If You want me to work today, put Your healing hand upon me. If not, I rest in You and trust in You. Thank You that You do all things well. Amen.

May 27, 2005

“For He shall deliver the needy when he cries; the poor also, and him that has no helper.” Psalm 72:12

God has so graciously been carrying me along at work and things are going more smoothly. I finished all 13 of the new patient’s physical examinations and 52 monthly visits plus all the sick visits for the month of May. I have now completed eight weeks of work at the nursing home.

My biggest concern right now is my vision which has become more blurry from all the long hours of charting on the computer. I saw an optometrist and she could not correct my left eye beyond 20/60 and said my left optic nerve doesn’t look right. I thank God that I don’t have a retinal detachment. My uncle went blind when he was about my age from retinal detachments.

June 1, 2005

After three hours of very uncomfortable eye tests with bright lights, the ophthalmologist said he couldn’t find any retinal or macular tears. He is referring me to a retinal specialist who can’t see me until August. Trudy, my dear friend who has battled glaucoma for many years, said that her eyes are in God’s hands. If she loses her sight, God will be her vision.

July 4, 2005

Two weeks ago a Nurse Practitioner (NP) at the insurance company resigned, so they assigned me to cover his patients in another nursing home as well as my own. So now I am responsible for 96 patients. When I interviewed for the position, they assured me that I would only have 70-80 patients. My new supervisor said this is their goal, but I’m the only one who is credentialed at the hospital which owns the second nursing home. I am so exhausted that I feel like I’m at the breaking point.

July 11, 2005

Mary, a NP at the main nursing home, told me there is a 32 hour position open that is not associated with the insurance company, and they want to recruit me for it! She also said the nursing home is losing money with the insurance company and will probably soon terminate their relationship. I like the administration at the nursing home, but have not had much support from the supervisors at the insurance company.

I interviewed with Dr R., and he offered me the position of 32 hours weekly with every Friday off, and full time benefits. He said they would bring me in at the top of the pay scale for Nurse Practitioners. This is such a gift from God!

Dear Lord, Thank You once again for Your wonderful deliverance and that You won’t test me above what I can bear.” Amen.

July 18, 2005

“Leaning on Jesus’ bosom.” John 13:23

God carried me through some grueling eye tests from the retinal specialist doctor. He strapped my head in a machine, put a magnifying glass straight on my eyeball, and then told me to look at a very bright light without moving. The tears were streaming down my face because it was so uncomfortable. Then I started silently thanking Jesus that He is the light of the world. I remembered the verse above and the wonderful hymn “Leaning on the Everlasting Arms”.

The doctor said part of my vitreous (like jelly in my eye) is covering the retina like wrinkled plastic wrap. There is nothing he can do about it, so we’ll just “watch it”. My new glasses arrived this week and I am seeing so much better. Thank You, dear Lord, for my vision today!

I told Bee, one of my coworkers, that I know the Lord Jesus Christ will be my eyes if I go blind. She came up to me a few days later and said, “I wish I had your faith. I feel so guilty about not teaching my adopted son anything about religion.” I shared with her the good news about Jesus Christ and how much He loved her that He died on the cross for all our sins and rose again. He wants her to receive Him as her personal Savior. I also gave her some literature and a children’s Bible study for her son.

August 10, 2005

I thank the Lord for a refreshing vacation with two ladies from church at beautiful Lake Tahoe in California. What stunning mountain scenery! We even caught some fish in the sparkling deep lake. The nursing home becomes my new employer tomorrow!

The Lord gave me a refreshing vacation at beautiful Lake Tahoe in California.

Reflection

I enjoyed my next five years of working in geriatrics at the nursing home. Every day was a new experience and challenge as I progressed in my knowledge of assessing and treating older adults. I also learned that I needed to communicate clearly with the family members since the resident often couldn’t remember the information I gave them. Even though I didn’t stay with the insurance company very long, God used that to get me in the door at the nursing home and guided me to a much more manageable job with less stress.