WANTED:

Outlaws~~~~~~~~~~~



We're going to make a complete blog of our trip... see you there!!

Visit our vacation pics at:

www.brijoy2006.blogstream.com or click the " Our Vacation 2006" under the blogs I like.

Remember this classic goodbye on M*A*S*H...

Today is the day. Hard to believe that 30 days has went by so fast. We have a huge day planned. Sadly, I found out about my "surprise" going away party at 2. The administrator kindly let it slip in casual conversation yesterday. I will not let on that I know, the staff would be hurt, hopefully she has managed to keep her mouth shut for 24 hours.

The local media will be there about 3. Brian's story of his "Where in the World is Brian?" activity was leaked to the press. Brian has been calling in to the people at the facility and they've been tracking him for several months all over the states as he worked. The residents have really enjoyed this. He will be bringing the Big Rig to show all the residents and families. Around 4 I will hop into the semi and ride into the sunset.

Tomorrow we will be heading for South Dakota for a grand adventure. See the sights, relax, spend some quality time together.

I hope I will have time to add the photos of today before we leave.

Wish me luck....it's gonna be a rough day

I have not shared this with many people, not even the people I work with daily. I was chosen, about 6 months ago to be involved in the first stages of a research project having to do with development of a new screening tool to assess adverse effects of atypical antipsychotic medications (AAPM) in elderly nursing home patients. I am very excited to be involved with this project as the tool may be used in every long term care facility in the nation to assess all nursing home residents using these medications and the side effects they may be exhibiting.

A little background, I hope it doesn't bore you to tears.

The current tool used is called the AIMS (Abnormal Involuntary Movement Scale.) This scale was developed when traditional antipsychotic medications like haloperidol (Haldol), fluphenazine, and thioridiazine were the primary medications of choice. These older medications can cause many long term side effects.

The older antipsychotic medications were not very forgiving. They cause tardive dyskinesia a long term side effect which includes rhythmic involuntary movement of the tongue, lips, or jaw, protrusion of the tongue, puckering of the mouth, flailing movements or involuntary movements of the extremities. There are more severe side effects such as acute spasm of muscle groups, fixed upper gaze, pseudo parkinsonism (ridged, slow movement, tremor, and pill-rolling) and akathisia a form of agitation manifested by the inability to sit still, pacing, or tapping feet. All these things were caused by the older antipsychotic medications. In a nut shell the people put on the medications in the 50's and 60's are in the nursing home system now. They display these side effects, some more blaring than others...my observation, it's like they have a form of cerebral palsy and antsy pants all rolled into one. They use several calories just sitting because they are always in motion. Once they have these side effects they can not be reversed.



The newer antipsychotic drugs such as clozopine, Zyprexa, risperidone, aripiprazole, and ziprasidone are called atypical antipsychotic medications (AAPM)are defined as being less likely to produce these long term side effects. The incidents of tardive dyskinesia appears to be 1/5 with these second-generation antipsychotics. But with these drugs, may come metabolic side affects like diabetes II, abnormal lipid profiles, and hyperprolactinemia. There is also speculation they may cause orthostatic hypotension.

The AIMS test which is currently used is a 24 step test, 12 observation steps then answer 12 questions on the bottom from 0-4, none (0) to severe (4) side effects noted.

The new test, which is in the works, will be a 10 step examination, including orthostatic blood pressure (laying, then sitting, then standing). We will also be gathering baseline blood sugars on all participants. I will be gathering data in my role in the research. I'm so excited to be a part of it, as I hope before I retire I will be using this very tool to assess my residents. That would be so cool!!



Just under 2 million Americans live in nursing homes; the lifetime risk of spending at least some time in a nursing facility is 43%. At least 50% of all nursing home residents have cognitive impairment, and mental disorders are estimated to affect 75 to 90% of the nursing home population. The prevalence of psychotic drug use in long-term care facilities ranges from 33-90%. Accusations about excessive use of antipsychotic medications in nursing homes have been raised suggesting they were being used for staff convenience without appropriate diagnosis and side effect monitoring.

Where I work currently we are the medication police. Every 60 days the residents I care for are evaluated by their physician and we review the need for these medications or try, slowly, to eliminate them or reduce the dosage. As for staff convenience, I could see this being a problem if you look at the whole picture. My opinion is these medications are useful, and needed. People suffering from dementia do not want to feel anxious, paranoid, angry, lash out...it's about their comfort, not mine. There is a need for these medications even with the risk of side effects mentioned above. It's about quality of life, comfort, and making through another day.

When you were born, you cried and the world rejoiced. Live your life so that when you die, the world cries and you rejoice.

-Cherokee Expression-

What are some common signs of dementia?



Dementia causes many problems for the person who has it and for the person's family. Many of the problems are caused by memory loss. Some common signs of dementia are listed below. Not everyone who has dementia will have all of these signs.

Recent memory loss. All of us forget things for a while and then remember them later. People with dementia often forget things, but they never remember them. They might ask you the same question over and over, each time forgetting that you've already given them the answer. They won't even remember that they already asked the question.

Difficulty performing familiar tasks. People who have dementia might cook a meal but forget to serve it. They might even forget that they cooked it.

Problems with language. People who have dementia may forget simple words or use the wrong words. This makes it hard to understand what they want.

Time and place disorientation. People who have dementia may get lost on their own street. They may forget how they got to a certain place and how to get back home. Nights and days get mixed up. They wander like they are searching for something.

Poor judgment. Even a person who doesn't have dementia might get distracted. But people who have dementia can forget simple things.

Problems with abstract thinking. Anybody might have trouble balancing a checkbook, but people who have dementia may forget what the numbers are and what has to be done with them.

Misplacing things. People who have dementia may put things in the wrong places. They might put an iron in the freezer or a wristwatch in the sugar bowl. Then they can't find these things later.

Changes in mood. Everyone is moody at times, but people with dementia may have fast mood swings, going from calm to tears to anger in a few minutes.

Personality changes. People who have dementia may have drastic changes in personality. They might become irritable, suspicious, paranoid, or fearful.

Loss of initiative. People who have dementia may become passive. They might not want to go places or see other people. Most people with dementia suffer from depression.

Everyone is forgetful at times. Think of it this way...Everyone misplaces their car keys regularly (daily for me), a person with dementia forgets what the keys are actually for. I am asked several questions about the "normal" behavior of people with Alzheimer's disease and other forms of dementia. There is no outline. Every person is unique as their disease progresses. There are stages and things that happen in each stage which, for the most part, can be predictable. But anyone who has dealt with a loved one with dementia knows, no 2 days are the same, you live life just adapting to the ups and downs, and you cherish the times where things seem to level off and become at least tolerable for the moment. Family members suffer through the disease. It is truly devastating.

Dementia is the loss of mental abilities and most commonly occurs late in life. Of all persons over age 65, 5-8% are demented. This percentage increases considerably with age. Twenty-five to 50% of people over 85 are affected.



They may forget what you said, but they will never forget how you make them feel.
- Carol Buchner-