1. Hellwig, Karen MN, RN-BC, PHN

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Looking at the gaunt face with unseeing eyes, it was getting harder to remember when her cheeks were plump, and eyes sparkled. Where is she? Does this desiccated body still hold the person I once knew? Her body barely held together by sinews and skin, yet her life force struggled on. I'm not sure she would want this, but I have no choice. I must care for the person my mother has become. Her story is both a happy and sad one. She led a contented life enjoying travel, friends, and hobbies. But sadly, those happy activities became increasingly less frequent as Mom began to develop signs and symptoms of dementia. Her stubborn refusal to use walking aids resulted in many falls during which she broke one hip and then the other on two different occasions. In addition, she was prescribed opioids to manage her back pain that was caused by degenerative joint disease and osteoarthritis. As we now know, opioids contribute to falls in older adults with osteoarthritis.


These frequent falls also caused trauma to her head including a ruptured eyeball. Brain trauma may have contributed to the progression of her dementia. Diminished hearing could also have been a contributing factor. Her memory, processing abilities, and judgment became impaired. Her fractured hips affected her ability to drive and necessitated locating a driver to take her marketing and to her social activities. Along came Mike, a member of Mom's church, who was thrilled to drive her for a reasonable price wherever she needed to go. Mike was very attentive to Mom, and soon they were going to movies, church functions, and even two trips to Hawaii which, of course, Mom paid for because she needed a driver and enjoyed his companionship. Mike became a part of our family and drove Mom to many family functions. As Mom's family and friends, we were delighted that she had an apparently caring and attentive friend and helper.


As Mom's dementia worsened, I gradually began to suspect there was more going on than her cognitive decline. She gradually became paranoid and called the police a few times thinking someone was looking in her window. She started saying, "Is that the good Mike or the bad Mike who is coming over?" At the time, I attributed these comments to her worsening dementia. During their last trip to Hawaii, I noticed Mom's legs were very dry and flakey. She giggled and said she had been taking a bath and was unable to get out of the tub so "scooted around" until she was finally able to get out. So where was Mike during all this? He apparently allowed her to remain in the bathroom for 2 hours without checking on her! Red flags started going up, especially when Mike commented that he and Mom were going to get married and move 2 hours away to a retirement home. Mom's eyesight was significantly impaired, so I began to write checks for her to sign. The checkbook register showed that she had written Mike several checks for up to $500 which he said were for "loans."


Mom's last fall resulted in a fractured arm so she required live-in caregivers to help her with activities of daily living and meal preparation. The caregivers reported that Mike would come over and argue with Mom saying we, her family, were throwing out all her things. This was very distressing for Mom. Mike would also call her home several times a day and harass the caregivers. When we attempted to prevent Mike from visiting Mom, he called the local police while I was with her. When I spoke with the policeman, I reported Mike's suspicious behaviors and manipulative attempts to assert control over my mother.


As nurses, we are mandated to report any indication of elder abuse and/or neglect. Based on my home health nursing experience in similar situations, I chose to utilize the legal system to protect my mother from harm. I could have reported the situation to Adult Protective Services, but I believed we were providing better protective care through the legal system. I was able to get a restraining order against Mike by reporting to the court multiple occasions when he was verbally, emotionally, and financially abusive and negligent. He unsuccessfully appealed the restraining order upon which he proceeded to the State Supreme Court where his appeal was also denied.


Meanwhile, as Mom's dementia progressed, she could talk and eat, but she could not process or respond appropriately verbally. Her ever-present appetite did not diminish, though she did experience some dysphagia. At times, she did not have an "off" switch to stop her chattering for days that impaired her ability to swallow.


Fortunately, Mom died peacefully in her own bedroom surrounded by people who loved her. I learned so many things from the eventful last few years of Mom's life. I learned that brain trauma may influence the progression of dementia and may have led to my mother's loss of the capacity to regulate her behavior. Despite multiple medication changes, she never regained behavioral control. I also learned that, even as a psychiatric home care nurse with extensive experience with dementia and geriatric psychiatric issues, it took a while for me to pick up on the subtle clues that Mom was being abused and neglected. Mike wanted to gain control of Mom and her money. Fortunately, we were able to stop his abusive and neglectful treatment of Mom so that she was able to be well cared for and generally happy until the end of her life.


Bronchodilators don't improve smoking-related respiratory symptoms in people without COPD

NIH: Researchers have found long-lasting inhalers that relax the airways and make it easier to breathe do little to help people who do not have COPD, but who do have respiratory symptoms and a history of smoking. COPD affects about 15 million Americans. However, millions of others who smoke or used to smoke and have some symptoms of COPD have also been prescribed bronchodilators. Inhalers have long been the primary go-to treatment for these patients because doctors either assume a patient has COPD, or if they don't, that their smoking-related symptoms could be helped by the inhalers. But while tobacco smoking causes a large spectrum of lung damage, the study showed bronchodilator therapy only helps patients with enough lung damage that would result in abnormal spirometry readings. Researchers enrolled 535 adults with symptoms of COPD, ages 40-80. Twice each day, study participants used an inhaler that contained either medication or a placebo. By the end of the trial, some adults in the medication (intervention) and placebo (control) groups saw slight respiratory improvements - this could mean they coughed less, produced less phlegm, or felt less winded - which was assessed through the St. George's Respiratory Questionnaire. However, the researchers found no significant differences between those receiving medication or placebo. They reported 56% (128 of 227) of participants who received the medication saw respiratory symptom improvements, compared to 59% (144 of 244) of those who took the placebo.