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Hi I Need An Expert Advice In Geriatric Care. My
Question: hi i need an expert advice in geriatric care. my grand father has advanced stage dementia. He is currently admitted in a super-speciality hospital here in our city - XXXXXXX XXXXXXX for deep vein thrombosis and grade 2 bed sores. a major obstacle for his treatment right now is dementia associated dysphagia. the doctors insist us for getting a PEG tube. according to them the treatment fails without nutritional support. i have read various articles regarding failure of PEG tubes making any progress for such patients. also his skin condition is delicate and there's a higher chance of PEG tube infections and other related complications. he also tends to continuously fiddle and scratch which might disturb the tube. I'm currently torn between deciding for or against PEG tube for my grand pa. your guidance and suggestions are much appreciated.
hi i need an expert advice in geriatric care. my grand father has advanced stage dementia. He is currently admitted in a super-speciality hospital here in our city - XXXXXXX XXXXXXX for deep vein thrombosis and grade 2 bed sores. a major obstacle for his treatment right now is dementia associated dysphagia. the doctors insist us for getting a PEG tube. according to them the treatment fails without nutritional support. i have read various articles regarding failure of PEG tubes making any progress for such patients. also his skin condition is delicate and there's a higher chance of PEG tube infections and other related complications. he also tends to continuously fiddle and scratch which might disturb the tube. I'm currently torn between deciding for or against PEG tube for my grand pa. your guidance and suggestions are much appreciated.
Brief Answer:
Dementia and dysphagia and DVT
Detailed Answer:
Hi XXXXXXX
Welcome to Ask a doctor.
As per the history,your g. father has got multiple complaints. The spectrum includes a background of dementia with DVT with dementia related dysphagia ,cellulite and impending sepsis.
He is in geriatric age group and has poor cardio respiratory reserves.
He needs an insertion of PEG tube and feeds via it.
This has been proven that in critical care illnesses and recovery,early and appropriate feeding is an integral(and underrated) aspects,helps the body to fight infection,builds immunity,prevents PEM(Protein energy malnutrition)and dehydration and prevents a negative calorie balance and electrolytes imbalance.Hence,feeding needs to be started as early as possible.
Yes....With a foreign body like it or catheter or cannula etc there is always a risk of infarction but that can always be managed.
Hope that I have answered your query.
Regards
Dementia and dysphagia and DVT
Detailed Answer:
Hi XXXXXXX
Welcome to Ask a doctor.
As per the history,your g. father has got multiple complaints. The spectrum includes a background of dementia with DVT with dementia related dysphagia ,cellulite and impending sepsis.
He is in geriatric age group and has poor cardio respiratory reserves.
He needs an insertion of PEG tube and feeds via it.
This has been proven that in critical care illnesses and recovery,early and appropriate feeding is an integral(and underrated) aspects,helps the body to fight infection,builds immunity,prevents PEM(Protein energy malnutrition)and dehydration and prevents a negative calorie balance and electrolytes imbalance.Hence,feeding needs to be started as early as possible.
Yes....With a foreign body like it or catheter or cannula etc there is always a risk of infarction but that can always be managed.
Hope that I have answered your query.
Regards
Above answer was peer-reviewed by :
Dr. Raju A.T
Brief Answer:
Dementia and dysphagia and DVT
Detailed Answer:
Hi XXXXXXX
Welcome to Ask a doctor.
As per the history,your g. father has got multiple complaints. The spectrum includes a background of dementia with DVT with dementia related dysphagia ,cellulite and impending sepsis.
He is in geriatric age group and has poor cardio respiratory reserves.
He needs an insertion of PEG tube and feeds via it.
This has been proven that in critical care illnesses and recovery,early and appropriate feeding is an integral(and underrated) aspects,helps the body to fight infection,builds immunity,prevents PEM(Protein energy malnutrition)and dehydration and prevents a negative calorie balance and electrolytes imbalance.Hence,feeding needs to be started as early as possible.
Yes....With a foreign body like it or catheter or cannula etc there is always a risk of infarction but that can always be managed.
Hope that I have answered your query.
Regards
Dementia and dysphagia and DVT
Detailed Answer:
Hi XXXXXXX
Welcome to Ask a doctor.
As per the history,your g. father has got multiple complaints. The spectrum includes a background of dementia with DVT with dementia related dysphagia ,cellulite and impending sepsis.
He is in geriatric age group and has poor cardio respiratory reserves.
He needs an insertion of PEG tube and feeds via it.
This has been proven that in critical care illnesses and recovery,early and appropriate feeding is an integral(and underrated) aspects,helps the body to fight infection,builds immunity,prevents PEM(Protein energy malnutrition)and dehydration and prevents a negative calorie balance and electrolytes imbalance.Hence,feeding needs to be started as early as possible.
Yes....With a foreign body like it or catheter or cannula etc there is always a risk of infarction but that can always be managed.
Hope that I have answered your query.
Regards
Above answer was peer-reviewed by :
Dr. Raju A.T
he has improved in Taking the oral feed (although not sufficient quantities) and so is being discharged today. we didn't opt for the PEG tube insertion since the gastroenterologist suggest that the tube may be problematic because of patient's tendency to fiddle and scratch -which is a serious issue , they had to tie his hands to the bed in order to save him from fiddling with the IV cannula (refer picture). he also let us know that it isn't an emergency. please advise on the best possible care that the patient needs at home? also few months from now how do we prevent the condition from getting worse? mobility has become an issue. Air bed is in place to prevent bed sores but I'm concerned about his stiff legs. he restricts from stretching the legs or being stretched and the folded legs are always inclined towards a side . physiotherapist couldn't do much to improve that. I've attached the discharge summary Incase you want to have a look at the medication he is on. my queries regarding the instructions are: 1) right now they insist pure liquid diet . may I know why? because we are confident that we can feed him food in pasty consistency. won't that help him better?( I understand that the peg tube has better advantage but we want to have it as last resort , don't want to subject him to any procedures. ) 2) they diagnosed him to be having seizure disorder (is the diagnosis accurate?) when it was just one episode of seizure which was the result of fluid accumulation in the brain (brain stroke due to vascular injury) which was resolved after burhole evacuation surgery. so is it necessary for him to continue taking levipil 500mg? apart from these please comment on predictable disease progression and what precautions can we take for that.
he has improved in Taking the oral feed (although not sufficient quantities) and so is being discharged today. we didn't opt for the PEG tube insertion since the gastroenterologist suggest that the tube may be problematic because of patient's tendency to fiddle and scratch -which is a serious issue , they had to tie his hands to the bed in order to save him from fiddling with the IV cannula (refer picture). he also let us know that it isn't an emergency. please advise on the best possible care that the patient needs at home? also few months from now how do we prevent the condition from getting worse? mobility has become an issue. Air bed is in place to prevent bed sores but I'm concerned about his stiff legs. he restricts from stretching the legs or being stretched and the folded legs are always inclined towards a side . physiotherapist couldn't do much to improve that. I've attached the discharge summary Incase you want to have a look at the medication he is on. my queries regarding the instructions are: 1) right now they insist pure liquid diet . may I know why? because we are confident that we can feed him food in pasty consistency. won't that help him better?( I understand that the peg tube has better advantage but we want to have it as last resort , don't want to subject him to any procedures. ) 2) they diagnosed him to be having seizure disorder (is the diagnosis accurate?) when it was just one episode of seizure which was the result of fluid accumulation in the brain (brain stroke due to vascular injury) which was resolved after burhole evacuation surgery. so is it necessary for him to continue taking levipil 500mg? apart from these please comment on predictable disease progression and what precautions can we take for that.
Brief Answer:
Brain stroke
Detailed Answer:
Hello.....
Hi.....
Post-traumatic epilepsy (PTE) refers to epilepsy that develops after TBI(Traumatic brain injury). PTE is to be distinguished from normal seizures,as the brain is acutely traumatized, inflamed, and metabolically disrupted.Since the risk of recurrence after a single late post-traumatic seizure is over 70%,clinicians give prophylactic antiseizure drugs(levipil).It will be tapered down and stopped after a period of time when there is no risk to him.Sudden stoppage of it can precipitate seizures.
It's good that he is accepting oral feeds but there is always(more or less) an involvement of palatal and pharyngeal in stroke patients so there is a risk of regurgitating and aspiration hence feeds are always started cautiously.Patient head should be up and quantity of feeds should be small.
Recovery from critical illnesses affect the ability of the body to digest and absorb food. A clear liquid diet allows the body to slowly recover, reducing the risk of nausea ,vomitings and aspiration and making it easier to absorb the nutrients.Clear liquids are easier for the body to digest and they leave nothing behind in the digestive tract so chances of abdominal distention are not there.
Because clear liquids provide calories, electrolytes, and water, they help nourish the body and prevent dehydration. Clear liquid diets are safe for short-term use and as soon as he tolerates,will be shifted to semisolids and then to solids.
If he is irritable and takes out cannula Tec,he should made to wear boxing gloves which will restrict him to do so.
Keep air bed inflated and there should be proper padding of pressure points.There should be 2 hourly turning. Go for intermittent chair sitting,if possible.Apply talcum powder and spirit on back to prevent bed sores.He should be kept dry and urine and motion soakage should be avoided.
Most important aspect of rehabilitation is physical therapy.
Principal physical therapy modalities must be regularly carried out to prevent or delay the development of upper and lower limb contractures. These include: (1) regularly prescribed periods of daily sitting, standing and/or walking baby steps with support (if possible)(2) passive stretching of muscles and joints; (3) positioning of the limbs to promote extension and oppose flexion and (4) splinting which is a useful measure for the prevention or delay of contractures.
A minimum of 2 to 3 hours of daily physio is necessary in addition to passive stretching for the control of contracture formation in.Each joint should be moved multiple times. Passive stretching to maintain or improve range of motion is an enormously important component of the program to prevent contractures. Such passive range of motion (PROM)has been documented to be efficacious in slowing the development of contractures.
A program of passive stretching should be started as early as possible in the course of disease and become part of a regular morning and evening routine. Proper technique is essential for passive stretching to be effective. With each stretch, the position should be held for a count of 15 and each exercise should be repeated 10 to 15 times during a session.Stretching should be performed slowly and gently.An overly strenuous stretch may cause discomfort and reduce cooperation.
Lower limb positioning may be a useful adjunct for preventing contracture formation. The limb should be placed in a resting position that opposes or minimizes flexion. The prone lying position is an effective method to stretch the hip flexors.
Splinting is another adjunctive measure used to slow the development of contractures in such patients.
Ankle-foot orthotics (AFOs) or nighttime resting splints have been used to maintain a 90° angle of the foot relative to the tibia(lower leg).
Such splinting is effective for reducing heel cord contractures.
Splints should be worn on top of the pressure garment.Doing Range of motion (ROM) exercises help keep the muscles and joints of the limbs flexible. A physical therapist (PT) will teach you and your family,how to do ROM so that you can help in the healing process.
Psychological support and motivation is an integral part of care too.
Wishing the best.
Hope that I have answered your query.
Regards.
Brain stroke
Detailed Answer:
Hello.....
Hi.....
Post-traumatic epilepsy (PTE) refers to epilepsy that develops after TBI(Traumatic brain injury). PTE is to be distinguished from normal seizures,as the brain is acutely traumatized, inflamed, and metabolically disrupted.Since the risk of recurrence after a single late post-traumatic seizure is over 70%,clinicians give prophylactic antiseizure drugs(levipil).It will be tapered down and stopped after a period of time when there is no risk to him.Sudden stoppage of it can precipitate seizures.
It's good that he is accepting oral feeds but there is always(more or less) an involvement of palatal and pharyngeal in stroke patients so there is a risk of regurgitating and aspiration hence feeds are always started cautiously.Patient head should be up and quantity of feeds should be small.
Recovery from critical illnesses affect the ability of the body to digest and absorb food. A clear liquid diet allows the body to slowly recover, reducing the risk of nausea ,vomitings and aspiration and making it easier to absorb the nutrients.Clear liquids are easier for the body to digest and they leave nothing behind in the digestive tract so chances of abdominal distention are not there.
Because clear liquids provide calories, electrolytes, and water, they help nourish the body and prevent dehydration. Clear liquid diets are safe for short-term use and as soon as he tolerates,will be shifted to semisolids and then to solids.
If he is irritable and takes out cannula Tec,he should made to wear boxing gloves which will restrict him to do so.
Keep air bed inflated and there should be proper padding of pressure points.There should be 2 hourly turning. Go for intermittent chair sitting,if possible.Apply talcum powder and spirit on back to prevent bed sores.He should be kept dry and urine and motion soakage should be avoided.
Most important aspect of rehabilitation is physical therapy.
Principal physical therapy modalities must be regularly carried out to prevent or delay the development of upper and lower limb contractures. These include: (1) regularly prescribed periods of daily sitting, standing and/or walking baby steps with support (if possible)(2) passive stretching of muscles and joints; (3) positioning of the limbs to promote extension and oppose flexion and (4) splinting which is a useful measure for the prevention or delay of contractures.
A minimum of 2 to 3 hours of daily physio is necessary in addition to passive stretching for the control of contracture formation in.Each joint should be moved multiple times. Passive stretching to maintain or improve range of motion is an enormously important component of the program to prevent contractures. Such passive range of motion (PROM)has been documented to be efficacious in slowing the development of contractures.
A program of passive stretching should be started as early as possible in the course of disease and become part of a regular morning and evening routine. Proper technique is essential for passive stretching to be effective. With each stretch, the position should be held for a count of 15 and each exercise should be repeated 10 to 15 times during a session.Stretching should be performed slowly and gently.An overly strenuous stretch may cause discomfort and reduce cooperation.
Lower limb positioning may be a useful adjunct for preventing contracture formation. The limb should be placed in a resting position that opposes or minimizes flexion. The prone lying position is an effective method to stretch the hip flexors.
Splinting is another adjunctive measure used to slow the development of contractures in such patients.
Ankle-foot orthotics (AFOs) or nighttime resting splints have been used to maintain a 90° angle of the foot relative to the tibia(lower leg).
Such splinting is effective for reducing heel cord contractures.
Splints should be worn on top of the pressure garment.Doing Range of motion (ROM) exercises help keep the muscles and joints of the limbs flexible. A physical therapist (PT) will teach you and your family,how to do ROM so that you can help in the healing process.
Psychological support and motivation is an integral part of care too.
Wishing the best.
Hope that I have answered your query.
Regards.
Above answer was peer-reviewed by :
Dr. Yogesh D
Brief Answer:
Brain stroke
Detailed Answer:
Hello.....
Hi.....
Post-traumatic epilepsy (PTE) refers to epilepsy that develops after TBI(Traumatic brain injury). PTE is to be distinguished from normal seizures,as the brain is acutely traumatized, inflamed, and metabolically disrupted.Since the risk of recurrence after a single late post-traumatic seizure is over 70%,clinicians give prophylactic antiseizure drugs(levipil).It will be tapered down and stopped after a period of time when there is no risk to him.Sudden stoppage of it can precipitate seizures.
It's good that he is accepting oral feeds but there is always(more or less) an involvement of palatal and pharyngeal in stroke patients so there is a risk of regurgitating and aspiration hence feeds are always started cautiously.Patient head should be up and quantity of feeds should be small.
Recovery from critical illnesses affect the ability of the body to digest and absorb food. A clear liquid diet allows the body to slowly recover, reducing the risk of nausea ,vomitings and aspiration and making it easier to absorb the nutrients.Clear liquids are easier for the body to digest and they leave nothing behind in the digestive tract so chances of abdominal distention are not there.
Because clear liquids provide calories, electrolytes, and water, they help nourish the body and prevent dehydration. Clear liquid diets are safe for short-term use and as soon as he tolerates,will be shifted to semisolids and then to solids.
If he is irritable and takes out cannula Tec,he should made to wear boxing gloves which will restrict him to do so.
Keep air bed inflated and there should be proper padding of pressure points.There should be 2 hourly turning. Go for intermittent chair sitting,if possible.Apply talcum powder and spirit on back to prevent bed sores.He should be kept dry and urine and motion soakage should be avoided.
Most important aspect of rehabilitation is physical therapy.
Principal physical therapy modalities must be regularly carried out to prevent or delay the development of upper and lower limb contractures. These include: (1) regularly prescribed periods of daily sitting, standing and/or walking baby steps with support (if possible)(2) passive stretching of muscles and joints; (3) positioning of the limbs to promote extension and oppose flexion and (4) splinting which is a useful measure for the prevention or delay of contractures.
A minimum of 2 to 3 hours of daily physio is necessary in addition to passive stretching for the control of contracture formation in.Each joint should be moved multiple times. Passive stretching to maintain or improve range of motion is an enormously important component of the program to prevent contractures. Such passive range of motion (PROM)has been documented to be efficacious in slowing the development of contractures.
A program of passive stretching should be started as early as possible in the course of disease and become part of a regular morning and evening routine. Proper technique is essential for passive stretching to be effective. With each stretch, the position should be held for a count of 15 and each exercise should be repeated 10 to 15 times during a session.Stretching should be performed slowly and gently.An overly strenuous stretch may cause discomfort and reduce cooperation.
Lower limb positioning may be a useful adjunct for preventing contracture formation. The limb should be placed in a resting position that opposes or minimizes flexion. The prone lying position is an effective method to stretch the hip flexors.
Splinting is another adjunctive measure used to slow the development of contractures in such patients.
Ankle-foot orthotics (AFOs) or nighttime resting splints have been used to maintain a 90° angle of the foot relative to the tibia(lower leg).
Such splinting is effective for reducing heel cord contractures.
Splints should be worn on top of the pressure garment.Doing Range of motion (ROM) exercises help keep the muscles and joints of the limbs flexible. A physical therapist (PT) will teach you and your family,how to do ROM so that you can help in the healing process.
Psychological support and motivation is an integral part of care too.
Wishing the best.
Hope that I have answered your query.
Regards.
Brain stroke
Detailed Answer:
Hello.....
Hi.....
Post-traumatic epilepsy (PTE) refers to epilepsy that develops after TBI(Traumatic brain injury). PTE is to be distinguished from normal seizures,as the brain is acutely traumatized, inflamed, and metabolically disrupted.Since the risk of recurrence after a single late post-traumatic seizure is over 70%,clinicians give prophylactic antiseizure drugs(levipil).It will be tapered down and stopped after a period of time when there is no risk to him.Sudden stoppage of it can precipitate seizures.
It's good that he is accepting oral feeds but there is always(more or less) an involvement of palatal and pharyngeal in stroke patients so there is a risk of regurgitating and aspiration hence feeds are always started cautiously.Patient head should be up and quantity of feeds should be small.
Recovery from critical illnesses affect the ability of the body to digest and absorb food. A clear liquid diet allows the body to slowly recover, reducing the risk of nausea ,vomitings and aspiration and making it easier to absorb the nutrients.Clear liquids are easier for the body to digest and they leave nothing behind in the digestive tract so chances of abdominal distention are not there.
Because clear liquids provide calories, electrolytes, and water, they help nourish the body and prevent dehydration. Clear liquid diets are safe for short-term use and as soon as he tolerates,will be shifted to semisolids and then to solids.
If he is irritable and takes out cannula Tec,he should made to wear boxing gloves which will restrict him to do so.
Keep air bed inflated and there should be proper padding of pressure points.There should be 2 hourly turning. Go for intermittent chair sitting,if possible.Apply talcum powder and spirit on back to prevent bed sores.He should be kept dry and urine and motion soakage should be avoided.
Most important aspect of rehabilitation is physical therapy.
Principal physical therapy modalities must be regularly carried out to prevent or delay the development of upper and lower limb contractures. These include: (1) regularly prescribed periods of daily sitting, standing and/or walking baby steps with support (if possible)(2) passive stretching of muscles and joints; (3) positioning of the limbs to promote extension and oppose flexion and (4) splinting which is a useful measure for the prevention or delay of contractures.
A minimum of 2 to 3 hours of daily physio is necessary in addition to passive stretching for the control of contracture formation in.Each joint should be moved multiple times. Passive stretching to maintain or improve range of motion is an enormously important component of the program to prevent contractures. Such passive range of motion (PROM)has been documented to be efficacious in slowing the development of contractures.
A program of passive stretching should be started as early as possible in the course of disease and become part of a regular morning and evening routine. Proper technique is essential for passive stretching to be effective. With each stretch, the position should be held for a count of 15 and each exercise should be repeated 10 to 15 times during a session.Stretching should be performed slowly and gently.An overly strenuous stretch may cause discomfort and reduce cooperation.
Lower limb positioning may be a useful adjunct for preventing contracture formation. The limb should be placed in a resting position that opposes or minimizes flexion. The prone lying position is an effective method to stretch the hip flexors.
Splinting is another adjunctive measure used to slow the development of contractures in such patients.
Ankle-foot orthotics (AFOs) or nighttime resting splints have been used to maintain a 90° angle of the foot relative to the tibia(lower leg).
Such splinting is effective for reducing heel cord contractures.
Splints should be worn on top of the pressure garment.Doing Range of motion (ROM) exercises help keep the muscles and joints of the limbs flexible. A physical therapist (PT) will teach you and your family,how to do ROM so that you can help in the healing process.
Psychological support and motivation is an integral part of care too.
Wishing the best.
Hope that I have answered your query.
Regards.
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Yogesh D
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