Living With Care

Improve Your Nutrition from the Ground Up!

Wed, 10 Mar 2010 10:39:53 GMT

March is National Nutrition Month®! This annual event focuses on the importance of making healthy food choices and maintaining positive eating and exercise habits. This year’s theme is “Nutrition from the Ground Up.”

Golden Living encourages our patients and their families to make informed food choices as a way to help improve their overall health and well-being. Good nutrition doesn’t have to mean a diet overhaul; it can start small with little changes. Below are some suggestions for improving your nutrition from the ground up.

1. Eat more fruits and vegetables: Consider your daily eating habits and think about where more fruits and vegetables can be added. You can start by adding just one serving each day (whether fresh or frozen) to one meal or snack and increase it every few weeks. The addition of fiber and vital nutrients will carry you a long way towards better health.
2. Make calories count: Too often, people think of foods as good or bad and that only those on the ‘good foods’ list are okay. All foods are good in moderation. You should consider portion size and how the foods fit into a balance for the day. Read the label for all nutrients - not just carbohydrates or sugars, but also for fats and salt. Items that claim to be low in sugar are often high in fat to compensate and vise versa. A small amount of the real thing is often better and more economical. If you have a sweet tooth, have fruit and yogurt for dessert. For a snack in the afternoon, have some trail mix or nuts. There is no reason to go hungry just because you are making healthful changes. To figure out how many calories you need to achieve a healthy weight, visit a dietitian, or for general guidance visit www.mypyramid.gov.
3. Test the taste buds: Expand your horizons! A healthy eating plan emphasizes fruits, vegetables, whole grains, low-fat or fat-free dairy and includes lean meats, poultry, fish, beans and nuts. Try a fish you’ve never eaten or find a new vegetable recipe. A diverse menu with new items forces us to think about our food, and therefore, we tend to make better choices.
4. Exercise: Exercise is a must in order to properly use the nutrition you consume to build and maintain lean body mass. Whether it’s walking or some other physical activity, aim for 20 minutes of exercise five times a week, or 30 minutes three times a week.

For more tips on building your healthful diet from the ground up, during National Nutrition Month and all year long, visit www.eatright.org/nnm.

Spinach Salad with Avocado, Blueberries, Feta and Lemon-Balsamic Vinaigrette

Wed, 10 Feb 2010 15:49:40 GMT

This beautiful salad is loaded with good and good-for-you ingredients. The list of nutrients in this salad is too large to list, but some of the key players are calcium, potassium, B-complex vitamins, omega-3 fatty acids, iron and Vitamin C. In fact, the vitamin C in the lemon juice will even help your body absorb the iron in the spinach!

Ingredients:

4 cups baby spinach (4 oz.)
1/8 cup mint leaves
1/8 cup Basil leaves
Juice of 1/2 lemon
2 teaspoons balsamic vinegar
1 teaspoon chopped shallot
1/2 teaspoon salt
2 tablespoons extra-virgin olive oil
Freshly ground black pepper
1 /2 cup crumbled feta cheese
1/2 cup fresh blueberries, or 1/4 cup dried
1 ripe yet firm avocado
2 oz.. toasted sliced almonds

Directions:

Place the spinach in a large mixing bowl. Stack the mint and Basil leaves and cut them crosswise into thin strips. Toss the mint and basil with the spinach.
For the dressing, combine the lemon juice, vinegar, shallot, and salt in a small bowl. Whisk in the oil. Season the dressing to taste with pepper.
Pour the dressing over the greens, tossing to coat lightly. Divide the dressed spinach among 4 salad plates. Sprinkle the blueberries and 1/4 of the feta crumbles over the spinach.
Cut the avocado into quarters. Peel and cut each quarter into 3 slices. Arrange the slices on top of each salad and add a sprinkle of almonds. Serve immediately.

Makes 4 servings

Pan-Seared Salmon and Tuna Duet with a Pineapple-Avocado Relish

Wed, 10 Feb 2010 15:49:17 GMT

I highly recommend using a wild-caught fresh salmon instead of farm raised fish. This will give you the best flavor. However, both fish are known for their omega-3 fatty acids and other healthy attributes. The relish adds an element of freshness that makes for a light, vibrant dish. Enjoy!

Ingredients:

1/2 cucumber, peeled, seeded, quartered lengthwise and thinly sliced crosswise
1 cup small diced fresh pineapple
1/2 red bell pepper, seeded and julienned into 1-inch strips
2 tablespoons chopped shallot or red onion
1 tablespoons chopped fresh cilantro
1 tablespoons lime juice
1 1/2 teaspoons canola oil
1 teaspoon honey
1/2 teaspoon red pepper flakes or minced Serrano chile
1 teaspoon salt
2 salmon fillets, and 2 tuna fillets, each 3 oz. and about 1 inch thick
1/4 teaspoon freshly ground black pepper
Lime wedges for garnish

Preparation:

In a bowl, combine the cucumber, pineapple, bell pepper, shallot and chopped cilantro. Toss gently to mix.
In a small bowl, whisk together the lime juice, 1 teaspoon of the canola oil, honey, red pepper flakes, and 1/2 teaspoon of the salt. Pour the lime mixture over the cucumber mixture and toss gently to mix and coat evenly. Set aside.
Sprinkle the salmon and tuna fillets on both sides with the remaining 1/2 teaspoon salt and the black pepper. In a large nonstick frying pan, heat the remaining ½ teaspoon canola oil over medium-high heat.
Add the fish to the pan and cook, turning once, until opaque throughout when tested with the tip of a knife, 4-5 minutes on each side.
Transfer the salmon and tuna fillets to warmed individual plates and top each filet a tablespoon of the relish. Garnish the plates with the lime wedges. Serve immediately.

Makes 2 servings

Mediterranean Sauteed Broccoli and Grape Tomatoes

Wed, 10 Feb 2010 15:48:03 GMT

This dish of sautéed broccoli and tomatoes is tossed with healthy Mediterranean ingredients just before serving. Broccoli is loaded with beta-carotene, vitamins C and E and calcium. The tomato will supply you with beta carotene, vitamin C, lycopene and fiber
Olive oil’s health benefits are due to both its high content of monounsaturated fat and its high content of antioxidants. Studies have shown that olive oil offers protection against heart disease by controlling LDL ("bad") cholesterol levels while raising HDL ("good") cholesterol levels.

Ingredients:

8 ounces broccoli crowns, trimmed and cut into bite-size florets
1 cup grape tomatoes, cut in half
1 tablespoon extra virgin olive oil
2 cloves garlic, minced
1/4 teaspoon salt
1/2 teaspoon freshly grated lemon zest
1 tablespoon lemon juice
10 pitted Kalamata (Greek) olives, sliced
1 teaspoon dried oregano
A pinch of black pepper

Preparation:

Preheat an 8-inch or 12-inch skillet over medium-high heat.
Toss broccoli, tomatoes, oil, garlic and salt in a large bowl until evenly coated. Pour into the hot skillet and sauté, 10 to 13 minutes.
Meanwhile, combine lemon zest, lemon juice, olives, oregano and pepper in a large bowl. Add the hot sautéed vegetables and stir to combine. Serve warm.

2 servings, about 3 to 4 oz. each

Roasted Garlic Mashed Sweet Potatoes

Wed, 10 Feb 2010 15:45:43 GMT

The oft-overlooked sweet potato has risen to star status thanks to its healthful benefits. This sweet treat packs a powerful punch: vitamins A,C,E, loads of fiber and beta-carotene. The garlic in this recipe will be sweet to the taste and not pungent, so kissing your honey after eating these spuds will be a sweet experience.

Ingredients:

8 cloves of garlic, peeled and trimmed
2 tablespoons (1 fl.oz.) olive oil
Pinch of salt
1/2 lb. sweet potatoes, scrubbed, peeled and diced medium
2 tablespoons (1 oz.) butter
1/4 cup plus 2 tablespoons (3 fl. oz.) milk
Salt and fresh ground black pepper to taste
A pinch of nutmeg.

Preparation:

Preheat oven to 375
Peel and trim the cloves of garlic
Place garlic in foil with olive oil and kosher salt. Seal and place on a small baking sheet
Bake garlic until soft and sweet, about 30 minutes
After baking, place roasted garlic on a small plate. Mash garlic and olive oil with a fork to make a paste
In a sauce pan, cover potatoes with cold water season with salt. Bring the water to a boil and simmer until potatoes are fork tender. Drain the potatoes and return to pot.
In a separate sauce pan heat the milk and butter until butter is melted.
Pour milk and butter mixture on top of potatoes. Add roasted garlic paste, nutmeg and salt and pepper to taste. Mash with a fork just until incorporated

Makes 4 servings.

Green Tea Chocolate Truffles

Wed, 10 Feb 2010 15:45:12 GMT

This is a simple recipe to make white chocolate balls with the delicious flavor of green tea. The sweetness of white chocolate is well-balanced by the bitterness of green tea powder. The truffles will be light green in color and will look simply outstanding when served with some fresh raspberries as a garnish.

Your heart and blood vessels will benefit from the antioxidants found in the green tea. Additionally, dark chocolate may help lower blood pressure if you choose a chocolate with a 70 percent or higher cocoa content.

Ingredients:

1/2 lb. white chocolate, finely chopped
2 teaspoons green tea powder (maccha), plus more for coating
1 tablespoon milk
1/4 cup heavy cream
Fresh raspberries for garnish

Preparation:

Finely chop white chocolate and put in a medium bowl. Put 2 teaspoons of green tea powder in a small bowl.
Warm milk in microwave and pour over green tea powder. Stir well.
Put heavy cream in a small pan. Heat the cream on medium heat and stop the heat before cream starts to boil. Stir in the milk mixture.
Pour the hot cream over white chocolate. Stir well until the chocolate melts. Cool the chocolate mixture until it reaches room temperature, about one hour. Scoop the chocolate into about 1 1/2 inch balls and place them on a sheet of parchment paper.
Cool them in the refrigerator for about one hour, or until firm. Round chocolate balls by hand and roll in green tea powder to coat. Cool green tea chocolate balls until firm.
Serve 3 truffles on a plate with a few fresh raspberries for color and a flute of champagne for the bubbles.

Makes 12 balls

Celebrate Valentine's Day With These Heart-Healthy Recipes

Wed, 10 Feb 2010 15:44:13 GMT

February is American Heart Month! According to the American Heart Association, cardiovascular diseases, including stroke, are America’s number one killer. The goal of American Heart Month is to educate the public and raise awareness about heart disease and stroke.

At Golden Living, we want our patients, residents and their families to be educated about the healthy lifestyles that help maintain healthy hearts. Maintaining a healthy lifestyle involves good nutrition, managing your weight and exercising.

With Valentine’s Day just around the corner, we want you to know that good nutrition doesn’t have to mean boring food.

In celebration of American Heart Month, Golden Living’s Chef Peter has put together a Valentine’s Day menu that you can enjoy while still getting important nutrients that are part of a heart-healthy diet.

Fruits and vegetables are important for getting vitamins and fiber in your diet. B-complex vitamins can protect against blood clots and hardening of the arteries, while fiber can help lower cholesterol. Try the Spinach Salad with Avocado, Blueberries and Feta, the Mediterranean Sautéed Broccoli and Grape Tomatoes or the Roasted Garlic Mashed Sweet Potatoes.
Fatty fish delivers omega-3 fatty acids, which helps protect against heart attacks. Try the Pan-Seared Salmon and Tuna Duet.
Antioxidants can help protect your heart and blood vessels. Try the Green Tea Chocolate Truffles.

You can learn more about American Heart Month and heart health at www.americanheart.org.

Pharmacy Services in Nursing Homes are Highly Specialized

Tue, 05 Jan 2010 14:54:06 GMT

Providing medications and pharmacy services to nursing homes has become highly specialized. Most pharmacies that provide these services are closed-door, or closed to the public, operating more like a hospital pharmacy than a retail pharmacy.

It is necessary that the long term care facility contract with a consultant pharmacist to review the medication use of each resident monthly, and to assure that the facility is complying with all state and federal regulations for the safe and appropriate use of medications. This includes medication receipt, storage, administration and disposal.

The consultant pharmacist also serves as a member of the facility’s quality assurance committee, and provides advice to management regarding infection control, preventing medication errors and improving medication use systems. Finally, they provide education to the facility staff to improve safe and effective medication use. Consultant pharmacists have specialized training in geriatrics, and many are board certified geriatric pharmacists (CGP).

The Centers for Medicare and Medicaid Services (CMS) lists the following minimum Long-Term Care (LTC) Pharmacy Performance and Service Criteria for Medicare Part D network pharmacies:

The pharmacy has a pharmacist and delivery services available 24 hours a day, seven days a week
The pharmacy provides same-day delivery for new orders which will satisfy the state and federal conditions for participation requirements for medication availability in nursing facilities
The pharmacy provides timely delivery of refills
The pharmacy provides timely emergency medications when necessarys
The pharmacy has a licensed pharmacist available to review new medication orders for possible drug interactions and notify the facility if problems or potential problems are noted
The pharmacy has a licensed pharmacist available to provide interim Medication Regimen Reviews requested by the nursing facility within 72 hours of receipt of such request
The pharmacy provides intravenous (IV) medications and supplies when necessary
The pharmacy provides compounded/alternative forms of drug composition to meet the needs of residents
The pharmacy agrees to continue to maintain or immediately obtain any necessary technology required to be compatible with the ordering/receiving/administering electronic systems that this living center may use currently or in the future
The pharmacy assures accurate and complete labeling consistent with all federal and state rules and regulations, including expiration dates and lot numbers; and provides medications in unit-of-use packaging, and in quantities appropriate for long-term institutional care*

*CMS Long Term Care Guidance March 16, 2005

Proper Medication Disposal

Fri, 11 Dec 2009 13:59:03 GMT

Medicines play an important role in treating certain conditions and diseases, but they must be taken with care. Additionally, unused portions of these medicines must be disposed of properly to avoid harm. Almost all medicines can be thrown away in the household trash after mixing them with some unpalatable substance (e.g., coffee grounds) and sealing them in a container.

However, certain medicines may be especially harmful and, in some cases, fatal in a single dose if they are used by someone other than the person the medicine was prescribed. For this reason, a few medicines have special disposal directions that indicate they should be flushed down the sink or toilet after the medicine is no longer needed. If you dispose of these medicines down the sink or toilet, they cannot be accidently used by children, pets, or anybody else.

It is important to note that disposal by flushing is not recommended for the vast majority of medicines. Unused or expired medicines that do not have flushing directions in the label can be disposed of safely in the household trash by:

Mixing them with something that will hide the medicine or make it unappealing, such as kitty litter or used coffee grounds.
Placing the mixture in a container such as a sealed plastic bag.
Throwing the container in your household trash.

Drug take-back programs for disposal can be another good way to remove unwanted or expired medicines from the home and reduce the chance that someone may accidentally take the medicine. You should contact your city or county government’s household trash and recycling service to see if there is a take-back program in your community and if there are any rules about which medicines can be taken back. You can also talk to your pharmacist to see if he or she knows of other medicine disposal programs in your area.

Does flushing the medicines on the list down the toilet or sink drain pose a risk to human health and the environment?

Recent reports have noted trace amounts of medicines in the water system. However, the majority of medicines found in the water system are a result of the body’s natural routes of drug elimination (in urine or feces). Scientists, to date, have found no evidence of harmful effects to human health from medicines in the environment.

Disposal of these select, few medicines by flushing contributes only a small fraction of the total amount medicine found in the water. The FDA believes that any potential risk to people and the environment from flushing this small, select list (see below) of medicines is outweighed by the real possibility of life-threatening risks from accidental ingestion of these medicines.

Medications Recommended for Disposal by Flushing (21kb)

Spicing up the Kitchen for Seniors: Ways to Make Meals More Enjoyable

Wed, 09 Dec 2009 15:59:55 GMT

Food is a very sensory experience for most people. For many, especially older Americans, food can help them reconnect with the past. Smells, colors, textures and — most importantly — taste can bring back nostalgic memories of our roots. For those with dementia or other memory challenges, good food experiences are a wonderful way to bring back pleasant memories that make the diner feel good about life. For seniors of immigrant decent a chance to eat a meal reminiscent of their cultural heritage brings a feeling of pride and wholeness.

Too often, caregivers and families assume that bland food is what seniors need. What they really need and want is a meal or snack with good flavor. There is absolutely no excuse for preparing or serving boring unattractive food to anyone — regardless of age. Meals should come alive with both flavor and color. People use all their senses when they eat, beginning with their eyes. The sight of a beautiful, colorful meal increases appetite, gets the saliva glands working and gives the dinner experience a sense of contentment. Meals that are appetizing are vital to the physical and equally important, the emotional well being of seniors.

It is best to involve seniors in meal and menu planning. Get to know what they like or do not like. Ask them about their favorite recipes and involve them in the shopping and preparation of their meals, if possible. If tasks like peeling carrots, snapping beans or tearing lettuce prove too difficult for them; invite them into the kitchen anyway. Engage them in conversation about food, talk about the smells, or ask them to share one of their favorite food memories. Let them taste dishes as they are being prepared and welcome their input.

When shopping and planning a week of meals, work in dishes that will convert into two or three other meals. One of my favorite tricks is buying a roasted grocery store chicken on Sunday and serving it with roasted potatoes and carrots. On Monday, you could make a chicken salad out of the dark meat. Later, use the rest of the chicken, with some potatoes, carrots, celery, a little thyme and milk and VOILA! You have the basis for chicken and dumplings. All you need to complete the meal is to use your own recipe or one from one of the popular powdered biscuit mixes found in grocery stores to make the dumplings.

Another favorite is pot roast. Begin with a three- to four-pound pot roast for a meal. Then you can choose from shredded beef enchiladas, pulled barbeque beef sandwiches, or beef pot pie, as additional meal options all out of one dish.

Try enhancing the flavors of foods like mashed potatoes, rice, couscous or legumes without adding sodium. You can achieve this by cooking them in vegetable or chicken stock. Use fresh herbs, which are now available year ‘round in most grocery stores. Adding the zest of lemons, limes or oranges to enhance and enliven soups, salads, sauces, dressings, dips and roasted or grilled meats also will make meals more appealing.

Flavor, variety, freshness and nutrition in senior meals will play an increasingly important role in menu planning as Baby Boomers age. This group definitely will not settle for bland, uninspired meals. The average American eats a variety of foods and styles every week. For many of us, it is common to eat Italian, Mexican, Japanese, BBQ, Chinese, Cuban, and a little take out chicken on a regular basis. The same pattern, whenever possible, should continue into old age for most of us.

At our Golden LivingCenters we work hard to provide enjoyable meal experiences that our residents will look forward to every day.

Take a little time to learn what your favorite seniors want to eat. Then, spend time planning your menus, and get fresher ingredients. These small steps will help you provide healthier and more appetizing meals for the older adults in your life. To round out the experience, all they will need is good conversation, good friends and a little love.

Treating Chronic Pain in the Elderly – Be Careful

Wed, 09 Dec 2009 15:47:38 GMT

As we age, we tend to accumulate diseases, doctors and drugs. It is very important to make sure that medical care is coordinated to avoid drugs that may be unnecessary or that conflict with each other. Therefore, you should always consult your physician before starting or stopping any prescribed treatment, and consult your physician or pharmacist about the use of any herbal or non-prescription drug with prescription medications.

Older adults are more sensitive to the effects of medications, both positive and negative. This means that medications should be used at the lowest effective dose for the shortest duration necessary. There should be a clinically valid reason for each medication and the goals of treatment should be understood by the patient and caregivers. If the medication does not achieve the desired goals in a reasonable time period, then the dose should be adjusted or another drug should be tried.

Recently, much has been written about the potential adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, Celebrex and Aleve. In fact two drugs in this class (Bextra and Vioxx) have been taken off the market because the risk of treatment exceeded benefits for many patients.

The NSAID class of drugs can be particularly dangerous for elderly patients. These drugs are often used to treat arthritis and other chronic or persistent pain, and if used properly they can be effective. However, they can also cause significant side effects including stomach ulcers, worsening of heart failure, kidney failure and blood pressure control. In fact, in a recent press release dated May 1, 2009, the American Geriatrics Society (AGS) announced that it has published new guidelines recommending these drugs “be considered rarely, and with extreme caution, in highly selective individuals.” AGS recommends that acetaminophen (Tylenol) should be considered as initial and ongoing treatment of persistent pain, particularly, muscle and joint pain, because of its “demonstrated effectiveness and good safety profile.”

Also remember that many non-prescription drugs contain NSAIDs such as naproxen (Aleve), ibuprofen (Motrin), and many sinus or other pain medications that contain these as an ingredient. Always consult your physician before stopping any prescribed treatment, and consult your physician or pharmacist about the use of any herbal or non-prescription drug with prescribed medications.

Enabling Freedom: Alzheimer’s Care Units as Therapeutic Settings

Wed, 09 Dec 2009 15:33:55 GMT

The concept of “Enabling Freedom” came about at Golden Living in recognition of the ever shrinking world of people with Alzheimer’s disease and related dementias. While assessing potential residents in home settings, our clinicians would hear comments like: “mom can’t go outside unattended, she would wander away and get lost,” or “we don’t let dad in the kitchen, it’s too dangerous.”

We found that persons with AD were becoming prisoners of the living room. Through the concern of well-meaning caregivers, their world had shrunk to one room in the house where they could be constantly observed and protected. We wanted to give them back their freedom.

Our Enabling Freedom program begins with the premise that mostly wandering for persons with dementia is not a problem. Our Alzheimer care units have been designed to accommodate wandering. By constructing spaces that are familiar to residents, such as kitchens, living rooms, laundry rooms, chapels, and diners, we created an environment that nurtures, accommodates behavior, promotes safety, and embraces independence. By allowing residents access to all secured indoor and outdoor areas, the “problem” of wandering was no longer a problem.

By simply allowing safe, unimpeded wandering, we expanded their world, and according to family members, decreased agitation and in some cases improved cognition. A process we call “normalization.” We also encourage our staff not to use words such as: no, don’t’ touch, you can’t etc., words many were used to hearing, with all good intent, before they came to us.

Another benefit of “Enabling Freedom,” is the reduction in the use of psychotropic medication, in particular, the atypical antipsychotics. We found that many residents coming from home or other facilities were already on these medications. During our initial assessment, we determine why these medications were initiated. If it was due to behaviors “typical” of AD, we recommend dose reduction or discontinuance if possible. Our environment, our staff and our programming are designed to accommodate those behaviors.

We choose not to be bound within the limits of traditional long term care, instead we seek out and adapt new knowledge in the art of caring. I believe that those we care for are our greatest teachers. What we learn from them will result in an enhanced quality of life through all stages of the disease. Our secured environment enables residents to wander safely, with or without an agenda. We believe that wandering is not a “problem behavior” within a prosthetic environment that cues the residents and allows interaction with their “home.”

Our Alzheimer’s Care Directors attend 3 days of training and our CNA’s receive 20 hours of specialized education, all geared to giving them a greater understanding of the abilities and social needs of persons with AD.

Our programming is based on assessed interests and needs and is delivered in homogeneous groupings that we call “family groups.” The direct care staff follows that family group throughout their shift and leads the activities for the group. Similar cognitive and functional abilities allow everyone to participate. Activities are designed along the lines of Montessori principles that encourage residents to be successful at each task. The programs are designed to maximize residents’ abilities and assist in maintaining cognitive and functional skills for as long as possible.

Through a partnership of caring, we create an environment that nurtures, accommodates behavior, promotes safety and embraces independence.

Understanding Influenza in 2009

Wed, 09 Dec 2009 15:03:46 GMT

Experts predict that two or more distinct influenza strains will circulate in the Northern Hemisphere this winter. In addition to the seasonal influenza, they expect to see many persons infected with a new strain called H1N1 novel or swine influenza. In fact, this strain is expected to be predominant this winter in the United States, as it was this past summer in the Southern Hemisphere. However, because the seasonal vaccine will not protect against novel H1N1 influenza, an additional vaccine is being developed.

Always consult your doctor for specific advice or if you have any flu-like symptoms such as fever (usually high), headache, tiredness (can be extreme), cough, sore throat, runny or stuffy nose, body aches, diarrhea and vomiting (more common among children than adults).

Prevention – Seasonal Influenza
The Centers for Disease Control (CDC) recommends that most persons be vaccinated against the seasonal influenza as soon as vaccine becomes available in September. Those at highest risk for seasonal influenza complications include:

Pregnant women
People between the ages of 6 months and 19 years of age
People aged 50 years and older
People of any age with chronic health disorders or a compromised immune system
People who live in nursing homes and other long-term care facilities
People who care for those at high risk including:
- All workers in a health care setting
- Household contacts of persons at high risk for complications
- Household contacts and caregivers of children <5 years of age with particular emphasis on vaccinating contacts of children <6 months of age (these children are at higher risk of flu-related complications)<

Treatment – Seasonal Influenza

Typically, antiviral drugs such as Tamiflu capsules and Relenza Inhaler are used to treat influenza infection and to provide protection to persons who have been exposed to someone with active infection. Seasonal influenza had high resistance to Tamiflu last winter and the same is expected this year. This makes vaccination for seasonal influenza critical this year.

Prevention – Novel H1N1 Influenza
The CDC recommends that the following groups be vaccinated against the novel H1N1 influenza as soon as a vaccine becomes available:

Pregnant women
People between the ages of 6 months and 24 years of age
People between the ages of 25 and 64 years of age who have chronic health disorders or a compromised immune system
People who care for those at high risk including:
- Healthcare and emergency medical services personnel because infections among healthcare workers can be a potential source of infection for vulnerable patients. Also, increased absenteeism in this population could reduce healthcare system capacity
- Household contacts and caregivers of children less than 6 months of age

Treatment – Novel H1N1 Influenza
Tamiflu and Relenza should be effective and are recommended to treat active infection and to provide protection to persons who have been exposed to someone with H1N1 novel influenza this year.

For more information on influenza visit our Flu Center.

Do I really need all of these medications?

Wed, 09 Dec 2009 14:35:59 GMT

As we age, we tend to accumulate more doctors and pills. This is due in part to the fact that we also tend to accumulate chronic diseases such as osteoporosis, high cholesterol, high blood pressure, etc. With more diseases to treat, this often times leads us to more specialists, and more pills to take.

Although multiple medications may be necessary to treat multiple disease states, it’s important that the use of multiple medications is done appropriately. Simply, the benefits of a medication should exceed the risks, including the actual or potential side effects. A good example of the appropriate use of multiple medications is when a laxative, such as senna capsules or bisacodyl, is taken to prevent or treat constipation from opiod pain drugs such as morphine. This side effect is very common with morphine and similar drugs, and typically does not resolve without the use of laxatives. Another example is the use of Vitamin D to improve the absorption of calcium to help strengthen our bones.

However, the use of multiple medications can be inappropriate, such as when a drug is used to treat the avoidable side effect of another drug. An example of this is using Celebrex to treat muscle pain caused by taking Lipitor. Muscle pain is a well-known side effect of Lipitor and other statin drugs, and if severe, is typically treated by lowering the dose or changing to a different type of drug to lower cholesterol. Adding a drug such as Celebrex is typically not very helpful for this type of muscle pain, and may actually cause other side effects such as fluid retention and elevated blood pressure. If another drug is then added to treat the fluid retention or elevated blood pressure, it is known as a prescribing cascade, which can have devastating consequences, especially for older adults.

In fact, a study in 1997 found that “for every $1 spent on drugs, $1.33 is spent managing the complications of drug therapy!!!”*

How can you avoid the inappropriate use of multiple medications?

Ask your doctor if there are non-drug treatments that may be appropriate.
If you see multiple doctors, take a current list of medications including non-prescription and herbal remedies so they are informed about all your treatments.
Know what each drug is being used to treat and how it should be taken.
Ask your doctor or pharmacist to review your medications periodically to assure that they are still needed, are not causing significant side effects, and the benefit exceeds the risk.
Ask your doctor how long each medication should be taken. i.e. is treatment long-term or for a limited duration?
Never start taking a non-prescription or herbal treatment without consulting your doctor or pharmacist who knows your health history and current medications.

*Bootman JL, Harrison, DL, Cox E “The health care cost of drug-related morbidity and mortality in nursing facilities” Arch Intern Med 1997 157 2095.

Bringing Life’s Simple Pleasures to Our Residents

Wed, 09 Dec 2009 14:27:51 GMT

We are committed at Golden Living to patient-centered care. Our goal is to create a home, not a “home-like” environment for all of our LivingCenter residents. One step we have taken in this initiative is called “Life’s Simple Pleasures.” A pleasure is defined as anything identified by the resident or responsible party that enhances the quality of life and brings joy to the resident. It might be: a newspaper delivered with a hot cup of coffee when they wake up, or, an English muffin and cup of tea at 10:00 A.M or, a walk outside, or, a beer or glass of wine before dinner.

The staff at the participating LivingCenters singles out a simple pleasure for each resident, and then provides for that pleasure at least five times a week. The entire LivingCenter staff is involved in it one way or another.

Since many of these “simple pleasures” revolve around food, we have liberalized some diets. We’ve also found we sometimes need to rearrange schedules to accommodate the wishes of our residents. Response to this program has been very favorable from both residents and staff.

At Golden Living we have taken to heart the words of Rose Marie Fagan, the executive director of the Pioneer Network. “When we transform nursing homes into human communities, places for living and growing, we will ultimately change the very nature of aging in America.”

Our commitment at Golden Living to patient-centered care has led us to adopt the following values and principles of the Pioneer Network:

• Know each person
• Each person can and does make a difference
• Relationship is the fundamental building block of a transformed culture
• Respond to spirit as well as mind and body
• Risk taking is a normal part of life
• Put person before task
• All elders are entitled to self-determination wherever they live
• Community is the antidote to institutionalization
• Do unto others as you would have them do unto you—yes, the Golden Rule
• Promote the growth and development of all
• Shape and use the potential of the environment in all its aspects: physical, organizational, psycho/social/spiritual
• Practice self-examination, searching for new creativity and opportunities for doing better
• Recognize that culture change and transformation are not destinations but a journey, always a work in progress

Nurse Practitioners in Long-Term Care

Mon, 16 Nov 2009 17:07:26 GMT

Nurse practitioners (NPs) play a vital role in long-term care by providing high-quality primary care, similar to that of a physician, but always under their own license. They are master’s-prepared advanced practice nurses, and much of their work involves collaborating with physicians, rather than just working alongside them.

NPs are able to diagnose and treat a range of health problems; order, perform and interpret diagnostic tests; treat acute and chronic conditions; prescribe medications and perform other treatments. Besides clinical care, nurse practitioners spend time focusing on health promotion, disease prevention, health education and counseling.

Why is it so important when nurse practitioners choose to work in long-term care? Of the approximately 115,000 nurse practitioners currently practicing in the United States, only 4.1 percent have specialized as geriatric. Although the majority of nurse practitioners who work in long-term care are not directly employed by a nursing facility, it has been shown that when the geriatric nurse practitioners are directly employed by the long-term care facility, they are able to better affect patient care and outcomes (Rosenfeld, 2004).

Nurse practitioners avoid the role of “physician substitute,” but rather emphasize the shared practice model of nurse practitioners and physicians. The model is more one where nurse practitioners and physicians perceive each other as a complement to one another, not as a substitute (Roblin, 2004). The role of the geriatric nurse practitioner involves a shared practice with all members of the healthcare team (Lambing, 2004).

Geriatric nurse practitioners and their expertise

The role of a geriatric nurse practitioner depends on the setting, but it commonly includes educating and coaching patients, families, and nurses and performing physical and psychological assessments. NPs also consult with other caregivers to evaluate individualized patient care. They may also serve as leaders by directing interdisciplinary teams and conducting or participating in research activities. (Bourbonniere, 2002).

What distinguishes the geriatric nurse practitioner is the ability to recognize and place importance of the “synergism of multiple disciplines” to manage the treatment of geriatric patients. Because of the many health conditions that tend to exist in the elderly population, this synergy can serve the long-term care residents, the clinical functioning of those facilities, and the continued role development of geriatric nurse practitioners.

Geriatric nurse practitioners are the most successful model when they are able to provide formal education sessions for certified nursing assistants, form collaborative problem-solving teams with certified nursing assistants, consult with registered nurses and licensed practical nurses, and join the quality assurance committee (Krichbaum, 2005). Geriatric nurse practitioners are able to improve the quality of care for residents by influencing the ways in which structures and processes of care interact.

The practice sites and models vary, but what is clear is that geriatric nurse practitioners, when working in various roles—not as physician extenders, but as high functioning collaborators—create positive changes in the care of our elders.

Is Tylenol Safe?

Tue, 01 Sep 2009 15:32:12 GMT

Acetaminophen is the most widely used medication in the United States. It is supplied as a single ingredient in such brands as Tylenol, and in combination with many other non-prescription and prescription drugs. If you have questions about products containing acetaminophen you should seek the advice of your physician or pharmacist.

Acetaminophen is safe and effective when used as directed for mild to moderate pain from arthritis to headaches, and to reduce fever in children and adults. In fact, acetaminophen is arguably the safest pain reliever on the market in the United States. Other pain relievers such as ibuprofen (Motrin, Advil), naproxyn (Aleve), and similar drugs may have significant side effects on blood pressure and kidney and heart function, especially in the elderly. Recent guidelines from the America Geriatric Society recommend that these drugs be used only rarely in the elderly, and then only at the lowest effective dose for the shortest possible duration.

However, when total daily doses of acetaminophen exceed 4000mg liver damage can occur. Therefore, for patients with liver disease or a history of significant alcohol use, the maximum tolerated dose of acetaminophen may be much lower at around 2000mg per day. Because of the number of extra strength and combination products containing acetaminophen and its availability in both non-prescription and prescription drugs, many consumers and some health care providers fail to recognize that the total daily doses are exceeding these recommended daily maximum doses.

Three advisory committees to the Food and Drug Administration (FDA) met in late June to discuss the growing number of cases caused by overuse of acetaminophen. Emergency rooms have reported 56,000 visits a year of liver failure and 100 overdose deaths a year, because of acetaminophen. They made several recommendations including:

1. Reduce the maximum recommended daily intake of acetaminophen from 4000mg per day to around 2600-3200mg per day
2. Reduce the maximum recommended single dose from 1000mg (2 extra strength Tylenol) to 650mg (2 regular strength Tylenol)
3. Require that only one concentration of liquid acetaminophen be marketed to avoid confusion and accidental overdose, especially
in children
4. Remove prescription drugs in combination with acetaminophen (Percocet, Vicodin, Darvocet) from the market.

You should always seek the advice of your physician or pharmacist with questions about products containing acetaminophen, including safe doses and the best medication for your condition.

Fun and Delicious Fiber

Wed, 08 Jul 2009 10:32:59 GMT

I make this dish so regularly that every time I am in the supermarket, I pick up a pint of grape tomatoes knowing that I will be using them in the near future. It is a great, light, tasty and quick dish to prepare. My wife likes any kind of pasta but, I like Pappardelle. You can use any pasta you prefer or happen to have on hand.

Fresh tomatoes and asparagus add fiber to this dish, while the olive oil provides healthy fat. If you’d like to add protein to the dish, try adding roasted chicken or tuna.

Pasta with Grape Tomatoes
Ingredients
¼ cup olive oil
2 large garlic cloves sliced thin
1 bunch blanched or grilled Asparagus
1 pint grape or cherry tomatoes, sliced in half
½ teaspoon red pepper flakes
2 large basil leaves, chopped
salt to taste
1 pound Pappardelle pasta
freshly grated Parmagiano-Reggiano cheese for serving

Directions
1. Bring a pot of liberally salted water to a boil, add pasta and cook until al dente. When pasta is cooked, set aside ¼ cup of the cooking liquid and drain the rest.
2. While the past cooks, add olive oil and garlic to a large sauté pan over medium heat. Cook until garlic is lightly browned, then add the sliced tomatoes, red pepper flakes, basil, and salt.
3. Sauté the tomatoes until they are softened and have started to release their juices, about 3 minutes. Add Asparagus and toss.
4. Add the ¼ cup of cooking liquid to the sauté pan with the sauce and toss until completely coated.
5. Dish out into individual serving bowls and serve with grated Parmagiano-Reggiano. Season with sea salt and fresh ground pepper.

Getting the Most Out of Your Exercise

Mon, 22 Jun 2009 16:55:34 GMT

Eating right and exercising are vital to maintaining optimum health. Eating a boost of low fat calories and protein within 30 – 40 minutes after exercising helps take advantage of the exercise you just completed. It also builds lean muscle mass which burns calories and fat.

Below is a recipe from Chef Peter for you to enjoy after a great work out. The recipe includes carbohydrates for energy, protein for strength, calcium for strong bones, antioxidants and fiber. Just remember not to over indulge. If you can’t share it, refrigerate the leftovers for tomorrow. Don't have what you need for this recipe? You can get your antioxidants another time when berries are on hand. A glass of low-fat chocolate milk will give you the carbohydrate boost and the protein to help build lean muscle after the work out. Keep moving and enjoy.

Tropical Blueberry Smoothie

½ cup orange juice
¼ cup pineapple juice
¼ cup blueberries, frozen
1 cup plain yogurt
½ teaspoon fresh grated ginger
½ banana
6 ice cubes

Blend all ingredients in a blender or food processor until smooth. Serve in a tall glass. It should make approximately 3 cups. This should be enough for three people to share. The recipe has roughly 175 calories, 6 grams of protein and costs around .50 cents per serving.

Blueberry – Yogurt Smoothie

1 cup frozen blueberries
1 cup frozen raspberries
1 cup vanilla yogurt
1 cup 2% milk
3 tablespoons honey
1 teaspoon fresh orange zest
½ banana
½ tsp of nutmeg

Make sure all your ingredients are chilled, and keep the berries frozen. Blend all ingredients in a blender or food processor until smooth, about 2 minutes. Serve in a tall glass. For a smoother, less fibrous and less expensive alternative, substitute the raspberries for strawberries.

Makes 4 ½ cups

One cup provides approximately 200 cal and 6 grams of protein. The cost is around $1.00 per glass due to the higher cost of raspberries.

Protein With a Kick

Mon, 22 Jun 2009 16:47:50 GMT

Ropa vieja, or "old clothes," describes the shreds of meat, peppers, and onions resembling a mess of colorful rags. This robust stew from Spain is sure to become a family favorite! Serve with couscous or steamed rice.

Ropa Vieja: Braised Beef, Peppers and Onions
Ingredients

7 tablespoons olive oil
3 pounds inside round or flank steak
3 bay leaves
1 onion, peeled and studded with 4 whole cloves
Kosher salt and freshly ground black pepper
2 green bell peppers, seeded and thinly sliced
2 red bell peppers, seeded and thinly sliced
4 garlic cloves, roughly chopped
1 yellow onion, thinly sliced
3 teaspoon dried oregano
3 teaspoon ground cumin
3 tablespoons tomato paste
1 (14 to 16-ounce) can of tomato sauce
1 12-ounce can of beer
½ cup pimiento-stuffed Spanish olives, drained and halved
1 cup frozen peas, thawed

Directions

Heat 3 tablespoons of olive oil in a large skillet over medium-high heat. Season the steak with salt and pepper and cook, turning once, until well browned.
Transfer the steak with 1 bay leaf and the clove-studded onion to a large pot, with a tight-fitting lid, and cover with 1 inch of water. Bring to a boil; lower the heat, and simmer, covered, until tender, about 1 ½ hours. Remove from the heat and cool the meat in the liquid for about 30 minutes. Transfer meat to a platter and cover, to keep warm. Reserve 2 cups of the cooking liquid. (Stew may be made up to this point 1 day ahead.)
Meanwhile, return the skillet to medium-high heat and heat the remaining 4 tablespoons oil. Add the remaining bay leaf, peppers, garlic, onion, oregano, and cumin and cook, stirring, until softened and fragrant, about 8 minutes. Add the tomato paste and cook, stirring, until dark red, about 1 minute more. Add the 2 cups reserved liquid, tomato sauce, beer, and olives and bring to a boil. Lower the heat and simmer until slightly thickened, about 10 minutes.
While the vegetables are cooking, pull the steak into shreds. Add the steak and peas to the vegetable mixture and cook, stirring, until just heated through. Season with salt and pepper, to taste. Serve with white rice.

Serves 8. Serving Suggestion: White rice, Arepas, or Corn cakes

Tasty, Healthy Spring Vegetables

Mon, 22 Jun 2009 16:45:27 GMT

When I was growing up asparagus marked the beginning of spring. Nothing was better than that first taste of these sweet tender shoots drenched in butter or lightly blanched, chilled with a touch of herbed, made-from-scratch buttermilk dressing. Alas with the inception of year round produce, and bottled dressing Asparagus has lost its mystery and once a year uniqueness for some people. For me it remains mother nature's special gift to end the winter blues. I prefer a splash of Sherry or red wine vinegar, a little extra virgin olive oil and some thinly sliced Bermuda onion.

Asparagus Lasagna in the Roman Sephardic Style
Ingredients

4 pounds medium asparagus, trimmed
3 tablespoons extra-virgin olive oil
Salt
¼ cup (½ stick) unsalted butter
¼ cup all-purpose flour
1 ½ cups chicken broth, heated
½ cup water, heated
7 ounces mild goat cheese, such as Montrachet, Ricotta works too!
1 teaspoon freshly grated lemon zest, or to taste
6 (7 by 6 ¼-inch) sheets instant (no-boil) lasagna
1 2/3 cups freshly grated Parmesan
1 cup heavy cream

Directions

Preheat oven to 500° F.
Cut the tips off each asparagus spear and reserve them. Cut the stalks of the asparagus into ½-inch lengths.
In each of 2 large, shallow baking pans, toss half the asparagus stalks with half the oil, and salt to taste, coating them well. Roast them, shaking the pans every few minutes, until they are crisp-tender, about 5 to 10 minutes. Set them aside. Lower oven temperature to 400° F.
In a saucepan, melt the butter, add the flour, and cook the roux over moderately low heat, stirring, for 3 minutes. Add the broth and the water in a stream, whisking, and simmer the mixture for 5 minutes. Whisk in the goat cheese, zest, and salt to taste; continue whisking until the sauce is smooth.
Arrange 1 sheet of pasta in each of buttered 9 by 13-inch baking dishes, and spread each sheet with ¼ of the sauce. Top the sauce in each dish with ¼ of the reserved roasted asparagus. Sprinkle the asparagus with 1/3 cup of the Parmesan. Continue to layer the pasta, sauce, asparagus, and Parmesan in the same manner, ending with a sheet of pasta.
In a bowl, beat the cream with a pinch of salt until it holds soft peaks. Arrange the reserved asparagus tips on the pasta, spoon the cream over the pasta and the asparagus tips, spreading it with the back of a spoon. Sprinkle the remaining 1/3 cup Parmesan on top.
Bake the lasagna on the middle oven rack for 30 minutes, or until it is golden and bubbling. Let stand for 10 minutes before serving.

Serves 8. Roasted red peppers and canned Artichokes can be used to intriduce color and an added dimension to the recipe.

Healthy Eating Made Easy

Mon, 22 Jun 2009 16:40:24 GMT

Nothing says summer like a light, delicious meal. Asian Style Lettuce Wraps have it all: big, bold flavors, fresh, crunchy vegetables, cool and crispy lettuce and rejuvenating herbs combined for a delicious, nutritious meal. In addition, they are a healthy way of eating made easy! Recently, lettuce wraps have been turning up in restaurants across the country where they are most often offered as an appetizer. However, lettuce wraps also work great as a light summer meal.

The secret to good wraps is bold spicing, along with good texture and crunch in the fillings. Lettuce wraps may be a healthy alternative to flour tortillas or pita bread, which often contain many refined carbohydrates.

Lettuce wraps are a great way to deliver a main dish meal. You can easily create lettuce wraps in an almost endless array of variations at home. Many meat, seafood, poultry, vegetable and cheese combinations are prime candidates for fillings. You can use the same ingredients you use in burritos, pita bread, spring rolls, or phyllo dough.

Asian Style Lettuce Wraps
Ingredients
2 cups julienne grilled, roasted or steamed skinless chicken breast
3 tablespoons rice vinegar
1 ½ tablespoons light soy sauce
1 ½teaspoons sesame oil
1 tablespoon chopped fine fresh ginger
1/3 cup julienne snow peas
¼ cup chopped green onions
¼ cup cellophane or fried rice sticks (crisp)
1 tablespoon lime juice
1 teaspoon fish sauce
¼ cup coarse chopped cilantro
1 cup shredded or julienne carrots
1 cup shredded red and green cabbage
Four to six butter lettuce leaves
Peanut sauce (see recipe below)
Asian dipping sauce or Asian Chile sauce (Sambal olek)

Quick Tips:
1. Pick large, pliable leaves
2. Dry lettuce before serving
3. Vary textures, color and flavors in filling
4. Make fillings and sauces ahead of time

Directions
1. In a medium bowl combine all ingredients. Mix well and chill.
2. Prepare peanut sauce.
3. On platter, fill the lettuce leaves with the chicken mixture Add small 2oz. containers each of peanut sauce and Asian dipping sauce to platter. 4. Dip into peanut sauce and Asian dipping sauce as desired.

Serves 4

Note:
Add small amounts of different vegetables such as julienne celery, bok choy, mushrooms or zucchini or sliced blanched asparagus to chicken mixture if desired.

Lettuce wrap nutrition information per serving (no sauce):
Total Fat: 12g
Saturated Fat: 2g
Cholesterol: 25mg
Sodium: 190mg
Carbohydrate: 18g
Dietary: Fiber 3g
Sugars: 7g
Protein: 18g

Peanut Sauce
1/3 cup peanut butter
3 tablespoons hot water
2 teaspoon lime juice
1/4 teaspoon cayenne pepper
2 to 3 teaspoons bottled plum sauce

Directions:
Combine peanut butter and hot water; mix with fork until well blended. Blend in lime juice, cayenne and plum sauce until well blended.

The Importance of Vitamin D

Thu, 18 Jun 2009 13:49:35 GMT

Vitamin D is often known as the “sunshine vitamin” due to the fact that it is synthesized in our bodies when our skin is exposed to sunlight. What many people may not realize is just how important this nutrient is.

Vitamin D is referred to as a hormone. Its function is to be a messenger to the body to absorb Calcium from sources other than bone. Thus, when missing, the body starts mining the bone for Calcium, making our bones weak and brittle. This is just the beginning. Vitamin D deficiency has long been linked to rickets, which causes weakening of the bones and may lead to fractures.

Studies show that most Americans do not get enough Vitamin D. There are only a few foods that provide Vitamin D in our diets, e.g., fatty fish, liver and fortified foods such as milk, orange juice and some breads and cereals. The rest of our Vitamin D usually comes from exposure to the sun.

I understand that it can be difficult to get enough Vitamin D from the sun when we live in a culture that has been trained to always wear sun screen to avoid skin cancer. However, exposure to the sun without sun screen for 10 minutes a day, three times a week is usually long enough to allow our bodies to synthesize enough Vitamin D.

As people age, however, their ability to produce Vitamin D from sun exposure declines so special attention must be paid to their Vitamin D levels. An important reason that seniors in particular should make sure they get enough Vitamin D is that research shows that getting enough Vitamin D may help reduce the risk of falls due to a possible strengthening effect that Vitamin D has on the bones. Furthermore, scientists are now learning that Vitamin D deficiency can also affect things such as brain performance in older adults, immune deficiency, cardiovascular health, hypertension, insulin resistance and cancer risk.

Vitamin D excesses are stored by the body and therefore too much can also be toxic to your system. That is why fortification of foods is so heavily regulated.

Therefore, I recommend that seniors talk to their doctor or dietitian about Vitamin D and find out whether or not a supplement is recommend. People who live in northern parts of the country may not get enough Vitamin D from sunlight during the winters. Also, people who have darker skin may require longer amounts of time in the sun to produce the same amount of Vitamin D as those with fair skin. No matter your age, paying attention to the amount of Vitamin D in your diet is a great way to help ensure that you stay as healthy as possible.

Valentine's Day Recipes from Chef Peter

Wed, 11 Mar 2009 13:41:55 GMT

To have a memorable Valentine's Day, you don't have to spend it in a fancy restaurant or out on the town. For a romantic night, consider staying home with your love and preparing these simple, delicious and economical dishes. These dishes have the benefit of small, well-balanced portions made with fresh fruits and vegetables. Of course, there's also the benefit of a romantic meal with great company!

For your entree: a coriander-crusted rack of lamb with Pico de Gallo. This may sound like a luxurious dish, but it is surprisingly simple to prepare. If you add oven-roasted herb potatoes and a tossed salad of baby greens, you get a complete meal for two for around $20. Plus, you get the added benefit of spending quiet time together. Enjoy your meal and some wine in front of the fireplace. Now that's a beautiful thing!

Top off the night by sharing dessert: Pavlova with macerated fruit. This decadent, romantic dessert is also simple and easy to prepare. The meringue may be prepared a day ahead of time, and the dish is extra tasty drizzled with a bit of chocolate sauce.

Coriander crusted Lamb with Pico de Gallo

Information
Prep time: 10 min
Cook time: 30 min
Serves: 2

Ingredients
For lamb:
3 tbsp olive oil, plus extra for greasing
1 tsp cumin seeds (toast lightly)
1 garlic clove, crushed and minced
1 tsp ground coriander
3 tsp course sea salt
1 rack of lamb with at least 6 to 7 bones, with the fat cap pulled off, or trimmed and scored
lemon wedges and fresh cilantro sprigs to garnish

For pico de gallo:
1 large Roma tomato, diced
1 small Bermuda onion, diced
1 tsp minced jalapeno
1 tbsp chopped fresh cilantro
1 lime

Directions
1. Prepare pico de gallo by combining Roma tomato, Bermuda onion, jalapeno, cilantro and juice of half a lime. Toss well and chill.
2. Meanwhile, mix olive oil, cumin seeds, garlic, coriander seeds and salt together in a bowl to form a paste. Coat the meat side of the rack with the Coriander paste. Preheat oven to 400 F.
3. Heat one tablespoon of olive oil in a skillet. Place the seasoned side of lamb down in the hot olive oil, lower heat to medium. Crust rack for at least 4 to 5 minutes on each side. Put in a 400 F preheated oven and roast for 20 minutes.
4. Remove from oven and allow the rack to rest for at least 10 minutes before slicing between the bones to have at least 2 portions of 3 bones per portion. Plate and top with the pico de gallo and garnish with the lemon and cilantro springs.

Pavlova with Macerated Fruit

Information
Prep time: 30 Minutes
Cook time: 50 Minutes
Ready In: 1 Hour 20 Minutes
Serves: 4

Ingredients
2 egg whites
1/3 pinch salt
1/2 teaspoon vinegar
2/3 cup sugar
1/2 teaspoon vanilla extract
2/3 cup sweetened whipped cream
1/3 cup fresh strawberries, sliced
2/3 cup kiwifruit, peeled, halved lengthwise, and sliced
1/3 fresh peach or nectarines - peeled, pitted and sliced
2 tablespoons and 2 teaspoons fresh blueberries or blackberries

Directions
1. Preheat the oven to 450 F. You will be turning the temperature down to 300 F when you put this in to bake.
2. Combine the egg whites and salt in a large bowl. Beat with an electric mixer, or stand mixer using a whip attachment until able to form soft peaks. Sprinkle in the sugar 1 tbsp at a time while continuing to whip to stiff peaks. Stir in the vanilla and vinegar. Divide evenly into 4 round mounds on a baking sheet lined with parchment paper.
3. Place the Pavlova into the oven, and immediately reduce the temperature to 300 F. Bake for 40 to 50 minutes, or until the top is crisp and a pale straw color. Leave in the oven, and turn off the heat. Let it stay in the oven until the oven has cooled completely.
4. Once the Pavlova is cooled, top generously with sweetened whipped cream. Arrange the strawberries, kiwis, peaches and blueberries in a decorative fashion on top on top.

When Your Loved One Is Confused

Fri, 13 Feb 2009 16:59:58 GMT

I had just begun my medical internship in Chicago—and my wife, Jan, and I were more than a thousand miles from our nearest family member—when our first child, Jonathan, was born. Everything was new, there was much to learn, and there was much we didn’t know. We turned to books and manuals for guidelines on how to care for a newborn.

After 25 years of practicing medicine and taking care of patients who suffer with confusion, I realize there is a need for something similar for caregivers of confused patients.

Whether your loved one’s confusion is temporary (e.g., due to medications) or permanent, here are 10 important guidelines to consider. It shouldn’t surprise you that many of these guidelines are the same ones Jan and I learned more than two decades ago when Jonathan, now a medical school student, was a newborn.

1. Establish Routines. Try to keep to routines, such as eating breakfast at a certain time, going to church, taking a walk, eating familiar foods, and watching favorite television shows. The body responds to rhythms that are familiar. These routines will keep your loved one calmer and help make them more predictable.

2. Create visual reminders. Patients who are confused often need reminders about the date and time. Consider having a calendar and clock prominently displayed in your house. That is why nursing homes place signs in conspicuous places that say, for example, “Today is Thursday, July 7, 2009.”

3. Have reasonable expectations. Don’t expect loved ones to do tasks beyond their capabilities. I remember a man who asked his wife to let the dog into the house. Evidently, the dog had been barking at the door to come in. Instead, his wife let the dog loose from the yard and “Lassie” was found days later. Although familiar tasks need not be ruled out, most confused patients will no longer be able to perform tasks previously done. Use tact and wisdom to assist them, while avoiding condescension and embarrassment.

4. Be respectful. Try to respond respectfully to questions and comments—even when the talk is nonsensical. It is hard to believe that the intelligent person you once knew is so “out of touch.” Consequently, it is hard to avoid becoming impatient and frustrated. But keep in mind that your impatience or frustration will usually make the person worse.

5. Maintain regular sleep patterns. Getting a good night’s sleep is important for you and your loved one. Have regular rituals before bedtime; such as, getting into your pajamas an hour before bedtime, dimming the lights at a certain time or having a glass of milk before retiring.

6. Resist taking things personally. Don’t try to dwell on or psychoanalyze wild thoughts and paranoid behavior. Simply do your best to change the topic. Your loved one may even say hurtful things. Don’t take it personally—always remember that it is a diseased and confused mind that is talking.

7. Record medications, complaints and problems. Keep records of all of the medications (past and present) that your loved one has taken. Be sure to write down any adverse reactions. Also, keep a list of medical complaints and problems so you can tell the doctor about these as your loved one may forget.

8. Accompany them to the doctor’s office. Because of the confusion, your loved one will need help presenting his or her medical history to their physician. Ride along with them and talk to the physician separately, if needed. (One of my patients with dementia would forget about his chest pain moments after it subsided. Wisely, his wife told me and we easily controlled the pain with a simple medication. During the entire office visit, the patient vehemently denied any such pain and accused his wife of making it up!)

9. Schedule respite times for yourself. Being a caregiver for a confused loved one can be physically, emotionally and spiritually draining. It is a stressful undertaking. Someone coming in for a few hours can give you the time away you need to do chores and simply have some time for yourself. The time may come when you will no longer be able to care for your loved one. Be realistic about this possibility.

10. Remain loving. No matter how confused, patients will sense an uncaring tone or atmosphere. Just like newborn babies, adults can somehow feel whether someone is being loving or harsh. I am always uncomfortable holding newborn babies. I can never seem to get their head in the right spot and I worry that I might drop them. Babies sense this and often cry when I hold them. But when Jan holds them, they can sense love and assurance and they immediately calm down. Don’t forget that despite their confusion, your loved one will sense your attitude—just like a newborn.

Finally let me close with three things I want you to always remember:

1. Remember to ask for help. Don’t hesitate to ask others and God for help. Share the care with family members and others—it will help you and it will be a blessing to them.

2. Remember to be kind to yourself. The days and hours can be very long when you are taking care of a confused and disoriented loved one. On bad days you will become impatient and frustrated. Be kind to yourself and be thankful that your loved one won’t remember your anger or frustration. Thankfully, Jonathan doesn’t remember all of the mistakes that I made as a parent!

3. Remember that you are blessed. You are blessed to have someone you love and your loved one is blessed to have you. “And now these three remain: faith, hope, and love. But the greatest of these is love.”— 1 Corinthians 13:13

Electronics and Culture Change: Wii a Collaboration Between Rehab and Recreation

Fri, 13 Feb 2009 16:59:34 GMT

By now, most of you have probably heard of the exciting fifth-generation home videogame console from Nintendo® called the Wii™. What you may not realize is that it’s not just kids who get a kick out of this highly-interactive system. Since the release of Wii in September 2006, rehab centers, hospitals, assisted living centers and long-term care facilities in the United States and abroad have been utilizing the Wii system in their programs.

Rehab

Wii is part of a trend in “virtual rehabilitation”: physical or cognitive rehabilitation entirely based on or augmented by virtual reality, utilizing means such as robotics or video games.

What really makes the Wii stand out from other videogame systems is its unique wireless controller, the Wii remote. Because of the Wii remote’s similarity to other remote controls, people who use the system are less likely to be intimidated by the new technology. The remote is used as a hand-held pointing device that can detect motion and rotation in three dimensions. Many of the different games require the development of various fine-motor and group-motor skill abilities to accomplish certain tasks and also to tap into cognitive functions such as mental tracking and short-term memory.

Both physical therapists and occupational therapists have observed that some of the Wii games require body movements similar to traditional therapy exercises. However, patients are so engrossed with the game itself that they have a tendency to forget that what they’re doing is work! In traditional rehabilitation, the usual stretching and lifting exercises that help people regain strength and movement can be uncomfortable, repetitive and downright boring. When patients use the Wii, they may even improve their therapy results because they’re so entertained by what they’re doing.

Because the exercises are in a game format, Wii creates an inner competitiveness. The person isn’t working; they’re trying to win. The Wii can be used with a yoga ball, balance mat, arm weights or ankle weights to add difficulty or emphasize different skills.

Using the Wii in treatment can help benefit balance, arm movement, eye–hand coordination, range of motion, endurance, strength and coordination. Although the Wii requires more physical involvement than just frantic thumb movement, people who are in wheelchairs or need the assistance of a walker can still play most of the games.

A recent addition to the Wii family is the Wii Fit™ . Released in May 2008, the Wii Fit focuses on improving balance. Players stand on the pressure-sensitive Balance Board that can detect weight and balance as the user exercises. .

The Balance Board’s accurate feedback on a player’s weight distribution is perfect for those with brain injuries, especially when those with one limb stronger than the other can be encouraged to strengthen both through play. The board is useful in a variety of ways. For those who have weight-shifting or balance issues, the biofeedback that the force plate registers gives a good on-screen monitor of their progress. Even for the most basic patient, Wii Fit can be used to get their hands off of their cane, walker, etc., and start them using their arms while trying to maintain a non-supported base of support.

Recreation

Recreational therapists have also noted benefits using the Wii with their patients. When residents in our LivingCenters use the Wii as part of their rehab therapy, it can carry over into recreation programs after their therapy is complete. They can continue to build on the skills they were working on in rehab and turn them into new leisure interests.

Our residents are getting the chance to participate again in activities that they had given up because of their health, but at a level that suits their abilities today. A resident who can no longer handle a 16-pound bowling ball can bowl again with the Wii. Using the Wii is a safe, no-impact way that our residents can continue involvement in some of the leisure activities they’ve done all their lives, and still have just as much fun.

Our residents say that playing games on the Wii “brings back a lot of memories” of things they used to enjoy. Using the Wii also helps our residents gain new leisure interests—you don’t have to have previous skills in the games to be successful playing them on the Wii.

Culture Change

Today’s seniors are becoming more and more technology-savvy, and this is demonstrated by the laptops, MP3 players and cell phones that often accompany them when they come to our LivingCenters. But will they play videogames? According to the Entertainment Software Association, the fastest-growing audience for video games is players over the age of 50.

The Wii fits in well with the culture change our LivingCenters are undergoing. As we’re developing neighborhoods, residents, families and staff need social opportunities to get to know each other better. The interaction truly is meeting a psychosocial need—it draws people together. The sound of the bat hitting the ball, bowling pins knocking over, the roar of the crowd—all entice people to stop by and watch. The competition has had people who hardly knew each other cheering and hugging in the span of a few hours. It’s an activity that residents, staff and family members can play together—creating a positive, interactive experience and promoting stronger relationships. Long-term care centers that have been using the Wii are noticing that it’s a good way for staff to learn about the past activities of their residents. Some facilities have even started bowling leagues, complete with snazzy shirts for team members. The teams play other neighborhoods and, in some cities, other facilities.

The Wii is easy to learn how to use and comes pre-packaged with five sports games, including Golf, Tennis, Bowling, Boxing and Baseball. It also comes with a “fitness test.” The test uses an algorithm to look at all levels of play, and incorporates coordination, speed and accuracy.

What is an appropriate diabetic diet?

Fri, 13 Feb 2009 16:59:10 GMT

Every day, dietitians are asked what the appropriate diet is for a person with diabetes who lives in a long-term care setting, such as a nursing facility. Naturally, this can be a confusing subject since, over the years, there have been many different opinions on this topic.

In the past, it has been thought that strict diets were the way to go when managing diabetes. However, studies have shown that a calorie-restricted diet can have a negative impact on the resident’s food intake. Strict diet modifications have led to eating less at mealtimes, which can result in increased snacking on unhealthy foods. It can also lead to the resident consuming very little or nothing at all, and this is never a healthy option.

Current Standards of Practice

The current diet model for those with diabetes is to provide a consistent amount of carbohydrates at each meal, each day. Studies have shown that carbohydrates from sugars are no more rapidly absorbed than carbohydrates from starch when included as part of a meal plan. Much to the appreciation of diabetics in long-term care facilities, research has shown that residents will eat better when they are given a less restrictive diet rather than a specific calorie level or energy-controlled diet.

Diabetics dining in one of our Golden LivingCenters have advantages over dining at home. LivingCenters can provide measured portions, menus written by dietitians, consistent mealtimes and regular observation by nurses and dietitian visits. How many of these advantages do most people have at home three times a day? Very few.

These advantages reduce the need for restrictive diets and allow residents to eat more of the things that they love. When residents eat what they like, it is less likely that they will suffer from malnutrition, and it is far more likely that they will enjoy their lives as much as possible!

We are now also seeing more and more people who come to our LivingCenters for short-term care and rehabilitation. This group of people may also benefit from the dining advantages listed above. Having meals that are made on-site, taste good and are served in reasonable portions, without eliminating a specific nutrient or ingredient, shows how returning home can be successful when making the right choices.

Understandably, not every person with diabetes will benefit from a liberalized diet. Due to specific circumstances, some may require more individualized meal planning from a registered dietitian, and blood glucose monitoring may be recommended as a way to evaluate the effectiveness of the nutrition care plan. Often it may be more important to make medication changes rather than food adjustments.

As members of the healthcare team in a long-term care facility, dietitians are responsible for ensuring that the residents’ nutritional needs are met. Implementation of the nutrition recommendations is an important step toward achieving this goal for individuals with diabetes.

Providing a Consistent Carbohydrate Diet

So, how do you go about providing a consistent carbohydrate diet if one is needed? And what is “carbohydrate counting”?

Carbohydrate counting is a precise method of meal planning for independent people with diabetes. Foods containing carbohydrates (grains, vegetables, fruit, milk) have the largest effect on blood glucose level. There are two levels of carbohydrate counting: basic and advanced.

Basic carbohydrate counting is generally used by people with type 2 diabetes, and consists mostly of counting and eating consistent amounts of carbohydrates.

Advanced carbohydrate counting is often used by people taking insulin, and is made up of recognizing and managing patterns in blood glucose, food, medication and exercise for intensive management of blood glucose. (Source: www.americandiabetesassociation.com)

For the long-term care population, basic carbohydrate counting is typically used.

The guidelines for diabetic diets used by Golden Clinical Services allow most foods that are allowed on a regular diet and allows for some regular desserts at mealtimes or as snacks.

Each LivingCenter dietitian is that LivingCenter’s source for assessing, creating and educating others on the meal plan in collaboration with all disciplines.

Chef Peter's Perfect Mashed Potatoes

Thu, 29 Jan 2009 08:33:14 GMT

There has been much written on the best way to make mashed potatoes - how long you cook them, with peel or without, reserving some of the cooking liquid, etc. etc. I have discovered that the real trick to creamy, buttery, heavenly potatoes is to use Yukon Gold potatoes instead of Russets. That's really all there is to it (along with butter, cream, salt and pepper). Just start with the type of potato that tastes better and mashes up better. I am not a potato snob, so New potatoes will do fine and Russets in a pinch.

Starchy potatoes, like Russets, have high starch and low water. Starchy potatoes are great for baking and French fries, and good as mashed potatoes. When cooked in water, they disintegrate; when cooked by dry heat, they become crumbly and fluffy.

All-purpose, or chef's potatoes, like Yukon Golds, have medium starch and medium water. All-purpose potatoes are great in stews, soups, mashed potatoes, or for roasting. When cooked, they are at once moist and fluffy: they keep most of their shape in soups and don't dry out when baked.

Here's my recipe for perfect Yukon Gold mashed potatoes. These are not for the faint of heart. Serves 4.

Ingredients

1/2 lbs Yukon gold potatoes, peeled and quartered length-wise
1/2 teaspoon Kosher salt
1/4 cup heavy cream
4 Tbsp butter
1 Tbsp milk
Kosher salt and Pepper to taste

Directions

Put potatoes into a saucepan. Add 1/2 teaspoon salt. Add water until potatoes are covered. Bring to boil, reduce heat and simmer, covered, 15-20 minutes, or until done - a fork can easily be poked through them.

Warm cream and melt butter, together, either in microwave or in a pan on the stove. Drain water from potatoes. Put hot potatoes into a bowl. Add cream and melted butter. Use potato masher to mash potatoes until well mashed. Use a strong spoon to beat further, adding milk to achieve the consistency you desire. (Do not over-beat or your potatoes will get gluey.) Add salt and pepper to taste.

Variations I suggest: add Boursin cheese, cheddar, chives, roasted red peppers, roasted garlic, a touch of horseradish, chopped artichokes, sautéed spinach or dandelion!

Chicken with Mushrooms and Leeks

Tue, 27 Jan 2009 10:57:13 GMT

I love this served over angel pasta tossed with a bit of olive oil and a touch of kosher salt. Oh, and a tall glass of Chardonnay!

Ingredients

5 organic chicken breasts, boneless, skin-on preferred
4 tablespoons olive oil
2 cups sliced leeks
1 ½ cup assorted sliced mushrooms
½ cup grape tomatoes, cut in half
zest of 1 orange
1 teaspoon chopped fresh sage
salt and pepper to taste
A pinch of crushed red pepper

Directions

In a heavy sauté skillet heat the olive oil on medium-high heat. Lightly dredge chicken in flour and sauté in the oil. Brown on both sides. Quickly add the remaining ingredients and sauté until the leeks are tender. Season and squeeze a bit of the juice of the orange over the chicken before serving. Serves 5.