Contents 4 Letter from the Editor 24 Sponsors & Locations
DEPARTMENTS
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HEALTH 5 Are You Eligible for Medicare?
AEP is almost here! Take a Deep Breath
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October is healthy lungs month!
7 Home Oxygen Therapy 20 Community Resources 23 Caregiver Tips: Barrier Creams
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CULTURE 22
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12 Leo Tangatailoa: 4th Genera
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tion Wood Carver Frogs & Frogging The Many Jobs of Josephine Bandmann The Versatility of Tofu “Around Hawaii� Crossword Puzzle Keiki Wa`a Project
On the cover: Leo Tangatailoa is the 4th generation of wood carvers in his family. Born and raised in Lahaina Maui, he has been carving for over 35 years. In this photo, he works on a piece of milo wood that is taking the shape of a mahi mahi and turtle. More photos in the centerfold.
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Letter from the Editor
Elder Resource
What is more important: Health or culture?
Health & Culture for Seniors & Caregivers in Hawaii
At Elder Resource we believe both are equally important. Culture engages people, sparking enthusiasm for the pursuit of a meaningful life, despite limitations. For over two years, we’ve been developing Elder Resource Magazine on Kauai to see what works & what doesn’t, what information seniors & caregivers want and need to know about healthy aging, and how to get this resource into the hands of those who need it the most. The result? An educational magazine designed for the mind, body and spirit. It’s a magazine that inspires people to stay active and socially engaged, while providing continuing education for those involved in the aging process--either first-hand or as a caregiver.
Christine Bothmer, RN Editor & Publisher
Julie Bothmer-Yost Graphics, Design & Millennial Perspective
Judith Lee Copy Editor & Creative Consultant
Contributing Writers Paul Gammie Yolie Yee Misao Tamura Advisors
Hawaii’s state-funded hospitals, once considered to be the state’s healthcare safety net, are being subjected to rounds of alarming job and service cuts. For this reason, coupled with the growing population of older adults and the relative decrease in the numbers of potential caregivers, continuing health education for seniors & caregivers is a modern-day necessity.
Winifred Tamura-Lis, PhD, MSN, RN-BC
Continuing health education for seniors & caregivers is our primary goal, and we look forward to providing this resource to communities around the state. Whether you are a private citizen, a small business owner, a corporate, non-profit or government executive, your opinion is important to us. Please contact us if you are interested in learning more or would like to have this resource in your community. Contact me directly at cbothmer@elder-resource.org or call (808) 212-2760.
© Elder Resource, 2015 Printed in Hawaii
-Chris Bothmer, RN 4
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Gerontological Nursing
Allen Stinson HR & Logistics
Leilani Hino Auntie Advisor
The material in this magazine is for educational purposes only and not intended to replace the advice of your healthcare provider. All rights reserved. Advertisement in Elder Resource does not imply endorsement of products or services. Subscriptions $24 per year (6 issues).
Contact Elder Resource Mail: P.O. Box 1257 Koloa, HI 96756 Email: info@elder-resource.org Phone: (808) 212-2760
Are You Eligible for Medicare? AEP is Almost Here
By Yolie Yee, VP of YeeCorp Financial
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hat is AEP anyway? For those who are eligible for Medicare, the AEP is the “Annual Enrollment Period” during which time you may select different Medicare Advantage plans. It affects everyone who is medicare-eligible.
Who is eligible for Medicare? Generally anyone who is 65 or older or those younger than 65 who have qualified for social security disability benefits. Each year, AEP runs from October 15th through December 7th. As early as October 1st of each year, people eligible for medicare will begin receiving volumes of information on different plan offerings. There is a method to this madness! As you get these packets of information put them in a neat pile somewhere as you might want to sift through it during the AEP, but with a more targeted effort later. What is more important to watch for in the mail is your “Annual Notice of Change” (ANOC) or “Evidence of Coverage” (EOC) letter from your current medicare advantage plan. Read this letter carefully as it will tell you whether your plan will remain the same, change or terminate come January 1st. All medicare advantage plans are required to mail this letter to their members by October 2nd of each year. Read this letter carefully, and do not be afraid to call and ask your plan to explain the letter so you understand what changes will be happening on January 1st. The letter will tell you if you need to change. Once you understand what the changes will be, think about the plan you had in the past year. Were there any claims problems? Were the out-of-pocket expenses you paid unusually high, prescription costs high, or did you hear of other benefits offered by other plans? This is the time to look and compare all of these features. Check out the website, www.medicare.gov. At this site you may compare all the 2016 plans that are available to you and compare them side-by-side, apples-to-apples. When you have a general understanding of the plans, make it a point to attend group presentations of these plans or sift through the packets of information for the specific plan that you are interested in. Consider if changing to another plan will give you greater savings, access to more benefits,
and/or give you greater value than what you currently have. During the AEP, read the information packets, attend group presentations, have face-to-face meetings with plan representatives, and enroll in a new plan if that’s what you want. If you later learn about a better plan during the AEP, you can enroll in that better plan and that will automatically disenroll you from the first plan. The AEP lasts seven weeks, and you may change plans as many times as you want during this period, but the plan you are LAST enrolled in will be your plan effective January 1st. YeeCorp Financial & Insurance Services was established in 1988, and advises clients on life and health insurance. I can be reached at (808)245-5384, ext 23 if you have additional questions regarding medicare.
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Take a Deep Breath October
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Healthy Lungs Month By Christine Bothmer, RN
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f you have a hard time breathing, it’s hard to enjoy life’s simple pleasures. Treatments and lifestyle changes can help you feel better, stay more active, recover from the flu or pneumonia and slow the progress of chronic lung diseases like COPD.
The lungs are one of the few vital organs with an opening to the outside of the body, so they have unique ways to protect themselves. The upper respiratory tract is lined with mucus and hairs for trapping particles that could damage the lower respiratory tract. The lower respiratory tract is where inhaled oxygen is absorbed into the body and carbon dioxide waste is released with every breath you take. The lungs’ defense mechanisms can become overwhelmed by dust (small airborne particles) or fumes, so wear protective gear if you are unable to move to clean air. This is especially true for people exposed to dust or fumes on a regular basis, because lung damage often starts long before side effects such as shortness of breath appear. Even with low levels of dust or fumes, over time the effects accumulate and are often irreversible. ASTHMA. In the short term, small amounts of dust and fumes can cause an asthma attack. For some people, breathing in these substances can cause their lungs to over-react, producing too much mucus and squeezing the airway narrower to prevent the vapors or dust from entering. This can block oxygen too, and in Hawaii approximately 5000 people are seen in emergency rooms each year because of asthma according to the Hawaii State Department of Health. While asthma-related deaths are rare, they are highest among people ages 65 and older than any other age group (Asthma Facts--CDC’s National Asthma Control Program Grantees, 2013). 6
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Continued on Page 8
DO’S and DON’TS of Home Medical Oxygen Therapy By Paul Gammie of Gammie Home Care Medical research and technology have given today’s physicians a powerful tool to assist patients with a variety of respiratory and cardiac challenges. Use of medical grade oxygen is a proven therapy which has helped many people in our community live better and fuller lives. If a family member or friend is someday prescribed by their physician to begin home oxygen therapy (for whatever reason), here are some interesting things to consider: DO be supportive of the patient and understand this therapy can potentially give them renewed energy, better mental clarity, more restful sleep and better endurance for activities of daily living. DO encourage a patient to continue their normal living patterns, even while on oxygen. Do go to family gatherings, sporting events and various social events, etc. Oxygen is a tool for them to continue living the lives they enjoy, not staying at home and being a hermit.
DO understand the equipment providing this therapy is reliable and very safe when properly handled. DON’T have open flame near a person using home oxygen. Oxygen is not an explosive gas, but it does promote combustion. Oxygen will not explode if exposed to open flame, but flame will burn faster and hotter when exposed to high levels of oxygen. Never allow a patient’s oxygen tube to catch on fire! DON’T put filled oxygen tanks in the trunk of your car. This can be very dangerous should an accident occur as pressure inside the tank can cause the tank to become a projectile if it’s damaged during an accident. Always store oxygen tanks in the middle of the car when transporting, as this is the safest area in the event of an accident. DON’T use a higher dose of oxygen than what your doctor has prescribed. Too much oxygen can sometimes be just as dangerous as too little oxygen. If in doubt, call your doctor. Oxygen supplies, education on usage and helpful information is available in Lihue at Gammie Home Care. 2906 Akahi St., Lihue. Their phone number is 632-2333. Also on Maui, go to www.gammie.com
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Continued from Page 6 Asthma can begin at any age. For older adults, an asthma attack may not be recognized as asthma if: they have never been diagnosed with asthma; they have a chronic disease such as COPD or heart failure; they are recovering from the flu, a cold or pneumonia.
From the National Institutes of Health: COPD (chronic obstructive pulmonary disease), is a progressive disease that makes it hard to breathe. “Progressive” means the disease gets worse over time. Most people who have COPD smoke or used to smoke. Long-term exposure to other lung irritants—such as air pollution, chemical fumes, or dust—also may contribute to COPD. In COPD, less air flows in and out of the lungs because many of the lung’s tiny air sacs are damaged and don’t work
as well, and/or lots of thick mucus forms in the airways, making the airway smaller and making it hard to breathe. COPD develops slowly. Symptoms often worsen over time and can limit your ability to do routine activities. Severe COPD may prevent you from doing even basic activities like walking, cooking, or taking care of yourself. Treatments and lifestyle changes can help you feel better, stay more active, and slow the progress of the disease. Pneumonia is an infection of the lungs. The infection inflames the lungs’ tiny air sacs, which may fill up with fluid or pus, causing a cough, fever, chills, and trouble breathing. Many factors affect how serious pneumonia is, such as the type of germ causing the infection, your age and overall health. Many people can be treated for pneumonia at home with oral antibiotics. Some people may need treatment in a hospital. It usually takes 2 to 3 days to feel better, but tiredness from pneumonia can last for a month or more. Anyone who has worsening symptoms should see a doctor. Aspiration Pneumonia can occur if you inhale food, drink, vomit, or saliva from your mouth into your lungs. This may happen if something disturbs your normal gag reflex, such as a brain injury, swallowing problem, or excessive use of alcohol or drugs. It’s easy to get discouraged when you can’t catch your breath or are coughing a lot, especially if you have a chronic disease like COPD. Continued on Page 10
Protect yourself from the flu and many types of pneumonia by keeping your vaccinations up to date. Photo: Jim Gathany/CDC 8 elder-resource.org I October 2015
For tips on how to prevent aspiration pneumonia, and answers to common questions, see page 10.
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Continued from Page 8 By keeping up on the latest developments, communicating regularly with the healthcare team, and starting good habits known to improve the lives of people with COPD, many people continue leading meaningful lives. Ask your healthcare team what you can do to stay strong, and many people find yoga and meditation helps with breath control.
Are you a caregiver? Help prevent aspiration pneumonia by: • Offering thickened liquids and proper food consistency according to their prescribed diet • Assuring the person is alert before offering liquids or food • Assisting the person to sitting straight up for eating and drinking • Encouraging them to tuck their chin when swallowing • Avoiding rushing & distractions • Encouraging the person to sit upright for at least 30 minutes after meals.
A doctor uses a stethoscope to listen to a woman’s lung sounds. Photo: Amanda Mills/CDC
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Common Questions, Answered Rest or exercise? If you’re recovering from an infection such as pneumonia or the flu, it is important to get plenty of rest while your body fights off the infection. Add exercise slowly, after your healthcare provider says it’s okay to start exercising again. For chronic conditions such as COPD, it is important to follow an exercise program approved by your healthcare provider. This will help you stay strong and keep your breathing muscles in good condition--essentials for maintaining your independence. What about liquids? Sometimes even drinking and eating is tiring, but it is important to stay hydrated. If a person gets dehydrated, the phlegm and mucus in their airways can get so thick that they can’t cough it up. Staying hydrated allows you to clear your airways more easily. Some people must limit fluids because of a chronic illness. Having a hard time sleeping? It is hard to sleep when you’re short of breath. Try elevating the head of your bed. This allows gravity to give your lungs more room to expand. If you don’t have an adjustable bed, try using extra pillows under your head and shoulders or place 6-inch blocks under the feet of the head of the bed. How much to elevate? A good place to start is 30°. During severe shortness of breath episodes, sitting straight up gives your lungs the most amount of room to expand. What about medications? Report any unexpected or severe side effects to your doctor, who can change the dosages or switch you to a different but similar medication that might help you feel better. For asthma that is not well controlled, ask your healthcare provider for an asthma action plan which will help you take steps in preventing an asthma attack from getting worse.
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Leo Tangatailoa
4th Generation
Wood Carver
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By Christine Bothmer
eo Tangatailoa is the 4th generation of wood carvers in his family. Born and raised in Lahaina Maui, he has been carving for over 35 years. “A lot of people ask me ‘How did you learn?’ and I say ‘I don’t remember . . . because I was so young. All I know is all my life, I know how to carve.” The designs carved into the heads of the tikis have different meanings. “The wave sign represents water. water is life,” explains Leo. Other common designs include leaves for healing, nihoniho (small teeth) for protection, and the zigzag represents the never-ending connections from generation to generation.
Loisi applies a special coating that gives the carvings a nice shine but also allows for the texture of the wood to be felt.
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Leo & Loisi Tangatailoa at their stand at the Roxy Square in old Kapaa town, Kauai. Leo also displays his carvings at Kilohana and the Grand Hyatt. Call him at (808) 212-2958 for days & times.
Leo: “It’s like you’re making a canoe. If you carve out the whole thing at once that canoe won’t last. It will crack. You have to do a little at a time and let it rest.” “You know you have a masterpiece when you work on it until--if you touch it one more time, you’ll ruin it.” --Leo Tangatailoa. Photo by Loisi Tangatailoa
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Frogs and Frogging Excerpt from the journal of Misao Tamura
Living in the valley for almost 22 years, I am well aware of the ways of the frogs. February and March is usually the mating season. The male and female will congregate from afar to a pond, which in our case was next to the house. Mating commotions take place during the day but are most active on a moonlit night. Then they return to where they came from, though a number will remain in our pond. After a period, when the egg laying time comes, the male frog rides the female and endlessly strokes out the jelly-like mass containing hundreds of 1/8” round beads of eggs on the surface of quiet water. In time the eggs hatch to tiny tadpoles. Gradually the hind legs grow first at the base of the tail and finally the fore legs, after which the tail breaks away. Frogs eat bugs, flies, insects, and other aquatic animals. They also live on certain vegetation and fruits. Depending on the environment and supply of food, it will attain adulthood in a few years. In the beginning we never learned to prepare frog for food. Mr. Chui of Kapaa came now and then, and we would catch a dozen frogs for him to take home. He was a happy man. Then grandfather Fukuda returned back to Hanalei after living in Waimea Valley of South Kauai, working in the taro paddies for a few years. He had learned how to prepare frog for food. On one of his visits to Kilauea, he asked us to catch a few frogs. He cut off the head, pulled the skin off and removed the gut and the ends of the legs. It was cooked in a skillet with a little water, soy sauce, sugar and it
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American Bullfrong photo: NPS/Herbert Young
tasted good. A very clean protein and it didn’t smell fishy.* We were introduced to a new food. Thereafter, like fishing, frogging became one of our past times. Frogging is best on a dark night, as they are alert when the moon is up. We did a lot of frogging up and down the Kilauea River. The mountain streams of Puu Ka Ele and Kaloko were our favorite areas, frogging up one stream and then another stream on our way back. On a good night it was possible to gig 50 to 100 frogs during a night. The frog population has declined since the introduction of the cattle egrets which feed upon the tadpoles and growing frogs. *Editor’s note: Not to be confused with the cane toad, which has toxic glands and should not be eaten.
What is more important:
Health or Culture? At Elder Resource, we believe both are equally important. Culture sparks enthusiasm for the pursuit of a meaningful life, despite limitations. Our Mission: continuing health education for seniors & caregivers.
Sponsor Elder Resource Magazine in your community
info@elder-resource.org
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The Many Jobs of Josephine Bandmann
--excerpts from an interview with Christine Bothmer
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was born and raised right above Opaekaa Falls. My dad used to milk about six or seven cows, and we had to go down to the village to deliver milk. We walked down the trail, down to the Chinese man and bring him a gallon of milk. Then we walk along the river to the Japanese family, Fujita, and give them a gallon of milk. Then we get across the rails over there where the mango tree was and we give one gallon milk to the Japanese family. Then we go home. In 1939 my dad sold our place and we moved to a smaller place where I’m living right now.
I worked for Kondo’s Soda Works, right down here in Kapaa town. We bottled the sodas. I worked for him for awhile running the operator machine, watching the bottles go by.
thing what I did. In 1991 my husband passed away. Then the hurricane came by, Iniki. Iniki took my house. So I stayed with my daughter for a while until I built my house in 1994.
I came 16 years old and went to work for Hawaiian Fruit Packers--the pineapple factory up in Kapahi. My job was building boxes because those days they pick the pineapple from the fields, put it into boxes and bring it the cannery. Then I worked in the hot can department, catching the cans coming out of the cookers. My last job there was I was the crush cooker. I see that all the crush gets into the tanks. And of course I tend to my kids. My husband worked for the Lihue Plantation. We got married in 1955, raised our four kids, two girls and two boys.
I just celebrated 20 years volunteering for the Foster Grandparent program. I volunteer at Kapaa Elementary. I enjoy what I’m doing.
I had my own farm. I raised my own beef, I had cows, pigs, chickens, I had a lot of eggs, and I worked in the pasture--I can fix fence, I can use a hammer and a power saw and all that kind of stuff. I enjoyed every16
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People ask me ’when are you going to retire?’ I say ‘Well, when my legs cannot go, my hands cannot work, then maybe I will retire.’ Every night I ask the lord to give me a good day the next day, give me a good night’s sleep so I have a good clear mind and strength in my body. If we don’t help our kids and our grandkids, who is going to help them? I ask the lord to let me live to 100 with a good clear mind so I can keep helping. I’m still needed on this earth.
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C. Bothmer
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Miso Soup By Christine Bothmer
oday you can buy miso soup freeze dried in little packets, and just add boiling water. This is very convenient, delicious and a great addition to an emergency food kit. But when I have time, I like to make it from scratch. Nowadays, “from scratch” usually means going to the grocery store and buying all the ingredients separately and combining them in some way--chopped, sliced, mashed; baked, boiled, fried, or served raw.
Miso Soup (2 servings): • Dried bonito fish soup stock or other dashi • 2 Teaspoons miso paste • 2 Tablespoons soft tofu, cut into small squares • 1 Teaspoon dried wakame seaweed • small amount of sliced green scallions Soak dried wakame in a small amount of water to reconstitute; drain. Follow package instructions to make 1 cup dashi. While boiling gently, add miso paste and stir. Once the paste dissolves, add seaweed, tofu and scallions. Heat through and serve hot.
Left: In this Meiji Era photograph by T. Enami, this young Japanese girl grinds soybeans. She would probably have a good laugh at our modern interpretation of “from scratch.” 18
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Hiyayakko
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By Christine Bothmer
• • • • • • • • •
5 ounces firm tofu ½ teaspoon grated ginger 1 ½ teaspoon chopped green onion 1 ½ teaspoon soy sauce 5 ounces firm tofu ½ teaspoon grated ginger 1 ½ teaspoon chopped green onion 1 ½ teaspoon soy sauce 1 pinch toasted sesame seeds
C. Bothmer
cool summer Japanese dish. This is one of many ways to make it--experiment with soft tofu and other ingredients, such as dried bonito flakes, perilla leaf, pickled ginger. Some people add a small amount of sugar, sesame oil or lemon juice to the soy sauce before drizzling over the tofu.
Slice tofu into bite-size squares or leave whole. Drizzle soy sauce over and top with your favorite ingredients. Enjoy!
Immature soybean pods. Photo: Peggy Greb/USDA
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photo contributed by Lola Cruz of Kekaha Sofia Castro from Kekaha and Jojo Hilo from Kaumakani won for the opening game of Water Balloon Toss. Kekaha Seniors won several of the games this year, including bingo.
Hawaii Community Resources Contact info for seniors & caregivers. Area Code is 808.
County Senior Centers are a gathering place for social events, classes, exercise groups, arts, crafts, health & community information. Kauai 241-4462 Maui 270-7308 Honolulu 973-7258 Hawaii 961-8708 Aging and Disability Resource Centers help older adults, individuals with disabilities, and family caregivers find options for long term supports and services. Kauai 241-4470 Oahu 768-7700 Maui 270-7774 Molokai 553-5241 Lanai 565-6818 Hilo 961-8626 Kona: 323-4390 Child Welfare Services To report abuse or neglect, call: Oahu: 832-5300 Neighbor Island call 1-800-494-3991 Adult Protective Services To report abuse, neglect, financial exploitation by others or serious endangerment due to self-neglect of a vulnerable adult, call: Kauai 241-3337 Oahu 832-5115 Maui 243-5151 East Hawaii 933-8820 West hawaii 327-6280 USDA Home repair grants Home repair grants for income qualified homeowners ages 62+. To see if you qualify call: Kauai 245-9014 Oahu 541-2600 Maui 871-5500 Molokai 553-5321 Hilo 933-8330 20
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Keiki Wa`a Project By Christine Bothmer
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he Queen Lili`uokalani Children’s Center’s Ohana Caregiver Group was treated to an interactive lesson recently by maritime educator Steven Soltysik. “The lesson is deeper than what appears on the surface,” explains Captain Steve. Hands on and simple, the lesson emphasizes “gaining a sense of direction at a young age.” After a short video and talk about Hokulea’s current journey around the world, keiki and caregivers were given basic instructions for building either a model Hokulea or a fishing canoe. The wooden model parts were made by inmates of the Kauai Community Correctional Facility.
Captain Steve (above) and his assistant Lana Paki (right) helping kids assemble their canoes. Image on page 3: Uncle & nephew enjoying an ahi poke pupu.
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CAREGIVER TIPS
product review C. Bothmer
DON’T LET THE BABY AISLE SCARE YOU By Christine Bothmer, RN
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or the best choice in barrier creams, steer clear of the home care product aisle and check out the baby section. You’ll find creams with a variety of skin protectants, including zinc oxide and dimethicone (silicone); also plant extracts, fish oils and beeswax.
What is barrier cream? Barrier creams help prevent skin damage caused by exposure during episodes of incontinence. They are an oily barrier between the skin and waste. Other names to look for on the label include moisture barrier, skin barrier, skin protectant, diaper rash cream or paste.
The most cost effective choice? Usually petroleum jelly. Keep an eye out for sales, which can drive prices even lower on some of the more premium products which contain soothing plant extracts. The highest price isn’t always the best choice--avoid the temptation of fancy labels and check out the ingredients list Crossword Solution
to be sure your money is well spent. How to use? Apply barrier creams to clean skin that could become soiled from incontinence. How much to use depends on several factors including the frequency of incontinence episodes and the condition of the skin. When cleaning, it’s not necessary to remove all the barrier cream--excessive wiping can actually damage delicate skin. Simply clean any soiled areas and re-apply barrier cream. For persistent rashes or raw skin, talk to a healthcare provider. It could be a skin infection that needs special medication, usually in ointment or powder form. If you work for a healthcare facility, follow their established policy of care. While it can be tempting to follow the advice of others, especially co-workers who have a lot of experience, take the time to review the guideline in the Policies & Procedures Manual, usually found in the nurses’ station. Your workplace may have it under a different name, so ask your charge nurse if you are unable to find it. visit our archives I elder-resource.org
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