Live to Eat … Eat to Live

Recently I started a series of blog entries I’m calling “The Common Senses of Caregiving.”  For the next several blog entries, I’m going to share some information about the importance of the sense of taste in caregiving (and for caregivers).

We equate eating with pleasure, sociability … and health.   Most of us can recall a home-made remedy our mothers or grandmothers gave us when we had colds or flu.  My wonderful Ukrainian grandmother, Johanna Timko, would mix a potent concoction of honey, whiskey, and lemon to soothe our sore throats and colds.  Did that crazy cocktail work because of the combination of ingredients, or because of Grandma’s love?  It didn’t matter; it just worked.

When we are young and healthy, we relish a great meal.  We take eating for granted.  But as we age, and particularly if we are sick or under prolonged stress, eating becomes difficult and even -- at times -- dreaded.  As we age, our taste buds regenerate at a slower rate, reducing our sense of taste.  Some of drugs and medical treatments used for cancer, epilepsy, Parkinson's disease, diabetes, and high blood pressure can make food taste strange (or just plain bad), thereby diminishing our appetites. Damage to the brain stem, thalamus, and cerebral cortex may also cause taste problems. 

When we are caring for someone who is ill, we will likely encounter challenges getting them to eat.  We may also struggle with our own nutrition: we may find ourselves not hungry, skipping too many meals, or eating overly processed fast food on the run.  Our goal – for our loved ones and ourselves -- is to ensure enough nutrition to meet the body’s intensified needs. Weight loss is often inevitable with certain disease processes, but it should not be inevitable for caregivers, who need to maintain their own health, strength, and energy to provide the care required.  

Three fundamental issues may need to be addressed before we can help a loved one or patient eat and drink.   Let’s examine the first of them today: 

Sore Mouths and Throats
Chewing and swallowing can be painful to those suffering from canker sores, thrush infections, dry mouths, and cracked or chapped lips.  The best approach is early diagnosis and immediate treatment with appropriate prescribed and over-the-counter medications.  You might also try: 

·         Moist and liquid-based foods, such as soups and stews, that are easier to swallow.

·         Soft, cold foods like ice cream, frozen fruit-juice bars, watermelon and grapes. These may feel and taste better than other (chewy, crunchy, harder) foods.

·         Using a straw to make swallowing water or beverages easier.  

·         Apple and nectar juices instead of highly acidic juices (like tomato and citrus) and carbonated beverages.

·         Avoiding spices. 

These simple adjustments can significantly ease mouth and throat pain … and make eating not merely tolerable, but enjoyable again.
 

Refreshing Our Homes

The smells caused by illness, infection, incontinence and many forms of treatment can quickly accumulate in our homes, and can permeate and linger.  These smells are complicated to manage each day, but can evoke particularly painful emotions after a loved one has died at home.

To alleviate these complications more easily, caregivers (and friends and helpers of caregivers) should consider:

·        As You Begin

o       Apply a thin layer of Vicks ® Vapo Rub ® inside your lower nostrils and under your nostrils to counteract odors as you work.  At the end of the day some odors may remain in your nose despite this, these odors will subside within several hours.

o       Wear old clothes that can be washed repeatedly or discarded if the smell is too pervasive. 

o       Wear gloves to protect hands from abrasive cleaning agents, objects that can cause injury, and clinging odors.

·        Ventilation

o       For most of us, the days after the loss of a family member are difficult and hectic.  Ensuring open ventilation is one of the most immediate and least-time consuming measures you can take to ease unpleasant smells in the home.  Open the windows for as long as possible; you may find that you must keep them open for days, or in extreme cases, weeks.

o       Install new filters in the air ducts (heating, air conditioning), preferably filter strips with activated charcoal or silica gel that will absorb the particles in the air and greatly reduce odors.  Promptly dispose of old filters.

·        Cleaning

o       Launder lines and towels as quickly as you can.  Try to avoid mixing them in the laundry basket with other items. Laundry may need to be washed twice, using bleach if possible in the first wash.

o       Launder clothes (including robes and pajamas) as quickly as possible, even if you plan to eventually pack them up and give them to local charities.

o       Clean kitchens/bathrooms with bleach.  Do not mix bleach and ammonia products as that will release toxic fumes.

o       Odors on furniture and small areas of carpeting may be neutralized with a pet deodorizer. 

o       When cleaning carpets, remember that odors permeate down to the floor padding, so both sides of the carpet and the padding should be cleaned. 

o       Odors also remain in walls.  Usually, these odors can be eliminated by washing the walls. If odors linger, a fresh coat of paint may be required. Using a primer will seal in any lingering odors.

o       When cleaning is complete, have someone who was not involved in the cleaning walk through the home to note if odors persist. 

·        Professional Cleaning

o       While this can be the most costly option, it is frequently the most effective.  Professionals who clean up after fires and floods are very familiar with how to eliminate locked-in odors; these professionals may also thoroughly clean the air ducts.

·        Removal

o       There are extreme cases where stains and odors are so locked into furniture, bedding, drapes, and carpeting that repeated attempts at cleaning do not help (and where it may not be cost-effective to call in professional cleaners).  In these cases, removal and replacement may be the only option.  This can also be the hardest option, particularly if it involves a cherished quilt, or a beloved couch. 

Most family caregivers understand that long after we’ve cleansed our homes of a smell, it may linger in our memory and be easily triggered.  Sometimes, these memories bring us joy (the memory of a loved one’s perfume); at other times, the mere smell of bleach or other cleaning products can trigger difficult memories.  The power of smell to permeate our memories and emotions cannot be underestimated.

Sense of Smell: A Brief Case Study

Caring for Charles was challenging in many ways; he was resistant to suggestions, changes in his daily schedule, and the need to move off his recliner.  Charles suffered from obesity, diabetes, open wounds, incontinence, and a fungal infection on the skin of his legs.  His health was a time bomb, heightened by so many complications.  

In addition to many predictable challenges, those of us who served as Charles’ caregivers had an additional hurdle to clear:  the overwhelming, sickeningly sweet foul odor when we opened the door of his home. We provided health aides to help with his personal hygiene and housekeeping.  His sister and brother visited on the weekends and tried to “freshen” the apartment by hanging dryer sheets and placing room deodorizers in each room.  He had clean clothes, towels and sheets.  The trash was removed every day.  The odor came from Charles himself and especially from the infections of his wounds and rashes.  Despite the wave of nausea that hit us as we entered his home, Charles’ wound and skin care had to be done daily.  

We found a very simple coping strategy:  by applying a thin layer of Vicks ® Vapo Rub ® on the inside of and under our nostrils just before entering his home to provide care or visit, we could counteract the bad odors without affecting Charles. After leaving Charles’s home we would use a light air-freshening spray (like Febreeze ®) to our clothing as we did have others to visit.  We never did these activities in Charles’ presence because we did not want to embarrass him in any way.

(By the way, the next time you have to take a long flight, remember this solution!)

Sense of smell

As we age, all our senses diminish to some degree.  The sense of smell usually fades but does not completely disappear.

Smells fall into 3 broad categories; good, bad and strange.

Hmm, what smells good to you?  Apple pie, cinnamon rolls, chocolate brownies, coffee??  Smells can certainly entice an appetite. This may be especially effective with the elderly or a busy caregiver, bringing back memories which could have the desired effect of getting a bite or two into a fussy eater.  

Tempting smells can just as easily cause nausea.  Remember being a coffee addict until you got pregnant? A simple whiff could send you running for the nearest bathroom. The individual who is ill may have the same response.  

Flowers and perfumes can also have either effect.  It is best not to provide care or visit wearing heavy perfumes or lotions.  Massaging a loved one with an overly fragrant lotion should be a pleasant, comforting experience not one that results with nausea or a coughing spell.    

Some “bad” odors are simply unavoidable; these are usually related to spoiled foods, old trash, body odors, products of elimination, vomitus, and infection. It is best to prevent or control the cause of these smells instead; good ventilation, removal of the items causing foul odors as soon as possible, cleaning up spills and using activated charcoal products to control odors. Covering the odors does just that and the mixture of smells is often worse than before.  When trying to remove offense odors care should be taken not to use strong smelling cleaners, such as heavy scented detergents, or bleach.  Strong smells may result in respiratory irritation, headaches, nausea, vomiting, or loss of appetite. Heavy air fresheners, perfumes and candles can be as reactive to the individuals in the home as the odor itself.
The use of candles should be avoided in homes where oxygen is in use to prevent the rapid spread of fire.
 
Strange odors are those not familiar to you, usually related to cooking spices.  If the individual and their family are not bothered by the smell, it can usually be tolerated for short intervals by visitors.