Dr. Theresa Redling, D.O.

A recent study shows multivitamin supplement use is associated with less cognitive decline. So it is recommended that older adults take a multivitamin supplement. In addition most people need a vitamin D3 supplement Theresa M. Redling DO, FACP Chief, Geriatric Health Cooperman Barnabas Medical Center Director, Maida Geriatric Institute Assistant Clinical Professor of Medicine Rutgers-New Jersey Medical School

Sadly hospice very underutilized, so it depends on how your mother was prior to being enrolled. If one is not taking anything by mouth, no food or liquids, the average time to death is 10- 14 days. Hospice care is authorized for people with < 6 months to live if disease progresses at its usual course. People are recertified every 3 months. Theresa M. Redling DO, FACP Chief, Geriatric Health Cooperman Barnabas Medical Center Director, Maida Geriatric Institute Assistant Clinical Professor of Medicine Rutgers-New Jersey Medical School

Firstly, you need to determine why your bowels are loose. Are you lactose intolerant? Are you taking a supplement that can cause loose stools ( magnesium is classic). You need a complete evaluation by a physician Theresa M. Redling DO, FACP Chief, Geriatric Health Cooperman Barnabas Medical Center Director, Maida Geriatric Institute Assistant Clinical Professor of Medicine Rutgers-New Jersey Medical School

Yes we prefer using SSRIs like escitalopram ,citalopram, sertraline, and others in this class.at times we may use benzodiazepines ( like alprazolam or lorazepam) until the SSRIS start to work ir to augment the drug. Treatment if anxiety/ depression in the elderly is both safe and effective. Theresa M. Redling DO, FACP Chief, Geriatric Health Cooperman Barnabas Medical Center Director, Maida Geriatric Institute Assistant Clinical Professor of Medicine Rutgers-New Jersey Medical School

Nothing has changed as far as the care that hospice provides. I am not sure how old this question is- as we are not isolation residents in nursing homes or other elder care facilities, or limiting visitation- although Covid has certainly not gone away. Hopsice provides 1.5 hours of an aide a day, a hospice nurse that visits regularly, a spiritual advisor, volunteers, medications for the condition the person is on hospice for and equipment like hospital beds, oxygen, etc. Theresa M. Redling, DO, FACP Chief, Geriatric Health and Disease Management Medical Director Maida Geriatric Institute at Cooper Barnabas Medical Center Assistant Clinical Professor of Medicine Rutgers New Jersey Medical School Office 973-322-7636 Fax 973-322-7673

I am not sure why you cant visit now. I am not sure how much your mother can understand and integrate new information. If you can reach out to her frequently by phone or through video calls, perhaps the NH staff can help here. Some people with dementia may actually do better without constant reminders that their loved ones are not with them, meaning frequent calls may make the person more agitated. So less communication maybe better. Making sure your mother's room is decorated with photos of family and things that make it homelike usually are comforting things as well. With dementia there is not a " one size fits all" plan of care. Each person requires their own individualized care plan Theresa M. Redling, DO, FACP Chief, Geriatric Health and Disease Management Medical Director Maida Geriatric Institute at Cooper Barnabas Medical Center Assistant Clinical Professor of Medicine Rutgers New Jersey Medical School Office 973-322-7636 Fax 973-322-7673

Most nursing home staffs are adept in assisting residents to adjust to their new home. Make her room as home like as possible Family photos, her favorite quilt, etc. Make sure she can easily access you via phone, tablet, etc Speak to the facilities social worker and ask them to engage your mother in any cognitively and physically appropriate activities. It may take a few months for her to adjust - but most do. Theresa M. Redling DO, FACP Chief, Geriatric Health Cooperman Barnabas Medical Center Director, Maida Geriatric Institute Assistant Clinical Professor of Medicine Rutgers-New Jersey Medical School

Serious illness stirs up all kinds of emotions. Your husband may have some unresolved guilt or other emotion that is making it difficult to communicate with you. Maybe he has some past experiences that color his response. Did he love someone who had a bad hospice experience ? Does he feel like you are giving up on her ? or maybe he has had an experience that reflects all his anxiety about her care and diagnosis. Ask him- what are his concerns and why is he angry (Is he ?) First, you both should see what your mothers wishes are for her care, if she can participate in her decision making. If she is too ill now, have you discussed circumstances prior that could direct you to choose the best options for her care that reflect her preferences ? If so, that takes precedence over others decisions- although there may need to be some realistic discussions about expectations. If her wish is to live to see her grandchild married and they are only 15, then perhaps a discussion about what is important to her now is indicated. I want to be home with my family, I dont want to spend my last days in the hospital, I want to enjoy the foods I love etc I hope you have a good relationship w her doctor. Please ask the doctor to be frank and transparent about her condition. IF she receives treatment, is she expected to live for weeks? Months ? years ? Is she well enough to get aggressive treatment- and is this an option? Surgery ? chemo ? radiation? With a realistic picture of her cancer trajectory you maybe able to better put together a treatment plan. If there is a lot of tumor spread, and or she is very frail, then the best option maybe hospice w focused comfort care. Sometimes we bridge the transition to hospice with palliative care- a focused approach towards managing symptoms in people with life threatening or life limiting illness. An understanding that hospice is not giving up it is respecting the person to allow them a peaceful and symptom free transition to end of life care. Theresa M. Redling, DO, FACP Chief, Geriatric Health and Disease Management Medical Director Maida Geriatric Institute at Cooper Barnabas Medical Center Assistant Clinical Professor of Medicine Rutgers New Jersey Medical School Office 973-322-7636 Fax 973-322-7673

Sundowning is term used to represent increasing confusion in people with cognitive impairment in the evening. There are many reasons this may happen. They include days end fatigue, change in sleep pattern. A doctor should see if there are any other medical reasons this is happening as well. There are meds available to help with evening agitation. See if you can find a Geriatrician or Geriatric psychiatrist to help or an internist with solid Geriatric skills. Good luck! Theresa M. Redling DO, FACP Chief, Geriatric Health Cooperman Barnabas Medical Center Director, Maida Geriatric Institute Assistant Clinical Professor of Medicine Rutgers-New Jersey Medical School

Hospice is a benefit offered by most health plans. It is focused comfort care for those that have less then 6 months to live if the disease progresses along its natural course.this benefit offers a hospice nurse at least weekly, 1.5 hours of an aide, all the medical equipment needed for the illness, all the medications needed for comfort a social worker, pastoral care, volunteers and a physician that oversees the patients care. The goal is comfort and dignity at the end of life. It allows for another layer of care for those with advanced disease. Theresa M. Redling DO, FACP Chief, Geriatric Health Cooperman Barnabas Medical Center Director, Maida Geriatric Institute Assistant Clinical Professor of Medicine Rutgers-New Jersey Medical School

Subacute rehabilitation is sometimes called geriatric rehab as it is often more appropriate for seniors- requires the person to rehab 1.5 hours a day vs acute rehab 3-5 hours/day. Most SAR is in a long term care facility(a nursing home). Certain beds are desginated as rehab beds. The payment is completely different for SAR- billing a patients Medicare A plan. Where LTC is out of pocket or paid for by Medicaid. Theresa M. Redling, DO, FACP Chief, Geriatric Health and Disease Management Medical Director Maida Geriatric Institute at Cooper Barnabas Medical Center Assistant Clinical Professor of Medicine Rutgers New Jersey Medical School Office 973-322-7636 Fax 973-322-7673

Alzheimer's is the most common type of dementia. There are many types including vascular (multiple strokes ),lewy body, Parkinson's - and others. A physician should start the evaluation by taking a full history, especially looking at meds that can cause confusion . Depression should also be ruled out. Brain imaging like an MRI should be done as well. Labs to rule out any metabolic or nutritional abnormalities should also be done. Consideration should be given to referring to a neuropsychologist, as treatment for each type of dementia is often different, especially now with new treatments for AD. Theresa M. Redling DO, FACP Chief, Geriatric Health Cooperman Barnabas Medical Center Director, Maida Geriatric Institute Assistant Clinical Professor of Medicine Rutgers-New Jersey Medical School

Older adults are susceptible to depression as well and it is not a phase. This is a serious condition , that when left untreated can have a significant impact on and older adults quality of life. The good news is that elderly respond equally as well to treatment of depression. Theresa M. Redling, DO, FACP Chief, Geriatric Health and Disease Management Medical Director Maida Geriatric Institute at Cooper Barnabas Medical Center Assistant Clinical Professor of Medicine Rutgers New Jersey Medical School Office 973-322-7636 Fax 973-322-7673

Please engage with your physician to address your needs. You would probably be surprised how much your family wants to help and Support you. Theresa M. Redling DO, FACP Chief, Geriatric Health Cooperman Barnabas Medical Center Director, Maida Geriatric Institute Assistant Clinical Professor of Medicine Rutgers-New Jersey Medical School

Depression is more common in people with dementia. The person may not be able to say they are depressed but they may have other symptoms like poor appetite, lack of interest in life , insomnia amongst other possible symptoms. At times it maybe difficult to determine whether rhe symptoms are related to depression or dementia. A trial of drug treatment may sometimes be indicated. Theresa M. Redling DO, FACP Chief, Geriatric Health Cooperman Barnabas Medical Center Director, Maida Geriatric Institute Assistant Clinical Professor of Medicine Rutgers-New Jersey Medical School

Incontinence is a common problem particularly in older women. First one needs to make sure there is no underlying issue like an infection. Then a thorough exam , determine overactive bladder, stress Incontinence or a mixture of both. There us treatment for each type of Incontinence- it should not be accepted as a normal part of aging Theresa M. Redling DO, FACP Chief, Geriatric Health Cooperman Barnabas Medical Center Director, Maida Geriatric Institute Assistant Clinical Professor of Medicine Rutgers-New Jersey Medical School

Opioids can be safe if monitored closely. Usually, a small prescription post op with regular f/u visits. Start low and go slow and manage expectations. Start w a non opioid med like acetaminophen and can consider layering small dose of tramadol ( renal adjust if needed) 25 mg every 6-8 hr or oxycodone ( 2.5 mg ) is every 4 hrs as needed. Anticipate side effects like constipation. About 30 % of people get nauseated. Always assess for history of any substance abuse -even managing serious pain can lead to addiction-but short term use is usually not a problem Theresa M. Redling DO, FACP Chief, Geriatric Health Cooperman Barnabas Medical Center Director, Maida Geriatric Institute Assistant Clinical Professor of Medicine Rutgers-New Jersey Medical School

First make sure there is no underlying medical issue contributing to her decline ( ck B12 Thyroid) Then treatment with medication may be appropriate. The one drug least likely to interfere with her PD is sertraline. If she needs an appetite boost a small dose of mirtazapine before bed may be useful Theresa M. Redling DO, FACP Chief, Geriatric Health Cooperman Barnabas Medical Center Director, Maida Geriatric Institute Assistant Clinical Professor of Medicine Rutgers-New Jersey Medical School

Sorry this is not my area of expertise Theresa M. Redling DO, FACP Chief, Geriatric Health Cooperman Barnabas Medical Center Director, Maida Geriatric Institute Assistant Clinical Professor of Medicine Rutgers-New Jersey Medical School

Depends on what they are due to. Is she cognitively impaired ? Depressed? Lacking sensory input ( visual or hearing impairment)? Maybe attention seeking or her way to tell you her needs are not being met. Behavioral issues especially with those w cognitive issues are not always easy to find the trigger. Need to do some investigating where the Behavior comes from. Hope this helps! Theresa M. Redling DO, FACP Chief, Geriatric Health Cooperman Barnabas Medical Center Director, Maida Geriatric Institute Assistant Clinical Professor of Medicine Rutgers-New Jersey Medical School