Wednesday, 28 November 2018

Managing Fatigue As a Caregiver


As a physical therapist, I’ve been helping people deal with the problem of fatigue for a long time. Even in the depth of all that Karen and I faced, we dealt with it. So will you. This section provides some tips and hints that may help. First, look to treat the things you can.
Dehydration is one of the more common problems facing the sick or elderly. If you suspect mild dehydration, adding a few glasses of fluids per day may turn that around. For more severe cases, medical help may be needed.
Electrolyte imbalances are easily treated by supplementing whatever is low. A routine blood test will show it. Calcium, magnesium, and potassium are the most common culprits. A little (a pint or two) of your typical sport drink usually contains enough electrolyte replacement to bring most people back into balance. Pedialyte will have a little more as well. If you suspect an electrolyte imbalance, it is of little harm to give a sport drink even if they don’t need it, but be careful in cases with edema or congestive heart failure, as salts may make these conditions worse.
Low vitamin and mineral levels also can give fatigue. B12 is a common suspect here. Anemia may be related to iron deficiency. Natural sources include most meats and dark green leafy vegetables. For more on nutrition, see Eat Right in Chapter 4, Dancing in the Rain: Healthy Habits for Caregivers, and Chapter 12, Food and Nutrition. Good nutritional balance helped Karen’s anemia immensely, but it sometimes wasn’t enough. She was given medications to help stimulate her bone marrow and eventually was given a transfusion. All this helped her fatigue.
Remember, when supplementing fluids, electrolytes, or vitamins, you are “trying” these things to see if they help. If they don’t help, don’t continue to push them.
Medical management of fatigue can be simple or a tricky business. If low thyroid is the problem, a simple test will show it. Synthroid, which functions as a synthetic thyroid, can help restore normal metabolism and energy. There are other drug-based strategies to boost energy, but each drug comes with its own issues and difficulties. Psychostimulants, corticosteroids, and megestrol acetate are some of the more commonly used drugs, and they seem to give variable success. There are others as well, depending on the particulars of the case. Seek consultation with your loved one’s physician team and pharmacist about the risks and benefits of each.

Managing Their Fatigue

Adapt their lifestyle a bit to accommodate a lower energy level. They probably won’t be able to, or want to, do as much with a day. Plan a bit less activity in a day, but do plan activity. Most people have a time of day when they have the most energy. For Karen it was the afternoon. For others, it’s the morning. Try to plan activities in this time and allow your loved one to cancel if they just don’t feel up to it.
This includes emotional and mental activities as well as physical ones. Remember, the brain is a hungry machine and it takes a lot of energy. It also needs exercise. You might notice diminished concentration and decision making as the brain tires. Honor this and let them rest when they need to.
Use microresting. In other words, help them to rest whenever they can wherever they can. If there is a quiet moment and a comfortable place, help them use it.
Try to keep overall activity level of big days and smaller days fairly close to each other in volume. In my PT clinic, to help give values to this concept, we put a measurement on activities using the metabolic equivalent of a task(MET). One MET equals the effort required to sit or lie down quietly. Hiking would be 6 METs, while grocery shopping would be 2.3 METs. Multiply METs by the time spent on the activity, and you have MET hours. For a list of MET values, see
Karen and I generally tried to keep the activity level of our big days no more than 50 percent more than that of our rest days, and vice versa. We never actually calculated the METs for Karen, but some people do find the structure of this system helpful; either way, you get the idea. Allow one or two days of relative rest following a bigger day, but not more than three rest days.
Exercise is still helpful in maintaining or even building your fatigued loved one’s strength and endurance. The big lesson here is to have them do what they can and not what they can’t. Effort level is relative. For most people, 20–30 minutes per day of moderate cardiovascular exercise is recommended, even when very sick. For most people, this would be exercising to a heart rate that is 60–70 percent of their age-adjusted (220 minus their age) projected maximum (equivalent to zone 2). For most healthy people, this means walking at a brisk pace, and for fit people, easy running. For Karen, when things were good it meant walking up stairs or hills and doing strengthening exercises. When things were difficult, it could mean just walking in the house with support. Either way, Karen did what she could.
This is an adapted excerpt from the book “Caregiving 101: A Practical Guide to Caring for a Loved One”
CREDIT: Caregiving 101 Dave Leffmann PT



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