Health and Wellness

Incontinence is not an inevitable part of aging

By Martha Swats, Owner/Administrator, Comfort Keepers

Bladder incontinence is a highly prevalent disease that not only affects a senior's health, but impacts their daily lives emotionally, socially, and economically. With a rapidly growing senior population, more people will experience incontinence − however, it is not an inevitable part of aging.

What happens: The body stores urine in the bladder, a hollow organ much like a balloon. During urination, muscles in the bladder tighten to move urine into a tube called the urethra, while the muscles around the urethra relax and let the urine pass out of the body. When the muscles in and around the bladder don't work properly, urine can leak. Incontinence can occur for short periods of time due to urinary tract infections, constipation, or as a side effect of a medication.

When leaking urine lasts longer, it may be due to:

• Urge Incontinence: The most common diagnosis, this involves an urgent need to urinate resulting in the loss of urine before arriving at the toilet, caused by involuntary contractions of the bladder that can't be stopped. Also called overactive bladder, it can be caused by strokes, dementia, Alzheimer's disease, multiple sclerosis, Parkinson's, or injuries. Conditions such as pelvic floor atrophy in women, prostate enlargement in men, or constipation in either sex can also lead to urge incontinence.
• Stress Incontinence: This occurs when an increase in abdominal pressure overcomes the closing pressure of the bladder. Abdominal pressure rises when you cough, sneeze, laugh, climb stairs, or lift objects. The bladder muscles of seniors may be so weak that leaking can occur just by getting up out of a chair. Stress incontinence is more common in women due to pregnancy and childbirth, and a lack of estrogen in postmenopausal women can also cause muscular atrophy that may lead to the condition. Men with enlarged prostates, have had prostate cancer treatments or surgery can also develop it.
• Overflow Incontinence: Rarely diagnosed, this occurs when one's bladder never completely empties. Sufferers frequently feel the need to go and often leak small amounts of urine. This condition is often caused by an obstruction in the urinary tract system or by a bladder that either has very weak contractions or is unable to contract at all. Causes include an enlarged prostate or damage from prostate surgery, constipation, fecal impaction, and nerve damage from stokes or diabetes.
• Functional Incontinence: This incontinence is caused by disabilities. Arthritis could make unzipping one's pants difficult, or a bad hip could make a trip to the facilities take longer than expected − and accidents might happen. Neurological disorders, stroke complications, Alzheimer's disease, dementia or multiple sclerosis are other causes. Often, the mind cannot plan or carry out a bathroom trip.
• Mixed Incontinence: People can have more than one type of incontinence. Usually there is a combination of stress and urge incontinence, especially in women. People with severe dementia, Parkinson's disease, neurological disorders, or who have had strokes can suffer from urge and functional incontinence.

Urinary incontinence diagnosis: Your loved one may feel embarrassed by accidents and the use of absorbent pads or protective underwear, which, in turn, could trigger a reluctance to visit the doctor. Or there could be some confusion about which specialist to see. But stress to your loved one that the best reason to see a doctor is that senior urinary incontinence is quite treatable. If your loved one feels comfortable with his or her primary care doctor, start there. Women can also find a urogynecologist, while men could visit a urologist; either can see a geriatrician, or a nurse practitioner who specializes in incontinence issues.

What to expect: A urinalysis to rule out infection or blood in the urine; blood tests to check on kidney function, calcium and glucose levels; a thorough discussion of one's medical history; and a complete physical exam, including a rectal exam and a pelvic exam for women, and a urological exam for men. The doctor may prescribe a medicine that calms muscles and nerves to treat an overactive bladder. If leakage is caused by weak muscles, the doctor or nurse can suggest exercises to strengthen the pelvic muscles. The doctor may fit a woman with a device worn in the vagina that helps lift the bladder. If other treatments fail, surgery may be suggested to improve bladder control.
What caregivers can do to help: Avoid giving drinks like caffeinated coffee, tea, and sodas that increase urination, but don't limit water; keep pathways clear and the bathroom clutter-free with a light on at all times; make sure there are regular bathroom breaks; if there is a tendency to leak urine at certain times of the day, trips to the bathroom ahead of time can help; supply underwear that is easy to get on and off; and use absorbent underclothes for trips away from home.
Discussing it with your loved one: Find a time when you and your loved one can be alone together, and discuss the subject with sensitivity and clarity. This is a dignity issue. Help your loved one understand that dignity is very important to both of you.


Comfort Keepers can help. Comfort Keepers' Interactive Caregiving keeps senior clients engaged physically, mentally, and emotionally while living independently at home. Call your local office today to find out more about all the ways we can help your loved one.

ASK KELLEY How do I handle an after-prom party?

Dear Kelley,
My 17 year old daughter asked if she could host an after prom party at our home next month. Although I originally liked the idea of the kids being here, I'm scared I can't monitor every little thing they do. This went from five couples to significantly more. The alcohol in my home is not locked in a liquor cabinet and even if it was, they could bring their own and I may not know. I want them at a safe home with adult supervision. However, I don't want to be on the hook for any poor choices they could make. Do you have any thoughts on this? I'm looking to make an informed decision.
Local Mom

Dear Local Mom,
This is a great question and one I get asked frequently. There are many occasions throughout the school year that call for a party - graduations, proms, holidays, birthday parties - it's not hard to come up with a reason to celebrate! However, your concern is warranted. New Hampshire, like many other states, does have a Party Host Liability Law (RSA 644:18). Under this law, hosts can be charged with a misdemeanor, receive fines up to $2,000 and spend a year in jail. The underage drinkers could face consequences as well. License suspension, loss of vehicle, loss of college scholarships, fines up to $600, fines up to $2,000 if caught with a false ID and possible prison sentence. If you allow this after prom party at your home, all it would take is one person under the age of 21 to have an alcoholic drink or illegal drug to be in violation of the law.
I have known some parents that have hosted similar parties and provided a fun, safe and substance free after prom experience. However, it is hard to do and is never fool proof. If you choose to do this, you will want to be sure to lock up any alcohol or medications in your home. Eliminating access is the key! However, if you are worried about what could go wrong, I suggest connecting with your child's school to see if they are offering any substance free after prom events. This will eliminate any risk to you and your family, while still providing a fun alternative to a potentially dangerous party setting (NH DHHS' Bureau of Drug and Alcohol Services).
For more information on New Hampshire's Party Host Liability Law (RSA 644:18) please visit . To report an underage drinking party anonymously, you can contact 211 or local law enforcement. Remember, the best parties are the ones our kids make it home from! We all have a hand in keeping our communities safe.

Comfort Keepers - Respite care is crucial for caregivers

By Martha Swats, Owner/Administrator, Comfort Keepers

Respite care is not self-indulgent. It's a necessity. Caring for an older or ill family member can be hugely rewarding and bring you closer − but being consumed by it will drain you physically and emotionally, and eventually cause burnout.
That's why it's important for caregivers to seek occasional respite from their responsibilities, whether it's for a few hours a week to run personal errands − or longer to take a much-needed vacation. Respite care offers you the chance to de-stress, restore your physical and mental energy, and keep your own life in balance.
The many benefits of respite care
Respite care for loved ones provides short-term breaks for caregivers, for their own wellbeing, and the wellbeing of the person for whom they are providing care. After all, you want to be at your very best, both physically and mentally. There are many benefits to be had through respite care. They include having:

1. Leisure time for renewal – Take a walk, read a book, browse the internet, visit an art gallery or museum, listen to music – whatever brings you a sense of joy and calm.
2. A change of venue – Escaping routine caregiving can help you relax, bring you a new perspective on the situation, and gives you a chance to clear your head to come up with new solutions to problems or concerns.
3. Enjoyment and pleasure – As a caregiver, you must remember that you have the right to enjoy life. You also have no reason to feel guilty.
4. A renewed sense of self – You are an individual who also needs to live your life and keep a firm grip on your own identity.
5. Socialization – Don't be isolated or feel alone. Take time to engage with friends, family, and co-workers by sharing meals, conversation, and experiences.
Once you have  decided to pursue respite care
• Involve your loved one. When planning for time off from your caregiving duties, make sure to keep your loved one informed. Involve him or her in deciding how much time you will be away, and who will fill in for you when you're gone. Express how he or she will benefit from you being more relaxed and refreshed. Reinforce the idea that they will also benefit from socializing with other people.
• Acknowledge your role. A survey of family caregivers by the National Family Caregivers Association showed that family caregivers often refuse to accept that caregiving is a separate role from their role as a parent or spouse. The survey found that shifting this attitude and accepting that caregiving is a separate role had a profound impact on their situations.
• Assess your needs. Decide what care will be needed in your absence, and if there are specific caregiver skills needed to take care of your loved one.
• Stay organized. Use a calendar to organize and plan for assistance, and don't forget to schedule time for yourself. Schedule in some respite time and indicate how you plan to use it.
• Create your own space. Once you've decided on having respite relief, find a place for yourself, whether it's a porch, spare bedroom, or simply a corner of a room. You shouldn't have to leave the house to get some alone time to enjoy hobbies, relax – and do the things you love most.
• Deal with your feelings. Bottling up your emotions takes a toll on your psyche and your health. Share feelings of frustration with friends and family. Seek support from others who are in a similar situation. Talk with a professional counselor, or join a caregiver support group.
• Remember to say "no" when it's necessary. Accept the fact that you can't do everything, and resist the urge to take on more than you can handle. If someone asks you to do something that you just can't take on, be honest, explain why you can't − and don't feel badly about it.
• Stay positive. Do your best to not dwell on the negative. Hold a family meeting or call a senior care mediator to resolve conflicts with siblings and other relatives. Remember to be proud of all that you are doing, and focus on the rewards of caring for someone you love.

Health care records go electronic in Lakes Region

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Drs. John Grobman and Glenn Lieberman use a new electronic records system to check an X-ray at Advanced Orthopaedic Specialists in Gilford. The medical practice is part of LRGHealthcare, which has installed a comprehensive system to more efficiently handle patient records. (Courtesy photo)


LACONIA — The two biggest health care systems in the Lakes Region are collaborating in a comprehensive electronic medical records program intended to provide information to doctors and patients more efficiently.

LRGHealthcare, which runs the Lakes Region General Hospital and Franklin Regional Hospital and associated providers, has joined with Speare Memorial Hospital in the project.

The new medical records system is 10 days old.

LRGHealthcare CEO Kevin Donovan said that before the system came online, some doctors were still taking down medical records with a paper and pen. Others worked on a computer system that wasn't linked to other local health facilities or departments.

With the new system, records will be shared throughout the LRGH system and with the Speare hospital system as well.

For example, a patient's information provided at a doctor's office within the system would be immediately available to doctors in the hospital should the patient have to go there.

“We all used to play in our own sandbox,” said Patti Strohla, chief nursing officer at LRGHealthcare. “Now we're all in our own playground.”

Also, there will be a portal for patients to keep track of their medical test results, order prescriptions and schedule appointments.

“We know that electronic health records improve quality of care, can improve efficiency for the organization and ultimately will allow us to better communicate with partners in the community to facilitate better care,” he said Friday.

A $42 million investment is being made in the new system, with some of the expense arising from the computer hardware needed to make it all work. The new technology should lead to better tracking of health care, leading to improved quality. It should also be more efficient than the old method of record-keeping, saving money along the way.

The planning phase for the system has lasted a year and a half. Some of the computers will be based on carts that can be brought from room to room. Doctors will be able to show imaging to patients to explain health care issues.

Computer experts have been at the elbows of doctors and nurses trying to operate the new system over the last week. Those assistants will be around for a full month.

Many other health care systems across the country have already implemented electronic record keeping systems.

“We are catching up,” Donovan said. “We are in the latter part of the wave of adoption.

“Our ultimate goal is to be early adopters in the use of technology in new and exciting ways and others will look to us for improving patient care.”

He also asked for people to patient with their local health care providers as everyone comes up to speed on the new system.

“We greatly appreciate the patience of our community as we go through this transition,” Donovan said. “We know that we're learning, it can elongate the process and make it slower. We are working hard to get up to full speed.”

Genesis set to consolidate in downtown building


LACONIA — With the need for its mental health services steadily rising over recent years, Genesis Behavioral Health had been looking for several years for a suitable space that it could use to consolidate its Laconia-based operations under one roof. So, when a large downtown building owned by LRGHealthcare came on the market, Genesis was eager to make a deal. The purchase-and-sales agreement was announced in December of last year, and this week the parties announced that the transaction has been completed. The property, at 575 Main St., will undergo an extensive renovation and Genesis hopes to occupy the space in December of this year.

Maggie Pritchard, Genesis Behavioral Health executive director, said, "This building gives us an opportunity to demonstrate to our staff, our patients and the community the significance that mental health treatment has in all our lives. We have been fortunate to work with LRGHealthcare, Conneston Construction, and Samyn-D'Elia Architects to support us and help us see this dream become a reality."

"We are pleased to be part of Genesis Behavioral Health's solution to finding a new home in Laconia," said Kevin Donovan, president and CEO of LRGHealthcare. "It's nice to know that not only will this historical building be revitalized, but it will continue to house an important community service."

The property at 575 Main St. includes three connected buildings and 23,000 square feet of space on three floors. 

Ann Nichols, director of development and public relations for Genesis Behavioral Health, said the private nonprofit organization will be able to move all of its Laconia-based operations into the building. Genesis currently operates clinical offices out of two different locations – one on North Main and another on Church Street – and rents two other locations for administrative offices. 

Nichols said the Main Street building will have "much more space" than the aggregate of its other Laconia offices. 

Genesis also has a clinic in Plymouth, Nichols said that operation won't be affected by the the purchase of the 575 Main Street property. Genesis's after-hours services will continue to be located at LRGHealthcare's Medical Office Building, located on the campus of Lakes Region General Hospital. The Main Street property will be staffed during normal business hours.

Approximately 130 employees will work in or out of the 575 Main St. property, said Nichols. That figure includes staff that assist patients at their homes, she noted. Genesis staff will use public parking lots, such as the parking garage, and patients will have access to a parking lot shared with the neighboring Citizens Bank.

First, though, the building will undergo an extensive renovation.

The renovation will include aesthetic improvements, as well as investments into the building's energy efficiency. Nichols wouldn't give the total amount of the renovation work, but said it will cost "several million" dollars. The project will be funded through the sale of its properties at 771 N. Main St. and 111 Church St., as well as through the sale of tax credits, bond financing and through a capital campaign.

Renovation is expected to start in May, and Genesis hopes to be able to move into the building as early as Dec. 1.

Laconia Mayor Ed Engler welcomed Genesis to downtown.

"It's good on two fronts. One, that we keep that job base downtown. Two, that the actual building will have a lot of money put into it, which will increase its value, both in the short term and the long term, to the community."

Genesis Behavioral Health, which celebrated its 50th year in 2016, has seen the need for its services grow steadily over recent years. Between 2009 and 2016, the number of patients increased by more than 28 percent, from 3,104 in 2009 to 3,976 last year. The organization serves people from 24 towns in Belknap and southern Grafton counties.

Nichols said the opioid crisis has contributed to the growing need for mental health services, even though Genesis does not offer in-patient substance misuse therapy. 

"Many people dealing with an addiction have a co-occurring diagnosis," said Nichols. "Both of those things need to be treated in order for a patient to be on the road to wellness."


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Genesis Behavioral Health announced this week that it has completed the purchase of the property at 575 Main St., which had previously been owned by LRGHealthcare. After an extensive renovation taking place this summer and fall, Genesis will move into the building as early as December. (Adam Drapcho/Laconia Daily Sun)