Atherosclerosis and Long-Term Care Needs
ContentsWhat Is Atherosclerosis? Risk Factors For Atherosclerosis Symptoms Of Atherosclerosis Medical Complications Of Atherosclerosis Selecting A Cardiovascular Healthcare Provider For Atherosclerosis Common Care Needs Related To Atherosclerosis Selecting A Professional Caregiver For Atherosclerosis Paying For At-Home Care For Atherosclerosis Making The Home Safe With Atherosclerosis The Caregiver’s Role In Atherosclerosis Planning For Future Care Needs With Atherosclerosis Residential Long-Term Care Options For Atherosclerosis Selecting A Long-Term Care Facility For Atherosclerosis Paying For Long-Term Care For Atherosclerosis Legal And Financial Considerations With Atherosclerosis FAQs About Atherosclerosis
At the present time, heart disease is the leading cause of death worldwide. Over 600,000 people die of heart disease every year in the U.S. Atherosclerosis is one of the most common causes of heart disease and coronary artery disease. After reading this guide, you will have a better understanding of what atherosclerosis is and how to manage it as well as the type of care that a family member may need when living with the disease.
What Is Atherosclerosis?
Atherosclerosis is the medical term for a buildup of plaque which causes inflammation inside arteries of the body, particularly arteries in the legs (called peripheral vascular disease), heart (called coronary artery disease), brain, and other organs.
Arteries are large blood vessels that carry blood from the heart to other parts of the body. Atherosclerotic plaques may create a blockage in the artery walls which may cut off oxygen-rich blood flow to certain organs or tissues. This buildup of plaque is thought to occur due to endothelial dysfunction of the endothelial cells that line the arterial walls.
A plaque may also rupture in an artery causing a blood clot to form which can lead to a heart attack if a coronary artery is blocked (also known as myocardial infarction) or a stroke if one of the carotid arteries to the brain is blocked.
While healthy arteries are flexible, atherosclerotic plaques cause the arteries to become less elastic over time. The arteries gradually harden and narrow due to the buildup of plaque that blocks them. As a result, the heart has to work harder to pump blood through the body and the muscles of the heart weaken.
Risk Factors For Atherosclerosis
Although the exact cause of atherosclerosis is not known, certain factors may increase a person’s risk of developing this condition. Known risk factors include:
- A family history of coronary heart disease (also known as coronary artery disease)
- Poor diet
- Lack of exercise
- High low-density lipoprotein cholesterol (high LDL cholesterol)
- Low high-density lipoprotein cholesterol (low HDL cholesterol)
- Elevated homocysteine levels
- High blood pressure
- Sleep apnea
- Heavy alcohol consumption
Symptoms Of Atherosclerosis
The symptoms of atherosclerosis may vary depending on which arteries are affected. Some commons symptoms of the disease include:
- Angina (chest pain)
- Shortness of breath
- Confusion or disorientation
- Pain or weakness in arms and/or legs
Atherosclerosis is sometimes called a “silent killer” because people with this condition may not know they have it until they have a myocardial infarction (also known as a heart attack) or a stroke due to buildup or rupture of plaque in the carotid arteries to the brain.
Even individuals who seem healthy may suffer from atherosclerosis. Early detection and prompt treatment are critical to improving a person’s long-term prognosis.
Medical Complications Of Atherosclerosis
The prognosis for a person with atherosclerosis may depend on several factors including when the condition was first diagnosed, whether the person has other health conditions, and whether they have already experienced a heart attack or stroke.
It is important that any underlying health conditions such as high blood pressure, diabetes, and high LDL cholesterol/low HDL cholesterol are properly treated. For people with these conditions, medication or lifestyle changes may help reduce their risk of developing atherosclerosis.
If development of atherosclerosis has already occurred, treatment may still limit damage to artery walls. In some cases, surgery may be required to restore proper oxygen-rich blood flow to blocked arteries. Common surgeries for blocked arteries due to atherosclerosis include:
These surgeries often require hospitalization. In some cases, the person may be hospitalized for only a few days. However, if the individual has already experienced a heart attack or stroke, they may be hospitalized for several weeks.
With proper treatment, many people are able to recover after a heart attack or stroke. However, an individual’s prognosis will depend upon a variety of factors. A person’s doctor can provide more information on what long-term implications an individual may expect from their condition.
Selecting A Cardiovascular Healthcare Provider For Atherosclerosis
Most individuals with atherosclerosis receive an initial diagnosis of the disease from their primary care physician. If a doctor suspects atherosclerosis, they may order several tests to confirm the diagnosis.
If the atherosclerosis is confirmed, a primary care doctor may refer an individual to a cardiologist or vascular surgeon. A cardiologist is a doctor who specializes in treating diseases that affect the heart. A vascular surgeon treats diseases that affect blood vessels, arteries, and veins.
While a primary care physician can often provide referrals to qualified specialists, some individuals may prefer to choose their own healthcare provider. Family members may also wish to interview a prospective care provider when making their decision.
Some questions to ask a prospective doctor or surgeon include:
- What experience do you have treating people with this condition?
- How severe is my atherosclerosis?
- Is it likely that I will have a heart attack/stroke?
- Can my condition be improved with treatment?
- What treatments are recommended for someone with my condition?
- Is surgery recommended? If so, who will perform this surgery?
- What lifestyle changes should I make?
A person who has already had a stroke may also be referred to a neurologist. Neurologists specialize in disorders affecting the brain or nervous system. These specialists can help address any health problems caused by a stroke.
If an individual has already experienced a heart attack or stroke, they may also be referred for physical therapy or occupational therapy. These forms of therapy can help a person rebuild their strength and adjust to their new health needs.
- How can I effectively treat my symptoms?
- What forms of physical activity are safe for me?
- Will I make a full recovery? If not, what kind of improvement can I expect?
- What home modifications are helpful for a person with my condition?
Common Care Needs Related To Atherosclerosis
An individual’s care needs will depend upon their overall health status. Some people with atherosclerosis may be able to care for themselves and live independently. However, if atherosclerosis is accompanied by other serious health problems, regular care may be needed. If a person is recovering from a heart attack, stroke, or surgery, they may need extensive care.
If a person has recently had surgery, they may be instructed to delay bathing while the incision area heals. If this is the case, the incision area should be kept dry. Sponge baths may be advised during this period. Many people are advised not to take baths or go swimming for the first few weeks of their recovery. Consult the hospital discharge instructions to learn when normal bathing habits may be resumed.
Some individuals with coronary heart disease may become dizzy or faint when bathing. Hot showers or baths may worsen these symptoms. Using a shower or bath chair may be helpful in preventing falls.
A person who is recovering from heart surgery may be advised to remain still during their recovery. They may need to avoid twisting their upper body or lifting their arms over their head. These individuals may find it helpful to wear shirts or dresses that can be buttoned or tied on rather than items that must be pulled on over the head.
If surgery was recently performed, an individual may need to avoid tight clothing that puts pressure on the incision area. It may be best to avoid wearing bras, belts, or other restrictive clothing during the recovery process.
A person who recently had surgery or a heart attack may be unsteady on their feet. Shoes with a low heel are often the safest option.
Individuals with atherosclerosis often receive special dietary restrictions from their doctor. Common dietary restrictions include:
- Limiting sodium
- Limiting saturated fat
- Increasing daily intake of fiber
Diet plays a crucial role in controlling atherosclerosis so these instructions should be carefully followed.
A person who was recently hospitalized may have other special dietary needs. An individual’s doctor or the hospital discharge instructions can provide more information regarding dietary needs.
Many people lose their appetite after a serious illness or surgery. Caregivers can encourage healthy eating habits by providing the individual with frequent light meals.
Many people with atherosclerosis are able to maintain their personal hygiene without help. However, a person who has recently been discharged from the hospital may need assistance. Caregivers should consult hospital discharge instructions for more information about personal hygiene products that may not be recommended.
If an individual recently had surgery, they may need help caring for their wound or incision. The hospital discharge instructions will typically explain how to safely care for a surgical incision. These instructions should be followed carefully to reduce the risk of a surgical site infection. Avoid using sunscreen, lotions, or creams near the incision site unless a doctor directs otherwise.
Individuals with atherosclerosis may able to perform their daily grooming tasks independently. However, if a person recently had a heart attack or surgery, they may be advised not to lift their arms over their head for several weeks. These individuals may need help washing, brushing, or styling their hair.
Any person with a heart condition should take precautions to avoid overexertion. If the individual become dizzy, fatigued, or short of breath, it is important for them to stop and rest. It may be helpful to perform grooming tasks in stages to allow for a rest between each task.
Standing for a long period of time may also lead to dizziness or fatigue. Some individuals find it helpful to sit down on a chair or stool while performing their personal grooming.
A person who recently had a heart attack or surgery may feel dizzy, faint, or weak for several weeks afterward. It may be difficult for an individual to safely use the toilet on their own. A caregiver’s help may be required, particularly for the first few days after returning home from the hospital.
Individuals who take prescription pain medications such as opioids may feel particularly dizzy or drowsy. It may be advisable to install handrails or grab bars beside toilets for increased safety.
Opioid pain medications may sometimes cause constipation. If this occurs, consult the individual’s doctor and ask which over-the-counter treatments might help. Symptoms of constipation can often be eased by drinking plenty of water. Caregivers should ask a doctor for advice on how to safely increase an individual’s water intake if they have been on a fluid restricted diet.
Transfer From Bed To Chair
If an individual has recently had surgery, they may need a caregiver’s help to move from their bed to a chair. Both the individual and their caregiver should make sure this process is performed as gently and gradually as possible. The person should avoid twisting their upper body or making sudden movements as this may pull or tear an incision site.
Maintaining proper posture may help reduce joint pain and muscle fatigue. Good posture may also improve a person's overall health. Some individuals may receive special instructions from their doctor or physical therapist about additional exercises they should perform during their recovery. Caregivers can help by ensuring that a person has a safe, comfortable location to perform these exercises.
Some individuals with atherosclerosis may have limited mobility, particularly after a heart attack or surgery. Strenuous physical activity may be discouraged during this period. However, some individuals may be advised to stay or become more physically active. A doctor may also advise a person to perform special exercises during their recovery to gradually increase their mobility.
If an individual has difficulty mobilizing on their own, a mobility aid may be helpful. Mobility aids may include canes, walkers, wheelchairs, and scooters. If a person is having difficulty with mobility, their doctor or a physical therapist will be able to recommend an appropriate mobility aid.
Atherosclerosis may be treated with a variety of medications. As noted earlier, it is important to ensure that any underlying medical conditions such as high blood pressure or diabetes are also treated in order to reduce the risk of complications from atherosclerosis. A person who has had a heart attack, stroke, or recent surgery may be prescribed several different medications including cholesterol-lowering drugs.
It is crucial that all medications are taken as directed. If a person has difficulty keeping track of their medications, caregivers can help by creating a system for recording when each dose of medication must be taken. Caregivers can also help make sure that the person does not run out of their medication by arranging for regular refills from the pharmacy.
After a major illness or surgery, many people experience powerful feelings of anxiety or depression. A person who recently had a heart attack or stroke may experience mood changes. In some cases, these symptoms may negatively affect the individual’s physical and emotional recovery.
If a family member has specific concerns about an individual’s behavior, they should contact the person's doctor to tell them about their concerns. A mental health evaluation may be needed.
If an individual recently had surgery or a heart attack, they may also experience pain, nausea, or dizziness. While these symptoms are often normal and expected, they should be reported to the person’s doctor. The doctor can offer guidance on which medications may provide some relief.
Special Medical Equipment
Individuals with atherosclerosis may be advised to use special equipment such as blood pressure machines or pulse oximeters to monitor their condition at home. Some individuals may also have implantable devices inserted such as pacemakers to help prevent heart failure. In some cases, these devices may come with supplemental monitoring equipment which must be used at home.
Caregivers can help by familiarizing themselves with the devices or equipment the person must use. In an emergency, it is important that caregivers are able to inform medical personnel about any devices or implants an individual has or is using. This information should be provided to all caregivers and a copy of the information should also be kept in the person’s wallet or purse.
Coordinating Medical Care
A person with atherosclerosis may need to see several different doctors or therapists to treat and monitor the disease. Some individuals may find it difficult to keep track of their appointments and medical records.
Caregivers can help an individual by creating a central area in the home where all medical information is kept. A wall calendar or Google calendar may be helpful for documenting medical appointments. A Google calendar may be especially useful as it can easily be shared with other family members or caregivers who are responsible for providing transportation.
Some individuals may also wish to create a binder that contains all personal health information. Relevant information to include in the binder may be things like:
- Lab results
- Pharmacy leaflets
- List of all medications an individual is taking
- Contact information for doctors and pharmacies
An individual or their caregiver can then take this binder to all medical appointments. This helps ensure that each doctor who sees the individual has access to important medical information.
If a person has recently undergone surgery or had a heart attack, they may not be able to drive for several weeks or months. Their doctor will provide more information about when it is safe to resume driving.
Individuals who have been hospitalized are usually not allowed to drive themselves home. A family member or caregiver must provide transportation. Caregivers can provide support by arranging this transportation in advance.
In many areas, local nonprofit organizations provide free transportation services for people in need. The U.S. Department of Health and Human Services (HHS) offers an Eldercare Locator tool which helps individuals and families find transportation services in their area.
In many cases, an individual with atherosclerosis may safely continue performing household chores as long as they feel well enough to do so. However, if the person recently had a heart attack or surgery, they may receive special medical instructions which prohibit certain household chores and activities.
Some individuals may be advised to avoid pushing, pulling, or lifting heavy objects during their recovery. Family members and caregivers may need to assume responsibility for any strenuous chores. A person should resume their chores gradually and only with their doctor’s approval.
If an individual has complex health needs, they may wish to begin planning for any future health emergencies. It may be desirable to add a trusted family member to bank accounts or credit cards so this person can help the individual manage their finances.
In some cases, a person may wish to arrange for a power of attorney. This document gives a family member or other trusted individual the authority to make financial decisions on another person’s behalf. Power of attorney can be a very beneficial document to have in place if an individual suddenly becomes incapacitated and cannot make decisions on their own.
Selecting A Professional Caregiver For Atherosclerosis
If an individual requires more care than family can provide, it may be time to hire a home care services provider.
When choosing a professional caregiver, it is important to consider what kind of help an individual needs. The family will need to determine if a person needs help with the activities of daily living (ADLs), such as bathing or dressing. They will also need to assess whether the individual needs support with medical tasks, such as administering medication or changing wound dressings.
Custodial caregivers may provide companionship or help with transportation. These caregivers also provide assistance with ADLs including:
- Personal grooming
- Meal preparation
Skilled personnel are qualified to provide certain types of medical care including:
- Administering medications
- Changing wound dressing changes
- Monitoring vital signs
- Maintaining or operating home medical equipment
- Administering physical therapy
It is important to choose a caregiver that is able to provide the kind of care that an individual requires. If medical support is needed, an individual and their family should select a caregiver with the appropriate medical training.
Caregivers with various levels of medical training include:
- Registered nurses (RN)
- Licensed practical nurses (LPN)
- Certified nursing assistants (CNA)
- Home health aides (HHA)
Paying For At-Home Care For Atherosclerosis
If professional at-home care is needed, an individual and their family will need to decide how to pay for this type of care.
Medicare provides coverage for skilled at-home care under the following circumstances:
- A doctor certifies that skilled care is required.
- The individual is under a doctor’s care.
- The individual is homebound.
- The individual does not require 24/7 care.
Most insurance providers (including Medicare) do not pay for custodial care. However, Medicaid and certain other insurance providers may provide coverage for custodial care in some circumstances. Be sure to contact a person’s insurance provider to learn more about which services are covered under their insurance plan.
If an individual does not qualify for at-home care coverage and is struggling to pay for care, local nonprofit organizations or government organizations may be able to help. Contact the county’s Department of Health or Department of Social Services to learn more about relevant services in one’s local area.
Making The Home Safe With Atherosclerosis
If an individual has recently been hospitalized following a heart attack or surgery, certain home modifications may be necessary to ensure their safety once they return home.
- Secure or remove rugs to prevent tripping
- Tape down electrical cords or move them to another area
- Maintain clear paths so the person can navigate easily throughout the home
- Minimize clutter and keep personal items off the floor
- Keep rooms well-lit so the person can see clearly
Some individuals may have difficulty standing up after using the toilet. Others may become dizzy or fatigued while in the bath or shower. These individuals may benefit from special bathroom equipment designed to prevent falls.
Helpful bathroom equipment may include:
- A shower stool so an individual can sit.
- A bath chair or grab bars installed by a tub.
- A non-skid mat for a shower or tub.
- Handrails or grab-bars by a toilet.
People with heart disease may occasionally feel dizzy, short of breath, or tired. Some individuals may have difficulty climbing up and down staircases. It may be helpful to move their bedroom, home office, or other frequently used items downstairs to make them more accessible for the individual.
The Caregiver’s Role In Atherosclerosis
Many people with atherosclerosis are able to care for themselves on a day-to-day basis. However, some individuals with atherosclerosis require more complex care.
Depending on an individual’s age and overall health, ongoing care may be needed. If a person has already experienced a heart attack or stroke, they may require round-the-clock care from a live-in caregiver or a care facility. A person who has recently undergone surgery may also need regular care as they recover.
Lifestyle changes play an important role in treating atherosclerosis. Caregivers may be able to help by providing support in the following ways:
- Ensure that the person follows a heart-healthy diet including plenty of fruits, vegetables, whole grains, and sources of lean protein. Limit sugar, sodium, and alcohol.
- Encourage the person to stop smoking. A doctor may be able to offer additional guidance on how to quit.
- Help the person to maintain a healthy body weight. People who are overweight or obese should consult a doctor or dietician to develop a weight-loss plan.
- Supervise the person when they engage in physical activity. If the individual is elderly or has complex health needs, ask their doctor which forms of physical activity are safe for them to engage in.
Planning For Future Care Needs With Atherosclerosis
Many people who receive a diagnosis in the early stages of the disease are able to maintain their health and independence for a long period of time. Individuals who carefully follow their doctor’s instructions and receive the appropriate treatment may have no special care needs.
However, others may need extensive care soon after diagnosis. Some individuals are only diagnosed with atherosclerosis after they have already experienced a heart attack or stroke. Many people with atherosclerosis also have additional health issues such as diabetes or arthritis which require special care as well.
Regardless of whether or not an individual is currently able to care for themselves, it is important to start planning for future care needs as soon as possible. Because individuals with atherosclerosis have a higher risk of having a heart attack or stroke, their care needs may change suddenly. An individual and their family should make a long-term care plan before it is needed.
An individual and their family may begin planning for future care needs by considering the following questions:
- Who will provide at-home care if the individual needs help at home?
- Is it possible or desirable for the individual to live with a family member? If so, with whom?
- Will the individual use a home health agency? If so, which one?
- Which long-term care facilities may fit the individual’s needs?
- How will the individual pay for long-term care?
Some people may qualify for certain government benefits, including social security, Medicare, Medicaid, or veterans benefits. It may be helpful to explore these benefits as one plans for future care needs.
Residential Long-Term Care Options For Atherosclerosis
If a person requires more support than an at-home caregiver can provide, a long-term care facility may be a better option.
Suitable long-term care facilities may include:
Independent living facilities are designed for individuals who are able to care for themselves on a day-to-day basis, but require some help with housekeeping or household maintenance. Individuals who need regular medical care or support with most ADLs may not be good candidates for independent living facilities.
ALFs offer a greater level of support than independent living facilities. These facilities provide some medical care such assistance taking medications. However, ALFs do not provide round-the-clock medical support.
A nursing home may be the best option for an individual who requires continuous medical care. Nursing homes provide skilled nursing care for people who have complex medical conditions. Nursing home staff provide ongoing medical supervision and assistance with all ADLs.
Selecting A Long-Term Care Facility For Atherosclerosis
There are many factors to consider when choosing a long-term care facility. An individual and their family must first determine what level of care is needed. Once a facility has been chosen, it will be necessary to determine how to pay for this type of care.
A primary care physician may be able to provide recommendations for local long-term care facilities. If an individual is planning to pay for the facility through their health insurance policy, it may also be helpful to contact the health insurance provider for a list of facilities who accept their form of insurance.
If an individual receives coverage through Medicare, the Medicare website features a search tool to help locate long-term care facilities in one’s local area.
Once an individual and their family have identified a prospective facility, they should visit the facility and take a tour. It is important to ask questions to determine if the facility will be a good fit.
- What healthcare services are provided at the facility? What services are not provided?
- What amenities are offered?
- Who will care for the individual on a day-to-day basis?
- What is the staff-to-patient ratio?
- What kind of training has the staff received? What are their professional credentials?
- What safety policies are in place?
- If the individual experiences a serious health emergency, how will the situation be handled?
A checklist may also help an individual and their family evaluate whether a care facility is safe, comfortable, and a good placement.
Paying For Long-Term Care For Atherosclerosis
Paying for long-term care is a challenge for many families. It is important to begin planning for long-term care needs as early as possible. Making plans in advance may allow an individual and their family to find more affordable care options.
Medicare provides coverage for certain long-term care options including care in a skilled nursing facility (SNF) immediately after a hospitalization or sudden health crisis. However, Medicare does not cover most other long-term care options including custodial care. Medicaid may offer more extensive long-term care coverage for certain low-income individuals.
If a person’s health insurance policy does not provide coverage for long-term care, it may be necessary to consider other payment options. An individual and their family may be able to pay for long-term care through a life insurance policy or home equity loan.
A long-term care insurance policy may be another option for paying for long-term care. However, a person who already needs long-term care may not qualify for this type of policy if they do not have one already. It is best to apply for this kind of insurance as early as possible.
Legal And Financial Considerations With Atherosclerosis
Individuals with atherosclerosis may wish to make certain legal or financial arrangements to protect themselves in the event of a sudden health crisis. It may be helpful to decide in advance who will make legal or financial decisions on a person’s behalf in the event that they become incapacitated. A variety of different legal documents may serve this purpose.
An advance directive is a legal document that specifies a person’s wishes for their end-of-life care. A living will is a type of advance directive that explains what end-of life medical care an individual wishes to receive should they be unable to communicate this information themselves.
A power of attorney document gives a trusted individual the authority make medical or financial decisions on another person’s behalf if they are unable to make decisions on their own.
Many people with serious health conditions delay preparing these documents as it can be distressing to consider the possibility of becoming permanently incapacitated. However, preparing an advance directive or power of attorney document can help ensure that an individual’s wishes are respected if an emergency occurs.
FAQs About Atherosclerosis
1. Is atherosclerosis reversible or is the condition progressive?
Left untreated, the damage caused by the development of atherosclerosis is progressive and potentially life-threatening. In most cases, the damage caused by atherosclerosis cannot be reversed. However, it may still be possible to halt the progress of atherosclerosis with appropriate treatment.
Early diagnosis and prompt treatment may greatly improve one’s prognosis. Medication can help prevent the disease from progressing further. Lifestyle changes also play a crucial role in decreasing one’s chances of having a heart attack or stroke.
2. Is atherosclerosis a genetic condition?
A person may be more likely to develop atherosclerosis if a close relative was diagnosed with the disease. An individual may have a higher risk of developing atherosclerosis if a first-degree relative was diagnosed with cardiovascular disease at a young age (before age 55 in men or before age 65 in women).
However, there is no guarantee that a person will develop heart disease simply because a family member has it. Lifestyle factors play an important role in reducing one’s chances of developing cardiovascular disease. Even if a person has a possible genetic predisposition toward these conditions, it is possible to improve cardiovascular health by maintaining a healthy lifestyle.
3. I have been diagnosed with atherosclerosis but have never had any heart problems in the past. Should I still take this diagnosis seriously?
Many people are startled to learn that they have atherosclerosis. The disease does not always cause symptoms so the diagnosis may come as a surprise. The good news is that atherosclerosis can sometimes be halted with prompt medical treatment and appropriate lifestyle changes.
If you or a family member have been diagnosed with atherosclerosis but have not had a heart attack or stroke, the diagnosis should still be taken seriously. By treating the condition early, it may be possible to avoid a heart attack or stroke in the future.
4. My family member seems very depressed after their heart attack and heart surgery. Is this normal? What can we do to help?
Mental health challenges are very common after a cardiovascular event. Some studies have shown that up to a third of individuals who have had a heart attack may later experience symptoms of depression. Even those who have never experienced a heart attack may feel frightened or depressed by their cardiovascular health problems.
In many cases, these symptoms may be effectively treated. It may be necessary for the person to take medication or see a counselor. Joining a support group may help an individual and family members deal with feelings of stress or anxiety.
If you notice that your family member with atherosclerosis is showing symptoms of depression, ask a doctor what steps you should take.
Proximity of care is very important when considering options
Research care options that are nearby when thinking about the next step for your loved ones.
Leona J. Werezak RN, BSN, MN is a registered nurse and adjunct nursing professor. She has 24 years experience working in a variety of healthcare settings including such remote locations as the Arctic Circle. Her research in early stage dementia was published in the Canadian Journal of Nursing Research and re-published in their 40th anniversary issue which showcased exceptional research published since the journal began. Her work in dementia care has also been published in the Journal of Gerontological Nursing. She currently teaches surgical nursing care on a thoracic/vascular unit to baccalaureate nursing students. Her clinical work with nursing students involves extensive work with older adults who have multiple chronic health conditions.