Tuesday, December 31, 2013

Exercise for the Elderly

It is never too late to start.

George Burns, comedian legend who lived to be 100, used to say, “If I knew I was going to live this long, I would have taken better care of myself!” As more Americans enter their golden years they can begin to identify with the wit and wisdom of Mr. Burns. Most seniors today can expect a much longer life span than previous generations, yet longevity without quality of life is a major concern for this growing segment of the population.  The golden years are really no fun if you are hindered by a fail or sick body.

Regular exercise has been proved to be a key element to improving quality of life for seniors and the elderly.  Besides boosting mood and producing a feeling of well being, the benefits of exercise among this age group include improvements in blood pressure, diabetes, osteoarthritis, osteoporosis and neuro-cognitive function.  According to the American Academy of Family Physicians, regular exercise dramatically helps the elderly:

·      Fight off infection and sickness by increasing the function of the Immune System.  This makes recovery from illness less a strain to the aging body.

·   Reduce risk of heart disease and blood pressure by strengthening the Cardio-Respiratory and Cardiovascular functions of the body.

·    Increase bone density by curbing the loss of bone mass.  This reduces the risk of osteoporosis and broken bones due to falls.

·      Promote proper elimination of bodily waste and actively aids digestive health.  This aids in the prevention of colon cancer.

·         Lower the risk of Alzheimer’s disease, dementia and age-related morbidity.

·         Aid in the management of high cholesterol and arthritis pain.

If regular exercise protects from chronic diseases, improves moods and lowers chances of injury, why is it that 75% of older Americans do not participate in physical activity? Many elderly claim discomfort or disability as their main reason not to exercise.  Some fear injury but most have fallen into the habit of a sedentary lifestyle which they continue as they age.  Yet according to a Harvard Alumni study, increases in life expectancy can be gained by people who begin regular exercise even at the age of 75.  In fact they tend to outlive those who were physically active earlier in life and later gave up exercising.  In other words, it is never too late to start.

According to the American College of Sports Medicine and American Heart Association, there are three areas of physical activity that elder adults should concentrate on.

  • Aerobic Exercise - Thirty minutes of moderate to intense aerobic activity five days a week will increase the body’s cardio respiratory endurance and improve the delivery of oxygen and nutrients to tissues.  Aerobic activity includes anything that gets the heart rate up and requires faster breathing such as walking, dancing, jogging, biking or swimming.
  • Strength/Resistance Training - Strengthen muscles by working on all major muscle groups two to three sessions a week.  Strength training builds and tones muscles, prevents loss of bone mass and improves balance.  Strength training is done with repetitive motions using light weights, resistance bands or nautilus machines.
  •  Stretching/Flexibility Exercises - Maintaining flexibility and balance are essential in minimizing fall risks.  Stretching to warm up and cool down from exercise reduces muscle soreness.   Yoga and Pilates programs focus on developing a strong ‘core,’ the set of muscles dealing with the stomach, lower back and spine which help the elderly with posture and back pain.  Tai Chi or Qi Gong exercise uses slow controlled movements which promote balance.

Many elderly people may feel that starting an exercise program at their age is beyond their abilities.  By starting slowly, elderly exercisers can build up endurance, strength and confidence over time.  Those new to exercise should set obtainable goals and chart their exercise activity to keep their program on track until it becomes a habit.  Joining an exercise class especially designed for the elderly will help ensure that exercise is done properly, reducing risk of injury.  Also participating in a class makes exercise a fun, social event. With long range health as the goal, daily exercise is one thing that the aging can do to ensure their golden years are truly golden.

Kate McCarthy is Director of Operations for HomeAid Health Care which provides non-medical home services for the elderly who wish to remain safe and independent at home.  HomeAid is a sister company to Prairie Home Assisted Living which has served the  physical, spiritual, mental and health needs of their residents since 1999.  Together the two companies provide comprehensive care that meets the needs of the elderly in the Fox Valley of Wisconsin.

American College of Sports Medicine Position Stand.  Exercise and physical activity for older adults.  Med Sci Sports Exerc. 1998;30:992-1008.

AAFP, “Promoting and Prescribing Exercise for the Elderly” by Rober J. Nied, M. D. & Barry Franklin, PH.D.  Retrieved on 5/23/12 from www.aafp.org/afp.

Monday, December 9, 2013

Falls Are Life Changing Events

25% of elderly who fracture a hip due to a fall 
will die within 6 months of the injury.

The Facts are Frightening: 

  • Falls are the leading cause of death from injury for people 65 years and older.
  • The risk of falling increases with age. One-third of 65 year old people fall annually.   Half the people over 80 year old people fall every year.
  •  Two-thirds of those who have taken a fall will fall again within six months.
  •  The elderly account for over 75% of deaths that result from falls.
  •  Over 95% of hip fractures are caused by falls.
  •  Although the risk of falling is greater for women than men, men are 40% more likely to die from a fall than women.
  • Falls almost always lead to loss of independent functioning for elderly and most require life-long nursing care.
  •  Medical costs, due to falls involving the elderly, runs over $30 billion annually.
  • Even falls that do not result in serious injury have a psychological effect among elderly as they unnecessarily restrict their activities due to fear.
Although there isn’t one single reason an elder might take a fall, there are basic risk factors that often contribute to falls.  The more risk factors present in an elder’s life, the more likely they are to take a fall.  With falls being the number one threat to an elder’s independence, it is amazing that more people are not aware of these risks and the fact that they are mostly preventable.

Risk Factors to Falls:

·         Osteoporosis Porous bones are less resistant to strain and break easily.  Osteoporosis is the primary cause of fractures in older adults, especially among women, and is caused by hormonal changes, calcium and vitamin D deficiency and lack of physical activity.  Brittle bones can be prevented by getting enough calcium in the daily diet, sunlight or Vitamin D supplements and regularly doing weight-bearing exercises.

·         Lack of Exercise – Not having a regular exercise program results in poor muscle tone and loss of muscle strength.  Bone mass as well as general flexibility are also lost.  Regular physical activity increases muscle and bone strength and improves balance and flexibility.  With as little as 15 minutes a day, even those of advancing years can gain back lost muscle strength and decrease their risk of falls.

·         Impaired Vision – Many age related vision diseases can increase the chances of falls.  Cataracts and glaucoma change an elder’s depth perception, visual acuity, peripheral sight and vulnerability to bright light.  These limitations deter their ability to safely move in their environment.  Yearly checkups with an ophthalmologist will determine if any age-related diseases require medical attention.  Also using contrasting colors will help accent balance-aids making grab bars and handrails more noticeable.  Sometimes something as simple as daily cleaning of eyeglasses can make a dramatic improvement in vision and is an easy preventative measure.

·         Medications – The elderly usually take quite a few different medications and many of these can contribute to falls.  Sedatives, anti-depressants, and anti-psychotic drugs reduce mental alertness, cause dizziness and drops in blood pressure.  People who take multiple medications always have a greater risk of taking falls because the meds affect their balance and gait.  Knowing the common side effects of medications is a good place to start, but for the elderly it is wise to discuss ways of reducing fall risks with the physician or pharmacist.  Ask for an assessment of medications from the physician. Taking the lowest effective dosage, knowing the interactions between various medications and over the counter drugs and getting rid of out of date medications is also necessary. Also consider using walking aids while taking medications that impair balance.

·         Environmental Hazards – Most falls happen at home and the majority of those are due to tripping over something on the floor, such as throw rugs or electrical cords.  Poor lighting, lack of grab bars and cluttered environments also play a role in these falls.  To reduce the possibility of falls do a walk-through of the home looking for problem areas or have an occupational therapist look at the home and assess areas of risk.  Age proof the home as a preventative measure against falls and other accidents.  For practical tips on age proofing the home see HomeAid Health Care Elder Topics Blog http://homeaidhealthcare.blogspot.com/.

For the elderly, falls are life changing events.  Beyond the pain and fear resulting from falling, the majority of elders who are injured are not allowed to return to their previous lives.  Injuries mean long stays in hospitals, rehabilitation centers and hours of physical therapy.  Fears and concerns over repeat falls often mean moving to an institutionalized setting and dramatic loss of independence.  For many, the injuries resulting from a fall is the trigger than starts a decline that leads to death.  Preventative intervention to reduce risk factors will greatly reduce opportunities for falls and fall related injuries and can be the key element that maintains an elder’s quality of life.

Kate McCarthy is Director of Operations for HomeAid Health Care which provides services for the elderly who wish to remain safe and independent at home.  HomeAid is sister company to Prairie Home Assisted Living which has served the physical, spiritual, mental and health needs of their Residents since 1999.  Together the two family owned companies provide comprehensive care for the elderly in the Fox Valley of Wisconsin.

“Falls Among Older Adults: An Overview” by Center for Disease Control & Prevention. www.cdc.gov/injury/wisqars.com Accessed 11/21/13. 
“Fall prevention: 6 tips to prevent falls” by Mayo Clinic staff, www.mayoclinic.com/health/fall-prevention.com.  Accessed 11/21/13.
“Preventing Falls in the Elderly” by K.R. Tremblay Jr. and C. E. Barber, www.ext.colostate.edu. Accessed 11/21/13.

Monday, November 25, 2013

Fall Prevention & Home Safety Checklist

Falls are life-changing events for the elderly.
A fall changes everything for the elderly. A fall usually results in fractures, which means hospitalization, time in rehab, physical therapy and major changes in their living situation.   In many cases a fall means it is impossible for the aged person to remain independent at home, which means moving to an institutionalized setting.  In many cases a fall triggers the start of a dangerous decline in elderly person’s health.

Preventing falls needs to be taken seriously.  Check your elderly loved one’s home for safety hazards that increase their risk of falls and accidents.  A thorough home evaluation is a great way to prevent senior falls and serious injury and is a good place to start when considering elder proofing the home.  Taking steps to make the home suitable for those of advanced age will help ensure your loved one can remain independent and safe at home much  longer.  
Use these questions as a guide to making the home a safe place for your elderly loved one.

1.         Are step surfaces non-slip?
2.         Are step edges visually marked to avoid tripping?
3.         Are steps even and in good repair?
4.         Are stairway handrails present?
5.         Are handrails securely fastened to fittings?
6.         Are walking paths covered with a non-slip surface and free of tripping hazards?
7.         Are walking paths clear, safe and even with no holes in the concrete?
8.         Is sufficient lighting available to provide safe ambulation at night?
9.         Are leaves and snow cleared away?
10.       Are tools and yard equipment safely and securely stored?

Helpful tips
  • Poor lighting often contribute to trips and falls.  Install light switches at the top and bottom of stairways to avoid using stairs in the dark.
  • Install lights or colored tape on each step highlight the distinction between each step. 
  • Paint door sills a different color than the floor.
Interior (Entry and Main Living Area):
1.         Is the entryway clear of clutter with at least 36” wide access?
2.         Do the door locks operate smoothly?
3.         Does the porch light adequately light the porch and the door?
4.         Are the light switches located near room entrances?
5.         Are the lights bright enough to compensate for limited vision?
6.         Are the lights glare free?
7.         Are stairways well lit?
8.         Are handrails present on both sides of stairway?
9.         Are the handrails securely fastened?
10.       Are the stairways free of objects?
11.       Are there light switches at top and bottom of stairs?
12.       Are the stairs marked to highlight the distinction between each step?
 13.      Are steps slip resistant?
14.       Are steps even and uniform in size and height?
15.       Are there smoke and carbon monoxide detectors present with fresh batteries?
16.       Are all electrical outlets cool to the touch?
17.       Are electric cords properly plugged in and safely tucked away?
18.       Are there nightlights in halls and stairwells?
19.       Are electric heaters placed away from rugs, curtains and furnishings?
20.       Is the fireplace chimney clear of accumulation and inspected annually?
21.       Are carpets in good repair with edges tacked or taped down?
22.       Are linoleum and plastic stair treads secure?
23.       Are throw rugs secured with non-slip backing and taped down?
24.       Are floors finished in a non-slip way? Has high polish been avoided?
25.       Are rooms uncluttered to permit unobstructed mobility?
26.       Is water temperature reduced to prevent scalding?
27.       Are water faucets clearly marked hot and cold?
28.       Is the furnace checked yearly?
29.       Are there established house-smoking rules?
30.       Does room furniture allow easy access to doors and windows?
31.       Do the doors, drawers and windows open and shut easily?
32.       Is the furniture strong enough to provide support during transfers?
33.       Are telephones easily accessible?
34.       Are flashlights available in every room?
35.       Is glow tape stuck on important items to identify them in dark?
36.       Are cleaners and poisons clearly marked?
37.       Are window and door locks sturdy and operational?
38.       Are medications properly stored and usage instructions written down?
39.       Is a first aid kit available with up-to-date supplies?

Helpful tips
  •   Improve the lighting in your home by using brighter bulbs, at least 60 watts.
  •     Use lampshades or frosted bulbs to reduce glare.
  •     Use uncut, low pile carpeting instead of thick pile to reduce tripping potential.
  •     Replace windows with polarized glass or apply tinted material to eliminate glare.
  •     Use chairs with seating at least 14 –16 " from the floor and sturdy armrests to              provide leverage while sitting or rising.

1.                  Are dishes and food stored on lower shelves for easy access?
2.                  Is step stool sturdy and have a high handle for support?
3.                  Are step stool treads slip resistant and in good repair?
4.                  Is lighting sufficient, especially over the stove, sink and counter-tops?
5.                  Are towels and curtains kept away from the stove?
6.                  Are electric appliances and their cords kept well away from the sink?
7.                  Is flooring non-slip?
8.                  Are the “Off” indicators on stove and appliances clearly marked with brightly colored tape?
9.                  Is there a telephone in the kitchen? Are emergency telephone numbers displayed including family contacts?
10.              Is there a fire extinguisher within easy reach and in good order?
11.              Are whistling teakettles and food timers in use?
12.              If the pilot light on the stove goes out, is the gas odor strong enough to alert the homeowner?
13.              Is food properly stored?
14.              Are refrigerator and cupboards free of spoiled or expired food?
15.              Are pots and pans of a lightweight type?
16.              Are potholders and oven mitts available?
17.              Are the appliances, including refrigerator and stove, in good working order?
18.              Are pet dishes set out of walking area?
19.              Are table and chairs strong and secure enough to provide support when leaning, standing or sitting?

Helpful tip

  • A well-organized kitchen will make cooking and cleaning easier and prevent falls.  Re-arrange frequently used items to avoid excessive bending and reaching. Use a hand-held reaching tool for hard-to-reach objects.

1.                     Are lamp and light switches within reach of the bed?
2.                     Is the electric blanket in good working order?
3.                     Is the telephone accessible from the bed?
4.                     Is there an emergency telephone list near the telephone?
5.                     Is there a flashlight and a whistle near the bed?
6.                     Are medications stored away from the nightstand?
7.                     Is the bed an appropriate height for easy transfer?

Helpful tips

  •  It can be challenging, not to mention expensive, to keep fresh batteries in flashlights. Try purchasing flashlights that plug into the wall and remain constantly charged. Some rechargeable flashlights even have built in nightlights to make them easy to locate in the dark.
  • Stand slowly when getting out of bed. Give your body time to adjust to an upright position.
  •  Wear well-fitting slippers and avoid nightwear that drags on the ground.
  •  Tie the belt on your robe.
  •  Keep pathways between the bed and bathroom and the bedroom door unobstructed by clutter or furniture.
  •  The bed should be at least 18” high (from the top of the mattress to the floor) to allow more comfortable and safe transfers.
  • The edge of the mattress should be firm enough to support a seated person without sagging.
1.                  Is the door wide enough for unobstructed access with a cane, walker, or wheelchair?
2.                  Is the threshold low enough to avoid being a tripping hazard?
3.                  Does the floor have a non-slip surface?
4.                  Are floor rugs secured with non-slip backing and carpet tape?
5.                  Are grab bars securely fastened next to the toilet and in the tub and shower areas?
6.                  Are there non-skid strips, decals or rubber mats in the tub or shower?
7.                  Is there a tub or shower seat available?
8.                  Is the toilet seat elevated for easy transfers?
9.                  Is there sufficient, accessible, glare-free light available?
10.              Is there telephone access available in the bathroom?

Helpful tips

  •  If you are on strong medication or in a frail or delicate condition, do not bathe by yourself. Have someone assist you in and out of the bath and check on you periodically.
  • Use a bath chair, grab bars and hand held shower to provide stability when bathing.
  • Do not use towel bars for support.
  • Check water temperature with your hand before entering the tub or shower.
Other Preventative Measures
Exercise regularly. Regular exercise increases strength, stamina, balance and coordination. It also helps to increase bone density and balance hormone levels. It improves circulation, blood pressure, and heart and lung health.

Do an annual Brown Bag Review.  Simply place all medications, prescribed and over the counter medications, along with any herbal, nutritional and natural health supplements into a brown paper bag. Take it in to your doctor or pharmacist to review the medications for potential interactions or side effects like dizziness or sleepiness.  The more information gathered about medications taken, the less likely there will be negative side effects from conflicting medications.

Have vision and hearing checked once a year.  Both vision and hearing problems can increase fall risks.

Keep glasses clean.

Wear sturdy, well-fitting shoes with non-skid soles.  Take care of the feet.  Consult a  doctor about any pain, numbness, tingling or any wounds that are not healing properly.

Most home health agencies will perform a home safety inspection and make recommendations for insuring the safety of your loved.  Occupational therapists will also make suggestions on how to improve safety at home.  

Kate McCarthy is Director of Operations for HomeAid Health Care which provides services for the elderly who wish to remain safe and independent at home.  HomeAid is sister company to Prairie Home Assisted Living which has served the physical, spiritual, mental and health needs of their Residents since 1999.  Together the two family owned companies provide comprehensive care for the elderly in the Fox Valley of Wisconsin.

Source: CBS News, The Senior's Choice