Study shows better palliative care needed

This is an interesting and relevant article that should be of interest to all of us who are caring for  declining older parents and other loved ones:

Thousands of Canadians are suffering unnecessarily each year because they do not have access to palliative care, says a new study by the Canadian Cancer Society that calls on governments to make end-of-life care part of a new federal-provincial health accord.

The new study comes one week before provincial healthcare ministers sit down in Vancouver with their federal counterpart to discuss a new deal on health. It also comes as governments consider new laws to allow doctor-assisted death in response to last year’s landmark Supreme Court of Canada ruling. That ruling, which removes physician-assisted death from the Criminal Code, is set to take effect next month, but on Monday the court heard arguments from Ottawa asking for a sixmonth extension of that deadline.

With end-of-life issues now on the national agenda, the cancer society says it’s time for governments to guarantee all Canadians access to palliative care through new legislation.
The new study finds there are gaps in the system, there is no common definition of palliative care and there is a lack of information on what is available where. It recommends that a national standard be developed that includes clear measures.

It is expected that 75,000 Canadians will die of cancer this year, but about half will spend their final hours in an emergency room or acute-care hospital bed, said Gabriel Miller, director of public issues with the cancer society. This, even though studies show most patients want to die at home.

“It has been a shameful secret of Canadian health care for many years that there are massive holes in the way that we care for our very sickest people, especially as they approach the end of life,” Mr. Miller said. “This issue is now getting some attention because the courts have forced governments to grapple with end-of-life issues, and now it is up to governments to act.”

While some pockets of the country are addressing the issue, including Quebec – which has included palliative care as part of its new law on doctor-assisted death – the study finds there is inconsistent and inadequate palliative care in many parts of the country.

The federal government has promised to invest $3-billion over four years in home care, and Mr. Miller is hopeful some of that will be earmarked for improvements in palliative care.
“If we can’t do something to make end-of-life and palliative care better in this country at this moment, we will never do it,” Mr. Miller said.

Maureen Taylor, co-chair of the provincial-territorial expert panel that made recommendations late last year on the issue of physician-assisted death, stressed it should not be framed as an either-or debate.

The top recommendation of the panel was a national strategy for palliative and end-of-life care that includes physician-assisted dying.

Ms. Taylor became an advocate for medically assisted dying following the death of her husband, well-known Toronto physician Donald Low, and said that even with a robust system of palliative care, some patients will choose assisted death.

As well, she said some patients who die without palliative care may have rejected the option when it was offered. More education is required among the medical community and patients and their families about the benefits of palliative care, she said.

© Copyright The Globe and Mail Inc. All Rights Reserved


Childless, unmarried baby boomers warned to prepare for future

Childless, unmarried baby boomers warned to prepare for future.
Dr. Mireille Norris says elder orphans are a growing problem across the country.
A new study is raising awareness about the problem of "elder orphans" — seniors who have no children, spouse or any other family member to care for them as they age.
The research comes on the heels of an incident earlier this week in North Carolina in which an 81-year-old cancer patient with no caregiver called 911 to ask someone to buy him some food.
Dr. Maria Torroella Carney, the chief of geriatric and palliative medicine at North Shore-LIJ Health System, recently completed a case study and literature review that she will be presenting to The American Geriatrics Society's Annual Scientific Meeting this weekend.

 Dr. Maria Carney says that the problem of elder orphans is growing.
"It seems that, with increasing longevity and the trend toward having fewer children and families being fragmented, that this risk of aging alone is increasing," she told CTV's Canada AM from New York.
In Canada and the U.S., the number of seniors is expected to grow dramatically over the next 10 to 15 years. Statistics Canada says the proportion of seniors in Canada could rise from 15 per cent in 2011 to 23 per cent by 2031.
Carney's study found that nearly one-quarter of Americans over 65 are currently at risk of becoming elder orphans. That proportion could grow. U.S. census data show that one-third of Americans currently between the ages of 45 to 63 are single — a 50 per cent increase from 1980.
Although the number of elder orphans is likely rising, very little research has been done on these seniors and the issues they're facing.
"The first challenge is one of awareness that this is a vulnerable population," Carney said.
As well, there is little research on how these seniors will affect society and the medical system in the years to come. Hospital social workers and geriatricians already see elder orphans in their work every week, but there are few guidelines about how to help them long term.
"It's a societal problem we all have to address and we are hoping to draw attention to it," she said.
Not only do aging seniors living alone struggle with isolation and loneliness, they often grapple with growing health problems, says Carney. Some also struggle with dementia and have no one who can help them make decisions about their own care.
Elder orphans are also hard on the medical system, says Carney, since they are often in crisis and need to seek help from costly hospital emergency rooms. The better approach, she says, would be to have care plans in place for these seniors so they don't end up in crisis in the first place.
For single adults who are in now their 50's and 60's, Carney has this advice: start making plans.
"Think about advanced directives," she advises. "Who will be that decision-maker for you if you are unable to make decisions? Get a health care proxy; find an advocate, create a strategy for yourself."

Angela Mulholland,; Published Friday, May 15, 2015 8:43AM EDT 



A special place for elderly with severe dementia

A special place for elderly with severe dementia is showcased here:

In a Dutch town about 20 kilometres outside of Amsterdam, a small community lives in what at first glance seems like a real-life version of The Truman Show.

Hogewey has a grocery store, a theatre and a barber shop. The only twist is that many of its 152 residents live unaware that their orderly community is actually a nursing home for people with severe dementia.
"We protect our residents from the unsafe world. They do not understand the world outside this because the outside world doesn't understand them," says Yvonne van Amerongen, an employee at Hogewey who also helped develop the concept.Hogewey was officially opened in 2007, but the idea has now caught the attention of health-care professionals in Ontario and Alberta."We protect our residents from the unsafe world. They do not understand the world outside this because the outside world doesn't understand them."
​Rhonda Desroches, who helped create a smaller-scale Hogewey in Penetanguishene, Ont., says relatives of the residents are pleased with how happy their family members seem to be in the new facility.Dementia is a growing problem. According to the Alzheimer Society Canada, one out of 20 Canadians over 65 has Alzheimer's Disease, and that figure jumps to one in four for Canadians over 85. In 2012, the World Health Organization declared dementia a public health priority.Many dementia patients move into nursing homes, where they are monitored in a safe setting. But some medical professionals want to shift patients away from unfamiliar, clinical settings and into spaces that resemble more typical surroundings.The citizens of Hogewey share a house with about six others, and are classified according to one of seven lifestyles.
For example, former tradespeople often live together in homey accommodations and eat a lot of Dutch comfort food. Those used to an upper-class lifestyle may join the Gooi group, named after a posh Netherlands region, and are more likely to feast on French cuisine in a stylishly decorated abode.Each household has at least one health-care worker present who helps with housework and other tasks.Residents are free to stroll all through town."You will see [residents] sitting in a restaurant with a glass of wine or buying a box of chocolates from the supermarket," says van Amerongen of those who still understand the concept of money. A worker and a resident from each house walk to the market daily to buy groceries.Employees organize day trips to nearby shopping centres or towns. Special bikes allow two people to sit side by side so residents and health-care workers, volunteers or family members can cycle in pairs.Nearby townspeople frequent Hogewey's amenities, and often go to concerts or the annual Christmas fair. On Sint Maarten, a Dutch holiday similar to Halloween, children knock on residents' doors to sing songs in exchange for candy.

Like all Dutch nursing homes, Hogewey is partially funded through taxes. Residents pay a portion of the cost based on their income.Van Amerongen says she regularly consults with organizations outside the Netherlands that want to create similar facilities. Plans to transform four existing nursing homes and build two new ones in Oslo, for example, have progressed "quite far," she says.One of her colleagues frequently travels to Canada where there's increased interest in developing the concept. Researchers from the University of Alberta recently visited Hogewey to study it.
Last August, Georgian Bay Retirement home in Penetanguishene, Ont., opened a section designed to recreate the look and feel of the 1950s and '60s.Theme rooms include a vintage kitchen, a garage with a 1947 Dodge and a nursery with dolls designed to feel like actual babies, says Rhonda Desroches, who helped create the space. The idea is to try and transport patients to a time they may recall that is associated with positive feelings.
All the doors in the theme rooms look like bookshelves, so residents won't recognize them and stray.In Florida, a company called Miami Jewish Health Systems wants to create a program that reflects Hogewey's philosophy "to really make living as normal as possible within the scope of the disease," says Marc E. Agronin, the company's vice-president of behavioural health and clinical research.Miami Jewish Health Systems is planning a transformation of its 28-acre campus to give dementia patients more freedom by creating a safe space where they're not confined to their rooms.Total honesty can cause 'significant problems'

While certain health-care professionals see Hogewey as the future of dementia care, others criticize it for being dishonest.Some aspects of Hogewey seem "fantastic," says Julian Hughes, the deputy chair of the Nuffield Council on Bioethics in London, England, which studies ethical issues in biology and medicine and advises policy makers.

It's worrisome when a village or aspects of it are deliberately deceitful, says Hughes, who was part of a working group for Nuffield's 2009 report on ethical issues in dementia, including truth-telling.

There are those that believe deceiving dementia patients breaches their trust. As the council's report states, some say it "serves to undermine the remaining grip the person with dementia may have on the everyday world." Patients who realize something is amiss could become upset and slightly paranoid, Hughes says.

Van Amerongen insists that kind of criticism comes from people who misunderstand how Hogewey operates. The people who work at Hogewey aren't merely actors trying to create the illusion of a normal neighbourhood, she says.

There are nurses on staff, but the amenities are operated by real cooks, waiters and other employees who aren't health-care professionals. They're just trained to deal with dementia patients.

"There's no trick here," says van Amerongen.

She says that while some Hogewey residents recognize the caregivers as nurses, others simply think of them as "a nice friend." Hughes says it's morally acceptable not to ruthlessly tell dementia patients the truth about certain situations. "There's a difference between a Potemkin village where everything is just a facade [and] a place like Hogewey."

In its 2009 report, the Nuffield Council determined it's important to consider a person's best interests, like whether the information would needlessly distress them. The council said sometimes it may be best to evade or give partial answers. When you tell someone suffering from dementia that a loved one has died, they may not remember, says Agronin from Miami Jewish Health Systems. It often makes little sense to repeatedly deliver the news, traumatizing them each time.

Agronin says that for him, it's about making people feel comfortable and oriented. That can be achieved by some of the things Hogewey does, like furnishing a patient's room and common spaces to be reminiscent of their previous home."There's a difference between a Potemkin village where everything is just a facade [and] a place like Hogewey."

Aleksandra Sagan · CBC News
May 4, 2015

Planning an elderly parent’s long trip

Planning an elderly parent's long trip requires thought and caution.

Your 80 year old mother wants to visit her sister who is older than she is and still lives in their small village in Scotland.

She says, "it is her 85th birthday coming up and if I do not visit her now I may never see her again". She is right and has a point; but the question is whether it is a good idea to go and if so alone or with someone? Flying has become a real chore and for elders it has many challenging components.

First of all, depending on your mother's health, there maybe issues with getting to the airport well in advance and waiting around for the flight to leave. There is the extra security hassle that is not kind to seniors as they must often wait for long period in line. Then there is the flight itself: unless one can afford to fly executive class it is not easy, especially if there are extra bathroom urgent needs. Changing planes often adds a lot more time and stress so all that has to be taken into account. The last thing is if there are pre-existing illnesses which there almost always are: they have to be stable for travel insurance to be reasonably secure in its coverage.

So if the decision is to go here are some things for you to consider and arrange:

  • If someone can accompany your mother that would be great
  • If there is a direct flight that would be preferable
  • Explore with the airline what kind of security and boarding assistance they offer
  • See how early really you have to be at the airport if you make all the proper arrangements
  • Check insurance companies to make sure that if you get a policy it will really fulfill its promises should something terrible happen
  • Make sure that at the arrive destination there will be proper greeting arrangements
  • See what medical access there is in the place she is going

So what about Scotland? Depending on the season and the cities there might be direct flights or, if not, just one stopover.

  • Medical care is very high quality.
  • The people in general are very helpful.
  • The food although not to everyone's taste is quite safe and nutritious depending on how much fish and chips you eat.

If she really wants to go, there is something to said for helping her to this as if not she may regret not having gone when it becomes too late, for the rest of her life.

Caregiver dementia

Caregiver dementia: oh yea, it's real.
There's an overlooked type of dementia, and it's more common than Alzheimer's.
For years, we’ve read that Alzheimer’s disease is the leading cause of dementia. That’s not entirely true.The leading cause is “caregiver dementia,” which strikes an estimated 100 million overwhelmed and stressed-out caregivers worldwide. The term was used initially in the 1980s, and while not an official medical diagnosis, it includes symptoms such as disorientation, forgetfulness and depression.Stressful conditions produce high levels of the hormone cortisol, which, over time, may contribute to memory loss. Think about it: You’re working long hours, you see no end in sight and you’re exhausted. Who can think straight under those conditions?In my late 30s, while in the throes of caregiving for my father with Alzheimer’s, I couldn’t recall what year it was while writing a check at the grocery store. How does a woman in her late 30s ask the twenty-something cashier what year it is? Mustering the courage, I asked and she laughed, then looked away as if I were joking. Thinking I could leave that part of the check blank – but I couldn’t even recall the month or day – I asked again in desperation. She refused to tell me. If it weren’t for the older woman behind me who offered, “Honey, it’s 1997,” I’m sure I would have left without my groceries. The woman’s kindness enabled me to relax and surprisingly, the month and day easily came to mind. Despite the positive outcome, I felt anxious as I left the store and drove home.Imagine if I had been caring for my spouse instead of my father. A 2010 Utah study published in the Journal of the American Geriatrics Society of 1,221 couples tracked for 12 years found that seniors caring for a husband or wife with dementia had six times the risk of getting dementia as members of the general population. Surprisingly, men were most susceptible, facing double that risk.   

Fortunately, caregiver dementia is reversible, as is dementia caused by depression, drug or alcohol abuse, hypothyroidism and vitamin B-12 deficiency.
Even undiagnosed urinary tract infections may lead to sudden behavior changes such as confusion, agitation, withdrawal or delirium according to the Alzheimer’s Society in the U.K.Medicines will also have varying effects, as we grow older. As we age, our liver and kidneys don’t work as efficiently resulting in a buildup over time of unprocessed medications. These chemicals become toxic leading to dementia symptoms or delirium.Which leaves us with caregiver dementia.Until caregivers are able to take proactive steps to overcome feelings of hopelessness resulting from the stress of caring for another person, they’ll continue to endure embarrassing and even scary moments.While on a familiar road, I had a momentary lapse of where I was, when it was and even who I was. It was scary, because I was driving. I maintained enough self-control to keep steering straight (fortunately, the road was straight) while maintaining a steady speed. This incident and a number of other wake-up calls made me finally reach out for help with caring for my father.

Caregivers are a hearty bunch, but we won’t be for long, unless we take notice when multiple alarm bells ring. If we don’t heed the warnings soon enough, many of us will die before those for whom we are caring. We lucky ones will wonder, as my husband and I did, if we were getting Alzheimer’s while trying to keep up with my father’s care. Seriously! There was a time we were looking for home-care options … for us!
The onset of caregiver dementia is real and it strikes primary caregivers. Those who heed the call and take action will survive.But there’s more to being a caregiver than just surviving. We need to apply both legs of our “caring” and “giving” nature to overcome and thrive. We start with a break. As little as a five-minute respite can make all the difference. Ultimately, we’ll need help. Today, caregivers have a variety of options to choose from, including in-home and adult day care, residential care and assisted living. The only other cure is to stop caregiving, and this is not an option for many.

Brenda Avadian, M.A., is the executive director of The Caregiver’s Voice, bringing family and professional caregivers knowledge, hope and joy since 1998. She is a caregiver expert speaker at state and national conferences. The author of nine books, Brenda’s career includes university professor, executive coach, keynoter, corporate consultant and caregiver. She also serves as a STUFFologist at STUFFology 101, where she advises people on how to declutter, while helping elders prepare to downsize. Born and raised in Milwaukee, Wisconsin, Brenda resides in rural Los Angeles County, California. She serves as a director on the board of the Independent Book Publishers Association and loves hiking in the Angeles National Forest.

Exercise can help slow disease progression in elderly

Exercise can help slow disease progression in elderly.
Though being active won’t reverse dementia, buying ‘two or three years
of quality time is pretty significant,’ researcher says
Sure, physical activity is good for your body and mind. But why? And
how much of it do you really need?
Researchers examining the benefits of exercise are now getting down to
the nitty-gritty, finding new clues about how it may deter illnesses
such as dementia and cancer.
While there’s plenty of evidence to show that regularly breaking a
sweat may reduce the risk of Alzheimer’s disease and other forms of
dementia, much of that research has previously been conducted on
healthy individuals. But new studies presented this week at the
Alzheimer’s Association International Conference in Washington suggest
physical activity may also improve the lives of those who already have
the disease or are on the path to developing it.
One of those studies, conducted in Vancouver, showed “significant”
improvements after exercise in the cognitive function of participants
with mild vascular cognitive impairment, or “silent strokes,”
characterized by small lesions of damage in the brain.
Silent strokes tend to go unnoticed and don’t come with the typical
signs of stroke, such as facial drooping and slurred speech. But they
do tend to lead to these more severe, obvious strokes and increase the
risk of vascular dementia, where restricted blood flow to the brain
causes cognitive issues, explains researcher Dr. Teresa Liu-Ambrose,
an associate professor and Canada Research Chair at the University of
British Columbia and the Vancouver Coastal Health Research Institute.
Among the 71 participants in the study, ages 56 to 96, those who did
moderate-intensity walking for 60 minutes, three times a week, not
only showed better cognitive function, such as memory and attention,
after six months, compared with those in the control group, who were
not assigned regular exercise; their cognitive function also tended to
be better than at baseline, suggesting exercise may minimize the
progression of silent strokes.
Scans showed the brains of those in the exercise group were also more
efficient. Plus, participants who exercised reduced their body mass
index and blood pressure – which is not exactly surprising, but
supports the idea that cardiovascular health is vital to maintaining
brain health.
“The converging suggestion is that exercise … truly can [affect] the
very mechanistic level at which … people are developing the cognitive
issues,” Liu-Ambrose says.
That’s not to say you can reverse dementia with regular exercise, she
says. But it may halt its development. “To even buy yourself two or
three years of quality time is pretty significant,” Liu-Ambrose says.
Meanwhile, researchers in Alberta have found 300 minutes a week of
moderate to vigorous aerobic exercise is better than 150 minutes a
week for reducing the risk of breast cancer. In a study published in
the journal JAMA Oncology earlier this month, Calgary cancer
epidemiologist Dr. Christine Friedenreich and her team tested how
differing amounts of exercise affected body fat in 400 inactive
postmenopausal women, since body fat has previously been shown to
increase the risk of postmenopausal breast cancer.
One group was assigned to exercise 30 minutes for five days a week,
for a total of 150 minutes, which is the minimum recommended by
Canada’s physical activity guidelines. A second group was asked to
exercise for 60 minutes, three days a week for a total of 300 minutes.
Both groups were asked not to change their diets.
“A lot of the [physical activity] guidelines were actually developed
for cardiovascular disease prevention,” explains Friedenreich of
Alberta Health Services and the University of Calgary. “But for
cancer, we hypothesized that we might actually need a greater amount
of exercise.”
The researchers found both groups benefited from sticking to their
assigned exercise regimen for 12 months, but those who did a higher
volume of exercise had greater reductions in body fat. Previous
research by the team showed a dose-response to exercise, leading to
reductions in a series of biomarkers including body fat, endogenous
estrogen, insulin resistance and inflammation.
Friedenreich considers her latest findings empowering for many, as
physical activity is an inexpensive and non-invasive way of reducing
one’s risk of cancer. “A lot of people are quite concerned about
getting cancer and this is something they can do,” she says.

WENCY LE­UNG  © Copyright The Globe and Mail Inc. All Rights Reserved

Relatives of sick, elderly feel distressed

Relatives of sick, elderly feel distressed.
The strain of caring for the sick and the elderly is increasingly
being felt by family and friends, says a new Ontario report that finds
one-third of informal caregivers are in distress – a number that has
doubled in the space of just four years.
The new findings were released late Tuesday by Health Quality Ontario,
a provincial agency that advises the government and monitors the
performance of the health-care system with a range of benchmarks. It
found that almost all long-term home-care patients in the province
rely on the help of family and friends for emotional comfort, as well
as for routine tasks such as grocery shopping, transportation,
managing medication and personal care. But one in three primary
caregivers reported last year feeling distressed, angry or depressed,
or said they were unable to continue providing that support. That’s up
from slightly less than 16 per cent in 2010.
The finding is the latest in a string of reports that point to a
growing need for supports to help Canada’s aging population remain at
home. It comes at the same time that the Canadian Medical Association
is calling for a $3.3-billion federal investment in seniors care and
when, for the first time, Canadians older than 65 now outnumber those
younger than 15. A report last month by British Columbia’s Seniors
Advocate found a similar portion of unpaid caregivers in that province
were in distress, providing an average of 30 hours of support each
“People are older, sicker, living longer and they are in hospital for
a much shorter period of time,” said Joshua Tepper, the chief
executive officer of Health Quality Ontario and a family doctor.
In his own practice in Toronto’s low-income neighbourhood of Regent
Park, Dr. Tepper said he has witnessed the increased burden placed on
families as they care for one or more aging relatives – often juggling
the demands of work and family across several generations. More than
once, he said, children have come to act as translators for
grandparents at medical appointments because sons and daughters can’t
take the time away from work.
Dr. Tepper said the spike in the number also may be a sign of a
growing comfort among caregivers to speak up about the pressures they
are feeling. “People are being more frank about the impact of caring
for a loved one has on themselves without them feeling guilty about
it,” he said.
In a related finding, the annual report shows wait times for longterm
care beds in the province have dropped over the past five years, but
there are wide variations depending on where in Ontario patients live,
and whether they are moving from a hospital bed or from their home.
The longest wait – more than eight months – is for Toronto residents
living at home who are applying for long-term care. The wait for those
applying from a hospital ranges from 197 days in the
Mississauga-Halton area west of Toronto to 34 days in the health
region that includes London, Ont.
The long waits in some parts of the province such as Toronto may be in
part because individuals prefer to go to a home that caters to a
particular ethnic group, Dr. Tepper said.
The report, called Measuring Up 2015, looks at 40 indicators and
includes the following findings: Ninety-four per cent of Ontario
residents have a primary care provider, but half say they are not able
to get a same-day or nextday appointment when sick or when they need
after-hours care. Timely access varies widely across the province, but
it is not necessarily linked to the ratio of doctors to the local
population, suggesting, Dr. Tepper said, that other variables such as
scheduling and hours of work may be a factor. Over the past decade,
suicide rates in Ontario have remained constant despite growing
efforts to focus on mental illness. Smoking rates have fallen to 18
per cent in Ontario, the second lowest in the country after British
Columbia. Ontario residents are also becoming more active.



© Copyright The Globe and Mail Inc. All Rights Reserved

Seniors in nursing homes: where are they most likely to die soonest?

Seniors in nursing homes: where are they most likely to die soonest?

Seniors living in private nursing homes are more likely to die within six months of their stay than those living in non-profit facilities, a group of researchers has found.
A recent study by the Institute for Clinical Evaluative Sciences (ICES) found that for-profit seniors’ homes have a 16 per cent higher death rate for seniors within six months of arrival, and that there is a 33 per cent greater likelihood that they’ll end up in hospital.
"Those are not trivial numbers," said Dr. Peter Tanuseputro, a researcher behind the study. "If there’s a way that we can get to the bottom of this and correct it, we could potentially be preventing many, many hospitalizations and potentially many deaths."
The figures are particularly concerning for Ontario, where nearly 60 per cent of seniors’ facilities are privately run.
As Canada’s aging population grows and the demand for long-term care facilities rises, experts say the root cause behind the discrepancy needs to be addressed.
One researcher suggests it may have to do with the staff-to-senior ratio.
"A lot of the research finds that for-profit facilities actually hire fewer staff. One can’t help but ask [if that is] because more staff affects the bottom line," said Dr. Margaret McGregor, a family physician and researcher at the University of British Columbia.
She adds that, for seniors experiencing sub-standard care, finding a solution can be challenging.
"They can’t get up and leave and say, 'I’m going somewhere else,'" McGregor told CTV News. "It’s the welfare of … the frailest members of our society."
The difference in numbers calls into question why both long-term care facilities receive the same subsidy from the provincial government, and how both must meet the same guidelines for care.
But comparisons made between the two types of facilities is unfair, according to the agency that represents both private and not-for profit homes in Ontario.
"Even though we’re getting sicker and more frail elderly (people) coming into our homes, the quality indicators show that we’re stabilizing and improving in areas," said Candace Chartier, CEO of the Ontario Long Term Care Association. Staff 
Published Saturday, October 24, 2015 10:03PM EDT 

A parent facing the loss of the driver’s license

One of the biggest challenges your parent may face is the impending or actual loss of the ability to drive, or the loss of the driver's license.

Some elders have enough insight to realize that driving is becoming too stressful or perhaps dangerous and gradually decrease the nature of their driving.

I have seen many who on their own cease to drive on major highways or do not drive after dark or when the weather is inclement. Some decide on their own to give up their car because owning it has become a hassle, what with the costs, the repairs, the parking issues depending on where they live.

I recall the challenge to my late father and the early indication of his cognitive decline when he began getting parking tickets for failing to move the car to the correct side the street when the city introduced alternate side of street parking for street cleaning. As often happened, he correctly moved the car, but failed to recall he did so and then moved it back to the "wrong" side of the street with the subsequent hefty parking fine.

The most challenging scenario that you may be called up to assist your parent is after a visit to a physician, such as a geriatrician for an assessment of cognitive decline where the issue of driving comes up, which is not expected by the patient and by the end of the visit, your parent discovers that his or her driver's license is either in jeopardy pending a more in-depth driving assessment. Or, of a report that is going to be sent to the licensing authority reporting significant cognitive impairment or dementia which in most jurisdictions results in the cancellation of the driving license. This often leads to outrage, fury or disbelief on your parent's part as they try to dissuade the doctor, or put the blame on you for taking them to the appointment.

It is not easy to deal with this, but with time and repeated explanations by the doctor as to the necessity of following the law the anger may wear off. Moreover, if you do a good accounting of the cost of keeping the car, the cost of insurance, repairs and parking, it often turns out that the money saved will more than pay for any taxi trips required by the person to do what they were doing with their car. Many local taxi companies happily create accounts with elders that avoids having to pay for each ride and many provide assistance with walking devices for example. It is a challenge, one that occurs often, but will usually wane in time–it cannot be avoided but can also be dealt with in a supportive and compassionate manner.

Important to keep our elders active

It's important to keep our elders active. 

And here is an excellent article about that challenge:


Elizabeth Knebli takes her exercise regimen very seriously. “It took
me four years to figure out that retirement is another job,” the
former executive says with a laugh. “There are all sorts of things you
need to learn.”
On a sunny morning in November at a recreation centre in midtown
Toronto, the 71-year-old has just finished a two-hour city-run yoga
class. “Mondays, it’s yoga; Tuesdays, tai chi and on Friday,
low-impact aerobics,” she says.
Job No. 1 after retirement was figuring out how to integrate fitness
into her week, “anchoring Monday to Friday.”
In addition to making her body limber, Ms. Knebli says exercise has
opened doors to new friendships and social activities. Flanked by her
yoga friends, who go out for breakfast after their class, she’s keenly
aware of the dangers of isolation.
“It gets you out of the house. If you sit at home, you end up living
between four walls. You start to forget how to talk.”
Isobel Gallagher, 76, agrees. The Toronto resident also does yoga
twice a week, while filling her social calendar with films,
performances and volunteering. “When I have too many down days, I get
She takes classes designed for retirees at York University’s Glendon
campus and at the University of Toronto, and finds they give her the
impetus she needs to stay stimulated. “I’ll say: ‘Do I really want to
go out in the snow?’ ” Ms. Gallagher says. “Then you feel a sense of
accomplishment when you get there.”
What Ms. Knebli and Ms. Gallagher have discovered is that exercise and
brain-stimulating activities are the glue that holds together the mind
and body past 65, something that’s well-documented in scientific
According to a 2014 article in Canadian Geriatrics by Vancouver
researchers Dr. Marisa Wan and Dr. Roger Wong, their review of
numerous studies found that physical exercise can have profound
effects on the cardiovascular system, lowering blood pressure,
improving the efficiency of the heart and reducing arterial plaques.
It can also improve muscle mass and balance, reducing the chance of
falls that cause many seniors to land in long-term facilities or
“Older people who have been identified as recurrent fallers, for those
who have been exposed to an exercise program, there is evidence that
suggests they are less likely to fall,” says Dr. Wong, clinical
professor of geriatric medicine at the University of British Columbia.
He says it’s postulated that exercise helps at “the muscle level, the
bone level – but also at the heart and blood-vessel level, and the
brain level.”
But not all exercise is equal, cautions Dr. Laurie Mallery, an
internist geriatrician at Dalhousie University in Halifax. “Generally,
we tend to under-exercise older people … we can improve the manner in
which we do it.”
Dr. Mallery says that while many programs focus on low-intensity
activities, weight training and Pilates can push seniors a little
more, maximizing the benefits such as muscle strengthening and
improved postural alignment.
“Being functionally active – it dictates their quality of living,”
says Judy Chu, a registered kinesiologist at Baycrest Health Sciences
in Toronto who tailors exercise programs for clients 50 and older.
“Inactivity is like smoking – it creates lack of function and lack of
function becomes a barrier to quality of life.”
In addition to keeping the body fit, exercise may also help protect
the brain, and that fascinates Dr. Tarek Rajii, chief of geriatric
psychiatry at the Centre for Addiction and Mental Health in Toronto.
He says it’s believed that physical exercise releases chemicals
related to the neuroplasticity of the brain and improves circulation,
potentially staving off anxiety, depression and cognitive problems
such as dementia and Alzheimer’s disease.
“Part of what we’re doing when we’re engaging in a physical activity
is there’s a mental activity happening,” says Dr. Rajii.
And mental exercise – such as learning a language, attending an art
class, going to a lecture or watching a movie – can also go a long way
in preserving brain health, as can merely interacting with others at
the actual event. “Mental inactivity is a risk factor for dementia,”
says Dr. Rajii.
He’s currently conducting a large-scale, randomized, doubleblind study
aimed at preventing dementia and Alzheimer’s that began this past
spring in which people with mild memory problems or a history of
depression are enrolled in an eight-week, five-days-a-week “brain
camp.” Participants in the $10-million, five-year study perform two
hours of mental exercises daily in a class setting while wearing
electrodes that send signals to the brain to “prime the
neuroplasticity.” Once they complete the eight-week period, they get
“booster” classes every six months. Their memory is assessed once a
Feedback has been positive. “They feel they are enjoying it – they
feel they are benefiting on an individual level,” Dr. Rajii says.
Ms. Gallagher is certainly convinced of the benefits of exercising her
body and mind. “I will go until I can’t any more.”

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