Don’t let spring cleaning become spring falling for the elderly

It just happened to my wife, an avid early morning walker. She does everything ‘right’ in terms of the ‘right’ shoes, coat, scarf, hat—you name it –she does it. The only thing she does not do is make sure the weather is perfect and receptive to activities of middle, later age, and elderly individuals. 

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We must protect the elderly and aging when crossing streets

The Mayor of the City of Toronto recently called to safety islands to be created for the elderly and aging to use when crossing busy and large intersections. This is has been an issue on my mind for a long time. The piece below I wrote last year precisely about this all too common threat. 

Bottom line: We must protect the elderly and aging when crossing streets.


Watching the ribbon of news on roll across the bottom of my television is often very disturbing. 

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Nursing home drama: wrong treatment

This is an email from a long time friend on the west coast. 

Her point is simple and poignent… a nursing home drama: wrong treatment.

Her challenge: how to help her failing fahter.

It's not pretty, and so many of us experience the same trauma. 

Please read on.

On Thursday, dad's geriatric psychiatrist contacted me to discuss his treatment. The facility is saying he is being aggressive, so they are looking at his meds to adjust. Less than a half hour later the doctor called me back asking if the facility had contacted me because they are indicating they will send him to emergency where he will essentially be sedated. The doctor doesn't agree with this and has him on the waiting list to get into the geriatric floor at the hospital. 

Dad is physically fine, he gets around and is busy. He tends to get into other people's rooms and moves everything around and tries to fix things. His eyesight is really bad, so he feels for things. One care aide at the home is calling this aggressive behaviour. He has had a couple of incidents, but they were because he was alone and could have been redirected, no one was hurt or even close to being hurt. Dad jokingly does a one two jab action, then laughs. It is a jest, not aggressive whatsoever. His main care aides say he is the least aggressive person, but busy and gets into things. The facility have told us we have to be there from the time he wakes until he goes to sleep or they will send him to emergency here he will be sedated and returned to the facility or he may not have anywhere to go. 

The home has a lack of staff and often there is often no LPN on his floor. If they are on breaks there is no one there. This is a dementia unit for high needs patients. They will move in temporary replacement staff that do not have dementia training, nor read the patients charts and make comments such as why are we even feeding these people.

They have lost his shoes, his dentures, his glasses, they don't shave him and I have to ask for him to be changed. They are supposed to contact us when incidents occur and they haven't.

It is appalling. I am putting in a formal complaint to the health authority, licensing board, and ministry. The disease is hard enough on its own without having to deal with the system. Not sure why I am sharing, except that I know you went through the disease part. This is not the norm as far as care, is it? I am working with the doctor and hopefully we can get him into a place that has adequate care. 

Maybe you need a follow up book on how to ensure your parent is being cared for?

Clearly, her father needs the right kind of care. 

He seems to need regular attention and care. And a way to vent his interets and energy.  It seems he's not violent or dangerous. But ongoing stimulation may be needed.

Bottom line: the system needs stronger checks and balances. It needs to be able to effectively understand and manage the needs to those who are suffering from various stages of dementia. 

 

Medications and the elderly: some good advice

Here is an excellent recent article in the Globe & Mail about medications and the elderly. Well worth the read and some reflection. 

THE QUESTION
My mother is in her 70s and suffers from a lot of health problems. I am very worried that she has been given too many different medications that are too strong for her. What should I do?


THE ANSWER
It’s possible that your mother may need all the drugs she is currently taking. But it’s also true that patients sometimes get prescribed drugs and remain on them when they are no longer required.
“Doctors are really good at starting medications, we are not so good at stopping them,” says Dr. Kimberly Wintemute, the primary care co-lead of Choosing Wisely Canada, an organization dedicated to reducing unnecessary medical treatments.
During a hospital stay, for instance, a patient might be given a sleeping pill or a heartburn drug and the prescription keeps getting renewed.
Over time, a patient can end up on a growing list of medications. About twothirds of seniors living in their own homes take five or more drugs, according to data collected by the Canadian Institute for Health Information. One-quarter of seniors are prescribed 10 or more medications.
Each new drug that’s added to the mix increases the risk of adverse side effects and medication interactions.
» The elderly are especially vulnerable to these problems. Not only do they tend to have more chronic conditions than younger people, but the aging process can also change the way the body handles medications.
For instance, the liver and kidneys – which play a key role in processing and excreting drugs – tend to work less efficiently as we age.
In fact, the liver can sometimes become overwhelmed trying to handle several drugs simultaneously. As a result, certain medications don’t get “activated” and essentially won’t work.
“Picture a bus and everyone is trying to get on at the same time – some people are not going to fit and will be left behind,” explains Dr. Cara Tannenbaum, co-director of the Canadian Deprescribing Network, a group that is trying to prevent the inappropriate use of medications.
Furthermore, as we age, we lose muscle mass which is replaced with fat and that can cause problems because some drugs are stored in fat tissue. This means medications can linger longer in the body and thereby exaggerate their effects, Wintemute says.
Another concern is the government approval process for new medications. Drugs are usually tested on relatively young people with just one medical condition – not elderly individuals with multiple ailments. “We don’t always know how a new drug is going to act in very old and very frail people,” says Dr. Debbie Elman, the lead physician for the Academic Family Health Team at Sunnybrook Health Sciences Centre.
Patients may suffer from a host of side effects and drug interactions including confusion, dizziness, fatigue, constipation, diarrhea, incontinence, weight loss, depression, agitation, anxiety as well as sexual dysfunction. It can be difficult to tell if a particular symptom is caused by a medication or if it represents a new medical ailment. A patient might be wrongly diagnosed with dementia or another medical condition even though a drug is really to blame.
So, what can be done to reduce the risks posed by multiple medications?
First and foremost, a patient should get all medications at the same pharmacy, Elman says.
She points out that patients are often treated by several medical specialists – and each one may be prescribing different medications. No single doctor may have a complete picture of what a patient is taking. However, when all prescriptions are picked up at the same drug store, the pharmacist can check for potentially hazardous drug combinations.
The pharmacist can also conduct a review of a patient’s medications and help determine if some may no longer be appropriate.
For a thorough assessment, the pharmacist will need to know if the patient is also taking any non-prescription drugs, herbal remedies or vitamin and mineral supplements. It’s important to keep in mind that so-called “natural” health products may interact with medications and either reduce or intensify their effects.
Tannenbaum says many patients don’t know why they are taking certain medications or what they do.
She suggests that patients, or their family members, should use the website medstopper.com to learn more about their medications. Simply type in the name of a drug and up pops a great deal of useful information, including if a certain medication might be particularly risky for seniors. Another website, deprescribing.org, provides guidance on how to wean off a medication that may be harmful or is no longer needed.
Of course, patients shouldn’t quit taking a drug without consulting their medical specialists or family doctor. But by first talking to a pharmacist and checking out the recommended websites, they can at least have an informed discussion with the physician responsible for their medical care, Tannenbaum says.


Paul Taylor is a patient navigation advisor at Sunnybrook Health Sciences Centre. He is a former health editor of The Globe and Mail. You can find him on Twitter @epaultaylor and online at Sunnybrook’s Your Health Matters.

Plan now to plan ahead for the right substitute decision maker

Choose the right substitute decision makers (SDM) now.

With all the recent focus on what is now called advance care planning (ACP) in the medical and social work literature, it is important for people especially middle-aged and older people to understand what is at stake.

Using the old terminology of a "living well" there has been a transformation from what used to be a few words in a document somewhere or as a conversation with the family member likely to be the SDM that for example the parent "would not want any heroics" if they develop a terminal illness. The reality is that is no longer enough to help those empowered to make such decisions on your behalf. The new world of medicine has many things that can be done that are no longer considered "heroics" but just part of contemporary every day medicine.

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Elderly parents may be taking wrong medications

 

This is an interesting and worrysome article about how many aging people are taking the wrong medicines: http://www.ctvnews.ca/health/more-than-400m-a-year-spent-in-canada-on-drugs-that-harm-seniors-study-1.2956741

If you haven't, it might be a good time to ensure your aging parents and loved ones are taking the right meds. Talkk with them; ask their pharmacists to go over what they take. And don't forget over the counter medicines and vitamins.

Summer safety for our elder parents and even us!

Most of us look forward to summer. Those who can often take vacation during this season, and many families use it for opportunities to visit their loved ones especially if they are far away from where we live year round.


For those who can, summer is often a time of recreational outdoor activities which may include long walks, swimming, going to beaches and such activities as cycling. Of interest is the fact that with the expansion of the older population many what have been referred to as seniors or elders are now actively involved in physical activities including those outdoors.

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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.

Continue reading “Childless, unmarried baby boomers warned to prepare for future”

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.

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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
week.
“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.

 

by ELIZ­A­BETH CHURCH

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