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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Caring for a parent afflicted with Alzheimers

Caring for a parent afflicated with Alzheimers is challenging.

Listen here​ as Dr. Michael Gordan discusses key considerations in a CJOB 680 interivew with host Jeff Currier in Winnipeg.

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. 


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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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.

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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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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

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.