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Downstate Medical Services Listing

Exercise While
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Home Safety Tips for Caregivers

•Eliminate area rugs - they’re easy to trip on - polished floors are slippery - wall-to-wall carpeting is best.

•Make sure shoes are well-fitting, with non-slip soles.

•Replace burnt-out bulbs immediately so the older person won’t try to do it herself.

•Place everything the senior will need on shelves that are within reach to discourage the temptation to climb.

•Make sure all stairs are fitted with handrails and install grab-bars and rubber mats in the tub or shower.

•Remove hazards to walking outside the house, paying special attention to ice and snow removal.

•Although walking is good exercise, discourage seniors from going out in bad weather.

•Advise seniors not to stand up too quickly from sitting (this can cause dizziness) and, in general, discuss accident prevention with them. The key is to make them aware of dangers without belittling their competency.

Other Trouble Spots and possible solutions

• Driving can be a problem, with poor eyesight, failing judgment and slow reaction time. Dr. Bourke recommends that frail, elderly persons over 80 take a yearly driving test.

• Nutrition in older people is often substandard. Caregivers should encourage drinking water and fruit juices, and eating vegetables, fruits, fiber and protein. B vitamins, including folic acid and B12 are especially important to mental alertness. Visiting a senior center regularly helps, since they provide nutritious meals. Regular dental visits insure that the elder is able to eat well.

• Insomnia plagues many older people. The use of sleeping pills or alcohol is ineffective and invites dependency, restless or interrupted sleep, and impaired motor skills and mental clarity —increasing the risk of accidents. Encourage seniors to eliminate caffeine and naps during the day; get daily exercise; and turn off the TV two hours before bedtime.

• Recognize that substance abuse can be a problem and may be a cause of mental confusion or frequent falls. If you discover a problem, help the older person to get counseling.

"Life has a funny way of turning things upside down. You wake up one day, and everything has changed," muses Melissa Girard, whose 77-year-old mother, Ann Harris, recently slipped on the ice, fracturing her right arm and left ankle. It was not that long ago that Melissa, who works full time to support herself and her children, relied on her mother to watch the children after school. Now Mrs. Harris’ eyesight is failing, and the ice mishap is the most serious of a recent series of health emergencies. Melissa has added caring for her mother to her responsibilities.

DAs a caregiver, Melissa has plenty of company. Children of Aging Parents, a non-profit charitable organization, notes that almost a quarter of all U.S. households contain a caregiver looking out for an elderly person or persons. With women– typically wives, sisters, and daughters– making up 73 percent of these caregivers, Melissa is one 16.3 million women nationwide who struggle to meet the needs of an aging loved one. "Caretakers new to the job may not know what to watch out for in an older person whose physical or mental health is deteriorating," says Edmund Bourke, MD, Professor and Interim Chair of the Department of Medicine at SUNY Downstate Medical Center and Director of Geriatrics at the Brooklyn Veterans Administration Medical Center. "Elderly people–and their caretakers–could be spared a lot of misery by observing some basic guidelines."

Safety at Home
Falls, like Mrs. Harris’, are the great enemy of seniors. Poor eyesight, weakening muscles, dizziness and mental confusion increase the risk of falls. Osteoporosis–the thinning of bones that can affect men as well as women–makes it more likely that a broken bone will result.

Guard Against "Polypharmacy"
A major danger for seniors is the sheer number of drugs they may take for different medical conditions. Drugs that can be tolerated well in isolation can have dangerous side effects when taken with other drugs ("drugs," in this sense, includes even herbal remedies and over-the-counter laxatives, headache and arthritis medications). "Studies show that seniors taking four or more medications are at enhanced risk of falling," says Dr. Bourke. "Be sure every doctor prescribing medications knows what else the older person is taking."

The Three "Ds"
The media these days is full of news about Alzheimer’s disease, characterized by the progressive loss of memory. When should forgetfulness be a worry? "It’s not easy to distinguish early dementia from the milder forgetfulness of normal aging, but forgetfulness that causes a problem in daily life should be brought to a physician’s attention," says Dr. Bourke. About 40 percent of people over 80 develop some form of cognitive impairment–the temporary or progressive breakdown of normal thought processes. Other than Alzheimer’s, causes can include depression, drug interactions and side effects, plus dementia linked to cardiovascular problems that impair delivery of blood to the brain.

Caregivers should watch for what Dr. Bourke calls "the three Ds:" Depression, Delirium, and Dementia. He recommends seeing a doctor when forgetfulness occurs together with one or more of the following:

• word confusion (forgets word or uses wrong word)
• forgets important names (such as a grandchild)
• object confusion (can’t name a familiar object)
• can’t plan or organize

Depression may be hard to recognize in an elder, Dr. Bourke warns. The person may deny feeling blue, but make frequent self-deprecating comments or jokes. Other symptoms include hints of deep-down sadness, or a loss of interest in things that once aroused passion. Counseling and the right medication usually help the person reconnect to life.

Promote Vigor
Older people who live alone, particularly, may begin neglecting routines they followed for years. Then, they need anything from a nudge to daily checkups to ensure that they get dressed every day, shop for and eat healthy foods, bathe and exercise regularly and follow medical advice. Maintaining regular habits helps older people stay oriented in the present, and doing things for themselves maintains self esteem. Be careful not to take responsibility away unnecessarily. "That can lead to regression and becoming ‘chair-bound’," says Dr. Bourke. For as long as they are able, older people should continue to shop and cook, pay bills, wash clothes, vacuum and do chores around the house, as well as pursue hobbies, have a social life, entertain children and do volunteer work. If disability interferes with normal activities, help the senior explore other ways of accomplishing the same task. Help with part–but not all–of the work.

Exercise and Getting Out
Physically active elders are healthier and happier. Statistics show that the more exercise they get, the longer they live. "Any exercise is better than none," says Dr. Bourke. "That’s a good reason to do household chores." Many senior centers offer exercise programs along with mind-engaging activities and the opportunity for social interaction (see Resources For Caregivers, p.11).

Care for the Caretaker
Just like doctors and nurses who work in high-stress environments, people caring for elders need to pay attention to their own physical and mental health. Anger and resentment frequently flare up, coexisting with love and good intentions. Caregivers need to arrange breaks for themselves–nights out with friends or a weekend away every now and then. Dr. Bourke advises finding outside professional services to meet some of the senior’s needs, plus seek counseling or a support group for yourself (see p.11).

End of Life Decisions
"Everyone over 65 should express their wishes about when life support should stop," says Dr. Bourke. "But they should also have the right to defer the decision or have a family member decide on their behalf." Remember too, he says, that seniors should have opportunities to change their minds later about wishes they expressed in a living will or "Do Not Resuscitate" (DNR) order. Query them periodically to be sure their feelings remain the same.

It’s hard to talk about end-of-life questions, but caregivers can try working these subjects into the conversation from time to time. Important topics include dying at home, versus in the hospital. "Most people want to die at home, but only 10 percent do," he says. "Making it happen requires planning." Caretakers and elders should look into options for home hospice care, or for entering a free-standing or hospital-based hospice unit, well before services are needed. The object of hospice, or palliative care, goes beyond making the ill person pain-free and comfortable. Hospice staff also provide support and counseling to the dying person and family members, helping achieve understanding and acceptance of this phase of life. Health insurance typically covers the cost of hospice in the last six months of life.

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