No one gets excited at the idea of being on bed rest. We can all agree it’s not something we would necessarily want to experience. What we may not realize is just how risky bedrest can be, especially for the elderly.
Bed rest most commonly occurs within the hospital, but can definitely happen at home as well. When an elderly person is admitted to the hospital, they typically remain in bed. While they may not have been “put on bedrest” by doctor’s orders, the outcome is that they tend to remain in bed. Our hospital system is set up in such a way that those who are admitted to the hospital largely remain in bed all day long.
The problem is that remaining in bed all day long is one of the worst ways to recover from almost anything!
Bed rest limits someone’s physical activity to little more than a few steps to and from the washroom, a few times daily. That is not enough physical activity to maintain muscle mass.
The data proves that with an alarming statistic:
For every day of bed rest, the frail elderly lose 5% of their mobility.
Consider how long an elderly person tends to be in a hospital. Once admitted, most elderly patients are hospitalized for at least a number of days, but upwards of a week or ten days wouldn’t be uncommon. After a week of bed rest, 35% of mobility is lost! If someone is unfortunate enough to be in the hospital for two weeks—which is all too common—on average they would lose 70% of their mobility.
That's a very high risk!
That could mean that prior to hospitalization, someone was living independently and walking without any aides. After two weeks in the hospital, that same person now requires a walker and struggles to get out of bed or out of a chair. That’s a drastic change in their ability level and independence. It will significantly impact the quality of daily life.
With such a high risk of losing mobility on each day of bed rest, you can see why it is critical to keep people up and moving as much as possible (unless expressly prohibited by doctor’s orders). Seniors should be encouraged to sit up and get out of bed and into a chair, stand up and sit down numerous times to keep leg muscles strong and do exercises either seated in a chair or passive exercises in the bed.
Even just sitting up straight in a chair is beneficial since it is typically easier for people to breathe deeply or cough and expel when they’re upright versus lying down. Many elderly patients are at high risk of developing pneumonia while in hospital, and failing to sit up, breathe deeply, cough and expel can increase that risk. Developing pneumonia will lengthen a hospital stay, which increases the likely number of days on bedrest—meaning more days of losing 5% mobility each day!
Unless a medical condition or injury specifically requires immobilized bed rest, remaining active in any possible way is absolutely essential to recovery and long-term maintenance of mobility and muscle mass.
Next time you’re visiting a senior in the hospital, have them sit up or get out of bed and into the chair.
You just might be helping to save their mobility and prevent the 5% daily loss!
In 2014, a number of organizations across Canada came together to promote a campaign called Fall Prevention Month. During the month of November, this campaign encourages organizations and individuals to come together to coordinate fall prevention efforts for a larger impact. The goal is to collectively raise awareness about fall prevention strategies and to help everyone see their role in keeping older adults safe, active, independent and healthy.
What are the impacts of falls?
Unintentional falls are the leading cause of injury for Ontarians aged 65 and over.
Recovering from a fall can be very difficult and with an increasing number of falls, it is important we take measures to prevent them.
How can we prevent falls?
The good news is that falls are preventable injuries! There are five key factors that caregivers and seniors should consider in order to prevent falls.
1) Eyesight – vision is an important part of balance and good vision helps to prevent falls. Everyone who is over the age of 65 should have their vision checked every year.
2) Your home – if you have clutter on your floors or stairs, it increases the chance of tripping and/or slipping. Make sure cords, scattered rugs, pet toys, books, etc. are in their proper place. Also, if your home is dark it increases the chance of falling, especially on stairs. Make sure to create a space that is well-lit!
3) Exercise – the most important thing you can do to prevent falls is to stay and remain strong! Walking, fishing, gardening, tai chi. Light yoga – whatever you enjoy! – do it to increase activity levels.
4) Medication – some medications cause dizziness on their own, or when mixed with others. It’s important to properly manage your health! Always take medication as directed and ask your pharmacist to review them if you are taking more than 2 medications.
5) Eating a healthy diet – Vitamin D and calcium help to keep strong bones. A diet to include more greens, lean protein, and less sugar will help you in remaining strong. You may want to talk to your doctor about supplements or other alternatives.
Most of all, don’t do it alone! It takes a community to prevent a fall and we all have a role to play. Here at Warm Embrace, we have a wonderful team of caregivers who can help you and your loved one to remain safe at home.
What is the difference between curing and healing? When we seek medical attention, are we hoping to be cured or hoping to be healed?
Dr. Mark Greenberg grapples with the issue of being cured versus being healed on a daily basis. Dr. Greenberg is a pediatric oncologist at The Hospital for Sick Children and has received the Order of Canada (2011) for his work.
In his TEDx address, Dr. Greenberg outlined the difference between being cured and being healed. When we seek medical intervention, we are looking to be cured of whatever ailment sent us to the doctor in the first place. We believe that we (or at least the doctors) have some semblance of control over the health care being provided. If we follow doctors’ orders, we expect to be cured.
Healing, however, is an entirely different issue. When someone suffers from a life-threatening illness, being physically cured is only the beginning. Life-threatening illness requires healing. Healing is more than just a physical process; it is also a psychological, social, and societal issue. It includes the patient directly, as well as the patient’s family, social network, and support system. Healing involves adapting to the new physical state of the patient and may include coping with emotional scarring.
Dr. Greenberg explains that coping with a life-threatening illness is the ultimate loss of control. It defies our Western mythology that if we work hard enough and are good people, then all will be fine. Grappling with this loss of control in the face of life-threatening illness plays out in family interactions and in dealing with doctors. Far too often, patients are physically cured, but they never fully heal. Dr. Greenberg asserts that compassion for the individual, rather than a focus on control of outcomes, leads to more comprehensive healing.
Healing is a psychological, social, and societal issue with implications beyond the individual, reaching to the health care system as a whole. Therefore, your family physician alone cannot help your loved one through the healing process; what your loved one needs is a team of people.
Adapting to a new physical state can be difficult that is why your loved one needs a team comprising of you, their doctor(s), nurses and caregivers. Wherever your loved one might be living, the help of a professional caregiver can provide them with social and physical support.
You don't have to go through the curing or healing process alone.
A resident named, Delores, fell three times in two weeks. Her third fall landed her in the hospital where she remained for 10 days. She was at risk of falling previously, but now, after 10 days of deconditioning in the hospital, her risk is even higher.
Delores has long been on the waitlist for long term care, but now that her needs have escalated, her care is beyond what can be safely managed within a retirement setting.
To escalate her placement on the LTC waitlist, Delores had to be discharged from the hospital under the Home First LHIN strategy. She went back to her residence after her 10-day hospital stay.
Now that Delores is in the community, she can be reassessed for long term care and be considered a crisis level. Even if someone is on the crisis list though, it doesn’t mean that a bed is immediately available.
Delores may still be waiting for weeks—or longer—for a suitable LTC placement to become available.
In the meantime, Delores is in your care, and she’s at an extremely high risk of falling. You are now worried that she cannot be left alone since she forgets that she is at risk of falling and she is inclined to get up and try to walk without her walker. Since her previous three falls were all attempts to make it to the washroom, you are very well aware that she may attempt to rush to the washroom and fall yet again.
Warm Embrace can help to meet this need!
If Delores is on the crisis waitlist for LTC and she needs 24/7 attendant care, the LHIN may provide some PSW support for various shifts. Warm Embrace can provide the rest. We can cover up to 24/7 care to ensure that Delores is never left alone. We can help to bridge the gap before Delores receives a suitable placement in long term care. This way, Delores is safe and has the one-on-one attendant care that she needs.
Just think how relieved you will feel, knowing that you can utilize the support of Warm Embrace when someone you know is awaiting crisis LTC placement.
One of your long-standing residents, Jean, has just been discharged after a ten-day stay in hospital. She has been discharged back to your residence, but she has declined considerably in the past 10 days.
She lost quite a bit of her strength from being in bed all day at the hospital, and since she was catheterized, she’s struggling with incontinence now as well. Previously she was independent with personal care and was able to get to the dining room on her own. Now, she’s needing help with toileting and sometimes she’s not even a one-person transfer.
Your care team were already stretched thin across residents with high needs. There are key times of day when you simply don’t have enough staff available all at the same time.
That’s where Warm Embrace comes in.
Jean needs a dedicated caregiver who can attend to her increased needs as she recovers from her hospital stay. If she requires a two-person transfer assist, our caregiver can be one of the two required people. Jean’s caregiver can attend to her toileting needs and assist her in getting to and from the dining room at a time when your staff have many other residents who need help getting to meals.
Jean’s caregiver can work together with her on some strengthening exercises to help her return to a greater state of independence. Of course, the goal is to help Jean remain independent enough to remain in your residence much longer.
If, however, Jean’s medical condition deteriorated while in the hospital to the point that she now qualifies for long term care placement, Jean’s caregiver will provide the assistance she needs while she remains in your residence awaiting placement. With her increased needs, Jean may require more than your staff have the capacity to provide, especially when other residents also have many complex needs.
If you have a resident like Jean who is returning from hospital, you can recommend that they implement a dedicated caregiver from Warm Embrace to help them as they recover. We recognize that our role might vary depending on the goals of the resident and their health. Any combination of the following are possible:
Temporary assistance as your resident recovers from hospitalization/surgery/recent illness until they regain their strength and abilities and no longer need our help
Ongoing support to match your resident’s new ability level and needs, allowing them to remain living in your residence even though their needs have increased.
Crises support if your resident is awaiting long term care placement and their needs have drastically increased.
Our support ensures the resident has all the care they need after returning from the hospital, while also reducing strain on your staff.
The next time you have a resident with a pending hospital discharge, remember to make Warm Embrace part of the planning process and have care in place for a smooth return to your residence.
Did you know that vision loss is not a part of normal aging? Normal aging might include changes in your vision, but the loss of vision altogether is not a normal part of aging. Normal aging includes changes to the body that all people will experience, provided they live long enough. Changes to hair—such as hair loss, or hair turning white/gray—is a normal part of aging. Everyone’s hair will eventually turn colour and become thinner if they live long enough. Macular degeneration, by contrast, is not a normal part of aging because it is not inevitable that someone will eventually experience macular degeneration.
Age-related Macular Degeneration (AMD) is the leading cause of vision loss for people over age 50. It affects 15% of people over age 50; it affects 30% of those over age 75. AMD is a serious condition because it can severely impair someone’s sight as it progresses.
The macula is an area of the eye that is responsible for detail vision. It is the bull’s-eye of the retina, and it is what allows people to read. The macula is essential for the detail vision necessary for reading; the rest of the retina cannot read; only the macula can read. If the macula is severely impaired, the ability to read will disappear; larger or stronger glasses won’t solve the problem as only the macula can provide the detail necessary for reading.
There are two types of macular degeneration—dry and wet.
Dry AMD is much more common, accounting for 85% of all AMD cases. Its impact is less severe because those with dry AMD typically only lose 10-20% of their vision. Wet AMD is less common, but its impacts are more severe. Only 15% of those with AMD experience the wet version, but they will typically lose 80-90% of their vision and become legally blind.
Dry AMD always precedes wet AMD. Sometimes people ignore symptoms and by the time they see an ophthalmologist, the dry AMD has become wet and is much more severe. With dry AMD, the peripheral vision is maintained and will not be lost. The visual detail provided by the macula is what may be affected. Reading will become difficult, but most people will not become blind as a result of dry AMD alone. In fact, only 5% of people with dry AMD will progress to vision that measures as legally blind, and that typically requires 10 years of progression. Dry AMD typically progresses quite slowly.
What are the risk factors for AMD?
Heredity — almost half of all AMD cases are genetic. It isn’t as simple as having a specific gene; it is a series of genes that are responsible for AMD.
Smoking — increases risk by 3-4 times the rate of a non-smoker. Smoking also increases the risk of wet AMD. Combine the hereditary risk with smoking, and the risk rises to 34%!
Age — while you cannot control the risk factor of age, you can control sun exposure. AMD is the wearing out of the macula. Overexposure to the sun can expedite this process.
Nutrition —maintaining excellent nutrition is important for eye health. Once diagnosed with AMD, patients are advised to eat a nutrient-rich diet that is high in vitamins, minerals and antioxidants (or supplement as needed). When patients follow this regimen, there is a 25% reduction in vision loss.
Wet AMD — if someone has wet AMD in one eye, they have a 50% risk of also developing AMD in the other eye.
Those with AMD are well aware of vision changes and how that impacts detail activities such as reading or needlework. What people underestimate is how AMD can impact practical elements of day-to-day living and increase risk in other areas of life.
Older adults with vision loss have:
Twice as much difficulty with day-to-day living compared to their peers
Twice the risk of falling
Three times the risk of depression (often linked to the loss of reading ability, a key enjoyment activity for many people)
Four times the risk of a hip fracture
Vision loss affects more than just vision!With increased risk of falls, fractures, depression, and difficulty with daily living, someone’s life could be severely impacted.
How do you prevent AMD?
Regular eye exams are crucial to ensure that AMD or any other vision concerns are detected early and treated in the most effective ways possible. Of Canadians who do not wear glasses, 50% have not had their eyes checked in the past 5 years, if ever! Even if someone does not wear glasses, they should still visit an optometrist occasionally to check eye health.
If you know a senior with vision loss who is at risk of falls, fractures, depression or having trouble with daily tasks, we can help!
If 10 people witness a crime, how many different accounts will there be? Undoubtedly, there will be 10 unique eyewitness accounts. There might be similarities between the 10 stories, but there will most definitely be distinctions between the accounts, possibly even with contradictory details.
Why is this?
Each of us has a unique experience of the world. We can’t help but view the world through our own unique lens. It also means that we interpret the world around us through that same lens, and pass judgement or draw conclusions based on our experience and our perspective.
The same is true for those who have dementia. They are viewing the world through their own unique lens and filtering it based on experience and perspective. They have a massive additional challenge because—their brain is significantly affected by a disease that interferes with how they can process information.
They cannot rely on memory to recall past experience or to logically process information. For example, if someone with dementia sees a blue towel crumpled on the floor, they could ask if it’s a dolphin. At that moment, their brain did not process that dolphins can only survive in water and they do not live in people’s homes. Their brain is unable to recall past information about dolphins or access memory to know that their home does not have any pets. At that moment, they see something that looks like it could be a dolphin and their brain interprets that data to conclude that must be what they are seeing since there is no other information to explain it.
Another example is, if an elderly woman with advanced dementia says she needs to pick her children up from school, she sincerely believes this to be the case. She is not aware that she is 86 years old and has not had school-age children in over 50 years. She is not aware that you are her daughter and you are the schoolgirl she is concerned about. At that moment, her brain is accessing long-term memory for information that has changed drastically over the years, but she is unable to recall more recent memory that would put her long-term memory in context.
Her reality is that she has school children to pick up and she cannot leave them alone. She is an attentive mother and needs to get to her children. Your reality is that your 86-year old mother is determined to pick up a school child, and you have not been that school child in nearly 50 years. In fact, you have grandchildren now who are starting in school.
Your realities are different in that moment. While your reality may be more factually correct, it is nearly impossible to have someone with dementia adjust their reality to match yours. It is far more effective to understand their reality and match them in theirs. Focusing on facts is rarely useful. Focusing on emotions is the most effective way to handle differing realities.
Focusing on facts would be reorienting your mother to your reality: “No Mom, you don’ have to pick children up from school. I’m your daughter and I haven’t gone to school in nearly 50 years; even your grandchildren have finished school. You’ve got great-grand-children starting in school now. You don’t need to pick up anyone. You’re staying here with me.”
The comments are all factually correct, but they are not helpful to the person with dementia. The pieces don’t fit together; she is unable to access the memory and process that would allow all the information to make sense. Instead, try to join her in her world.
“Oh, you have children! Tell me about your children.” Get your mother talking to understand her mindset. An emotion will likely surface, and you’re looking to understand what her emotional state is in the moment and ideally address her emotional concern.
You’re matching your mother’s reality and joining her in her world for a few moments, rather than trying to force her to join you in your version of reality. Keep the conversation going and create that emotional connection.
Don’t fight different versions of reality; learn to join your loved one in their version of reality by focusing less upon the facts, and more upon the emotions.
Dementia and Communication: What to Expect in the Late Stages
Tuesday, July 2, 2019
In the late stages of dementia, or in severe Alzheimer’s, communication is significantly impacted. By this stage, both speech and language can be affected. The person with advanced dementia is not aware of their communication deficits; they may not be able to think beyond their own needs to notice the perception challenges of the family caregiver with whom they are communicating.
Understanding the limitations of late-stage dementia is critical to communication. Knowing the challenges that will exist and the ability level of your loved one makes all the difference for successful communication.
Here are 7 elements of communication that will have become difficult, directly impacting the expectations we should set for late-stage dementia communication:
1. Highly Variable
Your loved one is going to fluctuate in ability level—by the day, by the hour, even within a minute. Just because a person with dementia can clearly articulate a concept one minute, does not mean that she is able to do so the next minute. There can be islands of fluent and coherent language where she can express herself with impressive clarity. Understand that her ability to express herself will fluctuate drastically, and a moment of inability is not laziness or faking, or manipulation.
Perseveration is a focus or preoccupation with a particular concept. It is often expressed as worry or concern. In the later stages of dementia, perseveration is quite common and is often expressed through repeated questions or a repeated focus on certain words/topics.
3. Reduced Vocabulary
The mental dictionary of vocabulary is not only shuffled as it is in the early stages, but there are also now entire sections of the dictionary that are missing. Vocabulary may be reduced to simple words, or your loved one may surprise you with complex words in one moment and lack of simple words the next moment.
4. Unrelated Utterances
Late-stage dementia causes disorganized thinking, resulting in a conversation that jumps around frequently. Where there might be some linkage between concepts in the mid-stages, in the late stages, words or ideas may be expressed that are entirely unrelated. The reduced vocabulary causes your loved one to grasp at other, unrelated words to fill the gap.
5. Word order and Agreement
One of the hallmarks of language is the correct arrangement of words—words need to be used in the correct order and in agreement with each other. In the later stages of dementia, words become easily entangled, sentences are mixed up, and correct grammar may be lost.
6. Speech Disturbances
Throughout the earlier stages of dementia or milder Alzheimer’s, language is affected. In the late stages of dementia, speech may also be affected. Someone may have trouble pronouncing words, forget how to pronounce certain syllables, or begin to stutter. In the very late stages, speech may be significantly impacted so that words are no longer discernable.
7. Non-Verbal Cues Paramount
When your loved one can no longer understand the meaning of the words you are saying, he/she will rely upon understanding your intonation, your body language, the tone of your voice, and your approach.
Your words could be pleasant and clear, but if you appear to be upset or hurried, your words will be lost. Only your upset nature or hurried and flustered sense is being conveyed to your loved one. The person with dementia may then respond to your perceived emotion, completely separate from the words that you are saying.
As someone with dementia progresses through the illness, their ability to analyze their own communication dwindles. By the late stages, they are not able to self-assess their communication at all.
As a family caregiver communicating with your loved one, or as a health care professional communicating with clients, it is our responsibility to anticipate the above 7 challenges and accommodate accordingly.
4 Reasons to Get Elders Out of the Hospital Quickly!
Your mom just had surgery and you thought she’d be in the hospital for weeks, but she’s being discharged today! You may feel as though your mother is being pushed out of the hospital door just to make space for the next patient, but there’s a lot more to it than that.
Here are four reasons why you don’t want an elderly relative to remain in hospital any longer than necessary:
1. Bedrest is TERRIBLE!
When someone is sick or recovering after surgery, it is tempting to pamper them while they remain in bed all day long, but that is actually the worst thing for recovery. For every day of bed rest, the frail elderly lose approximately 5% of their mobility. After only a week of bedrest, they could be down by 35% of their mobility—and they may not have started with 100% prior to surgery. Getting up and out of bed is crucial to retain mobility and strength. Encouraging someone to get up periodically throughout the day will prevent the 5% mobility loss that comes with complete bedrest.
2. Hospitals make you sick!
The risk of contracting an additional illness while in hospital increases the longer you remain in hospital. Those with weakened immune systems are most likely to contract superbugs such as MRSA or C-difficile which are antibiotic resistant.
These illnesses can cause severe diarrhea which often leads to dehydration, which increases the risk of delirium—the next item on the list.
3. Delirium, Dementia or Despair?
Delirium is a state of confusion that can be mistaken for a sudden case of Alzheimer’s Disease. It is NOT a form of dementia, but it can mimic dementia. The frail elderly are at high risk of developing delirium in the hospital.
Here are some of the risk factors:
Medication changes—their regular medication routine may be changed to help with diagnosis
Interrupted sleep—injections in the middle of the night, a nurse checking in, etc.
Day/night reversal—orientation to time of day becomes difficult when lights are on all night and circadian rhythm is interrupted.
Lack of social interaction—while nurses and doctors may conduct a test or provide care, they cannot remain at a patient’s bedside for hours at a time. The loneliness and sense of isolation can cause the elderly to despair. With a sense of time interrupted, someone may believe they have been abandoned for days.
4. Get back on the john!
If an elderly person is at risk of falling or they need assistance, they won’t be permitted to toilet independently. They can press the buzzer to request help, but hospital staff may not be immediately available. In many cases, it is easier to catheterize a patient to ensure that they are not attempting to get out of bed and risk falling on their way to the bathroom.
The longer someone is catheterized, the greater the risk that they will become incontinent. The catheter holds open the muscles that usually contract to block the bladder. Those muscles will essentially become lazy. The catheter might be removed, but the muscles may have lost their ability to retract and no longer be able to contract sufficiently to contain urine.
Losing the ability to hold one’s bladder has enormous ramifications. Beyond the increased care needs, someone’s confidence and quality of life can be negatively impacted by incontinence.
The hospital is the right spot for someone who is acutely ill or injured, but it’s a terrible place to recover! Returning home as soon as possible will prevent these four risks of a prolonged hospital stay. We can help your loved one remain healthy and well!
You grow attached to your residents and you hate to see them move on from your residence into Long Term Care. You wish you could keep them with you even longer! You may even feel a little torn because on one hand, you have grown fond of each resident and you want them to remain in your home, but you also see the toll it takes on your staff when care needs suddenly increase.
Warm Embrace can help you to have the best of both worlds! Your residents can remain living with you much longer, without placing an increased burden on your staff.
One of our greatest success stories was with a gentleman at a retirement home in Kitchener. When he moved into the retirement home, he had occasional nighttime urinary incontinence due to prostate issues. After prostate surgery, he became entirely incontinent and he wasn’t able to self-manage. Because of this, he was self-isolating, remaining in his room and not attending any activities or events.
He had AM/PM care from the LHIN, but many days he wasn’t ready to get out of bed when the PSW from the LHIN arrived. That left the retirement home staff to attend to his needs at the busiest time of day—the morning rush. He needed assistance numerous times throughout the day as well and it was taking quite a toll on the staff.
Warm Embrace was brought in to help support this gentleman so he could remain living in retirement and not move into long term care. We intentionally scheduled our service at the time of day that was heaviest for the retirement home team. That way, their efforts could be focused on other residents, knowing this gentleman was well-cared for.
Our caregivers attended to his personal care needs in the morning—on his schedule when he was ready to get up. Our caregivers ensured that he was bathed and dressed in fresh clothes. Each day, they changed the bedsheets and laundered them, along with any other soiled laundry. While this gentleman had weekly laundry included in his package, our team was responsible to immediately launder soiled items so they didn’t remain in his suite until laundry day.
Once he was dressed and ready for the day, we’d get him to breakfast and then take him on an outing. With a caregiver’s reassurance, he began leaving his room to attend events and activities. When he required assistance, we’d be right there to provide it. His confidence began to return!
Our morning visits thoroughly covered the busiest time of day, and the retirement home staff was able to provide the coverage for this gentleman required in the afternoon. Working together as a team, we supported this gentleman in remaining in his retirement home of choice for an additional three and a half years.
We are pleased to partner with you and your team to provide the same support to any of your residents who require it. We intentionally schedule our services at your highest need times of day to reduce the strain on your staff.
Our Warm Embrace caregivers can support your highest-needs residents on a one-to-one basis, freeing your staff to attend to all the other residents in their care. Together, we can help your residents to remain with you for many more years to come!