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!
That’s a trick question—there is no age when exercise isn’t important. Just because someone is elderly doesn’t mean they’re exempt from exercise!
It does mean the exercise needs to be modified to match ability level and possible injuries or conditions such as arthritis. What qualifies as exercise also shifts as someone ages. When someone is young, it may take a jog or run to get their heart rate up, whereas an elderly senior may increase their heartrate just by walking. The important thing is to increase the heart rate and to get the blood and oxygen flowing.
Sadly, many seniors lead highly sedentary lives. All too often, the lazy boy recliner becomes the centre of seniors’ worlds. They settle into the recliner first thing in the morning and watch television for a significant part of the day. They nap in the chair…they may even sleep in the chair all night as a surprising number of seniors tend to do.
The most activity they get is a few steps to the washroom and back. Even then, I’ve met many seniors who intentionally limit their fluid intake to reduce the number of washroom trips required! Going to the washroom may be the only activity they’re getting, and even then they’re limiting that.
A senior who has become accustomed to such a sedentary lifestyle will need to reintroduce activity gradually. Compared to their currently sedentary day, it does not take much effort to suddenly double activity levels! Simply getting up and out of their chair becomes a form of activity that cannot be taken for granted.
If you’re visiting someone who tends to be overly sedentary, encourage as much movement and activity as possible.
As a precaution, you might avoid suggesting “exercise”. Calling it “exercise” may be a barrier to some elderly people. If they don’t have the same context as you do for prioritizing fitness and exercise, they may not be inclined to want to “exercise”.
Instead, integrate basic activity into your visit. Suggest sitting at the kitchen table together for a bit. Ask them to show you around. Step outside into the backyard. While it may not qualify as exercise for you, it is most definitely an increase in activity for them. Be mindful to not push too hard too quickly, but continually suggest more and more activity—and increasing lengths of time out of the lazy boy chair.
When you’re in the kitchen together, ask them to reach items out of the cupboard. Bending, stretching, reaching are all basic movements that are necessary to maintaining a range of motion. Ask for help folding laundry and putting it away. The “excuses” you use to call your loved one into another room, or get them up and out of their chair are only limited by your imagination.
Before you know it, you might start getting a little devious in the creative ways you encourage more activity during your visit. The better you can disguise the increased activity as anything other than exercise, the more successful you’ll be!
Inclusion is a hot topic and a very important one for our elderly population. It emphasizes the importance of inviting the active participation of all citizens, including our elderly population, into our social fabric.
The Canadian Network for the Prevention of Elder Abuse (CNPEA) has reported that:
Being socially isolated is a common affliction among older adults. More than 30% of Canadian seniors are at risk of becoming socially isolated.
Isolation and loneliness are as bad for your health as smoking 15 cigarettes a day.
And, social isolation can put seniors at increased risk for elder abuse.
Inviting the elderly population into social spaces is the first step, the second next step is creating an age-friendly community.
What exactly is an age-friendly community?
Being age-friendly means that there are no barriers to accessing services in the community, regardless of age or ability. A city that is designed to include and be accessible for its elderly residents is automatically factoring in the needs of its younger population.
For example, if a community is accessible for someone using a walker or wheelchair, it is also accessible to a parent pushing a stroller. The examples that we think of quickly are usually about physical accommodation such as ramps, wider doorways, longer crosswalk signals, etc. These accessibility features are certainly important, but a truly age-friendly community is about far more than just physical accessibility.
Dr. John Lewis, professor at the University of Waterloo, points out that currently, one-quarter of Waterloo Region’s population is age 55 plus. That number is only going to increase in the next few decades. It is not acceptable that there are ageist prejudices towards 1/4 of our population! If we want to have a community that is inclusive to all members, it needs to be designed to suit those who are age 55 and older.
Age-friendly communities are about inclusion and a sense of belonging. It is about receiving the respect and dignity that all citizens deserve, regardless of ability or age.
Often, these issues relate directly to coping with ageism. Ageism is the stereotyping of and prejudices against someone because of their age. It might include automatically treating someone in a certain way, just because they appear to be a senior.
For example, assuming someone is hard of hearing because they have gray hair is an ageist stereotype. Another example is the way that professionals often speak about a senior to their family members, as though the senior is not even in the room! The conversation should be directed to the relevant person, regardless of age.
In addition to physical challenges, some people experience cognitive changes. These people deserve the same level of respect and inclusion as all other members of society. Brenda Hounam, dementia advocate and spokesperson, highly advises communicating about dementia itself. Rather than hiding her challenges with dementia, she has decided to be very public and make others aware of her disease.
Hounam suggests that people “open the doors for communication—just ask”. She feels that it is much better to ask for clarification and to communicate clearly with someone who has dementia; do not just make assumptions. She asks that people do more than just listen; she wants people to truly hear and validate what she is saying. Hounam’s overarching message is that “we are all unique, and we all have something to contribute until the last breath.”
Being inclusive and respectful of all citizens—regardless of age, ability, or illness—better allows us to fully acknowledge and appreciate the contributions of all members of society.
Driving is a very personal issue that involves strong emotions. For many seniors, driving is a privilege they’ve had for decades, and their personal sense of identity and independence is often linked to their ability to drive. When driving seems so second nature, it can be difficult for people to remember that driving is truly a privilege, not a right.
So, when is it time to give up the privilege of driving?
Oftentimes, the person who is suffering from dementia is the least aware that anything is wrong. They may not notice that their reaction time has changed, or that their judgment is off. The family are often the first ones to be concerned about driving, and rightfully so, as research shows that someone with dementia is eight times more likely to be in an accident than the average population.
Some warning signs to watch for if you have an elderly who is driving with dementia:
Damage to the car
Difficulty navigating familiar routes
Simple errands taking hours longer than necessary with no explanation
Mixing up the gas and brake pedals
Missing stop signs or traffic lights
Problems with lane changes and merging
Passenger input is required
Family refuse to get into the car
Consider the “grandchild question”: do you feel comfortable allowing the grandchildren to ride with their grandparent behind the wheel? If your answer is no, there are likely significant concerns about your loved ones’ driving ability.
If you are concerned about your loved ones’ driving, you need to speak to their doctor. It is ideal to attend a doctor’s visit with your loved one; you may also write letters to inform the doctor of the changes your loved one is experiencing.
The family doctor is required to notify the Ministry of Transportation, and it is the MTO who will revoke the licence (not the family doctor). After being notified by the family doctor, the MTO will send a letter directly to your loved one (not to the family doctor). The letter will state whether they may continue to drive, they need an assessment, more medical evidence is required, or the licence is revoked.
What happens when their licence is revoked?
If the licence is revoked, it is HIGHLY advised that your loved one’s car be removed from the property. Someone with dementia may no longer remember that they are not allowed to drive. Disabling the vehicle is an option, though it is remarkable how handy and mechanically-minded many seniors from that generation can be, so the simple options of unplugging the spark plugs or draining the battery may be insufficient. The most ideal solution is to have the vehicle removed from the property altogether to ensure that your loved one is safe, and to ensure that others are safe as well.
It is important to understand how devastating the loss of a licence can be for many seniors. It can result in loss of independence, reduced social interaction, loneliness, lowered self-esteem, depression, and increased stress on family and friends. For all of these reasons, family doctors do not just send letters to the MTO easily; they must have concrete evidence of imminent safety concerns. To minimize the negative impact of losing a licence, family and friends can assist by providing alternate means of transportation and socialization.
There are volunteer driving services that can be accessed through your local community centres or the Alzheimer’s Society. Taxi companies are often able to offer discounts to “frequent riders”. If your loved one drives less than 4000—5000km per year, then it is cheaper to take a taxi everywhere than it is to maintain the car. From a purely economic standpoint, driving may simply be too expensive compared to alternate options! Appealing to your loved one’s financial sense may be more effective than having them agree that their driving is no longer safe.
When people hear the term “advanced care planning” they often think it’s about having a will or planning a funeral. While those topics are important, they are not part of Advanced Care Planning. Advanced Care Planning is all about while you’re still alive—what happens if you are unable to make a decision for yourself? Who will make a decision on your behalf?
The person to make a decision on your behalf is called a Substitute Decision Maker (SDM). The SDM should be someone you trust, and someone who knows you very well so that they can make the types of decisions that you would make yourself. It is the responsibility of the SDM to act in your best interests and to make decisions that you would make, even if they would personally choose something different.
Did you know that you already have an SDM? Even if you haven’t selected someone, there is a hierarchy that is set out and followed, in lieu of having selected your SDM. Here is the hierarchy:
2. Power of Attorney (POA) for Personal Care
3. A representative appointed by the Consent and Capacity Board
4. Spouse or partner
5. Children or parents
6. Parent with the right of access (i.e. custody)
7. Brother or sister
8. Any other relative by blood, marriage, or adoption
9. Office of the Public Guardian and Trustee
If a substitute decision-maker is required, this list is consulted—starting at the top, if someone doesn’t have number one, they move onto number two and likewise until they find someone who can act as your substitute. The catch is that you might select someone who isn’t reflected on this list. For example, you might have a really close friend who has known you for 40 years but friends don’t make the list. Instead, a long-lost cousin would qualify as “any other relative by blood, marriage or adoption.” If you would like the friend to make your decisions for you, then you need to appoint that friend as your Power of Attorney for Personal Care — then they are at the top of the hierarchy should the need ever arise.
Sometimes people figure that they have lots of relatives and people who care about them, so they don’t appoint a POA. Such situations can be tricky though. For example, if someone is in their 60’s and no longer married, but they have three adult children in their 30’s as well as parents who are aged 85 and 92 — all five of these people would need to agree on every single decision. Based on the hierarchy chart, parents and children have equal ranking; one does not trump the other. As long as the children are over age 16, they can be an SDM. In this example, there are three children over age 16 and two parents who are presumed capable and a unanimous decision would be required for any medical decisions. You can imagine how complicated this situation would become!
Looking at the hierarchy, you may be content with the automatic SDM. For many people, the automatic option is number four — spouse or partner. To be considered common-law for the purpose of assigning the SDM, the couple must have been living together for at least one year prior to the SDM being appointed.
If a couple separates or divorces, they are no longer considered under option number four. An ex-spouse of decades would be overlooked as the SDM and a distant relative could be assigned instead. If a divorcing couple were amicable and still wanted to be SDM for each other, they would need to assign each other as their POA for personal care.
The safest way to ensure that your medical decisions are made as YOU would wish is to confirm your selection for SDM or appoint a Power of Attorney for Personal Care. This eliminates possible confusion or delay as people sort through the hierarchy. Appointing an SDM or POA gives you the opportunity to discuss in advance what your wishes would be. Don’t assume that someone else would know your preferences — tell them what you would like for your own personal care.
While it is always preferable to discuss your wishes with your POA, you might be surprised to know that it is possible to appoint someone as POA without their knowledge! There is no paperwork requiring a POA to accept the position. Theoretically, someone can be appointed as a POA and never be informed. They are just called upon to act as SDM when the need arises.
However, there is no requirement that someone accepts the role of Substitute Decision Maker (SDM) at any time. A spouse who is highest on the hierarchy can refuse to act as the SDM and have the responsibility roll over to the next level. Even a POA can refuse the responsibility of the SDM and decline being involved. For this reason, it is often advised that you select an SDM or POA as well as a backup — in case your first SDM is unavailable or unwilling to act as SDM.
There are a few requirements for who is eligible to be an SDM:
1. They must be capable
2. 16 years of age or older
3. Have no court orders or separation agreements in place
4. Be available
5. Be willing to act as SDM
Beyond these basic criteria, you want to select someone who will act in your best interests, so what other criteria can you use?
Here are a few important elements to consider:
Do you trust this person to make all your decisions for you?
How well does this person react in stressful times?
How well do they handle emergencies?
Is this person willing to be your SDM? (remember—just because you appoint them, doesn't make them willing to act as SDM!)
Express your wishes to them; communicate your health care goals and preferences so they can be confident in making decisions on your behalf.
If there is ever a situation when you are unable to make your own health care decisions, you want to be certain that you have the right person in place who will make decisions that you would make for yourself — this is what Advance Care Planning is all about.
The quick synopsis of what to do for Advanced Care Planning:
Select and confirm in writing your selection of SDM or legally appoint a POA;
Ensure that person/those people are informed that they have been listed;
Provide them with information about your wishes so they can confidently decide on your behalf.
Do you know a senior who has suffered a serious fall? Likely you do, since approximately 30% of seniors who live in the community suffer a fall each year. The consequences of a fall can be quite serious—injury, hospitalization, even death from complications.
Did you know that falls are the cause of 90% of all hip fractures, 50% of all injury-relatedhospitalizations in seniors, and the 5th leading cause of death in the elderly?! These numbers also double when a senior has dementia. So, it is extremely vital in keeping seniors strong and steady on their feet.
Why do seniors fall in the first place?
“Falling isn’t as much about slips and trips. It’s about the failure to recover. Slips and trips happen at all ages” (Dr. George Fernie). There are various external factors at play that contribute to slips and trips; such as:
Poor footwear (e.g. slippers)
While some falls can be attributed to tripping—such as tripping over floor mats, pets or curbs—other falls seem mysterious. The person will report that they just went down and we're not sure why. In many of those mysterious cases, the fall is due to internal factors such as:
Visual and hearing deficits
Neuropathy (abnormal sensory feedback)
Low blood pressure
Pain and foot drop
Weakness and tightness
Slowed reflexes and balance disorders
What can we do to prevent falls?
1. Get rid of all the external factors that cause slips and trips!
Ensure that your living space has no loose carpets or rugs, the lighting is bright for increased visibility, all chairs are sturdy with armrests, everything needed is on the main floor (no stairs), and that proper footwear is worn in the house.
2. Improve balance and stability!
“She says she wants to keep living in her home. We say it starts by keeping her on her feet” (American Academy of Orthopedic Surgeons). The number one key to fall prevention is staying active! Physical activity has shown to mitigate the deathly consequences of falls – just walking, gardening or housework is enough for an elderly loved one.
However, when your elderly loved one refuses to do regular exercise the best option is to increase their base of support.
To remain balanced, there must be a stable base of support—the wider the base of support the more stable it becomes. The base of support is the invisible box that can be drawn around your feet when you are standing. Added to this is our centre of mass—which is approximately where our belly button is located.
When someone’s centre of mass is in the middle of their base of support, they are perfectly balanced. When their centre of mass begins to reach the outer edge of their base of support, they are more prone to falling.
For example, a ballerina narrows her base of support to be only one square inch when she is en pointe. Her balance is quite precarious because her base of support has been reduced. The only way that she remains upright is by perfectly hovering her centre of mass over her base of support. She is constantly adjusting to ensure that her centre of mass doesn't sway too far aware from her base of support.
In contrast, a football player crouches low and spreads his feet wide so that he has a wider base of support than he normally would. He may even put one hand to the ground adding a third point of contact and expanding his base of support further. He has a stable base of support, and his centre of mass is positioned in the middle of his base.
In the case of a frail senior, their feet may ache or have bunions, causing that person to only walk on the edges of their feet, which reduces their base of support and their balance. Instead of using the full surface of their foot, they have reduced their base of support more like a ballerina. As well, the senior’s posture may be more forward-leaning, pushing the centre of mass to the outer edge of the base of support, causing instability. A senior will not likely be crouching down to touch the ground for support, the way a football player does.
The best way to create a strong base of support is to use a walker. The four wheels of the walker expand someone’s base and provide the necessary support. Much like a football player, a well-balanced senior using a walker is less likely to fall than a senior who is precariously balancing on sore feet. If their posture is forward leaning then the walker extends the base of support ensuring that the centre of mass remains in the middle of the base of support.
Encourage the seniors in your life to carefully assess their centre of mass and base of support to ensure that they are as safely balanced as possible. Every fall that is prevented is a great success and ensures a longer and healthier life for that senior!
You know your mother needs assistance, but she refuses to even consider it. She insists that she doesn’t want to lose her independence. You’re frustrated because you’re trying to be proactive and prevent a crisis, but your mother won’t hear of it.
Be reassured! You are not alone! Your mother is not the first senior to bristle at the notion of receiving help. In fact, most of our homecareclients here at Warm Embrace started out exactly like your mother—Estelle sure did. Estelle started out adamantly insisting that she didn’t need or want any help at all.
I can hardly blame Estelle for resisting help. Very few people are quick to put up their hand and say “yes, I need help”—and that is true at any age. Our North American culture places a high value on independence, and many people tend to define that as “doing everything myself.”
Estelle rejected homecare because she was afraid that if she can’t do it all herself, then she won’t be considered independent. In her mind, that would mean being one step away from a dreaded nursing home.
We define independence differently. We believe that independence doesn’t mean that you do it all yourself; instead, independence means that you get to choose how everything is done. Independence means that you’re the boss. You make your own decisions. It doesn’t mean you physically do everything; it means you have control in how it is done.
Homecare doesn’t take away a senior’s independence. In fact, it often does the opposite. It often grants senior more independence.
Estelle did not lose her independence, and that’s probably why she now adores her two favourite caregivers. Estelle did not lose anything; she gained.
Estelle benefited from:
Gaining two new best friends
Enjoying stimulating conversation
Eating healthy meals and having more energy
Re-establishing her social connections because her caregivers can drive her to events
More physical activity by keeping up with her caregivers—instead of just sitting watching TV
Improved sleeping patterns since she’s no longer napping all day out of boredom
Your mother could benefit from homecare just as much as Estelle. Your mother can go from just barely surviving to actually thrive.
What NOT To Do:
When you mention the idea of homecare or introducing a caregiver, don’t highlight what your mother can’t do. Don’t point out all the activities she’s no longer managing, even though it may seem obvious and glaring to you.
Do NOT point out that:
She has lost her licence and no longer drives
The only healthy meals she eats are the leftovers you bring
She hasn’t been to a social event in six months
Her housekeeping standards are slipping
What To DO:
Highlight all of the gains your mother will benefit from when she has a wonderful new caregiver in her life. Point out how her life will be even better.
DO point out that:
She can now go anywhere she likes without worrying about calling a cab
She can go to social events and visit friends she hasn’t seen lately
Her caregiver will be a new friend with whom to play scrabble
She will enjoy having a visitor in the lonely winter months when she doesn’t usually get out
Even when you’re out of town, she’ll still have a consistent visitor
She will be the boss and SHE gets to decide what she does, together with her caregiver
When seniors see that they are not giving anything up, they are not losing anything, they are more receptive. Seniors are often keen to accept new friends and live life more fully.
Help your mother to see all that she stands to gain, and the conversation may be easier. We’ve helped countless families through the exact same struggle you’re experiencing, and we can make suggestions specific to your situation. Call us for more ideas!
A senior benefits from homecare by suddenly eating better meals and that senior now has more energy to independently manage more tasks. Another senior might benefit from our accompanied transportation and now that senior can attend all the activities and functions she once enjoyed. She is regaining her life back; she is not losing independence!
When seniors recognize what they can gain from homecare, they are more receptive. They are gaining a new friend who will ensure that they enjoy each day and live it to the fullest.
The good news is, we managed to win them over and now they are clients who absolutely adore their caregivers and can hardly imagine life without Warm Embrace.