Dance and Meditate Your Way to Better Balance!

Dr. Rein Tideiksaar — Mon, 14 May 2012 10:31:38 GMT

Balance, the ability to control and maintain one’s body position whether in motion or when still, often deteriorates as people grow older. Last month, I addressed the topic of declining balance and the benefits of balance and strength training to improve balance. Some elders, especially those individuals who are frail and/or have health conditions, may find strength training that includes lifting weights undesirable or not even feasible. Therefore, I suggested yoga, tai chi (TIE-chee) and dancing as alternative forms of exercise to enhance balance. Now let’s take a look at the potential benefits of all three.

Yoga

Yoga, an eastern discipline developed in India more than 5000 years ago, is a form of exercise or physical activity that consists of a series of postures and gentle movements. With respect to balance, yoga strengthens the muscles around the ankle and hip joint, improving the range of motion and flexibility of these joints. This helps the body remain stable and balanced. Other benefits of better balance include:

•   Greater confidence, especially in being able to accomplish everyday activities.
•   Less fear of falling; more confidence in going about one’s daily activities.
•   Greater ability to transfer from the floor, which is important for elders who experience difficultly getting up from the floor after falling.

There are many yoga postures and movements to choose from. In elders with disability or limited balance it’s best to begin slow; start with sitting postures. Once individuals feel comfortable and more stable, they can move up to typical standing postures with the support of a wall or chair to increase safety and avoid the chances of falling.

Tai Chi

Another good exercise for balance is tai chi. Originally developed in ancient China for self-defense, tai chi is a self-paced form of exercise and stretching. To do tai chi, the individual performs a series of rhythmic postures or movements in a slow, graceful manner. Each posture flows into the next without pause, ensuring that the body is in constant motion. Tai chi improves balance by strengthening the muscles and joints surrounding the hips and legs.

Most forms of tai chi are suitable for elders regardless of age or physical ability; tai chi emphasizes technique over strength. Because tai chi is low impact, it may be especially appropriate for elders unaccustomed to exercise. In addition, many elders find tai chi attractive because it's inexpensive (it requires no special equipment) and can be done either alone or in a group.

Dance

All types of dance, including ballroom dancing (rumba, foxtrot, salsa, waltz, etc) and even ‘rock n roll’, practiced on a regular basis (about twice-weekly) are excellent forms of exercise to regain balance. Dancing causes individual muscles to work against some form of resistance thereby increasing muscular strength and agility, and thereby, improving balance.

Benefits of dance-based exercise include:

•   Improvements in walking.

•   Increased self confidence in balance, especially in accomplishing everyday activities. Balance confidence is also linked to a decrease in ‘fear of falling’.

•   Improvements in a number of conditions associated with falling (including arthritis, Parkinson’s disease, dementia, and depression). Dance grouped with tai chi is often used to improve joint mobility and balance in elders with arthritis.

•   Decreased social isolation; the social aspects of dance help to overcome feelings of loneliness and depression.

Elders who enjoy dancing are more likely to continue, and in so doing, gain greater physical benefits. Even so, the physical demands of dance should be appropriate to the capabilities of the elder. Therefore, it’s important to select a form of dance and exercise routine that matches the physical capabilities of the elder.

Additional Benefits

There are a host of other health benefits gained from yoga, tai chi and dancing, which includes:
•   Lowering of high blood pressure
•   Reducing high cholesterol and blood sugar levels
•   Controlling body fat and weight.
•   Reducing anxiety and depression; improving mental ability.
•   Improving sleep
•   Promoting a sense of well-being and social inclusion.

Getting Started

The basic steps of getting started with exercise include:

Finding a Class

•   Yoga, tai chi and dance classes are held in many communities locations (senior centers, YMCA/YWCA, health clubs, community recreation centers, etc.)

Learning About

•   There are dozens of books and DVDs about yoga, tai chi and dance. However, consider seeking guidance from a qualified instructor (especially for yoga and tai chi) to gain full benefits and learn proper techniques. An instructor can teach you how to practice yoga or tai chi safely, especially if you have chronic health conditions or balance problems.

Checking with Your Doctor

•   Although yoga, tai chi and dance are generally safe, it’s important to talk with your doctor before starting a new program. This is particularly important if you have any chronic health problems that affect your joints, back or bones (osteoporosis).

Just Do It

•   To gain the balance and confidence benefits of yoga, tai chi or dance, dosing is important. To reap the greatest health benefits, exercise must be practiced regularly (2-3 times a week for a period of 8-12 weeks). Once you recognize some benefit, you may enjoy longer and greater benefits by continuing to exercise for a longer duration.

Go Slow

•   Although yoga, tai chi and dance are relatively safe forms of exercise, with virtually no harmful side effects, it's possible to strain your muscles or overdo it when first starting out, or you could aggravate an existing health condition. Therefore, always start low and go slow.

Click here to read Dr. Rein Tideiksaar’s article, “What Seniors Can Learn from Falls.”

Rein Tideiksaar Ph.D., PA-C (or Dr Rein as he is commonly referred to) is the president of FallPrevent, LLC, Blackwood, NJ, a consulting company that provides educational, legal and marketing services related to fall prevention in the elderly. Dr Tideiksaar is a gerontologist (health care professional who specializes in working with elderly patients) and a geriatric physician's assistant. He has been active in the area of fall prevention for over 30 years, and has directed numerous research projects on falls and has developed fall prevention programs in the community, assisted living, home care, acute care hospital, and nursing facility setting. To learn more, check out the Doctor’s professional profile on LinkedIn: http://www.linkedin.com/pub/dr-rein/6/759/592. If you have any questions about preventing falls, please feel free to email Dr. Tideiksaar at drrein@verizon.net

If you found this article useful, please click the “Share This” icon below to make it available to your family and friends.

Aging at Home? Tips for Preventing Injuries and Isolation

Michelle Seitzer — Mon, 07 May 2012 10:17:06 GMT

Nursing home or stay at home: most people wouldn’t flinch. Home is where we want to be; aging in place is the ideal scenario.

Everyone has moments of loneliness, whether they live alone or in a house full of people. However, seniors who are aging in place alone may experience it more frequently.

Sometimes there are legitimate obstacles in the way of leaving home: loss of a driver’s license, incontinence, anxiety, doctor’s orders and more. Those who would rather not burden their family or friends with transport requests opt to stay put.

Isolation doesn’t happen overnight, but simple decisions delaying action (i.e. the mail can wait until tomorrow, I’m too tired to go to the hairdresser, etc.) quickly compound. Before long, the less time a person spends “out and about,” the more difficult it becomes to get out.

The Risks of Solitary Living

Seniors who live alone should regularly invite friends, neighbors or family members to join them for a meal (or meet at a local restaurant, if possible, for social engagement opportunities). Eating alone too often may increase the risk of infections, illness, malnutrition, loss of appetite or even mental confusion, says this article from A Place for Mom.

Hoarding is another issue that, like isolation, can sneak up on a person gradually. It doesn’t take long before a few days of unwashed dishes begins to smell, before unopened, unsorted mail transforms into a heap of paper. Again, the longer things are left undone, the harder it is to DO them, no matter how urgent the need.

If mobility is a problem, there is an increased risk of falling or sustaining an injury while trying to navigate through the house. Accordingly, all seniors who live alone (even those without mobility issues) should utilize lifeline systems and medical alert bracelets to get immediate help when needed.

Tips for Preventing Injuries

Know someone who is aging in place alone or soon will be? Help them do so successfully; share these suggestions for creating a safe environment:

Make sure your home is barrier-free. Stay ahead of the hoarding curve by removing clutter in cabinets, closets, and drawers, on tabletops, and in frequently used rooms. Clear paths for smooth travels (whether by walking or power scooter), move or rearrange bulky furniture, and remove trip hazards (high-pile rugs, lamp cords, etc.).

If you travel outside the home, plan ahead. If you use a cane or walker, bring it along. An auto ramp or car lift may be a practical solution for someone who wants to leave the house on a regular basis but has a mobility impairment.

Is the bathroom safe? A majority of injuries and falls among home-bound seniors take place in the bathroom. Integrate non-slip surfaces, grab bars, and barrier-free baths, tubs, and showers to temper the hazards of the “water closet.”

Modify the home to better support aging in place. Put lever-style handles on all doors.
Widen hallways to accommodate a power scooter or power chair. Install countertops with rounded edges.

(NOTE: These modifications may be costly. Read this post, “Where the Heart Is: How to Pay for Home Modifications” for grants, loans and other available payment options.)

Tips for Preventing Social Isolation

Guard yourself -- or a senior you know -- against isolation with these practical tips:

Stay connected. Skype, online forums, Facebook, email, and the good old-fashioned phone or letter: access all options for staying in touch from right where you are.

Set a routine; establish boundaries. Keep up with regularly scheduled appointments as much as possible. You can say no to a dinner invite or a neighbor’s offer to drive you to the store on occasion, but don’t make it a habit; consistent social interaction is essential to preventing loneliness and isolation.

Go outside. Unless you are physically limited to staying inside, try to get out -- even just to read a magazine on the porch or for a short walk -- at least once a week.

Learn about community resources. Visit or call your local AAA (Area Agency on Aging) office to find out about Meals on Wheels programs, nearby senior centers (most serve hot meals and provide daily activities), public transportation options, and other community-based support services.

Hire a companion. Most home care agencies offer companions who can assist with bill paying and letter writing, provide transportation to appointments, help with errands and housework, or simply come to visit and chat.

Hire a housekeeper. Maybe your Mom doesn’t need company, but she’s overwhelmed by housework. Bring in a cleaning service once a month or once a week -- however often the services would be helpful.

Consider a roommate (or pet). Sometimes, there is just no replacement for human or animal companionship. Use your judgement on whether a pet would be more work than help. A roommate, perhaps a friend who recently lost her spouse, or a grandchild who just moved back home after college, may be a desirable solution though -- and one that often benefits both parties.

Click here to read Michelle Seitzer’s article – You Can Stay at Home! – Modifications for Seniors to Age in Place.

Michelle Seitzer is a freelance writer and editor who specializes in elder care content. Seitzer writes for a number of senior-related websites, including 101 Mobility.com, the nation’s leading sales, service and installation provider of a complete line of mobility and accessibility products and equipment that may be customized to suit each individuals’ home care needs. Learn more about the company at http://101mobility.com/ or email Michelle (mseitzer@101mobility.com).

If you found this article useful, please click the “Share This” icon below to make it available to your family and friends.

eCareDiary to Broadcast First Live Online Support Group for Family Caregivers "Caregivers Speak!"

Susan Baida — Wed, 02 May 2012 12:19:33 GMT

eCareDiary will broadcast the first live online support group called "Caregivers Speak!" Created by and for caregivers, Caregivers Speak!, will debut on Tuesday, May 8th at 2:00pm EST on BlogTalkRadio.com. Hosted by Margery Pabst, eCareDiary's caregiving expert and co-author of Enrich Your Caregiving Journey, it will continue to air live on the 2nd Tuesday of every month.

Three experienced caregivers are invited on the program to share their perspectives and strategies that have helped them overcome a particular challenge. Host Margery Pabst presents a new challenge each month ranging from coping with guilt to more controversial issues such as dating when a spouse is lost to Alzheimer's. The audience listens in either on the Caregivers Speak! channel on BlogTalkRadio or by calling in on (347) 857-3399.

According to eCareDiary Co-founder, Susan Baida, "For the first time, caregivers can come out of isolation by joining a live online support group and actually listen in or speak with one another."

The caregivers on the panel represent a wide variety of situations, types of illnesses that they have dealt with, cultural backgrounds, and roles. A 30 minute program, listeners are then invited to participate during the last 10 minutes with questions or comments.

Each live program will be recorded and available for download on eCareDiary's website for those who missed it and wish to listen to it later. Caregivers Speak! is a safe online support group for new and seasoned caregivers alike to share their experience and support.

Susan Baida, Co-Founder of eCareDiary.com

Don't Fall into the Guilt Trap! - 3 Tips for Caregivers

Margery Pabst — Mon, 30 Apr 2012 12:32:48 GMT

One of the most common comments from caregivers is “I feel so guilty.” As a caregiver, I feel guilt frequently. I decided to consider why this state of guilt exists in most of us.

Here are some thoughts about our caregiving roles:

-Most of us care for someone who took care of us. Our parents and spouses certainly did along the way, so caregivers assume that we must provide the same attention and care for them.

-If we are caring for a child, perhaps our thoughts are about how we may have caused the child to be disabled or to have a chronic disease. What did we do wrong? Was it our genes? Was it something we forgot to do like not watching carefully in a dangerous situation?

-Some guilt is self-imposed and some comes from the responses of others. We impose guilt on ourselves when we feel we’ve omitted something like not taking someone out for a meal. Sometimes we take people’s comments the wrong way and assume they are reminding us of our shortcomings. A statement like, “Mother knows she can always depend on me” can be taken the wrong way by a sibling who is assuming that the comment suggests they are undependable.

Given these common situations, how can we caregivers manage the guilt we feel in whatever form it takes? I have three suggestions:

-First, APOLOGIZE if you said something hurtful to your care partner like, “I just answered that question, didn’t you listen?!!!” We all say things we regret, so a simple apology will clear the air, making everyone feel better.

-Second, PLAN for your care partner’s time with others. Find enriching opportunities that utilize the skills of other family members and friends, thus giving you time to create balance and recharge batteries. We simply cannot be there for every need all the time. To impose that lofty goal on ourselves dooms us to a guilt ridden caregiving journey!

-Third, ACCEPT COMMUNICATION objectively rather than personally. Don’t let remarks and all the little communications hitches along the way irritate you. Many snide remarks come from those who are just trying to make themselves feel better. Simply assign those remarks to the “That’s Their Stuff” category.   The complaining uncle or the nosey aunt, the lazy sister in another state or the self important friend, take them for who are are. Letting them get under your skin saps energy!

For example, brother Sam says, “Mom seems lonely.” Your caregiving mental set may jump to the assumption that brother Sam thinks you are falling down on Mom’s care. Sam may be trying to lay a guilt trip on you, or he may be just stating what he is observing. Either way, take a deep breath and ask, “How can we relieve her loneliness?” With this open-ended question, you’ve accomplished the following:

1) You place the responsibility on more people, not just on your back.
2) The question puts you and Sam (and perhaps other siblings) into a problem solving   mode.
3) The problem solving mode puts you into the position of actually discussing the issue rather than focusing emotion and anger on one another.

I’m a big fan of the open-ended question because you can usually accomplish these three outcomes. Questions that result in placing responsibility on more than one person, that put you and others into problem solving, and that actually begin to solve an issue are the ones that successful caregivers use.

Click here to read Margery Pabst’s article on “Applying the “Just Do It’ Philosophy to Caregiving”.

Margery Pabst is the co-author of Enrich Your Caregiving Journey. She is eCareDiary’s caregiving expert and hosts the monthly show, “Caregiver and Physician Conversations”. eCareDiary and Margery are also launching a second show, “Caregivers Speak!!” on Tuesday, May 8 at 2PM. Also, watch for Margery’s Expert Q/A posting on the website. You can access more information on Margery’s work at www.pivotalcrossings.com.

If you found this article useful, please click the “Share This” icon below to make it available to your family and friends.

Making Your Parent's Move to a Care Community Guilt-Free

Carole Larkin — Mon, 23 Apr 2012 10:35:29 GMT

It may be the hardest decision of all to hand over your loved one’s physical care to a “village” (an assisted living, memory care community or a nursing home). It is usually the last, last, last resort. It happens when your last nerve is broken, your body is hurting, your spirit is beyond exhaustion and you are pretty sure that you will be dying soon, very soon. And still the guilt demon in your head whispers to you, “Bad girl (bad boy). You promised to never do this. Till death do us part…, or all children must take care of Mom or Dad” What to do?

And so with regret, you allow them to move out of the house. There, the decision is done! Or is it? With some couples, or parents and children it is NOT done. Even if the person with dementia has physically moved out to a community, the person at home has not committed to the decision that they already made. They will take them out of the community for visits to the home often, sometimes every day, returning them in late afternoon or evening, or sometimes even bringing them back home permanently after a few weeks or months in the community. The problem here is the guilt demon is silenced, but you are left with the same situation, or worse that caused you to move them to the “Village” in the first place.

It all revolves around your COMMITMENT to the path you set out on when you agreed to have them move. When they change residences you need to understand that you are setting them up in a new home. If you want them to have the best life possible or why else are you having them go to the “village”? Then you must allow them to integrate into that home. If you are doing it solely because you need a just a little bit of a break, then bring someone into the home for a number of hours, and you get out of the house, or have them go into “respite” (a short stay at a community to give you a break, say for a weekend, a week, two weeks). Don’t move them permanently.

When you make the COMMITMENT to move them permanently, that means that you are giving the “village” time to welcome them in, get them assimilated into the routines and the rhythms of that community, bond with the staff, and perhaps make friends with other residents. One of the most important benefits of moving into a community is the socialization opportunities one gets from living with other people. Most times the person with dementia was isolated and bored in their home, even living with their spouse or children. No one person is able to keep them engaged all day every day. It’s unrealistic to expect anyone to be able to do that, ever. (Even Bob has Harvey to help).

You have a better chance of more engagement being in a community with more people available to engage with your loved one (i.e. staff and other residents). If you keep spiriting your loved one back home day in and day out, they never get the chance to adapt and adjust to their new home. Their stay there has no chance to be successful, no matter how top notch the place is.

Don’t do that to your loved one. Give them the chance to become part of the community. Communities often tell the families to not visit for a week or longer when they first move in. That’s simply to give the person a chance to become part of the community and become comfortable with their new life. After that, visit them every day, if you need to, but visit with them there. Take them out to eat, take them to the art gallery, to other places of interest but do not take them back home. It confuses them. They won’t know where they really live. It’s scary to them. It’s as if they were homeless. You wouldn’t want to feel that way, would you?

If it’s a bad place, or just the wrong place for your loved one, and they don’t do well, you can always move them, but give the place a chance (meaning at least three months) unless of course, there are signs of significant deterioration or abuse.

Conversely, if your loved one improves significantly, enough so that you say, I can care for them now, and want to bring them back home again, think again. Is it possible that they got better because the place was able to provide things you couldn’t at home? Many times the answer is yes, they could. Things like socialization and engagement with others, trained aides to assist your loved one with the necessary activities of daily living like taking their medications, bathing regularly, eating nutritious foods and other things that you were not able to get accomplished with your loved one on a routine basis. Persons with dementia have a tendency to cooperate more often with strangers or “professionals” simply because they want to be seen as good and compliant people to others, and mostly because they don’t feel comfortable with saying “no” to them. They sure feel comfortable saying no to you. They know that you have to love them anyways, after all you are family.

Know this, however. No matter what a community can do for your loved one, there is one thing that you do that they can never replace, no matter what. They cannot give them the love that you can. They are not their spouse or child. They can never know all the secret things you know about the person that can make them happy. Those secret things come from years of knowledge, love, sharing, and intimacy; things like where to scratch their back, things like singing special songs to them from your shared past.

There is a world of difference between physical care and real (emotional) love. Physical care is NOT the only way you can show love. Remember this crucial fact. It will do you good to repeat it daily, hourly even, in the beginning.

So in conclusion, if you are going to move them- move them in your head and in your heart. Truly allow the community to do what they do best, take care of your loved one physically. You do what you do best; give them the love that they need emotionally. Above all, move them for their sake, not for yours. And once you do that, tell yourself everyday that you are doing that because you love them and want the best quality of life for them. Those things said often enough inside your head, will quiet the beast of guilt down to a tolerable level.

Click here to read more articles on Alzheimer’s and Dementia Care.

Carole Larkin MA, CMC, CAEd, QDCS, EICS is a geriatric care manager who specializes in helping families with Alzheimer’s and related dementias issues. She also trains caregivers in home care companies, assisted livings, memory care communities, and nursing homes in dementia specific techniques for best care of dementia sufferers. Her company, ThirdAge Services LLC, is located in Dallas, TX.

If you found this article useful, please click the “Share This” icon below to make it available to your family and friends.

Why is My Balance Worsening?

Dr. Rein Tideiksaar — Mon, 16 Apr 2012 08:02:51 GMT

To accomplish everyday activities, balance is essential. When we rise from a chair or bed, climb stairs, step into our bathtub, reach up on our toes to retrieve something overhead, bend down to pick up an object from the floor or simply walking about our body is constantly working to control balance. Balance is so routine that we never think about it. That is, until a fall happens.

How Does Balance Work?

The ability to maintain balance is a complex task that depends on two major components:

•   The sensory system—made up of vision, inner ear motion sensors and position sensors -- provides us with information about our body’s position in the environment. For instance, we rely on our eyes to tell us if the environment is moving or still; also to help us see and prepare for potential dangers and obstacles which can lead to falls. We rely on our inner ear motion sensors to tell us if we are upright or leaning, standing still or moving. We rely on position sensors in our feet and joints to tell us if the surface we are standing on is stable.

•   The musculoskeletal system—made up of muscles and joints--helps us coordinate the movements needed to maintain balance. For example, a sudden loss of balance is detected by the sensory system. Upon detection, signals are relayed to muscles and joints throughout the body, which then spring into action in an attempt to correct this loss of balance and avoid a fall.

As individuals age, the capabilities of both the sensory and musculoskeletal system decline. As a result, the ability to maintain balance declines. Also, there is a decrease in the ability to correct any loss of balance before a fall occurs.

Balance impaired individuals typically exhibit difficulty with:

•   Rising from a chair, bed or toilet. Persons are unable to rise without using arms for support; when attempting to rise they exhibit unsteadiness.

•   Walking and turning (360°). Persons are unsteady and need to hold onto an object (walls, furniture) for support; when walking they stagger from side to side.

•   Standing with eyes closed (with feet as close together as possible). Persons are unsteady and need to hold onto any object for support; they are steadier with feet apart.

Symptoms accompany balance loss may include:

•   A sensation of dizziness or vertigo (a whirling or spinning movement).
•   Lightheadedness or feeling woozy.
•   Blurred vision; difficulty seeing.
•   Disorientation; unable to concentrate.
•   A sensation of losing balance; feeling like you are going to fall.

Symptoms may appear and disappear over short time periods or may last for a longer period.

What Causes Impaired Balance?

Problems with balance can occur when there is a disruption in any of the sensory and musculoskeletal components. As we get older, diseases such as glaucoma and cataracts can alter vision. Ear disorders can disturb inner ear sensors from performing correctly. Stiff joints and reduced muscle strength can worsen attempts to maintain balance. Diseases in which abnormalities of balance exist include diabetes, Parkinson’s disease, stroke, arthritis, low blood pressure, etc. However, diseases are not the only reason for balance loss. A history of injuries, such as concussions, ear infections, or serious sprains or fractures, may contribute to a loss of balance over time. Lastly, many drugs can affect balance as well.

Can Failing Balance Be Improved?

The answer is yes, balance can be improved. Elders are able to recover from balance disorders and regain control. If elders have a problem with balance, a visit to the doctor and engaging in some form of balance exercises are the two most important steps to take. It is not unusual for individuals with a history of balance problems to regain their balance control through accurate diagnosis followed by specific medical treatment and exercises.

The Doctors Visit

Because of the wide variety of balance disorders, identifying the cause of a balance problem and what treatment options are the most appropriate is important. Some elders experiencing balance problems have an obvious medical condition, such as diabetes or Parkinson's disease that is the source of the problem. In other individuals, balance difficulties can be an early indication of an underlying disease condition yet to surface. In addition, reviewing medications, both prescription and over the counter that may be detrimental to balance control, is vital.

Balance Exercises

Exercises can limit the loss of balance control or improve its performance. That is why beginning a fitness program is essential in maintaining and promoting good balance. To improve balance, exercise should include both balance and strength training. Other programs that benefit balance include yoga, Tai Chi
(gentle physical exercise and stretching) and twice weekly ballroom dancing classes. These programs also help gain confidence with balance and reduce fear of falling.

The following are 3 simple exercises (*) to help get you started.

Sitting and Standing

•   One of the easiest exercises for balance and leg strength is sitting and standing. Sit down in a sturdy chair and stand up (without using the armrests for support) as quickly as you can. Do this as many times as you can without becoming dizzy. Start off slow and gradually build up the number of times that you can stand up and sit down.

Walking Heel to Toe

•   Stand straight up and place the heel of one foot in front of the toe of the other foot. This is like walking on a high wire act without leaving the ground. Walking heel to toe is a good balancing exercise.

Heel Lift

•   Stand facing a counter with your feet shoulder-with apart. Put your hands on the counter for balance, and lift up onto the balls of your feet. Your heels should be at least 2 inches off the ground. Heel lifts help improve balance by strengthening weak ankles.

(*) There are many good exercises that improve balance. To find out what’s best for you, speak with your doctor.

Click here to read Dr. Rein Tideiksaar’s article, “Don’t Let Falls Be in Your Future”.

Rein Tideiksaar Ph.D., PA-C (or Dr Rein as he is commonly referred to) is the president of FallPrevent, LLC, Blackwood, NJ, a consulting company that provides educational, legal and marketing services related to fall prevention in the elderly. Dr Tideiksaar is a gerontologist (health care professional who specializes in working with elderly patients) and a geriatric physician's assistant. He has been active in the area of fall prevention for over 30 years, and has directed numerous research projects on falls and has developed fall prevention programs in the community, assisted living, home care, acute care hospital, and nursing facility setting. To learn more, check out the Doctor’s professional profile on LinkedIn: http://www.linkedin.com/pub/dr-rein/6/759/592. If you have any questions about preventing falls, please feel free to email Dr. Tideiksaar at drrein@verizon.net

If you found this article useful, please click the “Share This” icon below to make it available to your family and friends.

Why is Mom's Dementia Worse in the Evenings?

Shannon Martin — Mon, 09 Apr 2012 10:51:03 GMT

I recently did an informal survey to find out how many people were familiar with Sundowner’s Syndrome (or sundowning behavior) in dementia. The results were mixed…professionals who had worked in eldercare, especially in care facilities, were pretty aware of this concept. Most family caregivers and the general public were not, or had never heard the name for it even if they had experienced it.

Sundowner’s syndrome or sundowning describes the worsening of symptoms, especially confusion, agitation and restlessness, in persons with dementia in the late afternoon/evening (sundown) hours. The exact causes are unknown, but likely to relate both to the light/environment and habits from throughout life of this time being a time of change or expectation (i.e. time to leave work and return home, time to have dinner ready for the family, etc.) that thus impact our circadian rhythms/internal clock. You can read more along with tips for Alzheimer’s caregivers who experience Sundowners Syndrome.

As an Alzheimer’s caregiver, you can anticipate this time frame and try to plan accordingly. It may be a bad time to have your loved one running errands or attending an event, especially if it has already been a long day and he/she is feeling tired. A calm, quiet environment may be best. Or, at least, you may be better able to manage things in an environment where you have more control.

At the same time, distraction and activity can help. It may be a good time for “busy work” or an activity which keeps your loved one engaged yet calm. He or she may also need more reassurance and redirection during these hours. Music can be soothing, or consider engaging the person in reminiscence or storytelling.

Sometimes finding the root cause of the agitation can help you find solutions. Your loved one may get hungry or have a drop in blood sugar at this time. There may be a “worry” that agitates him or her, such as the need to get home or imagining some scenario. Without arguing about the reality of these situations, you can often “find a solution” (whoever said caregiving didn’t require creativity?).

Additionally, there may be things your medical provider can suggest to help with physiological causes. Light therapy has shown some success in this area. Your loved one’s doctor may wish to adjust medications or timing of dosages.

For someone with dementia, transitions can be especially tough. You may want to read our previous blog article, Hospitalization Considerations for Persons with Alzheimer’s Disease. If your loved one suffers from sundowning behaviors, make sure that providers know about this and understand what might trigger or worsen the behaviors and what helps. If your loved one does not have a one-on-one caregiver, the sundown hours may be a time to have that one-on-one care available (whether at home, at hospital or an assisted care facility, especially after a transition). Consider hiring an Alzheimer’s Specialty caregiver or rotating family members to stay and help.

Shannon Martin, M.S.W., CMC, is Director of Communications at Aging Wisely, LLC (http://www.agingwisely.com), a professional care management and patient advocacy organization and EasyLiving, Inc. (www.easylivingfl.com), a licensed home care agency, in Clearwater, FL. Shannon served as adjunct professor at Eckerd College in St. Petersburg, FL, where she created a course on “Eldercare”. Prior in her career, Shannon served as social services director and admissions coordinator in an assisted living/skilled nursing facility and worked as a social worker and volunteer coordinator for a large hospice.

If you found this article useful, please click the “Share This” icon below to make it available to your family and friends.

Caring for Your Aging Parents Causing Family Disputes?

Chris Cooper — Mon, 02 Apr 2012 09:57:59 GMT

While the image of a happy family where everyone always gets along is pleasant, this simply doesn’t represent reality for many people. Take the story of a brother and sister that I knew. As children, these two siblings had never really gotten along, and as adults they’d become estranged. Eventually, however, it became clear that they were going to have to come together to deal with the needs of their elderly mother, who had severe dementia and could no longer live independently. Unfortunately, each had different ideas about the kind of care she really needed.

The sister had found a family home where she thought her mom could live. It was a small place with just six beds. A couple ran the facility, and there were no nurses or other medical professionals on staff. The home only cost $1,000 a month, which was a big plus in the mind of the sister. However, when the brother came into town to deal with this issue, he had a different idea about what would be best for the mother. This visit was the first time he’d seen his mother in many years, but he realized right away that something was definitely not right. Even though he wasn’t that involved in the family, he saw that his sister’s idea wasn’t the best. That’s when he called me to set up a meeting with him and his sister to talk about how to care for their mother.

When I sat down with the two of them, it was obvious that they were very estranged. However, they were cordial and civil to each other and to me. The siblings told their mother’s story, explaining that she had become very dependent and was having a lot of trouble remembering to do things on her own. In addition, she was a diabetic and needed a daily insulin injection. Of course, this family home the sister had found didn’t have any medical staff, so it wasn’t at all clear how the mother was going to get the care she needed if she moved there. In fact, when the brother went to visit the family home and asked how this situation would be handled, he got a very telling answer. The man who owned the home said, “Don’t worry, she’ll get her insulin every day.” Wink, wink.

That response was a huge red flag. What the home’s owner meant was that an untrained, unlicensed individual was going to be giving the mother her insulin injections. Obviously, that wasn’t an acceptable situation. Unfortunately, the mother was at the point where she couldn’t afford anything other than this basic level of care. The only other option was a nursing home, since that’s what Medicaid would pay for. And that’s exactly what the sister wanted to avoid. However, I explained to the brother and the sister that the nursing home was the preferable option, because their mother simply wouldn’t be safe in the family home setting because of her medial issues.

Since then, the siblings’ mom has passed away. She ended up living out the rest of her life in a nursing home, where she had very good care and actually improved from living on her own. She was eating better and getting her insulin on a regular basis, and there was always someone paying attention to her needs. In the end, the siblings made the right choice.

The dilemma this brother and sister faced isn’t uncommon. Often, when adult children try to make housing arrangements for parents as they become disabled, they don’t consider the right factors. They may not like the idea of a nursing home. They may think certain facilities are too expensive. There can be a temptation to go for the cheapest option possible. Well, just as there’s a big difference between the cheapest hotel and the most expensive hotel, there’s a huge variation in the level of care you get at a basic family home versus a nursing home. If your elderly parent needs medical care or supervision, a nursing home may be the best?and safest?option. And in this case, that’s what the brother and sister hadn’t seen right away?that their mother’s medical needs outweighed some of their other concerns.

This was also a situation where the sibling’s estrangement could have caused real problems for their mother. Fortunately, the brother and sister, despite their personal conflict, were able to sit down and come to an agreement, without having to resort to more formal mediation or litigation, and without the state needing to come in and appoint a guardian. This is a good story to keep in mind when you’re making your own decisions about caring for an elderly parent, since it’s an excellent example of the importance of dealing with disputes about care before they become big problems that end up causing harm to the very person you’re trying to help.

Click here to read Chris Cooper’s article on Are Your Parents Hiding their Health Problems from You?

Chris Cooper, CFP®, is the owner of ElderCare Advocates, Inc. a geriatric care management and long-term-care consulting firm. He is also the owner and founder of Chris Cooper & Company, Inc., a fee-only financial planning firm that works with small business owner, persons preparing to retire, and the very elderly. Chris is a regular contributor to eCareDiary.com and was recently interviewed by eCareDiary’s co-founder, Susan Baida, regarding Empowering Family Caregivers. Chris has also on has appeared on CBS's Early Show, NBC's Today Show, and is a regularly featured guest on CNBC's Power Lunch. He is frequently quoted in The Wall Street Journal, USA Today, The New York Times, Kiplinger's Personal Finance, Money, and SmartMoney.

If you found this article useful, please click the “Share This” icon below to make it available to your family and friends.

eCareDiary to Present at 2012 Aging in America Conference

Susan Baida — Mon, 26 Mar 2012 13:45:58 GMT

John Mills, eCareDiary Chairman and Margery Pabst, Co-author of “Enrich Your Caregiving Journey” will present a workshop entitled, “Strategies for Uniting Families: Tools and Technology to Help Family Caregivers” at the 2012 Aging in America Conference in Washington, DC on Saturday, March 31st, 2012 from 8:00 AM – 9:00 AM EST. The workshop will be conducted at the Omni Shoreham hotel in the Governor’s boardroom.

In the workshop, Margery Pabst will address the challenges involved in getting families to act cohesively when caring for an ill or aging loved one and will provide practical advice on getting everyone to work together. She will discuss storytelling as a natural tool for family cohesiveness. John Mills will focus on caring from a distance and technology to assist caregivers and care recipients.

eCareDiary.com offers a free e-tool for caregivers called the Care Diary that helps family caregivers manage appointments, medications and store important documents in a secure and private place. In addition, eCareDiary licenses software to innovative care providers throughout the country.

John Mills has over 20 years of experience in the health care field having focused on health care policy, technology and insurance product development. He was a member of President Clinton’s Task Force on Health Care Reform.

Margery Pabst is a facilitator and national speaker on life transitions. She is the host of eCareDiary’s radio show, “Caregiver and Physician Conversations” and is an expert on caregiving for eCareDiary ‘s “Expert Q&A”.

Hosted by the American Society on Aging, the Aging in America Conference takes place on March 28th – April 1st, 2012 in Washington, DC at the Marriott Wardman Park and Omni Shoreham hotels. It is the largest gathering of a diverse, multidisciplinary community of professionals from the fields of aging, healthcare and education, along with business leaders from across the United States.

Susan Baida, Co-Founder of eCareDiary.com

Five Keys to Preventing Osteopathic Fractures

Dr. Rein Tideiksaar — Mon, 26 Mar 2012 10:38:19 GMT

In February’s blog posting, I discussed the consequences of falling and suffering a fractured hip. I reviewed the main causes of hip fracture, including falls and osteoporosis (loss of bone) as critical factors. This month, I’m going to discuss how people can look after their bone health and prevent hip fractures. There are a number of preventive steps that elders and/or their caregiver can take:

Talk with Your Doctor
Any prevention plan starts by visiting the doctor. Discuss your concerns about osteoporosis and whether you or a loved one might be at risk for the disease. To determine your bone health, your doctor will ask you a variety of questions about your lifestyle and medical history. Also, he or she will want to know if anyone in your family has suffered from osteoporosis or if they have broken bones (both men and women with a maternal family history of hip fractures have a greater risk for developing osteoporosis).

Based on a comprehensive medical assessment, your doctor might recommend that you have your bone mass measured. A bone mass measurement is the only way to tell if you have osteoporosis. A bone density test can measure bone density in various sites of the body. If the test is conducted at intervals of a year or more, it can detect osteoporosis before a fracture occurs and even predict your chances of having a fracture.

Because osteoporotic hip fractures are generally caused by falls, avoiding a fall is equally important. There are several other simple suggestions that can help prevent falls and hip fractures. People need to have regular eye-checkups, wear sensible, hard-soled flat shoes, and be careful of medication side effects. It’s a good idea to bring a list of all medications you are taking so your doctor can review them for side effects that can increase the likelihood of falls.

Nutrition
Diet is a major factor in strengthening bones. Healthy doses of calcium and vitamin D can help prevent hip fractures. The National Institute of Health (NIH) recommends people 50-years and older should intake 1,200 mg of calcium daily. It’s important that you discuss with your doctor the right level of calcium for you. There are numerous calcium supplements available. However, there are several factors to consider when taking supplements, including how much you take, other medications you may take and the form of calcium supplement you take. It’s best to check with your doctor for guidance.

Vitamin D plays a major role in calcium metabolism in the bone. Because elders generally consume less vitamin D and absorb calcium poorly, check with your doctor about your daily intake of vitamin D. The NIH recommends people 51- to 70-years-old consume 400 IU of vitamin D daily, while those 71-years and older should consume 600 IU. Many benefits are ascribed to vitamin D beyond its well-known effects on calcium and bone metabolism. Vitamin D in adequate amounts is beneficial to muscles as well, decreasing the risk of falls.

In addition, a healthy, well balanced diet, high in calcium (skimmed milk, yogurt, cheese, sardines, tofu, green leafy vegetables) and vitamin D (oily fish, cod liver oil, eggs, fortified dairy products) should be encouraged.

Physical Activity
Exercise helps keep bones strong and avoid falls by improving strength, balance, coordination and flexibility. Recommended exercises for people with osteoporosis consist of:

Strength training exercises

These include the use of free weights, weight machines, or resistance bands to strengthen the muscles and bones in your arms and upper spine. Strength training works by slowing the rate of bone loss.

Weight-bearing aerobic activities

These activities involve doing aerobic exercise on your feet, with your bones supporting your weight. Examples include walking, dancing, low-impact aerobics, elliptical training machines, and stair climbing. These types of exercise work directly on the bones in your legs and hips to slow mineral loss. Avoid any high impact exercises (jumping, running or jogging) that can lead to fractures in weakened bones.

Flexibility exercises

Being able to move your joints through their full range of motion helps maintain good balance and prevent injury.

Stability and balance exercises

Fall prevention is important for people who have osteoporosis. Stability and balance exercises help your muscles work together in a way that helps keep you stable and less likely to fall. Simple exercises such as standing on one leg or movement-based exercises such as tai chi can improve stability and balance.

Because of the varying degrees of osteoporosis and the risk of fracture, certain exercises may be discouraged. Ask your doctor if you’re at risk of osteoporosis-related problems, and find out what exercises are appropriate for you.

Home Safety
Many hip fractures are preventable by recognizing potential fall the hazards in the home and taking the necessary steps to make the environment safer. Use these checklists to make sure that your or your loved one’s home doesn’t pose any health or safety hazards.

Hip Protectors
To reduce the chances of hip fracture, individuals can wear a hip protector. Hip protectors are designed to absorb the impact of a fall on the hip bone. In essence, hip protectors act as shock absorbers around the hip providing a cushion between the hip bone and impact surface. Hip protectors are ideal for individuals who are at risk for both falls and hip fracture.

By following the above strategies, the risk of breaking a hip can be decreased dramatically. Some individuals, in addition, may require treatment with pharmacological therapies aimed at slowing down the rate of bone loss. Currently, the most effective medications for osteoporosis that has been approved by the FDA (Federal Drug Administration) are anti-resorptive agents, which decrease the loss of calcium from bones. Individuals should consult with their doctors to find out about the benefits and risks associated with these medications.

Click here to read Dr. Rein Tideiksaar’s article on What Seniors Can Learn from Falls.

Rein Tideiksaar Ph.D., PA-C (or Dr Rein as he is commonly referred to) is the president of FallPrevent, LLC, Blackwood, NJ, a consulting company that provides educational, legal and marketing services related to fall prevention in the elderly. Dr Tideiksaar is a gerontologist (health care professional who specializes in working with elderly patients) and a geriatric physician's assistant. He has been active in the area of fall prevention for over 30 years, and has directed numerous research projects on falls and has developed fall prevention programs in the community, assisted living, home care, acute care hospital, and nursing facility setting. To learn more, check out the Doctor’s professional profile on LinkedIn: http://www.linkedin.com/pub/dr-rein/6/759/592. If you have any questions about preventing falls, please feel free to email Dr. Tideiksaar at drrein@verizon.net.

If you found this article useful, please click the “Share This” icon below to make it available to your family and friends.

Recent Posts in eCare Diary Blogs