Seating people comfortably

Many elderly and disabled people in care sit for long periods of time.  Some are able to move themselves while others are not able to move without assistance.
 
For those of us caring for the elderly and disabled we need to think carefully about how we seat those in our care. We need to consider things like:

• posture
• pressure relief
• potential mobility

 
Good posture is important to prevent back pain, encourage mobility, assist swallowing and prevent chest infections. When choosing a chair for a client it needs to be supportive to prevent them from slumping over. 
 
When sitting for long periods of time without being able to adjust your position, circulation to areas on a person’s bottom, legs and back can be cut off causing discomfort and, if left, pressure sores.

When sitting for long periods of time without being able to adjust your position, circulation to areas on a person’s bottom, legs and back can be cut off causing discomfort and, if left, pressure sores. 

​Pressure relief is important. Some chairs have pressure relief features built into them; we recommend these, especially for people who are unable to change their position. Alternatively pressure cushions can be used.  
 
Air filled pressure cushions (Rohos) can be problematic.  They can be slippery causing a person to slide forward into a slumped posture.  A slumped posture is uncomfortable, can make it hard to swallow and breathe effectively and take part in activities. The cushions raise the height of the seat, which may cause the feet to dangle, leading to discomfort under the thighs.  While sitting it’s important to have feet on the floor or a footrest.
 
For more information on pressure injuries follow this link.
https://www.therapyprofessionals.co.nz/uploads/4/9/5/2/49523375/skin_injuries_caused_by_pressure.pdf
 
Keeping people mobile as long as possible is in everyone’s best interests.  If you are caring for someone who can still stand themselves up or better still walk safely, it’s important you choose a seat that encourages them to stand and get out of easily. This means their feet must be flat on the floor, the chair has armrests at the right height to push up from and the seat surface is firm enough to wriggle forward.

​The ideal seat for a person, maintains an upright posture with their bottom back in the chair and hips at a 90 degree angle. The chair needs to support the spine, thighs with a gap behind the knees and the armrests should support the arms with relaxed shoulders.  Feet need to be flat on the floor or supported on a footstool.

For more information on choosing a seat follow this link https://www.therapyprofessionals.co.nz/uploads/4/9/5/2/49523375/choosing_a_comfy_armchair__.pdf
 
If you need some help seating the elderly or disabled in your care our friendly Physiotherapists and Occupational Therapists can help just contact us at Therapy Professionals.
 
                Ph:      03 3775280                            Email:           admin@tpl.nz
 
 

Arthritis

Most of us have heard of arthritis, however, did you know there are about 140 different types of arthritis?  The most common are Osteoarthritis, Rheumatoid Arthritis and Gout.
 
The causes of the different types of arthritis vary, however, the thing they have in common is there is an inflammatory response in the joints causing swelling, pain, stiffness and joint damage. Arthritis can affect all age groups with the elderly being most affected, generally with Osteoarthritis.

Osteoarthritis

Osteoarthritis is caused by ‘wear and tear’ on the joints cartilage. Cartilage is on the end of our bones protecting our bones from damage, it act like a cushion. Over time the cartilage breaks down and may completely go. Injuries to joints often accelerate the breakdown of joint cartilage.  It generally affects the feet, hands, knees, hips and lower back. Most people over 65 will have some osteoarthritis.

Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune disease, which means the immune system attacks the tissues of the body - in this case the linings of the joints.  It also affects other parts of the body.  There may be periods where the disease is active or not active and it may burn itself out after a number of years.
 
It affects all age groups - in childhood rheumatoid arthritis is called juvenile arthritis

​Gout 

In gout uric acid crystals form in and around the joints, commonly around the big toe, and may move to the knees, elbows, wrists, and fingers.  It causes excruciating pain and swelling.  Uric acid is a by-product of digesting a protein called purine, which the body isn’t excreting.  Being overweight, genetics, taking certain medications, sugary drinks, alcohol, eating too much liver, meat and seafood, and existing kidney disease may cause uric acid to stay in the body.  An attack can come on suddenly. To prevent joint and kidney damage, it needs to be treated quickly. 

Treatments

The aim of treatment is generally to reduce the swelling, pain and damage to the joints.

​For more information:

https://www.arthritis.org.nz/forms-of-arthritis/
https://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/arthritis
https://www.healthline.com/health/arthritis

If you need help to get mobile, exercise or you need dietary advice our friendly physiotherapists and dietitians can help just contact us.
​
                        Ph:   (03) 377 5280        Email:           admin@tpl.nz

​Food for a Healthy Heart

It's never too late to look after your heart, improve your health, and get the most out of life. Here are some guidelines to help you choose the best foods for your heart:
 
​Fruit and Vegetables 
Have fruits and/or vegetables at every meal and for most snacks. 
 
Grains and Starchy Vegetables

• Select whole grain breads or high-fibre breakfast cereals, in place of white bread and low fibre varieties. 
• Have a baked potatoes or kumara instead of deep-fried chips.
• Swap white flour for wholemeal.
• Just eat one grainy or starchy food at each meal

Protein – meat, poultry, legumes, fish, seafood and eggs

• Include a protein in one or more meals each day.
• Cut fat off meat and chicken
• Drain the fat of tinned products
• Steam, grill or pan fry fish and seafood
• Add legumes to meat dishes they make the meat go further

 
Dairy Products

• Have low-fat milk, and milk products.
• Eat reduced fat cheeses
• Select a plain unsweetened yoghurt over sweet baking

Drinks

• Drink plenty of fluids each day, particularly water
• Have unsweetened tea and coffee with low fat milk
• Have soda water instead of fizzy drinks and fruit juices.
• Keep your alcohol consumption down

 
General tips

• When cooking limit sugar or salt 
• Choose ready-prepared foods, snacks and drinks low in saturated fat, sugar and sodium. 
• Avoid butter, deep-fried and fatty foods 
• Have sweet bakery products or pastries and fruit juices only occasionally.

If you are struggling to change your diet Therapy Professionals friendly Dietitian can help just contact us.
                                                Phone: 03 377 5280                      Email: admin@tpl.nz

Are My Elderly Parent’s Coping?

As our parents move in to Shakespeare’s ‘Sixth stage of man’ many of us in our middle age are busy with our careers and bringing up children.  We often take our parents for granted and forget they are ageing.  If we see them regularly, we may not notice subtle changes or if we live elsewhere and rarely see them, we may get a shock at their decline between visits.  Compounding this, most parents don't want to be a 'bother' and aren't good at telling their adult children they need help.
 
It can be a shock to see our parents slowing down and not coping. We may have no idea how to deal with their changing state. Some of us respond by ignoring or minimising the situation, while others will behave more like a bossy parent.  More often than not, even with the best intentions, we don't know when and how to respond. 

In my experience with my own mother and observing others it's best to start talking with your parents early in their retirement, and keep talking about all the different scenarios that may happen as they age, good and bad.  For each scenario, find out the options for care or help and discuss these with your parents. Most importantly, find out what they want to happen in each case.

​It may help to start by arranging a power of attorney, and who will be responsible for their health, welfare and finances should they become incapable of making those decisions.  A change in the ability to manage one’s affairs could happen suddenly after a health event, like a stroke, or slowly as a result of dementia.  It’s best to be prepared.
 
Become informed with your parents on how ageing may affect them and how they may look after themselves to extend their independence and enjoyment of life.  There is plenty of information on the Internet to help with this.  I suggest you look at local reputable resources.
 
Regularly check in with your parents, and ask them if there is anything they are struggling with.  If so, discuss alternative ways of managing the problem area. Be observant, and if you notice there has been a change in, say, the standard of house keeping, tactfully discuss this with them.  Again, it is helpful if you've discussed at an earlier time how to manage these changes and how best to broach the subjects with them.

Changes you may notice include, a drop in:
 

• household cleanliness and tidiness
• household and garden maintenance
• personal hygiene and grooming
• weight and lack of food in the fridge and cupboards
• bills being paid on time 
• managing trades people and technology

 
It is well worth having these hard conversations with your ageing parents as it helps take some of the stress out of their decline and allows you to more readily enjoy their final years.
 
If your parents are struggling at home our friendly therapists may be able to help them maintain their independence. Just contact us at Therapy Professionals 
 
Ph:                              03 3775280
Email:                        admin@tpl.nz

 
‘The sixth age shifts
Into the lean and slipper’d pantaloon,
With spectacles on nose and pouch on side;
His youthful hose, well sav’d, a world too wide
For his shrunk shank; and his big manly voice,
Turning again toward childish treble, pipes
And whistles in his sound. Last scene of all,
That ends this strange eventful history,
Is second childishness and mere oblivion;
Sans teeth, sans eyes, sans taste, sans everything.’
 
William Shakespeare – As you like it.  “The seven stages of man.”
                      
                   

It's Mental Health Awareness Week 

21 September – 27 September.  
Mental Health Awareness Week is run each year by the Mental Health Foundation and it's more timely than ever. This year's theme is Reimagine Wellbeing Together – He Tirohanga Anamata.  It’s time to reflect on how we can all improve our mental health.

The five ways to wellbeing guide

Five Ways to Wellbeing is a set of five simple, evidence-based actions which can improve wellbeing in everyday life. 

Background
​
The Five Ways to Wellbeing was introduced to Aotearoa New Zealand in 2009 as part of Mental Health Awareness Week, building on work done by the New Economics Foundation (NEF) for the UK Government. 
​
This paper aims to develop confidence in organisations and workers that their communication of the messages is supported by best practice, built upon good understanding of the evidence and reflects a consistent national approach. The Mental Health Foundation has commissioned a review of how the Five Ways to Wellbeing has been implemented in Aotearoa since 2009. Further information and practical tips on how to use the Five Ways is available on the website. ​

Prevent the spread of cold and flu with regular hand washing
 
In the mid 19th Century Ignaz Semmelweis and Florence Nightingale pioneered hand washing as prevention against the spread of infection.  This simple practice revolutionised health care and public health.  It is  still as important today as it was then.
 
Hand washing is the most effective means of preventing the spread of infection, including winter colds, and flu.  
 
Hand washing needs to be done before:

• eating or preparing food

 
and after:

• sneezing, coughing or blowing your nose or a child’s.
• gardening or playing outside
• contact with animals
• going to the toilet or changing nappies
• looking after sick people

 
Hand washing is not just putting a little soap on your hands and running them under the tap.  It requires soap that froths, cleaning all the surfaces of the hands for at least 20 seconds.
 
The following 7 steps for good hand washing are: 

Step 1:           Turn on taps; adjust water temperature to desired heat.
Step 2:            Wet hands under running water.
Step 3:            Apply soap to palm of hand (use a soap that froths up well)
Step 4:            Ensure contact of soap with all surfaces for at least 20 seconds, refer to the
                        following:

​                           a)  Palm to palm                 b) Right palm over left back                 c) Palm to palm fingers
                                                                                   of hand and vice versa                           interlaced.                                        

                               d) Backs of fingers to        e)  Rotational rubbing of            f) Rotational rubbing, backwards and
                                         opposing palms with          right thumb clasped                   forwards with clasped fingers of right
                                         fingers interlocked.             in left palm and vice                   hand in left palm and vice versa.  
                                                                                        versa.

Step 5:           Rinse hands thoroughly for about 20 seconds, as long as it takes to sing Happy
                        Birthday through twice.
Step 6:           Dry hands thoroughly with clean towel or paper towel.
Step 7:           Where possible turn taps off with elbows or paper towel (avoid hand contact with
                        taps and door handles).
 
NB      Any broken skin areas should be covered with a dressing.            
 
 
Hand washing technique
(Aycliffe et al, 1978, Lawrence 1985)

“The Origins of You: how childhood shapes later life”

New book examines how childhood shapes later life.

Jim Mora’s interview of Richie Poulson, one of the researchers of the longitudinal Dunedin study on human development and author of: The origins of you: How childhood shapes later life.

To listen to interview click here

It is very interesting and we recommend you listen to it

Are you losing your mobility?

As we age most of us want to keep our independence, this requires us to be mobile. The ability to get up and about with ease is essential for everyday life.
 
How might you know if you are in danger of losing your mobility?  To help, here are some early signs of immobility.  They include:

• being unsteady on your feet
• difficulty getting up and down stairs
• avoiding stairs
• avoiding doing any exercise
• reluctant to go out
• a decline in housekeeping
• a drop in personal grooming and hygiene
• difficulty getting out of a chair
• falls

 
There are many reasons why immobility may happen as we age, some common ones are:

• an underlying health condition or disability causing an abrupt or gradual decline eg Arthritis, Stroke, Parkinsons Disease, dementia

 

• being less active over time and losing our strength and balance

 

• being bedridden after a short illness or operation 

 

• a fear of falling

 

• low armchairs and seats which are hard to get out of

 

• uncomfortable or unsupportive footwear

 

• long toenails, corns, ingrown toenails and other foot problems

 

• loneliness, depression and anxiety

 

• alcohol consumption

 

• being overweight or malnourished

The good news is in most cases we can improve our mobility by dealing with the underlying problem and doing regular strength and balance exercises. The sooner we start the better off we will be.
 
Regardless of our age, regular exercise keeps us fit and makes us feel better. Being physically active strengthens the heart and lungs while supplying increased oxygen to the body.  This nourishes and strengthens muscles and joints making them work more efficiently. The spin-off is you have greater mobility, feel more energetic, look better and possibly have more fun.
 
If you or someone you know is showing signs of immobility our friendly Physiotherapists can help just contact us at Therapy Professionals.
 
Ph:                              03 377 5280
Email:                        admin@tpl.nz

Prevention of Chest Infections - Top tips

Environment  
         
Indoors 

• keep indoor temperature minimum of 18°
• put lids on pots when cooking to reduce moisture 
• vent dryers to the outside
• open windows on a fine day
• air the bed covers over end of bed

 

Hygiene about the house - look at your use of chemical cleaners. 
 
The Asthma Foundation recommends: 

• using Green Works Natural Spray Cleaner Multi Purpose which can be found in most supermarkets.
• limiting the use of strong smelling cleaners, air fresheners, and fly sprays.

 
Outdoors

• Wear an extra layer of clothing on cold days, including a hat.
• Wheelchair bound people get colder than people who can move themselves
• Pollen – high levels of pollen may irritate asthma

 
The following websites have extensive information about environmental factors and respiratory health

• The Lung Foundation Australia - https://lungfoundation.com.au 
• Asthma Foundation – https://www.asthmafoundation.org.nz

Positioning and Activity:
 
Positioning

• regular changes in position are important for people who cannot more themselves.

          Ideas include:  tilting the wheelchair, resting on the bed, time on the floor, sitting in a lounge
          chair, changing position at night.
 

Activity

• regular physical activity is important for good chest health, especially during the winter.

          Ideas include:  walking and running games, catching a ball, singing, dancing, laughing,
​         swimming, blowing games (bubbles, whistles, straws).

Feeding  

• Eating and Drinking Plans are prescribed by the Speech Language Therapist (SLT), and help prevent aspiration for people with Eating and Drinking Difficulties.  Always contact the SLT if changes are necessary, even if they are short term.

 

• The recommended position for eating and drinking is seated upright (90º).  Contact the SLT if this cannot be achieved. 

 

• Feed one person at a time, especially if they are unwell.  This prevents cross contamination from saliva and coughing and allows you to watch carefully that they are eating and drinking safely.

General Health 

• Known respiratory conditions – people with asthma, COPD or Bronchiectasis should have a team management plan with regular monitoring.

•  Correct inhaler techniques – seek advice for correct use and care of inhalers from your Health Advisor.  

• General personal hygiene – regular hand washing, coughing and sneezing into a tissue or your elbow, and regular cleaning all help to prevent spread of illness.

 
When unwell  

• Coughing  - A strong cough will clear mucus and food particles from airways.  Coughing during meal times should be reviewed by SLT.  Coughing will spread infection.  Manage the risk of illness spreading by positioning the person away from others and regular cleaning of surfaces.

 

• Give the ill person small, light meals and extra fluids 8 plus cups a day.  Contact the SLT if the person is having difficulty eating and drinking as a result of other illness.  

 

•  Record fluid intake.

​Oral hygiene and saliva

Oral bacterial can cause chest infections, especially for people who have swallowing difficulties.

• Teeth cleaning twice daily is an important part of preventing chest infection.

 

• Aspiration of saliva into the lungs increases the risk of chest infections. This can be reduced by maintaining good oral hygiene and good positioning.

 
Therapy Professionals Ltd’s therapists can help many ways during illness.  Please feel free to contact us for information and advice. 
 
 
                 Phone:           03 377 5280
                 Email:            admin@tpl.nz
                 Website:       www.therapyprofessionals.co.nz

​Ageing and Unplanned Weight Loss

Unplanned weight loss or malnutrition is more common in older people than any other age group.  Regardless of age, unplanned weight loss can indicate a change health and wellbeing and should be checked out by your Doctor.
 
As we age we may lose weight for a number of reasons, which will include some of the following:

• our appetite decreases 
• we lose muscle and bone mass
• we may struggle to chew foods and swallow food and fluids (dysphagia)
• because of Illness, medication and disability
• the loss of our sight and hearing
• our loss of taste and smell
• stress, lack of sleep and fatigue
• we are lonely, depressed or bored
• we are on a tighter budget
• we have difficulty getting to the shops
• we have few cooking skills or motivation to eat and cook alone is low
• our alcohol intake
• we are inactive and don’t feel as hungry

 
Regardless of our age if we are losing weight and it’s unintentional see your Doctor to rule out any underling health problem. Other things you can do to maintain or increase your weight are:

• Have three small tasty meals a day, with small snacks between.
• Add extra calories to meals by adding butter, margarine, syrups, grated cheese, cream etc. 
• Have tasty good looking meals and snacks – use garnishes and flavour enhancers such as salt, spices, stocks or sugar.
• Moisten food with gravy and sauces and condiments if needed for swallowing.
• Serve so the meal looks good on a smaller plate to prevent overwhelm.
• Eat your main meal of the day when you are most hungry and awake ie midday or evening.
• Reducedistractions& conversation while eating.
• Eat while comfortableand relaxed.
• Chop or grate harder textured foods if swallowing is a problem.
• Ensure dentures fit well.
• Monitor by weighing monthly, no more.
• Fortify your milk (see recipe below):

If, after trying these suggestions, you continue to lose weight ask a Dietitian or your GP
about oral nutritional supplements such as Fortisip and Ensure. 

Remember, supplements don’t replace a good balanced diet they complement it.
​
If you want some help with changing your diet our friendly Dietitian can help.
Just contact us at Therapy Professionals.   
 
           Phone:      03 377 5280
           Email:        admin@tpl.nz
           Website:   www.therapyprofessionals.co.nz