Know the risks of air travel
 
Air travel poses certain risks to the frail and elderly.  Below is an abridged list that one should be aware of.
 
Hypoxia – this is essentially a change in cognition due to the changing air pressures. This is frustrating in that it can be undetectable except through magnetic resonance scans. One might sense something is off if the elderly person acts delirious during or after the flight.
 
Stroke – The leading cause of inflight death is cardiac related.  If the older person has had a stroke in four or less weeks, they should not fly.  The trip should be postponed (ideally until the patient is fit and well) or the trip should be made on the ground.  Similarly, if they have had a myocardial infarct within three months, they should not be flying.
 
Deep vein thrombosis and pulmonary embolism – in layman’s terms, if one sits for a long time one decreases blood circulation and increases the risk of blood clots.  These clots may present later after the travel experience.
 
The Australian Centre for Disease Control (CDC) offers this advice for travellers, “air travel may increase a person’s risk for VTE (Venous thromboembolism) by two - to four fold”.  They go on to point out other studies found:
 
 “A similar increase in risk is also seen with other modes of travel, such as car, bus, or train, implying that the increase in risk is caused mainly by prolonged limited mobility rather than by the cabin environment”.
 
Effect on body gases – the pressure changes within the cabin also affect the gases inside a person’s body. Travellers should avoid carbonated drinks and gas-producing foods like beans, chewing gum, cabbage and brussel sprouts.
 
Ear and sinus problems – severe ear pain, tinnitus, or vertigo occurs in nine percent of air travellers. That statistic is for all ages, so the elderly has an even higher chance of being impacted. Any persons with a middle ear and sinus problems will have an extremely painful experience and possibly cause damage to their health.
 
Motion sickness – those in a frail condition are most prone to motion sickness.  The sudden lift off and any turbulence along the way may leave them feeling nauseous.   This can lead to dehydration and a host of other scenarios.   Those travelling with them should plan ahead and administer an anti-nausea band or anti-nausea medicine prescribed by their doctor before boarding.
 
Other measures one can take is to pre-select seats away from the engines and closer to the plane’s centre of gravity (ie the inside seats slightly behind the wings).  Some experts also recommend flying at night to reduce the visual elements.
 
Temperature regulation – aircraft tend to be highly air-conditioned to lower the risk of infection, so don't forget the simple items like light jackets to control the person’s core temperature.

Road Trips
 
When going on the road with an elderly person, carers need to remember the basics.  Plan on frequent stops, every two hours.  Sitting for a prolonged period is hard on the body and will increase fatigue.
 
It is likely that all travellers will need the restroom anyway, so plan on each of these stops adding an hour to the trip.  The older person is moving slowly but you need to be sensitive to their health condition.
 
And last but not least, if there is any doubt about how the person may be impacted by flying or driving long distances it might be a good idea to look into alternative travel services such as medical transport.  
 
Ref: Aged Care New Zealand Issue 2 2021

 Some self defence basic breakaways
 
1.  Avoiding Kicks 

Turn back side of leg, keep foot on the floor, step into kick turning your body away
 
 2.  Avoiding hits 
​
 Both arms up to block, protecting your face
 

 3.  Wrist Grab – use element of surprise 

• Weakest joint is the thumb
• Step in and pull out
• Make a fist first
• If the arm is up then pull down, if arm down pull up
• If person is really strong, then use your other hand to clasp, pull again at weakest link – reach under or over and pull, step away and leave
• If they grab both hands same principle applies
• Even if you are sitting you can do this, the joint to pull away from the weakest point – THE THUMBS

6.  Clothes hold – same as hair - push knuckles 

• Lapel grab – turn to your left, use your left hand and trap the hand to your body, keep your elbow high to protect your face, grab his elbow then lift, it will turn him away, step in close and push away

 
 
7. Bites 
​

• Don't pull away – push into the bite, it hurts them more but causes the jaws to weaken

 
 
You can also access:
 
http://www.quc.ac.uk/schools/schoolofnursingandmidwifery/clinical educationcentre/videoteachingresources/breakawaytechniques/
 
 
 
Reference:  ©Pumahara Consultancy 2018
 
 

These are simply strategies that you may need to use, to compensate for the difficulties you are having since your injury.

 For example: 

 You can never remember appointments anymore, so you now keep a diary with you at all times.
The diary is a memory strategy and helps you function on a day to day basis.

 Often people find the idea of a strategy difficult to grasp and will not want to use one, because they functioned perfectly well without it prior to their injury however many difficulties following a brain injury do not get better or go away. 

 At this point, if you want to be successful at home/socially or at work then you will need to find a way to “overcome” the problem.​

Some "tried and true" strategies
 
Managing Fatigue

• All difficulties following a brain injury are made worse by fatigue, so this needs to be managed effectively before progress can be made in any area of recover.
• Firstly, you need to be aware of how fatigue affects you. To do this you may chart your activities during the day and then note down how you feel. Do you get headaches, feel clumsy or irritable? You will become aware of how much you can do in a day before your brain gets overloaded and you start to make mistakes or forget things
• Once you have figured this out you can put in your rests and your fatigue management breaks during the day
• A good strategy here is to take a weekly planner sheet and plan your days. You can pace your activities during the day and balance physical and cognitive ( brain ) activities
• By looking at the whole week you can balance your days to avoid overload
• Your brain will have a much better chance of functioning well if you keep your mental energy at a consistent level.

 
 
Managing Attention and Concentration

• If your fatigue is under control then you have a much better chance of being able to concentrate on what you are doing
•  Most people after a brain injury find that multitasking/doing two things at the same time is not possible any more
• Again, in the first place, you need to be aware of when your concentration fails you and then a strategy needs to be put in place
• Noise/internal/external distractions will affect your concentration; you need to manage distractions
• Reduce the chance of noise and visual distraction distracting you by: turning off TV/radio, pulling blinds/curtains/repositioning your desk at work 
• Manage internal distractions i.e. stress/anxiety/worry by writing things down ,talking to someone about it, problem solving with help or simply letting yourself make a specific time to think about what is on your mind
• Multitasking will be too hard and cause too many difficulties (e.g. making the dinner while talking to children/talking on the phone and taking a message)
• Distractions can cause you to go from one thing to another without firstly completing what you were doing
• A strategy needs to be used - write a list and do one thing at a time, then tick it off to show it has been completed
• Talk through the steps aloud as you do them
• Write yourself sticky notes to stay focused/remind yourself what you were doing for example; what was in the oven 
• If you feel you are losing concentration have a phrase e.g. “stay on track” to keep your attention on the task
  

Managing Processing of Information
 

• If your fatigue is managed well and you are concentrating, then information is likely to get processed
• Information that you hear, see or read, for example, has to get sorted out and put into storage so you can remember it or relate to it later
• When you have had a brain injury, your processing can be slow and if information comes too quickly/is too complicated, or your brain is overloaded, then information gets lost
• It is very important to realise when this is happening and use a strategy such as:

           - Dictaphone to record lengthy/complex information so you can listen to
             a number of times
          - Answering Machine to record phone messages rather than trying to
            write them down and listen 
          - Taking notes
          -  Asking for repetition/clarifications
          -  Repeating information back to people
          -  Breaking information into chunks
          -  Paraphrasing/summarising written information
          -  Asking people to slow down
         -  Getting rid of distractions (e.g. going to a quiet place if you are having to
           process complicated instructions)
 
Managing Memory

• To target memory it is important to look at fatigue, attention and concentration and processing in the first instant
• When strategies are in place for these areas and difficulties still remain it is important to look at what memory strategies are going to work for you
• What do you forget regularly?
• What systems did you have in place prior to your injury?
• Are you a visual or an auditory person?
• Strategies will need to be tried out and then practiced
• New learning is difficult following a brain injury, so strategy use won’t happen overnight
• Habits need to be formed
• Having a routine and using a daily planner helps you manage your memory problems

 
If you get into a routine things become habit – the pressure is taken off your brain to remember what you are supposed to be doing.

• ​Diary – look at your diary at set times of the day – write ​everything down
• Organised systems – file bills, letters, reports
• Keep things that need to be dealt with in an obvious place
• Put things in the same place
• Make keys obvious by attaching them to a large key ring
• Use sticky notes around the house in prominent places
• Central notice board – for notes and reminders
• Calendar on the wall
• To Do lists
• Shopping lists 
• Watch/phone beepers/alarms
• Photos and names/significant features to help you remember new people

 
Managing Executive Functioning
 

• These are all the skills that help you plan and organise activities, initiate them, stay on track, monitor how you are doing, keep within a time frame and complete things.
• Strategies are extremely necessary if you have difficulties in this area, otherwise you could be thinking of great ideas and things to do, but nothing ever gets done.
• Try strategies such as:

            - step by step checklists
           - alarm/timer to go off when you need to do something
           - a daily plan will increase your chances of getting things done – when you see it written
           - specific times for planning and organising
           - prompts/alarms to get you up
           - feedback and prompts from others can also be a valuable strategy initially until you find a
             way of managing your difficulties independently
 
 
Managing Social Skills/Behaviour
 

• This is probably the trickiest area to tackle with a strategy
• To target difficulties with social skills and behaviour you have to be very aware of what you are doing
• Do you talk too much?  Are you rude to people without realising it?  Do you speak without thinking?  Do you talk about yourself all the time?
• Firstly you will need help from a family member/close friend/work colleague – someone you trust and feel okay with to give  Feedback
• Ask them to give you a signal/sign when you are perhaps talking too much/not turn taking/straying off the topic - this will increase your awareness
• Be aware of your listeners reactions – are they looking bored/surprised/offended?
• Do use the Stop – Think – Go strategy – this will slow you down and enable you to think before you speak
• If you find you offend people look at situations – where and when it is happening – Are you tired?  Is it too noisy?  Are you over stimulated and likely to be irritable?
• If you can identify what happens you can then plan for certain situations (rest prior to going)
• You can warn people…”I am very tired and sometimes I don’t think before I speak, please don’t be offended”.
• You can plan to keep to certain topics
• Role play prior to going, how you will be and what you will talk about

 
All strategies are quite simple and mostly common sense.  Often after an injury your brain is too tired to think of ways around things, even if they seem simple.
 
These are all just ideas. Your rehabilitation team will help you identify the need for strategies and assist you to find the ones that work for you.
 
 
Reference:  ACC 
                     Laura Fergusson Trust

Best flooring for a senior living community
from Aged Care New Zealand Issue 2 2021

Choosing floor coverings for care facilities can be challenging. It’s about more than just function and performance; it’s about creating an ambience that helps residents feel comfortable and relaxed. The choice of floor covering should also help to improve infection control and create hygienic environments. At the same time, it’s essential that finishes stand up to the daily demands of a live, operating care home.
 
Though the abilities of the people living in senior communities are varied, the flooring requirements are the same. No matter how able-bodied residents are, safety and accessibility are the top concerns. Safety must encompass accommodations for visual impairment, slip hazards, transition hazards (between material), and flammability.
 
Durability, ease of maintenance, and sustainability are significant considerations as well. When it comes to choosing among flooring recommendations for the elderly, mistakes made in material selection or flooring installation can be dangerous – even deadly. Thus, the best flooring for a senior living community is one that takes into account the specific needs of it’s residents
 
Seven senior flooring options
 
With great influence from the hospitality industry senior flooring options have dramatically changed. Many flooring products are being installed to accommodate for various spaces. The challenge of evaluating senior flooring options is selecting a material with a homey feel that is functional, safe and durable since carts and wheelchairs can damage floor coverings over time
 
Luxury vinyl tile 
Stunning floors can be designed with luxury vinyl tile (LVT) and the use of water jet cutting technology. Along with modular products, there are numerous vinyl plank patterns that feature a wood-look. Some even have bevelled edges to enhance the plank effect. The advantages these products offer include high resiliency, high point loads to resist indentation, more sound absorption that vinyl composite tile (VCT) or porcelain tile, added comfort and super easy maintenance. Vinyl tiles easily pattern and can be water just cut prior to installation for more intricate patterns. And they are often manufacturing with antimicrobial additives.
 
Rubber 
Natural rubber tiles or rolled rubber flooring is another option for senior living communities. Rubber is a rapidly renewable resource, making it very durable and a good shock and sound absorber. Available in in many colours, rubber has a natural finish that gets better over time. It is naturally antibacterial and requires very low maintenance. And like LVT, it can be pre-cut in intricate patterns using a water-jet technique.
 
 Carpet 
Carpeting still remains a dominant material in flooring for senior living communities. Healthcare carpet installers say the broadloom carpet is a cost effective option for offices and areas where replacement and heavy traffic is not such a big concern. Carpet tile has made it’s entry in non-critical care spaces. It’s fast becoming a favourite for its ease of installation and replacement, as well as the variety of patterns and colours. Plus, it’s a natural acoustical conditioner, promoting speech privacy in large spaces.
 
Cork 
Installers also recommend cork flooring. Like carpet, cork is shock absorbent and comfortable to stand on for long periods of time. Cork flooring has a 40-year life span when it is maintained properly. Plus, cork is all natural, biodegradable and renewable.
 
Terrazzo 
Believe it or not, terrazzo flooring – once used extensively in healthcare facilities – is finding its way back into common spaces in senior living communities. This is primarily because it is so low maintenance. Simply sweep and mop occasionally: that’s it! You’ve done the maintenance needed to keep up a terrazzo floor.
 
Linoleum 
Available in both tile sand rolled goods, linoleum can be water jet cut to created intricate patterns. It’s naturally antibacterial and antistatic, as well as durable, flexible, and sound absorptive. Padded linoleum behaves very similarly to padded vinyl but it’s not quite as stain resistant. Despite this, linoleum is still easy to clean, maintain, and disinfect.
 
Dual-stiffness flooring 
Researchers reviewing falls that occurred in a nursing home form 2008 to 2010 discovered that 82 falls occurred on dual stiffness flooring (DSF) which is flooring that incorporates a layer of compressible material meant to cushion falls.  No resident who fell on the DSF experienced a fracture.  Of the 85 falls on regular flooring there were two fractures.  “The fracture rate of 2.4 percent of falls on the regular floor is consistent with previous reports in the literature, whereas a zero percent rate found on the DSF floor is a clinically significant improvement,” the researchers wrote.

Choosing the best flooring for a senior living community is essential to creating a safe and easy to manage environment. The options outlined in this article provide some great flooring recommendations for the elderly but ultimately the right flooring choice depends on the unique needs of a senior living community’s residents.
 
 
Ref: Aged Care New Zealand Issue 2 2021
 
 

Kitchen Bench Exercises – hold the bench if necessary

• While washing the dishes:
  • 5-10 knee bends: heels down: bend as far as comfortable [for thigh muscles]

• While drying dishes
  • 5-10 heel raises [for calf muscles]

• waiting for the kettle to boil:
  • heel/toe stand (feet in line one in front of the other).  Balance with as little support as possible for 10 seconds!  Change feet and repeat [for balance]

• waiting for the microwave:
  • ‘mini-jog’ on the spot without the feet leaving the ground;  30 seconds minimum [for leg muscles and aerobic fitness]

Hallway Exercises

• After using the bathroom - Tip-toe walk at least 20 paces [for calf muscles, ankles and balance]

 

• Using a hallway: once in the morning and once in the afternoon heel/toe walk  [for balance]

 
Bathroom Exercises

• After teeth cleaning

 
Posture check!

• Shoulders back, head up, chin tucked in
• A back stretch as far as comfortable

Lounge Exercises

• Every ad break on TV
  • Straighten leg fully with toe pulled up; lower slowly
  • Straighten leg fully with toe pulled up; hold 5 seconds
  • Straighten leg fully taking 5 seconds; hold 5 seconds, lower taking 5 seconds

 
         These can be done with a weight on the ankle [for thigh muscles]

Bedroom Exercises

• In bed before rising [for joint mobility]

 

• Bend one leg at a time as far as possible, then stretch out straight on the bed, making sure the knee is fully straightened -5 x

 

• Bend both knees and place feet on the bed; lift your bottom up, hold 5 seconds and lower [for buttock and trunk muscles] – 5 x

 

• Stretch both arms above your head, helping the weaker one with the stronger one if necessary [shoulder stretch]

 

• Opening the drawers – do a knee bend instead of bending your back [for thigh muscles]

 
These exercises are designed to increase strength and improve balance.
 
Do them within your limit of comfort – they SHOULD NOT CAUSE PAIN.

DiningRoom/KitchenExercises
 

• Sit to Stand  Sit on dining chair and stand up using your arms as little as possible.

 
              Repeat 5x.  Work up to 20x for leg and buttock muscles
 
 
Leg Weights Exercise for thigh muscles
 
Sit on dining chair – wrap weights round ankle
 
Start with:

• Straighten leg fully with toes pulled up; lower slowly

 
Progress to:

• Straighten leg fully; hold 5 seconds; lower slowly

 
Further progression:

• Straighten leg fully; taking 5 seconds; hold 5 seconds, lower leg fully taking 5 seconds

Note:  

• Begin with a weight that feels comfortable for you.

Band Exercises

​Sitting – before lunch exercises

​Do each exercise slowly – control the stretch and release part of the movement.

History of Music Therapy in New Zealand
From the Music Therapy NZ website
 
The beginnings
“Several historical threads interweave the beginnings of a national body for professional music therapy. Individual musicians, from the late 1950’s, were using music therapeutically- Warren Green (Otago), Marie O'Brien (van Asch College Christchurch), Ariadne Danilow and Judith White (Wellington), Lu Quin (Rotorua), Margaret Knight (Tokonui Hospital), Mary Edwards (Homai College Auckland), Marie Franklin with Eleanor Rose and a team of volunteers (Kingseat Hospital (Auckland). In 1974 Marie Franklin and Eleanor Rose, with audiologist Dr Bill Keith, brought pioneer music therapists Paul Nordoff and Clive Robbins to New Zealand to run main centre workshops on working with children with hearing impairment and learning disabilities. This initiative was a major contribution to the understanding and development of music therapy in Aotearoa New Zealand. About the same time a budding concert pianist, Mary Lindgren, who had gone to the UK from New Zealand for further piano study, met pioneer Juliette Alvin and was invited to join to Alvin’s music therapy trainee/practitioner course, the first of its kind in Britain. This she did, and became determined and energised to encourage music therapy as a profession in her home country. Her 1974/75 visit was therefore driven by that goal and was a major factor in the establishment of the New Zealand Society for Music Therapy in 1975. We honour her name and pioneering work through one of our grants, the Lindgren Project F
 
1974
 
New Zealand Society for Music Therapy (NZSMT) established
The NZSMT was founded as a charitable organisation, with the aim of raising awareness and provision of Music Therapy and support for the emerging profession.
 
1975
 
Sir Roy McKenzie 
Another key figure from this era, philanthropist Sir Roy McKenzie, became a significant supporter and benefactor from these early days until his death in 2007. The McKenzie Scholarship and McKenzie Music Therapy Hospice Fund were established with donations from Sir Roy and are named in his honour. Sir Roy giftedMThNZ shares in Rangatira several times, readily responded to requests for urgent financial support, but also gave financial advice and always came to special events. The organisation would not have begun, nor would it be in the position it is today, without the significant contributions of Sir Roy.
 
 
1975 – 2000
 
Raising the profile of music therapy 
NZSMT works to raise the profile of Music Therapy in New Zealand: publishing newsletters, establishing the Annual Journal, and lobbying politicians and policy makers in health, education, justice, welfare and community (Croxson, 2001). The society, through the significant time and energy of many individuals, brings international Music Therapy clinicians, researchers and educators to NZ for training courses, conference presentations, workshops and professional development courses (Croxson, 1993, 2001, 2002, 2003, 2007; Krout, 2003). 
 
Professional association established 
The New Zealand Association for Music Therapists (NZAMT) is established (with branches in Wellington, Manuwatu, Auckland, & Christchurch) alongside the existing NZSMT, with the following aim: 

[To] develop and maintain professional standards in Music Therapy in New Zealand, provide input into Music Therapy training programmes, ensure that a high standard of supervision was maintained, and to link with other relevant associations as appropriate. Activities included professional development days, the development of a Code of Ethics and work towards Standards of Clinical Practice for Music Therapists, job descriptions and register/s, pay scales, copyright documents, professional indemnity insurance, and the development of a Music Therapy training programme. (Rickson, 2014)
 
1995
 
NZSMT established the New Zealand Music Therapy Registration Board 
In order to be registered, a Music Therapist needs to have completed a recognised Music Therapy training, adhere to a Code of Ethics, and engage in ongoing professional development and supervision. While the NZ Music Therapy Registration Board operates independently of Council, it remains a function of Music Therapy New Zealand and continues to be underwritten by the society.
 
2000
 
Masters of Music Therapy Course 
After 18 years of effort, politically and financially, the first tertiary course in Music Therapy was approved in 2000. Barbara Mabbett, Natali Allen and Morva Croxson drew up the documentation and curriculum for the course through the Education Committee which Natali, a nurse, Chaired. In 2002 the first programme leader, Dr Rober Krout, was appointed, and in 2003 the Master of Music Therapy (MMusTher) programme enrolled its first students at the Wellington campus of Massey University, and was then absorbed into New Zealand School of Music (NZSM), a collaboration between Massey University and Victoria University of Wellington (VUW) (2005 to 2015) and now part of VUW alone. The current course is taught by Dr Sarah Hoskyns, Director and Associate Professor, and Dr Daphne Rickson, Senior Lecturer. For more information about the course, please refer to the University of Victoria website.

2000 – 2003
 

RMThs, Specialist Service Providers 
NZSMT successfully advocated for RMThs to be listed as service providers in the Ministry of Education’s Specialist Service Standards for students funded through the Ongoing Resource Scheme (ORS).
 
Early 2000s
 
First Music Therapy Centre founded 
NZSMT provides the first seeding grant in support of Raukatauri Music Therapy Centre (RMTC), the first (and currently only) dedicated Music Therapy centre in New Zealand. Founded by Hinewhei Mohi in 2004, in collaboration with Campbell Smith, Boh Runga and other local music industry people, RMTC is a charitable trust that provides Music Therapy to children and young people with special needs. 
 
2004
 
Unifying the organisation 
NZSMT rebrands as Music Therapy New Zealand (“MThNZ”), our new trading name, with a new logo, a website, and shortly afterwards an online forum for Registered Music Therapist members. NZAMT, regional branches, were brought together to form one national body with the aim of creating a more unified and economically viable organisation. It was also an acknowledgment that the profile of NZSMT membership was shifting from being predominantly friends and supporters of Music Therapy to mainly professional Music Therapists (Rickson, 2014). Governance and general promotion of Music Therapy is delegated to the Council. NZAMT is replaced by the Education Training and Professional Practice group (ETPP), with a forum of seven elected RMTh members whose role was to manage all aspects of professional development and liaise with the National Executive, tertiary providers and the Registration Board.
 
2005
 
AHANZ members 
Following significant consultation regarding the HPCA Act, MThNZ joined and became active in Allied Health Professional Associations Forum (AHPAF), later rebranded as Allied Health Aotearoa New Zealand (AHANZ).
 
2010
 
Restructuring 
For a number of reasons, the decision was made for the Society to discontinue the professional development activities, disband ETPP and amend the Rules accordingly, and undertake a re-visioning process which led to a restructure and the new Council and portfolio roles. New Zealand Society for Music Therapy continues to be the legal name for Music Therapy New Zealand (trading name).
 
2013
 
MThNZ Regional Groups established 
The intention for reestablishing regional groups are for ‘ground up’ advocacy, support & networking forums for all MThNZ members, as well as to create connections and grow relationships with related professionals and organisations in local areas.
 
2015
 
Increasing our reach 
MThNZ establishes itself within social media, creating a Facebook page that seeks to increase every New Zealander’s awareness and value of Music Therapy in its multiplicity of models, Music Therapy research, Music Therapy Week and other MThNZ events and activities.
 
2016
 
First ever Music Therapy Week 
MThNZ establishes the first ever Music Therapy Week, which aims to increase the awareness of Music Therapy and celebrate the Music Therapy that is happening throughout NZ in health, education and varied settings. It also provides a platform that aims to foster connections with other disciplines and ensure every New Zealander knows how to access a Registered Music Therapist. 
 
2016
 
Looking to the future 
MThNZ rebrands and rebuilds their website, taking a giant step forward with the opportunities that advancing technology and communications enables for increasing awareness and understanding about Music Therapy as an allied health profession.
 
 
Reference: Music Therapy New Zealand Website. https://www.musictherapy.org.nz
 
Therapy Professionals Ltd has provided music therapy in Christchurch since 1998. If you have a child with a disability who’s struggling music therapy may help.  
 
Just contact us on:  03 3775280                               Email:admin@tpl.nz

Have you fallen or do you fear falling?
 
Four easy ways to remain surefooted and safe everyday,
from an 80 year old ex physio 

 1.  Don’t rush
 

• the faster you go, the bigger the mess
• rushing is inefficient and hard on us
• enjoy a steadier pace

2.  Be aware of heel-roll-toe
 
As we get older we lose the spring in our step and the muscles that lift our toes weaken.  We need to compensate for these losses and walk safely.
 
 
Your feet matter
 
Wear firm fitting shoes, sandals or bare feet.
 
 
Feel the soles of your feet move inside your shoes.  They will tell you:

• where your feet are
• the kind of surface you are walking on
• if your weight is evenly balanced.

Place feet slightly apart with toes slightly turned out.
 
Exaggerate the natural heel-roll-toe action

​Practice heel-roll-toe whenever you walk
 

• slowly for several weeks.  When you feel familiar with the action, take longer and quicker steps
• from first step of the day, and when up at night (if drowsy take smaller steps with your feet wider apart).
• when out walking: if you start to scuff or when paths are rough.

 
As many falls occur at home, heel-roll-toe is as important when you go from room to room as it is going from street to street. 
 

3.  Carry objects close to your body
 
To maintain good posture when you carry objects, stand tall with your neck and shoulders loose.
 
When walking and carrying:
 

• stand talll
• lean with the crown of your head keeping your feet well grounded
• aim to keep your hands empty and arms free to swing
• balance small items in pockets of your vest, jacket or coat
• attach light bags to body
• carry waterproofs and extras in a light backpack
• avoid awkward, uncomfortable bags and umbrellas.

​​If you must carry heavy objects, try not to hunch or lean towards the weight, even if it is on wheels.   Keep tall and straight, then the weight will seem lighter.

4.  Keep your legs strong
 
      Climb hills and stairs when available.
 
       Don’t always depend on sticks and handrails.
 
    If hills and stairs aren’t available, standing up from sitting is a great exercise for
    thigh and core muscles.

Stand up in three simple moves:

1. 1.   Sit tall, relax neck and shoulders, look ahead.
2. 2.   Bring head and shoulders forward.
3. 3.   Straighten your knees to stand up.

 
Sit down again in three simple moves:

 1.   Bring head and shoulders forward
                                              2.   Bend your knees
                                              3.   Gently lower

In conclusion

​Establish these activities NOW, before you learn “special” balance exercises.  These habits will be with you when you are past doing the balance exercises.  They will be with you until the end of your life.

Why are seniors always so cold?
 
Winter may bring sparkling snow and for some, the holidays; but it also brings increased heath issues – especially for seniors. It’s a good idea to know what to look for and expect so that those you care for can stay healthy
 
As people age, their bodies become more sensitive to cold temperatures.  This is because of a decrease in the metabolic rate.  Ageing bodies are not capable of generating enough heat to help maintain their normal temperature and thinning of the skin is another factor that may contribute to the ‘feeling of cold’ in older adults.
 
The increased sensitivity to cold or feeling cold more than usual, can however, mean that the person is suffering from mild hypothermia.
 
Hypothermia is a condition characterised by extreme low body temperatures.  When the temperature of the body falls below 32 degrees, the body becomes so cold it starts to shut down.
 
The National institutes of Health noticed that hypothermia is a less obvious danger for vulnerable adults that requires immediate treatment.   Individuals who are older are at an increased risk of hypothermia because their bodies cannot withstand the cold as long as younger people. It’s also true that some medications and illnesses can further heighten this risk.
 
Seniors naturally create less body heat, which means they are often colder than younger individuals to start with.  Signs of hypothermia include slowed reactions and movements, sleepiness, slurred or slow speech and confusion.  Wearing layered winter gear along with a hat, gloves and warm shoes can do wonders in preventing hypothermia.  The home environment temperature should be set to 24 degrees Celsius or higher.
 
Seniors may want to talk to their physicians about any medications or chronic health problems that could increase their risk of hypothermia.
 
Heart troubles worsen
 
According to the National Heart Foundation, seniors who have cardiovascular conditions may experience increased side effects in the cold.  Because lower temperatures and winds can reduce body heat, blood vessels tend to constrict, making it more difficult for oxygen to reach the entire body. The NHF recommends that seniors where layered clothing to trap heat and provide insulation.  Seniors who are thin are especially at risk of cold-related cardiovascular issues because they do not have as much fat to provide warmth and keep blood flowing. 

Chronic pain often flares up
 
It’s common for seniors to have chronic pain like arthritis. When it is cold outside, many people note their symptoms worsen.  This can lead to taking excess pain medications, whether prescribed or over the counter.  Seniors should talk with their doctor if they find their joints are more painful than usual. Physicians may recommend changing their medication or trying home remedies like Epsom salt baths to relieve the aches.
 
Sleep habits are altered
 
During the winter, the amount of sunshine is typically far less than during the rest of the year. This can make anyone feel sluggish and want to sleep more.  Getting extra rest isn’t a problem until sleeping becomes a huge part of the day.  Seniors may want to consider setting the alarm to wake up for breakfast and ensure they’re not staying in bed late because of the winter darkness.  Keeping a regular schedule can be a big help in avoiding sundowners syndrome, as can opening the blinds and turning on the lights during the daytime.  Sundowners syndrome, or sundowning, involves a pattern of sadness, agitation, fear, delusions and hallucinations that occurs in dementia patients in the late afternoon, evening and at night.  This increased confusion around twilight can be distressing for both patients and caregivers alike.
 
Falling risks increase
 
Seniors who live in climates that receive snow and ice during the winter are also at an increased likelihood of falling.  Those who live at home and do their own shovelling or yard work are especially likely to fall.  However even individuals who reside with caregivers and walk with supervision may be at risk.  Areas around the home should be shovelled and salted to prevent falls, and they should ask for assistance when required even if it’s just an arm to lean on when walking to the car.  The elderly should consider using a walker to help them stay balanced while walking outdoors in the winter.
 
Falling risks also go up indoors during the winter because melted snow on the floor can prove slippery.  A senior who has been outside and become very cold may have reduced mobility and balance and can fall while moving indoors.  Always check on seniors when the temperature dips or snow and ice are present.

Various factors that contribute to cold sensitivity include:

• Low blood pressure
• Poor metabolic rate
• Loss of elasticity of the blood vessels
• Thinning of the fat layer beneath the skin. This is responsible for fat conservation, which helps to keep the body at the right temperature.
• Exposure to cold water
• Side effects of certain medications, such as beta blockers, calcium channel blockers.
• Physical problems
• Certain medical conditions such as thyroid disease, high cholesterol to name a few

 
Medical Conditions contributing to being cold:

• Anaemia
• Poor blood circulation
• Diabetes
• Thyroid complications

 
Signs of cold sensitivity:

• Shivering even when the room temperature is not too low
• Skin turns pale
• Breathing rate becomes slow
• Memory loss
• Hands begin to fumble
• Confusion sets in
• Seniors become exhausted
• Speech becomes slurred
• Undue fatigue
• Loss of co-ordination

 
How to keep seniors warm when they are cold:

• Raise the room temperature to keep it warm
• Give seniors warm beverages but avoid alcohol as it triggers heat loss.  If the person is unable to swallow the warm drink, they should not be forced.
• Use mealtimes to generate heat.  Eating large portions can generate heat by amping up the body’s digestive process.
• Avoid using anything hot or warm directly on their skin.
• It is also not advisable to give any form of massage.
• If the senior is wearing damp clothing, it is advisable to remove these quickly and put on dry ones.
• Use an electric blanket, or layers of blankets over the person to keep them warm.

 
Awareness and vigilance are important.  Feeling cold even in the warm climates is a signal that a person should see a doctor.  All the above-mentioned tips should help caregivers keep their loved ones warm.
 
Article from Aged Care NZ Issue 02 2021

Managing difficult behaviours in dementia
 
There are more than 78,267 New Zealanders with dementia, and 80 percent
of them may develop behavioural symptoms such as aggression, hallucinations, 
or delusions at some point.
Author:  Linda Conti, RN, CHPN
 

As the geriatric population grows, health care practitioners will increasingly encounter distressed caregivers of dementia patients asking for help in handling difficult behaviours.  Though most agitation is probably a result of deteriorative changes, health care professionals can influence behaviours.
 
Ensuring needs are met using reassuring language, changing environments, and engaging in soothing activities are among helpful strategies for addressing undesirable behaviours.
 
Agitation is the most common reason families place loved ones with dementia in nursing homes.
 
Some experts suggest that all behaviours are forms of communication.  So confounding or ‘bad’ behaviour may actually be an effort to communicate an unmet need when the disease has robbed a patient of words and logic.  Resistance-type behaviours may be a response to loss of control, confusion about what is happening, or even feeling rushed in a particular situation.  A patient may be depressed, in pain or responding to stress.  There is supposition that as the nervous system degenerates, it leaves patients with decreased ability to cope with stress.
 
Caregivers need patience and persistence to sort through patient’s behavioural clues.  They should begin by ruling out straightforward physical factors such as pain, injury, constipation, infection, wet briefs, tight or uncomfortable clothes, or a patient feeling too hot or too cold.
 
A patient may provide clues about an underlying problem. In one actual situation, a patient complained bitterly that his foot hurt.  In the emergency department, an assessment revealed a severe bladder infection. Following treatment, the patient said his foot no longer hurt.  He had provided the biggest clue – that he had pain and it was up to caregivers and healthcare professionals to find the source.  
 
Caregivers should review the events of the previous day to evaluate whether a patient may be fatigued from lack of sleep or whether there are changes to a patient’s routine or environment, including the presence of simple holiday decorations for example. Change is the enemy of dementia.
 
Experts in the field of dementia have identified six situations that commonly spar agitation, including fatigue, change, a perception of loss, level of stimulation, excessive demands, and physical stressors such as pain, infections, or constipation.
 
 
Difficult behaviours
 
Agitation and aggression
 
Agitation, restlessness, and anxiety are common in people with dementia, but even more worrisome is aggression.  These behaviours can begin abruptly, or build from a patient’s frustration.  They key to managing them lies in examining the source of behaviours to understand the feelings leading to the actions.

After checking for physical discomfort, examine what happened immediately before the negative behaviour.  What triggered it?   Spending the time to figure this out may help prevent future incidents.  Use a soft, soothing tone and reassurance in addressing the patient, such as “You seem upset.  I’m sorry you’re upset but I’m right here.  Let’s get a cookie”.
 
Try a change of environment, something surprising or distracting: dancing, singing a song, going for a walk, or simply going to another room.  Involve the patient in an art activity or ask for his or her help with a task.  Go for a ride in the car.  Play familiar hymns, Christmas carols, or old-time music.  Keep in mind that reasoning doesn’t work.
 
Wandering
 
Nearly two thirds of people with dementia will wander at some point.  Be prepared.  A patient may wander when looking for someone ‘going to work”, relieving boredom, or looking for a place to eat.  Identifying the reason for wandering may provide clues about managing it.
 
Suspicion or paranoia
 
This is a phase many people with dementia experience.  They may believe someone is trying to steal their money or belongings. This feels very real to dementia patients; explaining and logic won’t work.  This is a manifestation of the disease, and not the patient’s thought, it’s not personal.
 
Let the person speak without correcting him or her, be reassuring, reminding him or her who you are and that you are here to help, using phrases such as, “Let me help you look for the money”, and then redirect attention to something else in the room. If money is a recurring issue, put coins and small bills in a purse or wallet for you to “find” in the future. If a person believes people are breaking into the house reassure him or her with statements such as, “That must be scary.  I’m right here.  I’ll make sure nothing bad happens.” Then refocus attention.
 
Sleep issues
 
Many people with dementia experience difficulty with their circadian rhythms that dictate sleep and wake states.  Some tips too help normalise sleep habits include maintaining consistent sleep and daily routines; limiting daytime sleep to 15-20 minute naps; increasing daytime activity, including physical activity such as walking or dancing; avoiding caffeine or serving it only in the morning, offering a light bedtime snack to prevent hunger as a cause of agitation; allowing as much independence as possible in decision making, including a person’s most comfortable sleeping spot; considering melatonin to promote sleep, and keeping a night light on and the room uncluttered.
 
Seek medical advice if these measures don’t work.  There may be medical conditions contributing to the night-time confusion and agitation. A physician can also review a patient’s medications, limiting those causing reactions or that are unnecessary.
 
Bathing
 
For some dementia patients, bathing prompts agitation. It may feel strange to a person with dementia to have help with an activity he or she has always performed privately.  Preparation can help enormously.
 
Treat pain first. If the patient experiences pain with movement, medicate at least 30 to 60 minutes before the bath.  Have at the ready all the supplies you will use. Explain what you are going to do and allay fears.  Maintain modesty and ensure the room and water temperature are comfortable.
 
Let the patient do as much as possible for him- or herself.  Providing choices restores a sense of control at a time when the person has lost control of so much.  Offer choices such as, “Would you like to wash your face or would you like me to help?”
 
Maintaining regular routines, including a regular bath routine, is the key to maintaining serenity. Rushing or startling a person with dementia may provoke agitation.
 
Communication
 
Simple things can greatly enhance communication with a dementia patient.  Focus on the communication style.  Sit down, if possible, to be at a person’s eye level; standing over someone can feel threatening.  If there is a chance the patient has forgotten who you are, introduce yourself. Use a pleasant voice with a smiling facial expression.  Speak slowly, calmly, and clearly – not more loudly.  Don’t argue or try to reason with the person; logic doesn’t work.
 
Speak in short sentences, pausing after each to allow a person to process what you have said. Give one simple instruction at a time. When a patient with dementia is told “Put your shoes and socks, brush your teeth, comb your hair, and come to the kitchen to eat your breakfast”, none of those things may happen.  Use hand gestures when possible, such as patting the chair in which you want the person to sit.  Wait patiently for a reply before repeating yourself.

Delirium
 
Delirium is characterised by a sudden change in thinking ability as opposed to the drawn-out disease process of dementia.  Delirium is treatable and should be promptly addressed. If non-drug treatments fail, antipsychotics can be effective. 

Delirium is characterised by a sudden change in thinking ability, inability to focus or sustain attention, changed perception of surroundings, disorganised behaviour, variable or fluctuating status, and a sudden onset within hours or days.
 
Delirium triggers include a new or changed environment, such as hospitalisation; electrolyte imbalance; faecal impaction; urinary retention; drug interactions or side effects; pain; stress; injury; or a serious medical problem such as a stroke, organ failure; or blood clot.
 
As with agitation, delirium can often be prevented or reversed with a calm, familiar environment and routines, activity during the day and quiet surroundings at night, glasses and hearing aids that are working and in place and relaxation, such as music, massage, or reading to the patient.

Solutions for dementia induced behaviours
 
Bright light
 
Exposing elderly adults with dementia to bright light boosts their mood.  Circadian rhythms are very sensitive to light.  Research has shown that nursing home residents exposed to bright light for nine hours per day experienced fewer dementia and depression symptoms.  It also improved disturbed thinking, mood, behaviour, functional abilities and sleep.
 
Adding melatonin reduced the time it took to fall asleep and increased the length of sleep in the study. However, when given alone, it made residents more withdrawn during the day.  When used with bright light therapy, melatonin reduced aggressive behaviour and didn’t produce resident withdrawal.  This research indicates that melatonin should be used only in conjunction with bright light therapy.
 
Rummage bags
 
People with dementia often feel a sense of loss – of objects, memory, and the ability to communicate.  This sense of having lost something can cause anxiety or agitation.  A rummage bag is a tool to occupy, distract, and satisfy a patient with dementia with an activity related to what they are feeling.  It can also relieve boredom.
 
Use a large purse, a men’s toiletry bag, or any other bag, with an assortment of familiar objects that might be interesting to touch, manipulate, or examine.  It can easily be filled with common objects in the home. Be sure to avoid items small enough to swallow, sharp objects, or anything that can be disassembled.  Be creative.  A bag might include items such as keys, address book, wallet, unbreakable mirror, coin purse, small stuffed animal, sample credit cards, photos, TV remote without batteries, comb, old cell phone, sealed flashlight, or a bottle opener.

Distraction kit

Create a bag or box of interesting, unexpected, and pleasant activities to introduce when you need to redirect a person’s attention.  Eventually the box may have such pleasant associations that the patient quickly redirects his or her attention to it.  It could include items such as aromatherapy or perfume; a sound machine with chirping, rain, waves, and other sounds; picture books; a music box; lotion for a hand or foot massage; a flannel basket to warming a dryer and wrap around feet; or special treats.
 
Though none of these techniques will work all the time, patience, persistence, and trial and error can reduce agitation in dementia patients, significantly improving quality of life for both patient and caregiver.  
 
 
Author:  Linda Conti, RN, CHPN, Director of marketing for Pathways Home Health and Hospice.
 
Aged Care Issue 2 2021