When communicating becomes difficult
 
When someone’s age, disability, injury, or illness is making communication difficult, it can make life very frustrating. Here are some helpful tips to improve communicating with someone who is struggling to communicate:

• face the person down at their eye level 
• have a quiet environment, reduce or eliminate distractions such as TV or radio 
• ensure one person speaks at a time.
• speak at a normal rate, pausing at the end of each sentence to wait for a reply
• keep sentences short with one question or piece of information 
• don’t use ‘baby talk’ or shout.
• they don’t appear to understand – repeat or give the information in a different way. eg: “Do you want to visit Meryl?” - “Should we go see Meryl?”
• you’re unsure what they’ve said, ask them to repeat or rephrase, eg: “I didn’t quite pick that up – say it again please?” or “I’m having difficulty picking that up, is there a different way you can say it?”
• choices help narrow down expected response. eg: “Would you like tea or coffee?”  To help, use containers and show them as you say each choice or write the options down.
• yes or no questions keep the information simple and clear. eg: “Would you like a cup of tea?” not“What do you want to drink”?
• check you’ve understood their message eg: “Are you telling me…?”
• admit when you haven’t understood eg: “I’m not understanding you today, can you repeat that for me”
• acknowledge you’re aware they know what they want to say but are struggling to get the words out.
• don’t assume they aren’t able to understand what’s said. 
• give as much information about what’s happening as you can.
• use gestures, writing, drawing, devices, communication notebook or cards. 

 
Therapy Professionals friendly Speech Language Therapists can help make communication easier, just contact us:
 
            Phone: 03 377 5280                        Email: [email protected].

Some helpful hints for exercise class leaders taking
​classes for older people
​

Keep in mind when taking exercise classes these important points:

• enjoyment
• companionship
• exercise as an everyday part of life ie regular and ongoing

 

Hints for the class

• Try to have two levels of exercise ie choice of hard or easy; fast or slow to accommodate different abilities

• Chairs must be available to rest if necessary – the floor may not be an option for some

• Class participants need to know it’s ok to sit if they need to 

• Consider individual special needs eg a client may have to hold a chair or need wall support while doing balance exercises

• Encourage 30 minutes of exercise of some sort a day; this can be done in several bursts and not just all at once

• Variety of exercise is great - eg walks, swimming, exercise class, bowls, gardening, dancing

• WALK  WALK  WALK!!!

Specific Conditions
 
Arthritis -      Osteo and Rheumatoid

• In an acute phase

(pain, swelling, stiffness, heat around a joint)
Rest is best – start exercising as these symptoms subside

• High impact exercises are tough on older joints and not wise on damaged arthritic joints

• Maintaining a good range of movement in all joints is important “Use it or lose it”.

• Muscle strength is important to help support joints

 
Osteoporosis

• Postural exercises are important to minimise the development of that round-shouldered look

• High impact exercises put too much stress on weakened bones, especially the back

• Flexion (forward bend) of the spine with weights in the hands places too much stress on weak thoracic (mid back) bones

• The more walking and weight bearing activity people do the better for bone density.

 
Total Hip Replacement
 
Those movements to be avoided over the first eight weeks (all patients have been told in hospital)

• Hip and knee flexion of more than 90°
• Avoid low chairs
• Turning the leg inwards - “pigeon-toes” (internal rotation)
• Avoid crossing the legs - sitting
• Avoid crossing the legs – standing
• No “grape vines”!
• Avoid twisting the body and hence turning the leg inwards

​Total Knee Replacements
 

• Work those thigh muscles (quadriceps)
• Getting full leg extension – (the knee straight) is more important that full bend
• Regaining knee bend takes time – avoid forcing it
• Kneeling becomes very uncomfortable/impossible – best avoided

Hints for Stair Climbing – for troublesome hip or knee

• One step at a time

 

• Going up stairs

           Good leg up first

• Going down stairs

           Bad leg down first
          “Up to Heaven, down to Hell”

Getting down to the floor and up
 
Down to the floor      -           use a chair – seat to lean on

• go down on one knee first (the bad leg)
• then down on the second knee
• hands to the floor (on all fours)
• lower buttocks to the ground

 


Up from the floor      -           get on all fours next to a chair

• put hands on the chair seat
• bring good leg up to half kneeling position
• use chair for support to rise to standing

 

Chest conditions and shortness of breath
 

• Encourage participants to stop for a rest before they get very short of breath

 

• Remember – you should be able to exercise and still talk!

 

• Suggest stop-start exercise – intermittent rests

 

• Keep reminding class they can do a slow/easier version of an exercise

 
 
Specific Movements to Stress
 

• Dorsiflexion (foot up)
  • older folk tend not to lift their feet as high, hence can trip on very little      

 

• Quadriceps Exercises (thigh muscle)
  • essential for all mobility and to protect knees

 

• Sit/Stand Exercises          

           -  standing up easily is a very basic vital movement for independence and very good quads
              exercise – try slowly up and down (as long as                    knees are not sore)
 

• Exercises to encourage getting knees fully straightened – more important than full bend ie inner range quads exercise

 

• Hip extension – one of the first movements to become limited with hip arthritis

 

• Shoulder exercises to encourage good posture.  Especially important for osteoporosis, ankylosing spondylitis where severe curvature of the thoracic spine can occur

 

• Balance exercises are important to this age group and it does improve with practise!!

 
          -   encourage using support (a chair or wall) if confidence is lacking
         -    Or holding each other!
         -     progress to not holding on for these exercises
 

Suggestions
               
        -     walk on tip toes
       -       “heel-toe” walk
       -       heel walk
      -        exercises standing on one leg
      -        walking backwards

​There are over 100 types of arthritis. Each type of arthritis is different, therefore, needs different treatment.  Arthritis may cause pain, stiffness, swelling, tenderness or inflammation of the joints or affected areas.  It can also prevent some movements which are necessary for the activities of daily living.
 
It is important that people should try to learn as much as possible about this disease so that they may be able to understand how to control it.

​Functional parts of a joint:
 
Cartilage:
A tough material that cushions and protects the ends of bones. (Example of arthritis in this part: osteoarthritis.)
 
Synovial membrane:
A thin layer of tissue which surrounds the joint and contains and produces a lubricating fluid (synovial fluid).  This fluid oils the joint and is also responsible for keeping the cartilage healthy.  (Examples of arthritis in this part:  rheumatoid arthritis, gout.)
 
Bursa:
A small sac located near the joint which contains a lubricating fluid.  This sac allows smooth movement of muscle across muscle and tendon across bone. (Example of inflammation of this part: bursitis.)
 
Muscle:
The muscles are elastic tissues that work together to move the bones by contracting and relaxing.  (Example of involvement of this part:  fibrositis.)
 
Tendon:
Tissue fibre which attaches muscle to bone.  (Example of involvement of this part:  tendonitis.)
 
Ligament:
Tissue fibre which attaches bone to bone. (Example of arthritis in this part:  ankylosing spondylitis.)

OSTEOARTHRITIS
 
Also called:
 
Degenerative joint disease
Degenerative arthritis
Osteoarthrosis
 
What is it?
 
Osteoarthritis is a degenerative disease which most often affects the ‘weight-bearing joints’ ie ankles, knees, hips, spine.   The cartilage breaks down, tears, or rips and leaves the bone surfaces without a cushion.
 
How do I get it?
 
The cause of arthritis is not definitely known, but it can be caused by one or more of the following factors:
 

• normal wear and tear
• injuries to joints
• the natural ageing process
• heredity
• abuse of joints
• insufficient use of joints

 
How does it affect me?
 
Bony growths or ‘spurs’ may appear in the affected joint, causing intense pain and limited movement.
 
Due to the lack of cartilage, bone surfaces rub together resulting in pain and limited movement.

RHEUMATOID ARTHRITIS
 
What is it?
 
Rheumatoid arthritis is a disorder which involves many of the body’s systems and often affects the toes, ankles, knees, shoulders, elbows and fingers.  The synovial membrane which lines the joint, becomes inflamed.  About one person in 100 of the population have rheumatoid arthritis, and two to three times more women do than men.
 
How do I get it?
 
There is no known specific cause of rheumatoid arthritis, but the latest theories suggest that it develops from a viral or bacterial infection.
 
It is an auto-immune disease, which means your body is attacked by its own defence mechanism.
 
How does it affect me?
 
Rheumatoid arthritis causes many problems because it works on many of the body’s systems.
 
Some of the problems are:
 

• pain
• swelling
• weakness
• fatigue
• stiffness
• weight loss
• fever
• joint deformity

 

Reference: Healthy happy ageing:  a positive approach to active living
Yvonne Wagorn, Sonia Théberge, Dr William R Orban
 

Care Home / Aged Care Checklist
 
Care homes and aged care facilities vary considerably and it’s important to get the best fit for your family member.  It’s often hard to know what to look for.  Here’s a checklist from the Aged Advisor 2023 edition which may help you decide.  Consumer also put out a good checklist a number of years ago.  https://d3c7odttnp7a2d.cloudfront.net/assets/8159/Rest_Homes_checklist.pdf

​Use this as a reference.
You may wish to either tick if it applies, add ‘yes’ or ‘no’ or give a personal rating from 1-5 to help compare your options.
from Aged Advisor   www.agedadvisor.com

Questions:

Facility and Care
​
What are the levels of care offered? (eg rest home, dementia)

Is there an ORA/Entry Price? (eg $230,000)

Is there a Premium Room Fee? Daily, weekly, 28 days? (eg  $30 per day)

Is a GP on call 24/7?  Is a registered nurse on 247? (eg yes, yes)

Overall atmosphere in the care home?  (eg light, warm, homely)

Last DHB Audit result?  (eg 48 months)

Individual Room

Do rooms appear clean and homely?

Is there plenty of natural light?

Was the temperature comfortable?  Adjustable heating in the room?

Can residents bring own furniture?

Do the rooms have an ensuite?
 

Social 
​
Are residents normally in the lounge or own room?
Can they choose?

Is there a weekly activities programme?
What are the activities like?

Is there a Physio, Occupational or Diversional Therapist?  How many hours per week are they available?

Is there spiritual care available?  How often?
Within the home or externally sourced?

Overall atmosphere in the village?

Were staff / management approachable / friendly?

Did residents appear relaxed and happy?

Location
​
Near friends, family? (eg yes, yes)

Nice green spaces?  Multiple quiet spaces / gardens?

Ground floor or multi-level?

Easy parking for visitors / family?

Meals
​
Do meals look appetising?

What do other residents / visitors say about food?

Are there tea / coffee making facilities for residents?

Are special dietary needs met?  Is there any additional cost?

Reference:  Aged Advisor 2023 edition