Looking after our feet is important, and it becomes even more so as we age.
 
In this new Covid-19 era we are more conscious of infection control and hygiene than ever before. It shouldn’t be any different when it comes to our feet.
 
Fungal, bacterial infections and cellulitis are all common conditions podiatrists see which can have adverse effects on the feet, and most of these are acquired from lack of infection control.
 
Ideally speaking a podiatrist or nurse should be treating the feet of aged care residents, but, if not, these are some key things one needs to bear in mind when tending to a person’s foot health:
 

• Hands should be washed thoroughly with appropriate hand soap before putting on sterile gloves.
• A clean set of instruments (clippers, files, etc.) must be used for each person.
• Use disposable paper or plastic liner under the feet to act as a receptacle for the clippings (used towels and other debris may harbour germs).  Cleaning then disinfecting with alcohol, ammonia or chlorine or sterilised tools should be used.

​Common foot ailments
With body changes over the years, geriatric foot problems can range from small aggravations to debilitating issues. Conditions like corns, calluses and ingrown toenails are more common. This is especially true if footwear doesn’t fit properly but the elderly are also more likely to develop problems like athlete’s foot and fungal nails, as their immune system may have more trouble managing pathogens.
 
Fungal infections
Less elastic skin and weaker immunity can invite more fungal infections in seniors. Fungal infections often start on the sole of the foot may be scaley and itchy. If it is not treated, the infection can spread to the toenails. Treatment includes antifungal creams and sometimes pills. Fungus is hard to kill, so medication should be used for as long as directed. Tip: Don’t smear cortisone creams on the rash. They weaken the skin’s defenses and worsen the infection.
 
Callus
A callus is formed as a protective layer in response to pressure and friction on the skin. The body develops it for a reason and only a medical professional should be removing it. In fact, a podiatrist or doctor are the only people that should ever be cutting any skin away on a person’s feet. A sterile blade should be used to perform this task ensuring that only what is safe to be removed will be.
 
Bunions
Similar to a callus, bunions are painful bony limps that grow along the inside of the foot at the joint where the big toe meets the foot. Bunions grow slowly as the big toe angles inward. Tight, narrow, shoes like high heels may worsen them. That’s why bunions appear much more often in women. They can run in families, too. Icing, special pads, and shoes that aren’t too high help.  A doctor might suggest surgery in serious cases.
 
Corns
Corns form due to friction and pressure which creates a hard layer of skin which tends to be cone shaped and presses into the deep layers of the skin.  Tight shoes, wearing no socks in shoes, and foot deformities are common causes.  They can be removed by a health professional which is generally painless.  We don’t recommend corn pads as they can break down the healthy skin around the corn.
 
 
Bone Spurs
One might mistake these smooth bony growths for bunions. With bunions, the bones are out of place. Bones spurs, on the other hand, are growths at the edge of the bones of the foot, often at the heel, mid-foot, or big toe. If they get big enough, they push on nearby nerves and tissues and will hurt. Osteoarthritis or a strained tendon or ligament can cause these growths, which are more common as one ages, especially after age 60.
 
Ingrown toenails
Sometimes, the side of a nail (usually on the big toe) grows into the skin. It can happen at any age, but it is more common in older people. The toe may swell, hurt, and become infected. Sweaty feet, being overweight, and diabetes all increase the changes for an ingrown toenail. To prevent it, avoid cutting the toenails too short or wearing high shoes.
 
Do not let anybody that is not medically trained “fix” the ingrown toenail. There are multiple “magic” treatments out there at the moment, none of which have been proven to work long or short term and most of them will actually make the nail worsen and have been found to spread infection. In severe cases, a doctor may have to remove the nail root.
 
Fat pad atrophy
Getting older often can bring extra weight and fat. But the one place one can lose padding is in the feet. That’s bad, because one needs the cushioned layer to protect the feet from daily wear. One may feel pain in the ball of the foot and heel. Shoes with cushions or custom-made foam shoe inserts called orthotics may help. Or a foot doctor may suggest another treatment like filler injections to replace the fat pad.
 
Bursitis
Small fluid-filled sacs, called bursae, help cushion the joints, bones, and tendons. Repeated motion or friction from shoes can make them swell. In the foot, the toes or heel might get red, swollen, and painful. Ice, padding, and non-steroidal anti-inflammatory drugs (NSAIDs) can help. Severe cases may need a corticosteroid shot or even surgery.

Morton’s Neuroma
This is very common foot condition. As many as one in three people may have it. Symptoms include pain in the front part of the foot or a feeling like one is walking on a rock or a marble. It happens more often in older women and in those who wear high heels or shoes with tight toe box. Switching footwear, shoe pads, and massage may help. If the pain gets severe, a podiatrist or doctor may suggest steroid shots or surgery.
 
Hammertoe
This is an abnormal bend in the middle joints or a toe. It’s usually the “second” toe, next to the big one. But it can also affect the third, fourth, and fifth toes. One will notice an unusual shape, and may have some pain when it is moved, as well as corns and calluses from the toe rubbing against your shoe. A doctor can treat it with special footwear, pain meds, and sometimes surgery.
 
Cracked heels
Mature skin makes less oil and elastin, which leaves it drier and less supple. Without regular care, the heels may harden, crack, or hurt. Being overweight worsens the problem. Special creams called keratolytic help slough off the tough top layer. This may be followed up with a pumice stone to remove dead skin. Applying moisturising lotion every day will also help. If the heels get swollen and red, talk to a doctor as prescription ointment may be required.
  
Plantar Fasciitis
If one develops pain on the bottom of the heels, it is likely to be plantar fasciitis. The plantar fascia is a long ligament that runs along the sole of the foot and supports the arch. Repeated stress, like jogging, or even everyday strain can irritate it, causing pain and stiffness. If one has high arches or is overweight, one may be more prone to this problem. Rest, ice, over-the-counter pain meds, and calf muscle stretches can help.
 
Diabetic foot Ulcer
Diabetes can damage the nerves so that one may not feel small cuts or wounds in the feet. The feet may also tingle, feel numb, or have jabbing pain. Foot ulcers can start as something small like a blister, but then get bigger and infected. They are a major cause of amputations in people with diabetes. Keep blood sugar controlled and check the feet often. See a doctor immediately if there is a wound that does not heal.
 
Foot care tips for winter
Just as with the rest of the body, feet need special care in the winter:

• Keep the feet clean and dry: We want our feet warm in winter but sometimes warm and toasty leads to sweaty and damp. Make sure feet are washed every day and dried well, paying particular attention to between the toes.
• Look at the feet: in winter one tends to jump from the warm shower to warm socks and shoes. Be sure to check the feet every day. If one can’t bend to see the feet, a mirror works well. Look for any areas of redness, or irritation to that skin. If one can’t do this yourself ask a friend or family member.
• The skin still gets dry in winter. Make sure to keep up the daily moisturiser.
• Keep the feet not too hot and not too cold, just right. Be careful not to warm cold feet up too quickly as this can lead to chill blains and circulation issues. Start with a warm temperature first and them increase the heat. Always check the temperature with the hand first.

 
Fortunately, investing in foot care can make a significant difference for most foot problems in the elderly. Podiatrists can help individuals and carers manage any discomfort that one has and establish care habits to prevent future issues.
 
Adapted from:          Rachael Harper, Podiatry NZ Board Member
                                   From Aged Care NZ Issue 02 2021

Post Retirement Planning
From Aged Care New Zealand Issue 02 2021
 
With the average life expectancy creeping up to nearly 80, individuals need to
stretch out their retirement savings further than originally planned. That means saving
more and planning for longer. The earlier you begin, the better the chances are of
having  enough retirement funds to last a lifespan.

Retirement now looks very different to what we remember.  As career opportunities have broadened and changed, one may never get to experience the traditional and often radical shift from full time work to full time retirement, and you may want to keep working or doing all the things you currently enjoy as you get older.
 
The Commission for Financial Capability (CFFC) uses the three stages of retirement to encourage people to think about ageing well and preparing for the future.  These stages are broken down into Discovery (around 65-74), Endeavour (around 75-84), and reflection (85+).
 
The discovery stage
 
In this stage, one may still be working part time or be self-employed.  You may be interested in doing all the things that you did not have time for when you worked full time, such as travelling, spending more time on your hobbies and interests, learning new skills and visiting  family.
 
You may also be physically and mentally capable of leading a fairly active lifestyle.  CFFC dubs this as the ‘doing’ years and this may come with increased living costs as you explore what you can do in retirement.  It is important to plan your expenses and savings to ensure you can enjoy this part of retirement and continue to be comfortable in the future.
 
The endeavour stage
 
The  middle range of retirement may be a time where you focus on developing your skills or explore new ones.  Having a routine may help manage your energy so you can maintain the activities you enjoy.  At this point it may be a good time to consider downsizing the house or finding ways to reduce home maintenance. Financially, one may still be pursuing hobbies and travel, but at a slower pace which will steady annual expenditure.  Many people in this stage consider releasing equity from their family home as they downsize to  plan for future  costs.  At this stage you may need to plan for future health issues and allocate savings for future health services. 
 
The reflection stage
 
In the later stages of retirement, one often needs more help as health and finances limit personal independence and choice.  Many people enjoy these years of retirement by spending time with loved ones, making memories, and reflection on past memories.  The cost of living at this stage may drop dramatically as one spends more time at home, but if any health issues occur then costs may rise rapidly. It is important to plan for future health needs, which may require family support, and government and community agency support.
  
Planning finances
 
The earlier one begins planning for retirement, the more prepared and confident one can be when you do retire.  The New Zealand Superannuation (NZ Super) payment for people over the age of 65 does help cover expenses in retirement but will most likely not be the amount one wants to spend in retirement.  You will need other sources to supplement income in retirement such as personal savings, KiwiSaver, investments, and assets.

Paying off debt
 
If one has any debt such as from credit cards or a mortgage, you should aim to pay these off as quickly as possible. Entering retirement mortgage-free will free up your NZ Super payments and will give you a chance to build up savings before you retire.  You can find more information about paying off mortgages before retirement at sorted.org.nz.
 
Working in retirement
 
There is no compulsory retirement age in New Zealand, and many people continue to work with flexible hours, part time or casual hours during their retirement.  One may still receive NZ Super if you are over 65 and working or receiving an overseas pension.  Some people choose to work because they need the extra money on top of NZ Super, or because they can and want to stay employed at an older age.  You can find more information about receiving NZ Super and another income at workandincome.org.nz.
 
Equity release
 
If one owns a property or other valuable asset, you may find a lot of your money is   unusable.  During retirement many people consider selling their house and downsizing or moving into a more manageable property. This can free up some of your money to be used elsewhere.  You can also consider getting a reverse mortgage on your house, which is when you borrow an amount of money against the property to be repaid when you sell the house or when you pass away.  Applying for a reverse mortgage is a big decision that should be done with independent legal advice. You can find more information about these at Consumer.org.nz
 
KiwiSaver and NZ Super
 
KiwiSaver is a voluntary savings scheme that helps individuals put money aside for retirement.  One chooses a percentage of your salary to be deducted and saved with a KiwiSaver scheme provider such as a bank.  It is designed to help individuals save for retirement or to buy a first house.  You can find out more about KiwiSaver on the iRD website.
 
NZ Super is a pension that people 65 and over can receive.  You can still receive NZ Super if you are not retired and it is not income tested.  The NZ Super rate depends on an individual’s living situation, whether they are single or in a relationship, and whether they receive any other benefit.  You can find the rates for NZ Super at workandincome.govt.nz
 
Retirement and savings planners
 
Sorted, which is the financial guidance service developed by the Commission for Financial Capability, has a retirement planner tool to help individuals evaluate whether they are financially on track for the retirement lifestyle they have in mind.  They also have a calculator to track any KiwiSaver contributions to plan ahead for retirement.  Individuals can find more tools for planning, budgeting, debt repayments, savings and more on the website.
 
Website of interest:  Information on improving retirement and planning ahead can be found on the CFFC website.

​According to a 2016 report, one in 75 New Zealanders currently experience some form of dementia. Although dementia is not a normal part of the ageing process, it is more common for people over the age of 65, and 1 in 3 people over the age of 90 have it.  There is currently no cure for dementia.
 
The Ministry of Health acknowledged the need to focus on improving the quality of  life for people with dementia and their carers, families and whanau by identifying key action areas (Google improving-lives-people-dementia).
 
In the Netherlands, Hogewey Dementia Village has a unique concept and home to over 150 people with severe dementia.  Residents live a seemingly normal life, but are actually being supervised by caregivers at all times.  Within a fully secure environment residents are free to roam around, visiting shops, getting their hair done or being active in one of the 25 clubs available at Hogeway.  There are almost twice as many caregivers as residents in the village and they staff everything from the grocery store to the hair salon.
 
Locally, Summerset have been trialling a new dementia care model and have recently opened their generation ‘Memory Care Centre’ at their Cavendish village in Christchurch.
 
As well-established leaders in dementia care, Summerset is proud to be opening the doors to their brand-new memory care centre in Cavendish.
 
Summerset’s vision for their new centre is to enable people living with dementia to continue to lead active, positive lives in a safe and homely environment.

​While they already have a memory care facility in Levin, this new centre uniquely  capatalises on a biophilic design scheme.  Fundamentally, the design connects residents with nature through natural lighting, earth tones and natural landscape features.  Summerset say this connection has been proven to enhance residents cognitive function, physical health and psychological well-being.
 
 A key feature of the centre is a specifically designed sensory room.  Hosting New Zealand’s first interactive light table from Netherlands, a Tovertafel, they hope this feature will help dementia residents experience happiness by promoting mental stimulation, social interaction and physical activity.
 
Residents at Summerset stay in apartments, each with a double bedroom, ensuite bathroom, living area and kitchenette.  Many people living with dementia are still active so their apartments are sized to allow for freedom of movement and space for personal belongings.
 
The layout of the centre also incoporates unique features to assist with wayfinding.  Included in this is a circular design, wall murals, personalised apartment doors and colour coding for amenities.
 
Furthermore, safety is prioritised for residents through hidden buttons for boiling water, and induction cooktops in kitchens.
 
Their aim is monitoring technology, and preventing unnecessary accidents, will give residents both the protection and independence they need.
 
Finally, specialist staff are employed by the care centre.  With extensive knowledge of dementia, they hope this brings a  passion for care to their centre.
 
The Village Manager says families have been quick to praise the design, recognising the value of resident safety, comfort and happiness.  She attests “every design element, every safety feature, has been allocated very purposely for the intention of caring for those with dementia.” When families first see the features on offer, she claims they can be very emotional.
 
She says they frequently note the comfort of setting their mum or dad up just as they would at home.  Residents can continue their normal daily duties such as vaccuuming, helping in the kitchen and gardening to help with a sense of normality. She believes this makes the move into the care centre easier as their lives can continue just as the did outside of it.

​For Summerset, an important part of their service is catering to each person’s  individual needs.  When the Care Centre Manager saw residents craved the satisfaction of nurturing a pet, they decided to adopt this into the design.  The introduction of two female canaries to the Memory Care unit has since been met with absololute delight by residents.
 
She says many residents now sit outside to reminisce about their childhood pets, and others take great care in feeding and caring for the birds. She describes this experience as a blessing, privileged they get to make such a special difference in the lives of residents.
 
Ref: Aged Care Advisor 21

​Stroke is the third highest cause of death in New Zealand after cancer and coronary heart disease.  But our new research shows very few people are aware of the risk, particularly in Pasifika communities – despite being much more likely to have an early stroke.
 
Each year about 9,000 New Zealanders have a stroke according to the latest data, 2322 died of stroke in 2016. Just over half the people who survive a stroke live with
ongoing health impacts.
 
Our study, based on a random national sample of 400 people, shows only 1.5 percent identified stroke as a common cause of death.  In contrast, 37 percent identified heart disease and 33 percent identified cancer as common causes of death.
 
Our research is unique in that it recruited a group of participants who represent New Zealand’s ethnic groups.  It shows people from Pasifika communities have the lowest stroke awareness, despite being at higher risk than the general population.                

​Recognising stroke symptoms and risk factors
 
The research also shows around 43 percent of people surveyed did not believe they could tell if a person was having a stroke.
 
The most common symptoms of stroke are:

• the sudden onset of face drooping on one side
• arm weakness, especially if one sided
• a speech difficulty
• complete or partial loss of vision on one side
• swallowing difficulties
• acute confusion or memory loss
• unusually severe, abrupt headaches

 
While the majority responded correctly to stroke symptoms, a large proportion (46-70  percent) also responded yes to unrelated symptoms, such as chest pain.

​How to recognise if someone is having a stroke
 
Awareness of stroke risk factors was also low.  There is clear evidence that stroke is highly preventable.  Ten potentially modifiable risk factors are associated with around 90 percent of strokes.
 
Risk factors include high blood pressure, diabetes, smoking, low levels of physical activity, and a diet low in fresh fruit and vegetables.  Without any prompting, only 30 percent of people identified two or more risk factors for stroke.
People identifying as Pasifika or Māori recognised fewer stroke symptoms compared to European New Zealanders and Pasifika people were 58 percent less likely to correctly identify risk factors.  This is an important finding because our earlier research highlights that age standardised rates of stroke are 30-60 percent  higher for Pasifika and Māori, with an onset 15 years earlier compared to European New Zealanders.
 
A Pasifika person in New Zealand is twice as likely to die of a stroke as a European New Zealander.  That disproportionately high stroke risk combined with lower awareness about strokes and their warning signs, means New Zealand needs to develop more language and culturally specific educational material, as well as better methods of delivery.

​Stroke rates in younger people on the rise
 
In our study, higher incomes and education were both associated with better stroke awareness and this is similar to findings in other developed countries such as Spain.  People in middle-income households were twice as likely to correctly identify stroke risk factors as those on low incomes.
 
People for whom English is a second language, or who don’t speak it at all are further disadvantaged.  If we want to improve stroke prevention, we need to develop better communication strategies to address language gaps to understanding that stroke is avoidable. 
 
Globally and in New Zealand, the number of people having strokes and dying from them is increasing because people are living longer and are more exposed to risk factors, including a more sedentary lifestyle.
 
For the first time over the past decade we’ve started to see an increase in the rate of younger people having strokes.  This is of concern.  It means more people are living longer with disabilities caused by a stroke and experience growing health and financial stress themselves as well as in their families.
 
Given that stroke is highly preventable, we call for better access to population wide strategies available to people at all levels of risk of stroke.  Existing strategies are mostly aimed at people at moderate to high risk of cardiovascular diseases, including stroke.

This so called ‘high risk’ strategy leaves out most people at risk while those in the high-risk categories often lack the knowledge and motivation to address their individual lifestyle risks.
 
Preventing strokes will cut the risk of other deadly diseases
 
Population wide strategies aimed at stroke prevention would also help prevent other major non- communicable diseases with similar risk factors, including coronary heart disease, many types of cancers and even some types of dementia.
 
The free Stroke Riskometer app can assess an individual’s risk of stroke, inform them about their personal risk factors and provide information about symptoms.  Free blood pressure checks provided by the New Zealand Stroke Foundation throughout the country help raise awareness of the most important modifiable risk factors for stroke.
The economic cost of stroke is enormous with an estimate of NZ$1.1 billion for 2020, increasing to NZ41.7 billion by 2038.
 
The high health, social and economic burden of stroke on New Zealand – and its disproportionate impact on Māori and Pasifika communities – needs to be addressed urgently.  The lower level of awareness in these groups highlights we need to deliver information that is tailored and delivered by culturally competent community workers.
 
We also need to complement these steps with improved access to affordable healthy foods, preventative primary healthcare, and support at individual and community levels to improve health and lifestyle.
 
Author:
Rita Krishnamurthi 
Associate Professor, AUT
 
 
Ref: Aged Care NZ Issue 02 2022