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Dietary considerations for better breathing A healthy diet for older adults with chronic obstructive pulmonary disease (COPD) can lead to better breathing and possibly facilitate weaning from mechanical ventilation by providing the calories necessary to meet metabolic needs. Author: Ilaria St. Florian, MS, RD A New Zealand Health survey conducted suggests that despite a growing awareness of COPD, only 64 per cent of respondents had ever heard of it. Yet, according to NZHIS Mortality Data, COPD is the third leading cause of chronic morbidity and mortality and over 610,000 are affected. COPD is a progressive lung disease that makes breathing difficult due to partially obstructed air flow into and out of the lungs. It results from an inflammatory and destructive process in the lungs stimulated by exposure to toxins, primarily due to a history of smoking cigarettes. Healthy older adults’ bronchial tubes and alveoli are elastic, thus, when they breathe in and out the lungs inflate and deflate much like a balloon. In contrast, patients with COPD experience limited airflow through their airways, due to either a loss of elasticity and/or inflamed, damaged or mucous-clogged airways. Because the airways are partially blocked, breathing becomes difficult and the lungs begin to lose their ability to effectively take up oxygen and remove carbon dioxide. Symptoms of COPD include chronic cough, often referred to as smoker’s cough; excessive mucous production; wheezing; shortness of breath; tightness in the chest; and a decrease in exercise capacity. The leading cause of COPD is cigarette smoking; in fact, most patients with COPD are either current smokers or have a history of smoking. According to the New Zealand Lung Foundation, an estimated 80 to 90 percent of COPD deaths are attributed to smoking, and smoking cessation is the most effective means of disease prevention. Other causes include long-term exposure to indoor and outdoor air pollutants, occupational chemicals, fumes, dust, and second-hand smoking. In rare cases, a genetic component may increase susceptibility.  COPD is an umbrella term that includes both emphysema and chronic bronchitis. Patients with emphysema are referred to as pink puffers and experience shortness of breath to a loss of elasticity and eventual damage to the air sacs, leading to impaired exhalation and a build-up of gas in their lungs. These patients are typically thin, often exhibiting significant weight loss due to the increased energy requirements associated with laboured breathing. In contrast, patients with chronic bronchitis are referred to blue bloaters and are typically normal weight or overweight and oedematous and experience persistent cough, increased mucous production, and shortness of breath due to inflammation, scarring, and eventual narrowing of the airways. The term COPD is used to refer to these two conditions because patients often exhibit features of both. As the disease progresses, an individual’s ability to breathe worsens, and some patients may require supplemental oxygen or mechanical ventilation. Although COPD is largely preventable, it is not curable and lung damage is irreversible. Therefore, treatment focuses on smoking cessation, symptom management, improved conditioning and increasing a patient’s ability to lead an active life. Maintaining a healthy weight is vital For most people breathing is unconscious and perceived as effortless. Yet, for many adults with COPD, breathing requires a conscious effort. Because of this added effort, patients can increase their resting energy expenditure (REE) by 10 to 15 percent. As a result, if they do not compensate for their increased energy needs used by adding more calories to their diet, they will lose weight. In addition to increased REE, patients lose weight due to decreased dietary intake because of an inherent inability to eat rather than a lack of appetite. Reasons for poor nutritional intake include the following:
The purpose of nutrition care for this population is to provide adequate energy to minimise the risk of unwanted weight loss, avoid loss of fat-free mass (FFM), prevent malnutrition, and improve pulmonary status. Research shows that COPD is a disease that not only affects the lungs but can also have systemic consequences, as well as result in severe weight loss and FFM depletion. Combined, loss of weight and FFM can adversely affect breathing by reducing the strength and function of respiratory and skeletal muscles. The risk of malnutrition is a common concern among patients with COPD who lose an excessive amount of weight and FFM. Malnutrition can impair pulmonary function, increase susceptibility to infection, lower exercise capacity, and increase the risk for mortality and morbidity.  Antioxidant, vitamin and mineral considerations Research indicates that cigarette smoke contains free radicals and other oxidants that can lead to oxidative stress, subsequent inflammation, and reduced airflow to the lungs. For this reason, antioxidant therapy has been proposed for its ability to minimise free radical damage and reduce inflammation. In fact studies have shown that patients who continue to smoke have low concentrations of serum vitamin C. According to findings from the National Health and Nutrition Examination Survey, a positive relationship exists between an increased dietary intake of vitamin C and pulmonary function. Researchers have found that smokers, as well as patients experiencing acute exacerbations, had lower plasma levels of certain antioxidants (eg ascorbic acid, vitamin E, beta-carotene selenium) and that this imbalance between oxidants and antioxidants leads to oxidative stress and inflammation and could be a significant contributing factor to the systemic effects characterised by the disease. Although the research is not sufficient to conclude that anti-oxidant therapy can slow COPD’s rate of progression, findings indicate that the consumption of fresh fruits and vegetables is positively associated with improved pulmonary function, fewer symptoms, and possibly reduced oxidative stress. Keeping in mind that elders may develop vitamin and mineral deficiencies due to reduced dietary intake is also important. Many patients with COPD are prescribed glucocorticoids to help reduce airway inflammation and improve breathing. However, one of the side effects of glucocorticoid use is bone mass loss and eventual osteoporosis, leading to an increased risk of fractures. Several risk factors can cause osteoporosis, and patients with COPD typically have many of them, such as the use of glucocorticoids, smoking, vitamin D deficiency, low BMI, malnutrition, and decreased mobility. According to a recent that examined the impact of COPD on osteoporosis development, 36 to 60 per cent of patients with COPD eventually develop osteoporosis. For this reason, patients who are starting a long-term inhaled or oral glucocorticoid therapy are encouraged to supplement it with calcium and vitamin D since bone loss occurs rapidly upon initiating treatment.  The importance of proper nutrition
Proper nutrition can help reduce carbon dioxide levels and improve breathing. Specifically, it is important to focus on the percentages of total carbohydrate, fat, and protein that patients consume to see how their diet composition impacts their respiratory quotient (RQ), defined as the ratio of carbon dioxide produced to oxygen consumed. To put it simply, following metabolism, in the presence of oxygen carbohydrate, fat and protein are all converted to carbon dioxide and water. However, the ratio of carbon dioxide produced to oxygen consumed differs per macronutrient; the RQ for carbohydrate is 1 fat is 0.7, and protein is 0.8. From a nutritional stand point, this means that eating carbohydrates will yield the most carbon dioxide, while eating fats will yield the least carbon dioxide. Hence, prescribing a high-fat, low carbohydrate diet would reduce patient RQ levels and carbon dioxide production. In fact, patients who have difficulty increasing ventilation following a carbohydrate load or patients with severe dyspnoea or hypercapnia may benefit from ahigh-fat diet. Protein needs should be assessed on an individual basis. Intake should be high enough to stimulate protein synthesis, prevent muscle atrophy, and maintain lung strength but should not contribute excess calories to the diet. The general rule of thumb is about 1.2 to 1.7 g/kg of protein daily, or approximately 20 per cent of total caloric intake. As for fluids, patients who are not on a fluid-restricted diet should be encouraged to drink liquids (2 to 3 litres per day) to keep mucous thin and help clear the airways. There is still debate as to the effectiveness of nutrition therapy in improving anthropometric measurements, lung function, and exercise capacity in patients with COPD. According to the Global Initiative for Chronic Obstructive Lung Disease, nutrition supplementation coupled with exercise may increase efficacy. Although exercise is probably the last thing most patients with breathing problems want to think about, engaging in regular exercise has been shown to improve overall strength and endurance, reduce symptoms of dyspnoea and fatigue, improve cardiovascular function, and breathing. In addition, well-conditioned muscles use less energy, which can help stabalise REE levels. Authors: Ilaria St. Florian, MS, RD From Aged Care NZ Issue 02 2021 Cleaning and waste disposal procedures: Infection Control Cleaning techniques have an important role to play in the wellbeing of people living and working in residential aged care. From Aged Care New Zealand Issue 01 2022 The health, wellness, safety and overall care of residents in aged care facilities has always been of the utmost importance, but the onset of COVID 19 has led to a distinctive elevation of the cleaning crew. Aged care cleaners have always been important, but now everyone recognises it. Cleaners have never been so appreciated and are now finally getting the recognition they deserve and the resources they should always have had. People in facilities are acknowledging the cleaning staff and understanding that they’re doing as difficult a task as what the care worker does and as vital, if not more. And residents are appreciating the cleaners, which is positive for the workforce. Examining the challenges and solutions of cleaning techniques and products within aged care facilities can help provide a safe and high quality health system that offers ultimate care required and elevate the overall standard for people living in aged care facilities.  Cleaning – general procedures Cleaning is important for infection control – particularly in work areas – because deposits of dust, soil and microbes on surfaces can transmit infection. Contaminated areas such as operating rooms or isolation rooms must be cleaned after each session, and spot cleaned after each case or thoroughly cleaned as necessary. The following basic principles should be followed:
Cleaning – specific procedures Surface cleaning Floors in aged care facilities should be cleaned daily or, as necessary, with a vacuum cleaner fitted with a particulate-retaining filter. The filter should be changed in accordance with the manufacturer’s instructions. The exhaust air should be directed away from the floor to avoid dust dispersal. A ducted vacuum cleaning system can also be used; as long as safe venting of the exhaust air is ensured.  Damp dusting using a lint free cloth is essential. Brooms disperse dust and bacteria into the air and should not be used in patient or clinical areas. Dust retaining mops which are specifically treated or manufactured to attract and retain dust particles, do not increase airborne counts as much as ordinary brooms and remove more dust from surfaces. However brooms and dust retaining mops should not be used in clinical areas where there is high risk of infection associated with dust (for example, burns units). The procedure for routine surface cleaning is as follows:
Specialised areas Isolation and treatment rooms and ensuite bathrooms should be cleaned at least twice daily. Sterilising processing departments should be cleaned at least twice daily and when visibly soiled. Wet areas The following should be cleaned at least daily and more frequently as required:
 Walls and fittings
Cleaning other infection disease agents Spills of blood and other body fluids and tissues should be cleaned using standard spills management procedures. PPE used when cleaning contaminated surfaces should be incinerated after use. Reusable eye protection should be cleaned as above. Maintenance of cleaning equipment Cleaning items (including solutions, water, buckets, cleaning cloths and mop heads) should be changed after each use. They should also be changed immediately following the cleaning of blood or body substance spills. These items should be washed in detergent and warm water, rinsed and stored dry between uses. Mops with detachable heads should be laundered between uses. Waste disposal All healthcare facilities should have policies and procedures in place for the correct management of all waste generated. The Environmental Protection Authority New Zealand (EPANZ) has clear guidelines on how waste should be managed. The National Health, and Medical Research Council (NHMRC) also has guidance on the management of waste generated in healthcare facilities. Waste is classified into three main groups of waste:
All waste should be stored in secure areas until collection. Waste disposal companies licensed with the EPA will collect all clinical and pharmaceutical waste for disposal in specialised waste disposal facilities, which are also licensed by the EPA. Waste should be removed from clinical areas at least three times each day, and more frequently as needed, such as from specialised areas. Waste bags should be tied before removing from the area. General waste disposal Place in general waste bin for removal. Walls and screens should be cleaned quarterly or if visibly soiled. Blinds and curtains should be cleaned quarterly of if visibly soiled. Carpets should be vacuumed daily, and other floor surfaces washed daily when soiled. Bed and examination screens should be changed weekly and when visibly soiled. Cleaning other infection disease agents Spills of blood and other body fluids and tissues should be cleaned using standard spills management procedures. PPE used when cleaning contaminated surfaces should be incinerated after use. Reusable eye protection should be cleaned as above. Maintenance of cleaning equipment Cleaning items (including solutions, water, buckets, cleaning cloths and mop heads) should be changed after each use. They should also be changed immediately following the cleaning of blood or body substance spills. These items should be washed in detergent and warm water, rinsed and stored dry between uses. Mops with detachable heads should be laundered between uses. Waste disposal All healthcare facilities should have policies and procedures in place for the correct management of all waste generated. The Environmental Protection Authority New Zealand (EPANZ) has clear guidelines on how waste should be managed. The National Health, and Medical Research Council (NHMRC) also has guidance on the management of waste generated in healthcare facilities. Waste is classified into three main groups of waste:
All waste should be stored in secure areas until collection. Waste disposal companies licensed with the EPA will collect all clinical and pharmaceutical waste for disposal in specialised waste disposal facilities, which are also licensed by the EPA. Waste should be removed from clinical areas at least three times each day, and more frequently as needed, such as from specialised areas. Waste bags should be tied before removing from the area. General waste disposal Place in general waste bin for removal.  Clinical waste disposal
Place in biohazard bags as soon as possible. Biohazard bags have a biohazard symbol and are currently coloured yellow. Single use sharps should be placed (by the user) into a sharps container that meets the Australian and New Zealand Standards AS 4031:1992 and AS.NZS 4261:1994. Pharmaceutical waste disposal When uncertain about how to dispose of leftover pharmaceuticals they should be returned to pharmacy for correct disposal. Most disinfectants can be disposed of through the sewer system by running cold water into the sink before pouring the disinfectant into the sink. Leaving the cold water running for a few moments after the disinfectant has been disposed of dilutes the disinfectant. Impacts of infection control One of the biggest and most common challenges for aged care facilities is infection control. The risk of healthcare associated infections occurs for many reasons, and while they can’t be completely eliminated they can be managed with the correct protocols. Environmental services or frequent touchpoints such as door handles, bathroom taps, and lift buttons can carry infections, which is why Community and Public Health recommends these areas be cleaned more frequently than the routinely recommended daily cleaning. Other elements including productivity and time management are pivotal for success. It is important aged care facilities continue to solve the challenges they are facing while striving for the best possible cleaning standard for residents. Reference: Aged Care NZ Issue 02 2022 Kitchen Comforts From Aged Care New Zealand Issue 2 2021 Many older adults are choosing to age in place, and some need a helping hand to continue living at home safely and comfortably  Preparing meals in a kitchen is not without peril, especially for older adults. What the majority of us take for granted can become dangerous for the elderly with heated surfaces, knives, heavy cookware and upscale electrical appliances that require some skill to operate. No matter how much one wants to protect an ageing person, independent living means that the senior will be cooking in the kitchen and using appliances. The kitchen is typically the hub of the home, and many seniors genuinely enjoy cooking. Taking that freedom away is often emotionally devastating. Taking intentional action to minimise the risk of accident or illness is not just common sense – for everyone's sake – and revisiting safety tips for the kitchen is never a waste of time. First off, the kitchen should have ample lighting, especially next to the stove, to keep seniors from tripping, spilling hot foods, or even adding the wrong ingredients to their recipes. Spillage Water is often a problem in the kitchen - possible issues include spilled water from the sink, leaking refrigerators and pipe leaks. Spilled water can make the kitchen floors slippery, so nonslip mats should be placed below the sink and in front of the oven – the areas where spills are most likely to occur. Clutter can also cause seniors to trip or accidently drop items, resulting in injury. Older adults should also make a habit of closing all drawers and cabinets after opening them to get items such as ingredients and utensils for creating their meals. If doors and drawers are left open, seniors can easily run into them and get painful bruises. Being careful with cookware When cooking, seniors need to remember to turn each pot handle so that they are not hanging over the edge of the stove and able to be bumped or tipped over. It is safest to use pans or pots with handles on both sides for cooking provided they are cautious about handles being heated by another burner. Ageing adults should also make sure oven mitts and potholders are easily accessible to prevent burns. Many new stove models also come equipped with a stove top light that lets a person know that the stove’s surface is too hot to safely touch.  Keep items within easy reach Ageing adults need to get out of the habit of climbing or standing on a chair in the kitchen to reach items, which could cause them to lose their balance and injure themselves. To prevent this, seniors should keep the kitchen items they use most often within easy reach. Also, they should store heavy items on a counter or at waist level, because bending over to get a heavy item on a lower shelf or grabbing something weighty from a higher one could cause a strained back. Thwart foodborne illness Ageing adults should take preventative measures to make sure the food they’re cooking is safe and won’t cause them to get sick. If a senior has poor vision or is just forgetful, they may ingest expired food. Eating food past its expiration date can be a hazard. When preparing meals, they should use different cutting boards for meat and other types of food. To make it less confusing, they can use a red cutting board for slicing meat and a green one for chopping vegetables. After a meal, seniors should also put any leftovers in sealed containers and refrigerate immediately. Bug infestations Seniors who have a lot of clutter or food lying around may experience ants, rodents, roaches or other insects that can contaminate food. They can cause seniors to get sick if not taken care of properly. Prevent fires Kitchen fires are a common occurrence in homes occupied by elderly residents. Seniors are often forgetful and may leave the stove on. Fire can also accidently erupt if a dishcloth or paper towel inadvertently touches a hot burner. It’s a good idea to have an oven or stove shutoff switch installed, which turns off the appliance if it’s left unattended. Installing a shutoff can avert an accidental fire. A warning will also be sent to a friend or family member if the oven is left unattended for too long. Seniors should also consider installing a lifesaving monitored smoke detector in the kitchen that sounds an alarm and calls the local fire department. Microwaves do not pose the significant fire danger of a stove top. It is a relatively safe way for an ageing individual to quickly and efficiently cook an entire meal. However, above the stove microwaves can pose some threats. If a senior has to reach to get food out of the microwave, there is a higher risk of hot or heavy items falling on the senior. Kitchen aids Kitchen items that help a senior continue to live independently in a safe environment are an ideal addition to any person’s home during their golden years. Arthritis and ageing often make opening a jar difficult, if not impossible. A jar opener is a handy kitchen gadget that helps open jars without straining or hurting hands. A simple tool like this can help seniors feel more confident in the kitchen.  Kitchen aids
Kitchen items that help a senior continue to live independently in a safe environment are an ideal addition to any person’s home during their golden years. Arthritis and ageing often make opening a jar difficult, if not impossible. A jar opener is a handy kitchen gadget that helps open jars without straining or hurting hands. A simple tool like this can help seniors feel more confident in the kitchen. A senior can also sustain a severe cut from the metal lid of a can. However, there are can openers that open a can efficiently without leaving a sharp edge. This prevents seniors from accidently cutting themselves. Automatic openers can also help seniors with arthritis. For seniors who still want to prepare meals but have health conditions that make cooking alone unsafe, a professional caregiver can be a great resource. Many older adults are choosing to age in place, and some need a helping hand to continue living at home safely and comfortably. Many seniors love to use their kitchens and having the help of a professional caregiver can ensure they’re able to do so safely. When considering in-home care, families should make sure their senior loved ones have the resources they need to maintain their independence and remain healthy. Trusted in-home care professionals can assist seniors with daily tasks like cooking, bathing, and exercise, and they can also encourage them to focus on healthier lifestyle habits. Ref: Aged Care New Zealand Issue 2 2021 New technologies reduce falls Among fall-prevention technologies, whole body vibration is gaining momentum From Aged Care, Issue 02, 2021  The statistics are familiar: each year, one in three people aged 65 or older will fall, and falls are the second leading cause of death among older adults. The National Institutes of Health, state, and local agencies have published volumes of information about the perils of elders’ falls, but no comprehensive, feasible program to prevent falls has emerged. There is little excitement or consistency in the programs, and many produce lackluster results. Of course, we understand the risks. But often, despite the statistics and our best efforts at motivation, many older adults make little or no effort to exercise or adopt physical activity. So, where do we go from here? The answer lies in education. In addition to identifying elders at risk of falling, it’s important to emphasise the proactive solutions that can be effective. There are scientifically researched tools available that can help significantly reduce the incidence of falls. Among the major causes of falls are: environmental, such as home trip hazards or electrical wires, footstools, elevated thresholds, and uneven outdoor terrain, including sidewalks and curbs; vestibular problems’ neuropathy and other diseases; diet; physiological problems affecting ankles, feet, knees, and hips; muscle deterioration; and obesity. Most agree that exercise, particularly weight resistance, presents the best option for older adults. However, many older adults who would benefit from such training are strangers to lifting weights or running on treadmills. For individuals in the 80s, this form of training was not widespread years ago and health clubs offering such exercises simply weren’t in existence. But there are alternatives.  hole body vibration As early as the 1970s, the East Germans and Russians were experimenting with technology that came to be known as whole body vibration (WBV). Basically, it involved a metal platform to adjust involuntarily in order to achieve balance, WBV also caused the muscles to fire at different frequencies, thereby taxing muscle strength. At first, the technology was used to train athletes, improving coordination, muscle growth, and calorie burn. During that era, the Soviets found that this new technology could be used during orbital space flight for their cosmonauts to combat the ravages of weightlessness, which caused muscle and bone density platforms and held on with straps. Concurrently, American astronauts had to abort long-term space flights because of the deleterious effects of extended weightlessness and often had to be carried on stretchers after disembarking from the capsules. Evolving technology Throughout the 1990s, WBV technology took flight in Europe; many universities and medical establishments began to quantify its results. Numerous studies were commissioned and most of the early studies emanated from Europe. Around 2000, the technology was introduced to the United States via trade shows specific to the fitness industry and directed to, for example, health clubs. There was a barrier to market entry through that means of distribution, as fitness devotees refused to believe that a few minutes on a WBV platform could deliver benefits similar to those achieved in an hour on traditional fitness equipment. However, the concept ultimately took hold in universities and physical therapy clinics, and hundreds of additional studies were conducted to understand the benefits of WBV and how it could benefit various segments of the population. The conclusions on its benefits included the following:
These results were achieved through WBV’s causation of the following responses:
About 10 years ago, competitors attempted to enter the market. Fast-forward to 2015 when researchers identified a new demographic that could benefit from WBV. It appeared ideally suited for the older adult population for the following reasons:
Measuring program success How is this success measured in terms of fall prevention? There are several means of testing individuals’ likelihood of falling, and a variety of balance-testing assessments. The fear of falling plays a role in fall risk as well. By utilizing specific measurement tools, a practitioner can advise older adults regarding the following:
A new device features insole sensors that relay to the practitioner real-time information regarding walking patterns, balance, and sway with dynamic rather than static measurements. A Bluetooth relay switch attached to the shoestrings sends the information to an iPad for recording the results. Early diagnosis provides older adults and their physicians or practitioners detailed information about individuals’ fall and likelihood so recommendations on training, medication, diet, physical therapy, and other corrective measures can be made. This new science has augmented, if not surpassed, the merits of casual observation such as sit-to-stand, get-up and go, and other subjective observational tests. Other helpful devices Once older adults experience a fall or a near miss, they frequently stop moving in favour of sitting, for fear that their next move might lead to a catastrophic break of limb, hip, or skull. This results in weight gain, muscle loss, and balance deterioration, the expected physiological results of inactivity.  Ankle-foot orthotics (AFO), which can enhance stability when standing and walking and sometimes correct physiological problems, can be prescribed. Confidence associated with AFO use can directly influence an older adult’s psyche regarding walking ability, helping to avoid falls.
Falls are so deleterious, and physically and financially costly, that additional proactive solutions must be devised and, more importantly, implemented. Author: Brian Lewallan, Aged Care Issue 02, 2021 Osteoporosis – not just a woman’s disease ‘Only women get osteoporosis, right?’ Not quite.  At least one in five Kiwi men will break a bone because of osteoporosis and when men get a hip fracture, they’re more likely to require care in a long-term facility. Even worse, 37% of men who get a hip fracture will die within a year after the accident. It shouldn’t be this way.
One of the biggest issues is that people simply don’t know that men are also at risk of this disease. In fact, men are less likely to be assessed or receive treatment for osteoporosis after they’ve broken a bone. It’s incredibly important that men know they’re at risk of this disease. The good news is, it’s never too late to start taking action for your bones Here are three ways men (and women) can help minimise the risk of osteoporosis. Maintain a healthy body weight If you have lower body weight, you’re more likely to have less bone issues. Also, if you’re older, having low body weight will mean you have less fat padding around the hips, taking away a nice cushion to minimize the impact of all fall. So, make sure you eat a balanced nutritional diet, and maintain a healthy body weight. Quit smoking Smoking slows down the cells in your body that build bone health. If you’re a smoker, try to decrease how much you smoke, or quit entirely so that your bones can stay healthy. Don’t drink as much alcohol This is also a tough habit to break. But alcohol affects the cells that build and break down bone. Too much alcohol can also make you unsteady on your feet, making you more likely to trip, fall and break a bone. Try to decrease your alcohol intake. Seriously your bones will love it. Exercise Most importantly if you or the men in your life have broken a bone following a simple trip or fall since you turned 50, you are twice as likely to break another bone in the future. And, if you would like to learn more about how to improve your bone health, please visit the website www.knowyourbones.org.nz If you need help to gain weight or want an exercise programme that is right for you, just contact Therapy Professionals Ltd phone: 03 377 5280 or email: [email protected]. Our friendly therapists can help. From: Keeping on August 2023 Herbal gardens offer multiple benefits Not only is gardening relaxing but it also improves hand-eye coordination, motor skills and self-esteem.  One doesn’t need a green thumb or a huge plot of land to reap the benefits of growing fresh herbs. Not only are herbs versatile and capable of lending great flavour to foods, and as natural remedies that benefit personal health and beauty, but the specific act of growing a herbal garden itself helps in many ways, especially for seniors. Planting a herb garden is a wonderful way to enjoy the sights, smells and tastes of a wide variety of plants. Fresh herbs are often easy to cultivate and can grow in a small garden in the back yard, in pots on an outdoor patio or sunroom, or even in a window box inside a kitchen. Gardening is a wonderful hobby that enables seniors the opportunity to show his or her creativity. It is a great activity that can be shared with others like grandchildren, with friends in a club as a social activity or even alone. Not only is gardening relaxing but it also improves hand-eye coordination, motor skills and self-esteem. Herbs have many values but a few of the most common uses include aromatherapy, medicinal, as seasonings and flavourings in foods and beverages, and in salads. Many herbs are chockfull of cancer-fighting antioxidants, valuable nutrients, fat-free flavour, and more. Before beginning any herbal treatment, caregivers should check with their senior’s doctor to make certain that it does not interfere with medications that he or she may already be taking. The word Aromatherapy is derived from ‘aroma’ meaning fragrance or smell, and ‘therapy’ meaning treatment. This ancient herbal art can enhance health in many ways. It is a stress reliever and mood enhancer and can be successful in treating minor disorders. Some examples are to stimulate the immune system and strengthen your body’s ability to resist disease and infections, to alleviate digestive problems like constipation and abdominal spasms, to enhance the respiratory system to treat coughs, sinusitis and tonsilitis, to ease muscular pain by promoting relaxation and toning, improving circulation and lowering blood pressure, combating stress-related disorders like insomnia and tension headaches, and even in treating anxiety, depression, and grief. Think of growing and using relaxing herbs such as chamomile, lavender or mint, rosemary, oregano, thyme, chive and sage for this purpose. The herbs can be dried and used in potpourri, simmered in a pot on the stove to release their fragrance, hung upside down and used as natural air freshener wrapped in a gauze bag and used in a bath or even dried and steeped to make herbal tea. In the medicinal world, herbs have been used for centuries to help with a variety of ailments. (Again, it’s important to check with a senior’s doctor before using any herbs for medicinal purposes.). ‘Old fashioned remedies’ are for the most part herb based and have been used for generations to help with conditions from upset stomachs to anxiety and even strengthening the immune system.  The first apothecaries (pharmacies) were stocked with botanical ingredients. Garlic is considered to be good for the heart and cholesterol conditions and has been shown in studies to possess anti-bacterial and anti-viral properties, effective boosting the immune system and fighting all types of infections. Lemon balm, lavender, and marjoram can calm nerves and reduce anxiety. And peppermint is soothing and settling to a ‘sour stomach’. ‘The wise old herbs,’ as sage and rosemary are known, have been shown in studies to enhance brain function and may help to ward away Alzheimer’s disease.
The herbs may also be used in cooking. Seasonings are of course the most common use of herbs in any herb garden. Herbs add a lot of flavour to recipes besides providing various health benefits. No herb garden would be complete without basil, oregano, sage, thyme, chives or mint to season up dinner each and every night. Consider planting some lemon basil, lemon thyme, Thai thyme or another variation of any number of great herbs that offer different flavours. One can add delicious, healthy herbs to marinades, sauces and soups. Herbal vinegars are not only decorative but mineral-rich as well. Salads can be made with many herbs and are a special treat during the spring and summer months. Consider a borage with some mesclun lettuces topped with some chives, dill, oregano and basil. It doesn’t have to stop there; many herbs lend themselves to being eaten in their raw form and add great flavour to any salad. When looking for a healthy remedy to help a senior stay engaged, active and healthy, a small herb garden can be just what the doctor ordered in more ways than one. Ref: Aged Care New Zealand, Issue 02, 2022 Happy Feet  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:
 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:
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. Best living practices in Dementia care Today’s technology and the environments we create are helping those with dementia in new and rewarding ways. We explore one model that is on the rise.  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 Most New Zealanders don't know how deadly strokes are Claiming 2,300 lives a year and rising.  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:
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 |
AuthorShonagh O'Hagan Archives
October 2024
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