Why Do Older Adults Fall?
The most common causes of falls in the elderly and the risk factors that contribute to a fall are divided into the following categories:^2,3
Physical Risk Factors – impairments, chronic conditions, and medications
Environmental Risk Factors – hazards in and around the home
Behavioral Risk Factors – activities or decisions made by an individual

Physical Risk Factors

• Declines in Physical Fitness: Many adults become less active as they age. Without regular physical activity, one loses muscle strength, balance, coordination, and flexibility. This inactivity leads to instability which increases the risk of falling, and the inability to break the fall effectively. It also increases the chances of a serious injury and a more difficult recovery.
• Impaired Vision: Age-related eye diseases make it difficult, sometimes impossible, to detect fall hazards, such as steps, slippery surfaces, and thresholds. Conditions like glaucoma or cataracts limit vision. Poor vision can increase the chances of falling.
• Chronic Conditions: There are numerous chronic health conditions that can put a senior at risk of falling. Some of the common conditions include:

o   Heart disease – heart failure, low blood pressure, and arrhythmias can lead to fainting.
o   Brain disease – epilepsy, Parkinson’s disease, Alzheimer’s disease, and other cognitive disorders.
o   Diabetes – poorly managed diabetes can lead to visual impairments, leg numbness, and in extreme cases, diabetic coma.
o   Osteoporosis – a disease in which bones become less dense, resulting in weak bones that are more likely to break.
o   Inner ear problems – the most important organ for our sense of balance is in our inner ears; issues with it can cause vertigo.
o   Alcoholism – alcohol abuse, especially when combined with certain medications, can easily cause a fall.

• Medications: A wide variety of medications can increase the risk of a fall. Side effects, such as drowsiness, dizziness, dehydration, and low blood pressure, can all contribute to an accident. Sedatives, antidepressants, antipsychotics, opioids, and some cardiovascular drugs are among the most common, causing these side effects. Additionally, over-the-counter medications and dietary supplements can have powerful side effects and collaborative effects, also.

Environmental Risk Factors

• Unsafe home conditions – obstacles in the home like cables in pathways, poor lighting, clutter, loose carpets, or slick floors.
• Hazardous conditions outside the home, like clutter in the yard, uneven ground, or ice and snow.
• Poor or no personal aid equipment like canes, walkers, or grab bars.
• Uncomfortable or poor shoe ware.

Behavioral Risk Factors

• A person’s fall risk is influenced by the types of activities they engage in, the level of physical demand, and their willingness and ability to adapt their routine for enhanced safety. For example, laundry is a normal activity for many people, but it can require a lot of exertion for a senior, especially if they must carry a heavy basket throughout their home. This task can be risky on its own, but without taking proper precautions such as wearing secure footwear or attempting to navigate stairs with the basket, they put themselves at greater risk. Failing to modify behaviors to adapt to new or challenging activities is a serious contributing factor for falls.
• Rushing to the bathroom, especially at night when not fully awake or when lighting may be inadequate.
• Being distracted by multitasking and failing to notice an environmental hazard, such as a curb or step.

Preventing Falls in Older Adults

Following some simple steps will significantly reduce the risk and consequences of falls in the elderly and help keep seniors happy and independent for as long as possible. If a caregiver is involved, fall prevention must be a team effort.^4,5
Step 1: Get Educated

• Learn about the impact of falls on the elderly and ways to prevent them.
• Read CDC’s Stay Independent brochure. This contains a questionnaire to determine an individual’s level of risk.
• The National Council on Aging (NCOA) leads the National Falls Prevention Resource Center to provide awareness and education on falls and promotes evidence-based falls prevention programs and strategies across the nation. Here you can explore desired topics and find the latest webinars.

Step 2: Speak Up

• Talk openly with your healthcare provider about fall risks and prevention.
• Inform your provider if you fall, worry about falling, or feel unsteady.
• Review all your medical conditions and medications with your provider and discuss any side effects like feeling dizzy or sleepy. Some medicines, even over-the-counter medicines and herbal supplements can increase fall risks. As one ages, the way medicines work in the body can change. Ask your provider about taking vitamin D supplements to improve bone, muscle, and nerve health.
• If you get dizzy or lightheaded when transitioning from seated to standing position, read CDC’s Postural Hypotension brochure, which has information to manage these symptoms.

Step 3: Get Eyes, Ears and Feet Checked Annually

• See your eye doctor to have your eyes examined. Update your eyeglasses as needed and always wear your prescribed glasses. Ensure that you have no eye conditions that can limit vision, like glaucoma or cataracts.
• Have your ears analyzed to eliminate the possibility of any problems with your inner ear that may make you feel dizzy. Wear your hearing aids if you use them.
• Have your healthcare provider check your feet and discuss proper footwear. Ask whether seeing a foot specialist is advised.

Step 4: Exercise to Improve Your Balance and Strength
Exercises that improve balance, coordination and increase muscle strength lower your chances of falling. It also helps one feel better and more confident. Tai Chi is a good mind-body activity which helps with balance and strength. Discuss with your healthcare provider about an exercise program that’s best for you.

Step 5: Make Your Home Safer

• Remove clutter, like clothes or books, from places where you frequently walk.
• Ensure rugs and carpets are secure and use double-sided tape if needed to keep them in place.
• Keep items that you regularly use in places where they can easily be reached.
• Have grab bars in the shower/tub and near the toilet. Consider using a shower chair.
• Use non-slip mats in the bathtub and on shower floors.
• Improve the lighting in your home. As people get older, they need brighter lights to see well. Get lighter window treatments or remove them altogether.
• Have handrails and lights installed on all staircases.
• Wear well-fitting shoes with good support when inside and outside the house.
• Get help when needed: don’t put yourself at risk in challenging situations. Get someone to help instead of climbing ladders and stools yourself.
• Consider positioning fall mats next to the bed, in the bathroom, or other places where falls may be more common so that they can cushion the fall.
• Medical alert systems can benefit and give the elderly peace of mind that help is at the push of a button. Furthermore, automatic alert systems can detect a fall without requiring a button to push.

New Applications Being Studied to Help Prevent Falls and Fall Injuries

• Wearable airbags – a Chinese company has designed a vest to protect the head, shoulders, back, and hips when a fall occurs. On top of accomplishing the necessary materials, they determined an algorithm that predicts whether a sudden movement will result in a fall, promising to deploy the airbags within milliseconds for active protection of the wearer before they reach the ground. The company has spent five years working on this system and it continues to be upgraded. If perfected, it could soon reach the entire globe, helping to save lives and reduce harm among an already vulnerable population.⁶
• Smartphone app – researchers at Binghamton University have developed an app to help study and prevent falls in older adults. The phone can be used not just for evaluation, but for delivering intervention. The study began in June 2022 and set out to investigate the body’s ability to maintain balance while standing and walking. Among the study is a Computerized Dynamic Posturography (CDP) system, which measures “postural sway” by analyzing foot pressure, force, and motor reactions while the user stands in a harness on a locked or moving platform. Using this specialized motion-capture gear, the researchers examined gait speed and balance. Improvements, especially in gait speed, have been shown to reduce the risk of falls. If participants show an improvement after utilizing the smartphone-based program, the intervention could be seen as clinically effective.⁷ 

The Importance of Transitions of Care
The term Transitions of Care (TOC) describes a process of transferring a patient’s care from one setting or level of care to another. Settings of care may include hospitals, long-term care facilities, and rehabilitation facilities. This transition most often involves a patient moving from an acute, inpatient setting to an outpatient care environment. Transitions increase the risk of adverse outcomes due to the potential for miscommunication as care responsibility is given to new parties. Primary care physicians (PCPs) often encounter care gaps that are beyond their control due to factors such as inaccessible patient records, unclear discharge care plans, or limited effort by others to engage the primary care team, the patient, or caregivers. Therefore, it’s crucial to have effective provider communication with patient comprehension of discharge instructions in place for a safe and effective transfer.⁸

Even though there are many things that can cause a fall, there are even more things that one can do to prevent them. Utilizing some simple precautions will greatly prevent falls and injuries. Staying active and alert will lead to a better quality of life and the ability to stay independent for as long as possible.

References:

^1,4 CDC https://www.cdc.gov/injury/features/older-adult-falls/index.html
^2,5 Med Alert Help https://medalerthelp.org/blog/falls-in-the-elderly/#:~:text=Falls%20are%20common%20in%20old%20age%2C,it%E2%80%99s%20only%20one%20of%20the%20reasons.&text=Falls%20are%20common%20in,one%20of%20the%20reasons.&text=common%20in%20old%20age%2C,it%E2%80%99s%20only%20one%20of
³ AgingCare https://www.agingcare.com/Articles/Falls-in-elderly-people-133953.htm
⁶ My Modern Met https://mymodernmet.com/wearable-airbags-elderly-fall-protection/?utm_source=join1440&utm_medium=email&utm_placement=newsletter
⁷ Newswise https://www.newswise.com/articles/smartphone-app-could-help-prevent-falls-in-older-adults?sc=dwhn&user=10053418
⁸ Transitions of Care https://transitionsofcare.org/

5 for 65 and over: There are five core vaccinations for people 65 and over and they are the flu vaccine (influenza), the pneumonia vaccine, the shingles vaccine, the Tdap or Tetanus, diphtheria and pertussis vaccine, and the Covid-19 vaccine.

Influenza (flu) vaccine: People 65 and over are more susceptible to serious complications caused by the flu. Immune systems change as we age, and our defenses are not as strong, leaving individuals in this age bracket more likely to experience serious health complications, hospitalizations, or even death because of the flu. The CDC recommends everyone over 6 months of age, but especially seniors, receive a flu shot each year.  Here’s what to know:

• It is preferable to get the vaccine in September or October but even through December or January will help protect someone when the flu is still circulating.
• Our immunity becomes reduced over time and the flu virus changes each year so annual vaccination is required. Nasal Spray vaccines are not recommended for this age group
• There are two flu vaccines designed specifically for the 65 and over age group:
  • The High Dose Flu Vaccine and the Adjuvanted Flu Vaccine.  The high dose, brand name Fluzone High-Dose contains four times the antigen (the inactivated virus that promotes the immune response within our bodies). The higher ratio of antigens increases the body’s production of antibodies to protect against the virus should it encounter it. Studies show that it boosts immunity for individuals 65 and over by about 24% compared to the regular flu vaccine.
  • The adjuvanted flu vaccine, brand name Fluad Quadrivalent, is made with an additive, MF59 adjuvant, that helps our bodies create a stronger immune response.

Pneumonia vaccine: This vaccine is given to protect against pneumococcal diseases, such as pneumonia, meningitis, and bloodstream infections. The US office of Health and Human Services recommends that your health care provider guide you to what is right for you.

• Pneumococcal pneumonia is an example of a serious complication related to the flu https://www.cdc.gov/flu/symptoms/symptoms.htm that can cause death.
• Vaccines for pneumococcal diseases can be administered at the same time as your flu vaccine.

Shingles vaccine: You may have gotten a shingles vaccine shortly after turning 50. If you haven’t yet, then add this one to your list.

• The CDC recommends two doses of the shingles vaccine, brand name Shingrix spaced two (2) to six (6) months apart.
• The shingles vaccine is the only way to protect against shingles and postherpetic neuralgia (PHN) the common complication caused by shingles.
• Do not get the Shingrix vaccine if you currently have shingles, the CDC recommends that you wait until the rash has completely disappeared before receiving the vaccine.

Tetanus, diphtheria, and pertussis (Tdap) vaccine:  This combination vaccine protects against diphtheria and pertussis which spread from person to person, and tetanus which enters the body through cuts or wounds.

• The recommended dose is one dose then a booster dose every 10 years.
• If a severe or dirty wound or burn is involved, and it’s been longer than five (5) years of receiving the vaccine, a booster shot should be given.
• Talk with your healthcare provider if the recipient of the vaccine has seizures or another nervous system problem or has ever had Guillain-Barré Syndrome (also called “GBS”)
• Talk with your healthcare provider if the recipient of the vaccine has ever had allergic reactions, severe or life-threatening allergies, or other complications from previous vaccinations.

COVID-19 vaccine: If you are still unvaccinated and you need a compelling reason to get your COVID 19 vaccine – here it is: “Adults 65 years old and older who were fully vaccinated with an mRNA COVID-19 vaccine (Pfizer-BioNTech or Moderna) had a 94% reduction in risk of COVID-19 hospitalizations and vaccination was 64% effective among those who were partially vaccinated (Pfizer-BioNTech or Moderna)” according to the CDC.

• As with the flu, older, unvaccinated adults, because of less effective immune systems, are more likely to be hospitalized or die if they contract COVID-19.
• COVID-19 vaccines are available at no cost.
• CDC does not require U.S. citizenship for individuals to receive a COVID-19 vaccine.

Are these Vaccines Covered by Medicare?

According to the office of The U.S. Health And Human Services:

“Medicare Part B covers vaccines that protect against the flu and pneumococcal disease — and the hepatitis B vaccine if you’re at increased risk for hepatitis B. It also covers vaccines that you might need after an injury (like the tetanus vaccine) or coming into contact with a disease (like the rabies vaccine).

Medicare Part D plans generally cover more vaccines than Part B. But depending on your Medicare Part D plan, you may have out-of-pocket costs for these vaccines. Contact Medicare to find out what’s covered.”

For more information on vaccinations:

• Consult your health care provider.
• Connect with local or state health departments.
• For vaccine package inserts and information visit the Food and Drug Administration (FDA)
• Access the CDC 1-800-232-4636 (1-800-CDC-INFO) or the CDC’s vaccines website.

Resources:
https://www.hhs.gov/immunization/who-and-when/adults/seniors/index.html
https://www.cdc.gov/flu/highrisk/65over.htm
https://www.cdc.gov/vaccines/vpd/shingles/public/shingrix/index.html 
https://www.cdc.gov/vaccines/hcp/vis/vis-statements/tdap.html 

The first step of medication management is talking to your parent’s doctor. Bring them a complete list of all the medications they are taking and ask them about their effectiveness. Many medications are prescribed by specialists, without oversight from a primary physician, and could react negatively when combined. Also ask what each are for, and if they are absolutely necessary. Overprescribing is also a common in health care.

If your loved one is struggling to take the right dosages, explain the situation to the doctor and ask if there is a better system. Can they take them all at once to make it simpler? Or is there another brand that can be taken less often?

For many seniors, the struggle to remain organized with medications is an everyday problem. You’ve probably seen the infamous plastic pill boxes many seniors use. These boxes are a good idea but often fall short for people who are easily confused. Many pill boxes aren’t clearly labeled, and its’ still easy to forget if you’ve already taken a dosage.

One option for effectively managing medications is creating a medication routine. If the pills need to be taken three times a day, suggest your dad take one with breakfast, lunch and dinner. Combining habits is a helpful way to remember. Make sure to check with their doctor first.

You can also do something as simple as marking it on a calendar or logging it on a mobile app. There are also alarms on phones, computers and watches that indicate when it’s time to take medicine. Some apps and watches feature helpful information, including the name of the drug, the amount to take, and the doctor’s name for questions. These may not be good fit for someone who struggles with technology or is frightened by beeping or loud sounds. If it leads to more stress, it’s not a good solution.

One of the more helpful and affordable solutions is asking for medication blister packs. Talk to your pharmacist about the situation and request that your mom’s weekly medicines be sealed in blister packs. You have probably seen these before; they are the metallic-looking packs that antibiotics arrive in. Caregivers can also purchase blister pack kits to sort and pack themselves. The labels are usually clearer, and the empty space of a taken dose is an effective visual it’s already been completed.

If your loved one is still struggling with the usual options, it’s time to get more help. After all, their safety is the goal. A medication reminder service may be a good option for you. MyMedChecks is a program of the senior housing referral company CarePatrol and offers a free 30-day trial. You don’t need to use a credit card to sign up. After the trial, continued use of one call per day costs $19.95 per month. Two calls costs $29.95 per month, and three calls per day costs $39.95 per month. For more information, visit http://mymedchecks.com.

This information is provided by CarePatrol of Baltimore, a senior housing placement agency that serves the Baltimore city and county areas. If you or your loved one need to find a new home, consider talking to a CarePatrol housing placement specialist. They will sit down with you, assess your needs and financial situation, and offer the best options they can find. They are also available for tours and guidance during your final search. You can contact a specialist at (410) 844-0800, CarePatrolBaltimore@CarePatrol.com or www.carepatrolbaltimore.com. You can also find them on Facebook at www.facebook.com/CarePatrolBaltimore.

A Johns Hopkins Medicine lead research study identified four primary behaviors that contribute to a significant reduction in death from all causes over the research period by an astonishing 80%! (Smith, Johns Hopkins Center for Behavior and Health). In order – the biggest impact drivers to living a long and healthy life are: 1.) Do Not Smoke 2.) Maintain a healthy weight 3.) Move your body (30 minutes a day) 4.) Make healthy food choices. 1

All of these are within our control. It is ok to start with baby steps, just get moving in the right direction. Smoking is clearly the most detrimental behavior to overall health. Affecting coronary arteries, lungs, and increasing the risk of cancer and stroke – smoking is the number one bad habit to give up. 2

There are many articles out there on good habits that help you live longer, everything from drinking coffee or tea (for the antioxidants), getting good sleep, meditating (mindfulness), and eating a Mediterranean diet. Equally important for longevity is a good social network for emotional health and the connective layer it provides to better overall health. 3

People who have strong social connections are more likely to follow up on annual physicals, take medications as prescribed, and have higher levels of happiness than those who don’t have a good network. Social networks are important in health recovery as a part of disease management or recovery from surgical procedures and research has shown that individuals with a strong social network are more likely to adhere to their medications and recovery programs. Social networks also step in to provide support for smoking abstinence or cessation, moderation in alcohol consumption, and other healthy behaviors. 4

Interestingly, even before COVID’s impact, the U.S. has been experiencing declining longevity rates as compared to similar countries, specifically skewed to lower social-economic groups. Factors such as holding a college degree, higher levels of income, and your zip code (access to healthcare, support networks, and an indicator of socioeconomic status) are impact areas for building longevity. Higher economic groups are experiencing higher longevity rates, while lower economic groups are experiencing declining rates.  So, while socio-economic indicators are connected to longevity, it is the behaviors themselves that are driving it. 4

Communities will benefit as they are able to reach out and lift the overall availability and access to care and raise the health literacy levels of the whole community so that the leading good habits may be embraced by every economic level. The burden of chronic disease in the US is a heavy one, with 90% of the country’s 3.8 trillion-dollar annual health care total being driven by people with chronic disease and mental health conditions. 5 As one famous well-wisher put it “live long and prosper,” however it is more aptly put “prosper and live long.”

At any age, and at any level of health, taking the initiative to work on the four key factors of not smoking, maintaining a healthy weight, moving your body daily, and eating a healthy diet will add years to your life. Additionally, people who practice these good habits tend to feel better and enjoy a more mobile and active life with a reduced burden of disease and other health-related problems. Longevity is within everyone’s reach! And today’s modern technologies are making it easier to stay connected, stay on target and manage health in new and meaningful ways.

1. https://www.hopkinsmedicine.org/health/wellness-and-prevention/4-top-ways-to-live-longer
2. Johns Hopkins Health – Transform Your Life in Four Simple Steps (hopkinsmedicine.org)  

&. https://www.hopkinsmedicine.org/health/wellness-and-prevention/its-never-too-late-five-healthy-steps-at-any-age 

3. https://www.kingsfund.org.uk/projects/improving-publics-health/strong-communities-wellbeing-and-resilience
4. https://jamanetwork.com/journals/jama/article-abstract/2776338
5. Chronic Diseases Are Main US Public Health Concern (medscape.com)

Get them a calendar and help them make plans. If they are able to get out, make a weekly “date” for them to go to lunch. Share this idea with family and friends who are nearby and ask everyone to take a week to be on “the care patrol calendar”. Equally important to planning lunch outings, is making plans to just be present with them. Grandkids, friends, caregivers, church members, and neighbors can all take turns spending an hour listening and “going down memory lane” with their senior. Just knowing that someone is coming to visit for an hour is a tremendous help in avoiding “the blues”.

Whether your loved one is homebound or they are able to travel, making plans with them, giving them something to look forward to and spending time listening to them are the greatest gifts you can give. Share the gift of planning, listening and loving in 2019!

Here’s the breakdown:

1. Alzheimer’s is the most common form of dementia. Between 60 and 80 percent of all cases, according to the Alzheimer’s Association. Signs and symptoms include memory loss, confusion, depression, or mood changes.  A progressive disorder, Alzheimer’s starts before symptoms are recognizable. As it progresses, killing off brain cells, symptoms become worse. Coordination and difficulty walking may become a problem. Some patients have difficulty swallowing. One of the earliest signs is difficulty in communication, forgetting names and recent activities or places, and disorientation. A high number of patients with Alzheimer’s will wander. There is a genetic component that may influence the likelihood of someone getting Alzheimer’s.
2. Caused by a lack of blood flow to the brain, Vascular Dementia is the next most common form of dementia. Possible causes impacting blood flow to the brain are atherosclerotic disease and stroke, afflictions that increase with age. With Vascular Dementia, patients may experience hallucinations and other vision problems in addition to confusion, disorientation, and concentration problems.  Communities must be equipped to manage the severity of the dementia symptoms and an honest discussion with your senior placement specialist can help in this evaluation.
3. Dementia with Lewy bodies (DLB) or Lewy body dementia involves a chemical interruption of messages to the brain, caused by protein deposits in nerve cells in the cortex (part of the brain). This interruption leads to confusion, disorientation, and causes memory loss. Visual hallucinations, sleep disturbances, and even fainting may be issues for these patients. These protein clumps may also be found in patients with Alzheimer’s and Parkinson’s disease. This is a more common type of progressive dementia. Facilities that are able to secure patients who wake in the night or are at the risk of falling from  fainting AND have the experience dealing with hallucinations is mandatory. Some communities will not take patients with Vascular or Lewy body dementia because of problematic behaviors, sometime sexual in nature, where patients’ confusion and hallucinatory symptoms may cause all sorts of problems. Similar to Alzheimer’s and Parkinson’s, Lewy body patients may have trembling hands, difficulty walking and general weakness.
4. Parkinson’s disease, in its advanced stages, may cause dementia. In this instance, reasoning and judgement are the hallmark symptoms to look out for. This iteration may also cause hallucinations. irritability, paranoia, and depression may develop as the disease progresses. Trouble speaking and forgetting words while in conversation is also common. Caused by abnormal clumps of protein deep in the brain. A degeneration of dopamine producing nerve cells results in involuntary and uncontrollable body movements.  Parkinson’s is progressive, often leading to dementia similar to Alzheimer’s or DLB.
5. Frontotemporal dementia affects the front and side part of the brain. Also known as Pick’s disease, it includes several different types of dementia but all effecting this part of the brain that impacts language and behavior. This part of the brain is associated with personality. Causing compulsive behavior, speech problems, loss of inhibitions, loss of motivation, and difficulty recalling the meaning of common words, Frontotemporal dementia refers to any type of dementia that is caused by problems with this part of the brain. There are some communities that will not accept a resident with this dementia.
6. CDJ or Creutzfeldt-Jacob disease is a rare form of dementia effecting one in 1 million people annually. It is an aggressive and deadly form of dementia, where patients often die within the first year of diagnosis. Depression, agitation confusion and memory loss are common hallmarks. This dementia affects the body and patients may experience twitching and stiffness of muscles.
7. Wernicke’s disease, Wernicke-Korsakoff syndrome, or Wernicke’s encephalopathy are caused by a lack of vitamin B-1. Wernicke, a brain disorder. is a result of bleeding in the lower brain areas. Double vision, loss of muscle control, as physical symptoms of Wernicke’s disease, develop into Korsakoff syndrome when untreated. Korsakoff Syndrome is a memory disorder causing trouble with remembering things, learning new things, and processing information. These two syndromes are often grouped together and classified with dementias although they are not true forms of dementia. The similarities are so similar it makes sense to list it here.
8. Mixed dementia is where someone has more than one type of dementia and is very common. According to Mayo Clinic, autopsy studies in of the brains of dementia patients 80 and older showed many to have a combination of several causes.  Although people may not know they have multiple types. The symptoms are different from person to person. However, with progression, difficulty in speaking and walking is common. Early symptoms might include disorientation, memory loss, behavior and mood changes.
9. NPH or Normal Pressure Hydrocephalus causes excess fluid to build up in the ventricles of the brain. Designed to cushion our brain and spinal cordes, ventricles are filled with fluid. But too much fluid places pressure on the brain that causes damage, and can lead to symptoms of dementia. NPH may be caused by injury or infection that causes bleeding, brain tumors, or brain surgeries that leave fluid or bleeding in the brain. Sometimes the cause is unknown. This type of dementia can sometimes be cured with surgery so it’s important to seek treatment and intervene early!
10. Huntington’s disease, a genetic condition that causes a breakdown in the brain’s and spinal cord’s nerves cells, prematurely wasting away. Juvenile Huntington’s is rarer and adult onset fist shows signs in someone in their 30’s -40’s. The breakdown in nerve cells leads to dementia and impaired movement resulting in difficulty in walking, swallow and with jerking movements.

Dementia is also a result of other diseases such as multiple sclerosis, HIV or other illness or injuries that cause damage to the brain cells. Family history, age, repetitive brain injury (accidents or sports injuries) or infections with high fevers, poisoning, alcohol abuse, or cancers may all cause a form of dementia to manifest.

As with other disease, maintaining a healthy lifestyle, with good diet and exercise, no smoking and moderate to no alcohol use, and other healthy lifestyle measure, may aid in stemming the onset of dementia.

1 https://www.aarp.org/caregiving/basics/info-2019/memory-care-alzheimers-dementia.html
2 https://www.healthline.com/health/types-dementia#huntingtons-disease 
3 https://www.mayoclinic.org/diseases-conditions/dementia/symptoms-causes/syc-20352013

Confusion, delirium, marked sleepiness, disorientation, hallucinations, agitation, aggression, these changes in mental function may be caused by post-operative delirium if they are occurring after a surgery that required anesthesia. Post-operative delirium is one of the most common surgical complications for older adults according to The American Geriatrics Society. It is also preventable 40% of the time.

Because it is so common, and because it is largely preventable, it is important for older adults and their care providers to be informed about the risk factors and best practices for mitigation. Understanding what is normal post-op disorientation and sleepiness and what is the more serious post-operative delirium is important so patients can take protective measures and seek proper treatment to prevent long term problems.

Often mistaken for dementia, a range of cognitive disorders that are irreversible and that impact memory and other cognitive functions, post-operative delirium typically lasts a week or less as a patient recovers from surgery. However certain underlying risk factors can prolong the condition, which can cause complications for a patient such as injury, further hospitalization, and potential long term care requirements. Post-operative delirium may also lead to cognitive and functional decline.

Underlying factors that can cause complications often play the driving role in a patient developing post-operative delirium. Especially at risk are those individuals with existing cognitive issues, patients who are on certain medications, and elderly patients. Even though post-operative delirium can happen at any age, it is most likely to afflict older patients. It is important for elderly patients to have a medical exam and discuss with their doctors any medications prior to surgery.

When diagnosing a patient with post-operative delirium, the care team must map back to its probable underlying causes. These can include disrupted sleep problems, poorly managed pain, an infection, or a reaction to a medication. In addition, the family and other care providers close to the patient can be leaned on for additional support and recovery tactics.

Family members can play a critical role in reducing the incidence of post-operative delirium. Activities such as walking, helping with meals and proper hydration, and playing games or working on cognitive challenges such as crossword puzzles with the patient have been shown to be effective in lessening the chance of post-operative delirium as well as the severity of post-operative delirium in patients who develop it.

Other factors to prepare recovering patients for optimum results include proper access to hearing aids and reading glasses, familiar faces and voices to sooth and calm the patient post-surgery, and a return to a regular even sleep cycle.

The AGS CoCare®: HELP program, formerly known as The Hospital Elder Life Program, originally created by Dr. Sharon Inouye is a well-studied, effective, and innovative model of hospital care designed to prevent both delirium and functional decline for older adult surgical patients. This evidenced based practice is focused on delirium prevention through multi-component intervention. Well documented as effective, it is implemented in over 200 hospitals. Free clinical tools and screenings are available through the American Geriatrics Society CoCare HELP website.

Resources:

https://help.agscocare.org/About_AGS_CoCare_program_help 

With warmer weather finally making its way to us, it’s time to talk about a common but extremely serious topic that affects us all, but especially seniors — dehydration.

The human body is made of approximately 60 percent water, so when your fluid levels are too low, the body naturally suffers. If severely dehydrated, your body won’t have enough water to carry out its normal functions, and you may experience a range of symptoms, including weakness, dry mouth, exhaustion, dry skin, cramping, dizziness, nausea and potentially vomiting.

Increased thirst is the most obvious sign, but it’s not always present. More serious symptoms include low blood pressure, convulsions, bloated stomach, severe cramping, rapid but weak pulse, dry eyes, wrinkled skin with no elasticity and rapid breathing. Generally, dehydration occurs when you’re losing more water than you’re putting in.

Heat can be dangerous for seniors, since it leads to excessive sweating, so it’s best to be extra diligent during warmer weather. Carry a water bottle with you when you’re out, and remind mom and dad to drink on a regular schedule, rather than when they feel thirsty.

Why it’s more common in seniors
Since older adults possess a lower volume of water overall and often have health concerns or conditions like diabetes and medications that often act as diuretics, dehydration is a serious and common concern among the elderly. Aging itself also makes people less aware of thirst, and it becomes more difficult to regulate fluid balance as you get older, since kidneys do not work as efficiently. You simply lose more fluid more quickly.

If you’re younger, be careful not to compare your water levels with your aging loved one to determine if they are dehydrated — your body has more water in it, so you can afford to lose more and be okay.

What to do
If you loved one is suffering from mild dehydration, the answer is simple — get them to consume more fluids. Dehydration is a manageable condition, but it must be consistently monitored. Drinking fluids on a schedule, ensuring they have access to beverages they prefer, and not pushing them to consume a large amount all at once should help.

For more moderate levels of dehydration, water enhanced with electrolytes tends to be more helpful. Gatorade and coconut water are decent options if you’re short on time.

Don’t be afraid to ask your doctor. If dehydration is severe, seek medical assistance immediately— it’s possible they may need fluids intravenously. The most important thing is to not wait to act.

This information is provided by CarePatrol of Baltimore, a senior housing placement agency that serves the Baltimore city and county areas. If you or your loved one need to find a new home, consider talking to a CarePatrol housing placement specialist. They will sit down with you, assess your needs and financial situation, and offer the best options they can find. They are also available for tours and guidance during your final search. You can contact a specialist at (410) 844-0800, CarePatrolBaltimore@CarePatrol.com or www.carepatrolbaltimore.com. You can also find them on Facebook at www.facebook.com/CarePatrolBaltimore.

• Wash your hands before putting on your mask.
• Wear your mask over your nose and mouth and secure it under your chin. (Not just the tip of your nose, not just the top of your chin, full coverage is what we’re going for!)
• Fit your mask snugly against the sides of your face. (Adjust to eliminate gaps!)
• Make sure you can breathe easily.
• When you take off your mask, handle it only by the ear loops or ties. (You don’t want to get any collected virus back on your hands!)
• Store your used mask safely to keep it clean between uses. (Zip sealed plastic bags work well.)
• Wash your cloth mask regularly, preferably in a washing machine. (Recommended after each use)

And yes, wearing a mask is one of the best things we can do to protect ourselves and others! Joseph G. Allen, director of the Healthy Buildings program at Harvard indicates that when you wear a mask, “you protect yourself; you protect others, you prevent yourself from touching your face.” (2)

Key factors like fit, fabrics, and size of coverage area all play a role in a mask’s effectiveness, but even if you can’t get your hands on an N95 mask, the gold standard in masks, don’t stress. It’s really interesting to know that when everyone wears a mask, the combined filtration efficiency increases! 3 There is a real cumulative effect.

And while wearing a mask is an inconvenience, we are all going to need to keep at it, at least for a while longer, well into 2021. That’s why it is important for us all to learn how to use a mask properly and to the best effectiveness. It should feel a little bit stuffy under there, that’s a good sign that you are doing it right. Don’t fidget with it, and don’t pull it under your nose or down to your chin. In the same respect, don’t let your chin hang out the bottom.

It’s also important to make sure the sides are snug against your face, you don’t want to have gaps were air, and virus particles, can flow in and out unfiltered. You want to wear it so that it comes up, close to the bridge of your nose, and all the way down over your chin, and under your chin. Tighten the ear straps to pull it snug to your cheeks. Remember, you don’t want gaps that can let particles in and out. (4)

Remember to put your mask on inside your car or inside your home or apartment before you go out into public spaces. Common areas, moving in and out of a store or a waiting room or elevator, poses more of a threat to exposure, so you don’t want to be donning your mask when you are inside these spaces! It would be better to do so before encountering potentially higher contamination areas.

New strains of COVID19 circulating have cause some experts to recommend layering up masks to provide additional protection. With the three new, highly contagious variants on the loose, wearing an extra layer of fabric or fiber-based mask will likely create a more effective physical barrier as we discussed above. The cumulative effect of the combined filtration efficiency.

Supporting research published in the journal Matters found that when a nylon layer is worn over a surgical-style mask, “it improves the fit and effectiveness of filtration of virus particles from a range of 53%-75% to up to 90%.” (5)

Double-masking is a good way to enhance the seal around your face. Gators and bandanas and other loose-fitting masks that offer the minimal protection can be layered under or over a surgical mask, thus creating a better coverage solution. Or two surgical masks can be layered together. Just be mindful that multiple layers can make breathing through the cloth more difficult. If you find that you are adjusting it constantly or more than usual, it might not be worth the tradeoff. The goal is to put on the mask, and then don’t touch it. Each time you touch your mask or your face you risk transferring contaminants from your hands.

Masks are just one layer of defense against the COVID virus. It is important to use them in combination with social distancing and hand washing. And follow the protocols outlined by the CDC for proper handling, frequent washing, and proper snug fit. Remember, any kind of mask is better than no mask. And doubling up, especially in light of the new strains of virus, sounds like a pretty good idea indeed. Stay safe, stay sane, and mask up!

1 https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/protect-your-home.html

2, 3 Masks Work. Really. We’ll Show You How – The New York Times (nytimes.com) www.nytimes.com/interactive/2020/10/30/science/wear-mask-covid-particles-ul.html

4 How NOT to Wear a Mask – The New York Times (nytimes.com) www.nytimes.com/2020/04/08/well/live/coronavirus-face-mask-mistakes.html

5. Should you wear double masks? Some experts say yes (freep.com) www.freep.com/story/news/health/2021/01/31/double-masks-covid-19-coronavirus-variants/4278626001/

Most of us have heard of Alzheimer’s disease and have a sense of the debilitating effects that it has on a person. What many people don’t know, however, is that there are more than 10 types of dementia, of which Alzheimer’s is just one iteration.

At CarePatrol, we work with many clients seeking memory care. As memory care consultants and senior placement specialists, the CarePatrol Team needs to be well-versed in the different types of dementia. The CarePatrol Team must have a deep understanding of the communities in our region that specialize in, or have accommodations to meet, the needs of the various types and intensities of dementia patients. For this reason, the Founder of CarePatrol Baltimore recently became certified as a dementia care trainer!

Read on below to learn more about dementia and how to handle it, or contact us now for the compassionate care you and your family deserve.

Dementia Symptoms

Memory loss is a primary indicator of dementia. Other symptoms such as depression, confusion, and coordination problems may also be present. In all cases, this is caused by changes in the brain cells and nerve cells that may also affect personality, behavior, and the ability to perform basic tasks. The changes, often caused by disease, are typically not reversible and affect language and decision-making in addition to memory, depending on the areas of the brain that are impacted.

For memory care placement, it is important to have a whole picture of the symptoms being displayed by the patient. Not all patients exhibit all symptoms of their type of dementia, and in some cases, it is not possible to formally diagnose dementia.

At CarePatrol, we do a thorough intake assessment to have a complete understanding of the individual. The symptoms become more important to understand as we work towards the safest living solution. The primary symptoms of dementia we look to accommodate and factor into the decision-making process include:

Disorientation and Confusion

Memory problems and poor judgment are one of the earliest and most common symptoms of dementia. Clearly defined areas, circular hallways to avoid dead ends, and visual labeling are necessary aspects for a safe environment for patients exhibiting these symptoms.

Language Difficulty

Forgetting words, using unusual words, losing track of conversation, and lost ability for reasoning and judgment are common in dementia patients. These symptoms require caregivers to be patient and empathetic, often having to repeat themselves over and over and provide gentle direction for simple tasks.

Hallucinations and Visual Problems

Understandably, this symptom can create panic and confusion in the patient. Experience dealing with hallucinations prepares a community for what your loved one is going through.

Sleep Disturbances

Difficulty falling asleep, waking in the night, sleepwalking, and falling asleep suddenly during the day can all wreak havoc on a patient. Safety as well as overall health is at risk with patients who suffer from sleep disturbances.

Behavioral Problems with Violent or Sexual Undertones

As the disease progresses, people suffering from dementia may begin thinking someone else is their spouse or thinking a care provider is a home intruder. Inappropriate behaviors like these are often one of the symptoms that cause patients not to be accepted to a care center. Lewy Body Dementia and Vascular dementia patients are often not accepted at some communities because of these behavior problems. Knowing the extent of the symptoms and the capabilities of the community is the best way to find a good fit for the patient.

Wandering

6 in 10 people with dementia will wander according to the Alzheimer’s Association. This very common symptom of dementia requires extra safety precautions such as enclosed outdoor areas, tracking bracelets, key-coded doors and elevators, and alert systems. This is one of the highest areas of difficulty for memory care communities to manage.

Increased Fall Risk

Difficulty in walking, weakness, and tremors are all common symptoms of dementia. Fainting is also a possibility. Thus, it is imperative that communities remove all fall hazards and have their rooms set up with fall prevention in mind. This may mean rug removal, no wires to trip over, and repairing uneven floors.

Different Types of Dementia

The different types of dementia include the following:

• Alzheimer’s disease
• Vascular dementia
• Lewy body dementia
• Parkinson’s disease dementia
• Frontotemporal dementia
• Creutzfeldt-Jakob disease
• Wernicke-Korsakoff syndrome
• Mixed dementia
• Normal pressure hydrocephalus
• Huntington’s disease

Different types of dementia are caused by different issues in the brain and nervous system, like a lack of blood flow (Vascular), an attachment of proteins to nerves in the brain (Parkinson’s, Lewy body), and bleeding in the brain (Wernicke). It can also be caused by a combination of causes.

Dementia Comorbidities

Some of the above symptoms are caused by Alzheimer’s and related dementias, but some are a comorbidity in need of their own treatment program separate from the dementia. One example is depression. Depression often goes hand-in-hand with dementia, but it is a wholly separate disorder and requires its own treatment plan.

How is Dementia Diagnosed?

There is no one test to determine if someone has dementia. Doctors diagnose Alzheimer’s and other types of dementia based on an assessment of day-to-day function, behavior, family history, and medical history as well as a physical exam. Brain scans can also be used to rule out stroke-related damage and other conditions that may cause dementia-like symptoms.

Risk Factors for Dementia

Risk factors are lifestyle choices and aspects of your genetics that make developing dementia more likely. These include:

• High blood pressure
• Smoking
• Drinking alcohol
• Diabetes
• Obesity
• Sedentary lifestyle
• Poor diet/nutrition
• Depression and social isolation
• Traumatic brain injuries/chronic traumatic encephalopathy

People who have family members with dementia are more likely to develop dementia themselves. In addition, women are more likely to develop dementia than men are.

Caring for Patients with Alzheimer’s Disease and Dementia

In addition to managing the symptoms of dementia and creating a safe environment, it is important to provide cognitive stimulation, a healthy diet of prepared meals, and encouragement to eat, as well as a means of activity appropriate for the patient. Also, be informed about how they handle difficult behaviors. You do not want a memory community that relies only on anti-psychotic medications. Discuss whether advanced care is available and how the care plan will be tailored to meet your loved one’s individual needs and preferences.

Contact CarePatrol for Reliable Memory Care, Resources, and Support

Dementia is usually a progressive disorder. There are many considerations that go into memory care placement, and the decision can be overwhelming for families and individuals alike.

If you are noticing cognitive decline in your loved one and worry they may be developing dementia, reach out for a consultation now. We are here to help you and your loved one maintain a great quality of life and manage symptoms of dementia with patience and compassion.

A chronic and progressive movement disorder, usually associated with aging individuals, Parkinson’s is not currently curable, but it is treatable, and many people go on living productively with managing the disease. One of the most important and effective treatments is exercise.

Parkinson’s effects how you move, and exercise helps keep you moving. Walking, swimming, cycling, whatever you enjoy doing that is active, is beneficial. Come up with a plan with your care team, one that is suited to your interests and fitness level and make it a priority in your treatment. Consider an exercise “prescription” as designed with a physical therapist, to get you started and to focus on the areas you need the most attention. ¹ Parkinson’s effects individuals differently so understanding your symptoms is an important step to creating an exercise plan that best meets your needs.

For Parkinson’s complications such as slowness and stiffness, feeling weak, and cognitive problems, exercising is a good solution. Exercise helps with overall balance and coordination and helps build strength and stamina. This is important for everyone but especially important for people with Parkinson’s because these are areas that are compromised by the disease. The level of compromise varies from person to person. Research has shown that exercise can have a restorative effect, helping to slow the progression of the disease and improve overall balance and coordination.

In people with PD, exercise training not only improves their muscle strength and function, it has additional benefits as well:

• Reduced shaking, improving movement (helping with slow movement), and balance
• Enhances the efficacy of levodopa therapy, the primary treatment for Parkinson’s
• Improves heart and lung capacity – which supports stamina
• Improves endurance – through enhanced strength and stamina
• Improves  gait disturbances
• Improves cognitive function
• Improves quality of life ²

Certain types of exercise are particularly beneficial – some doing what medications cannot. In a podcast  with the Michael J. Fox Foundation, Dr. Lisa Shulman, movement disorder specialist and professor of Neurology at University of Maryland, discusses the benefits of exercise as a treatment for Parkinson’s. Especially when there are issues of mobility – exercise has a good capacity to relieve symptoms. Research is finding that many different approaches are effective. One size doesn’t fit all. Aerobic exercise impacts endurance. Weight training impacts strength. Dance or yoga impacts flexibility and balance.

It has been discovered that exercise can improve symptoms that no pill can: treadmill training has a direct affect on how fast you are able to walk and how far, how long, and improves gait. Gait improvement is a significant area where medications simply don’t work. Similarly, it was discovered that individuals who practiced Tai -Chi improved balance, an area that is hard to improve with medication, but improves with exercise.

Improved mood or reduction in fatigue are other good benefits to exercise when you have Parkinson’s. Exercise is a social outlet, it has emotional benefits, which is more difficult to research, and we can’t measure definitively the brains of people with Parkinson’s who are exercising. We don’t know if it’s changing the underlying biological progression of the disease. But we do know that it is having an impact.

Can we delay the trajectory of the disease? In Dr. Shulman’s opinion, yes – and that’s adding years of quality of life to people who have Parkinson’s. ³

References:

1 “Exercise”, The Michael J Fox Foundation for Parkinson’s Research. https://www.michaeljfox.org/news/exercise

2 “What is the Role of Exercise with Parkinson’s Disease?”  ParkinsonsDisease.net; Health Union https://parkinsonsdisease.net/treatment/exercise/

3. Shulman, Dr. Lisa, “Podcast: How Can Exercise Help Manage Parkinson’s,”  The Michael J Fox Foundation for Parkinson’s Research. https://www.michaeljfox.org/podcast/podcast-how-can-exercise-help-manage-parkinsons

Are you caring for a loved one or older adult? If so, you know how challenging the job can be. If you’ve become irritable and unhappy, it could be because of caregiving burnout, a state of physical, emotional and mental exhaustion that is often accompanied by a negative change in attitude.

Burnout is most common when the primary caregiver does not seek help with their responsibilities and when they try to do more than they are physically or financially able to do. It’s an oppressive and overwhelming feeling, and it can be detrimental to the health of both you and your loved one or patient.

Here are some common signs to look for if you think you’re burning out, and how to combat them:

1. You experience an overall lack of energy. If you’re always feeling exhausted or low energy, it could be a sign you’re taking on too much. When you’re taking care of someone else, it’s natural to put their needs first – and neglect your own.

2. You stop doing things you once loved and no longer take “me” time. Have you begun cutting the book club you’ve been in for years? Perhaps you feel too tired to do things you once enjoyed. Many caregivers also express feelings of guilt when doing personal things, unrelated to their patients. While that sentiment is coming from a good place, try to remember it’s just as important to take care of yourself as it is your loved one.

3. Taking care of others constantly can lead to stress and anxiety. Many caregivers describe their job as their exclusive responsibility. They don’t ask for help or feel like no one can, and they feel solely responsible for their patient. This level of commitment can be very stressful, not to mention exhausting. Consider getting respite care, either from friends or family, or from a community. Even taking the day to clear your head can be very beneficial to both of you.

4. You begin isolating yourself and withdrawing. Because of fatigue, guilt and listlessness, many caregivers withdraw from things they once enjoyed, and the people they care about. The lack of personal interaction with others contributes to physical, as well as emotional, stress.

In fact, many caregivers work themselves sick. Neglecting your emotional wellbeing often leads to or goes hand-in-hand with negative physical consequences. Since you are overworked, you’re likely not taking care of yourself physically. It becomes too tiring and time-consuming to cook healthy meals or exercise regularly. You have to find a way to take care of yourself too.

5. Increasingly impatient and irritated with the person you’re caring for. Feeling any or all of the above side effects is more than enough to feel frustrated. If you’re feeling short-tempered and irritable, try not to take it out on your patient. Instead, try venting or channeling it into something productive. If you’re creative, consider writing in a journal, writing a poem or song, or painting. If you need someone to talk to reach out, there are always people around to help. When you’re feeling particularly irritable, it’s best to step away from your patient, take a deep breath, and refocus – either on yourself or the job at hand.

6. You feel like you’re not making a difference, no matter how hard you try. It can be unsatisfying not seeing the direct results of your hard work. And it’s even more complicated when your patient has a progressive, worsening disease like Alzheimer’s or Parkinson’s. In situations like these, try to remember that it’s your job to preserve your patient’s dignity as much as possible, and to give them the best quality of life you can. It’s not your job to cure them, as hard as it is to admit. In some situations, doing the best you can is making much more of a difference than you realize.

When it’s not working anymore:
If you’re a caregiver experiencing burnout, you’re not alone. It may be time to find an alternative or more permanent resolution to your loved one’s needs. If you realize it’s time to find a new home for you or your loved one, that offers support for their everyday needs, consider talking to a senior housing placement specialist with CarePatrol. They will sit down with you, access your needs and financial situation, and offer the best options they can find. They are also available for tours and guidance during your final search.