Grief, Bereavement and Loss

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grief2Grief, Bereavement and Loss

A guide to coping with loss after the death of a loved one

Coping with the death of a loved one is a personal experience. There is no normal or perfect way to respond. 

It is our hope that this article will:

  • Help you understand your feelings of grief
  • Offer ways to cope with your grief
  • Give you information and resources you need

What does grief, mourning and bereavement mean?

  • Anticipatory grief is the feeling of grief that can happen before your loved one’s death.
  • Grief is the personal response to a loss
  • Mourning is a process of adapting to the death of your loved one
  • Bereavement is the time spent grieving after your loved one’s death

 

The person loved is no longer alive, but the memories will live on forever. That part of your whole being that loves him/her is embraced when you allow yourself the privilege of remembering.          Alan D. Wolfelt

 

What can grief feel like?

When someone you love dies, your emotions, health, social life and spiritual wellbeing can change. You may feel unusual and upset by these changes.

You may experience:

  • Feeling numb
  • In disbelief that your loved has died
  • Anxiety and distress
  • Loneliness
  • Anger
  • Guilt
  • Sadness
  • Depression
  • Confusion
  • Trouble focusing and making decisions
  • Crying or Sighing
  • Having lucid dreams about your loved one
  • Seeing images of your loved one
  • Feeling relieved
  • Aches and pains
  • Upset stomach
  • Loss of sleep and being tired
  • Changes in sleep and appetite

You may lose interest in:

  • Day-to-day routines
  • Sex or intimacy
  • Relationships

How long will I grieve?

Grieving is a process.       Everyone experiences grief differently. There is no right or wrong way for you to react to the death of a loved one.

Symptoms of grief will occur less often and fell less intense as time passes. As symptoms of grief lessen, you will feel able to return to day-to-day life.

People can have both good and bad days when they’re grieving. Grief can come in waves of strong emotional feelings caused by reminders of your loved one… sometimes for no apparent reason at all.

Feelings of grief can return or feel worse on special days like birthdays, anniversaries and holidays when your loved is especially missed. It is normal to revisit your grief throughout your life… even when you have moved on.

 

Mourning never really ends. Only as time goes on it erupts less frequently – Alan D. Wolfelt

 

How can I help myself?

Body
  • Take care of yourself
  • Talk to your family doctor about any physical concerns
  • Take part in activities you enjoy such as going for a walk, reading or exercising
Social
  • Talk with a friend, family member or a member of your faith community
  • Share memories, stories and photographs of your loved one
  • Join a group or do one-on-one counselling – This can be done in person, by phone or over the internet.
Emotional and Spiritual
  • Be patient – grieving takes time
  • Know that other people have responded in the same way
  • Let yourself experience the pain of grief
  • Know that it is alright to express your feeling
  • Write a letter to your loved one… express yourself and keep it safe
  • Use the resources of your faith and spirituality

 

There is help… Reach out!

Bereaved Families of Ontario:       416-595-9618 .     http://www.bereavedfamilies.net
  • Provides group, one-on-one and phone support for adults, teenagers and children

 

Canadian Virtual Hospice:          http://www.virtualhospice.ca
  • Information and support on palliative and end-of-life care, loss and grief.

 

Respite Services:               http://www.hospice.on.ca/hospiceontario.php
  • Has over 180 associate and individual members who provide free bereavement support across Ontario.

 

University Health Network Bereavement Support Group – 416-603-5836
  • Offers an 8 week bereavement group

 

Wellspring Cancer Support Network:     416-961-1228           http://www.wellspring.ca
  • Community-based cancer support centres that offer a variety of programs to individuals and family members

 

Other Resources:

  • Your faith or spiritual community
  • Your family doctor or health team
  • Your Funeral Home

Grief only becomes a tolerable and creative experience when love enables it to be shared with someone who really understands – Simon Stephens

 

 

Senior Care: Personal & Home Safety

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Panic Alarm Bracelet

Personal and home safety, for people with alzheimer’s disease and dementia.

Seniors can still remain in their homes, as long as safety measures are put in place to ensure their safety.

As Dementia and Alzheimer’s progresses, a person’s abilities change. But with some creativity and problem solving, you can adapt the home environment to support these changes.

How Dementia affects safety

Alzheimer’s disease causes a number of changes in the brain and body that may affect safety. With creativity and flexibility, you can create a home that is both safe and supportive of the person’s needs for social interaction and meaningful activity.

Depending on the stage of the disease, these can include:

  • Judgment: forgetting how to use household appliances
  • Sense of time and place: getting lost on one’s own street; being unable to recognize or find familiar areas in the home
  • Behavior: becoming easily confused, suspicious or fearful
  • Physical ability: having trouble with balance; depending upon a walker or wheelchair to get around
  • Senses: experiencing changes in vision, hearing, sensitivity to temperatures or depth perception

Home safety tips

  • Assess your home: Look at your home through the eyes of a person with dementia. What objects could injure the person? Identify possible areas of danger. Is it easy to get outside or to other dangerous areas like the kitchen, garage or basement?
  • Lock or disguise hazardous areas: Cover doors and locks with a painted mural or cloth. Use “Dutch” (half) doors, swinging doors or folding doors to hide entrances to the kitchen, stairwell, workroom and storage areas.
  • Home Safety Checklist: Contact us at “In Or Care – Home Care Services to conduct a safety survey and discuss measures to correct findings. The process is easier than you think and solutions need not be cost prohibitive.
  • Be prepared for emergencies: Keep a list of emergency phone numbers and addresses for local police and fire departments, hospitals and poison control helplines.
  • Make sure safety devices are in working order: Have working fire extinguishers, smoke detectors and carbon monoxide detectors. Routine inspections, testing and replacing back-up batteries on applicable devices as just as important… Don’t assume because you have then, that they’re functioning as they should.
  • Install locks out of sight: Place deadbolts either high or low on exterior doors to make it difficult for the person to wander out of the house. Keep an extra set of keys hidden near the door for easy access. Remove locks in bathrooms or bedrooms so the person cannot get locked inside.
  • Keep walkways well-lit: Add extra lights to entries, doorways, stairways, areas between rooms, and bathrooms. Use night-lights in hallways, bedrooms and bathrooms to prevent accidents and reduce disorientation.
  • Place medications in a locked drawer or cabinet: To help ensure that medications are taken safely, use a pillbox organizer or keep a daily list and check off each medication as it is taken.
  • Remove tripping hazards: Keep floors and other surfaces clutter-free. Remove objects such as magazine racks, coffee tables and floor lamps.
  • Watch the temperature of water and food: It may be difficult for the person with dementia to tell the difference between hot and cold. Set water temperature at 120 degrees or less to prevent scalding.
  • Support the person’s needs: Try not to create a home that feels too restrictive. The home should encourage independence and social interaction. Clear areas for activities.

Six in 10 people with dementia will wander

A person with Alzheimer’s may not remember his or her name or address, and can become disoriented, even in familiar places. Wandering among people with dementia is dangerous, but there are strategies and services to help prevent it.

Who is at risk of wandering?

Anyone who has memory problems and is able to walk is at risk for wandering. Even in the early stages of dementia, a person can become disoriented or confused for a period of time. It’s important to plan ahead for this type of situation. Be on the lookout for the following warning signs:

Wandering and getting lost is common among people with dementia and can happen during any stage of the disease. 


  • Returns from a regular walk or drive later than usual
  • Tries to fulfill former obligations, such as going to work
  • Tries or wants to “go home,” even when at home
  • Is restless, paces or makes repetitive movements
  • Has difficulty locating familiar places like the bathroom, bedroom or dining room
  • Asks the whereabouts of current or past friends and family
  • Acts as if doing a hobby or chore, but nothing gets done (e.g., moves around pots and dirt without actually planting anything)
  • Appears lost in a new or changed environment

 Tips to prevent wandering

Wandering can happen, even if you are the most diligent of caregivers. Use the following strategies to help lower the chances:

  • Identify the most likely times of day that wandering may occur:
Plan activities at that time. Activities and exercise can reduce anxiety, agitation and restlessness.
  • Reassure the person if he or she feels lost, abandoned or disoriented: If the person with dementia wants to leave to “go home” or “go to work,” use communication focused on exploration and validation. Refrain from correcting the person. For example, “We are staying here tonight. We are safe and I’ll be with you. We can go home in the morning after a good night’s rest.”
  • Ensure all basic needs are met: Has the person gone to the bathroom? Is he or she thirsty or hungry?
  • Avoid busy places that are confusing and can cause disorientation: This could be shopping malls, grocery stores or other busy venues.
  • Place locks out of the line of sight: Install either high or low on exterior doors, and consider placing slide bolts at the top or bottom.
  • Camouflage doors and door handles: Camouflage doors by painting them the same color as the walls, or cover them with removable curtains or screens. Cover knobs with cloth the same color as the door or use childproof knobs.
  • Use devices that signal when a door or window is opened: This can be as simple as a bell placed above a door or as sophisticated as an electronic home alarm.
  • Provide supervision: Never lock the person with dementia in at home alone or leave him or her in a car without supervision.
  • Keep car keys out of sight: A person with dementia may drive off and be at risk of potential harm to themselves or others.
  • If night wandering is a problem: Make sure the person has restricted fluids two hours before bedtime and has gone to the bathroom just before bed. Also, use night-lights throughout the home.

Make a plan

The stress experienced by families and caregivers when a person with dementia wanders and becomes lost is significant. Have a plan in place beforehand, so you know what to do in case of an emergency.

  • Keep a list of people to call on for help: Have telephone numbers easily accessible and update them every six months.
  • When someone with dementia is missing: Begin search-and-rescue efforts immediately. Ninety-four percent of people who wander are found within 1.5 miles of where they disappeared.
  • Ask neighbors, friends and family to call if they see the person alone.
  • Keep a recent, close-up photo and updated medical information on hand to give to police.
  • Know your neighborhood: Pinpoint dangerous areas near the home, such as bodies of water, open stairwells, dense foliage, tunnels, bus stops and roads with heavy traffic.
  • Keep a list of places where the person may wander:
This could include past jobs, former homes, places of worship or a restaurant.
  • Provide the person with ID jewelry: Medical alert bracelet and or electronic wander guard device preferably with GPS capability.
  • If the person does wander, search the immediate area for no more than 15 minutes: Call “911” and report to the police that a person with Alzheimer’s disease — a “vulnerable adult” — is missing. A Missing Report should be filed and the police will begin to search for the individual. Make a point of knowing what they’re wearing for a more accurate description.

Many people with dementia want to live at home for as long as possible. Often, this is with support from others. However, it can be difficult managing everyday situations if you have dementia, particularly as the dementia progresses and you get older. As a result, some people may not be as safe at home as they used to be. This factsheet looks at how a person with dementia can stay safe at home and in the surrounding environment. It identifies some risks in the home environment and suggests ways to manage them.

 It is important to find the right balance between independence and unnecessary harm. The person with dementia should, where possible, be involved in decision-making and their consent sought and given about changes. If this is not possible, it is important that those making the decision do so in the person’s best interests.

Many of the issues in this factsheet are related to the normal ageing process. However, having dementia can place a person at higher risk of experiencing some of these issues. Everyone will experience dementia in their own way. The type of risks they face, and strategies to manage these, will depend on the individual and their situation.

Avoid falls

Falls are a common and potentially serious problem affecting older people. The risk of falls increases with age. This may be because of a range of factors: medical conditions (such as stroke), medication, balance difficulties, visual impairment, cognitive impairment and environmental factors. Falls can have detrimental effects on people, including injuries, loss of confidence and reduced activity.

For some people with dementia, the condition can also increase the likelihood of falling.

There are a number of things that can be done at home to reduce the risk of falling:

  • Home safety: Check the home for potential hazards such as rugs, loose carpets, furniture or objects lying on the floor. An occupational therapist may be able to help with identifying hazards and suggesting appropriate modifications.
  • Exercise: Regular exercise can improve strength and balance and help to maintain good general health. A referral to a physiotherapist may also help. Speak to your GP to find out more.
  • Healthy feet: Foot problems, including foot pain and long toenails, can contribute to an increased risk of falls. Seeing a podiatrist (a health professional who specializes in feet) can help. Contact your doctor to find out more.
  • Medicines: Medication can have side effects, including dizziness, which could increase the risk of a fall. Changes to medication or dosage, as well as taking multiple medicines, can increase a person’s risk of falling. Speak to the doctor about a medicine review if the person with dementia is taking more than four medicines.
  • Eyesight: Regular eye tests and wearing the correct glasses may help to prevent falls.
  • Keep objects in easy reach: If something is going to be used regularly, keep it in a cupboard or drawer that is easy to access.
  • Try not to rush: Do things at an appropriate pace; many people fall when they are rushing.

Improve lighting

As people get older they need more light to see clearly. This is because of age-related changes to the eyes. These changes include:

  • Pupils becoming smaller
  • Increased sensitivity to glare
  • Reduced amount of light reaching the retina.

Dementia can cause damage to the visual system (the eyes and the parts of the nervous system that process visual information), and this can lead to difficulties. The type of difficulty will depend on the type of dementia. Problems may include:

  • Decreased sensitivity to differences in contrast (including colour contrast such as black and white, and contrast between objects and background)
  • Reduced ability to detect movement
  • Reduced ability to detect different colours (for example, a person may have problems telling the difference between blue and purple)
  • Changes to the visual field (how much someone can see around the edge of their vision while looking straight ahead)
  • Double vision.

Improved lighting can reduce falls, depression and sleep disorders, and improve independence and general health. The following tips may help:

  • Increase light levels and use daylight where possible.
  • Minimize glare, reflection and shadows. Glare can be distracting and can reduce a person’s mobility.
  • Lighting should be uniform across any space, and pools of light and sudden changes in light levels should be avoided. This is because when a person gets older, their eyes adapt slowly to changes in light levels.
  • Remove visual clutter and distractions such as carpets with floral patterns.
  • Use colour contrasts to make things clearer, ie: a light door with a dark frame.
  • Leave a light on in the toilet or bathroom during the night. A night-light in the bedroom may help if someone gets up in the night.

Store dangerous substances safely

Dangerous substances, including medicines and household cleaning chemical should be stored somewhere safe. If the person with dementia is unable to administer their own medication safely, arrangements should be made for someone else to do this. A dosette box could be helpful. These have separate tablet compartments for days of the week and/or times of day such as morning, afternoon and evening.

Adaptations to the home

As people get older they may experience difficulties in managing everyday activities such as cooking or bathing, for a variety of reasons. People with dementia may experience additional challenges as their dementia progresses, because of memory problems or a reduced ability to carry out tasks in the correct sequence.

Adapting the home can help people with dementia to maintain their independence and reduce the risk of harm. It can also help to adapt some everyday tasks slightly. The following tips may help:

  • Label cupboards and objects with pictures and words so that they can be identified.
  • Where possible, use devices that only have one function and are easy to identify, for example a kettle.
  • Place clear instructions that can easily be followed somewhere visible.
  • Make sure the kitchen is well lit.
  • If there are concerns about using gas or electrical appliances inappropriately, contact the gas or electricity company and ask for the person to be put on the priority service register. This means that they will be eligible for free regular safety checks and will be able to get advice about safety measures such as isolation valves (advice is also available for care givers).
  • Fit an isolation valve to a gas cooker so that the cooker cannot be turned on and left on. Devices are also available for electric cookers.
  • Look into products that may help to maintain independence and safety such as electric kettles that switch off automatically.
  • If the person’s ability to recognize danger is declining, consider removing potentially dangerous implements such as sharp knives, but place other items for everyday use within easy reach.
  • Create a “wander loop” in your home, a safe pathway that allows the patient to safely roam.
  • Use reflector tape to create a path to the bathroom.
  • Cover radiators and electrical outlets with guards.
  • Lock doors that lead to places like basements and garages.
  • Install safety locks and alarms on exit doors and gates.
  • Cover smooth or shiny surfaces to reduce confusing glare.
  • Eliminate shadows with a lamp that reflects off the ceiling.
  • Cover or remove mirrors if they are upsetting to a person with hallucinations.
  • Store car keys in a locked container; disable the car.
  • Do not allow unattended smoking.
  • Make sure an I.D. bracelet is being worn at all times.
  • When selecting home care, make sure to hire an aide who has been trained to deal with dementia and Alzheimer’s patients, and is under the supervision of a skilled home care nurse.
  • And, most importantly, constantly re-assess your parent’s abilities with the help of a nurse or physician.

Avoid fire

There are ways to minimize the risk of fire in the home, including fitting smoke alarms and carbon monoxide detectors, and checking home appliances.

Local fire and rescue services can provide free home safety visits. They offer advice about how to make the home safer, as well as fitting smoke alarms and planning escape routes. Electric and gas appliances can be dangerous. It is important to check appliances to make sure they are working safely. Some appliances will have built-in safety features. Consider placing safety devices on stoves so that they are not accidently placed, or left on the on position.

Stay safe outdoors

Being outdoors is important for people of all ages and has many benefits. It is good for mental and physical health, including wellbeing, sleep and appetite Being outdoors can have psychological benefits such as reduced depression and agitation. Activity can also enhance a person’s independence and wellbeing. A garden, balcony or outdoor space can help to bring these benefits to people with dementia. It is important to manage any risks that may come with being outdoors.

The Following suggestions may help:

  • Make sure the area is well lit. This could be done with a sensor light, so that if a person is outside and daylight is fading they are still able to see adequately.
  • Put a rail on any stairs to help the person get up and down them. It can also help to highlight the edges of each step.
  • Avoid trip hazards such as loose paving slabs or uneven surfaces.
  • Have seating areas so that the person can take a rest or enjoy being outside if they are unsteady on their feet.
  • Use shelter to protect people from the elements if they want to spend a long time outside – a parasol or hat to minimize sun exposure.

Ensuring your home is adequately assessed for safety concerns is you first step in assuring that your love one enjoys their decision to remain in their home for as long as possible.

We can help. From an initial assessment to providing the home care services you need to meet your needs.

Senior Care: Driving for Seniors

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Senior Driving CarCan a person be too old to drive?

The answer to this question is not clear-cut and not one that should be applied across the board to all seniors. Nonetheless, with the current growth in our aging population we need to seriously review current and future policies on driving as they apply to seniors. As a community and society, we need to better understand the challenges / barriers and step in to mitigate. Policy review and changes is not something that affects seniors… it will affect our selves in the coming years. This is a delicate balance as we attempt to protect society from senior drivers we also need to ensure that we protect their rights and inevitably, our own rights as a senior citizen. Statistically speaking: Next to young male drivers, people aged 70 or older have highest accident rate

The New Retirement: In a recent, CBC News presented a series on life for people 60 years and older. Canadians Seniors are living longer than ever before, a fact that is radically changing the meaning of retirement. Many people see it as a time of reinvention, a time to try new things. CBC News is published stories on seniors who are doing remarkable things in the so-called twilight years. In one instance, a police officer pulled over a driver for driving too slow and impeding traffic. The officer glanced at the driver’s license and saw her age — 94 — and explained he wasn’t going to give her a ticket. But a couple of weeks later, she said she received a letter notifying her that her license was suspended for medical reasons.

“Never thought of not having a car, never crossed my mind,” explained Ellison. “When you can’t go out and get in your car and go where you want to go, it’s like having your arm cut off.”

According to the latest figures from Statistics Canada, three-quarters of Canadians aged 65 and older have a driver’s license. But research also shows that the older a person is, the greater risk they are on the road. StatsCan reports that other than young male drivers, people aged 70 or older have the highest accident rate. Furthermore, seniors are much more likely to be killed in collisions.

The loss of a driver’s license can affect quality of life: 

Those statistics don’t change the fact that once a person loses their license, it greatly affects their lifestyle and overall mental health. “It’s been demonstrated and said many times, that receiving the news that you will be losing your driver’s license has the same weight as being diagnosed with cancer,” said Sylvain Gagnon, a researcher for the Canadian Driving Research Initiative for Vehicular Safety in the Elderly (CANDRIVE). He explained the news of losing your license, can often be followed by depression and a significant loss in quality of life. Figures show that access to a car affects a person’s social habits. StatsCan found that seniors who primarily travelled via their car were the most likely to have partaken in a social activity in the past week, at 73 per cent. The StatsCan research shows that seniors who depend on others to get around are more likely to be reluctant when asking to attend leisure activities (rather than essential activities, like doctor’s appointments). Since losing her license, Ellison must now rely on her daughters and friends for transportation to her personal and social errands.

Life without wheels:

The loss of a license may be even more detrimental for seniors living outside urban areas. According to StatsCan, people aged 65-74 are slightly more likely to live outside urban areas. Of those seniors, a large number reportedly do not use transit because of a lack of service in their area, which may only further immobilize them.

According to Ellison, if you are out in the country and don’t drive, “you just might as well be dead”. — Peggy Ellison, Ontario Senior .

Ellison was 21 when she first got her license. She went on to two driving-related jobs, including parking cars at a garage and driving a bus for 20 years. She said that in the seven decades that she had a license, she was never in an accident. “I haven’t changed because I got old, at least I don’t think I have,” said Ellison. It is estimated that people make eight to 12 navigating decisions for every kilometre they drive. According to the Ontario Ministry of Transportation, even small changes as a result of aging can affect your driving. In Ontario, a person’s driver’s license can be suspended if a doctor or optometrist feels a person has a condition that may impair their ability to drive. Doctors are bound by law to report this condition to the Ministry of Transportation, which then reviews the information and acts accordingly. A doctor may take into account a number of factors when assessing a senior’s ability to drive, including vision, mobility and cognitive abilities. “You will never be able to tell in a doctor’s office whether someone is safe to drive,” said Gagnon, who is also a psychology professor at the University of Ottawa. Gagnon explained driving is a complex task, and there is no one single indicator of a driver’s competence. A doctor can only hope to narrow down the grey area of who is safe to drive. CANDRIVE is currently trying to come up with an instrument that could be used by doctors to assess older drivers.

Renewal process for seniors:

In the meantime, some provinces require that drivers be retested once they reach a certain age. For instance, in Ontario at the age of 80, drivers must renew their license and continue to do so every two years. They complete a vision test, a written test and sit in on a group education session. They may also be required to take a road test. In provinces such as Alberta, a driver needs to take a medical exam at the age 75, and again at 80 and every two years after that. Doctors are not required by law to report seniors who they believe are unfit to drive. However, the province has other safety measures in place. For instance, when drivers renew their license they have an obligation to disclose whether they have a medical condition that would affect their ability to drive. In Alberta, anyone can request that someone’s driving privileges be reviewed if they suspect that person is becoming a danger on the road. Trent Bancarz, a spokesperson for Alberta Transportation, said the majority of the requests probably come from family members. “If you do have someone in your family that either due to age or due to a medical condition is maybe not a safe person to be out there, it’s really hard to either confront them or to take their driving privileges away,” said Bancarz. But he said there should be no age bias involved with the decision to take away someone’s license. “Some people are better able to drive a vehicle at 82 then some other people at 45,” Bancarz said.

Seniors forced to change lifestyle:

Gagnon warned the recommendation to take away someone’s license should not be made lightly, because of the dramatic impact it can have on a person’s life. How a senior reacts to the news that he or she can no longer drive may depend on a number of factors, including a senior’s autonomy, how far away they are from their services and what the alternate transportation methods are.

The day after Peggy Ellison sold her Buick to a young man in town, she took out the Yellow Pages with the intention of buying a golf cart, a four-wheeled vehicle that doesn’t require a license. Her new ride was delivered to her home the next day. “There’s nothing like having a car,” Ellison says, “but it makes me feel a little bit of independence again since I got my cart. I love to have wheels.

This year, more than 3.5 million drivers over 65 will strike out on Canadian roads – the highest number in history. That fact is fuelling a simmering debate over whether Canada’s provinces ought to have tougher licensing criteria for elderly drivers. Most provinces require drivers aged 80 and up to renew their license and take a written test every two years. None have mandatory in-car driver tests. However, on a per-kilometre basis, seniors are the most collision-prone operators on the road. They are also subject to some of the highest insurance rates, on par with the rates levied on newly licensed young males. The problem with those statistics, experts argue, is that they belie much of the grey that muddies the senior driving issue. “The mere fact that you are old doesn’t mean you have a problem,” said Dr. Jamie Dow, the medical adviser on road safety for the Société de l’assurance automobile du Quebec, a crown corporation responsible for licensing drivers and vehicles. “The fact that you are older does make you more susceptible to having a problem.” Public health data supports this.

In 2010, two thirds of Canadians over the age of 65 were using multiple medications and nearly nine out of 10 suffered from a chronic condition; a quarter of adults in the 65 to 79 age group suffered four or more chronic conditions. In the over 80 year old group, the number jumped to more than a third, according to data from the Public Health Agency of Canada. “There is clearly a strong association between age and illness,” said Bonnie Dobbs, and Edmonton-based gerontologist who helms the Medically At-Risk Drivers’ Centre at the University of Alberta, a research centred devoted to studying the impact of medical conditions on driving. “Age is not the primary determiner of fitness to drive. [But] as we get older, we’re more likely to have one or more of the illnesses that can impact our ability to drive.” Nellemarie Hyde, an occupational therapist and program co-ordinator for Saint Elizabeth Driver Assessment and Training service in Ontario, regularly evaluates senior drivers with medical illnesses. The most common are diabetes, which can impact both vision and sensory function – think ability to gauge force on gas or brake pedals – Parkinson’s Disease with its hallmark physical tremors, stroke victims and people living with dementia and other mild cognitive impairments. “Mild memory deficits don’t necessarily affect driving directly,” she said, adding that she focuses more on a driver’s ability to concentrate, focus and multi-task. She also tests for strength, range of motion, co-ordination, sensation and visual perception. “We want the client to be able to continue driving safely,” she said, adding: “The challenge is when a medical condition starts to change how they drive.” Picking up on that condition is where policy makers struggle.

In most provinces, doctors are legally mandated to inform licensing bodies when they suspect a patient is no longer competent to drive. However, most doctors are “totally unprepared to do it,” said Dow. “Most physicians have no training in evaluating drivers or the effects of medical conditions on driving,” he said, adding the subject is rarely touched on by medical schools. The result is that some provinces are deluged with declarations from physicians. In other cases, physicians barely report at all. Several efforts are under way to provide physicians with tools to easily and efficiently identify medically at-risk drivers without risking discrimination by age. Through the SAAQ in Quebec, Dow runs free seminars for doctors on which exam observations ought to trigger red, road-related flags. Last year, Quebec recorded 16,000 physician declarations, compared with just 1,800 in 2003. In Ontario, Shawn Marshall, an Ottawa-based rehab medicine specialist, is near the end of a five-year, multi-province study called CanDrive, which follows 1,000 drivers over the age of 65 and aims to produce an even more accurate tool. “You want to have a screening tool that is valid, reliable and has high accuracy. You don’t want to identify people falsely,” he said, noting it strains provincial systems and unfairly restricts individuals who belong on the road. “The average 65-year-old is a healthy person,” he said. “Driving is important. To maintain your independence in many places throughout Canada, you need to be able to drive.”

How Does Age Affect Driving?

More and more older drivers are on the roads these days. It’s important to know that getting older doesn’t automatically turn people into bad drivers. Many of us continue to be good, safe drivers as we age. But there are changes that can affect driving skills as we age.

Changes to our Bodies: Over time your joints may get stiff and your muscles weaken. It can be harder to move your head to look back, quickly turn the steering wheel, or safely hit the brakes. Your eyesight and hearing may change, too. As you get older, you need more light to see things. Also, glare from the sun, oncoming headlights, or other street-lights may trouble you more than before. The area you can see around you (called peripheral vision) may become narrower. The vision problems from eye diseases such as cataracts, macular degeneration, or glaucoma can also affect your driving ability. You may also find that your reflexes are getting slower. Or, your attention span may shorten. Maybe it’s harder for you to do two things at once. These are all normal changes, but they can affect your driving skills. Some older people have conditions like Alzheimer’s disease (AD) that change their thinking and behavior. People with AD may forget familiar routes or even how to drive safely. They become more likely to make driving mistakes, and they have more “close calls” than other drivers. However, people in the early stages of AD may be able to keep driving for a while. Caregivers should watch their driving over time. As the disease worsens, it will affect driving ability. Doctors can help you decide whether it’s safe for the person with AD to keep driving.

Other Health Changes: While health problems can affect driving at any age, some occur more often as we get older. For example, arthritis, Parkinson’s disease, and diabetes may make it harder to drive. People who are depressed may become distracted while driving. The effects of a stroke or even lack of sleep can also cause driving problems. Devices such as an automatic defibrillator or pacemaker might cause an irregular heartbeat or dizziness, which can make driving dangerous.

 Smart Driving Tips

Planning before you leave:

  • Plan to drive on streets you know.
  • Limit your trips to places that are easy to get to and close to home.
  • Take routes that let you avoid risky spots like ramps and left turns.
  • Add extra time for travel if driving conditions are bad.
  • Don’t drive when you are stressed or tired.

 While you are driving:

  • Always wear your seat belt.
  • Stay off the cell phone.
  • Avoid distractions such as listening to the radio or having conversations.
  • Leave a big space, at least two car lengths, between your car and the one in front of you. If you are driving at higher speeds or if the weather is bad, leave even more space between you and the next car.
  • Make sure there is enough space behind you. (Hint: if someone follows you too closely, slow down so that the person will pass you.)
  • Use your rear window defroster to keep the back window clear at all times.
  • Keep your headlights on at all times.

Car safety:

  • Drive a car with features that make driving easier, such as power steering, power brakes, automatic transmission, and large mirrors.
  • Drive a car with air bags.
  • Check your windshield wiper blades often and replace them when needed.
  • Keep your headlights clean and aligned.
  • Think about getting hand controls for the accelerator and brakes if you have leg problems.

Driving skills: Take a driving refresher class every few years. (Hint: Some car insurance companies lower your bill when you pass this type of class. Check with AARP, AAA, or local private driving schools to find a class near you.)  

Medicine Side Effects: Some medicines can make it harder for you to drive safely. These medicines include sleep aids, anti-depression drugs, antihistamines for allergies and colds, strong pain-killers, and diabetes medications. If you take one or more of these or other medicines, talk to your doctor about how they might affect your driving.

Am I a safe driver? Maybe you already know of some driving situations that are hard for you–nights, highways, rush hours, or bad weather. If so, try to change your driving habits to avoid them. Other hints? Older drivers are most at risk when yielding the right of way, turning (especially making left turns), changing lanes, passing, and using expressway ramps. Pay special attention at those times.

Is It Time to Give Up Driving? We all age differently. For this reason, there is no way to say what age should be the upper limit for driving. So, how do you know if you should stop driving?

To help you decide, ask:

  • Do other drivers often honk at me?
  • Have I had some accidents, even “fender benders”?
  • Do I get lost, even on roads I know?
  • Do cars or people walking seem to appear out of nowhere?
  • Have family, friends, or my doctor said they are worried about my driving?

Am I driving less these days because I am not as sure about my driving as I used to be? If you answered yes to any of these questions, you should think seriously about whether or not you are still a safe driver. If you answered no to all these questions, don’t forget to have your eyes and ears checked regularly. Talk to your doctor about any changes to your health that could affect your ability to drive safely.

How Will I Get Around? You can stay active and do the things you like to do, even if you decide to give up driving. There may be more options for getting around than you think. Some areas offer low-cost bus or taxi service for older people. Some also have carpools or other transportation on request. Religious and civic groups sometimes have volunteers who take seniors where they want to go. Your local Agency on Aging has information about transportation services in your area.

If you still have a vehicle consider a companion service that will keep you company as needed and provide you with a driving service, to and from where you need to go.  In Our Care – Home Care Services can do that, its effective, inexpensive, convenient and safe.

Therapeutic Touch & Sensory Quilt

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“Busy Hands & Mind”

Sustain a clients natural need to keeps hands engaged and active

Sustain a clients natural need to keeps hands engaged and active

Pre-amble: Market and Economic Impact

As of 2013, there were an estimated 44.4 million people suffering with dementia worldwide. This number is expected to increase to an estimated 75.6 million by 2030, and 135.5 million by 2050. Alzheimer´s Disease will be one of the biggest burdens of the future society showing dramatic incidence rates: every 69 seconds someone in the US develops Alzheimer´s Disease, by mid-century someone will develop Alzheimer´s Disease every 33 seconds. In 2013 44 million people will be affected with the disease worldwide  In the US Alzheimer´s Disease is now the 6th leading cause of death across all ages. It was the fifth leading cause of death for those aged 65 and older. Since the incidence and prevalence of Alzheimer´s Disease increase with age, the number of patients will grow dramatically with our society getting older. By 2050 we need to expect that patient numbers have tripled to 135 million Alzheimer´s Disease patients worldwide.

The Alzheimer´s Disease market is currently estimated at $ 5 billion annually with projections that show the market potential will surpass $ 20 billion by 2020.

The global economic impact of Alzheimer´s Disease is shown by the worldwide cost of $ 640 billion, which exceeds 1% of gross world product. It can be seen as the most significant health crisis in the 21st century. 

The 2010 annual costs of treating and caring for patients worldwide was an estimated US$604 billion and in the the US alone was $183 billion. This figure is expected to increase to $ 1.1 trillion in 2015. Alzheimer´s Disease is becoming the third most expensive disease counting for 30% of the US healthcare costs. The medical costs for Alzheimer´s Disease patients are three times higher than for other older patients. There is also a big financial impact for the individuals and their families as the out-of-pocket-costs for the Alzheimer´s Disease patients are higher than for any other disease. As expenses for assisted living or nursing homes can often not be afforded, 70% of Alzheimer´s Disease patients live at home resulting in high impact of family’s health, emotional well-being as well as their employment and financial security.

Cost of Treatment
Currently there is no disease-modifying treatment for the Alzheimer´s Disease on the market. The disease usually is diagnosed late when already 70% of the nerve cells in the brain are dead. Several high-impact nutritional and supplementary treatment products are being developed and should particularly impact on prevention. Five drugs are approved and marketed which treat the symptoms. Better understanding of the underlying biology will lead to several new axes of treatment in different stages of clinical testing. The impact of a disease-modifying treatment can be huge: Delaying the onset of Alzheimer´s Disease by 5 years starting 2015 could result in a prevalence reduced by 5.9 million (43%) in 2050 in the US alone. Expressed in money, a delay of onset of 5 years would could result in savings of $ 447 billion of the total expected costs of $ 1.078 billion in the US alone.

Costs of informal care (unpaid care provided by families and others) and the direct costs
 of social care (provided by community care professionals and in residential home settings)
 contribute similar proportions (42%) of total costs worldwide, while direct medical care costs
are much lower (16%).

So how can WE help?
We cannot claim to be able to mitigate nor have a direct impact on the projected ageing population growth and relevant Dementia/Alzheimer’s statistics. However, we can offer a number of Home Care Services solutions to help families who are caring for a loved sufferingwith Dementia/Alzheimer’s? To review our full line of services, please visit our home page… under Services. For the purpose of this article we are offering a tool to help the family caregiver gain some control and management over their loved one who may be suffering with these deceases… A Therapeutic Touch and Sensory Quilt. This is not a typo… “QUILT”.

According to the College of Nursing at the University of Arkansas for Medical Sciences, Little Rock 72205 – U.S.A.

Abstract
Agitated behaviour in persons with Alzheimer’s disease (AD) presents a challenge to current interventions. Recent developments in neuro-endocrinology suggest that changes in the hypothalamic-pituitary-adrenal (HPA) axis alter the responses of persons with AD to stress. Given the deleterious effects of pharmacological interventions in this vulnerable population, it is essential to explore non-invasive treatments for their potential to decrease a hyper-responsiveness to stress and indirectly decrease detrimental cortisol levels. This within-subject, interrupted time-series study was conducted to test the efficacy of therapeutic touch on decreasing the frequency of agitated behavior and salivary and urine cortisol levels in persons with AD. Ten subjects who were 71 to 84 years old and resided in a special care unit were observed every 20 minutes for 10 hours a day, were monitored 24 hours a day for physical activity, and had samples for salivary and urine cortisol taken daily.

The study occurred in 4 phases:

    • Baseline (4 days),
    • Treatment (therapeutic touch for 5 to 7 minutes 2 times a day for 3 days),
    • Post-treatment (11 days), and
    • Post – “wash-out” (3 days).

An analysis of variance for repeated measures indicated a significant decrease in overall agitated behaviour and in 2 specific behaviours, vocalization and pacing or walking, during treatment and post-treatment. A decreasing trend over time was noted for salivary and urine cortisol. Although this study does not provide direct clinical evidence to support dysregulation in the HPA axis, it does suggest that environmental and behavioral interventions such as therapeutic touch have the potential to decrease vocalization and pacing, 2 prevalent behaviors, and may mitigate cortisol levels in persons with AD.

Alzheimer’s patients, particularly those in the more advanced stages can get quite tense and fidgety. To help relieve stress and tension in these special people, we have developed our own line of fidget quilt. As the disease worsens, hands become more restless and fidgety. These quilts offer something tangible to occupy their hands… providing gentle yet constant therapeutic stimulation for the mind and soul. Resulting in an enhanced quality of life for both the patient and the caregiver.

So how do our quilts work?
They help to stimulate curiosity, memories and awareness, provide a sense of purpose and of “doing something”, and this having a calming & soothing affect on the user.

Active Hands & Mind Quilt - Engaging, calming and soothing those clients suffering with Alzheimer's

Active Hands & Mind Quilt – Engaging, calming and soothing clients suffering with Alzheimer’s

Our quilts are more than just a “tangible repository of memories.” 
They are user-friendly, functional, induce comfort and warmth… providing a constant reminder of a family that loves them. Whether it’s the combination of textures used (softly contoured corduroy, faux fur, textured linens,,, etc) this quilt will provide the kind of tactile stimulation that will calm and soothe your loved one. It keeps their anxious hands engaged, mind occupied and their legs warm. Great for anyone, this is a must for anyone with progressive dementia or alzheimer’s.

Because people with Alzheimer’s and other dementia experience an ongoing decrease in their brain’s functions, simple, repetitive movements and sensory experiences become more important. That’s where our lap quilts come in. With their intentional variety of textures and extra accessories, fidget quilts provide comfort through the hands and the eyes. For a men’s quilt, you might want to personalize with items of a past hobby or interest (nuts, bolts, golfing or fishing items). We safely fasten the items or string them so that the patient will fidget with the items from one end of the lace to the other. Our quilts are handy & conveniently sized (24”X 30”) made from colourful patterns to entertain the eyes and with a warm backing to keep the lap warm. Attached to the quilts are buttons of various sizes to captivate the fingers and the eyes, a zipper, strips of cloth, and shoe laces, which can be tied or manipulated in a number of ways (over and over again). There’s a plush toy, shapes, a pocket with things in them, jingle bells and anything else that may be of significance to your loved one. Our quilts can be a Godsend to a caregiver while bringing significant relief to the patient… through it’s calming and soothing therapeutic affect.

We take extreme care to ensure that all items are safely secured so that they cannot become free or removed (unless cut out) to avoid any potential choking hazard. The laces, fabric strips or anything that dangles are also cut to lengths whereby they cannot be used as a means of restraining, or become a ligature capable harming your loved one.

Our quilts are easy care for and washable… of course anything that cannot be washed, is fastened so that it can be easily unclipped and reattached after washing.

The quilt will give the family a feeling of joy watching their loved one’s restless fingers occupied with all the different activities and textures that gives them that soothing and calming disposition.

They make wonderful birthday, Christmas, anniversary, or any special occasion gift, or to simply say “I Care and I love you”

We engage the family’s input when creating a custom quilt or you can opt for a generic quilt already pre-manufactured, incorporating a number of therapeutic sensory activities and items.

Our core business is providing Home Care for seniors in their homes or wherever home may be. However, we also understand that although you may not yet require our assistance, you can still benefit from something that we can offer… like our “Busy Hands & Mind Quilt”.

Our quilts are inexpensive, provide such rewarding results and delivered for free anywhere in Toronto, Mississauga, Oakville and Brampton. Outside of these areas there “MAY” be an additional charge for shipping… but we can discuss it. Of course outside of Ontario, national and international orders shipping costs are extra.

Please contact us today, to discuss the order of one of our Quilts, or to discuss any challenges you may be facing and how our services can help you remain independent, protected, safe, and in you home / community.

You got questions, we have answers: (905) 785-2341 or email us at 

 

 

 

 

Alzheimer’s & Dementia Care… The road ahead

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Alzheimer's & Dementia Article1Alzheimer’s and Dementia Care… The road ahead

Caring for a loved one with Alzheimer’s disease and other types of dementia can be a challenge, not only for the person diagnosed but also for their spouses and family members. Although caring for someone with Alzheimer’s or dementia can seem overwhelming at times, the more information & support you have, the better you will handle the demands and determine the long-term care options that are best suited to you and your loved one.

 

 

THIS ARTICLE WILL DEAL WITH:

  • Preparing yourself for the care
  • Developing routines
  • Engaging your loved one in activities
  • Planning activities with your loved one
  • Handling challenges as they present themselves
  • Considering long term care
  • Assessing assisted living or nursing homes

Preparing yourself for Alzheimer’s & dementia care

You may be dealing with a whole range of emotions and concerns, as you come to grips with an Alzheimer’s or other dementia diagnosis. There’s no doubt you will be worried about how your loved one will change, how you will keep him or her safe & comfortable, and how much your life will change in order to sustain it. Emotions such as anger, grief, and shock will be likely to be experienced. Adjusting to this new reality is neither, easy or immediate. It is critically important to give yourself some time, process the road ahead and reach out for help and support from a number of resources available. The more support you have, the better you will be able to help and manage your loved one, care.

While some of these tips are aimed specifically for people with Alzheimer’s, they can equally apply to persons suffering with other types of dementia.

Early-stage Alzheimer’s care preparations

Some Alzheimer’s & Dementia care preparations that are best done sooner rather than later. It’s hard to consider these questions at first, as it means thinking about a time when you or your loved one is already well down the road of his or her Alzheimer’s journey. However, putting such preparations in place early helps a smoother transition for everyone later on. Depending on the stage of diagnosis, include the person with Alzheimer’s & Dementia in the decision-making process as much as possible. If the person is at a more advanced stage of dementia, at least try to act on what their wishes would be.

Questions to consider in preparing for Alzheimer’s and dementia care:

▪   Who will make healthcare and financial decisions when the person is no longer able to do so?

While this is difficult topic to raise, if your loved one is still lucid enough, getting their wishes down on paper means they’ll be preserved and respected by all members of the family. Consider having a family meeting involving the person and those who may be impacted with the decisions being made (all children, and or grandchildren who may have to ultimately step up and take on a role in their care). In most cases such family meetings can go smoothly as it pertains to respecting the affected person’s wish. However, do not hesitate to involve an elder law attorney to best understand your options. You’ll need to consider power of attorney, both for finances and for healthcare. If the person has already lost capacity, you may need to apply for guardianship/conservatorship. Last but not least, their Personal Will if one is not in place already.

▪   How will care needs be met?

It is not uncommon that some family members assume that a spouse or nearest family member can take on the role of caregiver, but this assumption is not always the case or even possible. Caregiving is a rather a large commitment, and one that becomes greater over time. The person with Alzheimer’s and or advanced Dementia will eventually need round-the-clock personal care. Although family members are more than willing to take this challenge on, many family members may have their own health issues, jobs, and other roles & responsibilities. Communication is essential to ensure that the needs of the affected person are known & met, and that the caregiver has all the support in place to meet those needs.

▪   Where will the person live?

Knowing their wishes ahead of time will certainly ease the process in making this decision. Their own home will more than likely be their first wish. However, before concluding that home care is the final decision, consider a home assessment to determine the appropriateness of the home to meet their care needs. An assessment can be performed free of cost and determine the care needs and client’s challenges for today and moving forward. This way you will know if perhaps the home is fine for now, but difficult to access or make safe for later. On the other hand, the home could be fully suitable for their care… now and to meet future challenges. This is the type of information that will be invaluable to make informed decisions. If the person is currently living alone, for example, or far from any family, it may be necessary to relocate or consider care options that best suits their need, care, wishes… or a facility with more support.

Find out what assistance your medical team can provide in these areas. In some countries, you can also hire a care manager privately. Geriatric care managers can provide an initial assessment as well as assistance with managing your case, including crisis management, interviewing in-home help, or assisting with placement in an assisted living facility or nursing home.

Developing day-to-day routines

Having a daily routine in Alzheimer’s & Dementia care helps caregiving run smoothly. These routines won’t be set in stone, but they give a sense of consistency, which is beneficial to the Alzheimer’s patient even if they can’t communicate it.

While every family will have their own unique routine, you can get some great ideas from your medical team or Alzheimer’s support group, especially regarding establishing routines to handle the most challenging times of day, such as evenings.

  • Keep a sense of structure and familiarity. Try to keep consistent daily times for activities such as waking up, mealtimes, bathing, dressing, receiving visitors, and bedtime. Keeping these things at the same time and place can help orientate the person.
  • Let the person know what to expect even if you are not sure that he or she completely understands. You can use cues to establish the different times of day. For example, in the morning you can open the curtains to let sunlight in. In the evening, you can put on quiet music to indicate it’s bedtime.
  • Involve the person in daily activities as much as they are able. For example, a person may not be able to tie their shoes, but may be able to put clothes in the hamper. Clipping plants outside may not be safe, but the person may be able to weed, plant, or water. Use your best judgment as to what is safe and what the person can handle.

Communication tips

As your loved one’s Alzheimer’s progresses, you will notice changes in communication. Trouble finding words, increased hand gestures, easy confusion, even inappropriate outbursts are all normal. Here are some tips, do’s and don’ts on communicating:

Communication Do’s and Don’ts?
Do
Avoid becoming frustrated by empathizing and remembering the person can’t help their condition. Making the person feel safe rather than stressed will make communication easier. Take a short break if you feel your fuse getting short.
Keep communication short, simple and clear. Give one direction or ask one question at a time.
Tell the person who you are if there appears to be any doubt.
Call the person by name.    
Speak slowly. The person may take longer to process what’s being said.
Use closed-ended questions, which can be answered as “yes” or “no.” For example, ask, “Did you enjoy the beef at dinner?” instead of “What did you have for dinner?”
Find a different way to say the same thing if it wasn’t understood.Try a simpler statement with fewer words.
Use distraction or fibs if telling the whole truth will upset the person with dementia. For example, to answer the question, “Where is my mother?” it may be better to say, “She’s not here right now” instead of “She died 20 years ago.”
Use repetition as much as necessary. We prepared to say the same things over and over as the person can’t recall them for more than a few minutes at a time.
Use techniques to attract and maintain the person’s attention. Smile, and make eye contact, use gestures, touch, and other body language.
Don’t
Ever say things like: “Do you remember?” “Try to remember!” “Did you forget?” “How could you not know that?!”
Ask questions that challenge short-term memory, such as “Do you remember what we did last night?” The answer will likely be “no,” which may be humiliating for the person with dementia.
Talk in paragraphs. Instead, offer one idea at a time.
Point out the person’s memory difficulty. Avoid remarks such as “I just told you that.” Instead, just repeat it over and over.
Talk in front of the person as if he or she were not present. Always include the person in any conversation when they are physically present.
Use lots of pronouns such as “there, that, those, him, her, it.” Use nouns instead. For example, instead of “sit there” say “sit in the blue chair.”
Use slang or unfamiliar words. The person may not understand the latest terms or phrases.
Use patronizing language or “baby talk”. A person with dementia will feel angry or hurt at being talked down to.
Use sarcasm or irony, even if meant humorously. Again, it can cause hurt or confusion.

Planning activities and visitors

As you develop daily routines, it’s important to include activities and visitors into their life. You want to make sure that the Alzheimer’s patient is getting sensory experiences and socialization, but not to the point of getting over-stimulated and stressed. Here are some suggestions for activities:

  • Start with the person’s interests.
  • Ask family and friends for memories of interests the person used to have. You’ll want to tailor the interests to the current level of ability so the person doesn’t get frustrated.
  • Vary activities to stimulate different senses of sight, smell, hearing, and touch. For example, you can try singing songs, telling stories, movement such as dance, walking, or swimming, tactile activities such as painting, working with clay, gardening, or interacting with pets.
  • Planning time outdoors can be very therapeutic. You can go for a drive, visit a park, or take a short walk. Even sitting on a balcony or in the backyard can be relaxing.
  • Consider outside group activities designed for those with Alzheimer’s. Senior centers or community centers may host these types of activities. You can also look into adult day care programs, which are partial or full days at a facility catering to older adults and/or dementia patients.

Visitors and social events

Visitors can be a rich part of the day for a person with Alzheimer’s disease. It can also provide an opportunity for you as the caregiver to socialize or take a break. Plan visitors at a time of day when your loved one can best handle them. Brief visitors on communication tips if they are uncertain and suggest they bring memorabilia your loved one may like, such as a favorite old song or book. Family and social events may also be appropriate, as long as the Alzheimer’s patient is comfortable. Focus on events that won’t overwhelm the person; excessive activity or stimulation at the wrong time of day might be too much to handle.

Handling challenges in Alzheimer’s and dementia care

One of the painful parts of Alzheimer’s disease is watching your loved one, display behaviours you never would have thought possible. Alzheimer’s can cause substantial changes in how a person acts. This can range from the embarrassing, such as inappropriate outbursts, to wandering, hallucinations, and even violent behaviour. Everyday tasks like eating, bathing, and dressing can become major challenges.

As painful as some behaviours are, it’s critical not to blame yourself or try to handle all the changes in behaviour alone. As the challenging behaviour progresses, you may find yourself too embarrassed to go out, for example, or to seek respite care. Unfortunately, difficult behaviour is part and parcel of Alzheimer’s disease. Don’t isolate yourself. Ask for help from the medical team and reach out to caregiver groups for support. There are ways to modify or better accommodate problem behaviours. Both the environment you create at home and the way you communicate with your loved one can make a substantial difference.

Considering long-term Alzheimer’s and dementia care

It’s the nature of Alzheimer’s disease to progressively get worse as memory deteriorates. In the advanced stages of Alzheimer’s, your loved one will likely need round-the-clock care. Thinking ahead to these possibilities can help make decisions easier.

Care at home

There are several options for extending care at home:

  • In-home help refers to caregivers that you can hire to provide assistance for your loved one. In-home help ranges from a few hours a week of assistance to live-in help, depending on your needs. You’ll want to evaluate what sort of tasks you’d like help with, how much you can afford to spend, and what hours you need. Getting help with basic tasks like housekeeping, shopping, or other errands can also help you provide more focused care for your loved one. Be sure to look for a service provider who has extensive Geriatric Care experience.
  • Day programs, also called adult day care, are programs that typically operate weekdays and offer a variety of activities and socialization opportunities. They also provide the chance for you as the caregiver to continue working or attend to other needs. There are some programs that specialize in dementia care. Alternatively, you can hire a caregiver for the days you need it for without any time commitment. This may alleviate some stress on the part of the patient, as they do not have to leave their familiar surroundings.
  • Respite care. Respite care is short-term care where your loved one stays in a facility temporarily. This gives you a block of time to rest, travel, or attend to other things. Of course, you can hire a caregiver for the block of time desired. This may alleviate some stress on the part of the patient, as they do not have to leave their familiar surroundings.

Is it time to move?

As Alzheimer’s progresses, the physical and mental demands on you as caregiver can gradually become overwhelming. Each day can bring new additional challenges. The patient may require total assistance with physical tasks like bathing, dressing, and toileting, as well as greater overall supervision. At some point, you won’t be able to leave your loved one alone. Nighttime behaviours may not allow you to sleep, and with some patients, belligerent or aggressive behaviours may exceed your ability to cope or feel safe. Every situation is different. Sometimes, you can bridge the gap by bringing in additional assistance, such as in-home help or other family members to share the caregiving burden. However, it is not a sign of weakness if moving to your loved one to a facility seems like the best plan of care. It’s never an easy decision to make, but when you’re overwhelmed by stress and fatigue, it’s difficult to maintain your caregiving standards. If the person with Alzheimer’s is living alone, or you as the primary caregiver have health problems, this option may need to be considered sooner rather than later.

When considering your caregiving options, it’s important to consider whether you are able to balance your other obligations, either financial or to other family members. Will you be able to afford appropriate in-home coverage if you can’t continue caregiving? Talk to your loved one’s medical care team for their perspective as well.

Evaluating an assisted living facility or nursing home

If the best choice is to move the Alzheimer’s patient to a facility, it doesn’t mean you will no longer be involved in their care. You can still visit regularly and ensure your loved one gets the care he or she needs. Even if you are not yet ready to make that step, doing some initial legwork might save a lot of heartache in the case of a crisis where you have to move quickly. The first step is finding the right place for your loved one.

Choosing a facility

There are two main types of facilities that you will most likely have to evaluate for a loved one with Alzheimer’s: an assisted living facility or a nursing home.

Assisted Living

Assisted living is an option for those who need help with some activities of daily living. Some facilities provide minor help with medications as well. Staff are available twenty-four hours a day, but you will want to make sure they have experience handling residents with Alzheimer’s disease. Also be clear about what stage your loved one is at, as he / she may need to move to a higher level of care.

Nursing Home

Nursing homes provide assistance in both activities of daily living and a high level of medical care. A licensed physician supervises each resident’s care and a nurse or other medical professional is almost always on the premises. Skilled nursing care providers and medical professionals such as occupational or physical therapists are also available.

How do I choose a facility?

Once you’ve determined the appropriate level of care, you’ll want to visit the facility announced and unannounced—to meet with the staff and otherwise evaluate the home. You will also want to evaluate the facility based on their experience with Alzheimer’s residents. Facilities that cater specifically for Alzheimer’s patients should have a designated area, for residents with dementia.

Questions to ask such a facility include:

  • Policy and procedures – Does the unit mix Alzheimer’s patients with those with mental illness, which can be dangerous? Does the program require the family to supply a detailed social history of the resident (a good sign)?
  • Environment – Is the unit clean? Is the dining area large enough for all residents to use it comfortably? Are the doors alarmed or on a delayed opening system to prevent wandering? Is the unit too noisy?
  • Staffing – What is the ratio of residents to staff? (5 to 1 during the day, 9 to 1 at night is normal). What is staff turnover like? How do they handle meals and ensure adequate hydration, since the person can often forget to eat or drink? How do they assess unexpressed pain—if the Alzheimer’s resident has pain but cannot communicate it?
  • Staff training – What training for Alzheimer’s care do they have? Does the facility provide staff with monthly in-service training on Alzheimer’s care?
  • Activities – Is there an activity plan for each resident based on the person’s interests and remaining cognitive strengths? Are residents escorted outside on a daily basis? Are regular outings planned for residents?
  • Services – Does the unit provide hospice services? What were the findings in the most recent Ministry conducted inspection? What are the rates of infectious outbreaks? What is the resident rate of injury incidences?

What to expect during a transition

Moving is a big adjustment both for the person with Alzheimer’s and you as their caregiver. Your loved one is moving to a new home environment with new faces and places. You are adjusting from being the person providing hands-on care to being an advocate. Remember to give yourself and the Alzheimer’s patient time to adjust. If you’re expecting to move, try to have essentials packed and ready to go, and as many administrative details taken care of as possible, as sometimes beds can come up quickly. Work closely with staff regarding your loved one’s needs and preferences. An extra familiar face during moving day, such as another relative or close friend, can also help.

Each person adjusts differently to this transition. Depending on your loved one’s needs, you may either need to visit more frequently or give your loved one their own space to adjust. As the adjustment period eases, you can settle into the visiting pattern that is best for both of you.

Please contact us today, to discuss any challenges you may be facing and how our services can help you remain independent, protected, safe, and in you home / community.

You got questions, we have answers: (905) 785-2341 or email us at 

 

Living Longer, Healthier & Happier

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Women Wearing Colorful Bathing CapsPrepare Yourself – To live longer, healthier and happier

“If I’d known I was going to live this long, I’d have taken better care of myself.” So said Eubie Blake, the great ragtime composer and pianist who was still performing at the age of 99, the year before his death. Let’s face it: old age is what lies ahead. If you’re 40 or 50 or even 60, you might not give much thought to the health challenges of aging. But just as planning for future financial needs is important, so is planning for optimum health in our later years.

 

What should you prepare for, and how?

Medical experts express about the major health issues that may lie ahead. While some diseases, such as Alzheimer’s and certain cancers, continue to confound researchers, a great number can be prevented, forestalled, or minimized with a healthy lifestyle and regular health screenings. Sharon Brangman, MD, AGSF, spokeswoman for the American Geriatrics Society, says, “The more you do in middle age to prepare yourself for successful aging, the better.”

Obesity and Metabolic Syndrome

About three-fourths of adults aged 60 and older are overweight or obese. Obesity is related to type 2 diabetes, cardiovascular disease, breast and colon cancer, gall bladder disease, and high blood pressure.

More than 40% of adults 60 and older have a combination of risk factors known as metabolic syndrome, which puts people at increased risk for developing diabetes, cardiovascular disease, and certain cancers. It is characterized by:

  • Waist measurement greater than 40 inches in men, 35 inches in women (apple-shaped body)
  • Triglyceride level of 150 mg/dL or higher
  • HDL “good” cholesterol level less than 40mg/dL in men, 50 mg/dL in women
  • Blood pressure of 130/85 or higher
  • Fasting glucose level of 110 mg/dL or higher

“Women in, and post-menopausal stages tend to accumulate fat around the waist and hips, and men get the gut,” says Brangman. “The best way to fight it is with increasing exercise, reducing alcohol intake — because a lot of alcohol calories go right to the gut — and reducing calorie intake. Also, increase your healthy fat intake — omega-3 fatty acids and unsaturated fats. And eliminate trans fats completely because there’s no safe amount of those.” She also advises avoiding foods sweetened with high-fructose corn syrup. The common sweetener is found in everything from sodas to breakfast cereal to low-fat yogurt. “In middle age, we should eat foods as close to naturally prepared as possible.”

Arthritis

Arthritis affects nearly half the elderly population and is a leading cause of disability. “Old injuries from playing weekend warrior or high school football, and years of wearing high-heeled shoes catch up with us,” says Brangman. “And arthritis in the knees is the price we pay for walking upright on two legs.” The keys to prevention: avoid overuse, do steady, regular exercise rather than in weekend spurts, and stop if you feel pain. “The adage, ‘no pain, no gain,’ is not true.” And managing your weight is just as essential for joint health as cardiovascular health. The Framingham osteoarthritis study showed that a weight loss of just 11 pounds could reduce the risk of developing osteoarthritis in the knees by 50%.

Osteoporosis and Falls

Osteoporosis and low bone mass affects almost 44 million adults age 50 and older, most predominantly affecting women. According to the National Osteoporosis Association, osteoporosis is not part of normal aging. Healthy behaviours and treatment, when appropriate, can prevent or minimize the condition.

In a given year, more than one-third of adults, age 65 and older experience a fall. Twenty percent to 30% of those who fall suffer injuries that decrease mobility and independence; falls are the leading cause of death from injury in this age group.

“Stop smoking, watch your alcohol intake, get plenty of calcium, and limit foods with high acidic content,” says Brangman. “Avoid sodas. They encourage loss of calcium. Our bodies always maintain calcium, and when there’s not enough coming in from our diet, it comes out from our bones. One reason women are especially at risk for osteoporosis is that if they’ve had children; it takes a whole lot of calcium to develop a baby, and that calcium is taken from the mother’s bones if she’s not getting enough in her diet.” Adults in middle age need 1,000 to 1,200 milligrams of calcium daily.

Vitamin D, “the sunshine vitamin,” is also important. Using sunscreens to protect against harmful UV rays is wise, but sunscreens also blocks the same ultraviolet rays the body needs to make vitamin D.

Furthermore, with age our bodies become less efficient at making vitamin D from sunlight. There is a move to get the FDA to increase the minimum requirement for vitamin D to at least 800, or maybe even 1,000 units. Most multiple vitamins contain 400 units. Make sure you’re getting enough from low-fat dairy products, or take a supplement.”

Weight-bearing exercise also helps to keep bones healthy. “If you’re not exercising, starting at any age is beneficial. It’s never too late, but the sooner the better.

Cancer

Risk for developing most types of cancer increases with age.

As women age, the rate of cervical cancer decreases, and endometrial cancer increases. Sometimes women slack off gynecological exams after their childbearing years, but I still think it’s important for women to get regular exams.”

The risk of prostate cancer increases with age, and black men have a higher rate than white men. Screening should start in your 40s, and at the very least should involve a digital rectal examination.

Lung cancer accounts for more deaths than breast cancer, prostate cancer, and colon cancer combined. “Stop smoking.”

Cardiovascular Disease (CVD)

Younger baby boomers take heed: cardiovascular disease (CVD) affects more than one-third of men and women in the 45- to 54-year age group, and the incidence increases with age. Cardiovascular diseases, which are diseases of the heart or blood vessels, are the leading cause of death in the U.S. and Canada. They include arteriosclerosis, coronary heart disease, arrhythmia, heart failure, hypertension, orthostatic hypotension, stroke, and congenital heart disease.

A healthy lifestyle can reduce the risk of heart disease by as much as 80%, according to data from the Nurses’ Health Study, an extensive research effort that followed more than 120,000 women aged 30 to 55 starting in 1976. Looking at data over 14 years, the researchers showed that women who were not overweight, did not smoke, consumed about one alcoholic drink per day, exercised vigorously for 30 minutes or more per day, and ate a low-fat, high-fibre diet had the lowest risk for heart disease.

If you have high blood pressure, get it under control. It reduces the rate of stroke and heart attacks. People say the medicines have bad side effects, but there are enough medications to choose from that you and your physician should be able to find one that’s right for you.

Prepared foods are loaded with salt. Limit salt intake to control high blood pressure. The minute food comes out of a can or frozen food package or from a fast-food environment you lose control of the ingredients. This is another reason to eat foods as close to naturally prepared as possible.

Vision and Hearing Loss

Age-related eye diseases — macular degeneration, cataract, diabetic retinopathy, and glaucoma — affect 119 million people aged 40 and older, according to the 2000 census. And that number is expected to double within the next three decades.

“Eating foods with high antioxidant content may be helpful in reducing vision loss due to macular degeneration,” says Brangman. “And taking vitamin supplements for eye health may help. A lot of my geriatric patients are taking them now, which may not be as helpful as taking them when you’re younger.”

It also appears that smokers are at higher risk for macular degeneration, so that’s another reason to stop smoking. Regular eye exams should include screening for glaucoma, which is called “the sneak thief of sight” for the fact that the first symptom is vision loss. The disease can be arrested, but vision lost to glaucoma cannot be restored.

The incidence of hearing loss increases with age. Twenty-nine percent of those with hearing loss are 45-65; 43% of those with hearing loss are 65 or older.

Hearing loss takes a toll on the quality of life and can lead to depression and withdrawal from social activities. Although hearing aids can help, only one out of four people use them.

High-frequency hearing loss is common in old age and made worse by a lifestyle that includes exposure to loud sounds. The 40- and 50-year-olds who went to the rock concerts that were so loud they were pulsating in their chests are starting to pay. Another factor is working or having worked in a noisy environment, such as airports or factories.”

Her advice to people at any age: Don’t use earbuds! Any source of sound that fits in the ear canal, such as using Walkmans or iPods, really puts your hearing at risk. If you’re going to use an iPod, don’t put it directly in your ear, and lower the volume.”

She says hearing aids are not an ideal solution for hearing loss. “My patients complain that they magnify the wrong sounds. They keep their $3,000 or $4,000 hearing aids in the nightstand.”

Teeth

The good news is that you’ll probably keep your own teeth, and implants and bleaching can make your teeth look years younger than the rest of your body. Only about 25% of people over age 60 wear dentures today.That’s because of a lifetime of good dental health and diet. Unfortunately, the people who haven’t had a lifetime of good health care and healthy practices are at risk for losing their teeth.The US and Canadian Dental Associations advises brushing twice a day with fluoridated toothpaste, flossing daily to remove plaque, and visiting your dentist regularly.

Mental Health: Memory and Emotional Well-being

Forget what you think you know about memory loss and old age. It is not inevitable. So why do so many people say, “My memory isn’t what it used to be,” or “I’m having a senior moment?” Stress, anxiety, and mental overload are most likely responsible. “Stop multitasking,” says Brangman, who is professor and division chief and geriatric medicine director at the Central New York Alzheimer’s Disease Centre, SUNY Upstate Medical University in Syracuse, N.Y. “Our brains are made for us to do one thing at a time. Multitasking overloads the brain so people aren’t remembering things and get concerned they’re having memory problems.”

Doing the things that keep your heart healthy will also keep your brain healthy. The same blood vessels that go to the heart branch off and go to the brain. Exercise, control your blood pressure, quit smoking, and if you have diabetes, keep it under control.

Staying mentally active is as important as staying physically active. Join a book club, stay up on current events, engage in stimulating conversations, and do crossword puzzles. “The new rage is Sudoku puzzles. They’re absorbing and require a tremendous amount of concentration, and there’s a lot of satisfaction in getting it right.”

One of the perplexing problems of aging is Alzheimer’s disease. About 3% of men and women aged 65 to 74 have Alzheimer’s disease, and nearly half of those aged 85 and older may have the disease. We’re not aware of anything people can do to prevent Alzheimer’s or dementia, but we’re learning new things about the brain every day.

Among all age groups, depression is often an under-diagnosed and untreated condition. Many people mistakenly believe that depression is a natural condition of old age. Of the nearly 35 million Americans aged 65 and older, an estimated 2 million have a depressive illness and 5 million more may have depressive symptoms that fall short of meeting full diagnostic criteria.

When you get older, you’re dealing with life-change issues. Kids leaving home, health problems, loss of parents & friends, and advanced ageing related issues (financial, caregiver arrangements, physical challenges, etc). We notice that all the basketball players are younger than us, and the music and ads are for a younger demographic. He advises anticipating and preparing for the changes to come.

One of the biggest life changes is retirement. Many people have their sense of worth tied up with work. In retirement, depression and suicide rates rise.

Prepare for retirement by thinking about what some call “the second act”. What would you have wanted to do if you hadn’t done your career? Jimmy Carter is a perfect example. After his presidency, he went on to become a humanitarian, working on behalf of international human rights and Habitat for Humanity.”

Recognize that some physical abilities will decline, but giving up sports altogether isn’t the answer. People who are active in sports such as basketball or football should think ahead to activities such as golf or water polo that put less stress on the joints.

Also recognize in your 40s and 50s that parents and grandparents won’t be around forever. In anticipation of their getting old and dying, making contact and tying up loose ends can be useful.

Nurturing your spiritual side may be in order as you get older and face mortality. For many people who have drifted away from religion or spiritual practice, it’s sometimes comforting to reassess that. Do I need to connect with my religion or spend time becoming the spiritual person I want to become? Pay attention to it if it’s important to you.

Finally, just the way you figure out your finances, figure out what you need to make you happy, and if you have a medical problem or mental health problem, how will you deal with it. Make some strategic decisions about how you want to live your life.

Do Your Part

according to the Centre for Disease Control (CDC)Much of the illness, disability, and deaths associated with chronic disease are avoidable through known prevention measures, including a healthy lifestyle, early detection of diseases, immunizations, injury prevention, and programs to teach techniques to self-manage conditions such as pain and chronic diseases . While the future will undoubtedly bring medical advances in treatments and cures… but if you can keep all your parts original, they are the best.

Of course, this is not a road that you must commute alone. You can benefit through a service partnerships with In Our Care – Home Care Services to maximize your independence, mobility, safety and engagement in social and community events.

Please contact us today, to discuss any challenges you may be facing and how our services can help you remain independent, protected, safe, and in you home / community.

You got questions, we have answers: (905) 785-2341 or email us at 

 

 

The Most Common Age Related Issues

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The Most Common Age Related Issues

Healthy Aging

Thanks to new medications and surgical techniques, people are living longer. However, the body we had at 55 will be a very different body than the one we have at 75. Many issues, both genetic and environmental, affect how we age. The most widespread condition affecting those 65 and older is coronary heart disease, followed by stroke, cancer, pneumonia and the flu. Accidents, especially falls that result in hip fractures, are also unfortunately common among the elderly population. Numbers and statistics are climbing as the aging population continues to escalate.

 

Many of our elders are coping with at least one of the following conditions, and many are dealing with two or more of the following

 

  • Heart conditions (hypertension, vascular disease, congestive heart failure, high blood pressure and coronary artery disease)
  • Dementia, including Alzheimer’s disease
  • Depression
  • Incontinence (urine and stool)
  • Arthritis
  • Osteoporosis
  • Diabetes
  • Breathing problems
  • Frequent falls, which can lead to fractures
  • Parkinson’s disease
  • Cancer
  • Eye problems (cataracts, glaucoma, Macular Degeneration)

As our body changes, other things to be aware of are:

  • A slowed reaction time, which is especially important when judging if a person can drive.
  • Thinner skin, which can lead to breakdowns and wounds that don’t heal quickly
  • A weakened immune system, which can make fighting off viruses, bacteria and diseases difficult
  • Diminished sense of taste or smell, especially for smokers, which can lead to diminished appetite and dehydration

The list can seem daunting. However, with proper care, elders have a life filled with joy.

Please browse our many other articles relating to specific topics.

Our aim is to ensure that seniors are protected, kept safe and well cared for. For those individuals who wish to continue living in their own homes, we offer a variety of services to support that very goal and serve you in ways you did not think possible: For example, we also offer a complete home maintenance plan so that you or your loved never has to deal directly with contractor in order to access services. We take care of that and minimized any risk of fraud or sub-standard services. Your golden years are your to enjoy and we want to ensure you do.

Please contact us today, to discuss any of the above mentioned challenges you may be facing and how our services can help you remain independent, protected, safe, and in you home / community.

You got questions, we have answers: (905) 785-2341 or email us at 

Senior Care: Sleep Disorders

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Night Sky - Sleeping TimeInsomnia and hypersomnia are associated with mood disorders and depression in particular. In vulnerable individuals problems sleeping should be noted; enabling better sleep can bring significant relief and help cope with the illness.

Sleep disruption is a very common finding in patients with psychiatric difficulties. A large community study found that a much higher proportion of people with insomnia or hypersomnia (sleeping more than usual) have a major psychiatric illness when compared to people who do not have these sleep complaints. Furthermore, when someone has insomnia early in life he or she is more likely to develop depression in later life. Over 70% of patients who are acutely ill with a psychiatric condition have insomnia and unfortunately the sleep disruption may not improve even when the illness is in remission and are known to cause depression. One’s social situation is another important factor, for example, if one is living in poor housing with little income and few social supports, or in an abusive relationship, then there is an increased risk for becoming depressed.

Doctors will usually encourage the use of antidepressant medications first as it can be difficult to take advantage of therapy when one is feeling so low. Psychotherapy can be long-term, looking at the factors from the past that may have resulted in or made one vulnerable to depression, or short-term, focusing more on the current situation and teaching one strategy to deal with the negative thoughts that often accompany depression.

Do psychiatric disorders cause sleep disorders?
Insomnia co-occurs with depression more than with any other illness, either medical or psychiatric. Sleep disruption (insomnia or hypersomnia) is one of the symptoms used to determine whether or not someone is depressed. It is often one of the first signs of an episode of depression, often preceding the onset of low mood and dissatisfaction in people who have recurrent depression. Typically, people have difficulty getting off to sleep, have many awakenings across the night and awaken in the very early morning and cannot get back to sleep. They feel very tired in the daytime and this makes the other symptoms of depression difficult to tolerate. There are some people for whom depression results in them sleeping much more than they normally would. When the sleep of people with a depression is recorded in the sleep clinic, we find that they have a delay in falling asleep, less deep sleep and poor sleep quality. They often have more REM sleep (rapid eye movement sleep, which is when dreaming occurs) and it occurs earlier in the night.

As mentioned above, it may be the case that sleep may not go back to “normal” even when the depression has improved. It is important to pay close attention to sleep hygiene factors, such as eliminating caffeine and keeping a regular sleep-wake schedule. Learning and practicing relaxation strategies can be very beneficial. It may be helpful to do some therapy, such as cognitive behavioural therapy, aimed specifically at treating the insomnia. The more one can work on such strategies when one is well the easier it will be to put them into practice should the depression recur in the future. When there is a history of depression alterations in sleep may signal its recurrence. Getting the insomnia under control as soon as possible will likely improve the course of the illness. Given the strong associations between sleep disruption and depression, it may even be worth considering restarting treatment for the depression at this point before it advances to a higher level of severity.

There is no doubt that sleep disruption often appears when a psychiatric illness develops. This is not surprising since the increased arousal and anxiety that often accompanies such illnesses will make it more difficult to sleep. However, there is evidence that the opposite may be true, that is, insomnia may trigger psychiatric illness or make someone who is vulnerable more likely to have an episode of illness. It may be the case that mental health and sleep are controlled by common brain mechanisms. When these mechanisms are altered or become disrupted, both sleep problems and psychiatric illness may occur.

How do mood disorders affect sleep?
Depression is the most common mood disorder. Approximately 1 in 4 women will suffer from an episode of depression at some time during their lives. The number for men is less but a significant proportion will also suffer from this condition. An episode of major depression is diagnosed when there is a history of feeling sad or not being able to enjoy things as much as usual for at least 2 weeks (often it is much longer than this). This feeling is accompanied by several other symptoms such as having difficulty paying attention and concentrating; loss or significant increase in appetite; insomnia or hypersomnia; having recurrent thoughts about wishing that one were dead or thinking about ending one’s life; not being able to get pleasure out of things previously found pleasurable.

Do antidepressants affect sleep? 
The recording of sleep in the sleep clinic shows that antidepressants have the greatest effect on REM/dreaming sleep, decreasing the amount. Patients sometimes notice that they dream more vividly after starting an antidepressant and in rare cases, nightmares can be problematic. Excessive dreaming may occur during withdrawal from an antidepressant.

What causes depression? 
There are likely many causes. One is a genetic vulnerability. A strong history of depression in a family increases the likelihood that one will have a similar condition. Depression can also result from certain medical conditions such as hypothyroidism, stroke, head injury and HIV. There is evidence that ongoing sleep disruption contributes to depressed moods. Certain medications, for example prednisone can trigger or worse episodes of depression. Unfortunately, antidepressants can cause or worsen restless legs syndrome, periodic leg movements (PLMs) during sleep, and sleep bruxism (teeth- grinding), often resulting in fragmentation of sleep.

What happens to sleep during depression?
The main focus of treatment must be treating the underlying condition, namely the depression. This is done through the use of antidepressants and/or psychotherapy. There are many antidepressants available nowadays and most people are able to find adequate relief from their difficulties. The response to an antidepressant varies greatly from person to person. There are certain antidepressants that almost always make one sleepy and the doctor treating a patient for whom insomnia is a problem may choose one of these in order to help treat the sleep problem. Some doctors, when starting an antidepressant, may also give the patient a short-term supply of a sleeping medication such as zopiclone or lorazepam (especially when anxiety is also causing difficulties). Such medications should be used in the short-term only and should be discontinued when the depression starts to respond to the antidepressant. There is no doubt that enabling someone to sleep if they have been depressed and not sleeping well for some time, can bring significant relief and helps them cope with their illness and even get better. Most antidepressants change sleep. As noted above, some such as mirtazapine are beneficial in that they are sedating and they can, therefore, be taken at night to treat insomnia. Some antidepressants, for example, buproprion, often make one feel more alert and awake. Hence, they are useful when the patient suffers from hypersomnia. Some people find it is more difficult to get to sleep, and complain of sleep disruption, when they first start taking the medication. These disruptive effects usually last for 4-6 weeks and if they persist another medication should be tried or a sleep-promoting agent added.

How to Get a Good Night’s Sleep — Even When You’re Depressed
People suffering from depression and bipolar are usually significantly affected by disrupted sleep patterns. Sometimes spending hours in bed, unable to get out, yet you just can’t sleep. Other times you end up sleeping, but wake up at 4 a.m., your mind racing with all sorts of negative thoughts. It’s not just you, and getting the right amount of sleep as very important… actually… critical to good health.

Depression both causes and is compounded by sleep disruption. The low energy caused by sleep deprivation also affects your ability to treat depression. How on earth can you make and attend appointments with experts, exercise or eat properly when you are perpetually exhausted? And socializing? Don’t even go there — the last thing you want to do when tired is talk to people. But what if you could take control of the situation, finally get a good night’s sleep and enjoy the benefits of restorative sleep and higher energy levels?

With a little bit of willpower and a change in routine, you can do this. Sleep is important. In fact, respondents to my survey of over 4,000 people rated getting a good night sleep number 10 (out of 60) in importance for overcoming depression and bipolar.

So where do you start in finally getting a good night’s sleep?

Sleep Hygiene
In the same way that you maintain personal hygiene through washing your body and oral hygiene by brushing your teeth and flossing, sleep hygiene is a set of practices to follow as a routine, which will yield a good night’s sleep.

As a general point, this is a good idea even for those not suffering from depression, as there are many health benefits to a full night’s sleep. There’s a huge list of practices, which can form part of sleep hygiene, but it’s down to you as to which ones will work best for you.

As a general rule of thumb, though, the aim is to create a routine, which you can follow. The following points reiterate and emphasize the importance of routines & transforming your environment into the most conducive and sleep inducing space possible. Several points to enhance a good night’s rest couple here, but the one I recommend most is the one that is hardest to do:

Use your bed only for sleep
You will find it harder to sleep if you stay in your bed all day, unable to move or act. I know I did. This is because you end up associating your bed with a general state of inertia, rather than the place in which sleep occurs. So even if you transfer to a sofa or somewhere else horizontal to lie all day, this is a very important step to take.

Don’t Force Yourself to Sleep
You can’t will yourself to sleep and getting frustrated at your inability to sleep doesn’t help either… nor does glancing at the clock every few minutes. Try some meditation exercises in bed, such as paying attention to your breath, which will help clear your mind a little and take attention away from the thoughts racing around in your head.

Have a Bedtime Routine
A bedtime routine, regularly followed, signals to your body that it’s time to start winding down, which helps encourage sleep. Things like avoiding upbeat music and stimulants like cigarettes, alcohol and caffeinated drinks and trying a little bit of meditation or yoga, putting on some relaxing music or some lavender essential oil or pillow spray can all help prepare you for sleep.

Maintain the Proper Atmosphere
If your bedroom isn’t a good sleep environment, you’ll find it difficult to relax. A bedroom which is dark, quiet and cool (but not cold) is crucial achieving a good night’s sleep. Too light and you’ll struggle to sleep. Too noisy and you may be awakened by sounds during the night. If it’s the wrong temperature, you’ll be tossing and turning and kicking off the covers during the night. Consider having a fan in the room. As well as helping to regulate the temperature, the ‘white noise’ of the fan’s engine can be a helpful noise to tune in to and help encourage sleep.

Sleep Better, Feel Better, Beat Depression
Once your sleep hygiene improves, you will feel more refreshed and energized and really feel the benefits of a good night’s sleep – and wonder why you didn’t initiate good sleep hygiene earlier! Then you can start making real progress in boosting your mood. You will have the energy and motivation to take action, you’ll also have the practice and experience of making changes to your lifestyle and routine, so you know that you can do it and it is beneficial.

What Other Techniques Can Help Me Sleep?
In addition to trying medications, here are some other tips to improve sleep:

  • Learn relaxation or mindfulness-based meditation and deep-breathing techniques.
  • Clear your head of concerns by writing a list of activities that need to be completed the next day and tell yourself you will think about it tomorrow.
  • Get regular exercise, no later than a few hours before bedtime.
  • Don’t use caffeine, alcohol, or nicotine in the evening.
  • Don’t lie in bed tossing and turning. Get out of bed and do something in another room when you can’t sleep. Go back to bed when you are feeling drowsy.
  • Don’t lie in bed to watch TV or read. This way, your bed becomes a cue for sleeping, not for lying awake.

How is depression and sleep disorders related?
Depression is a mood disorder that is characterized by sadness, or having the blues. Nearly everyone feels sad or down from time to time. Sometimes, however, the sad feelings become intense, last for long periods, keep a person from leading a normal life, and interfere with sleep.

According to the National Institute of Mental Health, symptoms of depression may include the following:

  • Difficulty concentrating, remembering details, and making decisions
  • Fatigue and decreased energy
  • Feelings of guilt, worthlessness, and/or helplessness
  • Feelings of hopelessness and/or pessimism
  • Insomnia, early-morning wakefulness, or excessive sleeping
  • Irritability and restlessness
  • Loss of interest in activities or hobbies once pleasurable, including sex
  • Overeating or appetite loss
  • Persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment
  • Persistent sad, anxious, or “empty” feelings
  • Thoughts of suicide, suicide attempts (if you are thinking of acting on ideas about suicide, call your local 24-hour suicide hotline right away).

Depression in Men
While clinical depression was once considered a “woman’s disease,” more than 6 million men in the U.S. have depression each year. Unfortunately, the lingering image of depression as a female condition may keep men who are clinically depressed from recognizing the symptoms of depression and seeking treatment. Depression actually affects both sexes. It disrupts relationships and interferes with work and daily activities. The symptoms of depression in men are similar to the symptoms of depression in.

There are several reasons why the symptoms of clinical depression in men are not commonly recognized. For example, men tend to deny having problems because they are supposed to “be strong.” And American culture suggests that expressing emotion is largely a feminine trait. As a result, men who are depressed are more likely to talk about the physical symptoms of their depression — such as feeling tired — rather than symptoms related to emotions.

Men are less likely to show more “typical” signs of depression such as sadness. Depression in men may cause them to keep their feelings hidden. Instead of expressing a depressed mood, they may seem more irritable and aggressive. For these reasons, many men — as well as doctors and other health care professionals — may fail to recognize the problem as depression.

What are the consequences of untreated depression in men?
Depression in men can have devastating consequences. The CDC reports that men in the U.S. are about four times more likely than women to commit suicide. A staggering 75% to 80% of all people who commit suicide in the U.S. are men. Though more women attempt suicide, more men are successful at actually ending their lives. This may be due to the fact that men tend to use more lethal methods of committing suicide, for example using a gun rather than taking an overdose of pills.

Is depression common in elderly men?
Although depression is not a normal part of aging, senior men may have medical conditions such as heart disease, stroke, cancer, or other stressors that may contribute to depression. For example, there is the loss of income and meaningful work. Retirement is difficult for many men because they end up with no routine or set schedule to follow. These changes may increase the stress they feel, and a loss of self-esteem may contribute to depression. In addition, the death of family and friends, the onset of other health problems, and some medications can contribute to depression in men.

How is depression in men treated?
More than 80% of people with depression — both men and women — can be treated successfully with antidepressant medication, psychotherapy, or a combination of both. If you are uncertain about whom to call for help with depression, check out the following list from the National Institute of Mental Health:

  • community mental health centers
  • employee assistance programs
  • family doctor
  • family service/social agencies
  • health maintenance organizatios
  • hospital psychiatry department and outpatient clinics
  • local medical and/or psychiatric societie
  • mental health specialists such as psychiatrists, psychologists, social workers, or mental health counselors
  • private clinics and facilities
  • state hospital outpatient clinics
  • university or medical school affiliated programs

Depression is classified as major if the person has at least five of these symptoms for two weeks or more. However, there are several types of depressive disorders. Someone with fewer than five of these symptoms who is having difficulty functioning should still seek treatment for his or her symptoms. Tell your doctor how you are feeling. He or she may refer you to a mental health care specialist.

How Are Sleep and Depression Linked?
An inability to sleep, or insomnia, can be one of the signs of depression (a small percentage of depressed people, approximately 15%, oversleep or sleep too much). Lack of sleep alone cannot cause depression, but it does play a role. Lack of sleep caused by another medical illness or by personal problems can make depression worse. An inability to sleep that lasts over a long period of time is also an important clue that someone may be depressed.

What Causes Depression?
There are several factors linked to depression, including

  • Family history of mental disorders
  • Chemical imbalances in the brain
  • Physical and mental health disorders
  • Environment such as living in a place that is often cloudy and gray
  • Stress
  • Alcohol or drug abuse
  • Medications
  • Lack of support from family and friends
  • Poor diet

How Is Depression Diagnosed?
Your doctor will take your medical history, and will likely ask you whether anyone in your family has depression or other mental health problems. He or she may also ask you to describe your moods, your appetite and energy, if you feel under stress, and if you have ever thought about suicide. Your doctor will also perform  physical exam to determine if the cause of your symptoms is caused by another illness.

What Depression and Insomnia Treatments Are Available?
Treatment choices for depression depend on how serious the illness is. Major depressive disorder is treated with psychotherapy (counseling, or talk therapy with a psychologist, psychiatrist, or licensed counselor), medications, or a combination of the two. Drugs tend to work more quickly to decrease symptoms while psychotherapy helps people to learn coping strategies to prevent the onset of future depressive symptoms.

Medications used to treat depression include antidepressants such as:

  • Selective serotonin reuptake inhibitors (SSRIs), like Zoloft, Prozac, Celexa and Paxil. These medications can perform double duty for patients by helping them sleep and elevating their mood, though some people taking these drugs may have trouble sleeping.
  • Tricyclic antidepressants (including Pamelor and Elavil)
  • Serotonin/norepinephrine reuptake inhibitors (SNRIs) like Effexor, Pristiq, Khedezla, Fetzima, or Cymbalta, that raise levels of both serotonin and norepinephrine — brain chemicals that are thought to be involved in the neurobiology of depression.
  • Novel antidepressants such as bupropion (Wellbutrin)
  • Some of the most effective types of psychotherapy for depression are cognitive-behavioral therapy and interpersonal therapy. With cognitive-behavioral therapy, ptients learn to change negative thinking patterns that are related to feelings of depression. Interpersonal therapy helps people to understand how relationship problems, losses, or changes affect feelings of depression. This therapy involves working to iprove relationships with others or building new relationships.

Sleeping Pills
Hypnotics are a class of drugs for people who cannot sleep. These drugs include Ambien, Sonata, and Restoril. Doctors may sometimes treat depression and insomnia by prescribing an SSRI along with a sedating antidepressant or with a hypnotic medication. However, hypnotic drugs usually should be taken for a short period of time.

The FDA has also approved a prescription oral spray called Zolpimist, which contains the sleep drug Ambien’s active ingredient, for the short-term treatment of insomnia brought on by difficulty falling asleep.

Psychotherapy can also address coping skills to improve a person’s ability to fall asleep… because nothing beats a good night’s sleep.

 

Senior Care: Elderly Suicide

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Sad older gentleman

Loneliness & depression can bring on other challenges

The Elderly and Suicide

So we’ve all heard of depression. We even seem to be aware of what causes it & how to overcome it, but do we really?

So what’s the big deal with depression?   The deal is…

In 2011 statistical report stated that someone over the age of 65 commits suicide every 90 minutes (16 deaths per day). In 2013 it was reported that this statistic had doubled. Elders, account for one-fifth of all suicides, but it only represents 12% of the population. White males over the age of 85 are at the highest risk and completion of suicide attempts, almost six times the national average. The suicide rate among elders is two to three times higher than in younger age groups. Elder suicide may be under-reported by as much as 40% or more. Omitted are “silent suicides”, i.e., completions from medical noncompliance and overdoses, self-starvation or dehydration, and “accidents.” The elderly have a high suicide rate because they use firearms, hanging, and drowning. The ratio of suicide attempts to completions is 4:1 compared to 16:1 among younger adults. “Double suicides” involving spouses or partners occur most frequently among the aged. Elder attempters have less chance of discovery because of greater social isolation and less chance of survival because of greater physical frailty and the use of highly lethal means.

What are the causes?

Elder suicide is associated with depression and factors causing depression, e.g., chronic illness, physical impairment, unrelieved pain, financial stress, loss and grief, social isolation, and alcoholism. Depression is tied to low serotonin levels. Serotonin, is a neurotransmitter in our brains that regulates and limits self-destructive behaviour.  As we age our Serotonin levels decrease placing us at greater risk. Depression remains under diagnosed and undertreated among the elderly population.

What are some of the key risk factors of elder suicide?

  • Loss of spouse.
  • A late onset depressive disorder.
  • A debilitating and/or terminal illness.
  • Severe chronic/intractable pain.
  • Decreasing independence and self-sufficiency.
  • Decreased socialization and social supports.
  • Risk often accumulates among the elderly. An individual may be white, male, and an alcohol user and then become a widower or depressed.

What are some of the myths of elder suicide?

  • It is the outcome of a rational decision and justified.
  • Elder victims are usually seriously or terminally ill.
  • Only very severely depressed elders are at risk of suicide.
  • Suicidal elders never give any indication of their intent.
  • The suicide of an older person is different from that of a younger individual.

What are the warning signs?

The following may indicate serious risk:

  • Loss of interest in things or activities that are usually found enjoyable
  • Cutting back social interaction, self-care, and grooming.
  • Breaking medical regimens (e.g., going off diets, prescriptions)
  • Experiencing or expecting a significant personal loss (e.g., spouse)
  • Feeling hopeless and/or worthless (“Who needs me?”).
  • Putting affairs in order, giving things away, or making changes in wills.
  • Stock-pilling medication or obtaining other lethal means

Other clues are a preoccupation with death or a lack of concern about personal safety. “Good-byes” such as “This is the last time that you’ll see me” or “I won’t be needing anymore appointments” should raise concern. The most significant indicator is an expression of suicidal intent.

Why aren’t community agencies or providers doing more service involvement with older men?

Community agencies basically serve elderly women who have a suicide rate well under the national mean for all ages. Community agencies may be little concerned because elder suicide is uncommon in their caseloads.

Agency philosophy:

The prevailing value in most services for the aged is to optimize self-sufficiency in terms of individual capability and safety. A commitment to autonomy may cause community agencies to let the client or patient control decisions on referrals to other resources, alerting relatives, or involving available services.

Agency Misconceptions:

  • Community agencies and providers may accept some of the myths about suicide such as:
  • If someone’s determined to commit suicide, no one can stop him or her.
  • Those who complete suicide do not seek help before their attempt.
  • Those who kill themselves must be crazy.
  • Asking someone about suicide can lead to suicide.
  • Pain goes along with aging so nothing can be done.
  • It makes sense for an old person to want to end their suffering.
  • Old people are used to death and loss and don’t feel them like younger folks.
  • Those who talk about suicide rarely actually do it.
  • How many health or human service professionals, other staff, and volunteers believe these statements to be true?

Lack of risk assessment:

A lack of attention to elder suicide and a concentration on client or patient self-determination and self-sufficiency may limit community agencies’ response. Most community agencies do not recognize the problem and consequently do little or no screening for it among their clientele.

What can community agencies do?

Individual prevention must focus on what drives suicide. “Doing something” basically comes down to caring. Community level prevention of late life suicides will require “creative partnerships of primary care providers. This means that senior centers, home care providers, hospices, adult day care, home-delivered meals programs, para-transit, and other organizations serving the elderly are going to have to team up with community mental health centers. This must start soon as the high-risk segment of the aged population is growing rapidly and the oldest baby boomers are within a few years of turning 65. The boomers will arrive in their “golden years” having manifested higher suicide rates on the way than prior generations.

If you think… This cannot be happening here in Canada, Think again!

Canada’s elderly are at high risk of suicide experts say, and Canadian men aged 85 to 89 have the highest rate of suicide. THE CANADIAN PRESS: Dr. Marnin Heisel says public awareness about suicide lets people know their physical and mental health problems can be treated effectively. Studies show that Canada’s elderly are at a much higher risk of suicide than adolescents, and there is growing concern among mental health experts that psychological care may be out of reach for most seniors. Dr. Marnin Heisel, a clinical psychologist and professor at the University of Western Ontario, says lack of public awareness of the issue is a key problem that affects not only the elderly but also their families and the public in general.

“One of the challenges that people face is thinking ‘I’m unique in this, I’m alone, there’s something wrong with me, no one can understand it,’ and then they tend to back away from family, other supports, including professional supports” Heisel said in an interview.

Public awareness lets the people struggling with these issues know that they are not alone and their physical and mental health problems can be treated effectively, he said. It may also cue their relatives into the fact that their older family members who are struggling with depression might be contemplating suicide, he said. “They might, as a result, begin asking their family (member) ‘How are you doing? Are you struggling with some of these things?’ or even asking them if they’ve thought of suicide.” A 2009 report by Statistic Canada states that men aged 85 to 89 have the highest rate of suicide among any age group in Canada, at a rate of about 31 per 100,000, and usually do so through more violent means. A report by the chief public health officer released the following year also showed that men over the age of 85 have on average higher suicide rates than all other age groups. For most Canadians, psychological services — which can easily run $100 or $200 an hour — are not covered by provincial and territorial health-care plans, but psychiatric services and medications generally are. Psychological care is covered only if it’s hospital-based. “But many if not most hospitals, at least in Ontario, typically don’t have very much in the way of psychological services and typically not for older adults,” said Heisel. “One thing we do know is that unless somebody has extremely good third-party health coverage, or they are a child in the school system, or a veteran, or if they have access to psychological services as a result of a motor vehicle collision — most Canadians can’t access psychological services unless they pay out-of-pocket. Heisel says research has shown that 75 per cent of older adults who die by suicide had seen a primary-care physician or provider within a month prior to ending their lives. “That suggests that primary care is a key place where we should be assessing for screening for suicide risk factors and then try to implement aggressive, meaning very focused, interventions,” Heisel said. “And we really don’t see that happening, literature supports that treatments works extremely well; it just requires funding to do that.” There’s also concern that many elderly suicides go undetected due to the way they are reported by coroners across Canada. “I can envision a circumstance, for example, where an elderly male is found (deceased) in a bed alone … maybe with no history of depression or suicidal thinking that he had expressed to anybody, and the coroner could determine that the death was due to natural causes and not even order an autopsy because of the age group,” said Dr. William Lucas, Ontario deputy chief coroner for inquest. “And if the person had used a relatively subtle means like an overdose of medications … that wasn’t obvious … we wouldn’t know,” he said. Heisel says research shows that when the means of death are more ambiguous, then suicide is more likely not to be detected. He goes on to say, “It’s somewhat frustrating because we really don’t know the full scope of the issue”. The frustration stems from the fact that many suicide prevention strategies are largely aimed at youth. That’s why he says he decided to speak publicly about the issue. Victims of depression say that family is what helps them the most in combating episodes of depression, in addition to staying physically active, mentally stimulated, including social companionship in their daily lives with interaction in the community. “Those are the good things in life when periods of depression start to creep in”.  Incorporate them to combat depression and from recurring episodes. One patient says… “Well if the glass is half empty, it must be half full … I try to forget about the half-empty side but what a wonderful half full my life is.” The following posted articles also speak to this issue in the same relative terms… it a bigger problem that we think and about to get bigger. Be sure to also read the posted comments from readers, as it further illustrates the issue in the elderly communities. Suicide rates climb among elderly in Canada. Elderly suicide rates hitting new highs as traditional social networks break down. Over the past years our aging population has skyrocketed. This growth is only expected to increase exponentially over the next 15-20 years. The issues we are currently facing and learning about are just the beginning of the cycle. Growing challenges relating to care of our elderly will continue to provoke our ideals of what is acceptable in our society. Anything that we have an answer for (treatment) is therefore a preventable measure… like the treatment for depression and respectively reduce depression related suicides.

The following graphs illustrate the population growth for the following demographics.

graph1depressionsuicide graph2depressionsuicide

For a more detailed population projection statistical review visit the Canadian Statistics web page.

It is within us to create an environment whereby our elders are cared for in a manner that protects them physically & holistically, paving the way for the future. Our campaign and advocacy to enriching the lives of our elderly should be one of our primary goals… “We ourselves are becoming to ones who will require care in the near future and our actions today will dictate the outcome for ourselves tomorrow”.

Senior Care: Depression in the Elderly

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DepressionamonelderlyDepression among the Elderly population

According to Health Canada, older Canadians are living longer, more independently, healthier, and more affluent than ever before. Todays seniors are physically more active, engaged with their families, in their communities, and are becoming international globetrotters.

They are challenging many of the negative stereotypes we hold about aging and showing us that life is for living with fortitude, vitality, and vigour.

However, it is true that some seniors struggle from time to time with mental illness. For seniors living in the community, it is estimated that 5% to 10% will experience a depressive disorder that is serious enough to require treatment. The rate of anxiety and depression increases dramatically to 30% to 40% for seniors living in an institutional setting.

The great news is that for most people with depression (over 80%) do respond well to treatment and achieve a complete and lasting recovery. Sadly, 90% will NOT seek needed help or their depression will be missed or ignored, denying them beneficial treatment for mental health problems.

Why aren’t seniors getting the help they need?

  • Depression in the elderly can be difficult to recognize. It can easily be overlooked as a symptom of another medical condition.
  • Family, friends and medical personnel often see depression as a normal part of the aging process and the inevitable result of the losses of life we all will experience.
  • Family, friends and medical personnel often see depression as a normal part of the aging process and the inevitable result of the losses of life we all will experience.
  • Many seniors were raised to be self-sufficient and stoic in the face of life’s challenges making them reluctant to complain about how they are feeling or ask to for help. They are used to working hard to solve their own problems and feel ashamed by their inability to cope.
  • Some seniors (and possibly even their friends and family) don’t know that depression is an illness and that treatment is available and works!

How do I know if its depression?

Depression is more than just feeling sad. It affects the whole person including their feelings, thinking and their physical health. It also lasts a long time. It’s important to know what to watch for. Anxiety and slowing of thoughts are common symptoms. For many seniors depression is often expressed through many vague complaints of physical aches and pain. The most common symptoms of depression include:

Physical changes

  • Changes in appetite – a resultant weight loss or weight gain.
  • Sleep disturbances – trouble falling asleep, staying asleep or sleeping too much.
  • Some seniors (and possibly even their friends and family) don’t know that depression is an illness and that treatment is available and works!
  • Sleep, when it comes, does not restore and refresh. People often report feeling worse in the morning with the mood -lifting as the day goes on.
  • Decreased energy, with feelings of weakness and physical fatigue.
  • Some people experience agitation with restlessness and have a need to move constantly.
  • Phantom pains, headaches, muscle aches and pains, with no known physical cause.
  • Stomach upsets – constipation.

Changes in thinking

  • Thoughts may be confused or slowed down which makes thinking, concentrating or remembering information more difficult.
  • Decision-making is difficult and  or often avoided.
  • Obsessive ruminations, a sense of impending doom or disaster.
  • Preoccupation with perceived failures or personal inadequacies leading to a loss of self-esteem.
  • Becoming harshly self-critical and unfairly judgmental.
  • In extreme cases, there can be a loss of being in touch with reality, perhaps hearing voices (hallucinations) or having strange ideas (delusions).
  • Persistent thoughts of death, suicide or attempts to hurt oneself.

Changes in feeling

  • Loss of interest in activities that were once a source of pleasure.
  • Decreased interest in and enjoyment from sex.
  • Feelings of worthlessness, hopelessness, and excessive guilt.
  • Deadening or an absence of feelings.
  • Sense of overwhelming or impending doom.
  • Feeling sad, and down that may be worse in the morning, lifting as the day goes on.
  • Crying for no apparent reason.
  • Irritability, impatience, anger and aggressive feelings.

Changes in behaviour

  • Withdrawal from social and leisure activities.
  • Failure to make important decisions.
  • Neglecting duties such as housework, gardening, paying bills.
  • Decrease in physical activity and exercise.
  • Reduced self-care such as personal grooming, eating.
  • Increased use of alcohol or drugs (prescription and non-prescription).

Why is it important to treat depression in the elderly?

  • Depression throws a dark cloud over our emotional well-being, draining away pleasure, and robbing people of hope, further isolation, and despair.
  • Depression tends to last much longer in the elderly and can result in unnecessary or premature placement in institutional care.
  • If depression is not managed, it can compromise the treatment of other conditions and can increase the risk of prolonged disability or early death.
  • Untreated depression can also leave seniors more vulnerable to developing other serious health conditions such as heart disease, infections and immune disorders.
  • Depression can make people feel angry, irritable and anxious. This can rob families of the pleasure of their loved one’s company and place an additional burden on care providers.
  • The risk of suicide in elderly is high and it is particularly high for depressed elderly men.

What factors can increase the risk of depression in the elderly?

  • The presence of other illnesses, which compromises their ability to get around and be independent.
  • Some medications or the interaction between medications are associated with depression.
  • Living with chronic or severe pain.
  • Living alone without a supportive network of friends, social interaction, and family.
  • The recent death of a loved one or fear of own death.
  • A previous history of depression or family history of depressive disorder.
  • A past history of suicide attempt(s).

Illness increases the risk of depression

There are a number of medical conditions that are associated with depression in the elderly. Some are:

  • Heart problems including having a stroke
  • Low thyroid activity
  • A lack of vitamin B12 or folic acid
  • Low blood pressure
  • Rheumatoid arthritis
  • Cancer
  • Diabetes

Commonly prescribed medications are also associated with depression or making depression worse such as:

  • Blood pressure medications
  • Beta-blockers
  • Steroids
  • Digoxins
  • Sedatives

Treatments involving these medications may warrant a discussion with the treating physician to rule out their use as the cause of the depression. Don’t stop medications without advice as a sudden discontinuation can have serious health consequences when the body struggles to adjust.

What can we do to help our loved one overcome depression?

Medication

Usually relief is felt within a few weeks of starting medications, however it can take longer for older people to feel better. Sleep and appetite are usually the first to improve. Don’t expect a complete recovery right away. It usually takes about ten to twelve weeks to lift out of depression. Often those close to you who will see an improvement in your mood before you begin to feel it.

Build social supports

The paradox of depression is that at a time when you most need to draw people close – you may want to avoid contact with others. However, most people find that the support of family, caregivers, friends, participation in a self-help group, or talking with a professional counselor can be very helpful in overcoming depression. Dealing with social isolation is an important part of healing and can help prevent further episodes of depression. Many conducted studies show that being part of a supportive family, being part of a religious group or being active in your community is an important part of health, wellbeing and improved quality of life.

Talk therapy

Psychotherapy can be very helpful in dealing with losses, solving challenging problems or dealing with the social impact of depression. Cognitive therapy can help you look at your thought patterns, which may be negative and self-criticizing. It will also help you make the connection between your thoughts, feelings and behaviours. What you think affects how you feel and how you behave.

Electroconvulsive therapy (ECT)

ECT is a treatment that uses electrical impulses to change the chemical balance in the brain. It is often used as a treatment of last resort for those patients who have not responded well to other forms of treatment, who remain a suicide risk, or have other serious medical conditions that prevent the use of medication. It remains controversial, so it is important to do your research so you can make an informed decision.

What factors protect seniors from depression and build resilience?

Have you ever wondered why some people just seem happy or are able to weather the inevitable storms that life throws their way with wisdom and grace? So have researchers and they have learned a lot about what builds healthy resilience, makes for a happy engaged life and helps us cope during difficult times. Some of us are just blessed with a happy, easygoing temperament. The rest of us may have to work at it.

What have we learned about how to maintain good mental health throughout the life cycle?

The self-help mantra is, “Never get too angry, too lonely, too tired or too hungry”. This is really good advice for living a healthy balanced life. People who have experienced a mood disorder learn quickly how true this motto is. If your balance is off in one of these areas, it is important to take active steps to gain control of your health. Having strong family, friendships and community supports will go a long way in keeping you free from depression.

Health Canada reports that more and more elderly are spending time alone – going days at a time without seeing or talking to another person. This is not good for our mental health and can lead us to become too inward in our thinking. Changes in our social network are an inevitable part of life. Family members grow up, move away or get busy with their daily lives. Retirement takes us out of the mainstream of working life. As we age, death becomes an unfortunate companion robbing us of people we loved and cared for. Sickness can sap our strength and take away our vitality. All of these changes can cause us to lose valuable sources of support and connection. You may feel it is too late to build new friendships – that too much effort is required to add new interests and people into your social network. But it’s worth the investment. Research shows us time and time again that people with a well-developed social network have better physical and emotional health and an improved quality of life.

Tips for building social supports

Take the time to consider what you like. Start small – adding one new thing at a time. Be patient – it may take some research to find the activities that will suite you best. Become a risk taker – try doing something you have never done before. Buddy up with someone else in trying new things out. Lend a helping hand to others. There is nothing that builds confidence like helping others.

Become a joiner!

  • Check out the local community Centre for seniors clubs and social programs.
  • Join a book club, choir, bridge group, or gardening club.
  • Let your family know you would like to spend more time together. Be specific in your asking.
  • Rekindle a hobby or up a new hobby.
  • Become a mentor for a young person.
  • Volunteer your time.
  • Get involved in a political party.
  • Find out about how to get involved in your community.

Get physically active

Recent research has found that moderate exercise and weight lifting – yes lifting barbells – has a remarkable ability to treat depression in the elderly. In fact, moderate exercise has been found to be as effective in treating mild depression as medication. Strengthening your muscles has also been found to reduce the risk of falling and hip fractures – the number one reason seniors end up in institutional care.

An exercise program should include active movement to build balance and coordination, stretching to improve flexibility by moving your joints through their full range of motion, ways to strengthening your muscles, and, finally, activities to get your heart pumping. Consider joining a senior’s exercise program in your community to strengthen your social network as well as your body… Just do it!

Exercise your mind

Along with aging often come subtle changes in brain functioning. It may not seem as easy to remember names. Learning new skills can seem harder. But just like your body, a healthy nimble mind requires active exercise. Think of ways you can challenge your brain. Play chess, bridge, and computer games or do crossword puzzles. Consider taking an adult education course – anything that will exercise the grey matter.

Eat well

Diet plays an important role in preventing illness and keeping us well. The absence of essential minerals and vitamins is associated with many serious health problems including depression. Many elderly people neglect this important part of their health. If you live alone, it may not seem worth the effort to cook yourself a meal. Depression can also rob people of their appetite. Use the clock to tell you when to eat if your body doesn’t let you know when you are hungry. Restore balance by starting to keep track of what you are eating.

Tips for healthy eating:

  • Consider taking a multi-vitamin every day.
  • Build variety into your diet.
  • Keep healthy foods easily available.
  • Choose whole grain and enriched grain products.
  • Choose fresh foods over manufactured foods.
  • Choose dark green and orange vegetables more often.
  • Lower the fat level in your milk and choose leaner cuts of meat.
  • Consider poultry, fish, dried beans and lentils as an alternative to red meat.
  • Drink plenty of water.
  • Take care in your use of alcohol.
  • Strive for a healthy body weight.
  • Use Canada’s Food Guide as your reference to healthy eating.

Express your feelings

Recent research suggests that the ability to express your feelings clearly and directly has a positive and beneficial effect on mental health, life satisfaction and personal well-being. Talking about concerns helps you organize your thinking and clarify your thoughts. Keeping a personal diary is helpful even if you never share these thoughts with others. It can also help you gain insight into your moods by tracking what is going on in your life and how you are feeling. In this way you can take steps to address problems before they become overwhelming.

Feed your soul

Having a strongly held belief system has been found to be one of the protective factors for good mental health. If you are not currently involved with a religious group, consider finding a place of worship in your community that makes you feel welcome. If you don’t have strong religious beliefs or a group to which you hold affiliation, try learning more about different religious groups. Perhaps by exploring other beliefs you will find a spiritual home. But spirituality is not confined solely to religion. Many people find great conform in art, nature, theatre, and other pursuits.

Music soothes the savage breast – singing ignites the soul

There is nothing more stirring than listening to music – except perhaps playing it or singing along. In fact, music can help to sooth anxious nerves and lift your spirit. Consider joining a choir or sing along to your favourite tunes. Just make sure you add a dose of music to your day.

Turn loneliness into solitude and know the difference

Too much time alone can leave us feeling distant, isolated and lonely. This can worsen feelings of depression. We all have our own comfort level about how much time we like to be with others. Pay attention to how you are spending your time. If you are spending too much time alone, take steps to add balance. That said, finding comfort in one’s own company is also an important part of a happy healthy life.

Care for a pet

Looking after a pet is a big responsibility and a lot of work. But boy, is it worth it. Scientists have looked closely at the effect that pets have on our health. They have found that seniors who live with and care for pets have better physical health and mental well-being than those who don’t. They are also better able to cope with stress and are more physically and socially active. Pets have even been found to lower blood pressure. Having a pet has also been found to reduce the risk of suicide in people when they are depressed. Their unconditional love and affection provides valuable company, keeps you active and helps to draw others to you.

Keep a positive attitude

Being thankful is a cornerstone of emotional well-being. In fact, some research suggests that maintaining a positive outlook on life can boost your immune system and protect you from illness. Sickness and loss has a nasty way of dominating the thinking of people as they age. While your aches and pains and past surgeries are of pressing concern and interest to you – they may not make good conversation for others. Try to avoid dwelling too much on the negatives of life. Instead take time to count your blessings. Seek out positive people. Broaden your network to include people of different ages and backgrounds. Get out of the rut of daily life by trying new things. Become a great conversationalist by sharing stories. Keep up on current affairs and popular shows. Share with others what you like and what you value. Make sure to take an interest in their views too. Listen actively to what they say and ask questions. Everyone has a fascinating story to tell if you just take the time to ask. Focusing on positive communication helps to bring people close and helps you keep your thinking open to new ideas.

Laugh out loud and laugh a lot

Research again shows us that there is powerful healing in laughter. It changes our brain chemistry in a positive way and helps us look at problems in new and creative ways. So – go rent a Marx Brothers film or whatever brings a smile to your face.

Ask for help if you need it

Don’t be afraid to ask for help. It is a sign of strength, health and maturity. Working through concerns with a professional can bring out new ideas and offer a fresh perspective in solving problems. Having help can help you stay in charge of making your own decisions.

 

 

The above tips are gatherings from various sources, but for more in-depth information on some of the aforementioned topics, I offer the following readings:

Beating the Senior Blues: How to Feel Better and Enjoy Life Again, by Leslie Eckford and Amanda Lambert, New Harbinger Pub. 2002

There is an excellent review of depression treatments for older adults from the US Surgeon General at

Health Canada produces an interesting monthly newsletter updating readers on recent research related to the elderly. Division of Aging & Seniors

Wherever You Go There You Are: Mindfulness Meditation in Everyday Life by Jon Kabat-Zinn

Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness by Jon Kabat-Zinn