Technology is being developed in a variety of areas to assist in geriatric care.  Significant efforts are underway in both the consumer and professional markets.  Already these efforts are bearing fruit.  You can read about some in my earlier blogs and I'll be highlighting others in the coming weeks.

Let's start the discussion with some categories.  Technology is entering the the consumer side of eldercare both in the home and on the Internet.  This work could be grouped as follows:

In Home:

Consumer Products 
- Family Communication 
- Wellness and Assistance
Health Products 
- Services 
- Diagnostics Reporting
Safety 
- Monitoring Services 
- Products
Research Initiatives 
- Continuous Monitoring – Automatic Detection 
- Decision Support

Person Health Records
- Microsoft Vault 
- Google Health
- Hundreds of Others
Medical and Non-Medical Information
- Health Sites
- Support Group Sites
- Commercial Sites

After posting my blog yesterday about caregiver stress, I discovered that Dear Abby just gave advice to a stressed-out reader on the 10th (read the letter by clicking here).  The letter was from ‘Overwhelmed in Cincinnati’, who is struggling to balance her roles as a caregiver for her mother, who has Alzheimer’s, and a mother of three – while also juggling a career.  She feels she’s in over her head with worries about her mother’s safety, well-being, and financial considerations. 

Dear Abby wisely referred ‘Overwhelmed’ to the Caregiver Stress Check from the Alzheimer’s Association (www.alz.org) that I mentioned in my blog yesterday.  If you’re a caregiver, please remember the importance of taking care of yourself.  If you are experiencing a lot of stress, take the quiz here.  Your local Alzheimer’s Association, health care provider, or a geriatric care manager are all good resources to help you manage your responsibilities and reduce your stress.

"Caring for an older adult can be rewarding and fulfilling but can also place great physical, emotional and financial demands on those who take care of them. In fact, a recent issue of the Journal of Immunology compared Alzheimer’s caregivers to non-caregivers, finding that caregivers aged between four and eight years faster than non-caregivers. In light of these statistics, and in recognition of November as both National Alzheimer's Disease Awareness Month and National Family Caregivers Month, the American Occupational Therapy Association (AOTA) is offering tips for caring for the adult caregiver.

Research recently published in the American Journal of Geriatric Psychiatry tested an occupational therapy home intervention, the Tailored Activity Program (TAP), that systematically evaluates and tailors activities to individual capabilities and trains families in setting up and using activities in daily care. TAP reduced behaviors that trigger nursing home placement and the amount of time families spent supervising and providing care.

“Our research shows that occupational therapists play a critical role in the care of individuals with dementia and their family caregivers,” said Laura N. Gitlin, Ph.D., director of the Jefferson Center for Applied Research on Aging and Health and professor in the Department of Occupational Therapy at Thomas Jefferson University. “Occupational therapy practitioners are uniquely qualified to evaluate individual capabilities, engage individuals with dementia in activities, help families learn specific communication, task and environmental simplification strategies and to take care of themselves.”

Laurel Cargill Radley, MS, OTR, associate director of professional affairs at AOTA, adds, “Occupational therapists can help individuals and their families promote or maximize independence, safety and function.”

Occupational therapy practitioners recommend adult caregivers:

1. Join a therapy or discussion group for caregivers of older adults.
2. Share the responsibility of caring for an older adult.
3. Ask others for help.
4. Develop a schedule that distributes caregiving responsibility.
5. Consider adult daycare or home health aides to provide occasional breaks to full-time caregivers.
6. Create moments of joy throughout the day by participating in pleasurable activities.

Additional caregiver resources can be found on the Centers for Medicare&Medicaid Services’ (CMS) new Web site, http://www.medicare.gov/caregivers/.

Founded in 1917, the American Occupational Therapy Association (AOTA) represents the interests and concerns of more than 36,000 occupational therapists, assistants and students nationwide. The Association educates the public and advances the profession of occupational therapy by providing resources, setting standards including accreditations and serving as an advocate to improve health care. Based in Bethesda, Md., AOTA’s major programs and activities are directed toward promoting the professional development of its members and assuring consumer access to quality services so patients can maximize their individual potential. For more information, go to http://www.aota.org/."
This article was originally published by the American Occupational Therapy Association.

For the last several months, we have been discussing safety concerns for the older adult.  We all know that medication management and fall risk prevention are instrumental to healthy aging, but a holistic picture is what is most important to assist in aging in place and maintaining good “health”.  As the boomers age, we will see more and more written on wellness, well-being, and just overall aging tips. 

But what is key to a healthy life style?

According to American Geriatrics Society it is

1. Not smoking
2. Drinking alcohol in moderation
3. Exercising
4. Getting adequate rest
5. Eating a diet high in fruits and vegetables
6. Coping with stress and
7. Having a positive outlook.  

These are important, but I feel that whether you are elderly or young, you need to understand your overall health issues, have social connections, be at peace with where you are in life, have a purpose, live in a safe environment that supports your needs, and keep your brain functioning. 

Good Morning America does a segment that highlights individuals celebrating their 100th or older Birthday.  Today a man was 107! I am always amazed at the life history of those over 100...  The majority have remained both physically and intellectually active and have remained connected with society.  Amazing, they never reference how many fruits and vegetables they have eaten!!   So stay connected… and do your brainteaser and always learn something new each day. 

In several of my past blogs, I discussed safety concerns and the older adult.  One the main concern is medication safety. Not just the management of medications but how many are actually taken.

It is often reported in the news about a medical error made and the impact it has on individual lives.  Those articles are frequently about hospitals errors.  But have you ever thought about the older adult and how they manage at home...?  The impact our current health system has on managing medications...?  How chronic illnesses such as congestive heart failure, diabetes, and arthritis impact the older adult and his/her caregivers...?  Different providers – prescribing different medication – generic versus brand names.  multiple medications with multiple doses all affect the medication management and the safety of the older adult.

Let’s look at the key safety issue: polypharmacy (multiple medications).  
A caregiver may ask what defines polypharmacy or how many pills or too many?  The answer would have to be that different entities in the current health care system define Polypharmacy differently.  I have seen it defined as low as two or more medications, but in general it deals with using more than three to five medications or herbal supplements for longer than 90 days in a given year.  In my career I have witnessed shoe boxes filled with medications that have numbered over 20 different medications- especially when dealing with multiple chronic diseases, over the counter medications, herbs, and vitamins.

Where should the caregiver and/or older adult start in trying to deal with their medications?
First, realize that the main problem with polypharmacy is that it increases the clients’ risk for drug interactions.  Drug interactions occur when one medication or herbal supplement reacts negatively with another medication when they are taken together. It is important to report any side effects to your physician.
 
The following are some steps you can take to prevent drug interactions:

• Provide a complete list of your medications and herbal supplements to your physician and/or pharmacist
• Discuss how each medication/herbal supplement works inside the body.
• Verify with your physician that you are receiving the recommended dose of each medication/herbal supplement.
• Verify with your physician that you are receiving the recommended form of each medication/herbal supplement you are taking (pill, liquid, tea, extract).
• Determine how many times a day your medications/herbal supplements should be taken.
• Discuss any side effects that might be experienced.
• Discuss the common prescription medication interactions.
• Discuss the common herbal supplement interactions.

If you can not complete a list of medications, take them all into your physician or pharmacist and have a list made for you. 

The National Institute on Aging is a great resource for learning more about medication managements, herbs, vitamins and safety concerns - learn more by clicking here.

Since I don’t have a healthcare background, I had a very limited understanding of physical therapy.  I thought it was only “prescribed” after an injury or surgery to help with rehabilitation.  I didn’t realize it could be “prescribed” to treat on-going issues often faced by seniors, such as loss of mobility or  balance deficiencies.

We became concerned when my Mother became increasingly unsteady on her feet and had difficulty getting up from a chair.  We thought these symptoms were signs of progressing disease or advancing age and “came with the territory.”  When we shareed these concerns with my Mother’s gerontologist, he ordered a physical therapy evaluation and three physical therapy sessions a week to increase her mobility.  My sister and I were thrilled to learn that exercises could help and that my Mother could be taught techniques to help her get in and out of the car and move around more safely and easily.

Mother has been attending her “exercise class” for about two weeks.  She told me she likes it and that they do most of their exercises while sitting in a chair… so it is not too difficult.  We are thrilled she is paying attention and participating.  Earlier this week, I took my Mother out to dinner.  We were seated in a long, low booth.  As we went to leave, I offered my hand to my Mother to help her up. She looked at me and shook her head and said “No, I need to use my legs.”  And I watched in amazement as she positioned her feet and pushed up with her legs and got out of the booth.  We both reacted with big smiles – because she had “done it herself.”

• Schedule of care events (e.g. medical appointments, therapy, geriatric care visits)
• Medical issues (e.g. Alzheimer's, arthritis, incontinence, congestive heart failure, diabetes, COPD)
• Health provider contact information and specialties
• Medication list including dosage, frequency, prescribing physician, and other specifics
• Recent Hospitalizations
• Client contact information
• Updates on key issues of aging such as Caregiving, Advanced Directives, Living Independently, Family Communications, Depression, and more
• Resources
• and more

It also supports secure, private interactivity with the Health Care Manager providing geriatric care for the family using tools like a discussion board, contact logs documenting visits and phone conversations, and posting of care goals like improving home safety, reducing isolation, improving depression, improving mobility, supporting treatment plans, and so on.

An Alzheimer's patient once came to me after he had got out of his house and was found hours later in a ditch approximately 2 miles from his house.  Wandering is often a scary symptom of Alzheimer's disease and dementia.  It's confusing and scary for a senior who does not know where he/she is or where they are going; and is scary and worrisome for family caregivers.  Wandering can occur anytime but tends to increase in the late afternoon/early evening hours.  There are several things caregivers can do to keep their loved ones safe at home. 

Tip #1:  Use deadbolts on doors leading outside, place them high or low on doors
Tip #2:  Take locks off of bathroom and bedroom doors to avoid your loved one from locking themselves in
Tip #3:  As the sun starts to go down, close the blinds/curtains and turn lights on
Tip #4:  Install appliances that shut off automatically
Tip #5:  Keep toxins i.e. cleaners, bleach, poisons; and prescription medications in a safe, secure space
Tip #6:  Remove clutter from around the house
Tip #7:  Install a door alarm or place a motion sensor in your loved one's room at night to alert you when they are awake and moving
Tip #8:  Label doors, drawers, and cabinets; this is most helpful in the earlier stages

A professional geriatric care manager can help you in reviewing your home and finding assistance for home modifications.  For more tips and information, check out The Complete Guide to Alzheimer's-Proofing Your Home and home modification tips.

Summer is officially here... and the heat waves begin. Did you know that more people die from heat waves each year than from hurricanes, lightning, tornadoes, floods, and earthquakes combined?? (CDC)  As a caregiver or friend, how can you help keep your loved ones safe?

Older adults are particularly vulnerable to the effects of heat stress because the elderly do not adjust as well as younger persons to sudden changes in temperature.  Also, an older adult’s chronic illness may affect how his/her body responds to heat and many older adults take medications that impair the body’s ability to regulate its temperature or medications that inhibit perspiration.  

Heat stroke is the most serious heat-related illness. It occurs when the body becomes unable to control its temperature: the body's temperature rises rapidly, the body loses its ability to sweat, and it is unable to cool down. Body temperatures rise to 106°F or higher within 10 to 15 minutes. Heat stroke can cause death or permanent disability if emergency treatment is not provided.
Warning signs for heat stroke vary, but may include the following:

    - An extremely high body temperature (above 103°F)
    - Red, hot, and dry skin (no sweating)
    - Rapid, strong pulse
    - Throbbing headache
    - Dizziness
    - Nausea

According to the CDC, you can help protect elderly relatives and neighbors who are at risk by:

    - Visit him/her at least twice a day and watch them for signs of heat exhaustion or heat stroke
    - Take him/her to air-conditioned locations if they have transportation problems
    - Assist them in obtaining air-conditioning
    - Make sure older adults have access to an electric fan whenever possible.

Heat wave deaths can be prevented. For more information, visit these links:

http://www.hhs.gov/disasters/emergency/naturaldisasters/heat/index.html 

http://www.epa.gov/aging/resources/factsheets/index.htm#itdhpfehe

June is Home Safety Month.  Have you assessed your parents’ home and developed a disaster plan?  With all the environmental issues that are in the news, it’s a good time to review home safety and develop a disaster plan for parents or the special older adult in your life. The focus of this blog is on falls, which are the number one safety risk for older adults. Nearly one third of America’s older adults fall each year, with seventy percent of these falls occurring at home.

Ten Tips for Home Safety – Fall Prevention

1. Remove all throw rugs; if one cannot live without throw rugs, make sure they are secure with non-slip backing
2. Install grab bars in bathroom, especially in the shower/tub
3. Provide adequate lightening, especially around stairwells and pathways 
4. Keep a flashlight by the bed 
5. Use a nightlight 
6. Keep pathways clear of objects, especially electric cords
7. Remove clutter
8. Make sure the handrails on stairways are accessible and sturdy
9. Check carpets for any tears and/or holes
10. Review all medications- prescriptions, over the counter, herbs, and vitamins with doctor and/or pharmacist to reduce risk of dizziness and weakness 

Other areas of home safety for older adults is same as for others:

• Make sure to have a working smoke detector on each level of the home 
• Have a fire extinguisher on each floor
• If there is someone in the home using oxygen, make sure there is an oxygen awareness sign and that no one smokes in the area where there is oxygen
• Make sure there is a working carbon monoxide detector on each level of the home
• Keep a telephone within easy reach with numbers large enough to see in hurry
• Have a disaster plan
• Have a fire evacuation plan

Resource:  The Home Safety Council (HSC) website, www.homesafetycouncil.org, offers more information, illustrated handouts, and virtual home safety tour.

Look for next week’s blog addressing key components of a disaster plan of an older adult.