Inside: Caregiver SOS | Nutrition News | Aging Simulation | Product Spotlight
February 2018 Edition
Elder orphans: Aging alone See page 10 Published by
Almost half of Canadians would not want others to know if they had dementia T
he Alzheimer Society recently announced that while awareness about dementia has increased, stigma and negative attitudes around it continue to persist. The Society released findings of a new survey to coincide with Alzheimer’s Awareness Month in January and to kick off its new social awareness campaign — I live with dementia. Let me help you understand — to spark conversations and encourage Canadians to see dementia differently. The Leger-led survey, which questioned 1500 Canadians between the ages of 18 and 65 online, also reveals that 46 per cent of respondents would feel ashamed or embarrassed if they had dementia, while 61 per cent of those surveyed said they would face discrimination of some kind. The survey also shows that one in four Canadians believe that their friends and family would avoid them if they were diagnosed with dementia, and only five per
cent of Canadians would learn more about dementia if a family member, friend or co-worker were diagnosed. “These results validate our thinking, that stigma is one of the biggest barriers for people with dementia to live fully with dignity and respect,” says Pauline Tardif, CEO at the Alzheimer Society of Canada. “The findings underscore the work we must still do to end stigma once and for all. There is no shame in having dementia. We can’t let negative perceptions stand in the way of people with dementia seeking help and support. Life without discrimination is a right for anyone affected by this disease.” To tackle stigma, the Alzheimer Society is letting the experts do the talking — people living with dementia. People like Roger Marple. For this proud father and grandfather, who developed young onset Alzheimer’s three years ago at age 57, his diagnosis was a tough pill to swallow. But with time, Roger
overcame his initial shock and sadness. He had too many dreams to pursue. “I still do things that have meaning in my life, like getting out, playing golf and travelling. I’ll continue to enjoy life for as long as I possibly can to the best of my abilities. Isn’t that what we all aspire to do?” Roger and others invite Canadians to hear their inspiring stories and take a few pointers from them on how to be open and accepting towards people with dementia. Their stories are featured on a dedicated campaign website, where visitors will also find tips on how to be more dementia-friendly, activities to test their knowledge, and other resources to take action against stigma and be better informed about a disease that has the potential to impact every single one of us. To help stop stigma and read the full survey, visit ilivewithdementia.ca — and use the hashtag #ilivewithdementia to help spread the word. LC
Additional survey results Canadians believe that people with Alzheimer’s disease or another form of dementia are likely to • be ignored or dismissed (58 per cent); • be taken advantage of (57 per cent); • have difficulty accessing appropriate services or supports (56 per cent); and • be feared or met with distrust or suspicion (37 per cent). Other highlights • 56 per cent of Canadians are concerned about being affected by Alzheimer’s disease. • Of greatest concern is their fear of being a burden to others, losing their independence and the inability to recognize family and friends. • Only 39 per cent would offer support for family or friends who were open about their diagnosis. • Three-in-ten Canadians (30 per cent) admit to using dementia-related jokes. Quick facts • Today, over half a million Canadians have dementia (including Alzheimer’s disease). • In less than 15 years, an estimated 937,000 Canadians will have dementia • Alzheimer Societies across Canada provide programs and support services for people with all forms of dementia, including Alzheimer’s disease, and their caregivers.
This article was provided by The Alzheimer Society of Canada. 2 Home and LongTerm Care News FEBRUARY 2018
contents February 2018
Cover story: Elder orphans
Six minute challenge
4 5 8 16 18 20 21 23 24 27
Behaviour changes after a stroke
Senior sector innovation
Editor’s Note Frailty Digital health Cultural sensitivity Nutrition news Caregiver SOS Winter risks for seniors Artificial intelligence and Alzheimer’s Product Spotlight Preventing dementia
26 Caring for dentures
Activities and games for Alzheimer’s
Missing senior in Whitby, Ontario I f you live in the Durham Region east of Toronto you may have heard about James (Jim) Pearson. He is an 89 year old man with what a family member describes as “very extreme loss of memory, though he has not been diagnosed with Alzheimer’s.” He was last seen on January 13th at his home near downtown Whitby. As of today (Jan 23rd) he is still missing. This past November I had the pleasure of driving this same Jim Pearson home after he became lost and I found him wandering up and down my street, about 2.5 km from his home. He asked me for directions to his street and I quickly realized he wasn’t just lost – he had forgotten how to get home. It was cold and he told me he had been walking for a while so I offered to drive him home. Grateful and relieved he got in my car and within a few minutes I dropped him at his door. I asked him if this had happened to him before and he said that sometimes he forgot things and made a wrong turn here or there. I softly suggested he mention it to his doctor and was hoping to speak with someone in his family but he lived alone and quickly got out of my car and hurried inside after thanking me profusely. When I saw the photo and press release that Jim was missing my heart sank. Having had a grandfather who suffered from Alzheimer’s disease I know firsthand the challenges this disease brings to family and loved ones. In the case of my grandfather, he absolutely refused to move in with family so that we could ensure his safety (after he was found wandering and couldn’t get home several times). Ultimately, my father had to invoke his status as Power of Attorney and force my grandfather to live with him. It was very difficult for everyone. Fortunately, with the assistance of a personal support worker and 24-hour care we were able to keep my grandfather safe, but this is just not an option for many families of seniors with dementia. Not every
610 Applewood Crescent, Suite 401 Vaughan Ontario L4K 0E3 TEL. 905.532.2600 FAX 1.888.546.6189
email@example.com Advertising Representative
firstname.lastname@example.org Accounting Inquiries
email@example.com Circulation Inquiries
UPCOMING DEADLINES MARCH 2018 ISSUE family is in a position to provide care and many families may be unaware of how dire the situation with their loved one is. If you have a family member with dementia who is still living independently it’s important to plan ahead and be proactive. Your loved one may be adamant on remaining independent and with new technology it is possible. From GPS devices to Medic Alert bracelets, there are now ways to improve safer independent living for people who wander and get lost. Families can also reach out to the The Alzheimer Society of Canada for information and tips on preventing wandering. Jim Pearson was last seen in Whitby, he is described as male, white, with grey hair and five-foot-five-inches tall and approximately 110 pounds. He was wearing a black Giants toque, a heavy, navy blue, down-filled coat that goes to his knees. He was possibly wearing track pants and running shoes. His photo is available on the Durham Regional Police Services’ website. Anyone with any information about Pearson’s whereabouts is asked to call Det. McFarlane of the Central West Criminal Investigations Bureau at 1-888-579-1520, ext. 1835 LC
Kristie Jones Editor, Hospital News
4 Home and LongTerm Care News FEBRUARY 2018
EDITORIAL: February 12 ADVERTISING: Booking and Material — February 20
APRIL 2018 ISSUE EDITORIAL: March 12 ADVERTISING: Booking and Material — March 20
Home and Long Term Care News is published for consumers who are supporting and/or involved in home care or long term care. It is available free of charge from distribution racks in hospitals across Ontario. The statements, opinions and viewpoints made or expressed by the writers do not necessarily represent the opinions and views of Home and Long Term Care News, or the publishers. Home and Long Term Care News and Members of the Advisory Board assume no responsibility or liability for claims, statements, opinions or views, written or reported by its contributing writers, including product or service information that is advertised. Changes of address, notices, subscription orders and undeliverable address notifications, and inquiries can be sent to: firstname.lastname@example.org Subscription rates in Canada for single copies is $35.00 per year. Canadian Publications mail sales product agreement number 42578518. From the publishers off Hospital News, reporting on health care news and best practices for over 30 years.
Including the voices of persons living with frailty in healthcare decision-making Older Canadians say their top priorities are better coordinated care systems and more community and home-based supports By Katherine McGilton and John Muscedere oday, over one million Canadians are medically frail — approximately 25 per cent of those over age 65 and 50 per cent past age 85. The aging of Canadian society and the growing number of older adults living with frailty poses unprecedented societal and medical challenges which will only increase in the coming years. In 10 years, over two million Canadians may be living with frailty, which is defined as a state of increased vulnerability, with reduced physical reserve and loss of function across multiple body systems. Frailty reduces a person’s ability to cope with normal or minor stresses, which can cause rapid and dramatic changes in health. Frailty isn’t simply getting older. The risk of becoming frail increases with age, but the two are not the same. Those living with frailty are at higher risk for negative health outcomes and death than we would expect based on their age alone. To meet the challenges of increasing numbers of Canadians living with
THE RISK OF BECOMING FRAIL INCREASES WITH AGE, BUT THE TWO ARE NOT THE SAME. frailty, we’ll need to begin to reorganize how we provide both social supports and restructure the healthcare system to meet their needs — a tall order. Key to the successful transformation of the Canadian health and social support landscape is evidence informed by persons living with frailty, their families and caregivers. Call it patient-centred care or a value agenda, we need to include the lived experiences of patients and families in how we do research, plan and care for them. So what do they say is a priority when we take the time to ask them? The Canadian Frailty Network embarked on a study to establish priority areas for researchers from the perspective of Canadians living with frailty, their caregivers and related stakehold-
ers. This study asked older Canadians what they believe are the important questions related to the care, support and treatment they think would help maintain physical, mental and social well-being for older adults. What we found was that their top priority concerned the organization of health systems. Older Canadians told us they want integrated and better coordinated care that would meet both their health and social care needs and those of their families and caregivers. Not surprisingly, given Canadian geography and the fact that so many older Canadians live some distance away from family, the second priority was that care, services and treatments should be tailored to meet the needs of older Canadians who are isolated and/or without family and caregiver support or advocates. Their third ranked priority involved having more community and home-based services, programs and resources to prevent, manage or slow the progression of frailty or minimize its impact.
The remaining priorities cover a wide range including providing alternative models of housing, such as multigenerational or shared living options; resources to reduce unnecessary hospitalizations and emergency department visits; and better and more-informed attitudes and skills from those providing care and services to those with frailty. Older adults must have a voice in policy and program priority setting if we are to implement systems that are responsive to their needs. The need for patient involvement in setting both frailty research and policy priorities is particularly urgent since older adults have historically been underrepresented in decision-making in health and social care systems. Priority setting with the voices of older adults can only make the health and social services systems better — for everyone. As our society ages, and as we begin to manage the challenges that come with an aging society, let’s make sure to listen to the voices of those living with frailty. LC
Katherine McGilton is a Senior Scientist at the Toronto Rehabilitation Institute-UHN, a Professor in the Lawrence S Bloomberg, Faculty of Nursing at the University of Toronto and a Network Investigator with Canadian Frailty Network. John Muscedere is the Scientific Director and CEO of the Canadian Frailty Network (CFN). He’s also an Expert Advisor with EvidenceNetwork.ca, Professor of Critical Care Medicine at Queen’s University and an intensivist at Kingston General Hospital. www.longtermcarenews.ca
FEBRUARY 2018 Home and LongTerm Care News 5
NEWS PRED-FALL trainees test the effectiveness of compliant flooring and wearable hip protectors with their “hip impact simulator.” Photo credit: Injury Prevention and Mobility Lab, Simon Fraser University
Preventing falls and reducing injuries when they happen By Sean Mallen e did not know it at the time, but the boyhood experience of helping his grandmother navigate the icy sidewalks of Winnipeg was a motivator for Steve Robinovitch’s research as an adult. “More and more I could see the physical and psychological effects of aging on her ability to maintain mobility,” he says. “She was very brave but also fearful of falling.” They were well-founded fears. Most of us have heard the stories of an older relative falling, breaking a hip and then going into a decline leading to an earlier death. Statistics support the anecdotes. Injuries suffered by older adults in falls cost about $3.5 billion a year in
Canada. About 25 per cent of older adults who break their hips will die within the year. Increasingly researchers are noting that traumatic brain injuries are also exacting a terrible toll — accounting for close to half of the deaths related to falls. Falls are the number-one reason for people having to enter care homes. “The costs are enormous for both the individual and their family members,” says Dr. Robinovitch. A Professor in the School of Engineering Science and the Department of Biomedical Physiology and Kinesiology at Simon Fraser University, Dr. Robinovitch is the co-lead of a research project called PRED-FALL: Technologies to Predict, Prevent and Detect Falls. The project is supported by AGE-WELL,
6 Home and LongTerm Care News FEBRUARY 2018
Canada’s Technology and Aging Network. The PRED-FALL research team is conducting innovative research using networks of video cameras to understanding the circumstances of falls in long-term care. They are also developing a wearable sensor system that can transmit sophisticated information about mobility patterns and falls. The product might rely on sensors based in a smartphone or wrist-watch. Such a device may deliver early warning signs of risk for falls, and provide real-time feedback to assist in exercise and rehabilitation. “Wearable sensor systems are providing us with the ability to monitor both the quantity and quality of movement as people go about their daily activities.
The challenge is working together with care providers, older adults and researchers to agree on the most relevant outcomes, and to address the barriers to adoption,” says Dr. Robinovitch. The PRED-FALL team is also field-testing innovations that hold great promise. Among them: a technology called “compliant flooring”. They worked with an industry partner to modify an existing flooring sublayer called “Smart Cell” that was designed for workers who need to be on their feet for long hours. It feels like a normal floor, but beneath the surface are banks of columns that compress when an object forcefully strikes them, and then pop back up afterwards. “You can actually drop an egg on it and the egg bounces back,” says project www.longtermcarenews.ca
co-lead Dr. Fabio Feldman who is the Manager of Seniors Fall and Injury Prevention at Fraser Health (and a former student of Dr. Robinovitch’s at SFU). The PRED-FALL team is testing the concept through a clinical trial in 150 rooms in a care facility — half were randomized to get compliant flooring, and half were renovated with a control flooring. The results will not be known until later this year, but research in the lab would indicate that it could make a real difference on the frequency of hip fractures and head injuries. “It’s a relatively simple but promising intervention,” says Dr. Feldman. Compliant flooring represents a shift that Dr. Feldman promotes — especially for long-term care — from thinking not only about fall prevention, but also injury prevention. “There is a risk that, if staff focus only on fall prevention, they may dis-
INJURIES SUFFERED BY OLDER ADULTS IN FALLS COST ABOUT $3.5 BILLION A YEAR IN CANADA. ABOUT 25 PER CENT OF OLDER ADULTS WHO BREAK THEIR HIPS WILL DIE WITHIN THE YEAR courage residents from physical activity because they’re afraid the person is going to fall. And then quality of life goes down for the residents,” says Dr. Feldman. “An advantage of the flooring is, once it is installed, you don’t need to rely on user acceptance and adherence in adopting the technology — it’s what we refer to as a “passive” form of prevention. Of course, we need evidence on clinical and cost effectiveness to support installations. These are two outcomes of our clinical trial.”
Along with the examination of existing products, the researchers are designing their own versions of compliant flooring. They are seeking to strike a balance — to create something that will cushion falls, but not be so soft as to limit the movement of wheelchairs and other equipment, or impair balance. In addition, PRED-FALL is developing the next generation of wearable hip protectors. Even though hip protectors have been shown to be effective, reducing the risks of fractures by as much as 80 per cent, the challenge has been convinc-
ing people to wear them consistently. In addition to comfort and appearance, the garments require frequent laundering, and can complicate toileting. Dr. Feldman says that their solution is to eliminate the garment and instead use pads that attach directly to the person’s skin using skin-friendly double-sided tape. It means that the pads can be worn for up to 21 days and do not need to be removed for visits to the bathroom. The product is undergoing clinical trials and a local company is poised to get it to market. Now, many years after watching his grandmother cope with the fear of falling, Dr. Robinovitch takes satisfaction in pursuing research that is preventing older people from fall-related injuries. “It’s immensely valuable to me that our work is contributing knowledge that could improve the lives of older adults. It’s a major motivation for me.” LC
Sean Mallen is a Toronto-based writer and communications consultant. AGE-WELL is a federally funded Network of Centres of Excellence that is harnessing the power of new technologies to benefit older adults and caregivers. The pan-Canadian network brings together researchers, industry, nonprofits, government, care providers and end-users to develop solutions for healthy aging. For more information, visit http://agewell-nce.ca/
Your Home Healthcare Provider of Choice
Providing quality, experienced healthcare professionals wherever you call home.
FEBRUARY 2018 Home and LongTerm Care News 7
A session at the Canada Health Infoway 2017 Partnership Conference.
Connecting for Digital Health By Karen Schmidt he Canada Health Infoway (Infoway) 2017 Partnership Conference was a resounding success, hosting a record number of 339 attendees who came together in Calgary, Alberta from November 14-15 to network, share experiences and Connect for Digital Health. We chose Connecting for Digital Health as the conference theme because Infoway and its partners are now focusing on making and enabling the connections that will give Canadians access to health services, and their health data, electronically.
Better access means more convenient and efficient health services, such as PrescribeITTM, Canada’s new national e-prescribing service that enables a prescriber to electronically transmit a prescription to a patient’s pharmacy of choice. Better access also means providing a gateway to personal health information and support tools through things like virtual services and portals. These kinds of connections enable patients to be better informed and better able to collaborate with their care teams to improve their health and healthcare. This approach will trans-
8 Home and LongTerm Care News FEBRUARY 2018
form the way healthcare is delivered, benefiting patients and their families, clinicians, health organizations and Canada’s health systems. It’s win-win for everyone. Conference delegates heard from an impressive array of national and international speakers who discussed opportunities and addressed the challenges of transforming healthcare delivery in Canada. For example: • Andrew Slater, Chief Executive Officer of Homecare Medical New Zealand, spoke about the journey to develop innovative virtual mental
health services at scale in New Zealand and how more than one million people were connected in just 16 months; • Mariann Yeager, CEO of The Sequoia Project, the leading interoperability organization in the United States, shared insights about building nationwide health data sharing initiatives, which enable exchange across disparate geographies, vendors, technologies and networks; and • Dr. Alikah Lafontaine, Medical Lead (North Zone) for the Aboriginal Health Program within Alberta
NEWS Health Services, addressed the unrealized potential for digital health to impact Indigenous Peoples, and how digital health innovators, providers and regulators can align their efforts by focusing on community-based priorities. In addition, delegates heard from patients and industry experts who talked about: technologies that will support and enable connections; clinician leadership in using digital technologies; data governance; privacy; cybersecurity; medication safety and patient engagement. Members of Infoway’s Board of Directors also joined Infoway’s President and CEO, Michael Green, to talk about the next wave of health innovation in Canada. Patients were instrumental in the success of Partnership 2017. Patient Advisors Garry Laxdal and Darlene Gallant worked with Infoway from the earliest stages of planning to shape the program themes, select speakers and advise about
patient scholarships. They and other patients were also active participants in the two-day program. As a result, we are proud to say that Partnership received Patients Included accreditation for the second straight year. “Having patients here, I think, serves to remind everybody of what events like this are really all about, that patients are the focus of the whole healthcare system and everything that we’re doing,” says Colleen McGavin, a patient from Victoria, British Columbia. “I am impressed at the incredible innovation and different things that came up from everybody,” says Iris Kisch, a patient from Calgary. “The learnings were unbelievable. And I know I am proud to walk shoulder to shoulder with everybody that was there as an equal partner in healthcare.” For the second straight year, the conference was held during Digital Health Week (November 13-19), the annual celebration of all things digital health.
The week included a number of activities led by Infoway and supporting organizations, to recognize the progress we have made together to improve the health and lives of Canadians through innovative digital health solutions. Besides having a record number of attendees, the conference reached a broader audience through live webcasts of the opening keynote sessions each day. The webcasts reached 334 people, including 100 who tuned in from the Canadian Home Care Association 2017 Home Care Summit in Halifax, Nova Scotia. The inspiring discussions that took place at the conference extended into social media platforms with the #ThinkDigitalHealth hashtag collecting 6.6 million impressions. It also included three Facebook Live videos resulting in 2,056 views. “More healthcare should look like this conference,” says Jessica Havens, a patient from Calgary. “More health
care should involve patients from the beginning, before anything happens, and while it happens, we should be in an ongoing dialogue. Healthcare needs to become more of a dialogue, and that’s my biggest takeaway (from the conference), using digital health to create that dialogue.” If you missed attending the conference in-person or virtually, or contributing to the conversation on social media, you can access some of the recorded sessions, and the PowerPoint presentations online. Infoway wants to thank our generous sponsors and everyone who participated in the 2017 Partnership Conference for sharing their time, insights and experiences. Connecting for Digital Health was our goal, and we achieved it. We look forward to welcoming everyone to our next Partnership Conference, which will be held November 13-14, 2018 in Montreal, Quebec. LC
Karen Schmidt is Director, Corporate Communications at Canada Health Infoway.
Personalized home care services At Bayshore Home Health we understand that leaving home can be a challenge and that staying at home is the best ŽƉƟŽŶĨŽƌĂůŽƚŽĨŽůĚĞƌĂĚƵůƚƐ͘ƐǇŽƵƌ neighbourhood care provider, we are ŚĞƌĞƚŽƐƵƉƉŽƌƚǇŽƵĂŶĚǇŽƵƌĨĂŵŝůǇ ƚŚƌŽƵŐŚĞǀĞƌǇƐƚĞƉŽĨƚŚĞĐĂƌĞƉƌŽĐĞƐƐ͘ FREE IN-HOME CONSULTATIONS NO LONG TERM CONTRACTS BONDED & INSURED CAREGIVERS
Support is just a phone call away. 1.877.289.3997 www.longtermcarenews.ca
www.bayshore.ca FEBRUARY 2018 Home and LongTerm Care News 9
will demand different services to fill different needs By Susan Hyatt
10 Home and LongTerm Care News FEBRUARY 2018
ew trends generate new terms and one you are going to hear a lot more about is elder orphans. They are Baby Boomers who are childless or estranged from their families, and living without a partner to care for them. There is little research on them in Canada or elsewhere, but we do know from the 2016 Canadian census that 33 per cent of seniors aged 65 and older are women who live alone, and 17.5 per cent are men who live alone. Also, there is a growing number of ‘grey divorces’ in Canada or, as the Vanier Institute calls them, ‘silver separations.’ These are divorces among elderly couples. Data for the period 1985 to 2005 shows a gradual increase in divorce rates for men aged 50-54 years from 7.2 to 11 per cent, and for women, from 5.4 to 8.9 per cent. The Vanier Institute cites the work of U.S. sociologist Susan Brown of Bowling Green State University who sees an emerging trend among divorced couples aged 40-69, with women initiating the divorce 66 per cent of the time. A late-in-life divorce can have significant financial impact, and the changes in economic security can be difficult for women, especially if they live alone. Her research focuses on family events and the transitions made throughout life with an emphasis on the implications of the rapid transformation of family life for the health and well-being of adults and children. Why should we be concerned about elder orphans? These people can become socially and/or physically iso-
WHY SHOULD WE BE CONCERNED ABOUT ELDER ORPHANS? THESE PEOPLE CAN BECOME SOCIALLY AND/OR PHYSICALLY ISOLATED WITHOUT ANY FAMILY MEMBER OR CAREGIVER AROUND TO HELP THEM lated without any family member or caregiver around to help them. They may be reluctant to appoint Power(s) of Attorney to help them if they are incapacitated and cannot speak for themselves. And with no family or partner they may not have told anyone about their express wishes or choices known where it concerns making decisions about future care or future living accommodations. Today church congregations and healthcare providers are talking about elder orphans. There is worry in the community that this group is vulnerable, and as they reach their later years they are susceptible to all kinds of scams and elder abuse. Even identity theft. Planning is crucial at all stages of life and especially crucial for people in this group. Here are some important questions to ask: • How should elder orphans start to plan ahead? • Who can help them should they have serious surgery or a terminal illness? • What happens to their assets after they die if they don’t have a will? (Today 48 per cent of Canadians do not have a will, never mind one that is up to date.) Elder orphans are more prone to
suffer from loneliness and social isolation if they have no family and are not part of a vibrant community. This is why they must get their legal issues cleared up, and this may require an estates attorney who is familiar with estate planning. This will involve drawing up a will, and drafting Powers of Attorney in the event that one day you are incapable of making decisions for yourself. Then there are such matters as shopping for basic daily items, managing medical appointments, and staying active and social. The latter point can be especially daunting for an elderly person aging alone. In the United States an Elder Orphans’ Facebook Group got started in 2016 and over the first year it gained 5,000 new members. Today it serves as a support and self-help group, and for many of these people it may be the only support they get. “Most of the members are very grateful to have found us and realize that there are so many more like them,” says Carol Marak, who started the group. She is a recognized authority on older adults aging alone and an editor at www.seniorcare.com. “We all share the same grievances, the same hardships and challenges,” Carol says. “We give support to peo-
ple who are going into surgery or who have had an emergency or some sort of medical event, and I cannot tell you how supportive that feels for the people who are going through an incident like that.” Looking to the future with a growing aging population, consideration will have to be given to services that elder orphans will need. Who will act as their Powers of Attorney if they have no one? There needs to be a trusted community of people to whom an elder orphan can turn when they need help. For example, churches have elder orphans in the congregation, but they may also have retired police officers, firefighters, medical specialists, not to mention lawyers, who can lend a helping hand. Why not set up a group of these people within the congregation? Another benefit of this is that such friends and trusted peers of elder orphans can serve as an oversight of the appointed Power of Attorney to ensure that the person’s best interests are addressed. Likewise for the healthcare system. It is a prime time to be considering what the options are for smart aging. The fact is that many Canadians will age alone as elder orphans. Professional associations of healthcare workers could start addressing these concerns through regular education sessions, and include eldercare issues in all their discussions that involve preparation for retirement. Canada has a greying workforce. We need to think about elder orphans and plan ahead. As the saying goes, an ounce of prevention and early discussion is worth a pound of cure. LC
Susan Hyatt is the CEO of Silver Sherpa Inc. Her company offers clients a Personalized Living Plan™ for smart aging. For more information visit: https://www.silversherpa.net Susan Hyatt can be contacted at email@example.com. www.homeandlongtermcare.ca
FEBRUARY 2018 Home and LongTerm Care News 11
Empathy is a strong suit
Aging simulation offers Sienna’s senior executive a personal perspective
By Drew Tapley is jumpsuit is tightened by straps that bend him over to restrict his movements. Weights are applied to his arms and legs to burden motion. During this whole process, his only remarks are to confirm if something is too tight or uncomfortable; which of course it is. It’s designed to be. Brian Richardson is wearing an aging simulation suit at Baycrest Health Sciences in Toronto — a global leader in geriatric research with a focus on brain health. He is the Chief Marketing Officer at Sienna Senior Living, and was invited to try on the suit and participate in a senior role-play experience, observed by his team. Baycrest’s manager of training and simulation, Lisa Sokoloff, yanks the straps down. Before she clips them into place, she checks that he is okay. The more straps and weights she adds, the more assurances she needs. Once the neck brace goes on, thick yellow-lens goggles are placed over almost half his face, followed by ear plugs and gloves. It’s all designed to demonstrate an intimate insight into the everyday experience of a senior with advanced years, reduced range of motion, rapidly failing eyesight and hearing loss, and dementia-related confusion. Someone asks if he’s hot inside the suit. “It’s not hot as much as very awkward and restraining,” says Brian, visibly flustered. Lisa makes an announcement to Brian’s colleagues, who are gathered around him. “Once we start the simulation, please don’t engage with him. We want him fully immersed in the experience.” She explains what is about to happen, how long it will last, and whether anyone has any questions. Then she
exits the room as Brian sits on a chair adjusting the goggles to find a more comfortable fit. He soon discovers there isn’t one. Lisa re-enters in the role of a healthcare worker overseeing a medical appointment in a busy clinic or hospital. “Brian? Come with me. Let’s go!” she says, her tone abrupt and cold. “We’re really backed up today so I need you to hurry it along, please.” He stands with the use of a cane and is led into the corridor, where he ambles along slowly, his confidence eroding with each step.
“Can you go any faster, please?” asks Lisa the healthcare aide. “I can’t!” responds Brian with brittle honesty. After walking down a corridor and into another room, he’s told there is a table with some forms. The lights are off. He proclaims that he can’t see. They are turned on. It’s clearly an afterthought. He’s asked, or rather told to read and sign medical consent forms so they can move on with the procedure. “I’ll be back in a second,” she announces, and he’s left alone with the forms to
read and sign before her prompt return and a matronly scolding for not having signed them yet. “Brian, what’s the holdup here?” she asks, clearly annoyed. The pen that’s been left for him is actually a drinking straw, quickly swapped for a pen. By way of an explanation as to why he’s being rushed around, he’s told that they are behind today because somebody phoned in sick. “You know what that’s like,” she says. It’s more of a statement than a question, and another order is issued on its heels for him to vacate the room and
Drew Tapley is a Writer at Sienna Senior Living. 12 Home and LongTerm Care News FEBRUARY 2018
NEWS Opposite page: Brian Richardson of Sienna Senior Living is assisted into the aging simulation suit by Lisa Sokoloff, Manager of Simulation and training at Baycrest Health Sciences. Right: The simulation suit is designed to demonstrate an intimate insight into the everyday experience of a senior with advanced years.
head next door for the procedure. The simulation is exaggerated, of course, to drive home a clear message. In another room with boxes everywhere and limited floor space, Brian is directed to a gown that he’s expected to put on himself, much to his dismay. “So, I am literally supposed to put this on?” he asks while lifting a folded gown off a bedside cabinet. “Yes, please. It ties in the back,” she states before walking off. Eventually, she heads back over and helps him with the gown before instructing him to “Just hop up on the bed.” He replies with thinly-veiled frustration, “I don’t know about hop!” And then the experience is over after just seven minutes. Brian wastes no time in removing the goggles, weights and suit. “It was really awkward,” he says with palpable relief. “The goggles are disorienting with a huge reduction in range and depth of vision. I felt anxious, confused and frustrated, both at the healthcare worker and myself for my loss of control. It was all very unnerving.” Brian admits that he would never normally sign something without reading it. “I relented. I just did,” he says. “And that’s atypical of me. I would normally have said something about the way I was being treated, but I felt vulnerable and was much more tolerant than I otherwise would have been. I feel like I’m not that far away from all of this, so it’s particularly hard hitting for me. “When I next go into one of our residences, I will have a different perspective. And this was only a few minutes. I’ve done deep sea diving with weights and never felt that combination of sensations before. This experience will definitely help me rethink the way we approach marketing and communications for our residents.” LC
FEBRUARY 2018 Home and LongTerm Care News 13
Behaviour changes following a stroke manageable pieces and explain each task. Alternate between difficult and easy tasks and tackle the more complex ones only when the resident is well-rested. Offer support or assistance when the resident becomes frustrated. • Always assess for pain since untreated pain can lead to anger. Pain is very common after stroke, particularly shoulder pain which occurs in up to 72 per cent of stroke survivors.
he loss of or damage to brain cells due to a stroke can change how a person feels and behaves. While some residents show little or no change in behaviour, others may exhibit significant changes depending on the area of brain that was damaged, how severe the damage was and how long ago the stroke occurred. Behaviour change may also be a response to the life-changing impact of the stroke itself. A resident’s personality, thinking, understanding and coping strategies before the stroke can also impact on behaviour. Their behaviour may change over the course of the day or the week. It is important to understand that the resident may not be aware of the changes (agnosognosia) and/or may not realize how their behaviour is affecting others. The following are behaviour changes which may be observed following a stroke:
A resident who has damage to the right side of their brain may develop apathy or a lack of interest in daily activities or leisure activities. These residents may be unwilling to complete a task or, if they have previously failed at a task, will be unwilling to attempt it again. Helpful strategies • Support the resident by finding out where their interests lay. • Help them to participate in related activities. This may mean using assistive devices such as card holders or adapting activities to meet their current abilities. • If a resident is unable to complete a particular task, encourage them to try again but do not force their participation. Respect their decision and try again at another time.
ANGER AND AGGRESSION
Some residents may experience anger more frequently, have less control over outbursts and/or get angry over things that wouldn’t normally bother them. These behavioural changes are not attention seeking. They may be the result of the brain damage and the resident cannot control these feelings. Anger may also be a response to the resident’s loss of independence, pain, difficulty communicating, fatigue and/ or frustration when trying to perform a task that was once easy. Helpful strategies • Look for precipitating triggers to the behaviours and avoid them. • Always approach the resident from
their unaffected side to avoid surprising them. • Provide consistency in routines and respect preferences.
14 Home and LongTerm Care News FEBRUARY 2018
• Explain each task before you begin. The resident may become overwhelmed with complicated tasks. Try breaking the tasks into smaller more
The stroke may have left the resident with cognitive, communication and/or mobility impairments. Their personal appearance may have changed, impacting their willingness to socialize based on fears of how they will be perceived. Adjusting to these effects of stroke can be difficult and residents may develop poor self-image or low self-esteem. As
well, the resident may feel sad and lose their sense of purpose. These feelings can result in the resident refusing to participate in activities and/or withdrawing from activities that they used to attend, negatively impacting their quality of life and recovery. Helpful strategies • Find out what interests the resident. You can do this by talking to them and their friends and family. • Encourage participation. • Assess what interventions might be needed to help the resident participate. Referral to a physio or occupational therapist may be needed. • Consider how best to engage the resident in their self-care, promoting optimal independence. Make it as easy as possible for them to participate in activities.
IT IS IMPORTANT TO UNDERSTAND THAT THE RESIDENT MAY NOT BE AWARE OF THE CHANGES (AGNOSOGNOSIA) AND/OR MAY NOT REALIZE HOW THEIR BEHAVIOUR IS AFFECTING OTHERS IMPAIRED SOCIAL JUDGMENT
The resident may lack control over the decisions they make or the actions and words that they use; they may display inappropriate social behaviour. They may not understand the limits of their abilities and lack insight. The personality of the resident may change subsequent to the stroke; the introvert becomes an extrovert or the easygoing relaxed individual becomes stubborn.
Helpful strategies • Make sure the resident and family understand that these behaviours are a result of the stroke. • Avoid situations where the resident may be required to make decisions beyond their ability. • Make the environment as safe as you can. • Reinforce good actions. When inappropriate behaviour occurs, ensure feedback is provided privately and respectfully.
Remember that the impacts of a stroke are determined by where the damage occurred and will vary with each individual. For all behaviour change, remember that the resident is struggling to cope and may not be able to control their feelings and/ or actions. As well, fatigue is a very common effect of stroke and can negatively impact behaviour so be sure the resident is well-rested. You can help by using patience, respect and a problem solving approach that involves the resident, family and your healthcare team. Consider a referral to social work, recreation therapy and/or behavior supports as an excellent option to support the resident and family. LC
This article was submitted by the Community and LTC Coordinators of Ontario’s Regional Stroke Networks.
WE WILL BE THERE! Nurses PSWs - Alzheimers HCA - Sick Kids Massage Therapy Homemakers Companions
Sitters Foot Care Nurses Drivers Live in Caregivers Denture Services at home Palliative Care
>HP[PUNMVY`V\YUL_[JHSS Royal Canadian Health Care Services Inc.
905.669.5453 Serving all of Ontario including HAMILTON • TORONTO • OTTAWA
24 HOURS 7 DAYS A WEEK www.longtermcarenews.ca
firstname.lastname@example.org www.rchcs.com FEBRUARY 2018 Home and LongTerm Care News 15
Cultural sensitivity By Ellen Kirk-Macri anada is a country rich in cultural diversity. This adds interesting aspects to our society, but it also creates the need for awareness of cultural differences. This is particularly important in the area of healthcare, where added stress can intensify problems associated with a lack of cultural sensitivity.
Providing culturally-sensitive care requires staff to recognize the client’s culture and how it affects the client-staff interaction. This starts with staff learning about the cultures of the people served. Some of the factors that may come into play include: • Some cultures view illness as a punishment not subject to human control. • Some cultures have gender restrictions, which can have an impact on who can provide care, particularly intimate care. For example, in Islam there are rules governing gender interaction, including guidelines defining modest behaviour. But these rules vary by denomination and cultural group, and not all Muslims practice their religion with the same level of strictness. • Some cultures adhere to a strict family hierarchy, which can limit the client’s ability to make his/her own healthcare decisions. • Views on death, dying, and palliative care can also vary from culture to culture. • Some cultures place a high value on the integration of traditional remedies with Canadian medicine. For example, some Aboriginal peoples integrate traditional healing, which may include the use of sacred herbs, healing ceremonies, and healing circles.
The medicine wheel is a symbol that can represent the importance of the balance of the four components of health: spiritual, mental, physical, and emotional.
• Communication can be difficult as a result of language barriers. Nonverbal communication patterns may also pose challenges. For example, in some cultures eye contact is important; in
Aspects of cultural sensitivity • Cultural identification: Identify the • Communication method: Be aware that nonverbal client’s culture and learn about its communications patterns can customs. affect whether the information • Beliefs: Identify religious and spiritual beliefs and take them into is being communicated effectively. account, so they can be respected • Comprehension: Double-check in the care plan. to ensure that the client/family • Language barriers: Identify understands the information potential language barriers and being conveyed. make arrangements with family, • Personal bias: Staff members friends, or outside translators to should always be aware of their ensure the client understands own culture and its implications what is being communicated. to prevent them from having an Outside translators are generally effect on the way they interact the preferred option, as someone with clients. It is important to who knows the client may insert remember is that clients should a bias or use the position of always be treated with respect. translator to speak for the client.
others, avoiding it may be preferred. Caregivers must also examine their own cultural beliefs with an eye to determining if they may impact the delivery of care. While their own beliefs and practices may be very different from those of their clients, staff must remain accepting and respectful of clients’ cultures.
CHECK AND DOUBLE-CHECK
Because of differences in both language and patterns of nonverbal communication, the caregiver may believe the client is providing an affirmative response or acknowledging understanding when, in fact, he/she doesn’t truly understand what has been said. This may be due to misunderstanding of the words used to convey the information or to the cultural belief that an affirmative response is the only polite response. One way to determine if there is true understanding is to ask the client (or a family member when the client is unable to speak on his/her own behalf) to relay the information back in his/her own words. LC
Ellen Kirk-Macri is a nurse and certified diabetes educator. 16 Home and LongTerm Care News FEBRUARY 2018
The six minute challenge By Andy Savela n Ontario, personal support workers (PSWs) have only six minutes to prepare long-term care residents for breakfast, including getting washed, dressed and using the washroom. You may wonder how it’s possible for an elderly person to get ready so quickly in the morning. The simple answer is that it isn’t. Unifor is Canada’s largest private sector union, and we represent more than 315,000 members across the country working in every major sector of the Canadian economy, including approximately 29,000 in healthcare. In early December 2017, Unifor launched an initiative called The Six Minute Challenge, asking Ontarians to attempt to do what PSWs and long term care residents do every day — get ready in the morning in six minutes and post their photos to social media, using #6minchallenge. After taking the challenge, participants are urged to contact their MPP to ask for their elected representative to support the call for four hours of direct, daily care for every long-term care resident. While the results of participants of the challenge have been amusing in some cases — they point to a very serious problem. Long-term care residents are not getting the kind of care they deserve. Similarly, personal support workers are faced with the impossible task of trying to deliver quality care in a dignified and humane way, while working in an assembly-line like environment. In Ontario no minimum standards of care exist for the sector, which means that residents are not guaranteed a certain number of hours of direct care per day, regardless of the needs or seriousness of their circumstances. We asked some of Unifor’s health care members in long term care about the challenges they face at work, here is what two of them said:
Andy Savela spoke about the Six Minute Challenge at Unifor’s Ontario Regional Council in December, in Toronto. “Our residents need four hours of direct care per day so that they can have quality of care with dignity. We are working so hard on a daily basis to give quality care to our residents but it is extremely difficult when you have 13 plus residents to care for. Our residents desperately need more front line workers.” – Kelly, Sault Ste. Marie, PSW for 30 years “No one deserves to die alone. Imagine dying, with no family to comfort you but the PSW taking care of you. Now imagine dying alone because there is not enough staff to spare the time. We need a minimum of four hours of direct care because our residents need us.” – Beckie, Thunder Bay, PSW for 16 years This problem didn’t happen overnight. It has been worsening over the last two decades with chronic underfunding and short-staffing in long-term
care homes. For the last 15 years, our union, joined by other unions, frontline staff members, families and residents, have been calling on the government to establish a minimum standard of care for the sector. Specifically, we are calling on the government to require a daily average of four hours of direct care for all long term-care residents. In November 2017, we were pleased to see the Ontario government unveil Aging with Confidence: Ontario’s Action Plan for Seniors, which included a commitment to a minimum standard of care. While it’s an excellent start and signals a recognition of the crisis within the long-term care sector — it falls short of meeting the needs of residents. For example, a short fall in the plan is that although it calls for four hours of care for each resident, included in these calculations is administrative overhead, vacation and sick time and
other staffing costs. This amounts to millions of misrepresented hours of time, which are not at all going towards direct care for residents. Staffing levels also need to be measurable and enforceable, right across the sector. What is a nice idea on paper often falls away when faced with reality. This is why Unifor is renewing its call on the government to make sure that the rules are in place and regularly enforced so that all long-term care homes comply. Do you wonder if you could get ready in the morning in six minutes? Try and find out. First, watch this short video at www.unifor.org/6minchallenge and then share your results on social media using the hashtag #6minchallenge. Together, we can make a meaningful difference for long-term care residents, but we all must raise our voices in support of four hours of direct care, for every resident, every day. LC
Andy Savel is Health Care Director, Unifor. www.longtermcarenews.ca
FEBRUARY 2018 Home and LongTerm Care News 17
The resident caregiver relationship at meals By Dale Mayerson and Karen Thompson he ability to feed ourselves is a skill learned early in childhood; loss of this ability for aged persons has significant emotional and physical effects. Long-term care residents should be encouraged to maintain their independence and eat by themselves whenever possible. There are, however, many reasons why a resident may require help. Physical and/or cognitive problems can result in a need for assistance with eating. Even those who can eat independently may require help with setting-up their meal and getting started. Supports can range from cueing, partial assistance, adaptive utensils and dishware, up to total assistance. Proper identification of these problems is a key factor so that appropriate interventions can be started promptly, in order to increase nutrient intake and therefore the overall health and well-being of residents. Signs that a resident needs assistance with eating may include poor meal intake, refusal to come to the dining room or lack of interest or focus on meals. Cognitive impairment may result in confusion and behaviors that prevent a resident from eating, or a resident may simply forget how to use utensils, chew and/or swallow. Physical issues such as stroke, severe arthritis or Parkinson’s disease may be related to difficulty with chewing, swallowing, poor vision, or the inability to use one’s arms and hands. Sometimes tremors or physically being unable to be properly positioned to eat may interfere with the ability to eat. The type and level of assistance required to support and maintain a resident is determined by the care team and will change as the resident’s condition progresses. A resident’s abilities can vary from day to day or time of
SIGNS THAT A RESIDENT NEEDS ASSISTANCE WITH EATING MAY INCLUDE POOR MEAL INTAKE, REFUSAL TO COME TO THE DINING ROOM OR LACK OF INTEREST OR FOCUS ON MEALS day. This should be considered when individualizing strategies to assist with eating. While it is important to maintain the resident’s self-feeding skills as much as possible, this must be weighed against the resident’s need for adequate nutrition and hydration intake. Often the agreed upon strategies will include a combination of support with eating and direct assistance with eating. Involving the resident in planning is essential. The caregiver assisting a resident with eating is a very intimate interaction and should be performed with dignity and respect at all times. A positive eating experience can improve the resident’s physical as well as emotional
health. Caregivers at meals can include staff, volunteers and family members. Caregivers must be trained in proper techniques. Some ‘best practices’ include being seated next to the resident and not assisting the resident while standing. Both eye contact and pleasant conversation with the resident may encourage better food and fluid intake. Using a small, metal teaspoon to feed residents, especially when portioning pureed textured foods, is the safest method, so that swallowing is easy for the resident. Caregivers should be mindful of the swallow actually taking place, so that food is not pocketed in the cheeks, or remaining in the mouth. If the meal assistant is not sure what to
do, then asking a trained staff member what is the safest option, so that the resident does not have a coughing or choking incident. The caregiver must thoroughly understand the individual goals and strategies in place and focus on the resident by being attentive, listening well and by providing for the resident by anticipating individual needs. Describing a resident’s meal choices and providing opportunity to choose foods and beverages gives some control back to the resident. Asking permission from the resident to begin assisting, or, if they would prefer a specific food first, also helps make mealtime a more resident-centered experience. This must be done in a fashion that encourages the resident’s independence and eating skills and is not in any way obtrusive. Dining room conversation should be directed to the resident by engaging in appropriate conversation, always refraining from engaging in staff to staff conversation that excludes the resident. Assisting at a comfortable pace is critical for safety and in helping the resident enjoy the meal. Long–term care homes must establish and maintain a culture of respect around providing assistance with eating. A good place to start would be to avoid use of demeaning terminology such as ‘feeders’ and ‘bibs’ and instead use terminology such as ‘residents that require assistance with eating’ and ‘aprons’ or ‘clothing protectors’. Family members and volunteers provide a great deal of this type of assistance in the long–term care setting. Homes need to provide these helping hands with the knowledge and skills to perform the task effectively and safely. Processes should be in place to identify high risk situations and determine how to maintain safety. LC
Dale Mayerson B Sc RD CDE, and Karen Thompson, B A Sc RD are Registered Dietitians with extensive experience in Long-term care. They are coauthors of “Menu Planning in Long Term Care and Retirement Homes: A Comprehensive Guide” and have participated for many years on the Ontario Long Term Care Action Group, an advocacy group of Dietitians of Canada. 18 Home and LongTerm Care News FEBRUARY 2018
Yes. I live with dementia. Let me help you understand. I was diagnosed when I was 57. My hopes and dreams in life have not changed. Iâ€™m Roger.
LEARN MORE AT Ilivewithdementia.ca #Ilivewithdementia
Strong sibling relationships can fracture under caregiving stress My brother lives out of town. Whenever he comes in to visit mom he says he is not sure why I make such a fuss about her dementia. He says that I am making a “mountain out of a molehill.” I used to get along well with him, but now I feel like I can’t stand seeing him. Signed, Get out of town
When a sibling lives farther away from their caregiver brother or sister, they may not realize the day-to-day tasks of taking care of parents.
he brother-sister story is always a difficult one, as there are so many layers. The added complication of your brother being out of town creates yet another hurdle. I often hear caregivers call their relatives who come in to see their relative “the knight in shining armour” or “the lucky one.” They seem to get the easier part of the job as perceived (and is often the case) by the sibling who lives close by and does the day-to-day care. Strong relationships can fracture with the stress of caregiving. This is true especially when the siblings are not in close contact to deal with commonplace issues that arise in the care of their elderly parent. The task of dementia caregiving is one that only grows over time. Initially, some limited supervision and support may be needed, but as time and the disease progress, it is inevitable that more time is spent with your ailing loved one and more hands-on support and care are required. A lot of stress between siblings occurs when one sibling is not cognizant of all the components of care that are being provided. If someone is not present for the day-to-day caregiving routines, it may not dawn on him or her how much is involved, such as the steps it takes to organize and get to a medical appointment, establishing consistent home care or arranging daily shopping excursions. The many phone calls, liaisons with professionals and support seem never-ending. The sibling who lives out of town may make faulty assumptions about the caregiving situation. They also may not see the extent of cognitive slippage and changes in functioning that are occurring. Mom’s daily activities (which may not be seen by your brother) may be slipping, but her ability to maintain social interaction may still be intact and less affected. Furthermore, mom may respond to the “out of towner” in
delight and excitement as the novelty and the lack of practical demands are often felt. This can be a further irritant to a sibling who is working hard to manage day-to-day chores with little or no thanks. Siblings may approach the task in a different manner based on their gender as well. There is evidence that men approach caregiving in a more task-oriented approach. Many look at caregiving as an extension of their jobs and utilize management style techniques to get necessary caregiving tasks done. To add to the complexity of the scenario, when one of the siblings is doing a disproportionate amount of the work it can foster anger, frustration and eventually feelings of unfairness. These negative emotions can also invade the relationship with mom and with your sibling. It is prudent to sit down and have a formal meeting. If you cannot accomplish it alone, a professional can help mediate, support and try to help you both find common ground. A lot of sibling differences emerge from a basic lack of understanding of the situation, or from stylistic differences. Additionally, the type of relationship and commitment you each have to your parent may also differ. Don’t give up on finding a path and common ground. Caregiving should not demolish the good will and family history that was there before. Establishing some basic communication and some understanding is always helpful, even if bad feelings have arisen. If you are interested in participating in a Baycrest – U of T study looking at brother-sister approaches and responsibilities to dementia caregiving, contact: 416-978-5694 or Natasha.email@example.com for more information. LC
Nira Rittenberg is an occupational therapist who specializes in geriatrics and dementia care at Baycrest Health Sciences Centre and in private practice. She is co-author of Dementia A Caregiver’s Guide available at baycrest.org/dacg. Email questions to firstname.lastname@example.org. This article originally appeared in the Toronto Star. 20 Home and LongTerm Care News FEBRUARY 2018
Winter risks for seniors By Crystal Gonder
ce, snow, cold temperatures, injury and illness can make winter a very hazardous time — especially for seniors. Like most things in life, when it comes to winter risks, it’s always better to be prepared. By following these wellness tips, you can help keep aging loved ones safe and healthy through to spring. Check and inspect. Winter weather calls for extra checks to make sure things are as safe as possible. Have furnaces and hot water heaters inspected and replace batteries in smoke and carbon monoxide detectors. Ensure that space heaters shut off when they reach a set temperature or tip over. If your senior is still driving, a mechanic should check the car’s heating system and defroster, install snow tires, replace worn wipers, and top-up wiper fluid. Stock up. Severe weather can cause power outages and isolate seniors until roads are cleared. Be ready for major storms by making an Emergency Preparedness Kit. Essentials like warm blankets, flashlights, non-perishable food, bottled water, medications and pet supplies will help them ride out the storm safely. Of course, if your loved one uses assistive equipment — like oxygen, respirators or dialysis machines — backup power options should be ready for long-term outages. Stay warm. Lower metabolic rates, poor circulation, illnesses and certain medications can make it harder for seniors to stay warm and can increase the chance of frostbite and hypothermia. Set heat to 68°F or higher, and if heating bills are a concern, close off the rooms they don’t use. In particularly
frigid weather, outside activities should be limited. If loved ones do venture outside, make sure exposed skin is covered, and that they dress in layers and add a scarf to protect lungs from cold air. Prevent falls. Falling is one of the biggest dangers seniors face, and it can cause serious and long-term damage. Keep lots of salt or sand ready for icy walkways and steps, and if possible, hire someone to take care of shovelling. Make sure your loved one wears sturdy, high-traction boots and replace worn cane tips. To prevent indoor slips, put a winter mat in the entranceway to safely store wet boots. Boost immunity. Good nutrition provides the best defense against winter illnesses. Encourage your loved one to increase their fruit and vegetable intake, choose lean protein and take daily multivitamins and probiotics. Ask a doctor if they recommend any extra supplements for the winter. Make sure your loved one gets yearly flu shots and consider vaccinations for pneumonia and shingles. Good sleep and reducing stress will also help fight illness. Keep in touch. Isolation and depression are not uncommon for seniors during the winter, especially if they live alone. Try to encourage regular visits with family and friends, keep up with phone calls and recruit neighbours to provide a network of care and support. Wintertime certainly comes with its fair share of challenges. With a little planning and safety steps in place, you and your loved one will be ready for whatever Mother Nature sends your way. For more resources and tips visit www.familycaregiving.ca . LC
Crystal Gonder works in communications at VHA Home Health Care. www.longtermcarenews.ca
MAKE SURE YOUR LOVED ONE WEARS STURDY, HIGH-TRACTION BOOTS AND REPLACE WORN CANE TIPS
Helping people live with independence, dignity and in comfort since 1925. • Nursing • Physio and other therapies • Personal care and support • Homemaking
Also specializing in:
• Palliative support needs • Dementia care • Respite • Wound care
FEBRUARY 2018 Home and LongTerm Care News 21
Workshop inspires students to brainstorm senior-sector innovations By Ilan Mester ften times, the best ideas surface when people with different perspectives join forces. Recently, the Baycrest-led Centre for Aging + Brain Health Innovation (CABHI) welcomed more than 60 high school students from William Lyon Mackenzie to participate in ideation workshops. The inter-generational event offered a unique opportunity for students to interact and collaborate with members of our Seniors Advisory Panel — a group of older adults from all walks of life who advise CABHI. Led by Bianca Stern, CABHI’s executive director, health innovations, the students learned about the needs of aging adults and brainstormed innovations that could impact this growing population. The session marked the beginning of an exciting partnership between CABHI and the Toronto-based high school. “Bianca shared with us what CABHI does and what the organization could offer,” explains Cindy Law, a science teacher from William Lyon Mackenzie. “And I jumped at the opportunity.”
THE STUDENTS LEARNED ABOUT THE NEEDS OF AGING ADULTS AND BRAINSTORMED INNOVATIONS THAT COULD IMPACT THIS GROWING POPULATION Cindy’s students are taking part in this year’s ExploraVision, a nationwide competition that challenges youth to envision new technologies and project them 20 years from now. “The partnership with CABHI works so well with the ExploraVision contest that I’m running with my students. The biggest hurdle to this contest is defining the problem that the students want to solve. Once you truly understand the problem, it is relatively easy to dream big in order to come up with possible solutions. Bianca made such an eye-opening comment to me: ‘To define a problem, you need to know what the problems are from talking with people — an empathy piece.’” Indeed, a number of students said they gained a lot from interacting and hearing the stories of older adults during the session. “We learned it’s im-
portant to focus on the people who will actually use the innovation,” shares a Grade 12 student. “[CABHI] provided us not only with a space to generate solutions, but also access to the Seniors Advisory Panel,” says another student. “And CABHI also presented other companies that are thinking about similar projects and connected us to them. I think it’s a really great environment to work in and I’m thankful for this opportunity.” The workshop, delivered three times for different classes, took the students through an ideation process. “We had them brainstorm in small groups and utilize different modalities to promote the process of ideation; whether it was speaking with their peers and writing ideas on paper, talking in smaller and larger groups, and using the whiteboards,” says Alana Bernick, an Oc-
cupational Therapist who is acting as a liaison between CABHI and the high school. Alana says there are three phases to the project — the first of which involved a pre-reflection where students were encouraged to think about what aging means to them. “We wanted to get at two things: we wanted them to be more aware of some of the stereotypes; the discourse that is at play in our society and how that funnels down to our everyday conversations with people and how we engage with older adults. At the end of the day, the goal was focused around design. We wanted them to take that idea of design and explore what it is within our environments, people, and in carrying out meaningful activities, that are challenges for older adults. What are some of the successes that older adults are experiencing and how can we capitalize on that success?” Having completed the pre-reflection phase and the collaborative workshop, the next phase for the students will involve continued support from CABHI. The students are invited to use the unique CABHI space — including rooms with floor-to-ceiling white boards — while they’re developing ExploraVision proposals. Alana will also connect interested students with relevant researchers, clinicians and entrepreneurs who can help nurture their ideas. “I think the continuous connection that we have with CABHI, the continuous mentoring, is really important,” adds Cindy. “Because once the students formulate a potential solution, they can actually check in with someone who has expertise in the area and would be able to assess whether their solution is something that is truly innovative. LC
Ilan Mester is a communications specialist at The Centre for Aging + Brain Health Innovation (CABHI). 22 Home and LongTerm Care News FEBRUARY 2018
RNAO highlighting systemic issues in long-term care By Daniel Punch hen the broad-based, provincial public inquiry takes a hard look at Ontario’s long-term care sector this June, the Registered Nurses’ Association of Ontario (RNAO) will be there to ensure no stone is left unturned. RNAO was granted standing in the Long-Term Care Homes Public Inquiry, which will examine the circumstances surrounding the murders of eight nursing home residents by former RN Elizabeth Wettlaufer. Led by Justice Eileen Gillese, the inquiry will look at the specifics of the murders — which occurred between 2007 and 2014 at three southwestern Ontario nursing homes — as well as the systemic issues that may have contributed to this tragic situation. “Regrettably, we can’t bring back the lives we lost in this horrific tragedy. However, the inquiry must honour their memory by getting to the bottom of what happened,” says RNAO President Carol Timmings, adding that RNAO was the first organization to call for a public inquiry when news broke about Wettlaufer. “It is vital to fully understand where things went wrong in the system, and also to expose the shortcomings in Ontario’s long-term care sector. This is the only way we can make broad and sustained positive changes that will protect the health and safety of all nursing home residents.” With standing at the inquiry, RNAO will be able to present evidence and call witnesses. The association will use this opportunity to highlight flaws in the investigatory, disciplinary and reference check processes used by long-term care homes. This includes the College of Nurses of Ontario’s (CNO) ability to investigate and discipline its members — registered nurses (RN), nurse practitioners (NP) and registered practical nurses (RPN) — and whether third parties have a duty to report concerns when a nurse is not practising safely. Continued on page 24
Researchers to evaluate the impact of using artificial intelligence to detect earliest stages of Alzheimer’s ilfrid Laurier University researchers are part of a health innovation team piloting a cutting-edge brain health assessment and risk management program that uses predictive analytics and artificial intelligence (AI) to detect Alzheimer’s at the earliest stages. The goal of the program, which is led by Saint Elizabeth Healthcare, is to improve access to services, independence to age in place and quality of life for patients and caregivers in Ontario. Josephine McMurray, assistant professor in the Business Technology Management program, and Azim Essaji, associate professor of Economics, both from Laurier’s Lazaridis School of Business and Economics, will evaluate the economic impact of the program. “Early detection and management of declining cognition and Alzheimer’s is important as it can slow or reverse the
disease process and alleviate the burden on individuals, their families and the health system,” says McMurray. The BrainFX screening tool will be used with 10,000 patients during the study to identify cognitive decline earlier than conventional tools and allow for earlier personalized treatment planning. Anonymized data from these patients will be aggregated with data from the Canadian Institute for Health Information and analyzed for early risk factors using machine learning and AI. This early identification algorithm will be used by healthcare providers to scan their electronic records and flag at-risk patients. McMurray, Essaji and the health innovation team will assess the feasibility and economic impact of using early detection tools and predictive algorithms that may improve the lives of people living with cognitive
disease by helping them to live more independently longer. “The indirect effects of reducing people’s lifetime costs of healthcare are important to consider as Canada’s population greys,” says McMurray. In December, the Ontario Ministry of Health and Long-Term Care announced $5.47 million in funding for 12 projects through the Health Technologies Fund. This project, entitled Brain Health Screening and Risk Management Program, received $493,000 from the ministry and includes a partnership between Laurier and Saint Elizabeth Health Care, BrainFX, ThoughtWire Corp., Southlake Regional Health Centre, and four Family Health Teams (FHT) in the Waterloo Wellington Local Health Integration Network (Upper Grand FHT, Two Rivers FHT, Mount Forest FHT, and the Centre for Family Medicine). LC
FEBRUARY 2018 Home and LongTerm Care News 23
Easy Reach Toilet Seat Easy Reach LLC develops the “Easy Reach” toilet seat for easier care and better quality of life in the home or the hospital.
Height with seat is 20″ top to bottom
new start-up company Easy Reach, LLC has developed the “Easy Reach”, an elevated toilet seat adapter with side-access that allows independence in the restroom for patients and prevents heavy lifting for caregivers. The patented technology developed through collaboration between Jason Derrington and the University of Southern Indiana will greatly enhance user care by allowing proper side-wiping techniques, and minimizing assistance needed. The patented urine splash guard prevents urine leakage and contamination, reduces the risk of slipping around the toilet while eliminating foul odors. We want to ensure that your staff, patients, and loved ones are operating in a safe and convenient restroom environment. The Easy Reach Toilet Seat was designed to mitigate multiple risks that are involved in a healthcare facility, and now is available for in home use. This product is restoring dignity to those we care for. Bringing easier care for caregivers and best of all, a better quality of life. Unlike any other toilet riser on the market, you can put your own elongated seat on top and are able to close the lid. This seat is solid and will fit snug to your toilet and provide a stable and safe method to maintain your independence.
Side Access: • Allows for proper wiping techniques • Minimizes assistance needed • Increases independence Patented Urine Splash Guard: • Prevents urine leakage and contamination • Reduces risk of slipping around the toilet • Reduces foul odor and janitorial work Durability & Sturdiness: • Designed to safely hold 600 pounds • Easy installation • Fits firmly on elongated commodes Six years ago I reached a turning point in my life; I was shot multiple times while being in the wrong place at the wrong time. It left me paralyzed from the waist down and has changed the way I function in every-day life. After being instantly humbled, I struggled with the difficult task of living life in a wheelchair. For instance, I was stuck in an airport bathroom and let’s just say it was a horrible experience! These circumstances led to the fruition of my invention, the Easy Reach. I have persevered throughout the creation of my product and have now completed the manufacturing process, along with receiving many happy customers. If you would like to learn more information about the Easy Reach toilet seat, please feel free contact me at email@example.com LC
This content was provided by Easy Reach LLC. For more information visit www.easyreachtoiletseat.com
RNAO Continued from page 23 RNAO also wants to see employers mandated to disclose termination notices and any issues related to patient safety to prospective employers during reference checks. “Our hearts continue to be with the family members of each victim. They need answers, and Ontarians need to know they can trust nursing homes and the health professionals caring for their loved ones,” says Timmings. “We want the public to know that the overwhelming majority of nurses go to work with the intention of providing safe and quality care to nursing home residents.
However, many do so under extremely challenging staffing conditions.” Looking more broadly at the longterm care sector, RNAO will show how current funding and staffing models are harming quality of care and resident safety in Ontario’s nursing homes. RNAO CEO Doris Grinspun says nursing homes are consistently understaffed, especially when it comes to regulated staff: NPs, RNs, and RPNs. “Ontario’s seniors living in nursing homes are being shortchanged by archaic funding models that don’t fit today’s reality. Now, more than 50 percent of
long-term care residents are 85 years of age or older and 90 percent of all residents have cognitive impairments,” Grinspun highlights. Moreover, she says “...current models of government funding are actually unintentionally penalizing nursing homes when they improve the health outcomes of their residents.” Grinspun hopes these issues and others will be addressed when Justice Gillese makes her recommendations following the inquiry. “Let this inquiry be a turning point for residents in nursing homes,” she says. “From here
on, we must give older Ontarians the respect they deserve by investing in a strong and accountable long-term care sector to help them age safely and with dignity.” RNAO is the professional association representing registered nurses, nurse practitioners, and nursing students in Ontario. Since 1925, RNAO has advocated for healthy public policy, promoted excellence in nursing practice, increased nurses’ contribution to shaping the healthcare system, and influenced decisions that affect nurses and the public they serve LC
Daniel Punch is a Communications Officer/Writer at RNAO 24 Home and LongTerm Care News FEBRUARY 2018
Dear Mom, You were my rock. My best friend. From the beginning it was always us. Then suddenly, I was alone. Gliding out on the ice, my legs were shaking. My heart was broken. But you steadied me. As you always did. Thousands watched... except the one I wanted most. But we did it mom. I wish you were there. Almost as much as I wish you were here.
Joannie Rochette Olympic medallist Lost her mom to heart attack â„˘ Life. We donâ€™t want you to miss it. and the heart and / Icon on its own or followed by another icon or words are trademarks of the Heart and Stroke Foundation of Canada.
What are common problems caused by poor-fitting dentures ost adults opt to replace missing teeth with dentures for aesthetic and practical reasons. Whether it’s a full set or just partial, a set of wellmade and properly fitted dentures can alter a person’s appearance, boost their confidence, and make a huge difference in their daily activities. If you or someone in your care uses dentures, you will probably agree that loose dentures are a nuisance. But did you know that loose-fitting dentures can also: • Affect the way a person speaks • Be uncomfortable or even painful to wear • Make awkward clicking or snapping noises while chewing • Cause embarrassment if the dentures keep falling down, especially in public
HEALTH ISSUES CAUSED BY POORFITTING DENTURES
Poor fitting dentures can also cause the following health issues: Unhealthy eating habits — Poor-fitting dentures can make eating a painful or uncomfortable experience. Some denture wearers cope with the pain
A SET OF WELL-MADE AND PROPERLY FITTED DENTURES CAN ALTER A PERSON’S APPEARANCE, BOOST THEIR CONFIDENCE, AND MAKE A HUGE DIFFERENCE IN THEIR DAILY ACTIVITIES and discomfort by eating foods that are easier to chew, which excludes many healthy foods that are fibrous or have harder textures, such as vegetables, meat, nuts, and seeds. This may solve the issue in the short term, but over time can lead to weight loss, malnutrition, or even an eating disorder. As a caregiver, if you see signs of extreme weight loss or a change in eating habits, consider taking the person in your care to a dentist to have their dentures examined and resized if needed. Gum and mouth irritation — Loose dentures can chafe the gums, causing mild or severe inflammation of the mouth. Swollen gums can easily become infected so be on the lookout for red, angry-looking gums or a white plaque.
Changes to the jaw joint — Dentures that don’t fit properly can affect someone’s bite, leading to changes in the jaw joint. In turn, this can result in joint pain, headaches, pain in the neck and/ or facial muscles, and can be severe enough to impact day-to-day living. Jaw bone atrophy — Jaw bone atrophy is the most serious problem related to dentures because, unlike other bones in the body, the jaw bone cannot form new bone tissue. Constant wear and tear on the jaw bone causes it to literally dissolve under pressure in a process called resorption. You can help prevent these issues by scheduling regular dental appointments for the person in your care and observing their mouth health in between appointments. See a dentist right away if you recognize any of the above signs. A Home Support Worker can accompany the person in your care to the dentist, or other appointments, when you can’t get time off work to take them yourself. How long do dentures last? Dentures were not designed to last a lifetime; on average, they can last
up to 10 years before they need to be repaired or replaced. Time, normal wear and tear, and our mouths naturally changing shape as we age are some factors that can alter the original fit of dentures. Handling the dentures with care and practicing good oral hygiene can help make dentures last as long as possible, and help the person in your care stay comfortable and healthy.
HOW TO CARE FOR DENTURES
Did you know that plaque and tartar can also build up on dentures just as they do on real teeth? Here are some tips for proper denture care: • Brush dentures daily to remove food deposits and plaque, and to help prevent staining. • Use a soft toothbrush to clean dentures and massage gums, tongue, and palate every day before inserting dentures. This helps to stimulate soft tissues and help remove plaque buildup. • At night, soak dentures in a denture cleaning solution or a mixture of equal parts warm water and vinegar to prevent them from drying out. If the dentures have metal clasps, soak them only in warm water, not vinegar. • Don’t try to fix broken, chipped, cracked, or loose dentures yourself. Dentures are custom-made in a dental laboratory using equipment not normally found around the house. Take damaged dentures to a dentist for repair. Following these tips can help prolong the life of your dentures and minimize the risk for future health issues due to loose dentures and poor oral hygiene. LC
This article originally appeared on elizz.com and is reprinted with permission. 26 Home and LongTerm Care News FEBRUARY 2018
New study findings offer some hope in preventing dementia By Jeff Zimman o drug, diet, physical exercise regimen, or other behavioral intervention has ever been shown effective in reducing the risk of dementia in a randomized controlled trial — but recently, a specific computerized brain exercise had breakthrough results, showing a decrease in dementia risk in a study published in Alzheimer’s & Dementia: Translational Research & Clinical Interventions, a scientific journal of the Alzheimer’s Association.. Researchers from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) Study followed 2,802 healthy older adults for 10 years (as they aged from an average of 74 to 84). They looked at the impact on aging of different types of cognitive training, by randomizing participants into a control group and three intervention arms: 1) a memory strategy group; 2) a reasoning strategy; and 3) a group training on a computerized speed of processing exercise. Participants in each of the cognitive training arms were asked to engage in a total of 10 sessions of training (about an hour per session) conducted over the first five weeks of the study. A subset was asked to do an additional four sessions at the end of each of years one and three of the study. The group that trained on the computerized speed of processing exercise (for 10-18 hours) was the only group that did significantly better than the control — with a 29 per cent reduction in the hazard of dementia for the overall speed training group. When researchers looked at those who trained more, they found those who completed more sessions had lower risk. The incident rate of dementia for those who completed the most sessions in speed training (at 5.9 per
Posit Science is the developer of brain-training program BrainHQ, clinically proven to improve cognitive performance.
“PLASTICITY-BASED, COMPUTERIZED, SPEED OF PROCESSING TRAINING HAS DIFFERENTIATED ITSELF BASED BOTH ON THE DATA AND ON THE NEUROPHYSIOLOGICAL MODEL FROM WHICH IT WAS DEVELOPED” cent) was 45 per cent lower than the control (at 10.8 percent); 42 per cent lower than for those who did the most memory training (at 10.1 per cent); and 39 percent lower than for those who did the most reasoning training (at 9.7 per cent). “Relatively small amounts of training resulted in a decrease in risk of dementia over the 10-year period of 29 per cent, as compared to the control,” says Dr. Jerri Edwards, lead author of the article and a Professor at the University of South Florida, College of Medicine, “And, when we looked at dose-response,
we saw that those who trained more got more protective benefit.” Participants in the computerized brain training group were trained on a highly specific task designed to improve the speed and accuracy of visual attention, including both divided and selective attention. To perform the divided attention training task, a user identified an object (i.e., car or truck) at the center of gaze, while at the same time locating a target in the periphery (i.e., car). As the user gets the answers correct, the speed of presentation becomes faster. In the
more difficult training tasks, the target in the periphery is obscured by distracting objects. That exercise is exclusively licensed to Posit Science, and is commercially-available as the “Double Decision” exercise of the BrainHQ.com brain training program. The paper notes the same exercise has previously been shown effective across multiple clinical trials in older adults on standard measures of cognitive abilities (e.g., speed of processing, attention and working memory) and functional abilities (e.g., maintaining the ability to live independently, depressive symptoms, feelings of control, and health-related quality of life), as well as in real world activities (e.g., driving safety, balance and gait). In other studies in pre-dementia conditions, it has driven improvements in cognitive and functional abilities, as well as brain structure. Continued on page 28
Jeff Zimman is co-founder of Posit Science, developers of brain-training program BrainHQ. www.homeandlongtermcare.ca
FEBRUARY 2018 Home and LongTerm Care News 27
Scientist awarded funding for digital storytelling for
caregivers of Indigenous adults with dementia By Maggie Frampton r. Janet McElhaney has received a Catalyst award from AGE-WELL, Canada’s Technology and Aging Network, for new research that aims to support Indigenous families with dementia through digital storytelling. Dr. McElhaney’s project, Understanding how to appropriately support Indigenous families with dementia through digital storytelling: a community-based approach, will introduce the technology as a way for caregivers to share their common experiences. “Storytelling is a practice in Indigenous cultures that sustains communities, validates experiences and expresses experiences of Indigenous peoples, and nurtures relationships and the sharing of knowledge,” says Dr. McElhaney, Vice President of Research and Scientific Director at Health Sciences North Research Institute. “This project will help connect caregivers to enhance the caregiving experience with family members living with dementia.” Community partners on the project are N’Mninoeyaa Indigenous Health Access Centre in Cutler, Ontario and File Hills Qu’Appelle Tribal Council Health Services in Saskatchewan. “This is an important and innovative research project that has strong potential to make a difference for families of people living with dementia,” says Dr. Alex Mihailidis, Scientific Director of AGE-WELL. The pan-Canadian network brings together researchers, community organizations, industry, older adults and caregivers to develop solutions to support healthy aging. Dr. McElhaney hopes to see digital storytelling integrated into training sessions for caregivers and used as a tool to promote community-driven models of care that can help to address emerging health issues related to dementia for Indigenous peoples in Canada.
Dr. Janet McElhaney “Indigenous populations in Canada are rapidly aging. Compared to non-Indigenous Canadians, dementia rates are reported to be 34 per cent higher in Indigenous persons. This may be explained by the earlier onset of multiple chronic conditions that have been linked to increased risk for dementia,” says Dr. McElhaney. Dr. McElhaney also holds the position of Health Sciences North Volunteer Association Research Chair in
Maggie Frampton is a Communications Specialist at Health Sciences North. 28 Home and LongTerm Care News FEBRUARY 2018
Healthy Aging, and is affiliated with the Northern Ontario School of Medicine. She is grateful for the support from AGE-WELL for making this project a reality, and to the Health Sciences North Volunteer Association for its ongoing support. AGE-WELL is a federally funded Network of Centres of Excellence dedicated to the creation of technologies and services that benefit older adults and caregivers. LC
New study Continued from page 27
“This study highlights that not all cognitive training is the same,” says Dr. Edwards. “Plasticity-based, computerized, speed of processing training has differentiated itself based both on the data and on the neurophysiological model from which it was developed.” “There are now well over 100 peer-reviewed studies on the benefits of our brain exercises and assessments across varied populations,” says Dr. Henry Mahncke, CEO of Posit Science which has commercialized the exercise as part of the web, tablet, and smartphone app BrainHQ platform. “This type of training harnesses plasticity to engage the brain in an upward spiral toward better physical and functional brain health.” BrainHQ is an online subscription service at www.BrainHQ.com used by millions of people across the globe on both a paid and free subscription basis. Most subscribers are individuals, but certain businesses, health organizations, associations, insurers, and other groups, provide BrainHQ to their customers and members. DynamicBrain of Ottawa runs classes and distributes BrainHQ to groups in Canada. The scientific team that creates and validates BrainHQ exercises involves hundreds of scientists worldwide, including researchers at McGill University, University of Calgary, and University of Toronto. BrainHQ is now offered in ten languages, including English and Canadian French. In fact, Fédération Québécoise des Sociétés Alzheimer (the Quebec Federation of Alzheimer Societies) recently began offering both individual subscriptions and group classes in BrainHQ. “We work with a global team of independent researchers who are continuously pushing the boundaries of our understanding of the brain,” Dr. Mahncke explains. “We expect many more exciting announcements in the year ahead, and we plan to work with the medical community and regulators to expand beyond our wellness and performance offerings to assist people with specific medical conditions and concerns.” LC www.homeandlongtermcare.ca
HERO the CEOâ€™s Inside: From
ation / Safe Medic ence Matters Desk / Evid
s se / Career / Nursing Pul
tion May 2017 Edi news.com
2017 Nursing Heroes urses N1 A Salute to N
IS COVERAGE D GUARANTEE
FULL-TIME THAT WORK BENEFITS E WHO DONâ€™T KJVU[YHJ[ FOR THOS VYWHY[[PTLJHZ\HSHU Z HUM PYLL (ILULÃ„[WS OVZWP[HSYL[ HUK LLZ viders.ca WSV` OVZWP[HSLT ealthcarepro w.h ww | 77 1.866.768.14
Along with having their story published, the winner will also take home:
$1,000 Cash Prize
$500 Cash Prize
$300 Cash Prize
/H]L `V\ ILLU PUZWPYLK LUJV\YHNLK VY LTWV^LYLK I` HU LTWSV`LL VY HJVSSLHN\L&/H]L`V\VY`V\YSV]LKVULILLU[V\JOLKI`[OLJHYLHUK JVTWHZZPVUVMHUV\[Z[HUKPUNU\YZL&+V`V\RUV^HU\YZL^OVOHZNVUL HIV]LHUKIL`VUK[OLJHSSVMK\[`& /VZWP[HS 5L^Z ^PSS VUJL HNHPU ZHS\[L U\YZPUN OLYVLZ [OYV\NO V\Y HUU\HS National Nursing Week (May 7th to 13th) JVU[LZ[ 5VTPUH[PVUZ JHU IL Z\ITP[[LK I` WH[PLU[Z VY WH[PLU[Z MHTPS` TLTILYZ JVSSLHN\LZ VY THUHNLYZ 7SLHZL Z\ITP[ I` April 6th HUK THRL Z\YL [OH[ `V\YLU[Y`JVU[HPUZ[OLMVSSV^PUNPUMVYTH[PVU!
à ® -\SSUHTLVM[OLU\YZL à ®@V\YJVU[HJ[PUMVYTH[PVU à ®-HJPSP[`^OLYLOLZOL^VYRLKH[[OL[PTL à ®@V\YU\YZPUNOLYVZ[VY` Please email submissions to firstname.lastname@example.org or mail to: Hospital News, 610 Applewood Crescent, Suite 401, Vaughan, ON, L4K 0E3 0M`V\KVUV[YLJLP]LJVUÃ„YTH[PVU^P[OPUOV\YZVMLTHPSPUN`V\YUVTPUH[PVU WSLHZLMVSSV^\WH[LKP[VY'OVZWP[HSUL^ZJVTVYI`[LSLWOVUL _
FEBRUARY 2018 Home and LongTerm Care News 29
Activities and games for patients with Alzheimer’s disease A
s a caregiver of someone with Alzheimer’s, you can use games and activities to help stimulate their mind
and senses. Alzheimer’s disease is often known as “the long goodbye” not only because of its ability to affect someone’s cognitive and functional abilities, but also their emotions and moods, behaviour, and physical abilities, leaving behind a shell of a once-vital person that family and friends barely recognize. This can be tough to witness, but there are some ways you can continue to engage with the person in your care and spend quality time together. Alzheimer’s disease affects everyone differently, so it’s often difficult to predict how it will progress, the symptoms (and the order in which they appear), and the duration of each stage (early, middle, late, and end of life). Since there is no cure, people with Alzheimer’s, and their caregivers, rely on treatment plans prescribed by the doctor, plus lifestyle changes to slow the progression of the disease. Caring for someone with Alzheimer’s can be as rewarding as it can be emotionally and physically challenging. It’s difficult to watch someone you know struggling to perform everyday tasks and your natural reaction may be to just take over. However, research shows that people in the early stages of Alzheimer’s can still acquire and process new information, helping them to learn or improve their performance on cognitive tasks, so it’s important to let them try the task themselves, as long as it’s safe for them to do so. You can help slow the decline of their memory and cognitive abilities, and help them to remain as independent for as long as possible, by keeping them busy with games and activities that stimulate the mind and
challenge their mental, functional, and physical abilities. There are tons of activities and games that you, as a caregiver, can do with the person you’re taking care of. You can use items from around the house and your own creativity, or use specific materials like those used in the DementiAbility Method, to develop activities that the person in your care will enjoy and learn from.
You can also play a matching game with the person in your care by placing all of the wooden shapes in the bag, and have the person find matching pieces by feel. Repeat this process until all of the pieces have been paired. Placing the objects in the bag eliminates distractions and stimulates the sense of touch, while the matching process helps to strengthen cognitive function.
DEMENTIABILITY METHOD ACTIVITIES
ART THERAPY ACTIVITIES
DementiAbility activities are a series of games and activities specifically for dementia and Alzheimer’s patients that have been adapted from the Montessori Method. Originally designed for use in the classroom, when DementiAbility is applied to someone living with Alzheimer’s (which is just one of the forms of dementia), this method can mean increased independence, higher self-esteem, and a sense of fulfillment that they have a meaningful role in society. One of the most popular activities you can use is called Mystery Bag, or Stereognostic Bag. What you need for this activity: • 10 pairs of wooden shapes such as cubes, rectangular cubes, prisms, spheres, and eggs • A cloth bag Start by spending a few moments having the person look at and feel each shape. Have them observe the different forms each shape takes on when placed down on a different side. Once they’re familiar with the shapes, you can move on to activities that involve touch. Place the cubes and rectangular cubes inside the bag, and ask the person to reach in and feel one shape. As they pull the shape out of the bag, they verbally say whether the shape is a cube or a rectangle.
30 Home and LongTerm Care News FEBRUARY 2018
Various forms of art such as music, visual arts, drama, and writing, are a great way for caregivers of people living with Alzheimer’s to engage creativity, improve behavioural issues, and provide an outlet for self-expression. Listening to music is one of the simplest and most cost effective ways to spend time with the person you’re taking care of. It requires almost zero effort on your part to turn on the radio or the music app on your phone, and play songs that the person in your care finds enjoyable and familiar. Playlists of their favourite songs can help you set a certain mood — for example: • Upbeat songs to get their energy going • Slow, meditative songs for winding down at the end of the day Encourage them to clap or dance, and if it helps to have a demonstration, clap and dance along as well! Art projects such as painting, drawing, and sculpting can give someone with Alzheimer’s a sense of accomplishment and are a tactile form of self-expression. If the person in your care is in the middle to late stages of Alzheimer’s, you may need to help them get started by showing them how to perform each action. Remember to keep the project
on an adult level, use non-toxic materials, and avoid sharp tools. Make conversation as they create their masterpiece and provide encouragement, but give them plenty of time and space if they need it to finish their work.
Some of the best sensory activities to do with a person with Alzheimer’s aren’t the kinds that have rules or a points system. They’re the everyday activities you normally do around the house. Everyday activities — You can probably do these everyday activities quickly on your own, such as setting the table, dusting, and making the bed, but asking the person you’re taking care of to “help” you gives them a sense of purpose and pride. Letting the person in your care take on simple tasks around the house shows them that they’re a valued member of the family, one whose contributions are still very much needed and appreciated. www.homeandlongtermcare.ca
RESEARCH SHOWS THAT PEOPLE IN THE EARLY STAGES OF ALZHEIMER’S CAN STILL ACQUIRE AND PROCESS NEW INFORMATION, HELPING THEM TO LEARN OR IMPROVE THEIR PERFORMANCE ON COGNITIVE TASK Hand massage — Giving the person in your care a gentle hand massage is another sensory activity that he or she will likely find enjoyable. This activity can be relaxing for both you and the person you’re taking care of, and the physical and social aspects will be appreciated when verbal communication becomes more difficult in the later stages of the illness. Tending a garden — Gardening is another great way for the person in your care to get out of the house, enjoy the sunshine, and see the fruits of their labour grow right before their eyes. If possible, give them their own
patch in the yard, or a few pots so they can garden indoors, where they can plant whatever seeds they like. Going for walks — If gardening is not something they’re interested in, perhaps a stroll through the neighbourhood or public park to admire flowers planted by others will be more enjoyable. This is a great sensory activity that allows them to get some light exercise into their daily routine.
Jigsaw puzzles, dominos, playing cards, dice, and word puzzles are sim-
ple games that can be easily adapted as Alzheimer’s recreational activities for the person in your care. • Find a jigsaw puzzle with a picture of something they like, such as flowers, a mountain scene, or a favourite animal. • Play a matching game with dominos or stand them up and knock them over. • Use the playing cards in a sorting activity. For example, you can ask the person in your care to sort the cards according to colour, suits, or numbers. • Rolling dice can be good for dexterity. Make up simple games like adding numbers or matching patterns, or just simply let them roll the dice however many times as they like. • Word search puzzles should have large print, with no diagonal or backwards words so that it’s easy but challenging enough to hold their interest.
Activities that are cognitive and stimulate the mind are just as important as those that exercise the body. Reading – Books and magazines on topics that interest them can be good to promote discussion. Try to find books that have large print and lots of colourful pictures, but are not childish. Audio books are a great alternative to printed books. Life story book or memory box – You can work with the person you’re taking care of to create a “life story book.” Gather pictures from family and friends and put them all together, along with notes about each one, into a photo album of memorable events in his or her life. A simpler version to create is a memory box, which is a special box where you place their favourite objects, pictures, and keepsakes. The person you’re taking care of can look at these items whenever they want, hold each object, and recall or ask you why these items have a special significance. In times of agitation, taking out the memory box or life story book can have a calming effect on Alzheimer’s patients. This is also a nice way to incorporate a legacy building activity to enjoy for years to come. Whatever activities you choose to engage in with the person in your care, remember that each activity should be meaningful, not just busywork, and should be appropriate to their manual dexterity and ability to process logic. Activities and games should be judgment-free and simple to accomplish. Find a balance between cognitive and tactile activities because when the mind and body are both stimulated, the person in your care may find them more interesting. Provide written and verbal instructions, and don’t be afraid to demonstrate the game or activity if necessary. Keep the activity area clean, uncluttered, and well-lit. Work with safe materials (such as wood and unbreakable plastic) with smooth edges and that are large enough to prevent them from being swallowed. If the person you’re taking care of shows interest in a new activity, incorporate it into the routine but don’t be afraid to try new things. LC
This article appeared on Elizz.com and is reprinted with permission. www.homeandlongtermcare.ca
FEBRUARY 2018 Home and LongTerm Care News 31
I donâ€™t want to feel scared
Help change the lives of 11 million Canadians living with diabetes or prediabetes. Donate at EndDiabetes.ca
Published on Feb 1, 2018