FOR THE ELDERLY – TO WALK OR NOT TO WALK – THAT IS TOO OFTEN THE QUESTION

“Sit down Gladys, please sit down.” Gladys was the 102 year old former Army nurse living in a small 15 resident, senior care cottage in Clearwater, Florida. Yes, Gladys was a little confused at times, and she did forget that she needed help to walk. But from the time she was up in the morning,(dressed for the day in one of her many flowered dresses and comfortable, sensible shoes) all she heard was to “sit down.”

It is not surprising that people age two want to walk. Or that people twenty-two, fifty-two, and sixty-two, want to walk for that matter. No matter what your age, walking means independence. Walking builds the kind of strength you are not able to build any other way. Walking provides weight bearing that builds bone and protects against osteoporosis. Walking gives any person the chance to feel their muscles move, and know they are alive.

Walking for the elderly, is protective of their overall health in so many ways. Walking reduces the incidence of urinary tract infections, protects against pneumonia, supports appetite, maintains muscle mass, gives the elderly opportunities for socialization and most of all maintains the ability to walk.

The good news for Gladys was that her attempts to stand, and then to sit down again several times daily, was maintaining her thigh muscles. She instinctively reached out for the arms of her chair when she stood and because of the constant practice she was quite steady going from sitting to standing. But more than that, no matter how many times she was asked to sit back down, Gladys’ spirit was still visible in her ongoing attempts to get going.

It was kindly pointed out to Gladys’ direct caregiver, that going out first thing in the morning and taking a walk, before it became hot might be a good idea for Gladys. All she needed was someone to take her arm and give just a little support from time to time to help with her balance. Didn’t seem too much to ask for this woman who had given so much, to so many, during her career. But no, now that twenty-something girl was in charge of her and the “girl” didn’t think Gladys needed to walk. So it began again, “Gladys please, please sit down.”

If you know of a Gladys who wants to walk but everyone around her is afraid she will fall please go to www.merrywalker.com and see some safe ambulation devices.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

FALLS, SENIORS AND NURSING HOMES

Phil lives alone unless you count his dog, Clare. Phil now is seventy-three and most people would have considered him in better than average shape. He is not one for exercise but he always has watched what he eats, and was blessed with good genes. However, Phil made some very bad decisions.

It happened on a very nasty night in the Midwest. There was a ugly ice-sleet storm raging outside when Clare needed to go out. Phil did his usual thing at night he took Clare out into the backyard. Too bad his usual thing was to walk Clare in his underwear. So when Phil fell, he was too embarrassed to call out to his neighbors for help.  So there he lay with an injured leg, shoulder and arm, out there on the ice.

Because Phil didn’t want to call for help it took him two and a half hours in the cold, on the ice, to pull himself to his back door and drag himself in.   This experience caused Phil to be hospitalized for five days and is now in a nursing home due to the pneumonia that set in while hospitalized.

What seniors can do to protect against falls:

  • if you live alone (and are even if in very good condition like Phil) wear an alert button
  • think ahead, make good decisions and be proactive – is it really a good idea in any weather to be outside in your underwear
  • prepare for the weather – when in snow, ice, sleet – carry a small bag of salt, sand or gravel to throw out in front of yourself as you walk
  • for those who have to go out in all weather – consider rubber ice cleats that easily attach to the bottom of any shoe or boot – they are easy to put on and off and very in expensive

It really didn’t seem like it would be Phil who would be in a nursing home, at least not until a very old age. Bad weather got him there, and a fall, but more than that it was bad choices.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

FALL PREVENTION GUIDELINES FOR SENIORS IN WINTER WEATHER

Of course the elderly and seniors are afraid of falling, but Beth was only 31 when she fell on ice in a parking lot. Beth was late for work and walking much too fast for the slippery conditions in the parking lot that day. And the parking lot as slick as it was, made her fall even harder, resulting in a fractured wrist.

Walking in winter weather calls for extra diligence in:

  • Taking care of your body, for it to function as limber and flexible as possible. Warm up your legs, feet and knees before you go out in snow and possibly slippery conditions. A great way to warm up feet is with a warm water soak in Epsom salts. Difficulty walking can be due to inflammation which will make tissue painful, tight and stiff. Knees, legs and feet can be especially vulnerable to inflammation, and that inflammation can be tracked back to poor food choices. Avoid inflammatory foods; sugar, white flour, white potatoes, white rice, and pretty much anything that is white.
  • Exercising – to improve strength and balance. Maintain a regular exercise routine and on days when the elderly cannot get out, it is even more important to exercise. Stretch before going out, stretching improves circulation and limbers the joints and muscles.
  • Careful, but appropriate use of pain medications. Just as a person in a healthcare situation would take a pain medication before going to therapy, so also medicating before walking outside maybe just as appropriate. Arnica gel is a great topical for pain, swelling and stiffness. There are new reports all the time on the benefits of Ibuprofen medications for inflammatory pain relief.
  • Dressing for the weather. Now that you have those legs, knees and feet warmed up, keep them that way. Three light layers of clothes are preferred to one heavy layer. Be aware of any clothing that might be too restrictive, and actually decrease the ability to move. I personally love the new warm light weight fabrics – long underwear anyone?
  • If the elderly use a cane or walker they should also use that walking device, in winter weather. However caution needs to be taken when rubber tips on canes/crutches become wet – they can be extremely slippery on a hard surface indoor floor.

Many elderly people become isolated in winter and suffer from depression. Going outdoors, enjoying fresh air, nature and socializing is so necessary to protect against depression in winter.

Virginia Garberding RN
Certified in Gerontology and Restorative Nursing

FOR THE ELDER MOVING INTO A NURSING HOME MAY BE SYNONYMOUS WITH BECOMING WHEELCHAIR BOUND

Is it now standard practice that you move into a nursing home, you are immediately assigned a wheelchair? When you visit a nursing home, how many elderly people do you see still walking?

It may start on admission, where the wheelchair just seems to come with your room. Or it may begin when you are just too slow for the staff, so when walking any distance, they automatically say “Let’s get you a wheelchair.”

Years ago in “old school nursing” (see confessions of an old nursing home nurse on this site) we must have had 95% of our residents (they were patients then) in wheelchairs. But those were the days when Medicare didn’t pay for therapy for persons with Alzheimer’s disease. Now everyone is eligible for benefits from therapy to help them continue to walk.

When you take an elderly person who can still walk, and sit them in a wheelchair they will:

  • Become weaker – not using their muscles can contribute to weakness very fast
  • Become helpless – every time you do something for an elder that they could do for themselves, you make them helpless
  • Become more difficult to care for, the stronger and more flexible an elder is, the easier it is to care for them
  • Feel bad about themselves; everyone likes to be able to take care of themselves, as long as they can.
  • Lose strength not only in their legs but in their respiratory system, elimination and digestive systems.
  • Have an increased chance of developing skin breakdown.
  • No longer be treated the same as an independent person who walks. People in wheelchairs always state that people don’t talk directly to them, make eye contact, or talk about them.

Helping an elderly person continue to walk means:

  • Walking them from place to place, their room to the shower, their room to the dining room.
  • Have the elder sit in different chairs, and on different surfaces throughout the day. Have the elder sit in a dining chair during meals, a recliner watching TV, on a couch during an activity – always varying the sitting options during the day.
  • As soon as the elder seems to be having more trouble walking – get the therapy department involved to re-build strength.

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

BEST SHOES FOR ELDERLY – KEDS

10 REASONS WHY I LIKE KEDS FOR THE ELDERLY

  • Elderly don’t tend to pick up their feet when they walk – they may “shuffle.”
  • Thick soled athletic shoes have a “super grip.”
  • Thick soled athletic shoes because of the super grip can “catch” on carpet and tile when an elder doesn’t pick up their feet and many times cause a fall.
  • Thick soled athletic shoes tend to be heavy shoes, the elderly need to wear a lighter shoe.
  • The elderly often lose sensation in the bottom of their feet – maybe due to diabetes or decreased circulation.
  • The elderly need to be able to “feel” the floor through their shoes – to help tell them where they are.
  • The elderly can better feel the difference between a carpeted surface and a tiled surface through a shoe with a thinner sole
  • Keds shoes have a thin and flexible rubber sole so the elderly can feel the floor better through the bottom of the shoe.
  • Keds  – “Champion” is the same shoe as their first design in 1916. Improvements in that original shoe increased the ability of the shoe to absorb shock and protect the foot from jars and jolts. (All with the same thin sole)
  • Elderly with Alzheimer’s disease need as much information as they can get as to what is going on around them. They even need the information they get from the bottom of their feet, through their shoes.

See also blog: March 18, 2010 – GOOD OLD “KEDS” – BEST SHOES FOR CONFUSED ELDERLY

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

THE STROKE – THE FALL WITH FRACTURE – LIFE CHANGES WHEN THE ELDER CAN NO LONGER WALK

Barbara is 82, and has chronic respiratory problems. Her daughter says “Mom does just fine walking with the therapist at home, but when she leaves, Mom can’t walk again.” The ability to walk is so often the difference between staying in your home, and going to a Nursing Home.

A friend of mine just had back surgery, and the doctors told him, there was a 10% chance of his being paralyzed following the surgery. As he lay in bed recovering, he gave quite a bit of thought to those words and how close he had come. His surgery was a success, but what if?

Research and practical experience and observation tell us the tragic consequences of no longer being able to walk are:

  • Physical – muscle loss – 3-5% a day
  • Physical – Increased risk of edema, decreased blood flow
  • Physical – Decrease in appetite
  • Physical – Increase in frailty
  • Physical – Increase in incontinence and constipation
  • Physical – shortening of muscles
  • Physical – weakened body functions – decrease in lung capacity
  • Physical – Loss of bone density (increase in possible fracture)
  • Mental – Experience negative attitude toward people in wheelchair
  • Mental – Loss of confidence
  • Mental – Increased feelings of uselessness
  • Mental – Decreased quality of life

LIFE CAN CHANGE FOR THE CAREGIVER AS WELL

Life will change for the caregiver as well, if the elder can no longer walk. There is increased danger of injury to the home caregiver, who needs to support an elder’s weight when they walk. The caregiver can sustain pulled muscles, back injuries from lifting the elder. A change in socialization, if the elder is too difficult to take out, do to inability to walk.

Do what the Nursing Home does

When the elder needs the assistance of one caregiver to walk, they can continue to walk safely and independently while re-building strength, in an ambulation device. A good one is the Merry Walker, an all American made product. Merry Walker makes walkers for the home as well as Nursing facilities. If the elder maintains the ability to stand up from a seated position and walk with one caregiver, they may be a candidate for a Merry Walker Ambulation Device.

The Merry Walker is made from tubular steel for strength, and is black powder coated to help the person with visual impairment. The  tubing design, creates four sides of support for the elder. Each walker has a padded seat and casters so the elder can roll independently wherever they wish, with the security of the seat right behind them at all times. No longer do they need to turn around before they sit. Elders who continue to walk will be stronger, more independent and happier.

Go to: www.merrywalker.com to see the wide variety of supportive walkers the experts use.

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

GOOD OLD “KEDS” – BEST SHOES FOR CONFUSED ELDERLY – REALLY

Feet tell you where you are
Many elderly people like to go barefoot. Why wouldn’t they? We are constantly getting information about where we are through the bottom of our feet. When babies first start to walk, you can actually see their feet curl a little on the floor, as they try to grip the floor with their feet when they walk. They are learning to feel where they are, through the messages they are getting from the bottom of their feet.

When I see a confused elder with heavy athletic shoes, I think of how years ago we forced baby feet into these hard, heavy, clunky, high top tie shoes that they couldn’t possibly have been able to feel the floor through. Now the best baby shoes have thin, soft cushiony soles where the baby can still get information about the floor surface through their feet.

What information are the elderly trying to get through their feet?
Elderly many times lose sensation in the bottom of their feet due to a disease process, such as diabetes. Added to that loss, are the complications of perception for a person with Alzheimer’s disease. The lack of depth perception and ability to see the changes in the surface of the floor. A scatter rug of a dark color can look to the confused elder like a big gaping hole in the floor. Walking from one surface, a smooth surface like a tiled floor, to a carpet area can cause problems.

What’s so great about “Keds”
The “Keds” brand first came out in 1916, over 90 years ago. They still carry the first design they started with, the basic Champion. They have the same thin rubber sole they started with. Improvements came over the years in increased ability to absorb shock to protect the foot from jars and jolts, with the same thin sole. That sole is what is so great about Keds for the elderly.
(You now can even design your own “Champion” go to: www.keds.com)

The confused elder many times just doesn’t pick up their feet as well when they walk. The heavy athletic shoe, with the industrial strength grip sole can grip too much for the elder and cause a fall. Especially when catching on a thick carpet with soles that have a super grip bottom. The elder certainly can’t feel the floor and understand better where they are through, those thick soles designed for the athlete.

Increase the feeling in the bottom of your feet
A simple exercise while you watch TV can be to roll an old tennis ball back and forth under your bare feet. Just put a tennis ball on the floor and roll it forward and backward under the bottom of one foot at a time with your foot. This can increase the flexibility of the foot as well as increase the sensation, on the bottom of the foot.

Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com

Caregiver Tips: The confused senior who keeps forgetting their cane or walker.

Forget

Very difficult for confused senior to aquire new memory.


It is much easier for a person who has used a cane or walker in the past to use it after they suffer from memory loss. Once the person has used something for a long period of time, they automatically reach for it. The The senior with Alzheimer’s disease who has the most problem forgetting their cane or walker is the person who never used this device before they developed memory loss.

Long remembered body movements.


I remember a man who had long since stopped smoking, who was still going through the motions. He would reach into a shirt pocket and act like he was pulling out a package of cigarettes, but of course the cigarettes were no longer there. He would go through the motions of taking one out, put it in his mouth and light it. Even though this man had stopped smoking years ago, he had gone through these motions so many times, his body kept doing the long remembered motions.

We know that verbal reminders don’t work. Saying “Don’t forget your cane” over and over all day will just frustrate the individual and the caregiver. The individual with Alzheimer’s disease doesn’t want to be reminded all the time of the mistakes they are making.

Use body memory when confused senior forget their cane.

The best thing to do is just repeatedly put the cane or walker in the person’s hands. Build that body memory of having that device in their hands, learning by doing. You can just simply say “Cane” or “Walker” but no more. If you are talking about something unrelated like “Your daughter Sally, is coming for lunch today” while you put the cane in the person’s hand, when they stand up to walk, they still are learning to remember their cane.

Their body is doing the learning for them – and your reminder is putting it in their hands, not what you say.

Caregiver Tips: When a elder with Alzheimer’s disease just wants to keep Walking

Alzheimer's Disease Walking

Walking or wandering the benefits of keeping moving.

 
We are always told the benefits of walking. Walking maintains the tone in your muscles so that you can continue to support yourself. Walking helps your lungs get better air exchange. Now see the healthcare community wanting to get people up very soon after any type of procedure. I just spoke to a granddaughter of a man with Alzheimer’s disease who recently died of pneumonia. She said he just wasn’t getting up anymore, and his last months were in bed.

Walking helps all of the elder’s systems work better.


Walking helps with the process of elimination. Many elderly people are bothered with the problem of constipation. Movement stimulates all body systems to work better.

Walking keeps the heart strong and the blood circulating. The saying goes that anything that is good for the heart is good for the brain. Increasing the circulation also bring more blood to the brain.

Mall walking can help a person release some pent up energy and give the elderly person with Alzheimer’s disease the positive feeling of having worked out. Mall walking also give a person the opportunity to see other people and greet them. Just passing someone and smiling and saying, a cheerful “Hi.” It is a very normal activity that anyone can enjoy – and be good at.