Whether you read a book, article or watch a show on health and fitness, all avenues to wellness include exercise. If the benefits of exercise could be packages in a pill form, the product would sell out. But what if all of those well known benefits could be achieved in an entertaining and virtually pain free way. Mirabai Holland has created such a program with her Moving Free Longevity Solution DVD set.

This program is created for beginners or anyone who has had trouble getting on or staying on a fitness program. Mirabai’s Moving Free system can take you from being a sedentary person to an active one in only 5 minutes at a time. Mirabai has a pleasant personality and uses gentle coaching as she encourages you along the way to better fitness.

The Cardio Dance Level 1 video in this DVD set is especially motivating. Her use of beautiful seaside scenery and engaging music ensure the participant will not become tired of this video any time soon. It begins with the necessary information to make this a safe experience. A brief description of the circulatory system as well as easy to follow directions on taking your heart rate. This video and all of her other videos can be used in small increments, starting slow and building until a person can do the entire program.

Mirabai is a certified health coach and certified exercise physiologist. Her Moving Free approach to exercise is designed to provide a movement experience so pleasant it really doesn’t feel like work. People say of her “Mirabai makes me want to exercise.”

Seniors know that when they now go for their annual Medicare fitness check, they will be asked how often they exercise. How wonderful at any age to be able to say you spend 20 minutes three times a week dancing your way to fitness.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing


The conversation around the conference table was familiar. Why are our patients getting younger and younger we asked each other?  I had heard this many times before, but this time it was different. The speaker, who was so questioning about what could possibly account for this, was herself only twenty-five. Kelly was concerned for her parents and grand-parents. She said she was regularly going home and telling her Dad, “We just had another patient come in today, who is so much younger than you are.” Why is this happening she asked, “aren’t these people supposed to be old?”

We talked about the fact that these people didn’t just have one diagnosis that brought them to the nursing home. No, they had led a life that led to multiple systems breaking down.

Proven life choices that keep the elder out of a nursing home:

  • exercising and maintaining an active lifestyle
  • getting enough sleep
  • spending time outdoors, enjoying sunlight and fresh air
  • having satisfying, close relationships
  • being a life long learner
  • minimizing stress in your life
  • being of service to others
  • having employment (or volunteer positions) that use your talents and skills
  • maintaining a spiritual life – remaining close to your faith
  • eating a balanced (a variety of foods) and nutritious (focused on vegetables/fruit/protein) diet

Yes, patients in the nursing home are getting younger and younger. At the same time nursing homes are getting better at providing all the therapies, social service counseling, diet counseling, etc., to help the elder turn around their health. So much better for Kelly’s dad to make these choices now, before he has fewer options.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing


12 Point Senior Living Assessment (continued):

6.      Reduce the Risk of FALLS. This is always the place where the children or family will get more buy in for a home          assessment. Every senior knows of someone who fell and their life changed dramatically. And they are right,                the goal is not to fall, not to get hurt, not to have a fracture. The statistics show that a fall increases the                            likelihood of spending your remaining days and possibly years in a nursing home.

Are the floors free and clear of clutter, extension cords, piles of old mail, magazines, general debris, are there               scatter rugs? Are there motion activated night lights and adequate room lighting? Are there pets that dart                      around the indoor living space that could be under foot? And most of all, is there a history of falls, has this                    senior  fallen before? Do not assume that you would know if the senior has fallen, many a senior if able to get up          independently will not tell anyone they have fallen. The question must be asked.

Please go to the “search” button on this site and search “falls” or go to the falls category, this is a topic that                     cannot be over stated.

7.    Emergency – smoke detectors. Are there functioning smoke detectors? Is there a system in place to change the              batteries on a regular basis. As in Part I under cooking, this is the time to look for indications that something has       been  burnt – pot holders, dish towels, cutting boards, etc.

8.     Neighborhood safety. How close is the nearest neighbor, does the senior know the neighbor? Do you know the             neighbor? Would the neighbor be willing to check on your senior if you called them? Does the senior feel safe in           the neighborhood? Safe in their home? Safe going out at night? Does the senior, if they drive, feel safe going to              their car? This is the time to take a look at door locks and window security. Is there a system in place to ensure            that the senior cannot get locked out of their home by mistake?

9.     Water Temperature. Check the water temperature, make sure it is set below 120 degrees. As a person ages, they            may lose the ability to accurately feel water temperature due to diseases. Checking the water temperature on a             regular basis reduces the chance that this costly mistake will be made.

10.    Money Management. Are there stacks of bills sitting around or sitting in bags? Have you found money hidden               in interesting places? One elderly man decided to hide his money in a family Bible, to quickly forget where he               had hidden it. Are all of the seniors services in good working order, any indication that a service has ever been             interrupted?

11.     Does the senior have a healthcare/financial power of attorney in place? Is the power of attorney well informed            of the seniors wishes? Is there a living will? Make sure that if a decision has been made to have a “Do Not                       Resuscitate” form in place, that it is posted in a visible location if needed.

How often this assessment is completed is a judgement call. If the senior is very highly functioning, it will just give a heads up on what things to be looking out for. Over time, what started as an annual check can begin to be twice a year and for some areas, turn into monthly checks.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing



She was just pausing at the entrance of the grocery store, I paused as well to ask if I could be of assistance. She said no, she just needed to stop for a minute for her eyes to adjust to the dim light of the store on this sunny August day. She shared that she was now 86 years old and she had to be more careful. How very fortunate she was, shopping alone, car in the lot, very attractive slack outfit on and gray hair piled on top of her head in a very fetching bun.

As anyone knows who finds themselves sitting with a group of seniors chatting about their health issues, people do not age in the same way at the same rate. Even identical twins will age differently. If we all aged exactly the same everyone would become more and more alike as they get older, and that is not the case.  Older adults vary in the same way younger people do in their attitudes, recreational activities, how they look, and social connections.

But physically there are some similarities:

  1. Vision, as with the lady in the grocery store, aging causes a greater sensitivity to glare. Adapting to changes in light levels is slower and there is greater difficulty seeing in lower light.
  2. Heart, the heart muscle thickens with age and the body’s ability to extract oxygen from blood diminishes.
  3. Arteries, stiffen with age, making it more difficult for the heart to pump blood forward through arteries that are less elastic.
  4. Lungs, between the ages of 40 – 70 breathing capacity diminishes about 40%.
  5. Brain, the aging brain loses axons and neurons that connect with each other.
  6. Kidneys, gradually become less efficient in removing waste from the blood.
  7. Bladder, the bladder capacity declines.
  8. Body fat, with aging fat tends to settle more in the deeper organs of the body causing more of a apple shape.
  9. Muscles, without exercise muscle mass will decrease about 23% between the ages of 30 and 70.
  10. Bones, bone mineral is lost and replaced throughout the life time but at the age of 35 you no longer replace as much as is lost.
  11. Hearing, it becomes harder to hear higher pitches with aging, and background noises make hearing more difficult.
  12. Personality, does not change with the aging process. However seniors who experience chronic pain, or a significant loss are at risk for depression.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing


Whether it is bath soap, air freshener, laundry products, scented candles, or the cologne on the check out clerk at your local grocery, we are surrounded by scented air. While it is law to list ingredients on these products, there is a significant loop-hole. The word “fragrance” in so many products used every day, represents many substances the average person would not consider a pleasant odor. These chemicals masquerading as a fragrance, are for the most part derived from petroleum and coal tar products.  These chemical concoctions are found is products all around us, and are directly related to many health concerns.

These chemical mixtures are protected under a misconception that they are “trade secrets.”  There might have been a time in years gone past that the combination of certain essential oils and flowers were highly protected secrets. However these days, the secret that is being protected, is where these chemicals come from and what they do to human health.

Current research is telling us compared to other senses, the sense of smell is directly connected to brain health. That smells are able to pass the blood brain barrier, that protects the brain from many other forms of attack. These hundreds of fragrances created in laboratories, with many times banned chemicals, are responsible for many disorders. Surrounding ourselves with all of these scents is leading to negative emotions, irritability, brain fog, fatigue, headaches, dizziness, tremors, convulsions, and the list is growing.

There is recently even a new term for that person, who through the use of strong smelling products, intrudes on others. It is “second hand fragrance” similar to second hand smoke. It is when one person makes a decision to use several strong smelling products (shampoo, deodorant, hair spray, perfume, laundry products) and by doing so contaminates the air quality of others. There was a recent report on the news regarding sunscreen products, and they found many people bought a product not on how effective it was for sun protection, but because of the way it smelled.

The elderly as well as the very young are at increased risk for neurological problems connected to fragrances that pass the blood brain barrier. Yet many times the offender is an elderly person who has become so addicted to their fragrance, that they literally no longer smell it.

If you have been guilty of second hand fragrance, do what people did years ago, put a little vanilla extract behind your ears.

Suggested reading: “Get A Whiff of This” by Connie Pitts

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing


What kind of therapy can a person get?

Therapy is determined by two things. The benefits that are available from Medicare A, and B as well as the individuals insurance co-pay, is always the first consideration. The amount of time actually used for therapy is as important as the payer source, and is determined by the individual’s progress in therapy. Medicare and private insurance do not pay for maintaining function or ability, they only pay for improvement. Once it has been determined that the patient has reached their full potential they are discharged.

How often do you get therapy?

Many family members think that the more therapy a person receives, the faster they will recover. However the person who tires easily, and also may be receiving more than one form of therapy, will have to be scheduled according to their energy levels. Their energy may depend on what time of the day it is, as well as how long a therapy session they can tolerate. This is why therapy is scheduled in minutes, and charged to Medicare in that way. Making good use of the their therapy time, results in better use of therapy funds.

Types of therapy:

  • Geriatric therapy – for the elder who is fragile due to age. Therapy can provide strengthening exercises working closely with the a dietitian to provide increased nutrition.
  • Therapy following stroke, head injury, nerve injury – the therapies work through the re-educating of muscle groups. The patient is provided services in physical therapy, occupational therapy and speech therapy. Most of the time these patients requires all three therapies.
  • Pain management – for the patient with stiff joints resulting from disease processes as well as soft tissue injuries physical and occupational therapies will help. As well as for pain that is associated with other physical and chronic disorders.
  • Edema therapy – the therapy department monitors excessive fluid in extremities and provides therapy to conservatively control this fluid imbalance.
  • Orthopedic rehab – whether it is a hip replacement or a fracture the therapy department through assessment and evaluation develops a personalized program reflecting the patients’s strengths and needs. So if the patient is returning to work therapists would want to know what kind of work, so that the program could reflect what the person previously did.

In order to create that personalized therapy program, the patient or family, will have to think about what is their goal for this person. The goal may be that the elderly person with dementia can once again eat independently. Or, that the person with a debilitating stroke will once again be able to use a toilet.

When the therapy team knows the patient’s goal they can begin to develop that very personal, therapy plan of care.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing


“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 and see some safe ambulation devices.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing


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


Boxing and Parkinson’s Disease

I recently saw a news show on television that highlighted the benefits of boxing, for persons with Parkinson’s disease. While everyone interviewed identified positive results, all the way from; moving better, to being motivated and at times being pushed to participate.  Those who strongly recommended boxing never really hit the nail on the head, and told us why this sport would work so well.

Boxing and Crossing the Mid-line

Picture an imaginary line from your head to your feet cutting your body in half. Every time you do something with your right hand and arm, swinging to your left and therefore crossing your mid-line you also increase the right-left connection in your brain. Watching the show and seeing the participants either hitting a punching bag, or in a ring hitting an instructor, you can easily see the therapy involved. When they punched with their right hand they frequently crossed over their body and hit the opponent on the right side of his body.

The brains two sides coordinate with their opposite side of the body. All of the connections happen in the middle of the brain called the limbic system. Exercises that cross the mid-line, reinforce and support  the connections in the limbic system. The limbic system is also the site of emotional intelligence, explaining why people feel happy after exercise.

Creating exercises that cross the mid-line

A simple balance exercise turned into a brain exercise can include swinging arms across the body. Kicking a leg across the mid-line while holding on to a chair is a simple brain movement. Bouncing a ball in front of you, with your right hand and then switching to your left hand, crosses the mid-line. Starting with a larger bouncing ball and then scaling down to a smaller and smaller ball also improves balance.

Great games with small children such as a bean bag toss when done crossing the mid-line, is a fun way to exercise the brain. Older children enjoy playing catch, and can start by just bouncing a large ball back and forth. Till they then can catch a ball in midair and switch up to a smaller ball.

Take that even further by hitting a tennis ball, volley ball, anything that provides that movement of crossing the body. Especially so for the confused elder who enjoys just throwing a beach ball around the family circle, or maybe a wild game of balloon toss. The easiest mid-line exercise for just about everyone, is to cross your arms and give yourself a big hug. The limbic system, is why that feels so good!

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing


Once again the flu and cold season is rolling around. Not only at your local drug store will the pressure be on to get a flu shot, but all of those people in nursing homes will be vaccinated as well.  While try as they will, the pharmaceutical companies cannot get those significant numbers that prove that vaccines prevent flu. However the proof is easy to obtain that regular brushing of teeth, can prevent infections.

I was recently told by a speech therapist that a Japanese study proved that dental hygiene was twice as effective against pneumonia than medical intervention including antibiotics.

When teeth are not brushed regularly, a slime starts to develop on the teeth and gums. I have heard it compared to the slime that collects on the water in a vase, once the flowers have passed their prime. Poor dental care is one of the most upsetting situations for the family visiting in the nursing home. When Mom or Grandma is unkempt, smells of urine or has dirty teeth and nasty breath, she just doesn’t seem like Grandma.

Many times for the elder in a nursing home, they have medications that impact on their dental hygiene. The medications may cause excessive saliva or dry mouth, either condition impacts the ability to keep teeth clean. There are several products available for dry mouth and dry lips, Biotin works well.

For the elder with excessive secretions using a suction machine with an adaptive tooth brush attachment prevents the build-up of secretions at the back of the throat. The brush can have a small smear of tooth paste or be dipped in mouth wash or Biotin. This works well with the elder who is no longer able to clear and spit secretions independently, or is unable to follow directions from the caregiver to do so.

For the confused elder I always recommend a children’s toothbrush. The smaller size is less invasive in the elder’s mouth. When the elder is no longer able to rinse and spit, the use of a children’s toothpaste is also recommended. These are made for someone who will most likely swallow the paste. By far the usual favorite is grape flavored toothpaste over the minty ones used by adults.

The most important thing is to just get started. Being accustomed to the feel of a toothbrush, as well as the feeling of clean teeth should never be allowed to be forgotten.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing