Although the next best selling “How to” self improvement book is always right around the corner, the basics never change. The only change seems to be in the interpretation.

11 Proven Keys to Live Long and Age Well:

  1. Eating a balanced and nutritious diet
  2. Exercising regularly
  3. Getting adequate sleep
  4. Getting regular fresh air and sunlight
  5. Having social connections
  6. Being a lifelong learner
  7. Reducing Stress
  8. Working towards goals
  9. Being of service to others
  10. Maintaining a spiritual connection
  11. Having stimulating employment

As the saying goes, the “devil is in the details.” There is no lack of books defining a balanced and nutritious diet. Anyone with a sincere interest in improving their health need only go to their local bookstore. The problem comes with those details. Do you have a eating disorder, metabolic problem, thyroid issues, a need to lose weight, gain weight, an alcohol addiction, a need for probiotics, there is a book for your condition.

The list doesn’t seem all that long, just 11 key things to do, it is just so hard getting number 1 right. Maybe the goal should be to focus on getting numbers 2 through 11 right first. And for that pesky number 1 – everyone knows what foods are bad. Just don’t eat those.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing  


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


Dementia care involves first and foremost, providing for the safety of the person with dementia. One of the major symptoms of dementia, is the loss of safety awareness. Hand in hand with that, is the loss of the ability to reason, or think your way out of a situation. A real problem, if the situation is dangerous.

Added to providing for safety, is having good dementia communication, knowing what a happy environment looks like for someone with dementia, providing for social and spiritual needs as well as addressing everything physical.

5 Critical Areas of Dementia Care:

  1. Safety – walking alone across a busy highway, putting something on a hot burner and walking away forgetting about it, going outside in sub-zero temperatures without a coat, and more. Protecting the confused elder without having him feel he is being controlled, is good dementia care.
  2. Communication – just having the most beautiful home, with the best security system, won’t lead to great dementia care. Especially if the caregiver doesn’t know how to effectively communicate with a confused person. Good communication involves the speaker and the listener. When the confused elder is no longer able to communicate well, the burden is on the caregiver. The caregiver must know how to communicate through touch, gestures, smiles, patience and kindness.
  3. Environment – the environment needs constant review, and may change over time. Thinking of the environment as a way to make the elder with dementia know where they are and what is expected, is great dementia care. Clutter needs to be eliminated as it contributes to confusion. A kitchen needs to be used for preparing and eating meals. Having a TV running at all times in a kitchen reduces the environmental cues, that are telling the confused person, where he is. Creating a happy environment involves using music, activities, creating enjoyable smells, like the smell of cookies baking.
  4. Social and spiritual needs – whether this means continuing in church attendance, or participating in social groups, these connections remain important.  When the elder can no longer play that card game they won at for years, continuing the activity, while changing the level of the game is what is important. Getting together with familiar people, playing a game, laughing together, watching a movie together, these are important parts of dementia care.
  5. Physical – involves really knowing the person physically. What are the physical problems the person is challenged with other than dementia? Does this person have a vision or hearing deficit? Also good dementia care means knowing when the confused person has had a physical change in condition, when they cannot tell you. Physical also literally means engaging in physical activity to keep the body strong.

Many of these areas crossover to other areas. The person with a hearing deficit, will have an added burden of communication, increasing their confusion. The person who may be diabetic, will no longer be able to understand, how unsafe it is to not follow their diet restrictions.

To provide over all wellness, only 5 areas of dementia care turns, into a very big job.

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


“No decent man could have allowed an animal to suffer like that, they should have put him in jail. ” This is one of the sentiments expressed in the book, Saving Simon. Simon is a donkey who is very much in need of rescue, from the neglect that was bringing him close to death. The farmer who owns Simon has so many pressing concerns, that the right time never comes to attend to his donkey.

As the story unfolds, you realize it is about much more than the rehab of an animal. An animal that many point out hasn’t much purpose anyway. It is the story of several animals and people who enter and exit the writer’s life, as he tends to Simon. And yes, the story of that farmer, who never intended the lack of care for Simon to get as out of hand as it did. Many people could connect with the farmer as he waits and hopes for his situation to get better. When it does, he tells himself, he will make everything right.

But when considering Simon and his worth, how worthy is a donkey anyway? The point is made that while many people are shocked and outraged at the crimes against animals. The same people can be unfeeling for other people.  People can be labeled good or bad and therefore worthy or unworthy, of our concern.

This is a book you will think of often, after you have put it down. Compassion, the caring for someone or some thing with no thought of return. When the one you are caring for is unable to give you even gratitude in return. The lesson here on compassion, is so fitting, during the holiday season. Saving Simon, by Jon Katz a wonderful gift for any season.

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


Dementia is not a disease. The word dementia refers to a number of symptoms such as a decline in the ability to reason, remember, and even focus and think. There are many diseases that cause dementia and because each disease affects the brain in different ways, the word “dementia” is a broad term.

The most prominent disease is Alzheimer’s because it affects so many more people than Parkinson’s, Huntington’s, even stroke. Not only do the diseases resulting in dementia, affect the brain in many different ways, the cause and rate at which the dementia progresses is also variable.

In Alzheimer’s disease the outer layers of the brain are most affected resulting in the loss of memory and language. Other diseases such as Parkinson’s, and Hydrocephalus (fluid on the brain), affect the inner parts of the brain. This results in a decrease in the speed of thinking and an inability to initiate movement. Many times a person with Parkinson’s will actually get “stuck” in place while walking. They had a sudden inability to move and need to take a step backwards before they can once again go forward.

Dementia can also be the result of a severe trauma to the brain. Head injury resulting in blood clots can cause dementia. Brain tumors, a Vitamin B-12 deficiency, hypothyroidism, and of course multiple strokes may result in dementia.

As in all conditions what you are looking for is a change. If a person never could remember names, and they run into someone at the mall that they haven’t seen for years, and don’t know their name, it doesn’t mean they have Alzheimer’s disease. But when something is different and unusual for the person, especially if it has come on quickly, that requires a visit to the doctor for testing. Testing to rule out infection, drug interactions, depression, nutritional deficiencies, all of those things that can make a person appear to have Alzheimer’s disease.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing



There are consequences to living a risky lifestyle. The wellness check list tells you what a healthy lifestyle is and isn’t. Taking a close look at the areas that the wellness check targets, tells you what behaviors are ultimately going to cause disease.

Many of the tests check for cancer. Cancer is caused by external factors such as tobacco, infectious organisms, eating an unhealthy diet as well as internal factors such as inherited genetics, mutations, hormones and immune conditions. These factors may act together or in sequence.

What this tells us is that a substantial proportion of the cancers diagnosed could be prevented. All cancers caused by tobacco use and heavy alcohol consumption could be prevented.

Of the over 589 thousand deaths predicted in 2015 from cancer in the United States, 178 thousand will be directly caused by smoking alone. A third of the cancer cases will be directly related to obesity, physical inactivity and poor nutrition.

Seventy-eight percent of all cancers diagnosed are in people age 55 and older. The cost of cancer in 2011 in the United States alone was 88.7 billion.

So what about the wellness check? Will it make a difference? Only, if people are able to make the changes recommended. The best place and most obvious place to start are with smoking and diet.

Increase fiber, vegetables, fruit, (only if you do not have a sugar problem) reduce the use of red meats and eliminate processed foods and meats. And with winter behind us, time to increase that physical activity they talk about.

Virginia Garberding RN
Certified in Gerontology and Restorative Nursing


Part II

Preventative care under the ACA is offered by the insurance provider – but when is it free? When isn’t it free?

There is a list of 15 preventative services that are recommended by the Affordable Care Act. These are things like blood pressure screenings, testing for cholesterol levels, mammograms, colonoscopies, vaccines and so on.

These recommended preventative services require no; co-pay, out of pocket payment or meeting any deductible. The goal here is to offer these screenings/services to catch a disease process before you have any symptoms.

So what isn’t considered preventative and so isn’t free?

Any change in your health that is found through the preventative screening, requiring follow up testing and treatment, is not free. This could include lab work or other testing to manage or treat a condition. Medical treatment for a specific health condition and any on-going care is not included in “preventative” care. Any future diagnostic care or treatment is not part of preventative care.

Once a condition is identified, that will require any on-going or future treatment, it now is covered under your health care policy with the deductibles you selected.

Wellness checks serve an even greater purpose through organizing your healthcare. Instead of the burden being placed on the patient, to always know what is significant to report to the doctor. The wellness check will now ferret out those facts. If you are uncomfortable bringing up unusual bowel movements with your doctor, the wellness check will bring it up for you.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing