Time flies!

I can't believe the semester is almost over... it went by so quickly! I learned so much and I feel more comfortable with working in the geriatric field.
I was surprised to learn that there was primary and secondary aging. I figured it was all just clumped together into "aging." I also thought that some diseases, like arthritis, were a normal part of aging. I was wrong! Most of the normal signs of aging were not surprising to me (i.e wrinkles, grey/white hair, decrease in senses). However, I did not think of them from an OT perspective before; it surprised me how these normal aspects of aging can lead to so many other problems.

 
Examples:
Hearing- A loss of hearing could lead to social isolation, depression, and decreased safety.
Taste & Smell- A decrease in these senses can lead to decreased food intake and nutrition, decreased safety, and social participation (especially when cooking/eating involved).

Link to Article on Untreated Hearing Loss
Geriatric Nutrition
Making Sense of Sensory Loss

Most of the patients that I saw this semester had hearing loss. It is hard to know how loud or close to talk to them without looking like you are yelling at them. Also, it was hard to know how much of the conversation they were missing due to not wanting to keep asking, "What did you say?"

My grandma has not been able to smell anything for at least 5 years. One of her favorite things used to be candles... so we would always get her pretty scented candles for presents. Now that she can't smell anymore, we never buy them for her and she said she really misses being able to smell her candles.

A big thing that I have noticed with my grandma as well as the patients is the high amount of salt and sugar they put on their food. WOW!

I am looking forward to our summer break, then next semester! Oh my goodness, our last one before fieldwork 2...Scary and Exciting!

What's Your Favorite Food?

I can't believe that summer session is only two days from being completed. It seems like we just started talking about working with geriatrics yesterday. I know I've learned so much this summer even with such little time to do so. It's been hectic with everything going on, but I wouldn't really want it any other way. One of the biggest things I learned is that no matter how much you plan and attempt to think of everything, it always changes. Not one day went by as I "had planned." But as far as learning for test, reading our text book, doing field work at a skilled nursing home, and even while interviewing a few folks, one change that comes with "normal aging" that I think was the biggest surprise was the loss of ones senses, in particular, taste.
I've always known that as we age our body slowly breaks down and some things that worked one day wouldn't work the next. I knew hearing would lead to hearing aids and we would one day need glasses to read a book, or these days, watch our favorite shows. But I never really stopped to think about losing the ability to taste our favorite meal. That's always been a classic question one asks to get to know someone, "what is your favorite food, or meal?" And often some of our fondest memories are situated around events that involve food, such as Thanksgiving. For birthdays, special events, and holidays something is usually cooked up for a particular reason. I know one of the things that I miss most about my grandmother was her mashed potatoes, mhmmm, I've never had any quite like hers since she lost the ability to cook.
But one day, if someone were to tell me I might never like the taste of mashed potatoes again, I'd probably laugh at them as if they told had just told a joke. And if my favorite food was something like fried chicken to go with those potatoes, and someone told me I couldn't eat those at all anymore, I'm pretty sure I'd toss something across the room. What's the point of aging if we can't even enjoy what we like anymore? I can see how one might not be able to indulge in solid foods for their entire life, but the fact that our taste buds change?!  But, then again, when I think about myself now, my taste buds have already been changing. I know enjoy broccoli and salads, I'll choose an apple over a candy bar, and "chicken fingers" at fast food restaurants don't tempt me anymore. So, if my change tastes can change to this point, what's to keep them from changing again.
Also, not only could this affect how we enjoy food, but it could cause us serious problems. If I were to bite into an apple and it tastes bad, I would know the immediately spit it out. But as our tastes changes, we lose the ability to know if items are rotten (spoiled). Imagine enjoying your favorite cereal with lumpy milk! If we no longer want to eat our favorite foods, why on earth would we want to eat what we really don't want to. If salads were already difficult to eat, why bother when they taste even worse. The decline in our taste senses can even lead to malnutrition and health problems (health issues).

With all of the changes the body will go through as we age day-by-day, this is the most surprising to me. I still can't imagine a day I won't enjoy my favorite meals, even though I have seen it happen to those around me. Until then, I'll keep trying new foods and as many mashed potatoes as I can until I might one day either find the ones that taste like my grandmothers or I just don't want them anymore.

Does my diaper make my butt look big?

A lot of factors of normal aging are obvious when you know someone who is over 65. You can see the whitening of their hair, the loosening and bruising of their skin and perhaps notice they can't hear or see as clearly as you can. I wasn't surprised to learn about the decline in the five senses or in bone density, muscle mass, and organ systems. I was surprised to learn that incontinence was NOT a normal part of aging.

Since incontinence issues are so common among older adults I figured that it was the norm. At Rose Manor, there's not one patient in there that does not wear Depends, even if they are able to get up and go to the bathroom independently. My grandparents don't wear depends (that I know of) but I do know they have issues going to the bathroom sometimes. At night my grandma grabs herself a good book and says "I'm going to sit on the pot" and she'll be gone for 30 mins. I just figured that since the metabolism gets slower as you age, it is just harder to regulate and control the bowel and bladder.

To me, all of the other normal parts of aging were obvious. However, incontinence is prevalent among elders but it's not a normal part of aging. I'm relieved to hear that because wearing Depends and relying on someone to change you does not look appealing. I'm definitely going to be an advocate for strengthening the pelvic floor muscles and making sure that people are aware about what is NOT a normal part of aging.

This video helps explain more on how to prevent incontinence and educate people on ways to control bowel and bladder issues.

Geriatric Summer Reflections

                            
This summer has definitely been an interesting one!  We were able to experience and work with a number of different people who enhanced our classroom education.  The topic today is one factor of normal aging that surprised us.  There were a number of surprises but the biggest one to me was the 1% decrease after the age of 30!  It did however bring some consolation by way of explanation to the morning aches & pains that were never there before, having to look for my car keys for a half hour because I forgot where I put them and accidentally burning my boiled eggs!  It was also interesting when doing the interviews to hear the different levels of decline related to primary aging in the different individuals.  It definitely isn't all down hill at lighting speed but a slow and progressive process that is compensated for over time.

One of my interviewees used to play couples tennis until she nearly took out her partner because she wasn't in her line of sight.  Since, she has continued to play tennis to keep active but just one on one.  This person also confirmed the facts we went over in class do to aging; adding more salt to food, increased thirst, decreased vision, loss of sensation and decreased sense of smell as the years have gone on.  It was very enlightening to hear her positive attitude on getting older despite the decline in key areas.  She has continued to keep physically active in hopes of doing senior Olympics after retirement!  I've included a little video here of a team of senior volleyball Olympians, very inspiring! 

http://www.nsga.com/video/rallying-troups

So to wrap it up I depart this summers blogging by saying regardless of the inevitable physical changes, it is a positive perspective that will make the years ahead more enjoyable :-) Peace.

It Don't Mean a Thing if You Ain't Got That Swing

With your pharmacy store helper

   and my hormone patch

do you think we could possibly

   make a great match?

(submitted to the 10th International Longevity Light Verse Contest by Jane Moralice of Costa Mesa, FL)

     It's time for health professionals and caregivers to address sexuality in elders who live in the community and long-term care skilled nursing facilities.The Area Agency on Aging in Pasco-Pinellas, Fl,(http://www.agingcarefl.org/aging/normalAging) an area with a large number of seniors, has identified six characteristics besides heredity and genetics that are traits of people in areas with exceptionally long life expectancies. They are:

1. Following a diet low in animal fats and high in vegetables and whole grains
2. Moderate consumption of alcohol
3. Maintaining physical activity throughout life
4. social involvement in the community
5. Having an environment that is challenging and free from pollutants
6. Sexual activity that continues into later years--they are sexually active and free to express themselves in this way.

     According to a training module called Geriatrics, Palliative Care and Interporfessional Teamwork Curriculum, put out by the NY/NJ Veteran's Administration www.nynj.va.gov/docs/Module19.pdf,

elders do not mind discussing sex and in fact, are quite interested in the topic. However, current aging stigma enforces beliefs such as: elders don't want to be sexually active, they have a decreased interest, they are incapable of sexual relations, and it is dysfunctional for seniors to want to have sex.

     That is where our role as professionals comes in. We have to be willing to initiate the conversation. It will benefit the patient/OT relationship by building rapport and trust and help shatter myths about sexuality and aging. There is an increasing elder demographic and life-expectancies are increasing, making sexuality a significant subject for older adults.

     In our treatments, we must be respectful and nonjudgmental, take accurate sexual histories and assessments, ask direct questions, educate patients and caregivers about safe practices and adaptations, listen to patient concerns and be willing to refer them to specialists for assistance if necessary.

     This summer, I found out just how willing elders are to talk about this topic, which seems to be more uncomfortable from the professional side of the coin. I interviewed three elders of various ages and always asked their opinions of sex. One lady, who is 96, said she thinks sex is one of the most natural things in a person's life. She remained sexually active well into her 80s, when her husband's health declined. She assured me she always had a very active sex life. Afterall, she said, her husband was French and "you know how they are with lovemaking."

     Also, my mother and her friends, who are all widows, continue to talk and joke about sex. None are currently active, but one 84 year old joked that when she goes to the nursing home she will ride around in her wheelchair and interview the prospects.

     Following is a link to a Youtube video that challenges aging sexuality stigmas and encourages members of the Allied Health Professions to talk about the elderly and sexual behaviors. Because of restrictions, you must follow the link to youtube to view it. Please do. It will be worth your time.

<iframe width="560" height="315" src="http://www.youtube.com/embed/sw6UetyUuD0" frameborder="0" allowfullscreen></iframe>

 

Can you smell the roses?

I knew that your senses change as you age, but I didn’t realize the extent of the changes that could occur.

For example, even though I’m not a senior citizen, I’ve been wearing reading glasses for years.  And this week, when we had an activity at a nursing home, we were helping some residents work on crafts.  One resident had forgotten to bring her glasses to the activity room.  As a result, she wasn’t able to work on her craft.  It’s surprising how much a simple thing like forgetting your glasses can keep you from doing things that you want to do.

We’ve learned that as you age, you might have trouble tasting saltiness in foods.  Once, my father-in-law was having barbecue at our house.  He wanted to add more barbecue sauce.  When he reached into the refrigerator, he didn’t realize that he accidentally took chocolate sauce instead of barbecue sauce.  He put it on his barbecue, and even as he continued eating, he didn’t notice what he had done.

Smell can also be affected by aging.  Sometimes I’ll comment to my mother that I smell something, and she doesn’t smell it and isn’t aware of it at all.

Most people are aware of how common it is for senior citizens to have hearing loss.  Very often, when working at the nursing home, we need to stand in a certain position where the residents could hear us more easily, and we need to be sure to speak clearly.

The following Web site offers info about aging and sensory changes.

http://www.intelihealth.com/IH/ihtIH/WSIHW000/22030/23724/347117.html?d=dmtContent

Often, by the time we have time to stop and smell the roses, it’s hard to smell them!

Driving

Watch the video! It is Jerry Seinfeld talking about older people driving! It is so funny!

Driving has changed in the United States. The streets are much busier and congested and everyone just seems to be in a hurry! There should be new laws made to keep up with our fast growing society. People 70 years and up should need to take tests every two years to renew their license. The test should include an eye exam and a road test. This would decrease the number of accidents on the road. There should also be training for DMV staff on what to look for while doing the test. The staff could be trained with a program like CarFit. This is a program developed by the American Society on Aging with AAA, AARP and AOTA. The program looks at an older person's car to make sure that it is the right "fit" for them. Examples of what they are looking at are: Foot Positioning on gas/brake pedals, mirror adjustment to eliminate blind spots, seat belt positioning and position of the person with the steering wheel (should be 10 inches or greater). If the DMV staff knew what to look for, it would make the test much more effective. The staff would not need to do the entire CarFit program... this might be too time consuming. But if they were concerned, they could refer the driver to a CarFit program where they could do additional testing. They would need to make the CarFit program mandatory before receiving their license.Also, Doctors need to ask their patients about driving. Doctors see the patients the most often so they need to be responsible for talking to the patient about driving, giving information and doing a thorough eye exam including testing visual acuity and field of vision. The Doctors could also refer older drivers to programs such as CarFit. It would help if this was something that was done early (at 65) so that drivers are well educated and feel like the Doctor is trying to help, not take away there independence.More INFO:Click here for CarFit
Tips and Play a Driving Game 

What OT can do!

                                       

Elderly Driving--Simulated or Real?

Elderly Driving (a joke)
A mature (over 50) lady gets pulled over for speeding and this drama unfolds:
  Elderly Woman: Is there a problem, officer?
Officer: Ma'am, you were speeding.
  Elderly Woman: Oh, I see.
Officer: Can I see your license, please?
  Elderly Woman: I'd give it to you, but I don't have one.
Officer: Don't have one?
  Elderly Woman: I lost it--four years ago for drunk driving.
Officer: Oh, I see....Can I see your vehicle registration papers, please?
  Elderly Woman: I can't do that.
Officer: Why not?
  Elderly Woman: I stole this car.
Officer: Stole it?
  Elderly Woman: Yes, and I killed and hacked up the owner.
Officer: You what?
  Elderly Woman: His body parts are in a plastic bag in the trunk if you want to see.

The officer looks at the woman and slowly backs away to his car and calls for backup. Within minutes, five police cars circle the elderly lady's car. A senior officer slowly approaches, clasping his half-drawn gun.

Officer 2: Ma'am, could you step out of the vehicle please?
The woman steps out of her vehicle.
  Elderly Woman: Is there a problem sir?
Officer 2: One of my officers told me you have stolen this car and murdered the owner.
  Elderly Woman: Murdered the owner?
Officer 2: Yes, could you open the trunk of your car please?
The woman opens the trunk, revealing that it's empty.
Officer 2: Is this your car ma'am?
  Elderly Woman: Yes, here are the registration papers.
The officer is quite stunned.
Officer 2: One of my officers claims that you do not have a driver's license.

The woman digs into her handbag and pulls out a clutch purse containing her license and hands it to the officer. The officer examines the license. He looks quite puzzled.

Officer 2: Thank you ma'am. One of my officers told me you didn't have a license, you stole this car, and you murdered and hacked up the owner.
  Elderly Woman: Bet the liar told you I was speeding, too.
-Anonymous

     It is difficult to answer the question about whether or not it is better to use a driving simulator or behind the wheel  (BTW) testing for elderly drivers. Both have their pros and cons.
     As far as simulators are concerned, when used in conjunction with client/family interviews, visual and cognitive tests such as clock drawing, trail-making and the short blessed, they can yield enough information to determine a person should not be driving or at the very least should also have a BTW evaluation.
     Drawbacks however, can include different types of simulators revealing different results (depending on simulator width, lighting and assessment data), training of the evaluator, driver unfamiliarity with computer simulators (which creates an unnatural feel), and the real presence of simulator sickness (nausea, dizziness, headaches) that stops some testing before completion.
      BTW testing will help determine the client's driving abilities by testing visual-perceptual, cognitive, and motor skills necessary for driving. It is especially useful for judging attention to multiple stimuli at one time.
      As noted in the article "Evaluating Driving as a Valued Instrumental Activity of Daily Living" (AOTA publication, Productive Aging, January, 2011), BTW testing can effectively reveal if a person with physical difficulties can drive safely with the necessary adaptations. Unfortunately, when it comes to cognitive changes with aging, BTW training is not as cut and dried.
     Years of patterned behavior behind the wheel can mask many cognitive difficulties as the driver performs automatic procedures practiced for many years. Some of these include staying in lanes, stopping at red lights and operating the vehicle at proper speeds. Unless an unexpected event occurs, it may not be as easy to spot decline in judgment or reasoning, and creating BTW situations that would identify them may pose a danger to the driver and evaluator.
     In the article "Evidence-Based  and Occupational Perspective of Effective Interventions for Older Clients that Remediate of Support Improved Driving Performance" ( AOTA publication, Driving and Community Mobility, March, 2008) the authors note that "most individuals fail to recognize their decline in driving competence and adjust to lower levels of visual acuity, reduced reaction time, and reduced peripheral vision and cognitive function." Therefore, giving these drivers insight into their deficits would be the most valuable intervention practice.
     Accordingly, aging drivers are less likely to accept the validity of simulated testing, regardless of the information presented. Therefore the best approach to driving evaluations is an extensive testing that includes interviews, cognitive testing, driving simulations and behind the wheel driving.
     The OT community should embrace both options, and in treating the whole person, should provide an individualized assessment that directly addresses each client's unique needs. That is the goal of Older Driver Safety Awareness Week December  3-7, 2012. http://www.aota.org/olderdriverweek

Taking Freedom

You've spent your entire life struggling to earn every penny you have in your bank account. You've managed to have and raise a family through the good and bad times. You voted for presidents and politicians to help the US's success. You've done simple things like cooking what you want, when you want. Gone to the movies when you feel the urge, and even been able to go to the bathroom when you knew you had to go. However, as you age you find these things disappearing to fit other peoples schedules. You may be able to vote, but when? and where? You have someone else tell you what you can and can't eat, and even if it's solid or mush. You have to wait on someone just to go to the bathroom. Your bank account that has your money is now only accessible to the family you managed to raise, or even worse, a non-family member. It's extremely difficult to lose the right to choose what you want when you want. You've spent your entire life learning, working, earning, etc, and now that your retired and can finally do what you want, it's taken away. So your done to just being able to do the essentials in life and requiring help in most of your decisions. But, you are still able to drive to the post office to mail your letter to a family member that lives across the country. And seemingly out of nowhere, someone comes up and tells you they are going to take away your last bit of independence and freedom, your car. It's how you've gotten around since you were 15. It helped establish you as an adult and allowed you to travel and even work. It got you to school to get the education to get the job! It allows you to visit your friends when you want to. And now...it's gone.

It's a very difficult decision in any ones life. I remember having to take my grandmother's keys when she began to show signs of dementia. A drive she took every Sunday and Monday to church for 60 odd years suddenly became a thing of life and death. To take her car was to take away her life. She thrived on counting the money for her church. When that went away, it was almost as if she had no more purpose and the dementia quickly progressed soon after. It seems if we let her keep the car, she might of had a couple of extra years with us. But would that of been worth it when she was getting lost? Driving 10-15 MPH in a 45? and even making careless decisions. Fortunately, she never caused an accident as some of the stories at the end of this webpage concerning  senior citizens and driving.(sad stories.)

But how do we as a citizens who are affected by senior citizen driving know what we can do. We know there's driving laws and test out there, as we each had to pass a test to receive our license. But what about for senior citizens? I believe one of the reasons it's so hard for us to to know is enough with the elderly being able to drive is that there is not set laws. Each state has it's own guidelines, (renewal) and even then, most of them require very little to renew a license. Some states one can do everything online without any personal contact. How is the DMV supposed to regulate licenses without contact?! One way family members can help is to inform the eye doctor or the physician about a loved one who is showing signs. The doctor can then take the license away, but that still requires a lot of effort and a lot of time ends in conflict between the family and their loved one. This is a interesting link that also has a small interactive part to show how the elderly is affected with age and driving, interactive. But with each state having different laws and different times and limits for renewal, it's no wonder it's hard for the elderly to have restrictions. If we can't keep up with the laws with a "fully functional" brain, how are the elderly when there cognitive abilities are slowing.

Until we have set laws that are fluid among the states, I find it very difficult to think that we can have a decent process in which to regulate senior citizen's and their licenses. Below are some links for the elderly and their loved ones. They demonstrate ways to improve elderly driving and also warning signs to look out for. Until the government comes up with a set of rules that is a standard across the US, it will be up to those who interact with the elderly to enforce driving regulations.
http://seniordriving.aaa.com/
http://www.alz.org/care/alzheimers-dementia-and-driving.asp

8 Year Olds Can Play Video Games

Watch this video:

This video is supposed to help someone know what it feels like to drive a semi-truck. After watching this video would you feel 100% comfortable with driving a semi-truck? I wouldn't! Notice how both mirrors are consistiantly in the visual, but the passenger seat is not. When you drive a regular size automobile, is that what you see?

What I know about driving a car is you have to actually turn your head to see the passenger mirror which then limits your vision on the drivers side. Would you agree that a semi-truck may be harder to steer than a regular size automobile? This may give a person somewhat of the visual aspect of driving a semi-truck, but it does not simulate the actual feeling and multi-tasking that takes place while driving.

Even though a person who is retaking his/her driving test is most likely not learning how to drive a semi-truck, a simulated test seems a lot easier than an actual driving test because you only have to really focus on one of your five senses which is your vision. A simulated driving test is nothing more than playing a video game, which can be mastered by children under 10 years old. If a child is good at a driving video game, would you trust him driving your car? Most likely not. Therefore it is important for people who are driving on the road to be competent in many aspects that take place when you drive.

According to Smartmotorists.com  they state that "research on age-related driving concerns has shown that at around the age of 65 drivers face an increased risk of being involved in a vehicle crash. After the age of 75, the risk of driver fatality increases sharply, because older drivers are more vulnerable to both crash-related injury and death. Three behavioral factors in particular may contribute to these statistics: poor judgement in making left-hand turns; drifting within the traffic lane; and decreased ability to change behavior in response to an unexpected or rapidly changing situation".(http://www.smartmotorist.com/traffic-and-safety-guideline/older-drivers-elderly-driving-seniors-at-the-wheel.html)

Giving a simulated driving test can hinder a senoir citizen in several ways. For example, they may be great drivers on the road but unfamiliar to the simulated driving test or videos games at all for that matter. Therefore if they fail the simulated driving test, will their licence be taken away becuase of that?

Nothing beats the real thing. Driving is something we should all be cautious about. Let's make the time and money to have more safe drivers on the road.

License renewal for seniors

I live in Virginia, and I have seizure disorder.  Therefore, every 2 years, I have to submit documentation from my doctor verifying that my condition is under control and that I can drive safely.

This might be a good solution to the question of older drivers.  Maybe every 2 years, an older driver should have a medical exam and should provide a doctor’s certification that the driver is capable of driving safely.  If there are any health issues that could affect the driver’s ability to operate a vehicle, the doctor could indicate what needs to be done.

There are many people in their 90s who may drive just as well as people in their 70s.  Therefore, it’s hard to suggest a specific age when a driver should have a medical exam every 2 years, but if I had to choose an age, I would probably suggest 70.

The medical exam should include assessments of vision and hearing.  The state could determine what other factors should be assessed, based on the changes that tend to occur as people age.

North Carolina already indicates that licenses can be issued only to people who are physically capable of driving and don’t have health issues that would prevent them from driving safely.  The requirement to have a doctor’s statement every 2 years could be one way of verifying the ability of older drivers.  That way, they could continue to have their licenses renewed in accordance with the current system.
 

For more information about North Carolina’s requirements for obtaining and renewing licenses, you can visit this Web page:

http://www.ncdot.gov/dmv/driver/license/

Let’s be glad that animals can’t get licenses!

Keeping it REAL...

         

So the topic for the day is whether or not simulated driving evaluations are equivalent to an ACTUAL driving assessment.  After doing a little research on the matter it is apparent both evaluations will obviously give some sort of end result – duh.  The question is which evaluation is more reliable?  Statistics are statistics & will always give some informational result.  However, it begs to question; how is a SIMULATION is ever going to be REAL?  We don’t simulate our self to the grocery store or simulate dropping the kids off at school so why would we simulate a driving evaluation?  Let’s keep it real!  With all the different dynamics of personality out there it would most likely behoove the public to take a driving evaluation in real time, real everyday situations & base the results off of reality.  I have included here a couple links on an example of a simulated driving evaluation & another link on a study done from a Virtual Evaluation (VE).  See & judge for yourself how close to real life these things can possibly be.

 

LINK #1 =

► 2:19► 2:19

www.youtube.com/watch?v=7wogpRazlu8

LINK #2 = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2186376/