Driving Seniors

This week in class we discussed the controversy of driving and aging, and the benefits of programs such as CarFit. Having these programs is a wonderful source, and as long as they are truly safe to drive, who's to stop them? The problem is knowing when they cross the line of being safe. Not only do they pose a threat to theirselves, but to other motorists as well. I think about my grandma, who until she broke her hip last year was driving locally- to and from church, the store, and nearby family. I was concerned about her driving when she did, but it gave her that last but of freedom and independence, not to mention allowed her to stay more active and involved.. who was I to oppose that? All of us who drive can relate to the amount of freedom that it gives us to have our licence and drive. I can only imagine how it must feel to have that taken away from you. There are many reasons that people can't drive, some physical some cognitive. I love the fact that many adaptations are available for the physical aspect. I don't think that given the chance my grandma would drive now. She did make the comment to my mom the other day that she would be glad when she got her car back (it has been in the shop)- we are not sure if she really thinks she could drive. She has Alzheimer's and is showing signs consistant with the mod stage.. no way would she be safe to drive. Fortunately, she has supportive family that takes her everywhere she needs to go- I thought about other people in her situation that may not have the outside support. How many people are still driving that do not have family to decide that it is not safe anymore? I think that there should be stricter laws for seniors renewing their license, and required more frequently. I found some info on the DMV websitehttp://www.dmv.com/nc/north-carolina/senior-drivers. I was surprised that they have 5 years to renew there license. A lot can change in 5 years for aging individuals! Also, they can have restrictions that allow them only to drive during day, and non rush hour times. I wonder how well these guidelines are tested and followed through?

stress on the elderly

My whole family which includes 11 girls and 2 men (my dad and my husband)just came back from a week at the beach. Unfortunately my Dad came home to a house full of WATER. It ruined the entire down stairs. It's hard to see your father look so defeated, he's 77 years old and all the furniture my parents had collected over the years is probably ruined.
I saw him just a few hours ago and he looks like he's aged over night. I was little shock at how he looked, It made my heart hurt. I have a terrible feeling of loss, the house looked just like it did when I graduated High School,(circa 1984)It was comforting,my mom's stuff is still there.
I feel have a newly found sympathy for seniors who have to move from their homes of 30 years. To pack up their wholes lives into a few boxes and to move into a place that is not their home. The stress and sadness of leaving all their things that they get comfort from, is a heavy burden to bare.

Communication Skills

I have to say, it's very uncomfortable to me to work on my communication skills. It's a bit painful to look at your faults and difficult to change a lifetime of habits. On FW though it's very clear how important these skills are in motivating clients and also negotiating with the rest of the team. With the client, getting to truly understand them by actively listening and getting them to connect with you is the key to motivating the reluctant person. If you can't connect, then negotiating with a co-worker to take over is a great way to making sure your personality conflicts are not going to hinder treatment of the client. I've seen the therapists at the SNF work together by playing to their strengths and asking each other to step in when the other has failed with a certain client. These ladies know each other well and what the other's limitations are so they work well together but I could see where being the new therapist, this could be a problem or when there is a heavy case load and there is little time for negotiating patient swaps.

I've been reading Messages: The Communication Skills Book which reiterates many of the things we've learned in class but also goes into more detail on better communication. Reading different examples of the same material has helped to clarify some of the techniques we've been taught.

Commercials

It is my belief that commercials need to be approved by a lot of people of different back grounds before they are put on the air. Otherwise they are likely to offend people of different ethnicity, origins, people with physical or mental disabilities. This rang true as soon as I saw the new Heineken can commercial. It really irked me that they put on this commercial that you don't need to have a color change marker that reacts to the cold, you have hands to feel how cold it is. So, what about the people that have no hands, whether they were born with a malformation, or if they were in an accident, or needed an amputation for another medical reason. Are the people that made this commercial not realizing how demeaning this commercial could be to someone. I am going on strike and not drinking anything Heineken, and suggesting my friends do the same! Maybe this should be a great commercial for Coors. You can tell their beer is cold before you get a nasty warm beer in your mouth, even if you don't have hands!

As I have been working with the elderly population this semester I have seen several men with ambulated legs, and one with an ambulated arm. So, this commercial really rang true. Yes, he still had one arm, but if that arm has some nerve damage as a lot of people with diabetes have over time, what then? After this commercial, I am really opening my eyes to a lot more suggestions from the tv. A lot of commercials really make growing old look horrible, which adds to the stigma that all of know too well, ageism. Ageism is the discrimination of the aged. Wrinkle cream you don't want to look old, or it's too embarrassing to buy Depends at the grocery store, so buy them online. All of these add to the stigma of getting older. But, I guess it sells items. However, this commercial is going to do the opposite in my eyes.

If you have not seen the commercial yet, I invite you to click on the link below and it will take you to U-tube to watch the horrible commercial.

Heineken commercial.

Cell Phones for Seniors

I came across a very interesting website today www.squidoo.com/cell-phones-for-seniors. It has an elaborate listing of cell phones designed specifically with the senior citizen in mind. This is another exciting example of how our society is starting to consider the older generation in areas such as product development and marketing. I believe this is a trend that is going to gain much more momentum in the near future as the baby boomers age. Below is a list of some of the features the phones offer (very OT minded in their concept!):

• One touch emergency response button (Pre-program up to 5 #'s. When the button is pressed, the phone will cycle through all 5 #'s until one is reached)


• Easy grip surface


• amplified sound


• fewer functions


• larger, well-spaced buttons


• larger screen font


• large, lighted display screens


• hearing aid compatible


• smaller, simpler packages


• "say a command" feature - can speak commands


• "read out mode" - they can have callers and text read aloud to them


• voice dialing and memo


• voice-driven menus


• health-related apps


• reminder alarms


• Medication Info. apps


• Flashing alert for incoming calls

A little goes a long way

Mealtime is important to all of us. It is often a center point for gatherings and socializing, family time, and even time to relax- not to mention vital to our wellbeing. When does it become ok to take that away from someone? I noticed on FW one day a staff member assisting someone with feeding, but while doing so, her body was completley turned away from the lady, and she was watching the T.V. in the room, only turning around to shovel another spoon of food in the client's mouth. Granted, the client did not seem to be cognitively aware, but should that matter? Shouldn't they still be treated with dignity and respect. Even something so little as turning your chair towards them, and giving them your undivided attention. How do we know what they are able to process even if they aren't able to express themselves? I can imagine having to be assisted with feeding is already degrading, but I can't imagine having someone sit there and feed me in such a way that made me feel like they were bothered and would rather be anywhere but there. I think it is so important to remember that one day that could be a loved one or even ourselves. We should always treat others like we want to be treated, no matter their physical or cognitive levels.

I found this website while searching for information about mealtime in SNF's. It is advocating for respect to our elderly population, not only at mealtime but all the time, and how important it is for society's attitude about elderly to change. I feel fortunate to be going into a field where I can make a difference in the treatment of these individuals.
http://www.barbadosadvocate.com/newsitem.asp?more=local&NewsID=259

So, this weekend I moved into a new apartment. And, for the last week or more I did not want to buy food that I was just going to have to move. In doing both of these, I have been eating different kinds of food and more fast food, which has had an interesting effect on me. Depending on the types of food I have been eating I have either been lethargic or just dazed. Now that I am in my new apartment I am feeling better and more energetic. Energetic enough to unpack all of my boxes in less than 24 hours.

With all of this happening to me, it really makes me wonder how the food at some of these senior facilities is affecting their level of energy and the amount of effort they are vs. how much energy they could be putting into their therapy.

A little while back I started keeping track of my food and how it makes me feel after I eat certain foods. And tried to find something that would help me figure out what I needed to eat, and I came upon this website What foods can affect the way I feel and increase my energy levels?

I know their are a lot of nutritionists at most of these facilities, and I know that the ones I met with really know their stuff, but it is hard to talk to them & get the information I needed in words I could understand. So, I hope this website puts things into words that others can understand the way I did.

What They Hear

We touched on a subject in class this week that has been on my mind for a while. I think most of us would be able to easily recognize abusive or negative communication of staff towards patients but there is another more prevalent and deceptively benign type of communication that takes place in facilities. Examples of this type of communication would be staff members carrying on conversations amongst themselves during tx sessions instead of interacting with the patients themselves. Another example would be staff members talking about the patient's status or performance when the pt. is sitting right there, especially if it is not positive. I recently heard one clinician telling another that something a patient with dimentia did while performing a certain task was "bizarre". The pt. was sitting right there between the 2 clinicians. In the movies, doctors always tell family members to talk to coma patients as though they can understand every word you're saying because it is unknown how much they really do hear and understand. If that is true for a coma patient, obviously it is for the geriatric patient. One of the articles I read on this topic stated: "Negative examples were given, such as talking over residents' heads and performing care of residents in a routine-like manner. " Another article said: "it is not just negative forms of communication that leave people feeling distressed; 'neutral' styles of communication can also have this effect. A neutral style of communication is defined as staff focusing on a task that needs to be completed, and lacking empathy and warmth." I believe we should view every interaction we have with a patient as an opportunity to lift their spirits. It could make all the difference in their recovery, their quality of life and our sense of purpose and personal fulfillment as therapists.
These are the 2 articles I read that support my views:
http://www.orebrolan.se/download/18.3bd692b4121b0cc24e2800013029/Encounter+staff+descriptionopn+Wadensten+mfl.pdf
http://www.nursingtimes.net/nursing-practice-clinical-research/improving-communication-skills-in-care-of-those-with-dementia/1493021.article

The Dreaded ADL

I got to work on toileting for the first time. Lucky for me, my patient is breaking me in slowly. She refused to actually use the toilet but she went through all the motions for me including handling her LB garments, which she did splendidly. She is making great progress and I believe she will be able to be D/C'd soon. While at the SNF, I ran into a patient I used to regularly talk to when I used to volunteer there and asked her how she was doing. It broke my heart to hear that she has given up on going home. She was always so cheerful and worked hard in therapy when I was a volunteer over a year ago. Her health has severely declined and she has accepted it. She is still getting OT though for toileting because it is still important to her. Toileting was one thing I always dreaded having to deal with before going out on fieldwork. Hearing how important it is to clients to be able to maintain that ability first hand now makes it a priority on my list.

Senior center tour

Last week while our teacher was at the beach relaxing, we were instructed to take a tour of a senior center in the area. I chose a facility in the next town over because I had seen their catalogs and knew it was an active senior center. I was very pleased with what I saw, the facility was fairly new,the staff was kind and inviting, they had a restaurant style kitchen and a "ballroom" located next to the kitchen and offered an array of classes.
But as I was driving home, I thought to myself "Well, there sure were alot of Mercedes in the parking lot!" I notice these things because I drive a little tiny "Scion". And the kitchen was big and shiny.. but they don't provide a "lunch program" for the needy elders in the community. And the Town has their own bus service for Seniors and the Disabled that will come right to their door and drop them off at the Senior Center for $2.00?!!
So my question was to myself was: Where do the less fortunate seniors go? If the Senior Center in their OWN town does not serve their needs, then where do the needy go? I feel a little sad that this facility is so under utilized. I can see the potential that is facility could have, a niche, they could fill.

Age really is just a number

For an assignment, I had to interview someone who was 65 or older. I went to my grandma's (who is 82), with intentions to interview her. She is in early stages of Alzheimer's and broke her hip about 8 months ago. Her sister (my great aunt) who is 78, was visiting when I got to her house. I ended up doing my interview on my great aunt, and while doing so realized the great differences between her and her sister, even though they were only 4 yrs apart in numerical age. My aunt is very active at the senior center, still driving, and completley independent. My grandmother has had a great decline in activity, and relies alot on my mother for everyday activities. Watching them side by side, it was obvious how age really is just a number; they are only 4 yrs apart, though their abilities and independence are on opposite ends of the spectrum. I wonder what it must feel like to have grown up so close together all those years, been so much alike, and then all of a sudden have so much difference? Dementia and other diseases doesn't strike at a "set" age, nor does it affect everyone. It make me think, how old would I be if I didn't know how old I was? Would I feel alot older than I actually am, or alot younger? What things in my life can I change to make a positive impact on how I age?

Senior Center Visit

As a class assignment, we had to visit a local senior center this week. My visit was very eye-opening in a good way. The center I visited was bright, with high ceilings and lots of artwork displayed very tastefully throughout. Most impressive was that there were 2 exercises classes, 4 different group games, and 3 art classes taking place just in the hour and a half I was there. The staff was upbeat and knowledgeable and the energy in the place was very high. I was almost envious and was happy to hear that younger people can take some of the classes if they pay for them. This is a good way for the center to earn extra money and the intergenerational aspect is beneficial for young and old alike. I thought it would be a good idea to buddy up with a senior who may need some assistance and take a class together.
If you've read one of my previous blogs, you know I am working with my parents to encourage them to get involved with their local senior center. Thus far, they have not gone but are starting to consider it. I asked one of the staff members at the center I visited and she said you did not have to be a local resident to attend the center. Because my local center is so nice and has such a variety of activities, my new plan of action is to ask them to accompany me to one or more of the classes the next time they come to visit me. Maybe that will be the first step in getting them involved in the center where they live. Here's a link that reinforces the positive impact of senior centers on the geriatric population:
www.helium.com/items/71524-the-benefits-of-senior-centers-in-helping-elderly-parents-find-community

Getting the best out of Therapy

So, this week my client at the location we are doing field work got another therapy added on to her schedule. Now, she has three students, plus her normal therapist working on her case. On the day I saw her She had already had 2 therapy sessions and then worked with me for an hour and a half. She was exhausted by the time our session was over, but was still as bubbly as ever.

Although a lot of clients get an exuberant amount of therapy, not all of them can handle everything they are receiving. And some clients don't receive the amount of therapy they need. But, they are required by insurance to receive whatever amount of therapy as the therapist sees fit and gets approved. And all I can hope for is that the therapist that first evaluates each person understands what kind of impact they could have on a patient's outcome. If they request too much therapy and the patient could relapse, or get denied on their next claim. If they request funding for too little therapy, their recovery is going to take longer & be more expensive for the patient in the long run. It is all a matter of really knowing your stuff. Knowing the medical system and the diagnosis that you are dealing with, as well as it's normal course.

We were lucky enough to be a part of a school that takes this seriously. Between my school and the fieldwork site, everyone wants our clients to get the best out of their therapy. And my client is getting the best of both worlds.

Not Just About the Equipment

OK. Last week I blogged about how to motivate my patient to work on ADLs and possibly discussing with her what she needs to be able to do in order to go home to motivate her to do this. After a fun craft session and getting her comfortably back in bed, I talked to her about her wanting to go home and needing to work on self-care tasks and standing tolerance. I also conspiratorially added that my instructor wanted me to work with her on those activities and she agreed. I gave her a choice of what she could work on and she chose "going to the bathroom". Not MY first choice but hey, it's not about me. I came across an OT blog about Elderly patients' perceptions about PADL interventions. It made me realize that not only giving our patients a choice of which ADLs to work on but HOW they want to be able to accomplish it is important. I won't have to worry about this with my lady who definitely lets me know her likes and dislikes but for future patients, it will be important to find out how they really want to be able to their ADLs. It may be they don't want to use adaptive equipment or do things in a different way. We need to remember not to focus just on the end result but also the process along the way.

PTSD

I was at the bank "chatting up" the loan officer when he told me about his son, a Iraq veteran who suffered from PTSD. The son went to the V.A. to seek medical attention but was turned off by what he saw. He saw the older vets sitting in the halls with amputations and drooling on themselves and he RAN out of there. His father eventually got him to go back to the V.A. but his father told me "it didn't end well".

For the rest of the day I felt so bad,I thought of all the Tx.'s I could have done with him. Maybe some leather work, something so he could get his aggression out, a journal, so he could express his feelings.

There has to be other options for families with a loved ones suffering with this disorder. So, I hit the world wide web looking for information. I found this staggering statistic "only 1 in ten vet's who enter treatment for PTSD in the V.A. actually COMPLETE the program". The military in the last few years have created programs that are directed at reducing the stigma in receiving services for mental health problems. There are many websites dedicated to our "warriors" so I have included one for you to see.

There is this new treatment for soldiers with PTSD, it's called Virtual Reality Technology, it takes the solider back to the actual "traumatic event" so they are able to work through the issues safely with a professional. I've attached an actual session of a soldier using this new technology.

I believe this is a new field that is opening for OT professionals, we need to educated our elected officals on OT and how we can change and maybe save lives of our soldiers.

http://www.pbs.org/wgbh/pages/frontline/digitalnation/virtual-worlds/health-healing/a-soldiers-therapy-session.html

http://www.realwarriors.net/

The power of motivation

Motivation. Without it, you really don't have much- or you do, but you don't really care cause you aren't interested in doing whatever it is. I find myself in these "ruts" where I don't have motivation to do this or that, and I am sure that everyone at some point in time faces this problem. For most of us it is temporary, and we soon pass out of the funk, get over it, and carry on. For some, this motivation doesn't come so easy. During my FW at the SNF, I have realized the power of motivation, and how powerful of a tool this can be as a therapist. Many of the clients are medically compromised, lonely, away from home, and just depressed. I can imagine that over time, it may be easy to lose that motivation. Once it's gone, then what? They lose interest in participating in activites, therapy, ect.. It is so important as OT practictioner to recognize this issue, and realize how we can use ourselves therapeutically and "re"motivate our clients. Sometimes it only takes rewording what you say to get them interested; instead of asking them if they want to do something, tell them you have a really fun activity to do so let's get started! Our clients will feed off of our energy, and it is our job to keep them motivated in therapy. Know your client and what they like.. be encouraging and positive. I am learning that this aspect of therapy is just as (if not more so) important as the actual activity itself. I googled ways to motivate your clients, and came across an article that introduced a new activity that can be used in therapy.... MAGIC! I have never even thought of this activity, but wow, what a great fun activity; and I think it would be a great tool to motivate clients who are bored with the same old same activities! I am excited to read more about this as a therapeutic tool, and thought I would share the link so you could use it too! http://http://www.magictherapy.com/therapists.html#BenefitsofMagicTherapy

Geriatric Drivers

I read 2 interesting articles this weekend related to the issues surrounding the geriatric community on our roadways. (1. www.jsonline.com/features/health/119156544.html, 2. www.westport-news.com/opinion/article/Should-elderly-drivers-be-retested-399215.php) The obvious conflict is the senior's right to independence vs. society's right to safety. One study rated seniors as second only to teens as a group involved in fatal car crashes. (I guess the only bright side to that statistic is that teens hold the number 1 slot and not seniors). Decreased reaction time, vision, judgement, hearing, muscle strength and flexibility, and concentration all contribute to the elderly driver's increased risk behind the wheel. One of the main problems concerning this topic is that there is no clear-cut line between when a person is safe to drive and when they are not. Lots of times, adult children are reluctant to make the call that their parents are unsafe to drive because then the responsible falls on them to figure out how to provide for their parents those things that have been lost - ability to buy groceries, participate in social situations, get to and from dr.'s appts., etc., etc., etc.. I personally believe that while a senior's independence is of utmost importance, it is trumped by the need to keep society as a whole safe on the roads. The articles list one of the current roles of OT's/OTA's as being evaluators of driving ability among the elders. So we get to help make the determination that a senior needs to be pulled off the roads. I am going to do more research into this idea (maybe for my blog next week) but these articles made me wonder about OT's role in a transport system for seniors who have lost their licenses. Public transportation such as riding a bus (independently) is out of the question for alot of seniors who have disabilities. Obviously OT's/OTA's are trained in proper transfers and the particulars of the medical conditions affecting this population. I am curious if OT clinicians are running businesses out there for this specialized purpose. I also wonder if there is any possible way insurance may cover a service of this nature? I'll do some research and try to find the answers to these questions. Maybe some of us could start our own business one day :). In the meantime, here is a website that contains more on OT's role in evaluating driving skills, in case you may want to take on this role in the future: www.aota.org/olderdriver.

video

I saw this on ABC news the other night. This is why OT is so important, we help people reach their goals.


http://abcnews.go.com/US/paralzyed-bride-jennifer-darmon-walks-aisle/story?id=13399347

new role

In my last post I wrote about my experience as a CNA working in a SNF and how I was hesitant to ever work in geriactrics again. On the tour of our FW facility I thought "Wow, what kind of place has our instructors taken us?" The facility was small, and the bedrooms held 3 clients per room and they all seemed really sick. This was a little unnerving for me because the retirement community I worked as a CNA was client paid and very upscale. Our guide, who worked as an OTA, introduces us to all the clients we passed in the hall. She knew all their names and they were so happy to see us. All these clients are in need of our services, I could see how much OT could help them be more independent.I think may be these are the types of clients that need me the most. Yahoo, that excites me I can put all my skills to work, I can instruct, educate and give SBA with min. verbal cueing. Watch out Seniors here I come!!

Doing what we like to do does wonders.

At times during the past week I have wondered what to do with elder clients. I had a plan and all of the supplies and was ready to go. Yes, I was nervous. But, I knew that my client would enjoy this activity and I was kind of excited to get going. However, as soon as I tried to find my clients file I found out that she is being discharged from therapy. Stinks, but I moved on to my next client in very little time and started from scratch on what to do with my new client with the supplies I had brought with. With some help from my supervisor I was able to get the client involved and change all of the supplies I brought into an totally different activity that not only lasted this past session, but we will be able to finish next session. And a major bonus is that the client is really looking forward to figuring out how to make a word find. I'm not sure if she realizes what it will be at this point in time, but she is excited.

It really makes a difference if a client is excited about doing an activity. It makes it that much more therapeutic. She really wants to do this for a different reason than what I am doing the activity. She is doing it for fun. I am helping her create this word find to increase her Upper body strength and increase the length of time she is able to do a task. I know through school that making tasks therapeutic has a lot to do with really making the activity something that the person enjoys. Otherwise, they are not going to want to do the activity, or be less than enthusiastic about the activity. Then I found this little diagram and it really hit home.

So, the moral of the story...Do something you like to do or it is not worth doing. And for the therapists out there, make the activities client-centered, so they get the most out of their treatment.

Finding Motivation

This week on FW was a lesson straight out of the books on the importance of meaningful activities in therapy. The OT working with my patient had been having difficulty getting this lady to participate in therapy. She had refused the OT the day before with the promise of working with her the next day. When we went to get her for her "appointment", she again refused stating she had already worked with PT and was tired. It dawned on me that she equated therapy with exercise and when I told her I had a couple of games we could play somewhere other than in the therapy room, she was willing to participate. What could have been a second refusal turned into meeting the OT's needed minutes of therapy and showing progress in activity tolerance. During the therapy session, this lady commented on some flowers outside and we incorporated making a flower arrangement for her to take to her room. She liked the decoupaged vase we used and I asked her if she'd like to make one for our next session and her grin was all I needed for an answer. I was lucky to find another activity my lady wanted to do but thinking about future sessions and how to go about working on her dressing and toileting goals is another problem. The OT mentioned she had to "trick" her into working on her ADLs. In an article entitled Motivating the Elderly Client in Long-Term Care it was stressed that giving the client a choice in activity and goals to work on goes a long way. I think reminding my lady about her goal to get home and discussing what she needs to be able to do in order to do that and then letting her decide what she wants to work on will hopefully get her to work willingly on her ADLs. We'll see how this plan works in future sessions.