Older Age Archives - Medwest

Positive thinking about aging may be lowering our risk of dementia

A study from the United States has found older adults with a positive attitude towards ageing may be less likely to develop dementia, even if they are genetically predisposed to it.

Yale University researchers studied a group of more than 4,000 adults aged 60 and above and found those who held positive beliefs about ageing had a 44 per cent lower risk of developing dementia (even if they were at a higher risk) compared to those who held negative beliefs.

The risk was even lower among people with a genetic predisposition to the condition.

The study, suggests that positive age beliefs may act as a protective factor against dementia, supporting the case for a public health campaign against ageism.

Dr Becca Levy and her colleagues at Yale School of Public Health recruited 4,765 American adults with an average age of 72 who did not currently have dementia.

The first step of the research was to assess the participants’ attitudes towards ageing then assessing them every two years on a range of cognitive skills to determine whether they had developed dementia.

Participants’ beliefs about ageing were assessed using an “Attitude toward Ageing” scale, in which they were asked about the degree to which they agreed or disagreed with statements such as, “The older I get, the more useless I feel”.

If somebody strongly agreed with that statement, they would be given a score that suggests they have a more negative belief about ageing. But if they disagreed, then they would receive a score that indicates a positive view of ageing.

To assess the potential effects of the study on people genetically predisposed to dementia, 26 per cent of people included in the sample were carriers of the APOE-e4 gene variant, one of the strongest risk factors for dementia; affecting one fifth of Australia’s population.

Researchers found overall that participants who had positive beliefs about ageing had a 43.6 per cent lower risk of developing dementia over the course of four years, compared to those holding negative beliefs.

The difference was even more significant for those with the APOE-e4 gene variant with those who had positive beliefs having a 49.8 per cent lower risk of developing dementia compared to their high-risk counterparts holding negative beliefs.

The results took account of other factors that could influence the findings, including age, education, sex, race, cardiovascular disease, diabetes and baseline cognitive performance.

Stress may explain why as studies suggest the mechanism by which age beliefs may influence the development of dementia is likely to involve stress. as it was found that individuals who had more positive age beliefs had lower stress levels. It was also shown that those who have more negative age stereotypes seem to have an exacerbated response to stress.

It has been found that stress can be related to the development of dementia so its possible that stress plays a major role in the findings of the study.

However the results should be interpreted with some caution because the diagnostic tool used to identify patients with dementia — a short telephone interview — was not the gold standard for diagnosing dementia.

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Cold Weather and Arthritis

Many people with arthritis dread the cooler months. Some say they can even predict the temperature change simply by the increase in swelling and pain in their joints. But is there any truth to this idea that stiff and sore joints flare up when temperatures fall? And if so, what’s causing the issue?

One aspect of cool weather that’s been argued could affect joints is barometric pressure, which is essentially the force exerted by the weight of our atmosphere.

Some researchers have proposed that a drop in barometric pressure, which tends to accompany cooler, damper weather, could allow tissues in joints to swell and put pressure on nerves that control pain signals.

However at extremes of barometric pressure, like going to the top of Everest or diving over 50 meters — you can certainly get joint pain, but with minor variations in barometric pressure that you get at normal altitude can have little impact on pain, otherwise you’d get sore joints from driving up the top of a local mountain.

The other culprit of this might be misbehaving nerves. Bodily changes triggered by cooler weather can have the side effect of amplifying pain signals from joints. Many arthritis sufferers have pain that persists, despite having joints that are not extensively damaged.

One proven reason for this is that their nervous system is essentially misbehaving. The pain signals travelling along nerves from their joint are amplified in the brain by signals carried on separate nerves called sympathetic nerves.

When it’s cold, these nerves constrict blood vessels in the limbs, to minimise heat loss and help keep warm the core of the body, where vital organs are.

But the increased activation of these nerves around joints in response to cold weather might also lead to an increase in the pain a person feels.

So what’s the solution? Just get moving!

Shorter days and cool temperatures can make us less inclined to be active, and immobility can also make arthritis pain worse.

If you focus on overcoming obstacles that stop you exercising in cold weather rather than just blaming the weather could be a helpful approach. Getting active can also help overcome a low mood for many people.

So go get a head start on the cooler months by starting regular exercise now.

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Lower back pain and why it’s more common than you think

Did you know that 80% of people will experience lower back pain at some stage of their life? Back pain is a symptom caused by numerous conditions and it is one of the most common reasons for people missing out on work and enjoying life. Fortunately, most back pain is caused by musculoskeletal conditions and can be readily treated with great success. Generally lower back pain is something you can also avoid with some back education, back care strategies and even simple back exercises.

Lower Back Pain is categorised into the following categories:
1. Specific Spinal Pathologies
2. Radicular Syndromes
▪ Radicular Pain eg Sciatica
▪ Radiculopathy
▪ Spinal Stenosis
3. Non-Specific Lower Back Pain

Specific Spinal Pathologies

Some conditions that cause back pain do require urgent and specific referral and treatment. These can include spinal infections, malignancy, spinal arthropathies (eg rheumatoid arthritis) CES or spinal fractures. These conditions do require early diagnosis and prompt referral onto the appropriate medical specialist. Luckily these conditions only account for less than 1% of back pain sufferers, but it is important to determine the case of your pain.

Radicular Syndromes

Lower back pain can result from structural damage that can irritate or even pinch a nerve. Researchers believe that radicular syndrome causes 5-10% of the presentations of back pain to GP’s. The most common nerve that can be pinched in the lower back is usually your sciatic nerve. We’re sure you’ve heard of it before. You may be diagnosed with sciatica if you are suffering radicular pain down your leg due to a back injury. While the sciatic nerve is the most common nerve that can be affected by a spinal injury, any nerve can be affected.

Back injuries such as a herniated disc (slipped disc), facet joint sprain, degenerative disc disease, spondylosis, and back ligament sprain can all contribute to or cause radicular pain syndrome due to swelling or space occupying material adjacent to the spinal nerve. Ouch! The nerve is either irritated (radicular pain) or pinched/compressed (radiculopathy).

Spinal stenosis is slightly different condition and relates to compression within the spinal canal. Spinal stenosis is usually more prevalent as you age.

Non-Specific Lower Back Pain

Non-Specific Lower Back Pain (NSLBP) is the term used to classify sufferers of lower back pain where no specific structure has been injured. It is really a diagnosis of exclusion. In other words, your spinal health care practitioner has excluded specific spinal pathologies and any of the radicular syndromes mentioned above as the cause of your back pain or symptoms. Fortunately, these conditions account for approximately 90-95% of the lower back pain causes and they can nearly always be successfully managed conservatively and without the need for surgery! Most improve within two to six weeks. They can be fast-tracked with pain relief and physiotherapy techniques such as manual therapy and back exercises.

Causes of Non-Specific Lower Back Pain

The causes of this common lower back pain are numerous but roughly fall into either a sudden (traumatic) or sustained overstress injuries.

Most people can relate to traumatic injury such as bending awkwardly to lift a heavy load that tears or damages structures. However, sustained overstress injuries (eg poor posture) are probably more common but also easier to prevent. In these cases, normally positional stress or postural fatigue creates an accumulated microtrauma that overloads your lower back structures over an extended period of time to cause injury and back pain.

Most commonly, NSLBP is caused by back muscle strain, back ligament sprain. Other chronic back conditions such as degenerative disc disease may underly the acute conditions and predispose you to the acute pain.

The good news is that you can take measures to prevent or lessen most back pain episodes. Early diagnosis and specific individualised treatment is the easiest way to recover quickly from lower back pain and to prevent a recurrence.

What Should You Do If You are Suffering Lower Back pain?

As you can see while lower back pain is common, the diagnosis of the cause of your back pain is specific to you and therefore the treatment or investigation pathway does vary from case to case. A GP is a good place to start but visiting a top notch Physio like those at Medwest will get you back on the mend in a heartbeat!

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The Safe use of Ultra Low Beds

With risk factors such as dementia, delirium, agitation, disorientation, limited mobility and acute illness affecting elderly patients, this puts them at a higher risk of falling from a bed. Some of these patients may have been nursed on mattresses on the floor so it’s important to understand how to best manage these situations and potentially incorporate Ultra Low Beds.

When the use of bedrails is inappropriate, consideration should be given to the use of an Ultra Low bed. However, they should not be seen as a universal falls prevention solution and provided inappropriately for mobile patients, as this could be deemed as restraint.

Ultra Low beds can reduce the risk of a fall from height, whilst allowing staff to attend to the patient, with consideration to back care.

It is important to note that even when Ultra Low Beds are used correctly in the lowest position, some patients may still sustain serious injuries such as a fractured hip or intracranial injury. As a result, it is important that even these falls are taken seriously.

Assessment for Ultra Low Beds  

Patients should be assessed individually by a registered nurse or therapist to establish the most appropriate method of preventing falls from a bed.

This should include:

  • Completion of the Bedrails risk assessment
  • Completion of the Falls Care Plan

Considerations

  • Physical illness – Some medical or nursing interventions may be challenging or impractical when using an Ultra Low bed
  • Psychological illness or distress – the unusual position of the bed may trigger distress, agitation or increased confusion for the patient
  • Previous accidents and injuries resulting from falls – the time, place and cause of a previous fall may or may not indicate that an Ultra Low bed would reduce the patient’s risk
  • Tissue viability – recent concerns have been highlighted about the compatibility of certain Ultra Low beds with some air flow mattresses.
  • If the patients skin inetgrity is at risk, the assessing nurse or therpaist should consider if the Ultra low Bed available has a full profiling capability. Some Ultra Low beds do not have a ‘knee break’ i.e. they raise the patient’s legs so that their lower legs are horizontal. This then results in the patient’s sacral area sitting in a ‘V’ with undue pressure on the sacrum. If the patient’s skin integrity is at risk, a fully profiling bed should be used, allowing the patient to sit in a naturally contoured position.
  • If the Ultra Low bed may cause a problem when used with certain matresses e.g it has been noted that when a patient sits on the side of the Richmond bed and compresses the standard mattress, this can result in pressure on the back of their legs. If this is the case, staff should ensure that the patient does not sit on the side of the bed for protracted periods or they should identify a more suitable mattress.
  • If the bed will be compatible with a bed table as they may not fit under some Ultra low beds.
  • When patients are assessed individually by a registered nurse or therapist for an ultra low bed, it would be deemed good practice to document in the patient’s notes / falls care plan that the patient has been consulted with regarding the use of the ultra low bed. Documentation should include that the patient is aware of the restrictions the ultra low bed may impose on them, but have given their consent to its use to reduce the risk of further falls and ensure their safety.
  • If there are concerns that the patient may not have capacity to consent to its use, then an assessment of capacity should be made in line with the 6 steps outlined in the Guardianship and Administration Act 1993 .
  • If the assessment of capacity demonstrates that the patient lacks capacity to make this decision themselves, then the multi disciplinary team should make a best interest decision also involving the patient’s next of kin.
  • The outcome of the capacity assessment should also be clearly documented in the patient’s notes / falls care plan.
  • Variation in cognitive status over a 24 hour period e.g. nocturnal confusion
  • Disability/capability – the use of an Ultra Low bed may improve/impede the patient’s ability to transfer.
  • Patient’s weight – check the weight limit for the Ultra Low bed available, as it may not be suitable for patients over a certain weight.

When using an Ultra Low bed

  • Document the decision to use or not use an Ultra Low bed in the nursing notes and falls care plan. This should include the rationale and whether or not bedrails are appropriate.
  • Ensure the decision is communicated to all members of the multidisciplinary team.
  • The use of Ultra Low beds should be reviewed daily (on wards where alternative bed options available) and recorded.
  • Ensure the Ultra Low bed is kept away from floor level furniture, doors, lockers, pipes, wheelchairs, commodes, radiators and other low level hazards to reduce the risk of personal injury to the patient.
  • Ensure the Ultra Low bed is either placed flush to a wall or with a large enough gap either side, to prevent asphyxial entrapment if the patient slipped between the side of the mattress and the wall.
  • When the patient is on the Ultra Low bed, the bed must be returned to the lowest level to prevent a fall from height after being attended to by staff. All staff must ensure that the bed is at it’s lowest level if the patient is left unattended.
  • Staff who are unfamiliar with the patient’s current fall status should check the Inpatient Falls Care Plan and Bedrail Risk Assessment before contemplating use of the bedrails if they are attached to the bed.
  • Crash mats at the side of an Ultra Low bed should be used with caution. These can cause a trip hazard for both patient and staff. When the patient is not using the Ultra Low bed e.g. sitting in an armchair, any crash mat in use should be removed from the bed area and stored safely.
  • Choice of mattress to be used on the bed should be determined by assessing the patients weight, skin integrity and any risks of injury or entrapment. The assessing nurse should ensure that any air flow mattress being considered is suitable for use with the Ultra Low bed available.
  • Take care when positioning the legs of a hoist under the Ultra low bed, as limitations imposed by the low height of the bed could cause a manual handling concern.
  • Prior to completing any manual handling manouevre, ensure that the bed is at the correct height for the patient and staff.

With this comprehensive list, you can ensure that you know have the knowledge to affectively asses and manage patients who require the use of Ultra Low Beds.

 

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Optimal Seating with the Help of Physiotherapy

In this article we will take a look a some general information on the management of older aged residents with seating and wheelchair needs. Firstly, appropriate seating and wheelchairs are crucial to provide residents with optimal comfort and freedom to move.

Key issues for consideration are:

  • Resident Comfort
  • Correct positioning and Posture
  • Pressure reduction for areas like the buttocks and sacrum
  • How the resident is going to move or be moved about

It’s important to think about which type of chair the resident may need, be it a Standard Wheelchair, Tub Chair, or Arm Chair.  When it comes to these types of chairs, make sure you ask yourself these important questions.

Armchairs:

  1. Does the resident have easy access to a variety of venues and social events?
  2. If the resident is ambulant does the chair allow them to stand with ease?
  3. Do staff need to assist the resident to stand?
  4. If staff need to use a stand hoist, can it effectively approach the chair?
  5. Would an electric chair raise assist the resident and staff?
  6. Can the resident’s feet rest comfortably on the floor?
  7. Does the resident need to elevate their feet regularly?
  8. Would an electric recliner/ raise chair better meet the resident’s needs?
  9. Does the resident need a cushion?

Wheelchairs:

  1. Does the resident wish to self-propel the wheelchair?
  2. Is the resident at a high risk of pressure areas?
  3. Would a tilt in space wheelchair be appropriate?
  4. Do the legs need to be elevated?
  5. Is the chair easy to push and maneuver?
  6. Will the resident be taken outside in the wheelchair?
  7. Does the resident have any major postural concerns e.g deformity or contractures, leaning to one side or bending forward, asymmetry.

A basic physiotherapy assessment of someone’s needs for customized seating will include an assessment of:

  • Pain
  • Contracture
  • Posture
  • Pressure issues
  • Mobility levels
  • Quality of life issues

Care Plans for residents should incorporate the following:

  • The chair or wheelchair the resident sits in when out of the bed
  • Whether the resident has a specially prescribed cushion to sit on
  • Whether the resident should be assisted to stand up, walk or self-propel a wheelchair
  • When and for how long the title-in-space mechanisms should be used
  • Whether leg rests should be elevated and for how long

Common mistakes:

  1. Not putting on brakes when the resident is stationary or only putting on one brake
  2. Not positioning the resident so buttocks are well back and central
  3. Not using specially prescribed cushions
  4. Not keeping equipment in good working order e.g not repairing faults or broken parts, not keeping tires properly inflated.

When it comes to correct seating for older people, knowing the ins and outs can allow everyone to rest easy.

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Simple tips to Help Prevent Falls for Older People

Falls can happen to anyone, but unfortunately, as you become older, falls can become more common and more serious. Most elderly people fall in and around the home and falls are also common in aged care homes. If you have a serious injury it can lead to a change in where you live and how you live your life, so it’s important to understand what causes falls and how to prevent them.

Changes in your body such as vision problems, weakening muscles and also stiffening joints can increase your chances of falling. Falls can also be a sign of a new health problem, medication side effects or issues relating to balance.

The good news is that there are a number of things you can do to help prevent falls and even minimise potential injuries if you do fall. The best place to start is knowing how to reduce the risk of falls by:

  • Maintaining a healthy and active lifestyle, with plenty of regular exercise to prevent your muscles weakening and joints stiffening
  • Wearing the right shoes – comfortable, well fitting, flat shoes with soles that grip well
  • Avoiding walking around in socks
  • Hazard proofing your home
  • Making sure there is adequate lighting, especially at night
  • Using your walking aid at all times
  • Installing grab rails in the bathroom
  • Marking the edge of steps so they are easy to see
  • Wearing hip or limb protectors

Home maintenance and modification services may also help prevent falls by making your home safer and more secure and you may also want to consider installing a personal or medical alarm. Your choice of device will depend on many things, such as who can come to help, the distance over which the device works, how much it costs and other personal factors.

If you’ve had a fall in the past six months, your chances of falling may be increased, so don’t just dismiss falls as part of getting older, lack of concentration or clumsiness; talk to a health professional and ask about different options that may help you.

Medwest offers a range of allied health services and have been working with older people in aged care facilities and clinics for over 10 years. We have expert knowledge in the treatment of issues that can lead to falls through a variety of services.

Medwest Physiotherapists may be able to help you with balance and strengthening exercises. You can also ask us about equipment such as a walking frame or stick to help you move about more safely. It’s important that any equipment you do use is adjusted to meet your needs and is well maintained.

Medwest Podiatrists are also the best people to speak with if you have painful or swollen feet, tingling, pins and needles or bunions, as all of these things can affect your balance. Our Podiatrists may also suggest ways to improve your circulation and decrease any swelling in your legs and feet, and provide advice on suitable footwear.

Our Occupational Therapists can assess your home environment for potential hazards. They can also help you with modifications to make your home safer, such as rails in the bathroom, and provide you with an exercise program.

So there you have it, a comprehensive guide for preventing falls for yourself or a loved one.

Older People, Aged Care, Melbourne, Elderly, Falls Risk Older People, Aged Care, Melbourne, Elderly, Falls Risk

Keep Happy with Hydrotherapy

With so many older people facing physical issues, Hydrotherapy is fast becoming the tool of choice to helping ease tension and increase happiness. Hydrotherapy is essentially a therapeutic technique in which heated water is used to treat various types of injuries and diseases. Performed in specially designed heated pools, this type of therapy is highly recommended for older adults who are experiencing pain from a physical disorder or illness.

Hydrotherapy is commonly used for older people who suffer from various ailments that affect their mobility or those suffering certain neurological conditions. Water and heat therapy has been used for centuries for all types of pain and injuries and come in a range of different classes for different types of participants.
The main therapeutic element of Hydrotherapy is of course, warm water. Its thermal effects alleviate various pains and stimulate the immune system by applying heat and pressure to the body. Water is usually heated to around 34 degrees to increase blood circulation, improve muscle tightness and joint flexibility.

Once an older adult enters the pool, they will experience a massage like feeling from the hydrostatic effects of the warm water. As a result, the nerves will then carry the heat and pressure deeper into the body where it can help improve blood circulation, lessen the body’s reaction to pain, and even eliminate stress hormones! When blood circulation improves, it can help heal damaged tissues and rejuvenate injured muscles.

The experience of weightlessness allows the body to relieve aching muscles and reduce tension and it’s believed that the hydrotherapy treatment allows you to release endorphins, which will then act as a natural pain reliever. As people tend to become weaker as they grow older, hydrotherapy treatment is great way of rehabilitating those aging muscles.

To top of the list of benefits, Hydrotherapy helps eliminating toxins from your body and provides relief from stress and anxiety! So what are you waiting for? Don on the togs and jump right in, the waters just right.

Hydrotherapy, Exercise, Older, Elderly Hydrotherapy, Exercise, Older, Elderly

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