Preventing Falls, Fractures and Broken Bones in Elders

Falls, fractures and hip replacements are common problems in elderly people, due to bone loss, bone fragility and osteoporosis.

Did You Know?

• More than 90 percent of hip fractures are associated with osteoporosis.
• Nine out of 10 hip fractures in older Americans are the result of a fall.
• Elderly individuals who have a hip fracture are 5 to 20 percent more likely to die in the first year following that injury than others in this age group.
• For those living independently before a hip fracture, 15 to 25 percent will still be in long-term care institutions a year after their fracture.

Falls are serious at any age, and breaking a bone after a fall becomes more likely as a person ages. Many of us know someone who has fallen and broken a bone. While healing, the fracture limits the person's activities and sometimes requires surgery.

Often, the person wears a heavy cast to support the broken bone and needs physical therapy to resume normal activities. People are often unaware of the frequent link between a broken bone and osteoporosis. It is known as a silent disease because it progresses without symptoms, osteoporosis involves the gradual loss of bone tissue or bone density and results in bones so fragile they break under the slightest strain. Consequently, falls are especially dangerous for people who are unaware that they have low bone density. If the patient and the doctor fail to connect the broken bone to osteoporosis, the chance to make a diagnosis with a bone density test and begin a prevention or treatment program is lost. Bone loss continues, and other bones may break.

Even though bones do not break after every fall, the person who has fallen and broken a bone nearly always becomes fearful of falling again. As a result, she or he may limit activities for the sake of "safety." Among Americans age 65 and older, fall-related injuries are the leading cause of accidental death.

Why Do Elderly People Fall More Easily?

The Fall Itself

Several factors can lead to a fall. Loss of footing or traction is a common cause of falls. Loss of footing occurs when there is less than total contact between one's foot and the ground or floor. Loss of traction occurs when one's feet slip on wet or slippery ground or floor. Other examples of loss of traction include tripping, especially over uneven surfaces such as sidewalks, curbs, or floor elevations that result from carpeting, risers, or scatter rugs. Loss of footing also happens from using household items intended for other purposes – for example, climbing on kitchen chairs or balancing on boxes or books to increase height.

A fall may occur because a person's reflexes have changed. As people age, reflexes slow down. Reflexes are automatic responses to stimuli in the environment. Examples of reflexes include quickly slamming on the car brakes when a child runs into the street or quickly moving out of the way when something accidentally falls. Aging slows a person's reaction time and makes it harder to regain one's balance following a sudden movement or shift of body weight.

Changes in muscle mass and body fat also can play a role in falls. As people get older, they lose muscle mass because they have become less active over time. Loss of muscle mass, especially in the legs, reduces one's strength to the point where she or he is often unable to get up from a chair without assistance. In addition, as people age, they lose body fat that has cushioned and protected bony areas, such as the hips. This loss of cushioning also affects the soles of the feet, which upsets the person's ability to balance. The gradual loss of muscle strength, which is common in older people but not inevitable, also plays a role in falling. Muscle-strengthening exercises can help people regain their balance, level of activity, and alertness no matter what their age.

Changes in vision also increase the risk of falling. Diminished vision can be corrected with glasses. However, often these glasses are bifocal or trifocal so that when the person looks down through the lower half of her or his glasses, depth perception is altered. This makes it easy to lose one's balance and fall. To prevent this from happening, people who wear bifocals or trifocals must practice looking straight ahead and lowering their head. For many other older people, vision changes cannot be corrected completely, making even the home environment hazardous.

As people get older, they also are more likely to suffer from a variety of chronic medical conditions that often require taking several medications. People with chronic illnesses that affect their circulation, sensation, mobility, or mental alertness as well as those taking some types of medications are more likely to fall as a result of drug-related side effects such as dizziness, confusion, disorientation, or slowed reflexes.

Drinking alcoholic beverages also increases the risk of falling. Alcohol slows reflexes and response time; causes dizziness, sleepiness, or lightheadedness; alters balance; and encourages risky behaviors that can lead to falls.

The Force and Direction of a Fall

The force of a fall (how hard a person lands) plays a major role in determining whether or not a person will break a bone. For example, the greater the distance of the hip bone to the floor, the greater the risk of fracturing a hip, so tall people appear to have an increased risk of fracture when they fall. The angle at which a person falls also is important. For example, falling sideways or straight down is more risky than falling backward.

Protective responses, such as reflexes and changes in posture that break the fall, can reduce the risk of fracturing a bone. Individuals who land on their hands or grab an object on their descent are less likely to fracture their hip, but they may fracture their wrist or arm. Although these fractures are painful and interfere with daily activities, they do not carry the high risks that a hip fracture does.

The type of surface on which one lands also can affect whether or not a bone breaks. Landing on a soft surface is less likely to cause a fracture than landing on a hard surface.

Preliminary research suggests that by wearing trochanteric (hip) padding, people can decrease the chances of fracturing a hip after a fall. The energy created by the fall is distributed throughout the pad, lessening the impact to the hip. Further research is needed to fully evaluate the role of these devices in decreasing the risk of a hip fracture following a fall.

Bone Fragility

Although most serious falls happen when people are older, steps to prevent and treat bone loss and falls can never begin too early. Many people begin adulthood with less than optimal bone mass, so the fact that bone mass or density is lost slowly over time puts them at increased risk for fractures.

Bones that once were strong become so fragile and thin that they break easily. Activities that once were done without a second thought are now avoided for fear that they will lead to another fracture.

Safety Tips to Prevent Falls Among Elderly

Preventing Falls and Fractures

Safety first to prevent falls: At any age, people can change their environments to reduce their risk of falling and breaking a bone.

Outdoor Safety Tips to Prevent Falls:

• In nasty weather, use a walker or cane for added stability.
• Wear warm boots with rubber soles for added traction.
• Look carefully at floor surfaces in public buildings. Many floors are made of highly polished marble or tile that can be very slippery. If floors have plastic or carpet runners in place, stay on them whenever possible.
• Identify community services that can provide assistance, such as 24-hour pharmacies and grocery stores that take orders over the phone and deliver. It is especially important to use these services in bad weather.
• Use a shoulder bag, fanny pack, or backpack to leave hands free.
• Stop at curbs and check their height before stepping up or down. Be cautious at curbs that have been cut away to allow access for bikes or wheelchairs. The incline up or down may lead to a fall.

Indoor Safety Tips to Prevent Falls:

• Keep all rooms free from clutter, especially the floors.
• Keep floor surfaces smooth but not slippery. When entering rooms, be aware of differences in floor levels and thresholds.
• Wear supportive, low-heeled shoes, even at home. Avoid walking around in socks, stockings, or floppy, backless slippers.
• Check that all carpets and area rugs have skid-proof backing or are tacked to the floor, including carpeting on stairs.
• Keep electrical and telephone cords and wires out of walkways.
• Be sure that all stairwells are adequately lit and that stairs have handrails on both sides.
• Consider placing fluorescent tape on the edges of the top and bottom steps.
• For optimal safety, install grab bars on bathroom walls beside tubs, showers, and toilets. If you are unstable on your feet, consider using a plastic chair with a back and nonskid leg tips in the shower.
• Use a rubber bath mat in the shower or tub.
• Keep a flashlight with fresh batteries beside your bed
• Add ceiling fixtures to rooms lit by lamps only, or install lamps that can be turned on by a switch near the entry point into the room. Another option is to install voice- or sound-activated lamps.

• Use bright light bulbs in your home.
• If you must use a step-stool for hard-to-reach areas, use a sturdy one with a handrail and wide steps. A better option is to reorganize work and storage areas to minimize the need for stooping or excessive reaching.
• Consider purchasing a portable phone that you can take with you from room to room. It provides security because you can answer the phone without rushing for it and you can call for help should an accident occur.
• Don't let prescriptions run low. Always keep at least 1 week's worth of medications on hand at home. Check prescriptions with your doctor and pharmacist to see if they may be increasing your risk of falling. If you take multiple medications, check with your doctor and pharmacist about possible interactions between the different medications.
• Arrange with a family member or friend for daily contact. Try to have at least one person who knows where you are.
• If you live alone, you may wish to contract with a monitoring company that will respond to your call 24 hours a day.
• Watch yourself in a mirror. Does your body lean or sway back and forth or side to side? People with decreased ability to balance often have a high degree of body sway and are more likely to fall.

Practice Balance Exercises Every Day

While holding the back of a chair, sink, or countertop, practice standing on one leg at a time for a minute. Gradually increase the time. Try balancing with your eyes closed. Try balancing without holding on.

While holding the back of a chair, sink, or countertop, practice standing on your toes, then rock back to balance on your heels. Hold each position for a count of 10. While holding the back of chair, sink, or countertop with both hands, make a big circle to the left with hips, then repeat to the right. Do not move your shoulders or feet. Repeat five times.

Reducing the Force of A Fall

Take steps to lessen your chances of breaking a bone in the event that you do fall: 

• Remember that falling sideways or straight down is more likely to result in a hip fracture than falling in other directions. If possible, try to fall forward or to land on your buttocks.
• If possible, land on your hands or use objects around you to break a fall.
• Walk carefully, especially on hard surfaces.
• When possible, wear protective clothing for padding.
• Talk to your doctor about whether you may be a candidate for hip padding.

6 Things That Cause the Elderly to Fall

Falls are the leading cause of death, injury and hospital admissions among the elderly population. In fact, one out of every three seniors falls every year. Last year alone, more than 1.6 million seniors were treated in emergency rooms for fall-related injuries.

Several factors contribute to the fact that seniors fall so much more frequently than younger people:

• Lack of physical activity. Failure to exercise regularly results in poor muscle tone, decreased bone mass, loss of balance, and reduced flexibility.
• Impaired vision. This includes age-related vision diseases, as well as not wearing glasses that have been prescribed.
• Medications. Sedatives, anti-depressants, and anti-psychotic drugs, plus taking multiple medications are all implicated in increasing risk of falling.
• Diseases. Health conditions such as Parkinson's disease, Alzheimer's disease and arthritis cause weakness in the extremities, poor grip strength, balance disorders and cognitive impairment.
• Surgeries. Hip replacements and other surgeries leave an elderly person weak, in pain and discomfort and less mobile than they were before the surgery.
• Environmental hazards. One third of all falls in the elderly population involve hazards at home. Factors include: poor lighting, loose carpets and lack of safety equipment.

However, falls are not an inevitable part of growing older. Many falls can be prevented, by making the home safer and using products that help keep seniors more stable and less likely to fall.

Preventing Falls in an Elderly Person's Home

Caregivers can do several things to make the home safer for their senior mom or dad:

• Install safety bars, grab bars or handrails in the shower or bath.
• Put no-stick tape on the floor in the tub. 
• Use a stool riser seat to make getting on and off the toilet easier.
• Install at least one stairway handrail that extends beyond the first and last steps.
• Make sure stairs are sturdy with strong hand railings.
• Be sure that stairwells are well-lit. Consider making the lighting in your home brighter to aid vision.
• Make sure rugs, including those on stairs, are tacked to the floor. 
• Remove loose throw rugs. 
• Avoid clutter. Remove any furniture that is not needed. All remaining furniture should be stable and without sharp corners, to minimize the effects of a fall.
• Change the location of furniture, so that your elderly parent can hold on to something as they move around the house.
• Do not have electrical cords trailing across the floor. Have additional base plugs installed so long cords are not necessary.
• Have your parent wear non-slip shoes or slippers, rather than walking around in stocking feet.
• Make sure all rooms have adequate lighting. Consider motion-sensitive lights that come on when a person enters a room. Use night lights in every room.
• Keep frequently used items in easy-to-reach cabinets.
• Use a grasping tool to get at out-of-reach items, rather than a chair or stepladder.
• Keep the water heater thermostat set at 120 degrees F, or lower, to avoid scalding and burns.
• Wipe up spills and remove broken glass immediately.

(Source:  AgingCare.com)

World Alzheimer Report 2013 "Ä Journey of Caring" - An Analysis of Long-Term Care for Dementia

The World Alzheimer Report 2013 ‘A Journey of Caring: An Analysis of Long-Term Care for Dementia’, reveals that, as the world population ages, the traditional system of “informal” care by family, friends, and community will require much greater support. Globally, 13% of people aged 60 or over require long-term care. Between 2010 and 2050, the total number of older people with care needs will nearly treble from 101 to 277 million.

Long-term care is mainly about care for people with dementia; around half of all older people who need personal care have dementia, and 80% of older people in nursing homes are living with dementia. The worldwide cost of dementia care is currently over US$600 billion, or around 1% of global GDP.

The report which was researched and authored by Prof Martin Prince, Dr Matthew Prina and Dr Maëlenn Guerchet on behalf of the Global Observatory for Ageing and Dementia Care which is hosted at the Health Service and Population Research Department, King’s College London.

Recommendations: 

·       Governments around the world should make dementia a priority by implementing national plans, and  by initiating urgent national debates on future arrangements for long-term care

·     Systems should to be in place to monitor the quality of dementia care in all settings – whether in  care homes or in the community

·    Autonomy and choice should be promoted at all stages of the dementia journey, prioritising the  voices of people with dementia and their caregivers

·       Health and social care systems should be better integrated and coordinated to meet people’s needs

·      Front-line caregivers must be adequately trained and systems will need to be in place to ensure paid  and unpaid carers receive appropriate financial reward in order to sustain the informal care system  and improve recruitment and retention of paid carers

·      Care in care homes is a preferred option for a significant minority – quality of life at home can be as good, and costs are comparable if the unpaid work of family caregivers is properly valued

·      The quality of care in care homes should be monitored through the quality of life and satisfaction 

   of their residents, in addition to routine inspections, as care homes will remain an important  component of long-term care.

More information, click on ->  World Alzheimer Report "A Jounrey of Caring"

(Source:  ADI)

5 CAUSES OF ALZHEIMER'S OUTBURSTS

For people taking care of elderly parents with Alzheimer's or Dementia, one of the biggest challenges is dealing with outbursts of agitation and aggression.

Techniques for managing Alzheimer's aggression such as re-directing the person's attention or medication can certainly help. But Cindy Steele, an RN and Nurse Scholar for Copper Ridge, a residential care community, says the key is finding out what is causing the outburst.

"Dismissing aggression as a normal behavior associated with Alzheimer's doesn't enable the caregiver to fix whatever is causing the outburst. Why do they seem to get upset? What causes it?" says Steele, who focuses on behavior management for Alzheimer's and dementia.

She says agitation and aggression are typically caused by one or more of these five factors:

Cognitive Impairment

Sometimes caregivers overestimate what their parent with Alzheimer's or dementia is capable of accomplishing.  If a person with Alzheimer's is asked to do a task, and they are not able to complete it, they get upset and frustrated, which results in an outburst. Caregivers must adjust their expectations to their parent's capabilities.  And remember that Alzheimer's and dementia are degenerative diseases. Parent's abilities will decline over time, which means expectations must be shifted continually.

Psychological Disorders

Steele says that 40% of people with Alzheimer's develop depression, due to a neuro-chemical imbalance in the brain. Anxiety disorders and delusions also occur quite commonly in people with Alzheimer's.  Once these imbalances are identified and diagnosed, medication can be prescribed that has proved to help tremendously.

Physical Problems

Outbursts might be associated with physical problems. The person might have a headache, a rash, constipation, or fatigue. This means caregivers must be vigilant about watching their elderly parent's physical well-being and noticing when changes occur. When people with Alzheimer's have physical problems, they might be unable to tell the caregiver. The behavior – in the form of a tantrum – is their form of communication.

Environment

The person may be reacting to an uncomfortable environment. For example, a room may be too cold, too noisy, or too crowed. Their inability to clearly communicate their discomfort turns into an outburst.

Approach

People with Alzheimer's react and respond to how a caregiver approaches them. Trying to rush them, or force them to do something they don't want to do can result in agitation.  How you approach the person with Alzheimer's is key, Steele says. Use a gentle tone of voice, but don't be condescending. Don't rush them as they try to complete a task, even if they are moving at a frustratingly slow pace. Don't demand that they do something or bark orders at them. Ask them. Use calming gestures and gentle touch.

Getting to the root cause of outbursts will help caregivers manage behavior more effectively and may lesson the frequency of agitation and aggression.

(Source:  AgingCare.com)

FOOT CARE ADVICE FOR PEOPLE WITH DIABETES

If you have diabetes, it's important to pay special attention to your feet. Diabetes can lead to nerve damage in the feet (peripheral neuropathy), which, in turn, can reduce your ability to feel sensations, like cold, heat or pain. Also, diabetes can impair circulation and wound healing by hardening and narrowing the arteries that supply blood to the legs (peripheral arterial disease, PAD).

A wound on your foot that doesn't heal can turn into an ulcer that may become infected. And if you have severe peripheral neuropathy, you may not even know it's there. Left untreated, or if treatment is unsuccessful, amputation may be required in severe cases.

What should you do? People with diabetes should follow the self-care measures described below:

·         Inspect your feet each day - Contact your doctor promptly if you notice any infected toenails, swelling, sores, cuts, bruises, blisters or red spots that do not heal after a day. Also, call your doctor if you experience tingling, numbness or pain in your feet.

·         Wear shoes and socks - Always wear footwear even when you're indoors. If you walk barefoot, it's easy to injure your feet without realizing it. Avoid wearing tight socks or garters or elastic bands to hold up socks because they can cut off circulation to your feet.

·         Wash your feet daily - Use a gentle soap and warm water. If you have nerve damage and the water is so hot it scalds your skin, you may not notice it. 

·         Treat calluses and corns gently - If recommended by your doctor, gently file calluses and corns after bathing, using an emery board or pumice stone. Do not use chemicals, razor blades or other harsh methods to remove corns or calluses. 

·         Dry your feet thoroughly after bathing - Use a nonabrasive towel to gently blot dry your skin. And don't forget to dry the spaces in between your toes.

·         Moisturize your feet - Apply a thin layer of skin cream to the top and bottom of each foot after drying your feet. Avoid putting lotion between your toes, where excess moisture can contribute to infection. 

·         Cut your toenails once a week - Cut the nails straight across without curving in at the edges. Cutting into the corners of the nails can lead to ingrown toenails.  Also, avoid cutting your nails too short. 

·         Carefully wash any cuts or blisters - For cuts, use a mild antiseptic like Bactine and cover the cut with a dry, sterile dressing and paper tape. If you develop a blister, rub an antibiotic cream on it a few times daily until it heals. Never pop a blister.

·         Avoid heat and cold - Feet can be damaged easily by cold surfaces or frostbite. Be sure to protect your feet from the cold during winter by wearing extra-warm socks and shoes or boots. Although most people never think of it, sun can be damaging to your feet as well. To avoid a sunburn if you're wearing sandals, apply sunscreen to your feet and keep them out of direct sunlight.

(Source:  John Hopkins Health Alert, Posted Diabetes on 27 June 2013)

SAT/5OCT13 ADFM Public Talk "Vascular Dementia" By Prof. Dato Dr Raymond Azman Ali from UKM

Dear Caregivers and Members of the Public, 

ADFM National Caregivers Network will be holding a FREE Public Talk for Caregivers and Members on “VASCULAR DEMENTIA” by Prof. Dato Dr Raymond Azman Ali, Senior Consultant Neurologist and Dean of UKM Medical Faculty and Director of UKM Medical Centre.  The Public who are interested are welcome to register.

VASCULAR DEMENTIA is the second most common cause of dementia in older people. Because it has a lower profile than Alzheimer's, many people don't suspect Vascular Dementia when forgetfulness becomes problematic.

Prof. Dato Dr Raymond Azman Ali in his talk will share with our Caregivers and members of the public what Vascular Dementia is and its causes, symptoms and treatments.  Determining the root cause can help determine the best action plan. If it's Vascular Dementia, certain lifestyle changes can help prevent further damage.

DETAILS:

TOPIC :  "VASCULAR DEMENTIA" 

Day / Date : Saturday, 5 October 2013

Venue:  ADFM PJDaycare Centre, No. 6, Lorong 11/8E, Seksyen 11, 46200 Petaling Jaya

Program:

2:00pm      Registration of Attendance

2.30pm      Talk on “Vascular Dementia” by Prof. Dato Dr Raymond Azman Ali

3.30pm      Q & As

4.00pm      Light Refreshments/End

Who Should Attend?

·      Caregivers & families of PWDs (Persons with Dementia)

·      Healthcare Workers

·      Anyone who wants to find out more about Vascular Dementia

Compulsory Prior Registration:

1.   Register online now ->  Registration Form   

2.   Email: jenny@adfm.org.my or Fax:  03 7960 8482.

3.   SMS 016 608 2513 with full name and contacts if you do not have email access.

Any inquiries, call Jenny at 016 608 2513 / 03 7931 5850 / 7956 2008. 

See you at the talk and, kindly be punctual !!! 

Thank you!

VASCULAR DEMENTIA

Vascular Dementia is the second most common cause of dementia in older people. Because it has a lower profile than Alzheimer's, many people don't suspect vascular dementia when forgetfulness becomes problematic. It's also difficult to diagnose so it's difficult to know exactly how many people suffer from vascular dementia. Current estimates attribute 15% to 20% of dementia cases in older adults to vascular dementia.

Determining the root cause, its causes, symptoms, and prognosis, can help determine the best action plan. If it's vascular dementia, certain lifestyle changes can help prevent further damage. 

What Is Vascular Dementia?

Compared to Alzheimer's disease, which happens when the brain's nerve cells break down, vascular dementia happens when part of the brain doesn't get enough blood carrying the oxygen and nutrients it needs.

Though they happen in different ways, it is possible to have both vascular dementia and Alzheimer's disease. Discouraging as this sounds, there is ample reason to control the risk factors that contribute to vascular dementia. Allowing the condition to run its course without intervention can make Alzheimer's disease worse.

What Causes Vascular Dementia?

Vascular dementia occurs when vessels that supply blood to the brain become blocked or narrowed. Strokes take place when the supply of blood carrying oxygen to the brain is suddenly cut off. However, not all people with stroke will develop vascular dementia.

Vascular dementia can occur over time as "silent" strokes pile up. Quite often, vascular dementia draws attention to itself only when the impact of so many strokes adds up to significant disability. Avoiding and controlling risk factors such as diabetes, high blood pressure, smoking, and high cholesterol can help curb the risk of vascular dementia.

Catching the condition early also helps limit the impact and severity of vascular dementia. Early detection requires an awareness of risk factors and, more importantly, efforts to keep them under control. Anyone who suspects vascular dementia should talk with his or her doctor.

Symptoms of Vascular Dementia

Symptoms of vascular dementia depend on what part of the brain is affected and to what extent. Like Alzheimer's disease, the symptoms of vascular dementia are often mild for a long time. They may include:

-  Problems with short-term memory

-  Wandering or getting lost in familiar surroundings

-  Laughing or crying at inappropriate times

-  Trouble concentrating, planning, or following through on activities

-  Trouble managing money

-  Inability to follow instructions

-  Loss of bladder or bowel control

-  Hallucinations or delusions

Symptoms that suddenly get worse often signal a stroke. Doctors look for symptoms that progress in noticeable stages to diagnose vascular dementia. Alzheimer's, by comparison, progresses at a slow, steady pace. Another clue is impaired coordination or balance. In vascular dementia, problems walking or balancing can happen early. With Alzheimer's, these symptoms usually occur late in the disease.

Who Is at Risk for Vascular Dementia?

Some risk factors for vascular dementia can be managed; others, like age and gender, cannot. Among all factors, high blood pressure carries the greatest risk; vascular dementia almost never occurs without it.

Likewise, a high risk of stroke goes hand in hand with risk for vascular dementia. One-quarter to one-third of strokes are thought to result in some degree of dementia. People who smoke, consume excessive amounts of alcohol, have diabetes, or heart disease also have a higher rate of the condition.

Vascular dementia most commonly occurs in people between the ages of 60 and 75. Men seem to be more vulnerable than women, and the condition affects African-Americans more often than other races. People whose age, sex, or race puts them at increased risk of vascular dementia have that much more reason to manage risk factors within their control.

Vascular Dementia Treatment

Currently, no available treatments can repair the damage of vascular dementia once it's happened. Nonetheless, diagnosis provides important knowledge and the opportunity to prevent further damage.

Prevention typically involves bringing high blood pressure under control through exercise, diet, and medication. The same goes for diabetes if it exists. Patients should stop smoking and curb the use of alcohol. 

Though medical options are limited, behavioral interventions such as cues and reminders can improve the quality of life for everyone involved. Family members and friends can place notes in visible locations around the house with daily plans and instructions for how to use basic items. Stepping up communication, reminding the person with vascular dementia what day it is, where they live, and what is going on in the family, can help keep them connected to the here and now.

Prognosis for People with Vascular Dementia

If the conditions that cause vascular dementia go untreated, the prognosis is not good. A person with vascular dementia may seem to improve for periods of time until another stroke takes away more brain function, memory, and independence. Eventually, untreated vascular dementia usually ends in death from stroke, heart disease, or infection.

Although vascular dementia is a serious condition, catching it early and preventing further damage are the best medicine. People with vascular dementia can work with their doctors and families to detect and manage the condition.

(Source:  WebMD.com)

HOW IMPORTANT IS PLAY FOR ALZHEIMER’S PATIENTS IN THE LATE STAGES?

I call that place the “zombie wall.”

By Mary Gazetas

My husband is living in the last stages of Alzheimer's. Clinically

he’s a Seven.

He’s in a home and he can’t walk, rarely talks, and he can

no longer participate in organized activities.

Reading, writing or watching television disappeared over two

years ago.

One question readers might ask is, “Gosh, Well Then What Can He Do?”

Part of an answer is to share what I tell my children, my three grown children who live far away.  When they check into see how their Dad is doing, I find a huge part of my response is to describe to them what he loves to play with.

He’s now playing with things that would amuse and keep occupied a 9 month old - a one year old child.  I am no expert.  May be it is even a younger age.  I don’t know.

It took me awhile to realize how important it was that he had things in front of him to touch and move around.  It was about a year ago when he could still more or less feed himself to a degree that I began to notice he loved to play with his food.  I called it the “sand box.”

Anything close by his meal tray in the dining room became fair play.  Things that were within reach and that he could see that were there to make him curious.

It was common to see him rip open paper sugar packets, pour his cup of milk into another vessel or make a puddle to put his fingers into. Use his paper napkin to fold into a shape to cover a cup or a piece of uneaten food. Use his blue terry cloth bib to cover and hide things under.  Activities most of us would associate with what a very young child likes to do.

Besides eating, the playing part was a large part of his meal experience as I sat beside him.

For him this was fun. So I never tried to discourage him despite some objections from the residence staff. To me, that kind of behaviour indicated he was still curious about things. He wanted to play. He was bored!  Why would I want to tell him it was not cool to do that?

I read that having a “rummage basket” close at hand was a beneficial method to keep people like him active. I brought in objects from home that I hoped might be a-connect for him. Things that may be he might remember or be curious about.

Into the basket went objects such as his empty wallet, decorated wooden Easter eggs, pens, really small art books of his favourite artists, toy animals, a water gun, and hard-boiled egg covers made of wool from my mother’s kitchen.  He didn’t seem that interested in those objects. Then one day when I showed up one of the care-aides had put the basket on its side on his table. Now he could actually see inside. What a difference!

Pasted on the wall above his bed is a care plan that describes to all the staff what I think is important re his level of care. No more parking him in his wheelchair by a wall after lunch with nothing for his hands to do. I call that place the “zombie wall.” Instead over time they now get it. After the noon meal, take him back to his room so he can sit beside an open window, with his bedside table in front of him, to place an assembly of toys to touch.

A few weeks ago it struck me he needed some new toys. I went to the local IKEA store children’s area and bought a set of stacking cups and another piece made of wooden thick rings to place on top of one another on a small pole.

They are now his favourites.

When I entered his room this afternoon he was wide awake, playing with all in front of him -   stacking, grouping, curious and happy.

One of his care-aides told me another staff person had come into the room earlier and mentioned she had bought the same toys recently - toys for her one year old grandson. I wasn’t there for that conversation.  But I did hear that there is a need to create an awareness that people like my husband have returned to a very early stage of a childhood from long ago.

Meanwhile, I am going to take the wooden stacking rings home to make the holes larger with my drill because he has trouble seeing how to get them to fit on the vertical pole.  I don’t want him to struggle to do that.  I want him to feel he is winning.

Is P L A Y important?  You bet it is. The job of a caregiver is to figure out what is best for their loved one. There are no easy answers - it’s all about trial and error. Plus experimenting to see what might engage them and what might not.

In Bob’s words - Welcome to the Alzheimer's World, we have to be playful and have fun too.

Mary Gazetas was an artist, a writer, a volunteer who lived in

Richmond B.C. Canada.  At the beginning she knew nothing about Alzheimer’s.  In fact she didn’t even know how to spell that word.

At first she and her husband were overwhelmed by so much information available.  Looking back it was a slow learning curve.  Once diagnosed (February 2008) the progression of her husband’s Alzheimer’s was fairly slow until he went into a steep and sudden decline.

Mary went to Heaven on April 17, 2012. Her words sing loud and true.

(Source:  Alzheimer’s Reading Room, 5 September 2013)