Walker Safety

Walkers are valuable tools that promote mobility.  They can help when a resident has poor balance (like after some strokes) or is weak.  But incorrect use can have disastrous results.  Here are some simple guidelines for helping residents use their walkers safely.

Right Walker

First, make sure the resident has the right walker.  There should be rubber hand grips and non-skid rubber tips or wheels on the legs.  A lightweight walker allows the resident to easily lift it over bumps or stairs.  Some have wheels on the front legs if the resident has trouble lifting the walker while walking.  Sturdy wheels are a must.  Other options are hand brakes, baskets for carrying and legs that are adjustable to varying heights. If the resident has a tendency to tip backwards, the height of the walker can be adjusted down slightly to redistribute his weight.

Starting Out

When getting up from a chair, put the walker directly in front of the chair.  Then have the resident slide forward in the chair, keeping the feet directly under him.  Then have the resident use the arms of the chair to slowly stand.  The resident should grasp the walker handles firmly and move forward into the center of the walker.  When walking, watch the resident to be sure he does not put the walker too far ahead of this body.

Sitting

When the resident is ready to sit down, have him back up to the chair such that he can feel the chair on the back of his legs.  If one leg is weaker than the other, have the resident put his weight on the stronger leg.  The resident should keep one hand on the walker while the other reaches for the arm of the chair.  When he has a firm grasp, he should move the other arm to the chair, then lower himself down.

Remember, to be safe using a walker:

• the resident must take small steps
• he should never tilt or pull on the walker when getting up from a sitting position
• chairs should have armrests
• walkers should be examined routinely to be sure wheels and tips are secure and not worn down. 

This article was originally published in Pathways Residential Care Journal - Issue 3.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

Advance Health Care Directives

A Gift to Families

An advance health care directive tells your family and doctor what you want done if you can’t make decisions for yourself.  Your family and doctor don’t have to guess what you would have wanted.  What would be the highest priority?  It might be to be pain free, or to not be on a ventilator, or to have everything done to keep you alive as long as possible.  This isn’t just for older people, all adults should make one.  After all, young people can be injured in accidents that leave them unable to speak.

Three Parts

An advance health care directive has three parts.  In the first part you name a person to be your agent (and alternates in case the agent is not available).  The agent can legally make health care decisions for you and is called a Durable Power of Attorney for Health Care.  In the second part, you state in detail the treatments you would want, or would not want, and under what circumstances—things like feeding tubes, ventilators and what to do if your heart and breathing stop.  In the third part you can say if you want to be an organ or tissue donor.

Choosing an Agent

The person you choose as an agent must be 18 years old, and someone who knows you well and who will honor your wishes, even if they are different from yours.  A husband or wife is not automatically recognized as a patient’s spokesperson in California.  The agent may be a family member, a friend, or even an attorney, but caregivers in a facility cannot be agents for residents.  Agents may choose a doctor, hospital, skilled facility or hospice for you.  The agent may also accept or refuse treatments on your behalf, and consent to organ donation.

Making it Legal

An advance health care directive does not need to be prepared by an attorney, but it must be signed and dated in front of two witnesses (who are not the agent or alternate) or it can be notarized.   There is no official, standard form.  One web site where you can get advance directives in several languages is www.codaalliance.org.

When complete, you should make sure your doctor, loved ones and agent all have copies.  The original should be kept in a safe place and a copy should go with you to the hospital.  Experts recommend that an advance directive be updated at least every 10 years, in the event of a divorce, or if the agent is unable to act.  The directive is valid forever unless you revoke it or state in the directive the date on which you want it to expire.

This article was originally published in Pathways Residential Care Journal - Issue 3.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

Do Your Patients Get Enough Sleep?

Many Don't

Nearly 41 million American workers—that’s 30% of the labor force—get 6 hours of sleep or less each night, according to the CDC.  They are putting themselves and those around them at risk. 

This data is from the National Health Interview Survey done in 2010 and was published in the April 27, 2012 issue of CDC’s Morbidity and Mortality Weekly Report.

“Not surprisingly, workers who work the night shift are more likely to not get enough sleep,” said Dr. Sara Luckhaupt, lead author.  Others include people with more than one job or working more than 40 hours a week; widows and divorced people; those with a high school education; and African-Americans.

Short sleep duration is linked to:

• Car accidents (CDC estimates 20% of crashes)
• Weight gain
• Heart attack, stroke, falls
• Depression, substance abuse, irritability
• Poor attention, work absenteeism

Nearly 70% of those working night shifts in transportation and warehousing are sleep-deprived, the study said.  Although inadequate sleep was most common to workers on night (44%) and rotating (32%) shifts, 29% of people who regularly work day shift averaged 6 hours or less.  Working nights and sleeping during the day, in particular, disrupts the natural sleep cycle, called circadian rhythm, Luckhaupt said.

The National Sleep Foundation recommends 7-9 hours of sleep nightly for healthy adults.

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 24.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

Reasons to Get Online & On Your Feet

Agile Minds

We have known that mental activity staves off cognitive impairment, and the same is known about exercise.  But is it even more effective if seniors do both?  It looks like the answer is yes.

Research involving seniors ages 70 to 93 demonstrated that any amount of moderate exercise in conjunction with using a computer during the previous year resulted in a 64% less likelihood of mild cognitive impairment compared with those who reported neither activity.

According to lead researcher, Yonas Ged, MD, of the Mayo Clinic in Scottsdale, AZ, there was a significant additive effect when both exercise and the computer were employed.  Geda and colleagues examined data from the Mayo Clinic Study of Aging, an ongoing population-based study of individuals living in Olmsted County, Minn. The analysis included 926 men and women who did not have dementia.  The researchers controlled for age, sex, education, medical co-morbidity, and depression.

Among seniors who had normal cognition, 36% reported getting any moderate exercise and using a computer in the previous year.  Among those with mild cognitive impairment, only 18.3% reported both exercise and computer use.

The study was reported in the May, 2012 issue of Mayo Clinic Proceedings and was supported by grants from the NIH and numerous foundations.

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 24.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

Acupuncture for COPD

It's Effective

Dyspnea during exercise can be debilitating.  This fact coupled with earlier findings that acupuncture has been shown to reduce dyspnea in cancer patients led a team of Japanese scientists to explore whether it would also help people with COPD.  They found that, in fact, it does help.

Researchers at Kyoto University conducted a randomized study of 68 patients who were taking standard medications for COPD in various stages.  They were randomly assigned to have actual acupuncture or a placebo treatment in which needles did not penetrate the skin.  Patients received treatment once a week for 12 weeks.

Results showed a statistically significant improvement in dyspnea ratings.  As their dyspnea subsided, patients also demonstrated in tests that they were able to tolerate exercise better and increase the distances they were able to walk.

The study was led by Masao Suzuki, PhD, and published in the Archives of Internal Medicine.

More information is available at: Suzuki M, et al “A randomized, placebo-controlled trial of acupuncture in patients with chronic obstructive pulmonary disease (COPD): the COPD-acupuncture trial (CAT)” Arch Intern Med 2012; DOI: 10.1001/archinternmed.2012.1233.

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 24.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.