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Virginia's ALZHEIMER'S
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ALZPOSSIBLE INITIATIVE |
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VIRGINIA ALZHEIMER CAREGIVER
FORUM
EDITED BY VACAPI's Education Core
Chaired by Ayn Welleford, PhD, Marilyn Pace Maxwell and
Cathy Saunders |
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June
2007
FALLS and
FALLING - Problems and Solutions for the Individual with Alzheimer's
Disease |
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Alzheimer's and Falls - connection, challenges,
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ALZHEIMER'S AND
FALLS - CONNECTION, CHALLENGES and SOLUTIONS
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Many caregivers
report falls as a frequent concern. Whether the concern
stems from need for extra help in the home, education to
reduce risk of falls, or recovering both physically and
psychologically after a fall the need to prevent harm to
self and loved one is clear in all of our minds.
Read below three
separate perspectives and submit your comments in our
forum.
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Caregiver's Perspective
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Falling
and the Individual with Alzheimer's Disease
- a Caregiver's Perspective
By Jan F. Bell
As a caretaker, you can get
overwhelmed by all the suggestions, tips and guidelines
for so many subjects from so many sources... There are
many books, organizations, community support groups and
training opportunities available but you really wish
that you had trained for something in the medical field
so you feel competent.
Our biggest arguments were
concerning falling. I wanted Mom to do safe things:
don’t pickup all the dishes, watch out when turning
around, turn on the lights at night, take small steps at
the front door. Mom wanted to continue what she
always did: move about freely, cook, clean, help around
the house. She struggled to maintain her independence
and usefulness while I wanted to protect and prevent
injury.
Finally, as her dementia
and Parkinson’s progressed, I had to take falling
seriously and our life would not be the same. I looked
at everything from
her perspective of losing balance, tripping
and falling and made drastic changes so she could
continue to move at will, do the things she desired and
reduce our confrontations. The most helpful changes were
exercise, medications and adaptations.
There are lots of sources
for exercise: PT, yoga, the Y, etc. Since she refused
to “exercise”, I substituted it for “shopping," or
pushing a grocery cart.
Her doctor was helpful in
reviewing all drugs for side effects such as: balance,
drop in blood pressure upon standing, dizziness, etc.
I switched to nice plastic
dinnerware and drink cups and removed all sharp knives
and the stovetop knobs. Small rugs, glass objects and
low tables were removed as trip hazards or possible
injury-causing. Walkways were cleared and widened for
her walker (if she should use it) and other paths with
unsafe step downs were blocked off from her wanderings.
Furniture was turned so she could use their support.
Night lights were positioned to give as much light as
possible with her nighttime bathroom trips. Clothing
was removed from low drawers and mirrors or reflecting
objects were removed or covered. By the time she left,
our house was pretty well stripped and “softened” and I
generally let her move freely. Because of her dementia,
if I removed objects discreetly, she never missed them
or I was able to divert any questions without distress
to her.
To my mother and me, the
subject of “falls and falling” seemed so “unmedical.”
But in the end, falls became the
big issue.
It was falls that brought the EMS to our house several
times, trips to the ER and the doctor for X-rays and
finally, the last trip to the hospital. Falls will
happen. I am glad that I could make some changes that
lessened the anxiety for both of us...
Jan Bell has
been the caregiver of her mother, Ms.
Frances Flagler,
who passed earlier this month. Jan has graciously
accepted to write this article during these sad times as, in
her own words, "it will help me rethink this part of our
passage." Jan wishes to express her thanks to Manor
Care staff at Imperial Plaza as well as those at Heartland
Hospice, "all wonderfully trained staff for dementia and
gentle, compassionate care."
Contact us to comment on Jan Bell's perspective or
visit
our Forum to enter it directly.
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Gerontologist's Perspective
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Yoga for Individuals with
Alzheimer’s to Reduce Falls
by Nancy
Glenmore Tatum MS, E-RYT 500, CMT, Owner and Director of
Glenmore Yoga & Wellness Center
According to the Centers
for Disease Control and Prevention:
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1 of every 3 adults age
65 or older falls each year.
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Falls are the leading
cause of injury and death among older adults.
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Falls are the cause of
87% of all fractures and the second leading cause of
spinal cord and brain injury among older adults.
Major factors contributing
to older adults’ falls are: a history of a previous fall,
dizziness, problems with gait and balance, neurological and
musculoskeletal disabilities, side effects from medication
use, problems related to confusion, visual impairments, and
fear of falling. Muscle atrophy is one cause for balance
and gait problems. If we become less active muscles
atrophy, or reduce in size and strength. This reduces the
mobility and balance needed to maneuver effectively.
An individual is more
likely to fall if confused because the confused person is
often unaware of the surroundings and unable to think
clearly or react quickly enough to break the fall. People
with Alzheimer’s have a higher risk of falls and fractures
than do people the same age without the disease. Once
injured, they are also more likely to re-injure themselves.
These factors are directly related to impaired mobility and
loss of independence.
The Mayo Clinic reports
that people with Alzheimer’s feel better, both physically
and emotionally, when they get regular, moderate exercise.
As little as 20 minutes of exercise three times a week can
boost mood, decrease risk of falls, reduce wandering and
delay nursing home placement in people with Alzheimer’s.
 The
accepted view of the aging process has been one of
stiffening, rigidity and closing down. Without proper
exercise, the body contracts losing height, strength and
flexibility. Gerontologists have proven that remaining
active throughout life halts bone and muscle loss. Yoga
softens the aging process by moving each joint in the body
through its full range of motion. Yoga helps to prevent
falls by improving balance, coordination, posture, and body
mechanics.
Results from a study which
I conducted in 2000 with assisted living residents concluded
that weekly seated yoga classes increased feeling of general
well-being of residents, increased knowledge of body
awareness and body carriage, and decrease in the number of
falls and resulting injuries. Yoga not only strengthens
bones, it actually helps to prevent falls by improving
balance and coordination, posture and body mechanics. When
falls occur, yoga reduces the degree of trauma and
likelihood of fractures by strengthening the muscles and
making the body more flexible. Strong muscles are better
able to control and absorb the impact of falls.
My current research study
is nearing completion to determine the effects of yoga on
older adults, ages 58-83, to increase their ability to
comfortably transfer to and from the floor. The study has
used a group of yoga exercises to strength and increase
flexibility in the lower body, increase body awareness and
balance. Midway through the study participants reported
that their confidence had been restored and that they were
no longer afraid to be on the floor. Results from the study
will be available this August.
Photography credit: Nancy Glenmore Tatum
 Nancy
Glenmore Tatum MS, E-RYT 500, CMT, has practiced and taught
Hatha Yoga since 1970 and is the owner and Director of
Glenmore Yoga & Wellness Center. Nancy holds an MS in
Gerontology. In addition to a 200 and 500 hour teacher
training program Nancy has created a program to prepare yoga
instructors to teach therapeutic yoga specifically to older
adults. Nancy is a Certified Yoga Instructor through the
Himalayan Institute and is a member of the International
Yoga Therapy Association. During the last decade Nancy has
conducted two research studies on the effects of yoga on
older adults.
Contact us to comment on
Nancy Glenmore Tatum's perspective or
visit
our Forum to enter it directly.
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Chiropractor's Perspective
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Alzheimer's
Disease and
Falls
by Kevin P. Walsh, DC, CCP, Doctor of Chiropractic
and Chiropractic Pediatrics, Walsh Family Chiropractic
When defining
the symptoms of Alzheimer’s disease, rarely does one find
falls listed as one of its symptoms. True.
However, falls are one of the common associated conditions
due to the often seen age-associated factors of chronic
conditions, physical deconditioning, medication related
problems, and dementia.
According to the
American Geriatrics Society, approximately 35% to 40% of
generally healthy older persons over the age of 65 fall
annually. Incidences increase nearly three times for those
persons in need of assisted living services.
Unintentional
injuries are the fifth leading cause of death in older
adults according to a study by the CDC. More pointedly,
75% of unintentional deaths were the result of falls.
Therefore, identifying risk factors, taking steps to prevent
falls, and early intervention following a fall should be
strongly considered when caring for a person with
Alzheimer’s.
When identifying
risk factors, you need to ask three questions about the
physical, chemical, and environmental state of the person
you are caring for.
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First, does
the person have any noted muscle weakness in the upper
or lower extremities, visual deficits or balance
disorders that may make him or her more prone to falls?
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Second, is
the person taking multiple medications or a medication
which side effects may make him or her drowsy or impair
their balance?
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Third, what
environmental factors such as loose carpeting, poor
lighting, or lack of safety equipment near stairs or in
the bathroom are present?
I suggest
answering the questions and then create a check list of
areas to address. Here are some recommendations:
The Physical
If the person
has muscle weakness or balance problems, take steps to
improve strength and balance by enlisting in an exercise
program that focuses on balance and coordination such as
Balance and Gait Training, Tai Chi, Yoga, and/or Pilates.
Use canes, crutches, walkers, and other assistive devices
to keep mobile.
As a
Chiropractor, I take balance and coordination a step
further. I work with my patients not only to improve
balance and coordination of their skeletal and neuromuscular
systems, but to also improve their functional mobility and
efficiency. Postural inefficiencies resulting from prior
injuries along with often decades of adaptation create
inefficient or aberrant movement of the spine and
extremities which can lead to imbalance and/or falls.
Doctors of Chiropractic use specific chiropractic
adjustments along with stretches and strengthening exercises
to help restore normal spinal movement and function.
Vision should be
monitored regularly to prevent falls resulting from loss of
visual acuity, decreased visual fields, cataracts, etc.
The Chemical
Become informed
of the side effects of medications the person is on by
researching the meds and/or consulting their pharmacist and
physician. In some cases, there may be an alternative
treatment that does not cause dizziness or impair balance.
If the person is seeing multiple physicians, keep a list of
medications prescribed by each physician to ensure that
there are no adverse reactions when combined with other
medications.
The Environmental
This is an area
that you may be able to evaluate and make the necessary
improvements on your own. If you need help, consult a
licensed home inspector, handyman, or health professional
who is familiar with the safety needs of a senior. Have
them come to the home to perform an evaluation and make
recommendations. Simple home repairs, additions, and
subtractions can go a long way to preventing falls.
Finally, it is
important to intervene immediately following a fall. Many
times the injuries from a fall are not visible. If you are
aware of a fall be sure to seek medical evaluation.
Internal bleeding and fractures are the most common injuries
from a fall with the 65+ age group. It is also important to
investigate how they fell. It may be because of one of the
physical, chemical, and/or environmental influences that
were not noted in your evaluation previously. Because
Alzheimer’s is a memory disorder, I would also recommend
training him or her to write down in a journal how and where
they fell and what areas hurt following the fall since they
may not remember to tell you about the fall. Check the
journal regularly to ensure falls aren’t overlooked. The
frequency may be more frequent than you think.
 Dr.
Walsh holds a Doctorate of Chiropractic from Life University
and is the owner of the
Walsh Chiropractic Center in Williamsburg, VA, which is a
center dedicated to treating the patient as a whole by
reducing stresses on the spine through quality chiropractic
care and promoting optimal health through education and
guidance concerning diet, exercise, and stress.
Dr. Walsh began his chiropractic career in Lilburn, Georgia
at Multi-HealthCare Plus, a multi-disciplinary practice.
As a result, Dr. Walsh had the opportunity to work
hand-in-hand with an orthopedic surgeon, pain management
physician, general practice physician, chiropractors,
physical therapists, and massage therapists.
Contact us to comment on
Dr. Kevin Walsh's perspective or
visit
our Forum to enter it directly.
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Educator's Perspective
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Falling and
the Individual with Alzheimer’s Disease
by E. Ayn
Welleford, PhD - Chair & Associate Professor, Department
of Gerontology, Virginia Commonwealth University
As
an academic educator much of my responsibility is to clarify
ageist attitudes, miscommunication and misunderstandings
presented in the media and held by the public and
professionals who care for our elders. One rampant ageist
misunderstanding is that Age causes terrible things
to happen to people. I know some of you are thinking,
“Oh brother, here she goes again.” The truth of the matter
is, there are good and bad things about all stages of the
lifespan (Do you remember adolescence? Either yours
or your offspring’s?). Each stage involves development
which includes both growth and decline. As an
educator, my responsibility is to tease out the truth and
share it in order that we may all pursue improved eldercare
and our own vital aging.
Falling
is one of those issues where we need to better our
understanding. Our experts in this month’s newsletter
are aiding our understanding by getting to the heart of the
matter of Falling and Individuals with Dementia. One of the
frequently cited risk factors for falls is age. However,
researchers know that age cannot be considered a causal risk
factor due to the numerous confounding and extraneous
variables often associated with age. By this I mean
the numerous other issues that are age-related or that make
people so different from each other as they age. Some
of these mentioned by our panelists include: weakness due to
deconditioning, visual impairments, medication related
problems (MRPs), environmental factors (due to a lifetime of
accumulation of memorabilia). Other confounding
variables may include: fitness history in addition to
present activity level, nutritional status, presence of
osteopenia, level of education, health status, existing
chronic diseases, cognitive ability, presence of dementia,
genetics, sensory function (vestibular and kinesthetic
sense), and vascular health. When people say “age”
they are really referring to so many other issues. Still
people believe that age predicts falls. In reality age
is shorthand for all of these other confounding factors.
When you compare yourself with your neighbor of similar age
you see that we cannot compare two people much less
thousands of people simply based on age without considering
the numerous factors that impact functional health that have
little really to do with chronological age.
This month, our
panelists encourage us to do two things:
(1) To get to
the heart of the matter in terms of what really precipitates
falls among individuals with dementia, and
(2) How do we
consider the diversity of precipitating events and
conditions (i.e., confounding risk factors) to reduce fall
risk and recover post fall in order to promote the best
quality of life among our elders.
I hope you’ll
join us on July 24 as our panelists share their efforts
to improve eldercare! (click
here to learn more about this live discussion)
 Dr.
Ayn Welleford is Chair, VCU Department of Gerontology,
Associate Professor,VCU Department of Gerontology, and
Associate Director, Virginia Geriatric Education Center. Dr.
Welleford received her B.A. in Management/ Psychology from
Averett College, M.S. from the Department of Gerontology and
Ph.D. in Developmental Psychology from VCU. She has taught
extensively in the areas of Lifespan Development, and Adult
Development and Aging. As an educator, researcher, and
previously as a practitioner she has worked with a broad
spectrum of individuals across the caregiving continuum. As
a gerontologist she currently works extensively with formal
and informal caregivers to improve elder care through
education. Outside of the classroom and working with various
community agencies, Dr. Welleford provides community
education on a variety of topics, including: Steps to Aging
Well, Building Successful Mother-Daughter Relationships,
Intergenerational Programs, and Family Caregiving. Dr.
Welleford conducts research, through mixed methodology, in
the areas of caregiver burden, coping with distress, adult
mother-daughter relationships, successful aging, and
geriatric education.
Click here to read more about Dr. Welleford's work.
Contact us to comment on
Dr. Welleford's perspective or
visit
our Forum to enter it directly.
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ADDITIONAL RESOURCES
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OSTEOPOROSIS - CAN IT HAPPEN TO YOU?
Osteoporosis is a bone-thinning disease that causes serious
fractures, commonly of the hip, spine and wrist. Known as
"the silent thief", it progresses without symptoms until
bones begin to break. Osteoporosis is a major public health
threat for the 10 million Americans who already have it and
the 34 million who are at risk. Risk factors include:
-advanced
age
-female
-small,
thin frame
-Caucasian or Asian
-low
lifetime calcium intake & Vitamin D deficiency
-family
history of osteoporosis
-postmenopausal or early menopause
-suffering from fractures after age 50
-smoking
cigarettes or drinking alcohol in excess
Don't
let this "silent thief" sneak up on you! Use
PREVENTION as your first line of defense!
CDE = A Diet rich in Calcium and Vitamin D
and regular Exercise.
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For
people of any age, staying active and performing both
weight-bearing and muscle-strengthening exercise
stimulates bone growth and helps prevent osteoporosis.
So get up and...................
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Take
a stand, walk the dog, climb some stairs, pedal a bike,
hike a trail, jog in the park, walk your favorite golf
course, play tennis or go dancing.
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Also
include muscle-strengthening exercises such as lifting
weights to improve agility and balance and reduce the
risk of falls/bone fractures.
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Try
to make daily exercise deposits into your "bone bank,"
especially prior to age 30 when your bones reach their
peak bone mass.
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Women, don't stop at age 30! If you do, you might
deplete your "bone bank" deposits by the time you reach
middle age.
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Men,
don't think you are immune! While the majority of
osteoporosis victims are women, 20% are men. YOU could
be one of those men.
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If
you are at risk, continue to strengthen your bones and
discuss additional options with your doctor. These
options include bone density testing and certain
medicines that have been proven effective for increasing
bone mass.
Prepared by Nancy DeNike, VCU Department of Gerontology,
Richmond,
VA
Source: National Osteoporosis Foundation (www.nof.org)
Contact us to suggest another resource or
click here to post it in our forums.
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CONNECT-AND-LEARN
OPPORTUNITIES IN YOUR AREA
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Check with your local
Alzheimer's Association Chapter,
Area Agency on Aging or any such relevant source of
services and training opportunities (search via the
Senior Navigator for additional regional/local
services and information centers).
Contact us to suggest a learning opportunity in your area.
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LIVE DISCUSSION
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A
live discussion titled "Falling and the Individual with
Alzheimer's Disease" was held the 24th of July,
noon, EST, featuring Dr. Ayn Welleford, Dr. Kevin
Walsh, Jan Bell and Nancy Glenmore Tatum. A one
hour interactive presentation discussed the challenges
and implications of falls for the individuals with Alzheimer's
disease. Click the "play" button below to watch and
listen to the recorded webinar.
 Click
here to download the presentation slides.
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LAST ISSUE
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May 07 - EFFECTIVE COMMUNICATION WITH YOUR PHYSICIAN
How do you
communicate with your physician or your loved one's
physician so that you feel you are being heard and getting the
results you know are needed? Many of our caregivers take a
list, bring along an advocate, or in drastic times find
another physician. What approaches have worked for you?
Review the perspectives of a caregiver, an educator and a
physician in our May 2007 issue. Also
review the
recording of our webinar held the 31st of May, 2007, featuring
Drs. E. Ayn Welleford (Virginia Commonwealth University) and
Russell H. Swerdlow (University of Virginia).
Click here to access the May 2007 issue
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NEXT ISSUE'S MAIN TOPIC
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July 07 - Skin care/skin breakdown
Contact us to
contribute materials, ask questions on this topic or suggest another topic.
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DISCLAIMER: The Virginia Alzheimer Commission
AlzPossible Initiative does not provide medical advice
nor promote any product or service. The contents of this
newsletter are for informational purposes only and are
not intended to substitute for professional medical
advice, diagnosis or treatment. Always seek advice from
a qualified physician or health care professional about
any medical concern, and do not disregard professional
medical advice because of anything you may read in this
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