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Senior Care in Action: 18 Tips for Preventing Indoor Falls
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October 4, 2012
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In the Caregiver's Words

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“I think I could speak clearer and did not wait as long in answering questions,” she said. “Sometimes, in the past, things would leave my mind and I couldn’t remember things.” Let me just start by saying that this could be a quote from the first Alzheimer’s disease patient to undergo a successful treatment to reverse the condition. Not a cure, and no one yet knows how durable the change, but a rather significant clinical step in the right direction. Our medical science staffer, Dr. Steve Steiber, and I have written before about how there are a number of FDA-approved therapies for Alzheimer’s Disease and hundreds I clinical trials, but so far there is nothing that does more than slow the progression of Alzheimer’s cognitive decline. Scientists at West Virginia’s Rockefeller Neuroscience Institute have initiated a “proof of concept” trial on just six 50 to 85 year old mild to moderate Alzheimer’s patients using ultrasound to penetrate the blood brain barrier, a layer that protects the brain itself from all that can invade our blood stream. They used a thousand tiny probes with oscillating ultrasound that used microscopic bubbles that could move into the area of the brain most affected by Alzheimer’s amyloid plaque. The ultrasound seems able to break up some of this debilitating plaque. This first test seems to demonstrate the safety of the technique as well as likely efficacy, but all of this is with a couple caveats. First, it is with a very small number of patients. The real test will come later when a large enough number of subjects can be tried in order to demonstrate cognitive differences that are statistically significant. Second, it is “just” the ultrasound that has cross the blood brain barrier to break up the plaque. Medical professionals see this method as really kind of a transportation test. If they can safely cross the blood brain barrier to the part of the brain where they can address the disease head on, the hippocampus, then they can use the waves and their tiny bubbles to carry actual chemicals that fight the plaque to where they can do the most good. It’s a bit like showing that we can launch a special rocket that succeeds in getting where we want to go; and now we can potentially attach an important payload to this rocket. (Yes, it is brain surgery and rocket science…) The doctors and researchers in this project admit that it may take a few years to begin to realize the full potential of this technique, but it is the patient’s husband who takes our rocket science and brain surgery metaphor a “small step” further. “This is man on the moon stuff,” Mark Polak said of his wife’s success in the first trial. “Maybe we’re on to something?” If you want to read more on the science, please click here; if you want to read more of the personal story of one patient’s experience with the science, please click here. Charlotte Bishop is an Aging Life Care Advisor, Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. She also is the co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia. And yes, we may be revising this book a bit sooner than we had anticipated...
During this pandemic, over 13,000 more Alzheimer’s and other dementia patients have died than expected from these cognitive disorders, and it’s not the virus. Those with any of the forms of dementia living in facilities designed to protect them from the deadly virus have died, not from COVID, but from isolation. The number of COVID deaths has broken through the 200,000 mark this week, and we all know that older adults are much more vulnerable to the virus than younger Americans. Senior communities, in particular, have been extraordinarily careful about not allowing family members from the outside to get near their older loved ones in order to protect residents from infection. But doctors have reported a surprising rise in the numbers of falls, pulmonary infections, sepsis and depression among dementia patients during these past six months among patients who had been quite stable and otherwise healthy for years prior to the pandemic. An option to explore with your loved one’s senior community is to seek permission to hire a private duty caregiver through an agency who can attend your loved one. Many communities are overworked and understaffed in the present pandemic/quarantine, and added personal attention will benefit your loved one. The Alzheimer’s Foundation of America (AFA) has some recommendations for families and caregivers of someone who has been diagnosed with Alzheimer’s or other dementia caring at home:
1. Dementia patients have sensitivity to water, so sing a couple verses of “Happy Birthday” as you help them wash as a pleasant distraction;
2. Be careful to be a calm model, because a dementia patient will be very attuned to what you say and your body language;
3. Since washing is critical and they may resist washing, talk in a soothing tone and consider a fragranced soap that they may like;
4. As an alternative for cleaning hands use an alcohol-based hand sanitizer – 60%+ alcohol according to CDC;
5. Encourage consistent hydration to bolster their immune systems, but also be prepared to assist with more trips to the restroom;
6. Have visual and tactile diversions on hand like photo albums, lively musical movies or just sorting the socks from the week’s laundry.
Everything about this pandemic is unprecedented, a word that I personally have used more times in the past six months that all of my years leading up to it. So, this is the latest learning in response to the scientists who are paying attention to the impact of COVID. We will keep you informed as we learn along with everyone else on this “unprecedented” journey. Charlotte Bishop is an Aging Life Care Advisor, Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. She also is the co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia.
In our book, How Do I Know You?: A Caregiver’s Lifesaver for Dealing with Dementia, we say: Alzheimer’s remains the only disease in the top ten causes of death in the United States that cannot be prevented, cured or slowed. Stop the presses. New research suggests that there may be ways to slow the onset of the disease, if not prevent it. Let me repeat that. Some early results from a cognitive training regimen show that it may be possible to delay or slow the onset of Alzheimer’s disease. It may even be preventive, but that will take a very long term waiting game to see if the delays that are evident in the clinical studies can be sustainable. The results from this research show that a computerized cognitive training program in which patients were enrolled was able to reduce the risk for onset of dementia by 29% at ten years! In scientific jargon, that’s not nothing! Here is the other great part: those subjects who engaged in the most training got the most benefit. Does that sound like what we see in professional athletes …or professional anything? Those who put the most work into the program get the most out of it. Please let me tell you the rest of the story…Existing research has demonstrated that mental training that focused on retaining memory or processing did not reduce any risk for dementia. This present research was a study in Toronto among nearly 2,800 older adults whose average age was 73.6 years and who were living at home. They were assigned to three groups with three types of cognitive training: • memory, • reasoning and • processing speed. It was the processing speed groups which showed the results. Compared with a control group, those who went through this training had a 29% lower risk of developing Alzheimer’s. The memory training and reasoning groups were not different from their respective control groups after 10 years. All of this held true even after the investigators adjusted for any differences in other conditions or characteristics like gender, diabetes, depression or cardio-vascular health. Researchers are not sure why processing speed works this way, but it may be that working on processing speed builds up mental reserve. Maybe it’s like interval training for athletes. Mastering speed…bursts of work…grows their overall capacity. When the dementia erodes some of their cognitive capacity, they simply have more capacity on which they can draw. Clearly, a couple next steps will include following these people longer…but also trying to tap into what really is happening in the brains. That said, it stands to reason that if you can work on your “processing speed,” you will retain more ability over the long run. Get processing! Charlotte Bishop is an Aging Life Care Advisor, Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago.
The news cycle calls the COVID-19 crisis a rapidly developing story. It unfortunately also has been one with a lot of voices and one for which we have no precedent. I will not add my voice this week, but I offer a couple of trustworthy voices from the last 24 hour cycle. Please consider this counsel from Dr. Asaf Bitton, MD, MPH, a healthcare leader from the Harvard University School of Public Health. He says: “So what does this enhanced form of social distancing mean on a daily basis, when schools are cancelled? I can suggest the following: 1. No playdates, parties, sleepovers, or families visiting each other's houses. This sounds extreme because it is. We are trying to create distance between family units and between individuals across those family units. It is uncomfortable, especially for families with small children or for kids who love to play with their friends. But even if you choose only one friend to have over, you are creating new links and possibilities for the type of transmission that all of our school/work/public event closures are trying to prevent. The symptoms of coronavirus take 4-5 days to manifest themselves. Someone who comes over looking well can transmit the virus. Sharing food is particularly risky - I definitely do not recommend that people do so outside of their family. We have already taken extreme social measures to address this serious disease - let's not actively co-opt our efforts by having high levels of social interaction at people's houses instead of the schools. Again - the wisdom of early and aggressive social distancing is that it can flatten the curve above, give our health system a chance to not be overwhlemed, and eventually may reduce the length and need for longer periods of extreme social distancing later (see what has transpired in Italy and Wuhan). We need to all do our part during these times, even if it means some discomfort. 2. Take walks/runs outside, but maintain distance (ideally 6 feet between people outside your family). Try not to use public facilities like playground structures as coronavirus can live on plastic and metal for up to 3 days, and these structures aren't getting regularly cleaned. Try not to have physical contact with people outside of your family. Going outside will be important during these strange times, and the weather is improving. Go outside every day if you can but stay physically away from others. Try not to have kids play with each other (even outside) if that means direct physical contact. Even basketball or soccer involve direct contact and cannot be recommended. If people wish to go outside and have a picnic with other families, I strongly recommend keeping distance of at least 6 feet, not sharing any food at all, and not having direct physical contact. Invariably, that is hard with kids, so these shared, "distant" picnics may be tricky. Do not visit nursing homes or other areas where large numbers of the elderly reside, as they are at highest risk for complications and mortality from coronavirus. We need to find alternate ways to reduce social isolation in these communities through virtual means instead of physical in-person visits. 3. Reduce the frequency of going to stores/restaurants/coffee shops for the time being. Of course trips to the grocery store will be necessary, but try to limit them and go at times when less busy. Consider wearing gloves (not medical - but perhaps washable) and of course washing hands before and after really well. Leave the medical masks and gloves for the medical professionals - we need them. Maintain social distance from folks. Take-out meals and food are riskier than making food at home given the links between the people who prepare food, transport the food, and you. It is hard to know how much that risk is, but it is is certainly higher than making it at home. 4. If you are sick, definitely stay home and contact a medical professional. If you are sick, you should try isolate yourself from the rest of your family within your house as best as you can. If you have questions about whether you qualify or should get a coronavirus test, you can call you primary care team and/or consider calling the Partners Health Care hotline staffed 8AM-8PM every day - 617 724 7000, or the Massachusettes department of public health at 617 983 6800. Don't just walk in to an ambulatory clinic - call first. Obviously if it is an emergency call 911. 5. We need to push our local, state, and national leaders to close ALL schools, events, gatherings, and public spaces now. A local, town by town response won't have the needed effect. We need a statewide, nationwide approach in these trying times. Contact your representative and the governor to urge them to enact statewide closures. As of today, 6 states had already done so. We should be one of them. Also urge them to fund emergency preparedness and make increasing coronavirus testing capacity an immediate and top priority. I realize there is a lot built into these suggestions, and that they represent a real burden for many people, businesses, and communities. Social distancing is hard and may negatively impact others, especially those who face vulnerablities in our society. I recognize that there is structural and social inequity built in and around social distancing recommendations. We can and must take steps to bolster our community response to people who face food insecurity, domestic violence, and housing challenges, along with the many other social inequities. I also realize that not everyone can do everything. But we have to try our absolute best as a community, starting today. It is a public health imperative. If we don't do this now voluntarily, it will become necessary later involuntarily, when the potential benefits will be much less than doing so right now.” Please also let me add some good news from FDA: "Aimed at ramping up testing capacity in the U.S., the FDA will now allow individual states to authorize the use of laboratory-developed tests by qualified in-state labs for the coronavirus causing the current outbreak. The labs do not have to engage with the FDA nor will they need to apply for Emergency Use Authorization (EUA).
1. Although states are not required to follow New York's lead, the Empire State's system may serve as a useful guide for others.
2. The FDA will also allow the distribution of commercially developed tests prior to Emergency Use Authorization under certain circumstances and only after the tests have been validated. The agency believes that a 15-period should be sufficient to prepare an EUA filing.
3. The agency will also allow the distribution of serology tests (tests that detect SARS-CoV-2 antibodies in the blood) contingent on the tests being validated, the FDA being notified and the inclusion of warnings that the tests have not been reviewed by the FDA and results should not be the sole basis for diagnosing or excluding COVID-19.
4. The FDA says more than 90 test developers have sought its assistance thus far."
Back to Charlotte here... A lot of you who read my posts are caregivers...if not to an older loved one, then to others within your orbits. My longstanding advice is perhaps more relevant than ever in a crisis. You will do a better job of caring for others if you also are taking good care of yourself! Charlotte Bishop is an Aging Life Care Advisor, Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. She also is the co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia.
I have again asked our vice president for geriatric care manager services, Steve Steiber, Ph.D. to share his insights, this time about diabetes and some late-breaking news. He has nearly two decades experience in pharmaceutical medical device consulting prior to joining CCM.
More than 11 percent or, or nearly 27 million, Americans have either diagnosed or undiagnosed diabetes according to the most recent data. We include the "undiagnosed" in this figure, because anyone who has a consistently high A1C level (the measure of long term blood glucose) is creating an opportunity for other medical problems. For anyone who is a caregiver to an older loved one, this "diabetes epidemic" should be all the more alarming, because the prevalence of diabetes and what is termed "prediabetes" more than doubles to nearly 27 percent of those 65 years of age or older. The reason for the title of this posting is that diabetes is one of those medical conditions that seems to almost invariably be part of multiple diagnoses or medical conditions. So if your older loved one has been diagnosed with either diabetes or prediabetes, you need to help them to manage diabetes as well as the other companion conditions. For instance:
1. Diabetes is associated with higher levels of chronic fatigue. A recent study in the Netherlands found that these two conditions seem to go hand in hand, but they could not conclude that high blood glucose "causes" fatigue. It is just more likely to be there if a person runs "high" on a consistent basis.
2. Chronic kidney disease (CKD), a condition in which the kidneys progressively lose their ability to filter body fluids, is twice as common in people already diagnosed with diabetes. Scientists suggest it is the glucose that binds to red blood cells in the blood stream that block and break down the micro-vascular tissue of the kidneys leading to CKD.
3. High blood pressure and diabetes also tend to go hand in hand. For the same reasons that the kidneys suffer from high blood glucose levels, all the other circulatory system is adversely affected. And the negative synergy of poor circulation along with further hindrance to circulation create the potential for a real cascading of medical complications.
4. Retinal eye compromise and its ties to diabetes complete the circulatory issues caused by consistently high blood sugar levels. By blocking the tiny vessels that nourish the retina of the eye, diabetes effectively starves the eye causing a loss of vision or diabetic retinopathy.
5. People with diabetes have a higher risk of depression than those without. There is some speculation on how this happens,. but most professional agree that depression does not cause depression. A fair number, however, state that the feeling of the unfairness of the disease or the loss in control over their diabetes and the associated anxiety cascade into depression.
Please let Steve know if you have any questions about diabetes, drugs, their side effects or the unique medical challenges faced by older adults or others with special needs. Please email to: ssteiber@creativecaremanagement.com.
Charlotte Bishop is a Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families who need geriatric care management services in metropolitan Chicago. Please email your questions to info@creativecaremanagement.com.

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Senior Care in Action: 18 Tips for Preventing Indoor Falls

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