Speaker summaries
This page contains speakers for this year. Summaries for previous year's speakers are available on these pages:2009
2008
2007
Sharon Gaskin, MS, OTR/L, Occupational Therapist
Nancy Fiedelman, Eldercare Consultant
Physical Therapists, Jordan Tucker, PT, DPT and Joy McLaughlan, PT
Matthew McKeon, Speech/Language Pathologist
Jennifer Edge with the Fairfax Area Agency on Aging
Petra Riedel-Willems, Sounder Sleep System
September 2010
Sharon Gaskin, MS, OTR/L, Occupational TherapistContact info:
Inova Fair Oaks Hospital, Physical Medicine & Rehabilitation Department
3600 Joseph Siewick Drive, Fairfax, VA 22033
703-391-3642
www.inova.org
Sharon gave us a handout with the key points of her presentation about cognition and improving function.
Cognition
Neuropsychological investigations show significant indications that there is a relationship between cognition and PD. Three areas of cognition are: attention, memory and executive functions Sorting and planning tasks are examples of executive functions.
Attention
We need to focus initially, then sustain what we've heard.
Selective - not letting yourself be distracted (e.g. listening to a speaker and not be distracted by someone walking by)
Alternating - can you switch back and forth between 2 things (e.g. while working in the kitchen, someone reminds you about a coming appointment) Divided - can you truly keep your full attention on 2 or more tasks at the same time (e.g. drive & talk on cell phone) While driving, it's actually easier to talk to a passenger in the car than to someone on the cell phone. This is because the passenger is aware of the situation you're both in and will adapt (e.g. stop talking if you need to concentrate on the road).
Memory
7 numbers is about our working memory
Grouping numbers helps us to remember them (e.g. phone numbers)
Short term memory - about a 5 - 10 minute time span
Long term memory - Most people don't have a problem with long term memory because these memories tend to stick.
Executive functions
This area is the toughest one to work with and it involves our self-awareness. Tells us when we're feeling scattered about doing things. Helps us organize things and set goals. It's our inhibitor because it keeps us from saying things we really shouldn't and helps us with initiation such as wanting to do something.
Improving Function
Attention:
1st step - if you can't pay attention you won't remember things An Occupational Therapist works with helping people who want to improve their attention so they can do things they couldn't do as well or as safely as before (e.g. keeping appointments, remembering names/faces)
Card game to practice skills
Start by choosing one card from each suit and placing them face up on the table. Use cards that don't have the letter "e" in the name (e.g. ten, ace, queen) Sort the rest of the cards by suit, placing cards with letter "e" face down on the piles while all other cards are placed face up. This involves 2 tasks and there should be no errors. Practice and aim to complete the task quickly.
www.lumosity.com has lots of brain games. You can start with a free trial but be prepared to pay monthly fee.
A couple of examples of the kind of games you can play:
1) bird watching - Has a target that you have to keep your focus on. Another bird flashes on the screen and you have to move your mouse to where the bird flashed.
2) bird migration - Shows V-shaped group of birds. You pay attention to one bird that sometimes goes in the same direction as the other birds and other times it doesn't, and you need to ignore the other birds. As quickly as you can, you're supposed to identify the direction of that one bird.
Some strategies that can help:
• highlight things that are important
• slow down
• use your finger to follow what you're reading
• talking aloud will help you focus
• a digital recorder to take notes
Improving your memory is an active process. What is the problem? What can you do when the system you were using is no longer working?
Memory:
external strategies
What changes can we make to the environment? (e.g. digital recorder)
• using lists for shopping, meeting dates
• post-it notes - (e.g. on the door to remind you what to take with you when you're going out) or painter's tape (doesn't stick to the wall permanently)
• to remind you about meetings, (see also association strategies)
• before you go out, put the things you plan to take with you by the door
• enlarging things (e.g. writing the first letter "e" instead of "egg)
• calendar - highlight doctor's appointments in red Other strategies that don't involve writing with a pen:
• use different devices like a tape recorder, paging systems, vibrating or alarm watch to remind you when to take medications
• a talking calculator gives feedback so you know you entered the correct numbers
• for keys - a wireless object device where you push a button and an alarm on your keys will help you to find them
• If you leave your reusable bags in the car instead of taking them into the shop, try keeping them where you'll see them when you get out of the car
• routines
• answering machines - Leave yourself a message by calling your home phone using your cell phone.
Internal strategies
Grouping and association
Activity - Sharon divided the room into two groups read a different list of words for each group. We had to remember them and write them down. The side that were given a list of fruits and vegetables got more right because they were all associated together. The other side had odd, unassociated items that were harder to remember (e.g. milk, box, elephant, pencil, scissors, knife, pocketbook, envelope)
Pegging - What if you needed 4 things from the grocery store e.g. broccoli, dishwashing liquid, bananas, soup. Instead of trying to remember the 4 items, make a list of the first letter for each word B_B_D_S (similar to association strategy). It works even better if the letters can form one word for you to remember.
Loci - A strategy to use places to remember things. Imagine putting the things you need to remember in the room that they would belong in, in your house.
External strategies may be more effective than internal strategies.
Executive functions strategies
• a family member can pre-organize to help the person having difficulty
• limit your choices
• do important tasks at peak times
• use time marking - If there are problems with time awareness, someone with difficulty may not be aware of how long it takes to complete a task. Use a kitchen timer for awareness of sense of time
• set manageable goals
• brainstorm - to find different ways to come up with solutions - the answers don't have to be correct as long as the person is thinking
• re-examine the problem in a different way
One couple uses a big wall calendar in the kitchen that they review their activities for the coming week every Sunday night. It takes them from short term thinking to long-term thinking.
Question: What can you do if you hear a question but you're slow to respond? This may be because you're processing the question. Attention exercises can help and it helps to deal with one thing at a time (part of executive function)
Resources for some examples from above plus much more:
www.goldviolin.com - wireless object finder
www.bindependent.com - talking calculator, step pad
www.epill.com - vibrating 12 alarm pager
August 2010
Nancy Fiedelman, Eldercare ConsultantContact info:
ElderCare@AynsleyGroup.com
703-893-8989
www.aynsleygroup.com
Is there long term care insurance available for people with PD?
In Virginia you can apply with a pre-existing condition and it must be covered after 6 months. No policy can exclude dementia
The rate might not be financially feasible but you can still apply.
VICAP (Virginia Insurance Counseling and Assistance Program) provides free health insurance counseling with info about Medicare, Medicaid, health care denials, and long term care insurance.
Fairfax Area Agency on Aging VICAP webpage
Virginia Department for the Aging VICAP webpage
What can one expect for support from a social worker or caseworker (in the hospital)?
Nancy was a hospital social worker for many years.
Any one hospitalized is entitled to a social worker, case worker, nurse, combination of both. They are available to help you plan for your discharge. Assistance varies from hospital to hospital and social worker to social worker but they are there to provide a safe transition to nursing home/home. They have access to all medical staff working with the patient. Don't wait for them to speak to you - seek out your contact so you can be part of planning. Social workers often just give a list of nursing homes or home care agencies and may have limited exposure to the full range of community resources.
Everyone should have an advocate when in hospital.
If it isn't a family member, then you can hire an aide.
Don't wait until you're discharged and not have a plan.
There is a provision under Medicare that you are entitled to a safe discharge plan. This doesn't include help with an ongoing plan - e.g. 6 months later.
Medicare has a publication - Your Discharge Planning Checklist that includes an action plan, medications list and resources.
A Family's Caregiver Guide to Hospital Discharge Planning is another resource.
Alexandra said that in South Australia they produced a brochure and have a consumer group.
Ruth Ann made the point that there are a number of publications related to patient safety and they consistently say patients should have an advocate. HIPAA says you can designate your advocate.
You should have someone with you 24/7. When we're sick we might not think about things as clearly as when we are well.
Keep a list of medications/dosages/times with you in your wallet. People are told that while they are in hospital they are not allowed to self-medicate but some hospitals will allow this (Johns Hopkins?). You can be proactive. Be pleasant but firm.
What are the most important home renovations to make for accessibility and safety?
There is a tax credit available for making your home accessible in Virginia equal to 50% of the total cost or $2000. Unused credit can carry over for 5 years.
What it covers: no-step entrance to home, interior doors with 32 inch clear wide opening, reinforcement of bathroom walls, grab bars and light fixtures.
The U.S. Department of Health and Human Services, Administration on Aging has a Home Modification Fact Sheet that includes information about how to pay for home modifications and lists resources to learn more.
RebuildingTogether.org has a Home Safety Checklist created in partnership with the U.S. Administration on Aging.
Fairfax county has a web page on Resources for Home Modifications for People with Disabilities. Fairfax county used to hold an annual symposium at the Government Center but we're not sure if it is still being held.
What should we do to prepare for down the road?
Plan ahead!
Legal planning includes wills, trusts, and an Advance Directive (typically includes a health care proxy and living will)
Have conversations with your family members. Don't wait until something happens.
Make sure family members know how to access your important documents and communicate your desires ahead of time.
Learn about resources in the community before you need them. The Guide to Retirement Living Sourcebook has lots of resources but keep in mind that the companies all pay to promote themselves in the Sourcebook so there are other companies in the community that are not included.
Visit various communities to gather information so you have it should you need it. Take a tour - look at the things the marketing people don't show you. Meal times are a great time to check out staffing levels. Visit on any day of the week, not just weekdays during business hours.
Nursing homes have a legal requirement to post staffing patterns. Check that it's been updated for that day. Check out the Medicare website - Medicare Compare is a useful tool. Contact the Northern Virginia Long-Term Care Ombudsman - a log of consumer complaints is on the website.
Ask your physician for his opinion but he/she may not deal directly with resources. Work with someone who has knowledge of the various resources.
Locating home care agencies
Depends on your needs and the person's expertise. Staff are often trained to deal with memory impairments but not Parkinson's.
The Virginia Department for the Aging has a booklet called Homecare a Resource Guide
Home care agencies may or may not be licensed by Virginia Dept. of Health and you learn more about this on their website. It is best to work with a licensed agency. Some agencies consider themselves licensed if they have a business license but you should look for a home care provider license.
The Medicare.gov site has a list of every Medicare-licensed home health care agency in the country called Home Health Compare.
The VA Dept of Health also publishes a directory of licensed home care and hospice providers. The listing doesn't always include a date for when it was last updated so it's best to call.
Waivers - some home care agencies can be exempt. e.g. homemaker/companion/chore services do not have to be licensed because they do not involve hands-on care.
Nancy has a list of questions to ask. You can contact Nancy if you'd like a copy.
Ask home care agencies if they have people on staff who have worked with people with PD.
Agencies have different employment styles such as independent contractors, registries, or employees.
There are different types of agencies:
* companion - no training required
* CNA (Certified Nursing Assistant) help with bathing, eating and other Activities of Daily Living. An RN may provide supervision but not medical care.
* Medicare certified home care provides all levels of care and will have an RN on staff. Some provide therapy, some have limited social work services. Non-skilled services not covered by Medicare.
Before you call an agency, decide what you're looking for so you can tell an agency what you're looking for. Do your homework ahead of time to decide how much time you need help. Costs average around $18-22/hour.
What costs are covered by Medicare?
Medicare and Homecare is an official U.S. Government publication
There are four criteria to be eligible for home care under Medicare.
Respite care
Respite care is a general term - when someone is allowed to live in assisted living community to give the caregiver a break or to try out a community before they decide to live there. The term is used for resources that one might receive at home and in a skilled nursing facility as well. There may be a minimum and/or maximum number of days.
Limited services are available through Fairfax county including a companion registry. Some services are income dependent.
Resources:
• Fairfax county's booklet "When You Need a Break: A Guide to Fairfax Area Respite Resources for Family Caregivers." This listing is not inclusive and not necessarily vetted.
• Fairfax county's Family Caregiver Support Program page.
• There are six adult day programs in Fairfax county.
• Alzheimer's Family Day Center
July 2010
Physical Therapists Jordan Tucker, PT, DPT and Joy McLaughlan, PTContact info:
Physical Medicine & Rehabilitation Department
Inova Fair Oaks Hospital
703-391-3642
www.inova.org
Jordan and Joy work in the outpatient neurological rehabilitation program and are trained to work with people living with PD. They also work with speech and occupational therapists (like our September speaker, Sharon Gaskin). Physical therapy is also available at Fairfax, Mt. Vernon and Reston hospitals. Bill M. and David have been seeing them and recommend them highly.
Jordan explained that everyone has different symptoms - as we know - and they evaluate each person to be sure they are given the best treatment for their particular problem. Flexibility, balance and learning how to stand and walk correctly are some of the problems they are concerned with. Keeping our ankles, hips and knees moving correctly is very important.
Based on their assessment, they'll give you adaptations to make life better given the changes you've experienced from PD. They can also liaison with your neurologist to ask the right questions about your medications and symptoms.
Flexibility is important because muscles get tight. Muscles work easier when they are flexible. Balance depends on flexibility - muscles that would keep you upright don't kick in when they are tight.
Strength - Is loss of strength due to PD or less movement?
If muscles are short and tight (e.g. chest) and need to be stretched, the opposite group muscles are weak (e.g. upper back) and need to be strengthened. Increase core and back muscles for improved balance.
Posture & balance
Joy demonstrated how we should stand; ears, shoulders, hips should all be in alignment for good, safe posture. (see diagram)
If your pelvis tips back you'll be inclined to fall backwards. It's called retropulsion and is common with PD. A movement to correct it, is to sit on a chair in front of table, hands stretched out in front, and lean forward to shift pelvis forward.
Your balance point is over your navel if your pelvis is properly aligned.
With stooped forward posture they would work on lengthening chest muscles and strengthening the upper back. Posture is a big proponent in balance & falling.
We need to have automatic balance reaction in order to keep from falling. They don't want people to fall so they assess your fall risk like checking the flexibility of your ankles. Can you pick up your toes? If not, you could scuff your feet and trip.
With PD automatic balance reactions are slowed.
To improve your balance make regular activities harder. For instance, doing mind games while walking so you can deal with distractions.
Other considerations
Assisted device
Are you using an assisted device? Do you need one? is it the correct one? Are you using it correctly?
Exercise is important!!
. . . especially with PD. The more you can do the better, especially early on in the disease process. Keep moving - to challenge balance and increase strength and flexibility. Some suggestions are dancing, tai chi, water aerobics and going for a walk with family. Music can be a good motivator to get moving; dance classes are available to those interested. Just put on some good music and dance around your house (carefully) . Use music to make walking smoother. Hearing the beat helps the body move to the rhythm and it might help you move and pick up your feet better. If you're freezing, try putting on music to help you move better or use a metronome.
Big Band music has a consistent good pace. If you don't like the exercise you won't do it so do something you like to do.
A study showed the effect of walking with alpine/walking poles - it is good for arm movement when you lose arm swing. Joy explained the use of alpine poles to keep arm movement natural and easier. Alpine poles are available from Target and REI, and other sporting goods stores. Make sure they're tall enough for you and you're not leaning forward. At REI they will help you get the right fit and height. Two poles are better than one for arm movement and trunk rotation. Your arm swings out with opposite forward foot.
Another study on cardiovascular exercise showed that people living with PD require more oxygen and energy so they tired out more easily leading to a desire to sit and not move (picture lots of nodding from our group). So find activities to use your heart and lungs and increase endurance.
Freezing
Freezing is caused by a delay in transmission from brain to muscles to get started.
Some suggestions to unfreeze:
• big, exaggerated movements. Think BIG a la Lee Silverman technique
• march in place lifting knees high
• practice stepping over things
• your companion can put his/her foot in front of yours so you can step over it
• visualize yourself moving
• concentrated relaxation will help unstiffen/unfreeze
• gentle rocking with companion gently pushing your forward and back or side to side to unlock
All you need is a physician's referral to see Jordan and Joy. They can also help with reorganizing your house; moving items around to make it easier for you to get around without the possibility of falling.
When out and about be prepared to call for help if needed.
• Mobile Help / Anywhere Help Button. A personal medical alert emergency response service but unlike Lifeline which only works in the home, the Anywhere Help Button also works when you're away from home. (Thanks Ruth Ann!)
• Carry a cell phone with you so you can speed dial your spouse or 911
• Keep your phone in a holster on your belt rather than in your pocket for easier access.
• Medic Alert bracelets
• Road ID - ankle bracelet with contact ID and also available with Emergency Response Profile (ERP)
Four take-aways from Jordan and Joy's talk
1. Stretch daily to decrease and prevent further stiffness and changes in posture. Good to stretch when meds are wearing off and when you get up in the morning but you can stretch anytime you're feeling stiff. When you're standing around and have nothing else to do - putting something in the microwave, commercial breaks (stand up and stretch)
2. Think about where your pelvis is - balance point should be between feet not forward or back
3. Practice exaggerated movements - marching, toes up
4. Exercise regularly - keep aerobic capacities
How long do PT's work with you?
Depends on needs of patients
Medicare will pay for immediate needs, but also for you to come back some time later for re-evaluation and to work on new issues. It doesn't need to be a one-shot deal.
Testimonial
Bill & Julie M. said Jordan and Joy are really practical. They asked him if he could come for therapy in his down period so they could help him better. They are
great with suggestions - like to move bed closer to the door or place a chair in a more convenient spot so you have a place to rest
May 2010
Matthew McKeon, Speech/Language PathologistMatt's contact info:
Matt McKeon - Speech/Language Therapist
phone: 703.385.0555 x5392
email: speechtherapy@thevirginian.org
address: The Virginian
9229 Arlington Boulevard, Fairfax, VA 22031-2504
website: www.thevirginian.org
A speech/language pathologist treats language, voice (LSVT - voice treatment), cognition (memory, problem solving cognition), swallowing
About Matt
Matt is 28 years old, grew up in Philly and now works with adults as opposed to earlier in his career working with children. He practices the Lee Silverman Voice Treatment (LSVT). He works closely with Ear Nose and Throat (ENT) doctors as well as otolaryngologists. He has done research on the aging voice with the VA hospitals and has worked with voice disorders. He works with all levels of patients at the Virginian from the continuing care unit, assistive living and skilled nursing departments. He also works with outpatients. However, he is only able to work with Medicare insurance. He welcomes calls and questions and will recommend other speech therapists in the area including those that take insurance other than Medicare.
In order to be treated by Matt, Parkinson's patients must first be evaluated by an ENT or otolaryngologist such as Dr. Patty Lee. from Otolaryngology Associates. (Dr. Lee spoke to our group in April 2008.) You must bring a referral. The reason he volunteers to speak to various groups is to educate the PD population.
Signs
Weak voice - voice that is quiet - breathy, airy, doesn't carry far
When people start leaning in to you, asking you to repeat what you're saying
Patients can't be heard and will say that their spouse needs hearing aids.
People avoid doing things like calling people on the phone, answering the phone.
Difficulty with speaking reduces independence.
A clinical symptom of PD is a monotone voice, no rise and fall in speech.
Some patients have festinating speech when sometimes speed will pick up and voice will go quieter. With LSVT this will cease.
LSVT
LSVT is a voice treatment designed for people living with PD
who have a weak voice and low volume. A weak voice is a voice that does not have resonance and no volume. Poor perception of how loud a person is speaking is the problem. After working with hundreds of patients, Matt perceives that often people feel that they are putting in the same effort as they always have to speak, so why change.
94% of Parkinson's patients have speech disorders. Parkinson's patients don't realize that they are speaking quietly and would speak louder if they realized they were speaking so quietly. As the disease progresses they'll put in the same effort of speech they always have, but the volume isn't the same it was. They need to feel like shouting in order to produce a normal volume but people don't like to shout.
When putting effort into your voice when you speak he uses a rating of 10 as normal. If you have been speaking at an effort of 10 for 40 years and then are diagnosed with PD and your muscles are weakening, now you may be putting in an effort of 5 but getting the volume of 4. PD affects muscles. Just like your legs may not move the way you want them to, your voice muscles, or vocal cords, aren't working the way you want them to and must be exercised for strength and flexibility just like all your other muscles. Muscles have the ability to relearn a new task. He trains patients to speak at a level 8 to get a normal volume. He gives you permission to yell at your therapist! Use of biofeedback is implemented in this technique via a tape recorder.
LSVT is a commitment of 4 weeks, 4 days a week totaling 16 sessions.
Each session is one hour. If you miss 2 weeks you will be discharged because the therapy must start over. You cannot take any breaks within these 16 sessions in order for this therapy to be successful. After the 16 sessions, you must practice 10 minutes every day for the rest of your life. You need to recalibrate the amount of effort you need to put into speaking in order to be heard. An expert can motivate you and give you biofeedback and get you to speak louder. The goal is to re-teach your muscle and you need a coach to do this. He believes that you cannot do this therapy alone because the biofeedback is so important. When speaking, 70-74 decibels is considered normal. 50 decibels is silent and 90 decibels is yelling. Most people living with Parkinson's usually have a level of 62-63. The goal for Medicare is "normal". All of Matt's patients have improved.
It takes about 2 weeks for PD patients to understand the perception of their volume of speech. You can expect to double your volume after LSVT. It is important to be able to speak at a normal volume because it is an expression of yourself. LSVT slows speech down. If you think about it, when you yell it is really prolonged vowels (Hiiiiii or Looook Ooout). If you talk fast you get quieter.
The key is remembering to practice and use the technique. Your muscle range of motion in speech affects pitch. If you don't use it you will lose it. You will be tired after the session and it takes effort but you will build up your endurance as with any muscle. It is easier to fix this speech problem if done early. You should be proactive and start working these muscles sooner rather than later. If you have a supporting spouse or caregiver to assist you with practice it is beneficial. Aging in itself makes the vocal folds (cords) weaker.
If your voice is getting weaker, it's likely it will get weaker and it will be harder to correct. Try to treat it early because LSVT does work and it's better to deal with it before it becomes an issue that affects your life. You can expect to double the volume of your voice.
Example of treatment - speaking loud. Breathe in - repeating words. It's how you say words not just saying them. not all speech therapists are voice therapists.
How long the treatment lasts depends on the patient and the motivation received from his/her support system. Caregiver should sit in with patient so they can learn the cues and practice using them with the patient for consistency. You will need to keep doing it 10 minutes every day for the rest of your life but it's much like as eating and sleeping. Not that big of a deal.
Think LOUD!
Question about what helps with drooling. He has no therapeutic treatment for this. Suggests you consult a doctor for medication to reduce excess salvia production.
Medicare Therapy Cap
Medicare pays $1860 for outpatient speech and physical therapy in one year. LSVT absorbs all of that in the 16 required sessions. Occupational therapy has its own cap of $1860. The cap was eliminated for 2010 but write to your congressman and ask that the elimination stays in effect. A diagnosis of Parkinson's disease allows you to exceed the cap as does a diagnosis of voice disorder. Call Medicare to confirm and for a list of services available for PD patients. A therapist can not treat you without a prescription.
Swallowing
When you swallow if things go down the wrong way you cough. Vocal cords protect your airway and keep things out of your lungs. They sit on top of the trachea and are open when you breathe. When you hold your breath they're shut.
Impaired swallowing leads to aspirating. Aspirating has to do with inhalation. Choking means you are unable to breathe. Often with PD patients timing is an issue and food or liquid goes down the throat before you actually swallow while the airway is wide open although it should be blocked when swallowing.
A treatment available is VitalStim, neuro electrical stimulation. A neuromuscular stimulating device emits small electrical current to stimulate the muscles responsible for swallowing.
Talk to your doctor if you have trouble swallowing. Only a speech therapist can treat swallowing - there's no pill. Matt can also treat people with this therapy.
Sometime ears and eyes making tears can also indicate swallowing issues (they can also indicate many other conditions).
Silent aspiration is when things go down the throat into the lungs without you realizing. Examples would be thin liquids like tea, water, coke, etc. The result may be pneumonia. Often people are treated for pneumonia but not the cause, so they are treated, released from hospital, and then pneumonia reoccurs, etc. The result is repeated pneumonia. You can get a swallow study done in a hospital. The speech therapist will work with the radiology to determine why you are aspirating.
A swallow study is an outpatient procedure. They give you food and drink and take x-rays of your throat so they can see exactly what's going on. A speech therapist and radiologist do the test but it's the speech therapist that will tell you why you're aspirating.
Matt hasn't heard of any medication helping swallowing. With Medicare you have to show constant improvement. A weak voice can affect the ability to clear your throat. With swallowing treatment, voice seems to improve, too.
A handy tip for Caregivers
Instead of saying "Speak louder", or "Can't hear you", and other phrases that could be perceived as nagging, try a hand signal like raising your thumb. (Thanks, Liz!)
March 2010
Jennifer Edge with the Fairfax Area Agency on Aging (Adult and Aging Services)She started with a slide show on what you can do to increase your safety in the home and in the community. There are affordable ways to do this with help from County agencies. Louise had her house checked for ways to make it safer and had a second handrail added to her stairway. Jennifer showed a graph which explained how injuries in the home increase drastically after age 65. One-third of older citizens experience at least one fall a year. Exercises, especially ones that help with strength and balance, can help prevent falling. Speak to your doctor about what exercises are best for you.
Proper lighting is very necessary, especially at night. Have your eyes checked at least once a year, and be sure to have night lights in your bedroom, bathroom, hall and a lighted stairway, if necessary. Avoid wearing bifocals when going down the stairs.
She also brought up the matter of medications; check with your doctor or pharmacist to see if you are taking them correctly and at the right times.
We all need to de-clutter our houses. Ask a friend or family member to help with this or go to the website - www.soothingspaces.com, for help or suggestions. Be sure to move everything off the stairs so you won't trip over anything, and have walkways clear in case of an emergency. Clear off your kitchen counter (we all know how cluttered that can become) and make a "to keep" and "to throwaway" pile. Set up a basic file system with labeled folders for all your important information.
Don't rush! Get up slowly and take your time. Don't hurry to answer the phone or doorbell - let the answering machine do the work. Take your time getting to the door - people will wait. Some common causes of falling are loss of balance, falling out of bed, falling on the stairway, slipping on slick floors, slipping on ice or snow, loss of strength in your legs, and poor eyesight. Some things that might help your home environment would be to install a tub bench, grab bars, maybe in several places. Try to keep slippery leaves off your walkway and paint your outside steps with some kind of florescent paint or use non-skid tape inside to make them stand out, especially at night.
To prevent slips and slides, clean up spills right away. Be cautious about floor surfaces, especially in the bathroom and kitchen. If possible, install (or have them installed) grab bars near the shower to help you get in and out. Do not depend on towel racks or soap dishes - they might not hold. A grab bar can double as a towel rack, but a towel rack cannot double as a grab bar! We need to be careful about our footwear - try to wear shoes that have a non-slip sole. Remember "safety before beauty" when it comes to footwear. In the kitchen, move hard to reach items to a more convenient place.
Remember, the County offers exercise classes, workshops on fall prevention, nutrition, consultation on medication management, in-home consultation to identify safety risks, and minor home safety modifications. All are free to county residents.
The next series of spring activities will be held in Mount Vernon on Mondays from April 12 - May 17. Contact Jennifer if interested.
The phone number for the Agency on Aging is 703-324-7210. Or, go to www.fairfaxcounty.gov/aaa.
Contact info:
Jennifer Edge
Program Coordinator, Independent Living Project
jennifer.edge@fairfaxcounty.gov
(703) 324-7210
January 2010
Petra Riedel-Willems, Sounder Sleep SystemOur speaker this month was Petra Riedel-Willems, a teacher who works with adults and children to help them achieve better sleep patterns. Her first question was "how many of you have trouble sleeping."? Of course, most of us raised our hands. Her program makes people more aware of how they move. She explained that during the day our mornings are more energetic, with a drop in energy in the afternoon. This is telling our bodies that we need to relax in some manner - even a 10 minute nap helps She used a chart to show us what she meant. Everyone needs to take time to rest and relax, especially before bedtime.
Sleep is very important to all of us - it has many healing qualities.
There are many reasons why we don't sleep well. Sleep Apnea (you actually stop breathing for up to a minute) which wakes you up every time this occurs. She explained that we should always sleep with our mouths closed to better distribute oxygen and carbon dioxide. She gave us all a sleep strip to put over our mouths, which forces you to breathe through your nose. Other reasons for not sleeping well are getting up quite often to go to the bathroom, snoring, have too much light in the room. Complete darkness is better because light triggers the brain to wake up. Use a small night light if necessary.
Ms. Willems taught us a calming method of holding our right thumb (the thumb has a direct connection with the brain's motor cortex) with our left hand and breathing deeply in and out. This should be done right before bedtime so we are rested and calm before going to bed. Try not to eat anything after 6 or 7 p.m. Also, no caffeine after that time. The body has to process the food and therefore you will not rest as well. She also suggested that we need to turn over every two hours. We should be able to do this without disturbing our sleep.
She had several books which she recommends. They are:
• The Miracle of MSM by William Regelson, MD
• Alkalize or Die by Theodore A. Baroody.
• Salt Your Way to Health by David Brownstein, M.D. (Natural salt, can be found at Trader Joe's)
• Take Control of Your Health by Dr. Joseph Mercola
