Category Archives: Living with a Neurological Condition

“Health Challenges & Recommendations for the Older Adult”

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Stanford University (stanford.edu) sponsored a 3-part series on geriatric health in May. The first evening, May 11, 2006, included this lecture:

“Health Challenges & Recommendations for the Older Adult”
Speaker: Peter Pompei, MD, Assoc Prof of Geriatric Medicine, Stanford Univ

Local support group member Karen D. gave me her notes on the lecture. This post attempts to summarize some of the key points in that lecture.

Robin
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Karen’s Notes from

“Health Challenges & Recommendations for the Older Adult”
Speaker: Peter Pompei, MD, Assoc Prof of Geriatric Medicine, Stanford University
May 11, 2006

Dr. Pompei distributed a document on “Aging parents: Five warning signs of health problems.” You can find a copy of this online at:

mayoclinic.com/health/aging-parents/HA00082

The five warning signs are:
* unintended weight loss
* difficulties maintaining their home (so that the home becomes unsafe)
* failure to keep up with daily routines and personal appearance
* poor mood (down or depressed)
* difficulty getting around (which means that they have difficulty caring for themselves)

Dr. Pompei introduced the concept of homeostenosis. When we were young, we could adapt to stressful environments. But when we’re older, we can’t bounce back.

Dr. Pompei also distributed an article in the April 2006 issue of Geriatrics magazine, titled “Health promotion in older adults: Promoting successful aging in primary care settings.” You can find a copy of this online at:

www.geri.com/geriatrics/data/articlestandard/geriatrics/152006/318873/article.pdf

The article states that:

“Although achieving and maintaining health is influenced by many factors,
one of those is within the grasp of almost everyone: Making wise health
choices… (These) choices…can be summarized by an easy to remember
phrase: eat right, eat less, and exercise more.”

(That particular issue of Geriatrics magazine has a number of interesting articles, including one on exercises for the frail and home bound:
www.geri.com/geriatrics/data/articlestandard/geriatrics/202006/327139/article.pdf.)

Dr. Pompei recommended two websites with health information:

American Geriatrics Association
www.healthandage.com

Merck Foundation
www.merckmedicus.com

The lead article on the American Geriatrics Association website is how
physical fitness can fight off dementia.

During the Q&A period, someone asked how a patient should be told he/she is losing it. Dr. Pompei’s answer was: be forthright but show that the patient may not understand.

Suggested gadgets (utensils and bed canes)

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At the last support group meeting, some of us were talking about two gadgets in particular — weighted utensils and bed canes.  I said I’d follow up with a couple of folks about these gadgets.  Rather than just sending the follow-up email to those couple of people, I thought I’d include everyone.

UTENSILS

There was a disability conference in SJ last year.  There was a workshop devoted entirely to gadgets.  The presenter passed around some weighted utensils and explained that these were useful to those with Parkinson’s.  I’m sure many of you have seen the utensils with the large, black Oxo handles (ergonomic, soft, big grip).  (The assisted living center where my Dad lives ordered a set at my request.  They paid $20/each.)  The presenter made of point of saying that while those were good, the weighted ones were better.  Somehow the weight sends a signal to the brain that there’s something for the hand to grip.  The presenter works for activeforever.com (phone 800/377-8033).  I ordered the weighted soup spoon ($7.95, item #A17040 04) and weighted fork ($6.95, item #A17040 01) for my Dad.  The weighted utensils do improve my Dad’s grip and he’s better able to eat on his own.  If I had to do it again I’d probably get only the spoon.  Note that when someone else is holding the utensil and helping with the feeding, you will want to use a regular spoon.  The weighted soup spoon is purposely deeper than other soup spoons; we’ve found that the regular spoon works better if someone else is doing the feeding.  One other feature of these weighted utensils that we don’t really value but others might is that they are bendable.  This company distributes all sorts of accessibility and convenience products.  Another one I’ve purchased from them is a plastic scoop dish ($4.95, item #A17023); this is handy to have.

BED CANES

My dad has two — a regular one and a travel one.  The regular one is called a BedCane from Standers, Inc. (stander.com – company name ends in S but the web address doesn’t).  The handle is wide, very sturdy, and somewhat cushioned.  The handle attaches to a solid wood base, which is tied to the mattress.  The whole thing is very sturdy.  I think we paid $60 for this.  The travel bed cane is called TravelHandles from Bed Handles (bedhandles.com).  They cost $110 for a box of two handles.  Another support group member and I recently split the cost and each got a handle.  For us, one handle is sufficient.  It worked great in Acapulco with my Dad last week!  The only caution I would have is that the handle is a bit large; it would only fit in our large suitcase.  We also have the non-travel version called the Original Bedside Assistant; I would say the travel version feels just as sturdy although the travel handle is made from aluminum.

If any of you have a gadget you’d like to recommend, send me an email and I’ll distribute it to the wider group.

Robin

Points from an expert physical therapist – on PD and parkinsonism

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I attended Marilyn Basham’s presentation this afternoon on “Caregiving Made Easy for Parkinson’s Individuals.”  She’s the physical therapist (PT) at The Parkinson’s Institute (TPI).  I picked up a few tidbits at the presentation that I thought I’d pass along.  As the presentation was focused on Parkinson’s Disease (PD), not everything applied to the situations we are dealing with but there were still many interesting points that apply.

Here are the points I found interesting….  (with some of my comments in parantheses)

People with PD and Parkinsonism MUST use a walker or wheelchair to make them as safe as possible.  It’s very important to have mobility and postural strategies worked out with a physical therapist and/or neurologist.

PD is evident when 60-80% of the cells in the basal ganglia have died.

The “automatic motor programs” we have are stored in the basal ganglia.  One of these “programs” is what tells us that to stand up from a low chair, we need to scoot to the edge, put our feet underneath us, lean forward, and push up.  PD folks must either receive cues as to the steps of these programs, or they must practice it so many times that doing it becomes somewhat automatic again.

To overcome freezing (called “gait initiation failure”), you can put masking tape on the floor to provide a visual cue.  Put the tape at thresholds or where ever the person often has the freezing problem.  (Of course this won’t work for those with PSP who have downward gaze palsy.)

A suggested verbal cue to give someone who wants to speak is:  “Swallow.”  (pause to let the person swallow)  “Take a deep breath in and then, at the top of your breath tell me what you want.”  (pause to let this happen)  Swallowing is important because fluid accumulates in the back of the throat and those with PD are not aware of it.  You can give them gum to initiate a swallow response.

Before someone with MSA (or PD with blood pressure fluctuations) stands up, give them a glass of water with salt in it or Gatoraid.  This will increase the blood pressure.  Obviously the person’s diet and blood pressure medication needs to be taken into account before following this suggestion.

We must give time for those with these diseases to process information!  Be patient!  Give long pauses.  Don’t overload them.  Don’t give them more than one complex task at a time.  Walking is a complex task.

(Some of you know that my father and I communicate by our holding up fingers to designate an answer.  Example, “do you want 1 for coffee, 2 for tea, or 3 for nothing,” and I hold up 1, 2, and 3 fingers.  He answers by holding up fingers.  Long after the fingers come up, he may try to verbalize the answer.)  I asked Marilyn why my father could hold up fingers faster than he could verbalize a response.  Marilyn said she didn’t know why but pointed out that parents of small children teach their children sign language long before the children can verbalize.

Dementia is rare in PD.  (It’s definitely common in the Atypical Parkinsonism diseases.)  PD folks may lose their keys but they still remember what keys are and how to use them.  (I thought that was a good story for remembering what dementia is.  My dad, for example, cannot remember how to use an ATM card.  I see the dementia very clearly.)

A patch for Sinemet is in the works.  (Some of your loved ones take Sinemet.)

The head of TPI thinks that PD is the most curable of all the neurodegenerative diseases.  (Let’s hope he’s right because hopefully those diseases related to PD can be cured quickly too.)

Regards,
Robin

Free Recordings or Tapes – National Federation of the Blind

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Free Recordings or Tapes – National Federation of the Blind

National Federation of the Blind LogoMy father hasn’t been able to read a newspaper or a book since November.  He thinks it’s because he’s been sick; he says his eyes are tired. I assume it’s the downward gaze palsy worsening. He loves the Sunday New York Times. Whenever I visit, I tried to read some of that paper for an hour.  I get very sleepy reading, however!

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