Growing older may seem like a natural, graceful process, but the progression is often all but smooth.  As we age, many activities that we used to do without a second thought become difficult and, in some cases, can even be dangerous. 

One area of independent living where seniors face the most challenges is in the bathroom.  Maintaining the ability to care for one's own hygiene is essential to a healthy self-image and overall happiness.  For seniors who are strong mentally, but suffer from physical ailments like arthritis or other joint/mobility problems, the struggle with independence can be very difficult. 

Most elderly accidents happen in the home and more specifically, they happen in the bathroom.  Developing senior friendly bathrooms is a key element to safe, independent living.  There are simple items that can be purchased and installed to increase bathroom safety for seniors.  Raised toilet seats and toilet safety frames can make the rise and descent from a toilet less of a strain on aged or injured knees and hips.   If limited upper mobility is a problem, the addition of a self wipe toilet aid or Bottom Buddy can make cleaning after the toilet easier as well. 

Speaking of hips, a slip in the shower can shatter an aged hip all too quickly.  Fractured hips mean months of immobility and physical therapy.  Make a safe senior shower with shower chairs , or a shower bench .  Include a shower transfer bench to make getting into the tub easy as well.  A single grip portable grab bar can make life much easier as well since it can be moved to different areas of the bathroom and used as needed.

Even the simplest thoughtfully placed item like table top toe nail scissors can transform a bathroom accident waiting to happen into a bathroom safety net for seniors.  We spend the first part of our lives learning to be independent and follow that by putting our independence to work for the larger second portion of our lives.  As we round the bend from youth and middle age, holding onto our independence becomes even more important.  Support the seniors in your life by making bathroom safety for seniors a priority and supporting independent living for as many years as possible. 

With any terminal or long term illness there are physical challenges that a caregiver will need to handle, but the true challenge lies in making certain that those physical obstacles don't create greater low self-esteem and poor self-image issues that can make a sick persons days longer and harder than they need to be.  The role of caregivers in encouraging independent living for patients is vital at every stage of life. 

There are so many tasks that a person goes through life performing everyday on their own, but when that person becomes ill and must depend on a caregiver to perform those tasks it can be embarrassing, disheartening and often leads to hopelessness.  The truly skilled caregivers and home care providers are equipped with the right tools to not only make their job easier and more manageable, but to make the care itself, less humbling for the patient.  

One area that is obviously difficult for both patients and home care providers is in the bathroom.  The function of this room can be greatly improved with simple items like locked raised toilet seats with handles , a Bottom Buddy to help extend a patients reach and even a universal toilet paper holder that makes keeping a fresh roll in reach a breeze even when bedside commodes are necessary.  In home care situations where getting to the bathroom is a problem, male and female urinals provide a discreet option without odors and messes.  Making it easy for a patient to do this once simple task themselves or even with as little caregiver involvement as possible is a great way to restore pride. 

Another problem area shares the room with toilet and it is the shower.  For many the solution for self-bathing is as simple as a good shower chair (a rotating shower chair is the ultimate self-bathing helper) and some No Rinse shampoo and body wash .  Shampoo caps and bathing wipes are a great option for limited mobility patients to tend to their own hygiene when a caregiver is not present.  When the strength and coordination for getting in and out of the tub or shower is not there anymore, but the dignity and pride is still intact, other products like open back gowns , wash mitts and shampoo basins make a caregiver's job quicker, having a less negative impact on the patient's ego. 

Other than the bathroom, most of a patient's controllable discomfort can be eliminated with simple comfort foods, proper cushioning and the right attire.  From egg crate cushions , Carex cushions and bed wedges that can make getting up from resting and sitting positions easier, and even more comfortable, to great circulating footwear like Comfort Strides , Edema slippers , Diasox and Swell sox that can make being on their feet a joy rather than a strain. 

Depending on the severity and level of illness and disease, caregivers and home care providers have a variety of items available to them that can help their patients maintain their dignity and pride while making the care providers job easier as well.  But there will never be enough gadgets in the world to replace the truly unique quality that a home care, hospice care and even a family care giver provides which is the time, companionship and skill of encouraging independent living for a strong emotional fabric. 

Cumulative Trauma Disorder

Cumulative trauma disorder (CTD) is a general term that describes a range of physical problems caused by repeated movements using a keyboard and/or a mouse. Over time, the repetitions have upset the normal body balance. About two-thirds of all work-related injuries are caused by CTD. Although a number of different disorders are generally labeled as CTD, they all result in similar symptoms such as pain, numbness, tingling, and/or loss of strength in the hands, wrist, forearms or elbow. The most common CTD injuries in coders are carpal tunnel syndrome, ganglion cysts in the wrist and inflammation of tendons in the wrist and elbow. Carpal tunnel syndrome is caused by nerve compression from swollen tendons in the wrist. Ganglion cysts are caused by joint degeneration and often result in a small bump on the wrist. Tendonitis causes pain and swelling of the tendons around the wrist and/or elbow. These injuries usually develop slowly from repeated movements coupled with poor posture and may take years before symptoms are noticed. Prevention techniques to avoid CTD include:

- Position the forearms at a 90 degree angle with the wrists in a neutral position to reduce pressure on tendons and nerves. Adjust the chair, desk, and mouse pad to achieve this body position.

- Use a well-cushioned rest for the wrist and forearm while typing to avoid contact stress , which puts direct pressure on nerves and tendons

- Try to take a break to walk around for 5 minutes every hour

- Perform easy stretching exercises before, during, and after work specifically for the wrist, forearms, and elbow.
- If CTD has progressed to the point where osteoarthritis of the wrist or elbow has developed, consider taking the dietary supplement glucosamine. Glucosamine has anti-inflammatory effects and helps to reduce cartilage damage. Typical glucosamine dosages are 1000-1500 mg per day. A full spectrum liquid vitamins supplement may prove helpful as well. The best liquid vitamins are those that are derived from whole foods.

Back, Neck, and Shoulder Problems

Lower back pain is one of the most common musculoskeletal conditions in adults with about 80% of adults reporting low back pain at least once in their lifetime. Neck and shoulder pain is extremely common in frequent computer users while occurring much less in the general population. Computer programmers are at high risk of musculoskeletal problems in the back, neck, and shoulder primarily due to the amount of time sitting in positions that are not ergonomically correct. Although each day of poor posture results in very little trauma to the soft tissues, repeated microtrauma can ultimately lead to muscle strain and joint inflammation. Back, neck, and shoulder overuse injuries can be prevented by following the tips below.
- Ensure that your lower back is against the back rest of the seat, which will reduce tension and possible strain of the lower back muscles. Use a lumbar support to ensure adequate back support.

- Buy an ergonomic chair with plenty of adjustment points to ensure an individualized fit. Consider using an exercise ball as a work chair. An exercise ball requires you to constantly contract the stabilizing muscles of your torso to stay balanced. Strengthening these core muscles will reduce the risk for lower back strain from poor posture and ergonomics.

- Adjust your workstation so that frequently used objects are easily within reach. Try to minimize reaching, twisting, and turning the head.

- Try to take a break to walk around for 5 minutes every hour

Eye Strain

Eye strain occurs when a person looks at a computer screen for long periods of time. Symptoms of eye strain include tired, burning, or watery eyes, blurred vision, headache, and light sensitivity. Normally, symptoms of eye strain are not permanent and will lessen once the eyes are rested. However, it can sometimes take a few days for symptoms to completely resolve. For the full-time coder, breaks of several days are not practical and the condition can easily worsen over time. Below are ways to prevent eye strain from becoming a chronic problem with lingering visual side effects

- Take breaks for your eyes during the day. Each hour, spend 5 minutes looking at something other than your computer screen.

- Blink more often or use eye drops to avoid dry eyes.

- Ensure the computer monitor is an appropriate distance from your eyes, usually about 24 inches.

- Check office lighting for excess glare on the monitor, which can cause eye strain.

General Health Issues

Computer programmers often work long hours under tight deadlines. Many coders have little time to walk away from the computer while at work and little spare time outside of work. As a consequence, many coders eat salty, sugary and caffeinated snacks and beverages during the day or they will even skip eating altogether. Proper nutrition is important to support general health and combat fatigue. Programmers will often not take time away from the computer to eat a meal and will choose snacks from a vending machine. The high sugar content and lack of protein and fiber in most snack foods contribute to increased fatigue in the afternoon from blood sugar drops.

- Spend 5 minutes each morning to pack a healthy lunch.

- To prevent fatigue by maintaining blood sugar levels, eat a snack in the morning and one in the afternoon. Snacks should contain protein, fat or fiber to blunt blood sugar rises. Examples of healthy snacks include nuts, fruit, yogurt or nutrition bars/shakes. Raw vegetables are an excellent snack and are rich in health promoting phytonutrients

- Limit caffeine intake and stick with non-caffeinated beverages after mid-morning. This will help maintain adequate hydration, help avoid late day caffeine crash and may help with sleep problems.

Programmers should dedicate time on most days to exercise, preferably an enjoyable activity to help maintain compliance. However, coders are frequently sedentary due to a perceived lack of time. Workers with full-time jobs have better exercise compliance if they workout in the morning since lack of time and fatigue often sabotage plans for workouts later in the day. Improvements in overall fitness and muscular strength can help to minimize fatigue and prevent muscle and joint injuries in the workplace.

Summary

Computer programming is a demanding job with 30% of coders reporting symptoms of computer-related injury. These injuries are largely preventable with proper ergonomics, adequate rest, proper nutrition, adequate exercise, and stretching.

Dr Linda Posch, MS SLP ND

Aging is associated with several physiological changes that have a significant negative impact on total body water levels. A decrease in fat-free mass, which contains about 75% water, is observed with aging and contributes to dehydration in the elderly. As a consequence, older adults have approximately 60% body water compared to 70% in younger adults. Furthermore, the thirst sensation, which is the main stimulus for water intake, is blunted in the elderly. Due to this blunted thirst response, older adults generally have a lower fluid intake than their younger counterparts [1]. The part of the brain known as the mid cingulate cortex is often hindered in the elderly population and is the main contributor of a blunted thirst response [2]. Since mild dehydration produces sensations of thirst, elderly persons may not recognize the normal physiological signs of dehydration. The kidneys allow more water volume to be excreted with increasing age [3]. The prevalence of diuretic use, which exacerbates fluid losses and increases dehydration risk, is greater in the elderly. Finally, the tendency of drier skin in elder adults is partially explained by the decrease in water content of the stratum corneum, the outermost layer of skin [4].

When water loss is greater than water intake, dehydration can occur. Although there is no absolute definition of dehydration, tracking body weight provides a reasonable indicator of hydration status. Mild dehydration, characterized by a loss of 2-5% in body weight, results in weight loss, thirst and mouth dryness. If dehydration progresses, dangerously high body temperature, reduced cardiac output and kidney failure can occur. Once 15% of body weight is lost, death is imminent and is most commonly caused by brain damage, cardiac arrhythmia or kidney failure.

Older individuals have a higher risk of becoming dehydrated than younger adults [5]. Dehydration is the most common fluid and electrolyte disorder in the elderly with a prevalence of 20-40% [6] and is a frequent cause of morbidity in the elderly. Complications can include reduced mental function, thromboembolic events, infectious disease and kidney stones. The incidence of mortality incidence is also higher in dehydrated vs. hydrated elderly patients.

Due to the negative physiologic effects associated with dehydration, the elderly are advised to consume at least 8 cups of fluid per day under normal conditions. Fluid intake can be in the form of food or liquid [7]. Fluid intake should be increased above 8 cups if any of the following conditions are present: diarrhea, vomiting, bleeding, edema, infection, fever, exposure to warm environments or diuretic use. Unfortunately, 25% of persons over 85 years of age drink under 1 liter of fluid per day. Conversely, overconsumption of water may cause water intoxication in older adults as a result of the decline in the kidneys ability to dilute urine.

To ensure adequate hydration in the elderly, several strategies can be implemented. A regular drinking schedule is effective in maintaining safe daily fluid intake, utilizing either a written schedule or verbal prompting. Elderly people should monitor body weight at least once per week to ensure weight is maintained within a narrow range. Urine color should be clear or slightly yellow. Dark yellow or orange urine is very concentrated and implies a dehydrated state. Geriatric caregivers also play a vital role in helping to prevent dehydration. Patient education regarding hydration strategies is also critical. When older adults are taught that thirst is an unreliable indicator of hydration, water intake increases. Fluid intake has been shown to increase when older persons are provided different beverage options which include phytonutrient rich fruit and vegetable juices which offer some of nature’s best liquid vitamins. Other methods that can be utilized to maintain hydration in the elderly are keeping liquids easily accessible, encouraging family members to participate in feeding and recording daily fluid intake. Furthermore, taking medication with fluids should be encouraged as this is associated with greater daily fluid intake. [8].

In summary, aging is associated with fluid intake reductions and greater risk of dehydration. Dehydration in the elderly is associated with a higher complication rate and must be regularly monitored. Regular follow-up from caregivers and patient education on strategies to maintain adequate hydration levels are essential to preserve optimal health in older age.

Dr Linda Posch, MS SLP ND

References

1. Kenney, W.L. and P. Chiu, Influence of age on thirst and fluid intake. Med Sci Sports Exerc, 2001. 33(9): p. 1524-32.

2. Farrell, M.J., et al., Unique, common, and interacting cortical correlates of thirst and pain. Proc Natl Acad Sci U S A, 2006. 103(7): p. 2416-21.

3. Beck, L.H., The aging kidney. Defending a delicate balance of fluid and electrolytes. Geriatrics, 2000. 55(4): p. 26-8, 31-2.

4. Berardesca, E. and H.I. Maibach, Transepidermal water loss and skin surface hydration in the non invasive assessment of stratum corneum function. Derm Beruf Umwelt, 1990. 38(2): p. 50-3.

5. Ferry, M., Strategies for ensuring good hydration in the elderly. Nutr Rev, 2005. 63(6 Pt 2): p. S22-9.

6. Lavizzo-Mourey, R., J. Johnson, and P. Stolley, Risk factors for dehydration among elderly nursing home residents. J Am Geriatr Soc, 1988. 36(3): p. 213-8.

7. Valtin, H., "Drink at least eight glasses of water a day." Really? Is there scientific evidence for "8 x 8"? Am J Physiol Regul Integr Comp Physiol, 2002. 283(5): p. R993-1004.

8. Chidester, J.C. and A.A. Spangler, Fluid intake in the institutionalized elderly. J Am Diet Assoc, 1997. 97(1): p. 23-8; quiz 29-30.

Caregiver strain is a term used when the emotional and/or physical health of a caregiver is compromised or when the demands of care giving are greater than the available resources (Given 1992). Over 15 million adults currently provide care for elderly relatives in the United States (Schulz 1998). The number of caregivers will likely continue to increase as the population lives longer. By 2030, 20% of the United States population will be 65 years or older (Koizumi 1998). Without this extensive network of caregivers, many cared for individuals will require permanent admission to institutions or health care facilities. The costs of these services are not covered by insurance in many cases. Therefore, many caregivers must provide this care at home. The average caregiver spends over 10% of their annual income on care giving expenses (Evercare 2007). Of caregivers that support an elderly person, 40% also simultaneously support children. Caregivers spend 23-41 hours per week on caregiver duties alone, with low-income caregivers reporting a greater time commitment (Evercare 2007). Given that 64% of all caretakers also work outside the home, the overall burden that the typical caretaker bears is enormous.

The cumulative burden of time commitment, prolonged stress, financial strain, and the physical requirements of care giving may increase the risk for physical health problems in caregivers. Elderly caregivers who report strain caused by care giving have a 63% higher mortality risk versus non-caregivers (Schultz 1999) as well as higher rates of depression, anxiety, and alcohol use. Furthermore, these caregivers are at greater risk of placing the family member in a long-term health care facility and using in-home services more often due to inability to cope with the strain of care giving (Brown 1990). The benefits of reducing caregiver strain are evident. Therefore, there is a strong need to identify factors that can lower caregiver strain and the complications associated with this strain.

Management of Caregiver Strain:

Maintain A Healthy Lifestyle

- Devote free time each day to exercise or participate in other activities that can help to reduce chronic stress. Exercise regularly for a minimum of 20 minutes at least 3 times a week. Choose an activity that you enjoy such as walking, dancing, swimming, etc. Yoga or tai-chi may be particularly beneficial for the caregiver because they teach relaxation techniques that can be used at any time throughout the day when faced with a stressful situation.

- Meditation is an effective method to reduce stress and requires little time. When stress is high, the caregiver can go to a quiet area, sit or lie still, breathe deeply, and clear the mind. Physiological and psychological benefits of meditation have been reported with as little of 5 minutes on most days of the week. Visualizing comforting scenes or memories or listening to easy music can aid with meditation.

- Eat nutritious balanced meals, limit caffeine and alcohol intake, do not smoke and try to get 6-8 hours of sleep each night. Occasional juicing can provide a quick shot of natures best liquid vitamins and can act as a natural phytonutrient supplement. Proper nutrition is vital for caregivers given their energy expenditure.

- See your personal physician if the chronic stress associated with care giving begins to feel overwhelming. Screening tools are useful to identify whether care giving stresses are excessive and may require intervention. The most common screening test is the Caregiver Strain Index test (Sullivan 2002), which can be found at http://www.consultgerirn.org/uploads/File/Caregiver%20Strain%20Index.pdf.

Take Scheduled Breaks

Caregivers often do not take regular breaks due to feelings of guilt. However, just like a regular job, breaks are needed in order to avoid undue stress. A support system consisting of family, friends and professional caregivers needs to be established and used regularly to allow the caregiver this much needed time.

Ask For Help

Ask for help when needed. About 75% of adults that provide care for an elderly family member do so with no additional help. When care giving stresses are great, the support system should be utilized.

Education

Caregiver stress may worsen due to a lack of understanding of a family member’s condition. The caregiver should attempt to educate him/herself and identify available resources available for the cared-for family member’s condition.

Attend A Caregiver Support Group

This group may help the caregiver understand that his/her feelings are normal. Furthermore, this group may offer practical advice on better ways to manage excessive caregiver stress and will allow opportunity to discuss issues, successes and feelings related to care giving.

Caregivers comprise a significant proportion of the United States population and help to reduce the financial burden associated with use of health care facilities. However, care giving is associated with a significant physical, psychological and financial burden to the caregiver. By incorporating some of these caregiver stress management recommendations, the caregiver can continue to provide optimum care while successfully managing stress. Ultimately, this will help the caregiver to maintain health thereby allowing him/her to provide optimum care for the person in need.

Dr. Linda Posch MS SLP ND

References

Brown LJ, Potter JF, & Foster BG. Caregiver burden should be evaluated during geriatric assessment. J Am Geriatr Soc 1990;38:455-60.

Evercare. (2007). Family Caregivers – What They Spend, What They Sacrifice. http://www.caregiving.org/data/Evercare_NAC_CaregiverCostStudyFINAL20111907.pdf

Given, C., Given, B., Stommel, M., Collins, C., King, S., & Franklin, S. (1992). The Caregiver Reaction Assessment (CRA) for caregivers to persons with chronic physical and mental impairments. Research in Nursing and Health. 15:271–283.

Koizumi LS, et al, ed. (1998). The public health. In: Health Care Almanac and Yearbook. New York: Faulkner and Gray:263.

Onega LL. (2008). Helping those who help others: the Modified Caregiver Strain Index. Am J Nurs 108:62-9.

Sherwood, P.R., Given, B.A., Given, C.W., Schiffman, R.F., Murman, D.L., Lovely, M., et al. (2006). Predictors of distress in caregivers of persons with a primary malignant brain tumor. Research in Nursing and Health. 29:105–120.

Schulz R & Beach SR. (1999). Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. JAMA 282:2215-9.

Schulz R & Quittner AL. (1998). Caregiving for children and adults with chronic conditions: introduction to the special issue. Health Psychol 17:107-111.

Sullivan MT. (2002). Caregiver Strain Index. J Gerontol Nurs 28:4-5.

Arthritis, which means inflammation of the joints, is a condition that causes pain, swelling and limited movement in one or many joints of the body. Arthritis can be caused by many different illnesses and must be treated accordingly. The treatment for arthritis may include medication to reduce the pain and swelling of the joints. Occupational and physical therapy may also be advised.

Occupational therapists can teach arthritis sufferers how to perform daily activities in a way that doesn't aggravate their condition. They can show them how to modify their home and workplace so that painful motions are reduced. It is also the therapist's job to suggest products that can help perform everyday tasks with minimum effort. Products of this type help people with tasks that involve dressing, bathing, cooking and housekeeping. They are available on the LifeSolutionsPlus website.

Physical therapists are useful in providing information on how to use mobility aids such as walkers and crutches. They can also suggest various exercises, which are designed to strengthen muscles and help preserve the use of the joints.

There are several therapeutic methods available to patients to control pain and swelling. Rest is probably the most important especially when multiple joints are affected and fatigue is a problem. Individual joints affected by fatigue can be supported by the use of splints or a collar for the neck. Another major issue is weight control. This is a factor that must be controlled in the person with arthritis. Excess weight puts too much stress on already painful joints. Foot care also must be addressed since it is important that the body stay in alignment while walking. Finally, heat packs, ice packs and warm baths/showers are useful to help to relieve pain and relax muscle spasms around affected joints. In general, the person suffering from arthritis must improve his lifestyle. They must eat properly, get enough rest and do the right types of exercise. Swimming and water exercises have proven especially effective in reducing pain. Medication can also prove useful in controlling the pain and swelling associated with the disease.

Recommended Products
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Osteoarthritis is a disease of the cartilage, which is the protective shock absorber that separates bones and keeps them from rubbing together. Once this protective substance is destroyed, the bones will grind on each other and lead to joint injury. Although the exact cause of Osteoarthritis is not known, it is usually blamed on genetics, old age, or the result of an injury to the joint.

Osteoarthritis is not like Rheumatoid Arthritis in that it does not affect the body symmetrically. There are three main areas of the body that are usually affected by this type of arthritis. They are the fingers, hip and knees, and spine. Symptoms begin with an occasional aching in the joint that lasts only a few minutes. Gradually as more cartilage is worn away, the pain increases and becomes continuous. There is usually limitation of joint movement and localized tenderness when the joint is touched. The joint feels warm and there may be considerable swelling. Lumps on the bone called osteophytes may develop and begin to pinch surrounding nerves causing severe pain. As the condition progresses, the joint becomes unable to be moved. Tendons become shortened and muscles go into spasm.

People diagnosed with Osteoarthritis need to take charge of their condition. They must live a proper lifestyle that includes the right kinds of exercise. Swimming and water related movement is very beneficial to the arthritis patient since exercising in water puts less strain on joints. Other aspects of their lifestyle must include eating the right foods, getting enough rest and eliminating such things as smoking, alcohol and illegal drugs. Doctors can prescribe medications that can help with the pain and joint inflammation. As with other types of arthritis, the patient can find many products on the market that are designed to help them accomplish everyday tasks. These simple aids can make a very big difference in the quality of their lives.

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Rheumatoid Arthritis is a chronic condition that affects the joints with swelling, redness and pain. It affects the joints in the arms and legs, specifically the wrists, fingers, knees and ankles. This type of arthritis is distinguished from other types of arthritis by its symmetry. This type of arthritis produces inflammation of the lining membrane of the joint. It affects the same joint on both sides of the body. It can also affect the heart, lungs and eyes in some patients.

The most common symptom of Rheumatoid Arthritis is fatigue. Other symptoms include low-grade fevers, loss of appetite and loss of weight all of which precedes the pain, stiffness and swelling of the joints. Inability to sleep is another problem that adds to the patient's overall fatigue. Morning stiffness and stiffness after inactivity are other common symptoms that may last for several minutes or up to several hours. Arthritis sufferers, in general, find that their pain increases when the weather changes, but sufferers of this type of arthritis are even more susceptible to rises in humidity and drips in barometric pressure. Patients with Rheumatoid Arthritis also have the presence of painless lumps under the skin usually on the forearms, ankles and fingers. These lumps disappear after a few months but the inflammation of the joints remain. The cause of this condition is unclear. It is believed by some doctors that patients who have Rheumatoid Arthritis some virus or bacterium trigger the disease in those people who have a genetic predisposition to it. It is also associated with various infections such as strep throat and mononucleosis. Instances of severe stress and even the weather have been known to trigger the disease.

Treatment for Rheumatoid Arthritis may include prescription drugs and over the counter pain medication such as Tylenol or Advil. Over all body health is key. Body weight must be controlled so that excess weight is not put on effected joints. Adequate rest is important and a healthy diet is recommended so that the body gets the vitamins and minerals it needs. An exercise program should be designed to strengthen muscles and to increase range of motion in the effected joints. Water exercises are the best since they put the least amount of strain on the joints. Since stress is a factor in this condition, it must controlled or eliminated from the environment. Lastly, the patient should make use of products that help to make everyday activities easier to perform.

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