Keeping Seniors Safe in Cold Weather

Happy New Year everyone. Winter is in full swing here in New Hampshire and Maine. Winter in New England sure can be lovely but for our home care clients, their families and other seniors, winter brings it’s own set of challenges.

For primary caregivers of an elderly loved one, there are numerous things to consider to keep seniors safe during cold weather. Here are some things to consider:

• Increased Risk of Hypothermia: Seniors must be careful to avoid hypothermia. Some health conditions and medication can increase the risk of hypothermia and can make seniors less aware of a drop in body temperature. Regular checks from a family member or in home care provider are essential to make sure they are warm.

• Increased Personal Care Needs: Winter weather and dry indoor air can cause skin to become dry and irritated. Extra attention by caregivers and additional hygiene care is essential during the winter months.

• Increased Risk of Fall: Although there are always fall hazard to be aware of for seniors, winter weather adds a whole new set of fall risks. One slip on icy or snowy steps can lead to serious injury for a senior. In home care providers must take extra care in keeping the home and walkways clear or snow or ice. Traction Cleats for snow and ice are a great idea, they would even make a great gift for a senior in your life.

• Isolation Induced Depression: For seniors, getting out in the winter weather can be a real challenge. Lack of social contact, interaction and exercise can lead to depression. It is important for caregivers to keep this in mind and seek out safe outings or stay at home indoor activities. Family caregivers or in home care providers can help alleviate some of this through activities done together such as: games, baking, crafts, book reading, etc. Caregivers can also provide transportation to activities.

• Fire and Carbon Monoxide Hazards: As mentioned before, seniors are susceptible to cold temperatures. Oftentimes, to help with the cold, or to help in times of power outage, space heaters or generators might be used. These can be a fire or carbon monoxide hazard when not installed properly. Placing these appliances too close to fabrics (ie: curtains, bedding, etc.) or furniture can cause a fire. Without proper ventilation, they can cause carbon monoxide poisoning. Caregivers can read instructions and check for installation. In-home care providers can check on seniors safety. Also, a check should be performed to be certain that fire and carbon monoxide detectors are all in working order.

The National Council on Aging has a great article on their website with more information on keeping seniors safe in cold weather. You can find it here.

Senior Driving

From time to time a family member may become concerned about a loved ones driving abilities. Although driving ability is not necessarily determined by age and many seniors drive safely and successfully, there are changes which can affect driving ability over time. Many of these changes happen as we age and these can contribute to unsafe driving practices. Some changes can affect the ability to turn the head to check for traffic, or to brake quickly. Other changes affect the ability to respond appropriately to situations as they occur. All drivers must have the ability to react quickly to other cars and people on the road.

How dangerous is it?

Some elderly drivers are a danger to themselves and others on the road. Driving is an activity which requires many thought processes, actions and movements all happening simultaneously. It requires quick thinking and quick reactions, which for many people, diminish with age. According to the National Highway Traffic Safety Administration (NHTSA), statistics do show that older drivers are more likely than younger ones to be involved in crashes. Risk of injury or being killed in a motor vehicle accident does increases as people age. In addition, a senior who is involved in a motor vehicle crash is at greater risk of injury or death than someone younger. If you are hesitant about having the discussion about driving with your loved one, considering the possible outcome could help you overcome your hesitation.

How do you know when the time has come?

There are warning signs to look for if you are concerned about a family members driving or even your own. We have put together a "Senior Driving Checklist" for you to print and fill out. When you notice some of these warning signs it is time to assess the situation. Don't wait for an accident to happen. You can also take a look at the other resources we have listed.

How to talk with your loved one about driving

First of all, do not assume that one discussion will be all that is needed. This is a delicate situation which may require many conversations. You must be respectful of their right to make choices.

Secondly, don’t come on too strong or as a “know it all”, be considerate of their thoughts and feelings, and let them have a say. If your loved one has Alzheimer’s disease or dementia they may be unaware of the changes in their abilities and capabilities. When someone is unaware of the changes, this can result in great reluctance on their part of giving up the ability to drive. They may see this as a great loss of their independence and can be quite traumatic for some people. It is important to consider the person’s feelings.

Ask them questions.  Lead the conversation with questions to get them talking. This may help them to see the need to give up driving. Ask them “How have you felt recently when driving or after driving?”, “Have you gotten confused at all recently when driving?”, “Can you tell me about the new dents on your vehicle?” It may even be possible for you both to fill out the “Senior Driving Checklist” together.

What if they are reluctant to give up driving?

Many seniors are reluctant to give up driving because they fear the loss of their independence. In this situation, rather than just taking their keys, a road test would be a good consideration. In some states, the local Department of Motor Vehicles offers testing to determine a person’s abilities when driving and responding to situations when on the road and in traffic. They can also test for vision and distance perception. If your state does not offer this service, there are companies which offer this service. The Alzheimer’s Association or other similar agency may be able to provide a list of resources. Some places offer a Mature Drivers course, if your loved one is reluctant to take the course, remind them that their insurance and their roadside assistance may offer a discount for taking it.

What if they refuse to give up driving?

• If at all possible it is always best to get your loved one to agree to give up driving voluntarily.  The loss of the independence can be traumatic and can lead to depression, having that right taken from them can be even more traumatic. Be prepared for this ahead of time. Sometimes however, they simply refuse to do so voluntarily. Then comes to the difficult decision, for their safety and the safety of others, to take drastic measures.
• Involve their physician: Schedule an appointment with your loved one and their physician so you can discuss the situation together, seniors often will listen to and respect the opinion of their physician. If you do go to talk to the doctor, bring alone a copy of the “Senior Driving Checklist” filled out. Sometimes the loss of driving ability is a process and the doctor may recommend some first steps such as the agreement to not drive after dark. Discuss these options together.
• Involve their optometrist/ophthalmologist: as stated above, seniors will often respect their opinion.
• Involve the State Department of Motor Vehicles (DMV): In some states, it might be best to alert the department of motor vehicles. The caregiver can often meet with a representative and request a driving test and vision examination, some states do not honor this request.  In some states you can write a letter directly to the DMV and express your concerns, or request that the person’s license be revoked. The letter should state that “(the person’s full name) is a hazard on the road,” and offer the reason (Alzheimer’s disease). The state may require a statement from your physician that certifies the person is no longer able to drive. Research your state or talk to a physician who may be able to guide you. Contact your local DMV to find out their recommendation on how to proceed.
• Control access to the keys: designate one person to do all the driving and give them exclusive access to the car keys.
• Disable the car in some way:  Discuss this with a mechanic.
• Give the person a set of keys that looks like his or her old set, but that don’t work to start the car.
• Consider selling the car: Discuss with your loved one the potential financial savings which comes with selling the car. There could potentially be enough savings to pay for any public transportation or even taxi rides. There would be savings on insurance, vehicle payments, gas, maintenance, etc.

If you have increasing concern about your loved one’s driving, the above information should give you some ideas for how to begin the conversation. If you are in our area and need transportation services, feel free to call us to discuss some options for your family.

• Senior Driving Checklist (PDF)

Additional Resources:

• Drivers 65 Plus: Check Your Performance A Self-Rating Tool with Facts and Suggestions for Safe Driving https://www.aaafoundation.org/sites/default/files/driver65.pdf
• How to Help an Older Driver: A guide for planning safe transportation by AAA
• We Need to Talk:  family conversations with older drivers by The Hartford Group

Turning 'Home Sweet Home' Into 'Home Safe Home': Home Safety Tips

by Elinor Ginzler, AARP.org

As your family members or loved ones age, so does their home. It is good practice to step back occasionally and examine the home to see how well the living arrangement supports your loved ones’ daily needs and activities. There are many steps you can take to ensure that your family members stay safe and comfortable in their home.Often these changes can be made with little or no cost, while they also make the home more user-friendly and welcoming. In this column, I note some safety tips to evaluate in your loved ones’ homes, so you can help them successfully age in place.

I’ve written before about the numbers: Nearly 90 percent of olderAmericans want to stay in their current home as they age. Overwhelmingly, that’s where people want to live if they need care as they get older. But sometimes, features in your loved ones’ homes can be their biggest obstacle to remaining independent. As a caregiver, I know the safety of your loved one is your primary concern. By taking small but-practical steps, including the modifications I describe below, you can transform your loved ones’ “home sweet home” into “home safe home.”

No-Cost Changes for Home Safety

• Remove all scatter and throw rugs, which can lead to falls.
• Open blinds and curtains, and raise shades during daylight hours to increase natural light inside the home.
• Place electrical, phone and computer cord, along walls, where they will not trip anyone. To avoid the risk of fire, do not run the wires under carpeting.
• Remove clutter fromthe staircases and hallways to prevent trips and falls.
• Set the hot-water heater to 120 degrees to prevent scalding and to reduce energy consumption.

While all of the above can be done without spending money, you might find some changes are hard for your loved one to accept. For instance, Mom may like her scatter and throw rugs because they add color to her rooms. It’s important that you explain to her why you are suggesting removing these trip hazards. Tell her you want her to consider the change because you’re worried about her falling and seriously hurting herself. Be creative in how you approach the conversation – perhaps suggest that she could move the rug from the floor to the wall or add throw pillows on a chair or sofa to add color without safety risk.

Low-Cost Changes for Home Safety

As you make these no-cost changes, I suggest you look around your parents’ house to see whether or not you could take additional steps to ensure the safest possible home. Here are some low-cost changes ($35-$75) and will make a home even safer:

• Increase lighting by using the highest-watt bulbs possible for fixtures or lamps.
• Place double-sided tape or carpet mesh under area rugs to prevent slipping.
• Install offset hinges on all doors to add 2 inches of width for easier access.
• Replace traditional light switches with easy-to-use, rocker-style switches.
• Install night lights in hallways between bedrooms and bathrooms.
• Replace knobs on cabinets and drawers with easy-to-grip D-shaped handles.
• Add anti-slip strips in the bathtubs and showers.
• Mount grab bars in the bathtubs and showers, and place a sturdy water-proof seat in the shower so your loved one can sit down while bathing or showering.
• Install a handheld adjustable shower head for easier bathing.
• Install handrails on both sides of each stairway to support your loved ones’ sure footing.

You can find low-cost tools and products at your local hardware or home improvement store. It's important that you or a contract or properly install all the updates, so find a reputable handyman to help you if you need assistance.

It might be hard for your loved one to consider certain features, such as the installation of grab bars in the bathroom. “I don’t want those things,” Mom might say. “It’ll look like a hospital room.” This is the time to speak from your heart. Use “I” statements. Tell her you worry about her and you want her to be safe in her home. Add that grab bars come in a range of colors and finishes that can match the decorating scheme of any bathroom. Tell her the days of “institutional-looking grab bars” are long gone. Go with her to the store to look at what’s now on the market.

In addition to the changes listed above, always remember to have a properly rated fire extinguisher in the kitchen area, and fire and carbon monoxide detectors on all floors of each house.

AARP recently developed a video, “There’s No Place Like Home.” (Watch: Part One, Part Two.) It documents how easy and affordable it can be to update kitchens and bathrooms to dramatically improve home safety. You can show the videos to your parents to help them understand that they can easily improve their safety and your peace of mind.

Extensive Changes

Since your loved ones likely want to live at home as long as possible, consider more extensive changes to the home so that it will be sure to meet loved ones’ daily living needs. Design features such as multi-level countertops and pull-out drawers in the kitchen provide easy access to pots and pans. No-step entries to the home may cost more, but they can make homes safer and more comfortable for everyone.

AARP and the National Association of Home Builders (NAHB) have collaborated to help develop a certification program for remodelers, builders, and developers who focus on the connections between home design and the needs of aging people. The Certified Aging-in-Place Specialist (CAPS) program teaches building professionals about the changing needs of people as they age, as well as products and building techniques that can better support aging in place. While there are more than 1,700 certified professionals in the U.S., there is only one in Oklahoma.

Growing Consumer Interest

Realtors, interior designers, and architects have discovered that consumers are starting to show more interest in features and products that promote successful aging in place. People are also realizing that when homes are designed and constructed with these features, the homes’ value increases.

In Georgia, an “Easy Living Home” designation has been developed. It focuses on three key features of home design; all new homes constructed using the Easy Living Home approach have:

• Accommodations for first-floor living, with the master bedroom and full bath on the first floor
• At least one no-step entrance to the central living area of the home
• A maximum clearance (up to 36 inches across) in all doorways for easy movement throughout the home

Proponents contend that these homes are “easy to build, easy to visit, and easy to sell.” Across the country, builders, developers, and realtors are replicating elements of “universal design” – design informed by features that provide comfort, safety, and the ability to age in place. There is  significant consumer interest in aging in place and the type of home required for it.

Home Safe Home

No home can be “sweet” if it isn’t “safe.” The types of home features and fix-its described in this column make homes easier to use, which increases the independence of residents and makes caregiving easier.

I hope that these ideas prompt you to evaluate your loved ones’ home and to make the kinds of changes that you deem necessary and beneficial.

Elinor Ginzler is a national expert on independent living and aging issues. She currently serves as AARP’s lead spokesperson on caregiving, housing, and mobility issues, including older drivers’ safety.

Source: http://www.lifeseniorservices.org/seniorline/Turning_Home_Sweet_Home_Into_Home_Safe_Home.asp

Falls in the Elderly

GEORGE F. FULLER, COL, MC, USA, White House Medical Clinic, Washington, D.C.

Am Fam Physician. 2000 Apr 1;61(7):2159-2168.

See related patient information handout on the causes of falls and tips for prevention, written by the author of this article.

Falls are the leading cause of injury-related visits to emergency departments in the United States and the primary etiology of accidental deaths in persons over the age of 65 years. The mortality rate for falls increases dramatically with age in both sexes and in all racial and ethnic groups, with falls accounting for 70 percent of accidental deaths in persons 75 years of age and older. Falls can be markers of poor health and declining function, and they are often associated with significant morbidity. More than 90 percent of hip fractures occur as a result of falls, with most of these fractures occurring in persons over 70 years of age. One third of community-dwelling elderly persons and 60 percent of nursing home residents fall each year. Risk factors for falls in the elderly include increasing age, medication use, cognitive impairment and sensory deficits. Outpatient evaluation of a patient who has fallen includes a focused history with an emphasis on medications, a directed physical examination and simple tests of postural control and overall physical function. Treatment is directed at the underlying cause of the fall and can return the patient to baseline function.

Elderly patients who have fallen should undergo a thorough evaluation. Determining and treating the underlying cause of a fall can return patients to baseline function and reduce the risk of recurrent falls. These measures can have a substantial impact on the morbidity and mortality of falls. The resultant gains in quality of life for patients and their caregivers are significant.

Epidemiology of Falls in the Elderly

From 1992 through 1995, 147 million injury-related visits were made to emergency departments in the United States.1 Falls were the leading cause of external injury, accounting for 24 percent of these visits.1 Emergency department visits related to falls are more common in children less than five years of age and adults 65 years of age and older. Compared with children, elderly persons who fall are 10 times more likely to be hospitalized and eight times more likely to die as the result of a fall.2

Trauma is the fifth leading cause of death in persons more than 65 years of age,3 and falls are responsible for 70 percent of accidental deaths in persons 75 years of age and older. The elderly, who represent 12 percent of the population, account for 75 percent of deaths from falls.4 The number of falls increases progressively with age in both sexes and all racial and ethnic groups.5 The injury rate for falls is highest among persons 85 years of age and older (e.g., 171 deaths per 100,000 white men in this age group).6

Annually, 1,800 falls directly result in death.7 Approximately 9,500 deaths in older Americans are associated with falls each year.8

Elderly persons who survive a fall experience significant morbidity. Hospital stays are almost twice as long in elderly patients who are hospitalized after a fall than in elderly patients who are admitted for another reason.9 Compared with elderly persons who do not fall, those who fall experience greater functional decline in activities of daily living (ADLs) and in physical and social activities,10 and they are at greater risk for subsequent institutionalization.11

Falls and concomitant instability can be markers of poor health and declining function.12 In older patients, a fall may be a non-specific presenting sign of many acute illnesses, such as pneumonia, urinary tract infection or myocardial infarction, or it may be the sign of acute exacerbation of a chronic disease.13 About one third (range: 15 to 44.9 percent) of community-dwelling elderly persons and up to 60 percent of nursing home residents fall each year; one half of these “fallers” have multiple episodes.14 Major injuries, including head trauma, soft tissue injuries, fractures and dislocations, occur in 5 to 15 percent of falls in any given year.15 Fractures account for 75 percent of serious injuries, with hip fractures occurring in 1 to 2 percent of falls.15

In 1996, more than 250,000 older Americans suffered fractured hips, at a cost in excess of $10 billion. More than 90 percent of hip fractures are associated with falls, and most of these fractures occur in persons more than 70 years of age.8 Hip fracture is the leading fall-related injury that results in hospitalization, with these hospital stays being significantly prolonged and costly.16 It is projected that more than 340,000 hip fractures will occur in the year 2000, and this incidence is expected to double by the middle of the 21st century.17

One fourth of elderly persons who sustain a hip fracture die within six months of the injury. More than 50 percent of older patients who survive hip fractures are discharged to a nursing home, and nearly one half of these patients are still in a nursing home one year later.18 Hip fracture survivors experience a 10 to 15 percent decrease in life expectancy and a meaningful decline in overall quality of life.

Most falls do not end in death or result in significant physical injury. However, the psychologic impact of a fall or near fall often results in a fear of falling and increasing self-restriction of activities. The fear of future falls and subsequent institutionalization often leads to dependence and increasing immobility, followed by functional deficits and a greater risk of falling