Neighborhood Nurse -

Tips for Staying Healthy & Living Well will be updated periodically, so check in here for new information.

Staying Upright in Winter Weather

 By Wendy Cohan, RN

Each year hundreds of thousands of people fall and break a hip, often leading to dire health consequences. Approximately 1 in 6 women over the age of 50 will break a hip, according to a recent Canadian study. A broken hip often leads to serious complications.   Even in cases of complete recovery, a broken hip still usually means surgery and a hospital stay.  An important cause of fracture-related falls in seniors is the weather:  ice, snow, rain-slicked sidewalks, and wet slippery autumn leaves are all potential hazards seniors need to treat with a little caution. 

Often it’s a matter of maintenance, requiring assistance to rake leaves, shovel snow, and salt or gravel side-walks.  But, sometimes, it’s just a matter of adapting foot-ware to outside conditions.  Sturdy boots with a non-skid sole and ankle support are very helpful in preventing falls in seniors.  Even if you only need to get them out of your closet a few times a year, they’re worth having.  If you’re on a tight budget, resale and thrift shops often have a good selection of lightly-used shoes and boots.

Umbrellas are also useful, especially in rainy places like the Northwest Oregon.  Some umbrella shapes and fabrics can obstruct vision, making it harder to see cars in pedestrian crossings, for example.  Try to find an umbrella with a relatively flat top made from a light-colored fabric or clear plastic. 

Another potential hazard is the low light levels we experience here in the Northwest in winter.  Make sure you have adequate outdoor lighting and a railing to assist in negotiating steps.  Indoors, make sure you have a nightlight in your bathroom, and especially in the bathrooms of any guests staying in your home.  Visitors will not as familiar with the environment, which increases the risk of a fall. 

Can you think of anything else that might help to prevent falls?  Staying strong!  So, once you’re outfitted with proper foot-ware, your walk is cleared and sanded, and you have a walking companion, by all means get out and enjoy the winter weather. Walking is wonderful exercise. It brings added benefits of breathing fresh air and interacting with other folks in your neighborhood. 

If spending time outdoors in winter, it’s a good idea for seniors to let someone know where they’re going, and when they should expect to return.  Accidents do happen, and a little preparation makes for safer consequences.

Keeping Your Cool ... in the Heat of Summer (especially for seniors)

The Problem

Tragically, each summer we read news articles about hundreds of seniors who succumb to heat stroke in their own homes, in major cities all across our country.    We need to prevent this situation from happening by creating an action plan for extended periods of high heat, and by teaching seniors and their caregivers effective ways to stay cool.

Who We Need to Watch Out For

During a heat wave, we're all at risk for heat-related illnesses like heat exhaustion and more serious heatstroke, especially those who have been over-exposed to heat for an extended period and those who have over-indulged in exercise.  But, some people are more vulnerable than others to extreme heat, including those groups listed below.

• People on dialysis
• People with diabetes, heart disease, and respiratory diseases like COPD
• People who are overweight
• People who take medications including diuretics, sleep medications, drugs to treat Parkinson's disease, some anti-depressants, and some psychiatric medications
• Pregnant women, infants, and toddlers
• And last but not least, seniors 
  

How Seniors are Affected

As we grow older, thirst recognition is diminished - many seniors may literally not feel thirsty, and should be encouraged by family members and caregivers to make a concerted effort to drink more fluids, especially water and diluted sports drinks like Gator-Aide.  Older bodies also have less effective temperature regulation, and  often less awareness of their own needs for cooling and re-hydration. Poor circulation complicates the situation for some seniors. When the body needs to cool itself, blood is shunted from the internal organs to the periphery to radiate excess heat (the reasons African elephants have such large ears), but poor circulation in the extremities prevents this cooling process from occurring effectively, causing body temperature to rise to unsafe levels. 

Recognizing Warning Signs

Heat exhaustion can develop over several days of unrelieved warm temperatures, exacerbated by dehydration from inadequate water intake (Popular beverages that include caffeine, sugar, or alcohol can contribute to dehydration). Signs may include cool, moist skin in combination with a rapid, weak pulse, rapid shallow breathing, excessive sweating, dizziness, headache, nausea, paleness, and weakness. Persons with these symptoms during extended warm weather should be given liquids such as water, diluted sports drinks, and chilled summer soups, made comfortable in a shady or air-conditioned environment, and dressed in loose, light, breathable clothing.  Their living quarters should be adapted to offer good cross-ventilation, shade, and cooler temperatures.  Good public environments to spend time in during hot weather include most senior centers, movie theaters, libraries, and shopping malls.  In fact, the city of Portland, Oregon, where I live, has made a good effort to educate and provide services to seniors during hot-weather events, which seem to have become more common in the past decade.  

Heatstroke is a more serious condition, and can even be life-threatening, especially in those with fragile health.  Heat stroke occurs when the body has lost the ability to cool itself, and body temperature is high, usually 103 degrees or above.  The pulse is strong and rapid, and breathing is shallow and rapid.  In addition to the dizziness, headache and slight nausea caused by heat exhaustion, heatstroke may lead to confusion, red, hot dry skin (as opposed to cool, clammy skin), and the victim may lose consciousness. Persons with these symptoms must receive emergency medical treatment as quickly as possible - first, call 911, then keep the person as cool as possible by removing clothing, sponging with cool water; offer conscious victims frequent sips of cool water, and wrap them in a cool moistened sheet, while waiting for help to arrive.

Plan Ahead for Hot Weather

Prepare for hot weather by stocking cooling foods and beverages, keeping ice in your freezer, soft flexible gel packs are handy for wrapping in a towel and used to cool the body.  Place chilled flexible gel backs in the arm pits or on the forehead for 10-15 minutes, and then change locations.

Food Safety

Speaking of keeping cool, it's really difficult to keep refrigerator and freezer temperatures cool enough in extremely hot weather.  You can help by adjusting refrigerator and freezer temperatures, assisting in moving the appliance away from the wall, allowing greater air to circulate, and vacuuming dust off the coils, as well as discarding unsafe and past-dated foods.  Fresh fish, chicken, turkey, and other animal proteins are particularly vulnerable to spoilage, which some seniors may not be aware of due to a decreased sense of smell and taste (another attribute of aging). A gentle reminder to your older family members may be in order during hot weather.

It Takes a Neighborhood 

Here are some things you can do to help:

• Donate an unused, working fan or air conditioner to a senior center or other charity that assists seniors.
• Check on elderly, chronically ill, or morbidly obese neighbors to make sure they're weathering the heat safely and appropriately. Make sure they have adequate supplies of cooling fresh fruits and vegetables, liquids, and medications.
• Offer to hang an outdoor shade or blind on the south or west sides of their home, with the assurance that you'll also help remove it when the hot spell is over.
• Don't wait for them to ask for help - offer your assistance.  If you have a cool basement family room or den, invite them to spend the hottest late afternoon and early evening hours with you, or offer to take them to a movie as your treat!  Visiting with your elderly neighbors is a good way for each of you to get to know one another better and to develop a trusting relationship.  It all comes back to you in the end.  The elderly neighbor whose grass you mow or who you drive to the senior center may be the one to call the police when a prowler comes around while you're on vacation, or may offer to keep an eye on your furry friends while you're out of town.

Seniors, too, can and often do have a strong support network of friends and acquaintances who check up on each other.  These connections are so important.  If you're a senior and do not have this kind of support system, consider going to your local senior center and volunteering or signing up for various programs, and attending local luncheons and field trips.  Soon you won't feel alone anymore, and besides the benefits to you, personally, your participation could benefit someone else in unexpected ways.

I simply can't imagine how it must feel to know that a close neighbor died from a heat-related illness, while I sat in my home completely unaware, and more importantly, uninvolved.

The Importance of Vitamin D - Especially in the Elderly

Several recent studies have shown how important it is to maintain a healthy level of Vitamin D in our bodies, and how so many of us are deficient in this hormone-like vitamin.  Vitamin D is produced by our bodies naturally when our bare skin is exposed to the sun's rays, even in as little as 15 minutes.  However, few of us get enough sun exposure to produce enough Vitamin D, especially in the long winter months and in rainy climates like Oregon and Washington.  Taking a vitamin D supplement in the preferred form of Vitamin D3 is a very good idea, particularly for the elderly.

Studies done in nursing homes and retirement centers show that many seniors are severely deficient in Vitamin D - not surprising, given the lack of sun exposure many people with mobility issues and sometimes a loss of independence face.  What can vitamin D do to help seniors?  

Vitamin D has an extremely widespread positive affect on the human body, helping to maintain mood and prevent depression, helping to prevent aching muscles and joints, and maybe even helping to prevent some cancers.

Best of all, Vitamin D supplements are very economical and can be purchased in your neighborhood pharmacy.  Before beginning your vitamin D regimen, it is a good idea to have your doctor check your vitamin D level, and recommend an appropriate dosage.  However, if you spend the majority of your time indoors, and do not already take a Vitamin D supplement, it may be safe to start on your own and see if it makes a difference in your mood and level of discomfort.  It may take a few weeks to have an effect.

Stay Strong to Avoid Falls

One of the body's strongest muscles is the quadriceps muscle, which runs up the front of the thigh.  This is one of the muscles that is very important in climbing stairs, pushing up from a chair, and perhaps most importantly, in preventing falls in seniors.  Why?  Because when we lose our balance, most of our weight  falls onto one leg, and we instinctively tighten the quadriceps muscle in the weight-bearing thigh to push back, shifting weight back to the other leg.  But, when these muscles are weak, we are unable to shift our weight back to the other leg to compensate, and end up toppling over.  Many older people have weak quadriceps muscles, but these muscles can be strengthened by doing a simple exercise daily.

This easy and effective quadriceps-strengthening exercise should be done holding onto the edge of your kitchen table or counter for balance. 

• Keep your feet at least shoulder-width apart, hold lightly onto the edge of table or counter and bend both knees simultaneously, lowering your body about 6 to 8 inches, or until you feel a slight strain along the front of your thighs.  This action works the quadriceps muscle.  
• Use the same muscle to push yourself upright again. (Avoid pulling yourself up using your arms. It's important to work the quadricep muscle exclusively.)
  
•  Repeat!  Start with half a dozen repetitions twice a day, and work up. 

When you do this exercise, keep your chin up and your eyes fixed ahead and think about your posture.  Gently push your chest forward and your shoulders back, expanding your lungs.

Stop when your muscles feel tired. Also avoid dipping too low, as it can put a strain on your knees.

If you live with another person and they are capable of helping you, have them stand behind you to spot you for the first few times until you are comfortable with this exercise.