Nurses are key to fall prevention

Long Beach Health Department along with Heart of Ida is offering a training workshop for nurses to assess fall risk. This is a strong developmental step towards improving and maintaining the health of our community's older adults.

Is care management part of the solution?

I've been pondering for nearly 40 years if a person or a system manager a positively effect a person's care. I started working on this question at one of my very first positions at a cancer rehabilitation research project. One of the primary objectives was to reduce the use of the emergency room by person's with receiving cancer therapies. We were successful in identifying more social determinants and the unanticipated consequences of interjecting a 'care manager' between the patient and their clinician.  The conversation has been added to substantively by a recent brief "Finding a Match: How Successful Complex Care Programs Identify Patients"

check out page 10 for Seven Take-Aways from Successful CCM Programs.

It's personal

When asked to present on fall prevention, inevitably a member of the audience shares a story. Which I've come to refer to as the 'grandmother story'. And so that is where I start. Whether presenting to community decision-makers, clinicians, or older adults I have one or two people relate their 'grandmother story'.

You see falls are personal. We all know the statistics but what isn't getting through with current messaging is that falls are not a normal part of aging. And an older adult needs to pay personal attention to remaining risk free or risk reduced.  So on April 9th, 2015 I'll be testing out an expanded version of this idea. I'm supported in this by my colleague Dr. Yakura and two very able public health nursing interns, Nate and Nicole.

Resource: Reducing older adult falls in institutions

The past 12 months have been filled with an extraordinary number of fall prevention tactics. Community screenings, teaching professionals how to screen, implementing an education program for those who've developed a 'fear of falling', expanding Tai Chi Moving for Better Balance in different settings and on and on.
One of the most troublesome is reducing falls in institutions or those who qualify such as in CBAS programs. I presented at a local nursing home the other day. Much of the information has been well developed and compiled into a toolkit. I highly recommend for those involved with fall risk reduction or fall prevention to review and implement as 'prescribed'!

http://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/fallpxtoolkit.pdf

Smart Senior Transportation

As we ready ourselves for another American Independence Day we might think of independence as the ability to do things without needing others.

Like driving a car.  Remember how excited we were the first few times we got to “solo” in the family sedan?  And remember how we were told that with this new “right” to independence we also took on a whole new set of responsibilities!

A driver’s license is an example of a coming of age, a certainty of future freedom and limitless opportunity. Certainly true when one is a teen and wanted to ‘get out’ and see the world even if it was just down the street.

But when did a driver’s license become the means of independence for older adults?  And at what cost to themselves and others?

Shockingly twice as many older adults than teenagers are killed in motor vehicle accidents each year, according to the Center for Disease Control (CDC). Nationwide, 15 seniors lose their lives every day in an effort to maintain their independence.

If the reason auto fatality rates increase at age 75 and again at 80 due to susceptibility to injury and medical complications then let’s address that. If the older adult may have occasional diminished reflexes let’s get ‘smart’ car technology to prevent starting the car just like impaired drivers due to alcohol. Let’s keep senior’s reflexes sharp and their medical conditions stable. At the same time we could increase preferable transportation options.

Taking away a driver’s license is tantamount to proposing a constitutional amendment. My thought is: mobility yes, driver’s license maybe.

It is the right of the people to be secure in pursuit of mobility outside their home. Their rights against unreasonable limits on this freedom shall not be violated.

The point then is to define unreasonable limits not based on being too old but on being too inattentive, too stiff to turn one’s head or too visually impaired. Most thorough analyses show that age is not the determinant but capability, coupled with competent self-judgment is the key. Some 69 year olds are highly distractible; some 86 year olds are serious, thoughtful and have timely responses.

In a recent survey Christine Thayer, master’s candidate in Gerontology at CSULB, discovered “the most sought destinations of older adults in Long Beach (in order of demand) were: social activities, the grocery store, medical visits and the drug store. She adds, “Driving was the most usual form of transportation. But interestingly, walking was the second highest, although less than driving”.

According to local senior transportation expert Diane Johnson, an urban personal transportation system has three elements: private car; public bus transit, and for-profit cab. But to be effective for those who do not have a driver’s license, a forth component is essential: a door-to-door transit system. 

Long Beach advocates have long sought to offer this avenue to reduce the need for senior’s at-risk for injury or accident to be dependent on a car. Cities such as Compton and Gardena have a federally funded Para-transit system that offers door-to-door service for older adults and those with disabilities.

I missed the lecture about how dependent we would become on the car. Or that I’d be strongly encouraged to stop walking, share rides or take the bus. Our attitudes about riding the bus are mixed; and generally the bus has not been considered hip or current. Most middle aged adults may have missed having to ride to school on the bus and certainly not once they pocketed keys to the family car. Buses are for children, poor people – not people like us. Now we have to have programs to teach people how to get on and off the bus.

We are addicted to impulse rides and the reluctance to walk ‘too far’.  Need some fast food? Just pop in the car and go to a drive-thru. Antsy for some action? Cruise the freeways to a shopping center. It seems the only downside if you travel using transit or friends is the need to plan. Like grocery shopping just once weekly if a car is needed; but more often if the grocery is just down the street and you can walk there. Some schedule all their doctors’ appointments on one day a week so they can make dependable arrangements. The pay-off is their week is not cluttered up with various office visits and they can play bingo, exercise, volunteer, attend knitting class or join the fellows for a pool game down at the hall.

Legislation is needed to mitigate the limits of merging archaic systems like bus lines with free or subsidized shuttles. Inane constraints include the inability of public transit services to go across county lines. Living in Long Beach as a senior, you know that going from Leisure World to the downtown Long Beach hospitals, which may be just a few miles, represents a significant transit barrier. Obstacles such as these may cause those who shouldn’t drive to continue to drive.

We like to tell ourselves later is soon enough. After all, Mom's erratic driving hasn't caused any damage beyond scratched paint and even though she's increasingly forgetful she still has good days.
Our motto seems to be "Why do today what you can put off to tomorrow?" So first – the self-assessment:
• Can you depress the brake pedal with your knee bent?
• Do you have difficulty deciding when to enter a lane of moving traffic?
• Can you lift your arm high enough to adjust the rear view mirror?
• Can you go outside in the bright sunlight and immediately see clearly?

There are 20 other great questions such as, can you keep up with traffic or have you had ‘fender benders’ and these can be found in the State of California’s Senior Guide for Safe Driving.

To be sure, attitude re-adjustment is unpleasant and altering federal funding streams seems near impossible but boomers need to face facts: no one gets out alive. Mom is going to die. She needs our help to have a good quality life as her body, and perhaps her mind, fails. Boomers love to talk about "giving back" to the community. How about showering some of this largess on the person who's earned the payback?

So, now is the time to call Elbow to Elbow, The Volunteer Ride Share Program and speak to Chris Palzer at 562-506-2801 or email cpalzer@alpertjcc.org. Give back to help those younger than you experience what that fourth rail of the transportation system looks like.

And for those who’d like to see Long Beach use federal dollars for a door-to-door shuttle, well just write your councilperson and describe your needs. And suggest that there be an Office on Aging so the city can create best-practices on this issue. Or read a few issues of Trends in Senior Transportation from the National Center of Transportation – people have been working on wrapping their arms around senior transportation. Locally you are encouraged to attend the Older Adult Transportation Task Force in Long Beach and help plan for our community’s mobility and transportation future.

So just like a financial plan for retirement; each of us needs a well-thought out personal transportation plan. What’s yours?

Local Resources:
Elbow to Elbow - The Volunteer Ride Share Program and speak to Chris Palzer at 562-506-2801 or email cpalzer@alpertjcc.org or check out their website elbowtoelbow.wix.com/elbowtoelbow
Older Adult Transportation Task Force (Long Beach) contact Diane Johnson djohnson@alpertjcc.org

Other Resources:
National Center for Senior Transportation  http://seniortransportation.easterseals.com/site/PageServer?pagename=NCST2_homepage
Centers for Disease Control Fact Sheet – Senior Drivers
http://www.cdc.gov/Motorvehiclesafety/Older_Adult_Drivers/adult-drivers_factsheet.html

 

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A Bouquet of Bulbs for your Mother-Light Bulbs, that is….

While May includes Mother’s Day, it is also Older Americans and Healthy Vision month – who knew? Yet it makes perfect sense because mothers come in all ages: young, middle and older.

Flowers, gifts and cards are all part of the Mom’s day landscape, but it is often the gift of illumination that can ease the burden of tired eyes and greatly increase the safety of our more senior mothers. Simply improving the lighting of a senior’s home can make all the difference.

At age 94 Bella, both active and capable, lived at home by herself. She enjoyed dressing up and driving to church. She adored cooking for her children, and for her children’s children! Every week Bella visited her friend Ada, who couldn’t get out any longer but loved to share stories of raising her children.

Bella was a happy and productive person until one night she was awakened by a loud sound. She got out of bed to see what was causing the sound and awkwardly stumbled over the edge of the table while trying to reach for the light switch. She fell, hit her head, and was transported to the hospital.

That was the last time Bella could take care of herself. The simple act of falling while trying to find the light switch robbed her of her independence.

The whole thing could have easily been prevented!

There are numerous articles about the tragedy of older adults falling, but do you know why they fall? Falls occur with frequency in older adults for a wide range of reasons and with a complex set of underlying causes but a large percentage of falls are due to visual impairments. Problems of poor sight, loss of visual field, sensitivity to glare all represent changes due to age, eye disease or lack of eye care. These conditions put the person, more often than not a woman, at risk for injuries and falls.

Poor vision really alters what older adults are able to do. They become increasingly sedentary and go out less which can greatly increase isolation from friends, family and the larger community. This is especially important for woman as older woman have higher rates of visual impairment.

Teri Hershberg, a low vision expert who works with older adult women says that “one of the most common problems with vision loss for older women is social isolation. Women love to talk, shop, be with others but when they lose their sight they don’t recognize people as easily, and in fact, may appear snobbish. So they start to withdraw and become reluctant to ask for help.”

It is difficult for many people to understand a partial loss of vision. People think that blindness is total lack of vision but it is more common to lose partial vision such as central vision loss or diminished peripheral vision, or depth perception or colors.

Adult children often ask “is my mom faking, being overly dramatic, or complaining unnecessarily?  My grandmother says she can’t read the paper, see if the food in the refrigerator is spoiled or read her mail, but she certainly can tell when I get a new hair style or new outfit or my kids have a stain on their clothes. Is she blind or NOT?!”

Cataracts are a big problem but a largely treatable condition. By age 80, more than half of all Americans have a cataract (National Eye Institute). This is terribly costly for our country, but not as costly as injuries and hospitalizations if left uncorrected. A cataract clouds the eye’s lens and is the leading cause of vision loss in the United States. An estimated 20.5 million (17.2%) Americans 40 years and older have cataract in one or both eyes, and 6.1 million (5.1%) have had their lens removed operatively. And it is expected to get worse, increasing to 30.1 million by 2020. There is treatment for cataracts but unfortunately not everyone gets it. Lack of insurance and lack of awareness means that those that need treatment often don’t get it.

Macular degeneration is a more serious condition for women.

“It is not easily treated”, attests Ms. Hershberg. “It affects areas of one’s visual field”. But there are other conditions, she adds, “I’m also worried about the epidemic of diabetes and the subsequent loss of vision as a consequence of poorly managed diabetes. And retinal detachments or retinal tears which can occur as a result of falls or injuries and vision loss caused by a stroke.” 

Bad eyesight due to reduced visual acuity occurs in one of every six seniors over 80 years of age. These folks need glasses. And why doesn’t this happen? Once again, there is no national coverage for glasses. So the very people who need it most; who have to do more for themselves due to their limited financial situation, can not turn to Medicare or MediCal for routine eye care.

This disconnect in Medicare coverage largely occurs because it is not set up to prevent expected disabilities such as poor vision. In May 2010 the Academy of Ophthalmology responded to research from the Los Angeles Latino Eye Study that showed Latinos have higher rates of visual impairment, blindness, diabetic retinopathy and cataracts than non-Hispanic whites. In just the first 5 hours nearly 500 people were screened for eye disease and impairments.
 

And the government knows that 23% of adults over 85 have difficulty seeing (per Federal Agency Report, 2008). So the experts know, the government knows and the people know. So let’s consider this.

Your mother’s and grandmother’s eyes are changing but their homes have not. A home once thought of as a sanctuary and the family castle may be more like a dungeon. Lighting is especially overlooked as a necessary modality for remaining independent. Too bright light is uncomfortable, but the transition from bright to dark is hazardous. All those endless hallways in the family home or narrow stairways up to the add-on second floor – great memories from your childhood – but still have just a single light bulb for illumination creating shadows and hazards.

Bella’s home was mired with traps. The house had not aged as gracefully as the homeowner. Frankly, it is amazing she hadn’t fallen before. Expensive but now worn carpeting poised a constant tripping danger. Furniture low to the floor, stylish in its day, was now a hazard.

And of course she hadn’t had an eye exam in years.

So her fall wasn’t inevitable. In fact most falls are preventable. We can change this – it may be the cost of a light bulb. Or it may be giving the gift of an eye exam or glasses.

So this mother’s day give the gift that keeps on giving, light bulbs – have you checked your mom’s house to see if any need changing. Dimes to doughnuts they do. Have you littered the hallways and paths with nightlights? Is the light illuminating the pathway (the right answer) or the wall (the wrong answer?)

Check out where your mom organizes her medications. Is it well lit? Is there a magnifying glass close at hand? Is there a dark surface that she can view the pills on?

Here are a few other ideas: take your older parent to a falls prevention training program, provide housekeeping services to keep the pathways uncluttered, put frequently used items in a consistent place.  And finally, get the seniors an eye exam.

Will they be resistant to these changes?  Yes, they probably will put up a bit of a fuss. Their determination is one of your mother’s or grandmother’s strength but just as when you were a child, you found ways to get what you wanted. I’m sure with loving; thoughtful planning you can start this process.

Local Long Beach area resources:

St. Mary’s Foundation Low Vision Center. The Center is located on the second floor of the Parr Health Enhancement Center, 1055 Linden Avenue, the building directly across from the main hospital. The Center can be reached at (562) 491-9275. The Low Vision Center provides FREE services to the Southern California community and helps persons with limited vision enhance their vision to its fullest potential. The Center also helps individuals with low vision to achieve the greatest degree of independence possible regardless of their visual loss

Heart of Ida. a local non-profit dedicated to preserving independence for older adults has installed hundreds of light bulbs in senior’s homes. Their well trained repair techs may have gone to improve the safety of the bathroom or the entry but find in almost all cases burnt out light bulbs, non-working switches and worn plugs. Heart of Ida offers evidence-based fall prevention training to older adults throughout the city of Long Beach. For more information call (562) 496-4734 or info@heartofida.org to get more information about their programs please go to www.heartofida.org

Teri Hershberg, MPA - Long Beach low vision expert may be reached at teri601@hotmail.com.

Disabled Resources Center Inc. of Long Beach (DRC) - The services offered by Disabled Resources Center evolved from giving information and referrals, to providing over sixteen services to thousands of people each year in the cities of Artesia, Avalon, Hawaiian Gardens, Lakewood, Long Beach, and Signal Hill.

Most of the staff members are people with disabilities, as are the members of the Board of Directors, who provide positive role models for other people with disabilities. The mission of the agency is to empower people with disabilities to live independently in the community, to make their own decisions about their lives and to advocate on their own behalf.

Contact the DRC at (562) 427-1000; TTY: (562) 427-1366 info@drcinc.org;. The DRC is located at 2750 E. Spring Street, Ste #100, Long Beach, CA 90806

Long Beach VA Medical Center: Services for Veterans of the Armed Services – Male or Female with a Visual Impairment

The Visual Impairment Services Team (VIST) Coordinators are case managers who have responsibility for the coordination of services for visually impaired Veterans and active duty Service members.  VIST coordinator duties include providing and/or arranging the provision of appropriate treatment in order to enhance functioning such as making referrals to Blind Rehabilitation Centers, Blind Rehabilitation Outpatient Services, and low vision clinics.  Other VIST coordinator duties include identifying newly identified individuals who have disabling visual impairment, providing counseling, problem resolution, arranging a review of benefits and needed services, and conducting educational and outreach programs relating to VIST and blindness.

Veterans and eligible active duty Service members should contact the VISUAL IMPAIRMENT SERVICES TEAM at  the Long Beach VA Medical Center located at 5901 E. 7th Street, Long Beach, CA 90822 or call 562-826-5696 please leave a voice mail message include your name, phone number, and best time to reach you. Your call will be returned! Their website is http://www.va.gov/BLINDREHAB/VIST.asp

Dayle McIntosh Disability Resources Center - Dayle McIntosh Center helps people with disabilities live independently and succeed in every area they desire. The Center is not a residential program, but a consumer-driven organization that provides a broad menu of on-site and remote services. Their mission is to advance the empowerment, equality, integration and full participation of people with disabilities in the community. The Center is located at 13272 Garden Grove Blvd., Garden Grove, CA 92843, (714) 621-3300; TDD (714) 663-2087 and at http://daylemc.org

Center for the Partially Sighted. Headquarters are located in Culver City with several branches around greater Los Angeles. The Center’s mission is to provide the tools and techniques that maximize the ability of partially sighted children and adults to live successful and independent lives. For more information call (310) 988-1970 or find it at www.low-vision.org.

Braille Institute. The Braille Institute has a broad and in-depth range of services and programming. Refer to their information at http://brailleinstitute.org/. Or call 1-800-BRAILLE (272-4553) Monday - Friday, 9 a.m. to 4 p.m. (PST).

 * Photo acknowledgement from GE commercial division

Taking care of business

When You are a Senior - Falls May Be Unexpected 

But They Should Not Be a Surprise! 

This is my pitch for Fall Prevention Month 2012.  I could cite all the statistics and seriousness of falls over the age of 65. However, falls are just plain bad and frankly embarrassing, which is why people don't take care of the problem. That is, under reporting and reluctance to act.

I'm privileged to be associated with the Fall Prevention Coalition at USC's Gerontology Center and Heart of Ida, Long Beach.  Both are working to reduce the rate and severity of falls. Will we succeed?

To do so would mean we'd have to take care of business - now.