Mature couple in warrior yoga position. Side view. Horizontal.
Most people take good balance for granted and don’t even think twice about activities such as walking from a sidewalk onto the grass, leaning over to tie their shoes, or getting out of bed in the middle of the night.
However, for people who have poor balance, normal activities can be extremely challenging and often dangerous. Symptoms that accompany impaired balance can include dizziness, vertigo, visual problems, hearing problems, nausea, fatigue, and difficulty with concentration and memory. And balance problems often become prevalent in older adults, for a variety of reasons – medication side effects, chronic health conditions, ambulation problems, and more.
Balance is the ability to maintain your body’s center of mass over its base of support. A properly functioning balance system allows us to see clearly while moving, determine direction and speed of movement, and make necessary adjustments to maintain stability and posture during different conditions and activities without conscious thought.
Balance relies on a complex set of body’s systems, including the following sensory input:
Our eyes help us adjust our body’s position and movement, so we can move around obstacles in our path.
Nerve receptors in the inner ear are sensitive to movements and help control motion, equilibrium and spatial orientation.
Proprioception or touch
Receptors called “proprioceptors” in the skin, joints, ligaments, and muscles receive signals indicating the position and movement of your body.
All three of these information sources send signals to the brain. The signals sent to the brain are then sorted and integrated with learned motions. For example, we know how to navigate an icy sidewalk and adjust our movements due to our learned memory.
You need sensory input, integration of that input, motor control, and muscle strength to maintain stability, during both purposeful movements, such as lifting yourself out of a chair, and reflexive ones, such as recovery from a trip over a curb. Injury, disease, neurological disorders, certain medications, and advancing age can affect all the systems involved in balance.
Nightingale’s Vestibular Rehabilitation Therapy (VRT) is designed to help patients with imbalance, vertigo, dizziness, or movement sensitivity related to many different conditions. The inner ear, or vestibular system, plays an integral role in the control of posture and balance. Deficits in the vestibular system may result in decreased independence, loss of balance, the inability to perform activities of daily living, in addition to increasing the patient’s fall risk.
It’s important to learn the facts behind these senior psychotherapy myths.
Change can be hard for all of us, but consider for a moment the depth of change experienced in aging. The elderly encounter changes in health, in self-identity, in their roles and responsibilities and relationships with others. Loss of friends and loved ones becomes more common, along with loss of physical ability and sometimes mental acuity.
One of the best ways to adapt to change is through counseling; yet sadly, senior psychotherapy is disproportionately underutilized. In fact, as few as 3% of licensed psychotherapists have received specialized training in geriatric counseling. There are three main myths surrounding counseling for the elderly that our Scottsdale respite care experts want to debunk in order to help more families consider seeking psychological care for the seniors they love:
Myth #1: The elderly are too “set in their ways” to benefit from counseling.
Some of the many beautiful qualities that develop as we age include increased wisdom, maturity, character, and authenticity. While some older adults may exhibit some measure of stubbornness, it’s often a defense mechanism, indicating an underlying issue that should be addressed. A professional counselor can help the senior gently peel away the layers of pain and loss to uncover the root of the problem and provide effective coping skills.
Myth #2: Because the elderly are nearing the end of life, senior psychotherapy isn’t worth the time invested.
The truth is, none of us know how many days we have left to live – and yet we all should have the opportunity to live each of those days to the fullest. Every older adult has a rich history, a story to tell, and struggles that have either been overcome or are continuing to hinder their ability to experience the inner peace and joy they deserve; and senior psychotherapy is a great way to help the elderly come to an acceptance of their past and to set and achieve future goals.
Myth #3: The difficulties experienced by some older adults are insurmountable – and counseling won’t help.
Even with debilitating, chronic conditions such as Alzheimer’s disease, a trusted, professional psychotherapist can meet the senior in his or her own reality, providing comfort, reduced feelings of isolation, and ability-appropriate mechanisms to achieve a higher quality of life.
At Nightingale Homecare, we believe in a holistic, whole-person approach to care that addresses both the physical and emotional needs of seniors. Our experienced Scottsdale respite care team is on hand to help families find the resources they need, including senior psychotherapy care, in addition to our full range of in-home services such as:
Most seniors experience vision change, making them twice as likely to experience multiple falls as those with normal vision.
People with vision loss are almost twice as likely to experience multiple falls as those with normal vision. For those with vision loss, everyday tasks such as grocery shopping or navigating crowded spaces can be a source of anxiety. Limited vision also may mean risking a fall away from home, leading many to become homebound and isolated.
Changes in Vision as We Age
Most seniors experience the following normal vision changes that are associated with the aging process. In addition, there are age-related eye conditions that will result in vision impairment.
Increased need for light:
This is a result of a smaller pupil and aging lens. A senior requires four to ten times more light than a younger person.
Reduced visual acuity:
After age 60, our ability to see clearly declines. This makes it hard to see steps, or you may not be able discern a curb at the end of a sidewalk. If you have reduced visual acuity, you may be more sensitive to glare.
Increased sensitivity to glare:
Even though you may need a brighter light source than a younger person, your vision can be reduced by glare. Examples include sunlight shining through a window then reflecting off shiny surfaces, glass tables, waxed floors, or bright light from unshielded bulbs.
Difficulty adapting to light and dark:
You may not be able to adjust to different light levels, especially in low light. This makes walking to the bathroom at night a significant fall risk.
Reduced contrast sensitivity:
A loss of sensitivity to detect contrast effects your ability to recognize objects or faces, textures and patterns.
Decreased depth perception:
You may find it difficult to determine how close or how far away an object is. This makes the detection of how high or low a step is very difficult. You may have trouble estimating the height of a step and misplace your foot, leading to a trip or fall. You may think that carpet is uneven and alter your balance and walking to accommodate the misperception. It also makes it difficult to perceive objects in areas of shadows, low light or bright lights.
Seeing spots that block central vision due to age-related macular degeneration:
This makes it hard to detect obstacles in your path, and difficult to walk across streets or a parking lot.
Decreased visual field due to glaucoma:
Your peripheral vision is very important to driving or walking. If you have peripheral field loss and are looking straight ahead, your lack of peripheral vision will not alert you to dangers coming at you. People with peripheral vision loss also experience night blindness, meaning vision might okay during day but impaired at night.
Visual changes due to medications:
Evaluate all medications with your health care team when you notice changes in vision. Even medications you have been on long-term may be affecting your vision.
Ways to Reduce Your Risk of Falls Due to Vision Changes
You want to be able to move about confidently and safely and to detect dangerous obstacles such as tripping hazards, stairs, curbs, moving vehicles, or people in enough time to react safely.
View Falls as Controllable
For those with vision loss, falling may be inevitable. Knowing this keeps many feeling like it’s too risky to leave the house. Learning how to recover from a fall unassisted can help alleviate fear and regain the confidence to leave the house again.
Correct problems with new glasses and keep them clean at all times.
Optimal lighting conditions include more than one light source in a room and higher wattage light bulbs.
Use even lighting throughout home.
Install night lights to navigate in dark rooms and hallways.
Use natural light from windows.
Give yourself extra time to adjust when going from a well-lit to a dimly-lit room.
Pause to adjust to the change between dark to bright environments.
Do not wax your floors.
Wear sunglasses outdoors.
Avoid directly facing the sun.
Cover bulbs with a shade.
Stairs: Use bright, non-skid paint or tape to contrast the edge of each step.
Floors: Use colored tape across thresholds when floors are of different heights.
Furniture and Carpeting: Remove clutter and keep pathways clear. Selecting contrasting colors or patterns in furniture and flooring can help.
Improve Bathroom Safety
Install grab bars.
Use brightly colored rugs that are secure on the floor with rubber non-skid backings.
Low Vision Rehabilitation Evaluation
Studies show that people start losing independence when their corrected visual acuity drops to 20/60 or worse. Most health insurances cover low vision rehabilitation examinations. A low vision specialist can evaluate the degree and type of vision loss you have, prescribe appropriate low vision aids, recommend non-optical adaptive devices, and help you learn how to use them.
Finding a Low Vision Specialist
To find a low vision specialist near you, go to www.whatislowvision.org and click on “find a low vision specialist.”
If You Do Not Have Insurance Coverage
EyeCare America, a public service foundation of the American Academy of Ophthalmology (AAO), has several programs designed to meet the needs of those who don’t have vision insurance. To find out more about EyeCare America’s programs, call (877) 887-6327. If you are eligible, you will receive the name of a volunteer eye doctor in your community, along with instructions for making an appointment.
September is National Yoga Awareness Month, and the benefits of yoga, regardless of a person’s age, are phenomenal. Yoga for elderly adults, when combined with other healthy lifestyle habits such as diet and exercise, has been shown to minimize hypertension, strengthen bones, and help with weight loss. It may even reverse heart disease, according to one study.
Yoga for elderly adults can be extremely beneficial.
At Nightingale Homecare, providers of the highest quality senior care Phoenix, AZ and the surrounding area have to offer, we love helping the older adults in our care engage in ability-appropriate yoga. In addition to enhanced physical health, yoga for elderly adults can also improve memory, boost the senior’s mood and outlook, and reduce anxiety.
Half Chair at the Wall: Stand about 12” from a wall, with the back touching the wall. Lift the arms forward and up over the head, facing the palms toward each other, and then slowly bend the knees and squat towards the floor, until a seated position is achieved about halfway to the floor. Hold while taking five breaths, and then stand and repeat.
Warrior: Stand and place feet hip-width apart, while the right foot is held still, bend the right knee to a right angle, and shift the left foot back about 3 feet, pointing the left toes out to the side. Raise the arms straight up near the ears and look up. Hold for three breaths, return to standing straight on both legs, and repeat.
Cobbler’s Pose: From a seated position with legs spread out and the spine straight, bend the knees and bring the feet up toward the pelvis area, with soles touching. Press the elbows against the thighs, coaxing them closer to the floor (without causing any discomfort or pain).
Alternate-Nostril Breathing: Place the tips of the right index and middle fingers between the eyebrows, and then place the thumb on the right nostril and the ring and pinky fingers on the left nostril. While pressing the thumb against the right nostril, breathe in through the left nostril. Alternate for the next breath, and repeat for five minutes.
Let Nightingale Homecare help the seniors in your life maximize health and quality of life! Our care team is always available to provide the encouragement and motivation for older adults to engage in yoga and other exercise programs, along with a wide range of personalized medical and non-medical in-home care services. To learn more about our services in senior care in Phoenix, AZ and the surrounding areas, call us at (602) 504-1555 at any time!
Learn more about the importance of hydration for seniors.
The importance of hydration for seniors cannot be overstressed. In an older loved one, dehydration can occur rapidly and be life-threatening. Many older people often are not as quick to feel thirst as younger people are, so they may not be drinking enough ﬂuids to begin with. This, combined with health concerns that might cause your loved one to reduce her ﬂuid intake, puts the older person at high risk for dehydration.
When you are caring for an elder loved one, offer a drink of water every time you interact with him or her, and make sure she always has fresh water within reach. However, be aware that even when offered water, many older people will say, “I’m not thirsty” or, “I’ve already had too much to drink today.” You may need to be persistent in encouraging your loved one to regularly drink water.
Fluid balance occurs when the amount of ﬂuids a person takes in equals the amount of ﬂuids the person loses. Each day, we lose ﬂuid in the form of urine, sweat, bowel movements and breath vapor. To maintain a state of ﬂuid balance, we must take in enough ﬂuid each day to equal, or balance, these losses. When ﬂuid balance is not maintained, your loved one may develop either dehydration (too little ﬂuid in the body) or edema (too muc h ﬂuid in the body).
Dehydration can result from conditions such as vomiting, diarrhea, fever or severe blood loss. A very common cause of dehydration, however, is simply not drinking enough ﬂuids. Many elderly people have conditions that put them at risk for becoming dehydrated. For example, a person who has problems with mobility or other disabilities may have a difﬁcult time getting up to get a drink. Your loved one may also cut back on ﬂuids because she is trying to reduce the number of times she needs to get up and go to the bathroom, or she is afraid that she will not be able to make it to the bathroom in time. Some seniors who are incontinent may also reduce their ﬂuid intake because they think this will lower their risk for having an episode of incontinence. However, it is important to know that decreasing ﬂuid intake does not decrease incontinence, nor does it decrease trips to the bathroom. In fact, the opposite may be true. As the urine becomes more concentrated, it irritates the bladder and may increase the urge to urinate, resulting in the need to urinate more frequently.
As your loved one’s caregiver, you will play an important role in helping to ensure that she takes in enough ﬂuids. Here are some tips to encourage fluids:
Frequently offer ﬂuids that your loved one likes at the temperature she prefers.
Encourage her to drink plenty of ﬂuids with each meal.
Frequently provide your loved one with a pitcher of clean, fresh water. Encourage her to drink each time you enter the room.
Be sure she has a clean drinking glass or cup within easy reach. Reﬁll the glass if she cannot do it. A drinking straw or a plastic water bottle with a screw-on lid and a straw may make it easier for some people to drink independently.
If she frequently refuses beverages, offer ﬂuid-rich foods instead, such as ice cream, popsicles, gelatin or fruit.
If your loved one becomes dehydrated, her physician may give an order to “encourage ﬂuids” or “push ﬂuids.” This means that she should be urged to drink as much ﬂuid as possible. Encourage her to drink each time you enter the room and again on your way out. Keep a record of the amount of ﬂuid your loved one drinks and record the total for the day on the flow sheet for her physician and for your reference.
Be on the Lookout!
Dehydration is a serious condition. If you suspect that your loved one is dehydrated, contact her physician immediately. Signs and symptoms of dehydration include the following:
Poor skin turgor (the skin does not return to its normal shape when gently squeezed or pinched)
Passing of small amounts of dark-colored urine
Very dry skin or chapped lips
Edema, or the state of retaining too much water, can result from medical conditions (such as chronic heart failure or kidney disease) that make it hard for the body to rid itself of excess water. Your loved one’s physician may place restrictions on the amount of ﬂuid she is allowed to have each day.
When you are caring for a loved one and ﬂuid restrictions are in place, the physician will tell you how much ﬂuid she is allowed to have over the course of the day. Offer small amounts of ﬂuid at regular intervals. This will help to prevent your loved one from becoming too thirsty.
Measuring and Recording Fluid Intake
When orders to encourage or restrict ﬂuids are in place, you will need to measure and record your loved one’s ﬂuid intake. A person’s ﬂuid intake includes all of the liquids she drinks, as well as foods that are primarily liquid (such as soups) or that are liquid at body temperature (such as ice cream or popsicles).
Although in everyday life ﬂuids are usually measured in ounces (oz), in health care, ﬂuids are measured and recorded in milliliters (ml) or cubic centimeters (cc). A milliliter (ml) is equal to a cubic centimeter (cc). One ounce equals 30 milliliters or 30 cubic centimeters.
With prepackaged items, printed information on the container indicates how much it holds. For example, a small prepackaged milk container contains 8 ounces, or 240 ml (remember, there are 30 ml in an ounce). In other cases, you will need to determine how much ﬂuid the container holds. When you are caring for your loved one and need to measure ﬂuid intake, you can determine the amount of ﬂuid your cups, glasses and bowls hold by ﬁlling them with water and then pouring the water into a measuring cup.
To measure and record ﬂuid intake, observe how much ﬂuid your loved one consumes at each meal and in between meals. For example, if she had 8 oz (240 ml) of milk, 4 oz (120 ml) of coffee and 12 oz (360 ml) of soup with lunch, you would record her ﬂuid intake at lunch time as 720 ml. Then, if she had another 8 oz (240 ml) of tea in between lunch and dinner, you would record her ﬂuid intake as 240 ml.
Sometimes your loved one may not consume all of the ﬂuid in the container. In this case, estimate how much of the total was consumed. For example, if she only drank about half of her coffee at lunch, you would estimate the amount to be 2 oz (60 ml) instead of the full 4 oz (120 ml).
Remember the Importance of Hydration for Seniors – Nightingale Homecare Can Help!