Archive for the ‘Ambulation’ Category

Posted on October 11, 2010 - by Nurse Virginia

FOR THE ELDER MOVING INTO A NURSING HOME MAY BE SYNONYMOUS WITH BECOMING WHEELCHAIR BOUND

Is it now standard practice that you move into a nursing home, you are immediately assigned a wheelchair? When you visit a nursing home, how many elderly people do you see still walking?

It may start on admission, where the wheelchair just seems to come with your room. Or it may begin when you are just too slow for the staff, so when walking any distance, they automatically say “Let’s get you a wheelchair.”

Years ago in “old school nursing” (see confessions of an old nursing home nurse on this site) we must have had 95% of our residents (they were patients then) in wheelchairs. But those were the days when Medicare didn’t pay for therapy for persons with Alzheimer’s disease. Now everyone is eligible for benefits from therapy to help them continue to walk.

When you take an elderly person who can still walk, and sit them in a wheelchair they will:

• Become weaker – not using their muscles can contribute to weakness very fast
• Become helpless – every time you do something for an elder that they could do for themselves, you make them helpless
• Become more difficult to care for, the stronger and more flexible an elder is, the easier it is to care for them
• Feel bad about themselves; everyone likes to be able to take care of themselves, as long as they can.
• Lose strength not only in their legs but in their respiratory system, elimination and digestive systems.
• Have an increased chance of developing skin breakdown.
• No longer be treated the same as an independent person who walks. People in wheelchairs always state that people don’t talk directly to them, make eye contact, or talk about them.

Helping an elderly person continue to walk means:

• Walking them from place to place, their room to the shower, their room to the dining room.
• Have the elder sit in different chairs, and on different surfaces throughout the day. Have the elder sit in a dining chair during meals, a recliner watching TV, on a couch during an activity – always varying the sitting options during the day.
• As soon as the elder seems to be having more trouble walking – get the therapy department involved to re-build strength.

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

Posted on June 22, 2010 - by Nurse Virginia

BEST SHOES FOR ELDERLY – KEDS

10 REASONS WHY I LIKE KEDS FOR THE ELDERLY

• Elderly don’t tend to pick up their feet when they walk – they may “shuffle.”
• Thick soled athletic shoes have a “super grip.”
• Thick soled athletic shoes because of the super grip can “catch” on carpet and tile when an elder doesn’t pick up their feet and many times cause a fall.
• Thick soled athletic shoes tend to be heavy shoes, the elderly need to wear a lighter shoe.
• The elderly often lose sensation in the bottom of their feet – maybe due to diabetes or decreased circulation.
• The elderly need to be able to “feel” the floor through their shoes – to help tell them where they are.
• The elderly can better feel the difference between a carpeted surface and a tiled surface through a shoe with a thinner sole
• Keds shoes have a thin and flexible rubber sole so the elderly can feel the floor better through the bottom of the shoe.
• Keds  – “Champion” is the same shoe as their first design in 1916. Improvements in that original shoe increased the ability of the shoe to absorb shock and protect the foot from jars and jolts. (All with the same thin sole)
• Elderly with Alzheimer’s disease need as much information as they can get as to what is going on around them. They even need the information they get from the bottom of their feet, through their shoes.

See also blog: March 18, 2010 – GOOD OLD “KEDS” – BEST SHOES FOR CONFUSED ELDERLY

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

Posted on March 29, 2010 - by Nurse Virginia

THE STROKE – THE FALL WITH FRACTURE – LIFE CHANGES WHEN THE ELDER CAN NO LONGER WALK

Barbara is 82, and has chronic respiratory problems. Her daughter says “Mom does just fine walking with the therapist at home, but when she leaves, Mom can’t walk again.” The ability to walk is so often the difference between staying in your home, and going to a Nursing Home.

A friend of mine just had back surgery, and the doctors told him, there was a 10% chance of his being paralyzed following the surgery. As he lay in bed recovering, he gave quite a bit of thought to those words and how close he had come. His surgery was a success, but what if?

Research and practical experience and observation tell us the tragic consequences of no longer being able to walk are:

• Physical – muscle loss – 3-5% a day
• Physical – Increased risk of edema, decreased blood flow
• Physical – Decrease in appetite
• Physical – Increase in frailty
• Physical – Increase in incontinence and constipation
• Physical – shortening of muscles
• Physical – weakened body functions – decrease in lung capacity
• Physical – Loss of bone density (increase in possible fracture)
• Mental – Experience negative attitude toward people in wheelchair
• Mental – Loss of confidence
• Mental – Increased feelings of uselessness
• Mental – Decreased quality of life

LIFE CAN CHANGE FOR THE CAREGIVER AS WELL

Life will change for the caregiver as well, if the elder can no longer walk. There is increased danger of injury to the home caregiver, who needs to support an elder’s weight when they walk. The caregiver can sustain pulled muscles, back injuries from lifting the elder. A change in socialization, if the elder is too difficult to take out, do to inability to walk.

Do what the Nursing Home does

When the elder needs the assistance of one caregiver to walk, they can continue to walk safely and independently while re-building strength, in an ambulation device. A good one is the Merry Walker, an all American made product. Merry Walker makes walkers for the home as well as Nursing facilities. If the elder maintains the ability to stand up from a seated position and walk with one caregiver, they may be a candidate for a Merry Walker Ambulation Device.

The Merry Walker is made from tubular steel for strength, and is black powder coated to help the person with visual impairment. The  tubing design, creates four sides of support for the elder. Each walker has a padded seat and casters so the elder can roll independently wherever they wish, with the security of the seat right behind them at all times. No longer do they need to turn around before they sit. Elders who continue to walk will be stronger, more independent and happier.

Go to: www.merrywalker.com to see the wide variety of supportive walkers the experts use.

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

Posted on March 18, 2010 - by Nurse Virginia

GOOD OLD “KEDS” – BEST SHOES FOR CONFUSED ELDERLY – REALLY

Feet tell you where you are
Many elderly people like to go barefoot. Why wouldn’t they? We are constantly getting information about where we are through the bottom of our feet. When babies first start to walk, you can actually see their feet curl a little on the floor, as they try to grip the floor with their feet when they walk. They are learning to feel where they are, through the messages they are getting from the bottom of their feet.

When I see a confused elder with heavy athletic shoes, I think of how years ago we forced baby feet into these hard, heavy, clunky, high top tie shoes that they couldn’t possibly have been able to feel the floor through. Now the best baby shoes have thin, soft cushiony soles where the baby can still get information about the floor surface through their feet.

What information are the elderly trying to get through their feet?
Elderly many times lose sensation in the bottom of their feet due to a disease process, such as diabetes. Added to that loss, are the complications of perception for a person with Alzheimer’s disease. The lack of depth perception and ability to see the changes in the surface of the floor. A scatter rug of a dark color can look to the confused elder like a big gaping hole in the floor. Walking from one surface, a smooth surface like a tiled floor, to a carpet area can cause problems.

What’s so great about “Keds”
The “Keds” brand first came out in 1916, over 90 years ago. They still carry the first design they started with, the basic Champion. They have the same thin rubber sole they started with. Improvements came over the years in increased ability to absorb shock to protect the foot from jars and jolts, with the same thin sole. That sole is what is so great about Keds for the elderly.
(You now can even design your own “Champion” go to: www.keds.com)

The confused elder many times just doesn’t pick up their feet as well when they walk. The heavy athletic shoe, with the industrial strength grip sole can grip too much for the elder and cause a fall. Especially when catching on a thick carpet with soles that have a super grip bottom. The elder certainly can’t feel the floor and understand better where they are through, those thick soles designed for the athlete.

Increase the feeling in the bottom of your feet
A simple exercise while you watch TV can be to roll an old tennis ball back and forth under your bare feet. Just put a tennis ball on the floor and roll it forward and backward under the bottom of one foot at a time with your foot. This can increase the flexibility of the foot as well as increase the sensation, on the bottom of the foot.

Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com

Posted on March 28, 2009 - by Nurse Virginia

Caregiver Tips: The confused senior who keeps forgetting their cane or walker.

Very difficult for confused senior to aquire new memory.

It is much easier for a person who has used a cane or walker in the past to use it after they suffer from memory loss. Once the person has used something for a long period of time, they automatically reach for it. The The senior with Alzheimer’s disease who has the most problem forgetting their cane or walker is the person who never used this device before they developed memory loss.

Long remembered body movements.

I remember a man who had long since stopped smoking, who was still going through the motions. He would reach into a shirt pocket and act like he was pulling out a package of cigarettes, but of course the cigarettes were no longer there. He would go through the motions of taking one out, put it in his mouth and light it. Even though this man had stopped smoking years ago, he had gone through these motions so many times, his body kept doing the long remembered motions.

We know that verbal reminders don’t work. Saying “Don’t forget your cane” over and over all day will just frustrate the individual and the caregiver. The individual with Alzheimer’s disease doesn’t want to be reminded all the time of the mistakes they are making.

Use body memory when confused senior forget their cane.

The best thing to do is just repeatedly put the cane or walker in the person’s hands. Build that body memory of having that device in their hands, learning by doing. You can just simply say “Cane” or “Walker” but no more. If you are talking about something unrelated like “Your daughter Sally, is coming for lunch today” while you put the cane in the person’s hand, when they stand up to walk, they still are learning to remember their cane.

Their body is doing the learning for them – and your reminder is putting it in their hands, not what you say.

Posted on March 12, 2009 - by Nurse Virginia

Caregiver Tips: When a elder with Alzheimer’s disease just wants to keep Walking

Walking or wandering the benefits of keeping moving.

 
We are always told the benefits of walking. Walking maintains the tone in your muscles so that you can continue to support yourself. Walking helps your lungs get better air exchange. Now see the healthcare community wanting to get people up very soon after any type of procedure. I just spoke to a granddaughter of a man with Alzheimer’s disease who recently died of pneumonia. She said he just wasn’t getting up anymore, and his last months were in bed.

Walking helps all of the elder’s systems work better.

Walking helps with the process of elimination. Many elderly people are bothered with the problem of constipation. Movement stimulates all body systems to work better.

Walking keeps the heart strong and the blood circulating. The saying goes that anything that is good for the heart is good for the brain. Increasing the circulation also bring more blood to the brain.

Mall walking can help a person release some pent up energy and give the elderly person with Alzheimer’s disease the positive feeling of having worked out. Mall walking also give a person the opportunity to see other people and greet them. Just passing someone and smiling and saying, a cheerful “Hi.” It is a very normal activity that anyone can enjoy – and be good at.