Celiac disease can wreak havoc on your diet and your taste buds. But nutritionist Tricia Thompson shows that one need not sacrifice nutrition or flavour. Her well-indexed and extensively-referenced text provides information about the disease, as well as assistance with identifying gluten-free products and ensuring nutritional integrity. Best of all, she’s focused on taste, so you can be certain her recipes provide the best of both worlds.

www.mhprofessional.com

Visit seniors.gc.ca to learn more.

Did you know that 1 in 3 people over the age of 65 fall at least once every year? Exercising three or more times per week will help to combat falls by increasing muscle strength and balance.

Preventing a fall is important. Falling can result in serious injury, reduced muscle function and possibly loss of independence – something we all value!

With the warm weather coming, it’s important to keep your balance while you enjoy your favorite outdoor activities. Some tips to help with balance include:

• Warm up – stretch your legs before walking, running or gardening
• Wear shoes that lace up, support your foot and grip the ground
• Watch your step – be aware of surroundings and watch for tripping hazards
• Slow down and concentrate on the task at hand
• Avoid uneven surfaces
• Maintain your base of support – standing and walking with feet slightly apart improves stability
• Use a cane or walker if recommended by a health care provider
• Consult a physiotherapist for simple exercises to improve strength, balance and endurance

Saint Elizabeth is an award-winning not-for-profit and charitable organization. Our team of more than 6500 nurses, rehab therapists, personal support workers and crisis intervention staff deliver nearly five million health care visits annually.

• One in 10 adults and one in 12 children will contract an infection while in a Canadian hospital.
• Canada’s healthcare-associated infection rate is nearly 12 per cent, one of the worst among developed countries (the figure is approximately 10 per cent in the US and UK, and 6.7 per cent in France).
• In 2003, there were 220,000 hospital-acquired infections in Canadian hospitals, resulting in 8,000 deaths.

My message is this: stay away from hospitals unless absolutely necessary—especially if you’re an older adult.

An alert for the frail elderly

The risk of acquiring an infection is higher in frail elderly people, who often present with a weakened or compromised immune system. They may enter hospital for treatment or observation of a condition that we consider untreatable in a physician’s office and succumb to a hospital-acquired infection. The introduction of an infection not only increases the length of their hospital stay, but also decreases the possibility of recovery from the original disease.

The offending bacteria

At the moment, four major hospital-acquired bacteria are currently in circulation:

• Clostridium difficile, an intestinal bacterium.
• FRI, a respiratory-based illness.
• Methicillin-resistant Staphylococcus aureus (MRSA), a skin and lower intestinal bacteria.

• VRE, a lower intestine, blood, urine and skin-based bacteria.

These bacteria are resistant to standard antibiotics, and are most often transmitted by simple and often avoidable contact.

Main routes of transmission

Infections are spread by poor housekeeping and direct physical contact from hospital staff as they perform procedures on a patient and neglect to use accepted hygiene practices, the most effective of which is proper handwashing. Medical and hospital staff who travel between patients are a means of spreading pathogens. Essentially, the staff act as carriers.

The main problem is that once an infection has spread through the body, antibiotic treatments that can work in an otherwise healthy person may not be effective in a frail patient with an impaired immune system.

It is my observation (and I spend hours in hospitals ensuring that events happen and medical staff are available for questions) that hospital personnel travel too frequently between patients, units and other hospitals and easily become vectors for the transmission of germs. And then there’s “musical beds.” Patients are frequently transferred between different areas of the hospital while they wait for procedures, treatments or to be admitted. The most offending areas are hubs such as the emergency department, operating rooms, intensive care and step-down units. Most recently, a client was transferred seven times during her hospital stay. To the horror of her family, she succumbed to C. difficile following successful surgery and died in the same hospital within weeks.

How can infection be prevented?

All hospitals have sanitation protocols regarding uniforms, equipment sterilization, washing and other preventative measures. Thorough handwashing (or use of alcohol rubs) by medical personnel before and after each patient contact is one of the most successful preventative measures in combating hospital-acquired infections. Equipment sterilization, patient isolation and appropriate cleaning with bleach are additional effective tactics. Simply put, prevention is achieved by scrupulous infection-control procedures—which, unfortunately, are often not followed in the rush to provide care.

More careful use of antibiotics is also considered vital to reducing the presence of resistant bacteria, along with the possible consideration of probiotics to replace healthy bacteria in the bowel.

Best practice should probably dictate that all patients are in single rooms, thus providing a physical barrier to infections and a constant reminder to staff of isolation practices. Let’s hope that all new hospitals are designed with this in mind!

Too little, too late

An often overlooked issue is the nutritional status of patients and how this influences resistance to infection. Many patients who stop eating because of sickness are often left far too long before the situation is rectified. The intervention of a dietician, use of calorie counts and prompt addition of additional calories through dietary supplements cannot be overemphasized. If necessary, the option of a nasogastric or gastric feeding tube may need to be explored sooner rather than later.

Managing hospital stays

The lessons to be learned are as follows. First, stay out of hospital if at all possible. Second, if you must check in, keep your wits about you as you interact with both the environment and the staff. And third, don’t be afraid to speak up if you feel that stringent infection-control procedures are not being followed

First Steps Out of: Anxiety

By Dr. Kate Middleton

Anxiety is a normal, human response to problematic situations. Unfortunately, it can also reach a point at which it seriously interferes with day-to-day activities. Dr. Middleton’s myth-busting and interactive guide clearly describes the biological origins of this reaction, points out problematic behaviours (such as avoidance), and outlines the steps that will put those who are suffering from chronic anxiety on the road to recovery. The First Steps series also addresses eating disorders, depression, problem drinking, problem gambling, and bereavement.

www.lionhudson.com

Figuring out what’s what and who’s who

A geriatric emergency management nurse, provides specialized frailty-focused nursing services in emergency departments. Seniors represent as many as 30% of the patients seen in emergency departments, more than any other age group. Illness complexity, hospital admission rates, lengths of stay and risk of functional decline are all high for seniors. Indeed, emergency department visits are often sentinel events for seniors, threatening loss of independence, health and well-being. By providing specialized frailty-friendly services, decline and loss of independence can often be prevented or postponed.

An intensive care unit, critical care unit, intensive therapy/treatment unit or high dependency unit is a specialized department in a hospital that provides intensive care medicine. A geriatric intensive care unit is a special type of unit dedicated to the management of critically ill elderly patients. The goal of this unit is to restore physiologic stability, prevent complications, maintain comfort and safety, and preserve pre-illness functional ability and quality of life in older adults.

A step-down unit is a hospital nursing unit that provides care intermediate between that of an intensive care unit and a normally staffed in-patient division, such as a medical unit.

A personal support worker is trained “care aide.” The personal support worker may observe and report clinical and treatment information, assist with range-of-motion exercises and other rehabilitative measures, take and record blood pressure, temperature, pulse, respiration, bodyweight and height, assist with ambulating and mobilization, and help with personal hygiene.

Licensed practical nurses and registered practical nurses are regulated healthcare professionals who work in partnership with other members of the healthcare team to provide nursing services to individuals, families and groups of all ages. Licensed practical nurses assess, plan, implement and evaluate care for clients throughout the life cycle and through palliative stages. They do not administer intravenous medicines or give injections or narcotics. They can take basic vitals, give routine medicines and provide basic care.

A registered nurse is a nurse who has graduated from a nursing program at a university or college and passed a national licensing exam. A registered nurse can administer intravenous medicines, give injections including narcotics and perform admission assessments. These nurses will often assume an administrative role regarding staff management, compliance and reporting.

Occupational therapy treatments that develop, recover or maintain clients’ activities of daily living. The therapist helps clients not only to improve their basic motor functions and reasoning abilities, but also to compensate for permanent loss of function.

A physiotherapist or physical therapist provides physical rehabilitation and pain relief. A physiotherapist assesses a patient’s physical abilities and needs, and develops an individualized treatment plan including therapeutic exercise, manipulations, massage and education.

Speech-language pathologists have expertise in assessing and intervening for typical disorders of communication and swallowing, such as prevention, counselling, treatment, consultation, management, rehabilitation and education.

A dietitian is a healthcare professional who focuses on proper food and nutrition to promote good health. The goals of dietitians are to provide medical nutritional intervention to address medical issues involving dietary intake.

Social workers help people function in their environments, deal with their relationships, and solve personal and family problems. Geriatric social workers try to improve the quality of life for senior citizens and help alleviate some of the negative aspects of aging.

Physical medicine and rehabilitation, physiatry or rehabilitation medicine is a branch of medicine that aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. The objective of rehabilitation is to transition a patient from an illness to recovery, with physical, emotional, social and spiritual components. The process is initiated in the rehabilitation hospital and continues after the patient is discharged back to the community.

Complex continuing care or chronic care units provide continuing, medically complex and specialized services in hospitals for patients with long-term illnesses or disabilities requiring skilled, technology-based care that is not available at home or in long-term care facilities. These units provide patients with room, board and other necessities, in addition to medical care.

 Pat M. Irwin, BA, AICB, COCA, is president of ElderCareCanada and a certified mediator.

Having a loved one in hospital is one of the most stressful experiences a caregiver can have. It’s often fraught with fear, confusion, frustration and disappointment—but it can also be a productive learning experience that enhances a senior’s life. What makes the difference?

Successful hospital experiences have common factors:

• Comprehension—of who does what in the hospital universe.
• Confidence—to ask questions of the “experts.”
• Continuity—despite changing units, staff and routines.
• Communication—effectively requesting, receiving and understanding information.
• Cooperation—how to work as a team member.

To illustrate these concepts, let’s follow a patient on his journey and look at different scenarios in the hospital experience.*

Roy Gilbert, 80, is divorced and was living alone in his suburban bungalow. He managed fairly well with frequent calls from his daughter, Sheila, who lives 90 minutes away, and a helpful next-door neighbour. Climbing the stairs from the laundry room one day, Roy slipped on a stair, pitched forward on his face and rolled face-first down the stairs, landing at his back door. Two days later his neighbour noticed the newspapers on the porch, tried her back-door key and immediately discovered an unconscious Roy. The neighbour called 911, then Roy’s daughter, and his adventure began.

Scenario one

Dad was alone in his house when he fell. When the neighbour found him, he was rushed to the hospital.

In the emergency department, Roy was seen by a geriatric emergency management (GEM) nurse.

The GEM nurse spent extra time with Roy until he was stabilized. When his daughter, Sheila, arrived, the GEM nurse explained that a diagnosis of cerebral stroke had been made and immediate surgery was scheduled to repair the blood vessels and reduce the bleeding. She explained that tests would be done later to determine the extent of brain damage, and that after surgery Roy would be moved to the intensive care unit (ICU) for observation. Since at this point Roy was barely conscious and unable to speak, Sheila was very anxious to learn as much as possible from the nurse. She was greatly reassured by her comprehension of the upcoming process.

Roy’s surgery was successful and he was moved to the ICU while his recovery was monitored. Sheila maintained watch in the waiting room until the charge nurse in the unit advised her to go home for a rest and change of clothes—Roy would be there for 12–24 hours, and then moved to a step-down unit on another floor.

After a few days of keeping in touch by phone, Sheila went to Roy’s room to find he had been moved to a medical unit—that must be a good sign! She found him in a chair, hooked up to tubes but conscious. He recognized her and tried to wave, but was unable to move his right arm. Roy seemed unable to speak, merely grunting. Sheila unpacked his clothes and went hunting for some answers.

Scenario two

I stood at the nurse’s station for 15 minutes and no one even looked up from their computer screens. How can I find out what’s happening with Dad’s care?

Finally, someone did give Sheila some attention and asked her to return to Roy’s room where someone would come to see her. A young woman eventually arrived, name-tagged “Julie, personal support worker.” When asked if she was “the nurse,” Julie replied no, but that the licensed practical nurse (LPN) would be in soon and the registered nurse (RN) would be giving him a shot later.

Susan, the LPN, arrived with a number of pills and a blood pressure monitor. “We’re very glad you’re here—I’ll send the patient care manager in to see you.” The patient care manager, who is usually an RN, is responsible for all aspects of planning, organizing and directing the delivery of patient care services within hospital care units. She assesses all incoming patients for their requirements from the care team, which includes nurses, physiotherapists, occupational therapists (OTs), speech pathologists, psychologists, dieticians, recreation therapists and social workers. These team members interview new patients to identify goals, which are then assigned a tentative achievement date. These goals may seem deceptively simple—”sit alone on edge of bed for one minute”—but they are challenging and meaningful to the patient. The team meets weekly to discuss progress, share information and make any adjustments. After their initial meeting, Sheila quickly realized that the patient care manager was going to be her number-one ally in obtaining information about her dad.

Over the next few days, Roy began to meet his care team.

Karem, an OT, worked to adapt activities to meet Roy’s changed abilities.

Continued on page 2

Five tips for clearing clutter

1. Trays are useful for everyday belongings.
2. Jars are good for items found on desks, kitchen counter tops and in the bathroom.
3. Bins work for mismatched objects around the house.
4. Cubbies and stack-up bins can hold anything from shoes to books and are kid friendly.
5. Hooks can be placed anywhere for an instant storage unit. Use them for whatever you can imagine.

Source: www.about.com