Health Finders

The Health Department has a library of health issues called "Health Finders." If there is a medical condition that you would to know about, call the Outreach Nurse, Nancy, at the Center.

Preventing Falls in the Elderly

By Beth Schuerman, Alaska Injury Prevention Center

Falls are one of the leading problems facing the elderly. Many times injuries from falls lead to permanent disability, limiting a person's active independent life. It is estimated that one-third of all persons 60 years or older suffer from falls each year. Here a few quick facts:

• The risk of falling increases with age and is greater to for women than for men.
• Two-thirds of those who experience a fall will fall again within six months.
• A decrease in bone density contributes to falls and resultant injuries.
• Failure to exercise regularly results in poor muscle tone, decreased strength, and loss of bone mass and flexibility
• At least one-third of all falls in the elderly involve environmental hazards in the home.

With statistics like those, don't we all want to take those extra precautionary measures to protect us from becoming a victim of a fall? The old-population's risk of falling is related to three influences: The normal aging process, higher incidence of chronic illness, and environmental conditions.

• Wear supportive and rubber-soled shoes, and wear ice grippers in the winter.
• Eat sufficient calcium. Postmenopausal women need 1500 mg of calcium daily.
• Get sufficient vitamin D in order to enhance the absorption of calcium into the bloodstream.
• Regularly do weight-bearing exercises to improve strength and muscle tone.
• Limit your intake of alcohol.
• Undertake daily activities in a safe manner, such as reaching and bending properly, and taking time to recover when rising from a chair or bed.
• Use a cane or walker to help maintain your balance.
• Have regular checkups by an ophthalmologist to detect and monitor age-related eye disease such as cataracts and glaucoma.
• Install sturdy handrails on both sides of stairwells.
• Paint the top and bottom stair step to show contrast from the other steps.
• Have adequate lighting at the top and bottom of stairs, and in hallways.
• Know the common side effects of all medicines taken.
• Have a firm chair, with arms, to sit and dress.
• Put in a bedside light with a switch that is easy to turn on and off.
• Clear passageways and stairs of clutter and electrical cords.
• Rearrange furniture so they are not obstacles.
• Secure rugs with nonskid tape; remove throw rugs.
• Install grab bars near toilets and tub.
• Add nonskid mats or appliqués to tubs and shower stalls.
• lf necessary, use a bath bench and/or a rised toilet seat.

There is an increased opportunity for injury in Alaska. Our winters are dark and icy, adding to the incidence of falls and posing additional challenges. It is wise to invest in a pair of ice grippers, designed to slip over the soles of your shoes or boots and having metal spikes, studs or springs that grip the ice to prevent falls. They are available at ASAC and from sports stores and they vary in price but range around $20. This is an investment that very possibly could save you thousands of dollars in medical bills.

If you are a ''walker'', it is importantly remember that Alaska's long hours of darkness add additional dangers for pedestrians. Just because you can see a car, do not assume that the driver can see you. Carry a flashlight with you when out walking and use reflective tape products on the front and back of your coat for better visibility Alaska Injury Prevention Center has free reflective tape available; call 929-3939.

Lastly, it is important to have a communication plan. lf you don't already have one, consider carrying a cell phone or subscribing to Lifeline. Create a plan for communication should you get stranded, injured, or need help.

Don't allow yourself to become a statistic. Be sure to do all you can to prevent yourself from being a victim of a fall. Take proper care of your body, conduct a safety tour within your home, and protect yourself when walking outdoors.

Nine Tips for Patients

Few of us like being patients, but there are ways to take charge of the situation and make the best of it.

It's no fun being a patient. You're sick or worried about being so. There's the loss of control to contend with as your illness (and the health care system) seems to take over. Even normally assertive and intelligent people find themselves 'shutting down" so they can't understand new information or think clearly about important decisions. Others become irritable or downright hostile - not a great mind-set for making medical decisions either.

On the bright side, patients now have more rights than ever before. Most doctors today neither want nor expect patients to passively follow orders. And the Internet provides vast resources to help you understand your condition and make choices.

Earlier Ibis year, Harvard Medical School sponsored a forum titled, "Taking Charge: Patient Advocacy for Yourself or a Loved One." Dr. Nancy Keating, an internist at Brigham and Women's Hospital, and Dr. George Demetri, director of the Center for Sarcoma and Bone Oncology at the Dana-Farber Cancer Institute, led the discussion. Here are nine suggestions that emerged from the forum:

1. Bring along a family member or close friend.

This is perhaps the single most important piece of advice anyone can give. Patients need a second pair of eyes to look out for them and a second set of ears both to hear their concerns and to listen to the doctors and nurses. If you don't have anyone close by who can accompany you in person, ask the doctor to list someone in the medical record who should be called before crucial decisions are made or after something important has happened.

2. Talk to a nurse.

Even if we know better, some of us are a little too eager to be good patients, so we don't complain or admit to having a problem. Others may feel embarrassed at repeatedly asking, "What does that mean?" Some find themselves claming up around authority figures. If you don't feel comfortable talking to a doctor, seek out one of the doctor's nurses or some other staff member. It's no secret that patients confide in nurses and other staff. Many doctors have found out more about their patients from nurses than they'd ever find out on their own.

3. Know your options.

Most medical journeys have several crucial forks in the road. If a doctor presents you with only one choice, chances are you're not getting the full story. Of course doctors often do - and should - make recommendations. If you make a choice not favored by a doctor, then you must decide whether that doctor can still provide you with the care you need.

4. Set the terms of the relationship.

A study published several years ago showed that most patients want a collaborative relationship with their doctor. But people's preferences vary. The researchers found that roughly one in four people prefer an active, take-charge role, while one in ten prefer a more passive one and would rather defer to the doctor's expertise. But when researchers asked people how well their preferences matched their actual experience, only half said it was what they wanted.

There's a limit to how much any patient can influence the dynamics of his or her relationship with a doctor. But if you find your doctor too bossy or too deferential, make that known. If it continues to bother you, think about switch-big doctors (see #9).

5. Think through your priorities.

Treatments often involve trade-offs that only you can sort out. Are you willing to go for a potential cure even if it means harsh side effects? Or are you more comfortable with a conservative approach that has drawbacks but also a well-established track record'? As best you can, express your thoughts to your doctors. if they know about your values and preferences, it can mean more fruitful and focused discussion of treatment choices.

6. Use the Internet.

Sure, the Internet is full of half-baked hokum arid untested snake oil. But today there's also plenty of credible health information, so much so that it's really a missed opportunity not to get online and tap into it. Harvard Medical School provides editorial oversight of the Aetna InteliHealth site at www.intelihealth.com. The Web site for the National Institutes of Health is a treasure trove with a great deal written for the public. The federal government's National Library of Medicine offers PubMed, a free, searchable database of all the medical journals.

7. Get your medical records.

Under the federal Health Insurance Portability and Accountability Act (HIPAA), you have a right to see and get copies of your medical records. You'll probably be charged for the copies, so it can get expensive. HIPAA also gives you the right to ask for changes to your medical record, although doctors have the final say-so over whether they'll be made. We're not suggesting that everyone go out and get copies. But getting acquainted with your medical biography can help you become a fully informed patient.

8. Bring a tape recorder to your office visit.

This may seem intrusive but - especially if you have a serious medical condition like cancer or heart. disease that involves complicated treatment choices - listening to an audiotape after your visit may help you understand things you didn't grasp the first time around. Just refreshing your memory can be helpful.

9. Find a doctor you like and respect.

This can he hard. Your health insurer may limit your choices. For routine care. manv people want someone whose office is nearby. Good doctors are often popular, so they may not he accepting new patients. But especially if you have some health problems, the value of compatibility with your doctor is hard to overrate.

...and don't feel obligated to stick with one you don't. It's important to make a good- faith effort to work with your doctor - and it can be work. But don't settle for someone you don't like or trust. It may not feel like a good match from the doctor's perspective, either. You'd both be better off going your separate ways. Thanks to Harvard Medical School

When is Too Old to Drive?

Aging, no matter how healthy we are, slows down our physical and neurological mobility. Simple tasks, once easy to perform, become more daunting. Slowly our independence is robbed as aging gives way, leaving driving as one of the last frontiers of freedom we have. This makes it particularly hard to tell a spouse, parent, or loved one that they shouldn't drive anymore because their ability is impaired and they're a danger to themselves and others. If they don't recognize it themselves, they'll not only be hurt by the accusation, but insulted as well. Expect them to put up a fight.

Americans are living longer than ever before thanks to healthier life-styles, increased exercise, greater awareness about nutrition, and more advanced medications to either control or delay the onset of typical old age maladies. If seniors can be found jogging or playing tennis today, then when do they become too old to get behind the wheel of an automobile?

Tips to consider on how to make an evaluation of someone's driving ability before you approach them:

If you begin to notice a change in their driving ability such as driving slower, poor reaction time to lights and signs, more timid about faster drivers, reluctance to drive on the freeway, driving erratically - then the first thing you want to do is ask in a subtle way how he or she has been feeling lately.

Listen for any unusual complaints (more tired than usual, not seeing well, lethargy, hearing seems impaired, etc.). Pay attention to their behavior around the house. Is anything out of the norm? Could it be a case of overmedication? When was the last time they had a checkup? Perhaps you should go on their next medical appointment to ask questions. Quite often the elderly won't admit to physical ailments, so we have to take charge.

The first thing you should do is rule out any medical causes for the change in driving habits. If it's not a medical problem, then very likely it is just the wrath of old age slowing down the senses. For some it's simply their sight; for others it could be hearing, or just a slowing reaction time, most of which have reasonable solutions.

Next, offer to go on a few little errand trips - to the store, the cleaners, etc. - with them. Observe for your-self firsthand their driving skills. Are they driving in a manner that could cause an accident, or worse, put them in harm's way?

If you notice a radical difference in driving ability, you should then call a family meeting to discuss your findings. This may be more difficult for some than for others, since your family may be spread out across the country. However, you could do a conference call or an on-line discussion.

The most important thing to remember is to be as gentle and caring as possible. Be prepared to offer your observations without it sounding accusatory. Remember: you're taking away their freedom so it won't be easy. Expect them to be angry and rebellious but don't hold it against them. Put yourself in their shoes. Let them know you're doing this because you love them and want them to be safe, and are prepared to help them in any way you can.

You must have a plan in place for who will handle all their errands, doctor appointments, and visits to their friends. It can become extremely time-intensive to become a chauffeur every day amidst your own busy life-style. Taking away one's driving privileges is a difficult thing to do, so keep in mind that you may not succeed. The last thing any senior wants to do in their golden years is to depend on you or anyone else for help, especially if he or she has always been independent. Before you share your concerns with your loved one, have a plan in place that will be easy and simple to follow, one that won't interfere too much with their normal routine.

Be sure to contact family and friends to encourage consistent visits to help prevent this person from getting lonely or depressed. Arrange times for them to get out and visit as well, perhaps every Saturday or Sunday for a few hours. There are senior organizations in every community that offer activities, events, and driving services. Check into them. The most common cause for suicide among the elderly is loneliness and boredom; no one should die that way.

It is our responsibility to ensure that safe driving habits are practiced not only by our children, but by our aging parents or spouses as well. Take good care of them, and treat them with the same dignity and respect that you would want for yourself when you're their age. It's never as far away as we think.