Yes, I'm talking about falls again. I have to! Falls can be extremely dangerous for older persons and can result in broken bones, head injury, shaken confidence and immobility. As I mentioned in the review on the Falls Prevention Programme, it is extremely important to do what we can to prevent falls in older persons. The most important change to make includes doing regular strength and balance exercises. In addition, below are 10 tips to help you take necessary action in preventing costly, potentially traumatic falls:
"Falls can be extremely dangerous for older persons and can result in broken bones, head injury, shaken confidence and immobility..."
1. Check your eyesight - your vision plays an important role in your sense of balance and movement. It is a good idea to check your eyes at least every 2 years. Remember that bifocal glasses can make objects appear closer than they really are and could cause you to trip or lose balance. Ask your Optician for advice. And if the cost is a problem, call your local social services division and ask if you qualify for any relevant grants or assistance.
2. Manage your medications - some medications can make you faint, unsteady or light-headed on your feet. These include tablets for high blood pressure, diabetes and insomnia. Talk to your doctor about it and ask if the dose can be reduced, or the medication changed.
3. Ensure good lighting around the house, especially on the stairs. If you need to get up in the middle of the night to use the bathroom, use a night light or switch on the light first before doing anything else.
4. Have handrails fitted in the bathroom or on the stairs to make it safer and easier to get in and out of the shower, or to climb the stairs. Remember it's better to be safe than sorry and handrails cost very little compared to the cost and pain of breaking your hip.
5. Keep your house clear - rearrange your furniture to help you move around or to prevent you from bumping into things. Keep the floor clear of anything that might make you trip, such as carpets, boxes, cords or anything else.
6. Remember pets can cause you to fall as well as they tend to scurry under your feet! Put a bell on their collar to alert you of their presence or use a brightly coloured collar so you will see them better (e.g. red).
7. Use a non-skid mat in the bathroom or if you already have a mat that you like, you can stick a rubber sheet underneath to prevent it from moving. Alternatively, if you are re-doing your bathroom, put in non-skid tiles. Wet tiles are notorious for making people fall!
8. Avoid standing on a chair to change light bulbs or to hang up curtains. Ask someone else to do this or if you have to, use a stepladder.
9. In the garden or yard watch out for uneven paths, sharp stones and slippery surfaces after it rains. Keep foot paths clear. Put in railings or a ramp as needed.
10. Use proper footwear and clothes - it is important to choose suitable shoes that fit you well. Buy shoes with a good grip, low heels and high sides. Inspect your shoes. Think about what problems you have with respect to walking. Let's take Diabetes for example. People with Diabetes over time can develop a loss of sensation in their feet. You might often wear sneakers which tend to be well-cushioned and are very comfortable, but tend to have thick soles. Therefore, because you cannot feel the floor this may make you more unsteady. Avoid rubber slippers as they invariably make people fall. Avoid flared pants or clothing that trails to the ground. Avoid walking in slippery socks or tights. You can buy special socks that have a grip underneath.
AND ABOVE ALL
Continue to exercise regularly to improve your strength and balance.
Generic drugs have gotten a bad reputation in the Caribbean, perhaps because a lot of people are not convinced that the quality of these drugs is good, depending on the source.
First of all, what is a generic?
So this is what happens: A drug company, a multi-billion dollar organisation, conducts years of clinical trials before a medication receives approval for use by the general public. Because of the huge amount of money they invest, they are granted a patent (a license to produce the drug) which lasts for many years. This means that only that company has the right to make the drug during that time so they can make back their money.
After the patent expires, other drug companies are legally allowed to produce generics, or copies of the drug. This is good news for many older people who cannot afford expensive drugs and also for countries like the UK which provides free medication for people over 60.
So for example, Aricept is produced by a company called Pfizer and was the first medication approved to treat Alzheimer’s Dementia. The active ingredient in Aricept is Donepezil Hydrochloride. The patent that Pfizer had for Aricept is now expired, which is good news because now many companies around the world are producing generics such as Palixid (produced in Hungary) and Apo-Donepezil (produced in Canada) at a much cheaper price which is then passed onto the buyer who saves money..
So are the generics just as good as the branded drugs?
In my opinion, yes. But I would definitely choose generics from the US, Canada, the European Union or Australia/New Zealand because their quality standards are rigorous. There are many reports of medications produced in small, unsanitary factories in other countries around the world and even reports of fake medications packaged in fake boxes! So be careful of where the generic is produced and ask your doctor or pharmacist if you are not sure.
Why do all medications have two names?
One is the brand name (usually larger and in bold) that is used for marketing and the smaller name below is the active ingredient which is the important one. So always check the small writing below the brand name. For example it will look like this:
ARICEPT or PALIXID
Donepezil Hydrochloride Donepezil Hydrochloride
Another example is:
PANADOL or TYLENOL
As you can see Aricept and Palixid are the same drug, and Panadol and Tylenol are the same drug, just different brands! (NB: Paracetamol is called Acetaminophen in the US).
If I were you, I would go for the cheaper option, because in the long run you will save yourself a lot of money!
There are 3 licensed medications for the treatment of the above types of Dementia: (for more info on the different types of dementia, visit our dementia page)
1. Donepezil (brand names in T&T: Aricept, Palixid and Yasnal-Q)
2. Rivastigmine (brand name Exelon)
3. Galantamine (brand name Reminyl)
These medications have been proven to do several things:
They are not wonder drugs, but they are the best we have to treat these illnesses.
These medications, like all medications, have side effects. They can make people feel sick, nauseous, dizzy, vomit, have diarrhoea or they can interfere with sleep. However most of the time they do NOT cause any side effects at all. Also, if the side effects are mild they usually go away in 1-2 weeks and so it is best to persist and not give up too easily.
What to do if the side effects are intolerable?
If the person is on Donepezil 10mg daily here are some suggestions:
1. Ensure that the person is taking the medication after a full meal if they are having gastrointestinal side effects (stomach problems). This type of medication tends to be harsh on the stomach, so taking it after a meal is helpful.
2. Sometimes that's not enough and we have to add in a medication called a ‘proton pump inhibitor’ (e.g. Nexium, Prilosec, Omeprazole) to protect the stomach, and that can sometimes work very well to solve the problem. Omeprazole is available for free on CDAP.
3. Sometimes lowering the dose from 10mg to 5mg daily works, and so that is an option that you can try. If that works then we leave the person on 5mg daily indefinitely.
4. If the person is getting nightmares from taking the medication at night, then you can have them take the medication in the morning/lunchtime instead and that may get rid of the problem.
5. Sometimes none of this works and I have to change it to an alternative medication such as Reminyl or Exelon which are both available in T&T but are more expensive (over $1000 per month). Exelon also comes in patch form so the medication bypasses the stomach and goes directly into the bloodstream, therefore avoiding any side effects affecting the stomach. Exelon patches are applied to the person’s back and have to be changed every 24 hours.
6. Finally, sometimes some people do not tolerate any of these medications and we have to accept that. There is a second line treatment however, called Memantine (brand name Namenda or Ebixia), that is not available in T&T but is available in Barbados, the US, UK and Canada.
Making the decision to place your loved one in a Nursing Home can be very stressful. You may feel guilty about the decision, but you may also feel like you have no other choice. For persons suffering from difficult diseases which require 24-hour care, it can be necessary. There is no shame in making this decision if it is your best or only option for your loved one.
In the Caribbean, Nursing Homes are a recent trend. With the increase of older persons across the region, they have been popping up to fill the need for elder care. However, it's happened very quickly and Caribbean governments have not yet implemented policies to govern nursing homes. This means that they are widely unregulated and unfortunately, many are not appropriate or well-run.
For example. in Trinidad, there is no legal requirement for homes to provide a certain number of staff to patients. There is also no legal requirement that Nursing Home Staff have adequate qualifications. It is therefore very important to do your own research when choosing a home. The guidelines below are meant to help you make the best decision available to you and have been adapted from a UK organisation, Unforgettable.org.
But bear in mind that the Caribbean still has a long way to go in providing formal, holsitic care for older persons. You are unlikely to find an ideal, affordable care home but you can find a home that is appropriate and well suited to your loved one.
'...they are widely unregulated and unfortunately, many are not appropriate or well-run. It is therefore very important to do your own research when choosing a home'
Visit more than one home
Treat each visit as if you’re shopping around for a new house and choosing a good school for your children – at the same time. You're not only looking for a sturdy, safe building and convenient location, but for warm, qualified, caring staff to look after someone you love and who may, in many respects, be as vulnerable as a child.
Questions to ask the manager/staff:
'If the manager hesitates, is unable to provide first and last names, or clear roles for staff, this is a sign of a home with an inadequate care team...'
Before making a decision:
• If possible, take the person, especially if thay have dementia, to see the home before hand. Ask any other friends or relatives, whose opinion you’d value, to visit, too.
• Drop in again – this time unannounced and at a different time of day if possible. Staff should still welcome you if they have nothing to hide.
After making your decision:
Understand that moving your loved one to a care home can be a difficult transition at first. They will need time to adjust and settle in. Once you choose a home, try to work with staff to ensure that your loved one is comfortable as far as possible. Your job as a loving caregiver to your relative does not end when you place them in a home. Instead, you are now part of a bigger team to help care for your ageing relative.
Christmas time is here again. Treat yourself or your loved one with a gift that will make ageing a bit easier. If you know someone who is struggling with daily tasks because of reduced mobility or athritis, then one of these 5 items can really make their life, and the life of their family members, much easier.
Scroll to the bottom of the page to complete the order form for any of these 5 items via our partners at Care Safety Solutions Ltd.
(All prices provided are inclusive of VAT and shipping.)
#1.- Self-Standing Cane with Light - from SteadyCane ($385.00 TTD)
I hurt my foot recently and used crutches for a while. It's extra dangerous to walk into a dark room if you have a walking stick or crutches. Not to mention, it can be hard to find somewhere to lean them up when you're not using them. This walking stick: stands up by itself, is foldable for easy transport, has a wrist strap to help you hold it easily, is height adjustable for short people like me and has a bright LED Light to help you see where you're going.
#2- Automatic One Finger Can Opener ($400.00 TTD)
If you have athritis, a shoulder injury or if you are just fedup of struggling with big, heavy can openers, this one is for you. Just place the Automatic Can Opener on top of the can, press the button and the can will be open in seconds. A little extra help in the kitchen is always useful.
#3- Car Caddie- to help you get in and out of the car easily ($485.00TTD)
Seniors who may not move as briskly as they used to might need a little extra support to get in and out of a vehicle. The Car Caddie is a sturdy and easy to reach device to help get you to a standing or sitting position. It can help reduce the likelihood of pain and falls when entering or leaving the car.
#4- Portable Fall Alert for Cane, Walker or Wheelchair ($750.00TTD)
Falls are serious business. They can lead to head injuries, broken bones and a decrease in somebody's confidence. Help prevent falls with an alert which attaches to a walker, wheelchair or cane. If the walker, cane or wheelchair tips past a 30 degree angle, the alarm sounds. This can also be used as a PANIC alert system that is in easy reach if someone is in danger.
#5- Door knob Gripper (pack of 2) ($350.00TTD)
Only when we get older do we realise how difficult little things like opening a door can be. But for people with limited dexterity or mobility, turning a smooth, round door knob can be very frustrating. The door knob grip cover gives you something to hold on to and makes it easier to use slippery doorknobs. It's also quick and easy to install and even easier to use.
So there you go. 5 gift ideas for mom or dad, granny or grandpa, or even just for you. Remember, there are many useful gadgets specially designed to make getting older safer, easier and more enjoyable.
Follow Age Caribbean for more updates and advice on age-friendly services.
Dr James Bratt, Lead Consultant at Age Caribbean and Geriatric Psychicatrist.