Archive for the ‘emergency preparedness’ Category

Driving and Dementia

Monday, April 19th, 2010

The American Academy of Neurology has released a guideline on Driving among Patients with Dementia.

Concerned about the Driving Ability and Driving Safety of a patient, parent, friend or loved one?

Ask yourself the following questions.

QUESTIONNAIRE for FAMILY OR CAREGIVER :
1. How many times has the patient been stopped or ticketed for a traffic violation in the last three years? (0, 1, 2, 3, 4 or more)
2. How many accidents has the patient been in, or caused, within the last three years? (0, 1, 2, 3, 4 or more)
3. In how many accidents was the patient at fault in the last three years? (0, 1, 2, 3, 4 or more)
Use this scale to answer the following questions:
1 strongly disagree;2 disagree; 3 no opinion; 4 agree; 5 strongly agree.
1. I have concerns about the patient’s ability to drive safely.
2. Others have concerns about his/her ability to drive safely.
3. The patient has limited the amount of driving that he/she does.
4. He/she avoids driving at night.
5. He/she avoids driving in the rain.
6. He/she avoids driving in busy traffic.
7. The patient will drive faster than the speed limit if the patient thinks he/she won’t be caught.
8. The patient will run a red light if the patient thinks that he/she won’t be caught.
9. The patient will drive after drinking more alcohol than the patient
should.
10. When he/she gets angry with other drivers, the patient will honk the horn, gesture, or drive up too closely to them.

cartoon from telspatch.co.uk

cartoon from telspatch.co.uk


If you have numerous YES responses:
1. Seek help from the patient’s healthcare provider for an assessment of Dementia (neurologist, geriatrician).
2. Make sure the patient gets a vision and hearing check.
3. Review medications and drugs (including alcohol and sleeping pills) that may increase the risk of driving accidents.

Source: American Academy of Neurology Guidelines 2010
Published in: Neurology 74 April 20, 2010

Tips to Reduce Clutter and Hoarding

Sunday, March 28th, 2010

Hoarding

Some people will hoard or save numerous items, including dirty clothes, food, and papers. Losing a meaningful role in life, work, friends, family, and a good memory can have an impact on a person’s need to hoard and or to “keep things safe”. Hoarding in this population is oftentimes triggered by the fear of being robbed.

When working with persons who have dementia, it is essential that you keep their safety in mind. Order, routine and simplicity are most helpful. A house or room that is relatively uncluttered is the ideal environment.

Ten Tips to Consider

1. Let go of ideal notions of cleanliness. Your patient may value items that appear to you as worthless. Parting with their belongings (even used paper cups) can cause severe emotional distress.

2. Ask your patient if they can donate or sell their belongings to charity.

3. Focus on fall prevention. Create pathways free of debris, loose cords or slippery rugs. Some frail patients hold onto furniture or other items while moving through the room; preserve their “props” until other assistive devices (canes, walkers) can be introduced.

4. Focus on fire prevention. Red flags include newspapers stored on top of or inside a hazardous area.

5. Be creative and negotiate. Consider photographing belongings, as this may help the patient part with things and preserve memories.

6. Begin by reorganizing a small corner of a room, a single table, or just a section of the table.

7. Have a friend or relative present during a major cleanout, preferably one who already has a supportive relationship with the patient. Clean-outs can be overwhelming to people with severe hoarding behavior. Have a back-up plan in case emergency psychiatric services are needed.

8. Discuss how to safeguard valuables in the cleaning process. Have a written contract. Agree on what to do with valuables that turn up, such as money, jewelry, or collectibles.

9. Consider relocating an individual to a new room if the clutter is the result of physical or mental frailty. A new environment can provide a fresh start and enable the patient to receive needed services sooner.

10. Plan for on-going maintenance and supervision to maintain a decluttered environment.

Adapted From: Weill Medical College of Cornell University

Pacquiao Wins Clottey Fight After Knocking Out Swine FLu

Sunday, March 14th, 2010

14 March 2010 Pacquiao defeats Clottey thus winning the unanimous decision to retain his World Boxing Organization welterweight title and his status as the world’s finest boxer.

A little known fact about this champion boxer is how he knocked out the campaign against swine flu or AH1N1.

The Philippines was one of the last countries affected by swine flu, and it arrived at the time when the boxing great Manny Pacquiao won his match against Ricky Hatton.

In a few ads for swine flu prevention, he was even compared to the beneficial VCO or virgin coconut oil. For example, a blog in talkph.net quotes: “Former Agriculture Secretary and President of the Federation of Free Farmers Rep. Leonardo Montemayor says virgin coconut oil (VCO) has natural properties that boost the immune system to avoid catching the strain. “ In this blog taking VCO was likened to Pacquiao’s training and preparation for the Hatton boxing match. “He has to train very well, strengthen himself and his body. Ganun din tayo, we have to strengthen our immune system against this very deadly virus,” says Montemayor.

The flu awareness campaign would have triumphed if this champ was hired to promote flu prevention. However, there was a negative buzz generated by Pacquiao’s refusal to be quarantined.

In this blog by Sunstar Network:

“MANILA — Boxing champion Manny Pacquiao will return to Manila as scheduled, ignoring advice from Philippine health officials to observe self-quarantine in the United States to help prevent the spread of swine flu.”

The Department of Health and WHO advised Pacquiao and his group to observe self-quarantine after their return from Las Vegas, but the boxing champ and his party chose to ignore the advise and arrived at the airport shaking hands and hugging fans. Could this fearless boxer possibly be taking VCO?

Protect Seniors from Heat Stress

Tuesday, March 9th, 2010

Heat exhaustion is a form of heat-related illness that can develop after several days of exposure to high temperatures and inadequate or unbalanced replacement of fluids.

Warning signs vary but may include the following:

* Heavy sweating
* Paleness
* Muscle Cramps
* Tiredness
* Weakness
* Dizziness
* Headache
* Nausea or vomiting
* Fainting
* Skin: may be cool and moist
* Pulse rate: fast and weak
* Breathing: fast and shallow

To protect yourself from heat stress and heat stroke, follow these tips:

# Drink cool, nonalcoholic beverages. (If your doctor generally limits the amount of fluid you drink or has you on water pills ex. furosemide or hydrochlorothiazide, ask him how much you should drink when the weather is hot. Also, avoid extremely cold liquids because they can cause cramps.)
# Rest.
# Take a cool shower, bath, or sponge bath.
# If possible, seek an air-conditioned environment. (If you don’t have air conditioning, consider visiting an air-conditioned shopping mall or public building to cool off.)
# Wear lightweight clothing.
# If possible, remain indoors in the heat of the day.
# Do not engage in strenuous activities.

seniors swim
If you are living with or taking care of an older person

* Visit older adults at risk at least twice a day and watch them for signs of heat exhaustion or heat stroke.

* Encourage them to increase their fluid intake by drinking cool, nonalcoholic beverages regardless of their activity level.

Warning: If their doctor generally limits the amount of fluid they drink or they are on water pills, they will need to ask their doctor how much they should drink while the weather is hot.

* Take them to air-conditioned locations if they have transportation problems.

If You Don’t Have Air Conditioning:

• Take a cool shower, bath or sponge bath.
• Create cross-ventilation by opening windows on two sides of your house.
• Keep windows open at night.
• Keep curtains, shades or blinds drawn during the hottest part of the day.
• Cover windows when they are in direct sunlight.
• Electric fans may help, but when the temperature reaches the high 90s, fans won’t prevent heat-related illness.
• Go somewhere that’s air-conditioned like the shopping mall, the movies, the library, a senior center or a friend’s house. If you don’t have a car or no longer drive, ask a friend or relative to drive you. If necessary, take a taxi. Don’t stand outside waiting for a bus.

More heat stroke and heat stress information from the CDC link: Centers for Disease Control and Prevention USA

Wanted: Earthquake Relief for Elderly Victims

Sunday, February 28th, 2010

Older persons in Haiti continue to suffer from the devastating effects of the earthquake that left thousands dead and hundreds of thousands homeless. One particular unique problem in this very poor country is the large number of persons suffering from HIV. Many orphans and young children of HIV are being cared for by their grandparents and elderly members of the community. The low priority that older persons receive in the relief efforts can only mean greater suffering for the young HIV orphans.

The low priority that older persons receive in the relief efforts in Haiti can only mean greater suffering for the young HIV orphans.

At least two organizations give priority attention to older persons. The American Association of Retired Persons AARP with the international NGO for older persons HelpAge have been assisting each other in providing direct relief to older persons in Haiti.

With the 8.8 magnitude earthquake in Chile and the potential devastation from tsunamis across the Asia-pacific region, we can only hope that help continues to arrive in a timely and sufficient manner to all persons, including the old.

Old Woman in Chile Earthquake

Pandemic Flu H1N1 Vaccination 2010

Saturday, February 20th, 2010

The flu pandemic is not over.
The 2009 AH1N1 influenza virus continues to be the dominant influenza virus in circulation in the world. Based on historical data, pandemics are characterized by several successive waves, potentially more impactful (e.g. 1968 pandemic). Compared with seasonal flu, the proportion of severe / deadly cases in previously healthy and young subjects is substantially higher. Although fewer older persons were infected with the pandemic AH1N1 virus, paradoxically, infected older people will experience the highest rates of severe disease and death of any age group. Vaccination of older persons is therefore a priority.

Because it is the dominant circulating strain, the WHO recommends that the pandemic H1N1 strain should be incorporated into the seasonal flu vaccine for 2010. Keiji Fukuda, MD, MPH, special adviser to the WHO director-general on pandemic influenza, stressed that the recommendation does not indicate that the pandemic is over.

Although fewer older persons were infected with the pandemic AH1N1 virus, paradoxically, infected older people will experience the highest rates of severe disease and death of any age group. Vaccination of older persons is therefore a priority.

“The recommendation to put the pandemic virus in the upcoming vaccine really means that this has been a dominant virus, and it is expected that it will continue to be a very significant virus circulating around the world,” Fukuda said.

The WHO Recommendation for the Composition of the 2010 Southern Hemisphere (SH) Vaccine is:
— an A/California/7/2009 (H1N1)-like virus, the pandemic strain
— an A/Perth/16/2009 (H3N2)-like virus;
— a B/Brisbane/60/2008-like virus.

2010 Clinical Guideline for Fall Prevention

Monday, February 1st, 2010

Excerpts from the American and British Geriatric Societies Clinical Practice Guideline 2010:

Prevention of Falls in Older Persons

Summary of Recommendations

SCREENING AND ASSESSMENT

1. All older individuals should be asked whether they have fallen (in the past year).
2. An older person who reports a fall should be asked about the
frequency and circumstances of the fall(s).
3. Older individuals should be asked if they experience difficulties with walking or balance.
4. Older persons who present for medical attention because of a fall, report recurrent falls in the past year, or report difficulties in walking or balance (with or without activity curtailment) should
have a multifactorial fall risk assessment.

Photo of the 4-step balance assessment demo at the Training of Trainors program, COMADD and Palo SHS:

TOT 4 steps group

The multifactorial fall risk assessment should include the following:

Focused History
1. History of falls: Detailed description of the circumstances of the fall(s), frequency, symptoms at time of fall,
injuries, other consequences
2. Medication review: All prescribed and over-the-counter medications with dosages
3. History of relevant risk factors: Acute or chronic medical problems, (e.g., osteoporosis, urinary incontinence, cardiovascular disease)

Physical Examinations
Functional Assessment
Environmental Assessment

Details are available at the AGS Website

Older Persons in Emergencies and Disasters

Monday, January 18th, 2010

In the wake of the earthquake in Haiti, HelpAge International reminds us to improve the way we provide relief to older persons in emergencies and disasters.

Background

Older people face particular threats from the world’s increasing number of conflicts and natural disasters, but are not often identified as a vulnerable group. HelpAge International believes older people’s rights, needs and capabilities must now be recognised in all emergency programmes.

We have over 20 years’ experience of work in natural disasters and complex emergencies. Our mandate in humanitarian relief is to target the most vulnerable older people and their immediate carers, dependants and families. We aim to enhance the capacities and contributions of older people in emergency situations by maximising the use of local knowledge and human resources, and integrateing our activities into local systems.

We lobby the United Nations, European Union, major donors and international relief agencies to address the needs of older people and enhance their contribution in the wider, longer-term development context

Key issues for older people in emergencies

Mobility

As communities flee, many older people, particularly the housebound, can be left behind without support. Many choose to stay, fearing a long journey or death in a foreign country, and are then extremely vulnerable during periods of violence. In the physical chaos associated with the early stages of an emergency, older people may be unable to struggle for food and resources, travel long distances or endure even relatively short periods without shelter. Older people need to be identified and their situations assessed as early as possible in an emergency situation.
Health

Most non-governmental organisations (NGOs) emphasise primary health-care programmes that target children and women, but neglect older people.

Emergency food and nutrition programmes are rarely adjusted to their needs – for example, hard grains can be inedible because of dental or other health problems – and there is a tendency to see supplementary food programmes for older people as a waste.

Reduced mobility, combined with having to travel to centralised health systems and sources of water, can create significant barriers to older people’s access to health services. Chronic health needs, for example, diabetes, are often not addressed. Considering older people’s specific health needs is critical to emergency planning.

Livelihoods

When communities return home, older people typically face difficulties in accessing land and other scarce resources. Exclusion from credit, income-generation and food-for-work programmes is common and exacerbates their loss of independence, status and dignity. Rehabilitation and reconstruction programmes need to ensure that older people have full and equal support in rebuilding their livelihoods.

Psychological and social effects

The feelings of loss, trauma, confusion and fear that are familiar to all people in emergencies can be even more damaging for older people. In regions hit by frequent disasters, famine or conflict, they may have suffered repeated personal losses, physical displacement and dislocation of social structures. They may need special support to recover emotionally and find new roles.

Isolation

For older people in emergencies, isolation sharply increases the levels of risk. Loss of family, carers and community ties can leave older people without support mechanisms, and abandonment, discrimination and self-exclusion are common. Socially or physically isolated older people need to be identified and given targeted support.

Gender

Although refugee populations tend to include a lot of older women, age and gender barriers are more likely to exclude them from decision-making and resources than older men. Social and religious restrictions on women’s movement, speech and public exposure can also increase their vulnerability during emergencies.

Welcome to Geriatrics Philippines Blog

Saturday, July 19th, 2008

Welcome and share your thoughts and comments on how we can improve the health and quality of life of Older Filipinos.Philippine General Hospital Geriatric Clinic Activity