Month: May, 2010

Exercise for Seniors? Have You Lost Your Mind?!

Blog Post by Jacqueline Sinke

Jacqueline is the owner of Fitness & Function, LLC. Her company provides personalized mobile wellness services including in-home personal training, therapeutic exercise, and fitness and nutrition consulting. For the past seven years, Jacqueline has also been a fitness instructor for seniors at the Elsie Stuhr Center in Beaverton. 

Exercise for Seniors…A Relatively New Idea

We all know that exercise is important to obtain and maintain health and fitness. However for older adults, the benefits of exercise often make the difference between independence and dependence. 

Purposeful exercise, rather than just exercise, can be strategically used to prevent chronic disease and illness. However, in my business, I have also found that purposeful exercise helps many seniors to manage existing chronic conditions. Exercise also reduces the risk of falls, fractures, and loss of function.

I have been working as a health fitness professional for over 18 years. I specialize in working with individuals with chronic medical conditions and with older adults.  In the last 15 years, exercise for seniors has really evolved in relation to the specific types of exercises recommended and the overall attitude of physicians and care providers.

About 10 years ago when I was implementing functional fitness programs for seniors in assisted living facilities, I clearly remember the staff at the facilities being opposed to the idea and thinking that I had lost my mind. The next stumbling block was the medical community. Doctors were reluctant to give seniors medical clearance for exercise participation. Often the reason for not recommending exercise was that the patient was “at high risk of falling,” even when the exercise program was designed to help seniors by reducing their risk of falling.

At that time most physicians seemed quite unaware of the tremendous benefits of appropriate exercise for seniors including function, physical health, and mental wellness…even for seniors in monitored environments like assisted living and nursing homes. Since then, attitudes have changed. Even the AMA (American Medical Association) and ACSM (American College of Sports Medicine) have recent initiatives under titles like “Exercise is Medicine.” In these initiatives, physicians are encouraged to recommend exercise and physically active lifestyles for their patients. Gratefully, the benefits of exercise to health and wellness are now generally recognized.

There are now specific exercise recommendations, tests, and prescriptions for older adults and frail older adults for the prevention, treatment and management of chronic medical conditions. Health and fitness professionals now need to specialize, depending on the population group they choose to work with, to provide safe and effective exercise programs. Guidelines and recommendations are set by the ACSM and the AHA (American Heart Association).

I specialize in exercise for older adults across all five levels of functioning as well as for individuals with chronic medical conditions. I take my business on the road by providing mobile wellness services such as therapeutic exercise, personal training, and home fitness care. Most of my clients are seniors who are either living independently at home, with or without a caregiver; or who are residing in assisted living, independent living, or an adult foster home.

Each individual’s reason for exercise is different. Prevention of falls and fractures are a common goal. For those who exercise, even if a fall occurs, the severity of injury is reduced. For several clients with type 2 diabetes, the research shows that exercise of  appropriate quality and quantity, both moderate and intensive, utilize blood  glucose   uptake in a way that approximates several diabetes drugs such as Metformin, Pioglitizone, and Rosiglitizone. For these diabetic patients, exercise can reduce daily blood glucose levels and A1c.

Clients with peripheral artery disease, atrial fibrillation, neuropathy, and seizures need a supervised exercise program that both helps treat the condition and helps maintain functional independence.

The client with a hip replacement, who has maximized his physical therapy sessions, can continue to get the benefits of joint stability, bone density, muscle strength, and mobility by continuing a recommended exercise program.

A breast cancer survivor with lymphedema, osteopenia, osteoporosis, fatigue, depression, and loss of energy can benefit from specific exercises that stimulate lymph drainage. Through exercise, she can slowly and progressively increase her overall strength, endurance, and bone density.

A 72 year old female client with high blood pressure, hyperlipidemia, and osteopenia is, through exercise, able to reduce her blood pressure and obtain near normal levels of LDL, HDL, and triglycerides.

A 94 year old with Alzheimer’s disease, hip and shoulder replacement, difficulty walking, and frailty can use exercises to maintain strength for mobility, so she can continue to live with her family.

Many of the personal training clients I have are long-term clients; I have been training them for 3 to 6 years one to three times per week. For many, the exercises performed help maintain independent living skills, and they can enjoy living life at home. For some staying at the same service levels is important in order to keep health care expenses down.

For others, the benefits are to regain strength, mobility, and stamina. They want to return to a previous level of functioning and maintain this function and health over time. As the in-home personal training business has evolved, my company began offering “Home Fitness Care.” This new term describes what we do to help seniors remain independent living at home by making sure they receive needed exercise. Our programs follow the health guidelines set by ACSM and AHA.

Most seniors are very clear that they won’t perform the exercises on their own and need a gentle push. They want someone who can hold them accountable and monitor and supervise their progress. We often provide progress reports to family members and healthcare providers upon request. In cases where we observe a change in behavior, physical function, vital signs or medical condition, we report to the listed emergency contact. Also, blood pressure and heart rate monitoring can be part of the exercise care sessions. 

It has happened several times that through our observation and questioning about feelings, pain, discomfort, sleep, fatigue, nutrition, or hydration, we were able to catch an important, emergent change in health status that was missed by family members or other caregivers. In each session, I ask clients how they feel that day and how they were feeling after the last exercise sessions and the day after. Thus, I am able to detect and record unusual patterns and uncover issues with falling, sleep, and medication. As health fitness professionals, we observe movements and talk to the clients during the 45 to 60 minute exercise sessions. We also keep records on balance, number of repetitions, resistance used, stretches, and flexibility.

Family members or physical therapists are often the ones who refer new clients to us. We begin with an initial consultation at their home to see if home fitness care or personal training/therapeutic exercise training is the appropriate fit for both parties. Prior to any exercise, we require the client to complete a health/medical history form and need a medical release from the healthcare provider. After the medical release is received we can perform an assessment so that an exercise/activity plan can be developed. For the exercise training sessions we often bring exercise equipment and do not recommend clients to purchase equipment until it becomes clear what is needed.

I have worked with many seniors and seen their lives change for the better. Exercise made it happen. Quality of life is precious for each senior and this is preserved through physical activity. It is never too late to start, and you are never too old to begin. Please don’t hesitate to contact me with any questions or comments. 

Jacqueline Sinke, Owner
Fitness & Function LLC.

Email: fitnessfunction@comcast.net
Phone: 503-267-1030
Web: www.FitnessAndFunction.com

1 Comment by Mike Brunt on May 25, 2010
filed in Physical Activity and Conditioning

Laughter Yoga

Blog Post by Paul Perry
As a returning student, Paul is pursuing his Encore Career through PCC in the Gerontology field with special interest in Memory Care for Alzheimer’s and dementia-challenged people.  He has worked as an Eligibility Assessment and Verification Specialist with the San Diego County Department of Social Services and later as a Licensed Oregon Land Surveyor.

Health Benefits of Laughing and Laughter Yoga

As part of my internship as a Life Enrichment Associate with Hearthstone at Murrayhill, in their Memory Care area I have been creating and leading in some of the group activities for the residents.  One idea I had was to use some of the fun I had at the Laughter Yoga club at PCC where I learned how to laugh for no other reason than the health benefits it brings to all of us.  Laura Lou Pape-McCarthy is the organizer who every week inspires club members to spread the word.

When I first started with a small group of dementia challenged people some did not understand why we would laugh out loud for no other reason but to have fun.  But since the goal is to recapture some of that child-like fun we had when we were younger, they began to see how good it makes us feel to exercise those laughter muscles we may not use for days at a time, as well as the refreshing feeling we all get through healthy breathing techniques that go along with the laughter yoga routine.

Some of the residents had difficulty understanding “the point” of laughing our loud for no reason.  Others were tickled by the idea right away.  Quite honestly it is the less cognitively impaired ones who didn’t understand.  The more advanced residents just did what others were doing and liked it.  The exercises all start with deep unified breathing just like many of the morning get-moving type activity that groups do.  The exercises are modified for memory care as most are sitting down with some in wheelchairs and others using walkers so the movements are not as extreme as in the regular Laughter Yoga gatherings where we walk around and move our arms a lot.

The routines all have names and they help to set the stage for each exercise.  Like “Aloha Laughter” where the group collectively says out loud “Aloooo, ha, ha, ha, ha”.  That is, saying the word together and then using the “ha” part of the word to begin laughing out loud, “Ha, ha, ha, ha, etc..”.  Sounds kind of crazy but its really a lot of fun.  Part of the fun is taking a deep breath in together and then, saying the Aloha word together and then, laughing together while looking at each other’s eyes and laughing and making the moment fun.  Afterwards everybody feels good.  Trust me, I’ve seen it.

Another routine is called “Vowel Laughter” and is based around the group saying each vowel sound (a, e, i, o, u and sometimes y) and turning the “a” sound into laughter that sounds sort of like “hey, hey, hey, hey…” and then the “e” sound into laughter that sounds sort of like “tee, hee, hee, hee…” and through each of the vowels.  For example the “o” sounds like Santa Claus “Ho, ho, ho, ho…” and on.  

The idea with these “exercises” is to make yourself laugh out loud with everyone else.  That’s the hard part at first but it gets easier each time you all do it together.  There are some videos of Laughter Yoga on YouTube.com.  Just type in Laughter Yoga!

The local website is www.LYInstitute.org (Laughter Yoga Institute).

Paul W. Perry
Gerontology Student
PCC, Sylvania Campus

1 Comment by Mike Brunt on May 17, 2010
filed in Alzheimer's and Dementia, Physical Activity and Conditioning

Parish Nursing – Promoting Health of Body, Mind, and Spirit (Part 1)

Blog Post by Barbara Hula, BSN, RN
Parish Nurse, St. Juan Diego Parish, 1280 NW Saltzman Rd., Portland, Oregon

Parish Nursing – Promoting Health of Body, Mind, Spirit
(Part 1)

Parish Nursing, or as it is now called, Faith Community Nursing  is deeply rooted in all religions –Christianity, Judaism, Buddhism, and Muslim.  All faiths address the issue of illness and wellness, of disease and healing, of caring and curing.  People turn to their faiths to interpret their misfortunes, to summon strength and to fight illness.

Faith Community Nursing is about health promotion and disease prevention and encompasses seven functions with a philosophy of caring for the whole person. These nursing roles, however, do not embrace a medical model of care or include invasive practices such as blood drawing or medical treatments.  Faith Community Nurses are simply the bridge between the medical community and the spiritual community.

Faith Community Nursing is recognized by the American Nurses Association as a specialty practice combining professional nursing and health ministry within a Faith Community.  A Faith Community Nurse must be a Registered Nurse, licensed to practice nursing in his or her state.

Learn more about Faith Community Nursing in the Region. Northwest Parish Nurse Ministries.

No Comments by Mike Brunt on May 11, 2010
filed in Religious and Spiritual Resources

The Best Medicare Benefit – Hospice

 Blog Post by Maggie Peck-Alberton, L.C.S.W., Serenity Hospice

Maggie has been a medical social worker for over 30 years in the Portland and Salem areas. For most of this time, Maggie has worked in hospice organizations, but she has also worked as a hospital discharge planner. One of Maggie’s great hobbies is sewing, and in her spare time, she loves to sew various items for charitable organizations including veterans, churches, and the boy scouts.

The Best Medicare Benefit

The cost of healthcare is on everyone’s mind. One cannot pick up a newspaper or listen to a news broadcast without being reminded that healthcare costs are growing. I would like to focus on one bright light, in this dark mess, that has been a success for both Medicare and its consumers…and that would be the hospice benefit.

Hospice started in Great Britain in the late ‘60s and traveled to the U.S. during the era of new social programs, the late ‘60s and early ‘70s. Hospice is a type of medical care that provides comfort and support to both the patient and their caregiver(s), whether that be family, friends, or paid caregivers. Many areas of the nation have in-patient facilities, whereas the Portland Metro area only has one in-patient facility, that being Hopewell House in SW Portland. Hospice care in the area is primarily “home based,” describing wherever “home” may be (the patient’s home, a relative’s home, or a care facility). While the hospice benefit does not pay for the room and board costs of a patient’s care, it does cover other services that help a patient to remain comfortable in their desired environment.

Hospice is currently the only benefit that Medicare pays at 100%, without a co-pay or without participation of the patient’s Medicare supplemental insurance. The services it covers include:

  • Physician services (hospice physicians)
  • Nursing care (nurse visits once per week or more often as necessary)
  • Medical supplies and appliances that can be rented
  • Medications approved by hospice for symptom management and pain relief
  • Short-term in-patient care for pain symptom control
  • Spiritual counseling as desired
  • Bereavement counseling as desired for up to 13 months after the death of the patient
  • Physical, occupational, and speech therapy as ordered by physician
  • Medical social services
  • Dietary and other counseling
  • Volunteer services

 

The Portland metro area and the Willamette Valley are fortunate to benefit from a hospice organization that provides additional services. Serenity Hospice and Palliative Care was started in August, 2006, by two Army Veterans who sought to better serve veterans and their spouses. It has since expanded to include all terminally ill patients. Serenity Hospice brings additional services to patients without cost, to ease their discomfort and to support “the whole person” (physical, emotional, and spiritual). The following complimentary therapies are available to Serenity Hospice patients:

  • Massage therapy
  • Acupuncture
  • Acupressure
  • Acutonics
  • Aromatherapy
  • Reiki
  • Craniosacral therapy
  • Reflexology
  • Music thanatology

 

Many families of patients reflect back to the comfort their loved one received from these non-traditional therapies that are not usually offered free of charge by other hospices.

Why is hospice the best Medicare benefit? In my opinion, Medicare saves money by paying a hospice a daily rate to cover all of the medical care related to a patient’s terminal diagnosis and to manage the service delivery. If a patient was at home and dying without hospice care and the symptoms became too severe, what typically happens is that the patient is transported by ambulance to the emergency room. The transportation alone to the E.R. would pay for days of hospice coverage, not to mention the work-up costs of acute care medicine. Medicare does not want to hospitalize patients who can receive qualified and competent care at a less costly level. In the example above, the patient transported by ambulance to the emergency room would probably be treated for acute pain and discharged to a nursing facility that could provide less costly care, at the patient’s expense.

Most patients who are dying want to be at home, amongst their family and friends, their beloved pets, and with their own possessions. No one wants to be in a cold and clinical environment, as it may be frightening and not comforting. Hospice strives to provide comfort care, and as I refer to it, “tuck in” a patient in the warmth of supportive services. It is not uncommon for Serenity Hospice patients to have family and friends gathered at a patient’s bedside, with clergy attending to the spiritual needs, the nurse managing the symptoms and explaining what is happening to the family, and the music thanatologist playing soft harp or guitar music in the background.

As social workers, we try to be present to attend to the bereavement issues and to offer services as needed in the coming year. All of these services provide quality to the dying process and help prepare the survivors for life after the patient’s death. For Medicare, it limits the cost of care as most studies reveal a person uses the most health care dollars in the last six months of life.

So, it is a “win-win” situation. The patient benefits from additional care that facilitates dying at home in comfort, and the accountants of Medicare are pleased that the money was well spent (quality of care) and the costs were contained.

If you know anyone who is facing a life-threatening illness, begin the dialogue of what their wishes are, and begin to think of how this person could stay at home and be well cared for. If you need further information, feel free to consult Home Instead Senior Care at 503-530-1527 or Serenity Hospice at 503-639-0600.

Maggie Peck-Alberton, L.C.S.W.

1 Comment by Mike Brunt on May 3, 2010
filed in End-of-Life Care
At Home Instead Senior Care, we provide non-medical services to senior citizens in their own homes or apartments. Our services include companionship, light housekeeping, meal preparation, medication reminders, escorting to appointments, personal care, and dementia care. We help seniors maintain their independence and help them stay safe, healthy, and happy at home, wherever home may be.