AGING IN PLACE!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! OCCUPATIONAL THERAPISTS CAN HELP!!

Dum dum dum…AGING IN PLACE! FINALLY! Most of you have probably aged considerably since I first promised this post a few days ago. Or weeks ago. I have no concept of time. Anyway.

We had a recent lecture on this, and I’m just going to hit a few high points in terms of interesting stuff…just my own understanding on how “aging in place” works based on lecture, textbook, and my own ideas….

First of all, we all hear in the news about how the Baby Boomers are aging and since there are so many of them, that’s an issue we need to really face. And it’s not like people beg to go into nursing homes – ideally, it seems like most people would want to “age in place” and have their home be accommodating to their growing gerontological needs. People thrive in their own homes, with their own furniture and their own memories, rather than being in sterile and impersonal (or at the very least, unfamiliar) environments. If architects, contractors, and the general population started asking for universal designs or homes that could easily accommodate changes, life could get a lot easier for people. Most people just don’t think about it until it is too late – either they no longer have the money, or the energy, or the ability.

Some modifications are simple and somewhat cheap – non-concrete wheelchair ramps, grab bars in the bathroom, lever handles instead of door knobs elevated toilet seats, firmer and higher furniture, etc. Other modifications go a lot more in-depth and can include widening hallways for wheelchair access, concrete wheelchair ramps, raised dishwashers, enlarging the bathroom, building a roll-in shower, making counters that can go up or down with a button, and more.

Basically, someone could go to an OT (especially one who specializes in this kind of thing) and say, hey, I have these issues, or my house is like this – how can we make my house universally accessible, or how can I at least make some changes that will make the aging process a little easier to handle? Based on the person’s budget and remodeling possibilities, the OT can take various routes with it, from recommending certain assistive devices to a huge remodel. Obviously, the OT is not the one actually doing the construction – an architect and trusted contractor are needed for this part of it.

Home modification can seem pretty simple, but it can be the difference between being able to live at home in peace for many more years, or having to go to a nursing home. This is especially huge for the growing population of Alzheimer’s patients, who do best with old memories and routines – the change to a new routine and house arrangement can be very confusing and difficult.

So…my post was possibly rather anti-climactic after the big build-up…go Google “Aging in Place” to learn more, and realize that occupational therapists can play a big role in helping with transitions, adjustments, modifications, suggestions, etc. Dear Abby needs to start recommending OTs for all the concerned sons and daughters who write in about their parents!

I’m going to c/p several comments I got when I first mentioned “Aging in Place”, because I really appreciated the input!

aginginplace has left a new comment on your post “Part 2 of our 1st few days of OT school…with OT …”:
I am an “aging program specialist” with the U.S. Administration on Aging. My expertise is in neighborhood programs for older adults living independently regardless of their challenges in doing so. I use the Google feature of tracking web information on the topic of “aging in place” and your blog appeared in my report this morning. I am glad you found the topic of interest! Sometimes students in the health professions see only older adults with physical and mental health limitations. I work full time at age 66, but in my small agency of less than 100 professionals, we have two full time WWII veterans – one 86 and the other 90! However all of us “older folks” are really appreciative of what you are learning and what you will be doing for seniors (and others) in the future!
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From Keith, who also appreciates OT students, and keeps giving me ideas for posts!: It was great to read about the aging in place discussion. I’m a proponent of that concept and live it every day. Well, not the aging part, LOL, but the concept of having attendants in the home, workplace, home modifications, etc. This past summer, I had a semi-automatic door installed at my house. The remote control is velcroed to my wheelchair’s control box. Velcro is a miracle fabric!

I’m going to go for the night. Tomorrow, be prepared for REALLY COOL ELECTION FLIERS!!!!!!!!!!! OT STUDENTS, GO TELL ALL YOUR FRIENDS!

OT…authority…doctors…geriatrics…

I’m on a roll. Bear with me. I have one more random story, then an aging in place post, then I need to go shower and prep for tomorrow. I just really wanted this off my to do-list since I have plenty of other things to put in its place. I’m actually feeling slightly overwhelmed right now with our occupational therapy school schedule. I tried to make an Excel spreadsheet of all our assignments and their due dates, but I had a hard time figuring out when stuff was actually due. I feel like right now I don’t fully understand what I should be doing and when. I’m a control freak, so that sucks!

I do know I have plenty to do with the Tai Chi research project, ASD Elections (VOTING STARTS TOMORROW! KAREN DOBYNS AND BROOKE WARD! YES!), Officer stuff, Meals on Wheels, Well Elderly, etc…but just don’t even know where to dive in. Wow.

So. The real point of this post. When my partner and I were collecting Tai Chai baseline data, using a variety of assessments, there were several assessments that required the subject deciding on their own their level of satisfaction in life, or their perception of their health status. It was really interesting to see the generation gap at this point. Almost none of the subjects could handle their life satisfaction question without help. They would say things like “Well…let’s see…I had X children…Y years with my spouse…I was a Z….gosh, what do you think?”. We’d gently remind them that it was their choice and there was no wrong answer, but it was still difficult for them. We found out during a recent lecture that this generation believes firmly in the doctor telling them what to do, and I think this was a similar situation – we were the ones in charge – we see ourselves as little know-nothing OT students, but they see us almost as authority figures in the health arena, who should tell them their answers.

For the health status, it was interesting to see that many of them said they had great health, even if they were on a ton of medication. They’d list all their aches and pains and problems and medications, musing out loud, and then be like “Well…I guess I’m in pretty good health…”…when my partner and I would be thinking they’d say their health was poor. They tend to overestimate.

Just a few things I found interesting!

Dementia…rehab…geriatrics..OT

We have a lecture on dementia coming up. I’m looking forward to it. Another example…I observed a geriatric patient who had classic (but undiagnosed) signs of Parkinson’s. The shuffling gait, the perseveration (sp?), shakiness, etc. She never spoke unless spoken too, and it was very rarely more than a word or two. She was very old and deconditioned and we were always trying to get her to increase endurance and strength. She always had the cutest smile when the OT would work with her and try to get her to do something. She would look at us with this small smile, which to me read as “Are you guys serious? What do you guys think you’re doing?” I adored her smile. She seemed to get what was going on, and showed her wry smile frequently. I was shocked when I was informed she had dementia. To me, dementia is still a matter of crazy-talk…but apparently it can be much more subtle. I guess I’ll learn more in our upcoming lecture.

This particular case kind of made me wonder when enough is enough. If the woman is deconditioned, VERY old, and has no desire to participate, do occupational therapists really need to be “torturing” her with rehab? I don’t know…

PS: I saw some creative use of flower arranging at this facility as well. They would have one person with the patient guarding the patient standing up, and one person holding long fake flowers in the air for the patient to reach. Then the patient had to bend down a little to get the long stem into the long vase. It was a clever occupation-based activity.

Quality of Life versus Safety?

Healthcare is almost never black or white. Sometimes you have to juggle medical issues with quality of life issues. For example, I once observed a geriatric patient with Parkinson’s who really didn’t need to be eating normal food anymore, due to the danger of aspiration. He was deteriorating rapidly and didn’t have much control over his swallow.

However, eating was one of the few things he truly enjoyed. Was it more important to ruin his quality of life with safety? Or should safety come first, regardless of how it affects quality of life?

It was actually the speech therapist who made the decision on avoiding food, but it was the occupational therapist who knew how much enjoyed food. This case, for me, was a good example of the “gray” area that accompanies almost all healthcare decisions.

Gerontological Gem #483320

Gerontology is the study of aging in humans. It is distinguished from geriatrics, which is the branch of medicine that studies the diseases of the elderly. ….

1. I bet you didn’t know I have several old walkers in my backroom 😡 My crazy neighbor found them and gave them to me.

2. Most people are supposed to wear compression stockings their first few days in rehab, until they can walk a certain amount of feet. Compression stockings are really tight and help prevent DVT, or deep vein thrombosis. ANYWAY…they are hard to put on swollen feet!

http://hcd2.bupa.co.uk/fact_sheets/html/compression_stockings.html

This link shows a picture of an easier way to tug them onto feet since it makes it not as hard to get the heel on. My OT supervisor on my Level I fieldwork at Healthsouth showed the trick to me and it is cool!

I'm totally flunking OT school when it comes to common sense

I had a birthday (yay Patsy) dinner with some good friends of mine.

At the dinner table:

Me: Cat toys are expensive, but cats like weird things. My orange kitty in San Diego used to steal my mom's watch every morning while she was in the shower, and take it all over the house, so that Mom had to hunt her down.

Burt: Why didn't she just put the watch in a drawer?

Me: Wow. I never thought of that solution. That's it, I'm totally failing out of OT school!!

This OTS is pondering. And now sleeping.

Why is it that the more time I have, the less I want to do?!!! I'm going to go take a short nap, even though I have a to-do list of about five million things to do, and I'm not even exaggerating!! House chores, grocery shopping (I DONT EVEN HAVE PEANUT BUTTER! THE WORLD IS COMING TO AN END!), studying for management, computer backup, thank you notes, starting on well elderly stuff, reading on aging, blahdey blahdey blah blah BLAH!!!!!!!  It's interesting stuff, but it's still hard wanting to switch from reading trashy gossip to reading a textbook. I also have an online management meeting today with my 3 other group members + our online professor, at 4pm Central, and I guess I better get prepared. Oh well. After my nap I'll be super turbo charged and spout out questions and ideas like there is no TOMORROW.

I prepped my aging in place post! It's advanced a step! Progress, not perfection. Oh, I also have a post brewing in my brain about what makes identity….ie a lot of us identify ourselves as what we DO…while many with disabilities have to identify themselves as what they THINK…interesting…pondering this…a future post based on some recent e-mails as well as a conversation with my mom about the book and movie The Diving Bell & Butterfly, written by a dude who has a brainstem stroke and is locked inside his own body…and can only blink for communication.

Occupational therapy students have different tastes…

You all are allowed to come after me with FLAMING PITCHFORKS if put off my Aging in Place post one more day!!! I am sooo bad!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Here is a disturbing convo OTS Kerri and I had (she is an anatomy assistant)

Me: I love holding babies
Kerri: I love cutting up dead people.

:O

Hey, tomorrow, voting starts for Assembly of Student Delegates Steering Committee! AOTA Student Members need to go vote on www.aota.org!! Remember Karen Dobyns & Brooke Ward are the coolest people in THE ENTIRE WORLD!!!!!!!!!!!!!!!!!!!!!!!!!!! I'll post our flyers tomorrow!

OT thoughts on making a bed?

I was making my bed this afternoon so I could replace the bedroom lightbulb (haha made your brain hurt), and I realized my bedsheet setup may be amenable to OT. I spent a year in Norway as an exchange student in high school, and they make their beds differently. Most people have just one twin or full-size all-year-long down comforter, and it's the same size as the bed surface – it doesn't go over the edges. It just has a duvet cover on it. No sheets – just the bottom cover you lie on and the duvet comforter. So in the morning you just lift up the comforter and it takes 10 seconds instead of a few minutes to make the typical American bed with sheets and comforters and tucking in and all that. So for example, I have a full-size bed, and then I have a twin-sized down comforter on top. Very handy. Because duvets can be a pain to put on depending on the style, this isn't really a great bed set-up for someone with poor upper extremity strength, but it could useful for someone who only has lower extremity problems.

Also in Norway, most traditional couples have two matresses within one frame, and two comforters as well – that way each person has their own comforter and there is no fighting for the covers. I think that's a neat idea. So those of you with sheet-hogging spouses, replace your king-size comforter with two smaller ones! This could be especially handy if the one of the spouses has special needs and it's not easy to share covers.

I dunno. I haven't seen these suggestions elsewhere so maybe they are stupid. It just popped into my head as possibilities. The occupational therapist student brain of mine is working overtime. La la la.

About to head out for the night!! Maybe late tonight I'll feel like reading for Management, or writing my Aging in Place post, or working on my 10-week Well Elderly Program, or organizing my newly printed OT papers. Or. Maybe I'll feel like sleep. We shall see.

Holding babies…a future occupational therapist

This french vanilla yogurt is DISGUSTING.

This morning was my first day back volunteering in the Special Care Unit of a local pediatric hospital, holding babies. It was really nice to be back. I held one baby for close to an hour and he was a tongue-thruster with jerky movements, abducted thumbs, and flexed wrists (a lot of these kids have these issues). He was kind of fussy. He was crying when I walked in so I hurriedly picked him up, but I should have turned off his TV first. He gazed away from me the entire time, just staring at the Pooh characters on the screen. Once I heard some loud gurgly diaper noises (TMI?)  I put him down and let his nurse know, and then moved on to another kid. (I don't change their diapers myself since a lot of them have special protocols due to their conditions).

This next kid was adorable. However, he was the size of many one month babies, when in reality he was almost a year-old (again, most of these babies rarely look their age). He had almost no head control and he also had the abducted thumbs. He was very quiet and serene and didn't appear to have unusual GI issues beyond the typical stuff, so I decided to try some vertical tummy time with him. I held him against me so he could try and extend away from me. He did not have the arm strength or the neck strength to do this very well, but even a little bit is better than nothing. He stayed this way for an impressively long time, and then rested against me with his head under my chin. It was so sweet to hold this baby against me this way. Eventually he got a little fussy, so I put him in my arms so that it was more familiar to him as it more approximated a bed position. I rocked him and sang and held his little pacifier in his mouth. He put his hand on mine and eventually fell asleep. My volunteer shift ended ten minutes later, but I stayed an extra 30 minutes so I could keep holding him while he slept, since most of them don't transition well. He startled several times as janitors banged things and nurses talked loudly, which kind of irritated me, for his sake. He eventually woke up and I put him back in. He never babbled or made a single sound the entire time I held him, besides a little crying at one point. I felt sad for him, but I really enjoyed our cuddle time. I also love holding the babies pacifiers in their mouth (most of them have weak suck patterns and require some pressure/assistance) – these pacifiers have an inverted outer part so your finger actually is within the pacifier tunnel, in their mouth, so you can feel them sucking on your finger to some extent. So cute.

This yogurt is STILL disgusting. Ugh. Okay anyway. It was a nice experience. I talked to a nurse about how I'd love to just stop by when I can during the week, even if I am not scheduled, since my occupational therapy class schedule isn't consistent enough to allow a weekly time. I told them Volunteer Services had said that wasn't okay, but that from what I could tell, they could always use more volunteers. They agreed and said just call up and check, but it would be rare that we would turn you away. So I'm glad – I don't need the hours recognized by anyone, I just want to give these babies some attention!

I also called the OT I got to shadow over at the hospital on my pediatric Level I fieldwork, since she was mostly in that unit, and asked if I could start following her again a few times. My first time there I had only been in school a month or so, and the unit was pretty overwhelming, with all the tubes and poles and beeps. I was so scared of the babies that I didn't soak in as much as I could now.

My house is a mess but I clean it like every day. I'm apparently a messy person for the first 14 hours of the day, and then a clean person the last hour and get it all picked up. Weird huh.

PS!: The picture I found for this post sparked my memory. Go look on Youtube for documentaries on “Reborns”, which are amazingly realistic baby dolls! A lot of chicks buy them and treat them like real babies! It's kinda crazy!
PS2: I've been posting TONS and Google still isn't recognizing me high in the searches anymore. For a while there I was like the 3rd search result, coming up even before the AOTA, which made me laugh. Anyway,  I'm now a crying occupational therapy student with an OT blog 🙁