Navigation of our complex health care system may seem to be a daunting and impossible task for many. However, with the right guidance and support that Social Workers can provide, it becomes much more possible to develop the right combination of resources and community supports that will be integral to supporting both clients and their caregivers towards ageing in place. After all, for most of us, there really is "no place like home" and there is no better place to support a person to remain healthy and independent whenever possible.For the past sixteen years, I have worked with older adults as part of a Geriatric Assessment Outreach Team. Our mandate was to support seniors to be healthy and remain living in their own homes, for as long as possible and as safe as possible. In this role, I spent a great deal of time in the homes of people who are 65 years of age or older, who were living independently in the community. While the situations I encountered were diverse and often complex, what I can tell you with surety is that the vast majority of seniors have a deep desire to remain living in their own home. Clients would often tell me, "I'm going out of my home feet first, in a box," or "I am not moving anywhere, especially to a Long Term Care Home!"
One of the most difficult health issues that many seniors face is that of developing dementia, which can make it exceptionally challenging to remain living in your own home. Even with the support of a loving spouse or adult children, caring neighbours and friends, living with dementia is by far one of the most challenging and devastating health issues to manage. Of course, there are no absolute guarantees that we will not develop dementia. There are so many factors that we do not have control over, like our genetics. But as with any health issue, there are things we can do to actively prevent or prolong the onset of dementia. Each of us has a role to play in meeting our long-term health goals of aging in our own homes. We can try our utmost to age healthy and to minimize the risks of developing dementia.
As a recent retiree, the issues and challenges around aging have become increasingly relevant as I move into my "young-old," years. It turns out that social workers are not immune to aging! Like many of my clients over the years, I too want to grow old at home. I want to remain active, stay independent and alert; and I want to live my life to the fullest. And also like many people, I do not always do the "shoulds," in terms of my own health. I should eat better, exercise regularly, drink more water, and get more sleep. The advice I gave to clients is now advice that I give to myself, family and friends. It is a phrase you will find throughout current research on healthy aging: "What's good for the heart is good for the brain."
Aging in Place
To support "aging in place," my primary responsibility in conducting geriatric assessments was to look at whole health, helping to determine how a variety of factors might be impacting an individual's ability to function well on a daily basis. As a team we assessed physical well-being, which included mobility and risk for falls. I would gather information about the medications being taken, because prescription medications, over-the-counter medications, vitamins and even herbs can (and do) affect the mind, mood and physical well-being of a senior. I also looked at how much alcohol and/or other substances they may have been using. This may surprise some, but some seniors do enjoy a joint every now and then. In fact, as the Boomers are aging, we definitely are seeing more and more seniors who indulge in the use of common as well as more illicit street drugs.
Taking a whole-health approach meant that we needed to ask those hard, and at times, embarrassing questions. We also assessed mental health and brain health - how were they doing cognitively? How was their memory functioning? I looked at how safe their home was and how safe they were in their immediate community; and yes, I assessed driving safety too! Our assessments were always carried out in a manner that reassured clients and families that our goal in geriatric assessment was to help seniors stay right where they wanted to be, at home.
The Alzheimer's Society of Canada defines Dementia as, "a set of symptoms that are caused by disorders affecting the brain" (Alzheimer's Society of Canada, 2017). Alzheimer's Disease is progressive, fatal, and one of the most common causes of dementia. It affects every aspect of a person's life as well as every aspect of the lives of the people who love and care for their loved one living with dementia. What makes intervention especially difficult in cases of dementia is that every person experiences the disease differently, and the course of the disease can be somewhat unpredictable. How fast it progresses and what symptoms manifest is different for each person. It is also impossible to predict how or when symptoms will present themselves. Symptoms can affect all four developmental domains over time including cognition, physical abilities, emotional/psychological and spiritual health. Alzheimer's can also affect behaviour. What we do know is there is still no cure for Alzheimer's Disease and it robs the affected person of his or her independence, over time.
Alzheimer's disease is one of the most known causes of dementia but there are also other related dementias. The most common types include: Mild Cognitive Impairment, Vascular dementia, Mixed dementia, Frontotemporal dementia, Lewy body dementia, Young onset dementia, Creutzfeldt-Jakob disease, Down syndrome and the rarer forms of dementia, that might include Huntington's disease or Multiple sclerosis, as examples (Alzheimer's Society of Canada, 2017). In other words, there are multiple reasons and multiple risk factors as to why someone might develop dementia. The Alzheimer's Society of Canada is one of the best sources for information about various kinds of dementia. They have a website full of resources, and you can access a variety of links that will take you to specific sources of information on each of the dementias mentioned.
Making Healthy Choices
The brain, like your heart and lungs, is a vital organ - and just as we do things to keep our heart and lungs healthy, we need to make healthy choices for our brain. So, what can we do? There are several factors that are known to keep the heart, blood vessels and lungs healthy. Keeping a healthy body weight, good nutrition and hydration is the place to start. Obesity and poor nutrition, over time, often lead to heart disease, stroke and diabetes. In turn, these health conditions increase the risk for developing Alzheimer's disease. So eating a heart healthy diet increases the likelihood that your brain is also being well nourished, therefore decreasing the likelihood that memory will decline; some food for thought.
Staying hydrated is also important. "Our brains depend on proper hydration to function optimally. Brain cells require a delicate balance between water and various elements to operate, and when you lose too much water, that balance is disrupted. Your brain cells lose efficiency. Years of research have found that when we are lacking in H2O, we have more difficulty keeping our attention focused. Dehydration can impair short-term memory function and the recall of long-term memory" (Gowan, 2010). Drink water, it does the brain good.
Exercising regularly - I know, I know, easier said than done, but crucial for heart and therefore brain health. Why? When we exercise, our heart gets pumping and it makes sure the blood gets up to our brain, thus providing our brain cells with oxygen and nutrients. We don't have to get fancy - go for a good, brisk walk, take a swim, pedal a bike, do yoga, chair exercises are effective too, but please, DO exercise, at least three times a week for about a half hour to forty-five minutes
Getting a regular, good night's sleep is essential for a healthy heart and brain. "People who don't sleep enough are at higher risk for cardiovascular disease-regardless of age, weight, smoking and exercise habits. One study that examined data from 3,000 adults over the age of 45 found that those who slept fewer than six hours per night were about twice as likely to have a stroke or heart attack as people who slept six to eight hours per night" (National Sleep Foundation, 2012). Sleep deprivation also affects memory, mood and daily function. A lack of sleep is likely to increase the risk of developing Alzheimer's disease, because less sleep or sleeping poorly is tied to an increase in brain levels of beta-amyloid, a toxic protein that builds up and forms plaques in the brain. As we know, plaques are found in the brains of those with Alzheimer's.
We all know that smoking increases our risk for heart disease, lung disease, cancer and many other health issues. Smoking suffocates the brain. It cuts off oxygen. As I said earlier, our brain needs oxygen and nutrients to function. Smoking impairs our cardiovascular system, therefore, it affects the health of our brains too. Quitting is the best option, but even cutting back can make a difference. Keep on trying!
Trying to "not sweat the small stuff" keeps our stress levels down and in turn, helps to keep our blood pressure at healthy levels. Keeping track of our cholesterol and blood sugar levels can be helpful too. We want to keep all of these "levels" within the recommended ranges. Our doctors can help us to understand these ranges. Again, diet, hydration, exercise and sleep help us to keep our levels in these areas under control.
Embracing moderation in our lifestyle choices is a simple approach to adopt. By not drinking alcohol to excess or abusing drugs that may place our body, including our brain, at risk; we can improve our health outcomes. "Our ability to maintain life-long brain health is very much influenced by the choices we make in our daily lives. Research has found that next to aging, the most influential factors in determining one's susceptibility to Alzheimer's disease are lifestyle and environmental factors" (Alzheimer's Society of Canada, 2017).
We can also make simple "safety choices", like wearing a helmet when we bike or skate. We are learning that head trauma, particularly repeated concussions, seem to increase our risk for developing Alzheimer disease. Do you wear your seat belt? Motor Vehicle accidents, even fender-benders, place us at risk for head injuries. Making sure your home is safe is an important step in keeping your brain safe. Do you have scattered rugs, things cluttering your stairways, cords that cross over doorways or pathways, that can increase your risk for tripping and having a fall? If you do, move them! Make sure you have good lighting in your home, especially at night. Installing movement-censored lights that will click on when you get up to go to the bathroom at night or that will come on as you are walking up your lane way or walkway, can keep you safe. Use a non-slip mat in your bathtub. If you have any issues with balance, having grab bars in your tub or shower will help to keep you safe. Falls are one of the major causes of head injuries in seniors, and most falls are preventable.
The fun-factor is important in healthy aging too! We need to stay socially active and engaged with our family, friends and community. When we are engaged socially, then we are engaged mentally. Nurture your present relationships and go out and make new friends too! Volunteering in your community is a great way to meet new people, get to know your community and to feel great about "paying it forward." In this case, what's good for the brain is good for the heart. We are relational beings and our hearts are happy when we are connected. When our hearts are happy, our brains are offered dopamine, the feel-good chemical that plays a major role in reward-motivated behaviour. Go out and try new things.
Life-long learning is proven to be one factor that deters the onset of dementia. Find activities that stimulate your brain. Try to think outside the box. Maybe you have always wanted to play piano or the flute? Well, there's no time like the present. There are countless new and innovative apps on our iPhones or tablets that also engage our brains and many of them are free. If you don't have access to a tablet, or like to do things the "old fashioned" way, play Scrabble, Boggle, do crosswords and puzzles, or read, read, read! My mother, who is now 91 years old, took a computer class a few years ago because she wanted to keep in touch with her world-traveling grandchildren. Today, you can find her on Facebook, Twitter, Instagram, email, text and a few other social media accounts. She is connected and living proof that it is never too late to learn new things.
As social workers, we need to learn all that we can about best-practice interventions with older clients, so that we can give them the very best opportunities to age well and to live well. We are role-models, so we also need to "walk the talk." We are all aging and therefore, we are all in this together. I am one of many that would like to "age in place." I too, want to live a full and abundantly rich life, be healthy and feel healthy for as long as possible. Although there are no absolute guarantees, I want to do everything in my power to prevent the onset of dementia and other age-related syndromes or conditions. While there are no promises in life, we can improve our odds. We can start every day, by reminding ourselves that what is good for our hearts is good for our brains.
References & Links
Alzheimer's Society of Canada, 2017
National Sleep Foundation, 2012
"Why Your Brain Needs Water," by J. Gowan, 2010
In addition to being a retired Registered Social Worker and Geriatric Assessor, Joyce is a Subject Matter Expert for the OASW's Online Certificate: Advanced Social Work Practice with Older Adults.
In the winter of 2016, Ontario Association of Social Work (OASW), launched its first, online Certificate Program: Advanced Social Work with Older Adults. It was proven to be a resounding success and is now being offered annually. The decision to focus on advanced social work practice with older adults reflects the conviction of the OASW, that there is a vital need to build knowledge and expertise for social workers, with this burgeoning demographic. It seems to me, that as social workers, we not only need to develop knowledge and skills in order to intervene with our older clients and their families; but, we have to be realistic and acknowledge that we, ourselves, are not immune to aging and nor are our own loved ones.
The advanced practice course offers social workers the opportunity to learn best-practice skills, in order to make a difference in the daily life of older people. There are six modules, each developed with evidence based information relevant to experienced social workers. The modules cover topics such as: Normal Aging, Geriatric Syndromes/ Conditions, Geriatric Assessment and Screening Tools, Mental Health, Pharmacology, Ethics and Care of the Elderly and Policy and Macro Perspectives. As one of the facilitators of this course, I too want to make a difference for my clients, my colleagues, my family, my friends and myself. Hope to connect on-line with you in the Advanced Practice Certificate course. Are you with me?
- Joyce Hamelin, MSW, RSW