For many seniors, doctor’s visits are stressful. There are sometimes complex health issues that need to be addressed and your loved one is unsure where to start. You can use this checklist to help ease anxiety and ensure a smooth visit.
Arrange for transportation to and from prior to the appointment. If you are unable to attend, companion/PSW services can be arranged through Alert Best Nursing & Home Care to accompany your loved one. 

Check if the appointment or associated tests require seniors to contact their insurance company ahead of time for pre-certification or other purposes. Check if fasting will be required or if there are certain foods your senior needs to avoid.
Pack everything needed for a successful appointment:

• Insurance cards
• Health Card
• Payment for co-pays or other charges
• Contact information for other doctors
• List of current medications
• List of allergies/medical conditions
• Medical records, if needed
• A list of questions for the doctor
• A notepad or device for note-taking

Verify at checkout after the appointment: 

• If further testing or labs are required
• When new prescriptions should be picked up
• If there are instructions or treatment notes seniors can take home with them
• When follow-up appointments are scheduled
• If any payment is due 

Keep an eye out for the expiration date on the health card. If you need to renew an expired card and are in the Province of Ontario, you can visit www.ontario.ca/page/health-card-renewal-replacement-and-cancellation for up to date renewal information. 

Summertime is a favorite season for most Canadians and especially older adults who spent most of the time indoors during the cold winter months. While summer is a great time for outdoor fun with family and friends, the heat and sun can be dangerous if precautions aren't taken.
If you are a senior or a caregiver, here are some tips for a fun, safe summer.

Stay Hydrated:
You are more susceptible to dehydration because you lose your ability to conserve water as you age. You also can become less aware of your thirst and have difficulty adjusting to temperature changes.
You should drink at least eight glasses of water per day to stay hydrated, more in conditions of extreme heat and humidity. Salt and potassium replacement products (Gatorade) are also helpful. Avoid caffeine (coffee, tea, cola) and alcohol, which can actually dehydrate the body.

Check Your Medications
Make sure your medications won't be affected by higher temperatures -- especially if you don't have air conditioning in your home. Some medications are less effective if stored at temperatures higher than room temperature.

Keep Cool:
Even small increases in temperature can shorten the life expectancy for seniors who are coping with chronic medical conditions. Cool your home by keeping hot, humid air outdoors. Shut windows and doors as well as blinds or shutters. Stay indoors on lower floors in hotter, more humid weather. Shopping malls, movie theaters, churches and libraries provide welcome, cool spaces. They also afford a great opportunity to get out of the house and get some exercise, without the exhaustion of the heat.

Contact your city/local municipality office to inquire if there are any programs to assist seniors with fewer resources to get air conditioners or fans. Take a cool shower or bath which can lower your body temperature on extremely hot days. Temperatures inside the house should never exceed 85 degrees for any prolonged period of time.

Stay In Touch:
You should let friends and family know if you will be spending an extended period of time outdoors, even if only gardening. Do these tasks in the early morning, not during peak heat or sun. Keep track of time and do not stay outside for long periods of time.
Caregivers should check in regularly with the senior when temperatures are high.

Know Who To Call:
Prepare a list of emergency phone numbers and place them in an easy to access area. This way, the right people can be called to help quickly, to prevent any further issues or to keep medical problems from getting worse.

Keep The Menu Light:
Eating yogurt, fruit, vegetables, salads and chilled soups in smaller portions can keep your body from overworking and overheating.

Dress For The Weather:
Everyone, including seniors, should dress for the weather. When it's hot out, some people find natural fabrics (such as cotton) to be cooler than synthetic fibers. Wear light-colored and loose-fitting clothes to help feel cooler. They reflect the heat and are more comfortable.

Protect Your Body:
Sunblock will protect your skin from damage. Use at least SPF 30 or higher sunblock, along with wearing hats and sunglasses. Don’t forget the bug spray too!
Vision loss can be common among seniors, and too much exposure to the sun can irritate eyes and cause further damage. Wearing sunglasses can protect your eyes from harmful UV rays and preserve your vision.

Be Aware Of Heat-Related Illnesses:
During the summer, be particularly cautious about abnormally high body temperatures. Heat stroke is an advanced form of hyperthermia that can be life-threatening. Make sure to know the warning signs and get medical attention immediately if you or anyone you know is experiencing these symptoms:

• Body temperature greater than 104 degrees
  
• A change in behavior such as confusion or agitation
  
• Dry, flushed skin
  
• Nausea and vomiting
  
• Headache
  
• Heavy breathing or a rapid pulse
  
• Not sweating, even if it's hot out
  
• Dizziness or fainting
  

If you or an elderly loved one start to feel any of these symptoms, ask for medical help!

Check The Weather Report:
A heat wave is at least 48 hours of excessive heat and high humidity. It is difficult and dangerous for everyone, especially seniors. A heat index tells how hot it feels as it combines the air temperature and relative humidity. Direct sunlight can increase this temperature by several degrees.

Know Your Risk:
These health factors may increase the risk and threat of a heat related illness:

• Poor circulation, inefficient sweat glands, and changes to the skin by normal aging
  
• Heart, lung, and kidney diseases, as well as any illness that causes weakness or fever
  
• High blood pressure or conditions that require changes in diet. Low salt diets may face added risk
  
• Taking several different prescriptions for various conditions
  
• Being overweight or underweight
  
• Drinking alcoholic beverages
  

Keep cool and stay safe this summer in the heat!
 

Summer is finally here but does the thought of ticks and Lyme disease make you a bit nervous of going outdoors this summer? Here are some information and tips for how to protect you and your family while hitting the great outdoors this summer:

What is Lyme disease?
We Ontarians are fortunate to have an abundance of wilderness that provides us great opportunity to enjoy the outdoors.  But one thing to keep in mind when outside—especially in wooded areas and those with tall grasses, bushes and shrubs—is Lyme disease.

Lyme disease is spread to humans through the bite of an infected, Blacklegged Tick and health officials are seeing an increase in the number of cases in the province.
“We’ve seen a marked increase in the number of confirmed cases of Lyme disease in Ontario, particularly in the last year,” says Dr. David Williams, Ontario’s Chief Medical Officer of Health. “This is partly due to an increase and expansion of Blacklegged Tick populations to new areas of the province.”

The most common symptom of Lyme disease is an expanding skin rash, which can appear between three and 30 days after a bite. However, many people never get or see a rash.
If the disease is left untreated, other symptoms may develop including fever, chills, headache, fatigue, muscle and joint aches, problems with your heartbeat, breathing, balance and short-term memory. In rare cases, Lyme disease may result in death.

“It is important to see your health care provider as early as possible if you have symptoms or if you feel unwell in the weeks following a tick bite,” says Dr. Williams. “The earlier treatment is received the better.”

How do people contract Lyme disease?
Blacklegged Ticks cannot fly, but settle in brushy areas until they attach themselves to a passing person or animal. The ticks are known to feed on migratory birds and can be carried throughout the province. Lyme disease is not transmitted from person-to-person; however, dogs and cats can carry Blacklegged Ticks inside and place families at risk of being bitten.

Check your pets for ticks daily and talk with your vet about keeping your pet protected from ticks. If your pet is found to have a tick, remember that you are at risk when spending time in the same environments.
 
When you’re out in tick habitat, protect yourself by taking these precautions:

• Wear light-coloured clothing. It makes ticks easier to spot
• Wear closed footwear and socks and a long-sleeved shirt tucked into long pants. Tuck your pants into your socks
• Use a tick repellent that has DEET or icaridin on your clothes and exposed skin (be sure to follow the manufacturer’s directions)
• Search your clothes and body for ticks at least once a day, paying special attention to areas such as the groin, navel, armpits, and scalp and behind ears and knees. Use a mirror to check the back of your body or have someone else check for you. Don’t forget to tick check children in your care
• Take a shower as soon as you can after being outdoors to more easily find and wash off any ticks crawling on you
• Place outdoor clothing through the dryer cycle for 60 minutes on high heat before washing to kill any ticks that may be hard to see. Ticks thrive in wet environments

What if I find a tick?

1. Use fine-tipped tweezers to grasp the tick as close to the skin as possible
2. Pull the tick out slowly with even pressure to ensure mouth parts are removed and body is not crushed
3. Wash area with soap and warm water
4. Put the tick into a container with a lid or a sealed plastic bag
5. Bring the tick to your local health unit for identification

DO NOT

• Grasp around bloated belly and squeeze the tick
• Use a match, heat or chemicals to try and remove it
• Twist the tick when pulling it out

Current Lyme disease risk areas in Ontario
While not all Backlegged Ticks can cause Lyme disease, there has been an increase in the number of areas in Ontario where Blacklegged Ticks have been identified or are known to exist.
Infected ticks are continuing to spread and can now also be found in in the Simcoe-Muskoka district, York Region and all of Eastern Ontario as well as Hamilton and parts of Northwestern Ontario.
For more details, review the Lyme disease risk area map:
 
While the probability is low, it is possible to encounter an infected tick almost anywhere in the province.

For more information please consult the Public Health Agency of Canada or the Ontario Ministry of Health and Long-Term Care.
 
 
 

We are extremely fortunate to have been introduced to The Angel Project founder Lisette Kingo through our Rotary Club and we wanted to share with you the amazing work they do for patients in hospital.

What is the Angel Project and What do we do? 
Our charity was founded in 2008 by Lisette Kingo after a visit to the Complex Care unit at Parkwood Hospital. Many patients spend decades in Complex Care units in hospitals and will never go home again; accident victims, MS, ALS patients and others who have been left without tools and the finances to fend for themselves and have been abandoned by their families and society. Hospital foundations are wonderful however they have such a large need to fill that the social agenda and Complex Care units are often left to the last. 
Do you know that hospitals do not provide what we consider basic needs to patients such as shaving cream or soap and there are virtually no funds for recreational activities such as outings? 
We pride ourselves on being one of the very few organizations that operate with minimal overhead, and a totally volunteer team and board of directors. The majority of  funds we raise through our website donations (www.theangelproject.ca) or various fundraising events, go directly to our patients or the Complex Care Unit at the hospital.  At The Angel Project we not only raise funds to assist in at least one outing per eligible patient per year , when possible we assist with the purchase of  items such as wheelchairs, voice boxes and speech computers. Although there are some provincial funding for these, it is not enough for patients who do not have enough to cover the patient portion, The wait for provincial funding is also excruciating . We also assist with basic needs such as providing soap, shaving cream, shampoo and even simple comforts such as stuffed animals, soft blankets or gifts at Christmas.  Our patients at Joe Brant Hospital (Burlington) and Parkwood Hospital (London) depend on the funds we raise through our fund raising events and private donations.

To help raise their awareness and build sustainable  support of The Angel Project, we have created a Hockey tournament, The Angel Tournament , to “skate for those who can’t”,  now in our Fourth year. We have details about the success of  last year’s event at www.theangelproject.ca. This year we have of the City of Burlington and Nelson arena to host the tournament. We will have approximately 70 children involved in the tournament, all “skating for someone who can’t.” 

Here is a breakdown of just some of the items The Angel Project has provided patients and hospitals with. To give you an idea for example just one piece of equipment can cost upwards to $10,000

• Countless customized wheel chairs for patients
• Giving a voice back to patients who are unable to speak post stroke or spinal cord injury through funding computers, dynovox computers, and speaking devices
• Over $50K in rebuilding lounges and spaces for patients
• Construction of hospital outdoor garden area with pergolas and furniture
• SMART board for patient use
• Many iPads with retina displays
• Hand Cycle for rehabilitation for bedridden patients
• Several large screen TV’s and DVD players as well as movie library
• WII systems and play stations
• Hundreds of Hand made quilts for patients
• Hundreds of Personalized Christmas gifts
• Funding for a “Slush fund” this fund is set up so that patients do not have to go though the red tape for a few dollars for small extras, such a hair cut or manicure. 
• Bingo Carts with prizes as well as gift cards, iTunes cards, Tim Horton Cards, games etc. 
• Chair lifts
• Computer systems and speech programs
• Voice Boxes
• Re vamp of patient lounges (including designer curtains, furniture, electronics etc) 
• Outdoor gardens including garden furniture plants etc. 
• Outings to hockey games, rock in the park, western fair , trips to the mall, trips to park etc. Including medical transport.
• Medical transport for patients to attend various events. 
• Support “ NEW HOPE” a short film for speech pathologist made by patients. 
• BEPAP Machine to assist patients in breathing
• Electric Chair lift
• The creation of craft corners with supplies and space. 
• Funding for entertainment such as a musician coming to visit the hospital .
• Pocket talkers
• Sliding boards for patients transfers
• Eze turn transfer disc
• Stroke Walkers
• Treadmill
• Upper extremity mobile cable system
• Apple TV
• Exercise equipment and activity supplies

But more than any of the listed items it is often the little things that make the biggest difference. Hygiene items, such as shampoo and soap and a handmade quilt to make a patient feel human and cared for. Hand made personalized Christmas cards for patients to let them know they are not alone. 
In the words of our patients “ The angel project and its volunteers are truly Angels that walk among us”

To learn more about Lisette and the Angel Squad, visit: www.theangelproject.ca/

With the hot summer months fast approaching, it is crucial to keep hydrated! WebMD walks us through what happens to our bodies when we do drink enough!

• You Stay Regular

​It’s common to get a little constipated if you don’t drink enough water. Inactivity, diet changes, illness, and even stress can add to the problem. The constipation usually passes on its own, but you can help move things along with exercise, over-the-counter meds, and of course, water.
See a doctor if your constipation lasts for more than a week or two or you have dizziness, bad pain in your belly, or blood in your stool. These could be signs of something more serious.

• Your Joints Work Better

Water makes up a large part of your joint cartilage that helps absorb shock and make bone-against-bone movements smoother. Water also can help keep gout (a painful joint condition) at bay.  It helps flush toxins from your body that could inflame your joints, too.

• You Sweat

And that’s a good thing! As sweat evaporates from your skin, it cools down your body. Have a couple of extra cups of water in the couple of hours before you head out for exercise. Try to take about 10 big gulps every 15 minutes or so during your workout, too. Remember, you might not see the sweat you lose if you’re in the pool or an air-conditioned gym.

• You Avoid Dehydration

Without enough water, you can sweat away too much fluid. You can also lose sodium and potassium that your body needs. It’s especially true in the heat. When it happens, you may be thirsty, pee less than usual, and your mouth might dry out. You could even feel dizzy, lightheaded, and confused.

• Your Kidneys Stay Healthier

Water helps your kidneys remove waste from your blood. If you don’t get enough water, that waste -- along with acids -- can build up. That can lead to your kidneys getting clogged up with proteins called myoglobin. Dehydration can also lead to kidney stones and urinary tract infections.

• You Keep Your Brain Sharp

You may not remember as well, think as clearly, or concentrate as easily when you’re low on water. And you don’t have to be seriously dehydrated. It can happen if you’re just a little below where you should be. How little? Less than 4 cups of water in a 150-pound person.

• You May Gain an Athletic Edge

Even mild dehydration can make you tired.  So it makes sense that athletes who replace the sweat they lose with water and electrolytes (minerals like sodium and potassium) have lower body temperature, more muscle, stronger hearts, more brain power, and more energy. It all adds up to better performance.

• You Could Lose Weight

People who had just 2 or 3 more cups of water a day seem to have less fat, sugar, salt, and overall calories through the day. That means proper hydration could help you lose weight.
Extra water can replace empty, sugary calories many people drink with meals. Water also seems to speed up your metabolism, and it takes up space in your stomach so you feel more full. 

• Your Heart Works Better

Your ticker doesn’t have to work as hard when you drink enough water. In fact, even mild dehydration affects your blood vessels (making them less springy) about the same as smoking a cigarette. Skimping on water also leads to less blood in your body, which can lower your blood pressure and raise your heart rate. It takes just 15 to 20 minutes for enough water to even things out.

• You’re Less Likely to Faint

You’re less likely to pass out when you give blood if you’ve had enough water. The same seems to be true if you’re careful to replace water lost through sweat or urine. When levels get a bit low, your blood pressure can drop and your nervous system can’t control it as well. That could make you faint. Watch out for this if it’s hot outside, and especially when you exercise.

• How Much Is Enough?

A good rule of thumb is 15 cups a day for men and 11 cups for women. But keep in mind that includes total fluids. You get 20% to 30% of your water from food. You get more from other drinks like juice, tea, and milk. If you’re sick, you’ll need more (especially with diarrhea or vomiting). If you’re exercising or outside in the heat, focus on getting a little extra, too.

• Don’t Have Too Much

Too much water can dilute the salt in your blood enough to make you sick (it’s called hyponatremia). Plus, you don’t want to overdo it if you have certain health issues or take drugs that cause you to retain water, like NSAIDs, opiates, antidepressants, or others. Drink enough to keep a hint of yellow in the colour of your urine, but not so much that it’s always clear, or you spend all day in the bathroom. Talk to your doctor if you’re unsure.

Slide show link from WebMd: www.webmd.com/a-to-z-guides/ss/slideshow-drink-enough-water?ecd=wnl_spr_060119&ctr=wnl-spr-060119_nsl-LeadModule_cta&mb=g1ARPZ4CCSqHVhQJ2c50eJAyWFWqf9PL6V8y21avtvU%3d

​

Do you have an aging family member that is struggling to keep up with the daily work around the house? Are they skipping meals or lacking proper nutrition because they just don't want to think about it or are struggling with the cooking? Are they having some trouble with their personal care, such as bathing, dressing, or using the bathroom but perhaps too embarrassed to say anything or are scared of a fall?  If you are going through this we can help!

Alert Best Nursing & Home Care is a solution for helping your aging loved one with all those things while still maintaining their independence. The below are 4 examples of how home care can help:

#1: Keeping the House Clean:

If you’ve noticed that your senior's home is starting to look a bit unkempt or that dust is gathering, they may be having trouble cleaning on their own. It’s also possible that their vision is failing, and they simply don’t see the dust and dirt. Home care staff can perform light housekeeping duties, such as vacuuming, dusting, sweeping, mopping, laundry, bed linen changes 

#2: Meal Times:

Many times we see seniors resorting to processed foods that are convenient and easy to make in the microwave but with inadequate nutritional value. This can lead to all kinds of health issues, such as malnutrition, obesity, or increased risk for serious conditions. Our staff can prepare balanced meals that include healthy ingredients, like fruits, vegetables, whole grains, and lean proteins. 

#3: Personal Care/Hygiene 

For older adults who have mobility or balance problems, bathing can be a scary and sometimes dangerous task. Water combined with the smooth surfaces in most bathrooms can result in a fall.
Our trained staff can assist with getting in and out of the tub or shower safely while also preserving your loved one's dignity as much as possible. Staff can also help to comb their hair, shave, or apply makeup.

#4: Managing Medical Conditions

Older adults with medical conditions may have trouble managing their symptoms and following doctor’s advice. They may forget to take medication or check their blood sugar which can lead to further or future problems. Our staff can provide medication reminders and can also remind your loved one when it’s time to check their blood sugar. Our Registered Staff (RPN/RN) can also provide health assessments, health teaching and education. Staff are also available to accompany your loved one to appointments and take notes if you are unable to attend.

For a complimentary consultation please give us a call at 905-524-5990  

Put Out the Welcome Mat
Many allergy triggers, like pollen, move into your home on your shoes. Ask your friends and family to wipe them before they come inside. Choose a rubber mat that's easy to clean. Better yet, ask visitors to leave their shoes at the door.
 
Clean the Air With a HEPA Filter
It can capture 99% of the tiny particles that trigger your allergies. It works best for removing pet dander and pollen, but not as well for dust mites. Look for units tested by the Association of Home Appliance Manufacturers that list the clean air delivery rate (CADR). Make sure the number is at least two-thirds of the room's square feet.

Upgrade Your Furnace Filter
Try pleated paper filters with a MERV (efficiency) rating of 7 to 13. They can be almost as effective as a HEPA filter. Or go for an electrostatic one that uses charged fibers to trap allergens. Change filters every 3 months to keep your furnace working well. A more expensive option is a whole-house HEPA or electrostatic filter unit that's added to your heating and air-conditioning system.

Electronic Air Cleaners
These machines don't use filters or fans. Instead, they change the electric charge on polluting particles. Some of these products, though, release ozone, which can sometimes make your allergies worse. 
You can move them from room to room, put one on your furnace, or mount it on your ceiling.

Use a Neti Pot
You can ease your allergy symptoms if you clean out the passageways of your nose. Fill the pot with lukewarm salt water made with sterile or distilled water. Or use boiled tap water after it cools down. Tilt your head over the sink, then pour the liquid into one nostril and let it drain out of the other. You can also use a bulb syringe or rinse bottle.

OTC Allergy Medications
They come in pills, eye drops, and nasal sprays. Antihistamine pills give you relief from sneezing, watery eyes, and runny nose. Decongestants work for a stuffy nose. Try antihistamine drops if your eyes are itchy.
Allergy nasal sprays prevent sneezing and runny nose. Decongestant nasal sprays aren't the same thing. If you use them for more than 3 days, they can make your stuffiness worse.

Humidifiers and Dehumidifiers
Dust mites -- tiny creatures that live in your bed, sofa, and carpet -- can trigger your allergies. They thrive in warm, moist air, so you can fight back if you keep your indoor humidity low. But too-dry air can irritate your nose and make your symptoms worse. Strike a balance by making the humidity in your home between 30% and 50%. You can monitor it with a device called a hygrometer.

Remake Your Bed
You can avoid some allergy attacks if you keep dust mites out of your mattresses and pillows. Choose pillows and comforters filled with man-made material that's less likely to trigger symptoms, instead of mite-friendly feathers. And cut back on throw pillows.

Cover Up
Surround your pillows, mattress, and box springs with allergen-proof covers. Prices can range from $20-$150, depending on your bed size.

Upgrade Your Dust Cloth
Trade in your old one, which stirs up allergy-causing particles while you dust, for a microfiber cloth. Unlike a cotton towel or an old T-shirt, it has fibers with an electrostatic charge that attracts and traps dust. It's OK to put it in the washing machine. You can get microfiber mitts for hard to reach or delicate items, and special wipes for electronics.

Wear a Mask and Gloves
Housework and yard work stir up a lot of allergy triggers, from dust and pet dander to pollen and leaf mold. Keep problems away with an inexpensive safety mask. Use gloves when you work outside, or indoors when you handle household cleaners.

Use a HEPA Vacuum
Vacuuming once a week can help allergy-proof your home, but standard machines can stir dust and allergy triggers into the air. Instead, you can trap them if you use a vacuum with a replaceable HEPA filter or a double bag.

Steam Cleaning
It helps get rid of dust mites in carpets and upholstered furniture. You can rent a steamer at a grocery or home improvement store, or buy your own. Some manufacturers offer cleaning solutions that are specially made to control allergy triggers. Vacuum after you steam clean to get rid of dead mites.

Wipe Out Mold
It loves warm, wet places like the kitchen and bathroom. To get rid of it, you have to clean, disinfect, and dry. Scrub away with soap, water, and a stiff brush. Disinfect with a mold-killing product that has 5% chlorine bleach, or use hydrogen peroxide or vinegar. Check for leaks, and use an exhaust fan to keep it from coming back.

Pet Beds and Shampoos
You can scale back your symptoms if you keep your contact with pet dander to a minimum. Use a mild shampoo to wash your animal often. If your cat doesn't like baths, at least wipe his fur with a damp washcloth. You can also buy pet wipes. Use plastic beds that can be wiped down, or wash the bedding in hot water at least once a week.

Buy Washable Toys
Stuffed toys collect dander and dust mites as well as dirt. Check the labels when you buy them to make sure it's OK to wash them. Toss them in the washing machine with hot water every week. Store them on shelves or in a hanging net, but not on the bed. Wipe down plastic or wooden toys with a damp cloth.

By: Alexandra Curkovic,  clinical nurse specialist, Hospital Elder Life Program 

Have you ever heard of delirium? This disorder isn’t commonly understood, but it is a common concern among older adults in the hospital (it can also affect kids).
It’s an acute disorder, which means it usually appears suddenly and doesn’t typically last too long. It can develop in as little as a few hours and symptoms tend to fluctuate in severity throughout the day. People with delirium have problems in attention and awareness. It is most common in older patients who are hospitalized, but the symptoms are not always easy to identify.

A patient with delirium may have difficulty following a conversation and may get confused about their environment to the point that they don’t recognize they are in the hospital. Changes to the patient’s physical environment—like moving a patient to a new room—may make symptoms worse.

What does hospital delirium look like?
People with delirium can act confused and may:• have trouble paying attention
• be forgetful
• be restless and upset
• have trouble concentrating
• startle easily to any sound or touch
• slur their speech
• ramble and jump from topic to topic
• not know where they are
• have trouble staying awake
• see and hear imaginary things
• mix up days and nights
• act confused for a short period of time during the day and then be suddenly okay
• drift into sleep during conversation

Delirium can have serious, negative effects on a person’s ability to function independently and can affect their quality of life long term. It can also increase a person’s likelihood of developing dementia.

A patient’s perspective on delirium:

John Vlainic, a former Hamilton Health Sciences employee, experienced delirium while he was in the hospital being treated for a serious infection. He describes the experience as completely disorienting. “I remember being adamant there were men on the roof outside my hospital room window,” he says, recalling one of the visions he imagined. “I also became convinced the machine warming my oxygen was dangerous. I decided I would unplug it in the middle of the night.”

John’s wife Ruth says it was concerning seeing her husband in this state. They were glad when his delirium started to lift after a couple days.

What’s the difference between dementia and delirium?

Dementia develops over months, with a slow progression of cognitive decline over years. On the other hand, delirium occurs abruptly over a few days or weeks, and symptoms can come and go during the day. A person with dementia is much more likely to develop delirium when hospitalized.
The main difference separating delirium from dementia is inattention and level of alertness. The individual with delirium simply cannot focus on one idea or task. This inattention is usually present in later stages of dementia.
Level of consciousness for patients with delirium may fluctuate from very tired to very easily startled state whereas patients with dementia are normally alert unless they are in the later stage. .

Risk factors for hospital delirium:

There are several risk factors that can make a person more likely to develop delirium. The tips below will help you to reduce these risk factors in the hospital:

1. Cognitive impairment: People with existing dementia or mild cognitive impairment are more likely to develop delirium. Look out for signs of changes in thinking like memory loss or difficulty with daily tasks.
How to help: If someone has cognitive impairment, keep their mind active while they’re in the hospital. Ask questions about current season, holidays, past hobbies and family members. Bring familiar items, like board games or books to their room to help occupy them.

2. Sensory impairment: Hearing or vision loss can make it more difficult for someone to assess their surroundings and can contribute to delirium.
How to help: Bring their sensory aids with you to the hospital and label them. If they typically wear hearing aids or glasses, make sure they wear them during their hospital stay.

3. Loss of mobility: Lack of movement can make someone more likely to develop delirium. A patient who walked independently before hospitalization may feel unsteady during their illness or after an operation, and need assistance with a walker or other mobility device.
How to help: Advocate for removal of tethers such as IVs and oxygen tubes, and urinary catheters. Encourage the patient to move throughout the day to keep their muscles strong. Family members can help!

4. Dehydration: When people get dehydrated, they are significantly more likely to develop delirium.
How to help: Watch out for physical indicators of dehydration like muscle weakness, speech difficulty, dry mouth and a pale lining inside of the mouth. Encourage drinking throughout the day. Talk to the care team to make sure your loved can safely drink.

5. Recently added medications: New medications can increase someone’s risk of delirium. The medications most often associated with delirium are benzodiazepines and anticholinergics.
How to help: Discuss alternative medications with the care team to reduce risk.


If delirium develops while your loved one is in hospital:

• Tell the staff right away if you see a change in thinking.
• Develop a plan of care with the staff to help with the confusion.
• Try to redirect to current season, date and place. Explain why they are in the hospital. You may need to repeat this many times. Do not argue if they see things differently.
• Continue to ensure glasses and hearing aids are worn if needed.
• Continue to ensure your loved one is eating and drinking well. Ask your nurse if it is okay to feed your love one.
• Continue to encourage walking.


Hamilton Health Sciences has a Hospital Elder Life Program (HELP) service available for patients over 75 who are in select clinical areas at Hamilton General or Juravinski hospitals. If your loved one develops delirium, ask if these services are available on their unit. Click here for more information about the HELP Program.
This helpful handout provides more information for patients and families can learn more about preventing delirium while in the hospital.

Each year, approximately 1,300 individuals in Ontario are admitted to long-term care (LTC) within 180 days of an acute care hospitalization for stroke or transient ischemic attack (TIA).  To better understand the sociodemographic characteristics and burden of care for stroke survivors admitted to LTC, a new provincial report was released by CorHealth Ontario and the Institute for Clinical Evaluative Sciences, entitled:  Ontario Stroke Evaluation Report 2018: Stroke Care and Outcomes in Complex Continuing Care and Long-Term Care. This report provides a review of data between 2010 and 2015, and delves into the nature and extent of rehabilitation therapy and stroke best practices available to stroke survivors in these settings.

The intent of this report is to inform system planning, facilitate and advocate for system change, and identify opportunities for quality initiatives and research.
Of stroke survivors residing in LTC, key findings for 2014/15 include the following:

• 2% were women
• 3% required extensive assistance with activities of daily living
• 8% were at high risk for depression
• 4% experienced bowel incontinence and or 61.3% were reported to have bladder incontinence
• 3% had severe cognitive impairment
• 6% were considered to be socially engaged
• 9% were admitted to inpatient rehabilitation prior to admission to LTC (an increase from 21.5% in 2010/11)
• 4% did not receive any core therapies (i.e. physiotherapy, occupational therapy and speech-language pathology) and no stroke survivors received all three core rehabilitation therapies. Given that time spent in therapist-supervised core rehabilitation is calculated over a 7-day period, the median number of minutes of physiotherapy received per day was 6.4.  Only negligible amounts of occupational therapy and speech-language therapy services were provided.
• 4% received nursing restorative care programming (a decrease from 28.5% in 2010/11)
• 5% experienced a fall
• 3% diagnosed with atrial fibrillation received anticoagulant medication within 90-days of discharge from acute care
• 1% died within 6 months of admission to LTC following their acute stroke or TIA.

Also of note were the low health-related quality of life scores (mean = 0.37 out of 1) and the proportion of stroke survivors in LTC over 85 years of age, which increased from 36.1 to 40.8 per cent over the five-year period.
Conclusions from the report specific to LTC are outlined below:

1. Stroke survivors in LTC settings have high care needs requiring extensive assistance with activities of daily living. Their low degree of social engagement and poor health-related quality of life are concerning.
2. Rehabilitation for stroke survivors in LTC is almost exclusively physiotherapy. The time spent in rehabilitation therapy and recreation therapy per day is minimal, and access to physiotherapy and nursing restorative care in LTC has declined over time. The low health-related quality of life scores may be attributed to the limited rehabilitation, nursing restorative care and recreation therapy, and the prevalence of depression and pain.
3. Defining the role of LTC in the stroke recovery trajectory will become more imperative as the shifting demographic is predicted to result in an increasing number of LTC admissions and increased stress on the overall health care system.

MORE: PUTTING A STROKE COACH IN EVERY PATIENT’S CORNER

This report also outlines the following recommendations specific to LTC which address changes at the system, regional and facility level:

1. Limited provision of rehabilitation to stroke survivors in LTC warrants review of resource allocation/care models for rehabilitation therapy and nursing restorative care programming to inform an appropriate model for this setting.
2. Regional Stroke Network Community and LTC Coordinators should advance stroke best practices and LTC staff education by:
   • Leveraging existing stroke care resources (e.g. Taking Action for Optimal Community and Long-Term Stroke Care©, Stroke Care Plans for LTC, etc.), existing technology (learning management systems, software solutions) and partnering with stakeholders such as the RNAO LTC Best Practice Coordinators.
   • Supporting specialized training of LTC staff in secondary stroke prevention and highly prevalent post stroke complications such as urinary incontinence, fall prevention, pain management, and post stroke depression.
   • Supporting LTC facilities in modifying care planning libraries to include best practice care interventions as outlined in the Stroke Care Plans for LTC (e.g., integrate the Stroke Care Plans into care planning libraries where gaps are identified).
   • Collaborating with LTC facilities to sustain current efforts and explore further innovations in fall prevention strategies and programs to promote safe mobility.

The LTC representative from your Regional Stroke Network is available to provide further information and to support quality initiatives aimed at enhancing  best practice stroke care provided to residents of Ontario LTC Homes. To access this representative within your area, please email CorHealth Ontario at info@corhealthontario.ca.

Direct Link: hospitalnews.com/ontario-stroke-evaluation-report-2018-stroke-care-and-outcomes-in-complex-continuing-care-and-long-term-care/

Submitted by Community & LTC Coordinators of the Ontario Regional Stroke Networks.