By: Julie Corliss

If you’re confused by the terms used to describe heart attacks, you’re not alone. They’re often described as “mild” or “massive,” or even the ominous-sounding “widow maker.” But these terms are not necessarily helpful, and they may create confusion and anxiety.
The good news: most people who have a heart attack survive. The bad news? “Any heart attack can be fatal, no matter how big, how small, or where it occurs in the heart,” says Dr. James Januzzi, a cardiologist at Harvard-affiliated Massachusetts General Hospital. “Furthermore, there’s a lot of misunderstanding among the general public about what a heart attack actually is,” he says.

The connection between heart attack vs. cardiac arrest
Perhaps the most common source of confusion is the difference between a heart attack and cardiac arrest. A heart attack (what doctors call a myocardial infarction or MI) is defined as damage to part of the heart muscle caused by inadequate blood flow to that area. Most of the time, this happens due to a blockage in one of the heart’s arteries. Known as a type 1 heart attack, such blockages typically occur when cholesterol-laden plaque lining an artery ruptures. A clot forms, obstructing the vessel.
While a heart attack is a plumbing problem, a cardiac arrest is an electrical problem. Cardiac arrest happens when the heart’s electrical system malfunctions, causing it to beat rapidly and chaotically — or to stop beating altogether. Without blood circulating to the brain, lungs, and other organs, the person gasps or stops breathing and becomes unresponsive within seconds.
A heart attack is a common cause of cardiac arrest, but most heart attacks do not lead to cardiac arrest. Other possible causes of cardiac arrest include heart failure, a clot in the lungs, a serious imbalance of potassium, magnesium, or other minerals in the blood, a drug overdose, or a blow to the chest.

Does size matter?
Some heart attacks cause more harm than others. During a heart attack, blood levels of a protein released by damaged muscle (troponin) give some sense of severity. Afterwards, an ultrasound of the heart (echocardiogram) can reveal the extent of the damage. “A large heart attack will significantly reduce the squeezing strength of the heart muscle,” says Dr. Januzzi.
The term “widow maker” refers to a heart attack caused by a blockage near the top of the left anterior descending (LAD) artery, the main artery that supplies blood to the front of the heart. However, heart attacks that involve the LAD are not necessarily fatal, and those involving other arteries can be deadly, too.

What to do
Call 911 right away if you or someone near you has symptoms of a heart attack or cardiac arrest. Common heart attack symptoms include:
•    uncomfortable pressure, squeezing, or pain in the chest
•    pain or other uncomfortable sensations in an arm, the back, neck, jaw, or stomach
•    shortness of breath
•    sudden nausea or vomiting
•    lightheadedness or dizziness
•    unusual fatigue.
Signs of cardiac arrest are a sudden loss of responsiveness and abnormal breathing (either not breathing or only gasping). Give hands-only cardiopulmonary resuscitation (CPR) until help arrives.

​ A 2010 Canadian study of hospitalized, elderly patients identified that there is a huge unmet need, that providing more support for end-of-life conversations and advance care planning will have a large positive impact on improving end-of-life care in Canada.[3]

What is an advance care plan?
An advance care plan describes your wishes at the end of life, in the event that you cannot speak for yourself. Your plan may include information about your values, goals and preferences for procedures that you do or don't want to have as well as other information about your care at the end of life (for example, religious rituals, being able to see a family member, dying at home or in palliative care, etc.). The most important aspects of advance care planning are naming one or more Substitute Decision Makers - someone who will speak on your behalf and make decisions for you when you are not able to do so yourself - and having a conversation with them about your wishes. See: www.advancecareplanning.ca for details.

Who should make an advance care plan?
Every adult should make a plan. You can't predict how or when you will die - so having a plan ensures that others know your wishes and that your voice will be heard if you cannot speak for yourself.

When is an advance care plan used?
You plan is only used if you are unable to make your own health care decisions (e.g. you are in a coma or your illness has impaired your ability to make decisions). Your representative can use it to guide your care and to express wishes on your behalf.

By: Harvard Health
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Try this exercise for better bone health.
Strength-training exercises create stresses on the bones throughout your body, stimulating extra deposits of calcium and nudging bone-forming cells into action. Try this exercise now and then send for your report to get more!

Bridge — exercises the muscles of the back, backs of the thighs, and buttocks

Lie on your back on a mat with your knees bent and your feet flat on the floor. Put your hands next to your hips with palms flat on the floor. Keep your back straight as you lift your buttocks as high as you can off the mat, using your hands for balance only. Pause. Lower your buttocks without touching the mat, then lift again. Do eight to 12 repetitions. Rest and repeat the set.

Falls Prevention Programs and education help to improve the quality of life of seniors aged 65 years and older and decrease the burden of falls on the health care system.
Falls lead to serious injuries, sometimes death, hospitalization, and are the main reason that seniors are institutionalized in Long Term Care.

Risk Factors can be broken down into six main areas:

1.    Physiological

• Balance deficit
• Gait deficit
• Muscle weakness
• Mobility Issues
• Inappropriate use of assistive devices

2.    Medical

• History of falls
• Addiction to drugs or alcohol
• Cognitive impairment
• Diseases such as Arthritis, Osteoporosis, Coronary Artery Disease, Diabetes, Parkinson disease
• Depression
• Postural Hypertension

3.     Socio-demographic

• Age
• Gender
• Social determinants of health – living in poverty, housing, income, education  

4.    Pharmacological

• Anti-epileptic drugs
• Anti-psychotics
• Incorrect use of pain medications
• Use of multiple drugs – drug interactions
• Psychotropic drugs – sedatives, antidepressants, anti-inflammatory drugs

5.    Behavioural

• Agitation, confusion
• Fear of falling
• Inappropriate footwear
• Haste or poor-judgment
• Risk taking

6.     Environment

• Poor lighting
• Mats that don’t have rubber backing
• Loose carpeting or floor boards, linoleum
• Electrical cords that are placed along walking paths
• Poorly lit staircases
• Clutter and debris
• Outdoor environment: no snow and ice removal
• Cracked walkways
• Unsafe stairs, rails
• Poor outdoor lighting

At Alert Best Nursing we do a free client and environmental assessment for new clients. The home safety check is done for the benefit of our clients and staff, to reduce the risk for falls and other injuries. Often minor issues can be resolved. Problems that require medical assessment or repairs are discussed with the client and family.

For more information on Falls Prevention Programs go to Google and search for SHRTN the Senior Health Research Transfer Network.

Yvonne Griggs

While there are guidelines in place for medical consent, things aren’t as clear when it comes to romantic relationships or sexual consent. There have been cases in the news about dementia patients and their capacity to consent to sex. “When it comes to dementia and sexuality… the aging population has been described in the media as a ‘rape case time-bomb,’” observe Alisa Grigorovich and Pia Kontos.
In their article “A New Way to Think About Dementia and Sex,” Grigorovich, a Postdoctoral Fellow with the Dalla Lane School of Public Health, and Kontos, a Senior Scientist with the Toronto Rehabilitation Institute University Health Network point out that “the sexual rights of persons living with dementia are largely ignored within residential care policy, professional training and clinical guidelines.”
Their article, which claims that “a new ethic of dementia care is urgently needed,” points out that current guidelines for lawmakers and physicians do not address the sexualities of persons living with dementia and that guidelines should in fact be crafted to support sexual expression and facilitate sexual rights.

Senior Living Communities, Consent and Capacity
For administrators of senior care communities, the lack of clear legal or medical guidelines around sexual consent in the case of someone with dementia creates a challenge when it comes to protecting seniors in their care, while also supporting their sexual rights.
From a legal perspective, “consent to have sex is similar to informed consent,” Furman says. “Capacity to consent is complicated by the fact that consent may be necessary for different sexual acts and is act specific,” he says.
Steve Morgan, of the Senior Housing Forum, suggests that senior living providers are on the side of caution while acknowledging that “residents have the right to be sexually active if that is their mutual desire.” Morgan suggests that “while it’s hard to talk to families about their parents or grandparents’ sexual activities, families need to be part of the discussion when they have the legal right to be involved.”