Health and Aging (Seniors Health)

Welcome to the Horizon Health Network’s Health & Aging Network

The Health & Aging Network is a diverse program that meets many of the major health needs of the older adult in an inpatient and outpatient environment. Our Network Programs target the older adult who has multiple interacting health problems. These problems can be related to medical illness, memory and cognitive issues, mobility problems, psychological issues and social difficulties.

Our Mission:

Within a safe environment and with respect for the dignity of those we serve, the Health & Aging Network will deliver quality, holistic health care to patients, their families and the community.

Interdisciplinary teams work with older adults to restore or maintain maximum functional independence, promote optimal health, and maintain or improve quality of life.la

We believe:

Older adults have a combination of physical, mental, social, emotional and spiritual needs.
Health education and accurate information will support older adults and their families in making informed choices.
Older adults and their families have a right to receive information on injury prevention and health promotion.

Healthy Lifestyle Patient Services Health Information Resources Research

Balance Brain Health Exercise Nutrition

What is balance?

Balance is the ability to remain upright and steady whether you are sitting, standing, walking or running. Balance is complex and requires the work and input from the following systems.

Visual system allows us to see, detects light, shapes and movement.
Vestibular system is our balance centre. It provides information about movement of our body and the environment around us.
Somatosensory body/sensory system provides information about pressure, movement, touch and perception.
Musculoskeletal system is the bones, muscles and tendons that move our bodies.

These 4 systems overlap to maintain balance, but as we age, the overlap reduces.

Why do we need to do balance exercises?

As you get older, you may start having trouble with your balance due to:

Weakness
Dizziness
Chronic conditions (arthritis, osteoporosis, Parkinson’s disease, etc.)
Medications

Important for fall prevention

Each year, more than 1/3 of people age 65 or older fall. Falls and fall-related injuries, such as hip fracture, can have a serious impact on an older person’s life. If you fall, it could limit your activities or make it impossible to live independently. Balance exercises, along with certain strength exercises, can help prevent falls by improving your ability to control and maintain your body’s position, whether you are moving or still.

You can do balance exercises almost anytime, anywhere, and as often as you like, as long as you have something sturdy nearby to hold on to if you become unsteady. In the beginning, using a chair or the wall for support will help you work on your balance safely.

Balance exercises overlap with lower body strength exercises, which also can improve your balance.

Modify as you progress

The exercises which follow can improve your balance even more if you modify them as you progress. Start by holding on to a sturdy chair for support. To challenge yourself, try holding on to the chair with only one hand. With time, you can try holding on with only one finger, then no hands. If you are steady on your feet, try doing the exercise with your eyes closed.

Safety tips

Have a sturdy chair or a person nearby to hold on to if you feel unsteady.

Talk with your doctor if you are unsure about doing a particular exercise.

Finding Balance NB

Trauma NB

The Alzheimer Society

Dementia – Information and resources for navigating dementia in New Brunswick

You have probably heard that exercise and activity are good for you. In fact, exercise is one of the healthiest things you can do for yourself, especially as you get older. Being physically active can help you stay strong and fit enough to keep doing the things you like. Making exercise and physical activity a regular part of your life can improve your health and help maintain your independence.

Be as active as possible

It can be tough to make exercise part of your daily routine. Staying active produces long-term health benefits and may improve health for many older people who already have diseases and disabilities. Think of exercise like you do your medications… schedule and plan for it.

Being inactive can be risky.

Some older people are reluctant to exercise as they think it is too hard or will harm them. Some think they need special equipment or to join a gym. Yet studies show that ‘taking it easy’ is risky and can cause you to lose your independence. Older people who are inactive lose ground in 4 areas that are important for staying healthy: endurance, strength, balance and flexibility. Lack of exercise can lead to more visits to the doctor, more trips to the Emergency Department and more use of medications.

Prevent or delay disease

Scientists have found that staying active can prevent or delay many diseases and disabilities. For example, studies show that people with arthritis, heart disease, chronic pain, Parkinson’s disease or diabetes benefit from regular exercise. Exercise also helps with high blood pressure, balance problems and difficulty walking.

Manage stress and improve mood

Regular moderate exercise can help manage stress and improve your mood. Activity can help reduce feelings of depression and improve your cognitive function.

4 types of exercise:

Endurance:

Endurance activities like walking, biking or swimming increase your breathing and heart rate. It improves the health of your heart, lungs and circulatory system. They can make it easier for you to:

Push your grandchildren on swings
Vacuum
Work in the garden, rake leaves
Play a sport such as tennis, pickleball
Prepare a meal

Strength:

Strength activities include lifting weights and using resistive bands. They can make it easier for you to:

Climb stairs
Carry groceries, do laundry
Open jars
Carry smaller grandchildren
Lift mulch in garden

Balance:

Balance exercises like tai chi can improve your ability to control your body when you are moving or still. Improving balance can help you to:

Prevent falls
Stand on tiptoes to reach high
Walk up and down stairs
Walk on uneven ground without falling

Flexibility:

Flexibility exercises can help you to move more easily. Improving flexibility can help you to:

Improve your posture
Look over your shoulder when driving
Make the bed
Bend to tie your shoes
Pull on your socks and pants
Put a sweater on over your head
Swing a golf club
Go dancing

SAFE

Zoomers on the go

Good nutrition is important at any age. Eating well helps you feel your best every day. Healthy eating starts with healthy choices.

Healthy eating plays a huge part in healthy aging. Food plays an important part in keeping our whole body working at its best. Food gives us fuel, so we can do our daily activities. Protein, which we get through dairy, meat, fish, poultry, nuts, seeds, and legumes (beans), keeps our skin and muscles strong and healthy. Vitamins and minerals are also important. Calcium, for example, helps us maintain strong bones.

We come in every shape and size. A healthy weight is important, but dieting is not the way to do this. Diets cause the loss of muscle, and as we age, we need to keep our muscles strong. Instead of diets and focusing on what the scale reads, focus on keeping healthy by eating regularly, making good food choices, and being active. A few tips are:

Choose foods that you enjoy and are low in fat and sugar.
Don’t skip meals. Eat when you are hungry and stop when you are full.
Plate your food so that colourful green and orange vegetables take up half of the plate. On the other half, add grains and protein foods like meat, poultry, eggs, nuts, seeds, beans, or fish.
Eat your meals slowly.
Choose fruit instead of juice.

You can check out these websites for other suggestions:

Healthy Eating for Seniors

A Guide to Healthy Eating for Older Adults

“I’m just not hungry”

Some older adults find their appetite changes. Some may eat less than they used to at mealtime. Others may skip meals entirely. Sometimes this is because of a health condition, or the side effects of a medication. Other times a change in appetite happens because:

They are less active, so not as hungry.
Food doesn’t taste the same as it once did.
Making meals has become too hard and tiring.
Eating a meal alone is not enjoyable.
Food costs too much.

If you are having a hard time with appetite, try taking a short walk before mealtime. Make food tasty by adding your favourite herbs and spices. You could also try finding people to share a meal with at a community centre, church, or friend’s home.

Meals are not meant to cause stress or make you tired. Meals should be simple to plan and shop for, prepare, cook, and enjoy. For some, making less healthy choices, or skipping meals seems like the easier way to go. Horizon’s dietitians can help you plan quick and simple meals. They can give useful tips on how to save money at the grocery store, and how to safely prepare, cook, and store food.

Malnutrition

Sometimes older adults lose weight without trying. This type of weight loss can make people feel tired, dizzy, unwell, and unable to do the activities they enjoy. Weight loss like this can lead to malnutrition, and it happens very quickly and easily.

“How do I know if I am at risk of malnutrition?”

Ask yourself 2 simple questions:

Have I lost weight in the last 6 months without meaning to? If you don’t know the number from a scale, think about your rings, clothing, dentures, or shoes. Do they fit looser than they did?
Have I eaten less than usual in the past week?

If you’ve answered yes to both of these questions, you may be at risk of malnutrition.

“Why has this happened to me?”

Sometimes weight loss happens because you have felt unwell, or have been dealing with feelings of loneliness, grief or depression. Maybe you haven’t had the money to purchase food or the know how or ability to prepare food on your own. You didn’t do anything intentional – it just happened. The good thing is, there are ways that can slow this, and turn things around. It’s never too late to start healthy eating, and a Horizon dietitian can help.

“I have questions. What can a Horizon dietitian do for me?”

Horizon has a group of wonderful outpatient dietitians, who can answer all of your questions.

Dietitians are food experts. They listen to your concerns, review your medical history, and do all they can to support you in making healthy food choices. Our dietitians can give tips that will help you:

eat well to feel your best.
eat well with a health condition (e.g.: high blood pressure, diabetes, cancer, irritable bowel syndrome or IBS).
eat well with food allergies, likes/dislikes, cultural or religious eating practices.
with:
- planning meals that are simple and easy on the wallet.
- ideas on cooking for 1 or 2 people, and for large or small appetites.
- easier grocery shopping.
- finding foods that are easier to bite, chew and swallow.
- finding foods that decrease symptoms, like nausea, gas, bloating, etc.
- getting the best nutrition possible at meals when you don’t feel like eating a lot.

You, or a loved one, may call to book an appointment with one of our dietitians without needing a referral from the doctor. You can be seen in person, or virtually through a phone call, or on the computer. To make an appointment with a dietitian, contact your local hospital or health clinic and ask for the Clinical Nutrition department.

Patient and Family Centred Care St. Joseph’s Hospital Ethics Spiritual & Religious Care

Patient and Family Centred Care involves patients, family and the health-care team working together in the planning, delivery and evaluation of health-care services. “It is founded on the understanding that the family plays a vital role in ensuring the health and well-being of patients of all ages.”

The Health & Aging Model of Care includes six goals: Quality and Excellence, Patient Safety, Health Promotion and Wellness, Accessibility, Inter-professional Collaboration and Efficiency and Effectiveness. These goals direct our approach to Patient Centred Care.

Information Sharing, Participation, Dignity and Respect, and Collaboration are the four components of Patient and Family Centred Care. These four components ensure that the five key actions of: Assessment and Management, Leadership, Advocacy, Research and Education support our philosophy of quality holistic Patient and Family Centred Care.

Patient and Family Centred Care is associated with a higher rate of patient satisfaction, involvement of family, better outcomes and more cost-effective care.

Individual Plan of Care
Goal Attainment Scaling
Creating a Safe Environment
Interdisciplinary team approach to care

Individual Plan of Care

The individual plan of care is based on the admission and ongoing assessments and will include referrals to and interventions as planned by the various team members. The plan of care is integrated with the discharge and/or the long term placement plan. Mutual goals are set with the patient/family and interventions are geared toward rehabilitation and improving the patient’s level of functional independence (Goal Attainment Scaling). The information needs of the family and the availability of community resources are assessed and considered at all phases in the plan of care. The plan of care is reviewed by the team at team conferences, in conjunction with the patient/family, and at family conferences.

Goal Attainment Scaling (GAS) is a goal setting and evaluation tool that measures individualized outcomes for geriatric and rehabilitation inpatients. Goals are set in areas where improvement is anticipated. Goals can include mobility, treatment, activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

GAS helps direct the interprofessional team to set achievable goals that are focused on the patient’s discharge plan; the tool keeps the team focused on the goals of the patient records the patient progress, and identifies any challenges for discharge.

The GAS tool is initiated for all admissions in the clinical areas of geriatrics and rehabilitation. The GAS is initiated within the first week of admission and then updated weekly during team rounds. The scores are measured on admission, throughout the hospital stay and on discharge from the unit. The team determines the goals after discussion with the patient and/or family, based on what the hope for discharge will be.

Creating a Safe Environment

Creating a special environment that is not only safe but also allows for freedom of movement, mobility and socialization are priorities in unit design and construction. Safer environments can be created by designs which consider the unique needs of the population, and the integration of creative and technological solutions when possible and appropriate. A homelike atmosphere is enhanced by separate dining areas, ‘wander’ routes, television and social areas, and rehabilitation areas.

Interdisciplinary Team Approach to Care

The patient, family and caregivers are provided opportunities to play an active role in the plan of care and are an integral part of the team by communicating concerns to health professionals, and becoming involved in the patient’s health maintenance and functional improvement. All patients are encouraged to be active participants in their care so that they can make independent lifestyle decisions and health choices. The interdisciplinary team will provide patients with complete information regarding their health and, with the patient’s permission, discuss this information with their family/caregivers.

St. Joseph’s Hospital has an Ethics Committee consisting of staff and community members. The committee meets regularly to discuss both clinical and organizational ethics issues. Clinical issues relate to the care of patients while organizational issues include discussions that are more general in nature and affect the whole hospital.

You may contact the Ethics Committee for a formal consult by using our Ethical Issues Referral Form which is available at each nursing station and through reception at the main entrance (506-632-5405). Patients, their loved-ones and staff are welcome to bring an issue forward to the Ethics Committee.

An excellent resource for making end-of-life decisions is available at the Canadian Hospice Palliative Care Association website www.advancecareplanning.ca. Take a moment to visit the site, watch the video and download the workbook.

Spiritual & Religious Care coordinates and provides emotional and spiritual support, as well as counseling, to people of every belief and value system. We offer a wide variety of services to patients and their families in an open, honest and non-judgmental environment. Where end of life support is needed, a ministry of presence and support is available.

Constipation Delirium and the Older Person Dementia Falls Prevention Frailty Grief Parkinson’s Disease Urinary Incontinence

Ninety-five percent of people have between 3 bowel movements a day and 3 bowel movements a week. Infrequent bowel movements are considered ‘constipation’ if you need to strain, if the stool is hard and pebbly or if you are having bowel movements less than 3 times a week.

It is essential that you see your health-care team if you are unexpectedly losing weight, have blood in your stool or there is a change in your stools (pencil-like stools or infrequent stools without a change in diet or lifestyle). Your health-care team will need to rule out colon cancer as a cause of your constipation.

Many people have long-term (or chronic) constipation without a serious underlying disease. This can often be caused by a decrease in exercise/activity, insufficient fibre in the diet and/or a decreased fluid intake. Constipation can be uncomfortable and can also have some long-term effects on your health including hemorrhoids, impaction and diverticulitis (infected outpouchings in the wall of the colon).

There are a number of helpful websites with information about constipation and lifestyle changes. If diet and lifestyle changes do not result in comfortable, regular bowel movements, you should talk to your health-care team about as-needed or daily laxatives.

Links:

Did you know?

Delirium is a medical condition that causes a temporary problem with mental function.
Delirium in the older person is a medical emergency. If left untreated, it can have permanent neurological consequences and it can result in premature death.
Delirium occurs in up to 50% of older persons admitted to acute care settings.
Delirium is not a mental illness.
Delirium is not the same as dementia. It can occur in people with or without dementia.

What does delirium look like?

Delirium is a sudden change in mental status, or sudden confusion. It develops over hours to days. Early diagnosis and treatment offer the best chance of recovery.

There are three main types of delirium:

Hyperactive delirium, where the person may be agitated, aggressive, restless, paranoid, or delusional. The person may hallucinate.
Hypoactive delirium, where the person may be very sedated and suddenly display disinterested behaviours. This is the most common type of delirium.
Mixed delirium, where the person may alternate between hyper- and hypo-active states.

A person with delirium may or may not display all of these symptoms. Symptoms may come and go throughout the day and often increase at night.

What is causing the delirium?

Delirium in an elderly person may be caused by one or many factors. Some of the most common causes for delirium are:

Infection (i.e. urinary tract infection or respiratory tract infection).
Severe illness (i.e. dehydration or severe diabetes).
Chronic health problems such as heart failure.
Post operational (post heart surgery, hip or knee surgery).
Medications (multiple medications, new medication, side effects from medication).
Discontinuing drugs (prescribed or recreational) and alcohol.

Who gets delirium?

Though delirium can develop in anyone, it is more common in older adults. Delirium is one of the most common and preventable conditions affecting older adults during a hospital stay. Some of the factors that may put people at risk for developing delirium are:

Age – especially those who are 80 and older.
Multiple medications.
Surgery – especially where an anesthetic was used.
Hearing and or vision loss.
Individuals with memory impairment or dementia have an increased risk of developing delirium.
Individuals who have previously experienced a delirium are at greater risk for developing another.

How is delirium treated?

The cause(s) of delirium need to be figured out before treatment begins. Health care professionals will look for underlying causes by doing careful assessments and tests. Despite in depth testing at times causes for delirium are unknown. Generally, delirium clears within a few days; however, some cases may not clear for weeks or even months. It is also important to note that not everyone who suffers from delirium returns to their usual state.

What you can do to help

It is important for family members to help health care professionals recognize the signs and symptoms of delirium. Family members know their loved ones best and are able to provide valuable information about changes in behaviour. Some of the things that family members can do for a loved one with delirium are:

Be calm and reassuring.
Encourage proper nutrition and fluid intake.
Promote physical activity; encourage walking if it is safe to do so.
Ensure that hearing aids and or glasses are in place if necessary.
Promote healthy rest and sleep; sleep lights low and reduce noise and distractions.
Keep track of changes in behaviour.

Delirium in older adults often goes unrecognized by health care professionals. Delirium is an under-recognized but surprisingly common problem.

It is important for you as a family member to talk about changes in your loved one even if no one asks. Sudden changes in mental status and function need to be investigated.

Helpful Links

Mayo Clinic

Clinical Best Practice Guidelines

Dementia – Information and resources for navigating dementia in New Brunswick

If you have noticed gradual changes in memory and thinking, it may be helpful to read about dementia. As time goes by you will likely have new questions. The Dementia Trilogy is a set of three booklets about dementia.

Introduction to Dementia

An Introduction to Dementia lists the earliest signs of dementia. It helps answer some of the more common questions like, “What is the difference between dementia and Alzheimer’s disease?”

The Dementia Compass

The Dementia Compass offers some tips to help a person with dementia with their day-today activities. It also describes some personality changes that can be symptoms of dementia.

Later in the Dementia Journey

Later in the Dementia Journey provides helpful yet sensitive information to help focus on comfort in the later stages of dementia.

Information for Caregivers

Caring for someone with dementia can be rewarding but it can be challenging at times. This document provides resources to support you and your care of the person living with dementia.

A fall is when you suddenly land on the floor or ground. There does not have to be an injury.

Falls include slips and trips and are caused by a loss of balance or a lack of ability to recover your balance. Falls can happen anywhere.

Click here for valuable information to help older adults and their families work together to prevent falls.

Everyone has a combination of abilities and disabilities. As we age, our disabilities may increase. We may need help from others to manage day to day. When a person’s disability and health problems overwhelm their ability to live independently, consider ‘frailty.’ A frail older person often has problems with walking and daily function. They may be on many medications and have serious health problems. They may also have difficulty with memory, or vision and hearing. A frail person would be at risk if left alone for extended periods.

Why is frailty important? Frail adults are at increased risk of becoming sick and having difficulties during hospitalization or major medical interventions. A frail person will have more difficulty recovering after an illness, and they have a higher chance of losing mobility and function. Persons with frailty may have a shortened life expectancy.

Consider ‘frailty’ when making health or future care decisions.

Links:

Simply defined, grief is the normal and natural reaction to significant emotional loss of any kind. Death and divorce/separation are obvious painful losses. Within the Health and Aging Network, loss from dementia or frailty leads to multiple losses of independence, relationships (spousal, family and friends), driver’s license, home/apartment and many others, including losses that family, caregivers and loved one’s experience.

Unresolved grief can contribute to physical, cognitive, emotional, and spiritual decline. Grief consumes a tremendous amount of energy and too often stays buried under the surface and only symptoms are treated. It is important, to find ways to care for yourself when you are experiencing the pain of grief.

Unresolved grief is cumulative, so new experiences of loss may bring up thoughts and emotions from past losses. This is normal and it is common for those who are dealing with age-related losses to begin grieving other losses that happened many years ago.

Grief can occasionally trigger clinical depression. It is important to talk to your doctor if grief is preventing you from engaging in the basic activities of daily life like eating, sleeping and taking care of yourself, or if you are experiencing grief reactions that are so severe that you are unable to experience any joy.

As you grieve, there will be many reminders of your loss in your day-to-day life. Be compassionate with yourself as you encounter painful thoughts and feelings. Try to show the same kindness to yourself that you would show to a dear friend who was suffering.

Patient Information Resources:

Spiritual and Religious Services in each area of Horizon offers grief support for inpatients and their families. Please request a consult or call the department directly if you or a loved one are in the hospital.

If you are looking for a grief group, often local funeral homes, counselling centres or churches offer grief programs.

Links:

Virtual Hospice http://www.virtualhospice.ca/en_US/Main+Site+Navigation/Home/Support/Support.aspx

The New England Donor Services website, aftercare section has many helpful resources: https://caringconnectionsneds.org/

The Dougy Center provides online resources and information to help support children and youth who are grieving: https://www.dougy.org/

If you or someone in your family has been diagnosed with Parkinson’s disease you are not alone. Parkinson’s disease affects 1 in 100 people over the age of 60 and there are approximately 8,400 people in the Maritimes living with Parkinson’s disease. Parkinson’s disease causes problems with movement and coordination. People can experience tremor, muscle stiffness, slowness of movement, feeling off balance plus many other symptoms. Parkinson’s disease will slowly worsen overtime. So what can you do about it?

First, see a doctor and make a plan on how to manage your disease. Take medications to control your symptoms as directed.
Secondly, stay physically active and live a healthy lifestyle which includes eating a healthy diet and reducing stress.
And lastly, learn good coping strategies and maintain a positive attitude. Join support groups and involve family in your care to help you cope with this disease.

Over 3 million individuals suffer from Urinary Incontinence (UI) in Canada. Unfortunately, most individuals suffer in silence due to the taboo nature of this topic. UI continues to be under reported, under diagnosed and under treated even though it can often be cured.

UI is defined as involuntary leakage of urine and is associated with reduced quality of life for seniors. Although not life-threatening, UI can have a negative impact on physical, social, and emotional well-being, and add to personal care expenses. (Statistics Canada – Health Report, October 2013)

There are 5 main types of UI: stress UI, urge UI or overactive bladder (OAB), mixed UI, overflow and functional incontinence.

There are many different treatment options for UI. These include behavioral approaches, lifestyle changes, ‘Kegel’ exercises, medications, pessaries and surgery.

There is an array of good, accurate websites available with information on UI and treatment options. Get informed today! No one should suffer in silence.

Overview

Horizon Health Network and Collaborative Care Seniors Health are committed to providing the best care possible for our older adults in New Brunswick. To that end, we also share a commitment to involvement in Clinical Research that pertains to older adults in our community and health care facilities.

Our Clinical Research involves extensive collaborations nationally and internationally with many academic and clinical researchers, health care professionals, and community partners. This allows for extensive teamwork that brings multiple perspectives and skill sets that allow research to evolve, and add to our knowledge so that we can provide the best possible, evidence-informed care to our older adults in the province.

In the past, we have participated in over 20 clinical trials as an investigational site nationally and internationally. We have been involved in the testing of over 10 existing and investigational medications for the treatment of dementia, primarily Alzheimer’s disease. At this time, we work in collaboration with many researchers, and allied health professionals from many different health care organizations and universities across Canada and internationally. We also work with a large research group called the Canadian Consortium on Neurodegeneration in Aging, and are a site for the Canadian COMPASS ND study.

Currently, our research involves leading and collaborating on several Healthy Senior Pilot Projects that are funded by the Public Health Agency of Canada in New Brunswick. The topics of these research projects target prevention of dementia, navigational support after a diagnosis of dementia, navigational support for successful transitions from hospital after a fracture, and frailty in the hospital environment.

We also recognize that, in addition to Clinical Research, Quality Improvement work is very important. This activity allows us to evaluate our current practices and improve processes and practices if needed to ensure that we are providing evidence-informed care.