Sunday, March 10, 2019

Unpaid caregivers and the supports available

The federal, provincial and territorial governments recognize the need to keep seniors at home as long as is suitable for the person, as well as the benefits of doing so. They also recognize that their caregivers require significant support. The literature describing and analyzing services that support and sustain people with dementia living in their own homes is growing. The expansion of these services and programs is also growing, partly due to policies and practices that are increasingly emphasizing the benefits of supporting people to live in their own homes, for the individuals, their caregivers and health systems at large. While there are multiple gaps in the evidence base, some of the practices and recommendations that may help keep seniors with dementia in the community longer include:
·         Avoiding unnecessary hospitalizations by ensuring safe environments and providing assistance and support with more instrumental activities of daily living like shopping, food preparation and managing finances
·         Improving early detection, which could be beneficial in modifying lifestyle in order to delay the onset of symptoms as long as possible and in expanding cognitive reserve through intellectual stimulation
·         Maintaining and improving activities of daily living, like getting dressed and managing personal hygiene, by providing rehabilitation/exercise programs
·         Providing group housing options for seniors who would otherwise be living alone and unsupported
·         Providing better technology and support to seniors with dementia in the community
·         Providing meaningful breaks to unpaid caregivers through respite care and adult day care programs for individuals with dementia
·         Ensuring that education, training, practice guidelines and tools for front-line home care providers are available to support them to provide high-quality person-centred dementia care
Providing effective support to those living with dementia in the community and their families is an important component of dementia strategies. Such support helps caregivers to maintain their caregiving activities and have a personally rewarding experience.
Find out more about some of the community support resources available for caregivers in Unpaid caregiver challenges and supports.


Friday, March 8, 2019

Most seniors with dementia live at home

About 61% of seniors with dementia in Canada live at home — and they require support while staying there. There are approximately 5.8 million seniors in Canada and about 5.5 million live at home. CIHI analysis finds that of the estimated 431,000 seniors living with dementia in 2015–2016, more than 261,000 were estimated to reside outside of publicly funded long-term care or nursing homes.

Dementia in Canada
Canadians living with dementia want to maintain their independence; they want to live at home and engage with their community,” said Pauline Tardif, CEO of the Alzheimer Society of Canada.

Comprehensive home and community care are an essential part of this equation. It helps maintain the quality of life for people with dementia while also providing needed support for caregivers.

As Canada’s population ages and chronic disease rates increase, federal, provincial and territorial governments are recognizing the need to make home care more available and accessible. About 61% of seniors in Canada with dementia live outside of long-term care or nursing homes: 69% of those younger than 80 and 58% of those 80 and older.

A Common Statement of Principles on Shared Health Priorities is a recent agreement between the federal, provincial and territorial governments to provide substantial federal investment over 10 years, in part, to improving access to health care and support services at home and in the community.

Seniors with dementia living at home have complex care needs
Seniors with dementia who receive care at home may present more challenges than those without dementia because they are more clinically complex. Some of the characteristics of these individuals include the following: 
·       1 in 5 have severe cognitive impairment
·       1 in 4 (28%) require extensive assistance or are dependent for activities of daily living
·       1 in 4 exhibits any responsive behaviours
·       1 in 4 have signs of depression

Seniors with dementia who live at home score worse on behavioural and cognitive scales compared with other seniors living at home and receiving care. Seniors with dementia exhibit responsive behaviours such as verbal and physical abuse, socially inappropriate behaviour and resisting care more frequently than those without dementia (25% and 4%, respectively).

However, among all seniors with dementia receiving home care, a larger proportion does not exhibit any responsive behaviours (75%) than do (25%). Seniors with dementia score the same in health instability (as measured by the CHESS Scale) and are admitted to hospitals less frequently. The CHESS Scale (Changes in Health, End-Stage Disease, and Signs and Symptoms) detects health instability and is designed to identify individuals at risk of serious decline.

Of seniors with dementia, about one-third of those 65 to 79 and 42% of those 80 and older live in a long-term care home. Overall factors influencing long-term care admission for people with dementia were assessed with the methodology used in CIHI’s Seniors in Transition report. 6 factors significantly increase the odds of entering long-term care or nursing homes following an initial assessment to determine eligibility for long-term care for individuals with dementia:
  • Seniors with dementia who receive their initial assessment in the hospital are about 5.6 times more likely to enter long-term care as those who are assessed elsewhere.
  • Seniors with dementia who live alone (without a primary caregiver in the home) are around twice as likely to enter long-term care as those who live with their primary caregiver.
  • Seniors with dementia who have a caregiver who is unable to continue providing care are around twice as likely to enter long-term care.
  • Seniors with dementia who have a recent history of wandering are about 1.7 times more likely to enter long-term care.
  • Seniors with dementia with a moderate level of cognitive impairment are about 3.8 times more likely to enter long-term care than seniors with no cognitive impairment; those with a very severe level of cognitive impairment are about 3.5 times more likely than those with no cognitive impairment.
  • Seniors with dementia who are dependent on physical assistance for daily activities like personal hygiene, eating and walking are 3.8 times more likely to enter long-term care than those who are independent; this decreases slightly to about 1.4 times if they require only supervision.
These identified characteristics can help us understand some of the challenges associated with providing care to individuals with dementia in the home and can help inform strategies to better support them and their caregivers to pursue home care for longer and more safely.

Thursday, March 7, 2019

Practical advice from caregivers, for caregivers

"Sharing the Journey" is a video series - funded by the Victoria Hospitals Foundation - that offers family caregivers practical advice to help them respond to new challenges while maintaining a meaningful and healthy relationship with a loved one living with dementia. 

Much of what caregivers express as a burden could also be called unresolved grief. The videos for caregivers and families provide information about common losses related to caregiving, their potential negative impact and the importance of acknowledging and supporting grief.

The information in these videos is useful for everyone in the community who may have friends, neighbours, coworkers or customers who have dementia. These videos are also available on our Island Health YouTube channel.

The word dementia is a general term that refers to a cluster of symptoms caused by physical changes to the brain.
Research on Dementia Care.

The Cognitive Health Initiative (CHI) on Vancouver Island is a five-year, innovative clinical research program supported through a generous donation from a Victoria family with significant matched in-kind support from Island Health and the University of Victoria.
The collaborative partnership between Island Health, the University of Victoria, University of BC and Island Medical Program will integrate leading-edge research into the advancement of evidence-based practice to improve cognitive health for our ageing population.

Caring for a Loved One
Caregivers usually say that their most important goal is to care for their loved one. However, it is also important to remain physically and mentally healthy in order to care for others.
The following materials are available to help families care for themselves and their loved one:
Caregiver’s Manual - Dementia (Seniors Health Practice and Education, Island Health)

Wednesday, March 6, 2019

Feeding the birds

This is a wonderful story and it is true. You will be glad that you read it, and I hope you will share it. Thanks to my friend George who shared it with me.

It happened every Friday evening, almost without fail, when the sun resembled a giant orange and was starting to dip into the blue ocean.

Old Ed came strolling along the beach to his favourite pier.

Clutched in his bony hand was a bucket of shrimp. Ed walks out to the end of the pier, where it seems he almost has the world to himself. The glow of the sun is a golden bronze now.

Everybody's gone, except for a few joggers on the beach. Standing out on the end of the pier, Ed is alone with his thoughts . . . and his bucket of shrimp.

Before long, however, he is no longer alone. Up in the sky, a thousand white dots come screeching and squawking, winging their way toward that lanky frame standing there on the end of the pier.

Before long, dozens of seagulls have enveloped him, their wings fluttering and flapping wildly. Ed stands there tossing shrimp to the hungry birds. As he does, if you listen closely, you can hear him say with a smile, 'Thank you. Thank you.'

In a few short minutes, the bucket is empty. But Ed doesn't leave. He stands there lost in thought, as though transported to another time and place.

When he finally turns around and begins to walk back toward the beach, a few of the birds hop along the pier with him until he gets to the stairs, and then they, too, fly away. And old Ed quietly makes his way down to the end of the beach and on home.

If you were sitting there on the pier with your fishing line in the water, Ed might seem like 'a funny old duck,' as my dad used to say. Or, to onlookers, he's just another old codger, lost in his own weird world, feeding the seagulls with a bucket full of shrimp.

To the onlooker, rituals can look either very strange or very empty. They can seem altogether unimportant . . . maybe even a lot of nonsense.

Old folks often do strange things, at least in the eyes of Boomers and Busters.

Most of them would probably write Old Ed off, down there in Florida . . . That's too bad. They'd do well to know him better.

His full name:  Eddie Rickenbacker. He was a famous hero in World War I, and then he was in WWII. On one of his flying missions across the Pacific, he and his seven-member crew went down. Miraculously, all of the men survived, crawled out of their plane and climbed into a life raft.

 Captain Rickenbacker and his crew floated for days on the rough waters of the Pacific. They fought the sun. They fought sharks. Most of all, they fought hunger and thirst. By the eighth day, their rations ran out. No food. No water. They were hundreds of miles from land and no one knew where they were or even if they were alive.

Every day across America millions wondered and prayed that Eddie Rickenbacker might somehow be found alive.

The men adrift needed a miracle. That afternoon they had a simple devotional service and prayed for a miracle.

They tried to nap. Eddie leaned back and pulled his military cap over his nose. Time dragged on. All he could hear was the slap of the waves against the raft . . . suddenly Eddie felt something land on the top of his cap. It was a seagull!

Old Ed would later describe how he sat perfectly still, planning his next move. With a flash of his hand and a squawk from the gull, he managed to grab it and wring its neck. He tore the feathers off, and he and his starving crew made a meal of it -- a very slight meal for eight men. Then they used the intestines for bait. With it, they caught fish, which gave them food and more bait . . . and the cycle continued. With that simple survival technique, they were able to endure the rigours of the sea until they were found and rescued after 24 days at sea.

Eddie Rickenbacker lived many years beyond that ordeal, but he never forgot the sacrifice of that first life-saving seagull . . . And he never stopped saying, 'Thank you.' That's why almost every Friday night he would walk to the end of the pier with a bucket full of shrimp and a heart full of gratitude.

Reference: (Max Lucado, "In The Eye of the Storm", Chapter 24, pp..221, 225-226)

PS: Eddie Rickenbacker was the founder of Eastern Airlines. Before WWI he was a race car driver. In WWI he was a pilot and became America 's first ace. In WWII he was an instructor and military adviser, and he flew missions with the combat pilots. Eddie Rickenbacker is a true American hero. And now you know another story about the trials and sacrifices that brave men have endured for your freedom.

As you can see, it is a great story that many don't know . . . You've got to be careful with old guys; you just never know what they have done during their lifetime.