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Archive for category: Seniors Health

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Screen Time: How Much is Too Much and How to Change It

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

I was enjoying a nice dinner with a friend (also an occupational therapist) and we started a great conversation about phone use with our children.  She asked me “how much screen time is too much”?  Of course, there isn’t really an academic answer, but we talked from a professional perspective about the behavior of phones, the social risks and benefits, and from the parent side of our fears and worries about how these have become a staple in the lives of our kids. Then, she changed my world by introducing me to the concept of screen time (more on that below).

Parents have very polarized views on phones, so I get that how I manage this in my household may not fit with the values of others.  To recap, I have four teen daughters ages 14-18.  Our phone philosophy is that we provide our girls a phone for their 14th Birthday (Grade 9) and pay for this until their 18th Birthday.  After that, they are on their own to fund this expense (and can get as many gigs as they want).  On our plan, they have 2 gigs each and do not get an extension if they run out.  Their access to Wi-Fi at home is scheduled and is not limitless.  They are not allowed to have their devices in their bedrooms (concessions are made sometimes but they already have “old school alarm clocks” to negate the “I need it to wake up” argument) and they know that if this is beside their bed it needs to be in airplane mode to not disrupt their sleep.

Too strict?  Perhaps, but I see phones like every other “potentially harmful” thing I keep my kids from.  Sedentary time, junk food and pop consumption (tip – just don’t buy it!), and of course we do not serve them alcohol or buy them cigarettes.  I ensure they are all engaged in something active and encourage them to make decent food choices, even if they don’t.  Those things are easy for me to “parent about” because it is well established that “sitting disease” is a thing, “diabetes and obesity” are a problem, and alcohol and drugs are horrible for developing brains (not to mention illegal for my kids based on age).  But screen time?  How much is “too much”?  We don’t really know that yet.  We know that phones are highly addictive – more addictive than cocaine – and cause a whole host of behaviors that, like addictions, are hard to break.  They also promote highly sedentary behavior (they are typically used while sitting). So, here is how I handled this (and note this is for iPhones with a family plan, I don’t know how this works with any other devices):

  • Go to: “settings, screen time”.  To get to know how this works, the top shows your usage.  Push on that and you have the option to look at Today or the Last 7 Days.  Below that is a list of all the things you do on your phone and for how long.
  • Go back to “screen time” and you will see somethings below your usage:

o   Downtime (schedule time away from the screen)

o   App Limits (set time for apps)

o   Always Allowed (things you want to always have access to)

o   Content and Privacy (blocking inappropriate content

  • Then below that, you will see “Family” and a list of those “underage” as per your family plan.

Now for the cool parent stuff.  You can click on any one of your children’s devices and you can see for each of them what you can also see for yourself.  Patterns, usage behavior, time on certain things, and you can also put limits to the above (Downtime, Apps, Always Allowed and Content).  It asks you for a password so as a parent you can pick something that the kids won’t know.  They can’t change their limits on their own.

I don’t recommend arbitrarily just going in and setting limits as I think the best part of the “screen time” feature is the conversation that can happen around figuring out what is “reasonable”.  With my kids, I chatted with each of them about their usage pattern (something they never looked at).  We talked about the time on their Apps, and for some, questions like: “4 hours on Rodeo Stampede”?  This brought their awareness to their habits and allowed me to understand their insight into whether this was “good, bad or ugly”.  And honestly, it was a mix of all three.  After we understood their patterns, we decided on our “screen time limit” (for us three hours / day) and went through to give permission for all the “good” to continue, the “bad” to be limited, and the “ugly” to stop.  And the best thing is that these limits apply regardless of data or Wi-Fi – so even if they have unlimited Wi-Fi in public places, they can’t use their devices more than programmed.

Since implementing this several weeks ago, their screen time has dropped significantly, and they don’t even use their devices to their limits (which were set lower than their averages to start with).  In fact, three hours might be more than they need.

All of this brings me back to a popular concept in my profession of occupational therapy:  behavior change starts with being able to track and understand it in the first place.  Once you know where behavior is at, you can make a conscious and concerted effort to modify it to improve your own health.  Even if you drop your usage by 30 minutes a day and maintain that for several weeks, you just returned yourself 3.5 hours per week to do other (healthier?) things.

What’s next Apple?  An iFridge?

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What is Growth Mindset?

When it comes to “mindset” Carol Dweck, a professor of psychology, states that people have either a fixed or a growth mindset and states that:

  • With a fixed mindset, one believes their qualities and abilities are fixed and therefore cannot change even with practice.
  • With a growth mindset, one believes their qualities and abilities will continue to change with time, effort and experience.

The term “Growth Mindset” is used frequently when talking about children and youth pertaining to education, however, it is not just for kids.  As clinicians who work with people of all ages who have sustained life-altering injuries, we often come across fixed mindsets and work to help clients reframe their thoughts and form goals based on a growth mindset.   Learn more about growth mindset in this TedTalk featuring Carol Dweck.

 

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Self-Care for Caregivers: Put Yourself First

Caregiving is a job.  A job most people don’t apply for, aren’t trained for, do not get paid for, and receive little to no time off from.  When a loved one is injured or ill often the job of full-time caregiver falls on the spouse, adult children, or other family and friends.  Though many are happy to give as much love and support as possible in their loved one’s time of need, the job of caregiver can be isolating, exhausting and can often result in caregiver burnout and additional health-related concerns for the caregiver themselves.

Remember that you cannot take care of someone else if you are not taking care of yourself.  You may risk becoming useless to your loved ones if you do not first take care of yourself.

The following infographic provides more information about the caregiving role and solutions to help reduce the mental and physical health-related issues that often stem from the job of caregiver.

 

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To learn more about how to care for yourself or a loved one as a caregiver take a look at our previous post, “Put on Your Own Oxygen Mask First.

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Being a Life-Long Learner Can Help You Age Well

As we’ve mentioned before when discussing how to support optimal aging, the old cliché is true when we talk of cognition – “use it or lose it”.  Just as we need to exercise our bodies for physical health, we must do so for our brain to support cognitive health.  Learning something new is a great way to flex the muscles in your brain, and the great news is you don’t have to sit in a classroom to do so.  Take a look at the following from the McMaster Optimal Aging Portal which discusses how online learning can support you as you age.

McMaster Optimal Aging Portal:  How online learning can support optimal aging

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Accessible Emojis Coming Soon to a Device Near You 👍

Cheers to Apple 👍 for working with multiple organizations to create new emojis that “better represent individuals with disabilities.”  Though it will take some time for these emojis to be available on your device, it is a great step forward for inclusivity in our daily lives.

photo care of Emojipedia Photo

Learn more about the new emojis in the following care of Time Magazine.

Time:  Prosthetics, Guide Dogs and Wheelchairs: Here Come Apple’s Proposed Accessibility Emoji

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How Anxiety and Depression Can Impact Cognition

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)
Co-written with Ashley Carnegie, Occupational Therapist

As a student working with an Occupational Therapist in the community, I realized early in my placement that many clients struggle with anxiety and depression in combination with cognitive challenges like decreased attention, concentration and focus, difficulties with memory, and slower information processing abilities. This spiked my interest, as I was unaware of the possible impact anxiety and depression could have on cognition and how these symptoms could be related.  I decided to look into this further, and am sharing my findings below.

Occupational Therapists work in a wide variety of settings including the community. As the hospitals become less and less able to accommodate people long-term, community-based occupational therapy services are becoming more and more common. Working in the community allows occupational therapists to reach a wide variety of clients, and therapists utilize a strength-based approach to build on the client’s current strengths to promote wellness and productivity.

Depression and anxiety are the most common types of mental illness throughout the world, including Canada. From my community placement experience as a student Occupational Therapist, I have found that the majority of the clients I have seen are experiencing depression and/or anxiety, often in combination with other primary diagnoses.

Interestingly, depression and anxiety can negatively impact the way the brain thinks, learns, and processes information and thus how it functions.  However, the relationship is complicated as a decrease in cognition may also lead to an increase in depression and/or anxiety which can then perpetuate the cycle.

Research has highlighted how anxiety and depression can negatively impact several aspects of cognition including:

  • Psychomotor speed
  • Attention
  • Executive functioning
  • Problem-solving
  • Attentional switching
  • Cognitive flexibility
  • Visual learning
  • Memory

The result for most people tends to be poor functional outcomes in their daily lives. Additionally, the brain regions believed to be responsible for these functions have been shown to be abnormal in people that also suffer from anxiety and depression  (e.g. hippocampus, amygdala, temporal lobes, and prefrontal cortex). Decreased memory, slowed information processing, and issues with verbal communication can negatively impact multiple areas of people’s lives. This information demonstrates the importance of the need to detect and treat anxiety and depression as early as possible as well as the need for early cognitive interventions for clients with anxiety and depression.

As a student Occupational Therapist, I wanted to further investigate how Occupational Therapists can help. I found evidence that Occupational Therapists can help clients in reducing functional decline, while also reducing the probability of relapse by treating cognitive deficits. Occupational Therapist’s target these areas by teaching client’s cognitive remediation and compensation strategies during their interventions and treatment monitoring.

Examples of remediation interventions may include:

  • Retraining higher-level cognitive skills (e.g. strategy use, self-monitoring, self-correction, problem-solving, self-evaluation)
  • Education
  • Relaxation and stress management techniques to regain control
  • Divided attention training (e.g. learn tasks separately and then combine tasks)
  • Imagery
  • Rehearsal strategies

Examples of compensatory interventions may include:

  • Modifying the environment (e.g. dim lights, reduce distractions)
  • Altering the task, (e.g. use of rest breaks, breaking the task into smaller components, repetition of instructions)
  • Use of both internal and external cueing/reminders (e.g. use of mnemonics, post-it notes, organizers, applications)

With both, often, a cognitive behavioural approach is taken.  Cognitive behavioural therapy (CBT) works to change clients thought structure to allow positive mood change, enhance coping strategies/problem solving, and help challenge faulty beliefs.

Anxiety and depression are common and are known to negatively impact a person’s cognition.  Worsening cognition then can deteriorate anxiety and depression further.  Early intervention is key to break this cycle and to promote function and wellness.   Occupational therapists play a vital role in providing interventions for those with anxiety and/or depression by implementing interventions for these issues, as well as treating the common resulting cognitive deficits.  Both remediation and compensatory techniques are used, often through cognitive behavioral therapy.  If you, or someone you know, is struggling with anxiety or depression this may present as cognitive difficulty, or if cognitive issues are present, anxiety and depression may also surface.  Consider occupational therapy if you would like support and strategies to improve these symptoms and to reduce their effect on your daily life.

 

References:

1. Carrier, A., & Raymond, M. H. Community occupational therapy practice in Canada: A diverse and evolving practice.

2. McRae, L., O’Donnell, S., Loukine, L., Rancourt, N., & Pelletier, C. (2016). Report summary-Mood and Anxiety Disorders in Canada, 2016. Health promotion and chronic disease prevention in Canada: research, policy and practice, 36(12), 314.

3. Statistics Canada (2014) Survey on Living with Chronic Diseases in Canada (SLCDC). Retrieved from http://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&SDDS=5160

4. Lee, R. S., Hermens, D. F., Porter, M. A., & Redoblado-Hodge, M. A. (2012). A meta-analysis of cognitive deficits in first-episode major depressive disorder. Journal of affective disorders, 140(2), 113-124.

5. Jaeger, J., Berns, S., Uzelac, S., & Davis-Conway, S. (2006). Neurocognitive deficits and disability in major depressive disorder. Psychiatry research, 145(1), 39-48.

6. Bora, E., Fornito, A., Pantelis, C., & Yücel, M. (2012). Gray matter abnormalities in major depressive disorder: a meta-analysis of voxel based morphometry studies. Journal of affective disorders, 138(1), 9-18.

7. Femenía, T., Gómez-Galán, M., Lindskog, M., & Magara, S. (2012). Dysfunctional hippocampal activity affects emotion and cognition in mood disorders. Brain research, 1476, 58-70.

8. Lorenzetti, V., Allen, N. B., Fornito, A., & Yücel, M. (2009). Structural brain abnormalities in major depressive disorder: a selective review of recent MRI studies. Journal of affective disorders, 117(1), 1-17.

9. Fleming, J. (2017). An occupational approach to cognitive rehabilitation. Workshop presented through the Canadian Association of Occupational Therapists, Toronto, ON.

10. Grieve, J. I., & Gnanasekaran, L. (2008). Intervention for Cognitive Impairments. Grieve, JI, & Gnanasekaran, L.(3rd ed. ed.). Neuropsychology for occupational therapists: cognition in occupational performance. Oxford. Malden, Mass.: Blackwell.

11. Haran, D. (2009). Cognitive-behavioral therapy for depression. The Israel journal of psychiatry and related sciences, 46, 269.

12. Knapp, P., & Beck, A. T. (2008). Cognitive therapy: foundations, conceptual models,  applications and research. Revista Brasileira de Psiquiatria, 30, s54-s64.

 

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Safe Ways for Seniors to Remain Active in the Winter

Winter has fully arrived in Ontario bringing with it freezing cold temperatures, icy surfaces and lots of snow!  If you don’t enjoy any of the these, that’s okay.  Though you may not be able to safely or comfortably enjoy the great outdoors there are still great ways to remain active during the Winter season.  The following care of the McMaster Option Aging Portal discusses some great ways for seniors to stay active without the dangers that can arise when trying to brave the elements.

McMaster Optimal Aging Portal:  Four ways to stay active this winter

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Social Outings Rx

We’ve said this before and we will say it again… being social is good for your health.  Occupational Therapists recognize the importance of social interaction within leisure activities for persons with and without disabilities. We work with clients to explore their interests to help find activities that offer opportunities for social interaction and, if needed, find ways to address the different barriers to engaging in these meaningful past times.

Great news!  Your family doctor can help with this too. There is now a pilot program in Ontario that allows physicians to write prescriptions for social activities and the ROM is assisting with this initiative.  Learn more in the following care of CBC News.

CBC News:  Doctor’s orders: ‘Social prescriptions’ have been shown to improve health

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Why You Need to Talk About End of Life Decisions

You survived the birds and bees talk… what can be more awkward than that?   Having a discussion about end of life wishes is something all adults should do with their adult children, partner, and/or loved ones.  Though the topic may be awkward and something you would rather avoid, without these conversations it is difficult for children, or powers of attorney, to make the decisions you would want if and when the need arises.  The following article care of Chatelaine Magazine reinforces the importance of having these discussions and what they should include.

Chatelaine:  How to talk to your family about end-of-life decisions

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Aging in Place: Making the “Stay or Go” Decision

This great resource provides some helpful advice to seniors that face the difficult decision to “stay or go” when it comes to housing as they age:

McMaster Optimal Aging Portal: Should I stay or should I go? Factors influencing older adults’ decisions about housing

The “Bottom Line” as outlined in this link is helpful, but I have added some other thoughts relating to the important “stay or go” decision:

The Bottom Line

Older adults’ loss of independence and declining capacity often lead to a decision to move to safer housing where care will be provided.

It is true that one of the most important factors in staying or going from the home includes the ability to get care.  Homecare from the public sector is not usually sufficient and private care is costly.  Friends, family and neighbors can only do so much.  But what if there was a way to delay the need for care by being proactive and addressing declining health actively by making changes to promote safety and independence BEFORE care needs become significant?  Occupational therapy can help people to be safer and more independent at home, and should be one of the first people you consult with if you are facing declining function.

The most important factors when making this decision are usually social and psychological considerations, not merely practical or economic considerations.

This is also true.  Isolation and reduced ability to self-motivate, engage and activate important self-care and home tasks greatly impact if someone can manage with or without supports.  Often the loss of a spouse or partner creates isolation and quickly forces people to have to adapt to a new way of living and managing alone.  This can often be the catalyst that determines if a home is too much to manage, or if a person can remain where they are.  Many seniors have the economic resources and family support to make changes to their home or living situation, but often they resist using these resources to manage their own needs.

Having a better understanding of the range of factors influencing older adults will help family members and professionals better support them in the decision-making process.

Also a great point.  However, I would argue that solving issues related to senior housing and living needs to be a customized approach.  “Understanding seniors” does not create a roadmap of how to help people through their unique challenges.  There is no cookie cutter solution and getting input and help at the actual home (i.e. not in an office or clinic) is the ideal approach to develop the most appropriate solutions.

Consider occupational therapy if this can help you or a loved one to stay home safely, independently and for as long as possible.

Learn more about factors to consider when looking to Age in Place in our post, Occupational Therapy and Aging in Place.