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Tag Archive for: seniors

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Understanding Elder Abuse

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

Co-written by Darren Schutten, MSc (OT)

Today, June 15th is World Elder Abuse Awareness Day. Elder abuse has been a growing concern worldwide. In fact, it is estimated that 16% of older adults have been abused in the community setting in the past year.  This number jumps to a staggering 64% within institutional settings.  However, it is felt that these figures are unrepresentative of the true problem, as only 4% of elder abuse gets reported due to fear of retaliation, worry about getting the abuser in trouble, mental incapability, or feelings of shame and embarrassment.

The World Health Organization defines elder abuse as “a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person.”   This type of abuse typically occurs when there is an imbalance of control between the abuser and the elderly individual.  The concept of elder abuse has evolved over time to include: physical, psychological, sexual, neglect, and financial abuse.

I’m sure most of us have seen examples of this happening.  When I worked at the bank, we had a senior who was repeatedly withdrawing money for a roofer. We contacted her family with concern, and they determined that the client was in fact being taken advantage of. Or, in another example, I am aware of an elderly woman who went to buy a coffee and discovered that she no longer had money in her bank account. Her daughter was managing her finances and through review, it was discovered that these had been squandered through gambling and the purchase of things such as a “money-making machine” off the internet (true story!). Or, of course, there are the stories whereby a senior is scammed on the phone, or the news shares examples and videos of elder mistreatment by staff in long term care. Or, what about those seniors you may know or worked closely with who refused to take their prescribed medications, refuse help, and try to take care of themselves? This behaviour is considered self-neglect and actually falls under the umbrella of elder abuse.

As occupational therapists (OTs), we work closely with seniors both at home and in the community. We assist people with self-management of things like personal care, finances, homemaking, and of course symptom management and the overall ability to function. Through our work, we may see or hear about all types of elder abuse.  For example, we may notice unexplained injuries such as bruises, bumps, or grip marks on a senior client’s arm indicating potential physical abuse. Or, maybe we may notice a sudden change in the senior’s psyche such as increased fearfulness or nervousness during an OT treatment session that was not present during prior sessions. This may be a sign of recent psychological abuse. Or, it is quite possible that an OT who works in an institutional setting may be told by residents that they are feeling neglected in their care. These are just a few examples of how an OT may encounter elder abuse in their practice, but regardless it is important for all OTs to learn about the different signs of elder abuse as they may be a key stakeholder in preventing the abuse from continuing. And whatever type of elder abuse we may be exposed to as OTs, it is important to know our reporting obligations.

In Ontario, anyone who knows or has reasonable grounds to suspect that a senior resident in a long term care home or retirement home has been, or might be abused, it is mandatory for that person to report the abuse.  The same obligation to report applies for seniors with developmental disabilities.  Reports can be made by calling the police or relevant support agencies.  Support agencies can be located by calling a local helpline (e.g. Seniors Safety Line).  However, OTs are not required to report abuse if the senior lives in their own home or in any setting other than what was mentioned above.  Seniors have the right to live at risk and refuse help with the abusive situation they are involved in, and as OTs, as long as the client is competent to make their own personal care or financial decisions, those rights need to be respected.  As OTs who may be put in these types of situations, we can still help by staying in contact with the senior on a regular basis. Overall, whatever practice setting we work in or the company we work for, it is important as OTs that we know the relevant legislation, policies, and codes of ethics that we are bound to in order to practice as competent OTs.

References

  1. World Health Organization. (2016). Elder abuse: The health sector role in prevention and response. Retrieved from https://www.who.int/violence_injury_prevention/violence/elder_abuse/Elder_abuse_infographic_EN.pdf?ua=1
  2. Elder Abuse Ontario. (2018). Elder abuse prevention (ON). Retrieved from https://www.elderabuseontario.com/
  3. Ontario Human Rights Commission. (n.d.). Elder abuse & neglect. Retrieved from http://www.ohrc.on.ca/en/time-action-advancing-human-rights-older-ontarians/elder-abuse-neglect
  4. Canadian Association of Occupational Therapists. (2012). CAOT position statement: Elder abuse prevention and management and occupational therapy (2012). Ottawa, ON: CAOT Publications ACE.
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Senior Safety and the Vital Role of Occupational Therapy

Canada’s population is aging. In 2015, there were almost 6 million people over the age of 65 – that is nearly 1 in 6 Canadians. As we grow older, we face an increasing risk of falls, accidents, disabilities, and illnesses.  As a senior how can you stay safe and healthy?

Why is Older Adult Safety Important?

Older adult health and safety is important for maintaining our ability to age in place of choice.  Statistics Canada has highlighted the following safety risks for older Canadians:

  • 89% of Canadian seniors had at least one chronic health condition. Arthritis and rheumatism were the most common.
  • 25% of Canadian seniors reported having 2 or more chronic conditions such as high blood pressure, arthritis, back problems and diabetes.
  • 63.7% of Canadian seniors reported to have been injured in a fall.
  • There are 3.25 million people aged 65 and over in Canada who have a driver’s license.
  • 92.1% of seniors live in private households.

These statistics demonstrate the increased risk to seniors for health and other safety concerns.

Occupational Therapists Can Help!

Occupational Therapists are trained professionals who address all aspects of getting people back to doing things they want to do, need to do, or have to do, but may be experiencing challenges when doing so.  Occupational Therapists can support older adult’s health and well being through providing supports for seniors to maintain active social connects, manage changes in health conditions, and to continue engaging in activities that provide them with meaning and joy.

These are the following areas that an OT can help keep seniors safe and healthy!

Fall Prevention 

Falls are the leading cause of injury among older Canadians with 20-30% of seniors experiencing one or more falls each year.

Occupational Therapy can help seniors prevent falls by assessing their functional status and reviewing the hazards in their environment that may put them at risk for falling. Strategies to prevent falls can be discussed, such as:

  • General Education on how to do activities differently to stay safe.
  • Equipment and devices to assist.
  • Home modifications such as lighting, flooring, organization, and layout.
Aging in Place

In 2011, 92 % of all seniors ages 65 + lived in private homes, and over 10 million seniors are living with a chronic condition.  Older adults also have disproportionately higher rates of unmet care at home. Thus, ensuring these individuals function safely and independently at home is a high priority.

Occupational Therapy can help by assessing the home and the homeowner to ensure a proper fit between the person and environment to promote overall health and safety.  Additionally, an OT can prescribe the proper assistive devices, education and help people plan ahead so they can “ age in place” without being at risk.

Keeping Senior’s Active

Remaining physically active as you age can help reduce, prevent or delay diseases and can help to manage stress, improve mood and boost cognition.  Statistics show that 57% of Canadian seniors consider themselves physically inactive.

Occupational Therapy can help seniors remain physically active by:

  • Creating custom activity plans based on health and abilities.
  • Helping seniors create a daily schedule that includes physical activation.
  • Helping seniors to find appropriate facilities and groups to join or other productive and meaningful activities.
Sleep

Sleep is important for recovering from illness and injury, staying healthy, and ensuring people have sufficient energy during the day to accomplish life roles. Difficulty sleeping is a common and detrimental issue for people in various life stages.

Occupational Therapy can help seniors reduce sleep problems by:

  • Reviewing sleeping positions and patterns to suggest improvements for both comfort and quality of sleep.
  • Assessing the bed, mattress, and pillows to ensure the body is sleeping in the optimal position for comfort.
  • Prescribing assistive devices to improve sleep positioning, bed transfers, and bed mobility.
  • Helping people to implement a new sleep routine that will improve your sleep quality and duration.
Cognitive Impairments

According to the Alzheimer’s Society of Canada as of 2016, there are an estimated 564,000 Canadians living with dementia – plus about 25,000 new cases diagnosed every year.

Occupational Therapy can help people with dementia or who have altered/declining cognition by:

  • Educating people and loved ones on how to maximize function while still promoting independence and safety in the completion of activities of daily living.
  • Assessing cognition, abilities, and environment to make suggestions on ways to compensate for declining cognitive skills through direct therapy or environmental modification.
  • Developing routines and schedules that promote independence and eases the role and need for a caregiver.
  • Prescribing safety equipment and devices to optimize function.
Transition Stages
  • Occupational Therapy can play a crucial role in helping seniors through live transitions this by:
  • Identifying, planning and helping people engage in finding new meaningful occupations outside of work.
  • Providing education on role changes, spending time with family and friends, healthy lifestyles and choices.
  • Helping discover new ways to occupy their time, participate in leisure activities and find new interests.
  • Improving quality of life through promotion of independence and pain management strategies.

 

For more information on how Occupational Therapists help improve the lives of older adults check out our infographic:  Occupational Therapy Works for Seniors.

 

Resources

http://www.statcan.gc.ca/pub/11-402-x/2012000/chap/pop/pop-eng.htm?fpv=3867

https://www.tc.gc.ca/media/documents/roadsafety/cmvtcs2013_eng.pdf

Turcotte, M (2014). Canadians with unmet home care needs.

http://www.statcan.gc.ca/pub/75-006-x/2014001/article/14042-eng.pdf

http://www.caot.ca/default.asp?pageid=1454

http://www.caot.ca/default.asp?ChangeID=1&pageID=621

http://www.caot.ca/default.asp?pageid=1501

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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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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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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.

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The A to Z of OT: I is For… Injury Prevention

“An ounce of prevention is worth a pound of cure.”  Benjamin Franklin

Did you know that in Canada falls are the leading cause of injury amoung older Canadians?  And that 20-30% of seniors experience one or more falls each year?  Falls are also the number one cause of both brain and spinal cord injury in seniors.  How can we put a stop to injuries caused by falls?  PREVENTION. Really, it is the best medicine.  Learn how Occupational Therapists help to prevent falls in the following episode from our OT-V video series.

 

 

October is Occupational Therapy Month and to celebrate we will be sharing a new series called the A to Z of OT.  In our attempts to further educate the public about what Occupational Therapists do we will be highlighting twenty-six of the awesome ways OTs provide Solutions for Living.  

We encourage you to follow along and to add to the discussion by highlighting other awesome things OTs help with for each corresponding letter!

 

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How Can Occupational Therapists Best Support Older Adults as they Transition to Non-Drivers?

Guest Blogger Lauren Heinken, Occupational Therapist

It’s winter, and with the season comes decreased daylight and increased risk of weather-related adverse driving conditions. These factors can contribute to a higher incidence of motor vehicle collisions, and this may be particularly true for older adult drivers who are experiencing physical and cognitive health changes. The Ontario Ministry of Transportation (MTO) reports that senior drivers with cognitive impairment/dementia have up to 4.7 times the risk of being involved in a motor vehicle collision. The MTO’s Senior Driver License Renewal Program operates in an effort to ensure that older adult drivers are screened for health changes that may impact their ability to drive. Occupational Therapists (OTs) may be involved in the process by administering the screening tools that can play a role in determining an individual’s fitness-to-drive; however, physicians and the MTO work together to ultimately decide whether an individual is able to maintain their license or not.

Many older adults see driving as imperative for maintaining their independence, especially if they have been lifelong drivers or are relatively unfamiliar with other forms of transportation. More physically demanding forms of transportation, walking to bus stops, or cycling, may no longer be viable alternatives for many. Outside of the main urban centres, Canada’s population is dispersed across great geographic distances; in more rural areas, public transportation services may be sparse if available at all. The distances individuals need to travel on a frequent basis to access services and participate in activities of their choosing are often great. As health professionals who focus on helping individuals find ways to engage in their chosen occupations, it fits that OTs should be involved in supporting older adults who have lost, or are at risk of losing, their ability to drive.  OTs can work with their clients to minimize the way in which losing one’s license influences overall quality of life and ability to engage in chosen occupations.

As with any major life change, planning for the loss of one’s drivers license well in advance can help to limit the impact of the change when it happens. After all options for ensuring and promoting someone’s ability to drive safely have been exhausted, the next responsible therapist-client step would be to initiate discussions related to transportation alternatives, regardless of whether or not this lifestyle change will be occurring in the near future. It is understandable that OTs may be reluctant to initiate these discussions as safe continuation of driving is often an emotionally charged subject and can lead to very difficult conversations.  Introducing the subject slowly and matching the content of the conversation to the client’s comfort level can help to limit any negative effects on the OT-client therapeutic relationship. Below is a proposed progression of an OTs involvement with a client who has lost, or is at risk of losing their ability to drive.

 

 

 

 

OTs should let the changing seasons serve as a reminder to consider initiating these discussions during client sessions. Although clients may be unreceptive and unwilling NOW to accept intervention aimed at preparing for this lifestyle change for LATER, a brief discussion may be enough to get them thinking about this important topic to help them adjust to the possibility when / if it arises.  Sometimes as therapists the ideas we introduce early are not accepted for months or years later, but our role includes having the patience to work with clients around their comfort level and to support change when they are ready to accept it.

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Older Adults and Financial Stress

In a previous post, Solutions for Disability-Related Stress, we discussed how clients who are ill or who have been injured almost always deal with financial stress, and provided some solutions an Occupational Therapist can offer.

Other sources of financial stress can stem from aging.  Our senior population faces increased healthcare bills, long-term living expenses and more which can all create a great deal of anxiety.   Take a look at the following guide care of Reverse Mortgage Alert (not a mortgage broker) to learn more about Senior’s financial stress and to find some coping strategies.

Reverse Mortgage Alert:  Financial Stress Coping Guide for Seniors