Category / Exercise

Taking a Familiar Walk: Dementia Amid COVID-19

June 12, 2020

A daughter experiences the neighborhood from her mom's perspective
By Laurie Matlin

My 95-year-old mother has reached the limits of her patience with the daughter in her basement. As one of her nine children currently helping out, I take no personal offense. Even for people without dementia, COVID-19 can complicate a well-planned life.

“I’m going away,” she declares one mid-spring day. “Everyone in this place has something to do but me!” My dad and I have just emerged from his office from where we ordered groceries online. She doesn’t understand this new system, and she believes I have overstepped my role.

Mom finds her wool coat and struggles with its zipper. Dad leans in to see how he can help. They turn to me, and I quickly zip the uncooperative coat.

As a power play among younger people who might wish to exert control, running away can be particularly problematic for people with dementia like my mom. Yet here we are, Dad and I both acting as accomplices as if Mom were a temperamental kindergartner bound to return before dinner.

She reaches for her hat and scarf. “Do you want the red one?” Dad asks helpfully. She ignores him and grabs the gray hat with matching scarf. Strands of frizzy silver curls slip out from under her cap, and she slides red Keds onto her feet. Wearing the same sweat outfit she has donned over the past few days, she suddenly looks more youthful.

“You can’t come with me!” she barks at me. Dad pleads for her to reconsider.

“I’m going away,” she declares one mid-spring day. “Everyone in this place has something to do but me!”

“I’m just going for the mail,” I tell her. Stay non-confrontational, I whisper to Dad.

With Dad on one side and me on the other, she manages a step from the front door, then another step off the stoop. Her eyes narrow, and she begins a steady pace along the front sidewalk.

She pauses at the driveway. “Which way did Sam go?” she says aloud to no one. Sam was my late brother with Down syndrome who regularly walked to a bus stop for his job.

Mom looks left, starts in that direction, then stops.

“There’s neighbors there,” she speaks again to herself, allowing me privileged insight as to how her mind is working.

Following Closely Behind

She glances in the opposite direction and sees a hill. “That’s too high,” she says, and I marvel how one part of her is speaking for another part to hear. She resumes her original direction, but now crosses the street.

“Hi Fran!” Pauline, the neighbor she sought to avoid, waves after watching for a bit. Mom makes no acknowledgement, her feet pattering on the pavement. Ten feet behind her, I serve as her shadow in stealth. I smile at Pauline, shaking my head and pointing to my ears to suggest Mom’s hearing inadequacies.

I follow Mom down the hill and around the bend. Tracking her requires few skills attributed to private eyes; I could have practically stepped on the back of her shoe without being spotted. While systematically on guard, she is less capable of easily turning around.

The neighbor teen on his driveway peers momentarily at this odd-looking lady who is overdressed in temperatures approaching 80 degrees. He smirks, resuming the whump, whump, whump of his basketball before pivoting in an easy layup.

From the other side, the mail truck approaches. The mailman looks at Mom as if he’s unsure how he might be of help. While swift for a person her age, Mom walks gingerly, almost like a child with autism, her big toe angling up, and it is perhaps this rigidity that alerts the viewer that something is slightly off. Mom slows at the tree, grabbing a branch. She seems to wish to wait for the mail truck to pass before resuming her plan.

It is at that moment that she turns around and finds me standing at her back. “Hi Mom! What are you doing over here?” I feign happy surprise that our paths should cross at just this moment. The ruse seems to work. “I am heading over there,” Mom points with no rancor in her voice.

I fall in line with her pace and we turn down another street. “The road is closed that way. Maybe we need to go a different way,” I suggest, pointing to the diamond-shaped construction sign. She continues past the sign. We proceed as two toddlers locked in parallel play, aware but not working at all together.

A Walk She Needed

“Where are you going?” I ask after a bit.

“Sam walked this way to catch the bus. It took him downtown,” she explains.

“And then what?” I ask.

“Who knows?” she replies without pausing. She tolerates my presence, perhaps welcoming another mind to support her if things turn rough. I marvel at the workings of her plan, as if following breadcrumbs left by Sam in a different time when buses operated because that’s what buses are supposed to do.

“Why do you want to go downtown?” I ask.

“I want to get to the railroad. Where my father worked,” she explains. She has talked recently about her need to get to her father at the train station, a commuter system that no longer exists in our town. Her father died a half-century ago.

She says she needs to rest and maneuvers herself atop a a tree stump cut at waist level. She watches the birds and feels the breeze, then eventually gets up to walk again.

“You’ve come an awful long way,” I suggest.

“I thank you for walking with me,” she says so softly I lean to hear her words. She still doesn’t look at me, but her voice conveys warmth that surprises me.

No answer.

“I wonder if we might turn around,” I probe gently.

“I’d like to get to the top of the hill,” she starts and then seems to change her mind. She turns around, like Forrest Gump who abruptly ends after running across the country.

“I thank you for walking with me,” she says so softly I lean to hear her words. She still doesn’t look at me, but her voice conveys warmth that surprises me. There is something she needed in this, I realize.

Life Is More Than Just Staying Alive

We continue silently, less fast-paced than on the outward jaunt. She rests at times, but then starts moving again. She reaches the side door to the garage.

“Do you need a hand?” Dad’s face suddenly appears at the doorway, surely watchful for her return.

“No, I can do it myself.” Her voice is resolute but without confrontation. Still, she takes his hand, then ambles up two steps.

When she turns, her eyes suggest a glimpse of a larger world. Her autonomy expanded just a little, other parts loosened from more rigid bounds. In this moment, her opinions still matter and her inner compass is shaken to new life. She looks straight at me.

“Thank you, Laurie,”she says, as if for that moment she can see me as something more than the invader in her land.

Life is more than just staying alive, her presence seems to say. Like unsteady feet on pavement, uncertainties will always arise. “Let life happen to you,” the poet Rilke wrote more than a century ago. “Life is in the right, always.”

The dual punch of dementia and COVID-19 is not easy, not even one little bit. But if we pay attention, maybe there’s still something we can learn.

By Laurie Matlin

Laurie Matlin is on personal leave from her job as a hospital and palliative care chaplain resident while she helps to care for her parents. A former journalist, she has been keeping a video diary of what she calls a sacred time in her family's life.    

Your Brain Has an Immune System, and You Can Boost It

June 5, 2020

It can help you deal with stress, self-esteem and motivation in the pandemic
By Stephen L. Antczak

You’re probably familiar with your immune system — your physiological immune system, that is. It’s the one that sends white blood cells to dispatch with pathogens. But what about your psychological immune system? This is an especially important idea to think about now, in the time of COVID-19 and social distancing.

The term “psychological immune system” was coined by psychologists Daniel Gilbert, who is probably best known for his book Stumbling on Happiness, and Timothy D. Wilson, who is known for his research on self-knowledge. But the basic concept goes back to Sigmund Freud and his ideas regarding defense mechanisms, which were elaborated on by his daughter, Anna Freud, in her book, Ego and Mechanisms of Defense. In fact, “ego defense” is, at least for our purposes, a mechanism to protect the self, or self-image, from whatever threatens it.

A good way to think about the psychological immune system is provided by Emily Rosenzweig, senior behavioral scientist at Ochsner Health, a nonprofit academic health care system in Louisiana: “A range of mental processes triggered by a threat to our sense of self-esteem, self-worth and self-concept.”

What can threaten a person’s self-image, or their self-worth? How about being referred to as a “nonessential” worker?

What can threaten a person’s self-image or self-worth? Here’s an example: being referred to as a “nonessential” worker and told to stay home, losing a significant amount of income in the process.

Positive Self Talk

Here’s where you can use your psychological immune system to help. You can tell yourself that you are valuable to society, the current pandemic situation is temporary and the lives of many others are diminished, even if just a little bit, by your absence.

You should also admit to yourself that people can still live meaningful lives without you, and that’s OK, too. It doesn’t diminish your value as a human being.

Positive self-talk can be quite helpful. However, don’t overdo it.

For example, you wouldn’t want to tell yourself that without you being there, the lives of others are completely devoid of meaning and those people are just miserable. Knowing that’s probably untrue would likely make you feel worse.

“There’s a sweet spot,” says Rosenzweig. But, she adds, “you can’t deny existing negative emotions.” If you try to completely obliterate those negative emotions, however, you’ll probably wind up feeling worse as your brain produces counterarguments that undo your attempts to make yourself feel better.

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Less-Than-Ideal Coping Mechanisms

Being aware of your psychological immune system means you’ll be better able to recognize when it kicks in.

Think about the coping mechanisms you use in a stressful situation or when dealing with the difficulties life throws at you. Do you feel better when you pour yourself a glass of wine or three? Do you avoid dealing with things by binge watching Netflix?

Avoidance is one of your psychological immune system’s tactics, even though it may not be good for you in the long run. Like your physiological immune system, your psychological immune system can opt for the short-term fix over long-term wellness.

Not that drinking one glass of wine or watching two episodes of your favorite show are counterproductive. We all need some downtime. Both are easy to overdo, however, and that undermines the effectiveness of your psychological immune system.

Once Again, Exercise Is Key

So, what can you do to bolster optimal functionality of your psychological immune system?

First of all, you need to feel motivated.

Dr. John Ratey, associate clinical professor of psychiatry at Harvard Medical School and author of the bestselling book, Spark: The Revolutionary New Science of Exercise and the Brain, has a suggestion: Exercise.

“Exercise reduces stress and anxiety, and promotes a better mood — all factors that go into motivation,” Ratey says.

Of course, you also need to feel motivated to exercise and in the tug-of-war between staying fit and Netflix, that motivation can be hard to come by.

Ratey suggests doing something easy, like going for a walk every day, preferably outside, even if it’s just a short walk.

Can’t go outside? There’s an app for that. Ratey suggests downloading the free 7 Minute Workout app on your phone. “It’s all bodyweight exercises, and it activates all major muscle groups.” There are many other workout apps you could try as well.

Developing Goal-directed Behavior

There’s also something you can do to maximize the effectiveness of exercise, at least when it comes to your brain and your psychological immune system: Use exercise to help you turn goal-directed behaviors into healthier new habits while making progress towards your goals.

Having a goal is a good way to motivate yourself, but also a way to focus on those behaviors you need to make progress towards that goal.

For example, getting out of debt and becoming financially solvent requires a series of smaller steps to achieve. A good first step in that direction is to create a household budget, which is something you can work on a bit each day while social distancing.

Here’s how exercise fits in: Stress can impair your ability to undertake goal-directed behaviors by making you fall back on normal habits. If your habits are binge-watching Netflix, drinking alcohol or eating cereal late at night, stress may reinforce those less-than-ideal behaviors.

But exercise reduces stress and increases motivation. So, it’s a behavior you might undertake to achieve the goal of better cardiovascular fitness, losing weight or both. In that way, it’s a goal-directed behavior all by itself. But exercising will also help you stay motivated and focused on your other goal-directed behaviors, by reducing stress and increasing motivation.

No Gym? No Worries — How to Stay Fit at Home

May 5, 2020

Plus: the right amount of exercise to stay healthy during the pandemic
By Sheryl Jean

Part of the The Coronavirus Outbreak: What You Need to Know Special Report

Since his gym closed, you might find Tom Hippman, 55, working out to Journey’s “Eye of the Tiger” in his Dallas living room, using whatever props he can find.

He’s been doing sit-ups against the wall, deadlifting 64-load bottles of Woolite, running through his parking garage and other exercises for 45 minutes a day.

Tom Hippman uses household items for weight training

“Being in a seven-hundred-square-foot apartment is a little more challenging,” Hippman says. “I’ve taken it on as a challenge.”

Many people are spending more time at home thanks to social distancing and shelter-in-place orders amid the coronavirus pandemic. That means some can’t go to the gym or group classes to stay fit like they usually would.

“With coronavirus out there, there’s a tendency not to exercise, but now it’s even more important,” says Dr. Rajiv Misquitta, director of lifestyle medicine at Kaiser Permanente Medical Center in South Sacramento, Calif. “If people don’t have a [fitness] plan at home, they’ll become sedentary and that will affect their health.”

Regular exercise is important to keep your body and mind healthy. But you don’t need a gym, expensive equipment, special clothing or a large space to do many activities at home.

Exercise, But Not Too Much

Adults typically should get at least 150 minutes of moderate-intensity exercise a week, according to the U.S. Department of Health and Human Services. But it’s different during this coronavirus pandemic, says Tamara Hew-Butler, an associate professor of exercise and sports science at Wayne State University in Detroit.

Instead, Hew-Butler recommends 20 to 45 minutes of moderate exercise three times a week. People, however, can modify that guidance according to their normal fitness routines. But exercise no more than five times a week and no exercise if you have flu-like symptoms, Hew-Butler adds.

To replicate your gym workout, replace your usual equipment with household items, such as canned food for barbells or a bowling ball instead of a medicine ball.

Research on the response of the body’s immune system to exercise shows moderate exercise is “the sweet spot” and inactivity or exercising too much can increase your risk of respiratory viruses, says Hew-Butler, an avid runner. The goal during a pandemic, she explains, is to maintain your fitness level, not increase it.

How do you know if you’re overdoing it? Listen to your body. Extreme soreness, pain or fatigue are probably signs you’re exercising too much.

Stick to an Exercise Routine

Squats work muscles from your feet to your core

Create an exercise routine. Make it simple, so you’ll achieve your goals and want to keep exercising.

Older adults should combine moderate aerobic activity with balance and muscle-strengthening (at least twice a week) exercises. Balance and muscle mass deteriorate as people age.

To mirror your gym workout at home, replace your usual equipment with household items, such as canned food for barbells or a bowling ball instead of a medicine ball.

Erika Nelson of St. Paul, Minn., often rearranges the living room furniture or moves her car out of the garage to perform exercises, yoga and Pilates. She does tricep dips with a chair and jumps off her deck.

Nelson, 54, says staying active is important to her.

“I really need it for my brain more than my body,” she says. “I push myself to do it, and I always feel better after.”

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Staying Motivated

Exercising at home can be challenging without equipment, an enthusiastic coach and team support. But it doesn’t mean you can’t interact with others. Talk to your trainer or workout buddies by phone and with video chat apps.

Another idea: Get into a little competition with friends on your number of daily steps or push-ups, suggests Misquitta, who is a certified personal trainer.

Mix various activities to keep things interesting or try something new. Think about what you enjoy: Gardening and dancing count as aerobic exercises, too.

If you need a little inspiration, you’ll find many online resources, such as yoga videos on YouTube and digital music services, like Spotify.

Track Your Progress

Stay motivated and accountable by tracking your activity. Wear a fitness tracker, use mobile apps to track your exercise regimen or simply write down what you do (number of steps or repetitions, your heart rate) on a calendar to see your progress week to week.

Exercises to Try

The following simple exercises don’t require special equipment. The how-to links for them are from the American Council on Exercise website, and the yoga poses are from the Yoga Journal website.

Cardiovascular training:

The National Association of Sports Medicine recommends cardiovascular training three to five times a week or one to three times a week for beginners.

“You want to get your heart rate up a little bit, get warm and start sweating,” Misquitta says. He suggests walking or jogging in place while watching television, walking up and down stairs, dancing or doing jumping jacks.

Core (abdominal muscles):

  • Ab crunches: This provides similar benefits as sit-ups with less strain on your neck and back.
  • Planks: While planks focus on the core muscles of your abdomen and lower back, they really work the whole body. You can start on your knees or place your elbows on a hassock or couch.
  • Trunk rotations: This exercise usually is done with a medicine ball, but you can use a household item, like a heavy book. Start with two pounds and gradually increase the weight.

Upper body:

  • Push-ups: In addition to upper-body muscles, push-ups work your core. If you can’t do push-ups on your toes, start on your knees or plant your feet against a wall.
  • Bicep curls: You can use water bottles or jugs of laundry soap instead of barbells.

Lower body:

  • Squats: Misquitta says squats give you the most bang for your buck. Squats work muscles from your feet to your butt and your core. Use a chair for support.
  • Lunges: This exercise also strengthens abs and improves balance and mobility. First, you may want to become comfortable doing a single-leg stand. Later, extend your arms toward the front or hold weights for a greater challenge.

Yoga poses for balance:

  • Chair pose: It also strengthens the lower back and arm and leg muscles.

Tree pose: Beginners can stand near a wall for support. Extend your arms toward the ceiling for more intensity.

How Meditation Can Help With Chronic Pain

December 30, 2019

Experts say meditation can work as well as medications for some people
By Patricia Corrigan

You’ve probably figured out that taking a few deep breaths in a stressful situation can calm you down. And you may know that practicing meditation on a regular basis helps many people cultivate serenity. But did you know that some studies show meditation can alleviate pain?

“We have pretty strong evidence that mindfulness meditation is helpful for chronic pain conditions,” says Wen Chen, chief of the basic and mechanistic research branch at the National Center for Complementary and Integrative Health’s Division of Extramural Research in Bethesda, Md. The center is part of the National Institutes of Health.

“We experience pain where the body is injured, but we also experience the psychological and social aspects of pain. Mindfulness meditation works on the psychological aspect,” Chen says.

Meditation is an ancient practice, and we know very little about how it works,” she adds. “We do know that it’s low risk, it’s not invasive and you can do it on your own. Lots of people find it beneficial.”

And it appears that an increasing number of Americans are finding meditation beneficial for a variety of different reasons. In 2012, only 4.1% of adults in the U.S. practiced meditation, but by 2017, the number had increased to 14.2%.

Wen Chen

A government-sponsored site with an overview of mindfulness meditation reports that research about the practice’s ability to reduce pain “has produced mixed results,” but in some studies, “scientists suggest that meditation activates certain areas of the brain in response to pain.”

Reducing Pain Through Mindfulness Meditation

An estimated 11.2% of the U.S. adult population suffers from chronic pain, according to a research post Chen published three years ago.

“Prescription opioid medications present serious risks, both medically and socially,” she wrote, and she cited a study that provides “compelling evidence for the existence of a non-opioid process in the brain to reduce pain through mindfulness meditation.”

“With mindfulness meditation, you accept the (pain) message, and gradually, your body and brain stop sending it. It’s like turning down the volume control.”

So what is mindfulness meditation? One evidence-based form, known as mindfulness-based stress reduction (MBSR), is an eight-week program developed by Jon Kabat-Zinn at the University of Massachusetts Medical Center in the 1970s.

A teacher-certification program has placed its instructors in almost every state, but you also can learn the method through Kabat-Zinn’s MP3s and CDs. Plus, some pain-management programs offer mindfulness-based stress reduction training, so check with your doctor.

“MBSR has a breathing component where you focus on your breathing as you meditate. That aspect of slow breathing is very helpful,” Chen says, “and quite a few researchers point toward the breathing component as quite important to relieve pain. Just twenty minutes of mindful breathing can often do the trick.”

She adds that in addition to looking at MBSR, researchers also are evaluating mindfulness-based cognitive therapy, a modified form of psychotherapy, and progressive relaxation techniques for pain management.

Other Benefits of Meditation for Pain Control

Danny Penman

Danny Penman, a journalist in Bristol, England with a Ph.D. in biochemistry, teaches and writes about meditation. He is the co-author with Vidyamala Burch of the book Mindfulness for Health: A Practical Guide to Relieving Pain, Reducing Stress and Restoring Wellbeing, published in the U.S. as You Are Not Your Pain.

The British Medical Association honored the book with first place in the organization’s 2014 Medical Book Awards competition. In 2013, a clinical trial conducted at the University of Manchester in England showed that the eight-week program outlined in the book is “highly effective at reducing anxiety, stress and depression.”

Other clinical trials have shown that mindfulness is “at least as effective as the main prescription painkillers,” Penman says.

Powerful painkillers do dull the sensation of pain, but the medications also lose their effectiveness over time and have addictive qualities. According to the National Institute on Drug Abuse, roughly 21% to 29% of patients prescribed opioids for chronic pain misuse them and between 8% and 12% develop an opioid use disorder. About 80% of people who use heroin first misused prescription opioids.

“We all have to come to terms at some point with illness or suffering, and I believe that in the longer run, mindfulness is at least one of the answers,” Penman says. Pain, he adds, is a message, and the body and the brain keep sending that message.

“With mindfulness meditation, you accept the message, and gradually, your body and brain stop sending it. It’s like turning down the volume control,” he says.

Professional Reassurance: ‘You Can’t Fail at Meditation’

While still in school, Penman started meditating as a means of stress reduction. In 2006, he was in a paragliding accident.

“Once my pain was under control, I started meditating seriously, and after a couple of weeks, I was able to reduce my painkiller intake by two-thirds,” he says. He later trained as a meditation teacher specializing in pain relief.

Many of us know people who say they have tried meditation, but failed. Penman says that’s not possible.

“You can’t fail at meditation. Ironically, the moment you think you’ve failed is a moment of mindfulness because you have come back into the present moment and are no longer wrapped up in your other thoughts,” he says.

Some people who think they have failed “build a catastrophe around it, letting in fears and anxieties that can amplify their pain,” Penman says.

“Meditation is like physical exercise,” he continues. “The more you do it, the more you begin to relax, and the easier gets. You may still have doubts or fears, but it gets easier each time you do the basic practice and focus on your breath. The more you meditate, the more you will benefit.”

Whether you’re just starting or giving mindfulness meditation another go to help cope with pain, once you understand what to do, you need to set aside only 10 or 20 minutes each day for the practice.

Over time, it will become a comfortable habit, so Penman suggests you simply begin. He says, “The hardest thing in the world is taking that first breath.”

By Patricia Corrigan

Patricia Corrigan is a professional journalist, with decades of experience as a reporter and columnist at a metropolitan daily newspaper, and a book author. She now enjoys a lively freelance career, writing for numerous print and on-line publications. Read more from Patricia on her blog.

Staying Mobile in the Hospital Helps to Get Better and Get Out

October 22, 2019

It’s counterintuitive to some, but activity is proven to make all the difference
By Edie Grossfield

Part of the Age-Friendly Health Care Special Report

(Editor’s note: This story is part of a series for The John A. Hartford Foundation.)

In her work as the chief nursing officer for Anne Arundel Medical Center in Annapolis, Md., Barbara Jacobs recently found herself dodging a lot of patients walking in the corridor as she made her way down the hall.

“There were so many people up and moving, and that was a good problem to have,” she recalls. Jacobs is pleased that the hospital’s initiative of the past two years to keep patients — especially older ones — mobile during their time there is working.

Because staying mobile helps maintain muscle function and overall healing, it also reduces the risk of falls.

Like many hospitals around the country, Anne Arundel is recognizing the important role mobility plays in healing, reducing the risk of medical complications and ensuring that older patients will be able to return home after they’re discharged, rather than having to go a nursing home or rehabilitation facility.

Immobility Leads to Problems

“One of the things that is absolute is when a person becomes immobile, the loss of muscle tone is very, very quick — the actual loss of muscle mass is quick,” Jacobs says. “So, when a person comes into the hospital and becomes immobile, it’s significant — even if you’re young, you will go out feeling weak.”

And weakening muscles is just one of the negatives of being in a hospital bed for days.

“When we lay in a bed, our lungs are laying back against the back of our body,” Jacobs explains. “For maximum performance of our lungs, you’re supposed to be standing or sitting, where gravity is helping open our lungs. So, we’re more prone to developing pneumonia (and other respiratory illnesses) because our lungs are not in the position that they should be if we leave you in bed all day long.”

Immobility during a hospital stay is connected to a number of other problems, including frailty, falls and even death, “even after controlling for illness severity and comorbidity,” according to a 2018 article in the journal Gerontology and Geriatric Medicine.

Hospitalized older adults who remain mostly in bed are 34 times more likely to die and six times more likely to end up in nursing homes after their hospital stays than those who move around at least twice per day, according to research that included nearly 500 people age 70 and older.

Mobility Priority at Anne Arundel

In 2017, Anne Arundel Medical Center began its new mobility practices in the hospital’s geriatrics unit, which is an Acute Care for the Elderly (ACE) unit. Anne Arundel’s ACE unit is part of the hospital’s “age-friendly” initiative, with the goal of aligning care to what matters most to each patient.

Patients of all ages, inside and outside the ACE unit, who are able to get out of bed and move are encouraged to do so — ideally at least three times per day.

“It depends on the patient, obviously,” Jacobs says. “There are times when the person is too sick to get up. But for most people, they should be getting up and mobilizing as far as they can every day.”

That means doing some walking, even if it’s only a short distance.

“If the farthest you can get is walking from your bed to the door, great,” Jacobs says. “If you only go from the bed to the door two times today, but the next day you go fifty feet, that’s great.”

To help get patients moving, Anne Arundel has people called “mobility quality technicians,” whose main job is to ensure that patients who are able to move do so daily.

Movement and Socialization With ACErcise

The ACE unit also launched “ACErcise,” a group exercise program that Jacobs says is popular with patients. The groups do chair exercises and walk to and from their hospital rooms. Other hospitals around the country with ACE units have similar programs.

“Part of what makes it great is the socialization of being together,” Jacobs says. “Then, we had some (patients) who said, ‘Can we just eat together?’ So, after ACErcise, we put up a table and they can eat together.”

This emphasis on mobility has been important to patient Cline Warren’s recovery, says his wife Martha Warren. The couple live in southern Anne Arundel County. Cline Warren, 91, who has dementia, was brought into the hospital after he accidentally ingested a caustic substance.

“He’s much better,” Martha Warren says, adding that along with the exercise, the socialization aspects have been especially helpful. “It certainly contributes to being less bored — you know, being in your room alone. And (it helps to) be able to focus on other patients or the activity director.”

Patients ‘MOVE’

At St. Mary Mercy Livonia, a hospital in the Detroit suburb of Livonia, hospitalized patients have been staying active through “Mobility Optimizes Virtually Everything,” or MOVE, since 2017.

“As I was researching this topic prior to implementation of MOVE, I found out that every day a person spends in the hospital bed can take up to four days to regain their strength,” said program manager Belinda Dokic, adding that the hospital implemented MOVE because “mobility can also be a medicine.”

As part of MOVE, each patient receives “personalized mobility goals,” which nurses and aides review daily with patients.

MOVE began in St. Mary Mercy’s observation unit. This included adding full-time ambulation aides who were trained by the hospital’s physical therapists on how to safely move patients to avoid falls and injuries. Toward the end of 2018, the hospital added MOVE to its medical/surgical unit.

The goal of MOVE is to walk patients twice per day. Patients who are unable to walk are encouraged and helped to at least move from their bed to a chair for some period of time during the day.

“Any movement is good.” Dokic says. “Even if the patient is laying in bed and we (adjust) the bed for them to sit up and eat (a meal) that way, or we move them from bed to chair or even help them walk from a chair to the shower — all of this is considered movement.”

Mobility Helps With Fall Prevention, Too

Because staying mobile helps maintain muscle function and overall healing, it also reduces the risk of falls. This is something Dokic has seen at St. Mary Mercy, where the patient falls rate in the two units with the MOVE program decreased from 2.7% to zero from the last quarter of 2017 to the first quarter of 2018.

For some, more movement brings concern of more risk of falls, but a study led by Johns Hopkins Hospital researchers in 2016 found that increasing patient mobility did not increase the number of patient falls with injuries.

St. Mary Mercy carefully trains its ambulation aides, Dokic says. “I think it was four hours of training, where they were shown how exactly to move the patients without putting them at risk to have a fall,” she says.

Patient and Family Buy-In

Nurses and other staff working on mobility programs occasionally encounter concerned family members who believe their parent or other loved one shouldn’t be moving around while in the hospital.

“The family member might say, ‘Well mom’s been sick. Just let her rest in bed,’” Jacobs says. “But we’re actually not helping mom if we just let her rest in bed the whole time. So we have to actually say to the families, ‘No, this is an important part of your mother’s healing, that we get up and ambulate with your mom.’”

Staff also encounter patients who would rather not get up, understandably, because they don’t feel well. In that case, Jacobs says, it’s important to remind patients and families that remaining immobile could lead to a longer hospital stay, or worse.

“There’s a question we ask everybody every day (in the ACE unit), and that’s ‘What is it that really matters to you?’ This is part of our age-friendly work,” Jacobs says. “And the majority of patients answer that they want to get home. Well, the best thing we can do to get you home is to keep you moving. So, if that’s your plan, let us help get you there.”

By Edie Grossfield

Edie is Next Avenue’s health and caregiving editor. In this role, she reports on the information people need to make sound decisions about caregiving, their health and the health of their loved ones. She has been a journalist for more than 20 years, reporting and editing for newspapers and magazines. Edie has a master’s degree in journalism from the University of Wisconsin-Madison. Reach her by email at

UPRITE Fall Prevention Education Program in our Care Communities

September 23, 2019

September 23 is Fall Prevention Awareness Day!

Learn more about our fall prevention efforts in our care communities.

Every community that serves the older population is looking for ways to reduce falls. There is no one concrete way to prevent falls. "Knowing this, we take special precaution to keep our residents as safe as possible while they are in our care, and one way we do that is through the UPRITE Fall Prevention Education Program,” says Ginny Burke, director of clinical education and quality.

The main focus on the UPRITE Fall Prevention Education is that everyone in the community, from nursing to housekeeping to maintenance, can help prevent falls. In fact, UPRITE stands for YoU help Prevent Resident Incidents with Team Effort!

“All team members who work in the neighborhoods in our skilled nursing and personal care communities know the residents just as well as a nurse does, so we have trained different disciplines to be looking, watching, and pointing out any potential fall risks,” says Ginny.

“UPRITE really focuses on the importance of being aware of what’s going on around you. If a team member is passing through a neighborhood and notices someone is trying to get up alone, they assist them or get a team member that can. If they notice a call light is on, they will pop their head in – a resident may need something that is just out of reach such as the television remote or a tissue. It’s the little things like this that can prevent bigger things from happening,” Ginny says.

In our care communities, we have a larger number of residents who are wheelchair bound, or who use walkers to get around. Because the mobility of some of our residents is limited, they often experience weakened legs and muscles due to inactivity. Ginny says, “In order to assist those residents who have limited mobility, we encourage our team members to frequently ask if there is anything the resident needs, even if they have just helped them or are just checking in. We have found that rounding consistently has improved resident satisfaction and safety.”

Interested in learning more about fall prevention? Check out this article for stats and other facts about fall prevention.

How to Successfully Adopt a New Healthy Habit

September 20, 2019

Experts offer tips to increase your chances of sticking to it
By Patricia Corrigan

Tell my massage therapist you’re struggling to stick with a healthy habit of any kind and her reply sounds like something your dental hygienist would say: “Only floss the teeth you want to keep.”

That’s a spin, of course, on “use it or lose it.” If you want a strong body, a calm mind and an elastic brain — not to mention clean teeth — you’ll want to tend to them all in turn. Plus, remember to eat your vegetables, work on your balance and go to bed at the same time every night, too.

Bernice Brandmeyer, 86, of Creve Coeur, Mo., admits that sticking with healthy habits isn’t easy. “Right now I’m out of the habit of going to my water exercise class,” she says. “I’m gradually forcing myself back into it by having my pool bag ready at the door. When it’s time to leave for class, I don’t think about it, or I’ll stay home. I just go.”

Deciding to Change and Following Through

Forming new habits or reinstating ones we’ve let slide is tricky, according to Wendy Wood, a social psychologist and provost professor of psychology and business at the University of Southern California. “We underestimate how complicated the change process is,” she says. “We’re impressed when we just make an initial decision to establish a new habit, but then we have to follow through — and that’s hard.”

“Once you make a decision to form a new habit, figure out a way to make it fun, because the initial motivation is hard to maintain.”

Wood has a few tips for establishing healthy habits that stick:

Assess your environment. “Our actions are closely tied to our environment, so explore opportunities to make desired changes easier,” Wood says. “Having a TV or laptop in the bedroom makes it harder to turn off the screen and stick to your plan of going to bed earlier.” If your goal is to incorporate more exercise into your day, place some of the equipment in plain sight, such as dumbbells or a yoga mat, so they become part of your environment and remind you to do it.

Some years ago, a Weight Watchers leader told me that you don’t need will power to establish healthy eating habits — you need a strategy. My friend, Susan French, 69, of San Francisco, applied that wisdom to her exercise routine.

“I decided I was done going to the gym,” she says. “I’ve been going a long time, and I’m tired of putting on my sports bra and my yoga pants and going out the door. It’s a long walk there and back.”

Now she exercises at home, working out for an hour six days a week with an aerobics class on the computer. “I really, really like this,” French says, “and I’ve been doing it for over two months.” How confident is she that she will keep it up? She laughs and replies, “Yesterday, I canceled my gym membership.”

Make change fun. “People are likely to repeat behaviors they find rewarding, so once you make a decision to form a new habit, figure out a way to make it fun, because the initial motivation is hard to maintain,” Wood says.

Gail Pennington, 70, of University City, Mo., finds learning new languages fun. “I’m on my two hundred and ninety-ninth day of learning Italian,” she says. “I have no plans to go to Italy, but this entertains me, and it’s good exercise for my brain.”

Pennington is going to Quebec later this year, so she’s also refreshing her French. “A shopkeeper in Paris once complimented my French, and speaking to a native speaker and being understood makes me happy,” she says.

That good feeling comes from a release of dopamine in the brain, Wood says. “If the brain responds to an activity with dopamine, that makes a stable memory trace and cements what you did to get that reward. That’s your brain enabling you to repeat what was rewarded in the past and makes it easier next time.”

Be patient. Experts say it takes two to nine months to establish a new behavior as a habit. “Many behaviors we try to make habitual have multiple steps to them — complicated steps that involve decision-making and some habitual response,” Wood says. “If you make a new behavior easy and fun, then it will be something you keep doing. As that practice accumulates, it becomes a habit.”

One mind trick that works for me is to put my qigong (a mind-body-spirit practice) sessions and aqua yoga classes on my calendar; I schedule them just as I would for lunch with a friend or an appointment. I consider these classes commitments, and when my phone “dings” to remind me it’s time to get ready, I do.

‘Prove to Your Brain That You’ve Got This’

Marcia Reynolds, a behavioral scientist based in Phoenix, recommends talking about changes you want to make. “Say it aloud, ask for help from family and friends; that makes you more accountable,” she says.

A leadership coach and author of the book Outsmart Your Brain, Reynolds also believes in posting quotes or pictures in places where you will regularly see them to remind you of your goal as you work to establish a new habit. She also cautions against beating yourself up when you don’t always live up to your new expectations.

“We often focus on where we lapsed, what we didn’t do,” she says. “As we move toward change, the brain needs evidence that we will be successful, so, remember to look at what you did well, even when it’s just one thing. Prove to your brain that you’ve got this.”

Whether you want to start meditating, stop smoking or practice random acts of kindness, Reynolds recommends making these or other changes for personal reasons. “If you’re doing it for a family member or for your doctor, that’s not good enough,” she says. “For the best end result, a strong emotional launch requires a deep personal desire.”

By Patricia Corrigan

Patricia Corrigan is a professional journalist, with decades of experience as a reporter and columnist at a metropolitan daily newspaper, and a book author. She now enjoys a lively freelance career, writing for numerous print and on-line publications. Read more from Patricia on her blog.

Ready, Set, Go – Starting an Exercise Routine Now May Extend Your Lifespan

September 12, 2019

Whether you’ve done it for years or are just getting started, a new study suggests that maintaining the recommended physical activity level may extend your lifespan.

We all know that getting a good workout in regularly is beneficial to your overall health. However, a recent study from The BMJ has concluded that it’s not too late for those who haven’t yet prescribed to the recommended two to five hours of moderate-intensity exercise.

The population-based study took a look at over 14,000 middle-aged and older people’s baseline physical activity. Then, over the course of approximately 12.5 years, it compared those who maintained, increased or decreased their physical activity level with causes of mortality, such as cardiovascular disease and cancer. 

The findings?

“Middle aged and older adults, including those with cardiovascular disease and cancer, stand to gain substantial longevity benefits by becoming more physically active, irrespective of past physical activity levels and established risk factors—including overall diet quality, body mass index, blood pressure, triglycerides, and cholesterol. Maintaining or increasing physical activity levels from a baseline equivalent to meeting the minimum public health recommendations has the greatest population health impact,” stated research program leader Soren Brage, Ph.D., the University of Cambridge.

At Longwood at Oakmont, our successful living retirement community, we help our residents thrive by offering a variety of wellness options to choose from. We are here to help keep your physical, intellectual, social and spiritual pillars active and growing. We offer many options for different levels of fitness and are always exploring new choices for our residents. To learn more about what Longwood at Oakmont offers, head here.

You can find the rest of The BMJ study and more details on the results here. 

Learning New Things: No Audience Required

September 10, 2019

For writer Elaine Soloway, improving on later-life skills is best done solo
By Elaine Soloway

As the instructor was assembling foam dumbbells for her upcoming water aerobics class, I was grateful her busyness kept her from looking my way.

Because I was wearing goggles instead of my eyeglasses, her image had a soft blur, as if she were a figure in an impressionist painting. But there was no mistaking the steel grey hair, her body as slim and muscled as someone decades younger, and her air of drill sergeant.

“Please don’t watch me,” I sent silently through the moist air of the indoor pool. For I knew if she did, my long-ago YMCA Beginning Swim teacher wouldn’t be able to resist striding over to tell me what I was doing wrong.

As I lowered myself into the pool, I was relieved the instructor had settled into a lounge chair far from my lane. “Surely, she can’t see me here,” I told myself as I took a calming breath and ducked under the water.

My reluctance to be viewed, to perform for others, moves out of water to my bench at the piano keyboard.

Without her eyes on me, I slid slowly through my lane, reminding myself to face the pool’s bottom as if it were a mirror, and pretend I was laying my head on my left arm as my face lifted out to the right. Then, I sent myself a REMEMBER to close your mouth after an intake of air, and once under water, blow out through mouth AND nose.

The Lecture I Hoped to Avoid

This was my inelegant stroke, taught to me by a coach I discovered two years ago who helped me learn to swim at age 78, after my many attempts with other coaches, including the taskmaster lounging nearby. After several lengths, I emerged and quickly wrapped myself in towels, grateful my iWatch had credited me for the 30-minute routine.

As I removed my cap, goggles and fins, I heard: “You’ve got to move your left arm more, Elaine.” It came from a sharp voice on a lounge chair. How had she seen me from that distance?

“Um, I have arthritis in that shoulder,” I said, as apologetic as a student who had once again forgotten homework.

By now, she had risen from her chair and delivered the lecture I had hoped to avoid: How that pained arm would only get worse if I didn’t activate it, how uneven my stroke would be without a powerful left arm, how awkward….

“Oh, okay, sure,” I mumbled as I gathered my gear and waved goodbye.

Expertise Was Never My Zenith

Back home, after playing the film of our morning’s encounter in my head, I realized I loathe anyone watching me when I perform any of my lifetime goals, which are: to swim and breathe on one side, play Rodgers and Hart on the piano and speak Spanish in the first tense.

As long as I can remember, I envied those who could perform that trio of tasks and wondered why they didn’t crow about their achievements — that’s how glorious I thought these talents are.

Of course, those individuals had skills that were much more proficient than the basement level targets I set. But I never aspired to reach their levels. Expertise was never my zenith. Mediocrity would satisfy me, just as much as a slim slice of my favorite pecan pie.

My reluctance to be viewed, to perform for others, moves out of water to the bench at my piano keyboard. I AM playing Rodgers and Hart, but likely quite differently than they envisioned when the lyrics and notes danced through their talented heads. Often, although the sheet music calls for F Major 7, I may decide to have only the A and C link hands. And sometimes, just to see if I can hear a difference, I’ll allow the F to stand alone.

Not as Shy as You Might Think

As for Spanish language, I’ve come up with the ideal way to practice and improve — sans teacher or classmates swiveling their heads to signal errors. Every evening, seated with a glass of wine, a spiral notebook and a pen, and my Apple device open to Google Translate, I record my daily activities in Spanish. Because I tend to do the same things most days, I learn how to write and read vocabulary that applies to me.  Desperté a las 4 am después de un buen sueño.  (“I woke up at 4 a.m. after a good sleep.”) You get the idea.

Based on my seeming embarrassment to be viewed as I splash, tap and roll my R’s, you might tag me as shy. But you’d be wrong. Read my close-to-the- bone writing, or listen to me at an event where I’m a saucy, but comfortable, speaker.

The difference between those scenarios and my undercover endeavors is that my late-in-life trio was hard-won and too precious to risk abandonment if critiqued. I won’t take that chance.

By Elaine Soloway

Elaine Soloway is a PR consultant, writing coach and tech tutor, and the author of Bad Grandma and Other Chapters in a Life Lived Out Loud and Green Nails and Other Acts of Rebellion: Life After Loss. The Emmy Award-winning television series 'Transparent' was created by Elaine Soloway's daughter Jill and inspired by their family. Follow Elaine on Facebook, Twitter @elainesoloway and Instagram.

Do you exercise your toes?

July 10, 2019

Tai Chi offers a multitude of health benefits – and toe exercise.

Calm the mind. Reduce your blood pressure. Better your balance. Thanks to the Tai Chi class available at Longwood at Oakmont, residents are able to experience multiple health benefits that stem from the practice.

Tai Chi, originally developed for self-defense, has evolved into a graceful form of exercise that's used for stress reduction and a variety of other health conditions. Residents are encouraged to partake in Tai Chi not only due to the health benefits involved, but because of its emphasis on stretching and balance, which can help to prevent falls.

Doreen Boyce, longtime resident of Longwood at Oakmont, began taking the Tai Chi classes as soon as they were available in October 2017, and fell in love with the art. “I had read about Tai Chi and it sounded so intriguing. Dick Van Dyke even promoted it on television, crediting Tai Chi as the reason he can still tap dance in his 90s, and I thought, ‘Oh I want to be like that!’”

The class, offered three times a week at the Wellness Center, is taught by Phil Jannetta, who was trained in Tai Chi in Japan. According to Doreen, Phil devotes a segment of the class to what he calls “loosening” exercises, where participants gently stretch and exercise every joint in the body, including fingers and toes.

Doreen enjoys these exercises, saying, “You stretch your whole spine and you feel better for it. We older people may sit too much, so we need these loosening exercises to keep in shape!” After the loosening exercises, the class dives into the traditional portion of the Tai Chi session.

“It engages your mind and your body, and for Tai Chi, one’s mind and body must be in tune. That’s how one can reduce the risk of falling and stimulate the brain,” Doreen shared. She continues, “While doing the loosening exercises, you find that your feet and hands tingle because the blood gets into the joints, which is very important at my age. One of the reasons I think Tai Chi is good for not falling is because it exercises your toes, which, when strengthened, can really aid in preventing falls. Most people don’t think about that, because who exercises their toes?”

Doreen has never experienced a fall. “Can I attribute this to Tai Chi? I have no idea, but the fact that the exercises claims to prevent falls further reinforces my desire to continue.”

Last June, Doreen underwent surgery for a knee replacement, putting her Tai Chi on hold as she recovers. She still occasionally participates in the loosening exercises, but she can’t wait to get back to full-time Tai Chi. “Although I am a Tai Chi enthusiast, I must curb my enthusiasm and discipline myself so I don’t interrupt the healing process.”

FUN FACT: According to Masterpiece Living, poor balance and gait have shown to be significant contributors to falls. Their research suggests that participating in balance activities such as Tai Chi improve gait and physical balance. In fact, Tai Chi exercise helped to reduce multiple falls by 47.5%!


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