Dr. Jeffrey Guild outlines several practical steps that individuals can take to prevent themselves or their loved ones from ending up in a nursing home.
These include making a conscious decision to avoid nursing homes, building a support team, entrusting healthcare management to a professional, and prioritizing physical health.
He also highlights the significance of taking proactive measures to maintain health and safety as one age and seeking professional assistance to make necessary adjustments to the home environment.
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(00:00:53) – Hi, this is Dr. Jeffrey Gild. This is how to Avoid Going to a nursing home. Okay, I’m play yet and need to figure this mic out a little bit better. Okay, and that’s probably good. Hi, I’m Dr. Jeffrey Guild and today we’re gonna talk about how to avoid going to a nursing home. Hi, I’m Dr. Jeffrey Guild and today we’re gonna talk about how to avoid going to a nursing home. So the first thing you can do to prevent yourself from going to a nursing home is
(00:01:43) – Sure .
(00:01:47) – So the first thing you can do to avoid going to a nursing home is to decide not to go to a nursing home. And I know this sounds
(00:02:02) – The first thing to, the first step to avoid going to a nursing home is to decide not to go to a nursing home. The first thing you can do to avoid going to a nursing home is to decide not to go to a nursing home. And I know this sounds like common sense, but this has huge implications on how you will behave with yourself, your family, your daily life. And then that decision will make a huge impact going forward. Cuz a lot of people don’t decide, they think that well this might may or may not be inevitable or a lot of my friends are going to nursing homes or you know, I’m likely to just end up at this facility or we’ll figure it out as we go. Or you know, I just don’t want to think about it. So deciding not to go to a nursing home is the first step and that’s gonna make, so deciding that. So deciding not to go to a nursing home is the first step and then that’s gonna lead. So deciding not not to go to a nursing home is the first step and that’s gonna have massive implications all the way down the line. And those are the things we’re gonna talk about today.
(00:03:11) – And understand that going to a nursing home or a facility of some type is not inevitable, especially in today’s healthcare world. There are many, many options that you can utilize in order to make sure that yourself or someone that you care about is able to stay active and independent in their home and they don’t have to go to a facility that’s not inevitable. There’s so many more resources now. There’s so many more things that you can do now, both without bringing in any additional help. And then also there’s endless amounts of additional help that you can do tailored specifically for you that will prevent you from ending up in that situation.
(00:03:57) – Also very important, your wishes to your family is are very power. Also very important. Your wishes to your family are very, very powerful. When you proclaim something and you say that I do not want to go to an to a facility, then your family will likely adhere to that. They will do whatever they can to prevent that from happening. Very likely. That’s our experience with our clients and their families. Whatever the parent wants or the grandparent or whoever the person is, whatever their wishes are, those tend to get followed very closely if at all possible. And usually family members and loved ones will go above and beyond to make sure that those wishes are carried out the way that the aging person wants to happen. So making this decision will not only change your actions as someone who’s trying to prevent yourself from getting into a a nursing home or a facility of some type, it’ll also change the actions of the people around you, including the healthcare provider team that is around you as well.
(00:05:12) – And speaking of uh, health and speaking of healthcare provider team, very important. And speaking of healthcare provider team, the next thing you can do to avoid going to a nursing home is set up a team of people around you. And this can be structured very traditionally or you can get very creative with it. So for instance, we have a client who basically has people who just come in and help out in their home and they schedule them just basically around the clock. And that way they always just have young physically active people around that knows ’em really well that they’ve built a relationship with and it’s not necessarily caregivers they hel, they’re helping with the cooking and the cleaning and all this. So they’re more, they take care of the home but they’re also there to help out our client and his wife. So they’re also there to help out our client and his wife as well. And they’ve built in this kind of 24 7 coverage where they’re taking care of and they don’t necessarily have to hire out, you know, traditional caregivers in the way that the healthcare system might traditionally think of them also.
(00:06:22) – So you can get very creative like that or so you can get very creative so you can get very creative like that and understand that there are a lot of things that are well set up already. So for instance, your medical team, who is that? Do you, of course you have your primary care doctor, but what are also the other specialists that you need to see if you have Parkinson’s, do you have a neurologist? If you have multiple sclerosis, do you have a neuro take that out. Of course you have your primary care doctor who it should be involved in what you’re doing but also what are the other specialists or who are the other specialists that you see as well for any conditions that you may have,
(00:07:06) – You also may want some, you also may want rehab professionals around you. So physical therapy, occupational therapy, speech therapy, depending what your needs are or at least well connected to a good rehab team. And if you’re getting to the point where you’re thinking about going into or worrying about going into a nursing home, you likely may have had physical therapy or occupational therapy already by this point. So where are the good places that you’ve gone to that you enjoyed and got great care and service versus the places that you did not find as beneficial? And start and start looking and researching in advance. Try to find a rehab team that you’ll be able to go to on a moment’s notice if something happens, if you have a fall, if you go out to the hospital and need to get discharged, if you do end up in a facility temporarily and then you need a rehab team when you get home, who might that team be?
(00:08:04) – And we’ll talk about this more when we talk about the actual just taking care of your physical body. But having that rehab team around you can be very, very important and especially you’ll need them on a moment’s notice because you don’t know when you’re going to need them. It can happen, we see with people all the time where we see with people all the time where they’ll have a fall or something will happen or some we’ll see all the time where people will fall or something will happen and then they do need that rehab professional around them as quickly as possible. But then they’re searching, right? So if you have that set up already, that can be extremely beneficial. That can be extremely beneficial
(00:08:56) – Now. Now they also have what’s called private. Uh, now there’s also care managers and there’s probably a number of names for this and it may depend on your local city or or who, what they call themselves. But it’s basically very fan. But this is a group of professionals that they’re usually licensed registered nurses or social workers or speech therapists or something. And they usually are managing the, and they’re usually managing the healthcare needs of a client and their family. They might be taking them to doctor’s appointments and then be able to take notes and translate everything to make sure that nothing gets missed. Though they may be able to bring in caregivers or rehab professionals, they’re kind of the conductors of the healthcare system for individuals. And these are very, very powerful resources if you’re in a situation, if you have an aging parent or loved one and you need additional help taking care of them or especially if that person is removed physically from everybody else.
(00:09:59) – So you might have somebody in one city but then you’ll have the next person who takes care of them in a completely other city. And so because of the lack of proximity, it can be more difficult to take care of an aging person if they’re beginning to fall and go to the hospital and these things start happening, their memory isn’t what it used to be and they’re going to their doctor and you’re having conversations with them and it’s like, so what did the doctor say? And of course if there are memory problems then that can be a limiting factor. But if you have that healthcare professional who is kind of that conductor of an individual, then you can make sure you don’t miss out on that valuable information from the doctors and the specialists to make sure that whatever’s needed can be spotted in advance. And then you can prevent going to the hospital or going to a nursing home by being very proactive by having that healthcare professional, whether they are a social worker or registered nurse or whoever it is, uh, looking over medications and all these different things. These are very, very powerful resources and can be a huge tool if your goal is to stay in your home and go and avoiding going to a nursing home.
(00:11:16) – You also wanna make sure that your medical and financial powers of attorney’s situation is completely set up. You don’t wanna wait until you end up in the hospital.
(00:11:26) – You don’t wanna wait until you end up in the hospital or you don’t wanna wait till something catastrophic happens. You want to get an attorney that you trust that you can have everything set up and make sure that whoever you want your medical, financial power of attorney to be that you make that decision and you let that be known and make sure that what you make known matches what is on paper. It’s amazing the situations that we’ll run into as we’re working with an older population. The number of people who don’t have these things set up or they think they’ve had ’em set up but they may not or there’s just a lot of confusion around it, it’s something that people tend to avoid. It’s kind of like convincing a 35 year old to do estate planning and a lot of these things are like that.
(00:12:07) – And so it’s very, very difficult at times to get people to take action when there may not be a dire need yet. And of course, as everybody knows, of course a 35 year old should get a will and do estate planning, especially if they have children in property or whatever it might be. But how many of them do? And especially how many of them get to the actual estate planning level and beyond the will level. So this is the type of thinking that you want to have as you’re planning going, as you’re planning, avoiding going to a nursing home, you want to plan ahead and take action well in advance. You don’t wanna wait to decide who your medical, financial power of attorneys are and you definitely want to communicate that across the board so everybody knows who those people are.
(00:12:54) – Now as far as your doctor these days, I would highly recommend if you’re getting older and especially if you’re over the age of 80 or 70 or whenever you think is appropriate, definitely over the age of 80, do you have a doctor that you can fully trust and rely on and to be able to communicate with them easily and will the office get the information to them the way that you you need? And if you’re not getting that from your doctor, and this is becoming more and more of a problem in our healthcare system, just there’s so much more red tape these days, doctors are completely overwhelmed with too much volume of patients coming in. And so there has to be different models in healthcare and the good news is there are different. And the good news is these models do exist. So there’s concierge doctors and there’s also direct pay doctors and what you might find is find one in your local area and call them up and see what the difference is.
(00:13:48) – How do they handle working with their clients? That might be different from a traditional doctor that you might be used to. Now if you’re already working with the concierge doctor, here’s the other thing or direct pay doctor use, utilize them the best you can. You’re usually you’re able to reach out to them, usually you’re able to reach out to them quite easily. So make sure that you’re doing that. Don’t hold back. Make sure that if there is something wrong, you’re taking action and you’re fully utilizing the services of a direct pay or concierge doctor. Very, very important and this is how you get ahead on things. Now think of it, one ER visit can completely change everything. Just the cost of the ER visit itself can be the cost of a concierge doctor or direct pay doctor. So look into it and see if it’s the right fit for you. It might be something that you want to take advantage of because being proactive on the medical side is one of the best things you can do to prevent yourself from going to the hospital and going to a nursing home.
(00:15:00) – Other team members that you might think of of course are caregivers and I usually recommend that people really invest in and I usually recommend that people take a lot of time to screen out and look into a caregiver or a caregiving service because the caregiver can really make or break a situation. This is the individual that’s going to be on the ground with your aging loved one usually all day, every day or at least a large chunk of time and taking care of them and their needs. So you wanna make sure that you find the right person or persons and don’t be afraid to you know, try one out and then move on to another one if it’s not the right fit. Or make sure that you’re interviewing people properly. Don’t just accept well this is just how it is. If you’re not happy with the service because that person is going to be a big factor in how well your aging loved one is either advancing and progressing and improving versus are they declining. And yes, the caregiver has a large part to do with this and it can be difficult take out that sentence so take the time it’s worth. So it’s worth the amount of time and energy that you spend in interviewing people, working through people, finding the right caregiver for what your needs are, but also who connects with the aging loved one your
(00:16:26) – Find the right caregiver for your needs, but also who’s the person that’s gonna connect the most with the person who’s being taken care of, whether it’s your parent or neighbor or or grandmother who is gonna connect with the person that you care about the most. And so finding that person that’s gonna connect with them can also just make a big difference. It might be just a personality change that needs to happen and that’s okay. It’s okay to make that type of a switch because the person who’s able to engage with your aging loved one is the person that’s going to make a big difference cuz they’re the boots on the ground usually day in, day out. So you don’t want to, so you want to take the, so you want to take the time to look for a good quality caregiver.
(00:17:20) – Next recommendation to avoid going to, an next thing to do to avoid going to a nursing home is go to your doctor on a regular basis and keep up with the medications. In fact, make sure that you get in the habit of every time you go to the doctor, write down questions before you get into the doctor’s office and just make that a systematic habit. And I know that and yes I know how much that sounds like common sense, but it’s amazing the number of times including myself, that we don’t do those things. That we don’t systematically make that habit. So when you go into the doctor, especially if you’re, so when you go into the doctor, especially if you want to avoid going to a nursing home, have those questions written down in advance ahead of time. That way you know what to ask in the moment.
(00:18:09) – Cuz usually we do forget no matter who we are, once we get in front of the doctor, we get going on with other things and they’re moving fast and they’re checking this and checking that, it can be very easy to forget, oh I should have asked ’em this, I should have asked an that or I had that symptom, or whatever it might be. So write down the questions in advance as they come up and then you’ll have everything you need when you go into the doctor because making sure that the medications are correct to make sure that you don’t have too many medications or side effects or making sure that you don’t have too many medications or side effects with certain medications or little symptoms that are creeping up that you don’t know if they’re a problem or or if they’re not. All these things need to be brought out because you don’t know when that one little symptom is going to be a big deal or if that medication interaction that’s causing a little bit of a symptom is going to become a big deal or not.
(00:19:03) – And a lot of people end up in the hospital and end up in a nursing home simply for these simple reasons because the medications and the medical management is not addressed the way it should be. And speaking of medical management, just making sure that your blood numbers are where they need to be, your vitals are where they need to be. Your blood pressure, heart rate, making sure that your medications are keeping your vitals where they need to be and to make sure that your blood pressure is not getting too low, but also that it’s not getting too high. These things need to be checked regularly to avoid going to a nursing home and you’re forgetting to that level of medical complexity so to speak. Then checking these vitals on a regular basis, then checking these vitals on a regular basis can make a big impact on preventing yourself from going to a nursing home.
(00:19:49) – It’s these little things that make the difference that we do on a consistent basis. In fact, it’s also a good idea to just basically check your blood pressure on a regular basis daily or even multiple times throughout the day to make sure that the type of coverage that you’re getting with your medication if you are on medication is what it needs to be. Because if you’re gained to that point where you’re thinking about or worrying about going to a nursing home, then it’s important to check these things on a regular basis. Not only blood pressure but also so get, so investing in a blood pressure cuff can be very beneficial. Uh, especially one of the automated ones that are simple to use. I recommend the ones that go up on the arms, not the ones that go on the forearm and getting a pulse oximeter, the device that goes on your, on your finger to measure oxygen and heart rate, that can also be very beneficial as well to just make sure your heart rate and your oxygen is where it needs to be as well.
(00:20:44) – It’s very simple to buy these things nowadays, especially on Amazon. You don’t have to have connections to, you know, medical supply company to get this type of stuff anymore. Uh, you don’t even have to walk to the drug store. You just basically have Amazon deliver it for you or wherever you, you wanna buy all this stuff online. These things can easily be delivered to your doorsteps. All you have to do is just take action and get it done, get it in there and just start monitoring and start monitoring your vitals on a regular basis. So monitoring your vitals and going to the doctor on a regular basis. Ask those questions about your medications, about your medical situation. Make sure that all your bases are covered. It’s a great way to prevent yourself from going to the hospital and uh, it’s a great way to prevent yourself from going to the hospital and avoid going to a nursing home. The next way to avoid going to a nursing home is to just, the next way to avoid going to a nursing home is my bread and butter, which is take care of your physical self. The next way to avoid go, I didn’t like that one. The next way to avoid going to a nursing home is to take care of your physical self.
(00:22:04) – Because if you’re physically, because if you’re physically well off, if you’re physically healthy, then that’s gonna take care of a lot of other problems that you don’t have to compensate for. Because if your physical body is in good shape, then all these other things become less relevant. It’s not to mean that these other things aren’t important, but if the physical body is good, then all these other things just become less and less and less relevant for an individual person and the people that they care about. So of course strength and power, and this is things we’ve talked about quite a bit, the ability to stand up from a chair, especially without using your hands if at all possible, the ability to respond quickly if you’ve fallen. Because what tends to happen is our muscles and especially the muscles that allow us to create power to respond quickly, decline with age. And this is a neurological thing that,
(00:23:01) – And this is a whole nother conversation, but the main takeaway is the quicker our body’s able to respond when we lose our balance and to be able to stand up from a chair and be able to stand up from a floor and all these important things are extremely vital in how independent we remain. And if we’re able to have a lot of leg power, basically how much can we move a lot of force quickly or how much, how quickly can we utilize our strength that is very determinant of our level of independence? How, what, what we call functionality, how well we’re just able to manage everyday life. If we have that power in our legs, then we can do a a lot of things that we wouldn’t be able to do otherwise. Not just go stand, not just stand up from a chair and climb stairs, get up from the ground, but also when we fall and lose our balance, how quickly can our muscles respond?
(00:23:49) – Basically how it’s more of our nervous system really. How quickly can our nervous system respond to our muscles and create an automatic response to prevent ourselves from following? Now, creating automatic response is a whole nother thing and that’s something that we as physical therapists work at quite a bit by having that leg power maintained or progress helps with that quick automatic response. And it does tend to decline and it does tend to decline with age. And we can train it though, we can make it better. So there’s a number of ways that you can do that. Now of course, strength is also very important along with power and strength is a component of power. So this is just basically the ability to lift a certain amount of weight. So it might be the ability to stand up from a chair one time or stand up from a chair a number of times.
(00:24:34) – How much assistance do you need to do that? Can you do it by pressing your hands into the chair and you can stand up three to five times or are you able to stand up from a chair without using your hands at all? And so that is a good determinant of like strength overall, how quickly you can stand up from the chair is a determinant more of power to put it very simply. And so these are things that you can work on on your own. You don’t necessarily need a professional to start doing these things. You can start implementing now. So if you want something to get started, basically walk every day on a regular basis and also work on standing up and down from a chair on a regular basis. Do this every single day. And that’s a quick simple way to begin to address this problem.
(00:25:18) – And speaking of walking, basically walking every day, whether it’s around your house with a walker, we actually had a client do that and she would even had a pedometer on and you know, measure the footsteps and you know the smartwatch and all that stuff. And she would measure how many steps she’s taken throughout the day and she would just walk circles around her house with a walker or sometimes without a walker depending on what level of balance she was at. And she did very, very, very well because she was very proactive in that way. And then several years on where she’s still living at home independently cuz she has that level of tenacity and she’s over the age of 90 years old and she has that tenacity to get after it and to be able to do those simple things. The simple things can make a big difference.
(00:26:01) – And it doesn’t have to be a ton of energy, it doesn’t have to be complicated, it doesn’t have to be a massive deal. These simple things, walking and standing up from a chair on a regular basis can go a long way to improve your physical abilities because if you can walk longer than your heart system, your cardiovascular system and your lungs, your pulmon and your lungs, your pulmonary system are gonna be a lot better off. Now if these things are a lot better than a lot of these other medical complexities tend to get better as well. So your medications that you need might be reduced. And so if you reduce the number of medications that you need, you reduce the risk of,
(00:26:52) – If you reduce the risk of medications that you need, then you reduce the number of medical interactions that might go the wrong way. And as well, if you go into a procedure where they need to put you under anesthesia, if you are less medically complex, you’re less likely for the anesthesia to have an effect on your brain. So the older we tend to be and the more medically complex we tend to be, then that increases the likelihood of the anesthesia. If you go in for a surgery, hip replacement, whatever it might be, you increase the risk of the anesthesia taking effect on your brain and reducing your cognitive abilities and increasing the risk of dementia. So walking on a regular basis can really go a long way to begin to prevent those problems. So you want your heart and your lungs to be as strong as possible.
(00:27:39) – You want your heart and your lungs to be as strong as possible. And of course your musco skeletal system will improve along with that as well if you’re up and walking on a regular basis. And the key is to walk continuously. Don’t just say, okay, I’m walking from here to there and I’m doing that a bunch throughout the day. Now that’s very good. That’s the first step is to stand up and and be walking around for a short burst. But if you really want an improvement of your cardiovascular system, walking continuously for as long as you can or a good amount is a great way to improve your heart health and your lung health. And not only does, and not only does walking prevent dementia if you go under surgery, but even if you don’t go under surgery at all.
(00:28:46) – Now remember dementia can also be caused by our cardiovascular system. So if we’re walking in, we’re making our cardiovascular system better and stronger, then that actually helps reduce the risk of dementia from the standpoint that it reduces the causes of the circulatory system causing dementia. Because what flows to our brain of course, and what brings blood to and from our brain is our circulatory system. So if we address our circulatory health, our heart health, our blood vessel health, then we can help reduce the risk of dementia and other types of cognitive problems by simply improving blood flow to our brain. And a good way to do that of course is make sure that our medications are under control and walking or doing some type of cardiovascular exercise on a regular basis. If you’re not able to walk, then going and getting on a bike and just getting your heart rate up for a good long amount of time is going to be very beneficial.
(00:29:41) – Now if you’re able to do 30 minutes, do at least 30 minutes if you can. And of course if you can do 45 or 60 minutes, that’s even better. And so if you’re not able to start there, then start with five or 10 minutes, do with what you can do and then build up. And it’s amazing what can happen as you build up over the time. It’s amazing what can happen when you build up over time. And to me that’s one of the fun things of exercise. It’s seeing that progression, it’s you have complete control for the most part over your human body by moving it, sculpting it, lifting, stretching, doing whatever you want to do. You have a large amount of control over how good your body is and that’s part of the fun of it. And seeing that progression and saying like, wow, I was doing this before, now I’m doing this or I was lifting this much before, now I’m lifting this much. Or I was this size then and I’m this size now. Whatever our goals are, whether we’re trying to get bigger or smaller or whether we’re trying to improve how far we can walk or how many times we can stand up and down from a chair or how much weight we can lift, whatever we wanna do with our bodies, we have a large amount of control over that because we can shape and sculpt our bodies how we want to.
(00:31:02) – Now, another way to take care of our physical bodies is of course balance. And this is a big one. The first thing you can do to improve your balance is to be up and walking on a regular basis. If you’ll use a walker now, go ahead and keep walking with a walker so that you’re safe. And just because you’re using a walker doesn’t mean that that doesn’t work on your balance. If you’re up and walking on a regular basis with a walker, that’s gonna improve your balance only to a certain point of course. But it’s better than not because the other option is if you’re not up and walking on a regular basis, even if you’re using a walker, you can have better balance or worse balance walking with a walker or it might be the type of walker that you’re using. You might be able to walk with a walker with four wheels versus a walker with two wheels and one might be better for you than another.
(00:31:49) – Now if you’re not using a walker and you want to get after this and prevent yourself from using a walker, this is a great time to start basically now. So you wanna start now to prevent balance problems. And remember, as we often talk about, our balance system declines very quickly and even by a time we’re in our thirties and forties, our main balance system, our vest stable system has declined. And the proof of this is take your children to, and the proof of this is take your children and your grandparent to the amusement park and see how well you do on the rides versus them and how dizzy you get or how much you want to go on all those spinning rides and all that stuff versus them. It’s not just because of age, it’s not just because you’re gotten older, it’s because you haven’t done those things since childhood in that way.
(00:32:37) – Now if you took someone who did do those things, things on a regular basis, let’s say a fighter pilot or something like that, or someone who does spend themself or around on a regular basis, then they would be able to do those things as adults when they’re 45 years old, it’s if you don’t use it, you lose it. If we stimulate it, then it’s going to improve and get better. If we don’t stimulate it, then it’s going to slowly or quickly decline. So if our balance is declining by the time we’re in our thirties and forties, what happens by the time we get into our seventies, eighties and nineties with our balance? So the first thing you can do of course is walk on a regular basis with or without a walker. Of course, regular exercise and going to group exercises or doing some type of balance training in a fitness setting is a great way to start.
(00:33:21) – If you’re worried about actual falling and that’s a valid concern, go to your doctor, go to a physical therapist if you want the main specialist, go to a vestibular specialist. That can be an occupational therapist or a physical therapist or a chiropractor. There’s a number of different rehab professionals that are are, there’s a number of different rehab professionals that are vestibular specialists and those are the main specialists in our main central balance system. Basically business and vertigo disorders. But they’re also very, very, very specialized in balanced training because they’re specialists of the main central balance system of the human body. So you can go to a vestibular specialist or just going to a physical therapist say in general is a good place to start. Of course, generalized balance training as I tend to call it, is a good place to start and it may not get you everything that you need, but it’s a good place to start.
(00:34:11) – It’s, it’s certainly better than not doing anything or, and it’s better than just walking. So going and getting the help that you need is very, very important. And you want to act now. You don’t wanna wait, you don’t wanna wait until you see signs of a balance problem because by then it might be too late. The earlier that you start, the more you exercise and stimulate your balance system and avoid the decline of your balance as soon as possible, the less costly it’s gonna be, the less time it’s gonna take to work on it. And of course the less likely you are to end up in the hospital and end up in a nursing home. Cuz once you start that downhill decline, it can be more difficult to climb up out of that. So you want to act proactively before something catastrophic happens. And it’s amazing how quickly something catastrophic can happen. So you want to act now, you don’t wanna wait, you want to act now to prevent yourself from having a balanced problem that’s gonna lead to a fall and and have you end up in a nursing home and the hospital.
(00:35:20) – Now something else to think about as far as physical bodies. And there’s a term that you is thrown around in the general public and now we actually have something that is quantified by a number of very good, uh, systematic reviews and meta-analysis. We actually have a definition for frailty. So what is frailty? Basically it, it’s been defined now in the research as can you stand up five times from a chair without using your hands, how much energy would you say that you have, low or high energy most of the time. And also have you lost 5% or more weight in the past year? And if you’re over the age of 70 and you answer towards the negative towards two of these questions, then that is then that is the definition of frailty. And this is well supported in the research by now. If you wanna see the research for this download our tips report about balance and falls.
(00:36:12) – And you can see the specific evidence for this with those meta-analysis and systematic reviews. Basically the gold standard in research that say that, yes, based on all these great randomized control trials and great studies, this is basically the accumulative data that says, uh, this is the accumulative data that’s, this is what the cumulative research says about this particular topic. And so a lot of research has been done on frailty and the great part is it’s been defined very simply now. So again, basically, can you stand up five times from the chair without using your hands? Have you lost 5% or more weight in the past year? And how’s your energy level? And if you answer negatively to two of those things, then that’s a definition of frailty. Now if you answer yes to all three or towards a negative, now if you answer to the negative of all three, then you’re even more likely to be more frail.
(00:37:12) – And what that means is you’re less likely to be able to handle just your physical environment as well as your peers. And it is a significantly increased risk of following simply by being frail according to that definition. So how do you address that? Of course, strength and power, which we’ve already talked about going to your doctor on a regular basis, make sure that your weight is where it needs to be because oftentimes now as people get older, the concern is not, we want you to weigh less as what might be for the rest of the population. We want to avoid obesity problems and things like that with the rest of the population. Usually as people are older, it weighing too little is more of the concern. We don’t want people to weigh too little and we want people to have a good healthy amount of weight on them, but that’s up to you and your doctor.
(00:37:59) – And checking with your doctor on where your weight is is very, very important because frailty is a big problem that can increase risk of falls and just general decline as well. And of course a big change in weight, especially weight loss can also be a red flag for things like cancer and other scary things that you want to spot in advance. So have your doctor monitor your weight on a regular basis that, so have your doctor monitor your, so have your doctor monitor your weight on a regular basis and check for frailty and make sure that other red flags don’t come up that you need to know about. And you’re certainly your doctor needs to know about to help spot things in advance.
(00:39:00) – So to take care of your aging self, just get started by walking on a regular basis and stand up and down from the chair on a regular basis. You go beyond that. If you work on fitness related routines, if you participate in group exercise classes or you just get after it in the weight room or whatever you like to do, if you like to go to yoga, Pilates, whatever you like to do, find the things that you like to do that you can go to on a regular basis and participate in and engage in. And that’s gonna help you remain consistent with your exercise routine. If you were to ask me to go to group exercise on a regular basis, I probably wouldn’t be consistent with it. I love just going to the gym and working out by myself and lifting weights. That’s the thing I tend to enjoy the most.
(00:39:42) – So I’m more likely to do that on a regular basis. I’m less likely to go to yoga or you know, body pump classes or whatever it might be. Uh, in group exercise classes. Some people completely thrive off of group exercise classes. So getting in a routine of going to those group exercise classes and engaging with other people and engaging in a community, all these things can be very powerful tips, especially for people who are getting older, being around people on a regular basis who are looking out for them and are engaged with them. And people to do social things on a regular basis. Go out to lunch or to go visit or if something happens, go visit them in the hospital if something happens. And that can be also another helpful tip is be around a community of people who are focused on their health and also who are looking out for one another. Because you often find that if you get into a population of people who are older and they’re going to something on a regular basis church or um, group exercise or a gym of some type, what whatever it might be, they tend to look out for one another. And you know, if someone doesn’t show up, you know they’re calling them on the phone saying, Hey, just make sure you’re okay or stealing ’em a text. Like, hey, just make sure you’re okay that you know, uh, is everything, you know,
(00:41:00) – People who are in, you’ll tend to find that old, you’ll tend to find that a lot of times older people if they’re, you’ll often tend to find that a lot of people in communities are looking out for one other. And this is particularly true with the older population. If someone doesn’t show up, you know, they’re calling your text and saying, Hey, you know, uh, wanna make sure you’re okay, make sure that there isn’t anything wrong, you know, um, are you gonna make it tomorrow? You know, things like that. So if you have a community of people looking out for you, that can also be something very powerful to prevent yourself from going to the hospital and then go into a nursing home. Okay, quick break. Okay, back to it. Okay. Excuse me. Okay, no, sorry about that guys. Okay, there we go. All right and back to it. The next thing you can do to avoid going to a nursing home is check the home environment. And the first step here is to start just basically walk around the house and look for obvious things that stand out to you that, yeah, that’s a fall hazard, that’s a fall hazard. Or usually there’s, there’s a,
(00:43:51) – That’s a fall hazard, that’s a fall hazard or you know, that, you know, that’s a kind of a problem or that part’s usually, you know, kind of slippery right there. They’re usually water on the floor, you know, over there. So looking around the house and finding out the most obvious things that you don’t even need a professional to that you don’t even need a rehab professional to help you find. Start with those things and then just go from there and start fixing those things. Something very simple is basically just clean up the house, make sure it’s removed of clutter so that someone doesn’t trip over things. And if you start there, start with the most obvious things, then you can easily then just go to the next thing, the next thing and the next thing. And this doesn’t have to be overwhelming, you don’t have to say, oh my gosh, we have to bring in all these people and completely modify the whole house and you know, um, now it’s gonna look like an institution because we’re gonna put all these grab bars in and all this stuff. You don’t have to start with that. Start with the most obvious things first.
(00:44:55) – Now once you start with the obvious things, then go to the bathroom cuz that’s one of the most common places that people will fall. So think of how does the person getting in and out of the shower or the bathtub, is it still appropriate for them to go into the shower and outta the bathtub? Do you need a shower chair? Are they able to easily stand by themselves? Do they have a mat that is preventing them from falling because it provides a, do they have a mat on the shower that is, provides friction instead of a slippery surface? Just starting with those basic things, is the person able to stand up from the toilet easily enough or has their strength gone downhill? And so you might need to get an elevated toilet seat or you need to work on their leg strength so that they can continue to stand up from the chair.
(00:45:43) – So looking in the bathroom is a good place to start. Does there need to be grab bars and all those sorts of things. And you can start with bringing in an occupational therapist and those are the individuals that can help you kind of line up, okay, where do the grab bars need to be? If you’re at that point, you get into the bathroom and you realize, yep, we’re gonna need some grab bars in here in the shower, uh, by the toilet and all that, bring in an occupational therapist and have them basically measure, okay, based on the individual person that we’re talking about, you’re gonna want the grab bar, you know, at this level and you’re gonna need this type of grab bar. And you know, vertical versus horizontal versus diagonal and all those little details. That is what an occupational therapist does. A physical therapist can help you with kind of more general ideas as far as changing the home environment, but you’ll want an occupational therapist when it comes to all these old details. You don’t want to hire just, you know, a construction guy to come out and, you know, just kind of put up grab bars willy-nilly because you’re, because this is because you’re not gonna get the outcome that you want. These things are all more individualized based on the individual person and what their needs are and to make sure that you have the right thing, the right thing, that’s, and to make sure that you have the right thing. And also I’ve seen the,
(00:47:02) – To make sure that you also have the right thing. And I’ve seen people put in the wrong type of grab bar, say like the ones with suction cups or whatever that then come off when they use them and they fall because they installed the wrong type of grab bar. Or maybe the grab bar’s not secured as well as it should. And so then it, and so that becomes a problem. Okay, hold on, I might just need to start this over. Okay, I’ll start with the bathroom as I’ve kind of gone down a rabbit hole, I don’t need to go down.
(00:47:46) – So the first place to start, once you do just kind of a general common sense view of the home is the bathroom because that’s the most commonplace for older people to fall. So starting with of course the shower, starting something simple as installing a surface that is not slippery and it’s amazing how many times people don’t go to that step. So again, very simple common sense things that you can run to target or Walmart or you know, order Amazon, whatever and just and solve that problem right out of the gate. Does the person need to be sitting and should they no longer be standing when they’re in the shower or should they still be taken a bath or is it very precarious as they’re getting out of the bathtub? And that should no longer be the main way that they clean themselves of, okay, I’m gonna try this again. And clearly a physical therapist, not an occupational therapist.
(00:48:48) – So the first place to start is the bathroom because this is the most common place for people to fall. So look at of course the toilet, how high it is. Is a person able to stand up from the toilet well enough? And if not, do they need to work on their strength and their power of their legs? Do they need to work with a physical therapist on their ability to stand up more easily from the toilet? Do they need an elevated toilet seat so that they can stand up more easily? Or do you want to install a toilet that’s higher up so that the person can stand up more easily in general without an elevated toilet seat? There’s all sorts of options now and of course there’s grab bars and all sorts of things that can be installed in the home environment. And you wanna make sure that you have an occupational therapist as the person who’s coming out and basically saying, okay, this height here with this grab bar and this one diagonal, this one horizontal.
(00:49:39) – And you know, this is what you need based on the individual person. An occupational therapist is the licensed professional that you want for all those specific details because you don’t wanna just guess at this. You want the right healthcare provider providing you the specifics as far as what you need when it comes to a grab bar. Because the worst case scenario of course, is that the grab bar comes off or it was not installed correctly or it’s not the right thing and actually causes a fall, or they may not be effective if it’s just not the right thing in general. So you want to have a good professional, usually an occupational therapist that can come out and make all those details, uh, recommendations for you.
(00:50:24) – Now look at the floors in the home as well. And again, remove clutter from the home environment. You can put double side tape around the surface of, you can put double side tape around the surface. Uh, you can put double side tape around the perimeter of the, you can put double side tape around the perimeter of your rugs and that can avoid the conflict that a lot families experience where the children wanna pull up all the rugs and get rid of all the rugs in the house. And then of course the parent says, no, I love my rugs. You know, keep those there and it’s this big conflict, you can use double-sided tape and to prevent that problem from happening that way the rugs are able to stay on the surface and they’re not flopping up all the time. And of course rugs can still be a problem because they’re a transition piece, but at least they can be a compromise. Uh, and of course for, and of course to remove the problem altogether is removing the rugs, uh, altogether. And then you don’t have those transition problems. But double, double-sided tape can be a happy compromise when and double-sided tape can be a happy compromise.
(00:51:40) – Now a lot of people think that carpet is better than hardwood floors because oh, it’s a padded surface, so if I fall, then I’m less likely to get hurt. The act opposite is the truth because carpet provides a lot of problems for walkers, for canes and also for our balance in general. And don’t go in with the mentality of I want to pad myself if I fall. And again, this sounds like common sense, but a lot of people say this all the time, or the idea of walking in the grass is actually better than walking on the concrete because it’s more padded. So if I fall, then I’ll take the route with the grass because I’ll be more padded. The opposite is the truth. So part of the problem with both grass and carpet is that it actually kind of mutes our balance. Basically the sensation from our legs up to our brain that tells our brain about where our legs are in space is muted when we’re walking on, when we’re walking on these soft surfaces.
(00:52:40) – So whether it’s grass or carpet, when we walk on those things, then the information going up to our brain is less potent than it would be if we walked on concrete or hardwood floors. So you want to go in with a mentality of preventing falls in the first place and not worry about patting yourself when you do fall. If you’re gonna be using a walker or a cane or a wheelchair, carpet can be a major problem because it can really slow a person down, it can get in the way, it can cause people to stumble more easily then hardwood floors or tile or whatever it might be. And also chairs we see a lot of times, especially because we work in the home environment with our clients, chairs are a big problem on carpet because they’re difficult to move out and push back into the, because they’re difficult to move out and then push back in. If the person is on carpet, especially if the person’s older and they don’t have the upper body strength, they may not have the balance. And so it’s much more difficult to push the chair out and in if they’re on a carpeted surface versus a hard flat surface.
(00:53:56) – Now outside the home, think about your steps into an so outside your home, think about the steps going into and out of the house, uh, slopes and all those sorts of things. So outside the house, think about, so outside the house, think about the steps going into and out of the house. Now the big takeaway I want you to think from here is, do you need a railing?
(00:54:33) – Now the big question I want you to ask yourself here is, does this environment need a railing based on the person’s physical abilities where they are now or were they’re likely to be in the relatively near future or even moderate term future? Do they need a railing based on the home environment? So how many steps are going into the house and is that person going to be able to physically go up and down those steps quite easily based on their physical abilities? And here’s the dirty little secret that lot people won’t tell you. Your friends will love you for putting in a railing because a lot of times you’re, because a lot of times the person’s peers, so let’s say your aging parent or a neighbor, whoever it is, their friends are also having the similar types of problems that they are. So if your aging parent is having a balanced problem, likely a lot of the times their friends are too.
(00:55:22) – So they will be more grateful if you install a railing going into and outta the house, maybe even two railings. And the people who are visiting them on a regular basis, which is likely people who are their peers, will be very grateful for that, even if they don’t tell you. So don’t worry about, oh, what’s it gonna look like? Or, uh, you know, what my friends think? Or whatever it might be. Of course these are the stories that we tell ourselves on a regular basis, but it’s a railing that can be a, but it’s a railing that can be a big difference between someone falling on steps and not falling on steps. And the fall on steps can be a big catastrophe. These are the big falls that tend to happen that land people in the hospital and into a nursing home. So you want to address the question of does a railing need to be installed and then address that appropriately. And of course there’s so, and of course there’s so many things in a home environment that could be covered and that’s a whole nother, you know, podcast episode for another day.
(00:56:42) – And of course there’s so many thing, um, I need to reword that. And of course there’s so many things that can be talked about when it comes to home modification and, and fall prevention in the home environment. That’s a whole nother episode for another day. But these are some simple things you can start with for now. And also just thinking about it and getting started on the process. Again, the first tip, the first tip is to start and look for the obvious things and then go from there. And that’s a great way to get started in preventing falls in the home environment. And again, it doesn’t even need to be for an older person. It can be for just a regular family, parents in their thirties and forties with young kids, or not even young kids because if someone slips and falls in the shower, that’s also a big deal and can lead to major injuries even if the person is not older. So starting with just fall prevention in general is a good idea no matter what type of family or person that you’re talking about. So start with the obvious things and then go from there
(00:57:46) – And don’t worry about thing and don’t worry about making your home look and don’t worry about your home looking to institutionalized because there’s lots of workarounds for this. There’s a lot of different, there’s lots of workarounds for this. There’s a lot of different things that you can purchase, the types of grab bars that you can use or how things are installed. There’s so many options nowadays that you can do to make these home modifications without your home looking to institutional. So to start the process and know that there are solutions and there are ways to know that there are solutions and there are ways to prevent the problems that you or your family members might be worried about, again, making the home look too institutional or what will my friends think or whatever. There are solutions for these sorts of things, and we work with this on a regular basis with our clients.
(00:58:46) – And if you have an older home, recognize that you’re more likely to have more problems than someone who has a more modern home. The doorways tend to be more narrow and there’s generally less thought about ADA compliance and, uh, the ho the safety and, and, uh, the ability for people to get around in a home environment, especially as they’re getting older. So if you have an older home, you might have to do more work or you might have to think about more things. What if the, what if a walker’s brought into the scenario or a wheelchair is brought into this house? What’s gonna happen? So if you have an older home, you might have to be more proactive and do a lot more. There might need to be construction or whatever it might be. So you will have to be more on the ball if the home is older because they’re just not built with the same mentality that more modern homes are.
(00:59:42) – Now, again, the main thing with home modification is don’t get overwhelmed. Just get started. Start with the most obvious things first, and then go step by step from there. Now also do plan ahead and it’s a good idea to plan ahead. What is reality going to look like for the person living in the home and the safety, and where are they realistically likely to be in the short to medium term future or even long-term future? Because just like anything else in life, the more you plan ahead and implement and protect, the more you plan ahead and take action on the things that you know, need to be fixed in advance when you know that it’s likely to happen, the more that you’re likely to prevent problems in the future.
(01:00:38) – Okay,
(01:00:55) – Now the next thing, the next way to avoid going to a nursing home is focus on the psychology and the thinking abilities of the cognition of the person for yourself or someone that you care about. Think about the environment around the person. So making sure that they are getting stimulated on a regular basis. Are they getting regular visitors? Are they engaging in activities, social or otherwise? That helps stimulate their brain and brighten their day, liven them up. And often I talk about limbic system stimulation. Basically the emotional part of the brain, stimulating them on a regular basis. It’s probably overly simplistic, but it’s a good way to think about it. If we are emotionally engaged with what we want to do day to day, if we’re doing things that are meaningful to us, then it’s going to liven us up. It’s going to give us a huge amount of energy because our nervous system gives us a ton of energy.
(01:01:49) – It’s not just, you know, food and calories and, and all this stuff. Our nervous system is very, very powerful at give Our nervous system is very, very powerful at giving us a lot of energy. And so if we’re emotionally stimulating our brain on a regular basis, preferably daily, then that’s gonna give us energy to engage with life. And that’s gonna help us, and that’s gonna help prevent us from going to the hospital, going to a nursing home, the social interaction around us, and all those different things. A sense of purpose in the person’s life is massive. And having that sense of purpose, whether it’s helping out other people or volunteering or seeing their grandchildren on a regular basis or whatever it is that just lights them up, brightens them up, ha empower them to be able to do those things on a regular basis. And if they’re not able to do those things, what needs to be done to get them to be able to do those things on a regular basis?
(01:02:48) – And of course, cognitive stimulation. So how much are we engaging our brain on a regular basis? I usually tell people avoid over. I usually tell people over, I usually tell people, don’t overly rely on crossword puzzles and all this sort of stuff. Think about more challenging things such as starting a, learning a new instrument that you haven’t learned before, learning a new language that you haven’t before. Um, some of our older clients are still running businesses. There’s so many things that people can do that will really stimulate the brain and it’s these much more complex, harder things that people do that are mentally challenging. That’s what really a lot, that’s what stimulates our brain. That prevents cognitive problems more so than anything else. And of course, regular exercise and movement also helps prevent dementia and cognitive problems as well. So exercise and movement on a regular basis. Movement is neurological stimulation to the brain and that helps improve cognition or at least slows its decline. And like many other things that we’ve talked about, cardiovascular training, improving blood flow to the brain helps to reduce the risk of dementia and other cognitive problems. And just stimulation throughout the day is very, very impactful. Preferably not the tv, but getting outside social engagement and interaction with life is gonna help people prevent cognitive decline and reduce the risk of dementia.
(01:04:33) – Okay,
(01:04:33) – I think a little thing now to wrap
(01:04:35) – It up.
(01:04:41) – So hope this was, so, hope this was helpful to pro. So hope
(01:04:52) – So. Hope this was helpful information if your fooc, so if your goal is to prevent yourself or someone that you care about from ending up in a nursing home, hope this was helpful information. Hopefully some things to think about in advance as well as things that you can implement now today and tomorrow to build, to prevent yourself or someone that you care about from going to the hospital, going to a nursing home. If you like this information and information, just if you like this information, subscribe to our channel and we’ll look forward. If you like this information, subscribe to our channel and we’ll get more information. If you like this information, subscribe to our channel and we’ll get more out to you so that you can, if you like this information, subscribe to our, if you like this information, subscribe to our channel and we’ll look. If you like this information, subscribe to our channel and you’ll get more helpful information if you want to prevent yourself. If you like this information and if you like this information and information like it, subscribe to our channel and you’ll get more. And we’ll almost done. Knock it out.
(01:06:17) – If you like this information go, if you like this information, subscribe to our channel and we’ll get more out to you. All right, done.