Friday, April 24, 2009

Physical screening to improve balance

The first step to take before beginning any kind of balance training program is to have a complete physical evaluation by your family physician. Be sure it is safe for you to begin an exercise program. Talk to your doctor about what kind of exercise is right for you, and then do it regularly. Exercise makes you stronger and improves your balance!

Ask your family physician for a referral to a Physical Therapist who will be able to do a thorough evaluation of your strength, range of motion, and balance in order to set up an individualized program to correct any deficits and help improve your balance.

Join a fitness club and continue with this program once you have completed your instruction with the Physical Therapist. Sometimes the Physical Therapist can accompany you to the fitness club and train you on the specific machines that are best suited for you, and techniques that help you avoid injury. Or you can work with a Personal Trainer, a Certified Senior Strength Trainer, or a knowledgeable employee at the fitness center.

Have your hearing checked. Many balance issues can be attributed to inner ear dysfunction.

Have your blood pressure checked regularly.

Have your vision checked and make sure your eyeglasses or contact lens prescription is up to date and appropriate. It goes without saying that your depth perception can influence how you move your body through space. Have you ever tried going downstairs with your reading glasses on and suddenly everything looked blurry or out of focus?

Have your feet checked for decreased sensation or feeling. Be mindful of a diabetic condition called neuropathy. This is not only painful, but can definitely interfere with your balance.

Be aware of any other disease processes that may affect your balance, as well as changes in mental status or activity level.

Have your pharmacist or your doctor review your current medications for side effects and drug interactions that may result in conditions such as drowsiness or dizziness.

Thursday, April 23, 2009

Better balance: an important issue for retirees

As we age, our balance is affected (and not in a good way!) by several factors. Gravity takes its toll on our posture, as does sitting at a computer or in a recliner chair for most of the day. Poor posture causes our spine to be out of alignment which therefore affects our balance. Loss of flexibility and strength also contribute to a decline in the body’s responses to situations in which balance is challenged. Decreased circulation can negatively influence the brain’s ability to recover from loss of balance. Declining sensory input such as hearing, vision, and sensation are additional factors that contribute to falls. Muscles that are deconditioned from inactivity are less efficient in preventing falls.
The good news is, that many of these physical and neurological losses can be compensated for. Other factors that can help us avoid falls have to do with how we manage our physical environment.
As a Certified Senior Strength Trainer and specializing in age-associated issues, I would like to offer some helpful suggestions in my next several blogs. Some are aimed at basic home safety, while others include exercises and balance drills.
As always, before beginning any kind of exercise program, be sure you have cleared this with your family physician. And if you want to try some of the balance activities, be sure you have someone to spot you, or are in an area where you can be safe while performing them.

Wednesday, April 22, 2009

Home safety in retirement Part 4

As a last word on this subject, I want to discuss home safety for seniors that live alone. As an example, let’s take my friend Karen (fellow blogger on RetireUSA). She is a very youthful and active retiree, a member of the Ashland Rowing Club, an avid gardener, enthusiastic hiker, and participant in yoga classes. While we are “best friends” and usually chat on the phone or e-mail every day, these conversations often occur early in the morning, and then perhaps we don’t touch base again for another 24 hours or longer. In the interim, she has gone out hiking with her dog, or has been busily repairing her chicken coop or some plumbing issue in her garden irrigation system, and has accidentally tripped and fallen. Now what? It gets very cold here in Oregon at night, up until the summer months, and spending hours on the ground could present serious health issues in addition to the pain from the broken bone or whatever happened in the fall.

One solution is to subscribe to a system such as Lifeline. This is a small device that is worn like a wristwatch, or around the neck like a medallion. You can designate the people you want to be called in an emergency, in whatever order you choose, by just pushing one button on the device. For example, Karen might want to have me contacted first, but if I’m not home, the system would automatically continue to call the next number on the list like Jan or Marianne. If none of us are available, the system keeps scrolling through Karen’s list until it finally contacts someone. Some people prefer to have the system call 911 immediately.

Another option is to carry your cell phone or portable device in your pocket or a small pack at all times. However, this is not as reliable as Lifeline, since you may forget to keep it with you, whereas Lifeline is worn like a piece of jewelry at all times.

Monday, April 20, 2009

Retirement Home Safety Part 3

A last series of home safety tips involving the exterior of your home.

1) Install railings in all stair cases, inside and out.
2) Make sure existing stair railings are solid and in good repair.
3) Make sure outside lighting is adequate, especially on uneven walkways.
4) Keep sidewalks and pathways free from debris and loose gravel.
5) Wet leaves and other decaying plant matter are slippery – keep walkways clean and swept.
6) Beware of icy conditions on driveways, sidewalks, and steps.
7) Use double-sided tape to keep outdoor rugs from slipping.
8) Paint a contrasting color or a strip of brightly colored tape on the front edge of all steps so you can see them better.
9) Make sure there are handrails on both sides of the stairs, and that they are as long as the stairs themselves.
10) Fix loose or uneven steps. Make sure the steps are of equal height, and that they conform to current building codes.
11) If you need wheelchair access to your home, be sure any ramp is built to conform with building codes as well. Even a very slight incline can be terrifying if you are trying to negotiate that slope in a wheelchair! I believe the standard is: For every inch of rise, you need 12 inches of run. This can result in a very long ramp, which may require switchbacks in order to fit it onto your available property. Again, it is critical that you consult a professional before adding a structure like this. Your local Senior Services agency can probably refer you to the appropriate resources.

Sunday, April 19, 2009

Retirement Home Safety Part 2

In this section, I will address tips for retirement home safety in the kitchen and living room areas. Above all, pay attention to your surroundings! There are many potential hazards in a home environment, and you need to be constantly aware of what they might be and how you can be safe.

1) Remove loose throw rugs in entry ways and halls.
2) Make sure living areas are free of clutter. If necessary, have someone move your furniture so you have clear access routes around your home.
3) Check for electrical or oxygen cords or tubes that may be a potential source of tripping.
4) Wipe up kitchen spills promptly.
5) Be careful if Fido or Kitty get underfoot, especially at feeding time when they like to gather around your feet, or while going up and down stairs.
6) Be careful of long gowns or loose, flowing garments that may entangle your feet.
7) Change lightbulbs in hallways to the brightest wattage practical.
8) Use double-sided tape to keep rugs from slipping.
9) Install railings in all stair cases.
10) Make sure existing stair railings are solid and in good repair.
11) Coil or tape cords and wires next to the wall so you don’t have to walk around them or step over them. If necessary, have an electrician install more outlets.
12) Organize cabinets so you don’t have to stretch and reach overhead. Keep frequently used items at about waist high level in cabinets. If you must reach high shelves, never use a chair to stand on. Instead, use a steady stool with a hand bar.
13) Have a light switch at the top and bottom of the stairs, and make sure to replace burned out or dim bulbs.
14) Place a flashlight and extra batteries within easy reach of your bed.
15) Examine floor coverings on stairs. Make sure they are firmly attached. Carpet on stairs can be replaced with non-slip rubber treads.
16) Paint a contrasting color or a strip of brightly colored tape on the front edge of all steps so you can see them better.
17) Make sure there are handrails on both sides of the stairs, and that they are as long as the stairs themselves.
18) Fix loose or uneven steps. Make sure the steps are of equal height, and that they conform to current building codes.
19) Use non-skid floor wax, or none at all.
20) Choose chairs with arms and good back support.
21) Use an electric lift chair if you have trouble arising from a low couch or easy chair.
22) If you use an assistive device such as a cane or walker, make sure it is within easy reach of your chair or bed.
23) Use a cordless phone or a cell phone. Consider a device such as Lifeline that you can wear at all times, that will activate an emergency alarm system in case you do fall. You have all heard the horror stories of retirees who live alone that have fallen and broken a hip or something, and were forced to lie there for hours or days before someone could be alerted to their dilemma and come to help.

Saturday, April 18, 2009

Keeping your retirement home safe

Some of us retirees have lived in our family home for 30 years. Others have opted for a more carefree lifestyle in one of the many types of resort-style retirement communities or some variation of a continuing care retirement community (See April 5, 2009 post). If you're one of the former group of retirees who just can't let go of the big family home and yard, then you need to think about keeping your retirement environment safe.

As a Home Health Physical Therapist, I have gathered up a lot of ideas for home safety for seniors, and will share some of them with you in the next several blogs. While retirement communities and assisted living apartments have often designed their units with home safety for seniors in mind, many of these principles can also be applied. These may seem like pure common sense, but if you gain even one bit of knowledge that will prevent a fall, I have done my job!

The first area I will address is the bathroom. This is probably one of the most common places that falls occur.

1) Make sure bathroom rugs are securely attached to the floor or have rubberized non-slip backing.

2) Install grab bars in the shower. Make sure they are anchored into studs.

3) Use a tub transfer bench or a shower chair if appropriate.

4) Put non-skid tape or decals on the floor of your tub or shower.

5) Install night lights in hallways, bathrooms, and bedrooms.

6) Keep trash receptacles emptied so debris does not accumulate and spill over onto the floor.

7) Keep shower curtains inside the tub so water doesn’t spill out onto the floor.

8) Wipe up spills promptly.

9) Keep soap within easy reach while you are in the tub or shower, and make sure soap dish is located so soap does not fall out of tub or shower stall onto the floor.

10) Install a fan in the bathroom so steam from the bath or shower does not build up.

11 Organize cabinets so you don’t have to stretch and reach overhead.

12) Use non-skid floor wax, or none at all.

13) Consider using a bedside commode if you have to get up frequently in the night to go to the bathroom.

14) Use a toilet riser or install grab bars if you have difficulty arising from a low toilet seat. Make sure they are securely installed.

Friday, April 17, 2009


An interesting new development which is an alternative to traditional doctor’s visits is the specialty of Telemedicine. This is a way for retirees to receive medical information via telephone, the Internet or other networks. Telemedicine may be as simple as two health professionals discussing a case over the telephone, or as complex as using satellite technology and video-conferencing equipment to conduct a real-time consultation between medical specialists in two different countries. Telemedicine generally involves communications and information technology instead of hands-on medicine. This can be very important to seniors who are homebound.

As a Home Health Physical Therapist, my colleagues (nurses, occupational and speech therapists) often wish there were more of us to provide these important services to homebound seniors. Telemedicine certainly looks promising to fill part of this ever increasing need for seniors to remain at home and as independent as possible.

Basically, Telemedicine allows patients to visit with physicians live over video for immediate care. Whether you live in the center of Los Angeles or deep in the Brazilian Amazon, Telemedicine is an invaluable tool in Healthcare.

Here's an example of how Telemedicine works every day. Say you have a horrible sore throat and visit your healthcare provider who does an examination and is concerned with what he or she sees. Your provider recommends a referral to an ENT (Ear/Nose/Throat) specialist for a follow up diagnosis and treatment plan. Well, instead of traveling to the nearest specialist, which could be anywhere from a 45-minute drive to an 18-hour boat ride up the Amazon River, your provider connects you directly to the ENT specialist via Telemedicine.

The advantage of this arrangement is that the specialist actually hears your medical history and current condition directly from you and your provider instead of receiving a dictated note in the mail, which all takes time. Meanwhile you are still suffering!

The specialist can diagnose and recommend treatment immediately. And an additional benefit is the the opportunity for your doctor to ask questions and learn from each and every consultation. This continual education will be an immeasurable benefit to all his or her patients.

Thursday, April 16, 2009

It's Never too Late to Start a New Business

Many near-retirees find that even with financial success they want to stay "in the game" and continue to build their businesses or start new ones.

CNN took a look at good cities where you can launch a new business, ranking factors like availability of skilled employees as well as lifestyle and business amenities. Surprisingly the winner was Bellevue Washington with a high standard of living, proximity to great scenic, cultural and leisure attractions and well educated workers.

Read more about America's best places to launch a business at CNN

Tuesday, April 14, 2009

Add more "bling" to your walking program

As mentioned in a previous blog, using walking poles can increase the amount of calories burned by using the upper body. Another way to accomplish this is by carrying hand weights, or wearing cuff weights, and exaggerating your arm swing. While this does not give you the advantage of reducing force on your joints, it does work the triceps, biceps, and shoulder muscles. Stronger muscles use more calories, and this calorie-b. urning effect tends to last even while you’re at rest. As a Certified Senior Strength Trainer, I have reviewed a lot of literature that has made me a believer in strength training. What a great idea to add this component to a walking program!

Another way to maximize energy expended and therefore burn more calories while walking is to examine your gait pattern. Try to lengthen your stride, and reach out with your heel, so it is the first part of your foot to hit the ground. Then roll forward onto the front of your foot and concentrate on lifting off with your toes. Make sure you bend your knees, and strive for a fluid leg motion instead of short, choppy strides with straightened legs. We practice this very fluid, slow walking in Tai Chi for balance class as a warm-up exercise, concentrating on using every muscle in the foot.

To really monitor your activity level, you may want to get a heart rate monitor. This way you will not exceed the fat burning zone, and especially if you are just starting an exercise program, you will not be stressing out your heart too much. It will also ensure that you are walking fast enough to get some aerobic workout. A very simplified formula is to take 220 minus your age, and multiply that by .6. If you are reading this blog, I assume you are a retiree, and perhaps 60 years old. This would mean your target heart rate would be about 96 beats per minute. If you are 70 years old, .6 of 150 is a targer heart rate of around 90.

As always, it is important to consult your Primary Care Physician before beginning a walking program.

Saturday, April 11, 2009

Slower is better

This is probably the best news you’ve ever heard: Walking slower is actually a better fat-burning technique than speed-walking or jogging! The research suggests that more vigorous bouts of exercise tend to stimulate the appetite and slow your metabolism. A moderate-paced walk reduces the production of certain appetite-stimulating hormones, and helps you avoid those post-workout binges. A slower pace also triggers your body to burn fat, where exercise with increased intensity burn sugar since it is a faster source of fuel. Even small amounts of exercise signal the body to burn fat from the abdominal region.

As a Baby Boomer who has worn out both knees from running and skiing, this is music to my ears! To think that there is a way to lose weight and belly fat by a moderate walking program is something I can really incorporate into my retirement exercise program.

Other benefits of a walking program include: Sounder sleep, more energy, less anxiety, better moods, improved confidence, increased libido, and sharper thinking. Do any of these conditions resonate with my fellow retirees? It seems aging can be a process that chips away at all the above quality of life issues, so why not fight back with a walking program?

Please consult your Primary Care Physician before embarking on a walking program to make sure it is appropriate for you.

Wednesday, April 8, 2009

Walk away the pounds

Retirees face a never ending battle of the bulge as our metabolisms get more sluggish and our activity levels decrease. Retirement means more time to play tennis or ski or run marathons for some lucky folks who still have healthy joints. For others whose joints have been damaged over the years by overuse or arthritis, those vigorous activities are no longer tolerated. So we have to find other ways to exercise and maintain fitness in retirement.

In an earlier post, I mentioned how my sedentary husband Mark has started a walking program in a last ditch attempt to lose some weight. He proudly announced to me yesterday that he has lost 8 pounds in the past 7 weeks! And this with very little effort in terms of dieting. Basically the only thing that has changed about his daily routine is the inclusion of a moderately paced 30-minute walk.

There is research to back this up, but somehow anecdotal reports are even more convincing! Mark is certainly a believer now.

An interesting bit of research suggests that three 10-minute mini walks are even more effective than a 30-minute walk. This has something to do with waking up your metabolism and encouraging the body to burn fat more efficiently.

Sounds simple, and indeed it is! And here is a great idea: Use walking poles to help support your body weight, decrease the stress on your joints, and improve balance and stability on uneven surfaces. Using poles makes you feel more secure, and therefore makes walking feel easier.

But here’s a very exciting finding from some new research out of the Cooper Institute in Dallas: Using poles actually boosts the number of calories burned by 40%! Your body has to recruit muscles from your core, abdominal muscles, upper body, arms and back when you use the poles. This is such an easy and inexpensive way to add more oomph to your workout! You can just use a pair of old ski poles (there are usually some lurking somewhere in your garage or your neighbor’s), or make a modest investment in a pair of poles that are specific for hiking. These are adjustable in length, which is a useful feature for hiking up a long incline – you can shorten the poles for the ascent, and lengthen them for the descent. They can also be used as a weapon to fend off unfriendly dogs!
It is always important to consult your Primary Care Physician before beginning any new exercise program to make sure it is safe for you.

Tuesday, April 7, 2009


Even with the price of fuel, a very popular retirement option is to fly away south in the winter to escape the cold and gloom of northern climates. Many folks do this in their RV’s which allows them the freedom to sample different areas. It’s as simple as hooking up and heading on down the road when you feel you have explored a region to your heart’s content. In fact, for some, the call of the open road is irresistible, and they just can’t wait to see what’s around the next corner! Others like to return to the same RV park year after year, and look forward to joyous reunions with friends who come back each winter from all over the U.S.

So, what is an RV (recreational vehicle)? If you can answer this question, then you are already out there having fun in the sun! For those who are not familiar with the various options, I will give you a little background information.

RV’s come in all sizes and shapes! That is a gross understatement, but important to realize. Here are a few of the most popular types of RV’s.

A motor home is a self-contained unit, with the engine included. These can be huge “diesel pushers” which can cost hundreds of thousands of dollars. Rock stars travel in these things! They could have fireplaces, washers and dryers, and elegant furnishings. The really big ones are called “Class A” motor homes. Driving them is similar to a Greyhound bus. Smaller motor homes which sit on a regular pickup truck chassis are called “Class C”. They usually run on regular gas, and drive like an oversized pickup. Motor homes usually have generators, so you can “dry camp” (without having to hook up to electricity) for several days at a time, and have all the comforts of home (TV, hair dryer, microwave). The disadvantage is if you want to run down to the corner store for a quart of milk, you need another vehicle unless you want to drive your rig. So often you see these units towing another car.

Then there is a 5th Wheel. This is a unit that is towed by a pickup truck, with part of the RV extending over the bed of the truck. Many retirees like the way these units tow and find them easy to park and maneuver. The bedroom and bathroom are usually in the front of the rig in the part that extends over the back of the pickup, so you have to walk up a couple of steps to get there and sometimes “crawl to your bed” in the smaller units. Again, these can be large and magnificently appointed, or smaller and more affordable. You must have a pickup to tow them, but the advantage is that you can unhook the unit and now you have a regular vehicle to drive around.

Another more traditional type of RV is the travel trailer. Remember the Airstream? They still make them, and they are very luxurious! These can be towed with a regular full-sized SUV (with a large enough engine and towing package), or a pickup. These also come in all sizes, even tiny ones that can be towed with a regular car! The advantage of the trailer over the 5th Wheel (in my opinion) is that they are all on one level, and you don’t have to climb up steps to get to your bathroom and bedroom. They are also more aerodynamic than the big 5th Wheels which can loom over the top of your pickup and be rather scary to drive if there are severe crosswinds. As with a 5th Wheel, you have the advantage of being able to unhook and drive your car for shopping or exploring. Again, these come in all sizes and price ranges.

For camping (vs. actually living in your rig), there is the cab-over camper which sits in the bed of your pickup. These are not readily detached from the pickup, but they have the advantage of being compact and easy to drive. As with all RV’s, there are many price ranges and styles.

One feature of all the above RV’s that makes a huge difference in how you can enjoy your space is the slideout. Some of the big 5th Wheels and motor homes have up to three of these room extensions. But even small trailers and cab-over campers are now being made with at least one slideout. It’s really amazing how a little extra room can make such a difference.

There are many decisions to be made, but hopefully this gives you some vocabulary to begin your search. You can read many articles on-line about RV'ing in retirement, and I would encourage a lot of shopping and talking to RV owners, in addition to RV sales people, before you even consider buying one. As with any vehicle, there is a huge depreciation factor the moment you drive it off the lot if you buy a new RV and then decide to trade. Once you know what you want, you can buy used RV’s for significant savings, especially in this down economy.

Enjoy the freedom of the open road, and saying goodbye to winter!

Sunday, April 5, 2009

Continuing Care Retirement Communities

Like it or not, we’re all getting older. As a “young” Baby Boomer, I’m one of a number that is set to skyrocket. In 2006 there were an estimated 37 million people in the U.S. were were 65 years and older. That number is projected to become 71.5 million by the year 2030.

Finding residences that allow for independence but also provide needed care down the road will be a challenge for my age group. We need to realize that it’s not too soon to begin considering retirement options that allow for lifestyle changes as we age. One very interesting concept that promotes aging in place is the Continuing Care Retirement Community.

I recently read about a fabulous Continuing Care Retirement Community in Pennsylvania called Kendal at Longwood and Kendal at Crosslands. The many opportunities for growth and development in these Pennsylvania retirement communities are guided by Quaker values.

As a Physical Therapist, I can appreciate the 18,000-square-foot Health and Wellness Center which consists of an aquatic area, massage room, and fitness center. Attached to this is the rehabilitation department including an occupational therapy simulated living area as well as a physical therapy gym. The wellness and rehab staff use a team approach to make sure residents can remain within the community.

This Pennsylvania retirement community recognizes how important being active is in terms of stimulating the mind and body. Residents have access to a variety of activities within the community such as producing plays, assisting with the community’s local cable TV station, shelving books in the library, and repairing furniture in the woodshop. Active residents enjoy tennis courts, putting and chipping greens, and endless walking/cycling trails throughout the campuses. There are more than 85 activity groups that encompass everything from crafts studios complete with looms, kilns and easels, as well as classes in horticulture, photography, and interior decorating. There is a ballet bar, yoga room, and a “pets and plants” area. This allows residents to enjoy the social aspects of a community garden, as well as having access to birds, dogs, and cats without having to care for them 24 hours a day in their own cottage or apartment.