Selecting an Aquatic Facility

In honor of National Physical Therapy Month, Global Health Aging is presenting a weekly four-part article series on aquatic therapy. This is Part 3 in this series. Part 1 focused on the aquatic therapy marketplace and Part 2 focused on selecting an aquatic practitioner. Click here to read Part 4.


Selecting an aquatic facility may be one of the most personal considerations for a prospective aquatic patron. Depending upon an individual’s circumstances, the choice of which facility is best for each patron may vary. At one extreme, there are classes in a resort location, on the shore of a beach or off the dock of a lake home. However, the most common facility is the community pool.

Different health considerations and performance or functional objectives may be central to any patron’s focus. Therefore, an aquatic consultant may be helpful in isolating a patron’s specific requirements. This article focuses on natatoriums (indoor swimming pools) that are open year round as well as some of the many important features of an indoor facility including Access and Water Temperature/Depth.

Access

  • Zero Depth Entry
  • Wide Stairs with Handrail(s)
  • Chair Lift
  • Pool Ladder

Getting into and out of a pool can be a problem for a large number of people who will benefit from aquatic therapy and exercise. In the bullet list above, Zero Depth Entry is the most desirable way to enter the water gradually. Consider wave pools designed with a wide cement slope into deeper and deeper waters of the pool.

In a cost-effective simulation to the wave pool design, a sloping ramp that may actually contain a turnaround or two is ideal. It is much like wading into the ocean, but without the risk of shells underfoot, jellyfish stings, or waves that knock one off balance. In essence, a patron may walk or move their wheelchair into the water using a gently sloping ramp.

Wide Stairs: Ideally, handrails on both sides are sufficient for at least 90 percent of patrons accessing the pool waters. These standard rise pool steps are very helpful in performing some types of therapeutic exercises; a definite plus for most patrons.

Chair Lift: This is very important to consider as land-based ambulation requires canes, walkers and especially wheelchairs. One note of caution to wheelchair-bound patrons: transition between wheel chair and chair lift can be challenging. In addition to a lifeguard on duty, a patron needs a caregiver to assist and perhaps even accompany the patron into the pool. Skill set, including licensing and certification requirements for practitioners and instructors, is  undefined in this circumstance. In other words, the patron’s aided entrance into the pool cannot be assumed to come from the aquatic practitioner.

Pool Ladder: Despite being the most difficult to use, pool ladders affixed to the poolside and deck can be quick and accessible for patrons with sufficient upper body strength and balance. Safe entry into the pool from a ladder attached to the pool deck requires backwards entry. Patrons should consider placing one foot on each subsequent rung although it is more important to focus on the distance between the bottom last rung and pool floor, especially if the patron is not “water safe” (able to float, swim or otherwise not panic when not grounded to the pool floor).

Emphasis must be restated on the requisite upper-body strength to hoist oneself up each rung of the ladder if no easier exit is available.

Water Temperature/Depth

  • Temperature
  • Depth

Temperature: In most circumstances, temperature and depth are equally important. Patrons can generally tolerate aquatic aerobic exercise at 78 degrees F and up to about 84 degrees F or perhaps 85 degrees F. Therapeutic water temperatures are best between 88 degrees F and 92+ degrees F. However, some medical conditions like multiple sclerosis need cooler temperatures even though temperature considerations can also affect certain people with diabetes and some neurologic or degenerative conditions. Arthritis patients have their own specific condition guidelines: 84-88 degrees F for exercise and 92-100 degrees F for therapy.
Note: Facilities that come close to the temperatures necessary for a patron’s specific use can still be considered when the patron invests in warm-water apparel such as a wet vest or aquatic wetsuit.

Depth: Manufacturers in the personal and therapy pool industry tend to hover around a 4-foot-8 to 5-foot-2 inches maximum depth for vertical exercise applications. These parameters seem to target patrons at or below 6-foot in height, which means that a waist belt or noodle is employed to support patrons adequately to achieve full range of motion (ROM) of extremities when suspended (not touching the pool floor) in water.

Depth, of course, is a specifically personal consideration, especially when a patron may not be “water safe.” Comfort in the water, where a patron is able to relax and not panic, is the ultimate consideration in patrons who are self-described as “afraid of the water.”

The choice of water depth is sometimes also a personal consideration. In therapy, if the focus is rehabilitating a joint on a lower extremity, the patron will begin in deeper water, somewhere between shoulder and chest or sternum depth, and progress to more weight-bearing, shallower water when the muscles and joints are stronger. However, depending upon an individual’s center of buoyancy or COB (as it relates to lean muscle mass), it may be difficult for some patrons to stay grounded on the pool floor. If the patron is not water safe, staying grounded will be necessary for the participant to remain relaxed. Fear induces muscular tension which can be counter-productive in aquatic therapies and exercise. Involuntary or unintentional rigidity of muscles may increase the chance of injury and it will make the patron more likely to sink. At a minimum, the tension may inhibit the participant’s ability to perform the exercises with proper form and control; thus making the time spent working not as effective as it can be.

Deep water exercise tends to encourage the use of flotation devices like noodles, hand buoys, and waist belts. By far, the waist belt is the most effective equipment to use in water when performing vertical workouts like cross-country skiing, deep water running, leaping, jumping jacks and other moves where all limbs may be working concurrently. A noodle may be straddled between the legs or wrapped around the back either at the waist or under the arms. Hence, deep water can be a very rigorous form of aerobic work, targeting not only muscle strength but also endurance. Deep water exercise can also enhance range of motion when performed slowly or with a hold between changes of direction of the limbs. One of the most important considerations about deep water work is that postural alignment is maintained with shoulders back (and down) over the hips. This alignment is critical in maintaining core strength and minimizing back strain.

The task of selecting a facility has so very many different considerations to review in making a choice. Often, an aquatic patron does not have the luxury of a large selection of facilities available to them. When visiting a facility and observing the staff and instructors, all these ideas will prepare the new patron to be watchful of conditions, which can make it necessary to plan and prepare ahead of their first aquatic therapy or exercise experience. A good question to always ask on a site inspection is whether towels are provided.

Water is, for most people, a therapeutic medium when comfort of the patron is properly addressed. Plan to heal, grow stronger and enjoy!

Felecia Fischell is an Aquatic Specialist with twenty-three years experience in aquatics. She leads aquatic classes and consults as an aquatic personal trainer and a swim instructor at the Franklin County Family YMCA in Virginia. Formerly the Founder of FunLife Aquatics Consulting in Maryland, Felecia presents at health fairs and has given aquatic presentations to high schools, Howard County Board of Education, Howard County General Hospital and Howard County Community College.

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Selecting an Aquatic Practitioner

In honor of National Physical Therapy Month, Global Health Aging is presenting a weekly four-part article series on aquatic therapy. This is Part 2 in this series. Part 1 focused on the aquatic therapy marketplace. Click here to read Part 3.

Photo Credit: Ann Fisher
Photo Credit: Ann Fisher

Over the last thirty years, the field of aquatic therapy has steadily grown in US allied healthcare. Insurance companies that reimburse for aquatic therapy ONLY reimburse for a licensed physical therapist or maybe a physical therapy assistant. Depending on the state, there are some workarounds like a certified instructor being employed by a physical therapy practice or hospital. All too often, though, the employers err on the side of legal caution, fearful of liabilities which may be inherent in land-based physical therapy but seem almost non-existent in aquatic therapy.

Out of respect for those licensed in physical therapy, Aquatic Therapy Rehab Institute (ATRI) certified instructors, who do not have a degree and license in physical therapy, are discouraged from calling themselves “aquatic therapists”. Physical therapists, however, are not required to have aquatic certification to bill for aquatic therapy. So, if you are in need of aquatic therapy, perhaps as pre-operative conditioning or after your insurance allowable coverage for physical therapy has been exhausted, what can you look for in an aquatic professional?

Many reputable organizations either post or offer access to staff biographies. Like they do in the physician offices, those practicing aquatic therapy should specifically display their credentials. A certificate, license or degree from a bona fide organization can be a first tier requirement. Certifications usually require professionals to obtain continuing education hours to maintain credentials. This must be done every two years or less, and professionals should display the one that is relatively current.

Certifications from organizations like ATRI, Aquatic Exercise Association (AEA) and Aquatic Therapy University (ATU) may give an indication that your practitioner has met certain stringent requirements to authenticate their expertise. ATU has more recently been established specifically to target degreed professionals in both physical and occupational therapy. In some instances, even speech pathologists are obtaining certifications as evidence is now emerging on warm water activities. The soothing effects of such activities can advance progress in remediating stroke, traumatic brain injury (TBI) deficits or other speech pathologies, including some oral cancers.

Across all three certifying organizations, a broad and sometimes intensive proficiency needs to be demonstrated. This includes sufficiently answering test questions governing anatomy, physiology, kinetics and some physics as it pertains to water properties, as well as skill demonstration, especially when performing physical manipulations in the water.

Even when a licensed physical therapist is practicing aquatic therapy, it is important to know what additional training and credentials the aquatic professional may have by a certifying organization. All the knowledge of anatomy, physiology and kinesiology may not be as helpful if the practitioner has not spent a significant amount of time in water experiencing how the body works differently on land and in waist or shoulder deep water. It is more important that the aquatic practitioner have a deep understanding of how the properties of the water can be used to best achieve the functional goals or milestones of the participant.

Thus, beyond finding credentials, seeing is believing. Take time to observe your aquatic practitioner and ask permission to observe – perhaps make a video with your cell phone or take notes. Compare one practitioner to another or better yet several others! Look to find many of the following qualities:

  • Clearly defined milestones and functional goals/expectations of outcome;
  • Workload progression that supports goals: meaning variances in
    • time to accomplish an exercise;
    • range of motion;
    • effort or exertion;
    • depth of water used;
    • length of extremity in activating a particular joint;
    • exercises performed where extremities are operating in different depths;
    • exercises performed where extremities are operating in different planes;
    • use of equipment such as drag and buoyancy equipment;
    • cadence/rhythm/speed;
    • breath cueing and control (when to inhale and exhale; diaphragmatic breath);
  • Attentive observation of and note-taking about the patient (some PTs bring their laptops poolside and pay more attention to their computer than their client);
  • Apparent knowledge of how to make modifications of exercises to insure progress without pain or injury;
  • Cheerful disposition and encouragement based upon progress toward goals.

With all or most of these objectives meeting your approval, ask to speak with the professional and ask for referrals. In some cases, aquatic practitioners are award winners in their fields. They may have published research articles or been written up in a local paper or support group newsletter. Be sure to contact references and add their comments to your observation notes. It is best to have a conversation with a prospective aquatic specialist to make sure you communicate easily and understand their instructions. Sometimes, communication disconnects can derail the most qualified professional’s efforts to guide you toward your functional goals.

This kind of upfront investment in your self care may prove the best return for not just your dollar, but more importantly your well-being. After all, your health is your greatest wealth!

Felecia Fischell is an Aquatic Specialist with twenty-three years experience in aquatics. She leads aquatic classes and consults as an aquatic personal trainer and a swim instructor at the Franklin County Family YMCA in Virginia. Formerly the Founder of FunLife Aquatics Consulting in Maryland, Felecia presents at health fairs and has given aquatic presentations to high schools, Howard County Board of Education, Howard County General Hospital and Howard County Community College.

 

Aquatic Therapy Marketplace

In honor of National Physical Therapy Month, Global Health Aging is presenting a weekly four-part article series on water aerobics. This is Part 1 in this series. Click here to read Part 2.

Welcome to the 21st century and a new American Healthcare System. The advent of the Affordable Care Act (ACA) and its gaining foothold of functional acceptance in America presents an interesting opportunity for citizens who are making a paradigm shift: movement from managed health care to managed self care. Who will be making this shift? Citizens are moving into a realm of do-it-yourself healthcare management through many fields of allied health.

Photo Credit: OakleyOriginals
nPhoto Credit: OakleyOriginals

One such allied healthcare service is becoming more commonly prescribed and sought after: Aquatic Therapy. National collegiate teams and professional franchises have led the way as it is most commonly used in sports medicine. Patrons in private and public clubs, especially non-profits like YMCAs, are blazing new trails in aquatic practices, catching up with other countries around the world.

Whether it is prescribed or not, many patrons now choose to seek services outside the coverage of their insurance. In the 21st century, aquatic exercise and therapies are steadily growing with the aging of the baby boomer population. The trend is growing more rapidly in younger populations where an overuse injury from a favorite sport may occur. The younger “weekend warriors” are aware of the conditioning and rehabilitative outcomes from employing aquatic exercise and therapies in support of their favorite sport.

In today’s aquatic marketplace, how can new patrons, of any generation or experience, determine what is desirable in an aquatic program, facility or instructor? The industry is so new that standardization in practice is far from being established and even farther from being commonly known or accepted. Insurance regulations governing those who may be reimbursed for services are sorely misaligned. This means that many aquatic therapy participants can get insurance coverage for “aquatic therapy” but it may not be the best available instruction and care.

Knowing this about the industry now, three questions come to mind: What do you look for in an aquatic facility or program? And thirdly, who or what kind of person with what skill-set or credentials is most important when becoming a patron of aquatic therapy?

Since university degree programs and licensing in physical therapy do not instruct or test students in this aquatic modality, aquatic patrons need be guarded in their pursuit of care. Water exercise can be performed anywhere between high impact and totally suspended, meaning no contact with the pool floor. This variance assures that there is some effective form of aquatic therapy for all ages, most types of injuries, and almost any physical condition a person may need to address. Even speech pathologists are gaining advancements through aquatic environments.

Water therapies can be passive or active. An active therapy is something the patron does in response to the therapist’s instruction and it may ultimately become an exercise. A passive therapy is a physical maneuver or manipulation that the therapist does to the patron’s trunk, limb or extremity. More often than not, passive therapies are practiced only by those aquatic professionals specifically trained in aquatic therapies. They may or may not hold a degree or license in physical therapy.

As the aquatic industry continues to evolve, it can very well become its own discipline in colleges. Presently, there needs to be a lot more work put toward the effort of standardizing practices, quantifying outcomes and modifying insurance coverages. This will allow certified professionals even without degrees in physical therapy to be compensated or reimbursed for their services.

When practitioners universally understand and consistently use the properties of water to their fullest potential, then best outcomes for patrons will emerge.  Aquatic therapies will then become a first line application for preventative and restorative allied healthcare. For instance, physicians will prescribe pre-operative aquatic conditioning to keep the muscles, ligaments and tendons surrounding a surgical site as strong and healthy as possible. Doctors will also place post-op patients in water before commencing land- or weight-bearing exercises so that the supporting muscles, tendons and ligaments can begin moving sooner and speed the healing and recovery process from the surgery performed. The efficacy of aquatic therapy is growing exponentially, thanks to the wisdom of experience; once relegated to senior citizens. The positive experiences of seniors may now be shared by all ages with varying abilities and health constraints.

Felecia Fischell is an Aquatic Specialist with twenty-three years experience in aquatics. She leads aquatic classes and consults as an aquatic personal trainer and a swim instructor at the Franklin County Family YMCA in Virginia. Formerly the Founder of FunLife Aquatics Consulting in Maryland, Felecia presents at health fairs and has given aquatic presentations to high schools, Howard County Board of Education, Howard County General Hospital and Howard County Community College.

How Quality Sleep Can Improve Skin Health During Post-Menopause

Photo Credit: 123rf
Photo Credit: 123rf

As the world gets busier day by day, many Americans fail to get enough quality sleep. In fact, lots of people are ready to sacrifice bedtime to catch up on daily tasks. The problem of insufficient sleep has become a huge concern and the Centers for Disease Control and Prevention (CDC) now considers it an epidemic along with obesity. Approximately 50-70 million U.S. adults have sleep problems, according to the CDC. Gallup supports this data stating that 40 percent of U.S. adults sleep less than seven to nine hours as recommended by the National Sleep Foundation. Only 59 percent of U.S. adults meet that benchmark.

Lack of sleep is viewed as the cause of major disasters that have claimed and destroyed many lives. Less than the ideal sleep duration leads to difficulty concentrating, poor memory and other cognitive problems. These reduce productivity and result in accidents and man-made calamities. Lack of sleep also leads to a host of life-threatening diseases such as diabetes, hypertension, obesity and cancer. According to a paper presented at ENDO 2015, the Endocrine Society Annual Meeting in San Diego, sleeping 30 minutes less than the ideal on weekdays can boost diabetes and obesity.

Effects To Skin

Insufficient sleep is a major factor that speeds up the body’s aging process. As such, it can lead to many skin-related problems like dull skin, premature wrinkles and bags under the eyes. Sleep experts say that deep sleep allows the body to do two essential processes to produce healthy and  glowing skin: cell repair and release of growth hormones. Decreased cell repair function can boost the body’s inflammatory response, causing more acne and increased skin sensitivity. In addition, more inflammatory cells in the body mean further breakdown of collagen and hyaluronic acid, the chemicals that give bounce, glow, and translucency to the skin.

Sleep deprivation disrupts hormone balance in the body. Therefore, sleeping less prompts the body to secrete more cortisol, the stress hormone. Excessive cortisol in the body can destroy skin collagen, the protein responsible for a smooth and elastic skin. Sleep loss also lessens human growth hormones that help thicken skin, increase body mass, and strengthen the bones. Moreover, lack of sleep leads to poor water balance, resulting in dull and dry skin. In addition, poor water balance in the body causes bags under the eyes and premature wrinkles.

Post-menopausal Sleep Problems

Adults, across all age groups, need eight hours of sleep on average. But elderly people are having a more difficult time falling asleep. Compared to their younger days, they have more trouble staying asleep. Approximately 50 percent of seniors have no problem sleeping. Seniors are light sleepers and their sleep efficiency – amount of time spent in bed as opposed to the number or hours spent in sleeping – falls at a rate of three percent per decade after they reach the age of 60. Lower sleep efficiency means shortened time in deep sleep.

For senior women, the effects of post-menopause contribute to sleep deprivation. The National Sleep Foundation states that postmenopausal women are less satisfied with their sleep and as many as 61 percent of them have symptoms of insomnia. Doctors cite hormone problems in women as the reason for lesser sleep satisfaction. Their fluctuating estrogen levels produce hot flashes and night sweats that disturb the sleep cycle. Drop in estrogen levels may also lead to sleep apnea, a condition that interferes with breathing during the night. Moreover, lowered progesterone levels in postmenopausal women are linked to insomnia.

During post-menopause, disruptions in women’s psychological condition results in sleep problems. The changes in their bodies before and during menopause may bring anxiety, depression, and stress that hinders the body to relax.

Tips for Better Sleep

To maintain a daily dose of sound sleep, do the following tips:

  • Engage in more physical activities. A daily exercise routine is a great way to induce deep sleep. Just make sure it is done less than an hour before going to bed.
  • Make relaxation methods a part of life. Stress and anxiety often make sleep difficult for most people, especially the elderly. Meditation, yoga, proper breathing, and other relaxation activities calm the muscles and nerves, and cues the body to release the sleep hormone melatonin.
  • Make the bed and bedroom a place only for sleep and sex. Almost a third of the day should be devoted to sleep. Thus, the bedroom should be comfortable and free from distractions. Make sure the bed and mattress are also comfortable for a restful sleep.
  • Get enough exposure to sunlight. Daylight exposure regulates the sleep-wake cycle or circadian rhythm. Sunlight cues the body to increase production of serotonin and melatonin. Serotonin is a molecule in the body that regulates sleep and melatonin keeps the body’s circadian rhythm in check. Be careful about getting too much sun exposure as it will trigger age spots. Using sunscreen can prevent current age spots from multiplying or enlarging in size.
  • Put daily activities in order as this can greatly reduce stress and anxiety.
  • Set a sleep schedule and stick to it even during weekends. Going to bed and waking up at a specific time every day will keep the circadian cycle in order.
  • Avoid eating a heavy meal, smoking as well as drinking alcohol and caffeine a few hours before bedtime. While these activities may satisfy the appetite, they can wreak havoc on the sleeping pattern.
  • Consult a doctor. Always discuss sleep problems with a doctor because there are some health conditions and medications that can disturb the sleeping pattern. A hormone imbalance during post-menopause also causes serious inconveniences including much-needed sleep. A doctor may prescribe hormone replacement therapy to restore the decreased estrogen and progesterone levels.

There is no alternative to daily quality sleep to improve health and beauty. A restful sleep not only retains health in postmenopausal life, but it also revitalizes skin to regain a healthy glow.

George Shanlikian MD is the medical director of Genemedics Health Institute. He is a national leader in the field of bioidentical hormone replacement therapy (BHRT) and preventative medicine.

Expectations and Reality: A Review of Long-Term Care

Tendercare Nursing Home. Photo by Jeffrey Smith.
Photo Credit: Jeffrey Smith.

Unfortunately, it is impossible to create a standardized time frame regarding end-of-life or long-term care since it varies case by case. While there are signs and symptoms that allow people to predict the direction that someone’s health is going, many individuals begin long term care after a sudden life change that leaves them unable to care for themselves at home. One day, they could be healthy and the next, there could be a stroke or fall. In the best-case scenario for a situation like a stroke or fall, patients return home after successful rehabilitation, but more often than not, patients are unable to fully recover. When this happens, depending upon the severity of the person’s impairment, they are either taken care of by family members or moved into an institutional setting.

About 80 percent of seniors receiving long-term care remain within a private home (either their own or a family member’s), and the remaining 20% are moved into facilities. Each situation has pros and cons and what is best for one individual may not be the right choice for another. Those who remain within their homes are often eligible for home-health services to aid family members in their responsibilities. According to the AARP Public Policy Institute, the elderly population in nursing homes has declined over the past ten years with more people receiving care at home, living in assisted living, or being taken care of in group homes. Nursing homes are generally preferred if a person needs 24-hour supervision.

Long-term care, a general term, refers to the type of assistance provided for people with cognitive or physical limitations. Caregivers provide patients with the care needed to complete daily activities. If patients are unable to remain at home, facilities continue rehabilitation to try and strengthen patients and improve their quality of life. Not only does a more functional patient ease the burden of the caregiver, but the more a resident can do by him or herself (eating, using the bathroom, bathing, and changing), the happier they generally are. As age and illness advance, it is important to not have unrealistic expectations since people start to naturally decline.

Typically, long term care is not paid for by insurance companies so cost is definitely a factor when deciding what is best for your loved one. Even with 80 percent of elders receiving care through informal caretakers such as family members, there is still monetary value attributed to this “donated” care. The time spent caring for a loved one could be spent employed elsewhere with wages. There are also transportation costs to think about since an informal caregiver performs duties otherwise performed by paid healthcare aides. It is therefore important to reach out to a social worker as there are benefits that caregivers may not be aware of in their home state. Some states provide a stipend to informal caregivers while other states grant special benefits. Planning ahead and purchasing long-term care insurance can be a good option for many families. Even without this type of insurance, many facilities, especially hospices, charge on a sliding scale. In some states, there is no fee at all beyond Medicaid coverage. See here for eligibility guidelines and a list of Medicaid rules in your home state.

From long-term care, people unavoidably move toward end-of-life or palliative care, and when a loved one makes the transition, it is not about giving up or hastening death. Rather, it is about making death as comfortable and painless as possible. Many people mistakenly believe that admission to a hospice facility is determined by a life expectancy of six months or less, but this is false. Palliative services exist to relieve emotional or physical pain and to manage symptoms.

Before getting to this stage in life, it is crucial to have a written and notarized document, declaring how your loved one would like the end of their life managed in case they become unable to make decisions for themselves. Without preference information available in one’s medical records, it becomes harder on families in a time when things are already hard enough. Thankfully, people live in a time when long-term care and end-of-life care have made one’s later years more comfortable.

Max Gottlieb is the content editor for the Arizona Long Term Care System (ALTCS) and Senior Planning in Phoenix, Arizona, USA. Senior planning is a free service that has helped many Arizona seniors and their families navigate the process of long term care planning. ALTCS and Senior Planning find and arrange care services as well as help people apply for state and federal benefits.

 

 

Max Lugavere, Bread Head and the Changing Face of Alzheimer’s

Alzheimer’s is a scary disease. The thought of losing one’s mind while still alive is unsettling and it doesn’t get easier as cognitive and physical decline are closely related. Research has shown that all types of dementia experience mobility decline, even those progressing to Alzheimer’s disease (AD). As dementia progresses, decline in mobility is evident especially as gait and balance become impaired. Alzheimer’s is the 6th leading cause of death in the United States and an estimated 5.4 million Americans currently suffer from AD. Unlike other major diseases, it seems there is little or no solution to preventing or treating Alzheimer’s. HIV, Stroke and Heart disease have decreased significantly in the number of deaths but Alzheimer’s has greatly increased with devastating statistics. Clearly, the US has a crisis on its hands.

“People with Alzheimer’s disease live a long time, but require constant and very expensive care. They are prevented from working due to the debilitating nature of the illness and those who leave the workforce to care for a family member with Alzheimer’s impact economic productivity.”

While strong research investment is important, advocacy is even more crucial as it gets more people interested in putting an end to Alzheimer’s. In the past few years, millennials have also become strong advocates for issues concerning this disease. Organizations such as Hilarity for Charity and The Purple Elephant focus on the millennial generation and some of these organizations are even managed by millennials, a trend that is changing the face of AD. One millennial who is presenting a fresh take on Alzheimer’s is Max Lugavere. This 32-year-old filmmaker is working on a project that explores the impact of diets and lifestyles on brain health in a documentary called Bread Head. The trailer is fascinating especially as Max asks new questions about Alzheimer’s including the possibility of preventing the disease based on the choices we make.


Global Health Aging was pleased to interview Max Lugavere on his documentary as well as why millennials are starting to get interested in aging and health issues affecting older adults. We hope you find the interview informative.

Global Health Aging: BREAD HEAD asks new questions about Alzheimer’s disease. Do you think people can avoid Alzheimer’s even if they are predisposed to it (family history, heredity, etc)?
Max Lugavere: One thing is for sure—you can do everything “right” in accordance with the current science, and still get it, the same way that you can wear your seat belt all the time but still end up in a fatal car accident thanks to some fluke of bad luck. Science hasn’t provided us with a silver bullet just yet. HOWEVER, you can also greatly minimize your risk—quite easily in fact. My goal is to make people aware of the fact that Alzheimer’s is only determined by your genes for a VERY small number of cases. Less than 5%. For the rest of us, it’s the interplay between our genes and our lifestyles that determine our chances, for Alzheimer’s and for any number of other ailments. Our health is largely in our control—genes are not destiny!

Global Health Aging: The idea that Alzheimer’s is type 3 diabetes is groundbreaking! How does this change everything we know including the beta amyloid proteins that may cause Alzheimer’s?
Max Lugavere: The “type 3 diabetes” moniker is a hypothesis, and diabetes doesn’t cause Alzheimer’s, but it does greatly increase the risk. It does seem that they may be more like cousins, with a similar underlying pathology—meaning the mechanics behind the disease. The thing about type 2 diabetes (a biological disaster which has reached epidemic proportions in the States as well as in India, China, and throughout many emerging economies) is that it’s characterized by decreased sensitivity to insulin, and it’s diagnosed when you have too much blood sugar as a result of your cells not able to use glucose properly. But you can show decreased sensitivity in various organs, places of the body, before crossing the threshold where a full-blown T2D diagnosis is made; your brain being one of them. And this precedes the buildup of the plaques that clog Alzheimer’s brains by decades.

Max Lugavere

Global Health Aging: In the BREAD HEAD trailer, you pose the question about Alzheimer’s being inevitable or avoidable based on the choices we make. How did you come to exploring this idea?
Max Lugavere: I picked Alzheimer’s because it’s the most common form of dementia, but my interest and research goes beyond Alzheimer’s. I am concerned with not only preventing neurodegeneration, which begins in the brain decades before the first symptom, but also optimization. We live in a time where attention is the new limited resource; distraction is constant. It’s sort of like a kind of obesity of the mind. So I think anything we can do to maximize our cognitive health, the better and more enriched our lives will be.

Global Health Aging: Millennials are starting to get interested in aging and health issues affecting older adults. How can this trend affect the way society views aging and older adults?
Max Lugavere: I think it’s in part because the oldest millennial is now 35. Unlike previous generations, we were brought up with the tools of the internet. Information has been set free. We’ve also invested in human capital more than any previous generation. So I think we are more proactive about holding onto our health and even optimizing it. We’re the generation, after all, that’s ushering in the quantified self movement. It’s awesome to not only witness but to be a part of.

Global Health Aging: BREAD HEAD is innovative! What would you tell people who think nothing can be done to prevent Alzheimer’s as research has shown?
Max Lugavere: I’d tell them they need to get with the times. We’re finally at the end of the era of “diagnose and adios”. That said, we still have a long way to go, so in that sense, it’s imperative to support scientists that are continuing to do this incredibly vital research, both towards a cure and for prevention. It’s also important to look to technologies like my friends at Neurotrack that are devising brilliant ways of early diagnosis, which is key.

Acknowledgements and Further Information

I would like to thank Max Lugavere for taking the time to answer our questions. If you want more information on Max Lugavere, visit his website here.

Sophie Okolo is the Editor-in-Chief of Global Health Aging.

The Green Revolution – Care Delivery Redesigned

A growing trend in long-term care delivery has sparked the redesign and re-engineering of senior living centers. This trend includes the integration of plants, gardens, and greenhouses within communities. For instance, assisted living homes and skilled nursing facilities nationwide have adopted horticultural programs in order to improve psychological health and serve as a therapeutic comfort for older adults. Mere exposure to living plants and flowers have also shown to increase activity levels in the elderly as well as influence health outcomes for seriously ill patients.

                                                                      Photo Credit: mksfca

Redesigning homes range from developing community plots or atria that encourage active teamwork and participation through gardening to “meditative labyrinths” or aromatherapy gardens. In fact, the Robert Wood Johnson Foundation-supported “Green House Project” takes advantage of greeneries, natural light, gardens, and therapeutic outdoor spaces that drastically improve the environment and ambience of care settings. The Foundation has called the project a “catalyst for significant social change in how frail older adults are cared for in this country” and the initiative is being adopted at sites nationwide.

Green House Project homes may qualify as assisted living centers or nursing homes and can be funded through Medicaid or Medicare. Medicaid provides free or low-cost health coverage for families and individuals with low income and limited resources in the United States. Medicare is the federal health insurance program for Americans age 65 and older, certain younger people with disabilities, and people with end stage renal disease and amyotrophic lateral sclerosis (ALS). The widespread growth of the Green House Project and other pilot programs represent a movement towards person-centered, comfort-based care. These programs also reflect a broader paradigm shift in the delivery system towards non-medical needs, personal comfort and well-being.

Raca Banerjee works in health care policy and consulting. She has conducted research on a wide variety of policy and legislative issues related to the Affordable Care Act, Medicare, long-term care, health IT, and more. Raca is an active participant of Rotary Club International. In her free time, she enjoys volunteering, performing music, playing tennis, and learning new languages.

Health Benefits of Pet Ownership for Seniors

As most pet owners already know, our pets are best friends and considered part of our families. Especially in nursing homes where the elderly suffer from depression, loneliness, and lack of social contacts, pets can be very therapeutic, improve the quality of life, and alleviate emotional and physical problems. Research has shown that stroking and even talking to a pet lowers one’s blood pressure and heart rate which can lead to an increase in life expectancy. When a person is stroking a pet, a chemical reaction takes places and a high level of mood enhancing hormones, such as serotonin, prolactin and oxyctocin is produced, while less stress hormones are released.

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In the US, pet therapies, also called animal-assisted therapies, are very common and popular in nursing homes. Owning a pet might not be for everyone because of the many responsibilities that come with a pet ownership. Pet therapy allows the elderly to spend time with a pet, usually a dog, and feel closeness. In addition, the elderly have something to look forward to and feel that they have a purpose in life again. While pets in nursing homes can ameliorate the psychological state of mind, they also contribute to an improved physical health of the elderly such as reduced need for medication and improved vital signs. The elderly who take their dog for a walk prove to have improved mobility, more social interactions, and enjoy their daily exercise routine. It has been researched that older pet owners walk significantly farther when they walk with a dog, which can contribute to the fact that pet owners require fewer doctor visits.

The European Union understands the importance of pet ownership for the elderly. As part of the Europe 2020 Initiatives, a new campaign was launched to promote the benefits of pets for the elderly. The motto is called “Animals are good for us, be good to them. We care.” IFAH Europe, the International Federation for Animal Health Europe, started a Facebook page where anyone can get information on how to care for pets. The elderly are also asked to post personal videos about how they enjoy their lives with a pet. This campaign promotes the benefits of pets for the elderly and may raise awareness of the elderly’s emotional needs.

In Romania, pet therapies are just as common, but dogs used for pet therapy have a different story to tell; they are street dogs. Bucharest, the capital of Romania, has more than tens of thousands of street dogs. The dogs have always been seen as a plague and had a bad reputation due to a few fatal incidents with city residents. After a 4 year-old boy was killed by a street dog in 2013, a law was published stating that street dogs will be euthanized unless they have a home. As a response to the law and a vision to save the dogs and give back to the community, the organization Vier Pfoten started a project and trains street dogs to be used for pet therapy in nursing homes. What a great idea to save street dogs in Bucharest as well as give comfort and companionship to elderly!

Martina Lesperance is a Health Educator and Screening Technician in El Paso, Texas.

Aquatics for Life

Inactivity in the elderly has become an ever increasing epidemic in the United States. Politicians as well as insurance and health care providers need to band together to reverse this trend to insure the longevity and quality of life. The elderly are not only at risk for lifetime diseases such as diabetes and heart disease; they are at risk for greater loss in bone density which translates into greater probability of falling and breaking bones.

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Land-based physical activity is important for the elderly as it increases muscle and strength development, bone density and endurance which are both respiratory and cardiovascular. On the other hand, aquatic exercise benefits EXCEED land-based activities since it trains muscle parity and balance. Land-based exercise in the elderly is fraught with potential for injury. Likewise, unsupervised weight training can lead to torn muscle fibers, strained or torn ligaments, and unbalanced overtraining of some muscles while not sufficiently training the complementary muscles equally. Water exercise in a class format allows for participants to work at their own comfort level of perceived exertion. Good water instructors will always cue participants to work below the threshold of pain. In other words, participants can work to tension and ask for modifications of moves when in pain.

For the elderly, a good rule of aquatic exercise is to be mindful of aches and pains in advance of a water workout. If two hours later, the pain is greater than before training, then the participant has done too much. At this point, they can notify the instructor for modifications of moves that may affect their pain experienced. Because aquatic exercise trains complementary muscle pairs like biceps and triceps, the potential for injury in land-based exercise or activities of daily living (ADL) is reduced. Moreover, aquatic activities not only balance muscle pairs, they inherently strengthen the core muscles which provide for better over-all balance and strength. Core strength can show some correlation to immunity and overall health.

All seniors, especially those who are overweight, need to exercise in a muscle-balancing, core strengthening and reduced-risk-of-injury environment. Aquatic exercise is perhaps the ultimate life-time sport!

Felecia Fischell is an aquatic specialist with 25 years experience in aquatics. She leads aquatic classes and consults as an aquatic personal trainer and a swim instructor in and around Smith Mountain Lake, Virginia, USA. The Founder of FunLife Aquatics Consulting and Personal Training, Felecia presents at health fairs and has given aquatic presentations to high schools, Howard County Board of Education, Howard County General Hospital and Howard Community College.

Dementia Village: A Unique Place

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Dementia
can affect anybody and there is no cure for it. It is estimated that in 2050, more than 16 million Americans will have Alzheimer’s, which is the most common form of dementia. Dementia is a disease that affects the mental ability to perform everyday life activities. A person who has dementia progressively experiences a decline in memory loss which results in confusion and even fear. Imagine if you could not remember your own spouse, children, or even forget where you are at a certain time? People with dementia live in their own world and as the disease progresses, need help from care givers. Oftentimes, this care will be provided in a nursing home.

In Holland, a Dementia Village called “Hogewey”, has been created where every patient has dementia. The nursing home has specialized itself to provide care to dementia patients and offers amenities that the elderly need to feel at home and secured. All rooms face a courtyard in which patients can sit outside, enjoy the sun, and even go for a walk on a trail. Physical exercise is important for all ages and even for elderly with dementia. Exercise benefits the brain cells and oxygen flows to the brain. For the families, it is a relief to know that their loved ones are taken care of and can live in a world that is true to them.

Hogewey is certainly a unique place and its positive effects on patient care have already been studied by Germany, Switzerland and USA. In the USA, a dementia village is already in planning. It will be based in San Luis Obispo and called Maha Cielo Village. No one knows how much it will cost to build the village or how much the monthly rent will be for elderly. Just so you know, the construction of Hogewey cost $25 million, of which $22 million was funded by the Dutch government. Although it is a great project, not every patient with Dementia may be able to afford the monthly rent of $7000 at Hogewey or at any other Dementia Village. Government agencies, insurances, non-profit or private organizations may have to come on board and support patients needing financial assistance.

Martina Lesperance is a Health Educator and Screening Technician in El Paso, Texas.