Doctors must review prescribing habits

Older Canadians may be taking too many unnecessary drugs. Are you among them? I’m not! Does your primary care physician know how many drugs you’re actually taking on a daily basis? My doctor knows how many I’m taking; just the ones he’s prescribed, and only ONE on a daily basis — a thyroid medication. Pain management medications for issues related to aging with cerebral palsy are taken ‘as required’.

According to the Canadian Institute for Health Information, 1 in 4 Canadian seniors is prescribed 10 or more drugs. In 2016, about 1.6 million seniors (representing approximately 1 in 4 Canadians age 65 and older) were prescribed 10 or more drug classes. I’m having an OMG moment, people.

How many of those drugs are actually necessary, or prescribed for a condition that no longer exists? Did their treating/prescribing physician forget to tell them they were no longer required after the condition resolved? Or was a dependence created and the doctor kept on prescribing them at patient request. Sadly, patient-directed prescribing happens and it’s a problem. 

Upon release from hospital, how many seniors are sent off with a brown bag full of drugs, to be taken along with what’s currently on board, as part of their daily regimen? Where’s the monitoring? Can the patient remember which is to be taken with food and which is to be taken with extra water. It’s all so confusing, and not getting it right can be dangerous if not fatal.

As well, seniors/elderly taking anti-psychotic drugs without sufficient follow up to determine continued efficacy are at risk and treating physicians must accept some of the responsibility. Men and women in this age group still living on their own need to be followed. Nursing home and other similarly housed individuals also need to be assessed if they’re taking such medications.

Some drugs may actually be setting the stage for dulled senses and accelerate the risk of falls — a vicious cycle begins. A serious fall results in a hospital admission to treat the injury, perhaps with an extended stay, creating the potential for contracting any number of airborne infections. Sometimes, one layered on another. Hospital stay extended. Pneumonia settles in; more medications. Sleeplessness — sleeping pills. Anti-anxiety medications are often part of a hospital stay, with some patients continuing to take them or seek them long after release. That warrants investigation. Sadly, what started out as a minor situation at home, with a direct link to over-medication, leads to a death in hospital from a condition totally unrelated to the initial falling incident. Time for a change of approach.

I’m pleased to know use of antipsychotics and benzodiazepines in long term facilities has declined since 2011; it can’t be lost on health care professionals that those drugs seriously impact quality of life for the aging person and that there needs to be more focus directed at establishing other ways of assisting seniors in care facilities adjust to their circumstance. Government funded research programs to explore drug use is redundant. Why not direct funds to resources that physically and mentally stimulate elderly in care, making their days more palatable. Imagine being essentially parked in a chair all day in front of a television, surrounded by a number of similarly aged people, some of whom having lost the capacity to engage. 

There is much to be done. Doctors say it is not uncommon to encounter patients taking more than 20 drugs to treat acid reflux, heart disease, depression or insomnia or other disorders. My head is spinning. Why so many ‘doctor drugs’, as I call them? There needs to be a place for nutrition education, physical therapy, occupational therapy. Mental health counselling amongst seniors needs to be given much more attention. Constructive communication is critical if clinicians are to effectively treat their senior and geriatric patients in a manner that contributes to improved quality of life.

Overuse of prescription drugs amongst the elderly can be a gradual thing; taking a drug to lower blood pressure causes swollen ankles, so a diuretic is added to the mix. The diuretic lowers potassium, so another drug is layered on to treat that. Oh, and then there’s the nausea caused by the drug treating potassium deficiency. Mental confusion sets in because of the drug used to treat the upset stomach. The cascade effect. 

I call upon all doctors in this province and across the country to conduct ‘brown bag’ medicine reviews. Going over the list of daily medications, who prescribed them and why is like a good housecleaning; getting rid of what’s not needed and perhaps downward adjusting dosage and strength of certain medications that may be interfering with quality of life.

Networking with local social service agencies to connect seniors to community would be a perfect prescription.

Carla MacInnis Rockwell is a freelance writer and disability rights advocate living outside Fredericton, NB with her geriatric Australian silky terrier and a rambunctious Maltese. She can be reached via email at carmacrockwell@xplornet.ca

Brain training is in your hands

Photo: Michael Parzuchowski

Since joining various online news and chat groups specific to parents raising children with cerebral palsy, one theme has not changed — my message about the importance of daily hands-on interaction, whether that child will ever walk, ever speak, ever DO anything significantly purposeful, by the typical standards of purposeful. Any and all trains the brain.

Moving the arms, up and down, in and out; moving the legs, up and down, in and out. Pedaling the legs, Pull-ups, sit ups, side rolls. Move it! All of this infantile movement is communicating with the brain to pave the way for new connections, more stable connections that contribute to acquisition of other milestones of typical children. For atypical infants and toddlers, it’s vitally important to have conversation while moving the arms and legs for them. Developing hearing and listening skills while moving the body provides more bang for the proverbial buck. The brain, like a sponge, takes it all in.

Depending on type and degree of brain insult, learning to roll over, crawl, sit up, stand up, step and walk will take time — sometimes years. For some, however, the anticipated goal of walking may never be realized; that’s okay — there are other goals to work on. Speaking, listening, and developing eye-hand co-ordination are three important skills that will carry children through their lives whether they ever walk or run. Those who will never reach those milestones, forever to rely on others in their world to be their eyes and ears still have a place  — people contact is their brain training.

When I think about the years that were spent teaching me to walk and to know that at 65, I’m still doing it, I have to pat myself on the head. Maybe, the back, too. My arms are long! 

It’s a disturbance to my sensibilities that there are so many children today who are totally disconnected from movement and they do not live with any sort of disability like cerebral palsy. What’s going on? They sit, isolated, frantically running fingers overy tiny keypads looking at tiny screens. Hmm!

They’re tethered to technology to such an extent that their brain power is being diminished instead of being enhanced, as one would think technology would ‘do’ for our young people. Au contraire, technology devices can make the developing brain very lazy.

Do you remember that feeling of joy you had as a child while painting a picture, building a snow fort with your brothers or building a birdhouse with Mom or Dad or baking cookies with the parent who likes to bake? For a child, the sense of accomplishment was huge and met with a boisterous acknowledgement. Lots of esteem building. Humans need that.

Unfortunately, today’s children are often deprived of the powerful opportunities to use their hands to create, engage and connect. They’re not sufficiently encouraged by adults in their world to get outside and DO. Much of what I experienced as a child in terms of hands and movement, today’s children will never know unless we revisit the past to stimulate the future.

From toddlerhood to date, I’ve used my hands to navigate my world. I rely on my hands as much as my feet to move me from Point A to B; touching a countertop, a table, a chair as I move about.  I also use my hands to create; crafting, baking, cooking. I use my hands to recreate, as I read bound books and e-books, play online scrabble, navigate around the keyboard to connect video camera to chat with my friend, Mary, across the pond. Out and about, I use my hands to propel a wheelchair that carries me around the outside world.  My brain is constantly being trained.

Children today are often limited to using their hands and fingers to keyboard their way through their days. Are they helping around the house with cooking and cleaning? Have they experienced planting a garden and seeing the fruits of their labours from ground to dinner table? If they haven’t, they’re missing so much. There’s more to life than swiping a screen with the index finger. 

Parents have an opportunity to contribute to their own brain training right along with  their children simply by recognizing the need to limit internet time and saying NO to technology for critcal periods of the day - like meal time. Get into the after dinner routine of having a family time. Board games are great brain trainers. Setting limits on their own use instills in their children the value of getting involved in life, hands first. Helping hands in the community is a way of connecting one to another and another. That makes for great brain training. Imagine the possibilities. A day of brain training also contributes to a ‘good tired’ for a good sleep but remember this —  never go to bed with technology. That blue light disturbs REM sleep and that impacts brain training. Can’t have that!

Carla MacInnis Rockwell is a freelance writer and disability rights advocate living outside Fredericton, NB with her geriatric Australian silky terrier and a rambunctious Maltese. She can be reached via email at carmacrockwell@xplornet.ca

I am a pressure wound survivor

“Man 'rotting alive' from bedsore dies of infection” read the headline of a recent CTV news feed. 

Bob Wilson, from Burlington, Ontario, died on Saturday, 8 June, as a result of complications of a preventable condition — a pressure wound.

What those in authority need to answer to is how this man could have gone for so long without anyone noticing he was in trouble; in an acute medical crisis? How? No excuses!

After sustaining a fall and concurrent head injury, Mr. Wilson was hospitalized in one facility, to be then transferred to another for surgery related to that head wound. It was then the issue with his backside was discovered. In both facilities, where was his access to health care professionals who should have been doing their job on a daily basis? No, I’m not being harsh; I’m being real. Mr. Wilson was failed by the very people charged with his care. How many people across this province, across this country have died as a result of preventable pressure wounds?

Several years ago, my own father, while in a nursing home in this province, suffered through a skin ulcer that went unreported and therefore untreated until a family member stepped in, but not before Dad experienced excruciating pain. Where was nursing staff? How many others in just that one facility had a similar experience?

I am a pressure wound survivor; shearing wounds on both thighs that took two years to heal — for normal skin colour to return as wound surface area shrunk. Shearing occurs when skin is repeatedly dragged across a surface and sustains an irritation. In my case, I did not feel anything happening. By virtue of the way I position myself while seated, shearing wounds are possible but don’t always happen to people in my circumstance. Prevention and wound care is an ongoing process.

Prevention should be the gold standard in every nursing home and special care facility where people with limited mobility or those who are bed-ridden live. As example, a basic daily requirement if we are to stay well, is to be clean, with a daily check of ‘at risk’ areas, followed by cleansing, drying and applying antibiotic topicals as required. That should be a given in all health care settings treating patients on a daily basis. Full stop!

If Mr. Wilson had been properly washed every day, even a slight discoloration on his skin would have been observed and charted — or it should have been. Then there’s the smell of rotting flesh. Who could miss that? 

Health care professionals owed Mr. Wilson a duty of care he did not receive. My late father was owed a duty of care he did not receive.

In my case, what alerted me to a problem happened while I was showering. While washing the wound site (unseen at that point), I felt a sting. My skin, like paper,  had torn.  It was then I looked, turning my head to view in the hall mirror. After that OMG moment, I called the doctor. The skin break was very minor but the discoloration was expansive. I went into action, applying what I called my ‘war wound’ salve.  In a glass bowl with lid, I squirted a healthy gob of aloe vera gel into which I added a really good squeeze of polysporin ointment. Then, 10 drops of tea tree oil, blending really well. Four times daily, after cleansing the area, I applied a thin film of the salve, which is kept refrigerated.

Within a short time, while the salve was healing the wound, I began using a Roho (air cushion) on my desk chair and in my wheelchair during outings. As well, I used an air-filled mattress topper on my bed. Both were new to my health care management protocol and significantly contributed to wound healing. Contributing to pressure wound prevention, chair cushions and mattress toppers should be standard issue in every nursing home across the province.

For the next few months, over a period of visits from  Extra-Mural Occupational Therapists and then a nurse, measurements of wounds, along with photographs, were taken. One OT explained that the biggest concern was with ‘tunneling’, where damage travels below the surface to the muscles and bones. Mr. Wilson’s wound was to the bone.

Knowing how Mr. Wilson died and having read my story, it’s time for all of  you to let the medical community know that you understand the seriousness of this often preventable condition and you’re not going to accept their cavalier attitude any longer. That is your right. If you have a relative currently in a care facility in this province or any other, it is your right to demand skin checking; if an area is suspect, treat it. Taken further, to be a good neighbour, make it your duty to encourage checking of other patients who may not have frequent visitors. You’d expect no less for yourself. You are your brother’s keeper.

Carla MacInnis Rockwell is a freelance writer and disability rights advocate living outside Fredericton, NB with her geriatric Australian silky terrier and a rambunctious Maltese. She can be reached via email at carmacrockwell@xplornet.ca