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

What children really need and how they can get it

Iphones have no place at the dinner table

John Ruskin, a leading English art critic of the Victorian era had it exactly right — “give a little love to a child, and you get a great deal back.” What happens when children are deprived or at least feel deprived of love? “You don’t love me!”; “If you loved me ….”

I recently read about a child killing another child  — inside a classroom. A 10 year old fifth grader died in North Carolina 2 days after the altercation. How does this happen? Children limited in loving interactions with their first teachers, their parents, are often lacking in social rules that govern behaviour. Is it not  a parent’s role, with love, to meet the demands of teaching proper conduct? 

What happened in that classroom that took it to the point where the teacher lost control of the situation?  So many questions. We’re not likely to hear much more about this given that both children are minors. Let’s hope the press doesn’t beat the proverbial dead horse and instead moves to the greater issue. The greater need. What can we, as thinking, feeling human beings do to ensure that children in our community are not lost in the shuffle? 

Today’s children seem to be living with an inordinate level of stress and I assert that a lot of it comes from one thing — lack of positive regard on a regular basis from the significant people in their lives — their parents. Refrigerator parents/emotionally absent parents really need to start taking stock of what their sitting on the proverbial sidelines is doing to their children.  The latest bit of technology — that much whined for tablet, the larger internet package to stream more movies, or the pricey running shoes or the best jeans will never be enough to fix what’s really wrong. There’s a wounded child inside that youthful body with the potty mouth and the bad attitude, wanting more and more stuff, when what he needs is a hug. Did over-indulgence with stuff create that ‘little monster’ Mom and Dad now describe? Step back and take a look. Who over-indulged? Is over-indulgence a sign of a parent’s own wounded inner child?

Technology has significantly and forever changed the landscape with regard to how people interact and that includes children; from the very young, even pre-verbal, to the much older, high school student. Don’t get me wrong, technology is a great thing. I’ve been able to appreciate all manner of opportunities since travelling on the ‘information highway’. Long before that, though, I had in the world, real life, up close and personal interactions with real people, doing real things from going to school, to playing outside as a child, to hanging out with friends in university and during my work life, to playing the role of wife and stepmother during that phase of my life. For me, the internet replaces the bricks and mortar libraries that I was never able to visit with ease.

The internet and all that goes with it is a great tool for children — to learn; to connect with other young people around the world, sharing common interests, talking about what life is like where they live. All good things, right? Of course, but in moderation — especially during the formative years. Children are spending too much time tethered to technology; in fact, far too many are actually sleeping with it and that’s scary and sad at the same time. Parents, where are you? Oh, wait, you’re tethered to your own devices and not interacting, using your inside voices to engage with your children. 

That’s a huge problem, folks. Huge. Children will be better rested for improved school performance if technology stays out of the bedroom. Family relationships will blossom if  iPhones don’t have a place at the dinner table.

Children getting into fights with other children, children arriving at school appearing tired and ill-prepared for the day, children being in a perpetual state of upset, day after day. What’s going on? It’s important for teachers to ask soft questions with as little leading as possible. What’s actually more important, though, is for parents to be having real, meaningful conversations with their children on a daily basis. It doesn’t have to be a long drawn out affair — a check in and a check-up. These ‘mini meetings’ may well be the way to fend off a blow-up at school, in the classroom or on the playground. 

What children need each day and every day is the gentle, guiding hands and voices of the influencing adults in their world  - technology can never replace a hug or a “well done, son.”  Think about that the next time you sit down to watch television.  Call your child out from his room and his own television and go for a walk. Go ahead and talk, too! You’ve got this.

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

Nurse practitioners and physician assistants fill important gaps

 

I echo Ted Flemming’s sentiments with regard to the function of the ER and the need for changes; changes that are long past due. Expanding physician hours is not the only solution; it’s simply a band-aid on a gaping wound that requires multiple sutures. 

Following Mr. Flemming’s assessment was a thought-provoking piece delivered by 3 ER physicians who paint a scary picture of the implosion of ER services. Is the system irrevocably broken? Perhaps not. Physicians assistants also had a say in the matter. The prognosis seems grim. Is it?

From my perspective, as armchair critic, what may contribute to health and wellness is a roster of nurse practitioners and physician assistants in every hospital across the province taking on all those patients with health/medical concerns that are clearly not emergencies. ER wait times have become life threatening. 6-12, 20 hour ER waits is is unacceptable. Full stop! Adding an extra layer of health care via nurse practitioners and physician assistants has potential to break into the flow of ER congestion as they are able to spend with the patient the time the doctor just doesn’t have. That time can be spent educating patients about what IS an emergency and what is not. Armed with knowledge reduces anxiety and may minimize the frequency of future ER visits.

Sometimes, ER traffic is comprised of frequent flyers, as I like to call them; not always those without a family doctor, but folks who think that every little thing, from a hangnail to a sniffle requires emergency medical attention.  And then there are those who fear they won’t get seen in a timely manner and avoid going to the ER when they really should, waiting to the point where an ambulance is called to their home. Sadly, it’s sometimes too late. A catch-22 to be sure. 

Funding to provide more physician hours has not been changed since 2004. Wait times are perilously long while physicians work diligently to break the back of the heavy load they carry. They cannot possibly do good medicine in circumstances that test their resolve to keep going. Sick patients get sicker and those who wait with them get understandably anxious. Then the pressure cooker of emotions explode. No winners.

We are a population that's aging, many in nursing homes; lots of men and women are aging in their own home but sadly, far too many find themselves aging in hallways and other spaces in hospitals because there are no nursing home beds. Equally sad is when an elderly couple has to be separated, with different nursing home placements. I’m sorry, but that’s cruel and inhumane. There’s no other way to spin it. Compassionate care must rule the plan of health services delivery.

From where I sit, we really are in full crisis mode, with too many people spending far too much time complaining about the flaws in the system instead of assessing their own contribution to that problem. Assessing what they can do in their own lives, on a daily basis, to limit their own over-use or even misuse of ER services. It’s not just about doctors, nurses and other clinicians and the care they provide. It’s about all of us.

If each community developed educational sessions on a biweekly basis, where people coul gather to get information about various concerns, I am certain that would go a long way to stemming the flow  to the ER of those who are experiencing nothing more than a bit of misguided fear, anxiety or loneliness. For some, the ER has becoming a social gathering place. Look around and see how many people come in as a group, when only one is the patient to be seen. Organising informal gatherings serves another purpose. It connects the isolated to people and potential goods and services they may require to enhance continued aging in place living. It reinvigorates communities and establishes new people connections. Providers of health care would be ideally suited to hold informal lecture series to meet, greet and educate.

A movement within communities to develop programs of service and learning would become the sutures to the wounds of isolation and loneliness experienced particularly by the most vulnerable — the elderly. Doctors would do well to ask more probing questions about lifestyle and how days are spent by those seniors who live alone. Signs of trouble would be evident with deficiencies in nutrition, lack of quality of sleep, worry about what’s to become of them when their circumstance changes. So many questions. Groups of like minded individuals within the community sharing those concerns and talking about them can ease the burden and concurrently improve physical and emotional health of the often disenfranchised.

Points to ponder.

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

Me, my wheelchair and scooter, oh my

Carla's canine companions are MIA. They 'don't do rain'.

I’m 65! I have arrived! Arrived without any major ongoing health issues, testament to following the ‘you are what you eat’ and ‘use it or lose it’ school of living well daily.

From the age of 2ish to age 8, it was heavy metal waist-high braces with lots of leather; from 8-12, metal ankle-foot orthotics (AFOs).

Braces free from age 12 to date, save a few months in the 80s with a short-lived relationship with moulded plastic AFOs, I still rely on  axillary crutches, having never felt safe using the forearm crutches of my my toddlerhood. My current pair, beat up wooden things with attached ice picks thanks to A.R. Menzies, certified orthotists, are genuine antiques. I learned recently that the ice picks are not longer part of today’s crutches.

Last year my wheelchair, after 28 years of service was officially retired and, via Tango Medical, donated to the Easter Seals loaner program as it still had life left in it for the occasional user.

Just as with my ‘little red racer’ my new chair is not used full time. Instead, it’s for grocery and other shopping outings in the city where walking would be exhausting. Regardless of age, exhaustion is a key player in the life of one living with cerebral palsy. Having a chair that fits is very important as well; after a few false starts and taking some getting used to, not unlike breaking in a new pair of shoes, my new chair almost fits me.

I’ve lived outside the city for many years and as time passed it became clear that a wheelchair wasn’t going to be enough to cope with hilly roads, particularly given I have a wonky ticker and propelling a chair up even a slight incline made me feel sick. Since 1999, I’ve benefited from a mobility scooter that, on a daily basis for many years, was much enjoyed by my last terrier, Mr. Jake the Cairn.

Like me, the scooter is gettin’ on in years and starting to show its age, and like me, it requires a tweak every now and then. Several years ago, Trent Mundie, then with Apollo Medical visited me here at my home to assess my scooter; it was veering sideways — sorta like me! The tiller/steering mechanism was broken. Trent left me with a loaner while my scooter was being repaired — that’s service! Once fixed, Mr. Digby and I were back running the roads.

Like Mr. Digby and me, it hummed along great until this past winter when it was getting sluggish. I hoped it was nothing more than pooped out batteries as it came close to taking 3 men and a boy to get the seat off to dismantle the scooter into 3 easy pieces during previous repairs. Major muscle power would be required. I had been leery using the scooter in the winter for fear of it stopping and me being stranded. Recently, on a trash to the road trip, I knew I was in trouble when the battery indicator drifted into the white/red zone after only a short distance on a fully charged battery. There was no way I was going to do that again until the scooter was serviced.

A couple of weeks ago, since Trent, now with Embracor, wasn’t available to replace the batteries, he sent his colleague, Scott, who was prepared —  he brought along a little blow torch! When I told him how old the scooter was, he commented that it was in very good shape, going on to say that he’d seen scooters and wheelchairs only 2-3 years old that were really banged up — lots of wear and tear.  No doubt their users gave them a lot more daily use than I give mine.

Scott, from Embracor

Ready to Ride

For persons with mobility challenges, when something goes wrong with equipment, it’s critical that we have access to people who appreciate our need for mobility and safety. Thanks to A.R. Menzies, Tango Medical, Embracor, among others, we can live and work in the community, confident that our modes of transportation will be kept in tip-top shape.

Since the battery replacement, I was able to do what most homeowners do with ease — take out the trash. So confident was I that the scooter would work just fine, I hopped on, not bothering with shoes. Steering with one hand and holding  a box for disposal in the other, I made it to the end of my driveway. Mission accomplished. 

There was only one thing missing. The passing trucker didn’t honk his horn. Hey, I was color co-ordinated with robe, PJs n socks. Next time, I’m bringing a dog!

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

Mr. Digby and me, aging in place together

In 2 days, Mr. Digby, already geriatric, will be 16 years old. Actually, he’s advanced geriatric; the term as it applies to a dog sets the age 11.5 for a small breed such as the D-dude. Just as with humans, the senior and geriatric dog experience similar declines and deficiencies which may include changes in sleep patterns, eating habits, daily routines and waning interest in things once enjoyed. Mr. Digby has, in a word, become persnickety.

I  am a senior. By definition, in medical terms, senior is more a function of chronological age - a number. As to geriatric, we think more in terms of health, of physicality, of overall well-being and how the body is performing or perhaps not performing.

For people and pets, fragility includes various combinations of the following: weakness, fatigue or exhaustion, weight loss, impaired balance, decreased physical activity, slowed motor performance, social withdrawal, mild cognitive dysfunction, increased vulnerability to physiological stresses.

It’s important to pay attention to cues that suggest insufficient nutrition, which contributes to significant declines in all aspects of daily living . Perhaps it’s time for a dentist appointment to check for cavities or disease that compromise proper chewing which would impact nutritional input. Ill-fitting dentures would also warrant investigation if eating has declined, particularly if there is noticeable weight loss.

From the outset, to promote exercise, Mr. D. was fed 1/4 cup of kibble morning and evening via a food dispensing ball. In recent months, however, he stopped ‘working for eats’. Hard kibble was the culprit. I started feeding him in the dish he came with, measuring out the portion and pouring warm water on it. His morning repast included an extra 1/4 cup of nutrient dense food to to counter the effect of weight loss due to chewing deficiencies with concurrent tooth loss. Though he’s shown no interest in the food ball, attempts to put it away failed. He wants it left right where it is! 

Persnickety entered the examination of Mr. Digby’s aging when he suddenly didn’t want kibble in his dog dish. Now, he enjoys fine dining from a cereal bowl, with a soft biscuit on top. He’s gone from a crunchy biscuit to a soft one, but he still takes it to the living room to eat before he comes back to the kitchen to have the main course. There’s still a lot of mental engagement and he enjoys the routines of his day, whether it’s eating, having play time on the floor with me, or going outside, tethered with Miss Lexie to enjoy the fresh air. One thing I’ve noticed that he no longer does is ‘sing’ along to his favourite Jukebox Oldies; Connie Francis was a regular singing partner. At least I have a few recordings of him belting out the tunes.

Many of the same habits apply to geriatric men and women who may be finding it difficult to eat; using utensils to cut up food is exhausting so it may be time for family members or other givers of care to present meals with cutting already done, and condiments at hand, so that all the older person has to do is enjoy the meal. As well, adaptive dinnerware and cutlery significantly enhances the eating experience, allowing the diner to eat without having to fight to keep food on the plate, fork or spoon. Interestingly, red dinnerware has been demonstrated to stimulate eating. Red, is after all, a power colour and my personal favourite.

In the absence of dietary restrictions, smoothie nutrition provides an immediate energy boost. Though I have the metabolism of 3 men and a boy and eat like a lumberjack, I still have a smoothie almost every day. The dogs enjoy a slosh of blended berries, banana and yogurt, too. For the senior or frail geriatric, proper nutrition also ensures better health overall with less likelihood of contracting a cold or becoming otherwise unwell.

Mr. Digby has issues with sleep and wakefulness and nocturnal ‘anxiety’; the disturbed sleep pattern is part of the canine cognitive disorder, not unlike Alzheimer’s in humans. He’s been on 5mg of melatonin each evening for the past few weeks and is doing very well. Though they’re berry flavoured quick dissolve tablets, he won’t take them in anything but yogurt. For my own good sleep, a sleep mask and room darkening blinds rule the night. We both sleep like babies, though one of us snores terribly. No, it’s not me!

And so, to honour old dogs and old broads with dogs, a contribution to your local animal shelter or rescue group wouldn’t go amiss. They’re always looking for volunteers, too. Dog walking is a great way to connect with the community. Leave cell phones at home and be fully present with your canine companion. It’s a dog’s life, after all.

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