Intermittent Fasting Information Session

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Please join me (Angela G. Gentile) at Village Chiropractic in Winnipeg (482 River Avenue) on Friday, April 26, 2019; 6:00 pm – 7:30 pm. I will be presenting an education session on “Intermittent Fasting for Health & Weight Management.” I’ve been practicing an IF lifestyle since December 26, 2018 and I haven’t looked back. I am excited to share what I have learned and I am looking forward to answering any questions you may have.

Please register soon – it’s FREE and spots are limited!

 

Angela G. Gentile, MSW, RSW

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Memory Rescue by Dr. Daniel Amen (2017) – Book Review

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I am a geriatric mental health clinician, and frequently I am asked: “How can I improve my memory skills?” The usual recommendations from doctors are, “Exercise and learn new things.” I have been on a quest to find some other tips and tools that people can use to help improve or maintain their brain and memory functions as they age. This need has led me to try to find the perfect book to recommend to those who are looking for more information. “Memory Rescue” has some useful information but it’s not the book I was looking for.

I purchased a copy (Amazon) of psychiatrist Dr. Amen’s book “Memory Rescue: Supercharge your brain, reverse memory loss, and remember what matters most” which has a second subtitle, “The official program of the Amen Clinics.” The Amen Clinics are found all over the USA, and the services and programs offered there are to help people with various mental health and brain health concerns (such as memory loss, ADD, and traumatic brain injury).

This book starts out with 20 testimonials and reviews which is very impressive until I realized they were all from men. The male-dominated view about memory problems and the Amen Clinic program was very strong. The only female presence I felt was from Dr. Amen’s wife, Tana, which was very sparse. There were also a handful of case studies that were about females. As a woman reader and professional, I wish there had been a more balanced perspective.

The overall takeaway of this book, for me, was that this was a big advertisement for his Memory Rescue Program that he offers through his Amen Clinics and the MyBrainFitLife.com website. There were case examples of how his clinics help people, and there were lots of “SPECT” (single photon emission computed tomography) scan photos to “prove” it. Even after looking at numerous SPECT images, I still wasn’t 100% sure what I was looking for. I felt these images were a bit overkill.

Here in Canada, we don’t have access to Amen Clinics, and SPECT scans are reserved for those exceptional cases (which I am still not sure what those cases are.) We tend to favour CT, MRI and PET scans.

Ultimately I was looking for concrete tips on “how to improve memory skills” and “how to improve memory problems.” Amen’s program is intended to enhance your mood and memory skills using the BRIGHT MINDS risk factor approach, with each letter standing for a component of the “ultimate memory formula.” Blood Flow, Retirement and Aging, Inflammation, Genetics, Head Trauma, Toxins, Mental Health, Immunity/Infection Issues, Neurohormone Deficiencies, Diabesity, and Sleep Issues. There was quite a lot of repetition throughout the book, with the main recommendations being: Exercise, Nutrition, Nutraceuticals (and supplements).

On pages 28-30, you can take the “Amen Clinics’ Early Warning Signs Questionnaire.” Your score will provide you with a risk of “significant memory issues,” from low to high. Amen states, if you are at moderate to high risk, it is important to get a thorough medical evaluation.

This book brought up some new terms and concerns. Those including my need for nutraceuticals (which Amen sells on his BrainMD website), getting tested for the APOE gene (related to Alzheimer’s disease), an integrative medicine doctor (but doesn’t say where I can find one). He was heavy on the recommendation of Gingko Biloba (a natural supplement that has limited research evidence to help prevent memory problems, see GEM study). He was anti-marijuana use and wasn’t that clear on what the recommendation was for alcohol use (was it 2-4 servings a week or only 2?).  He suggests coconut oil is good for our brains, but I have read that it is not good for our bodies. There is a lot of reference to the Memory Rescue Diet, but it is not discussed until chapter 16. There are a lot of references to the Bible, which surprised me. He also suggested that “praying to release your worries and to rejoice over the good things around you can help reduce your risk of mental health problems” (p. 337).

Ultimately, as I mentioned earlier, I was looking for specific tips and techniques to help people improve their memory skills. The most helpful part of the book in this regard is found in Chapter 17 “Sharpen Your Memory––Brain Workouts for a Richer Life.” He provides a lot of suggestions of what activities can help strengthen the different areas of the brain such as playing Scrabble, completing crossword puzzles, and learning to play a new musical instrument. He suggests engaging in “map reading” without a GPS device. He’s a big fan of table tennis and other coordination activities, such as dancing, yoga, and tai chi. He says we should travel to new and interesting places and develop relationships with smart people. Music, especially classical, can enhance memory and cognitive function. Surprisingly, I didn’t find the instruction to “pay attention” to what we are doing, which I believe is an essential tip for being able to remember things in the first place. He doesn’t speak to word-finding difficulties, either, which is one thing a lot of older folks are initially concerned about.

The book is well-referenced, and he claims to walk the talk. The index is sub-par, and it could have been enhanced to make finding things a lot easier to find. Some of the reviews online of Amen Clinics state it is a very costly program. There is no mention of costs, but there is mention that the process of improving cognition or mental health often takes months. It’s assumed the program costs thousands of dollars. The MyBrainFitLife.com online program also has a cost, a yearly fee of USD 99. There are some free Brain Assessments (which I completed) which can help one decide on the level of risk one is at. If someone already has memory impairment, a caregiver or loved one will need to read this book as it tends to have some jargon and technical language, and there is lots to read and learn about.

I would recommend this book to anyone who is interested in the Amen Clinic Memory Rescue Program. For specific information on brain health and tips for improving memory skills, Chapter 17 is where you want to start. If you believe in God or a higher power, this will also confirm your faith in how prayer and scripture can support your mental health. The book is somewhat repetitive, however, it drives home the main message––that having a healthy body means better chances for a healthy brain.

I’ll leave you with this: Amen provides hope––“Yet new research suggests that a ‘memory rescue’ program, like the one presented in this book, can dramatically improve memory and can prevent and sometimes even reverse some forms of dementia. Given how most doctors approach this issue, however, you cannot count on traditional medicine to rescue your memory.” (p. 4).

Angela G. Gentile, MSW, RSW (Specialist in Aging)

 

 

Watch Your Step! Fall Prevention Tips

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Source: Simon Howden, Free Digital Photos.net

Did you know that one in three Canadians over the age of 65 will fall this year?

Some of these falls are life-threatening. In fact, falls are the leading cause of injury-related hospitalizations of older adults in Canada (Smith, Wager & Elliott, 2010). In 2004 Statistics Canada reported falls cost the health care system an estimated $2 billion.

In Canada, falls are the leading cause of head injury hospitalizations in adults (Canadian Institute for Health Information). Thirty-five percent of injuries from a fall result in broken or fractured bones (Statistics Canada). The cost to the health care system and to personal quality of life is staggering.

It is important to know the risks and to prevent falls from happening.

These falls happen everywhere; be it in the home, the community or in long-term care. There are some helpful online risk assessment tools and other resources to help older adults who are at risk, or who simply want to be pro-active in fall prevention. A study done in 2009/10 showed that fall related injuries from simply walking comprise forty-five percent of self-reported injury. (Statistics Canada, Community Health Survey).

Self-Assessment for Older Adults Who Live Independently

For older adults who live alone, the Staying on Your Feet website provides a self-assessment questionnaire for older adults, called Prevent Falls Check-Up. Once completed, a Check-Up report is provided which offers a variety of suggestions and tips for falls prevention. The main message here is that most falls are preventable, and steps can be taken to reduce risk.

Safety is far more important than what preventative and risk-reducing measures “look like.”

Concerns about getting in and out of the bathtub? Arrange to have grab bars installed. The Canadian Mortgage and Housing Corporation has released guidelines on the best placement for grab bars for maximum effect and ease of use. We have to get past the idea that grab bars may make us look weak or frail.

Taking medication? For those on three or more medications who are experiencing bouts of feeling light headed or dizzy, regular medication reviews are recommended. Medication adjustments may be required to help reduce unwanted and potentially harmful side effects that can cause an increased risk for falls.

Could the home surroundings be made safer? When a person has lived in a place for many years, they tend to not see where improvements can be made. If the person tires easily, perhaps a relative can help select rest areas where small chairs can be set to provide breaks. If the person tends to walk the same path through his/her home, move furniture to ensure a clear pathway.  If a small pet tends to get underfoot, install a bell on its collar. Move commonly used kitchen items to easy-to-reach areas to reduce the need for step stools. For hard to reach items, never stand on a chair – always use an appropriate stool or short step-ladder made for such a purpose, and preferably one with a handle at the top to provide steady support.

Is footwear safe? Slippers or mules with no backs, overly worn soles or shoes that are too tight, can all contribute to falls. Ensure the person has a good pair of well-fitting shoes, preferably without laces that could cause tripping, and with lots of room in the toe box. Wear these shoes in the house. Shoes that move with one’s feet will help reduce falls in the home.

Problems with blood pressure? Postural hypotension, or a sudden lowering of blood pressure when changing head elevation, is common among those 65 and older. A good tip is to get in the habit of sitting on the edge of the bed for a few seconds upon awaking before standing up. This allows the blood pressure to adjust to reduce the risk of dizziness upon rising.

Overactive bladder? If bladder incontinence or urgency poses problems, rushing to the bathroom can be a fall risk, especially in the night, and especially for homes where the bathroom is not close to the bedroom. Consider purchasing a bedside commode. The commodes of today are much more user-friendly and attractive than in our grandmother’s day, and we should not be embarrassed to install one in our bedroom. Purchase a screen to hide it during the day if embarrassment is an issue.

Need to use the stairs? Falling on stairs is the third most reported reason for falls, (Statistics Canada, Community Health Survey) after walking and snow/ice slips. 12 Steps to Stair Safety at Home is a one-page checklist on stair hazards and ways to look at stair issues effectively. First and foremost handrails should be on both sides of the staircase and should be used in every instance, no exceptions.

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What to Do After A Fall is a poster that can be printed off and kept in various places around the home. It is especially recommended for those who live alone and have already experienced a fall.

Personal Response System to Ensure Safety

If the risk for falls is high or family members are concerned about their loved one falling, one popular option is to get a personal response system. The Philips Lifeline AutoAlert service is a great optional feature that will automatically summon help if the person falls. There are many other such services and some of them are:  ADT, Alert1, Bay Alarm, Care Innovations, LifeAlert, LifeFone, LifeStation, Medical Guardian, Mobilehelp, and RescueAlert. Some research may be needed to find the one right for the circumstances, and these may not all be available in Canada. Some people are worried about the appeal of wearing a device such as a necklace or bracelet but modern technology makes many of these devices appear as regular jewellery. In Canada, Costco stores provide two such devices – Medical Alert and Direct Alert.

Buddy Systems

Although there are reportedly only one fifth as many falls in residential care facilities as in private homes (according to Statistics Canada), it is still important to be aware of fall risks and prevention strategies in seniors’ residences.

Some seniors’ residences have a buddy system or a safety check program in place. Examples would be where the tenant puts a door knob hanger or other signal (garbage can for example) outside their doors at night and remove them in the morning to signal that all is well. Alternatively, a phone call once or twice a day can ensure one’s safety with the added bonus of social interaction.

The Prevalence of Falls in Long-Term Care and Residential Facilities

Some people who live alone move into long-term care settings because of their complex medical needs and increased risk for falls. Nursing Home (NH) residents who fall are at risk for injury such as a fractured hip or other bones. Sometimes a fall results in death.

The Winnipeg Regional Health Authority listing of Critical Incidents Reported to Manitoba Health from October 1, 2013 – December 31, 2013 identified 34 NH resident falls over the three-month period. One of these falls resulted in death. Seven of the falls were witnessed by a staff member, and 27 were unwitnessed. Of these unwitnessed falls, 16 resulted in a fractured hip and a trip to the hospital for surgical repair.

According to a 2008 Winnipeg Regional Health Authority publication, the Personal Care Home View, 18,868 falls were reported in nursing homes in Winnipeg in one year. Most falls occurred in residents’ rooms on evenings and weekends.

Falls Risk Assessment Tool for Long-Term Care Facilities

The Johns Hopkins Falls Risk Assessment Tool (FRAT) helps identify the level of risk in NH residents, based on the following criteria:

  • Recent falls
  • Medications
  • Psychological factors
  • Cognitive status

If a person has had recent falls, it increases the risk for a repeat occurrence. Certain medications, such as sedatives, antidepressants, antipsychotics, anti-Parkinson’s, antihypertensive, diuretics or hypnotics can also increase risk. Psychological factors such as dementia, anxiety, depression, decreased cooperation, impaired insight or judgment (esp. re: mobility) also increases risk for falls. Finally, the higher the level cognitive impairment, the higher the potential for an incident.

The overall FRAT score is out of 20, with a higher score indicating increased risk. A low, medium or high Fall Risk Status is identified on the resident’s care plan. For those with identified risks, intervention strategies can be formulated, and referrals to other specialists may be initiated. For example, a geriatric psychiatrist or pharmacist may be consulted to review medications. Additionally, an occupational therapist may be required to assess mobility to determine the need for mobility aids and appropriate footwear. For example, hip protectors may be recommended. Also, anti-slip etching can be applied on the floor around the bed and most certainly should be in the bathroom in the shower area.

Identify, Prevent and Reduce Risk

Most falls can be prevented, and education is key. If You Fall is a guideline that can be kept on hand regarding what to do if a person has a fall including “How to get up” and the importance of “Telling the doctor.”

Regular exercise can help strengthen muscles and keep the body limber. It can also help with balance issues. Seek out the help of a qualified professional such as a physiotherapist for a tailor-made exercise program.

A healthy balanced diet and regular doses of sunshine (or Vitamin D) are also important to help keep bones and muscles strong and healthy.

Whether the older adult is living independently or in a long-term care setting, education and assessment can help identify, prevent and reduce the risk for falls. If you are keen on the subject, consider holding an awareness month, week or day like the Fall Prevention Awareness Month promoted in British Columbia and consider what kinds of activities you would like to include.

 

Angela G. Gentile, MSW, RSW

August Janice Bailey, Dip. Herb, HCA

 

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Angela G. Gentile, M.S.W., R.S.W. is a clinical social worker and author of the book, “Caring for a Husband with Dementia: The Ultimate Survival Guide”, “A Book About Burnout: One Social Worker’s Tale of Survival” and the “Dementia Caregiver Solutions” app for iPhone and iPad. She lives in Winnipeg, Manitoba with her husband and two adult children. For more information, visit: www.AngelaGGentile.com

August Janice Bailey, Dip. Herb, HCA is a Health Care Aide, an herbalist, a writer, and a falls prevention researcher and analyst. She is interested in many aspects of healthy aging including  nutrition and movement strategies. She works with seniors to reduce fall risks in their homes. August lives on the West Coast in Courtenay, British Columbia with her daughter. She can be reached through LinkedIn.

 

Additional References/Resources:

Government of Manitoba (2014). Critical Incidents Reported to Manitoba Health. Retrieved from http://www.gov.mb.ca/health/patientsafety/docs/ciq31314.pdf

Preventing Falls in Older Adults – Winnipeg Regional Health Authority, Manitoba, Public Health Resources  http://www.wrha.mb.ca/community/publichealth/PREVENTINGFALLSINOLDERADULTS_000.php

Partners Seeking Solutions with Seniors and Manitoba Pharmaceutical Association. Date Unknown. Fall Prevention: How does what I take or what I drink affect my risk of falling?  Retrieved from http://mpha.in1touch.org/uploaded/web/Legislation/Practice%20Resources/PSSSFallsPreventionPamphlet%20Updated%20Nov2014.pdf

Scott, V., Wager, L. and Elliott, S. (2010). Falls and Related Injuries Among Older Canadians. Retrieved from http://www.hiphealth.ca/media/research_cemfia_phac_epi_and_inventor_20100610.pdf

Statistics Canada (2014) Seniors’ Falls in Canada: Second Report. Retrieved from http://www.phac-aspc.gc.ca/seniors-aines/publications/public/injury-blessure/seniors_falls-chutes_aines/index-eng.php

Winnipeg Regional Health Authority (2008). Personal Care Home View, April 2008. 5:4. Retrieved from http://www.wrha.mb.ca/ltc/pch/files/PCHView_Apr08.pdf