active ageing and elderly care
The Malta Independent on Sunday 21 July 2019
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active ageing
HEAR now
Because our hearing ability often alters with age, we asked CHRISTOPHER DEGUARA, BSc(Hons)UK, MSc(Aud)Melit, for some ways to understand this process and to help with the symptoms. How does our hearing alter with age?
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earing loss is a natural ageing process. It decreases our ability to hear the entire hearing frequency spectrum. Each letter and sound in our environments has a different frequency at a different level. However, this is subjective to each and every individual as a result of genetics, awareness of hearing prevention and hearing care, and incidents one encounters throughout one’s life.
What types of hearing loss might affect people as they age and what causes them? There are three types of hearing loss; 1. Sensorineural: caused by damaged cells in the Cochlea, a snail-like hearing organ converting mechanical sound waves into electrical signals and transmitting to the auditory cortex of the brain, for sound to be processed into words and environmental sounds such as the sound of an air conditioner fan. 2. Conductive hearing loss: sound waves are inhibited from reaching the Cochlea as a result of a mechanical restriction which could be caused by: • Excessive ear wax • A foreign body in the ear canal • A perforated ear drum which could be caused by inserting cotton buds or foreign objects inthe ear canal. • Reduced mobility of the three smallest bones of the body found behind the ear drum and the Cochlea. 3.Hearing loss from both sensorineural and conductive causes. Sensorineural mostly affects elderly people. However we also diagnose elderly patients with mixed hearing loss resulting from middle ear bone degeneration such as Otosclerosis.
What can be done to help prevent and delay hearing loss? As audiologists one of our main objectives is to promote awareness on prevention. It is crucial to stress how exposure to excessive noise, occupational as well as recreational, causes hearing loss. When exposure to such environments cannot be avoided it is recommended that hearing protection devices are always used. These can be also be custom made for improved
efficiency and comfort. Examples of such environmental sound areas are Listening to loud music with or without headphones Exposure to high impulse noises such as shooting or fireworks Working with power tools, machinery or on other loud noisy environments.
Are there obvious symptoms of ear/hearing problems which people should look out for and not ignore? The main symptoms will probably be observed by family members and their loved ones. These may include: Watching TV with the volume exceptionally loud The person finding discussions harder to be understand and/or mixing words which sound alike. In my experience persons with hearing loss tend to deny it until it reaches a level where their quality of life is diminished, through social isolation, from limited participation in daily social activities either recreational, occupational or voluntary.
What should people do when they become aware their hearing is not as sharp as it could be? If someone observes the effects of hearing loss in their loved ones an audiological consultation with a registered local audiologist is recommended. This gives the opportunity to assess the health status of both the right and left auditory system. More awareness is required of the necessity of such visits being part of an annual health check, especially for people over 60, so problems can be detected early. Then the habilitation process, when it comes to aiding and improving one’s hearing and understanding capabilities, which are two different physiologic processes, will also be much easier.
What are the effects of hearing loss on people as they age? Hearing loss happens so gradually that
How can we safeguard our hearing?
a person can adapt by substituting their sense of hearing with that of vision by lip reading. But this can only suffice to a certain extent. Other effects include Having the TV too loud and annoying other family members. Embarrassing situations during conversations, caused by answering questions wrongly, leading to a person not speaking or using monosyllables, without actually understanding what is being said. Being a higher risk of accidents either as a pedestrian or driver Research reveals how hearing loss and Tinnitus (ringing in the ears) is quite annoying and distressful; making someone choose to avoid social activities leading to a reduced quality of life and other health issues associated with hearing loss that include depression, social isolation, dementia, cognitive decline and falls.
Our ears need to be checked and cleaned routinely by an ENT specialist, using micro-suction technique. It is essential to protect our ears when they are exposed to water, especially while swimming or washing, as these could be a source of infection. This can be done by using customised protection devices recommended by your personal audiologist. Protection is also essential when one is exposed to loud noise. It is essential to encourage the younger generation to the use custom-made protection devices provided by an audiologist.
What can be done to improve things for people with hearing loss and where can they find help? Currently, several hearing solutions working hand in hand with modern technology can be found. We have two independent hearing systems the left and the right, similar to our vision. They function independently, but complement each other to attain one single objective. Thus, hearing loss in the left ear can be of a different level than in the right. So, like using spectacles with two different lenses, we may need to use two hearing aids ( binaural hearing aids) to support each system and programme each hearing aid as clinically indicated. Whilst the professional responsibility of the practising audiologist is to provide the appropriate hearing aid power for each individual’s hearing loss level, ultimately the level of performance is the exclusive choice of the individual. But, it is recommended that a person goes for the most appropriate level of performance, according to the needs of their daily activities, to improve their quality of life. But as a result of the social stigma of the old large banana-style hearing aids people need more support from relatives and friends to seek audiological advice on the health of their ears and the effects of hearing loss or associated comorbidities. Then they can benefit from the hearing systems technology that is available today to improve their quality of life, and that of their loved ones and care givers, by improving communication which is essential for overall care and the quality of life we all deserve. Christopher Deguara, BSc(Hons)UK, MSc(Aud)Melit.
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LOVELY WATERCOLOUR memories What are your earliest, happiest, wildest recollections and how can you capture them to savour and share?
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t a certain age we spend less time craving the new and challenging and begin to value going back, either physically or in our imaginations, to places we've loved. We long for time to revisit old friends and retain an interest in the things we loved doing; staying involved however we can. We reread books, leaf through photo albums and use music, old movies, reunions and every means of communication possible to hold on to whatever made us happy and fulfilled decades ago. This is not necessarily because life now is any less enjoyable although, sadly, that may be the case for some people, but because our past is who we are. It's the sum of ourselves – what we've achieved, created, enjoyed. And whatever the total may be; regrets and triumphs, delving enthusiastically into our memories can not only bring back so much, but also help us deal with incidents and times to come. Past experiences can influence current situations for the better and give us the courage of our convictions, when we have to call on it. There is plenty to be said for the theory that wisdom comes with age.
A lot is said and written about keeping our minds and memories alert; it's easy to fear losing either when we forget that some of us may not have had very good memories in the first place. But going back in time and mind is a useful exercise. Doing it to collect family stories and memories for future generations, as if compiling notes for a family saga or novel will make it less like one of those 'what to do after 50' suggestions. And another thing, they may not give it a thought now, but by the time they have their own partners, children and grandchildren the information they can find, will provide future family members with their own sense of heritage. Reality TV programmes and internet sites that help people trace their family tree have never been more popular. Discovering details about past family members is fascinating, especially if some of it might have been hidden for various reasons. Not all would be unpleasant. People have hidden great feats of heroism through modesty or because they themselves didn't believe they had done anything exceptional. But, considering the interest in period dramas and documentaries it's not surprising that spotting a
gadget, mode of transport, fashion item etc from our reminds us again how things have changed. Fast as things are changing it's highly likely that the sight of a CD player today will conjure up the same flicker of nostalgia as portable record players do for
those who used them to listen to the music of the time. What to do then, as an excuse for hours of daydreaming about happy events? Preserve them. Take photos of certain treasures – paintings, jewellery, household items and decorations, trophies etc. Gather
old letters and get prints of old slides and photos. Then catalogue them, including captions, as far as possible of who is in each photo and when, where and why it was taken. Write short explanations of when and how certain possessions came to you. It will save future generations wondering where they are from and what they meant to you and may add a very special sentimental story for them. Use the time to make memory books for children and grandchildren or archive material for schools or museums. Also edit and remove whatever X-rated material you would prefer went no further than your own private drawers, and to write little messages or postscripts on letters, diaries and notebooks that you intend to leave behind. And never imagine that anything is too small or
insignificant. Letters and diaries from past years can clarify many unanswered questions and give those who read them welcome reminders, explanations and answers to questions they didn't or couldn't ask. For example, the father whose old school reports, containing his teachers' assessments and the headmaster's comments explained, some 60 years later, why he had never bawled his daughter out for day dreaming and not concentrating during boring lessons. They had both, received similar reports for the same lessons. And he had been too honourable to punish his daughter for something he had done himself. Generations today share things and speak to each other more than any other. But for many more to come these connections with each others' past lives and memories will always reveal a far greater understanding.
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JULY 2019
THE WAY we were
LOUISE DINGLI ponders on the way aging changes so many of our perceptions.
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s we get older everything changes. I don’t mean just physically, – wrinkles, receding hairlines and most of our anatomy heading south. I mean our perceptions, and what we have always believed to be long-held truisms. It may sound trite but we are not the same people we were 40, 20 or even five years ago. Since stumbling into my pension years, I think I am entitled to refer to myself as a practising geriatric, so I feel able to speak for, at least some, members of the wrinkly generation. An extreme example of what I mean happened to my wife and I just recently. We were sitting on a bench, overlooking a beach on a warm spring day; just sitting chatting and generally enjoying the ambience. Until my wife broke the spell by asking me if I could recall a similar scene from our long departed childhoods. She was referring to occasions when I, my siblings and friends would be taken to the beach by our paternal grandparents. We kids would charge around like mad things, prodding the depths of rock pools, kicking a football along the sand or just generally being hyper energetic. But, seeing Nannu and Nanna seated serenely on a bench watching our games, I was often moved to feel sorry that they, for reasons that I could only imagine, were missing out on the fun that we youngsters were having. This same grandfather never missed listening to the news on Redifusion at midday. And for the 10 minutes or so that the bulletin lasted we kids would be told to clear off out and play, or else to keep silent for the duration of the broadcast. At the time I could never understand why Nannu wanted to listen to such dry old stuff. But these days I too have become a news junkie… yes even when the producers of the stuff are intent on spinning it politically or struggling to find news of any consequence. Like most young people, when I watched some poor old geriatric performing some poor old geriatric task… like pottering in the garden, I always swore I would
never ever be reduced to such dull, sedentary jobs when/if I ever reached my dotage. And yet here I am today, happily deadheading the flowers and sweeping up the bougainvillea leaves slowly and methodically. And that’s another thing I’ve noticed as the years have crept up on me, these days I do things, everything, so much more slowly– not slower and better – just slower and more methodically. It is often observed that the older one gets the further to the right (politically) one moves, I think this is true. As a young man I was certainly very left-wing, it is just my luck that at a time in my life when I may have wanted to vote for a centre right political viewpoint, there is no longer a centre right party to vote for. A recent poll among older people threw up the figure of just 40% of over 55s who would claim to embrace, and be au fait with, information technology, including social media etc. I consider this a surprisingly low figure, or maybe it’s because I need to be reasonably proficient in
using a computer for my work. But even so I steer well clear of stuff like Facebook; and with good reason in the light of recent happenings. Incidentally, my cousin Martin – (three months younger than me) still thinks Facebook is something the police keep to refer to multifarious mug shots of criminals. On the other extreme, I recently sat behind a young woman on a bus journey from Valletta to St Paul’s. Just as nearly everyone now does, she never once looked up from her phone throughout the entire journey, as she tapped away at it non-stop. And, from over her shoulder I could see why. She was imparting information of riveting relevance to a third party. It must have been spellbinding stuff. At Pieta I read the, maybe secret coded message, which went: “I’m eating a brownie on the bus now, will text again when I finish it.” Sometimes I’m glad I’m no longer of an age where I might ever find the need to impart that sort of drivel to anyone… young or like me… ancient.
Summer Events at CAREMALTA CareMalta strongly promotes activeageing and proves this through the various activities it organises on a regular basis. The summer brings about ample feasts and events and CareMalta strives to celebrate these special events by bringing them closer to the residents under its care.
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radition and experience were the main ingredients of a very eventful week at Casa San Paolo. The 'traditional feast' was celebrated in one of CareMalta’s facilities to bring memories and promote the idea of active ageing in long term care. An event which was
organised by the home with the support of volunteers and the participation of residents themselves made this activity a special one. A lot of work and preparation went into the organisation of this successful event. The ‘festa' was held by the pool which was surrounded by decorations one can immediately associate with a traditional village festa. The event included band marches and traditional food and drinks to create the right atmosphere for the benefit of the residents, some of whom had not been to a village feast for quite some time. Whilst this event is one of the many that are continually organised at homes
run by CareMalta, this festa is one of the most anticipated events. It is one of the main events that form part of the company’s Active Ageing programme
for the 1600 residents under CareMalta’s care. CareMalta also organised an event on the eve of Imnarja Feast at Zejtun Home, another home for the elderly that it operates. The main event was held in the garden where an exhibition of animals was displayed all around for the residents to enjoy, along with an exhibition of fruit and vegetables and a showcase of old farm equipment related to this feast. One of the residents at this home also displayed his personal collection of wooden handmade works. A number of gazebos were set up along with stalls for drinks, ice-cream and freshly cooked imqaret apart from a fenkata, prepared for the local residents and finger food for all the guests along with live entertainment. A raffle was also organised with a number of hampers to be given out as prizes to the lucky winners. For more information about CareMalta kindly visit www.caremalta.com or call on 22584200
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ADJUST YOUR HOME for simple living It's never too soon to take stock of our surroundings and wonder how they will work for us in the future
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e always imagine our homes being a haven of comfort and security, but as we age, and our needs and expectations change it's a good idea to think about, and make, easy and practical changes here and there to ensure life will not become difficult in the one place we may want to remain, home. Take some time to wander through you home and think where problems might occur. Consider floors and floor surfaces. Are these fairly level and in good condition with no bad cracks, uneven tiles, broken steps and banisters? A hand rail or ramp could help if there are steps up to your front door, or if your rooms are on various levels, as many are in older properties and houses of character. A stair lift could make all the difference if you are unable to have a
bedroom and bathroom on ground level. And today many people are adding lift shafts to new designs, to be ready in case they are needed. Any outside areas need to be assessed for safety to ensure they are secure. Ground surfaces should be slip-proof all the year round, and they need extra lighting. It is a good idea to have switches made to work from indoors and outside, especially if there is a courtyard thoroughfare, or regularly used garden rooms. In small gardens and courtyards large pots and raised beds on non-slip tiling or artificial turf make an attractive, easy-care outdoor space to grow plants, entertain and relax. Check that boundaries are strong enough to serve their purpose, that stone walls and pillars, both ornamental and those acting as supports, are not eroding, and replace missing slabs and pointing before these cause problems from crumbling, shrinkage or damp.
Wrought iron fencing and railings for balconies, terraces and outside staircases need checking for signs of rust and corrosion. Damaged rivets and bolts can easily work loose and cause a serious accident. Ensure that climbing plants, and those with large roots, are not damaging their own surrounding area. Make sure water pipes and electrical items are in good condition and can be easily reached if necessary. You might also think about installing extra outside lighting and security features and alarms. At the same time you could put in a video entry phone or intercom so you don't have to answer the door to strangers. And it may be useful to fit a key safe by the front door; that is a small secure box to hold your door key. This is particularly useful if you want relatives, friends or carers to be able to come in and out. Doors and windows,
active ageing
especially wooden ones can become ill-fitting over the years causing drafts and leakage from rainfall. Repair or replace them gradually so they don't become a serious problem. This also goes for roofs, where a permanent membrane or other waterproofing solution should stop the threat of problems in future. Keep up to date with any solar heating system inspections and persuade someone kind to check your water tank now and again to avoid overspills. For indoor rooms like bathrooms and kitchens, where there is a lot of movement and the involvement of hot pots and pans, water and slippery surfaces, a lot can be done to help prevent accidents. Check plumbing systems regularly, install easily operated taps, and shelving that is easy to reach. Safety switches, grab rails, banisters on steps and stairs, safe floor surfaces and locks and bolts that are easy to operate are all worth putting in before they become vital necessities. This will give a home added security and comfort and save the extra upheaval of having
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work done as an emergency, instead of when you can plan for it. As time goes by you will be glad you have not left helpful alterations till the last minute and you will be discovering that there are literally hundreds of fascinating and indispensible gadgets available in stores and online, that will relieve the strains of everyday chores and activities, should they appear. All through our lives we've looked for quicker, easier ways to do things we have to do and we think ourselves clever when we find some. We should not be put off seeking the same help by the patronising tone used to advertise so many of the services and tools that could transform our lives. So many of the current angles for targeting Generation P (pensioners) are unimaginative and, frankly, pathetic. Just one example – the obvious difference between ourselves and a 30something, smiling, blond, lazing in an adjustable bath tub wearing full make-up and a floral swimsuit. Just who do these manufacturers think their average buyer really is?
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GADGET Technology makes life easier as we get older but nobody wants to be reminded of the running years, so here are some useful gadgets that will fit into any multigeneration household.
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ho wouldn’t love a fun little ‘robot’ vacuum cleaner which hardly takes up any space and easily covers the spaces you have to get onto your hands and knees to reach; or an obliging robo-aide who can do everything from turning on the TV to making a cup of tea? And, the way things are going it will probably not be long before these things are part of every household. But, for the time being we have to rely on the gizmos and gadgets that are readily available to make life easier as time goes by. Large number cell phones are the answer for anyone with altering eye sight. Smart phones may be the most universally used models but cell phones can serve many purposes, including acting as a medical alert system. If having the TV volume at a considerate level means straining to hear it, and you don’t want to disturb your partner or neighbours by turning it up enough to be able to listen comfortably, try using wireless buds, or assistive listening headphones. The sound stays crisp and clear, you can listen to TV or hi-fi sound systems and they are light and easy to use. When health concerns arise it could be very reassuring if you have a digital talking thermometer. All the hassle of taking your temperature is removed, since it gives you your readings out loud , removing the need to peer at tiny numbers or try and work out the colour shades on regular thermometers. Steps and stairs are easier to negotiate with a step-up cane which gives you a mid-step ‘leg up’ on most stairways. And with some you only need to push a button with your foot to adjust the platform according to the size of the stairs. Sitting up in bed can be made easier with a bed ladder, which is a very simple bed aid that helps users to sit up in bed. The bottom ends of the cords tie around the bed legs, and
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TS for all the ladder rungs enable the user to pull themselves up with a hand over hand movement. It is suitable for single to king size double beds. Free standing holders for hair driers, bottle and jar openers in multiple designs, accessories to make writing easier for people who have difficulty gripping pens, tools to make handling door keys and unlocking doors simpler, multiple aids for use in bathrooms, kitchens, gardens, for reading print, holding books and kindles can all be found with a little searching. Of course, everyone would rather be able to manage as they always have done throughout their lives, but few people can do that as age creeps in. We are lucky to be living at a time when so much attention is paid to helping older people to remain independent and able to enjoy as much as they hope to. Technology, it must be admitted can be a huge help and a lot of fun. And, for now at least, with some simple hints on settings and security, we can use it on our terms. Accepting change and embracing ways to combat its effects will mean the difference between giving in and feeling defeated or carrying as on as usual and enjoying life.
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Ensuring SAFE TRAVEL cover Time to travel does not always mean it’s easy to just pack up and go. Here are some hints on avoiding one obstacle that prevents so many older people from travelling – insurance
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ou are fit enough to get about, give or take a few aids and perhaps some occasional assistance. You can afford basic transport and accommodation, and you and your travel companions, if you choose to go with any, see no reason why your holiday plans should differ from those of previous years just because you hold a karta anzjan. But they do. Numbers speak louder than words and no amount of written health certificates, spotless driving licences, no claim bonus records on insurance policies, or Instagram shots of your latest bungee jump are going to convince travel insurance providers that you are younger than it says on your passport! They seem to be convinced that elderly travellers are a high risk; more likely to fall, causing themselves serious injury, become ill, or need extra medication if their journey arrangements change. Statistics are used to justify upping the cost of even basic insurance for travellers over 60, and hiking it steadily for every five or 10 years after that. Many companies will not even offer cover to anyone of 70 plus, at all. How many travellers must seriously wonder whether it is better to risk the cost of medical care, repatriation, replacing possessions, whatever, against a possible four-figure sum paid out and no claim being needed after all? Holiday costs can be mitigated by travelling with companies that organise and conduct tours designed for older people or by travelling in off peak times and looking out for low cost options and all-in deals, to keep the cost of the holiday itself down. These may not be to everyone’s taste and will not work if you want to join a family holiday with a mixed age group. In which case, you will be
needing insurance one way or another, so what should you be looking for? Make a list of items and eventualities you may need to be covered for and refer to it frequently while choosing your policy; especially if you already have some form of travel insurance, through your personal policies or travel agent, for example. You could avoid doubling up on coverage. Check very specifically what the each policy covers. If something is not clearly written down don’t assume it will be included somewhere else. In all cases, find out and obtain whatever health certificates and vaccinations you may need. These and a’fit-to-fly’ certificate from your doctor could mean the difference between whether or not you are successful if you have to make a claim. • Medical coverage: This can be just to cover illnesses or injuries that happen while you
are travelling. But, to be on the safe side, it should also cover all preexisting and chronic illnesses, even those that are in remission. And don’t leave out conditions which you have had so long, and are managing so well, they have ceased to be an issue for you. If you do not mention these when purchasing your cover you could find any payouts being halted, should they flare up or cause problems on your trip. • And not to put a downer on anyone’s travel plans, you could consider evacuation and repatriation coverage, in the unlikely event that you become unable to leave your destination or travel home in normal circumstances. • Baggage coverage: This is to cover the cost, as far as possible of replacing possessions that are stolen and/or damaged or lost beyond all hope of recovery. It
is a mine field, really. The moral is simply, don’t travel with irreplaceables, because insurance compensation rarely actually replaces. The most it can do is compensate, at probably less than face value for much loved items of clothing, sport equipment, the fruits of holiday shopping trips and i-phones and tablets, though sadly not the data they carry. Find coverage which relates to the countries you are visiting, your means of travel, whether you are taking only carry-on baggage, or not, and whether your luggage includes commercial items. • Financial default coverage: provides reimbursement for payments made to a travel supplier that completely ceases operations due to financial default or bankruptcy. Booking and travelling through recognised travel agents gives some protection in these cases, but
do-it-yourself holiday trips can leave you open to the ejja hamorru attitude of pop-up B & Bs and airlines. • Miscellaneous Finally consider how much it could cost to sit out an unpredictable weather event, replace lost or stolen cash and bank cards or airline tickets; sort out technical malfunctions while making bookings on line, or printing out tickets, missing a flight, losing prescribed medications – these could all be very costly, With the right approach you should be able to find the insurance you need, even if it means working out tailormade coverage. There are companies who are savvy enough to see the potential advantages of offering insurance to older travellers, and that is where you should begin. And many policies can be flexible enough for you to minimise the premiums and still be well insured!
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New services for ELDERLY CARE in the community
The work of the Parliamentary Secretariat for Persons with Disability and Active Ageing is strongly focused on improving the lives of elderly persons living in our community. Thus, its efforts are greatly directed towards providing support through service provision for those residing in their homes.
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nly last week, the Parliamentary Secretary for Persons with Disability and Active Ageing, Anthony Agius Decelis, following the demand from numerous
elderly persons, launched a new phlebotomy service. While as things stood, there are free phlebotomy services at Mater Dei Hospital, those who have mobility problems have an issue as there is no free service that currently caters for them. At best, such clients resort to
private services, with the consequent financial burden. On the contrary, the newly introduced service will be provided in the comfort of the individual’s home, according to the client’s requirements and eligibility criteria. The main objective of the new
phlebotomy services, launched as a pilot project in Birkirkara and Mosta, is to deliver a safe, accessible, good quality and convenient free of charge phlebotomy service; to housebound elderly and persons with disabilities. Those requesting such service, as well
as those interested in gathering further informaton may call on 2258 9393. Another pilot project which was well-received, is that ofSilver T, a free transport service, for older persons to run errands independently within their community. Starting in Żurrieq, Mosta and Gżira, as a pilot project in 2018, this initiative was later extended to: Baħrija, Burmarrad, Ħal Safi, Imtarfa, Imsida, Rabat and Ta’ Xbiex. Other on-going community services cater for the diverse needs of older persons from providing daily support, household maintenance, recreational to professional therapy. To name a few schemes, the Department of Active Ageing and Community Care provides handyman services, meals-on-wheels, home help, occupational and physiological therapy. Additionally, the 28 active ageing centres across the country ensure that older adults participate in a variety of activities and events. Further to this, in the coming weeks, a new service in the community targeted at addressing mental health issues amongst the elderly will be launched. The Parliamentary Secretariat for Persons with Disability and Active Ageing truely believes in the importance of a holistic approach towards elderly care, being it in residential homes, or for elderly persons living in the community.