Senior Toronto blog

January 29, 2019

Get some sleep

Sometimes I think I’m nothing but a leaky bucket. I’m up every couple of hours all night long. By about 4 am, my body gets fed up with all those interruptions, and won’t go back to sleep any more. So then the next day I’m a zombie, walking around in a daze, can’t get anything done. And the next night it’s the same thing all over again.

You too? We’re not alone. Over 50% of seniors have insomnia. There are plenty of possible reasons: medical or psychiatric disorders, chronic pain, medications, frequent urination at night, bereavement, financial problems, sedentary lifestyle, too much napping, and on and on. If you ask Dr Google, you’ll get lots of contradictory scientific-sounding advice, folk remedies, ads and testimonials. So I decided to search the medical literature, to see which insomnia therapies have actual hard evidence behind them.

Here’s a selective summary of what I found. I’ve included only actions you can take yourself at home, for free. Of course, you can also enroll in a sleep therapy program, but you have to pay for that. You should see your doctor to rule out or control medical conditions that might be affecting your sleep. If that results in a prescription, make sure you’ve discussed all the possible side effects and interactions with your other medications. You don’t want anything that will make you groggy in the daytime and liable to fall. It’s the same issue with over-the-counter remedies, with the added hazard that Health Canada maintains very lax standards and provides virtually no oversight over this industry. So you never know what you’re actually getting; producers can lie with impunity on their labels.

Pick whatever you want from these categories. Apparently you get better results if you use approaches from more than one category.

Stimulus control

  • The goal is to associate your bed only with sleep (well, and maybe one other thing)
  • Don’t watch TV, talk on the phone, listen to the radio, check your messages, read or eat in bed
  • Go to bed only when you feel sleepy
  • If you can’t fall asleep after 20 minutes, leave the bedroom and engage in relaxing activities like reading on the couch until you feel drowsy, then return to bed

Sleep hygiene

  • The goal is to practise healthy behaviours that promote good sleep
  • Exercise regularly, but not within four hours of bedtime
  • Avoid tobacco, stimulants, caffeine and alcohol six hours before bedtime
  • Avoid excessive liquids and heavy meals three hours before bedtime
  • If you have to take naps, limit them to 30 minutes or less, before 3 pm
  • Get up at the same time each morning
  • Make sure that the bedroom is dark and quiet, and that the temperature is comfortable
  • Increase your exposure to natural light and bright light during the day and early evening
  • Don’t watch the clock

Relaxation

  • The goal is to counteract stressors that interfere with sleep
  • Practise progressive muscle relaxation in bed
  • Avoid unpleasant or strenuous tasks right before bedtime
  • Don’t watch TV or use a computer near the time you want to fall asleep
  • Avoid strong or negative stimuli like computer games or horror movies near bedtime
  • If you have a smartphone, turn it off at night and don’t keep it in the bedroom
  • Schedule time to wind down before bed. Give yourself at least 15 – 30 minutes. Try meditation, deep abdominal breathing, yoga, crossword puzzles or a warm bath. Write down your thoughts in a journal

Sleep restriction

  • The goal is to improve sleep efficiency through mild sleep deprivation
  • Figure out how much time you actually spend sleeping
  • Limit the amount of time you spend in bed to the number of hours you spend sleeping, but it shouldn’t be less than five hours. If you’re not sure, pick six hours
  • Spend only that number of hours in bed. Adjust your bedtime, but still get up at the same time each morning
  • If you are wide awake during this time, get out of bed and carry out a quiet activity like reading outside the bedroom. Go back to bed only when you feel drowsy
  • Keep to this schedule for two to four weeks
  • After you reach 85% sleep efficiency, increase sleep time by 15 minutes each week until you obtain seven to nine hours of sleep per night

December 29, 2018

How do you know you’re old?

We’ve all read those jokes, mostly written by young people, and usually downright mean. See what you think of these. They’ve been vetted by a group of wise seniors (my pals and I).

You know you’re old when

  • No one asks you for ID to prove you’re old enough for the senior discount
  • Salespeople at the hardware store come up to you unbidden and ask you if you need help
  • Middle-aged people offer you a seat on the subway
  • Grocery store cashiers spread out the heavy items among all your bags, so no bag will be too heavy for your old bones
  • You don’t have a smartphone because you don't see the need and don’t want the distraction
  • Sales staff and receptionists paste on a benevolent smile and talk to you loudly and slowly
  • People stop asking you for directions
  • You still cook from scratch and don’t think it’s any big deal
  • Waiters stand there watching to see if you can figure out the pay-at-the-table credit card reader
  • You’re glad to have a whole day at home

November 29, 2018

What to do when you’re stuck at home

Winter started early this year, with snow and slush already in mid-November. Looks like it’s going to be a long haul. For those of us seniors with a fear of falling, this means a long season of staying put. What can we do with those dreary days at home? Here are a few ideas to keep from landing in that blue funk:

  • Get an e-reader so that you can download books from the Toronto Public Library. Then you don’t have to worry about getting to the physical library if the weather’s bad. Make sure you pick an e-reader that allows you to download library books. See TPL’s instructions.
  • Pick some kind of music you want to learn more about. Find an internet radio station that plays that music. Start listening.
  • Learn to cook something new. Maybe learn how to bake bread, or cook some vegan dishes.
  • Learn to play euchre or cribbage. There are lots of websites that explain how to play and let you practise online. Then, if you move into a retirement home later on, you can join right in.
  • Find some exercise videos you can work out to. There are plenty of free workouts for all levels of fitness. Here’s a good starting point.
  • Stock up on puzzle magazines. Try different kinds: crosswords, Sudoku, cryptograms, logic. Use a mechanical pencil so the point stays sharp.
  • Start a blog. It’s easy to do with free software you can find online. We seniors need to make ourselves heard.
  • Get a Lego set or some jumbo jigsaw puzzles. Set them up someplace where you can leave them out, and just keep returning to them when you feel like it.
  • Teach yourself to play the ukulele. Buy a cheap one and maybe an instruction book, or try some online tutorials. Once you know three or four chords you can play hundreds of songs. Sing and play your heart out.
  • Volunteer from home. Go to Charity Village and check the box that reads Only show home-office based volunteer positions.

October 30, 2018

We’re getting soaked

Why is it that so many products and services we seniors need to maintain our aging bodies and manage our lives are so bloody expensive? I guess people in these businesses haven’t been reading the StatsCan reports and think we’re all millionaires. Here are some of the more outrageous examples.

  • Eyeglasses. Many of us need bifocals, so the lenses alone can cost from $500 to $1000. But then why does it cost hundreds of dollars more for frames? They’re just a bit of plastic or metal and a few screws, all mass-produced. Did you know that just one company controls most of the market?
  • Hearing aids. These can range from $1200 to $4000 and more for each ear. You sometimes have to pay dispensing fees too. Ontario’s Assistive Devices program may subsidize you to a maximum of $500 for each aid. The components actually cost only about $100 to make.
  • Orthotics. If you have fallen arches or plantar fasciitis, you might be given a prescription for custom orthotics. They typically cost between $300 and $600. In Ontario, they can be prescribed only by physicians, podiatrists or chiropodists, and provided by podiatrists, chiropodists or pedorthists. There is strong evidence of effectiveness for only a few conditions. There are lots of unauthorized people selling orthotics for conditions that won’t get any benefit. Do your homework.
  • Good walking shoes. If you have orthotics, you need roomy, sturdy walking shoes to put them in. These days, a pair can cost from $100 up to $400. Good walking shoes have always been expensive, but in the last few years the price has stayed high while the quality has gone down. Nowadays the treads wear smooth in a year or two, and sometimes even fall off in pieces. Many shoes are now made of synthetic materials instead of leather, and they cause blisters. Often the manufacturer doesn’t even tell you any more what the shoes are made of, not in the shoe, not on the box. They do tell you what the box is made of, though.
  • Dentures. It’s pretty common to lose teeth in old age, and then we need dentures. They can cost from $1000 to $30000 or more, depending on whether they’re partial or complete and what techniques are used. Even if you have extended health insurance, dentures are often considered cosmetic and aren’t covered. Explain that to someone who has no teeth.
  • Mobility aids. The Ontario Assistive Devices program (ADP) pays 75% of the cost of mobility aids such as manual wheelchairs, power wheelchairs, power scooters and wheeled walkers. You are allowed to buy only ADP-approved equipment from ADP-approved vendors. But the pricing framework does not reflect current costs. An equipment vendor may not be able to provide certain ADP-approved equipment because the maximum funding through the ADP does not cover the wholesale cost of the equipment. Small independent stores selling mobility aids can’t absorb these cost overruns and therefore often cannot provide the prescribed equipment, even though it is on the ADP-approved list.
  • Physiotherapy. In 2013 the Ministry of Health delisted non-hospital physiotherapy from OHIP. They also delisted one-on-one physiotherapy in retirement homes. Now some insurance providers are delisting it too. Seniors (65+) can still get coverage if we meet the criteria, which focus on acute care. To get the service, you must go to one of the designated publicly funded clinics. Typically, they provide 20-minute group sessions. You may be put on a wait list to get in. If your condition doesn’t fit the government’s criteria, you’ll have to go to a private clinic and pay for the treatments yourself.
  • Extended health insurance. If you were lucky enough to have extended health and dental coverage while you were working, you’re in for a shock in retirement. These plans provide only partial reimbursement for the various services, and limit the number of times per year you can use them. The caps or maximum limits for drugs, dental, vision, hearing and allied health care are generally low. You are really paying in advance for these services, whether you use them or not, plus the administrative costs and profits of the insurance company. So it makes more sense to just budget for these costs, set the money aside, and pay them yourself. If sometimes those expenses are lower than you expected, then the money’s there for you to use for other things.
  • Medications in long term care homes. The Ontario Drug Benefit Plan (ODB) allows pharmacies to charge a copayment of $2 for low-income seniors, or $6.11 for higher-income seniors, for each prescription. In practice, most pharmacies waive the $2 fee for seniors living in the community. But in long-term care homes, residents routinely get charged $2 for each prescription. Many prescriptions in these homes are packaged to supply a week at a time, and residents are charged $2 for each weekly package, forcing them to pay at least four times what they would pay in the community. It’s a fantastic windfall for the few pharmacy services that control this market.
  • Corporate trustees. Suppose you can’t manage your own finances any more, but don’t have anyone to appoint as your power of attorney for finance. You’d like to find a professional to handle this. Until a few years ago, you could arrange it through a trust company. But now trust companies will take this on only if your portfolio is worth a million dollars or more. Lucky for us we’re all millionaires.

September 29, 2018

Loneliness in old age

This won’t be news to you: loneliness in old age is rampant. It’s a disease, an epidemic, a tsunami. Just ask Google.

It doesn’t behave like other diseases, though. We don’t go to the doctor and have tests done to get diagnosed. We’re the ones who decide if we’re lonely. We might say we’re lonely if we feel that we’re not connected meaningfully to other people, to the world, to life; that we don’t belong anywhere. We might feel this way even when we’re surrounded by people, if the relationships are not satisfying. And we might not feel this way even when we’re alone; we might be perfectly content with solitude.

The research literature offers some surprises. It turns out that there are two stages in life when loneliness peaks. One is in young adulthood (teens and twenties), the time of life when we’re trying to figure out who we are and what role we will play in the world. That’s a lot of responsibility at a time when we don’t yet have life experience and resilience skills to help us through. The other peak is in old-old age (80+). That’s a time when our social world may be shrinking. We may have lost a spouse or close friends, and health issues may be keeping us at home.

I think there’s a special poignancy to loneliness among seniors. We need all the resilience we’ve built up over the years to deal with those painful losses and our own physical and maybe mental decline. Not everyone has the social skills or the will to make new friends at this point. Those who have had difficulties with relationships all their lives may now need to accept that this is how it will always be. And we may feel shame about our loneliness. We may not want to admit our feelings to others, and risk falling into the stereotype of the lonely old person, and becoming an object of pity.

I’m no therapist, and don’t want to serve up clichés. So I’ll just say that I think we need to become good, honest friends with ourselves in old age. That might involve figuring out just how much interaction we really want now, and what kind. Do we want high social involvement? Then we might look for activities like social clubs, book clubs, or group dining. Maybe we want high involvement, but where the main focus is not social. Then we might choose activities like choirs, fitness classes, sports, or card games. Maybe we want activities that don’t need to involve us very much, like lifelong learning classes. Or maybe we’d like high involvement solo activities, like reading, computer games, hobbies, or crafts. Maybe we don’t want to do any soul-searching, we just want to keep busy. No shame in that. Many seniors are very involved with family or religious activities or volunteer work. It’s pretty easy to fill up our calendar; there are hundreds of options right here at Senior Toronto.

On the wall in my computer room I have a print of Vermeer’s painting, The Lacemaker. A young woman sits bent over her work, bobbins and pins in hand. Her expression is intense, rapt, totally involved, mind, body and soul. The light shines on her face and hands. Behind her there’s just a grey wash, no hint of a background at all. There’s no need; her world is complete as she plies her craft. I love that state of mind and try to seek it out. For me it comes when I’m learning something interesting and feel myself grow in understanding, like when I’m preparing a blogpost or learning a new piece of music. Then I’m fully alive, and it gives me such pleasure, it’s impossible to feel lonely.

August 30, 2018

Carebots

Robots in eldercare: looks like it’s a question of when, not if. Our population is aging rapidly, as we baby boomers reach retirement age. We’re living longer too. There are more seniors in Canada now than younger people, so who will look after us all? The home care and long term care industries, always strapped for resources, are eager to find new ways to cut costs. Much robot technology has already been developed and is being deployed in Japan, where the population is aging even faster than ours, and where the use of robots in eldercare is now supported and promoted by government policy. So there’s probably a robot or two in our future. I hope that it’s not just presented to us as a fait accompli, but that first we have a thoughtful discussion about what the risks and benefits are, and who the robots should serve. How will carebots affect our lives?

Carebots can perform many chores now done by personal support workers in home care and long term care. They can bathe us, feed us, lift us into and out of wheelchairs, mop the floor, do the laundry, fetch and carry objects, dispense pills and more. So they could enable us to stay independent longer in our own homes. In long term care, robots would relieve care staff of some repetitive chores. We might even prefer a robot to a human caregiver for intimate tasks like bathing and dressing. But then we will lose the social interaction with human caregivers. Will we miss it? Interaction with human caregivers is not always positive. Who would you rather have change your diaper, a carebot or a resentful, burnt-out daughter? Who will control what the robots do? Will we seniors be empowered to start and stop the tasks? How would carebots be controlled if we have dementia? If the carebot drops you on the floor, who would be liable?

Carebots can be used as health and safety monitors. They could remind us to take our pills, detect falls, take our vital signs and relay them to medical staff, let staff know when we leave our beds, follow us around the house, and enable virtual visits by healthcare professionals or family members controlling the robot remotely. If family members can visit you virtually from the comfort of their own homes, or assure themselves that the carebot is looking after your safety, will they visit you less in person? What privacy do you have when your every move is being monitored, recorded and reported? Who should have access to all that information? What if carebots, in the interests of our safety and well-being, restrain us from doing what we want to do, like going out for a walk or binging on ice cream?

Finally, carebots can be programmed to provide companionship. They can respond to questions, show facial expressions, play games with us, use spoken words and gestures, and suggest activities. There are fuzzy, cuddly robot animals that wag their tails when they’re petted. If family members know the senior is kept busy and entertained with a carebot, will that give them guilt-free permission to visit less often? Is it deceptive and exploitive to encourage seniors to form relationships with machines? Seniors may be well aware that companion robots are not people, but may not mind if they enjoy the interaction anyway.

Policy about the use of robots in eldercare will ultimately be made by politicians, with heavy lobbying by industry players. I hope they seek input from seniors and seniors’ advocates too. Carebots should serve the needs of seniors first and foremost, not caregivers and investors.