Disclaimers, FTC (US) Guidelines

Ads are everywhere. On sites where one thinks one can avoid them. Why does Oprah have them? Really. A whole new industry has sprung up around this. There is a web site that promotes the "Secrets of advertising to seniors". There are ads for sites that promote advertising and try to get you to sign up! There are ads for housing, home care, pharmaceuticals, and assistance with ADLs. Now, there is a new target audience. Family members, stressed with caring for ailing parents are encouraged to buy electronic devices to monitor their parents, much like interactive baby monitors. I think we are lulled into a false sense of security. Our failing seniors want adult care, the human touch, and caring caregivers who will provide them with social interaction.

I take a great deal of pride in researching this blog. I have counselled many seniors around the issues of health care advertising aimed at seniors. I am increasingly appalled by the number, the extent and the range of advertising and propoganda, and blatant manipulation of seniors as businesses, and website managers, try to earn a buck.

The US, in its infinite wisdom, has instituted new guidelines, rules and regs around bloggers. Praise Be! 

• The complete revised Guidelines (PDF) can be found at .  The Federal Trade Commission has also posted several short videos explaining the Guidelines.

Perhaps it is time that Canada looks at the same issue.
The Canadian Association of Retired Persons (affiliated with the American AARP site - with BIG bucks and research dollars) has tons of ads, with little teeny articles that provide little information, and little credibility. The Vancouver-based: Association for Active Aging Professional, charges big bucks to sign up for their organization. Hundreds of dollars to keep abreast of current issues - logically a Canadian government responsibility, free of cost and supported by those committed to helping us all age gracefully. 

The revised US FTC Guidelines state that:

• Bloggers and online word-of-mouth marketers are required to disclose any material connection to a company
• When reviewing the company’s products or services (failure to disclose any payment or receipt of free product from an advertiser or someone acting on their behalf could expose you to liability);
• Both advertisers and endorsers can be liable for false or unsubstantiated claims made in an endorsement;
• Advertisements containing consumer endorsements, or testimonials, must disclose what results a reasonable consumer could expect from the product and can no longer rely on a disclaimer that “results may vary”;

This, of course, applies to book reviews, as well. 

MD Whistleblower: U.S. Preventive Services Task Force and Mammography: Evidence-Based Medicine or Medical Rationing?

MD Whistleblower: U.S. Preventive Services Task Force and Mammography: Evidence-Based Medicine or Medical Rationing?

The theories abound out there! They recommend not to check your breasts yourself. I disagree, as you must be familiar with what is normal for you and your body.

Yet, we see the research: 1 in 2000 women will be diagnosed through a mammography with breast cancer. 1 in 1000 are given false positives.
In Canada, 20 % of the screenings are in error. You be the judge.
Your age is the important factor. If you are in your forties, your breasts are too dense for an accurate reading. Once you hit age 50, they say to have mammographies every two years.

Scoot out of the way!

I regularly spot these fabulous transportation vehicles. I recall how difficult it was to persuade Dad to even use the a walker, let alone a wheel chair. Then, when he was confined to a wheelchair, it drove him crazy. 

Imagine the senior with limited mobility, having the freedom of zipping around town. Muskoka towns are populated with these scooters. With modern batteries, they can manage our hills and roads.

These little scooters are just a great transportation vehicle, but there have been accidents. I have had students with disabilities have to learn that their wheelchair is now an extension of their personal space. As the article says, those driving a scooter need to understand how much space they take up, and to avoid rolling over toes.

I have previously posted about the signs to watch for in senior drivers. It is difficult to be told that your skills are not what they have been.

Senior Drivers in the news tell us a story of dangerous driving, as response times increase, mobility is decreased, and age takes its toll on our bodies.

I spotted this gentleman on our way up to Lake Superior Park! Obviously, having a good time...he waved at every driver that passed by.

As I wrote previously in, Senior Drivers in Ontario, Transport Canada warns of seniors having car accidents in intersections. Current stats, in the recent Ontario move to more severely curtail teen drivers, reveals statistics that demonstrate seniors are more risky than newbie teen drivers.

I read a really sad, startling and funny article in Macleans.ca.

Beware of seniors driving scooters
Macleans.ca - Toronto,Ontario,Canada
He recalls one elderly man who gave up his licence “on the premise he could drive this thing like a car.” Repeatedly, police urged the man and his scooter onto the sidewalk.

“You are to yield to vehicles and bicycles,” he booms. “You can’t pull into traffic. Use the crosswalks. Wear bright clothing. Remember! You are a pedestrian!” 

I can't imagine telling such seniors what to do! Like teenagers, they take their new freedom for granted and the ones in the news story have been acting like hooligans. Rather a 2nd wind, methinks. 
Many new contraptions provide seniors with more opportunities for freedom and transportation. One man sold his father's car, invested the money and arranged for a taxi company to look after all of his transportation needs. This makes a lot of sense.


Col. Potter Cairn Rescue Network: Wheelchair riders often lose out ...
Last month, a 43-year-old Yucaipa man was left in critical condition after being struck by a truck while he crossed Yucaipa Boulevard in a motorized wheelchair. The truck was driven by a 16-year-old boy, who police said was not speeding and tried to stop before plowing into Wayne Swanson's wheelchair.

Patients need advocates

This is the kind of story that makes all of Canada look bad. One hospital with questionable, dangerous, illogical practices. My Dad had a brain tumour removed. He wasn't capable of much. This man, blind, with heart problems, was released after two day. On the way home he had a stroke and the Emergency crew did not want to readmit him without an EMS crew bringing him in. It is shameful treatment to leave him there for the 3 minutes they said the Emergency staff were arguing with the man's brother.

Stroke victim had trouble getting back into hospital

For more info, read the article.

This is the same hospital where Brian Sinclair died...

The Health Sciences Centre is the same hospital where Brian Sinclair, a 45-year-old double amputee with a speech problem, was found dead in his wheelchair after spending 34 hours in the emergency department waiting room in September 2008.

This really addresses the point that family members must advocate for patients. With underlying heart issues, hospital stays are risky for some. There are many Superbugs out there, and they thrive in hospital, but for someone with a heart condition to be sent home? 

What do you do if you do go home? In Ontario you are eligible for CCAC to send people to your home to give you care. In some instances, people are sent home without enough support in place. In this situation, there are groups who advocate for seniors, for example, to ensure that you have the right level of care. If you need a long-term care home, not a retirement home with little in the way of nursing care, it is your right to stay put. 

Women in my generation are faced with not just one, but potentially two parents or in-laws being home, ill and unable to care for themselves. The stories abound.

WHERE THE WOMEN WENT

This is a powerful documentary. I watched it previously on The Fifth Estate: "Where the Women Went". A sad tale of women trying to make ends meet. With the fishing industry collapsing, these women do what they have always done, worked hard at making a living wherever they can find it.

 Watch Where the Women Went online

They leave Newfoundland, to go across the water  to work in Nova Scotia. 

See the Google map: Newfoundland to Halifax

Scathing audit says Newfoundland ferry service fails to offer ...‎

HALIFAX, NS — The Crown corporation operating the ferry service that links Nova Scotia with Newfoundland is ineffective, inefficient and plagued with serious problems, the federal auditor general says in a report released Thursday.

 See "How the Women Get There"

Untrained workers, they work as live-in caregivers for the elderly, the sick, and the dying. This is a difficult issue for those who do not live in the cities or rural areas. Or for those without access to support services. The barriers to Aging at Home are immense for many people.

They have many issues, the first is getting from Newfoundland, going by ferry to North Sydney. Taking shuttle buses for another 6 hours to Halifax. One woman, a paraplegic, is cared for by these women, staying for days at a time. Another woman, with early Altzeimer's Disease, is cared for for two weeks at a time. This is a similar issue to the women brought in from foreign countries, to live with a family and provide care.

We know how difficult caregiving is when we care for our own loved ones. I cannot imagine how difficult it is to leave friends and family to work off of the island. 

Elder care is a huge issue in the world. We are not the only ones with problems. But what are we going to do about it?

H1N1 - on-line resources

The human brain is hardwired to be visual. I find maps and graphics of great help. Who knew we'd be tracking a pandemic in this day and age?

Google Maps has one of outbreaks. It appears to be Wiki-based, added to by users, and so take it with a grain of salt. They have maps on many other topics, too. At first blush, it appears out-of-date, since they cite Canada as having 53 cases, when, in fact Ontario alone had 79 deaths (according to TV media sources). Can you blame me for being dubious?!

Go to the nearest hospital emergency department or call 911 right away if you or your child has any of the following symptoms:

• Difficulty breathing / shortness of breath when doing very little or resting
• Continuous vomiting or severe diarrhea with signs of dehydration such as dry tongue, dry mouth, decreased peeing (no urine for the past 6-8 hours), or very yellow/ orange urine
• Stiff neck, sensitive to light
• Seizures or convulsions
• Confusion or disorientation

In Ontario you can phone Telehealth. Or, Ontario's Ministry of Health has created a self-assessment tool to help determine whether you or someone else has signs of H1N1. 

Influenza assessment for children UNDER 5 years of age 

Influenza assessment for adults and children OVER 5 years of age  

Download printable self-assessment charts for adults and children [PDF]


you are best to work with your provincial or territorial health care system, or contact your family physician, barring that, there are some H1N1 Regional Flu Assessment Centres, like those in Toronto, that are far preferable.


And then, there is helpful Microsoft, who wants to help you self-diagnose. I am leery of such, except that they do say to stay at home if you can manage your symptoms. For those in the USA: 

'Tis an American website, and they state: "This self-assessment is intended for residents of the United States only." You are required to put in your US Postal Code. It is interactive, and they are collecting data from this location. Interesting data, if it can be relied upon.

For More Information in Ontario

For information about seasonal flu, H1N1 and pandemic preparedness call ServiceOntario, INFOline at 1-800-476-9708 (Toll-free in Ontario only)
TTY 1-800-387-5559. In Toronto, TTY 416-327-4282
Hours of operation : 8:30am - 5:00pm

Telehealth Ontario at 1-866-797-0000
TTY: 1-866-797-0007
Hours of operation : 24 hours, 7 days a week

Do you glow in the dark?

The Globe published an article:

Experts urge tracking of X-rays, CT scans

X-ray technology has been around for decades, but the issue of radiation has been heating up as new research considers the health risks

 This is something I have pondered, but not for long. I am of an age when they recommend mammograms, but have not yet had one. I am unconvinced that, without symptoms or signs (e.g., lumps) that it is necessary and will detect cancer early.

There is radiation in X-rays mammograms and computed axial tomography (CAT or CT) scans. By the way, there is no radiation in Magnetic resonance imaging (MRI) or an ultrasound.

The Canadian Association of Radiologists(CAR) Estimates that up to 30 per cent of CT scans are inappropriate or contribute no useful information to help the patient.

Do You Need That CAT Scan? (PDF - CAR pamphlet)

The radiation dose from a CT scan is 100 - 500 times more than from a conventional X-ray. 

 I have written previously [See: Screening vs. diagnosis of cancer] about the concerns some physicians have with over diagnosis, or  prediagnosis of lumps, a normal part of aging. The statistics around this issue are scary. CBC quoted one physician as saying that there is a 5 - 6% error rate in mammographies. 
--For every one positive case there are 55 other women with diagnostic studies who have nothing wrong with them. (Dr. Marla Shapiro) 
Now, we have to worry about excessive radiation, too. 
The suggestion from the CAR, is to be your own advocate:

• Question your physician [see Questions to ask your doctors   |   Questions to Ask the Doctor | Cancer.Net ]
  
• Ask if it is medically necessary - e.g., do the risks provide a benefit?
• Do not have X-rays or scans 'just in case'
• If you have a scan done, ensure that it will be available for a consultation, or appointment with a specialist. You should not have multiple scans and unnecessary radiation.
• Ask if the scanner is using 'reduced radiation techniques'. This is your right. Let them know what you know!
• If you end up in emergency and they want to give a CAT scan, question them. You should have a diagnosis by a physician or a conference with a radiologist. 
  

The use of CAT scans have increased 8 times since 1980, and is growing by 10% per year. KNow what you need, vs. what you do not need for diagnosis. Ensure that the tests you have are necessary and correct. The use of CAT scans for children and pregnant women are dangerous. Children are growing, and their cells are sensitive. In the last 10 years, radiation imaging of pregnant women has increased 100%. These can be gene-altering X-rays.

Comfort measures

End-of-life care means that we look after the needs of our client, and him him/her comfortable.

This means controlling the environment, having a Pain Management Kit on hand, feeding the patient as s/he indicates, providing physical comfort measure for skin, mouth, preventing bed sores by moving the patient every two hours or so.

Dr. Mike Harlos warns that common end-of-life complications include pneumonia, exacerbated by other physical issue: dementia, malignancy, and neurodegenterative, respiratory, and rheumatic conditions.

Quality of life Bill of Rights

Quality of life and end-of-life care policies in Canada are clear. The Canadian Bill of Rights guarantees the dignity and worth of every human being. The Government of Canada (2000) in its policy statement said the key mechanisms for improving the care of the dying include:
• Service delivery by interdisciplinary teams
• Access to services in the most appropriate location
• Availability of services when needed, whether for a few hours or around the clock
• Availability of services before death is imminent
• Services for a broad-based clientele, both with respect to cultural background and type of illness
• Awareness and skill in pain and symptom management
• Support for caregivers and family members

Symptom Management In Comfort End-Of-Life Care Of Pneumonia
I have learned that it is important to give regular doses of pain medication, to achieve, or quickly 'reclaim comfort', as Dr. Harlos says.

Often, patients are given oxygen to relieve breathing issues. It keeps them calmer, as they fight a little less to get a breath.
Typical symptoms may include, but are not limited to:

• Dyspnea (shortness of breath)
• Tachypnea (rapid breathing)
• Agitated delirium (80% or more in the final days)
• Pain
• An agitated state of paranoia
• dry lips since the patient breathes by mouth  (use a sterile mouth creme)

The mistake many caregivers make is in feeding the patient when s/he isn't hungry. The body begins to shut down, organ by organ, and food with compromise the client's comfort as i tries to digest food.
Patients, one nurse told me, can go two weeks without food, two days without water and two minutes without air.

My mother was eating about a tablespoon of food, three times a day in her last two weeks. This is entirely normal. My father, similarly, reduced his food intake slowly. It was only sweets he loved!

If you are choosing to remain at home, caregivers should be given a Pain Management Kit, to be used in the event of severe pain in the wee hours. Ensure that you advocate for this. It is well within the patient's End-of-life Bill of Rights (Gov't, 2000) , no matter where you live, and how many health care support workers are available to you.

Deaths

• In 2006, 228,079 Canadians died (Statcan.ca*)
• 75% of all deaths occur in people over 65 years of age.
• 75% of the deaths take place in hospitals and long-term care facilities.
• Each death potentially affects the well being of an average of five other people.

• An estimated 5% of dying Canadians receive integrated and interdisciplinary palliative care.
• About one quarter of the total deaths in Canada are related to cancer, but cancer patients account for more than 90% of those receiving palliative care.
• The number of institutional palliative care beds has been cut as result of health care restructuring.
• Few provinces have designated palliative care as a core service with a specific budget.

Palliative Care

• People are receiving significantly different treatment in various institutions across the country.
• People over 65 years of age are less likely than younger people to want to die at home.
• Rural residents have considerably less access to palliative care than the residents of large urban areas.
• Most of the costs and other burdens of homecare are assumed by the family.
• Palliative care relies disproportionately on charitable donations for survival.

(from: Government of Canada. 2000. Quality end-of-life-care: The right of every Canadian. )

Palliative Care(PPT)

Bereavement Care. End of Life Care. Terminal phase. Current Model .

The Dying Person's Bill of Rights (PDF)

Canadian Hospice Palliative Care Association
National association provides leadership in hospice palliative care in Canada. 

See also:

• Palliative Care available from Community Care Access Centres
• Palliative Care - information, reports and related links
• Advanced Care Planning Guide
• Life Care Transition Life Event - information from Seniors Canada On-Line
• Locate a hospice
• Directory of Hospice Palliative Care Services

Assistive Devices for seniors - part 2

The Ontario government provides assistance in renting or purchasing assistive devices for those without the finances to purchase special equipment Assistive Devices Program (ADP). There are agencies which provide money for  things such as wheelchair ramps, and other needs. 

If you suffer from a particular disorder, you are wise to contact their organization, as most have great plans in place. While agencies do much fundraising for research, we must ensure that financial support is there for those who need a wheelchair, a ramp, or a walker.

There are many sources of funding for the client's share of the cost, if you go through ADP, including :

• voluntary/charitable organizations e.g. March of Dimes, The Easter Seals Society, Kiwanis, Lions Clubs, 
• Canadian Cancer Society, WarAmps
• social assistance
• Department of Veterans Affairs
• insurance companies.

What bothers me are concerns with clients who are emotionally or psychologically unable to determine funding sources. The CCAC in Ontario should provide simple equipment such as mattress pads, bandage changes, etc., or lack of knowledge of needs on the part of a case manager who does not understand a client. My mother avoided telling the truth to her case manager, as she was afraid of us forcing into another living arrangement. It was frustrating! She refused help from Red Cross, homecare support that would have made her life easier. She spent energy vacuuming, rather than fighting her cancer, leaning on the sink in pain as she made my father's lunchtime sandwiches, shaking with pain or fatigue?

Another issue that shocks me, is that at the time of Dad's diagnosis of being terminal, funding ceased for his walker and his wheelchair. They do not want to provide funding if they have less that 6 months to live. I guess it wasn't worth the paperwork for them.

Dad had a great walker, but CCAC also installed devices in the shower: a large handle to prevent him falling, and a wonderful seat that spanned the bathtub to allow him to sit and be showered, once he was unable to get in and out and have his daily bath.

Much research has been done in this area, especially in the large US market:

Assistive Devices: MedlinePlus (USA)

25 Sep 2009 ... The primary NIH organization for research on Assistive Devices is the National Institute on Deafness and Other Communication Disorders

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   Many companies offer workers to help, but we were hard-pressed to get any help figuring out something simple like back support.
   
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      Now, you would think that a company, like Obus, would have PK seminars for the many companies that specialize in Assistive Devices. NOT. We were looking for back supports. I have a chronic back issue, as does hubby, and sitting on the sofa, or in the car, is difficult. We phoned a large pharmacy chain, which offers many such devices. No one there knew if these products would help.
      
      We spoke to the physiotherapist. His comment: take them home, try them and see if they work. Of course, he doesn't know. I am amazed, in this day and age, that Obus would not provide enough information in Product Knowledge  seminars. I know that when our son worked in a small outdoor equipment store, they would have monthly PK sessions, in which they learned about various products (sleeping bags for subzero weather, hiking shoes( and such issues as foot pronation or suppornation, which affect product choice.
      
      
      Next call: to Obus International. Fortunately, an 800 number. The sales rep did not have a clue about her product. She read out the specifications, which we had found on their webpage, and added no new information. We bought it and will try it.
      ~~~~~~~~~~~~~~
      Footwear, Pronation, and Knee Pain
      Arch height is a major factor in determining the amount of foot pronation. Flat feet often cause overpronation but not all overpronators have flat feet.
      
      
      
      

      Assistive Devices for Independent Living for Seniors, the ...

      
      
      Disability Products offers secure shopping for assistive devices that support independent living for seniors, the handicapped and disabled,
      
      
      
      
      
      
      

      Industry Sector Office: Assistive Technology/Assistive Devices

      
      
      16 Sep 2009 ... The Canadian Assistive Technology (AT) and Assistive Devices (AD) industry is tracked and supported by Industry Canada.
      
      
      
      
      

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         Assistive Devices / Seniors Canada

         
         
         Seniors Canada On-line provides single-window access to Web based information and services that are relevant to seniors 55+, their families, caregivers
         

         
         

         
         

         Ontario Ministry of Health and Long-Term Care - Public Information ...

         
         

         The objective of the Assistive Devices Program (ADP) is to provide consumer centered support and funding to Ontario residents who have long-term physical ...
         

         
         
      
      

   
   
   
   

Assistive Devices for seniors - Superphone

There are a lot available! There are things that lift, technology to help with hearing and clothing to make dressing and undressing easier.

We have ramps on a lot of homes in My Muskoka. In my book, I wrote about hubby's search for a Superphone for my Dad. Dad had a hearing loss in both ears. He was unable to make them work properly, his ears filled with wax, and he kept turning up the hearing aids until they screamed and whined,  and broke.

Book excerpt:

After his tumour was removed in 2003, he could not hear much. Brian did a great deal of research to find this phone. Dad’s “superphone” blinked when there was voice mail, and it upset him terribly. The problem was that when there was a phone message waiting, the huge, bright red light flashed and Dad could not figure out how to get access to the messages. They had never had voice mail.


Hubby ended up going to the various phone stores around Ottawa. Why not speak to a representative and find out the kind of phone that would boost hearing for Dad, and allow us to talk to him when, for example, Mom was having surgery or radiation and Dad was alone at the house?

At the first store, Bell, they all knew the ins and outs of every cell phone, and could find one for all needs. They had no idea what Brian was talking about when it came to a phone for the hearing impaired.

These young people, who had had PK seminars up the yin yang, and could navigate their way through Bell's computer, 'Emily', at the speed of a button push, had no product knowledge in this area.

What next? The Internet. Sure. After research, we knew more about these products than those who sold them. This is what we ended up with. Superphone. With the aging population and the Silver Tsunami, you'd wonder why on earth they do not know about these things.

This phone can be turned up, or turned to 'normal', and I could sit the receiver on the floor and still hear the conversation.

It has bells and whistles I had not heard of, nor had the 3 phone store reps in the various outlets Brian visited. This phone increases decibels by an exponential factor. As we queried the reps, they did not know what a dB was!

Decibel - Wikipedia, the free encyclopedia

The decibel (dB) is a logarithmic unit of measurement that expresses the magnitude of a physical quantity (usually power or intensity).

I was amazed. You'd think with cell phones, and cordless phones, this might be a number worth understanding. We wanted Dad's phone to amplify sound for him. We seldom talked to him on the phone.

This phone has large buttons, as many of us need reading glasses!

With a push button, you can go from 'normal' to a higher decibel ("amplify") in an instant, so that anyone in the house can answer it. I loved it. But Mom and Dad hated it. Another $300 down the drain. They did not like the light that indicated a call. They were not amused. Once Dad's brain tumour caused dementia, he accepted it a bit more. But, in the long run, he was unable to figure out the function of things like the phone or TV clicker, and we had to take the phone away. He was calling all sorts of people in town, and calling us at 2:00 in the morning.