Multi-Specialty Teams Help Seniors Manage Diabetes (Part 1 of 2)

A multi-disciplinary medical team of pharmacists, podiatrists, optometrists, ophthalmologists, dentists and dental hygienists best assist seniors in managing their diabetes by addressing medication, foot health, vision impairments, dental loss, and heart conditions, researchers at the U.S. Centers for the Disease Control (CDC) and Prevention and the U.S. National Institutes of Health (NIH) say.

While most of the aforementioned categories of physicians may not have time to take on these different aspects of diabetes outside of their specialties, they may be able to ask questions and provide their senior patients with advice during regular visits, check-ups and exams, the National Diabetes Education Program’s (NDEP) Pharmacy, Podiatry, Optometry and Dental Professionals Work Group of CDC and NIH say.

The joint-federal agency working group releases their annual reference guide titled Working Together To Manage Diabetes: A Guide for Pharmacists, Podiatrists, Optometrists and Dental Professionals to train medical professionals to converse with aging diabetics about treating their condition with insulin, drugs, proper diet, exercise and sleep.

The booklet’s recommendations on how to diagnose and manage pre-diabetes and diabetes are based on clinical work and research by the medical professional trade organization American Diabetes Association (ADA). It and other specialty-based literature and materials are available at

Affected professionals also include primary care, family practice or internal medicine physicians, physician assistants, endocrinologists, certified diabetes educators, nurses, nurse practitioners, registered dietitians, cardiovascular specialists, renologists, neurologists, psychologists, psychiatrists and social workers.

Certified diabetes educators are trained healthcare providers who can counsel and train diabetics about their condition by setting behavioral goals and discussing health issues. A diabetes educator is usually a nurse, dietitian or pharmacist certified to guide and instruct patients about diabetes and self-care.

Diabetes Prevalence and Impact

Deemed severe, common, expensive but able to be controlled, diabetes is considered the sixth leading cause of death in the country and impacts at least 21 million individuals with at least 6.2 million undiagnosed. It costs the nation nearly $200 billion in direct and indirect expenses.

Nationally, diabetes ranks first among all long-term, deadly diseases as the cause of lower limb amputation that is not connected to trauma, first as the cause of acquired blindness and first as the cause of kidney disease ending up in dialysis.

The condition also contributes significantly to heart disease, being its number one cause of death in the country. At least 65 percent of senior diabetics die from heart failure.

Meanwhile, the prevalence of diabetes increases. Federal research shows it has more than tripled in the last 25 years from 5.8 million to the current 21 million, and in some states, over 25 percent of adults are diabetic. Projections will continue to be high. By the year 2050, the number of diabetics is expected to reach 39 million.

With current trends, one out of every three individuals nationwide will contract diabetes in his or his adulthood and may find his or her life span reduced by 10 to 15 years.

There are three forms of diabetes, type 1, type 2 and gestational diabetes. Federal research shows that, as of 2005, about two-thirds of adults nationwide were obese with the body mass index (BMI) of over 25, contributing to the onset of diabetes in this segment of the population.

In fact, the incidence of obesity has jumped by 61 percent since 1991, leaving more than 60 percent of adults overweight. A high body mass index and obesity pose the greatest risks to individuals for developing diabetes.

Type 1 is defined an autoimmune disease that is characterized by the destruction of insulin-producing beta cells. This version of diabetes can take place at any age but most especially in childhood or young adulthood.

Type 1 diabetes patients can develop ketoacidosis, a diabetic complication in which the body releases excess blood acids also known as ketones. Diabetics must take insulin daily whether by injection, insulin pump or inhalation.

Additionally, type 1 diabetics must test their blood sugar several times every day, follow a customized meal plan and take part in physical exercise.

Type 2 diabetes is connected to insulin resistance. The pancreas produces insulin but it is not recognized or used by other body tissues. Patients of this form of diabetes are treated with insulin, drugs or both. Otherwise, the condition can be controlled with an individualized food plan and physical exercise.

The development of type 2 diabetes is multifactorial, with insulin resistance, sedentary lifestyle, advancing age and obesity contributing to this increase.

This version of diabetes hits nearly 10 percent of the country’s population of young adults and double of the senior segment with a high incidence among those who are obese and physically inactive.

Still, the number of type 2 diabetics among children and teens is increasing, a n important concern as the number and intensity of complications grow with age.

Type 2 diabetes affects African Americans, Hispanics, Native Americans, Alaska Natives, Hawaiians or other Pacific Islanders and they are all two times as likely to have the condition as whites of the same age group. Some sectors of the Native American population suffer the highest rates of diabetes in the world.

The third form, gestational diabetes, involves glucose intolerance in women at the time of pregnancy. Gestational diabetes is most likely to take place among African Americans, Hispanics and Native Americans. It also occurs in obese women with a family history of diabetes.

At the time of pregnancy, mothers are treated to have their blood glucose levels stabilized so as to not affect their infants. Afterward, five to 10 percent of gestational diabetics are discovered to have type 2 diabetes. Indeed, women with gestational diabetes harbor a 20 percent to 50 percent risk of contracting diabetes over the next five to 10 years.

Other forms diabetes stem from genetics such as “maturity-onset diabetes of youth,” surgery, drugs, malnourishment, infections and other illnesses. They make up 1 percent to 5 percent of such cases.

Prevention Tools

About 54 million individuals aged 40 to 74 years of age — an age group that makes up 40.1 percent of the country’s population — suffer from pre-diabetes, which endangers them into developing type 2 diabetes.

Without action, pre-diabetics can advance to type 2 by a rate of 10 percent higher every year. They also have a higher risk of heart disease and stroke.

Pre-diabetes, “a condition in which blood glucose levels are higher than” what is considered healthy “but not in the diabetes range,” is described as “impaired fasting glucose (IFG) of 100 to 125 mg/dL or impaired glucose tolerance (IGT) diagnosed by a post 75-gram glucose challenge of 140 to 200 mg/DL.”

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of NIH can assist patients and providers in determining whether they are at risk for pre-diabetes. Federal research identifies three types of prevention: primary prevention to keep diabetes from occurring and secondary prevention to prevent complications in those who are already stricken with diabetes (e.g., prevention of foot disease).

Still, a third version, called tertiary prevention, means avoiding worsening complications such as an amputation from injury to a diseased foot or death.

These three levels of prevention occur because of the high financial and non-financial costs of diabetes. Federal research shows that more than 4,100 individuals per day are diagnosed with diabetes. As a result, 55 lose their sight, 120 undergo renal failure and 230 lose a limb to amputation — daily.

To test for diabetes, medical professionals will perform finger sticks or forms of laboratory testing. To qualify to conduct laboratory testing, professionals must be registered with the Centers for Medicare and Medicaid Services (CMS) under the Clinical Laboratory Improvement Amendment (CLIA) of the law governing the policy and procedures of the federal agency.

The amendment sets quality standards for accuracy, reliability and timeliness of test results no matter what types of tests are performed. Three classes of tests and certification have been set and the categories depend on the level of difficulty and effort of the method used.

It has set up rules for each category of testing calling for quality control and documentation processes. Some states have added more requirements for different laboratory sites or medical professionals. For more information, professionals are asked to consult their state agency and the CMS website at

To help those who already have diabetes, the guide, Working Together To Manage Diabetes: A Guide for Pharmacists, Podiatrists, Optometrists and Dental Professionals, provides detail on the type of drugs that best manage blood sugar, including insulin, as well as blood pressure and cholesterol.

The booklet concentrates on diabetes-related complications affecting foot health, vision, oral care and medication therapy issues. Using clinical graphics, including patient education posters to be hung in a medical office, and four specialty-based prevention brochures, it aims to encourage interdisciplinary medical team work to treat diabetes and make appropriate patient referrals.

Additionally, another booklet, the Working Together Medications Supplement, instructs on how to understand and properly use medications meant to control diabetes and can be used to organize team care. Package inserts or another guide titled the Physicians’ Desk Reference include prescribing information.

The Working Together Medications Supplement guide provides insights for professionals and senior patients on such issues as:

–The different types of insulin and the appropriate times to administer them so as to not conflict with a scheduled procedure;

–The most common symptoms of medication use to help a medical specialist to pinpoint a problem and make an appropriate referral to another specialist;

–Reduction of adverse interactions of drugs prescribed by different specialists;

–Avoidance of accidental overdosing or underdosing by generating awareness of medication names, strengths and dosages, and;

–Making the most of each visit, check-up or exam to teach patients about how to correctly use prescribed drugs and to receive drug use counseling from a primary care physician or pharmacist.

Physicians, specialists and other medical professionals can access the reference guides, which are all free, at the Centers for Disease Control and Prevention’s continuing education website, and fill out an evaluation form and post-test.

Taken together, the guides are meant to help professionals identify the different type of diabetes and to prevent complications; to practice key messages to senior patients about diabetes; to articulate the most pressing concerns about drug therapy, foot health, vision and oral care for diabetics, and; to interpret the outcomes of the Diabetes Prevention Program (DPP).

According to the American Diabetes Association Standards of Medical Care, Diabetes Care reference guide, professionals are required to train senior patients to pay attention to their hemoglobin A1C, a test that shows their average blood glucose over three months (the goal is an A1C of less than 7 or 150 mg/dL), a blood pressure reading at less than 130/80 mm Hg, and a cholesterol count of less than 100 mg/dL.

With such training, senior patients are expected to practice sound self-management habits. They can maintain a customized, healthy meal plan with the help of the dietitian, participate in physical exercise, avoid cigarette smoking with guidance from a certified diabetes educator, and take prescribed drugs properly with counseling from a pharmacist.

Social workers can help coordinate government services for patients, especially seniors, and mental health professionals can assist them with depression and other mental illness issues as they pertain to diabetes.

Resources geared at assisting them can be found at the NDEP’s Better Diabetes Care Web site at

Finding the Time

Pharmacists, podiatrists, optometrists, dentists and dental hygienists may not find time to look at a senior patient’s medications, feet, eyes or teeth, especially if each category of physician feels entrenched in his or her specialty, members of the joint CDC-NIH work group say.

However, specialists are capable of sending direct messages to their senior patients about health problems or issues they have noticed. Instead of opening a statement with wording such as, “You should see someone about that … ,“ a specialist could tell his or her patient that, “I recommend that you … “

For example, a pharmacist does not need to be a podiatrist, an optometrist or ophthalmologist or a dentist or dental hygienist or perform an exam to determine when a senior patient presents with a problem that warrants the attention of another category of specialist, the workgroup members say.

A minute is all that is needed, for example for a pharmacist, to view a senior patient’s foot, mouth or eye to ask some questions about medications, supplies or cigarette use, they say.

By merely mentioning the problem a pharmacist, for instance, may have identified, he or she reinforces the need for prevention once he or she examines the issue before referring the patient to another specialist-colleague, goes the argument of the workgroup.

A pharmacist, podiatrist, optometrist, ophthalmologist, dentist or dental hygienist can support comprehensive diabetic care by going beyond his or her specialty to point out potential issues and then make a referral with an “I recommend … “ statement.

CDC-NIH workgroup members say patients will be grateful to specialists for taking their health and well-being into consideration, setting up a referral system and adopting a comprehensive team-care approach with their professional peers.

Foot Health

Besides podiatrists and as part of a comprehensive diabetes care team, pharmacists, optometrists, ophthalmologists, dentists and dental hygienists and other specialists ought to watch their senior patients for the most common diabetes-related foot issues: neuropathy, vasculopathy, dermatological conditions and musculoskeletal problems.

To assess for peripheral sensory neuropathy or the loss of sensation in the feet, specialists should check for the senior patient’s experience of tingling, burning, numbness or sensation of bugs, crawling on the skin of the feet. Podiatrists seek to detect this foot condition by using an instrument known as the Semmes-Weinstein 5.07 (10 gram) monofilament.

Senior diabetics with neuropathy are nearly two times more likely to suffer from ulcers in the feet than their peers without this condition. For senior diabetics with both neuropathy and foot deformity, the danger of cultivating ulcers is 12 times greater. Still, furthermore, senior diabetics with a history of foot disease, including previous amputations or ulcers, face a worsening risk of up to at least 36 times greater.

The demographics most at risk for lower-extremity ulcers and amputations are members of the male gender, non-Hispanics, African Americans, seniors and diabetics of at least 10 years, having past cigarette use and having a history of poor blood sugar control or heart, eye and kidney complications.

A comprehensive foot exam for diabetics includes evaluating “pulses, sensation, foot biomechanics,” which is defined as foot structure and function, and nails. NDEP medical literature titled Feet Can Last A Lifetime describes how to use this monofilament to conduct a complete foot exam and can be accessed at

Vasculopathy represents the cramping of calf muscles when walking, also known as “charley horse”, which leads to several rest periods bet. The cramping stems from insufficient blood in the area below the knee, caused by the blocking of the arteries, which commonly happens in the lower extremities of senior diabetics.

Nighttime severe cramping and toe aches are known as rest pain and is treated by walking or allowing the feet to hang over the side of the bed. This particular symptom means there is an end-stage blood vessel disorder and tissue ischemia, all of which comes before the onset of diabetic gangrene.

Neuropathy is cited by clinical research as being most responsible for ulceration and related foot complications. However, an inadequate blood supply can also lead to bad ulcer healing and, thus, amputation. Both neuropathy and not enough blood should be factored into a complete diabetic foot exam and care.

Dermatological conditions are exemplified by feet corns and callouses, also hyperkeratotic lesions, which are the result of “elevated mechanical pressure and shearing of the skin.” These conditions come before the “breakdown of skin” and cause “blisters or ulcers.”

Additionally, “surface lacerations and heel fissures or maceration (softening by wetness)” can all result in infection. “Corns, callouses, toenail deformity and bleeding under the nail” may be symptoms of neuropathy. “Fungus infections of skin or nails” become secondary infections that must be treated immediately.

“Musculoskeletal symptoms” in diabetic feet may emerge with “muscle-tendon imbalances” because of motor neuropathy. Such deformities include the hammertoes, bunions, high-arched foot or flatfoot, which raises the possibility for irritation of the foot in the shoe.

A patient’s style of life and his or her family history can determine the status of foot health. Senior diabetics who smoke are four times more likely than smokers without diabetes to acquire lower-extremity vascular disease.

Consuming foods high in fat and sodium and remaining physically inactive can lead to insufficient long-term control of blood glucose and place the patient at risk for diseases of the peripheral nervous system and blood vessels.

Additionally, a family history of illnesses of the blood vessels in the brain and coronary artery disease may mean a greater risk of lower-extremity arterial complications. Foot types or shapes may make a patient more vulnerable to biomechanical deformities that could end in skin breakdown.

Senior patients with neuropathy are highly likely to acquire degenerative arthropathy, also known as Charcot foot, that targets the joints and results in a red, swollen and deformed foot that can be taken for cellulitis. A Charcot foot usually means little to no pain and may progress over weeks to months before a specialist discovers it in a patient.

Radiological imagery may reveal a collapse of joint structure and can be taken for osteomyelitis. Therapy for Charcot foot is a light cast, in the absence of any swelling, and special shoes to correct changed biomechanics. If Charcot foot is not treated, the senior patient’s feet can degenerate into greater deformity, ulcers and, in the end, amputation.

Podiatrists and specialists in general should watch for senior patients who complain that their shoes don’t fit or wear slippers or shoes with portions cut out to adapt to changes in foot shape or limping.

The American Diabetes Association (ADA) and the American Podiatric Medical Association (APMA) take into consideration two forms of risk for developing diabetic foot complications: high risk and low risk.

The symptoms of high risk for developing foot disease include a “loss of protective sensation, absent pedal pulses, foot deformity, a history of foot ulcers and prior amputation.” By sharp contrast, for low risk, none of these symptoms exist.

To prevent low-risk senior patients from advancing to high risk, both professional trade associations, the ADA and the APMA, ask specialists to urge them to control their A1C, or hemoglobin blood sugar levels, blood pressure readings and cholesterol count and to quit smoking for those using cigarettes.

To assist high-risk senior patients, both organizations ask specialists to help patients guard against developing ulcers through self-management training, foot care and using the proper footwear. Light trauma “such as stubbing a toe or stepping on a sharp object” is the event most likely to lead to acquiring ulcers.

As a result, specialists are asked to stress to senior patients and their families the need to take the initiative to clear out walking areas, especially near the bed and the route to the bathroom, and to use night lights to enable a senior patient to see in the dark.

Additionally, high-risk senior patients must know who and when to call about their foot health issues. Same-day emergency calls to a primary care physician or podiatrist will likely be about a puncture wound, ulcer, redness or new foot pain. For less urgent issues such as patients with callouses or thick or ingrown nails, a podiatrist should be phoned and visited within a matter of days.

Nearly 20 percent of senior diabetics who visit their primary care physicians or specialists for check-ups or exams will present a foot health issue. With each visit, their doctors must ask their senior patients to take off their socks and shoes and check both feet for problems.

The likelihood of developing foot ulcers among diabetics is 15 percent. Worse still, the probability of diabetics with kidney complications and undergoing dialysis at risk for foot complications is higher but is treatable.

A podiatrist or other specialists are asked to pose senior diabetics the following questions when probing for foot care problems:

Whether they know how diabetes affects their feet, that diabetes puts them at risk for ulcers, which can result in amputations, and that foot care can prevent this;

Whether they have had a comprehensive foot exam in the past year and, in particular, one by a podiatrist, and a foot inspection by a primary care doctor, and;

How do they care for their feet daily and if their care regimen includes looking and touching for cuts, bruises, puncture wounds, corns or callouses, redness or pus; cleaning the feet’s skin and nails daily; drying in between toes; checking the insides of shoes for materials before wearing them and avoiding walking barefoot at all times.

Specialists can also refer senior diabetic patients to foot care literature from NDEP in English and Spanish at

Care Angel Tracks Recovering Senior At Home For Families

After five weeks in the hospital for a heart operation, she is recovering at home alone in another town and state.

So how to keep track of mother?

Officially since the spring of 2015, Wolf Shlagman, founder/CEO of Care Angel in Miami and Fort Lauderdale, Fla., entrepreneur and, for 20 years, telemedicine expert, has been offering a solution.

Care Angel is a computerized system that can record and report an aging relative’s vital signs to alert families of any change in health status before they take action.

Billed the “Virtual Caregiver,” the Smart Care “artificially intelligent voice response technology” platform can be customized to record a soothing family member’s voice for the sick relative in question to hear, to provide the relative with care by landline or cell phone using Apple Play or Google Play and to provide health data about the relative for family members.

Shlagman explained that, through company research, he learned that other organizations such as the Diabetes Foundation, offered such health-oriented customized software service.

“Seniors don’t want to burden families,” he said during a demonstration/interview with this writer at an annual conference of the American Society on Aging, a 5,000-member, multi-disciplinary organization addressing different aspects of aging, in response to a question about the program’s different facets.

“[They] won’t check in. It helps seniors [become] more independent. [You] just answer the phone. It’s all audio. [You learn about mother’s vitals and you say, ‘Good’ or ‘Oh, not good.’]

“[You can then communicate by asking your mother,] ‘What’s your blood pressure? [Do you] need anything?’”

The Care Angel program answers questions by family members about their senior relative. The answers are converted into ready-to-use dashboard notification, alerts, care insights and reports on the Care Angel Caregiver app.

If the answers show that all isn’t well or the relative is in need, Care Angel will notify the selected family-and-friend network, also known in the product’s parlance as the Care Circle, to empower them to act quickly to prevent larger problems or tragedy.

“When I set my mother up [with the Care Angel system], it gives [up] information,” he said. “Who else do you want to receive alerts? [You can set up the program to send data to] friends, sisters, brothers and neighbors.”

He explained that senior long-term care and short-term care and chronic illness management in general make up two-thirds of the $3 trillion-plus spent yearly on health care.

Federal research, some of which appears on the Care Angel website, counts at least 50 million seniors in the country, which will increase to 120 million over the next 20 years and more than 1.5 billion around the world.

Research predicts that, in coming decades, adults will live at least 20 years longer, deal with several health conditions, take several prescription drugs, suffer from injuries and fight to stay alive, fully-functioning and independent.

“One of the realizations in healthcare [is that we are spending $4 trillion[-plus in] health care [costs],” Shlagman said. “Two-thirds [of that is in] senior care.”

Meanwhile, about 70 million caregivers are providing much of the senior care, he added. Shlagman pointed to federal research finding senior care fast-becoming the greatest expenditure to every layer of society.

“[The industry of senior care forms] 20 percent of our gross national product (GDP) and [it is] growing,” he said. “ … The task of caregiving [can] take a decade of a person’s life.”

Nearly 40 percent of adults in the nation serve as caregivers for more than 20 hours to their aging relatives who have serious medical issues, taking its emotional and financial toll on them and their families and triggering the $300 billion in costs to businesses, insurers and other facets of society.

As a result, he said, families, insurers and businesses are confronting these issues, finding new means of enabling seniors to age in place and addressing the high costs for senior care.

“It really is about [balancing work with family obligations],” Shlagman said. “It is relevant [to] those issues. You [can’t] be there for [aging] mothers and fathers [as you balance] family [and] work. You don’t connect. Days and weeks [can pass with] no connection [to your aging mother or father].”

In response, he said, Care Angel, also titled Care Angel VIP Care Service, is meant to alleviate such healthcare costs by using technology to inform families of medical problems in advance, decreasing the number of unneeded and pricey hospitalization visits and repeat visits, enhancing results and being detailed about the health status of patients.

“We are growing our company [and we’ve done the] research,” Shlagman said of the company and the previous firms he ran. “We got bought out. We got sold. I asked a colleague of mine [to join me in a new venture and we put together our] collective experiences and know-how.”

Prior to owning Care Angel, Shlagman served as CEO and founder of Consult-A-Doctor from 2007 to 2013, a former telehealth company connecting patients to physicians, and to MyCity Networks, an IT company.

He added that he and his business partner were inspired by their own roles as caregivers to their aging mothers.

“I realized how I took care my mother [and] my partner took care of his mother for 10 years,” he said. “[We both] had caregiving duties and tasks. … It [caregiving] impacts so many people. It has a ripple effect into life and work.

“Among [several] things in my head, [we thought about] what was going to be [our] approach. We really came together [to study this]. We had research and sleepless nights.

“[What we offer through Care Angel] is not out there. I looked at [several programs].”

Shlagman said that the flu, a fall or the wrong medication can worsen matters for chronically ill seniors and their families.

Vital details such as skipping prescriptions, neglecting to make refills, not drinking enough water or other fluids, not eating enough or at all and being inattentive to symptoms should not be overlooked — just because, for instance, an aging mother does not wish to phone family members and burden them with her troubles, he added.

“My mother takes medications,” he said. “She’s up and down. I don’t know how she feels. Care Angel [would serve as a] virtual caregiver, checking on mother [and her] blood pressure [and] alerting me and family members when something’s wrong. [Care Angel is meant to] prevent [mother’s health status from escalating [into something] worse.”

Shlagman said that Care Angel executives and product developers researched and thought about the absence of family caregivers from the care of seniors at home and the level of expense and training required to hire home health care nurses and other staff and to purchase medical devices for use in their homes.

“Home [health care] workers [and] devices in the home are costly [to hire and purchase],” he said. “[There’s] a lot to learn and train. [There’s] a lot involved.”

He added that his team also also took into account every phase of senior care in designing the Smart Care platform.

“We saw [the] senior care continuum [and took it into consideration when developing Care Angel],” Shlagman said. “[It] shifts management [of] care [of] seniors [to this system]. [It helps the] family [keep track of mother].”

They also pondered ease and convenience in developing the platform.

“Our solution is aimed at being so simple since you need to answer the phone,” he said. “You can reach out and talk [to your aging relatives about] services.”

First, a family member using Care Angel registers with the platform and starts the app. He and she then clicks on a green circle with a “person+” icon on the page.

A Care Wizard will appear and instruct the family member to go through the sign-up process, which, Shlagman said, takes two minutes. During registration, he or she will be given the choice of recording a personalized greeting.

If the family member elects to, he or she can click on an “Care Recipient” icon and a “gear icon.” Finding a “Greetings” tab and a pencil icon, the family member can record and listen to his or her recording or hit “Re-Record” to start again.

“[A family member signs in to] Care Angel [and adds all of the information, following the instructions,” he said, demonstrating the platform at the conference. “You tell the system] who to watch [whether that is] mother [or] father and what conditions [they have]. I can record my voice.”

The calls to the aging relative from the Care Angel platform are referred to as “Care Angel VIP Care Calls,” which, Shlagman said, take less than two minutes.

The default setting allows the program to phone once on Monday, Wednesday and Friday but family members can edit the defaults to customize the system for their sick relative’s needs, he added.

Questions include “How did you sleep? How do you feel? Are you in pain? Did you take your medicine? How is your appetite? Did you drink enough water? Have you been exercising?” The system also inquires about blood pressure, blood sugar and oxygen level of the aging relative.

“[Care Angel will] call mother from the app,” Shlagman said. “ … [The] service will call [the family to let them know what is happening]. [The family] checks in on her. It [asks] her questions. [It learns if] she’s in pain [or if there is] blood.”

Family members can view data about the senior relative daily, weekly or monthly on the Care Angel VIP Care dashboard if they set it up and have access to Care Insights to learn about negative or positive health trends concerning the patient.

“[When we program the system,] we are asking [Care Angel] to take [our loved one’s] medical, blood pressure and glucose readings,” he said. “[The system] tells us what [mother’s vital signs] are. [The] reports [on mother’s vital signs] will be sent to families.”

In fact, the dashboard, which obtains its data from the Care Calls, includes information about the relative on sleep, feelings, needs, water, exercise and appetite. The Vitals section of the dashboard contains readings on blood pressure, sugar and oxygen levels if the family members set up Care Angel to retrieve it.

Through the calls and Care Alerts, the members can learn, for example, whether the relative is drinking enough water, taking his or her medicines or what their blood pressure readings were in a month.

“I [as a family member] will get alerted,” Shlagman said. “I will see the Care [Angel] insights, including blood pressure and glucose. [I learn if she is] sleeping or [how she is] feeling or, [for example, what is her] glucose [level].”

The Medications section of the dashboard exhibits whether medicines were taken, missed, skipped, ran out or were scheduled to be taken later. The Care Reports section maintains a summary of the relative’s health data in one site.

“Mother has high blood pressure,” he said. “[The Care Angel programs] are managing the blood pressure. [The Care Angel programs] are self-managed. [The program is designed to guarantee prescription drug use] adherence [and to deal with] unplanned [events].”

And the entire system can be accessed by families for free.

“Millions will use [it for] free,” Shlagman said, mentioning other software platforms Pandora and Spotify in terms of pricing and profit margins. “[There are] additional features. We want to provide as much value [as possible]. We [want to provide] additional value.”

He added that he worked with a number of senior-care organizations at the conference to forge partnerships to support and further develop Care Angel.

“[I am] working [with] partners at this conference,” he said.

“Everyone [is] in the care continuum. We may interface [with] organizations and may have contracts. [We are interested with partners who want to] help seniors and lower costs [for families]. A lot of [people] want to add value. [A] lot of customers look at what we are giving [them].”

Shlagman said that his team is dedicated to growing and enhancing Care Angel.

“Whenever you have any product, it’s a living, breathing thing,” he said. “You can get incredible [results]. [There is] constant [research and fine-tuning]. [It’s] never-ending. [It’s more] improvement. [We] take feedback.

“We want to help a million-plus families. [We are] helping families watch their loved ones. We [will] grow as quickly as it takes [to make it] grow.”

Assistive Technology, Home Modifications Boost Senior Mental, Physical Functionalities (Part Three)

“One of the ladies [I provide services for] has arthritis,” she said. “She lives in [a senior independent living facility]. In that place, there is [a] senior facility [that contains] bars [to prevent falls]. [Other places say] ‘We don’t [carry] bars, grab bars.’

“[In] every [senior long-term care facility and assisted living center I visited in the past], [I see chairs with] one or two arms or two legs. I have some problems [like getting] chairs with arms.

“[When I talk to some seniors in long-term care, I will get comments like, ‘The] kids are too busy. I tell my wife to get me [a] chair [with particular features to accommodate my illness and disability’]. How many [assisted living facilities or senior long-term care centers] don’t have a table? They put [so many objects] on it [that it no longer functions as a table for mealtimes].”

Eckhouse established her business using her master’s degree training in gerontology from 2000, her work in senior long-term care and rehabilitation services, her 30 years of experience as an occupational therapist and later her certification as an “aging in place” specialist in 2008. Her thesis project for her master’s degree at Northeastern Illinois University was “Internet-based Resources on Information for Successful Aging and Independent Living.” Her website is at

A member of the Chicago chapter of ASA and the AARP, Eckhouse networks locally with the Senior Lawyers Committee of the Chicago Bar Association, Senior Services Division of the City of Chicago Providers Council, CJE SeniorLife and Covenant Methodist Homes to learn about the latest trends, research and practices in senior long-term care and home care to inform her commercial services.

“[With our current] health (care) system, you [may have, for example,] one week of [emergency room medical center or hospital care or] housing and three or four [weeks of] rehabilitation,” Eckhouse said. “You are lucky [to have] two weeks [of adequate transition time in between categories of care].”

As do most local companies, ElderSpace staff must consider the material, designs and regulations under which private family residences built after World War II were constructed to determine home improvement plans.

“[In the] post-World War II [era,] [there was a brand of] emerging housing [that they created to accommodate new middle city and suburban families throughout the country],” Eckhouse said. “[The] standards never changed. Cabinets and door knobs used [a particular material and design].”

Part of the counseling to homeowners and some of the products used for transforming homes include assistive technology such as computers, tablets and Skype, she said.

For example, if seniors living at home or in a long-term care facility need to take five or six bottles of medicine and they are forgetful, a specially-built machine may be set to help them remember to take them on time, in the correct dosage and with the right frequency.

“We call [on] assistant technology [to enable seniors to perform basic daily life functions],” Eckhouse said. “There are different ways that technology can help. Some technology is to help people [with tasks on a step-by-step basis] and others are sensors. [In either case,] technology is for communication.”

Still, she said, the difficulty of working with technology is learning the rules and laws governing use and implementation.

“With technology, it is complicated,” Eckhouse said. “The definitions aren’t the same. The government passes laws [on the definitions and regulations]. You are working with documents, namely electronic paperwork, and working with patients to try to implement [those machines or equipment].”

Read This Story From the Beginning: Part One

This article was originally published March 10, 2014 on the website of, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

Assistive Technology, Home Modifications Boost Senior Mental, Physical Functionalities (Part Two)

Loeb-Aronin praised another collaborator, Sherri Snelling, California-based CEO and founder of the Caregiving Club, executive producer of the “Handle With Care” TV show and newsletter editor, for bringing in a caregiving component to the intergenerational program activities. Snelling’s website is at

At the workshop, all professors and cognition, gerontology and geriatrics experts demonstrated how a variety of intergenerational activities around the country improved self-sufficiency, health care, mental and physical functioning and access to technology. The panelists shared “mind-building activities” and Internet-based content.

“[At] Pace and Case universities, [I and a team of instructors developed products to assist seniors with] loss of memory,” Loeb-Aronin said. “[The] computers and tablets [were used] with programs for recognition. [These programs] sensitized college instructors in [the] senior center [when they are working] with tablets [to address seniors with] memory disorders.”

“I [work on these projects with a team of] collaborators. [I get] advice and help from visitors and advisors [at my centers and universities]. Sometimes, there is an agency or group [that sponsors, leads or funds our work].”

Eckhouse said she started ElderSpace in July 2006 to assess the houses of seniors and enhance their living space at affordable rates to enable them to continue their lives at home and in their neighborhoods.

“[We encourage] planning, saving and aging in place,” she said. “[Most people don’t say] ‘I’m thinking of talking to [a] planner.’ Most people don’t want to plan. [They remain in] denial and worry. Don’t wait for a crisis [to occur to take action].”

Assessments focus on the mental and physical functions of a senior in his or her home, problem areas in his or her quality of life and health care and high-risk spots for injuries or falls in houses. Eckhouse said the assessments take into account whether there is sufficient lighting, safe and usable bathrooms, availability and use of house keys and accessibility of faucets and appliances in the kitchen as a whole.

She added that, after assessments, she offers modifications, adaptations, occupation therapy and products to the homes of her elderly customers using universal design and a specialized team of architects, engineers and construction workers.

“Home modification goals [are] safety, independence and functionality,” she said. “ElderSpace [provides] village members with communities and multi-generational housing. [We] retrofit space and create transportation and walking areas and visibility programs.”

She said ElderSpace helps Baby Boomers or seniors at different stages of rendering their homes more livable whether they are recovering from illness or accidents, coping with disability, remodeling or planning ahead for their houses and health care.

Aside assisting with planning changes to the house and staying at home, the company will also provide products, services and counseling on physical accommodations for Alzheimer’s and dementia patients, accident and fall prevention, assistive technology and contractor referrals.

Changes can take the form, for example, of placing studs in walls for future grab bars, widening doors with offset hinges to avoid hands getting caught in door jambs, lowering the height of counters, cabinets, and toilets, providing solid office chairs, modifying lighting, adding lighting and ultra-sense faucets, placing walkers at the top and bottom of stairs to prevent falls and removing barriers.

“Escalators, stairs and even revolving doors [are] products,” Eckhouse said. “[When I went to visit] Lurie [Children’s hospital in downtown Chicago,] everything [went] up. [I saw a] two-story escalator.”

Eckhouse explained that many of her company’s ideas for in-home accommodations come from the structural features she finds missing as well as the ones present in many medical centers and senior long-term care facilities.

Continued: Part Three

This article was originally published March 10, 2014 on the website of, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

Assistive Technology, Home Modifications Boost Senior Mental, Physical Functionalities (Part One)

Both assistive technology and modifications to one’s private home can connect seniors to the digital world, improve their intellect and knowledge base and enable to perform daily life tasks, a computer science expert and a gerontologist said on a panel at an annual conference on aging.

Felice Eckhouse, a gerontologist, occupational therapist, aging in place specialist certified by the National Association of Home Builders and founder/president of ElderSpace, Inc., a company started to assess and improve home environments to empower seniors to safely age in place in Chicago, and Dr. Gene Loeb-Aronin, founder/director of the Center for Technology and Cognitive Health of Older Persons in west suburban Wheaton, Ill. and the Center for Community Informatics in north suburban Wheeling, Ill., made their observations during their poster panel presentation titled “Are We Ready to Age in Place?” at the Aging in America conference by the American Society on Aging (ASA).

The presentation was also alternately called “Connecting Elders With Social Computer Networking via Intergenerational Community-Based Programs.”

“We invent terms because they sound pretty [such as] ‘aging in place,’” Loeb-Aronin said. “The problem is not re-defined. [There are different] pieces of the puzzle. Another problem [has to do with] doing enough [to promote successful aging in place and quality senior long-term care]. You look around. How many people are aging?

“Personally, it does not matter [which] neighborhood [seniors live in, how they obtain health care and what government services they participate in]. People are [not] writing about this but we don’t know how to implement [the technical resources needed to] to support home care.

Eckhouse said there are varying perspectives on age and this will color how prepared the industry and government are for the rise in the number of seniors.

“What [is life going to be like at age] 50, 60 and 70?” she said. “We’re in [the] middle [of a senior care revolution and transformation of the aging in place movement]. [Age] 75 [is the] beginning of the old and old-old. There are not that many [members of this age group]. [It depends on how you look at it.] [Either] no one’s old [or] everyone is old.”

Loeb-Aronin explained that both of his centers use volunteers to teach and initiate seniors in urban and suburban communities around the country to use information technology to hone their cognitive skills and become more knowledgeable about the world around them.

“[Our programs are meant to resolve] aging needs and [to promote] brain health,” he said. “[We want to help seniors attach names to] faces and [preserve their] memories.

“Volunteers help seniors [get] connected with people all over the world. [These aging] issues are all over the world. I lived in Australia [for a time]. I followed these organizations. I’ve got a lot of content.”

Editor of the Journal of Community Informatics and reviewer of the Journal of Informing Sciences and Merlot, Loeb-Aronin uses his educational background, research on learning, psychology and aging, instruction and travels to different countries and memberships in global organizations to enhance learning and development, create curriculum and technologies and write journal articles on aging and technology subjects. One of his websites include

Locally, Loeb-Aronin sits on the planning committee on ASA’s Chicago Roundtable of bimonthly meetings of geriatric professionals at Rush Presbyterian St. Luke’s University Medical Center in Chicago. He is also affiliated with Roosevelt University in its campuses in Chicago and northwest suburban Schaumburg, Ill.

Aside from their poster session on aging in place, Loeb-Aronin participated in a 90-minute workshop at the conference titled “Intergenerational Activities and Community Involvement: A Winning Plan for Quality Senior Living.”

He co-hosted the workshop with Dr. T.J. McCallum, associate professor of psychology of Case Western Reserve University in Cleveland, Ohio, Dr. Jean Coppola, associate professor at Pace University, Dr. Kristin Bodiford, program director of the initiative Creating Aging-friendly Communities, Dr. Robert Winningham, associate professor and division chair of the Department of Psychology at Western Oregon University, gerontology professor and expert on cognition.

Continued: Part Two

This article was originally published March 10, 2014 on the website of, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

Social Work Researchers Say Laws, Regional Policies to Senior Abuse Are Scattered, Inadequate (Part Three)

Both researchers said that each of the 50 states they studied protects seniors from physical abuse, financial or material exploitation and neglect but definitions vary. Forty-four states carried emotional or psychological abuse provisions or laws. Forty states had laws or provisions on self-neglect. Thirty-seven states addressed sexual abuse. Thirteen states protected against abandonment. Ten states – Alaska, California, Hawaii, Louisiana, New York, Pennsylvania, Rhode Island, Utah, Washington, and Wyoming – defined all seven NCEA categories of abuse.

For example, Virginia identifies adult abuse as “the willful infliction of physical pain, injury or mental anguish or unreasonable confinement of an adult,” combining both physical and emotional or psychological abuse. Hawaii defines psychological abuse as “the infliction of mental or emotional distress by use of threats, insults, harassment, humiliation, provocation, intimidation, or other means that profoundly confuse or frighten a vulnerable adult.”

For independently-defined abuse, no state, Jirik and Sanders said, had independent definitions of all seven NCEA categories of abuse. This held for six states on physical abuse; 46 states on financial or material exploitation; 46 states on neglect; nine states on emotional or psychological abuse; 16 states on self-neglect; 17 states on sexual abuse, and eight states on abandonment.

For age definitions, sixteen states specified ages 60 and older; six states, ages 65 and older; Hawaii, ages 62 and older; 14 states specified two ages for persons under its elder abuse law, age 18 and older and ages 60, 62 or 65 and older. Four states – Maryland, Mississippi, North Dakota, and West Virginia – had no specified age for a defined population. The remaining states defined the age of requirement as 18 years and older.

Jirik and Sanders pointed to a lack of consistency among the 50 states on training requirements under their elder abuse and neglect laws with some provisions being detailed while others were vague. Thirty-two states did not define any training requirements for investigators of senior abuse or the categories of professionals to be involved, although training could be at an administrative or department level or regulated in a different law or code. The remaining 19 states specified training for investigators of elder/dependent adult abuse and the type of professionals required.

Read This Article From the Beginning: Part One

This article was originally published March 10, 2014 on the website of, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

Social Work Researchers Say Laws, Regional Policies to Senior Abuse Are Scattered, Inadequate (Part Two)

In recent years, both said, state laws on elder abuse and neglect have expanded. In particular, more states are requiring mandatory reporting of incidents. In 2000, researchers found that seven states did not demand reporting of elder abuse and neglect cases, a figure that has now dropped to three states.

States have greatly expanded the categories of abuse prosecuted. In 2001, researchers found abandonment to be addressed in 10 state laws, a number which has grown to 13 states. In that same time period, 42 state laws included emotional abuse in its categories and this has extended to 44 states.

Still, by comparison, Jirik’s and Sanders’ research paints a grimmer picture: abuse definitions vary from state to state; only eight states have specific elder abuse laws, namely, Connecticut, Illinois, Massachusetts, Ohio, Oregon, Pennsylvania, Rhode Island and Wisconsin.

Few states, they said, protect against all seven categories of elder abuse as defined by the National Council on Elder Abuse (NCEA) under the U.S. Administration on Aging, and have specific laws on mandatory reporting and penalties for failure to report, specifically, California, Pennsylvania, Rhode Island, Utah, Washington and Wyoming. Many types of abuse are not independently defined but described in general. While state laws share particular concepts, they all differ in the details and the methods in which they are carried out, making scientific comparison difficult, they said.

In fact, Jirik and Sanders reported, many of the professionals central to the study reported feeling unable to intervene on behalf of seniors in trouble, have had to grapple with the self-determination and mental competency levels of their victims, found difficulty understanding and applying the laws of their state, did not succeed in having the cases they report accepted for investigation and found it hard to partner with under-resourced and under-trained investigative agencies.

To embark on their study, both researchers examined elder laws in state university libraries or government websites, focusing on state laws germane to home-based community services (HBCS) instead of senior long-term care facilities. Jirik performed the coding for the laws and reviewed them with Sanders. Both discussed the outcomes with two other elder abuse researchers, sampled particular states and phoned their elder abuse program directors to confirm their findings.

Concentrating on 2011 and 2012 state laws, Jirik and Sanders made records of statute numbers and titles, the type of victims covered, elder abuse cases versus dependent adult abuse cases, definitions of elder abuse, comparisons to the categories defined by the NCEA, mandatory reporting requirements and penalties, investigative agencies, provisions of consent and professional training.

This mode of collection was based on two well-known attempts at elder abuse law analysis: the 2000 articles titled “Statute Definitions of Elder Abuse” by J. M. Daly and G. Jogerst and “Adult Protection Service Laws: A Comparison of State Statutes from Definition to Case Closure” by L. Roby and R. Sullivan.

NCEA defines the following seven terms of elder abuse and neglect as follows: physical abuse as “acts of violence, physical punishment, inappropriate use of drugs;” emotional or psychological abuse as “threats, humiliation, harassment and isolation;” financial of material exploitation as “misusing or stealing money or possessions;” sexual abuse as “unwanted touching, including all types of sexual assault or battery;” neglect as “failure or refusal to provide elder with necessities such as food or medicine;” self-neglect as “failure or refusal of an elder to provide himself or herself with necessities;” and abandonment as “desertion of an elder by person who has assumed responsibility for [an] elder.”

Aside from finding that only eight states had elder or dependent adult abuse laws, Jirik and Sanders found that 14 state laws protect both dependent adults and elders from abuse with California’s “Elder Abuse and Dependent Adult Civil Protection Act” being a prime example. Twenty-nine states have dependent adult abuse laws that include seniors under certain conditions such as New Jersey’s “Adult Protective Services Act” for victims aged 18 and older, mentally or physically disabled persons and victims of abuse, neglect or exploitation.

For mandatory reporting, both researchers found three states – Colorado, New York state and North Dakota – did not specify mandatory reporting. Six states – Delaware, Indiana, North Carolina, Rhode Island, Utah, and Wyoming – had a universal mandatory reporting requirement. Thirty-one states required a specific class of professionals to report incidents. The remaining 11 had a universal reporting requirement with a list of specific professionals.

For penalties for failure to report, Jirik and Sanders found that 42 states have penalties, which include classifying the negligence as a misdemeanor, applying a fine of a $500 maximum and imposing a six-month jail term. Six states – Delaware, Indiana, Maryland, New Jersey, North Carolina, and Ohio – did not specify a penalty for professionals who failed to report. Three states – Colorado, New York state and North Dakota – have neither a mandatory reporting law nor penalties.

Continued: Part Three

This article was originally published March 10, 2014 on the website of, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

Social Work Researchers Say Laws, Regional Policies to Senior Abuse Are Scattered, Inadequate (Part One)

Nationwide, public and private sector laws and policies to elder abuse and neglect are fragmented and do not sufficiently address a problem that, if left under-addressed, may grow overtime with the number of seniors in the country’s population, two social work authors of a state law and policy research study on the subject said during their panel at a conference on aging.

Stacey Jirik, BSW, with the DuPage County Senior Services in Illinois and Sara Sanders, Ph.D, MSW, associate professor and Hartford faculty scholar, undergraduate social work program director at the University of Iowa and gerontology and end-of-life care expert, recommended more unified strategies when they discussed their 50-state study of federal and state senior abuse and neglect laws and policies, titled “Elder Abuse in the United States: An Analysis of Elder Abuse Policy and State Elder Abuse Statutes.”

Urging social workers, case managers, state directors of federal Area Agencies on Aging (AAA), registered nurses, home health care workers, elder abuse investigators and academicians to relate their professional experiences with elder abuse and neglect, Jirik and Sanders compared notes about laws and policies of the different states conference attendees hailed from.

During the panel, participants identified their state and the most effective solutions, greatest challenges, funding, attempts at advocacy, training, elder abuse and dependent adult abuse laws, mandatory reporting and penalties confronting elder abuse and neglect.

As the population continues to age, both social work experts said, the specter of elder abuse and neglect will loom larger. Their study, which encompasses legal statutes and policies across the country, found that between 1 to 27 percent of seniors are abused and that, for every case that is reported, 14 are not.

Meanwhile, the two panelists said, the U.S. Census 2010 found seniors make up 13 percent of the nation’s population or 40.3 million people. Government estimates project that, by the year 2030, one of every five persons in the nation will be aged 65 and older. This is, in large part, due to the medical and technological advancements that increase the life span for aging Baby Boomers.

Many researchers believe that senior abuse and neglect law and policy are in the same state that the issue of child abuse had 30 years ago and that the subject of domestic violence had 15 years ago, both said. Some have described the problem of elder abuse as a “patchwork quilt” of so many factors making an influence independently, making for disparate solutions to the problem.

Jirik and Sanders concluded that, over the decades, senior abuse has not received the same level and degree of “attention from professionals or the public” that child abuse and domestic violence have been given.

Both explained that elder abuse is not well-addressed because of the lack of societal value placed on older adults. With respect to detecting, treating and reporting elder abuse and neglect, physicians have not been involved in the overall effort because it has not been incorporated into their medical training, they said.

The public’s ageist attitudes and lack of awareness and an aging victim’s fear of retaliation contribute to inaction, they added. And resources needed to combat elder abuse at the federal, state and local level are limited when compared with that afforded child abuse and domestic violence.

By contrast, they said, government, business and nonprofit efforts are most effective against elder abuse and neglect when the victims of abuse are actively engaged in the fight, a wealth of research exists on the subject and there is a great deal of media attention.

Both social work experts recommended that policymakers and care professionals achieve greater uniformity among state laws in terms of the number of categories of elder abuse and protective remedies enacted and used, including for seniors not covered by dependent adult abuse laws.

They also called for more research on federal and state laws and policies to analyze and interpret such factors as the connection between the wording or length of laws and the types of elder abuse reports, the type of reports accepted or the overall outcome of senior abuse cases. They asked panel participants to deepen their understanding of how the federal and state laws and policies work and to articulate their “positive and negative aspects.”

Jirik and Sanders urged participants to become advocates against senior abuse and make its victims a priority, fighting against accompanying social stigma, a lack of funding for intervention programs and the pervasive ageism that leads to public apathy or inaction.

Continued: Part Two

This article was originally published March 10, 2014 on the website of, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

Improvement of Government, Community Resources Would Boost Rural Seniors’ Mental Health in Canada, Panelists Say (Part Three)

Falls and Loss of Mobility

Bacsu added that loss of mobility and falls were other prime concerns. They reflected gender differences and involved no discussion of health care to resolve them. Both worsened respondents’ sense of social isolation, limited activities around the house and fostered a loss of confidence and independence. Particularly, falls incited feelings of stress and anxiety.

SPHERU research in 2011 on falls and physical mobility found that about 85 percent of seniors’ injury hospitalizations stem from falls. About 50 percent of seniors were fallers. If they fell once, it was predicted that they would fall again. About 30 to 50 percent of seniors suffer a fall each year. Up to 25 percent of falls result in serious injuries such as a fracture requiring hospitalization. Falls account for 54.4 percent of all injury hospitalization, 75.7% of all in-house hospital deaths, and cost $6.2 billion per year.

Fall-hospitalization rates were higher for women at 19.2 per 1,000 than for men at 10.8 per 1,000 and survival rates from hospitalizations are lower for men.

“Participants downplayed [the] seriousness of falls,” she said. “Men reported falls performing high-risk activities. Women reported falls performing day-to-day activities. Women often kept falls to themselves. The threats of relocation [to a long-term care facility] and [being] institutionalized [are very real]. [It is] sad and depressing. [As a result, senior respondents to the study doubted any hope of] ever getting better. [After all, their] mobility [was] compromised.”

Comprehensive Solutions

To mitigate the effects of gender, spousal health, finances, social isolation and physical mobility on rural mental health, Novik said seniors must stay active with physical exercise, reading, gardening, music, Sunday worship services and dealing with their ability to drive a vehicle. Such activities will give them a sense of empowerment, she said.

Many seniors interviewed expressed optimism and used their sense of humor. For example, Novik said some seniors said they were lucky to live in a small village where they knew all of the residents who could help them with emergencies and could drive them within a half-hour of healthcare service.

Seniors, she said, want to make decisions and solve problems. They have a strong sense of autonomy and independence and like to take part in organized activities, including those with intergenerational opportunities, improved rather than “sketchy” Internet access, support groups for grief and Alzheimer’s disease, more information about mental health services, home health care, assisted living and nursing home services for seniors, nutritious Meals on Wheels, sun lamps, services for Native American seniors, financing counselors and loan forgiveness.

Additionally, Novik said seniors asked for greater infrastructure accommodation in Saskatchewan, including jets or planes traveling two to three hours, additional jet or plane flights, all-weather roads, trains traveling express and higher ridership on local buses and revamped airports.

Read This Story From The Beginning:
Part One
Part Two

This article was originally published Feb. 19, 2014 on the website of, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

Improvement of Government, Community Resources Would Boost Rural Seniors’ Mental Health in Canada, Panelists Say (Part Two)

This is because Canada’s rural areas have residents with lower incomes, less education, less adequate housing, less access to rail and public transit services and lower quality of health care than in the country’s urban areas.

“Our rural areas are elderly,” Novik said. “Young people moved to the cities. When we talk rural and remote, we talk about [distance]. [We gain an appreciation for] how rural and remote Saskatchewan is.”

Travel within the province is hard, she added. For seniors who live in Ottawa, Perth is 20 minutes away by car or rail. Rural communities that include the First Nations indigenous populations are one hour away from Watrous and Saskatoon, the province’s largest city with a population of 257,300. Woseley is one hour away from Regina, the capital of Sasketchewan, and a three- to four-hour drive from Preeceville in central Saskatoon. Residents can’t drive in or out of the region.

Yet rural areas are seen in a positive light, masking their socioeconomic problems, Novik said.

“One-dimensional views [of] problems leave little scope for addressing mental health,” she said. “Rural areas [are] often characterized as idyllic and pastoral with less stress, strong community networks and close connections to the land. [Yet, for example,] the provinces built [the] hospitals but [they’re] not sustainable.”

By contrast, research more than one century old did not romanticize the country’s rural areas, she said. In 1908, Canada had less than 10,000 people. “[The] rural [areas were] conceptualized as being underserved, sparsely populated and geographically disperse,” Novik said.

Meanwhile, SPHERU research in the present day found that about 15.4 percent of those 65 years old and older live in Canada. Between the years 2006 and 2026, the number of seniors in Canada is expected to increase from 4.3 million to 8 million. By 2036, seniors will reach approximately 25 percent of the total population.

Seniors made up 85 percent of all hospital patients in 2011. About 47 percent of them have completed hospital treatment but remain in acute care, skilled nursing facilities, nursing homes and rehabilitation because they await a transition to a long-term care facility.

At the same time, 80 percent of Canadians surveyed support the development of more home health care and community-based programs for the elderly.

As a result, more research must be generated to examine and improve the supports that enable rural seniors to stay at home to age in peace, although funding is hard to secure with government budgetary cuts, a troubled global economy and fierce competition for research dollars, Novik said.

“It is challenging to get research dollars,” she said, referring to the interdisciplinary SPHERU studies as focusing on Regina in Saskatchewan with provincial and national funding. “With our research, we can exchange insight and share mental health [facts and statistics].”

Novik said that Canada has adopted the World Health Organization’s (WHO) goals and objectives in 2009 for mental health.

“Addictions and other sources of stress exist [for seniors],” she said. “They [seniors must] cope with stress. [Reiterating WHO’s definition of mental health, it is a] state of well-being in which the individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his own community.”

Senior Community-based Interviews

Based on Canadian psychiatrist, professor and researcher James Cantor’s social care model of 1989 to identify government policy, community and kin-level interventions to improve rural aging, SPHERU’s “Rural Healthy Aging” research concentrated on the subject matter of formal and informal support for rural seniors. Researchers asked extensive questions about how senior respondents were being supported and where the support originated from.

Formal and informal supports meant home health care, senior housing, access to information about senior services, an accommodating public infrastructure and transportation. SPHERU researchers summarized the responses from seniors and interpreted them in five categories in terms of social interaction, independence, cognitive health, mental health, mobility and community involvement.

The project uses the tools of community-based participatory research (CBPR), collaboration and capacity building. Community partners are involved in all stages of the research from other questions that have been asked and investigated previously.

For the academic year of 2009 to 2010, the pilot study conducted 42 interviews over three years with rural seniors in Preeceville, Watrous and Woseley, all in Saskatchewan.

In 2011, SPHERU researchers conducted 40 interviews for 16 men and 24 women aged 64 to 98 years of age. In 2012, 36 interviews were performed with 14 men and 22 women of the same age range. The third wave of interviews occurred in Watrous in April 2012. Researchers completed two interviews with each participant in Woseley and final ones in November 2013.

Juanita Bacsu, project coordinator and a researcher with the Saskatchewan Population Health and Evaluation Research Unit (SPHERU) of the University of Saskatchewan who recently completed her doctorate degree in community health and epidemiology at the school, said there were five key themes to interviewing rural seniors on mental health: gender, spousal health, finances, isolation and physical mobility.

“We looked at socioeconomics,” Bacsu said of the videos of senior testimonies. “They already had risk factors for mental health [problems]. [The research was] interwoven [with testimonies about] gender. Men described greater differences in mobility. [They viewed their] inability to complete outdoor work more negatively.

“Women identified [the] stress of learning new tasks [such as] driving [and] finances when spouses did this before. There is a sense of loss. You could [hear it] in [the] gentlemen’s voices.”

Mental health, she said, was linked to spousal health, especially caregivers. Caregivers often put spouses’ well-being first and they feared spousal separation through long-term care. Grief and loss of their spouses were identified as key issues.

Additionally, Bacsu said, there was a need for service awareness, particularly for respite for caregivers and long-term care for senior patients. A lack of service was a rich source of mental stress.

Women interviewees, she said, worried over the increasing costs of medicine, ambulances, home health care and the cost of living, especially paying their monthly bills. They said training in financing would be helpful and revealed that they handled their finances differently after their husbands died.

Aging respondents also spoke of the negative consequences of physical and mental isolation, Bacsu said.

“[There is] limited interaction [in the] small villages,” she said. “[There is] no running water.

[The] isolation [is] exacerbated by limited mobility and winter [because of] ice, cold [and] daylight. [The] caregivers [are] isolated [and are] unaware of supports. [They are] reluctant to ask for help [because they] don’t [want to] burden others. [There is] limited senior’s housing [so there is a] fear of being sent away [if they inquire about such services].”

Continued: Part Three

This article was originally published Feb. 19, 2014 on the website of, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.