HEALTH CARE OF OLDER PEOPLE: WHEN A NURSING HOME IS NEEDED

ALTERNATIVES TO NURSING HOMES FOR OLDER PEOPLE: MODIFYING ENVIRONMENT TO ENHANCE INDEPENDENCE

KEEP YOUR CHILD’S HEALTH: ENCOURAGING GOOD SLEEP HABITS

There is much that you as parents can do to foster good sleep patterns. This can start as early as infancy, when babies should be allowed to develop their own sleep rhythms. Do not wake your baby for a feed, and do not worry about imposing rigid feeding schedules. Let him fall into a cycle of feeding and sleeping — this is usually evident by 6 months of age, though it is often earlier and sometimes later.

It is from the toddler period onwards that parents can actively do things to encourage good sleep habits.

1. Avoid exciting or very active games>just before bedtime. It is very difficult for a child to quickly switch from an exciting activity which has the adrenaline flowing to a quiet state conducive to sleep.

2. Develop a regular bedtime routine (see p. 132) and precede this with a period of quiet activity.

3. Sometimes daytime naps mean the child is not tired at bedtime. If this is the case with your child, you may want to limit the amount of daytime sleep.

4. Try to be flexible about the exact time of going to bed. It may be a little later in summer, where darkness descends much later than in winter, or if the child obviously is not tired, or where there is a special occasion.

5. Avoid staying with the child until he falls asleep, or he will never learn to fall asleep by himself. At the end of the bedtime ritual, kiss your child goodnight and leave the room.

6. Night waking should not be reinforced by giving your child a drink or cuddle in the middle of the night. If he wakes, just ensure that he is alright, then make it clear that you expect him to go back to sleep.

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LOSS OF APPETITE/LOSS OF WEIGHT – INTRODUCTION

These two often go hand-in-hand, so I have put them under the e heading. Loss of appetite, with or without some nausea and/or change in how things taste is quite common in people with cancer. Often these symptoms are due to treatment rather than to the cancer itself, because both chemotherapy and radiotherapy can produce loss of appetite and weight. Of course, cancer itself can also cause loss of appetite and weight, especially when it is in the stomach area, liver or pancreas. However, it by no means always does so—loss of weight is not something that happens to everybody with extensive cancer. Some people never lose weight — not even in the final stages.

If your appetite is poor and/or some things now taste unpleasant, try to work out what tastes do appeal to you now and plan your diet accordingly. Don’t force yourself to eat certain foods that you now find unpleasant just because you believe they are ‘good for you’. Look for a more appealing alternative— for example, if you find meat distasteful, you may be able to get the protein you need from nuts, seeds, beans, dairy products and eggs.

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FRACTURES – PELVIC BONES; SPINE

The pelvic bones may be fractured in a fall or in a motor car accident. No attempt should be made to get the patient to walk. Carry him on a stretcher, or on your back, or with two people — one can hold him under the arms while the other supports the legs.

In men, the urethra, or tube, leading from the bladder to the outside, may be ruptured with a pelvic fracture. The affected person may be unable to pass urine, or there may be a blood-stained discharge from the urethra.

If a fracture of the spine is suspected, the greatest danger is to the spinal cord and, if this is damaged, paralysis, either paraplegia (affecting the lower limbs) or quadriplegia (affecting all four limbs), may result.

Be particularly careful with a person who is injured after diving into shallow water. Dislocation to the spine at the neck may cause damage to the spinal cord.

You must be extremely careful in moving this type of victim. Preferably, leave him to the expert, an ambulance man or a trained first-aider.

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GLANDULAR FEVER – TREATMENT

The lymph glands of the body are enlarged as also is the spleen, an organ which lies tucked up under the ribs on the left side of the abdomen.

The liver is involved in most cases but only in about a sixth, does jaundice or yellowing of the skin, appear.

Unfortunately, there is no specific treatment except rest in bed. Aspirin or paracetamol eases the pain and reduces the fever.

Lethargy and depression are common symptoms and, unfortunately, these may persist for months.

Recurrences of glandular fever are not uncommon and can occur weeks or months later.

While the virus has not yet been identified there is some research which seems to indicate that it is identical with an already discovered virus known as Epstein-Barr virus.

One theory is that EBV is a common infection in man normally well tolerated.

A minority which escape infection reach adolescence and then as a result of the virus develop infectious mononucleosis.

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FIBROADENOMA OF BREASTS – PAINFUL BREASTS

Cancer of the breast usually appears as a painless lump but women who suffer pain in the breast are often frightened it is a symptom of cancer. It rarely is.

Painful breasts mainly occur at the time of the periods but they also can be unrelated to the menstrual cycle. Pain is often associated with the presence of many tiny lumps throughout the breast tissue.

For severely painful breasts, radical treatment can be used. This involves removing all the breast tissue, leaving the skin and the nipple, and inserting an implant.

Two new drugs have been shown to be of great value in relieving breast pain. One is bromocriptine which, among other uses, can be used to suppress milk production after childbirth.

The other is danazol, which was introduced to treat endometriosis, a disorder where the lining tissue of the womb may occur in other tissues such as the ovary. Both drugs produce relief of breast pain in 70 to 80 per cent of cases.

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TREATMENT OF SYMPTOMS – SPECIALISED TREATMENT

What if your practitioner refuses to pay attention to your symptoms and behaves as though tests and anti-cancer treatments are more important than your comfort? In this case, I suggest you very seriously consider changing practitioners. This will be easiest for those of you who are not having any specialised treatment. If you are, it may still be possible to find a practitioner who can both supervise your specialised treatment and take care of you. If you can’t find such a person, you could consider continuing the specialised treatment under your original expert’s supervision, while seeing another practitioner for care of your symptoms. Your local general practitioner may be prepared and able to do this.

Yet another possibility is to stop your specialised treatment. Think carefully about the costs and benefits of continuing with it. To the costs you considered when agreeing to have it, you must now add the fact that your symptoms are being ignored. As a result, you are experiencing discomfort and inconvenience. This extra cost could be enough to tip the balance in favour of stopping your treatment.

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THE G.I. FACTOR AND WEIGHT REDUCTION: HOW CAN THE G.I. FACTOR HELP?

One of the hardest parts of trying to lose weight can be feeling hungry all the time, but this gnawing feeling is not necessary when you are losing weight. Carbohydrates are natural appetite suppressants. And of all carbohydrate foods, those with a low G.L factor are amongst the most filling and prevent hunger pangs for longer.

In the past, it was believed that protein, fat and carbohydrate foods, taken in equal quantities, satisfy our appetite equally. We now know from recent research that the satiating (making us feel full) capacity of these three nutrients is not equal.

Fatty foods, in particular, have only a weak effect on satisfying appetite relative to the number of kilojoules they provide. This has been demonstrated clearly in experimental situations where people are asked to eat until their appetite is satisfied. They over-consume kilojoules if the foods they are offered are high in fat. When high carbohydrate and low-fat foods are offered, they consume fewer kilojoules, eating to appetite. So, carbohydrate foods are the best for satisfying our appetite without over satisfying our kilojoule requirement.

When we eat more carbohydrate, the body responds by increasing its production of glycogen. Glycogen is stored glucose, the critical fuel for our brain and muscles. The size of these stores is limited, and they must be continuously refilled by carbohydrate from the diet. Good glycogen stores ensure a well-fuelled body and make it easier to exercise. Even when we are not exercising, the body will use a mixture of carbohydrate and fat, attempting to match the carbohydrate : fat ratio of the fuel mixture to that which has been eaten in the diet.

Because fat is less satisfying to our appetite, it is easy to over-consume fatty kilojoules. That is why reducing the dietary fat intake is a far more effective means of achieving weight control while satisfying the appetite than restricting carbohydrate intake. By eating a high carbohydrate diet it will be easier to lower your fat intake, and by choosing that carbohydrate from low G.I. foods, you make it even more satisfying.

What’s more, even when the kilojoule intake is the same, people eating low G.I. foods may lose more weight than those eating high G.I. foods. In a South African study, the investigators divided overweight volunteers into two groups: one group ate a low kilojoule, high G.I. diet and the other, a low kilojoule, low G.I. diet. The amount of kilojoules, fat, protein, carbohydrate and fibre in the diet was the same for both groups. Only the G.I. factor of the diets was different. The low G.I. group included foods like lentils, pasta, porridge and corn in their diet and excluded high G.I. foods like potato and white bread. After 12 weeks, the volunteers in the group eating low G.I. foods had lost, on average, 9 kilograms—2 kilograms more than people in the group eating the diet of high G.I. foods.

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FAT LOSS: THE MACRO ENVIRONMENT

The physical macro environment. Influences on body fatness in the widet physical environment include the food supply, availability of facilities for physical activity, and the demands for physical activity for day-to-day living. The food supply within a population is influenced by a number of factors including agricultural practices, pricing and taxation structures, manufacturing and food processing, marketing and the availability of distribution outlets as well as the general economy. Supply is ultimately affected, however, by Government policy and public demand.

Meat and livestock producers were traditionally rewarded for fatter carcasses by having prices determined by total weight and/or fat content. Dairy producers also received greater incomes from higher milk fat content. However, public demand for lower-fat products has caused a shift away from prices based on fat. The public shift towards chicken meant an increase in the production of poultry. This led to an increase in battery hen farming, and as a result of the reduced activity of the birds (which were previously free range), the fat content of poultry seems to have increased significantly.

In the meantime, public demand led other meat producers to significantly reduce the fat content of their product, through different farming, butchering and marketing practices. Lean pork, beef and lamb are now highly comparable with poultry in fat content, and in some cases, lower in fat. Hence changes in the food supply can influence changes in the availability and use of products likely to facilitate increases in obesity and this has become a targeted activity of the public health lobby.

Food processing and supply is also influenced by the market place and public policy. Requirements for labelling of fat content of packaged foods accompanied by public education campaigns aimed at increasing awareness of rattening and non-fattening products, can help reduce their demand and in turn put pressure on food producers to modify the supply. Programs like Tick the Tick’4 also bring nutrition into the equation for manufacturers and making the product eligible to achieve the tick endorsement becomes the goal for which manufacturers can aim.

Fast food outlets have increased their turnover dramatically in Western countries, with an estimated 1 in 3 meals now reportedly purchased outside the home. Per capita consumption of takeaway foods has increased by 10 per cent per year since 1984, with a total annual market in Australia in 1994 of $5 billion. Approximately $540 per capita is also spent per year on snack foods, compared to $506 on fruit and vegetables. Government policy in the form of incentives, as well as disincentives (such as taxes) for the production and sale of reduced-fat takeaways is one future option to slow down the increases in obesity.

Public education campaigns are also necessary at this level to help develop skills for choosing and preparing food. A very important accompaniment to such education efforts are attempts to improve the food choice in places where people eat, such as school and work canteens, lunch bars and institutions such as hospitals and boarding schools. Even small changes, such as not automatically buttering baked goods, may have a major impact, simply because of the volume of people eating in these settings, and work to this effect must be a priority for health authorities.

The options for energy/fat expenditure in a society can also be influenced at a macro environmental level. As technology advances, with increases in the number and type of effort saving devices both in the workplace and in the community, the need for daily movement is reduced. The development of motor vehicles and other transport options, for example, has reduced the need to walk. For many people, men in particular, the work environment offered the main opportunity for physical activity. Even twenty to thirty years ago many jobs required some degree of physical effort, but the development and increasing sophistication of machinery continues to reduce this significantly. Decrease in work place activity is often given as one of the main reasons for the increases in fatness of working class men in recent times. Ifs interesting to note that only a little more than twenty years ago, white collar workers were generally fatter than blue collar workers. But in some ‘blue collar’ areas like industrial cities, 3 in 4 men are now regarded as overweight or obese compared to 1 in 4 amongst ‘white collar’ men.

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