The cumulative effect of small risks

While shower safety is not really his point, Jared Diamond provides a great example of how we mentally minimize risks by not factoring in how many times we are exposed to them:

“Really!” you may object. “What’s my risk of falling in the shower? One in a thousand?” My answer: Perhaps, but that’s not nearly good enough.
      

Life expectancy for a healthy American man of my age is about 90. (That’s not to be confused with American male life expectancy at birth, only about 78.) If I’m to achieve my statistical quota of 15 more years of life, that means about 15 times 365, or 5,475, more showers. But if I were so careless that my risk of slipping in the shower each time were as high as 1 in 1,000, I’d die or become crippled about five times before reaching my life expectancy. I have to reduce my risk of shower accidents to much, much less than 1 in 5,475.

Now, one way to mitigate this risk is to only shower once a month, whether I need it or not.  (Need, by the way, seems to be a subjective judgement.  It seems I'm quite content stretching the interval between showers out quite a ways--but my wife and children prefer I adhere to a much shorter cycle. Apparently they don't have my safety in mind. Humpfh) 

A much smarter way to address the issue and reduce risk is to change the environment in which you shower.  Modern surfaces with better slip resistance, nice grab bars, alcoves to keep things tidy, controls in easy reach.  These and other things will make for a much reduced cumulative risk.

The same applies to other areas--small changes, reducing what seem like small risks, that over time have a high likelihood of happening and bringing about nasty consequences.

http://www.nytimes.com/2013/01/29/science/jared-diamonds-guide-to-reducing-lifes-risks.html?src=me&ref=general&_r=0

The importance of mindset

I'd like to thank Tim, a PT in Northern CA for catching my colleague Brian on a very valid issue of proper mindset.  A while back Brian was interviewed for a video segment on aging-in-place. You can see the video at the link. As Tim said, some good information.
 

http://www.seniorhometours.com/Portland-Oregon-Your-Retirement-Connection-Video-of-Aging-In-Place-Interview-and-Living-with-Family-Discussion.html

But Tim makes a great point, to wit "I could not help but to cringe on the 3 occasions when the term "wheelchair bound" was used.  As you know, a wheelchair allows for independence and therefore does the exact opposite of 'bind'."  Tim's exactly right.  While I'm sure there are some people who, once fully ambulatory, now feel "bound" to their chair, in reality it is their chair that enables them to get out and about in the world, it is only binding from the perspective of what was, not what will or can be. Mobility is key to our wellbeing. 

His comment made me think of some wheelchair racers who passed me by while I was running a 10K some years ago. While they were moving too fast for me to ask, if I should have had the inclination to do so, I doubt that they were feeling tethered.

It also made me think of what can truly bind the wheelchair user--ineffective access.  While instances of barriers and poor design are rampant in our cities, many chair users can more effectively navigate in much of the public world than in their own home.  And our public policies don't help much there. A few years ago we were called to urgently build a ramp for a couple.  The husband needed twice a week kidney dialysis and had recently lost his ability to walk. Medicaid provided the wheelchair and the transportation, but would make no accommodation for getting him in and out of the home.  And this was not a couple of small steps that could be bumped down. Like providing a car but no key and no way to open the garage door.  Their frustration (and fear of what would happen if they could not get a solution) was palpable.

Assistive devices and modifications go hand in hand as things that cut the ties that bind us and make our lives easier.  But we need to have the proper mindset of what they bring to our lives when built or used well, rather than thinking of them as symbols of loss.

The where's and whys of falls

We’ve been providing our free online home assessment for nearly 7 years now and about 500 people have taken it. I’m starting to look at some of the data for patterns—while it is not a scientific survey, we can still see some interesting things by looking at what people are experiencing.
One thing that we do is ask if they have fallen recently and if so, how often. We also ask them where they have fallen. I plugged these “where” responses into a word cloud—if you are not familiar with these, a word cloud simply counts the words and shows words that occur more commonly in a larger font size. The results are interesting and confirm much of what we know about falls:

• First, 43% of people completing the assessment reported falling, and that 43% reported an average of 5 falls in the past year—underscoring that once falls begin they can become relatively common due to chronic issues like poor balance, dizziness, vision problems or strength issues like “weak knees" or medical issues like a drop in blood pressure or "low blood sugar”

• Tripping over any variety of objects is another common issue—rugs, stools, garden hoses, even the family dog are all mentioned.

• Stairs or steps stand out as a key item related to falls—interestingly, when looking at the actual comments it is clear that this is much more commonly related to a single or short set of steps than a long stairway. We spend a lot of time worrying about staircases between floors but it is those hidden steps like sunken living rooms or entrance steps that appear to be the bigger culprit in falls--many who don't feel safe navigate long stairs probably simple avoid them--we've had a number of clients who have only lived on the ground floor of their house and avoided the upstairs or basement.

• It's no surprise that the bathroom comes out as the most common location for a fall followed by the bedroom—where people report falling getting out of or around the bed. Ensuring that we have adequate support around the bed and taking our time here is and important but often overlooked area for home mods--my own mother fell getting our of bed and broke her pelvis, starting her long spiral of decline.

• The kitchen is also a common place to fall—often because we are leaning or bending over and lose balance. Better cabinet design and retrofit pull-out shelving can help.

• Living rooms/Dens are also common mentions. Some of this may simply be becuase these are rooms where we spend time--reading, watching TV, visiting. Steps, tripping hazards, loss of balance are all mentioned--the only pattern appears to be that these are rooms where we spend time, and so are going to get their share of falls.

• Falls are hardly limited to the interior of the home. Sidewalks and outdoor garden areas come up regularly (look for the words individually). Tripping over objects or uneven surfaces appears to be quite common—reinforcing the need to ensure that pathways are smooth and continuous.

I’ll be sharing more insights from our assessment tool over the coming months.

Cooking Safety

Laurie Orlov (http://www.ageinplacetech.com/ )was kind enough to provide a link for a home safety device in a comment to my last post. I thought I would add it here to ensure it gets noticed. This is an aftermarket device that can be added to improve safety for electric ranges. It is the latest generation of a type of product that has been on the market for awhile and certainly is something to consider.

However, a point I was trying to make is that features like this are more effective and generally more functional when they are designed into the product in the first place. The nice thing about the fire fighting faucet is that the technology is integrated so it looks better and works continuously in the background. Similarly, more faucets could be designed that inherently limit the scald risk. And devices like stove could have better safety features built in--is it this type of technical advancement I'm hoping to see (at affordable levels)

Until then, the aftermarket solutions will have to do.

http://www.cookstop.com/

Smart technology that protects everyone

I came across this article in the NY Times today about a faucet that fights fires. Seems that the faucet is linked to a fire alarm. When the alarm trips, a special valve opens and a pump under the sink produces high pressure jets of fine mist. This mist immediately turns to steam around the fire and robs it of oxygen, putting the fire out.

I would love to see (read that as I have been WAITING to see)technology built into stoves that can sense when a pot gets too hot or when one has been left unattended for too long and lowers the temperature. That would be a better first line of defense. But having seen the effects of fires caused by overheated pots and pans or even unattended air poppers and other countertop appliances, this device will be a nice, non-intrusive approach to solving one of the worst after effects of "a senior moment."

http://tinyurl.com/y9zxxu8

Body Dryer

This product made its way through my e-mail scanners--I rarely pay attention to those messages, but this appears to be another product coming over from the UK/Europe where product design for bathing accessibility seems to be ahead of what we have over here. It is a full body dryer, making it easier for someone to dry off after a shower without bending or assistance. The claim is that cost to operate is about the same as laundering towels--suppose that depends on how often you wash your towels tho.

Can't vouch for how well it works yet, but seems an ideal product for lots of folks.

http://www.tornadobodydryer.com/featuresandfaqs.html

What lesson will they learn?

As we boomers age and take first hand seats watching how our older friends and our parents handle the journey, I wonder what lessons we will really learn. Many times, we have customers who call us out to discuss a plan for an aging or disabled relative, only to have the person’s condition worsen before anything can be done. Often, the loved one passes away. In some cases they have spent years dealing with frailty and diminished ability, with an environment that creates stress or unhappiness, but when they finally decide to take action, it is too late. In the current economy, this is happening more and more.

In just the past month, we numerous examples—a family that made some urgent modifications and bought a portable ramp that never got out of the box because their loved one died. A family who wanted to make home better for their father who was in their 80’s—he passed away just before we were to visit the home. He was surrounded by his grandchildren and passed quietly in his sleep—isn’t that how we would all like to go.

One lesson, the one I would like to see, is that we need to be proactive in order for adaptations to our homes to provide value. But I’m sure many others will see a lesson of “why bother.” Perhaps this will be resignation that the latter stages of our life will be short and not worth taking precautions for. And that will be true for some. But for many more, life could be safer and more gratifying if we plan ahead. Not just for things like walk in showers or masters on the main, but for basic requirements for sound roof, durable flooring and efficient HVAC.

As a generation, which will be the lesson we most often learn—act, wait or not bother at all?

Aging in place and pets

I don't normally read the lifestyle and advice columns in the newspaper. But while looking for the crossword puzzle, Deborah Wood's Pet Talk column caught my eye today and got me thinking. She writes about a choice of a dog for an 85 year old who lives independently and has recently had knee replacement surgery (read it here).

Her article reminded me that pet care can become a bit more of a demand as we age, but the companionship pets offer is a great contributor to healthy aging and well-being. At In Your Home we regularly do small projects that help older homeowners take care of their pets more easily. Some examples:

• Pet doors. Giving Fido a little freedom to come and go without mom having to get up and let him out can be a good thing. You want to ensure the doors are properly installed to minimize heat loss and security risks. They now offer doors that unlock and relock automatically, triggered by a sensor the pet wears.
• Pet runs. Having a secure run complements the pet door--we often install paver stones to create a cleanable, non-muddy surface for a pet run, keeping the dog from wandering into trouble and reducing housekeeping and gardening chores. And the pavers are easily removed by the next homeowner if desired.
• Handheld showers. Not just good for mom or dad, good for washing the dog as well.
• Food storage and dispensers. Keep quantities of food on hand but away from vermin, and they can minimize the amount of bending/reaching required.
• Flooring choices. Commonly we are looking to make flooring smoother and more durable to handle walkers or scooters. Laminate flooring can be tough as (dog) nails, but is not so good for under a cat box or with a pet that has "accidents." This sort of standing moisture will penetrate the seams of most laminate and not only be hard to clean, but will swell and damage the laminate itself.
• How about some hooks by the door to keep leashes handy and easy to grab? Or making sure Fido's bed is not located where it will be a tripping hazard? Simple steps like these can really help keep the joy of pet ownership strong.

I guess I'll have to read these columns more often if they make me think--after all, brain exercise is why I wanted the crossword puzzle.

The cost of falls

CBS News reported yesterday on new survey findings from the CDC on the prevalence and risk of falls. According the report, 1.8 million report falling in the prior three month period--up from prior numbers of 5.8 million per year. Costs of these non-fatal falls is estimated at $19 billion. The CBS report notes that many senior adults may not take wise precautions because of "embarrassment"--but don't really touch on the fact that many safety modifications do not need to look institutional nor signify frailty.

Watch the news report here:

http://www.cbsnews.com/sections/i_video/main500251.shtml?id=3919186n&channel=/sections/health/videoplayer204.shtml

Helping Boomers plan and adapt

The Boomer Advisor just published the first in a series of articles we've written on how to adapt the home. The targeted readers here arethe boomers who are more typically going to be concerned about these issues for a parent or grandparent. But, as the article notes some of us boomers have started experiencing the need already or will soon.

In the article we take the design of a typical modern bathroom and point out a variety of issues and tips for better design.

Read the full article at the Boomer Advisor and let us know what you think.

http://www.advisor.com/boomer/story/remodeling-safety-bathroom?page=0%2C0

Why bother?

I came across the grab bar install shown in the photo the other day. Unfortunately, I did not have someone with me who could have sat in the tub and shown the impracticality of this installation. If you are lying in this tub, to try and use this bar your arms are high and above the plane of your shoulder which makes it impossible to gain leverage—believe me, I tried it. And, the grab bar is almost useless for getting down into the tub—probably a good thing because once you get down there it is not going to help you get back up. The bar also offers no support to someone showering.

This installation (in a hotel room) is clearly something that was done to meet at requirement or policy (or a desire to not obstruct the soap dish) without regard for the actual benefit of the user. Worthless—someone who knew what they were doing could have easily specified or installed the bars in a position that would have been more likely to be beneficial. Does anyone see a practical aspect here that I am missing? Or is this just a waste of stainless steel?

A Positive Attitude

One of the things we often think about is that real success for Aging in Place will come when more of today's elders (and the boomers who will follow) develope a more positive attitude toward AIP modifications. I came across an article that put it well: "The key to aging in place, experts say, is to embrace rather than deny the need to adapt living spaces to meet physical changes as mobility, eyesight and hearing decline." This came from an article from the Washington Post, but I found it reprinted in the on-line version of the Hong Kong paper The Standard. Link to The Standard Article.

This article profiles the efforts of 90 year old Charlotte Goldstein to adapt her home to improve safety. The picture shows some basic handrails put up to complement the existing banister on her stairs. A very practical solution and a fairly common project for our company. But I am still more likely to encounter people who say they can make do without the second rail. I recently met with a woman who had already fallen and fractured a collarbone who refused either a second hand rail or any form of slip protection on her stairs because "it just wouldn't look right." However, I think that seldom are these reactions about cost or aesthetics--simple rails are not that expensive and I am as likely to get resistance from the well off as those who struggle on a fixed income. Plus they can be made made to fit in with decor and are easy to remove.

No, unfortunately it is the perceived weakness that such modifications are seen to represent that prevent "embracing" making changes to our homes. That and persistent denial even in the face of real need. Mindsets like these create the most resistance. Only when an increasing number of people see that the virtue is in preparing and that part of being able to keep your home is keeping it appropriate to your abilities and phase of life will a major barrier to successful aging in place fall to the wayside.

Care in choosing contractors

We're not the sort of people who like to try to sell by creating fear, but I came across this video clip and thought I would pass it on. It underscores the risks people face when dealing with contractors. While it does not make the point, seniors can be at an even greater risk for this sort of scam artist. It's part of the reason why we started our business--to provide a recognizable, trustworthy resource for a wide variety of home maintenance and remodeling needs. Because we are insured, licensed and take extra steps like conducting employee background checks and training on customer service, we are seldom the cheapest option in town. While sometimes cheapest is a deal, often it becomes an expensive lesson or even turns into a risk for your family. For seniors on tight budgets and a sense of what things used to cost, the temptation can be strong to save money. But seniors can often be at greater risk due to decreased mental capacity, medical conditions, grief from a lost spouse and so on. And, as one of our customers said last week when scheduling a grab bar installation--"I don't want something that is going to pull out of the wall." Even a handyman who isn't a crook can unintentionally create problems by improper methods.

As this story mentions, not all states regulate contractors, so verifying the contractor can be a problem. They give some good tips in the video clip. They did not mention Angie's List--a great way to see what customers say about the company and how the company responds, which is often just as important.

The video is located at the link below, and you'll have to watch a commercial of some sort before it starts--the one I saw was for a video game.

http://video.msn.com/video.aspx?mkt=en-US&brand=msnbc&vid=b83da96a-d107-4f6c-ba7d-8d7c7bd3ba03

Beware the easy fix for increased lighting

One of the common issues we experience as we age is that we need more light to see clearly--especially the print of important things like medicine bottles, food packages, and, in my case, the daily crossword puzzle. The best way to get this additional lighting varies by what we need it for and by the condition of our eyes. But one solution that is never a good one is to shove higher wattage bulbs into fixtures that are not rated for them. Doing this can cause burns and fires.

I say this and many people scoff--what can be the harm of a brighter light bulb? Mountain out of a mole hill, they say. Well, witness this customer we helped out last week who called to have some water damage around a light fixture repaired. When our handyman got there, he found not water damage but heat damage. The owner had installed 100 watt bulbs in a closed fixture rated for 60 watt bulbs. Not only was the ceiling scorched and discolored, but the plastic junction box and wires were "crispy." The potential for a fire was very real.

Just a reminder that if more light is in your future, upgrade your fixtures to handle it. Also, consider putting them on dimmers so that you don't waste the wattage when you don't need it.