The Forgotten Disposables

"I think they [authorities] need to look at whether we are having deaths due to heat in long-term care homes. The problem is, if they don't look, they are not going to find it."

"In a normal year these rooms are incredibly hot. I have been in old homes and new homes where there is no air conditioning and I could not stand it."

"Every year when we get heat waves we get calls and I can't imagine that the premier's office doesn't get calls. Every June we start getting calls from people shocked that the home they chose for their parents doesn't have air conditioning."

"It is definitely something that should have been on his [Ontario Premier] radar."

Jane Meadus, staff lawyer, Advocacy Centre for the Elderly

"[The air conditioning units in older homes] are not sufficient in soaring temperatures."

"A major part of fixing this issue will take addressing the long-term infrastructure problem facing long-term care homes in Ontario."

"We have been advocating for upgrading older homes over the pas ten years and we hope to see this process underway as soon as possible."

"This is an issue that needs to be addressed across the long-term care sector, for both residents and front-line staff who are working tirelessly through the pandemic in full PPE [personal protection equipment]." 

Rebecca Scott-Rawn, spokesperson, Extendicare Long Term Care

The Ottawa Valley is a geographic area of weather extremes; extreme cold and snow accumulation in the winter, and extreme heat and humidity throughout the deep summer months. A century ago, struggling to cope with such temperatures presented a quandary to residents of the areas comprising the Ottawa Valley; they 'pioneered' the geology and the atmospheric conditions as hardy survivors. In this modern era where advances in heating and cooling to cope with adverse weather events make it possible for the greater population to access coping technology there is little excuse for institutions designed to care for the elderly and the health-compromised not to come equipped with air-conditioning.

Extreme heat conditions prey on the elderly and the health-compromised; their physical comfort should be assured as much as possible, and living conditions that moderate the effects of both extreme cold and extreme heat should be an integrated part of what is offered in long-term care homes. When most people rent apartments or buy houses, air conditioning in a climate of high humidity is an issue of enquiry. Making it puzzling that people arranging for elderly relatives to be placed in such homes bypassing such a critical issue as to later claim they had no idea that homes they decide upon lacked the forethought to cool the inner environment for their residents and staff.

Ottawa, the capital of an advanced society, a wealthy and technology-based nation, appears to have failed the most elementary of tests in ensuring that the elderly and health-impaired, placed in long-term care homes, could rely upon the same comfort that any shopper can access entering a commercial establishment. Calls have now been raised by advocates of improved senior housing to have Ontario's coroner track heat-related deaths in long-term care homes. Quebec records such deaths, Ontario does not.

Many long-term care homes operating in the province lack what is considered a basic amenity in control of  temperatures in living interiors. A situation which can be directly linked to elderly people living in such homes succumbing to the dual effects of impaired health exacerbated by extreme heat conditions. Deaths in long-term care homes are not investigated by the coroner's office, so deaths attributed to other factors may be linked to extreme heat exhaustion in the elderly.

With the advent of the novel coronavirus mandating that routines and exposures be handled differently, the impact on elderly residents in such homes is notable. In homes where common areas may be air conditioned but not individual rooms, relief in the common areas is denied as a result of self-isolation, where residents are kept in their rooms. Fans which might otherwise be useful in moving air around, are disused, linked to concerns of spreading COVID-19.

There is no legal requirement for care homes to be fully air-conditioned, a simple fact that the province's premier was unaware of. Under the Long Term Care Act, such homes are required to have at least one designated cooling area for every 40 residents; unworkable under the changed regimes caused by the global pandemic. On the other hand, care homes are required by that same Act to have a plan for the prevention and management of hot weather-related illness. 

The issue, newly brought to the fore in the wake of a horrendous death count resulting from COVID in such homes, has awakened the conscience of provincial government where the premier is considering making air conditioning mandatory in homes.

The summer of 2020 will go down in history books for the crushing weight of the global pandemic all over the world, making millions of people ill, with the SARS-CoV-2 virus responsible for the untimely deaths of over a half-million people world-wide. 

In the Ottawa Valley, this summer is also turning out to be one of the hottest on record, with prolonged and frequent heat waves, ongoing days of 30C and higher, along with high humidity. Both municipally-operated and privately operated long-term care homes are now facing criticism over their lack of vision in failing to implement plans to include air-conditioning in homes where the elderly feeble live in unspeakably difficult conditions.

Premier Doug Ford says his government will move 'rapidly' to require Ontario long-term care homes to have air conditioning. (Nathan Denette/The Canadian Press)

Taking Note of Potential Dog-Walking Risks for Seniors

"Dog walking, which has repeatedly demonstrated social, emotional and physical health benefits, is a popular and frequently recommended activity for many older Americans seeking new ways to stay active."
"This study highlights that while there are undoubtedly pros to dog walking, patients’ risks for falls must be factored into lifestyle recommendations in an effort to minimize such injuries."
Kevin Pirruccio, medical student, Perelman School of Medicine, University of Pennsylvania

"We make all these recommendations about pets, and yet we don't really understand if there are potential negative implications."
"There are things we should be aware of before saying, 'Hey, you should get a dog and take your dog for a walk'."
Jaimo Ahn, associate professor of orthopedic surgery, Penn Medicine

A growing body of research is discovering that pet ownership and health and happiness go together. But this is also a new area of study, without having as yet achieved any robust sample sizes or control. Now a new study, while validating that seniors who bring companion pets into their homes and respond to the dogs' need to exercise -- taking them out for daily walks -- are in the process aiding their own health for the better, it is the very act of walking with a leashed dog that "imparts a significant and rising injury risk in older adults".

Unsurprising, since leashed dogs are known to pull impatiently, are able to walk more speedily than their people; dogs sometimes get underfoot and cause stumbles; and if an older person is walking on uneven ground, it presents no hazard for a four-footed animal, but it might for a human. Dogs can get into an altercation with another dog while on leash. In short, any number of causes for a stumble or a fall can arise when walking a leashed dog in an outdoor environment. Winter walks present even more challenges with icy surfaces underfoot.

The University of Pennsylvania researchers' study found that between 2004 and 2017, bone fractures associated with walking leashed dogs doubled, and then some, among U.S. residents 65 years of age and up, of whom eight in ten who suffered fractures were women. The most commonly injured bones were in the hips, wrists and upper arms. The U.S. Consumer Products Commission which records injuries, reported a nationally representative sample of some 100 emergency rooms nationwide and produced a public data base of dog-walking fractures.

Those fractures increased from 1,572 reported in 2004 to 4,396 in 2017, a reported number of incidents that rose at a significantly higher rate as compared to the overall number of fractures. Baby boomers, pointed out Dr. Ahn, are more active than their counterparts in previous generations, and he believes that health-care providers are increasingly suggesting to their patients that having a dog in their household would give them an incentive to get out and get walking, to improve their overall health, without thinking through to important caveats.

The study, published in JAMA Surgery, focused exclusively on seniors, representing a group that Dr. Ahn felt his team of researchers recognized as most vulnerable to this type of physical injury, for whom broken bones can result in a particularly insidious outcome. The study, emphasized Dr. Ahn, was not meant to discourage seniors from acquiring dogs as pets, nor to get out walking with them. Health care providers, he stated, should ideally discuss risks with patients and older people in particular.

Karen Arnold via Wikicommons

Centenarian Vigour

"We can improve VO2max and performance at every age."
"[However, Mr. Marchand is] very optimistic, with many friends [studies link social ties with longer life. His simple diet of yogurt, soup, cheese, chicken and one glass of red wine does not reflect most peoples']."
"[Yet his example is inspiring for those who aspire to age well]."
"[B]eyond the establishment of new performance records at an extremely old age, the possibility for improving their performance and maximal oxygen uptake (VO2max) during this last period of life is a way for 'adding life to the life' rather than searching to 'kill the death'."
"This study shows for the first time that, at a very old age, VO2max and performance could still be increased with training."
Dr. Veronique Billat, professor of exercise science, University of Evry-Val d'Essonne, France

AP Photo/Thibault Camus

Robert Marchand is quite the person. Standing at a full [diminutive] 1.5 meters in height, weighing 52 kilo he might not appear at first sight an impressive figure. Although seeing a man of 105 dressed in the bright gear usually associated with biking enthusiasts might cause anyone to do a double-take. This man, however, is unique in a way that men of his age do not normally tend to be. He has the enthusiasm of a 20-year-old and the energy and drive of a 50-year-old. Now that's distinctive.

The working life of this man was as a truck driver. He had also done stints as a gardener, a firefighter, and lumberjack. Most often, when people think of others accomplished at physical tasks they conjure up visions of big, strapping fellows. The reality is, however, that pound for pound, lithe, short and muscular men are able to exert more muscle than their tall and hefty counterparts. Just watch a moving crew in action.

Once this man retired he took up the habit of daily recreational cycling. He cycled on the suburban Paris roads close to his home and also on an indoor trainer, but all the cycling he engaged in was at a leisurely pace, just enjoying himself. Now, the physiology of this remarkable man, has become the subject of a scientific study, one that saw publication in the Journal of Applied Physiology. And the findings from the study may alter how we regard the aging body and how athletic pursuits can prolong life.

Dr. Billat professionally engages in the study of professional and recreational athletes, and is also involved in their training. She found Mr. Marchand's demonstrated physical pursuit and prowess in cycling of great interest. He had competed in cycling events for centenarians, and pedaled over 22.54 kilometers to set a global benchmark for his age group. And Dr. Billat thought of testing the wisdom in exercise science that held that fitness declines after age 50, irrespective of frequent exercise.

She  had previously satisfied herself through research that if older athletes engaged in intense exercise they could indeed increase their V02max, and now wanted to test the method on someone of Mr. Marchand's age; Mr. Marchand himself in fact, since he has no competitors in his field of excellence matching his age. The university human performance laboratory tested his heart rate and allied indices of cardiorespiratory fitness, finding all indices healthy, substantially above average.

Mr. Marchand was also exceptional in that at his age he was not on any medication regimen. Dr. Billat placed her new test subject on a new training regimen where 80 percent of his workouts were to be performed at an easy intensity while the remaining 20 percent was performed at a difficult intensity, over a period of two years. At that point he made the effort to increase his one hour track world record of 24.25 kilometers.

AP Photo/Thibault Camus

All the physiological markers tested two years previously were re-tested, and the discovery made that Mr. Marchand's V02max was 13 percent higher than before, and he had increased pedaling power, to an increase of close to 40 percent. He then pedaled for almost 27 kilometers at 105 years of age. While Dr. Billat was more than satisfied with the results, Mr. Marchand claimed not to be, and intends to improve his distance, targeting age 106.

Isolation and Loneliness in the Elderly

"There's been an explosion of public awareness here, from local authorities to the Department of Health to the media."
Paul Cann, founder, The Campaign to End Loneliness, London, U.K.

"The profound effects of loneliness on health and independence are a critical public health problem."
Dr. Carla M. Perissinotto, geriatrician, University of California, San Francisco

"This is the first time we've found a cellular substrate for this experience."
"And we saw the change after 24 hours of isolation."
Dr. Kay M. Tye, neuroscientist, Massachusetts Institute of Technology

"Denying you feel lonely makes no more sense than denying [that] you feel hunger."
Dr. John T. Cacioppo, professor of psychology, University of Chicago

"We have this kind of male pride thing. We say, 'I can look after myself. I don't need to talk to anyone', and it's a complete fallacy."
"Not communicating helps to kill us."
Mike Jenn, 70, retired charity worker, London

"I was a bit anxious walking into a roomful of people."
"But I immediately thought, 'Yeah, this is a place [the Men's Shed workshop/social gathering] that could work for me'."
Keith Pearshouse, 70, retired school principal, London 

Neuroscientists at MITT recently published new findings of research linked to the brain and loneliness. Their study, appearing in the journal Cell, identifies a region known as D.R.N., or dorsal raphe nucleas, earlier recognized as a link to depression. Dr. K.M. Tye and colleagues discovered that when mice were kept in a social unit dopamine neurons in the D.R.N. remained relatively inactive.

Once the mice were separated and isolated from one another, even for a short period of time, the neuron activity surged once they were reunited with other mice, after having been apart. Researchers have evidence that links loneliness to physical illness as well as to cognitive decline. Loneliness, as far as they are concerned, is a better predictor of early death than obesity.

In Blackpool, England, a 24-hour call center was established to aid older adults requiring help in filling a most basic need; contact with others. Loneliness is increasingly viewed in Britain as an issue seriously affecting health and as such has become a public health matter worthy of receiving public funds and attention. The call center, named The Silver Line helpline, handles roughly 10,000 calls on a weekly basis.

Local governments and the United Kingdom's National Health Service have established programs whose purpose is to mitigate loneliness and dozens of towns and cities in England, now host these programs.

Professor Cacioppo deplores the negative aspect given to loneliness, that it is a sign of weakness, or an indication that someone is incapable of independence. His laboratory work has demonstrated the effect of chronic loneliness, associated with increased levels of cortisol, a major stress hormone, along with higher vascular resistance, capable of raising blood pressure while decreasing blood flow to vital body organs.

White blood cells are affected by signals activated in the brain through loneliness whose affect has the potential to impair the effectiveness of the immune system. A national survey of older adults rendered data in 2012 enabling Dr. Perissinotto to analyze the relationship between loneliness and health outcomes in older people. Of the 1,604 study participant, 43 percent reported being lonely and they were seen to have significantly higher rates of declining mobility, of difficulty performing routine activities, along with higher rates of death six years on from the study.

It was noted that 70 percent of the calls to The Silver Line come from women; men are more loathe to admit they are lonely. Retired charity worker Mike Jenn operates a "Men's Shed" in London for the purpose of welcoming older men into a comfortable environment doubling as a woodworking shop. A concept that was initiated in Australia, it has been shown to work very well. Over 300 Men's Sheds now operate throughout England, Scotland and Ireland.