Older Adults Examine Health Care Options

by Food and Drug Administration (FDA)

At the end of the movie "The Wizard of Oz," Dorothy clicks the heels of her ruby slippers together and repeats, "There's no place like home" until she magically returns to the safe haven of her bedroom in Kansas.

Like Dorothy, many ailing older adults feel there's no place like home.

Surveys reveal that most older adults would rather be cared for in the comfort of their own homes than in a nursing home. Some studies have shown that people heal more quickly at home than in an institution and that home care often is the less expensive alternative. These factors, combined with the swelling ranks of the graying sector, have made home health care a growing concern in this country. The number of elderly receiving home health care in 1988 was more than double that in 1977, according to the National Association for Home Care.

Fortunately, various agencies are rising to meet the burgeoning need for home-based care of senior citizens, and thanks to technological advances in portable medical equipment, many treatments previously possible only in a hospital (such as kidney dialysis and intravenous feeding) can now be given at home. The Food and Drug Administration is responsible for ensuring that the new home medical devices used for these treatments are safe and effective.

In addition, emergency response devices such as "Lifeline" provide instant access to emergency care if necessary. The development of specialized gadgets, such as grab bars and stove mirrors, have also made the home environment safer and more accommodating for older people.

Home Improvements

A number of health impairments that often accompany old age — such as limited mobility and strength, and vision or hearing loss — make modifications to the home imperative. Often, simple devices such as loop handles instead of doorknobs on cabinets can spell the difference between dependent and independent living for an older person.

A number of changes may also be necessary to improve the safety of the home. Falls are the most common cause of fatal injury for older people. In 1982 alone, more that 2,500 people 65 and older were treated in hospital emergency rooms for injuries that resulted from tripping over rugs. Double-faced adhesive carpet tape or rubber matting applied to the backs of rugs can help prevent these accidents. Changes in floor levels should also be clearly marked with white or reflecting tape, and stairways should be well-lit.

Wet, soapy tile or porcelain surfaces are slippery, making the bathroom a hazardous area for the older adult. Textured strips applied to bathroom floors and to the bottoms of tubs and showers can help prevent falls. Many elders find grab bars on the wall adjacent to the toilet and in the tub or shower helpful. Tub seats are good for people in wheelchairs or those with loss of strength who have difficulty lowering themselves to the floor of the tub.

Knob-type faucet or tub hardware should be replaced with single-lever faucets, which can be easily operated by arthritic hands. To avoid burns, anti-scald temperature controls can be installed to prevent the water temperature from rising above an established limit. Settings can also be lowered on hot water heaters.

Narrow doorways can pose a problem for senior citizens who use walkers or wheelchairs. Removal of a door can often provide the needed clearance. If this isn't feasible, "swing-clear" hinges can enlarge a door opening nearly two inches. Lever latches instead of standard doorknobs alleviate the problem arthritics have with gripping or twisting. Likewise, slide bolts are easier to operate than deadbolts and provide nearly the same security.

As people age, they generally find that background noises interfere with their ability to hear and participate in conversations. Carpeted floors and curtained windows can reduce noise levels and distracting echoes.

Because it takes older people longer to focus vision when moving between ight and dark areas, light levels should be kept consistent in bedrooms and hallways, and night lights should be used.

The kitchen can pose particular problems for senior citizens. For those with impaired hand dexterity, simple devices can aid food preparation. Cutting boards with spikes, for example, hold foods such as vegetables in place for cutting, and boards with indentations hold mixing bowls in place.

A mirror above the stove allows a person in a wheelchair to see what's cooking in pots, and sling belts attached to the counter can support someone unable to stand for long periods. Items can be moved safely between the kitchen and serving area on wheeled storage carts.

To avoid fires, store flammable items such as potholders, dish towels, or plastic utensils away from the range. Roll up long, loose sleeves securely before cooking. The Consumer Product Safety Commission estimates that nearly three-quarters of all people who die from clothing fires are over 65. Many of these fires start when long sleeves ignite while the person is working over the stove.

Because some older people have lowered immunity, they need to be especially careful about exposure to food-borne microorganisms that can cause serious — even fatal — infections. (See "Food Safety Crucial for People with Lowered Immunity" in the July-August 1990 FDA Consumer.) Senior citizens, therefore, should avoid unpasteurized milk or raw or undercooked eggs, poultry, fish, shellfish, or meat. Hands, utensils, counters, and cutting surfaces should be washed with hot soapy water between preparation of different foods, particularly after handling raw eggs, meat, poultry, or fish. Plastic or glass cutting boards should be used, rather than wooden ones, which are difficult or impossible to clean adequately. When handling raw meat, poultry, or fish, cover any cuts or open sores on the hands with a plastic sealing bandage or plastic gloves. (For more information on food safety, see page 18 of this issue.)

Emergency Response Devices

A number of emergency response devices help ensure that an older person who lives alone will get needed help when an emergency arises, whether it's an inability to get out of the tub or a heart attack. These small devices, available at local hospitals, are worn around the neck. The wearer simply pushes a button and is connected to an experienced operator. This operator, who has access to the caller's medical history and numbers of people to contact in an emergency, summons help.

About the Author

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FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.