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Winter Safety for Older Adults

Our guest experts in February 2011 were members of the multidisciplinary Wellness for Independent Seniors (WISE) program team at Women’s College Hospital.

WISE aims to help seniors obtain information about health and wellness, link to community and support services, and cope with the changes associated with aging. The goal of the WISE program is to optimize the quality of life for seniors living in the community. Find out more about the WISE program.

The WISE team:
Lina Jobanputra, Social Worker
Tania Oblijubek, Physiotherapist
Joanna Osborne, Registered Dietitian
Naffisa Nathwani, Occupational Therapist

Here are their answers on Winter Safety for Older Adults.

Q: I have recently started using a cane, which has been a big improvement in getting around. However, being a new cane-user, I have no experience with it in snow, ice and cold weather, and am not comfortable outside. Can you offer any advice about winter cane use?

A:The physiotherapy association of Canada has put together a very good fact sheet on this question. The important message is to use a grip on the end of the cane tip for the icy and snowy weather and to ensure you are wearing appropriate footwear with grips when walking outside. Please see information from this fact sheet below:

There are several innovative devices on the market that are both easy to use and effective. One of them is the Yak Trax. Inspired by the Tibetan yak, this product has tubes and steel coils that wrap right around your boots or shoes. The Yak Trax functions somewhat like a tire chain to provide traction and stability on packed snow or ice. While there is no guarantee it will prevent you from slipping on ice or snow, the Yak Trax is considered one of the best products on the market for winter walking.

Another product that may help you safely navigate icy sidewalks is a walking stick or cane with an ice grip on it. There are several different types of ice grips on the market; some are retractable, others are studded.

If you are elderly, disabled or have recently suffered an injury you will probably need to invest in a good quality walking aid. As well as reducing the risk of falls, a walking aid can decrease the effort and energy required to walk, decrease the weight on an injured, fragile or weak leg, and compensate for a lack of balance. This is especially important in winter when inclement weather makes coping with an injury or disability especially challenging.

The Canadian Physiotherapy Association has recently published an information sheet on walking aids. It will provide you with details on everything you need to know about walking aids and how to use them.

While accessories and walking aids are a great way to help prevent a fall in winter, don’t under estimate the effectiveness of a good winter boot. Make sure your winter boots have good treads.

If you do fall and injure yourself this winter, consult your physiotherapist. Physiotherapists are health-care professionals who help people of all ages and lifestyles gain and maintain their desired level of active living and physical mobility. Physiotherapists not only treat injuries, they also teach you how to prevent the onset of pain or injury which can limit your activity.

 


Q: My 77-year-old father insists on shovelling his own driveway. His health is very good, but I have read that shovelling snow can be dangerous, and can cause heart attacks. Is this safe? 

A: This is a very good and common question. Snow shovelling is considered a very high-intensity activity and probably not a good start into exercise if one is sedentary. If your father has an active lifestyle then shovelling can be a good addition. Our physiotherapy association has prepared a very good fact sheet on this question that I have attached. It outlines choosing a shovel and proper technique to prevent injuries.

The Scoop on Snow Shovelling
Physiotherapists offer advice for safe shovelling

While many people recognize that shovelling snow is hard work, physiotherapists caution that shovelling can place severe stress on your heart, and cause stress and strain on your body.

Research in the Journal of Cardiopulmonary Rehabilitation has identified snow shovelling as a high-risk activity for cardiovascular events. Every year shovellers also sustain injuries such as pulled and strained muscles from repetitive twisting and improper lifting. However, Canadians can still enjoy cardiovascular benefits from snow shovelling if they prepare themselves and listen to their bodies.

Snow shovelling has a similar intensity to jogging, racquet sports, and other strenuous sporting activities. Individuals will be better prepared for shovelling if they avoid being sedentary by regularly participating in activities like walking.

Important tips for shovellers include warming up before shovelling, taking frequent breaks, and separating the job into smaller stages to prevent overexertion. Shovellers should take notice of any symptoms of back pain or repetitive strain, and should be aware of any warning signs of cardiac distress including shortness of breath, chest and/or upper body pain or discomfort, palpitations, and other symptoms such as anxiety, sudden extreme fatigue, nausea, dizziness or lightheadedness.

Shovelling can be made even more difficult by the weather. Cold air makes it harder to work and breathe, which adds extra strain on the body. Cold, tight muscles are more likely to strain than warm, relaxed muscles. Take time to stretch and prepare your body for activity with a simple warm-up before shovelling, and wear warm clothing.

The Canadian Physiotherapy Association offers the following tips to help you get a handle on safe shovelling:

Choose a shovel that’s right for you:

  • a shovel’s handle is the appropriate length when you can slightly bend your knees, and hold the shovel comfortably in your hands at the start of the shovel stroke
  • a bent-handled shovel can reduce bending compared to a traditional straight-handled shovel
  • a shovel blade that is made of plastic will be lighter than a metal one, putting less strain on your spine
  • a smaller blade may be better than a larger one because it avoids temptation to pick up a pile of snow that is too heavy for your body to carry

Use proper techniques:

  • Grip the shovel with your hands at least 12 inches apart, and keep one hand close to the base of the shovel. Positioning your hands further apart will help increase your leverage.
  • Squat with your legs hip-width apart, knees bent and back straight. Lift with your legs. Do not bend at the waist.
  • Scoop small amounts of snow into the shovel and walk to where you want to dump it. Holding a shovel of snow with your arms outstretched puts undue strain and compression on your spine.
  • Step in the direction in which you are throwing the snow. This will help prevent twisting of the low back and ‘next-day back fatigue’ experienced by many shovellers.

Take care of your body:

  • If you have any doubts about your ability to shovel due to health concerns, injuries, or inactivity, consult a physiotherapist.
  • Clear heavy snow in two stages: by skimming snow from the top, then removing the bottom layer.
  • Take a short rest or decrease the intensity of effort slightly if you find yourself unable to say a long sentence in one breath.
  • Take frequent breaks when shovelling – stand up straight and walk around periodically to bring your spine back to a neutral position. You can also do standing extension exercises by placing your hands in the small of your back, bending slightly backwards, holding the position for several seconds, and repeating this movement five to 10 times.

 



Q: My husband and I recently moved to Toronto from Victoria, B.C., where the climate was much milder. We get most of our exercise by walking, which we were able to do year-round in Victoria. I find the colder weather here irritates my asthma, and I can’t be outdoors as much in winter. How can I maintain my fitness level during the cold months?

A: It can be challenging to keep up an exercise routine in the winter months. You want to aim for 150 minutes of cardiovascular exercise (i.e. exercise where your heart rate increases) and twice-weekly weight training. Below are some excellent suggestions to take your program indoors.

Visit or call local shopping malls to see what they offer. Here is a list put together by Toronto Public Health (please note that these are some of the many malls within the GTA that may offer mall walking programs):

 


Q: I’m 68 and was recently diagnosed with osteoporosis. This was a shock, since I’ve never had any health problems. I have now become very afraid of falling and having a fracture that might affect my health. This gets even worse in the winter. What can I do to protect myself?

A: As you may have had explained to you, osteoporosis is a relatively common condition in which there is a slow loss of bone mass along with microscopic changes to the structure of bone. These changes lead to thinner and more fragile (weaker) bones that can break easily.

While some risk factors are non-controllable (gender, age, ethnicity, body frame, family history), there are lifestyle factors which can be controlled.

  1. Quit smoking if you are currently a smoker. Cigarette smoke appears to have a direct toxic effect on bone.
  2. Engage in regular weight-bearing exercise like brisk walking/jogging/dancing/tennis/aerobics (30 minutes, four times per week) and resistance/strength exercises such as weight training (eight to 10 repetitions per muscle group, two to three times per week). Bones, like muscles, become stronger and denser when you ‘stress’ or place demands on them.
  3. Limit alcohol consumption to no more than two alcoholic drinks per day.
  4. Limit sodium (salt) in your diet and caffeine to no more than three small cups of coffee, tea and/or cola daily. Excess salt, phosphorus (found in “fizzy” soft drinks) and caffeine can lead to increased excretion of calcium in the urine.
  5. Meet your daily calcium requirements, ideally through diet but if necessary, also supplementation. While most calcium is used to build and maintain healthy bones and teeth, we require small amounts of calcium in our blood for other body functions (muscle contraction, blood clotting and nerve conduction). When our daily level of blood calcium falls below the amount required, calcium may be removed from existing bone. With repeated withdrawals over time, calcium reserves become depleted and bone mass is reduced. Refer to the tables below for your daily calcium requirements according to Osteoporosis Canada, and dietary sources of calcium.

Supplementation: Ideally, calcium requirements should be met primarily through dietary sources. Calcium supplements are necessary when dietary intake of calcium-rich foods doesn’t meet daily needs. The two types of calcium supplements recommended are calcium carbonate and calcium citrate. Dosage depends on your daily requirements and the amount you get from your diet (e.g. if you are over age 50 and your diet provides on average 600 mg calcium, then you will need to supplement with approximately 500-600 mg calcium. You could choose to take one dose of 500 mg calcium carbonate OR two doses of 300mg calcium citrate). Remember, your body cannot absorb more than 500 mg calcium at one time (the excess is lost in urine), so do not exceed 500 mg calcium from supplement and/or food at one time.

  1. Meet your daily vitamin D requirements, which are necessary for the absorption of calcium and helps calcium become incorporated into bone. Our bodies make vitamin D when our skin is exposed to sunlight (15-30 minutes on our face, arms, and hands). Unfortunately people living in Canada are not exposed to enough sunlight from October to March, and potentially during the summer if they use sunscreen consistently or stay out of the sun. As a result, we need to get vitamin D from other sources such as fortified milk or supplements. Osteoporosis Canada recommends a daily supplement of 800 IU as the minimum dose for adults with osteoporosis, regardless of age and doses up to 2,000 IU are often recommended. Doses above that level may be prescribed by your doctor. Refer to the table below for your daily vitamin D requirements according to Osteoporosis Canada and dietary sources.

Supplementation: A vitamin D supplement or multivitamin/mineral supplement with vitamin D should be taken with a meal or snack as it is better absorbed in the presence of some fat. Look for vitamin D3 on the label of your supplement (versus vitamin D2) as it has been shown to be more effective at increasing blood levels of vitamin D.

Age group

Total Daily Calcium Recommendations

Canada’s Food Guide (daily svgs)

Age group

Total Daily Vitamin D Recommendations

Adults
< 50 years

 

1,000mg*

2 servings** milk/alt

Adults 
< 50 years

400-1000 IU* and low risk for bone fracture

Adults
> 50 years

 

1,200mg*

3 servings** milk/alt

Adult
> 50 years

 

800-2000 IU*

*Recommendations are for diet and supplementation combined.
** 1 serving of milk/alt = 1 cup (250mL) milk or fortified soy beverage; ¾ cup yogurt or kefir; 1½ ounces cheese
Note: recent research indicates that for women over age 70, those with a history of heart attacks and strokes, and those with reduced kidney function, calcium intake should be limited to 1,000mg/day.

Sources of Calcium

Portion Size

Amount Calcium per Portion

Milk (skim, 1%, 2%, chocolate)

1 cup (250mL)

300 mg

Calcium fortified beverage (e.g. soy, rice, juice)

1 cup (250mL)

300 mg

Yogurt, plain

¾ cup

300 mg

Cheese, firm (cheddar, swiss)

1.5 oz

300 mg

Salmon, canned with bones

½ can

300 mg

Tofu, made with calcium

¾ cup

200 mg

Baked beans, soybeans, white beans, cooked

1 cup

150 mg

Almonds

¼ cup

75 mg

Bok choy, kale, rapini, okra, cooked

½ cup

75 mg

Chickpeas, kidney beans, cooked

1 cup

75 mg

Broccoli, cooked

¾ cup

50 mg

Sources of Vitamin D

Portion Size

Amount Vitamin D per Portion

Milk

1 cup (250mL)

100 IU

Salmon, canned

75 gm

608 IU

Herring or trout, cooked

75 gm

156 IU

References:

  1. Women’s College Hospital Multidisciplinary Osteoporosis Program
  2. Health Canada – Vitamin D and Calcium: Updated Dietary Reference Intakes
  3. Osteoporosis Canada – Vitamin D

 


Q: At what age should someone consider not driving anymore in winter?

A: The Canadian Association of Occupational Therapists (CAOT) has launched the National Blueprint for Injury Prevention in Older Adults in February 2009. This document strives to enhance the capacity of older drivers to maintain their fitness to drive and the ability to drive safely for as long as possible.  For more information on normal aging and safe driving, please visit their website http://www.olderdriversafety.ca

There is NO specific age that determines a person’s ability to remain a safe driver. Many older adults continue to be safe drivers and make decisions not to drive in situations in which they feel less confident. As we age, there are changes in our abilities which may affect our ability to drive safely. For example:

  • vision: you may begin to notice glare and find it more difficult to see in the dark, scan the environment, or see things in your peripheral vision
  • physical: you may feel weaker, stiff, experience pain or move more slowly
  • cognition: you may have more difficulty remembering things, making decisions or doing activities when there are distractions
  • reaction time: you may find it more difficult to react quickly in different situations

The following are warning signs of unsafe driving:

  • you lose your way
  • you have less confidence in your driving skills
  • you notice other drivers honk at you
  • you miss stop signs or traffic lights
  • you mix up gas and brake pedals
  • you have trouble with lane changes or merging
  • you have minor accidents or traffic tickets
  • your passenger needs to help you
  • family and friends refuse to get in the car with you

IF these warning signs reflect your situation, maybe it is time to make some changes to your driving strategies or have your driving evaluated. 

The following is a list of safe driving strategies that one can use to avoid being in risky driving situations:

  • choose a vehicle that is easier to drive, such as one with automatic transmission or power options such as adjustable seats
  • make sure your vehicle is in good working condition
  • make sure your seat, steering wheel and mirror are properly adjusted
  • limit driving at night, in bad weather (such as during the winter), during rush hour or on limited access highways
  • be careful when changing lanes, making a left-hand turn or merging into traffic.
  • maintain a safe following distance
  • take breaks if you are driving a long distance
  • have regular medical checkups
  • make sure you know how your medications might affect your ability to drive

After age 80, you will be required to renew your license every two years; information via Ministry of Transportation. For further tips and information, please visit http://www.mto.gov.on.ca/

 



Q: How can I encourage my aunt to join me for walks in the winter? I’ve heard there are ‘shoe grips’ to put over your shoes. Do they really work? Or would they just give someone a false sense of security in slippery conditions?

A: In addition to Yak Trax (see Question 1, above), there are two other products available at Lee Valley & Veritas (http://www.leevalley.com)

  • Icer’s ® - Originally developed to reduce winter walking hazards for seniors, these  anti-skid safety soles are also used by letter carriers and city workers to help increase traction when walking in slippery conditions (ice, snow, slush, etc.).  They are lightweight and flexible; and the formed rubber soles are studded with metal cleats that provide exceptional traction on slick surfaces. The soles easily slip over regular footwear (shoes or boots) and secure with Velcro® fasteners. They are ideal for winter use when walking, shoveling or ice fishing – wherever traction is needed.  Sizes vary from youth’s to men’s XX-large with the cost of $39.50
  • STABILicers Lite ™ - these are lightweight anti-slip soles that have 24 unique bidirectional hardened steel cleats that grip ice and snow to provide maximum traction, allowing one to confidently walk or jog in the winter.  They are made of thermoplastic elastomer, and they stretch easily over footwear and stay securely in place.  These are available in four sizes with the cost of $22.50.

Please note that these products will help to reduce the risk of falls, but they do not prevent falls, particularly if there are concerns with balance, strength, hypotension (low blood pressure), etc.  If you do have any of these issues, please consult with your family doctor.

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