Ageing often results in a loss of ability or reduced capacity. However, with a little effort, your golden years can be a fulfilling and rewarding time. Here’s how to achieve this
As we grow older, we diminish in capacity. We may not believe or accept it, but it is a reality. This reduction in capacity is often more prevalent in people with an SCI, as there is already a compromised baseline.
If we rise up to the challenges, work towards optimising whatever remaining capacities we have and shift our minds to be the most that we can be, our lives will remain fulfilled and continue to have purpose. In the second part of the silver roller’s toolkit, we look at what we need to do physically and mentally to achieve this.
Growing old together
As we grow older, we need to consider our spouses – those of us who are fortunate enough to have a spouse. They, too, develop back, shoulder or knee problems. Their strength and agility decrease. They can no longer help us in the way they used to. Consider them and ask for assistance from others.
Take the lead where situations allow you to; don’t leave it to your spouse to look for help. People respond faster to requests from people with disabilities, and by taking charge you are showing your spouse that you care and that they have not just regressed into simply being your caregiver.
Keeping the muscles strong
As we grow older, exercise tends to be placed on the back burner, but this is probably the worst thing we can do. People with paralysis should continue to exercise all the body parts that are still mobile and do passive movements of all joints. The benefits are significant and include working the heart and lungs for cardio fitness and deep breathing.
It also counters bone thinning, strengthens the core muscles of the trunk and shoulders, and promotes general wellbeing. For self-propellers (manual-wheelchair users) it is particularly important to keep the shoulders strong and supple. Rotator cuff injuries tend to turn paraplegics into quadriplegics. Speak to a biokineticist about an exercise programme to maintain the integrity of your shoulder strength and suppleness.
Mortality and morbidity
Mortality is what kills us and morbidity is what makes our lives miserable. Often the things that make us miserable can also eventually kill us. The major causes of mortality among people with mobility impairments include pressure sores, urinary tract infections, kidney failure and obesity-related conditions such as strokes, heart attacks and diabetes.
The things that make us morbid include constipation, a neurogenic bladder, spasticity and spasms, temperature regulation, autonomic dysreflexia and the complications of thinning bones. There are ways to manage these issues.
Pressure sores: As we age, our skin thins and is more fragile, which increases the potential for pressure sores. Pressure relief should be done routinely. If you are a quadriplegic, your caregiver must assist. However, if you have some upper body function, you can also drop your chest onto your knees and rock yourself from side to side. It is best to sleep on your stomach for as long as possible. If that is uncomfortable or not possible, turning every three hours is advised. It is very important to do a top-to-toes examination for pressure sores at least once a day, or twice if you are a quadriplegic.
Managing the bladder and kidneys: This revolves around bladder-voiding management, whether that means continence wear, indwelling or sleeve catheters, or intermittent catheterisation. The aim is to prevent urinary tract infections and kidney damage from poorly managed and unhygienic catheterisation. As we get older, all our bad bladder-management shortcuts start to catch up with us …
Obesity: The “enforced inactivity” of paralysis often results in obesity or extreme obesity, which could lead to hypertension, heart failure, diabetes and respiratory complications. With age, our bones tend to thin. Obesity and thinning bones are not a good combination and can worsen back problems such as collapsed vertebrae, kyphosis (hunchback) and scoliosis. Over and above health issues, obesity also makes life difficult for caregivers. Managing weight in people with an SCI entails much more than just dieting. Especially when we grow older, it is essential to consult a dietitian at least once a year to ensure that we consume the required fluids, nutrients and minerals correctly. Mineral imbalances and being underweight can have equally devastating effects.
Constipation: Bowel movements, or the lack thereof, become more of an issue as we age, along with other problems relating to spasticity and joint contractures.
Resources to help manage health
For more on all of the above, visit the ROLLING INSPIRATION website at www.rollinginspiration.co.za. Select the “Regulars” tab and click on “Ida’s Corner”. There you will find articles on pressure sores (April 2016), bladder management (July 2018), obesity (May 2017), constipation (February 2019), spasticity (August 2016), and passive movements (March 2016).
There are also articles on autonomic dysreflexia, temperature regulation and mental health topics to be found in back issues. The website contains a wealth of helpful information, and some articles are even accessible to non-subscribers.
Keeping the mind stimulated
Have a reason to get up in the morning. Get a hobby. Take on a challenge that stretches you. Cultivate and cherish friendships wherever – don’t be choosy. Loneliness is more debilitating than a disability. The homes of friends seldom, if ever, are accessible, but your local coffee shop usually is.
Find places where you can visit on equal footing. Focus outwards, don’t draw into yourself. Look actively at how you can be a blessing to someone else – even if it is just a smile, a kind word, a listening ear or a shoulder to cry on.
We are so focused on being human doings, we forget that, first and foremost, we are human beings. So if we lack in the capacity to do, no matter what our disability, we have an unlimited capacity to be. Let’s be there for one another. Be a human being. Become involved. Care actively.
Ida’s Corner is a regular column by George Louw, who qualified as a medical doctor, but, due to a progressing spastic paralysis, he chose a career in health administration. The column is named after Ida Hlongwa, who worked as caregiver for Ari Seirlis for 20 years. Her charm, smile, commitment, quality care and sacrifice set the bar incredibly high for the caregiving fraternity.
email: georgelou@medscheme.co.za
