Exercise is Medicine (中文翻譯在下方）

Questions following the Presentation/Workshop December 3, 2017

 

Question 1.

Could Director Jan elaborate more on “Exercise Patience”?

Answer:

I’m not sure whether the question is about “Exercising Patience” or “Exercise for Patients” – the two English words sound the same but have very different meanings. However, let’s try to address both meanings.

I think we would all agree that although we establish exercise/activity plans for each of our clients/patients, we need to observe and adjust these plans depending on the abilities of the client.
This applies more so for older people who live with dementia, or other cognitive issues, and the related functional decline they so often suffer. These older clients may have very good days followed by bad days. So we need to be patient and understanding. Even though we established goals based on our best efforts in assessing the client’s abilities, we need to be flexible and prepared to adjust these as required.

This is one of the major reasons why we have suggested the role of preparing an exercise prescription for older people with dementia be with a trained health professional. And that the client be monitored by the trained health professional to ensure the types and intensity of the activities remain appropriate for that client.

 

Question 2.

Please provide more information about “Oral Hygiene” and the links with Dementia?

Answer:

Sadly, gum disease, tooth rot/decay and sensitive teeth are very common for people over the age of 60 years. And for older people with Dementia oral hygiene may be overlooked, by the person themselves and/or their caregivers. Products from the bacteria associated with gum disease have been detected in the brains from people who had a diagnosis of Dementia (University of Central Lancashire study 2013). Bacteria can enter the bloodstream from activities such as chewing or eating. From the bloodstream bacteria may enter the brain and trigger an immune response. The chemicals released during the immune response can lead to changes in the brain that are typically associated with Alzheimer’s disease. These chemicals may also be responsible for increases in confusion and deterioration of memory.

Therefore, although a direct link between poor oral hygiene and dementia is yet to be clinically proven, it would seem very logical to maintain a healthy mouth to minimise these risks. Even just the discomfort from decaying teeth or sensitive gums may cause stress and suffering for the person with Dementia, but they may not have the communication skills to describe the source of their discomfort.

 

Question 3.

Managers in day care settings in Taiwan are not willing to mobilise residents and/or clients with Dementia because of safety concerns (risk of falls) and insufficient numbers of caregivers. How can we persuade managers to allocate more resources?

Answer:

This issue is universal. The risk of falling is often quoted as the reason why it older people with Dementia spend much of the day sitting in chairs that prevent them from standing and attempting to walk. It is agreed that the problem wouldn’t be as great if there were more care staff to provide assistance (stand-by of hands-on) on a regular basis. And the economic realities are that most organisations can’t afford the number of staff needed to provide this level of assistance.

There are no simple solutions, however, our research in Australia has shown that keeping people mobilising on a regular basis has reduced the costs of providing care. Sitting not only leads to a weakening of the weightbearing muscles and bone density of the lower limbs, but can have other significant changes to body functions that will impact the costs of providing care. For example, bladder and bowel function are much better if the client is able to stand and move, rather than be seated most of the day. Lung function may be improved. Stress on the heart through increased intrathoracic pressure when sitting may be reduced.

I think most health providers and managers would agree, but the hard economic

realities are that managers are given only so many $s to provide care.
Could I suggest that this issue is one that we could all work collaboratively and develop more convincing arguments to influence resource allocation.

Thank you all for your enthusiasm and generosity in sharing the day in the presentation and workshop. I hope there will be other opportunities for us to stay in touch. You are very welcome to make contact and discuss these and other issues further.

 

 

運動如同藥物

針對2017/12/03 的演講和工作訪的問題回答

問題1.

是否可以請Director Jan 對於 “運動病人”做更深入的解釋？

回答

我不確定這個問題是針對 “運動病人” 或是 “給病人做的運動”。這兩個名詞在英文聽起來很相像，但是意思卻非常不ㄧ樣，以下會針對這兩種名詞說明我個人的看法。

我想我們應該都可以同意，對於每個客戶/ 病人/ 個人的運動和活動的安排，都需要針對不同個體本身的能力，經過觀察和調整來做計畫。

以上的建議也同時包含，失智症的老人、認知功能障礙者、還有相關的機能喪失者。這些長者，在大部分的情況都能將身體狀況維持在相對良好的狀態，但是無法避免仍會有較糟的情況。當我們身為運動處方簽的建議者，需要非常有耐心和同理心。雖然在我們的評量表系統中，會希望評量出客戶/病人/個人的最佳表現，用以準確的給予適當的建議，但是同時身為評量者，也必須有彈性、並且適時的調整評量要素。

這也就是為什麼，我們會希望，每位給予失智症長者安排運動計畫的評量者，都需要經過專業的醫療訓練。 並且在監督客戶運動時，能適時的調整他們的運動種類及強度，以達到功效。

 

問題2.

請提供更多資訊關於 “口腔衛生” 與失智症之間的關係。

回答

很不幸的是，大部分超過60歲的老人，普遍都有牙齦疾病、牙床潰爛和敏感性牙齒的問題。然而很多失智症患者本人、照護人員以及家人時常忽略病患的口腔衛生。

經過實驗指出，從失智症患者的腦中，檢驗出口腔細菌所製造的同樣成份 （University of Central Lancashire study 2013)，口腔細菌可以從咀嚼和飲食之下進入血液中，細菌可以透過血管進入到腦部，並同時引發免疫系統的反應。而在免疫系統啟動時所製造出的化學物質，會導致腦部的變化，該變化通常和阿茲海默症有所關聯，該化學物質同時也和記憶力惡化和混淆有關係。

由此可證，雖然口腔衛生和失智症尚未有直接的關聯，也還需要經過臨床實驗證明，但維持口腔保健，是ㄧ個合理的舉動，可用以降低這些風險。而且蛀牙或是敏感性牙齦症狀，都會為失智症患者帶來壓力和不適，但患者本身可能無法明確的溝通並指出他們身體所承受的不舒適的情況。

 

問題3. 

在台灣的日照中心的主管，由於安全顧慮(跌倒風險）以及照護人員數量不足，不願意促進失智症者的行動力。我們該如何說服主管分配更多的資源呢？

回答

世界各地都有同樣的問題。在照護中心的觀點中，“降低跌倒的風險” 永遠是失智症患者無法站起來走動的原因，因而常常整天被安置在坐椅上。我們都認同，只要安置更多的照護人員提供協助（ㄧ旁關注，但不動手幫助），就可以減少這個問題的產生。但從實際經費狀況考慮下，大部分的機構都沒有足夠的費用來雇用足夠的照護人員，達到這方面的人力需求。

對於此問題，永遠都沒有簡單的解決方式。不過，從我們澳洲的研究指出，維持一個人的基礎行動力，能夠減少照護的成本。長期坐著，不僅導致肌肉的萎縮和骨骼疏鬆外，還會讓身體機能改變，增加照護成本。例如：當人能夠站立和走動時，他的膀胱和腸道功能，會比長期坐著的人要好，而且人體坐著時胸腔內壓會減弱，導致血壓降低會提高心血管疾病的產生。

我想大部分的健康中心管理者都會同意我以上所說的，但屈就於現實之下，管理者也只能利用有限的經費來提供服務。 請容許我提出一點建議，希望能夠透過大眾一同合作，發展出更具有說服力的證據，藉以說服管理者們對於健康照護資源上的分配改進。

非常的感謝你們的熱情和慷慨，積極參與當天的講座和工作訪。我希望往後能有更多的機會讓我們再續前緣。歡迎你們來ㄧ起加入討論，並且提出其他問題，我們可以保持聯絡。