FEETS is an acronym that we developed to provide Caregivers with a checklist of five areas that are important  to monitor regularly.  FEETS stands for Feet, Eyes, Ears, Teeth and Sleep. Proper care and attention to these can detect illnesses and conditions at an early stage and may help to prevent permanent, irreversible damage. Regular monitoring of FEETS can also help to maintain the highest level of emotional well being for the older person by preventing falls, social isolation, depression and anxiety.

Feet

Good foot health is important  for balance, stability, and mobility. If feet deteriorate, a person's ability to walk  can become compromised. When this happens a person is at risk for falls and  social interaction and independence can be restricted. Problems with the feet can include corns, toenails which are ingrown, infections, and wounds. People with diabetes can have impaired circulation which leads to reduced feeling in their feet. If they have a wound or injury they may not realize it. Due to the reduced circulation, the wounds can cause  permanent damage, and even lead to  the necessity for amputation.

For good foot health:

1. Have regular appointments with a podiatrist of a foot care nurse every eight weeks. Many foot care nurses will visit private homes.
2. Make sure that shoes fit comfortably and are not impeding circulation.
3. If someone has edema of the ankles and feet, try to keep the feet elevated at least to the waist level when sitting.  Review with a physician treatment  for edema.
4. Wash and examine feet regularly.
5. Pay attention to wounds and small cuts, especially if they seem not to be healing.
6. Learn and do regularly exercises which increases balance and strength.

For more on foot health and aging, click here.

Eyes

Common eye problems that may go undetected for quite a while include cataracts,  macular degeneration, and glaucoma.  People often wear their eye glasses when they are often no longer appropriate for the degree of type  of visual impairment they have. Another problem is diabetic retinopathy, a condition of the retina which results from diabetes. If untreated, it can lead to blindness.

Poor vision can lead to falls, accidents from driving , and wheelchairs or walking aids, social isolation, decreased self confidence,  and malnourishment.

For good eye health:

1. Have an eye exam  annually, by either an optometrist or ophthalmologist.  There are some optometrists that will do home visits. An eye exam can detect diabetes that may otherwise go undiagnosed.
2. Glasses should be reviewed yearly  to ensure they are still appropriate for the degree of visual impairment.
3. Caregivers should ensure that the glasses being worn are the ones that were last prescribed. Sometimes glasses may be lost, and a person will resort to using older ones.
4. Remember that even someone with advanced dementia should have eye exams. Even if they are not able  to respond, an optometrist or ophthalmologist can detect problems which are impacting on quality of life.
5. Visit the CNIB website to find  a range of visual aids.

Ears

Impaired hearing may be the result of ear wax, infection, or injury. Sometimes it is easily treated.

Impaired hearing  and problems in the ears can lead to tinnitus, dizziness and falls, social isolation, and inappropriate diagnosis of cognitive impairment. Someone with a hearing impairment may be embarrassed when they are unable to hear, and will pretend that they do in order to maintain dignity. They also may avoid social situations in which they are unable to hear.  Some of the symptoms that are found in persons with dementia such as anxiety  and mistrust can sometimes be the result of hearing impairment and not part of the dementia itself.

Hearing aids which might help older people cope with hearing loss are often not used for several reasons.It can be difficult to become accustomed to using a hearing aid effectively.  Even if one is worn,  the battery may not be changed often enough. Or a  person may be unable to adjust the hearing aid properly due to either cognitive impairment, a physical impairment or arthritis.

For good hearing:

1. Have an ear exam regularly  to avoid a build-up of ear wax. Syringe regularly by a physician or qualified nurse when necessary.
2. Maintain a regular and frequent schedule of battery changes  and maintenance of hearing aids.
3. Plan activities that are appropriate for someone with  impaired hearing. Examples of these are small group activities, one-on-one interactions, and activities in areas where there are not a lot of background noise and disturbances.
4. Have a hearing test yearly.
5. If a hearing aid is more than five years old, find out whether a newer one can provide easier use or better hearing.
6. When speaking to an older person, ask if they have a hearing impairment. If they do, speak to their better ear, speak so they can see your mouth,and let others know  that this may be an issue.
7. Someone with dementia should  continue to have their  hearing checked and  if appropriate, fitted with a hearing aid. They may take them longer to become accustomed to it, but it can be important to their quality of life.

For more on hearing and dementia, click here.

Teeth

Problems with teeth  and gums or other areas of the mouth are often undetected. When untreated, they can lead to  the loss of teeth, infection  in other parts of the body, and pain. Someone with untreated pain in the mouth may stop eating.  Infections in the mouth have been associated with cognitive impairment, some cancers, and heart disease.

Poor oral hygiene, including regular  visits to a dentist or hygienist, can occur because someone is unable to travel, because they cannot (or believe they cannot) afford it, or because they think it is unnecessary. They may not be able to carry out the fine motor skills needed for brushing or they may forget to maintain good oral hygiene because of memory loss. A caregiver may not bring someone to the dentist because they fear the person will be too agitated  or anxious to sit through an exam or treatment.

Good oral hygiene includes regular cleaning and care of dentures, plates,  and of gums.

For good oral health:

1. See a dental hygienist  and dentist regularly.  There are dental hygienists who will treat someone in their own home. If necessary, find a geriatric dentist. Their expertise focuses on dental health in older people.
2. Use an electric toothbrush  if a manual one is too difficult.
3. Encourage mouth rinsing daily with a  dentist recommended mouthwash.
4. Make sure that dentures fit well and are cleaned properly.
5. Hire home help or  a companion whose job description includes assisting in oral hygiene.
6. If  someone is in  assisted living or residential care,  ensure that oral hygiene is part of the care or service plan.
7. Discuss with a dentist alternatives to dentures such as implants.

For more on oral health and seniors, click here.

Sleep

It is not true that older people need less sleep than other adults. In fact, they may need more time to sleep, because of changes in sleep during aging. These changes include more time in stage one sleep and less time in stage four sleep. Stage four sleep is the deep sleep that revitalizes and provides rest.

Poor sleep can result from a number of medical conditions that are frequent with older people. These include arthritis, diabetes, kidney disease, prostate cancer, dementia, and pain.  Also, restless leg syndrome and sleep apnea may be present but undetected  and causing sleep disruption. Both may be treatable. In addition, many of the medications that older people take can adversely impact sleep. These include antihistamines, thyroid medications,antipsychotics such as  risperdone, haldol, olanzapine (Zyprexa), seroquel, anti depressants such as  prozac, diuretics,anticholinergics for Alzheimers disease such as aricept.

When sleep is poor, people can be at increased risk for falls, depression, social isolation,  and cognitive impairment in areas such as memory and judgment. The result of poor sleep can lead to a diagnosis of dementia or an assessment that dementia has progressed further than than it actually has.

For healthy sleep:

1. Make sure that medications prescribed for sleep are appropriate for the problem.
2. Try melatonin
3. Nap as needed during the day. A two hour nap can provide for what is lost during impaired sleep at night.
4. Review pain  treatment and adjust as necessary.
5. Do a thorough medication review.
6. Look for undetected health problems.
7. Create appropriate ambience in sleep area.
8. Teach or encourage yoga and meditation.
9. Ask  about sleep patterns and habits, and how restful sleep is.
10. Discuss further sleep investigations from a public or privately funded sleep disorders clinic.

For more on sleep and aging, click here.

When providing care  for an older person, remember FEETS: Feet, Eyes, Ears, Teeth, Sleep  for the best health and quality of life as possible!