Anyone for Coffee?

Sounds can also have a place in helping simulate appetite.  A simple app called "Coffee Maker" (free)
has the background noises of a cafe.  The clinking of cups, the swishing of heating milk and the chatter of people have a real coffee shop feel.  You can select the coffee you want such as cappuccino, then the type of coffee.  You then grind and brew, pick a cup, then tip the coffee and milk in ( of course all these things add a physical component which as a physio I love!)  A variety of decorations are available for toppings.  This can be a great app for people who are unable to get out and about, but enjoy the atmosphere of a cafe.

Lily was a client with frontal lobe dementia.  When she was anxious she could be quite obsessive about food and drink.  She would continuously ask for coffee, but then never drink it.  One particular day she was very distressed and demanding a drink.  I sat down next to her and asked if she would like to make her own coffee.  I had the volume control turned up and she loved all the cafe sounds and took her time decorating the milk foam.  My very clever friend in the catering staff saw what I was doing and quickly made up a coffee for Lily and myself, so that by the time we had finished, I moved the iPad away and there were our coffees!  I left the cafe sounds on while we drank, so that it was like we were out on our own coffee adventure.  Another lovely moment.

Cooking Apps for the Elderly

Visual and auditory cooking activities can help stimulate appetite and encourage people with food choices.  How often have you watched a cooking show and ended up feeling hungry!  There are a whole variety of cooking and food apps, including apps for specific cultural groups as well as different food groups.  Some apps offer very creative decorating options ( such as Cake Doodle mentioned in an earlier post).

"The Video Cookbook-Patisserie" (free, with in-app purchases) uses photographs and video to demonstrate the preparation and cooking of different desserts.  Ingredients are listed and each recipe is rated for difficulty.  The quality of the videos is great and they are enjoyable to watch, even if you don't plan on cooking anything!  There are many simple recipes that would be easy to do for any population. A great one for getting kids involved!

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Hydration App for the Older Person

Appropriate hydration is very important for well being.  In older people it can contribute to significant health issues.  For some older people, particularly with altered smell and taste, it can cause drinking pattern changes.  Some individuals need to limit their fluid intake, while others do not drink regularly enough.  Lack of adequate hydration can contribute to falls in the elderly.  A very useful app for fluid intake is "Daily Water" (free).

The desired number of glasses of fluid per day can be nominated and there is an option to set an alarm as a reminder.  It can be used by those on fluid restriction or people who require prompting with drinking.

I was working with  Henry who had significant constipation issues and used the app to encourage increased fluid intake.  He was surprised at how much he needed to drink, but within days his constipation had improved.

Taste and Smell and Digital Technology

Our sense of smell and taste helps us to enjoy food and drink.  Smell also helps us to enjoy perfumes and aromas.  Good smells and taste make food more attractive, so we are more likely to get appropriate nutrition and hydration.  Interestingly, research has shown adequate nutrition and hydration are closely linked to a decrease in the risk of falls.
Both senses also provide a safety mechanism, telling us when food has gone off, or if there are dangerous fumes such as smoke or gas.

There are many causes for altered smell and taste such as colds and flu's, allergies, smoking and some medications.  As some people age, they often have some reduction in smell and taste.  Head injuries, Parkinson's disease and Alzheimer's disease can also cause a loss of smell.

Management

Treat colds, flu's and allergies
Cease smoking
Have a medical review of medication
Present food in an attractive way with different colours and food types.  This uses vision and texture to stimulate smell and taste and therefore appetite.

There are many ways to use technology to help stimulate appetite, monitor fluid intake and have some cooking and food fun.  My next few posts will look at some of these apps.

Let's Bake a Cake!

Virtual cooking is great fun, but can also be useful in stimulating appetite and looking at food choices for the elderly.  "Cake doodle" ($1.29) is one of those apps I think is worth paying for.  There are a number of free cake baking apps, but as far as I have found, none are as good as this one! 

Start with selecting a cake recipe, Red Velvet is one of my favourites (The ingredients are listed, so that if you want to bake the cake in your own kitchen you can).  On the screen you have your bowl with all the ingredients on the table.  You get to sift your flour, cut your butter, crack the eggs, squeeze, shake, tap, twist, tilt, grate and stir!  All these actions are also good for promoting hand and arm dexterity.

Then there are lots of choices for frosting, letter decoration, toppings and toppers!  You can make a cake for any occasion.  When you are finished, you can tap to eat the cake with corresponding munching sound effects.  You can take a screen shot and save it to your photos or send it to a friend.

My next series of posts will be about taste and smell and how it relates to digital technology.  You didn't think it could?  Well stay posted!

My "Old and Appy" lemon cake.  Deeelicious!!!

Top 5 Auditory Apps for the Elderly

I forgot to add the summary of the 'Top 5 Auditory Apps'! So here it goes...

1.  "Nature Sound" (free).  Create sounds of nature and relaxation music.
2. " Tiny Piano" (free).  An easy to use piano app with built in success.
3.  "guess your song" (free).  Allows you to use your own music library to create a song guessing game.
4.  "RIDBC Auslan Tutor:  Key Signs" (free).  Australian sign language pictures and videos from the Royal Institute for Deafness and Blind Children.
5.  "Verbally" (free).  Wonderful communication app.  Use words, phrases or write your own words.  Sentences can be read or the 'Speak' option can be used.

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Management Techniques to Assist with Touch and Dexterity

Here's a summary of simple tips to assist with touch and dexterity;

1.  Have clean and well moisturised hands.
2.  Keeps nails shorter.
3.  If required use a stylus pen.
4.  Turn off "Multitasking Gestures"
5.  Demonstrate apps and screen navigation.

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iPads and infection control

Since we have been talking about touch, lets consider how touchscreens can be a potential source of infection.  They may be touched multiple times a day, perhaps by more than one person, they are coughed and sneezed on and are often very rarely cleaned!

"deBac-app" (free) is an interactive cleaning guide for the iPad.  As well as how to clean the iPad, it also records each successful clean.  This log file is very useful in checking that the device is being cleaned regularly.

Disinfectant wipes are recommended for medical settings, therefore it is important to read the "Instructions for cleaning and disinfection" before using the app.

Please note that this app is not an Apple product.

Touchscreen and Skin Changes

Touchscreens are not as responsive when a person has thickened, dry skin on their fingers.  With ageing, glands produce less oil.  This can mean skin is much dryer.  Thickening of skin can be caused by a number of conditions, such as rheumatoid arthritis and eczema.

Management of Skin Changes;

Before using touchscreens clean hands.
Use moisturisers on hands.  Allow the cream to be fully absorbed before touching the screen.
Manage any skin conditions that may cause dryness and skin thickening.

Dexterity and Touchscreens

If a person has hand dexterity problems such as arthritis or a stroke, they can have difficulty extending their fingers to put their fingerpads on a touchscreen.  An older person may find it hard to individually manipulate each finger independently from each other. This may cause a problem with a feature of the iPad called "Multitasking Gestures".  This usually allows the user to use four or five fingers to swipe the screen to access the multitasking bar or move left to right between apps.  For people with dexterity issues this causes the screen to keep moving to other apps.  In this instance it is possible to turn off the feature to make it easier to use the touchscreen.

Turning off the Multitasking Gesture

Go to "Settings"
Look down the left tool bar
Select "General"
Scroll down to "Multitasking Gestures"
Swipe the "on/off" button to "off"
To turn the Multitasking Gesture back on, simply swipe the button back to "on"

Touchscreens and Age Related Finger Nail Changes

Nails change with increasing age and can make using a touchscreen difficult.  Nails tend to grow more slowly and can become brittle and discoloured.  Fingernails may crack and split.  Nutritional deficiencies such as iron deficiency or kidney disease can cause changes in nail health.  Long nails can sometimes make it difficult to use touchscreens, as they do not react to input from nails.

Managing Nail Issues

Keep nails shorter and file rough edges.  Older people may need assistance with this, as it requires a high level of fine motor skills to do it safely.
If there are ridges, pits or lines on nails, check with your health professional for health related issues.
If a person still has difficulty with nails touching the screen or with hand dexterity, try using a tablet or iPad pen.  These look like a pen, but have a soft tip, which can be used on the touchscreen instead of using your fingers pads.

This one is a working ink pen, but the other end is used as an iPad stylus pen.

Sensation Changes in Old Age-Touch

Touch includes the sensations of pain, temperature, body position, pressure and vibration.

With ageing there can be decreased blood flow to the nerve endings, spinal cord or brain, changing or decreasing the bodies ability to recognise variations in all these areas.

There can be reduction in sensory levels of vibration, touch and pressure.  Sensation of pain can be decreased or increased.  People may overdress or underdress because they cannot accurately feel temperature differences.

Strategies to manage age related changes in touch;

Ensure pain is well controlled.  Pain is far too often poorly managed in older people.  It's hard to enjoy yourself when you are in pain.
Have a comfortable room temperature and appropriate clothing.
Ensure supported seating and if using a table, have it set around elbow height.
Demonstrate apps and navigation of the screen to show how little pressure is needed.  Older people sometimes 'hit' the touchscreen as they are used to pushing buttons.  My Mum originally looked like she was trying to crack my iPad!