Editor’s note: The Caregiving Chronicles blog has partnered with Century Health Systems to bring additional expert information and advice to the MetroWest caregivers we strive to serve at CaregivingMetroWest.org. Century Health Systems, the parent corporation of Distinguished Care Options and the Natick Visiting Nurse Association, has allowed Caregiving Chronicles to get some valuable insight from its staff for our ongoing series of Q&A sessions with caregiving experts.

In this entry, we discuss a topic that is very timely with this week’s bitter cold and the first significant snowstorm of the season predicted for this weekend – winter safety tips and advice for family caregivers and their loved ones. Providing insight is Judith Boyko, MBA, MS, RN, who has served as the CEO of Century Health Systems since it was established in 2001.

Boyko holds a Bachelor of Science degree in Nursing from the University of Pittsburgh, a Master of Science in Public Health from the University of Massachusetts, Amherst and a Master of Business Administration from Clark University. She has been recognized by the Home & Health Care Association of Massachusetts as Manager of the Year in 1997 and received the Deborah Blumer Community Health Leader Award from the MetroWest Community Health Care Foundation in 2007. She can be reached at info@natickvna.org or 508-651-1786.

Caregiving MetroWest: Winter weather means snow, cold and ice, which in turn means shoveling, salting and sanding. What should you do to make sure the walkways, driveways and steps of your home, or the home of your loved one, are safe?
Boyko: The cold, snowy New England winters are especially dangerous for older adults. It’s important to make sure that elder loved ones are safe both inside and outside of their homes.

In order to keep outside areas safe in the winter, be sure to assess the structural integrity of stairways, walkways, driveways and sidewalks before the snow and ice appear. If there are loose steps, wiggly handrails, wet leaves or other debris, be sure to repair and clean before the snow arrives. Be sure that all lighting is working properly and provides an appropriate amount of light to ensure the safety of someone walking outside your loved one’s home.

CGMW: Just as importantly, what should you remember to do to make sure you avoid accidents or injuries while performing those tasks? Are there any options/organizations in the area to get help with shoveling, snow removal, etc. if you or your loved one are not able to do that?
Boyko: Shoveling snow can put a strain on one’s back as well as one’s heart. So, if you’re older, this one is simple. Find someone to shovel for you. Get in touch with a local senior center (or Council on Aging) or a nearby religious institution, which may be able to identify local residents willing to help out.

If you do choose to shovel, have a light snack before you go out (The American Heart Association says that eating a large meal prior to or soon after shoveling “can put an extra load on your heart”). Shovel for 15 minute increments and go inside for a warm-up break. Using a small shovel will prevent you from lifting large, heavy loads of snow, thereby reducing the strain it puts on your body.
Learn more about how to avoid injury while shoveling show from the American Physical Therapy Association.

CGMW: Keeping your home warm in the winter is important, especially for an older adult who may be more sensitive to the cold. Space heaters, fireplaces and wood stoves are among the options to provide some extra heat, but they can be dangerous if not used properly. How should you make sure any extra sources of heat are being used safely?
Boyko: The National Fire Protection Association (NFPA) says that “half of home heating equipment fires are reported during the months of December, January, and February.”

First, keep anything that can burn at least three feet away from any heating unit. This can include furniture, window drapes and bedding. Never use an oven as a home heater. Test smoke alarms monthly. Turn off any heating units before leaving the room or going to sleep for the night, and consider one that has a sensor to power down in case it falls. Finally, never cover a space heater.

If your home has a chimney, hire a chimney cleaning service annually. Burning fires in a fireplace creates a buildup of soot inside the chimney that has the potential to burn and cause a chimney fire.

The NFPA has some very useful tips to prevent heating related fires.
Finally, keep in mind that in Massachusetts, unvented kerosene heaters are illegal.

CGMW: What other things should you do to make sure your home or the home of an elder loved one is safe during the winter?
Boyko: First and foremost, if you or a loved one experiences an emergency, call 911. For individuals who need oxygen support, be sure that extra oxygen tanks are available.

Home safety is important year-round. Some general home safety tips include the following:
•    Remove clutter; it poses a fall risk.
•    Remove scatter rugs, which can also cause falls.
•    Ensure there’s ample lighting in the home, especially at night.
•    Install assistive devices for additional support. Such devices include a bed transfer handle, a bedside commode, night lights, shower grab bars and tub seats.
•    Use a grabber for out-of-reach light items or to pick up items from the floor.
•    Keep all appliance doors closed when not in use.

Personal safety within the home is also important, so keep these tips in mind:
•    Stay hydrated.
•    Keep indoor temperature warm.
•    If you take medication, be sure your supply can last through a storm.
•    Elderly people feel the cold more acutely than younger folks because they have thinner skin and, typically, a lower body weight. Hypothermia is a condition by which one’s body temperature is extremely low. So, in the cold, run a humidifier to keep the humidity in a room so your loved one doesn’t dry out. Be sure your loved one drinks plenty of water to help regulate their body temperature. And be sure they go to the bathroom before bed. When one sleeps with a full bladder, one’s body is working hard to heat that full bladder up and doesn’t get to the rest of the body.

Some general indoor safety tips include the following:
•    Close and latch all windows throughout the home.
•    Never use a gas or charcoal grill indoors; the fumes are deadly.
•    Charge all laptop, tablet, cell phone and cordless phone batteries in the case of a power outage.

CGMW: Even in bad weather, we can’t always stay inside. What precautions should people take for themselves and their loved ones with outdoor activities in the winter? How about driving in the snow and ice?
Boyko: If your loved one uses a cane, consider adding winter tips to the bottom so the rubber doesn’t slip on the ice. Have trouble getting out of a car? The Car Cane is a great tool that provides leverage to get out more seamlessly. Natick VNA physical therapists recommend using YakTrax to provide traction on the ice. (But be sure to remove them before going inside!)

Some general car safety tips:
•    Do not travel when visibility is low.
•    Keep a survival kit in the car that includes blankets, a first aid kit, a windshield scraper, a fully-charged cell phone, tool kit, jumper cables, paper towels, a bag of sand or kitty litter for added traction, a shovel, a brightly colored cloth in the event of emergency, flashlight/batteries, and a can of compressed air with sealant for emergency tire repair.

CGMW: Winter is also flu season. Is it too late to get a flu shot? What are the benefits of getting one? Are there other annual shots you should get for the winter?
Boyko: The U.S Food and Drug Administration recommends that everyone ages six months and older get a flu shot annually. While they say that “it’s best to be vaccinated by October… getting the vaccine in January or later can still offer protection …”

While there aren’t other annual shots recommended for the winter, the Centers for Disease Control and Prevention (CDC) recommends that everyone over the age of 65 get two vaccinations against pneumococcal disease (pneumonia), which it says “kills thousands of adults, including 18,000 adults 65 years or older.” Here’s a snapshot of the CDC’s recommendations for adult immunizations.

Finally, a one-time shingles vaccine is recommended for those aged 60 and over, as this disease of the nerves “can cause burning, shooting pain, tingling, and/or itching, as well as a rash and blisters,” according to the National Institute on Aging. Shingles can cause long-term issues, as well.

CGMW: Some winter illnesses don’t have symptoms as easy to see as the flu. What is seasonal affective disorder or seasonal depression and how can it be treated?
Boyko: The Mayo Clinic defines “seasonal affective disorder” (SAD) as “a type of depression that’s related to changes in seasons… sapping your energy and making you feel moody.”

There are several ways in which SAD can be treated:
•    Get some light. At least half an hour each day can help to regulate one’s mood. This can be accomplished by going outside (be sure to wear sunscreen, even in the winter) or through light therapy. Talk to your loved one’s doctor about light therapy and which course may be most appropriate.
•    Eat cleaner. The processed foods that many of us can’t seem to shy away from can deplete our energy and cause depression, anxiety or mood swings. Find an indoor farmer’s market, grab some fresh produce and eat a healthy, clean meal. It will help to reinvigorate your loved one and may even boost their mood!
•    Socializing in the winter months can be challenging to say the least. But those who suffer from SAD may benefit from being with family and friends; it can keep their mind busy and improve their frame of mind.

CGMW: Getting through the everyday challenges of a New England winter is tough enough. But as we were reminded repeatedly last winter, this region can also be home to some severe weather. What should you do to be prepared before and during a major storm or blizzard?
Boyko: Juanita Allen Kingsley, Century Health Systems’ Director of Business Development, presents a winter safety talk for older adults talk. Here are some of the tips she shares with her audiences:
•    Be prepared!
•    Make sure your car is winter-ready.
•    Stock your pantry with non-perishable foods and your fridge with extras such as milk and other perishables so you are set if you can’t get out when the weather is bad.
•    Have your prescriptions delivered by mail, so that you don’t have to go out in bad weather to get your medications.
•    Have someone lined up to shovel your walk when it snows. If you insist on doing it yourself, make sure you have good footwear, a snow shovel handy near the door, and warm gloves and hats and scarf.
•    Have flashlights with good batteries in several places around the house for use if the power goes out.
•    Set up a daily check-in call with a family member or friend. It’s important that we check in on each other.
•    If you don’t have a landline, make sure you keep your cell phone charged.
•    Finally, if your loved one is on oxygen at all times, notify her electric provider so that in the case of a power outage, it can target her home to resume power quickly.

CGMW: Are there any other things for caregivers to consider for themselves and their loved ones during these winter months?
Boyko: Take extra good care of your physical health – eat well and keep moving, whether it’s a gentle exercise video you do or walking at the mall with friends.

•    Plan activities to get out. Winter days feel long and it’s important to break up time at home with social opportunities.
•    Look into options for companion care for your loved one. Whether it’s paid help, like a companion or home health aide, or a church friend coming for a couple of hours, you need your “me time.”
•    If you do feel yourself getting depressed, call your doctor. There may be a medical reason behind your depression or you may be a candidate for talk therapy or medication.