Social Anxiety Can Still Affect Teens in a Virtual World

Dr. Hina Talib, Adolescent Medicine Specialist, Children’s Hospital at Montefiore

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By Dr. Hina Talib, Adolescent Medicine Specialist, Children’s Hospital at Montefiore

For teens who spent the summer months social distancing and the months prior to that under stay-at-home measures, the new school year may reignite feelings of anxiety.

Even in the new virtual world where most teens will be learning, at least in part, via remote or virtual instruction, interacting with classmates and teachers on video may leave teens feeling fearful, embarrassed or awkward.

Some teens may struggle more than others to adapt to these new circumstances. Teens who suffer from social anxiety disorder may need extra support, especially when these feelings cause distress or lead to avoidance of social settings. If these behaviors persist for more than 6 months, this is considered social anxiety disorder Anxiety disorders are the most common mental health conditions in children and up 15% of teens may have social anxiety disorder, most of which are not recognized or treated. 

Social anxiety disorder is commonly seen in pre-teens and tweens, more often in girls and in children with other mental health disorders or family members with anxiety disorders.

Social anxiety disorder is an intense fear of social or performance-type situations. They may feel alone during virtual class and unable to connect with friends and teachers. They may express intense fear of doing or saying something embarrassing online, of asking questions or of being asked a question over the platform. They may appear shy, introverted, restless or inattentive on camera. Some will be reluctant or unable to independently “log on” to class or enable their cameras so they can be “seen.” Physical symptoms like racing heart, feeling faint, nausea, shaking and sweating may be present and may be harder for teachers and parents to notice remotely than when in-person.

Returning students who feel anxious or conflicted about back to remote school should be assured that these feelings are entirely normal in these uncertain times. Social skills over remote technologies are not the same as in-person; they require orientation, practice, troubleshooting and acceptance of the limitations. Coping skills, preparation and practice are key for overcoming social anxiety in teens. The goal is to help them move from avoiding uncomfortable parts of the remote school day, to facing the fears and practicing “working-through it.” 

Teens can try breathing exercises and remember that no-one can tell on camera that they are doing it. Mindfulness or meditation practices help too. Chair yoga or scheduled movement breaks can help ease stress as well. Additionally, role-playing a virtual lesson or planning a virtual study-date with a smaller group of peers or having tweens volunteer to go first or answer questions, may relieve the discomfort of waiting to be asked and be a good way to get comfortable with this new environment. 

We know that teens thrive on social connections and adolescence is a key time to develop life-long relationship building skills, so we need to validate their concerns, help to alleviate worries and provide tools for a successful and rewarding school experience. 

Aging with HIV/AIDS: ‘You CAN Modify the Aging Arc’

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To mark National HIV/AIDS and Aging Awareness Day on September 18, Arthur Fitting, LGBT Program Director at the Visiting Nurse Service of New York, is interviewing key experts on this wide-ranging topic, looking at what people with HIV, partners, caregivers, communities and the health care industry can do to help expand knowledge, reduce HIV stigma, and promote healthy aging. Today’s conversation is with Stephen E. Karpiak, PhD, Director of GMHC’s lead researcher on HIV and aging and Director of the National Resource Center on HIV & Aging.

We invite you to add your insights and experience to the conversation.

Arthur Fitting: What are the most important issues that people should know about aging with HIV?

Stephen Karpiak: Older adults living with HIV carry with them a number of other risk factors, which can include a history of substance abuse and smoking, high levels of depression, poor diet and a habit of being sedentary. Many people aging with HIV are on Medicaid and have limited resources. That’s a risk factor, too, as is being Black or Latino. All these risk factors contribute to inflammation in the body, and therefore increase their likelihood of having more comorbidities or more severe incidents of those illnesses. 

AF: Can you expand on the role inflammation plays in aging, particularly aging with HIV?

SK: Inflammation (overstimulation of the body’s response system) is the common pathway through the disorders of aging. If you’ve lived 60, 70, 80 years, you’ve gone through a lot of inflammatory episodes, many of them unbeknownst to you. Smoking, depression, eating processed foods, drinking too much alcohol—all those things cause inflammation that can imperil your health.

A lot of people with HIV think, “Okay, I’ll take my pills for the rest of my life and that’s the only thing I need to change.” No, it’s not. Treating the HIV is the easy part. The anti-retrovirals tamp down the inflammatory response considerably. But, on the other hand, if you smoke, have Hep B, remain sedentary, eat poorly—that contributes to the inflammatory cascade. 

So yes, you should take your pills. But you should also eat better, exercise, do not socially isolate. If you have mental health issues, don’t let them go unaddressed. These are the social determinants of health that make a huge difference in the lives of older people with HIV.

AF: How do people with HIV build on the knowledge they have of their illness to learn more about their health as they age? 

SK: Their concern for so long has been the virus, but now they should begin to understand: they’re aging. None of us are prepared for aging, as far as I’m concerned. We have to be preemptory, and that’s not the kind of medicine we practice in this country, preventive medicine. We wait until a plane falls out of the sky; we do nothing preemptively. 

With HIV/AIDS, the sole goal has been viral suppression. We’re obsessed with it, and I get why: for the benefit of the patient and to stop the spread. I certainly get it. But that’s not the only thing that’s important about this person—this is a whole person. We’ve totally relegated other risk factors, especially mental health, to tertiary issues. COVID has elevated that issue again. When we screen for depression, the numbers are always 3 to 5 times higher in people with HIV than in a similarly aged control group. And the average rate of PTSD is 35%. For me, that’s untenable. Suppression is treatable. But we have to expand the scope of what we treat.

AF: How should people navigate their health care as they get older? Should they seek to involve a geriatrician in their treatment along with their primary care provider?

SK: It’s generally conceded that the only physicians who know how to manage multiple morbidities are geriatricians or people who understand geriatrics. Certain HIV units are literally retooling care standards within the HIV clinics to include the methodologies of geriatrics. The geriatrician is aware of function, that your quality of life depends on how functional you are, how independent you are in your own home. Chronological age is a poor measure of aging. One of the challenges of geriatrics is how do you meaningfully measure age.

There aren’t enough geriatricians in this country. The model now is if you think you have an issue related to aging—frailty, pre-dementia, limitation of ADLs (activities of daily living)—your primary care physician refers you to a geriatrician, who does a workup and sends recommendations back to your PCP. And that’s if you can find a geriatrician.

AF: What is the age breakdown of the U.S. HIV population today?

SK: In New York City, out of 127,000 people with HIV, 60% of them are age 50 or over. Nationwide, out of 1.2 million, 63% are 50+, and 15% are 65+. HIV patients might not be considered old but may have all the symptoms of being old. 

AF: How do you find health care access is for people aging with HIV, and for the older LBGTQ+ population in general? The Visiting Nurse Service of New York, where I work, has provided SAGE training to every employee for LGBT cultural issues, sensitivities and best practices around sexual orientation and gender identity. But SAGE reports about 20 of LGBT people avoid medical care for fear of discrimination.

SK: There’s still a lot of bias in the health care system. Your PCP may see HIV-positive patients all the time, but as you get older, you may be referred to a rheumatologist, cardiologist, nephrologist, or another specialist who doesn’t see HIV people all the time. They and their staff are not ready for that person, and the stigma of HIV is alive and well today. They may say or ask something injurious to the patient, who then gets turned off and never goes back to the doctor. I know home visitors at VNSNY are trained to avoid those pitfalls, but not everyone is. 

AF: The old adage is you can’t stop aging. But you’re saying that’s not true. We can slow down the aging process if we pay attention to our health and get the care we need.

SK: Absolutely. You can modify the aging arc. It’s always better to do it sooner rather than later. If you’re 75, you’re not going to behave like you’re 30—your body doesn't have those kind of reserves—but there are all kinds of things you can do to practice good preventive medicine. Eat right, exercise, stop smoking, avoid stress and attend to your mental health.

AF: Thank you Steve for this interview and all you are doing for our community, and thanks too for supporting the work we are doing at VNSNY in the areas of LGBTQ+ home health care.

Preparing to Have a Healthy School Year

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With the new school year upon us, parents can help their children stay healthy and strong. In a school year in which children will be learning in person, remotely, or through a blended model because of COVID-19, here are some important topics to keep in mind:

*Annual checkup: During an annual checkup, a pediatrician can help detect health problems early, when they are easiest to treat.

Even during the COVID-19 outbreak, it’s important for your child to keep having regular checkups, according to the Centers for Disease Control and Prevention. 

Now is a good time to call your child’s pediatrician to ask about making an appointment for a checkup or needed care. Before the next visit, whether by telehealth or in person, write down any questions you may have. 

*Immunizations: Follow your pediatrician’s advice and keep your child’s immunizations, including seasonal vaccines like the flu shot, up to date. The American Academy of Pediatrics strongly supports continuing to give children their shots during the COVID-19 outbreak.

*Hand washing: Hand washing is one of the most important ways to reduce the spread of germs, including the virus that causes COVID-19.

Children should wash their hands frequently and thoroughly with soap and running water for at least 20 seconds each time. It’s especially important to wash hands before eating, and after blowing their nose, coughing, or sneezing; using the toilet; touching animals or their food; or playing outdoors.  

*Healthy lifestyle: A lifestyle that includes regular exercise and good nutrition can strengthen your child’s immune system. Make sure your child eats enough fruits, vegetables, and whole grains, and avoids saturated fats. Also, incorporate physical activity in their daily routine.

*Bedtime routine: The recommended bedtime routine has three key parts: brush and floss teeth, read a book, and make sure children have the same bedtime each night.

To help your child get used to waking up earlier during the school year, you can build the bedtime routine one part at a time, move the bedtime slowly to the desired time, and limit the use of electronic devices. Sleeping enough each night leads to improved physical, mental, and emotional health in children, according to the American Academy of Pediatrics.

Fidelis Care is focused on children's health and wellness, and providing support and resources to parents as a new school year begins. We provide quality, affordable health insurance coverage to children and adults of all ages. To learn more, call 1-888-FIDELIS (1-888-343-3547; TTY: 711) or visit fideliscare.org/everychildcovered.

Amid a Global Pandemic, Immigrant Families Face Even Greater Health Care Insecurities

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By Angel Rosario

At EmblemHealth, I lead a dedicated team that’s embedded in our neighborhoods to help families answer questions about health care coverage and services. 

For some, we are the first people that patients have spoken to about whether they qualify for coverage, if they can get the preventative care they need, or how to deal with chronic conditions. We frequently encounter deep-rooted fears and a reluctance from immigrants and their families about how they can access health care.

Their fears are directly linked to the “public charge” rule, which is a new federal regulation that gives federal immigration officials the ability to deny applications for green cards and visas for those new to the country who have used certain government assistance programs. The rule, and confusion surrounding it, have led many to delay obtaining health care or avoiding it altogether; often resulting in people going  to the hospital or worse, watching loved ones die. From a public health and community perspective, we all must ensure this doesn’t happen.

When we talk to people about health insurance, many emotions are exposed, including concerns about qualifying for health coverage. Every day, I watch people walk away from no-cost health insurance because this new rule makes them feel targeted and exposed.

During this uncertain time, where more than 5 million people have confirmed coronavirus cases in the U.S, there’s an especially crucial need to ensure all who need it, have access to health care. Yet, uncertainty runs high for many in migrant communities, unsure  if they can enroll in health insurance and if doing so will designate them as a “public charge”.

Last week, a federal appeals court blocked this proposed rule from being enforced in Connecticut, New York, and Vermont. Unfortunately, the court action has not alleviated anxiety. Individuals  are worried that applying for health care assistance will result in denial of a green card, visa renewal, or US citizenship, or even deportation.

Everyone has a vested interest in this debate; because the more people with coverage helps protect our communities from disease. The facts are New Yorkers can be fully covered. The public charge rule only affected Medicaid, not other coverage, such as the Essential Plan, Child Health Plus, or Qualified Health Plan. Furthermore, even prior to the court action, the federal government exempted pregnant women and children under 21 seeking Medicaid coverage from the public charge rule. Now the court has made it possible for families to seek coverage for others not previously exempted under Medicaid.

This is a confusing time, and we are here to help. If you or someone you know is worried about getting access to health coverage, please call us at 888-432-8026 where you can get answers. Getting coverage helps you protect your family, ultimately making communities safer.

Angel Rosario is the Vice President of Marketplace Sales at EmblemHealth, a New York nonprofit health insurance plan that serves over 3.2 million New Yorkers and nearly half a million patients through AdvantageCare Physicians (ACPNY), where more than 70,000 of its patients are insured through Medicaid.

Children Need to Go Back to School- Parents Say

OpEd: 

In-Person Learning Can’t Be Replaced

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By Monet Elzey and Lude Bonnet, Parents of New York City School Children

It’s been 179 days since New York City schools closed due to the pandemic. Some of those days have felt like weeks, while others have passed with the blink of an eye. But as parents, one thing has remained constant: our devotion to the health and well-being of our children.

The shift to remote learning in March was an incredible feat by teachers, students, and families. Countless hours have been poured into keeping our children on track over the past six months, and the resiliency of our communities has been a beautiful thing to witness. We made it through some of the toughest days in our City’s history, during the height of a crisis no one could have ever prepared for. 

Today, we’ve made it through the worst of that crisis—and we’re uniquely positioned as the only major school district in the country able to safely send our children back to school in the fall. Our children, their education, and their futures can’t afford to wait.

As parents and educators, we know there is no substitute for the experience of being in a classroom. Our children have so much to gain from being in-person with their teachers, peers, and friends during this critical time. One of us has a son whose eyes light up when he talks about going back to his high school to start his junior year. He can’t wait to be back with his friends and a step closer towards graduation. The memories of when he first began his educational journey are still clear as day. It breaks my heart to think about a world in which he spends his last moments as a New York City student in our apartment every day, away from his friends, and separated from the teachers who want him to succeed.

Being in school is an experience that can’t be replaced. And that’s why we are so hopeful we can make blended learning work. It’s a chance to get our children back to their classrooms, where they learn best with one another.

As of now, the majority of students will begin the school year in a blended learning model, where they will be learning in-person in their own school buildings part of the week and learning remotely during the remaining days. Our schools play such a critical role in our communities, and hundreds of thousands of New York City parents are ready to safely get their kids back to their classrooms.

Are we nervous? Of course, we’re parents. We lie awake at night thinking about our kids, especially our youngest children. How can we help them understand that they can’t hug their friends? Will they remember to wear their masks all the time? None of it will be easy. Our young ones are dealing with the change, confusion, and even trauma the pandemic has brought into their lives. The social and emotional support of educators, friends, parents, and loved ones is needed more than ever for all developing young minds. We are so grateful for the wrap-around care that is already being planned out in our school communities.

Planning for the school year is never easy, but this fall has required far more preparation than ever. We’ve seen first-hand the work our teachers, principals, and even our Mayor and Chancellor have put in to keep our schools and classrooms safe. A later start to school is allowing educators and families more time to thoroughly prepare for the start of a school year like no other, and mandatory testing will help keep our communities safe and healthy.

We refuse to put our children in harm’s way. One of us has a daughter who was diagnosed with Lupus and making sure she’s healthy has caused many sleepless nights. So, safety is absolutely non-negotiable. Knowing that day-in and day-out, there are teams disinfecting the hallways, spacing out classrooms, ensuring adequate ventilation, and taking every precaution necessary for our children provides a little bit of peace during this turbulent time. Health and safety are leading the way as schools prepare a safe and supportive learning environment for our children, and we know school leaders are doing everything they can to start the school year strong.

As parents, we’re reassured. But above all, we’re hopeful. We believe we can make this work, and that we can give our kids the kind of learning experience they can only get in a classroom. During this unprecedented moment, we want nothing but the best for our children – and we know every New York City parent wants the same for their child. That’s what we owe our young people. Let’s do all we can to make that a successful reality this year.

How EmblemHealth is Supporting the Health of The Bronx

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During these uncertain times, questions about health care can be confusing and overwhelming. Many individuals don’t know where to turn, and what they should ask of their provider or their health insurer. 

For more than 80 years, EmblemHealth has worked to make quality health benefits accessible and affordable to all New Yorkers. Along with our physician partners, AdvantageCare Physicians (ACPNY) and community practice partners like BronxDocs, we offer a wide range of services and resources to our community members, including the following:

Removing Barriers to Care with Neighborhood Care

Navigate the health care system, making the most of your health insurance benefits and having access to local and community resources is important to your health. Through EmblemHealth Neighborhood Care, we provide in-person and virtual customer support to help you gain access to the care and resources available in the community. With numerous health wellness programs, we’re here to help the Bronx community learn and keep healthy behaviors. Our trained professionals offer personalized support in multiple languages, including English and Spanish.

Receiving Local Care from BronxDocs 

Bronx residents deserve access to high-quality, coordinated and culturally competent care. Our community practice partner, BronxDocs is a top-notch medical practice offering care at multiple locations throughout the Bronx community. 

You can schedule an appointment at any location by calling (646) 680-5200. BronxDocs is committed to delivering care that is patient-centered, compassionate, and quality-driven at in-person or virtual appointments. 

BronxDocs can care for your whole family, with a full suite of health care services including: Cardiology, Cardiovascular, Family Medicine, Gastroenterology, Gynecology, Internal Medicine, Laboratory, Ophthalmology, Orthopedics, Pediatrics, Physical Therapy, Podiatry, Pulmonology, Urology, and more. BronxDocs offers a special focus on senior care for Medicare patients. 

You can count on BronxDocs to provide access to the right type of appointment at the right time either in-person, via telephone, or through virtual video appointments and all Medicaid, Commercial and Medicare insurance plans are accepted. BronxDocs offers primary care and pediatric appointments within 24 hours and appointments with specialists are available within one week of your call. Providing high-quality, convenient care is the highest priority during these times, and Bronx residents deserve continued access to high-quality care.

Scheduling Virtual Visits

During these unprecedented times, EmblemHealth is working to ensure members can have access to medical appointments using convenient virtual provider visits. 

Now, you can use your tablet, computer, or phone to schedule appointments for urgent, primary or specialty care. If you are feeling anxious or experiencing grief or depression, you can use these virtual visits to access behavioral health specialists. People in the Bronx wanting to schedule a virtual visit with BronxDocs should call (646) 680-5200. 

Protecting City of New York Employees

EmblemHealth has been serving New York families for over eight decades. We’ve supported our members through the Great Depression, and in the aftermath of 9/11. Today, with the health and economic challenges facing our country and our city, we remain dedicated to ensuring City of New York employees have access to safe, quality care. After all, City of New York employees are the heart and soul of New York. 

For those workers, many of whom have been on the frontlines of the COVID-19 crisis since the beginning, our commitment to limiting exposure to COVID-19 while still caring for this critical workforce and their families remains a top priority. To that end, we are pleased to provide prescription drug delivery services, among other options.

In addition, City of New York employees have access to EmblemHealth’s City of New York HMO Preferred Plan, which combines a personalized health care experience with affordable coverage for city workers. These benefits include concierge health coaching service offered at no additional cost to our City of New York HMO Preferred Plan members, through our dedicated “Gold Line.” 

For more information on how EmblemHealth is supporting the Bronx, visit emblemhealth.com/bronx.

How to Help Kids Cope with Unusual School Year

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With all the changing plans and confusion during this back-to-school season, it is unsurprising that many students will be feeling more intense back-to-school jitters. In fact, with all the turbulence and disruption of the last school year, many more children could be feeling anxious about how this school year will go. And parents and caregivers are in the same boat. 

Dr. Zubair Khan, child psychiatrist at the Montefiore School Health Program, advises that families need to have open and honest conversations ahead of the start of school, and continue these conversations often throughout the year. 

“The first thing to do, which is very important, is to acknowledge that it’s going to be an unusual year,” says Dr. Khan.

According to health professionals, the COVID-19 pandemic has taken a toll on the mental health of many children, with heightened feelings of loneliness, isolation, anxiety and depression. Everyone wants children to have the best school experience and get a quality education, while being able to cope with the challenges that will likely continue throughout the year. Dr. Khan offers these simple tips for families to keep in mind during these uncertain times:

*Be honest: 

Help kids understand what they are walking into, and reinforce that the new environment is intended to keep everyone safe and healthy.

*Explain that things may change – and that’s ok. Explain that everyone will need to be flexible and accepting.

*Maintain a schedule at home – Children thrive on a routine: make sure they are getting enough sleep, eating a healthy diet and getting physical activity every day.

*Manage expectations – Recognize that both children and adults may feel worried and stressed, but model positivity and reassure yourself and children that it will be ok.

*Practice and teach mindfulness techniques to help everyone cope with moments of stress or anxiety. Deep breathing exercises are easy and effective for children of all ages, as well as adults.

*If caregivers are concerned about their child’s changing behavior, consult with your pediatrician for further guidance.

Undoubtedly, the school year ahead will present challenges as children try to adjust and many families learn how to navigate teaching and working from home. 

Dr. Khan reminds families to have an open mind, share feelings with each other, and trust that the guidance from teachers and schools is intended to protect children’s safety and ensure they continue to learn and develop academically. 

Navigating Suicide Prevention in a Global Pandemic: Home Health Care Insight

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By Deirdré DeLeo, MA, LCSW, Visiting Nurse Service of New York, Community Mental Health Services 

When the COVID-19 pandemic first hit New York City, our daily lives shifted dramatically–and rapidly. It is not unusual during these unprecedented times to experience being overwhelmed with feelings of worry, sadness and loss–loss of how things were, of connections to others and loss of certain freedoms and privileges.

If any of these sound relative to your own experience, you are not alone. According to a recent study conducted by the U.S. Centers for Disease Control and Prevention, 40 percent of U.S. adults reported dealing with mental health issues or substance abuse in late June, 11 percent of which seriously considered suicide. Additionally, essential workers, unpaid adult caregivers, those who are racial/ethnic minorities and younger adults ages 18-24 reported disproportionately more severe mental health struggles, substance abuse and suicidal ideation. 

It is important to note that while this time of crisis has exacerbated increased symptoms of mental illness, suicide was a public health concern even before the pandemic and continues to be so. 

In my role as Associate Director for Community Mental Health Programs and Clinical Operations at the Visiting Nurse Service of New York, my colleagues and I are trained to observe and skillfully respond to people of all ages who may be struggling with mental health issues.

September is National Suicide Prevention Awareness Month and a time–perhaps more fitting than ever–to discuss how those struggling with mental illness and their loved ones can navigate a public health crisis during a public health crisis.

Look for Signs

Use the increased time you are spending with roommates or family to be one step ahead when it comes to recognizing signs and symptoms someone you love might be contemplating suicide. Phrases like, “I can’t do this anymore,” “I just want to give up,” or “I’ll never be good enough,” may disguise suicidal desires and can be a transparent but overlooked sign that someone might be thinking about suicide. 

Other signs and symptoms to take note of include: increased use of drugs or alcohol, a change in sleeping habits (either can’t sleep or sleeping more), introduction of new habits, reckless behavior, or the giving away of prized possessions. While we have all endured a social disconnect in some variety during the pandemic, uncharacteristic withdrawal from social interaction can also be a sign that someone is severely depressed or struggling with suicidal thoughts. 

Stay Connected…

Humans are social creatures, but once social distancing regulations were put into place many of our daily face-to-face interactions stopped. That may be taking a bigger toll after more than six months of what feels to many like a “lockdown.” It’s natural to feel alone during this time or believe your relationships with friends or family are drifting apart, both of which can produce depressive patterns. 

Now is the time to let technology help you stay connected with loved ones, whether through a simple text message, a humorous meme, social media post or through more personal avenues such as a voice or video call. While there may not be game-changing updates to share, a quick touch-base can mean a lot in these challenging times. Don’t be afraid to ask someone you care about if they are struggling. And don’t be afraid to listen to what they say if they open up. It is important too not to minimize what someone says with comments like, “don’t say that.” Just listen and let them express how they feel.

…But Know When to Disconnect!

Anyone listening to the news these days might find themselves feeling overwhelmed, endangered or hopeless, wishing there was a way to “make things better.” We live in a time (and city) where things are so fast paced. There’s a wealth of information is at our fingertips, but as efficient and helpful as this might be, it is also important to know when information overload becomes too much to handle. Try setting aside time once or twice a day to get news updates. “TMI” can add to stress in our already stressful lives.

Air it Out!

Quarantined conditions have given people limited options when it comes to enjoying activities beyond the square footage of their homes. Spending too much time in one indoor space can increase feelings of agitation, anxiety or confinement. Additionally, many people who cohabitate are spending extended time together in tight spaces, which has the potential to create conflict fueled by general stress. Remember that we all need alone time, even if we’re isolated from the rest of the world! Getting outside, even just sit on your stoop or a park bench for a few minutes, can be a much-needed change of scenery and a simple way to break out of repetitive routines.

Find Hope in Each Day

It’s standard to feel hopeless during a pandemic, but hopelessness can often trigger suicidal ideation. Take some time each day to practice self-care and do something enjoyable, whether it’s watching a TV show, working on a craft, trying a new recipe, taking a hot shower with your favorite scents or reading a book. Make sure you are also eating and drinking water properly and keeping physical active–even if that means dancing to a favorite song or walking laps around your room! 

Many of us have also had radical changes in how our time is structured, so keeping a schedule can be a great way to not only have your priorities in order, but also ensure that you pencil in self-care activities and always have something to look forward to! Thinking about the future–or even the next month–can be intimidating and even feel impossible at times, but conquering life one day at a time will always provide you with a daily gift: You’ve won another battle–and you are a winner.

If you or someone you care about seems seriously anxious or depressed, it’s time to get help. Remember to Ask, Listen and Get Help by calling NYC WELL at 1-888-692-9355.

To learn more about the VNSNY Bronx Mobile Crisis Team and other community mental health services visit VNSNY.org. 

Deirdré DeLeo, is the Associate Director of Programs and Clinical Operations with the Visiting Nurse Service of New York and its Community Mental Health Services division. For more information please visit www.VNSNY.org or call (800) 675-0391.  

Taking the Right Steps: Tips for Preventing Falls at Home

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By Abigail Fortune, PT, DPT, Visiting Nurse Service of New York

One out of four Americans age 65 and older experience a fall each year, and one out of five falls will cause serious injury, according to the U.S Centers for Disease Control and Prevention. 

It is also important to note that 60 percent of falls that require hospitalization occur at home. That’s an important point to remember this September as National Falls Prevention Awareness Month comes in the wake of the COVID-19 pandemic here in New York City. 

As a licensed physical therapist with the Visiting Nurse Service of New York, my colleagues and I work to keep our patients safe from falls in their homes. We educate them and their family caregivers so they are aware of risk factors and consequences of serious falls, and we work to help them build strength and regain balance that can decline with age or after hospitalization. Sometimes people believe that falls are an inevitable or natural part of aging—I can assure you, that does not have to be true. 

As a matter of fact, falls can be significantly reduced–even prevented–by implementing some practical lifestyle adjustments.  

In honor of Falls Prevention Awareness Week from September 21-25, I am sharing some tips for caretakers and homebound seniors to prevent falls in or around the home.

Clear Your Path

Cluttered homes can be severe safety hazards and increase chances of tripping or falling. Evaluate each room in the home and consider rearranging furniture or putting certain items into storage in order to create as open of a space as possible. Take note of any objects that can increase risk of tripping such as shoes, books, laundry baskets, pet toys or anything that can roll. Electrical wires should also be moved out of walkways or taped down. Do not hide any wires under rugs, as this can be a fire hazard!

Slippery When Wet

Be aware of any liquid spills, including water transfers from sinks, showers, swimming pools, rain–even condensation from air conditioners–that can increase chances of slipping. Bathrooms are high-risk areas for falling, so make sure to have anti-slip bathmats in your shower or bathtub. Railings or grab bars in the bathroom are also helpful to have in order to improve steadiness, catch any slips before they become falls or help get you back on your feet after a fall. Rugs should also be laid out in the bathroom, especially outside of the shower, to avoid any wet and slippery floors. 

Keep Light on Your Feet

Make sure to keep your home well lit, especially as autumn approaches and the sun begins to set earlier in the day. Take advantage of daylight, open your window blinds and “let the sunshine in,” but as also make sure to keep entryways and staircases well lit. Plug-in nightlights are helpful to have along stairways and in shadowed corners as well as right below light switches that might not be easy to see on the wall. Keep tableside lamps in frequently used locations such as the bedside and living room.

Find your ‘Sole’mate

Putting the correct shoes on your feet can help you stay on your feet! Ill-fitting shoes can increase instability or chances of falling. Make sure to wear proper footwear with anti-slip properties, closed backs and rubber soles. Also, in perhaps one of the first falls prevention lessons we are taught, always make sure your shoelaces are tied!

Let’s Get Physical!

Increased time spent at home due to social distancing is likely to reduce body movement, so it is vital to maintain strength and agility through regular activity. Healthy seniors and people of all ages should participate in an exercise program at least twice a week at home, with doctor’s approval. Your doctor may even recommend you work with a physical therapist if you’re living with a condition that can interfere with your movement or coordination. Simple stretches or yoga poses can also be effective in staying active and improving balance. Pairing up with a friend can make exercise fun and safe as well.

Getting in Gear

Canes, walkers, or other assistive devices can make a world of difference in terms of stability. Walking equipment should always be within arm’s reach (or on each level of the home if there are multiple stories). Equipment should also be maintained regularly, and rubber tips on canes and walkers should be kept intact. Worn-out tips are unreliable and can increase chances of falling, so be sure to visit your local drugstore or local surgical supply store to purchase new rubber tips if needed. 

Glasses with a proper prescription are also essential, especially as one gets older. According to the National Council on Aging, as one ages, less light reaches the retina which can make contrasting edges, obstacles, potential safety hazards and obstacles more difficult to see. Poor depth perception can also lead to problems navigating uneven or slippery surfaces. Seniors should visit a doctor for a vision assessment every year and pursue treatments that will correct any problems that arise. 

Know the Health Risks

Seniors and caretakers should be well-informed on certain health conditions that increase the risk of falls. For example, diabetes can cause joint pain, foot sensitivity, dizziness and vision problems. COPD, CHF, low blood pressure and other circulatory diseases can also cause dizziness and affect balance. Balance and mobility may be impacted by bone and joint conditions, such as osteoporosis and arthritis, and eye diseases such as glaucoma and cataracts interfere with vision. 

Medications that depress the central nervous system increase the risk of falling, as do certain medications, such as pain relievers, heart medications, antidepressants, seizure medications, over-the-counter sleep aids, allergy medications and some cold and cough remedies. Optimal awareness and regular check-ins with your physician can help manage symptoms, address side effects and reduce risk.

Stay Connected

While many homebound seniors have assistance at home, their loved ones may not be able to visit them frequently. Mobile devices are extremely helpful to have on hand, whether for simple text messaging, voice or video calls, or even for use of your phone’s built-in flashlight to see more clearly in the dark. Be sure to have caretakers on speed dial in case of a severe fall or other health-related emergency, or identify a neighbor who can be trusted in case of immediate need. If your loved one is at risk of damaging falls or health conditions, regular check-ins can be very useful, especially in a time of such isolation, and may even help save a life! Home care providers like VNSNY can also provide information about setting up a subscription with services like Life Alert for elderly loved ones who live alone.

Abigail Fortune is a physical therapist and rehabilitation instructor with the Visiting Nurse Service of New York. For more information please visit www.VNSNY.org, or call 1-800-675-0391.

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