Is It Memory Loss?

Lucy couldn't find her insurance cards. She looked in her wallet. It wasn't there. She looked through her purse. No luck. Finally, she found it on her desk. Yesterday, she forgot where she put her keys. Her memory seems to be playing games with her and she is starting to be worried about itLucy saw her doctor. After a good physical exam and lab work-up, the doctor said that Lucy was fine. Lucy's doctor suggested that take a class, play cards with friends, or help out at the local school to sharpen her memory.

What is mild forgetfulness?
It is true that some of us get more forgetful as we age. Itmay take longer to learn new things, remember familiar names and words, or find our glasses. These are usually
signs of mild forgetfulness, not serious memory problems. If you’re worried about your forgetfulness, see your doctor. You also can do many things to help keep your
memory sharp. Finding a hobby, spending time with friends, eating well, and exercising may help you stay alert and clear-headed.

Here are some ways to help your memory:
• Learn a new skill.
• Volunteer in your community, school, or place of worship.
• Spend time with friends and family whenever possible.
• Use memory tools such as big calendars, to-do lists,and notes to yourself.
• Put your wallet or purse, keys, and glasses in the same place each day.
• Get lots of rest.
• Exercise and eat well.
• Don’t drink a lot of alcohol.
• Get help if you feel depressed for weeks at a time.

Swine Flu: Taking Care of a Sick Person in Your Home

The Swine flu A virus outbreak has reached 91 confirmed cases in the United States according to the CDC update posted April 29th, 2009. Patterns of a more severe illness may emerge in the United States.

The main way flu viruses spread is from person to person in air droplets from sneezes and coughs. This can happen when droplets of an infected person travel through the air and are deposited on the mouth or nose of people nearby. Flu viruses may also be spread when a person touches respiratory droplets on another person or an object and then touches their own mouth or nose (or someone else's mouth or nose) before washing their hands.

If a loved one you are caring for becomes ill with the virus:
- Check with the health care professional about any special care needed, particularey in individuals with a health condition such as diabetes, heart disease, asthma, or emphysema.
- Check with health care professional about whether they should take antiviral medications which have been found to be very helpful in treating the Swine Flu A Virus.
- Stay home for 7 days after the start of illness; fever must be gone first before venturing out of the home.
- Get plenty of rest.
- Drink clear fluids such as water, broth, sports drinks, electrolyte replacement such as Pedialyte to keep from becoming dehydrated.
- Cover coughs and sneezes with facial tissue. Dispose of soiled tissues immediately into a paper bag.
- Clean hands with soap and water or an alcohol-based hand rub often and especially after using tissues and after coughing and sneezing into hands.
- Avoid close contact with others-do not go to work or school while ill.
- Be watchful for emergency warning signs that might indicate you need to seek medical attention.

Seek emergency medical care right away if a sick person at home:Has difficulty breathing or has chest pain.
- Has purple or blue discoloration of the lips.
- Is vomiting and unable to keep liquids down.
- Has signs of dehydration such as dizziness when standing, absence of urination, or in infants, a lack of tears when they cry.
- Has seizures, or uncontrolled convulsions.
- Is less responsive than normal or becomes confused.

A Season for Sadness?

For as long as she could remember, Mary had bought winter clothes two sizes larger than her summer ones. As soon as the weather turned cold, she found herself craving rich, creamy foods and sweets. By Christmas, she was usually five pounds heavier than she’d been at Halloween. By the end of the holidays, she’d put on another five. "I just can’t control my appetite," she told a friend. "Then I get so depressed about being fat that I feel miserable for months."

In fact, Mary not only looked different in the winter, she acted differently. In the summer she was full of pep, spending as much time as she could out in the sun. In the winter, she holed up inside the house for entire weekends. Her husband once described her as "the original couch potato." It wasn’t that she didn’t want to get up and do things-she couldn’t. She didn’t have the energy. Her nerves also seemed more on edge. "Don’t mind mom," she heard her son tell a friend when she yelled for them to lower the volume on the TV. "She’s just in one of her moods."

As she began her annual countdown to spring, she once told her husband, "I’d rather be off hibernating," She couldn’t wait for the first crocuses to push up through the earth. Whereas she usually didn’t feel like fussing over Christmas, she celebrated Easter in grand style. And even though she cooked up a storm, she usually was able to curb her appetite and start losing weight. "Just getting ready for swimsuit time," she’d laugh.

One winter Mary’s family decided to give themselves a special Christmas present: two weeks in Florida. "None of my clothes will fit," she wailed. But when she got into the sunshine, she started feeling so good she didn’t care. As if it were as easy as taking off a heavy coat, Mary shed her winter gloom. The vacation was one of the happiest times of her life. But after returning home, her spirits sank.

A few weeks later, Mary’s seventeen year old grandson, working on a research paper, came across an article on a specific type of depression that strikes mainly in winter. "Read this, Mom Mom," he said. "It sounds like you." As Mary read the article she had to agree that the description of seasonal affective disorder fit her perfectly. The piece included an address for the National Institute of Mental Health, and Mary wrote away for more information on SAD. She also talked to her doctor, who referred her to a psychiatrist in town. His recommendation: phototherapy, or daily exposure to bright light.

Mary purchased a specially designed light box, which she set up in her kitchen next to the table where she read the newspaper in the early morning. Later in the day, she rearranged her easy chair so that her seat was closer to the window. She took daily walks to get the benefit of whatever sunlight there was. She felt lighter, more energetic and her food cravings diminished. And although she still waited eagerly for the first flowers of spring, she felt relieved that winter had lost its terrible hold on her spirits.

Light therapy has been endorsed by medical circles and therapists worldwide as an effective treatment for the depression associated with SAD. The range of specific application is vast and the research continues.

In addition to treating SAD, light therapy -- also known as phototherapy -- has been found to be helpful to elderly patients with dementia or Alzheimer's syndrome. It is known that melatonin levels decrease as we age and there is a syndrome common in the elderly that is called "sundowner's syndrome." In winter months and summertime alike, when the sun goes down those with Alzheimer's or dementia can become sullen, depressed anxious or morose as darkness approaches.

A spectrum of light appliances designed for use in treating SAD is available on the market today.

In a recent study called the Heart and Soul Study, scientists looked at over 1000 people with stable coronary heart disease, followed for almost five years, measuring depressive symptoms at baseline in relation to subsequent heart failure, MI, stroke, transient ischemic attack, or death.

It has long been known that depression is known to increase the risk of heart disease. The study found that if you increase exercise in depressed patients, you're going to reduce their risk of heart disease. But the thing to remember about depressed patients is that they are that much less motivated to do things, so it takes extra effort to get them to exercise, take their medications, and stop smoking.

Take home points: light therapy and exercise will go far to decrease the winter blues.

Tips and Hints for Choosing In-Home Care Services

• Be Organized. Develop a summary of information about the care needs of your loved one that you want the caregiver to be aware of. Also, when searching for a service provider, draw up a list of questions to ask the agency.
• Ask the Home Care Agency if they have a back-up person on-call in case of caregivers becoming ill, or not showing up.
• Provide the aide with a checklist of duties for EACH DAY.
• The aide should not sleep, or smoke in your home.
• If there is a problem, immediately contact the agency that sent the aide.
• The aides should provide their own lunch/dinner.
• Do not tip. No money should be exchanged with the home health aide
• Do not send your loved one out in a car with the aide unless this situation is prearranged with the agency. Be sure the agency completes driver record checks on all employees.
• Aides should not use the phone for lots of personal calls.
• Make sure you know in advance how payment is expected.
• Some aides are Certified Nurse’s Aides (CNAs) and others are not. Some will take a blood pressure and a pulse, others will not. Ask the agency.
• There should be some consistency after about 1 to 2 weeks regarding the person who is sent to the home. Sometimes it takes a week or so to get the same person on the schedule for your home. Be patient!
• What is the hiring practice of the agency? Have background checks been performed on every caregiver? What about Elder Abuse or Child Abuse database checks? Are they
bonded and insured?
• If there are too many late shows/no shows or inconsistencies, CHANGE AGENCIES (speak to them about the problem first, perhaps they can correct the situation).

Elder Abuse

Older adults can become more vulnerable to others who may take advantage of them. An elderly person with short term memory problems may open the door to a stranger and allow them in the home. Mental and physical problems may make them more difficult for the people who live with them.

Tens of thousands of seniors across the United States are being abused: harmed in some substantial way often people who are directly responsible for their care. More than half a million reports of abuse against elderly Americans are reported every year, and millions more go unreported.

Elder abuse tends to take place where the senior lives: most often in the home where abusers are apt to be adult children; other family members such as grandchildren; or spouses/partners of elders. Institutional settings especially long-term care facilities can also be sources of elder abuse.

Physical elder abuse is non-accidental use of force against an elderly person that results in physical pain, injury, or impairment. Such abuse includes not only physical assaults such as hitting or shoving but the inappropriate use of drugs, restraints, or confinement.

In emotional or psychological senior abuse, people speak to or treat elderly persons in ways that cause emotional pain or distress.

Verbal forms of emotional elder abuse include

• intimidation through yelling or threats
  
• humiliation and ridicule
  
• habitual blaming or scapegoating
  

Nonverbal psychological elder abuse can take the form of

• ignoring the elderly person
  
• isolating an elder from friends or activities
  
• terrorizing or menacing the elderly person
  
• Elder neglect, failure to fulfill a caretaking obligation, constitutes more than half of all reported cases of elder abuse. It can be active (intentional) or passive (unintentional, based on factors such as ignorance or denial that an elderly charge needs as much care as he or she does).
  

This involves unauthorized use of an elderly person's funds or property, either by a caregiver or an outside scam artist.

An unscrupulous caregiver might

• misuse an elder's personal checks, credit cards, or accounts
  
• steal cash, income checks, or household goods
  
• forge the elder's signature
  
• engage in identity theft
  

Scams that target elders include

• Announcements of a "prize" that the elderly person has won but must pay money to claim
  
• Phony charities
  
• Investment fraud
  

The following are warning signs of some kind of elder abuse:

• Frequent arguments or tension between the caregiver and the elderly person
  
• Changes in personality or behavior in the elder
  

If you suspect elderly abuse, but aren't sure, look for clusters of the following physical and behavioral signs.

Physical Abuse:

• Unexplained signs of injury such as bruises, welts, or scars, especially if they appear symmetrically on two side of the body
  
• Broken bones, sprains, or dislocations
  
• Report of drug overdose or apparent failure to take medication regularly (a prescription has more remaining than it should)
  
• Broken eyeglasses or frames
  
• Signs of being restrained, such as rope marks on wrists
  
• Caregiver's refusal to allow you to see the elder alone
  

Emotional Abuse:

In addition to the general signs above, indications of emotional elder abuse include

• Threatening, belittling, or controlling caregiver behavior that you witness
  
• Behavior from the elder that mimics dementia, such as rocking, sucking, or mumbling to oneself
  

Neglect:

• Unusual weight loss, malnutrition, dehydration
  
• Untreated physical problems, such as bed sores
  
• Unsanitary living conditions: dirt, bugs, soiled bedding and clothes
  
• Being left dirty or unbathed
  
• Unsuitable clothing or covering for the weather
  
• Unsafe living conditions (no heat or running water; faulty electrical wiring, other fire hazards)
  
• Desertion of the elder at a public place
  

Financial Exploitation:

• Significant withdrawals from the elder's accounts
  
• Sudden changes in the elder's financial condition
  
• Items or cash missing from the senior's household
  
• Suspicious changes in wills, power of attorney, titles, and policies
  
• Addition of names to the senior's signature card
  
• Unpaid bills or lack of medical care, although the elder has enough money to pay for them
  
• Financial activity the senior couldn't have done, such as an ATM withdrawal when the account holder is bedridden
  
• Unnecessary services, goods, or subscriptions
  

  
  

If you are know an elder who is being abused, neglected, or exploited, tell at least one person. Tell your doctor, a friend, or a family member whom you trust. Other people care and can help you. You can also call your local Office of Aging.

Insomnia Affects Treatment of Depression

Depression occurs in 5-10% of older adults. Risks for depression include recent loss of a loved one, sleep disturbance, loss of physical abilities, and a history of depression.

Older adults with persistent insomnia were more likely to have depression. Treatment for insomnia is important to overcome depression. Treatment consists of medications and altering behavior that occue with insomnia.

In order for behavioral strategies to work, the patient must be willing and open to change behaviors. Changing habits, or behaviors can be difficult to do. The following behaviors are suggested:

Restrict the time spent in bed.

Establish regular wake up time

Go to bed only when sleepy

Stay in bed only when asleep

Practices that help sleep include:

Regular daily exercise

Daily routines

Treating medical problems such as sleep apnea

Using the bed only for sleep and sexual activity

Practices that hurt sleep include:

Alcohol use

Caffeine use

Worries

Poor sleep environment

Using bed for things other than sleep or sexual activity

Innovative Program Reduces Rehospitalizations Among Elderly

Hospitals are dangerous places for the elderly due to frequent medical errors. Almost 25% of elderly have an adverse event related to processes typically used to discharge an elderly person home. A new program is helping the elderly avoid problems associated with discharge.

This innovative program includes a predischarge history and physical tailored to the special needs of geriatric patients, with emphasis placed on communication and teamwork among providers from different disciplines, a detailed medication review with a pharmacist, and a predischarge meeting among the patient, the patient's caregiver, and a clinician.

The program was tested in general medicine wards run by hospitalists at 3 hospital centers in different states. At 3 days postdischarge, 88% of the study group described their health as better than it was before their hospital stay compared with 79% of those who did not have this process used as part of the discharge planning process.

Improving the transition from hospital to home with more information and better communication about care needs after discharge to home improves overall health. While this process is not used in all facilities at this time, there are things that you can do to help your loved one in the hospital:

• Visit frequently and ask questions about your loved one's progress.
• Keep notes about what is discussed.
• Provide the doctor and staff with a list of the medications he/she was taking prior to hospitalization.
• Review your loved one's medical history with the clinical team. Ask about the current status of each medical condition.
• Ask questions about signs or symptoms your loved one is experiencing in the hospital.
• If you ask to speak to someone and no one comes to address your concerns within one hour, assertively ask to speak to someone again. If the doctor is unavailable ask to speak to the nursing supervisor or RN assigned to your loved one's care.
• Before discharge, ask for a printout of the list of medications that your loved one will be taking at home. Compare it with your list and determine any changes in the schedule. Ask questions about anything you do not understand.
• Ask about any changes needed in your loved one's diet, activity, or treatments.
• Ask about your loved one's ability to care for him or herself. Does he or she need help with walking or dressing, bathing safely? Medication management?
• Request home therapy and nursing visits if there are any changes in his or her ability to care for self.
• If he or she is unable to walk safely without help, consider a rehabilitation hospital or skilled nursing facility stay before returning home with home services.
• Ask about follow-up care needed after discharge.