An Age-specific Food Pyramid Recently Released

Tufts University has updated its food pyramid for over-70 adults, called the Modified MyPyramid for Older Adults, stressing nutrient- and fiber-rich foods over supplements. The modified pyramid emphasizes whole grains, fruits and vegetables. The modified pyramid encourages the use of fiber-rich foods in all food groups and reduced fat intake focusing on low saturated fat and vegetables rich in proteins. The importance of fluid balance is emphasizd.

Older adults need fewer calories because they are not as physically active as they once were and their metabolic rates slow down. However, the aging body still requires the same or higher levels of nutrients for optimal health outcomes. In order to get a nutrient dense diet, the following foods are encouraged:

• Whole, enriched, and fortified grains and cereals such as brown rice and 100% whole wheat bread.
• Bright-colored vegetables such as carrots and broccoli.
• Deep-colored fruit such as berries and melon.
• Low- and non-fat dairy products such as yogurt and low-lactose milk.
• Dry beans and nuts, fish, poultry, lean meat and eggs.
• Liquid vegetable oils and soft spreads low in saturated and trans fat.
• Fluid intake.

Physical activity such as walking, swimming, house work and yard work are emphasized. Regular physical activity is linked to reduced risk of chronic disease and lower body weights.

There are numerous study findings that obesity in adults 70 years and older has been increasing. Physical activity is one way to avoid weight gain in later years and the consequences of sedentary lifestyle.

The Modified MyPyramid for Older Adults stresses the importance of drinking enough fluids by having a row of glasses as its foundation. A common problem associated with aging is the lack of thirst even when the body lacks adequate water intake.

Medical Research Findings: Today and Tomorrow Can be Vastly Different

Isn't science a wonderful thing? Because of medical research, our life expectancy has changed dramatically. In 1900, the average life expectancy for a man was 47 years of age! Today it is 77 and getting older as we speak.

Medical research has allowed a death sentence for people diagnosed with HIV in 1982 to now become a chronic illness for the vast majority of those diagnosed since 1995. Cancer of the breast and prostate most often lead to death in in the 1960's. Today, the degree of the cancer determines survival. The lower the degree, better the survival rate.

Yesterday I reported that social, mental and physical activity to counteract loneliness helps to decrease the likelihood of developing dementia. Today, new research indicates that physical activity helps reduce the risk of Vascular dementia, but not Alzheimer's dementia.

These reports can become pretty confusing. You may feel as though your head is spinning. So what are you to believe?

Research reports are as good as the design and execution of the study. It is impossible for lay people to scrutinize every piece of information they hear and determine whether or not it is sound research.

Only time can really tell what will hold water in research results. While learning the results of studies is helpful, looking at the data is important to a physician, nurses, and other allied health professionals. Ask your health care provider to explain things that you hear that are pertinent to you.

Using common sense is helpful along the way. Consider the example of exercise. Does exercise help keep a person healthy? Scientific research is showing that, yes, it does. In years past, people were thinner because they did work that required alot more physical effort compared to most jobs today. Facts show that most adults in previous times did not develop diabetes. Diabetes was seen mostly in children who acquired it from a genetic or immune disorder.

Today, twenty percent of all adults age 60 years and older develop diabetes. Thirty(30%) percent of older adults who are obese have diabetes as compared to 13% of their thinner counterparts.

At least 10 million Americans at high risk for type 2 diabetes can sharply lower their chances of getting the disease with diet and exercise, according to the findings of a major clinical trial at the National Institutes of Health (NIH). All of the people enrolled in this study participated in lifestyle changes with diet and exercise which reduced their risk for developing diabetes. About 15% developed diabetes within 3 years of this study. Not reported in the short report was how many continued with the lifestyle changes.

I reported early in this blog that a new study reported that exercise will help reduce the risk for vascular dementia. So why talk about diabetes? People who exercise less often have a higher risk of developing diabetes. Diabetes causes complications in the blood vessels. Vascular dementia is one of these comlications. Vascular dementia is caused by a change in the blood flow in the vessels of the brain, causing cell death. Cell death in the brain causes dementia.

A tangled web or a domino effect? Lifestyle factors play a huge role. Balance in how many aspects of life impact health overall: stress level, social interaction, sleep, diet, exercise and physical activity level are all predictors of health. This is the overall theme to learn from current medical research findings. What we learn today, the changes in lifestyle made today, can effect our health tomorrow.

Loneliness Can Increase Dementia Risk

A 4 year study completed at Rush University, Chicago shows that lonely elderly are more than two times likely to develop dementia than those who are not lonely. Older adults with a good social network, who were frequently involved in social activity, and were mentally stimulated demonstrated less risk for dementia.

Loneliness was associated with more rapid decline in overall cognition, memory, perceptual speed and visuospatial ability. Staying mentally and physically active are keys to beating both loneliness and decreasing the risk of dementia. One recent large group study found that staying mentally active reduces the risk of Alzheimer's disease and other forms of dementia by nearly half by building and maintaining a reserve of stimulation.It is a case of "using it, not losing it." Another study found that older people who exercise three or more times a week had a 30 to 40 percent lower risk of developing Alzheimer's and other types of dementia. Even light activity, such as walking, seemed to help.

Many families struggle with the best way to reduce social isolation, loneliness, and mental and physical stagnation for their elderly family members. Environmental barriers can be obstacles to overcoming social isolation. Attending a senior center or becoming involved in a senior club can provide activities such as exercise, meals, games, and trips. Libraries, book stores offering book clubs and quilting groups are just a few of the possible choices that can improve a person's mental and physical health inexpensively.

Elderly family members who are physically unable to participate in a public venue because of decreased function can certainly benefit from visits from church members, adult day centers, and non-medical home care providers. The visits must focus on the interests of the individual. As such, a history of the elderly person's interests and lifelong hobbies is important to putting together a worthwhile and meaningful plan to decrease loneliness and stimulate interest in life's rewards.

Assistance With Aging Skin Changes

Skin changes as the body ages. It becomes thinner. It loses some of its elasticity. It is less able to protect itself from damage, and it heals more slowly from cuts or burns.

Dry skin is a common problem in older adults. To avoid dry skin:

Shower or bathe with warm water

Apply a skin lotion over the whole body, while it is still damp

Always shower and apply lotion immediately after swimming in a chlorinated pool or sitting in a spa

Avoid saunas

Apply lotion to entire skin surface at bedtime

Use only soaps designed for dry skin

Consider using a humidifier on cold, dry winter days.

It helps to be slightly damp when lotion is applied to help lock in moisture. But don't leave the skin too damp, or fungal infections can develop. Women should dry under the breasts, and both men and women should dry their genital areas well after showering or bathing.

Skin tears are very common. They tend to be shallow, involving the outer most layer of the skin. Tears occur from rubbing, pulling or touching on something in the home. For example, bumping counter tops, coffee tables or bedposts can result in a tear. It is important to try to prevent such injuries. Look around the home and remove potential targets. Consider padding bedposts or corners of tables with soft cushiony materials.

Stop the bleeding by applying direct pressure to the wound. If bleeding does not stop within a few minutes, obtain assistance from your health care provider.

Wash the wound with soap and water. If the injury occurred outside and rocks or gravel are inside the wound, they need to be removed.

If the cut or tear is small, you can apply an antibacterial cream and then a bandage. It is usually most helpful to apply a soft roll of gauze, wrapping it around the affected area and applying tape to the gauze instead of directly onto the skin since many people experience more skin tears from the adhesive sticking too well to the skin and tearing as it comes off.

Watch for signs of infection, such as: odor, pain, fever, drainage, redness, red streaks, or warmth in the area. If you notice any of these signs, contact your doctor as soon as possible.

Alcohol Use and Abuse

Anyone at any age can have a drinking problem. Rachel takes a fifth of whiskey to her mother every 2 weeks. Rachel's mother Mary admits that she drinks a few each evening to help her get to sleep. This is common. Families, friends, and health care professionals often overlook their concerns about older people’s drinking. Sometimes trouble with alcohol in older people is mistaken for other conditions that happen with age.

The aging body does not handle alcohol the same way. The same amount of alcohol can have a greater effect as a person grows older. Some research has shown that as people age they become more sensitive to alcohol’s effects. High blood pressure, ulcers, and diabetes can worsen with alcohol use. Many medicines—both prescription and over-the-counter—can be dangerous or even deadly when mixed with alcohol.

This is a special worry for older people because the average person over age 65 takes at least two medicines a day. Aspirin can cause bleeding in the stomach and intestines. If a person takes aspirin while drinking alcohol, the risk of bleeding is much higher. Cold and allergy medicines (antihistamines) often make people sleepy. When alcohol is combined with those medicines, it can make drowsiness worse and driving even more dangerous. Alcohol used with large doses of the pain killer acetaminophen can raise the risk of liver damage. If your loved one is taking any over-the-counter or prescription medications, ask the doctor or pharmacist if its safe to drink alcohol.

Even drinking a small amount of alcohol can impair judgment, coordination, and reaction time. It can increase the risk of work and household accidents, including falls and hip fractures. It also adds to the risk of car crashes— a special concern because almost 10 percent of this nation’s drivers are over age 65. Heavy drinking over time also can cause certain cancers, liver cirrhosis, immune system disorders, and brain damage.

Alcohol can make some medical concerns hard for doctors to find and treat. For example, alcohol causes changes in the heart and blood vessels. These changes can dull pain that might be a warning sign of a heart attack. Drinking also can make older people forgetful and confused. These symptoms could be mistaken for signs of Alzheimer’s disease. For people with diabetes, drinking affects blood sugar levels. Ulcers also may become worse with alcohol use.

Studies show that older problem drinkers are as able to benefit from treatment as are younger alcohol abusers. To get help, talk to the doctor. He or she can give you advice about your loved one's health, drinking, and treatment options. Your local health department or social services agencies can also help. There are many types of treatments available. Some, such as 12-step help programs, have been around a long time. Others include getting alcohol out of the body (detoxification), taking prescription medicines to help prevent a return to drinking once sober, and individual and/or group counseling. Newer programs teach people with drinking problems to learn which situations or feelings trigger the urge to drink as well as ways to cope without alcohol. Because the support of family members is important, many programs also counsel married couples and family members as part of the treatment process. Programs may also link individuals with important community resources.

Holiday Blues

Older adults can have an especially hard time with the holidays. There are many causes. The loss of an important person in the last year, or the anniversary of a loss or traumatic event can make memories come back that can dampen spirits. Family misunderstandings and conflicts can intensify — especially if it's all thrust together for several days. Conflicts are bound to arise with so many different personalities, needs and interests. On the other hand, if he or she is facing the holidays without a loved one, he may be especially lonely or sad.

Not being able to do what they used to do in years past can be difficult to handle as an elder may be "stuck" on looking at what they used to do during the holiday season. It can be hard to cope with the reality that a six course dinner for twelve isn't feasible anymore.

For some people, holidays are a source of stress. Falling into the trap of becoming isolated by limitations or leaning on fantasies of how holidays should be can lead to depression and can be avoided.

Elders can anticipate the stressful periods of the holiday by preparing ahead for the people and situations that create stress. Keep in mind that taking care of oneself is a gift to everyone else because everyone ends up having a happier and healthier holiday. Encourage your loved one to take some time this holiday to do a little pampering, give a gift to themself. Treat him or her to a foot bath and massage with nicely scented soap.

Develop new traditions. Space events throughout the holiday season. Take your loved one for a ride to enjoy Christmas lights. Have your parent help wrap presents. Write out Christmas cards together while listening to Christmas music. Watch a favorite Christmas movie together.

While the feeling of the blues may vanish once the holidays are over, it is possible that your loved one is experiencing true depression. Click on the key word "Depression" to go to other posts about depression.

High Blood Pressure is Linked to Dementia

According to a recent study, older adults with high blood pressure may be more likely to develop a type of mild cognitive impairment that can lead to vascular dementia. People with high blood pressure had a 40% greater risk of mild cognitive impairment, and a 70% higher risk of cognitive impairment that does not involve memory difficulties.

People with high blood pressure are at risk for vascular disease which can cause changes in the blood flow to the brain and a higher possibility of stroke. Small, frequent changes to the blood flow to the brain may cause small silent strokes. These small areas of stroke over time cause cumulative changes in the cognitive abilities of the brain.

Vascular dementia is different from Alzheimer's dementia. There are differences in the pattern of cognitive changes. Older adults with Alzheimers disease generally hsve a gradual progressive decline in all areas of brain function, whereas an older adult with vascular changes may have step-wise changes associated with the occurrence of each stroke. There are no hard and fast rules as to the type or severity of cognitive changes in vascular dementia because different areas of the brain are responsible for different cognitive functions.

Although not all strokes result in vascular dementia, as many as a third of the people who have a stroke will experience dementia within six months. Vascular dementia also can occur without a complete blockage of an artery. Portions of the brain can be starved for oxygen and food by reduced blood flow from arteries narrowed by vascular disease. Vascular dementia can also be caused by low blood pressure, brain damage caused by brain hemorrhage, blood vessel damage from such disorders as lupus erythematosus or temporal arteritis.

Other risk factors for vascular dementia include high blood pressure and diabetes. There is no treatment to cure vascular dementia. The best medicine is preventive use of blood pressure medicine and medications to reduce blood sugar if a person has known high blood pressure or diabetes. Healthy lifestyle factors are ultimately the best way to prevent vascular dementia, including daily exercise, maintaining a diet low in saturated fat, high in complex carbohydrates and portion control.

Source: Archives of Neurology

Lung Disease: Reducing the Effects of the Environment on Lung Function

Environmental hygiene, which is reducing air pollution has a strong effect on lung function. Any person with lung disease or at risk for the flu needs to be protected against environmental pollution such as tobacco smoke. Other environmental exposures are also important to control including house dust and pet dander. Indoor environmental exposure increases during the winter months compounding any respiratory illness including the flu.

An approach to lowering the concentrations of indoor air pollutants in your home is to increase the amount of outdoor air coming indoors. Most home heating and cooling systems, including forced air heating systems, do not mechanically bring fresh air into the house. Opening windows and doors, operating window or attic fans, when the weather permits, or running a window air conditioner with the vent control open increases the outdoor ventilation rate. Local bathroom or kitchen fans that exhaust outdoors remove contaminants directly from the room where the fan is located and also increase the outdoor air ventilation rate.

Furnace filters come in many different designs and efficiencies and can be easily installed in your heating system.

Humidifiers can be installed in your heating system to maintain desirable humidity levels, or you can purchase stand-alone units that will serve your needs.

Dehumidifiers also serve a useful purpose. If your basement or other areas of your home have high humidity problems, a dehumidifier can correct these problems and maintain levels between 30 and 50 percent.

Seal off mattress and pillow encasings with zippered casings. Wash bedding frequently in hot water. Remove feather bedding (pillows, down comforters and mattress pads) and replace with products filled with synthetic fibers instead. Use 100% cotton blankets and pillow cases. Wash plush toys in hot water or bag and freeze for 24 hours every couple of days.

Bathe your pet with specialty shampoos at least weekly. Make beds and sofas off limits for animals. Remove carpeting and curtains to prevent dander build up that’s difficult or impossible to remove.

Frailty: Improve Balance

Frailty in your aging parent or loved one can be prevented with regular exercise. If your older relative or friend is reasonably healthy, he or she can begin a regular program of exercise including stretching, weight training, and low impact aerobics, after discussing it with his or her physician. Exercise can help to avoid accidents, improve strength and mobility, lower blood pressure, and help to prevent or control some diseases. If your loved one is frail or ill, you can ask the physician about what exercises may be appropriate.

One of the primary areas of concern in frail older adults is balance. The balance system includes all the senses that tell a person how they are moving, the brain which puts this information together, and the muscles that control movements. People of all ages and abilities need to keep their balance system healthy, and no one is too young or too old to benefit. A healthy balance system helps a person to look and feel good - move freely and confidently, and have more energy and strength. A poor balance system causes a person to move more conservatively and be fearful of normal movement. Decreased mobility leads to more severe balance impairment and more fear of movement. Get the picture?

The complex balance system needs plenty of regular 'practice'. As children we develop good balance by practicing balancing activities - walking along walls, jumping, spinning and climbing. Your older relative or friend may want to begin such an exercise program under a physical therapist’s supervision. Physical therapy, when ordered by a physician, is covered under most health insurance plans. Discuss the potential benefit of phyical therapy with the doctor. The physical therapist can show how to do range of motion, stretching, and strengthening exercises. Over time, these exercises can help to increase strength, balance and ultimately mobility.

The Flu Likes It Cold

The flu killed 36,000 older Americans in 2003. Of all age groups, people over 84 are at the highest risk of dying from flu complications. People over 74 face the second highest risk. Older people and people with chronic illnesses are at the greatest risk of getting complications from the flu, such as pneumonia. The elderly have reduced cough and gag reflexes. Their immune systems are also not as strong.

The New York Times reported today that Mount Sinai School of Medicine has found that the flu virus is so prevalent in winter due to environmental conditions. The flu likes the cold weather. It is more stable and stays in the air longer when air is cold and dry. In test animals, the virus was transmitted best at a low humidity of 20%, and not transmitted at all when the humidity reached 80%. The animals also released viruses nearly 2 days longer at 41 degrees than at room temperature of 68 degrees.

The flu usually spreads from person to person in respiratory droplets when people who are infected cough or sneeze. People occasionally may become infected by touching something with influenza virus on it and then touching their mouth, nose or eyes.

Healthy adults may be able to infect others 1 day before getting symptoms and up to 5days after getting sick. Therefore, it is possible to give someone the flu before you know you are sick as well as while you are sick. To decrease the likelihood of passing the flu on this winter, be sure to wash your hands frequently, cover your mouth with a tissue when coughing or sneezing, and discarding tissues immediately after use.

The flu tends to start suddenly and may include the following symptoms:

Fever (usually high)
Headache
Tiredness (can be extreme)
Cough
Sore throat
Runny or stuffy nose
Body aches
Diarrhea and vomiting (more common among children than adults)
Having these symptoms does not always mean that you have the flu. Many different illnesses, including the common cold, can have similar symptoms.

Treatment for the flu:
Rest
Drink plenty of liquids
Ask your doctor or pharmacist before buying a new over-the-counter cold or flu medicine to make sure they won't interfere with prescribed medicine.

Call the doctor if your loved one or you have:
Trouble breathing
Your symptoms don't improve or get worse after 3 to 4 days.
After feeling a little better, you develop signs of a more serious problem. Some of these signs are a sick-to-your-stomach feeling, vomiting, high fever, shaking chills, chest pain, or coughing with thick, yellow-green mucus.

What Is Causing Weight Loss?

Elderly patients with unintentional weight loss are at higher risk for infection, depression and death. The leading causes of involuntary weight loss are depression, cancer, heart disorders and digestive diseases.

Medications that may cause nausea and vomiting, difficulty swallowing, and anorexia can also cause unexpected weight loss. Multiple medication use, or polypharmacy, and the reduction of medications used in psychiatric disorders are also causes. Unfortunately, in as many as 25% of those with unintentional weight loss there is no identified cause.

In all cases, a visit to the physician are needed to determine unforeseen causes. The doctor will want to complete blood tests, a phydical exam, obtain a stool and a urine sample.

It is important to play close attention to the environment to determine other factors that may play a role. For example, many older adults lose weight due to disinterest in preparing a meal to eat alone. Others may rely on meals on wheels for the daily meal and ration out the contents for other meals. Addressing these issues are important to get to a possible solution such as sharing meal preparation duties and having congregate meals with neighbors. It is also possible that the older adult may think that they ate a sandwich a few hours earlier but was really yesterday. Short term memory loss or early dementia is a frequent culprit behind weight loss.

Once a cause is identified, treatment will be provided to treat the condition. Protein supplements and meal supplements are abundant on the market in both liquid and nutrition bar forms. Many appreciate supplements that have natural taste appeal including milk shakes made with ice cream, and peanut butter on bananas. Occasionally, if a person expresses a real aversion to food, appetite stimulants may help to improve the appetite.

Making the Holidays Less Stressful and More Enjoyable

When you're caring for a family member, the holidays can change dramatically from what they once were. Though initially difficult and emotional, It helps to change your mindset to plan “new” holiday traditions that will help make the holidays happier, less stressful, and preserve family traditions.

Whether you’re going to your aging loved onesí house or they are coming to yours, the holidays are a wonderful opportunity to open the lines of communication and earn more about your family history.

❖ When the group is gathered (at dinner, for example), encourage each person, even the youngest child and non-family members to share their favorite holiday memories. How did they celebrate the holidays as children? What was their favorite gift and why? What was their favorite holiday memory? What was their favorite holiday food?

❖ Take advantage of any opportunity that arises, such as while preparing dinner or wrapping presents. While these stories are fun and informative for the whole family to hear, don’t force a group activity.

❖ Slow down the day. Ask that only one person (including the children) opens a present at a time. It gives everyone the pleasure of seeing the gifts being opened and reduces the activity level which makes the atmosphere feel more relaxed.

❖If your loved one is coming to your home, keep in mind that too much noise, activity, and hustle and bustle can be overwhelming for the elderly. Set aside a “quiet place” where anyone can go to get away from the ctivity. (But make sure that it isn’t a place that will displace others, such as the room with the television.)

❖ Don’t over schedule the day. “Sharing” flows best during the down time.

❖ Prepare as much as you can in advance so you have longer periods of “calm” time.

❖ Put in those safety aids you’ve been thinking about (such as grab bars in the
bathroom and/or lighting in dark hallways and stairs).

If your loved one is coming to your home from an assisted living community or nursing home, in addition to the above, also:

❖ Confirm holiday meal times with the staff so that you can pick up your loved one before the meal has started and return them in time for the evening meal.

❖ Make sure you have all meds and (extra) supplies your loved one will need.

❖ The elderly get cold more easily so suggest they dress in layers and bring an extra sweater. You may also want to have an extra sweater or blanket on hand at your house.

❖ If your loved one has dementia, it’s important to make the atmosphere as relaxed as possible – too much excitement can make them anxious and agitated.

❖ Talk with your other guests – especially siblings about their needs and expectations and negotiate – in advance – any differences around what’s best for your loved one.

❖ Talk with your kids about your loved one’s situation (for example, they may not remember them or may have physical limitations or issues)and coach them on how to handle it.

❖ If your loved one has an aide, decide in advance whether s/he will be needed for the day and make appropriate arrangements.

❖ Allow family and friends to help you. If you don’t get any offers of help, ask for it. Divide up the caregiving duties, clarify the scope of each, and ask each person which one they’d like to take.

If you’re visiting your loved one at the assisted living community or nursing home:

❖ Unless you’re planning to eat with them (and made arrangements in advance),
confirm holiday meal times so your visit doesn’t conflict.

❖ If possible, arrive an hour or two before mealtime so you have an opportune
time to leave.

❖ Try to coordinate schedules if other family members who will also be visiting. You may want to plan the visits at different times so that your loved one has company throughout the day.

❖ If you visit all at once, keep the atmosphere as calm as possible. Sitting literally lowers the energy level so visit in a location with enough chairs for everyone.

❖ If you bring children, talk with them in advance and coach them on appropriate behavior. Depending on your loved one’s condition, you may decide not to bring very young children.

❖ If your loved one hasn’t gotten gifts for the visiting children, you may want to bring a present “from” your loved one for each of the children that they can play with while there.

❖ Whether the children come or not, encourage them to make cards and gifts that can be hung or placed in the room.

Is It Elder Abuse?

Elder abuse is the mistreatment of an elderly person. It may include assault, threats of assault, verbal abuse, financial exploitation, physical and/or emotional neglect, or sexual abuse. Elder abuse is one of the most under-reported problems in the country because victims may be ashamed, unable to report it, or fearful of reprisals if they speak up. Abuse is more likely when the stress level of the individual providing the care is heightened as an older person’s condition worsens.

The following symptoms may be as important clues to, but not necessarily signifying, possible abuse:
• Bruises, burns, or cuts
• Dehydrated or malnourished appearance
• Anxiety, confusion, or withdrawal
• Expressions of shame, embarrassment, and fear
• Poor personal hygiene
• Overmedication or oversedation
• Sudden bank account withdrawals or closings

In most places, either Adult Protective Services (APS), the Area Agency on Aging (AAA), or the county Department of Social Services is designated as the agency to investigate allegations of elder abuse. If the investigators find abuse, they make arrangements for services to help protect the victim. Call the National Eldercare Locator at 800-677-1116 and ask for the county Area Agency on Aging telephone number.
In Berks County, the Office of Aging's phone number is (610) 478-6500. Possible elder abuse can be reported anonymously at 1-866-623-2137.

Effective Ways to Communicate With Someone with Alzheimer's Disease

When someone you love has Alzheimer's Disease, every day communication can be a challenge. Decreased communication abilities does not mean that the person is unaware of their surroudinfgs. Most people with Alzheimer's disease are very aware of the difficulty they are having, especially early on in the disease process. Here are some general tips to help decrease the frustration surrounding communication:

Reality orientation or trying to encourage a person to remember simply do not work. Instead, use memory aids such as labeling objects (i.e. closet, bathroom). Be aware that as Alzheimer’s disease progresses, an individual’s ability to name objects and use words decreases.

When you need their attention, it pays to simplify the environment for the person with Alzheimer’s. Eliminate distracting noises such as the radio or TV, or loud conversation so that he or she can concentrate more effectively.

If you have an intercom system at home, do not use it to communicate with the person with Alzheimer's disease. The patient may be frightened or confused by hearing a voice on the intercom.

Always begin by identifying yourself and calling the person's name. Always approach the person from the front. Maintain good eye contact.

Use short, simple sentences. Speak slowly. Be specific. Use the name of the person or object instead of “this” or “they”.

Keep tone of voice low and pleasant and facial expression warm and friendly.

Use non-verbal cues: a reassuring touch, a smile, a demonstration stating the emotion.

Give the person plenty of time to respond to your question (20 seconds). If you need to repeat what you've said, repeat your question exactly the same way.

Use concrete language. Avoid abstract terms.

Talk in positive terms. Constant use of “no” or commands increases resistance.

Don’t test the patient’s memory. Erase the words, “Don’t you remember?” from your
vocabulary.

Give directions simply and one at a time.

When helping with personal care, tell the patient what you are doing each step of the way.

Add occasional social or reassuring comments to avoid “task-focused talk” only.

Do not appear rushed or tense. The patient will become tense and agitated.

Listen to the patient. Try to find the key thought and take note of the feeling or emotion being expressed along with the spoken word.

Reassure through words. Remind the patient who you are and that you will take care of him.

Sometimes asking a “Why” question can get to the reason behind a repetitive question and decrease its occurrence. (i.e. “Why are you concerned about what time it is?”)

Is Your Parent Over-medicated?

Overmedication and adverse interaction of drugs are a common problem for older people.Older adults may not need the same dose of medication they have taken for many years due to changes in the body. For example, the body rids of many medications through the kidneys, but kidney function decreases with age. The medication dose does not leave the bloodstream at the same rate, so the blood levels can creep upward, resulting in over-medication.

Also, many drugs have interactions with food or other drugs in older people that would not occur in younger persons. And, prescription drugs can interact with over-the-counter medications to create a serious health problem.

Problems with medication can occur because the patient lacks adequate information to make informed choices about their schedule for taking presciption drugs, or over-the-counter medications. Patients do not always receive adequate information about drug interactions, and patients often do not ask enough questions about side effects or interactions which may occur.

Overmedication can occur when several physicians prescribe drugs for a patient, and are unaware of other medications the patient is taking. Problems can also arise when there is no system in place to ensure that medications are taken as prescribed.

Possible side effects of overmedication may include:

Slowed reaction: speech, movement and thought
Sleeplessness
Increased confusion
Unsteady gait
Constipation
Dry mouth
Blurry vision
Increased agitation
Uncontrollable repetitive movement of the tongue, feet, hands and trunk
Hallucinations


If you notice any of these changes, or changes in the overall well-being
of your parent, you may want to suggest that they schedule an appointment with their doctor. In order for this appointment to be successful, your parent should take with them a list of all drugs — prescribed and over-the-counter — they are currently taking.

The pharmacist is also an excellent source of information about drugs and should be consulted as well as the physician. A pharmacist can discuss not only possible interactions and problems with a medication, but suggest strategies for managing medication as well. Your pharmacist can advise you and your parent if a visit to the physician and a review of medication is needed.

ADDITIONAL THINGS YOU CAN DO:

1. Help your parent make a list of prescriptions and over-the-counter medications they are currently taking. Go through their medicine cabinet and kitchen shelves with your parents and throw out all outdated prescriptions and medications.

2. Make sure that they are only getting their prescriptions filled at one pharmacy or, if they are using a mail-away service, that anyone filling their prescriptions has the complete list of medications in their file.

3. Remind them to discuss any new prescriptions with their pharmacist to make sure they understand the possible side effects, possible interactions, and that the pharmacist has added it to their file.

More Than "The Blues"

Depression is a common illness, yet few sufferers are properly diagnosed. This is especially true for the depressed elderly. Many people from the generation of the Great Depression and prior were indoctrinated with the philosophy that you just have "to pull up your boot straps and move on".

Everyone experiences changes in mood, ranging from minor frustrations to the grief that accompanies a major loss. Someone who is clinically diagnosed with depression experiences changes in behavior that interferes with the ability to manage every day activity, feel pleasure, or maintain interest and ability to concentrate is not a simple case of the “blues.” It is an illness that doctors, psychiatrists, psychologists, and other mental health professionals have made great progress in understanding and treating.

Aging itself does not cause depression, but many conditions that occur among the elderly can contribute to its cause. Some of these are:

• Diseases that produce chronic pain, disability, dependence on others to perform routine tasks due to the disabling illness, little social contact with others, and fear

• Some medications, such as steroids and those for the treatment of hypertension, heart disease, and diabetes may have the side effect of depression, although this does not occur for most people

• The loss of friends and family may create a continual mourning process contributing to feelings of loneliness and isolation

• Keeping fears and negative feelings “bottled up,” due to the fact that many parents grew up in an era when expressing these feelings was not acceptable

Depression is usually a treatable illness. Talk with your parent’s or your own physician about your concerns. They can suggest an appropriate professional for diagnosis. Treatment may include counseling sessions, medication, and a supportive family.

Is it Alzheimer's?

Confusion, forgetfulness, and changes in behavior are not normal signs of aging, as many beleive. These symptoms point to possible Alzheimer's Disease.

Although Alzheimer’s affects one in 10 people over the age of 65 and one in two over the age of 85, according to the Alzheimer’s Association, the symptoms are often not recognized until the disease has progressed, sometimes considerably.

Almost half of Alzheimer’s disease patients are first diagnosed in the moderate
to severe stages of the disease. Being able to identify symptoms of the disease is the first step to a timely diagnosis. Although there is no cure, there are medications to help alleviate symptoms associated with the disease.

Treatment needs to start as soon as possible, because the longer the delay in treatment, the less function is maintained. The drugs currently used to treat Alzheimer's Disease are not a cure, but studies point to benefits. Most people treated are able to maintain a higher level of function for longer periods of time. Although decline in abilities to care for oneself and cognitive deterioration is inevitable, medication therapy clearly is beneficial.

If you have noticed any of the following changes in a loved one’s behavior, cognition and daily functioning, consider this an opportunity to address potential signs of Alzheimer’s disease with a doctor. The Alzheimer’s Association recommends that adults be familiar with the symptoms, which include:

✷ Difficulty performing familiar tasks, such as forgetting how to do routine chores, prepare a meal, participate in lifelong hobbies or dress appropriately for the weather.

✷ Disorientation, such as forgetting where the toothbrush was placed the night before or where one lives.

✷ Changes in behavior – as Alzheimer’s progresses, behavior changes, such as
restlessness, sleeplessness, delusions, hallucinations, and pacing back and forth.

✷ Changes in mood – mood swings from calmness to anger and fearful or suspicious thoughts about oneís surroundings may occur.

How to Help a Resistant Parent

Elderly parents who need help are often the ones who resist it the most. It's all too common that they adamantly insist they can still manage their daily lives on their own. But when you see your parents not eating properly, wearing the same clothes every day, failing to take their medication, or letting the garbage pile up excessively, you know you have to intervene. The key of course is to curb your strong insistence on handling their affairs, and to gradually introduce them to the services they need.

Here are tips on how to get help for a resistant parent:

1. If your situation requires immediate attention, contact a geriatric care manager who has the expertise to help your parent accept assistance. A Geriatric Case Manager offers professional consultation and care management to help you make the right decisions in caring for your parent.

2. The elderly usually respect the advice of their doctors. Consult with your parent's physician and ask the doctor to suggest a plan that includes a home health aide to assist with maintaining the health and safety of your parent so that he or she can continue to remain at home. If your loved one needs care after returning home from the hospital, ask both the discharge planner and the doctor to recommend a home health aide as part of recuperation.

3. Work together with your family to encourage your loved one to accept help. If your parent sees you are united in your concern for his well-being and think a home health aide is a good solution, he or she might be more willing to listen and give it a try.

4. Ask your parent's neighbors to help with small tasks like picking up groceries, watering the lawn, shoveling snow, and taking out the garbage. This will show him or her how much more comfortable and less confusing her life would be with even more help inside her home. Point out how overwhelmed he or she gets doing everyday household chores like laundry, cleaning, and preparing meals.

5. If you have a kind and compassionate neighbor, ask her to stop by with a meal every day and chat with your parent. Once he or she sees he can trust the neighbor, it will be easier for him to open his home to other kinds of help.

6. To make sure that your parent is eating right, suggest having meals delivered by meals-on-wheels programs usually run by senior centers and religious organizations. Your parent might be more amenable to meals provided this way, geared to his diet and liking.

7. Usually the elderly are conscious about spending their money and will accept services that cost very little or that are free. Groceries and pharmacies offer free delivery, health clinics, hospitals, and public health departments offer free health screenings and shots, and dentists offer services for the homebound. Learn what is available to your mother in her community so that she will learn to take advantage of and accept all types of help.

8. Don't be afraid to consult with others who also have aging parents resisting help. The ideas that work for them may be valuable to you too.

Keeping a Healthy Home This Winter

In the fall and winter most people spend a lot more time indoors as the temperatures drop and the days get shorter. Unfortunately the environment in our homes may not be as healthy as it should and may in some instances be deadly. EPA studies of human exposure to air pollutants indicate that indoor air levels of many pollutants may be 2-5 times, and occasionally, more than 100 times higher than outdoor levels.

Fortunately there are several simple things that can be done that will help to prevent illness and injury from an unsafe home environment.

Carbon Monoxide
Accidental carbon monoxide poisoning kills hundreds of people every year in their homes. Sources of carbon monoxide are unvented kerosene and gas space heaters; leaking chimneys and furnaces; back-drafting from furnaces, gas water heaters, wood stoves, and fireplaces; gas stoves; automobile exhaust from attached garages; environmental tobacco smoke.

To help prevent carbon monoxide from leaking into your home you should have all gas appliances checked by a professional before use in the fall. Also remember to make sure the flue is open when using the fireplace, use exhaust fans that are vented to the outdoors over gas stoves, used only vented space heaters, use the proper fuel in kerosene space heaters and don't idle your car in the garage.

Asbestos
Asbestos is a very fine mineral fiber that is used mostly in insulation materials. Its danger is that these fibers are so fine they can be inhaled into the lungs where they can accumulate. This accumulation of fibers can cause lung cancer or asbestosis (scaring of the lungs). Although used less widely in building materials there is still a considerable amount to be found in older homes and buildings. The EPA suggests that usually it is best to leave asbestos material that is in good condition alone and to the extent possible, prevent them from being damaged, disturbed, or touched. Periodically inspect for damage or deterioration. Discard damaged or worn asbestos gloves, stovetop pads, or ironing board covers. If there is a need to remove or disturb asbestos materials, be sure to have a professionally trained contractor do the work.

Formaldehyde
Formaldehyde is a colorless, pungent-smelling gas, which can cause watery eyes, burning sensations in the eyes and throat, nausea, and difficulty in breathing in some humans exposed at elevated levels. High concentrations may trigger attacks in people with asthma. There is evidence that some people can develop a sensitivity to formaldehyde.

Sources of formaldehyde in the home include building materials, smoking, household products, and the use of un-vented, fuel-burning appliances, like gas stoves or kerosene space heaters. Formaldehyde is also used in a number of manufactured products. For example, it is used to add permanent-press qualities to clothing and draperies. In the home it is most often found in building materials such as pressed fiberboard (it is found in the adhesives). Formaldehyde emissions will generally decrease as products age. When the products are new, high indoor temperatures or humidity can cause increased release of formaldehyde from these products.

To reduce exposure to formaldehyde emissions you should avoid use of pressed wood products or use exterior grade products, which emit less formaldehyde. You should also maintain a moderate indoor temperature, decrease humidity and have adequate ventilation.

Allergic Reactions
Allergies can cause everything from a runny nose and itchy eyes to an asthma attack. Dust, mold and animal dander are among the biggest causes of allergies. Fortunately these problems are can be easily corrected.

1. Use window coverings and flooring that are easily cleaned and dusted. If you have carpet, vacuum frequently. Damp dust washable surfaces frequently.

2. Remove any water damaged carpeting or wallboard. These damp materials are breeding places for mold and mildew. Re-pot house plants frequently as mold may grow in the soil.

3. Have your heating and air-conditioning ducts cleaned yearly to remove mold that may be growing there.

4. Change your furnace filters every 2-3 months, or consider using a high efficiency air filter system in your heating and air conditioning system.

5. Reduce humidity levels in your home by using a dehumidifier or your air conditioner. Empty the water from dehumidifiers frequently to prevent mold growth.

6. Consider buying an artificial tree as live or recently cut evergreen trees provide a source for outdoor pollutants inclduing molds and pollens to enter the home.

So You've Decided on Home Care Help; Now What?

As discussed in previous posts, accepting a few hours of caregiving help can decrease the stress and burden of care. Once you make the decision, what can you do to prepare for regular caregiver help. Here are suggestions to help you prepare for home health care:

1. Make a list of clearly written emergency phone numbers: police, fire department, ambulance, physicians, dentist, and other health care providers, pharmacist, home and work number of grown children, number of a close neighbor.

2. Make a list of helpful phone numbers: the market, library, repairmen, clergymen, other relatives and grandchildren, friends.

3. Make a list of your loved one's likes and dislikes including food preferences, TV programs, hobbies/activities of interest, outings, and routines.

4. Make a list of all medications and the times they are to be taken. (Note: Home health aides do not administer medications. They can, however, remind patients when to take their medications.)

5. Make a list of what you would like accomplished on a daily basis, such as eating meals, bathing, changing clothes, an exercise regime, getting outdoors.

6. Put a baby monitor next to your loved one's bed or buy a telephone with an intercom so that he can easily call for help.

7. If your loved one needs help moving from bed to chair or to the bathroom, seek recommendations from the home care agency about the appropriate (if needed) equipment that will make home care easier -- electric bed, wheelchairs, walkers, bed rails.

8. Make sure the home health care giver has a place to put her belongings.

9. Make a list of reminders of certain "house rules" such as religious observances, and other concerns you or your parent might have. You can expect that caregivers will never smoke or drink alcohol in your home.

10. Encourage a good relationship between your loved one and the health care giver. Allow the care giver to express her own ways of doing things and her own needs.

Speaking to Someone Who is Speech Impaired

Speech can become impaired as a result of illness such as Stroke, Multiple sclerosis, Parkinson's Disease or head injury. The following suggestions will help both the caregiver and the person being cared for less anxious and frustrated about changes in the ability to communicate.

1. Speak slowly and clearly. Don't raise your voice as hearing has not been affected. Speak in a normal tone of voice.

2. Limit distractions. Sit close to the person in a quiet setting in order to avoid unnecessary strain or frustration.

3. Ask questions so that the answer is either yes or no. For example, instead of saying "what do you want for breakfast"? ask "Would you like cereal today?". If he or she responds with a "no", ask another question to determine choice.

4. Encourage the person receiving care to closely watch the speaker's lips to help pick up clues to what is being said.

5. Ask the speaker to repeat what she said if you did not understand it. It may help if you encourage him or her to speak a little slower so that words are more concise.

6. Limit the time of your conversations so as not to tire the person.

7. Provide paper and pencil if necessary.

8. Demonstrate your willingness to take the time and make the effort to communicate.

9. Provide encouragement for the person to speak.

10. Do not lose your patience.

11. Don't supply words. One of the easiest pitfalls is to try to anticipate the next word the person is going to use and supply it.

12. Don't correct the person's communication attempts. Be accepting of errors, and understand that speech and language will improve with time and proper training. Don't say, "No, that's wrong," but "Let's try that again."

13. Discourage the person from remaining alone all day. When possible, a person should have opportunities to interact with others, in order to see that they can be accepted and can enjoy life despite their speaking difficulties.

14. Speak to a frail elderly person as an adult and not a child. Speaking down to the elderly may create feelings that could lead to frustration and depression, or resentment against you.

15. Give positive reinforcement (verbal and nonverbal) of the person's progress.

When Your Loved One is Hard of Hearing: What to Tell Visiting Family

Hearing loss occurs for a variety of reasons. While it can be a normal part of the aging process, hearing loss frequently occurs due to exposure to noises associated with occupational exposure.

It can be difficult for visiting family members to communicate well with a person who is hearing impaired. Encourage them with these suggestions so that they can have a worthwhile visit:
1. Always be sure to get the person's attention before speaking.
2. Position yourself so that the person can see your face clearly.
3. Speak clearly, slowly, in good lighting, and directly facing the hearing-impaired person.
4. Form words carefully and keep sentences relatively short.
5. Lower the pitch of your voice. Also adjust telephone rings, doorbells, and emergency alarms to a low tone.
6. Avoid unnecessary chatter that may confuse the person. Try to reduce distractions in the immediate environment.
7. Use facial expressions or gestures appropriately to help express yourself. Visual clues are important in helping the hearing-impaired person understand what you say.
8. Check to make sure the person understands what you are saying. Rephrase your message if necessary, and try to give more clues. (For example, instead of saying, "The nurse will be dropping by this afternoon to see you," rephrase as, "Your nurse, Mom, will be coming here at 3 o'clock to check on you.")
9. Avoid chewing gum and placing your hands by your mouth when you speak.
10. Demonstrate your willingness to take the time and energy to communicate with the person.
11. Do not lose your patience.
12. Learn in which ear the person has better hearing and try to speak to that side.
13. Don't shout. Shouting only increases non-intelligible sounds. Increasing the loudness only distorts what the person hears.
14. Do not speak in places where background noise such as traffic or many persons talking at once can interfere with hearing.
15. Don't speak too softly, run words together, or look away from the listener while speaking.

Here are some other don'ts that can interfere with lip-reading:
1. Don't exaggerate.
2. Don't speak too fast.
3. Don't speak in poorly lit areas.
4. Don't speak with something in your mouth - pencil, food, gum, cigarette.

Reduce the Chance of the Flu and Other Illnesses

As the weather gets colder, we spend most of our time inside. Close contact with others increases the chances of getting the flu, colds, and other illnesses. It's important to take preventative measures to reduce the risk of getting the person you are caring for ill, or becoming ill yourself. These recommendations are important for the caregiver AND person requiring care to follow:

Wash your hands and your loved one's hands frequently. It is important to wash thoroughly before working in the kitchen and after handling soiled or contaminated materials and after using the bathroom. Pay attention to cleaning around the nailbeds and underneath nails as these are good places for germs to hang out.

Clean counters, tables and shelves where food is prepared and stored. Food may be contaminated if it is placed on soiled work areas or in unclean containers.

Keep foods covered. Close cartons and replace covers to prevent contamination or infestation by bugs. All perishable foods should be stored in the refrigerator, especially cooked foods.

Dispose of garbage. Drain off liquid before putting it in a paper or plastic-lined pail. Roll or wrap garbage in paper and place outside in large, covered can each day.

Recyclable containers such as tin cans and bottles should be rinsed out to destroy odors and discourage insects and small rodents - such as rats and mice which are great carriers of disease. Wash garbage cans, dirty water pails and trash cans with hot, soapy water.

Clean all areas of the bathroom carefully, especially around the toilet. The warmth and moisture of the bathroom are easy places for germs to grow.

Cover the nose and mouth when coughing or sneezing. Droplets released into the air can spread the flu and cold as a person breathes in the air. If you don't have a tissue, cough or sneeze into your upper sleeve, not your hands.

Put used tissues into the waste basket immediately so that others don't pick them up and use them. Keep a paper bag or waste basket close by to place used tissues in.

Cover open sores or cuts on the fingers or hands with clean bandages and wear disposable gloves. If these sores are slightly infected, serious infection could be transmitted while handling food.

Get at least 7-8 hours of sleep. Rest is a requirement for a healthy immune system which will help you fight off infection.

Eat a well-balanced diet and supplement your diet with a multivitamin with minerals daily to boost your immune system.

Research has also shown that daily exercise will also help your immune system fight off illness.

Storing Medications Safely

Proper storage of medication is important to prevent accidental poisonings and misuse. The following recommendations can assist you in safe medication management for your loved one.

1. Keep medications out reach of children or anyone who might misuse them.

2. Check to see which medications need refrigeration. Make sure they are stored where they will not freeze and where children cannot easily reach them.

3. Store medications away from light and heat, which can effect their chemical composition.

4. Make sure the person taking the medication can read the label clearly.

5. Keep medications in the same place in the medicine cabinet or storage area.

6. Make a schedule for the person taking the medication so that it becomes routine.

7. Dispose of a medication if it has no label, if the label cannot be read clearly, or if the medicine is outdated.

8. Be sure that medications that look like water or soft drinks are labeled so that no one else drinks them.

9. Keep an available list of important telephone numbers of family members, the poison control center, the rescue squad, and the family doctor.

10. Take care of how you dispose of unused or outdated medications in the presence of children and the elderly.

Helping a Loved One With Limited Vision

Fading vision is very common in the elderly, yet many seniors are unaware of the changes in their eyesight. Older people need three times as much light as young people. They have trouble seeing in dim light, and can't readily focus on moving objects or distinguish colors and shapes. The inability to see clearly can lead to a safety hazard. With a few adjustments, a person's daily living can certainly be brighter.

Here are 15 tips on how to help a person with poor eyesight:

1. Brighten the entire living area, especially stairways, hallways, and places where the person reads.

2. Distribute light evenly in all rooms.

3. Put night lights in the bedroom, hallway and bathroom.

4. Put reflector tape on the edges of stairs to make them easier to see.

5. Make sure light switches are at the entrances to all rooms.

6. Install lights that automatically turn on at dusk.

7. Write notes in large dark letters.

8. Suggest a larger television or an easier-to-view black-and-white TV.

9. Buy lubricating eye drops that help prevent dryness, which makes eyes itch and burn.

10. Wear bright colors when you visit.

11. Provide large-print books, newspapers, and magazines.

12. Decrease glare by covering shiny surfaces and adding blinds or shades to windows with bright sunlight.

13. Check to see that certain medications are not the cause of blurred vision.

14. For persons who are unable to enjoy reading on their own, provide books on tape.

15. Provide sunglasses with 100% UV protection to cut down on glare.

When You Meet Resistance to Help at Home

When the time comes for you to realistically consider home health care for loved ones who can no longer safely live on their own, it is normal to meet resistance to the offer of help. The people who need care the most are often resistant to giving up their independence and autonomy, as they perceive it. This is understandable. Rather than arguing, stand back and try to offer appropriate responses that acknowledge how they are feeling and provide suggestions to alleviate their fears.

Here are some suggestions for resistance to home health care you may encounter:

1. When your loved one says, "I don't need any help," point out how overwhelmed she gets doing normal household chores; or how she forgets to renew important prescriptions, or how she has set off the smoke alarm several times in a month, or any other specific examples. Then tell her how much more comfortable and less confusing her life would be with help. Show her that help would enable her to stay in her home as long as possible.

2. When your parent says, "I like things done my way. I'm the only one who knows what to give your father to eat," tell her she can be involved in supervising the health care giver.

3. When your loved one says, "I don't want a stranger in my house," allay her fears by staying over one or two days and by popping in to see how things are at different hours of the day and night when caregivers are scheduled.

4. When your parent says, "I'm not throwing away my savings when I can manage on my own," contact her accountant or financial planner to assure her that she can afford help. Also discuss the fact that the savings were meant for times when help would be needed.

5. When your loved one says, "I won't have any of those people in my house," discuss the matter of prejudice and urge her simply to give the home health care giver a try.

6. When your parent says, "Absolutely no," contact the home care agency and arrange a home visit with another senior who is happy with her care giver. Seeing a positive situation is always good motivation.

7. Encourage your loved one to express her fears and concerns about what is happening.

8. Discuss what would happen if she won't let people help her. Let her experience a day without your help -- no meals, soiled clothing -- so that she sees that she needs regular assistance.

9. Slowly introduce your parent to outside services. For example, arrange to have someone deliver her meals or do her shopping. A kind, compassionate person coming into her home may earn her trust and prepare her to be open to further assistance.

10. If the situation requires immediate attention, consider hiring a geriatric care manager who has the expertise to help your loved one accept assistance.

Home Health Aides: What to Expect

Home Health Aide services provided from a reputable company can be a great help in assisting your loved one maintain their independence at home. There are several standards that you can expect from all reputable service providers. Use these guidelines to evaluate the quality of services provided:

1. Your home health aide should be on time.

2. Your home health aide should provide the proper level of care that you and the agency's nursing supervisor defined in the plan of care.

3. The home health aide works in collaboration with the nurse to notice and report any changes, both physical and emotional, that might indicate the beginning of medical problems.

4. The home health aide should demonstrate respect for your family's values.

5. The home health aide should never use the phone for personal reasons, never borrow or buy anything from you or lend or sell anything to you.

6. The home health aide should be observant and report any safety hazards within the home.

7. The home health aide should be neat, clean, and act in a professional manner.

8. The home health aide should be sensitive to your loved one's needs and concerns.

9. The home health aide should keep her or his work and private life separate.

10. The home health aide should never smoke in your loved one's home.

Avoiding Falls

Falling or fear of falling causes many older adults to put limits on their activity, causing a downward spiral of decreased strength, less balance and deconditioning which leads to an increased risk of falling. There are a number of actions that can be taken to decrease the risk of falling.

Encourage your loved one to:
1. Wear shoes and slippers that have non-slip soles. Avoid wearing socks only - they might cause a slip.

2. Be extra careful if the bathroom floor becomes wet. If the bathroom has handrails, encourage him or her to hold onto them when getting up or down. Make sure non-slip strips are on the bathtub floor.

3. If he or she wears a bathrobe or nightgown, be sure it is short enough to avoid tripping on.

4. Discourage leaving clothes, magazines, bags, or other objects lying around on the floor - they are easy targets to trip over.

5. Place loose electrical cords or telephone wires out of walking areas.

6. Before going to sleep, place glasses within easy reach. Get out of bed or chair slowly, and sit up before standing.

7. Sit in higher chairs or chairs with armrests - they're easier to get in and out of.

8. Remove or secure any loose rugs or mats.

9. Make sure hallways and staircases are well lighted. (If the hallway or staircase in the building is not well lighted, call the superintendent.) When walking up or down stairs, hold onto a handrail or use a cane.

10. Wipe up any kitchen spills as soon as they happen.

11. Place lamps in dark areas. If he or she walks into a dark area, let eyes first adjust to the dark.

12. If he or she do fall, DON'T PANIC! Try using a stable chair or some other piece of furniture to help him or her to get up. Call 911 for help if he or she cannot get up.

Staying Healthy This Winter

Both you and the one you care for can stay healthy this winter with some care attention. Consider the following recommendations:

1. Get your flu shot. The virus that causes the flu changes each year. You may also want to ask your doctor about the pneumonia vaccine.

2. If you or your loved one have asthma, breathing in cold air can cause an asthma attack. To lower this risk, wear a scarf over your mouth to warm the air before you breath it. If you do develop a persistent cough or a fever over 100, call your doctor.

3. Cold weather is hard on arthritis sufferers. If you or your loved one have arthritis in your hands, keep them as warm as possible by wearing mittens or gloves, even if you plan to go out for a short walk. Keep them moving to reduce stiffness!

4. If you or your loved one have heart disease or high blood pressure, do not carry heavy packages, shovel snow or stay outside too long. The extra layers of clothes you need in the cold weather also make your heart work harder. However, exercise is still important during the winter months, so just pace yourself and limit exposure in the cold weather to short periods.

5. Be extra careful of icy sidewalks and streets. Be sure to wear shoes or boots that have rubber treads and do walk slowly. As we age, some of us are at higher risk for fractures, if we have osteoporosis and we fall. Check with your nurse or doctor about your risk of osteoporosis.

6. Be sure to eat well. Food provides the body with energy (from carbohydrates) and heat. Be sure your diet also contains protein daily to prevent your muscles from deteriorating. This will keep you stronger and warmer during the winter months. There are many ways to increase the protein in your diet at low cost. One way is to add non-fat dry milk to hot chocolate mix instead of water. Before you change your diet, talk to your doctor first.

7. You should also drink plenty of water and other beverages to keep your protective layers of skin intact and moist. It is a good idea to eat foods with water in them like soup, fruits and vegetables. Review your dietary restrictions with a nutritionist, your nurse or your doctor.

8. Because the winter air is dry, it can cause nosebleeds. If you have radiators in your home, you can increase the moisture in the air by placing a loaf pan on the radiator filled with clean water daily. Also, a humidifier can help, but be sure to clean it regularly.

9. If you live in a house with a hot-water heater, set the temperature on the hot-water heater to 120 degrees or lower. As people age, their sense of touch declines. The chance of scalding from hot water increases. If you cannot control the hot-water heater, always turn the hot water on last and off first, especially in the shower.

10. To help prevent frostbite when the temperature drops below zero, keep your skin covered and dry. If you think you may be getting frostbite, go indoors immediately. Warm the affected skin. DO NOT RUB to avoid damaging skin tissue. If you can, use warm water (never hot). If the affected skin still doesn't feel better, call your doctor.

Eating Healthy At Any Age

A healthful diet is important at any age. Maintaining a healthful diet helps control diabetes, high blood pressure, high cholesterol, digestion and elimination, and can also strengthen bones. While we all need our daily dose of vitamins, minerals, and nutrients to maintain good health, the elderly need them even more, since, as you age, your metabolism slows and you tend to eat less food. That means that the food you do eat must pack a healthy punch. A diet that includes a variety of foods in moderation is best.

Since some ordinarily healthy foods are contraindicated with certain medications (for instance, don't eat lots of green, leafy vegetables if you are taking Coumadin, a blood thinner), you should always consult with your doctor before changing your diet.

Here are some additional recommendations:
1. Keep your diet low in fat, low in caffeine, and low in alcohol.

2. Eat at least five servings of vegetables and fruits a day. Include dark green vegetables such as broccoli and spinach, and citrus fruits such as oranges and grapefruits.

3. Have two servings of protein a day. Protein is necessary to build and repair skin, hair and muscles. Choose from lean meat, fish, chicken, eggs, and cheese, or from beans, peas, and nuts.

4. Have many servings of bread, rice, cereal, potatoes, and corn to fuel your body and boost your energy, and go easy on cakes, cookies, and other sweets, which have empty calories.

5. Drink plenty of fluids. This will help your digestion and keep your kidneys working well, and prevent you from becoming constipated and dehydrated. Although incontinence may be a problem, it is still very important to have liquids.

6. Add fiber to your diet. Along with fluids, this will aid in digestion. Start moderately, eating from a choice of carrots, potatoes, apples, broccoli, green peas, prunes, bran cereal, corn, grape-nuts cereal, a little at a time each day. Also check the labels on foods for fiber content. About 20 to 35 grams of fiber is a good daily amount.

7. Ask the doctor about taking a multivitamin supplement if it is too difficult to get all the nutrients you need from diet. Older people particularly need the important vitamins B-12, B-6, D, A, E, and folic acid.

8. Eat foods that are rich in calcium to strengthen bones (particularly in aging women). These include nonfat dairy products, dark green leafy vegetables, tofu, salmon, sardines, citrus fruits, and dried beans. Consider taking a calcium supplement of 1,000 to 1,500 milligrams a day.

9. If you have high blood pressure, limit your intake of sodium, mostly found in processed food. Consult your doctor about your sodium intake if you take diuretics or have diarrhea.

10. If you have diabetes, cirrhosis of the liver, or take diuretics, eat fish and other seafood which provide zinc. This mineral helps heal wounds and aids the appetite.

Risks to Spousal Caregivers When Spouse is Ill

When one spouse of a married couple is in the hospital or dies, there is a risk that the other spouse will become ill or die.The level of risk for the caregiver depends on the type of medical condition that the ill spouse has. This study was done by Harvard Medical School. 500 couples age 65 or older were evaluated over a period of nine years. During that time, more than two-thirds of the individuals were hospitalized and more than one-third died. The study was able to evaluate how specific illnesses or diseases affect the caregiver partner.

A wife’s risk of death is 61 percent greater during the first 30 days following the death of her husband. If a wife dies, the husband’s risk of death during the first 30 days increases by 53 percent. Time tends to help people heal. After one year, surviving husbands in the study had a 21 percent increase in the risk of death, and surviving wives had a 17 percent increase.

One of the most significant finding of this study is the serious effect that a spouse’s hospitalization can have on the caregiver spouse. In some cases, the effect of sudden, serious illness is almost as devastating to the caregiver spouse as a death would be. This risk remains elevated for up to two years. The period of greatest risk is within 30 days of a spouse's hospitalization or death.

Researchers have found that caregivers tend to have more of the following:
• Decreased ability to fight illness
• Slower healing rates
• Higher hospitalization rates
• Higher death rates
• Higher incidence of headaches, gastro-intestinal problems and insomnia
• Increased risk of heart disease
• Increased rates of poor general health

The following are examples of psychological effects common to caregivers.
• Depression
• Anxiety disorders
• Stress/ Burden
• Guilt
• Higher incidence of suicide

Emotional signs of caregiver stress and exhaustion include:
• Anger at self and the patient
• Social withdrawal from friends and activities
• Irritability leading to moodiness
• Negative thoughts and reactions
• Inability to concentrate
• Problems at work
• Alcohol and other substance use

Through all this muck is some good news. Research has also clearly shown that access to a good social support network can offset some of the physical, mental and emotional effects some caregivers deal with:
• Seek help for depression or stress. Don’t be afraid to recruit family and friends to help, or join a Caregiver Support Group. The first step is the hardest, but you will be glad you did.
• Call your local Area Agency on Aging. Find out about Respite Programs, Caregiver Care Coordination and other caregiver programs. Take advantage – they are there to help you.
• Inform yourself. Seek out educational resources online or at your local community or senior centers.
• Visit your doctor regularly. Prioritize your health; it is just as important to care for yourself as it is for the one that you love.


You can't take care of your loved one properly without first taking care of yourself.

• Taking Care of Yourself
You, the caregiver, are incredibly important. The welfare of another person depends on you. If you aren't in good health, that other person also may suffer. So, if you've taken on the role of a caregiver, you've also accepted a special responsibility to take care of yourself. That means taking care of yourself physically, emotionally, mentally, spiritually, interpersonally and financially. Listen to your body. Your body will tell you when you are pushing yourself too hard.
• Pay attention to nutrition. Take your vitamins and make a good diet a part of your life.

Daily Renewal
Caregiving takes energy. Spend a little time every day renewing your energy before you become drained; that way you have a reserve to work from.
• Exercise! Try to squeeze it into your schedule, incorporate it into what you already do. Try walking more and see how your energy increases.
• Take time off. It is often easier said than done, but even just an hour can make a world of difference. Use family or community support to make this happen.
• Try relaxation techniques. You can do them anywhere, and they can often give you that extra energy you need. Do breathing exercises, meditate before bed or try aromatherapy. Do what works for you.

Managing Behaviors That Occur in Dementia

Behaviors and psychological symptoms of dementia can be a burden to caregivers and effect the quality of life for both the caregivers and the recipient of care. The key to any behavior is to first understand the behavior and what is driving it. What is the nature and extent of the problem?

What triggers the behaviors?
Noisy rooms
Loud music
Being tired
Need for toileting
Illness
Pain
Change in Routine

The severity of problem behaviors is often evaluated by the risk of harm to the person with dementia or to those caring for him or her. Hitting or kicking would be considered more severe than verbal agitation. Keep in mind that all behavior has meaning. Because a person with dementia cannot think logically, their behavior is more difficult to understand. The person wih dementia is not acting purposefully, they cannot control outbursts or irrational behaviors.

Behaviors have three parts:
1. A trigger: something that causes a response
2. Problem behavior occurs
3. Consequence to behavior

It is helpful to keep a diary to evaluate what is occuring in the environment that may be causing a behavior. Facial expressions and body language may provide some clues. Time of day, a particular activity such as meal time or bathing may trigger a behavior. An activity such as a bath may be well received in the morning when the person with dementia is well-rested, but he or she becomes agitated if the bath is given in the evening when he or she is more tired.

Sleep disturbances are also common with night time awakening and excessive napping during the day. It is important for the person with dementia to get adequate sleep balanced with adequate daytime exercise. Discourage long naps dduring the day and provide regular exercise and activities. If your loved one awakens at night time, keep the lights low, speak softly, provide a light snack, calming music, and perhaps a back rub.

Its also important to evaluate whether or not your loved one is experiencing pain, causing disruptive behaviors. Look for moaning, pacing, grimaces, or increased problem behavior with movement. Speak with the physician to get your loved one appropraite pain relief if this is occurring.

People with dementia find it diffuclt to plan and adapt due to the cognitive changes with dementia. It is extremely helpful to have a consistent routine with few changes from day to day. A change in routine is likely to cause anxiety and an increase in problem behaviors. Schedule personal care activities at the same time every day to avoid needless anxiety.

How to Tell if Caregiving Help is Needed

Have you noticed that your loved one's home is less clean than it once was? Is your loved one's personal appearance clean and neat or does their clothing show signs of repeated wear even though it is soiled? Is your loved one grooming or has he been unshaven for a number of days?

Is there a pile of unopened mail on the table? When you open the refrigerator, do you see only an old piece of cheese and an outdated carton of orange juice?

If these changes are noted, your loved one may be going through some physical or cognitive changes that effect his or her ability to care for him/herself. But the cause of the problem may not always be what it first appears.

For example, you might think that Dad is depressed and losing interest in his appearance. Instead, it could be that his hands have started to shake, making it hard for him to hold his razor steady or to use the iron. You may think that Mom is ill and has lost her appetite, when in fact she just finds the grocery store confusing and difficult to navigate.

These activities are referred to as Activities of Daily Living and can be broken down into two groups:

Instrumental Activities of Daily Living
Ability to Handle Finances
Ability to Travel Independently
Ability to use the telephone
Grocery Shopping
Laundry
Food PreparationHousekeeping
Ability to take medications independently

Activities of Daily Living
Bathing
Dressing
Transferring from bed to chair
Walking
Eating
Toileting
Grooming

Loss of the ability to perform instrumental activities of daily living require consideration to what support an person needs in order to continue to live independently. These are the activities that older adults ask others
for assistance with when their ability to perform them become impaired. These activities are easy to support with the right help available through family, friends, or hired assistance.

Research study reports and experience indicate that older adults with disability on at least one instrumental activity of daily living item are frailer because they had more associated disorders, poorer cognitive function and more frequent falls.

Older people who do not have help for daily tasks such as dressing and bathing are much more likely to be hospitalized for acute illness than older adults who receive the help they need, a Purdue University study indicates, suggesting that reducing health-care costs for older adults may be as simple as providing them with a little household help each day. Older adults who qualify for nursing-home care because of their disabilities in daily tasks can continue to live in their homes provided they receive assistance with fundamental needs such as bathing, dressing and preparing food. Elders who lived alone without such needed assistance were more likely to require hospitalization. After a few weeks of help with daily tasks, however, the need for health care dropped off, implying that a little help with the basics goes a long way.

If a homemaker or personal assistant helps these frail elders for a few hours a day, they would be less likely to experience medical conditions such as hunger, dehydration, falls and skin problems that occur when disabled older adults do not receive needed help with daily tasks.

How to Avoid Medication Errors

It is important to know the medications that your loved one is taking and why they are geing given. Of course, this also applies to medications that you take. Medication errors are the most common form of health care mistakes.

Ask about the purpose of the medication. Ask for written information about it, including its brand name and generic name. Also ask about any side effects.

If you don't recognize a medication, verify that it is being prescribed for your loved one (or you).

If you or your loved one is given an IV, ask the nurse how long it should take for the liquid to run out. Tell the nurse if it doesn't seem to be dripping properly (either too fast or too slow).

Whenever you or your loved one receives a new medication, tell your doctor or pharmacist about any allergies or negative reactions to medications in the past.

If taking multiple medications, ask the doctor or pharmacist if it is safe to take those medications together. This holds true for vitamins, herbal supplements and over the counter drugs too.

Make sure you read the handwriting on any prescriptions written by the doctor, If you can't read it, the pharmacist may not be able to either.

Why Do People With Dementia Wander?

People with Alzheimer's Disease and other dementias wander due to a variety of reasons. If a person is increasingly forgetful, they may start an activity and forget what they were doing and go out to seek to remember. In the middle to later stages of Alzheimer's Disease, a person will regress to an earlier age and go out in search of something from their past, such as a house or relative from childhood.

A person with dementia often experiences hyperactivity & restlessness due to changes within the brain. The hyperactivity will cause a person to wander aimlessly to burn off the extra energy they are experiencing.

It isn't unusual for a person with dementia to become anxious to changes in their surroundings, such as a move to an adult day center or assisted living facility.

When a person with dementia has a lifelong habit such as taking a daily walk, they may become lost after making a turn off of their own street.

How can a caregiver prevent wandering?

Keep a diary. This may pick up on certain events that trigger wandering.

Consider making an area of the garden secure so they can wander safely.

Avoid leaving things in sight that may remind them of wandering, such as hats or coats.

Alert neighbors and caregivers about their wandering.

Ensure they always carry identification for example, an identity bracelet with contact telephone number. The Alzheimer's Association's Safe Return Program can assist when a person with dementia is lost or wanders. Safe Return web link: http://www.alz.org/we_can_help_medicalert_safereturn.asp

Keep a recent photograph preferably in electronic form, to help police if they get lost.

Keep a list of contacts of people who you can called upon quickly to search if the patient becomes lost.

Create visual barriers across exits with mirrors or curtains. This may deter them from leaving.

If a person cannot be dissuaded from leaving, accompany them. It may then be possible to divert them and return home.

Consider door alarms which alert you to doors being opened. The Alzheimer's Store's door alarm link: http://store.nexternal.com/shared/StoreFront/default.asp?CS=ageless&StoreType=BtoC&Count1=518154323&Count2=435294747&CategoryID=2&Target=products.asp

Lock doors. Sometimes the safest thing to do is lock the door and in some cases, relocate door locks. Placing locks above eye level, or down low on the door at ankle level. Ensure doors can still be opened by the caregiver in case of emergency.

Avoid using medication to stop wandering. It may increase confusion and cause other problems such as incontinence.

Tips for Caring for a Loved One with Alzheimer's Disease

People with Alzheimer's disease have a progessive neurological disease. Arguing with them does no good!


"Problem behaviors" are problems for caregivers, but are forms of communication or reactions to stress for the person with Alzheimer's. Ask yourself what occurred to cause the behaviors. People with Alzheimer's Disease respond to physical discomfort, conditions of the environment such as strange noises, or changes in routines.


Physical discomfort - Behavior may be provoked by pain, fever, infections, the need to go to the bathroom, or other discomforts. Evaluate the person and offer relief.


Environmental factors - Behavior may be provoked by a new environment, noise, stimulating light, crowding, or an uncomfortable temperature. Modify the environment, removing the cause. Promote routine and try to keep change to a minimum.


Tasks expected by others - Behavior may be provoked by tasks that are too complicated or by caregivers who crowd or expect too much. Break tasks down into simple steps, give simple directions, and approach quietly and reasonably. And, again, never argue!

Migraines, Restless Leg Syndrome and Depression May Be Associated

Migraines may be associated with Restless Leg Syndrome (RLS), according to results of a study conducted in Germany. The cause may be with a chemical imbalance of dopamine in the brain. The occurence of Restless Leg Syndrome increases to a peak at age 65 years and then decreases. Family history is seen in 50% of patients with Restless Leg Syndrom and family history is also prevalent for patients with migraine. Patients with migraine are three times more likely to have depression. Depression has also been associated with Restless Leg Syndrome.

In this study, patients with migraine and RLS were older and had longer length to each migraine episode. They also had a higher score on depression scales. The authors concluded that there was an association between RLS and migraine and a possible co-association with depression.

Older persons with depression rarely seek treatment for the illness. Unrecognized and untreated depression may result in suicide if untreated. The highest rate of suicide in the US is among older white men.

Symptoms in older persons may differ somewhat from symptoms in other populations. Depression in older people often appears as memory problems, confusion, social withdrawal, loss of appetite, inability to sleep, irritability, and, in some cases, delusions and hallucinations. Older depressed individuals often have severe feelings of sadness, but these feelings frequently are not acknowledged or openly shown. Sometimes, when asked if they are "depressed", the answer from persons suffering from depression is "no".

More older adults are apt to seek treatment for physical ailments than they are with symptoms of depression alone. Restless leg syndrom and migraines may be the reason an individual will seek medical treatment.

As a caregiver, it is helpful to point out the symptoms of depression, if seen, to assist the doctor in prescribing treatment for the entire list of symptoms of migraines, RLS, and depression. Treatment protocols often include a combination of drugs to treat coexisting conditions.

Source : Reuters Health Information

A View of Early Alzheimer's Disease

Sometimes Azheimer's disease is diagnosed after someone has unexpected difficulty with some aspect of a job that had previously been routine. Changes in memory and other changes in cognition can be detected early. Alzheimer's disease can occur in adults as early as age 60.

It is quite possible for the person with Alzheimer's disease to be involved in their own care when the diagnosis is made early. While there is no cure currently for Alzheimer's disease, cholinesterase inhibitors is a class of drugs used to slow the progression of Alzheimer's disease.

This video attached provides a picture of early Alzheimer's disease entitled Mind Matters: Life with Alzheimer's Disease. The video comes courtesy of Healthology. Please visit http://healthology/main/video.aspx?focus_handle=alzheimers-disease&content_id=1734&brand_name=vid_health

Staph at the Gym? Not if You're Careful

With recent outbreaks of MRSA (methicillin-resistant staphylococcus aureus) infections across the country, many are wondering if they can contract the bacterium at the gym. Centers for Disease Control and Prevention officials confirm that the infection can be spread through shared sports equipment or through skin-to-skin contact, but say the risk is low. They advise open sores or cuts be kept covered when working out as a precaution. It is also noted that cases of MRSA in gyms would be hard to track because the germ has a long incubation period.

As Reported by The New York Times

Helping Families Stay Together

Maria Radwanski RN MSN CRRN
Health Calls
867 Berkshire Blvd. Suite 104
Wyomissing, PA 19610
(610) 685-2422

http://www.healthcallshomehealth.com/

Choosing a Personal Emergency Response System

A Personal Emergency Response System (PERS) is an electronic device designed to let you call for help in an emergency. If you are a disabled or an older person living alone, or caring for someone, you may be thinking about buying a PERS .

How a PERS Works
A PERS has three parts: a small radio transmitter (a help button carried or worn by the user); a console connected to the user's telephone; and an emergency response center that monitors calls. When emergency help (medical, fire, or police) is needed, the user presses the help button. It sends a radio signal to the console. The console automatically dials one or more pre-selected emergency telephone numbers. Most PERS are programmed to telephone an emergency response center where the caller is identified. The center will try to determine the nature of the emergency. Center staff also may review your medical history and check to see who should be notified.

If the center cannot contact you or determine whether an emergency exists, it will alert emergency service providers to go to your home. With most systems, the center will monitor the situation until the crisis is resolved.

Purchasing, Renting, or Leasing a PERS
A PERS can be purchased, rented, or leased. Some hospitals and social service agencies may subsidize fees for low-income users. There is usually a one time installation fee and a monthly monitoring charge which may cost from $10 to $45.

Before purchasing, renting, or leasing a system, check the unit for defects. Ask to see the warranty and service contract and get any questions resolved. Ask about the repair policy. Find out how to arrange for a replacement or repair if a malfunction occurs. Ask for information about prices, system features, and services. You can then use the information to comparison shop among other PERS providers.

Shopping Checklist
To help you shop for a PERS that meets your needs, consider the following suggestions:
1. Check out several systems before making a decision.
2. Find out if you can use the system with other response centers. For example, can you use the same system if you move?
3. Ask about the pricing, features, and servicing of each system and compare costs.
4. Make sure the system is easy to use.
5. Test the system to make sure it works from every point in and around your home. Make sure nothing interferes with transmissions.
6. Read your agreement carefully before signing.

Questions to Ask the Response Center
You also may want to ask questions about the response center:
1. Is the monitoring center available 24 hours a day, 7 days a week?
2. What is the average response time?
3. What kind of training does the center staff receive?
4. What procedures does the center use to test systems in your home? How often are tests conducted?

It's time to re-enroll in a Medicare D plan

It's time to re-enroll in Medicare D again. Even if you enrolled in a plan last year, you need to re-evaluate yours or your loved one's plan and re-enroll. Unfortunatley, plans change from year to year, and some plans will be discontinued. To start, go to the web link below:
http://www.medicare.gov/MPDPF/Public/Include/DataSection/Questions/MPDPFIntro.asp?version=default&browser=IE%7C7%7CWinXP&language=English&defaultstatus=0&pagelist=Home&ViewType=Public&PDPYear=2008&MAPDYear=2008&MPDPF%5FMPPF%5FIntegrate=N

Be sure to take your time and read everything you can about the different plans. While a Medicare Advantage plan provides you with a lower cost Medicare health insurance plan through a private company plus the drug plan, the benefits that you enjoyed under traditional Medicare will change. Some plans are offering no monthly premiums, but the plan does not have the same coverage rules as Medicare. Each year, the plan can change its rules, coverage, and premiums.

Each new enrollment affords you the opportunity to disenroll in the plan you had the previous year. However, you must wait until the next enrollment period, typically starting in November each year to change your plan.

Each of the plans vary widely, so it is very important to pay attention to detail when evaluating each plan. In some plans, you can pick your doctors only from the plan's network. In others, you can either choose doctors from in-network, or you can go outside the network. Some of the plans pay only for in-network care, while others will pay for care both in- and out-of-network.

You always have the option of choosing the traditional Medicare plan, but you always should consider enrolling in a Medicare D-only (pharmacy plan). The Medicare D drug benefit offers insurance that will pay some of your drug expenses and will protect you against very high costs. If you have additional drug coverage – from an employer or a state pharmacy assistance program, for example – this will reduce your out-of-pocket expenses more. There is an annual deductible, but the cost to you won't be more than the cap set by Medicare for the year. In 2007, the deductible was capped at $265.

Look for free counselling sessions by your local Office of Aging. Here in Berks County, PA, the Office of Aging and the Berks County Senior Citizens Council provides free seminars through the Apprise program throughout the county. Schedule link:
http://www.berksaging.org/index.html