Caregiver Resource Center

Social Support Activities Lead to Better Quality of Life As One Ages

2011-08-10T11:24:00.000-05:00

How important is social support as a person ages? This may seem like an easy question to answer. Most people would not choose isolation and loneliness versus spending time with companions. However, can lack of social support really hinder a person’s overall quality of life?

Lack of social support is related to negative impacts on health and well being, especially for older people. Having a variety of positive social supports can contribute to psychological and physical wellness of elderly individuals. Support from others can be important in reducing stress, increasing physical health and defeating psychological problems such as depression and anxiety.

When considering who provides social support for an elderly individual our first thoughts are of family members. While it is true that most support does come from family members, there are many circumstances in which family members cannot be supportive (stress due to responsibilities, illness, death, financial problems, job relocation). In the United States the fastest growing age group of individuals are those 85 years and older. Due to this fact, family supports will inevitable decrease for these older individuals. A need for community-based services is more important now then ever before.

Community-based services can be extremely useful for elderly individuals. Services for older persons can encompass many areas, but one of the most important areas as discussed previously is social support. Support for elderly persons can be found in many places including: senior centers, assisted living facilities, meal delivery, religious affiliations, adult day care centers, etc. These services can provide positive social supports that can help older persons defeat loneliness and isolation. However, social support must encompass more then physical presence or conversation. Studies have shown that social support services should contain quality activities. These activities should promote positive self-awareness.

Self-awareness is key to a person’s overall quality of life and satisfaction. Many leisure social activities can be used to help increase an individual’s self-awareness. Activities for elderly individuals may include reminiscence groups, journal writing, readings of favorite book passages, group exercise, singing groups, etc. Individuals may also feel more self-satisfied if they are part of the planning of social activities that take place.

Two of these community-based service centers that provide quality social support services for elderly individuals are discussed below.

Senior Citizen Centers

Today, there are estimated to be about 15,000 senior centers across the United States. Senior centers act as a focal point for older Americans to receive many aging services. The most common services offered at a senior center include health programs (including Zumba and Yoga), arts/humanities activities, intergenerational programs, employment assistance, community action opportunities, transportation services, volunteer opportunities, education opportunities, financial assistance, senior rights counseling/legal services, travel programs and meal programs. These programs and activities can help promote positive self-awareness.

Lori Beckle describes how participating in her local senior citizens center has given her the independence and life satisfaction she thought was lost when her husband died in 2009. “ I was devastated and so frightened for my future without Ed. He was my only friend and the one I turned to when I felt alone. My daughter invited me to attend our local senior center where a bereavement group was being held for those who had lost a loved one. I met Phyllis during the group and now I have a new friend I call when I become afraid. Phyllis has helped me develop the skills to get through the tough times and focus on my immediate happiness.”

Adult Day Care Centers

According to the National Adult Day Services Association (NADSA), there are currently more than 4,600 adult day care centers nationwide. Adult day care is a program in which activities are provided to promote social support and health services to an older adult during the daytime. Most centers operate Monday through Friday during daytime hours. Social support services at an adult day care can consist of musical entertainment and singing groups, group games such as cards, gentle exercise, discussion groups (books, films, current events), holiday/birthday celebrations and local outings. Not only are these social activities provided, but participants of the program can also develop lasting relationships with staff and other participants. Adult day care centers also provide meals and health services. Adult day care centers differ from other programs for elderly individuals, because they allow the participants to develop and increase self-awareness by encouraging independence.

Amanda describes her experience as a volunteer at her local adult day care center. She stated, “ I was involved in planning the activities for Thursday afternoons. I wasn’t sure what kind of activities my older friends would enjoy so I had them share their favorite activities they participated in when they were my age (23). I soon realized that I was hearing the most fascinating stories of hopping trains, college dances, swimming in the lake, etc We decided Thursday afternoons would be spotlights of each individuals’ lives as a twenty-something. One of the participants told me that Thursdays became a highlight for her week.”

Adult Day Care Centers and Senior Citizen Centers help to provide an elderly individual the opportunity to participate in social support activities. Social support activities found in these programs can be beneficial to a person’s quality of life and overall satisfaction. With a higher self-awareness and quality of life an individual can reduce the risks of mental and physical health problems as they age.

Why are we never “ready for that” product or service until it’s too late? Start conversations BEFORE a need is apparent. What questions are you going to ask today?

2011-07-01T14:52:00.001-05:00

Susan Estrada sells tech items. She shares her real-time experience at the San Diego Country Fair. She sells products that are meant for both the young and old which accomodate for a special need. For example, she had a med-e-lert medication dispenser, a talking clock, an ezRead Visual Aide Magnifier as well as less techie items like a spork at her booth.

After seeing literally thousands of people pass the booth, she made some interesting observations. Thirty-five to 59 year-old men were interested in anything techie. Women controlled the money, so if these men wanted to buy anything, they went looking for the female with the pocketbook. Multi-generational family groups with a physically-impaired elder family member didn’t even stop to look. The identified caregiver of the family didn’t stop even though she looked interested. These observations are right in line with market analyses of sales trends.

Why are we never “ready for that” product or service until it’s too late?

Families are afraid of upsetting the apple cart. Dr. Linda Rhodes, gerontologist and author of Should Mom Be Left Home Alone? Should Dad Be Driving? suggests starting conversations much earlier, long before a need is apparent.

Some "What if Scenarios" to review with a loved one to plan ahead include:

• IF you have a stroke or break a hip, what rehab or nursing home facility would you like to go to for recuperation?

• IF you're sick and need home health care, what agency should be called?

• IF it's not safe for you to live alone, what assisted living facility should we visit?

• IF you can't get around and do for yourself but can still stay at home, what kind of services do you want to help you with daily living?

Some TO DO suggestions include:

• Create a "Rainy Day Folder" that places all of your directives in one place and share a copy with family members.

• Fill out a Living Will so everyone will know what you want regarding any end-of-life decisions

• Make a list of all your physicians and identify the hospital of your choice in the event of an emergency

• Choose a Durable Health Care Power of Attorney so a trusted loved one can make health care decisions when you're too sick to make them

Dr. Rhodes warns, "Plan for the unexpected and share your plans with family members, NOW. Unplanned decisions are uninformed decisions, and in the heat of a crisis, they are rarely in anyone's best interest."

What questions are you going to ask today?

Heat-related Illnesses: What You Need to Know Now

2011-06-08T15:45:00.000-05:00

Have you been outside today? The summer days are upon us, and as the days get hotter it is important to remember the risks heat exposure poses to some of the most vulnerable members of our community: infants and seniors. Seniors, in particular, are at a risk for heat exhaustion and heat stroke, two related but very different illnesses that can develop from exposure to high temperatures and lack of fluids.

A Look at Heat Exhaustion
Heat exhaustion is a milder form of heat stroke, and though not as fatal it can easily lead to heat stroke if not treated immediately. Those who are at most risk for heat exhaustion are seniors, people with high blood pressure, and those who work outdoors or exercise in the heat. It is important to stay hydrated and out of the heat in these months of the year, and symptoms can be hard to notice at first.

Symptoms of heat exhaustion include:
• Heavy sweating
• Pale skin
• Muscle cramps
• Tiredness
• Weak
• Dizzy
• Headache
• Nausea/vomiting
• Fainting
• Skin that is cool and moist to the touch
• Fast and shallow breathing
• Drowsiness

What To Do If You See the Signs
If you or someone you are with is suffering from any of the symptoms of heat exhaustion it is critical to begin treatment immediately so it does not progress to heat stroke, a true medical emergency. To begin treatment, immediately begin to cool the victim down using any combination of these methods provided by the Centers for Disease Control:
• Cool shower or bath, even spray with a garden hose if you are outdoors and cannot make it inside.
• Rest in an air conditioned environment.
• Lightweight clothing.
• Cool, nonalcoholic and non-caffeinated beverages (alcohol and caffeine can promote dehydration). If the symptoms get worse, or last longer than one hour, it is essential that you seek medical attention.

Investigating Heat Stroke
Heat stroke is the next progression in heat exhaustion if it is left untreated, and requires emergency medical attention. In its worst cases, the victim can suffer from permanent organ damage or even death. It is a form of hyperthermia, which is a raised body temperature that can severely impact your health permanently. Though our bodies generally can dissipate heat by radiation through the skin, or sweating, when extreme heat conditions occur, the body may not be able to cool itself down well enough or fast enough causing the stroke. Additionally, someone who is dehydrated may not be able to sweat fast enough or cool down quickly, which can cause their body temperature to rise too high as well. Those with heart, lung and kidney disease, as well as those taking medications that can cause them to be vulnerable to heat strokes, are at a greater risk.

Symptoms of heat stroke, though similar to heat exhaustion, are more severe, and are both physical and neurological. Physically, the victim can suffer symptoms similar to a heart attack, and typically the following are noticed: nausea, vomiting, fatigue, weakness, headache, muscle cramps, difficulty breathing, absence of sweating-hot red or flushed dry skin, and rapid pulse. Neurological signs include: confusion, agitation, hallucinations, and strange behaviors.

If you notice someone exhibiting these signs, immediately call 911 and begin to cool the victim down. Many of the same cooling methods for heat exhaustion work well, in addition to fanning the victim to promote sweating, and monitoring their body temperature with a thermometer until the body temperature drops to 101-102 degrees and use any and all cooling methods until medical help has arrived. Always remember that prevention is the key.

Avoiding heat exhaustion and heat stroke is crucial when temperatures rise.
• The most important measures to prevent heat strokes are to avoid becoming dehydrated and to avoid vigorous physical activities in hot and humid weather.
• If you have to perform physical activities in hot weather, drink plenty of fluids (such as water and sports drinks), but avoid alcohol, caffeine and tea, which may lead to dehydration.
• Your body will need to replace important chemicals (such as sodium) as well as fluids if you sweat excessively or perform vigorous activity in the sunlight for prolonged periods.
• Take frequent breaks to hydrate yourself. Wear hats and light-colored, lightweight, loose clothes.

Know Your Rights About Health Care

2011-06-03T14:00:00.005-05:00

Did you know there is a Patient Bill of Rights? The Patient Bill of Rights that was adopted by the U.S. Advisory Commission on Consumer Protection and Quality in the Health Care Industry in 1998. Virtually any organization that provide services and bill Medicare and Medical Assistance are required to inform patients of these rights when they start providing services to the individual.

So what does the Patient Bill of Rights say?

Information Disclosure: You have the right to accurate and easily-understood information about your health plan, health care professionals, and health care facilities. If you speak another language, have a physical or mental disability, or just don’t understand something, help should be provided so you can make informed health care decisions.

Choice of Providers and Plans: You have the right to a choice of health care providers who can give you high-quality health care when you need it.

Access to Emergency Services: If you have severe pain, an injury, or sudden illness that makes you believe that your health is in serious danger, you have the right to be screened and stabilized using emergency services. These services should be provided whenever and wherever you need them, without the need to wait for authorization and without any financial penalty.

Participation in Treatment Decisions: You have the right to know your treatment options and to take part in decisions about your care. Parents, guardians, family members, or others that you select can represent you if you cannot make your own decisions.

Respect and Non-discrimination: You have a right to considerate, respectful care from your doctors, health plan representatives, and other health care providers that does not discriminate against you.

Confidentiality of Health Information: You have the right to talk privately with health care providers and to have your health care information protected. You also have the right to read and copy your own medical record. You have the right to ask that your doctor change your record if it is not accurate, relevant, or complete.

Complaints and Appeals: You have the right to a fair, fast, and objective review of any complaint you have against your health plan, doctors, hospitals or other health care personnel. This includes complaints about waiting times, operating hours, the actions of health care personnel, and the adequacy of health care facilities.

Some practical advice to assure that you are adequately informed:

Speak up if you have questions or concerns, ot if you don't understand information provided to you. It's your or your loved one's body and you have a right to know.

Pay attention to the care you or your loved one is receiving. Makre sure you/they are getting the right treatments and medications. Don't assume anything.

Make sure staff providing care are introducing themselves and you know what their credentials are.

Notice whether or not the staff is washing their hands. Hand washing is the most important way to prevent the spread of infections. Don't be afraid to gently remind the caregiver.

Makre sure the health care professional confirms your/ your loved one's identity before giving medications or treatments.

Educate yourself about the diagnosis, services provided and the care plan. Gather information. Write down important information the doctor tells you and ask if the doctor has any written information you can take with you to look at later.

Thoruoghly read all forms and make sure you understand them before you sign anything. If you don't understand something, ask for a better explanation.

Make sure you understand how to use any equipment that is being used.

Know the medications and why they are prescribed. Ask about the purpose and ask for written information which can be provided by the pharmacy. Know both the brand and generic names of the medications. Know the possible side effects to watch out for.

Whenever a new medication is prescribed, tell the doctor about any allergies and other medications prescribed to be sure that it is safe to also take the new medication.

Ask for a list of providers for services recommended. The hospital or nursing facility should not automatically assign providers for on-going care. You get to choose who you want for continuing care needs.

TRANSITIONS Reduces Re-hospitalization

2011-05-27T12:00:00.000-05:00

Hospitals are dangerous places for patients due to frequent medical errors. Almost 25% of all patients have an adverse event related to processes typically used to discharge a person home. A new program is helping avoid problems associated with discharge. This innovative program includes a predischarge history and physical tailored to the special needs of geriatric patients, with emphasis placed on communication and teamwork among providers from different disciplines, a detailed medication review with a pharmacist, and a predischarge meeting among the patient, the patient's caregiver, and a clinician. The program was tested in general medicine wards run by hospitalists at 3 hospital centers in different states. At 3 days postdischarge, 88% of the study group described their health as better than it was before their hospital stay compared with 79% of those who did not have this process used as part of the discharge planning process. Improving the transition from hospital to home with more information and better communication about care needs after discharge to home improves overall health. While this process is not used in all facilities at this time, Health Calls is implementing these services to assist patients In the transition to home. There are things that you can do to help your loved one in the hospital:

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

Reducing Medical Stroke Risks

2011-05-19T16:00:00.002-05:00

May is National Stroke Awareness Month. The National Stroke Organizations has published the following guidelines.

Medical stroke risk factors include:
Previous stroke, previous episode of TIA or mini stroke, high cholesterol, high blood pressure, heart disease, atrial fibrillation and carotid artery disease. These medical risk factors can be controlled and managed even if you have already had issues with any of them in the past. Talk with your doctor about what will work best for you.

Lifestyle stroke risk factors include:
Smoking, being overweight and drinking too much alcohol. You can control these lifestyle risk factors by quitting smoking, exercising regularly, watching what and how much you eat and limiting alcohol consumption.

Public Stroke Prevention Guidelines
1. Know your blood pressure. If it is elevated, work with your doctor to keep it under control. High blood pressure is a leading cause of stroke. Have your blood pressure checked at least once each year—more often if you have a history of high blood pressure.

2. Find out if you have atrial fibrillation (AF). If you have AF, work with your doctor to manage it. Atrial fibrillation can cause blood to collect in the chambers of your heart. This blood can form clots and cause a stroke. Your doctor can detect AF by carefully checking your pulse.

3. If you smoke, stop. Smoking doubles the risk for stroke. If you stop smoking today, your risk for stroke will begin to decrease.

4. If you drink alcohol, do so in moderation. Drinking a glass of wine or beer or one drink each day may lower your risk for stroke (provided that there is no other medical reason you should avoid alcohol). Remember that alcohol is a drug - it can interact with other drugs you are taking, and alcohol is harmful if taken in large doses. If you don’t drink, don’t start.

5. Know your cholesterol number. If it is high, work with your doctor to control it. Lowering your cholesterol may reduce your stroke risk. High cholesterol can also indirectly increase stroke risk by putting you at greater risk of heart disease - an important stroke risk factor. Often times, high cholesterol can be controlled with diet and exercise; some individuals may require medication.

6. Control your diabetes. If you are diabetic, follow your doctor’s recommendations carefully because diabetes puts you at an increased risk for stroke. Your doctor can prescribe a nutrition program, lifestyle changes and medicine that can help control your diabetes.

7. Include exercise in the activities you enjoy in your daily routine. A brisk walk, swim or other exercise activity for as little as 30 minutes a day can improve your health in many ways, and may reduce your risk for stroke.

8. Enjoy a lower sodium (salt), lower fat diet. By cutting down on sodium and fat in your diet, you may be able to lower your blood pressure and, most importantly, lower your risk for stroke.

9. Ask your doctor if you have circulation problems. If so, work with your doctor to control them. Fatty deposits can block arteries that carry blood from your heart to your brain. Sickle cell disease, severe anemia, or other diseases can cause stroke if left untreated.

10.If you have any stroke symptoms, seek immediate medical attention.

National Stroke Awareness Month: Guidelines to Recognize and Act Quickly Can Reduce Symptoms

2011-05-16T16:00:00.001-05:00

May is Stroke Awareness Month. The following guidelines are Published by the National Stroke Association.

Stroke 101
• Stroke is a brain attack, cutting off vital blood flow and oxygen to the brain.
• In the United States, stroke is the third leading cause of death, killing about 137,000 people each year, and a leading cause of serious, long-term adult disability.
• From 1996 to 2006, the stroke death rate fell 33.5 percent and the actual number of stroke deaths fell by 18 percent.
• Approximately 795,000 strokes will occur this year.
• Stroke can happen to anyone at any time, regardless of race, sex or age.
• Approximately 55,000 more women than men have a stroke each year.
• Men’s stroke incidence rates are greater than women’s at younger ages, but not older ages.
• African Americans have almost twice the risk of first-ever stroke compared with whites.
• Types of Stroke:
o Ischemic stroke occurs when arteries are blocked by blood clots or by the gradual build-up of plaque and other fatty deposits. About 87 percent of all strokes are ischemic.
o Hemorrhagic stroke occurs when a blood vessel in the brain breaks leaking blood into the brain. Hemorrhagic strokes account for thirteen percent of all strokes, yet are responsible for more than thirty percent of all stroke deaths.
• Two million brain cells die every minute during stroke, increasing risk of permanent brain damage, disability or death. Recognizing symptoms and acting fast to get medical attention can save a life and limit disabilities.
• The prevalence of transient ischemic attacks (TIA) increases with age. Up to 40 percent of all people who suffer a TIA will go on to experience a stroke.
• The estimated direct and indirect cost of stroke for 2010 is $73.7 billion.

Stroke Strikes Fast. You Should Too. Call 9-1-1.
Few Americans know the symptoms of stroke. Learning them—and acting FAST when they occur—could save your life or the life of a loved one. Remember that: Stroke Strikes Fast. You Should too. Call 9-1-1.

Common stroke symptoms include:
• Sudden numbness or weakness of the face, arm or leg – especially on one side of the body,
• Sudden confusion, trouble speaking or understanding,
• Sudden trouble seeing in one or both eyes,
• Sudden trouble walking, dizziness, loss of balance or coordination,
• Sudden severe headache with no known cause.

Use the F.A.S.T. test for recognizing and responding to stroke symptoms:

F = FACE Ask the person to smile. Does one side of the face droop?

A = ARMS Ask the person to raise both arms. Does one arm drift downward?

S = SPEECH Ask the person to repeat a simple sentence. Does the speech sound slurred or strange?

T = TIME If you observe any of these signs, it’s time to call 9-1-1 or get to the nearest stroke center or hospital.

Regional Philly Forum Offers Straight Talk on Lupus - May 17

2011-05-13T19:00:00.002-05:00

Lupus is a challenging disease that often leaves patients feeling alone and misunderstood, challenging to recognize, diagnose and treat. This chronic autoimmune disorder can affect many organs, including the skin, brain, joints, and other internal organs. Symptoms vary widely, wax and wane and often mimic other conditions. Since the disease manifests itself in numerous different ways, patients often are misunderstood at home and in the workplace.

While many patients might not “look” sick, they may be silently managing the debilitating pain, fatigue and other symptoms associated with lupus. This can lead to a lack of understanding from friends, family members and even physicians. Lupus can be challenging to recognize, diagnose and treat. The chronic autoimmune disorder can affect many organs, including the skin, brain, joints, and other internal organs. Symptoms vary widely, wax and wane and often mimic other conditions. Background materials about the disease are available on the recently launched “the us in lupus” website at www.usinlupus.com.

Doctors and patient ambassadors from “the us in lupus” community at www.usinlupus.com are traveling to cities across the country to offer support, information, and tips for people living with the chronic autoimmune disorder and their caregivers, family and friends.

Two such advocates, Dr. Daniel Kirby and Rena Baldwin, will visit Philadelphia during Lupus Awareness Month in May to help lupus patients discuss their challenging disease – and to help forge new understanding among patients and their caregivers, family and friends.

WHEN
Tuesday, May 17, 2011
Registration: 6:30 p.m.
Program start: 7:00 p.m.

WHERE
Crowne Plaza Philadelphia/ Valley Forge
260 Mall Boulevard
King of Prussia, PA 19406

INFORMATION
To register or learn more about this event log on to www.usinlupus.com or call 1-855-874-6587 to register.

These forums are sponsored by Human Genome Sciences and GlaxoSmithKline.

Ways You Can Help Your Family Prevent Medical Errors

2011-05-10T19:00:00.002-05:00

About one in three people in the United States will encounter some kind of mistake during a hospital stay, according to a recent study reported in April. This finding is about 10 times higher than estimates using older methods. Adverse reactions to medications account for nearly 1.1 million emergency department visits annually by elderly patients alone. 33% of these patients end up being hospitalized for further treatment.

Much more work is needed to improve health care quality. Medical errors are mistakes, when something happens with your health care that doesn't work out or when the wrong plan was used. Medical errors can hurt or even kill people. Many, including doctors, hospitals, nurses, and others are working hard on initiatives to prevent medical errors. These can be medicine errors, mistakes with surgery, tests, diagnosis, equipment, lab reports and other aspects of health care delivery. They can happen during even the most routine tasks such as when a hospital patient on a salt free diet is given an high-salt meal.

You can protect yourself and your family from medical errors.
1. The single most important way you can help to prevent errors is to be an active member of your health care team. Talk to you doctor, nurse and other health care workers. Tell them important information about your health. Ask them questions. Make decisions about your health care with them.
2. Make sure that you receive the right medicine. Bring your medicines with you to all doctor appointments or at least a correct current list of your medicines which includes the dose and frequency that you take them. Include on your list medicines that you may buy over the counter including aspirin, cold medicine, vitamins, and herbs. This will help your doctor make sure that your new medicine does not cause problems with the ones that you are already taking. Tell your doctor if you have any allergies. Also tell about any problems your medicines have caused, such as a rash or a stomach ache. When your doctor gives you a prescription, look at the writing. Is it easy to read? If you can't make out the letters, the drugstore may not be able to either. When you pick up your medicine at the drugstore, make sure it is what the doctor ordered. Ask questions before you leave the drugstore. If you receive the wrong medicine from the drugstore, ask about it.
3. Make sure you follow the right schedule and take the right amount of medicine. Ask your doctor: "What time of day should I take this medicine?"; "do I need to take this medicine with food?'; "How much should I take each time?". Make sure you know how to measure your liquid medicine. The label may say teaspoon but do not use the teaspoon you eat with to measure your medicine. These do not hold the right amount. Use a special measuring tool designed to accurately measure the amount. These are available for purchase at the pharmacy.
4. Errors made in procedures performed by health care workers can make you sick. Illness can spread when health care workers don't wash their hands and apply gloves. It is okay to ask anyone who touches you whether they have washed their hands. Some foods can make you ill. Know what foods your doctor doesn't want you to eat.For example, people with heart failure can not have salt in their food, and diabetics receiving a meal with lots of carbohydrates or sugar can become sicker.
5. Make sure that your doctor operates on the right part of your body. Talk to your doctor about the surgery. Ask what will be done. Be sure your surgeon makes a mark with a pen before the surgery on the part of your body where the surgery will happen just prior to the surgery, while you are still awake.
6. When you are discharged from the hospital, ask your doctor to explain the treatment plan you will use at home. This includes learning about your medicines and finding out when you can go back to your regular activities. Research shows that doctors think their patients understand more than they really do about what they should or should not do when they return home.
7. Make sure that those caring for you have all the important health information about you. Do not assume that everyone knows everything they need to know.
8. Ask a family member or friend to be there for you and to be your advocate. Having someone who can help get things done and speak up for you if you can't is important. Even if you think you don't need help now, you might need it later when you are groggy and sedated after surgery, or not able to think clearly if you aren't feeling well.
9. Know that more is not always better. It is a good idea to find out why a test or treatment is needed and how it can help you. You could be better off without it.
10. If you have a test, don't assume that no news is good news. Ask about the results.

Doctors and nurses, other healthcare providers want to offer safe care. They learned to do "no harm" in their training. In spite of that, defects in the health care delivery system result in errors. Teamwork among everyone, including patients, is essential.

5 Tips for Getting the Most of Your Doctor’s Visits When You or a Loved One Is A Patient in the Hospital

2011-05-01T08:00:00.002-05:00

You may recognize this common scene that occurs in room after room on any floor in any hospital. A patient has had tests or is waiting to have tests. A doctor has been in to review the findings and has a plan. Or the patient is waiting to see the doctor. In either case, once the doctor leaves, the patient and their loved ones don’t always have a clear sense of what the next step or plan is. I have seen families write notes on the back side of a discarded breakfast menu so that they can be sure that they ask a follow-up question of the doctor the next time he or she visits. Then of course, the family waits until the next visit which may be 24 hours later.
I have been on both sides of this scene. I have been there as a clinician coaching the family to help them understand and interpret what they have heard and then as a daughter anxiously waiting to hear the results of the test and waiting all day with the hope of getting a 2 minute conversation with the doctor.
I recently read an observation that people ask more questions when buying a cell phone than they ask their doctors. Your health and your loved one’s health are more valuable then any cell phone! Use these tips to get the most information to make an impact on the quality of the care your loved one receives in the hospital.
1. Get a spiral bound notebook. Family members are often at a loss as to what to bring in as a gift for someone in the hospital. Use a spiral bound notebook to jot notes down listing details from the hospital staff providing information.
2. Ask more questions, get involved. When you ask questions you get answers that can help you make better decisions and get better quality care. Read that last part again: better quality care. People who are more involved in their health care management receive better quality care. Questions usually don’t appear to you until after the doctor has left the room. Write down all your questions. Remember, there is no dumb question, especially when it comes to your health. Write down the answers offered to you by the doctor to help you remember and sift the information as you think about it later.
3. Ask what all the options are for treatment. There are at least three treatment options for most conditions: a conservative approach, the usual treatment, and more aggressive treatments. Not all treatments may be available to you in the current hospital setting. It’s good to ask anyway. Newer or more aggressive treatment options may not be available in the hospital you are in. Find out where you may go to receive more aggressive treatment if needed.
4. Ask what would happen if you don’t follow the recommended treatment. There are many people who don’t agree with the treatment approach that the doctor has recommended but never tell him/her. Treatment may be started in the hospital, but most often, treatment needs to continue after you leave the hospital. Are you going to realistically follow through with the treatment plan? If you don’t think that is possible, or you know that your loved one will forget or won’t have ability to leave home to get treatment, discuss that with the doctor now so an alternative can be arranged. For example, if the patient is going to need to have therapy and the doctor wants the patient to go to an outpatient clinic but you need to return to work and the patient cannot drive, explain this. Home Health Care is a possible solution in this case. Most of the time, alternatives are available.
5. Ask what follow-up will be required. Follow-up doctor visits, lab work, additional tests, treatments often follow after a hospital stay. Unfortunately, 1 in 5 patients end up being re-hospitalized within thirty days of a hospital stay. Why? Lack of follow-up with a timely doctor office visit and medication confusion and/or mismanagement are the most frequent causes. Leaving the hospital is often a flurry of activity and a lot can get lost or missed in the confusion. Pay attention to discharge instructions provided both verbally and written prior to leaving the hospital. Keep the instructions in a safe, deliberate place, like the spiral bound notebook until you get home and settled. Then, pull out the instructions again and read them carefully. Most of the time, the medications have been listed, follow-up treatments or tests and instructions to call the doctor’s office have been listed. Now is the time to follow through with the instructions. Getting settled can be difficult and these details are often overlooked and result in deteriorating health and re-hospitalization if not promptly taken care of.

Difficulty Understanding Basic Health Information May Lead to Higher Risk For Death

2011-04-22T19:23:00.001-05:00

Health literacy is a person's ability to understand instructions on prescription drug bottles, appointment slips, medical education brochures, doctor's directions and consent forms, and the ability to negotiate complex health care systems. Health literacy is not simply the ability to read. It requires a complex group of skills including reading, writing, and reasoning to understand concepts inorder to make health behavior decisions.

Medication bottles collected in medicine cabinets across the country simply read: "Take as directed". For those adults who have limited health literacy, or are limited in their ability to make sound health care decisions, this has little meaning. Take Charlie, for example,who has bronchitis and has been taking a swig from that cough medicine the doctor prescribed that has codeine in it. His caregiver discovered he was drinking from the bottle after she found him on the floor in his kitchen. He had been drinking the medicine staight from the bottle without measuring the amount every 2 or 3 hours. If a little is good for you, more is better, right?

More than 75 million English-speaking Americans have limitations in their ability to make health care decisions. Health literacy can be improved. Patient teaching handouts, medical forms, and health web sites make it easier to understand and improve patient-provider communication.However, the most important strategy for people with limited health literacy is to have a person with them to advocate for them at doctor appointments, during short procedures and especially while in the hospital.

What is your biggest concern for someone you love with limited health care literacy who requires health care?

Cooking for the Person With Diabetes

2010-12-29T15:53:00.003-05:00

The way you cook for a person with diabetes is the way you should cook for the whole family. By cutting down the fat, sugar, and sodium in recipes, you lower everyone’s risk for diabetes and other chronic diseases.

Use of Sugar and Artificial Sweeteners
In some recipes, sugar can be safely cut by 1/4 to 1/3. Cookies and cakes may not turn out as well when all of the sugar is eliminated.
Artificial sweeteners work best in foods that do not need sugar for color, texture, or moistness.
For the best recipes made with less sugar or an artificial sweetener, use a good diabetic cookbook or recipes from companies that make artificial sweeteners.
You can substitute small amounts of sugar for other carbohydrates in the diet. But use foods high in sugar very seldom, as they only have empty calories.

Cutting the Fat and Sodium
Eat very little fried food.
Bake, broil, grill, boil, poach, and roast.
Trim all meat well. Remove skin and fat from poultry.
Season vegetables with fat-free, low-sodium broth rather than fatback, margarine, oil, or butter.
Cook in a nonstick pan or skillet.
Use a nonstick vegetable spray on pots and pans.
Switch to reduced-fat tub or liquid margarine.
Sprinkle on lemon juice, herbs, and spices instead of salt or fat for flavor.
Use reduced-fat and fat-free foods carefully. Some are high in calories from sugar or other carbohydrates. Many are also high in sodium.
Eat more low-calorie vegetables instead of large portions of meat, poultry, or fish.
Have fruit for dessert.
Use nonfat or reduced-fat milk, cheese, and sour cream.
Use reduced-fat salad dressing and mayonnaise, or cut regular dressing in half with plain nonfat yogurt.
Cut the fat or oil in a recipe by 1/4 to 1/2.

Is It Memory Loss?

2009-11-02T06:51:00.003-05:00

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

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

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

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

2009-04-30T11:20:00.002-05:00

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

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

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

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

A Season for Sadness?

2008-12-02T09:44:00.003-05:00

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

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

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

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

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

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

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

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

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

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

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

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

Tips and Hints for Choosing In-Home Care Services

2008-12-01T12:40:00.000-05:00

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

Elder Abuse

2008-11-10T13:41:00.001-05:00

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

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

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

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

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

Verbal forms of emotional elder abuse include

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

Nonverbal psychological elder abuse can take the form of

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

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

An unscrupulous caregiver might

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

Scams that target elders include

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

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

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

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

Physical Abuse:

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

Emotional Abuse:

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

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

Neglect:

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

Financial Exploitation:

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

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

Insomnia Affects Treatment of Depression

2008-11-09T10:14:00.001-05:00

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

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

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

Restrict the time spent in bed.

Establish regular wake up time

Go to bed only when sleepy

Stay in bed only when asleep

Practices that help sleep include:

Regular daily exercise

Daily routines

Treating medical problems such as sleep apnea

Using the bed only for sleep and sexual activity

Practices that hurt sleep include:

Alcohol use

Caffeine use

Worries

Poor sleep environment

Using bed for things other than sleep or sexual activity

Medication Side Effects? What To Do

2008-11-06T20:06:00.000-05:00

Taking multiple medications unnecessarily is perhaps the best definition of polypharmacy. Older adults use 34% of all prescription medications and 40% of all over-the-counter medications. According to one study, as many as 28% of hospitalizations in the U.S. were related to medication errors and 2/3 of these could have been prevented. Another study in the Veterans Administration health system focused on patients 65 years and older found that in more than 40% of patients there was inappropriate medication use and underuse for patients taking more than 5 medications per day.

The more medications a person is taking, the risk for mistakes in medication dosing occurs. Also, as the body ages, medications are processed differently. The liver and kidneys are the main organs involved in metabolizing medications and these organs function differently as a person ages. Medications remain in the system longer than they should because absorption rates are slower, medications are highly concentrated due to poor circulation, the liver shrinks and there is decreased hear function, which affects metabolism, and decreased kidney function affects how the drug flushes from the body.

Another concern for the elderly is adverse drug reactions. Oftentimes, adverse drug reactions are mistaken for normal signs of aging such as loss of appetite, unsteadiness, falls, confusion, and urinary incontinence. However, these symptoms are not just connected to aging. It's the combination of age, multiple medications, and adverse drug reactions is cause for concern.

It is important to explore alternatives to medication to solve the problem whenever possible. For example, some drugs may cause dizziness when first taken, but this reaction subsides once

A person has been on the medication for a few weeks. The doctor may instruct your loved one to get up slowly from a seated or lying position or take the medication with food, or he may recommend another nondrug therapy until this effect subsides. If the reaction is severe, one solution could be switched to another medication that doesn't have the same effect. But prescribing another medication to combat dizziness shouldn't be the first action taken.

It's important when helping your loved one with the medications and possible side effects to go to the doctor with them. It's difficult to remember instructions and all the details of the dialogue with the doctor.

Take a list of all the medications he or she currently is using, even if another doctor prescribes that medicine, or even if it is an herb or over-the-counter medication.
Take a list of your questions with you to the appointment. This will help make sure all of your questions are addressed as conversation can cause you to be side-tracked and forget something you thought was important.
Ask the doctor to write the brand and generic name of the drug on the list and why it is prescribed.
Double check how often and when it should be taken and whether it should be taken with a meal, whether or not she or he should avoid alcohol or any particular foods and if there are any over-the-counter medications to avoid.
Find out what side effects to watch for
Ask when to call the doctor if adverse effects develop.
Ask the doctor what medicine your loved one can stop taking, especially if the doctor wants to prescribe a new medication

When filling new prescriptions, ask the pharmacist for a printout of instructions. At home, write out a medication schedule for your loved one to follow at home. It may also be important to use a medi-set, or medi-planner to be sure that the drugs are taken when prescribed.

Medications help older people to overcome life-threatening acute illnesses and to live successfully with chronic diseases. But with the benefits can come risks. By knowing what drugs your loved one is taking and their potential dangers, watching carefully for untoward effects, communicating your concerns to the doctor, and taking the time to check how the medications are working, you can help your loved one get the better part of the medication bargain.

Tips for Choosing an Adult Day Care Center

2008-11-02T14:03:00.001-05:00

• Identify services in your area. For names and phone numbers of the adult day centers, try: • Yellow Pages (“Adult Day Care;” “Aging Services;” Senior Citizens’ Services,” etc.)
• Area Agency on Aging (AAA) Call 1-800-677-1116 for the AAA in your area, or search for them online. See the “Aging Answers Rolodex”.
• A local senior center
• Your family doctor
• A Geriatric Care Manager
• Call first! Call adult day centers and ask for a flier or brochure, eligibility criteria, a monthly activity calendar,a monthly menu and application procedures.

• Know what to ask. Look for the following information:
• Owner or sponsoring agency.
• Years of operation.
• License or certification (If required in your state).
• Hours of operation.
• Days open.
• Transportation
• Cost – Hourly or daily charge, other charges,financial assistance.
• Conditions accepted – such as memory loss,limited mobility, and incontinence.
• Staff credentials.
• Number of staff per participant.
• Activities provided – Is there variety and choice of individual and group activities?
• Menu – appeal, balance.
• Tour. After reviewing materials, make an appointment to visit two or more centers that might meet your needs.
• Check references. Talk to two or three people who have used the center you are considering. Ask for their opinion.
• Try it out. Select a day center. Try it for three to five days. It sometimes takes several visits for new participants to feel comfortable in a new setting and with a new routine. If you have questions or are experiencing any problems, ask for a conference. The staff may have suggestions to make the transition easier both at home and at the day center.

Assistive Devices that Prevent Falls

2008-03-24T19:59:00.001-05:00

Each year, thousands of older adults fall and this often results in injury, including broken bones. A broken bone for the elderly can be the start of more serious problems. These accidents can lead to a lasting disability and loss of independence.

Aging in itself does not cause falls. There are however, a number of chronic health problems that can result in falls. For example, diabetes and heart disease, circulation, thyroid and nervous system problems all may affect balance. Some medications may make a person dizzy. Eye problems or alcohol affect steadiness. Any of these may make a fall more likely.

Osteoporosis makes bones thin and easier to break. This disease can make any fall more dangerous and a major reason for broken bones in women and men as they age. When a person's bones become fragile, even a minor fall can cause one or more bones to break. People with osteoporosis must be very careful to avoid falls.

Accidents seldom "just happen". Taking care of health by exercising and getting regular eye exams and physicals may help reduce the change of falling. Getting rid of tripping hazards in the home and wearing non-skid shoes also may help. To reduce the chances of breaking a bone in the event of a fall, one should be sure to get enough calcium and vitamin D each day.

Use of assistive devices can prevent harmful falls. These devices include canes, walkers, and reachers. A physical or occupational therapist can help your loved one decide which devices might be helpful and how to use them safely. Ask the doctor for a referral for an evaluation.

Canes can help one fell steadier when walking especially when in unfamiliar places or where walkways are uneven. Different types of canes are available. They can be purchased from medical suppliers, local pharmacies, and even stores that provide equipment for mountain climbers.

There are many styles of cane handles. Some have grips made of foam or that fit the shape of the hand. There are canes that fold up, have adjustable lengths, and even those with spikes on the bottom to aid walking on icy surfaces. Sand or salt spread on icy surfaces around the home will help reduce the risk of a fall.

Be sure the length of the cane fits your loved one. The elbow should ne at a comfortable angle when using the cane. A cane that is too short may make the person unsteady. A cane that is too long is harder to use. A physical therapist can help your loved one learn how to use the new cane properly. Some users like to decorate their canes to make them seem less utilitarian.

For a person who is at risk for falling, a doctor or physical therapist might suggest using a walker, which aids balance by giving a wide base of support. Different types of walkers are available. Some have two wheels so the walker can't roll away. These work well for those who need to put weight on the walker when walking. Other walkers have four wheels and brakes for going down inclines. These can sometimes roll out of control, so be sure that your loved one knows how to use the walker safely.

There are many accessories to make walkers more convenient. A basket, tray, or pouch can be added to carry items from place to place. These add-ons can be purchased or, less expensively, fashioned at home. For example, a child's bicycle basket fastened safely on the front of the walker makes a handy carrier. Homemade pouches made ofpretty fabric can drape nicely over the front bar and can be fastened with simple snaps, buttons, or Velcro.

Rechers are special grabbing tools that can be purchased at many hardware and most medical supply stores. A reacher, or grabber, also can help to prevent falls. This simple tool lets one take, or replace, lightweight items from high shelves. By using one, a person can avoid standing on a stool or chair, which may be unstable. The reacher also can be used to pick up dropped items. Many are equipped with a magnet on the tip for picking up small metal objects.

Cordless or cell telephones also can help prevent falls. Encourage your loved one to carry the phone from room to room. When it rings, he or she won't have to rush to answer it. Not rushing could avert a harmful fall. These phones are also handy if your loved one is lying down. Rising suddenly to answer a fall can cause a drop in blood pressure and result in dizziness.

If your loved one is often alone at home, suggest that she or he check out a home monitoring service. Usually, the person wears a button on a chain around the neck. In the event of a fall or emergency, the person just pushed the button to alert the service. Emergency staff is then sent to the home. You can find local "medical alarm" services in the phone book. Be warned, however, that these systems often are not covered by Medicare or medical insurance.

2008-03-05T12:53:00.001-05:00

For the half of Americans who take more than one prescription daily, life is about to change for the better, thanks to new onePAC^TM prescription packaging from Parata Systems.

onePAC prepares a person's medications by day and dosing time in a sealed, clear plastic packet that is arthritic-approved for easy opening. Each onePAC dose is custom-printed with the person's name; day and time of dose; medication names, strengths and descriptions; and other details to help them take the right medications at the right time, every time.

onePAC Helps Your Pharmacist Help You

Consumers request onePAC from their local pharmacy, so they keep that important care touch point with their local pharmacist. onePAC packaging is filled right at the pharmacy using Parata's automated technology, and verified by the pharmacist, who is most familiar with the patient's medication needs.

"If you or a loved one have faced the stress of missed doses of an important medication, or struggled to use a pillbox, the peace of mind and ease of onePAC packaging is immediately appealing," said Tom Rhoads, executive vice president for customer and market strategies at Parata Systems. "From caregivers and their family members, to parents whose children must take medications at school, to busy travelers — onePAC helps people know when and how to take their medicines, reducing risk and ultimately helping them live healthier lives."

How it Works

Rendering the "SMTWTFS" pillbox obsolete, a 30- to 90-day onePAC supply comes to patients as a perforated strip of individual onePAC packages, one for each dose, prepared in a convenient dispensing box that displays the next dose to be taken.

And it all happens right behind your pharmacy counter. Parata's new PACMED technology makes it affordable and efficient for local pharmacies to provide this valuable service to consumers. It automatically and accurately prepares up to 50 multi-dose packages per minute; a big improvement over traditional med-prep programs, which can be very time-consuming for pharmacy staff to administer.

Request Free Sample at www.myonepac.org or 1-888-onePAC1

onePAC packaging is available now at pharmacies across the United States and Canada. Interested consumers can visit www.myonepac.org or call 1-888-onePAC1 to learn more and to request a sample, which can be passed along to local pharmacists who don't currently offer onePAC packaging.

Better Adherence Improves Health, Lowers Healthcare Costs

Nearly one-quarter of long-term care admissions occur because someone is no longer able to safely and independently follow a medication regimen. Failure to take medication as prescribed impacts the effectiveness of the medication. It also contributes to an estimated $100 billion in additional healthcare costs annually, from increased hospitalizations, doctor visits, lab tests and nursing home admissions, according to the National Community Pharmacists Association.

Companies that work in the long-term care sector, such as LTC Solutions, Inc., are rallying behind this new technology and its implications for people who take medications, whether at home or in residential settings. "When it comes to helping people who take multiple medications take them consistently and safely, onePAC packaging is the wave of the future," says Patty Crawford, president of LTC Solutions. "The impact of the nursing shortage is forcing senior health care providers to seek safer and more effective ways to administer medications. Whether in long-term care settings or at home, onePAC packaging is a timely innovation in how medications are dosed. The impact on improved health and extended independence is incalculable."

About Parata Systems

Durham, N.C.-based Parata Systems, LLC, was founded in 2001 to offer industry-leading technology that improves consumers' safety and convenience at the key touch points in the circle of pharmacy care: fill, serve and adhere. Parata's solutions include: Parata RDS (Robotic Dispensing System) to improve the speed and reduce prescription errors in retail pharmacies; Parata eXpress APM to expand convenience, safety and privacy with self-service prescription pickup; and onePAC packaging, which improves patient safety by promoting adherence with customized, convenience packaging for medications. To learn more call, click or visit Parata Systems, www.parata.com, info@parata.com, 1-888-PARATA1 (727-2821

Recognizing Dehydration

2008-03-04T13:13:00.001-05:00

Dehydration can be a serious matter with symptoms including lethargy, headache, and even hallucinations. A person may die if the case is extreme.

Elderly people are less likely to be able to tell if they are getting enough to drink and therefore are at greater risk of becoming dehydrated. This is because an area of the elderly person's brain underestimates how much he or she needs to drink.

The part of the brain that indicates to a person how much water she or he needs is called the mid cingulated cortex. In elderly people, this region of the brain malfunctions.

Researchers at the Howerd Florey Institute in Melbourne, Australia studied two groups of people, one group made up of people age 65-74 and the other group of people age 21-30. The participants were given salty water through their vein and then allowed to drink as much water as they wanted. Even though both groups got equally thirsty, the older group drank half as much as the younger group/

Through imaging with a PET scan, the researchers found that the mid cingulated cortex turned off much earlier in the older people than the younger ones. Much smaller amounts of water were needed for the older person's brain to signal "enough".

This is important information for caregivers to keep in mind. Your elderly family member may feel that they have plenty of fluid when they are actually becoming dehydrated. This is especially true in warmer weather.

Remind your loved one to keep drinking those liquids. Adults should drink at least 8 glasses of water per day to prevent dehydration and physically active people may need to drink more.

Heart Attack: Would You Survive?

2008-02-28T09:30:00.001-05:00

Last week, a report was published in Morbidity and Mortality Weekly Report by Dr. J Fang, of the US Center for Disease Control and Prevention indicating that a survey completed in 14 states found that less than 1/3 of adults are aware if all 5 warning signs and symptoms of a heart attack and WOULD call 911 first.

Respondents were also asked to choose the one action that they would take first, from the following, if they thought that a person was having a heart attack or stroke: take the person to the hospital, advise the person to call a doctor, call 911, call a spouse or family member, or do something else.

Although respondent awareness of some of the five major signs and symptoms of MI was quite high, it was lower for others:

pain or discomfort in the jaw, neck, or back (48%)
feeling weak, lightheaded, or faint (62%)
chest pain or discomfort (92%); pain or discomfort in the arms or shoulder (85%);
shortness of breath (93%).

A total of 86% of respondents reported that they would call 911 if they thought someone was having a heart attack or stroke.

Most adults know the more classic symptoms of Chest pain and pressure, but many people have variant symptoms, especially women who more often have atypical symptoms:

stomach distress including nausea and vomiting
weakness, lightheadedness
pain in back or neck
shortness of breath

Many people have the tendency to be in denial when symptoms occur. Personally, I have experienced 2 loved ones getting help late because the symptoms were atypical and they waited to see if the symptoms would go away on their own. Unfortunately, waiting for the symptoms to disappear results in death for too many people. Commit to a quick decision, make the decision for a loved one who may be refusing to dial 911. You won't regret it: they are much more likely to be successfully treated and go back to a normal lifestyle.

The Warning Signs of Nutritional Risk

2008-02-21T19:14:00.003-05:00

The Warning Signs

Any disease, illness or chronic condition which causes you to change the way you eat, or makes it hard for you to eat, puts your nutritional health at risk. Four out of five adults have chronic diseases that are affected by diet.

Confusion or memory loss that keeps getting worse is estimated to affect one out of five or more older adults. This can make it hard to remember what, when or if you've eaten.

Feeling sad or depressed, which happens to about one in eight older adults, can cause big changes in appetite, digestion, energy level, weight and well-being. Eating too little and eating too much both lead to poor health. Eating the same foods day after day or not eating fruits and vegetables, and milk products daily will also cause poor nutritional health. One in five adults skip meals daily. Only 13% of adults eat the minimum amount of fruits and vegetables needed.

One in four older adults drink too much alcohol. Many health problems become worse if you drink more than one or two alcoholic beverages per day.

A healthy mouth, teeth and gums are needed to eat. Missing, loose, or rotten teeth or dentures which don't fit well or cause mouth sores make it hard to eat.

As many as 40% of older Americans have incomes of less than $6,000 per year. Having less -- or chosing to spend less -- than $25-30 per week for food makes it very hard to get the foods you need to stay healthy.

One-third of all older people live alone. Being with people daily has a positive effect on morale, well-being and eating.

Many older Americans must take medicines for health problems. Almost half of older Americans take multiple medicines daily. Growing old may change the way we respond to drugs. The more medicines you take, the greater the chance for side effects such as increased or decreased appetite, change in taste, constipation, weakness, drowsiness, diarrhea, nausea, and others. Vitamins or minerals when taken in large doses act like drugs and can cause harm. Alert your doctor to everything you take.

Losing or gaining a lot of weight when you are not trying to do so is an important warning sign that must not be ignored. Being overweight also increases your chance of poor health.

Although most older people are able to eat, one of every five have trouble walking, shopping, buying and cooking food, especially as they get older. Most older people lead full and productive lives. But as age increases, risk of frailty and health problems increase. Checking your nutritional health regularly makes good sense.

Alzheimer's Disease: When Is the Right Time to Take the Keys?

2008-02-18T19:40:00.003-05:00

Driving demands good judgment, quick reaction times and split-second decision making. For a person with Alzheimer’s, judgement and visual perceptions are effected in the middle stages of the disease.

Driving inevitably becomes difficult, and your loved one may become unsafe on the roads. Families often struggle over when to take the keys from a person with limitations, including the limitations brought on by Alzheimer's Disease. Families anticipate that the person may be upset by the loss of independence and the need to rely on others for going places. This sense of dependence may prevent people with dementia from giving up the car keys.

A diagnosis of Alzheimer’s disease alone is not a reason to take away driving privileges. However, caregivers are not always best at determining if it is safe for a person with dementia to continue driving. They may be in denial about the person's impairment or may not be comfortable assessing the person's driving skills.

The American Academy of Neurology recommends that driving evaluations should be conducted every six months for individuals with Alzheimer's Disease.

Warning signs of unsafe driving

Forgetting how to locate familiar places

Failing to observe traffic signals

Making slow or poor decisions

Driving at inappropriate speeds

Becoming angry and confused while driving

Hitting curbs

Poor lane control

Confusing the brake and gas pedals

Returning from a routine drive later than usual.

Getting lost on a short drive in previously known route

Once it’s clear the person with Alzheimer's disease can no longer drive safely, you’ll need to get him or her out from behind the wheel as soon as possible. If possible, involve the person with dementia in the decision to stop driving. Explain your concerns about his or her unsafe driving, giving specific examples, and ask the person to voluntarily stop driving. Assure the person that a ride will be available if he or she needs to go somewhere.

Transition driving responsibilities to others. Tell the person you can drive, arrange for someone else to drive, or arrange a taxi service or special transportation services for older adults. Find ways to reduce the person’s need to drive. Have prescription medicines, groceries or meals delivered.

Ask your doctor to advise the person with Alzheimer's disease not to drive. Involving your doctor in a family meeting on driving is probably more effective than trying by yourself to persuade the person not to drive. Ask the doctor to write a letter stating that the person with Alzheimer’s must not drive or a prescription that says, “No driving.” You can then use the letter or prescription to tell your family member what’s been decided.

Ask a respected family authority figure or your attorney to reinforce the message about not driving. Also ask your insurance agent to provide documentation that the person with dementia will no longer be provided with insurance coverage.

Experiment with ways to distract the person from driving. Mention that someone else should drive because you’re taking a new route, because driving conditions are dangerous, or because he or she is tired and needs to rest. You may also want to arrange for another person to sit in the back seat to distract the person while someone else drives.

If the person with dementia wanders, he or she can also wander and get lost by car. Be prepared for a wandering incident and enroll the person in MedicAlert® + Alzheimer’s Association Safe Return®.

In the later stages, when the person is no longer able to make decisions, substitute his or her driver’s license with a photo identification card. Take no chances. Don’t assume that taking away a driver’s license will discourage driving. The person may not remember that he or she no longer has a license to drive or even that he or she needs a license.

If the person insists on driving, take these steps as a last resort:

Control access to the car keys.

Designate one person who will do all the driving and give that individual exclusive access to the car keys.

Disable the car. Remove the distributor cap or the battery or starter wire. Ask a mechanic to install a “kill wire” that will prevent the car from starting unless the switch is thrown. Or give the person a set of keys that looks like his or her old set, but that don’t work to start the car.

Consider selling the car. By selling the car, you may be able to save enough in insurance premiums, gas and oil, and maintenance costs to pay for public transportation, including taxicab rides.

Write a letter directly to the Department of Motor Vehicles in your state and express your concerns, or request that the person’s license be revoked. The letter should state that “(the person’s full name) is a hazard on the road,” and offer the reason (Alzheimer’s disease). The state may require a statement form your physician that certifies the person is no longer able to drive.

The Merits of a Healthy Lifestyle on Aging

2008-02-14T14:41:00.003-05:00

Some significant healthy lifestyle information comes today out of the Physicians Health Study at Harvard Medical School. Men who quit smoking, maintain healthy weight and blood pressure, and get regular exercise in their early elderly years may live longer and in better health than their counterparts who do not follow healthy lifestyles. The study looked both at healthy lifestyle associated with living to the age of 90 and at late-life function in men.

Factors associated with an increased risk for death before 90 years of age were:

smoking
diabetes
obesity

In contrast, regular exercise was associated with a nearly 30% decrease in the risk of death.

The good news is that it is never too late to start a regular exercise program. Researchers have studied the effects of exercise on even the most debilitated elderly. The exercise program consisted of resistance training three times a week and endurance training twice a week for four to eight weeks. Resistance training resulted in significant increases in strength, particularly in those who were the most debilitated. All elderly patients can participate in resistance training, leading to increased strength and functional status.

Structured rehabilitation provided by licensed therapists has proven results, even among the ill elderly. Positive changes in lifestyle including quitting smoking, eating a healthier diet, and regular exercise will decrease the risk factors for disease, the risk for debilitating illness and premature death.

Plan Ahead

2008-02-12T20:41:00.000-05:00

If you or a loved one becomes sick, there are 10 things you need to know ahead of time:

1. Names of their doctors. If you don't know anything else, this is probably the most important piece of information. The chances are good that your parents' doctors can provide much of the rest of the information needed as well as more details about your parents' specific health histories.
2. Birth dates. Often medical records and insurance information are cataloged according to birth date. This can improve communication in an emergency or a crisis.
3. List of allergies. This is especially important if one of your parents is allergic to medication — penicillin, for example.
4. Advance directives. An advance directive is a legal document that outlines a person's decisions about his or her health care, such as whether or not resuscitation efforts should be made and the use of life-support machines.
5. Major medical problems. This includes such diseases as diabetes or heart disease.
6. List of medications. It's especially important that a doctor know if your parent uses blood thinners.
7. Religious beliefs. This is particularly important in case blood transfusions are needed.
8. Insurance information. Know the name of your parents' health insurance provider and their policy numbers.
9. Prior surgery. List past medical procedures, such as cardiac bypass surgery.
10. Lifestyle information. Do your parents drink alcohol or use tobacco?

If your parent will need home health care, what agency should be called? If you or a loved one can't get around and do for yourself but can still stay at home, what kind of services do you want to help you with daily living?

Most families don't know this information until the unexpected happens. Plan for the unexpected now and share your plans with family members, NOW. Unplanned decisions are uninformed decisions, and in the heat of a crisis, they are rarely in anyone's best interest. Take proactive steps now:
• Create a "Rainy Day Folder" that places all of your parent's directives in one place and share a copy with family members.
• Fill out a Advance Directive or Living Will so everyone will know what your parent wants regarding any end-of-life decisions
• Make a list of all your parent's physicians and identify the hospital of choice in the event of an emergency
• Encourage your parent to choose a Durable Health Care Power of Attorney so a trusted loved one can make health care decisions in the event that he or she cannot make decisions independently
• Choose a home health agency that will provide home health visits once in hospital or inpatient skilled care is no longer necessary. An agency that can provide private duty care if needed in addition to visits by therapists and nurses will help eliminate the need to deal with multiple agencies.

Home Health Aides

2008-02-11T18:40:00.000-05:00

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.

Dietary Recommendations for The Aging Body

2008-02-05T20:05:00.000-05:00

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. Eat 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. Even if urinary incontinence is 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-nut 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 adults 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. 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.

Indoor Pollutants Can Affect Lung Health

2008-02-02T21:37:00.000-05:00

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.

Improving Communication With A Loved One With Alzheimer's Disease

2008-01-30T20:49:00.000-05:00

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 person 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 his or her 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 person 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 person will become tense and agitated.
Listen. 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 him 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?”)

Planning Ahead for Future Need

2008-01-25T08:54:00.000-05:00

If you or a loved one becomes sick and need home health care, what agency should be called? If you or a loved one can't get around and do for yourself but can still stay at home, what kind of services do you want to help you with daily living? Most families don't know this information until the unexpected happens. Plan for the unexpected now and share your plans with family members, NOW.

Ask permission of your loved one to have the discussion. Having a conversation about the need for long term care is in the best interest of the entire family. Because the need for long term care is a challenging topic to discuss, some people might need more time to think and reflect on it than others. Asking permission assures your loved one that you will respect his or her wishes and honor them. Some ways of asking permission are:

- “There is something very important to me that I would like to speak with you about. I’d like to talk about your wishes and desires for the time when your health requires more care than you or I can provide at home.”

- “I would like to speak with you about the options and benefits of long term care. I don’t want to alarm you, but it will make me feel better if I know your wishes when it comes to your health in the future.”

Unplanned decisions are uninformed decisions, and in the heat of a crisis, they are rarely in anyone's best interest. Take proactive steps now:

• Create a "Rainy Day Folder" that places all of your directives in one place and share a copy with family members.

• Fill out a Living Will so everyone will know what you want regarding any end-of-life decisions

• Make a list of all your physicians and identify the hospital of your choice in the event of an emergency

• Choose a Durable Health Care Power of Attorney so a trusted loved one can make health care decisions when you're too sick to make them

• Choose a home health agency that will provide home health visits once in hospital or inpatient skilled care is no longer necessary. An agency that can provide private duty care if needed in addition to visits by therapists and nurses will help eliminate the need to deal with multiple agencies.

Getting your loved one to focus on and speak about this topic can be a very challenging process. A common response is, “I don’t need any special help.” Your loved one may not want to show signs of weakness or loss of control, which many people associate with long term care. Don’t be discouraged. Let him or her know you are concerned and that by discussing this topic, you are looking out for his or her best interests. Although you don’t want to pressure your loved one, be persistent and return to the topic over time.

Be a Good Listener
By listening, you can learn the wants and needs of your loved one.

It is important for you to understand what is best for your loved one when it comes to long term care, so spend most of the conversation listening. Your goal is to answer questions he or she might have and be able to provide insight on the topic. Here are some helpful tips:

Listen to his or her needs; what he or she is sharing is important.
Show respect.
Acknowledge your loved one’s right to make choices.

Provide Information

There’s a widespread misconception that Medicare pays for long-term care, but in fact, it only pays for very short term stays in skilled nursing. The average monthly cost of a nursing home nearly $7,000, and stays that exceed several years, it’s critical for people to start planning while they still have the ability to choose the long-term care service and finance options that are best for them.

It is important to realistically evaluate the costs associated with long term care and identify what is affordable in each case. On this page you can find a link to the National Clearinghouse for Long term Care, which provides helpful tools to support families in planning for future health care needs.

Medical versus Non-medical Care

2008-01-23T10:31:00.000-05:00

There are two different types of home care providers, medical and non-medical. A non-medical home care agency can provide bathing and dressing assistance, medication reminders, and assistance with transferring from the bed to a chair. Caregivers will do household chores such as light cleaning, laundry, errand running, grocery shopping, picking up prescriptions, light meal preparation, and getting the mail. They will also provide services that help with socialization and transportation like accompanying the aging adult to a doctor’s appointment, sitting and watching TV together, playing card games or board games, taking the senior to special events or senior centers, going to the library, and other social activities.Non-medical caregivers cannot assist with medication administration but can remind someone to take medications that have been pre-poured.

Medical or "Skilled" home care providers are Medicare-certified home health agencies. Caregivers are licensed registered nurses and licensed practical nurses who can provide assistance with all aspects of personal care as well as nursing care that non-medical staff are unable to do. For example, nurses can assist with medication adjustments, provide tube feedings, insert catheters, care for patients with specialized equipment management and health monitoring needs such as tracheostomy care and ventilator support.

No one can take care of your parent or spouse exactly the way you would, but a good agency will provide caring and compassionate staff who do the best job they can. The squeaky wheel always gets the grease when it comes to service providers. Do your homework prior to hiring an agency, and be sure to check on your aging loved one regularly.Visit unexpectedly, and monitor what’s happening in the home. Speak up and communicate with the agency!

Minimizing Confusion While Your Loved One is Hospitalized

2008-01-21T09:34:00.000-05:00

Some older adults experience confusion when they are hospitalized due to the change in environment. Delirium, a temporary confusion can occur to even the completely oriented older adult when they are ill and in a strange environment. Delerium can lead to safety concerns, such as risk for falling since the individual is confused and unable to follow through with instructions that ordinarily he or she could handle.

Here are some things that can be done to reduce the risk of delirium:

1. Bring a complete list of all medications, with their dosages, that your loved one takes to the hospital. It is important to also include all over-the-counter medicines. It may help to bring the medication bottles as well.

2. Prepare a "medical information sheet" listing all allergies, names and phone numbers of physicians, the name of the patient's usual pharmacy and all known medical conditions. Also, be sure all pertinent medical records have been forwarded to the doctors who will be caring for the patient.

3. Bring glasses, hearing aids (with fresh batteries), and dentures to the hospital. Older persons do better if they can see, hear and eat.

4. Bring in a few familiar objects from home. Things such as family photos, a favorite comforter or blanket for the bed, rosary beads, a beloved book and relaxation tapes can be quite comforting.

5. If your loved one becomes confused while in the hospital, plan to stay as much as possible. During an acute episode of delirium, relatives should try to arrange shifts so someone can be present around the clock. Help orient the patient throughout the day. Speak in a calm, reassuring tone of voice and tell the patient where he is and why he is there. When giving instructions, state one fact or simple task at a time. Do not overwhelm or over stimulate the patient.

6. Massage can be soothing for some patients.

7. If you detect new signs that could indicate delirium -- confusion, memory problems, personality changes -- it is important to discuss these with the nurses or physicians as soon as you can. Family members are often the first to notice subtle changes.

My Parent Doesn’t Want Any Help!

2008-01-16T14:07:00.000-05:00

Perhaps you have noticed that Mom or Dad isn’t bathing regularly, or the bills
aren’t being paid, or the house is uncharacteristically messy. Maybe they seem to forget directions from one location to anther, or even worse, they have had a car accident,or re p o rt falling in the home when no one was around to help them. Often, adult children of aging parents notice changes in their loved ones, and when the aging adult is confronted with the facts, they say, “Oh everything is fine, I don’t need any help, don’t worry about me!”

The loss of independence and choice is something none of us want to face. Having our own children tell us what do to or how to live our lives is uncomfortable at best. Many aging adults are also very private about their financial matters, and will not discuss income or assets with adult children. How do you start that conversation with your parents? There is not a one-size-fits-all answer. Below are some tips that might help the process along.

Pick an appropriate time and place. Avoid large family gatherings,holidays, birthdays, and other celebrations. A quiet location, in their home or yours might be more comfortable.

Avoid blaming or accusing. Instead, redirect the conversation by telling your parent how YOU feel. For example, “Mom, I find myself worrying about you a lot these days, and I would like to tell you why I am feeling this way.”

Talk to a geriatric care manager in your area for some good advice on how to approach your parent’s specific needs. That care manager has helped family members have this kind of conversation hundreds of times throughout their career. They are full of helpful hints and tips.

If you decide to seek the services of a geriatric care manager, ask them about their approach when it comes to dealing with difficult clients, or clients who may not perceive a need for services. I often tell adult children that when they approach their parents about setting up an evaluation, they might tell their parents, “I know you don’t want me to worry about you, and I only want the best for you. Having this professional come over and talk to us would really make me feel better. If you would agree to talk with her, we can look at her recommendations together and see if any of them make sense. Is that fair?”

Remember that having a third party, who is not a family member and is completely objective, can help the senior see things from a different point of view. They feel like they are getting some professional advice, as opposed to opinions from their children.

Finally, if the senior is truly not living safely, a geriatric care manager can let the senior know that they need to make some choices about their care or living arrangements NOW, before someone else has to make that decision for them later. Of course, this is done with professionalism, courtesy, compassion, and caring.

Making the Most of Doctor Visits

2008-01-14T12:41:00.000-05:00

If you go with your parent to see the doctor, here are a few tips that will help you be an ally and advocate:

Bring a prioritized list of questions and take notes on what the doctor recommends. Both can be helpful later, either to give information to the primary caregiver, or to remind your parent what the doctor said.

Before the appointment, ask your parent, the primary caregiver, and your siblings if they have any questions or concerns they would like you to bring up.

Bring a list of ALL medications your parent is taking, both prescription and over-the-counter, and include dosage and schedule (if your parent sees several different doctors one may not necessarily know what another has prescribed).

Tell the doctor about what your loved one used to do, but can no longer do. Sometimes patients come to accept a certain level of disability, particularly if it's the result of a condition that has come on slowly. For example, if she used to garden or knit, but her hands and fingers ache, these are things you should tell the doctor. If you don't share these problems with the doctor, she may miss out on treatments.

When the doctor asks a question, do not answer for your parent unless you have been asked to do so. Always talk to the doctor and to your parent.

Be active during the doctor visit. Take notes and ask questions if you don't agree or don't understand.

Tell the doctor if a treatment or medicine isn't working and ask for something different.

Ask the doctor to discuss other options if he or she saysa test or procedure are needed and you or your parent don't think you it's needed.

Get a second opinion from another doctor if you don't agree with what the doctor is telling you. Find out if your parent's health plan will pay for the cost of getting a second opinion.

• Respect your parent’s privacy, and leave the room when necessary.

• Ask the doctor if she or he can recommend community resources that might be helpful.

Staying Warm This Winter: Special Considerations for the Elderly

2008-01-12T15:24:00.000-05:00

Cold weather is very risky for older people. Almost everyone knows about winter dangers such as broken bones from falls on ice or breathing problems caused by cold air. But the winter chill can also lower the temperature inside an older body. That can be deadly if not treated quickly. This drop in body temperature, often caused by staying in a cool place for too long, is hypothermia. A body temperature below 96°F may seem like just a couple of degrees below the body’s normal temperature of 98.6°F. It can be dangerous. It may cause an irregular heartbeat leading to heart problems and death.

When you think about being cold, you probably think of shivering. That is one thing the body does when it gets cold. This warms the body. Muscles shiver in response to messages sent by the nerves. Shivering increases muscle cell activity that, in turn, makes heat. But, shivering alone does not mean hypothermia. So, how can you tell if someone has hypothermia? It can be tricky because some older people may not want to complain. They may not even be aware of how cold it is.

Look for the “umbles”—stumbles, mumbles, fumbles, and grumbles—these show that the cold is affecting how well a person’s muscles and nerves work. Watch for:
■ Confusion or sleepiness
■ Slowed, slurred speech or shallow breathing
■ Weak pulse or low blood pressure
■ A change in behavior during cold weather or a change in the way they look; alot of shivering or no shivering; stiffness in the arms or legs
■ Chilly rooms or other signs that they have been in a cold place, or
■ Poor control over body movements or slow reactions.

If you think someone could have hypothermia, take his or her temperature with a thermometer. Make sure you shake the thermometer so it starts below its lowest point. If the temperature doesn’t rise above 96°F, call 911. The only way to tell for sure that someone has hypothermia is to use a special thermometer that can read very low body temperatures. Most hospitals have such thermometers. The person must be seen by a doctor. If possible, the doctor should know about hypothermia and work in a well-equipped hospital emergency room. There, the health care team will warm the person’s body from inside out. For example, they may give the person warm fluids directly into a vein using an I.V. Whether the person gets better depends on how long he or she was exposed to the cold and his or her general health. While you are waiting for help to arrive, keep the person warm and dry. Move him or her to a warmer place, if possible. Wrap the person in blankets, towels, coats—whatever is handy. Even your own body warmth will help. Lie close, but be gentle. You may be tempted to rub the person’s arms and legs. This can make the problem worse. The skin of an older person may be thinner and more easily torn than the skin of someone younger.

Some things that put any older person at risk for hypothermia and some things you can do to avoid it include:
■ Changes in the body that come with aging can make it harder to feel when someone is getting cold. It may be harder for his or her body to warm itself. Pay attention to how cold it is where you are.

■ If a person doesn’t eat well, you might have less fat under the skin. Fat can protect the
body. It keeps heat in. Make sure your loved one is eating enough food to keep his or her weight up.

■ Some illnesses may make it harder for the body to stay warm. These include:
➤ Disorders of the body’s hormone system such as low thyroid (hypothyroidism),
➤ Any condition that interferes with the normal flow of blood such as diabetes, and
➤ Some skin problems such as psoriasis that allow the body to lose more heat than normal. Regular doctor visits can keep any illness under control.

■ Other health problems might keep a person from moving to a warmer place or putting on more clothes or a blanket. For example:
➤ Severe arthritis, Parkinson’s disease, or other illnesses that make it harder to move around
➤ Stroke or other illnesses that can leave a person paralyzed and make clear thinking more difficult
➤ Memory disorders or dementia
➤ A fall or other injury.

■ Some medicines often used by older people also increase the risk of accidental hypothermia. These include drugs used to treat anxiety, depression, or nausea. Some over-the-counter cold remedies can also cause problems. Ask the doctor how the medicines your loved one is taking affect body heat.

■ Alcoholic drinks can also make a person lose body heat faster. Encourage your loved one to use alcohol moderately, if at all. He or she should not drink alcohol before bedtime when it gets colder outside—and maybe inside, too.
■ Clothing can make a person colder or help keep warm. Tight clothing can keep the blood from flowing freely. This can lead to loss of body heat. Encourage your loved one to wear several layers of loose clothing when it is cold. The layers will trap warm air between them.

Maybe you already knew that a person's health, age, what they eat or drink, even clothes can make it hard for a person to stay warm enough wherever they are. What you might not realize is that people can also get cold enough inside a building to get very sick. In fact, hypothermia can even happen to someone in a nursing home or group facility if the rooms are not kept warm enough. People living there who are already sick may have special problems keeping warm.

If someone you know is in a group facility, pay attention to the inside temperature there and to whether that person is dressed warmly enough. Homes or apartments that are not heated enough, even with a temperature of 60°F to 65°F, can lead to illness. This is a special problem if they alone because there is no one else to comment on the chilliness of the house or to notice if a person are having symptoms of hypothermia. Set the thermostat for at least 68°F to 70°F. If a power outage leaves him or her without heat, move him or her to stay with family or friend.

Avoid using space heaters if the home seems cold or if they want to keep the thermostat set lower to keep heating costs down. Some types are fire hazards, and others can cause carbon monoxide poisoning. The U.S. Consumer Product Safety Commission has information on the use of space heaters, but here are a few things to remember:

Make sure the space heater has been approved by a recognized testing laboratory.
■ Choose the right size heater for the space being heated.
■ Keep substances that can catch fire like paint, pets, clothing, towels, curtains, and papers away from the heating element.
■ Keep the door to the rest of the house open for good air flow.
■ Turn the heater off when unattended such as when leaving the room or going to bed.
■ Make sure smoke alarms are working.
■ Put a carbon monoxide detector near where people sleep.
■ Keep the right type of fire extinguisher nearby.

Don’t forget the need to stay warm when it’s cold outside. Remember that this means knowing if weather forecasts are for very cold temperatures or for windy and cold weather. Your loved one may lose more body heat on a windy day than a calm day. Weather forecasters call this the wind-chill factor. They often suggest, even when the outside temperature itself is not very low, that the wind-chill factor is cold enough for people to stay indoors. If your loved one must go out, they must dress correctly. Be sure to wear a hat and gloves, as well as warm clothes.

Sometimes older people need help making sure their home will keep them warm enough. Some help is available. If the home doesn’t have enough insulation, contact the state or local energy agency or the local power or gas company. They can give information about weatherizing the home. This can help keep the heating bills down. It is also important to think about only heating the rooms in use in the house. For example, shut the heating vents and doors to any bedrooms not being used. Keep the door to the basement closed. If your loved one has a limited income, he or she may qualify for help paying your heating bill. State and local energy agencies or gas and electric companies have special programs that he or she may qualify for. Another possible source of help is the Low Income Home Energy Assistance Program (LIHEAP). This program supports some people with small incomes who need help paying their heating and cooling bills. The Area Agency on Aging has information on programs such as these.

Advice for New Family Caregivers

2008-01-10T15:16:00.000-05:00

When you're starting out as a family caregiver, it's hard to know where to begin. Perhaps you've only recently realized that a loved one needs assistance, and is no longer as self-sufficient as he or she once was. Or perhaps there has been a sudden change in a loved one's health. Now it's time to take action, and take stock of the people, services and information that will help you care for your loved one. The earlier you find support, the better.

1. Start with a diagnosis. If your loved one is forgetful at times or has gone through a noticeable personality change, take him or her to a neurologist or diagnostic clinic. A thorough evaluation will rule out any reversible causes of dementia symptoms, such as depression, nutritional deficiencies, reactions to medication or infection. An early diagnosis of Alzheimer's disease, or another disease that causes cognitive impairment, has many benefits. First, treatment for Alzheimer's disease is most effective in the earlier stages and can buy more independence for your loved one. Second, knowing your loved one's diagnosis can help you plan ahead realistically.

Learn as much as you can about your family member's condition. This information will confirm that you are not imagining things or exaggerating your loved one's behavior. Especially when you're dealing with dementia, learning about the diagnosis will help you keep in mind that it's the disease that is causing your loved one to gradually lose control over his or her behavior. Many books, videos and classes are available to inform you about what you can expect as your loved one's disease progresses.

2. Talk with your loved one about his or her finances and health care wishes. If your relative is able to complete a Durable Power of Attorney for finances and health care, assist her or him in meeting with an elderlaw specialist to draw up these documents. This planning can help relieve your immediate anxiety and make you better prepared for the future. It can also start important discussions with your family members. If your loved one doesn't have the capacity to execute these documents, you will need further legal advice to learn about your options.

3. At this stage, consider inviting family and close friends to come together and discuss your loved one's care. If possible, your loved one should be included in the meeting. List the tasks that are needed so they can be more easily divided up. Let everyone discuss their concerns, as well as how much and what kind of help each person can offer. As the primary caregiver, it's best for you to focus on accepting what assistance your friends and family are offering, even if it's not exactly what you had in mind.

4. Check into programs such as Meals on Wheels and adult day care programs. These resources are available so that you don't have to do everything yourself'and to give you a break. You can also see if there are caregiver classes and workshops offered in your community by the Area Agency on Aging. These education programs will help you feel more confident and make the time you spend caregiving easier for both you and your loved one.

5. After all of this planning, don't forget what's most important: finding support for yourself. Caregivers often feel isolated as they take on more responsibility, and as their social lives move into the background. A support group is a good place to meet other family caregivers who have really "been there". You can attend support groups in your community, as well as through the Internet.

What Stressors Do You Feel As A Caregiver?

2008-01-08T20:00:00.000-05:00

Caring for your older relative or coordinating services for them through community agencies can be overwhelming. Feelings of frustration, depression, anger or guilt are not uncommon. Many caregivers decide to join a support group to provide emotional comfort. These groups allow people to share feelings and information and relieve stress, resentment and anxiety. Others seek help from their clergy or call their local agency on aging for assistance.

The following questionnaire will help you to become more aware of the stresses that you may be under. For each statement, answer for yourself whether each statement describes you or does not describe your situation.

I find I can't get enough rest.
I don't have time for myself.
I feel frustrated or angry.
I feel guilty about my situation.
I don’t get out much anymore.
I argue with the person I am caring for.
I argue with other family members.
I don't feel I know enough to be an effective caregiver.

If the response to one or more of these statements is "describes me," it may be time to begin looking for help with caring for your older relative and help in taking care of yourself.

Signs of Too Much Stress
PHYSICAL: headache, muscle aches, sleeping and eating problems, getting sick frequently.
EMOTIONAL: guilt, anger, loneliness, depression, and anxiety.
MENTAL: forgetfulness, difficulty making decisions, attention wandering.
INTERPERSONAL: withdrawal, blaming, irritability, impatience, and sensitivity to criticism.
SPIRITUAL: feelings of alienation, loss of hope, purpose, and meaning.

What caregivers need most, say professionals, is a clear sense of their own limits as caregivers. This means you may want to try to:
· Talk openly with your aging relative and other family members.
· Assess the problems.
· Figure out where to get help.
· Decide how much help you can realistically supply.

As you begin to assess your own situation keep in mind:
(1) Caring for yourself is a priority.
(2) Know and respect your limits.
(3) Arrange for time for yourself (to be alone).
(4) Arrange for time with a spouse, other family and friends.
(5) Give yourself credit for things you do well.
(6) Caregiving can be a partnership in which you share responsibilities with others.

Fortunately there are some things that you can do to help manage caregiving stresses. The first step is to reflect on how you spend your time each day. Imagine a "typical" day. Ask yourself, "How much time do I spend?" (estimate the number of minutes or hours each day)
EATING _____
SLEEPING _____
GIVING CARE TO AN OLDER PERSON _____
TAKING PART IN FAMILY ACTIVITIES _____
WORKING AT MY JOB _____
ACTIVITIES WITH FRIENDS & NEIGHBORS _____
SPIRITUAL ACTIVITIES _____
BEING ALONE _____
OTHER _____
Total Hours _____

Now that you have sketched out how you spend your time, you can determine how much time you have for yourself and how much time you have with friends or other family members.

Case Study:
Nan Harris felt guilty about asking someone to stay with her father while she did errands but she couldn't find time to go food shopping or keep her own doctors' appointments. Even more troubling, she realized that the only person she was regularly talking to was her sister. Somehow, the challenges of arranging care for dad had taken a priority over keeping up with friends and her own interests. The second step may be to arrange for a substitute caregiver for short periods of time so that you can get some time away from your caregiving responsibilities.

Nan called her Area Agency on Aging for information about eldercare services. She was fortunate because there was a respite program near her which provides trained volunteers to act as substitute caregivers for short (2-4 hours) periods of time once a week. Nan later related that the "time I spent alone revitalized and recharged me."

Listening to music, reading, taking walks and other forms of exercise, can help you to better handle the stresses you may experience during the day. Taking care of personal business also can help you feel more in control of daily pressures. While most caregivers feel that they can, should or must provide all the care to their family member, carrying the total burden is not helpful and probably impossible in the long run.The third step is to ask for other assistance from family, friends, churches, in-home aide services and community agencies.

Before you dismiss the idea of seeking help consider these three points:
1. Additional help allows you to be a more effective caregiver by giving you time away from the person you are caring for.
2. Your spouse or older relative benefits by seeing and being with someone other than you.
3. Community-based services often allow the older family member to postpone using a nursing home by providing the more difficult and/or skilled care that is needed and can be provided in the home.

Osteoporosis: Not Just a Women's Disease

2008-01-06T13:02:00.000-05:00

Oseteoporosis is a disease in which the bones become weak and can break easily. Often people don't know that they have osteporosis until a bone actually breaks or fractures. Any bone can be affected by osteoporosis, but the most common bones that break are in the hip, back, and wrist. The condition is quite serious because fractures can lead to pain, hospitalizations, surgery, disability, and even death.

Bones are made up mostly of proteins and minerals. Two minerals that are especially important in bone are calcium and phosphorus. Bones are living tissues and old bone cells are always being replaced by new ones. There are special cells that build up new bone (osteoblasts) while other cells (osteoclasts) break down old bone. As people get older, their bodies don't replace all the
bone that has been broken down, and bones tend to become more porous, weaker and more likely to break.

Osteoporosis is not just a woman’s disease. Not as many men have it as women do, but men need to worry about it as well. This may be because most men start with more bone density than women and lose it more slowly as they grow older. Millions of Americans have osteoporosis.They are mostly women, but more than 2 million men also have this disease. White and Asian women are most likely to have osteoporosis.

Other women at great risk include those who:
✦ have a family history of the disease,
✦ have broken a bone while an adult,
✦ had surgery to remove their ovaries before their periods stopped,
✦ had early menopause,
✦ have not gotten enough calcium throughout their lives,
✦ had extended bed rest
✦ used certain medicines for a long time, or
✦ have a small body frame

Experts don’t know as much about this disease in men as they do in women. However, many of the things that put men at risk are the same as those for women:
✦ family history
✦ not enough calcium or vitamin D
✦ too little exercise
✦ low levels of testosterone
✦ too much alcohol
✦ taking certain drugs
✦ smoking

It is best to prevent osteoporosis before it starts, and there are many steps that everyone can take to decrease the risk of bone loss. If your loved one is at high risk of osteoporosis or is already experiencing bone loss, talk to the doctor about testing and treatments. The test used to diagnose osteoporosis is called a bone density test. This test is a measure of how strong -- or dense -- bones are and can help your doctor predict risk for having a fracture. Bone density tests are painless, safe, and requires no preparation. Bone density tests compare bone density to the bones of an average healthy young adult. The test result, known as a T-score, tells how strong the bones are, whether a person has osteoporosis or osteopenia -- low bone mass -- and risk for having a fracture. Some people may be unaware that they have already experienced one or more spine fractures. Height loss of one inch or more may be the first sign that someone has experienced spine fractures due to osteoporosis. Multiple spine fractures can cause a curved spine, stooped posture, back pain, and back fatigue.

The goal of treatment is to prevent fractures. A balanced diet rich in calcium, adequate vitamin D, a regular exercise program, and fall prevention are all important for maintaining bone health. There are medications that can slow the rate of bone loss and even help rebuild bone. Several medications are approved by the Food and Drug Administration for the treatment of osteo-porosis. Since all medications have side effects, it is important to talk to the doctor about which medication is right for your loved one.

When bones are weak, a simple fall can cause a broken bone. This can mean a trip to the hospital and maybe surgery. It might also mean being laid up for a long time, especially in the case of a hip fracture. So, it is important to prevent falls.

Some things you can do are:
✦ Make sure your loved one can see and hear well. Encourage them to sse glasses or a hearing aid if needed.
✦ Ask the doctor if any of the drugs he or she is taking can make him or her dizzy or unsteady on their feet.
✦ Encourage your loved one to use a cane or walker if walking is unsteady. A physical therapist can make recommendations for the most appropriate walking device and train your loved one to use it properly.
✦ Wear rubber-soled and lowheeled shoes.
✦ Make sure all the rugs and carpeting in the house are firmly attached to the floor, or don’t use them.
✦ Keep the rooms of the home well lit and the floor free of clutter.
✦ Use nightlights.

Caregiving: A Difficult Role

2008-01-01T08:23:00.000-05:00

Being a caregiver for an older adult is a tough job. Caregivers are faced with decisions everyday. Throughout the caregiving ecperience, people second guess themselves about every day care. You may ask yourself "what would my loved one do if were me receiving the care"? You find yourself trying to hang on to anything that might indicate a wrong diagnosis.

Accepting a diagnosis such as cancer, Alzheimer's disease, MS, or Parkinson's disease is very hard to do. As each day passes, there are new challenges. It can be a surreal experience. It takes a team to handle the ever changing situation as you do your best to keep your loved one safe and to keep yourself from becoming burned out.

You must be sure your loved one is safe in their own home. In many cases, movement can deteriorate as a disease progresses, so safety and prevention of falls become a primary concern.

Alzheimer’s disease patients may awaken at night and must be supervised to insure they don't wander away from the home. The job of a caregiver is so taxing that it is best handled by a family team if possible.

Each family member can take on a different role, doing what each are best at. Some may be able to sit by the patient and talk and make the loved one smile. Others can tackle the legal issues and paperwork that seems endless. Everyone can give all that they can and do the best at what they know how. Not everyone is good or comfortable in the same role.

Consider the story of Bettty. She is 58 years old and the sole caregiver to her husband, John, 64 years old, who was diagnosed with primary-progressive multiple sclerosis, three months following his retirement. He is paralyzed from the upper chest downwards-and is losing ground every day. By necessity Betty has learned to use power tools, do plumbing chores, get urine out of the carpet, recognize possible pressure sores and dress a 6’5", 240 pound dead weight.

All the errands, car servicing and driving are her responsibility. She does all the cooking, shopping, cleaning and laundry and has learned to give haircuts because she has found that the outside world really isn’t wheelchair accessible.

She misses the hugs, the snuggling, the hand holding, the love making, the dancing, and the strong shoulder to lean on. Depression, loneliness, hopelessness, and fear (including fear of getting sick herself and not being able to care for her husband and the fear of what will happen to her) – and guilt because she feels those things –are constant companions.

She needs help finding affordable long term care insurance that takes into consideration the fact that MS (and other chronic illness) patients can live decades while totally physically incapacitated. She needs a central clearing house of services available to assist her in caring for her husband and home.

It is important for families to reach out for help. Don’t be embarrassed by the things your loved one may say or do. They are ill and people will understand. Seek the help of friends, your church, social services, and if possible, a geriatric care manager. The job of caregiver is too big for one person regardless age or background. Eventually you will need help and you shouldn’t wait until the disease has taken a physical and mental toll on you along with your loved one. Go to local support groups or support groups on line.

If you live in Berks County, PA and would like a listing of local support services, please contact me at the confidential e-mail link on the right side of this blog page.

An Age-specific Food Pyramid Recently Released

2007-12-26T15:43:00.000-05:00

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

2007-12-21T16:12:00.000-05:00

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

2007-12-20T14:53:00.001-05:00

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

2007-12-19T18:46:00.001-05:00

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

2007-12-17T19:45:00.000-05:00

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

2007-12-14T09:53:00.000-05:00

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

2007-12-11T20:17:00.000-05:00

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

2007-12-10T08:58:00.000-05:00

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

2007-12-08T19:15:00.000-05:00

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

2007-12-06T12:34:00.000-05:00

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?

2007-12-04T20:13:00.000-05:00

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

2007-12-03T13:22:00.000-05:00

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?

2007-12-02T13:11:00.000-05:00

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

2007-12-01T12:55:00.000-05:00

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?

2007-11-29T14:28:00.000-05:00

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"

2007-11-28T10:28:00.000-05:00

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?

2007-11-27T09:07:00.000-05:00

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

2007-11-26T16:36:00.000-05:00

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

2007-11-25T16:24:00.000-05:00

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?

2007-11-24T16:13:00.000-05:00

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

2007-11-23T15:21:00.000-05:00

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

2007-11-22T09:30:00.000-05:00

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

2007-11-21T09:13:00.000-05:00

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

2007-11-20T19:51:00.000-05:00

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

2007-11-19T19:46:00.000-05:00

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

2007-11-18T19:33:00.000-05:00

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

2007-11-17T19:09:00.000-05:00

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

2007-11-16T18:56:00.000-05:00

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

2007-11-15T20:46:00.000-05:00

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

2007-11-14T16:21:00.000-05:00

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

2007-11-13T16:46:00.000-05:00

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

2007-11-12T16:02:00.000-05:00

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

2007-11-11T12:47:00.000-05:00

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

2007-11-10T12:23:00.000-05:00

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?

2007-11-08T19:21:00.000-05:00

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

2007-11-07T19:10:00.000-05:00

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

2007-11-06T08:13:00.000-05:00

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

2007-11-04T18:44:00.000-05:00

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

2007-11-02T13:41:00.000-05:00

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

2007-11-02T13:27:00.000-05:00

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

2007-10-31T18:34:00.000-05:00

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

MRSA or Mrs. A? Who or what is she? Why is everyone suddenly talking about her?

2007-10-30T13:50:00.000-05:00

MRSA is all over the news right now. Fifteen years ago, MRSA was only found in hospitals. Now, it is a common garden-variety WEED- the kind of wildflower that no one wants and doesn't die with ordinary weed killer. MRSA continues to infect people in the hospital, but is also can cause serious infection in healthy individuals, including healthy athletes.

Why is it in our schools?MRSA is an abbreviation for Methicillin-Resistant Staphylococcus Aureus. MRSA is considered a "super bug", which means that it can be difficult to treat because it is resistant to most antibiotics. The bacteria in MRSA is sometimes referred to simply as "staph," or "staph A". Staph is a common germ found on the skin of healthy people. Because MRSA is found on the skin, infections are occuring from simple cuts and scrapes during football games and wrestling matches.

If staph gets into the body it can cause a minor infection such as boils or pimples or serious infections such as pneumonia or blood infections. One antibiotic commonly used to treat staph infections is methicillin. While methicillin is very effective in treating most staph infections, some staph bacteria have developed a resistance to methicillin and can no longer be killed by this antibiotic.

Traditionally, MRSA only infects hospital patients who are elderly or very ill. Those at more risk are people who have had frequent, long-term, or intensive use of antibiotics. IV drug users and people with chronic illneses or who are immuno-suppressed are also at increased risk.

In the past, MRSA rarely infected healthy people. It isn't unusual now, to find serious skin infections in healthy children, adults, and the elderly living in the community. Skin infected with MRSA will appear red and inflamed around wound sites. An infection will start out looking like a pimple or bug bite. The germs can tunnel deep into the skin and cause infection deep in the tissue below the skin. The infection can get severe enough to cause fever, extreme tiredness, urinary tract infections, pneumonia, toxic shock syndrome, and even death.

While MRSA is resistant to many antibiotics and can be difficult to treat there are a few antibiotics that can cure MRSA infections. Unless the bacteria is completely treated, it can return, especially if the patient doesn't finish the complete course of antibiotic therapy.

The best way to prevent MRSA:

Hand Washing and Normal First Aid
Wash hands immediately after experiencing a cut or brushburn. Clean the skin well, dry it and cover it with a bandaid. Casual contact such as hugging is okay. Persons should use gloves, however, before handling any body fluids of infected persons, and remove the gloves and wash the hands before leaving the infected person's room or home.

Gloving
Those providing first aid to others must wear gloves when touching blood, body fluids and contaminated items. Remove gloves between contact with people and wash hands immediately.

Equipment Care
Appropriate cleaning and disinfecting equipment is important in limiting the spread of the germs.

Handling of Laundry
Clean clothing, towels, and sheets that have blood or body fluids immeditely or as soon as possible to prevent the spread of the bacteria to your own skin and to others. If they need to be moved before laundering, place in a closed plastic bag and wear gloves when handling them.

Here's what you can do to protect yourself, family members or friends from hospital-acquired infections:

Ask all hospital staff to wash their hands before touching you — every time.

Wash your own hands frequently.

Make sure that intravenous tubes and catheters are inserted and removed under sterile conditions; some hospitals have dramatically reduced MRSA blood infections simply by sterilizing patients' skin before using catheters.

Preventing MRSA found in the Community

Keep personal items personal. Avoid sharing personal items such as towels, sheets, razors, clothing and athletic equipment. MRSA spreads on contaminated objects as well as through direct contact.

Keep wounds covered. Keep cuts and abrasions clean and covered with sterile, dry bandages until they heal. The pus from infected sores often contains MRSA, and keeping wounds covered will help keep the bacteria from spreading.

Sanitize linens. If you have a cut or sore, wash towels and bed linens in hot water with added bleach and dry them in a hot dryer. Wash gym and athletic clothes after each wearing.

Wash your hands. In or out of the hospital, careful hand washing remains your best defense against germs. Scrub hands briskly for at least 15 seconds, then dry them with a disposable towel and use another towel to turn off the faucet. Carry a small bottle of hand sanitizer containing at least 62 percent alcohol for times when you don't have access to soap and water.

Get tested. If you have a skin infection that requires treatment, ask your doctor if you should be tested for MRSA. Many doctors prescribe drugs that aren't effective against antibiotic-resistant staph, which delays treatment and creates more resistant germs.

Making Your Home Accessible for Aging Needs

2007-10-29T12:25:00.000-05:00

Senior citizens fear moving into a nursing home and losing their independence more than death, according to a research study released this week. "Aging in Place in America,” commissioned by Clarity and The EAR Foundation, also found baby boomers emotionally distraught about their aging parents' future. The poll stated that 82% fear their parents will be mistreated in a nursing home and 89% worry their parents will be sad.

Bottom line, Americans of all ages value their ability to live independently. But without a plan for aging in place, it can be hard to stay in control of your life. Knowing your health risks and financial options can make a big difference in your ability to stay in a familiar place. Aside from active life expectancy, chronic illnesses and the ability to provide for daily needs must be considered in the plan. As lifestyles and needs change, the home environment must change to make it possible to remain safely at home.

Home modifications make living at home safe, comfortable, accessible, and enjoyable. In some cases, it may be better to convert part of the caregiver's home into on "accessory apartment," designed to accommodate the physical needs of an elderly relative. An accessory apartment provides a safe, accessible living space while maintaining independence for both the caregiver and the carereceiver. Home modifications help a person remain at home with dignity, safety and comfort.

The following are examples of some of the potential safety risks within a home and some of the possible solutions.

Stairs
Ramps or stair glides
Railings on both sides
Lighting at top and bottom of stair
Non-slip surfaces on treads
Adjust height of riser

Bathrooms
Grab bars
Accessible sinks
Built in shower seats
Faucet levers
Mirror extensions
Wider doorway
Control of water temperatures

Floors
Non-slip surfaces throughout the house

Entrance
Doorbell
Peep holes
Door intercoms

Telephones
Jumbo-button telephones
Adjustments for hard of hearing
Telephones throughout the house
Telephone awareness lights

Kitchen
Lower counters and shelves
Wider doorways
Jumbo face clocks
Lower windows
Under counter lights

Bedroom
Rearrange closet space
On/off touch control lamps
Crank operated windows
Widen doorway

Electricity
Ground fault circuit interrupter-type (GFCI) electrical outlets

Lighting
Oversized light switches or lighted switches
Night lights in rooms and hallways
General lighting improvement throughout the house

Fire/Burglary
Smoke alarms
Fire extinguishers
Security systems (medical and personal)

Resource
National Aging in Place Council http://www.naipc.org/

Poor Driving Skills- Now What?

2007-10-26T12:35:00.000-05:00

If you are concerned about an elderly driver, closely monitor their driving before deciding whether they need to brush up on their driving skills or give up their driver’s license altogether.

1. Watch for changes in driving habits, general behavior, and health.

2. Encourage a driving evaluation through your local Department of Motor Vehicles, along with refresher driving lessons and the AARP Driver Safety course.

3. Offer some evaluation tools to assess driving risk, or work together on these quizzes.

4. Explore ways to reduce driving, such as making purchases online or through mail-order catalogs. If possible, arrange for home delivery of groceries, and home visits by personal care providers.

5. If necessary, get support from the doctor and other family members.

6. Look into alternative ways of getting around. Maybe your loved one can continue to drive some of the time (such as in the daytime or off the freeway), and alternative transportation can fill the need for rides at other times.

7. If you feel that it is time to talk to your loved one about stopping driving, approach the issue with sensitivity. A driver’s license signifies more than the ability to drive a car; it is a symbol of freedom, independence and independent living, self-sufficiency, being employed, fun and spontaneity, involvement in social and religious activities. Some see the ability to driver as a right; however, it is a priveledge. Understandably, driving is not a privilege that anyone—teenager or elder—wants to relinquish willingly. As important as it is to treat the senior driver with respect and not jump to unjust conclusions, it is also important to help the elderly driver retire from the road.

Start slowly and try to persuade the senior to give up the keys. Some approaches that may work:

Be understanding about resistance. The senior may dismiss you and refuse to listen to you. Emotion may get in the way of a rational decision.

Ask questions, rather than make demands. For example, “Would you consider not driving at night?”

Talk about safety considerations. Many senior drivers who shouldn’t be driving have already had an accident or some close calls. Remind the impaired driver of the danger of serious injuries and that the safety of others is also at risk.

Explain transportation options. Help the senior driver see that living without a car won’t make them permanently homebound. Acknowledge the lifestyle change, but also show them how to continue favorite activities and to remain mobile.

Emphasize financialsavings. The cost savings associated with giving up a car may be a selling point for some older drivers. Costs include insurance, gasoline, maintenance and repairs, and license and registration fees.

Offer rides and visits. Volunteer to come by once a week or to provide rides on a regular basis for things like grocery shopping, library visits, or doctors’ appointments.

Seek their understanding of the situation. Some elderly drivers may be aware of their faltering ability, but be reluctant to give up driving completely. Another person’s concerns may force the senior driver to act. They may even feel relieved to have someone else help make the decision to stop driving.

Should Dad Still Drive?

2007-10-26T12:09:00.000-05:00

For many, asking this question is equivalent to opening Pandora's box. It is an issue of independence. While everyone ages differently, many people are able to continue to drive into their seventies, eighties, and even nineties. Some seniors are at higher risk for road accidents. The elderly are more likely to receive traffic citations for failing to yield, turning improperly, and running red lights and stop signs - an indication of decreased driving ability. A person 65 or older who is involved in a car accident is more likely to be seriously hurt, more likely to require hospitalization, and more likely to die than younger people involved in the same crash. In particular, fatal crash rates rise sharply after a driver has reached the age of 70.

If you know an older driver who is experiencing trouble on the road, it is important to carefully monitor the situation. There are physical changes in aging that may affect road safety:

Visual decline
Vision declines with age, which means depth perception and judging the speed of oncoming traffic become more difficult. The eyes also lose the ability to process light, which makes night vision worse and causes more sensitivity to bright sunlight and glare. By age 60, you need three times the amount of light that you did at age 20 in order to drive safely after nightfall.

Hearing loss
Approximately one-third of adults over age 65 are hearing-impaired. Because hearing loss happens gradually, a senior may not realize they are missing important cues when driving, such as honking, emergency sirens, or a child's bicycle bell.

Limited mobility and increased reaction time
With age, flexibility may decrease as response time increases. A full range of motion is crucial on the road. In addition, chronic conditions can limit mobility (rheumatoid arthritis, Parkinson's disease, sleep apnea, heart disease, or diabetes).

Medications
People often take more medications as they age. Certain medications, as well as a combination of medications and alcohol, can increase driving risk. Be particularly careful about medication side-effects and interactions between medications.

Drowsiness
Aging can make sleeping more difficult, resulting in daytime tiredness and an increased tendency to doze off during the day (or while driving). In addition, certain prescription drugs cause drowsiness.

Dementia or brain impairment
Mental impairment or dementia makes driving more dangerous and more frustrating. Brain impairment may cause delayed reactions to sudden or confusing situations on the road.

There are also problems in the driving environment that can affect drivers of any age. If an older adult is experiencing other problems, these challenges can make it even more difficult to drive safely: signs and road markings that are difficult to see or to read, complex and confusing intersections, older vehicles that lack automatic safety features, newer dashboard instrument panels with multiple displays all affect driver safety.

Warning signs of unsafe driving ability:

Abrupt lane changes, braking, or acceleration

More frequent "close calls", or dents and scrapes on the car or on fences, mailboxes, garage doors, curbs, etc.

Failing to use the turn signal, or keeping the signal on without changing lanes.

Drifting into other lanes.

Driving on the wrong side of the road or in the shoulder.

Trouble reading signs or navigating directions to get somewhere.

Missing highway exits or backing up after missing an exit.

Difficulty with Range-of-motion of the neck, affecting the ability to look over the shoulder, turn head, or move hands or feet.

Trouble moving the foot from the gas to the brake pedal, or confusing the two pedals.

Feeling more nervous or fearful while driving or feeling exhausted after driving.

More conflict on the road: other drivers honking; frustration or anger at other drivers.

Oblivious to the frustration of other drivers, not understanding why they are honking.

Reluctance from friends or relatives to be in the car with the senior driving.

Getting lost more often.

Trouble paying attention to signals, road signs, pavement markings, or pedestrians.

Slow reaction to changes in the driving environment.

Increased traffic tickets or "warnings" by traffic or law enforcement officers.

If you would like a free copy of the Driver Safety Rating Form, e-mail Health Calls at: MRadwanski@healthcallshomehealth.com

Minimizing Confusion While Your Loved One is Hospitalized

2007-10-25T15:06:00.001-05:00

When an older person is hospitalized, an illness or the change in enviroment can cause confusion, which is usually temporary. Confusion can be a safety concern because the older adult may not think or act as rationally as he or she would normally, and this could result in a fall or injury in the hospital. It is important to plan ahead before a hospital stay to reduce the risk of confusion.

Be prepared in case of a hospitalization. It is important to have this information on the ready at all times:

1. A complete list of all medications (with their dosages), as well as over-the-counter medicines.

2. Prepare a "medical information sheet" listing all allergies, names and phone numbers of physicians, the name of the patient's usual pharmacy and all known medical conditions. Also, be sure all pertinent medical records have been forwarded to the doctors who will be caring for the patient.

If your loved one is hospitalized, there are a few things that you can do to help prevent confusion:

1. Bring glasses, hearing aids (with fresh batteries), and dentures to the hospital. Older persons do better if they can see, hear and eat.

2. Bring in a few familiar objects from home. Things such as family photos, a favorite comforter or blanket for the bed, rosary beads, a beloved book and relaxation tapes can be quite comforting.

3. Help orient the patient throughout the day. Speak in a calm, reassuring tone of voice and tell the patient where he is and why he is there.

4. When giving instructions, state one fact or simple task at a time. Do not overwhelm or over stimulate the patient.

5. Massage can be soothing for some patients.

6. It is always important to have an advocate available for the patient. Stay with the hospitalized patient as much as possible. If your loved one becomes confused, relatives should try to arrange shifts so someone can be present around the clock.

7. If you detect new signs that could indicate delirium -- confusion, memory problems, personality changes -- it is important to discuss these with the nurses and physicians as soon as you can. Family members are often the first to notice subtle changes.

How Do I Know if Mom Really Needs Help?

2007-10-23T14:39:00.000-05:00

In some cases, the sudden start of a severe illness will make it clear that help is needed. In other cases, your loved one may ask for help. When you don't live with the person you are concerned about, you have to think carefully about possible signs that support or help is needed. You might want to use any time that you are together to take stock.

Some questions to answer during your visit include:

• Are the stairs manageable or is a ramp needed?

• Are there any tripping hazards at exterior entrances or inside the house (throw rugs, for instance)?

• If a walker or wheelchair is needed, can the house be modified?

• Is there food in the fridge? Are there staple foods inthe cupboards?

• Are bills being paid? Is mail piling up?

• Is the house clean?

• If your loved one is still driving, can you assess their road skills?

• How is their health? Are they taking several medications? If so, are they able to manage their medications?

• What about mood: Does he or she seem depressed or anxious?

If you do not see your loved one often, changes in his or her health may seem dramatic. In contrast, someone who is with him or her everyday might not notice such changes, or realize that more help, medical treatment, or supervision is needed. Sometimes a geriatric care manager or other professional is the first to notice changes. For families dealing with Alzheimer’s disease and other dementias, it can be easier to “cover” for the patient — doing things for him or her, filling in information in conversations, and so on — than to acknowledge what is happening.

A few good conversation starters are:

If you thought there might be a change in Aunt Joan’s condition, whose opinion would you seek?

"I didn’t notice Dad repeating himself so much the last time I was here. Do you remember when it started?" Some changes may not be what you think. Occasional forgetfulness does not necessarily indicate Alzheimer’s disease. Before you raise the issue of what needs to be done, talk to your parent and other involved family members about your concerns.

Try not to sound critical when you raise the subject. Instead, mention your particular worry, for example, “Mom, it looks like you don’t have much food in the house — are you having trouble getting to the store?” and explain why you are concerned. Listen to what she says about the situation, and whether he or she feels there are problems.

Discuss what you think needs to be done: “Do we need to get a second opinion about the diagnosis? Can you follow the medication schedule? Would you like some help with housework?” Try to follow up your suggestions with practical help, and give specific
examples of what you can do. For example, you might arrange to have a personal or home health aide come in once a week. You might schedule doctors’ appointments
or arrange for transportation.

In some cases you may have to be forceful, especially if you feel that the situation is unhealthy or unsafe. Do not leave a frail adult at risk. If you have to act against the wishes of your loved one, be direct and explain what you are going to do. Discuss your plan and say why you are taking action.

More Should Get Flu Shot

2007-10-22T13:27:00.000-05:00

For the last two years we were in a frenzy over the lack of flu shot availability. This year, there doesn't appear to be a shortage in supply.

Will YOU get your flu shot? It's not just for the elderly, children, and people with chronic illnesses anymore.

Why? Well, what happens if YOU get the flu and pass it on to the person you are caring for? You are not immune to the flu and you can pass it on.

The experts at the Center for Disease Control say that every year in the United States, on average:

5% to 20% of the population gets the flu; more than 200,000 people are hospitalized from flu complications, and; about 36,000 people die from flu. Some people, such as older people, young children, and people with certain health conditions, are at high risk for serious flu complications.

Flu viruses spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose. Most healthy adults may be able to infect others beginning 1 day before symptoms develop and up to 5 days after becoming sick. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick.

Some other good health practices to help prevent the flu from spreading include:

1. Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.

2. Stay home when you are sick. If possible, stay home from work, school, and errands when you are sick. You will help prevent others from catching your illness.

3. Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick. Throw the tissue away as soon as possible to prevent the spread of germs.

4. Clean your hands. Washing your hands often will help protect you from germs. Use warm water and lather with soap. Rub your hands together for 10 seconds, then rinse your hands and dry them. If you aren't able to use soap and water right away, use a alcohol-based waterless hand sanitizer.

5. Avoid touching your eyes, nose or mouth. Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.

6. Practice other good health habits. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food. These healthy habits will keep your immune system healthy which helps if you are exposed to the flu or other illnesses.

Tips to Aid People with Poor Eyesight

2007-10-20T19:03:00.000-05:00

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.

Managing Your Medical Devices At Home: Practical Advice

2007-10-18T10:15:00.000-05:00

As noted in yesterday's blog, it's important to know how your medical device works. Here a some practical tips:

1. Read the material that came with your device. Follow the operating instructions precisely for proper operation of the device. Keep the operating instructions close by to the device to trouble shoot if problems with the operation arise. Pay attention to alarms and error messages. Know what they mean.

2. Ask the supplier questions about your device and take notes.Call the supplier for help if you don't understand how the device works. For larger equipment,the company will come out to your home to show you how to properly operate the device.

3. Ask what you need to operate your device. Do you need electricity, running water, telephone, or computer connections to operate your device? What should you do in the event of a power failure? Do you need to invest in a generator to use as back up? Always have a back-up plan and back-up supplies.

4. Check to see that your home is suited for your device. For example, will there be enough clearance in the hallway for a power wheelchair to get through? Do the stairs, doorways, bathrooms or house wiring present any problems?

5. Report to your supplier any problems you have with the operation of the device.

6. Take good, tender loving care of your device and follow the instructions for cleaning, replacing batteris and filters, and protecting the device from excessive heat, cold, spills from food or fluids. Keep extra batteries for your device and know how to replace them.

7. Can you safely take the device from home to school, work, church and vacations? Check ahead of time to see if these places are suited fot your device.

8. Dispose of your medical device according to the manufacturer's instructions.

9. Dispose of any fluid wastes according to the instructions for everyone's health and safety.

10. Make sure you know what to do if your device fails. Have emergency phone numbers for the supplier, homecare agency, doctor, and manufacturer. Be sure that you have the after hour phone numbers as well.

11. Educate your family and caregivers about your device. Include them in any demonstrations that the equipment provider gives you.If the device is given while in the hospital or nursing facility, be sure caregivers who will be assisting at home are included in the training. Ask them to do a hands-on demonstration to show they can safely and effectively use the device.

12. Keep children and pets away from the device. Don't let children play with dials, settings, on/off switches, tubings, machine vents, or electrical cords. Don't allow pets to chew or play with electrical cords or tubes.

13. Check with your supplier to see if you can turn off the device when it is not in use.

14. Contact your doctor and home healthcare team often to review your health condition. Check to see if there are any changes that my affect the way you or your caregiver use the device. Are there changes in vision, hearing or ability to move? Have you had an illness, new medicines, loss of feeling?

15. Report any serious injuries, deaths, or close calls due to equipment failure. Report these events to the FDA at 1-800-332-1088. The FDA will take action when needed to protect the public's health. Report these events also to the supplier.

Tips for Safe Care of Medical Device Use at Home

2007-10-17T12:19:00.000-05:00

Approximately 1,355,300 patients receive home health care services each year and across the country more than seven million people receive home care each year by both agencies and family members. The growth of homecare allows people to stay at home rather than go to alternatives. It is cheaper to receive care at home, so insurance companies see it as the better alternative.

Home care has also grown because of technology that is now available at home. Medical devices are being made smaller and more portable. It isn't unusual no for people to receive IV therapy, ultrasound, respiratory treatments, ventilator-assisted support at home.

Although more patients enjoy the benefits of receiving medical care at home, they are using medical devices that were not originally designed,tested, or approved for the home environment. This can create a potentially hazardous situation for patients.

Halls and entry spaces in homes are often not large enough to maneuver or properly use some medical equipment. Electrical wiring of some houses may be inadequate to handle the correct voltage to handle the medical equipment's voltage needs. Some medical devices do not work properly as a result of electromagnetic interference caused by other equipment in the home such as microwave ovens, video game systems and security systems.

Children and pets provide a unique challenge in the home. Children can topple equipment while playing; animals can chew through wiring and tubing of many medical devices. Many patients lack the supplies needed and may be unable to properly sanitize and sterilize medical equipment or safely dispose of infectious waste created by medical devices.

Nurses and therapists from homecare agencies are trained to evaluate the physical aspects of the home for safety. This is a part of every new evaluation and continues at each visit with patients in their homes. However, healthcare providers are rarely present when devices malfunction.

Look for tips in my next post to use and maintain your medical devices safely and effectively in your home.

Strategies for Effectively Making Use of Your Resources While Caregiving

2007-10-16T09:14:00.000-05:00

How do you build a network of support while providing care to a loved one? Your family is the most obvious place to start. Family members can be recruited for any number of things. Social support is really important. Some family members may be best at coming over to visit over coffee and then there are others who aren't comfortable coming over unless there is something to do. Try and use the skills of the family to everyone's advantage. So while some are happy to come and visit often with your loved one while you get out to go shopping others might be able to take over for a day just once in a while.

Friends & Neighbors may not really know what is going on while you are preoccupied with caregiving. Your friendship may suffer if they aren't made aware of what you're up against. Friends can be a real asset and they may be perfectly happy to help you with tasks such as cooking or doing some ironing while you see to the bath. You need to strike a balance with friends so keep this in mind. While it may sometimes appear an effort to maintain relationships there are often dividends to be had that may not seem so obvious - until you lose contact.

Look through the newspaper to see who offers what. You may find volunteer networks, handymen and services you hadn't previously thought of that could help your particular needs.

The fact that you are reading this means you are already using the internet. Check out www.caregiver.org, where there are many resources to meet the myriad of needs as a caregiver.

Local support in the form of support groups are available. You can find information about upcoming meetings in the newspaper.

Respite provides alternate care for a person in order to give their caregiver some time away from their caring role. Respite can often be undertaken in your own home, or day centers, or a residential facility. To find out out respite care speak to people in local support groups, home health agency, or your local doctor or social services.

Respite Care

2007-10-14T14:35:00.000-05:00

Respite care is occasional rest or relief for the primary caregiver(s) of a child or adult with a chronic medical condition or disability. Caring for a child or adult with intense medical needs, behavioral challenges, or other disabilities can be mentally and physically exhausting. Parents and other caregivers need to be able to get away for a short period of time for rest or to spend time with other members of their family, such as their spouse or other children.

With respite care, you can feel safe leaving your loved one while you run errands, shop, or just relax; more extensive respite care can allow you to continue working outside your home or help you juggle caring for your children and an elderly adult. Above all, remember to keep in touch with yourself. If you are sick, exhausted, or overworked, you can't provide good care for anyone. Caregiving is an act of love, but is also a demanding, challenging job. No one can handle it alone. Getting help for yourself is one of the best things you can do for your loved one, and it will enable you to keep giving top-quality care.

If you neglect yourself, you are putting your loved one at risk - taking time for yourself will also benefit your care recipient.

In-home services offer a wide range of options, including companion services, personal care, household assistance, and skilled nursing care to meet specific needs of those involved. Contact your local Area Agency on Aging for more information about in-home services. All states also have a local chapter of the Alzheimer’s Association that can assist with valuable information about respite options and support for caregivers.

Respite care facilities provide overnight, weekend, and longer stays for someone so a caregiver can have longer periods of time off. These facilities provide meals, help with activities of daily living, therapeutic activities to fit the needs of residents, and a safe, supervised environment. Examples of such facilities include nursing homes, residential care facilities, and assisted living facilities.
Emergency respite is often offered in many nursing homes, residential care facilities, and assisted living facilities. Emergency respite care may be needed when a caregiver becomes ill or must go out of town unexpectedly, or if the care recipient is at risk of abuse or neglect. It is best for the caregiver to be prepared for this type of respite by finding the best facility and registering ahead of time. Each community is unique in its response to crisis respite and the elderly. Some communities have emergency guest houses for such situations, while in other communities, State Medicaid dollars will pay for emergency respite in nursing homes or assisted living facilities.

Adult day services provide a planned program that includes a variety of health, social, and support services in a protective setting during daytime hours. This is referred to as a "community based service" and is designed to meet the individual needs of functionally and/or cognitively impaired adults. Adult day services programming may provide:
• Social activities
• Counseling
• Meals
• Transportation
• Recreation
• Medical help
• Mental stimulation
• Options such as bathing
• Exercise
• Therapies such as physical and speech
• Emotional support for both caregiver and participant
• Education for both caregiver and participant

Questions to ask about respite care programs
• How are care providers screened?
• What is the training and level of experience of the care providers?
• Will care providers need additional training to meet specific family needs?
• How, and by whom, are the care providers supervised?
• What procedures does the program have for emergencies?
• Are families limited to a certain number of hours of services?
• Does the program provide transportation?
• What is the cost of services? How is payment arranged?

What Lies Ahead For Family Caregivers?

2007-10-12T12:44:00.000-05:00

Long term care is a family issue, but it is more often a woman’s issue. Throughout history women have been the primary caregivers in our lives. Women live longer than men. Women often care for family members young and old.

The first baby boomers are retiring this year. It is important to understand what lies ahead of us as our nation ages. Women also live longer than men and often care for family of all ages.

As our population begins to age, it's even more important that we understand what lies before us. Although we see increases in male caregivers all the time, the fact
remains that when it comes to Long-term care for our family members and our spouses, today women carry the weight. Daughters, daughters-in-law, wives, sisters, and nieces often ccept the role of caregiver for aging adults in the family. Across
the U.S. there are women commonly referred to as “the sandwich generation" who are
playing dual roles in their families. They are often a mother themselves, but caring for their own aging parents at the same time. The level of stress and frustration can be overwhelming.

Careers are being put on hold, and promotions passed upin order to accommodate the busy schedules of their children and their parents. Even so, there is still not enough time for these women to meet everyone’s needs. A financial burden results
as well.

Women in America also tend to marry men who are older than themselves. Therefore, they often end up caring for their chronically ill spouse in later years. When this happens, it is sometimes the case that all of the retirement funding and assets are used by the “ill” spouse for long-term care, leaving nothing in savings to care for
the “well” spouse later in life.

It is estimated that one out of two women will need long-term care at some point in their lives. One out of three men will also require long-term care. So why do more women need services? Our life expectancy is still longer than the average male.

So, then, when a caregiver needs a break, where can they turn? Caregivers of all kinds need a break now and then. So, where does a caregiver turn when they are feeling stressed out, tired, emotionally drained, or overwhelmed? Respite (res- pit) care is often the answer. Respite care is time off for the caregiver. Respite gives the caregiver time away to rest and do necessary activities so that you can continue to provide good care for your loved one. Often, being a caregiver is a job
that can be physically and emotionally draining. Without relief,your physical and emotional health can be affected, reducing the quality of care for your family member.

There are several options when it comes to respite care, which will follow in the next post.

Caregiving Can Take a Toll on Your Health: Take Control

2007-09-28T12:35:00.000-05:00

The stress and time that caregiving requires can put a strain on a person's health. Family members, friend, and health care professionals can give you a break and help out when you cannot be there.

Find out what tasks family and friends are willing to help with. Keep the list of people you can call on with their telephone numbers and a list of things they will help you with.

A structured schedule and tasks that need to be taken care of are a big help to those that are helping. This provides a framework of what needs to be done, and when. Having this list ready ahead of time will also take the stress off of you when you are busy.

Make your own health your first priority. Numerous research studies have shown that caregiver stress can cause illness and premature death due to the stressors of caregiving. Investing in yourself is not selfish, it is necessary for the preservation of your own health and well-being. Taking care of you first will assure that you will be capable of meeting your loved one's needs later. Staying fit and healthy helps you cope, manage stress, and make it through the tough days when they come.

Be dedicated to a health routine that cares for you so that you can be there to care for your loved one. Schedule time for yourself. It's important to be involved doing things that you enjoy to refuel and re-energize.

Eat a balanced diet. Exercise regularly. Get plenty of rest. This will reduce your stress, give you more energy and improve your mood.

See your doctor regularly. Emotional stress and turmoil can be hard on your health.

Take time for yourself several times each week to recharge your batteries.

Who needs a Durable Power of Attorney?

2007-09-27T13:23:00.000-05:00

You have the right in most situations to decide what medical care you receive. In order to assure that you maintain these rights if you are unable to communicate your wishes yourself, you can name a Durable Power of Attorney to make medical decisions for you.

Sometimes it is hard to know a patient’s wishes. For example,does your family know
if you want to be on a breathing machine if you are in a coma and will never wake up?You can make sure your doctors and others know your wishes by completing a living will and choosing someone to make decisions for you when you can not.

A Durable Power of Attorney allows you to give someone permission to make medical decisions for you if you are unable to make those decisions yourself. The person you name to represent you may be called an agent, attorney-in-fact, health care proxy, patient advocate, or something similar, depending on where you live. It is unpleasant to think about being seriously ill or injured. However, it may be helpful to think about such situations before they occur. This way you can make your wants and beliefs known. You should talk to your family and your doctor about your beliefs
and the type of care that you do or do not want. What do you want your doctor to do
if you are in a coma? Do you want to go on living if you become terminally ill and
must be fed through a tube?

A Durable Power of Attorney is different from a Power of Attorney. A Power of Attorney allows you to have someone else make financial decisions on your behalf and to pay your bills, and manage your estate if you are currently incapable of handling these matters yourself.

There are several things that you can do to make your doctors aware of your wishes
about using life-sustaining treatment. You can appoint an agent (someone to make
decisions for you), you can prepare a living will, or you can do both.

The most important thing to do is to identify the person who will talk with your
doctor about your medical care if you are unable to do so. This person is your substitute decision maker, or agent. You need to talk to your agent about the care you would want if you were terminally ill or in a coma. Your agent can represent you if you cannot speak for yourself.

You may want to choose your agent now. You can choose whomever you want to serve as your agent — such as your spouse, or a parent, a son or daughter, or a friend. You can make your choice of an agent legally effective by signing a durable power of attorney form.

Your attorney can assist you drawing up this form. If you would like a free copy of an example of a Durable Power of Attorney form, simply e-mail Health Calls @ MRadwanski@healthcallshomehealth.com with your name and address for a copy to be sent to you.

Plan Ahead

2007-09-24T21:31:00.000-05:00

Build a Support System

2007-03-29T20:38:00.000-05:00

How To Build a Support System
Look within the family when starting to build a support system. Family members, even if not direct caregivers, can be recruited for any number of things. Social support is really important. Some family members may be best at coming over for a coffee and chat and some only feel they are helping if there's things to do.

The point is to try and use the skills of the family to everyone's advantage. So while some are happy to do the grocery shopping, others might be able to take over for a day just once in a while.

Friends & Neighbors
Friendships and neighbors will frequently say "tell me if there's anything I can do". Unfortunately, those offers to help are going to dwindle over time if you don't allow them to do something. How many times is someone going to offer their help if they are constantly turned down? Friends can be very helpful if they are given tasks that both of you are comfortable with. For example, they may feel inadequate taking over for an entire day, but may be a huge help with getting odds and ends completed while you are busy with giving your loved one a bath. Tasks such as cooking or doing some ironing may seem small and insignificant to them, but make a huge dent in the daily work load for you. Think about what the neighbor may really be saying when they offer their help; for the most part it's not just lip service. My sister's mother-in-law was reluctant to take a neighbor up on her offer to visit with her infirmed mother on a Saturday afternoon while she went to her grandson's football game. She really did want to help! Leaving her "Mum" in the care of the neighbor gave both of them quality time. Enid came back home recharged and ready to tackle the rest of the weekend.

Community Services
Check the yellow pages, read the newspaper to see who offers what. You may find volunteer networks, handymen and services you hadn't previously thought of that could help your particular needs. Most larger towns and cities have their own websites. You may find a place to post free ads for volunteer help or services.

Websites
The fact that you are reading this means you are already using the net to your advantage. You might also want to check out eldercare locator who offer a service to link those who need assistance with state and local area agencies on aging and community-based organizations.

Respite
Respite provides alternate care for a person in order to give their caregiver some time away from their caring role. Respite can often be undertaken in your own home, or day centers, or a residential facility. To find out out respite care speak to people in your local area, or your local doctor or social services.