Heart Attack: Would You Survive?

 

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

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?

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

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

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

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

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

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

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 surroundings. 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 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

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

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

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!

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

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

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

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?

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

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

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

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.