An Alzheimer's patient once came to me after he had got out of his house and was found hours later in a ditch approximately 2 miles from his house.  Wandering is often a scary symptom of Alzheimer's disease and dementia.  It's confusing and scary for a senior who does not know where he/she is or where they are going; and is scary and worrisome for family caregivers.  Wandering can occur anytime but tends to increase in the late afternoon/early evening hours.  There are several things caregivers can do to keep their loved ones safe at home. 

Tip #1:  Use deadbolts on doors leading outside, place them high or low on doors
Tip #2:  Take locks off of bathroom and bedroom doors to avoid your loved one from locking themselves in
Tip #3:  As the sun starts to go down, close the blinds/curtains and turn lights on
Tip #4:  Install appliances that shut off automatically
Tip #5:  Keep toxins i.e. cleaners, bleach, poisons; and prescription medications in a safe, secure space
Tip #6:  Remove clutter from around the house
Tip #7:  Install a door alarm or place a motion sensor in your loved one's room at night to alert you when they are awake and moving
Tip #8:  Label doors, drawers, and cabinets; this is most helpful in the earlier stages

A professional geriatric care manager can help you in reviewing your home and finding assistance for home modifications.  For more tips and information, check out The Complete Guide to Alzheimer's-Proofing Your Home and home modification tips.

Got a headache, back pain, high cholestrol levels, etc?...then pop a pill.  That is often the "magic" solution in today's health care system.  According to the American Heart Association, 32 million Americans take 3 or more medications daily.  Seniors often take double or triple that amount and sometimes more.  The problem is, is that with all medications come potential side effects and then to treat those side effects people are often prescribe another medication and so on.  Another problem is that seniors often have multiple physicians who often are not aware of what the other physicians' treatment plans are and what medications they are prescribing.  According to Medco Health Solutions, a pharmacy benefits manager, "the risk for drug errors is 7 times greater in seniors than in people under age 65."  CNN.com released an excellent article this week titled "Is Grandma drugged up?"  This article tells a story of a 66 year old woman who was experiencing confusion and slurring of her words.  Her family took her to the emergency room where the possibility of a stroke was ruled out; she was admitted to the hospital and was diagnosed with Alzheimer's Disease.  Her children believed that the diagnosis was incorrect, as she has been functioning independently.  They took their mother to a geriatrician at the University of Oklahoma for a second opinion, where they were told that she most likely did not have Alzheimer's Disease but was overmedicated.  Dr. Jerry Gurwitz's philosophy is "that any new symptom in an older person should be considered a drug side effect until proven otherwise."  Not only do medications have side effects but they also interact with other medications causing contraindications, enhancing side effects, etc.  It is important to always keep a current list of medications, including prescriptions, over-the-counter medications, herbal medications and supplements.  All medications, not just prescriptions, can interact with each other, as well as, food/beverages and other substances i.e. tobacco.
There are several ways caregivers can assist in medication management.  If you feel that your parent is being overmedicated, talk with your primary care physician or geriatrician, and pharmacist.  There are also several online tools you can use to check your medications for interactions.  Here are two online tools:  PDRhealth.com and drugdigest.org.  Educating yourself on what medications cause potential problems for seniors is a good way to become an advocate for your parent.  As well as knowing the suggested lists of medications to avoid if a senior has a specific diagnosis.  My Health Care Manager also reviews seniors' health history and medications and can consolidate that information into one locale to assist families in managing their parent's health care.

My Health Care Manager has introduced a new FREE service that uses a little bit of technology to connect you to a lot of geriatric care research and experience. 

If you look in the upper right hand corner of this page you will see a "sunburst" linking you to a free service called the Caregiving Community.  By joining the Caregiving Community you can ask a question of our geriatric care management team and get an answer by the next business day.  Ask as many questions as you want, whenever you want.  In addition, once a month you will receive another Caregiving Community solution selected from best questions and answers we've tackled that month.  There is no cost for the service; all you need to provide is a name and email address.  We will not share or sell your name with others and we will not inundate you with any kind of high pressure sales.

So what's the catch?  Well, we do have a company interest here.  We believe that by providing valuable information to people caring for a senior in their life those caregivers will turn to us if they ever need help.  No tricks.  We know that if we can help families with the complex issues of aging everyone wins.

We are hearing more and more about the older adults being taken advantage by a scam artists, being victims of violent crime and even human interest stories of seniors being found alone, malnourished and unable to care for themselves.  But what exactly is elder abuse? 

According to the National Center on Elder Abuse (NCEA),  elder abuse is any form of mistreatment that results in harm or loss to an older person. It is generally divided into the following categories: 

1. Physical-  physical force that results in bodily injury, pain, or impairment. It includes assault, battery, and inappropriate restraint.
2. Sexual- there is non-consensual sexual contact of any kind with an older person
3. Domestic Violence- an escalating pattern of violence by an intimate partner where the violence is used to exercise power and control
4. Psychological- the willful infliction of mental or emotional anguish by threat, humiliation, or other verbal or nonverbal conduct.
5. Financial- the illegal or improper use of an older person's funds, property, or resources. 

Other terms you may hear about are 'neglect' (failure of a caregiver to fulfill his or her care giving responsibilities) and 'self-neglect' (failure to provide for one's own essential needs.) More detailed information can be viewed at www.preventelderabuse.org/elderabuse/elderabuse.html - NCEA.

The problem of elder abuse is large and is also under-reported.  In a National Incidence Study on Elder abuse, approximately 450,000 elderly adults experienced abuse in 1996. If self neglect had been included, it would have risen to  551,000. The NCEA Estimates of Prevalence in the U.S.

• "...between 1 to 2 million Americans age 65 and older have been injured, exploited or otherwise mistreated." 
• One in 14 incidents in domestic settings (excluding self-neglect) are believed to be brought to the attention of authorities.
• In overall reporting of financial exploitation, one in 25 cases suggests that there may be five million financial abuse cases.
• For every case reported to authorities, an estimated five cases of elder abuse go unreported.

What can you do? You can enhance the awareness of elder abuse. In most states, it is required that health care professionals report suspected abuse. But even if it is not mandated is the right thing to do.  If you would like more information on mandated reporting, visit http://elder-law.lawyers.com/Elder-Abuse.html.

Also, educate yourself.  The Hartford Foundation Institute for Geriatric Nursing has created a tool to document and assess for elder abuse.  It can be found at  www.hartfordign.org/resources/education/tryThis.html. 
It can assist you in assessing and summarizing abuse and neglect concerns by assessing the senior’s appearance, indicators such as bruise and/or fractures- or with self neglect malnutrition and/or signs of depression- or in areas of exploitation, where the senior’s monies have been mishandled. 

The key is to be aware, seek information, and help the seniors preserve their dignity and their rights.  Let’s keep our seniors safe.

To read our special Update on Senior Fraud, please click here.

As we entered into spring, the presidential candidates continue the health care debate.  The real issue is that the US has an aging population.  By 2030, the number of adults age 65 and older will nearly double to 70 million. With twenty percent of the Medicare population having at least five chronic conditions (e.g. hypertension, diabetes, arthritis), the question remains: How do we care for these elders? 

Geriatrics is a growing specialty where physicians, nurses, social workers and other health care providers receive special training dedicated to improving the health, independence and quality of life of all older adults.  Geriatricians are physicians who are experts in caring for older persons; they are initially trained in family practice or internal medicine and then complete at least one additional year of fellowship training in geriatrics. They have the expertise to coordinate services among multiple specialty care providers.  For more information on the profession, visit the American Geriatrics Society website at http://www.americangeriatrics.org.

A geriatrician will coordinate a health assessment for older adults with the primary goal of encouraging and promoting wellness and independent function. The health assessment will include an interdisciplinary team approach to the physical, emotional, cognitive, functional, and medication status of the older adult.  If you would like to locate a physician in your area who is sensitive to the special needs of older adults, you can submit your request by completing a form on line located at http://www.healthinaging.org/public_education/physician_referral.php  or contact a geriatric care manager in your area.  To locate a local geriatric care manager, visit http://www.caremanager.org/.  In addition, telephonic geriatric care management services are now offered by My Health Care Manager.  To learn more, visit our website by clicking here.

Family members of aging parents who have dementia or Alzheimer's Disease have a difficult job.  Individuals with dementia and Alzheimer's often show changes in personality, emotions, and social behavior.  These changes are common symptoms of the disease and occur with the cognitive decline.  Family members often feel a sense of ambivalence, having both positive and negative feelings toward their aging parents.  In a 2007 USA TODAY/ABC News/Gallup poll, "Slightly less than half of those [family members] providing help say it has caused them some stress or a great deal of stress." (USA TODAY/ABC News/Gallup poll, May 24-June 3, 2007).  Feelings of anger, resentment, and guilt are all common among family caregivers.  Lack of assistance and support from other family members and lack of time can all contribute to these feelings.  This person is your mother or father whom you love, and your feelings of anger and resentment can cause feelings of immense guilt.  Family members often express depression and a sense of sadness watching their once independent and capable parent decline.
You are not alone!  Most family members caregiving for a parent of dementia or Alzheimer's express these same feelings.  It's important to care for yourself!
Here are a few tips for caring for yourself:
1.  Take time for yourself!  Set aside time each week to go to a movie, out to dinner with a friend, shop by yourself, take a yoga class, read, golf, enjoy time by doing your favorite hobby, etc.
2.  Deep breathing exercises.  When your loved one has you frustrated, try to take deep breathes and de-stress.
3.  Set up a schedule with other family members to help out with mom/dad.
4.  Enlist the help of friends, neighbors, church members, etc. 
5.  Maintain connections with friends and your community.  Caregivers often isolated themselves from others and focus all time on mom/dad.
6.  Join a caregiver support group.  See the Alzheimer's Association for local support group information. 
7.  Educate yourself.  Learning about dementia and Alzheimer's Disease will help you understand the impact of cognitive decline on everyone involved.
8.  Call on a geriatric care manager for assistance.
9.  Be aware of your stress level.  Know your stress level and know when it's time for a break.
10.  Don't be afraid to ask for help.  Caregiving is a 24/7 job and even the best caregiver needs a break!

Many families will get together this weekend for Easter.  Sons and daughters who may not see their aging parents often will travel to visit them and families will be reunited.  The holidays are often when adult children notice signs of aging in their parents, whether its a physical decline or a change in cognition. 

Encourage your parents to see their health care providers to address any changes that may inhibit their daily lives, whether it's a change in mobility or trouble with balance, or difficulty remembering things or worsening arthritis.  Proactively addressing these issues can help seniors maintain their mobility, better manage chronic illnesses, and put support systems in place prior to a crisis.

It can be difficult to bring up issues like this during a family holiday, so you may consider scheduling another visit in the near future.  Sometimes denial is the reponse to the aging process.  If your parents don't want to discuss the issues with you, you can enlist the help of a health care provider or other trusted advisor (whether it's a geriatric care manager, their long-time CPA or attorney, or even a close friend) to encourage them to proactively address the issues.

I was just reading an article extolling the virtues of the Personal Health Record in helping seniors and their families.  It was all true … and I wanted it to say more.  The Personal Health Record is also a critical tool in knitting together geriatric care provided by the health system.

The current U.S. health system does not have a good way to connect all of facets involved in caring for elders.  Arguably, it doesn’t have a good way to connect itself for any of us.  There are professional initiatives underway like the Indiana Health Information Exchange, but these are major long term undertakings.  In addition, there is little or no reimbursement available to health care providers for extensive coordination of care.  Add to these obstacles the desire of most Americans to go wherever and whenever they choose for care and it’s not hard to see why this challenge isn’t easily solved.

 

The Personal Health Record, however, is a tool available immediately to help address the coordination.  With a complete record in hand you can dramatically speed and improve outcomes from the health system.  Knowing the specifics of treatments and medications your loved one is using, knowing the recent health incidents, just knowing the other providers involved in care - can mean a faster diagnosis, earlier treatment, and even saved lives.

 

You are the glue!  Make your parent’s Personal Health Record and have it available.  Carry the essential information with you and them.

Don't procrastinate any longer.  Create your medication list or, if you are a caregiver, create one for your aging parents.  If you want help and advice get a geriatric care manager. 

This first job is easy to start.  Even if you are going to enlist help from a geriatric care manager or other in home services, having this list will only speed up their ability to help you or your loved one.  The medication list is the first step in any program of medication management.

Click on this link for a FREE quick spread sheet from one of my previous posts - Medication List Spreadsheet.

Make copies of the list and let your doctors know, it's critical.

For those of us caring for aging parents, there is information, support, and shared experiences to be found in the world of books.  The New York Times just published a review of a new book called 'My Mother, Your Mother: Embracing Slow Medicine, the Compassionate Approach to Caring for Your Aging Loved Ones'.  Written by Dr. Dennis McCullough, a practicing geriatrician at Dartmouth Medical School, it champions taking a different approach when treating older patients.  Gone is the focus on high technology and strong medicine, with 'slow medicine', the focus is on family-centered care, less invasive testing and procedures, and exploration of all options (i.e. depression would not automatically be treated with strong drugs, but first one might see if having a pet or hiring a companion could relieve the depression). 

While this approach may not work for everyone, and may not be preferred in all situations, the book is worth a read for those with aging parents.  It's not all about medicine- as the review points out, some of it is simple advice like "it is always the right time to say ‘thank you’ and ‘I love you’ ", and a reminder to really listen to your aging loved ones- their voice can often tell you more about their health or state of mind than their words or actions.

To read the review on The New York Times website, click here.
To view the book on Amazon, click here.

I work for a Geriatric Care Management company – My Health Care Manager.  I work with RN’s that have in-depth geriatric experience.  I read about geriatric care and caregiving on a daily basis.  I even give talks on Caregiving to employer groups in Indianapolis. So, I thought I was prepared, I thought I was handling things well, I thought I was the “exception” – the caregiver who takes everything in stride, who gets enough rest and who effortlessly achieves work/life balance without giving it a second thought.  That was until last weekend.

Last weekend, I crashed.  I was tired and irritable, got in arguments and cried without provocation.  I had finally had it.  I was tired of trying to be all things to all people – a devoted daughter, an attentive friend, a dedicated employee and a caring partner.  I was tired of not finding time for myself, tired of not curling up with a good book, tired of doing too much laundry and tired of sorting through tax records.  I was tired of answering my Mother’s questions over and over, I was tired of grocery shopping and most of all I was tired of being responsible.   

With shock, I realized my energy was all but depleted and I couldn’t believe the depth of my tiredness both physically and emotionally.  So, I crashed and slept a lot, read books and a caring partner took me out to dinner, cooked dinner for me and took my Mother and me to lunch.  He stepped in to prop me up and I was grateful for his help.  By Monday, I was feeling much better and ready to face the world.

When I spoke with a close friend about what happened – she wasn’t surprised and pointed out that my Mother had moved here six months ago.  She reminded me that I had been on the go ever since. I hadn’t realized how much time had passed or even thought about it, but realized she was right.  No wonder I was tired and cranky and motion sick from my merry-go-round life.

It was a rude awakening and I realized that I needed to follow some of the advice I often share with others. So I expressed my concerns to several friends and two volunteered to take my Mother on an outing (without me).  I worked less.  I engaged an Accounting Firm to help me with some financial tasks.  And a very thoughtful partner continued to provide encouragement and support as well as “date nights” and flowers.  And, most importantly, I gave myself a break!  I read books in the evening and let the laundry pile up.  I treated myself to an extravagant spring purse and savored chocolate covered blueberries.  It didn’t take much to bring the balance back to my life, but I learned a valuable lesson. 

So, the next time I give a talk about Caregiving – I’ll admit I didn’t follow the rules espoused in my carefully crafted Powerpoint presentation.  I’ll share my story.  I hope my experience will help others recognize that trying to be all things to all people is a useless endeavor, especially when it means you lose yourself in the process.

 

Families caring for aging parents or other aging loved ones know that it can be a difficult balancing act- especially for the primary caregivers, who often work full-time.  In addition to being a caregiver, you want to spend time with your family and children, you want to keep your close friendships, you want to maintain your performance (and attendance) at work, and on top of all of this- you know you need to take time for yourself as well!  You can only be 'Superman' or 'Superwoman' for so long... taking time for yourself can help prevent caregiver burnout- a very real problem.

Employers are realizing that caregivers may need extra help, and many are stepping up to help their employees.  Some are offering flex-time to allow caregivers more flexibility, and others provide general referral services to things like adult day care centers.  Many are starting to offer even more extensive eldercare benefits to their employees, like access to our company (My Health Care Manager) and geriatric care management services... to read an article from the IndyStar on 'Balancing Burden of Eldercare', please click here.

We recently had some experience with the "set it and forget it" approach to the medication list.  It's too easy to make a medication list during a flurry of activity to get organized and then consider it done... for good.  Of course medications, dosages, and frequencies change over time and the list needs to be kept current.

For anyone dealing with multiple medications, keeping it current isn't enough.  It also needs to be communicated.  When you first build a medication list for yourself, your parents, or other loved one you should send it to every provider involved.  Yes EVERY provider and caregiver.  If you expect the health care community to make the best choices, they need to know all the medications in play.

At My Health Care Manager our best practice is to write a cover letter to all the health care providers and attach the full medication list.  For members under our Medication Management Program we extend this same notification every time there is a change to the prescription list.  This lets the provider know who else is involved in the care and what medications may be impacting their treatment recommendations.

As a caregiver or active senior, you can certainly do this yourself without the help of geriatric care manager.  Remembering to communicate is the key.  Don't forget to tell the other caregivers involved.  This is critical to making certain the proper amounts are taken and that potentially serious mistakes are avoided.

For the New Year I would like to share some resources and various sites that are useful whether you are looking for assistance in locating elder care services or trying to find specifics regarding geriatric health care.

Where you aware that the National Institute on Aging provides publications and other materials such as “Age Pages that address healthy aging, caregiving and specific topics such as dementia, diabetes and tips on medications.  Call 1-800-222-2225. or visit web www.nih.gov/nia.  Majority of their information is provided free of charge.  Other government sites are the Administration on Aging www.hhs.gov  or for the official governmental site for those who have Medicare http://www.medicare.gov

Some of the associations that share geriatric information are the American Association of Retired Persons  www.aarp.com   American Geriatrics Society , www.americangeriatrics.org and caregiver alliance www.caregiver.org

For end of life issues – Aging with Dignity is an excellent site to assist you in addressing those hard to discuss topics ( http://www.agingwithdignity.org). Aging with Dignity is a non-profit organization that was established to provide practical information, advice and legal tools you need to assist you in identifying and documenting your wishes and those of your loved ones.  The document called the “Five Wishes” is legally valid in 40 states  you can obtain a copy at http://www.agingwithdignity.org/5wishes.html

As we meet the challenges that 2008 will bring – I will continue to provide tips and resources to assist you in navigating the health care system and meeting the needs of your aging parents.   

Happy New Year!  

As the holidays come to a close, are you experiencing the holiday blues? Are your parents? While you where visiting your aging parents did you notice any signs of depression or mood changes? It is known that suicide rates increase over the holidays. But did you know that between 5% to 20% of persons over age 65 living in the community suffer from depression (2002, Primary Care Geriatrics)?

Depression is a common disorder among the elderly but is not a normal part of growing old.  It is one of the diagnoses that continue to go untreated. There are many reasons for this, one being that physicians have the tendency to focus on illnesses affecting the body instead of the mind. Another key reason is that the older adult was taught to be independent and feel that they should take care of themselves and "their” problems. Your parent may feel that they should not “bother” their physician or you with their feelings of loneliness/depression. As the adult child, you may feel that you do not have the right to intrude on your parent’s privacy.  But, if your parent has any of the common depressive symptoms such as irritability, frequent crying, loss of interest or pleasure, weight gain or loss (especially weight loss), insomnia, fatigue, decrease in ability to concentrate, feeling of hopelessness and/or suicidal thoughts, please assist him/her in making an appointment with his/her physician. If you can, go with them to the appointment and take a list of symptoms/ concerns to share with the physician.  Reinforce that these depressive symptoms are treatable and that he/she deserve to feel better, to have more energy, and to continue to age in place.  

 One day I googled “depression in the elderly” and received 369,000 results- here are some resources that might assist in you in your search.

 

Resources:

 

The geriatric depressions scale is a self - administered scale that can measure depression in the elderly.

 

GERIATRIC DEPRESSION SCALE (GDS)

 

CHOOSE THE BEST ANSWER FOR HOW YOU FELT THIS PAST WEEK.

                                                          

CIRCLE ONE (YES OR NO)

 

  1.  Are you basically satisfied with your life?     Yes     No

  2.  Have you dropped many of your activities and interests?     Yes     No

  3.  Do you feel that your life is empty?     Yes     No

  4.  Do you often get bored?     Yes     No

* 5.  Are you hopeful about the future?     Yes     No

  6.  Are you bothered by thoughts you can't get out of your head?     Yes     No

* 7.  Are you in good spirits most of the time?       Yes     No

  8.  Are you afraid that something bad is going to happen to you?     Yes     No

* 9.  Do you feel happy most of the time?     Yes     No

 10.  Do you often feel helpless?     Yes     No

 11.  Do you often get restless and fidgety?     Yes     No

 12.  Do you prefer to stay at home, rather than going out and doing new things?     Yes     No

 13.  Do you frequently worry about the future?     Yes     No

 14. Do you feel you have more problems with memory than most? Yes No

*15. Do you think it is wonderful to be alive now? Yes No

 16.  Do you often feel downhearted and blue?     Yes     No

 17.  Do you feel pretty worthless the way you are now?     Yes     No

 18.  Do you worry a lot about the past?     Yes     No

*19.  Do you find life very exciting?     Yes     No

 20.  Is it hard for you to get started on new projects? Yes     No

*21.  Do you feel full of energy?     Yes     No

 22.  Do you feel that your situation is hopeless?    Yes     No

 23.  Do you think that most people are better off than you are?     Yes     No

 24.  Do you frequently get upset over little things? Yes     No

 25.  Do you frequently feel like crying?     Yes     No

 26.  Do you have trouble concentrating?     Yes     No

*27.  Do you enjoy getting up in the morning?     Yes     No

 28.  Do you prefer to avoid social gatherings?     Yes     No

*29.  Is it easy for you to make decisions?     Yes     No

*30.  Is your mind as clear as it used to be?     Yes     No

  

*Appropriate (nondepressed) answers = yes, all others= no... or count number of CAPITALIZED (depressed) answers

Score: _____ (Number of "depressed" answers)  

 

            Normal               5 +/- 4

            Mildly depressed    15 +/- 6

            Very depressed      23 +/- 5

________________________________________________________________

 

References:

1.  Yesavage JA, Brink TL, Rose TL, et al.  Development and validation of a geriatric depression rating scale:  a preliminary

report.  J Psych Res. 1983; 17:27.

 

2.  Sheikh JI, Yesavage JA.  Geriatric Depression Scale:  recent evidence and development of a shorter version.  Clin Gerontol.

1986; 5:165-172.

The Geriatric Depression Scale may be used freely for patient assessment according to the authors

 

http://depression.about.com/od/elderly/Elderly_Depression.htm

http://www.consultgerirn.org/topics/depression/want_to_know_more

http://nihseniorhealth.gov/depression/aboutdepression/01.html

 

Today, many families are separated by distance and may see each other only a few times a year.  For those with aging parents, the holidays spent together can often be when adult children notice changes in their parents or loved ones.  You may notice that your mom seems forgetful or has had a change in cognition, your father has less mobility than the last time you saw him, or maybe your aunt's arthritis symptoms have worsened.  This can be a difficult situation, especially for long distance caregivers.

It's important that their geriatricians or health care providers be notified of changes in their behavior, symptoms, or overall well-being.  You can ask your loved one to accompany them to doctor visits, or employ the help of a geriatric care manager if you are unable to be there.  This will help you understand the situation, their diagnoses, and the treatment plans given to them by the doctor.  Encourage them to ask their doctor questions if they don't understand their doctor's recommendations or their prescribed medications, especially if they have multiple prescriptions.  Many of us are not familiar with the health care system, and it can be daunting.  Geriatric care managers can help explain the situation, help you weigh your options, and work to make sure that your loved ones are getting the quality of care that they deserve.

It can be hard to be a caregiver, and it can also be hard to realize that you may need to step into that role.  Don't be afraid to ask your friends and family for support. 

Have a wonderful holiday season.

·   An excellent resource regarding evidence based practice for nurses in clinical and educational settings is the Harford Institute for Geriatric Nursing, New York University College of Nursing http://www.consultgerirn.org/ . This site covers geriatric topics including but not limited to overviews, definitions, background information such as incidence, prevalence, assessments, assessment tools, and nursing care strategies. In dealing with fall prevention, as an example, the information that you will have access to is a general overview of falls, definitions, along with assessment tools and educational material. One tool that is shared is the Tinetti assessment tool for the older adults who can ambulate independently. The site also provides nursing care strategies, treatment protocols and management recommendations.

·   Age related changes (such as altered visual acuity, decreased balance and muscle strength, hypotension, and changes in bladder function such as frequency and/or incontinence) increase the risk of falls. If you have a hospital based practice, you know that falls are the single largest category of incidents in an acute care setting and for people over 65 years of age, falls are responsible for one third of deaths (http://www.consultgerirn.org/).

·    In dealing with the elder population, always remember to evaluate for the risk of falls and provide fall prevention education. Another resource for educational materials is the National Institute on Aging  www.nihseniorhealth.gov .

The Alzheimer's Daily News website recently featured a short article on planning ahead for long-term care.  The source was our very own Indianapolis Area Vice President, Jeannie Keenan, RN.

Stories about this topic have been fairly prevalent in the news recently.  Many of the baby boomers have not planned ahead when it comes to providing care for their aging parents.  This could be paying for the cost of a retirement community or assisted living facility for their parents; it could be bearing the cost of bringing eldercare services into the home.

As our parents age, it can be difficult to address the often emotional issues of failing health, loss of mobility, cognitive decline, or just the need for a little bit of extra help or a smaller, more manageable living space.  Seniors may be reluctant to move and sometimes their adult children may not agree on what is best for their parents.  This underscores the importance of one of Jeannie's tips: Begin talking about the issues and the future early.  It is much easier to plan ahead than to be caught off-guard.  Planning ahead offers you more time to complete thorough research of the options, prepare financially for the future, and come to a decision with which the whole family can be pleased.

While this article focuses on the financial aspects of long-term care, many other variables can be involved in the issue including family dynamics, a parent's medical needs, a parent's wish to continue aging in place, or the adult children's desire to relocate parents closer to them.  A geriatric care manager can assist families as an objective third party, knowledgeable about local facilities and their capabilities and reputation, and familiar with all of the living options available for seniors based on their particular needs and desires.

Click here to read Jeannie's planning tips.  You may also learn more about Jeannie Keenan by clicking here.

Today, November 14, is World Diabetes Day- the first ever!  A resolution passed in December of 2006 by the United Nations created an annual United Nations Day for World Diabetes starting in 2007.  For more information on the day of recognition, please visit the World Diabetes Day homepage.

It just so happens that two recent studies have highlighted some of the issues affecting diabetics...

A diabetes study in the Journal of General Internal Medicine (set for the December issue) found that of diabetic seniors, 92% have at least one other chronic condition.  Even more worrisome: almost 50% have three or more other chronic medical conditions in addition to diabetes.  Seniors often make managing their other chronic conditions a priority and fail to properly manage their diabetes.  Many of the other conditions in seniors were triggered (or aggravated) at least in part by their diabetes.  The study stresses the importance of holistic care and taking a 'whole-person approach' to disease management. To read more about the study, click here.

For families, diabetes can affect multiple generations.  It's important to take preventative measures like eating a healthy diet and being active.  Once diagnosed with diabetes, it's important to take care of yourself!  A recent study in Australia suggested that more than 60% of those diagnosed with diabetes are wearing the wrong size shoe.  The wrong size of shoe could increase the chance of having foot problems, which (especially for diabetics) can even lead to amputation.  Please encourage those with diabetes in your family to have their feet properly measured to ensure they are wearing shoes the correct length AND width for their feet.  For more on this study, please click here.

It's important for seniors to work with their health care provider or geriatrician to manage their diabetes.  As the first study finds, many seniors have other chronic conditions in addition to diabetes.  For these seniors and their caregivers, a geriatric care manager or eldercare manager can partner with them and their other health care providers to approach their disease management in a more holistic fashion.

In my last blog, I focused on memory loss that is typically associated with aging. As we all know, aging starts as soon as we are born.  But did you realize that most older adults are healthy and engaged in normal activities. According to Hartford Institute for Geriatric Nursing approximately 78% of  65+ are healthy. For additional statistic and resources visit Hartford Institute for Geriatric Nursing’s new site http://www.consultgerirn.org/resources .   Today, I would like to talk about living a healthy lifestyle as we age. Genetics plays a pivotal role in our health outcomes but we need to acknowledge that environmental conditions and the quality of health care that one receives strongly influences the aging process. Aging is a combination of both genetic and environmental factors. Everyday we witness this. A person who has inherited high cholesterol from his/her parents but chooses to continue to smoke which impacts his/her risk factor for heart disease. This puts him/her at a risk for a heart attack. So what are some key behaviors for maintaining a healthy lifestyle while we age: not smoking, drinking alcohol in moderation, exercising, getting adequate rest, eating a diet high in fruits and vegetables, coping with stress, maintaining a positive outlook on life.  Another import component is to keep up with your health screenings.  It is not uncommon during a geriatric assessment to find out that breast cancer runs in a woman’s  family, the mother and sister both died for breast cancer, but the surviving sister who is 70 has not had a mammogram in years, even though Medicare pays for it.  It is important to always talk to your physician and schedule your necessary screens.     As a start, review the health care screening activities listed below.  You may want to use the following tool to keep track of your screening activities and share it with your physician.  

Recommendations		Date Completed
Yearly  **	Flu Vaccine
> 65  1 dose **	Pneumococcal Vaccine
1 booster dose q 10 yrs *	Tetanus Vaccine
> 60  -- 1 dose *	Shingles Vaccine
> 65  q 1 -2 yrs  *	Mammogram/Clinical Breast Exam
Q 3yrs  - can be stopped > 70 *	Pap Smear
At least 1 x after age 65 *	Bone Density Test
At least once in people with HTN or Hyperlipidemia *	Diabetes Mellitus Screening
If diabetic – q 3 mo	Hemoglobin A1c
Yearly if HTN, Diabetes etc. *	Eye Exam
Yearly *	Hearing  Exam
> 50 yearly then q 5yrs/10 years *	Colon Cancer Screening (FOBT, sigmoidoscopy/colonoscopy)
At least Yearly *	Blood Pressure Screen
> 65 screen  - q yr	PSA ( male)
Q 5 yrs/ more often if CAD, DM, PAD, or Prior Stroke	Lipid Disorder Screening
Other Screening Activites

 CDC Recommendations & US Preventive Services Task Force (USPSTF) * USPSTF (AGS: Geriatrics at Your Fingertips 2007)  Remember that a geriatric care manager can always assist in you assessing your dimension of well-being and in designing an action plan to maintain a healthy lifestyle while you age.