As a caregiver, the responsibility for decisions regarding your parent’s care falls to you.  Often you wish you could discuss the options, choices and next steps with your parent, just as you discussed so many choices in the past…where to go to college, where to have your wedding reception, which neighborhood to select.  But parents with Alzheimer’s cannot help with current decisions as their ability to reason, compare and choose has been ravaged by the disease.  Sadly, dementia robs them of their ability to chart their own course.

So, what should caregivers do when faced with a variety of paths – how do you know how to choose what is best for your parent? How do you know when a parent’s living environment is no longer safe? How do you know when a parent needs more assistance? 

Here are a few suggestions:

• Pay attention to your parent – they may be confused, but they will give you clues when things aren’t going well.  They may seem more agitated, confused or disoriented.  Their routine may change and a situation that has worked well in the past, now poses problems.  For example, they may no longer want to eat dinner because they either can’t remember where the Assisted Living Dining Room is located, or they are afraid to leave their apartment.  
• Check in with their caregivers – have other family members, a companion, assisted living staff or adult day care workers noticed a change in your parent?  Are they concerned? 
• Take your parent in for a check-up – have the Doctor evaluate your parent and review their medications and mental and physical health. 
• Review your parent’s ability to complete Activities of Daily Living – things like bathing, dressing, continence, mobility, feeding.  Has there been a change in their ability to do these things?
• Engage a Geriatric Care Manager – have them conduct an independent assessment to provide an unbiased view of the situation.

Once you have gathered the above information, spend time thinking and talking to others you trust about the findings.  Choose the next step based on what you think is best for your parent at this moment in time.   For instance, if you determine that they need more assistance, think about the pros and cons of providing additional assistance in their current environment vs. moving them to a new environment such as a Memory Care Unit.   There is no “right” decision.  Take comfort in the fact that you have been both thorough and thoughtful when you made the decision.  Always remember that your parent is better off when you address concerns as they arise vs. postponing decisions until a crisis arises.

It is a myth that older adults need more sleep than younger adults.  In reality, older adults need about the same amount of sleep as everybody else – between 7-9 hours each night.  Typically, many go to bed earlier and wake up earlier than when they were younger.  This could be due to the fact that their bodies are in a pattern of getting up early daily to go to work, etc.  It is true that elders experience less “efficient” sleep, meaning they spend less time in the deeper stages of restorative sleep and feel less rested when they wake up.  Hence, many older adults fall into a pattern of taking naps during the day.  It is essential to get a good nights sleep every night as a part of healthy aging.  Sleeping well will help you feel rested the next day along with being able to concentrate better.  If you do find yourself not sleeping well, here are some tips to consider:
1. Follow a regular sleep schedule – Go to bed and get up at the same time each day – even on the weekends.
2. About 30 minutes before going to bed, do things to relax your body (read a book, take a bath, watch TV, listen to music)
3. Have a comfortable pillow
4. Exercise regularly but not within 3 hours of when you plan to go to sleep.
5. Do not have caffeine late in the day since it is a stimulant and can keep you awake at night.
6. Drink less fluids in the evening.  Getting up throughout the night to use the bathroom breaks up your sleep.
7. Make an effort to get outside everyday to get some sunshine.

If you still feel tired and are not sleeping well it is important to see your doctor about this so you can get a good night’s sleep without having to count sheep. 
 

My Mother has declined precipitously during the past six weeks.  We’ve watched helplessly as her confusion increased, her mobility worsened and her sense of time and place evaporated.  Yet, a routine Doctor’s  appointment and lab work did not reveal any treatable physical changes.
Yet, everyone around her noticed the decline – my sister, the companion, her Health Care Manager (a geriatric care manager from My Health Care Manager) and the nurses at the Assisted Living facility.  We were saddened to see my Mother struggle with this new stage of life and worked together to offer additional support.  We all ASSUMED that this was the natural progression of the dementia.

Our Health Care Manager was puzzled by what my Mother was experiencing.  She had worked with many, many seniors and felt that my Mother’s cognitive decline did not fit the typical pattern.   She felt that the changes my Mother started to experience happened overnight vs. being a gradual process.  It bothered her, so she sent a letter to my Mother’s physician and explained her concerns.  This led to a conversation between my Mother’s Doctor and the Health Care Manager.  As they reviewed my Mother’s case, a light bulb went off.  My Mother had a medication change in December….was it possible that the med change was negatively affecting her current physical and mental state?   Was it possible that the changes we’d noticed were not necessarily caused by the next stage of the dementia, but a medicine interaction? 

Thanks to the Health Care Manager’s detective work and follow up with the health care provider, we’ve stopped the new medicine that was added to my Mother’s care plan in December.  We have our fingers crossed that we will see a difference and that some of the decline will be reversed.  It is possible that there are other causes – a series of small strokes, for example.  But for now, we are addressing what the Doctor thinks is the most likely cause.

We’ve learned a good lesson.  Never assume that even small changes are “normal” …question everything!  And seek professional help whenever necessary. 

 

When our weather changes,  everyone is worried about the “winter dangers”  such as broken bones from falls on ice (especially for older adults with mobility issues) or breathing problems caused by cold air, but cold weather is very risky for older people. The winter chill can lower the temperature inside the body and that can be deadly if not treated quickly.  A dropped body temperature, hypothermia, can be caused by staying in a cool place.  The normal body temperature is 96° F and it only takes a couple of degrees below the body’s normal to be dangerous such as causing an irregular heartbeat leading to heart problems and death.

It is very important for a senior to know his/her surroundings and prepare for the winter months.  Changes in the older adult that accompany aging make it harder for them to know when they are getting cold.  It is also harder for the body to warm itself. So it is very important for older adults to pay attention to the weather and how cold it is going to get.

Some general safety recommendations from the American Geriatric Society are:

1. Stay indoors when it's very cold outside, especially if it's also very windy; and keep indoor temperatures at about 65 degrees or above
2. If you have to go outside, don't stay out in the cold or the wind for very long
3. Wear two or three thinner layers of loose-fitting clothing. (They are warmer than a single layer of thick clothing.) Always wear: a hat, gloves or mittens (mittens are warmer), a coat and boots, a scarf to cover your mouth and nose and protect your lungs from very cold air
4. Stay dry; wet clothing chills your body quickly
5. Go indoors if you start shivering- it's a warning sign that you're losing body heat.
6. Know the warning signs of hypothermia: lots of shivering; cold skin that is pale or ashy; feeling very tired, confused and sleepy; feeling weak; problems walking; slowed breathing or heart rate. *Note: Don't rely on shivering alone as a warning sign, since older people tend to shiver less -and some, not at all-as their body temperature drops. Call 911 if you think you or someone else has hypothermia.

For safety reasons, remember: stay warm, keep your thermostat set above 65, and have a plan if you lose power. 

**The following post is from my guest blogger, Natalie Langley, MSW.  She is a Geriatric Care Research Analyst for SCANS (for more on SCANS, please see Eric Tinsley's blog by clicking here).**

Brrr, its cold outside, what can we do?

The winter months are often a barrier when it comes to being able to go outside and enjoy the weather.  For seniors, this can restrict the ability to go outdoors for exercise and entertainment.  Caregivers may be struggling to find activities for their loved ones to keep their spirits high during the winter months and avoid isolation.  Below are some helpful ideas to help keep your aging loved one engaged.

• Reminisce with the person.  Take out vacation, family, or wedding photo albums, and share memories
• Watch classic movies
• Play games or cards
• Invite friends/family over for tea and snacks
• Visit the library
• Have the health care provider recommend simple exercises for your loved one, which could help improve balance and mobility 
• Attend a musical/play
• If arts and crafts are interests, go to the craft store and start a project (sew a blanket, paint a picture)
• Play CDs of all the person’s favorite songs

Driving is a key issue when it comes to the safety of older adults and the safety of others.  A news release from the Insurance Institute for Highway Safety (www.iihs.org) focuses on older adults.  As the population ages, there are more seniors on the road each year; however, from 1997-2006, the number of senior drivers killed in crashes decreased.  During this time period, the number of seniors involved in fatal crashes also decreased.  Many older adults report limiting their driving as they experience declines in memory, vision, mobility, and health, which may be a factor in the study findings.  For more information, the full release can be found on the IIHS website at http://www.iihs.org/news/rss/pr121608.html.

Many factors can affect an older person's ability to drive including loss of vision, loss of mobility, slowed reaction times, and cognitive decline.  It's important that caregivers monitor their aging loved one's ability to drive and address any concerns sooner rather than later.  You may want to speak to your loved one's doctor, or even have your loved one complete a driving assessment.  A geriatric care manager can help you address difficult issues like taking away the keys, and also help you identify alternative means of transportation in the area.  For more about My Health Care Manager's services, please visit our website.

The next post will contain safety tips for seniors driving in winter weather conditions, so be sure to check the blog again soon.

I would like to talk about scams on the elderly.  I am a board certified elder law attorney and am supposed to know something about the elderly and their problems.  However, the susceptibility of the elderly to scams is something that greatly puzzles me and I do not have an answer for it.  I just cannot understand the mechanism which makes smart people (who would never fall for a scam when they were younger) fall for the same scam when they are older.  I remember a case last year in which the son of an elderly woman brought in 3 grocery bags full of scam mail his mother was answering.  She had probably wasted about $20,000 on lotteries, sweepstakes, and con mail.

Right now on my desk are three files representing clients I have dealt with for a long period of time.  I will call them Clients A, B and C.   A was an executive of a company and had to be financially sophisticated to hold that job.  He came to me a month ago with a letter saying he had won $1,000,000 but needed to send in a processing and handling fee to secure his winnings.  He wanted me to authenticate his winnings.  When I told him it was a scam, he seemed disappointed but said he valued my opinion.  In his younger years, he would have thrown the letter in the waste basket.  In his older years, he took it to his attorney hoping it was something.  Why did age make him more vulnerable?

Client B was not an executive type but a blue collar worker.  He was always very handy with everything around the house.  He saved a lot of money by doing many things for himself.  He once showed me a lake cottage he had built himself.  I know he has saved several hundred thousand dollars - some of which I think is now at risk.  His son says he has been answering scam mail and sending checks to various people to secure his winnings.  He brought me an official looking letter saying he was very close to winning a large jackpot.  I told him it was a scam but I don't think he believed me.  The con is always the same.  Tell someone they have won something and ask for some money back to secure it.

Client C, an elderly lonely gentleman, is about to be taken advantage of by a woman, who promises him companionship.  In return, he will make her financially comfortable.  He came to me for some legal documents regarding the new relationship.  After I figured out what was going on, I respectfully declined to do the work.  I said I just did not want to see him get involved and would not aid him.  Again, I asked myself why his judgment had changed.  Was it just being lonely or was the same thing at work that makes the elderly so vulnerable to sweepstakes?

I don't know but I sure have a ring side seat in watching it happen.

I have the privilege of speaking tomorrow (October 10, 2008) at the Indiana Geriatrics Society Fall Conference. My topic is:

Vision for the Future: Impact of Informatics on the Continuum of Caregiving

We are constantly hearing certain buzz words in eldercare: aging in place, healthy aging, senior healthcare, wellness, and senior well-being.  How do we truly age in place and take care of our senior health needs in our current healthcare system?  One should become aware of the truths about aging versus the myths that are out there.  One should also help health care providers to promote wellness and independent function by asking them questions and having periodic overall health assessments. 

Do you know – Is this TRUE or a MYTH?

Most older adults are sick. 

MYTH!  Most older adults (78% of 65+) are healthy and engaged in normal activities.


If you are old, you are sick. 

MYTH!  Only 23% of older adults claim to have a disability.  85% of the debilitating diseases are from cancer, coronary artery disease, stroke, diabetes, kidney failure, obstructive lung disease, pneumonia, and flu. Remember  -- Chronic illness does not translate into functional inability.


Older adults have more chronic diseases than younger persons, but fewer acute illnesses.  

TRUE!  Older adults have more chronic diseases than younger persons, but fewer acute illnesses.  There are 102 acute illnesses reported per 100 people over 65 and 230 acute illness per 100 people under the age of 65.   85% of the debilitating diseases are from cancer, coronary artery disease, stroke, diabetes, kidney failure, obstructive lung disease, pneumonia, and flu.


Your body systems are affected by age.

MYTH!  Body systems such as your heart and lungs are minimally affected by age but PROFOUNDLY influenced by lifestyle behaviors such as cigarette smoking, physical activity,  what you eat, and sometimes if you have enough resources to access the care you need.

What should the older adult expect?  The older adult can expect to lose 2 inches of height by age 80, which can lead to changes in posture and our feet - which could affect our balance and create a potential fall risk.  Another fact is that the body cannot regulate its temperature as it did when one was younger, so an older adult needs to be aware of exposure both cold and heat.  If the temperature outside is high, the older adult is at risk for heat stroke.  

The most important item for an older adult to remember?  A health assessment promoting wellness and independent function is a must.  Remember that health care needs to be individualized… and that the body can remain healthy as one ages. Although our organs may gradually lose some function, a senior may not even notice these changes except during periods of great exertion or stress.
Today, there are more than 4 million Americans 85 and older. That number is expected to grow almost 5 times by the year 2050.  By the year 2030, it is estimated that the “oldest-old” (85 years and older), will grow to 10 million people. 

Views on aging are changing  

TRUE!  Aging is no longer synonymous with physical decline and illness. 


Future Blogs will continue to address the issues of senior health care and healthy aging.

Resources:
• Luggen, A.,S Meiner,S. E. (Eds.). (2001) National gerontological nursing association: Core curriculum for gerontological nursing. St. Lois:  Mosby.
• Mezey, M, Fulmer,T, Mariano, C, (Eds.). (2005) Best nursing practices in care of older adult. Curriculum Guide. ( 3rd ed.) New York:  The John A. Hartford Foundation: Institute for Geriatric Nursing.

For the last several months, we have been discussing safety concerns for the older adult.  We all know that medication management and fall risk prevention are instrumental to healthy aging, but a holistic picture is what is most important to assist in aging in place and maintaining good “health”.  As the boomers age, we will see more and more written on wellness, well-being, and just overall aging tips. 

But what is key to a healthy life style?

According to American Geriatrics Society it is

1. Not smoking
2. Drinking alcohol in moderation
3. Exercising
4. Getting adequate rest
5. Eating a diet high in fruits and vegetables
6. Coping with stress and
7. Having a positive outlook.  

These are important, but I feel that whether you are elderly or young, you need to understand your overall health issues, have social connections, be at peace with where you are in life, have a purpose, live in a safe environment that supports your needs, and keep your brain functioning. 

Good Morning America does a segment that highlights individuals celebrating their 100th or older Birthday.  Today a man was 107! I am always amazed at the life history of those over 100...  The majority have remained both physically and intellectually active and have remained connected with society.  Amazing, they never reference how many fruits and vegetables they have eaten!!   So stay connected… and do your brainteaser and always learn something new each day. 

Since I don’t have a healthcare background, I had a very limited understanding of physical therapy.  I thought it was only “prescribed” after an injury or surgery to help with rehabilitation.  I didn’t realize it could be “prescribed” to treat on-going issues often faced by seniors, such as loss of mobility or  balance deficiencies.

We became concerned when my Mother became increasingly unsteady on her feet and had difficulty getting up from a chair.  We thought these symptoms were signs of progressing disease or advancing age and “came with the territory.”  When we shareed these concerns with my Mother’s gerontologist, he ordered a physical therapy evaluation and three physical therapy sessions a week to increase her mobility.  My sister and I were thrilled to learn that exercises could help and that my Mother could be taught techniques to help her get in and out of the car and move around more safely and easily.

Mother has been attending her “exercise class” for about two weeks.  She told me she likes it and that they do most of their exercises while sitting in a chair… so it is not too difficult.  We are thrilled she is paying attention and participating.  Earlier this week, I took my Mother out to dinner.  We were seated in a long, low booth.  As we went to leave, I offered my hand to my Mother to help her up. She looked at me and shook her head and said “No, I need to use my legs.”  And I watched in amazement as she positioned her feet and pushed up with her legs and got out of the booth.  We both reacted with big smiles – because she had “done it herself.”

• Schedule of care events (e.g. medical appointments, therapy, geriatric care visits)
• Medical issues (e.g. Alzheimer's, arthritis, incontinence, congestive heart failure, diabetes, COPD)
• Health provider contact information and specialties
• Medication list including dosage, frequency, prescribing physician, and other specifics
• Recent Hospitalizations
• Client contact information
• Updates on key issues of aging such as Caregiving, Advanced Directives, Living Independently, Family Communications, Depression, and more
• Resources
• and more

It also supports secure, private interactivity with the Health Care Manager providing geriatric care for the family using tools like a discussion board, contact logs documenting visits and phone conversations, and posting of care goals like improving home safety, reducing isolation, improving depression, improving mobility, supporting treatment plans, and so on.

June is Home Safety Month.  Have you assessed your parents’ home and developed a disaster plan?  With all the environmental issues that are in the news, it’s a good time to review home safety and develop a disaster plan for parents or the special older adult in your life. The focus of this blog is on falls, which are the number one safety risk for older adults. Nearly one third of America’s older adults fall each year, with seventy percent of these falls occurring at home.

Ten Tips for Home Safety – Fall Prevention

1. Remove all throw rugs; if one cannot live without throw rugs, make sure they are secure with non-slip backing
2. Install grab bars in bathroom, especially in the shower/tub
3. Provide adequate lightening, especially around stairwells and pathways 
4. Keep a flashlight by the bed 
5. Use a nightlight 
6. Keep pathways clear of objects, especially electric cords
7. Remove clutter
8. Make sure the handrails on stairways are accessible and sturdy
9. Check carpets for any tears and/or holes
10. Review all medications- prescriptions, over the counter, herbs, and vitamins with doctor and/or pharmacist to reduce risk of dizziness and weakness 

Other areas of home safety for older adults is same as for others:

• Make sure to have a working smoke detector on each level of the home 
• Have a fire extinguisher on each floor
• If there is someone in the home using oxygen, make sure there is an oxygen awareness sign and that no one smokes in the area where there is oxygen
• Make sure there is a working carbon monoxide detector on each level of the home
• Keep a telephone within easy reach with numbers large enough to see in hurry
• Have a disaster plan
• Have a fire evacuation plan

Resource:  The Home Safety Council (HSC) website, www.homesafetycouncil.org, offers more information, illustrated handouts, and virtual home safety tour.

Look for next week’s blog addressing key components of a disaster plan of an older adult.

Last week, I traveled from Indianapolis, IN to Litchfield, CT with my Mother to attend my sister’s wedding.  It was a long trip as we got to the airport early to deal with security, took a 2 hour flight to Newark and then rented a car and drove 3 hours to a Bed and Breakfast in Connecticut.  Along the way, we had to take our shoes off, give up our purses for a security inspection, and take escalators, elevators and a train in pursuit of a National rental car.  Everyone knows that traveling today is an exercise in both patience and logistics…b ut when you are accompanying a senior who is not steady on her feet and tends to be confused….. the patience/logistics requirements increase ten-fold.

Planning and advance preparation can help ease the journey.  In our case, I found it helpful to:

• Keep my Mother’s ticket and ID with mine, rather than risk her misplacing the paperwork.
• Consolidate all carry-on items in one bag (meds, jewelry, reading material), so there was less to keep track of during the trip.
• Dress for the security line….slip on shoes, no heavy jewelry, easy to remove jacket.
• Bring an extra sweater, as most airports are freezing.
• Pack snacks in case of airline delays, missed meals and long wait times.  The food court can be a long way from the assigned gate – a walk a senior is not up to.  If a senior has diabetes or a loss of mobility, packing snacks is essential to avoiding missed meals or long walks to the food court.
• Request a wheelchair or flag down a motorized cart to assist with transportation from gate to gate, if necessary.
• Stop when the senior gets tired and sit for a few minutes.  The airport pace is very difficult for a senior to keep up with.  This is especially true if your loved one has a loss of mobility.
• Limit information and do not provide it all at once – just focus on the next step and explain to the senior.  Discussing the entire itinerary i.e. we are catching a plane, then renting a car, then driving to Connecticut... is too overwhelming.
• Remember that the crowds, noise and fast pace of the airport can contribute to a senior’s confusion and anxiety.  Try to buffer them as much as possible by walking so that they are close to the wall and you are on the outside to take the bumps as people push past you.
• Be sensitive to their fears – dementia may cause even seasoned flyers to feel nervous about flying.
• Enlist help – ask someone else to accompany you to help with luggage, logistics and provide moral support.
• Enjoy the senior’s sense of wonder along the way – for them, a plane trip is a rare and exciting event. 

In summary, traveling with a senior should not be taken lightly.  Advance planning is key to ensuring a safe and stress-free trip for both caregivers and seniors alike. Be prepared, be patient and always remember that seniors will need extra special care and attention during the trip.

As a follow up to the Elder Abuse blog, I was reading more about the safety risk of older adults. Did you know that a government study found that most victims of health care fraud are over age 65?   Quackery has been around for centuries. We have all grown up with Grandma’s remedies but today with TV, magazines, mail, web sites, and word of mouth there are more and more ways to be sold unproven remedies and “miracle cures.” This puts our elderly at risk! The older adult is frequently targeted for such scams and they are often unaware that the unproven remedies may cause harm. Not only do they waste their money, but it can prevent them from receiving the medical treatment that they may need.

How can they protect themselves?

• Get the Facts
• Be cautious
• Don’t believe everything they hear
• Take time
• Ask questions
• Request information
• Talk with their health care providers.

If you would like more information on how to protect yourself or how to check a product, you can contact:

Council of Better Business Bureaus (CBBB)
4200 Wilson Boulevard
8th Floor
Arlington, VA 22203
Check the telephone book for the number of your local chapter.
www.bbb.org

U.S. Food and Drug Administration (FDA)
5600 Fishers Lane
Rockville, MD 20857-0001
Phone: 1-888-INFO-FDA (1-888-463-6332—toll-free)
www.fda.gov

Quackwatch, Inc.
Quackwatch, Inc, is a nonprofit corporation making information available to combat health-related frauds, myths, fads, and fallacies.
www.quackwatch.org

For more information on health and aging -
Visit NIHSeniorHealth.gov (www.nihseniorhealth.gov), a senior-friendly website from the National Institute on Aging and the National Library of Medicine. The simple-to-use website features popular health topics for older adults. It has large type and a "talking" function that reads the text out loud.

Watch for my next blog --  “ Crime and the Elderly”

Anyone who has dealt with an aging parent or a senior friend that has cognitive decline knows how hard it is to discuss those difficult topics such as driving, advance directives and/or their wishes to age in place. These conversations usually happen during a crisis situation, e.g. the senior has fallen and been admitted to the hospital,l or suddenly their car has a huge dent in the back end. As I discussed in my last blog, there is no easy way to begin discussions about the senior’s ability to drive when he/she has memory loss. It is even harder to conduct these conversations when you have not been involved with the senior on a routine basis. Whether it is regarding their driving ability or their end of life wishes, as an adult child you have to remember to preserve your parent’s dignity while assisting them to talk about their decisions.

If at all possible, do not have these conversations during a crisis. Plan a convenient time to have these conversations with your loved one. Remember that you want to keep the conversations positive- thinking of solutions; progressive- how the issue will be addressed over time; and productive- not argumentative. It is important to keep the senior engaged.

Decide beforehand who is best to conduct the conversation. This is a discussion for the family members, but a decision needs to be made.  For instance, if it is regarding the senior’s driving skills, the person to deliver the message needs to be aware of how the senior is currently driving. Is the area of concern a one-time accident… or is it a daily roller coaster ride?

Decide on the best time to have these conversations. You want everyone to be calm, not filled with apprehension. You want it to be convenient for all of the people involved in the discussions.  For instance, in regards to advance directives, you do not want to hold these discussion in a hospital room while waiting for surgery. The conversations regarding your parent’s wishes regarding durable power of attorney or health care representative should be held prior to any illness.

It is best to pick the topic of discussion and have it prior to the crisis. Regarding advance directives, the earlier you can have these conversations, the better. Everyone - no matter what age they are - needs to decide on their own health care decisions… especially their wishes if they become unable to make decisions for themselves.  The financial power of attorney also needs to be decided before the senior has cognitive decline.

Develop a personal conversation plan for each topic that you would like to address and solicit professional support as needed. For example, if your parent has a relationship with a lawyer from drawing up their will, encourage your parent to talk with the lawyer about advance directives, including durable power of attorney. You may even help them set an appointment with their lawyer. Hopefully they will allow you to attend, but if not, ask them how it went and talk to them about your wishes.  

There is no clear-cut right or wrong time to have these difficult conversations. The key thing to remember is to have the conversations before your parent is unable to have them. 

Some good resources are Alzheimer’s Association’s website www.alz.org and the National Institute on Aging.  Click here for the NIA’s Caregiver Guide for more tips on communication or visit http://www.nia.nih.gov/NR/rdonlyres/C2F11D41-E5FE-435D-9C9D-A3489319D4AD/6531/Caregiver_Guide307.pdf.