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.

What does it mean to be young at heart?  I believe each individual's definition of being young at heart is different.  It comes down to our own thoughts about our personal well-being.  Optimal well-being can only be defined by ourselves.  Optimal well-being not only involves our thoughts on our physical health, but it also includes our mental and emotional well-being, social well-being, spiritual well-being, intellectual well-being, functional well-being, etc.
I think that my 77 year old grandmother is an excellent example of how someone is young at heart.  She always seems to have a good time.  She likes to have fun, has a good sense of humor and is always on the go...going out to lunch with her girlfriends, playing in her card club, participating in church functions and community organizations, watching sports (an avid basketball and baseball fan), and playing Wii bowling.  Through a family night event at her church, she has discovered the fun and exercise of Nintendo Wii bowling.  She has taken it upon herself to learn a new technology, how to play Wii bowling.  She teaches her senior peers how to play, engages them in friendly competitive games, and crowned herself the winner of "the old ladies division."  This game has created so much fun for her and is another example of how she keeps herself young at heart.  Not only should we look to seniors on how to stay young at heart, but we should share our discoveries with others.

At any age, people want to achieve and maintain a good overall quality of life.  For seniors, reminiscence is a great way to achieve insight and improve their personal quality of life.  Reminiscence is a process of remembering prior life events.  The goal of reminiscence is to help seniors retrieve positive events, feelings, and happy memories.  The end result creates more self-esteem, a more pliable mood state, improved coping skills, and improved social skills.  Helping seniors recall the positives from their past will aid them in their feelings and coping skills towards any current life challenges.  The main purpose is to rekindle their personal purposes which will also help restore self-confidence.
When I was in graduate school, I conducted reminiscence groups at an assisted living facility.  For my first group, I had 4 people attend.  My topic for that first group was "Summertime Vacations" and I asked people to come to the group with a story of a past summertime vacation and something from that vacation, a picture, something they purchased, etc.  Even though these individuals lived in the same building, they didn't know each other.  As I started facilitating the conversation about vacations, people started talking and laughing and saying "I traveled there too, did you go see that ...."  I enjoyed listening to everyone talk and as the group ended and people left, they stood around and kept talking and made a new friend.  My group size began to grow each time as people were enjoying themselves and were talking about it in the dining room and telling others they should come.  I set the date, gave the topic and they provided the conversation and their own props, which somtimes including a photograph, a song, a baked good, an outfit, etc.  I did this group for 4 months and ended my time there with a "Family Traditions" reminiscence group with a group of 28 participants.
I encourage everyone to take the time to reminiscence with your loved one or any older adult.  People love to talk about things that made them happy or excited them, plus you might gain a little history knowledge along the way. 

Retirement can be a time of increased socialization, improved quality of life, and exploration.  However, retirement can often create a new set of challenges i.e. limited financial resources and potentially redefinement of one's self-image.  By educating ourselves, we can assist our parents in attaining and maintaining a good quality of life, help them manage losses, and overall allow them to maintain their identity as an individual.  Achieving and maintaining a good quality of life is an important factor for everyone.  As our parents, and even the Baby Boomers, start to retire, a new role for them is born.  Retirement should not define them as to what they no longer do but what they are doing.  By supporting your parents in what they are doing during retirement allows them to maintain their own identity and set the standards for a quality life.  It is important to be conscious of potential losses i.e. going from an active work life to having the availability of free-time.  This surge of "free-time" can sometimes create a wave of emotions i.e. loss of self-image and identity.  Remaining active during retirement will not only assist with overall wellness, but will help the individual define their self-image and maintain a good quality of life.
Here are some resources for retirees:
Seniors Daily Online
Senior Volunteers
Florida Senior 360
Meaningful Retirement
Healthy Living during Retirement
AARP Community
Where to Live After 50
Retirement Living Information Center

After retirement, many seniors search for other ways to fill their days, provide mental stimulation, and make a difference.  Popular post-retirement activities include spending time with family and friends, indulging in hobbies and sports, taking continuing education classes, and traveling.  Many also choose to help their communities by volunteering some of their time for a good cause.  These activities can keep seniors involved in their communities, provide physical activity and mental stimulation, and improve their quality of life.

What kind of opportunities are available and how can I find them?  There are opportunities abound for volunteers of all ages- you just have to know where to look.  The internet is a great resource!  In addition, think about some of the opportunities that may not be listed on the internet.  Does your loved one like music?  Try your city's symphony.  Teaching?  They could become a tutor for a local literacy group.  Your city's symphony, local NPR station and public television station, zoo, museum, and humane society are all great places to start and often struggling to find volunteers.

Volunteering is a great way to stay involved and it can be a fun activity for your loved one- whether they volunteer alone, with friends, or you pick a special opportunity that you both enjoy.  Some great places on the internet to begin your search: 

• Corporation for National and Community Service - oversees AmeriCorps, SeniorCorps, etc.  Many opportunities for 55+ (www.getinvolved.gov)
• SCORE - working and retired business owners and executives provide free advice to small businesses (http://www.score.org/index.html)
• VolunteerMatch.org - matches volunteers to opportunities based on location and area of interest (www,volunteermatch.org)
• Other local organizations (e.g. OASIS in Indianapolis at www.oasisnet.org)

Every so often we come across a product that turns out to be really useful in caring for aging parents.  Sometimes these are even fun for the family, as well.

One such product is the Presto Printer.  This printer works by itself to receive emails with no special Internet connection required.  There is a corresponding service that assures that no SPAM gets through and that it's easy to send messages, pictures, and more.  For more details click here for a PDF brochure. 

This can really help the family stay in touch and reduce feelings of isolation for seniors - improving well-being.  It's also away for grandchildren or even great grandchildren to take an active role in caregiving.

We've had enough success with this, we're able to pass along a special offer from Presto - two months free service.  Go to www.presto.com/myhealthcaremanager to take advantage of this deal.

How many times have I heard this phrase and nodded my head in agreement?  But how many times have I put this into practice?  Not many, I fear. 

 

Until now…..until I became a caregiver.  Until I realized that obsessing over the small stuff will serve no purpose.  It won’t slow my Mother’s dementia.  It won’t give me peace of mind and it won’t make either of us happier or less frustrated.

 

So every day I look for “stuff” to put in the “small stuff” category.  Almost everything is finding a home here – unless it directly affects my Mother’s health and wellbeing.  For instance, when my Mother loses her purse and her wedding ring and her keys – I just help her look for them, knowing we’ll find them hidden in the laundry hamper or dresser.  Or when my Mother confuses the date, calls me repeatedly about the same issue or can’t remember what she had for lunch – I let it go.  Because worrying about it isn’t going to make it better.

 

I’m still sweating though – thanks to a maniacal personal trainer at the exercise club I just joined.  My thrice weekly workout is intended to help manage stress …..but I refer to it as “sweating the big stuff” – specifically the BIG Treadmill, BIG Elliptical Trainer and BIG Weight Machines!

This week marks the 10th anniversary of the "Web Log" ... the genesis of the "Blog".  Of course, sharing ideas over the internet goes back to the dawn of the net itself.  The original idea of the then government sponsored network was to connect academic institutions and government agencies for the purpose of research and collaboration.

The Blog came along originally as a way to share information about where the "blogger" had been on the internet that day and what they had experience.  It quickly became an on-line diary of sorts.  This created the "stickiness" of the concept which since evolved in that dimension and many more.  

For My Health Care Manager the concept has been extended to caregivers helping aging parents and even seniors looking to improve the health and well-being.  Take a look at the blogs listed here - you'll find information on all of the most common heath challenges facing seniors and their families.  Some examples include falls, home safety, dementia, congestive heart failure, diabetes, and many more.

Having access to key thoughts on these challenges is valuable, but even more valuable is the key blogging concept of providing direct feedback to the author.  If you have a question of a comment on an article you've read, don't hesitate to use the "Comments" link right below the posting.  You can read comments and responses from others and best of all ask your question directly. 

If you don't see an article on the subject you're most interested in, post your question as a comment to the top entry in the Blog.  We'll answer the question in a future blog, comment, or email.

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.

If you live in a part of the country where season is changing to ice and snow, I am sure your are worried about that icy accident where you could fracture your hip. Just remember to be careful and do not take chances on icy and/or wet surfaces.  A simple fall can have a dramatic impact on your life.

But remember that falls happen everyday, even on beautiful days.  As you age, your sight, hearing, muscle strength, coordination and reflexes begin to change. You may notice that your balance may be off or that you lose mobility.  If you have diabetes or heart disease, your balance can be affected and some of the medications that you are taking can cause dizziness. Then there is Osteoporosis, where your bones become thin and break easily.  All of these things can contribute to your first fall- creating that change in your life that affects your overall well-being.  So how do you take care of yourself to remain active and maintain your quality of life?  Here are a few simple tips:  

Ø      Contact your doctor and ask him about Osteoporosis and a bone density test that will tell you how strong your bones really are or if you need medications to help strengthen your bones.  

Ø      Plan an exercise program that is right for you. Always talk with your doctor before beginning your exercise program  

Ø      Review your medications with your pharmacist and/or physician for any side effects. 

 Ø      Stand up slowly – this will prevent you from feeling faint if your blood pressure drops too quickly  

Ø      Wear shoes and socks (low-heeled shoes that fully support your feet).  

Ø      If you have handrails in your home, make sure they are safe and use them.  

Ø      Pick up your throw rugs.  

Ø      Don’t take chances.  

Ø      Make your home safe by making sure you have good lighting and keeping areas tidy.  

Ø      In your bedroom, put your telephone next to your bed.  

Ø      Keep night lights on.   

Some additional fall prevention resources are:  

Ø      The Older Consumers Safety Checklist is free by contacting the U.S. Consumer Product Safety commission at www.cpsc.gov  

Ø      National Institute on Aging provides Age Pages on osteoporosis, home safety and fall  prevention tips at www.nia.nih.gov    

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.    

With the Hollywood writers strike, some of those writers may be treating this time as a much-needed break from the daily grind, as they are only required to work 20 hours a week manning the picket lines.  Unfortunately, as most caregivers know, caring for aging parents is a full-time job.  And this is often on top of the full-time hours put in at a paying full-time job.  It can often be tiring, emotionally and financially draining, and very hard.

 

For family caregivers that are in need of a well-deserved respite, don’t hesitate to ask for help...  Don’t hesitate to take a well-deserved break!  Accept the help that your family and friends offer or hire outside help to give you a few hours (or a few days) of help each week.  Caregiver burnout is real – especially for working caregivers.  Understand that you must first take care of your own health, and that asking for help or accepting help may make you a better caregiver in the long run by reducing your stress levels and allowing you some respite.

 

Providing care for a loved one, organizing their health care and managing appointments, checking on their home safety, spending time with them to prevent isolation, AND doing all of the other duties that come with the territory is extremely time consuming, sometimes confusing, and sometimes stressful.  If you find yourself ‘in over your head’ or just needing some advice, you may consider enlisting the help of a geriatric care manager.  Geriatric care managers can help facilitate communication within your family, give you advice on avoiding caregiver burnout, and offer tips and tricks to help you manage the health conditions of your loved one (whether it be helpful ways to remind your mother with diabetes to check her blood sugar, tips on communicating with a senior suffering from Alzheimer’s, ways to improve your father’s quality of life or help manage your uncle’s arthritis, or a better way to manage the multiple medications prescribed to your grandmother).

I’ve recently started reading ‘A Day in the Life of a Dementia Sufferer’ blog, and think it gives great insight into the disease - especially because our family members suffering from dementia don’t always verbalize their own experience with dementia like Leah (the blogger) does. I came across a post about her decision to take up digital scrapbooking as a hobby- allowing her to ‘organize’ her memories. I’ve also read tips for caregivers that encourage them to help their aging parents or other loved ones document their own special memories, family history, and favorite stories. This can take on all sorts of forms- whether you prefer to create photo albums, write down stories, take new family photos, record stories and conversations, or even just reminisce with your loved one.

By sharing with your loved one, you maintain your close relationship, grow your relationship, get insight into their life and personality - and you will probably hear some great stories. For older adults, it can mean a lot to have their life and memories preserved, and talking about their past, remembering the ‘good old days’, and creating new treasured memories through interacting with their loved ones can help their sense of well-being. Embarking with your loved ones on a project like this can be extremely rewarding. One of my favorite NPR programs is ‘StoryCorps’, an oral history project (find out more here). StoryCorps has individuals interview a loved one about anything they choose – the questions range from ‘life in general’ and ‘how we met’ stories to experiences during desegregation and remembering another loved one who has passed away.  The interviews are moving and help remind me just how important each one of is - and how large our impact on the lives around us is.

You don’t have to participate in StoryCorps (although click here to find out how to participate), and you may not be comfortable interviewing your loved one. The point is that as we age, many of us like remembering our lives, leaving our ‘legacy’, and above all, interacting with loved ones. How can you get involved with your loved one? Will you bring over a photo album to flip through the next time you see your mom? Will you help your uncle write his memoirs? Don’t wait any longer – start the conversation with your loved one today… you may hear some great stories!

Standing alone in her closet, my then 91 year old Mother’s femur suddenly broke and she fell.  Alone, and up to that moment living well independently in her home, she pulled herself to the phone and made the 911 call.  My wife and I were 2,000 miles away when the call came, and the next flight out got us back to the hospital just after the orthopedic surgeon had spiked her femur and placed an artificial hip cap.  Up to that point, all of the decisions were made for us, and thankfully they were good ones.  Now it was our time, with no map or experience, to navigate the health care maze that older adults and their families have to face alone.

The hospital’s case manager met with us and advised that Mother was going to be discharged after her third night (afterwards, but not at the time, it was clear that her capitated Medicare reimbursement would reach its end so it was time to go) to a rehabilitation facility that we could choose from a list she provided.  Miraculously, a skilled nursing facility (SNF) sales liaison appeared and assured us all details would be handled and a bed awaited Mother.  We were lucky.  Later we learned in another experience that ongoing relationships with the SNF sales liaisons and the case/discharge managers are well lubricated relationships – but thankfully referral fees are illegal.  But the big questions of how well matched the SNF was for Mother, the short or long-term nature of the facility (a big factor in short term rehab motivation), in or out-of-plan for supplemental insurance coverage, the staffing ratios of the SNF (patients divided by nurses and other skilled assistants), and the state’s and Medicare’s results from surprise audits were lost in the emotion of the family decision.

We’ll pick up with the first night in the SNF in my next blog, and you will soon understand what motivated me to create and found My Health Care Manager, as a consumer-side rather than provider-side, professional advisor for older adults and their families for navigating the issues and options of aging and eldercare.  But, in the meantime, please share your experiences and advice as a caregiver or senior from similar encounters involving home safety issues, falls, or unexpected hospital stays.

“Taking Steps to End Alzheimer’s” was extremely successful in Indianapolis. My Health Care Manager's Team stepped up and supported this event, not only financially but in the spirit of raising awareness.  It is estimated that there are 4 million Americans with Alzheimer’s and that number is expected to grow dramatically impacting millions of caregivers across the country. What is one of the most important things for caregiver to do. You should identify Alzheimer’s disease as early as possible and take care of yourself.   Remember the onset of the disease is gradual with loss of short-term memory, mood and/or personality changes. Your loved one may have difficulty finding the right word or not able to recognize objects, he/she may forget ordinary things like a pencil, turning off lights or the stove, closing windows, or locking the door. Be aware as a caregiver that this disease can cause emotional, psychological, and physical problems- causing social isolation for the caregiver as well as their loved one. Always remember, that to be able to take care of your loved one, you need first to take care of yourself. Identify your support network and stay connected with others.  Several resources for caregivers are: The Alzheimer’s Association, www.alz.org ; education and referral center,s The Family Caregivers Alliance www.caregiver.org ; and the National Family Caregivers Association, www.nfcacares.org.

At the center of the tools to help with geriatric care management you will find the Personal Health Record (PHR).  Wikipedia has this to say about the Personal Health Record: "The PHR is an ill-defined concept that has been developing over several years."  You'll be pleased to know that it doesn't stop with that.  In fact, it goes on to describe some of the key elements.

Perhaps the most common confusion is comparing the PHR to and Electronic Medical Record (EMR).  An EMR provides a hospital, doctor, therapist, or even insurance company with useful information.  It does little, however, to directly impact the people most affected - the senior and caregiver trying to understand a care regimen.  The few interactions with these systems which do exist, such as Explanation Of Benefit (EOB) statements, are often confusing and frustrating for aging parents.  Little or no information is available from these systems on care plans, medications, multiple disease states, life style, state of mind, living circumstances, support networks, caregivers, or the other complexities faced by seniors.  They do not represent a holistic picture of the environment impacting independence and quality of life.

The Personal Health Record (PHR) has developed in response to this need.  The PHR provides a way for individuals to build and maintain a health care record independent of their health care provider and easily understood by the family.  The reliance on the individuals' understanding of their health situation and care plans to populate the PHR means that great care must be taken with the completeness and accuracy of the record.

Most caregivers can build this PHR either as collection of paper documents or using a variety of computer tools.  A geriatric care manager can help by understanding all the materials to include, off loading the time consuming tasks from a caregiver, taking advantage computer tools, and providing a knowledgeable review of the contents.