In earlier blogs, I've mentioned a variety of in home technology advances to assist people caring for aging parents who hope to remain living independently.  Among these are safety tools for monitoring the home environment intended to help seniors who are "aging in place". 

One thing that doesn't come up enough in the discussion of these tools is the question of ethics.  How invasive should family members, or monitoring services, be allowed to be?  There are people looking at both the technology and the surrounding ethical issues.  One such group is the Ethical Technology in the Homes of Seniors (ETHOS) effort underway at Indiana University.  The focus of the ETHOS team is developing tools and guidelines to protect the privacy of senors living at home.  According to the team, seniors often underestimate the risks to privacy involved with technology use.

You can read more about there efforts by clicking on this link http://ethos.indiana.edu/. 

Last week I had the opportunity to present a paper at the Human-Computer Interaction International Conference.  This was the 13th occurrence of the conference and the event was well attended by key researchers and companies concerned about how computers interact with people. 

Jean Bandos co-authored the paper titled "Impacting the Continuum of Caregiving through Innovation in Informatics: Senior Care Navigation System (SCANS)".  Other members of the SCANS team contributed, as well.  You won't find the paper in the conference proceedings however, due to Intellectual Property concerns with the conference publisher's copyright requirements.  In spite of those restrictions the paper and the presentation were well received.

What struck me about the conference on a general level was the amount of attention being given internationally to the challenges of older adults and senior health care.  Conference attendees came from China, Japan, UK, Germany, India, Spain, and many other places - representing some 49 countries in all.  Support for seniors living independently and dealing with challenges like immobility, well-being, and cognitive decline surfaced as a major sub-theme to the conference.  World wide researchers are examining how computers can help with aging parents.  

The specifics were wide ranging from topics like augmented navigation for assistive mobility devices to ontologies for adaptive user interfaces to cope with the specific needs of the elderly. 

I was genuinely encouraged that so many top brains are looking for ways to improve eldercare services.

I've been seeing several ads for voice recognition phones, lately .  The idea is to provide both the sound through the ear piece and a text display of what's being said.  This can be a terrific tool for older adults with hearing problems. One example can be found at the CapTel web site.

This service can have impact on senior well-being in several ways.  The example shown by most of the advertisers is reducing feelings of isolation by making it easier for grandparents to speak with grand kids and other friends and family.  It can also play a very practical role in caring for aging parents, as well.  Caregivers can communicate more frequently by adding phone conversations to face to face interaction.  The text can also help assure that advice or instructions are more accurately understood.

These phones are another tool in the emerging market to help seniors who are  living independently. 

Over the last year, I have written several blogs on aging in place for older adults and their caregivers.  Today, in honor of Stroke Awareness month (April), I wanted to raise your awareness about this concern, which is a preventable health issue. I recently attended an educational session on stroke prevention and would like to share the National Stroke Association’s efforts to educate the public on recognizing stroke symptoms.  Most of us think of stroke as a disease of old age – one that is debilitating and causes lasting disabilities. But it can strike at any age. 

Did you know that 80% of strokes are preventable and that by acting in time, the long term of effects of strokes could be minimized?

Here are some simple tips to follow to prevent a stroke: 

• Know your blood pressure.      
• If it’s high, work with your doctor to lower it.
• Find out from your doctor if you have atrial fibrillation
• If you drink alcohol, do so in moderation.
• Find out if you have high cholesterol. If so, work with your doctor to control it.
• If you are diabetic, follow your health care provider's recommendations carefully to control your diabetes.
• Include exercise in the activities you enjoy in your daily routine.
• Enjoy a lower sodium (salt), lower fat diet.

Look for my next blog entry, where I’ll share with you an easy-to-remember way to recognize the symptoms of a stroke.  This is important for caregivers, aging adults, grandchildren – everyone should be able to recognize stroke symptoms so that quick action can be taken.
 

Remember Hillary Clinton’s book It Takes a Village which was written to address caring for children?  I find this same approach applies to the senior population.  It really does take a group of people, making a concerted and coordinated effort, to assist seniors as they age.  It takes time and careful thought to build a “village” for your parent.  Following are a few ideas to help you get started:

• Family – Primary:  spouse (if living), brothers and sisters, children, grandchildren, great grandchildren
• Family – Secondary:  nieces, nephews, cousins
• Friends: lifelong friends, new acquaintances, neighbors, club associates, church members
• Health Care Providers:  Primary Care Physician, Specialty Physicians, Physical Therapists
• Geriatric Care Manager:  Professional (typically nurse or social worker) to provides care advisory/advocacy  service addressing  specific needs of senior
• Companion:  Paid caregiver to provide services as needed:  cooking, transportation, companionship, assistance with activities of daily living
• Skilled Care:  Paid clinical care provided by licensed practitioners
  Independent Living or Assisted Living Facility Staff:  Nurses, administrators, social workers, certified nurse assistants

Care assistance and expertise is available from many sources.  Plan your village now - don’t overlook the many ways a support system can be built for your parent.   
 

A friend forwarded an email recently about something called the "Wellness Wizard".  This is system for automated reminders.  The caregiver records messages to be played at specific times and dates.  The idea is to provide reminders about medications or important appointments.  It also provides a mechanism for the senior ask for help from caregivers.

All-in-all this tool probably has some utility.   It's relatively inexpensive and could help people caring for aging parents who live independently feel more comfortable about their parent's situation.   

The only part of this that really bothered me was the claims about this product.  The company claimed it would:

• decrease avoidable readmissions
• maximize the well-being of their loved one
• reduce caregiver stress
• and more

The product can contribute to these, but it's really a stretch.

The truth is, it takes a coordinated effort.  Eldercare is not a tool.  Tools can only help.  Be wary of "over sell".  There's nothing that can replace a caregiver's involvement.  Even a geriatric care manager still needs the connection with family. 

Care managers and tools for eldercare can save time, improve situations and even well-being, but they are aides not replacements.

Maybe it's the latest social event, health craze, or the Baby Boomers wanting a fit, active life but today's seniors are anything but sedentary!  Seniors want more than just bingo...they want activities and social events that are fun, physically active, and socially stimulating.  Whether they are aging in place or have made the move to a retirement community/assisted living/other living option, seniors are getting involved!  If you're a caregiver, think about introducing your aging parent to some of the activities listed below.


Some of the activities today's seniors are involved in include:

1.  Travel clubs - On a flight to Scotland last year, I sat next to a retired couple who joined a senior travel club a couple years before.  They told me a story of getting married after high school, working their whole lives, and raising a family.  They rarely traveled during this time, so they decided it was time to see the world.  They had been to every US state except for 2 (but those were on the "to do" list) and had been to numerous countries in their travel club.  This is a goal I hope to achieve myself one day!

2.  Political events, campaign assistance

3.  Wellness and fitness clubs/activities

4.  Charity or volunteer work

5.  Dance classes (ballroom dancing, salsa, etc)

6.  Nintendo Wii game parties

7.  Creative arts classes (theater, artwork, pottery, glass blowing, etc)

8.  Trying new foods and restaurants

9.  Attending local theater events, the symphony, or historical museums

10.  Monte Carlo Night (casino games)

11.  Shopping excursions to nearby cities

12.  Book clubs

13.  Investment clubs

14.  Indulging in new hobbies (photography, coin collecting, golf, etc)

15.  Learning how to play a musical instrument

16.  Cooking classes

17.  Becoming a senior companion

18.  Winery tours

19.  Computer classes

20.  Happy hour events

Continuing to explore the technology to help with aging parents, in home monitoring is becoming more and more visible. 

One of my blog readers recently called my attention to this article from the University of Missouri titled "Health-Monitoring Technology Helps Seniors Live at Home Longer, MU Researchers Find".  Click here to read the article.  Articles like this one are appearing more and more, and research in these areas is on the rise.

That's not a surprising trend given the demographic shifts and the desire for seniors to continue living independently.  The article, in fact, leads off with this premise.

Using sensors, video, and other tools researchers at MU have built an early warning system to help identify problems and alert health care providers before problems escalate to full blown emergencies.  The study examined data collect of two years at an affliated retirement community to identify patterns leading up to adverse events.  Real time data can then be monitored - watching for these patterns.

Systems like this can help to provide peace of mind to families who are caring for aging parents and provide meaningful data to senior health care providers.

Perhaps the most difficult thing for a senior to do is give up the car keys.  Eventually nearly everyone has to, but driving is a major key to living independently and person's sense of well-being. 

Consumer side technology is being developed to help improve safety issues with seniors.  GM is developing a car windshield that uses infrared sensors, cameras, and lasers to enhance sharpness of items on the road.  The idea is to make lane marks or objects in the path of the vehicle more distinct.  See this article General Motors designs windshield that enhances objects to help seniors for more details on the development.

This is a example of a home (car) safety product targeted specifically at older adults.

The holidays are a time to get together as family and friends.  A lot of adult children may not live near their aging parents or have not seen them for several months, so the holidays are a time when families do get together but it may also be a time of discovery...that mom or dad needs assistance in their daily life.  If you are visiting or spending time with your aging parents, keep your eyes open to the indicators that they may need some assistance with staying independent.

Here are some things to be aware of when visiting your aging parents:

1.  Mail and bills are piling up or mom/dad is having a hard time with money management and bill paying, when this has not been a problem in the past.
2.  Minimal groceries in the refrigerator and cabinets, or food is left in the microwave or rotting in the refrigerator.
3.  Mom/dad is wearing the same clothes over and over, clothes are soiled or not getting properly cleaned.
4.  Grooming habits have declined, not bathing/showering, hair and/or facial hair is unkept, teeth/dentures not being properly cleaned.
5.  Prescriptions are not being filled - look for empty bottles around the house or for medications that have expired.  Are medications being taken properly?  Have mom/dad show you the medication management system in use.  Where do they store their medications?  Do they use a pillbox?  Who fills the pillbox?  Is it filled correctly?
6.  Are they keeping up with preventative practices (e.g. attending routine health exams, receiving routine/recommended vaccinations)?
7.  Difficulty walking or getting around the house, gait disturbance/difficulty with balance, trouble getting up from a chair, difficulty with stairs.
8.  Forgetfulness or confusion regarding recent conversations, familiar faces, simple tasks or daily activities.
9.  Check the house for hazards (e.g. rugs that can easily be tripped on, inability to take care of the lawn or shovel snow/ice off walkways).  Install grab bars in the bathroom if needed, and smoke alarms and carbon monoxide monitors.
10.  Be alert for scammers.  Scammers often prey on vulnerable older adults.  Are people calling or coming over to mom/dad's and you do not know who they are?  Are they giving money or writing checks to people or organizations that you do not know?

If you discover that your aging parent or loved one is in need of additional service, contact your local Area Agency on Aging for resources or a professional geriatric care manager for assistance.

Happy Holidays!

**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).**

In today’s society, we value independence… and part of that is being able to jump in our car and go where we need to go.  A major challenge for older adults who are unable to drive is feeling that they have lost some of their independence.  As times are changing, older adults’ schedules are becoming busier than before.  Whether it is picking up the grandkids, going to the doctor, beauty shop, or senior center to play cards, etc. older adults are not just sitting at home anymore.  However, older adults who are living independently and are unable to drive can still get to where they want/need to be in their community.  There are resources in our communities that do just that.  The following are some good resources that will help connect older adults to local transportation resources while still living at home.  Happy traveling! 

Area Agency on Aging office – Search by state and find the closest office nearby and contact the Area Agency on Aging to learn about transportation resources locally. (http://www.n4a.org/about-n4a/?fa=aaa-title-VI)

AARP:  State-by-State Guide to Transportation Assistance
(http://bulletin.aarp.org/yourworld/gettingaround/articles/state-by-state_guide.html)

More and more aging adults are moving in with their children or other family members, according to the U.S. Census Bureau.  Between 2000-2007, the percentage of parents moving in with their children rose 67% or 3.6 million.  There are many reasons why this might be occuring:
1.  Higher housing costs and the nation's current economic status
2.  Families are closer now than in the past
3.  Intergenerational households are increasing each year

The number of parents under the age of 65 that moved in with family grew 75%.  I recently read an article that stated 60 is the new 40.  Becoming a grandparent at a younger age is growing.  Some parents are moving in with their children to help raise and care for the grandchildren.  This concept gives the grandparent a "job" and responsibility while contributing to the family and takes away the cost of daycare.  Combining family resources is helping families and their expenses while also providing assistance, a stronger family bond, and preserving memories.

So pull out the sofa bed, clean out the guest room, or build on a small apartment cause mom may be moving in!  ECHO Housing is becoming more popular, Elder Cottage Housing Opportunity, sometimes coined "granny flats" or "mother-in-law suites".  This refers to a housing opportunity for seniors to share a separate living space on the same property or attached to a family member's home.  This concept brings parents closer to their families while also maintaining a sense of independence.  Zoning regulations do apply, so check with your local county or city zoning board.  For more information, check out ECHO Housing.

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. 

How would you want to spend your golden years?  I have lots of different ideas...I'd like to travel more, spend time with family and friends, be healthy, enjoy life!  I love visiting and learning from my grandmothers (and my grandfather).  It's interesting to ask them questions about their life as children, young adults, how they met my grandfathers, jobs they worked, etc.  My one grandmother has a great sense of humor and is always on the go.  She works one day a week, spends lots of times with friends and family, travels, and likes to learn new things.  My other grandmother is just a "sweet old lady" that grew up on farm, who has a green thumb, loves animals, and is a bird watcher.  Both are relatively healthy and live independently.  Some people fear getting older, but today's world offers many services and perks to seniors, such as, travel deals, wellness programs, lavish retirement communities, etc.  The seniors that have a zest for life in their golden years are an inspiration and should be applauded!

My colleague Jennifer brought another in home communication device/service to my attention recently.  It's called Celery. 

You may remember a previous blog (click here) on the Presto Printer; a great way to communicate with parents living independently at home of in a retirement community. 
Celery is a service which combines FAX and Email capability.  It allows a caregiver or remote family member to send an email to a FAX machine in their loved one's home.  This can include a text message and even pictures.  The FAX is hooked up to a standard phone line so you don't have to obtain Internet service or have a computer.  The exciting part is that the receiver can hand write a reply and FAX it back to a special Email service that will match it to a preset list of authorized email accounts and send the message on as an image.  This makes the communication two-way.  For more on Celery see their web site http://www.mycelery.com/. 

This could be used to reduce social isolation, provide reminders about heath care, improve medication management, and just keep in touch with distant and busy family members.

The My Health Care Manager's Client Portal serves as a communication platform for families caring for aging parents. It provides easy access to information like:

• 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.

My friend recently asked me about recommendations for improving family communications about their aging parents through the use of technology.  Their family is struggling with keeping everyone current on their parent's situation and having a more even view of care required to keep them living independently. 

No surprise to most of you, this is a very common problem.  Typically the family member living nearby and providing help with aging parents every week has to convince the distant relatives that problem is emerging.  Occasionally, it even works the other way.  A visiting family member who hasn't seen mom or dad in a while can sometimes be struck by the a dramatic decline in cognitive ability, memory loss, or even overall health that has crept up on the local caregiver.

There are several good free tools for sharing information with your family.  Many people use Yahoo Groups  for this (to learn more click here).  It's free and easy to use, but to take full advantage of the portal family members must have a My Yahoo ID.  The Id is free, as well, but it's extra steps.  These groups can have restricted membership and other monitoring controls.  Without a Yahoo ID people can still participate in email communication through the group much like a classic list-serve.

Google has a similar tool (click here).  There are also a large variety of these with a more specific medical focus.

Do you know of any communities that are not designated as a 55 and older community but it just seems they have naturally turned into that?  Those neighborhoods are becoming more and more common and are referred to as Naturally Occurring Retirement Communities or NORCs.  A NORC is community, neighborhood, apartment building, or street where the residents remain for years and “age in place”, allowing a naturally occurring retirement community to develop.  To “age in place” means to grow older in one location without having to move.  NORCs offer familiarity, feelings of independence, feelings of safety, and a comfortable environment  NORCs also tend to foster social gatherings, neighbors helping neighbors, neighborhood crime watches, and more accessible public transportation (as more and more people in the neighborhood utilize the transportation service, it will naturally develop a routine route in the neighborhood).

AARP reports that more than 80% of seniors wish to remain in their own home for the rest of their lives.  To age in place successfully, requires advanced planning regarding the senior's overall health care and well-being, home environment and safety planning, and preparation for aging-related changes.  A professional geriatric care manager can assist you in planning for aging in place.  For more information regarding aging in place, check out http://www.seniorresource.com.

When is the right time to talk to mom or dad about planning for the future?  Ideally, the earlier the better.  Usually when seniors are in their 70s is the best, unless signs of dementia or another health issue arises earlier.  It is important to understand your parent's healthcare and financial wishes and goals.  For most seniors, death is not their main fear but losing their independence is.  Planning for the future and having this conversation with mom or dad is not easy, as people do not want to think about a time when they'll need help and resources in order to continue to live independently.  It's important to have this conversation before a crisis hits.  Talk with your parents about their wishes regarding medical treatments, procedures, etc in the case that they are unable to make decisions for themselves.  Information that is discussed should be put into writing, a Living Will document.  Financial planning is also important and should be discussed with mom and dad.  These actions and steps should be lined out in a legal document.  By having this discussion early, the senior is not only verbalizing their wishes and goals but being responsible by planning for their future.