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.

When your other family members do not give you (the main caregiver) enough help or support, or do not agree or criticize your actions, what do you do?  Roles and responsibilities of adult children caring for their parent changes over time.  Statistically, the adult child who lives closest to the aging parent assumes the role of the main caregiver.  Most often this adult child is also a daughter.  This person often feels a sense of joy and pride in being able to assist mom or dad but also often feels overwhelmed, alone or deserted by the rest of the family.  The responsibility of caregiving is often not shared equally among the adult children or the rest of the family.  Some family members may be in poor health and physically unable to help, financially unable to help, have demanding jobs or live far away.  Family members who do not have the day-to-day experience of caring for an aging parent may not know what it's "really" like to care for mom or dad, or may not know enough or understand mom or dad's health conditions. 
All family members need to do their homework about mom or dad's health conditions. For example, knowing the symptoms of dementia will help give adult children a better understanding of mom or dad's actions. 
It's important for the main caregiver to recognize and acknowledge when you need a break or need some more help.  Remember...you need your family.  Keep other family members informed of what's going on with mom or dad.  Try Lotsa Helping Hands a handy web tool for keeping families connected.
Some family members and even the main caregiver cannot always commit the amount of time they truly want to towards mom or dad for multiple reasons.  Having a Health Care Manager to assist with eldercare management is a welcomed relief for several families and especially for the Sandwich Generation, adult children in the workforce raising their own family and trying to care for an aging parent.

I've had a few questions lately about technical help in dealing with memory loss.  There are some good tools to assist seniors and caregivers with things like medication management, appointments, self monitoring reminders, falling concerns, and even mobility. 

Saying this, I should quickly add that these are all fairly new and nothing has yet emerged standard practice.  This may be due to the reality that memory loss and related conditions of dementia are typically progressive diseases.  Meaning, a technology that works this month likely will not work in six months.  For example, one caregiver we were working with purchased an electronic pill dispenser.  Each time a medication was to be taken an ever more persistent alarm would sound to remind their loved one to take their medicine.  Some of these devices can even use a phone connection to dial a central database and report the activity of the unit.  This worked well for time, but one day their parent decided that this device was annoying, unplugged it, and put it under the bed.  Any attempts to reset the unit resulted in some similar behavior.  A new approach had to be found.

So for caregivers caring for parents with dementia, simply be prepared to monitor and make adjustments with any solution you might consider.  Technology can be a temporary suppport tool.  The news is better if your parent is not dealing with significant cognitive problems.  In this case, technology can be a real and lasting support tool.

There is no easy way to confront your loved one about their driving skills – especially when they view it as their last means of independence. But yet we hear horror stories of older adults causing a terrible accidents. We wonder ‘will that be my parent? When do “I “ step in and take their keys?’ Then we ask questions and get answers like “just hide their car keys” or “tell them the car is in the shop and they will forget about driving!” You know, they don’t forget and they find those hidden keys…

Then we expect their physician to magically have the answer to this difficult decision. In reality, there are no easy decisions or ways to address this most difficult issue. But the Hartford Financial Services Group, Inc. and the MIT AgeLab conducted a research study and created a guide to help people dealing with this specific situation http://www.thehartford.com/alzheimers/.

The Hartford Brochure  - “At the Crossroads” is a wonderful resource for anyone who is having conversations and/or thoughts about stopping a person with dementia from driving (http://www.thehartford.com/alzheimers/brochure.html). This guide was developed to assist people with dementia and their families prolong independence while encouraging safe driving. http://www.thehartford.com/alzheimers/

This guide provides suggestions for monitoring, limiting, and stopping driving while addressing the following areas:
• Why dementia and driving is a difficult issue
• Assessing concerns about driving behavior
• Monitoring driving behavior
• Easing the transition from driver to passenger
• Having positive and productive conversations
• Seeking help from outside sources
• Understanding how family relationships affect driving decisions
• Advice from caregivers who made this decision

The guide also covers many warning signs including but not limited to a decrease in confidence while driving; difficulty turning to see when backing up; easily distracted while driving; incorrect signaling; and scrapes or dents on the car, mailbox, or garage.

A key recommendation is to document and share with other family members and health care providers the frequency, type, and severity of accidents/incidents and any patterns of change. Remember that everyone has isolated incidents, but it is when there are patterns that conversations and decisions need to be made. However, if your loved one is confusing gas and break pedals or stopping in traffic for no apparent reason – it is time for immediate action. 

These additional sites may also assist you:

• American Occupational Therapy Association [301-652-2682]
  www.aota.org/olderdriver
  Excellent general information, self assessments, and important links
• National Highway Traffic Safety Administration [1-888-327-4236]
  http://www.nhtsa.dot.gov/
  Has fliers about many medical conditions that affect driving

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!

Let's return to the question of the impact of technology.  In particular, to the impact on a key issue facing seniors and caregivers, medication management.  We've touched on the fundamentals - preparing and communicating the medication list with simple computer tools.  What we haven't spent much time on is the day to day management of medications.

Technology can help.  For example, one of the tools My Health Care Manager makes available to seniors and their families is a weekly medication schedule.  This schedule provides a map of the all medications with the day and time and dosages they are to be taken over the course of the week.  This schedule can also provide a variety of additional information such as sliding insulin scales or even life style guidance for exercise or other activities.  In many cases our clients will actually record daily health monitoring results on the form (like blood sugars, blood pressures, and so on).  This is a great way to help aging parents and their care givers stay on top of the weekly regimen.  

There are some limits.  We have found that people dealing with Dementia (Alzheimer's disease or other forms) need the assistance of a caregiver to use a tool like this.  Often they will also need reminders through the course of the day to prompt taking their medications.  Technology can help here, as well.  There are a number of medication reminder systems emerging in the market.

 

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.

It's been said many times that caregiving is a difficult, but very rewarding experience.  Financially, however, caregiving can be costly.  Caregivers often help out with rent or mortgage payments, as well as the cost of in-home care services.  According to MetLife, the average caregiver assists with these bills anywhere from two to six years, and contributes a whopping $19,525 over that period.  While many caregivers provide only care and support and no financial system, some caregivers are contributing even more money to pay their loved ones' expenses.  This figure is independent of those paying for assisted living facilities or nursing homes, which can run around $70K/year and up.  There are often extra fees for those with dementia or Alzheimer's in addition to the normal rates.

As so many caregivers are providing financial support, this can raise questions when it comes to filing taxes.  USA Today has a timely Q&A for tax season... Yesterday they addressed the situation of a caregiver whose mother moved into assisted living due to an Alzheimer's diagnosis- and the caregiver is paying for it.  Is this tax deductible?  Yes!  For the details, please click here.

When I became a stepmother to my then 7 year old stepson, it was easy to find people to turn to for advice.  For I lived in the midst of a community of  mothers……in my neighborhood, at work and at church.  These built-in communities provided support and guidance as I assumed the joyous role of being a Mom to a precious little boy named Michael.  That was 20 years ago and the friendships I made with those other Moms still exist. Today,  we continue to share stories about our “children,” but have excitedly expanded the conversation to include “grandchildren” and the happiness we experience as we watch our children become parents. 

As a caregiver for a parent, I find this type of community missing in my life.  There is not a natural group of people, who are caring for their parents, as readily available to talk with and exchange experiences.  Some organizations, such as the Alzheimer’s Association, offer support groups that do wonderful work.  But it is not the same as simply walking out the front door anymore.  The fact is that caring for children is much more common than caring for parents…..or at the very least…..more frequently discussed.   

I’ve found that I need to actively seek out support and this has come from many different sources.  I frequently browse the eldercare section at my local Barnes and Noble.  I talk to my RN friends and co-workers.  I subscribe to the Alzheimer’s e-newsletter.   But the outpouring of support that comes so naturally when caring for children at the beginning of life is rather hard to find when caring for parents at the end of life.

Recognizing that a lack of community and support is a common occurrence among senior caregivers, my company recently established an on-line complimentary “Caregiving Community” to provide answers to difficult caregiving questions.  The goal is to provide assistance and support to adult children who are worried or concerned about their parents.   Each month, My Health Care Manager will send members of the “Caregiving Community” an e-mail update which will focus on common caregiving concerns and practical solutions in a quick, easy to read, question and answer format.   The first issue tackled the following:  “Dad’s car has new scratches and dents.  Is it time to take the keys away?” 

I’d like to personally invite you to join the “Caregiving Community.”  Its goal is to help you….help your parents.  Please click here to join the “Caregiving Community”.  I also encourage you to e-mail your questions to CaregivingCommunity@MyHealthCareManager.com.  These will be addressed in a future issue.  Rest assured, your e-mail address will not be shared with any other organization. 

Individuals with Alzheimer’s Disease and related Dementias often have significant communication changes as their disease progresses.  Due to physiological changes in the human brain, the individual can experience changes in cognition, reasoning, sequence and application, and personality changes.  Some individuals experience varying levels of confusion and disorientation i.e. familiar places may become unrecognizable, routine chores (using the washing machine, buttoning a blouse) may become difficult.  A person’s ability to reason may deteriorate and their thoughts of “reality” may change.  A person’s ability to do things in a sequence may become difficult e.g. putting on shoes first instead of their slacks.  Some individuals with Alzheimer’s Disease and related Dementias may also experience personality changes.  All of these changes are very common. 

As these changes occur, it becomes more difficult for that individual to communicate with family and others as well as for family and friends to communicate with their loved one.  You are not alone!  Effective communication is attainable with some suggested tips:

1. It’s important to remember that individuals with Alzheimer’s Disease only communicate 10% verbally.  Because their brain is functioning in a different way now, as family and caregivers we must be patient and pay attention to their non-verbal cues.  Try to figure out the meaning behind their actions.
2. Always speak in a slow, calm voice.  Make eye contact i.e. if they are sitting down, get down to their level of eyesight.
3. Use hand gestures and non-verbal cues when communicating. Show them what you want them to do.
4. Don't argue or correct them.
5. Allow your loved one to set their own pace; avoid hurrying or rushing them.
6. Eliminate any distracting background noise.
7. Ask yes/no questions, as they are easier for them to answer.  If you always get a “no” answer, instead of saying ‘do you want a shower?’, say “It’s time for our shower now.”
8. Repeat phrases as needed.  Avoid saying “I just told you 5 minutes ago…”  Keep in mind that they truly may not remember.
9. The sense of touch is powerful thing i.e. if they don’t understand your words, give a hug or a pat on the back to communicate.
10. Keep tasks and activities simple and give one instruction at a time.

See the Alzheimer’s Association’s website www.alz.org for more tips on communication.

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!

If you are a caregiver to someone with Alzheimer's or have a loved one that suffers from Alzheimer's, you may know how difficult it can be for children to understand (and cope with) the disease and the changes in their loved ones.  It can be hurtful that their Grandpa doesn't remember their name or disconcerting when Grandma asks the same question multiple times in a visit.  By teaching children the basics of Alzheimer's disease (at a complexity level suitable to their age and maturity) and the signs/symptoms/effects of the disease, you can help them understand the behavior of their loved one.  The Alzheimer's Association website (www.alz.org) has a special section for kids to help them understand the disease.  It also reviews some educational books on Alzheimer's geared toward children, and even gives a list of activities for children to do with their loved ones.  This is definitely a difficult subject to address, but supplying your child with information (instead of ignoring the issue) will help them be better equipped to understand the changes occurring in their loved one and the reason for those changes.  To visit the Alzheimer's Association website for kids, please click here.  To read a news story from the Winston-Salem Journal online (with more book recommendations, a real life story, and practical tips), click here.

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!  

2008 brings with it the promise of “new” – new resolutions, new opportunities, new challenges and new experiences.  New is good – for it keeps complacence at bay and ensures that 2008 will not be a rerun of  2007.  Fortunately, this writer is not on strike and doesn’t need to portray her life as a reality TV episode! 

But reality is right around the corner and with it comes the knowledge that my Mother is “slipping.”  Her confusion abounds about where she lives, what day it is and whether she has spoken to either my sister or me on any given day.  This we have taken in stride, but other cognitive changes, while relatively innocent, are concerning.   Over Christmas, my Mother drifted in and out of a “second childhood.”  It began when we rescued a cute Christmas Teddy Bear from CVS because my Mother thought it looked lonely.  The bear journeyed home with us and became part of the family.  The bear sat on the couch and watched TV, joined us at the dinner table and slept in the guestroom.  My Mother was always very aware of the bear’s whereabouts and became anxious when “Teddy” was not in sight.  It was sweet and her concern for the bear was quite real.  So, although I feel sad at times that my incredibly bright Mother can no longer find joy in reading, bridge and other intellectual pursuits, I feel great when I realize that she still has the same heart – one that is capable of making a new friend named “Teddy” and welcoming him into our family.

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.

The month of December is one of the most stressful times of the year and now you are the caregiver. You wonder how you will ever make it through this holiday season.  Remember the most important thing is be kind to yourself.  Take time to remember what is important to you.  It could be simply preparing your favorite foods or holding on to that one tradition that brings a smile to your face.  You do not need to do everything that everyone wants.  Some tips for making it special for you and your loved one would be to invite people in small groups to your home, to dig out the old family photo albums and reminisce with him/her about special times from the past. Engage him/her “in a trip down memory lane” conversation. Tape the conversations, makes wonderful gifts for the grandchildren. Involve the family that is far away, set up a phone schedule so everyone gets to talk.  Play soft music including some of the family’s favorite songs to help everyone relax. Simply take time to enjoy your time together. 

Enjoy the season! 

Additional resources for care giving are the Family Caregiver Alliance; http://www.caregiver.org/caregiver/   and the Alzheimer’s Association; www.alz.org

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.

Caring for someone with Alzheimer’s Disease (AD) is always a challenge. How do you take care of your loved one and still enjoy the holidays? The National Institute on Aging has many tips to assist you, especially during this holiday season. Some key tips are to 1) Keep or adapt family traditions that are important to you. Include the person with AD as much as possible 2) Recognize that things will be different, and have realistic expectations about what you can do 3) Encourage friends and family to visit. Limit the number of visitors at one time, and try to schedule visits during the time of day when the person is at his or her best 4) Avoid crowds, changes in routine, and strange surroundings that may cause confusion or agitation.

http://www.nia.nih.gov/Alzheimers/Publications/caregiverguide.htm

 

Always try to remember to do you best to have enjoy the holidays and try to find some time for the holiday things you like to do.

 I came across The Caregivers' Bible (Source unknown)  and wanted to share it with you as the holidays are approaching. 

• Maintain social contacts and as many activities as possible.
• Formally and in writing schedule respite time for yourself on a daily or weekly basis. Even a few minutes a day can make a difference in your outlook. Stick to that schedule.
• Involve other relatives in the care of the care recipient early on, including multiple-day care over weekends and holidays.
• Do not martyr yourself. No one should expect to provide all care every day without help. If you can, get a job or activity away from home for periods of time.
• Make sure that children and siblings understand the disease. Let them assume caregiving duties for short periods, so they experience first-hand the stress you experience as a caregiver. They, too, will suffer doubt, denial, guilt and anger, and the fury may be directed at you.
• Guilt and anger are normal emotions. Recognize them for what they are, and avoid acting on them. Anger usually accompanies a sense of guilt.
• The incidence of headache, insomnia, backache or other physical symptoms during caregiving can be stress-related, stemming from unresolved anger, guilt and/or depression. Nearly all caregivers are physically affected by the care recipient's illness. Face that fact and accept it. To remain an effective caregiver, you must take time out for yourself.

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.