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.

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.

• 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.

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).

How should a caregiver or a senior get started with this idea of a Personal Health Record (PHR)?  If you've been following my Blog so far you can already guess - The list of Medications.

The key elements to include are:

• Medication Name (Remember to include Over The Counter (OTC)medications and supplements, as well.)
• Prescription Number (if applicable)
• Dosage
• Frequency
• Route
• Prescribing Physician (if applicable)
• Refill Date
• Number of Refills, and
• Any Supplemental Information (It's often helpful to include the reason for taking the medication, special instructions, and so on.)

To download a simple excel spreadsheet you can use Click Here. 

Often families struggle to get these lists made accurately.  It can be very difficult to get complete and accurate information if your loved one is face cognitive decline, memory loss, or even simply struggling with declining eye sight.  This is especially true if you are living a long distance from one another.  A Geriatric Care Manager or a health professional can often help.

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!

Memory loss is typically the first sign of dementia, but what is dementia? When most people hear dementia they think of Alzheimer’s.  Alzheimer’s disease is the most common type of dementia. But there forms of dementia, such as vascular which affects approximately 15 -25% of dementias.  With vascular dementias the mental function is generally damaged by multiple small strokes and unlike Alzheimer’s, it usually appears suddenly.  Risk factors for vascular dementia include high blood pressure, high blood fat, diabetes, smoking, and old age. Vascular dementia is also more common in men than in women.

Dementia simply is that there is a problem with the brain that makes it hard for a person to remember, learn and communicate. As the dementia progresses the individual may have disruptive behavior and others. Remember with the first signs of memory loss, contact your primary care physician. If you are unsure of what questions to ask your physician, contact a geriatric care manager such as My Health Care Manager, www.myhealthcaremanager.com who will assist you in preparing for a discussion with your physician.   For more information on the types of dementia contact the American Geriatrics Society.  www.healthinaging.org . 

“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.

As our loved ones age, many face cognitive decline, dementia, or a diagnosis of Alzheimer’s.  The Alzheimer’s Association is doing all it can to help cure the disease.  While our blogs will discuss Alzheimer’s in more detail in the future, we wanted to call attention to the recent Indianapolis event promoting Alzheimer’s awareness.  On October 14, My Health Care Manager participated in the Alzheimer’s Memory Walk at the Indiana State Fairgrounds.  Over 1,800 people walked in support of the cause, and over $300,000 was raised through the generous donations from both companies and individuals.  We saw a lot of families participating in the walk, and would like to congratulate all of the individuals and teams who came out to support this worthy cause. 

I just came across a great book "Caregiving - The Spiritual Journey of Love, Loss and Renewal" by Beth Witrogen McLeod.  I've read the sections that apply to parental caregiving and saw myself in each page.  It was reassuring to read comments from other caregivers and benefit from their insight and experience.  It confirmed what I am already experiencing....that parental caregiving is not something I was prepared for...despite my experience caring for my son and a terminally ill spouse.

For with caregiving, comes a feeling of responsibility to make my Mother's days happy.  After all, wasn't it my decision to move her here when she could no longer live alone?  But after reading the book and discussing the situation with my Mother's Health Care Manager, I've learned that making my Mother happy is a completely unrealistic expectation.  So, I'm learning to be content with the "good" days, when her dementia isn't as pronounced and she takes great delight in going to lunch or for a drive.  I try to store these memories....not knowing what tomorrow will bring.  And on the days when she is unhappy and annoyed with the world, I let her vent...knowing that helps too...while recognizing it is just not something I can "fix."   

A friend here at My Health Care Manager sent me an article today with a very interesting statistic.  Science Daily reports that “Northwestern University's Feinberg School of Medicine has found that nearly 50 percent of patients taking antihypertensive drugs in three community health centers were unable to accurately name a single one of their medications listed in their medical chart.”  That’s right, not even ONE of their medications.  People simply can’t remember cryptic medical names, dosages, frequencies, and instructions for the multiple medications they’re taking.

It’s not hard to imagine that in a senior population where people may be dealing with cognitive decline that this statistic would be even worse.  Add to this, the fact that People over 75 take an average of 7.9 medications per day and someone struggling with health issues may be taking many more.  Nobody could remember all this, yet it may be one of the most critical elements to a geriatrician and other health care providers in determining treatment.

If you are a caregiver, encourage your loved one to get all their medications listed with the dosage, frequency, and any special instructions on paper.  Check it and make sure it's right.  If it's too complicated get help from a geriatric care manager or health professional.  Make copies for yourself, and all of the health providers your loved one contacts.

To read the full article “Patients Can't Recall Their Medications To Tell Doctors” Click Here.

My 79 year old Mother, Henrietta, has significant memory loss.  Her Dr. has used the words dementia and Alzheimer’s to describe her condition – both scary words that my sister and I do not use in Mother’s presence.

I have become my parent’s “parent.”  It is an odd shift of role reversal, one that is confusing and, at times, difficult for both of us.  But as I gently guide my Mother to select a new dress or pick an entrée while dining out, I realize that her decision making ability has simply disappeared.  Her mantra is “I’ll ask my Daughter.”  I’m grateful for the confidence so lovingly bestowed, but find the transition fraught with emotion – sadness, anxiety, frustration and the lingering doubt that I know how to do this well.