Much has been written about the requirements for executing advance directives such as powers of attorney, designation of a health care representative, living wills, arrangement for organ donation, and do not resuscitate orders.  Giving thought to any of these directives is a good idea in advance of the need for them - for seniors, their caregivers, and people of all ages.  Today I am thinking more about some of the things that can go wrong, or should I say go differently than anticipated with respect to advance directives.  For example:

1) The law in Indiana is that a designation of health care representative, more commonly known in other states as a health care power of attorney, is only effective when the principal is not able to make decisions.  Notice that in our documents the power to make decisions for someone else is usually prefaced by the words “whenever I am incapable of making my own health care decisions.”  That sounds clear enough, but in reality, a health care facility cannot practically decide, on a day to day basis when their patient is capable or not capable.  This tends to lead to a bias to ask the health care representative what care should be given, even when the principal is competent to make the decision.  It is the representative that may be paying the bills.  It is the representative who made the admission decision and has the most interaction with some of the staff. The point is that we must guard against allowing health care providers to always ask the representative.  It is the patient that should have input, if possible.


In my next couple of blog entries, I'll give more examples of how things can progress differently than expected...

An Alzheimer's patient once came to me after he had got out of his house and was found hours later in a ditch approximately 2 miles from his house.  Wandering is often a scary symptom of Alzheimer's disease and dementia.  It's confusing and scary for a senior who does not know where he/she is or where they are going; and is scary and worrisome for family caregivers.  Wandering can occur anytime but tends to increase in the late afternoon/early evening hours.  There are several things caregivers can do to keep their loved ones safe at home. 

Tip #1:  Use deadbolts on doors leading outside, place them high or low on doors
Tip #2:  Take locks off of bathroom and bedroom doors to avoid your loved one from locking themselves in
Tip #3:  As the sun starts to go down, close the blinds/curtains and turn lights on
Tip #4:  Install appliances that shut off automatically
Tip #5:  Keep toxins i.e. cleaners, bleach, poisons; and prescription medications in a safe, secure space
Tip #6:  Remove clutter from around the house
Tip #7:  Install a door alarm or place a motion sensor in your loved one's room at night to alert you when they are awake and moving
Tip #8:  Label doors, drawers, and cabinets; this is most helpful in the earlier stages

A professional geriatric care manager can help you in reviewing your home and finding assistance for home modifications.  For more tips and information, check out The Complete Guide to Alzheimer's-Proofing Your Home and home modification tips.

Summer is officially here... and the heat waves begin. Did you know that more people die from heat waves each year than from hurricanes, lightning, tornadoes, floods, and earthquakes combined?? (CDC)  As a caregiver or friend, how can you help keep your loved ones safe?

Older adults are particularly vulnerable to the effects of heat stress because the elderly do not adjust as well as younger persons to sudden changes in temperature.  Also, an older adult’s chronic illness may affect how his/her body responds to heat and many older adults take medications that impair the body’s ability to regulate its temperature or medications that inhibit perspiration.  

Heat stroke is the most serious heat-related illness. It occurs when the body becomes unable to control its temperature: the body's temperature rises rapidly, the body loses its ability to sweat, and it is unable to cool down. Body temperatures rise to 106°F or higher within 10 to 15 minutes. Heat stroke can cause death or permanent disability if emergency treatment is not provided.
Warning signs for heat stroke vary, but may include the following:

    - An extremely high body temperature (above 103°F)
    - Red, hot, and dry skin (no sweating)
    - Rapid, strong pulse
    - Throbbing headache
    - Dizziness
    - Nausea

According to the CDC, you can help protect elderly relatives and neighbors who are at risk by:

    - Visit him/her at least twice a day and watch them for signs of heat exhaustion or heat stroke
    - Take him/her to air-conditioned locations if they have transportation problems
    - Assist them in obtaining air-conditioning
    - Make sure older adults have access to an electric fan whenever possible.

Heat wave deaths can be prevented. For more information, visit these links:

http://www.hhs.gov/disasters/emergency/naturaldisasters/heat/index.html 

http://www.epa.gov/aging/resources/factsheets/index.htm#itdhpfehe

As nature is hitting us with all forces across the nation, hurricanes, tornados, fires & floods; a key resource for eldercare is a emergency supply kit. 

Each older adult’s needs and abilities are unique, but every older adult (and caregiver) can take important steps to prepare for all kinds of emergencies and put plans in place, even when residing in a retirement community.  Start by evaluating personal needs when making emergency plan. A commitment to planning today will help prepare the older adult for any emergency situation. Consider how a disaster might affect your individual needs.

• Plan to make it on your own, at least for a period of time. It's possible that you will not have access to a medical facility or even a drugstore.
• Identify what kind of resources you use on a daily basis and what you might do if they are limited or not available.
• Get an emergency supply kit.  (http://www.ready.gov/america/getakit/index.html)
• If you must evacuate, take your pets with you, if possible. However, if you are going to a public shelter, it is important to understand that animals may not be allowed inside.
• Plan in advance for shelter alternatives that will work for both you and your pets; consider loved ones or friends outside of your immediate area who would be willing to host you and your pets in an emergency.

When preparing for a possible emergency situation, it's best to think first about the basics of survival: fresh water, food, clean air and warmth.

Recommended Items to Include in a Basic Emergency Supply Kit:

• Water, one gallon of water per person per day for at least three days, for drinking and sanitation
• Food, at least a three-day supply of non-perishable food
• Battery-powered or hand crank radio and a NOAA Weather Radio with tone alert and extra batteries for both
• Flashlight and extra batteries
• First aid kit
• Whistle to signal for help
• Dust mask, to help filter contaminated air and plastic sheeting and duct tape to shelter-in-place
• Moist towelettes, garbage bags and plastic ties for personal sanitation
• Wrench or pliers to turn off utilities
• Can opener for food (if kit contains canned food)
• Local maps

Medications and Medical Supplies
If you take medicine or use a medical treatment on a daily basis, be sure you have what you need to make it on your own for at least a week, maybe longer.

• Make a list of prescription medicines including dosage, treatment and allergy information.
• Talk to your pharmacist or doctor about what else you need to prepare.
• If you undergo routine treatments administered by a clinic or hospital or if you receive regular services such as home health care, treatment or transportation, talk to your service provider about their emergency plans. Work with them to identify back-up service providers and incorporate them into your personal support network.
• Consider other personal needs such as eyeglasses, hearing aids and hearing aid batteries, wheelchair batteries, and oxygen.
• Include copies of important documents in your emergency supply kits such as family records, medical records, wills, deeds, social security number, charge and bank accounts information and tax records.

For more information on special needs, see Disaster Preparedness For People With Disabilities  from FEMA, and Disaster Preparedness for Seniors by Seniors from the Red Cross.

Keep in mind a disaster can disrupt mail service for days or even weeks. Consider direct deposit by calling the Go Direct toll-free helpline at (800) 333-1795 or sign up at www.GoDirect.gov. Sponsored by U.S. Department of the Treasury and the Federal Reserve Banks, this option will ensure you get your social security or SSI payment on time each month.

Preparing makes sense. Get ready now.

My sister got married last weekend.  It was a beautiful outdoor ceremony, despite an impending rain storm.  It thundered as they repeated their vows, which made me think of the “The Ten Commandments” movie. Thankfully, the only thing that caught on fire was the Unity Candle and no bushes blazed. 

My Mother was beautiful and enjoyed her role as Mother of the Bride.  With her hair professionally done, a pretty lavender jacket dress and pearls – she looked 15 years younger.  Ever the hostess, my Mother was concerned about the guests and did her best to make sure that those around her were having a nice time.  It was wonderful to see her looking so happy and composed.  It reminded me of other family occasions when she was more engaged and aware than she typically is now. 

My sister and I were overjoyed that my Mother could be present and enjoy the day.  We didn’t care that she wasn’t quite sure where we were or what day it was.  We just cared that she could celebrate with us.  WE LIVED IN THE MOMENT.  It is one we will cherish and remember forever. 

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.

This article "50 Communication Tips and Techniques for Caregivers" was recently sent to me.  This article lists good tips and techniques for communicating with someone who experiences memory loss.  These tips and techniques include information on communicating and speaking someone who has memory loss, attention techniques, nonverbal communication tips, behavior tips and techniques, and working/communicating with others who might be involved with the senior.

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

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

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

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

We are constantly hearing about identity theft and what to do and what not to do.  We may know someone who has had their identity stolen or tried to work with their bank when their account numbers had been stolen. Just last week, I had a friend who had someone steal his account number from Saudi Arabia – since it was the bank’s files that were accessed, he did not lose his identity or any money. Others whose personal debit cards have been stolen lost thousands of dollars.

The older adult is a prime target for identity theft, and maybe even more so those suffering from memory loss or Alzheimer's. It could be as simple as paying with a check to one of the frequent kids who come to their door selling magazines, cleaning products or someone offering to clean their carpets “free” and entering the home. Explain to your parent and/or older friend that when someone is using their name, social security number, or credit card without their permission, it is a crime. Tell them to keep their checking account private, report any stolen credit cards or checks, always review their monthly bank statement, and never let anyone enter his/her home to give a “free” demonstration. 

Last week I attended an awareness presentation on identity theft by local police officer.

Some tips are:

• Do not have your checks delivered to your apartment, front porch, or a mailbox that is not locked.
• Do not use your debit card freely at gas stations, grocery stores, etc. 
• Shred anything that has personal information.
• Do not pay by check to solicitors at your door
• Do not let anyone enter your home
• Be very careful when buying things online. Websites without security may not protect your credit card or bank account information. Look for information saying that a website has a secure server before buying anything online. 
• Check with the Federal Trade Commission (FTC) to find out how to protect yourself from common online scams that can trick you into revealing your personal or financial information.

Remember do not share your personal information – Ask questions – Report any thefts. 

If you're caring for aging parents, you may check these two resources for more information:

Federal Trade Commission
600 Pennsylvania Avenue, NW
Washington, DC 20580
877-382-4357 (toll-free)
www.ftc.gov

Look for the booklet 'Take Charge: Fighting Back Against Identify Theft.'
AARP- Consumer Protection offers a free online course regarding identity theft.
601 E Street, NW
Washington, D.C. 20049
888-687-2277 (toll-free)  
www.aarp.org/money/wise_consumer

Laurie recently posted a comment about her mom having problems mixing up her medications.  This is a very common problem.  The average person over age 65 is taking 8 prescription medications.  Someone who is battling chronic diseases may be taking many more. 

The number of medications is confusing in the best of circumstances, but clearly other challenges like declining vision, cognitive issues, or problems with manual dexterity make medication management a daunting task. 

Some of the posts in my blog can help.  See Technology in Day-to-Day Medication Management and Create Your Medication List Now.  You can also click here for our full blog list on Medication Management where you will find lots of additional advice and insight.

You can also ask question directly of a Health Care Manager by joining our Caregiving community.  Click here for that link.

Surveys show what most everyone already knows – seniors, by almost a 90% margin, desire to continue living in their current home rather than moving to an alternative living situation.  Many believe they can’t afford an equivalent senior living residence, but most do not want to leave the comfort and memories of their home.

Barring safety or health issues that would mandate a move, there are many ways to provide services that allow staying in the home – at least for awhile.  Some solutions are more expensive than moving to a senior living community, so if economics are an issue the alternatives need to be carefully compared.

The least expensive service (and not medically helpful) is a companion.  Hired directly, companions can be found in the $9 to $13 hourly range, and in the $14 to $20 hourly range if hired through an agency.  Important considerations including screening and background checking, back up for absences and vacations, supervision, taxes, insurance and turnover come in to play when making the decision between independents and agencies.  We have intervened in abusive companion cases as well as screened potential solo companions and agencies to help families arrive at the decisions they prefer.  According to the MetLife Mature Market Institute, the national average for agency-provided companion/homemaker services is $18 per hour.  Many times a companion can be utilized for shorter periods of time to provide assistance and friendship for shopping, errands, cooking or simply conversation. 

When higher skilled services are provided, they start with a certified home health worker and move up through Certified Nursing Assistants (CNAs) to Licensed Practical Nurses (LPNs) and Registered Nursed (RNs).  The national average is $19 per hour for home health aides (from licensed agencies) according to the MetLife Mature Market Institute.  In some areas, the average hourly rate is less than $13 and in other areas, it is more than $30. 

It’s important to assess the skill level and coverage needed to provide the necessary support for seniors living in their homes.  My Health Care Manager does this assessment using a Registered Nurse working with one of our 5,000 networked RNs throughout the U.S.  Using an unbiased professional helps in the analysis so the result is not skewed to a preferred alternative.

There will be more about this issue in my next blog.

According to the Mayo Clinic, there are nearly 10 million Americans that provide approximately 8.4 billion hours of unpaid care!  These caregivers are often family members.  Providing care in the home for someone who has Alzheimer's is a 24/7 job often with little relief.  I've met families who state they only get 4-5 hours of sleep at night because mom/dad will get up and mill about, or that they sleep with a baby monitor.  My grandmother used to say she slept with one ear open so she could hear what my grandfather was doing.  Caregiver stress can lead to feelings of resentment, physical health decline (heart attack or minor stroke), emotional distress, and possibly unintentional elder abuse.  I once had a wife of an Alzheimer's husband who said she knew she was at her breaking point, when she thought she was going to hit her husband and started having feelings of anger and resentment instead of love and patience.  I urge ALL family caregivers to not let the stress get to this breaking point.  It is OK to ask for and accept help.  I understand that we feel we are the best person for the job.  However, our job is also to take care of ourselves.  We are no good to our loved ones if we are stressed out and physically and emotionally distressed. 
There are several respite care options.  One is adult daycare.  The majority of adult day centers take a social approach verses a medical approach.  It's a time for seniors to get together in a social setting and do activities that promote physical and mental health.  Adult day centers allows caregivers to set their own schedule, take mom/dad there once a week or 3 times a week or every other week...this allows you, the caregiver, time to run errands, have lunch with friends, take a nap, etc.  Another respite care option is hiring an in-home companion to come and sit with mom/dad while you run errands or take some time for yourself.  Another option is having a volunteer from the local Alzheimer's Association or Area Agency on Aging come and spend time with mom/dad while you take time for yourself.  Another source of volunteers is the local university, check with the school of social work, education, or nursing. 
The goal is often to keep mom/dad at home for as long as possible.  Receiving and accepting assistance will help you achieve this goal as well as help you maintain your overall health so you can be the best caregiver.  There is no guilt or shame in accepting help from others, and all caregivers should be praised for doing this often difficult job!

Last week, I ran across an elder friend who was worried about identity theft. She had no idea what it meant and was fearful that someone would take all her money.  Not having enough money to live on or living with the fear that someone will steal all their money is a common theme among older adults. Anyone who has worked in long term care has seen the 90 year old woman who sleeps with her purse!  But in today’s world, older adults’ fears are more than warranted. Often the elder is the target of crime and fraud.

The National Institute on Aging reports that “older people are less likely to be victims of crime than teenagers and young adults, the number of crimes against older people is hard to ignore. Older people are often targets for robbery, purse snatching, pick-pocketing, car theft, or home repair scams. They are more likely than younger people to face attackers who are strangers. During a crime, an older person is more likely to be seriously hurt than someone who is younger.” (www.nia.nih.gov)

So as caring friends, care providers, or adult children, what do we recommend to help?  Tell them to:

• Keep the home safe (e.g. doors and windows locked when not home)
• Know who is at the door before opening it 
• Know the phone number for the local police
• Have easy access to a phone
• Don’t keep large quantities of money – whether on your person OR hidden at home!
• Be cautious with your money
• Have pension checks, social security checks sent to your bank for direct deposit
• If you give the Power of Attorney to someone, make sure it is someone you know very well and trust
• Don’t be afraid to hang up on telemarketers, pushy salespeople, or even someone from a charity or other organization that you haven’t heard of and are not sure whether to trust
• Never give out personal information especially your credit card number and social security number
• Be on guard about door-to-door salespersons

One of the newest concerns is identity theft -- Look for my next blog for resources to assist the elderly with protecting their identity.

Alzheimer's Disease is a world of uncertainty for both the person affected and the family members.  It's important to create moments of joy within that disease and with that senior.  Alzheimer's and dementias affect each person differently, some people have personality or behavioral changes, some lose brain functioning at a faster rate, etc.; their world becomes different.  It is important for family members to pay attention and learn where their loved one is at.  This is not an easy task for family members because the senior's memory maybe affected to where they no longer recall their wife or that they have children, etc.  If we try to correct them, it causes more confusion, anger, sadness or depression for the senior.  Try to put yourself in "their world"....  I once stood in front of a mirror with a lady affected by Alzheimer's and she said "who's that old lady?"  Instead of me saying that's you (since she did not recognize herself), I merely said "I'm not sure exactly, but it's a good thing we are two good-looking ladies."  In her mind, she was in her mid-30s and could recognize herself in an old picture of when she was in her 30s, but if you showed her a picture of herself today, she didn't recognize herself.  Another lady was taking all her clothes and other belongings and gathering them up and putting them into piles, stating she was getting ready for a garage sale.  Instead of telling her it was the middle of winter and she wasn't having a garage sale, I started a conversation by asking her what she was going to buy with her garage sale money.  She said a new car and some new clothes, so we talked about cars and shopping while I helped her "decide what goes and what stays".  We had a great conversation and a fun time.  It is difficult for family members to join in mom or dad's world because it is not "our reality."  But it is their's.  It's our turn to help create memories of joy.  If their thoughts or actions are not physically harming to themselves or others, then just try to roll with where they are at.  Correcting them or trying to bring them to "our reality" will only cause emotional anguish.  The article, "Finding Moments of Joy Helps Alzheimer's Patients" gives additional tips on how to create moments of joy.

To make effective use of any set of tools you need to combine them with process.  In the case of caring for aging parents, the process is something you have to repeat over and over.  The situation changes, health conditions like diabetes or cognitive concerns change, needs and desires change, and all of these play in to the decisions about the next course of action.

At My Health Care Manager we have defined, detailed and implemented processes at all levels of service delivery - over 100 in all.  These include detailed flows, processing narratives, measures, entry and exit criteria, responsibility identification, and more.  At the core, however, these processes all revolve around this simple cycle.

If you are caring for a senior, consider adopting a process like this one and implementing changes in the top 3 (or fewer) areas of concern in each iteration.  Clearly, trying to change too many things at once can actually be counterproductive.  Any of us, especially if we're sick, depressed, or struggling with cognitive decline, can only impact a small number or areas at one time.

Understanding that this is a cycle with re-evaluation can help manage the sometimes overwhelmingly long list of things needing attention.

Continuing on the family communications theme from my last blog, I want to share our experience with a wonderful product that helps family and friends easily communicate with an older adult.  The product and its service is called Presto, and it’s a one-way email product.  Someone (my wife in our case) serves as the manager to allow approved people’s email addresses to send messages and photos to the senior’s Presto email account.  The community can be as large as desired with adult children, grandchildren, friends and neighbors all authorized to send.  This “authorized sender” status eliminates spam and solicitations which is a great value Presto provides in its ongoing service.

At the receiving end is a HP ink-jet color printer with a dial-in modem that has been simplified for ease of use by a senior.  Adding paper is easily done by my mother and father-in-law, both 95, but one of the family changes the ink cartridges when necessary.  The Presto service dials the printer several times a day and transmits whatever is has received.

The result is the “magic” that appears from friends and family whenever it is sent.  My father-in-law has saved every message and picture he has received over the last 2 years (we bought both of them units at Christmas two years ago), and he eagerly awaits new messages.  The same with mother. 

Since My Health Care Manager is independent of all vendors and health providers, we don’t make a penny on the recommendation.  However, the Presto people will include an additional cartridge (HP95) and 2 months’ free service if you order it from www.presto.com/myhealthcaremanager in recognition of our support.

My mother moved to Indianapolis last August.  The move was difficult, as she moved away from her friends and an area where she had lived for almost 30 years.  Her move into an Assisted Living Facility in Carmel, IN meant she would receive the care she needed, but it impacted her independence when she gave up driving, downsized to a smaller apartment and lost her social network.

The past ten months haven’t been easy for either of us.  My Mother has struggled to adapt to a new place and make new friends.  I have struggled to balance work and caregiving, while maintaining time for myself and the things I enjoy.  We have both struggled to adjust to the dynamics of a shifting Mother-Daughter relationship.

Throughout it all, my Mother has conceded that she likes it here….yet has repeatedly asked me if she can move back to where she used to live.  We’ve discussed this and I’ve explain that her home in Pennsylvania is 11 hours away and that it is probably better if she stayed here, so we can see each other more often and I can help her with things.  She has reluctantly agreed that this is the best plan, but we have both felt sad that she can no longer live as she used to and that her cognitive decline has changed her life in ways neither of us imagined.

That’s why yesterday was a wonderful day and a blessing to be appreciated for a long time.  It started out innocently enough.  I took my Mother shoe shopping.  She needed some sturdy, comfortable flats for summer.  The shoe store clerk was exceptionally nice to my Mother and found a pair of stylish, yet practical shoes.  My Mother selected a summer purse she liked too – so was quite happy with our shopping expedition.  She commented as she left that she liked the shoe store quite a lot and was glad it was nearby.

Later at dinner, she looked at me and said “Can I stay here?”  I responded by saying of course she could stay here, that she lived here now…in Carmel….about five miles from my house.  She responded by saying “Good, I like it here and I like having dinner with you and going shopping.”  Her comments were sincere and something I’ve longed to hear for ten months.  I quietly thanked God for helping her become comfortable in a new place.

Everyone needs a place to belong and a place to call home.  I believe my Mother has finally come to think of Carmel, Indiana as home and I am grateful and thankful that she is happy to be here. 

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

How can they protect themselves?

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

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

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

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

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

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

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

Got a headache, back pain, high cholestrol levels, etc?...then pop a pill.  That is often the "magic" solution in today's health care system.  According to the American Heart Association, 32 million Americans take 3 or more medications daily.  Seniors often take double or triple that amount and sometimes more.  The problem is, is that with all medications come potential side effects and then to treat those side effects people are often prescribe another medication and so on.  Another problem is that seniors often have multiple physicians who often are not aware of what the other physicians' treatment plans are and what medications they are prescribing.  According to Medco Health Solutions, a pharmacy benefits manager, "the risk for drug errors is 7 times greater in seniors than in people under age 65."  CNN.com released an excellent article this week titled "Is Grandma drugged up?"  This article tells a story of a 66 year old woman who was experiencing confusion and slurring of her words.  Her family took her to the emergency room where the possibility of a stroke was ruled out; she was admitted to the hospital and was diagnosed with Alzheimer's Disease.  Her children believed that the diagnosis was incorrect, as she has been functioning independently.  They took their mother to a geriatrician at the University of Oklahoma for a second opinion, where they were told that she most likely did not have Alzheimer's Disease but was overmedicated.  Dr. Jerry Gurwitz's philosophy is "that any new symptom in an older person should be considered a drug side effect until proven otherwise."  Not only do medications have side effects but they also interact with other medications causing contraindications, enhancing side effects, etc.  It is important to always keep a current list of medications, including prescriptions, over-the-counter medications, herbal medications and supplements.  All medications, not just prescriptions, can interact with each other, as well as, food/beverages and other substances i.e. tobacco.
There are several ways caregivers can assist in medication management.  If you feel that your parent is being overmedicated, talk with your primary care physician or geriatrician, and pharmacist.  There are also several online tools you can use to check your medications for interactions.  Here are two online tools:  PDRhealth.com and drugdigest.org.  Educating yourself on what medications cause potential problems for seniors is a good way to become an advocate for your parent.  As well as knowing the suggested lists of medications to avoid if a senior has a specific diagnosis.  My Health Care Manager also reviews seniors' health history and medications and can consolidate that information into one locale to assist families in managing their parent's health care.

Recently, a colleague made me aware of a free, on-line publication about Alzheimer’s, The Alzheimer’s Daily News - http://alznews.org.  I signed up for the daily e-mails with some trepidation.  I wasn’t sure just how much I wanted to know – given my family’s history.  However, I finally decided that knowledge is power and signed up for the newsletter.  Some days the articles make me sad, some days they make me afraid, some days they give me hope and, thankfully, most days they help me cope. 

Yesterday’s edition contained a story about a keynote address presented by Jolene Brackey, the author of Creating Moments of Joy for the Person with Alzheimer's or Dementia.  I thought the advice she offered was some of the best I’ve read and plan to order her book.  Her talk focused on everyday situations and realistic approaches.  One of the best bits was her comment about body language.  Her point is that a person with dementia or Alzheimer’s may not be able to communicate as they have in the past…but that they can still read body language.  Therefore,  it is important for caregivers to convey a relaxed and open posture and positive mood.  What a great idea and something caregivers should try to achieve, although it may take some practice!

To link to the complete article, please click here.

To view the book on Amazon, click here.