I’m Jean Bandos, MSN, CNS, APRN, BC.  I’m a gerontological clinical nurse specialist with vast experience in care management of the older adult. I’ve spent the majority of my career assisting the older adult and their families navigate the health care system. In my blog, I’ll share some eldercare resources and assist in spreading the word on “tips” for caregivers of aging parents.    

 

 To learn more about me, please visit our website.

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.

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.

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

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.

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”

We are hearing more and more about the older adults being taken advantage by a scam artists, being victims of violent crime and even human interest stories of seniors being found alone, malnourished and unable to care for themselves.  But what exactly is elder abuse? 

According to the National Center on Elder Abuse (NCEA),  elder abuse is any form of mistreatment that results in harm or loss to an older person. It is generally divided into the following categories: 

1. Physical-  physical force that results in bodily injury, pain, or impairment. It includes assault, battery, and inappropriate restraint.
2. Sexual- there is non-consensual sexual contact of any kind with an older person
3. Domestic Violence- an escalating pattern of violence by an intimate partner where the violence is used to exercise power and control
4. Psychological- the willful infliction of mental or emotional anguish by threat, humiliation, or other verbal or nonverbal conduct.
5. Financial- the illegal or improper use of an older person's funds, property, or resources. 

Other terms you may hear about are 'neglect' (failure of a caregiver to fulfill his or her care giving responsibilities) and 'self-neglect' (failure to provide for one's own essential needs.) More detailed information can be viewed at www.preventelderabuse.org/elderabuse/elderabuse.html - NCEA.

The problem of elder abuse is large and is also under-reported.  In a National Incidence Study on Elder abuse, approximately 450,000 elderly adults experienced abuse in 1996. If self neglect had been included, it would have risen to  551,000. The NCEA Estimates of Prevalence in the U.S.

• "...between 1 to 2 million Americans age 65 and older have been injured, exploited or otherwise mistreated." 
• One in 14 incidents in domestic settings (excluding self-neglect) are believed to be brought to the attention of authorities.
• In overall reporting of financial exploitation, one in 25 cases suggests that there may be five million financial abuse cases.
• For every case reported to authorities, an estimated five cases of elder abuse go unreported.

What can you do? You can enhance the awareness of elder abuse. In most states, it is required that health care professionals report suspected abuse. But even if it is not mandated is the right thing to do.  If you would like more information on mandated reporting, visit http://elder-law.lawyers.com/Elder-Abuse.html.

Also, educate yourself.  The Hartford Foundation Institute for Geriatric Nursing has created a tool to document and assess for elder abuse.  It can be found at  www.hartfordign.org/resources/education/tryThis.html. 
It can assist you in assessing and summarizing abuse and neglect concerns by assessing the senior’s appearance, indicators such as bruise and/or fractures- or with self neglect malnutrition and/or signs of depression- or in areas of exploitation, where the senior’s monies have been mishandled. 

The key is to be aware, seek information, and help the seniors preserve their dignity and their rights.  Let’s keep our seniors safe.

To read our special Update on Senior Fraud, please click here.

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.

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

You have documented your end of life wishes and informed your loved ones (click here for 5 Wishes advance directives accepted in 40 states). Now you have questions about finalizing your funeral plans.  Where do you start?

First, you have to decide if you want the traditional full service funeral that usually involves a visitation (with the decision of open or closed casket), service, and transportation to the cemetery.  Or do you want a direct burial or direct cremation (which occurs shortly after death)?   If you do a direct cremation and/or burial, do you want a memorial service?  Who would you like to plan the service?  Remember, the service does not need to be at the time of cremation.

Once you have decided on your funeral plans, please discuss your wishes and any arrangements that you have finalized with your loved ones or with your attorney. The more documentation that you leave with your family, the easier it will be for them at the time of your death.  There may be family members who would not abide by your wishes if they are not in writing  - whether because of their religious beliefs or their own needs/beliefs.  Some individuals who want to be cremated have family members who feel that if there is not a traditional visitation where you can say goodbye that there is no “closure” to the person’s life.  Then there are those who do not want to see the body after death.  By documenting your wishes, you will assist your family in abiding by and understanding your wishes.

Funeral providers are required by law to provide you with a price list of all services and charges that will be incurred.  Many people prefer to prepay or designate a sum of money for payment of funeral expenses.  Laws differ from state to state regarding protection of payments made directly to the funeral home.  The Federal Trade Commission offers a list of questions to ask when you are considering funeral prepayment (click here or visit http://www.ftc.gov/bcp/conline/pubs/services/funeral.shtm).   Websites such as the Better Business Bureau (click here to visit www.bbb.org)  and Selected Independent Funeral Homes (click here to visit www.selectedfuneralhomes.org) can help guide you to reputable funeral providers.

Advance Directives and funeral planning are never easy topics to discuss... But  having those difficult conversations and documenting your wishes will benefit not only you, but those you love. 

Again, one great web site is the Federal Trade Commission's Consumer Guide to Funerals.  It provides information regarding funeral planning, pricing of services, questions to ask, and information about your options.  Click here to visit the site or go to http://www.ftc.gov/bcp/conline/pubs/services/funeral.shtm.

Do You Have Your Advance Directives Written??

 Over the last months, I have had the opportunity to assist several families that were thrown into dealing with their loved one’s end of life wishes. Each family story is different, but the common theme was “the elder parent “ had not discussed nor written down his or her end of life wishes. 

 One father’s wishes were to not have CPR and to not return to the hospital if he had an exacerbation of congestive heart failure. From code status and hospital admission, these wishes sound easy. But since the elderly parent had not discussed these wishes with his health care providers and family, the family wasn’t able to fully advocate for his rights.  When he had an exacerbation of his heart failure, the nursing home transferred him to the hospital. After being admitted, he had tests and treatments that prolonged his life. After several weeks, he died in the hospital.  If he had discussed his wishes, named a health care representative, or created a living will, the family could have advocated for his wishes and prevented this last hospitalization.  

 It doesn’t matter what age you are… if you wait until the last days of your life to make others aware of your wishes, your wishes may not be carried out.  Not because your loved ones don’t care, but because they will not have enough time to understand what you are requesting and be able to appropriately advocate for your rights. I cannot emphasize enough the importance of letting those close to you know your wishes and writing them down.

Have you had those conversations with your parents – with your children?

 If these conversations do not happen, the end of life decisions become very difficult and many times will divide a family at a time when they should be together.  Don’t let this be your family.  Do your research- and ask the hard questions. 

 An excellent site to visit is Aging with Dignity.  It will 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.

Another site is Partnership for Caring http://www.caringinfo.org/  and (1-800-989-9455). The Partnership for Caring has downloadable advance directives requirements for all 50 states, or one may call for advance directives documents. 

There is never a good time – but anytime is the right time.  Talk now.

National Healthcare Decisions Day aims to increase awareness about advance directives.  While the initiative focuses on patients, all Americans should take the time to make their wishes known regarding health care.  You should decide what treatments you do (or don’t) want to receive, and think about appointing someone to make these decisions and/or advocate on your behalf if you are incapacitated or unable to make your own decisions.

To find out more about National Healthcare Decisions Day, visit their website at www.nationalhealthcaredecisionsday.org.

National Healthcare Decisions Day is the perfect time for you to create your advance directives.  My next post will focus on the importance of advance directives for individuals and their families.

As we entered into spring, the presidential candidates continue the health care debate.  The real issue is that the US has an aging population.  By 2030, the number of adults age 65 and older will nearly double to 70 million. With twenty percent of the Medicare population having at least five chronic conditions (e.g. hypertension, diabetes, arthritis), the question remains: How do we care for these elders? 

Geriatrics is a growing specialty where physicians, nurses, social workers and other health care providers receive special training dedicated to improving the health, independence and quality of life of all older adults.  Geriatricians are physicians who are experts in caring for older persons; they are initially trained in family practice or internal medicine and then complete at least one additional year of fellowship training in geriatrics. They have the expertise to coordinate services among multiple specialty care providers.  For more information on the profession, visit the American Geriatrics Society website at http://www.americangeriatrics.org.

A geriatrician will coordinate a health assessment for older adults with the primary goal of encouraging and promoting wellness and independent function. The health assessment will include an interdisciplinary team approach to the physical, emotional, cognitive, functional, and medication status of the older adult.  If you would like to locate a physician in your area who is sensitive to the special needs of older adults, you can submit your request by completing a form on line located at http://www.healthinaging.org/public_education/physician_referral.php  or contact a geriatric care manager in your area.  To locate a local geriatric care manager, visit http://www.caremanager.org/.  In addition, telephonic geriatric care management services are now offered by My Health Care Manager.  To learn more, visit our website by clicking here.

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.

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!  

As the holidays come to a close, are you experiencing the holiday blues? Are your parents? While you where visiting your aging parents did you notice any signs of depression or mood changes? It is known that suicide rates increase over the holidays. But did you know that between 5% to 20% of persons over age 65 living in the community suffer from depression (2002, Primary Care Geriatrics)?

Depression is a common disorder among the elderly but is not a normal part of growing old.  It is one of the diagnoses that continue to go untreated. There are many reasons for this, one being that physicians have the tendency to focus on illnesses affecting the body instead of the mind. Another key reason is that the older adult was taught to be independent and feel that they should take care of themselves and "their” problems. Your parent may feel that they should not “bother” their physician or you with their feelings of loneliness/depression. As the adult child, you may feel that you do not have the right to intrude on your parent’s privacy.  But, if your parent has any of the common depressive symptoms such as irritability, frequent crying, loss of interest or pleasure, weight gain or loss (especially weight loss), insomnia, fatigue, decrease in ability to concentrate, feeling of hopelessness and/or suicidal thoughts, please assist him/her in making an appointment with his/her physician. If you can, go with them to the appointment and take a list of symptoms/ concerns to share with the physician.  Reinforce that these depressive symptoms are treatable and that he/she deserve to feel better, to have more energy, and to continue to age in place.  

 One day I googled “depression in the elderly” and received 369,000 results- here are some resources that might assist in you in your search.

 

Resources:

 

The geriatric depressions scale is a self - administered scale that can measure depression in the elderly.

 

GERIATRIC DEPRESSION SCALE (GDS)

 

CHOOSE THE BEST ANSWER FOR HOW YOU FELT THIS PAST WEEK.

                                                          

CIRCLE ONE (YES OR NO)

 

  1.  Are you basically satisfied with your life?     Yes     No

  2.  Have you dropped many of your activities and interests?     Yes     No

  3.  Do you feel that your life is empty?     Yes     No

  4.  Do you often get bored?     Yes     No

* 5.  Are you hopeful about the future?     Yes     No

  6.  Are you bothered by thoughts you can't get out of your head?     Yes     No

* 7.  Are you in good spirits most of the time?       Yes     No

  8.  Are you afraid that something bad is going to happen to you?     Yes     No

* 9.  Do you feel happy most of the time?     Yes     No

 10.  Do you often feel helpless?     Yes     No

 11.  Do you often get restless and fidgety?     Yes     No

 12.  Do you prefer to stay at home, rather than going out and doing new things?     Yes     No

 13.  Do you frequently worry about the future?     Yes     No

 14. Do you feel you have more problems with memory than most? Yes No

*15. Do you think it is wonderful to be alive now? Yes No

 16.  Do you often feel downhearted and blue?     Yes     No

 17.  Do you feel pretty worthless the way you are now?     Yes     No

 18.  Do you worry a lot about the past?     Yes     No

*19.  Do you find life very exciting?     Yes     No

 20.  Is it hard for you to get started on new projects? Yes     No

*21.  Do you feel full of energy?     Yes     No

 22.  Do you feel that your situation is hopeless?    Yes     No

 23.  Do you think that most people are better off than you are?     Yes     No

 24.  Do you frequently get upset over little things? Yes     No

 25.  Do you frequently feel like crying?     Yes     No

 26.  Do you have trouble concentrating?     Yes     No

*27.  Do you enjoy getting up in the morning?     Yes     No

 28.  Do you prefer to avoid social gatherings?     Yes     No

*29.  Is it easy for you to make decisions?     Yes     No

*30.  Is your mind as clear as it used to be?     Yes     No

  

*Appropriate (nondepressed) answers = yes, all others= no... or count number of CAPITALIZED (depressed) answers

Score: _____ (Number of "depressed" answers)  

 

            Normal               5 +/- 4

            Mildly depressed    15 +/- 6

            Very depressed      23 +/- 5

________________________________________________________________

 

References:

1.  Yesavage JA, Brink TL, Rose TL, et al.  Development and validation of a geriatric depression rating scale:  a preliminary

report.  J Psych Res. 1983; 17:27.

 

2.  Sheikh JI, Yesavage JA.  Geriatric Depression Scale:  recent evidence and development of a shorter version.  Clin Gerontol.

1986; 5:165-172.

The Geriatric Depression Scale may be used freely for patient assessment according to the authors

 

http://depression.about.com/od/elderly/Elderly_Depression.htm

http://www.consultgerirn.org/topics/depression/want_to_know_more

http://nihseniorhealth.gov/depression/aboutdepression/01.html

 

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

·   An excellent resource regarding evidence based practice for nurses in clinical and educational settings is the Harford Institute for Geriatric Nursing, New York University College of Nursing http://www.consultgerirn.org/ . This site covers geriatric topics including but not limited to overviews, definitions, background information such as incidence, prevalence, assessments, assessment tools, and nursing care strategies. In dealing with fall prevention, as an example, the information that you will have access to is a general overview of falls, definitions, along with assessment tools and educational material. One tool that is shared is the Tinetti assessment tool for the older adults who can ambulate independently. The site also provides nursing care strategies, treatment protocols and management recommendations.

·   Age related changes (such as altered visual acuity, decreased balance and muscle strength, hypotension, and changes in bladder function such as frequency and/or incontinence) increase the risk of falls. If you have a hospital based practice, you know that falls are the single largest category of incidents in an acute care setting and for people over 65 years of age, falls are responsible for one third of deaths (http://www.consultgerirn.org/).

·    In dealing with the elder population, always remember to evaluate for the risk of falls and provide fall prevention education. Another resource for educational materials is the National Institute on Aging  www.nihseniorhealth.gov .

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

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

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

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

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

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

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

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

Ø      Pick up your throw rugs.  

Ø      Don’t take chances.  

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

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

Ø      Keep night lights on.   

Some additional fall prevention resources are:  

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

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