According the America Geriatrics Society,  a person is expected to live another 16 years after turning 65, a person who is 75 can be expected to live another 10 years and person 85 can expect to live another 6 years.  So even though vaccinations are focused more toward children, it is important to prevent disease as you age and practice prevention.    A recent post contained information about special vaccinations that you may need to travel to certain areas of the world, but vaccines are also an important consideration for everyday life.  Caregivers and seniors should make sure to stay on top of their preventative health plans.

A great eldercare resource is the American Geriatrics Society.  Through their site and publications you can know the latest recommendations not only for flu shots and the older adult, but also the recommendations for vaccinations and prevention tests.  Medicare does pay for some of vaccinations such as the costs of flu, pneumonia, and tetanus immunizations.


Some vaccine recommendations for seniors are:

• Influenza Vaccine - yearly
• Pneumococcal Vaccine - 1 dose at age 65
• Tetanus Vaccine - 1 booster dose every 10 years
• Shingles Vaccine - 1 dose in immunocompetent people

Always remember to discuss a preventative health plan with your health care provider.   
 

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

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

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

Caregivers should explore eligibility for Veterans benefits.  Veteran health benefits are open to all Veterans. Family members may also be eligible to receive benefits. There is no monthly premium for VA care, but there may be a co-pay. For more information, visit the VA Health Care Eligibility & Enrollment www.va.gov/healtheligibility .

Additions resources are available at:

• Your local VA health care facility’s Enrollment Office
• www.va.gov/healtheligibility
• www.myhealth.va.gov
• Veterans Health Benefits Service Center 1-877-222-VETS (8387)
• Family member benefits www.va.gov/healtheligibility/familymembers

Veteran or Surviving Spouse Benefits Information

Veterans Financial, Inc. is a national company (not a part of the Veterans Administration) that provides free financial advice to veterans and their families who may now or in the future need assistance in their home, assisted living, or long term care facility.  Veterans Financial helps veterans and their surviving spouses apply for the VA’s Aid and Attendance benefit to ensure they are getting the benefits they are eligible for.  Aid and Attendance
The Aid and Attendance benefit is a benefit paid in addition to a monthly pension. 

You may be eligible for the Aid and Attendance benefit if the veteran or the surviving spouse:

• Requires the ongoing aid of another person in order to perform basic personal functions required in everyday living (i.e. bathing, eating, dressing, etc.) -OR-
• Is bedridden -OR-
• Is a resident in a long term care facility due to cognitive or physical incapacity -OR-
• Is blind, or nearly blind

Once Veterans Financial has an idea of your specific situation, they will advise seniors and/caregivers on options you have and help with the application process to help obtain the Aid and Attendance Benefit.

For more information on Veterans Financial, Inc. please visit: www.veteransfinancial.com or contact them at 800-835-1541.

“Still Alice,” a wonderful novel written by Lisa Genova,  is about a woman named Alice with early onset Alzheimer’s Disease.  The author, who is a neuroscientist, weaves scientific and emotional details of the disease throughout the story.  The story is told from Alice’s perspective – a 50 year old Harvard professor who begins to show symptoms of Alzheimer’s disease.  The book follows her journey from her initial assumption that her forgetfulness is due to menopause, through medical exams and testing, to telling family members and friends of her diagnosis, to living a life she had not expected.  As the story evolves, the reader learns how Alice feels as she struggles with day to day activities such as getting dressed, taking a walk and using her Blackberry.   The reader also experiences the pain felt by family members who learn how to be caregivers for Alice while coping with the knowledge that they may have inherited the gene that causes the disease.  The awkwardness expressed by former friends and colleagues jumps off the page as they struggle to interface with an Alice who is different from the Alice they remember.

The book is an emotional, honest read.   It boldly examines the frustration, depression and decline that accompany an Alzheimer’s diagnosis.  It explores Alice’s life over a three year period and is an honest, haunting and heartbreaking portrayal of life with Alzheimer’s.  Yet, the book shares hope by including discussions of possible treatments.  Most importantly, it teaches readers to view people with Alzheimer’s not as victims, but as people living their real lives. 

“Still Alice” has received high marks from the National Alzheimer’s Association… the book is featured on their website (www.alz.org).  For more information visit www.stillalice.com.   I recommend that everyone read this book, as it puts a very human face on a disease that will shape our future.

Medicare is a government health insurance program administered by the Centers for Medicare and Medicaid Services (CMS). 

If you meet one of the following criteria then you are likely to be eligible for Medicare benefits*:

• Citizen of the United States 
• If you or your spouse worked for at least 10 years
• 65 years of age or older
• Under 65, but have certain disabilities
• End-Stage Renal Disease (kidney failure that requires a transplant or dialysis)

*If you are not a citizen of the United States, but have lived in US continuously for a five year period, you can contact the Social Security Administration office  at 1-800-772-1213 to discuss your Medicare enrollment and eligibility.

Medicare has two main categories/plans to choose from:  the "Original Medicare Plan" and the "Medicare Advantage Plan". Under these plans there are four sub-categories:  Part A, Part B, Part C, and Part D.

Look for my next post to explain the 4 Medicare policies.

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

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

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

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

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

When I was a small child, a trip to my Grandmother’s house wasn’t very exciting.  For my Father’s Mother was quite elderly and her home contained itchy mohair couches and an absence of toys…except for an old fire truck and Lincoln Log set, leftover from my Dad’s childhood.  It meant getting dressed up and being on my best behavior.  My education minded Grandmother had gone to college in the 1920’s – a very unusual thing for a woman to do at the time.  She was the wife of a minister and a lovely, intelligent, caring person.  However, it was intimidating when she asked probing questions such as… what are you learning in math, what books are you reading and where are you going to college…… when I was only in second grade.

However, I do have some favorite memories about going to visit Grandma K.  She had these great pictures of my Dad and it was fun to see him as a child, as a member of his high school basketball team and later in a Navy uniform.  The other highlight was the Humpty Dumpty teapot.  The teapot was made in two pieces – the bottom section was a yellow brick wall and the top was a yellow, egg shaped Humpty Dumpty, painted with gold features.  It was a thrill when this was taken out of the china cabinet and used when my Grandmother served tea.  It was very, very special (I don’t think we were allowed to touch it) and it fascinated me.  Chocolate covered graham crackers and pastel bridge mints were also part of every tea and to this day I think of my Grandmother when I come across these treats. 

After my Grandmother passed away, my Mother and Father inherited the Humpty Dumpty teapot.  It followed our family through a multitude of moves and always found a special place in our home.  Today, due to space constraints, it sits atop my Mother’s refrigerator in her Assisted Living apartment.

On Monday, I took my Mother out to lunch.  While walking from the car back to her apartment, she became short of breath and we stopped to rest.  As she went to sit in the chair, she fell and although I had her arm…I couldn’t prevent the fall.  Thankfully, she was okay, but it was another sign that her mobility has decreased greatly in the past few months.

As we reentered her apartment, I went to the fridge to get her a cold drink, while she rested in the den.  I looked up and there was Humpty Dumpty looking down at me.  I had a fleeting thought that my Mother had become Humpty Dumpty, as falls were becoming an increasing part of her life.  I said a quick prayer that she wouldn’t experience a disastrous fall and gave the Humpty Dumpty teapot explicit instructions to watch over her… just as he has watched over our family for generations.

Lately, it has become increasingly difficult for my Mother to reach my sister and me by phone.  She gets confused about how to find our numbers and how to actually dial the phone.  We tried to solve the problem by posting our cell numbers near her phone, but over time she removed the information and we would be back to square one.

While perusing The Alzheimer’s Store catalogue (www.alzstore.com), I found a solution to our problem.  They sell a phone that has 3 pushbuttons and each pushbutton has a place for a picture.  After some programming was complete (thanks to my sister), the push buttons were aligned with our pictures and respective cell numbers!  Now, all my Mother has to do is push one of our pictures and the phone automatically dials our cell phone.  My Mother loves it and has been able to work it easily.  
 
The phone also features a button to increase the volume in the earpiece and an extra loud ringer option.  It includes a very easy to operate answering machine too – that clearly indicates when a message is present. 

The phone has helped my family stay connected and has given my Mother a measure of independence she was close to losing.  I am thankful that this product and others like it are addressing the needs of Alzheimer’s patients.

You can find the Memory Phone with a built-in Answering Machine at The Alzheimer’s Store as well as other products that can make life for caregivers and seniors a little bit easier.

Not to be out done by the Navigator development team, the SCANS team is continuing their "rolling release" of V1.3.  SCANS is the Senior Care Navigation System that provides geriatric care managers with expert advice, best practices, and practical tools to help families with the well-being or their parents.

The June edition of V1.3 includes 26 new resources, process, or tools.  The list includes items like these:

• Death in the Home – Information for Caregivers
• Tips for Alzheimer Caregivers
• Delirium vs. Dementia
• Transitioning an Individual with Dementia into a Facility
• Member Portal Instructions
• Continence Education – Constipation
• Urinary Incontinence – When to Seek Immediate Medical Attention
• Crime Prevention Education for Older Adults
• IADL (Independent Activities of Daily Living) Education
• Physical Therapy and Occupational Therapy
• My Medicare Matters
• Advance Directives for Mental Health Treatment
• Drug Review and Side Effects
• Geriatric Friendly Pharmacy
• Medicine Reconciliation:  Brown Bag Consultation
• Feeding Tube Education
• Special Diet Needs Education
• Defibrillator Education
• Diabetes Education
• Fibromyalgia Education
• Pacemaker Education
• Physician Planner Case Note
• Alternative Living Options Education
• Speech Therapy Education
• Social Participation Barriers
• Social Support Plan

These tools are available to the clients of My Health Care Manager and our affiliates.  Some of the content is also discussed in our blogs and can be accessed for free.  Check out Natalie Langley's blog titled "Healthy Aging".  Natalie is one of the principle researchers and authors of the tools in SCANS.  Her blog covers a holistic look at healthy aging and senior well-being.

It is becoming more and more popular for older adults to volunteer these days. 
Whether they are looking for something to occupy their time after retirement or just
want to help others, they are volunteering in the community.  There are many activities
you can do to help your neighbors, friends, and organizations.  You don’t have to
volunteer for many hours each day, you can spend 5 minutes helping or several
hours if you like.  Need volunteering ideas?  The AARP has a web site titled
“Create the Good”.  You can get ideas on where to volunteer at and how to make
a difference in the lives of others.  Check it out at http://www.aarp.org/community/groups/CreateTheGood

My Mother has lived in an Assisted Living facility for almost two years.  In many ways she has adapted well and I think she is comforted by the fact that I live nearby.  However, as her Alzheimer Disease progresses, I often hear “I want to go home.”  In talking with others, I’ve learned that this is quite common... yet hearing it tears at the heart of every caregiver I know. 

Following are some tips you may find helpful when the senior in your life tells you repeatedly:    “I want to go home.”

• Remember that it is very common for a senior to repeat this request often.  Usually they mean the home from 60 or 70 years ago, not the one they left most recently.
• “Home” means different things to different people – love, security, belonging, safety.  When a senior asks to “go home,” try to determine if there is an “unmet” need (i.e. need to feel safe, need to belong) and try to fill that as best you can.
• Don’t refer to the senior’s current location as home.  Point out that they are staying there for “awhile.”  When they say “I want to go home” tell them you will talk about it and name some future date.
• Find a good reason for them to stay where they are – i.e. people are nice, good food, close to family, nice apartment, fun activities and try to get them to “buy into it.”

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

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

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

As a caregiver, the responsibility for decisions regarding your parent’s care falls to you.  Often you wish you could discuss the options, choices and next steps with your parent, just as you discussed so many choices in the past…where to go to college, where to have your wedding reception, which neighborhood to select.  But parents with Alzheimer’s cannot help with current decisions as their ability to reason, compare and choose has been ravaged by the disease.  Sadly, dementia robs them of their ability to chart their own course.

So, what should caregivers do when faced with a variety of paths – how do you know how to choose what is best for your parent? How do you know when a parent’s living environment is no longer safe? How do you know when a parent needs more assistance? 

Here are a few suggestions:

• Pay attention to your parent – they may be confused, but they will give you clues when things aren’t going well.  They may seem more agitated, confused or disoriented.  Their routine may change and a situation that has worked well in the past, now poses problems.  For example, they may no longer want to eat dinner because they either can’t remember where the Assisted Living Dining Room is located, or they are afraid to leave their apartment.  
• Check in with their caregivers – have other family members, a companion, assisted living staff or adult day care workers noticed a change in your parent?  Are they concerned? 
• Take your parent in for a check-up – have the Doctor evaluate your parent and review their medications and mental and physical health. 
• Review your parent’s ability to complete Activities of Daily Living – things like bathing, dressing, continence, mobility, feeding.  Has there been a change in their ability to do these things?
• Engage a Geriatric Care Manager – have them conduct an independent assessment to provide an unbiased view of the situation.

Once you have gathered the above information, spend time thinking and talking to others you trust about the findings.  Choose the next step based on what you think is best for your parent at this moment in time.   For instance, if you determine that they need more assistance, think about the pros and cons of providing additional assistance in their current environment vs. moving them to a new environment such as a Memory Care Unit.   There is no “right” decision.  Take comfort in the fact that you have been both thorough and thoughtful when you made the decision.  Always remember that your parent is better off when you address concerns as they arise vs. postponing decisions until a crisis arises.

The SCANS content team headed by Jean Bandos along with the development team announced today that the SCANS Version 1.3 - May release is now available.  SCANS Version 1.3 is a major content release to the SCANS Knowledge Base.

In order to make more real-world tools for eldercare available more quickly, Jean and the team have devised a "rolling release".  For 3 months beginning in May another group of resources, processes, and tools will be made available to geriatric care managers at My Health Care Manager and our affiliates.

The May release contains 57 new and/or revised resources, processes and tools.  Some sample items include: 
 

• Behaviors and Alzheimer's Disease
• Grief Education
• Activities of Daily Living Education
• Depression and Alzheimer's disease
• Early Stages and Impact on Health
• Memory & Cognition Questions
• Memory Care Unit Checklist
• Memory Care Unit Education
• Mild Cognitive Impairment
• Sobriety Programs Resource
• Handyman Resource
• Private Handyman Contractor Checklist
• Smoke & Carbon Monoxide Detectors
• Daily  Money Management Education
• Financial Planning Education
• Trust Education
• Verifying Funeral Arrangements
• Veterans Benefit Information
• Elder Law Resource & Checklist
• Medication Management Procedure
• Medication Reconciliation
• Polypharmacy
• How to Find a Pain Specialist
• Pain Education
• Pain Resources
• Pain Visual Analog Scale
• Arthritis
• Heart Failure
• Hypertension Education
• Family History - Cancer Education
• Family History - Dementia
• Family History - Diabetes Education
• Family History - Heart Education
• Seat Belt Education
• Cataracts Education
• Glaucoma Education
• Hearing Aid Education
• Sensory Changes
• Assistive Devices
• Hospice Education
• Spiritual Connections

Stay tuned; the June release will include resources on incontinence, cognition, supporting services, and more processes.

Be sure to visit Jean's blog, click here.

Our Senior CAre Navigation System (SCANS) has released in a new edition - Version 1.2!
 
This version includes major extensions of the search functionality to make it easier for geriatric care managers to find specific tools and solutions.  This provides quicker access to hands on practical solutions for families caring for aging parents.  Of course, the structure and caregiver advice in each of the 25 Care Categories remains in place to assist the geriatric care manager overall care planning.

Also including in the 1.2 release are a variety new solutions, actions, resources and other content for helping with senior well-being and senior health care.

Every year the month of May is dedicated to "Older Americans Month" throughout the nation.  The Administration on Aging (AoA) picks a theme each year to go along with recognizing this special month.  This year's theme is "Living Today for a Better Tomorrow".  The focus is on ways to stay healthy and offer prevention programs and avoid the risk of chronic disabilities and injuries.  The tip this week from the AoA is for women to schedule regular checkups for their health.  Talk to the doctor about any changes you have noticed since your previous checkup and ask questions on ways to lead a healthy lifestyle.  Many women are the primary caregivers and may forget to take time out for their own health.  Women are encouraged to visit their doctor and receive a checkup as part of the Older Americans Month.

For more information on Older Americans Month, go to the Administration on Aging website at:  www.aoa.gov

A big topic floating around the aging world is the idea of healthy aging.  We see everyday in the media how important it is to eat healthy, quit smoking, exercise our minds and bodies, and stay fit.  For older adults, it is important to continue to live a healthy lifestyle.  I once read an aging article that said, "exercising everyday keeps the doctor away".  
                                             
Exercise is important for those who have heart conditions and can help them maintain their independence longer.  Many assisted living facilities offer aerobics, exercise, or even tai chi classes.  While exercise directly impacts your physical health, research has also shown that staying active impacts cognitive health.  The Alzheimer's Association states that what is good for the heart is also good for the brain.  Ideas for exercise include:  taking a dance class, walking to the store, parking further in the parking lot at the store, and gardening.  For more information about seniors and exercise please visit the Centers for Disease Control website for physical activity for older adults:   http://www.cdc.gov/physicalactivity/everyone/guidelines/olderadults.html

In working with seniors and their families, end of life care issues always come up.  It is a hard decision for the senior and families to make end of life care decisions, for example, whether to continue treating an illness or disease, implementing palliative care, or inserting a feeding tube.  These difficult decisions can often be made ahead of time by the individual via a Living Will.  Living Wills allow individuals the ability to document their end of life wishes, treatment preferences, and care options.  Any person over the age of 18, who is considered competent to make their own decisions, is able to complete a Living Will.  Living Will forms can be found at your local library, the internet, or an attorney's office.  Some states develop and recognize state-specific Living Will forms.  To download your state's specific advance directives form, check out Caring Connections.

The most difficult end of life decision to make is whether to insert a feeding tube or not.  A recent article from Health Behavior News Science, addresses recent studies on this issue.  For people with Advanced Dementia or degenerative dementia, the body is unable to metabolize food properly due to the brain damage.  The biggest fear for families is wondering if their loved one is "starving to death" or experiencing pain from hunger and thirst.  Hospice studies have indicated that few people experience this type of pain.  And if pain is exhibited it is often alleviated with palliative care and pain management.  In my career, I have had several physicians state that due to the brain damage and with the body going through the end of life process, that our bodies do not feel hunger or thirst.  But will we really ever know the answer to that question??  My motto as a geriatric social worker has always been, if I've made someone as happy and as comfortable as possible while they are here with us then I've done my job.  What I do know is that the decision to place a feeding tube is an individual decision and each person's situation should be considered separately.

For more information on studies, reviews of health care interventions, and evidence of clinical trials, check out the Cochrane Collaboration.

According to the latest report from the Alzheimer’s Association, the total health care costs are more than three times higher for people with Alzheimer’s and other dementias than for other people age 65 and older. It is reported that there are 5.3 million Americans living with the disease and every 70 seconds someone in America develops Alzheimer’s disease. By 2010, it is estimated that there will be nearly a half million new cases of Alzheimer’s each year. Currently we know that Alzheimer’s is the sixth leading cause of death in the country, surpassing diabetes; it is the fifth leading cause of death among individuals 65 and older.

My next blog will cover the newest focus for Alzheimer’s: early detection and intervention.

My Mother has declined precipitously during the past six weeks.  We’ve watched helplessly as her confusion increased, her mobility worsened and her sense of time and place evaporated.  Yet, a routine Doctor’s  appointment and lab work did not reveal any treatable physical changes.
Yet, everyone around her noticed the decline – my sister, the companion, her Health Care Manager (a geriatric care manager from My Health Care Manager) and the nurses at the Assisted Living facility.  We were saddened to see my Mother struggle with this new stage of life and worked together to offer additional support.  We all ASSUMED that this was the natural progression of the dementia.

Our Health Care Manager was puzzled by what my Mother was experiencing.  She had worked with many, many seniors and felt that my Mother’s cognitive decline did not fit the typical pattern.   She felt that the changes my Mother started to experience happened overnight vs. being a gradual process.  It bothered her, so she sent a letter to my Mother’s physician and explained her concerns.  This led to a conversation between my Mother’s Doctor and the Health Care Manager.  As they reviewed my Mother’s case, a light bulb went off.  My Mother had a medication change in December….was it possible that the med change was negatively affecting her current physical and mental state?   Was it possible that the changes we’d noticed were not necessarily caused by the next stage of the dementia, but a medicine interaction? 

Thanks to the Health Care Manager’s detective work and follow up with the health care provider, we’ve stopped the new medicine that was added to my Mother’s care plan in December.  We have our fingers crossed that we will see a difference and that some of the decline will be reversed.  It is possible that there are other causes – a series of small strokes, for example.  But for now, we are addressing what the Doctor thinks is the most likely cause.

We’ve learned a good lesson.  Never assume that even small changes are “normal” …question everything!  And seek professional help whenever necessary.