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

When is the right time to talk to mom or dad about planning for the future?  Ideally, the earlier the better.  Usually when seniors are in their 70s is the best, unless signs of dementia or another health issue arises earlier.  It is important to understand your parent's healthcare and financial wishes and goals.  For most seniors, death is not their main fear but losing their independence is.  Planning for the future and having this conversation with mom or dad is not easy, as people do not want to think about a time when they'll need help and resources in order to continue to live independently.  It's important to have this conversation before a crisis hits.  Talk with your parents about their wishes regarding medical treatments, procedures, etc in the case that they are unable to make decisions for themselves.  Information that is discussed should be put into writing, a Living Will document.  Financial planning is also important and should be discussed with mom and dad.  These actions and steps should be lined out in a legal document.  By having this discussion early, the senior is not only verbalizing their wishes and goals but being responsible by planning for their future.

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.

My Health Care Manager has introduced a new FREE service that uses a little bit of technology to connect you to a lot of geriatric care research and experience. 

If you look in the upper right hand corner of this page you will see a "sunburst" linking you to a free service called the Caregiving Community.  By joining the Caregiving Community you can ask a question of our geriatric care management team and get an answer by the next business day.  Ask as many questions as you want, whenever you want.  In addition, once a month you will receive another Caregiving Community solution selected from best questions and answers we've tackled that month.  There is no cost for the service; all you need to provide is a name and email address.  We will not share or sell your name with others and we will not inundate you with any kind of high pressure sales.

So what's the catch?  Well, we do have a company interest here.  We believe that by providing valuable information to people caring for a senior in their life those caregivers will turn to us if they ever need help.  No tricks.  We know that if we can help families with the complex issues of aging everyone wins.

What does it mean to be young at heart?  I believe each individual's definition of being young at heart is different.  It comes down to our own thoughts about our personal well-being.  Optimal well-being can only be defined by ourselves.  Optimal well-being not only involves our thoughts on our physical health, but it also includes our mental and emotional well-being, social well-being, spiritual well-being, intellectual well-being, functional well-being, etc.
I think that my 77 year old grandmother is an excellent example of how someone is young at heart.  She always seems to have a good time.  She likes to have fun, has a good sense of humor and is always on the go...going out to lunch with her girlfriends, playing in her card club, participating in church functions and community organizations, watching sports (an avid basketball and baseball fan), and playing Wii bowling.  Through a family night event at her church, she has discovered the fun and exercise of Nintendo Wii bowling.  She has taken it upon herself to learn a new technology, how to play Wii bowling.  She teaches her senior peers how to play, engages them in friendly competitive games, and crowned herself the winner of "the old ladies division."  This game has created so much fun for her and is another example of how she keeps herself young at heart.  Not only should we look to seniors on how to stay young at heart, but we should share our discoveries with others.

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.

At any age, people want to achieve and maintain a good overall quality of life.  For seniors, reminiscence is a great way to achieve insight and improve their personal quality of life.  Reminiscence is a process of remembering prior life events.  The goal of reminiscence is to help seniors retrieve positive events, feelings, and happy memories.  The end result creates more self-esteem, a more pliable mood state, improved coping skills, and improved social skills.  Helping seniors recall the positives from their past will aid them in their feelings and coping skills towards any current life challenges.  The main purpose is to rekindle their personal purposes which will also help restore self-confidence.
When I was in graduate school, I conducted reminiscence groups at an assisted living facility.  For my first group, I had 4 people attend.  My topic for that first group was "Summertime Vacations" and I asked people to come to the group with a story of a past summertime vacation and something from that vacation, a picture, something they purchased, etc.  Even though these individuals lived in the same building, they didn't know each other.  As I started facilitating the conversation about vacations, people started talking and laughing and saying "I traveled there too, did you go see that ...."  I enjoyed listening to everyone talk and as the group ended and people left, they stood around and kept talking and made a new friend.  My group size began to grow each time as people were enjoying themselves and were talking about it in the dining room and telling others they should come.  I set the date, gave the topic and they provided the conversation and their own props, which somtimes including a photograph, a song, a baked good, an outfit, etc.  I did this group for 4 months and ended my time there with a "Family Traditions" reminiscence group with a group of 28 participants.
I encourage everyone to take the time to reminiscence with your loved one or any older adult.  People love to talk about things that made them happy or excited them, plus you might gain a little history knowledge along the way. 

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.