Please join us at the Senior Health and Wellness Expo on April 6th from 10am-2pm at the Langdon Place of Dover. There will be many great vendors offering freebees, refreshments, offers, and great information on goods and services available to Seniors. Stop by and see our booth, meet some of our staff, take a moment to do our free Alzheimer's and Dementia Screening Test, and enter for a chance to win our beautiful gift bag! See you there!
A beautiful song by a 15 year old boy singing about his relationship with his precious Nan who battles Alzheimer's and his love for her. This goes out to anyone who's life has been impacted by this terrible disease. We understand, and we're here. Well done Harry!
Not Alone by Harry Gardner
In 2010, pneumonia, combined with influenza, was the eighth leading cause of death in the United Sates, according to the National Center for Health Statistics. On top of this, 1 out of 20 adults who get pneumonia dies, according to the Centers for Disease Control. This makes preventing pneumonia in the elderly a serious matter.
"Pneumonia is an inflammation of the lungs usually caused by bacteria, viruses, fungi or other organisms," says Dr. Norman Edelman, the chief medical officer for the American Lung Association. This inflammation causes an outpouring of fluid in the infected part of the lungs, affecting either one or both lungs. The blood flow to the infected portion of the lung (or lungs) decreases, meaning oxygen levels in the bloodstream can decline.
"This decline is more likely to happen in an elderly, sick, and/or debilitated 85-year-old. The body attempts to preserve blood flow to vital organs and decrease blood flow to other parts of the body such as the GI tract," says Dr. Joseph Mylotte, a professor of medicine at the School of Medicine and Biomedical Sciences at the University of Buffalo. "The effects [of pneumonia] are widespread even though the infection is localized to the lung." The complications of pneumonia in the elderly can be life-threatening, from low blood pressure and kidney failure to bacteremia, an infection that spreads to the bloodstream.
Elderly people are more susceptible to pneumonia for several reasons. Often they already suffer from co-morbid conditions such as heart disease, which means they don't tolerate infection as well as younger people, says Mylotte. Age also causes a decrease in an older person's immune system response, so his defenses are weaker. "Some virulent organisms can cause infection in younger people, but the infections can be worse in older people," says Mylotte.
Pneumonia is caused by more than thirty types of organisms; these different strains mean that symptoms can vary from case to case. However, the following symptoms can signal a bout of pneumonia:
- Malaise or feeling weak
- Green or yellow sputum
- Pain in the chest
- Shortness of Breath
Often, a person may think she is simply suffering from the cold or flu. Also, it is widely believed that the signs of pneumonia in the elderly can differ from the general population. An older patient might not have a fever. "The symptoms and signs are sometimes not as specific. They may be more sleepy and lethargic, or lose their appetites, or they may suffer from dizziness and fall. If there is underlying dementia, they might not be able to tell you how they feel. But it's all related to something going on in the lung," says Mylotte.
People are often exposed to the organisms that cause this disease, but the lungs' defense mechanisms usually protect people from infection. Sometimes these organisms break through a person's immune system, infecting the lungs' air sacs. Each lung has a major airway (bronchus) that divides into twenty-two tubes; these tubes further divide into more than one hundred thousand tiny tubes (bronchioles) that end in clusters of tiny air sacs (alveoli), where the transfer of oxygen to the body's bloodstream takes place. When a patient has pneumonia, the affected air sacs become inflamed and filled with fluid. This leads to breathing problems, a lack of blood flow to the infected sections of the lungs, and a decrease in the bloodstream's oxygen level.
PNEUMONIA CAUSES & DIAGNOSIS
Simple diagnostic tests can confirm a case of pneumonia in the elderly. A doctor who listens to a patient's lungs may hear bubbling sounds called rales and rattling sounds called rhonchus, which signal infection and inflammation in the lungs. A pulse oximetry test computes the blood's oxygen levels. A chest x-ray or CT scan is often the definitive diagnosis, telling the physician where the infection is and the degree of the illness. Sometimes a doctor will have the patient's phlegm or blood analyzed to decipher which organism is responsible for the infection.
Although pneumonia can be caused by more than two dozen organisms, pneumonia in the elderly is usually caused by bacteria or viruses. The streptococcus (or pneumococcal) pneumonia bacteria is responsible for an estimated forty thousand deaths every year, according to the Centers for Disease Control. The elderly are more likely to catch this strain of pneumonia. Streptococcus pneumonia can come on slowly or suddenly. It can damage the lungs, cause bacteremia in the bloodstream, and meningitis in the brain.
Viruses also trigger this disease, and are thought to cause about 50 percent of pneumonia infections in the general population. Usually viral pneumonia is less severe, but complications can include bacterial pneumonia.
Atypical pneumonia-causing organisms-such as mycoplasma and chlamydia-rarely cause pneumonia in the elderly. In the nursing home population, a small percentage of people suffer from severe pneumonia strains caused by organisms such as Gram-negative bacteria and Staphylococcus aureus, which can quickly end in death or with the patient on a respirator, says Mylotte.
PNEUMONIA TREATMENT & MANAGEMENT
Patients are treated for pneumonia depending upon which organism triggered the disease. Your loved one's medical provider can ascertain this through analyzing a phlegm or blood sample.
For a case of viral pneumonia, some patients may receive antiviral medications, but these are not commonly prescribed. And antibiotics are not used because they aren't effective against viruses. Bouts of viral pneumonia usually heal without medication, provided the patient rests, eats healthy food, and takes in plenty of fluids. If new symptoms arise, it is important to contact your loved one's doctor, as bacterial pneumonia is a possible complication.
Bacterial pneumonia is always treated with antibiotics. If a patient is in the hospital, it is typical for the hospital to follow strict treatment guidelines. These guidelines are part of pay-for-performance programs, meaning the doctor will get paid a better rate if she follows the guidelines, says Mylotte. Both the American Thoracic Society (www.thoracic.org) and the Infectious Diseases Society of America (www.idsociety.org) have standard treatment guidelines available on their respective websites. These are based on where the patient acquired the disease-in the community, in the nursing home, in the hospital-and these guidelines can be found on each organization's website. Whether at home or in the hospital, patients are usually administered a once-a-day therapy. Effective antibiotic treatments include respiratory fluoroquinolones such as moxifloxacin, says Mylotte, although there are several antibiotic therapies that work as well as these.
Treating bacterial pneumonia has become more complicated due to antibiotic resistance: The organisms that cause this disease mutate and can become resistant to drug treatment. This is one reason that it is important for a patient to finish her entire course of antibiotics; stopping treatment early actually encourages antibiotic resistance. Up until a few years ago, antibiotic resistance associated with bacterial pneumonia had been increasing, but it has recently decreased, according to Mylotte.
Both mycoplasma and chlamydia pneumonias are also treated with antibiotics. Mycoplasma pneumonia is also known as walking pneumonia. If your loved one has this strain, he or she usually will have milder symptoms, but it can take four to six weeks to heal completely.
Most pneumonia patients heal at home. About 15 to 20 percent of people with community-acquired pneumonia are treated in the hospital, while about 20 to 30 percent of people withnursing-home acquired pneumonia are also admitted to a hospital, according to Mylotte.
Whether a patient stays at home or in a hospital, she may take medications to ease fever, aches, and coughing bouts. Because coughing actually helps rid lung infection, this action shouldn't be entirely reduced. However, if the patient isn't getting any sleep, a low-dose cough suppressant can be prescribed. Patients with severe strains may need oxygen therapy to increase blood-oxygen levels. Caregivers should make sure a loved one is receiving proper hydration, eating at least a small amount of healthy food, and reporting worsening or new complications, says the American Lung Association's Edelman.
Complications that can arise from pneumonia include:
- Bacteremia: The possibly deadly infection invades the bloodstream and can infect the body's organs.
- Pleurisy and Empyema: With pleurisy, the membrane that covers the lungs (pleura) becomes inflamed. Empyema occurs when fluids causing inflammation become infected.
- Lung Abscess: A pus-filled cavity can develop in the infected lung area.
- Acute Respiratory Distress Syndrome (ARDS): When the lungs become severely injured due to pneumonia, respiratory failure can occur. Treatment includes the use of a mechanical ventilator (vent) and supplemental oxygen.
Pneumonia in the elderly as well as younger people occurs when a person's immune system is weakened. Although it can be transmitted via the air or hand-to-hand contact, if a person's immune system is strong he can fight off this infection. Preventing this disease with the following steps can keep it at bay:
- Pneumococcal Vaccine: This vaccine helps prevent twenty-three different strains of bacterial pneumonia (although there are many more strains of bacterial pneumonia out there). "It doesn't always engender a good immune response in adults, so it doesn't always work well," says Mylotte. He also points out the vaccine is effective for a shorter amount of time in older people. Experts recommend getting your first dose when you are in your 50s and your second dose at age 65, and then a new dose should be administered every five years.
- Influenza Vaccine: This vaccine is just as important as the pneumococcal vaccine. It doesn't work as well in elderly people, says Mylotte, but if an older vaccinated person gets the flu, it is usually a milder case. Pneumonia is often a secondary infection after an initial bout of influenza; people who receive this vaccine have less risk of developing pneumonia as a flu complication. Older adults should get a flu shot every year.
- Hand Washing: "I always tell people to wash their hands as much as they can. If your hands aren't raw in the wintertime, you are not doing a good job," says Mylotte.
- Dental Hygiene: Pneumonia infections can occur around infected teeth, says Edelman, so dental work should be kept in good repair.
- Good Health Habits: Exercise, rest and healthy eating can all increase resistance to pneumonia.
Edelman also recommends that frail elderly people who are already susceptible to infection should stay away from anyone who has the flu or a bad cold. Of course, preventing pneumonia in the elderly is always preferable to treating it. But if you suspect your loved one is suffering from pneumonia, quick intervention can be a life-saving occurrence.
By Michelle Perez
Yes, you can buy a present for a loving grandparent from a store, but they can be very impersonal. Why not make one with your kids? Kids will love the craft time and grandparents will love having something homemade.
"When a grandchild makes a handmade gift, the present is unique and the grandchild is giving of his time," says Sue Johnson, a grandmother of six from Lancaster, Virginia, grandparenting expert and author of Grandloving: Making Memories with Your Grandchildren. "It's also meaningful because we know they have been thinking about us when they made the gift, and it contains something of himself."
Like Johnson, Kimberly Jo Ellingsworth, a grandmother of five in Monterey, California, understands the significance of a handmade gift. "I always remember the look on my oldest grandson's face when he would bring something he made home and give it to us," she says. "He was so excited, and then even more excited because we used it rather than putting it on a shelf somewhere."
With the help of some very creative grandparents, we came up with eight fun ideas for things your little one can make (sometimes with your help) for this special person in their life.
- Create a Collage
- Grab your family photos and laminate them to place mats to send to grandma and grandpa. You'll always be there with them bringing joy to each meal.
- Make a CD
- Record the kids telling their grandparents about their favorite times with Nana and Papa "as a reminder of the importance of being together," Johnson says.
- Share Some Sunshine
- Have the kids draw grandma's favorite flower, then cut it out and have them paste their photo on it. Draw a big sun with your child's photo in it, and caption it "You are my sunshine!" Teach your kiddos the words to the song and put it on a CD to accompany the gift.
- Assemble a Coupon Booklet
- Have the kids come up with 10 things they can do for their grandparents -- everything from raking the yard to baking their favorite cookies -- and make each idea a coupon to put in a book.
- Personalize Magnets
- Get some magnetic tape and put pieces on the back of family photos to create instant fridge magnets.
- Film a Homemade Video
- Grab the video camera and record your kids being goofy. Or, as Johnson suggests, ask the kids to relay "our family history from the eyes of your grandchild."
- Puzzle It Out
- Paste a photo of your child on cardboard, cut it into pieces and send with instructions saying, "Put this together and see who loves you!"
- Make a List
- Write a list of "I love you because ..." statements to send to the grandparents to let them know how special they are.
- Plan an Activity or Outing
- Yes, physical gifts are nice, but grandparents often treasure the gift of memories with their grandkids even more. Your child and their grandparent can organize something fun for them to do together. For example, create a family trivia game with facts about each person, set up a scavenger hunt or get messy with an afternoon of finger painting. You can take photos of the special day and put them in an album from grandparents to look over.
Handmade gifts can be a tradition that grandkids and grandparents alike can look forward to. Get the little ones thinking of a new gift idea weeks, or even months in advance. This will make for a rewarding present the grandparents won't forget.
Michelle Perez is a freelance writer covering all things Denver. Her work can be found here.
There's an old saying about the eyes being windows to the soul. But the latest medical and dental research shows that the mouth truly is a window into one's overall health. Looking out for a loved one's health means not only keeping an eye on their nutritional intake and physical capabilities, but also on their teeth and gums. Senior dental problems can be common, from dry mouth to periodontal disease, and since oral health directly impacts the health of the rest of the body, these issues need to be taken seriously. Taking care of elderly teeth and gums is just as important as heart or digestive health.
COMMON DISEASES WITH ORAL SYMPTOMS
Researchers have found that many diseases in the rest of the body have oral symptoms. With careful examination of the teeth, gums, and tongue, dentists have found evidence of heart or liver disease, eating disorders, diet deficiencies, anemia, diabetes, arthritis, HIV, osteoporosis, and even some autoimmune diseases. "We're now realizing how they're interrelated," explains Dr. Cynthia M. Carlsson, assistant professor of geriatrics and gerontology at the University of Wisconsin School of Medicine and Public Health.
Not only does the mouth tattle on the rest of the body, oral health can actually affect overall health.
For example, recent studies show a correlation between gum disease and heart disease. In fact, risk factors for periodontal disease and cardiovascular disease are similar: smoking, stress, poor diet, excessive weight gain, and low exercise levels. One study suggests that people with severe periodontal disease face double the risk of fatal heart disease, and severe periodontal disease also is associated with higher rates of stroke in some studies. And in certain circumstances, a tooth infection has the potential to cause bacterial endocarditis, which is an infection of the heart's inner lining or the heart valves. Bacteria in the bloodstream can lodge on the valves or damaged heart tissue, and it could be serious enough to damage, or even destroy, the heart valves.
Periodontitis also appears to share risk factors with chronic degenerative diseases such as ulcerative colitis, and lupus. If a patient has severe gum disease, they may be advised to take antibiotics before undergoing invasive dental procedures such as gum surgery or tooth extraction.
Conversely, other diseases can affect the mouth. For example, diabetes affects healing, so if a diabetic senior has gum disease, it may take quite a bit longer to treat that gum disease.
Researchers now urge both doctors and dentists to be alert to overall health problems when taking care of elderly patients and encourage behaviors that will promote a healthy body from head to toes.
MAKING ORAL HEALTH A PRIORITY
It's easy for someone to let oral health slide a bit when they're distracted by other ailments. Perhaps arthritis makes tooth brushing painful, or they can't stand at the bathroom sink very long. "They're maybe not quite as vigilant because of their frailty, which leads to a quick decline in oral health, and this could be a detriment to systemic health," explains Dr. Marsha A. Pyle, director of the Training Center for Geriatric Oral Health and associate dean of Education at the Case School of Dental Medicine in Cleveland, Ohio. "You can't just treat dental disease in isolation."
It's best to brush after every meal, says Pyle, not just in the morning and at night. If a patient is at risk of periodontal disease, a dentist can prescribe special toothpastes or gels that help combat dental disease, as well as a daily treatment of high-fluoride gel or anti-bacterial rinse.
Carlsson advises encouraging your loved one to visit their dentist on a regular basis either to have their teeth cleaned or to have their dentures refit. Missing teeth or dentures that don't fit well can lead to potentially serious senior dental problems. "They may aspirate the food, where food goes down into the lungs and causes pneumonia," Carlsson says. Besides encouraging good nutrition and regular dental visits, watch him eat to see if he's avoiding something, and try to notice if any of his teeth look loose or broken.
Ill-fitting dentures can be a culprit in poor nutrition among seniors. When a person loses his natural teeth, his jaw bones begin to shrink away, leading to the jaw continually "remodeling" itself. Dentures that once fit well start slipping. So, a senior may start limiting the kinds of food he eats because it's too hard to eat, or because he's embarrassed that others may see him having trouble chewing.
"And it happens during a really important stage of a person's life. These really frail seniors really need their nutrition," Pyle says.
If a senior does lose her natural teeth, instead of traditional dentures, she could have implant-supported dentures. These implants are attached to the jaw bone, and a special denture snaps onto the implants. These implant-supported dentures fit more snugly than traditional dentures, so eating different foods shouldn't be a problem.
A less drastic measure places a softer material on the gum side of traditional dentures so they're more comfortable.
Just a few decades ago, 50% of all seniors had no natural teeth remaining, according to Pyle. That number has now dropped to 27% of those over age 65. "It's not a natural part of aging, I'm happy to say," says Pyle. "People now are aging with a full set of teeth."
Whether or not your loved one has his natural teeth or dentures, a little help from you can go a long way toward ensuring that he maintains good dental hygiene. A healthy smile may affect a person's confidence and self-image, but, more importantly, it will pay off not only in her oral health, but in her overall health as well.
DRY MOUTH: A COMMON ISSUE FOR SENIORS
According to Pyle, one of the major senior dental problems is dry mouth. "If they have a chronic disease managed by medications, one of the side effects is dry mouth. There are 400 medications known to cause dry mouth," Pyle says, including medications for common problems such as high blood pressure and depression.
While a small amount of gum recession is normal as seniors age, dry mouth increases that recession dramatically, leaving the mouth more susceptible to root area cavities. And those root surface cavities advance more quickly on the soft surface of a tooth.
There are many ways to treat dry mouth including:
- Increase liquid intake
- Rinse mouth frequently with water
- Use a commercially available saliva substitute
- Use specially-formulated toothpastes, chewing gum, or non-alcohol-based mouthwashes
- Apply lip moisturizer frequently
- Suck on tart, sugarless hard candies
- Avoid dry, salty foods
By Sarah Stevenson
Being stuck indoors due to winter weather can put seniors at risk of social isolation and poor quality of life. Find out what you can do to keep your elderly loved ones engaged and healthy.
The wild winter weather across much of the country is keeping many people indoors more than they would like, and being stuck inside can be a particular problem for seniors living alone– putting their mental, emotional, and even physical health at risk. Not only is it more difficult for the elderly to leave without risking winter dangers like the cold, falls, and dangerous driving conditions, it’s also harder for visitors to reach them. Winter weather can also have an effect on senior nutrition, if someone is unable to leave the house and shop for food. An even more distressing result of being trapped inside, unable to come or go, can be social isolation and loneliness.
Loneliness Affects Elderly Health and Well-Being
We often think of the elderly as residing in a senior community, with family, or in other shared housing situations, so it may be hard to imagine that loneliness is an issue for seniors. According to the U.S. Census Bureau, however, the probability of living alone actually increases with age. For women, the likelihood of living alone is 32 percent for 65- to 74-year-olds, but this increases to 57% for those aged 85 years or more; for men, the corresponding proportions are 13% and 29% . Even for centenarians—seniors who are 100 years of age or older—the numbers are astonishingly high: about a third of centenarians live alone at home.
Isolation in the elderly can lead to some distressing health outcomes, and even increase the risk of death. A 2012 review of the scientific literature, published in The Journal of Primary Prevention, stated that “social isolation has been demonstrated to lead to numerous detrimental health effects in older adults, including increased risk for all-cause mortality, dementia, increase risk for re-hospitalization, and an increased number of falls.”
Recent research reports shows how it effects seniors: at the 2014 annual meeting of the American Association for the Advancement of Science earlier this month, University of Chicago psychologist John Cacioppo reported that feeling extreme loneliness can increase an older person’s chances of dying early by 14%. “Feeling isolated from others can disrupt sleep, elevate blood pressure, increase morning rises in the stress hormone cortisol, alter gene expression in immune cells, increase depression and lower overall subjective well-being,” stated UChicago News.
What You Can Do If Your Loved One Is Isolated
According to Cacioppo, the danger isn’t necessarily solitude itself, but a subjective feeling of isolation, of lacking social engagement and face-to-face connections with others. Age-related health issues like vision loss, hearing loss or incontinence can increase this sense of isolation. So what can families and caregivers do to address the issue if we fear our loved ones are isolated? Here’s a list of suggestions for preventing senior loneliness and keeping our loved ones healthy and happy this winter:
1. Address Any Underlying Health Issues
Whether it’s arranging for the delivery of incontinence supplies or making sure your loved one has regular hearing or vision tests, being proactive about seniors’ health can help them feel better on a day-to-day basis. What’s more, it can diminish the social anxiety related to hearing, vision, or continence concerns.
2. Reach Out to Family, Friends, and Neighbors
If the weather makes it impossible for you to check on your senior loved one as much as you’d like, enlist the help of others who may be nearby and more easily able to visit. Can a neighbor knock on the door and check in? Don’t forget to call or email your loved one often to keep those connections strong even when you can’t visit in person.
3. Prevent Senior Malnutrition With Food Delivery
Seniors who live alone may be at greater risk of getting poor nutrition when the weather turns nasty. Consider getting food delivered by an online grocery service, or by an organization such as Meals on Wheels, which can provide not just nutritious food but social contact.
4. Encourage Safe Transportation and Mobility
Encouraging your loved ones to use the adaptive technologies they may need, from hearing aids to walkers, which can help them become more active and socially engaged. When it comes to getting outside the house, though, storms and snow can present a challenge. Give senior relatives rides when you can, or arrange safe transportation for them, whether it’s senior-friendly public transit, an ambulette or paratransit service, or a taxi.
5. Connect Older Loved Ones with Necessary Local Services
You can use the U.S. Administration on Aging’s Eldercare Locator website to get in touch with your local Area Agency on Aging. The AAA will know where your loved one can find senior centers, transportation services, and other helpful programs for the elderly. “Some AAAs even have volunteers who call and check in on home bound seniors living alone,” says a recent article by the AARP.
6. Consider Respite Care or Assisted Living
Sometimes our loved one needs more care than we are able to provide, especially in cases where the weather throws a (literal) roadblock. One option in this case is to book your loved into a short-term stay in a facility that offers respite care, so that their day-to-day needs are taken care of for the duration of their stay. However, if a senior requires ongoing help that is beyond your abilities – for instance, if they are cognitively impaired, or their physical care needs are increasing – this could be a sign they are ready for assisted living.
by Elinor Ginzler, AARP.org
As your family members or loved ones age, so does their home. It is good practice to step back occasionally and examine the home to see how well the living arrangement supports your loved ones’ daily needs and activities. There are many steps you can take to ensure that your family members stay safe and comfortable in their home.Often these changes can be made with little or no cost, while they also make the home more user-friendly and welcoming. In this column, I note some safety tips to evaluate in your loved ones’ homes, so you can help them successfully age in place.
I’ve written before about the numbers: Nearly 90 percent of olderAmericans want to stay in their current home as they age. Overwhelmingly, that’s where people want to live if they need care as they get older. But sometimes, features in your loved ones’ homes can be their biggest obstacle to remaining independent. As a caregiver, I know the safety of your loved one is your primary concern. By taking small but-practical steps, including the modifications I describe below, you can transform your loved ones’ “home sweet home” into “home safe home.”
No-Cost Changes for Home Safety
- Remove all scatter and throw rugs, which can lead to falls.
- Open blinds and curtains, and raise shades during daylight hours to increase natural light inside the home.
- Place electrical, phone and computer cord, along walls, where they will not trip anyone. To avoid the risk of fire, do not run the wires under carpeting.
- Remove clutter fromthe staircases and hallways to prevent trips and falls.
- Set the hot-water heater to 120 degrees to prevent scalding and to reduce energy consumption.
While all of the above can be done without spending money, you might find some changes are hard for your loved one to accept. For instance, Mom may like her scatter and throw rugs because they add color to her rooms. It’s important that you explain to her why you are suggesting removing these trip hazards. Tell her you want her to consider the change because you’re worried about her falling and seriously hurting herself. Be creative in how you approach the conversation – perhaps suggest that she could move the rug from the floor to the wall or add throw pillows on a chair or sofa to add color without safety risk.
Low-Cost Changes for Home Safety
As you make these no-cost changes, I suggest you look around your parents’ house to see whether or not you could take additional steps to ensure the safest possible home. Here are some low-cost changes ($35-$75) and will make a home even safer:
- Increase lighting by using the highest-watt bulbs possible for fixtures or lamps.
- Place double-sided tape or carpet mesh under area rugs to prevent slipping.
- Install offset hinges on all doors to add 2 inches of width for easier access.
- Replace traditional light switches with easy-to-use, rocker-style switches.
- Install night lights in hallways between bedrooms and bathrooms.
- Replace knobs on cabinets and drawers with easy-to-grip D-shaped handles.
- Add anti-slip strips in the bathtubs and showers.
- Mount grab bars in the bathtubs and showers, and place a sturdy water-proof seat in the shower so your loved one can sit down while bathing or showering.
- Install a handheld adjustable shower head for easier bathing.
- Install handrails on both sides of each stairway to support your loved ones’ sure footing.
You can find low-cost tools and products at your local hardware or home improvement store. It's important that you or a contract or properly install all the updates, so find a reputable handyman to help you if you need assistance.
It might be hard for your loved one to consider certain features, such as the installation of grab bars in the bathroom. “I don’t want those things,” Mom might say. “It’ll look like a hospital room.” This is the time to speak from your heart. Use “I” statements. Tell her you worry about her and you want her to be safe in her home. Add that grab bars come in a range of colors and finishes that can match the decorating scheme of any bathroom. Tell her the days of “institutional-looking grab bars” are long gone. Go with her to the store to look at what’s now on the market.
In addition to the changes listed above, always remember to have a properly rated fire extinguisher in the kitchen area, and fire and carbon monoxide detectors on all floors of each house.
AARP recently developed a video, “There’s No Place Like Home.” (Watch: Part One, Part Two.) It documents how easy and affordable it can be to update kitchens and bathrooms to dramatically improve home safety. You can show the videos to your parents to help them understand that they can easily improve their safety and your peace of mind.
Since your loved ones likely want to live at home as long as possible, consider more extensive changes to the home so that it will be sure to meet loved ones’ daily living needs. Design features such as multi-level countertops and pull-out drawers in the kitchen provide easy access to pots and pans. No-step entries to the home may cost more, but they can make homes safer and more comfortable for everyone.
AARP and the National Association of Home Builders (NAHB) have collaborated to help develop a certification program for remodelers, builders, and developers who focus on the connections between home design and the needs of aging people. The Certified Aging-in-Place Specialist (CAPS) program teaches building professionals about the changing needs of people as they age, as well as products and building techniques that can better support aging in place. While there are more than 1,700 certified professionals in the U.S., there is only one in Oklahoma.
Growing Consumer Interest
Realtors, interior designers, and architects have discovered that consumers are starting to show more interest in features and products that promote successful aging in place. People are also realizing that when homes are designed and constructed with these features, the homes’ value increases.
In Georgia, an “Easy Living Home” designation has been developed. It focuses on three key features of home design; all new homes constructed using the Easy Living Home approach have:
- Accommodations for first-floor living, with the master bedroom and full bath on the first floor
- At least one no-step entrance to the central living area of the home
- A maximum clearance (up to 36 inches across) in all doorways for easy movement throughout the home
Proponents contend that these homes are “easy to build, easy to visit, and easy to sell.” Across the country, builders, developers, and realtors are replicating elements of “universal design” – design informed by features that provide comfort, safety, and the ability to age in place. There is significant consumer interest in aging in place and the type of home required for it.
Home Safe Home
No home can be “sweet” if it isn’t “safe.” The types of home features and fix-its described in this column make homes easier to use, which increases the independence of residents and makes caregiving easier.
I hope that these ideas prompt you to evaluate your loved ones’ home and to make the kinds of changes that you deem necessary and beneficial.
Elinor Ginzler is a national expert on independent living and aging issues. She currently serves as AARP’s lead spokesperson on caregiving, housing, and mobility issues, including older drivers’ safety.
Connecting with others is at the core of being human - and it's something that doesn't change when a person has dementia. We're often asked what are good activities for dementia patients. It's important to know that there are many ways you can continue to form connections and strengthen bonds with your loved one during this time.
12 WAYS TO MAKE A CONNECTION
People with dementia often return to long-term memories of childhood. Their minds seem to only recall their younger years, and this is often where connections can be made. The next time you visit with your loved one, try one or more of the following activities to create a connection with them:
- Create a Memory Bag
- Fill the bag with items reminiscent of their late teens/early twenties. Scented products work well for this, as scents are strongly tied to memory. Try including soap, perfumes and aftershave, or holiday scents like gingerbread, pine and peppermint.
- Look Through Photo Albums
- Photo albums with pictures from their childhood or young adulthood are best for this. Old periodicals are another good option, particularly those that include many photos such as Life or Time magazines.
- Read Out Loud
- If your loved one has a favorite book, read it out loud to them and let them hold the book and feel the pages. Encourage them to enjoy the distinctive "old book smell." Reading aloud works especially well with poetry, as the cadence of the words are familiar and calming.
- Listen to a Playlist of Favorite Music
- Download songs or set up radio to stream that features music from their teenage years. Many internet radio stations include everything from classic rock to big band sounds, their favorite music should be easy to find.
- Sing Old Songs
- If they grew up going to church, sing old hymns with them. If it's around the holidays, sing holiday carols or other special songs. Class sing-a-longs and music classes were much more common in schools prior to the electronic age. You might be surprised at what songs your loved ones know and remember from elementary school.
- Watch Old Movies and TV Shows
- Did your parents grow up watching westerns like Gunsmoke or family dramas such as My Three Sons? Perhaps they were more interested in musicals like "The King and I" or "Singing in the Rain." You can find many favorite movies and shows from the 40s, 50s and 60s on Netflix or other streaming services.
- Go on a Nature Walk
- Use nature to integrate sensory experiences into conversation. Listen to birdsong, touch the wet grass, smell the roses and feel the sunshine on your shoulders. Ask what their favorite outdoor activities were during their youth and try to safely recreate similar scenarios if possible.
- Look Through Old Cookbooks
- In the past, women spent a great deal of their teenage years learning to cook and young adult years cooking for their families. Discuss origins and variations on old family recipes, or better yet, cook with those old family recipes and share the results with your loved ones.
- Enjoy Favorite Treats
- Look for candy or other indulgences that were commonplace when your loved one was young. Many companies specialize in nostalgic candy where you can buy old favorites like horehound candy and soft peppermint sticks. Even simple things, like an orange, can be a treat to someone who remembers when you only had them during holidays.
- Visit and Connect with Animals
- People who grew up on farms may enjoy an outing to a petting zoo or family farm where they can touch and talk to horses and other farm animals. Ask questions about animals, old pets, or what it was like to grow up on a farm. This is a great activity to involve grandchildren in, since many kids today are not familiar with farms.
- Reminisce Over Childhood Toys
- Nothing elicits childhood memories like familiar old toys. Erector sets, kewpie dolls, sock monkeys and marbles were some of the most popular toys during the 40s and 50s. There are many websites dedicated to antique toys. If you have any old toys available, bring them when you visit, ask questions about how they were played with, or, in the case of construction toys, build something together.
- Bring Back Old Skills
- Did your loved one quilt, crochet or knit? Put a homemade quilt or skein of yarn in their hands and let them feel the weight of the quilt and the scratchiness of the yarn. You may be surprised to find that your loved one can still crochet or knit a little bit, even though they have serious memory or cognitive deficits. Often, the muscles remember what the brain has forgotten.
Your loved one may be different than the person you have always known, but they still long for connection and companionship. You can encourage that connection by using these activities to enrich both of your lives.
Retirement can trigger a complex range of emotions, including fear and depression.
For some people, retirement planning conjures up images of languid days free from the demands of the daily grind, but for others the prospect of leaving the workforce may be a daunting or even frightening transition.
For most, this major milestone will elicit a mixture of emotions that fall somewhere between anticipation and apprehension. Retirement is, in fact, a complex experience for almost everyone, characterized by gains and losses and tremendous shifts in identity and routines.
"Unless those challenges are addressed and dealt with, the so-called 'golden years' can be tarnished," says Irene Deitch, PhD, psychologist and professor emeritus at the College of Staten Island, City University of New York. "Even those who may have thought they were prepared can find that the transition is tougher once they're actually in the throes of it."
Understanding the common hurdles of retirement — and how to overcome them — can be essential to making your retirement happy, fulfilling, and truly one of the best times of your life.
Emotional Pitfalls of Retirement:
- Who am I? "We often identify ourselves by what we do — 'I am a professor,' 'I am a painter,' 'I work on an assembly line,' or what have you," says Nancy K. Schlossberg, EdD, author of Retire Smart, Retire Happy: Finding Your True Path in Life. "The loss of an identity tag can be extremely disconcerting for many people."
- Loss of the work-world routines. We get used to going to work and seeing people who are part of that world (even the annoying colleague). Not having a place to go or a workplace to check in with can also lead to a sense of loss of both a social network and of organization, and can leave one feeling somewhat "lost at sea," says Dr. Schlossberg.
- Relationship shifts at home. Retirement, like getting married or having children, can exacerbate any fissures in a relationship, notes Dr. Deitch. "When one or both partners are at work, there is a natural division of personal space. Suddenly being together 24 hours a day, seven days a week can be incredibly disruptive."
- Sense of mortality. Retirement can serve as a reminder that you're closer to the end of your life. Even if that end is realistically 20, 30, or more years away, just entering retirement can trigger feelings of "What will I lose next?"
- Shake-up of self-esteem. If the retirement was under strained circumstances — being eased out, pressured to retire, or even fired — the loss of a job can be felt much more acutely and can lead to feelings of inadequacy, diminished self-esteem, and depression.
How to Transition Into Retirement
Once you've identified the roadblocks that are preventing you from making the most of your retirement, try these tips to create a new life for yourself that's as stimulating and joyful as you want it to be.
- First, give yourself some time. Understand that this will be a process. Your transition into retirement won't happen overnight, and your emotions may shift from one day to the next.
- Assess your resources. Consider the things you turned to during other periods of change in your life, says Schlossberg. To help you identify ways to cope with your transition into retirement, ask yourself three questions: Can I change what's challenging me? If not, can I change the way I see it? And finally, can I reduce my stress level through meditation, exercise, therapy, etc.? This will help you target areas that need work.
- Build your psychological portfolio. "We ready our financial portfolios but forget about our 'psychological portfolios,' which includes our identity, our relationships, and our need for a sense of purpose," says Schlossberg. Craft a new identity by imagining what you'd put on your new business card: World traveler? Gardener? Artist? Then build a new routine, whether it's a daily trip to the local coffee shop or a walk with a friend.
- Maintain friendships. Numerous studies have shown that friendship — even if it's just with one confidant — reduces stress, says Deitch. Make it a point to connect regularly with friends, and join groups or take classes in subjects you're interested in, which will lead to new friends. Men may especially find this helpful since they tend to form alliances based on shared interests and activities rather than relationships.
- Exercise. Not only will getting active increase mood-boosting, stress-relieving chemicals such as endorphins and serotonin, it'll also increase your overall health and help ward off illnesses.
- Make a mission statement. Write down a list of things you want to do and things you regret not doing and then identify ways you can achieve those goals.
- Find your path. As you consider your options, think about whether you want to spend your free time doing something similar to what you did in your job, or if you want to try something wholly different. Exploring something you've never done before can be a great way to stimulate your mind and make new friends.
- If nothing is working, seek help. No matter what you choose to do with your time in retirement, say experts, try to get involved and stay involved. Being inactive and feeling lethargic and depressed are signs that you may need to seek advice from a mental-health professional.Keeping a positive attitude about what tomorrow may bring, even if you feel down today, can also be a big help.
Getting the flu can be a nasty experience, no matter what your age or general health, and each year flu shots are a major public health initiative. But, because of the risks to the elderly, senior flu prevention is especially important.
According to the Centers for Disease Control (CDC), each year more than 200,000 people will be hospitalized because of the flu, and 36,000 of them will die.
"Disproportionately it's the elderly," explains Debra Beauchaine, MN, ARNP, and geriatric services director at Virginia Mason Medical Center in Seattle. Seniors in their seventies and eighties are at higher risk from the flu than seniors in their sixties, because of declining immunity to illnesses as they age.
HOW FLU SPREADS
Seasonal (or common) flu is one of the most highly contagious illnesses. It is spread by "respiratory drops"-coughing and sneezing. Someone may touch something with the flu virus on it-such as door knobs, telephones or shopping cart handles-then unwittingly touch their mouth or nose.
And it's not enough to simply stay away from other people who feel sick. "People may be contagious one day before they develop any symptoms, and for up to five days after becoming sick," Beauchaine says. "That's part of the problem; people don't realize they have the virus before they actually feel sick."
Flu symptoms include fever, chills, runny or stuffy nose, headache, sore throat, cough, extreme fatigue, and muscle aches. Nausea, vomiting and diarrhea are sometimes present, but rarely prominent.
Flu season typically runs from October through the end of February, but some years it runs into March and April as well. It is estimated that 10 to 20 percent of the U.S. population contracts influenza each year. Once someone gets the flu, the only real "cure" is to rest and drink plenty of fluids, although a doctor may prescribe Tamiflu® or Relenza®, both anti-viral medications which can keep the influenza virus from spreading inside the body and shorten the duration of symptoms. Both must be taken within 48 hours of the onset of flu symptoms, and neither is a substitute for a flu vaccination.
FLU & SENIOR HEALTH
While otherwise healthy adults can be laid low by the flu for a full week, senior citizens are at risk for becoming much sicker. "They are more vulnerable, once they get the flu, to develop complications," Beauchaine says. "Because the flu is really a pretty severe illness, they may not have as much of what we call 'physiological reserve' as a younger adult. So, seniors will feel very sick from a case of the flu and that puts them at greater risk for complications."
Dr. W. Paul McKinney, associate dean of the School of Public Health at the University of Louisville, explains that one of the more serious complications is primary viral pneumonia or a secondary bacterial pneumonia. Most hospitalizations and deaths from the flu are a consequence of pneumonia and other respiratory disorders. Also, if a senior has any chronic health conditions, such as congestive heart failure, chronic lung disease, even diabetes or renal failure, those could be exacerbated by the flu. And another common complication of the flu is dehydration, so drinking plenty of fluids is especially vital for the elderly.
SENIOR FLU PREVENTION
Staying away from work or crowded places while sick is important to prevent spreading the flu to others. But that's not an option for seniors living in nursing homes or assisted living facilities, making senior flu prevention that much harder at these communities. "When you congregate large numbers of people in close quarters, transmission is a lot easier," McKinney says.
However, Beauchaine points out that nursing homes usually require all employees to be vaccinated, which is the single most effective way to guard against getting the flu. And, it's important to get a flu shot every year, because the virus changes slightly from year to year. Getting a flu shot one year and not the next, will not protect someone from that year's particular strain.
"They should make every reasonable effort to get vaccinated early in flu season," McKinney says, but don't do it too early in the season, because occasionally the immunity will wear off before flu season ends, especially if the season lasts into March or April.
According to the U.S. Department of Health and Human Services, seniors covered by Medicare Part B pay no coinsurance or deductible for their flu shot, as long as they receive the shot from a Medicare provider.
What if a senior is otherwise healthy and doesn't feel they are "at risk?"
"There is no reason a healthy senior should defer a vaccine," McKinney says.
A University of Michigan study found that boosting elderly flu vaccinations could save as many as 6,500 lives over ten years. In fact, research from Johns Hopkins University shows that annual flu shots reduce the number of deaths among hospital patients by one half.
While vaccination is the most important senior flu prevention, it's only 70 to 90 percent effective, so some people who receive the vaccination will still get the flu.
So, for at-risk populations, it's especially important that everyone around them also gets vaccinated. That includes everyone involved in taking care of the elderly. And like nursing homes, some hospitals, such as Seattle's Virginia Mason, require all employees to be vaccinated.
The CDC's target groups for vaccination keep expanding, recently adding children aged 2-5, and lowering the seniors' age range from age 65+ to 50+. The CDC estimates 218 million Americans fall into the at-risk groups that should be vaccinated. "That's over two-thirds of this country," McKinney says. "This year we'll have 100 million doses of the vaccine, so we won't even be able to vaccinate 50 percent."
According to McKinney, the U.S. should not face a vaccine shortage this year. "Unless someone is in a very remote, isolated area, there shouldn't be a problem getting the vaccine," he says.
While it's not possible to get the flu from the standard injectable flu vaccine, which is made from a killed virus, some people will experience a sore arm for one to two days, and possibly a fever. (The newer nasal spray vaccine is made from a live attenuated virus and recommended only for healthy, non-pregnant people between the ages of five to forty-nine.)
Although some people believe certain foods or vitamins can ward off illness, Beauchaine says that while they may make you healthier in general, they aren't effective for senior flu prevention.
During flu season, practicing good hygiene can help people avoid catching or spreading the flu. Wash hands frequently, especially after touching door knobs and stair rails in public places. Always cover nose and mouth when coughing or sneezing, and immediately wash hands afterward. And, of course, stay away from people who are sick. People taking care of the elderly especially need to follow this type of common sense senior flu prevention.
Finally, don't confuse influenza with avian flu. While bird flu gets a lot of press these days, it is extremely rare, occurring when a human has direct contact with infected poultry or surfaces contaminated by secretions or excretions from infected birds. Vaccines to protect against bird flu are being developed, but are not yet available.
by Vicki Salemi
As tough as it may be to enlist the help of a "stranger" when it comes to caring for your parents, sometimes it's for the best. For one thing, it will take the strain off of you, but your parent will also benefit from professional care in the comforts of home. Whether it's being attentive to special medical needs of assisting with personal care or homemaking, having a home health care professional will provide a variety of benefits to both the patient and the family.
1 - Home care promotes healing.
"I know that our clients enjoy a much better quality of life which many families have said helped to extend the lives of their lived ones.," says Peter Ross, CEO and co-founder of Senior Helpers. "We focused on healing the mind, not just the body." Maxine Hochhauser, CEO of Visiting Nurse Regional Health Care System adds that in many circumstances the person rehabilitates better in the home. "They are in a familiar environment and are more comfortable. This is particularly true with individuals suffering from dementias."
2 - Home care is safe.
"Many risks such as infection are eliminated or minimized when care is given at home," says Ross. Quality home care by professional caregivers can help prevent issues that may become very serious within the home. One example includes preventing falls in the home since seniors may be too weak or dizzy from medication since they fall when they're cleaning or bathing.
3 - Home care allows for maximum amount of freedom for the individual.
Patients at home may be engaged with their typical daily activities as their health permits plus it allows patients to receive care in the least restrictive environment. "This is the most conducive to patient-centered care which allows individuals the most control over the care they'll receive and the manner in which they receive it," notes Hochhauser. "Plus, it allows individuals to remain in the community."
4 - Home care gives them some control.
As baby boomers age the home care option gives them more control over the type of care they'll get to choose. Hochhauser explains, "They want more choices and want to be a more active participant in their own care. Home care allows them the most say in their care as they are in the least passive situation."
5 - Home care is personalized.
According to Milca Pabon, RN, a home health care nurse with Adventist Home Health, "the best reason to choose home care is because the care that will be received in the home will be individualized to each patient according to their specific needs." Essentially home care is tailored to the needs of each patient as they receive one-on-one attention.
6 - It eases burdens on the family.
Pabon explains, "With the length of stay in the hospital decreasing patients are going home earlier and many of them do not choose to go to a rehabilitation center to recover," explains Pabon. Rather, they want to go home to their own environment with their loved ones and have someone provide them with care they'll need to reach their maximum level of function. She continues, "Families are willing to have their loved ones with them, but may feel inadequate or unable to provide their loved ones with the help that they might need."
7 - Home care is comfortable.
"Every study done has shown that people would prefer to stay in their home," says Constance Row, executive director of the American Academy of Home Care Physicians. There is familiarity and comfort of being in one's own environment surrounded by their loved ones. She notes, "It's a type of quality care that people would want for their senior relatives."
Seniors are better than younger people at getting their servings of fruit and vegetables, but that's still not saying much. Only 30 percent of people 65 and older eat five or more daily servings of fruit and vegetables, which is the minimum amount recommended for good nutrition.
Eating plenty of fruit and vegetables is especially important as you get older, because the nutrients and fiber in these foods can help reduce high blood pressure, lower your risk of heart disease, stroke, and certain cancers, stave off eye and digestive problems — and simply satisfy your hunger.
How Big Is One Serving of Fruit or Vegetables?
Before you try to eat an entire bunch of bananas or a bushel of apples, know this: One serving of fruit or vegetables equals half a cup, or about the amount you could hold in a cupped hand. Nutrition experts used to recommend five servings of fruit and vegetables per day, but that’s probably no longer enough, according to the U.S. Centers for Disease Control and Prevention (CDC). Individual needs are different, and depending on age, gender, and level of physical activity, you’ll require between 5 and 13 servings of fruit and vegetables each day.
To help determine your specific needs, visit the CDC’s fruit and vegetable calculator.
Meeting Your Healthy Eating Goal for Fruit and Vegetables
Follow these simple tips for increasing the amount of fruit and vegetables you eat each day:
- Add fruit and vegetables to your favorite dishes. Find ways to incorporate fruit and vegetables into foods you already eat. For example, stir fruit into your cereal or yogurt, add strawberries or blueberries to your pancakes, pack your sandwich with extra veggies,add vegetable toppings to your pizza, stir greens into your favorite casserole or pasta dish, or stuff your omelet with extra vegetables.
- Display your produce. Put your fruit and vegetables out on the counter or in a prominent position in the refrigerator, so that you'll be more likely to eat them.
- Try new things. Next time you go to the grocery store, pick out a new fruit or vegetable to try.
- Cook vegetarian. At least once every week, skip the meat (you could join in on Meatless Monday) and try a new vegetarian recipe for dinner.
- Snack away. Try snacking on fresh or dried fruit, carrot and bell pepper strips with a low-fat dip, or baked chips with fresh salsa.
Why We Eat Less as We Age
As you get older, certain age-related changes can make it more difficult to get the fruit and vegetables you need, such as:
- Difficulty chewing. Some people have dental problems that make it harder to chew, resulting in a reduced interest in eating.
- Changes in taste. Your sense of taste can change as you get older, so you may avoid some of the foods you used to enjoy.
- Mobility problems. For older people who are no longer able to drive, it may be difficult to get out and shop for fresh produce.
- Lack of motivation to cook. If you live alone, you may not feel like cooking just for one.
- Changes in appetite. For many people, getting older means that you just aren't as hungry as you used to be.
To get the most out of the fruit and vegetables you eat, aim for variety. Eat many different types of fruit and vegetables in a rainbow of colors. This will help ensure that you get the variety of nutrients your body needs for healthy aging.
Your new home in Dover, NH with care as you need it!
Dover, NH now features a beautiful and brand new complex specifically designed to provide apartments for those 62+ with daily needs. This unique concept provides the option of in-home care provided by Abundant Blessings Homecare for those who need a helping hand. Mast Landing also offers dining services.
Abundant Blessings Homecare is partnering with Mast Landing Senior Care Housing to provide service enriched housing.
GEORGE F. FULLER, COL, MC, USA, White House Medical Clinic, Washington, D.C.
Am Fam Physician. 2000 Apr 1;61(7):2159-2168.
See related patient information handout on the causes of falls and tips for prevention, written by the author of this article.
Falls are the leading cause of injury-related visits to emergency departments in the United States and the primary etiology of accidental deaths in persons over the age of 65 years. The mortality rate for falls increases dramatically with age in both sexes and in all racial and ethnic groups, with falls accounting for 70 percent of accidental deaths in persons 75 years of age and older. Falls can be markers of poor health and declining function, and they are often associated with significant morbidity. More than 90 percent of hip fractures occur as a result of falls, with most of these fractures occurring in persons over 70 years of age. One third of community-dwelling elderly persons and 60 percent of nursing home residents fall each year. Risk factors for falls in the elderly include increasing age, medication use, cognitive impairment and sensory deficits. Outpatient evaluation of a patient who has fallen includes a focused history with an emphasis on medications, a directed physical examination and simple tests of postural control and overall physical function. Treatment is directed at the underlying cause of the fall and can return the patient to baseline function.
Elderly patients who have fallen should undergo a thorough evaluation. Determining and treating the underlying cause of a fall can return patients to baseline function and reduce the risk of recurrent falls. These measures can have a substantial impact on the morbidity and mortality of falls. The resultant gains in quality of life for patients and their caregivers are significant.
Epidemiology of Falls in the Elderly
From 1992 through 1995, 147 million injury-related visits were made to emergency departments in the United States.1 Falls were the leading cause of external injury, accounting for 24 percent of these visits.1 Emergency department visits related to falls are more common in children less than five years of age and adults 65 years of age and older. Compared with children, elderly persons who fall are 10 times more likely to be hospitalized and eight times more likely to die as the result of a fall.2
Trauma is the fifth leading cause of death in persons more than 65 years of age,3 and falls are responsible for 70 percent of accidental deaths in persons 75 years of age and older. The elderly, who represent 12 percent of the population, account for 75 percent of deaths from falls.4 The number of falls increases progressively with age in both sexes and all racial and ethnic groups.5 The injury rate for falls is highest among persons 85 years of age and older (e.g., 171 deaths per 100,000 white men in this age group).6
Elderly persons who survive a fall experience significant morbidity. Hospital stays are almost twice as long in elderly patients who are hospitalized after a fall than in elderly patients who are admitted for another reason.9 Compared with elderly persons who do not fall, those who fall experience greater functional decline in activities of daily living (ADLs) and in physical and social activities,10 and they are at greater risk for subsequent institutionalization.11
Falls and concomitant instability can be markers of poor health and declining function.12 In older patients, a fall may be a non-specific presenting sign of many acute illnesses, such as pneumonia, urinary tract infection or myocardial infarction, or it may be the sign of acute exacerbation of a chronic disease.13 About one third (range: 15 to 44.9 percent) of community-dwelling elderly persons and up to 60 percent of nursing home residents fall each year; one half of these “fallers” have multiple episodes.14 Major injuries, including head trauma, soft tissue injuries, fractures and dislocations, occur in 5 to 15 percent of falls in any given year.15 Fractures account for 75 percent of serious injuries, with hip fractures occurring in 1 to 2 percent of falls.15
In 1996, more than 250,000 older Americans suffered fractured hips, at a cost in excess of $10 billion. More than 90 percent of hip fractures are associated with falls, and most of these fractures occur in persons more than 70 years of age.8 Hip fracture is the leading fall-related injury that results in hospitalization, with these hospital stays being significantly prolonged and costly.16 It is projected that more than 340,000 hip fractures will occur in the year 2000, and this incidence is expected to double by the middle of the 21st century.17
One fourth of elderly persons who sustain a hip fracture die within six months of the injury. More than 50 percent of older patients who survive hip fractures are discharged to a nursing home, and nearly one half of these patients are still in a nursing home one year later.18 Hip fracture survivors experience a 10 to 15 percent decrease in life expectancy and a meaningful decline in overall quality of life.
Most falls do not end in death or result in significant physical injury. However, the psychologic impact of a fall or near fall often results in a fear of falling and increasing self-restriction of activities. The fear of future falls and subsequent institutionalization often leads to dependence and increasing immobility, followed by functional deficits and a greater risk of falling
Protect yourself or your loved one
The elderly often rely on others to meet their most basic needs. Statistics tell us that about 9.5% of the elderly population is abused every year. Elder abuse includes neglect, physical abuse, financial exploitation, emotional abuse, and sexual abuse. One out of every 14 cases occurs domestically, usually within the victims homes. Abuse also occurs in nursing homes and other facilities. Physical Abuse is defined as the use of physical force that may result in bodily injury, physical pain, or impairment. This can happen even if the motives are good. For example we have seen family members who force there elderly mother into the tub, because she has dementia and would not cooperate. This forcing caused minor injuries. When confronted the family stated they were just doing what the nursing home did. This is a shocking story, and often how physical abuse occurs. Psychological Abuse is defined as the infliction of anguish, pain, or distress through verbal or nonverbal acts. What is often just family conflict and strife can easily get out of control and lead to psychological abuse. Financial Abuse or exploitation is defined as the illegal or improper use of an elder’s funds, property, or assets. A family member, neighbor, friend, even a hired caregiver, anyone who is close to the person can manipulate and abuse them for personal selfish gain. Neglect is defined as the refusal or failure to fulfill any part of a person’s obligations or duties to an elder, or the failure on the part of an in-home service provider to provide necessary care. This can easily happen just by family members conveniently forgetting about their elderly parent. Caregiving is a hard stressful job, rather than properly finding the help that is needed. Ignoring the problem is abuse.
We all have the right to be free from abuse, neglect, and exploitation. If you suspect any form of abuse to an elderly person, it is important for you to report it. The types of abuse discussed above could happen to any of our community’s elders. Without intervention, abuse almost always escalates. Because victims are often reluctant to report abuse, a person’s safety may depend on you to recognize and report suspected abuse. It would be far safer for you to report a suspicion and be wrong, then remaining quiet while abuse occurs. It is important to know that more than two-thirds of elder abuse perpetrators are family members of the victims or close family friends, typically serving in a caregiving role. When elder abuse occurs, it can be addressed – if it comes to the attention of authorities.
If you need to hire homecare assistance, we recommend using a licensed agency rather than hiring privately. Homecare agencies must conduct criminal background checks, and BEAS registry checks. The BEAS registry (bureau of elderly and adult services) is a database containing information on founded reports of abuse, neglect or exploitation of incapacitated adults by a paid or volunteer caregiver, guardian or agent. There are individuals with a clear criminal background check who in in the BEAS registry. The NH BEAS registry can be reached at (603) 271-3269. Also, keep in mind; only criminals who get reported and charged have criminal records. Some homecare agencies and nursing facilities conduct pre-hire personality tests. These tests help determine if an applicant has a tendency toward certain types of crime or questionable behavior.
Estate planning, guardianships, and the administration of probate estate and trusts can be complex and confusing. Each case is unique. Make a careful list of your assets, your family members, and your service providers, then contact your attorney. Everyone should have the following three documents:
1. A Durable Power of Attorneyauthorizes another individual to manage your property if you are disabled or otherwise unable to manage your property.
2. An Advance Directive authorizes others to make health care decisions for you during periods of incapacity and provides specific instructions to the medical profession as to management of a final or terminal illness. A simple HIPAA release can be added to this document to allow your care providers to talk with your agents before you become fully incapacitated.
2. A Last Will and Testament names a person to manage your affairs after your death, and governs the disposition of your property at death. The probate court will supervise this process.
Many people also create trusts, which generally allow your family to avoid or at least minimize the probate process. Specialized trusts can also provide additional care for special needs beneficiaries, hold assets for beneficiaries who are too young to manage their inheritance, or address other specific needs – including asset protection.
Guardianship – If you do not have these documents in place, and you become mentally disabled, your family will need to go to the probate court to obtain a guardianship. This is a time-consuming and expensive process, which typically occurs at the time of a crisis. The probate court is a helpful resource, but most families in the guardianship context wish they could spend time with their ill relative, rather than spending time at, or preparing for, the court house.
Nursing home costs – Many people believe that when full nursing care is needed, the government will cover the cost. This is NOT true. The only program that assists with skilled nursing care is Medicaid, which is a welfare program based on financial need. The application process requires submission of five years of financial records, showing that the applicant has not gifted assets away in order to apply for help.
Long Term Care Insurance – Like any kind of insurance, this product involves the payment of premiums in exchange for a promise to cover certain services. There are many different types of policies. Talk with an insurance agent who handles these policies routinely for further information.
No matter which documents you choose, the estate planning process will involve the same core discussion. Be ready to tell your attorney:
1. The approximate value of your assets and the nature of those assets. List bank accounts, valuable person property, real estate, marketable securities, insurance products, or retirement assets such as a 401k, IRA, SEP or pension.
2. Family dynamics; including your marital status, the marital status of your children and other intended beneficiaries, and the existence of competency issues among you, your children, and intended beneficiaries.
3. Identify the individuals who will make medical decisions for you when you are incapacitated and who will manage your estate (or trust) while you are incapacitated and upon death.
Deborah A. Fauver is an attorney at Cooper Cargill Chant, with offices in North Conway and Berlin, NH. Additional information about the firm and the estate planning process can be found at www.coopercargillchant.com
Providing care for a loved one can be stressful. Hiring homecare services should help relieve stress, not add to it. We made the following list to help make hiring a homecare service easier.
Things to consider:
1. Reputation: Ask around. Ask your hospital discharge planner about any agency you are considering. Rehabs or Nursing homes will usually provide you a list of agencies to consider. Senior centers and government services such as Service Link in New Hampshire are also great place to get information. Ask specifically about more than one agency for comparison purposes.
2. Check out their website: The agency’s website should be thorough, informative and professional.
3. Ask to have a free in-home assessment. Any reputable agency should be willing and able to provide an assessment of your loved one’s needs. This meeting should be one that is not only for admission purposes, but also to answer the family’s questions or concerns. The homecare representative should be willing and able to answer and help guide the family toward the options they have, without pressure. They should be willing to be a resource for you whether you use their services or not.
Questions to ask an agency:
1. Is your agency licensed by the state?
The states of Maine and New Hampshire require homecare agencies to be state licensed. New Hampshire also requires a state license for independent caregivers. If your family is considering hiring privately for care for your loved one please read our article on this topic "Use Caution When Hiring Independent Caregivers".
2. Will you take care of all required payroll paperwork for my loved one’s caregiver? Are your caregivers all employed by the agency?
The states of Maine and New Hampshire consider you an employer if you independently hire someone to work in your home. There is a large amount of paperwork involved in being an employer. This paperwork covers such matters as taxes, Social Security, workers compensation, disability, and liability insurance. One benefit of hiring an agency is that the agency normally does this for you. Even so, it is good to ask, as some agencies do use independent contractors as caregivers.
3. What kind of training do you provide for your caregivers?
To expect experienced and trained caregivers to work in homecare should be the minimum. However, it is important to ask if the hiring agency is training the caregiver themselves in addition to any formal training or schooling which the caregiver has had. What do they require for continuing education? Abundant Blessings Homecare’s new hire training and continuing education exceeds the state requirements in every area. Our RN is continuously adding and improving our training. We believe providing the very best training and continuing education will assure that our caregivers are the very best caregivers!
4. Do you conduct drug testing on your caregivers?
The states of Maine and New Hampshire do not require drug testing for home healthcare workers. Many homes in which home healthcare services are provided contain controlled substances, therefore we believe drug testing should be a vital part of the hiring process for any home care agency.
5. What kind of background check do you conduct on your caregivers?
Having peace of mind that your loved ones are in good hands is vital when hiring homecare services. The state of NH requires that homecare agencies in New Hampshire conduct only a State of New Hampshire criminal background check, not a Federal background check. They also do not require a motor vehicle driving record check. At Abundant Blessings Homecare we believe that State, Federal and Motor vehicle record checks are all essential when hiring homecare for a loved one. We run all three checks on all our caregivers. These additional checks are an added expense during the hiring process but we feel they are essential for peace of mind for your family. It is possible for someone to have a criminal record in another state which would show up on a Federal check and yet their New Hampshire background check would return "clear". We also believe motor vehicle background checks are imperative because often times home healthcare workers provide transportation for their clients.
6. Are your employees insured and bonded?
The state of New Hampshire requires insurance of homecare agencies, but not bonding. However, insurance does not cover theft; bonding does. Also, not all liability insurance is the same. You could ask the agency for a copy of their policy or ask what their liability insurance covers.
7. If at any time my loved one needs more hours of care (eg: 24 hour a day), or if a caregiver should call in sick, do you have the staff for coverage?
Any agency you hire should have enough staff to cover these situations should they arise.
8. What is your policy regarding sending a caregiver to my loved one’s home whom my loved one has never met?
It is not safe for an elderly person to be answering the door to total strangers. An agency should have a policy in place regarding the meeting of new caregivers. Abundant Blessings Homecare never sends new caregivers to a home blindly; we always conduct a “meet and greet”.
9. What kind of supervision do you provide?
Once a caregiver is placed in the home of your loved one, ongoing supervision of that caregiver needs to be provided. How often can you expect a Care Manager/Supervisor to be available? Your family is assigned a Care Manager who you will get to know and trust as your go to person. At Abundant Blessings Homecare our phone number is always answered 24/7 by a real person and if your Care Manager is off when you call, you will be connected with whomever is providing coverage. In addition, we conduct drop in visits just to see how things are going on a regular basis.
10. What kind of service agreement is required? What are your minimum number of hours?
All agencies have different policies. Find out what is required to be sure it will work for the needs of your loved one.
11. What is your method for tracking a caregiver’s arrival and departure from a clients home?
The agency should have a system in place for this that works for you and your family.
12. What are your hours of operation, and how are phone calls handled during odd hours?
Abundant Blessings Homecare is available by phone 24/7, and is always answered by a real person!
13. Do you provide a written plan of care which clearly describes any rates and fees?
The state of New Hampshire has requirements which must be on the plan of care. The plan of care should be thorough and well explained to your family.
14. How soon can you start services?
Your family may need homecare right away, yet the homecare agency may be too busy or too small to handle a quick start. They may need time to schedule services. This is a very important question to ask.
Summer is rapidly approaching, are you racking your brain trying to think of things to do with your aging loved ones? We have some ideas to help you! First of all, think of things that your loved one would enjoy, eg: picnics, walks. Try to incorporate those into summer-time fun! Here some idea's on behalf of us:
Create a garden, it doesn't have to be big or elaborate, it could even be a garden box. This is a fun activity that come with a beautiful product!
Attend a baseball game, or town festival! This provides great entertainment for all!
Pick a new hobby, such as bird watching! Identify all different kinds of birds with your loved one, it keeps your brain busy, and you occupied!
Take stroll to your nearest beach, or lake. You and your loved one can cool off while catching a great view! Even just dipping your feet in can cool you off on a hot summer's day!
Go for a picnic in the shade. You and your loved one can prepare the food and pack the basket together, help keep their minds stimulated!
Go to the park and people watch. Let your loved one reminisce on being young and seeing the children play. Listen to their stories of being young, or having children.
Don't forget sunscreen and water for all!
“Returning home from a hospital stay can result in unexpected challenges for many seniors. Finding themselves back at home after a hospital stay, many older adults struggle to manage their medications and make follow-up doctor’s appointments as well as obtain the physical assistance and in-home support they may require, at least on a temporary basis. As a result, many older adults do not successfully make the transition home well and end up returning to the hospital. In fact, one in five Medicare patients are readmitted to a hospital within 30 days after discharge. Studies have shown that nearly half of the readmissions are linked to social problems and lack of access to community resources”1 The readmission reduction program for hospitals has been an act of public law since October of 2013.2 Many steps have been taken to make sure the elderly are not discharged from the hospital blindly. Rehabilitation facilities have increased their services. Even many assisted living facilities and Nursing homes have added short stay and rehabilitation programs to help patients return home safely. Once home, local VNA and other Home Health Care companies can continue rehab for a predetermined period of time.
Abundant Blessings Homecare works with all these facilities; Hospitals, Rehabs, VNA’s… and we have been listening to your needs. We have also been listening to the families of the patients we care for. What this means is that our Care Managers will be in the facilities (Hospitals, Rehabs, Nursing Homes…), and available to the Social Workers, Nurses, Staff and families any time they are needed. They will also be in the homes of our patients supervising our team. Sometimes a patient is discharged from the hospital to a facility with future plans to go home with homecare services. In such a case the planning for their transition to home can begin immediately upon discharge from the hospital. In other cases, patients are discharged directly to home and homecare services are needed immediately, our Care Managers are able to respond to this need and help set this up.
We have always worked very well and closely with local VNA services to support any Rehab efforts (most people will not do exercises unless someone is there to assist and coach them). Most VNA services will provide needed Nursing, PT, OT, etc. as drop in visits. What we provide is homecare services which includes anything from 24/7 to 12 hour overnight services to any combination of hourly services as little as 3 hours a day, even weekends. The schedule will be whatever the family decides they need for assistance, even if it changes.
Our goals are for our Care Managers to form working relationships with all the facilities, to provide a bridge of seamless communication for the patient and their families. This would enable the families to be able keep the same Care Manager helping them for the long term. It is also our aim for our Care Managers to act as liaisons between all the facilities the patient and their families, so patients can get home and stay home safe. This will help unnecessary readmissions to be reduced, families to feel at ease, and the facilities to be informed of their continuous care and know they are in good care with Abundant Blessings Homecare.