A recent editorial in the Wall Street Journal by Laura Carstensen, the founding director of the Stanford Center on Longevity reminds us that as Americans we are living longer. But instead of looking at them as adding years to our lives, think about them as adding life to our years. Click here to read the article
A new study by the Oregon Health and Science University suggests that a lack of sleep or great changes in sleep habits could give you a greater risk of developing Alzheimer's Disease. Click here to listen to a story
The bright lights and big crowds make the holidays fun and exciting for many of us. But the season can present special challenges if you are a family caregiver of someone with Alzheimer’s or other form of cognitive impairment. A little planning can make the season less stressful for everyone in this situation. Geriatrics physician Dr. Cindy Carlsson, an Alzheimer’s disease researcher at the University of Wisconsin School of Medicine and Public Health, explained that Alzheimer’s patients may feel a sense of loss during the holidays, while caregivers can become frantic trying to keep up with holiday traditions and caring for their loved ones at the same time.
Carlsson shared advice for making the holidays more enjoyable for everyone. Here are four easy suggestions as you plan this year’s holiday time with your friend or loved one:
Follow a routine. Sticking to a routine can reduce the stress on the person with dementia, as well as his or her caregiver and family. “Holidays are anything but routine, yet a routine is the best way to be kind to the patient,” Carlsson said. “Make sure the day is as normal as possible by providing meals at the same time they usually are.”
Help your loved one remember. People with Alzheimer’s can become frustrated when someone tries to challenge their memories with questions like, “Do you remember me?” and “Do you remember what we did last summer?” Advised Carlsson, “Regardless of how close you are to the person, introduce yourself. You could also update them on your activities so that they don’t have to ask questions.” Carlsson said reminiscent therapy can be effective. She suggests going through old family photos with your loved one. In addition, you might even ask guests to wear name tags.
Involve your loved one in activities. “We recommend that you involve an Alzheimer’s patient with straightforward activities like wrapping gifts, folding napkins or simple crafts,” said Carlsson. Activities can provide mental and physical stimulation.
Take care of the caregiver. The best gift for a caregiver can be the gift of time and respite. The typical stress of caring for a person with Alzheimer’s can become even more overwhelming during the holidays. Carlsson said you can help a caregiver by offering to give them some time off. Families can prepare a plan to share the caregiving. For caregivers who will be hosting the holiday get-together, Carlsson suggests smaller gatherings or even a potluck.
Source: University of Wisconsin School of Medicine and Public Health, adapted by IlluminAge AgeWise.
Who Would Take Care of Your Loved One with Alzheimer’s Disease if Something Happened to You?
It is important to have a plan in case of your own illness, disability, or death.
• Consult a lawyer about setting up a living trust, durable power of attorney for health care and fi nances, and other estate planning tools.
Consult with family and close friends to decide who would take responsibility for the person with Alzheimer’s. You also may want to seek information about your local public guardian’s offi ce, mental health conservator’s offi ce, adult protective services, or other case management services. Th ese organizations may have programs to assist the person with Alzheimer’s in your absence.
• Maintain a notebook for the responsible person who will assume caregiving. Such a notebook should contain the following information:
• emergency phone numbers • current problem behaviors and possible solutions • ways to calm the person with Alzheimer’s
• assistance needed with toileting, feeding, or grooming
• favorite activities or food
• Preview long-term care facilities in your community and select a few as possibilities. Share this information with the responsible person. If the person with Alzheimer’s disease is no longer able to live at home, the responsible person will be better able to carry out your wishes for longterm care. For more information on planning, contact the Alzheimer’s Disease Education and Referral (ADEAR) Center at 1-800-438-4380 or www.nia.nih.gov/alzheimers for more information on planning for health, legal, and fi nancial matters.
Source: National Institute on Aging; portions provided by Informed Eldercare Decsions in association with IlluminAge. 2014
When a loved one is diagnosed with Alzheimer’s disease (AD), you need to start getting his or her health, legal, and financial affairs in order. You want to plan for the future, if possible, with help from the person while he or she can still make decisions. You need to review all of his or her health, legal, and financial information to make sure it reflects the person’s wishes.
Here is a planning checklist from the National Institute on Aging’s Alzheimer’s Disease Education and Referral Center: Update health care, legal, and financial information
• A Durable Power of Attorney for Finances gives someone called a trustee the power to make legal and financial decisions for the person with AD.
• A Durable Power of Attorney for Health Care gives someone called a proxy the power to make health care decisions for the person with AD.
• A Living Will states the person’s wishes for health care at the end of life.
• A Do Not Resuscitate (DNR) Form tells health care staff how the person wants end-of-life health care managed.
• A Will tells how the person wants his or her property and money to be divided among those left behind.
• A Living Trust tells someone called a trustee how to distribute a person’s property and money. Check for money problems People with Alzheimer’s disease often have problems managing their money. As the disease progresses, a person may try to hide financial problems to protect his or her independence. Or, the person may not realize that he or she is losing the ability to handle money matters. Someone should check each month to see how the person is doing. This person might be a family member or the trustee. Protect the person from fraud Scams can take many forms, such as identity theft; get-rich-quick offers; phony offers of prizes or home or auto repairs; insurance scams or outright threats.
Here are some signs that the person with AD is not managing money well or has become a victim of a scam:
• The person seems afraid or worried when he or she talks about money.
• Money is missing from the person’s bank account.
• Signatures on checks or other papers don’t look like the person’s signature.
• Bills are not being paid, and the person doesn’t know why.
• The person’s will has been changed without his or her permission.
• The person’s home is sold, and he or she did not agree to sell it.
• Things that belong to you or the person with AD, such as clothes or jewelry, are missing from the home.
• The person has signed legal papers (such as a will, a power of attorney, or a joint deed to a house) without knowing what the papers mean. Reporting problems: If you think your loved one may be a victim of a scam, contact your local police department. You also can contact your state consumer protection office or Area Agency on Aging office. For help finding these offices, contact Eldercare Locator at 1-800-677-1116 or www.eldercare.gov.
Recent events in the U.S. have drawn more attention than ever to the debate over gun laws and gun safety. Many studies have looked at the need for keeping children safe from firearms-related injury. But what about the safety of older adults? And when a senior has Alzheimer’s disease or other dementia, what should family do? Researchers from the University of Pennsylvania School of Social Policy & Practice examined the public health considerations related to firearm ownership among the elderly. Study authors Susan B. Sorenson and Brian Mertens report that more than 17 million seniors own at least one firearm—and they point out that with the growing number of seniors and current rates of gun ownership, more and more people over 65 will own guns.
The study authors examined several important considerations: Alzheimer’s and other dementia can make gun ownership dangerous for seniors—and for their families and other caregivers. It can be helpful to think of weapon ownership in the way we think about driving. Insights into taking away the car keys might be applied in this situation as well. Said Sorenson, “Memory, thinking and judgment as well as physical and behavioral competence issues related to the elderly person’s safe operation of a motor vehicle also apply to firearms. People with Alzheimer’s disease can have memory loss, personality changes, confusion, anxiety, fluctuating lucidity and other symptoms that can aff ect a person’s ability to responsibly, competently and safely own and operate a firearm.”
Even when a senior does not have dementia, studies show he or she is at higher risk of violent death for at least five years following the purchase of a handgun. This includes death by suicide: not only do the elderly have the highest rate of suicide; they are also more likely to use a gun for this purpose than are younger people. The authors suggest that nursing homes and other supportive living facilities, as well as family caregivers, should have guidelines for the possession of firearms. Says Sorenson, “Like most Americans, the elderly have the constitutional right to own firearms and there are many elderly people who are responsible gun owners. However, public-health policies must take action to promote the health of elderly persons and the safety of their caregivers.”
Signs that an elder is being exploited financially include atypical frequent ATM usage, multiple attempts to wire large amounts of money, and spending money on unusual items. Additionally, the guides include a list of agencies to contact to report fraud or a scam, as well as contact information for other agencies and organizations that can help financial caregivers with their duties. The Bureau contracted and worked closely with the American Bar Association Commission on Law and Aging to prepare the guides. A copy of the guides can be found at www.consumerfinance.gov/managing-someone-elses-money. Paper copies of guides may be ordered online at: http://promotions.usa.gov/cfpbpubs.html . Source: The Consumer Financial Protection Bureau. For more information, visit www.consumerfinance.gov
Robert E. O’Toole, President, Informed Eldercare Decisions
While many Americans still think of nursing homes as a primary provider of care for frail elders, few older Americans ever require nursing home placement.
Nursing homes are the most intensive form of longterm care and are sometimes the alternative best suited for those who need round-the-clock medical supervision. But whether that level of care is provided in a nursing home, or at home by home care aides, it comes with a steep price tag. In last month’s issue of the Caregiver Newsletter, we discussed the high cost of home care which typically runs between $16.00 and $24.00 per hour depending on what region of the country you live in. Th e cost of care in a nursing home also varies in diff erent regions of the U.S. ranging from $75,000 to $140,000 per year, with the most expensive being on the east and west coasts Fortunately, most seniors won’t require extended nursing home care. Only 5 percent will need fi ve years or more in a nursing home. Less intensive alternatives include home-care services that off er help with meals and household chores, assisted living facilities, and in some states, board and care homes provide a less intensive level of care, but are usually less costly per month than a nursing home. Th ere are also such community-based alternatives as adult day care programs, which provide care, recreation and meals for a few hours per day, to full day programs 5 days per week. In some states, the services are subsidized by state funding and can be paid for on a sliding scale based on the income of the elder. Th e average rate for adult day care last year was $70 a day, or about $18,000 annually. Licensing and certifi cation requirements vary by state and county. More than 5,000 centers run programs across the country and can be found through groups like the National Adult Day Services Association. Th e group recommends visiting potential centers and going through a checklist of options and amenities, including door-to-door transportation and accessibility. For more, visit: www.nadsa.org/consumers/site-visitchecklist. About 10 million seniors currently rely on others for daily care, such as help getting dressed, preparing meals or taking medication, according to a recent article by Matthew Perrone, of the Washington Post. That number will only increase as more of the nation’s 78 million baby boomers enter old age. Nearly 7 in 10 people will need some form of long-term care after turning 65, according to the Georgetown University Public Policy Institute. “Nobody wants to go to a nursing home; it’s the last resort,” said James Firman, president of the National Council on Aging. “People want to stay in their own home, and if they can’t, they want to go to a place where they can get assistance but that still feels homelike.” “Th e issue is that these are long-term costs and almost all of it comes out of pocket,” said John Migliaccio, director of research for Metlife’s Mature Market Institute. “It’s important to have some idea about what it will cost dad, mom or your husband to get the care they need.”
More People Report Feeling Worried About Memory Loss Than About Heart Disease, Cancer, or Any Other Condition?
“Where did I park?” You dashed into the mall, visited a few stores, and now, shopping bags in hand, you realize you can’t remember where you left the car. “I’ve met that fellow several times…what is his name?” Names, phone numbers, even familiar words...things sometimes seem to be “on the tip of your tongue” but escape quick recollection.
When you think about your own aging, what concerns you the most? Did you know that more people report feeling worried about memory loss than about heart disease, cancer, osteoporosis or any other condition? It is true that we experience memory changes as we age. Our speed of recollection and the amount of detail we remember decline. We are more likely to experience the classic “absentmindedness,” especially when we are multitasking and not paying full attention. Many of us worry that these changes might be symptoms of Alzheimer’s disease or other dementia. This is certainly a realistic concern.
According to the Alzheimer’s Association, one out of eight people will develop dementia, many of them living for decades with the disease. While not “an ordinary part of aging,” Alzheimer’s disease, stroke, Parkinson’s and other conditions that cause cognitive impairment are more common the older we get.
But the good news is that for most of us, the basic aspects of memory will remain pretty much the same: our vocabulary and language skills, reasoning and logic, the ability to pay attention, acquired skills like playing the guitar or cooking an omelet…and that special quality 10 Ways to Take Care of Your Brain that we usually refer to as “wisdom.”
As with so many aspects of aging, brain fitness varies from individual to individual. Some of this is hereditary. Yes, genes are a factor. But just as you can keep your body in shape by following a wellness regimen, there are also steps you can take to make it more likely that your memory will remain sound.
Here are some great things to remember:
• Remember to…practice good nutrition. We can choose foods that help protect our brains. Th e good news is, if you are one of the many adults who try to follow a “heart smart” diet, you are also on track for “brain smart” menu choices. A study by Columbia University researchers confi rmed that a high level of “good cholesterol” (HDL) is associated with a lower risk of dementia. Avoid: cholesterol, saturated fats, trans fats. Choose: fi sh, fruits, vegetables, and healthy fats such as olive oil or canola oil. Take a multivitamin—but don’t take megadoses that could be toxic. Even on a day-today basis, nourishing meals improve alertness and help us retain memories.
• Remember to…stay physically active. Just as a “heart smart” diet helps protect the brain, heartstrengthening aerobic exercise improves memory and even lowers the risk of dementia. A National Institute on Aging-funded study showed that moderate aerobic exercise can actually increase the size of the area of the brain involved in memory formation. Indeed, according to a study by University of 2 10 Ways continued from page 1 Wisconsin-Milwaukee researcher J. Carson Smith, “If you are at genetic risk for Alzheimer’s disease, the benefi ts of exercise to your brain function might be even greater than for those who do not have that genetic risk.” Talk to your healthcare provider about an exercise program that is right for you.
• Remember to…sleep well. You’ve probably noticed that when you don’t get enough good quality sleep, it is harder to concentrate the next day. And did you know that memories of the day are “fi led away” in the brain while we sleep? People who suff er from sleep disturbances often experience memory problems. But many sleep disorders are treatable, so speak to your healthcare provider if you experience trouble falling asleep, bothersome wakeful periods during the night, or snoring (which might suggest sleep apnea—a disorder that causes interruption in breathing during sleep).
• Remember to…treat depression and avoid stress. Both cause chemical changes that can damage the brain. If you are feeling overly stressed, or if depression is making it hard for you to focus and concentrate, talk with your healthcare provider. Counseling, meditation and other relaxation techniques can all help.
• Remember to…quit smoking and limit alcohol consumption. Many substances found in cigarette smoke damage the brain and impair memory. A study from Kaiser Permanente demonstrated a startling 172% increased risk of dementia among heavy smokers! And while a number of studies suggest that drinking in moderation might actually be benefi cial, having more than a drink or two per day can be toxic to the brain.
• Remember to…challenge your mind and memory. Mental stimulation encourages new connections between brain cells…so when it comes to the memory, “use it or lose it” isn’t just a cliché. Seek out a variety of mentally challenging activities. Learn a new skill—take up an instrument or study a foreign language. Join a club, volunteer, fi nd extra ways to increase brain-protecting social interaction. Visit a museum or work a diffi cult puzzle. Passive activities, such as watching TV, don’t off er the same benefi ts.
• Remember to…have a memory fi tness strategy. It is actually possible to increase memory sharpness through training. Visualization, concentration and other eff ective memory techniques improve the retention and accessing of memories. And people of every age now use supplemental technology—everything from simple sticky notes to voice recorders, personal organizers, day planners…the possibilities are endless.
• Remember to…use seatbelts and wear a bike helmet. Head injury can cause catastrophic damage to the brain and memory. And whether on the road or at home, take proactive steps to protect against falls. Remove clutter that might trip you up, install handrails by stairs and in the bathroom if needed, and ask your healthcare provider about a fall prevention class.
• Remember to…bring up memory concerns at your next healthcare appointment. Share with your doctor if you have experienced problems, especially disorientation, forgetting recently learned information, or a sudden inability to complete familiar tasks. While it’s tempting to be in denial about memory impairment, early diagnosis of conditions such as Alzheimer’s or mini-strokes allows treatment to begin right away. And when problems stem from a reversible or controllable condition, the sooner treatment begins, the better!
• Remember to…have your healthcare provider review your medications. Our lives are improved and extended by many of the medicines we take—but overmedication and the side eff ects of some drugs can dull the memory. Common culprits include tranquilizers, sleeping pills, pain medications, high blood pressure drugs. Your physician may switch you to a diff erent drug or dosage to lessen the eff ect. Why add stress to your life by worrying about your memory? Learn about the normal memory changes associated with aging, do all you can to take care of your brain, check out memory compensation strategies…and relax, knowing you’re doing everything you can to keep your memory strong through your later years.
Informed Eldercare Decisions in association with IlluminAge. Copyright 2014 IlluminAge
Nearly half of hospitalized American adults age 65 and older require decision-making assistance from family members or other surrogates because the patient is too impaired to make decisions independently, according to a new study from the Regenstrief Institute and the Indiana University Center for Aging Research. More than 13 million older adults are hospitalized annually in the United States, and that number is projected to increase as the population ages. Th is means that each year, millions of family members will have to make serious decisions for a hospitalized older adult. Th e vast majority of surrogates are children or spouses, and some patients have two or more family member making decisions together. Surrogates will commonly face decisions about life-sustaining care, such as whether to revive a loved one if his or her heart were to stop, as well as decisions about medical procedures and whether to send the patient to a nursing facility upon discharge. “As the population ages, family members of older adults should prepare for the crucial role they may play when their loved ones are hospitalized,” said Regenstrief Institute investigator Alexia Torke, M.D., M.S., associate professor of medicine at Indiana University School of Medicine, who led the study.
A higher proportion of intensive care patients needed surrogate decision-making, but the majority of patients in the study who required a surrogate were admitted to the general medicine wards, suggesting that families are needed to make decisions throughout the hospital. When patients cannot make decisions for themselves due to dementia, delirium or other types of cognitive impairment, physicians turn to surrogate decision-makers, most commonly a close family member. In some instances, a surrogate may have been previously designated by the patient who completed a Health Care Power of Attorney form, but in many cases the individual is not fully informed about the patient’s wishes.
Surrogates are asked to make decisions in critical areas including code status, ventilators and other life-prolonging therapies, surgery options, and post-hospital placement. All are vital to the patient’s care and outcome. Th e presence of a surrogate requires fundamental changes in the way clinicians communicate and make decisions for patient, according to the study authors. “Many hospitals treat family members as visitors rather than as members of the patient’s health care team,” Dr. Torke said. “In-depth interviews with surrogates conducted as part of my ongoing research has found that surrogates often have trouble contacting hospital staff and struggle for information about the patient.
Clinicians also reporting on a study from the University of Pennsylvania. frequently report making decisions with surrogates to be highly stressful.” Th e study authors call for redesign of hospital functions to account for the large and growing role of surrogates and to provide support for surrogates as they make health care decisions. Source: “Scope and Outcomes of Surrogate Decision-Making Among Hospitalized Older Adults” was published in the March 2014 issue of JAMA Internal Medicine. Th e study was supported, in part, by the National Institute on Aging and by the John A. Hartford Foundation.
Emily-Jane refuses her brother’s offer to pay for care for their mother, who is severely affected by a stroke. Growing up, Emily-Jane never felt she had enough of her mother’s attention, and now she neglects her own career and friendships to spend most of her time with Mom. Though exhausted, she says that at last her mother needs her. And yet, when her brother makes one of his infrequent visits, Emily-Jane feels he is still Mom’s “Golden Boy.”
As parents grow older, experience health crises and require more help from adult children, having siblings to share the caregiver load makes things easier. Right? If you weren’t quick to nod your head in agreement, you might be one of the many family caregivers who find themselves dealing with the “old business” and long-standing sibling dynamics that can re-emerge during this time.
Journalist and speaker Francine Russo refers to this stage as the “twilight of the family” in her book, They’re Your Parents Too: How Siblings Can Survive Their Parents’ Aging Without Driving Each Other Crazy. Russo’s book examines an often overlooked stress point in family caregiving: friction between adult siblings. Not only can conflict get in the way of providing the best possible care for our senior loved ones, but it can also have long-term impact on relationships within the extended family. Russo says that the aging of parents is part of a “new developmental stage of a family. “She says that the way siblings navigate this period together helps determine how they will continue to interact—or even if they will.
Russo, who covered the aging and baby boomer beat for Time magazine and now serves as a speaker on eldercare issues, offers many real-life examples of siblings negotiating this task. The book offers valuable advice for handling common eldercare events, such as the gradual decline or sudden health crisis of a parent; dementia; legal and financial problems; end-of-life planning; funeral arrangements; and estate issues.
The book shows how this challenge can draw families together—but can sometimes also bring out the worst in sibling relations. Brothers, sisters and parents who might have rarely communicated over the years are thrust back together, examining their family dynamics under the microscope of sudden proximity. Caregivers now in middle age are confronted with thoughts of their own mortality. Guilt, grief and unexpressed anger may add to the emotional minefield that can explode a family discussion in no time.
Disagreements are common Here are a few of the thornier—and most common—situations Russo describes:
• When there is an imbalance of care: a sibling who will not help, a sibling who prevents others from having a say. • When a sibling from out of town “swoops in” and criticizes the caregiving of another adult child who lives near Mom and Dad and provides the lion’s share of care.
• When siblings disagree about how much care elderly parents need, and how much independence is safe.
• When there are disagreements about endof-life care, especially when a parent has not shared his wishes on the matter. Russo offers suggestions for successfully navigating this group effort:
• Understand that much of the conflict siblings are experiencing actually arises from “old business” and established sibling dynamics.
• Learn all you can about aging, elder care, dementia and other relevant issues. What’s normal and what’s not? What can family expect? What resources are available?
• Bring in outside help. A geriatric care manager, elder care attorney or therapist can serve as mediator when siblings are contentious or come to an impasse.
• Look at this time in the family’s life as laying the groundwork for future relationships between siblings and grandchildren.
Russo points out that our “task” through childhood and adolescence is to separate from our parents and birth family to become autonomous individuals. But most of us will freely admit that there were gaps in the process. Our parents’ old age, the time when we parent our parents, can be a time of completing our sense of adulthood, and a time of healing.
Source: Informed Eldercare Decisions in association with IlluminAge.