WHEN IT’S TIME TO SEE A GERIATRICIAN

If you’re in your 60s or 70s, you may have wondered if you should start seeing a geriatrician instead of, or in addition to, your primary care provider. These are family doctors or internists with special training in the health needs of older adults. About 30 percent of people over age 65 need one, according to the American Geriatrics Society.

But you might not need to book an appointment at the same time you sign up for Medicare. “Geriatricians specialize in the care of people with multiple chronic medical conditions that cause challenges with their day-to-day physical and mental functioning,” explains Michael Steinman, a geriatrician at the University of California San Francisco. And so the reason for using this specialist is not determined by just age. “A 65-year-old with high blood pressure, high cholesterol and type 2 diabetes may benefit, but an 80-year-old who walks five miles a day and is only on one or two medications doesn’t need one.”

Usually, you see a geriatrician  for an initial consult, with follow-up as needed, says Mary Tinetti, M.D., chief of geriatrics at the Yale University School of Medicine. Most geriatricians work in centers and have a team-based approach; for example, besides meeting with the doctor, you’ll see a social worker, hearing specialist, nutritionist, and even physical or occupational therapists in the same visit. You’ll still see your primary care physician for day-to-day matters, like blood pressure checks or visits when you’re sick. If there isn’t a geriatrician near you and it’s hard for you to travel, Tinetti suggests seeing if a geriatric center will do a telemedicine consult. (You can check the American Geriatrics Society’s online locator serviceto find out if any of the nation’s 7,000 certified geriatricians practice near you.)

Reearch shows that it’s best to make an appointment sooner rather than later. Adults who see a geriatrician are less likely to end up in the hospital, possibly because these physicians are more likely to be on the lookout for warning signs such as frailty and appetite loss, and also are more likely to avoid prescribing potentially risky medications.

Here are four signs that you may need a geriatrician.

  • You’re on multiple medications. More than a third of adults over age 62 are taking at least five prescription drugs. Over 60 percent use some type of herbal or dietary supplement. But the more meds you’re on, the more likely you are to experience side effects, have cognitive problems or even end up in the hospital. “The older you get, the harder it is to metabolize and clear medicines from your body,” says Steinman. “And the more drugs you’re on, the more likely you are to experience drug-drug interaction.” A geriatrician can review all your meds and determine which ones you really need and which you can shelve.
  • You’re having trouble with your memory. Almost 60 percent of people over age 65 with probable dementia are undiagnosed or unaware that they have it, according to a Johns Hopkins University School of Medicine study published last year in the Journal of General Internal Medicine. A geriatrician can screen you for mild cognitive impairment (MCI), which is a precursor to dementia, as well as for depression, which can be more subtle in older adults, says Veronica Rivera, a geriatrician at the Icahn School of Medicine at Mount Sinai in New York City.
  • You’re less mobile. If you don’t feel as steady on your feet as you used to or are having trouble getting around, it’s a good idea to see a geriatrician who can assess your balance and gait, says Tinetti. (Falls are the leading cause of injuries and death from injuries among adults over age 65, according to the Centers for Disease Control and Prevention). A geriatrician can also give you balance-strengthening exercises to do at home and/or prescribe a course of physical therapy, as well as send a physical therapist or occupational therapist to your home to do a fall-risk assessment. All these steps can help keep you independent — and in your home — longer.
  • You’re hospitalized. Research shows that older adults who get care from a geriatrician in the hospital do better once they’re discharged. People over age 65 who got a geriatric consult while hospitalized for a traumatic injury such as a broken rib, head injury or fracture were able to resume about two-thirds more of their daily activities (like shopping, walking across a room, managing finances and self-care) than those who didn’t, according to a University of Michigan study published in JAMA Surgery. 

Written by: Hallie Levine, AARP

Source: agegracefullyamerica.com

Caregiving Language – Use It to Uplift and Embrace

Caregiving Language - Use It to Uplift and EmbraceIf you are caring for someone who is living with Alzheimer’s disease, maybe you can relate to this experience:

“Are you with me or not?” my father asked sternly.

“Yes, I’m with you!” I replied without hesitation.

Alzheimer’s disease had progressed between the mid- to late-stage of the disease for my father.

I scanned his face and the area for clues. None. I had no idea what he was talking about.

He looked annoyed at me – at my inaction. “We have to get going, now!”

“How about you take the lead? I’ll be right beside you.”

He walked to the front door. We stood there and waited.

It turned out, we were waiting for the train from California to England to fight with our “fellow countrymen.” My father’s never been to England. His fellow countrymen are Armenian, not English. And, of course, no train travels from California across the ocean, but none of that was important.

Even when someone is making so little sense, how you respond as a caregiver matters to your relationship with them. Even when a person with dementia can express himself, we might still be left asking ourselves, “What is he talking about?” You can’t be a mind reader, and you don’t have to be. Choose your words carefully with kindness to help this person feel secure and safe in your company.

The Negative Nature of Our Language

The words we choose impact how secure we help our care recipients feel. Oftentimes, we don’t realize how our language affects others.

After initial mishaps, I learned to align with my father’s requests.

When he says he wants to drive somewhere, I hand him the keys. Like the improvisational artist, I try keep the scene moving, having no idea what to expect. The fact is, he cannot legally drive anymore.

After he moved to California from his Wisconsin home of 45 years, I knew the new setting would be disorienting and he no longer had a car to drive. With some confidence I’d reply, “You had the car last. I don’t know where you parked it.” My strategy was to go along with him, not argue or correct.

He’d take the car keys and walk rapidly, pause, look at the car keys – two postal box keys, two house keys and a car key fob. Confusing to a man who was used to plain similarly sized keys. Distracted by something else, he set the keys down. Each time, I thought, Phew, that was a close call!

Ask yourself, “Do my words push people away or do they bring them closer?”

Our goal is to give verbal hugs with language that embraces. I aligned with my father’s request to drive and even handed him a set of keys. We want to uplift those we care for with our remarks.

It’s quite a challenge, because the English language limits our choices.

We speak mainly in either-or, black or white and yes or no. There are few words to describe the greys, the in-betweens and the maybes. Furthermore, our use of language tends to skew negative.

For example, consider one deflating yet all-too-frequent response to a compliment. A server, receptionist or a customer-care employee, may reply, “No problem.” After I uplift a person with words of praise, hearing “no problem” is deflating. I wonder, when did this become a “problem?”

It might feel more uplifting to reply with, “You’re welcome” or “My pleasure.” These words can feel more like an embrace.

Consider practicing these three tips to embrace and uplift with your words.

Language-Use Tips

Say what is.

Instead of saying what we don’t want or what isn’t –

“What did you think of that?”

“Not bad!”

“What would you like to eat?”

“Not ham!”

Practice using words to express what we want.

“I’m really in the mood for a small piece of roast beef. That would really hit the spot, right now.”

We spend so much time on the exception or what we don’t want, we can lose sight of the plentiful buffet of options before us.

Keep things positive with encouragement such as, “I’m in the mood for…” and keep a conversation going rather than shutting it down with a negative. Reread the italicized replies, above and take note of how you feel.

In general, this negative slant in our language-use, may be one reason our goals are elusive. When we focus on excluding or what we don’t want, that’s what we often get. When our attention and efforts are aimed toward what we want in life, we’ll have a better chance of achieving it.

Habits are hard to change. When we muster the courage each day and commit to apply these skills, we’ll have a better chance of success in day-to-day care of our loved one. Adding an improvisational tool will help, too.

Improv
The goal with improvisation is to keep the scene moving. The primary way to accomplish this is to respond affirmatively. Improvisational artists will say, “Yes.” They’ll also add “and” followed by a new piece of information.

While presenting a keynote recently, I briefed a volunteer and then asked her, “May I have $5.00?” She replied, “Yes.” As she reached into her pocket, she asked, “And may I have a $20?”

The audience laughed. She kept the scene moving, instead of refusing with “No” or “I don’t have a “five.”

Practice responding in such a way that you align yourself with your care recipient’s interests. Instead of shutting down communications and creating feelings of insecurity, you’ll strengthen your relationship and find space to add a touch of humor.

Add Humor
When the conversation is flowing, it frees-up creative energy. In the example above, the attendee’s response was a win-win. I got what I wanted and her clever response got her even more. Plus, we entertained the audience.

Interactions that include laughter (even smiles) bring people closer and strengthen feelings of security.

Are You with Me?

As my father and I stood at the door waiting for a train that would never come in our lifetimes, I remained clueless. I had no idea what he had in mind. Without challenging his resolve, I asked tangential questions.

“Do you think the train will take us from California to England?”

He looked at me quizzically.

“I mean, will we need to board another train?”

Trying to assess my sincerity, he replied, “We’ll be traveling through the night, making many stops to pick up others.”

Oh my! This is going to be a challenge. What the heck is he talking about? I tried another approach.

“Since we’ll need our strength, shall we eat, first? I’ll check the schedule to make sure we don’t miss the train.”

“Sure, let’s eat. Let’s make sure we don’t miss the train.”

After all that, I learned we were in the midst of WWIIHe had been paging through an issue of LIFE magazine.

In my personal experience as a caregiver, I have found that using these strategies results in uplifting and embracing communications and improving our relationships.

Source: Homewatch Care Givers – By Brenda, Avadian, MA, The Caregiver’s Voice

How to Discuss Unsafe Driving with a Senior

In the 29 years that I handled personal injury lawsuits, most of them were car accidents. I represented injured people hundreds of times. In cases where a victim had been hit by an older driver who should never have been behind the wheel in the first place, I always wondered why no one had addressed their unsafe driving and taken their car keys away. Surely their adult children, spouse or friends must have realized that it was only a matter of time before someone got hurt.

According to researchers at the University of Colorado School of Medicine, elders, their doctors and their family members tend to avoid the dreaded driving discussion until certain signs like straddling lanes, excessive nervousness, and sudden, unnecessary stops or accelerations start to appear. Unless physicians inquire about driving specifically (many don’t) or seniors self-report issues they’re having (a rarity), then family members must be the ones to spearhead this effort.

If you’ve noticed that an aging loved one just isn’t safe behind the wheel anymore, I strongly encourage you to intervene. Most seniors who are losing their ability to drive safely either don’t recognize it or refuse to face the thought of giving up their independence, mobility and control. Losing the ability to drive a car is a lifechanging event, as it is very difficult to maintain one’s own care at home without transportation.

Denial is a very common reaction to the early warning signs that an elder is becoming a dangerous driver. This can occur both among seniors themselves, who really don’t want to have this privilege taken from them, and their adult children, who must then find Mom and Dad alternate forms of transportation.

If you are noticing warning signs that an aging loved one is no longer a safe or reliable driver, don’t hesitate. Try these tips to handle this emotionally charged and difficult issue.

  1. Tips for Discussing Driving with a Senior
    Approach the subject respectfully and at the best time of day for your loved one. Ask if it’s a good time to sit down and talk about something that’s been on your mind lately.
  2. Bring up the issue of driving while you express care and concern for how difficult it must be to even talk about it. If your loved one resists the subject, gently insist that it must be addressed.
  3. Promise that you will do what you can to help improve their driving and keep them mobile.
  4. Encourage them to see a doctor to check for any physical and/or mental health issues that may be interfering with their ability to drive safely. In some cases, minor interventions, such as a change in medication or a new glasses prescription, may be able to improve a senior’s functional abilities enough to help them regain some of their driving skills. If you can, accompany your loved one to the doctor to ensure this issue is addressed.
  5. If the doctor determines that your loved one is no longer safe behind the wheel, present a strong, united front with them on the issue of giving up the car keys. Be gentle yet firm and focus on the importance of keeping your loved one and other members of the community safe.
  6. Research alternative forms of transportation in your loved one’s community. Options may be limited in smaller towns and rural areas, but family members, friends, neighbors or church members may be willing to help provide a lift here and there. Local transit resources, public transportation and ride-sharing services are excellent alternatives for seniors who are still capable of planning outings, sticking to a schedule and navigating their community. Be careful about promising to personally provide all rides on the condition that they agree to stop driving, though. Errands, doctor’s appointments and outings can add up to become a huge commitment both time-wise and financially.
  7. Try to present transportation alternatives in an encouraging way that allows your loved one to maintain as much autonomy as possible. Work with them to find different options that can help them maintain their schedule and lifestyle as much as possible.

Driving cessation is always a contentious topic, but the earlier it is addressed, the better. Do your best to approach your loved one with understanding, but don’t be afraid to stand your ground. Acting on this concern after an accident occurs is akin to applying sunscreen after one has already gotten sunburned—it might minimize the risk for future injury, but the damage has already been done.

Source: AgingCare.com, Carolyn Rosenblat