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The Changing Face of Retirement

Retirement from the job doesn’t mean retirement from living. Filling the retirement years meaningfully is one of the most important factors in a sense of having lived a great life.

What is your image of a retired person? Many who have not yet reached that age think of stereotypes: the former executive in a rocking chair with his newly issued gold watch…the couple zipping down the highway in their RV with a “We’re Spending Our Children’s Inheritance” bumper sticker…the widow who sits at home waiting for the grandchildren to visit….

The reality is, there are as many styles of retirement as there are retirees—and the million-plus Baby Boomers who turn 65 each year are reshaping retirement even more.

Most people look forward to retirement as a time of well-earned leisure and relaxation. Many have planned a financial strategy, including contingency plans for some of the negative things that might happen—a downturn in health, a loved one who requires caregiving, loss of a spouse, a change in the economy.

But research suggests that one aspect of retirement that most of us look forward to can also hold some negative effects. It’s a sure bet that some rest and relaxation are on your retirement “to do” list…but many retirees are surprised to find out that leaving work creates a “vocation gap” in our later years.

Many seniors are continuing to work for economic reasons. But it’s not just about the money. Ending one’s working years can carry a surprising number of pitfalls relating to a loss of what we might call “a sense of vocation.” “Vocation” doesn’t just mean one’s work; it refers to all the things that give us a sense of purpose. Did you know that gerontologists predict that one of the greatest health challenges baby boomers will face is depression? Sometimes there is a physical cause behind the sense of sadness and lethargy…but in many cases, depression is triggered by boredom and a loss of purposefulness. Here are some facts about the emotional aspects of retirement to think about as you plan for your retirement years:

Retirement is one of the big “life-changing events,” right up there with marriage, your first job, becoming a parent or the death of a loved one. People adjust to change in their own way—and even “change for the better” can be stressful.

Retirement can mean a loss of social context. Even if your co-workers drove you crazy sometimes…or if you didn’t socialize much at the office…or if your workplace relationships stayed firmly in the workplace…your job still probably included a lot of contact with other people. Even the self-employed generally have frequent contact with customers or clients. Removing that social context can leave a sudden gap.

Confidence and self-esteem often stem from work accomplishments. What’s the first thing people ask when they meet someone new at a party? Often as not, it’s “What do you do? Who do you work for?” Most adults consider their jobs to be an integral part of their identity, so finding an updated answer to that party question can be an important “task” of our later years.

Some retirees experience a sense of purposelessness. When you retire, the good news is that you are far more in charge of your own time…the bad news is, you have to provide all the structure yourself! Over the years, many of us become so wrapped up in our work that we neglect to cultivate outside interests. Work can be all-consuming, the main focus of our entire adult lives. Some retirees report feeling useless, as if “there’s nothing to wake up for in the morning.”

Retirement can mean a big change in family relationships. You’ve probably heard the old jokes about the wife who suddenly has to cope with the retired husband being underfoot all day. Nowadays, of course, it is just as likely to be the opposite. Then throw into the mix elderly parents and in-laws, adult children and grandchildren…whatever the dynamic of a family, retirement means a disruption of established patterns.

Retirement is a risk factor for inactivity. Research shows that physical activity is the most important contributor to healthy aging. For some people, retirement means more time to be active…but others find themselves evolving into couch potatoes. And depression is a real danger when we cut back on physical—and mental—activity.

Cultivating a Sense of Purpose Throughout Life

Researchers suggest several steps for transitioning into the retirement years active, engaged, and ready to make the most of what for many of us turns out to be a full third of our lives. And no matter how long you’ve been away from the workplace, it’s never too late to give your retirement ideas a “makeover”!

  1. Plan ahead. You know the importance of having a financial and healthcare plan in place. Add to that a strategy for enhancing your life with meaningful activities. Check out pre-retirement planning courses through your local senior center. Find out if your employer offers retirement planning counseling.
  2. On the other hand, allow for flexibility. Should you stay in the home or move to a retirement community? Move to a different area, perhaps to be near children, or for recreational opportunities? There are plenty of choices to be made—but in most cases, you don’t need to make them right away.
  3. Consider retiring in stages. More and more baby boomers are finding that leaving their jobs altogether might not be the best strategy. Many boomers are cutting back their work hours gradually. Others move into consulting work, or even begin an entirely new career path. Still others take lower-key part-time jobs. The fact is, financial realities and increased life expectancy make working beyond 65 a necessity for many…and many others simply do not choose to leave the workforce.
  4. Give from the heart by volunteering! Paid employment isn’t the only rewarding work. For many seniors, retirement allows the opportunity for giving back to the community. Consider working for an important cause, serving as a mentor, enjoying unpaid work for cultural institutions, or helping in a wide variety of volunteer agencies. What a great way to make new social contacts!
  5. Learn new skills, take up new hobbies. Many retirees report that they have “reinvented” themselves after leaving their career of many years. Retirement offers the luxury of time—at last you can pay more attention to those things that have always seemed interesting. Write a novel or your memoirs, learn a language, join a gym, take a class—the opportunities are limitless. Lifelong learning need not be expensive: check out community colleges, senior centers and other programs to find learning opportunities that are meaningful to you.
  6. Work out a schedule. After those first few weeks of sleeping late and lounging around the house, many retirees find that it is easy to lapse into inactivity. Plan to apply some of the same kind of discipline to your days that you always have. Working out a routine is a great way to avoid the pitfall of depression.
  7. Increase rather than decrease your level of physical activity. Exercise is one of the key factors to successful aging—so banish the thought of setting up residence in that lounge chair! One of the best uses of your increased leisure time is to up your exercise level, which can help control or prevent many physical and emotional conditions that become more common with aging. This is a great time to try those sports and activities you never could quite make time for.
  8. Build new relationships. Another key component to quality of life as we age is being involved in activities and relationships with others. Retirement provides more time to spend in activities with family and old friends…but it’s also a great time to expand our social network by forming new connections. Yet another reason to add new activities and interests!

Yes, it has almost become a cliché that “turning 65 is not an ending but a beginning.” Retirement from the job doesn’t mean retirement from living. Instead, once we are handed the precious gift of more control of our time, to fill those hours meaningfully is one of the most important factors in a sense of having lived a great life.

Copyright © AgeWise, 2014

 

What Seniors Should Know About Age-Related Macular Degeneration

Many eye diseases are treatable if diagnosed early enough. But often the damage from eye disease happens slowly, so a person doesn’t notice a loss of vision until it is too late. Vision loss can lead to depression, inactivity and overall decline in seniors.

The top cause of impaired eyesight in older adults is age-related macular degeneration. With the aging of our population, protecting against this vision-destroying condition is vital to keeping our senior population as independent and healthy as possible.

What is age-related macular degeneration?

Age-related macular degeneration (AMD) is the deterioration of the center area of the retina of the eye. The retina is the layer of tissue at the back of the eye that “sees”—that is, transmits images to the brain through the optic nerve. The center area of the retina, called the macula, is responsible for the sharp central vision we use for reading, driving, working a puzzle, sewing and so many other tasks.

There are two forms of macular degeneration:

Dry AMD occurs when the tissue of the retina thins and deteriorates. The light-sensitive cells break down, and central vision gradually becomes blurred. Dry AMD is associated with the appearance of drusen, small yellow deposits under the retina.

Wet AMD, also called neovascular AMD, is caused by abnormal blood vessels growing under the retina. These new vessels are very delicate, and begin to leak blood and fluid behind the retina. This damage can occur quickly.

What causes AMD?

The causes of AMD are not entirely understood. But we know that the thinning of the macula and the development of abnormal blood vessels behind the retina are in part the result of wear and tear on our body systems. Indeed, age is the top risk factor for developing AMD. Other risk factors include a family history of the disease, race (Caucasians are at highest risk), smoking, and medical conditions such as obesity, high blood pressure, high cholesterol and certain immune disorders.

How is AMD diagnosed?

In the earliest stages of the disease, the patient may not notice anything is amiss. Dr. Ahn-Danh Pham of the Indiana University School of Medicine says that all adults should be alert for any subtle changes in their vision. Dr. Pham, a retinal specialist, says, “As with most age-related vision problems, many people are unaware of slight vision losses and don’t realize that their vision has been compromised until it is too late.”

The signs of dry AMD include blurred vision, a blank spot in your visual field, and trouble reading or recognizing faces. You might notice that you need a brighter light for reading or that night driving is more of a challenge.

Wet AMD comes on more suddenly. The most common symptom is distorted vision. Straight lines appear crooked, and dark gray or blank spots may appear in your vision. This is because the blood and fluid leaking from the abnormal blood vessels push the macula out of position.

If you notice any of these signs, alert your eye care professional right away. He or she will dilate your eyes with special drops that open the pupil so the back of the eye can be seen. The doctor will look for drusen, the small yellow deposits over the back of the retina that are associated with dry AMD. Other tests allow the doctor to see the abnormal blood vessels of wet AMD.

In the early stage of the disease, our brains do a pretty good job of “working around” subtle vision loss. Especially if AMD is only present in one eye, the other eye will compensate. So routine dilated eye exams are important, to allow the doctor to detect AMD even before the patient notices any symptoms.

Can AMD be cured or treated?

Treatment for wet AMD consists of laser surgery; slowing or stopping the leaking of blood vessels by means of injections; or photodynamic therapy, a procedure that uses a combination of light and drugs. The National Eye Institute says that these treatments can help slow down vision loss and in some cases improve sight. But none of these treatments are a cure for the disease, and vision loss may continue despite treatment.

There is no treatment to reverse dry AMD. The goal, instead, is to prevent the condition from progressing to a more advanced stage. Certain lifestyle changes may prevent or delay further vision loss. These include having an annual eye exam, managing high blood pressure and cholesterol, exercising regularly, and avoiding smoking and second-hand smoke.

Nutrition is especially important. According to Prevent Blindness America, a wide variety of foods, including lentils, grapes, carrots, bell peppers, broccoli, spinach, sweet potatoes, kale, certain kinds of fish, turkey and some kinds of nuts, have been shown to aid eye health. Foods that contain refined starches and are high in sugar can be damaging to vision.

What about vitamins?

The National Eye Institute has conducted a series of important studies on the effect of nutrition on AMD. Certain nutrients were found to be protective against the development and progression of AMD, including vitamins A, C and E and zinc. The Institute continues to refine this research. It is a challenge to get the levels of these nutrients from diet alone. Ask your eye doctor whether you should take supplements containing these nutrients. (Be sure to tell your other healthcare providers that you are taking these vitamins; if you are already taking a multivitamin, the formula may need to be changed to avoid a higher-than-recommended dose of certain vitamins.)

Living with AMD

People with age-related macular degeneration can make the most of their remaining vision with special training and technologies. Ask for a referral to a low-vision specialist for instruction on how to compensate for the vision that is lost. Many community organizations and agencies offer information and services such as:

  • Training on new ways of doing things
  • Low-vision adaptive devices such as hand or stand magnifiers, magnifying spectacles, video magnifiers, screen readers, and special computer programs and equipment
  • Large-print books or audiobooks
  • Home modifications, including improved lighting
  • Alternate transportation when it is unsafe to drive
  • Support groups where people with low vision can exchange ideas and share experiences
  • Information about new research on treatments and vision-enhancement devices

The National Eye Institute also reminds seniors: “If you have lost some sight from AMD, don’t be afraid to use your eyes for reading, watching TV and other routine activities. Normal use of your eyes will not cause further damage to your vision.”

For More Information

The National Eye Institute offers consumer information [link to: http://www.nei.nih.gov/health/maculardegen/index.asp] about AMD and living with low vision.

Visit the Eye Care America [link to: http://www.geteyesmart.org/eyesmart/diseases/amd.cfm] website, sponsored by the American Academy of Ophthalmology, which offers consumer information [link to: http://www.geteyesmart.org/eyesmart], free eye exams and ideas for living successfully with vision loss [link to: http://www.geteyesmart.org/eyesmart/diseases/upload/SmartSight_handout.pdf ].

The information in this article is not intended to replace the advice of your doctor. Talk to your eye healthcare provider if you have questions about vision care, the AREDS formula vitamins or other eye care issues.

Copyright © AgeWise, 2014

When People With Alzheimer’s Disease Wander

Wandering is one of the greatest challenges faced by family caregivers whose loved one has Alzheimer’s or other memory loss. Over 60 percent of Alzheimer’s patients will become lost at some time. Most are gone only briefly, though long enough to frighten their loved ones.

Others may be lost for an extended period of time, and unfortunately, there are news reports each year of missing Alzheimer’s patients who are never located. It is a sobering fact that if a person with dementia is lost for over 24 hours, he or she is likely to suffer a fall or other serious injury, or even death from injury or exposure. Reports one family caregiver, “The thought that Dad would climb onto a bus at the corner and we would never find him again keeps me awake at night, even on nights when he is getting a good night’s sleep.”

Why do people with dementia wander?

For people with Alzheimer’s or other memory loss, confusion and disorientation make it increasingly difficult to recognize familiar faces and places, even a spouse or child, or a lifetime home. Geriatricians point out that the term “wandering” is something of a misnomer, because many times, in the person’s mind, his or her activity is not purposeless. She may be looking for the bathroom but be unable to find it. He may think it is time to leave for work, even if he retired years before. A great-grandmother might be searching for her children, in the belief that they are still small and in need of her care.

Other factors that contribute to wandering include restlessness, agitation and stress; boredom and lack of a sense of purpose; sleep disorders; physical pain; and the side effects of medications.

Keeping loved ones safe

When a loved one with dementia wanders, family often decide that a nursing home or other residential memory care is the best choice for the person. However, many patients fare much better at home, in familiar surroundings. How can families keep their loved one safe at home, for as long as possible? Here are some strategies recommended by professionals:

Observe your loved one’s patterns. The first step is to understand as best you can the reason for your loved one’s wandering. What are his “triggers”? Where does he usually try to go? During what time of day is he most restless? Does he seem to be looking for something, someone, or someplace?

Adapt the home to keep your loved one safe. Beyond the usual “aging in place” home modifications, you can add special locks to doors, safety gates to prevent exit, and an alarm that will sound if the front door is open. See the resources at the end of this article for information about other home modifications.

Be sure your loved one always carries ID, and a medical alert to tell others he has memory loss. If he doesn’t consistently carry a wallet, try a bracelet, pendant, or clothing labels. Contact your local Alzheimer’s Association office to learn about their Safe Return program. In addition, more and more families are also using a GPS or other tracking device to help locate loved ones quickly.

Notify neighbors and local merchants about your loved one’s condition. Ask them to contact you if they see your loved one alone when he shouldn’t be. Having this conversation with you makes it more likely that others will recognize the problem and feel comfortable getting involved.

Find out if your state has a “Silver Alert” program, similar to the “Amber Alert” for missing children. As law enforcement agencies recognize the needs of growing numbers of adults with dementia, more states are implementing this broadcast notification system.

Try “behavior modification” strategies. If your loved one expresses feelings of being lost or abandoned, reassure him he is safe. Redirect him to safe activities that fill his need for a sense of purpose. If “sundowning” (restlessness at night) is a problem, limit daytime naps. Dementia-care professionals have found that “correcting” a dementia patient frequently can increase agitation. “Don’t correct—redirect” is their guideline.

Have your loved one’s medications reviewed. A person with Alzheimer’s may take medications for the disease itself, for mood or other behavior changes, and for other medical conditions they might have. It is important to take medicines correctly, and it is just as important to be alert for side effects that might increase wandering and other difficult behaviors.

Provide appropriate activities to reduce boredom and isolation. Boredom is stressful for people with dementia, and increases wandering. Art activities, crafts, household tasks, singing, cooking simple foods and socializing all promote well-being and a sense of purpose, which makes it less likely that your loved one will wander.

Take advantage of respite care for family caregivers. Family caregivers need a break to renew their energy and take care of other responsibilities. Locate resources in your community where your loved one can spend time while you are at work, doing other tasks or just taking a break to recharge your emotional batteries. Many families have discovered the advantages of adult day programs specializing in the needs of people with memory loss, which provide condition-appropriate activities, socialization and supervision for people with Alzheimer’s and related conditions. Some of these organizations even offer after-hours care for participants who wander at night.

For More Information

The Alzheimer’s Association [add link to:  http://www.alz.org/care/alzheimers-dementia-wandering.asp] and the National Institute on Aging [add link to: http://www.nia.nih.gov/alzheimers/publication/home-safety-people-alzheimers-disease/home-safety-behavior-behavior] offer information on creative solutions for managing wandering.

Copyright © AgeWise, 2014

Senate Special Committee on Aging Launches Anti-Fraud Hotline

If you or someone you know suspects they have been the victim of a scam or fraud aimed at seniors, the U.S. Senate Special Committee on Aging has set up a toll-free hotline to help.

The hotline was unveiled in late 2013 to make it easier for senior citizens to report suspected fraud and receive assistance. It is staffed by a team of committee investigators weekdays from 9 a.m. to 5 p.m. EST. The investigators, who have experience with investment scams, identity theft, bogus sweepstakes and lottery schemes, Medicare and Social Security fraud, and a variety of other senior exploitation issues, will directly examine complaints and, if appropriate, refer people to the proper authorities.

Anyone with information about suspected fraud can call the toll-free fraud hotline at 1-855-303-9470, or contact the committee through its website, located at www.aging.senate.gov/fraud-hotline.

As chairman and ranking member of the committee, Sens. Bill Nelson (D-FL) and Susan Collins (R-ME) have made consumer protection and fraud prevention a primary focus of the committee’s work. This year the panel has held hearings examining Jamaican lottery scams, tax-related identity theft, Social Security fraud and payday loans impact on seniors.

“If you’re contacted about an offer that sounds too good to be true, then it probably is,” Nelson said. “This new hotline will give seniors a resource to turn to for assistance if they think they’ve been victimized or have questions about fraudulent activities.”

“Ensuring that seniors are as equipped as possible to avoid becoming victims of fraud and other scams is among our committee’s top priorities,” said Collins. “This new hotline offered by the Senate Special Committee on Aging will help to identify and put a stop to the cruel scams that hurt seniors and their families.”

Source: United States Senate Special Committee on Aging (www.aging.senate.gov)

Living With Heart Failure

February is American Heart Month, here is some background information about living with and managing this condition, which today affects over five million Americans.

Congestive heart failure (CHF) occurs when the heart is weakened and cannot pump enough blood for the body’s needs. This results in a backup of fluid throughout the body. CHF can be caused by previous damage to the heart muscle or valves, by high blood pressure, diabetes or other underlying conditions, or by a combination of causes.

Symptoms of CHF include shortness of breath, swelling of feet, ankles and abdomen, fatigue, coughing and raspy breathing.

MEDICAL TREATMENT FOR CHF

Occasionally CHF can be cured, if the condition is caused by an underlying heart defect that can be corrected with surgery. However, most cases cannot be cured. But medical treatment and lifestyle changes can improve symptoms and prevent further loss of heart function.

Medical treatments include surgery, medications, supplemental oxygen, and careful management of underlying conditions.

Lifestyle choices and following your healthcare provider’s instructions can prevent worsening of your condition. For example, it’s important to avoid smoking, excess cholesterol, obesity, alcohol abuse, inactivity, excess fluid intake and stress.

CHECKLIST FOR MANAGING CONGESTIVE HEART FAILURE

If you or a loved one has CHF, are you doing everything you can to manage the condition? Here is a checklist to guide you:

  • Am I under regular medical care?  
    It’s important that your physician monitor your heart health, medications and lifestyle. Keep all your appointments, and bring along any questions.
  • Do I take my medications as directed?
    Medications for CHF can work only if taken correctly—the right amount, at the right time, and in the right way.
  • Do I restrict my sodium (salt) intake?
    Sodium increases water retention, which puts extra strain on the heart. Your healthcare provider or dietitian can show you how to reduce sodium in your diet.
  • Do I avoid cholesterol and saturated fat?
    Cholesterol and saturated fat contribute to coronary artery disease, a major cause of CHF. Follow your physician’s recommendations for “heart smart” cooking, and read the labels on packaged products.
  • Am I a smoker?
    Tobacco damages the blood vessels and puts extra strain on the heart. If you are a smoker, ask your healthcare provider about smoking cessation programs.
  • Do I drink alcohol?
    Alcoholic beverages can weaken the heart, and may interact negatively with your medications. Ask about help if controlling your alcohol intake is a problem.
  • Do I limit my fluid intake?
    Excess fluid puts strain on the heart. If you’ve been instructed to limit liquids, be sure to keep track of everything you drink.
  • Do I weigh myself every day?
    A sudden increase in weight can be a sign of increased fluid retention. Report a gain of over three pounds in a day, or five pounds in a week. Be sure to weigh yourself at the same time each day.
  • Do I alert my healthcare provider if other symptoms worsen?
    Call your doctor if you experience increased swelling of legs, feet, abdomen; increased shortness of breath; irregular heartbeat (“palpitations”); increased fatigue, dizziness or fainting.
  • Do I get enough—and the right kind of—exercise?
    For most CHF patients, regular exercise can help the heart pump more efficiently—but it’s very important to follow an exercise program that is right for each case. Do not begin an exercise program without consulting your physician.
  • Do I get enough sleep—and make time for resting during the day?
    Rest periods are recommended, to give the heart a chance to work more easily.
  • Am I under a lot of stress?
    Stress and anxiety put strain on the heart. Develop relaxation strategies and eliminate stressful situations from your life.
  • Are my immunizations up to date?
    Flu and pneumonia are especially dangerous for people with CHF. Be sure you are immunized, and avoid persons with communicable diseases.

Lifestyle changes and following the healthcare provider’s instructions can prevent worsening of the condition. But successful management of CHF doesn’t just happen. It requires cooperation between patient and healthcare team. Family members and friends, too, can provide support and encouragement.

FOR MORE INFORMATION…

The American Heart Association (www.heart.org)  is the sponsor of American Heart Month. Their website offers information on heart failure [link to: http://www.heart.org/HEARTORG/Conditions/HeartFailure/Heart-Failure_UCM_002019_SubHomePage.jsp] and other cardiac conditions, including this recent comprehensive article appearing in the journal Circulation [link to:  http://circ.ahajournals.org/content/127/13/e525.full]

The Heart Failure Society of America (www.abouthf.org ) sponsors National Heart Failure Awareness Week, and offers educational materials and tutorials for people living with CHF, as well as for their family caregivers.

Copyright © AgeWise, 2014

Smart Salad Bar Choices

Did you resolve to lose weight in 2014? Polls show that losing weight and eating a more healthy diet top the New Year’s resolution list for many Americans. Many resolve to skip calorie-rich restaurant meals in favor of the salad bar. But you have probably read about the unhealthy pitfalls that lurk among those healthy veggies. Karen Collins, MS, RD, CDN of the American Institute for Cancer Research shares some information that can help you make a wise choice next time you pick up the plate and pick your salad ingredients.

Q: I love using a salad bar at lunch to help me get enough vegetables each day. How can I avoid creating one of those mega-calorie salads that make headlines periodically?

A: Salad bars are a terrific way to make vegetables a large part of meals, as recommended by guidelines from organizations such as the American Institute for Cancer Research. To control calories, be creative and fill most of your plate or take-out container with a wide variety of dark leafy greens (like spinach, romaine or other mixed salad greens) and plain colorful chopped vegetables (including carrots, peppers, cucumbers, mushrooms, tomatoes and more). For a sweet touch, include about a half-cup (a rounded handful) of unsweetened fresh fruit, such as pineapple or berries.

To make a main dish salad, include one of the following (or smaller portions of several): a half-cup of kidney or garbanzo beans; a half-cup turkey, seafood chunks, chopped hardboiled egg or tuna (unless it’s mixed with lots of mayonnaise); or one-third cup (a level handful) of nuts or sunflower or pumpkin seeds. If you want cheese, add about one to two tablespoons for flavor in combination with one of these leaner sources of protein. Otherwise, using just a half-cup of shredded regular cheese adds over 200 calories to your salad. Try Parmesan or feta for plenty of flavor in a small amount.

Finally, be careful with salad dressing portions. A full typical four-tablespoon size ladle of regular dressing probably contains 140 to 320 calories (and 500 to 640 milligrams of sodium). Even reduced-fat dressings add up. A ladle the size of a ping pong ball will give you two tablespoons. If it’s bigger than that, make sure you only fill the ladle part way before dressing your salad. You can extend salad dressing with lemon juice or splashes of vinegar. For even lower calories and sodium, dress your salad with lemon juice or vinegar and a couple teaspoons of plain olive oil (often in a cruet on the salad bar).

Source: The American Institute for Cancer Research (AICR) fosters research on the relationship of nutrition, physical activity and weight management to cancer risk, interprets the scientific literature and educates the public about the results. Its award-winning New American Plate program is presented in brochures, seminars and on its website, www.aicr.org. AICR is a member of the World Cancer Research Fund International.

When a Loved One Is Living with Chronic Illness, Home Care Can Help

Brian worries about his mother, 82, who was recently diagnosed with congestive heart failure. Mom’s condition is complicated by diabetes and osteoporosis. She doesn’t always remember which medications to take, or when to take them. And she says it’s more trouble than it’s worth to prepare a nutritious meal. Mom just doesn’t seem to be taking care of herself these days.Stan, 64, has early-stage Alzheimer’s disease. His wife Rosalyn, 55, wants to enable him to stay home as long as possible, but lately he has been calling her at the office multiple times a day. And last week she came home to find two stove burners on and the refrigerator left open. Her employers are sympathetic, but the phone calls are disruptive to all…and Rosalyn knows her distraction is obvious. “If only I didn’t have to worry about Stan while I’m at the office,” she thinks.

When a loved one has a chronic illness, living independently can be a challenge. Many seniors are dealing with health conditions such as:

  • Diabetes
  • Congestive heart failure or other heart condition
  • Chronic obstructive pulmonary disuse (COPD) or other lung disease
  • Stroke
  • Alzheimer’s disease or a related dementia
  • Visual impairment
  • Chronic kidney disease
  • Arthritis
  • Osteoporosis
  • Parkinson’s disease
  • Hypertension.

In some cases, when a person’s condition is medically complex, moving to a nursing facility or other care facility is the best choice. But most people who are facing health challenges would rather stay in the familiar comfort of their own home. If your loved one is in this situation, home care can help.

Of course, the first step is to ensure that your loved one’s medical needs are met, and that he or she complies with the healthcare provider’s instructions. You might be surprised to learn how many services can be provided right in the home. Depending on a patient’s care needs, registered nurses, nursing aides and home health aides can provide specialized medical services in the home. Home medical equipment and home modifications adapt the home to accommodate health needs. A personal alarm system and other technologies add an extra measure of security.

Less costly in-home companion care also helps many seniors stay at home. These older adults may not need intensive, technical health services, but are still challenged because the activities of daily living have become too difficult. Some of these tasks may have even been declared off limits by the healthcare provider. Patients may now need help with personal care, making meals, keeping up with the house and yard, getting to doctor’s appointments, or remembering to take medications. They may be coping with pain, mobility limitation, incontinence, fatigue or memory problems—and above all, they may feel lonely and isolated while home alone.

Family members and friends often try to provide the support their loved one needs. But many are juggling caregiving with jobs, children and other responsibilities. Caregiver stress sets in as family find their time resources stretched to the limit—and no matter how much they do, they still worry about whether their loved one is safe and well cared for. In addition, many family caregivers today are at the age when they may have care needs of their own!

Home Care Can Help

Home care can be the perfect solution when you can’t always be there to help your loved one. You can arrange for a qualified home caregiver to come every day of the week, or occasionally as needed. Your home care worker can:

  • Help with housekeeping, laundry and other household chores
  • Assist with personal care, such as bathing, grooming, dressing and going to the toilet
  • Prepare meals, including special diets
  • Transport client to the market, doctor’s appointments, and other trips into the community
  • Provide medication reminders
  • Provide companionship and a sense of security
  • Ensure peace of mind for family caregivers
  • Promote dignity and Enable the senior to feel a sense of greater dignity.

For seniors, personal well-being is tied to remaining active, engaged, and as independent as possible. When the home caregiver takes over those tasks that are “just too much,” this allows loved ones to spend their energy on things they truly enjoy—playing a game, going for a walk, attending social events…the kinds of activities that promote an enhanced quality of life.

A professional home caregiver can be a vital part of the care team…the “missing link” to help the senior, family and the health care team best manage health challenges.

Brian came to visit Mom on Sunday. He found a vase of fresh-cut flowers on the table. Mom’s dress was ironed and her hair styled just the way she likes it. And the refrigerator was full of nutritious snacks, just as the doctor recommended. Mom enthusiastically described the activities she and Joy, the new home caregiver, had done during the week. Brian sighed with relief to see Mom so well cared for.

Rosalyn’s two-hour presentation to clients at the meeting this morning went great! Afterwards, she realized that she had been totally focused on the proposal—secure in the knowledge that Stan was safe and supervised by the trained caregiver the agency provided.

Copyright © AgeWise, 2014

Another Great Reason for Seniors to Quit Smoking

You may have read that people who quit smoking can eventually lower their risk of heart disease and stroke. Previous research suggested that it could take up to 15 years for smokers to reach the same risk level of non-smokers.

But a new study suggests that older people may lower their risk in an even shorter time. At the 2013 American Heart Association Scientific Sessions, researchers from University of Alabama at Birmingham’s School of Medicine shared findings showing that seniors who quit smoking lower their risk of cardiovascular disease-related death to the level of people who have never smoked in a median of eight years. “It’s good news,” said senior researcher Dr. Ali Ahmed. “Now there’s a chance for even less of a waiting period to get a cleaner bill of cardiovascular health.”

The timeline doesn’t look quite as good for other conditions, such as cancer and emphysema. But quitting does begin to lower the risk, right away. “Smoking is the most preventable cause of early death in America,” said Dr. Ahmed. “If you smoke, quit and quit early!”

Smoking not only raises the risk of death. It also lowers quality of life. Smoking raises the risk of Alzheimer’s disease by 157 percent … increases muscle and joint pain in people with arthritis … and raises the risk of age-related macular degeneration, a leading cause of vision loss in older adults.  Virtually all health conditions are worsened by smoking. And if quitting for health isn’t reason enough, think of how much money smokers save when they quit!

Confirming that tobacco use causes one in five deaths annually and is the top cause of preventable death and disability, the U.S. Agency for Healthcare Research and Quality (AHRQ) recently recommended the new www.BeTobaccoFree.gov website, which offers one-stop access to the latest information on tobacco-related topics—including evidence-based methods of quitting. AHRQ’s Dr. Carolyn Clancy shares the START Method:

START the process by:

S = Setting a quit date. Pick a date within the next two weeks. That gives you enough time to get ready, but not so much time that you lose your determination.

T = Telling others about your plan to quit. Quitting is easier to do with support from others. Tell family, friends, and co-workers how they can help you.

A = Anticipating the challenges you will face. Most people who return to smoking do it within the first three months. Be prepared for situations when you will be tempted to smoke, and plan for how you will deal with them.

R = Removing cigarettes from your home, car, and work. Getting rid of things that remind you of smoking will help you get ready to quit. Clean your car, get rid of lighters and ashtrays, and have your teeth cleaned to get rid of smoking stains.

T = Talking to your doctor about getting help to quit. Some people need help to manage the withdrawal from nicotine. Ask your health care provider if a medicine might help you. You can buy some of these medicines on your own, like the nicotine patch or nicotine gum. Others require a prescription.

Studies show that seniors are less likely than younger people to enter a smoking cessation program. But the good news is that when they do, they are more likely to be successful at kicking the habit.

Smoking Cessation Resources and Information

Medicare Part B now covers certain smoking and tobacco use cessation treatment and counseling. Visit the Medicare.gov website [link to: http://www.medicare.gov/coverage/smoking-and-tobacco-use-cessation.html] to learn more.

Visit Smokfree.gov [http://smokefree.gov] for smoking cessation resources and information.

More smoking cessation support is available from the American Heart Association [link to: http://www.heart.org/HEARTORG/GettingHealthy/QuitSmoking/Quit-Smoking_UCM_001085_SubHomePage.jsp], the American Lung Association’s QuitterInYou website [link to: http://www.heart.org/HEARTORG/GettingHealthy/QuitSmoking/Quit-Smoking_UCM_001085_SubHomePage.jsp] and the Centers for Disease Control and Prevention (CDC) [link to: http://www.cdc.gov/tobacco/quit_smoking/how_to_quit/you_can_quit/index.htm].

Copyright © AgeWise, 2013

January is Glaucoma Awareness Month

At his routine eye exam, Alberto was startled when the ophthalmologist told him that he had developed glaucoma. “I didn’t have any symptoms at all!” Alberto said. His doctor prescribed medication to prevent vision loss. Without treatment, Alberto might have experienced a gradual loss of eyesight before he realized anything was happening.

Glaucoma is the leading cause of preventable blindness. According to Prevent Blindness America, glaucoma is a fast-growing health problem in the U.S. Today, over 2.7 million Americans have glaucoma—which represents an increase of 22 percent from only ten years ago! Just as troubling, half of the people who have glaucoma are unaware that they have the sight-robbing condition until they have lost up to 40 percent of their vision. This is why glaucoma is often called “the sneak thief of sight.”

Q: What causes glaucoma?

Your eye is about the size of a golf ball. It is filled with a clear, jelly-like fluid that keeps it round. The eyeball is constantly being filled with new fluid, and the old fluid drains away at the same rate. But if too much fluid is produced or not enough can drain, pressure builds up in the eye. Left untreated, this excess pressure will damage the nerves that let us see. This can result in loss of sight and eventually blindness. Glaucoma sometimes has a known cause, such as an eye injury, cataracts, scar tissue, or the use of certain medications. But in most cases, the cause is unknown.

Certain people are at higher risk of developing glaucoma: those over 60, family members of people with glaucoma, people with diabetes, and people who are very nearsighted. People of Asian, African and Hispanic descent are also at higher risk.

In about 5 percent of cases, glaucoma strikes suddenly, with severe pain and a sudden vision problem. This is called acute or closed-angle glaucoma. But in most cases, pressure builds up gradually, damage progresses slowly, and there is no pain. This is called chronic or open-angle glaucoma.

Q: What are the signs of glaucoma?

Dr. James Tsai of the National Eye Institute says, “Glaucoma often has no early warning signs. Often, a person will not experience any noticeable vision loss in the early stages of glaucoma. But as the disease progresses, a person may notice his or her side vision decreasing. If the disease is left untreated, the field of vision narrows and blindness may result.”

This loss of sight is often so gradual that the person doesn’t notice until central vision is affected. Other subtle symptoms may also be present, such as blurred vision or rainbow-colored rings around lights.

It is important to catch and treat glaucoma early. People over 40 should have their eyes checked every year by an ophthalmologist (a medical doctor trained in the diagnosis and treatment of eye disease). The eye care professional will test the pressure in your eye, look at the inside of your eye with a special instrument, and test your vision to detect any small changes that would suggest glaucoma. The tests for glaucoma are painless.

Note: In the acute type of glaucoma, symptoms are severe and sudden. Permanent loss of vision can occur within hours. The symptoms of acute glaucoma include redness of the eye, severe pain, headaches, nausea, sudden noticeable change in vision, and colored rings (“halos”) around lights. Acute glaucoma is a serious medical emergency. If you have the above symptoms, you should see a health care practitioner immediately.

Q: How is glaucoma treated?

Unfortunately, affected vision cannot be restored. But medical treatment can help prevent further damage. The goal of glaucoma treatment is to reduce the pressure inside the eye. Medication is usually prescribed. Some medications cut down on the amount of fluid the eye produces; others encourage a better flow of fluid out of the eye. Some drugs are taken in eye drop form, others as pills. It is very important to take your medication as directed.

People with the sudden, acute form of glaucoma usually need immediate surgery. And in some of the slower, chronic cases, the doctor eventually recommends surgery if medication fails to control the pressure well enough, or medicines are causing unacceptable side effects, making surgery the better alternative. Glaucoma surgery is relatively safe and painless, usually requiring only a short hospital stay. Today, laser surgery can make the procedure even shorter and easier.

Remember: glaucoma is treatable if detected early enough! So a glaucoma test should be a regular part of your annual physical examination.

Learn more about glaucoma, and spread the word

Prevent Blindness America [link to: http://www.preventblindness.org] provides free resources to educate the public about eye disease, including the Glaucoma Learning Center [link to: http://glaucoma.preventblindness.org].

The National Eye Institute offers consumer information about the diagnosis and treatment of glaucoma [link to: http://www.nei.nih.gov/health/glaucoma], including the Keep Vision in Your Future Glaucoma Toolkit [link to: http://www.nei.nih.gov/nehep/programs/glaucoma/toolkit.asp].

The Glaucoma Research Foundation [add link to: http://www.glaucoma.org] provides information about the latest research and treatment options.

Visit the website of the American Academy of Ophthalmology for consumer information about glaucoma [add link to: http://www.geteyesmart.org/eyesmart/diseases/glaucoma/index.cfm]

Copyright © AgeWise, 2013

 

Geriatric Care Managers Speak Out About “Observation Status”

A report released recently by the U.S. Department of Health and Human Services Inspector General (OIG), along with a survey of aging experts by the National Association of Professional Geriatric Care Managers (NAPGCM), demonstrated the need to better protect seniors’ access to nursing home care. The NAPGCM survey found that senior citizens are increasingly being denied needed rehabilitation care and socked with unexpected medical bills as the result of a growing trend of labeling Medicare hospital stays as “observation” visits. The survey of 315 geriatric care managers from around the nation was fielded July 12-16, 2013. Among the survey’s key findings:

  • Over 80% of the geriatric care managers surveyed said that inappropriate hospital observation status determinations by Medicare are a significant problem facing seniors in their community. Additionally, 75% of those responding said that the problem is increasing in their community.
  • Over 81% of the care managers polled identified failure to receive needed rehabilitation or other services as a major problem stemming from unfair observation status rulings. Additionally, 79% of those surveyed indicated that the rulings lead to financial hardship on seniors and their families and 75% cited emotional stress as a significant negative impact of the rulings.
  • 70% of the geriatric care managers responding said that contacting a hospital physician was the most helpful action step that can be taken to resolve problems associated with inappropriately being classified as in “observation status.”

“Seniors are being unfairly charged thousands of dollars and denied needed rehabilitation services,” said Jullie Gray, NAPGCM President. “Care managers are having some success in helping seniors avoid this Medicare trap, but the law needs to be changed,” she added.

The OIG report found that 1.5 million Medicare hospital stays in 2012 were classified as observation visits. A key issue is that classification as an observation visit may make a senior ineligible for Medicare coverage of often- needed rehabilitation following a stay at a hospital. Current Medicare law requires a patient to be in the hospital, classified as an inpatient, for three days in order to have Medicare cover the costs of rehabilitation in a skilled nursing facility. The new OIG report found that over 600,000 Medicare beneficiaries had hospital stays that lasted three nights or more but did not qualify them for SNF services.

In response to the NAPGCM survey, a certified geriatric care manager, Mary Ann Wonn of Boston, cited the example of a 76-year-old woman who went to the emergency room when she experienced sudden pain in her leg and was not able to put weight on it. The woman was diagnosed with a blood clot in her leg and stayed in the hospital for five days, receiving medications for the clot and pain. After five days she was stable but still unable to walk and could not safely go home. So she was sent to a rehabilitation facility for further rehabilitation.

The woman’s family said there was nothing about her hospitalization that flagged her status as anything but that of an inpatient. However, at the time of hospital discharge, they found out that their mother was classified as under observation status. As a result, Medicare would pay nothing for her rehabilitation stay in a skilled nursing facility. Ms. Wonn, who was hired by the family at this point, encouraged them to follow up regarding the observation status determination, but they did not want to pursue it as they were too emotionally drained. “It was very unfortunate that this took place – if I had been involved while she was in the hospital, I would have advocated for her to be admitted as an inpatient,” said Ms. Wonn.

Legislation aimed at fixing the problem has gained bipartisan support in the U.S. House and Senate. The “Improving Access to Medicare Coverage Act” ( H.R. 1179/S.569) would allow “observation stays” to be counted toward the three day mandatory inpatient hospital stay for Medicare coverage of skilled nursing facility services. NAPGCM has signaled its support for this legislation and is participating in a coalition advocating its passage.

Source: The National Association of Professional Geriatric Care Managers (NAPGCM). The NAPGCM was formed in 1985 to advance dignified care for older adults and their families. Geriatric Care Managers are professionals who have extensive training and experience working with older people, people with disabilities and families who need assistance with caregiving issues.  For more information or to access a nationwide directory of professional geriatric care managers, please visit www.caremanager.org.