Senior Wellness

Seniors Can Choose Wisely

I learned something valuable working in the hospice field for many years – not all medical tests are necessary. I’ve come to ask my doctor, “If you perform this test, will it change the plan of care?” “Do the health risks outweigh the benefits of the test or treatment?”

“7 Medical Procedures You Don’t Need,” is an article in the May 2012 AARP Bulletin (www.aarp.org) about unnecessary medical procedures and tests that have been identified by physicians as part of the American Board of Internal Medicine (ABIM) (www.abim.org) Foundation’s Choosing Wisely campaign. They are:

EKGs and stress tests for healthy people without symptoms.
Bone density scans for osteoporosis for women under 65 and men under 70 with no risk factors.
Antibiotics for mild to moderate sinus infections.
NSAID painkillers for people with high blood pressure, heart failure and any chronic kidney disease.
CT scans and other imaging for uncomplicated headaches.
Dubious diagnostic tests for suspected allergies.
X-ray, CT scan or MRI for low back pain.

If more seniors and their families asked similar questions to those posed above, they might have lower healthcare costs, and be less at risk of potentially dangerous or unwanted side effects and exposures.

World Health Organization Focus on Aging

The theme of World Health Day this past Saturday was “Good health adds life to years.” (www.cnn.com). I was pleased to see the focus on aging well and the challenge to stereotypes about elders. The article described the need to ensure that people are living healthier, as well as longer lives, as a public health issue that the World Health Organization (WHO) has identified as a priority.

Though the catalyst for retaining a life care planning law firm may well be a precipitating event such as a sudden or worsening illness, the benefit is that people get the help they need to find the best possible care, in the least restrictive environment, and assistance with accessing resources to pay for it. By bundling asset protection, public benefits qualification, care coordination, long-term care advocacy and crisis intervention services, people can live healthier and longer lives. The opportunity for improved quality of life and lower costs to society as a whole are enhanced.

Bullying: Elders Are Victims Too

Bullying as it relates to young people is back in the news thanks in part to the recent school shootings in Ohio. But were you aware that bullying is not just common among adolescents, but something that is experienced by our older adults? According to Robin Bonifas in her article in the latest edition of AARP Bulletin (www.aarp.org/bulletin), 10-20% of residents in senior care homes are mistreated by their peers. She cites examples of name calling, bossy behavior, loud arguments, and even cases of physical violence. Senior centers, assisted living and long-term care facilities can become a “forced” communal living situation with a mixture of personalities and ways of relating to others that are lifelong behaviors. Some facilities and centers have adopted strategies to preempt aggressive behavior, including:

Signing a code of conduct to treat peers with consideration and respect with written reprimands or other penalties if the code is not followed
Resident ambassadors to help transition newcomers into a community
Coaching by staff on how to cope with snubs and aggression
Teaching elders empathy for the physical and cognitive difficulties of others.

In another article, Sara Hacala provides a “civility tool kit” to help reverse the trend of escalating rudeness in our society. Two of these tools that can have great impact within a senior community are: 1) making a habit of practicing kindness, generosity and gratitude towards others, and 2) nurturing social relationships (balancing the impersonal nature of the Internet with phone calls and in-person contacts).

We can all act as positive role models for each other and hopefully create a cultural shift away from bullying and rudeness and towards better connectiveness.

Medication Misuse

I attended an inservice at Home Instead Senior Care in Phoenix on medication misuse presented by staff from the Area Agency on Aging. They have received a grant to provide community outreach and education about this public health issue. We learned that 50% of elders misuse medications and ER visits are up because of related falls or accidental poisonings. These statistics resonated for me as I thought of one of our clients in particular. There are many reasons for medication misuse – some intentional, some not – and I realized that she had fallen victim to several factors that have led to numerous falls and a recent ER visit.

First of all, she lives alone. She also takes many medications given by different doctors who don’t communicate with each other. She doesn’t completely understand what each medication is for or whether there are drug interactions she should be aware of. In addition, she doesn’t always have the money to pay for her medications, so she sometimes skips doses. This leads to inconsistency in drug effectiveness.

What she does right, though, is to keep a list of current medications handy, she doesn’t mix alcohol with her medications and she never shares medications with anyone else. But there’s more she can do, and more that I, as her elder care coordinator, can do to help enhance her safety and avoid more trips to the ER.

Some solutions offered in the inservice include: (1) Know your medications – what condition are they treating, what are the potential side effects and possible drug interactions. (2) Take all medications only as prescribed. (3) For my client who keeps an accurate listing of all current medications – make sure that all treating physicians have that list, so they can be on the lookout for drug interactions. (4) Ask health care professionals if there are programs to help pay for medications if you don’t have health insurance. For additional information, contact www.aaaphx.org.

Innovations in Dementia Care

Providing meaningful stimulation to an elder with Alzheimer’s disease can be challenging even for the most experienced caregiver. At times we can be at a loss with how to relate, communicate, connect. Having been in the field many years as a geriatric social worker, I’ve long been aware of the benefits of music, pets and baby dolls to evoke memories, verbalization and connection even in people with severe dementia. But I had never heard of the use of ventriloquists until reading an article in the AARP Bulletin (December 2011, Vol. 52 No. 10). Ventriloquists are now being used in nursing homes and assisted living facilities. “The experience relies on attention, immediate memory and imagination to spark memories.” Alzheimer’s patients will “tell their whole life story and remember the character months later.”

Another innovative advancement helps keep safe persons with Alzheimer’s who are ambulatory and at risk of wandering and coming to harm. CTX Corp has developed shoes with a miniature GPS implanted in the heel. Caregivers set a perimeter called a “geo-fence”, that allows wearers unrestricted movement within a certain area. When they stray outside the area, a Google Maps message pops up on a computer to alert caregivers.

New innovations such as these help to ease the challenges caregivers face and can enrich the life of someone with dementia, even if only for a moment or two.

Older Driver Safety Awareness Week, Dec. 6-10, 2011

According to the National Highway Traffic Safety Administration, the safest drivers are between the ages of 64 and 69 years old — they tend to wear their seat belts, and drive shorter distances less frequently. Driving is considered a right, and to many seniors it’s what keeps them independent and connected. However, normal aging is associated with many physical changes that can affect driving including slower reaction time, poor depth perception, visual and hearing deficits, decreased ability to focus and side effects from medications.

By 2030, one out of every five drivers will be over the age of 65 (www.aaa.com). Older Driver Safety Awareness Week is December 6-10. If you’ve had concerns about a loved one or a friend with regard to driving, here are some questions to help start a conversation (www.nhtsa.gov) — Are you:

Getting lost on routes that should be familiar?
Noticing new dents or scratches to the vehicle?
Receiving a ticket for a driving violation?
Experiencing a near miss or crash recently?
Being advised to limit/stop driving due to a health reason?
Overwhelmed by road signs and markings while driving?
Taking any medication that might affect driving safely?
Speeding or driving too slowly for no reason?
Suffering of any illnesses that may affect driving skills?

In addition, AARP (www.aarp.org) teamed up with the MIT AgeLab – in conjunction with the Hartford — to produce “We need to talk.” This on-line course provides family members information on the emotional connection to driving, tips on observing driving skills in their elderly parents and how to broach the subject of diminished skills.

So, be prepared with your observations and questions, and if necessary, suggest possible transportation alternatives. AAA offers free mature driver safety programs, including assessments and expert advice on aging and driving. (www.aaa.com).

Health Benefits for Elder Caregivers

Having someone who “needs” you gives you reason to get up in the morning. The psychological rewards of feeling purposeful and needed can’t be overstated. That being said, providing care to an elderly relative 24/7 can be a stressful and exhausting experience, one that could cause illness and a shortened lifespan for some. I have often counseled caregivers to take care of themselves too, or they may not be around to take care of their loved one.

Although caregiving can take a toll on someone’s health and wellbeing, there apparently are some significant physical benefits as well. A new study described in “Caregiving’s Hidden Benefits” by Paula Span (www.newoldage.blogs.nytimes.com) showed that a group of caregivers, who were followed over eight years, had lower mortality rates, maintained stronger physical ability and did significantly better on memory tests than non-caregivers. Caregiving is physical, and exercise improves physical health and cognition.

This is good news! However, regardless of the benefits, caregivers should continue to be encouraged to practice good self-care. This includes periodic respite, where care is relinquished to someone else for periods of time, and regular checkups with their primary physicians.

Delirium vs Dementia

When I was ten years old, my 40-year-old mother suffered a massive stroke. She lived to age 76, but not without significant challenges. My once soft-spoken, easy-going mother would suddenly become belligerent and combative with my father. After we had been through this several times, we came to understand that it was the hallmark of a urinary tract infection (UTI) and knew we had to get her to the doctor for diagnosis and treatment. Unfortunately, many people dealing with this issue think it is the hallmark of early dementia in elders, or progression of dementia in someone diagnosed with mild cognitive impairment. In fact, it is delirium, not dementia.

Delirium, also known as acute confusion, is a sudden change in mental functioning and behavior. It can present as agitation, disorientation and sometimes even hallucinations. There can be many causes for these changes. Before deciding that someone is experiencing signs and symptoms of dementia, seek medical advice to rule out a treatable physical condition. A course of antibiotics brought the mother we all knew back to us.

The Value of Preventative Care

The Centers for Medicare and Medicaid (www.cms.gov/medicare) recently reported that some of the cost of Medicare’s Part D prescription coverage has been offset by fewer emergency room visits and hospital stays. In other words, enabling Seniors to get drugs to manage chronic conditions such as hypertension, heart disease and diabetes reduces the need for visits to the hospital to treat those conditions.

Also this week, AARP reports that persons over 65 who regularly see a primary care doctor live longer, healthier lives. Their regular communication with a medical professional who understands their overall medical condition and is able to treat symptoms before they turn serious contributes to both a higher quality of life and cost savings for the health care system. See http://www.aarp.org/health/doctors-hospitals/info-07-2011/primary-care-linked-to-longevity-health-discovery.html.

My March 7, 2011 blog post described Medicare’s new Wellness benefit, which covers the cost of an annual wellness physical and some diagnostic tests, with no deductible or co-pay. It is good news for Seniors that policy makers are finally recognizing that preventative care and management of chronic conditions is not only good for patients but manages cost for the entire system. It is up to us to utilize all of these benefits to maintain good health and quality of life.

Help Prevent Falls with Tai Chi

Readers of this blog know that I encourage seniors to improve their quality of life through fitness and exercise. Not only is it a great way to socialize and feel better, but it has a measurable impact on improved health and well-being.

As reported in The New Old Age Blog, http://newoldage.blogs.nytimes.com/, the American Geriatrics Society and the British Geriatric Society have recently updated their guidelines for preventing falls to recommend the slow-motion Chinese exercise, Tai Chi. Tai Chi is especially effective for seniors because its small, controlled movements focus on increasing balance and core strength without the use of weights and with no impact on joints.

A quick search on Tai Chi and my city resulted in over 50 links for finding Tai Chi classes, and it is taught in many churches, synagogues and community centers for low or no cost.

Once your doctor has cleared you for an exercise program, it is important to find something you enjoy so that you stick with it. If organized classes aren’t for you, you can work on improving your balance by working up to standing on one foot for 30 seconds at a time. Stand near a straight back chair that you can grab on to if you need it, and try lifting up one foot for 5 seconds, then 10, increasing to 30 as you feel comfortable. As you improve your stability through this exercise, you might decide that you’d like to go even further through a Tai Chi class.