Abuse Reporting

According to the National Center on Elder Abuse Elder abuse is a term referring to any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult. The specificity of laws varies from state to state, but broadly defined, abuse may be:

Physical Abuse - Inflicting, or threatening to inflict, physical pain or injury on a vulnerable elder, or depriving them of a basic need. 
 

Emotional Abuse - Inflicting mental pain, anguish, or distress on an elder person through verbal or nonverbal acts. 
 

Sexual Abuse - Non-consensual sexual contact of any kind. 
 

Exploitation - Illegal taking, misuse, or concealment of funds, property, or assets of a vulnerable elder. 
 

Neglect - Refusal or failure by those responsible to provide food, shelter, health care or protection for a vulnerable elder. 
 

Abandonment - The desertion of a vulnerable elder by anyone who has assumed the responsibility for care or custody of that person.

 Signs and Symptoms of Abuse:

 Physical Abuse-

• Bruises, black eyes, welts, lacerations, and rope marks
• Bone fractures, broken bones, and skull fractures
• Open wounds, cuts, punctures, untreated injuries in various stages of healing
• Sprains, dislocations, and internal injuries/bleeding
• Broken eyeglasses/frames, physical signs of being subjected to punishment, and signs of being restrained
• Laboratory findings of medication overdose or under utilization of prescribed drugs
• Reports of being hit, slapped, kicked, or mistreated
• Sudden change in behavior; and the caregiver's refusal to allow visitors to see an elder alone.

Emotional Abuse-

• Being emotionally upset or agitated
• Being extremely withdrawn and non communicative or non responsive
• Unusual behavior usually attributed to dementia (e.g., sucking, biting, rocking) and
• Report of being verbally or emotionally mistreated.

Sexual Abuse-

• Bruises around the breasts or genital area
• Unexplained venereal disease or genital infections
• Unexplained vaginal or anal bleeding
• Torn, stained, or bloody underclothing
• Report of being sexually assaulted or raped.

Exploitation-

• Sudden changes in bank account or banking practice, including an unexplained withdrawal of large sums of money by a person accompanying the elder.
• The inclusion of additional names on an elder's bank signature card.
• Unauthorized withdrawal of the elder's funds using the elder's ATM card.
• Abrupt changes in a will or other financial documents.
• Unexplained disappearance of funds or valuable possessions.
• Substandard care being provided or bills unpaid despite the availability of adequate financial resources.
• Discovery of an elder's signature being forged for financial transactions or for the titles of his/her possessions.
• Sudden appearance of previously uninvolved relatives claiming their rights to an elder's affairs and possessions.
• Unexplained sudden transfer of assets to a family member or someone outside the family.
• The provision of services that is not necessary.
• Report of financial exploitation.

Neglect-

• Dehydration, malnutrition, untreated bedsores, and poor personal hygiene.
• Unattended or untreated health problems.
• Hazardous or unsafe living condition/arrangements (e.g., improper wiring, no heat, or no running water).
• Unsanitary and unclean living conditions (e.g. dirt, fleas, lice on person, soiled bedding, fecal/urine smell, inadequate clothing).
• Report of being mistreated.

Abandonment-

• The desertion of an elder at a hospital, a nursing facility, or other similar institution.
• The desertion of an elder at a shopping center or other public location.
• Personal report of being abandoned.

Although there are many similarities between States, each State has specific laws and rules that apply to suspected Elder Abuse.  Choose from the list of States below for more information or go to the NCEA website: 

http://www.ncea.aoa.gov/NCEAroot/Main_Site/Index.aspx 

 

Adult Day Care

Adult day care is now offered for older adults who may need assistance during the day while their regular caretakers are at work or busy with other activities.

WHAT IS ADULT DAY CARE?
Adult Day Care Centers are designed to provide care and companionship for seniors who need assistance or supervision during the day. The program offers relief to family members or caregivers and allows them the freedom to go to work, handle personal business or just relax while knowing their relative is well cared for and safe.

The goals of the programs are to delay or prevent institutionalization by providing alternative care, to enhance self-esteem and to encourage socialization. There are two types of adult day care: Adult social day care provides social activities, meals, recreation and some health-related services. Adult day health care offers more intensive health, therapeutic and social services for individuals with severe medical problems and those at risk of requiring nursing home care.

Seniors generally take part in the program on a scheduled basis and the services that are offered may include the following:

• Counseling
• Education
• Evening care
• Exercise
• Health screening
• Meals
• Medical care
• Physical therapy
• Recreation
• Respite care
• Socialization
• Supervision
• Transportation
• Medication Management

HOW DO ADULT DAY CARE CENTERS OPERATE?
These centers are usually open during working hours and may stand alone or be located in senior centers, nursing facilities, churches or synagogues, hospitals, or schools. The staff may monitor medications, serve hot meals and snacks, perform physical or occupational therapy, and arrange social activities. They also may help to arrange transportation to and from the center itself.
 

WHO CAN BENEFIT FROM ADULT DAY CARE?
The following case study is an example of a senior who may need adult day care services, both for his own well being and that of his family caregivers:
Paul is 69 years old and recently suffered a stroke. He needs some care and supervision so he lives with his son and daughter-in-law, David and Kira. However, because David and Kira both work, they need help to care for Paul during the day. They found a solution to their problem by having Kira drop off Paul at the local adult day care center in the morning, and having David pick him up when he gets off work in the evening. The center monitors Paul’s medications and offers him lunch, some physical therapy, and a chance to socialize with other seniors.

WHAT SHOULD I LOOK FOR IN AN ADULT DAY CARE CENTER?
Not all states license and regulate adult day care centers, there may be a great deal of difference between individual centers; therefore it is important to learn more about each of the centers near you. You will probably want to visit the centers closest to you, and to talk with the staff and other families that use the centers to determine if the facilities and programs available meet your individual needs. You may want to find out if your state has an Adult Day Care Association.
 

HOW DO I PAY FOR ADULT DAY SERVICES?
Costs vary among adult day centers. Costs range from $25 a day to over $100 per day depending on the services offered, type of reimbursement, and geographic region. While an adult day care center is not usually covered by insurance of Medicare, some financial assistance may be available through a federal or state program (e.g., Medicaid, Older Americans Act, Veterans Administration)
 

WHERE CAN I LEARN MORE ABOUT LOCAL SERVICES?
To find out more about the specific adult day care centers where you live, you will want to contact your local aging information and assistance provider or area agency on aging (AAA).

Advance Directives

Advance Directives (also referred to as Advanced Healthcare Directives) are instructions from an individual that specify what medical care should be provided if that individual is no longer capable of making medical decisions. Advance Directives is a general term that may refer to several separate documents including a Living Will, Power of Attorney and/or Health Care Proxy.

Living Will

A living will is a legal document that an individual usually develops with family members to make known his or her wishes regarding life prolonging medical treatments. It is important that family members and or close friends of residents in Nursing Homes or Assisted Living facilities work together with the resident to complete this document. It is also important that the documents are reviewed and updated periodically - especially when there is a change in the individual's medical status or a change in Power of Attorney.

As the laws governing such documents change from time to time, it is also recommended that the Living Will be reviewed and updated yearly regardless of other changes. Most states have developed forms that help families and residents to complete a living will without the need of professional advice from an attorney. It is strongly suggested that families consult with the individual's doctor(s) during the process of completing these documents. It is also important to have an open dialogue about the individual's wishes for medical care. Decisions about care will often force the Agent to make complex decisions that may not have been foreseen during the development of the Directives.

Power of Attorney

Power of Attorney is a document that allows an individual to appoint an individual to appoint a person or organization to handle that individual's affairs if the individual is unable to do so.

The person or organization that is appointed is of referred to as "Agent." There are several kinds of power of attorney.

• General Power of Attorney authorizes the Agent to act on the individual's behalf in a variety of situations.
• Special Power of Attorney authorizes the Agent to act on the individual's behalf in specific situations only.
• Health Care Power of Attorney (sometimes called Health Care Proxy) allows the individual to appoint someone to make health care decisions if the individual is incapacitated.
• Durable Power of Attorney is usually created by adding specific text the document. This means that the document will remain in effect if the individual becomes mentally incompetent. 
• Revocation of Power of Attorney allows the individual to revoke a power of attorney document.

Many State Governments have developed Advance Directive forms that comply with the State's current legislative statutes and make the development of Advance Directives much simpler for families.

Physician Order for Life Sustaining Treatment (POLST) Form

If you have unconditional preferences about health care that you do or do not want to receive, you should ask your doctor to complete a Physician Order for Life Sustaining Treatment (POLST) Form.  The physician orders found in a POLST Form should be followed by all licensed health care facilities and Emergency Medical Service providers. This form helps to translate the wishes expressed in your advance directive into orders that can be followed by health care providers.  You cannot be forced to complete a POLST Form.

 

Advocacy

Many older adults lose the ability to advocate for themselves, and when this occurs it is important to find a trustworthy person or entity to advocate for them. The best advocates for older adults are usually close family members or concerned friends. However, if no family or friends are available to monitor the best interests of an elderly person, there are organizations that advocate for older adults.

Legal Services

Advocacy services can assist you or your loved one legal help. Professional advocate services for the elderly often provide their clients with direct legal services in a wide variety of areas of law affecting seniors. Some of these areas include:

 

• Advance care planning
• Consumer protection
• Consent and capacity
• Elder abuse
• Health care
• Home care
• Long-term care homes
• Retirement homes
• Pensions and income

Professional advocates may also be able assist you or your loved one in his or her community. Advocates for the elderly able commonly able to work with individuals and their community (e.g. organizations, foundations, and community leaders) to organize broader social change and to offer convenient support, such as legal representation, administrative assistance, research and access to political and media networks.

 

Please refer to the Resources on this page for more information.

Alzheimer's Disease

Alzheimer's Main Page|Etiology|Diagnosis|Treatment|Prevention|Research

Introduction

Alzheimer's disease is a degenerative brain disorder that causes cognitive impairment and eventually leads to death. Symptoms of Alzheimer's include memory loss, behavior changes, personality changes, confusion, and a loss of the ability to carry out activities of daily living. According to the Center for Disease Control, Alzheimer's disease has dramatically increased in prevalence in the last 25 years, and is currently one of the seven leading causes of death in the United States. It is unclear whether more people have Alzheimer's than in the past, or if the effects are more noticeable as our population lives longer and older adults are more likely to suffer from the symptoms of Alzheimer's. Regardless, Alzheimer's is impacting our aging population and will likely continue to increase as Baby Boomer's age. According to the Alzheimer's Association, annual costs to Medicare and Medicaid will increase 65% in the next five years to treat Alzheimer's patients.

History of Alzheimer's Disease

In 1901, a 51-year-old woman, Auguste D, was admitted to the state asylum in Frankfurt. She was suffering from cognitive and language deficits, auditory hallucinations, delusions, paranoia and aggressive behaviour, and was studied by Alois Alzheimer (1864–1915), a doctor at the hospital.

Alzheimer moved to the Munich medical school in 1903 to work with Emil Kraepelin – one of the foremost German psychiatrists of that era – and when Auguste D died in April 1906, her brain was sent to him for examination. In November of that year, Alzheimer presented Auguste's case at a psychiatry meeting, and he published his talk in 1907.

In 1910, Kraepelin coined the term 'Alzheimer's disease' – a term still used to refer to the most common cause of senile dementia.

Course (from the Surgeon General)

Patients with Alzheimer’s disease experience a gradual decline in functioning throughout the course of their illness. Typically, a loss of 4 points per year on the Mini Mental Status Exam is detected, but there is a great deal of heterogeneity in the rate of decline (Olichney et al., 1998). Memory dysfunction is not only the most prominent deficit in dementia but also is the most likely presenting symptom. Deficits in language and executive functioning, while common in the disorder, tend to manifest later in its course (Locascio et al., 1995). Depression is prevalent in the early stages of dementia and appears to recede with functional decline (Locascio et al., 1995). Although this may reflect decreasing awareness of depression by the patient, it also could reflect inadequate detection of depression by health professionals. Behavioral symptoms, such as agitation, seem to be more prevalent in the later stages of Alzheimer’s disease (Patterson & Bolger, 1994); however, psychosis has been observed in patients with varying levels of severity (Borson & Raskind, 1997). The duration of illness, from onset of symptoms to death, averages 8 to 10 years (DSM-IV).

Prevalence and Incidence (from the Surgeon General)

Alzheimer’s disease is a prominent disorder of old age: 8 to 15 percent of people over age 65 have Alzheimer’s disease (Ritchie & Kildea, 1995). The prevalence of dementia (most of which is accounted for by Alzheimer’s disease) nearly doubles with every 5 years of age after age 60 (Jorm et al., 1987). Although more women than men have Alzheimer’s disease (that is, the prevalence of the disease appears to be higher among women), this may reflect women’s longer life spans, because studies do not show marked gender differences in incidence rates (Lebowitz et al., 1998). Incidence studies also reveal age-related increases in Alzheimer’s disease (Breteler et al., 1992; Paykel et al., 1994; Hebert et al., 1995; Johansson & Zarit, 1995; Aevarsson & Skoog, 1996). One percent of those age 60 to 64 are affected with dementia; 2 percent of those age 65 to 69; 4 percent of those age 70 to 74; 8 percent of those 75 to 79; 16 percent of those age 80 to 84; and 30 to 45 percent of those age 85 and older (Jorm et al., 1987; Evans et al., 1989).

The “graying of America” is likely to result in an increase in the number of individuals with Alzheimer’s disease, yet shifts in the composition of the affected population also are anticipated. Increased education is correlated with a lower frequency of Alzheimer’s disease (Hill et al., 1993; Katzman, 1993; Stern et al., 1994), and future cohorts are expected to have attained greater levels of education. For example, the portion of those currently 75 years of age and older—those most vulnerable to Alzheimer’s disease—with at least a high school education is 58.7 percent. Of those currently age 60 to 64 who will enter the period of maximum vulnerability by the year 2010, 75.5 percent have at least a high school education. A higher educational level among the at-risk cohort may delay the onset of Alzheimer’s disease and thereby decrease the overall frequency of Alzheimer’s disease (by decreasing the number of individuals who live long enough to enter the period of maximum vulnerability). However, this trend may be counterbalanced or overtaken by greater longevity and longer survival of affected individuals. Specifically, improvements in general health and health care may lengthen the survival of dementia patients, increasing the number of severely affected patients and raising their level of medical comorbidity. Similarly, through dissemination of information to patients and clinicians, better detection, especially of early-stage patients, is expected. Increased use of putative protective agents, such as vitamin E, also may increase the number of patients in the middle phases of the illness (Cummings & Jeste, 1999).

Symptoms of Alzheimer's disease

According to the Alzheimer's Association, the following symptoms may indicate the possibility of Alzheimer's disease:

1. Memory loss that affects day-to-day function. It's normal to occasionally forget appointments, colleagues' names or a friend's phone number and remember them later. A person with Alzheimer's disease may forget things more often and not remember them later, especially things that have happened more recently.

2. Difficulty performing familiar tasks. Busy people can be so distracted from time to time that they may leave the carrots on the stove and only remember to serve them at the end of a meal. A person with Alzheimer's disease may have trouble with tasks that have been familiar to them all their lives, such as preparing a meal.

3. Problems with language. Everyone has trouble finding the right word sometimes, but a person with Alzheimer's disease may forget simple words or substitute words, making her sentences difficult to understand.

4. Disorientation of time and place. It's normal to forget the day of the week or your destination -- for a moment. But a person with Alzheimer's disease can become lost on their own street, not knowing how they got there or how to get home.

5. Poor or decreased judgment. People may sometimes put off going to a doctor if they have an infection, but eventually seek medical attention. A person with Alzheimer's disease may have decreased judgment, for example not recognizing a medical problem that needs attention or wearing heavy clothing on a hot day.

6. Problems with abstract thinking.
From time to time, people may have difficulty with tasks that require abstract thinking, such as balancing a checkbook. Someone with Alzheimer's disease may have significant difficulties with such tasks, for example not recognizing what the numbers in the checkbook mean.

7. Misplacing things. Anyone can temporarily misplace a wallet or keys. A person with Alzheimer's disease may put things in inappropriate places: an iron in the freezer or a wristwatch in the sugar bowl.

8. Changes in mood and behavior. Everyone becomes sad or moody from time to time. Someone with Alzheimer's disease can exhibit varied mood swings -- from calm to tears to anger -- for no apparent reason.

9. Changes in personality. People's personalities can change somewhat with age. But a person with Alzheimer's disease can become confused, suspicious or withdrawn. Changes may also include apathy, fearfulness or acting out of character.

10. Loss of initiative. It's normal to tire of housework, business activities or social obligations, but most people regain their initiative. A person with Alzheimer's disease may become very passive, and require cues and prompting to become involved.

Risk Factors for Alzheimer's disease

Most people with Alzheimer's disease are 65 years old or older. Risk of Alzheimer's greatly increases after age 85. Additionally, family history of the disease increases one's chance of developing Alzheimer's. Some other risk factors include head injuries and poor heart function.

Alzheimer's Main Page|Etiology|Diagnosis|Treatment|Prevention|Research

Assisted Living

What is Assisted Living?

Assisted living facilities represent a type of residential care that can provide assistance to residents with activities of daily living such as bathing and dressing. Assisted living facilities do not provide the extensive medical care offered by skilled nursing facilities, but residents can receive some assistance with personal needs and medication administration. The monthly cost for an assisted living facility varies and is impacted by types of services offered to individuals. The average cost of an assisted living facility is approximately $2000 per month. Please refer to Resources regarding Assisted Living listed on this page.

Most assisted living facilities create a service plan for each individual resident upon admission.  The service plan details the personalized services required by the resident and guaranteed by the facility.  The plan is updated regularly to assure that the resident receives the appropriate care as his or her condition changes.

Common Terms

The term used for assisted living facilities differs across the country.  Other common terms for these facilities include:

· Residential care
· Personal care
· Adult congregate living care
· Board and care
· Domiciliary care
· Adult living facilities
· Supported care
· Enhanced care
· Community based retirement facilities
· Adult foster care
· Adult homes
· Sheltered housing
· Retirement residences

Assisted Living is the generic term used across the country.

In some states Assisted Living Facilities and divided into two levels:

Assisted Living Type I is a residential facility that provides assistance with ADLs and social care to two or more ambulatory residents who are capable of achieving mobility sufficient to exit the facility without assistance of another person.

Assisted Living Type II is a residential facility with a home-like setting that provides an array of coordinated supportive personal and health care services, available 24 hours a day, to residents who have been assessed.

How Does an Assisted Living Facility Differ from a Nursing Home?

Nursing homes are designed to care for very frail people that are not able to care for themselves and have numerous health care requirements. Assisted living facilities are designed to assist elderly persons who are able to care for themselves except for a few activities. Assisted living facilities are often deemed necessary when the person in question needs help preparing meals, bathing, dressing, performing household chores, is sometimes confused, or is experiencing memory problems.

What are Continuing Care Retirement Communities?

Assisted living facilities are often connected with independent living residences and nursing homes.  The combination is known as a continuing care retirement community.   The resident can take advantage of the full range of services available and the ease of transfer to a different type of facility as his or her condition and needs change without needing to look for a new facility, relocate, or adapt to a new setting.  For example, the resident may begin in the independent living residences, move to assisted living as he or she needs help with activities of daily living, and eventually move to the nursing home as ongoing care becomes necessary.

The three different contracts available to people wishing to become a member of a continuing care community are extensive, modified, and fee-for-service.  All three cover shelter, amenities, residential services, and any short-term and emergency care. The contracts differ in the amounts of entrance fees and monthly fees.

In addition to the costs mentioned above, an extensive contract also covers unlimited long-term nursing care with no corresponding increase in monthly payments.  This is the most expensive contract but may prove to be the most cost-effective in the long run.   The modified contract covers a specific amount of long-term nursing care in the monthly payments.  Once the specified amount is used, the resident must pay for any additional nursing care.  Residents under the fee-for-service contract must pay for long-term care at daily nursing care rates.  This is the least expensive plan because all future long-term nursing costs must be paid for separately from the contract.

Consult your financial planner to help you determine which plan is best for you.

What is Independent Living?

Independent living is for people who want to and are able to live independently but do not want to maintain a home.  Many people prefer to live in a community with others of the same age and with similar interests.  An independent retirement community allows for a great deal of social activities and trips.  Many independent living facilities also offer prepared meals and provide a wide range of amenities.

Please refer to the Resources section of this page for more information and links to other pages that can answer your questions regarding Assisted Living.    

 

Bladder & Bowel

Problems with bowel and bladder control become more common as we age; however, aging alone is not the primary cause of these problems. It is estimated that approximately 15% of individuals over 65 years of age, living at home, have problems with incontinence. The prevalence of bowel and bladder problems rises significantly when individuals are placed in residential settings.

Urinary Incontinence (UI)

Problems with bladder control often referred to as Urinary incontinence (UI) is a syndrome that can be caused by a combination of factors. Some of these factors occur in isolation while others occur in combination with each other. Age related changes can also contribute to problems with balder control. The American Geriatrics Society report that the prevalence of UI increases with age and affects women more than men (2:1) until age 80, after which men and women are equally affected. For people aged 65 years and over, 15% to 30% of individuals living in the community are incontinent and the prevalence for individuals in long-term care is at least 50%. Urinary incontinence can cause other medical problems, including cellulitis, pressure ulcers, urinary tract infections, falls with fractures, sleep deprivation, social withdrawal, depression, and sexual dysfunction. UI is not associated with increased mortality. UI impairs quality of life, affecting the older person's emotional well-being, social function, and general health. Incontinent persons often manage to maintain their activities, but with an increased burden of coping, embarrassment, and poor self-perception.

Urinary Incontinence (UI) and Caregiving

Caregiver burden is higher with incontinent older persons, which can contribute to decisions to institutionalize. According to the Utah Geriatrics Society, the estimated annual UI-related costs total more than $36 billion. For older persons in particular, continence requires mobility, manual dexterity, the cognitive ability to recognize and react to bladder filling, and the motivation to stay dry.

Risk Factors

Age-related changes in the lower urinary tract and are found in both continent and incontinent older persons. Why some older persons develop UI and others do not remains unclear. Any condition, medication, or factor that affects lower urinary tract function, volume status and urine excretion, or the ability to toilet can predispose a person to UI. Risk factors in community-dwelling older persons include advanced age, depression, transient ischemic attacks and stroke, congestive heart failure, fecal incontinence and constipation, obesity, chronic obstructive lung disease, chronic cough, diabetes mellitus, impaired mobility, and impaired activities of daily living. Among institutionalized older persons, UI is associated with impaired mobility, depression, stroke, diabetes mellitus, and Parkinson's disease; at least one third have multiple conditions. Although moderate to severe dementia is associated with UI, even severely demented persons remain continent if they have mobility for transfers. Thus, UI in demented persons may not be caused by dementia, but may be caused by multiple factors with treatable causes.

Clinical Types of Incontinence

Incontinence can be classified into diagnostic clinical types that are useful in planning evaluation and treatment.

1.  Transient Incontinence

Urinary incontinence that occurs as a result of treatable factors is called transient incontinence. Transient UI affects approximately one third of community-dwelling older persons and accounts for one half of the incontinence among hospitalized older persons. The causes of transient incontinence include: delirium, urinary infection, medications, some major psychiatric disorders stool impaction, restricted mobility, excessive fluid intake, diuretics, hyperglycemia, hypercalcemia, volume overload (congestive heart failure, venous insufficiency, hypothyroidism).

2.  Urge Incontinence

Urge UI is the most common type of UI in older persons. It is characterized by abrupt urgency and frequency. The volume of leakage may be small or large. The term overactive bladder refers to a condition with frequency, nocturia (the need to get up during the night to urinate), and urgency or urge UI, or both. Urge UI is associated with detrusor (bladder muscle) over activity (DO) that may be age-related, secondary to lesions in central inhibitory pathways (e.g., stroke, cervical stenosis), or due to local bladder irritation (infection, bladder stones, inflammation, tumors). Because DO is found in healthy, continent older persons, failure of lower urinary tract and functional compensatory mechanisms may play an important role in UI. Distinctions between detrusor hyperreflexia (DO associated with central nervous system lesions) and detrusor instability (DO without such lesions) are frequently blurred in the older persons. Less common causes of urge UI are interstitial cystitis (urge UI with otherwise unexplained pelvic pain) and spinal cord injury, which results in impaired detrusor compliance (excessive pressure response to filling) or detrusor-sphincter dyssynergia (concomitant detrusor and sphincter contraction), or both. DO may coexist with impaired detrusor contractility (detrusor hyperactivity with impaired contractility, or DHIC), with an elevated post void residual volume (PVR) in the absence of outlet obstruction. DHIC accounts for most established UI in frail older persons. Women can be misdiagnosed with stress UI if weak DHIC contractions are not detected, and men can be misdiagnosed with outlet obstruction because of the similarity of the symptoms (urgency, frequency, weak flow rate, and elevated residual urine). Persons with DHIC may be at increased risk for urinary retention if treated with bladder-relaxant drugs.

3.  Stress Incontinence

Stress UI, the second most common type of UI in older women, results from failure of the sphincter mechanism(s) to preserve outlet closure during bladder filling. Stress UI occurs coincident with increased intra-abdominal pressure, in the absence of a bladder contraction. Leakage is due to impaired pelvic supports or, less commonly, failure of urethral closure; the latter intrinsic sphincter deficiency occurs with trauma and scarring from anti-incontinence surgery in women and prostatectomy in men, or with severe urethral atrophy. Unlike the episodic leakage of genuine stress UI, this leakage is typically continual and can occur while the person is sitting or standing quietly. Stress maneuvers may trigger DO; with such stress-related urge UI, leakage occurs after a several-second delay following the stress maneuver.

4. Overflow Incontinence

Overflow UI results from detrusor (bladder muscle) underactivity, bladder outlet obstruction, or both. Leakage is small in volume but continual. The PVR is elevated, and symptoms include dribbling, weak urinary stream, intermittency, hesitancy, frequency, and nocturia. Associated urge and stress leakage may occur. Rarely, continual leakage is due to extra urethral incontinence (e.g., cystovaginal fistula). Outlet obstruction is the second most common cause of UI in older men; most obstructed men, however, are not incontinent. Causes include benign prostatic hyperplasia, prostate cancer, and urethral stricture. In women, obstruction is uncommon and usually due to previous anti-incontinence surgery or a large cystocele that kinks the urethra. Detrusor underactivity causing urinary retention and overflow UI occurs in only 5% to 10% of older persons. Intrinsic causes are replacement of detrusor smooth muscle by fibrosis and connective tissue (e.g., with chronic outlet obstruction). Neurologic causes include peripheral neuropathy (from diabetes mellitus, pernicious anemia, Parkinson's disease, alcoholism) or mechanical damage to the spinal detrusor afferents by disc herniation, spinal stenosis, or tumor.

Cancer

According to the information available on the American Cancer Society website, cancer develops when cells in a part of the body begin to grow out of control. Although there are many kinds of cancer, they all start because of out-of-control growth of abnormal cells. Normal body cells grow, divide, and die in an orderly fashion. During the early years of a person's life, normal cells divide more rapidly until the person becomes an adult. After that, cells in most parts of the body divide only to replace worn-out or dying cells and to repair injuries. Because cancer cells continue to grow and divide, they are different from normal cells. Instead of dying, they outlive normal cells and continue to form new abnormal cells.

Cancer cells often travel to other parts of the body where they begin to grow and replace normal tissue. This process, called metastasis, occurs as the cancer cells get into the bloodstream or lymph vessels of our body. When cells from a cancer like breast cancer spread to another organ like the liver, the cancer is still called breast cancer, not liver cancer. Cancer cells develop because of damage to DNA. This substance is in every cell and directs all its activities. Most of the time when DNA becomes damaged the body is able to repair it. In cancer cells, the damaged DNA is not repaired. People can inherit damaged DNA, which accounts for inherited cancers. Many times though, a person's DNA becomes damaged by exposure to something in the environment, like smoking.

Cancer usually forms as a solid tumor. Some cancers, like leukemia, do not form tumors. Instead, these cancer cells involve the blood and blood-forming organs and circulate through other tissues where they grow. Not all tumors are cancerous. Benign (noncancerous) tumors do not spread to other parts of the body (metastasize) and, with very rare exceptions, are not life threatening. Different types of cancer can behave very differently. For example, lung cancer and breast cancer are very different diseases. They grow at different rates and respond to different treatments. That is why people with cancer need treatment that is aimed at their particular kind of cancer.

Cancer is the second leading cause of death in the United States. Half of all men and one-third of all women in the US will develop cancer during their lifetimes. Today, millions of people are living with cancer or have had cancer. The risk of developing most types of cancer can be reduced by changes in a person's lifestyle, for example, by quitting smoking and eating a better diet. The sooner a cancer is found and treatment begins, the better are the chances for living for many years.

Care Management

Care managers provide guidance and advocacy for the older adult as well as assistance in providing the patient with the most appropriate care possible, while focusing the individual’s disease-specific needs. Care Management goals include the achievement of optimal health, access to care and appropriate utilization of resources, while fostering self determination of the older person to the greatest extent possible in decisions that impact his/her life.

Case managers are often employed by organizations that provide direct care such as hospitals, nursing homes, assisted living facilities, and continuing care retirement communities. However, case managers can also work directly for healthcare consumers.

A case manager hired directly by a healthcare consumer is paid directly by the consumer and fees vary by organization. Usually the initial assessment and coordination of care that directly follows is covered by insurance, consult your plan for details about these costs. Theoretically, an individual assigned to your case ought to reduce unnecessary healthcare costs, creating a personalized treatment plan that is both effective and efficient for the patient’s individual needs.

The clients of the care manager can include the patient, family members, other healthcare professionals and possibly others who play a role in caring for the older adult. Their unique role as a patient advocate allows case managers to determine the best treatment not only from a medical perspective, but according to the patient’s psychological, social and financial situation as well.

The Association of Professional Geriatric Care Managers recommends asking specific questions when hiring a geriatric care manager.

1. What are your professional credentials?
2. Are you licensed in your profession?
3. Are you a member of the National Association of Professional Geriatric Care Managers?
4. How long have you been providing care management services?
5. Are you available for emergencies?
6. Does your company also provide home care services?
7. How do you communicate information to me?
8. What are your fees? (These should be provided to the consumer/responsible party in writing prior to rendering services)
9. Can you provide me with references?

On all levels - physically, mentally, emotionally, and spiritually, utilizing a geriatric care manager can bring peace of mind to all parties concerned.

Resources http://newoldage.blogs.nytimes.com/2008/10/06/why-hire-a-geriatric-care-...

Caregiver Support

Extensive research has been done on caregiving and results show that caregivers can suffer from extreme stress leading to health problems for themselves. Adequate social support is important for caregivers when providing long term care.

10 Tips for Family Caregivers

• Caregiving is a job and respite is your earned right. Reward yourself with respite breaks often.
• Watch out for signs of depression, and don’t delay in getting professional help when you need it.
• When people offer to help, accept the offer and suggest specific things that they can do.
• Educate yourself about your loved one’s condition and how to communicate effectively with doctors.
• There’s a difference between caring and doing. Be open to technologies and ideas that promote your loved one’s independence.
• Trust your instincts. Most of the time they’ll lead you in the right direction.
• Caregivers often do a lot of lifting, pushing, and pulling. Be good to your back.
• Grieve for your losses, and then allow yourself to dream new dreams.
• Seek support from other caregivers. There is great strength in knowing you are not alone.
• Stand up for your rights as a caregiver and a citizen.

Source: National Family Caregiver's Association

Tips for Preventing Burnout

The first strategy for preventing caregiver burnout is: Don’t try to do it all alone. Taking on all of the responsibilities of caregiving without regular breaks or assistance is a surefire recipe for burnout.

Ask for help when you need it. Enlist friends and family who live near you to run errands, bring a hot meal, or “baby-sit” the care receiver so you can take a well-deserved break.

Also, there are services to help caregivers in most communities, and the cost is often based on ability to pay or covered by the care receiver’s insurance. Services that may be available in your community include adult day care centers, home health aides, home-delivered meals, respite care, transportation services, and skilled nursing.

• Caregiver services in your community – Call your local Area Agency on Aging, senior center, senior services organization, county information and referral service, university gerontology department, family service, or hospital social work unit for contact suggestions.
• Caregiver support for veterans – If your care recipient is a Veteran, home health care coverage, financial support, nursing home care, and adult day care benefits may be available. Some Veterans Administration programs are free, while others require co-payments, depending upon the veteran’s status, income, and other criteria.
• Your family member’s affiliations – Fraternal organizations such as the Elks, Eagles, or Moose lodges may offer some assistance if your family member is a longtime dues-paying member. This help may take the form of phone check-ins, home visits, or transportation.
• Community transportation services – Many community transportation services are free for your care recipient, while others may have a nominal fee or ask for a donation. Your local Area Agency on Aging (AAA) can help you locate transportation to and from adult day care, senior centers, shopping malls, and doctor's appointments.
• Telephone check-ins – Telephone reassurance provides prescheduled calls to homebound older adults to reduce their isolation and monitor their well-being. Check with your local AAA, religious groups, senior centers, and other public or nonprofit organizations.
• Adult day care – If your loved one is well enough, consider the possibility of adult day care. An adult day care center can provide you with needed breaks during the day or week, and your loved one with some valuable diversions and activities.

For more information, see Adult Day Care Centers: A Guide to Options and Selecting the Best Center for Your Needs.

Preventing caregiver burnout tip 2: Seek emotional support

Pablo Casals, the world-renowned cellist, said, “The capacity to care is the thing that gives life its deepest significance and meaning.” Although caregivers are often isolated from others, it’s essential that you receive the emotional support you need, so you don’t lose that capacity.

Share what you’re going through with at least one other person. Turn to a trusted friend or family member, join a support group, or make an appointment with a counselor or therapist. You can also draw strength from your faith. A congregation in a church or synagogue can provide the encouragement you need to feel good about your caregiving role, and may also be able to provide a break from time to time.

The value of caregiver support groups

Remember that old adage, "trouble shared is trouble halved"? A caregiver support group is one way to share your troubles. Seek out people who are going through the same experiences that you are living each day. If you can't leave the house, many Internet services are available.

In most support groups, you'll talk about your problems and listen to others talk; you'll not only get help, but you'll be able to help others, too. Most important, you'll find out that you're not alone.You’ll feel better knowing that other people are in the same situation, and their knowledge can be invaluable, especially if they’re dealing with the same illness you are.

Types of Caregiver Support Groups

Community support groups for caregivers: People live near each other and meet in a given place each week or month. You get face-to-face contact and a chance to make new friends who live near you. The meetings get you out of the house, get you moving provide a social outlet, and reduce feelings of isolation. Meetings are at a set time. You will need to attend them regularly to get the full benefit of the group. Since the people in the support group are from your area, they'll be more familiar with local resources and issues.

Internet support groups for caregivers: People are from all over the world and have similar interests or problems. You meet online, through email lists, websites, message boards, or chat rooms. You can get support without leaving your house, which is good for people with limited mobility or transportation problems. You can access the group whenever it's convenient for you or when you need help most. If your problem is very unusual – a rare disease, for example – there may not be enough people for a local group, but there will always be enough people online.

To find a community support group, check the yellow pages, ask your doctor or hospital, or call a local organization that deals with the health problem you would like to address in a support group. To find an Internet support group, visit the website of an organization dedicated to the problem or do a web search on the name of the problem.

Preventing caregiver burnout tip 2: Take care of yourself

When you are a caregiver, finding time to nurture yourself might seem impossible. But you owe it to yourself to find the time. Without it, you may not have the mental or physical strength to deal with all of the stress you experience as a caregiver. Give yourself permission to rest and to do things that you enjoy on a daily basis. You will be a better caregiver for it.

Tips for taking care of yourself:

• Incorporate activities that give you pleasure even when you don't really feel like it. Listen to music, work in the garden, engage in a hobby…whatever it is that you enjoy.
• Pamper yourself. Take a warm bath and light candles. Find some time for a manicure or a massage.
• Eat balanced meals to nurture your body. Find time to exercise even if it's a short walk everyday. Do the best you can to sleep at least 7 hours a night.
• Laughter really is the best medicine. Buy a light-hearted book or rent a comedy. Whenever you can, try to find some humor in everyday situations.
• Keep a journal. Write down your thoughts and feelings. This helps provide perspective on your situation and serves as an important release for your emotions.
• Arrange a telephone contact with a family member, a friend, or a volunteer from a church or senior center so that someone calls each day to be sure everything is all right. This person can help by contacting other family members with status updates or to let them know if you need anything.
• Try to set a time for afternoons or evenings out. Seek out friends and family to help you so that you can have some time away from the home. If it is difficult to leave, invite friends and family over to visit with you. Share some tea or coffee. It is important that you interact with others. (source helpguide.org)

Chronic Illnesses

There are many chronic illnesses that are of concern for older adults. Some of them tend to occur later in life like Chronic Obstructive Pulmonary Disease (COPD) while others are more likely to have their onset early in life, but become more debilitating as the person ages e.g. Multiple Sclerosis (MS). In this section we will address the chronic illnesses that are not addressed under the major page headings on the site. The illnesses that are addressed in main pages of the site include: Dementia, Alzheimer's Disease, Diabetes, Cancer, Heart Disease and Strokes. You will find some helpful information on common chronic illnesses such as: COPD, MS, Lupus Erythematosus, and Arthritis.

 

 

Competency

As people age and are confronted with illnesses and diseases that can effect the capacity for decision making the question of competency arises. A person's decision making ability can be impacted by short term factors, such as post-surgical delirium (which are quite common in older adults who undergo general anesthetic), or by long term factors such as progressive dementia.

The subject of competency comes up most often when an important decision needs to be made (e.g., consent for an important medical procedure or the decision to continue to drive) and there is some dispute about whether the person in question can make the determination appropriately. Today, in most states there are provisions that allow an individual to designate a person, or agency, to make these important choices for them if they are unable to make them for themselves. The process of assigning another to make important decisions for an individual is most often referred to as a Power of Attorney. An individual can also make some important decisions ahead of time using a Living Will or POLST form.

When there is a dispute between an individual's choice and what medical professionals, or family members, believe is in the person's best interests the question of competency can be brought to the courts. In most states a judge is the only entity with the power to supersede an individual's right to choose by declaring the person incompetent to do so. In making this important determination a judge will often rely on the expert testimony of medical professionals. Medical doctors, and other healthcare professionals, can play an important role in helping the judge make these difficult decisions. In the case of older adults it is often helpful to have neuropsychological testing to help delineate the person's cognitive strengths and weaknesses.

Consumer Protection

The elderly are often targeted by fraud perpetrators. Private information should never be given out to a person or organization that has contacted you even if they sound legitimate. Fear, intimidation, and enticement are often used to gain access to private information or to obtain funds. Often fraudulent organizations will ask for a small sum of money as a processing fee for some large gift, inheritance, tax refund, or other cash prize.

Counseling

People of all ages can benefit from counseling. Older adults who are experiencing significant or abrupt changes which may be causing disruptions in their lives can especially benefit from counseling. Mental health professionals who have experience working with geriatric issues can help an older adult learn to adjust to the losses/changes that have occurred and to acquire effective coping skills to improve mood. Developing a relationship with a mental health counselor can help older adults and their caregivers identify the things that may be out of balance and causing pain, sadness or stress. A counselor can also help individuals identify the skills that have been used in the past to manage these challenges and help improve the effectiveness with which these skills are used. Counselors help clients recognize and amplify their strengths and abilities while exploring the possibilities for personal development and community participation. Counseling services are often covered by Medicare and other commercial insurances. Please refer to these Resources for more information.

Frequently Asked Questions

How can I benefit from counseling?

Counseling has different effects for each individual, but a common desire is to just feel better emotionally and more content with life’s changes. Often people benefit from counseling by: *improving coping skills *practicing positive thinking *creating and achieving short and long term goals *working on relationships with others *increasing motivation to participate *identifying desires and needs

Will my information become part of my medical records?

A written release of information must always be signed by the client prior to exchanging information with other healthcare providers.

Will my relatives, friends or spouse be notified that I am in counseling?

Confidentiality is a key component in the therapeutic relationship. No one will know you are in counseling unless you choose to tell them. There are some notable exceptions under which information regarding your involvement may be revealed. One is by order of the courts; the other is because State Law requires that information about communicable diseases and the abuse of a child or an older adult must be reported to authorities.

Dementia / Delirium

Dementia

The term "dementia" refers to a decline in cognitive function. Dementia is not a disease itself but rather a description of a set of symptoms that can be caused by several different diseases or injuries. Dementia generally affects several areas of brain function including memory, attention, language and problem solving. A small number of cases of dementia can be reversed depending on the cause. Careful evaluation is necessary to identify the cause of dementia.

Higher mental functions (e.g., complex problem solving) are usually affected first in the process. In the later stages of the condition, affected persons may be disoriented in time (not knowing what day of the week, day of the month, month, or even what year it is), in place (not knowing where they are), and in person (not knowing who they are or others around them).

Symptoms of dementia can be classified as either reversible or irreversible, depending upon the etiology of the disease. Less than 10 percent of cases of dementia are due to causes which may presently be reversed with treatment. Causes include many different specific disease processes, in the same way that symptoms of organ dysfunction such as shortness of breath, jaundice, or pain are attributable to many etiologies. Without careful assessment of history, the short-term syndrome of delirium can easily be confused with dementia, because they have many symptoms in common. Some mental illnesses, including depression and psychosis, may also produce symptoms which must be differentiated from both delirium and dementia.

Delirium

Delirium is an acute and relatively sudden decline in attention-focus, perception, and cognition.  Delirium is not the same as dementia (the two entities have different diagnostic criteria), though it commonly occurs in demented patients.

Delirium may be of a hyperactive variety manifested by 'positive' symptoms of agitation or combativeness, or it may be of a hypoactive variety (often referred to as 'quiet' delirium) manifested by 'negative' symptoms such as inability to converse or focus attention or follow commands. While the common non-medical view of a delirious patient is one who is hallucinating, most people who are medically delirious do not have either hallucinations or delusions. Delirium is commonly associated with a disturbance of consciousness (e.g., reduced clarity of awareness of the environment). The change in cognition (memory deficit, disorientation, language disturbance) or the development of a perceptual disturbance, must be one that is not better accounted for by a pre-existing, established, or evolving dementia. Usually the rapidly fluctuating time course of delirium is used to help in the latter distinction.

Delirium itself is not a disease, but rather a clinical syndrome (a set of symptoms), which result from an underlying disease or new problem with mentation. Like its components (inability to focus attention, confusion and various impairments in awareness and temporal and spatial orientation), delirium is simply the common symptomatic manifestation of early brain or mental dysfunction (for any reason).

Without careful assessment, delirium can easily be confused with a number of psychiatric disorders because many of the signs and symptoms are conditions present in dementia, depression, and psychosis. Delirium is probably the single most common acute disorder affecting adults in general hospitals. It affects 10-20% of all hospitalized adults, and 30-40% of elderly hospitalized patients and up to 80% of ICU patients.

Treatment of delirium requires treatment of the underlying causes. In some cases, temporary or palliative or symptomatic treatments are used to comfort patients or to allow better patient management (for example, a patient who, without understanding, is trying to pull out a ventilation tube that is required for survival).

Etiology of Dementia

Alzheimer's disease is the most common cause of progressive dementia accounting for about 60% of all cases. There are a number of other illnesses that can result in symptoms of dementia. Some of these include: Vascular Dementia (multiple strokes) Korsakoff's Disease, Huntington's Disease (also Huntington's Chorea), Picks Disease and Creutzfeldt-Jakob disease (human spongiform encephalitis).

Vascular dementia

Vascular dementia, also known as vascular cognitive impairment, is second only to Alzheimer's Disease in cases of dementia in the elderly population.  Vascular dementia is caused by an interruption of blood flow to the brain often caused by mini-strokes.  Some symptoms of vascular dementia are as follows: 1) memory problems 2) slurred speech 3) emotional lability 4) loss of concentration 5) difficulty handling money 6) dizziness 7) wandering.

Korsakoff's Disease

Wernicke's encephalopathy is a degenerative brain disorder caused by the lack of thiamine (vitamin B1). It may result from alcohol abuse, dietary deficiencies, prolonged vomiting, eating disorders, or the effects of chemotherapy. Symptoms include mental confusion, vision impairment, stupor, coma, hypothermia, hypotension, and ataxia. Korsakoff's amnesic syndrome-a memory disorder-also results from a deficiency of thiamine, and is associated with alcoholism. The heart, vascular, and nervous system are involved. Symptoms include amnesia, confabulation, attention deficit, disorientation, and vision impairment. The main features of Korsakoff's amnesic syndrome are the impairments in acquiring new information or establishing new memories, and in retrieving previous memories. Although Wernicke's and Korsakoff's may appear to be two different disorders, they are generally considered to be different stages of the same disorder, which is called Wernicke-Korsakoff syndrome. Wernicke's encephalopathy represents the "acute" phase of the disorder, and Korsakoff's amnesic syndrome represents the "chronic" phase.

Huntington's Disease

Huntington's Disease is a degenerative genetic disease which affects both physical and mental function. The gene that causes Huntington's has been isolated so although the disease can be detected there currently is not a cure. The physical symptoms of Huntington's are uncontrolled movements, slurred speech and difficulty swallowing. The cognitive symptoms can include memory loss, irritability, emotional lability, difficulty with decision making.

Creudzfeldt Jacobs disease

Creudzfeldt Jacobs disease (CJD) is a very rare disease which is fatal and causes rapid dementia. Some of the symptoms of CJD include speech impairment, personality change, and coordination problems. CJD is the human corollary of Bovine Spongiform Encephalitis (BSE) also called "mad cow disease."

Dental Services

Your teeth can last a lifetime with proper home care and regular dental checkups. Even if you brush and floss regularly, you may face certain issues in your senior years when it comes to your oral health.  Wearing dentures, taking medications and general health conditions are some of these issues.

Try an anti-sensitivity toothpaste: Sensitivity can be an increasing problem as one ages. Your gums naturally recede over time, exposing areas of the tooth that are not protected by enamel. These areas are particularly prone to cold or hot foods or beverages, cold air, sweet and sour drinks and foods.    If the problem persists, it could be an indication of a cavity or a cracked or fractured tooth; a visit to your dentist is highly recommended for evaluation or treatment. 

Dry mouth is very common in seniors, and may be caused by medications (such as antihistamines, decongestants, pain killers, diuretics, high blood pressure medications and antidepressants) or certain medical disorders. If left untreated, it can damage your teeth.  There are various methods to restore moisture in your mouth, as well as appropriate treatment and medications. 

Existing health conditions such as diabetes, heart disease, or cancer, can affect your oral health. Patients with uncontrolled diabetes do not heal quickly after oral surgery or other dental procedures because blood flow to the treatment site can be impaired. People with diabetes who frequently take antibiotics are especially prone to develop a fungal infection of the mouth and tongue. Be sure to keep your dentist well informed about any health issues or medical treatment you might be undergoing so special needs are taken into consideration prior to dental procedures, if required. An example of these requirements is antibiotic premedication prior to dental treatment for patients with certain heart conditions to prevent Infective Endocarditis. IE is an infection of the heart's inner lining or valves which results when bacteria enter the bloodstream and travel to the heart. 

The American Heart Association's latest guidelines recommend preventive antibiotics prior to a dental visit for patients with:
   -- artificial heart valves
   -- a history of infective endocarditis
   -- certain specific, serious congenital (present from birth) heart conditions
   -- a cardiac transplant that develops a problem in a heart valve 

Dentures can make life easier for many seniors, but they require special care. An annual checkup is recommended for long-term denture wearers. 

Crowns and bridges are used to strengthen damaged teeth, replace missing ones or improve their appearance, shape or alignment. As with dentures, they require special homecare and annual checkups. 

Gum disease (periodontal disease) is a potentially serious condition that can affect people of all ages, but especially people over 40.  Among some factors that increase the severity of periodontal disease are bad diet, poor oral hygiene, systemic diseases (such as diabetes, heart disease, cancer, etc), environmental factors (such as stress and smoking) and certain medications that can influence gum condition (such as Dilantin). 

Regular dental checkups can ensure detection and treatment of early stages of gum disease when it is still reversible. 

Prevention is a key factor in oral health. The CDC, Centers of Disease Control, states that good oral health can enhance your quality of life by decreasing oral pain, difficulty eating, edentulism (total tooth loss), use of dental prosthesis, and the use multiple medications.

Easy steps to maintain good oral health (CDC, 2006): 

• Drink fluoridated water and use fluoride toothpaste; fluoride provides protection against dental decay at all ages.
• Practice good oral hygiene. Careful tooth brushing and flossing to reduce dental plaque can help prevent periodontal disease.

• It is important to see your dentist on a regular basis, even if you have no natural teeth and have dentures. Professional care helps to maintain the overall health of the teeth and mouth, and provides for early detection of pre-cancerous or cancerous lesions.

• Avoid tobacco. In addition to the general health risks posed by tobacco use, smokers have seven times the risk of developing periodontal disease compared to non-smokers. Tobacco used in any form—cigarettes, cigars, pipes, and smokeless (spit) tobacco—increases the risk for periodontal disease, oral and throat cancers, and oral fungal infection (candidiasis). Spit tobacco containing sugar also increases the risk of cavities.

• Limit alcohol. Drinking a high amount of alcoholic beverages is a risk factor for oral and throat cancers. Alcohol and tobacco used together are the primary risk factors for these cancers.

• Make sure that you or your loved one gets dental care prior to having cancer chemotherapy or radiation to the head or neck. These therapies can damage or destroy oral tissues and can result in severe irritation of the oral tissues and mouth ulcers, loss of salivary function, rampant tooth decay, and destruction of bone.

• Caregivers should reinforce the daily oral hygiene routines of elders who are unable to perform these activities independently.

• Sudden changes in taste and smell should not be considered signs of aging, but should be a sign to seek professional care.

• If medications produce a dry mouth, ask your doctor if there are other drugs that can be substituted. If dry mouth cannot be avoided, drink plenty of water, chew sugarless gum, and avoid tobacco and alcohol.

To maintain good oral hygiene it is important to maintain regular dental visits. However, the majority of older adults do not have insurance that covers dental services. When investigating insurance plans it is recommended to research insurance plans that assist with dental services. Medicaid, a Federal-State health insurance plan designed for those of low income and/or who are disabled, provides funding for dental care. No matter what your age may be you can qualify for Medicaid as long as your meet the requirements. Medicare, a Federal-State health program for older Americans over the age of 65, does not offer dental insurance. 

 


 

 

 

Diabetes

According to the American Diabetes Association, diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes continues to be a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles. There are two major types of diabetes type 1 and type 2.

Type 1 diabetes is caused by a deficit in the production of insulin. Type 2 diabetes results when a resistance to the effects of insulin develops.

Diabetes Statistics from ADA.

Total: 23.6 million children and adults -- 8.0% of the population -- have diabetes.

Diagnosed: 17.9 million people

Undiagnosed: 5.7 million people

Pre-diabetes: 57 million people

1.6 million new cases of diabetes were diagnosed in people aged 20 years or older in 2007.

Total prevalence of diabetes

Under 20 years of age: 186,300, or 0.22% of all people in this age group have diabetes. About one in every 400 to 600 children and adolescents has type 1 diabetes.

Two (2) million adolescents (or 1 in 6 overweight adolescents) aged 12-19 have pre-diabetes .

Although type 2 diabetes can occur in youth, the nationally representative data that would be needed to monitor diabetes trends in youth by type are not available. Clinically-based reports and regional studies suggest that type 2 diabetes, although still rare, is being diagnosed more frequently in children and adolescents, particularly in American Indians, African Americans, and Hispanic/Latino Americans.

Age 20 years or older: 23.5 million, or 10.7% of all people in this age group have diabetes.

Age 60 years or older: 12.2 million, or 23.1% of all people in this age group have diabetes.

Men: 12.0 million, or 11.2% of all men aged 20 years or older have diabetes although nearly one third of them do not know it.

Women: 11.5 million, or 10.2% of all women aged 20 years or older have diabetes although nearly one quarter of them do not know it. The prevalence of diabetes is at least 2 to 4 times higher among non-Hispanic Black, Hispanic/Latino American, American Indian, and Asian/Pacific Islander women than among non-Hispanic white women.

Non-Hispanic Whites: 14.9 million, or 9.8% of all non-Hispanic whites aged 20 years or older have diabetes.

Non-Hispanic Blacks: 3.7 million, or 14.7% of all non-Hispanic blacks aged 20 years or older have diabetes.

Disability Services

According to a recent National Institute of Health fact sheet,"research demonstrates that disease and disability are not an inevitable part of aging. Disability rates can be reduced, as evidenced by data from the National Long Term Care Survey, which found that between 1982 and 1999, the prevalence of physical disability in older Americans decreased from 26 percent to 20 percent. The downward trend in disability may be in danger of reversal as obesity threatens the gains that have occurred. According to the National Health Interview Survey, the disability rate among people ages 18 to 59 rose significantly from the 1980s through the 1990s, with the growing prevalence of obesity an important factor in this trend. Obesity and overweight put people at increased risk for potentially disabling chronic diseases such as heart disease, type 2 diabetes, high blood pressure, stroke, osteoarthritis, respiratory problems, and some forms of cancer."

Discrimination

Discrimination most often refers to prejudiced behavior towards or negative treatment of a group or individual because of their status or class. The person discriminated against has personal merits that are ignored in the face of this prejudice about an attribute, such as age, disability, religion, gender, race, etc. Older adults may be subjected to discrimination because of their advanced age or because of a disability associated with an illness. They can help protect themselves from discrimination by knowing their rights. There have been several laws enacted, such as the Civil Rights Act, the Americans with Disabilities Act, and Affirmative Action, to address and prevent discrimination in personal and public situations. Another example is the Age Discrimination Employment Act of 1967 (ADEA) was enacted to prevent discrimination in the workplace against persons 40 years old and older.

1. What is age discrimination?
If you are 40 years of age or older, and you have been harmed by a decision affecting your employment, you may have suffered unlawful age discrimination. The Age Discrimination in Employment Act (ADEA) is a federal law that protects individuals 40 years of age or older from employment discrimination based on age. Here are some examples of potentially unlawful age discrimination:
• You didn't get hired because the employer wanted a younger-looking person to do the job.
• You received a negative job evaluation because you weren't "flexible" in taking on new projects.
• You were fired because your boss wanted to keep younger workers who are paid less.
• You were turned down for a promotion, which went to someone younger hired from outside the company, because the boss says the company "needs new blood."
• When company layoffs are announced, most of the persons laid off were older, while younger workers with less seniority and less on-the-job experience were kept on.
• Before you were fired, your supervisor made age-related remarks about you, such as that you were "over-the-hill," or "ancient."
If any of these things have happened to you on the job, you may have suffered age discrimination.

2. Which federal law(s) cover older workers?
The Age Discrimination in Employment Act (ADEA) protects individuals who are 40 years of age or older from employment discrimination based on age. The Older Workers Benefit Protection Act of 1990 (OWBPA) amended the ADEA to specifically prohibit employers from denying benefits to older employees.
While an older worker is also covered by several other workplace laws, these are the main federal laws which specifically protect older workers against discrimination based on age. Age discrimination may be accompanied by other forms of illegal discrimination as well, such as sex, race, or disability discrimination.
The laws of most states also make it illegal to discriminate on the basis of age. For more information, see our page on state age discrimination laws.

3. Who is covered by age discrimination laws?
Workers who are 40 years of age or older are protected from employment discrimination based on age by the ADEA, if the employer regularly employs 20 or more employees.
Many states also make it illegal to discriminate on the basis of age; however, the minimum number of employees needed to bring a claim varies. For more information, please see our page on the minimum number of employees needed to file a claim under your state law.
If two workers are both protected by the ADEA, an employer still may not use age as the basis for an employment decision. For example, a company can't hire a 45-year-old over a 62-year-old simply because of age; if the company hired the younger employee due to her age, the 62-year-old employee would still have a claim.
The ADEA's protections apply to both employees and job applicants. If you are a current employee over 40 and are fired or not promoted due to age, you are protected. If you are not hired due to age, you are also protected.

4. Which employers are covered by the law?
The ADEA applies to employers with 20 or more employees, including state and local governments. It also applies to employment agencies and to labor unions, as well as to the federal government. The ADEA does not apply to elected officials or independent contractors. A number of court decisions have determined how to count the number of employees, so you may need to consult with an attorney to determine whether you are covered if your company employs approximately 20 employees.
If your workplace has fewer than 20 employees, you may still be protected under the laws of some states, even though your employer is not covered by the federal ADEA. For more information, please see our page on the minimum number of employees needed to file a claim under your state law.
While the ADEA states that state employees are covered under its protections, recent U.S. Supreme Court decisions have limited the ability of state employees to sue their employers for money damages (see question 15). If you are a state employee who has suffered age discrimination, you may need to discuss your individual situation with an attorney to figure out how best to proceed.

5. Are all older workers protected under the law?
No. The ADEA contains several exceptions:
• Executives or others "in high policy-making positions" can be required to retire at age 65 if they would receive annual retirement pension benefits worth $44,000 or more.
• There are special exceptions for police and fire personnel, tenured university faculty and certain federal employees having to do with law enforcement and air traffic control. If these exceptions may apply to you, check with your personnel office or an attorney for details.
• The ADEA makes an exception when age is an essential part of a particular job -- also known by the legal term "bona fide occupational qualification" or BFOQ. For example, if a company hires an actor to play the role of a 10-year old, or a teen's clothing store needs models, the ability to appear youthful is a necessary part of the job, or a BFOQ.

6. What forms of discrimination or unfair treatment are illegal?
Under the ADEA, it is unlawful to discriminate against a person because of his or her age with respect to any term, condition, or privilege of employment -- including, but not limited to, hiring, firing, promotion, layoff, compensation, benefits, job assignments, and training. As a result, the following practices are also illegal:
• An employer cannot retaliate against an individual for opposing employment practices that discriminate based on age or for filing an age discrimination charge, testifying, or participating in any way in an investigation, proceeding, or litigation under the ADEA.
• An employer may not include age preferences, limitations, or specifications in job notices or advertisements. As a narrow exception to that general rule, a job notice or advertisement may specify an age limit in the rare circumstances where age is shown to be a "bona fide occupational qualification" (BFOQ) reasonably necessary to the essence of the business (see question 5).
• Apprenticeship programs, including joint labor-management apprenticeship programs, generally may not discriminate on the basis of an individual's age. Age limitations in apprenticeship programs are valid only if they fall within certain limited exceptions; consult with an attorney if this may affect you.
• Nothing in the ADEA specifically prevents an employer from asking an applicant's age or date of birth. However, because such inquiries may deter older workers from applying for employment or may otherwise indicate possible intent to discriminate based on age, requests for age information will be closely scrutinized to make sure that the inquiry was made for a lawful purpose, rather than for a purpose prohibited by the ADEA.

7. What are valid reasons for an employer to fire an older worker?
Under the ADEA, there has to be a valid reason -- not related to age -- for all employment decisions. Examples of valid reasons would be poor job performance by the employee or an employer's economic trouble. In the case of layoffs, a company cannot use age as the basis for determining who is laid off and who is kept on. If most people who are laid off are 40 or older, and the majority of workers kept on are younger, there may be a basis for an ADEA complaint or lawsuit, especially if the employer has hired younger workers to take the places of workers over 40.

8. Is age ever a qualification for a certain job?
Yes, in very limited circumstances. The ADEA makes an exception when age is an essential part of a particular job -- also known by the legal term "bona fide occupational qualification" or BFOQ. For example, if a company hires an actor to play the role of a 10-year old, or a teen's clothing store needs models, the ability to appear youthful is a necessary part of the job, or a BFOQ. However, an employer who sets age limits on a particular job must be able to prove the limit is required because a worker's ability to do the job after a certain age is actually diminished.
 
9. Can I be turned down for a job because I am "overqualified?"
It depends. The ADEA only prohibits discrimination based upon age. Although increased age most often correlates with more skills and experience in the workplace, an employer is not required to hire the most qualified or experienced person for a particular position if the company believes that person's skills and experience are not the best match for the position. While some believe the explanation that a worker is "overqualified" is in essence a codeword for age discrimination, an employee would need to prove that the employer was motivated by the worker's age, rather than a valid reason other than age.
However, it would be unlawful for the company to refuse to hire an experienced individual based on the assumption, solely based on the applicant's age and lacking proof, that because they have more experience and/or skills than the position requires, the older employee might become bored and leave the job after only a short time. This is an example of the kinds of ageist stereotypes that can cause employers to discriminate against older workers.

10. Can I be fired or not hired because a younger employee costs the company less?
It depends. A valid reason other than age a company may use to justify the hiring of a younger worker is that the younger worker has less experience and a lower salary history, and may be willing to work in the same job for a lower salary than the older worker. If the company bases the hiring decision on this reason, it is not illegal.
However, an older worker cannot be terminated on the basis that the company either currently or in the near future will be required to pay retirement benefits or more costly insurance benefits (see the next section).

11. Can I be fired to stop my pension benefits from vesting or because my health insurance is more costly?
Firing workers in order to prevent them from earning their promised pensions is a technique some employers use to save money, but it is not legal. When the Older Workers Benefit Protection Act (OWBPA) was passed in 1990, it became clearly illegal for employers:
• to use an employee's age as the basis for discrimination in benefits, and
• to target older workers for their staff cutting programs on the basis that benefits were too costly.
An employer cannot terminate an older worker on the basis that benefits are too costly. The company must follow the "equal benefits or equal cost" rule, by providing either equal benefits to older and younger workers, or paying the same benefit costs for all employees. The law only allows an employer to reduce benefits based on age only if the cost of providing the reduced benefits to older workers is the same as the cost of providing benefits to younger workers. In other words, if an employer pays only $100 in monthly premiums for each worker, this policy does not violate the ADEA even if it causes the older worker to make a higher employee contribution or to have lesser benefits than a younger worker.
An employer could not, however, refuse to pay for the health benefits of all workers over 55 on the grounds that "it costs too much," if the employer pays the benefits of younger workers, or terminate all older workers so that the pool of employees for insurance purposes is less costly to insure.

12. Can an employer ask my age on a job application?
Nothing in the ADEA specifically prevents an employer from asking an applicant's age or date of birth. However, because such inquiries may deter older workers from applying for employment or may otherwise indicate possible intent to discriminate based on age, requests for age information will be closely scrutinized to make sure that the inquiry was made for a lawful purpose, rather than for a purpose prohibited by the ADEA.

13. Can my employer make me retire?
As long as an employee is performing his or her job duties, generally the answer is no. If an employee can no longer perform his or her job duties, however, the employer is allowed to discharge that person.
The ADEA does have special exemptions for police and fire personnel, tenured university faculty and certain federal employees having to do with law enforcement and air traffic control. Executives or others "in high policy-making positions" can be required to retire at age 65 if they would receive annual retirement pension benefits worth $44,000 or more. If these exceptions may apply to you, check with your personnel office or an attorney for details.
However, in an effort to save the company money or to reduce the size of the workforce without resorting to involuntary layoffs, employers will often offer older employees early retirement. Offering voluntary early retirement does not violate the ADEA. In exchange for increased retirement benefits or severance, employers may ask employees to waive their rights under the ADEA. In order to be legally effective, the waiver you are asked to sign must follow certain requirements (see next section).

14. Can I be asked to sign something waiving my legal rights?
If asked by your employer, you may agree to waive your rights or claims under the ADEA. However, the ADEA, as amended by OWBPA, requires that a waiver be knowing and voluntary. The law sets out specific minimum standards that must be met in order for a waiver to be considered valid.
Among other requirements, a valid ADEA waiver:
• must be in writing and be understandable. This means that if you only had a conversation with your boss about what will happen when you leave the company, without anything being put in writing, you have not waived your right to pursue an ADEA claim.
• must specifically refer to ADEA rights or claims. Some companies use what is called a "general release," where you agree to waive any and all claims against the company without the types of claims being specified. While this may be valid in other situations, it will not be legally sufficient to waive your ADEA claims.
• may not waive rights or claims that may arise in the future. This means you can agree to waive your right to sue for something that already happened, but you cannot waive your right to sue for something that hasn't happened yet. For example, you can waive your right to file a claim over your termination, but if a few years later, your employer reduces your retirement benefits, you still may be able to file a claim over that.
• must be in exchange for valuable consideration. This is a legal term that means that you must receive something in exchange for signing that you would not have received otherwise, like a larger severance package or additional benefits. If you were entitled to certain benefits anyway, and did not receive anything additional in return for signing a waiver, it is not valid under the ADEA.
• must advise you in writing to consult an attorney before signing the waiver. While you do not have to actually consult with an attorney, and may choose not to, you must have been advised in writing to consult an attorney.
• must provide you with at least 21 days to consider the agreement and at least 7 days to revoke the agreement after signing it. If you are presented with a waiver that you must sign immediately without the time to consider it properly and/or consult with an attorney, you cannot lose your rights under the ADEA. If you have signed something that you were only given a few days (or few hours) to consider, and you suspect that you are a victim of age discrimination, you should consult with an attorney to see whether your waiver is valid or not.
In addition, if an employer requests an ADEA waiver in connection with an exit incentive program or other employment termination program, the minimum requirements for a valid waiver are more extensive. For example, if the offer is being made to a group or class of employees, your employer must inform you in writing how the class of employees is defined; the job titles and ages of all the individuals to whom the offer is being made; and the ages of all the employees in the same job classification or unit of the company to whom the offer is not being made. This allows you to have relevant information, that you might not know otherwise, about how the offer affects older workers compared to other workers in the company. You should consult with an attorney to determine whether the waiver you have signed has complied with the more extensive requirements.
The U.S. Supreme Court has also ruled that you may challenge the validity of the waiver without first giving back the money you received in exchange for the waiver. Prior to this decision, based on the law generally applicable to other kinds of contracts, if you had accepted the money, you were considered to have "ratified" the waiver, or to have consented to the company's violation of the law in exchange for the money you received. This prevented older workers, who may have already spent all or part of the money before they learned that the waiver was illegal, from being able to challenge illegal waivers under the OWBPA.
 
15. Are governmental employees covered?
Under the ADEA's language, which Congress passed in 1967, the law specifically protected state government employees as well as federal, private sector and union employees. This meant that, just like other workers, state employees could sue their employers -- the states for which they worked -- for age discrimination.
However, the U.S. Supreme Court in January of 2000 ruled that state employees were not allowed to use the ADEA's provisions which allow employees who successfully sued their employers to recover money for back wages and other monetary losses. In the case of Kimel v. Florida Board of Regents, (No. 98-791, decided January 11, 2000), the Court held that Congress did not have the authority to authorize certain kinds of age discrimination lawsuits against states.
Thus, if you are a state employee, the ADEA no longer protects you from age discrimination. However, you may be protected by the laws of the very state that is discriminating against you. If you are a state employee who has suffered age discrimination, you may need to discuss your individual situation with an attorney to figure out how best to proceed.

16. Who enforces the law?
The Equal Employment Opportunity Commission (EEOC) is the federal governmental agency responsible for investigating charges of job discrimination related to an individual's age in workplaces of 20 or more employees. Most states have their own agencies that enforce state laws against discrimination (see question 18 below).
 
17. What are the remedies available to me?
Victims of age discrimination can recover remedies to include:
• back pay,
• hiring,
• promotion,
• reinstatement,
• front pay,
• liquidated damages (up to twice the amount of back pay) may be awarded in the event of a "willful" violation, if the employee proves that employer knowingly violated the ADEA or acted in "reckless disregard" of its provisions,
• other actions that will make an individual "whole" (in the condition she or he would have been but for the discrimination).
Remedies also may include payment of:
• attorneys' fees,
• expert witness fees, and
• court costs.
An employer may be required to post notices to all employees addressing the violations of a specific charge and advising them of their rights under the laws EEOC enforces and their right to be free from retaliation. Such notices must be accessible, as needed, to persons with visual or other disabilities that affect reading.
The employer also may be required to take corrective or preventive actions to cure the source of the identified discrimination and minimize the chance of its recurrence, as well as discontinue the specific discriminatory practices involved in the case. Your state law may allow for greater or different remedies than federal law. For more information, see our page on state age discrimination laws.

 

Diversity

As a relatively young country with a rich history of substantial immigration the United States of America thrives on diversity. America, like no other country has a synthesis of the world’s varied races, religions, and cultures. The coming together of cultures in America is so unique and exceptional that citizens can be as proud of their original cultural heritage as they are to be an American. Without its rich mixture of religions, races, and cultures, America would not be the great nation that it is today. Founded upon the basis of equality and freedom for all, America acts as a stage where intensely different cultures not only coexist peacefully, but also thrive and create a nation.

Doctors

As we age the frequency with which we will encounter physicians and other medical providers tends to increase.  Along with increased frequency there are also special needs that arise that are related to the aging process.  The following, from the American Geriatrics Society helps explain how the medical community is responding to the special needs of older adults.

Geriatrics and the Role of the Geriatrician

Geriatrics is the branch of medicine that focuses on health promotion and the prevention and treatment of disease and disability in later life.

A geriatrician is a medical doctor who is specially trained to prevent and manage the unique and, oftentimes, multiple health concerns of older adults. Older persons may react to illness and disease differently than younger adults. Geriatricians are able to treat older patients, manage multiple disease symptoms, and develop care plans that address the special health care needs of older adults.

Generally, geriatricians are primary care physicians who are board-certified in either Family Practice or Internal Medicine and have also acquired the additional training necessary to obtain the Certificate of Added Qualifications in Geriatric Medicine. There are approximately 9,000 geriatricians in the U.S. In addition, there are several hundred osteopathic physicians (DO) certified in geriatrics, as well as some 2,400 board-certified geropsychiatrists (a psychiatrist trained to deal with the mental health needs and specific syndromes faced by older adults). Other health care professionals who work on a geriatrics team, such as nurses, pharmacists and physical therapists, may have advanced training and hold special certifications in geriatrics.

Geriatrics: The Team Approach

There are other trained health professionals who specialize in caring for older adults. In some situations, a team of health care professionals will work together in the medical evaluation of an older patient. The geriatrics team may include, in addition to the geriatrician, any or all of the following professionals:

• Geriatrician
• Nurse
• Social worker
• Nutritionist
• Physical therapist
• Occupational therapist
• Consultant pharmacist
• Geropsychiatrist

These specialists look at the person holistically. The team considers the person's medical history and present health condition. The team also looks for the effects of past illnesses, as well as "geriatric syndromes" - common health concerns found in the frail elderly such as incontinence, frequent falls, memory problems, and the side effects caused by multiple medications.

Members of the geriatrics team look at many aspects of the patient's life. They evaluate the social support available to a patient, usually a spouse, children or friends, and his or her living and community conditions. The team also considers the patient's ability to perform activities of daily living (ADLs), such as bathing, dressing and eating. While the geriatrician often serves as the "point person," each member of the geriatrics team is a skilled health professional. All play an important role in the proper assessment and care of an older patient.

Who Needs to See a Geriatrician?

People over the age of sixty-five have different degrees of disability and illness. Some have no problems at all, while others have many serious health concerns.

While primary care physicians - general internists and family physicians - care for most older persons, geriatricians are often sought to provide consultations for the frailest of older persons because of their unique qualifications and training. Geriatricians frequently provide the primary care for older adults who have complicated medical and social problems.

Regardless of an older person's age, a geriatrician should be consulted when:

• An older person's condition causes considerable impairment and frailty. These patients tend to be over the age of 75 and coping with a number of diseases and disabilities, including cognitive (mental) problems; or
• Family members and friends are feeling considerable stress and strain as caregivers.

Education Opportunities

Research indicates that continued education has a positive impact on aging. Cognitive functioning reportedly decreases more slowly with higher levels of education, and there is evidence that maintaining an active mind can help offset some of the effects of aging on the brain. In his book Seven Strategies for Positive Aging Dr. Robert Hill states that "learning is an important Positive Aging strategy to help you remain vital in your later years." Dr. Hill goes on to write that "there is strong evidence that staying intellectually engaged helps sustain a wide array of cognitive processes including attention and memory. With the technological advances of the recent past it is easier, and more important than ever, for older adults to keep their minds active and to stay engaged in intellectual pursuits. There are many online opportunities for older adults to continue to utilize, and expand, their mental abilities.

Emergency Assistance

The increased incidence of illness and accidents about seniors highlight the need for ready access to emergency assistance services for older adults. Senior who live alone are increased needs due to the lack of someone else to call for assistance in the event of an emergency. In addition to the 911 service available in all communities, there are other emergency services are available for elderly persons. One example is the medical alert systems. These systems allow a senior to call for help using a special kind of pendant or bracelet. It is also important to be prepared ahead of time for emergencies and one important step is having necessary information readily available.

The MAYO Clinic recommends "10 things to know for an emergency" 

1- Names of their doctors. If you don't know anything else, this is probably the most important piece of information. Why? Chances are good that your parents' doctors can provide much of the rest of the information needed as well as more details about your parents' specific health histories.

2- Birth dates. Often medical records and insurance information are cataloged according to birth date. This can improve communication in an emergency or a crisis.

3- List of allergies. This is especially important if one of your parents is allergic to medication — penicillin, for example.

4- Advance directives. An advance directive is a legal document that outlines a person's decisions about his or her health care, such as whether or not resuscitation efforts should be made and the use of life-support machines.

5- Major medical problems. This includes such conditions as diabetes or heart disease.

6- List of medications and supplements. It's especially important that a doctor know if your parent uses blood thinners. It's also important for your doctor to know if your parents take any vitamin or herbal supplements that might interact with medications given in an emergency situation.

7- Religious beliefs. This is particularly important in case blood transfusions are needed.

8- Insurance information. Know the name of your parents' health insurance provider and their policy numbers.

9- Prior surgeries and major medical procedures. List past medical procedures including implanted medical devices such as pacemakers.

10- Lifestyle information. Do your parents drink alcohol or use tobacco?

Employment Assistance

Longer life spans are reflected in a work force that is staying employed longer. Government policy reflects this change as well. For example, the full retirement age for Social Security has increased from age 65 to age 67. People in the United States are working much longer than in the past.

Estate Planning

Estate planning is the process of managing and liquidating an estate in a manner consistent with the wishes and intentions of the estate owner. The goals of estate planning include making sure the greatest amount of the estate passes to the estate owner's intended beneficiaries, often including paying the least amount of taxes and avoiding or minimizing probate court involvement.  For older adults, an important consideration is also planning for incapacity.

The tools involved in estate planning include the will, trusts, beneficiary designations, powers of appointment, property ownership and other advance directives.

 

Falls & Injuries

According to the Centers for Disease Control and Prevention (CDC), unintentional falls are a threat to the lives, independence and health of adults ages 65 and older. Every 18 seconds, an older adult is treated in an emergency department for a fall, and every 35 minutes someone in this population dies as a result of their injuries.  Among older adults, falls are the leading cause of injury deaths. They are also the most common cause of nonfatal injuries and hospital admissions for trauma (CDC 2006).

Although one in three older adults falls each year in the United States, falls are not an inevitable part of aging. There are proven strategies that can reduce falls and help older adults live better and longer.

What outcomes are linked to falls?

• Twenty percent to 30% of people who fall suffer moderate to severe injuries such as bruises, hip fractures, or head traumas. These injuries can make it hard to get around and limit independent living. They also can increase the risk of early death (Alexander et al. 1992; Sterling et al. 2001).
• Falls are the most common cause of traumatic brain injuries, or TBI (Jager et al. 2000). In 2000, TBI accounted for 46% of fatal falls among older adults (Stevens et al. 2006).
• Most fractures among older adults are caused by falls (Bell et al. 2000).
• The most common fractures are of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand (Scott 1990).
• Many people who fall, even those who are not injured, develop a fear of falling. This fear may cause them to limit their activities, leading to reduced mobility and physical fitness, and increasing their actual risk of falling (Vellas et al. 1997).
• In 2000, direct medical costs totaled $0.2 billion ($179 million) for fatal falls and $19 billion for nonfatal fall injuries (Stevens et al. 2006).

Who is at risk?

• Men are more likely to die from a fall. After adjusting for age, the fall fatality rate in 2004 was 49% higher for men than for women (CDC 2005).
• Rates of fall-related fractures among older adults are more than twice as high for women as for men (Stevens et al. 2005).
• In 2003, about 72% of older adults admitted to the hospital for hip fractures were women (CDC 2005).
• The risk of being seriously injured in a fall increases with age. In 2001, the rates of fall injuries for adults 85 and older were four to five times that of adults 65 to 74 (Stevens et al. 2005)
• Nearly 85% of deaths from falls in 2004 were among people 75 and older (CDC 2006).
• People 75 and older who fall are four to five times more likely to be admitted to a long-term care facility for a year or longer (Donald et al. 1999).
• After age 75, white men have the highest fatality rates, followed by white women, black men, and black women (CDC 2006).
• White women have significantly higher rates of fall-related hip fractures than black women (Stevens 2005).
• Among older adults, non-Hispanics have higher fatal fall rates than Hispanics (Stevens et al. 2002).

 How can older adults prevent falls?

Older adults can take several steps to protect their independence and reduce their risk of falling. They can:

• Exercise regularly; exercise programs like Tai Chi that increase strength and improve balance are especially good.
• Ask their doctor or pharmacist to review their medicines—both prescription and over-the counter—to reduce side effects and interactions.
• Have their eyes checked by an eye doctor at least once a year.
• Improve the lighting in their home.
• Reduce hazards in their home that can lead to falls.

 

Financial Services

The financial demands of aging are numerous and difficult to understand and manage. Seeking volunteer or professional help with these tasks can help alleviate stress and anxiety. These financial demands may consist of:

• Paying bills
• Deposits
• Insurance and benefit claims
• Savings and investment decisions
• Tax preparation
• Other financial duties

 Seeking volunteer or professional help with these tasks can help alleviate stress and anxiety.

Additional tips in finance:

It is important to plan financially before a crisis hits. Finding a financial planner before you or your loved one become ill or disabled will help lesion the burden.

It is important to save, invest, and participate in prudent spending. If you or your loved one does not already have financial goals, then make them NOW. Setting financial goals will help to motivate one to save, help develop smart-money habits, and become your own personal planner. I you are having trouble with this on your own, it is recommended to seek professional help (bankers, accountants, and professional financial planners) to help get you going.

It may help to set up automatic payment for important, recurring bills such as water, electric, health insurance, mortgage, and other regular commitments. You can set this up so that the bills are paid electronically from your loved ones account. This will make it easier for you or your loved one to pay there bills and prevents late payments.

As a caregiver there are certain precautions you should take when trying to help your loved one with their finances:

It is important to know where your loved ones important documents are kept. These important documents could include bank and brokerage statements, wills, insurance policies, and pension records. This will give you access to the documents when needed in case of an emergency. This knowledge will help you protect your loved ones personal assets, including dividends, interest, insurance, pensions, Social Security payments, rental income, and the contents of safe deposit boxes.

It is important that you obtain access to the bank and brokerage accounts in the case of an emergency. This may include being able to write checks or withdraw funds and make arrangements through the bank to conduct transactions. Although with your loved one giving someone else their trusted caregiver access to their account could assist your loved one in case of an emergency, it may also complicate the situation. It is recommended to meet with a banker or attorney to seek advice on how to handle the financial situation.

There may come a time where it is important that you have an accurate assessment of your loved ones financial situation.  If your loved one is secretive about his or her finances it is crucial to have access to this information in case of an emergency where he or she cant get to it. This is also useful when your loved one experiences a crisis.  If your loved one is unable to pay bills or insurance due to certain experiences this information will allow you to take care of these payments for them so that the dept is not detrimental.

In some cases when the adult children are not aware of their elderly parents financial situation- when they are under the impression their elderly parents are financially secure but in reality they are struggling- if an emergency were to take place it would have a large impact on not only the aging parent but can also be a burden on the adult children and/or caregiver.

It is always helpful to have additional financial and legal advice. If your loved one has ever dealt with any bankers, lawyers, accountants, insurance agents, or financial planners in the past it may be beneficial to contact them for advice and, if necessary, further assistance.

There are also professionals that can help your loved one if they are suffering from an illness or disease. 

• Elder law attorneys- Estate planning, Medicare and Medicaid issues, insurance disputes, fraud cases, and other legal affairs affecting the elderly.
• Daily money managers- Pay bills, balance checkbooks, monitor insurance claims, and handle daily financial responsibilities for other people.
• Geriatric care managers- Help with various tasks, including money management and evaluating housing options. 

Also, remember there are FREE and low-cost assistance programs that you may be eligible for. 

• Financial counseling available to employees and their families.
• Social service agencies (state or county government agencies and private organizations)
• The local or national offices of disease-specific organizations (such as the American Cancer Society or the Alzheimer’s Association); and other membership groups.

 

 

 

 

Food and Meals

For many older adults the aging process creates challenges to eating well and getting adequate nutrition.   Challenges include access to food sources due to transportation problems, food preparation, and the tendency for appetite to wane with age. However, loss of appetite is often an early warning sign of something gone wrong.

“There’s a fair amount of evidence that suggests if you lose appetite as an older person, in the next six months, you’ll have a higher chance of dying,” said Dr. John Morley, geriatrics director at Saint Louis University Hospital, and a professor of medicine.

Despite conventional wisdom, weight loss is not a normal part of aging.  For seniors, protecting oneself from food insecurity and hunger is more difficult than for the general population.  For example, food insecure seniors sometimes had enough money to purchase food but did not have the resources to access or prepare food due to lack of transportation, functional limitations, or health problems.

 

Older adults are more susceptible to malnutrition because the stomach empties more slowly in later years, and the sight, smell and taste that used to make eating so enjoyable are diminished.           

 

Meals on Wheels Association of America

The Meals on Wheels Association of America is the largest and oldest organization in the United States representing those who provide meal services to those in need.  Their mission is to establish partnerships that will ensure the provision of quality nutritional services to seniors in need.  Some senior centers also provide free or low cost meals to seniors.

 

Causes of Senior Hunger

A 2001-2005 Population Survey data revealed that seniors were more likely to be at-risk of hunger if they were:

        ·       A young senior between the ages of 60 and 64.

·       Living at or below the poverty line.          

·       A high school dropout.    

·       African-American or Hispanic.  African-Americans were 4.2 percent and Hispanics 5.6 percent more likely to be at-risk of hunger compared to whites.           

·       Divorced or separated, or living with a grandchild. Marriage offered protection against food insecurity.

·       Seniors living with a grandchild were about 50 percent more likely to be at risk of hunger compared to those with no grandchild.

·       Renters.                  

·       Seniors without access to emotional and financial support are substantially more likely to suffer from hunger (about 50 percent more).

 

Effects of Senior Hunger

 An excerpt from The Causes, Consequences and Future of Senior Hunger in America; a study conducted by the University of Kentucky Center for Poverty Research and Iowa State University states that seniors experiencing some form of food insecurity are:

·       Significantly more likely to have lower intakes of energy and major vitamins. 

·       Significantly more likely to be in poor or fair health.                                                           

·       More likely to have limitations in activities of daily living (ADL).                                  

·       The effects of being marginally food insecure is roughly equivalent to being 14 years older.

 

Fraud / Crime Prevention

Crime Prevention

There are many fairly simple ways to help prevent crime towards older adults. Older adults are likely more easily targeted so more precaution is warranted. However, in developing precautions it is important not to develop fear. Some precautions follow:

• Install a peep hole.
• Install a security system.
• Install motion activated outside lights both front and back.
• Carry some cash, $25-$50, that you are willing to part with.
• Leave expensive jewlry at home when traveling alone or in unsafe areas.
• Join community watch programs.
• Make sure locks are easy to use and are used.
• Let family members know of plans and when to expect a check-in call.

Fraud Prevention

According to the National Consumers League's national Fraud Information Center, nearly a third of all telemarketing fraud victims are age 60 or older.  Studies by AARP show that most older telemarketer fraud victims have a hard time realizing that the person on the phone is someone trying to steal their money. 

Steps to Fraud Protection

Try to make seniors aware that illegal telemarketing is a serious crime that is punishable by heavy fines and long prison sentences. Once they realize the seriousness of the crime they may be more likely to hang up and report he fraud to law enforcement authorities. 

Explain to seniors why they may be particularly vulnerable.  Fraudulent telemarketers have been know to take advantage of the fact that:   

• It's difficult to tell whether someone is legitimate.
• Seniors tend to be trusting.
• We are all lured by the possibility of winning a valuable prize, strinking it rich, or taking an amazing vacation.  People tend to believe that it is their lucky day before questioning potential fraud.
• It is hard to hang up.  Many seniors feel as though it is rude to hang up the phone on someone. In addition, fraudulent telemarketers are trained in sales techniques that allow them to take control of the conversation. 

Help Seniors recognize the red flags of fraud. These include but are not limited to:

• A promise that you can win, make, or earn money easily.
• A demand that you act immediately or loose out on this "once in a lifetime" opportunity.
• A refusal to send you written information on the offer before you agree to buy or donate.
• An attempt to scare you into buying or doing something.
• An insistance that you wire money.
• A refusal to stop calling when you have asked them to not call you again.

It is important to be aware of when someone you love may be in trouble or a potential target of fraud.  Seniors may be in trouble if they:

• Receive inordinate amounts of mail advertising sweepstakes, prizes, free trips, potential money making opportunities
• Recieve frequent calls from telemarketers or other sales people offering great deals or asking for charitable donations
• Make repeated and/or large payments to companies in other states or countries
• Have difficuly with balancing their own checkbooks, paying utilities and other bills on time
• Subscribe to an inordinate amount of magazines
• Recieve free gifts from companies in exchange for something they bought or recveived as prizes

If you suspect fraud it can be reported to the National Fraud Information Center at 1-800-876-7060, M-F, 9 a.m. to 5 p.m., or at www.fraud.org.  The information you report to them will be transferred to law enforcement authorities. 

If you have reason to believe that fraudulent callers are repeatedly calling, it may also be necassary to change his or her phone number. 

If your loved one has fallen victim to fraudulent telemarketers and they have stolen money it is advised that the persons bank account and credit card numbers be changed.

Do-Not-Call Registry

It is important to know your "Do-Not-Call" rights.  Under federal law, you can tell a telemarketer not to cal you again.  Registering with the "Do-Not-Call" registry is free.  Call 888-382-1222, TTY 866-290-4326 from the phone number you want to register. In addition, you can also register online at www.donotcall.gov.

Funeral Services

The passing of a loved one is one is a very difficult thing for most people to manage. The emtional consequences of the loss are compounded by the many tasks that need to be completed in order for the deceased to be laid to rest. The following is a list of tasks that must be addressed when arranging for your loved one's final resting place.

1. Consult the Will of the deceased for any unique arrangements to be made.

2. Inform the following people as quickly as possible:

• The deceased's relatives and friends
• The deceased's employer
• Insurance company
• The doctor(s)
• The cemetery or memorial park (if one was specified in the Will)
• Any organizations, clubs, or unions to which the deceased may have belonged.

3. Arrange the Funeral Service (A Funeral Director can assist you with many of item choices ):

• Choose a Funeral Home (if desired)
• Arrange a meeting with the Funeral Director
• Choose a location (for example Church) if the service is to be performed elsewhere
• Decide on a time for the service
• Choose a type of service (i.e. religious, alternative, personalized, military, etc.)
• If necessary, choose clergy to officiate service
• Specify burial or cremation
• Choose a Casket or Urn
• Choose a Vault or Crypt
• Flowers
• Music
• Create the Funeral Car list
• Choose an outfit for the deceased
• Choose the following members to participate:
  • pallbearers (if necessary)
  • scripture readings (if not to be performed by clergy)
  • deliverer of eulogy (if not to be performed by clergy)
• Provide relevant information (i.e. surviving family members, location of services, etc.) for the newspaper and online notices
• Specify a Charity for donations in lieu of flowers
• Ensure that multiple copies of the "Proof of Death" are ordered (for life insurance claims, survivor's benefits, etc.)
• Make arrangements for a caterer or friends and family to help if you are having a gathering after the services
• Organize room and board for out-of-town relatives and friends

4) The following information will be required in order to request/process "Proof of Death" certificate:

• Name, home address and telephone number of deceased
• Name of business, address and telephone number of deceased
• Occupation and title of deceased
• Deceased's Social Insurance Number
• Veterans Serial Number
• Date of Birth
• Age at time of death
• Date of death
• Location of death (i.e. City, Town)
• Place of birth
• Citizenship
• Father's name
• Father's birthplace
• Mother's maiden name
• Mother's birthplace
• Religious name (if any)

5) Assemble the following documentation for the executor:

• Will, Living Will
• Trust(s)
• Birth certificate
• Social Insurance Number
• Marriage license
• Citizenship
• Insurance policies (life, health, accident, property)
• Bank statements
• Deeds to real estate
• Vehicle Ownership
• List of all assets (i.e. stocks, mutual funds, bonds)
• List of pension and retirement accounts (RRSP, RRIF)
• List of all living relatives
• Contract for the Cemetery or Memorial gardens
• CPP Benefits
• Veterans discharge certificate

Guardianship

Webster’s dictionary defines a Guardian as a person who guards or keeps safe and secure a minor child or an adult whom the law regards as incompetent to manage his or her own affairs. Legally, a Guardian is “one who has, or is entitled to, the care and management of the person or property, or both.”

Guardianship, then, is a legal relationship between a competent adult (Guardian) and an incompetent adult or minor child (Ward). Guardianship transfers rights and powers from the Ward to the Guardian, so that the Guardian has the power to make decisions on the Ward’s behalf. At the same time, Guardianship creates a duty on the part of the Guardian to act in the Ward’s best interests.

Guardianship is important because it allows a responsible person to substitute judgment for someone who cannot make or communicate decisions. Even so, Guardianship should be used sparingly, precisely because Guardians have so much power.

Health and Wellness

Professional consultation from experts in exercise and nutrition can help a motivated person more effectively achieve their fitness and health goals. For those with an inclination, but only fledgling motivation, expert consultation can help increase the likelihood that they will see success soon enough to increase that motivation.

 

Hearing Loss

According to the Mayo Clinic website the gradual hearing loss that occurs as you age (presbycusis) is a common condition. An estimated one-quarter of Americans between the ages of 65 and 75 and around three-quarters of those older than 75 have some degree of hearing loss.

Over time, the wear and tear on your ears from noise contributes to hearing loss by damaging your inner ear. Doctors believe that heredity and chronic exposure to loud noises are the main factors that contribute to hearing loss. Other factors, such as earwax blockage, can prevent your ears from conducting sounds as well as they should.

You can't reverse hearing loss. However, you don't have to live in a world of quieter, less distinct sounds. You and your doctor or hearing specialist can deal with hearing loss by taking steps to improve what you hear.

 

Ten Ways To Recognize Hearing Loss

The following questions will help you determine if you need to have your hearing evaluated by a medical professional: Do you have a problem hearing over the telephone? Yes No Do you have trouble following the conversation when two or more people are talking at the same time? Yes No Do people complain that you turn the TV volume up too high? Yes No Do you have to strain to understand conversation? Yes No Do you have trouble hearing in a noisy background? Yes No Do you find yourself asking people to repeat themselves? Yes No Do many people you talk to seem to mumble (or not speak clearly)? Yes No Do you misunderstand what others are saying and respond inappropriately? Yes No Do you have trouble understanding the speech of women and children? Yes No Do people get annoyed because you misunderstand what they say? Yes No From NIDCD.NIH website

 

If you answered "yes" to three or more of these questions, you may want to see an otolaryngologist (an ear, nose, and throat specialist) or an audiologist.

The material on this page is for general information only and is not intended for diagnostic or treatment purposes. A doctor or other health care professional must be consulted for diagnostic information and advice regarding treatment.

Excerpt from NIH Publication No. 01-4913

Heart Disease

According to the Centers for Disease Control and Prevention (CDC) heart disease is the leading cause of death in the United States and is a major cause of disability. Almost 700,000 people die of heart disease in the U.S. each year. That is about 29% of all U.S. deaths. Heart disease is a term that includes several more specific heart conditions. The most common heart disease in the United States is coronary heart disease, which can lead to heart attack.

The risk of coronary heart disease can be reduced by taking steps to prevent and control those adverse factors that put people at greater risk for heart disease and heart attack. Additionally, knowing the signs and symptoms of heart attack, calling 911 right away, and getting to a hospital are crucial to the most positive outcomes after having a heart attack. People who have had a heart attack can also work to reduce their risk of future events.

CDC Fact Sheet for Men

• In 2005, 322,841 men died from heart disease, the leading cause of death for men in the United States.1 
• The age-adjusted death rate for heart disease in men was 260 per 100,000 population in 2005.1 
• About 9.4% of all white men, 7.1% of black men, and 5.6% of Mexican American men live with coronary heart disease.2 
• The average age of a first heart attack for men is 66 years.7 
• Almost half of men who have a heart attack under age 65 die within 8 years.4 
• Results from the Framingham Heart Study suggest that men have a 49% lifetime risk of developing coronary heart disease after the age of 40.4 
• Between 70% and 89% of sudden cardiac events occur in men.4 
• Major risk factors for heart disease include high blood pressure, high blood cholesterol, tobacco use, diabetes, physical inactivity, and poor nutrition.5
   
• In a large study of blood pressure treatment and control, an average reduction of 12 to 13 mm Hg in systolic blood pressure over 4 years of follow-up was associated with a 21% reduction in coronary heart disease, 37% reduction in stroke, and 13% reduction in all-cause mortality rates.6 
• Studies suggest that a 10% decrease in total cholesterol levels may reduce the development of coronary heart disease by as much as 30%

 

CDC Fact Sheet for Women

For this fact sheet, the term "heart disease" refers to the broadest category of "diseases of the heart" as defined by the International Classification of Diseases and used by CDC's National Center for Health Statistics. This category includes acute rheumatic fever, chronic rheumatic heart disease, hypertensive heart disease, coronary heart disease, pulmonary heart disease, congestive heart failure, and any other heart condition or disease.

• Although heart disease is sometimes thought of as a "man's disease," it is the leading cause of death for both women and men in the United States and women account for 51% of the total heart disease deaths. 
• Of the 1,244,123 deaths among women in 2002, 28.6% were due to diseases of the heart. 
• Awareness of heart disease as the number one killer of women:
  • Good news: According to surveys by the American Heart Association, the percentage of women who spontaneously identified heart disease as the number one killer of women increased from 30% in 1997 to 46% in 2003. 
  • Bad news: Only 13% of the women in the 2003 survey perceived heart disease as their greatest health problem. While this is an increase from the 7% level in 1997, it still reflects an attitude that heart disease is "not my problem." 
• Heart disease is often perceived as an "older woman's disease," and it is the leading cause of death among women aged 65 years and older. However, heart disease is the 3rd leading cause of death among women aged 25–44 years and the 2nd leading cause of death among women aged 45–64 years. 
• In 2002, age-adjusted death rates for heart disease were higher among black women (169.7 per 100,000) than among white women (131.2 per 100,000).

There is a range of risk for heart disease depending on family and personal health history and the treatment recommendations from a physician will depend on a woman's level of risk. Regardless of the risk level, these lifestyle modifications are recommended for all women:

• Cigarette smoking cessation
• 30 minutes physical activity most days
• Heart-healthy diet
• Weight maintenance/reduction
• Evaluation and treatment of depression

Home Care

Home Care agencies (sometimes called Personal Care agencies) provide assistance with bathing, dressing, or other personal care. The agencies listed in the Resources section of this page may also provide respite care, companionship, homemaking, supervision or home maintenance. For information regarding specific agencies, please refer to the resources section of this page.

-

Home Health Care

Home Health Care is health care or supportive care provided in the patient's home by health care professionals (sometimes referred to as skilled care).

There are many home health care agencies to choose from in the State of Utah. Many of these agencies are funded by Medicare and supplemented by Medicaid or private insurance. Please refer to the Resources on this page for more detailed information on the services provided by each agency.

To get home health care that is paid for by Medicare:

1. Your doctor must decide that you need medical care in your home, and make a plan for your care at home; and
2. You must need at least one of the following: intermittent (and not full time) skilled nursing care, or physical therapy or speech language pathology services; and
3. You must be homebound. This means that you are normally unable to leave home. Being homebound means that leaving home is a major effort. When you leave home, it must be infrequent, for a short time, or to get medical care; and
4. The home health agency caring for you must be approved by the Medicare program.

You must meet all four of these conditions for Medicare to cover home health care.

Home health care can also be provided by family and friends. Often, the term “home care” is used to distinguish non-medical care or custodial care, which is care that is provided by persons who are not nurses, doctors, or other licensed medical personnel, whereas the term “home health care”, refers to care that is provided by licensed personnel.

How to find the Right Home Health Agency

(This information was taken from the website www.healthlearns.com)

Recovering from an illness or injury can be a stressful time for both the patient and the patient’s family. That stress is compounded when chronic illness or disability is involved. Research has consistently shown that, when at all possible, recovering at home is the best option for the patient’s physical and mental health. Unfortunately, when the patient is elderly or too injured or ill to care for themselves, recovering at home is sometimes not an option.

Finding friends or family members to assist with daily tasks is not always feasible. Even when family members are in a position to assist, the burden placed on them often puts a strain on their other family relationships, as well as their career and personal life.

Right Home Health Care Agency

Finding the right agency can be a daunting task, but not impossible, says Tilly Gambill, Manager of Marketing and Communications for the American Association for Homecare.

“People often receive home health services following a hospitalization or care in other care settings. Often the hospital discharge planner or social worker provides information on home health agencies,” Gambill says. “Ask the hospital for a list of home health care agencies in your community. In some communities, there may fewer available agencies. Physicians, friends, and family can recommend home health agencies, as well.”

The family got 2 references from the hospital and one from a family friend whose father with hypertension and diabetes receives home care services weekly.

To help them select the right provider, the National Association for Home Care suggests asking the following questions:

Questions to Ask a Home Care Provider

•    What are the qualifications and experience?

•    How long has the agency been in business?

•    Is the agency evaluated and accredited by a governing agency such as The Joint Commission’s Home Care Accreditation Program?

•    Is the agency licensed by the state?

•    Can the agency provide references? Ask for a list of doctors, hospital discharge planners and former clients who have experience with the agency.

•    How does the agency protect client confidentiality?

•    Is the agency inspected by any outside organization? May I see the results of the last inspection?

•    Does the agency perform a customer satisfaction survey? May I see the results of the last survey?

Questions About Caregivers

•    What are the credentials of the caregivers who work for the agency?

•    How does the agency select and train caregivers?

•    Do caregivers work directly for the agency? How are they supervised?

•    Are caregivers subject to criminal background checks?

•    Will the same caregiver be sent to my home for each visit?

•    Are nurses or therapists required to evaluate the patient’s home care needs?

•    If so, what does this entail?

•    Do they consult the patient’s physicians and family members?

•    Is the patient’s course of treatment documented, detailing the specific tasks to be carried out by each caregiver?

•    Will the agency schedule care at any time of the day or night that my physician says is necessary?

•    Can the agency provide me with written information about the rights and responsibilities of the providers, patients and caregivers?

•    Whom should I call with questions or complaints? How will the agency respond?

Questions About Services Provided

•    Can the agency provide me with written information about the services available?

•    Is there a written plan of care for each patient?

•    Does the agency involve the patient and caregivers in designing this plan and educate them about the care provided?

•    How does the agency respond to emergencies? How long does it take to respond to calls?

•    Will the agency help me find other community services such as Meals on Wheels or homemakers services, or help find medical equipment I may need?

Questions About Financials

•    Is the agency certified by Medicare?

•    Is the agency approved or accepted by my insurance plan or supplemental insurance?

•    How does the agency handle expenses and billing?

•    Does the agency provide detailed explanations of all the costs associated with home care?

•    What resources does the agency provide to help me get financial assistance, if needed?

There are several Internet based referral companies available online. This type of service has you complete a form listing the type of services you are looking for such as home care

Finding the right person for the right job is never the easiest thing to do but hopefully these tips will help you.

Home Remodeling & Repair

As we age, it may become increasingly difficult to maintain upkeep on our homes and we may need to rely on outside contractors to help us. Finding a contractor who can provide honest work at a fair price is important. Businesses that provide services can be located via the Internet or in the phone book. It is important to find a contractor that is licensed by the state you live in.

Hospice

According to the American Cancer Society Hospice is a philosophy of care. The hospice philosophy or viewpoint accepts death as the final stage of life. The goal of hospice is to enable patients to continue an alert, pain-free life and to manage other symptoms so that their last days may be spent with dignity and quality, surrounded by their loved ones. Hospice affirms life and does not hasten or postpone death. Hospice care treats the person rather than the disease; it focuses on quality rather than length of life. It provides family-centered care and involves the patient and the family in making decisions. Care is provided for the patient and family 24 hours a day, 7 days a week. Hospice care can be given in the patients home, a hospital, nursing home, or private hospice facility. Most hospice care in the United States is given in the home, with a family member or members serving as the main hands-on caregiver.

Hospice care is suitable when you no longer benefit from active treatment and the person is expected to live 6 months or less. Hospice provides palliative care, which is treatment to help relieve suffering, but not cure the disease; its main purpose is to improve a person's quality of life. The patient,  family, and doctor decide together when hospice care should begin.

One of the problems with hospice is that it is often not started soon enough. Sometimes the doctor, patient, or family member will resist hospice because he or she feels it sends a message of no hope. However, if the person gets better or the disease goes into remission, the hospice program can be discontinued and active treatment can begin again. A person can go back to hospice care at a later time, if needed. The hope that hospice brings is the hope of a quality life, making the best of each day during the last stages of advanced illness.

Hospice care services

There are many things about hospice care that set it apart from other types of health care.

Interdisciplinary team

In most cases, an interdisciplinary health care team manages hospice care. This means that many interacting disciplines work together to care for the patient. Doctors, nurses, social workers, counselors, home health aides, clergy, therapists, and trained volunteers care for you and offer support based on their special areas of expertise. Together, they provide complete palliative care aimed at relieving symptoms and giving social, emotional, and spiritual support.

Pain and symptom control

The goal of pain and symptom control is to help a person to achieve comfort while allowing them to stay in control of your life. This means that side effects are managed to make sure that the patient is as free of pain and symptoms as possible, yet still alert enough to make important decisions.

Spiritual care

Hospice care also tends to the spiritual needs of the patient and their family. Since people differ in their spiritual needs and religious beliefs, spiritual care is set up to meet the patient's specific needs. It may include helping look at what death means, to say good-bye, or to perform a certain religious ceremony or ritual.

Home care and inpatient care

Although hospice care can be centered in the home, a patient may need to be admitted to a hospital, extended-care facility, or a hospice inpatient facility. The hospice can arrange for inpatient care and will stay involved in the treatment and with the family.

Respite care

At some point during hospice care, the family and caregivers may need some time away from intense care-giving. Hospice service may offer them a break through respite care, which is often done in 5-day periods. During this time the patient will be cared for either in the hospice facility or in contracted beds in nursing homes or hospitals. Families can plan a mini-vacation, go to special events, or simply get much-needed rest at home while the patient is cared for in an inpatient setting.

Family conferences

Through regularly scheduled family conferences, often led by the hospice nurse or social worker, family members can stay informed about the patient's condition and what to expect. Family conferences also give those involved a chance to share feelings, talk about expectations, and learn about death and the process of dying. Family members can find great support and stress relief through family conferences.

Bereavement care

Bereavement is the time of mourning after a loss. The hospice care team works with surviving family members to help them through the grieving process. A trained volunteer, clergy member, or professional counselor provides support to survivors through visits, phone calls, and/or letter contact, as well as through support groups. The hospice team can refer family members and care-giving friends to other medical or professional care if needed. Bereavement services are often provided for about a year after the patient's death.

Volunteers

Hospice volunteers play an important role in planning and giving hospice care in the United States. Volunteers may be health professionals or lay people who provide services that range from hands-on care to working in the hospice office or fundraising.

Staff support

Hospice care involves staff members who are kind and caring. They communicate well, are good listeners, and are interested in working with families who are dealing with a life-threatening illness. Yet because the work can be emotionally draining, it is very important that support is available to help staff deal with their own grief and stress. Ongoing education about the dying process is also an important part of staff support.

Coordination of care

The interdisciplinary team coordinates and supervises all care 7 days a week, 24 hours a day. This team is responsible for making sure that all involved services share information. This may include the inpatient facility, the home care agency, the doctor, and other community professionals, such as pharmacists, clergy, and funeral directors.

Hospice care settings

Hospice care is defined not only by the services and care provided, but also by the setting in which these services are delivered. Hospice care may be provided in the home or in a special facility.

Most patients choose to get hospice care at home. In fact, more than 90% of the hospice services provided in this country are based in patients' homes.

Before making a decision about the type of program that is best for a patient and their family, it is important to know all the options and what each requires. A doctor, hospital social worker, or discharge planner can be very helpful in deciding which program is best.

Home hospice care

Many, if not all, of the home health agencies in a community, as well as independently owned hospice programs, will offer home hospice services. While a nurse, doctor, and other professionals staff the home hospice program, the primary caregiver is the key team member. The primary caregiver is usually a family member or friend who is responsible for around-the-clock supervision of the patient. This person is with the patient most of the time and is trained by the nurse to provide much of the hands-on care.

It is important to know that home hospice may require that someone be home with the patient at all times. This may be a problem if the patient lives alone, or if the partner or adult children have full-time jobs. But creative scheduling and good team work among friends and loved ones can overcome this problem. Members of the hospice staff will visit regularly to check on the patient and their family and give needed care and services.

Care begins when the person is admitted to the program, which generally means that a hospice team member visits the home to learn about the situation and needs. Return visits are set up so that your needs can be re-evaluated regularly. To handle around-the-clock patient needs or crises, home hospice programs have an on-call nurse who answers phone calls day and night, makes home visits, or sends the appropriate team member if needed between scheduled visits. Medicare-certified hospices are required to provide nursing, pharmacy, and doctor services around the clock.

Hospital-based hospices

Hospitals that treat seriously ill patients often have a hospice program. This arrangement allows patients and their families easy access to support services and health care professionals. Some hospitals have a special hospice unit, while others use a "hospice team" of caregivers who visit patients with advanced disease on any nursing unit. In other hospitals, the staff on the patient's unit will act as the hospice team.

Long term care facility-based hospices

Many nursing homes and other long-term care facilities have small hospice units. They may have a specially trained nursing staff to care for hospice patients, or they may make arrangements with home health agencies or independent community-based hospices to provide care. This can be a good option for patients who want hospice care but do not have primary caregivers to take care of them at home.

Independently owned hospices

Many communities have "freestanding," independently owned hospices that feature inpatient care buildings as well as home care hospice services. As with long-term care facility hospice programs, the freestanding hospice can benefit patients who do not have primary caregivers available at home

Hospitals

There are many full-service hospitals in most states and often a variety of hospitals offered in each county of each state. A list of major hospitals in your areas is listed in our resources section. Questions about each hospital and the services they provide can be found at their respective websites or by calling the contact number. If you have questions about the kind of care a loved one will receive, or if you have concerns about the care provided, it can often be helpful to contact the social services department. Most hospitals have clinical social workers and nursing care managers who can answer questions about your loved one's care and help you make decisions regarding aftercare.

Housing

Housing Choices: How to Determine the Best Housing

The housing needs of older adults are unique and so are the solutions.  As an adult grows older, there are often physical limitations that require families to explore options outside of living in the home.  Children or other family members should consider alternative living arrangements for their parents before their parents have an accident at home or have another event that might result in their needing to make a quick, and therefore often poorly informed decision.

There are many housing possibilities for older adults.  Options include private pay as well as subsidized living options. Subsidized housing is available to low-income residents including the elderly.  Subsidized housing can be a valuable option for seniors wanting to continue living in their own residence.  The United States Department of Housing and Urban Development subsidizes homes and apartments throughout the United States.

When considering housing options, the most common housing arrangements are:

Living with Adult Children

Parents may move into the adult child’s residence, live in an accessory apartment attached to it, or stay in Elder Cottage Housing Opportunity (ECHO) housing (a temporary cottage put up on the adult child’s property).

Homesharing

As at any age, two or more unrelated older people can share a house or apartment. Each person usually has his or her own bedroom, but they share the kitchen, other living space, and sometimes the bathroom. For an older homeowner who prefers not to live alone (or who needs the income), renting rooms in the home to other older persons is one solution. Some homesharing occurs when the older homeowner shares the home with someone in exchange for assistance with cooking, cleaning, etc.

Foster Care

Some families will take in an older person who needs some help with daily living. The foster family provides services such as cooking meals and doing laundry. Ideally, the older adult becomes a surrogate family member and receives emotional support and companionship as well as housing. Supplemental Security Insurance (SSI) may cover the cost of foster care.

Senior Retirement Communities

These communities are also called Senior Apartments or Senior Retirement Apartments. Residents who are mobile and can take care of themselves live in their own apartments in these buildings, but they share some meals in a central dining room and receive housekeeping services. The residence often provides a variety of social and recreational activities. Rental fees vary widely, and meals and other services are usually extra. There is usually no entrance fee. Some residences (subsidized congregate housing) receive public subsidies that keep rents down, but these often have long waiting lists and stringent income requirements.

Assisted Living

Assisted Living Facilities are residences that provide housing for those who cannot live independently but do not need skilled nursing care. The care in these facilities may include assistance with Activities of Daily Living (often called ADLs—this includes eating, bathing, dressing, laundry, housekeeping, and assistance with medications).  These facilities still allow the resident to live as independently as possible for as long as possible.

Assisted living exists to bridge the gap between independent living and nursing homes.  Residents in assisted living centers are not able to live by themselves but do not require constant care either.  It should be noted that Assisted Living is not an alternative to a nursing home, but an intermediate level of long-term care appropriate for many seniors. Most assisted living facilities create a service plan for each individual resident upon admission.  The service plan details the personalized services required by the resident and guaranteed by the facility.  The plan is updated regularly to assure that the resident receives the appropriate care as his or her condition changes.

 

In the State of Utah, there are two levels of Assisted Living Facilities:

Assisted Living Type I is a residential facility that provides assistance with ADLs and social care to two or more ambulatory residents who are capable of achieving mobility sufficient to exit the facility without assistance of another person.

Assisted Living Type II is a residential facility with a home-like setting that provides an array of coordinated supportive personal and health care services, available 24 hours a day, to residents who have been assessed.

 

Assisted Living is the generic term used across the country for this level of care. Other terms that may be used include: Residential, Care, Adult congregate living care, Board and care, Domiciliary care, Adult living facilities, Supported care, Enhanced care, Community based retirement facilities, Adult homes, Sheltered housing, Retirement residences.
It is important to learn the differences in care in each of these facilities as it may change by state or even by community.

 

Nursing Homes or Skilled Nursing Facilities (SNFs)

This is an option for those who need skilled nursing care and substantial, long-term assistance. This setting provides medical and personal care and meals. Bedrooms and baths may be private (although only for private-pay residents) or shared. Medicare may provide brief, short-term coverage following a hospitalization. Medicaid may offer coverage to residents who meet medical and financial eligibility requirements.

For more detailed information about Nursing Facilities, please refer to the longer explanation and discussion about Skilled Nursing Facilities on this website.

When considering housing options, here are some factors to consider:

While the choices may seem overwhelming, your parent’s stated preferences, level of need for assistance, and finances will help narrow the focus. To make an informed decision about housing, consider the facility’s Business Practices, Quality of Care and Service, Safety, Amenities, Location, Policies and Family Issues:

Business Practices

Questions to ask:
•    Is the facility currently licensed and operating legally?
•    Has its license ever been revoked, and why?
•    Are recent inspection reports available?
•    How long has it been in business?
•    Are financial records available?
•    Are references obtainable?

Quality of Care and Service

Questions to ask:
•    Do current residents appear to have their needs met?
•    Seem to be content? Interact well with the staff and owners?
•    Do staff and residents treat each other with dignity and respect?
•    Does staff take the time to listen and respond to resident needs?
•    What is the staff-to-resident ratio?
•    Are residents’ rights posted?
•    What training does the staff receive?
•    What do current residents or their relatives say about their care?

Safety

Questions to ask:
•    Does the facility have requisite safety equipment, such as fire extinguishers and smoke detectors?
•    Is there a sprinkler system (in larger facilities)?
•    Are conditions sanitary?
•    Are doors and locks secure?
•    Is someone on duty 24 hours a day, or is there an emergency call service?
•    Is a doctor available around the clock?
•    Are there any obvious hazards?
•    Are medications and medical care handled professionally?
•    Are facilities safely accessible for those with physical disabilities?

Amenities

Questions to ask:
•    Is the facility attractive and in good repair?
•    Does it have the style of living desired (private apartment, private room, private bath)?
•    Does it have the level of comfort desired (equipment, electronics, garden areas, adequate space for entertaining or hobbies, windows)?
•    What meals are provided?
•    Are the quality and quantity of meals adequate?
•    Does the food style suit your parent’s taste, nutritional requirements, and cultural preferences?
•    Are the social interactions and recreational programs appealing?

Location

Questions to ask:
•    Is it in a safe neighborhood?
•    Is it convenient for shopping, doctor visits, religious services, and social contacts?
•    Is it reasonably close to adult children’s homes?
•    Is public or private transportation provided or easily accessible?

Policies

Questions to ask:
•    Are there restrictions on behavior, such as smoking or drinking alcohol?
•    Are pets allowed?
•    Are guests (including overnight guests) welcome?
•    Are there formal visiting hours?
•    How much flexibility is there in meal times?
•    In a shared setting, how are responsibilities determined?
•    How are rate increases handled?
•    What are the facility’s discharge policies?

Family Issues

Questions to ask:
•    Will this move cause family problems?
•    If a parent and child are considering living together, can they (and the others living in the house) get along?
•    Is the space adequate?
•    Is the house equipped for the older adult?
•    Can you give the parent the attention he or she needs and expects?
•    Are your lifestyles compatible?
•    What are the advantages and disadvantages for both parties?
•    Are you comfortable with this serious commitment and reasonably sure it will work?

(Special thanks to AARP and its Web site where some of this information was found.)

Insurance Coverage

Insurance coverage is something that we all need for various reasons i.e., Life Insurance, Health Insurance, Auto Insurance.  In addition to the coverage needed by younger adults, older adults have special insurance considerations including Long-term Insurance, Medicare and supplemental/medigap plans. 

Insurance premiums may become particularly difficult to pay for low income older adults.  States can offer options to assist with those payments or to pay with health care co-payments.  See the information resources for information for additional information.

Legal Services

The Administration on Aging funds legal services programs in every state that "are designed to empower older persons to remain independent, healthy and safe within their own homes and communities as long as possible."

Throughout their later years adults may need legal services for a number of different issues  such as help with wills and estate planning, with issues related to competency, or with issues involving discrimination due to age or disability. 

Legal services are available through traditional sources as well as firms that specialize in serving older adults. Attorney's specializing in the legal needs of older adults may be certified by the National Elder Law Foundation leading to the title Certified Elder Law Attorney (CELA).  In addition there are organizations that provide legal services for free or a significantly reduced cost.  Services most often covered by a CELA include:

• Estate Planning
• Cohabitation and Pre and Post Nuptial Agreements
• Long Term Care Planning
• Comprehensive Estate and Medicaid Planning Evaluations
• Guardianship and Conservatorship Services
• Planning for People with Disabilities
• Planning for Parents of Children with Disabilities
• Tax Planning
• Real Estate Transactions

Senoir Legal Checklist

It is always usefull to create a document in which you record all important locations of information/documents such as: wills, powers of attorney, birth and marriage certificates, licenses, insurance policies, deeds, vehicle titles, checking and saving account information, investment information, names and addresses of important people, etc.  It is a good idea to provide a copy of this document to loved ones in case of an emergency. 

Find more information in our Resources section.

Long Term Care

According to the Official Medicare website Long-term care is a variety of services that includes medical and non-medical care to people who have a chronic illness or disability. Long-term care helps meet health or personal needs and can be provided at home, in the community, in assisted living or in nursing homes. Long-term care services may needed  at any age.

In 2009, about nine million men and women over the age of 65 needed long-term care.  By 2020, that number will expand to 12 million older Americans. Family and friends are the sole caregivers for about 70 percent of the elderly within the home environment.
According to the U.S. Department of Health and Human Services  people who reach age 65 will likely have a 40 percent chance of entering a nursing home, 10 percent of them will stay there five years or more.

Medicare and Long-Term Care:

While there are a variety of ways to pay for long-term care, it is important to think ahead about its financial costs.  Generally, Medicare doesn’t pay for long-term care, but pays only for a medically necessary skilled nursing facility or home health.  Patients must meet certain conditions for Medicare to pay for these types of care. Some Medicare Advantage Plans may offer limited skilled nursing facility and home skilled care coverage if it is medically necessary. 

Medicaid and Long-Term Care:

Medicaid is a State and Federal Government program that pays for certain health services and nursing home care for older people with low incomes and limited assets. In most states, Medicaid also pays for some long-term care services at home and in the community. Who is eligible and what services are covered vary from state to state. Most often, eligibility is based on income and personal resources.

Long-Term Care Ombudsman:

The long-term care ombudsman seeks resolution of problems and advocates for the rights of long-term care residents.  The goal of an ombudsman is to enhance the quality of life, the environment and the care of individuals of the long-term care services.  Each state has an Long-Term CareOombudsman who will advocate for consumers.

Medicaid

Medicaid is a medical assistance program that was established in 1965. Medicaid is financed jointly by state and federal governments and was established for low-income individuals who require assistance in paying for medical care. Although Medicaid has stringent guidelines for who qualifies, individuals may qualify for one or more of a variety of categories.  Medicaid payment go directly to the provider of services and are not paid to the Medicaid recipient.

Who is eligible for Medicaid?

In brief, the following groups of people may be eligible:

1. Adults with low incomes.
2. Pregnant women.
3. Low income children, children needing nursing home care, and teenagers living on their own.
4. Pregnant women may also be eligible for benefits.
5. Adults with low incomes who are 65 years and older or blind or disabled.
6. Terminally ill adults who need hospice care. Check with your Medicaid consultant to determine if you qualify.

How to sign up for Medicaid?

You can sign up in person or online.  To sign up in person contact the local Social Security Office or state Human Services Division to learn where the closest office is.  

Medicaid covers the following services: Ambulance, Doctor Visits, Emergency Room, Hospital, Laboratory Work, Specialists, Speech and Hearing Services.

How much income can I have and still qualify for Medicaid? It is always important to check with your Medicaid counselor as income levels vary based on family size and circumstances. However, typically to qualify, a person's income will likely be near the federal poverty level. The 'Spenddown Program' is for Individuals who are "medically needy" but don't meet income qualifications can spend down excess income, usually on medical expenses, in order to qualify for Medicaid assistance.

Doies Medicaid Cover Dental Costs?

Most states provide emergency dental services for adults, but less than 50% of states provide comprehensive dental services.  Check with your local office for eligibility.

Medical Clinics

With the growth of the older adult population, community-based elder health services are becoming critical components of the continuum of care for many health systems. These specialized health service centers for older adults, called "senior clinics," may vary widely in mission, scope of available services, background and skills of providers and overall capacity. The American Geriatrics Society has developed the following information to help you evaluate the services of the senior clinics available to you.

What is a senior clinic?

It is a group of health care providers specializing in senior care. The clinic may be part of a hospital system, a large group practice, or a smaller private practice. Locations identifying themselves as a "senior clinic" should offer a range of services custom-made for older adults.

Aren't most of my health problems just part of old age? Why would I need a special clinic?

Many people still believe old age means sickness, which is not true. The health care providers in a senior clinic should have expertise and training in diagnosing or recognizing and managing the common problems that occur with aging. They are focused on treating you as a whole person, including your physical and mental health, and your ability to function in your everyday activities.

What happens at a senior clinic?

Care is usually provided by a team consisting of two or more of these providers:

• physician, often a geriatrician
• nurse or nurse practitioner
• physician assistant
• social worker or care manager
• occupational therapist
• physical therapist
• psychologist or psychiatrist
• pharmacist
• dietitian

The team will help you with your mental and social needs, and monitor your ability to do the things you need to do everyday. They will meet regularly to check on your progress and give you advice about your care. For example, a social worker or care manager can help you and your family connect with local services. In some clinics, the team will oversee your care while you are in the hospital, a nursing home, or an assisted living facility. Senior clinics work best when you can receive care there on a regular basis. This is called primary care. The clinic may have a service that is a one-time evaluation of your health problems, but you should be able to go to the clinic for care after the evaluation. You will likely receive information and written material about your own health so you can take charge of it whenever possible.

 

What credentials should the providers have?

Physicians and nurses should have advanced education in geriatrics, and may be called nurse practitioners or clinical nurse specialists. Staff in senior clinics should also have senior sensitivity training.

How will team members know what each is doing for me?

The clinic should have a way of sharing information about your care with other people caring for you. For example, reports about your stay in the hospital should be shared with the skilled nursing facility and the team at the clinic. 

How will I know the team is doing a good job?

The clinic should give regular reports to the community and to patients about the effectiveness of the care being given. For example, the clinic might print information on the immunization rates of the clinic's patients. You should also be given the chance to tell the clinic staff how you liked the services they gave you, and the team members should have enough time to spend with you and your family to address your concerns.

How will I pay for the care?

Ask about the fees the clinic charges for its services, and find out whether or not Medicare and/or your other health insurance will pay for these services. Most clinics offered through managed care or HMO plans do not charge extra fees for their services-but again, you need to ask! There may be special financial payment plans for older adults who have limited financial resources.

Medical Equipment

Seniors can choose from hundreds of  local medical distributors — plus drugstores — to buy health supplies, equipment and devices. Even more outlets await online.

With so many choices, how do you find a good one?

Health experts advise seniors and their family members to first find out precisely what product they need and what their insurer covers.  Look carefully for a reputable vendor and only then shop for a deal. The process need not be hard. But there are consequences for picking a bad supplier of items such as diabetic test items, walkers, wheelchairs, soft goods, oxygen and medical feeding products.

Some tips

Is the product really necessary?

Did a doctor prescribe it? Don't get sucked in by ads, said Margherita Labson, who commutes between Davie and Chicago, where she is executive director of home care for the Joint Commission, which accredits providers.

"New technology is great. But do you need a new diabetes meter or do you just want one? What's it really going to do for you?" Labson said.

Which product is right for us?

If you and your doctor or counselor can identify in advance the exact product you need, shopping will be much easier. Try to check out a variety of brands. You can see whether you want a simple model or one with lots of options.

What is covered?

Insurers often negotiate deals with one or a few suppliers, giving consumers little choice. So make sure the supplier you choose is covered by your insurance. Even if you have no choice, you still can get a vote.  Call the plan to complain or praise the supplier. The feedback might influence its future choices.

Is the supplier accredited?

They don't have to be; but if they are, they have met basic guidelines. Medicare imposes 25 standards and will require all durable medical equipment firms to be accredited by Sept. 30.

Specialist or generalist?

Patients with a single condition, such as diabetes, might want a specialized supplier offering extra expertise. Those with many needs might want a supplier selling many types of items. If you must pick just one, make sure it covers all you need.

Local or mail order?

Mail-order companies might offer lower prices, but check the shipping cost, too. Also, ask whether the supplier can set up automatic refills so you don't have to reorder, said Marc Wolf, chief executive of Diabetic Care Services. Many local companies contract with a centralized warehouse which allows you to have a local contact while benefiting from the lower prices of a company that sells a huge volume.

Training and explaining.

Look for a supplier that sets up the equipment, teaches you to use it, repairs it and has backup plans for an emergency, such as a hurricane. And look for free extra services, such as the supplier billing your supplemental insurer or checking your home for risks that could cause a fall.

Many companies that offer Durable Medical Equipment (DME) related to respiratory illnesses or sleep disorders have trained staff such as a Registered Respiratory Therapist available to answer questions. Whenever possible, a trained and licensed practitioner should be available for everything from fitting a CPAP mask for sleep, for example, as well as providing expert advice regarding problems that can occur.

Be careful shopping for price.

Buying from discounters and online suppliers can save money, but make sure their products are the real thing and watch for hidden charges.

Medicare

Medicare is a Federal Insurance Program available to all individuals over 65 years of age, to certain qualified younger individuals and persons with end-stage renal disease.

Medicare Coverage is divided into three parts:

Part A is for the payment of hospital and Skilled Nursing Facility care. Most people automatically get Part A coverage without having to pay a monthly premium because they, or their spouses, paid Medicare taxes while working.

Part B is for payment of physician visits and the payment of visits with other qualified professionals. Most people pay a monthly premium for Part B.

Part C is Medicare Advantage Plans like HMOs and PPOs. Plans include Part A (Hospital) and Part B (Medical)coverage. Most also include Medicare prescription drug coverage. You pay a monthly premium for your health and prescription drug coverage.

Part D is for the payment of prescription drugs. Most people pay a monthly premium for this coverage. Some plans do not charge a premium. Please refer to the Resources on this page for a link to the official Medicare Web site.

Enrollment in Medicare is done through Social Security and can be accessed at the Social Security website.

Medications

Medications

According to the National Institute on Aging, individuals 65 and older consume more prescription and over-the-counter (OTC) medicines than any other age group. This may be because they tend to have more long-term, chronic illnesses—such as arthritis, diabetes, high blood pressure and heart disease—than do younger people.

Know Your Medications

To guard against potential problems with drugs older people must be knowledgeable about what they take and how it interacts with other drugs they are taking.  The older person, or their advocate, must partner with their physician and pharmacist to learn about possible drug interactions.  Advise health care professionals about all medications that the individual is taking, including over the counter drugs such as aspirin or antacids.

When More Isn't Necessarily Better

When prescribed and taken appropriately, drugs have many benefits: They treat diseases and infections, help manage symptoms of chronic conditions, and can contribute to an improved quality of life. Of all the problems older people face in taking medication, drug interactions are possibly the most dangerous. Polypharmacy, taking more than one drug, may result in uncomfortable or even dangerous side effects. This is especially a problem for older persons; who take an average of more than four prescription medications plus two over the counter medications.  For example, a person who takes a blood-thinning medication should not combine that with aspirin, which will thin the blood even more. Before prescribing any new drug to an older patient, a doctor should be aware of all the other drugs the patient may be taking.

Watch for Side Effects

Older people tend to be more sensitive to drugs than younger people are, due to changes in their metabolism , such a slowed digestion, liver and kidney function. They also may be more susceptible to certain side effects, such as a drop in blood pressure. For the older adult, "Start low and go slow" is good advice.

The following suggestions may also help:

•    Tell your doctor and pharmacist about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.  Assure that all your physicians know what others are prescribing, and ask one doctor (such as an internist or general practitioner) to coordinate your drugs.
•    Get all your prescriptions filled at one pharmacy. Your pharmacist can serve as a central point to maintain a list of all your medicines, and can screen for drug interactions to avoid harmful situations.
•    Keep track of side effects. New symptoms may not be from old age but from the drug you're taking.
•    Learn about your drugs. Find out as much as you can by asking questions and reading the package inserts. Both your doctor and pharmacist should alert you to possible interactions between drugs, how to take any drug properly, and whether there's a less expensive generic drug available.
•    Have your doctor review your drugs. If you take a number of drugs, take them all with you on a doctor's visit.
•    Follow directions. Read the label every time you take the medication to prevent mistakes, and be sure you understand the timing, dose prescribed, and how long to take it. Ask a pharmacist what foods to take with each drug. Some drugs are better absorbed with certain foods, and some drugs shouldn't be taken with certain foods.

Medicine and Special Needs

Arthritis, poor eyesight, and memory lapses can make it difficult for some older people to take their medications correctly. Studies have shown that between 40 percent and 75 percent of older people don't take their medications at the right time or in the right amount.

Invent a system to remember medication.  Devise a plan that fits your daily schedule. Some people use meals or bedtime as cues for remembering drugs. Others use charts, calendars, and special weekly pillboxes, and techniques such as turning medicine bottles upside down, to help them know at a glance if they have taken the medication.

Drug-taking routines should take into account whether the medication works best on an empty or full stomach and whether the doses are spaced properly. To simplify taking your medications, always ask for the easiest dosing schedule that's available for the drug you've been prescribed--just once or twice a day, for example.

Cutting Costs

For a new prescription, don't buy a whole bottle but ask for just a few pills. You may have side effects from the medication and have to switch. If you buy just a few, you won't be stuck with a costly bottle of medicine you can't take.
For ongoing conditions, buy medications in the largest quantities you can.
Comparison shop for the lowest price. Pharmacy prices can vary greatly. If you find a drug cheaper elsewhere, ask your regular pharmacist if he or she can match the price.
•    Ask for a senior citizen discount.
•    Ask your physician to prescribe a generic equivalent. These non-brand substitutes are tested to be sure they are chemically identical to the original and they deliver the same amount of the drug to the body in the same amount of time.
•    Get drug samples free. Pharmaceutical companies often give samples of drugs to physicians.
•    Buy store-brand or discount brand over-the-counter products. Ask the pharmacist for recommendations.
•    Find out about drug discount or assistance programs. site. like  your local chapter of national disease-related organizations (American Diabetes Association, etc.). Financial assistance may also be provided through the Center for Medicare and Medicaid Services if you qualify.  Ask your physician's office for drug discounts that are available.
•    Try mail order from a reputable pharmacy. Mail-order pharmacies can provide bulk medications at discount prices. Use this service only for long-term drug therapy because it takes a few weeks for delivery. 

What to Ask the Doctor

Before you leave your doctor's office with a new prescription, make sure you fully understand how to take the drug correctly. Your pharmacist can also provide valuable information about how to take your medicines and how to cope with side effects. Ask the following questions:
•    What is the name of this drug, and what is it designed to do? Is this a generic or a name-brand product?
•    What is the dosing schedule and how do I take it?
•    What should I do if I forget a dose?
•    What side effects should I expect? What should I do if I experience these side effects?
•    How long will I be on this drug?
•    How should I store this drug?
•    Should I take this on an empty stomach or with food? Is it safe to drink alcohol with this drug?

Mental Health

Mental Health is a term used to describe either a level of cognitive or emotional well-being or an absence of a mental disorder.  One excellent description of mental health comes from Dianne Hales and Robert Hales who define mental health as:

…the capacity to think rationally and logically, and to cope with the transitions, stresses, traumas, and losses that occur in all lives, in ways that allow emotional stability and growth. In general, mentally healthy individuals value themselves, perceive reality as it is, accept its limitations and possibilities, respond to its challenges, carry out their responsibilities, establish and maintain close relationships, deal reasonably with others, pursue work that suits their talent and training, and feel a sense of fulfillment that makes the efforts of daily living worthwhile.

Despite Research and Study...

Though Mental Health in older adults is a focus of much research and study currently, many older adults are not receiving proper diagnosis and care due to the stigma that is still associated with mental illness and the lack of knowledge about how to address the issue.

Knowledge is Power

Many of us may avoid discussing the issue with our parents for fear of alienating them.
Having good mental health throughout life does not ensure immunity from severe depression, Alzheimer's disease, anxiety disorders and other disorders in the senior years of life. In fact, some studies suggest that older people are at greater risk of mental disorders and their complications than are younger people.

Despite this fact, many of these illnesses can be accurately diagnosed and treated.

Mental illness facts:

•    From 15 to 25 percent of elderly people in the United States suffer from significant symptoms of mental illness.
•    The highest suicide rate in America is among those aged 65 and older. In 1985, this age group represented 12 percent of the total U.S. population, but accounted for 20 percent of suicides nationwide. That means close to 6,000 older Americans kill themselves each year.
•    Worldwide, elderly people lead the World Health Organization's list of new cases of mental illness: 236 older people per 100,000 suffer from mental illness, compared to 93 per 100,000 for those aged 45 to 64, the next younger group.
•    Severe organic mental disorders afflict one million older people in this country and another two million suffer from moderate organic disorders.
 

Depression, considered the most common mental disorder, afflicts up to five percent of people aged 65 and older. Many researchers think this is a low estimate, because depression can mimic dementia. Some experts thus estimate that as many as ten percent of those diagnosed with dementia actually suffer from depression that, if treated, is reversible.

Sadly, many of the nation's older population are reluctant to seek psychiatric treatment, which could cure or alleviate their symptoms and return them to their previous level of functioning.

 

Screening for Depression

 
How can I know when my parents are depressed?

Only a trained professional can formally diagnose Depression, but there are some telltale signs that, if present, should prompt  seeking professional help. And, while all of us may feel sad or unhappy at times, the illness of depression should not be considered just a normal part of aging.

Screening tools are available online. These tools can be used to distinguish the difference between feeling down or “blue” and being depressed by identifying the symptoms of clinical depression.  In addition, the more information we have about depression, the more likely it is that we can help our parents find appropriate treatments early on.

 

When is it Depression?

 
If you or a loved one experiences any of these symptoms of depression for more than two weeks, you should seek help.  Symptoms include: 

•    Feelings of worthlessness, hopelessness, helplessness, inappropriate guilt; prolonged sadness or unexplained crying spells; jumpiness or irritability; loss of interest in and withdrawal from formerly enjoyable activities, family, friends, work or sex.
•    Intellectual problems such as unexplainable loss of memory or the ability to concentrate; confusion and disorientation.
•    Thoughts of death or suicide; suicide attempts (seek help immediately).
•    Physical problems such as loss of appetite or a noticeable increase in appetite; persistent fatigue and lethargy; insomnia or a noticeable increase in the amount of sleep needed; aches and pains, constipation, or other physical ailments that cannot be otherwise explained.

A Word about Resistance

 
Many older people don't understand mental illnesses or acknowledge that they even exist. They feel ashamed of their symptoms or else feel that these symptoms are simply an inevitable part of aging.

Medicare, which sets the standard for health care insurance coverage, has traditionally discriminated against psychiatric care by offering a low level of benefits. Often, our older parents, their friends, those of us providing care and often their own doctors fail to recognize the symptoms of treatable mental illness in older people. They blame them on "old age" or think nothing can be done to alleviate the problem.

What Can We Do?

 

Don't ignore noticeable changes in your parent’s, or another older person's behavior or moods. These changes could be symptoms of depression, dementia, Alzheimer's disease, or other conditions for which you can get help. Seek medical and psychiatric evaluations, which can lead to treatments that can return an older person to a productive and happy life.

 

Recent Advances in Understanding Mental Health

 

The field of mental health has made many advances, particularly since 1980. These developments include an increased understanding of the brain's function through the study of neuroscience, the development of effective new medications and therapies, and the standardization of diagnostic codes for mental illnesses.

However, many questions about mental health remain unanswered, and many people around the world are unable to benefit from the knowledge and treatments that are available.

 

Few Get the Help Needed

 

Seven in ten Americans with a mental illness do not receive treatment. Biases against mental illness and lack of public awareness are among the obstacles that limit access to treatment and affect willingness to seek care. Fewer individuals with major psychiatric illnesses were institutionalized in the United States in the year 2000 than in 1980, but limited community resources had not yet met existing treatment needs.

The prevalence of dementia is rising as people are living longer, adding to the need for more resources. One of the main challenges for the field of mental health is overcoming the gap between an increasingly sophisticated understanding and treatment of mental illness and the availability of these advances to individuals and populations in need.

 

Anxiety

Recognizing an anxiety disorder in an older person poses several challenges.  Aging brings with it a higher prevalence of certain medical conditions, realistic concern about physical problems, and a higher use of prescription medications.  As a result, separating a medical condition from physical symptoms of an anxiety disorder is more complicated in the older adult.

Diagnosing anxiety in individuals with dementia can be difficult too. Agitation, typical of dementia, may be difficult to separate from anxiety. Impaired memory may be interpreted as a sign of anxiety and fears may be excessive or realistic depending on the person’s situation.

Anxiety in older adults is not well understood. Research on the course and treatment of anxiety in older adults, lags behind that of other mental conditions such as depression and Alzheimer’s. Until recently, anxiety disorders were believed to decline with age. But experts are beginning to recognize that aging and anxiety are not correlated; anxiety is as common in the old as in the young, although how and when it appears is distinctly different in older adults.

Just as with depression and other mental disorders, anxiety is an illness that needs to be diagnosed and treated by a medical and/or mental health professional. Both medication and psychosocial therapies are used to treat anxiety in older persons, although clinical research on their effectiveness is still limited. Anti-depressants rather than an anxiety medication (such as the benzodiazepines), are the most preferred medication for most anxiety disorders.

 

Dementia 

Dementia is a word for a group of symptoms caused by disorders that affect the brain. It is not a specific disease. People with dementia may not be able to think well enough to do normal activities, such as getting dressed or eating. They may lose their ability to solve problems or control their emotions. Their personalities may change. They may become agitated or see things that are not there.

Memory loss is a common symptom of dementia. However, memory loss by itself does not mean you have dementia. People with dementia have serious problems with two or more brain functions, such as memory and language.

Many different diseases can cause dementia, including Alzheimer's disease and stroke. Drugs are available to treat some of these diseases. While these drugs cannot cure dementia or repair brain damage, they may improve symptoms or slow down the disease.

Mental Health Issues in Residential Settings

The presence of mental health concerns in residential settings offers some complex challenges for the staff to manage. Residents may come into the setting with a pre-existing condition or they may develop mental illness after admission. Depression is the most common mental health concern in residential settings and Lombardo (1996) reported that the prevalence of depression among individuals residing in nursing homes ranged between 12 to 22 percent. This is significantly higher than the incidence of depression in people over 65 years who are living in the community, which is between 1 and 2 percent.

The state and federal governments have established procedures to assure that residents with mental illness get their needs met while in a residential setting. Every resident who is admitted to a nursing home with a history, or the presence of symptoms, of mental illness is evaluated through the PASARR system. There are also situations that arise where a person presents with symptoms of mental illness (e.g., excessive worrying) but they do not meet the criteria for serious mental illness used by PASARR. These individuals may still require treatment to reduce or eliminate their symptoms.

Please refer to other Web sites and resources listed on this page for additional information regarding Mental Health, Mental Illness and find support groups and informational resources available where you live.

 

Mobility

The following information was gathered from a variety of sources including: www.disabled-world.com

Mobility Issues

One of the greatest challenges facing older adults is the battle to remain mobile. Not only is a loss of mobility a blow to one's quality of life, it may have a snowball affect on one’s overall health.

For many seniors, any loss of mobility can be demoralizing, and using a walking aid may have a negative impact on one's pride.  But the more active an older adult remains, the more mobility her or she maintains.  Essentially, exercise allows older adults to maintain muscular strength as well as bone-density. Not only do these factors keep an individual upright and strong, they can help prevent—and protect from—the kind of bone fractures that result from falling in older years

.
Dealing with Compromised Mobility

Even if an individual has beenaffected by a condition affecting mobility, they are still capable of working toward keeping fit and in good health. In fact, with a little dedication and patience, anyone with limited mobility can sometimes even regain some of the lost mobility through exercise.

It has been noted that loss of mobility often leads directly to more serious health deterioration, This can be minimized with the use of durable medical equipment such as:

Canes

A simple cane can provide needed stability while also allowing one to maintain mobility for years to come.   Canes are often far more helpful and sophisticated than the canes of the past and can provide a sturdy support for walking.  

Other devices that can help an individual remain mobile are:

Walkers

A walker or walking frame is a tool for disabled or elderly people who need additional support to maintain balance or stability while walking. The person walks with the frame surrounding their front and sides and their hands provide additional support by holding on to the top of the sides of the frame. Traditionally, a walker is picked up and placed a short distance ahead of the user. The user then walks to it and repeats the process. With the use of wheels and glides, the user may push the walker ahead as opposed to picking it up. This makes it easier to use the walker, and does not require the user to use their arms to lift the walker.
A walker is a good tool for those who are recuperating from leg or back injuries, as well as those having problems walking or with mild balance problems. 

Electric or Motorized Wheelchairs

For an individual who cannot walk—even with the use of a walking device—a motorized wheelchair can be an option.  The “Wheelchair Site” offers the following descriptions of motorized wheelchairs:

Electric wheelchairs vary in ruggedness. Low-end electric powered wheelchairs have light frames that are suitable for indoor use, but that can crack, bend or  have motors die when they are used to excess in the outdoors. The latest high-priced electric wheelchairs are more rugged and reliable, with frames designed to handle more weight. Some newer electric models even have spring suspension, which allows a smooth ride over uneven territory.

• Rear-wheel drive wheelchairs are the traditional and most popular style. They are generally faster then front-wheel models but provide poor turning capabilities in comparison to front-wheel and mid-wheel models.
• Front-wheel drive wheelchairs have become more common because they provide tighter turning functions. Most front-wheel drive wheelchairs have a slightly lower top speed than rear-wheels because they tend to turn too readily at high speeds.
• Mid-wheel drive wheelchairs provide the tightest turning of all, but have a tendency to be unsteady when stopping and starting. Mid-wheel drives have caster wheels in the rear and an extra set of anti-tip wheels in front, which may limit their use on uneven surfaces.

Wheelchairs vary in price from around $1600 to $7500.  Medicare or other insurance programs will sometimes cover the cost of certain of these devices and require docotors orders.

Please refer to the Resources section of this page for information about devices that help improve and prolong mobility.

Moving/Organizing

As our parents continue to age and require more help the question of helping then move may come up.  In other situations they may just need help to get better organized so that they can access the things they need more easily.

Moving

Whether your parents are moving in with you, to a different independent living situation or moving to a residential setting (e.g. assisted living or nursing home), you have the choice to move them yourself or get professional help. 

 Organizing

There are also professionals who are skilled in the process of helping seniors get organized and of letting go of unneeded items.

Nursing Homes

A nursing home is a type of extended care facility that provides non-acute medical care to its residents.  Nursing homes are also called skilled nursing facilities (SNF) or nursing facilities (NF).   Nursing homes can serve some key roles for older adults.  An older adult can be admitted to a SNF after being discharged from an acute care hospital for further medical treatment.  These post acute admissions are often covered by Medicare, if the patient was hospitalized for at least 3 days, and can last up to 100 days.  Nursing homes can also provide respite or inpatient hospice care.  In some states nursing homes can also act as adult day care facilities without additional licensing. 

The most common role of a nursing home is for the long-term care of older adults who require some medical care or support.  The majority of long-term residents of nursing homes are funded through state Medicaid programs.  Medicaid pays approximately $130 per day for a person to reside in one of the State's licensed nursing homes.  Medicare does not pay for the long-term care of residents in nursing homes. 

Choosing a nursing home is an important decision for you and your loved ones; making sense of the information for the most appropriate facilities can be a daunting task. Medicare.gov has a useful tool that contains information about every Medicare and Medicaid-certified nursing home in the country. This information can be found at: Nursing Home Compare.  

Pain Management

Pain Management in Older Adults

The following information was taken, in part, from the web site: Drugs.com as well as from other sites including the Merck Manual of Geratrics.  For more information, please refer to the Resources section on this page.

As you become older, different changes occur in the workings of your body.  But pain is not a normal part of aging. Pain may be a sign that something is wrong with your body. 

What is Pain?

Pain is an unpleasant feeling and emotional experience related to injury or damage to the body. This is one of the most common complaints that remains poorly treated in the elderly. 

Merck describes pain as "a complex, subjective, and unpleasant sensation derived from sensory stimuli and modified by memory, expectations, and emotions. Diagnosis is by history and physical examination. Treatment may include drugs and nondrug treatments."

The Merck Manual of Geriatrics[fn]The Merck Manual of Geriatrics, third ed By Mark H. Beers, Robert Berkow, eds 2000, 1507 pp[/fn] goes on to explain:

• Because pain is very common among the elderly, all elderly patients should be asked about pain.
• Chronic pain can lead to social isolation, depression, polypharmacy, decreased functional status, and deconditioning.
• The cause of pain may be difficult to identify and may be multifactorial.
• Inadequate treatment of pain is common, particularly among the elderly.
• For chronic mild to moderate pain not due to inflammation, acetaminophen is usually preferred to NSAIDs because it is safer.
• The elderly are at increased risk of adverse effects and drug-drug interactions of analgesics. Thus, psychosocial support and nondrug treatments that reduce pain are particularly important.
• Patient and caregiver education and active caregiver involvement can help reduce pain and improve quality of life.

 What are the types of pain?

• Acute pain:  It comes on suddenly and does not last for a long period of time and can be caused be illness or injury. This usually goes away as your body heals, but may lead to chronic pain if left untreated.
• Chronic pain: This type of pain persists or grows worse over a long period of time. It may last for months or years due to a long term condition and may be pain that remains after you have recovered from an injury or illness. Chronic pain may persist even with medicine or treatment. It may not always be present but still may interfere with daily activities of daily living.

What causes pain in the elderly? Pain is often caused by more than one problem.  It may include damage to the nerves or tissues, such as skin, muscles, and internal organs. Sometimes, there is no clear or exact cause of pain. Any of the following may cause or trigger pain:

• Diseases, such as cancer, arthritis, migraines, and back problems.
• Physical injury, such as with surgery, accidents, or falls.

What other things should elderly people know about pain? All pain should be treated and can almost always be relieved.  The following are important things to know about pain and its management:

• Controlling pain is part of the whole treatment for disease.
• Pain medicines are not only for terminal diseases such as cancer and will not make a person control.
• Side effects from medicines can often be prevented and managed properly.

How can caregivers know if a person is in pain? Most adults can tell the exact location, intensity (how bad), and even the duration of their pain. But some individuals may have difficulty describing their pain; such as individuals who have dementia, brain damage, or a stroke. Others may even deny pain to show courage or escape treatment. The following are common signs to recognize if a person has pain:

• Crying, moaning, frowning, or sighing.
• Feeling sad, depressed, hopeless, aggressive, or angry most of the time.
• Noisy breathing calling out, or asking for help.
• Not changing positions very often to avoid pain, or positioning yourself in a way that it will not hurt.
• Poor appetite and eating habits, or sleeps more or sleeps less than usual.
• Pulls the part of the body that is hurting or gets upset at being touched.
• Restlessness, cannot get comfortable, and moves around a lot.

Treatment of Pain

Several types of therapy can help treat pain. Physical therapy (such as stretching and strengthening activities) and low-impact exercise, walking, swimming or biking, can help reduce pain. However, exercising too much or not at all can hurt chronic pain patients. Occupational therapy teaches how to do ordinary tasks can be done differently to avoid injury. Behavioral therapy can reduce pain through relaxation methods like meditation and yoga.
Neurosurgical treatments may also be effective in for cases of intractable pain.

 

 

Parkinson's Disease

What is Parkinson's Disease?

According to the National Institute for Neurological Disorders and Stroke (NINDS)Parkinson's disease (PD) belongs to a group of conditions called motor system disorders, which are the result of the loss of dopamine-producing brain cells. The four primary PD symptoms are tremor  in hands, arms, legs, jaw, and face; rigidity, or stiffness of the limbs and trunk; bradykinesia, or slowness of movement; and postural instability, or impaired balance and coordination. As these symptoms become more pronounced, patients may have difficulty walking, talking, or completing other simple tasks. PD usually affects people over the age of 50.  Early symptoms of PD are subtle and occur gradually.  In some people the disease progresses more quickly than in others.  As the disease progresses, the shaking, or tremor, which affects the majority of PD patients may begin to interfere with daily activities.  Other symptoms may include depression and other emotional changes; difficulty in swallowing, chewing, and speaking; urinary problems or constipation; skin problems; and sleep disruptions.  There are currently no blood or laboratory tests that have been proven to help in diagnosing  PD.  Therefore the diagnosis is based on medical history and a neurological examination and can be difficult to diagnose accurately.   Doctors may sometimes request brain scans or laboratory tests in order to rule out other diseases.

 

 Is there any treatment?

 At present, there is no cure for PD, but a variety of medications provide dramatic relief from the symptoms.  Usually, patients are given levodopa, which is converted to dopamine.  Nerve cells use levodopa to make dopamine and replenish the brain's dwindling supply.  Not all symptoms respond equally to the drug. Bradykinesia and rigidity respond best, while tremor may be only marginally reduced. Problems with balance and other symptoms may not be alleviated at all.  Anticholinergics may help control tremor and rigidity.  Other drugs, bromocriptine, pramipexole, and ropinirole, mimic the role of dopamine in the brain, causing the neurons to react as they would to dopamine.  Amantadine, and carbidopa also appear to reduce symptoms.  Rasagiline may also be used along with levodopa for patients with advanced PD or as a single-drug treatment for early PD. 

In some cases, surgery may be appropriate if the disease doesn't respond to drugs. A therapy called deep brain stimulation (DBS) has now been approved by the U.S. Food and Drug Administration. In DBS, electrodes are implanted into the brain and connected to a small electrical device called a pulse generator that can be externally programmed. DBS can reduce the need for drugs, which in turn decreases the involuntary movements called dyskinesias that are a common side effects.  It also helps to alleviate fluctuations of symptoms and to reduce tremors, slowness of movements, and gait problems. DBS requires careful programming of the stimulator device in order to work correctly. 

 

What is the prognosis?

 PD is both chronic, meaning it persists over a long period of time, and progressive, meaning its symptoms grow worse over time.  Although some people become severely disabled, others experience only minor motor disruptions. Tremor is the major symptom for some patients, while for others  it is only a minor complaint and other symptoms are more troublesome.  No one can predict which symptoms will affect an individual patient, the intensity of the symptoms also varies from person to person. 

 

What research is being done?

 

 The National Institute of Neurological Disorders and Stroke (NINDS) conducts PD research in laboratories at the National Institutes of Health (NIH) and also supports additional research through grants to major medical institutions across the country.  Current research programs funded by the NINDS are using animal models to study how the disease progresses and to develop new drug therapies. Scientists looking for the cause of PD continue to search for possible environmental factors, such as toxins, that may trigger the disorder, and study genetic factors to determine how defective genes play a role.  Other scientists are working to develop new protective drugs that can delay, prevent, or reverse the disease. 

 

Personal Care Services

Personal Care agencies (sometimes called Home Care agencies) provide assistance with bathing, dressing, or other personal care. The agencies listed in the Resources section of this page may also provide respite care, companionship, homemaking, supervision or home maintenance.

The following are a Patient's Bill of Rights from the National Association for Home Care and Hospice:

* The patient is fully informed of all patient rights and responsibilities.
* The patient has the right to appropriate and professional care relating to physician orders.
* The patient has the right of choice of care providers.
* The patient has the right to receive information necessary to give informed consent prior to the start of any procedure or treatment.
* The patient has the right to refuse treatment within the confines of the law and to be informed of the consequences of his action.
* The patient has the right to privacy.
* The patient has the right to receive a timely response from the agency to his request for service.
* A patient will be admitted for service only if the agency has the ability to provide safe professional care at the level of intensity needed.
* The patient has the right to reasonable continuity of care.
* The patient has the right to be informed within reasonable time of anticipated termination of service or plans for transfer to another agency.
* The patient has the right to voice grievances and suggest changes in service or staff without fear of restraint or discrimination.
* A fair hearing shall be available to any individual to whom service has been denied, reduced, terminated or who is otherwise aggrieved by agency action. The fair hearing procedure shall be set forth by each agency as appropriate to the unique patient situation (e.g., funding source, level of care, diagnosis).
The patient has the right to be fully informed of agency policies and charges for services, including eligibility for third-party reimbursements.
* The patient denied service solely on his inability to pay shall have the right of referral.
* The patient and the public have the right to honest, accurate, and forthright information regarding the home care industry in general and his chosen agency in particular, (e.g., cost per visit, employee qualifications, etc.).

Pet Services

Advantages of Companion Pets Mary M. Alward a freelance writer offered the following things to think about when an older adult is considering getting a pet. Companionship

Pets are great companions for elderly people who live alone and have little contact with family and friends. Pets give them a different outlook and bring laughter and love into their lives. They make seniors feel needed and keep them active seeing to the pet’s daily care.

Acceptance

Pets accept their elder owners as they are. They are devoted, forgiving and loving. They don’t hold grudges, bring up the past or stop interacting with their owners because of a difference of opinion.

Touch

Research has proven that touch is very important to the well being of humans. We all need to be hugged and be able to hug in return. A cat curled up in the lap of a senior or the friendly touch of a dog’s nose will help the elderly feel safe and secure and gives them a sense of reassurance and satisfaction. Stroking a beloved pet can lower blood pressure and lift depression.

Responsibility

By caring for a pet’s needs, such as feeding, grooming and walking, animals give seniors the incentive to maintain their own hygiene. Pets give the elderly a sense of independence, boosts self esteem and motivates them to perform daily tasks that may otherwise be ignored, such as bathing, eating and getting out of the house.

Safety and Security

Pets give the elderly a sense of security. Dogs alert them when someone comes to the door. Seniors feel safer answering the door when there is a dog present. Dogs can also alert persons who are hard of hearing to a ringing telephone or the ringing of a door bell.

Socialization

Dogs are an especially good choice for persons who need socialization. Seniors who walk their dogs get to know the people in the neighborhood. Animals help break the ice and encourage friendly conversation between people who might otherwise feel they have nothing in common. Seniors need to socialize to maintain good mental health and a pet provides them with stories to share with others.

Staying in Touch with Nature

When people lived in rural areas and were still allowed to keep chickens, ducks and other animals in cities and towns, they were constantly in touch with the natural world. Today’s society is largely urban and industrialized. Animals other than pets can only be found in petting farms and zoos. People have lost contact with nature which is always balm for the soul. Pets help seniors to stay in contact with nature and they fill voids that can otherwise lead to anxiety and depression.

Living for the Moment

Pets live for the moment. They cope with life’s ups and downs and then forget about them. Pets help the elderly to keep focused on the present and keep them in touch with the small pleasures of life. Pets take time to stop and smell the roses everyday. Seniors who have a companion pet tend to do the same. The innocence and trust of a companion pet help seniors to be less cynical toward life and to overcome feelings of isolation and rejection.

Disadvantages of Companion Pets

Pet ownership is not for all seniors. Before adopings a pet  it is important to look at every aspect of how the animal will impact their life. Let’s take a look at the disadvantages of pet ownership.

Costs

Many seniors live on a strict budget and have limited income. It will be very hard for them to incorporate food, grooming and veterinary bills into a budget that is already stretched to the limit. If you are a senior who lives on a scanty income, you may have to re-examine your desire to have a pet as a companion.

Limiting Mobility

If you enjoy traveling be sure to consider the fact that a pet needs constant care and attention. Will you be able to take your companion pet along on your trips? Can you afford to board him out or hire a pet sitter to care for him while you’re traveling? Will having a companion pet limit your mobility? Ask yourself these questions and answer them honestly. You may have to re-evaluate the idea of bringing a companion pet into your life, depending on where your priorities lie.

Pet and Disease

Pets can carry disease. Though they are not usually transmitted to humans,  people who are frail or who have a weak immune system may be susceptible. Seniors who fall into these categories should discuss the possibility of adopting a companion pet with their doctor.

The Pet’s Future

Some seniors prefer not to adopt a companion pet in case they become ill and cannot care for it at some point. It’s possible to have an alternative care provider to make arrangements for the pet’s care in case of infirmity or death. Individuals should specify who their pet should go to in their will to assure the pet’s future is secure.

Death of a Companion Pet

Seniors consider companion pets as family members. If the pet dies, the individual can be overcome with grief in the same way they would be if it was a human companion. Seniors who are completely alone can be deeply affected by the loss of a companion pet. Some elderly pet owners decline rapidly after losing their pet. Each person should assess whether or not they are willing to take the chance on losing a companion animal

Be Sure

If you are a senior who is contemplating adopting a companion pet, take into consideration how it will affect your life. Will you be able to properly care for the animal financially and physically? Be honest and evaluate the pros and cons carefully. Never adopt a companion pet because a family member or friend encourages you to do so. You know your capabilities and desires and it’s strictly your decision, no one else’s. You are the only one who knows if a companion pet will be an asset or a liability. Make your decision, whatever it may be, and stand firm.

Guide Dogs for the Blind

Guide Dogs for the Blind provides enhanced mobility to qualified individuals through partnership with dogs whose unique skills are developed and nurtured by dedicated volunteers and a professional staff.

Established in 1942, Guide Dogs for the Blind Services are provided to individuals from the United States and Canada at no cost.

A Guide Dog team consists of a dog who has been specially trained to assist a blind person with mobility, and a person.  The dog is trained to lead, obey commands, avoid distractions, and disobey a command if it would put the team in danger.

Theprogram is offers a lifetime promise of support by offering free support throughout the life of a Guide Dog team. The guide dogs normally don't live as long as the human partner so someone who is blind may be paired with many guide dogs throughout their lives.

Guide Dog For the Blind Campuses operate in California and Oregonwhich requires that the blind individual has to travel to California or Oregon and attend their trainings.  The general toll-free telephone number for both campuses: 1-800-295-4050.

Recreation

 Leisure and recreation participation has significant benefits for older adults, including increased self-esteem, improved social skills, and a sense of purpose and accomplishment. Recreation  helps satisfy the needs of the “total” person, including their physical, social, emotional, and spiritual well-being.

The increasing size and diversity of an older population challenges leisure services professionals to create and implement programs that serve older adults from diverse ethnic backgrounds with varying functional abilities and economic resources.

Examples of programs leisure services include:

• Group tours
• Arts and crafts
• Antiques
• Nature programs
• Senior theater
• Book clubs
• Educational travel
• Dancing
• Culinary clubs
• Gardening

Specific recreational opportunites as well as communities are available for seniors. Please refer to the Resources section on this page for more information about specific recreational resources.

Individuals with disabilities can obtain additional information about travel opportunities through ABLEDATA, www.abeldata.com or the Society for Accessible Travel and Hospitality, www.sath.org.

Rehabilitation - Inpatient

With the increased risk for falls, and other injuries, among older adults there is a greater likelihood that there will be a need for inpatient rehabilitation.  Because most older adults are insured through the Medicare program the options for inpatient rehabilitation for older adults are set up to comply with Medicare rules.  Inpatient rehabilitation is paid for through the Medicare A program (hospital insurance).

Most inpatient rehabilitation for older adults occurs on one of three settings 1- Transitional Care Units (TCU) that are part of a general hospital, 2- Inpatient Rehabilitation Facilities (IRF), and 3- Skilled Nursing Facilities (SNF).

Transitional Care Unit (TCU)

Transitional Care Units (TCUs) combine the advantages of rehabilitation and long-term care with the services of an acute care hospital. TCUs provide services for patients who are convalescing as well as those who need long-term care. TCU patients are typically more medically complex and require more nursing care. The goal of these units is for each patient to achieve the highest level of independence through individualized treatment plans.  TCU patients typically require less intense therapy than IRF patients. This is often due to the complexity of a patient’s medical condition. Although the majority of TCU patients require some form of therapy, there are patients on TCUs who receive none.

Inpatient Rehabilitation Facility (IRF)

Inpatient rehabilitation facilities serve patients with a multitude of diagnoses. The most common rehabilitation diagnoses include stroke, orthopedic conditions, arthritis, and spinal cord and traumatic brain injuries. Most patients are admitted directly from a hospital’s medical/surgical unit, but patients can be admitted from any level of care, as well as home.

Skilled Nursing Facility (SNF)

In order to be admitted to a SNF for rehabilitation treatment a person must be admitted from an acute care hospital, a TCU or a IRH.  Medicare Part A provides payment for post-hospital care in skilled nursing facilities (SNFs) for up to 100 days during each spell of illness.  A “spell of illness” begins on the first day a patient receives Medicare-covered inpatient hospital or skilled nursing facility care and ends when the patient has spent 60 consecutive days outside the institution, or remains in the institution but does not receive Medicare-coverable care for 60 consecutive days.

If Medicare coverage requirements are met, the patient is entitled to full coverage of the first 20 days of SNF care.  From the 21st through the 100th day, Medicare pays for all covered services except for a daily co-insurance amount; which is adjusted annually.  For 2007, the co-insurance for days 21-100 is $124.00/day.

Skilled nursing facility coverage includes the services generally available in a SNF: nursing care provided by registered professional nurses, bed and board, physical therapy, occupational therapy, speech therapy, social services, medications, supplies, equipment, and other services necessary to the health of the patient.

 Please refer to the Resources section on this page for information about rehabilitation centers in Utah.

Rehabilitation - Outpatient

Medicare and Medicaid will cover some outpatient rehabilitation services for older adults provided the services are provided in a manner consistent with Medicare/Medicaid requirements. 

Medicare and Medicaid also certify outpatient facilities that meet the requirements established.  To be certified as a Medicare and/or Medicaid Comprehensive Outpatient Rehabilitation Facility (CORF) a provider must follow applicable laws, regulations, and compliance information.

CORFs must provide coordinated outpatient diagnostic, therapeutic, and restorative services, at a single fixed location, to outpatients for the rehabilitation of injured, disabled or sick individuals.  Physical therapy, occupational therapy and speech-language pathology services may be provided in an off-site location. 

Respite

 

For those caring for an older adult, the work never ends.  The term “Respite” refers to many different options for caregivers that provide a much-needed break from this very difficult job.

 

Respite Care can also mean the services one can access that provide short-term, temporary relief to those who are caring for family members who might otherwise require permanent placement in a facility outside the home. 

 

According to some sources, in the United States today there are approximately 50 million people who are caring at home for family members including elderly parents, and spouses and children with disabilities and/or chronic illnesses. Without this home-care, most of these cared for loved ones would require permanent placement in institutions or health care facilities.

 

Even though many families take great joy in providing care to their loved ones so that they can remain at home the physical, emotional and financial consequences for the family caregiver can be overwhelming without some support. Respite can provide the much-needed temporary break from the often-exhausting challenges faced by the family caregiver.

 

Respite is the service most often requested by family caregivers and yet it is often difficult to find good options due to good care being inaccessible, or unaffordable regardless of the age or disability of the individual needing assistance.

 

It has been estimated that close to 80% of all long-term care is now provided at home by family caregivers to children and adults with serious conditions, including mental health issues, cognitive impairments and Alzheimer's disease.

 

Many professionals encourage caregivers to find good respite options for the sake of both the caregiver and the one being cared for.  In fact, finding good respite care is often essential for a caregiver’s emotional and physical health.   Few if any of us are capable of providing all of the services of caregiving without some help. 

 

Without respite, not only can families suffer economically and emotionally, caregivers themselves may face serious health and social risks as a result of stress associated with continuous caregiving. Respite has been shown to help sustain family caregiver health and wellbeing, avoid or delay out-of-home placements, and reduce the likelihood of abuse and neglect. An outcome based evaluation pilot study show that respite

may also reduce the likelihood of divorce and help sustain marriages.

 

Some forms of Respite

 

Respite can mean a number of things. It can be provided in your home or away from your home. It can also be provided by a family member or by a professional. 

 

Respite care provides short-term breaks that relieve stress, restore energy, and promote balance in your life.  Working with family members or friends may be difficult, but there are many respite care options and strategies that you may not be aware of.

 

Using respite care before you become exhausted, isolated, or overwhelmed is ideal, but just anticipating regular relief can become a lifesaver.

 

Different Types of Respite Care

 

In-home respite

 

• Informal family support and relief
• Online caregiver communities and video workshops
• Volunteer or paid companionship
• Personal care or skilled health assistance

 

Out-of-home respite

 

• Adult day programs (please refer to the category in this website titled “Adult Day Care” for more on this.
• Residential respite care
• Caregiver support groups

 

 

Analyzing Needs

 

Before making a decision about respite it is first essential to analyze the needs you have. For example, how much time do I need in order to feel the benefits of relief from my responsibilities?  Do I need support? Do I need a professional who can provide transportation and remind my loved one about when to take medication? Is it a change of scenery or an activity that will provide the most help?  What about mental stimulation, exercise or help with meal preparation?

 

Answering these questions will make it easier to decide what kind of respite is needed.

 

How will I pay for it?

 

Here is a list of different funding sources for respite care.

 

• Insurance:  Although medical insurance generally does not include respite coverage unless licensed medical professionals are involved, long term care policies usually fund services up to specific time or dollar limits.
• SSI:  Patients with disability coverage may be eligible for home health care benefits. Check your local Social Security office or call the toll free number to verify eligibility.
• Medicaid:   Medicaid does not fund respite directly, but some states use waivers to apply federal funds to offset respite costs for residents with specific conditions and disabilities.  Consult your state’s Administration on Aging website.
• Veterans’ Benefits:  The VA provides inpatient respite coverage for up to 30 days per year for qualified veterans.  In addition, when war-time vets care for their spouses, funding for in-home services are available on a state-by-state basis.
• Foundation Grants:  Private foundations, such as The Robert Wood Johnson Foundation and the Brookdale Foundation make grants to organizations that provide direct respite. These funds are usually awarded annually and posted on foundation websites.
• Nonprofit and Disability Organizations:  The United Way, the Alzheimer’s Association, and other disability-specific organizations may offer respite money in your area.  Agency care specialists can assist you in researching these funds.
• State Agencies:  Over half of all states allow family members to receive payment for providing respite care.  Eligibility, delivery modes and funding vary from state to state. 

 

Remembering the benefits and following these six tips can ease the process:  

• Plan and schedule frequent breaks. Respite is not just a service-it is an outcome that requires regular relief.
• Use checklists to teach providers about your care recipient’s schedules, likes and dislikes.  Offer suggestions for handling behaviors.
• Make back-up plans.  Always keep a list of alternate providers and resources.  Unplanned emergencies should not prevent you from taking care of yourself.
• Evaluate often.  Observe your care recipient before and after respite sessions.  Ask for brief updates and more detailed reports regularly.
• Expect changes.  Respite care is a process that often requires fine-tuning, Anticipating and accepting changes in personnel or programs can keep you from becoming discouraged.
• Attend your support group regularly. Structured and informal groups allow you to meet others in situations much like yours. You can talk, vent, laugh, and exchange tips with people who understand. If you can’t easily leave home, online communities, message boards and forums can provide much-needed support.

 

Senior Centers

The US Center on Aging reports that the first senior center opened 59 years ago in New York City under city sponsorship. There are now some 15,000 centers across the country, serving close to 10 million older adults annually. Since 1965, the Older Americans Act has provided some funding support to over 6,000 senior centers through service contracts for program activities. Many non-profit organizations also provide funding for Senior Centers. Not only do senior centers offer helpful resources to older adults, they serve the entire community with information on aging; support for family caregivers, training professionals, lay leaders and students; and developments of innovative approaches to addressing aging issues.

Senior centers are designated as community focal points through the Older Americans Act. While senior centers typically provide nutrition, recreation, social and educational services, and comprehensive information and referral, many centers are adding new programs such as fitness activities and Internet training to meet the needs and interests of the new generation of seniors. Please refer to the Resources section on this page for a complete list of Senior Centers in Utah along with their address and contact numbers.

Social Security

Anyone born in 1929 or later needs 10 years (40 credits) of employment to be eligible for retirement benefits.  These same credits are applied toward the Medicare benefit which becomes available for individuals at age 65.   Credits are determined by a set dollar amount of earnings and change on a yearly basis. 

Check the Social Security website on the resource section of this page for further information on the types of employment that count toward Social Secuirty credits. 

Social Security is not only available to retirees, but to workers who are disabled and survivors of workers who have died. 

The Social Security benefit was never intended to be the sole source of income for retirees; an estimated 40% of a retired persons income is replaced by the benefit.  Therefore, planning ahead with savings, investments and private pensions will assure a more comfortable retirement.

An individual has the option to receive the Social Security benefit as early as age 62.  These benefits are reduced by 1/2 of 1% for each month that the benefit is begun before the full retirement age. 

Strokes

A stroke occurs either when the blood supply to part of the brain is blocked or when a blood vessel in the brain bursts, causing damage to a part of the brain. A stroke is also sometimes called a brain attack.

Stroke is the third leading cause of death in the United States. Strokes  can cause significant disability such as paralysis, and speech and emotional problems. New treatments are available that can reduce the damage caused by a stroke for some victims but these treatments need to be given soon after the symptoms start.

The best treatment is to try to prevent a stroke by taking steps to lower your risk for stroke by exercising, eating and drinking alcohol in moderation, not smoking, and keeping your blood pressure under control.

If you think someone is have in stroke ask FAST questions:

FACE - Ask the person to smile.

Does one side of the face droop?

ARMS - Ask the person to raise both arms.

Does one arm drift downward?

SPEECH - Ask the person to repeat a simple sentence.

Are the words slurred? Can he/she repeat the sentence correctly?

TIME -If the person shows any of these symptoms, time is important.

Call 911 and assuring that the possible stroke victim receives treatment at a hospital within 3 hours are crucial for beneficial outcomes. 

 

Stroke Facts

·  Stroke is the third leading cause of death in the United States, over 160,000 people die each year from stroke in the United States. 

·  Stroke is a leading cause of serious long–term disability. 

·  About 700,000 strokes occur in the United States each year. About 500,000 of these are first or new strokes. About 200,000 occur in people who have had a previous stroke. 

·  Nearly three–quarters of all strokes occur in people over the age of 65. The risk  more than doubles each decade after the age of 55. 

·  Strokes can—and do—occur at ANY age. Nearly one quarter of strokes occur in people under the age of 65. 

·  More African Americans, of all ages, die from strokes than any other ethnic group.

Substance Abuse

Substance abuse is a problem that occurs across the lifespan. Seniors who have had difficulties with substance abuse early in life may continue to have problems as they age. Additionally, new stressors and depressed mood may lead to problems of abuse that didn't previously exist. 

The following is a excerpt from the American Geriatrics Society (AGS) website about substance abuse and aging.
The abuse and misuse of alcohol or drugs was once considered a problem only among the young. Unfortunately, substance abuse has become a growing problem among older adults as well. Community surveys suggest that misuse of alcohol or other drugs is a common cause of physical and mental health problems in older Americans, especially older men. Older adults are particularly vulnerable to the mental and physical effects of these substances, because of the changes that happen in our minds and bodies as we age. In fact, negative health consequences are sometimes seen in older adults at a level of alcohol or drug use that would be considered light to moderate in younger people.

Substance abuse has clear and profound effects on the health and well-being of older adults in all aspects of life. Many different organ systems can be damaged by substance abuse.  Substance abuse has negative effects on self-esteem, coping skills, and interpersonal relationships, which can add to other losses that are common in the later stages of life.

Many terms are used to define different levels of substance misuse, including dependence, abuse, problem use, and at-risk use. The medical definitions for these terms vary, but they all refer to the use of chemical substances in ways that lead to problems or disability, or to an increased risk of problems or disability. The first step is realizing that substance abuse is occurring, which can be difficult in older adults.

The warning flags of abuse are less obvious in older adults than in younger ones. For example, many older adults are retired and drink at home by themselves, so they are less likely  to be arrested, to get into arguments, or to miss work because of drinking. Also, many of the diseases caused by substance misuse (eg, high blood pressure, stroke, dementia, or ulcers) are common disorders in later life, so healthcare providers and family members may not be thinking of substance abuse as an underlying cause. In addition, the guidelines and screening tests that healthcare professionals use to diagnose substance misuse are often designed for younger people, and may not be easily applied to older adults.

Alcohol Misuse or Abuse

Drinking, is not physically or medically harmful, even among older adults. In fact, light to moderate alcohol consumption (an average of one drink per day) among healthy older adults can have health benefits, especially regarding heart health and longevity. Alcohol in moderate amounts may also promote relaxation and reduce social anxiety. However, alcohol abuse is associated with numerous negative health effects, especially among older adults. Alcohol abuse can cause serious illness, worsen other medical conditions, interfere with needed medications, and greatly decrease overall quality of life.

The terms "light," "moderate," and "heavy" drinking can mean different things to different people. In medical terms, one drink per day is defined as one 12-oz beer, one 4-oz glass of wine, or one 1-oz shot of liquor. A good definition of "low to moderate" drinking for older adults is "drinking that falls within the recommended guidelines for consumption and is not associated with problems." Older adults in this category drink an amount that falls within recommended guidelines and are able to set reasonable limits on their alcohol consumption. For example, they do not drink when driving a motor vehicle or boat, or when taking certain medications.

A good definition of "problem drinking," or the level of drinking that begins to be linked with mental health or physical problems, is more than one drink each day for older women, or more than two drinks each day for older men. However, drinking that causes problems is problem drinking, regardless of the amount.

Causes

Many older adults with alcohol problems are simply continuing a pattern of behavior or addiction that began earlier in life. Often, they have a family history of alcoholism, are not well-adjusted socially, and may have had previous legal problems related to alcohol. Alcohol abuse that begins in later life is often due to the stresses and losses associated with aging. People in this category often point to life events as the cause for their drinking. However, early retirement, premature health problems, and other life stresses can also be caused by alcohol abuse, rather than be the cause of it.

Many older adults with alcohol problems are simply continuing a pattern of behavior or addiction that began earlier in life. Often, they have a family history of alcoholism, are not well-adjusted socially, and may have had previous legal problems related to alcohol.  People in this category often point to life events as the cause for their drinking.

Problems associated with alcohol abuse

The most common medical problems associated with long-term alcohol abuse or dependence include the following:

• liver disease (eg, cirrhosis)
• chronic obstructive lung disease
• peptic ulcer
• psoriasis
• falls
• malnutrition
• mental impairment

Smoking makes matters worse and increases the risk of lung diseases, especially cancer. Alcohol abuse can also interfere with treatment for other problems. Alcohol can affect every part of the nervous system, either directly or indirectly (eg, by using up nutrients such as B vitamins). Long-term alcohol dependence can cause significant problems with the nervous system, including confusion, clumsiness, muscle problems, coma, and deterioration of the brain and spinal cord. Some experts estimate that 5-10% of dementia is caused by alcohol abuse.

Some people who abuse alcohol have additional psychiatric problems. In fact, older adults with alcohol abuse or dependence are nearly three times more likely to have another mental disorder. Alcoholism has been linked to mood disorders, suicide, dementia, anxiety disorders, and sleep disturbances. Alcohol is sometimes used by older people for self-medication, to ease the emotional pain of psychiatric or physical illness.

Sleep problems can be a sign of alcohol misuse or abuse. Alcohol may help someone fall asleep, but it actually decreases the amount of restful sleep throughout the night. This in turn increases anxiety and irritability. People who abuse alcohol are also lighter sleepers who wake up early in the morning, which can result in feeling tired and sluggish during the day. People with insomnia should never use alcohol as a way to fall asleep.

Another major problem associated with alcohol misuse in older adults is the danger of interactions between alcohol and other drugs, including over-the-counter medications. Of the 100 most frequently prescribed drugs, over half interact with alcohol. Alcohol slows the metabolism of some medications, resulting in the drug having stronger effects on the body. However, alcohol can weaken the effects of other drugs, including blood thinners, drugs used for seizure disorders, and some of the oral medications used to treat diabetes. Alcohol increases the effects of sedatives, which can decrease alertness and mobility. Frequent use of alcohol also increases the likelihood of intestinal bleeding in people taking arthritis medication or aspirin.

Withdrawal

Withdrawal symptoms can occur when alcoholics stop drinking and include the following:

• shakiness
• agitation
• sweating
• hallucinations
• seizures

The amount of time from the last drink to when typical symptoms of alcohol withdrawal begin is usually 24-36 hours. Approximately 5% of older alcoholic adults experience severe withdrawal problems called delirium tremens (DTs). This serious form of alcohol withdrawal is a medical emergency. Older people have a high risk of death from withdrawal, and complete withdrawal from alcohol may take considerable time. 

Identifying alcohol abuse

Alcoholism often goes undiscovered in older adults. Other medical problems, psychosocial problems, and effects of medication may make the signs of alcoholism difficult to recognize. In addition, symptoms such as confusion, falls, and physical problems may be incorrectly thought of as simply due to aging.  The stigma associated with having an alcohol problem, especially among older adults, may prevent some health professionals from even asking if such a problem exists.

Healthcare providers use several screening questionnaires to identify people at risk of alcohol abuse. Four key questions can provide a quick way to gauge alcohol abuse:

• "Have you ever felt you should slow down on your drinking?"
• "Have you ever felt annoyed by criticism about your drinking?"
• "Have you ever felt guilty or bad about drinking?"
• "Have you ever felt the need for an "eye-opener" in the morning to steady your nerves?"

A "yes" answer to any two of these questions indicates that a problem is likely. A "yes" answer to even one question indicates a possible problem that should be further evaluated. 

Healthcare provider swill likely ask about past alcohol use, to learn if the drinking stopped  or was cut down because of previous problems. People with a history of alcohol problems may need to be monitored in case new stresses cause them to "fall off the wagon." A history of at-risk drinking or alcohol dependence also increases the risk of developing other mental health problems in later life, such as depression or confusion.

Treatment

Prevention is clearly is the most effective treatment of alcohol abuse. Often, all that is needed to stop a problem before it starts is for healthcare providers or family members to show concern and to provide support, advice, and education on the effects of alcohol. In some cases, healthcare providers may ask people to keep a diary of their drinking patterns to help them recognize a potential problem.

People with long-standing alcohol problems usually need more forceful treatment. Fortunately, research has shown that older alcoholics do not have to hit "rock-bottom" before accepting treatment.

When an alcohol problem is identified, people important in the affected person's life need to seek instruction from experienced counselors to learn how to correctly motivate the person to begin treatment. Counseling can offer ways to deal with the negative behaviors of an alcoholic person, as well as ways to reduce or stop personal behaviors that might actually be encouraging alcohol intake or making it possible. Sometimes well-intended family members do not realize that their own behavior allows (or even ensures) that the person's addiction to alcohol continues. Confrontation the problem drinker as a group-an intervention-is one way to get the problem into the open and, if all goes well, to begin treatment. However, it is important to learn how to handle this situation in a supportive way, rather than being antagonistic.

Many options are available to treat problem drinkers, including the following:

• psychotherapy
• education
• inpatient or outpatient management
• specialized drugs

The treatment plan should be modified to fit to the needs of the individual. The at-risk drinker may need only to learn that others are concerned and to receive some advice and education in order to cut down. Older adults usually accept this type of approach, which can lead to substantially less use of alcohol among those at-risk for problems. In addition, trying to force the at-risk social drinker to accept a more rigorous program, such as Alcoholics Anonymous ("AA") or inpatient rehabilitation, may do more harm than good.

Medical support

Medical support usually begins with a thorough history, physical, and laboratory examination.  People who are severely dependent on alcohol, who have a high potential for problems in withdrawal, or who have other medical or psychiatric problems may need to be hospitalized before an outpatient treatment and management program can begin. The person is initially weaned off alcohol under medical supervision while hospitalized-a process called detoxification.

People with a long history of alcohol use should take multivitamins daily. Healthcare providers may also prescribe additional B vitamins, because levels often become dangerously low in alcoholism. People with very poor nutrition, mental difficulties, or nervous system problems may need to have their vitamin B12 level checked. Vitamin K supplements may be needed for people with bleeding problems.

Many people report symptoms of depression when they are not drinking. These symptoms usually get better after 3-4 weeks of a treatment program. Antidepressant medications are sometimes useful and are given after about 4 weeks of abstinence.

Rehabilitation

The outlook for recovery from alcoholism in older adults is generally good. Older people recovering from alcoholism are more likely than younger people to stay in treatment and remain sober. Regardless of age, all alcoholics should be considered to be always "in recovery," because there is no known cure that can allow problem drinkers to "start over" in social drinking without having a problem potentially develop again.

Rehabilitation programs for alcohol (and other drug dependence) use many strategies. Individual therapy can help a person overcome denial that he or she has an alcohol problem and can work on underlying problems, such as grief or difficulty in adjusting to retirement. Group therapy provides education on alcoholism, additional assistance in overcoming denial, and can help people develop other ways of coping. Groups also provide emotional support and can give a person a sense of belonging and renewed self-respect.

Medication can also help during rehabilitation. For example, people with underlying psychiatric problems may benefit from drug treatment for depression or anxiety. In addition, a drug called naltrexone can help people who have stopped drinking avoid a relapse. 

Joining AA helps many older adults. AA is a worldwide group of recovering alcoholics who assist others in their recovery. About a third of the people in AA are 50 and older. Each step of AA's 12-step program is important for successful treatment.

Family members or others who may have unknowingly allowed or encouraged the older person's alcohol abuse should also become involved in the treatment process. Involvement in groups like Al-Anon (a companion group to Alcoholics Anonymous) can help these family members and friends recognize and change their own harmful patterns of behavior. Al-Anon also offers relief and support to family members or caregivers who have been stressed, mistreated, or even victimized by an alcoholic. Other community and volunteer resources, such as senior citizens groups, visiting nurses, church groups, halfway houses, etc, are also available. Some retirement communities have developed their own support groups for people with alcohol problems.

Drug Abuse

Drug abuse or misuse is seen in people of any age, sex, race, nationality, or socioeconomic class. Among older adults, the problem is often with inappropriate use of prescription or over-the-counter medications. Commonly misused drugs include sedatives, hypnotics, pain relievers, diet aids, decongestants, and a wide variety of over-the-counter medications. Many medications used by older adults can lead to tolerance, withdrawal syndromes, or harmful medical consequences. Medical problems from misuse can include mental changes, kidney disease, liver disease, and injuries from falls.

Tolerance develops when the body needs a higher dosage of drug to get the same effect. Over time, the body adapts to each higher dosage, creating a vicious cycle of needing more and more drug while getting less and less effect. Tolerance can develop to many kinds of drugs, some of which can become addicting (eg, anti-anxiety drugs and sleeping pills).

The drugs most likely to be abused by older adults include anti-anxiety drugs, oral narcotics (eg, codeine), and sleeping pills. However, abuse of illegal drugs (including marijuana, cocaine, hallucinogens, and intravenous narcotics) has also been reported among older adults. Some older adults have lifelong histories of addictive behavior, while others have never had a drug problem before. Many people with drug addiction also have another problem, such as a major psychiatric illness. Addiction to more than one drug is also common.

Many older people with chronic pain avoid taking effective medications in adequate doses for adequate periods of time because they are afraid they may become addicted. It is important to keep in mind that undertreatment of pain is a significant problem, and that true addiction does not often arise in this situation.

Identifying drug abuse

Older people who are addicted to medication rarely admit it. Instead, they exhibit various signs and symptoms that may be related to the substance abuse, including the following:

• anxiety (eg, from tolerance or withdrawal)
• memory loss
• depressed mood
• agitation
• falls
• changes in blood pressure
• pain in the upper abdomen
• fatigue
• sleep disturbance
• appetite and weight loss
• weakness
• confusion

Addicted individuals commonly show drug-seeking behavior by visiting several doctors, getting several copies of the same prescriptions, and then filling them at different pharmacies.

Most people who abuse drugs (or alcohol) experience multiple psychological symptoms. Denial of addiction can sometimes be extreme, to the point that the person denies even taking any drugs. In less extreme circumstances, the person might minimize the amount of drug taken or the effect that the drug is having on his or her behavior and life. In rationalization, addicted people come up with reasons other than addiction for their drug use. Older adults commonly blame their physician for prescribing the medication. People addicted to medications also try to focus on other reasons why they need a "boost," such as problems in their marriage of a major medical illness.

Just like in alcohol abuse, family and friends may unconsciously support the behavior of the addicted person. These "enablers" may also show the symptoms of denial and rationalization, and try to focus the discussion away from the addiction.

Blood or urine tests can sometimes identify drug misuse or abuse. Urine drug screens can be used to identify traces of illegal drugs or to monitor recovering addicts. Blood or urine tests can also be used to measure the level of prescribed drugs in the body, to see if misuse or tolerance has developed.

Withdrawal

Drug addicts experience withdrawal symptoms similar to those experienced by alcoholics. Withdrawal symptoms vary from drug to drug, but can include shaking, sweating, feeling hot or cold, delirium, convulsions, and acute heart problems. Just like with alcohol withdrawal, the symptoms of drug withdrawal are possibly life-threatening and must always be monitored closely by a physician.

Treatment and prevention

The treatment for drug addiction is similar to that for alcoholism, with detoxification and rehabilitation phases. Detoxification usually requires hospitalization, where constant supervision can prevent the person from "sneaking" in drugs. Detoxification is a slow process, sometimes taking 8-10 weeks. After detoxification, symptoms of other illnesses should be treated. Frequently, other symptoms decrease on their own once the drug abuse is addressed.

Often, drugs are needed to treat withdrawal symptoms or to act as substitutes for the abused substance. For example, methadone can be used to wean people off of narcotics. This drug substitutes for the narcotic, without providing the "high" that drives the addiction.

All addictive medications are usually stopped once detoxification is completed. If the person needs treatment with narcotics for severe pain, such as from surgery or injury, they are given only under controlled circumstances and usually only in the hospital.

People should be encouraged when they have made progress in cutting down their drug use, even if they haven't been able to completely stop it. This may be particularly important for some types of medication misuse, such as overuse of antianxiety drugs.

Rehabilitation

As in recovery from alcoholism, recovery from drug addiction is considered an ongoing process rather than a cure. Rehabilitation programs for drug addiction include Alcoholics Anonymous, Rational Recovery, and Narcotics Anonymous. Older adults with drug problems often feel more comfortable participating in programs like AA, even if their addictions do not include alcohol because they are more likely to relate to the people who attend AA meetings than to the typically younger people who attend Narcotics Anonymous or other community programs for drug addiction.

Also as with alcoholism, family members should be counseled regarding the process of addiction. A discussion of their roles as enablers should be part of treatment.

One focus of rehabilitation among older adults is managing time. Keeping busy is important, both to reduce the free time available for drug-seeking behavior and to remove boredom that can increase the risk of relapse. Day programs and senior centers can be helpful. Supervised living arrangements (eg, halfway houses, group homes, nursing homes, and living with relatives) should also be considered.

Prevention

The best methods of prevention involve education along with the careful use of drugs that have the potential for misuse or abuse. Medication use among older adults should be monitored carefully. Older adults taking drugs that might be abused should visit their healthcare provider regularly (eg, at least every 3 months) for monitoring symptoms and medication use.

There are many groups that provide support for individuals struggling with this issue. Please refer to the Resources section of this page for information about these groups as well as contact information for organizations that provide assessment and treatment by professionals. 

Transportation

Demographics and Transportation Facts:

Tthe U.S. Census Bureau projects that the number of Americans age 65 or older will swell from 35 million today to more than 62 million by 2025 - nearly an 80 percent increase. Age-related sensory losses such as diminshed vision, hearing loss and musularskelatal changes (such as difficulty turning one's neck) contribute to difficulty in driving.  As a result  these individuals often become less willing or able to drive.  Without alternative methods of transportation the individual becomes isolated and eventually in danger of premature admission to an extended care facility.

According to the Surface Transportation Policy Project, the following is a list of facts concerning older adults and transportation:

• More than half of all non-drivers aged 65 and over stay at home in a given day, often because the do not have transportation options.
• Our transportation network must be prepared to meet the needs of a rapidly changing America where 1 in 5 people will be age 65 or older.
• Traditionally most Americans rely on driving a private vehicle to get where they need to go.  The lack of information about transportation alternatives and the distance required to walk to bus stops often leaves them isolated and without a means of transportation. 
• Older Americans living in sparsely populated geographical areas, are disproportionately affected by isolation because of fewer transportation options. 

 When To Stop Driving : 

The following checklist is useful in determining whether it's time to hang up the keys. 

Are you noticing any of the following signs:

1. Feeling uncomfortable and nervous or fearful while driving
2. Dents and scrapes on the car or on fences, mailboxes, garage doors, curbs etc.
3. Difficulty staying in the lane of travel
4. Getting lost
5. Trouble paying attention to signals, road signs and pavement markings
6. Slower response to unexpected situations
7. Medical conditions or medications that may be affecting the ability to handle the car safely
8. Frequent "close calls" (i.e. almost crashing)
9. Trouble judging gaps in traffics at intersections and on highway entrance/exit ramps
10. Other drivers honking at you and instances when you are angry at other drivers
11. Friends or relatives not wanting to drive with you
12. Difficulty seeing the sides of the road when looking straight ahead
13. Easily distracted or having a hard time concentrating while driving
14. Having a hard time turning around to check over your shoulder while backing up or changing lanes
15. Frequent traffic tickets or "warnings" by traffic or law enforcement officers in the last year or two

If you notice one or more of these warning signs you may want to have your driving assessed by a professional.  You may also want to consult with your doctor if you are having unusual concentration or memory problems, or other physical symptoms that may be affecting your ability to drive.  (AARP)

Many transportation options are available for seniors. Buses and light rail systems are equipped to help any passenger easily board. For more information on transportation, including programs designed to help older adults, please refer to the Resources listed on this page.

Utility Assistance

Help is available for seniors who have trouble meeting their utility expenses. See the Resources section of this page for more information.

LIHEAP - The Low Income Home Energy Assistance Program - is a federally funded program that helps qualified income-eligible individuals pay their utility bills and with weatherization projects to make homes more energy efficient. The program runs November through March or until funds are exhausted. Customers may receive an application from any Department of Human Services or a designated energy office.  You can access more information at the web address http://www.acf.hhs.gov/programs/ocs/liheap/brochure/brochure.html

REACH (Residential Energy Assistance through Community Help) is funded by voluntary contributions from local residents, Questar employees and stockholders, and it helps qualified income-eligible individuals pay their utility bills. Applicants must be at least 65 years old and/or handicapped or disabled. The program is a year-round program and will be open as funding permits. Customers must have applied for assistance through the state's HEAT program (Home Energy Assistance Target Program) before applying for REACH.

 

Veteran Services

A 2004 University of Michigan study reported that the veteran population is aging rapidly, with the percentage over age 65 expected to rise from 43% to 51% by 2010, and individuals over age 80 increasing eight-fold. For aging veterans the question often comes up about where they should get their health care.

Q.  I have good medical coverage from the Veterans Affairs health program. Do I need to enroll in Medicare as well when I turn 65?

A. You don’t have to, but there are good reasons why you should. In fact, the VA strongly recommends that all veterans who have VA health care also enroll in Medicare as soon as they become eligible (unless they have other coverage—for example, from an employer or union).

• VA health coverage isn’t set in stone and isn’t the same for everyone. The VA assigns enrollees to different priority levels according to various factors, such as income and whether they have any medical condition that derives from their military service. If federal funding drops, or doesn’t keep pace with costs, some vets in the lower priority levels could lose VA coverage entirely.

• Having both Medicare and VA benefits widens your coverage. If you need to go to a non-VA hospital or doctor, you’re automatically covered under Medicare Part A (hospitalization) and Part B (doctors and outpatient services)—whereas with VA coverage alone, you may end up having to pay the full cost yourself. The VA has rules about who qualifies for coverage at non-VA facilities, even in emergencies.

• If you happen to lose VA coverage in the future, when you’re well past 65 and not already signed up for Medicare Part B, you’d pay a late penalty to enroll at that time. The Part B penalty adds 10 percent of the premium for each year that you delay. So if you wait five years to sign up for Part B and in that time you have no other health insurance apart from the VA’s, you’d pay an extra 50 percent of the premium for the rest of your life. For example, instead of paying the monthly premium of $96.40 (in 2009), you’d pay $144.60—or an additional $578.40 over the year.

• Your prescription drug coverage in the VA is much better than Medicare’s, so you don’t need to join a Part D drug plan, and you wouldn’t incur a Part D late-enrollment penalty if you lose VA coverage in the future. Still, if you do decide to have Part D coverage as well as the VA’s, you’d have the flexibility of being able to use one or the other. You could get prescriptions from non-VA doctors and fill them at local retail pharmacies, and may be able to obtain medications that the VA doesn’t cover.  (Posted on the AARP website.)

Medicare Information for Veterans

     If You Choose to Use Your Veterans Benefits

If you choose to use your veterans benefits, Medicare generally cannot pay for services you get. Medicare cannot pay for the services you get from VA hospitals or other VA facilities. (There is an exception to this rule. There are cases where Medicare can pay for emergency inpatient and outpatient hospital services.) Medicare generally cannot pay if the VA pays for VA-authorized services that you get in a hospital that is not part of the VA system or from a doctor who is not affiliated with the VA.

     If You Choose to Use Your Medicare Benefits

If you choose to use your Medicare benefits, Medicare can pay for Medicare-covered services you get from hospitals and doctors not affiliated with the VA, as long as the VA will not be paying for the same services.

     When Covered Services are Different, Medicare and VA Each Help Pay

If the VA authorizes you to get hospital services in a hospital that is not a VA hospital, but does not pay for all the services you get during your stay, Medicare can pay for Medicare-covered services for which the VA does not pay. For example, if the VA authorizes a five-day stay and you remain in the hospital for 10 days, Medicare can pay for the Medicare-covered services you got during the five days not authorized by the VA.

     Co-payments: Sometimes Medicare Can Pay or Help Pay

The VA charges co-payments to some veterans with non-service connected conditions. The co-payment is the veteran's share of the cost of treatment. The veterans who are charged co-payments are those at or above certain income. Sometimes, Medicare can pay part or all of this co-payment amount. Medicare cannot pay you for VA co-payments for services furnished by VA hospitals and facilities, unless the services are emergency inpatient or outpatient hospital services. Medicare can pay if the VA charges you a co-payment for VA-authorized care by a doctor or hospital not affiliated with VA. Medicare may be able to pay all or part of your VA co-payment.

     Fee Basis Cards: Sometimes Medicare Can Help Pay

The VA issues "fee basis ID cards" to certain veterans. You may be issued a fee basis care because:

• You have a service connected disability.
• You will need medical services for an extended period of time; or there are no VA facilities in your area that can furnish the care you need.

If you have a fee basis card, you may choose any doctor you wish to treat you for the condition specified on the card. If the doctor accepts you as a patient and bills the VA for his or her services, the doctor must accept VA's payment as payment in full. The doctor may not bill you or Medicare for any charges not paid by the VA. If your doctor does not accept the fee basis card, you may file a claim with the VA yourself. The VA then pays the VA-approved amount, either to you or the doctor. If the VA payment is less than the Medicare-approved amount for the services, Medicare can pay benefits to supplement the VA payment. For this to happen, your doctor must bill Medicare for that portion of his or her charges not paid by the VA and attach a copy of the VA's explanation of benefits to the Medicare claim form.  Medicare payment may be delayed in some cases. When you choose to get your services under the Medicare program and you are also eligible for VA fee basis benefits, your VA fee basis eligibility may delay processing of your Medicare claim. The delay occurs because the contractor that pays Medicare claims must contact your doctor to make sure that the VA is not being billed for the same services for which Medicare has been billed NOTE: If you have Medigap insurance, it may be required to pay for VA services as if they were Medicare-covered services.

     Where to Get Help

If you have questions about whether the VA or Medicare should pay for your doctor services and other medical services, contact the contractor that pays your Medicare claims. If you have questions about whether the VA or Medicare should pay for hospital services or services furnished by other facilities, ask the provider of services to contact the Medicare intermediary

Vision Services

Disorders of Vision

The National Eye Institute (NEI) was established by Congress in 1968 to protect and prolong the vision of the American people. Thirty eight million Americans suffer significant vision impairment,  a figure that is expected to increase 40% by 2020, particularly in Americans over age 40.

Impaired vision and blindness is a world-wide health burden. The World Health Organization estimates that there are greater than 160 million people worldwide who are visually disabled. Of these, approximately 40 million persons are blind and, by definition, cannot walk about unaided. Blindness represents a public health, social and economic problem, especially for developing countries, where 90% of the world’s blind population live. The largest proportion of blindness is related to aging. Approximately 50% of the world’s blind suffer from cataracts. The majority of the remaining visually impaired individuals are blind from conditions that include glaucoma, age-related macular degeneration, corneal opacities, diabetic retinopathy, trachoma, onchocerciasis (also known as river blindness) and conditions that cause childhood blindness. Glaucoma is the second leading cause of blindness globally, followed by age-related macular degeneration (NEI website).

Age-Related Macular Degeneration (AMD)

Macular degeneration gets its name because the macula, in the retina, begins to deteriorate. This deterioration can cause blurry vision or create a blind spot making driving, reading, or face recognition difficult. MD is the third leading cause of blindness worldwide.  Symptoms include:

• An increased need  for increased light for reading, words become blurry
• Wavy lines in Amsler grid (a lined chart used to test the integrity of the macular).
• Face recognition becomes more difficult.
• Blind spot in central vision.

Age of onset

Older people (50+) are greater risk for Macular Degeneration, however, it can occur during middle age.  Age-Related Macular Degeneration is not aggravated or accelerated by vision use such as reading and has been primarily linked to genetic causes.

Treatment

Photodynamic therapy, using verteporfin (a medication used  for therapy to eliminate the abnormal blood vessels in the eye) has had some success in slowing the loss of vision in wet AMD.

Prevention

The NIH indicates that smoking, obesity, family history of MD, gender and race are all risk factors for developing macular degeneration. Women are at more risk than men, and Euro-Americans have a greater incidence than African-Americans. A variety of eye examinations are available to test for both wet and dry AMD. Research has found that anti-oxidants and zinc can be helpful in preventing AMD. Regular eye exams are also important to detect any degeneration early.  Many clinical trials are underway to discover the cause of, and treatments for, dry AMD.  Research and clinical trials are also being conducted for wet AMD,  no cure is yet available.

Other Eye Problems In Older Adults

There are several other eye problems that are more common among people as they age, although they can affect anyone at any age. They include:

•   Presbyopia

This is the loss of the ability to clearly see close objects or small print. It is a normal process that happens slowly over a lifetime, but you may not notice any change until after age 40. Presbyopia is often corrected with reading glasses.

•   Floaters

These are tiny spots or specks that float across the field of vision. Most people notice them in well-lit rooms or outdoors on a bright day. Floaters often are normal, but can sometimes indicate a more serious eye problem, such as retinal detachment, especially if they are accompanied by light flashes. If you notice a sudden change in the type or number of spots or flashes you see, visit your eye doctor as soon as possible.

•   Dry eyes

This happens when tear glands cannot make enough tears or produce poor quality tears. Dry eyes can be uncomfortable, causing itching, burning, or rarely some loss of vision. Your eye doctor may suggest using a humidifier in your home or special eye drops that simulate real tears. Surgery may be needed in more serious cases of dry eyes.

•   Tearing

Having too many tears can come from being sensitive to light, wind, or temperature changes. Protecting your eyes by shielding them or wearing sunglasses can sometimes solve the problem. Tearing may also mean that you have a more serious problem, such as an eye infection or a blocked tear duct. Both of these conditions can be treated or corrected by an eye doctor. 

•   Cataracts

Cataracts are cloudy areas that cover part of or the entire lens. Since a healthy eye lens is clear like a camera lens, light has no problem passing through the lens to the back of the eye to the retina where images are processed. When a cataract is present, the light cannot get through the lens as easily and, as a result, vision can be impaired. Cataracts often form slowly, causing no pain, redness or tearing in the eye. Some stay small and do not alter eyesight. If they become large or thick, cataracts can usually be removed by surgery.

•    Glaucoma

This condition develops when there is too much fluid pressure inside the eye. It occurs when the normal flow of the watery fluid between the cornea and the lens of the eye is blocked. If not treated early, this can lead to permanent vision loss and blindness. Glaucoma is less commonly caused by other factors such as injury to the eye, severe eye infection, blockage of blood vessels, inflammatory disorders of the eye. Because most people with glaucoma have no early symptoms or pain, it is very important to get your eyes checked by an eye doctor regularly. Treatment may include prescription eye drops, oral medications, or surgery.

•    Retinal disorders

The retina is a thin lining on the back of the eye made up of cells that collect visual images and pass them on to the brain. Retinal disorders interrupt this transfer of images. They include age-related macular degeneration, diabetic retinopathy, and retinal detachment. Early diagnosis and treatment of these conditions is important to maintain vision.

•    Conjunctivitis

This is a condition in which the tissue that lines the eyelids and covers the cornea becomes inflamed. It is sometimes called "pink eye" or "red eye." It can cause redness, itching, burning, tearing or a feeling of something in the eye. Conjunctivitis occurs in people of all ages and can be caused by infection, exposure to chemicals and irritants, or allergies.

•    Corneal diseases

The cornea is the clear, dome-shaped "window" at the front of the eye. It helps to focus light that enters the eye. Disease, infection, injury, and exposure to toxic agents can damage the cornea causing eye redness, watery eyes, pain, reduced vision, or a halo effect. Treatments include making adjustments to the eyeglass prescription, using medicated eye drops, or having surgery.

•    Eyelid problems

The eyelids protect the eye, distribute tears, and limit the amount of light entering the eye. Pain, itching, tearing, and sensitivity to light are common symptoms of eyelid problems. Other problems may include drooping eyelids, blinking spasms, or inflamed outer edges of the eyelids near the eyelashes. Eyelid problems often can be treated with medication or surgery.

•    Temporal arteritis

This condition causes the arteries in the temple area of the forehead to swell. It can begin with a severe headache, pain when chewing, and tenderness in the temple area. It may be followed in a few weeks by sudden vision loss. Other symptoms can include shaking, weight loss, and low-grade fever. Scientists don't know the cause of temporal arteritis but they think it may be caused by an impaired immune system. Early treatment with medication can help prevent vision loss in one or both eyes.Guide Dogs for the Blind

Guide Dogs for the Blind provides enhanced mobility to qualified individuals through partnership with dogs whose unique skills are developed and nurtured by dedicated volunteers and a professional staff.

Established in 1942, Guide Dogs for the Blind continues its dedication to quality student training services and extensive follow-up support for graduates. The programs are made possible through the teamwork of staff, volunteers and generous donors.

Services are provided to students from the United States and Canada at no cost to them.

A Guide Dog team consists of a dog and a person. The dog has been specially trained to assist a person who is blind with mobility. The dog is trained to lead, obey commands, avoid distractions, and disobey a command if it would put the team in danger.

One of the unique features of our program is our lifetime promise of support. Not only do we create the best partnerships, they also offer support throughout the life of a Guide Dog team, free-of-charge. As you know, our furry friends don't live as long as we do. Someone who is blind may be paired with many Guide Dogs throughout their lives.

Guide Dog For the Blind Campuses only operate in California and Oregon.  In order to be trained for mobility and a guide dog, one has to travel to California or Oregon and attend their trainings.  The general toll-free telephone number for both campuses: 1-800-295-4050.

Resources for sight-impaired individuals

Resources for individuals who are sight-impaired are typically offered by state or local governments. The National Federation for the Blind has divisions in each State.

For information regarding these resources, please refer to the Resources list on this page.

Volunteer Opportunities

Senior make up an increasing proportion of the population of this country.  With retirement coming earlier to many baby boomers, older adults today are active, involved, and interested in helping whether it be through charitable contributions or volunteer time.

According to a recent survey, almost 44 percent of all people 55 and over volunteer at least once a year; over 36 percent reported that they had volunteered within the past month. Approximately 26.4 older volunteers donate an average 4.4 hours per week to the causes they support - 5.6 billion hours of their time at a value of $77.2 billion to nonprofits and other causes .

Seniors of every age, ethnic and racial group volunteer to some level. Over 46 percent of persons ages 55 to 74 reported performing some type of volunteer work in the past year;  34 percent of those 75 years old and older reported volunteering.
 
Volunteering is one way to stay physically and mentally active in one's community. Social interaction is a vital piece of positive aging.

Senior Corps

The Corporation for National and Community Service offers three volunteer programs for older adults through Senior Corps. For nearly 40 years, Senior Corps programs have connected more than 500,000 Americans to service opportunities in their communities.

•    The Foster Grandparent Program connects volunteers age 60 and over with children and young people with exceptional needs. Foster Grandparents receive a stipend for their service.

•    The Senior Companion Program brings together volunteers age 60 and over with adults in their community who have difficulty with the simple tasks of day-to-day living.  Senior Companions also receive a stipend for their service.

•    RSVP offers "one stop shopping" for all volunteers 55 and over who want to find challenging, rewarding, and significant service opportunities in their local communities.

Local Resources

Most non-profit organizations rely heavily on the altruism of volunteers to accomplish their mission of service.  These organizations frequently post ads in the media requesting volunteer support.  Information can also be found at local  Volunteer Centers.