The Caregivers Home Companion - Timely Tips, Advice, Help

Timely Tips

Timely Tip: Keeping Your Brain Healthy

There are several sources of “brain food” to help keep us sharp as we meet our caregiving obligations and move into older age. Check out these examples:

Online:

www.sharpbrains.com – brain teasers and challenges
www.sudoku.com and www.websudoku.com – the popular game
www.instantchess.com and www.chessmaniac.com – online chess
www.brainbashers.com – brain challenges and games
www.dmoz.org/Games/Puzzles/Brain_Teasers/ – cryptograms, optical illusions, riddles

Software Programs:

MindFit, downloadable from www.positscience.com for $129
Brain Fitness2.0, from www.positscience.com for $395
BrainAge and Flash, for Nintendo DS game system, about $20 each

You can read the full story on ways to keep your brain vibrant and healthy during caregiving in Caregiver Brain Fitness: Trying No-Sweat Workout to Save Your Mind in Old Age, a feature article in the March 2008 edition of Caregiver’s Home Companion.

Timely Tip: Dealing with a Crotchety Parent

Sometimes dealing with an abusive or controlling parent can leave you feeling like there's no way out, but these guideposts will help you find your way to resolution:

Participate in support groups locally or online.
Use workplace programs and benefits such as employee assistance programs or family leave benefits. Ask for flex time.
Hire a geriatric care manager to serve as an advisor and ally.
Tap into the wealth of information on the internet and in bookstores.
Be pro-active in seeking help before a crisis.
Seek compromise rather than control.
Don’t make promises you may not be able to keep.

To get the full story on ways to work with an uncooperative or rude parent while retaining your composure, read the feature article Coping With a Difficult Parent – Sometimes a Referee Can Help in the February 2008 edition of Caregiver's Home Companion.

Timely Tip: Caregivers on the Brink

For caregivers, maintaining their own mental health while caring for a loved one can be a mounting challenge. To help avoid reaching the breaking point, the Family Caregiver Alliance cites these danger signs:

Between 40%-70% of caregivers have symptoms of depression, with 25%-50% meeting the diagnostic criteria for major depression.
Depressed caregivers are more likely to have other anxiety disorders, engage in substance abuse, and have chronic diseases.
Women who provide 36 hours or more of caregiving per week to a spouse show a dramatic increase in the risk of mental health problems.
Spousal caregivers who are at risk of clinical depression are more likely to engage in harmful behavior toward their loved one.
Caregivers have more serious chronic medical conditions, diminished immune response, and are at higher rate for premature death than non-caregivers.
Older caregivers (age 66-93) who experience caregiving-related stress have a 63% higher mortality rate than non-caregivers of the same age.

For the full story on strategies for reducing caregiving stress and avoiding going “over the edge,” read Stepping Back from the Brink: Taking Positive Steps Before You Reach the Breaking Point in the January 2008 edition of Caregiver's Home Companion.

Timely Tip: Facts About Elderly Falls

More than a third of a million Americans fall and break a hip each year – many of them elderly, who end up in a nursing home or never walk again. As grim this reality is, caregivers who are armed with the facts are better positioned to help their loved ones avoid this tragedy.

Here are a handful of facts about falls that may help you along the way:

Women are more likely to fall than men.
Two-thirds of those who fall once will fall again within six months.
Annually, falls are reported by one-third of all people 65 and older.
Among those 65–69, one in every 200 falls results in a hip fracture.
Among those 85 and older, one fall in 10 results in a hip fracture.
Approximately 9,500 deaths in older Americans are associated with falls each year.

For the full story on the danger of falls among the elderly, read Don’t’ Fall Down! Preventing a Third of a Million Elderly Broken Hips a Year in the December 2007 edition of Caregiver's Home Companion.

Timely Tip: Fitting in Fitness

Staying fit while caregiving is not a nice-to-do – it’s a must-do. Fit caregivers not only fell better and stay healthier, but they also are able to perform their family caregiving with more energy and reliability. And while fitting in a workout is far from simple, these tips may help you figure out the best ways to fit in enough time for your own exercise:

AM Exercise. There are few distractions, and research shows morning exercisers are more likely to stick with it.

Add Gusto to Chores. Quicken the pace when you scrub the sink, or use a push mower to burn more calories.

Make TV Minutes Burn. Lift dumbbells, ride the stationary bike or walk a treadmill during favorite TV shows. Or just get moving during commercials!

Include Your Loved One. Play music and move. Get outdoors for a walk. Bring the dog too.

Peer Pressure. Join a walking or dance club or even a sports league where others depend on you to participate.

Active Fun. Plan activities and trips that require you to walk, like to a park or at a mall.

Be Prepared. Keep a comfortable pair of shoes and a jacket in your car, in case you see an opportunity for a few laps around the grocery store or hospital.

Pencil It In. Schedule time to do the exercise video, take the dog for a walk, or hike with a friend.
For the full story on how best to keep in tip-top shape while caregiving, check out Staying Fit While Caregiving: You May Think It’s Impossible, But It’s Not, a feature article in the December 2007 edition of Caregiver’s Home Companion.

Timely Tip: How You Can Help a Family Caregiver

Maybe you aren’t the primary caregiver for a loved one, but you want to be involved, just as many of us do. No matter whether you live next door or 2,000 miles away, you can help your loved one and the family member who is giving them care.

Here are a few ideas:

Call the caregiver regularly to check in. This shows that you care about what is going on, want to be involved, and are there for the caregiver if he or she needs to talk.
Always ask if there is something you can do to help. If there is something you can do on an ongoing basis that would lighten the caregiver’s load, offer to do it.
Don’t take “No” for an answer too often. The caregiver may feel that he or she should be able to do it all – but they can’t! Ask what kinds of things are on the agenda for the upcoming week, then jump in with ideas for things you think you could do.
Offer to stay with your loved one to give the caregiver an occasional day or an evening off.
Buy the caregiver a gift certificate to a spa or movie tickets to make it hard for them to refuse to take some time off.

Get the full story about sharing family caregiving responsibilities in What to Do When Family Doesn’t Help Out – Six Caregiving Strategies, a feature article in the November 2007 edition of Caregiver’s Home Companion.

Timely Tip: Quick Tips for Getting Family to Help

It’s the rare individual who can shoulder the complete elder-caregiving burden without needing help, especially from family members who are invested in the loved one being cared for. Still, many caregivers are reluctant to each out for help – and sometimes don’t accept it when offered.

If you’re a loved one’s primary caregiving in this position, you should remember that people tend to respond to positive approaches. So, keep these principles in mind to improve your chances of getting family members to lend a caregiving hand:

Ask them: Be honest and direct. Say, “I need your help.” Then accept any and all offers of assistance.

Give them assignments: Be assertive. Say, “I need you to pick up Mom’s prescriptions.”

Inform them: Be proactive about keeping family in the loop.

Make it easy for them: Be creative about removing obstacles that keep people from helping, such as reimbursing them for expenses.

Accept them: Be tolerant of the differences in how people respond to change.

Thank them: Be grateful for any and all help given, and express it.
For the full story on strategies for getting family to help you care for an elderly loved one, read What to Do When Family Doesn’t Help Out – Six Caregiving Strategies in the November 2007 edition of Caregiver's Home Companion. Click here for more.

Timely Tip: What You Can Do About Cataracts

For many elderly, cataracts become more or less inevitable the older they get. But an informed caregiver or loved one can minimize the impact or even the chances of developing the vision-clouding condition. Try these tips:

Visit your eye doctor when you notice any vision problems, including blurred vision and sensitivity to light.
Wear sunglasses that block UVA and UVB rays. Polarized lenses are best, as they reduce scattered light, which causes glare.
If you need cataract surgery, talk with your doctor about temporarily stopping medications that might cause bleeding problems.
If cataract surgery is needed in both eyes, plan to have two separate surgeries about four to eight weeks apart.

You can read the full story on ways to deal effectively with cataracts in The Aging Eye: New Lenses Offer Cataract Patients Clearer Future, a feature article in the October 2007 edition of Caregiver’s Home Companion.

Timely Tip: Kid Caregiver Resources

It’s tough enough just growing up, let alone dealing with elder-caregiving stresses and strains. Yet that’s exactly what about 1.4 million children between the ages of 8 and 18 do every day. These youngsters act as caregivers for the elderly in their families.

The nature of children as caregivers demands special care for these growing souls. These programs can help children who become caregivers:

The Princess Royal Trust for Carers www.youngcarers.net
This UK organization provides a variety of services through its website. Chat rooms allow young caregivers to connect with other child caregivers and caregiving experts, to vent and to get advice and information about resources that can help them.

National MS Society www.nationalmssociety.org
In the US, the National MS Society has been a leader in recognizing and implementing support systems for families and young caregivers. Keep S’myelin, the Society’s online newsletter, is written for children, but helps both parents and children talk about the disease. The MS Society also provides support through family meetings and financial help for families in need.

American Association of Caregiving Youth www.aacy.org
Supports and promotes the awareness of youth who are both students and family caregivers. AACY raises awareness through education, research and direct services in cooperation with social, education, healthcare, government and community corporations, organizations and agencies.
Get the full story on children who are elder-caregivers in When Kids Become Caregivers, a feature article in the October 2007 edition of Caregiver’s Home Companion.

Timely Tip: Is an Independent Living Assessment Needed?

Family caregivers may instinctively feel they know when their aging loved one can no longer live safely on their own, but a formal assessment by a trained geriatric professional is always best, and is accompanied by specific advice on how to handle the situation.

Use this checklist as your own guide on whether it's time to bring in a professional eldercare expert to make that formal assessment with you and your loved one:

Has your loved one lost weight?
Do they appear poorly groomed -- unshaven, hair dirty or unkempt, or wearing dirty clothes?
Does their breath smell or do they have body odor?
Is there food in cabinets or the refrigerator?
Are dishes piled in the sink, carpets dirty, furniture dusty?
Is the house cluttered and the yard a mess?
Have they lost interest in going out or in activities they once enjoyed?
Do they seem unsteady or afraid to use stairs?
Have you noticed changes in their normal behavior or routine?

To get the full story working with a geriatric professional to assess your loved one's capabilities for living alone, read the feature article Gauging Whether Mom and Dad Can Continue Living on Their Own – Dealing with the Telltale Signs in the September 2007 edition of Caregiver's Home Companion.

Timely Tip: Using ADLs to Gauge Independence

Geriatric professionals use a variety of tools to assess the ability to function independently at home. Here is a listing of two common tools and their criteria, which you might find handy to use in making your own informal assessment of Mom and Dad:

Basic Self-Care Activities of Daily Living:

Bathing – including the ability to get in and out of a shower or tub
Eating – including the ability to cut food or butter bread
Dressing – including the ability to choose appropriate attire
Toileting – including the ability to transfer on and off the toilet
Transferring – the ability to get in and out of bed or a chair

Instrumental Activities of Daily Living:

Cleaning
Preparing meals
Taking medication
Doing laundry
Performing yard work
Bill paying/banking
Walking outside the home
Driving
Shopping
Using the telephone

For the full story on strategies for helping an elderly loved one maintain their living independence, read Gauging Whether Mom and Dad Can Continue Living on Their Own – Dealing with the Telltale Signs in the September 2007 edition of Caregiver's Home Companion. Click here for more.

Timely Tip: Helping Mom Stay Independent

By far, the greatest number of our elderly wish to live out their lives in their own homes. Of course, with health conditions and general frailty, that’s not always possible.

As their caregiver supporting their wish as long as possible, here’s a list of ways you can help your loved one remain independent:

Move major appliances such as washer and dryer from basement to main floor
Limit the need to use stairs as much as possible
Hire or provide help with cleaning, shopping, cooking, transportation, lawn care
Sign up for home-delivered meals
Hire home healthcare professionals to assist with morning and evening bathing and dressing
Remove tripping hazards such as area rugs
Install bright no-skid strips on steps
Put all often-used dishes and pans within easy reach
Purchase easy-to-put-on clothes and shoes; look for shoes with Velcro straps instead of laces, pull-on pants, and clothes with few buttons
Improve lighting throughout the home; install nightlights
Install grab bars in showers and tubs
Familiarize yourself with bills and when they are due; schedule bill paying day

Get the full story about ways to assess whether your loved one can safely live alone in Gauging Whether Mom and Dad Can Continue Living on Their Own – Dealing with the Telltale Signs, a feature article in the September 2007 edition of Caregiver’s Home Companion.

Timely Tip: Caregiving’s Impact at Work

If you think you’re in the minority feeling stressed and pulled in different directions by your job because you are caregiving for a loved one, think again.

A survey of 935 caregivers in 2004 by the National Alliance for Caregiving and AARP found the following:

57% reported having to go to work late, leave early or take time off for caregiving
17% had to take a leave of absence
10% switched from full-time to part-time work schedules
5% lost some job benefits
4% had to turn down a promotion
6% had to quit work
3% opted for early retirement

You can read the full story on ways to balance career pressures with caregiving obligations in Caregivers and the Workplace – How to Get the Support You Need, a feature article in the August 2007 edition of Caregiver’s Home Companion.

Timely Tip: Alternate Work Arrangements for Caregivers

Caring for a loved more times than not means balancing home and work with your caregiving challenge. When it comes to one’s career, the stress can put your job in jeopardy or require alternative working arrangements. In either case, it’s always best to be upfront with an employer about your caregiving obligations.

Here is a selection of alternative work arrangements a family caregiver can consider when talking with an employer about ways to cover their caregiving absences:

Compressed Workweek: Continuing to work 40 hours, but with more flexibility than 5 8-hour days. Examples include: Working four 10-hour days, working three 12-hour days, working a combination of half and full days.
Flexible Work Schedule: Continuing to work 40 hours, but with flexibility regarding the hours worked within a given day. For example, starting work at 7 a.m. instead of 8 a.m., and leaving at 4 p.m. instead of 5 p.m.
Reduced hours: Working fewer than 40 hours, but enough hours to maintain full-time benefits.
Part-time: Reducing the work schedule significantly below 40 hours. This may result in loss of some or all benefits.
Job Share: Part-time employment in which two or more people “share” a 40 hour a week.
Telecommuting: Working from home one or more days per week.

For the full story on how best to balance caregiving and your job, read Caregivers and the Workplace – How to Get the Support You Need, a feature article in the August 2007 edition of Caregiver’s Home Companion.

Timely Tip: Quick Social Tips for Single Caregivers

It’s been noted in multiple surveys that family elder-caregivers think holding onto or building a social life while caregiving is the single biggest challenge they face. No wonder, with the myriad responsibilities and wrenching time demands caregiving extracts.

These tips, especially formulated for single caregivers, will help jump-start your efforts to build a social life while caregiving:

•   Check your loved one’s health insurance policies to see if home health care services are covered
•   Hire part-time help to stay with the care recipient so you can go out
•   Take advantage of programs that offer respite for caregivers
•   Ask friends and family to stay with your loved one occasionally
•   When dating, be upfront about your caregiving situation
•   Don’t waste time trying to develop a relationship with someone who is not understanding and supportive of your caregiving
•   Find out if you are eligible for rights and benefits under the Family Medical Leave Act

For the full story on ways single caregivers can maintain a social life, read Getting a Life – Finding a Social Life as a Single Caregiver, a feature article in the July 2007 edition of Caregiver’s Home Companion.

Timely Tip: Medicare MSA Questions to Ask

Medicare Savings Accounts, a sort of medical emergency bank account program for the elderly, are one of the newest Medicare options available to our loved ones.

They are an optional part of the privately-administered Medicare Advantage Plan program and are more fully explained in the June 2007 feature article Exploring Medicare MSA’s – Is a Medicare Medical savings Account Right for Your Loved One? in the monthly newsletter Caregiver’s Home Companion.

As with any such program, caregivers and their elderly should carefully and fully check out the program for its suitability for your loved one. In doing so, here are questions to ask at a minimum:

How much will be deposited in the plan member’s account each year?
What is the plan’s deductible?
What is the plan’s annual out-of-pocket maximum?
What is the plan member’s financial responsibility for services after the deductible is met?
Is there a co-insurance responsibility with the services offered through this plan?
Is there coverage for any preventative or wellness services?
Is the patient limited by doctors or hospitals that are in the network?
What happens if the patient decides to see a doctor not in the network? What does that cost?
What happens if in an emergency the patient is taken to a hospital not in the network?
What, if any, are the costs associated with setting up the account with the bank?
Will the account earn interest?
How are funds withdrawn from the account?

Timely Tip: Geriatric Care Managers Can Be Life Savers

Geriatric care managers are perhaps the best ally a family elder-caregiver can have. These “care consultants” often have licenses in related specialties, such as social work or nursing, and bring a focused value of seeking what’s best for the elderly loved one to the working relationship.

A reliable geriatric care manager will offer this range of services:

Performs a client medical assessment, including physical and mental health
Holds in-depth conversations with the elderly client about their situation and preferences, as well as (separately) with family members
Holds conferences with physicians
Learns and understands family support system and dynamics
Reviews finances, legal affairs, and insurance
Makes referrals to appropriate experts such as lawyers, accountants, physicians, and psycho-therapists
Explains Medicare, Medicaid, and other insurance programs
Coordinates medical care among doctors with different specialties
Searches out and recommends appropriate living facilities
Negotiates financial arrangements with living facilities
Develops an overall care plan
Lays out and recommends the best options based on the complete picture
Helps family members understand and accept the situation and their options
Negotiates disagreements and helps family reach consensus
Secures and monitors in-home care
Facilitates move to new living arrangements
Negotiates arrangements with facilities
Provides ongoing consultation and support

Get the full story about geriatric care managers and their importance to family elder-caregivers in Geriatric Care Managers – The Elder-Caregiver’s Best Ally, a feature article in the April 2007 edition of Caregiver’s Home Companion.

Timely Tip: Questions to Ask Before Hiring a Care Manager

While geriatric care managers can be a valuable resource in your caregiving role, it is essential that the person you hire fits well with you and your loved one’s situation.

Before hiring anyone, there are a number of questions for an informed caregiver to ask a prospective GCM you’re considering hiring. They include:

Are you a member of NAPGCM (this helps ensure the GCM is licensed in their field and adheres to a code of ethics)?
What is your background and experience?
How long have you been providing care management services?
Can you provide references?
What licenses do you hold?
What is your care philosophy?
What are your fees and what services are covered?
Will you work within my budget?
How many clients do you handle?
How available will you be to me?

For the full story on geriatric care managers and their value to family elder-caregivers, read Geriatric Care Managers – The Elder-Caregiver’s Best Ally, a feature article in the April 2007 edition of Caregiver’s Home Companion.

Timely Tip: Problems as We Age

According to research funded by the Administration on Aging, older people identified the following as the most significant problems they face in performing functions of daily life that help them remain independent:

Opening medicine packages
Reading product labels
Reaching high things
Fastening buttons, snaps, or zippers
Vacuuming and dusting
Going up and down stairs
Cleaning bathtubs and sinks
Washing and waxing floors
Putting clothes over one’s head
Putting on shoes, socks, or stockings
Carrying purchases home
Using tools
If something happened at home, no one would know
Using the shower or bathtub
Tying shoe laces, bows, and neckties
Moving around the house without slipping or falling

For the full story on strategies for helping an elderly loved one maintain their living independence, read Is Mom’s Home a Potential Minefield? in the March 2007 edition of Caregiver's Home Companion. Click here for more.

Timely Tip: Identifying Age Bias in Health Care

The Alliance for Aging Research notes these indications that our elderly don’t always receive the best medical care:

Older patients are less likely than younger patients to receive preventive care.
Older patients are less likely to be screened for diseases and other health problems.
Proven medical interventions for older patients are often ignored, leading to inappropriate or incomplete treatment.
Older people are consistently excluded from clinical trials, even though they are the largest users of approved drugs.

Learn the full story about declining medical care for Americans as we age in Fighting for a Fighting Chance – Do Doctors Give Up on the Elderly?, a feature article in the January 2007 edition of Caregiver’s Home Companion.

Timely Tip: Valentine?s Gifts for Seniors

When searching for a meaningful Valentine’s Day gift for an elderly loved one, don’t settle for the same old box of candies again. Instead, consider highly fragrant items that bring back happy memories.

Scientists at the Monell Chemical Senses Center say that as the most ancient of our senses, smell is highly evocative because the brain connects odors to emotional memories.

“Odors can act as potent keys to open doors to the past,” notes Pamela Dalton, PhD, a cognitive psychologist at Monell, a Philadelphia-based research institute.

Dalton suggests taking a few minutes to think back on past conversations, trying to identify specific details mentioned by your loved one about happy times or occasions. Then try to connect scents to those memories.

Or, she suggests, off-handedly initiate a conversation to identify favorite smells and their emotional connections. Your great-aunt may mention lavender because it reminds her of a long-ago honeymoon spent in the south of France. Or Mom might wistfully talk about the smell of your father’s after-shave lotion.

“The more specific the connection between odor and experience the better,” says Dalton, “because scent memories are very dependent on context.”

Because of their strong connections with emotional memories, scented gifts might be especially appreciated by older adults who have impairment of other senses, including cognitive limitations.

Scent-infused gifts for seniors can include fragrant flowers, scented lotions and personal care products, herbal pillows, or potpourri.

Whatever you choose, it’s likely that your senior will appreciate a highly fragrant gift, advises Monell behavioral neuroscientist Charles J. Wysocki, PhD, who notes that the sense of smell declines with advancing age.

“Seniors often rate odors as less intense than do younger people,” says Wysocki, noting that this decline begins for some smells about age 40 and continues across ensuing decades.

And lest you forget: Valentine’s Day is February 14.

Timely Tip: Relief for Itchy Winter Skin

Winter can make dry skin especially irritating. Try following these tips to relieve winter itch:

Soak in the tub. Keep the water lukewarm. The temperature shouldn’t be above 90 degrees F. Adding bath oil to the water may help retain and replenish the oil in the skin.
Use soap sparingly. If possible, limit soap use to the face, armpits, genitals, hands and feet. Avoid antibacterial and deodorant soaps. Mild cleaners such as Cetaphil, Dove or Vanicream are less drying. Avoid products with fragrances and lauryl sulfates, which can be irritating.
Pat skin dry. Avoid rubbing or wiping the skin. Instead, leave it moist by gently patting or blotting with a towel.
Moisturize. Immediately after drying off, apply a thick moisturizing cream or ointment. Avoid creams or lotions that contain alcohol.
Use a humidifier. Keep indoor air moisture levels at 40% to 50%. Keep the house on the cool side; between 68 F and 75 F is reasonable.

-- Source: Mayo Clinic Health Letter

Timely Tip: Preventing Senior Identity Theft

With the spread of identity theft in the United States, the federal government has introduced a program specifically aimed at protecting seniors and their benefit checks.

The program, called Go Direct, urges the elderly to have their Social Security and other federal benefit checks directly deposited into their accounts, avoiding paper checks, trips to the bank, and the ultimate risk of having their ID lifted by criminals.

Sponsored by the Federal Reserve Banks and the U.S. Treasury, Go Direct works with more than 600 banks, credit unions, community based organizations, advocacy groups, police departments and elected officials to minimize the vulnerability of the elderly.

Why take on this direct deposit push? Consider these couple of facts:

Retirees and older people who receive benefit checks through the mail are 30 times more likely to have an ID theft problem than those who receive their check through direct deposit.
In 2005 alone, about 65,000 Treasury-issued checks -- $60 million in estimated value -- were forged.

To learn more about theGo Direct campaign, or to enroll in direct deposit, visit the Go Direct website or call toll-free to sign up at 800-333-1795.

Timely Tip: 10 Ways to Lower Your Blood Pressure

High blood pressure continues to wrack the U.S. population, both at middle age and among our elderly. But vigilance on the part of caregivers – for themselves and their loved ones – can help get blood pressure under control and keep it there.

Follow these 10 steps, as reported in the Harvard Heart Letter, to avoid a big problem later:

Check it. You can’t do much about your blood pressure unless you know what it is. Your doctor should check it at every visit. Measuring at home between visits is even better.
Get moving. Exercise can lower blood pressure by 10 points, prevent the onset of high blood pressure, or let you reduce your dosage of blood pressure medications.
Eat right. A diet for better blood pressure emphasizes fruits, vegetables, low-fat dairy products, whole grains, poultry, fish, and nuts.
Control your weight. If you are overweight, losing weight can lower your blood pressure.
Don’t smoke. Smoking a cigarette can cause a 20-point spike in systolic blood pressure.
Drink alcohol in moderation. Going beyond a drink a day can contribute to higher blood pressure.
Shake up your salts. Too much sodium and too little potassium can boost blood pressure. Aim for less than 1.5 grams of sodium a day, and at least 4.7 grams of potassium from fruits and vegetables.
Sleep is good. Chronic lack of sleep can contribute to high blood pressure. Get at least six hours a night.
Reduce stress. Mental and emotional stress can raise blood pressure. Meditation and deep breathing can lower it.
Stick with your medications. Taking medication can keep you from having a stroke or heart attack.

-- Source: Harvard Heart Letter

Timely Tip: Pay Attention to Peripheral Artery Disease

It's been called the most dangerous little known disease - PAD, or peripheral artery disease, affects up to 12 million Americans, most of them elderly. The disease, which affects the lower extremities and involves impeded blood flow, can lead to heart attack and stroke and eventually even gangrene and amputation.

You are at higher risk for PAD if you:

Are over age 70
Are a smoker or have a history of smoking
Are African American
Are diabetic
Have a family history of stroke or heart attack
Have high blood pressure
Have high cholesterol
Are overweight
Do not exercise regularly

More specifically:

One in 5 people over age 70 has PAD
One in 3 people over age 50 with diabetes has PAD
PAD is the leading cause of amputation in patients with diabetes
African Americans are twice as likely to develop PAD as Caucasians
Smokers have a four times greater risk for PAD than nonsmokers

What can you do about PAD? Strategies for preventing PAD are similar to those used to treat other arterial diseases and include:

Immediate cessation of smoking
Eating a heart healthy diet
Lowering blood pressure and cholesterol
Exercise
Controlling diabetes
Maintaining a healthy weight
Understanding family medical history

Learn everything you need to know about this insidious, little known disease. The October 2006 edition of Caregiver's Home Companion has detailed coverage. Click here for the full story.

Timely Tip: Elderly Rights, States and Driving

As we and our loved ones age, our capacity to perform certain functions diminishes. Thinking, driving, handling finances, and more are affected. But most often, our right to perform these functions is not legally taken away, except in certain situations involving a loss of mental competency.

Driving is a prime example. Here's a sampling of state laws regarding elderly drivers:

Only Illinois and New Hampshire require a road test for drivers 75 and older. In Illinois, drivers over age 81 must renew their license every two years, and those over 87 must renew their license every year.
In Tennessee, drivers over 65 do not have to renew their license at all.
In North Carolina, drivers 60 and older get to skip the parallel parking part of the road test.
California is the only state in which doctors are required to report drivers who are impaired due to illness or disability to the DMV.

For the full story on elderly rights in the face of diminished cognitive control, read Can Dad Still Vote? In the October 2006 edition of Caregiver's Home Companion. Click here for more.

Timely Tip: Poor Appetite May Signal Time to Call the Doctor

Are you finding it difficult to get your elderly loved one to eat well – or eat at all – on a regular basis? You are not alone, by any means. But realize there may be a physical or psychological reason for your loved one’s poor appetite. To get at the root of the problem, make sure you discuss potential causes with your health care provider.

Some physical or psychological issues that may interfere with appetite include:

Medication. Certain medications or combination of medications (both prescription and over-the-counter) may depress appetite. Bring all of your elderly’s medications to your next doctor’s appointment for a thorough talk about how they can affect appetite.

Gastrointestinal Disorders. Gastrointestinal conditions such as constipation, bloating, heartburn, or stomach pain can cause problems with appetite.

Difficulty Chewing or Swallowing. Poor dental care or medical conditions affecting the throat or swallowing may make eating difficult. If your loved one expresses such concerns, discuss potential treatment with your physician or dentist and try soft, smooth foods that easily slide down the throat. Examples include creamy pastas and casseroles, soups, stews, and yogurt.

Depression. This common condition among the elderly can wreak havoc on appetite. Discuss potential causes and treatments of depression with your health care provider to help maximize nutritional success.

For a detailed look at the problem of getting the elderly to eat a nutritionally balanced meal day after day, including tips on ways for caregivers to avoid a “food fight” with Mom or Dad, click here to read the food fight feature in the September 2006 edition of Caregiver’s Home Companion.

-- Sharon Palmer, RD

Timely Tip: Parish Nurses Are Life Savers for Caregivers

There’s a good chance you’ve never heard of parish nurses, but in fact, they just might be the best kept secret in elder-caregiving. Click here to read the full story of parish nurses and how they can help you with your care of a loved one.

In the meantime, understand that parish nurses:

Are registered professional nurses, licensed by the state, who are on the staff of a faith-based community.
Are usually part-time and may or may not be in paid positions
Come from all nursing specialties
Provide health and wellness education and counseling
Act as community liaisons and advocates for the ill and elderly
Can help people understand complex medical information and refer them to resources for additional information and support
Always respect the confidentiality of individual family members
Provide spiritual support but do not preach

They can help you and your loved one if either of you:

Feels confused by the complexity of the health care system
Has a question about a medical condition, treatment, medication, or symptoms
Needs help and doesn’t know where to turn
Has recently been released from the hospital
Needs the reassurance of a caring medical professional who will take the time to listen

-- Melissa A. Goodwin

Timely Tip: Learning About Personal Health Records

More and more, it is becoming apparent that personal health records – or PHRs – are an invaluable caregiver tool whose time has come.

With a PHR, caregivers can, in one place – electronically or in paper, keep all of the medical records, physician information, and updated general data readily available as a potentially life-saving resource for their elderly. They’re also an ideal way for the primary caregiver to keep their siblings abreast of Mom or Dad’s welfare.

For the full story on PHRs, read the cover story in the July 2006 issue of Caregiver’s Home Companion.

Here are several resources for caregivers to learn more – and even acquire – the PHR format to get started:

ü My Personal Health Record (www.phr.com) is operated by the American Health Information Management Association. It highlights a “shopping and evaluation tool” that helps consumers evaluate paper-based, Internet and PC software PHR formats, available either at cost or no cost.

ü Care New England, at www.carenewengland.org, offers a free, confidential Internet-based PHR that lets individuals track their own and their family’s health information.

ü Thomas Jefferson University Hospital offers a free Personal Health Manager CD-ROM. Phone 1-800-JEFF-NOW or complete the request form found at www.jeffersonhospital.org/jeffnow/article11759.html.

ü Free forms for use in compiling a paper PHR can be found at Merck Source, www.mercksource.com.

ü The Veteran’s Administration has rolled out its own PHR system at www.myhealth.va.gov.

ü Body Journal can be found at www.bodyjournal.com This system tracks up to 10 individual records, making it ideal for family use.

ü Records for Living (www.recordsforliving.com) is a software-based PHR available for a fee. It has features specially designed to benefit those living with chronic illness.

-- Paula McCarron

Timely Tip: 10 Ways to Increase Dietary Fiber

By adding the proper amount of fiber to our diets and that of our elderly, we can create a natural laxative in our bodies, avoiding the need for more harsh and sometimes dangerous laxatives – both prescription and over-the-counter – to combat constipation.

For the full story on the good and bad of laxatives and our elderly, see the July 2006 feature article in Caregiver’s Home Companion.

Here are 10 tips on using fiber to naturally balance your elimination schedule:

1. Switch to bran cereal for breakfast.

2. Sprinkle bran in soups, casseroles, and salads.

3. Substitute whole grain flour for about half of the all purpose flour in your favorite recipes.

4. Look for the first ingredient to be whole grain when shopping for bread, crackers, cereals, and pasta.

5. Switch from white rice to brown rice.

6. Try out whole grains for dinner, such as bulgur, barley, buckwheat, quinoa, or millet.

7. Instead of fruit juice, offer fresh fruit.

8. Include vegetables with each meal.

9. Offer a handful of nuts and dried fruit for a snack.

10. Include more dried beans and legumes in your menu, from tossing them into salads to featuring them as a high-fiber side dish.

-- Sharon Palmer, RD

Timely Tip: Walking in Dementia's Shadowing World

Caring for a loved one with dementia demands a caregiver to muster every ounce of fortitude – for their own sake as well as their elderly. Here are a few quick do-and-don’t tips to help you deal effectively with the challenge:

What Works:
-- focus on strengths
-- maintain independence for as long as possible
-- simplify the environment
-- remain connected with local resources

What Doesn’t Work:
-- environment that is unfamiliar
-- logical reasoning
-- overcompensating for person

For a detailed first-person look at dementia caregiving, read our May 2006 feature article in Caregiver’s Home Companion entitled Apple Pie and Mom, With a Pinch of Dementia Thrown In.

Timely Tip: Common Meds Where Depression Can Be a Side Effect

Not everyone reacts the same to medications, and sometimes one can take on the characteristics of depression from medications prescribed to help another condition. Here are some common drugs that can be linked in some to depression (not every drug within a class has this effect):

Pain medicines, including codeine and darvon
Blood pressure medications, including clonidine and reserpine
Hormones, including estrogen, progesterone, cortisol, prednisone, and anabolic steroids
Heart medications, including digitalis and propanalol
Parkinson’s disease meds, including levadopa and bromocriptine
Arthritis medications, including indomethacin
Meds for anxiety, including Valium and Halcion

For a detailed look at depression in our elderly, read our May 2006 feature article in Caregiver’s Home Companion entitled Depression and the Elderly: Why is Mom So Sad?

Timely Tip: Shining a Light on Safety

Safe footing and adequate lighting are increasingly issues as we age. Caregivers can take many steps to literally light the way for their aging loved ones. Here are simple tips for enhancing the safety and workability of nearly every area of the home for the elderly:

Position light on areas of work or concentration, never at eye level.
Put the light directly where it is needed. Use lamps that swivel and can be raised or lowered to help direct the light.
Lights can be installed anywhere. For task, cabinet and toe space lighting, miniature light sources work well in just about any location.
Provide extra lighting in stairs and hallways where it can be difficult to move easily.
Make sure lighting switches are positioned in easily found locations.
Contrast switchplates with wall color or use switchplates that contain small lights.
Consider pre-set light timers for difficult areas.
Use fluorescent wall sconces in hallways or in corners to provide even illumination and eliminate dark circles or shadows.

For a detailed look at lighting and the elderly, including many more tips, read our May 2006 feature article in Caregiver’s Home Companion entitled A Caregiver Primer: Shedding More Light for Aging Eyes.

Timely Tip: Keeping a Lid on Accidental Elderly Poisonings

Accidental poisoning among our elderly is a danger often brought on by the complex medication regimens they maintain, as most seniors take a number of prescription drugs on a daily basis, sometimes prescribed by different doctors. The wrong mixture of these drugs can prove fatal.

As a result, the American Society of Health-System Pharmacists (ASHP) is striving to increase awareness among elder-caregivers and their loved ones on the unwitting dangers that lie in well-intentioned prescriptions.

“Medication poisonings are a problem among our growing senior population,” said Daniel J. Cobaugh, director of research for ASHP’s Research and Education Foundation. “The good news is that healthcare professionals, caregivers and seniors can work together to create a solution. By being active participants in their healthcare and by staying informed of their medications and conditions, seniors and their caregivers can help doctors and pharmacists ensure they get the best possible care.”

ASHP offers these tips to reduce the risk:

Keep a list of medications. A written record of the medications taken, including drug name, dosage, and frequency, is an important tool to have during physician visits and in case of an emergency.

Communicate. Inform doctors and pharmacists of all medications taken, including non-prescription meds and dietary supplements, to reduce the chances of an interaction.

Learn about medications. Ask the doctor or pharmacist to explain why a certain medication is prescribed, the food and medicines to avoid, and possible reactions and side effects.

Use one pharmacy. Many seniors receive prescriptions from more than one doctor, making drug interactions more likely. By using one pharmacy, all prescriptions are consolidated and a pharmacist can check for possible interactions between medications.

Keep a journal. Make note of all symptoms, especially after taking medications. Painful or unexpected side effects may signal a need for adjusting a medication regimen.

Maintain a schedule. Holding to a routine can decrease chances of missing dosages or taking more than needed.

“Patients should immediately contact their physician if they experience an adverse reaction to their medicines,” says Cobaugh. If the physician is not available, Cobaugh recommends contacting the local poison center using the toll free number (800) 222-1222. For more medications safety tips and information, check out ASHP’s website.

Timely Tip: Exploring Adult Day Care

Finding the right day care facility for your elderly loved one can be a daunting task. Sure, you want a strong staff, clean and safe facility, and a warm atmosphere for your elderly, but how can you really know what’s in store?

Experts say a facility tour for you and your loved one is essential, and they recommend asking a series of questions to help you gain comfort that your decision is the right one.

Here are some questions to ask when selecting a day care facility:

What kinds of services are provided?

What kinds of activities are offered?

Is transportation provided?

What about meals?

What are the qualifications of the caregivers? Do they have experience with your loved one’s condition?

What is the ratio of caregivers to clients? (One caregiver to three or four clients is a good number.)

What are the hours of operation?

What is the cost?

Are they licensed or accredited by the state or any other organizations?

Can they provide references? Can you talk to some clients and their families?

For a detailed look at adult day care, read our March 2006 feature article on Caregiver’s Home Companion entitled Understanding the Ins and Outs – Adult Day Care Becomes a Basic Senior Service.

-- Kelly Morris

Timely Tip: Medicare Part D Explained – A Glossary

Medicare Part D represents the most sweeping changes in the federal government’s healthcare program for the elderly in nearly 50 years. But the program, which takes effect on January 1, 2006, has been criticized as overly complex, when simplicity is needed.

Our series on Medicare Part D goes into great detail explaining the program’s ins and outs from the standpoint of the family caregiver, including whether the program is right for your loved one. Check our first article explaining the program and our second on 10 steps to help you navigate the complex program.

Meanwhile, here is a brief glossary of basic terms related to Medicare Part D to help you chart your course through the program’s complexities.

Enrollment Period – The period of time in each year when an individual can elect coverage in a prescription drug plan or change to another plan without penalty.

Co-payment – The amount of money paid by an individual, a percentage of the total cost with the balance being paid by the insurance company.

Coverage Gap or Donut Hole -- The stage in many of the Medicare Prescription Drug Plans (PDPs) where the total cost of prescriptions falls to the plan beneficiary.

Creditable Coverage – Drug coverage offered by other plans, such as employers or unions, which provide coverage at least as good as the Part D plans.

Deductible – The annual amount of money to be paid by the enrollee before the insurance plan begins to provide payment for services. The actual dollar amount varies from plan to plan. Most often plans with lower deductibles have higher premiums.

Formulary – A listing of the drugs covered by a specific drug coverage plan.

Medicaid – A state/federally sponsored program for individuals who meet both income and health criteria due to exceptional need. This is a financial assistance program that provides assistance with health and medical expenses. Names for the program vary from state-to-state.

Medicare Part A – The Medicare benefit designed to assist with the cost of hospitalization, home health services, or skilled nursing care facilities. Provided without cost to eligible enrollees.

Medicare Part B -- The Medicare benefit that covers most costs related to doctor visits, outpatient care and other similar services. This is a premium-based program.

Medicare Part D -- The new Medicare program and benefit designed to provide prescription drug coverage for Medicare beneficiaries who have Medicare Part A and/or B.

Medigap – An insurance plan that provides supplemental coverage received from Medicare. Enrollees typically purchase these plans to cover costs not underwritten by Medicare.

Premium – The monthly cost of maintaining an insurance policy. Premiums must be paid on a timely basis in order to avoid a lapse or cancellation in coverage.

Timely Tip: Charting the Caregiving Evolution

Without a doubt, becoming a caregiver can be an emotional and most stressful time. Here is a brief overview of the four steps caregivers experience when involved in such serious transition: denial, resistance, exploration and commitment. Knowing these steps can ease you through the transition.

For a firsthand portrayal of the caregiver evolution, including tips to deal with the ordeal, see the September 2005 feature article Are You Flexible: Entering and Exiting the Role of Caregiver.

Though some experience these steps in a quick linear fashion that take moments or only days to complete, others take longer and find that they repeat some steps before they are able to commit to their new role. For example:

Denial: Thoughts that could characterize this step are “This isn’t happening,” “They won’t be staying long,” or “This isn’t going to affect my home life at all.” At the same time, feelings that arise are panic, anxiety, depression or avoidance.

Resistance: It is typical in this phase to evoke thoughts such as “Why me?” Or, “This can’t be happening.” Feelings of doubt, frustration, negativism, or distress are normal when going through this step in the transition.

Exploration: In this phase, feelings of confusion, excitement, insecurity, bitterness or uncertainty begin to mix with thoughts about moving forward and taking steps to accommodate the change. For example: “What if we tried renovating the bathroom to be wheelchair accessible?” or “Maybe home support can help on weekdays so I can continue to work,” etc.

Commitment: In this phase, the caregiver has accepted their new role and begins to look toward the future, make plans based on their new role, and feel more control over their lives. Teamwork and problem solving are also a characteristic of this step.

-- J.L. Manji

Timely Tip: What's in a Name? Plenty, if it's Medicine

Medication mistakes happen every day in the United States, sometimes with alarming consequences. The plethora of medicines taken by our elderly makes them especially vulnerable, making the watchful eye of caregivers very important for the safety of loved ones.

The Food and Drug Administration advises pharmacists and patients to be particularly aware of the medications whose names may sound alike or may look similar when handwritten on a prescription. Caregivers should likewise be alert and cautious.

Here are some examples of easy confusion:

Ambien and Amen
Cardene SR and Cardizem SR
Clonidine and Klonopin
Cozaar and Zocor
Feldene and Seldane
Flutamide and Flumadine
Norvasc and Navane
Retrovir and Ritonavir
Saquinavier and Sinequan

Remember this: If you have trouble reading the doctor’s handwriting on a prescription, the pharmacist may have trouble, too. Ask the doctor to write clearly.

Asking the doctor to note the reason a medication is being prescribed will also help prevent errors. For example, Norvasc is used to treat high blood pressure, while Navane is used to treat psychiatric disorders. If the physician writes “Norvasc, 10 mg for hypertension,” it will be easy for the pharmacist to know which medication to dispense.

Learn much more about medication mistakes and how caregivers can nsafegued their elderly by reading our feature story "Protecting Your Elderly: Medication Alert--Mistakes Are More Common Than You Think" in the Caregiver's Home Companion newsletter (August 2005).

--Kelly D. Morris

Timely Tip: Caring for a Loved One with Incontinence

Urinary incontinence is a frustrating and embarrassing condition that afflicts nearly a third of all our elderly living in a non-institutional setting, leaving family caregivers with the sometimes awkward and often unpleasant task of caring for their incontinent loved one.

Caregivers can get the full story on dealing with incontinence in a loved one by clicking here.

In addition, caregivers should be aware that these conditions and medications can cause or contribute to the condition.

CONDITIONS:

Cancer
Dementia, mental confusion or psychological factors
Restricted mobility
Urinary tract or prostate enlargement or infection
Side effects of medications
Impaired nervous system
Pelvic muscle weakness
Nerve or muscle damage after pelvic radiation
Developmental problems of the bladder
Pelvic, prostate, or rectal surgery
Bladder spasms

MEDICATIONS:

Diuretics commonly used for water retention and blood pressure increase the amount of urine produced and can cause urgency.
Antihistamines (this includes over-the-counter sleep medications and Tylenol PM), especially when taken by older men with prostate problems, can cause urinary retention, overflow incontinence, sedation and delirium.
Tricyclic antidepressants and antipsychotics can cause urinary retention and sedation as well.
Benzodiazepines (such as Valium or Xanax) can cause sedation, delirium and muscle relaxation.
Narcotic pain relievers can cause urinary retention, delirium and sedation.
Alpha-blockers (used for blood pressure or prostate problems) can cause relaxation of the urethra. This can be a problem for women who experience stress incontinence.
Alpha-agonists (over the counter decongestants) can cause urinary retention in men.
Calcium Channel Blockers (usually used for blood pressure - sometimes migraine headaches) can cause urinary retention.
Alcohol can increase the amount of urine produced, causes frequency, urgency and sedation

Timely Tip: Caffeine and Stress Not a Good Combination

What you eat or drink and when you consume it can have a direct bearing on the level of stress in your body. While there are many beneficial aspects of diet to be learned from our feature Taking Care of Yourself -- Attacking Caregiver Stress by Overhauling Your Diet in the May 2005 edition of Caregiver's Home Companion, there are also negatives to be avoided.

For example, while de-stressing your life by overhauling your diet, be mindful of the negative effect of caffeine in your system. This Caffeine Chart should help:

Source	How much caffeine?	Comments
Instant coffee	60-100 mg per cup	The amount of caffeine depends on how much you put in the cup
Fresh coffee	80-350 mg per cup	The amount of caffeine depends on: the type of beans ("Robusta" contains more caffeine than "Arabica") the way the coffee is made how strong the brew is
Decaffeinated coffee	2 - 4 mg per cup	The amount of caffeine is usually marked on the packet
Tea	8 - 90 mg per cup	Caffeine content depends on how strong the brew is
Cola drinks	35 mg per 250ml serve	Cola drinks often contain a lot of sugar too
Cocoa and hot chocolate	10 - 70 mg per cup	The amount of caffeine depends on strength of the brew and the other chemicals in the product
Chocolate bars	20 - 60 mg per 200 g bar	Chocolate also contains a lot of sugar
Some prescription and over-the-counter medications	20 - 100 mg per dose	Some medicines (cough, headache and slimming products) contain caffeine.

-- Sharon Palmer, RD

Timely Tip: Nursing Home Residents' Rights

The fact that your elderly loved one resides in a nursing home or similar facility does not mean they -- or you, as their caregiver -- have no rights. To the contrary, you both have a number of longstanding rights on your side.
The Nursing Home Reform Act of 1987 is the definitive piece of federal law governing the rights of nursing home residents and their families. In addition to establishing resident rights, the legislation set quality standards for nursing homes nationwide and defined the state survey and certification process to enforce the standards.
Here are the highlights of resident rights:
Residents have the right to be fully informed
Residents have the right to participate in their own care
Residents have the right to make independent choices
Residents have the right to privacy and confidentiality
Residents have the right to dignity, respect, and freedom
Residents have the right to security of possessions
Residents have the right to complain
Residents have the right to visits