Late Life Caregiving


Caregiving for older family members is not only rewarding, but especially challenging when the caregiver is a senior, too.  Due to older persons living longer and healthier lives, it is common for adult children in their seventies caring for their parents, adult children, grandchildren, and great-grandchildren.  Five generations living at the same time has resulted in caregiver burnout and health declines.  Caregiving among family members who are geographically distanced can be especially challenging.  Family members want to provide and typically step forward and embrace the challenge.  However, without resources and self-care, they ultimately suffer mental and physical health declines.  The challenge is to provide care but embrace self-care to avoid burnout and exhaustion.

Long-Distance Caregiving:
“Doris” is a 75-year old retired schoolteacher caring for her 97-year old father who lives 300 miles away in rural Pennsylvania.  She and her 77 year old brother, “Todd,” each live with him for two weeks at a time and then switch off.  Todd lives 200 miles from his father.  Neither of them have had a vacation in seven years.  Doris has become obese, developed diabetes, osteoporosis, and has failing eyesight. Todd and Doris have not had time for medical care or their diagnostics.  Doris has not had a colonoscopy or mammogram.  Todd never had time for his PSA tests.  Now, he has been diagnosed with prostate cancer, Stage III, and is deciding on his next steps.  Both of their spouses are complaining about their lengthy absences from home.   

Alzheimer’s Caregiving:
“Tim” is a 85 and he is a retired firefighter and then retired driving the school bus.  He has been married to “Jennie” for 65 years and he promised her he would never place her in a nursing home after her diagnosis of Alzheimer’s four years ago.  Tim, her only caregiver, has not slept through the night in two years and he is exhausted caring for her.  Jennie requires constant supervision because she wanders and she has become incontinent and does not know Tim or any other family members. In addition to caring for Jenny 24/7, Tim has fallen twice during the night and is recovering from a broken wrist.  Tim will not allow anyone to care for Jennie because he thinks he is the best caregiver for his wife. 

Multi-Generational Caregiving:
“Sally” is 58 and lives in rural Mississippi. She works full-time at a bank and has a part-time hairdressing business in her home.  Her parents, Dale and Patsy, retired and bought a mobile home and moved it onto Sally’s property, an arrangement they agreed to after Dale had his second heart bypass surgery and Patsy had a small stroke.  They both have mobility challenges.  Sally has custody of her three elementary-school age grandchildren because their parents are incarcerated.  Dale and Patsy used to help care for them but now their health is failing.  Sally’s middle daughter, Joanna, was diagnosed with Sickle Cell Disease as a teenager and lives with Sally but requires ongoing treatment and care and she is not able to work.  Sally’s long-time boyfriend, Joe, left last year because the environment was in his description “far too chaotic for my lifestyle.”  Recently, Sally called 911 because she thought she was having a heart attack.  After numerous tests and diagnostics, the diagnosis was severe emotional stress and anxiety.  

All three of these examples are composites of actual scenarios yet and represent an array of contemporary caregiving challenges.  In all three examples, the caregivers were committed to helping their family but at the cost of their own health.  In addition to losing their freedom, they had no self-care, no social life, and no support team, resulting in isolation and physical and mental health declines.

Adult day services are typically in churches or senior centers where older adults gather for social activities, recreation, and a congregate meal.  While some of the seniors have dementia and limited physical abilities, adult day programs provide supervision and safety during normal business hours and allow caregivers to remain employed and get a break from the responsibilities of caregiving. Here is a wonderful resource https://eldercare.acl.gov/public/resources/topic/Adult_Day_Programs.aspx

Caregivers with Medicare are allowed respite care for one week, provided the person they care for is in hospice care.  It entails moving the sick person to a residential hospice facility, a less than satisfactory solution that is often refused.  Sometimes the caregiver refuses and sometimes the loved one.  Nonetheless, it is a free option that provides at least one week of time to decompress and relax.  Here are the details. https://eldercare.acl.gov/public/resources/topic/Adult_Day_Programs.aspx

Resources available to local readers include the following:
Limestone County- Resources are available in Athens at the Council on Aging on Jefferson Street. https://limestonecounty-al.gov/departments/council-on-aging/

Giles County- South Central Tennessee Area Agency on Aging http://setaaad.org/120

Madison County and Northeast Alabama – TARCOG Area Agency on Aging http://tarcog.us/area-agency-on-aging/

Other national resources include:
Family Caregiver Alliance https://www.caregiving.com/




Milestone Celebrations


“Youth has no age.” Pablo Picasso

A friend of mine who recently turned 65 did not want to celebrate her birthday but we all talked her into it.  While “Helen” did not want to have a party to celebrate “old age,” her friends saw this an an opportunity to acknowledge her significant achievement.  Helen told us that all she wanted to do on her birthday was stay home in her pajamas and order a meat lover’s pizza.  She did not want any attention and she was in no mood for partying.  We deferred.  And then she changed her mind!

Celebrating a landmark or milestone birthday or anniversary is an opportunity to impose order on the passage of time, make some sense of the passage of time, and celebrate both the past and the future (Stephens & Williams, 2017). Society determines what is and is not a milestone or landmark occasion.  For example, in America, it is common to celebrate birthdays at age 16, 21, 40, 50, 65, 80, and 100.  Milestone anniversaries are typically celebrated for 10, 25, 40, and 50 years of marriage. 

Milestone birthdays can also be opportunities to engage in an unusual activity such as skydiving or take up a new hobby or sport.  I read about Ginny Reed, who recently turned 70 and began her “health adventures” with hiking and running (Corrigan, 2018).  I read about Lawrence, a CPA who turned 50 and took up a new passion, foot-launched paramotoring (Corrigan, 2018). 

Milestone birthdays also provide us with social bonding, status, and prestige with lots of positive emotion from family and friends as they come together to collectively acknowledge an important achievement.  It is also a time of reminiscing and reflecting but not everyone embraces that task.  Although I adore milestone birthdays for others and myself, it is important to respect the wishes of the others and not force a party, as doing so can trigger negative emotions and feelings. 

Corrigan, P. (April 23, 2018). Confronting a milestone birthday? What 10 people did, or plan to do, when turning 50, 60, 70, 80, and 90.  Retrieved from NextAvenue https://www.nextavenue.org/confronting-milestone-birthday/

Stephens, S., & Williams, L.A. (May 17, 2017). Why milestones matter: How birthdays and anniversaries shape our lives.  Retrieved from ABC News http://www.abc.net.au/news/2017-05-18/milestones-how-birthdays-and-anniversaries-shape-our-lives/8533906

 

Give-It-Up Itis ~ Yes, It is Real


Is it real?  Yes, this is a real condition when people just give up and die. 
I first encountered this phenomenon reading the 1946 classic, Man’s Search for Meaning by Viktor Frankl.  During WWII, Frankel, who was a medical doctor and psychiatrist, was incarcerated in four concentration camps where he and other inmates observed people giving up and dying.  They were not insane and displayed no physical illnesses.  However, the pattern of shuffling gait, disconnecting with the world around them, lying down and curling up, incontinence, and lying in their own excrement meant only one thing: That man would be dead in three days.  The concentration camp prisoners saw this so often that they could predict almost to the hour when their colleague would die. They just gave up.

Recently, a friend gave me an article about Give-Up-Itis [GUI] published online in The Conversation magazine published on September 27, 2018.  A new study by researcher John Leach, published in the Journal of Medical Hypotheses on 14 June described GUI as a real medical condition known as extremis but commonly known as fatal withdrawal.  GUI most often occurs from a traumatic situation from which there is no perceived escape and the person has no control. From a historical perspective, Leach described how GUI has been documented in 16th century Jamestown records, Africans who had been captured by European slave traders, concentration camps, atomic bombings, and POW camps of WWII, Korea, and Vietnam.  GUI has also been documented in cases of chronic or acute severe trauma such as the case of survivors of a shipwreck who witnessed their friend giving up and dying just hours before rescue. 

Stages:

1.     Social withdrawal; no motivation

2.     Apathy; disheveled and dirty; shuffling walk

3.     Loss of motivation; ceases personal hygiene; lack of speech output (empty mind)

4.     Catatonic state; stupor; ceases eating; no external responses even to pain

5.     Basic cognitive functioning intact; death

GUI is caused by frontal-subcortical circuit dysfunction which results in lack of dopamine.  In a medical setting, dopamine can be administered and the condition reversed. However, in the field, medical intervention is not available. “Motivation and goal-directed behavior are essential for coping and in the field, they could pushed into action by a leader if compelled to move around every day” to avoid accepting mental defeat (Leach, 2018, p. 18).  In his research, Leach also identified numerous examples how good people are essential to recovery.  At first paternalism and sometimes strong leadership and kind words helped victims snap out of their despair. 

The shuffling walk at Stage 2 was a key indicator to scientists that dopamine deprivation could reverse GUI.  Physical activity has been known to increase dopamine and whether forced or voluntary, activity and adopting goals was proven to be essential to survival.  Dopamine production is increased during activity and engaging in goal-oriented behaviors.  For example, daily shaving and undressing for sleep were examples of personal control and goal-oriented activity in Frankl's concentration camps.  The bottom line is that having good people around to help them get through trauma was essential to survival. 

References:

Leach, J. (2018).  “Give-up itis” revisited: Neuropathology of extremis.  Journal of Medical Hypotheses, (120), 14-21.  https://doi.org/10.1016/j.mehy.2018.08.009

The Conversation.  Give-up-itis: when people just give up and die.  Published September 27, 2018. Retrieved from https://theconversation.com/give-up-itis-when-people-just-give-up-and-die-103727


Risks and Death Facts ~ Older Adults


Risk factors:

According to the latest statistics from Our World In Data’s Global Burden of Disease Indicator (2018), the top five death risk factors among older adults worldwide are preventable and reversible conditions that are also risk factors for cardiovascular disease, the number one cause of death worldwide:

·        High blood pressure 6.35 m

·        High blood sugar [diabetes] 3.03 m

·        Smoking 2.4 m

·        High cholesterol 2.4 m

·        Obesity 2.07 m

Causes of death:

Sadly, the number one cause of death worldwide is cardiovascular disease and in most cases, it is a preventable condition.  The leading cause of death in older adults worldwide is cardiovascular disease with 11.11 million deaths in 2016, followed by cancer at 3.93 million.  Cancer risk factors include alcohol, carcinogenic substances, chronic inflammation, obesity, hormones, tobacco, and more, as indicated in the Cancer Prevention Overview from the NIH National Cancer Institute (2018). After cardiovascular disease and cancer, the top five causes of death in older adults are:  

·        Cardiovascular disease 11.11 m

·        Cancer 3.93 m

·        Respiratory disease 2.35 m

·        Dementia 2.23 m

·        Diabetes, blood, and endocrine diseases 1.7 m

Sources:

National Institutes of Health, National Cancer Institute (August 13, 2018).  https://www.cancer.gov/about-cancer/causes-prevention/patient-prevention-overview-pdq

Worldwide Causes of Death 2016: OurWorldInData.org (August 28, 2018) https://ourworldindata.org/grapher/causes-of-death-in-70-year-olds

Worldwide Death Risk Factors: OurWorldInData.org (August 28, 2018) https://ourworldindata.org/grapher/deaths-by-risk-factor-over-70

 

Happy Birthday Helen Granier ~ Going Strong at 105


Helen Granier turned 105 on Friday and she has no idea why she’s lived so long, because for years she indulged in bad habits. Turns out the secret to her long life is partying hard.

 “I never expected to live this long,” Helen Granier of Palm Harbor told WTSP. “No one in my family ever did. I don’t know what the secret is.”

Helen celebrated her birthday at Coral Oaks Independent Living Facility last week, where she has lived for the past nine years.

She reminisced about her life and how she went against the grain in her younger days.

“I used to drink beer and I smoked and everything,” she told WTSP. “I stayed out late, you know, dancing, and then I would go to work.”

She loved to dance, but her husband prevented her from going to Las Vegas to test her luck.

“My husband wouldn’t take me to Vegas, because he knew I liked to gamble. Oh, I loved to play the slot machines,” she said. “So I went to Las Vegas after he passed.”

Some memories are clear, as if they happened yesterday, she said. Helen was only five when World War I ended, but she said she still remembered it. She does not recall getting her driver’s license, though.

“I don’t even remember when I started to drive,” she laughed.

Sources:

The Week Magazine.  June 29, 2018


 

 

Successful Aging - 10 Proactive Steps


Hi Readers,
One of the questions I am asked most often is, “How can I age successfully and retain my independence?”  Although “success” is a relative term, everyone wants to attain optimum aging regardless of income, socioeconomic status, or limitations.  Is successful aging possible regardless of your circumstances?  YES! While there is no magic formula for retaining optimum health, strategies begin with living healthy and taking responsibility for making wise decisions about eating, lifestyle, social activity, and physical activity.

The Spring 2018 edition of AFA Care Quarterly included “10 Steps for Healthy Aging,” a strategy for retaining a healthy mind and body:

1.    Eat well – Although the article included guidance on fruits, meats, and vegetables, I recommend that all people age 65+ [unless directed otherwise by a physician] follow the eating guidelines detailed in the Tufts Food Pyramid. Eating well means maintaining a healthy weight and avoiding frailty, overweight, or obesity.  Eating well includes staying hydrated with at least 8 cups [64 oz.] of water daily.  Vital organs including the brain cannot work effectively when the body is dehydrated and dehydration in older adults mimics dementia.  http://globalag.igc.org/health/us/2007/pyramid.pdf

2.    Stay active-  Walking, aerobics, and weight training are included on the AFA list.  I also recommend Silver Sneakers and Sit and Be Fit, as both programs include low-impact activity for people with physical challenges and limitations.

3.    Learn new things – Research shows that people who retain their curiosity throughout life and engage in new activities give their brains a good workout.  Remember that language is also needed to keep the brain working! 

4.    Get enough sleep – Sleep deprivation mimics dementia, a condition known as psudodementia and may lead to memory problems, falls, and driving accidents.  Daytime napping is the number one cause of insomnia.

5.    Take your medication – No one likes taking medication but the average older adult takes five prescription medications daily.  Please take your medications as prescribed and speak with your primary care physician before taking over-the-counter products.

6.    Stop smoking and limit alcohol consumption – Cigarette smoking causes disease consequences including lung cancer, but COPD, cardiovascular disease,  and other chronic conditions.  Studies show that second-hand smoke impacts the health of others around you.  Alcohol may have protective factors but studies are contradictory.  Best to limit alcohol to moderate consumption.

7.    Social connectedness – Social isolation not only impairs cognitive health, but language is needed to keep the brain firing.  Retain your network of friends and stay in touch.  Talk to people and engage in conversation. 

8.    Check your blood pressure – I recommend keeping a log and check it around the same time every day.  If your physician has prescribed medication for HBP, take it!  I have encountered too many older adults who quit taking it due to negative side effects and some of them had strokes as a result.  The negative side effects typically diminish over time.

9.    Get your checkups – This includes being proactive and getting annual vaccines for flu and pneumonia.  Health screenings and diagnostic tests are now covered by Medicare.  Examples are PSA testing, mammograms, pap tests, sugar levels, and colonoscopies.  Here is a link to Medicare.gov showing types of preventive screenings and services. https://www.medicare.gov/coverage/preventive-and-screening-services.html

 

10. Get a memory screening – This is also covered now by Medicare.  If your primary care physician does not offer it, then ask for it.  These are typically administered by a social worker or case manager trained in interpreting the results.  I have administered hundreds of cognitive screenings and these are private, non-invasive assessments.  They are NOT “tests” for Alzheimer’s Disease.  As my readers know, AD cannot be diagnosed by the family physician.  The diagnosis is a result of brain imaging and other tests administered by specialists.  The overwhelming majority of older adults do NOT have AD. 

I recommend accessing or subscribing to the AFA Quarterly, published by the Alzheimer’s Foundation of America.  Their website is www.alzfdn.org. 

 

 

New Medicare Cards

Hi Readers, beginning this month, older adults will receive their NEW Medicare cards.  The purpose of replacing the old ones is simple: The new ones do not have the social security number.  

The National Council on Aging [NCOA] recently sent this information to me and I hope you find it useful.  I have also included some resources from Medicare.gov including the mailing schedule for the new cards.  AgeDoc

New Medicare Cards: 5 Things You Need to Know Before They Arrive


by: The My Medicare Matters Team at NCOA

Beginning April 2018, the Centers for Medicare and Medicaid Services will be sending new Medicare cards to beneficiaries. The new cards are being sent to decrease Medicare beneficiaries’ vulnerability to identity theft by removing the Social Security-based number from their Medicare identification cards and replacing it with a new unique Medicare Number.

Here’s what you need to know before they arrive.

  1. Medicare cards will be sent between April 2018 and April 2019. Make sure your address is up to date because Medicare will be sending it to the location associated with your Social Security account. To update your address information contact Social Security at 1-800-772-1213 or go online. https://www.ssa.gov/site/signin/en/
  2. Your new card will no longer include your Social Security number. It will include your name, new Medicare number, and the dates your Medicare Part A and Part B coverage started.
  3. Start using your new Medicare card once you receive it. Destroy the old one immediately, since it contains your Social Security number. If you happen to lose or misplace your card you can get a replacement, but you can also can access your new Medicare number on a Medicare Summary Notice or through Medicare.
  4. Keep your Medicare AdvantagePart D prescription, and/or Medigap. Continue using your health or drug plan’s card when you get health care or fill a prescription, but know you will also get the new Original Medicare card.
  5. The Railroad Retirement Board will issue new cards to Railroad Retirement beneficiaries.

These are just a few quick tips to keep in mind as new Medicare cards are issued. You can find additional information on the release of Medicare’s new card on Medicare.gov.

New Medicare card mailing schedule:


More resources and details:




Watch out for scams


Medicare will never call you uninvited and ask you to give us personal or private information to get your new Medicare Number and card. Scam artists may try to get personal information (like your current Medicare Number) by contacting you about your new card. If someone asks you for your information, for money, or threatens to cancel your health benefits if you don’t share your personal information, hang up and call 1-800-MEDICARE (1-800-633-4227).  


Older Adults, Vets, and Disabled Blamed for National Parks Revenue Decline


American Society on Aging [ASA] Board Chair Bob Blancato, Chair-Elect Karyne Jones, and CEO Bob Stein today condemned remarks offered by Interior Secretary Ryan Zinke during testimony to the Senate Energy and National Resources Committee on Tuesday.

As reported in The Hill, Zinke said “When you give discounted or free passes to elderly, fourth graders, veterans, disabled, and you do it by the carload, there's not a whole lot of people who actually pay at our front door. So, we're looking at ways to make sure we have more revenue in the front door of our parks themselves.”

ASA leaders responded by saying “On behalf of the older and disabled Americans and veterans in our membership we take offense at the comments of the Interior Secretary about all of these groups not continuing to enjoy free access to national parks. It is especially disingenuous coming from a Cabinet Secretary who according to published reports spent almost $140,000 in taxpayer funds to fix doors leading into his office. This proposal to impose these new fees should be shown the door.”

ASA will continue to support policies that provide preferential access to public resources for older Americans, youth, the disabled and the veteran community.

Reference:
Gstalter, M. (2018, March 13).  Zinke: Too many people enter national parks for free. The Hill.   Retrieved from http://thehill.com/blogs/blog-briefing-room/news/378220-zinke-too-many-people-can-enter-national-parks-for-free


Expanded Support from Alzheimer's Foundation of America



Hi Readers, her is some fantastic news from my friends at the Alzheimer’s Foundation of America:

 

AFA's National Toll-Free Helpline is
Now Open 7 Days a Week!

 

Effective 4 February 2018, AFA's National Toll-Free Helpline will be available to provide support, assistance and referrals to families affected by Alzheimer's disease seven days a week.
 
The new helpline hours are:
 
Monday-Friday: 9 am to 9 pm (ET)
Saturday: 9 am to 1 pm (ET)
Sunday: 9 am to 1 pm (ET)
 
Call 866-232-8484 to speak with one of AFA's licensed social workers if you have questions or need help!

 


Guide for Seniors ~ Recognizing and Avoiding Internet Scams

Hi Readers,

Globally, older adults are the most targeted group for scammers.  To approach this issue using a proactive stance, I have attached this guide developed by internet experts. 

https://www.attinternetservice.com/resources/senior-citizens-guide/

It was sent to me by the ATT community outreach manager, Gary Bell.  I hope you find it useful.  If you do, download and forward the booklet or pass along the link. 

 
 

Late Life Caregiving

Caregiving for older family members is not only rewarding, but especially challenging when the caregiver is a senior, too.   Due to older ...