Baby boomers’ health demands will pose challenges

Rebecca Koch, 100, of Toronto is one the country's more than 5,800 centenarians.

Baby boomers are starting to reach the stage in life when things start aching or stop working, when age starts to steal away progressively larger bits of physical and cognitive function.

“This is on absolutely everyone’s radar, without a doubt,” said Jennifer Ryan, a senior scientist in the field of cognitive neuroscience of memory at Baycrest, a Toronto teaching hospital that specializes in studies in aging and the brain.

“As scientists, we are aware of the approach of the baby boomers towards 65 and older. And funding agencies as well are very aware of the challenges that are going to arise as a result. People are working, I think, as fast as they can to really improve the lives of the boomers who are approaching that later stage in life.”

The preparatory work ranges from trying to predict the demand for medical specialists like the orthopedic surgeons who replace worn-out hip and knee joints, to devising screening tools to spot adults who are developing memory problems, to figuring out how to adapt living spaces so that aging boomers can safely stay in their own homes for as long as possible.

“Who wants to end up in a 200-square foot room with a cupboard? I mean, really,” said bioengineer Geoff Fernie. “People are saying, ‘No, I want something better.”‘

Fernie is the research director at Toronto Rehab, a rehabilitation hospital and research institute affiliated with the University of Toronto. His team is working to solve the practical, day-to-day problems that can plague older adults.

How do you use the toilet when you cannot lower yourself onto it or hoist yourself up? How can you shower safely? Is there footwear that can lower your risk of falling on the stairs or outside during the winter?

Fernie calls it “coming up with affordable things to help people manage.” His team has already developed and marketed “Toilevator,” a simple and inexpensive platform that raises a toilet to a level that’s more accessible for those with stiff spines or stiff knees.

‘People are wanting joint replacements done earlier now.’— Dr. Cy Frank

Fernie’s bioengineering team has a multitude of projects in the works that he said he believes boomers will need as they age.

“Once upon a time, people expected to end up in bed and be sick and die early and put up with things and be in misery,” he said. “And now they realize that just because you’re old doesn’t mean you have to put up with this stuff.”

Ryan and others see the same challenge. The boomer generation isn’t just a huge group of people. It’s a huge group of people with attitude.

By dint of its size, the baby boom generation is used to getting its own way. Boomers have had great expectations for their lives. And that isn’t about to change just because they’re becoming eligible for discounted bus fares.

“The baby boomers, I think, will not accept aging particularly well. They won’t go grey any time soon. And I think that they have a value around preserving not just their looks, but I think their health as well,” said Susan Kirkland, an epidemiologist in the department of community health at Dalhousie University in Halifax.

“What’s unique about them is that they’ve kind of changed the face of health and health care all the way through their lives. And they’re much different than previous generations in terms of how they deal with their health, what kind of services they expect and those kinds of things.”

Slowing cognitive decline

Kirkland is a principal investigator of a large national study that’s recording the ups and downs of aging experienced by more than 50,000 Canadians over the next 20 years. The Canadian Longitudinal Study on Aging is enrolling adults aged 45 to 85 with a view to getting a sense of how they are living as they age.

What problems they are facing? How healthy are they? Are government policies helping or hindering their passage through the last phase of life?

She doesn’t expect to see boomers accept the physical limitations of age the way previous generations did. And she’s not alone. Orthopedic surgeons — the medical specialty that deals with bones and musculoskeletal problems like cartilage damage and ligament tears — are already seeing the impact of the baby boom generation.

“People are wanting joint replacements done earlier now,” said Dr. Cy Frank, an orthopedic surgeon who specializes in knee surgery. “People are wanting them now when they’re in their … 40s and 50s, not in their 60s and 70s. So that’s increased the demand.”

That’s the boomer generation. If something hurts, they are not going to grimace and bear it. These are not going to be the grandparents of old, with tight perms or bad comb-overs, pressing a bag of frozen peas to arthritic knees in the hope of some fleeting pain relief.

“They expect more. And they want to be fixed,” said Frank, the executive director of the Alberta Bone and Joint Institute. “They want things repaired or replaced so that they can continue to live long, happy lives.”

Frank, meanwhile, is concerned there may not be enough specialists to handle the work. He recently applied for a grant to do some modelling to try to figure out how to address the coming demand. One of his favoured approaches is team work —orthopedic surgeons working with podiatrists and chiropractors, physiotherapists and occupational therapists to use resources rationally.

He also favours early intervention. If boomers can be taught to spot looming problems before they hit the crisis stage, rehabilitation or minimally invasive procedures could forestall major surgeries and should help keep boomers active longer, he said.

Ryan, too, sees early intervention as key to what is seen as one of the biggest problems the aging baby boomers may face — dementia.

Her field is working to develop better tools to screen for signs of memory loss that could be the early symptoms of Alzheimer’s or other degenerative cognitive conditions. She foresees a time when aging adults are urged to schedule memory screening tests in the same way they are encouraged to undergo colon cancer screening or mammograms for breast cancer.

“The idea is if you can catch some problems really early, then maybe you have a better chance of intervening or providing some kind of rehabilitation or compensatory strategy in order so that people can manage this declining cognitive function or maybe even keep it from declining further,” Ryan said.

“We want to slow down the decline.”

The Canadian Press

Posted: May 29, 2012 12:04 PM ET

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Diabetes management: How lifestyle, daily routine affect blood sugar

Diabetes management requires awareness. Know what makes your blood sugar level rise and fall — and how to control these day-to-day factors.

When it comes to diabetes management, blood sugar control is often the central theme. After all, keeping your blood sugar level within your target range can help you live a long and healthy life. But do you know what makes your blood sugar level rise and fall? The list is sometimes surprising.

Food

Healthy eating is a cornerstone of any diabetes management plan. But it’s not just what you eat that affects your blood sugar level. How much you eat and when you eat matters, too.

What to do:

  • Keep to a schedule. Your blood sugar level is highest an hour or two after you eat, and then begins to fall. But this predictable pattern can work to your advantage. You can help lessen the amount of change in your blood sugar levels if you eat at the same time every day, eat several small meals a day or eat healthy snacks at regular times between meals.
  • Make every meal well-balanced. As much as possible, plan for every meal to have the right mix of starches, fruits and vegetables, proteins, and fats. It’s especially important to eat about the same amount of carbohydrates at each meal and snack because they have a big effect on blood sugar levels. Talk to your doctor, nurse or dietitian about the best food choices and appropriate balance.
  • Eat the right amount of foods. Learn what portion size is appropriate for each type of food. Simplify your meal planning by writing down portions for the foods you eat often. Use measuring cups or a scale to ensure proper portion size.
  • Coordinate your meals and medication. Too little food in comparison to your diabetes medications — especially insulin — may result in dangerously low blood sugar (hypoglycemia). Too much food may cause your blood sugar level to climb too high (hyperglycemia). Talk to your diabetes health care team about how to best coordinate meal and medication schedules.

Exercise

Physical activity is another important part of your diabetes management plan. When you exercise, your muscles use sugar (glucose) for energy. Regular physical activity also improves your body’s response to insulin. These factors work together to lower your blood sugar level. The more strenuous your workout, the longer the effect lasts. But even light activities — such as housework, gardening or being on your feet for extended periods — can lower your blood sugar level.

What to do:

  • Talk to your doctor about an exercise plan. Ask your doctor about what type of exercise is appropriate for you. If you’ve been inactive for a long time, your doctor may want to check the condition of your heart and feet before advising you. He or she can recommend the right balance of aerobic and muscle-strengthening exercise.
  • Keep an exercise schedule. Talk to your doctor about the best time of day for you to exercise so that your workout routine is coordinated with your meal and medication schedules.
  • Know your numbers. Talk to your doctor about what blood sugar levels are appropriate for you before you begin exercise.
  • Check your blood sugar level. Check your blood sugar level before, during and after exercise, especially if you take insulin or medications that lower blood sugar. Be aware of warning signs of low blood sugar, such as feeling shaky, weak, confused, lightheaded, irritable, anxious, tired or hungry.
  • Stay hydrated. Drink plenty of water while exercising because dehydration can affect blood sugar levels.
  • Be prepared. Always have a small snack or glucose pill with you during exercise in case your blood sugar drops too low. Wear a medical identification bracelet when you’re exercising.
  • Adjust your diabetes treatment plan as needed. If you take insulin, you may need to adjust your insulin dose before exercising or wait a few hours to exercise after injecting insulin. Your doctor can advise you on appropriate changes in your medication. You may need to adjust treatment if you’ve increased your exercise routine.

Medication

Insulin and other diabetes medications are designed to lower your blood sugar level when diet and exercise alone aren’t sufficient for managing diabetes. But the effectiveness of these medications depends on the timing and size of the dose. And any medications you take for conditions other than diabetes can affect your blood sugar level, too.

What to do:

  • Store insulin properly. Insulin that’s improperly stored or past its expiration date may not be effective.
  • Report problems to your doctor. If your diabetes medications cause your blood sugar level to drop too low, the dosage or timing may need to be adjusted.
  • Be cautious with new medications. If you’re considering an over-the-counter medication or your doctor prescribes a new drug to treat another condition — such as high blood pressure or high cholesterol — ask your doctor or pharmacist if the medication may affect your blood sugar level. Sometimes an alternate medication may be recommended.
  • Illness

    When you’re sick, your body produces stress-related hormones that can help your body fight the illness, but they can also raise the level of blood sugar. Changes in your appetite and normal activity may also complicate diabetes management.

    What to do:

    • Plan ahead. Work with your health care team to create a sick-day plan. Include instructions on what medications to take, how often to measure your blood sugar and urine ketone levels, how to adjust your medication dosages, and when to call your doctor.
    • Continue to take your diabetes medication. However, if you’re unable to eat because of nausea or vomiting, contact your doctor. In these situations, you may need to temporarily stop taking your medication because of risk of hypoglycemia.
    • Stick to your diabetes meal plan. If you can, eating as usual will help you control your blood sugar level. Keep a supply of foods that are easy on your stomach, such as gelatin, crackers, soups and applesauce. Drink lots of water or other fluids that don’t add calories, such as tea, to make sure you stay hydrated.

    Alcohol

    The liver normally releases stored sugar to counteract falling blood sugar levels. But if your liver is busy metabolizing alcohol, your blood sugar level may not get the boost it needs. Alcohol can result in low blood sugar shortly after you drink and for as many as eight to 12 hours more.

    What to do:

    • Get your doctor’s OK to drink alcohol. Alcohol can aggravate diabetes complications, such as nerve damage and eye disease. But if your diabetes is under control and your doctor agrees, an occasional alcoholic drink with a meal is fine.
    • Choose your drinks carefully. Light beer and dry wines have fewer calories and carbohydrates than do other alcoholic drinks. If you prefer mixed drinks, stick with sugar-free mixers — such as diet soda, diet tonic, club soda or seltzer.
    • Tally your calories. Remember to include the calories from any alcohol you drink in your daily calorie count. Ask your doctor or dietitian how to incorporate calories from alcohol into your diet plan.

    Menstruation and menopause

    Changes in hormone levels the week before and during menstruation can result in significant fluctuations in blood sugar levels. And in the few years before and during menopause, hormone changes may result in unpredictable variations in blood sugar levels that complicate diabetes management. Also, the similarity of some symptoms of menopause and low blood sugar can result in errors in adjusting what you eat.

    What to do:

    • Look for patterns. Keep careful track of your blood sugar readings from month to month. You may be able to predict fluctuations related to your menstrual cycle.
    • Adjust your diabetes treatment plan as needed. Your doctor may recommend changes in your meal plan, activity level or diabetes medications to make up for blood sugar variation.
    • Check blood sugar more frequently. If you’re likely approaching menopause or experiencing menopause, talk to your doctor about monitoring blood sugar levels. You may need to do so more often or when you’re experiencing symptoms that you normally interpret as low blood sugar.

    Stress

    If you’re stressed, it’s easy to abandon your usual diabetes management routine. You might exercise less, eat fewer healthy foods or test your blood sugar less often — and lose control of your blood sugar in the process. Additionally, the hormones your body produces in response to prolonged stress may prevent insulin from working properly.

    What to do:

    • Look for patterns. Log your stress level on a scale of 1 to 10 each time you log your blood sugar level. A pattern may soon emerge.
    • Take control. Once you know how stress affects your blood sugar level, fight back. Learn relaxation techniques, prioritize your tasks and set limits. Whenever possible, avoid common stressors.
    • Get help. Learn new strategies for coping with stress. You may find that working with a psychologist or clinical social worker can help you identify stressors, solve stressful problems or learn new coping skills.

    The more you know about factors that influence your blood sugar level, the more you can anticipate fluctuations — and plan ahead accordingly. If you’re having trouble keeping your blood sugar level in your target range, ask your diabetes health care team for help.

  • By Mayo Clinic staff

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National Alzheimer’s Plan Released

Today the Obama Administration announced the release of the National Alzheimer’s Plan. U.S. Secretary of Health and Human Services Kathleen Sebelius reaffirmed our nation’s commitment to conquering Alzheimer’s disease and related dementias, with a specific goal of finding effective ways to prevent and treat the disease by 2025.

In addition to the release of the Plan the Administration also published a new website alzheimers.gov which will serve as a resource for those fighting the disease.

Read the Alzheimer’s Association comments on the plan.

Read the entire text of the National Alzheimer’s Plan (pdf) (html).

Posted on May 15, 2012 by Alzheimer’s Association

On January 4, 2011, The National Alzheimer’s Project Act was signed into law by the President of the United States after having been passed unanimously in both the Senate and House of Representatives.  This is a major victory for the Alzheimer’s Association’s chapters and advocates as well as the nation.  Once enacted, NAPA will create a national strategic plan to address and overcome the rapidly escalating crisis of Alzheimer’s.
NAPA is the largest legislative victory in many years for the Alzheimer cause.

Over the last several years, the Alzheimer’s Association has been the leading voice in urging Congress and the White House to pass the National Alzheimer’s Project Act (NAPA).  The National Alzheimer’s Project Act will create a coordinated national plan to overcome the Alzheimer crisis and will ensure the coordination and evaluation of all national efforts in Alzheimer research, clinical care, institutional, and home- and community-based programs and their outcomes.  Alzheimer’s advocates were instrumental in moving NAPA through Congress.  More than 50,000 e-mails, nearly 10,000 phone calls and more than 1,000 meetings by the Alzheimer’s Association and its advocates led us to the historic legislative victory for the Alzheimer community.

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Heatstroke: A deadly hazard of summer

To avoid heatstroke, avoid strenuous physical activity outside during the hottest time of the day, if possible.
To avoid heatstroke, avoid strenuous physical activity outside during the hottest time of the day, if possible.

(CNN) — Michael Musick is all too familiar with the toll heat can take on the human body.

He was helping his father put up hay on their family farm three weeks ago when his vision began to blur. His legs became weak and his muscles cramped.

“If you keep pushing it, after you see the stars, then everything goes black and you pass out,” said Musick, 46, who lives on a farm near Honaker, Virginia. This was the third time in five years that he had a heat-related illness, but this was the most severe. This time, he passed out twice.

“It’s pretty classic for folks. If they continue to have episodes of heat-related illness, they usually get worse each time,” said Dr. S. Hughes Melton, practicing physician in Lebanon, Virginia, who treated Musick for heatstroke.

A normal body temperature is around 98.6 degrees Fahrenheit, but in heatstroke the body can warm up to 106 degrees Fahrenheit or higher in 10 to 15 minutes. Death or permanent disability can result from heatstroke if not treated immediately.

The risk of heatsroke is up this week because of heat wave across the nation. Twelve states are under heat advisories from the National Weather Service as of Wednesday, including Musick’s Virginia. And even areas of the country that aren’t under heat advisories, such as Newark, New Jersey, and New York’s JFK airport, hit record highs Tuesday.

“When you have the kind of heat wave that we’re having now, we start to get worried,” said Dr. Janyce Sanford, chair of emergency medicine at the University of Alabama, Birmingham.

America under heat stress

This summer’s heat has already claimed at least one life: a 51-year-old man in Granite City, Illinois, died because of excessive heat, according to the Madison County coroner. He was found unresponsive in his mobile home, where the air conditioner was not working, according to CNN affiliate KMOV. The preliminary cause of death is heatstroke.

Between 1999 and 2003, there were 3,442 reported deaths resulting from exposure to extreme heat, according to the U.S. Centers for Disease Control and Prevention. During that time Arizona had the highest number of deaths related to hyperthermia, which happens when the body overheats (heatstroke is a form of it), followed by Nevada and Missouri.

Elderly people and young children, as well as people with chronic severe illnesses, are at highest risk of heatstroke.

Heat hurts your insides too

There are a few different forms of heat-related illnesses.

Heat cramps are usually considered mild, and can be treated with liquids and going into a cool environment. More severe is heat exhaustion, which involves elevation of body temperature, headaches, nausea and vomiting.

And then there is heatstroke, which is the most life-threatening. Heatstroke resembles heat exhaustion but may additionally involve neurological symptoms such as confusion and dizziness, or even coma. The body can no longer sweat, and internal temperature skyrockets.

Geoff Stoker, 24, remembers sweating profusely at soccer camp in high school and then, after three days, the sweating stopped altogether. He lost desire to eat, and vomited. His father, a surgeon, treated him for heatstroke at home, and he had no long-term side effects.

In Musick’s case, the heatstroke temporarily diminished his kidney function to about 50%.

Patients may also lose water weight through dehydration, said Dr. Sylvia Morris, hospitalist at Emory University Hospital Midtown in Atlanta, Georgia. A hospitalist is a physician whose focus is patients within a hospital.

Sanford’s hospital typically sees one or two chronically ill elderly patients who live without air conditioning and develop heatstroke in any given summer. But she believes the South sees fewer cases because people in that region are more acclimated to high outdoor temperatures; they’re more used to having to deal with heat than in other parts of the United States.

Treatment

In severe cases, patients must be admitted to the intensive care unit, where medical staff watch body temperature carefully. A 48-hour hospital stay would usually be necessary, Sanford said.

“If you can get them to treatment fairly quickly, they’ll survive it,” Sanford said. Chronic illnesses can complicate recovery, however.

Treatment focuses on cooling the patient down to a normal body temperature. If the patient has a clear airway, breathes normally and has normal circulation, medical staff will remove his or her clothes and spray cool water while a fan is blowing, Sanford said. Cool intravenous fluids also bring body temperature down.

Musick’s wife Teresa, recognizing heatstroke symptoms, drove him to the hospital when she noticed that his speech was slurred and his blood pressure was dropping. The emergency room staff gave him an IV, and the next day he followed up with Melton, who gave him two more IV bags.

“His body is not able to cool itself effectively, and so for him, he needs to avoid prolonged working in the heat. That’s really his only option at this point, because I don’t think his body will adapt,” Melton said.

Avoiding heatstroke

To protect yourself, try to avoid strenuous physical activity outside during the hottest time of the day — between 10 a.m. and 6 p.m.

People who must work outside should make sure they drink plenty of water every half-hour or so and take breaks in a cool environment if possible, Sanford said. Wearing lightweight, light-colored clothing and a wide-brimmed hat can also help.

You can tell if you’re dehydrated by looking at your urine, Melton said. If you’ve had adequate amounts of water, your urine will probably look light in color; darker means you should drink more.

And make sure you check on the elderly, especially if they don’t have air conditioning, Morris said. They should spend time in cool places such as a library or a mall to get a break from the heat, she said.

5 tips for surviving extreme heat

Kidney, liver and heart problems are all conditions that should make patients extra aware of the heat, and they should talk with their doctors about heat exposure, said Morris.

“People tend to forget to drink. By the time you’re thirsty, it’s really too late,” Morris said.

Musick said his problem is that he doesn’t like to drink water so much, and his hydration concerns his wife. But over the past three years he’s made an effort to get at least 8 glasses a day in his system.

Since his most recent heatstroke, he’s been resting and hasn’t been out on the farm.

“I am really pushing the hobby of farming to be retired,” Teresa Musick said.

By Elizabeth Landau, CNN
July 14, 2011 6:18 a.m. EDT

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Why Hire a Geriatric Care Manager?

During one especially dicey period with my mother, then in an assisted living facility, my brother and I hired a geriatric care manager, first for a consultation and then for additional help at an hourly rate. It felt like such an extravagance, given that we weren’t rolling in money, but the care manager helped solve a series of complex problems that I doubt I’d have solved by myself, mostly involving brokering a compromise with the facility, whose management wouldn’t let me hire a private aide for my mom but could not provide what she needed.

Relations had soured to the point that all I could do was scream at them, which was making a bad situation worse, so having an advocate was a blessing. Also, the care manager, who visited regularly with my mother, often was privy to concerns she was keeping from me, and she was always there for me by telephone, which was a lifesaver.

Many of you have asked questions about geriatric care management and how it is performed. I posed some of them to Patricia Mulvey, a care manager who has worked in hospitals, nursing homes, home-care agencies, hospice and bereavement programs, and as an independent contractor. Currently she is the director of the private geriatric care management service at the Jewish Home Lifecare System, which runs several long-term care facilities in New York City and its suburbs. With some modest editing, here are her thoughts.

Would you explain what geriatric care managers do, how they are trained and certified, how much they cost, and how consumers can make wise decisions if they decide to hire one?

A professional geriatric care manager has been educated in various fields of human services — social work, psychology, nursing, gerontology — and trained to assess, plan, coordinate, monitor and provide services for the elderly and their families. Advocacy for older adults is a primary function of the care manager. We belong to the National Association of Professional Geriatric Care Managers and are certified by one of the three certification organizations for care management — the National Association of Social Workers, the National Academy of Certified Care Managers, or the Commission for Case Managers.

Our rates vary by region and firm. Some firms charge an initial assessment fee; others bill by the hour only. In New York, an initial assessment is in the range of $250 to $750 for a one-and-a-half-hour assessment visit. Hourly charges run from $150 to $200. Some firms also require a retainer to cover the last month’s bill.

To be a savvy consumer, check the credentials of the care manager you are considering hiring to be sure they are a member of the National Association of Professional Geriatric Care Managers, as well as a member in good standing of their basic professional organization — say, the National Association of Social Workers. They also should be certified by one of the certification boards. You should check references and interview candidates.

An important part of working with the client and their families is chemistry. Be sure you get along with and like the individual you are considering hiring. They should be available 24 hours a day, seven days a week, and you should have access to their cell phone number or answering service. You should also be aware of other members of their team — nurses they may work with or their support staff — in case you have a question and can’t wait for the care manager to return your call.

What circumstances are most suitable and valuable for using a geriatric care manager? To put it another way, if you were in a caregiving situation and had limited means, when would this extra expense be money well spent?

An example is when things are going well — the elder is managing on his or her own, with little help and oversight, but the family is noticing slight changes, or the physician has indicated a change in status or diagnosis. This would be the time where it would be very beneficial for the family to know what resources are available to them, how much they would cost, how to access these resources and what options are available. Some of the key points to cover would be these.

  • What is day care? What types of rehab might be available? What does “short-term rehab” mean?
  • What is “respite” and where might it be available? Who pays for it?
  • Information about home care services. What kind of care and how much care can be provided at home?
  • Who pays for what services? This is key because a common misconception is that Medicare pays for long-term care.
  • What is the difference between Medicare and Medicaid?
  • What does insurance, either medical or long-term care, actually pay for?
  • What happens at the end of a hospitalization when discharge is imminent? Time is of the essence, because it is often Medicare or the insurance company’s determination as to how quickly things related to discharge must happen.
  • Is the health care proxy in place, appropriately witnessed and current? Is there a power of attorney? Does your state recognize other documents, such as a living will?
  • Has the conversation about the wishes stated in the health care proxy been discussed with the individual who has been nominated proxy? Does the physician have a copy of the document?
  • With a long-term care insurance policy, what is required for the policy to begin coverage?
  • What resources are available to pay for services? How much can the family afford? And who is going to pay for what?

A relationship with a professional geriatric care manager can allow the children of the elderly person to be children, while someone else manages the situation. When a son or daughter is providing the hands-on care to the parent, the quality time they have to be there emotionally for their parent is limited…. The care manager can handle the difficult interpersonal issues, address the immediate problem, remain connected once the crisis passes and get back involved as the situation requires it.

I’d imagine that long-distance caregiving and trying to keep someone in their own home with reliable help would be the two hardest things to navigate without professional assistance. Can you tell us some of the special challenges of having an elderly parent in Florida, or Chicago, or any place where you can’t go scope out the situation regularly and thus need eyes and ears on the ground?

As for home care, I know from friends how arduous it is to manage a staff of people working in a parent’s home. They quit. Or you have to fire them. They compete with one another for who’s top dog. The client, who is so dependent, becomes almost an emotional hostage, needing the aide so badly they may be afraid to complain or offend. How does a care manager guide families through this?

It is imperative to have eyes and ears available locally. This is not a process that can be managed long-distance, even as in-touch as we are with cell phones, text messaging and video conferences. We always work with another care manager in the other location to have an independent individual assess the facility and situation. I’ve frequently moved parents from the tri-state area to California, Florida or Arizona to be closer to their children, and moved the parents to the New York area from those very same states. Moving is one of the most stressful life events we can experience, and this applies at any age. The client needs as much support as possible, someone to help them pack, stop the newspaper, disconnect the cable, and much more.

Anyone with help in the home most definitely would benefit from help coordinating the aides and other staff going in and out of the home. Adding home care to the services delivered to an elder can be very traumatic — it’s saying that “you can’t take care of yourself anymore.” How would you feel if someone you didn’t know turned up one day and moved into your spare room, cooked meals in your kitchen, sat with you when you were watching TV or reading? It’s a huge transition for people to incorporate help into the home.

A care manager can closely monitor the situation, soothe over the hurt feelings and address the anger that comes from losing our independence. And yes, you are right, the elder may become an emotional hostage, afraid to say something for fear of retribution or recrimination. It’s best to let a professional address issues the elder is concerned with.

————

In an upcoming post, Ms. Mulvey will answer questions about how caregivers ought to look after themselves and why they often don’t, the differences between caregiving for a parent suffering from Alzheimer’s disease versus physical frailty, and how a lifetime of family baggage can cause strains between siblings and between adult children and parents during this role-reversing experience.

By New York Times, JANE GROSS, Founding Blogger

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May is Stroke Awareness Month

Learn how to raise stroke awareness during National Stroke Awareness Month in May and throughout the year. Explore the Resource Center for programs and activities aimed to increase public awareness of lifesaving stroke information and provide the stroke community a role in the act of raising awareness. Join stroke champions across the U.S. by encouraging others to be aware and share knowledge about stroke.

Prevention:

Up to 80 percent of all strokes can be prevented by working with a healthcare professional to manage risk.

Although stroke can happen to anyone, certain risk factors such as high blood pressure and diabetes can  increase chances of a stroke. By following the latest prevention guidelines and filling out a stroke risk scorecard to discuss with a doctor, you are on the path to preventing a future stroke.

Treatment:

Stroke is an emergency and must be responded to urgently so a doctor can evaluate whether or not treatment will help. Treatments for stroke include a clot-buster drug called tissue plasminogen activator (t-PA), a clot retriever device and a system for revascularization. t-PA must be given with three hours of the first symptom appearing. To make sure you and others act FAST and call 9-1-1 immediately at any sign of a stroke, learn the FAST test and read about all the sudden warning signs so you can respond appropriately.

Recovery & Rehabilitation:

Recovery from stroke is a lifelong process. For many people, recovery  begins with formal rehabilitation, which can restore independence by  improving physical, mental and emotional functions. It is important for  you and your family to know that no matter where you are in your  recovery journey, there is always hope.
National Stroke Association offers tools, resources and support for all types of issues survivors face after stroke.

By National Stroke Association

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Checking Your Blood Pressure at Home

You don’t always have to go to your doctor’s office to have your blood pressure checked; you can monitor your own blood pressure at home. This is especially important if your doctor recommends your blood pressure be monitored on a regular basis.

Tips for Checking Your Own Blood Pressure

There are certain factors that can cause blood pressure to temporarily rise. For example, blood pressure normally rises as a result of:

  • Stress
  • Smoking
  • Cold temperatures
  • Exercise
  • Caffeine
  • Certain medicines

Try to avoid as many of these factors as you can when taking your blood pressure. Also, try to measure your blood pressure at about the same time each day. Your doctor may want you to check your blood pressure several times during the day to see if your pressure fluctuates.

Before Checking Your Blood Pressure

  • Find a quiet place to check your blood pressure. You will need to listen for your heartbeat.
  • Make sure that you are comfortable and relaxed with a recently emptied bladder (a full bladder may affect your reading).
  • Roll up the sleeve on your arm or remove any tight-sleeved clothing, if needed.
  • Rest in a chair next to a table for 5 to 10 minutes. Your arm should rest comfortably at heart level. Sit up straight with your back against the chair, legs uncrossed. Rest your forearm on the table with the palm of your hand facing up.

Step-by-Step Blood Pressure Check

If you purchase a manual or digital blood pressure monitor (sphygmomanometer), follow the instruction booklet carefully.

The following steps provide an overview of how to take your left arm blood pressure on either a manual or digital blood pressure monitor. Simply reverse the sides to take a blood pressure in your right arm.

1. Locate your pulse

  • Locate your pulse by lightly pressing your index and middle fingers slightly to the inside center of the bend of your elbow (where the brachial artery is). If you cannot locate your pulse, place the head of the stethoscope (on a manual monitor) or the arm cuff (on a digital monitor) in the same general area.

2. Secure the cuff

  • Thread the cuff end through the metal loop and slide the cuff onto your arm, making sure that the stethoscope head is over the artery (when using a manual monitor.) The cuff may be marked with an arrow to show the location of the stethoscope head. The lower edge of the cuff should be about 1 inch above the bend of your elbow. Use the fabric fastener to make the cuff snug, but not too tight.
  • Place the stethoscope in your ears. Tilt the ear pieces slightly forward to get the best sound.

3. Inflate and deflate the cuff

If you are using a manual monitor:

  • Hold the pressure gauge in your left hand and the bulb in your right.
  • Close the airflow valve on the bulb by turning the screw clockwise.
  • Inflate the cuff by squeezing the bulb with your right hand. You may hear your pulse in the stethoscope.
  • Watch the gauge. Keep inflating the cuff until the gauge reads about 30 points (mm Hg) above your expected systolic pressure. At this point, you should not hear your pulse in the stethoscope.
  • Keeping your eyes on the gauge, slowly release the pressure in the cuff by opening the airflow valve counterclockwise. The gauge should fall only 2 to 3 points with each heartbeat. (You may need to practice turning the valve slowly.)
  • Listen carefully for the first pulse beat. As soon as you hear it, note the reading on the gauge. This reading is your systolic pressure (the force of the blood against the artery walls as your heart beats).
  • Continue to slowly deflate the cuff.
  • Listen carefully until the sound disappears. As soon as you can no longer hear your pulse, note the reading on the gauge. This reading is your diastolic pressure (the blood pressure between heartbeats).
  • Allow the cuff to completely deflate.
  • If you released the pressure too quickly or could not hear your pulse, DO NOT inflate the cuff again right away. Wait one minute before repeating the measurement. Start by reapplying the cuff.

    If you are using a digital monitor:

    • Hold the bulb in your right hand.
    • Press the power button. All display symbols should appear briefly, followed by a zero. This indicates that the monitor is ready.
    • Inflate the cuff by squeezing the bulb with your right hand. If you have a monitor with automatic cuff inflation, press the start button.
    • Watch the gauge. Keep inflating the cuff until the gauge reads about 30 points (mm Hg) above your expected systolic pressure.
    • Sit quietly and watch the monitor. Pressure readings will be displayed on the screen. For some devices, values may appear on the left, then on the right.
    • Wait for a long beep. This means that the measurement is complete. Note the pressures on the display screen. Systolic pressure (the force of the blood against the artery walls as your heart beats) appears on the left and diastolic pressure (the blood pressure between heartbeats) on the right. Your pulse rate may also be displayed in between or after this reading.
    • Allow the cuff to deflate.

    If you did not get an accurate reading, DO NOT inflate the cuff again right away. Wait one minute before repeating the measurement. Start by reapplying the cuff.

    4. Record your blood pressure.

    Follow your doctor’s instructions on when and how often you should measure your blood pressure. Record the date, time, systolic and diastolic pressures. You should also record any special circumstances like any recent exercise, meal, or stressful event.

    At least once a year, bring your blood pressure monitor with you to your doctor’s visit to check the machines accuracy. This is done by comparing a blood pressure reading from your machine with one from the doctor’s office machine.

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Diabetes symptoms: When diabetes symptoms are a concern

Diabetes symptoms are often subtle. Here’s what to look for — and when to consult your doctor.

Early diabetes symptoms, especially type 2 diabetes, can be subtle or seemingly harmless — if you have them at all. You could have diabetes for months or even years and not have any diabetes symptoms.

In the United States alone, nearly 6 million people have undiagnosed diabetes, according to the American Diabetes Association. But you don’t need to become a statistic. Understanding possible diabetes symptoms can lead to early diagnosis and treatment — and a lifetime of better health. If you’re experiencing any of the following diabetes signs and symptoms, see your doctor.

Excessive thirst and increased urination

Excessive thirst and increased urination are classic diabetes signs and symptoms.

When you have diabetes, excess sugar (glucose) builds up in your blood. Your kidneys are forced to work overtime to filter and absorb the excess sugar. If your kidneys can’t keep up, the excess sugar is excreted into your urine along with fluids drawn from your tissues. This triggers more frequent urination, which may leave you dehydrated. As you drink more fluids to quench your thirst, you’ll urinate even more.

Fatigue

You may feel fatigued. Many factors can contribute to this. They include dehydration from increased urination and your body’s inability to function properly, since it’s less able to use sugar for energy needs.

Weight loss

Weight fluctuations also fall under the umbrella of possible diabetes signs and symptoms. When you lose sugar through frequent urination, you also lose calories. At the same time, diabetes may keep the sugar from your food from reaching your cells — leading to constant hunger. The combined effect is potentially rapid weight loss, especially if you have type 1 diabetes.

Blurred vision

Diabetes symptoms sometimes involve your vision. High levels of blood sugar pull fluid from your tissues, including the lenses of your eyes. This affects your ability to focus.

Left untreated, diabetes can cause new blood vessels to form in your retina — the back part of your eye — as well as damage established vessels. For most people, these early changes do not cause vision problems. However, if these changes progress undetected, they can lead to vision loss and blindness.

Slow-healing sores or frequent infections

Doctors and people with diabetes have observed that infections seem more common if you have diabetes. Research in this area, however, has not proved whether this is entirely true, nor why. It may be that high levels of blood sugar impair your body’s natural healing process and your ability to fight infections. For women, bladder and vaginal infections are especially common.

Tingling hands and feet

Excess sugar in your blood can lead to nerve damage. You may notice tingling and loss of sensation in your hands and feet, as well as burning pain in your arms, hands, legs and feet.

Red, swollen, tender gums

Diabetes may weaken your ability to fight germs, which increases the risk of infection in your gums and in the bones that hold your teeth in place. Your gums may pull away from your teeth, your teeth may become loose, or you may develop sores or pockets of pus in your gums — especially if you have a gum infection before diabetes develops.

Take your body’s hints seriously

If you notice any possible diabetes signs or symptoms, contact your doctor. The earlier the condition is diagnosed, the sooner treatment can begin. Diabetes is a serious condition. But with your active participation and the support of your health care team, you can manage diabetes while enjoying an active, healthy life.

By Mayo Clinic staff

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‘Elderly’ No More

“Have you thought about changing the name of that blog you’re writing for?” Ann Fishman asked. “The boomers aren’t going to like it. They don’t ever want to get old.”

I’d called Ms. Fishman, president of Generational Targeted Marketing, a market research firm in New York, with a simple question. What language should we use in talking about people age 65 and older? Should we call them “seniors”? “The elderly”? “Older adults”? Something else?

“For heavens’ sake, don’t call them anything,” said Ms. Fishman. “Let’s talk about their interests and values.” Marketers, she noted, make it point to address potential customers’ “stage of life” and “lifestyle,” but never talk about their age.

But what’s the alternative for the rest of us, and for doctors who treat patients who fit this description, and for academics who study this demographic? What terms should we use to discuss this age group without giving offense?

I decided to conduct a small, random, unscientific survey by calling a few mostly past-middle-age experts and asking what they thought. Here are their responses.

Harry Moody, 67, director of academic affairs for AARP:

What’s going on is we have a problem with the subject itself. Everyone wants to live longer, but no one wants to be old.

Personally, I tend to use the term “older people” because it’s the least problematic. Everyone is older than someone else.

“For heavens’ sake, don’t call them anything,” said Ms. Fishman. “Let’s talk about their interests and values.” Marketers, she noted, make it point to address potential customers’ “stage of life” and “lifestyle,” but never talk about their age.

But what’s the alternative for the rest of us, and for doctors who treat patients who fit this description, and for academics who study this demographic? What terms should we use to discuss this age group without giving offense?

I decided to conduct a small, random, unscientific survey by calling a few mostly past-middle-age experts and asking what they thought. Here are their responses.

Harry Moody, 67, director of academic affairs for AARP:

What’s going on is we have a problem with the subject itself. Everyone wants to live longer, but no one wants to be old.

Personally, I tend to use the term “older people” because it’s the least problematic. Everyone is older than someone else.

 

Much of the time, it’s completely unnecessary to use age as an identifier at all. People don’t like it. That’s why you see organizations changing their names. Elderhostel got rid of “elder” and became Road Scholar. AARP shortened its name, which now doesn’t mention age or retirement.

Jane Glen Haas, 74, nationally syndicated newspaper columnist:

Don’t call anyone “elderly.” I associate that with people with physical disabilities who need constant care.

“Senior citizens” is a term coined in the late 1930s for people who needed a place to go, senior centers, to have a good lunch. To me, it implies somewhat impoverished older people, not the way people want to think of themselves.

“Aging” — to me that sounds like I’m declining.

I guess “older people” is best. I suppose if you had to call me something, I’d prefer that it be “writer” or “an older writer.”

Dr. John Rowe, 67, chairman of the MacArthur Foundation Research Network on an Aging Society and a professor of health policy at Columbia University:

People who study this talk about the “young-old,” roughly age 65 to 75, and the “old-old,” a group that tends to have more physical needs and functional impairments. The problem with terms like “the elderly” or “seniors” is that they lump these two groups together, and none of the young-old want to be identified with the old-old.

My view is that the elderly is a demographic group, like youth or middle age. I use it when I’m talking about populations. When I’m talking about individuals, then I say “older person.”

Personally, I prefer the term “senior,” but the fact is no one calls me that because no one thinks I’m that old.

Margaret Morganroth Gullette, 70, author of “Agewise: Fighting the New Ageism in America” and a resident scholar at the Women’s Studies Research Center at Brandeis University:

How we discuss age depends on the context and the underlying ideology. Society mostly adheres to a decline ideology that equates getting older with getting worse, usually from a health, and often from a financial, standpoint. Countering this is positive aging ideology that insists that many things get better with age. You’ve got a tug of war between these two views and over the direction of change that aging represents.

I prefer descriptions that imply movement to those that are static. Phrases like “aging past youth” or “aging into the middle years” or “aging toward old age” — I’d like to see those mainstreamed.

Thomas Cole, director of the McGovern Center for Humanities and Ethics at the University of Texas Health Science Center at Houston:

We’ve tried “elder,” but people don’t like that because it reminds them of patriarchy and the church. We replaced “old age” with “aging,” which carried more of a sense of dynamism, but now that doesn’t work either because of the anti-aging movement.

“Longevity” is a more positive term, without all the negative associations other words have gathered, but you can’t call an older person a “longevitist.”

The culture’s problem is that we split aging into good and bad.

We’re unable to sustain images of growing older that handle the tension between spiritual growth, the good, and physical decline, the bad. In the Hebrew Bible, aging is both a blessing and a curse. But our culture can’t achieve this kind of synthesis.

Dee Wadsworth, 62, staff gerontologist at the Preston Hollow Presbyterian Church in Dallas:

We don’t call people “junior citizens,” so why do we call them “senior citizens”?

“Elderly” is not generally accepted as a noun. To many of us, it’s associated with social services, health programs, long-term care. The American Medical Association prefers the words “older person” or “aging adult,” as do I. They’re neutral descriptions, neither positive or negative.

Boomers will never identify with “senior” — that’s their parents, not them. Senior centers, agencies on aging, other organizations with the word “senior” in them are all going to have to change their names if they want to draw the boomers.

Dr. Alexander Smith, 38, assistant professor of medicine at the University of California, San Francisco:

This came up as a disagreement between two of my senior mentors. One said he thought we should use the term “elderly” because it connotes a degree of respect that “older adults” doesn’t convey. The other said we should call elderly patients “older people” or “older adults,” because they are people first and foremost.

It’s not just terminology that’s at issue here. It’s our underlying attitudes about aging that really need to be addressed.

In general, I’d prefer to refer to people as they’d like to be called, but I don’t know what that is.

So much for the experts — what about you? What language do you think we should use to describe people who have advanced beyond the middle of their lives, and why?

By JUDITH GRAHAM, New York Times

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April Is National Parkinson’s Awareness Month

Parkinson’s disease is a disorder of the brain that affects the transmission of messages to the muscles. It is characterized by tremor, stiffness of the muscles, and difficulty in initiating movements. Over one million Americans have Parkinson’s disease. It occurs most often in later life, but can also affect younger people. Men face almost twice the risk of developing the condition. Parkinson’s disease is a progressive disease, which means that it normally worsens over time. It usually, but not always, develops slowly.

No one knows what causes Parkinson’s disease. Certain “Parkinson-like symptoms” can result from the side effects of some drug therapies, or can be caused by conditions such as a brain tumor, arterial disease, viral encephalitis, stroke, or head injury.

What are the Symptoms?

  • Tremor or involuntary movements—One or both hands or limbs may exhibit an involuntary trembling, which lessens when the person is using the affected part. Involuntary movements of the hand are common, and the person may seem to be “rolling” something between the fingers.

  • Rigidity of muscles; slowness of body movement—Posture may be stiff or stooped, with diminished movement of the arms and legs.

  • Shuffling gait—The person may take small, cautious steps, or may alternate slow steps with rapid ones.

  • Loss of facial mobility—The person’s face may seem to be expressionless.

  • Speech difficulties—Speech may be slow and expressionless, and the voice a low-pitched monotone.

  • Impaired balance—The person may have difficulty balancing or sitting up straight.

  • Deteriorating handwriting—The person’s writing becomes cramped, smaller and more difficult to read.

How Is Parkinson’s Disease Diagnosed?

At present, there are no laboratory tests that can confirm the diagnosis of Parkinson’s disease. In order to arrive at a diagnosis, the physician takes a family and health history from the person, and performs a thorough physical and neurological examination, observing the person’s movements and muscle function.  The physician will also rule out other disorders that can cause similar symptoms. Early diagnosis of Parkinson’s disease is important so that appropriate treatment can begin.

Managing Parkinson’s Disease

For now, there is no cure for Parkinson’s disease. But with early diagnosis and an effective plan of treatment, the symptoms of the disease can often be controlled or lessened. Treatment varies widely for each individual, and may include:

  • Medication therapy—A number of drugs can help control the symptoms of Parkinson’s disease. The choice of correct drug or drugs, the dosage, the method of taking medication, and the risk of side effects of drugs vary from person to person, requiring careful physician supervision.

  • Rehabilitative therapyPhysical, occupational and speech therapists can assess the person’s abilities and needs, and provide exercises to help maintain the highest possible range of motion, muscle tone, balance and flexibility, and communication ability.

  • Lifestyle alterations—Exercise helps maintain muscle tone and strength. Diet is important for nutrition, for maintaining an appropriate weight, and because protein level may be a factor in the person’s condition. Rest and stress reduction are also important.

Support groups and counseling are available to help the person and family members deal with the social and emotional impact of Parkinson’s disease.

Article compiled by and For More Information go to…

The National Parkinson Foundation website is a good source of information and resources about treatment, support and research.

The American Parkinson Disease Association website includes a directory of APDA Information and Referral Centers where Parkinson patients and family caregivers can access information and resources.

The Parkinson’s Disease Information Page offers information on Parkinson’s disease, causes, treatments, support from the National Institute of Neurological Disorders and Stroke.

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