Each November, the nation’s hospice and palliative care community observes National Hospice Palliative Care Month. This is a good time for everyone to think about their own end-of-life wishes. For an increasing number of people, their plans for this time include hospice care.
When a loved one is diagnosed with a serious or life-limiting illness, the questions facing an individual or a family can be overwhelming. The National Hospice and Palliative Care Organization (NHPCO) recommends that people learn more about hospice as an important option before they are faced with a medical crisis.
Hospice is not a place but a kind of care for people who have a life-limiting illness and are making the choice to focus on quality and comfort if more conventional treatments have become burdensome.
Hospices provide high-quality care specially tailored to your needs and valuable support to family caregivers.
With multiple hospices serving some communities, it can seem challenging to select one. NHPCO suggests the best way to begin is by reaching out to the hospice providers in your community to find the one best equipped to meet your specific needs.
“Choosing a hospice to care for yourself or a loved one in the final months or even days of life is an important and stressful process,” said J. Donald Schumacher NHPCO president and CEO. “Each hospice offers unique services and partners with specific community providers – so it’s important to contact the hospices in your area and ask them questions to find the one with the services and support that are right for you.”
Your physician, other healthcare providers or family friends that have taken advantage of hospice services in the past are other good ways to get a recommendation for a provider in your area.
Some of the questions important in choosing a quality hospice include:
- Is the hospice Medicare certified?
- When was the last state or federal survey of the program?
- Is the hospice accredited by a national organization?
- What services should I expect from the hospice?
- How are services provided after hours?
- How and where does the hospice provide short-term inpatient care?
- What services do volunteers offer?
- How long does it typically take the hospice to enroll someone once the request for services is made?
Another question is when to begin hospice care. Every patient and family must decide that based upon their unique needs. However, professionals encourage people to learn about care options long before they think they may need them.
To help families make a decision at a difficult time, the NHPCO has created a free worksheet to help consider and answer some of the important questions to consider when learning about or choosing a hospice. Down load the worksheet from NHPCO’s Moments of Life website.
In the United States the debate around gun ownership often focuses on teenagers; however, research shows that elderly Americans are the most likely to own a gun and that presents both medical and legal problems for physicians and carers.
Writing in a recent issue of the Journal of the American Geriatrics Society, Dr. Ellen Pinholt explored these issues and proposed a series of “red flag” questions which caregivers must ask.
While there is no upper age limit on owning a firearm, Americans aged over 65 have the highest prevalence of dementia, depression and suicide. Federal law prohibits mentally incompetent persons from possessing a gun; however, this only applies to a formal finding by a court and not necessarily to a physician’s diagnosis of dementia.
Using a series of case studies to explore the medical and legal dimensions of the issue, Dr. Pinholt suggested “5 Ls,” questions about gun ownership which should be asked as routinely as questions about driving.
- If there is a gun present, is it LOCKED?
- Is it LOADED?
- Are LITTLE children present?
- Does the gun owner feel LOW?
- Is the gun owner LEARNED about how to safely use the gun?
Source: Wiley Online Library News Release; Journal of the American Geriatrics Society, 4 June 2014
The U.S. Department of Veterans Affairs offers a free online brochure, “Firearms and Dementia.”
“Every year, tragically, people are burned, start fires, get an electric shock and even die from carbon monoxide poisoning, because they weren’t taking proper precautions,” said Dr. Alex Rosenau, president of the American College of Emergency Physicians (ACEP). “I don’t want anyone in my emergency department suffering from an injury that could have been easily prevented.”
Each year more than 2,500 people died in house fires in the United States, according to FEMA and another 12,600 are injured.
Another big concern each fall and winter is carbon monoxide poisoning. Carbon monoxide is an odorless and colorless gas that can cause sudden illness and even death. People can be poisoned by breathing it.
The most common symptoms of carbon monoxide poisoning are headache, dizziness, weakness, nausea, vomiting, chest pain and confusion. High levels can cause loss of consciousness. Every home should have a carbon monoxide detector, and if you have any of these symptoms, you should seek emergency care.
ACEP recommends the following:
- Check all smoke detectors and carbon monoxide detectors. Make certain they are working properly. If they are battery operated, change the batteries. There should be one of each detector on every floor of your house.
- Have a professional inspect your gas furnace at least once a year. One with leaks or cracks can be dangerous for your home, leaking carbon monoxide or possibly causing a fire.
- If you use a fireplace, have a professional inspect and clean it every year to avoid fires. Also make sure any flammable materials are away from the open flame area. Never burn trash, cardboard boxes or items that may contain chemicals that can poison your home.
- If you use a wood burning stove, have a professional inspect and clean the chimney each year. Make sure you have a safe perimeter around it, because it can radiate excessive heat. Place on a flame-resistant carpet, and use a screen to prevent sparks and hot coals from coming out of the stove. Use safe woods, such as oak, hickory and ash — avoid pine and cedar.
- Never use a range (electric or gas) or oven as a heating source. It’s not only a dangerous fire hazard; it can also release dangerous fumes, such as carbon monoxide.
- If you use an electric space heater, keep a safe perimeter around it. Make sure it is away from water or anything flammable like curtains, paper, blankets, or furniture.
Check for any faulty wiring that can cause electric shock or fire. Supervise children and pets around space heaters, and turn them off before leaving the room or going to sleep.
For more on this and other health related topics, go to www.emergencycareforyou.org.
Source: The American College of Emergency Physicians (ACEP), the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Visit the ACEP website for more information.
Urinary incontinence is an involuntary leakage of urine. It can occur as stress incontinence (which comes at a time of some form of exertion or when sneezing or coughing), urge incontinence (which occurs with or immediately following a sense of urgency), or a mixture of both. Excess body fat, especially in the abdominal area, is strongly linked to greater risk of urinary incontinence. Researchers say this could be a physical effect, due to pressure of excess fat pushing down and stressing the pelvic floor.
However, since studies also show that fat tissue is metabolically active and linked to inflammation and hormonal changes, it’s possible that these conditions are involved in the link between overweight and urinary incontinence. A recent review pulling together the results of six studies on this link concluded that modest weight loss may help reduce urinary incontinence. The good news is that a 5 to 10 percent weight loss seemed to make a difference, which could mean losing less than 10 pounds for some people.
However, excess weight is far from the only reason for urinary incontinence. It can be related to medications, hormone changes, surgery, childbirth and other causes. It’s unfortunate that many people who experience urinary incontinence are embarrassed and don’t discuss it with their healthcare provider. That is a shame, because in addition to weight loss, other remedies can also be considered. If you are overweight, modest weight loss also can make a difference in controlling or reducing risk of so many other health problems, including Type 2 diabetes and high blood pressure. Making a few changes in eating habits and activity to support a modest weight loss is a good idea. But don’t leave your doctor or other healthcare provider in the dark as you face this problem.
Source: Karen Collins, MS, RDN, CDN, FAND, of the American Institute for Cancer Research (AICR). The AICR is the cancer charity that fosters research on the relationship of nutrition, physical activity and weight management to cancer risk, interprets the scientific literature and educates the public about the results. Visit the AICR website to find a wide variety of consumer information on healthy diet.
During the last few years, our country has seen natural and man-made disasters that have disrupted lives, destroyed property and taken lives. Many in the East are still recovering from Hurricane Sandy. The West has experienced wildfires, earthquakes and the devastating Oso mudslide in Washington state. Tornadoes swept through the Midwest and South. And last winter brought prolonged, sometimes deadly, cold temperatures to much of the country.
One lesson we all learned during those events: In the wake of disasters, seniors and people with disabilities are especially hard-hit. Elders with mobility challenges, visual impairment or hearing often find themselves trapped at home without electricity or water. Family caregivers anxiously try to reach their loved ones to be sure they are safe.
People with Alzheimer’s disease are especially vulnerable in disaster situations. According to the Alzheimer’s Disease Education and Referral Center (ADEAR), impaired memory and reasoning may severely limit these seniors’ ability to cope. For caregivers, it is important to have a disaster plan that incorporates the special needs of loved ones who have Alzheimer’s or other dementia. ADEAR offers these suggestions:
“Riding it out” at home
In some situations, you may decide to stay at home during a natural disaster. Plan ahead to meet your family’s needs and those of your loved one with Alzheimer’s for a period of at least three days to a week. Include supplies and backup options in case you lose basic services.
You also will need special supplies for your loved one with Alzheimer’s. Assemble a kit, and store it in a watertight container. The kit might contain:
- Warm clothing
- Sturdy shoes
- Spare eyeglasses
- Hearing aid batteries
- Incontinence undergarments, wipes and lotions
- Pillow, toy or other comfort object
- Favorite snacks and high-nutrient drinks
- Zip-lock bags to hold medications and documents
- Copies of legal, medical, insurance and Social Security information
- Physician’s name, address and phone number
- Recent photos of your loved one
As part of your disaster planning, hold practice drills, with each member of the household performing specific tasks. Assign somebody to take primary responsibility for the person with Alzheimer’s.
Because the needs of a person with Alzheimer’s will change as the disease progresses, periodically update your plan to reflect these changes. For example, your loved one is likely to become less mobile in the later stages of the disease. How will that affect your plan?
If you must leave home
You may need to move to a safer place, like a community shelter or the home of a family member. Consider how you will get your loved one to go quickly and calmly. Be ready to use tactics that have worked in the past.
During relocation, the person with Alzheimer’s might become anxious and start to behave erratically. Remain as calm and supportive as possible. Your loved one is likely to respond to the tone you set. Be sensitive to his or her emotions. Stay close, offer your hand, or give your loved one a reassuring hug. Do not leave him or her alone.
To plan for an evacuation:
- Know how to get to the nearest emergency shelters. Some areas have shelters for people with special needs. Your local Red Cross chapters can direct you.
- Make sure that the person with Alzheimer’s is wearing an identification bracelet and/or identifying tags sewn into articles of clothing.
- Take along general supplies and your Alzheimer’s emergency kit.
- Bring your cell phone charger and keep the phone charged. Save emergency numbers to your phone.
- Plan to keep neighbors, friends and family informed of your location. Give them your phone numbers and a list of emergency numbers.
- Be sure that other people have copies of your loved one’s medical records. If necessary, they can provide these records to emergency medical staff to ensure that your loved one receives appropriate treatment and care.
- Prepare to prevent wandering. Many people with Alzheimer’s disease wander, especially under stress.
- If possible, plan to take along the household pet to comfort your loved one. (Remember that this might not be possible; FEMA offers preparation information for pet owners; see below for the link.)
If you become separated
You should not leave a person with Alzheimer’s alone, but the unexpected can happen. Avoid asking a stranger to watch your loved one if possible. Also, do not count on the person with Alzheimer’s to stay in one place.
To plan for possible separation:
- Provide local police and emergency services with photos of your loved one and copies of his or her medical documents, so they are aware of your loved one’s needs. Be ready to alert them if you and the person in your care become separated.
- Be sure that your loved one wears an identification bracelet.
- Contact your local Alzheimer’s Association chapter and enroll the person in the Medic Alert + Safe Return program, an identification and support service for people with Alzheimer’s disease who may become lost or injured.
- Make plans with trusted people who can help your loved one. Educate them about his or her disabilities.
- Give a trusted neighbor, friend or relative a house key and a list of emergency phone numbers
For More Information
The Alzheimer’s Association offers a disaster preparedness checklist with more reminders and safety preparation tips.
The American Red Cross offers a free online booklet, Preparing for Disaster for People with Disabilities and Other Special Needs.
Source: AgeWise. Checklist source: Connections, a publication of the Alzheimer’s Disease Education and Referral Center (ADEAR), part of the National Institute on Aging.
Will you live to be 100 years old? A study from Kings College London predicts a steady increase in the number of us who will achieve that advanced age. In 2011, there were approximately 300,000 centenarians worldwide. The Kings College researcher project that there will be three million people 100 or older by the year 2050—and by the end of this century, there could be 17 million! Where will these oldest seniors spend their final years, and what services will they need? Dr. Catherine Evans, Clinical Lecturer in Palliative Care at the Cicely Saunders Institute, King’s College London said: “Centenarians have outlived death from chronic illness, but they are a group living with increasing frailty and vulnerability to pneumonia and other poor health outcomes. We need to plan for health care services that meet the ‘hidden needs’ of this group, who may decline rapidly if they succumb to an infection or pneumonia. We need to boost high quality care home capacity and responsive primary and community health services to enable people to remain in a comfortable, familiar environment in their last months of life.” The researchers call for appropriate care at the end of life for these frail elders, to reduce hospital admissions and to support quality of life.
Source: AgeWise reporting on study from Kings College London; you can read more about the study here.
Many people believe that creativity peaks when we are young, diminishing as we grow older. But this
stereotype is a myth. In fact, research shows that creativity can be maintained and even increased as we age. Many lifelong artists have reached their most productive and innovative phase in their 60s and beyond.
The arts are entertaining and culturally important. But is creativity important for health? It seems that it is! Study after study shows that lifelong participation in graphic arts, music, dance, creative writing and other art forms all set the stage for better health in our later years. For example, researchers recently found that people who played an instrument when they were young enjoy a brain health advantage in their senior years.
But what if you didn’t spend much time on artistic pursuits when you were a child? What if you were too busy during your working years to pick up a paintbrush or join a musical combo? The good news is, it’s never too late to tap into the power of art! Just as we can begin an exercise program after age 65 even if we’ve always been couch potatoes, we can also put on an artist’s smock or take up an instrument at any age, no matter what our health status and abilities. The benefits of art are many—physical, emotional, intellectual, psychosocial and intergenerational. According a study authored by the late Dr. Gene Cohen, who was a pioneer in the study of aging and creativity, seniors who participated in an arts program reported a higher overall rating of physical health, fewer doctor visits, less medication use, a reduction in falls, and fewer other health problems. The National Academy of Sciences is currently doing more research on “the relationship of art-making and creativity to physical health and psychological well-being of older adults.”
This should not surprise us when we realize that expressing ourselves is a vital human need. Sharing our history, our view of the world, our hopes and dreams and fears … though words, through music, through images, through motion … promotes the sense of well-being that is a major measure of successful aging. Consider this small sampling of recent studies on the benefits to be found in these types of creative pursuits:
Music. A University of California San Francisco neuroscientist is using community senior choirs to help participants improve balance and strength, and reduce depressive symptoms, loneliness and memory loss. Music therapists from MetroHealth Medical Center in Cleveland use music to help hospital patients reduce pain and build strength. And intriguing research from Northwestern University suggests that musical training might help reduce age-related hearing loss.
Drama. Professors Helga and Tony Noice of Elmhurst College in Illinois are using acting and drama to provide increased brain stimulation for older adults. They have found that acting engages performers on many levels—physical, emotional and intellectual.
Dance. University of Montreal professor Dr. Chantal Dumoulin used a dance program to help women reduce incontinence. Dance has also been used in an effective fall prevention program, according to University of Missouri’s Jean Krampe. And the Parkinson Foundation offers dance programs to reduce movement challenges.
Creative writing. The TimeSlips program encourages the use of imaginative language to improve the quality of life of people who are living with Alzheimer’s disease and related disorders.
Visual arts. Learning a new hands-on skill can protect the brain. University of Texas at Dallas researchers listed digital photography and quilting as examples of activities seniors might choose to improve cognitive function. And art museums across the country offer special programs for people with memory loss. According to Dr. Luis Fornazzari of St. Michael’s Hospital Memory Clinic in Toronto, artistic abilities may be retained in the mind even when other abilities are lost. He described the work of an internationally known sculptor who was able to create works of art even though she was unable to draw the correct time on a clock or remember the names of things. “Art opens the mind,” says Fornazzari.
Opportunities to Explore Your Creative Side
DIY—do-it-yourself—isn’t only for young people. You can create your own an art program, if that is what you prefer. Explore a local art store and bring home a selection of paints and paper. Dust off your piano and try some new music, or buy a simple instrument. Write a memoir. Put on some music and dance.
But this is just a start. Art opportunities abound in the community, and creating art with others adds the benefits of socialization. Check out classes offered by your local senior center, senior services department, parks and recreation, community colleges and university extension programs. Art galleries and other cultural institutions often offer participation programs.
Take an old favorite to a new level. Do you sew from patterns? Create your own designs! Do you do needlepoint from a kit? Try painting your own canvas. Use your woodworking tools to make decorative items for holiday gifts. “Yarn bomb” a tree in your yard—and be prepared to explain your project to curious passersby. Or increase the benefits of gardening by taking a flower arranging class.
What art activities are best for you? Don’t be afraid to try something new! Neurologists tell us that novelty is good for the brain. Try a creative activity you’ve never tried before—maybe even something you don’t know much about. If you never took up a musical instrument, discover the joys of creating sound. If you’ve never participated in group singing, your local choir may offer eye-opening pleasures. Never stepped on a stage? In a drama group, you may discover that you love to ham it up.
Many adapted activities are available for people with physical or cognitive limitations. More than ever before, creative arts therapists offer technologies old and new to enable people with mobility, sensory or cognitive challenges participate in arts of every type. Your local senior center may offer ideas; check with organizations and foundations that serve people with your own particular health challenge to find innovative adaptive art ideas and to learn about local programs.
Copyright © IlluminAge AgeWise, 2014
This puzzle contains ideas for artistic opportunities that offer physical, intellectual, emotional and social benefits. Click here to download the puzzle, and give your brain a workout by finding all 20 words.
Need a little help? Click here for the solution to the puzzle.
Copyright © IlluminAge AgeWise, 2014
Each year, seniors on Medicare have a seven-week period during which they can switch their Medicare prescription drug plan (Part D) and their Medicare Advantage plan. The 2014 Medicare Open Enrollment dates are October 15 – December 7. Many people are tempted to just stick with the status quo. Yes, that might be easier—but it could also cost you money and make it harder to access the care and medications you need. It’s worth taking some time to review your current plans, and compare them to the other plans available in your area.
Here is a planning calendar from the Centers for Medicare & Medicaid Services:
During September and October:
Review. Your current plan may have changed; review any notices from your plan about changes for the upcoming year.
Compare: Beginning in October, use Medicare’s tools to see if your plan is still the best choice for your needs.
October 15—Open Enrollment Begins
This is the time of year when all people with Medicare can make changes to their health and prescription drug plans for the following year. October 15 is the first day that you can change your coverage. If you are then satisfied that your current plan will meet your needs for the next year, you don’t need to do anything.
December 7—Open Enrollment Ends.
The plan has to receive your enrollment request (application) byDecember 7.
January 1—Coverage Begins.
Your new coverage begins on January 1 if you switched to a new plan. If you stayed with your old plan, any changes to coverage, benefits and cost will begin on the first day of the year.
January 1 – February 14
If you’re in a Medicare Advantage Plan, you can leave your plan and switch to Original Medicare between January 1 – February 14. If you switch to Original Medicare during this period, you’ll have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage. Your coverage will begin the first day of the month after the plan gets your enrollment form.
Where to Get Help
As you are making your decision, here are places to learn more:
- Visit the Medicare website including the Plan Finder or call 1-800-MEDICARE (1-800-633-4227) and say “Agent.” TTY users should call 1-877-486-2048. Help is available 24 hours a day, including weekends. Let the customer service representative know if you need help in a language other than English or Spanish.
- The 2015 “Medicare & You” handbook should arrive in the mail around October 15. It will include a listing of plans in your area, and much more information. You also will be able to see the booklet online. (If you go to the site before that date, you will see the 2014 booklet, which may contain information that is out of date.)
- Review any information you’ve received from your current plan, including the “Annual Notice of Changes” letter.
- Get free, personalized health insurance information by calling your State Health Insurance Assistance Program (SHIP). You can find the number for your state’s SHIP in the Medicare & You handbook, or call 1-800-MEDICARE. Find out if your local SHIP offers workshops or other presentations to help seniors choose the best plans.
- To see if you qualify for Medicare’s “Extra Help” program that helps pay for medications for seniors with a limited income, contact the Social Security Administration at 1-800-772-1213 or visit the Social Security website’s “Extra Help” information page.
Source: AgeWise and the Centers for Medicare & Medicaid Services
Medications help millions of seniors control health conditions that threaten their lives and their quality of life. But managing medications can be a challenge. It’s important to take them as recommended, and to be alert for side effects. Doctors report that in some cases, seniors stop taking their medications. Sometimes the warnings on prescription drugs can be frightening! Or seniors might wonder if they are experiencing side effects. Money or transportation challenges sometimes keep them from getting recommended refills.
A new study published in the Annals of Internal Medicine sheds light on another surprising reason older adults might discontinue a medication: When a refilled prescription looks different than before, patients may be confused and stop taking the drug. Yet it’s not uncommon for a pill to look different, according to the American College of Physicians. Says study author Dr. Aaron Kesselheim of Brigham and Women’s Hospital, “The FDA does not require consistent pill appearance among interchangeable generic drugs, and the shape and color of patients’ pills may vary based on the particular supply at the patient’s pharmacy.”
Dr. Kesselheim and his team studied the records of 11,000 heart patients to see if they had taken their medications as directed. They found patients whose medications had changed in color were 34 percent more likely to stop taking the drug—and a change in shape raised the odds by 66 percent!
Dr. Kesselheim concluded, “Medications are essential to the treatment of cardiovascular disease and our study found that pill appearance plays an important role in ensuring patients are taking the generic medications that they need.”
He urges physicians and pharmacists to be aware of changes in a patient’s particular medication, and to reassure patients that the particular generic they receive may look different from a previous refill.
If you or an older loved one are concerned about the change of appearance of a drug you take, check with your doctor or pharmacist right away rather than discontinuing the drug or skipping even a single dose.
Source: AgeWise reporting on study from the Annals of Internal Medicine; news releases from the American College of Physicians; Brigham and Women’s Hospital