Older cancer patients rate own physical abilities as better than their caregivers do

Older cancer patients rate own physical abilities as better than their caregivers do

Older cancer patients and their caregivers often differ in their assessment of the patient’s physical abilities, with caregivers generally rating the patient’s physical function as poorer, according to a new study published in The Oncologist. The study also found that differences in assessment of physical abilities between patients and caregivers were associated with greater caregiver burden.

For as long as possible, older cancer patients are generally cared for in their own homes by family or friends, with spouses being the most common caregivers. This care can include everything from ensuring patients take their medication to transporting them to hospital appointments to bathing and dressing them, and can impose emotional, financial and physical burdens on caregivers.

“Caregivers are such an important part of our healthcare system, particularly for older adults with cancer,” says corresponding author Arti Hurria at City of Hope National Medical Center, CA. “We wanted to further understand the factors that are associated with caregiver burden.”

Based on their experiences treating older cancer patients, one factor Hurria and her colleagues at City of Hope thought might be important is differences in assessments of patient health and physical abilities between patients and their caregivers. “In daily practice we sometimes see a disconnect between what the patient perceives their general health and abilities to be in comparison to what the caregiver thinks. We wanted to see whether this disconnect impacted caregiver burden.”

To do this, Hurria and her colleagues questioned 100 older cancer patients being treated at City of Hope, together with their caregivers, about the patient’s general health and physical function, meaning their ability to perform everyday activities. They then compared the answers given by the patients and their respective caregivers. They also assessed the level of caregiver burden experienced by the caregivers, defined as a subjective feeling of stress caused by being overwhelmed by the demands of caring, by conducting a standard questionnaire on topics such as sleep disturbance, physical effort and patient behavior.

The 100 cancer patients, aged from 65 to 91, were suffering from a variety of different types of cancer, with the most common being lymphoma, breast cancer and gastrointestinal cancers. The ages of the caregivers ranged from 28 to 85 and the majority were female (73%), mainly either the spouse of the patient (68%) or an adult child (18%).

Hurria and her colleagues found that caregivers consistently rated patients as having poorer physical function and mental health and requiring more social support than the patients themselves did. However, only the disparity in the assessment of physical function was associated with greater caregiver burden. What is still unclear is the cause of this disparity.

“I think there are two possible explanations,” says first author Tina Hsu. “One is that older adults with cancer either don’t appreciate how much help they require or, more likely, they are able preserve their sense of independence and dignity through a perception that they feel they can do more than they really can. Alternatively, it is possible that caregivers who are more stressed out perceive their loved one to require more help than they actually do need. Most likely, the truth of how much help the patient actually needs lies somewhere between what patients and caregivers report.”

Based on their findings, Hsu, Hurria and their colleagues advise that clinicians should consider assessing caregiver burden in those caregivers who report the patient as being more dependent than the patient does themselves.

“Caregivers play an essential role in supporting older adults with cancer,” says Hsu. “We plan to further explore factors associated with caregiver burden in this population, particularly in those who are frailer and thus require even more hands-on support. We also hope to explore what resources caregivers of older adults with cancer feel they need to better help them with their role.”

Bruce A. Chabner, MD, Editor-in-Chief of The Oncologist, commented, “This report emphasizes the importance of direct communication between the health care team and the patient.  Among older patients, the reports of local caregivers may not accurately reflect the patient’s sense of well-being and symptoms.  The message is:  talk to the patient first!”

Article citation: “Are Disagreements in Caregiver and Patient Assessment of Patient Health Associated with Increased Caregiver Burden in Caregivers of Older Adults with Cancer?” Tina Hsu, Matthew Loscalzo, Rupal Ramani, Stephen Forman, Leslie Popplewell, Karen Clark, Vani Katheria, Rex Strowbridge, Redmond Rinehart, Dan Smith, Keith Matthews, Jeff Dillehunt, Tao Feng, David Smith, Canlan Sun, Arti Hurria. The Oncologist. Published Online: August 14, 2017; DOI: 10.1634/theoncologist.2017-0085. http://dx.doi.org/10.1634/theoncologist.2017-0085

About The Oncologist
Now celebrating its 22nd edition, this internationally peer-reviewed journal focuses on clear and concise interpretation addressing the multimodality diagnosis, treatment and quality of life of the cancer patient. Each issue is meant to impact the practice of oncology and to facilitate significant communication in the introduction of new medical treatments and technologies. The Oncologist is the official journal of the Society for Translational Oncology (STO).

About AlphaMed Press
Established in 1983, AlphaMed Press, which has offices in Durham, NC, San Francisco, CA, and Belfast, Northern Ireland, is the publisher of three internationally renowned peer-reviewed journals. The Oncologist® (www.TheOncologist.com), which is entering its 20th year, is devoted to community and hospital-based oncologists and physicians entrusted with cancer patient care. STEM CELLS® (www.StemCells.com), celebrating its 35th year, is the world’s first journal devoted to this fast paced field of research. STEM CELLS Translational Medicine® (www.StemCellsTM.com), currently in its sixth year, is dedicated to significantly advancing the clinical utilization of stem cell molecular and cellular biology.

About Wiley
Wiley, a global company, helps people and organizations develop the skills and knowledge they need to succeed. Our online scientific, technical, medical and scholarly journals, combined with our digital learning, assessment and certification solutions, help universities, learned societies, businesses, governments and individuals increase the academic and professional impact of their work. For more than 200 years, we have delivered consistent performance to our stakeholders. The company’s website can be accessed at www.wiley.com.

Nursing Home Disaster Plans Often Faulted As ‘Paper Tigers’

Nursing Home Disaster Plans Often Faulted As ‘Paper Tigers’

It does not take a hurricane to put nursing home residents at risk when disaster strikes.

Around the country, facilities have been caught unprepared for far more mundane emergencies than the hurricanes that recently struck Florida and Houston, according to an examination of federal inspection records. Those homes rarely face severe reprimands, records show, even when inspectors identify repeated lapses.

In some cases, nursing homes failed to prepare for basic contingencies.

In one visit last May, inspectors found that an El Paso, Texas, nursing home had no plan for how to bring wheelchair-dependent people down the stairs in case of an evacuation. Inspectors in Colorado found a nursing home’s courtyard gate was locked and employees did not know the combination, inspection records show. During a fire at a Chicago facility, residents were evacuated in the wrong order, starting with the people farthest from the blaze.

Nursing home inspectors issued 2,300 violations of emergency-planning rules during the past four years. But they labeled only 20 so serious as to place residents in danger, the records show.

In addition, a third of U.S. nursing homes have been cited for another type of violation: failing to inspect their generators each week or to test them monthly. None of those violations was categorized as a major deficiency, even at 1,373 nursing facilities that were cited more than once for neglecting generator upkeep, the records show.

“That’s the essential problem with the regulatory system: It misses many issues, and even when it identifies them, it doesn’t treat them seriously enough,” said Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy. “It’s always the same story: We have some pretty good standards and we don’t enforce them.”

In the wake of eight deaths at Rehabilitation Center at Hollywood Hills, Fla., following Hurricane Irma, heightened attention has focused on new federal disaster-planning rules, with which nursing homes must comply by mid-November. Those were prompted by nursing home and hospital deaths during Hurricane Katrina in Louisiana in 2005.

Dr. David Gifford, senior vice president for quality and regulatory affairs at the American Health Care Association, a nursing home industry group, said facilities have gotten better at handling disasters after each one. Most evacuations go smoothly, he said.

“After each one of these emergencies we’ve learned and gotten better,” Gifford said.

But advocates for the elderly say enforcement of rules is as great a concern, if not greater.

Dr. David Marcozzi, a former director of the federal emergency preparedness program for health care, said that inspectors — also known as surveyors —  should observe nursing home staff demonstrating their emergency plans, rather than just checking that they have been written down.

“If you have not implemented and exercised plans, they are paper tigers,” said Marcozzi, now an associate professor at the University of Maryland School of Medicine. “The emphasis from the surveyor has to be ‘Show me how you do this.’ ”

Gifford said pre-planning and drills, which are important, only go so far in chaotic events such as hurricanes.

“No matter what planning you might have, what we have learned from these emergencies is these plans don’t always work,” he said. Nursing homes take surveys seriously and face closure if they do not fix flaws inspectors identify, he added.

Inspection results vary widely by state, influenced sometimes by lax nursing homes or more assertive surveyors, or a combination, according to an analysis of two types of emergency-planning deficiencies. In California, 53 percent of nursing facilities have been cited for at least one of two types of emergency-planning deficiencies, and a quarter have been cited in Texas. No nursing home in Indiana, Mississippi or Oregon was issued violations for those two emergency-planning violations during the past four years.

Asked to explain the rarity of severe citations in emergency preparation, the federal Centers for Medicare & Medicaid Services, which oversees inspections, referred a reporter to its emergency-preparedness mission statement on its website.

The danger of high temperatures for elderly residents, which the Hollywood Hills case shows can be disastrous, has been well known. In a heat wave in 2000, two nursing home residents in a Burlingame, Calif., facility died and six others suffered severe dehydration, heat stroke or exhaustion.

During the past four years, inspectors have cited 536 nursing homes for failing to maintain comfortable and safe temperature levels for residents. Inspectors deemed 15 as serious, including two where patients were harmed, records show.

“There is undoubtedly little, if any, enforcement of the laws since we see the same tragedies repeated time and again,” said Patricia McGinnis, executive director of California Advocates for Nursing Home Reform.

Clarification: This story was updated on Sept. 19 clarify to make clear that 53 percent of nursing facilities in California and a quarter of them in Texas were cited for at least one of two types of emergency-planning deficiencies — not both types of deficiencies.

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation. Coverage of aging and long-term care issues is supported by The SCAN Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

A new age of care

A new age of care

Before there were nursing homes and social security legislation, the elderly lived in almshouses which also housed insane, homeless and inebriated people. Living conditions in these facilities were horrendous and dangerous. Thankfully, after some legislation passed nursing home numbers began to rise and gave seniors a better environment to live. Although there are still problems that occur, nursing homes are adopting new innovations and technologies to increase the quality of care for the elderly population.

The number of people older than 60 is set to hit one billion by the end of the decade, according to the United Nations Population Fund and HelpAge International. These increasing numbers show us the importance of the future of nursing home. With new advances, nursing homes are working towards a more active, social and healthy lifestyle that seniors can enjoy as they age.

For seniors that don’t require nurse care full time, independent living is becoming a popular choice. This allows the elderly to live in a senior facility and still have the ability to make independent choices on mobility, activities and food preparation. The elderly are also starting to co-house with one another allowing them to share the responsibilities and bills. With user-friendly technology such as alarm sensors that detect floods, carbon dioxide leaks and if someone falls makes these options viable for seniors who are still active.

Senior can be lonely and miss their family while living in nursing homes but video technology is helping them to connect. Services such as Skype or Facetime allows seniors to see and talk to their families, friends and even doctors. Technology advancements in wearables and mobile health are also helping seniors. Wearables can help healthcare providers to monitor heartbeat, hydration and physical activity. Mobile health can help remind seniors about medical appointments, insurance, records and taking medication.

Technology will continue to impact the way the elderly population are cared for. Caregivers need to stay updated with all the options in order to choose the best for their family members.

Nursing Home Healthcare

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Elder Abuse: ERs Learn How To Protect A Vulnerable Population

Elder Abuse: ERs Learn How To Protect A Vulnerable Population

Abuse often leads to depression and medical problems in older patients — even death within a year of an abusive incident.

Yet, those subjected to emotional, physical or financial abuse too often remain silent. Identifying victims and intervening poses challenges for doctors and nurses.

Because visits to the emergency room may be the only time an older adult leaves the house, staff in the ER can be a first line of defense, said Tony Rosen, founder and lead investigator of the Vulnerable Elder Protection Team (VEPT), a program launched in April at the New York-Presbyterian Hospital/Weill Cornell Medical Center ER.

The most common kinds of elder abuse are emotional and financial, Rosen said, and usually when one form of abuse exists, so do others. According to a New York study, as few as 1 in 24 cases of abuse against residents age 60 and older were reported to authorities.

The VEPT program — initially funded by a small grant from The John A. Hartford Foundation (a Kaiser Health News funder) and now fully funded by the Fan Fox and Leslie R. Samuels Foundation — includes Presbyterian Hospital emergency physicians Tony Rosen, Mary Mulcare and Michael Stern. These three doctors and two social workers take turns being on call to respond to signs of elder abuse. Also available when needed are psychiatrists, legal and ethical advisers, radiologists, geriatricians and security and patient-services personnel.

“We work at making awareness of elder abuse part of the culture in our emergency room by training the entire staff in how to recognize it,” said Rosen. It’s easy for the ER staff to alert the VEPT team and begin an investigation, he said.

A doctor interviews the patient and conducts a head-to-toe physical exam looking for bruises, lacerations, abrasions, areas of pain and tenderness. Additional testing is ordered if the doctor suspects abuse.

“Unlike with child abuse victims, where there is a standard protocol in place for screening, there is no equivalent for the elderly, but we have designed and are evaluating one,” said Rosen.

The team looks for specific injuries. For example, radiographic images show old and new fractures, which suggest a pattern of multiple traumatic events. Specific types of fractures may indicate abuse, such as midshaft fractures in the ulna, a forearm bone that can break when an older adult holds his arm in front of his face to protect himself.

When signs of abuse are found but the elder is not interested in cooperating with finding a safe place or getting help, a psychiatrist is asked to determine if that elder has decision-making capacity. The team offers resources but can do little more if the patient isn’t interested. They would have to allow the patient to return to the potentially unsafe situation.

Patients who are in immediate danger and want help or are found not to have capacity may be admitted to the hospital and placed in the care of a geriatrician until a solution can be found. Unlike with children and Child Protective Services, Adult Protective Services won’t become involved until a patient has been discharged, so hospitalization can play an important role in keeping older adults safe.

During the first three months of the program, more than 35 elders showed signs of abuse, and a large percentage of them were later confirmed to be victims. Changes in housing or living situations were made for several of them.

“It’s difficult to identify and measure appropriate outcomes for elder abuse victims, because each patient may have different care goals,” said Rosen, “but we are working on making a case that detection of elder abuse and intervention in the ER will improve the patients’ lives. We also hope to show that it will save money, because when an elder is in a safe place, expensive, frequent trips to the ER may no longer be needed.”

The team’s ultimate goal is to optimize acute care for these vulnerable victims and ensure their safety. They plan to work at continually tweaking VEPT to improve the program and to connect to emergency medical, law enforcement and criminal justice services. Eventually, they hope to help other emergency departments set up similar programs.

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

7 Techniques For Keeping Your ‘Thought Life’ Healthy And Your Stress Level Low

7 Techniques For Keeping Your ‘Thought Life’ Healthy And Your Stress Level Low

Life gives people plenty of reasons to be stressed.

Relationship problems, child-rearing issues, job woes and a lack of money are just some of life’s complications that can weigh people down – and cause health problems.

“It’s difficult to stay healthy and energized when stress is a daily reality,” says Dr. Greg Wells, author of The Ripple Effect: Eat, Sleep, Move and Think Better.

“Chronic stress can damage your body, threaten your mental health, put a strain on relationships, and take the joy out of life.”

But there’s no reason to surrender to stress, Wells says. He suggests seven techniques that can help you have a healthier “thought life” and recover from chronic stress:

• Move your body. Rhythmic, repeated motion is particularly soothing to the mind and body. A long walk, cycling, swimming, or running will all work, but any kind of movement relieves tension, improves circulation, and clears your mind.
• Get into nature. Head to the garden, the park, or the woods to lower your blood pressure, strengthen your immune system, reduce tension and depression, and boost your mood. “It’s stunning how good it is for your health to be in nature,” Wells says. “And I recommend you leave the cell phone and earbuds at home.”
• Practice yoga or Tai Chi. Therapy, yoga and Tai Chi are good ways to decrease stress and anxiety, increase energy, and boost the immune system. They also give you more stamina—needed in stressful times—and improve the quality of your sleep.
• Have perspective. Don’t be so quick to conclude that you “can’t handle” a stressful situation. “This is truly a mind-over-matter opportunity,” Wells says. “Believing that you are strong and resourceful actually makes you stronger and more resourceful.” Don’t give in to negative self-talk about not having what it takes to manage life, he says.
• Change the nature of your response. Research indicates that taking an active, problem-solving approach to life’s challenges relieves stress and can transform it into something positive. If you withdraw, deny the problem, or spend all your time venting, you’ll feel helpless. Instead, Well says, be determined to make a change, put effort into it, and plan for better results.
• Practice slow, deep breathing. Start applying the power of deep breathing each day. It will make a huge difference. Wells recommends you start small by taking three deep breaths each time you sit down at your desk—in the morning, after breaks, after lunch, and so on. It will help you become more patient, calm, and relaxed.
• Block time for single-tasking. Each day, schedule time in your calendar for focusing exclusively on one task. This task should be something that is important to you. “People love to talk about multi-tasking, but while doing several things at once might make it seem as if you are working hard, it’s an illusion,” Wells says. Your body and mind are not designed to work that way and it causes extra stress.

“Ultimately, it’s important to remember that your thoughts have a strong influence over stress levels,” Wells says. “What you choose to think about, or not think about, dictates how your body and mind react to everyday life.”

Dr. Greg Wells is an authority on high performance and human physiology. Wells’ latest book, The Ripple Effect: Eat, Sleep, Move and Think Better, hit shelves earlier this year. Dr. Wells is an Assistant Professor of Kinesiology at the University of Toronto where he studies elite sport performance. He also serves as an Associate Scientist of Translational Medicine at The Hospital for Sick Children, where he leads the Exercise Medicine Research Program.

Interrupted sleep can be harmful to caregivers health

Interrupted sleep can be harmful to caregivers health

In 2013 my husband’s aorta dissected. He had three emergency operations and, during the third one, suffered a spinal cord injury that paralyzed his legs. The night I drove him to the hospital I became his primary caregiver and advocate. After being hospitalized for eight months my husband was released to my care.

Catheterization was part of this care. Every morning at 3 a.m. the alarm clock went off, and I stumbled out of bed to help my husband catheterize. Afterwards he usually went back to sleep. I didn’t. Instead, I tossed and turned and worried about the coming day. Although a paid caregiver came at 6:30 a.m. and stayed two hours to get my husband up, I was still involved in his care.  

By one in the afternoon I was yearning for sleep. Interrupted sleep took a toll on me, and may be taking a toll on you. Perhaps you get up in the middle of the night to give a loved one medicine. You may have to get up to rescue a loved one who has fallen down. Personal health problems—arthritis, bursitis, restless legs, and bathroom breaks—may interrupted your sleep.

Rick Nauert, PhD examines this sleep disorder in “Interrupted sleep Can Be as Harmful as  No Sleep,” posted on the PsycCentral website. He uses new parents as examples of interrupted sleep. Although they’re awake a short time, interrupted sleep disrupts the parents’ normal sleep rhythms. “Parents often report feeling more exhausted in the morning than when they went to bed the night before,” he explains.

Nauert cites a study published in the journal of Sleep Medicine that states interrupted sleep is equivalent to no more than four hours of consecutive sleep. Wow! One thing is sure: You need at least seven hours of sleep. Over time, interrupted sleep can become sleep deprivation, and it’s dangerous.

According to a WebMD article, “10 Things to Hate About Sleep Loss,” the dangers of lack of sleep include:

  • Slower reaction time
  • Impaired thinking
  • Increased risk of heart disease
  • High blood pressure
  • Increased risk of stroke, diabetes
  • Lower sex drive
  • Depression
  • Impaired memory
  • Increased weight gain

“Sleep loss impairs judgment, especially about sleep,” the article concludes.

Thankfully, I found some solutions for interrupted sleep. To give me an extra hour of sleep, I changed the paid caregivers’ arrival time from 6:30 a.m. to 7:30 a.m. I followed the advice of my husband’s occupational therapist. Her idea: make a catheterization kit and let my husband, a retired physician, catheterize himself. I made the kit and set it on his bedside table.

Stacy M. Peterson and Brooke L. Werneburg, in their Mayo Clinic website article  “Sleep: The Foundation of Healthy Habits,” ask patients to establish a bedtime routine. We had a good routine; I just started it 45 minutes earlier. I continued to take naps when I needed them. However, I was careful not to nap for more than an hour.

Interrupted sleep is a serious health problem. Don’t let interruptive sleep interrupt your life and caregiving. Take action now!

Rediscovering your identity as a caregiver

Rediscovering your identity as a caregiver

Caregivers Rediscovering Their Identity

A friend’s wife suffered through a rough couple of years with cancer, and he served as her sole caregiver. Meeting up with him one day, I asked, “How are you doing?” He quickly replied, “Well, we’re doing okay. She just got home from the hospital, and seems to be having some better days. We have a long way to go, but our situation is better than it was.” He then shared test results his wife had, and gave a comprehensive update on her condition. After he paused for a moment, I pointedly said to him, “I asked how you are doing.” The ease of speech used to relay his wife’s circumstances instantly vanished.  As tears welled in his eyes, he managed to stammer, “Peter, I’m scared and worn out.”

Both responses my friend gave me reflect the condition of virtually every caregiver I know—including myself. We tend to lose our identity in the story of someone else. When a caregiver answers direct questions in third person singular (he, she, etc.) or first person plural (we, our, us), it’s a good indicator the loved one overshadows the caregiver’s identity. When asked about our own hearts, however, we find ourselves caught off guard, and usually struggle to share our feelings.

One of the caregiver landmines is the loss of identity.

It’s simply too easy to become lost as the person pushing the wheelchair.  We’re become the one standing in the hospital room corner, the one doing laundry or meals, etc. How can we talk about our own broken hearts or weariness when our loved ones have such drastic illnesses or challenges? Too many caregivers feel guilty for saying anything construed as complaining or wanting a break.  After all, the suffering loved one doesn’t get a break from pain/disease/ disability. But our injuries and wounds, whether physical or emotional, require attention—regardless of how they compare to others.

The loss of identity is the first step on a downward spiral for a caregiver.

If we don’t start paying attention to and taking care of ourselves, a strong resentment can quickly take hold. In a relatively short time, we can find ourselves tied in all kinds of emotional knots of guilt, and other negative feelings. Most don’t understand that caregivers can easily lose their identity in caring for that loved one.  In seemingly no time at all, it becomes difficult for caregivers to speak from their own hearts, pain, anger, frustration, and sadness. This loss of identity is the first step on a downward spiral for a caregiver.

Oddly, understanding this truth didn’t come from counseling or support groups (both of which I recommend), but rather I learned this one at the piano. Playing the piano since age five, I eventually earned a degree in music. In college I met Gracie who, although hurt from her terrible accident, is a wonderful singer. I mean, a no- kidding singer!  For years, we performed together, and I accompanied her on countless stages and in the studio. When Gracie’s health declined and she could no longer maintain a regular public schedule, my public performing appeared shelved, as well. Surprising me day at church, my pastor asked a special request, “Peter, would you play before services each Sunday morning as people gather and facilitate a more reverent atmosphere in the sanctuary?”

Finding The Melody

Agreeing to his invitation, I sat down to play hymns I’ve played since childhood, only to experience an unexpected issue.  Within just a few measures, I discovered my mind played a trick on me and I kept hearing Gracie’s voice. This led me to leave out the melody and I played only the accompaniment. The chords were nice, but they didn’t communicate the song. Quickly adjusting, I forced myself to play the melody.

We caregivers often find ourselves in this place: we lose the melody. Growing accustomed to someone else’s voice, we find ourselves playing a supporting role. The loss of our own voice, our melody—our identity, is a landmine with disastrous effect. That’s why I spend so much time on this issue for my fellow caregivers. We avoid this by reclaiming our identity and acknowledging our feelings out loud.  Using our own voices we can express, “I’m tired,” “I’m lonely,” “I’m scared,” “I’m angry,” or “I’m weary,” and seeking the help we need.

Caregivers can also reclaim healthy identities by cultivating trusted and appropriate relationships.  In those relationships, caregivers can safely express feelings and challenges with someone who understands their needs. Not limited to just friendships, a relationship with a trained mental health counselor can help sort through issues.

In addition, counselors can help connect to various respite and other type community services. Although each of these remain critical steps, they all start with a caregiver uttering: “I need help.” The next time a trusted friend asks, “How are you?” it may feel strange at first, but try and answer in first person singular. Appropriately sharing your own heartache and feelings is not self-centered; it is healthy—and healthy caregivers make better caregivers!

Tai Chi May Help Prevent Falls in Older and At-Risk Adults

Tai Chi May Help Prevent Falls in Older and At-Risk Adults

An analysis of published studies indicates that tai chi may help reduce the number of falls in both the older adult population and at-risk adults. The findings, which are published in the Journal of the American Geriatrics Society, offer a simple and holistic way to prevent injuries.

Tai chi is an ancient Chinese practice focused on flexibility and whole body coordination that promotes harmonized motion in space. Previous research has shown that tai chi is an effective exercise to improve balance control and flexibility in older individuals. This suggests that the practice might help protect against falls, which are a primary cause of traumatic death for older adults.

To investigate, Rafael Lomas-Vega, PhD of the University of Jaén in Spain and his colleagues searched the medical literature for relevant studies. The team identified 10 randomized controlled trials analysing the effect of tai chi versus other treatments (such as physical therapy and low intensity exercise) on risk of falls in at-risk and older adults.

There was high-quality evidence that tai chi significantly reduced the rate of falls by 43% compared with other interventions at short-term follow-up (less than 12 months) and by 13% at long-term follow-up (more than 12 months). Regarding injurious falls, there was some evidence that tai chi reduced risk by 50% over the short term and by 28% over the long term. Tai chi did not seem to influence when an older or at-risk adult was likely to experience their first injurious fall.

“Tai chi practice may be recommended to prevent falls in at-risk adults and older adults. The length of the interventions ranged from 12 to 26 weeks. The frequency of the 1-hour sessions ranged from one to three times per week,” said Dr. Lomas-Vega. “Due to the small number of published studies, further research is needed to investigate the effect of tai chi on injurious falls and time to first fall.”

Full Citation: “Tai chi for risk of falls. A meta-analysis.” Rafael Lomas-Vega, Esteban Obrero-Gaitán, Francisco Javier Molina-Ortega, and Rafael del-Pino-Casado. Journal of the American Geriatrics Society; Published Online: July 24, 2017 (DOI: 10.1111/jgs.15008): http://doi.wiley.com/10.1111/jgs.15008

The Journal of the American Geriatrics Society is a comprehensive and reliable source of monthly research and information about common diseases and disorders of older adults. For more information, please visit http://wileyonlinelibrary.com/journal/jgs.

About Wiley
Wiley, a global company, helps people and organizations develop the skills and knowledge they need to succeed. Our online scientific, technical, medical, and scholarly journals, combined with our digital learning, assessment and certification solutions help universities, learned societies, businesses, governments and individuals increase the academic and professional impact of their work. For more than 200 years, we have delivered consistent performance to our stakeholders. The company’s website can be accessed at www.wiley.com.

Featured image: cowardlion / Shutterstock.com

Writing through pain: A cancer survivor guides patients with pen and paper

Writing through pain: A cancer survivor guides patients with pen and paper

Would you be interested in participating in a writing group on The Caregiver Space? We’ve had The Page Listens since the beginning, but we’d like to organize a group that discusses the process together.

In 2013, Lynn Scozzari was staring at a photo of a naked woman seated on a rock, her arms thrust open to a valley below. Scozzari herself was seated at a table with fellow cancer patients and survivors in a conference room at Scripps Green Hospital in La Jolla, Calif. They were part of a writing… (more…)

8 Things Senior Citizens in Assisted Living Don’t Want to Hear

8 Things Senior Citizens in Assisted Living Don’t Want to Hear

Dealing with elder adults and senior citizens can be incredibly difficult. All of us, at some point, have experienced their seemingly strange behavior, the incessant talk about things that seem irrelevant to us, not taking the prescribed medications, and the frequent emotional outbursts. These small problems, however, can turn into a major issue for those in regular contact with senior citizens, particularly the caregivers working in an assisted living facility.

The first step towards resolving this dilemma is to improve your communication. Whenever you are interacting with senior citizens, you must choose your words carefully. If you don’t approach your conversations with utmost care, you will get worst reactions irrespective of your good intentions.

Better communication with seniors begins with understanding how much damage your words can cause to the seniors who already feel alone and neglected. If you care about the residents in your assisted living facility, you should avoid saying the following eight things when speaking to them.

1. “Sweetie” Or “Honey”

Infantilizing elder adults under your care is downright patronizing. Most adults don’t like to be called “honey,” “dear,” or “sweetie,” or any other pet name at all. Do not call them anything that you would also call a person under age ten, including “dear,” “sweetie,” “honey,” or worst of all, “young lady” or “young man.” You can call them “Sir” or “Ma’am,” which is a general title of respect applicable to all adult men and women. However, calling them by their names is the best way to open a conversation.

2. What’s It Like to Be Your Age?

Senior citizens are not different; they are merely their own category. However, asking them, “What is it like to be your age?” implies you are treating them as different people. Plus, old age brings plenty of health issues that most senior citizens don’t want to discuss with anyone. So, never open a dialogue with this question.

If you want to strike a personal conversation, try a more subtle approach such as “Tell me, Frank, how has the “culture of senior high” changed since you graduated?” Besides, if a senior resident wants to share something with you, they are more likely to do it on their own.

3. How Can You Forget That?

Short-term memory loss is a common complaint among older adults. In fact, they often lose short-term memory before long-term. As a result, they tend to forget all kinds of small things such as where they put their glasses or cane. Such memory lapses can be frustrating. However, this doesn’t mean you should be snapping and asking, “How can you forget that?” repeatedly.

You can try placing a few Post-it notes on the desk, fridge and the bathroom mirror as reminders. Remind them in a gentle tone. Saying something such as, “You are likely to trip and fall if you forget to keep your glasses handy, resulting in a serious injury.” can keep the tone light. Most, importantly, don’t lose your patience as impatience is what triggers the hurtful demeanor of conversation.

4. You Could Do That If You Really Tried

As a caregiver, you must have heard that you must encourage senior residents to participate in different activities and routine tasks to avoid loneliness. However, there is a thin line between encouragement and compulsion. The remark, “You could do that if you actually tried” implies compulsion, not encouragement.

Just because a senior citizen is in a physically fit condition, doesn’t mean he/she should go out there and play football. They need start with manageable activities such as a stroll in the garden. Plus, you need to stop when the senior citizen says so. Forcing them into doing things they don’t like isn’t going to help anyone including you and your colleagues.

5. I Just Showed You How to Do That Yesterday

Whether it is handling the new TV remote or making a video call with their children, learning new technology can be a challenge for most elder adults. However, with patience, you can teach them to use the latest gadgets. Most cable operators and even cell phone operators provide senior-friendly gadgets that make the learning process a lot easier.

Alternatively, you can print the step-by-step instructions in a large font and leave them near the TV remote. You can also contact volunteers from the nearest senior citizen center, high school, community center or college to teach basic internet and computer skills to the senior residents at your assisted living.

6. You Already Told Me That

We all have the tendency to repeat ourselves at some point. However, we often get upset with senior citizens as they repeat themselves too often. You must have heard those Vietnam War stories from a war veteran so often, you could repeat them word-to-word, in your sleep. But, as a responsible caregiver, it is your job to listen to these repetitions with patience over and over again.

7. Why Is Your Room or Bed So Messy?

Keeping the room and bed tidy becomes increasingly difficult in old age, particularly if you are suffering from ailments such as arthritis. Aging also brings a variety of hygiene and cleanliness issues to the forefront. As a caregiver, you have to deal with these issues regularly. So, instead of being harsh, help them with the housework.

8. Let Me Give You a Hand

Though the senior residents in your community will need help with some housework, don’t go overboard with helping, particularly if they can get around on their own. Promoting their independence not only promotes their sense of achievement, but also gives them assurance that they can control certain aspects of their lives. So, let them be as self-sufficient as possible. For example, if they can take a stroll or use a computer on their own, let them do it.


Though dealing with senior citizens can be difficult at times, as a caregiver, it is your responsibility to allow them to live as respectable individuals. You will have to connect and reconnect with them to build a better relationship. None of this sounds easy, but avoiding the above eight comments when speaking to elder adults can help resolve this dilemma.

What have you done to improve your relationship with the senior citizens in your assisted living facility? Let us know in the comments section below.

Featured image: Maxpixel

Evan Thompson, CEO and founder of Senior.One has a long standing interest in finding solutions for seniors. He helps connect senior citizens and their family members with elder care service providers and find the resources they need in one place. He offers information on nursing homes, hospice, financial planning, adult care, lifestyle and assisted living facilities in Albuquerque. He provides information on housing, medical professionals, financial planning services, and lifestyle options.

How to streamline your Rx mess

How to streamline your Rx mess

There are many compelling reasons that surround my move back home to live with my elderly mother—none the least of which is the near accidental overdose from the many Rx prescriptions whose labels she can no longer read.

Ask yourself these 4 questions to determine if you might need a little help in sorting out your own Rx mess.

1) Does your eyesight still allow you to easily read the Rx labels so you know the proper dosage to take?

2) Can you hear well enough over the telephone to place renewals for your Rx? Keep in mind automated phone robots—not the pharmacist—usually take and confirm your orders.

3) Do you have an organized system for dispensing meds so there is no confusion over did I already take my pill, or did I forget to put it on the tray?

4) Do you have a way to keep track of when renewals are due? Or are you surprised when you find an empty bottle and no pills left for today’s dosage?

I am sick at the prospect of taking on this role by myself. But after the brother living nearby trains me, it becomes part of my new weekly routine soon enough.

Studying his approach to counting, sorting, chopping and calling for the renewal of these pills, I feel confident that I can reorganize the grocery sack housing my mother’s entire health regiment.

3 Steps to Streamlining Your Rx Mess:


Step 1- Familiarize yourself with the pills.


  1. Know your pills by name and the reasons why each is taken.


  1. Know when and how the pill should be dispensed…with water, food, or on an empty stomach?


  1. This should be obvious, but be sure your doctor knows all of the medication you are taking in case one pill has a reaction with another. Especially important to communicate if you have more than one doctor—or are meeting for the first time a physician who is new to you.


  1. Laminate your pill chart (at end of post) and keep it in your wallet.

This will be essential information to provide at every doctor visit.


  1. Recognize the grooves and sizes that distinguish all white pills from each other. After the first time you drop your med tray (it happens!), spilling pills everywhere, you will know just how to put it all back together again.


Step 2- Streamline Rx Storage


  1. A shoebox holding a dozen prescription bottles upright works for me.


  1. Sorting the bottles in alphabetical order will make your inventorying much easier when it comes time for renewals later.


  1. On top of the bottle cap, write the renewal date due in Sharpie pen.


  1. Keep the blade for chopping pills inside this box as well.


  1. The shoebox is for storing the Rx bottles.

The med tray is for holding the day’s dosages.

Different sized med tray dispensers range from one time a day for 7-days to multiple times of the day for 7 days. The latter is what I use—and here is why I love it. There are four vertical rows, with 7 cells across in each row. The first two rows are yellow. The two rows beneath are blue. Guess what? Since I do not need to dispense meds four times a day, I re-label the slats to give me two weeks worth of pre-planned pills. Now I can load the tray with A.M. and P.M. meds knowing that the yellow is for week 1 and the blue is for week 2. Time saver for sure!


Step 3- Remember Renewals


  1. Do not put a nearly empty pill bottle away without red-flagging it.


Forgetting that tonight’s dinner pill was never renewed can be further complicated when it requires a doctor’s approval which—this being Friday—you will not get until Monday.


  1. Post renewal dates on top of standing bottles for a better alert.
  2. Laminate a version of the following Rx chart for your purse or wallet.


Pills, Powders, and Potions Chart


Laminate prescription chart to keep in handbags, and wallet for appointments.

Date Last Modified:
Patient Information Primary Care Information
Name of Patient Name of Doctor
Patient Phone Contact Phone
Caregiver Name Front office name(s)
Caregiver Phone Street Address
DOB Suite #, City, Zip
Insurance 1st Pharmacy choice: Phone:
Plan # 2nd Pharmacy choice: Phone:


Medicine Name

(add strength mg)

Reason Taken Pharmacy#1










Rx# Qty. Date Last Filled Next Fill


List in alpha order Blood pressure?


Pharmacy to fill Rx

(check this box)

Pharmacy to fill Rx

(check this box)

Needed for refill Make a note for pills cut in half Write on tops of bottles for ease Write on tops of bottles for ease


Now that you have taken stock of your Rx collection and sorted that mess from your grocery sack storage, you should be well on your way to managing your prescriptions with greater ease and care. With your new system in place, it will be a breeze if and when someone else needs to take over for you.


“What to Ask When Hiring a Caregiver?” will be the next blog posting here.

How Can You Help People Who Have Dementia and Don’t Realize it?

How Can You Help People Who Have Dementia and Don’t Realize it?

Being a caregiver for someone who has a memory deficit can be extremely challenging. It becomes even more difficult when that person is unaware of their dementia or any other limitations associated with it. Dementia can directly impact a person’s ability to follow directions, can compromise their safety,  impedes problem solving and abstract reasoning. It can cause them to be impulsive or unrealistic about their abilities. There are things you can do and approaches you should avoid as a caregiver facing these parameters.  

From an emotional standpoint it can be extremely frustrating for a person with dementia to be told they should not be doing tasks they believe they are very competent to manage. Any caregiver trying to create a safer environment may be on the receiving end of angry outbursts and defensiveness from the person with dementia whom they are trying to keep safe and protect. Here are some suggestions about how caregivers can approach working with a person with dementia who is unaware of it:

Communicate in a calm manner.

Be as empathetic and supportive as you possibly can. Be aware of the tone of your voice and the message you are sending and how it is or is not being received. Also be aware of your body language and facial expressions and what they convey.

If you find yourself starting to get angry or stressed remove yourself or take a time out for your own sake rather than arguing.

Take a break from the conversation or task at hand. If it safe to remove yourself from the person you are watching give yourself a few minutes to take a deep breath, regroup your thoughts, and calm down.

Try to separate the person from the disease.

This is tricky but important. Remind yourself the person with dementia is not intentionally trying to be contrary. The disease is causing their memory loss or inability to do the things they used to. Sometimes recognizing why someone is behaving in a negative way helps you get to be in their shoes and makes you feel less attacked and more understanding.

Don’t engage in arguments about who is right or wrong.

That won’t help anyone. All that does is reinforce the deficits the people with dementia has causing them to dig in and not do what you need them to do. Does it really matter if they think it is Thursday and you know it is Friday? The best thing to do is to distract or disengage from that conversation and focus on something that is neutral or something you know they will enjoy. People with memory problems may confabulate, or make up answers to explain things that happen. Just let them say their version of events and then move on to something else.

Try to pick tasks you can do together and work as a team.

Everyone wants and needs to feel wanted and useful. Maybe they can help put laundry in the washing machine or put dirty dishes in the dishwasher. Even if they make a mistake you can always pull the dirty dish out later if the dishes were clean.

Try to create as positive a relationship as you can.

Be friendly and warm with the person you are caring for.  They will be more apt to work with you than against you if they sense you are on their side or feel friendly towards them. You can do this by trying to give them as much control as possible about things that need to be done, and when and how they should be done. This makes them feel better when they believe they are making these decisions.

Give them two choices that are both acceptable options.

For example, lay out a blue and red shirt ask them to pick the one they want to wear that day. Do you want chicken or tuna for lunch today?

Break down the task that need to be done in as few and simple steps as you possibly can.

Make it as easy as possible for them to do chores or tasks. Have the watering can out and put water in it and the flower on the counter.

Don’t infantilize the person.

Don’t talk around them or about them when they are in front of you as if they were not there. Talk directly at them using their name. It is important to continue to reinforce people and their names to enhance memory.

Don’t remind them what they can’t do and reinforce what they can do.

Nobody wants to hear all of the things they can’t do. It is human nature to crave approval from others. Maybe grandma can’t play guitar anymore but she still has a beautiful voice. Pick a song you know she can sing and ask her to sing it for you.

Validate their fears or concerns.

Try to express your understanding about any fears, frustrations or anxiety they discuss. Be as empathetic as possible and validate their feelings as best you can. If they express fear for example, tell them “I know you were scared by that loud noise, I would be too. I am going to see what I can do to make it stop or make the noise less loud.”



Over 500k Americans discuss end of life care through Medicare

Over 500k Americans discuss end of life care through Medicare

The 90-year-old woman in the San Diego-area nursing home was quite clear, said Dr. Karl Steinberg. She didn’t want aggressive measures to prolong her life. If her heart stopped, she didn’t want CPR.

But when Steinberg, a palliative care physician, relayed those wishes to the woman’s daughter, the younger woman would have none of it.

“She said, ‘I don’t agree with that. My mom is confused,’” Steinberg recalled. “I said, ‘Let’s talk about it.’”

Instead of arguing, Steinberg used an increasingly popular tool to resolve the impasse last month. He brought mother and daughter together for an advance-care planning session, an end-of-life consultation that’s now being paid for by Medicare.

In 2016, the first year health care providers were allowed to bill for the service, nearly 575,000 Medicare beneficiaries took part in the conversations, new federal data obtained by Kaiser Health News show.

Nearly 23,000 providers submitted about $93 million in charges, including more than $43 million covered by the federal program for seniors and the disabled.

Use was much higher than expected, nearly double the 300,000 people the American Medical Association projected would receive the service in the first year.

That’s good news to proponents of the sessions, which focus on understanding and documenting treatment preferences for people nearing the end of their lives. Patients and, often, their families discuss with a doctor or other provider what kind of care they want if they’re unable to make decisions themselves.

“I think it’s great that half a million people talked with their doctors last year. That’s a good thing,” said Paul Malley, president of Aging with Dignity, a Florida nonprofit that promotes end-of-life discussions. “Physician practices are learning. My guess is that it will increase each year.”

Still, only a fraction of eligible Medicare providers — and patients — have used the benefit, which pays about $86 for the first 30-minute office visit and about $75 for additional sessions.

Nationwide, slightly more than 1 percent of the more than 56 million Medicare beneficiaries enrolled at the end of 2016 received advance-care planning talks, according to calculations by health policy analysts at Duke University. But use varied widely among states, from 0.2 percent of Alaska Medicare recipients to 2.49 percent of those enrolled in the program in Hawaii.

“There’s tremendous variation by state. That’s the first thing that jumps out,” said Donald Taylor Jr., a Duke professor of public policy.

In part, that’s because many providers, especially primary care doctors, aren’t aware that the Medicare reimbursement agreement, approved in 2015, has taken effect.

“Some physicians don’t know that this is a service,” said Barbie Hays, a Medicare coding and compliance strategist for the American Academy of Family Physicians. “They don’t know how to get paid for it. One of the struggles here is we’re trying to get this message out to our members.”

There also may be lingering controversy over the sessions, which were famously decried as “death panels” during the 2009 debate about the Affordable Care Act. Earlier this year, the issue resurfaced in Congress, where Rep. Steve King (R-Iowa) introduced the Protecting Life Until Natural Death Act, which would halt Medicare reimbursement for advance-care planning appointments.

King said the move was financially motivated and not in the interest of Americans “who were promised life-sustaining care in their older years.”

Proponents like Steinberg, however, contend that informed decisions, not cost savings, are the point of the new policy.

“It’s really important to say the reason for this isn’t to save money, although that may be a side benefit, but it’s really about person-centered care,” he said. “It’s about taking the time when people are ill or even when they’re not ill to talk about what their values are. To talk about what constitutes an acceptable versus an unacceptable quality of life.”

That’s just the discussion that the San Diego nursing home resident was able to have with her daughter, Steinberg said. The 90-year-old was able to say why she didn’t want CPR or to be intubated if she became seriously ill.

“I believe it brought the two of them closer,” Steinberg said. Even though the daughter didn’t necessarily hear what she wanted to hear. It was like, ‘You may not agree with your mom, but she’s your mom, and if she doesn’t want somebody beating her chest or ramming a tube down her throat, that’s her decision.”

KHN’s coverage of end-of-life and serious illness issues is supported by The Gordon and Betty Moore Foundation.

Are Seniors Really At The Most Risk For Scams?

Are Seniors Really At The Most Risk For Scams?

You may have heard from a friend or family member that seniors are the at the biggest risk for scams. It’s a commonly touted idea that because seniors have more economic freedom than other classes of society, because they worked more years on average, that scammers target them assuming they have lots of money to spare.

As it turns out, this isn’t just an urban myth. The hyperlinked article shows the results of research conducted by the North American Securities Administrators Association (NASAA). The results show clearly that seniors are the most targeted population group per capita. “It is imperative that we detect and prevent senior financial fraud before criminals who prey on our most vulnerable citizens steal from and devastate them,” said NASAA President and Minnesota Commissioner of Commerce Mike Rothman.

The good news is that are steps that seniors and their caregivers can take to seriously reduce their risk. The first step is free. Check out the infographic in this post and teach the senior to identify the most popular type of scams. By identifying and understanding how they work, the senior will be able to be more alert to the risk when a scammer contacts them. There are also identity theft protection services that can help provide aid to seniors after-the-fact. If their online security was breached, services like LifeLock will stop the damage and restore the senior’s credit.

If the senior uses a landline it is a good idea to look into some form of Caller ID. This might seem unnecessary to those who grew up using cell phones, but many seniors still don’t know who’s calling until they pick up the phone. This places them at increased risk to pick up for a scammer. If the phone screen/attachment read “Unknown Number” rather than the actual digits of the caller, they would be on high-alert and more likely to pick up a scam.

The combination of software protection like the caller ID and identity theft services, along with the manual identification of risk factors with the senior, should substantially reduce their risk of being scammed. There’s no need to frighten them with heavy statistics about their scam risk — the best approach is always to frame the problem in a positive light, by showing them how much they stand to gain by making sure they’re well-protected. This approach will increase the chances they’re receptive to understanding the risk factors.

identifying scams targeting the elderly

Brent Scott

Community Manager, LifeLock (a Symantec company)

4 Tips For Overcoming Life’s  Most Traumatic Experiences

4 Tips For Overcoming Life’s Most Traumatic Experiences

Wouldn’t it be great if our most difficult days came with Hollywood-happy endings?

In the movies, when faced with the worst possible situations, our heroes rise to the occasion and find strength they never knew they had. But those who experience real-life traumas are just as likely to end up questioning their faith in God, their family and themselves.

The scars, both physical and emotional, may never completely heal. And it can take years to find “meaning” from it all.

Even those who seem equipped to handle the worst – because of their religious beliefs or strong family and community connections – can find themselves questioning everything.

“There certainly are difficult lessons to learn when your life is suddenly turned upside down,” says Susan Mattern, author of “Out of the Lion’s Den: A Little Girl’s Mountain Lion Attack, A Mother’s Search for Answers.”

In 1986, while Mattern, her husband and their two children were hiking in Casper’s Wilderness Park in Orange County, California, a mountain lion grabbed her 5-year-old daughter, Laura, and disappeared. By the time she was found and rescued, Laura had been severely mauled. She survived, but lost the use of her right hand and the vision in one eye. She had severe brain injuries, and her life hung in the balance for weeks.

Mattern, a former nun, struggled with guilt, anger, stress and frustration as she fought to help her daughter recover – and to hold the county accountable when she learned the staff knew there were mountain lions in the park but hadn’t warned visitors.

In the decade after the attack, she lost her religious faith, but came out of the experience with a new kind of happiness and fulfillment.

Mattern has these tips for those battling to come back after a life-changing trauma:

  • Have faith in yourself. If you don’t believe in a higher power, or if you lose your religious faith, you can find your own meaning in life. “It was very difficult to give up my beliefs,” she says. “But instead of a vast emptiness where God used to be, there is caring, love and friendship.”

  • Have more than one focus. Mattern’s primary goal was helping her daughter get well, but the family also spent years battling Orange County in court. “The trial took up so much of our life, and that was a good thing in many ways,” she says. “It gave us another purpose.”

  • If you can’t find courage within yourself, look to those you love. Decades after her daughter’s attack, Mattern still is in awe of her friends; her husband, Don; and her daughter’s rescuers, doctors and legal team. But she draws the most strength from Laura, who isn’t bitter and lives an independent and fulfilling life.
  • Don’t expect to draw lessons from the experience right away. You may need to wait for the lessons to become apparent. It will take time and painful reflection, but it’s worth it, Mattern says. “It would be so depressing to go through all of this, only to learn nothing and have done nothing.” She realized, after years of searching, that the meaning of life was right in front of her – in her family, and the love she shared with family and friends.

Mattern says that after Laura grew into a young woman they were looking at a book that posed the question: If you could change one day in your life, which day would it be?

Mattern thought the choice was obvious. Laura disagreed.

“That day changed all of us, I know,” she told her mother. “But I wouldn’t have become the person I am today, and we wouldn’t have cared for each other as much as we do, or have such a wonderful family. No, I would leave that day just like it was.”

Susan Mattern, author of “Out of the Lion’s Den” (www.outofthelionsden.net), grew up in St. Louis, Missouri, and was a nun for six years before moving to California, where she met and married her husband, Don. They have two children, David and Laura. In 1986, Laura was attacked by a mountain lion in an Orange County park, and the family spent years helping her recover and fighting the county in court.

Work Better Together with 8 Useful Tips

Work Better Together with 8 Useful Tips

For every 100 million Americans who live with chronic pain, there are that many caretakers. The National Alliance for Caregiving and AARP conducted a national survey looking at family caregiving in the United States. The average caregiver renders 21 hours a week of unpaid care, has been caregiving for about 5-1/2 years, and can expect to maintain that level of care for an additional 5 years.

There are burdens for the caretaker just as there are life changes for the pain patient. Coming together is the beginning. Keeping together is progress. And working together is success.

Ulf Jakobsson, professor of the Center for Primary Health Care Research at Lund University in Lund, Sweden, explained, “Beyond the pain, there may be adverse effects on daily activities and quality of life for patients and their families. Some of these effects may include disruption of an individual’s ability to concentrate, be productive, socialize, or sleep, and may lead to feelings of isolation, depression, and anxiety.”

For the Pain Patient

It’s really easy to get lost in your pain. Yes, it can be all consuming but do not let that stop you from living. There are actions you can take every day to help you find your new normal. Start here.

Move. Try simple exercises or yoga. Movement helps loosen your muscles which can decrease your pain while allowing you to feel productive. Instead of taking the elevator, take the stairs. Every little bit helps. Depending on your pain levels, you can work with a physical therapist to avoid further injuring yourself. The main goal of physical therapy is to educate patients on the mathematics of stretching and strengthening, which in turn, aids in managing your chronic back pain — eventually accelerating your tissue healing — leading to recovery.

Invite. Ask your caretaker to attend a doctor’s appointment with you. Ironically, sometimes, if a caretaker doesn’t hear the information directly from a medical professional, they may not fully grasp the depths of your pain. Yes, they observe you on a daily basis, but it’s different. They may only see that you need guidance and may not understand why. Bringing them along to your appointment will allow them to hear straight from the horse’s mouth. It may even help them to appreciate how you feel on a daily basis when you ask for help.

Join a Support Group. Even if your caretaker apprehends your chronic back pain a little more, they may never completely relate to what you are going through. That’s why finding a local or virtual support group where people with your condition gather can be helpful to speak with like minded people who feel your pain, every day.

For the Caregiver

Guadalupe Palos, a licensed clinical social worker, registered nurse, and clinical research manager at MD Anderson Cancer Center in Houston, Texas , shared, “Caregivers of people in pain face a unique danger — it’s very easy to make the pain experience the center of the entire family’s world.

“For example, the atmosphere in a home often may be linked to whether the person in pain has a good or bad day. If it is a bad day, the caregiver’s reactions may range from being overly protective to silent anger. Whatever the reaction, it may affect other family members and even the person experiencing the pain. If the caregiver uses empathy and maintains a sense of calm, the family world is safe. But if the reaction is negative, it contributes to the chaos of the pain experience.”

Stay Calm and Be Supportive. Palos says to encourage the patient to become a self-advocate for their pain management. If they are included in their care, it may distract them from concentrating on their pain.

Communication is Key. Speaking, watching and listening are three crucial ingredients necessary to care effectively. Palos also explains that direct verbal communication between the patient and caregiver offers a better evaluation for greater pain management.

Take Time for Yourself. This is not being selfish. This is a way to keep your sanity. You are just as important as the patient you care for and you can’t properly care for another if you neglect to care for yourself.

“There are some simple things, including (a) doing something for yourself every day, such as meditating, taking a walk, or talking to a close friend; (b) not isolating yourself because of your caregiver role: (c) accepting the help that people offer; (d) bringing humor into your life; and (e) finding your spiritual self,” Palos concluded.

All for One and One for All

When you’re a full-time caretaker, it’s easy to think that your job is to sit stationary in the house with the patient watching television or waiting on them. Get creative. Find ways to get outside the house and do things that meets each of your internal needs and breaks up the in-house routine.

Get Busy, Together. Engage in normal activities that the pain patient and caregiver alike can do unitedly. Think outside of the box. Consider seeing a movie together,  allowing the caretaker to choose what you see. Or try a mediation session where you both can get your zen on while bonding in a unique fashion. Regular meditation can work to lower the body’s level of pain as well as improve sleep.

Get Active, Together. Start small. Instead of driving to that appointment or errand, try walking there together. It doesn’t have to be a sprint, just whatever your bodies can handle. If walking to an appointment will not work due to your location or the patient’s pain levels, go for that leisurely walk around your neighborhood with one another. The vitamin D and wind on your faces should improve your mood and allow you to take that break from the household monotony.

Lifestyle Coach and Certified Personal Trainer Simone Krame says, “Fitness is not always running the marathon or pushing ourselves to the extreme until we puke. It’s about moving in a way that feels good. It’s about getting that energy flowing and the endorphins moving – doing something that helps us. Our bodies are the physical homes for our spiritual selves, and we must take care of them in order to live a healthy lifestyle.”

So whether you’re the caretaker or the patient, instead of working against each other, work with one another. For the one in 10 Americans who live with chronic pain and their associated caretakers, this one’s for you. After all, we cannot accomplish all that we need to do without working together.

Macey Bernstein is a content specialist with a passion for crafting useful and actionable content that improves the lives of her audience. She is a dedicated reporter with a nose for news, a love for community, and a reputation for impeccable ethics. From writing press releases and legal briefs to event planning and execution she displays exceptional skill in journalism and creative direction. Macey is a graduate of the West Virginia University School of Journalism with a bachelor’s degree in journalism and public relations. For more information visit her Website.

Medicare Unveils ‘Skeletal’ Site For Hospice Comparison Shopping

Medicare Unveils ‘Skeletal’ Site For Hospice Comparison Shopping

Medicare launched a website aimed at helping families choose a hospice — but experts say it doesn’t help very much.

The Centers for Medicare & Medicaid Services this week released Hospice Compare, a consumer-focused website that lets families compare up to three hospice agencies at a time, among 3,876 nationwide. Following similar websites for hospitals and nursing homes, the site aims to improve transparency and empower families to “take ownership of their health,” according to a press release.

Through the website, families can see how hospices performed in seven categories, including how many patients were screened for pain and breathing difficulties, and how many patients on opioids were offered treatment for constipation.

But the measurements of quality, which are self-reported by hospices, have limited utility, some experts say. Over three-quarters of hospices scored at least 91 percent out of 100 on six of the seven categories, a recent paper in Health Affairs found. Because so many hospices reported high marks, there is “little room” for using these metrics to measure hospice quality, argued the authors, led by Dr. Joan Teno at the University of Washington.

The Hospice Compare grades are based on hospices reporting whether they followed a specific process, such as screening for pain when the patient arrives. This type of metric may lead staff to just check a box to indicate they completed the desired process, resulting in high grades for everyone, which is not helpful for consumers or for quality improvement, the authors wrote.

Meanwhile, Teno’s other research has found troubling variation in hospice quality, measured by how often hospice staff visit a patient when death is imminent.

“It’s nice that they’re at least beginning to be concerned about hospice quality,” said Dr. Joanne Lynn of the Altarum Institute, a longtime hospice physician  and researcher, of CMS’ new website. But “at the present time, it’s of pretty limited value.”

Lynn said people trying to choose a hospice would be better helped by other kinds of information, such as the average caseload for hospice staff; what percentage of patients are discharged alive; and whether the hospice predominantly serves nursing home patients or devotes significant resources to at-home care.

The Hospice Compare website also doesn’t say how often hospices run awry of federal regulations: Inspection reports, which contain verified consumer complaints as well as problems uncovered during routine inspections, are not part of the website, as they are for nursing homes.

Recent hospice inspection reports may be hard to find. Until a recent federal rule change, hospices could go as long as six years without being inspected. By 2018, CMS requires states to increase the frequency to once every three years.

Common quality measures for hospitals and nursing homes, such as mortality rates, don’t translate well to the hospice setting, where people are expected to die, Lynn noted.

Although Hospice Compare is “skeletal” at the moment, Lynn said, it does enable families to search which hospices are near them, and find the hospice’s phone number to start asking questions.

“I’m hoping that it continues to improve over time,” as CMS’ other consumer-focused websites have, she said.

Next year, CMS plans to add family ratings of hospices, including how timely hospice staff were when a patient needed help. CMS is also collecting data on the number of staff visits a patient received in the final week before death. That information should be made public in late 2018, a CMS spokesman said Wednesday.

KHN’s coverage of end-of-life and serious illness issues is supported by The Gordon and Betty Moore Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Traveling For Treatment: Tips And How To Cope

Traveling For Treatment: Tips And How To Cope

No matter what their diagnosis is, caring for a family member is a lifelong endeavor — a labor of love— that can be as taxing on you as it is on the person you’re caring for.

That endeavor becomes even more difficult if you need to travel to make sure your family member can get the care or treatment they need. Yet, this is hardly a rare occurrence. Approximately 11 million people around the world travel to other countries to receive medical treatment.

Whether you’re traveling across the state, across the country or around the globe, what can you do to help make the process easier on you, your family and the person you’re caring for?

Learn the Language

Countries that are popular destinations for medical tourism, as it’s being called, may have plenty of fluent English speakers who can help you or answer your questions while you’re in a medical facility. What happens when you’re heading out into the city to get food or supplies, though?

Don’t rely on a phrasebook or a translation app — take some time to learn at least a little bit of the language. You don’t need to be fluent, but being conversational in the local language will make the whole ordeal a little less stressful.

Plus, you may find that the more you speak with the locals, the more fluent you become. Immersion in the language makes it easier to learn — you learn naturally, as a local child would while they were learning to speak.

Take Some Time for Yourself

This isn’t easy when you’re in a foreign country and responsible for someone who may or may not be able to care for themselves for a short period of time.

One side benefit of these trips, sometimes called “reverse medical tourism,” is being able to see the sights of whatever beautiful country you’re visiting. You might not be able to plan a whole day cruise or anything elaborate like that, but it’s still important to take a little bit of time for yourself.

Research Everything

Flying across the globe to seek medical treatment for someone you’re caring for is an expensive proposition, so it’s important to research everything before you get on that plane. Look into the credentials and licensing for the doctor you’re planning to see. The medical standards may not be the same as they would be in Western hospitals.

Also, research the infection rate for the facilities where your family member may be undergoing procedures. Antibiotic-resistant bacterial infections are more common in facilities outside the United States, according to the CDC, so if a surgical procedure is in the plans, it’s important to ensure you take all the steps possible to avoid coming into contact with these bacteria.

Pack Light but Don’t Forget the Important Stuff

In the United States, the majority of medical professionals have transitioned to the use of electronic health records — digital charts rather than old-school paperwork. While this helps to streamline medical care and billing in the States, these records may not be accessible to physicians overseas. Make sure you pack all medical records and applicable medical paperwork.

If you’re worried about the weight of your luggage — because we all know how expensive checked baggage fees can be when you’re traveling overseas — make sure to get a digital copy of your files and carry them in that format on a hard drive or USB flash drive. This is also safer for things like films or X-rays, so you don’t have to worry about them getting damaged or crimped during the flight.

On the same note, get copies of all medical records generated while you’re overseas before you head back home. Your U.S. based doctor likely won’t have access to those files, so it’s important to bring them back with you.

Be Prepared to Stay a While

Recovery times will vary depending on your family member and the procedure or surgery you’re traveling so far for. You should be prepared to stay as long as necessary to ensure their recovery is going well and that it is safe to travel.

If the procedure you’re traveling for includes a surgery, it may require a longer stay. Flying in the first four weeks after surgery increases the risk of blood clots, which can be a dangerous complication for someone trying to recover from a medical procedure. The risk goes up if the surgery was done on the legs or below the waist.

Be Aware of Currency

Most insurance companies will not pay for procedures done overseas, though they may reimburse you for it once you return home. You will likely be required to pay for the procedure out of pocket, so make sure you have plenty of the correct currency. Currency exchanges will vary depending on the day.

When it comes down to it, even if you’ve got beaches and mojitos waiting for you, this will likely be a stressful trip and it may push you to the very limits of your ability. The key is not to panic — this is to help someone you love, so if you remember that, everything else will just fall into place.

Caring for someone else isn’t an easy thing, especially if you’re trying to do it halfway around the world. Take a deep breath and remember why you’re doing this — caring for someone is a labor of love in every sense of the phrase.

Image by Oles kanebckuu

Helping Those with Dementia (and Caregivers) Sleep Soundly

Helping Those with Dementia (and Caregivers) Sleep Soundly

If you’re a caregiver for someone with dementia, chances are you know the value of a good night’s sleep. Sleep plays a crucial role in our physical, mental, and emotional health, and quality sleep plays a huge role in quality care. Unfortunately, poor sleeping patterns are common amongst those with dementia, as well as family caregivers. Changes triggered by old age and dementia can make sleeping more difficult for those with memory disorders, while the stress and burdens of care can make a full night’s sleep rare for family caregivers.

While there’s no one-size-fits-all solution to sleeping issues — especially when dementia is involved, — small changes can make a big impact on the quality of sleep enjoyed by those with dementia and their care providers. If you’re finding quality sleep is a problem for your loved one or yourself, here are some of the adjustments you might want to consider making:

Improving Sleep for Those with Dementia

Alzheimer’s and other forms of dementia can throw up a number of roadblocks to quality sleep. Dementia can be disruptive to a person’s circadian rhythms, the natural cycle that the body uses to understand when it should be asleep and when it should be awake. Many people with dementia also suffer from Sundowner’s Syndrome, meaning they become more agitated and anxious in the evening. Additionally, seniors with dementia are also likely to suffer from poor sleep quality, which is common in old age.

As a caregiver, you can take steps to regulate your loved one’s sleeping schedule, reduce Sundowner’s-related agitation, and improve you loved one’s overall quality of sleep. These steps include:

  • Encourage a regular sleeping routine, including going to sleep at the same time each evening and waking up at the same time every morning. This will ensure minimal disruption to your loved one’s circadian rhythms.
  • Have your loved one spend time outdoors during the day or in an area with lots of indirect natural light. Sunlight is one of the best ways to regulate circadian rhythms, sending signals to the brain about when is best to be awake and when to go to sleep.
  • Take your loved one for walks during the day and find other ways to encourage light physical activity. Physical activity tires people out and lets the body know that it needs sleep in order to recharge.
  • Have your loved one avoid screens and other forms of stimulation before going to bed. Screens can disrupt circadian rhythms, while exciting TV shows or activities can induce Sundowner’s related agitation and anxiety.
  • Ensure that your loved one has a dark and quiet space for sleeping at night. Try to avoid any possible noises or disruptions that could wake your loved one, such as activity from other family members who are up late at night. Also try to avoid strange shapes or harsh shadows that could distress your loved one if they wake up at night.

Getting Enough Sleep as a Caregiver

People with dementia aren’t the only ones whose sleep is impacted by a memory disorder. As a family caregiver, you will typically wake up before your loved one and go to bed at a later time, meaning you often get less sleep than your parent or grandparent. It can also be tempting to stay up late and try to accomplish the things you couldn’t do during the day while providing care. In other cases, you might find yourself so stressed each night that you struggle to close your eyes.

By not getting enough sleep, you can easily put yourself at risk for caregiver burnout. It should come as no surprise that lack of sleep is one of the biggest signs of caregiver stress. And when you suffer from burnout, you put yourself and your loved one in an unwinnable position.

The good news is you can use the same steps — following a routine, getting sunlight and exercise, avoiding screens, and creating a comfortable sleeping space — to help yourself develop healthy sleep patterns. You might also want to take steps like practicing meditation (to reduce stress) and reducing your caffeine intake.

If you find that your sleeping problems are because you’re over-stretching yourself, you might consider professional dementia care. A few hours of professional dementia care for your loved one each week can give you the time you need to tend to other areas of your life. This means you’ll have a chance to accomplish other work, see friends, spend time with family, or take time for yourself. Even four to six hours of care once a week can be enough to make falling asleep easier at night.

If you think dementia care services may be right for your loved one, contact your local Visiting Angels office today to learn more about services available in your area.

The heat is on, so check on your elders

The heat is on, so check on your elders

This summer has already been a scorcher, and sadly, deadly for the most vulnerable populations, including our elders.

Arizona’s record-breaking heat wave has already claimed lives, and the rise in heat-related deaths, especially among the older population, is expected to increase.

While there is a robust public awareness campaign when it comes to leaving kids and pets in hot cars, it seems there is not as much of a focus on the dangers of heat exposure in the elder population. Some urban communities offer cooling stations and free fans for the poor and elderly, and these are important initiatives. But making resources available and getting people to use them can be two very different things.

I live in the Deep South, where air conditioning for the most part is seen as a necessity. However, as a kid in southern California, there were apartments we lived in that didn’t have air conditioning, and our family cars never had air conditioning. Entering a car that had been sitting in a sunny parking lot on a sweltering summer day for hours, felt like an oven, taking your breath away. I remember my skin sticking to the hot vinyl covering of the back seat, and my father would keep a couple of rags handy so he could touch the steering wheel without getting burned.

My less-than-fond memories of the heat were on my mind recently, after I spent two weeks tending to what was my parents’ condo in New Mexico. Yes, parts of New Mexico get insanely hot (such as Roswell) but my parents lived in mountainous Ruidoso, and though it’s only an hour and a half from Roswell, the difference in climate is surprising. While Roswell may be roasting in the 100s for most of the summer, Ruidoso usually maxes out in the low 80s. Summers are typically pleasant, moderate affairs, at least until monsoon season begins.

But not so this year. The high temperatures spiked into the 90s most days that I was in Ruidoso, and the condo does not have air conditioning. I survived the heat wave with just fans, but it was not pleasant. I’m in my early 40s and in reasonably good health. The heat left me feeling lethargic and sleep was difficult. It didn’t help that I caught a summer cold on top of it all. I would hate to think about handling that type of heat 30 years from now, while likely dealing with other chronic health issues.

The thing about heat is that it can be a stealthy killer, and its effects can sneak up on a person. I’m a big water drinker, so staying hydrated is a no-brainer for me, but I remember how hard it was to get Mom to drink enough water when I was her caregiver. Older generations grew up used to doing without, and may think it’s petty to complain about something like the heat.

I ran into a related problem with my mother. She insisted upon turning off the heat overnight, even though the temperatures could drop well below freezing during the winter. Mom also insisted upon leaving all of the windows open a crack, because she feared carbon monoxide poisoning. (A carbon monoxide monitor did not dissuade her open window habit.) As she was recovering from cancer, she said on one particularly frigid night that she’d like to leave the heat on. I nearly collapsed from shock. I kept my composure while being supportive of her “decision” that I had suggested dozens of times before. And it worked. Mom kept the heat on low during the night, which helped her sleep better and aided in her recovery.

It’s not enough to buy your elder loved one an air conditioner or make sure the furnace is in good shape. I’ve read far too many accounts of older people who had air conditioning, but refused to use it, due to financial concerns or just distrust of modern conveniences. I would encourage family caregivers to check in daily with their older loved ones who live in extreme climates, and see how they are doing. For long-distance caregivers, a neighbor or friend may be willing to stop by and make sure the home is at an appropriate temperature. It’s so easy to take these things for granted, but heat waves and cold snaps are still costing people their lives.

Travel with Seniors: A Little Planning Delivers a Lot of Fun

Travel with Seniors: A Little Planning Delivers a Lot of Fun

The busy summer vacation travel season is well underway, as families and friends gather for special occasions, trips of a lifetime, and everything in between. Whatever means of transportation is required, traveling with an older parent or loved one can add layers of complexity to a journey – not to mention assistive equipment such as walkers and wheelchairs – but sometimes a necessarily leisurely pace can allow everybody involved to relax and truly enjoy themselves, no matter what time of year you and your elderly companion hit the road. 

Flying With a Senior Companion

Unpredictable delays notwithstanding, flying usually gets you to a destination faster, but it requires more organization and patience than other modes of transportation. Even though TSA regulations in the United States seem to be a moving target, concessions have been made to seniors (75-plus) and their companions that expedite getting through security checkpoints. Here are a few additional tips to ensure safe and healthy travel with seniors:

  • First, confirm with your loved one’s physician that he or she is cleared to fly, and has had current flu and pneumonia vaccines. Request a doctor’s note explaining any surgical implants or paraphernalia, such as needles. If applicable, a TSA disability notification card can make it more expedient to get through security.
  • At the time of booking, request any desired assistance (wheelchair, electric cart, pre-boarding privileges), and reconfirm a day or two before departure.
  • Select seats in advance, when allowed. An aisle seat toward the front of the plane offers easier boarding and deplaning, but being near the toilets may be desirable for long-haul flights. Compression socks are recommended on flights longer than a few hours, even for travelers without risk of deep vein thrombosis (DVT).
  • Check in for the flight online 24 hours in advance, or call customer service for help choosing an optimal seat.
  • Pack light, but plan to check bags if an aircraft change is part of the itinerary.
  • Get to the airport a full hour earlier than suggested for your departure time.
  • Keep your older traveler’s prescription medications separate from other belongings for easy screening. On-board baggage limits don’t apply to medical supplies, equipment, mobility aids and assistive devices. Liquids exceeding 3.4 oz/100 ml are permitted. (Visit www.tsa.gov for further details regarding U.S. departures.)
  •  If your travel companion has dietary restrictions, order a special meal in advance, when offered, or bring his or her food on board.
  • Apply hand sanitizer liberally, and use antibacterial wipes to disinfect hard surfaces around his or her seat.


Tips for Traveling Abroad with Seniors

International travel with a senior may seem especially daunting, but once you dive into the planning process you may find the prospect isn’t as scary as you think. Many nations show great respect to older people, and as world populations age, it has become easier than ever for seniors to travel the globe.

Expert Valerie Grubb, author of Planes, Canes, and Automobiles: Connecting With Your Aging Parents Through Travel and the popular blog Travel With Aging Parents, has traveled extensively with her own mother. “Narrow sidewalks and ancient tourist sites can make some destinations in Europe tricky when vacationing with a parent in a wheelchair,” says Grubb, “so I strongly suggest doing a little research on accessibility before just showing up. That said, Mom and I particularly enjoy Paris and London, and have found local businesses and people to be incredibly helpful as we navigate around the city.”

Here are a few more tips to keep in mind:

  • Several weeks in advance, make sure any vaccines recommended for the destination are up to date.
  •  Ensure passports are valid for at least six months after the return date and request any necessary visa(s) well ahead of time.
  • Have a doctor provide a list of generic names for prescription drugs, as overseas pharmacists or physicians may not recognize all pharmaceutical brand names.
  • Travel insurance for seniors is costly, but it can be a lifesaver. Not only can a senior who takes ill be reimbursed for all or part of a trip, but a policy including evacuation insurance can help get him or her to appropriate medical care in case of an emergency.
  • Consider upgrading your cellular service to a roaming plan that provides full use of your phone for the duration of the trip, so you’ll be able to search the internet freely and call a hospital or ambulance immediately should the need arise. (In the European Union, call “112” for a police, fire or medical emergency.)


Traveling With Older People – The Basics

Destination, type of travel, and health and mobility are all mitigating factors that come into play when planning a trip, but a list of tips for traveling with seniors is a great place to start:

  • Do plenty of advance research and don’t hesitate to inquire about senior discounts – for travel, hotels, food, entertainment – both domestically and internationally.
  •  If he or she wears prescription glasses, bring a backup pair, as well as sunglasses for bright days. (Fitover and clip-on styles are great options.)
  • Hearing aids? Don’t forget spare batteries.
  • Use a smartphone to photograph all identification, medical cards and prescription bottles in case of loss or theft.
  • Keep meds in original packaging, and bring a week’s additional supply.
  • Pack a tote with favorite healthy snacks and beverages, and items such as playing cards, a book, travel pillow, and sweater or blanket.
  • Even for seniors who don’t have cognitive impairment, a wearable GPS device or ID bracelet bearing your name and contact phone number can bring peace of mind.
  • A ground-floor hotel room or one near an elevator may be best for seniors with mobility issues. Confirm that rooms identified as “ADA compliant” include grab bars and space for wheelchair maneuverability, as needed.
  • Don’t overschedule, and remain flexible to allow for naps or restroom stops. Whether due to medications, a specific condition, or simply age, older travelers are more likely to tire earlier. Symptoms of Sundowners Syndrome may be more pronounced when seniors with dementia are away from familiar surroundings.
  • To take some of the pressure off you and your family, consider hiring a professional caregiver to accompany you on your travels.


Overland Adventures

If time isn’t an issue, a road trip is the easiest and most straightforward way to travel with seniors. Although protracted hours on the asphalt can be exhausting, driving provides the option to stop anywhere and for as long as desired: unplanned detours to must-see sights (Wall Drug or World’s Largest Ball of Twine, anyone?) require little more than a flexible schedule.

While bus and train journeys offer less spontaneity and little or no privacy, they eliminate driving responsibilities, often provide Wi-Fi connectivity, and a restroom is always nearby.

Bon Voyage!

North American cruises are a popular vacation option for seniors because they take a lot of the preparation and trepidation out of travel: most ships and destinations are well equipped to cater to the social, medical, and mobility needs of older passengers. For people who live near one of the nearly 30 U.S. and Canada departure ports, embarking on a cruise is only slightly more onerous than navigating Costco on a Saturday afternoon.

While getting to overseas points of origination requires more time and effort, international cruises can offer senior travelers and their companions exotic experiences that don’t skimp on safety, comfort, or the convenience of English-speaking staff. 

One More Tour, With Honor

Seniors who served in the U.S. military may be eligible for an all-expenses-paid trip to Washington, D.C., to visit the National World War II Memorial and other sites that pay homage to their sacrifice during wartime. Honor Flights are made possible by generous donations from corporations, individuals, volunteers and airlines – including Southwest, the organization’s official carrier.

Since 2005, the non-profit Honor Flight Network (consisting of two groups that joined efforts in 2007) has flown tens of thousands of veterans to one of the three D.C.-metro airports, where arrivals are greeted by representatives from Heroes’ Welcome, an Honor Flight sub-group. A friend, family member or volunteer guardian typically accompanies vets.

As of May 2017, there are 131 hubs in 45 states, making it easier than ever for a veteran to get to an Honor Flight departure point. The program is primarily available to World War II and terminally ill veterans, but is also increasingly open to veterans of the Korean and Vietnam wars. To donate, apply or learn about self-funded tour participation, visit honorflight.org.

For more information

Traveling with an Elderly Parent

Caregiver Tips for Traveling with the Elderly

4 Ways to Soothe Sundowner’s Symptoms

Caregivers Traveling with Families

7 Tips for Safe and Healthy Travel with Seniors

Honor Flights Offer Veterans One More Tour with Honor


Tips to Deal with a Controlling Aging Loved One

Tips to Deal with a Controlling Aging Loved One

As people age, it’s not uncommon for their personalities to change and for them to become more controlling.  It’s usually the result of medication, pain, the frustrations of having difficulty doing things that were once easy and changing family dynamics.  While it can be frustrating and even unpleasant at times to deal with, there are things you can do to make the situation better and more bearable.

Kurt Kazanowski MS, RN, CHE, has more than 30 years working with seniors, first as a nurse, and now in hospice and homecare. 

His advice for dealing with a controlling aging loved one:  

1. They want to control something. 

Everyone wants to feel they can control their own lives, but there comes a point when we all lose grip of it. Our independence slips away, and we need help for the simplest things. That can be a defeating concept. It is a challenging reality with which to come to terms. Be sensitive to this in your aging loved one. Being surrounded by support and understanding only makes it easier.

2. Medications can change personalities.

Keep in mind when your loved one began their medications. Take note of any personality changes within two weeks, one month and a few months span. If you notice the personality changes coincide with the new medication and not another variable, speak with their health care provider about options.

Medications manipulate the chemical balances in our brains, and when that occurs, our moods and behaviors can shift. Offer the idea of starting one medication at a time to see how your senior changes in accordance to the new meds. This way, it is easier to pinpoint which medication causes which side effects.

3. Pain can make people act out.

When you are not feeling well and your body is in pain, it can cause you to lash out at those around you. If your senior parent is doing this, offer to find them relief in the form of therapy or medication. Occupational therapy can be a great tool to overcome painful patterns of movement and seek some relief.

4. Consider family dynamics.

Was your aging loved one always in charge of the family? Did they always dictate how things were going to be done? They might still be trying to exude this power over the other family members. If you are a child and the primary caregiver, your parent might still be trying to act out these old dynamics.

Controlling behaviors are considered abuse. Try to talk with your parent about how their actions make you feel. It is not too late to do this, and as your dynamic changes to caregiver, it can be a good time for healing past wounds. 

5. Use positive reinforcement patterns.

Reward the positive behaviors of your loved one. Do not reward, or punish, the negative behaviors. Using reinforcement patterns is one method to motivate your controlling loved one to better actions. If they are becoming upset or angry, offer them kindness and suggest to discuss it. If they don’t respond respectfully, leave and tell them you will come back when it is a better time. It may sound harsh, but it is better than scolding them or getting upset yourself.

6. Talk, if they are willing. 

Sometimes your controlling parent or loved one lashes out to get attention, like small children. They want someone to give them some more attention and care. Ask them how you can help. Genuinely speak to them. Most importantly, listen to what they are saying. They may just want to vent their frustrations to someone that cares. We can all understand that.

7. Grant them the little victories.

For them to feel they still have control, let them make decisions when possible. If you are going out to eat as a family, let them select the restaurant. Ask their opinion about important life matters to include them in situations. Help them find a creative outlet so they can focus their controlling energy into projects. Knitting, painting or sewing are some good options that require creative choices for them to control themselves.

8. Bring in the backups.

If nothing else works, you do have other opportunities. Don’t fret. You need to set your boundaries with your loved one, and if they do not respect that after a point, you can seek other help for them. There are assisted living and nursing home options. That way, there is a professional caregiver that will deal with the daily tasks for them. You can then take the personal family member role and see them whenever you see fit.

Kurt Kazanowski is an author, speaker, coach and consultant in the areas of aging, hospice and home care. He is a native of Detroit, Michigan, and has over three decades of experience in the field of healthcare. He received his bachelor’s degree in nursing from Mercy College of Detroit and practiced as a public health nurse for many years. Today, Kurt is the owner of two successful personal care home health companies – Homewatch CareGivers in Michigan where he lives and First Home Care in Moscow, Russia.

Kurt is also the author of A Son’s Journey.

Vets bill to keep veterans choice program afloat is signed

Vets bill to keep veterans choice program afloat is signed

Donald Trump signs vets bill to keep veterans choice program afloat

President Trump on Saturday signed a bill that will pump funds into the Veterans choice program to keep it up and running, while Washington continues to fight over how best to give veterans the care they earned – but which the government has sometimes failed to deliver. Approved in the wake of the wait-list scandal that… (more…)

Cancer survivors are more likely to use opioids

Cancer survivors are more likely to use opioids

A new study found that opioid prescription use is more common in cancer survivors than in individuals without a history of cancer. This was true even among survivors who were ten or more years past their cancer diagnosis. Published early online in CANCER, a peer-reviewed journal of the American Cancer Society, the findings come at a time of rising rates of opioid overdose and addiction that experts have categorized as an epidemic.

Little is known about prescribing opioids to relieve pain in individuals who have survived cancer. To investigate, Rinku Sutradhar, PhD, a senior scientist at the Institute for Clinical Evaluative Sciences in Toronto and an associate professor with the University of Toronto in Canada, and her colleagues analyzed information dating back to 2010 on 8601 adults at least five years past a cancer diagnosis who were matched with 8601 individuals without a prior cancer diagnosis based on sex and calendar year of birth. Follow-up was stopped at any indication of cancer recurrence, second malignancy, or new cancer diagnosis. The researchers looked for opioid prescriptions filled at a pharmacy during the observation period for each individual.

The rate of opioid prescribing was 1.22 times higher among survivors than corresponding matched controls. Over a 36-month period, the average number of opioid prescriptions filled by survivors was 7.7, compared with 6.3 for controls. This increased rate of opioid prescribing was also seen among survivors who were 10 or more years past their cancer diagnosis. Individuals with lower income, and those who were younger, from rural neighborhoods, and with more comorbidities had significantly higher prescribing rates. Sex was not associated with prescribing rates.

“Our research findings raise concerns about the diagnosis and management of chronic pain problems among survivors stemming from their cancer diagnosis or treatment,” said Dr. Sutradhar. “Physicians providing primary care to cancer survivors should consider close examination of reasons for continued opioid use to differentiate chronic pain from dependency.”

Full Citation: “Cancer survivorship and opioid prescribing rates: a population-based matched cohort study among individuals with and without a prior history of cancer.” Rinku Sutradhar, Armend Lokku, and Lisa Barbera. CANCER; Published Online: August 7, 2017 (DOI: 10.1002/cncr.30839).


URL Upon Publicationhttp://doi.wiley.com/10.1002/cncr.30839

About the Journal
CANCER is a peer-reviewed publication of the American Cancer Society integrating scientific information from worldwide sources for all oncologic specialties. The objective of CANCER is to provide an interdisciplinary forum for the exchange of information among oncologic disciplines concerned with the etiology, course, and treatment of human cancer. CANCER is published on behalf of the American Cancer Society by Wiley and can be accessed online at http://wileyonlinelibrary.com/journal/cancer.

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About Wiley
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