Posts Tagged ‘Tips’

Tips for Avoiding Elderly Heat Stroke & Exhaustion

Posted on: July 5th, 2017 by Jamie

I think it’s safe to say that summer has finally arrived here in Vermont and New Hampshire. Hot weather is dangerous, and seniors are particularly prone to its threat. Elderly heat stroke and heat exhaustion are a real problem. Please check on your older family, friends, and neighbors, especially if they do not have access to air conditioning. summer fan

There are several reasons for elderly heat vulnerability. People’s ability to notice changes in their body temperature decreases with age. Many seniors also have underlying health conditions that make them less able to adapt to heat. Furthermore, many medicines that seniors take can contribute to dehydration. Simple precautions are all that’s needed to keep safe. Here are some guidelines for keeping safe in hot weather:

  1. Drink Plenty of Liquids: Dehydration is the root of many heat related health problems. Drink plenty of water or juice, even if you’re not thirsty. But remember to avoid alcoholic or caffeinated drinks, as they can actually contribute to dehydration.
  2. Wear Appropriate Clothes: When it’s hot out, wear light-colored, lightweight, loose-fitting clothes and a wide-brimmed hat.
  3. Stay Indoors During Midday Hours: During periods of extreme heat, the best time to run errands or be outdoors is before 10 am or after 6 pm, when the temperature tends to be cooler.
  4. Take it Easy: Avoid exercise and strenuous activity, particularly outdoors, when it’s very hot out.
  5. Watch the Heat Index: When there’s a lot of moisture in their air (high humidity), the body’s ability to cool itself through sweating is impaired. The heat index factors humidity and temperature to approximate how the how the weather really feels. The current heat index can be found on all popular weather websites, and is also usually announced on local TV and radio weather reports during periods of warm weather.
  6. Seek Air-conditioned Environments: Seniors whose houses aren’t air-conditioned should consider finding an air-conditioned place to spend time during extreme heat. The mall, library or movie theater are all popular options. During heat waves, many cities also set up “cooling centers,” air-conditioned public places, for seniors and other vulnerable populations. Seniors without convenient access to any air-conditioned place might consider a cool bath or shower.
  7. Know the Warning Signs of Heat-related Illness: Dizziness, nausea, headache, rapid heartbeat, chest pain, fainting and breathing problems are all warning signs that help should be sought immediately.
  8. In addition to heat stroke, heat can kill by worsening existing chronic health conditions. For example, for the many Vermonters over the age of 65 who have a chronic condition—such as cardiovascular disease, Alzheimer’s disease, and diabetes—temperatures over 87°F can put them at a higher risk of life-threatening illness. People who feel unwell or faint in hot weather are also vulnerable to serious or deadly falls. People with chronic conditions may not show typical signs of heat illness, but rather worsened symptoms of their condition. If you or someone you know has a potentially dangerous chronic condition and begins to feel sick during a hot day, pay very close attention. If you have concerns about a person’s condition, dial 9-1-1 or get immediate medical attention.

8 Things Not to Say to Your Aging Parents

Posted on: March 16th, 2017 by Jamie

8 Things Not to Say to Your Aging Parents
Unintended barbs cut to the quick and can’t be taken back. Here are some better options.

 
By Linda Bernstein  Published March 6, 2016 at Next Avenue

 
I’m going to say something politically incorrect here: Sometimes our elderly parents make us a little nuts. (And sometimes they out-and-out drive us crazy.) We love you, Mom and Dad, but we’ve heard the story about Aunt Cissy pouring wine into the dog’s bowl so many times we can tell it ourselves – in our sleep.

 
The repetitions, the forgetfulness, the incessant asking whether we’d like a sandwich: Eventually it just happens, and out of our well-meaning mouths tumble snarky comments and insults that we really don’t mean but they…just… slip … out.

 

“Seniors often know that their memory and cognitive and physical abilities are declining, and reminders are only hurtful,” says Francine Lederer, a psychotherapist in Los Angeles who works with “sandwich generation” patients and their parents. But even when we manage to hold our tongue, frustration lingers. That’s when we have to be doubly mindful, because by repressing those emotions, we’re more likely to have an emotional outburst.

 
“You might be justifiably annoyed,” Lederer says, “but take a step back and consider how your parent must feel as she faces her diminished capacities.” When people first start “slipping,” they are aware of the loss, and they are often terrified, scared and saddened.

 
Since forewarned is forearmed, read through these eight common things we often catch ourselves saying plus suggestions for less hurtful ways to say them.

 

 

1. “How can you not remember that!?”
That lengthy discussion you had last week with your dad about getting the car inspected might as well never have happened. Older people often lose short-term memory before long-term and forget all kinds of things we think are monumentally important, like where they put their glasses or the keys – or when to take the car into the shop.

Say instead: “See this sticker? If the car isn’t inspected before the end of the month, a cop will give you a very expensive reminder.” Place a few Post-it notes around – on the dashboard, fridge, and bathroom mirror. Add a smiley face to keep the tone light. And if you still think your parent might forget, make the appointment then call your mom that morning to remind her.

 
2. “You could do that if you really tried.”
How hard is it to change the lightbulb in the table lamp? Well, if your hands shake a lot or you can’t reach the shelf where you keep the spare bulbs – or you’ve grown wary of electrical outlets – very hard. Simple tasks, like tying shoes, can become next to impossible if you have arthritis in your fingers or your back doesn’t bend easily. And being shamed into trying something doesn’t help.

Always Be Kinder Than You Feel
Say instead: “Let me watch and see where you’re having trouble so we can figure out how this can get done.” Or if you live out of town: “Ask (so-and-so) for help.” Older Americans, like everyone else, want to maintain their independence. But if a project is truly beyond their capabilities and they either don’t know anyone who could help (Or won’t ask), you might want to try find someone who can lend a hand.

 
3. “I just showed you how to use the DVR yesterday.”
Learning new technology is tough for any adult, but gadgets with lots of buttons and options pose a special challenge for someone whose cognition or eyesight is failing. Even those of us with nimble fingers and well-functioning frontal lobes can be stymied by a new device that labels the controls differently from the one we are used to.

 
Say instead: “The blue button on top turns the TV on, and there’s one set of arrows for changing the channel and another for the volume. I’ll show you again.” Better yet – ask your parents’ cable or satellite provider to recommend an older American-friendly remote control with a simple design. Some companies give these to older people for a nominal charge. If not, purchase one at a local electronics store. Or if they’re okay following instructions, you could write or print out step-by-step directions in large, legible type and leave it near the remote or listings guide.

 
4. “What does that have to do with what we’re talking about?”
One minute you and your dad are discussing summer vegetables and the next he’s talking about a problem with the sprinkler system. What happened? Conversations with elderly parents often “go rogue” – either because they can’t keep their mind on the thread or they are simply bored and want to change the subject.

 
Say instead: “I was telling you about my garden. You love my fresh lettuce!” If the subject is important to you, try to bring the conversation back on track without pointing a finger at their slipping powers of conversation. And try to avoid suppressing genuine anger or sadness, gently explain why the conversation was important to you. Another option: Say nothing and just listen.

 
5. “You already told me that.”
And don’t you ever repeat yourself? We all say things more than once – but because elderly parents seem to do it all the time, we lose our patience with them.

 
Say instead: “No kidding?! And don’t tell me that the next thing you did was …” Yes, you can make a joke of it -but only if your parent won’t feel hurt. Best-case scenario: Your mom or dad will feel amused and relaxed enough to join in.

 
6. “I want your silver tea service when you die.”
This is wrong on so many levels. Even worse than casually referencing their death is the fact that you come off like a circling vulture.

 
Say instead: “I have been reading how it’s helpful for everyone if parents leave a list specifying what will be left to whom.” Stress that unless they make their wishes known, there may be conflict among siblings and other relatives. I know one woman who gave her children and grandchildren stickers which they could use to mark items they desired (by placing them in the back or on the bottom).

 
7. “Wake up! (Or shhhh!) I thought you wanted to see this.”
The darkened halls of concerts, movies, plays and religious services (or even the TV room at home) cue our parents that it’s time for a quick snooze – which might be OK if there aren’t people around you trying to hear the show. There’s no need to remind older people that they’re committing a faux pas. And if their hearing is diminished, they may not realize that everyone can hear them “whisper.”

 
Say instead: “Mom, I know you don’t want to miss this.” Most likely she’ll fall asleep again. Then it’s up to you how many times you want to bother with the nudges – and not take it personally that your parent fell asleep on you.

 
8. “Hel-lo?! Your grandson’s name is Ryan.”
How many times have you called your husband by the dog’s name? Mixing up appellations can be a sign of cognitive impairment – or just a normal problem with word recall. The more it happens, though, the more likely it is that your parent is moving into a stage where he needs medical intervention.

 
Say instead: “It’s Ryan, Dad. Your first grandson’s name is Ryan.” There aren’t a lot of different ways to say this: The difference here is how you say it. Don’t sound critical or angry; say it gently and with a friendly smile. If your father is truly confused, he’ll probably be relieved that you’re not offended. If it’s just a slip of the tongue, he’ll be glad you’re not annoyed. If he really truly can’t remember your children’s names, you have larger issues to deal with.

 
The most important thing, Lederer stresses, is that as our parents age, we go out of our way to maintain good relationships. “When dealing with elderly people, let your motto be, “Reframe, don’t blame,” she says. A slip of the tongue can unleash a world of hurt and ill will. As exasperating as elderly parents can be, spouting off without thinking will only make them – and you – feel bad.

We shared this on our Facebook page earlier in the week and felt it was a great addition to our blog as well! You can view the original slideshow here.

November is National Family Caregivers Month

Posted on: November 8th, 2016 by Jamie

November is National Family Caregivers Month

 
Family CaregiversBeing a Family Caregiver is hard work. I know this from experience. Family Caregiving is both deeply satisfying and stressful. It can be physically demanding and emotionally draining. You are with a loved one but often feel alone. Then there is the financial piece: this is not a paid position and there are no sick days or health insurance. When providing this unpaid care, your own financial future is at risk since zero contributions are going into social security or a retirement fund. Family Caregiving is a full-time invisible job, and for many, it may be in addition to working another full-time job.

 
I want you to know that you are not alone. There are resources for you, ways to connect with others, and advocacy happening on your behalf. I am hopeful that things will get better, and as a nation we will come to embrace the hard work of Caregiving. I hope that you can take care of you. One simple thing that was helpful to me was to take a walk, every day if possible and sometimes with a friend. Here are three resources, in their own words, you need to know about. Please carve out the time to explore them.
Caregiver Action Network is the nation’s leading family caregiver organization working to improve the quality of life for the more than 90 million Americans who care for loved ones with chronic conditions, disabilities, disease, or the frailties of old age.

 

Caregiver Action Network is the organization that chooses the theme for National Family Caregivers Month annually and spearheads celebration of NFC Month nationally.

Celebrating Family Caregivers during NFC month enables all of us to:

• Raise awareness of family caregiver issues

• Celebrate the efforts of family caregivers

• Educate family caregivers about self-identification

• Increase support for family caregivers

The theme for National Family Caregivers Month November 2016 is “Take Care to Give Care”.

 

Next is The National Alliance for Caregiving is a non-profit coalition of national organizations focusing on advancing family caregiving through research, innovation, and advocacy. The Alliance conducts research, does policy analysis, develops national best-practice programs, and works to increase public awareness of family caregiving issues. Their mission: Recognizing that family caregivers provide important societal and financial contributions toward maintaining the well-being of those they care for, the Alliance is dedicated to improving quality of life for families and their care recipients through research, innovation, and advocacy.

 
And last but not least is the Family Caregiver Alliance. Founded in the late 1970s, Family Caregiver Alliance was the first community-based nonprofit organization in the country to address the needs of families and friends providing long-term care for loved ones at home. It began as a small task force of families and community leaders in San Francisco who came together to create support services for those struggling to provide long term care for a loved one who did not “fit” into traditional health systems: adults suffering from Alzheimer’s disease, stroke, Parkinson’s, traumatic brain injury and other debilitating disorders. The diagnoses were different, but the families shared common challenges: isolation, lack of information, few community resources, and drastic changes in family roles.

 
The services, education programs, and resources FCA provides are designed with caregivers’ needs in mind and offer support, tailored information, and tools to manage the complex demands of caregiving. FCA, as a public voice for caregivers, shines light on the challenges caregivers face daily and champions their cause through education, services, and advocacy.

The Cycles of Life Part 7

Posted on: September 13th, 2016 by Jamie

the Cycles of LifeThroughout these Cycles of Life posts, I have mentioned “list” several times. In this age of technology, I must admit that I am a fan of good old-fashioned paper. Don’t get me wrong, I love my smart phone and use it all the time but I also have a binder and a notebook for each of my parents. I find the binder is very helpful at doctor appointments and especially during a hospital visit or stay. The binder allows me to add, maintain and find their health care information easily plus I don’t need wi-fi or a data plan to use it.

 

 

Each binder includes: name, address, and phone number(s), complete emergency contact information, copies of health insurance information, complete list of all health care providers and their contact information, list of current medication(s) including what the medicine is for and list of medical issues/concerns. I also keep copies of the advance directive and the DNR/COLST in each binder. I divide my binder into sections: by each health care provider, medication and pharmacy information and hospital visits. For regular doctor appointments, the after-visit summary is printed and placed into the binder along with any other information/notes from the visit. This is what works for me. If you help with your loved one’s with their finances, the binder also becomes a valuable tool for cross-referencing medical bills and insurance statements with doctor visits, etc.

 

binder
For hospital visits and stays, I cannot stress this enough: write everything down. Begin the minute you walk in the door. Use whatever method works for you, paper or electronic, but do it. If you have entered via the ER and your loved one uses Medicare as their primary insurance, make sure you are aware of their hospital status: “inpatient” or “outpatient”. Even if they stay in the hospital overnight, they may still be considered an “outpatient” if they have not been admitted. This distinction is important to know so you need to ask. Here is a Medicare publication that helps define these terms and explain how this relates to coverage.

 

Time usually moves at the slowest pace you have ever experienced during a hospital stay. I keep track of the room number and name of the floor the room is on (patients are moved around), the name of the doctor overseeing the care, how often and when is that person around, will that person change (weekly or daily) and if so what is the name of the next person coming on. I always write down the name of anyone I speak with and what their position is. I ask what tests are being run, what the tests are for, when the test will be run, when the results will be ready, names of medications that have been given, what the medicine is for, what the diagnoses is, how certain they are, what other specialists are being called in on the case and why, and what happens next. Take as many notes as you can in the moment and copy them over as needed- did I mention that time moves very slowly at the hospital?

 
I also research what I can online and write down any questions that arise from my research. I am guessing doctors probably dislike Google however the internet can be a valuable tool if you are thorough and diligent with what you take away from it. When you get a chance to actually speak with the doctor, you want to be prepared as time is usually short and you need to maximize that time. I have to add that most health care providers chuckle when they see my binder BUT they take me quite seriously. In addition, you may have to advocate for your loved one. If you receive conflicting information, you can give specific examples and ask for clarification, over and over if need be. Lastly, things change, sometimes rapidly. There is a lot of information to manage and writing it down is a great way to keep up with it.

 
During a hospital stay the nursing staff is an exceptional resource for you; develop a positive and respectful relationship with the nurses and LNA’s as they do the majority of the actual care. Communicate information about your loved one to them, they can utilize it to provide better care and patient cooperation. If your loved one has any issues, you can help resolve them. As with all aspects of care, communication is key.

 
If you are not able to go to the hospital, write down everything you learn over the phone and be very assertive about being kept in the information loop. The doctor will call you when their schedule permits so if your information and questions are at your fingertips, it will be a more productive conversation. You may have to call many times each day, always try to speak to the nurse caring for your loved one as they know what is going on. Everything from above applies. Be patient, determined and kind-it will go a long way. Hospitalizations are just another part of the cycle, approach them with a strategy and it should help. Knowledge is power and allows for better planning and support.

 

 

The reality is that my binder system also allows me to have some control or at least to create the illusion of having some control over a situation where I have no control- my loved one aging and their health declining.

The Cycles of Life Part 6

Posted on: August 26th, 2016 by Jamie

The Cycles of Life 6For some people, the financial planning piece is the hardest part. For others, the health care piece is more difficult. You probably have a good idea about how your loved one feels. Either way the health care planning is equally as important, especially if there is a chronic illness present. Again, be gentle, yet firm; be empathetic yet realistic; be compassionate yet solution oriented. Be kind and be patient, this is hard. Communication continues to be the key/foundation to knowledge and knowledge is power.

 
If you have been following the previous posts, you already have created the foundation for the “official” health care planning paperwork. All of those ongoing conversations with your loved ones about their health and future goals should hopefully make this a bit easier. Now it is time to convert those conversations to paper on an Advance Directive for Health Care. It may be called something different where you live. Documents and laws vary state to state and typically a lawyer is not needed to complete it.
Another document to fill out is a DNR (Do Not Resuscitate)/COLST or POLST (Clinician or Physician’s Orders for Life Sustaining Treatment) Order. This is the Vermont DNR/COLST with instructions. Here is a comprehensive tip sheet from the Family Caregiver Alliance website regarding these documents.

 

I find the Vermont Ethics Network booklet entitled Taking Steps: Planning for Critical Health Care Decisions very helpful as it provides thorough explanations and instructions plus worksheets to help gather thoughts and feelings. Their website also has several forms you can download. They provide an overview of the basics for health care decisions and advance directives here.

 

Ultimately these discussions are truly about end-of-life issues. If you need additional resources to help you and your loved ones you may want to check out The Conversation Project:

“The Conversation Project is dedicated to helping people talk about their wishes for end-of-life care.
Too many people are dying in a way they wouldn’t choose, and too many of their loved ones are left feeling bereaved, guilty, and uncertain.
It’s time to transform our culture so we shift from not talking about dying to talking about it. It’s time to share the way we want to live at the end of our lives. And it’s time to communicate about the kind of care we want and don’t want for ourselves. 

We believe that the place for this to begin is at the kitchen table—not in the intensive care unit—with the people we love, before it’s too late.

Together we can make these difficult conversations easier. We can make sure that our own wishes and those of our loved ones are expressed and respected. If you’re ready to join us, we ask you: Have you had the conversation?”

In Vermont, we have a great resource that partners with the Vermont Ethics Network called Start the Conversation. For New Hampshire, they are here. These organizations offer downloadable conversation starter kits plus videos and lots of tips and good information. The Conversation Project also has a new resource for families and loved ones of people with Alzheimer’s and other forms of dementias.

No doubt these are difficult conversations to have BUT it is imperative you have them and continue having them as needed because things change. Once these documents are finished everyone will have peace of mind from knowing legal matters and medical preferences are spelled out. You won’t have to make a decision in crises-mode because you have been empowered to make an informed decision based on your loved ones wishes and goals.
After seeing your aging loved ones completing these legal and health care planning documents, you and your spouse need to do them as well. You now know just how critical they are. Update them as you yourself age and begin to have discussions with your children (if appropriate, of course) about your wishes and goals. As Start the Conversation wisely says, 

“Planning for end-of-life care before it becomes a worry is as important as all the other life plans you have made. Having a plan in place in advance makes it easier for you, your doctor and your loved ones if you are unable to tell them your health care choices because of an injury or serious illness.
Every moment is precious-especially at the end-of-life. Starting the conversation early can ensure that your choices are heard. It also means that when time becomes short, it can be spent doing what you enjoy most and not making last minute decisions. Talk about your wishes while you are in good health so you will be prepared. A health crises can happen to anyone at any time. Don’t wait. Start the conversation today. It’s a gift.”

 
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