Thanksgiving with Seniors: Checking for Signs of Dementia

Thanksgiving is right around the corner and with it, the holiday season officially begins. If you are like the host of other Americans that celebrate by gathering with family and sharing a delicious meal, it’s a great time to assess the health, both physical and mental, of the aging member(s) of your group.

Holidays are a prime time for families to detect dementia in a family member, according to the Alzheimer's Foundation of America, especially if it’s been a while since you’ve seen your older family members. While it’s certainly an exciting time, it’s also an extremely stressful time — regular routines are disrupted, and large groups of people means noise and excitement — it’s sort of a perfect storm of a time to determine if your aging loved one is exhibiting signs of memory loss.

If you spend Thanksgiving at your senior’s home, a quick bit of detective work will give you some insight into their mental health. Remember to do this stealthily! This is not the time for confrontation, but an opportunity to gauge if your loved ones are living their best lives.

Take a good look (and smell)
Has there been obvious weight loss? People with memory loss often forget to eat. If they are depressed, which often happens when someone begins to experience mental acuity changes, they may decide that cooking is too much bother.

How is their personal hygiene? Are clothes clean? Make note of their grooming to determine any odd or peculiar changes in their regular appearance.

In the house
Check the refrigerator for expired food. Or multiples of the same food. Take a look in the living areas; are they clean and free of clutter? Peek at more personal spaces. While common areas might have been picked up in anticipation of guests, out-of-the-way areas like bathtubs and closets might give a truer picture of a senior’s ability to keep up with general tasks. If they have plants or animals, are they thriving?

Is there any unopened mail hanging about? Paying bills, especially, may seem overwhelming. According to Forbes, financial decision-making capacity erodes early on in those suffering with memory loss, dementia, or Alzheimer’s disease.

Talk to neighbors
If you aren’t around much, talk to those who are. If you happen to see neighbors, ask if they have noticed any changes in your senior loved one. A certain red flag is isolation. If they don’t see your senior as often as they used to, it can be cause for concern. Now is the perfect time to exchange phone numbers and ask them to contact you if they see anything remiss.

If you do suspect that there are changes in your senior loved one’s mental acuity, don’t hide your head in the sand. Take the opportunity to talk to other family members and make a plan of action. The first step? Consult your elder’s primary care physician and in the meantime, perhaps enlist some help.

From all of us at Caregiverlist, we wish you a happy and healthy Thanksgiving.

Nursing Homes, Assisted Living Out of Middle Class Reach

It's all excitement around here as we await the release of the movie, The Hunger Games: Mockingjay - Part 1, in which our heroine, Katniss Everdeen (Jennifer Lawrence), leads the have-nots of Panem’s districts in a rebellion against the haves of The Capitol.

Dystopian views of a future society, in books and in movies, often feature a missing element of the population — the middle class. In these communities, only the very rich and very poor have access to services, the former is afforded private (superior) services, the latter, inferior, government-provided resources. Like it or not, America is beginning to look a lot like those futuristic civilizations where you are either very rich (and in the ruling minority) or very poor (the rest of us.)

The Harvard Joint Center for Housing Studies’ recent report, Housing America's Older Adults—Meeting the Needs of An Aging Population, shows that affordable elder housing will be one of the single biggest challenges we face in the near future.

Housing is the largest expense in many household budgets. Even though the majority of seniors prefer to age in place, many older Americans find that the high cost of housing expenses make it necessary to cut spending in other areas such as groceries and healthcare. In fact, over 37 percent of Americans aged 80 or older put more than 30 percent of their income toward housing expenses. And those are the property owners — the lucky ones.

In Joel Kotkin’s book The New Class Conflict, the author points out a “doomed” middle class.  In the wake of the housing bust, U.S. homeownership, which peaked in 2002 at nearly 70 percent, has since dropped to 65 percent in 2013, the lowest in almost two decades, according to the U.S. Census.

How does that affect senior housing? Even if you have the financial wherewithal to age in place, the Department of Health and Human Services estimates that 37 percent of those aged 65 and over will receive care in some sort of institutional setting at some point, with an average stay of one year.

Nursing home and assisted living costs are always increasing. The recent (Nov. 2014) Caregiverlist® Index reported the average annual cost for an Illinois nursing home is $72,631.35. Of course, quality of care usually decreases at lower cost points. The national average for assisted living base rates was $3,550 per month in 2012.
    
The typical homeowner aged 65 and over has enough wealth to cover nursing home costs for 42 months and enough non-housing wealth to last 15 months. The median older renter will not be able to afford even one month in a nursing home or in assisted living.

As a society, we will be facing these challenges together to make sure that the aging population, whether they be the Jeffersonian ideal “small landholders” or increasingly-numbered  “lower middle-class” have access to the similar quality housing and services in order to age with security and dignity.    

INFOGRAPHIC: Housing America
 

President Obama Proclaims November National Family Care Month

Caregiverlist has been championing the senior caregiver for years. Many of us come from family caregiving backgrounds and know the difficult (but rewarding) work of taking care of parents or grandparents.

And so each year since 1997 when President Bill Clinton signed the first Presidential Proclamation, November is recognized as National Family Caregivers Month — a time to thank, support, educate and empower family caregivers.

Family caregivers, often called “informal caregivers”, perform the brunt of senior care, without pay. Here in the U.S., according to the Family Caregiver Alliance, 43.5 million adult family caregivers care for someone over 50 years old and 14.9 million care for someone who has Alzheimer's disease or other dementia (statistics based on numbers from November 2012.)

Most elderly prefer to age at home and, because of limited funds, many times family caregivers are their only option to do so. Family caregivers provided services valued at $450 billion per year in 2009 and since the aging population will only increase (some estimate that those aged 65+ will more than double between the years 2000 and 2030), the value of family senior care will increase exponentially as well.

Most family caregivers (by the way, the majority of whom are women), also work outside the home and many times care for children as well. Thus the term Sandwich Generation. That care has an economic impact on the family caregiver as well. Surveys show that caregivers overall reported missing an average of 6.6 workdays per year. They turn down promotions, arrive late to work and/or leave early, take leaves of absence, or quit work altogether to provide much needed care to family members. That loss of productivity is estimated at $304,000 in lost salary and benefits over a lifetime.

When PBS did a story earlier this year on the average American long-term care family caregiver, I was surprised to see that my personal situation is not all that unique. The profile of the average long-term caregiver in the U.S. is a 49-year-old woman who works outside the home and cares for her widowed mother for an average of 20 hours per week. Yup, that’s me in a nutshell.

It’s great that there is national attention to this growing segment of the population — the family caregiver. While it’s true that families have always cared for their own, because life-expectancy is quite different than it was 50 years ago, family senior care can extend years, even decades longer than ever before. If family caregivers were no longer available, AARP says in a report, the economic cost to the U.S. health care and long-term services and supports (LTSS) systems would increase astronomically. It’s most certain that many elderly would find themselves in institutional settings like nursing homes, and the cost would be borne by the government, on both the federal and state levels.

It’s essential, therefore, that we as a society support the family caregiver in every way possible. It is essential to the well-being of our system of LTSS, our health care system, our economy, our workplaces, our families, and ourselves.

Because many professional senior caregivers come to the industry after spending years as family caregivers, Caregiverlist® provides some basic online caregiver training powered by Caregiver Training University to help the family (and professional) senior caregiver provide the best senior care possible.

And during the month of November especially, remember to celebrate and appreciate the senior family caregiver in your life, either by providing some respite care, taking them out for a relaxing evening, or by simply saying “thanks” (although I’m bucking for the night out!)

Do you have an issue you'd like to see tackled on this blog? Connect with Renata on Google+

White House Plans Conference on Aging in 2015

Americans are living longer than ever. One hundred years ago, in 1914, a man’s life expectancy was 52 years, a woman’s almost 57. If you are 65 years old in 2014, the Centers for Disease Control and Prevention estimates that as a man, you will live to about 83 and if you are a woman, your life expectancy is about 80 ½  years old.

In order to address the needs and concerns of an aging population, the White House is gearing up for its sixth White House Conference on Aging (WHCoA), to be held in 2015. The first conference was held in 1961, with subsequent conferences held each decade since.

Next year marks the 50th anniversary of Medicare, Medicaid, and the Older Americans Act. It’s also the 80th anniversary of Social Security. The 2015 White House Conference on Aging is an opportunity to look at these programs and see what public policies need to be implemented to understand the issues facing older Americans, their families and their caregivers.

WHCoA in 2015 will address four main issues: retirement security, healthy aging, long-term services and supports, and elder justice.

Financial security for retirees has changed in the last few decades, with fewer employers providing pensions. The future of Social Security is always in question and the need to protect that benefit is crucial to U.S. citizens retiring with dignity. Many older Americans have seen their retirement savings fall with the economy. The question of when to retire is being replaced with IF to retire. The conference will address “improving wages and benefits for all American workers—especially older workers—and ensuring opportunities for older Americans who choose to remain in the workforce, can provide additional avenues for income security in retirement.”

Healthy aging is made possible with better life choices including healthy eating, exercise, health screenings and supportive communities.

Senior care costs continue to escalate and it’s a fact that as we live longer, many of us will need assistance with the activities of daily living, whether it be through home care, assisted living, or nursing homes. Less than three percent of Americans currently have a long-term care insurance policy. WHCoA will explore new options to help Americans in preparing for their long-term care needs as they age.

The elderly are one of the most vulnerable segments of our society. Scam artists are just waiting to bilk people out of their savings. Physical and emotional neglect and abuse cut across economic, racial and ethnic lines, affecting seniors regardless of where they live.

Americans are encouraged to participate in the discussions. The White House is being more inclusive than ever before, bringing the conference online at www.WhiteHouseConferenceOnAging.gov, which will provide regular updates on Conference events and activities. You can get involved by signing up for weekly emails, or sharing your thoughts on elder issues or stories celebrating the contributions of older Americans.

Health Tips for Seniors to Age Well

Aging well and in place is a top priority for senior caregivers and the senior clients they serve on a daily basis. Living healthy doesn't mean you and your clients need to make drastic changes in the way you're living, though. Sometimes making a few small changes to your daily routine can have a profound difference in your health. The 101 Revolutionary Ways to Be Healthy app presents 101 categories of health tips and several more subcategories that break the tips down into actions for a healthier life. 

When users first open the app, they are presented with all 101 tips in a tiled fashion. Caregivers can swipe left or right to browse through the tips, which include "Make Time," "Ditch Debt," and "Break a Sweat." Once users see a tip that interests them, they can click on the tile to get more information and specific actions to improve health. Under the "Break a Sweat" tip, the subcategories include "One Crazy Workout," "Fit in a Flash," and "Test Your Endurance." Between the six subcategories, caregivers can pick the one action that most interests them and click on it and go to an article with further details- in this case, a high intensity work out. 

Not all tips in the app will apply to every user. The high intensity workout under Break a Sweat probably isn't appropriate for a senior, but other sections include tips on how to naturally dispel heartburn, change or create new habits and intuitive eating to lose weight. The app features a "Surprise Me" function that takes the user to a random tip. Sit down with a senior client once a day and let the app take you to a new random tip, then together pick a subcategory to read about. It will give you a chance to learn about healthy living together and possibly find a new change you can make together for healthy aging. 

The 101 Revolutionary Ways to Be Healthy app is available for Apple and Andriod platforms. 

Senior caregivers, let us know your feedback on this app and keep us posted if you discover additional apps that assist with caregiving duties and help relieve caregiver stress. You may also refer-a-friend to a senior caregiving job and win prizes weekly and monthly on Caregiverlist. 

-Paige Krzysko

Is Jibo Your New Senior Companion?

As you senior caregiver readers know, I’ve embarked on a mission to bring some technology into my elderly mother’s home so she can live independently longer, the way she wants to live. I made a list of her needs, the most important of which are keeping safe, connected, and engaged.

My mother is not alone in her needs. The 80+ age group is the fastest-growing segment of the world’s population. By 2050, it is estimated that there will be 392 million persons over the age of 80, more than three times the present. At the same time, there will be fewer caregivers for the elderly. Smaller and more geographically disparate families mean fewer family caregivers.  We are already experiencing a shortage of trained certified nurse assistants and home care aides. And, of course, ever-increasing senior care costs, whether in the home or in an institutional setting, means the entire system of elderly care needs to be rethought.

Technological advancements are growing exponentially, just as is our elder population. It makes sense, then, that someone utilize the advances in technology to address the true needs of people. The Jetsons’ Rosie, Luke Skywalker’s C3PO, fiction is rife with examples of robot family helpers. Beyond the physical assistance these robots provided, they were also companions and assistants. Those imaginings are now becoming reality.

Jibo, the “world’s first family robot”, is the brainchild of MIT professor and social robotics pioneer Dr. Cynthia Breazeal. Dr. Breazeal saw the necessity for technology that supports the needs of the human being.

“I do this because I want to empower people to stay healthier, to learn better, to age with dignity and independence (my emphasis)”, Dr. Breazeal writes on the Jibo blog. “... to support more empathic and emotionally engaging telecommunication with those you love, to delight and surprise & entertain so that people laugh and experience joy and wonderment more often, and to make our lives just a bit easier with a touch of technological magic.”

For seniors, that means an “attentive companion that can help you live with greater independence and stay connected to those you love.”

Here’s what Jibo can do (from the Jibo website):
See
Two hi-res cameras recognize and track faces, capture photos, and enable immersive video calling.
Hear
360° microphones and natural language processing let you talk to Jibo from anywhere in the room.
Speak
Hands-free reminders and messages, so you'll never forget and can always be in touch.
Learn
Artificial Intelligence algorithms learn your preferences to adapt and fit into your life.
Help
Like a personal assistant, Jibo proactively helps you, to make everyday tasks simpler and easier.
Relate
Communicates and expresses using natural social and emotive cues so you understand each other better.

Here's Jibo in action:



The Indiegogo campaign to crowdsource funding for Jibo started on July 16 and ended on September 14, 2014 and raised $2,289,506, and astonishing 2,290% of its $100,000 goal. Those numbers make it the most successful technology campaign on Indiegogo to date.

Over 4,800 Jibos were pre-ordered at $499, 28% of which are Developer Editions and upgrades (new application development is ongoing.) 71 Jibos will be donated to Boston Children's Hospital.

What do you think about Jibo and the future of carebots? Is this something you would welcome into your home? Personally, I’d love to see it in action. And if the response on Indiegogo is any indication, Siri’s in for some stiff competition.

Best (and Worst) Places to Grow Old

How do you envision growing old? I dream of living in a lake (or oceanside) house, growing my own food, within walking distance of a town with a vibrant cultural community, with family or friends nearby who I can count on if I’m in trouble. I am near transportation that allows me quick travel to a world-class city like New York, Chicago, Paris, London, Tokyo (or a myriad of others around the world—and if we’re dreaming, I also have a flat there) and access to an airport for occasional national and international travel.

For that dream to come true, I will need a few things. First, I will need an enabling environment. That means the place in which I live should have socioeconomic and political policies and programs in place to help me age with safety and dignity, and give me access to the best resources I need to age well.

I’d like to surround myself with vital members of the community, the educated (and, dare I say, employed.)

I will need some money, of course. The society in which I live should provide a little bit of a financial net. Some call it a pension, in the U.S. we call it Social Security.

Finally, you have nothing if you don’t have your health. The ideal spot to grow old will give me access to a clean environment and good medical care. Life expectancy should be high and I should live those years in good health and feel that my life has meaning.

How does one find such a spot?

HelpAge International's Global AgeWatch Index brings together data on health, income security, employment and education, social connections, safety and transportation into one number and ranks countries from 1 to 96 (with 1 ranking highest). The index represents nine out of ten people over 60 years old, all across the world.

Norway tops the list of overall global rankings. It earns first place in both income security and capability (employment and education). It comes in at number 4 in the enabling environment domain (social connections, safety, civic freedom, and transportation)—Switzerland wins here, and 16th in Health Status (Japan takes the number 1 spot.)

Overall, the U.S. ranks 8th, behind (in order), the aforementioned Norway, Sweden, Switzerland, Canada, Germany, the Netherlands, and Iceland. Better in some measures than others, I was surprised to learn that we as a nation rank 25th in Health Status, just behind Malta.

The worst places to grow old, according to the index are Afghanistan (96), Mozambique (95), West Bank and Gaza (94) and Malawi (93). But all around the world, life expectancy is on the rise.

The entire index is a fascinating interactive website with more data points than I can list. In addition to rankings by geographic area, the report includes emerging pension policies to help create basic regular income for the poorest of populations. Peru, Mexico, and Tanzania are among the countries highlighted for their new non-contributory “social pensions” as safety nets.

In a statement released by Help Age International, Professor Sir Richard Jolly, advisor to the Index as well as architect of the UNDP Human Development Index said, “People do not stop developing when they reach sixty or seventy or eighty. Our older years should be as much a time to expand our horizons as our earlier years.”

If you want to make a difference and make your aging voice heard, join Help Age International’s campaign Age Demands Action that is calling for a UN convention to protect older people's rights by law.

October is Breast Cancer Awareness Month

No one is immune to breast cancer—it is an equal opportunity disease. However, we know that breast cancer is the most common cancer among women and women between the ages of 75 and 79 have the highest incidence rate. The chance that a woman will get breast cancer increases from 1-in-233 for a woman in her thirties, to a 1-in-8 chance for a woman in her eighties. The good news is that the death rate for breast cancer in women has decreased since 1990. This is due primarily to early detection and treatment.

October is Breast Cancer Awareness Month and a good time to create an Early Detection Plan. The National Breast Cancer foundation has created and made available an application to receive reminders to do breast self-exams, and schedule mammograms based on your age and health history.

The Mayo Clinic lists these primary risk factors:

  • Age
  • Chest radiation as a child
  • Menstruation before the age of 12
  • Adolescent weight gain
  • No pregnancy or late pregnancy (after 30)
  • Lengthy use of oral contraceptives
  • Post-menopausal weight gain
  • Late menopause (after age of 50)
  • Increased breast tissue density

I had my own breast cancer scare a few years back. My annual screening mammogram showed an abnormality, so I was scheduled for a diagnostic mammogram. That was the longest week of my life. At the time, I had two small children and was beyond worried. I also had a lot of questions. I went to the website BeyondTheShock for answers and to prepare myself for my possible journey. What I found there was an incredible community full of support. Luckily for me and my family, my lesion was benign and there was no cancer. But the survivor stores I found at BeyondTheSchock, had I not been so lucky, would have been an inspiration.

When detected and treated early enough, your chances of surviving breast cancer are better than ever. Do it today. Make an appointment for that all-important screening, especially if you are a woman over 40. Remember, 1 in 8 women will be diagnosed with breast cancer in their lifetime, but when breast cancer is detected early, the 5-year survival rate is 98%.

Caregiverlist wants to remind seniors and senior caregivers alike to use National Breast Cancer Awareness month as a reminder to schedule your annual mammogram.

Where is Masterchef for Seniors?

I love MasterChef. And Iron Chef. And just about any show that features competitive cooking.

If you didn’t see Monday’s MasterChef finale, I’ll stay clear of spoilers, but one of the final contestants, Leslie Gilliams, was complimented by Gordon Ramsay for disproving the adage “cooking is a young man’s game.” Mr. Gilliams is 56.

Seniors are an anomaly on MasterChef. The oldest contestant, Sue Drummond, was 61 when she competed on MasterChef New Zealand. Kumar Pereira was MasterChef Australia’s oldest ever Top 24 contestant at 62.

While a small number of contestants were a bit older, the food they presented was not necessarily food that should be served to older adults.

As we age, it’s harder for our bodies to fight off the germs and bacteria found in raw or undercooked food. Salmonella, E. coli, and other bacteria can grow to high levels in some of the “healthiest” and tastiest dishes. Some of the MasterChef dishes that are not necessarily elderly-approved included:

  • Ceviche: a seafood dish especially popular in South and Central America. The raw fish is “cooked” by curing it in citrus juices such as lemon or lime.
  • Raw or undercooked eggs: these are found in Hollandaise sauce, homemade Caesar salad dressing, and tiramisu.
  • Raw meat: like carpaccio (thin shavings of raw beef fillet) and steak tartare.
  • Raw fish: shellfish, such as oysters, mussels and clams, and raw fin fish, like sushi and sashimi.
  • Soft cheeses: cheeses like feta, Brie, or Camembert (my favorite!) can be breeding grounds for bacteria.

Senior caregivers need to be especially careful when preparing meals for the elderly. Yes, the food needs to be palatable, look appealing, and be nutritious, but meals should be safe, first and foremost.

If you are a caregiver who subscribes to Caregiverlist’s newsletter, The Caregiver’s Gist,  you know we provide a delicious, nutritious recipe—safe for seniors.

We’d also love to hear from you caregivers. Do you have a special recipe that your senior client or loved one especially enjoys? Send it to me at renata@caregiverlist.com. I promise to try them all and report back on my favorites. Who knows? Maybe your recipe will make it into an online Caregiverlist safe-for-seniors cookbook.

And I’d like to challenge the MasterChef franchise. Your MasterChef Junior, the kids version of MasterChef, was incredibly popular. So popular in fact, that MasterChef Junior returns for Season 2 on Friday, Nov. 7.  Come on, Chef Ramsay, how about a MasterChef Senior?

Occupational Therapy's Role in Fall Prevention

Falls—they’re not just for seniors. However, whereas my recent tumble after meeting with a Chicago pothole resulted in some scrapes, bruises, and a banged-up ankle, injuries from falls for the elderly can be much more dire.

Have a nice trip, see you next fall!

September 23 marks the first day of fall in 2014, and it’s also the 6th annual National Falls Prevention Awareness Day, sponsored by the National Council on Aging (NCOA). This year's theme is Strong Today, Falls Free Tomorrow, and seeks to unite professionals, caregivers, and older adults in raising awareness and preventing falls proactively.

We at Caregiverlist have written a lot about falls and fall prevention over the years, and there’s good reason for that. Among older adults (those 65 or older), falls are the leading cause of injury death—over 21,700 older Americans die annually from injuries related to unintentional falls. By 2020, the annual cost of fall injuries (direct and indirect) is expected to reach $67.7 billion, according to the CDC. Those senior who survive falls can face long post-hospital nursing home rehabilitation.

The American Occupational Therapy Association (AOTA) and other professional associations, along with several federal agencies are part of the Falls Free© Initiative. Specifically, AOTA is promoting the role of occupational therapy in fall prevention.

What is Occupational Therapy (OT)?

Occupational therapist practitioners work with older adults in their homes or in facilities to do the day-to-day activities they want to do, safely. They perform an individualized evaluation, determine a person’s goals, help improve the person’s ability to perform daily activities, and evaluate if those goal have been met.

How does OT help in fall prevention?

The occupational therapist will remove environmental hazards in the home. They can suggest furniture arrangement so that there is plenty of room to walk without obstacles. If you hold onto furniture for balance, they will advise whether it is heavy enough to do that safely or suggest alternatives.

The therapist will review your entire home and be sure you can safely and easily get to the items you use on a regular basis. They’ll help create a plan for accessing things that are used most frequently.

The OT will evaluate the lighting throughout your home, making sure that you can see in potentially unsafe areas.

Occupational therapists will work with caregivers as well, educating them on proper patient transferring techniques, and providing proper guarding techniques while a patient is moving or managing stairs to reduce the risk of patient falls without
injury to the caregiver.

This 2008 video from University of North Carolina at Chapel Hill's Institute on Aging, offers advice on preventing falls and shows how an occupational therapist assesses potential hazards in the home.



Medicare often pays for occupational therapy if prescribed by a doctor. Speak to a medical professional to determine if an occupational therapist can increase your or your senior’s quality of life and perhaps reduce the risk of falls. I just wish they could fix potholes.

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