Millions of Americans struggle to provide care from a distance.

As lifespans lengthen and the number of seniors rapidly grows, more Americans find themselves struggling to care for an ailing loved one from hundreds or thousands of miles away.

The following is an excellent article that appeared in The Washington Post. If you have aging parents it is a must read...

Stop the re-hospitalization revolving door

People are hospitalized with acute heart failure when congestion, or fluid build up worsens to the point that it causes severe leg or abdominal swelling and makes it difficult for them to breathe. Treatment is mostly focused to relieve symptons.

Because of inconsistent follow-up care and difficulty getting patients to take prescribed medication properly and to follow a good diet and exercise regimen, many of them relapse and wind up back in the hospital or in some cases die.

The following tips can reduce that risk:

Review medication upon discharge -medical errors often occur during the transition from the hospital to home. Make sure that you review your medications with a health care professional before leaving the hospital. If you are unsure about any aspects of the instructions ASK FOR CLARIFICATION...don not assume anything. If possible try and fill the prescriptions before you return home or within 24 hours.

Schedule a follow-up visit - schedule an appointment with your physician within a week or tow of discharge. Do not be surprised if your primary care doctor does not have all of the facts at your follow up appointment. Make sure to bring all of hospital discharge instructions with you!

Continue to treat symptons - even if your symptons improve enough for your to go home, you still need ongoing care monitoring and medication.

Treat other medical conditions - failure to control contributing conditions such as high blood pressure and kidney disease are just a few reasons why re-admissions are high.

Walk your way to good health

Regular walking, a favorite exercise for senior citizens, is one of the most effective forms of physical activity that delivers substantial health benefits and improves heart health, says the American Heart Association. The latest addition to their tools for persuading people to exercise or Walking Clubs, which are quickly being formed in communities across the U.S.

Walking is also easy to start and continue and it has the lowest dropout rate of any physical activity. By joining or forming an American Heart Association Walking Club you can connect with others who share your goals, lifestyles, schedules and hobbies – and do it all free. Walgreens is the national sponsor.

An American Heart Association study revealed that American adults are 76 percent more likely to take a walk if another person is counting on them.

In contrast, research shows 45 percent of gym members will quit going to the gym in a given year and 30 percent will cancel their membership. Gym fees per member average about $765.40 a year.

“I encourage our patients to engage in regular exercise, including moderate-to-vigorous intensity walking programs, and the American Heart Association’s new Walking Clubs are a great resource,” said Barry A. Franklin, Ph.D., Director of Cardiac Rehabilitation and Exercise Laboratories at William Beaumont Hospital in Royal Oak, Mich.

“The accountability and camaraderie Walking Clubs provide will help those that struggle with a regular exercise commitment. Numerous studies have now identified a sedentary lifestyle and/or a low level of fitness as independent risk factors for cardiovascular disease.

Accordingly, for many people, Walking Clubs may provide a safe and effective lifestyle intervention to prevent heart disease and stroke.”

Hospital chaplains - a patients greatest advocate

Hospital chaplains have long been a source of comfort and solace for patients facing daunting illness. Patients who had a spiritual discussion while hospitalized reported being more satisfied with their overall care.

Studies indicate as many as 40% of patients with serious illnesses like cancer struggle with spiritual concerns, which can harm emotional and physical well-being, says George Fitchett, research director in the Department of Religion, Health and Human Values at Rush University Medical Center Chicago.

Patients who have negative thoughts—say, questioning God's care for them—are more likely to develop worse health outcomes than patients who show positive spiritual coping, such as turning to religion for solace.

Chaplains "are patients' greatest advocates," says Harold Koenig, director of Duke University's Center for Spirituality, Theology and Health. They should work closely with other medical professionals, he says, and help them understand how spiritual beliefs influence patients' treatment decisions and response.

Studies indicate that chaplain visits can result in less patient anxiety, shorter hospital stays and higher satisfaction. Still, a review in the Journal of Health Care Chaplaincy concludes that many studies haven't been rigorous enough to test effectiveness and define the best practices of chaplains' care.

A study published online in July in the Journal of General Internal Medicine found that among 3,000 patients hospitalized over a three-year period at the University of Chicago Medical Center, 41% wanted a discussion of religious and spiritual concerns, yet only half of that group reported having one.

Patients may hesitate to ask for a chaplain's services out of concern that chaplains will proselytize—even though in many cases they don't use explicit theological language and "are there to be companionable and offer support," says Wendy Cadge, associate professor at Brandeis University.

How Often Do Women Really Need Bone Density Tests?

Screening for osteoporosis can protect against fractures, but many women may be getting tested too often.

Older women are at higher risk of developing osteoporosis and bone loss, which can lead to potentially debilitating bone fractures. To gauge bone strength in these patients, many doctors order bone mineral density tests every two years — which is how often Medicare reimburses the test — but a new study finds that such screenings can be delayed much longer.

The latest research, published in the New England Journal of Medicine, suggests that most women with normal or near-normal scores of bone density on an initial test may not need another one for up to 15 years.

The study addresses a difficult question that many doctors caring for older patients face. Bone mineral density readings, or T scores, which measure bone thickness at certain spots, usually the hip and spine, compare patients’ bone density to that of a healthy young adult. So, a T score of -2.5 or lower qualifies as osteoporosis, and women at these levels are recommended to continue testing regularly and begin drug treatments to strengthen their bones. But what about women with slightly higher readings? Do they need to be monitored as often?

Read full Time Magazine article:

85 and older outpacing all other age groups in America

The 65+ senior population in the United States has outpaced the growth of all other age groups over the course of the last decade, and Census data released Wednesday indicates that the trend toward an aging America—including for the country’s “oldest old” population—is continuing.
The most recent Census data finds that there were 40.3 million people who were 65 years or older as of April 2010, up 15% from 35 million a decade earlier. As of April 2010, that population represented 13% of the overall population in the United States.

The aging of the baby boom bulge is “unprecedented,” said Carrie Werner, statistician, Age and Special Populations Branch, Population Division at the U.S. Census Bureau, in a call with members of the press Wednesday.
Of older Americans, the 85- to 94-year-old age group showed the greatest increase at near 30%.

Regionally, the Census shows that the South contains the greatest number of people 65 and older, but the percentage of those who are 65+ in the Northeast is greater than in any other region. Of 21 counties that saw their 65+ populations double over the past decade, five were located in Colorado, five in Georgia and five were in Texas. Additionally, the older population is more likely to live inside a metropolitan or micropolitan statistical area.

Can you die from a broken heart?

There really is such a thing as heartbreaking grief, suggests new research that finds losing a loved one can increase the risk of heart attack.
Within a day of a significant other's death, heart attack risk was 21 times higher than normal, said researchers who looked at data on nearly 2,000 heart attack patients. And within the first week after death, the heart attack risk for the bereaved was still six times greater than usual.

"Extreme grief can trigger heart attacks," said lead researcher Dr. Murray Mittleman, director of the Cardiovascular Epidemiology Research Unit at Beth Israel Deaconess Medical Center and Harvard Medical School in Boston.
"For at least a month the risk remains elevated and likely stays up even longer," he added.

The stress and anxiety of losing someone close can trigger heart-damaging biological processes, Mittleman explained.
"All of this can cause a physiologic response with an increase in heart rate and blood pressure, and also can cause changes that makes blood a little bit more sticky," he said. "This can increase the risk of having a heart attack."
After a death, it is important for immediate family members and friends to be aware of this connection and watch for signs of distress, Mittleman suggested.

"When an individual is grief-stricken, they often ignore their own needs and may not be as compliant with medication, may not take care of themselves as well," he said.

If the bereaved individual develops unusual physical symptoms, "don't assume it's just stress and anxiety; it may be a heart attack and should be taken very seriously," Mittleman warned. These symptoms include chest or stomach pain, shortness of breath, nausea, lightheadedness or a sudden, cold sweat.

Senior housing - 2012 and beyond

The economy is still the number one reason that many seniors have delayed moving into a senior housing community. Other reasons include: utilizing family, technology, medicine and community support to remain in their current environment.

This trend is forcing senior housing communities to accept residents with higher levels of acuity. This is turn can lead to a higher cost of care, and providers may need to raise their costs as a result of increased risk, or change their policies all together to avoid the consequences of higher acuity.

As the profile of senior housing residents change, so will the definition of types of senior care communities. The shift in resident profiles are giving way to a migration in communities:

• Independent Living Becomes More Like Assisted Living. As more home and community based services initiatives are implemented, seniors living in apartment complexes or 55+ communities will see a greater level of a la carte services offered that will resemble more of an assisted living “feel” at a lower cost delivery as services will be unbundled.

• Current Assisted Living Facilities will function more like Skilled Nursing. Current nursing homes will be handling the “sickest” seniors in the coming years as an alternative to hospital stays. The traditional model of nursing care will migrate to assisted living communities that can have differing levels of care within those communities. As part of this trend, many assisted living communities are finding that the average age of entry for its communities is increasing as people are living with less care longer.

• Dedicated Alzheimer’s care facilities will begin to re-appear in earnest in the next 12-24 months. This trend is similar to a period in the early 2000s when many dedicated memory care communities were established. At the time, there were funding problems and the trend was somewhat ahead of its time given the number of memory care patients. However, a decade later, the supply of ALZ/dementia care communities is low while the demand is steady and increasing, regardless of the funding issues.

Concepts such as multigenerational housing,senior villages, NORC's (naturally occurring retirement communities) co-housing, homes built with in-law apartments and other communal living solutions will continue to gain appeal as individuals and families learn about the costs of senior housing.

Older Americans will increasingly move in with their families—or each other— as the economics of co-housing/co-habitation make a compelling case for multigenerational housing. Each of these solutions provides maximum flexibility but as these models become more popular, regulation and funding to further develop these alternatives may stall future growth.

Those living in single-family homes will invest capital in their homes as more parents move in with their adult children. Using home office spaces, basements, attics and other existing solutions will make way for more formal renovations including the "granny flat" as either an add-on or standalone. Others may opt for prefab cottages or PODS as solutions that can be moved, stored or re-sold when a senior needs to move to a more comprehensive care community.

Renovation will be a key driver in adaptation for senior housing in both single family homes. The key will be the return on the investment (ROI) but given the uncertainty of the amount of time that an elder may live with their children, it is difficult if not impossible to have a sense of certainty with respect to time. And interesting fact that is emerging, is that the resale value of these modifications will have minimal effect on the value of the home unlike more popular renovations such as kitchens and baths.

As elder abuse grows, so does the need for shelters

The following USA Today article sheds light on the growing issue of elder abuse.

They're weak, physically or mentally disabled or both, and often at the mercy of people they depend on the most: relatives and caretakers.

They're the nation's fast-growing elderly population, and many are prime targets for abuse — physical, financial, sexual or emotional.

Concern among the elderly and their advocates is mounting as the number of seniors soars and more of them live longer.

The Cedar Village Retirement Community in the Cincinnati suburb of Mason this month opened a long-term care facility to victims of abuse. It is the first elder abuse shelter in Ohio and one of only a half-dozen in the country, all of them funded by non-profit groups.

"There is a genuine recognition by those who are concerned by the abuse of elders that there need to be appropriate safe houses for them to get them out of immediate harm's way," says Sally Hurme, AARP's senior project manager in education and outreach. "Nationally, we've been aware of the need for elder abuse shelters, but they've been slow in coming into fruition."

The first in the nation, the Weinberg Center for Elder Abuse Prevention at the Hebrew Home at Riverdale in the Bronx in New York City opened just seven years ago and serves as a model for the few others.

Read full article at USA Today...

Is there a connection between aspirin and macular degeneration?

A new study suggests that daily aspirin use among seniors may double their risk of developing a particularly advanced form of age-related macular degeneration, a debilitating eye disease.

The possible link involves the so-called "wet" type of age-related macular degeneration (AMD), a significant cause of blindness in seniors.

Aspirin use was not, however, found to be associated with an increased risk for developing the more common, and usually less advanced, "dry" form of AMD, according to the report published in the January issue of Ophthalmology.

Age-related macular degeneration affects the critical central vision required for reading, driving and general mobility. The damage occurs when the retinal core of the eye (the macula) becomes exposed to leaking or bleeding due to abnormal growth of blood vessels.

While the study uncovered an association between aspirin use and AMD, it did not prove a cause-and-effect relationship.

This point was also made by Dr. Alfred Sommer, a professor of ophthalmology and dean emeritus at the Bloomberg School of Public Health at Johns Hopkins University in Baltimore. He noted that while the study was "well executed," it should not be seen as definitive proof that aspirin use and AMD are linked.

"It is well known that aspirin [and other NSAIDs] can increase the risk of gastric distress and gastric ulcers," Sommer said. "Like any medicine, it should only be taken if needed. But those taking aspirin to prevent heart disease, particularly those at increased risk of heart disease, definitely do benefit and should not change what they do."

For more on age-related macular degeneration, visit the U.S. National Eye Institute

Working dogs...

Assistance dogs can make life easier for seniors in need.

While most people are familiar with guide dogs that help people who are blind or visually impaired, there are also a variety of assistance dogs trained to help people with physical disabilities, hearing loss and other various medical conditions.

Unlike most pets, assistance dogs are highly trained canine specialists — usually Golden and Labrador retrievers, and German shepherds — that know about 40 to 50 commands, and are amazingly well-behaved and calm.

Here's a breakdown of the different types of assistance dogs and what they can help with:

Service dogs: These dogs are specially trained to help people with physical disabilities due to multiple sclerosis, spinal cord injuries, Parkinson's disease, chronic arthritis and many other disabling conditions. They help by performing tasks their owner cannot do or has trouble doing, like carrying or retrieving items, picking up dropped items, opening and closing doors, turning lights on and off, assisting with dressing and undressing, helping with balance, household chores and more.

Hearing dogs: For those who are deaf or hearing impaired, hearing dogs can alert their owner to specific sounds such as ringing telephones, doorbells, alarm clocks, microwave or oven timers, smoke alarms, approaching sirens, crying babies or when someone calls out their name.

Seizure alert and response dogs: For people with epilepsy or other seizure disorders, these dogs can recognize the signs that their owner is going to have a seizure, and provide them with advance warning, so he or she can get to a safe place or take medication to prevent the seizure or lessen its severity. They are also trained to retrieve medications and use a pre-programemd phone to call for help. These dogs can also be trained to help people with diabetes, panic attacks and various other conditions.

For more information on assistance dogs go to Working Like Dogs an educational website for people who are interested in getting an assistance dog.

6 Time Management Tips for Caregivers

Caregiver stress is a popular topic these days, and for many caregivers burnout is a very real factor this time of year. I spoke with several people this week who are feeling that they can’t live up to what’s expected of them…that there simply aren’t enough hours in the day to take care of their children, their jobs, their ailing parents, their holiday plans etc.
In order to juggle caregiving responsibilities with all the other demands of daily life, time management strategies can be a life saver. Try these techniques next time you’re feeling overwhelmed:
• Unplug from technology: Laptops and cell phone with Wi-Fi are great, but they make us available to any and all who need us 24/7. Unless that’s part of your job responsibilities, it may be interfering with your ability to relax and enjoy whatever down time you have.
• Make a list: It’s hard to relax when you’re carrying around a mental “To Do” list. Before you go to bed each night, write down all the things you need to take care of the next day. That way you can put them on paper, and let the weight of responsibility go for the night.
• Mono-task instead of multi-task: Our brains can only focus well on one thing at a time. Trying to do too much at one time can cause silly mistakes that take time to correct.
• Start with the most dreaded task on your list: Avoiding an unpleasant task uses up a lot of emotional energy. Attack them first thing instead of worrying about them all day.
• Schedule time to recharge your batteries: Whether its 30 minutes with a cup of coffee and a good book, or 30 minutes at the gym, be sure you give yourself a little “me time” each day.
• Delegate what you can: No one can go it alone. Let your family, friends, and co-workers help when possible.

Weather and temperature changes can trigger COPD symptons

Weather changes are one of many factors that can trigger your COPD (chronic obstructive pulmonary disease)symptoms. Symptoms of COPD, which include shortness of breath, cough, and phlegm production, tend to get worse for some people when the air is very cold and when it is hot and humid.

"Weather extremes are not good," says Barry Make, MD, co-director of the COPD program at the University of Colorado in Denver. Dr. Make says that temperatures below freezing or above 90 degrees Fahrenheit tend to cause COPD symptoms to flare up.

When It's Cold and Windy -

Cold air and strong winds are known triggers for the worsening of COPD symptoms. Many people with COPD find that cold air can make it harder to breathe, leading to shortness of breath and wheezing. Frigid temperatures can also cause fatigue. "COPD patients just feel like they are more tired after they've been in the cold," explains Make.

Windy days can be practically problematic. "If COPD patients go out when it is windy and have to walk against the wind, there is more resistance," says Make. Therefore, it requires more exertion to walk, which can be difficult for someone with COPD.

If cold and windy climates bother you, try wearing a scarf or face mask loosely over your nose and mouth, and breathe through your nose on wintry days. The winter muffler and breathing through your nose warms the air before it enters your lungs, which can help

Spinal Fluid May Help Diagnose Alzheimer's disease

Searching for a better screen for early Alzheimer's disease, researchers think they have found a marker of change in the brain that precedes the onset of the disease by five to 10 years.

The indicator of trouble to come, they say, is a shift in the levels of specific components of the cerebrospinal fluid (CSF) in the brain and spinal cord. Among patients already diagnosed with mild cognitive impairment, a drop in such levels appears to be a sign of Alzheimer's years before symptoms develop.

The discovery, published in the January issue of Archives of General Psychiatry, could potentially aid in the use of disease-modifying therapies, which are designed to work best if applied when a patient is still in the early stages of disease.

"These markers can identify individuals at high risk for future [Alzheimer's disease] at least five to 10 years before conversion to dementia," study author Dr. Peder Buchhave, of Lund University and Skane University in Sweden, noted in a journal news release. "Hopefully, new therapies that can retard or even halt progression of the disease will soon be available. Together with an early and accurate diagnosis, such therapies could be initiated before neuronal degeneration is too widespread and patients are already demented."

The study results stem from more than nine years of follow-up to prior research that had involved 137 patients diagnosed with mild cognitive impairment, a mental state that often precedes dementia.

Over the course of the study, nearly 54 percent of the patients went on to develop Alzheimer's, while another 16 percent were ultimately diagnosed with different forms of dementia.

Specifically, among those who developed Alzheimer's, the researchers found that key aspects of their cerebrospinal fluid dropped off in the years before. In addition, other fluid properties actually went up.

The study team said that they believe that about nine out of every 10 patients with mild cognitive impairment who experience such fluid shifts will eventually go on to develop Alzheimer's disease.

Commenting on the study, one expert in the United States said that the new research "provides confirmation of the general concept that CSF can predict the progression of mild memory loss to mild dementia."

Dr. Sam Gandy, associate director of the Mount Sinai Alzheimer's Disease Research Center at Mount Sinai School of Medicine in New York City, added that the results of the European study largely echo those of a trial reported by researchers at the U.S. National Institutes of Health in 2010.

He noted that methods of early detection might prove valuable for research into the treatment of Alzheimer's disease.

"Most new Alzheimer's drugs are aimed at reducing amyloid [protein plaque] accumulation, and the general consensus is that these drugs will only work at early or presymptomatic stages of disease," said Gandy, who is also Mount Sinai Chair in Alzheimer's Disease Research. "The new paper strengthens the likelihood that CSF biomarkers can be useful for identifying that population of subjects with early or presymptomatic disease in order to recruit them into trials."

For more on early signs of Alzheimer's, visit the Alzheimer's Association.