Welcome ...

All too many times overwhelmed caregivers are physically and emotionally depleted and need to take time to rest and care for themselves. Believing in a holistic approach to caregiver stress and a strong commitment to helping our members find the right solutions, we created this blog to help you connect with others who, like you, may be facing the same eldercare issues and challenges. Feel free to comment, ask questions, and submit articles. Please forward the blog link to your family and friends. They'll be glad you did.

Warm regards,

Patricia Grace
founder & CEO
Aging with Grace

Thursday, March 29, 2012

The growing issue of cheating...


Shameless! Cheating Is Now Mainstream in America

We expect people to cheat on their taxes, to cheat on freeway speed limits, to barge into line without challenge. We no longer feel surprised when people cheat in business, sports, in their personal life, and in politics.

Our elders wax poetic about the erosion of values in our nation compared to their youth. However, many older Americans don't think twice about impoverishing themselves to qualify for government funded programs. Is that cheating? I'll let you decide.

The following is an excerpt from an excellent article that appears in The Fiscal Times about this growing moral issue.

Read full article...

Wednesday, March 28, 2012

Now I've read everything...

For some older adults, the online video game World of Warcraft appears to offer more than escapist adventure. North Carolina State University researchers have found that playing WoW actually boosted cognitive functioning for older adults — particularly those adults who had scored poorly on cognitive ability tests before playing the game.“We chose World of Warcraft because it has attributes we felt may produce benefits — it is a cognitively challenging game in a socially interactive environment that presents users with novel situations,” says Anne McLaughlin, Ph.D., an assistant professor of psychology at the university.

Monday, March 26, 2012

What's wrong with this picture?


Having worked in two Philadelphia area hospitals for several years, I can honestlty say that the new report from Thomson Reuters is rather spot on.

The study indicates that hospital employees have 10 percent higher healthcare costs than the general population and are less healthy. The average annual healthcare cost for a hospital employee and his or her dependents was $4,662, outpacing the general population by $538.

The report also found hospital employees were also more likely to be diagnosed with chronic medical conditions, such as asthma or diabetes.

"Ideally, the healthcare workforce would be a model for healthy behaviors and the appropriate use of medical resources," said Dr. Raymond Fabius, chief medical officer for the Healthcare business of Thomson Reuters. "Unfortunately, our data suggests that the opposite is true today. Hospitals that tackle this issue can strengthen their business peformance and community service."

It seems that hospital workers are among the unhealthiest of us all. And—hold on to your stethoscopes--there's actual science to back up that claim. A new Thomson Reuters Healthcare study says that hospital workers not only are generally sicker than the general population, but that they spend about 10% more on healthcare services and consume more of those services.

The study analyzed the health risk and utilization of 1.1 million hospital workers and compared them with 17.8 million health plan members across all industries nationwide.

Among the interesting nuggets:

Hospital employees and their dependents saw their physicians less often than the general public, but were 22% more likely to make an ER visit and spent 18% more time in the hospital if they went there.

The average annual cost for healthcare for hospital workers and their dependents was $4,662, or $538 more than the general population.

Hospital workers, the study authors speculate, are more likely to access expensive healthcare services because they are so convenient, and they may access care more frequently because they are more in tune with their symptoms, and the disparities do not result from hospital workers' increased exposure to communicable diseases.

A hospital or health system with 16,000 employees would save an estimated $1.5 million annually in medical and pharmacy costs for each 1% reduction in health risk.

Read full article...

Thursday, March 22, 2012

Why baby boomers are breaking up late in life


The following is an excerpt from a fascinating article written by Susan Gregory Thomas of the Wall Street Journal.

For the new generation of empty-nesters, divorce is increasingly common. Among people ages 50 and older, the divorce rate has doubled over the past two decades, according to new research by sociologists Susan Brown and I-Fen Lin of Bowling Green State University, whose paper, "The Gray Divorce Revolution," Prof. Brown will present at Ohio State University this April. The paper draws on data from the 1990 U.S. Vital Statistics Report and the 2009 American Community Survey, administered by the U.S. Census Bureau, which asked all respondents if they'd divorced in the past 12 months.

Though overall national divorce rates have declined since spiking in the 1980s, "gray divorce" has risen to its highest level on record, according to Prof. Brown. In 1990, only one in 10 people who got divorced was 50 or older; by 2009, the number was roughly one in four. More than 600,000 people ages 50 and older got divorced in 2009.

Read full article...

Wednesday, March 21, 2012

Even a little physical activity helps...


A new study provides more evidence that physically active seniors may have a better overall health outlook.

Out of 893 people around 80 years old, researchers found that the most active seniors had a lower risk of dying over the four-year study compared to those who moved the least.

"It's another strong piece of evidence that all seniors should be participating in physical activities," said Dr. Catherine Sarkisian, director of the Los Angeles Community Academic Partnership for Research in Aging.

Sarkisian, who was not involved in the new study, told Reuters Health this does not prove exercise makes people live longer. It could be that people who were healthy enough to exercise are the ones who would have lived longer anyway.

However, she said there is enough evidence to suggest that people who are more physically active are less likely to lose their memory or have to go to a nursing home, for example.

To see whether activity levels make a difference in lifespan, researchers led by Dr. Aron Buchman, a professor at Rush University Medical Center in Chicago, measured the daily activity level of local seniors, most in their late 70s and 80s, over 10 days.

The participants wore a small device on their wrists to record how much they were moving throughout the day.

The researchers then followed the group for about four years, during which a quarter of the seniors -- 212 -- died.

The seniors who were most active had about a 25 percent lower chance of dying compared to those who were least active over the four years, according to results published in the Archives of Internal Medicine.

Buchman and his colleagues wrote that the link between physical activity and a lower risk of death remained even after taking into account traits that may have affected both seniors' exercise routine and chance of dying, including mental ability, chronic health conditions and symptoms of depression.

"This suggests if you're increasing your activity -- even in your home -- it has some advantages," said Buchman.

Sarkisian thinks there is a stereotype that seniors are too old to learn new habits, but she said past studies have shown the opposite.

"Physical activity is one of the most important things that seniors can do to improve their health for the rest of their lives," she added.

People are motivated to exercise for different reasons, said Sarkisian. Some may want to exercise after seeing a friend die, become ill or fall. Others may want to exercise because of the immediate physical benefits, such as improved mood.

Older adults can check their local senior centers for exercise programs or talk to their doctors or a physical therapist for ideas, Sarkisian said. There are also programs tailored for people with physical limitations, such as those who are wheelchair bound or at an increased risk for falling.

Buchman,said it can also be as simple as an older person increasing their activities around the house. "If you can do light activity, do light activities."

Tuesday, March 20, 2012

Working and Social Security

The rules are straightforward and spelled out clearly on Social Security's website, but here's the short course:

If you are between 62 and 66, Social Security will deduct $1 from your benefit payments for every $2 you earn above the annual limit, which in 2011 is $14,160.
The year you turn 66, the cap is higher. In 2011, you can earn a total of $37,680 with Social Security deducting $1 for every $3 you earn above that.

Pay attention to the rules because payback can be tough. If you work and collect simultaneously, Social Security will continue to pay you while you work, then after you've filed your income taxes in April of the next year, it will send you a letter saying you made too much money and it is taking back what it overpaid based on the earnings limit.

People who have had this retirement planning scenario happen to them warn that this can put you in a real bind if you spent the money you earned as well as the money you simultaneously collected from Social Security. Both you and your spouse -- if that person is getting benefits based on yours -- could go for several months without getting a Social Security check.

Does it make sense to take a job if you're younger than full retirement age and already taking Social Security? Yes, because if Social Security suspends your benefit, it will recalculate it as if you hadn't claimed. So when you quit work or reach full retirement age, you'll get a payment that reflects the age at which you're currently claiming (minus the time for which you already received benefits) -- and that can raise your payment substantially.

Monday, March 19, 2012

Elderly patient hospitalizations decrease under the watchful eye of a primary care physician


As the primary-care workforce continues to be strained, new research shows that areas with higher levels of primary care have fewer patient deaths and preventable hospitalizations, according to a study in The Journal of the American Medical Association.

Researchers evaluated seniors with Medicare benefits who live in areas with higher levels of adult primary care physicians and physicians providing primary care. They found that elder patients were less likely to die or land in the hospital.

"A higher level of primary-care physician workforce, particularly with an FTE measure that may more accurately reflect ambulatory primary care, was generally associated with favorable patient outcomes," said the study authors.

Experts agree that graduating medical students electing other specialties other than primary care results in a primary care vacuum that must be filled.

If the United States could fulfill the primary-care need, it would result in 50,000 fewer deaths and 436,000 fewer hospitalizations in a year, notes Reuters.

Thursday, March 15, 2012

March is National Colorectal Cancer Awareness Month

Thanks to improvements in prevention, early detection and treatment, more than a million people in the U.S. count themselves as survivors of colorectal cancer.

Most people with early colon or rectal cancer have no symptoms of the disease. Symptoms usually appear only with more advanced disease. From the time the first abnormal cells start to grow into polyps, it usually takes 10 to 15 years for the polyps to develop into colorectal cancer. This is why getting the recommended screening tests before any symptoms develop is so important.

According to the American Cancer Society (ACS), fewer African Americans are dying from colorectal cancer than in previous years. However, African Americans still have the highest death rate of any other racial or ethnic group for most cancers, including colorectal cancer. An estimated 7,020 deaths from colorectal cancer are expected to occur among African Americans in 2012. Colorectal cancer is the third leading cause of cancer death in both African American men and women.

The causes are complex and are thought to reflect social and economic disparities more than biological differences associated with race. These include inequities in work, wealth, income, education, housing and overall standard of living, as well as barriers to high-quality cancer prevention, early detection and treatment services.

Chances of colon cancer increase with age. Diabetes, obesity, smoking and heavy use of alcohol also increase the risk. Screenings should start at age 50 and continue every 10 years after that, as long as results are normal. You should start earlier at the age of 40 if you have a family history.

Tuesday, March 13, 2012

You can make a difference!

In the latest effort to enlist seniors in the fight against Medicare fraud, federal officials have overhauled Medicare billing statements to make it easier to find bogus charges without a magnifying glass.

The new, more consumer-friendly format, which goes online Saturday on Medicare’s secure Web site, www.mymedicare.gov, includes larger type and explanations of medical services in plain English. The revised paper version, which is mailed to seniors every three months, will be phased in early next year.

“You can make a difference!” the revamped statement says. “Last year Medicare saved taxpayers $4 billion – the largest sum ever reported in a single year thanks to people who reported suspicious activity to Medicare.”

And for those who might need an incentive to scour their bills, the new statements promise a reward of up to $1,000 for a tip that leads to uncovering fraud. Although the bonus isn’t new, there’s no mention of it on current forms, which are sent to about 36 million beneficiaries in traditional Medicare.

“We approached this redesign from the standpoint of making it a more consumer-friendly document for beneficiaries and also a better fraud-fighting tool,” said Erin Pressley, director of creative services for the Centers for Medicare and Medicaid Services. “If they are paying attention to these documents, they are going to be the best defense we have.”
“It shouldn’t be a scavenger hunt,” she added.

Monday, March 12, 2012

Is your home causing you shortness of breath?

In most cases, people with chronic obstructive pulmonary disease (COPD) can keep symptoms such as cough, shortness of breath, or sputum under control. However, being aware of your COPD triggers — especially in your home — can help you avoid exacerbations.

Rid your home of these allergens and lung irritants to improve your COPD symptoms:

•Dust mites: These hardy creatures, invisible to the naked eye, can burrow into furniture upholstery and worsen symptoms for people with COPD.

•Pet dander: Although your dog may bring lots of love into your home, he also sheds dander and tiny flakes of dead skin. People with COPD or allergies may experience reactions to pet dander, saliva, or urine.

•Mold and mildew: Mold grows in moist places — like around your kitchen sink or in your bathroom and can be a health hazard for people with respiratory issues like COPD, asthma, and allergies.

•Cleaning products: Although a clean home is important, the products you use matter, too.
Aerosol and spray cleaners contain volatile organic compounds, which can make COPD symptoms worse.

The biggest myth about COPD is that you can't do anything about it. Although there is no cure for COPD, it can be treated and managed in many people. How well COPD can be treated depends on how advanced it is and what other diseases may be present, such as hypertension and heart disease.

Saturday, March 10, 2012

Annuities...not a good idea for the elderly


About 6 months ago my mother went to her bank because she had a CD that was coming due. The bank teller suggested she talk to someone at the bank who could discuss a financial product that could get her more money than CDs. The teller introduced her to a ‘member of our investment team.’ Funny that no one used the title insurance broker.

Mother was told that her money would be safe and available to her at any time should she need assisted care such as an assisted living community or in home care. Also, she was told that the annuity would be a great vehicle to use to qualify for the VA Aid & Attendance benefit. (The VA is starting to deny applications where annuities are used to impoverish the veteran or spouse.)
At 90 years of age she is very worried that she will out-live her money, so something other than a CD sounded good to her.

Thank goodness she is not a person to make a quick decision. After learning that her money would be not available without a penalty fee she decided to stay with the CDs.
As the founder of Aging with Grace, a national eldercare assistance program, I have heard horror stories from families who have suffered at the hands of aggressive bankers/brokers/financial planners that sold their elderly loved one deferred annuities. In most cases the older person suffered with some form of dementia. Although in several cases the person was able to carry on a relatively normal conversation.

The Neasham case should give pause to all annuity brokers…just because a lovely old lady appears fine she may be quite sly at masking a cognitive deficit!
Insurance professionals have an obligation to their clients, themselves and the industry to err on the side of caution when dealing with an elderly client. They can do so by inviting a family member, POA or the person’s attorney to attend the sales appointment.
Annuities are not an investment vehicle for the elderly, the length of time to make a profit due to the high cost of owning one and the fact that the elderly are generally in compromised health make it inappropriate.

Because of the fees associated with these products and the restrictions on cashing them in, they are hardly ideal for older investors who may need the money quickly, or who die before the investment matures.

Friday, March 09, 2012

Assisted living inspections on the chopping block

Advocates of long-term-care residents say the cuts, which have led to less frequent inspections, are worrisome. More elderly people with greater medical needs are entering the facilities, which provide more intensive care than independent living facilities but less than nursing homes.

"A vulnerable population and a weakened regulatory system is just asking for trouble," said Catherine Hawes, a researcher for the Texas A&M Health Science Center who specializes in long-term-care policy. "It's a prescription for disaster."

Industry representatives also are nervous. Annual state inspections, they say, are a good way to catch problems and fix them sooner.

"We just hope no incidents jump up and bite people," said Gail Harmon, executive director of the Texas Assisted Living Association.

The Texas Department of Aging and Disability Services recently eliminated 60 inspectors responsible for reviewing licensed long-term-care facilities, including nursing homes. More than 1,600 assisted living facilities do business in the state, and more than 250 are in the Houston area.

Less oversight

State officials say they will devote less time to assisted living facilities, which aren't as heavily regulated as nursing homes. Assisted living centers will likely be visited every 18 to 24 months instead of annually, said agency spokeswoman Allison Lowery.

Inspectors will try to continue to review facilities with poor compliance histories every year but will extend inspection times for those with good compliance histories, Lowery said.

Thursday, March 08, 2012

Are you at risk for congestive heart failure?

Five million Americans are living with congestive heart failure, and 400,000 new diagnoses are made each year.

Heart failure is a chronic, long-term condition with many causes. The most common cause is coronary artery disease, a narrowing of the small blood vessels that supply blood and oxygen to the heart. It can also result from an infection that weakens the heart muscle, a condition known as cardiomyopathy, or by a heart defect at birth. Other heart problems that may cause heart failure include congenital heart disease, heart attack, heart valve disease and some arrhythmias. In addition, diseases like emphysema, severe anemia and thyroid problems may contribute to heart failure.

Heart failure is defined as the inability of the heart to pump a sufficient amount of blood to rest of the body. The failing heart doesn’t stop working; it works less well. At first, congestive heart patients may notice symptoms like shortness of breath, rapid pulse or even fainting only when they exert themselves — while walking, running or dancing, for instance. But over time, breathing problems and other symptoms may occur even during rest.

Because heart failure affects the kidneys’ ability to dispose of sodium and water, common signs of the condition include swollen legs or ankles and weight gain as fluid accumulates.
Heart failure tends to affect older people more often: 1% of people aged 50 have heart failure, compared 5% of those aged 75 or older and 25% of those aged 85 years or older. The condition is more common among African Americans than whites.

To learn more about the symptoms and treatments of heart failure — most people with mild or moderate heart failure can be successfully treated — please see the National Institutes of Health or the AHA websites.

Tuesday, March 06, 2012

President Obama targets 2025 for effective Alzheimer's treatment


Effective treatments for Alzheimer’s by 2025? That’s the target the government is eyeing as it develops a national strategy to tackle what could become the defining disease of a rapidly aging population.

It’s an ambitious goal — and on Tuesday, advisers to the government stressed that millions of families need better help now to care for their loved ones.

“What’s really important here is a comprehensive plan that deals with the needs of people who already have the disease,” said Alzheimer’s Association president Harry Johns, one of the advisers.

Already families approach the advisory committee “reminding us of the enormity of our task,” said Dr. Ron Petersen, an Alzheimer’s specialist at the Mayo Clinic who chairs the panel.

The Obama administration is developing the first National Alzheimer’s Plan to address the medical and social problems of dementia — not just better treatments but better day-to-day care for dementia patients and their overwhelmed caregivers, too.

The plan still is being written, with the advisory panel’s input. But a draft of its overall goals sets 2025 as a target date to have effective treatments and ways to delay if not completely prevent the illness.

Some advisory members said that’s not aggressive enough, and 2020 would be a better target date.

“We want to be bold,” said Dr. Jennifer Manly of Columbia University. “We think the difference of five years is incredibly meaningful.”

Regardless, an estimated 5.4 million Americans already have Alzheimer’s or similar dementias — and how to help their families cope with day-to-day care is a priority, the advisory committee made clear Tuesday.

The disease is growing steadily as the population ages: By 2050, 13 million to 16 million Americans are projected to have Alzheimer’s, costing $1 trillion in medical and nursing home expenditures. That doesn’t count the billions of dollars in unpaid care provided by relatives and friends.

Today’s treatments only temporarily ease some dementia symptoms, and work to find better ones has been frustratingly slow. Scientists now know that Alzheimer’s is brewing for years before symptoms appear, and they’re hunting ways to stall the disease, maybe long enough that potential sufferers will die of something else first. But it’s still early-stage work.

Meanwhile, as many as half of today’s Alzheimer’s sufferers haven’t been formally diagnosed, a recent report found. That’s in part because of stigma and the belief that nothing can be done. Symptomatic treatment aside, a diagnosis lets families plan, and catching Alzheimer’s earlier would be crucial if scientists ever find a way to stall it, the advisory panel noted.

Among the goals being debated for the national plan:

Begin a national public awareness campaign of dementia’s early warning signs, to improve timely diagnosis.

Give
primary care doctors the tools to assess signs of dementia as part of Medicare’s annual check-up.

Have caregivers’ health, physical and mental, regularly checked.

Improve care-planning and training for families so they know what resources are available for their loved one and themselves.

A training program in New York, for instance, has proved that caregivers who are taught how to handle common dementia problems, and given support, are able to keep their loved ones at home for longer.

Such programs “are dirt cheap compared to paying for nursing home care,” said David Hoffman, who oversees Alzheimer’s programs for the New York State Department of Health.

But hanging over the meeting was the reality of a budget crunch. The government hasn’t said how much money it will be able to devote to the Alzheimer’s plan, and states have seen their own Alzheimer’s budgets cut.

“We’re not going to fix this without substantial resources,” Hoffman said. “In New York, we’re hanging on by our nails,” he added.

Friday, March 02, 2012

You get what you pay for...

Home health care companies are not happy with the Obama Administration’s push to require that home health workers receive minimum wage, despite the industry being one of just a few to maintain profits during the worst of the recession, reports USA Today.

Minimum wage is currently $7.25 an hour, and a Labor Department proposal issued in December calls for home health agencies to follow federal wage and hour laws for their workers, overturning a decades-old law that exempted home health care aides from federal wage laws.

Home health workers were never meant to be excluded from the law’s provision, according to the Labor Department, but changing the rules would affect the quality and cost of care for consumers, the industry says.

With Medicare and Medicaid accounting for about 75% of home health care service revenue, USA Today reports, salary increases in the industry could mean that the already-stretched government programs won’t be able to keep up.

Read the full USA Today. They recently ran another article talking about how high turnover affects home health quality, and how this could be related to low wages.

Is there any surprise that older Americans prefer home to a senior care facility?



When given the choice, many seniors prefer to stay in their homes rather than move into a nursing home or other sorts of retirement communities, and to facilitate this, houses need to be remodeled or include designs from the outset that allow for aging in place.

Although homebuilding levels are slowly recovering from 2007′s housing market crash, according to the National Association of Home Builders, the remodeling business is in full swing, says Mark Hager, President of Aging in Place.

CAPS certification, a program that was developed and launched by the Remodelers of the NAHB in 2011, in collaboration with the NAHB Research Center, NAHB 50+ Council, teaches a variety of professionals including remodelers, contractors, designers, architects, and healthcare consultants “strategies and techniques for designing and building barrier-free living environments,” according to the NAHB.

To aid aging in place, there are many design features and products that enable seniors to remain safely in their homes. Hager says the contractors and remodelers he knows are getting very busy with a lot of age-related business.

With many seniors financially unprepared for long-term care costs, aging-in-place can be an affordable alternative to moving into a retirement community.

Hager says,'over 60% of home remodeling is for aging-in-place remodeling, with the most commonly requested features including grab bars, higher toilets, curbless showers, wider doorways, ramps or lower threshold, and task lighting. Requests for residential elevators is also on the rise.'

Bathrooms and kitchens are the two main areas of a house that need special consideration.

Making the bathroom a safer place can include installing grab bars around toilets and in shower areas, or putting in non-slip floors, or placing special fall-protection mats in strategic areas.

In kitchens, some modifications include lower counters that are accessible for people in wheelchairs, drawer-style dishwashers, and appliances with automatic shut-off features.

Thursday, March 01, 2012

Fatal accidents increase among older drivers


Older drivers are much more likely to die in intersection crashes, and with each passing year the task of making a left turn becomes more challenging, according to a report released Wednesday.

The exhaustive compilation of years of research underscores a dispiriting bottom line: The first baby boomers began turning 65 last year, and as more members join the ranks of elderly, their inability to navigate traffic is forecast to result in more highway deaths.
If there is an antidote, it’s one that will help all drivers: making the roads and the vehicles traveling them easier and safer to negotiate. Another safeguard for a swelling, less-able population: providing other transportation options and building more self-contained communities.

“The growing ranks of older Americans will far outpace previous generations with their level of ability and activity,” said Will Wilkins, executive director of the nonprofit research group TRIP, a partner in the report.

In 2009, 5,288 people age 65 and older were killed and 187,000 were injured in traffic crashes. They accounted for 16 percent of all traffic deaths and 8 percent of the injured, but they accounted for 13 percent of the population, according to data from the National Highway Traffic Safety Administration. The TRIP report said the number of deaths among drivers age 65 and older grew to 5,750 in 2010 even as NHTSA’s data showed that overall traffic deaths hit a record low.

The federal Centers for Disease Control and Prevention say crash deaths per mile traveled begin to increase markedly after age 75 with deterioration in vision and the ability to reason and remember, as well as the rise of physical challenges such as arthritis and reduced strength.

The TRIP report, released Wednesday in partnership with the American Association of State Highway and Transportation Officials, said intersections were particularly troubling to older drivers. It cited NHTSA data that showed that in 2010, 37 percent of all fatal crashes involving a driver age 65 or older involved an intersection. Among younger drivers, only 20 percent were related to an intersection.

The report also pointed to a University of Kentucky study that said left turns presented a bigger problem for older drivers. When turning left, seniors have difficulty judging appropriate gaps in oncoming traffic and estimating the speed of oncoming vehicles.

The report said clear, simple and brighter road signs, better street lighting, wider traffic lanes, longer merge and exit lanes, rumble strips and additional left turn lanes would help older drivers.

Innovations being introduced in vehicles also will help older drivers, including lane change warnings and devices that sound alarms when something is too close in front or back of a vehicle. Meanwhile, more robust transit options will help older drivers who are considering whether they should continue driving.

The District, Virginia, Maryland and 31 other states have special provisions for older drivers that include more frequent license renewal, vision testing and road testing.

The TRIP report, using 2010 data, said that the District’s 49,226 drivers over the age of 65 accounted for 4 percent of the city’s traffic fatalities. Maryland’s 557,898 older drivers accounted for 17 percent of fatal accidents. And Virginia’s 807,561 older drivers accounted for 18 percent of fatalities.

Matt Gurwell, founder & President of Keeping us Safe offers tips to help people decide whether they should continue to drive. Gurwell, notes warning signs such as too frequent “close calls,” dents and scrapes caused by fences, mailboxes, garage doors and curbs; getting lost in familiar places; having trouble with signals, signs or markings; confusing the gas and brake pedals; misjudging gaps in traffic; experiencing road rage or honking drivers; becoming distracted; difficulty turning around while backing up; and getting multiple traffic tickets or warnings.

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