November is National Family Caregiver’s Month.

WANT TO HONOR VETERANS? HONOR THEIR CAREGIVERS

It’s no coincidence that November marks both Veterans Day and National Family Caregivers month. To truly honor veterans, we must also start honoring their caregivers.

Caregivers of veterans remain a largely invisible group. They are, at best, a footnote in debates about Medicare, veterans benefits, and budgets cuts to local services such as California’s recent decision to cut off Medi-Cal funding for adult day care centers.

Yet caregivers of veterans are not a voiceless bunch. As an advocate for caregivers of the elderly, I hear their stories every day. They speak loud and clear – if we choose to hear them. Take the words of Kathryn M. White, whose husband, a World War II veteran, is now battling Alzheimer’s disease: “I wish none of this ever happened. I wish that I had my wonderful, loving husband back but I know that is not possible.
We were the love of each others’ lives for 24 years and had a great marriage, but that Glenn has gone and I do not know this one.”

She included the following poem, written after assisting her husband through a recent doctor’s visit.

I am not just a Caregiver - I AM the Veteran

I asked the doctor, who was in a bad mood,
After I felt that he was being rude,

“Doctor have you ever put yourself in the shoes of the Vet?”

His answer made me want to shiver.

“Yes, but you’re not a Veteran…you’re just a Caregiver.”

I sat there a moment until I could find my voice.
I had to speak for all of us; he left me no choice.
With tears streaming down my face,
I had one goal: to put him in his place.

“I’m not just a caregiver and this I want you to know.
I’m the veteran and I hope it shows.
Alzheimer’s is taking his mind,
Moreover, I search for the items he can’t find.

“I am his mouth when he can’t speak.
I am his legs when his grow weak.
I am his ears when he can’t hear.
I am the one he counts on being there.

“I am his eyes when he can’t see.
I clean up the messes he makes, even his pee.
I lead him to bathe when he would rather not.
He totally depends on me; I am all he has got.

“I pick him up when he falls,
I lay awake listening for his call.

I pay the bills because he can’t think.
I prepare his meds and hand him a drink.

“We are on a journey into the unknown.
We’ll go together, as one, no, he won’t go alone.
So look into my eyes doctor, see my pain, lest you forget.
I am not just a Caregiver…I am the Vet

-- Patricia Grace, founder and CEO of Aging with Grace,

The best foods to control diabetes in the elderly

Eating healthy is important for everyone, but it's even more important for the nearly 26 million Americans who have diabetes — half of whom are older than 60. A healthy diet, coupled with regular exercise and medicine (if needed) are the keys to keeping your husband's blood sugar under control.

The American Diabetes Association offers a list of 10 superfoods for Type 1 and Type 2 diabetics. These foods contain nutrients that are vitally important to people with diabetes, such as calcium, potassium, magnesium and vitamins A, C and E. They're also high in fiber, which will help your husband feel full longer and keep his glycemic index low so his blood sugar won't spike. And they'll help keep his blood pressure and cholesterol in check, also critical for diabetics.

Beans: Kidney, pinto, navy, black and other types of beans are rich in nutrients and high in soluble fiber, which will keep blood sugar steady and can help lower cholesterol.

Dark green leafy vegetables: Spinach, collard greens, mustard greens, kale and other dark, leafy green veggies are nutrient-dense, low in calories and carbohydrates. A diabetic can't eat too much of these.

Citrus fruits: Grapefruit, oranges and other citrus fruits are rich in vitamin C, which helps heart health. Fiber in whole fruit slows sugar absorption so your husband will get the citrus fruit nutrients without sending his blood sugar soaring.

Sweet potatoes: High in vitamin A and fiber and low in glycemic index, sweet potatoes won't raise your husband's blood sugar at the same level as a regular potato.

Berries: Whole, unsweetened blueberries, strawberries and other berries are full of antioxidants, vitamins and fiber.

Tomatoes: Raw or cooked, this low-calorie food offers vital nutrients such as vitamin C, iron and vitamin E.

Fish with omega-3 fatty acids: Salmon, mackerel, herring, lake trout, sardines and albacore tuna are high in omega 3 fatty acids that help heart health and diabetes. But avoid the breaded and deep-fried variety.

Whole grains: Pearl barley, oatmeal, breads and other whole-grain foods are high in fiber and contain nutrients such as magnesium, chromium, folate and omega 3 fatty acids.

Nuts: An ounce of nuts provides important “healthy fats” along with hunger management. They also contain a nice dose of magnesium and fiber. Nuts are high in calories so a small handful each day is enough.

Fat-free milk and yogurt: These dairy foods provide the calcium and vitamin D your husband needs and can help curb cravings for snacks.

More information

For more details on healthy food choices for diabetics, including free recipes, go to diabetes.org or call (800) 342-2383.

Financial pressures driving some older Americans to drink...

Some older adults may turn to alcohol or cigarettes as a way to cope with financial stress, particularly men and people with less education, a new study suggests.

In the study, researchers surveyed 2,300 older Americans periodically between 1992 and 2006, and found that 16 percent reported growing financial strain over that time, 3 percent reported increases in heavy drinking (more than 30 drinks a month), and 1 percent said they'd started smoking more.

The youngest of the study participants were age 65 when the study began.

Older men who faced increasing financial stress were 30 percent more likely to become heavy drinkers than those who remained financially stable. This increased risk was similar for older adults with lower levels of education compared to those with more education.

Older women and seniors with higher levels of education tended to reduce their drinking when they encountered financial struggles, according to the study published in the November issue of the Journal of Studies on Alcohol and Drugs.

The findings don't actually show that financial problems were the reason for changes in smoking and drinking habits, but it is known that some people use alcohol and tobacco as a way of coping with stress, noted lead researcher Benjamin A. Shaw of the State University of New York at Albany.

"When you have a stressor that's not very controllable, people may focus on something to help control their emotional response to the stressor," he said in a journal news release.

Financial woes may be particularly stressful for older adults, Shaw added.

"They are out of the workforce, and they might feel like they have less time to recover or generally have less control over their financial situation," he explained

What every senior needs to know about hospital observation care.

How do I know the status of my hospitalization stay?

Ask your doctor or other hospital officials if you are in the hospital for observation or as a regular inpatient. If you are an observation patient, ask why. Even if you are admitted as an inpatient, the hospital can switch you to observation status; in that case, the hospital is required to notify you.

You may not be eligible for post hospitalization skilled Medicare benefits.

If you do not have three consecutive days of hospitalization as an inpatient -- excluding the day of discharge -- Medicare will not cover a subsequent stay in a nursing home. For those who do qualify, Medicare pays for up to 100 days of rehabilitation or skilled nursing care.

How long can the hospital keep me for observation?

Medicare expects patients to remain in observation status for no more than 24 to 48 hours. But there are no rules limiting the time; some patients spend several days in observation.

What can I do if the hospital won't change my observation status to inpatient?

"You cannot directly appeal the hospital's determination that you are or were an observation patient," says Ellen Griffith, a Medicare spokeswoman.

If you think you should be considered an inpatient, ask your personal physician to call the hospital and request a change in status, although your doctor cannot mandate this. If that is not successful, there are other steps you can take.

Flu shot hoping to "trick" the oldster's immune system

When it comes to getting flu shots, seniors are exceptional.

Yet despite their unusually high vaccination rates, they also account for an exceptional portion of flu-related hospitalizations: 90 percent, according to the Centers for Disease Control and Prevention (CDC).

It turns out their bodies are sluggish to react to the standard vaccines that easily rev up a younger person's immune system.

So doctors around the country are hoping to coax a better immune reaction from seniors this flu season by offering them a shot that packs four times the amount of dead flu virus to which the body can react.

This high-dose shot, manufactured by French pharmaceutical giant Sanofi Pasteur, has been proved in clinical trials to get a stronger immune response, the CDC said.

Whether a heightened immune response reduces the number of seniors contracting the flu has yet to be proved.

That clinical trial won't be completed until 2014.

But Dr. Larry Bush, an infectious-disease specialist in Atlantis, Fla., gives the shots to patients 65 and older.

So do many private physicians, supermarkets and pharmacies, including Bartell Drugs.

The elderly can choose the standard vaccine or the high-dose one. When his patients ask which he would pick, Bush tells them, "If I were over 65, I would get the high dose," he said.

Bush said that while we can't yet prove it is significantly more effective, it's certainly not less effective. And, Bush said, he's inclined to believe that a proven rise in immune response will translate to fewer cases of the flu.

"It makes sense," said Bush, a staff member at JFK Medical Center in Atlantis, Fla.

Though the CDC at one time advised only select vulnerable populations — including the elderly — to get vaccinated for the flu, that advice changed in 2008. The standing message now is that everyone 6 months and older should get a shot.

It's a message that is particularly important to older people.

"They're at much greater risk of complications and death," said Dr. David Greenberg, Sanofi Pasteur's senior director of scientific and medical affairs. "Influenza, we often say, is not just a bad cold; it's a terrible disease that can lead to hospitalizations and death."

The contagious respiratory virus can bring on a fever, headache, sore throat and runny nose. The flu can make existing chronic medical conditions such as asthma or diabetes worse. It also can cause complications such as sinus infections and bacterial pneumonia.

Flu and pneumonia are the seventh-leading cause of death in the United States among those 65 and older, according to the most recent data from the CDC.

The high-dose vaccine was licensed by the U.S. Food and Drug Administration in time for last flu season. Sanofi Pasteur estimates that 10 percent of the elderly population that was vaccinated last season opted for the high dose. The option is more widely available this year, company officials say.

Like the standard shot, the high-dose version is made of three flu strains deemed most likely to make people ill in that season.

But the high-dose shots pack more antigens, those elements that trigger a body's immune response.

Sanofi's Greenberg said the higher dose of antigens also results in more reactions from the shot.

"The downside is there are slightly more local side effects," Bush said. "A little bit more redness, a little bit more tenderness (around the shot area), a little bit more fever."

But when it comes to serious side effects, the high-dose vaccine is no different from the standard, the CDC said. "Most people had minimal or no adverse events after receiving the Fluzone High-Dose vaccine," it said.

Antidote for the Alzheimer's Epidemic: An Ounce of Will ad a Pound of Pragmatism

Surely, you’ve all read the grim reports about Alzheimer’s disease. The advancing age of the US population will usher forth an Alzheimer’s epidemic in the coming decade. The emotional toll of this epidemic will be immeasurable, and the financial impact could bankrupt the Medicare system.
That dire version of the story might sell newspapers, but it doesn’t really reflect the available options to a nation with a will to fight back. The good news is: we can manage this problem. And no elusive scientific discoveries are required to do so. We merely need to implement the medical knowledge that is already in hand.

This short summary outlines the pragmatic steps necessary to close the gap between the state of current medical knowledge and the lagging standard of care that is routinely practiced in primary care settings. We can avert this looming threat with an ounce of public will and a pound of pragmatism.

Read more...Brain Today

You're never too old to quit

Perhaps you’ve heard of the “damage is done” scenario. An elderly family member started smoking as a young person, maybe a teenager, tucking a pack of cigarettes into his rolled-up shirtsleeve or into her purse. Decades later, despite wall-to-wall anti-smoking ads, despite smoking being outlawed in nearly every public space, perhaps despite family pleas or doctors’ admonitions or even a heart attack, that person remains a smoker.

What’s the point of stopping now, he or she figures, when my body has already suffered the consequences of a lifetime of tobacco addiction? The damage is done, isn’t it?

So while the rate of smoking in those over age 65 is smaller — a bit over 8 percent — than it is in the younger population, more than 22 percent of whom smoke, older smokers are much less likely to try to stop. More than half of smokers ages 18 to 24 have tried to quit, the Centers for Disease Control and Prevention has reported, but only about a quarter of those over age 65 have. In the three decades following the first report by the surgeon general’s report on smoking and health in 1964, smoking rates dropped much more among younger adults than among older ones.

“They’ve been smoking longer, so they might be more nicotine-dependent,” said Bethea Kleykamp, a postdoctoral fellow in nicotine pharmacology at the National Institutes of Health, trying to explain those differences.

But in their article, “The Older Smoker,” recently published in The Journal of the American Medical Association, Dr. Kleykamp and Stephen Heishman, a nicotine researcher at the National Institute on Drug Abuse, argue that the damage isn’t done.

The good news for older smokers is that under the Affordable Care Act, Medicare now covers smoking-cessation counseling for any beneficiary who wants to stop. A quarter of older smokers have already made an attempt. (Previously, Medicare covered such programs only for those who already had a smoking-related disease.)

And Part D drug plans cover medications — patches, gum, pills — in most states. “We know that the best treatment is a combination of pharmacology and counseling,” Dr. Kleykamp said. You’d think that reducing smoking among the elderly population would save Medicare a boatload of money.