Struggling With an Abusive Aging Parent

The following is an excerpt from an article, written by Marc E. Agronin, MD, that appears in the New York Times New Old Age Blog.

Some new residents come into the nursing home like lions, roaring at staff members and fighting admission at every turn. Others come in like lambs, including an 84-year-old woman who arrived quietly after a complicated hip fracture ended her ability to live alone.Her presence on the unit raised little attention and no suspicion of a troubled past. But her son, when I eventually reached him, told a different tale: “My mother,” he said, “is a monster.”
Sensing my incredulity, he sighed heavily and detailed her sordid life as a boozing and gambling beast of a person who beat her son. He expressed hope that her arrival to our institutional purgatory would bring a minimum amount of care and attention as a slow but steady form of retribution.
She was thus bereft of all family contact, left abandoned in a bare room without even a single personal photograph. The son grudgingly agreed to intermittent contact with me, but not with his mother.
This woman joined a motley crew of other similarly accused characters in the nursing home — abusers, addicts, family outcasts and even a few psychopaths. Staff members are often unaware of the past sins of these residents, as they may be veiled by a lack of information, the presence of Alzheimer’s disease or other forms of memory impairment.

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Top Ten Things a Caregiver Needs from a Health Care Provider

Excellent insight from our friend Gary Barg of Today's Caregiver.

1. Attention: The caregiver's loved one may be the 27th similar case you've seen today; but to the caregiver, this is Mom or Dad, Sister or Lover.

2. Compassion: Be diligent in its application.

3. Time: A few moments of your undivided time is some of the strongest medicine you'll ever administer—and it costs so very little.

4. Respect: The person pushing the wheelchair is also part-time bookkeeper, psychologist, dietitian, insurance and incontinence expert, and a full-time general in the war they are waging with this illness. They not only need your respect, they DESERVE it.

5. Dedication: Be relentless in your devotion to your craft. The caregiver has entrusted you with their most valuable asset—their loved one. You earn that trust with your skill, knowledge base and ability. 

6. Honesty: The caregiver is your partner in this endeavor; they deserve (and can handle) the truth.

7. Prudence: The graceful administration of the truth is a true test of a caring professional.

8. Advocacy: Never accept less than the best your system has to offer their
loved one.

9. Understanding: The caregiver plays a pivotal role in the well-being of your patient; understanding the needs, wishes and fears of the caregiver improves your patient's care.

10. Your well-being: Know your emotional limit and learn when to ask for help. Your loved ones as well as the caregiver's loved one need you to remain well.

Gary Barg
Editor-in-Chief
Today's Caregiver

7 Myths about Growing Old

The graying of America.

Our country is getting grayer. The number of senior citizens in the U.S. has increased in the past decade to the point where baby boomers — those born between 1946 and 1964 — now account for a quarter of the population. And life expectancy, along with what doctors describe as our “active lifespan,” is predicted to increase by another two years in the next decade.

There are also more seniors in the workforce as boomers elect to continue working past retirement age, although this is due in part to the recent economic downturn, as well as the financial shortcomings of Social Security. The welcome presence and valuable contributions of elderly Americans is helping to debunk some common myths regarding seniors and the aging process. Here are seven such myths that have been disproved.

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Heart disease is more deadly for women

Here's who should be taking aspirin regularly, according to the American Heart Association: People at high risk of heart attack should take a daily low-dose of aspirin (if told to by their physician) and heart attack survivors should regularly take low-dose aspirin.

But new research published in the Journal of Women's Health found more than half of women who should be taking aspirin to prevent heart attack and stroke do not.

Heart disease is the No. 1 killer of women in the United States. And while slightly more women die from heart disease every year than men (432,709 women compared to 398,563 men in 2006, the most recent year for which data is available), many Americans (women especially) still mistakenly perceive heart problems as a "man's disease." There are too many women who don't know their risk for heart disease — or what to do about it.

In total, 217,987 women took the survey. Of that pool, 29,701 met the national guidelines for daily aspirin use. Only 41 percent of those who met the recommendation for primary prevention (before heart attack or stroke) reported taking aspirin on a daily basis, the researchers found. Additionally, only 48 percent of those who met the criteria for secondary prevention (after heart attack or stroke) responded "yes" to daily aspirin use.

Researchers also noticed some interesting patterns, among them that women with high cholesterol or a family history of heart disease were more likely to take aspirin.

In the Journal of Women's Health article, the researchers also note a need for more heart disease education programs for women: "This study provides direct evidence for the need for education about aspirin among clinicians and women for increased awareness and prevention of cardiovascular disease events," they write.

That doesn't mean you should go out and buy the family-size bottle of low-dose aspirin just yet. Regular aspirin use doesn't come without its own risks, such as bleeding or eye disease — and there's no hard-and-fast rule declaring aspirin a magic bullet for heart disease. Don't start (or stop) taking aspirin regularly without talking to your doctor first. He or she can help you find the right dosage. If you're healthy and have no risk for heart disease, you probably don't need the extra preventive measure.

Symptoms of Alzheimer's disease

No one experiences Alzheimer's disease in exactly the same way. As memory loss occurs, it affects cognition, coordination, personality, and standard of living very differently from person to person. However, researchers have identified some patterns in the way the disease progresses, allowing doctors to group Alzheimer's symptoms into three specific stages. This classification can help people to better understand how symptoms might unfold after an Alzheimer's diagnosis and can assist families in making plans for the future.

It's important to keep in mind, though, that while Alzheimer's symptoms have been clustered into stages, there's no way to tell how long any one stage or symptom will last or how quickly others will progress. People with Alzheimer’s die on average about four to six years after their diagnosis, but the disease can also take its relentless toll for as long as 20 years before death occurs.

Alzheimer's Symptoms:

You've forgotten where you've placed your keys. Or you can't remember the name of an actress in a particular movie. Or maybe you are relying more and more on notes to remind yourself you need to do important tasks. Are you suffering from Alzheimer's?

In most cases, the answer is probably not. Most of us experience some “normal” loss of memory, those annoying “senior moments,” as we age. Experts say that misplacing your keys isn’t the issue; forgetting what the keys are used for, however, can be. With this in mind, if you or a loved one is having memory problems that seem to be getting worse more rapidly or happening much more frequently than before, it might be time to pay your doctor a visit.

The following are some early warning signs of Alzheimer's, along with caveats you should keep in mind:

Forgetfulness -  People with early Alzheimer's often find themselves regularly forgetting important information they've just recently learned. On the other hand, there’s probably no need to worry about occasional lapses, such as misplacing your wallet or forgetting names — these types of memory lapses are normal and happen to most people as they get older.

Difficulty completing tasks - People with early Alzheimer's might not be able to remember the steps needed to cook a meal, balance a checkbook, or use a computer program. However, forgetting what you were just going to say or why you went into a particular room isn't unusual when it happens every now and then.

Disorientation - If you've found yourself getting lost in your neighborhood, or ever feel as if you suddenly don't know how to get home because you've forgotten where you are and how you got there, these are signs that could indicate the presence of Alzheimer's. But remember, both of these issues are much different than simply forgetting where you were headed, which can happen to anyone from time to time.

Misplacing objects - Putting objects in strange places — like your car keys in the microwave, or your hair dryer in the washing machine — can be a sign of early Alzheimer's disease. Don't worry if you or your loved one temporarily misplaces keys or a purse, though.

Lapses in judgment - If you notice that you or your loved one has started exhibiting some strange behaviors — like putting on several heavy layers of clothing on a warm day, wearing the same clothes day after day, or giving lots of money away to telemarketers or scam artists, there's reason to suspect Alzheimer's might be present.

Saving for retirement...there's an app for that

The following is an interesting article that appeared in Employee Benefit News.

Amid mounting concern about the nation’s savings rate and financial illiteracy, employers face enormous pressure to move the needle on retirement preparedness. One possible solution is to tap the wildly popular gaming trend, which, in turn, can actually help make retirement planning fun and more engaging than traditional approaches to employee education.

Among the financial providers looking to make a mark, ING U.S., has released a new mobile game app designed to help build investment and retirement planning awareness for consumers of all ages. Available for free on the App StoreSM for iPhone, iPod touch and iPad, the “Struct” application leverages the power of “gamification,” which integrates game elements such as points, levels and a leader board. It also exposes players to fundamental investing concepts and terms.

The premise of the game is for players to work with various building materials that symbolize different investment categories – steel (cash), wood (bonds) and glass (stocks) – as they build increasingly complex towers or “structs.” Three main characters, called the build crew, correspond to a unique investor style: aggressive, moderate and conservative. A fourth crewmember is a wild card, representing both market opportunity and risk.

Through crew selection and game objectives, metaphors about saving and investing are conveyed that parallel the concepts of risk, diversification, goals and achievement. Crew selection, a diversified strategy and material handling are critical to a player’s success.

“We know many individuals need to do more when it comes to preparing for their retirement,” said Rick Mason, president of corporate markets for ING U.S. Retirement, which hopes to promote financial literacy. “Gaining greater awareness about accepted investing and saving principles is a critical part of that process.”

Nielsen research shows game apps are the most downloaded items by smartphone owners, and iPhone users are playing games an average of 14.7 hours a month. Moreover, data from the Employee Benefit Research Institute and Newzoo suggests that there are more people in the U.S. who meet the definition of active gamers than who save for retirement. 

Players of Struct are introduced to each of the 12 game levels by an instruction guide, which provides tips that challenge the player to work with different building material and crewmembers. Each level brings new complexity, and the right combination of crew, material placement and speed helps the player score points and unlock achievements.

There are also surprise moves one can discover as they engage in play, including breakage, bonus points and the ability to discard a crewmember’s building material. The “Build School” brings the metaphors to life, demonstrating how investor style and asset classes can affect the outcome, while the game’s glossary helps to build knowledge of key financial terms.

Foster care for Vets

With increasing options in health care for the aging population, some American war veterans who could live in nursing homes for free are choosing to use their own money to fund their stays in medical foster homes through the Department of Veterans Affairs Medical Foster Home Program, reports a New York Times article.

Since the program’s beginning in 2000, nearly 1,500 veterans have been placed with voluntary caregivers who receive monetary compensation from veterans for care they provide. Most veterans using the program, with an average age of 70, remain in their medical foster homes until they pass away, according to the article.

The program was established to promote better better quality care of for veterans and currently operates in 36 states.

The New York Times reports:

It costs a site about $260,000 a year to introduce the program; each site can serve up to 30 vets. The V.A. finances each place for two years, after which the program is expected to be self-sustaining, said Dr. Thomas Edes, national director of geriatrics and extended care operations at the V.A.

Though medical foster homes are intended to provide better care, not to reduce costs, they operate for half the cost of nursing homes. “It is quite likely that it will save V.A. money and taxpayer money and veterans’ money,” Dr. Edes national director of geriatrics and extended care operations at the V.A said.

Given the vulnerability of the older veteran population, the V.A. approval process is rigorous. Only one in 10 to 15 applicants are selected. People with no formal training can apply, however, and many with family caregiving experience do. Once a veteran is placed in a home, the V.A. provides training for tasks like cleaning wounds, managing incontinence and safely transporting the new residents.

Veterans pay $1,800 to $3,000 a month for care, depending on their medical needs, often using their combined V.A. and Social Security benefits.

A national V.A. study measuring veterans’ satisfaction and costs won’t be completed until 2013 and 2015. But 30 percent of veterans who would qualify for V.A.-paid nursing homes choose instead to pay out of pocket for medical foster homes — evidence, Dr. Edes. said, that they prefer a home setting.

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