Seniors and Diabetes

The following article was originally published by National Care Planning Council:

In 2011, almost 11 million older adults living in the U.S–nearly 27 percent of people 65 or older–have diabetes. [i] Below is some information and tips on how to manage and prevent Diabetes.

I don’t have Diabetes, what is it?

Diabetes means your blood glucose (often called blood sugar) is too high. Your blood always has some glucose in it because your body needs glucose for energy to keep you going. But too much glucose in the blood isn’t good for your health. [i]

Glucose comes from the food you eat and is also made in your liver and muscles. Your blood carries the glucose to all of the cells in your body. Insulin is a chemical (a hormone) made by the pancreas. The pancreas releases insulin into the blood. Insulin helps the glucose from food get into your cells. [i]

If your body does not make enough insulin or if the insulin doesn’t work the way it should, glucose can’t get into your cells. It stays in your blood instead. Your blood glucose level then gets too high, causing pre-diabetes or diabetes. [i]

Aren’t there different types of Diabetes?

So glad you asked. There are three main kinds of diabetes: type 1, type 2, and gestational diabetes. The result of type 1 and type 2 diabetes is the same: glucose builds up in the blood, while the cells are starved of energy. [i]

Type 1 Diabetes

Type 1 diabetes, formerly called juvenile diabetes or insulin-dependent diabetes, is usually first diagnosed in children, teenagers, or young adults. With this form of diabetes, the beta cells of the pancreas no longer make insulin because the body’s immune system has attacked and destroyed them. About 5 to 10 percent of people with diabetes have type 1 diabetes. [i]

Type 2 Diabetes

Type 2 diabetes, formerly called adult-onset diabetes or non-insulin-dependent diabetes, is the most common form of diabetes. People can develop type 2 diabetes at any age — even during childhood. This form of diabetes usually begins with insulin resistance, a condition in which the body not use insulin properly. At first, the pancreas keeps up with the added demand by producing more insulin. In time, however, it loses the ability to secrete enough insulin in response to meals. 95% of people with diabetes have type 2. Type 2 diabetes is also more common in people with a family history of diabetes and in African Americans, Hispanic Americans, American Indians, Alaska Natives, and Asian and Pacific Islanders. Being over 45 years of age and overweight or obese raises the risk of developing type 2 diabetes. [i]

Gestational Diabetes

Some women develop gestational diabetes during the late stages of pregnancy. Gestational diabetes is caused by the hormones of pregnancy or a shortage of insulin. Although this form of diabetes usually goes away after the baby is born, a woman who has had it and her child are more likely to develop diabetes later in life. In fact, women who have had gestational diabetes have a 35% to 60% chance of developing diabetes in the next 10-20 years, according to the CDC. [i]

Pre-diabetes

Pre-diabetes means your blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. People with pre-diabetes are at an increased risk for developing type 2 diabetes and for heart disease and stroke. The good news is that if you have pre-diabetes, you can reduce your risk of getting type 2 diabetes. With modest weight loss and moderate physical activity, you can delay or prevent type 2 diabetes. [i]

What are some signs of Diabetes?

Many people with diabetes experience one or more telling symptoms, including extreme thirst or hunger, a frequent need to urinate and/or fatigue. Some lose weight without trying. Additional signs include sores that heal slowly, dry, itchy skin, loss of feeling or tingling in the feet and blurry eyesight. Some people with diabetes, however, have no symptoms at all. [i]

If Diabetes is Not Controlled

Diabetes is a very serious disease. Over time, diabetes that is not well controlled causes serious damage to the eyes, kidneys, nerves, and heart, gums and teeth. If you have diabetes, you are more than twice as likely as people without someone who does not have diabetes to have a heart disease or a stroke. People with diabetes also tend to develop heart disease or stroke at an earlier age than others. Over the years, high blood glucose damages nerves and blood vessels, oftentimes leading to complications such as heart disease, stroke, blindness, kidney disease, nerve problems, gum infections, and amputation. [i]

Economic Burden of Diabetes in the US

$174 billion – Total costs of diagnosed diabetes in the United States in 2007.[iii]

  • $116 billion for direct medical costs [iii]
  • $58 billion for indirect costs (disability, work loss, premature mortality) [iii]

After adjusting for population age and sex differences, average medical expenditures among people with diagnosed diabetes were 2.3 times higher than what expenditures would be in the absence of diabetes.[iii]

The total cost of diabetes in the United States in 2007 was $218 billion.[iii]

  • $174 billion for people with diagnosed diabetes [iii]
  • $18 billion for people with undiagnosed diabetes [iii]
  • $25 billion for American adults with pre-diabetes [iii]
  • $623 million for gestational diabetes [iii]

Preventing Diabetes

Whether you’re 20 or your 65 and you have yet to become Diabetic, it’s very important to do a few simple things to help in the prevention of Diabetes.  There are a few major things you can do to aid in the prevention of Diabetes:

  • Control Stress
  • Eat a balanced diet
  • Exercise
  • Limit sugar intake
  • Regular Dr. Checkups
  • Quit smoking (if applicable)

Controlling Diabetes

If you are already diabetic, it is very important to manage your diabetes.

Check blood glucose levels each day and log the results. This way you and your doctor can determine if your diabetes management plan is working. [ii]

Eat a balanced diet

Manage Stress

  • Relaxation techniques, practiced regularly, have been found to help people with type 2 diabetes — for whom stress blocks the body from releasing insulin — better manage their bodies’ ability to regulate glucose and thereby avoid complications. [iv]

Exercise

  • It has been shown to improve glucose tolerance – meaning that blood sugars are controlled with less medication. [iv]
  • It lowers the chance of developing serious complications from diabetes. [iv]
  • It helps the body manage stress. [iv]
  • It helps with weight control. [iv]

Visit your Dr regularly

Quit smoking (if applicable)

  • Unfortunately, smoking increases a person’s chance of developing diabetes complications — such as retinopathy, heart disease, stroke, vascular disease, kidney disease, nerve damage, problems with feet and more — in addition to increasing their risk of developing diabetes in the first place.  [iv]

Food to Eat and Avoid

Breads and Grains

Best Choices Worst Choices
Whole-grain flours, such as whole wheat flour White flour
Whole grains, such as brown rice Processed grains, such as white rice
Cereals containing whole-grain ingredients and little added sugar Cereals with little whole grain and lots of sugar
Whole-grain bread White bread
Baked potato or baked steak fries French fries
Whole-grain flour or corn tortillas Fried white-flour tortillas

Vegetables

Best Choices Worst Choices
Fresh vegetables, eaten raw or lightly steamed, roasted, or grilled Frozen vegetables, lightly steamed Canned vegetables with lots of added sodium Vegetables cooked with lots of added butter, cheese, or sauce
Fresh cucumbers Pickles (only if you need to limit sodium; otherwise, pickles are a good choice)
Fresh shredded cabbage or coleslaw Sauerkraut, (same as pickles; limit only if you have high blood pressure)

Fruit

Best Choices Worst Choices
Frozen fruit or fruit canned in fruit juice Canned fruit with heavy sugar syrup
Fresh fruit Chewy fruit rolls
Sugar-free or low-sugar jam or preserves Regular jam, jelly, and preserves (unless portion is kept small)
No-sugar-added applesauce Sweetened applesauce
100% fruit juice or low-carb juices Fruit punch, fruit drinks, fruit juice drinks, sweetened soda

Meats and Protein

Best Choices Worst Choices
Baked, broiled, grilled, or stewed meats Fried meats
Lower-fat cuts of meat, such as top sirloin Higher-fat cuts of meat, such as ribs
Turkey bacon Pork bacon
Low-fat cheeses Regular cheeses
Skinless breast of chicken or turkey Poultry with skin
Baked, broiled, steamed, or grilled fish Fried fish
Tofu lightly sautéed, steamed, or cooked in soup Fried tofu
Baked or stewed beans Beans prepared with lard

Dairy

Best Choices Worst Choices
1% or skim milk Whole milk
Low-fat yogurt Regular yogurt
Low-fat cottage cheese Regular cottage cheese
Nonfat sour cream Regular sour cream
Frozen low-fat, low-carb yogurt Regular ice cream
Nonfat half and half Regular half and half

Fats, Oils, Sweets

Best Choices Worst Choices
Baked snacks, such as baked potato chips, baked corn chips, puffed rice, or corn snacks Snacks fried in fat, such as potato chips, corn chips, pork rinds
Vegetable oils, non-hydrogenated butter spreads, margarine Lard, hydrogenated vegetable shortening, butter
Reduced-fat mayonnaise Light salad dressings Regular mayonnaise Regular salad dressings
Air-popped or calorie-controlled popcorn Butter-flavored stove-top popcorn

Beverages

Best Choices Worst Choices
Water, unflavored or flavored sparkling water Regular sodas
Light beer, small amounts of wine or non-fruity mixed drinks Regular beer, fruity mixed drinks, dessert wines
Unsweetened tea (add a slice of lemon) Sweetened tea
Coffee, black or with added low fat milk and sugar substitute Coffee with sugar and cream
Home-brewed coffee and hot chocolate Flavored coffees and chocolate drinks
Sport drinks Energy drinks

Tables above are from: WebMD

10 Dangerous Foods to Avoid

Candy

Not only do high-sugar foods like candy, cookies, syrup, and soda lack nutritional value, but these low-quality carbohydrates also cause a dramatic spike in blood sugar levels and can contribute to weight gain, both of which can worsen diabetes complications. Learn to satisfy your sweet tooth by snacking on high-quality carbohydrates such as fresh fruit. Apples, berries, pears, grapes, and oranges all have sweet, juicy flavors and are packed with fiber to help slow the absorption of glucose, making them a much better choice for blood sugar control. When snacking on fruit, pair it with a protein food, such as a string cheese, nonfat yogurt, or handful of nuts, to further reduce the impact on your blood sugar. [v]

 Fruit Juice

While whole fruits are a healthy, fiber-rich carbohydrate option for diabetics, the same can’t be said for fruit juice. They may offer more nutritional benefit than soda and other sugary drinks, but fruit juices — even 100 percent fruit juices — are chock full of fruit sugar, and therefore cause a sharp spike in blood sugar. Skipping the glass of juice and opting for the fiber-packed whole fruit counterpart will help you maintain healthy blood sugar levels and fill you up on fewer calories, aiding in weight loss. For a refreshing and healthy drink alternative, choose zero-calorie plain or naturally-flavored seltzer and jazz it up with a wedge of lemon or lime. [v]

Raisins

Eating raisins or other dried fruits may be a better option than snacking on cookies, but it’ll still spike your blood sugar. Why? During the dehydration process, fruits’ natural sugars become very concentrated, causing an unhealthy elevation in blood sugar when they are rapidly absorbed by the body. Just one more reason to stick with whole, fresh fruit options like grapefruit, cantaloupe, strawberries, and peaches. [v]

Pancakes & Syrup

A plate of pancakes with syrup is a total carb explosion and one of the absolute worst breakfast choices for someone with diabetes. Most pancakes are jumbo-sized and made with junky white flour, so downing a stack of three large flapjacks can be the equivalent of eating seven slices of white bread! Of course, the toppings make matters worse. Butter is loaded with artery-clogging saturated fat, and a typical half-cup pour of gooey pancake syrup adds 16 teaspoons of straight sugar to your breakfast! This starch-and-sugar overload will send your blood sugars into a tailspin (not to mention, help you pack on the pounds). Next time you’re at a diner, bypass the pancakes and instead order a low-carb, protein-rich egg white omelet stuffed with vegetables. [v]

French Fries

Overdoing it on greasy, fried foods can lead to weight gain and wreak havoc on your blood sugar. French fries, potato chips, and doughnuts are particularly bad choices for diabetics because they’re made with carb-heavy, starchy ingredients, which can cause blood glucose levels to shoot up. Fried foods soak up tons of oil, leading to lots of extra calories — and some, like fried chicken and many fried appetizers, are coated in breading which increases the calorie count even more. Many fried foods are also laden with unhealthy trans fats because they’ve been deep-fried in hydrogenated oils, which will raise your bad cholesterol and increase your risk of heart disease. Whether you already have diabetes or are working to prevent it, no amount of trans fats can be safely incorporated into your diet, so it’s best to check labels and keep hydrogenated oils far from your plate. [v]

White Bread

Refined starches — white bread, white rice, white pasta, and anything made with white flour — act a lot like sugar once the body starts to digest them. Therefore, just like sugar, refined starches interfere with glucose control and should be avoided by those with diabetes. Whole grains are a better choice because they’re richer in fiber and generally cause a slower, steadier rise in blood sugar. Instead of white bread or a bagel for breakfast, opt for a toasted whole grain English muffin (topped with a slice of reduced-fat cheese or scrambled egg for protein). At lunch and dinner, replace white carbs with healthier whole grain options such as brown or wild rice, barley, quinoa, and whole-wheat bread to minimize the impact on your blood sugar. Even high-quality, whole grain starches elevate blood glucose to some degree, so it’s still important to limit portions — stick with ½ to ¾ cup cooked grains or just 1 slice of bread at meals. [v]

Whole Milk

Saturated fats in dairy products have racked up a laundry list of negative side effects including raising “bad” (LDL) cholesterol and promoting inflammation throughout the body. But for those with diabetes, a diet high in saturated fat can cause another serious problem: Studies have shown that saturated fats can worsen insulin resistance. Keep whole milk out of the fridge, and pick up 1% low-fat or skim milk instead. Also, try your best to avoid whole-milk dairy products like cream, full-fat yogurt, regular cheese and cream cheese; instead, choose their reduced-fat counterparts whenever possible. [v]

Bacon

In addition to whole-fat dairy foods, fatty or marbled cuts of meat also carry a hefty amount of saturated fat, which initiates inflammation in the body and raises cholesterol levels. Since those with diabetes are already at an increased risk of heart disease, eating high-fat meats puts them at an even greater risk of heart disease than the average person. Instead of feasting on fatty bacon, hamburgers, bologna, hot dogs, or spare ribs, fill your plate with lean protein choices like skinless chicken and turkey, fish and shellfish, or lean pork tenderloin. [v]

Snack Cakes & Pastries

It’s common knowledge that packaged snacks and baked goods are loaded with sugar, sodium, junky white flour and preservatives. Their dangerous combo of sugar and refined flour spikes blood sugar and promotes inflammation, which interferes with insulin’s ability to function properly. If that isn’t enough to turn you away from the vending machine, you should know that these highly-processed sweet treats often contain trans fats. These toxic fats raise your cholesterol and risk of heart disease, and are by far the most dangerous of fat types for diabetics. Check labels carefully; always choose packaged products that list 0 grams trans fat and do not include any partially hydrogenated oils (a major source of trans fats) on the ingredients panel. By ditching these packaged desserts, you’ll save calories and cash and get a better handle on your blood sugar control. [v]

Pretzels

Pretzels have a healthy image, but a glance at the ingredients list reveals that their wholesome reputation is grossly undeserved. Nearly every brand is made from the same basic ingredients: white flour (wheat flour that’s been stripped of its nutrients and fiber), yeast, salt, and maybe some vegetable oil or corn syrup. It’s obvious from its subpar ingredient list that this popular snack is pretty much devoid of nutrition. Pretzels are baked, not fried like potato chips, which saves you a few calories, but the white, refined carbs do a number on your blood sugar and do little to satisfy your appetite. Skip the carb-fest and opt for a more balanced and filling snack that includes some protein to help steady your sugars. Great choices include a rice cake with reduced-fat cheese, a handful of pistachio nuts in the shell, or a nonfat Greek yogurt. [v]

[i] http://nihseniorhealth.gov/diabetes/diabetesdefined/01.html

[ii] http://www.homeinstead.com/senior-care-resources-illnesses-conditions/diabetes/pages/diabetes-care.aspx

[iii] http://www.homeinstead.com/senior-care-resources-illnesses-conditions/Diabetes/Pages/impactofdiabetes.aspx

[iv] http://www.care.com/senior-care-caring-for-seniors-with-diabetes-p1143-q317305.html

[v] http://www.joybauer.com/photo-gallery/worst-foods-for-diabetes.aspx

Written by Valerie Michel Buck

 Visiting Angels is a member of  The National Care Planning Council (NCPC), an organization dedicated to helping families recognize the need for long term care planning. More information is available at www.longtermcarelink.net.

~ Lori

Lori Holmgren RN, MSN

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What to Do with Dad’s Stuff

It’s been 12 weeks since my father died, but I still haven’t completely come to terms with the fact that he’s gone. I’m still surprised to come home every evening and see his reclining lift chair empty. I keep wanting to ask him if he wants his nightly ice cream. I miss his huge smile, as if the ice cream was the best thing in the whole world.  

But now the most painful part of the process is deciding what to do with his belongings.  I’ve given some things to charity, as he would have wanted me to do.  I’m going to give his shoes to “The Shoe Man.”  The Shoe Man, for those who are unfamiliar, is a charity that takes discarded shoes and sells them, the proceeds of which are used to build wells in impoverished countries.  He would have liked that. You see, my father was a Shriners Clown; he loved making children happy and giving selflessly to others. So anything of his that would help children and others would be important to him.

But I don’t want to do it. I don’t want to go through his things.  I am still too sad.  I miss him terribly and am still grieving.  So I have decided to wait a while longer to do this sad yet important task.  There is no law that says I have to do this within 12 weeks; there is no deadline.  The lesson here is to know that the time will be right when I am ready.  It is okay to be sad and move through this at my own pace.  I loved my Father dearly, and I miss him terribly. Of course it will be very difficult to go through his things.  And if I need another or a couple of more months to be ready, that is totally acceptable.  I will continue to talk about him, tell my friends that I miss him and am sad.  And when I look at his recliner lift chair, I will continue to picture him smiling about his ice cream treat.

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The Accidental Caregiver

The following article was originally published by National Care Planning Council:

You’ve heard people say it and maybe you have even said it yourself.  “Don’t worry Mom or Dad, I’ll take care of you in your old age.”

This always seems to be a simple loving gesture on your part as you see them beginning to age and settle into retirement.  The thought of their actually failing in health or mental capabilities seems absurd or at most, years down the road. Thus it catches most children and spouses unprepared and sometimes surprised when their loved one needs care and help with daily living activities.

A stroke, injury or sudden illness may result in the immediate need for a significant caregiving commitment.  On the other hand a slowly progressing infirmity of old age or the slow onset of dementia may require intermittent caregiving.  Either way, if you have not made provisions for this, you will accidentally become a “caregiver.”

Former first lady Rosalynn Carter made this statement,

“There are only four kinds of people in this world: those who have been caregivers, those who currently are caregivers, those who will be caregivers, those who will need caregivers.”

Statistics show that the possibility of becoming a family caregiver grows yearly.

“43.5 million of adult family caregivers care for someone 50+ years of age and 14.9 million care for someone who has Alzheimer’s disease or other dementia.”
Alzheimer’s Association, 2011 Alzheimer’s Disease Facts and Figures, Alzheimer’s and Dementia , Vol.7, Issue 2.

“The value of unpaid family caregivers will likely continue to be the largest source of long-term care services in the U.S., and the aging population 65 and over will more than double between the years 2000 and 2030, increasing to 71.5 million from 35.1 million in 2000.” Coughlin, J., (2010). Estimating the Impact of Caregiving and Employment on Well-Being: Outcomes & Insights in Health Management, Vol. 2; Issue 1

There are two types of caregiving scenarios, Formal and Informal.

Formal Caregivers

Formal caregivers are care providers associated with a service system.  Service systems might include for-profit or nonprofit nursing homes, intermediate care facilities, assisted livinghome care agencies, community services, hospice, church or charity service groups, adult day care, senior centers, association services and state aging services. Professional care managers and legal and financial professionals can also be of help.  Some these formal caregiver services are covered by Health Insurance, Long Term Care InsuranceMedicare and VA Benefits.  Otherwise for formal care where there is a charge, payment is out-of-pocket by the individual or family members.  Private pay, out-of-pocket for long term care services can be costly and advance financial planning is advised when possible.

Informal Caregivers

Informal caregivers are family, friends, neighbors, or church members who provide unpaid care out of love, respect, obligation, or friendship to a disabled person.
The number of informal caregivers range from 20 million to 50 million people.  This could represent about 20% of the total population providing part-time or full-time care for loved ones.

About two-thirds of those caregivers for people over age 50 are employed full-time or part-time and two-thirds of those–about 45% of all working caregivers–report having to rearrange their work schedule decrease their hours or take an unpaid leave in order to meet their caregiving responsibilities.

The average amount of time informal caregivers provide assistance is 4.5 years, but 20% will provide care for 5 years or longer (National long term care survey 1999).

Below are some of the activities provided by or supervised by informal caregivers. The Accidental Caregivers, involved in this type of care, will find themselves picking up a few things that need to be done or supervised in the beginning and adding more as the need increases.

  • Managing money and paying bills
  • Writing letters or notes
  • Making repairs to the home, maintaining a yard, and removing snow
  • Providing comfort and assurance or arranging for professional counseling
  • Answering the phone
  • Making arrangements for meeting medical needs and doctors’ appointments
  • Shopping and running errands
  • Providing transportation
  • Maintaining the household
  • Attending to personal hygiene and personal grooming
  • Administering medications
  • Help with walking, lifting, and bathing
  • Help with using the bathroom and with incontinence
  • Providing pain management
  • Preventing unsafe behavior and preventing wandering
  • Feeding
  • Providing meals
  • Doing the laundry
  • 24 hour care and monitoring
  • Nutrition management
  • Financial planning
  • Legal directives
  • Medical directives
  • End of life planning

Understanding the Progression of Care Commitment

The chart below illustrates the relationship of informal care to formal care.  As care needs increase, both in the number of hours required and in the number or intensity of activities requiring help, there is a greater need for the services of formal caregivers.

The Progression of Care Commitment
(The Four Steps of Long Term Care Planning, National Care Planning Council)

“Unfortunately, many informal caregivers become so focused on their task, they don’t realize they are getting in over their heads and that they have reached the point where partial or total formal caregiving is necessary.  Managing their own needs and daily schedule along with those of the person they are caring for can become so consuming and energy depleting that the caregiver themselves are in need of care.  It becomes time to bring in other family members, professional services and medical advisors to create a plan of care that is best for all involved.” - National Care Planning Council

Caregiver stress and caregiver burnout are serious issues that face caregivers providing both formal and informal care. Make certain you take care of yourself as well as take care of your loved one. The work of caregiver is difficult, but as caregiver Marlo Solitto said “Caregiving can be one of the most rewarding experiences of your life.”

Visiting Angels is a member of  The National Care Planning Council (NCPC), an organization dedicated to helping families recognize the need for long term care planning. More information is available at www.longtermcarelink.net.

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The Beginning of End-of-Life Planning

With the new year fast approaching, now is the perfect time to think about future planning for yourself and your loved ones. The following article was originally published December 6, 2013 by National Care Planning Council:

There are so many moments when you think about what you want for your final years in life. It’s never too late and never too early to prepare yourself and those around you for your final wishes.

This article provides an outline of the documents you should gather and distribute amongst your trusted Care Advocates. This outline is also something to help you prepare for your final years to help ensure peace of mind.

What are Care Advocates?

Your Care Advocate represents your interests. This person could be a caregiver, a child, a friend, an attorney or trusted advisor. These individuals can be vital when making caregiver decisions, arranging funding for services, arranging services or coordinating care. These individuals may also be responsibility for your power of attorney. Remember to choose those whom you trust as some of your information is personal and financially sensitive.

Health Care

  • Who are you entrusting to make your health care choices if you are not able to do so?  You may avoid this by setting up a living will or advanced directive.
  • What treatments would you like to have or would rather refrain from in case you become very ill?
  • Would you like to be resuscitated in case you stop breathing or your heart stops?
  • Would you like your family to pull the plug in cases where the option may be necessary?
  • If you need caregiving would you like this to be done through a home health care service or in a facility?
  • Have you considered purchasing long term care insurance?  Long-term care insurance helps pay for the care you need when you can no longer care for yourself.
  • Would you like to spend your very last days in a hospital, at home or in a hospice facility?
  • Do you have a living will to make sure your wishes for end of life health care are being executed?

Family and Estate

  • Is your will up to date? Does it reflect your current wishes and desires?
  • Have you chosen an executor of for your estate? Is this executor honest and able to complete your wishes?
  • Does your executor have all the facts they will need to settle your estate?
  • Have you considered working with an estate planner?
  • If you are caring for a loved one, elderly or minor, have you made arrangements for their care and guardianship?
  • Have you talked to elder law attorney about setting up a living will or advanced directive?
  • Have you talked to your children and grandchildren about who receives certain objects from you such as furniture, heirlooms, and mementos?
  • Have you talked with family about counseling for those who survive your death?

Finances

  • Have you set up your Power of Attorney? Have you decided on a trusted Care Advocate to pay bills and make financial choices on your behalf if you are unable to do so?
  • Do you have an updated list of your assets, debts and creditors?
  • Do you have a trusted Care Advocate that you can give access to your bank and investment accounts?
  • Do you have a trusted Care Advocate who can find all your legal papers, such a living will, birth certificate, etc? Do they have access to your safe deposit box?
  • Are your assets titled in a way where they can be dispersed after your death?  Is this in your will? Is your lawyer and or executor of your estate aware of this?
  • Does your pension(s), Social Security, Life Insurance, and Retirement Account(s) have the proper beneficiaries?
  • Do you own a business or are you a partner in a business? Who will run the business if you are unable to?
  • Have you arranged your funeral, burial or cremation? Does your Care Advocate know about these arrangements?
  • If you are a veteran or the surviving spouse of a veteran, have you considered applying for benefits from the Department of Veterans Affairs? Here is a list of VA Accredited individuals who advocate for veterans.

Other Important Issues

  • Have you talked to your spiritual elder about any religious concerns?
  • Have you tied up any loose ends such as estranged friends or relatives you would like to reconnect with?
  • Do you have any questions about death you need to discuss with a counselor or spiritual elder?
  • Would you like to leave anything written (including medical history, great stories, etc) or pictures to future generations?

It is always best to be well prepared for the end of your journey on earth, it helps ease the burden of family, friends and helps you get the best care for yourself with little misinterpretation to your final wishes and desires.

Visiting Angels is a member of  The National Care Planning Council (NCPC), an organization dedicated to helping families recognize the need for long term care planning. More information is available at www.longtermcarelink.net.

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Loss of an elderly parent

We all know that we will lose our parents one day.  We might even know that their passing is a blessing: no more suffering, no more sadness, no more struggle with disease or pain.  But no matter how much we know that day is coming and feel like we are ready, the impact is always tremendous.

This past October, my 93 year-old father died from a sudden bout of pneumonia. Despite the fact that we buried him more than a month ago, it feels like only yesterday.  Why couldn’t he be with us for one more Thanksgiving?  One more Christmas?  One more birthday, his 94th?  In my mind I know he is no longer suffering. But my heart misses him more than I can say and more than I can stand.

Now my sister and I are telling ourselves the same things we tell our clients when a parent dies: There is no set-in-stone timetable for mourning; give yourself permission to grieve as long as you need to.  You can leave your parent’s belongings right where they are until you are truly ready to handle the process of organizing, cleaning out drawers and closets, and giving things away.

Supportive friends, family, and community resources can help you grieve at your own pace. If your parent was on hospice, you can get emotional support from the hospice or your personal clergy.

I find comfort in my memories. I’ll always remember how Dad used to delight us with his animated stories of military service in World War II. I’ll never forget the way he would light up light a child every evening when he got his ice cream treat. Remembering those moments brings a smile to my face. But the memories are bittersweet: He won’t be telling those stories anymore.  He will never again ask for more ice cream. Nevertheless, he is always with me in my thoughts.

Talk about your parent; tell their stories. Your parent may not be physically living, but you can keep him or her alive in your memory. Dad can’t tell me any more stories about World War II, but when I find myself sharing them, I feel like I am honoring his memory and healing myself at the same time.  I may not have another Christmas with him, but this Christmas I will be telling his stories, just like he used to do; I will be making someone smile just like he would be doing. And I will keep doing that to feel close to him, because when I tell his stories, it feels like he is still right there with me.

Lori Holmgren RN, MSN

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Elderly Sleep Issues

Our bodies just aren’t made to last forever. They wear out and that creates all sorts of issues; sleep disorders being just one of many.

As we age, we tend to need less and less sleep. For example, senior citizens generally require 30-60 minutes less sleep than those younger than them (MedlinePlus, U.S. National Library of Medicine). In addition to the duration of the sleep, sleep intervals are also shortened. It’s not unusual for an elder to wake up several times per night for no apparent reason.

There are many, many reasons that sleep may be disturbed. In addition to simple age, some of those might include:

  • Depression
  • Inactivity (no regular exercise)
  • Associated pain (i.e., arthritis)
  • Medication side effects
  • Use of alcohol or caffeine

Of course, when an elder complains of lack of sleep or appears more tired than usual it prompts a caregiver to consider a physician’s visit, which is to be expected. A thorough exam with a complete history may show some insights as to the reasons for the poor sleep patterns. Yet, it is also likely that no one area will be identified as the cause, thus requiring a slow methodical elimination of potential causes; such as treating any chronic pain issues or reviewing and altering medications. It is also very important that solid information be obtained from the elder during this treatment period.

There are some simple, yet effective ways to improve one’s sleep:

  • Don’t eat too close to bedtime
  • Reduce the intake of alcohol and caffeine during the day, and especially just prior to bedtime
  • Avoid watching TV in bed
  • Increase your exercise programs (with your doctor’s permission, of course)
  • Try reading prior to bed
  • Make certain you stick to a routine, i.e., getting up and going to bed at the same time every day

Obtaining the proper level of sleep can be difficult. All sorts of issues can invade our minds as we try to fall asleep at night. The aging process doesn’t seem to cooperate with the sleep process very well.

Follow some of the easy tips mentioned above and hopefully sleep will once again be a pleasantry that you anticipate at the end of every day.

(Source: www.nlm.nih.gov/medlineplus/ency/article/000064.htm)

Lori Holmgren RN, MSN

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Healthy Living and Successful Aging

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The United States is experiencing a remarkable increase in the number of people who live to an old age. Our older population (people 65 years or older) numbered nearly 40 million in 2009 (latest year of available data). These folks represent one in every eight Americans, or 13% of the population. By 2030, it is projected that the U.S will be home to more than 72 million people age 65 and older.

This astonishing increase is largely a result of medical and health care advancements that simply allow people to live longer. Currently, the average life expectancy of an American is about 80 years old (nearly double that of our ancestors).

Health is Wealth

Living a long life is a goal most of us have in common. Ensuring that we spend the latter years of our life feeling healthy and happy should be an important part of that goal.

Health is indeed wealth, especially as we age. Embracing a healthy lifestyle and making health our number one priority will bring invaluable wealth to us as we age.

Although growing older is inevitable, there are many things we can do to avoid feeling older. Medical breakthroughs have and will extend our longevity, but how we decide to live our senior years will be crucial. Managing our physical health, maintaining relationships, following safety tips, and making adequate preparations to fund our retirement and long term care can help us make the most of our so-called ‘golden years.’

Below are suggestions for healthy living that will help each of us age successfully.

Stay Connected and Productive

One of the most important things you can do to stay healthy and happy as you age is to maintain your sense of purpose by staying productive and connected to people and things that are important to you. Spend quality time with at least one person (a family member, friend or neighbor) every day. Seek out those who uplift and challenge you. Avoid secluding yourself.

You can also fill your days rendering service to others who are not as fortunate as you. Giving time for a cause beyond yourself brings with it a sense of purpose you can’t achieve anywhere else. Your wealth of wisdom and experience will continue to grow as you reach out to others.

Activities that can help you remain connected and productive include: gardening, cooking, knitting, volunteering at a library or hospital, helping neighbors, visiting museums, traveling, playing cards or games, joining a senior center, starting a book club, taking a class, attending church, or learning and using a social media like Facebook.

Finally, challenge yourself mentally. Reading books or newspapers, doing crossword puzzles, drawing or painting, writing, studying, or learning to play a musical instrument are effective and fun ways to keep your mind sharp.

Collect and Write Family Histories

Those who pursue the gathering and writing of personal and family histories are always rewarded. As one of the older people in your extended family, you likely hold memories of people, places, and events that might be lost forever upon your passing. In this case, you are the family history. Don’t let it be lost to future generations. Take the time to preserve your heritage by writing these memories down.

Exercise Regularly

Exercise is a significant part of good health at every age. Unfortunately, many older adults do not get enough physical activity and exercise. Staying active can improve vitality, help maintain strength and flexibility, expand mental function, decrease risk for health problems, and may even help relieve chronic pain.

Find an activity you enjoy then ease into it at a pace and consistency your body can handle. Try to include a variety of endurance, strength, stretching, and balance exercises in your routine. Exercise choices may include yoga, walking, swimming, biking, gardening, and exercises classes designed for seniors. The key to successful exercising is variety.

Be sure to talk to your health care provider before beginning an exercise program.

Prepare Financially

For some, successful aging equates to financial responsibility, making sure that they have the right Medicare health plan, long term care insurance coverage and enough money to cover the costs of health care in retirement.

As soon as you have a job and a steady income, begin to plan frugally for retirement and the decades which follow. Planning early will help you to avoid unnecessary debt and live more comfortably during your final years. Use caution in cosigning financial notes (even with family members) when retirement income might be jeopardized. As you near retirement, be even more cautious about “get-rich” schemes, mortgaging homes, or investing in uncertain ventures. In all financial aspects, proceed cautiously so that the planning of a lifetime is not disrupted by one or more poor financial decisions.

The National Care Planning Council provides lists of eldercare planning services to help the public prepare for the years following retirement. The list includes care management services, financial advisers, elder attorneys, reverse mortgage specialists, advocates for veterans, home care services, and other types of eldercare providers.

Have a Healthy Diet and Lifestyle

Don’t smoke, eat right, and practice good hygiene. We’ve all heard these tips before, but we repeat them so often because they are crucial to maintaining a healthy lifestyle.

Eating right should include consuming nutrition-packed meals every day. Extra weight from poor diet choices increases your risk for heart disease, diabetes and high blood pressure.

Staying healthy also has the very practical impact of reducing out-of-pocket health care costs. A healthy person spends far less time at the pharmacy, the doctor’s office, and even the hospital.

Prevent Injuries from Falling

Falling is one of the most common causes of injury among seniors. Simple home modifications, the use of assistive devices, wearing sensible footwear, and removing hazards can reduce the risk of falling and the injuries that come with it.

Visit Your Doctor Regularly

About 80 percent of seniors are living with a chronic condition. Many chronic conditions, like diabetes and heart disease, can often be prevented.

Visit your health care provider regularly and follow their recommendations for screening and preventative measures. Screenings are particularly helpful as they serve as an early warning system. Much of the illness and disability associated with aging can be prevented (or slowed down) when you have the benefit of early detection. Regular dental, vision and hearing checkups should also be taken into consideration.

One of the most common conditions affecting older men is enlargement of the prostate gland, or benign prostatic hyperplasia (BPH). Among aging women, a loss of bone density (osteoporosis) is a particular concern.

Many people age 70 and older seek the care of a geriatric physician, also called a geriatrician. Geriatric physicians are medical doctors who specialize in the diagnosis, treatment and prevention of disease and disability in older adults.

Summary

Growing older is inevitable, but there are many things we can do to avoid feeling older. Medical breakthroughs have and will extend our longevity, but how we decide to live as we age is crucial. Managing our physical health, maintaining relationships, being productive, taking safety precautions, visiting our health care providers often, and making adequate preparations to fund our retirement and long term care can help us make the most of our senior years. 

Lori Holmgren RN, MSN

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