Senior Smarts:

When Your Decision Matters!

Emergency preparedness includes preparing for a medical emergency. Who will speak for you when you cannot speak for yourself?

Your medical emergency could happen one evening when you are on your way home and you are taken to the hospital.

Your medical emergency could happen one evening when you are on your way home and you are taken to the hospital. An Advance Directive will provide your loved ones with the answers they need to assist health care professionals with a treatment plan.”

An Advance Directive will provide your loved ones with the answers they need to assist health care professionals with a treatment plan.

ADVANCE DIRECTIVES

Advance Directive and Durable Power of Attorney provide instructions in your own words to family/caregivers, friends, and health care professionals when there is a significant condition change.

An advance directive is a written document in the form of a living will or durable power of attorney prepared by a competent individual that specifies what, if any extraordinary procedures, surgeries, medications or treatments the patient desires in the future, when he or she can no longer make such decisions about medical treatment (Taber's Cyclopedic Medical Dictionary)

You should have an Advance Directive to specify your decisions in the future regarding health care, end-of-life care, nutrition, hydration, hospice care, No Cardiopulmonary Resuscitation, and organ donation when you become unable to express your wishes. (Examples with supporting documentation: do not hospitalize, autopsy request, feeding restrictions, medication restrictions, other treatment restrictions.)

Secular Health Care Directive

"An optional addendum to your advance directive. The language in this addendum clarifies that admission to a religious-affiliated facility does not imply consent to particular care mandated by the institution's religious policies, and directs a transfer if the facility policy declines to follow the wishes outlined in an advance directive." (CompassionAndChoices.org)

End of Life Options Act

A California law that permits terminally ill adult patients with capacity to make medical decisions to be prescribed an aid-in-dying medication if certain conditions are met. Signed into law by Governor Brown in October 2015, the law went into effect on June 9, 2016. (coalitionccc.org/tools-resources/end-of-life-options-act/)

ELDER LAW

Elder law attorney refers to an attorney who specializes in providing legal services for the elderly, especially in the area of Estate Planning and Medicaid Planning. They handle general estate planning issues and counsel clients about planning for the management of assets and health care with alternative decision-making documents to prepare for the possibility of becoming incapacitated.

Elder law is a specialized area of legal practice covering estate planning, wills, trusts, arrangements for care, social security and retirement benefits, protection against elder abuse (physical, emotional, financial) and other involving older people. (http://definitions.uslegal.com/e/elder-law-attorney)

For an elder law attorney perspective, see Boomer Legal by Helene V. Wenzel, Esq., solo practitioner in Estate Planning and Elder Law, "Let's Talk Boomer Legal and Advance Care Planning": Power of Attorney, Advance Health Care Directive, Physicians Orders for Life-Sustaining Treatment, The Difference Between a "Living Will" and a "Will" (March 2015); and Living Trust, What Happens To The Estate if the Deceased Does Not Have a Will?, Preparing for an Appointment if an Attorney Prepares Documents, The Difference Between "Revocable" and "Irrevocable" Living Trust (April 2015).©2015.

NATIONAL HEALTH CARE DECISIONS DAY

As Advocate for National Healthcare Decisions Day, in 2014 I started Healthcare Decisions Week in San Francisco from April 9 through April 16. I invited San Francisco Public Library neighborhood branches to participate in acknowledging advance care planning.

See the April issue for this year's details.

SAVE THE DATE: APRIL 16.

A day to "inspire, educate and empower the public and providers about the importance of advance care planning."

"…National Healthcare Decisions Day is an initiative to encourage patients to express their wishes regarding health care and providers and facilities to respect those wishes, whatever they may be." (nhdd.org)

The following Self-Check can help you prepare to discuss this important subject with your loved one.

RESOURCES

Advance Health Care Directive. To download form visit the California Health Care Association at cmanet.org.

End of Life Option Act. SB-129. Bill Text.1

Five Wishes – Aging with Dignity. MY WISH FOR: The Person I want to Make Care Decisions for Me When I Can't, The Kind of Medical Treatment I Want or Don't Want, How Comfortable I Want to Be, How I Want People to Treat Me, What I Want My Loved Ones to Know.2

Secular Health Care Directives. For more information contact.3

Seniors & the Law": Guide for Maturing Californians, "PLANNING AHEAD," pp.6-7, State Bar of California educational guide. To request publications contact (888) 875-5297 or visit www.calbar.gov.

Write Your Will Workshop, Write Your Will Seminar and Introduction to Wills & Trusts are held at various branches of the San Francisco Public Library. You can find information on upcoming session in the monthly publication At the Library or sfpl.org.

Anise Matteson is an Advocate for National Healthcare Decisions Day, elder care consultant, retired Registered Health Information Technician, writer of reference books for seniors and Caring Boomers Newsletter, article excerpt ©2012, Information is educational only. For specific questions consult your physician and an attorney.

1. leginfo.legislature.ca.gov/faces/billNavClient. xhtml ?bill_id =201520160SB128

2. agingwithdignity.org/forms/5-wishes.pdf

3. CompassionAndChoices.org

March 2017

Getting Ready for Winter

The holiday season has arrived. On Thanksgiving Day, we reflected on our blessings and asked ourselves: What are you thankful for? As we prepare for Christmas, we [many Christians] will observe Advent—the solemn season of preparation—emphasizing repentance and hope.

Part 2: Hypothermia Senior Smart articles intended to provide solace for families coping with an anticipated loss or who have lost a family member this year: "Coping with the Holidays During Bereavement," December 2014, pp. 15 &18; "Learning from Grief," February 2015, pp. 15, 18 & 19.

I am currently drafting the Session Plan for a Bereavement Roundtable as part of a Seniors Ministry. More details later.

At the end of this article is more information to assist you during the hectic days of preparing for the holidays.

WINTER Writing the December article, today's November weather forecast: sunshine 60-63º, evening 30s to low 40s, rain over the weekend.

Winter has arrived! I encourage you to read and share the October article, "Getting Ready for Winter," p. 23.

Winter is the coldest season of the year—December through early March. Winterlike weather sometimes occurs in November or even earlier, and as late as May. Winter storms produce large snowfalls in some areas. The most snow falls in the western mountains and in much of the northern region east of the Rocky Mountains. Many winter storms bring rain to warmer southern areas.[1] 

Remember to keep in touch with your loved ones, or have someone check on them. In addition to hypothermia, dehydration can pose serious problems for seniors during the wintertime. 

Hypothermia. Occurs when the body temperature drops below 95ºF as a result of exposure to cold weather, prolonged exposure to indoor temperatures or immersion in a cold body of water.

BODY TEMPERATURE

ETIOLOGY[2] The heart rate and blood pressure decrease during mild to moderate hypothermia—95ºF to 82ºF. Breathing becomes slower and shallower. From 86ºF to 82ºF, the victim becomes unconscious. During hypothermia—64ºF to 59ºF—the action of the heart and the flow of blood stops completely. The electrical activity of the brain also stops at this level. 

Mild Hypothermia 93.2ºF - 96.8ºF

NB: Left untreated, hypothermia can eventually lead to complete failure of the heart and respiratory system and death.[3] Seek immediate medical attention

Accidental hypothermia. Occurs, for example, among hunters, sailors, swimmers, climbers, the indigent, homeless persons in winter, and alcoholics due to exposure to wet and cold conditions.[4] RELATED FACTORS[5]

Age: Older adults are more vulnerable to hypothermia because of: 1) the body's ability to regulate temperature and to sense cold may lessen; 2) a medical condition that affects temperature regulation; 3) inability to communicate when they are cold; 4) mobility issues inhibit seeking a warmer location. Mental Status: Dementia (wandering). Medical Conditions: Stroke, severe arthritis, Parkinson's disease, hypothyroidism, diabetes, dehydration. Medications: Antidepressants, antipsychotics, narcotic pain medication and sedatives.

SIGNS/SYMPTOMS[6a]

Moderate Hypothermia 86ºF - 93ºF

Early Signs: Cold feet and hands; puffy or swollen face; shivering (not all individuals shiver); pale skin; slurred or slower than normal speech; sleepiness; anger or confusion. Late Signs: Slow movements, difficulty walking, or clumsiness; jerky arm or leg movements, stiffness; slow heartbeat; slow shallow breathing; loss of consciousness.

FIRST AID[6b] CAUTION: Do not rub arms and legs. Do not apply heating pads or electric blankets. Do not give the person a warm bath. Do not allow the person to consume alcohol.

NB: The condition can present itself differently in older adults. (For example, some seniors will shiver a lot, while others may not shiver or have obvious signs of dangerously low body levels.) Look for cold skin and hands, pale skin, bluish lips and fingernails, confusion, fatigue, weakness and slow breathing.[7]

Severe Hypothermia Less than 86ºF

PROTECTING OLDER ADULTS An elderly person's home should be properly insulated and heated with living areas kept at a temperature of 70º F.[8] The thermostat should never be set below 65º F for a person who is 75 or older.[9]

Drink liquids consistently to prevent dehydration. Postpone outdoor activities when it is very cold outside.

Warm clothing and bedding are essential.[10] (Dress warmly indoors and outdoors—indoors: dress in layers, wear hat or cap; outdoors: wear a hat, a scarf, gloves or mittens, and warm clothing.) Use blankets or throws on your legs and shoulders, especially if you are sitting or lying down for prolonged periods of time.[11] Warm the bed and bedding before going to sleep.[12]

Heaters: Gas-powered: You should have a carbon monoxide detector. Electric: Make sure the cords are not damaged or frayed. NB: 1) Keep all heaters away from flammable materials—at least 2 feet—(e.g., cloth and paper). 2) Make sure the smoke detector is working properly[13]—functioning batteries. (As of July 1, 2015, California has ban the sale of smoke detectors with replaceable batteries. [abc7news.com – July 29, 2015])

Fireplace: Have the chimney and flues inspected. Clean yearly.[14]

RISKS of carbon monoxide poisoning: fireplace, gas heater, lanterns. NB: Never heat your home with a gas stove.[15]

Detectors*: Many local fire departments offer periodic free giveaways that include carbon monoxide detectors and/or smoke detectors. Contact the fire department to find information on their free carbon monoxide detector and similar programs. (www.ehow.com/facts_ 8054315_ can-carbon-monoxide-detectors.html)

The American Red Cross has distributed and installed free smoke alarms in some counties (e.g., Solano County). [Posted: Sep 30, 2015. www.redcross.org/news/press-release...] *NOTE: Due to submission deadline, this information has not been researched for updates.

Seniors who live alone should have someone they can ask to check on them—during very cold winter weather—at least once a day (e.g., a friend, a neighbor).[16]

Fire Extinguisher. A fire extinguisher is a metal container filled with water or chemicals used to put out fires. The kind used depends on the type of fire involved. [13] The extinguisher tells you for what class of fire it can be used. There are four types of fire extinguishers: dry, chemical, water, carbon dioxide and halon. [See: "Weather Forecast Preparedness: Rain, Lightning and Thunderstorm," WSO - June 2016, pp. 17 & 18.]

Readers were asked to contact me if you would be interested in my offering a seminar on how to use a fire extinguisher.

Warming Center. Short-term emergency shelter that operates when temperatures or a combination of precipitation, wind chill, wind and temperature become dangerous. Their purpose is the prevention of death and injury from exposure to the elements. This may include acute trauma from falling objects such as trees, or injury to extremities due to frostbite. A more prevalent emergency which warming centers seek to prevent is hypothermia, the risk for which is aggravated by factors such as age, alcohol consumption, and homelessness.[20]

DEHYDRATION IS A CONCERN According to Amedisys Home Health Care [literature from Boomer/Senior Expo several years ago], dehydration is one of the top 10 causes of hospital stays among people 65 years and over.

ETIOLOGY: Seniors are especially prone to becoming dehydrated because they eat and drink less than younger people. People also feel less thirsty during the winter and so are more prone to not drinking enough as they should.[17] AT-RISK are older adults who do not drink enough water.

SYMPTOMS: The person may appear flushed and have dry skin and mucous membranes, cracked lips, loss of skin turgor, and oliguria. Mental confusion and hypotension indicate a very serious dehydration.[18] Weakness or lightheadedness (particularly while standing), dark urine.[19]

ADVERSE EFFECTS: Results in fatal shock, acidosis, uremia, cellular disruption, renal failure, or death.

Parish Nurse. Nurses also provide services to congregation of a religious faith as a Visiting Nurse or Parish Nurse—another resource for the homebound.

Faith Community Nursing, also known as Parish Nursing, Parrish Nursing, Congregational Nursing or Church Nursing is a movement of over 15,000 registered nurses. (en.wikipedia.org/wiki_Faith_ community_ nursing)

Faith Roberts, RN, BSN (carle.com) defines a parish nurse as a registered nurse who acts as a vital link between the faith and medical communities. [See: "Defining the Parish Nurse," WSO - April 2014, pp. 3 & 14.]

ANNOUNCEMENTS

Medicare: Open enrollment ends December 7, 2016.

Covered California: Apply by December 15, 2016 to make sure your coverage begins on January 1, 2017. Open enrollment for private health coverage through Covered California begins Nov. 1, 2016 and ends on Jan. 31, 2017. (Tax penalty for not being covered: $695 or 2.5 percent of your income, minus federal tax filing threshold whichever is greater.)[www.coveredca.com]

MERRY CHRISTMAS AND LIFE'S BEST IN 2017!

Anise Matteson is an elder care consultant, retired Registered Health Information Technician and writer of reference books for seniors. Seminars by announcement. Information is educational. For specific questions and medical care, contact your physician.

December 2016 / January 2017

StrokeSmart magazine: Issue 4 2016 is the last issue subscribers will receive this year. The National Stroke Association is asking subscribers to consider sending a donation to ensure that StrokeSmart remains free for subscribers who receive a print copy each quarter. To contribute: call (800) 787-6537 or donate online at www.stroke.org/strokesmart2016.

For this writer's articles, see WSO: "Stroke Survival: Understanding Stroke," June 2014, p. 9. "Stroke Survival: Stroke Aftercare" (The "Saebo Reach" Splint), July 2014, p. 9. "Adaptive Clothing for Stroke Survivors," (Simple Closures), September 2014, p. 6. "Stroke Survival: Assistive technology Products" (Mac OS X & Windows Software, October 2014, p. 8.

RESOURCES

Frostbite and Hypothermia, March 2007. American Red Cross. A guide sheet for information on: Signals of frostbite include; What to do for frostbite; Signals of hypothermia include; What to do for hypothermia. [m4340104_Frostbite_and_Hypthermia.pdf]. "Talking about Disaster: Guide for Standard Messages, Frostbite/Hypothermia-1" is available at www.redcross.org.

Lifeguardmonitor.net. (877) 877-0197. Lifeguard Monitoring systems (Senior Medical Alarm) provide a Wireless Personal Emergency Response System for: Fall Detection – detects if you fall and notifies the monitoring station; Inactivity Monitoring – notifies the monitoring station when no activity has been detected; Smoke Detection – alerts you and emergency services when smoke is detected; Carbon Monoxide Detector – gives early warning of carbon monoxide poisoning and alerts monitoring system.

Medical Alert® + Alzheimer's Association Safe Return®. A 24-hour emergency response service that provides assistance when a person with dementia wanders and becomes lost or has a medical emergency. Enroll at (888) 572-8566 or alz.org/safereturn. [Brochure #770-10-0003, p. 29.]

National Weather Service. Provides active alerts, current conditions, forecasts, weather safety, education. www.weather.gov. Recorded weather: (831) 656-1725.

Silver Alert: A public notification system in the United States to broadcast information about missing persons—especially senior citizens with Alzheimer's disease, dementia or other mental disabilities—in order to aid in their capture. http://en.wikipedia.org/wiki/Silver_Alert.

We Check On You. www.wecheckonyou.com. (888) 932-5668. A national telephone reassurances service for homebound persons, disabled and seniors that wish to remain in their homes instead of being institutionalized. This service is important for people who are without family, are too far from family and who may feel lonely and isolated. Provides regular phone calls to your loved ones.

1,2. The World Book Encyclopedia

3. www.mayoclinic.org/diseases-conditions/hypothermia/basics/definition/con-20020453

4. Taber's Cyclopedic Medical Dictionary

5. www.mayoclinic.org/diseases-conditions/hypothermia/basics/risk-factors/con-20020453

6,11. www.pharmacytimes.com/publications/issue/2016/january2016/hypothermia-in-seniors-stay-safe-andwarm-this-winter

7,14,15. www.generalsolutions.net/four-winter-safety-tips-for-seniors/

8,10,12,16. www.encyclopedia.com/medicine/diseases-and-conditions/pathology/hypothermia

9,13,17. www.agingcare.com/Article/cold-weather-protection-for seniors-148625.htm

18. Encyclopedia and Dictionary of Medicine, Nursing and Allied Health

19. Amedisys Home Health Care

20. https://en.wikipedia.org/wiki/Warming_center20

MERRY CHRISTMAS AND LIFE'S BEST IN 2017!

Anise Matteson is an elder care consultant, retired Registered Health Information Technician and writer of reference books for seniors. Seminars by announcement. Information is educational. For specific questions and medical care, contact your physician.

Getting Ready for Winter

The weather is noticeably warmer—on some days reaching 70ºF. September 22 will be the first day of [autumnal equinox] autumn. After Thanksgiving the weather will begin to getcolder. Start now to get ready for winter.

Maybe you know a senior who would welcome an act of kindness to help them get ready for winter.”

Hypothermia is the cause of at least 1,500 deaths a year in the United States. It is more common in older people and males, and has caused deaths among soldiers during wars.[1]

BE PREPARED

Preparation should include:

• Checking your winter wardrobe for mending, replacing, and washing or dry cleaning.

• Warm clothing (hat, scarf, gloves, coat, sweaters, slacks, and socks).

• Warm shoes and slippers.

• Extra food and water.

• Flashlight and batteries.

• Advance Directive.

• Comforter for added warmth to bedding.

• Wash blankets or take to the cleaners.

• Heating system [furnace] is working properly.

• Weatherization (windows and doors) to eliminate drafts.

• Drapes and curtains (insulate the room).

• Cellular blinds. (The air inside the honeycomb structure creates a layer of insulation to help reduce heat cost.[2]

COLD WEATHER RELATED ILLNESS

Older adults are subjected to cold weather related illness due to prolonged exposure to a cold environment indoors (inadequately heated home or in an air-conditioned home.)[3]

HOMEBOUND

The homebound in some religious faiths are referred to as shut-ins.

Webster's Dictionary defines homebound as confined to the home, and shut-in as confined to one's home or an institution by illness or incapacity.

Degrees of confinement varies from one week, one month, to never leaving the home except in the case of emergencies, or no more than two days per week.

To learn more about "homebound ministry" see the October 2013 article "Homebound Survival" on page 8.

The article also includes questions for boomer and senior readers:

• If you are homebound, why?

• What are the challenges?

• What tools can help you age in place?

Your feedback is invited.

October 22 is Make A Difference Day. A day when people in the United States perform acts of kindness. Maybe you know a senior who would welcome an act of kindness to help them get ready for winter.

RESOURCES

Pacific Gas and Electric Company. www.pge.com/care. (800) 743-5000.

• CARE Program (California Alternative Rates for Energy). (866) 743-2273. Provides a monthly discount on energy bills for income-qualified households and housing facilities.

• REACH (Relief for Energy Assistance). (415) 648-0260. PG&E sponsored program administered by the Salvation Army. Provides financial assistance to low-income households. For more information call (800) 933-9677.

• FERA (Family Electric Rate Assistance). (800) 743-5000. Provides a monthly discount on electric bills for income-qualified households of three or more persons.

• LIHEAP (Low Income Home Energy Assistance Program). (866) 675-6623. Provides bill payment assistance, emergency bill assistance and weatherization services. (Department of Community Services and Development.)

• Medical Baseline. Provides services at the lowest rates to customers with documented needs. For more information call (800) 743-5000.

• Energy Partners. Free energy education and weatherization to income-qualified customers. For more information call (800) 989-9744.

PG&E also provides payment arrangements (payment schedules) and Balanced Payment Plan).

PG&E offers programs for: 1) Residential Single-Family, and 2) Tenants Sub-Metered Facility, per CARE Program Application for Residential Single Family Customers (01-9077 Rev. 06/01/06).

Canon Kip (Canon Kip Senior Center) Aging and Disability Resource Center. (415) 487-3370. Helps seniors and persons with disabilities to process their Pacific Gas & Electric bills with "HEAP Program."

• Home Energy Assistance Program from the Economic Opportunity Council (EOC) provides bill payment assistance once per year to your PG&E bill. Eligibility: Resident of San Francisco. Required documents for application.

Source: Episcopal Community Services of San Francisco, May 2010, Aging and Disability Resource Center. (flyer)

NOTE: Due to submission deadline, this list has not been researched for updates.

FOOTNOTES

• https://en.wikipedia.org/wiki/Hypothermia

•IKEA catalog

•www.mayoclinic.org/diseases-conditions/hypothermia/basics/causes/con-20020453

Anise Matteson is an elder care consultant, retired Registered Health Information Technician and writer of reference books for seniors. Seminars by announcement. mattesonecs@yahoo.com.

October 2016

WEATHER FORECAST PREPAREDNESS: HOT WEATHER

As I am writing this article, the weather is 62° and sunny. Bay Area forecast (San Francisco chronicle, August 16): "Coastal fog and low cloud will be possible again, particularly in the morning. Skies will be mostly sunny across the interior, with highs reaching the middle 90s in spots."

Where is summer? According to a San Francisco meteorologist, forecast for San Francisco: "higher temperatures in two months."

BE PREPARED

When the body starts to perspire, it is signaling you are becoming overheated.

Perspiration is a means of removing heat from the body and is increased by temperature and humidity.—midsummer temperatures or during strenuous exertion.[2] The chief role of perspiration is to maintain the body temperature at a constant level. Diminished or total absence of sweating may occur in the elderly.[3]

STATISTICS

A CDC study of the five years ending in 2003 attributed 3,442 deaths to exposure to extreme heat, about 689 per year.[4]

UV radiation is considered the main cause of nonmelanoma skin cancer, striking more than a million, and more than 250,000 Americans, respectively, each year. UV radiation also frequently plays a key role in melanoma, which kills more than 8,000 Americans each year.[5]

HEAT-RELATED ILLNESS

Hot weather subjects older adults age 65 and over to heat-related illness.

ETIOLOGY: Difficulty adjusting to sudden changes in temperature⁶; Chronic medical conditions that changes the body's response to heat;⁷ Prescription medications that impair the body's ability to regulate its temperature or that inhibit perspiration⁸; Dehydration (not drinking enough water or binging on alcohol or caffeinated drinks)⁹ Diminished or total absence of sweating.[10] RELATED FACTORS: Age: Elderly have lower body temperatures. Exercise: Temperature rises with moderate to vigorous muscular activity. Hyperthermia: Body temperature elevated above the normal range.[11] Severe hyperthermia: Body temperature of 104°F or higher.[12] Forms: Heat stroke, heat cramps, and heat exhaustion. Medical Conditions: Heart disease, fever, obesity, mental illness, poor circulation, or a sunburn.[13] Medications: Diuretics (likely to cause dehydration). Antihistamines (can make the body more sensitive to sun exposure and high temperatures). [14] SYMPTOMS: Dizziness, fatigue, vomiting, headache, fast heartbeat, shortness of breath, or a high temperature (greater than 104°F). [Note: Get immediate medical care.[15] ADVERSE EFFECTS: Heat stroke (death or permanent disability if emergency treatment is not provided); sunstroke, heat exhaustion, heat cramp, heat rash (prickly heat).

PRECAUTION: Wear clothing that is lightweight, light-colored, and loose-fitting; take frequent rest breaks, especially during strenuous activities; ingest adequate amounts of fluids; avoid hot, humid environments if possible; use a fan or air conditioner; seek air-conditioned areas (e.g., cooling centers); avoid midday sun; wear a hat (wide-brimmed); sunglasses or solar shield that block both ultraviolet A and ultraviolet B rays[17]; sunscreen as a defense against damage to the skin by ultraviolet rays[18]; umbrella as a sunshade; lip balm. [Note: Even resting in a shaded area, seniors can overheat on a scorching summer afternoon. [19]

PROTECTING OLDER ADULT

Visit older adults at risk at least twice a day and watch them for signs of heat exhaustion or heat stroke. Encourage them to increase their fluid intake by drinking cool, nonalcoholic beverages regardless of their activity. [Warning: If their doctor generally limits the amount of fluid they drink or they are on water pills, they will need to ask their doctor how much they should drink while the weather is hot.] Take them to air-conditioned locations if they have transportation problems.[20]

HEAT STRESS AND OLDER WORKERS

According to Mike Sterns ("Hot conditions stress older works"), "studies show that older workers are more susceptible to negative consequences from heat exposure."[21]

Every year thousands of workers suffer from some form of injury or illness from becoming overheated on the job some even die.[22]

At higher risk are workers wearing protective gear that includes tight-fitting clothes that do not breathe.[23]

Once the heat index gets into the 90s and above, threats start getting severe and precautions need to be raised.[24]

Preventive measures suggested by OSHA: Increase the amount of fluids you drink; take frequent breaks in cool places; if working in the sun use a sunscreen rated SPF15 or higher; a wide-brimmed hat; wear light, loose-fitting clothes.[25]

[Note: If you experience weakness or dizziness, stop working immediately and rest in a cool place.[26]

Weather Forecast

Heat index. Takes both temperature and humidity into account to give a more accurate account of how conditions affect the body.[27]

High heat index. Indicates an increased risk of heat stroke due to humid air that makes it more difficult to breathe normally.[28]

High UV index. Implies that a person is likely to get sunburned even under cloud cover.[29]

HEATSTROKE

Heatstroke is a form of hyperthermia that results from prolonged exposure to high temperature (normally air temperature of greater than 79°F and relative humidity greater than 70%.)[30] It can cause death or permanent disability without medical treatment.[31]

CLASSIFICATION: Exertional heat stroke (EHS) is due to overexertion in hot weather. Non-exertional heat stroke (NHS) occurs in climatic extremes and affects the elderly, infants and chronically ill.[32] ETIOLOGY: In extreme heat, high humidity, or vigorous physical exertion under the sun, the body may not be able to sufficiently dissipate the heat and the body temperature rises, sometimes up to 106°F or higher. A dehydrated person may not be able to sweat fast enough to dissipate heat, which causes the body temperature to rise.[33] SIGNS AND SYMPTOMS: High temperature; absence of sweating, with hot red or flushed dry skin; rapid pulse; difficulty breathing; strange behavior; hallucinations; confusion; agitation; disorientation; seizure, and/or coma.[34] TREATMENT: It is important to reduce the temperature as quickly as possible.[35] PREVENTION: See Heat-Related Illness.

SUNSTROKE

Sunstroke is a heat stroke caused by prolonged exposure to direct, intense rays of sun or from general excessive heat. [36] ETIOLOGY: There is a disturbance in the body's heat-regulating mechanism [that controls perspiration], particularly when there is little or no circulation of air. [37] Exposure to the sun varies depending on elevation (i.e., sea level, time of day, the reflection, and the wind.)[38] Individuals more susceptible: the elderly with underlying chronic disorders; those who use alcohol and atropine-containing drugs; those with certain skin disorders.[39] SYMPTOMS: Headache, dizziness, weakness, extremely high fever, absence of sweating, convulsions, sudden loss of consciousness; may be fatal.⁴⁰ TREATMENT: Immediate steps must be taken to lower the body temperature.[41] Seek medical attention. PREVENTION: Adequate ventilation and hydration. Wear proper clothing. Vigorous activities should not be undertaken in extremely hot weather. [42]

HEAT EXHAUSTION

Heat exhaustion (heat prostration) is an acute reaction to a hot, humid environment [43] the result of over exposure to heat or to the sun. ⁴⁴ If untreated, it can progress to heat stroke.⁴⁵ ETIOLOGY: Long exposure to extreme heat or too much activity under a hot sun causes excessive sweating, which removes large quantities of salt and fluid from the body; When the amount of salt and fluid in the body falls too far below normal, heat exhaustion may result[46]; A milder form of heat-related illness that can develop after several days of exposure to high temperature and inadequate or unbalanced replacement of fluids.⁴⁷ SIGNS AND SYMPTOMS: Heavy sweating, paleness, muscle cramps, tiredness, weakness, dizziness, headache, nausea or vomiting, fainting, skin may be cool and moist, pulse rate fast and weak, breathing fast and shallow.⁴⁸ [Note: It does not take all of these symptoms to indicate exhaustion.⁴⁹ TREATMENT: Seek medical attention. PREVENTION: Avoid long exposure to sun or heat; drink plenty of water; regular breaks from work; in the event of weakness or dizziness stop working immediately and rest in a cool place. ⁵⁰

SUNBURN

Sunburn (erythema solare) is a discoloration or inflammation of the skin due to overexposure to the sun.[51]

ETIOLOGY: Damage from sunlight is chiefly due to the effects of ultraviolet rays, the short heat rays,[52] between 290 and 320nm (sunburn rays), produce the characteristic changes in the skin [53] and may become a second degree burn (blistered and sore).⁵⁴

SYMPTOMS: Reddening of the skin. Severe sunburn: blisters, dizziness, headache, fever, vomiting.⁵⁵ Serious signs: fever of 102ºF or higher, chills, severe pain, sunburn blisters that cover 20% or more of your body; dry mouth, thirst, reduced urination, dizziness, fatigue—signs of dehydration.[56] TREATMENT: Ointment, lotions, or creams. For cases of severe sunburn, consult a physician. [57] PREVENTION: Stay indoors between 10AM and 4PM, if cannot, stick to shady spots; wear sun-protective clothing (broad-brimmed hat, long-sleeved shirt and pants, UV-blocking sunglasses); apply sunscreen. [58]

Ultraviolet Radiation (UV Radiation) [59]

UV radiation is part of the electromagnetic (light) spectrum that reaches the earth from the sun. Wavelengths are classified as UVA, UVB or UVC. Most UVC is absorbed by the ozone layer and does not reach the earth.

UVA and UVB play an important role in conditions such as premature skin aging, eye damage (including cataracts), and skin cancer. They also suppress the immune system.

UVA rays. Are present with relatively equal intensity during all daylight hours, throughout the year; penetrates the skin more deeply than UVB; and is the dominant tanning ray.

UVB rays. Are the chief cause of skin reddening and sunburn; play a key role in the development of skin cancer and a contributing role in tanning and photoaging; intensity varies by season, location and time of day; most significant amount of UVB is between 10AM and 4PM from April to October; can burn and damage skin year-round, especially at high altitudes and on reflective surfaces (snow or ice).

HEAT CRAMPS

Heat cramps is a spasm accompanied by pain in the muscles in the arms and legs or the abdominal muscles; [60] may be accompanied by symptoms of heat exhaustion .[61]

ETIOLOGY: Muscle spasm caused by the excess fluid or electrolyte loss that occurs with profuse sweating.[62] Are usually in conjunction with strenuous activity.[63] Can occur during exercise or work in a hot environment or begin a few hours later.[64] At Rist: Doing work in a hot environment; Sweating a great deal during exercise and drink large amounts of water or other fluids that lack salt.[65] SYMPTOMS: Muscle spasms that are: painful, involuntary, brief, intermittent, usually self-limited (go away on their own).[66] TREATMENT: Stop activity and rest in a cool place. Drink juice or a sports beverage. DO NOT take a salt pill unless directed by a doctor. To avoid the risk of heat exhaustion or heat stroke, continue resting for several hours after the pain goes away. Seek medical attention, if heat cramps do not subside within one hour of resting.[67] PREVENTION: Avoid or keep activity to a minimum; frequent rest periods; drink ample amounts of water; wear light clothing and a hat to protect the head.[68]

HEAT RASH

Heat rash (prickly heat), [malaria rubra] is an inflammatory skin rash due to an inability of the skin to adapt itself to an increase in temperature and humidity during periods of heat and humidity. [69]

ETIOLOGY: Occurs when sweat glands are blocked and the sweat produced cannot get to the surface of the skin to evaporate causing inflammation that results in a rash.[70] May occur as a side effect of some medication.[71] SYMPTOMS: Red clusters of pimples or small blisters on the neck and upper chest, groin, under the breasts, and in elbow creases[72]; prickly or itchy feeling to the skin [prickly heat].[73] TREATMENT: Move to a cooler environment; keep the affected area dry.[74] If rash persists, consult a physician.[75] If the area becomes infected, medical treatment is necessary.[76] [Note: If the areas are not properly treated, secondary infection may result with pus formation and rapid spread.[77]] PREVENTION: Wear light clothing; frequent bath or shower; drink liquids; air-conditioning or fan; avoid hot, humid conditions.

SOLAR SHIELD

Solar shield. Solar Shield® ClipOns attach to prescription eyeglasses or readers for sun-protection. Provide UVA/UVB protection. [78]

COOLING CENTERS

Cooling centers. An air-conditioned public facility where people may go for relief during periods of extreme heat.[79] The Department of Adult & Aging Services (DAAS) list the following senior centers in the area: OMI Senior Center [fans], 65 Beverly Street, 587-1443 and YMCA-Stonestown Branch Annex [fans], 3150 20th Avenue, 252-7135.

RESOURCES

Senior Centers with AirCon or Cooling Fans (Cooling Centers for Seniors – 400385). Department of Adult & Aging Services (DAAS) list of cooling centers in San Francisco. http://sf311.org/senior-centers-aircon-or-cooling-fans-cooling-centers-400385.

LIHEAP. (866) 675-6623. Provides grants and money for cooling, utility, and air conditioning bills. Apply anytime. Aid is usually offered for people who are within 75% of state's median income level. www.needhelppayingbills.com/cooling_bill_assistance_progra.html.

Occupational Safety & Health Administration (OSHA). Information on heat exposure can be found at www.osha.gov/SLTC/heatstress/. Provides small businesses with free on-site consultations. For more information, call (800) 321-6742. www.oshaeducationcenter.com/articles/preventing-heat-illness.aspx.

Anise Matteson is an elder care consultant, retired Registered Health Information Technician and writer of reference books for seniors. Seminars by announcement. Information is educational. For specific questions and medical care, contact your physician. mattesonecs@yahoo.com.

1,11,17,18,30,43,45,51,52,53. Taber's Cyclopedic Medical Dictionary

2,3,10,26,37,39,40,41,44,46,50,54,60. Encyclopedia and Dictionary of Medical, Nursing, and Allied Health

4. http://Listosaur.com/miscellaneous/Top-5-Weather-related-causes-of-death-in-the-us/

5,59. www.skincancer.org/prevention-uva-and-uvb

6,7,8,20,47,48. http://emergency.cdc.gov/disaster/extremeheat/older-adults-heat.aspx

9,13,22,23,24,25,27,28,31,,63,67,72,74. www.oshaeducationcenter.com /articles/preventing-heat-illness.aspx

12,33. www.medicinenet.com/heat_stroke/article.htm#heat_stroke_facts

14,19,29. www.dallashomecareassistance.com/protecting-seniors-from-heat-stroke/

15,64,65,66. www.webmd.com/fitness-exercise/heat-cramps

21. www.ishn.com/article/104119-hot-conditions-stress-older-works?v=preview

34. www.medicinenet.com/heat_stroke/page2.htm

35. The World Book Encyclopedia

36,38,55,57,61,62,68,69,75,77. The New Illustrated Medical and Health Encyclopedia

42. http://medical-dictionary.thefreedictionary.com/sunstroke

56,58. www.webmd.com/skin-problems-and-treatments/guide/sunburn#2

70,73,76. www.medicinenet.com/heat_rash/article.htm

v71. www.medicinenet.com/heat_rash/page3.htm

78. http://solarshield.com/solar-shields-clip-ons/

79. www.google.com/?gws_rd=ssl#q=define:++cooling+centers

September 2016

Weather Forecast Preparedness: Tornado, Flood, Hurricane and Wind

Tornadoes occur in the United States during the spring and early summer, mostly in the Midwest and states that border the Gulf of Mexico—Nebraska, Kansas, Oklahoma, Texas, Iowa, Missouri, Illinois, Mississippi, Indiana, Alabama, Georgia, and Florida.¹

In the United States, Most hurricanes affect areas near the Atlantic Ocean or the Gulf of Mexico—Texas, Florida, New England, New York, North Carolina, Mississippi, Louisiana, New Jersey, Pennsylvania, and Virginia—from June to November—most of them in September.²

If you have a loved one who is a boomer or senior living in states subject to severe weather conditions, keep in touch during the season or have someone check on them.

If you are traveling or plan to travel in the future, please read Spencer Christian's contribution to "Weather Forecast Preparedness" thoroughly. (See the June issue, "Weather Forecast Preparedness: Rain, Lightning and Thunderstorm," for the health care professional's perspective and resource list.) You may want to take these articles with you when traveling and a copy for your disaster kit and to share with your loved ones.

Safe travels.

TORNADO

Tornadoes are spawned by violent thunderstorms that create extremely unstable conditions in the atmosphere. The Bay Area is fortunate to be situated in a region where thunderstorms are rare, and tornadoes are even rarer. However, there are some important facts we should remember about tornadoes. They are the most dangerously violent of all storms, and are capable of generating winds over 200 miles per hour. Because tornadoes are so powerful, it doesn't matter whether windows in a home are open or closed—they are still likely to be shattered by the winds.

The safest place to be during a tornado is in a low-lying area. In your home, that means a basement, storm shelter, or lowest floor in the house. If possible, gather all members of the household in that low-lying area and try to cover yourselves with a large cushion, mattress, or blanket—if you can't get below ground level.

Motor homes are extremely vulnerable to tornadoes. Sturdier structures (buildings or shelters) will offer much greater protection.

If you're driving, don't try to outrun the tornado. If you can determine the direction in which the tornado is moving, drive at a 90-degree angle away from it. Also, if time permits, seek a ditch, valley, or other low-lying area. Then, get out of the car and crouch as low to the ground as possible, covering your head and face with your arms, or a blanket if you have one.

FLOOD

Floods occur when heavy and/or continuous rain produces a greater volume of water than the ground can absorb and more than rivers and other bodies of water can contain. Floods are most common in low-lying coastal areas and river flood plains. Flooding may last only a few hours or several days or weeks, depending on how extensive and severe the flooding is. Flood waters can produce costly and permanent damage to homes. If there is a flood warning in your area, try to move valuable possessions to the highest possible location in your home, and obey evacuation alerts if they are issued. Flood waters can quickly become contaminated with infectious bacteria. For your safety, do not attempt to drive or walk through deep puddles or pools of water. If your car stalls in rising water, quickly abandon the car and seek higher ground.

MEDIA WARNINGS

All electronic and digital media provide frequent and ongoing alerts during all forms of extreme weather. That includes radio and TV stations, weather apps on mobile devices, and numerous websites online.

Warnings and alerts from the media are issued in many forms. Radio and TV stations will often interrupt regular programming with severe weather alerts; they post warnings on their websites; and they use social media—Twitter, Facebook, Instagram, etc.—to post urgent weather information. News and weather apps are also offered by print and broadcast media for the specific purpose of providing severe weather updates.

HURRICANE

When travelers are visiting an area that is hurricane prone, they should pay careful attention to local weather forecasts and take seriously all alerts and warnings related to evacuation, flooding, dangerous wind gusts, travel restrictions or delays, etc. Although hurricanes can be very destructive, they tend to move slowly and in predictable paths. Therefore, those who are attentive will have time to either prepare for a hurricane's impact or move out of its path.

WIND

Some descriptive words used regularly in weather forecasting for the Bay Area to inform the public are:

Light winds/light breezes: Generally under 10 miles per hour.

Breezy: Generally 10 to 20 miles per hour.

Windy: Generally sustained winds over 20 miles per hour, with occasional gusts that are 25 to 35 miles per hour or higher.

Media Warnings

Local Bay Area media will issue alerts to help the public prepare for potential wind damage whenever we experience a pattern of sustained strong winds. Some of the possible hazards are: downed trees and power lines, power outages, increased fire danger, personal injury, property damage, dangerous driving conditions, and many more. The possibility of trees being uprooted is greater when the ground is saturated by rainfall. All of these factors are incorporated in weather preparedness reporting, which we provide on the following platforms: regularly scheduled newscasts, live "cut-ins" which interrupt regular programming, our websites, news and weather apps, Facebook/Twitter/social media.

©Information courtesy of Spencer Christian, Weather Anchor, ABC 7/KGO-TV.

1,2. The World Book Encyclopedia

Anise J. Matteson is an elder care consultant, retired Registered Health Information Technician and writer of reference books for seniors.

July 2016

Weather Forecast Preparedness: Rain, Lightning and Thunderstorm

As I am writing this article, the weather is 65º and sunny. The forecast for later in the week is for a chance of rain in the North Bay. (Then, it likely will rain in San Francisco.)

I decided on the weather for a series of articles after my experience with the force of the "gusty winds" of 45 miles per hour announced in weather forecasts on Sunday, April 24, felt as if they would blow in the side of the house.

Stories of seniors who have homes and they are thinking, 'Well I can't climb the stairs much anymore' but where am I going to go? I'd like to stay in my neighborhood…”

San Francisco focuses its attention on earthquake preparedness, since the city is prone to earthquakes. Rainstorms are just as disastrous. They cause flooding, property damage, uprooted trees, and death.

This article will address the issues from a health care professional's perspective for concerned boomers and seniors managing self-care, or who have an aging loved one. In Part 2, weather-related issues will be addressed by weather forecaster Spencer Christian.

Warm weather brings an increase in tornados and lightning—the Atlantic hurricane season officially begins June 1. Weather events that draw the most media coverage and evoke our deepest fears, hurricanes and tornadoes.22

BE PREPARED

In March and April, I focused on advance care planning and the importance of an Advance Directive if you are unable to speak for yourself. A change in the weather is a reason to have an Advance Directive.

When there is little time to evacuate you will need to grab important papers, wallet with ID, keys, medications and eyeglasses. A valuable RESOURCE—"grab & go binder" (health and other important information)—Elder Diary: Starter Kit, Matteson, ©2007, addresses organizing important documents. For more information, see resource list. A list of emergency supplies organized by J. Matteson is available upon request.

When heavy rain is expected, precautionary measures should include sandbags, keeping extra food and water, and a relocation plan.1

Please contact me if you would be interested in my offering a seminar on how to use a fire extinguisher.

PREVENTIVE MEASURES 2

A rainstorm is a type of extreme weather which can produce heavy rain, poor visibility, and sometimes thunder and lightning. Rainstorms are formed sometimes from large weather systems (hurricanes, cyclones, etc.). As the weather systems move inland and start dissipating, they lose energy. Then they turn into ordinary thunderstorms, then rainstorms.3

A thunderstorm is a storm accompanied by lightning and thunder.4

For your safety, preparedness instructions insist adhering to the following preventive measures: Check drainage systems regularly. Secure objects that can be blown by severe wind (i.e., lawn furniture, outdoor decorations, trash cans, hanging plants).5 Do not leave home unless absolutely necessary; follow weather forecasts. Do not allow children to play outside. Stay away from windows and metal doors; stay off porches.6 Do not lie on concrete floors and do not lean on concrete walls.7 Lightning may cause fire. Have a fire extinguisher—A-B-C type accessible. Keep emergency and first aid bags ready. Keep flashlights available for backup lighting. If there is a call for evacuation, comply.

During a thunderstorm: Unplug the power supply for home appliances to protect them from the passage of a thunderbolt through the electric current. Move immediately to the nearest building, or to your car. Avoid standing under trees and electricity poles. Construction workers should avoid working or standing in upland areas or on the roofs of buildings under construction. Avoid contact with anything metal—motorcycles, golf carts, golf clubs, and bicycles.8

To avoid electrical accidents at home:9 Never touch anything electrical with wet hands or bare feet. Use caution when operating electrical appliances near water sources and always switch off after use. Appliances must be discarded immediately if they have been immerged in water. Always keep clear of overhead power lines.

When driving: Check information on the latest road conditions and closures due to high water.10 Be aware of the changes that could occur to the roads as a result of changing weather conditions. Heavy rain can produce slippery road surfaces. Stopping quickly on wet pavement is more difficult. Pavement markings will be harder to see. 11 Turn on low-beam headlights. Do not use the car to navigate in the flooded areas, (turn around and go another way 12). Drive with extreme caution—potential for landslides or limited visibility. If you are in the car and strong winds are blowing, leave the car and head to the nearest safe place.

HOLIDAYS DURING THE RAINY SEASON

If you are caring for an elderly loved one, the following suggestions are excerpts from Elder Caregiver's Newsletter, ©October ٢٠٠٣:

Mobility: Make sure the tips of assistive devices are well-maintained and in good condition. Have someone with you for transferring to car and buildings. Wear good, safe shoes. Get plenty of rest before and after the event so that you will not become fatigued. Have a wheelchair when needed. Use safety ramps and access, if possible. Watch floors for wet spots. Choose a time that is not peak hours for shopping. Have an emergency system to call for help. (e.g., cellphone). Keep oxygen safe, transportable; check the equipment; make sure you have enough oxygen.

Traveling: Call ahead for airline assistance on and off plane. Let public transportation services know that they will have an individual that needs special assistance. Use an alternative to public transportation. Suggestions provided by Sharol, Physical Therapist.

Writer's comments: Wear shoes that are: appropriate for weather conditions; comfortable and with the appropriate heel height, if doing a lot of walking. Remember rain gear: raincoat and rain boots in lieu of an umbrella; protective wheelchair cover. Consider a fanny pack or backpack to carry the necessary items so that your hands are free if pushing a wheelchair or providing ambulatory assistance.

FIRE EXTINGUISHER

A fire extinguisher is a metal container filled with water or chemicals used to put out fires. The kind used depends on the type of fire involved.13 The extinguisher tells you for what class of fire it can be used.

There are four types of fire extinguishers: dry chemical, water, carbon dioxide and halon.

Classification labels include A – wood, paper, and ordinary flammables; B - liquid flammables, such as greases, gasoline and oils; C - electrical fires; D - flammable metals; K - commercial restaurants and cooking fires. Some extinguishers may have multiple label ratings. (e.g., ABC Kidde Dry Chemical Extinguisher uses include: A – Trash, Wood, Paper; B – Liquid, Grease; C – Electrical Equipment.)

Maintenance instructions: check the pressure indicator and inspect extinguisher monthly, or more frequently if exposed to weather or vandalism; indicator pointer must be in the green area. If indicator is not in green area, extinguisher will not work properly and must be discarded.14

NOTE: A fire extinguisher feels heavy even when empty [per indicator].

Disposal: All fire extinguishers that are made entirely of metal can be refilled or recharged if necessary. Contact the fire department for fire extinguisher recharging companies. 15

If the extinguisher is empty, take the canister to any recycling facility that processes steel. If the extinguisher is full, or partially full, the local fire company can safely discharge it for you. Afterwards, take it to a recycling center. Some fire companies even recycle the extinguisher for you.

Check with the local waste management facility to verify that it accepts discharged fire extinguishers with household trash. Dry chemical and halon extinguisher may be considered hazardous—if so, you will have to take them to a local hazardous waste center for disposal.

Extinguishers made prior to 1960 can be very dangerous. These extinguishers may contain carbon tetrachloride—a known carcinogen. Use extreme caution when handling older extinguishers and contact the fire department for guidance on how to transport and dispose of them safely.

STATISTICS

Flood: In the past 5 years all 50 states have experienced floods or flash floods. 16 Flash flooding is responsible for more fatalities—more than 140 annually—than any other thunderstorm-associated hazard. 17

El Nino (February 2, 1998) – DR 1203. Severe and widespread landslides triggered by intense rain all winter occurred in many counties including San Francisco, which was declared a federal disaster area. Overall, resulted in 17 deaths and $550 million in damage.18

Conditions resulting in a flood: Hurricanes, overtopped levees, outdated or clogged drainage systems and rapid accumulation of rainfall, winter storms and snowmelt.19

Lightning: Is one of the top three storm-related killers in the United States. On average in the U.S., lightning kills 51 people and injures hundreds more. People struck by lightning often report a variety of long-term debilitating symptoms. Most lightning deaths and injuries occur when people are caught outdoors in the summer months during the afternoon and evening. 20

Lightning Fatalities by State, 2005-2014: California.7 Rank: 11-20. Source: Storm Data. (lightningsafety.noaa.gov)

U.S. Lightning Fatalities, 2016: Five so far this year. Female. 1 Male. 4 (National Weather Service. www.lightningsafety.noaa.gov/fatalities)

NATIONAL FLOOD INSURANCE PROGRAM

In 1968, Congress created the National Flood Insurance Program (NFIP) to help provide a means for property owners to financially protect themselves. Participating communities agreed to adopt and reinforce ordinances that meet or exceed FEMA requirements to reduce the risk of flooding. Congress mandated federally regulated or insured lenders to require flood insurance on properties that are located in areas at high risk of flooding. 21

PROTECTIVE CLOTHING (WHEELCHAIR USERS)

Your loved one, too, needs to be protected from the rain. There are numerous protective clothing on the Internet for wheelchair users: capes and ponchos that cover for the top half of the body with extra length at the front for knee protection. You may want to visit Amazon.com and Pinterest to select your preference. The Silvert's Unisex Lined Wheelchair Poncho, a winter poncho with zipper is water repellent is available at www.1800wheelchair.com. (800) 387-7088. Do not forget rain boots and gloves.

RESOURCES

National Flood Insurance Program. (800) 427-2354. Offers flood insurance to homeowners, renters and business owners, if their community participates in the NFIP. To find out if your community is a NFIP partner, check the Community Status Book at https://www.floodsmart.gov/gloodsmart/pages/flood_ facts.isp.

California Driver Handbook. See: Special Driving Situations: Driving Hazards: Water on the Road; Slippery Roads; High Winds; Driving in Rain or Snow. Department of Motor Vehicles. (800) 777-0133. (Copy subject to availability at San Francisco Public Library.)

Department of Public Works. Provides residents up to 10 free sandbags leading up to and during severe rainstorms for properties prone to flooding. Hours: Monday – Saturday, 8 a.m. to 2 p.m. at MarinStreet/ Kansas Street gate. Proof of address required or call 311.

Elder Diary: Starter Kit. Anise J. Matteson. 2007. An instructional guide designed to help non-medical persons better manage the care of their loved one. Includes sample forms for recording medical and other important information. Inquire: mattesonecs@yahoo.com.

National Weather Service. Provides active alerts, current conditions, forecasts, weather safety, education. www.weather.gov. Recorded weather: (831) 656-1725.

Outdoor Public Warning System (OPWS) Siren Information. San Francisco Outdoor Public Warning System alerts residents and Visitors of the Bay Area about possible danger. In times of a disaster, the 15 second alert tone will sound repeatedly for 5 minutes. www.sfdem.org.

Travelers with Disabilities. (800) 455-2700. Defines the airlines policy for planning reservations for travelers with special needs: airport assistance, aircraft accessibility and in-flight assistance. www.delta. com/content/www/en_US/traveling-with-us/special-travel-needs/disabilities.html.

1. Began, Brian. "Deluge of wet weather expected this week." THE EXAMINER, January 17, 2010.

2. www.ncema.gov.ae/en/e-participation/blog/preventive-measures-to-avoidthe-risk-of-heavy-rain-lightning-and-thunderstorm.asp#page-=1

3. http://weather.wiki.com/Rainstorm

4. Webster's New Collegiate Dictionary

5,12. https://www.providenceri.com/PEMA/residents-advised-to-take-precautions-as-heavy

6,7,8,17,20.

9. www.gplinc.net/node/346

10,11. www.smithvilleherald.com/news/article_da98bfba-ea-28-52ab-8644-1efab1f9c98a.html

13. The World Book Encyclopedia

14. Walter Kidde, The Fire Extinguisher Co.

15 .www.ehow.com/how_5649264_dispose-old-fire-extinguisher.html

16. https://www.floodsmart.gov/floodsmart/pages/flood_facts.isp

18. resillience.abag.ca.gov/wp-content/documents/ThePlan-D-2011.pdf

19,21.

22. (http://listosaur.com/top-5-weather-related-causes-of-death-in-the-us/)

Anise Matteson is an elder care consultant, retired Registered Health Information Technician and writer of reference books for seniors and Elder Caregivers NEWSLETTER, ©2003. Information educational only. mattesonecs@yahoo.com.

June 2016

Senior Housing: Choosing Where You Live to Have a Dynamic Life

Iam prompted to express my expertise in elder care in response to Alexander Mullaney's interview with Joel Engardio ("Meet the District 7 Candidates," Ingleside-Excelsior Light, March 2016) regarding Engardio's response to: West Portal's commercial corridor. How do you see it growing in your term?

Stories of seniors who have homes and they are thinking, 'Well I can't climb the stairs much anymore' but where am I going to go? I'd like to stay in my neighborhood…”

Housing to which seniors can downsize.

Stories of seniors who have homes and they are thinking, 'Well I can't climb the stairs much anymore' but where am I going to go? I'd like to stay in my neighborhood…"

If my memory is correct, I read this statement in the West Portal Monthly sometime in the past few years.

There are service providers who can assist seniors with home modifications to age-in-place. They are Certified Aging-in-Place Specialists (CAPS).

There is medical equipment that can be installed: chair lift, platform lift, dumb waiter, home elevators, etc.

Mechanical lifts may be covered by health insurance.[1]

Neither you nor your loved ones have to experience this season of life alone. Everyone goes through each season. The difference is how it is experienced and who is willing to walk with you.

 Michael Menn, a licensed architect, remodeler and frequent industry speaker provided the following information for the Glossary in my reference book, Caring for an Aging Loved One: The Family Caregiver's Guide Book, ©2007.

 Definitions

 Aging-in-place. 1: living in your home safely, independently and comfortably regardless of age, income or ability level; 2: the pleasure of living in a familiar environment throughout one's maturing years; 3: the ability to enjoy the familiar daily rituals and the special events that enrich our lives; 4: the reassurance of being able to call a house a "home" for a lifetime; 5: using products, services and conveniences to allow or enable you not to have to move as physical and social circumstances change.

 Universal Home Design. Is intended to make the home friendly, or easy to navigate, for everyone.

 Certified Aging-in-Place Specialist (CAPS). Professionals trained in working with older and maturing adults in remodeling their homes to provide comprehensive and practical "aging-in-place," "universal design" and "visibility" solutions.

 What is CAPS?

 The American Association of Retired People (AARP) and the National Association of Home Builders (NAHB) have been working together to create the "Certified Aging in Place Specialist" (CAPS) program to help home remodeling professionals meet the needs of the burgeoning market. This training program is offered through individual state homebuilders associations to home remodelers.

 The program teaches the technical, business management and customer service skills essential to compete in this fast growing segment of the residential remodeling industry. It provides comprehensive, practical, market-specific information about working with older and maturing adults to remodel their homes for aging-in-place.

 CAPS professionals have the answer to your questions. They have been taught the strategies and techniques for designing and building aesthetically enriching barrier-free living environments. The CAPS program goes beyond design to address the codes and standards, common remodeling expenditures and projects, product ideas and resources needed to provide comprehensive and practical "aging-in-place," "universal design" and "visibility" solutions. CAPS graduates pledge to uphold a code of ethics and are required to maintain their designation by attending continuing education programs and participating in community service.

 The role of a the Specialist"

 A Certified Aging-in-Place Specialist (CAPS) has been trained in the following: 

The unique needs of the older adult population.

"Aging-in-Place" home modifications.

Common remodeling projects.

Solutions to common barriers.

Knowledge of "Universal Design."

Knowledge of "Visibility." 

While most CAPS professionals are remodelers, an increasing number are general contractors, designers, architects and health care consultants.

 Abbreviations

AIA - American Institute of Architects

CGR - Certified Graduate Remodeler © Information courtesy of Michael A. Menn, AIA, CGR, CAPS. Principal, Design Constructions Concept, Ltd.

AT-HOME LIVING: MECHANICAL LIFTS

Purpose: Mechanical lifts can be installed in homes in order to make uninhabitable areas more habitable.[2]

LIFTS

Stair chair. A device used to transport patients capable of being moved in a sitting position up and down a staircase or through narrow and confined spaces.[3] Attaches to the bottom of a stairwell.[4]

Stair Lifts [5]

Outdoor Stairlift. Weather-proofed. Waterproof cover.

Perched/Stairlift. When the user may have trouble bending at the knee and therefore cannot use a standard lift.

Sit/Stand Stairlift, For multiple users with different requirements.

Curved Stairlift. For more complex staircases.

Wheelchair stair lift: 1. Has a platform for a wheelchair instead of a comfortable chair. 2. Allows the senior to take their wheelchair with them up and down the stairs. 3. Provides them with a way to tackle the stairs by themselves. 4. Useful for seniors who are unable to transfer themselves from wheelchair to a chair lift.[6]

Platform Lifts

Platform lift. An unenclosed platform which carries persons and cargo in the manner of an elevator, usually over a short vertical distance. The platform is usually attached to theside of the lift mechanism.[7]

Wheelchair platform lift. Allows its user to roll onto the platform and then press a button to go up or down to reach the porch or the sidewalk.[8]

HOME ELEVATORS

Personal elevator. 1. For people in wheelchairs or seniors who have a walker or cane and find it difficult to go up and down the stairs in their home. 2. For homes that are two or more stories tall and that have a lot of stairs. 3. Can be installed into already established closets.[9]

Residential home elevator.

Residential home elevator

Personal elevator

Dumb waiter. 1. For seniors who are unable to maneuver the stairs easily and who often need items transferred from one floor to another. A mini manual elevator that allows the user to transfer laundry, prepared meals or other heavy items up and down floors.[10]

Seniors, you are a real estate developer or investor's dream come true!

Please contact me if you would be interested in my offering a seminar with service providers to learn more about options for remaining in your home when you are no longer able to climb the stairs.

Share "Your Story": If you are homebound, why? What would make your life more fulfilled?

RESOURCES

Home Safety Services. www.homesafety.net. (888) 388-3811. The Safety Fitting Experts provides in-home assessments and installations. Services to enhance independence include: home safety assessment, grab bars, stair railings, wheelchair ramp, stair lift, complimentary telephone consultation to help Bay Area residents enhance their independence and peace of mind. Certified Aging in Place Specialist. Licensed and Bonded General Contractor.

Home Improvement Assistance Programs for Seniors. Jim T. Miller. May 18, 2015. www.huffingtonpost.com/jim-t-miller/home-improvement-assistan_b_7306038.html. Programs that can help seniors with home repairs and improvement projects for aging-in-place. Options: Medicaid waivers; State and local programs (e.g., "nursing home diversion programs" or "deferred payment loans"), Area Aging Agency; Federal programs; Veterans benefits; Non-profit organizations (e.g., Rebuilding Together); Reverse mortgage.

Bruno's Residential Platform Lift. www.bruno.com/residential-vertical-platform-lift/. A 3:19 minute video on the automatic self-lowering ramp. (Also called porch lift.)

1,2,4,6,8,10. www.carefecthomecareservices.com/blog/types-mechanical-lifts-homes/

3. Taber's Cyclopedic Medical Dictionary

5. Acorn Stairlifts

7. standards.phorio.com/?t=definition&code=8152013099

Anise Matteson is an elder care consultant, retired Registered Health Information Technician and writer of reference books for seniors. Information is educational only. For specific questions and advice, consult a licensed contractor

May 2016

April 16 is National Healthcare Decisions Day!

This year marks the 9th Annual Healthcare Decisions Day and the 3rd Annual Healthcare Decisions Day in San Francisco with healthcare Decisions Week from April 9 through April 16. During the week, neighborhood branches of the San Francisco Public Library acknowledge advance care planning with books/materials display for Advance Directives, wills, trusts and estate planning.

The purpose is to inform patients of their rights regarding decisions towards their own medical care, and ensure that these rights are communicated by the health care provider. Specifically, the rights ensured are those of the patient to dictate their future care (by means such as a living will or power of attorney), should they become incapacitated."

I would like to thank last year's participants: Bookmobile (Library on Wheels/Seniors), Excelsior, Glen Park, Merced, Mission, Mission Bay, Visitation Valley, and Western Addition.

Prepare for the unexpected. Set aside time on April 16—visit the library; discuss your wishes with your loved ones; primary care physician or attorney. (Since April 16 is a Saturday, schedule an appointment April 11-15.) Name someone to speak for you when you cannot speak for yourself.

Patient Self-Determination Act (PSDA)

When you have completed your Advance Directive, you may indicate this with the wallet card that states you have advance directives

Passed by the U.S. Congress in 1990, it became effective on December 1, 1991. The purpose is to inform patients of their rights regarding decisions towards their own medical care, and ensure that these rights are communicated by the health care provider. Specifically, the rights ensured are those of the patient to dictate their future care (by means such as a living will or power of attorney), should they become incapacitated. The PSDA requires information to be given to adult patients about their rights under state laws governing advance directives, including: 1) the right to participate in and direct their own healthcare decisions; 2) the right to accept or refuse medical or surgical treatment; 3) the right to prepare an advance directive; 4) information on provider's policies that govern the utilization of these rights. The act also prohibits institutions from discriminating against a patient who does not have an advance directive. The PSDA requires institutions to document patient information and provide ongoing community education on advance directives. (1)

California law provides individuals the ability to ensure that their health care wishes are known and considered if they become unable to make these decisions themselves. (2)

End of Life Option Act

The "End of Life Option Act," ABX2-15, permits terminally ill adult patients with capacity to make medical decisions to be prescribed an aid-in-dying medication if certain conditions are met. On October 5, 2015, California became the fifth state to allow physicians to prescribe terminally ill patients medications to end their lives.[3]

An Advance Directive is a part of patient-centered care—a treatment plan specific to the patient's needs.

Your Story

In March, I asked readers: Why should you have written instructions for end-of-life care? And, to share your experience if you have recently experienced the loss of a loved one who did not have an Advance Directive. No responses have been received in time for this article.

I also wrote the Medical Director at UCSF Emergency Room to describe a case involving a patient brought to the Emergency Room who did not have an Advance Directive: Protocol; Medical team's decision for plan of care; Family's reaction; Family's decision.

And, the Medical Director at St. Mary's Medical Center to please provide information on: What patients and family members should know about Catholic hospitals honoring the patient's wishes who have advance directives when there is a change of condition? Will a Catholic hospital honor the patient's wishes conveyed by a family member orally that this is what the patient would or would not want when he or she became unable to speak for themselves? Are Catholic hospitals aware of the Secular Health Care Directive? No response has been received in time for this article.

April 16 is a day to "inspire, educate and empower the public and providers about the importance of advance care planning." I hope you find the information in the March and April articles helpful to make an informed decision about completing an Advance Directive.

RESOURCES

My Life, My Choices™. Planning for Future Healthcare Decisions. Hospice of Marin® Community Education Program. www.hospicebythe bay.org/index.php/about/speakers-bureau.

Hospice by the Bay. (415) 626-5900. Community services: include Advance Care Planning Seminars, Estate Planning Seminars and Community Grief Counseling and Support Groups. www.hospicebythebay.org/index.php/locations/san-francisco.

Good to Go RESOURCE GUIDE. Compassion & Choices MAGAZINE, Special Issue, 2012 Reprint, (800) 247-7421. www.Compassion AndChoices.org. Chapters include: How to Make Your Health Care Decisions Known, Your Wishes, Glossary, The Conversation.

1.http://definitions.uslegal.com/p/patient-self-determination-act-of-1990

2,3.www.cmanet.org/about/patient-resources/end-of-life-issues/

Anise Matteson is an elder care consultant, retired Registered Health Information Technician, writer of reference books for seniors, and Advocate, National Healthcare Decisions Day. Information is educational only. For specific questions and advice, consult your physician and an attorney. mattesonecs@yahoo.com.

April 2016

When Your Decisions Matter!

Emergency preparedness focuses on more than an emergency preparedness kit in the event of an earthquake, or a grab-and-go backpack if you have to leave your home suddenly because of a disaster. It includes preparing for a medical emergency. Who will speak for you when you cannot speak for yourself?

An Advance Directive will provide your loved ones with the answers they need to assist health care professionals with a treatment plan.

You should have an Advance Directive to specify your decisions in the future regarding health care, end-of-life care, nutrition, hydration, hospice care, No Cardiopulmonary Resuscitation, and organ donation when you become unable to express your wishes.”

ADVANCE DIRECTIVES

Advance Directive and Durable Power of Attorney provide instructions in your own words to family/caregivers, friends, and health care professionals when there is a significant condition change.

An advance directive is a written document in the form of a living will or durable power of attorney prepared by a competent individual that specifies what, if any extraordinary procedures, surgeries, medications or treatments the patient desires in the future, when he or she can no longer make such decisions about medical treatment. [1]

You should have an Advance Directive to specify your decisions in the future regarding health care, end-of-life care, nutrition, hydration, hospice care, No Cardiopulmonary Resuscitation, and organ donation when you become unable to express your wishes. (Examples with supporting documentation: do not hospitalize, autopsy request, feeding restrictions, medication restrictions, other treatment restrictions.)

Sectarian Health Care Directive

"An optional addendum to your advance directive. The language in this addendum clarifies that admission to a religiously-affiliated facility does not imply consent to particular care mandated by the institution's religious policies, and directs a transfer if the facility declines to follow the wishes outlined in an advance directive." (CompassionAndChoices.org)

ELDER LAW

Elder law attorney refers to an attorney who specializes in providing legal services for the elderly, especially in the area of Estate Planning and Medicaid Planning. They handle general estate planning issues and counsels clients about planning for the management of assets and health care with alternative decision-making documents to prepare for the possibility of becoming incapacitated. Elder law is a specialized area of legal practice, covering estate planning, wills, trusts, arrangements for care, social security and retirement benefits, protection against elder abuse (physical, emotional and financial) and other involving older people. (http://definitions.uslegal.com/e/elder-law-attorney)

For an elder law attorney perspective, see Boomer Legal by Helene V. Wenzel, Esq. solo practitioner in Estate Planning and Elder Law, "Let's Talk Boomer Legal and Advance Care Planning": Power of Attorney, Advance Health Care Directive, Physicians Orders for Life-Sustaining Treatment, The Difference Between a "Living Will" and a "Will" (March 2015); and Living Trust, What Happens To The Estate if the Deceased Does Not Have A Will?, Preparing for an Appointment if an Attorney Prepares Documents, The Difference Between "Revocable" and "Irrevocable" Living Trust (April 2015). ©2015.

NATIONAL HEALTHCARE DECISIONS DAY

April 16 is a day to "inspire, educate and empower the public and providers about the importance of advance care planning."

"…National Healthcare Decisions Day is an initiative to encourage patients to express their wishes regarding health care and providers and facilities to respect those wishes, whatever they may be." (nhdd.org)

As Advocate for National Healthcare Decisions Day, in 2014 I started Healthcare Decisions Week in San Francisco from April 9 through April 16. I invited San Francisco Public Library neighborhood branches to participate in acknowledging advance care planning.

See the April issue for this year's details.

Your Story

Why should you have written instructions for end-of-life care?

Please share your experience if you have recently lost a loved one and they did not have an Advance Directive. Submit by March 12 for April article on Advance Care Planning.

RESOURCES: ADVANCE CARE PLANNING

Advance Health Care Directive. To download form visit the California Health Care Association at cmanet.org.

Five Wishes – Aging with Dignity. agingwithdignity.org/forms/5wishes.pdf.

FIVE WISHES

MY WISH FOR:

The Person I Want to Make Care Decisions for Me When I Can't

The Kind of Medical Treatment I Want or Don't Want

How Comfortable I Want to Be

How I Want People to Treat Me

What I Want My Loved Ones to Know

Secular Health Care Directive. For more information contact CompassionAndChoices.org.

RESOURCES: Planning

Seniors & the Law: Guide for Maturing Californians, "PLANNING AHEAD," pp. 6-7. State Bar of California educational guide. To request publications contact 1-888-875-5297 or visit www.calbar.gov.

RESOURCES: WILLS

Write Your Will Workshop, Write Your Will Seminar and Introduction to Wills & Trusts are held at various branches of the San Francisco Public Library. You can find information on upcoming sessions at sfpl.org.

Taber's Cyclopedic Medical Dictionary

Anise Matteson is an elder care consultant, retired Registered Health Information Technician, writer of reference books and Caring Boomers Newsletter article excerpt ©2012, and Advocate, National Healthcare Decisions Day. Information is educational only. For specific questions and advice, consult your physician and an attorney. mattesonecs@yahoo.com

March 2016

Aging: Glaucoma and its Affects on the Eyes

Part 4 – Operative Treatment

If you have been following the series, you have a better understanding of why it is important to get tested, diagnosed, and treated early in the disease process. After reading this article, you will definitely realize the seriousness of this disease and two sources for eye surgery.

REASON FOR SURGERY

You may need surgery to treat glaucoma if you can’t tolerate medications or if they’re ineffective. Sometimes a single surgical procedure may not effectively lower your eye pressure. You may need to continue using eye drops, or you may need another procedure.[1]

COMPLICATIONS

Possible complications from glaucoma surgery include infection, inflammation, bleeding, abnormally high or low eye pressure, and loss of vision. Having eye surgery also may speed up the development of cataracts. Most of these complications can be effectively treated.[2]

LASER SURGERY

Trabeculoplasty.[3] May be performed as an outpatient surgery.

Indication: Open-angle glaucoma.

Procedure: A high-energy laser beam is used to open clogged drainage canals and help fluid drain more easily.

Action: Initially lowers intraocular pressure.

Complications:[4] Transient: Blurred vision, irritation and pain, conjunctivitis, iritis, ocular hypertension, photophobia, tearing, corneal opacities. Permanent: Peripheral anterior synechiae.

Types of Laser Trabeculoplasty (LP)

Argon Laser Trabeculoplasty (ALT)[5]

Indication: Open-angle glaucoma that continues to progress despite use of medications. Older adults who are unable to use medicines to treat.[6]

Procedure: An Argon laser beam is directed at the trabecular meshwork.

Action: Facilitate drainage of fluid from the eye. Lowers intraocular pressure.

Complications:[30] Transient rise in IOP. Low grade iritis. Formation of PAS. Corneal edema. Hyphema.

Selective Laser Trabeculoplasty (SLT)[7]

Indication: Primary open-angle glaucoma (POAG). An alternative for those who have been treated unsuccessfully with traditional laser surgery or with pressure lowering eye drops.[25]

Procedure: Uses a combination of frequencies that allow the laser to work at very low levels. It treats specific cells “selectively,” leaving untreated portions of the trabecular meshwork intact.

Action: Lowers IOP.

Side Effects: Soreness, redness, blurring of vision. Elevated eye pressure. Peripheral anterior synechiea. Inflammation and swelling.

Micropulse Laser Trabeculoplasty (MLT)[8]

Indications: POAG (primary open-angle glaucoma), pigmentary glaucoma, pseudoexfoliation glaucoma.[21]

Procedure: Uses repetitive low-energy laser pulses that are separated by brief rest periods.[15]

Action: Helps to minimize the IOP spikes that can sometimes occur after a laser procedure.

NOTE: This technology is still being evaluated by glaucoma treatment professionals.

Neodymium: YAG laser cyclophotocoagulation (YAG CP)[34]

An alternative to filtering microsurgery.

Neodymium: yttrium-aluminum-garnet (YAG) laser (1064 nm wavelength) has been used either with non-contact or contact methods to achieve cyclodestruction.[16]

Indications: Final and last ditch procedure to save an eye from glaucoma that are most difficult to control. Severe glaucomas that are resistant to therapies.

Procedure: Destroys part of the ciliary body, the part of the eye that produces intraocular fluid. The procedure may need to be repeated to control glaucoma.[9]

Action: Decreases the amount of fluid made.

Risks: Postop pain, marked inflammation of the outside and inside of the eye, markedly decreased vision for a period of one to six weeks after the procedure.

Complications: Permanent decrease in visual acuity in those with advanced glaucoma or retinas susceptible to swelling with intraocular inflammation.

Laser Peripheral Iridotomy (LPI)

Narrow-angle glaucoma occurs when the angle between the iris and the cornea is too small, causing the iris to block fluid drainage increasing inner eye pressure.[10]

Indication:[11] Narrow-angles and narrow-angle glaucoma. Acute angle-closure glaucoma. Chronic angle-closure glaucoma. Fellow eye of acute angle-closure glaucoma. Miscellaneous conditions, including phacomorphic glaucoma, aqueous misdirection, nanophthalmos, pigmentary dispersion syndrome, and plateau iris syndrome.

Procedure:[12] A small hole is made in the iris, allowing it to fall back from the fluid channel helping the fluid drain.

Action: [27] To prevent another attack of acute angle-closure glaucoma or progression to chronic angle-closure glaucoma. Chronic angle-closure glaucoma: IOP may remain the same or be lowered, depending on the extent of peripheral anterior synechiae.

Contraindications:[28] Conditions causing poor visualization of the iris. Angle closure due to synechial closure of the anterior chamber. Patient who is unable to cooperate.

Complications:[36] Brief blurred vision (common). Swelling of the clear covering (cornea) of the iris. Bleeding. Increased pressure in the eye. Later: Further clouding of the lens (cataract) compared to what the present was before laser treatment. Closure of the opening. Recurrent closed-angle glaucoma. Development of another type of glaucoma. Continued need for medications (depending on the person’s condition before laser treatment). Glare or double vision from light entering through the new opening.

RESOURCES

Eye Surgery Center of San Francisco. http://escsf.org. (415) 440-1100. Specializes in cataract surgery with intraocular lens placement, corneal transplantation, strabismus, treatment of glaucoma, and ophthalmic plastic and reconstructive surgery.

Glaucoma Clinic. UCSF. (415) 514-6920. TREATMENT: By referral, patients with conditions that have poor prognosis, including those who have had unsuccessful glaucoma surgery or have secondary glaucoma, advanced glaucomatous optic atrophy and patients who have vision only in one eye. SPECIALTY: Congenital, combined mechanism, narrow angle, open angle, and normal tension glaucoma. DIAGNOSTIC: Automated perimetry, darkroom prone provocative testing, specular microscopy testing, tonography, pachymetry, optic disk photography, optic nerve laser scanning, iris fluorescein angiography, A and B scan ultrasonography and ultrasound biomicroscopy. OUTPATIENT PROCEDURES: Contact Ng-Yag transcleral cyclophotocoagulation, endocyclophotocoagulation, Argon-laser trabeculoplasty, selective laser trabeculoplasty, Yag– iridectomies and laser sclerostomies. The Clinic also has extensive experience with surgically implanted valves and non-penetrating glaucoma surgery. www.ucsfhealthlorg/clinics/glaucoma/index.html.

Future articles: Filtering Surgery. Cyclodestructive Procedure. Drainage Implants

Reminder: April 16 is National Healthcare Decisions Day. Your decisions matter.

1,2,3.  www.mayoclinic.org/diseasesconditions/glaucoma/basics/treatment/con-20024012
4.  https://www.google.com/search?=free+photos:+trabeculoplasty…
5.  www.djo.harvard.edu/site.php?url=patients/pi/417
6.  www.webmd.eye-health/laser-trabeculoplasty-for-glaucoma
7.  www.glaucomaresearch.ca/en/treatment/surgery_laser.shtml
8.  www.glaucoma.org/treatment/micropulse-laser-trabeculoplasty-mlt.php
9,10,12.  www.glaucomaresearch.ca/en/treatment/surgery_laser.shtml
11,27,28.  http://enmedicine.medscape.com/article/1844179-overview
15.  www.treatmyglaucoma.com/micropulse
21.  www.aocoohns.org/wp-content/uploads/2012/90/Benjamin.pdf
25.  Understanding Medical Terminology
26.  http://ocvermont.com/glaucoma-surgery/selective-laser-trabeculoplasty-slt/
30.  www.eyewiki.org/Laser_Trabeculoplasty:Alt_vs_SLT
34.  http://willsglaucoma.org/nd-yag-cyclophotocoagulation-therapy-for-difficult-glaucoma
36.  www.webmd.com/eye-health/laser-iridotomy-for-glaucoma

Anise Matteson is an elder care consultant, retired Registered Health Information Technician and writer of reference books for seniors, and Advocate, National Healthcare Decisions Day. Information is for educational purposes. For specific questions and care, consult an ophthalmologist. mattesonecs@yahoo.com.

February 2016

Aging: Glaucoma and its Effects on the Eyes

Part 3 – Nonoperative Treatment

At this time, there is no cure for glaucoma. Optic nerve damage cannot be reversed. If glaucoma has been diagnosed and there has been vision loss, treatment can slow or prevent further vision loss.

REASON FOR TREATMENT

The goal of glaucoma treatment is to lower the intraocular pressure. To treat, doctors may: 1) lower your eye pressure, 2) improve drainage of fluid in your eye, or 3) lower the amount of fluid produced in your eye. [1]

ADVERSE EFFECTS[2]

Medications placed in the eye are absorbed into the conjunctival blood vessels on the eye surface. A certain percentage of the active ingredient of the medication, though small, will enter the bloodstream and may adversely effect functions such as heart rate and breathing.

Likewise, some types of eye drops may worsen certain existing medical conditions such as asthma. Some glaucoma drugs also interact with other common medications such as digitalis, prescribed for heart conditions.

EYE MEDICATIONS

Eye drops are classified by the active ingredients that helps make the drug work.[3]

If eye drops alone don’t bring your eye pressure down to the desired level, your doctor may also prescribe an oral medication, usually in the form of a carbonic anhydrase inhibitor to reduce your eye pressure. [4]

Prostaglandins

Latanoprost (Xalatan). Indication: Ocular hypertension and open-angle glaucoma. Action: Lowers pressure in the eye. Increases fluid drainage.

Bimatoprost (Lumigan). Indication: Open-angle glaucoma. Action: Increases outflow of fluid. Reduces IOP.

Beta Blockers

Timoptic. Indication: Chronic open-angle, secondary, and aphakic glaucoma, ocular hypertension. Action: Decreases fluid production and pressure.

Betaxolol (Betoptic). Indication: Chronic open-angle glaucoma and ocular hypertension. Action: Decreases fluid production and pressure.

Alpha –Adrenergic Agents

Apraclonidine (Iopidine). Indication: Prevention or control of IOP elevation. Used in combination with other medications. Decreases fluid formation. Lowers IOP.

Brimonidine (Alphagan P). Indication: Open-angle glaucoma. Action: Decreases fluid production and IOP.

Carbonic Anhydrase Inhibitors

Acetazolamide (Diamox)** Indication: Secondary glaucoma and preoperative treatment of acute-angle closure glaucoma. Action: Decreases secretion of aqueous humor. Lowers IOP.

Methazolamide (Neptazene).* Indication: Chronic open-angle or preoperatively in obstructive or acute-angle closure glaucoma. Action: Decreases secretion of aqueous humor. Lowers IOP.

Dichlorphenamide (Daranide).* Indication: Adjunct in glaucoma. Action: Decreases secretion of aqueous humor. Lowers IOP.

NOTE: These are rarely used. These medications may reduce production of fluid.][5]

Miotic or Cholinergic Agents [parasympathomimetics]

Pilocarpine (Isopto Carpine). Indication: Primary open-angle glaucoma. Emergency treatment of acute-angle closure glaucoma. Action: Cholinergic. Reduces IOP.

Carbachol (Isopto Carbachol). Indication: Open-angle glaucoma. Action: Cholinergic. Causes contraction of the sphincter muscles of the iris, resulting in miosis.

Ephinephrine

Dipivalyl epinephrine (Propine). Indication: IOP reduction in chronic open-angle glaucoma. Action: Decreases aqueous production. Increases aqueous outflow.

Hyperosmotic Agents

Isosorbide (Ismotic). Indication: Short-term reduction of IOP caused by glaucoma. Action: Promotes redistribution of water producing diuresis.

Mannitol (Osmitrol).*** Indication: Reduction of IOP. Action: Osmotic diuretic.

NOTE: One-time emergency. Indication: Severely high intraocular pressure that must be reduced immediately before permanent, irreversible damage occurs to the optic nerve. Action: Reduces IOP by lowering fluid volume.[6]

Combined Medications

Timolol maleate (Timoptic Solution). Indication: Chronic open-angle glaucoma, secondary and aphakic glaucomas, ocular hypertension. Action: Beta blocker. Decreases fluid production and pressure.

EXAMPLES: Beta blocker and alpha adrenergic agonist, or beta blocker and carbonic anhydrase inhibitor.[7]

MARIJUANA[11]

The American Academy of Ophthalmology, among other authoritative sources, say the risky side effects of marijuana (such as lowered blood pressure, increased heart rate, poor pregnancy outcomes, poor motor coordination, impaired memory and increased risk of cancer and emphysema) far outweigh any benefit.

Popular opinion persistently exaggerates the benefit of marijuana for glaucoma. This is unfortunate, because people who use marijuana instead of their prescribed glaucoma medication run a high risk of having irreversible vision loss.—L.S.

*tablet **tablet, capsule *** I.V.

Source: Multiple including Nursing Drug Handbook.

POSSIBLE SIDE EFFECTS[8]

Prostaglandins: Mild reddening and stinging of the eyes and darkening of the iris, changes in the pigment of the eyelid skin and blurred vision.

Beta blockers: May worsen breathing problems, slowed heart rate, lower blood pressure, and fatigue.

Alpha-adrenergic agonists: Irregular heart rate, high blood pressure, fatigue, red itchy or swollen eyes, and dry mouth.

Carbonic anhydrase inhibitors: Frequent urination and a tingling sensation in the fingers and toes.

Miotic or cholinergic agents: Smaller pupils, blurred or dim vision, or nearsightedness.

Epinephrine: Pigmented eye surface membrane (conjunctival deposits), blocked tear ducts and heart palpitations with an increased heart rate.[9]

MANAGING EYE MEDICATIONS[10]

Smartphone application that reminds patients when and how to take their eye drops:

EyeDROPS

Free app from HarPas International; also allows patients to take a photo of each bottle to avoid confusion.

Can track multiple medications.

Demonstrates the correct way to administer eye drops.

Basic EyeDROPS app: Free. Available for Android and iPhone.

Available for: Android phones though Google Play. Apple iPhone through the App Store.

NOTE: For Premium EyeDROPS app, Premium users will need to log-in. Visit www.eyedropsapp.com for information.

Editor’s Note: This is a shortened version of this article. To read more go to: westsideobserver.com/health.html

NEXT MONTH: Operative Treatment

Wishing you a Merry Christmas and life’s best in 2016!

SUPPORT GROUPS

RESOURCES: BOOKS/PAMPHLETS

Medicare and You 2015. Available in Large Print and e-Reader (iPad, NOOK, Sony Reader, or Kindle). To download a free digital version of the handbook visit Medicare.gov/publications. For eHandbook online visit medicare.gov/gopaperless. (See pp. 175-194, “Get Information About Prescription Drug Coverage (Part D)” for answers to: drugs covered; copayments; “donut hole”; formulary; enrollment.) (See pp. 205-206, “Getting Extra Help Paying Your Health & Prescription Drug Costs for information on: qualifying requirements; resources included; rvesources not included.) Medicare.gov. (800) 633-4227.

MEDICARE PRESCRIPTION SAVINGS GUIDE. 2015, Walgreen Co. Publication No. 000010673 – 749. Pamphlet provides information on: Coverage Phases; Cost terms; Medicare Prescription Plan Advisor, and more. Copy available at local Walgreen stores.

Medication Instructions Organizer by Anise J. Matteson. Instructional guide designed for organizing medication and treatment orders to help non-medical persons better manage self-care and the care of their aging loved ones. Contains: Important Documents Checklist; Self-Tests; an explanation of the forms purpose and what information you will be asked to complete; examples of completed forms; sample forms for recording medication and treatment orders and other important information. ©2009. MATTESON ELDER CARE SERVICES. Inquire: mattesonecs@yahoo.com.

RESOURCES: DISCOUNTS

AAA Prescriptions. www.AAA.com/prescriptions. (866) 222-7283. AAA Prescription Savings is a prescription discount program that provides discounts at participating pharmacies for AAA Auto Members to use their card to purchase prescriptions that are not covered by insurance. http://ww1.aaa.com/services/ cms/templates/index.html?page=AAAPrescriptions&zip=94109&devicecd=PC&referer=www.aaa.com.

RESOURCES: FINANCIAL ASSISTANCE

Get help with your Medicare costs. Publication No. CMS -10126. Medicare.gov/publications at “Your Medicare Costs” tab. (See p. 9, “Help for some low-income people.”) For more information about getting help with your prescription drug costs: (800) 772-1213. Apply online: www.socialsecuirty.gov/extrahelp.

Social Security Administration. www.socialsecurity.gov:

Medicare. ICN 46000.

Medication Premiums: Rules For Higher-Income Beneficiaries. Publication No. 05-105 36. www.socialsecurity.gov/medinfo.htm.

Understanding the Extra Help With Your Medicare Prescription Drug Plan. SSA Publication No. 05-10508. ICN 470112.

To determine eligibility, file: Application for Extra Help with Medicare Prescription Drug Plan Costs [Form SSA – 1020]. Apply online: www.socialsecurity.gov/extrahelp. Call: (800) 772-1213 to apply or request application.

RESOURCES: PRESCRIPTION DRUG COSTS

RXOutreach. www.rxoutreach.com. (800) 769-3880 or (888) 769-1234. Nonprofit pharmacy. Mission: To provide affordable medications. To find out if you are eligible visit http://rxoutreach.org/find-out-if-you-are-eligible.

WeRx.com. WeRx (mobile version): Compares prices for prescription medications at local pharmacies; coupons; maps. Available for iPhone, iPod and Android.

1,5,7,8. www.mayoclinic.org/diseasesconditions/glaucoma/basics/treatment/con-20024042

2,3,4,6,9,11. www.allaboutvision.com/conditions/glaucoma-3-treatment.htm

10. www.glaucoma.org/news/free-smartphone-app-helps-patients-manage-eye-medications.php

NEXT MONTH: Operative Treatment

Wishing you a Merry Christmas and life’s best in 2016!

Anise Matteson is an elder care consultant, retired Registered Health Information Technician and writer of reference books for seniors. Information is for educational purposes. For specific questions and care, consult an ophthalmologist. mattesonecs@yahoo.com.v

Anise Matteson is an elder care consultant, retired Registered Health Information Technician and writer of reference books for seniors. Information is for educational purposes. For specific questions and care, consult an ophthalmologist. mattesonecs@yahoo.com.

December 2015

Aging: Glaucoma and its Effects on the Eyes

Part 2 – Detecting Glaucoma

Eye examination and eye care are important for maintaining vision during the senior years for safe and fulfilling senior years. The Glaucoma Research Foundation recommends that “people at high-risk for glaucoma and those over age 60 receive an eye examination through dilated pupils every one to two years.” If not diagnosed timely and treated, glaucoma can lead to blindness.

For resources addressing eye exams and glaucoma specialists see Part 1.15

ROUTINE EYE EXAMS

Tonometry [1]

Tonometry measures the pressure inside the eye [intraocular pressure (IOP) by recording the resistance of the cornea to pressure (indentation).

Appalanation (Goldman) tonometry uses a small probe to gently flattened part of the cornea to measure eye pressure and a microscope (a slit lamp) to look at the eye. The pressure in the eye is measured by how much force is needed to flatten the cornea. USE: To measure IOP after a simple screening test (e.g., air-puff tonometry) finds an increased IOP.

Using electronic indentation tonometry, the rounded tip of a tool that looks like a pen is gently placed directly on the cornea. The IOP reading shows on a small computer panel.

Noncontact tonometry (pneumotonometry) is used in determining intraocular pressure by measuring the degree of indentation of the cornea produced by a puff of air.[2]

Reason for exam: 1) As part of a regular eye exam to check for increased IOP. 2) To check the treatment for glaucoma—to see if medicine is keeping the IOP below a certain target pressure set by your doctor.

Normal pressure range: 13-22 mm Hg.[3]

Ophthalmoscopy

Ophthalmoscopy is the examination of the interior of the eye.[4]

Optical Coherence Tomography (OCT)[5] is a non-invasive imaging test that uses light waves to take cross-section pictures of the retina.

The retina is a light-sensitive tissue lining the back of the eye.

OCT allows the ophthalmologist to map and measure the thickness of each of the retina’s distinctive layers seen.

Purpose: The measurements help with early detection, diagnosis and treatment guidance for retinal diseases and conditions.

Nerve Fiber Analyzer GDX[6] detects earlier changes and more sensitive objective changes. It is able to determine if you have glaucoma prior to your experiencing any visual loss.

Heidelberg Retinal Tomography[7] is a diagnostic procedure used for precise observation and documentation of the optic nerve head. A special laser is used to take 3-dimensional photographs of the optic nerve and surrounding retina. The image is captured by the laser focused on the surface of the optic nerve.

Optic nerve[8] is the nerve in the back of the eye.

Cupping[9] is typical nerve damage that occurs in glaucoma. As the cells making up the nerve die, due at least in part to increased pressure inside the eye, they die and disappear. When a sufficient number of these cells are gone, they leave behind a small “cup” in the nerve.

What doctors look for when examining the optic nerve: 1) The presence and extent of the “cup.” 2) How deep. 3) How wide. USE: To compute (e.g., the area of the optic nerve, the volume of the cup, the area of the rim around the cup).

DIAGNOSTIC EXAMS

Perimetry (campimetry) is a method of testing the perimeter of the visual field; Maps and qualifies the visual field, especially at the extreme periphery of the visual field; The systemic measurement of different light sensitivity in the visual field by the detection of the presence of test targets on a defined background.[10]

White-on-white perimetry[11] [automated perimetry] is the use of a white background and lights of incremental brightness. The computer maps and calculates the patient’s visual field.

Purpose: 1) Used in clinical practice, and in research trials where loss of visual field must be measured. 2) Used for blind spots.

Gonioscopy is an eye examination to look at the front part of the eye (anterior chamber) between the cornea and the iris to see if the drainage angle is open or closed. It also can find scarring or other damage to the drainage angle[12]—signs of abnormality (new blood vessels or torn places from past injury) causing secondary glaucoma.[13]

Pachymetry[14]Corneal pachymetry is the process of measuring the thickness of the cornea. It is an important test in the early detection of glaucoma.

Method: Ultrasonic or optical.

Ultrasound Technology: Corneal Waveform (CWF) [A-scan], an echogram scan that provides the ability to: more accurately measure the corneal thickness, measure changes in corneal thickness over time, and measure structures within the cornea.

Optical: Optical Coherence Tomography (OCT, e.g., Vistane) and online Optical Coherence Pachymetry (OCP), e.g., ORBSCAN).

Purpose: Used by glaucoma researchers and glaucoma specialists to better diagnose and detect early cases.

1,8. www.webmd.com/eye-health/tonometry

2,3,4. Taber’s Cyclopedic Medical Dictionary

5. www.geteyesmart.org/eyesmart/diseases/optical-coherence-tomography.cfm

6. www.eyecentral.net/services/gdx-nerve-fiber-analyzer.html

7,9. http://ophthalmology.med.ucb.cal/patient-care/ophthalmic-photography/heidelberg-retinal-tomography

10, 11. http://en.wikipedia.org/wiki/visual_field_test

12. www.webmd.com/children/gonioscopy

13. www.hopkinsmedicine.org/wilmer/glaucoma_center_excellence/book/ch06s02.html

14. https://en.wikipedia.org/wiki/Corneal_pachymetry

15. westsideobserver.com/health.html#sep15

Next Month: Nonoperative Treatment

Anise Matteson is an elder care consultant, retired Registered Health Information Technician and writer of reference books for seniors. Information is for educational purposes. For specific questions and care, consult an ophthalmologist. mattesonecs@yahoo.com

November 2015

Aging: Glaucoma and its Affects on the Eyes

Defining Glaucoma is Part I in this series of eye disorders and their medical implications in the aged. It is the third most common cause of visual loss. The most common type of glaucoma is primary open-angle glaucoma.1 More than 2.8 million Americans currently have glaucoma—whites: 64%; blacks: 20%. By 2050 most glaucoma patients will be non-white, due primarily to the rapid increase in Hispanic glaucoma patients. By 2018, the largest age group will be 70-79.12

More than $6 billion is spent annually for medical treatment costs related to glaucoma and disorders of the optic nerve.13

Affects On Quality Of Life

The negative outcomes experienced by individuals: eye pain; loss of peripheral vision; reduced visual acuity (especially at night); halos around lights; potential for ophthalmic emergency; fatigue; anxiety related to change in health status, presence of pain, possibility/reality of visual loss.

In persons of color, African ancestry, the important issues relating to glaucoma are: 1) three to four times more chance of having open angle glaucoma than other ethnicities, and it develops at an earlier age than others; 2) it is a more aggressive form of glaucoma leading to vision loss and blindness more often; 3) even if you take your eye drops as others do, you won’t quite get as much pressure lowering from the same dose; 4) glaucoma surgery (trabeculectomy) works less often in African-derived persons.2

According to Gary Heiting, OD (“Medical Eye Exams for Eligible Seniors for No Out-of-Pocket Cost!”) at www.allaboutvision.com/over60/free-exams.htm, ‘seniors need the most eye care.’ “Many seniors neglect their eye care and vision problems because they have low or fixed incomes or inadequate vision insurance.”

Anatomy Of The Eye

Iris. The colored portion of the eye; the pupil is in the center of the iris.

Lens [crystalline lens]. Lies directly in back of the iris. It focuses light rays on the retina.

Vitreous body. A transparent jellylike substance that fills the space between the lens and the retina.

Anterior chamber. The space between the cornea and the iris.

Cornea. The first part of the eye that reflects light.

Retina. The innermost layer of the eye; it perceives and transmits impulses of light to the optic nerve.

Optic nerve. The second pair of cranial nerves; sensory for vision.

Aqueous humor. The clear tissue fluid that circulates through the anterior cavity.

Ciliary body. Lies behind the iris.

The trabecular meshwork is the network of fibers between the anterior chamber of the eye and the venous sinus of the sclera; it contains spaces between the fibers that are involved in drainage of the aqueous humor and is composed of two portions: the part attached to the sclera and the part attached to the iris.14

Trabecular MeshworkTrabecular Meshwork

The Canal of Schlemm. The space(s) at the junction of the iris and cornea into which aqueous humor is drained from the anterior chamber.

Glaucoma

Glaucoma is a group of eye diseases characterized by increased intraocular pressure, resulting in atrophy of the optic nerve.3

Glaucoma occurs when the aqueous humor drains from the eye too slowly.4 The damage produces gradual and progressive visual field loss5 and can lead to blindness, if untreated.

Phacoglaucoma is lens changes induced by glaucoma.6

Intraocular pressure (IOP) is the normal tension within the eyeball, equal to approximately 12 to 20 mm Hg.7

Symptoms8

The frequent need to change eyeglass prescriptions, vague visual disturbances, mild headache and impaired dark adaptation.

Open-angle glaucoma causes mild aching in the eyes, loss of peripheral vision, halos around lights and reduced visual acuity (especially at night) that is uncorrected by prescription lenses.

Acute angle-closure glaucoma (an ophthalmic emergency) causes excruciating unilateral pain and pressure, blurred vision, decreased visual acuity, halos around lights, diplopia, lacrimination, and nausea and vomiting due to increased IOP. The eyes may show unilateral circumcorneal injection, conjunctival edema, a cloudy cornea, and a moderately dilated pupil that is nonreactive to light.

Types

Absolute glaucoma. An extremely painful form of glaucoma—the eye is completely blind and hard (as a result of elevated intraocular pressures), insensitive cornea, shallow anterior chamber, and depressed optic nerve.

Chronic glaucoma. A tonometer intraocular pressure reading of up to 45 or 50, the anterior ciliary veins are enlarged, the cornea is clear, the pupil is dilated and pain is present.

Closed-angle glaucoma (narrow angle glaucoma). Caused by a shallow anterior chamber. Intraocular pressure increases because the rate of movement of the aqueous is impaired.

Low-angle glaucoma. Intraocular pressures are normal (less than 22 mm Hg).

Malignant glaucoma. Characterized by a shallow anterior chamber associated with raised intraocular pressure and in the presence of a patent iridotomy; usually follows intraocular surgery, but has also been described to follow laser iridotomy or miotic therapy.10

Pigmentary glaucoma. Produced by the dispersion of organic pigment from the zonula ciliaris to the trabecular meshwork of the eye.

Primary open-angle glaucoma. The most common type of glaucoma. It usually affects both eyes, and there is a characteristic change in the appearance of the optic disk (the depression in the center of the disk) is enlarged. Visual loss is determined by the visual-field test.

Secondary glaucoma. Is related to various eye conditions which bring about marked fluctuations and elevations in the intraocular pressure; e.g., iritis and iridocyclitis, intraocular neoplasms, dislocation of the lens, central vein occlusion and trauma.11

RESOURCES

EyeCare America.  www.eyecareamerica.org.  (877) 877-6327.    A public service program of the Foundation of the American Academy of Ophthalmology for those age 65 or over.  If eligible for free eye care services:  can schedule free comprehensive eye exam; free eye care for the condition for up to one year; Medicare or other insurance accepted as full payment; uninsured – eye care is free.  (www.allaboutvision.com/over60/free-exams.htm)

Glaucoma Center of San Francisco.  www.glaucomasf.com.  (415) 987-2020.  Ophthalmologists provide complete eye exams and consultation, comprehensive medical, laser and surgical treatment.

Lions Foundation of Northern California – Nevada.  www.lionseyefoundation.com.  (415) 660-3950. In partnership with California Pacific Medical Center providing free ophthalmic examinations, operations and medication.  Visit the website for guidelines for patient referrals.

Pacific Eye Associates.  www.pacificeye.com.  (415) 923-3007. A private multi-specialty Ophthalmology group providing comprehensive eye care for medical or surgical eye problems, eyeglasses and contact lenses.  Some of the services provided:  Cataract Surgery, Glaucoma, Retina & Vitreous, Low Vision Rehabilitation.  Appointments:  Routine visits, same day emergency.  Thirteen ophthalmologists.  Three optometrists have specialized training in contact lens fitting and low vision aids.  

Prevent Blindness Northern California.  http://northerncalifornia.preventblindness.org.  (415) 567-7500.  (800) 338-3041.  Provides services to prevent blindness.  Adult Vision Screening Program:  Identifies early stages of eye disorders so they can find treatment.  Online “Glaucoma Learning Center” provides free information, for additional information call (415) 567-7500.

Vision USA.  www.aoafoundation.org/vision-usa/who-is-eligible.  Provides a basic eye exam and eyewear to low-income individuals.  Applicants must meet all five of the eligibility requirements to qualify.  State-run program for California:  California Vision Foundation.  www.californiavision.org.  (800) 877-5838.

1,5.  newfrontiers.americangeriatrics.org/chapters/pdf/rasp_7.pdf

2. www.hopkinsmedicine.org/wilmer/glaucoma_center_excellence/book/chapter_glaucoma_operations.html

3,4,7,8,9.  Taber’s Cyclopedic Medical Dictionary

6.  http://medical-dictionary.thefreedictionary.com/phacoglaucoma

10.  http://bjo.bjm.com/content/81/2/163.full

11.  Understanding Medical Terminology

12,13.  http://northerncalifornia.preventblindness.org/rise-and-cost-glaucoma

14.  http://medicaldictionary.thefreedictionary.com/trabecular+meshwork

Next Month:  Detecting Glaucoma

Anise Matteson is an elder care consultant, retired Registered Health Information Technician, writer of reference books for seniors—Caring for an Aging Loved One: The Family Caregiver’s Guide Book and Caring Boomers Newsletter—AMD article revised from February 2012. Information is for educational purposes. For specific questions and care, consult an ophthalmologist. mattesonecs@yahoo.com.

September 2015

Aging: Macular Degeneration and its Affect on the Eyes

More than 3.3 million Americans aged 40 and over are either legally blind (having best-corrected visual acuity of 6/60 or worse (=20/200) in the better-seeing eye) or are low vision (having best-corrected visual acuity less than 6/12 (<20/40) in the better-seeing eye). The leading causes of blindness and low vision in the United States are primarily age-related eye diseases such as age-related macular degeneration, cataract, diabetic retinopathy, and glaucoma.

Twenty-five percent of persons aged 75 and over have nonexudative ARMD and five percent have exudative ARMD. Early diagnosis and treatment is crucial to preserving vision.

VISION

Low vision is a significant loss of vision that cannot be corrected medically, surgically, or with eyeglasses.

Visual impairment or visual loss, is a decreased ability to see to a degree that causes problems not fixable by usual means, such as glasses.

Certified Low Vision Therapist (CLVT), Vision Rehabilitation Therapist (CVRT) and Orientation and Mobility Specialist (COMS) often work in close partnership with the optometrist or ophthalmologist and can provide training in how to use low vision optical or non-optical devices in practical everyday situations.

Vision rehabilitation includes a wide range of professional services that can restore functioning after vision loss.

Vision rehabilitation services allow people who are blind or have low vision to continue living independently and maintain quality of life. Services available: communication skills; counseling; independent living and personal management skills; independent movement and travel skills; low vision evaluation and training with low vision devices; and vocational rehabilitation.

Affects on Quality of Life

The negative outcomes experienced by visually impaired seniors: potential for falls; potential for serious injury or death when combined with hearing loss (e.g., inability to hear an approaching vehicle); potential for depression (e.g., secondary grief, anxiety and depressed mood); affects overall function: performing ADLS (basic and instrumental); involvement in social and religious activities; loss wages.

Statistics defined in “Utility Values of Patients with Age-Related Macular Degeneration (ARMD) and Response Groups” (The Burden of Macular Degeneration: A Value-Based Medicine Analysis by Gary C. Brown, MD et al) indicate patients’ enjoyment of life: Mild ARMD: 83%, Moderate ARMD: 68%, Severe ARMD: 47%, Very Severe ARMD: 40%.

CARING FOR THE AGED
Science

Ophthalmology. The health science pertaining to the eye and its diseases.

Optometry. The science of diagnosing, managing, and treating conditions and diseases of the eye and visual systems.

Eye Care

Ophthalmologist. A physician (M.D.) who specializes in the treatment of diseases of the eye and vision, prescribes glasses and contact lenses and performs eye surgery.

Optometrist. A doctor of optometry (O.D.) who prescribes glasses and contact lenses, gives vision exams. If an optometrist detects symptoms that indicate diseases in the eye, the doctor refers the patient to a physician. (The World Book Encyclopedia)

Optician. A specialist in filling prescriptions for corrective lenses for eyeglasses and contact lenses.

Vision Rehabilitation Services

Certified Low Vision Therapist (CLVT) instruct individuals in the use of residual vision with optical devices, non-optical devices, and assistive technology, and help determine the need for environmental modifications in the home, workplace, or school.

Certified Vision Rehabilitation Therapist (CVRT) teach adaptive independent living skills, enabling adults who are blind or have low vision to confidently carry out a range of daily activities.

Certified Orientation and Mobility Specialists (COMS) teach the skills and concepts that people who are blind or have low vision need in order to travel independently and safely in the home and in the community. They teach safe and independent indoor and outdoor travel skills, including the use of a long cane, electronic travel devices, public transportation, and sighted guide, human guide, and pre-cane skills.

MACULAR DEGENERATION

Age-related macular degeneration (AMD) is a progressive eye condition affecting as many as 15 million Americans, with 200,000 new cases each year.*

AMD causes severe vision loss—it attacks the macula of the eye.

The macular area is the area of the retina that provides central vision.

The retina is the innermost area of the eye, which receives images transmitted through the lens and contains the reception for vision, the rods and cones.

Central vision is vision resulting from light falling on the fovea centralis.

Symptoms

Blurring of central vision. Straight lines may appear distorted or warped. As the disease progresses, blind spots may form within the central field. The extent of central vision loss varies depending on the type of AMD—dry or wet.

AMD can make it difficult to: read, drive, recognize faces, watch television, safely navigate stairs, and perform other daily tasks.

Stages

Mild AMD. Visual acuity 20/20 to 20/40 in the better-seeing eye (e.g., visual acuity of 20/40 means that a person sees at 20 ft. what the normal eye could see at 40 ft.).

Moderate ARMD. Visual acuity 20/50 to 20/100 in the better-seeing eye.

Severe ARMD. Visual acuity ≤20/200 in the better-seeing eye.

Very severe ARMD. Visual acuity ≤20/800 in the better-seeing eye.

Types

Dry AMD (atrophic nonexudative, drusenoid macular degeneration). A characteristic is the accumulation of tiny protein and fat-containing “drusen” deposits in a tiny layer of cells beneath the photoreceptors in the retina called Bruch’s membrane. Reduction in central vision occurs gradually over many years. Total loss of central vision is usually not experienced—tasks that require finely focused vision may become more difficult. TREATMENT: No standard therapies currently exist.

Wet AMD (choroidal neovascularization (CNV), subretinal neovascularization, exudative, disciform degeneration). Abnormal blood vessels grow beneath the macula that discharge photoreceptor cells. Often progresses rapidly. Can cause substantial loss of central vision.

Treatment: Wet AMD

AREDS formulation [The Age-Related Eye Disease Study] is an over-the-counter antioxidant supplement recommended for people who are at risk of developing more advanced forms of either wet or dry AMD.

EYLEA™ (alflibercept) administered as an intraocular injection to block the development of unhealthy blood vessels underneath the retina.

Lucentis™ (ranibizumab) administered as an injection effective in reducing the risk of losing vision from the abnormal blood vessel growth under the retina associated with wet AMD.

Avastin® [colorectal-cancer drug] used “off-label” by some ophthalmologists to treat wet AMD.

Macugen® (pegaptanib) administered by injection into the eye to inhibit the growth of abnormal blood vessels under the retina.

Visudyne (verteporfin) Photodynamic Therapy (PDT) injected intravenously, it involves the use of a light-activated drug that targets and destroys the blood vessels that cause vision loss in wet AMD.

Vision-Enhancing Implantable Telescope is an implantable miniature telescope (IMT) for enhancing the central vision of people with end-stage, untreatable AMD. The IMT provides improved central and detailed vision by focusing and magnifying images onto the functional, outer regions of the recipient’s retina.

Clinical Trials: DRY AMD

Advanced Cell Technology (ACT) is a cell-based therapy using transplants of retinal pigment epithelial cells derived from stem cells.

Encapsulated Cell Technology (ECT) is a tiny capsule—the size of a rice grain—implanted into the eye. The capsule contains retinal cells that produce a vision-preserving protein, Ciliary Neurotrophic Factor (CNTF).

Fenretinide reduces the accumulation of vision-robbing toxins in the retina.

Clinical Trials: AMD

RetinoStat® is a gene therapy that blocks the growth of leaky, unhealthy blood vessels under the retina that cause vision loss in wet AMD.

Fenretinide reduces the incidences of wet AMD.

Clinical Trials: Therapies

Therapies include: eye drops, ocular injections, gene therapy and pharmaceutical agents.

Visual Field Testing

Visual field test is an examination that can detect dysfunction in central and peripheral vision which may be caused by various medical conditions.

Tangent Screen
Tangent screen [Bjerrum screen]

 

A simple device used in perimetry to test the central position of the visual field.

Amsler Grid
Amsler Grid

A grid of horizontal and vertical lines used to monitor a person’s central visual field.

A diagnostic tool that aids in the detection of visual disturbances caused by changes in the retina, particularly the macula, as well as the optic nerve and the visual pathway to the brain. Patients with macular disease may see wavy lines or some lines may be missing.

ASSISTIVE TECHNOLOGY DEVICES

Spotlight Text. A reading app and ebook reader specifically for readers with vision loss. Download at www.amg.org.

To address the topic of eye disorders I will be considering a Resource Fair. Date and details to be announced.

RESOURCES

Service Providers

California Telephone Access Program. www.ddtp.org (800) 806-1191. Provides assistive telecommunications equipment for persons with difficulty using a standard telephone because of vision, memory, speech or mobility difficulties. Products provided: big button, amplified, captioned, speech assist, picture dial, and portable.

Foundation Fighting Blindness.14 (800) 683-5555. Mission is to drive research that will provide preventions, treatments, and cures for people affected by retinitis pigmentosa, age-related macular degeneration, Usher syndrome and the entire spectrum of retinal diseases. Visit www.FightBlindness.org for the latest information on AMD treatments, research and clinical trials.

Lighthouse for the Blind and Visually Impaired. (415) 431-1481. Services include a Low Vision Clinic in partnership with UC Berkeley School of Optometry, offering low vision examinations on Fridays with a physician, and a follow-up visit with the Lighthouse Rehabilitation Specialist. To find out if you qualify, contact your primary eye care professional or the Lighthouse. For information or to schedule an exam, call (510) 642-5726or Lighthouse San Francisco.

NanoPac Inc. (800) 580-6086. Supplies products and services for individuals with disabilities (low vision, blindness, reading disabilities, quadriplegia, blind, legally blind): reading machines, hand-held magnifiers, software, adjustable tables ADA compliant, voice recognition and more.

Prevent Blindness Northern California. (415) 567-7500 (800) 338-3041. Provides services to prevent blindness. Adult Vision Screening Program: Identifies early stages of eye disorders so they can find treatment.

Senior Eye Care Program (National Eye Care Project). (800) 222-3937. Ensures seniors have access to eye care and promotes annual dilated eye exams. Raises awareness about age-related eye disease. Provides free eye care educational materials. Facilitates access to eye care. Visit www.eyecareamerica.org for referral questionnaire to determine if you qualify for a referral from Eye Care America.

The Macular Degeneration Partnership. (888) 430-9808. An outreach program of the non-profit Discovery Eye Foundation. Visit the website for up-to-date and accurate information about age-related macular degeneration, treatment, research, and vision rehabilitation. Call the toll-free “warm line” to have your questions answered or to receive support and local referrals.

Support Groups

Lighthouse for the Blind and Visually Impaired. (415) 431-1481. Promotes the independence, equality and self-reliance of people who are blind/visually impaired through rehabilitation training, employment placement, Enchanted Hills Camp and other relevant services. Programs: Learning Blindness Skills provides training to people who are new to blindness or low vision, teaching them how to use a white cane for getting around, reading braille, use accessible technology and master nonvisual techniques for graceful daily living. Access to Information Technology provides Access to Information Services, create braille and textile maps, audio files, accessible museum exhibits, braille documents, and assist web and app developers in creating content that is fully accessible. Adaptions, the Lighthouse Store is open Monday-Friday.

Books/Pamphlets

If You Are Blind or Have Low Vision—How We Can Help. Publication No. 05-10052. www.socialsecurity.gov/work (800) 772-1213.

Macular Degeneration: The Complete Guide to Saving and Maximizing Your Sight by Lylas G. Mogk, MD and Marja Mogk.

Anise Matteson is an elder care consultant, retired Registered Health Information Technician, writer of reference books for seniors—Caring for an Aging Loved One: The Family Caregiver’s Guide Book and Caring Boomers Newsletter—AMD article revised from February 2012. Information is for educational purposes. For specific questions and care, consult an ophthalmologist. mattesonecs@yahoo.com.

July-August 2015

Aging: Its Gerontology, Psychogerontology and Socioeconomic Implications

The Older Americans Act (Aging Magna Carta), a Bill of Rights for Older Americans was passed by Congress in 1965. “Its purpose strengthened by amendments in 1975 and 1978 is to “make available comprehensive programs which include a full range of health, education and social services to our older citizens…” In 1973, the Act was amended for eligibility to anyone 60 or older. Congress in cooperation with state and local government, established a structure of agencies that have become popularly known as ‘the aging network.’ ” (READER’S DIGEST. You and Your Rights.)

Geriatric specialists keep abreast of the different medications that an elderly person is prescribed to treat their more common health issues in order to decrease adverse side effects and avoid dangerous drug interactions.”

The Older Americans Act and National Aging Network can be found at www.aoa.gov.

CARING FOR THE AGED

Geriatrics is a branch of health care concerned with the diagnosis and treatment of diseases associated with the aged.

A geriatrician specializes in diseases and care of the aged for falls resulting in fractures, impaired memory, multiple diagnoses, hospitalizations due to heart disease, heart failure, cancer, hematologic conditions, accidents, enlargement of the prostate gland, rheumatoid arthritis, digestive disorders, pruritis and dermatology disorders. [geriatric specialist]

Geriatric specialists keep abreast of the different medications that an elderly person is prescribed to treat their more common health issues in order to decrease adverse side effects and avoid dangerous drug interactions. (www.vitals.com/geriatric-doctors/ca/san-francisco)

There are more than 122 geriatric doctors in San Francisco, according to www.vitals.com.

A gerontologist is a scientist who studies the process of aging and its biologic, mental and socioeconomic implications.

Gerontology is the study of aging and its affects—physiological, pathological, psychological and socioeconomical.

Psychogeriatrics is a branch of health care concerned with the psychiatric disorders associated with the aged.

Psychogerontology is a science that deals with the mental and emotional life of the aging, their ideation, memory and level of consciousness.

PHYSIOLOGICAL

Physical Disorders (Diagnostic)

Some physical disorders that may affect the elderly are:

Senile degeneration: The bodily and mental changes that occur during pathologic aging.**

Macular degeneration: Loss of pigmentation in the macular region of the retina, produces central visceral fluid loss.**

Senescent osteoporosis: A disorder of protein metabolism marked by increased porosity of bone.*

Physical Disorders (Symptomatic)

Blepharochalasis: Baggy eyelids.

Geroderma: Atrophic thickening and wrinkled skin of old age.*

Presbycusis (pesbyacusia): Progressive loss of hearing with aging.**

Presbyopia: Defective vision resulting from changes in accommodation in the aging process,* marked by the inability to maintain focus on objects held near the eye. [farsightedness].**

Progeria: Premature aging—early graying, baldness, sparse eyebrows, fine wrinkles around the mouth.*

Senescent pruritis: Itching of brittle dry skin of the aged, leading to scratching followed by excoriations and eczematoid changes.*

Senescent tremors: A benign essential tremor, marked by rapid alternating movements of the upper extremities.**

PSYCHOLOGICAL

Mental Disorders (Diagnostic)

Some mental disorders that may affect the elderly are:

Alzheimer’s disease: A chronic progressive cognitive disorder.**

Organic brain syndrome: Acute and chronic mental disorder associated with brain damage or impaired cerebral function.**

Senescent psychosis: A variety of states from mild senescent mental disorders to the extreme deterioration of senile dementia. Clinical types: delirium and confusion; depression and agitation; paranoia; presbyophrenia; senile dementia.*

Mental Disorders (Symptomatic)

Agnosia: Inability to recognize or comprehend sights, sounds or other sensory information.**

Apraxia: Inability to perform purposive movements although there is no sensory or motor impairment; Inability to use objects properly.**

Confabulation: A behavioral reaction to memory loss in which a person fills in memory gaps with inappropriate words or fabricated ideas, often in great detail.**

*Understanding Medical Terminology

**Taber’s Cyclopedic Medical Dictionary

SOCIOECONOMIC

In 2013, the percentage of persons 65 years and older in San Francisco was 14.2% and 12.5% in California (http://quickfacts.census.gov/ qfd/states/06/06075.html)

Financial

Income during retirement affects the life of seniors. Some seniors receive social security payment with no other source of income. Other seniors receive funds from earnings, savings, private insurance or pension plans.

An adequate income is needed to: maintain the standard of living to which seniors are accustomed to; afford home health services; long-term care (assisted living, care home, skilled nursing/rehabilitation facility); pursue interests or hobbies; afford transportation (owning and driving your own vehicle for as long as you are able); burial expenses (life insurance).

Health

Some seniors who have health problems cannot afford health care. Public health insurance (Medicare and Medi-Cal) pay only a percentage of the total medical expense. Fewer service providers are accepting Medicare.

A senior’s income affects the ability to: experience good physical and mental health to maintain self-care; find happiness in their life—‘doing what makes you happy.’

Family

Income affects seniors ability to engage in their relationships with family and friends because of related expenses (long distance or toll telephone calls, travel fares, gasoline costs, entertaining, etc.).

Housing

Seniors who are homeowners prefer independent living—aging in place in their own home, or, transitioning to senior apartment, retirement community, or independent living center. Low-income seniors housing choice is a low-income apartment.

There are 50 affordable senior housing facilities listed in New LifeStyles Guide to Senior Living and Care.

Assistance Programs

Special benefits for seniors: reduced property taxes; free legal services [60 years and older]; reduced fares for public transportation; reverse mortgage; HUD 202 Program [affordable senior housing].

RESOURCES

Administration on Aging (AOA). www.aoa.gov. An agency of the U.S. Department of Health and Human Services designated to carry out the provisions of the Older Americans Act of 1965. Programs: Office of Supportive and Caregiver Services; Office of Nutrition and health Promotion Programs; Office of Elder Justice and Adult Protective Services; Office for American Indian, Alaska Natives and Native Hawaiian Programs; Office of Long-Term Care Ombudsman Programs; National Aging Network.

City College of San Francisco. www.ccsf.edu/en/educational-programs-/school-and-departments/school-of-health-and-physical-education/older_adults.html. Non-credit classes designed for those 55 plus, but all are welcome to attend. Course offerings span several different disciplines, including computer, health and wellness, language arts, and the arts. Contact: Shelley Glazer, (415) 452-5839.

Department of Aging and Adult Services. www.sfhsa.org. Intake and Information Referral: (415) 355-6700; Adult Protective Services: (800) 814-0009 or (415) 355-6700; In-Home Supportive Services; Transitional Care Program; Meals for Seniors; SF Connected Program; Information Resources, Advocacy and Legal Services; County Veterans Service Office; Services for Active People with Disabilities and Seniors.

Episcopal Community Services of San Francisco – Canon Kip Senior Center. www.ecs-sf.org. Senior Services: (415) 487-3300 x 6211. Provides hot lunches (Congregate Meal Program); case management and community services (computer lab; exercise classes; support groups; nutrition; workshops; occasional field trips; read newspaper or play cards).

Little Brothers – Friends of the Elderly. http://littlebrotherssf.org. (415) 771-7957. Provides outreach, advocacy and companionship. Monthly visits; Medical Escorts: to and from doctor’s appointments and obtaining medication from pharmacy; Phone visits: Calling elders regularly.

On-Lok Lifeways 30th Street Senior Center. www.onlok.org/30th-Street-Senior-Center. (415) 550-2210. Activities Program; Always Active Program; Nutrition Program; Bilingual Case Management; Aging and Disabilities Resource Center (ADRC).

Osher Lifelong Learning. http://olli.sfsu.edu. (415) 817-4243. Offers classes, interest groups, and events at the SF State downtown and main campuses for those age 50 and up.

Paratransit Services – Whistle Stop. www.whistlestop.org. (415) 456-9062. Serves residents with special transportation needs in Marin County and individuals traveling to and through Marin from surrounding counties of San Francisco, Sonoma and Contra Costa. Also group van.

San Francisco Paratransit. www.sfparatransit.com. (415) 351-7000. Provides complementary paratransit services—SF Access--for SFMTA in accordance with the ADA.

Senior Center Without Walls. http://seniorcenterwithoutwalls.org. (877) 797-7299. Offers activities, conversation, classes and support groups through teleconferencing to homebound elderswho find it difficult to go to a community senior center.

Stonestown YMCA Senior Annex. /www.ymcasf.org/stonestown/facilities/senior_center. (415) 242-7115. Provides exercise classes, trips and lifelong learning program.

We Check on You. www.wecheckonyou.com. (888) 932-5668. Offers offering reassurance and daily reminders to elderly, convalescent, those who have no family, or who live alone, and routinely ascertain their state of well-being for caretakers if unable to contact loved ones.

BOOKS, DIRECTORIES

New LIFESTYLES Guide to Senior Living and Care. www.NewLifestyles.com. (800) 869-9549.

READER’S DIGEST. You and Your Rights: The Essential Guide to Federal, State and Local Benefits and Services. 1982. The Reader’s Digest Association, Inc. Available at www.abebooks.com/ Rights-Readers-Digest-Random-House-T/11210616969/bd.

Resources for Older Adults, People with Disabilities, Caregivers and Agencies Serving Seniors. Prepared by the City and County of San Francisco Department of Aging and Adult Services Intake Program. www.sfhsa.org/DAAS.htm. (415) 355-6700.

Senior Citizens Resource Directory, SAN FRANCISCO COUNTY. Resources, Services and Information for Senior Citizens. SeniorCitizensDirectory.com. (415) 681-8736.

Anise Matteson is an elder care consultant, retired Registered Health Information Technician, writer of reference books for seniors (Caring for an Aging Loved One: The Family Caregivers’ Guide Book), forum host Caring for an Aging Loved One. mattesonecs@yahoo.com.

June 2015

Let’s Talk Boomer Legal and Advance Care Planning

National Health Care Decisions Day

This year April 16 marks the 8th Annual National Healthcare Decisions Day and the 2nd Annual Healthcare Decisions Day in San Francisco.

National Healthcare Decisions Day is designed to raise awareness for the need to plan ahead for health care decisions related to end-of-life care and medical decision-making whenever patients are unable to speak for themselves and to encourage the specific use of advance directives to communicate these important decisions so that fewer families and health care providers will have to struggle with making difficult health care decisions in the absence of guidance from the patient.

An irrevocable trust is one that you make that you cannot revoke. These kinds of trusts are made for specific and complex purposes, among them, potential tax savings, and income but not principal distribution over a longer period of time. ”

For more information, visit www.nationalhealthcaredecisionsday.org

As Advocate for National Healthcare Decisions Day, I invited libraries citywide to participate in acknowledging April 16 National Healthcare Decisions Day in San Francisco with a books display the week of April 9 through 16 for Advance Directives, wills, trusts and estate planning.

Advance Directives are of such importance I have submitted a request for Mayoral Proclamation for April 16 as Healthcare Decisions Day in San Francisco.

Prepare for the unexpected. Set aside time on April 16—visit the library, discuss your wishes with your loved ones, primary care physician, or attorney. Name someone to speak for you when you cannot speak for yourself. When you have completed your Advance Directive, you may want to carry a wallet card that states you have advance directives.

BOOMER LEGAL

Living Trust

Also known as a revocable trust, this is an estate planning device that allows you to fund a trust that you create with your property, be it real property, financial assets, or tangible personal property. You may make changes to the trust (amendments); you may add and subtract property, e.g., buy a new house and add it to the trust; sell stocks and buy different ones. You are usually the trustee of your trust; you will name successor trustees who will be able to step in and manage the trust assets should you become incapacitated, and at your death. The benefits of a trust in lieu of a will are several: there is an orderly succession of persons to manage it during your life, including your incapacity; you can arrange for distribution of income and principal for your beneficiaries over the course of their lives; you can set up separate trusts for spouse, children, charities. And, there is no probate of the trust assets at your death.

What Happens To The Estate If The Deceased Does Not Have A Will?

In California, if your estate is greater than $150,000 in probatable assets, your estate will have to go through a process called probate. In California, the cost of probate will be about 8% of the value of the entire estate at death. In places like San Francisco and the Bay Area, that will be a considerable sum: some goes to the attorney; some to the executor, the rest to fees and the county court. Not only expensive, probate is also a time consuming and lengthy court-controlled series of petitions, hearings and filings that must take place when a California resident dies without a will, and surprisingly, when a California resident dies with a Will. Most people think, erroneously, that if they have a will, they can avoid probate. Not so.

The only sure way to avoid probate is not to die; or to die with a trust; or to die with each of your assets naming beneficiaries; or having ‘pay on death’ clauses, or ‘in trust for’ designations on each account. If you have real property in your name only, it will be a probatable asset. The only way to avoid probate of your home is to hold it in joint tenancy or as community property, not available to all persons, or desirable in all situations; or to place it in a trust.

Preparing for the Appointment if an Attorney Prepares Documents

Each attorney has her own intake procedure. Call the attorney or attorneys with whom you wish to meet. Ask them or their staff what you should bring with you. Usually an attorney will provide you with a list and/or a questionnaire that will help you organize your papers and think about the people you want to name as your agents for all of the documents.

The Difference Between “Revocable” And “Irrevocable” Living Trust

A trust is a way to hold property and arrange for its distribution at your death. A revocable trust is just that: it is a document that you may revoke (and/or amend) during your life, at any time, for any reason. You are the owner (settlor/trustor) of the property; you may also be the Trustee; and for all intents and purposes you are the beneficiary of your trust as long as you are alive and have legal capacity. An irrevocable trust is one that you make that you cannot revoke. These kinds of trusts are made for specific and complex purposes, among them, potential tax savings, and income but not principal distribution over a longer period of time. These kinds of savings are available in return for your giving up the authority to control them or change them at will. It is also customary to execute complex trusts where parts become irrevocable upon your death; but the trust is revocable during your life.

Last Month:

Power of Attorney: The Importance and Types of Designee

Advance Health Care Directive: How to Make it a Legal Document and Who Should Have a Copy

Physician Orders for Life-Sustaining Treatment

Living Will

Will

The Difference Between a “Living Will” and a “Will”

Reminder: For specific questions and advice, please contact your physician. If you require legal advice, you should seek the services of an attorney.

Helene V. Wenzel is a solo practitioner in Estate Planning and Elder Law. Her estate planning practice includes the preparation of wills, trusts, durable powers of attorney and advance health care directives; trust administration; and probate. Her Elder Law practice focuses on planning for incapacity; conservatorships; long-term and Nursing Home care; asset management and Medi-Cal eligibility.

Helene is past President of the Northern California Chapter of the National Academy of Elder Law Attorneys (www.NAELA.org), the largest elder law association of attorneys in the country. Helene regularly addresses community meetings, attorneys and other concerned professionals about estate planning and elder law concerns.

Anise Matteson is an elder care consultant, retired Registered Health Information Technician, Advocate – National Healthcare Decisions Day 2015, writer of reference books for seniors and Caring Boomers Newsletter. “Boomer Legal” was written by Helene Wenzel, Esq. for Caring Boomers Newsletter, mattesonecs@yahoo.com.

Let’s Talk Boomer Legal and Advance Care Planning

The Patient Self-Determination Act (PSDA) is a 1991 act of U.S. Congress that preserves individual rights to decisions related to personal survival. There are several methods for preserving autonomy: filing appropriating for durable power of attorney for health care, making a living will, or giving a directive to the physician (Taber’s Cyclopedic Medical Dictionary).

I asked an elder law attorney to write a few pages for my Caring Boomers Newsletter, ©April 2012. Helene V. Wenzel, a solo practitioner in Estate Planning and Elder Law provided the following information in the article Boomer Legal.”

Elder law attorney refers to an attorney who specializes in providing legal services for the elderly, especially in the areas of Estate Planning and Medicaid Planning. They handle general estate planning issues and counsel clients about planning for the management of assets and health care with alternative decision-making documents to prepare for the possibility of becoming incapacitated. Elder law is a specialized area of legal practice, covering estate planning, wills, trusts, arrangements for care, social security and retirement benefits, protection against elder abuse (physical, emotional and financial) and other involving older people (http://definitions.uslegal.com/e/elder-law-attorney/)

Citing a radio talk show host on Saturday evening, February 19, 2012, devoting an hour of his show to “How prepared are you?” and encouraging listeners to think about getting their documents in order: Advance Directives, Durable Power of Attorney (health care, financial) and a will, I asked an elder law attorney to write a few pages for my Caring Boomers Newsletter, ©April 2012. Helene V. Wenzel, a solo practitioner in Estate Planning and Elder Law provided the following information in the article “Boomer Legal.”

BOOMER LEGAL

Getting your “powers of attorney” completed — the Advance Health Care Directive and the Durable Powers of Attorney — is probably more important than executing your Will or your Trust. Why? Because, as is discussed below, the Executor of your Will is only authorized to distribute your “stuff” when you are dead; an Executor has no authority to do anything while you are alive; and nothing to say about your health or finances. While a trust can have effect in your lifetime as well as after your death (if you cannot manage your affairs, the trustee can “step up to the plate” to handle only those assets which are in the trust), again, it is limited in its scope. Meanwhile, should you have an accident or stroke, or should you lose your ability to make health and financial decisions for any reason for any period of time, your agent whom you named in your Advance Health Care Directive will have the authority – in writing – to discuss your situation with your doctors, ask for and receive medical reports, relate your concerns to the doctors and hospital personnel and make the kinds of decisions you would want made about your health care, including end of life care, nutrition, hydration and hospice care. And, the agent whom you named in the Durable Power of Attorney for Property and Finances will have authority, again, in writing, to handle those matters for you at your bank, brokerage, with your government benefits, with your property. If you have not prepared these two documents in advance, had them witnessed or notarized (a DPAP must be notarized because it controls property and finances), you could well find yourself in a CONSERVATORSHIP of your PERSON, your ESTATE or both. You do not want to be in any type of conservatorship.

POWER OF ATTORNEY: THE IMPORTANCE AND TYPES OF DESIGNEE

A Power of Attorney is a document that authorizes someone of your choosing, your “agent” or “attorney in fact” to make financial and property decisions for you should you be unable or incapable of making them. There are several types of powers of attorney: a Durable Power of Attorney means that the power you have authorized will endure after you are incapacitated. You could sign a durable power of attorney now that is immediately effective, meaning that your agent may act tomorrow, even though you are still competent to act.

You may want to execute a “springing” Power of Attorney, which means the Person you authorize to act must wait for an event to take place before s/he may act. You may want your power of attorney to come into effect on a specific date, say, your 80th birthday. Most people want a power of attorney to come into effect when your primary doctor has determined that you are no longer able to make financial decisions in your best interest. This determination requires a doctor’s intervention and medical examination.

There are “general” Powers of Attorney which can be short range or specific to a particular event. For example, you will be out of the country when the escrow on your house closes and you authorize a trusted person to complete the necessary paperwork for the sale. Or you authorize your accountant to make inquiry into your bank accounts.

These must be signed and notarized powers of attorney; they may have a limited time period: “From January 1, 2012 to April 15, 2012, from today to the sale closing”.

There is a short (3 page), Uniform Statutory Form Power of Attorney available on line; as well as longer, more complex DPAPs drafted by attorneys. Please be advised that a Durable Power of Attorney is a very powerful legal document and can be very dangerous if misused. You want your agent to have the widest scope of powers available. However, it is just such a broad set of authorities that presents the greatest risks of abuse. Choose your agent(s) wisely. If your DPAP is effective immediately, your agent should have a copy. If not, your primary agent should at least know where to find the document should it become necessary to use it.

ADVANCE HEALTH CARE DIRECTIVE: HOW TO MAKE IT A LEGAL DOCUMENT AND WHO SHOULD HAVE A COPY

Only a few years ago, Advance Care Health Directives were not considered important, if they were even known about. You may or may not recall the Terri Schiavo story which was all over the news for a period of time until she died on March 31, 2005.

Basically, Terri had been in what is known as a “persistent vegetative state” for about five years following some medical event. Her husband repeatedly stated that Terri and he had discussed the possibility of either of them being unable to communicate their wishes about healthcare and life saving measures, and that Terri had expressed her wish that she not be kept on life-saving procedures. However, Terri’s parents argued forcefully that she should be kept alive. The bottom line was that TERRI DID NOT HAVE A SIGNED HEALTH CARE DIRECTIVE. Everyone got involved, including the President of the country. We cannot say for certain that had Terri had a written advance health care directive, things would have gone more smoothly with fewer participants. However, what became clear was that a signed writing was the minimum necessary for a hospital or a court to acknowledge a person’s end of life wishes.

An Advance Health Care Directive is a document which authorizes someone of your choosing, your “agent” or “attorney in fact” to make health care decisions for you should you be unable, incapable, of making them. You may write in your own words or simply initial choices presented on a printed form. The agent named on this form has authorities you give her/him: about where you want to live if you become too ill to live at home; who may visit you in a hospital; about kinds of end-of-life care you may wish or not want; about any kinds of religious or spiritual services; about burial, cremation; and the person named in this document has the authority to claim your body at the hospital.

There are short forms and long forms. You can contact the California Medical Association to get an Advance Health Care Kit in several different languages (www.cmanet.org); there is an Aging with Dignity: Five Wishes booklet available which includes an advance health care directive.

You’ll want to be sure that your agents agree with your end-of-life decisions and will represent them to your doctors. As with a Durable Power of Attorney, you may give your agent immediate authority to handle your health care even though you are still capable of making decisions. Or, you may choose to have the document effective only after your doctor or doctors, in consultation with your agent, have determined that you lack the capacity to manage your health care. Which kind of document you choose is important; but making that decision is NOT an excuse for not executing a document as soon as possible. As long as you are competent, you may always amend it, replace it. But if you do not have one, chances that you will need a conservatorship of your person are great, too great to wait.

PHYSICIAN ORDERS FOR LIFE-SUSTAINING TREATMENT

Like the Advance Health Care Directive, but narrower in its scope, a California state POLST as it is known, is a document which sets forth your wishes for end-of-life care: do you want CPR (cardiopulmonary resuscitation); kinds of comfort care; nutrition.

However, this form is signed by your doctor with whom you have discussed your situation, and your doctor has effectively agreed to treat you as you wish. There are endorsed POLST programs and developing POLST programs throughout the states.

The California form is a bright pink form which is made to stand out among your papers accompanying you to a hospital. You can find the document on the internet at www.polst.org. This is a newer form; its use is not widespread. For many people, it may be too specific; but you should check it out.

LIVING WILL

A “living will” is basically a statement about the kinds of end-of-life care that you want your physicians to perform. It speaks directly to the physician, eliminating the need for an agent to act as an intermediary. For many people who do not have anyone they would trust, or want to burden, with making health care decisions, this document makes his or her wishes known to the physician. Even without designating an agent, the AHCD can also direct a physician to provide the kinds of medical care or end-of-life care that the principal wants when he or she is no longer capable of explaining them to anyone. This form effectively skips to the chase: it is about not wanting to be kept on artificial life support. As with the Advance Health Care Directive, it must be completed and executed by the principal while he or she has legal capacity to know what is being signed. It should be given to your medical provider to keep with your medical files.

WILL

Your “will,” what used to be known as a “Last Will and Testament”, basically is a document that has no effect until you die. You may change it during your life, but must execute a codicil and have it witnessed with the same formalities as the original will. If you change the will too often there can be complications at your death regarding the “correct” or “last” distribution plan. At your death, the person you nominate as your Executor will distribute your property according to the Will. However, your will may have to be probated; see below.

THE DIFFERENCE BETWEEN A “LIVING WILL” AND A “WILL”

OK, that’s easy; but it’s one of the most misunderstood differences. .A “will” is about property when you die. A ‘living’ will is about your health: keep me alive; pull the plugs. There used to be a separate form in California for a living will. Now, that form is rolled into the Advance Health Care Directive

Next Month: Living Trust

What Happens to the estate if the deceased does not have a will? If a person chooses to have an attorney prepare documents, how should they prepare for the appointment? The difference between “revocable” and “irrevocable” living trust

Helene V. Wenzel is a solo practitioner in Estate Planning and Elder Law. Her estate planning practice includes the preparation of wills, trusts, durable powers of attorney and advance health care directives; trust administration; and probate. Her Elder Law practice focuses on planning for incapacity; conservatorships; long-term and Nursing Home care; asset management and Medi-Cal eligibility.

Helene is past President of the Northern California Chapter of the National Academy of Elder Law Attorneys (www.NAELA.org), the largest elder law association of attorneys in the country. Helene regularly addresses community meetings, attorneys and other concerned professionals about estate planning and elder law concerns.

RESOURCES: ADVANCE DIRECTIVE

California Health Care Association. www.cmanet.org/resource-library/detail?item=advance-health-care-directive-kit-english. See website for cost of Advance Health Care Directive Kit (English).
California Hospital Association. www.calhospital.org/resource/advance-health-care-directive. Download
FREE Form 3-1: Advance Health Care Directive (English/Spanish).
Five Wishes – Aging with Dignity. http://www.agingwithdignity.org/five-wishes.php
Who you want to make health care decisions for you when you can’t make them. The kind of medical treatment you want or don’t want. How comfortable you want to be. How you want people to treat you. What you want your loved ones to know.

Physician Orders for Life Sustaining Treatment. To download “POLST FOR Patients and Loved Ones,” visit http://capolst.org.

State Bar of California educational guide Seniors and the Law: A Guide for Maturing Californians section titled “PLANNING AHEAD.” To request publications contact 1-888-875-5297 or visit www.calbar.gov.

RESOURCES: WILLS

Write Your Will Workshop, Write Your Will Seminar, and Introductory to Wills & Trusts are held at various branches of the San Francisco Public Library. You can find information on upcoming sessions at sfpl.org

SAVE THE DATE: April 16 – National Healthcare Decisions Day!

Anise Matteson is an elder care consultant, retired Registered Health Information Technician and writer of reference books for seniors—Elder Diary: Starter Kit, ©2007, is available for your care planning needs—mattesonecs@yahoo.com

March 2015

Learning from Grief

The subject of grief is emotionally challenging and explains the deficiency in family pre-needs planning.

Being a health care professional does not lessen coping with the loss of a loved one.

Clergy were contacted for contribution to this article, but did not respond; therefore, the article addresses the subject of grief from a medical terminology perspective. For specific questions and advice, please contact your health care professional. If you require legal advice, you should seek the services of an attorney.

As an advocate for National Healthcare Decisions Day (April 16), I encourage you to discuss advance care planning and complete an Advance Directive form so that your representative can speak for you should you become unable to speak for yourself. This will facilitate the grieving process [in the event of a death in the family].

Words of Wisdom

Say ‘I love you’ and ‘goodbye’ every day to your loved ones while they are alive.

Keeping secrets from adult children complicates the grieving process. The offspring need this information, especially if they are the executor of the estate.

Your age and the length of time you knew the deceased affects the grieving process.

Read books on the subject to know what to expect as you go through the grieving process.

People will take advantage of your vulnerability (e.g., before your loved one has been buried: a realtor solicits you to sell your house; a neighbor wants to buy your house for an offspring). These actions are disrespectful to the griever!

Your coworkers are not your grief companion. Limit your discussion. They will ask probing questions, listen, share ‘their loss’ story, and then complain to your supervisor about having the conversation.

Death changes relationships. Not everyone you know has a need to know of your loss.

Take enough time off from your job.

The first 60 days following the death of a loved one are the most crucial. Important decisions have to be made that cannot be postponed and require discussion with an attorney. Any irreversible decisions should be postponed and decided after considerable thought and discussion with an attorney.

If you are experiencing medical complaints, you should seek medical care from a medical doctor who recognizes your symptoms as part of the grieving process and prescribes an appropriate treatment plan.

In time, you will be able to adjust to a new chapter in life’s journey—planning for new goals, cherishing the memories and finding hidden gifts. Those gifts may be hidden amongst the clutter.

DEFINING GRIEF

Grief reaction is a bereavement by the death of, or separation from a significant person which may be first expressed by feelings of numbness and later by profound yearning for the lost one, restlessness and psychophysical responses. It may also be related to matters of importance such as enforced retirement or loss of home. (Understanding Medical Terminology)

Facts about grief response

Louis E. La Grand, PhD explains grief response in Healing Grief, Finding Peace:

• Grief is your response to deep love—an essential of life.

• Grief is exclusively individual.

• A condition—legitimate suffering.

• In the mourning process we start a transition, in effect to build a new persona and way of life.

• Healing grief is a natural process.

Types of grief

Chronic grief is the unresolved denial of the reality of a personal loss. Also called dysfunctional grieving.

Anticipatory grief is the intellectual and emotional responses and behaviors by which individuals (families, communities) work through the process of modifying self-concept based on the perception of potential loss.

It is characterized by sorrow; guilt; anger [choked feelings]; denial of potential loss; denial of the significance of the loss; Expression of distress at potential loss, [ambivalence, sense of unreality]; bargaining; Alterations in activity level, eating habits, sleep patterns, dream patterns, libido.

Dysfunctional grieving is the extended, unsuccessful use of intellectual and emotional responses by which individuals (families, communities) attempt to work through the process of modifying self-concept based upon the perception of potential loss.

It is characterized by Persistent anxiety; Depression; Altered activities of daily living; Prolonged difficulty coping; Loss-associated sense of despair; Intrusive images; Feelings of inadequacy; Decreased self-esteem; Diminished sense of control; Dependency; Death anxiety; Self-criticism.

Risk for dysfunctional grieving is the at risk for extended, unsuccessful use of intellectual and emotional responses and behaviors by an individual (family, community) following a death or perception of loss.

Risk factors include Preloss neuroticism; Preloss psychological symptoms; Frequency of life events; Predisposition for anxiety and feelings of inadequacy; Past psychiatric or mental health treatment.

(Taber’s Cyclopedic Medical Dictionary)

Disenfranchised grief is losses that are not socially recognized or sanctioned and given status of culturally recognized losses; therefore, they are not publically mourned. Formal rituals are limited or nonexistent. It may also occur to professional caregivers after the death of a patient. (La Grand, p. 189)

Ambiguous loss involves a lack of certainty that a loved one has died. May be psychological as well as physical (addictions, Alzheimer’s disease, comas caused by accidents). (La Grand, p. 196)

PHYSICAL RESPONSES OF GRIEF

Dr. La Grand describes the physical responses of grief as thus: “Sadness and sorrow will be expressed throughout the body in painful ways. Headaches, digestive disturbances, stress-related disorders of sleep and fatigue, and various aches and muscle pains are not uncommon when grieving. The degree of physical discomfort is directly proportional to the constant sad and hopeless thoughts you dwell on without deliberately deciding to take a break.”

EMOTIONS ASSOCIATED WITH GRIEF

Emotions associated with grief include: sorrow, longing (to see them again), guilt, numbness, anger, hopelessness, loneliness, and despair. (www.counselling-directory.org.uk/bereavement.html)

HOW WE GRIEVE

Elisabeth Kübler-Ross, MD explains how we grieve in her book, On Death and Dying:

Children

Young children have different concepts of death, and they have to be taken into consideration in order to talk to them and to understand their communication.

Children will react differently to the death of a parent…

Adolescent

Things are not much different than with an adult. The loss of a parent, in addition to adolescence, is often too much for them to endure.

Adults

Five Stages of Grief

Denial and Isolation: Denial is usually a temporary defense and will soon be replaced by partial acceptance.

Anger: When denial cannot be maintained any longer, it is replaced by feelings of anger, rage, envy and resentment. “Why me?”

Bargaining: An agreement which may postpone the inevitable from happening. Making a bargain with God in exchange for some additional time. Sets an imposed deadline (e.g., an offspring’s wedding).

Depression: A sense of great loss replaces anger and rage.

Reactive depression: Depression that is usually self-limiting following a serious event such as a death in the family, the loss of a job, or a personal financial catastrophe. The disorder is longer lasting and more marked than the usual reaction. (Taber’s)

Preparatory depression: Is taking into account impending losses. Preparatory grief. Preparing for final separation in order to facilitate the state of acceptance.

Acceptance: Almost void of feeling. (pp. 52, 63, 93, 97, 124, 185.)

DEFINING BEREAVEMENT

Bereavement is the time we spend adjusting to loss. The period of grief and mourning we go through after someone close to us dies. The expected reactions of grief and sadness upon learning of the loss of a loved one.

Stages of Bereavement

• Accepting that your loss really happened.

• Experiencing the pain that comes with grief.

• Trying to adjust to life without the person who died.

• Putting less energy into your grief and finding a new place to put it (i.e., moving on).

Bereavement Counseling

Bereavement counseling is designed to help people cope more effectively with the death of a loved one. Specifically, bereavement counseling can:

• Offer an understanding of the mourning process.

• Explore areas that could potentially prevent you from moving on.

• Help resolve areas of conflict still remaining.

• Address possible issues of depression or suicidal thoughts.

Bereavement counseling aims to get you to a point where you can function normally—however long it takes. (www.counselling-directory.org.uk/bereavement. html)

Bereavement Support Groups

Bereavement support groups provide opportunities for you to discuss your experiences and learn about grief with others who have experienced loss. (http://www.ucsfhealth.org/education/bereavement_services _and_information/bereavement_ resources_and_services/)

For a list of support groups, see “Senior Smarts: Coping with the Holidays During Bereavement” (December 2014) at www.westsideobserver.com/health.html.

MOURNING

Mourning is normal grief produced by the death of a loved one. It is an important part of bereavement. Mourning involves rituals—funerals, wakes—allows us to say goodbye.

Cyber mourning is the use of social media by mourners to express their condolences.

RITUALS

Formal and informal ritual promotes connection to the deceased and helps survivors by giving support, facilitating transition, and providing comfort. Ritual connections help establish an important pathway to accepting loss, establishing a new relationship with the deceased.

GRIEF COMPANION

Grief companions are people who will stand with you, listening to the pain being experienced and expressed.

GRIEF COUNSELOR

Grief counseling is a form of psychotherapy that aims to help people cope with grief and mourning following the death of loved ones, or with major life changes that trigger feelings of grief (e.g., divorce). (http://en.wikipedia.org/wiki/Grief_counseling)

CHAPLAIN

A chaplain is accountable as part of a professional patient care team; provides supportive care through emphatic listening, demonstrating an understanding of persons in distress; provides grief loss care; designs and leads religious ceremonies of worship and rites (memorials and funerals). (www.healthcare chaplaincy.org/userimages/professional-chaplaincy-its-role-and-importance-in-healthcare.pdf)

HEALING

Dr. La Grand explains how grief helps you heal and be at peace with the loss:

To successfully heal from suffering the death of a loved one is peace of mind through radical acceptance.

To help yourself experience inner peace: increase your ability to relate to others with courtesy, respect and humility, even as you grieve.

A crucial task of grieving is to establish new routines; create a nurturing support network; recognize when denial has run its course; “bad days” are normal; honor your spiritual self; start loving in separation; never self-pity.

GRIEF JOURNAL

Dr. La Grand explains:

Writing is a major therapeutic release.

Writing a journal serves as tool for managing the pain of grief. It helps you gain perspective and understanding of life that you did not possess previously.

Write in the journal at a selected time each evening or whenever you feel overwhelmed by feelings that need to be expressed.

Write your “specific” goals, either the night before or the first thing in the morning. Identify exactly what you want to get through and how you will do it as the day unfolds. (pp. 105-108)

WORDS OF CONSOLATION

“After the funeral, after the departure of relatives—family members feel most grateful to have someone to talk to, especially if it is someone who had recent contact with the deceased and can share anecdotes of some good moments towards the end of the deceased’s life. This helps the relatives over the shock and the initial grief and prepares him for gradual acceptance.” (Kübler-Ross, MD, p. 184)

RESOURCES: GRIEF COUNSELING/SUPPORT GROUPS

San Francisco Suicide Prevention. www.sfsuicide.org. Crisis Line: (415) 781-0500 or (800) 273-TALK (8255). Crisis Lines are for anyone experiencing crisis, grief or distress. Grief Support Group: Eight week peer led (not clinical) support groups for people who have lost a loved one to suicide. For information, call (415) 288-7105.

St. Mary’s Cathedral. www.stmaryscatheralsf.org. Sessions provide information on grief process, and tips on coping with loss of a loved one. Third Wed., 10:30 am-noon. Contact: Sr. Esther McEgan, RSM, (415) 567-2020, ext. 218.

Institute on Aging. Center for Elderly Suicide Prevention and Grief Counseling. www.ioaging.org/ collaborations-elder-protection/center-for-elderly-suicide-prevention/grief-services. 8-Week Basic Traumatic Grief Group, 8-Week Advanced Traumatic Loss Grief Group, Monthly Traumatic Drop-In Grief Group, Saturday morning Drop-In Grief Group, and Individual Trauma Loss Grief Counseling. Contact (415) 750-4111 for more information or to enroll.

Life Transitions Network (LTN). www.transitionalworkshops.com. (415) 263-4822. Moving Through Loss and Transition workshops provides a safe place to share your story, fully experience your feelings and learn new approaches to coping with losses and obstacles of all kinds

RESOURCES: BOOKS

Available at San Francisco Public Library:

How we grieve: relearning the world. Thomas Attig (1996).

Bereavement: counseling the grieving throughout the life cycle. David A. Crenshaw (1990).

The Mourning Handbook: The Most Comprehensive Resource Offering Practical and Compassionate Advice on Coping with All Aspects of Death and Dying. Helen Fitzgerald (1995, c1994).

Death and the family: the importance of mourning. Lily Pincus (1974).

Anise Matteson is an elder care consultant, retired Registered Health Information Technician, writer of reference books for seniors, forum host Caring for an Aging Loved One (forums.delphiforums. com/ elder_care)—mattesonecs@yahoo.com

February 2015

Coping with the Holidays During Bereavement

Christmastide is the festival season from Christmas Eve until after New Year’s Day.

Christmas is observed as a legal holiday that commemorates the birth of Christ—a Christian feast on December 25 or among Eastern Orthodox on January 6. It is observed with religious ceremonies and prayer.

The word Christmas comes from the early English phrase Christes Masse, which means Christ’s Mass.

This article is intended to provide solace for families coping with an anticipated loss or who have lost a family member this year.”

Many people write Xmas instead of Christmas. This form of the name originated in the early Christian Church. In Greek, X is the first letter of Christ’s name. It was frequently used as a holy symbol.

Christmas is a family occasion—relatives gather to exchange gifts and share their happiness.

The custom of exchanging Christmas gifts is a tradition associated with the gifts the Wise Men brought the Christ Child. Gifts are homemade or bought and wrapped with bright paper and ribbons.

Santa, a symbol of gift giving, creates an atmosphere of cheerfulness.

Family dinner consists of: meat, potatoes, vegetables, dressing, gravy, cranberry sauce, nuts and fruits. Dessert: fruit cake, plum pudding, pumpkin or mince pie. Drinks: eggnog.

Usually the word “White Christmas” is associated with snow at Christmastime. It is also a term associated with churches and social groups celebrated as a way of sharing. Several days before Christmas, members of the group wrap canned goods, turkeys, and other foods in white paper. They distributed these gifts to needy persons in the community. This tradition continues today with receptacles throughout the city for donating food items or purchasing a $10 bag of groceries for supermarkets to donate to a charity. (The World Book Encyclopedia)

HOLIDAY COPING STRATEGIES

This article is intended to provide solace for families coping with an anticipated loss or who have lost a family member this year.

To all my readers, may you and your loved ones enjoy a Merry Christmas and a healthy New Year.

Evaluate Your Coping Plans

♥ Do your plans isolate you?

♥ Do your plans reflect what a particular holiday means for you?

♥ The most difficult part of the holiday season?

♥ The most difficult people to be with?

♥ Grief triggers?

♥ Traditions you want to include?

♥ Traditions you do not want to include?

♥ People you would like to be with you?

♥ People you do not want to spend the holidays with?

♥ Things that might help you when you are feeling intense grief?

Assert Yourself

Dr. Louis E. LaGrand offers the following advice in his book Healing Grief, Finding Peace:

♥ Your needs come first. Tell family and friends specifically what you can and cannot do.

♥ You may want to eat out, have someone else hold it this year, or have others assume more responsibility.

♥ You don’t have to follow the exact schedule or routines of the past. Consider starting a new tradition.

♥ There is nothing wrong with reducing the amount of time you spend at events or in preparation for the day. Tell all concerned what your level of participation will be.

♥ Find a way to symbolically honor your deceased loved one. Make it a habit to acknowledge the memory of your loved one at major family events. It’s okay if tears flow.

♥ Tell yourself and accept the fact that the holidays will be different. Identify what emotions you are feeling and express them to your grief companion.

♥ Diligently manage your anticipation. Keep things simple and focus on the values, beliefs, joy, and wisdom of the deceased. Remember that laughter and a smile are still important parts of life.

TIPS FOR ADULTS ON PROVIDING EMOTIONAL SUPPORT FOR THEIR KIDS
DURING THE HOLIDAYS

Be aware of the behavior of adults, particularly parents on a grieving child. Parents must let the child know that adult tears are not a rejection of the child.

Don’t avoid long-standing family tradition. Traditions are often comfortable for the children. (e.g., decorating the tree, lighting the candles, the big family dinner.) Focus on available support from family and close friends.

Create a specific time during the holiday season to talk as a family about favorite memories of the person who dies.

Provide children with special amounts of attention, praise and emotional support.

Take an active role in helping the child cope.

Pay attention to cues and talk openly about how natural it is to be thinking of your loved one.

Recognize that the child may have questions about the death…Be patient and honest in your answers.

Provide reassurance through actions as well as words.

Recognize that children need to talk, not just to be talked to.

©Suggestions provided by: Hospice by the Bay, from: Helping Children Cope With Grief, by Dr. Alan Wolfelt—printed with permission of Hospice by the Bay for inclusion in Elder Caregivers NEWSLETTER – October 2003, p. 8.

GENERAL TIP FOR ADULTS ON PROVIDING EMOTIONAL SUPPORT FOR ADOLESCENTS

They should be listened to and allowed to ventilate their feelings, whether they be guilt, anger or plain sadness. (Elisabeth Kübler-Ross, MD, On Death and Dying, p. 185.)

SYMPATHY NOTE

How to write a letter to enclose with a holiday card to someone who has experienced the death of a loved one?

Barbara Kate Repa, Senior Editor at Caring.com has these suggestions:

♥ A handwritten note.

♥ Avoid explanations or excuses for tardiness.

♥ The note can be brief or long. The intent is to convey that you are thinking of him or her and sending support.

♥ Concentrate on extending sympathy rather than personal updates. Do not inject recounting your own loss.

♥ If you do not know what to say, phrases often used are:

With deepest sympathy,

Our heartfelt condolences,

My heart goes out to you and your family.

I’m so sorry for your loss.

_______ will be sorely missed.

Your family is in my thoughts and prayers.

♥ Use the deceased’s name.

♥ Talk about the deceased. Include specific comments about the person who died—an anecdote that captured the person’s personality, comment on how the person inspired or taught you or made you happy.

♥ Skip the unpleasantries (drudging up past disagreements, sums of money owed, comparison to other relatives death, apologies or explanations for having been out of touch or less-than-flattering words about the deceased).

♥ Avoid platitudes—clichés about death.

♥ Write from your heart.

♥ Include your return address and full name.

(www.caring.com/articles/sympathy--note)

CHEF’S CORNER

Everyone is invited to share your favorite holiday recipes for appetizers, soups, salads, meat, potatoes, dressing, gravy, desserts (cakes, pudding, pies), beverages and their history for easy-to-prepare meals for seniors and caregivers at Caring for an Aging Loved One Forum at http://forums. delphiforums.com/elder_care. Nutrition. Click on Holiday Recipes.

SUPPORT GROUPS

Support groups reduce the sense of isolation, become networks for cultivating new friends who understand what you are going through, provide a place where you can really tell it like it is. (Dr. Louis LaGrand. Healing Grief, Finding Peace, p. 169.)

Association for Death Education and Counseling. www.adec.org. Networking Groups: Online year-round on ADEC’s group page on Linked-In. Free for members to join and participate in discussions, share links and resources, ask questions and meet fellow ADEC members. Participation in Networking Groups is limited to ADEC members. To join, send an email to the Networking Group Chair. Bereavement Support Groups: Grief and Families. Grief at Work. Grief Camp. Hospital-Based Bereavement Programs.

Pathways. www.pathwayshealth.org/grief-support/support-groups.html. From September through June, Pathways provides separate support groups for loss of a parent, a spouse or a child. Groups examine common grief issues such as coping skills, loneliness, anger, “normal” grief and lifestyle changes. Afternoons (San Francisco – Weds). (650) 808-4603 or (510) 613-2092.

Caregiver Resilience Group: Meets in San Francisco 94102. (415) 801-0882.

Free Drop-In Support Group: Meets Fri. in San Francisco 94117. (415) 789-3759.

12 Week Grief Recovery Program: Meets Tues. in San Francisco 94131. (415) 691-7807.

Love, Loss and Letting Go: A Grief Process Group: Meets in San Francisco 94114. (415) 767-1585.

Widows Retreat: Brentwood, CA 94513. (925) 308-5494.

Hospice by the Bay Grief Support Groups. www.hospicebythebay.org/index.php/about/calendar/ grief-support-groups. Free Drop-In Support Group – SF: Comfort, emotional support and healing advice after the loss of a loved one. Weekly. No registration required. (415) 526-5699.

HOLIDAY EVENTS

Holiday Bazaar:  San Francisco Senior Center.  481 O’Farrell St.  (415) 771-7950.  Holiday Bazaar Preview Sale.  Contact the Senior Center in November for dates and details.

Holiday Meal:  Richmond Senior Center.  6221 Geary Blvd.  (415) 752-6444.  Call in October for information on:  Thanksgiving Meal, Christmas Meal and New Year’s Day Meal.  Meals are served 11:45 am.  It is recommended that you call ahead.  Suggested Donation:  $.

Holiday Event:  Stonestown YMCA – Senior Annex.  3150 20th Ave.  (415) 242-7135.  Hot Lunches:  Monday through Friday.  Holiday Events Calendar and ongoing events.  Contact the Senior Annex.

Nutcracker Ballet:  War Memorial Opera House. www.sfballet.org.   301 Van Ness Ave.  (415) 865-2000.  No senior or children discount.

Christmas Concert:  Davies Symphony Hall.  www.sfsymphony.org.  Grove St./Van Ness Ave.  (415) 846-6000.  Concerts for the kids, adults, the whole family. 
(©Elder Caregivers NEWSLETTER – October 2013, p. 11.)

Anise Matteson is an elder care consultant, retired Registered Health Information Technician and writer of reference books for seniors including Coping with the Holidays: Excerpts from Elder Caregivers NEWSLETTER, ©2007, and forum host for Caring for an Aging Loved One. cfaalo@yahoo.com.

December 2014

Alzheimer’s Awareness

November is National Alzheimer’s Awareness Month!mother with alzheimers and-daughter

Viewing the symptoms of Alzheimer’s as normal may result in delayed access to treatment and services.

In many cultures, the symptoms of Alzheimer’s and related disorders is viewed as part of the normal aging processes.

Benefits of early diagnosis

With early consultation, there is more Mild Cognitive Impairment and Early Alzheimer’s Disease diagnoses.

Individuals benefit from available treatments, eligibility for clinical trials, and can take an active part in planning for the future.

DIFFERENCE BETWEEN ALZHEIMER’S DISEASE AND DEMENTIA

Alzheimer’s disease is a geriatric mental disorder of older adults occurring in people over 65. Early onset [younger-onset] Alzheimer’s occurs before the age of 65. Senile dementia of the Alzheimer’s type [SDAT] is the most common form. The presenile form can begin between the ages of 40 and 60 [occurring before the expected onset of age-related changes— in middle age]. A chronic progressive degenerative cognitive disorder that accounts for more than 60% of all dementias; pathologically characterized by cortex atrophy, loss of nerve cells, senile plaques in gray matter and neurofibrillar degeneration. The onset of dementia is insidious. The person loses interest in social contacts, becomes anxious, depressed, disoriented; aphasia, agnosia and apraxia develop; the gait shows a hesitant shuffle and incapacitating flexion contractures mark the terminal decerebrate phase of life.

Dementia is an irreversible impairment of cognitive intellectual capacities, marked by memory impairment and, often, deficits in reasoning, judgment, abstract thought, registration comprehension, learning, task execution, and use of language. The cognitive impairments diminish a person’s social, occupational, and intellectual abilities. Dementia is somewhat more common in women than in men.

Senile dementia of the Alzheimer’s type (SDAT) is dementia occurring in older persons, usually over the age of 65, resulting from Alzheimer’s disease. (medical-dictionary.thefreedictionary.com/senile-dementia-Alzheimer’s-type)

SYMPTOMS

Cognitive: Symptoms that affect memory, awareness, language, judgment and ability to plan, organize and carry out other thought processes.

Behavioral: A group of additional symptoms that occur to at least some degree in many individuals with Alzheimer’s.

In early stages people may experience personality changes such as irritability, anxiety or depression.

In later stages, individuals may develop sleep disturbances; wandering impulses; agitation (physical or verbal aggression, general emotional distress, restlessness, pacing, shredding paper or tissues, yelling); delusions (firmly held belief in things that are not real); or hallucinations (seeing, hearing or feeling things that are not there). (Brochure #770-10-0003, p. 24.)

THE BRAIN: HOW ALZHEIMER’S AFFECTS IT

Plaques and tangles begin in the brain area involved in memory. They gradually spread to other areas. Eventually much of the brain is affected.

Plaques are deposits of a protein fragment called beta-amyloid that build up in the spaces between nerve cells.

Tangles are twisted fibers of another protein called tau that build up inside cells.

The destruction and death of nerve cells causes memory failure, personality changes, problems in carrying out daily activities and other symptoms of Alzheimer’s disease. (Brochure #770-10-0003, p. 12.)

In an October 25, 2011 email from Angela Geiger, Chief Strategy Officer, Alzheimer’s Association, “The Brain: How it works & how Alzheimer’s affects it,” Geiger offers these tips:

“Stay physically active: Physical exercise helps to maintain good blood flow to the brain and encourages the growth of new brain cells.

Eat a healthy diet: High cholesterol may contribute to stroke and brain cell damage, so follow a low-fat, low-cholesterol diet.

Remain socially active: Social activity can reduce stress levels, which help maintain healthy connections among brain cells.

Stay mentally active: Mental stimulating activities strengthen brain cells and the connections between them, may even create new nerve cells.”

The interactive brain tour can be found at alz.org/brain.

WHO IT AFFECTS

Statistics: An estimated 5.4 million Americans have Alzheimer’s and include 13 percent over age 65 and 50 percent 85 and older; seventy percent living at home—the impact affects family members, caregivers and friends.

Baby Boomers began turning 65 in 2011 creating an increase in the number of persons with Alzheimer’s. By 2030, the percentage of persons age 65+ with Alzheimer’s is expected to increase to over 19 percent.

In 2030 the average life expectancy will reach 81 years; by 2050—83 years.

Nearly two-thirds of Americans living with Alzheimer’s are women. About 13 million women are either living with Alzheimer’s or caring for someone who has it.

Risk Factors: Risk factors for developing Alzheimer’s are age, family history and genetics, and race. Latinos and African-Americans are at risk because they have higher rates of vascular disease. Other risk factors—serious head injury (auto, sports, falls), or conditions that damage the heart and blood vessels (heart disease, diabetes, stroke, high blood pressure and high cholesterol)—vascular dementia.

10 WARNING SIGNS OF ALZHEIMER’S

Memory changes that disrupt daily life

Challenges in planning or solving problems

Difficulty completing familiar tasks at home, at work or at leisure

Confusion with time or place

Trouble understanding visual images and spatial relationships

New problems with words in speaking or writing

Misplacing things and losing the ability to retrace steps

Decreased or poor judgment

Withdrawal from work or social activities

Change in mood or personality

10 Warning Signs Brochure

THE STAGES OF ALZHEIMER’S DISEASE

According to the Alzheimer’s Association, a system for defining the seven stages of Alzheimer’s was developed by Barry Reisenberg, MD:

STAGE 1: No impairment. Normal function. The person does not experience any memory problems.

STAGE 2: Very mild decline. May be normal age-related changes or the earliest signs of Alzheimer’s. The individual may feel that he or she is having memory lapses—forgetting familiar words or the location of everyday objects.

STAGE 3: Mild cognitive decline. Early-stage Alzheimer’s may be diagnosed in some but not all individuals at this point. Friends, family or co-workers may notice difficulties.

STAGE 4: Moderate cognitive decline. Mild or early-stage Alzheimer’s. At this point, a careful medical interview should be able to detect clear-cut problems in several ways.

STAGE 5: Moderately severe cognitive decline. Moderate or mild stage dementia. Gaps in memory and thinking are noticeable, and individuals begin to need help with day-to-day activities.

STAGE 6: Severe cognitive decline. Moderately severe or mid-stage Alzheimer’s. Memory continues to worsen, personality changes may take place and individuals need significant help with daily activities.

STAGE 7: Very severe cognitive decline. Severe or late-stage Alzheimer’s. In the final stage of this disease, individuals lose the ability to respond to the environment, carry on a conversation and, eventually, to control movement. They may still say words and phrases.

At this stage, individuals need help with much of their daily personal care, including eating or using the toilet. They may also lose the ability to smile, to sit without support and to hold their heads up. Reflexes become abnormal. Muscles grow rigid. Swallowing is impaired. (Brochure #770-10-0003, pp. 19-22.)

CARE PLANNING

Finding a doctor

Your local chapter of the Alzheimer’s Association can help you find the right doctor.

Family meeting

Hold family meetings to discuss your loved ones care needs. The Alzheimer’s Association can help caregiver’s plan together after diagnosis. Call (800) 272-3900 for a copy of “How to Hold a Family Meeting.”

Legal issues

Advance care planning for health care discussion-making when your loved one is no longer able to speak for themselves (e.g., Durable Power of Attorney, Advance Health Care Directives, will).

Medical issues

Setup a health care journal [elder diary] to assist the caregiver (and the elder, if able) with organizing medical information (e.g., Advance Health Care Directive, Durable Power of Attorney, instructions from health care professionals, medications, treatments, lab results).

Screening

Evaluation for diseases before they become clinically obvious. Screening can play an important part in early diagnosis and management of selected illnesses.Memory Screening: November 18 is Alzheimer’s Foundation of America’s National Memory Screening Day to promote early detection of memory problems including Alzheimer’s.

PROBLEM MANAGEMENT

Medic Alert ID

Medical identification continues to be a critical lifesaving tool for millions of people every day. Anyone living with diabetes, asthma, heart conditions, stroke risk, memory impairment, or allergies such as insect, food or medicines should wear a custom-engraved ID, in case they are unconscious and unable to speak for themselves. And those who are the primary caregiver for many individuals with these conditions should also wear a medical ID in order to ensure their loved one receives the attention they need. ©Information courtesy of Dick Van Slyke, American ID. ©2007. Caring for an Aging Loved One: The Family Caregiver’s Guide Book. (Matteson).

Wandering

Medical Alert® + Alzheimer’s Association Safe Return®: A 24-hour emergency response service that provides assistance when a person with dementia wanders and becomes lost or has a medical emergency. Enroll at (888) 572-8566 or alz.org/safereturn. (Brochure #770-10-0003, p.29.)

GPS Shoe: When a person wanders off from a pre-set distance, the caregiver will immediately receive an alert to their smartphone and computer, with a direct link to a Google map plotting the wanderer’s location. Available online through the Aetrix e-commerce site (www.aetrex.com). ©Information courtesy of Jerry Barber, SVP of Business Development, GTX Corp (GCT.013) for Caring Boomers Newsletter ©2011.

A June 25, 2014 email received from GTX Corp. announced the availability of its products on Amazon.com: “The first products offered include the company’s VL2000 Take-Along GPS Tracker and the Code Amber Alertags.”

Alzheimer’s Association Comfort Zone®: A web-based GPS location management service that allows families to monitor a person with Alzheimer’s.

Alzheimer’s door lock: Attaches to the inside of the door. Simple to use and people who experience Alzheimer’s cannot operate this lock. Available at Assist Security Product Div. of ALS,LLC,www.assistsecurityproducts.com.

Silver Alert: A public notification system in the United States to broadcast information about missing persons—especially senior citizens with Alzheimer’s disease, dementia or other mental disabilities – in order to aid in their capture.

Silver Alerts use a wide array of media outlets–such as commercial radio stations, television stations, and cable television – to broadcast information about missing persons. Silver Alerts also use variable-message signs on roadways to alert motorists to be on the lookout for missing seniors. In cases in which a missing person is believed to be missing on foot, Silver Alerts have used Reverse 911 or other emergency notification systems to notify nearby residents of the neighborhood surrounding the missing person’s last known location. (http://en.wikipedia.org/wiki/Silver_Alert.)

Name Label: Something not mentioned by the Alzheimer’s Association—sewing name label in clothing. If the person is not wearing a medic alert ID or GPS shoes, they can be identified by emergency responders.

SUPPORT GROUPS

Early Stage Group: Institute on Aging (San Francisco)

Mild Cognitive Impairment Support Group: VA Palo Alto Health Care System (Palo Alto)

S.F. (1): Open Discussion. 2nd Wed, 2-330pm. Institute on Aging, Alzheimer’s Adult Day Care. 750-5330 x368.

S.F. (2): Adult Children Caregiver Support Group, 3rd Tues, 5-630pm. Institute on Aging, Alzheimer’s Day Care. 750-5330 x368.

S.F. (3): Cantonese Language. 3rd Wed, 5-630pm. Self-Help for the Elderly, Adult Day Care Services. 677-7556.

S.F. (4): Open Discussion. 1st Sat, 1030am-noon. Institute on Aging, Alzheimer’s Day Care. 750-5330 x370.

S.F. (5): Support Group for Lesbian, Gay, Bisexual and Transgender Caregivers. Date & Time TBA. (925) 284-7942 or (650) 962-8111.

 

S.F. (8): Open Discussion. 2nd Thu, 1-230p. Jones United Methodist Church. 921-7653.
(www.alz.org/norcal/documents/12-2010-bayarea.insert_web.pdf)

Telephone Support Groups: Dementia Caregiver Group. 4th Mon, 7-830pm. Register: (800) 272-3900. www.alz.org/norcal/in_my_community_support.asp.

Learning Circles: Designed to help caregivers seeking additional support and knowledge about Alzheimer’s disease. Meets monthly. www.alz.org/norcal/in_ my_ community _support.asp.


RESOURCES
Alzheimer’s Association Northern California Chapter. www.alznorcal.org.
·      24/7 Helpline: Provides information, referral and care consultations in more than 140 languages.
·      Website: Provides comprehensive information about Alzheimer’s disease and how the Association can help those affected.
·      Support groups.
·      Educational workshops.
·      Green-Field Library: Resource center devoted to Alzheimer’s and dementia.
·      Educational materials: Provides information about all aspects of Alzheimer’s—for individuals with Alzheimer’s; for Spanish-speaking audience; for African-American audiences; for caregivers.
·      Support: Many chapters also provide special programs tailored to their communities including services for African-Americans, Latinos, rural residents and those who live alone.
·      Brochure #770-10-0003*: “basics of alzheimer’s disease: What it is and what you can do.”
·      Local Association: Alzheimer’s Association – Northern California Chapter. www.alznorcal.org.
·      Alzheimer’s Association Northern California & Northern Nevada Newsletter. www.alz.org.norcal. Print subscription and weekly e-newsletter.
Alzheimer’s Foundation of America. www.alzfdn.org. Provides optimal care and services to individuals confronting dementia, and their caregivers and families—through member organizations dedicated to improving quality of life.
care Advantage magazine. www.alzfdn.org. www.afacareadvantage.org. A FREE magazine for caregivers of people with Alzheimer’s disease and related illnesses.

Catholic Charities CYO. cccyo.org. San Francisco Adult Day Services, Alzheimer’s Day Care Resource Center. Access to extensive counseling and assistance with in-home-help referrals, financial counseling, and discussions about the difficulties of caring for loved ones for families and caregivers with Alzheimer’s disease.

Institute on Aging. www.ioaging.org.
·      A 24-hour Support Hotline (Friendship Line)
·      Adult Day Health and Social Programs
·      Alzheimer’s Day Care Resource Center
·      Art Programs
·      Care Coordination and Care Management
·      Elder Abuse Prevention Resources
·      Counseling and Bereavement Services
·      Education programs
·      Elder Suicide Prevention Services
·      Financial Management and Estate Planning
·      Geriatric/Psychological Assessment Services
·      Home Care
·      Information and Referral
·      Medication Monitoring and Reminders
·      Memory Care Services
·      Spiritual Care and Support
(Services for Seniors and Adults with Disabilities. City & County of San Francisco Dept. of Aging and Adult Intake Program, p.34)

Family Caregiver Alliance. www.caregiver.org.
·      Offers free and low-cost services to caregivers.
·      Information and Referral: Information about caregiving issues, including care for someone with Alzheimer’s disease and other dementias, and strategies for taking care of yourself. Fact Sheets, newsletters, publications on health conditions, care planning, legal issues and other topics.
·      Family consultation.
·      FCA Respite Options
·      Legal/Financial Consultations
·      Education and Support
·      Online Services
o   www.caregiver.org: FCA publications, newsletters, online support groups and more.
o   Link2Care: A secure password-protected dementia care website offering a caregiver discussion group, free access to health and legal experts, journals with guided exercise, and care-related articles.
o   Learning Together: Sign up online to find out about upcoming classes and workshops.
o   Caregiving Policy Digest: Bi-monthly e-newsletter. Focuses on public policy issues.
o   California Caregiver: Monthly e-newsletter designed for families and caregivers who live in California.

 

Transitioning

New LifeStyles (San Francisco Bay). www.NewLifeStyles.com. Provides a listing of Memory Care facilities in alphabetical order from Alameda to Walnut Creek for those with Alzheimer’s and other dementia.

Memory Care: Communities offering specialized programs for residents suffering from Alzheimer’s disease or other forms of memory loss. These programs can be offered by Residential, Assisted Living or Nursing communities. (p. 8)

San Francisco Alzheimer’s and Dementia Clinic: www.sfcrs.com. San Francisco Clinical Resource Center participates in clinical trials.

Senior Gems Program. www.seniorhelpers.com. Emphasis on what clients are still able to do. Caregivers use techniques designed to: foster supportive communication; promote positive environment; provide meaningful activities. Senior Gems classification system allows Senior Helpers to understand which stage of dementia the person is experiencing for care planning and selecting a caregiver for the individual. Complementary Senior Gems® DVD: An information DVD that can assist in your efforts to help your family with this disease.

If you are a caregiver or the loved one of someone who is caring for a person with Alzheimer’s, who takes care of you? Caregiving impacts the caregiver’s emotional well-being, health, employment and financial security. Your stress level is elevated. Your diet habits change. Where is the time for exercising? With the holidays approaching, it is a hectic time for the elderly, ill, families and friends. May this article provide information and support. I wish you and your loved ones the holidays best.

Anise Matteson is an elder care consultant, retired Registered Health Information Technician, writer of reference books or seniors (Elder Diary: Starter Kit, Caring for an Aging Loved One: The Family Caregivers Guide Book), and Advocate, National Alzheimer’s Awareness Month 2014. Photo courtesy of Dick Van Slyke, American Medical ID. For specific questions and advice, please contact your health care specialist and other professional service provider. If you require legal advice, you should seek the services of an attorney. cfaalo@yahoo.com.

 

November 2014

Stroke Survival:
Assistive Technology Products proloquo 2

I heard about assistive technology products [Proloquo] from a listener who called in to a radio talk show in August 2011 during the segment on Apple Products. Therefore, I included information on computer access and speech software for Windows and Mac OS X in the October 2011 issue of my Caring Boomers Newsletter. New products have been added since then.

Mac OS X SOFTWARE

Proloquo: a multilingual speech and communication solution, Augmentative and Alternative Communication (AAC), for Mac OS X for people who have difficulty speaking or cannot speak. The software offers features for users with limited vision or learning difficulties.

Other Communication Products

Proloquo2Go: an Augmentative and Alternative Communication (AAC) application for iPad, iPod touch and iPhone.

Proloquo4Text: a text-based communication app for people who cannot speak.

Infovox iVox: natural sounding voices and a choice of language.

Layout Kitchen®: functions as an editor for SwitchXS, Proloquo and KeyStrokes® panels and keyboards. Users can design their own switch panels with colorable and resizable buttons containing texts or images.

AssistiveWare describes itself as “a leading innovator of assistive technology software for iOS and Mac OS X and is committed to collaborating with the global community to make a difference in peoples’ lives; offers several assistive technology software products for Apple’s Mac OS X and iPhone, iPad and iPod touch.” For more products/information, visit www.assistiveware.com.

Head-Controlled Computer Access

Headmouse®Extreme: provides head-controlled access to computers and augmentative communication devices for people who have limited or no use of their hands.

WINDOWS SOFTWARE

SofType: an on-screen keyboard with a built-in mouse button utility—Dragger—and can be accessed using a mouse emulator (i.e., HeadMouse®Extreme).

Dragger: a software utility for manipulating the mouse buttons of a standard mouse or mouse emulator [by people who have physical motor challenges].

Origin Instruments Corporation describes itself as “the North American distributor for AssistiveWare, the leading supplier of assistive software for the Apple Macintosh. These products provide solutions for physical access, communications, speech synthesis, and low vision. Develops and delivers access software for Microsoft Windows including SofType and Dragger. Develops and delivers access solutions for people who do not have the ability to control a computer or iOS Device (iPads, iPhone or iPod touch) with their hands.”

You can download free, time-limited, full-function versions of their software for review and email them to request information on their free loan program for assessments, evaluations and demonstrations. For more products/information, visit www.orin.com.

When care planning, contact your health care specialist for specific questions and advice.

Anise Matteson is an elder care consultant, retired Registered Health Information Technician, writer of reference books for seniors and Caring Boomers Newsletter ©2011. Part IV in a four-part series focusing on stroke was revised August 2014 from the Newsletter for this article. Photo: enablemart.com file. Email: cfaalo@yahoo.com.

October 2014

Adaptive Clothing for Stroke Survivors

After a stroke it may be difficult to perform activities of daily living, especially donning and doffing clothes. Simple Pleasures provides a solution with garments for women.

For the September 2011 issue of Caring Boomers Newsletter, I asked Lynn Dow of Simple Closures for permission to use the description and photos from her flyer for adaptive clothing for the Problem Management section of the newsletter. In response, Lynne wrote: “Coming in September, we have a new line of clothes which fasten down the front with easy closure which will be particularly helpful for people with strokes. These can be viewed on our website around the middle of September. www.simpleclosures.com or phone 1-800-282-1163.” The clothing are Designed in San Francisco. Made in the U.S.A.

ADAPTIVE CLOTHING is designed specifically for women who experience wide-ranging physical and/or mental challenges.

Shirts

Simple Closure tops eliminate the twisting and turning movements common to putting on and taking off conventional tops and blouses. Each top fastens in back, maintaining the appearance of a pullover or front opening blouse

• Physical exertion is decreased, to conserve energy and reduce painful movements

• Closures are strategically placed to minimize discomfort on pressure points along the spine

Pants

• Waistbands have large openings which, when fastened, form deep functional pockets

• Elastic waistband in back allows for fluctuations in waist size

• Extra roomy legs accommodate edematous (swollen ankles and splints)

• Fast removal and ease during toileting, with minimal snaps along the waistband

Skirts

• Easy on and off, with elastic waists and full-length side openings

• Easy dressing of individuals who are unable to stand

• Skirts tuck underneath and snap in place easily as the wearer is turned from side to side in bed

Culottes

• Elastic waists and wide pockets

• Great coverage: looks like a skirt, but has all the practical advantages of pants

• Roomy legs allow for unrestricted movement

Reprinted with the permission of Simple Closures.
Next Month: Part IV: Assistive Technology Products

Anise Mattson is an elder care consultant, retired Registered Health Information Technician, writer of reference books for seniors and Caring Boomers Newsletter ©2011. Part III © Information courtesy of Lynn Dow, Simple Closures. Email: cfaalo@yahoo.com.

September 2014

Senior Smarts

Stroke Survival: Stroke Aftercare

When I decided to write an issue of the 2011 Caring Boomers Newsletter addressing stroke, one of the topics included was the SaeboFlex®

Saint Francis Memorial Hospital conducted a seminar and candidate screening on August 8, 2011 offering a “revolutionary” new therapy to stroke patients—The SaeboFlex® device. At this time, they were the first and only hospital to offer the therapy. Saint Francis Memorial Hospital has had great success with this splint and expanded its outpatient program; therefore, I thought this topic would be of significant interest to readers. Shanna Humphrey, OT wrote the following article telling the readers what they need to know to make an informed decision for qualifying as a candidate for use of the SAEBO in occupational therapy sessions.

Cerebral vascular accidents, or strokes, affect over 700,000 Americans each year. Many stroke survivors have a long-term loss of hand function and a resulting loss of independence. The Saebo Reach splint was designed by occupational therapists to address this type of injury. ”

A Revolutionary New Therapy: The “Saebo Reach” Splint

Cerebral vascular accidents, or strokes, affect over 700,000 Americans each year. Many stroke survivors have a long-term loss of hand function and a resulting loss of independence. The Saebo Reach splint was designed by occupational therapists to address this type of injury.

Occupational therapists, similar to physical therapists, address arm weakness in stroke survivors. Occupational therapists focus on functional activities during therapy with the end goal of increasing a patient’s independence in daily activities. Prior to the Saebo splint, therapists had difficulty incorporating the affected hand and arm into treatment during stroke rehabilitation. This splint allows the patient to immediately incorporate the arm into therapeutic activities. Occupational therapists at Saint Francis have had specialized training to fit patients with the Saebo splint and to progress the patient using this splint as a therapeutic tool. Patients cannot order the splint on their own without assist from a trained therapist and can only receive this therapy from trained therapists.

The splint is based on documented research of the brain’s remarkable ability to “re-program” itself following a stroke. Saebo splints have been effective for patients up to 20 years after their stroke. The splint is custom fit for each person, and works on a mechanical spring system. The splint opens the affected hand after the patient grasps, allowing the patient to incorporate the affected arm into functional activities. Repetitive practice of task-oriented, grasp and release activities can forge new pathways in the brain and result in increased hand and arm strength, control, and range of motion. The patient wears the splint during therapy sessions and also during daily practice sessions at home.

Stroke survivors need to have some function in their affected side to be a candidate for this therapy. The person needs to be able to lift his arm at the shoulder joint at least 15 degrees, bend his elbow at least 15 degrees, and close his hand. The candidate does not need to be able to actively open the affected hand. The candidate will need a caregiver to assist them to put on the splint for the therapy at home. Medicare and some commercial insurances pay for 80-100% of the splint and the occupational therapy. Medi-Cal and Healthy San Francisco do not pay for the splint. The splint costs $1600 without insurance coverage.

For the Saebo program, occupational therapy sessions usually last 1 hour, 2 times a week, for 3-6 months. To start O.T. at Saint Francis, a person needs a physician’s referral for “occupational therapy evaluation for Saebo splint.” Prior to calling, please verify from your insurance company if you are covered for occupational therapy and for the Saebo splint. Call (415) 353-6275 for an appointment.

Please visit the Saebo company’s website for more information, research, and videos: www.saebo.com

©Information courtesy of Shanna Humphrey, Occupational Therapist.

Next Month: Stroke Survival Part III: Adaptive Clothing

Anise Matteson is an elder care consultant, retired Registered Health Information Technician, writer of reference books for seniors and Caring Boomers Newsletter ©2011, “Saint Francis Memorial Hospital the First to Offer A Revolutionary New Therapy.” Email: cfaalo@yahoo.com.

 

July/August 2014

Stroke Survival: Understanding Stroke

Astroke, also referred to as apoplexy, cerebrovascular accident, cerebral hemorrhage, or transient ischemic attack is caused by the effects of any interference with circulation within the brain.

The blood supply to the brain is blocked by a thrombus or clot which blocks the entrance to a narrowed and roughened section of an artery (thrombus); and embolus (clot) that is carried from another part of the body, usually the heart, blocks normal blood passage; a brain artery burst (hemorrhage) and is unable to furnish blood cells with essential, nourishing blood; and in rare instances brain tumors or abscesses press on an artery and close it off (compression).

In a full scale stroke, there is paralysis of one side of the body, the face, or limbs, speech is affected, or there is a period of unconsciousness. In a mini stroke, there are dizzy spells, confusion, memory loss, handwriting change, a numb arm or leg.”

It is the fourth leading cause of death.

Warning Signs

The National Stroke Association What is Stroke lists the following symptoms as warning signs of a stroke:

Sudden numbness or weakness of the face, arm or leg—especially on one side of the body.

Sudden confusion, trouble speaking or understanding.

Sudden trouble seeing in one or both eyes.

Sudden trouble walking, dizziness, or loss of balance or coordination.

Sudden severe headache with no known cause.

Types of Stroke

The New Illustrated Medical and Health Encyclopedia indicates: In a full scale stroke, there is paralysis of one side of the body, the face, or limbs, speech is affected, or there is a period of unconsciousness. In a mini stroke, there are dizzy spells, confusion, memory loss, handwriting change, a numb arm or leg.

Risk Factors

Risk factors for a stroke include: heart failure, hyperlipidemia, hypertension, history of myocardial infarction, male gender, atherosclerosis of the aortic arch, atrial fibrillation, advanced age (especially older than 65 years), carotid artery disease, nonwhite race, peripheral vascular disease, physical inactivity, or a recent transient ischemic attack.

Statistics

­­Seven million people in the United States have survived a stroke.

Rehabilitation Options

According to the National Stroke Association, depending on the severity of a stroke, rehabilitation options include: a rehabilitation unit in the hospital; a subacute care unit; a rehabilitation hospital; home therapy; home with outpatient therapy; or a long-term care facility that provides therapy and skilled nursing care.

Resources

Stroke Survivor Support Group

National Stroke Association

Stroke Smart Magazine

This is part one of a four-part series of articles will focus on stroke: Part I: Understanding Stroke, Part II: Stroke Aftercare, Part III: Adaptive Clothing, and Part IV: Assistive Technology Products.

Next Month: Part II: Stroke Aftercare

Anise Matteson is an elder care consultant, retired Registered Health Information Technician, writer of reference books for seniors and Caring Boomers Newsletter ©2011. Part I is revised from the Newsletter for this article. Email: cfaalo@yahoo.com.

June 2014

Defining the Parish Nurse

When we refer to a nurse, it is usually as a licensed vocational nures (LVN), registered nurse (RN), or nurse practitioner (NP) in health care settings such as acute care facility, long-term care facility (e.g., skilled nursing facility (SNF)), home care, hospice, clinic and doctors office).

Faith community nurses are not expected to provide patient care in the church or at a patient's home but rather to be a source of referrals for services in the community. They coordinate existing services and supplement them with holistic dimension of health and caring.”

Nurses also provide services to the congregation of a religious faith as a Visiting Nurse or Parish Nurse—another resource for the homebound.

OVERVIEW

Faith Community Nursing, also known as Parish Nursing, Parrish Nursing, Congregational Nursing or Church Nursing is a movement of over 15,000 registered nurses.

Faith Community Nursing (FCN) is recognized as a specialty nursing practice.

Faith Community Nursing: Scope and Standards of Practice was approved by the American Nurses Association in 2005 (and updated in 2012) and define the specialty as "...the specialized practice of professional nursing that focuses on the intentional care of the spirit as part of the process of promoting holistic health and preventing or minimizing illness in the faith community."

(American Nurses Association, 2012, Faith Community Nursing Scope and Standards of Practice, Silver Springs, MD: Author, p.1).

To become a faith community nurse, the registered nurse must have a minimum of 2 years experience, must have a current license in the state where the faith community is located, and have completed a parish nurse foundation course for the specialty practice as recognized by the American Nurses Association.

Faith community nurses are not expected to provide patient care in the church or at a patient's home but rather to be a source of referrals for services in the community. They coordinate existing services and supplement them with holistic dimension of health and caring.

Faith community nurses typically belong to the Health Ministries Association which is the national professional membership organization for faith community nurses.

(en.wikipedia.org/wiki_Faith_community_nursing.)

Registered Nurse

Taber's Cyclopedic Medical Dictionary defines registered nurse as a nurse who has graduated from a state approved school of nursing, has passed the professional nursing state board examination, and has been granted a license to practice within a given state.

Holistic Health

Taber's Cyclopedic Medical Dictionary defines holistic medicine as the comprehensive and total care of a patient. The needs of the patient in all areas such as physical, emotional, social, spiritual, and economic, are considered and cared for.

PARISH NURSE

This month's glossary term from "Caring for an Aging Loved One: The Family Caregiver's Guide Book" is parish nurse.

When I asked a registered nurse for permission to use text from carle.com website for the definition of a "Parish Nurse" and the role of the "Parish Nurse," Faith Roberts, RN, BSN approved the following information with one change/addition. Under definition: many places are using the term faith community nurse. This can be used interchangeablly with parish nurse.

Definition of a Parish Nurse

A registered nuse who acts as a vital link between the faith and medical communities.

The role of the Parish Nurse

Health educator: Presents educational programs to the congregation for health screening and illness prevention.

Health counselor: Provides individual counseling services in the home or long-term care setting.

Advocate: Provides assistance to congregational members in finding their way through the health care systems.

Referral agent: Provides assistance with finding and making referrals to agencies, organizations and support services to improve the congregational member's quality of life.

Develops support groups; Initiates and organizes groups designed to assist the participants with a specific issue.

Volunteer training: Recruits and trains volunteers to provide assistance.

The Parish Nurse is a source of preventative and restorative care, ministering holistically to individuals and families.

The Parish Nurse is not a direct medical care provider.

Some of the services a Parish Nurse can provide:

Help in accessing and navigating the health care system.

Programs to promote healthy exercise and nutrition.

Education on health issues.

Support groups.

Health screening.

Assistance to new patients.

Support for hospitalized or homebound family members.

©Information courtesy of Faith Roberts, RN, BSN, carle.com.

Anise Matteson is an elder care consultant, retired Registered Health Information Technician, and writer of reference books for seniors, "Caring for an Aging Loved One: The Family Caregiver's Guide Book, ©2007. This article is an excerpt from her book. She can be reached at cfaalo@yahoo.com.

April 2014

Preparing for the Unexpected – Part I

March article will address planning for the unexpected from the health care professional perspective. April will present the elder law attorney perspective.

When a resident is admitted to a long-term care facility, he or she must provide information for the responsible party, next of kin in emergency, and mortuary preference.

Elder law is a specialized area of legal practice, covering estate planning, wills, trusts, arrangements for care, social security and retirement benefits, protection against elder abuse (physical, emotional and financial), and other involving older people.”

CARE PLANNING

Care Planning is defined as: Mobility/Safety/Self-Care (physical functioning); Nutrition (oral/dental); Elimination; Skin Condition; Sensory/Communication (hearing, speech, vision); Psychosocial/Recreation/Activity/Socialization (cognitive, behavior patterns, moods, psychosocial well-being, activity pursuits); Medical Management (disease diagnoses, health conditions, medications, special treatments and procedures).

Medical Management focuses on a specific problem: alteration in health maintenance; potential for injury; impaired adjustment; potential for death; alteration in diagnosis; unstable condition; exacerbation of diagnosis; refuses treatment; condition changes; recurrent symptoms; seizures.

Related approaches for addressing the problem: terminal care; Durable Power of Attorney; hospice; treatment as prescribed; medication as prescribed; monitoring signs and symptoms; notification of M.D.; diagnostic tests; emergency treatment; No CPR/Do Not Resuscitate; counseling; therapy.

ADVANCE DIRECTIVES

Advance Directives and Durable Power of Attorney provide instructions in your own words to family/caregivers, friends, and health care professionals when there is a significant condition change.

“Physicians and more than 75 national organizations believe that advance directives are so important that recently 50 states adopted the first National Healthcare Decisions Day, which takes place on April 16. [WHAT IS AN ADVANCE DIRECTIVE, July 16, 2009. By Jeneane Brian. www.livestrong.com/article/14354-what-is-an-advance-directive/]

National Healthcare Decision Day

April 16 is a day to “inspire, educate and empower the public and providers about the importance of advance care planning.”

“…National Healthcare Decisions Day is an initiative to encourage patients to express their wishes regarding healthcare and or providers and facilities to respect those wishes, whatever they may be.” (nhdd.org)

Examples

Some examples of Advance Directives with supporting documentation are: living will; Do Not Resuscitate (No Cardiopulmonary Resuscitation); do not hospitalize; organ donation; autopsy request; feeding restriction; medication restriction; other treatment restrictions.

RESOURCES: WILLS

Write Your Will Workshop, Write Your Will Seminar and Introduction to Wills & Trusts are held at various branches of the San Francisco Public Library. You can find information on upcoming sessions at sfpl.org.

RESOURCES: ADVANCE DIRECTIVES

Advance Health Care Directive. To download form visit the California Health Care Association at cmanet.org.

Five Wishes - Aging with Dignity. www.agingwithdignity.org/forms/5wishes.pdf.

FIVE WISHES

MY WISH FOR:

• The Person I Want to Make Care Decisions for Me When I Can’t

• The Kind of Medical Treatment I Want or Don’t Want

• How Comfortable I want to Be

• How I Want People to Treat Me

• What I Want My Loved Ones to Know

State Bar of California educational guide Seniors & the Law: A Guide for Maturing Californians section titled “PLANNING AHEAD.” To request publications contact 1-888-875-5297 or visit www.calbar.gov.

Next Month: Boomer Legal by Helene V. Wenzel, Esq., solo practitioner in Estate Planning and Elder Law.

TERMINOLOGY

Elder law attorney refers to an attorney who specializes in providing legal services for the elderly, especially in the areas of Estate Planning and Medicaid Planning. They handle general estate planning issues and counsels clients about planning for the management of assets and health care with alternative decision-making documents to prepare for the possibility of becoming incapacitated. Elder law is a specialized area of legal practice, covering estate planning, wills, trusts, arrangements for care, social security and retirement benefits, protection against elder abuse (physical, emotional and financial), and other involving older people. (http://definitions.uslegal.com/e/elder-law-attorney/)

Anise Matteson is an elder care consultant, retired Registered Health Information Technician and writer of reference books for seniors. Article revised from Caring Boomers Newsletter ©2012. Email: cfaalo@yahoo.com.

March 2014

Celebrating the Holidaysa challenged senior and caregiver at Christmas

During the holiday season the elderly or ill, family members, friends and caregivers will experience a more hectic schedule.

When I decided to write the October 2013 Elder Caregivers NEWSLETTER to help with holiday planning, I asked health care professionals for suggestions to help with caring for your loved ones.

Mobility

The tips of assistive devices are well maintained and in good condition.

Have someone with you for transferring to car and buildings.

Wear good safe shoes.

Get plenty of rest before and after.

Have a wheelchair when needed.

Use safety ramps and access, if possible.

Watch floors for wet spots.

Avoid peak shopping hours.

Have someone with you.

Have an emergency system to call for help (e.g. cell phone).

Keep Oxygen safe, transportable. Check the equipment. Make sure you have enough oxygen.

Decorating

Can a step stool be handled safely.

Packages under the Christmas tree are not in walkways.

Another option for placing packages: a table in another room.

Allow room for turning, if in a wheelchair.

Adhesive backing on throw rugs and doormats.

Traveling

Call ahead for airline assistance on and off plane.

Let public transportation services know that they will have an individual that needs special assistance.

Use an alternative to public transportation (e.g., Ready Wheels).

©Suggestions provided by Sharol, Physical Therapist.

Commentary

Wear shoes that are appropriate for weather conditions, comfortable, and appropriate heel height, for a lot of walking.

Caregivers, family members and friends may want to consider a fanny pack or backpack to carry necessary items so that your hands are free if pushing a wheelchair or providing ambulatory assistance. Raincoat and rain boots in lieu of an umbrella.

NUTRITION

Strategies to Handle Holiday Eating

Try not to overeat.

Eating should not be "all or nothing."

Eat low-fat tasty snacks in lieu of holiday candy.

Try to prevent yourself from gaining a lot of weight by trying to balance special treats with lower fat foods.

Be careful when prioritizing—do not overdue. Have a treat on Christmas, not the day before or the day after. (Prioritize—choosing the foods that are important to you and choosing these items as your "treats" for the event.)

Do not just take one of everything—you will get extra fat and calories you do not even care about.

Exercise

Party Tips: Attending a Party

Never go hungry—eat a snack before you go to the party to prevent being too hungry.

Take one, but not one of everything.

Watch the portion size.

Do not overeat. Try to eat slowly and move away from the food so that you do not get too tempted by "seconds."

Do not rush up to the food and start eating—chat with family and friends first.

Fill up on the low fat items such as salads, fruit, fresh vegetables, etc.

If you like to drink, try alternating each drink with a mineral water, or drink Spritzers that have only a little wine.

Party Tips: Hosting a Party

Prepare both low fat choices and high fat treats.

Do not prepare lots of extra, potentially left-over food.

Make sure you eat properly yourself on the day of the party so that you will not overdo it while chatting with your guests.

Try to modify your own traditional recipes to be lower in fat without sacrificing the taste: substitutesome fat; eliminate some fat; reduce the amount of fat.

©Suggestions provided by Judith Levine, RD, MS, Nutritionist, National Heart Assn.

Commentary

While enjoying the holidays remember to follow dietary regimen prescribed by your primary care physician and other health care professionals involved in your treatment plan. If you are taking medications, remember to follow the instructions on the prescription.

Dentures

Corn or cream corn.

Sweet potato pie with marshmallows.

What dentures can tolerate.

Offer choices.

Cook dishes that all (elderly, ill or caregiver, guests) can enjoy (e.g., pot pie).

©Suggestions provided by Barbara, Occupational Therapist.

PSYCHOSOCIAL

Family Involvement

The holidays are stressful and tend to fatigue one party or the other. The key to managing: Planning. Anticipate where conflict can evolve.

Caregiver

Plan to get needs met by someone else (e.g., a facility).

Plan festivity around the patient's best time of day when he/she is able to participate, then family members can have their own festivities.

Caregiver's family

Plan to make it as much as possible not to seem an additional burden.

Take over some of the holiday duties.

Realize how much the caregiver has given and give to them.

Patient

Listen to the person's reason for not participating.

How to cope with the holidays

Practice assessment and planning.

Hold a family meeting—give other members something to do (e.g., someone cooks the turkey, someone cooks dessert.

Move the dinner to a room that is comfortable for the patient (e.g., family gathers in the bedroom, if the family member is semi-bedridden).

Bring the party to wherever it needs to be brought to.

Be creative (in the living room—use the coffee table for a buffet table, in the bedroom—use the dresser for a buffet table).

With planning and forethought, the holiday festivities need not be all or nothing. Consider: patient, primary caregiver, rest of the family.

©Suggestions provided by John Bogardus, LCSW.

MEDICAL MANAGEMENT

Medication & Treatment

Maintain medication and treatment schedule.

Change of Condition

Medications and medical responses should follow the usual pattern prescribed by the doctor.

©Suggestions provided by Herbert Lints, MD, Internist.

CHEF'S CORNER: HOLIDAY RECIPES

Boomer and seniors, share your favorite holiday recipes and their history for easy to prepare meals for the seniors and caregivers at http://forums.delphiforums.com/elder_care. Nutrition. Click: Holiday Recipes.

Anise Matteson is an elder care consultant, retired Registered Health Information Technician, and writer of reference books for seniors, "Coping with the Holidays: Excerpts from Elder Caregivers NEWSLETTER," ©2007, included in this article. Contact: cfaalo@yahoo.com.

December 2013

photo of a veteranHonor Our Vets

Veterans Day honors men and women who served in the United States Armed services.  In 1919, President Woodrow Wilson proclaimed November 11 as Armistice Day to remind Americans of the tragedy of war.  A  law adopted in 1938 made the day a federal holiday. In 1954, Congress changed the name to Veterans Day to honor all United States Veterans.

Health care specific to veterans is outside of my area of expertise, except for an internship at Letterman Army Medical Center, Presidio of San Francisco, in the curriculum for Medical Record Technology.

The Department of Veterans Affairs is an important resource for veterans, their family/caregiver and friends.  The San Francisco telephone directory White Pages (US (Federal) Government) listings provide departments and telephone numbers.  The Department's website (www.sanfrancisco.va.gov) provides information on services available to veterans and their families for:  health care, benefits, crisis line, veteran services, and burials and memorials.

Neither you nor your loved ones have to experience a season of life alone.  Everyone goes through each season.  The difference is how it is experienced and who is willing to walk with you."

HEALTH CARE AND BENEFITS

San Francisco VA Medical Center:  A 104-bed facility and 120-bed Community Living Center.  Primary and mental health care is provided at five outpatient clinics.  There is a specialized homeless Veterans clinic in downtown San Francisco.  The Medical Center is affiliated with UCSF School of Medicine.  (www.sanfrancisco.va.gov)

Aid and Attendance Program:  Financial assistance for in-home care, assisted living or nursing home.    www.canhr.org/factsheets/misc _fs/html/fs_aid_&_attendance.htm)

Respite Care:  Can be received as an inpatient, outpatient or a home setting; and is for veterans who need skilled services, case management, and assistance with daily living or instrumental activities of daily living, are isolated, or their caregiver is experiencing burden. www.va.gov/GERIATRICS/Guide/LongTermCare/Respite_Care.asp)
 
Local Support Services for Veterans:  VA Medical Centers; Outpatient Clinics; Vet Centers; PTSD Program; Suicide Prevention Coordinators; VA Chaplains; Veterans Administration Offices.  Connected by:  Who You Are; Life Experiences; Video Gallery; Signs & Symptoms (http://maketheconnection.net/resources?gclid=CImMgfy9LkCFc01Qgodq2oAg)

Chaplain Services:  To speak with a chaplain at the San Francisco VA Medical Center, call Customer Service and your call will be transferred to Patient Advocacy where you can speak to one of three Patient Advocates.  Chaplain Services is also available to visitors.  (www.sanfrancisco.va.gov/visitors)

CAREGIVER SUPPORT

The San Francisco VA Medical Center offers seven support groups for caregivers:

(Web-Based Support Group) Building Better Care Givers:  Workshop:  managing fatigue and stress; managing difficult behaviors and feelings; making good decisions and future plans for your loved ones; improving your sleep, diet and stay active.

Starting the Conversation:  Housing Options—Finding the Right Fit:  Focuses on strategies to enhance resilience and restore balance.

Parkinson's Disease and Caregiver Support Group:  Provides education and emotional support to deal with the stress and strain of care giving.

Community Living Center Support Group:  Provides caregiver support for family members of Community Living Center residents.

Voluntary Respite Program:  Volunteers provide home respite for caregivers of homebound Veterans.

Family 2 Family Program:  Co-facilitated by Psychosocial Rehabilitation and Recovery Center (PRRC) staff and local chapter of the National Alliance for the Mentally Ill.

Caregiver Program for Post 9/11 Veterans:  Provides additional support to eligible post-9/11 Veterans who elect to receive care in a home setting from a primary Family Caregiver.

For more information, contact SFVAMC Caregiver Support Coordinator. 

National Caregiver Support Line:  (855) 260-3274.  Research/referral center for caregivers, Veterans and others seeking caregiver information; provides referrals to local VA Medical Center Support Coordinators and VA/community resources; and provide emotional support.  www.sanfrancisco.va.gov/services/caregiver/index.asp)

Patient Service Administration:  Provides Patient Information for:  Before Your Visit; During Your Stay or Care; and After Your Visit.  (www.sanfrancisco.va.gov/patients/)

PATIENT TRANSPORTATION

SFVAMC Shuttle Schedule:  Local – San Francisco VA Medical Center:  Three shuttle routes run Monday through Friday to:  Downtown Clinic (3rd & Harrison St.); San Bruno Clinic; UCSF.  (www.sanfrancisco.va.gov/patients/shuttlelocal.asp)

NURSNG HOME

Geriatrics & Extended Care – San Francisco VA Medical Center: Offers clinical services for older or functionally dependent Veterans.  Geriatric Services and Programs available:  Community Living Center; Respite Care; Rehabilitative Care; Hospice and Palliative Care; Geriatric Medicine Clinic; Home-Based Primary Care; Geriatric Teaching Programs; Geriatric Research.  (www.sanfrancisco.va.gov/services/Geriatrics.asp)

ELIGIBILITY INFORMATION

Veterans Benefit Administration:  Provides information on pre-discharge; compensation; education & training; vocational rehabilitation & employment; home loans; life insurance; pension... (http://benefits.va.gov/benefits)

CRISIS LINE

Veterans Crisis Line:  (800) 273-8255, press 1.   Formerly the National Veterans Suicide Prevention Hotline, provides confidential help for Veterans, their families and friends.  Responders are available around-the-clock, year-round, for confidential support calls.  Website provides:  Self-Check Quiz; Confidential Homeless Veterans Chat; Support for Deaf and Hard of Hearing; anonymous online chat service; text-messaging service; Learn to Identify the Warning Signs; Suicide and Crisis Resources.  (www.veteranscrisisline.net)

VETERAN SERVICES

San Francisco County Veterans Service Office:  Provides:  help to veteran or the dependent with understanding and applying for benefits and entitlements from the U.S. Department of Veterans Affairs; claim assistance; case management; advocacy.    (www6.sfgov.org/ index. aspx?page=162)  The Outreach Field Office is located at SFVA Medical Center.  (www.sfhsa.org/134.htm)

Swords to Plowshares:  Core services include:  Health & Human Services; Supportive Housing; Employment & Training; Legal Assistance.  (www.swords-to-plowshares.org)

DOMICILIARY CARE PROGRAM

VA Homes (Domiciliaries) were established for veterans who do not require hospital care, but who are unable to earn a living and have no adequate means of support.  The first U.S. Soldiers' Home was established for invalid and disabled soldiers.

Homeless Veterans
The Domiciliary [“Soldiers' Home”] evolved to become an active clinical rehabilitation and treatment program for veterans.  The programs are integrated with the Mental Health Residential Rehabilitation and Treatment Programs (MH RRTPs).  MH RRTPs provide specific treatment of medical conditions, mental illness, addictive disorders and homelessness.  (www.va.gov/homeless/dchv.asp)

A Google Search for “Veterans:  domiciliary homes – San Francisco” lists Veterans Homes of California – Yountville.  VHC – Yountville provides residential accommodations, recreational, social and therapeutic activities for independent living; offers:  residential care (assisted living), and inpatient care:  intermediate care, skilled nursing care, and general acute care).  (http://www.countyofkings.com/Veterans_ Services/VetsHomesofCalifornia.htm)

VETERANS ORGANIZATIONS

American Legion:  Services:  Health care; career assistance; financial center; youth support; family support; education information; claim assistance; benefits.  Veterans Health Care:  Provides health care information on various conditions; updated information on Department of Veterans Affairs.  Family Support Network:  Provides immediate assistance to service personnel and families whose lives have been directly affected by Operation Iraqi Freedom and America's war on terror.  (www.legion.org)

AMVETS National Services Foundation:  Services:  National Services Office assists veterans or veterans' dependent attempting to obtain compensation and benefits from the Veterans Administration; thrift store open to the general public; scholarships to veterans and their dependents; Americanism Program educates youth on American history; carillon bells in many National and State veterans cemeteries; VAVS volunteers at VA health care facilities; Task Force DVD provides safe entertainment for troops stationed overseas.  (www.amvetsnsf.org)

American Veterans Center.  Preserves the legacy of American servicemen.  The site provides an interactive environment to view, read, share or listen to veterans' stories.  (www.americanveteranscenter.org)

(CA Vets of Foreign Wars) Veterans of Foreign Wars, Department of California:  Provides college scholarships to high school students.  Provides free phone cards to active duty military personnel.  (www.vfwca.org)

DECEDENT AFFAIRS

Burials & Memorials.  Provides information on:  cemetery services; burials; headstones, markers and medallions; Presidential Memorial Certificates; cemeteries; national gravestone locator; burial flags; burial allowance.  (www.cem.va.gov/cem/burial_benefits/)

Life's journey takes us through many seasons.  Neither you nor your loved ones have to experience a season of life alone.  Everyone goes through each season.  The difference is how it is experienced and who is willing to walk with you.

Anise Matteson is an elder care consultant, retired Registered Health Information Technician, and writer of reference books for seniors.  She can be reached at cfaalo@yahoo.com.

November 2013

Homebound Survival

At sometime in our life, some of us are homebound due to injury, accident or chronic illness.

According to an article on the National Center for Biotechnology Information website, “there are up to 3.6 million people considered homebound. People who are homebound suffer from a multitude of medical and psychiatric illnesses. The homebound elderly suffer from metabolic, cardiovascular and musculoskeletal disease, as well as from cognitive impairment, dementia and depression at higher rates than the general elderly population.”

The adverse effects of being homebound have medical and psychological ramifications. They are often non-compliant with their treatment plan.”

In San Francisco, as of 2008, approximately 106,169 seniors (approximately 20 percent of the City’s residents aged 60 and over) were living in San Francisco. Seniors are defined by the U.S. Census as adults 60 years and older.

DEFINITION

The homebound in some religious faiths are referred to as shut-ins.

Webster’s Dictionary defines homebound as confined to the home, and shut-in as confined to one’s home or an institution by illness or incapacity.

Degrees of confinement varies from one week, one month, to never leaving the home except in the case of emergencies, or no more than two days per week.

CONTRIBUTING FACTORS

Medical

Diagnoses that may contribute to causing the elderly to be homebound: hypertension, diabetes mellitus, heart disease, osteoarthritis, arthritis of the spine, history of stroke and angina. Falls may also be a contributor.

Psychiatric Disorders

According to the NCBI article, “the two most prevalent mental disorders among the homebound elderly are dementia and depression. Dementia, including Alzheimer’s disease, is the leading problem associated with being homebound, affecting 29 percent of the homebound population.” They also experience cognitive impairment.

PROBLEM MANAGEMENT

The adverse effects of being homebound have medical and psychological ramifications. They are often non-compliant with their treatment plan.

There are resources that can help make the transition manageable, for example, Homebound Ministry.

HOMEBOUND MINISTRY

This month’s Glossary term from “Caring for an Aging Loved One: The Family Caregiver’s Guide Book” is homebound ministry.

I asked a clergyman to write one page for: the definition of “homebound ministry;” the role of the homebound ministry; how the elderly, their caregiver and loved ones can find out about a church’s Homebound Ministry. Rev. Richard Helmer provided the following information.

What are Homebound Ministries?

Homebound ministries describe churches or other religious communities providing support, visitation, and pastoral care at home for members who are unable to attend worship or otherwise join in the regular life of the community.

The nature of these ministries varies widely from religious community to community, from church to church. Most ministries include visits from the clergy for prayers, healing rites, and other sacramental acts (e.g. Communion). Lay (non-clergy) ministers may also participate by offering prayers, sacred readings, and other important religious services to the homebound and elderly. Support services such as transportation and providing meals can also be a part of the ministry of the religious community to the homebound.

Why participate in or receive Homebound Ministries?

The key to homebound ministries is to keep members in community even during times of illness or infirmity that prevent them from being active. Since they are unable to participate in the regular life of their religious community, that community comes to them, offering support, guidance, prayer, and solace.

How can I find out more about the Homebound Ministries my church or religious community provides?

Call the primary office of your religious organization or speak with a member of the clergy. Here are key points to remember:

• Be prepared to ask for specific religious services if you or those whom you care for desire or need them (e.g. meals, special prayers, transportation, etc.). Even if your religious community might not be able to meet all your requests, they may be able to refer you to services offered by other organizations.

• Ask how those participating in the Homebound Ministries program are trained and prepared this ministry. Training is now required by many religious organizations to screen those participating in homebound ministries and better equip them to be effective in their work with the homebound and elderly.

• To make you or those under your care more comfortable, ask that someone from your religious community already familiar to you make an initial visit or attend with the member or clergy first bringing the ministry to your home.

• Prior to the first visit, briefly describe the condition of those being visited (in bed, unable to walk, special medical conditions, etc.). This will help prepare the ministers for their initial visit as they will know what to expect. If they are bringing a meal, be sure to specify any dietary needs.

• Provide directions to the home and any details about gaining access, as necessary.

• In scheduling a homebound ministry visit, it is appropriate to select a time when a caregiver is also present, should assistance be needed.

• Those providing ministry to the homebound and elderly should be respectful. Visits of over an hour are not usual. If any situation with homebound visitations makes you or those under your care uncomfortable, notify the clergy or church office immediately with your concerns.

©Information courtesy of Rev. Richard E. Helmer, Rector, Episcopal Church of Our Savior.

Questions for boomer and senior readers

If you are homebound, why?

What are the challenges?

What tools can help you age in place?

Anise Matteson is an elder care consultant, retired Registered Health Information Technician, and writer of reference books for seniors, “Caring for an Aging Loved One: The Family Caregiver’s Guide Book.” This article is an excerpt. Feedback: cfaalo@yahoo.com.

October 2013

Celebrating Independence

Managing at-home living changes when one reaches the season of "old" age [the golden years]. Walking becomes more difficult, hearing and vision decreases, you cannot enjoy some of the foods that you love to eat.

Neither you nor your loved ones have to experience this season of life alone. Everyone goes through each season. The difference is how it is experienced and who is willing to walk with you.

When I decided to write a reference book for the elderly, their caregivers, family members and friends that would include a Glossary for non-medical caregivers, I asked a Certified Aging-in-Place Specialist to write one page for: The definition of "aging-in-place;"the definition of a Certified Aging-in-Place Specialist;and the role of a Certified Aging-in-Place Specialist. Michael Menn, a licensed architect, remodeler, and frequent industry speaker provided the following information.

Definitions

aging-in-place- 1: living in your home safely, independently and comfortably regardless of age, income or ability level; 2: the pleasure of living in a familiar environment throughout one's maturing years; 3: the ability to enjoy the familiar daily rituals and the special events that enrich our lives;4: the reassurance of being able to call a house a "home" for a lifetime; 5: using products, services and conveniences to allow or enable you not to have to move as physical and social circumstances change.

Universal Home Design- is intended to make the home friendly, or easy to navigate, for everyone.

Certified Aging-in-Place Specialist (CAPS)- professionals trained in working with older and maturing adults in remodeling their homes to provide comprehensive and practical "aging-in-place," "universal design" and "visibility" solutions.

What is CAPS?

The American Association of Retired People (AARP) and the National Association of Home Builders (NAHB) have been working together to create the "Certified Aging in Place Specialists" (CAPS) program to help home remodeling professionals meet the needs of the burgeoning market. This training program is offered through individual state homebuilders associations to home remodelers.

The program teaches the technical, business management and customer service skills essential to compete in this fast growing segment of the residential remodeling industry. It provides comprehensive, practical, market-specific information about working with older and maturing adults to remodel their homes for aging-in-place.

CAPS professionals have the answer to your questions. They have been taught the strategies and techniques for designing and building aesthetically enriching barrier-free living environments. The CAPS program goes beyond design to address the codes and standards, common remodeling expenditures and projects, product ideas and resources needed to provide comprehensive and practical "aging-in-place," "universal design" and "visibility" solutions. CAPS graduates pledge to uphold a code of ethics, and are required to maintain their designation by attending continuing education programs and participating in community service.

What is the role of a "Certified Aging-in-Place Specialist?"

A Certified Aging-in-Place Specialist (CAPS) has been trained in the following:

The unique needs of the older adult population.

"Aging-in-Place" home modifications.

Common remodeling projects.

Solutions to common barriers

Knowledge of "Universal Design."

Knowledge of "Visibility."

While most CAPS professionals are remodelers, an increasing number are general contractors, designers, architects and health care consultants.

Abbreviations

AIA - American Institute of Architects

CRG - Certified Graduate Remodeler

© Information courtesy of Michael A. Menn, AIA, CGR, CAPS, Principal, Design Constructions Concept, Ltd.

Anise Matteson is an elder care consultant, retired Registered Health Information Technician, and writer of reference books for seniors. She can be reached at cfaalo@yahoo.com

July 2013

Senior Smarts:

Celebrating Father's Day

Are you undecided what to give as a Father's Day gift?

Consider a discussion about Dad taking care of his health by scheduling a physical examination to include prostate exam [digital rectal exam].

Prostate cancer, a malignant tumor of the prostate gland, is the most common neoplasm in men over 65.

According to the American Cancer Society, nearly two-thirds of men age 65 or older are diagnosed with prostate cancer. About 238,590 new cases will be diagnosed in the United States and 29,720 men will die from the disease. It is the second leading cause of death in American Men.

According to the Prostate Cancer Research Institute, African-American men have the highest frequency of prostate cancer in the world and the highest death rate from the disease.

…nearly two-thirds of men age 65 or older are diagnosed with prostate cancer. About 238,590 new cases will be diagnosed in the United States and 29,720 men will die from the disease. It is the second leading cause of death in American Men.”

The disease is often asymptomatic, or with symptoms—dysuria, urinary hesitancy, nocturia; when the cancer has spread to the bone—localized or general bone pain. (For a complete list of symptoms, visit http://prostate-cancer.org, What are Prostate Cancer Symptoms?)

Complications in cancer of the prostate manifest when the cancer is not diagnosed early and it metastasizes.

Lab tests can define negative or abnormal findings: prostate specific antigen (PSA), a blood test that monitors the progression and response to surgical, radiation, and/or hormonal therapy. (It is also an early detector of recurrence of prostate cancer; urine test.); Prostate Cancer gene 3 (PCA3 (uPM3)), a gene-based test conducted on a urine sample; ultrasonography which uses ultrasound to produce an image or photograph of an organ; biopsy to confirm the diagnosis—TRUS, a biopsy of the prostate using transurethral ultrasound; saturation or mapping biopsy. These procedures are performed by physician's order.

Treatment options may include: pelvic lymphadenectomy; prostatectomy; transurethral resection of the prostate (TURP); radiation therapy; hormonal therapy; chemotherapy; biological therapy.

According to the Prostate Cancer Research Institute website, clinical trials include: cryosurgery; high-density focused ultrasound; proton beam radiation therapy.

Proper health care requires the expertise of your primary care physician and referral to the appropriate health care professionals. Information herein is for educational purposes.

Father's Day is celebrated the third Sunday in June to honor fathers; in my opinion, while wishing a stranger "Happy Father's Day" is well-intended, it may not be appropriate. The individual may have experienced a loss in the family--their father or a child, or are caring for an ill father.

To boomers with aging fathers—Happy Father's Day.

Anise Matteson is an elder care consultant, retired Registered Health Information Technician, and writer of reference books for seniors. She can be reached at cfaalo@yahoo.com

June 2013

Senior Smarts 

Celebrating Mother's Daya senior and friend

As we approach Mother's Day, the elderly, ill, family members, friends and caregivers will experience a more hectic schedule.

While enjoying the holidays, remember to follow the dietary regimen prescribed by your primary care physician and other health care professionals involved in your treatment plan.

 If you are taking medications, remember to follow the instructions on the prescription.

 Kitchen aids seniors may find helpful:  long handle reachers; talking food scales; big and bold 60-minute timer; large digit hand-held timer; jar opener with flexible ribbing on a built-up handle; peelers:  vegetable peelers with cushion grip or horizontal peelers with soft, comfortable grip; grater with suction feet; built-up handle eating utensils; food prep board (one-handed); bladeless hand-held electric can opener; curved eating utensils (comfort grip cutlery); plastic coated spoon [protects teeth and gums]; knife with sharp curved blade and solid handle [for those with the use of only one hand]; scoop bowl; scoop plate; tumbler with special cutout (nosey cup); spill-proof cup with lid that accepts a straw; 3-section plate; terry cloth food catcher; grip knob (faucet handles); wide-base pitcher; insulated pitcher; insulated mug; spouted beverage lid; two handle transparent mug; food guard [keeps food on plate]; non-slip matting [in lieu of place mat].

 Albeit Mother's Day is celebrated the second Sunday in May to honor mothers, in my opinion, while wishing a stranger Happy Mother’s Day is well-intended, it may not be appropriate.  The individual may have experienced a loss in the family—their mother or a child, or caring for an ill mother. ”

 Creative Cooking Made Easy instructions for cooking are:  Be accurate.  Read recipe and gather ingredients before starting to cook.  Preheat oven to degree specified.  Gather the necessary utensils.  Use standard measuring cups and spoons.  Glass cups with graduated markings are recommended for measuring liquids.

 The Settlement Cookbook instructions for serving food are:  Serve in the most pleasing manner possible.  Serve in small quantities.  Serve at frequent intervals.  Serve in appealing dishes.

 Albeit Mother's Day is celebrated the second Sunday in May to honor mothers, in my opinion, while wishing a stranger Happy Mother’s Day is well-intended, it may not be appropriate.  The individual may have experienced a loss in the family—their mother or a child, or caring for an ill mother. 

To boomers with aging mothers—Happy Mother's Day. 

Anise Matteson is an elder care consultant and writer of reference books for seniors, Coping with the Holidays:  Excerpts from Elder Caregivers NEWSLETTER, ©2007, included in this article.  She can be reached at cfaalo@yahoo.com.

May 2013

Ready for West Nile Virus Season?

First WNV positive Bird found Near City Collegemosquito on arm

West Nile Virus (WNV) infection, caused by the bite of a mosquito carrying the virus, is on the rise throughout California and across the nation. As of September 18, 2012, 126 human cases of WNV infection have been reported in California, including 6 WNV-related deaths. Nationally, 3,142 cases including 134 fatalities have been reported to the US Centers for Disease Control, making this year the highest number of cases reported year-to-date since 2003. Almost forty percent of the nationally reported cases are from Texas.

San Franciscans will be at risk for West Nile during the summer and fall when mosquito activity is at its peak,” observed Rajiv Bhatia, MD, Medical Director for Environmental Health at the DPH. “West Nile Virus is preventable and it takes all of us working together to continue to keep ourselves and our families protected.”

West Nile Virus can occur here, though no locally acquired human cases have ever been reported in the City since 2005 when it became a reportable disease. Mosquitoes can transmit WNV to birds, and so the recent finding of one West Nile-infected dead bird indicates that the virus is present in the local environment This is only the third WNV-positive bird in the City since 2007. The warm weather beginning in September is the environment that sets the stage for mosquitoes to breed and multiply. Preventing a mosquito bite is always the best first step in combating disease.

Working on the success of the popular Fight the Bite campaign that helped launch West Nile Virus awareness throughout California, local authorities are focusing their efforts on eliminating mosquitoes.

“San Franciscans will be at risk for West Nile during the summer and fall when mosquito activity is at its peak,” observed Rajiv Bhatia, MD, Medical Director for Environmental Health at the DPH. “West Nile Virus is preventable and it takes all of us working together to continue to keep ourselves and our families protected.”

In urban areas, the single largest source of mosquito breeding are storm drains and basins which are being regularly inspected and treated to prevent mosquitoes from hatching into adults. Homeowners can prevent mosquito breeding by keeping fish in ornamental ponds, repairing plumbing leaks, letting lawns dry before watering, clearing drains and gutters, and changing water in birdbaths, plant saucers , etc. weekly. Avoid mosquito bites by wearing long sleeved clothing, using a repellent and putting screens on windows.

DPH is available to enforce health code violations such as standing water or plumbing leaks. Complaints can be made through the City’s 3-1-1 customer service system, either on line or by calling 3-1-1.

“We are once again asking San Franciscans to be vigilant about mosquitoes and mosquito bite prevention,” said Tomás Aragón, MD, “People over the age of 50 and anyone with a weakened immune system need to be particularly cautious. Anyone with a high fever and headache for seven days should see a health care professional. Like sunburn, West Nile Virus is completely preventable. ”

Fight the Bite San Francisco campaign recommends the following methods to reduce the likelihood of getting bitten by an infected mosquito:

• Eliminate all sources of standing water where mosquitoes can breed

• While outdoors at dawn and dusk, wear long pants and shirts

• Apply insect repellent to exposed skin according to label instructions

• Report significant mosquito activity to DPH by calling 3-1-1

• Report dead birds to the State at 1/877/WNV-BIRD

Info::www.sfmosquito.org and www.westnile.ca.gov.

October 2012

A Winning Treatment for Sciaticaphoto of back pain

Sciatica often starts suddenly with pain in your lower back that radiates down from your buttock to one thigh and into your leg. You may have pain when you sit, sneeze or cough. You may also feel weakness, “pins and needles,” numbness, or a burning or tingling sensation down your leg.

Sciatica symptoms may result from general wear and tear, plus any sudden pressure on a disc. Most commonly, this occurs when a protruding or herniated disc irritates the sciatic nerve. Sciatica is a major source of disability and impairment of daily living activities. About 20 percent those with sciatica experience symptoms for more than six weeks. Fortunately, new evidence published this year in an international medical journal, The Spine Journal, identifies an effective treatment for this debilitating condition.

Medical doctors recently published the results of a study involving sciatica treatment. In the high quality study, 102 patients with acute back pain and sciatica with disc protrusion were randomized to active and simulated manipulation. Treatments were administered 5 days per week by experienced chiropractors for up to 4 weeks.

Results of the study were dramatic. Chiropractic care delivered a significant pain reduction benefit compared with simulated manipulation, and no patient experienced an adverse event. These impressive findings have important implications for the treatment of sciatica. Practitioners managing patients with acute back pain and sciatica with protruding discs should consider chiropractic care as a first option.

Dr. Scott Swanson is a chiropractor in Outer Sunset District of San Francisco specializing in the treatment of non-surgical spinal conditions. Call 415-566-7134 for additional information.

February 2010

To X-ray or Not to X-ray? xray of skull

That is the Question

Patients with a brief history of back pain frequently request an x-ray to determine the cause of their pain and to make sure it is nothing serious. While an x-ray might seem helpful, is it? Does it benefit the patient or simply expose him to risks?

Research studies confirm that x-rays are not necessary for most patients with a recent incident of low back pain and have generally been overused. A complete medical history and physical examination can usually identify any dangerous conditions that may be associated with back pain.

There are a couple major reasons why x-ray offers little value for patients with a recent attack of back pain. First, a lot back pain comes from ligaments and muscles that cannot be seen on an x-ray. Second, as we get older, the bones of the back change due to normal wear. On an x-ray, these normal changes can be mistakenly identified as the cause of back pain. Given these limitations, x-ray seldom provides information useful to treatment.

Aside from its lack of benefit, x-ray exposes patients to potentially harmful radiation. Medical health physicists have noted that low-back x-rays expose sex organs to large doses of ionizing radiation (many times greater than that associated with a chest x-ray). Pregnant women have been warned for decades to avoid x-rays because of the potential harm to the fetus. Although the precise effects of x-ray radiation remain uncertain, it is linked to serious risks, including cancer and death.

Another concern with x-ray is the financial cost. The US government recently estimated that the average cost for two low back x-rays is about $150. That means the overall cost of low back x-rays in America is nearly $1 billion every year -- most of which is estimated to be an unnecessary expense.

While x-ray generally is not helpful for assessing back pain, it may be necessary when a patient’s symptoms indicate a more serious condition requiring further assessment. For example, if a patient had a severe spinal trauma, a doctor might want to investigate the possibility of spinal fracture.

The advice for patients is to avoid x-rays unless there is a compelling reason for their use. Talk openly with your doctor about your specific condition and possible alternative means of diagnosis.

Dr. Scott Swanson is a chiropractor in Outer Sunset District of San Francisco specializing in the treatment of non-surgical spinal conditions. Call 415-566-7134 for additional information.

December 2009