Yet even during cooler times of the year, older adults are at risk of having a less than optimal level of fluid in their bodies. Dehydration can cause heart problems, low blood pressure, digestive disorders, confusion, and heat-related illness. It raises the risk of infections, especially of the urinary tract. It makes seniors more likely to sustain a fall injury. A study from the American Physiological Society even shows that while exercise gives us a memory boost, we don’t reap those benefits if we’re dehydrated.

Why are older adults at higher risk of dehydration? PET scans show that a region of the brain called the mid-cingulate cortex, which tells our bodies that we need water, often malfunctions in older adults. Older brains might not only fail to send signals that we need to drink but might even in effect say “OK, that’s enough” even if we’ve only taken a few sips.

Other factors compound the problem. Health challenges, including Parkinson’s disease, dementia, the effect of a stroke, and arthritis, can make it harder for a senior to stay well-hydrated. Certain medications, such as laxatives or those to treat congestive heart failure and high blood pressure, cause our bodies to excrete more fluid. Infections and fevers can dehydrate us. Some people with incontinence choose to refrain from drinking fluids, especially at night. And a person’s doctor might recommend restricting fluids if they have certain health conditions, such as heart failure or kidney disease.

Be alert for the signs of dehydration, which include extreme thirst, dry mouth, headache, lethargy, and hallucinations. It can be harder to recognize dehydration in seniors because they may not feel thirsty, and some of the symptoms of dehydration can be confused with other common conditions.

Here are eight common questions older adults have about proper hydration:

1. How much fluid should I drink each day? This varies from person to person, depending in part on their height, weight, activity level, and health conditions. For most people, around 64 ounces a day (eight glasses) is recommended. Ask your doctor about how much fluid you should be consuming.
2. What should I drink? Water is the very best choice! Because of their reduced thirst mechanism, seniors should drink before they feel parched. Get in the habit of sipping small amounts throughout the day. Keep a water bottle full and nearby. Add a slice of citrus fruit, cucumbers, or strawberries—appealing to look at, and delicious to sip.
3. What other fluids are good? Water is the very best way to hydrate, but there are other good sources of fluid, such as milk or non-dairy alternatives, 100% fruit juices, soup, veggies, and fruits. Watermelon, for example, is well-named, containing more than 90% water.
4. Is soda a good choice? Only in small amounts. Sugary drinks are linked with an increased risk of heart disease, obesity, and diabetes. A recent study from the University of Michigan even showed that consuming a lot of sugary beverages is associated with chronic liver disease.
5. What about sparkling waters? These can be an acceptable and tasty alternative, but read the label first—some have added sodium or sugar.
6. What about coffee and tea? These can have a mild diuretic effect, increasing our output of urine, but experts reassure us that we’ll still gain more liquid than we lose, so unless your doctor tells you otherwise, enjoy. Use sugar sparingly—and remember that those fancy sugary coffee drinks and even some tea concoctions are more of a dessert than a beverage.
7. What about alcoholic beverages? Beer, wine, and spirits may seem to quench our thirst, but in fact, alcohol has enough of a diuretic effect that it can dehydrate the body. Don’t drink more than your doctor advises, and have some water shortly before and after drinking alcohol.
8. What if I’ve been advised to limit fluids? People with heart failure and certain other conditions may be advised to limit their fluid intake and may take medications that cause the body to get rid of extra fluid. Have regular checkups and follow your doctor’s recommendations carefully.

The information in this article is not intended to replace the advice of your healthcare provider. Talk to your doctor about the ideal fluid consumption for you.

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1.Observe and LISTEN:

• People are more likely to take advice from those who listen to them. Are you really hearing what your aging parent has to say? Regular conversations can build trust. Your loved one will appreciate the fact that you’ve taken an interest in the things that matter to him/her.

• Before jumping in with suggestions, take the time to observe your parent. What are they still capable of doing? What do they have trouble with? How do they think of themselves? Knowing these strengths and weaknesses and which of these are tied to their identity can help you figure out an approach to take in suggesting services from an Aging Life Care Manager.  An Aging Life Care Manager will analyze this on their assessment, develop a customized plan of care that maximize the strengths of the person and offer suggestions to address the trouble areas that match each individual person. 

• Have the person who is the best communicator, listener and most influential to have this discussion with your parent. Most families will know who this person is. This could be the oldest male in the family, the youngest daughter, a doctor, an attorney, a friend who has used our service – every family is different but tapping the most influential person is a good source to move forward.

2. Choose your words carefully:

• Appeal to the values that matter most to your parent and stress your desire to enable them to maintain and enjoy what independence they still have. Aging Life Care Managers increase the older persons autonomy. We always have the best interest of the client in mind with all our suggestions/recommendations.

• Avoid emphasizing your loved one’s weaknesses and forbidding them from doing things. Each person places different value on qualities like respect, self-reliance and a sense of purpose

• The refusal of the aging parent to accept help is typically based in fear: no one want to lose control over one’s life. Hiring an Aging Life Care Manager could be perceived as the beginning of loss of control; it actually increases the amount of autonomy a parent has.

• Just about every adult child tries to use logical means to get an aging parent to change; it just doesn’t work unless there is a crisis. Don’t wait for a crisis!

• Consider the approach of asking the parent to do this for you. You don’t have the time, cannot afford to be away from work, live too far away, have children to care for, etc. Most parents do not want to burden their children.

• Your best course of action might be to tell your parent how their refusal is affecting you personally. Let them know how it would make you feel if she/he accepted the service of an Aging Life Care Manager. Would it give you peace of mind? Would you be more relaxed during the workday? Why not express these feelings?

Older adults with dementia are another story, though. Since they are often incapable of acknowledging the true extent of their cognitive and physical decline.  It often falls to the Medical Power of attorney to make this decision, to ensuring their health, safety and quality of life.

In Summary:

Be sensitive to the fears and insecurities that are causing your parent’s resistance. Once you understand your parent’s motivations, you can frame your suggestion for an Aging Life Care Manager service in a way that’s more likely to lead to productive discussion. Losing a bit of independence by getting help from others doesn’t have to equate with becoming a devalued and marginalized member of society. Everybody ages; you can’t stop that. But what Aging :Life Care Managers can and adult children can do is respond to someone’s limitations in a way that preserves dignity and value

You can be confident that once we are in the door, meet with them and they sense our sincerity, expertise and customized approach helping them to become more independent, this becomes the least of your worries.

You can contact Holistic Aging @ 412-486-6677 or info@holisticaging.com for Aging Life Care Management services in and around Pittsburgh, PA

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Through my international travels I have found that aging effects different geographical population groups differently. Our Western world view of individualism in which one financially self-sufficient, living alone, and in control, makes accepting help from others a challenge. On the other hand, many Eastern countries in the world do not subscribe to our Western ideal of individualism. Rather, they place greater value on long-term bonds with family and local community. When people grow into old age they are cared for by younger members of the family and community throughout the entire process. These adults are much better off. Consequently, we need to recognize the value of that thought process in the Western world and that it is nearly impossible to age alone and remain healthy.

What we all have in common is the need to implement a system that strengthens the autonomy of the older person, assure their active involvement and participation in all spheres of life to improve their well-being, and quality of life. As a result, we need to examine closely our current method of institutional care in assisted livings and skilled nursing facilities, move away from a disease centered and functional dependence approach, but rather to care that promotes independence and dignity of the older person. Medicine is only one part of the picture; as people are transitioning into an older person, we need to look at a whole host of solutions that can keep them healthier and happier for their entire lives.

Through our care management practice, we have had the unique opportunity to identify best practices that allow our older clients to transition into a holistic way of aging well. I believe these concepts can provide a framework for future aging models of care.

Our Aging Model of Care:

• Working through expected Life transitions with a predetermined plan
• Creating an autonomous environment that encourages the older person to accept help
• Helping to decrease dependence on medication; eliminating the unnecessary or duplicate
• Treating food as medicine and moving the person into healthy eating
• Recommending alternative and less invasive treatment for many age related conditions
• Determining the root cause of an issue, rather than treating the symptom
• Bringing the “disease” back into balance using a gentile approach
• Following all transitions of care in the current healthcare system
• Acting as the liaison in all areas such as medical, psycho-social, spiritual, cognitive, environmental
• Encouraging and allowing for participation in meaningful life events
• Spending time and enjoying nature as much as possible
• Some type of daily physical and cognitive exercise
• Social interactions and involvement of family and friends
• Multi-generational interactions

I had the opportunity to visit a “Dementia Village” in Amsterdam. Due to their revolutionary approach, the majority of residents achieved the simple goal of trying to make life as normal as possible. As a result of visiting this village, I have strengthened my belief in holistic care.  If you’d like to learn more about it you can read a descriptive article here.

When we look at our elders transitioning, we need to stop seeing aging as a disease that needs a cure. Instead, let us bring about a revolution in which future elder care will encourage a return to a natural way of living. We will be close to nature and the things we love. We will walk in the woods, sing songs and appreciate the bounty of the planet and we will AGE WELL.

The post Transitioning into an “Older Person” appeared first on Holistic Aging.

Complex tasks like driving require different sensory, motor, and cognitive functions and their interaction.

1. Sensory: Normal aging is associated with structural changes of the eye that lead to reductions in visual acuity and contrast sensitivity and increased glare sensitivity. Peripheral vision is reduced, leading to difficulty with making turns safely. Hearing can also be diminished in the older adult.
2. Motor Function: With increasing age, muscle strength strongly diminishes, and speed of movement is reduced. This can lead to a slowing of emergency maneuvers with the steering wheel or a prolongation of braking time. Further, trunk and neck flexibility, which is essential for looking back during driving, is massively reduced with age, leading to insufficient detection of targets in the back view.
3. Cognitive function: Executive functions which takes place in the frontal section part of one’s brain can change with a decline in cognitive function. This is the area where solution of problems, multitasking  and coping with unexpected situations is controlled. Driving a car is a typical example of such multitasking since it requires steering and operating the car, observing the traffic, being aware or predicting critical situations, as well as planning, executing, and adapting one’s own behavior

The December holiday season is a perfect time to take note of our seniors’ driving abilities and habits.  This time of year is when many families visit elderly parents, grandparents and other loved ones, so you can often get a first-hand look at any problems your elderly loved ones may have while driving.

In honor of Older Driver Safety Awareness Week, consider the following:

• Inspect your parent’s car for dings along with the garage.
• Ask your parent to drive you somewhere and notice any areas lacking in sensory, motor or cognitive function that may be concerning.
• Have a honest conversation with your loved one discussing these concerns.
• Suggest getting an independent driving test:
  • Occupational therapists, as well as certified driver rehabilitation specialists (CDRSs) can make important recommendations concerning the fitness-to-drive. To assist in formulating these recommendations, occupational therapists usually undertake both off-road (clinic-based) and on-road (in-vehicle) assessments. When conducted together these are referred to as a comprehensive driver evaluation (CDE). They use criteria that are quick and easy to use and provide clinically useful information about a client’s sensory, physical, cognitive–perceptual, and behavioral skills, and have a predictive relationship with the driver’s performance in a car.

The Life Care Managers of Holistic Aging can conduct initial testing to determine if a referral to an OT is needed. They can also offer recommendations on how to approach your elderly loved one regarding this discussion. Families frequently use us as “the bad guy” professional suggesting they get an evaluation so that the adult child can remain supportive and will not be seen for life as the person who took away their license.

Contact us today at https://holisticaging.com/contact/ to get in touch with our occupational therapists today!

How We Can Care for Our Loved Ones

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Holistic Aging and other programs across the country are reaching out to raise awareness about hospice and palliative care. Hospice and Palliative care month is an opportunity to acknowledge recipients of in-home care services, and celebrate that they are able to remain in the safety and comfort of their own homes while receiving quality care. Home health, home care, and hospice & palliative care providers have always been important to vulnerable citizens in our communities.

Hospice and palliative care are nothing to be afraid of. Life Care Management services offered through Holistic Aging-Options For Elder Care is based upon a belief that the body shouldn’t be looked at as individual parts, but rather our holistic approach looks at how the many parts and systems of the body interact and support one another. Our focus is on the Root Cause of the issue we are helping our clients resolve. 

What’s the difference between Hospice and Palliative Care?

Hospice and palliative care is care beyond cure. It is about speaking honest hard truths with empathy and loving kindness.

Hospice Care

Hospice helps provide comfort and dignity to millions of people, allowing them to spend their final months at home, surrounded by their loved ones. Hospice can help with such daily activities as administering medications, bathing, and dressing, but hospice does not provide full time caregivers. 

Palliative Care

Palliative care is specialized medical care for people living with a serious illness. This type of care is focused on providing relief from the symptoms and stress of the illness. The goal is to improve quality of life for both the patient and the family.

Hospice Service is completely covered by Medicare, can occur in the home, an inpatient hospice setting or a skilled facility, palliative care can only be provided in a home setting. You can choose to use any hospice provider and Holistic Aging can help with that process. Holistic Aging staff is familiar with the large number of Hospice providers in the Pittsburgh area and can offer customized recommendations to assist with this choice.

Once you choose either palliative care or hospice, you’ll have the support of an expert team of medical professionals and they will help you make choices along the way. Contact Holistic Aging for a FREE consult at https://holisticaging.com/contact/ 

The post Hospice and Palliative Care Month: Where to Turn for Support appeared first on Holistic Aging.

As parents, it is hard to acknowledge and accept responsibility for how much influence we have over the development of each of our children. Through my work with older clients and their adult children on a daily basis, I am frequently reminded of this influential power over a life time.

Typical Family Dynamics

As a Life Care Manager, I have counseled many adult children who resent their role in caring for their parents at the end of their lives. Not deliberately, of course, Mom and Dad may be doing things that alienate and push adult children away. Adult Children confide that their parents were never there for them when they were younger and now they resent being there for their parent. Parents don’t understand what they did to make the adult child turn away from them. My education and experience as a Registered Nurse, Aging Life Care Manager and mom of three typically leads me back to the parent and the adult child with perceived mistreatment by the parent.

Instead of offering advice to adult children on care of their parent, I decided to instead address the parent themselves with some advice that will benefit both generations over time.

Parenting Warning Signs

Parents whose entire being exists for their children often have unrealistic expectations of their adult children’s duty to them. Are you the parent who calls (text or email) your adult children so often that they ignore your calls? Are you a meddler always offering unsolicited advice?  Is your constructive feedback really just plain criticism? If any of the above sound familiar, treat them as red flags that cannot be ignored. Your goal is a better relationship and, as the parent, you’re in the driver’s seat.

In his book, When Parents Hurt, psychologist and parent Joshua Coleman, Ph.D advises parents in recognizing what they can do to improve the relationship and how to let go of what they cannot. Do you feel validated solely by your role as a parent? Coleman suggests that parents who exists for their children often have unrealistic expectations of their adult children. “It’s particularly difficult for parents who expect their kids to fix emotional problems from their (the parent’s) childhood, by being a shoulder to cry on, a sounding board, a confidant,” he says. Kids generally don’t want that role.

The establishment of an open environment of respect and valuing of your adult child’s lifestyle choices can help set the tone when the adult children need to gather together and help the older adult(s) in the aging process. As I have frequently told my aging clients’ adult children; your mom or dad will consider themselves your parents until the day they die. Your parent most likely modeled and taught you how relationships work, be that healthy or unhealthy. This means it is okay for both you and them to set your own boundaries.

Parents Should Use Gratitude

Dr. Coleman recommends parents can change this relationship by practicing the principles of gratitude; give thanks! The problem is, gratitude doesn’t always come naturally. The negatives in our lives—the disappointments, resentments, and fears—sometimes occupy more of our attention than the positives. Below, I highlight a number of practices for cultivating gratitude:

Count your blessings:

You can do this through mental imagery or writing it down in a diary. This simple practice is effective because it not only helps you remember and appreciate good things that happened with your children in the past; it can also teach you to notice and savor positive events that are currently happening.

Mental subtraction:

In the words of Joni Mitchell, “you don’t know what you’ve got till it’s gone.” But sometimes just imagining that something is gone is enough to make you appreciate what you’ve got. Mental Subtraction involves focusing specifically on important relationships, such as those with your children. Although it may be painful to imagine your life without them, doing so once in a while can serve as a reminder not to take that person for granted and may improve your relationship as a result.

Savor:

Ever notice that the first bite of cake is usually the best and then less and less so? Savor your relationship with your children. In the age of smartphones, it’s a common experience to see an entire family together with all their eyes glued to a screen of some type. Really notice your adult children, connect with them without distraction, praise generously; appreciate sincerely.

Say “thank you”:

Gratitude can be especially powerful when it’s expressed to others. Writing a thoughtful, detailed “Gratitude Letter” to your children is a great way to increase your own feelings of gratitude and happiness while also making the adult child feel appreciated and valued. Comment on a specific time you noticed what a great parent your daughter or son is. Tell them how proud you are of your their commendation at work. Each of these can make a huge impact on your relationship.

In the end, we are parents until the day we die. It’s our job to take the high road — even if we’re frustrated by past actions of our children.

None of us is perfect, but we can always check in with ourselves to ask: Is my relationship with my child as good as it can be? What can I do to make it better? The daily practice of gratitude is a great place to start. As a Life Care Manager, our goal is to help heal the entire family unit in whatever way we can.  We have counseled many families in developing more positive ways of healing themselves and their final years of a relationship with their parent.

For more tips on how to improve family dynamics when parents and adult children don’t get along, visit our website today!

The post When Parents and Adult Children Don’t Get Along appeared first on Holistic Aging.

Listed prominently in one of our clients chart and reinforced for all caregivers to see is the note: “If Jane asks where her husband is, tell her he is at the hardware store and will be back soon.” Jane’s response is typically, “I should have known, it’s where he can always be found when not with me.” This response always brings a smile to Jane’s face and many delightful stories associated with the hardware business.

Jane’s husband had owned a hardware store, and even after he sold the business, he could be found visiting the new owners and pursing the aisles. The family’s on-going joke was that they would bury him there. So we helped the family come up with a good Fibit (lies that are therapeutic).

You see, Jane’s husband had passed two years ago, and Jane would frequently forget. Prior to changing our story, every time Jane asked this question the caregivers in her memory unit would respond with the reality, that her husband had passed two years prior. Jane would find this very upsetting, reliving his death and the emotions associated with it, wondering how a loving wife could forget to attend her husband’s funeral, even questioning if it actually happened. There’s really no way to gently tell someone their spouse is dead….whether that death occurred yesterday or ten years ago.

When working with people with Alzheimer’s Disease or to other types of dementia, we offer “stepping into their world and seeing it from the perspective of the person with dementia”. Unless your loved one is in the very early stage of memory loss and wants to be reminded of a date, time or other reality based topic, join their journey rather than force reality on them. Keep this in mind and consider it when determining if a Fibit is right to use with your loved one, as well as what response to use.  

In recommending the use of a Fibit to those with memory issues or cognitive impairments consider two criteria:

1. Does telling the truth increase stress and anxiety?
2. Does the Fibit response alleviate this stress and anxiety; maybe even bring about joy?

Clearly this was effective for our client, Jane; it may not be for everyone. Each situation needs to be evaluated individually. Honesty is one of the best qualities in a human being and most of us shutter at the thought of telling a perceived lie, especially to our parents that embedded the importance of honesty into us. But sometimes, dementia changes the rules and honesty isn’t always the best policy when it causes pain and anxiety.

For more information on living in the world of Alzheimer’s Disease, visit our website today!

In the below video, panelists share differing thoughts during a discussion on Feb. 7, 2019, entitled “Is Dishonesty in Dementia Care Wrong” Angnieszka Jaworska, a philosophy professor at UC Riverside, underscores the importance of respecting a person’s autonomy. Bioethicist David Magnus and Dr. Marina Martin, both at the Stanford School of Medicine, discuss whether the act of lying may cause one to be less honest more frequently. Frankly, I don’t believe this to be a concern if you follow our recommendations for use of a Fibit.

The post Living in the World of Alzheimer’s Disease appeared first on Holistic Aging.

Coconut oil is composed predominantly of medium chain triglycerides (MCT). MCT oil is an easy way to get large concentrations of certain MCT. It usually contains C8, C10 or a combination of the two. The theory behind MCT potentially improving cognition is based on ketone bodies produced by metabolized coconut oil. Neurons in the brain use these ketone bodies for fuel, thus improving cognitive function.

The Results of MCT:

Definitive science and clinical evidence for using coconut oil is related to findings noted on PET scans in people diagnosed with Alzheimer’s disease (AD). The brain of these individuals with AD demonstrated a decreased absorption of glucose (the food for the brain). These same PET scan show that areas of the brain affected by Alzheimer’s readily take up ketones as an alternative brain fuel source. MCT produce ketones, which act as an alternative energy source for the brain and can therefore improve brain function. Whereas ketogenic diets can be useful for dementia and Alzheimer’s patients, it is difficult to get them to adhere to this restricted diet.

Coconut oil, which is is 60% medium chain triglycerides (MCT) can serve as an alternative energy source in the brain. As stated before, they produce a ketogenic effect. Patients with memory impairment showed significant improvement in memory after receiving oral supplementation with MCT. The treatment produced higher ketone levels in the blood (Reger et al., 2004). Higher plasma levels of ketones like β-hydroxybutyrate directly correlate with higher performance in memory scores during this study (Reger et al., 2004). Adding coconut oil or MCT oil to the diet has the advantage of being cost effective, easy to implement, socially acceptable and generally safe from significant side effects. Quality MCT oils contain either 100% caprylic acid (C8), 100% capric acid (C10) or a combination of the two.

The Research on MCT:

Dr. Mary Newport popularized the use of both coconut oil and MCT oil for treating Alzheimer’s disease. As a neonatal physician, she was familiar with the use of MCT oil in newborns. When her husband developed early-onset Alzheimer’s, she fed him MCT oil and coconut oil with some success. She’s now an outspoken advocate for the use of MCT and coconut oil for neurological disorders beyond dementia including Down syndrome, ALS, Parkinson’s and Huntington’s. Here is an interview with Dr. Mary and Steve Newport about Steve’s recovery from Alzheimer’s disease by eating Coconut Oil.

In the following video, you can listen to a panel discussion with five medical doctors regarding the problem of insulin resistance and the damaging effects of a high carbohydrate diet on Alzheimer’s disease, and how coconut oil can be effective in treating Alzheimer’s disease.

The Take Away:

Neuro-cognitive diseases have devastating effects and are incurable. There is a the lack of therapeutic alternatives and the relative absence of effective medications and adverse drug effects. These issues give us an urgent need for effective therapies. The five drugs currently used for treatment are supportive or palliative rather than curative or disease-modifying therapies. These drugs do not appear to alter the final outcome of the disease either. MCT offer neuro-protective benefits for a wide range of diseases including dementia, Alzheimer’s, Parkinson’s, stroke, epilepsy, and traumatic brain injury. “While more research certainly needs to be done in this area as well, I see no reason not to incorporate coconut oil in your diet, or the diet of a loved one who is exhibiting symptoms of brain degeneration. Coconut oil has so many profound health benefits; it’s not going to do any harm.”— Dr. Mercola

If you have any questions about incorporating coconut oil or MCT oil for dementia into your loved one’s daily routine, contact us today!

References

Neurobiol Aging. 2004 Mar;25 (3):311-4. Effects of beta-hydroxybutyrate on cognition in memory-impaired adults. Reger MA Henderson ST, Hale C, Cholerton B, Baker LD, Watson GS, Hyde K, Chapman D, Craft S.

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Living Will

We are afraid to speak of death and dying in the USA, as if having this discussion will increase the likelihood of it happening. Evening thinking about death can sometimes be overwhelming. One commonality to the human race is we will all die -death is a natural part of life, and should be discussed and planned for. Retaining control over one’s life and ending  life in a dignified state is a wish shared by all. Drafting a Living Will provides a written document outlining what your end of life wishes are including initiation, continuation,  withholding or  withdrawal of life-  sustaining  treatments. Detailed living wills also make known your burial/cremation wishes, plan your funeral service, choose your music  and readings, and provide  ideas for your  Eulogy, thus allowing a glimpse of how you want to be treated when you are dying. We recommend the use of 5 Wishes as it helps start the  conversation. It is not  so  much about the document, but the conversation and understanding that occurs when going through the steps to complete it.

Living Wills are necessary as advances in modern medicine have allowed doctors to prolong a body when the spirit of the person or what can be perceived as life has left. Families tend to think of this only when a relative is seriously ill, but frequently that may be too late as the person’s wishes are not known and decisions may be made that may not have been that person’s wishes. For those hesitant, I like to remind them it isn’t so much for them but to ease the minds of their loved ones who will need to be making these decisions on their behalf.

As Life Care Manager’s we have this conversation with our client’s on the initial assessment. Over 50% of our clients have not drafted a living will and of that 50% that have, most do not understand the implications of what they chose.

Things to consider when drafting a Living Will or reviewing a current one:

1. Choose a Health Care Agent: This should be someone who knows you well, someone you have verbally shared these values with and have direct experience seeing you implement your philosophy on life. It should also be someone who is close by so they are able to help you when needed. Your health care agent (Medical Power of Attorney) will make decisions regarding your medical care when you are not able to. This is typically a spouse, but you want to also choose someone younger than your spouse as you may both need assistance from this person as you age. Be sure to ask and discuss with this person before choosing them in this role. This person should have strong patient advocacy inclinations and understand the medical arena. Health Care Agents (medical POA) frequently hire Aging Life Care Professionals to assist them in this capacity.
2. Review the medical treatment desired when you cannot make these decisions and consider the implications of your decisions (use a nurse or other medical professional to help explain the consequences of these choices). For example, what does Do not resuscitate (DNR) mean? If I choose to be resuscitated, what are the implications to my quality of life if I receive chest compression’s and are placed on a ventilator to make me breath? What happens when a feeding tube is placed into someone who is in the end stages of life? What are the long term significance and impact on my life when choosing kidney dialysis? What purpose do blood products and IV antibiotic’s play in sustaining my life if I am nearing death?
3. What would I like for comfort in the end of my life? We all know everyone want to be as pain free as possible but do they want to be bathed daily? Do they want their hair to continue to be styled and colored, do they want a massage, do they want music playing, what kind of music? This list can and should be very specific to the person who is completing their living will.
4. Planning for the Final Arrangements: This is where you share your passions, sentient, and desires to assure your final arrangements are carried out according to your wishes. You can direct where you want services, what type (home burial, cremation, etc.), religious preferences, eulogy, specific songs or readings, you can even write your own newspaper notice and pick out your own picture.

Joe’s Story

We received a frantic call for assistance from Joe’s youngest child who was in crisis management mode and didn’t know where to turn. Joe’s wife had just passed away six months ago and dad was living alone, a diabetic, with kidney disease, who was found lying on the floor unresponsive in in his living room by a neighbor. Joe was currently not able to communicate his desires or needs, one side of his body was paralyzed and he was on a ventilator (breathing machine). Joe did not have a Medical POA or Living Will expressing his wishes. Doctor’s were refusing to speak to certain family members, family members had varying opinions on how aggressive to treat Joe, and there was significant disharmony among the siblings.

As you may have surmised, this scenario did not end well and the family could not agree to use our Life Care Management Services. Although deemed “brain dead” two of Joe’s children felt everything should be done to assure their dad had a “chance to recover”. Joe was left on the breathing machine, suffering skin breakdown, numerous infections, invasive, painful surgical procedures, feeding tube placed, and died in a hospital bed 40 days after his fall. At Joe’s funeral, the family stood divided into two groups – the two adult children and their families feeling they were glad they did everything, despite their dad’s poor quality of life at the end and the other two adult children and their families feeling tremendous remorse and sense of loss that their dad’s end of life was spent under what they perceived as in-human conditions. There is the possibility the family may remain divided the remainder of their life. This is why it’s important to be thinking about death ahead of time because it clarifies your life.

Mary’s Story

In the early stages of their mother’s Mary’s cognitive decline, Mary’s family called upon us to help them manage Mary’s life along with planning and project the needs for  Mary’s future.  When someone is diagnosed with any type of brain disorder (Alzheimer’s, Parkinson’s), this should be addressed without hesitation so the person can communicate their wishes while they are still capable. I lead the discussion with her family of five adult children and together, over time, we completed the 5 Wishes with Mary. Mary was in the initial stages of Alzheimer’s disease and still able to express her wishes clearly. All five children participated in this conversation and the recording of Mary’s wishes, including the older grandchildren. It was a wonderfully touching and enlightening experience for all the family to take part in.

Four years after, when she  was nearing her end stages of life and no longer able to communicate her own desires, we frequently referred to this document and  back to the conversations we had  completing it. Her family was comforted knowing they were following through exactly as Mary had desired. As Mary progressed to having swallowing issues, frequently  seen in the end stages of Alzheimer’s, there was never a question of placing a feeding tube as we knew Mary had been adamantly against this. We set up weekly music  therapy and had a personal play list made on an IPod for the staff in the secure dementia unit Mary had been moved to, placed on her when she became anxious. Mary  was an avid musician and music was very important to her life. 

We continued to dye Mary’s hair red, painted her nails, and massaged her feet and hands up until the day  of her passing. Her funeral was truly a celebration of life, with everything in place and pre-planned, there was no running around and making stressful  guesswork decisions. It was very relaxed and selected family member’s read the readings Mary had chosen, played her favorite songs, read her favorite readings and poetry and the family felt they had done the best they could with their mother Mary. Although she was missed, there was a tremendous sense satisfaction and acknowledgement that despite a diagnosis of Alzheimer’s, Mary’s had a wonderful quality of life her last four years and although Mary no longer recognized her children or could verbalize her needs, her children were able to carry out her end of life wishes.

Thinking about death clarifies your life. Think of your living will as a final gift to your children or loved ones, it’s not just the paperwork but the conversation before, during and after the Living Will (advanced directive) is written.  Have THAT conversation now!

If you have any questions or concerns about starting a Living Will, contact Holistic Aging or an elder law attorney for legal advice. The language used and requirements for making your living will legal depends on your state’s law.  Learn more about your state’s laws on Livings Will and Health Care Powers of Attorney.

TEDMED Great Challenges 2013“Discovery Doodle” by graphic recorder Leah Silverman, depicting some of the challenges offered by program participants in coming to grips with end of life care.

With over 30 years of experience in the Care Management industry, Bobbi is viewed by her peers as a seasoned expert in the management of care with the aging and disabled population. The Care Management division of Holistic Aging, Options For Elder Care, has been assisting the elder and disabled population in Pittsburgh PA and surrounds to age well since 2002.

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Me: “Hello, Holistic Aging, this is Bobbi, how can I help you?”

Caller Mary: “I am so glad to talk to someone, (big sigh) you won’t believe what I am going through trying to manage EVERYTHING with my mom and dad (bigger sigh) I wish I would have found you years ago! Jennifer, the elder law attorney thought we could use your service. What do you need to know?”

Me: Tell me your story Meet Jane and Joe Jones from Pittsburgh PA – both in the upper 80’s and according to their perception, are doing just fine! They do not agree that they need help, and really have a difficult time seeing their daughter Mary, who lives in Dallas, prospective of the situation. Despite a significant income, they are living in the typical Pittsburgh older adult frugal manner, in the 2 story home with only one bathroom on the second level home they raised their children in. They love their home and plan on spending the rest of their life there. At one time, they had Mary agree she would “NEVER PUT THEM IN A HOME.”

Mary The Daughter’s Story

Mary is married and works full time in a professional capacity in Dallas, she also has three children of her own and is helping manage her MIL care who lives by them in Dallas.  She has a brother, Tim, who resides with her parents (more about Tim later).

My mother Jane, is 87 years old and is very physically fit but has progressive memory issues that my 89-year-old dad, a retired executive from Westinghouse, Joe is minimizing. Dad’s mind is sharp but he has physical issues limiting his mobility. I am really worried about both of them; if their positive qualities were both combined into one person that person would be so healthy!

A Little About Mom

Mom has memory issues and continues to drive both her and dad since dad’s stroke a year ago has limited his mobility. Dad feels it is safe as he guides and directs her from the passenger seat and they only drive locally. There are dents on all the sides of the car, and into the garage entrance. They have gotten lost a few times, and I received a call from the police who helped get them home.

Mom can no longer clean the house, do laundry or cook. I really do not think she is bathing or changing her clothes regularly.  Her perception is that she is still doing these things well. I tried getting caregivers in to help, but my parents fired them, as they felt they were not helping. Dad is trying to take over, but it is out of his comfort level and he has never cooked. They are both losing weight and eating processed foods for every meal. Mom can be really mean to me and Dad, especially when I challenge or question her ability in any way. It has really become a strain on our relationship.

Mom also use to be the bill payer. Dad and my brother (more on him later) have taken over this but neither are that reliable with managing money or scheduling regular payments. I probably need to mention again about how frugal my parents are not wanting to spend money on anything.

A Little About Dad

Dad had a stroke last year that left him with weakness his left side. He was a real trooper with therapy and has really progressed. He uses a walker, and has one on both levels of the home. It is terrifying watching him go up and down the stairs to the bedroom/bathroom, which he limits to once a day. We were going to get a stair lift but afraid that mom would fall on it as she runs up and down the stairs. There is also concern about Tim and the stairs (more about Tim later). Dad is very resistant to any help coming in and views the need for help as a sign of weakness; he believes family should take care of each other.

Tim

Mary is very hesitant to talk about Tim at first but with some coaxing she reveals that Tim has lived with her parents since returning from Vietnam in 1975. He has had a difficult time retaining a job, cannot drive due to DUI’s and is most likely an alcoholic, but the family does not like to acknowledge this. Mom and Dad are accustom to taking care of Tim. Although Tim is another adult present in the house, Mary does not feel she can depend on her brother to help and if anything. Although she loves her brother, he is another person Mary has to worry about. Her parents don’t see it that way.

The Holistic Aging Life Care Management

First, for aging life care management, we will get a more detailed history from the family, and agree on a contract for service. We completed an assessment on the 9 areas for both mom and dad offering solutions. A mutually agreed plan of care was established and adjusted as changes occurred.

Brief Synopsis of Our Solutions for this Family

We are excited to report this family remained a client with us until both parents passed, and we are still helping the brother Tim who eventually also became a client of ours when his parents passed.

We were able to convince dad to “just try our service for a month” and it didn’t even take that long for dad to see how we directly allowed them to be more independent of their children with increased autonomy; our service not only assisted him and his wife but also his daughter Mary and son Tim.  We also worked with Mary to assume the financial Power of Attorney, POA, so that she could oversee paying of the bills (including ours) and allow us to act as the extension of her medical POA on sight. This freed up a lot of Mary’s time to return to being a daughter and greatly improved her relationship with her parents.

Mom’s Care

We got an appropriate dementia diagnosis (Alzheimer’s) for mom so that we could plan for the current and future needs. After some convincing on our part to be able to stay in the home safely, she agreed to 8 hours of caregivers with Holistic Aging concierge Senior Care Consultants a day. We provided what we call a 360 support for dementia – addressing all the issues surrounding the long-term management including caregiver and family education, responding appropriately, Medication monitoring (less the better), working with the doctor and other practitioners to allow her to age well, providing stimulating activities, assisting with her ADL’s, allowing autonomy yet maintaining an environment which kept her safe. We also had mom’s driving tested by a certified Occupational Therapist who conducts both in-person reaction time and on the road ability. Mom did not pass and although reluctant to accept; it was nice being able to take the blame of removal off an adult child. The caregivers we had in place were able to bring mom out and the Life Care Managers arranged for and attended all medical appoints acting as an advocate for both parents.

Dad’s Care

Dad’s overall health greatly improved with Life Care Management visits monitoring his health and contacting the doctor to prevent decline and hospitalizations. We convinced dad to move to the first level of the home, changing the dining room into his bedroom and adding a handicapped bathroom to this level (which added value to his home).  Dad agreed to PT and we maximized his part A and Part B Medicare benefits of this. Dad also had us as a sounding board to talk to about his concerns for his wife’s decline, sometimes not recognizing who he was. We were able to offer counseling and tactics to improve and accept his changing relationship with his wife.

Now about Tim

Tim developed a great trust in us as time went along, eventually asking us to assist him with his alcoholism. Over a two year period with many ups and downs, we assisted Tim to find the resources to detox from alcohol, rehabilitate himself, and accept counseling and get his license back.  We were able to get Tim involved with local Vietnam Vet groups and the VA system for his access to some great health care benefits. He also had a few diagnoses that entitled him to veteran disability benefits which we assisted him to acquire. Tim has been alcohol-free for six years now and still uses our service to help him manage his personal health care.

Eight Years Later

The last 2 years of mom and dad’s life required us moving them to an assisted living when the level of care needed surpassed what could be provided in the home. Fortunately, a few years prior we had assisted Mary and Tim in picking out the appropriate facility and had their parents added the waitlist.  Both parents passed gently within a year of each other with our support and on hospice.

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