Caring for a parent afflicted with Alzheimers

Caring for a parent afflicated with Alzheimers is challenging.

Listen here https://soundcloud.com/680cjob/parenting-our-parents​ as Dr. Michael Gordan discusses key considerations in a CJOB 680 interivew with host Jeff Currier in Winnipeg.

Nursing home drama: wrong treatment

This is an email from a long time friend on the west coast. 

Her point is simple and poignent… a nursing home drama: wrong treatment.

Her challenge: how to help her failing fahter.

It's not pretty, and so many of us experience the same trauma. 

Please read on.

On Thursday, dad's geriatric psychiatrist contacted me to discuss his treatment. The facility is saying he is being aggressive, so they are looking at his meds to adjust. Less than a half hour later the doctor called me back asking if the facility had contacted me because they are indicating they will send him to emergency where he will essentially be sedated. The doctor doesn't agree with this and has him on the waiting list to get into the geriatric floor at the hospital. 

Dad is physically fine, he gets around and is busy. He tends to get into other people's rooms and moves everything around and tries to fix things. His eyesight is really bad, so he feels for things. One care aide at the home is calling this aggressive behaviour. He has had a couple of incidents, but they were because he was alone and could have been redirected, no one was hurt or even close to being hurt. Dad jokingly does a one two jab action, then laughs. It is a jest, not aggressive whatsoever. His main care aides say he is the least aggressive person, but busy and gets into things. The facility have told us we have to be there from the time he wakes until he goes to sleep or they will send him to emergency here he will be sedated and returned to the facility or he may not have anywhere to go. 

The home has a lack of staff and often there is often no LPN on his floor. If they are on breaks there is no one there. This is a dementia unit for high needs patients. They will move in temporary replacement staff that do not have dementia training, nor read the patients charts and make comments such as why are we even feeding these people.

They have lost his shoes, his dentures, his glasses, they don't shave him and I have to ask for him to be changed. They are supposed to contact us when incidents occur and they haven't.

It is appalling. I am putting in a formal complaint to the health authority, licensing board, and ministry. The disease is hard enough on its own without having to deal with the system. Not sure why I am sharing, except that I know you went through the disease part. This is not the norm as far as care, is it? I am working with the doctor and hopefully we can get him into a place that has adequate care. 

Maybe you need a follow up book on how to ensure your parent is being cared for?

Clearly, her father needs the right kind of care. 

He seems to need regular attention and care. And a way to vent his interets and energy.  It seems he's not violent or dangerous. But ongoing stimulation may be needed.

Bottom line: the system needs stronger checks and balances. It needs to be able to effectively understand and manage the needs to those who are suffering from various stages of dementia. 

 

Elderly need to beware of identity theft efforts

Identity theft has become a major issue for us all. 

And the elderly need to beware of identiy theft efforts that are expanding at a huge rate.

This site we're recommending is really more US focused. But it also offers a lot of good advice for our Canadian followers who should be especially beware of Canada Revenue Agency knock offs!

It's worth checking out. Especially since identiy theft is so prevelent. For your aging loved ones, and even for yourself.

Check it out here: 

http://www.thesimpledollar.com/best-identity-theft-protection-services/

Free course about understanding dementia

We tripped across this multi-week free course offered online by the University of Tasmania in Australia. We did not sign up, but we did poke around and it looks interesting, engaging, and helpful. 

It's worth checkng out. 

Go here: https://mooc.utas.edu.au/?utm_source=Facebook&utm_medium=Landing%20Page&utm_campaign=UDMOOC

Medications and the elderly: some good advice

Here is an excellent recent article in the Globe & Mail about medications and the elderly. Well worth the read and some reflection. 

THE QUESTION
My mother is in her 70s and suffers from a lot of health problems. I am very worried that she has been given too many different medications that are too strong for her. What should I do?


THE ANSWER
It’s possible that your mother may need all the drugs she is currently taking. But it’s also true that patients sometimes get prescribed drugs and remain on them when they are no longer required.
“Doctors are really good at starting medications, we are not so good at stopping them,” says Dr. Kimberly Wintemute, the primary care co-lead of Choosing Wisely Canada, an organization dedicated to reducing unnecessary medical treatments.
During a hospital stay, for instance, a patient might be given a sleeping pill or a heartburn drug and the prescription keeps getting renewed.
Over time, a patient can end up on a growing list of medications. About twothirds of seniors living in their own homes take five or more drugs, according to data collected by the Canadian Institute for Health Information. One-quarter of seniors are prescribed 10 or more medications.
Each new drug that’s added to the mix increases the risk of adverse side effects and medication interactions.
» The elderly are especially vulnerable to these problems. Not only do they tend to have more chronic conditions than younger people, but the aging process can also change the way the body handles medications.
For instance, the liver and kidneys – which play a key role in processing and excreting drugs – tend to work less efficiently as we age.
In fact, the liver can sometimes become overwhelmed trying to handle several drugs simultaneously. As a result, certain medications don’t get “activated” and essentially won’t work.
“Picture a bus and everyone is trying to get on at the same time – some people are not going to fit and will be left behind,” explains Dr. Cara Tannenbaum, co-director of the Canadian Deprescribing Network, a group that is trying to prevent the inappropriate use of medications.
Furthermore, as we age, we lose muscle mass which is replaced with fat and that can cause problems because some drugs are stored in fat tissue. This means medications can linger longer in the body and thereby exaggerate their effects, Wintemute says.
Another concern is the government approval process for new medications. Drugs are usually tested on relatively young people with just one medical condition – not elderly individuals with multiple ailments. “We don’t always know how a new drug is going to act in very old and very frail people,” says Dr. Debbie Elman, the lead physician for the Academic Family Health Team at Sunnybrook Health Sciences Centre.
Patients may suffer from a host of side effects and drug interactions including confusion, dizziness, fatigue, constipation, diarrhea, incontinence, weight loss, depression, agitation, anxiety as well as sexual dysfunction. It can be difficult to tell if a particular symptom is caused by a medication or if it represents a new medical ailment. A patient might be wrongly diagnosed with dementia or another medical condition even though a drug is really to blame.
So, what can be done to reduce the risks posed by multiple medications?
First and foremost, a patient should get all medications at the same pharmacy, Elman says.
She points out that patients are often treated by several medical specialists – and each one may be prescribing different medications. No single doctor may have a complete picture of what a patient is taking. However, when all prescriptions are picked up at the same drug store, the pharmacist can check for potentially hazardous drug combinations.
The pharmacist can also conduct a review of a patient’s medications and help determine if some may no longer be appropriate.
For a thorough assessment, the pharmacist will need to know if the patient is also taking any non-prescription drugs, herbal remedies or vitamin and mineral supplements. It’s important to keep in mind that so-called “natural” health products may interact with medications and either reduce or intensify their effects.
Tannenbaum says many patients don’t know why they are taking certain medications or what they do.
She suggests that patients, or their family members, should use the website medstopper.com to learn more about their medications. Simply type in the name of a drug and up pops a great deal of useful information, including if a certain medication might be particularly risky for seniors. Another website, deprescribing.org, provides guidance on how to wean off a medication that may be harmful or is no longer needed.
Of course, patients shouldn’t quit taking a drug without consulting their medical specialists or family doctor. But by first talking to a pharmacist and checking out the recommended websites, they can at least have an informed discussion with the physician responsible for their medical care, Tannenbaum says.


Paul Taylor is a patient navigation advisor at Sunnybrook Health Sciences Centre. He is a former health editor of The Globe and Mail. You can find him on Twitter @epaultaylor and online at Sunnybrook’s Your Health Matters.

End of life health care wishes: be precise!


The issue of medically assisted dying should be in your estate
planning in the event you can’t make decisions on your own, or that your aging loved ones can't! Michael Gordon has often wirtten ane spoken on this. Here is another piece to consider.


Some people leave this earth with a sense of humour. I think of
Canadian lawyer and successful businessman Charles Vance Miller, who
died in 1926 and held a contest in his last will and testament where a
portion of his estate would be left to the Toronto woman who, in the
10 years following his death, gave birth to the most children. It
became known as the “Great Stork Derby.” Turns out that four women
shared the bequest (each receiving the equivalent in today’s dollars
of $2.1-million), each giving birth to nine children in 10 years.


While dying with humour is not often talked about, the more serious
and controversial issue of “dying with dignity” has been hot in the
press. The whole issue of medically assisted death is one that many
would like to ignore. The fact is, however, the issue should work its
way into your estate planning, particularly in the event you can’t
make decisions on your own. It brings to mind the story of a family
and a court decision from just four years ago.

The story
Mrs. F was a widow who gradually developed dementia. She was visiting
Florida in 2012 when she apparently inhaled some food that required
emergency help. By the time help arrived, she had experienced brain
anoxia and didn’t recover significant consciousness. A feeding tube
was inserted at the hospital in Florida before she was transferred
back to Toronto to a hospital there.


Soon after she arrived in Toronto, her family produced a power of
attorney for personal care prepared 10 years earlier, that included
the following wording: “I hereby instruct that if there is no
reasonable expectation of my recovery from physical or mental
disability, I be allowed to die and not be kept alive by artificial or
heroic measures. I do, however, instruct that medication be mercifully
administered to me to alleviate suffering even though this may shorten
my remaining life.”

It went on to read: “I authorize and direct my
attorneys for personal care to make on my behalf all decisions with
respect to my personal care if I am mentally incapable of making such
decisions myself.” Her attorneys for personal care were her three
children.


Given the wording of the power of attorney, Mrs. F’s doctor, on behalf
of the hospital, requested that they allow her to die. The matter was
taken to the Consent and Capacity Board (CCB), an independent body in
Ontario created under the Health Care Consent Act. On June 14, 2012,
the CCB supported the doctor’s request to end Mrs. F’s life because
they took her words in the power of attorney for personal care to be
directive, and not just precatory. But her children wanted differently
and took the matter to court. (As an aside, I have a problem with
others even trying to force a decision like this without simply
acquiescing to the wishes of the substitute decision makers – the
children who held power of attorney in this case – but I digress.)

The decision
On April 3, 2013, the Ontario Superior Court sided with the children.


Witnesses came forward, including rabbis, attesting to Mrs. F’s
Orthodox Jewish faith and life practices. Removing the feeding tube
would have been contrary to the tenets of Judaism that they believe
would have been important to her and which she embodied in all aspects
of her life.


After examining all the evidence, the court found that Mrs. F likely
did not understand or appreciate the words “artificial and heroic
measures” in her power of attorney for personal care. She likely did
not understand all the implications of what she signed. Her life-long
faith was accepted as an important factor that was not sufficiently
taken into account by the CCB. There was no evidence that she
requested an end-of-life clause (her lawyer had no notes of specific
discussions and simply discussed general issues related to powers of
attorney).

The learning
The issue of medically assisted dying should be in your estate
planning in the event you can’t make decisions on your own
 


Tim Cestnick, FCPA, FCA,
CPA(IL), CFP, TEP, is an author and founder of WaterStreet Family
Offices.

© Copyright The Globe and Mail Inc. All Rights Reserved

Aging and engaging: what can that mean for the elderly?

Aging and engaging: what can the mean for the elderly?

This interesting article can offer good insight.

Take a read. You'll find in helpful!

http://business.financialpost.com/news/economy/japan-in-transition-how-older-workers-can-help-ease-japans-growing-labour-issue

Informal caregivers to the aging is a huge challenge

This is an article from the Globe & Mail, Canada's national newspaper, that appeared on Labour Day, 2014. I just found it filed among old emails. It was meant to be used long ago, but I forgot about it. However, MIchael and I believe this is a very important concept that is worth reading today, just as much as two years ago. 

Fact is, informal caregivers to the aging is a huge challenge. It's a daily growing challenge across Canada, North Americal and around the world.


Labour Day typically comes with a barrage of reports on the status of
work in Canada. How many Canadians are employed and how many are
looking for work. What they are paid and how these earnings compare to
last year. Whether the numbers are better or worse than our American
counterparts.
Of course, this is crucial information and we need it to understand
both current and future prospects for Canadian workers. But there is
another group of essential workers about whom little will have been
written.
These are the 8.1 million informal caregivers who provide some form of
care to elderly parents or individuals with severe and prolonged
disabilities. Statistics Canada reported that in 2012, 28 per cent of
Canadians aged 15 and older cared for a family member or friend with a
long-term health condition, disability or aging needs.
Age-related needs topped the list, with 28 per cent of caregivers
providing assistance to elderly parents. Cancer was next at 11 per
cent, followed by cardiovascular disease at 9 per cent and mental
illness at 7 per cent.
While informal caregivers deliver essential services, they perform
these tasks at no pay. They basically make up a vast but largely
unrecognized and hidden work force in the country.
In fact, unpaid caregivers provide more than 80 per cent of care
required by individuals with long-term conditions. These informal
workers contribute an estimated $5-billion of unpaid labour a year to
the health-care system. One report pegged this figure at closer to an
annual $25-billion if all the wide-ranging tasks performed by
caregivers are included in the calculation.
Whether their economic value is $5-billion or $25-billion is largely
irrelevant in the grand scheme. Caregiver contributions, both
individually and collectively, are incalculable and invaluable because
they add profoundly to the quality of life of the individuals for whom
care is provided.
But the fact that caregivers are unpaid has meant that both their
contributions and their concerns have gone ignored. Their
“invisibility” also results from women still providing the bulk of
unpaid care. They are simply expected to pick up these
responsibilities as part of the caregiving role women typically assume
in society.
In a recent keynote address, a financial planning guru was asked by a
retiring audience member about the best steps to take in order to
secure one’s future. His answer: “Get yourself a daughter.”
The reply was only partly in jest. Caregiving used to be the exclusive
domain of women. But this societal expectation is changing,
fortunately. Data from Statistics Canada’s 2012 General Social Survey
showed that women now account for a slight majority of caregivers, at
54 per cent.
The survey also found that caregiving responsibilities typically fall
to those ages 45 to 64, with 44 per cent of caregivers in this
category. Most informal caregivers of this age also likely participate
in the paid labour market – unless they have to withdraw because of
their caregiving demands.
The demographics mean that employers must come to terms with
caregiving realities, which only will grow with Canada’s aging
population. Businesses will have to allow more time and work
flexibility. This need is particularly true for the care of persons
with episodic conditions, who have remissions with periods of good
functioning and recurrences that may require intensive assistance −
all unpredictable.
For their part, governments can provide more assistance with expensive
health-related costs. They can also modify income security policies to
allow some time off for caregiving. Employment insurance has taken
baby steps in this regard but needs a more generous approach.
Neither should workers, who must take some time for caregiving, be
penalized in their pension vesting. Several countries, including
Australia and Britain, have special pensions intended specifically for
caregivers. Others make pension contributions on behalf of caregivers
to avoid later penalty for lost employment time during working years.
No individual should be driven into poverty, either in present or
future, because of caregiving responsibilities.
On Labour Day, we need to pay attention to this huge group of
essential workers: the millions of informal caregivers who show up
nowhere in the employment numbers, but figure so prominently in real
life.

 

A very helpful guide to medical alert systems for the elderly

Since our very first book together in 2002, we've been big advocates to home safety measures for the elderly. We've both written and talked extensively about 'elder proofing' the home of our aging parents in a timely way. It's like having an insurance policy.

One critical component of home safety is having a reliable monitoring system. 

We have found a very interesting online site that reviews various products. One of its recent reviews was on home monitoring systems. It looks thorough, reliable, and unbiased. We thought you may find it helpful. It's here: http://www.reviews.com/medical-alert-systems/

Plan now to plan ahead for the right substitute decision maker

Choose the right substitute decision makers (SDM) now.

With all the recent focus on what is now called advance care planning (ACP) in the medical and social work literature, it is important for people especially middle-aged and older people to understand what is at stake.

Using the old terminology of a "living well" there has been a transformation from what used to be a few words in a document somewhere or as a conversation with the family member likely to be the SDM that for example the parent "would not want any heroics" if they develop a terminal illness. The reality is that is no longer enough to help those empowered to make such decisions on your behalf. The new world of medicine has many things that can be done that are no longer considered "heroics" but just part of contemporary every day medicine.

Continue reading “Plan now to plan ahead for the right substitute decision maker”