Guidebook to personal medical alert systems

There is a very helpful guidebook now available about home and personal medical alert systems for the elderly. It was proudced by the National Council for Aging Care.We think you will find it interesting and helpful. Find it here:


Type 2 diabetes might be reversible with…

There has been ample speculation and studies to support this article. But here is another one worth your time to read. Diabetes in the aging and eldelry is getting to be such a major health threat, that's it's worth our time to consider all logial options. Read on, here:

Falling is a danger for elderly

Falling is a danger for eldelry loved ones.

The Dutch, like people elsewhere, are living longer than in previous generations. Courses that teach fall prevention, and how to fallcorrectly, are gaining popularity. 

This link leads to a very interesting article from the New York TImes that explores and explains what the Dutch are doing:

Many elderly: I hear you, I hear you, or maybe I don’t

It's the case in many elderly: I hear you, I hear you, or maybe I don’t

The clinical scenario
It was one of those unusual clinics where I saw three similar cases in which the exact same issue surfaced and I was able to demonstrate that in “real time” to residents in training with me in the care of the elderly. The first of the encounters was with a couple accompanied by two family members. The couple lived at home with some personal care help and each had some degree of cognitive impairment, but not enough to completely interfere with reasonably safe functioning when under some supervision. I was interviewing and examining one member of the couple and my resident was doing the same to the other.

Denial or hearing impairment: a common scenario
As I embarked on my interview with the patient it became clear that as noted in previous visits, he was quite hard of hearing and according to the son who was with him, refused to wear his hearing aids because “they bothered him” and he often stated that he had “no problem with hearing”, while each time leaning closer to me to hear my question or answer and turning to the son to repeat the question.  With his wife, the resident also noted that in addition to some degree of cognitive impairment there was a significant degree of hearing impairment. 

Low cost, effective hearing enhancement: very dramatic at times
I retrieved my Pocket Talker® which I keep in the office for such cases. I put the earphones first on him and gradually turned the volume and suddenly his face lit up as I asked if he could hear me and he said, “very well”. We practiced a bit with the device until it was clear that he could engage in a three way conversation with his son and me.  

The resident was now ready to review the wife’s issues with me and the son entered the room with us as did his father. They had already learned from me that during the discussion, while I asked questions the son and husband were to sit quietly despite a desire to “help with answers” unless I asked them specifically to comment on something said to me by the patient. The resident had reiterated the story to me of mild dementia and emphasized that she was quite hard of hearing; she had refused hearing aids although the family was planning on acquiring them. I again retrieved the Pocket Talker® that I had just used with her husband, put on the head phones and as I increased the volume, like her husband’s, her face lit up when she heard my questions and I looked at the son and husband and said to them, “maybe you can get a deal if you get two of these”. 

A hearing augmentation “hat trick” 
Later, a different resident saw another patient. This resident had not been apprised of the earlier experience that we had with the couple. She recounted a history of progressive cognitive decline in the patient and also mentioned an issue with hearing that the patient’s daughter raised. Like the previous couple the daughter said her mother absolutely refused to go for a hearing assessment and said that she did not want “hearing aids” as she “did not need them” and they were “a waste of money”.  

I carried out the same manoeuvre that I had used with the previous couple. Although less dramatic than the previous cases, the way she responded to my repeated questions clearly indicated that she could hear better with the device.  In this particular case,  I was not convinced yet that some of the apparent cognitive impairment may have been perceived as such due to her hearing impairment or at least aggravated by it.  I explained to the daughter I was not yet sure of the degree of cognitive impairment, because “if you can’t hear it, you can’t remember it”. 

Don’t overlook hearing as part of the cognitive assessment
In these three situations during one clinic session the young residents who in their careers would see many elderly people with cognitive impairment or dementia, the message of the importance in hearing was clearly demonstrated.  It can be hard to convince older people to utilize hearing aids or pay for them. For many a simple and inexpensive Pocket Talker® may be a device that can be used as an introduction to the benefits of hearing enhancement or may on its own solve the hearing deficiency problem for the purpose of social communication.

Nursing home warning signs to watch for

There are some nursing home warning signs to watch for.

As those wanting to help and protect our aging parents and other loved ones, we need to be very careful in how we select nusring homes for them.

Here are the first two paragraphs for a Toronto Star article from a few months ago that underscore the reasons for flashing warning signs for us all:

Three troubled Ontario nursing homes — including a Mississauga home — have been ordered to stop accepting new residents due to substandard care.

The crackdown came this week after the Ministry of Health and Long-Term Care ordered each to “cease admissions,” meaning no new residents are allowed to move into the homes.

The message for us: 

Be very thorough and intense about examing any nursing home for your parents or other aging loved ones. Make sure you take the time to look carefully at the facility and what it offers. 

Take the sniff test: can you smell urine in the hallways, common rooms, shared bedrooms?

Talk to staff, residents, and family members of residents. Ask probing questions. 

In fact, if you want to be extra careful, come spot visit at various times of day and night a few times to get a sense of the care giving going on. 

There are lots of optons out there. Take your time, be patient, research. After all, you're making decisons that will impact the lives of your aging parents and perhaps other elderly loved ones.



Our annual eldercare advice for the holidays

This seems to be a big favourite year over year:

Suggestions of how to bet support aging parents and loved ones through family events.

Please take a look, and share with your friends, too.

Here it is:…derly-loved-ones/ ‎

Have a wonderful holiday season and we'll be back posting more in January.

‘Con­sci­en­tious daugh­ter’ is best long-term care plan

This was originally from the New York Times News Service  by Roni Caryn Rabin, and appeared in Canada on May 26th, 2017. I'd filed it, and forgot about it, but having just found it agian, feel it's important to share. So please take a look a this and reflect…


‘Con­sci­en­tious daugh­ter’ is best long-term care plan!

This week, the med­i­cal jour­nal JAMA Neu­rol­ogy high­lighted a loom­ing cri­sis for women and their em­ploy­ers: The grow­ing ranks of de­men­tia pa­tients who will end up re­ly­ing on fam­ily mem­bers, typ­i­cally daugh­ters, for their care.

“The best long-term care in­sur­ance in our coun­try is a con­sci­en­tious daugh­ter,” wrote the au­thors, all of whom are fel­lows at Stan­ford Univer­sity’s Clin­i­cal Ex­cel­lence Re­search Cen­ter, which stud­ies new meth­ods of health-care de­liv­ery.

The au­thors note that by 2030, one in five Amer­i­cans will be 65 or older, and the num­ber of older Amer­i­cans liv­ing with de­men­tia is ex­pected to in­crease to 8.5 mil­lion, up from 5.5 mil­lion now.

Most de­men­tia pa­tients even­tu­ally re­quire round-the-clock care, yet there is no clear na­tional road map or over­ar­ch­ing plan for pro­vid­ing it. Most of the care for older adults in the United States – from pay­ing bills to feed­ing, bathing and dress­ing – falls on un­paid care­givers and most of them are women.

Although men do pro­vide some care­giv­ing for older fam­ily mem­bers with de­men­tia, the bur­den is not shared equally, ex­perts say.

“Women are at the epi­cen­tre of care­giv­ing as a whole, and Alzheimer’s care­giv­ing in par­tic­u­lar,” said Ruth Drew, di­rec­tor of fam­ily and in­for­ma­tion ser­vices at the Alzheimer’s As­so­ci­a­tion. “Even though two-thirds of peo­ple with Alzheimer’s are women them­selves, two-thirds of the care­givers are also women. So there are more wives car­ing for their hus­bands than the re­verse, more daugh­ters car­ing for par­ents than sons.”

“We see a lot of daugh­ters car­ing not only for their par­ents, but their in-laws,” she added.
Most ex­perts don’t an­tic­i­pate that chang­ing sig­nif­i­cantly. That’s be­cause, de­spite progress, women con­tinue to do a dis­pro­por­tion­ate amount of child care.

Although men have be­come more in­volved and taken on more re­spon­si­bil­i­ties at home, “it hasn’t been a sig­nif­i­cant con­tri­bu­tion and cer­tainly hasn’t kept pace with women’s in­creased
par­tic­i­pa­tion in the work force,” said Dr. Clif­ford Sheck­ter, a fel­low at the Clin­i­cal Ex­cel­lence Re­search Cen­ter, surgery res­i­dent and a co-au­thor of the es­say.

When it comes to car­ing for peo­ple with de­men­tia, “the num­bers are skewed strongly to­ward women, and it’s hard to imag­ine that by 2030 the num­bers will even out to 50-50,” said Ni­cholas Bott, a neu­ropsy­chol­o­gist and an­other co-au­thor who is also a fel­low at the Clin­i­cal Ex­cel­lence Re­search Cen­ter. “It shouldn’t be an un­spo­ken rule that this falls on cer­tain mem­bers of the fam­ily, but as of now, it still is fall­ing pri­mar­ily on the daugh­ters and fe­male spouses more than on men.”

So how old might your parents get to be?

Just found this interesting piece online, I think on CTV. It appeared in Septemer, but what's a few months when you're talking a century-plus?

So how old might your parents get to be?

Dutch researchers claim to have discovered the maximum age "ceiling" for human lifespan, despite growing life expectancy because of better nutrition, living conditions and medical care.
Mining data from some 75,000 Dutch people whose exact ages were recorded at the time of death, statisticians at Tilburg and Rotterdam's Erasmus universities pinned the maximum ceiling for female lifespan at 115.7 years.

Men came in slightly lower at 114.1 years in the samples taken from the data which spans the last 30 years, said Prof. John Einmahl, one of three scientists conducting the study.
"On average, people live longer, but the very oldest among us have not gotten older over the last 30 years," Einmahl told AFP.

"There is certainly some kind of a wall here. Of course the average life expectancy has increased," he said, pointing out the number of people turning 95 in The Netherlands had almost tripled.

"Nevertheless, the maximum ceiling itself hasn't changed," he said.

Lifespan is the term used to describe how long an individual lives, while life expectancy is the average duration of life that individuals in an age group can expect to have — a measure of societal wellbeing.

The Dutch findings come in the wake of those by US-based researchers who last year claimed a similar age ceiling, but who added that exceptionally long-lived individuals were not getting as old as before.

Einmahl and his researchers disputed the latter finding, saying their conclusions deduced by using a statistical brand called "Extreme Value Theory", showed almost no fluctuation in maximum lifespan.

Einmahl said however there were still some people who had bent the norm, like Frenchwomen Jeanne Calment who died at the ripe old age of 122 years and 164 days. Calment remains the oldest verified woman to date.

Extreme Value Theory is a brand of statistics that measures data and answers questions at extreme ends of events such as lifespan or disasters.

Einmahl said his group's findings will be submitted for publication in a peer review magazine "within the next month or so."

Where’s your head at when it comes to parent care?

Where’s your head at when it comes to parent care?

So I’m watching a younger friend in what from my vantage point looks like a life and death struggle of values and wills about how to deal with his failing parents.

His father’s now 89; his mother’s 86, and they’re both on the steep and slippery slide toward needing major attention and care. His father is clearly suffering from some form of dementia, seemingly deteriorating by the day. His slip of a mother is frail and just a week ago broke her elbow in a fall and tests show osteoporosis is going to be a major health issue.

My friend is very focused on his career and social status. He really does have what’s often called a ‘trophy wife’. And two still young kids who are keeners and work hard at school and all the other activities they’re pressed to take.

The more evident his parents’ ills, the more he dives into his work and presses ‘the wife’ into service—to deal with his parents, support them, take them where they have to be taken, and even cook for them.

I know for a fact that he really loves his parents, and feels his achievements are due to their full court press on focusing his life, education, and career. Yet right now, he’s avoiding them and working harder than ever.

I have no idea what’s happening in his head at the moment. I only see conflict: the deeply rooted love vs. the distance he’s keeping.

Something’s out of whack. I think his drive for career success is a bit of a refuge because maybe he doesn’t know how express his affections and caring for his parents.

Do you take a regular reality check of where you stand in your support of aging parents?


Minimize emotional pain among the elderly and aging


One always hopes that as medical practitioners, we will be able to focus our attention on the medical issues faced by seniors and help families cope with the fears, disappointments and tragedies that are faced by loved ones in the midst of what are often life-altering illnesses. In short, as physicians, we want to minimize emotional pain among the elderly and aging.

Throughout our initial medical training, and most often during post-graduate training programs, the primary focus in general is: what is the “best of medicine” and what does “evidence-based medicine” tell us about treatment decisions and their ultimate impact on health, well-being and, often, the likelihood of death? 

This is particularly the case in the care of the older adult – whether in geriatric medicine or eldercare.

What is often surprising and baffling, especially to younger physicians, is the situation where the core of what appears to be the challenge in care provision is negatively tinged by what might be called family “strife.” 

At times, however, a more appropriate term would be venomous, hateful actions—actions that ultimately will be destructive to the family fabric. This should not be 
surprising to anyone who has even a modest understanding and familiarity with the world of literature—whether limited to English works, or more broadly including European or other literature.

Those medical trainees who have worked with me have in all likelihood heard me either seriously or humorously say, “If I were king, all first degrees would be in English literature.” Or when there is a complex family dynamic playing out, I might say, “It’s King Lear—if you have not read it ever or lately, read it or read it again—it’s all there.”

Sometimes I feel like that great American comic Jimmy Durante, who was quoted as saying, “I have a million of them, a million of them,” referring to his often delectable jokes. According to an online biographical history, it has been said that “I’ve got a million of ’em” is what Durante (1893-1980) often said after telling a corny joke. Durante was credited with “I’ve got a million of ’em” in a 1929 newspaper story.

I say this when referring to complex family situations in which what appears to be the worst in human interactions seems to be playing out. Often the issue is related to money (or property), and if one is in a position to hear the story from all the parties, it often becomes clear that, for whatever reason, the pot has come to a boil at this juncture of life.

This is usually because the flame heating the water that’s not boiling has been on for what appears to have been many years. Most of us know of such stories, hopefully not in our own families, but it is unlikely that there is a family who is not familiar with a “Lear-like” scenario in someone close to them. 

Greed, jealousy, hurtful memories, mean-spirited personalities, events that occurred—sometimes decades earlier— that were never resolved or that left indelible scars are often the reasons cited for the enmity I have had the good fortune to observe that, on some occasions, especially when a parent, in particular, is dying, though it could be another relative, there is the possibility of repairing long held animosities and bringing long-estranged family members back together. 

It does not always succeed, but I have witnessed the monumental efforts of health-care staff—especially those in social work, nursing and medicine, although any and all of the health-care staff can be key—in bridging the emotional moat that often separates family members. It may not always work, but I believe it is always worth the effort.

Living with the result of lifelong family strife is often disabling, and the scars that occur and that are left can have long-lasting negative effects on people’s lives and their own abilities to have meaningful and binding relationships with their siblings and offspring.