Childless, unmarried baby boomers warned to prepare for future

Childless, unmarried baby boomers warned to prepare for future.
Dr. Mireille Norris says elder orphans are a growing problem across the country.
A new study is raising awareness about the problem of "elder orphans" — seniors who have no children, spouse or any other family member to care for them as they age.
The research comes on the heels of an incident earlier this week in North Carolina in which an 81-year-old cancer patient with no caregiver called 911 to ask someone to buy him some food.
Dr. Maria Torroella Carney, the chief of geriatric and palliative medicine at North Shore-LIJ Health System, recently completed a case study and literature review that she will be presenting to The American Geriatrics Society's Annual Scientific Meeting this weekend.

Continue reading “Childless, unmarried baby boomers warned to prepare for future”

Planning an elderly parent’s long trip

Planning an elderly parent's long trip requires thought and caution.

Your 80 year old mother wants to visit her sister who is older than she is and still lives in their small village in Scotland.

She says, "it is her 85th birthday coming up and if I do not visit her now I may never see her again". She is right and has a point; but the question is whether it is a good idea to go and if so alone or with someone? Flying has become a real chore and for elders it has many challenging components.

Continue reading “Planning an elderly parent’s long trip”

Exercise can help slow disease progression in elderly

Exercise can help slow disease progression in elderly.
Though being active won’t reverse dementia, buying ‘two or three years
of quality time is pretty significant,’ researcher says
Sure, physical activity is good for your body and mind. But why? And
how much of it do you really need?
Researchers examining the benefits of exercise are now getting down to
the nitty-gritty, finding new clues about how it may deter illnesses
such as dementia and cancer.
While there’s plenty of evidence to show that regularly breaking a
sweat may reduce the risk of Alzheimer’s disease and other forms of
dementia, much of that research has previously been conducted on
healthy individuals. But new studies presented this week at the
Alzheimer’s Association International Conference in Washington suggest
physical activity may also improve the lives of those who already have
the disease or are on the path to developing it.
One of those studies, conducted in Vancouver, showed “significant”
improvements after exercise in the cognitive function of participants
with mild vascular cognitive impairment, or “silent strokes,”
characterized by small lesions of damage in the brain.
Silent strokes tend to go unnoticed and don’t come with the typical
signs of stroke, such as facial drooping and slurred speech. But they
do tend to lead to these more severe, obvious strokes and increase the
risk of vascular dementia, where restricted blood flow to the brain
causes cognitive issues, explains researcher Dr. Teresa Liu-Ambrose,
an associate professor and Canada Research Chair at the University of
British Columbia and the Vancouver Coastal Health Research Institute.
Among the 71 participants in the study, ages 56 to 96, those who did
moderate-intensity walking for 60 minutes, three times a week, not
only showed better cognitive function, such as memory and attention,
after six months, compared with those in the control group, who were
not assigned regular exercise; their cognitive function also tended to
be better than at baseline, suggesting exercise may minimize the
progression of silent strokes.
Scans showed the brains of those in the exercise group were also more
efficient. Plus, participants who exercised reduced their body mass
index and blood pressure – which is not exactly surprising, but
supports the idea that cardiovascular health is vital to maintaining
brain health.
“The converging suggestion is that exercise … truly can [affect] the
very mechanistic level at which … people are developing the cognitive
issues,” Liu-Ambrose says.
That’s not to say you can reverse dementia with regular exercise, she
says. But it may halt its development. “To even buy yourself two or
three years of quality time is pretty significant,” Liu-Ambrose says.
Meanwhile, researchers in Alberta have found 300 minutes a week of
moderate to vigorous aerobic exercise is better than 150 minutes a
week for reducing the risk of breast cancer. In a study published in
the journal JAMA Oncology earlier this month, Calgary cancer
epidemiologist Dr. Christine Friedenreich and her team tested how
differing amounts of exercise affected body fat in 400 inactive
postmenopausal women, since body fat has previously been shown to
increase the risk of postmenopausal breast cancer.
One group was assigned to exercise 30 minutes for five days a week,
for a total of 150 minutes, which is the minimum recommended by
Canada’s physical activity guidelines. A second group was asked to
exercise for 60 minutes, three days a week for a total of 300 minutes.
Both groups were asked not to change their diets.
“A lot of the [physical activity] guidelines were actually developed
for cardiovascular disease prevention,” explains Friedenreich of
Alberta Health Services and the University of Calgary. “But for
cancer, we hypothesized that we might actually need a greater amount
of exercise.”
The researchers found both groups benefited from sticking to their
assigned exercise regimen for 12 months, but those who did a higher
volume of exercise had greater reductions in body fat. Previous
research by the team showed a dose-response to exercise, leading to
reductions in a series of biomarkers including body fat, endogenous
estrogen, insulin resistance and inflammation.
Friedenreich considers her latest findings empowering for many, as
physical activity is an inexpensive and non-invasive way of reducing
one’s risk of cancer. “A lot of people are quite concerned about
getting cancer and this is something they can do,” she says.

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A parent facing the loss of the driver’s license

One of the biggest challenges your parent may face is the impending or actual loss of the ability to drive, or the loss of the driver's license.

Some elders have enough insight to realize that driving is becoming too stressful or perhaps dangerous and gradually decrease the nature of their driving.

I have seen many who on their own cease to drive on major highways or do not drive after dark or when the weather is inclement. Some decide on their own to give up their car because owning it has become a hassle, what with the costs, the repairs, the parking issues depending on where they live.

I recall the challenge to my late father and the early indication of his cognitive decline when he began getting parking tickets for failing to move the car to the correct side the street when the city introduced alternate side of street parking for street cleaning. As often happened, he correctly moved the car, but failed to recall he did so and then moved it back to the "wrong" side of the street with the subsequent hefty parking fine.

The most challenging scenario that you may be called up to assist your parent is after a visit to a physician, such as a geriatrician for an assessment of cognitive decline where the issue of driving comes up, which is not expected by the patient and by the end of the visit, your parent discovers that his or her driver's license is either in jeopardy pending a more in-depth driving assessment. Or, of a report that is going to be sent to the licensing authority reporting significant cognitive impairment or dementia which in most jurisdictions results in the cancellation of the driving license. This often leads to outrage, fury or disbelief on your parent's part as they try to dissuade the doctor, or put the blame on you for taking them to the appointment.

It is not easy to deal with this, but with time and repeated explanations by the doctor as to the necessity of following the law the anger may wear off. Moreover, if you do a good accounting of the cost of keeping the car, the cost of insurance, repairs and parking, it often turns out that the money saved will more than pay for any taxi trips required by the person to do what they were doing with their car. Many local taxi companies happily create accounts with elders that avoids having to pay for each ride and many provide assistance with walking devices for example. It is a challenge, one that occurs often, but will usually wane in time–it cannot be avoided but can also be dealt with in a supportive and compassionate manner.

When it comes to personal health care, buyer beware!

We are often mesmerised by TV personalities when it comes to our health care.

People just love to hear about their health and, in fact, this has been going on for as long as there was anything akin to "snake-oil" sales people. If you look back through the history of humanity there seems to have been from the earliest of days someone who was promising something akin to health, longevity, sexual prowess or perpetual good looks always of course for a fee.

With the advent of the printing press in the 15th century it became so much easier for those selling their health care products to do so in a mass production manner. With the sophistication of the printed word, the development of mass media such as newspapers and magazines, the public became bombarded with advertising for potions and lotions, pills and balms for hair, skin; for one's innards and one's outards, often with only the loss of money. At times, however, what was being sold by the quacks of the says had dangerous ingredients including arsenic or lead, for example.

In the modern era, these inducements to the benefits of medicine's miracles have moved from the radio airwaves to the television screen and now online. The public seems to eat up those personalities who with great charm and wit and often with what appear to be very credible medical or other health care credentials will do their best to convince the viewing public that if they would try product a or b or c–their problems would be solved. We see retired athletes promoting pills and balms for painful joints and people in white coats telling you what toothpaste you should used and movie stars talking about "laxation" which is the code word for constipation.

My advice is to take all the recommendations with a very low grain of salt (in keeping with the much touted low salt diet–physical and mental). Even people with academic medical positions whose name recognition is as great as the iconic 1939 movie with Judy Garland might not  be always accurate or reliable in their claims, according to some of the watch-dog critics of the media.

So when it comes to personal health care, buyer beware!

Choose the right substitute decision maker (SDM)

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 substitute decision maker (SDM), that, for example, the parent "would not want any heroics" if developing a terminal illness.

The reality is that it 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.


So a number of suggestions:

1) make sure your SDM can honestly and emotionally carry out your wishes;

2) try to be specific about those life-prolonging interventions that for sure you would not want–such as a permanent feeding tube if you are not conscious enough to appreciate food or those around you;

3) make sure in addition to writing a document, to have the conversation with those you decide you would like as your SDM;

4) get advice from a trusted doctor and lawyer as what you might want to include and how to frame a document if you want to write one.

Retaining mobility by staying active: key goal for all elderly

Those of us who have “been around” are aware that the quest and acknowledgement of the benefits of exercise for people of all ages is not new.

I recall a wonderful program in Scotland where I studied medicine, with a group leader standing on a centrally placed small stage surrounded by literally hundreds of seniors, who led them through a routine of dance and movement steps accompanied by very compelling Scottish country music themes. The compelling musical themes and beat and the “group” involvement resulted in an outstandingly successful exercise program.

Highly beneficial and “fun”
The important thing for North America’s senior population is the understanding that exercise, whether walking, running, dancing, biking, swimming or cross-country skiing, is not just for the young, but for all of us throughout a lifetime. Although the nature of the exercise might change, the importance of it in terms of sustained health benefits continues. It should be a key goal for all elderly people.

According to a number of recent medical journal reports, exercise and physical activity are important for older individuals as part of the recipe for remaining physically and mentally healthy and active. One study reported in the venerable Journal of the American Medical Association (JAMA) that “…limited mobility is a tell-tale sign of functional decline in ageing patients”.

Evidence is compelling
The key to healthy ageing and independence therefore lies in retaining one’s mobility, according to a US study published in JAMA, authored by Cynthia Brown and Kellie Flood from the University of Alabama. Their review “confirmed that increased physical activity and exercise are extremely important for healthy aging…… A decline in mobility seems to quickly lead to an across-the-board decline, including the routine activities of daily living.”

We know from other studies that heart and brain health and function are also enhanced by continuous physical activity. According to one review of their research, “Brown and Flood recommend that physicians should ask their senior patients two questions: whether they have difficulty climbing up 10 steps or walking a quarter of a mile; and because of health or physical reasons, have they modified the way they do these two things. Any modification of a task such as climbing 10 steps raises a red flag, said Brown. However, if identified early enough, appropriate corrective measures can be taken.”

Some amount is better than no amount
To complement this recent addition to our knowledge and understanding of the benefits of exercise and physical activity in the older population is a recent study from Denmark that demonstrates that moderate exercise is an even greater motivation for a healthier lifestyle than more intensive exercise. This is important to understand for seniors and those who promote and organize exercise programs for seniors who often still believe that the goal should be maximization of efforts. Such inordinate exercise goals are often rejected by many elders who therefore drop out of the programs or sometimes unfortunately sustain injuries from the excessive intensity of the exercise effort.

To paraphrase an overused saying- “just say yes to exercise”.

Hearing the same thing over and over: be patient and listen

In my geriatric practice one of the complaints of families is how often their loved one tells them the same thing over and over.

They use that symptom as evidence of cognitive decline – the inability to recall what was said previously. This symptom, although common and often indicative of cognitive functional decline, is also a manifestation of the common human propensity to focus on the narrative of one’s life and to recount it as part of one’s process of self-identity and validation. But, what is the separation between the normal attribute of recounting the narrative of one’s life and the pathology of cognitive impairment that fails to recognize the recent repetition of that story to a loved one?

The importance of stories

The telling of stories is important. In normal relationships and conversations, we spend much effort recounting life events to others. The tendency to be repetitive is universal, as anyone in a long-standing relationship will admit. If the topics of conversation between spouses are tracked over time, we would probably find the same topics repeated in one form or another repeatedly.

For instance, one partner in a marriage usually knows the political views of the other. When the topic comes up in a social setting, they often patiently listen to their partner express their views to presumably a new audience (although this is not always the case) with rare rude interruptions such as: “We’ve heard your views before. If you don’t have a new one, just stop talking.”

The challenge for those facing the extremes of repetition by a loved one who is experiencing cognitive impairment is knowing what to do. Family members usually learn to avoid interrupting the recounting of an event with “You told me already” or “I know,” as this may cause conflict with a denial that the conversation has taken place.

In the context of normal aging, family members may find that the retelling of one’s life narrative frequently occurs. This is one way we validate our lives, which is important as the past becomes increasingly important compared to the limited options for the future. This human need to tell our narratives is reflected in the interest by many in writing autobiographies and memoirs and in reading them. Being patient with our narrative-telling loved ones is important to them and ultimately to us.

Be patient and listen

The best recommendation I can make about this inevitable process is to find ways to be patient with your loved one and accept that even though you have heard the story before, acknowledging it and expressing an interest in it is helpful and even therapeutic to both of you, but especially to that aging loved one.

Video: Dealing with Alzheimer’s and Dementia

Parenting Your Parents co-author Dr. Michael Gordon was a recent guest on the national Canadian network show, Canada AM.

Here is a clip of that segment, which includes two other prominent guests who are dealing with parents who have advancing Alzheimer's and dementia.

We think you'll find it interesting and informative.

Canada AM: Dealing with Alzheimer's and dementia









Eldercare givers need clarity on rights vs. duties

What rights and duties must eldercare givers consider when decisions must be made on behalf of their aging loved ones? As a recent guest on the podcast, Dr. Michael Gordon explained how eldercare givers should think about rights versus duties when it comes to formally acting for aging loved ones.

Substitute decision makers– or, those with power of attorney– have a lot to think about, act upon, and decide. Understanding the difference between their right and duties is an important factor. Listen to this 25 minute podcast here as he explains what you may have to consider.

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