News You Can Use
- July 2018: Are older adults at risk during the summer months?
The heat and sun can be dangerous for people of all ages, and cause heat-related illnesses and other health issues, such as vision problems. Here are some general tips to help ensure a safe, healthy and fun summer.
Stay hydrated – Older adults are more susceptible to dehydration because as the body ages, there is a decrease in its ability to conserve water. Drink plenty of cool water, clear juices, and other liquids that do not contain alcohol or caffeine.
Talk to your doctor - Check with your doctor to be sure any medications you are taking will not be affected by higher temperatures, especially if you do not have air- conditioning in your home.
Stay cool - Do not try to exercise or do a lot of activities (including household chores) when it is very hot and/or humid. Try to keep your home as cool as possible by closing window blinds, shades or curtains during the hottest time of day, and using an air-conditioner. If you do not have an air-conditioner, go somewhere that is air-conditioned. Read a book or magazine at the library, walk around in indoor malls, watch a movie at the theater, or meet your friends at the senior center.
Protect your eyes - Vision loss can be common among older adults, and too much exposure to the sun can irritate eyes and cause further damage. Wear UV-blocking sunglasses to protect your eyes from harmful ultraviolet (UV) rays and to help preserve your vision.
Use sunscreen and wear a hat - Everyone, young and old, should wear sunscreen with a sun protection factor (SPF) of 15 or higher when outdoors to protect against sunburn and reduce the risk of skin cancer. A wide-brimmed hat can also help protect your skin from the sun.
Outdoor activities - If you enjoy the outdoors, wear loose, light-colored clothing. Consider getting outdoors earlier in the morning or later in the evening when the sun is not at its peak.
Too much sun or heat can cause heat-related illnesses such as: heat cramps, which is painful tightening of muscles in your stomach, arms or legs; and heat exhaustion where you feel dizzy, nauseated, weak and thirsty and may sweat a lot or have a rapid pulse rate. If you experience any of these signs, find a cool place, rest and drink water. Contact your doctor if you do not feel better soon.
Heat stroke is a medical emergency. Signs of heat stroke include fainting, confusion, agitation, dry flushed skin, not sweating, changes in pulse to strong and rapid or slow and weak, and a rise in body temperature (to more than 104 degrees Fahrenheit). Seek immediate medical attention.
If you live alone, have a friend or relative call to check on you during a heat wave. A heat wave is a period of excessively hot weather, which may be accompanied by high humidity.
The summer is a wonderful time of the year. Be prepared, take proper precautions, and enjoy the season with your family and friends.
- June 2018: What is the Protective Services Program?
22 Aging Services Access Point (ASAP) agencies have been designated by the Executive Office of Elder Affairs to operate the Protective Services (PS) program throughout Massachusetts. PS staff from these local agencies respond to reports of abuse and neglect of people age 60 and older living in the community. Staff investigate allegations of neglect, physical, sexual and emotional abuse, as well as financial exploitation of older residents. During state fiscal year 2017, 30,739 reports of abuse and neglect were received, of which 9,799 cases were confirmed.
Elder Abuse Reports can be filed 24 hours a day by phone at (800) 922-2275. For more information visit https://www.mass.gov/report-elder-abuse
To report abuse of a person with a disability under the age of 60, call the Disabled Persons Protection Commission (DPPC) at (800) 426-9009. To report abuse of a person in a nursing facility or hospital, call the Department of Public Health (DPH) at (800) 462-5540. For any age or setting, call 911 or local police if you have an emergency or life-threatening situation.
Limited conservatorship and guardianship services are available for older residents who require assistance in managing their financial and/or personal affairs and who are at risk of further abuse without a guardian. Through local ASAP/PS agencies, trained staff and volunteers operate the Money Management Program to help older adults who need assistance managing their finances.
- May 2018: Is there life after retirement?
Retirement is becoming an active phase of life with many older adults devoting at least some of their time to causes and interests that have previously taken a backseat to careers or family obligations.
With many charities and non-profits in need of help, there is no shortage of volunteer opportunities for those willing to donate their time and efforts during retirement. If you are not sure where to begin, start small; try short stints, maybe an hour per week reading to children in the hospital, or 2 hours in a food pantry, or one afternoon in a library.
You can also capitalize on your background. When you meet with an organization, mention the skills you used in your career. Some opportunities may require extra education that may simply be viewing a training video or a short training session with experienced volunteers.
There are many benefits to volunteering. Studies have connected volunteering with reduced depression and higher brain activity; it is even correlated with living longer. Volunteering keeps the brain active, which contributes to a person’s cognitive health. The National Institute on Aging reported that participating in activities that are meaningful and productive may lower the risk of dementia and other health problems in older adults.
Giving back to society is making a difference in the lives of others. Helping others is a significant source of happiness. Retirees who are active in charities also have a strong sense of purpose and higher self-esteem. Volunteering is also another opportunity to meet people and to make new friends.
OCES’ Volunteer page, https://www.ocesma.org/volunteer/, provides more information on volunteering and includes links to volunteer opportunities. You could become a mentor, coach or companion to people in need, or contribute your job skills and expertise to community projects. All OCES volunteers receive guidance and training to make a contribution that suits their talents, interests and availability.
Volunteering is best when you are doing something you enjoy. It is never too late to get started. Whether you just retired or are in your later years, there is an opportunity out there for you.
- April 2018 - Is Depression Part of Aging?
Aging can bring a set of new challenges. Some of these challenges may include medical problems, the loss of loved ones, or other stressful life events that can contribute to depression as we age. Although most cases of depression are diagnosed in young adults, depression can occur at any age.
Depression may go undiagnosed or misdiagnosed in some older adults. Some people may have less obvious symptoms or some may not be willing to talk about their feelings. Some signs of depression are often mistaken for normal behavior. It is important to know the signs and seek help if you are concerned about yourself or a loved one. Here are some possible signs of depression.
- Sad, anxious
- Loss of interest or pleasure in hobbies and activities
- Feelings of hopelessness, pessimism
- Feelings of guilt, worthlessness, helplessness
- Decreased energy, fatigue, being “slowed down”
- Difficulty concentrating, remembering, making decisions
- Difficulty sleeping, early-morning awakening, or oversleeping
- Appetite changes and/or unintended weight changes
- Thoughts of death or suicide, suicide attempts
- Restlessness, irritability
It is normal to feel uneasy, stressed, or sad temporarily, but depression is different from sadness – it can last longer and cause other issues. Certain individuals are at a higher risk for developing depression. If you are an older adult, you may be at a higher risk if you:
- Are female
- Have a chronic medical illness, such as cancer, diabetes or heart disease
- Have a disability
- Sleep poorly
- Are lonely or socially isolated
The good news is that in most cases, depression is treatable. The right treatment may help improve your overall health and quality of life. With the right treatment, you may begin to see improvements as early as two weeks from the start of your therapy. Some symptoms may start to improve within a week or two, but it may be several weeks before you feel the full effects. Seek help from your doctor to help identify your best options.
There are other ways to combat depression. Spending time with friends and family, making new friends, taking up new hobbies and getting active are a few suggestions. These suggestions are not just for those who may be depressed, but for everyone.
Many older adults are taking charge of their lives and not watching the world pass them by. Many towns have centers with activities and events that are open to all.
Leave depression behind, rekindle your self-esteem, overcome social isolation and restore hope and happiness to your life. As we continue to live longer, it makes sense to ensure we are living fulfilling lives.
- March 2018 : Can I get help preparing my taxes?
There are a variety of options to help you prepare and file your tax return.
The IRS Volunteer Income Tax Assistance program provides free preparation for filers with incomes of up to $52,000. The Let Us Help You page on the Internal Revenue Services’ website helps answer most tax questions and can help you find a tax preparer. Anyone with a Preparer Tax Identification Number (PTIN) can prepare a tax return for a client. However, tax return preparers have differing levels of skills, education and expertise. The IRS searchable directory is intended to help you with your choice by providing a listing of preparers in your area who currently hold professional credentials recognized by the IRS or who hold an Annual Filing Season Program Record of Completion. A trusted tax professional can provide helpful information and advice.
The AARP Foundation Tax-Aide is a program that offers free tax assistance and preparation for low-to moderate-income taxpayers, at more than 5,000 locations nationwide. To find a location near you, visit the AARP website.
This year the tax filing deadline is April 17, 2018. The reason for the date change is that April 15th falls on a Sunday and April 16th is Emancipation Day, a legal holiday in the District of Columbia. Under the tax law, legal holidays in the District of Columbia affect the filing deadline across the nation. In 2018, 155 million individual tax returns are expected to be filed.
It is important to note that even though the new tax bill, signed by the President, went into effect on January 1, 2018, most Americans will not see changes to their tax returns until they file their 2018 taxes.
During tax season, thousands of people have lost millions of dollars and their personal information to tax scams. Scammers use the regular mail, telephone, or email to scam individuals, businesses and tax professionals. Remember, the IRS does not initiate contact with taxpayers by email, text messages or social media channels to request personal or financial information. The IRS initiates most contacts through regular mail delivered by the United States Postal Service. More information about scams can be found on the IRS website including what to do if you believe you are a victim of a scam.
Individuals with diabetes are more likely to develop heart disease and have a greater chance of a heart attack or a stroke. Additionally, those with diabetes increase their chances of having high blood pressure or high cholesterol. You can protect your heart and health by managing your blood glucose (blood sugar) as well as your blood pressure and cholesterol.
A family history of diabetes can significantly increase a person's risk of developing the condition. There are two main types of diabetes; type 1 diabetes and type 2 diabetes. With diabetes, your blood glucose levels are too high and glucose comes from the foods you eat. Insulin is a hormone that helps the glucose get into your cells to give them energy. With type 1 diabetes, your body does not make insulin. With type 2 diabetes, the more common type, your body does not make or use insulin well.
You can also have prediabetes. Most people with prediabetes don't have any symptoms. Prediabetes means that your blood sugar is higher than normal but not high enough to be called diabetes. Having prediabetes puts you at a higher risk of getting type 2 diabetes. If you are concerned about your health or the health of a loved one, make an appointment to see your doctor. There are tests your doctor can prescribe to detect heart disease, make a diabetes diagnosis and determine if you are at risk for diabetes.
Here are a few tips to prevent or delay getting diabetes. Be sure to check with your doctor before starting any program.
- Maintain a healthy weight
- Follow a healthy eating plan
- Get regular exercise
- Don’t smoke
- Get a good night’s sleep
- Manage your stress
February is Heart Health Month. Heart disease is the leading cause of death for both men and women in the United States. The good news is that it is also one of the most preventable. Making heart-healthy choices, knowing your family health history and the risk factors for heart disease, having regular check-ups and working with your physician to manage your health are all integral aspects of saving lives from this often silent killer. Even making small changes in your habits can make a difference.
The following links provide more information on heart health and diabetes:
- January 2018: Are a lot of eligible elders not getting food stamps?
Q: Are a lot of eligible elders not getting food stamps?
A: Yes. More than 40% of low-income elders eligible for the federal Supplemental Nutrition Assistance Program (SNAP), commonly known as “food stamps,” are not on the program.
SNAP provides food and nutritional benefits to one out of every nine people in Massachusetts, including elders and people with disabilities. A recent study by Mass General Hospital found that participation in SNAP reduced annual health care costs by $1,400 per person per year. Seniors with poor nutrition are at greater risk for health conditions like chronic heart disease, depression, diabetes, and asthma. Another study showed that access to SNAP benefits reduces the likelihood of admission to a nursing home by 23%.
The SNAP program is also good for our Massachusetts economy. The $1.2 billion in SNAP benefits spent annually at grocery stores, supermarkets, and farmers markets throughout the Commonwealth creates an economic stimulus of around $2 billion into the local economy. An additional $1 billion in SNAP spending would generate 8,900 full-time jobs.
Each October, the federal government makes adjustments to SNAP benefits. This year SNAP benefit levels were slightly reduced due to the drop in the consumer price index for food costs. The minimum benefit for one person decreased from $16 to $15, and the maximum benefit for one person fell from $194 to $192.
SNAP advocates in Massachusetts have been working hard to close the “SNAP Gap,” which is the number of people who are eligible for SNAP—but are not on the program. Over 150,000 adults in Massachusetts age 60+ receives SNAP, which is roughly 10% of the elderly population. Nearly half (48%) of Massachusetts SNAP households include members who are elderly, or have severe disabilities.
But according to the Massachusetts Law Reform Institute and confirmed by a data match conducted by the Baker Administration, in 2016 there was a “SNAP Gap” of over 600,000 people who were on Medicaid, but not on SNAP---including 106,000 elders--most with incomes below 100% of the federal poverty level.
Under federal rules, elderly or disabled people can claim out-of-pocket medical expenses as a deduction to raise their SNAP benefit—but the majority of elder and disabled SNAP recipients in the Commonwealth who qualify for this medical deduction don’t use it. In addition to insurance and any hospital or doctor costs, they can claim out-of-pocket costs like vitamins, eye glasses, hearing aids, over the counter” medicine chest items, and mileage from driving to doctors and pharmacies. Elders can also use private or public housing costs, utility costs, and dependent care costs to raise their SNAP benefits.
To find out how to apply for SNAP benefits, call the state Department of Transitional Assistance at 1-877-382-2363, If you want to appeal a SNAP decision, local Legal Services offices may be able to provide advice or representation. Go to http://www.masslegalhelp.org/
- November 2017: Do elders or seriously ill have protections against utility shut-offs?
Yes. Households in Massachusetts in which all adult members are age 65 or older, whether there is a financial hardship or not, are protected against utility and phone shut-offs. “Utility” refers to the gas or electric service to your home, or your landline telephone. Cell phones and heating oil is not covered by utility law. Most oil companies require payment at delivery time. Be sure to ask all fuel companies if they offer a “senior citizen discount”.
Every year from November 15 to March 15, gas and electric companies cannot shut off your service if you are unable to pay your utility bills and if the service is used to heat your house. This moratorium does not apply if service was shut off for non-payment before November 15.
When all adult members of the household are age 65 or older, it is difficult for a company to shut off your utility service. To protect yourself, make sure that everyone 65 or older in your household has provided your utility companies with written information about their age.
If all the members of your household are not 65 or older but your child, or someone else in your household has been diagnosed as having a “serious” or “chronic” condition and you cannot afford to pay your bills because of financial hardship, the utility companies cannot shut off your service. The illness or condition must be verified by a medical doctor, nurse practitioner, or physician’s assistant. If a shut-off threat is on very short notice, your utility company has to accept a phone call from a doctor, but a follow up written letter will be needed within 7 days of the call. The utility company must keep service on for three months once learning that a customer is “seriously ill.” If your illness is “chronic,” you can receive six months protection. Ask your doctor’s office to fax their letter directly to the utility company, and to give you a receipt, as you may need proof to show your utility months later.
If you cannot afford to pay your utility bill and there is an infant under the age of one living in your house, the utility companies cannot shut off your service. 4To get this protection, you must submit a financial hardship form (obtained from the utility company) and provide proof of your child's age, through a birth certificate, letter, or official document from a physician, hospital, government agency, clergyman, or religious institution.
The law also protects grandparent-headed households, as long as the only people under age 65, living in the household, are minors (under age-18).
The Department of Public Utilities (DPU) is unlikely to approve a shut-off, especially if you are trying to make a good faith repayment effort. But if you own your home, a utility might try to put a “lien” or “attachment” on your home, to collect what is owed when your home is sold.
For phone land lines, the same “over 65” protections apply, as well as the “serious” illness protections. For phone service, only a doctor or clinician in a doctor’s office can certify illnesses. The same phone call from a doctor rule applies if a shut-off is imminent, with a follow up written illness letter within seven days. A doctor’s letter can be renewed two times, totaling 90-days protection.
The phone company will not shut-off service if the customer asks for “personal emergency protection,” demonstrates that he or she cannot pay the bill, and that phone service is necessary to protect the health or safety of a member of the household. An elder with an emergency alert button for example, could ask for personal emergency protection. If the phone company denies the protection, the customer can appeal to the Department of Telecommunications and Energy (DTE). Ask your gas, electric or phone company to send you an elder household protection form, or a serious illness/chronic condition, or personal emergency protection form.
Even with these shut-off protections, you are still responsible for paying off your bill, and you will be charged interest for late payments.
If you are facing a utility shut-off, contact the Attorney General’s Consumer Hotline at (617) 727-8400. To read more on your shut off rights, go to: http://www.masslegalhelp.org/special-protections-against-shut-offs.
- October 2017: What are the major lung conditions elders should know about?
Diseases of the lung are almost as common as breathing air. Lung problems that are common among older adults include: chronic obstructive pulmonary disease (COPD), pneumonia, lung cancer, and asthma.
Lung cancer is the leading cause of cancer death in the U.S. and the second most common cancer among both men and women. Almost 15.7 million people have been diagnosed with COPD, which is the third leading cause of death. The Centers for Disease Control estimates that 18.4 million American adults currently have asthma. The American Lung Association estimates that in 2016 there were 555,374 adults in Massachusetts diagnosed with asthma, 307,924 people with COPD and 4,302 people with lung disease.
COPD is a disease that makes it hard to breathe. It can be caused by smoking, secondhand smoke, air pollution, chemical fumes, or even dust. There are two types of COPD: emphysema and chronic bronchitis. Shortness of breath is one of the most common symptoms of COPD and may even occur when you are resting. People who have COPD may feel like their chest is so tight that they cannot breathe and they may cough a lot. COPD can also cause wheezing. COPD develops slowly and worsens over time. COPD can lead to strain on the heart, which can result in swollen ankles, feet, or legs. In advanced stages of COPD, people can have blue lips because they do not have enough oxygen in their blood. In older adults, COPD can sometimes be confused with asthma.
Although there is no cure for COPD, there are measures you can take to help you feel better. If you are a smoker who quits, you may breathe more easily and add years to your life. Your doctor might prescribe an inhaler, a special exercise program, breathing techniques, or extra oxygen. People with COPD should protect themselves by getting shots to prevent the flu and pneumonia.
Pneumonia is an infection of one or both of your lungs and people with pneumonia may have a fever, chills, trouble breathing, and a cough with mucus. Pneumonia can make you feel very tired, or sick to your stomach. For some older adults, pneumonia can be a serious problem that takes 3 weeks or longer to overcome. Pneumonia is most common in the winter months. It is caused by germs like bacteria, viruses, and fungi. If you smoke or drink a lot of alcohol, your chance of getting pneumonia increases. You can come in contact with germs that cause pneumonia during a hospital stay or in a nursing facility. To test for pneumonia, your doctor can do a physical exam, take a chest x-ray, or analyze a blood sample. Mild pneumonia can sometimes be treated at home with medications to fight the infection. Sometimes pneumonia must be treated in the hospital. To prevent pneumonia, don’t smoke, get a shot for the flu and pneumonia, wash your hands often with soap and water, and cover your nose and mouth when you sneeze or cough.
Lung Cancer – Some common signs of lung cancer include:
- A cough that does not go away and gets worse over time
- Constant chest pain
- Coughing up blood
- Problems with breathing, wheezing, or hoarseness
- Repeated problems with pneumonia
- Swelling of the neck and face
- Loss of appetite or weight loss
These symptoms may be caused by lung cancer or other health problems. Do not wait until you feel pain. See your doctor right away. Studies show that starting treatment for lung cancer early leads to better results. Treatment for lung cancer is based on the type of lung cancer and whether or not it has spread to other parts of the body. It also depends on the individual’s general health.
Asthma is a condition in which your airways narrow and swell and extra mucus is produced. This can make breathing difficult and trigger coughing, wheezing and shortness of breath. For some people, asthma is a minor nuisance. For others, it can be a major problem that interferes with daily activities and may lead to a life-threatening asthma attack. Asthma cannot be cured, but its symptoms can be controlled. Many people live long, healthy lives with asthma. Some blood pressure medications, like beta-blockers or aspirin, can interfere with your asthma treatment or make asthma worse. Your doctor can help you develop a plan to manage your asthma.
For tips to keep your lungs healthy, go to http://www.lung.org/lung-health-and-diseases/protecting-your-lungs/
- September 2017: Are there any strategies for preventing or slowing cognitive decline?
Most studies are cautious about answering this question. One recent report by the Lancet Commission on Dementia Prevention and Care concluded that one-third of dementia cases could potentially be prevented through better management of lifestyle factors, such as smoking, hypertension, depression, and hearing loss over the course of a lifetime.
Research is complicated by the fact that older adults can be affected by different forms of cognitive decline. Researchers classify three basic kinds of cognitive decline: normal age-related cognitive decline; mild cognitive impairment; and clinical Alzheimer’s type dementia. The number of Americans over age 70 with dementia and mild cognitive impairment is rising.
Dementia-related costs exceed those of heart disease and cancer. Some decline in cognition with aging is considered normal or inevitable, particularly for people past the age of 60. Investigators report that there is some evidence that three types of interventions have shown “encouraging, although inconclusive, evidence” of slowing or delaying the onset of age-related cognitive decline, mild cognitive impairment, and Alzheimer’s. The three interventions are: cognitive training, blood pressure management, and increased physical activity.
In 2015, the National Academies of Sciences, Engineering, and Medicine (NASEM) began a project examining the evidence on interventions for preventing, slowing, or delaying the onset of these cognitive impairments. In their report, Preventing Cognitive Decline and Dementia: A Way Forward, researchers highlighted three interventions, all of which showed mixed results:
- Cognitive training; Cognitive training is defined as a “ broad set of interventions, including those aimed at enhancing reasoning (like problem solving), memory, and speed of processing (like identifying visual information on a screen).” Structured training exercises may or may not be computer based. Some evidence suggests that cognitive training can improve long-term cognitive function and maintenance of independence in instrumental activities of daily living, like shopping and cooking, in adults with normal cognition. Researchers say results from cognitive training are “inconclusive, but encouraging” as a tool for delaying or slowing age-related cognitive decline. There is no evidence, however, that commercial, computer-based “brain training” applications are beneficial for long-term cognitive effects.
- Blood pressure management: There are many links between cerebrovascular disease, (cerebrovascular disease is a condition developed due to complications with the blood vessels that supply blood to the brain) Alzheimer’s Disease and dementia. A majority of dementia patients show signs of cerebrovascular disease. Improved control of blood pressure in patients with hypertension has been linked to a decline in stroke incidence and mortality, and it is plausible that blood pressure management would also reduce the risk of dementia and cognitive decline. Researchers say there is data to suggest that managing blood pressure for people with hypertension, particularly during midlife (ages 35 to 65 years), offers encouraging evidence for preventing, delaying, and slowing Alzheimer’s type dementia, but the results are still “inconclusive.”
- Increased physical activity: There are many well-documented health benefits of increased physical activity which has consistently been identified as one of the modifiable risk factors that could have the greatest impact on rates of cognitive impairment and dementia. Research suggests increased physical activity may be effective in delaying or slowing age-related cognitive decline. Indicators seem promising for resistance training and aerobic exercise, and vitamin B12. NASEM concluded that increased physical activity also provides encouraging but inconclusive evidence of delaying or slowing age-related cognitive decline. But there is not enough evidence to conclude whether increasing physical activity prevents, delays, or slows mild cognitive impairment, or has an impact on Alzheimer’s type dementia.
NASEM is optimistic about the future of research in this “exciting area of discovery.” Priority areas for further study on slowing cognitive impairments include: new anti-dementia treatments; treatments for diabetes and depression; dietary interventions; lipid-lowering treatments; sleep quality interventions; social engagement, and vitamin B12 plus folic acid supplementation. While research has shown promise, the results about slowing or preventing cognitive decline are "inconclusive", and research stresses that these interventions are all in need of further study.
- August 2017: Are there tips to make a home safe for people with Alzheimer’s?
Yes. If you are providing in-home care for a person with Alzheimer's disease, the National Institute on Aging has created a 44 page booklet with a checklist to make each room in your home a safer environment.
Alzheimer's progresses differently in each person, but here are some general principles that may be helpful:
- Think prevention. It is very difficult to predict what a person with Alzheimer's might do. Even with the best-laid plans, accidents can happen. Therefore, checking the safety of your home will help you take control of some of the potential problems that may create hazardous situations.
- Adapt the environment. It is easier to change the home environment than to change some behaviors. You can decrease any hazards and stressors that accompany these behavioral and functional changes.
- Minimize danger. A safe environment can be a less restrictive environment where the person with Alzheimer's disease can experience increased security and more mobility.
Your first question may be: Is it safe to leave a person with Alzheimer’s alone? This issue needs individual evaluation:
- Does the person with Alzheimer's become confused or unpredictable under stress?
- Do they recognize a dangerous situation, like a fire?
- Do they know how to use the telephone in an emergency?
- Do they wander or become disoriented?
- Do they become agitated, depressed, or withdrawn when left alone for any period of time? Talk this over with your doctor or other health care professionals to assist you as the symptoms of the disease change.
Complete a safety check in every room in your home. You may want to set aside a special area for yourself that is off-limits to anyone else and arrange it exactly as you like. A safe home can be less stressful for the person with Alzheimer's and for you. Enlist the help of your local Alzheimer's Association for suggestions. Here are some general tips:
- Display emergency numbers and your home address near all telephones.
- Use an answering machine when you can’t answer phone calls. Turn ringers on low to avoid distraction and confusion. Put all portable and cell phones and equipment in a safe place so they will not be easily lost.
- Install smoke alarms and carbon monoxide detectors in the kitchen and sleeping areas.
- Install secure locks on all outside doors and windows.
- Hide a spare house key outside in case the person with Alzheimer's disease locks you out of the house.
- Avoid the use of extension cords, and tack them to baseboards to avoid tripping.
- Install one handrail on stairways that extends beyond the first and last steps. Use carpets or safety grip strips on stairs. Put a gate across the stairs if the person has balance problems.
- Keep medications (prescription and over-the-counter) locked. Label each bottle of prescriptions with the person's name, name of the drug, drug strength, dosage frequency, and expiration date. Keep alcohol in a locked cabinet.
- Avoid clutter, throw out or recycle newspapers and magazines regularly. Keep all areas where people walk free of furniture. Keep plastic bags out of reach to prevent choking or suffocation.
- Remove all guns and other weapons from the home or lock them up. Install safety locks on guns or remove ammunition and firing pins.
- Lock all power tools and machinery in the garage, workroom, or basement.
For a room-by-room list of more Alzheimer’s home safety tips from the National Institute on Aging, click here https://www.nia.nih.gov/alzheimers/publication/home-safety-people-alzheimers-disease/home-safety-room-room
- July 2017: Is sciatic nerve pain something I just have to put up with?
No, sciatic pain does not have to be a chronic condition. The medical condition called “sciatica” is a major cause of work absenteeism and a major financial burden to both employers and our health care system. Your sciatic nerve is the largest nerve in your body. It begins as a bundle of nerves in your lower back and passes through your pelvis and down the back of each thigh. In the back of the thigh, the sciatic nerve splits into two smaller nerves called the tibial nerve and the peroneal nerve. The sciatic nerve carries impulses from nerves in your lower back to the muscles and nerves in the buttocks, thighs, and lower legs.
Sciatica is a symptom. It consists of leg pain, which might feel like a bad leg cramp, or a ‘pinched nerve’. The pain can shoot down your leg to your foot, making sitting or standing very painful. Sciatica can occur suddenly, or develop gradually. You might feel a numbness, or a burning or tingling ("pins and needles") sensation in your legs or toes.
The term ‘sciatica’ has come to be used to describe any pain felt in the leg along the length of the sciatic nerve. The incidence of sciatica is related to age. It is rarely seen before the age of 20, and it peaks in the fifth decade and declines thereafter. Between 13% and 40% of Americans will have sciatica sometime in their life. The nerve might be pinched inside or outside of the spinal canal as it passes into the leg. Sciatic pain seems to involve a complex interaction of inflammatory, immune and pressure-related elements. Symptoms like paralysis or incontinence indicate a more serious problem like nerve damage or a disease, and should be reported immediately to your primary care doctor.
The exact nature of the relationship of sciatica to disc, nerve, and pain is not yet certain. For some people, the pain from sciatica can be severe and debilitating. For others, the pain might be infrequent and irritating, but has the potential to get worse. A herniated or ‘slipped disc’ is the most common cause of sciatica, but there is no one basic cause. Not everyone’s spinal disks age at the same pace. Spinal disks lose their elasticity over time as they lose fluid and become brittle and cracked. These changes are a normal part of aging.
Another cause can be a small muscle deep in the buttocks that becomes tight or spasms, which puts pressure on the sciatic nerve. Narrowing of the spinal column, or a vertebra that is out of line, can affect the sciatic nerve. Fortunately, most cases of sciatica are short term, and the pain resolves within a matter of weeks or months. But some cases do not resolve quickly, and 10% to 40% of cases can require treatment for chronic pain.
Most patients with sciatica can be treated by their primary care doctor without the need for further diagnostic testing. The goal is to reduce the pain and increase mobility. Physical therapy, with customized stretching exercises to improve flexibility of tight muscles, are often where treatment will begin, along with the use of NSAIDs (nonsteroidal anti-inflammatory drugs) like aspirin or ibuprofen to temporarily relieve pain and inflammation. In other cases, tests like Magnetic resonance imaging (MRI) or computed tomography (CT) scan are used to obtain images of the structures of the back. Spinal injections of an anti-inflammatory medicine, or surgery is available for people who do not respond to other treatments, and who have severe pain. Many people believe that massage, yoga or acupuncture can improve sciatica.
You can take steps to protect your back and reduce your risk for getting sciatica pain by:
- Practicing proper lifting techniques: Lift with your back straight, bringing yourself up with your hips and legs, and holding the object close to your chest. Use this technique for lifting everything, no matter how light.
- Avoiding/stopping cigarette smoking, which promotes disc degeneration.
- Exercising regularly to strengthen the muscles of your back and abdomen, which work to support your spine. Whether you are sitting or lying down, tighten your stomach muscles often, hold them tight, then release.
- Using good posture when you are sitting, standing, and sleeping. Good posture helps to relieve the pressure on your lower back. Wrap up a towel for lower back support in your car seat or desk chair.
- Avoiding sitting for long periods.
- June 2017: Does retirement have a positive or negative impact on health?
Retirement can have positive or negative impacts on health. One study by the National Bureau of Economic Research concluded that complete retirement leads to a 5-16% increase in difficulties associated with mobility and daily activities, a 5-6% increase in illness conditions, and a 6-9% decline in mental health. However, these negative health effects can be reduced if the retiree is married, has social supports, continues to engage in physical activity after retirement, or continues to work part-time after retiring. The negative health effects of retirement may be larger if a person is forced to retire.
The National Institute on Aging says that health problems have a big influence on the decision to retire early, but less research has been done on how retirement affects your health after you retire. According to the Harvard Health Blog, retirement for some people is a chance to relax away from the daily grind---but for others, retirement can be a period of declining health and increasing limitations. One study ranked retirement 10th on the list of life’s most stressful events. Losing a spouse was number 1.
The U.S Health and Retirement Study data shows that retirees were 40% more likely to have had a heart attack or stroke than those still working. The increase was greater during the first year after retirement, and leveled off after that. Another study from England concluded that retirement significantly increased the risk of being diagnosed with a chronic condition. In particular, retirement raised the risk of a severe cardiovascular disease and cancer.
There are other studies which link retirement with an improvement or a neutral effect on health. One study found that retirement did not change the risk of major chronic diseases, and brought about a substantial reduction in mental and physical fatigue and depressive symptoms among people with chronic diseases.
So the impact of retirement on health may depend on the individual. The Harvard Health Blog suggests that “moving from work to no work comes with a boatload of other changes.” If you loved your work, retirement can bring some emptiness of purpose. If you had a stressful job, retirement brings relief. Either way, researchers offer these tips for a rewarding retirement:
- Don’t ‘retire’ from daily contact with friends and colleagues
- Maintain Activities like sports or traveling, to keep a purposeful daily life
- Be creative: keep your brain healthy by painting, gardening, or volunteering
- Keep learning: explore new subjects you have always been interested in
Understanding what large group studies say about retirement is interesting, but studies can’t predict how retirement will affect your life. People who retire because of health problems may not enjoy retirement as much as someone who retires feeling healthy. But, it makes sense to view retirement as a process. Often it is just the need to stay connected, and be a part of something bigger, that truly gives us that fulfillment in our later years, not the complete absence of work or responsibility.
- May 2017: Are Dietary Supplements Worth Buying?
Unfortunately, the answer is often “No.” Advertisements for “dietary supplements” frequently claim they will keep you from getting sick, or help you live longer. But according to the National Institute On Aging, “Often there is little, if any, scientific support for these claims…Some supplements can hurt you. Others are just a waste of money because they don’t give you any health benefits.”
There are many “dietary supplements” on the market today that are sold over the counter, including vitamins, minerals, fiber, amino acids, herbs, and hormones. Some products, like drinks or energy bars, have supplements added to them. The Food & Drug Administration (FDA) does not review these supplements before they reach the market, only if they believe a product is considered unsafe.
The best way to get vitamins or minerals is through the food you eat, not added supplements. If you feel you can’t eat enough, ask your doctor if you need a multi-vitamin and/or mineral supplement. It does not have to be labeled for “seniors,” and it does not have to be a large, or “mega dose” vitamin. The theory; “if a little is good, a lot must be better,” does not hold for supplements. Taking more than 100% of the daily value of a vitamin or mineral could be harmful, and your body may not be able to use the entire supplement, so you are wasting your money. People over the age of 50 may need supplements for certain purposes, such as vitamin B12, Calcium, vitamin D, extra Iron for women, and vitamin B6.
Antioxidants are natural substances found in food. There is no proof that large doses of antioxidants will prevent chronic diseases like diabetes, cataracts or heart disease. Rather than taking a supplement, try eating at least 5 servings per day of fruits and vegetables, or using vegetable oil and eat nuts (in moderation). These foods can give you the antioxidants you need.
There are also herbal supplements, like ginseng, Echinacea, or ginkgo biloba, which come from certain plants. When you use any herbal supplements, you are using them as a drug, and they can interfere with other medications you may already be taking. Some herbal supplements can cause high blood pressure, nausea, diarrhea, constipation, headaches, seizures, heart attacks, or stroke. Some supplements can increase the risk of bleeding or, if a person takes them before or after surgery, they can affect the person’s response to anesthesia. Dietary supplements can also interact with certain prescription drugs in ways that might cause problems. Vitamin K, for example, can reduce the ability of certain blood thinners to prevent blood from clotting. Antioxidant supplements, like vitamins C and E, can reduce the effectiveness of some types of cancer chemotherapy.
Before you start taking a dietary supplement, talk with your doctor or a registered dietician. Do not go on the recommendation of a friend or an internet site. Consider the source of any information you read: is it from a group that stands to make money from the sale of this product? If something worked for your neighbor, it does not mean that it will work for you. Don’t take supplements in place of, or in combination with prescribed medications without your health care provider’s approval.
All products labeled as a dietary supplement carry a Supplement Facts panel that lists the contents, amount of active ingredients per serving, and other added ingredients (like fillers, binders, and flavorings). The manufacturer suggests the serving size, but you or your health care provider might decide that a different amount is more appropriate for you.
There is a federal Office of Dietary Supplements (ODS), part of the National Institutes of Health, which publishes fact sheets that give consumers an overview of individual vitamins, minerals and other dietary supplements. ODS says if you don’t eat a nutritious variety of foods, some supplements might help you get adequate amounts of essential nutrients. However, supplements can’t take the place of the variety of foods that are important to a healthy diet. You can contact ODS at (301)435-2920, or visit their website at https://ods.od.nih.gov/HealthInformation/DS_WhatYouNeedToKnow.aspx
- April 2017: As I get older, does it really matter to stay physically active?
Absolutely. Regular physical activity and exercise are important to the physical and mental health of almost everyone, including older adults. There are many benefits from physical activity including:
- Maintains and improves your physical strength and fitness.
- Improves your ability to do the everyday things you want to do.
- Improves your balance.
- Manages and improves diseases like diabetes, heart disease, and osteoporosis.
- Reduces feelings of depression and may improve mood and overall well-being.
- Helps you fall asleep faster and deepen your sleep but don’t exercise too close to bedtime.
If you feel out of shape, but want to remain physically active, the key to success, according to the National Institute on Aging, is to build up slowly from your current fitness level. Health experts suggest that you consult your doctor before you start any new exercise program.
Start by determining your fitness level. Begin by asking these questions:
- How much time do you spend sitting?
- How much time and how often are you active?
- When you are active, what kinds of activities are you doing?
Here are 5 ways you can test your own fitness:
- Measure your endurance by picking a fixed course. Once around the block or from one end of the mall to the other. Time how long it takes you to walk it.
- Test your upper-body strength by how many arm curls you can do safely in 2 minutes.
- Test your lower-body strength by how many times you can stand from a seated position safely in 2 minutes. If you are unsteady, have someone there with you.
- Test your balance by how long you can safely stand on one foot. (Stand next to something sturdy that you can hold onto if you lose your balance).
- Test your flexibility by sitting toward the front of a sturdy chair, and stretching one leg straight out in front of you with your heel on the floor and your toes pointing up. Bend the other leg and place your foot flat on the floor. Slowly bend from your hips and reach as far as you can toward the toes of your outstretched foot. How far can you reach before you feel a stretch?
Write down your results. If these exercises were hard to do, just do what is comfortable and slowly build up. If they were easy, you know your level of fitness is higher. Now you can be more ambitious and challenge yourself. You can do these simple fitness tests once a month, and measure your progress at each session.
If you feel any pain or dizziness while exercising, stop. Muscle soreness lasting a few days and slight fatigue are normal after doing muscle-building exercises, at least at first. After doing these exercises for a few weeks, you will probably not be sore after your workout. For some exercises, you may want to start alternating arms and work your way up to using both arms at the same time. Breathe out as you lift or push, and breathe in as you relax. Don’t hold your breath during strength exercises. Holding your breath while straining can cause changes in blood pressure. Breathe in slowly through your nose and breathe out slowly through your mouth. Talk with your doctor if you are unsure about doing a particular exercise, especially if you have had hip or back surgery.
Some exercises for older adults, or those who are sedentary, include: brisk walking, stationary bike riding, low impact aerobics, swimming, and water aerobics. Safety during exercises is always important. Walk during the day or in well-lit areas at night, and be aware of your surroundings. Try not to walk alone or in secluded areas. To prevent injuries, be sure to use safe equipment. If you are exercising outdoors, dress in layers so you can add or remove clothes if you get cold or hot. Drink plenty of liquids when doing any activity that makes you sweat. Before and after you exercise, do a little light activity to warm up and cool down.
Each year, more than 2 million older Americans go to the emergency room because of fall-related injuries. You can learn exercises that will improve your balance and make you steadier on your feet. You can see pictures and short videos of any of these exercises, plus get more fitness tips by going to the National Institute On Aging website: https://go4life.nia.nih.gov/exercises. Go4Life is an exercise and physical activity campaign from the National Institute on Aging that is designed to help you fit exercise and physical activity into your daily life.
- March 2017: Is there more to using a drug plan than just selecting one?
Yes. Many people select a drug plan and then forget about it. But older adults report that medication costs and not understanding their drug benefits are major challenges. Older adults want easy to understand information on cost, coverage and provider networks to get the most out of their drug benefits.
People on Medicare are receiving their new prescription drug plan materials. It may be a Medicare Part D plan, or a Medicare Advantage Plan (Part C), but you can save money and avoid medication mistakes by understanding your benefits.
According to the National Association of Area Agencies on Aging (n4a), as many as 88% of Medicare recipients have not chosen the lowest possible total plan cost for their Medicare prescription drug coverage. These people could save money by choosing a plan that has a lower premium and the lowest possible out-of-pocket costs. N4a and Walgreens have teamed up to provide older adults and people with disabilities the education and programs they need to help maximize their Medicare pharmacy benefits.
Proper medication adherence is one of the keys to maintaining good health. Too many older adults may not have enough information about how to take their medications as prescribed for fear of incurring additional out-of-pocket expenses.
Here are some tips for getting the most out of your drug benefits, and for lowering your out-of-pocket costs:
- Every prescription drug plan has a list of covered drugs called a “formulary.” This list is divided into “tiers,” which vary by plan. Typically, a drug in a lower tier will generally cost you less than a drug in a higher tier. Ask your doctor or pharmacist if there are lower-cost options, such as lower-cost brands or generic substitutes on your plan’s formulary, or even over-the-counter options that can properly treat your medical condition.
- Many prescription drug plans have a “preferred pharmacy” network. If your plan has preferred pharmacies, you may save money and pay lower prescription copays if you use the preferred pharmacy.
- Some plans offer a mail order pharmacy that may offer lower drug prices. This may be a cost-effective and convenient way to fill prescriptions.
- Whether you are using a generic alternative, or a lower-cost brand alternative, if you are taking maintenance drugs, ask if you can get a less expensive 90-day supply instead of 30-day supply.
- At least once a year, ask your doctor or pharmacist to evaluate changes in your health and prescription needs, and about ways you may be able to reduce your medication costs.
- If you take medications for more than one medical condition, ask your doctor if you qualify for medication management therapy (MTM) from a pharmacist or other health professionals to ensure that your medications are working well together.
- Ask your doctor or pharmacist to review your prescriptions for falls risk. Some medications can interact together or affect you in a way that could increase your risk of falling.
- Talk to your doctor about ALL the medications you take, including over-the-counter (OTC) medications and “nutritional” supplements.
- If your prescription drug copayments are not affordable, ask your doctor if your drug manufacturers have a “patient assistance program” that reduces the cost of your drugs.
- The Prescription Advantage program provides financial assistance, based on income, for people with Medicare drug coverage. This program can help pay all or part of your Medicare drug co-payments, and can also provide an out-of-pocket spending limit. Once this limit is reached, Prescription Advantage will cover drug co-payments for the remainder of the plan year. Call 1-800-243-4636 and press “2” for details.
Choosing a drug plan is just the start. Learning more about your plan could help you save more.
- February 2017: What is the difference between hard of hearing and deaf?
Hard of hearing (HOH) refers to people who still have some useful hearing and can understand spoken language, in some situations, with or without amplification. Most HOH people can use the telephone, hearing aids and other assistive devices. The degree of hearing loss can vary, from mild to profound. Deaf people, on the other hand, have little or no hearing. They may use sign language or lip reading, and hearing aids may be used for both environmental awareness and to help make speech understandable. People who use spoken English to communicate are called “oral deaf.” Many individuals who are deaf lost their hearing before they learned to speak, and they view hearing loss, not as a medical condition that needs to be corrected, but as a cultural distinction.
People who are “late-deafened” are those who lost all or most of their hearing during or after their teen years, either suddenly or progressively. Most need sign language or lip reading to understand conversation, and cannot use the telephone. In many cases, doctors cannot definitively determine what causes deafness later in life. Some common causes include: exposure to loud noise, aging, meningitis, accidents, trauma, virus, Meniere’s disease, and tumors of the acoustic nerve. If you experience a sudden drop in hearing, unexpected dizziness, drainage from your ear, or significant pain in your ear or head, see a doctor as quickly as possible.
Acquired deafness is a traumatic loss, especially for people who lose their hearing suddenly. People who are born deaf never feel this overwhelming sense of loss, because they never experienced hearing. But for anyone who becomes deaf later in life, the sense of loss can be devastating and often report a feeling of isolation and loneliness. They may go through a grieving process that lasts months or even years. It is important to note that deafness does not mean that your recreational or social life has to stop. You can still do many of the same things you used to do, just differently.
There are some special concerns for older adults. The incidence of hearing loss increases dramatically with age. One third of all people over the age of 60 and 50% of people over 80 have some form of hearing loss. Hearing impairment is common and can seriously affect their safety, quality of life, and ability to live independently. Some seniors are not comfortable with new technologies like assistive listening devices or close captioned television and may lack the manual dexterity to manipulate the small controls on hearing aids and other devices. Seniors may be anxious about being able to remain living at home, and may be unaware of safety alerting devices and other assistive technology.
The Massachusetts Commission for the Deaf and Hard of Hearing can be used as a central point of contact for seniors and their caregivers. Their website is www.mass.gov/mcdhh. Much of the information in this article is taken from The Commission’s publication, The Savvy Consumer’s Guide to Hearing Loss. This publication lists organizations that offer supportive services, medical help, financial assistance and benefits programs, communications options, assistive technologies, and real life coping skills. To receive a copy of this book, call 1-800-882-1155, or 617-740-1700 (TTY).
- January 2017: Is it important for seniors to keep up with their vaccines?
Yes. A number of diseases, which can be prevented with vaccines, can cause significant illness, hospitalization, disability, and even death.
Older adults are more affected than most people by these diseases. According to the Alliance for Aging Research, more than half of the annual flu-related hospitalizations, and 90% of the annual flu deaths, are in people age 65 or over. Roughly half of the 1 million annual cases of shingles in the U.S. are in people over the age of 60. Even though seniors are hit harder by these illnesses, vaccination rates among older adults are dangerously low.
Your immune system is made up of cells that defend your body against a bacteria or virus, called a pathogen. It is your immune system which produces antibodies that destroy the pathogens. Every time your immune system reacts to a specific pathogen, it builds up a defense called immunity. The next time that pathogen shows up, your immune system “knows” the bacteria or virus, and removes it more quickly.
Vaccines imitate an infection, and tell your immune system to produce antibodies to protect you from a disease. By getting vaccinated, you also protect those around you who may not be vaccinated. This is called herd or “community immunity.” The more people who get vaccinated, the fewer chances a disease has to spread.
Here are some bacteria or viruses that can be treated with vaccines:
Influenza (flu) is a respiratory virus that spreads from coughing or sneezing droplets that land on you. Every year as many as 200,000 people are hospitalized from the flu.
Tetanus is a bacteria that enters the body through a deep flesh wound. It can interfere with the ability to breathe.
Diphtheria is a bacteria that attaches to the lining of the respiratory system and produces toxins. It can make it hard to breathe and swallow. This can lead to infections of the lung, blood, heart, kidney, and nerves.
Pertussis can lead to uncontrollable coughing, which often makes it hard to breathe.
Varicella is the chicken pox virus. Varicella zoster is a chicken pox virus that can be reactivated years later as a shingles infection. During their lifetime, 30% of Americans will develop shingles — around 1 million people each year.
Pneumonia is a bacteria or virus that infects the lungs. Every year, an estimated 53,000 people die and 1.1 million are hospitalized because of pneumonia.
Vaccines you received when you were younger (tetanus, diphtheria, and pertussis) can wear off, so you may need a booster vaccine. If there are vaccines you never received as a child (like chickenpox), it may be recommended that you get them as an adult.
As we age, our immune system weakens and puts us at a higher risk for certain diseases, like shingles and pneumonia. After age 60 there are additional vaccines that are recommended. Vaccines for measles, mumps, and rubella are not recommended for those ages 60 and up.
Talk to your doctor about staying up-to-date with your vaccines. The flu vaccine can change each season and even change mid-season. Your immunity decreases over the year and certain diseases and conditions can make it harder to fight off infection. With some chronic diseases, the complications of infection can be more severe. Ask your doctor about your risk for meningitis and hepatitis A and B.
Whenever you get vaccinated, ask for an immunization record card, and have it sent to your doctor’s office. Medicare Part B pays for flu, pneumonia, and hepatitis B vaccines. Medicare Part D plans must include all commercially available vaccines (except those covered by Part B). Medicare Part D or Medicare Advantage Part C plans, that offer prescription drug coverage, may also cover a number of these vaccines. Medicaid covers some of these vaccines.
For more information about what vaccines are recommended for you, visit this website www.cdc.gov/vaccines.
- December 2016: Is drug abuse an issue with older people?
Yes. Little attention has been paid to the issue of substance abuse, both legal and illegal drugs, among older adults. Recent data demonstrates that drug abuse is increasing among elders, and is a larger proportion of all substance abuse among this population.
One study in 2011 reported that 6.3% of those age 50 to 59 reported they had used illicit drugs in the past month, more than twice the rate recorded in 2002. Baby boomers (born between 1946 and 1964) have a lifetime rate of illicit drug use higher than those of people older than them. The number of older adults needing treatment for substance abuse is estmated to increase from 1.7 million in 2000 to 4.4 million by 2020.
Nonmedical use of prescription drugs among people 50 years and older is predicted to increase to 2.7 million Americans by 2020, and one recent study of elderly men in hospital emergency rooms showed that 11.6% involved opioid use, a rate nearly 5 times higher than marijuana, and 6 times higher than cocaine.
One large study of emergency department admissions in 2008, for illicit substance abuse among adults over age 50 years, noted that nearly 60% were aged 50 to 54 years, while only 1.5% were over age 75 years. Substance abusers were 70% male. The substances most commonly abused include cocaine (50%–60% of cases), heroin (25%), and marijuana (20%).
Researchers define “early onset users” as individuals with a long history of substance abuse who continue to abuse as they age. “Late-onset” substance abuse is a less common pattern, accounting for less than 10% of substance abuse. Some older adults who start abusing drugs do so because of medical factors, like higher rates of painful medical conditions that push the elder toward self-medication, and the development of psychiatric conditions, like depression or dementia. Older adults also suffer from higher rates of many of the same risk factors found in younger adults, like bereavement, social isolation, financial difficulties, or poor support systems.
Some studies suggest that in recent years prescription opioids have replaced heroin as the opioid of choice, including among elders. But among people who were early users of illicit drugs, heroin has been a drug of choice for so long that changing trends are not immediately reflected among older adult users.
The most common addiction among elders is with legal substances, like nicotine and alcohol. Psychoactive prescription drugs come in third, and illegal drugs, like marijuana, cocaine, or narcotics, come in fourth. One study of alcohol use in assisted living found that 60% of residents drank alcochol, 34% drank daily, 19% had health impacts from drinking, and 12% had physical or psychosocial harm from alcohol. Alcohol abuse is a risk factor for psychiatric illness: older adults are 3 times as likely to develop a mental disorder if they have a lifetime diagnosis of alcohol abuse.
Some studies recommend that every 60 year old should be screened for alcohol and prescription drug use/abuse as part of their routine physical exam. But diagnosis of elder drug abuse is a challenge for primary care doctors. Older patients may feel compelled to hide their abuse. Doctors may become absorbed with other medical concerns and neglect to explore the possibility of substance abuse. Bringing more attention to elder drug abuse will hopefully encourage physicians to become more comfortable learning about treating older substance abusers.
- November 2016: Do I have to “improve” to keep getting home health care?
No. One of the biggest mistakes that nursing facilities, rehabilitation centers and home health agencies make is telling people covered by Medicare that they can’t get skilled nursing, home health care, or physical therapy because they have “reached a plateau,” or “failed to improve.” The courts have ruled that “improvement” is not a requirement for Medicare therapy or home health benefits. A federal judge recently ordered Medicare to do a better job of informing health care providers that the so-called “improvement standard” was no longer in effect.
Older patients with chronic and progressive diseases like Alzheimer’s, Parkinson’s, or congestive heart failure are unlikely to “improve” over time, but they can still get physical therapy or home health care. Rehabilitation therapy helps prevent declines in walking, eating, speaking, dressing and bathing. Denying someone access to these treatments can worsen their disability, threaten their independence and result in more expensive health care needs.
People on Medicare might get confused reading their Medicare & You booklet, which describes on page 50 that home health is “part-time or intermittent.” That does not mean it has to be short-term. It is true that a doctor must approve your care, and you must be “homebound,” which is defined as having trouble leaving your home without help, and that leaving your home is a major effort. But you cannot be denied care because you are not “improving.”
In a 2013 court decision in Vermont, Medicare was ordered to pay for home health services to prevent a deterioration in a patient’s condition. The "stability presumption" was found to be unlawful. The Judge wrote: “A patient's chronic or stable condition does not provide a basis for automatically denying coverage for skilled services. The determination of whether a patient needs skilled nursing care should be based solely upon the patient's unique condition and individual needs, without regard to whether the illness or injury is acute, chronic, terminal, or expected to extend over a long period of time. In addition, skilled care may, depending on the unique condition of the patient, continue to be necessary for patients whose condition is stable.”
The fact that skilled care in a nursing facility or at home has stabilized a person’s health, does not render that level of care unnecessary. A person need not risk deterioration of his or her fragile health to validate the continuing requirement for skilled care. Your “failure to improve” cannot be used as a reason to deny you Medicare therapies or home health services. Your care cannot be cut off because you “exhibit a decline in functional status.”
If you are on traditional Medicare or Medicare Advantage, and are receiving services from a nursing facility, rehab facility or home health agency, and you think your covered services are ending too soon, you can ask for a fast appeal; this is referred to as an “expedited determination.” Your provider will give you a notice, before your services end, that will tell you how to appeal. For more information or assistance, call 1-800-323-3205 and ask for the Medicare Advocacy Project.
- October 2016: Are elders at greater risk of housing improvement scams?
Yes. Older adults are targeted because they often own a home outright, and have good credit. They are considered less likely to report a scam, may feel ashamed to file a report, or are unsure of how to file a report on a scam artist.
Here is a typical scam: A contractor tells an elder her entire roof needs replacing, and gives her a cost estimate that includes a “senior discount.” He promises to arrange for the financing. He then removes most of the roof, and gives the elder a contract at a much higher cost, saying that the damage is much more extensive than originally expected. The homeowner is afraid that if she does not sign the contract, the contractor will abandon the project, and the loan company will put a lien on her house. The repairs are so shoddy that the roof leaks. The elder stops making loan payments, and the loan company serves her with foreclosure papers to scare her into payment.
Home improvement scams can jeopardize your independence by costing you thousands of dollars, reducing your home equity, or even leaving you without a safe place to live. Scam artists sometimes pose as building inspectors or other officials, and use high-pressure tactics to demand immediate repairs to a roof, sidewalk, or driveway. They charge inflated prices and deliver sub-standard work.
Scam artists often go door-to-door saying they are working on other homes in the neighborhood. They pressure the homeowner for an immediate decision, and say they only accept cash, and want the full amount up front or they often say they have a lender they work with who will loan you the money. They usually have no license to work in Massachusetts.
To protect yourself from scams, before you hire any home contractor, the National Association of Area Agencies on Aging recommends that you be sure to:
- Ask the contractor for local references of homeowners they have worked with.
- Obtain a written estimate from more than one contractor, and do not assume the lowest bidder will do the best work.
- Ask for a written contract, and pay by check or credit card—never cash.
- Research financing, if needed, through a local bank or a credit union you trust.
- Limit your down payment, and pay the balance after satisfactory completion of the work. Before you make the final payment, make sure your have inspected the work, and compared it to what your contract said would be done. If you have a problem with the work performed that was charged to your credit card, you can ask your credit card company to withhold payment until the problem is corrected.
The Massachusetts Office of Consumer Affairs and Business Regulation requires home improvement contractors who work on detached one and two family homes to be registered. You can search a registry online by the company name to make sure you are using a registered contractor. https://services.oca.state.ma.us/hic/licenseelist.aspx
To file a complaint about a housing contractor, call the Massachusetts Office of Consumer Affairs at 617-973-8700. FAX: (617) 973-8799 or go to: Office of Consumer Affairs and Business Regulation (OCABR)
- September 2016: Are seniors at greater risk for hyperthermia?
Too much heat is not safe for anyone, but most people who die from hyperthermia are over the age of 50. There are several heat-related illnesses grouped under the name “hyperthermia” including:
- Heat syncope: sudden dizziness while you are active in hot weather. If you are not used to being out in hot weather, or you take a beta blocker to slow down your heart, you are even more likely to feel faint. If you feel dizzy, find a cool place to sit down—air conditioning is best—put your legs up, and drink water to make the dizziness go away. Drink water throughout the day, especially on a hot day before you exercise or go for a walk.
- Heat cramps: painful tightening of muscles in your stomach, arms, or legs. Cramps can result from hard work or exercise. Your body temperature and pulse may stay normal, but your skin may feel moist and cool. Rest in the shade to cool your body down and drink plenty of fluids, but avoid alcohol and caffeine.
- Heat edema: swelling in your ankles and feet when you get hot. Put your legs up to reduce swelling. Check with your doctor if the swelling does not go down soon.
- Heat exhaustion: your body can no longer keep itself cool. You feel thirsty, dizzy, weak, uncoordinated and nauseated. You may sweat a lot, you may have a rapid pulse rate, your body temperature may seem normal, but your skin may feel cold and clammy. Look for a cool place, stop to rest, and drink water. If you do not feel better soon, contact your doctor. Heat exhaustion can lead to heat stroke.
- Heat stroke: a medical emergency. Older people living in homes or apartments without air conditioning or fans are at most risk. People who become dehydrated or those with chronic diseases or alcoholism are also at most risk. The signs of heat stroke are: fainting, feeling confused, agitated, staggering when walking, grouchy, or acting strangely; a rise in body temperature over 104°F (40°C); dry, flushed skin; a strong, rapid pulse or a slow, weak pulse; not sweating, even if it is hot.
There are certain health problems that put you at greater risk for hyperthermia: heart or blood vessel problems; poorly working sweat glands or changes in your skin; being very overweight or underweight; heart, lung or kidney disease; drinking alcohol; conditions treated by drugs, such as diuretics, sedatives, tranquilizers, and some heart and high blood pressure medicines, which may make it harder for your body to cool itself.
If you live in a home or apartment without fans or air conditioning, try to keep your house as cool as possible. Limit use of your oven. Keep your shades, blinds, or curtains closed during the hottest part of the day. Open your windows at night.
If your house is hot, go to a cooler place—like a shopping mall, movies, library, senior center, or a friend’s house. Do not stand outside in the heat waiting for a bus. Dress for the weather: some people find that cotton is cooler than synthetic fibers. Do not try to exercise or do a lot of activities outdoors when it is hot.
Listen to weather reports before going outside. Shower, bathe, or sponge off with cool water. Lie down and rest in a cool place.
Heat and humidity can be especially hard on older people, so be mindful of the risk that hot days can bring. Use these tips to keep yourself cool when the heat is on.
- August 2016: Should I Buy Prescriptions Online? Are the cheap medications offered through online Canadian pharmacies for real?
The U.S. Food & Drug Administration (FDA) is very clear: “If you cannot confirm that an online pharmacy is licensed in the United States, you should not use that online pharmacy.” The FDA has no jurisdiction over prescription medications from other countries, and can’t guarantee their safety or effectiveness. Only 3% of online pharmacies reviewed by the National Association of Boards of Pharmacy are in compliance with U.S. pharmacy laws and practice standards.
Many consumers are turning to the internet for medications because they can get instant access to information and services. Consumers are also looking for cheaper alternatives. According to an FDA survey, one in four of surveyed internet users reported having purchased prescription medicine online. About 29% of those in the survey said they were not sure how to safely purchase medicine online. Online pharmacies associated with your health insurance plan, or a local pharmacy, are generally safe to use. But medicines ordered through illegal pharmacies could have been made anywhere.
One large online pharmacy based in Canada says it handles over 300,000 orders per year and tells seniors that it sources its drugs from “partner pharmacies” in India, Singapore and Europe “which are under strict government regulations of their country.” But they are not U.S. regulated. The internet pharmacy says, “The only difference between these medications and ones you would receive from a pharmacy in the United States is the price.” And the price difference is dramatic: A bottle of 84 Atenolol 25 mg. pills is $80 in the U.S. and $11 online. A bottle of 84 Aricept 10 mg. pills in the U.S. is $1,090 and $64 online. A bottle of 90 Lipitor 10 mg. pills in the U.S. is $399 and $60 online. You just go onto their website, place an order, pay by credit card, and fax your prescriptions toll-free.
But the FDA warns that buying prescriptions from fraudulent online pharmacies can be dangerous, or even deadly: “Counterfeit medicines should be considered unsafe and ineffective. These medicines may be less effective or have unexpected side effects.” These sites may also sell your information to other illegal websites and internet scams. “The products they provide may be fake, expired, and otherwise unsafe” the FDA says. In fact, many online pharmacy scams are so sophisticated that even health care professionals can have a hard time detecting illegal sites at first glance.”
Here are some warning signs of a fake online pharmacy:
They allow you to buy drugs without a prescription
They offer discounts or cheap prices that seem too good to be true
They send unsolicited email or other spam offering cheap medicine
They ship prescription drugs worldwide
They are located outside of the U.S. and say your drugs will be shipped from a foreign country
They are not licensed in the U.S. and by the board of pharmacy in your state.
It is illegal to import drugs to the United States for personal use, but the FDA does not object to personal imports of up to a 3-months’ supply of drugs that are not FDA approved if the following are true: if the drug is for a serious condition for which effective treatment is not available in the U.S.; if there is no commercialization or promotion of the drug to U.S. residents; if the drug does not represent an unreasonable risk; and if the person importing the drug states in writing that it is for his or her own use, and provides contact information about the doctor providing treatment. Drug products must be listed with the FDA before they may be imported for commercial use in the U.S. The foreign manufacturer is required to register with the FDA, and to identify a U.S. Agent. For more information, go to: www.FDA.gov/BeSafeRx
- July 2016: If I think I’m not ready for a hospital discharge, can I appeal?
Yes. If you are on Medicare, and you think your hospital services are ending too soon, you can file an appeal and gain some extra time from Medicare. You can ask questions about or challenge the quality of the health care you have received, your access to appropriate health care, your discharge from the hospital, or your termination from skilled services.
For example, if you are in a hospital, and you are told that you are going to be discharged, but you feel too sick to leave, you can appeal the discharge to the Medicare-designated Quality Improvement Organization (QIO). Livanta is the company for Massachusetts.
When the hospital is going to discharge a person on Medicare, they will give the patient a notice in writing called “An Important Message from Medicare,” which will explain how to file an appeal with Livanta. Medicare regulations require you to request a review no later than midnight of the day of discharge. On weekdays, Livanta’s Medicare Helpline is open 8 am to 5 pm, on the weekends the line is open 11 am to 3 pm. If you get a recorded message, leave your phone number. Once you appeal, you can then stay in the hospital without having to pay (except for copays and deductibles) until at least noon of the day after Livanta notifies you, the hospital, and the doctor of its decision. If you appeal to Livanta, you cannot be discharged without your consent. By appealing, you delay your discharge by at least a day or two.
To start your appeal, call Livanta’s HelpLine at 1-866-815-5440. Livanta will call and fax the hospital to request your medical records. A physician reviewer at Livanta decides whether or not you are healthy enough to be discharged from the hospital. When the review is complete, you will receive a phone call and letter from Livanta with the decision.
You can also file an appeal if you are enrolled in a Medicare Advantage managed care plan. You have the same appeal rights whether you are in traditional Medicare, or in a managed care plan. If you would like to have someone else explain your case to Livanta, you can appoint a representative to speak on your behalf. There are no fees to have your discharge appeal reviewed by Livanta.
Note: Be sure to ask your hospital: “What is my admission status?” If you are on “observation status,” you have appeal rights through the Medicare Administrative Contractor (MAC). The hospital should give you an Advanced Beneficiary Notice (ABN), which describes your appeal rights through the MAC.
You also have the right to appeal to Livanta over a termination of “skilled services,” such as home health, skilled nursing, hospice, and outpatient rehabilitation. Livanta will review your situation, and decide if continued skilled services are medically necessary, based upon standards of care.
This entire process must be completed within one day after Livanta receives all medical records for a hospital appeal request filed in a timely way, or within 24 to 72 hours (depending on the type of review) from your first call. If you are not satisfied with Livanta’s decision, you can request a further appeal---but any skilled services you receive after the termination or discharge date may not be paid by Medicare. This means you would be completely responsible for those costs.
For a link to the Livanta Medicare appeal process go to: http://bfccqioarea1.com/appeals.html
For more information about Medicare and Medicaid services go to: https://www.cms.gov/medicare/medicare-general-information/bni/ffsednotices.html
- June 2016: I am turning 65, how should I get ready for Medicare?
Between 2011 and 2030, 10,000 people each day will turn 65. That’s 73 million Americans who will be exploring Medicare health insurance for the first time. Medicare has several primary parts: Part A: is often called hospital insurance because it pays for your care while you are in the hospital. Part A also pays some of the costs if you stay in a skilled nursing facility or if you get health care at home. Part A also covers hospice care for people who are terminally ill.
- Part B: covers doctor visits, plus screenings, lab tests, outpatient hospital care and home healthcare which is not covered by Part A.
Parts A & B are known as “Original” Medicare, or “fee for service” Medicare. With Original Medicare, you can go to any doctor, hospital, skilled nursing facility or outpatient treatment clinic that accepts Medicare assignment.
- Part C: refers to private health care plans known as Medicare Advantage plans, which have contracts with Medicare. When you join one, you get your Medicare-covered healthcare services, all the same things as Medicare Part A and B. But Part C plans also may cover services that Original Medicare does not, such as eye exams, a pair of eyeglasses, or a hearing exam once a year. The plans may charge different amounts than you would pay through Original Medicare. Medicare Advantage plans may also cover prescription drugs. If they do, you cannot buy a separate Medicare prescription drug plan.
- Part D: provides prescription drug coverage to everyone with Medicare. To get Part D, you must join a plan run by an insurance company or a private company approved by Medicare. Each plan will vary in cost and the drugs covered, and plans can change from year to year. A plan that covers your prescriptions this year might change and not cover them the next year. If you take medicines now, or if you do not but your health changes or you need more medicines, this insurance will help pay for prescriptions and protect you from very high costs.
When you approach 6 months before your 65th birthday, here are some ways to prepare:
- Research the ABCD’s of Medicare and find out if you are eligible: Most people are eligible for Medicare when they reach the age of 65, or younger if they have certain disabilities that prevent them from working. Go to the website: www.MyMedicareMatters.org
- Learn when you can enroll: There are several times when you can enroll in Medicare.
- The Initial Enrollment Period is the first time you can sign up for Medicare. You can join Medicare Parts A, B, C and D at different times: The 3 months before your 65th birthday, the month of your birthday, and the 3 months after your birthday.
- If you were working for an employer and waited to sign up for Medicare, there is a Special Enrollment Period for Parts A & B any time you are working, or within 8 months following the month your employer health plan coverage ends, or when your employment ends (whichever is first). There is also a Special Enrollment Period for Part C & D, which is 63 days after the loss of employer healthcare coverage. If you miss your Initial or Special Enrollment Period, you can sign up for Medicare Parts A & B during the General Enrollment Period which is between January 1 - March 31 of each year. If you need to buy Part A, you must also enroll in Part B at this time.
- Finally, there is an Open Enrollment Period from October 15 to December 7th, when anyone with Parts A & B can switch to a Part C, or vice versa, and anyone can join, drop or switch a Part D plan, or change Part C plans. To help sort all this out, call 1-800-AGE-INFO, and press “3” to be connected to the free SHINE (Serving the Health Insurance Needs of Everyone) health counseling program in your area.