Travel for Those with a Chronic Health Condition

By Anne Pagnoni

As the end of summer nears, you may be considering a last minute vacation. If you or another member of your party has a chronic health condition, then there are some things that you may want to do before embarking on that fantastic voyage.

As soon as possible prior to your trip, arrange to meet with your physician to discuss any risks which may be involved with you traveling. This is especially important if you are traveling internationally as you may need immunizations or preventative medications prior to departure. Ask your physician for copies of recent EKG, laboratory, and x-ray results to take with you on your trip. If you are traveling to a country where English is not the primary language, then you may wish to have your medical records translated to the destination’s primary language. Keep in mind that while you may speak the language, if you are in a medically unstable condition, then you may not be able to communicate your health needs with the treating physician.

If you will be on an airplane or in a car for a long amount of time and have a history of circulatory problems, then you will want to take precautions to avoid swelling in the legs and developing blood clots. Make sure that you get up out of your seat or out of your car every hour or two and take a short walk; perform leg lifts several times per hour while sitting in your seat; and wear compression stockings.

Begin packing your luggage a week or two ahead of time to make the task more manageable. Pack all medications and medical supplies in your carry-on luggage. Bring extra medications in case you are delayed on your trip. Make sure your medications are in their original bottles to avoid any unnecessary delay at customs.

Contact your wireless cell phone provider to make sure that your phone can work internationally. Have the names, phone numbers, and fax numbers for all treating physicians and your pharmacy. Make sure you have the local numbers as 1-800 numbers typically do not work outside of the country. Have phone numbers of the local hospital in the country where you’ll be staying.

If you suffer from blood sugar issues or require food to take medications, then have a light snack on hand. This is especially important if you are traveling by plane as meals are no longer always served during a long flight.

Social Support Activities Lead to Better Quality of Life As One Ages

by Anne Pagnomi

How important is social support as a person ages? This may seem like an easy question to answer. Most people would not choose isolation and loneliness versus spending time with companions. However, can lack of social support really hinder a person’s overall quality of life?

Lack of social support is related to negative impacts on health and well being, especially for older people. Having a variety of positive social supports can contribute to psychological and physical wellness of elderly individuals. Support from others can be important in reducing stress, increasing physical health and defeating psychological problems such as depression and anxiety.

When considering who provides social support for an elderly individual our first thoughts are of family members. While it is true that most support does come from family members, there are many circumstances in which family members cannot be supportive (stress due to responsibilities, illness, death, financial problems, job relocation). In the United States the fastest growing age group of individuals are those 85 years and older. Due to this fact, family supports will inevitable decrease for these older individuals. A need for community-based services is more important now then ever before.

Community-based services can be extremely useful for elderly individuals. Services for older persons can encompass many areas, but one of the most important areas as discussed previously is social support. Support for elderly persons can be found in many places including: senior centers, assisted living facilities, meal delivery, religious affiliations, adult day care centers, etc. These services can provide positive social supports that can help older persons defeat loneliness and isolation. However, social support must encompass more then physical presence or conversation. Studies have shown that social support services should contain quality activities. These activities should promote positive self-awareness.

Self-awareness is key to a person’s overall quality of life and satisfaction. Many leisure social activities can be used to help increase an individual’s self-awareness. Activities for elderly individuals may include reminiscence groups, journal writing, readings of favorite book passages, group exercise, singing groups, etc. Individuals may also feel more self-satisfied if they are part of the planning of social activities that take place.

Two of these community-based service centers that provide quality social support services for elderly individuals are discussed below.

Senior Citizen Centers
Today, there are estimated to be about 15,000 senior centers across the United States. Senior centers act as a focal point for older Americans to receive many aging services. The most common services offered at a senior center include health programs (including Zumba and Yoga), arts/humanities activities, intergenerational programs, employment assistance, community action opportunities, transportation services, volunteer opportunities, education opportunities, financial assistance, senior rights counseling/legal services, travel programs and meal programs. These programs and activities can help promote positive self-awareness.

Lori Beckle describes how participating in her local senior citizens center has given her the independence and life satisfaction she thought was lost when her husband died in 2009. “ I was devastated and so frightened for my future without Ed. He was my only friend and the one I turned to when I felt alone. My daughter invited me to attend our local senior center where a bereavement group was being held for those who had lost a loved one. I met Phyllis during the group and now I have a new friend I call when I become afraid. Phyllis has helped me develop the skills to get through the tough times and focus on my immediate happiness.”

Adult Day Care Centers
According to the National Adult Day Services Association (NADSA), there are currently more than 4,600 adult day care centers nationwide. Adult day care is a program in which activities are provided to promote social support and health services to an older adult during the daytime. Most centers operate Monday through Friday during daytime hours. Social support services at an adult day care can consist of musical entertainment and singing groups, group games such as cards, gentle exercise, discussion groups (books, films, current events), holiday/birthday celebrations and local outings. Not only are these social activities provided, but participants of the program can also develop lasting relationships with staff and other participants. Adult day care centers also provide meals and health services. Adult day care centers differ from other programs for elderly individuals, because they allow the participants to develop and increase self-awareness by encouraging independence.

Amanda describes her experience as a volunteer at her local adult day care center. She stated, “ I was involved in planning the activities for Thursday afternoons. I wasn’t sure what kind of activities my older friends would enjoy so I had them share their favorite activities they participated in when they were my age (23). I soon realized that I was hearing the most fascinating stories of hopping trains, college dances, swimming in the lake, etc We decided Thursday afternoons would be spotlights of each individuals’ lives as a twenty-something. One of the participants told me that Thursdays became a highlight for her week.”

Adult Day Care Centers and Senior Citizen Centers help to provide an elderly individual the opportunity to participate in social support activities. Social support activities found in these programs can be beneficial to a person’s quality of life and overall satisfaction. With a higher self-awareness and quality of life an individual can reduce the risks of mental and physical health problems as they age.

Safer Travel for Those with Dementia

Summer is the time of year when many Americans plan summer and holiday travel. Whether you’re considering a weekend getaway or an extended stay, traveling with an individual who has Alzheimer’s requires additional thought and preparation.

People with Alzheimer’s and their caregivers need to be prepared for a change in schedule and environment. Even if it is a trip you have taken before, it may feel new for the person with the disease.

Additionally, as Alzheimer’s progresses, negotiating changes in environment will become increasingly challenging. Be prepared for the individual with the disease to experience some confusion or disorientation. Exercise caution, as wandering and getting lost are more likely during transitional times. The checklist below will help you plan for the trip and make it successful and safe.
Before going

• Call the Alzheimer’s Association chapter in the area you will be visiting. Let them know you will be staying in the area and ask about available resources. You can locate any chapter by calling 1.800.272.3900 or visiting www.alz.org/apps/findus.asp.

• Enroll the person in MedicAlert® + Alzheimer’s Association Safe Return®, a 24-hour nationwide emergency response service for individuals with Alzheimer’s or a related dementia who wander or have a medical emergency. You may also want to consider the Alzheimer’s Association Comfort Zone®, powered by Omnilink, a Web-based GPS location management service or Alzheimer’s Association Comfort Zone Check-InTM.

• If you are already enrolled in MedicAlert, update your records with temporary contact information (call 1.888.572.8566).

Upon arrival

• Let neighbors know a person with Alzheimer’s is staying next door and ask them to keep their eye out for wandering or other unsafe behavior.

• During the first few days after arrival, keep your schedule light with lots of down time.

• Create opportunities to re-acclimate the person to the new environment.

• Keep familiar things around.

• Limit access to money and credit cards.

• Limit access to driving.

• Be aware that the change can be chaotic for the person.

• Recognize the warning signs of anxiety and agitation.

For more tips on safety for people living with Alzheimer’s disease and related dementias, including concerns about wandering, disaster preparedness, home and medication safety, visit the Alzheimer’s Association Safety Center at www.alz.org/safetycenter or call 1.800.272.3900 to find the Alzheimer’s Association chapter closest to you.

Choosing Home Care Services that Meet Your Needs

by Anne Pagnoni

Making the decision to hire a home care service to provide care for your loved one is an important decision and can, at the same time, be very difficult. If an illness or recovery from surgery requires nursing care or physical therapy, a physician may order skilled home care services that provide both skilled providers and personal aides. Your decision is then based on the obvious medical determinations made by the doctor. But what if you as the family caregiver must determine the extent of care needed without the help of a doctor?

Each home care situation is unique. In the beginning, family or friends step in to help with simple tasks and support for aging seniors who want to stay in their homes. As long term care needs progress, more time is required to manage those needs. Physical and mental conditions change with aging making usually routine hygiene and daily living activities difficult for an aging individual. Even with the healthiest of seniors, the ability to drive a car, shop for groceries or do general housekeeping eventually needs to be relinquished to the responsibility of another person.

In one example, Karen, would stop by her parents' home on her way to work every morning and again on her way home from work in the evening. She checked in the morning to see that they were up and ready for the day and Karen would take a shopping list for things they needed. In the evening she delivered the needed items she had purchased during her lunch break and sometimes she fixed a meal when one was not prepared by her mother. This worked well until Karen began to notice her father did not shave or dress during the day and both parents were forgetting their medications. Karen felt more time and supervision was needed in their care but with her own family and job, she could not do it. Non-medical or personal home care services would be a good option for Karen to consider.

Before starting your search for a non-medical or personal home care company, determine what the care needs are and how much time each week will be required for assistance from the company. You may want to consult with the family physician and other family members as well as experienced social workers or care managers to determine needs. Most home care companies, as well, will help you do an assessment at no charge. With your care needs in hand, you are ready to begin your search.

The National Association for Home Care & Hospice (http://www.nahc.org/home.html) gives the following guidelines and checklist in searching for a home care company.

•How long has this provider been serving the community?

•Does this provider supply literature explaining its services, eligibility requirements, fees, and funding sources? Many providers furnish their home care clients with a detailed "Patient Bill of Rights" that outlines the rights and responsibilities of the providers, clients, and family caregivers alike.

•How does this provider select and train its employees? Does it protect its workers with written personnel policies and malpractice insurance? Does it protect clients from theft or abuse by bonding its employees?

•Does this provider assign supervisors to oversee the quality of care clients are receiving in their homes? If so, how often do these individuals make visits? Who can the client and his or her family members call with questions or complaints? How does the company follow up on and resolve problems?

•What are the financial procedures of this provider? Does the provider furnish written statements explaining all of the costs and payment plan options associated with home care?

•What procedures does this provider have in place to handle emergencies? Are its caregivers available on notice?

•How does this provider ensure client confidentiality?

If a home care company has not previously been recommended to you, ask for a list of previous clients and call for their experience with this provider.

Following up on these guidelines can help you determine the quality of personal care that is given. Many states license non-medical home care companies and require both legal and health standards to be maintained.

Read about individual home care companies in your area on the National Care Planning Council's website www.longtermcarelink.net.

Downsizing, Organizing, Handicap Remodeling, or Relocating

by Anne Pagnoni

When Robert and Anne bought their family home thirty years ago, their plan was to live through retirement in this home. They had furnished their home with refurbished antiques acquired from their many trips together. It was one of their cherished antique coffee tables that Robert tripped over, breaking his hip. Now with his return from the hospital in a wheelchair, the overwhelming task of making their home accessible for Robert’s wheelchair and safe for both of them faced Anne.

Remodeling for wheelchair access, organizing home furnishings and daily living items or downsizing and relocating to a smaller living area are monumental tasks that are many times thrust on senior home owners. Sometimes the need to do this is brought on by injury or age related illness. Home and yard maintenance can become a daunting chore for even the healthiest of seniors, requiring them to make a downsizing decision.

There is a large and growing industry of specialists who understand these challenges of elderly homeowners and are ready and willing to help with remodeling, organizing or the sale of the home and with the move to a new location.

A professional organizer provides skills in making the home safe and manageable. Relocating furniture, removing hazards such as electrical cords, throw rugs, heavy objects on shelves that might fall are some of the ways they make a home more senior friendly. They specialize in helping seniors part with items that clutter or have no valued use, so to make rooms less crowded or to make ready for a move to a smaller living space.

Handicap remodeling services and senior safety services offer help in adding wheelchair ramps and widening doorways. Bathrooms are made more accessible and safe, with hand rails, walk-in bath facilities and easier access to toilets.

If moving to a smaller retirement home or care facility is the best solution there is another senior specialty provider to call on called a Seniors Real Estate Specialist.

The Senior Real Estate Specialist concentrates more on a complete service package for the sale of the property and/or the purchase of a new living arrangement. The specialist also arranges for the services of a relocation specialist or Senior Move Manager to provide a complete, stress-free package for the elderly homeowner.

A move often requires downsizing and getting rid of a tremendous number of acquired possessions. The relocation specialist or Senior Move Manager, as they are often called, will typically provide a turnkey operation that includes assessing and identifying items to keep, arranging for auction or other disposal, cleaning the home, moving the belongings and setting up the new residence. The manager may also work closely with a real estate agent to arrange for the sale of the home and may also be involved in the financial transactions necessary to move into a new living arrangement.

All the help available to seniors may in itself be overwhelming. How do seniors choose the right service provider for their needs? How do they know they will hire someone qualified, responsible and honest? Area Agencies on Aging and State Better Business Bureaus are good resources to check out available service providers.

Family, friends and religious leaders can be valuable resources to seniors in referring service providers and helping to manage the hiring and supervision.

The National Care Planning Council’s website http://www.longtermcarelink.net/ provides educational articles and information on eldercare providers throughout the nation.

The Dangers of Osteoporosis

by Anne Pagnoni

Osteoporosis, which is a disease in which the bones become weak and brittle, is a condition affecting almost 10 million Americans with another 34 million being at risk for the condition. Of these almost 20% are men. While osteoporosis may not sound like a devastating disease, consider the fact that bones can become so weak and brittle that even mild stressors such as bending over, sneezing, or coughing can cause a bone fracture.

When we're younger, breaking a bone isn't necessarily a serious condition. Think of the young child who falls and breaks an arm while bike riding. He often returns to school with a cast on his arm and a marker so that all of his friends can sign it. Breaking a bone when we're older, however, is a serious condition. Broken bones due to osteoporosis most likely occur in the spine or hip both of which directly support our weight. Hip fractures in older adults can lead to disability and even death due to postoperative complications.

Some people with osteoporosis find themselves with spinal fractures even though they haven't fallen or otherwise injured themselves. This is a result of the bones in the back becoming so brittle that they begin to compress on each other. Compression fractures tend to be very painful and require a long recovery.

There are a variety of risk factors for osteoporosis - some we can change and some we can't. Risk factors that we can change include maintaining an adequate amount of calcium in our diets; stopping smoking; getting regular exercise; avoiding excessive alcohol consumption; and, if possible, avoiding the long-term use of corticosteroid medications. Risk factors that can't be changed include being a woman; increasing age; being either white or of Asian descent; having a family history of osteoporosis; being of a small body frame; possessing too much of the thyroid hormone; or having certain medical conditions including celiac disease and Crohn's Disease.

Certain medications can be prescribed to help slow bone loss and maintain bone mass. Hormone therapy, particularly estrogen, can help maintain bone density if started shortly after menopause; however, this can increase the risk of developing a plethora of other ailments including blood clots, breast cancer, and even heart disease. Physical therapy is another option which can be helpful in improving bone strength.

If you find yourself diagnosed with Osteoporosis, there are a few things that you can do to work to maintain your independence. Maintain good posture as this can help alleviate stress on your spine. If you need to lift something, make sure that you bend at your knees and not your waist, and lift with your legs. Wear low-heeled shoes with nonslip soles. Make sure that you don't have any tripping or fall hazards at home including electrical cords, throw rugs, and slippery surfaces. Keep your home brightly lit and install grab bars both inside and outside of your shower door. If you are in chronic pain, then discuss this with your doctor. Chronic pain can begin to limit your mobility, which will result in even more pain.

When it comes to osteoporosis, prevention truly is the best medicine. Make sure that you're getting adequate amounts of calcium and vitamin D in your diet. If you aren't sure that you're getting enough, then talk to your doctor about supplements that you can take. Exercise regularly. While you don't have to be a body builder, make sure that you're incorporating strength training with weight bearing exercises.

Be Aware of High Blood Pressure

by Anne Pagnoni

According to the CDC, almost 68 million people are living with high blood pressure, which is also known as hypertension. High blood pressure increases the risk for heart disease and stroke, which are the first and third leading causes of death, respectively.

Blood pressure is the force of blood against your artery walls as the heart pumps your blood throughout your body. If your blood pressure rises and stays high for a long period of time, then it can damage the body in a variety of ways. Blood pressure is measured in two numbers. The systolic number, which is the "top" number, refers to blood pressure when the heart is beating. The diastolic number, which is the "bottom" number, refers to blood pressure when the heart is resting between beats. A normal blood pressure reading is any reading when the systolic number is less than 120 and the diastolic number is less than 80.

Blood pressure varies during the day. It tends to increase when you're excited, nervous, or active. It tends to decrease when you are sleeping. It's important to keep in mind that if your blood pressure stays above the normal reading for the majority of the time, then you are at risk for hypertension and other health problems.

In addition to sleep, excitement, and activity, there are many other factors that impact blood pressure. The amount of water and salt that you have in your body; the condition of your kidneys, nervous system, and blood vessels; health conditions including thyroid disease and sleep apnea; and the varying levels of hormones in your body impact blood pressure. Age impacts blood pressure as blood pressure tends to increase as we get older simply because our blood vessels become stiffer as we age.

Hypertension has been shown to cause the arteries throughout the body to narrow in some places. As a result, blood flow is limited to various body parts which can lead to heart attack, stroke, or kidney failure. Aneurysms, which are abnormal bulges in artery walls, can form in blood vessels as a result of high blood pressure. Blood vessels in the eyes can burst or begin to bleed. This can lead to changes in vision or even blindness.

There are a variety of medications that can be used to treat hypertension. These vary from medications that help remove water and salt from the body to medications that slow down the heart or relax and widen blood vessels. Some individuals benefit from having two or more medications.

In addition to prescription medications, there are a variety of lifestyle changes that one can make to help decrease blood pressure. Eating a diet low in fat, cholesterol, and salt can help reduce blood pressure as well as limiting the consumption of alcoholic beverages. Men should have no more than two alcoholic drinks per day while women should have no more than one alcoholic drink per day. Physical activity is another way to manage high blood pressure. It's important to speak with your physician prior to starting any physical exercise regiment in order to learn what is safe for you to do. Maintaining a healthy weight can do wonders in the fight against high blood pressure. If you are a smoker, then quit smoking. There are products that can help you quit. Talk to your doctor for more information about these. Learn how to manage stress and relax. Some people choose physical activity while others opt for meditation or listening to music. Find out what works for you.

While high blood pressure cannot be cured, it can be controlled. Make sure that you work closely with your doctor to make sure that your hypertension is being properly managed. Managing your high blood pressure will allow you to live a long life.

For more information, please visit the Centers for Disease Control and Prevention or the National Heart Lung and Blood Institute.