10 Alzheimer's Warning Signs

I often hear people worrying about memory loss as they grow older and wonder if it is the beginning of Alzheimer’s disease. This article gives some great advice about what are common memory problems as we age vs what are warning signs of Alzheimer’s. This article may help some folks put their mind at ease.

Some change in memory is normal as we grow older, but the symptoms of Alzheimer’s disease are more than simple lapses in memory.

People with Alzheimer’s experience difficulties communicating, learning, thinking and reasoning – problems severe enough to have an impact on an individual’s work, social activities and family life.

The Alzheimer’s Association has developed a checklist of common symptoms to help you recognize the difference between normal age-related memory changes and possible warning signs of Alzheimer’s disease.

There’s no clear-cut line between normal changes and warning signs. It’s always a good idea to check with a doctor if a person’s level of function seems to be changing. The Alzheimer’s Association believes that it is critical for people diagnosed with dementia and their families to receive information, care and support as early as possible.

Early Warning Signs

  1. Memory Loss

    Forgetting new information is one of the most common early signs of dementia. General memory loss and forgetting important events and asking for the same information over and over are also common symptoms of early stage Alzheimer’s disease. What’s typical?Forgetting names or appointments occasionally and remembering them later.

  2. Difficulty Performing Familiar Tasks

    People with dementia often find it hard to plan or complete everyday tasks. Individuals may lose track of the steps involved in preparing a meal, placing a telephone call or playing a game. What’s typical? Occasionally forgetting why you came into a room or what you planned to say.

  3. New Problems with Writing or Speaking

    People with Alzheimer’s disease often forget simple words or substitute unusual words, making their speech or writing hard to understand. They may be unable to find the toothbrush, for example, and instead ask for “that thing for my mouth.” What’s typical?Sometimes having trouble finding the right word.

  4. Confusion with Time and Place

    People with Alzheimer’s disease can become lost in their own neighborhood, forget where they are and how they got there, and not know how to get back home. What’s typical?Forgetting the day of the week or where you were going.

  5. Poor or Decreased Judgment

    Those with Alzheimer’s may dress inappropriately, wearing several layers on a warm day or little clothing in the cold. They may show poor judgment, like giving away large sums of money to telemarketers. What’s typical? Making a questionable or debatable decision from time to time.

  6. Problems with Abstract Thinking

    Someone with Alzheimer’s disease may have unusual difficulty performing complex mental tasks, like forgetting what numbers are for and how they should be used. What’s typical?Finding it challenging to balance a checkbook.

  7. Misplacing Things and Losing the Ability to Retrace Steps

    A person with Alzheimer’s disease may put things in unusual places: an iron in the freezer or a wristwatch in the sugar bowl. What’s typical? Misplacing keys or a wallet, but being able to retrace steps to find it later.

  8. Changes in Mood or Behavior

    Someone with Alzheimer’s disease may show rapid mood swings – from calm to tears to anger and aggression – for no apparent reason. They may become extremely confused, anxious, suspicious or dependent on a family member. What’s typical? Occasionally feeling sad or moody.

  9. Trouble Understanding Visual Images and Spatial Relationships

    For some people, a change in visual processing may be a sign of early Alzheimer’s disease. They may have difficulty reading, judging distance and determining color or contrast, which may cause problems with driving. What’s typical? Vision changes related to cataracts.

  10. Withdrawing from Social Activities

    A person with early stage Alzheimer’s disease may avoid being social because of the changes they’ve experienced. They may remove themselves from sports, social events and hobbies. They may become passive, sitting in front of the TV for hours, sleeping more than usual or not want to perform daily living activities. What’s typical? Sometimes feeling weary of work or social obligations.

The difference between Alzheimer’s and normal age-related memory changes…


  • Forgets entire experiences

  • Rarely remembers later

  • Is gradually unable to follow written/spoken directions

  • Is gradually unable to use notes as reminders

  • Is gradually unable to care for self


  • Forgets part of an experience

  • Often remembers later

  • Is usually able to follow written/spoken directions

  • Is usually able to use notes as reminders

Long-Term Care Insurance: Costs & Benefits

I get calls almost every week from people wanting to set up care for their loved ones who think that insurance will cover the costs. Unfortunately this is seldom true unless you have purchased Long Term Care Insurance. This great article from A Place for Mom, explains more about LTCI and what it does and does not cover.

Retired teacher Anne Schuessler decided to purchase Long Term Care Insurance (LTCI) based on the uncertainty of the future. “I just wasn’t sure of what’s ahead for me and I felt this was kind of a safety net,” says 66-year-old Schuessler, who lives in Cedar Rapids, Iowa. “My children live far away. If I needed some extra help, I could get it without having to bother my children.”

Schuessler can’t know if she’ll ever need long-term care, but she does know her LTCI plan will help pay for long-term care costs, lessening the impact a health care crisis would have on her children. When a person can no longer care for herself, long-term care helps with the tasks of daily living, such as bathing or eating. This assistance can be necessary for many reasons: after an injury or debilitating illness; due to chronic illness or disability; because of a severe cognitive impairment, such as Alzheimer’s disease; or due to deteriorating physical or mental health.

LTCI is a relatively new product, as this arm of the industry began just 33 years ago. Only about 8% of Americans have purchased LTCI, but as the average life expectancy rate continues to climb, more people are realizing the need to plan for a long life. Whether you are researching LTCI for yourself or a loved one, it is important to know the benefits and potential drawbacks of purchasing a plan, policy and premium terms, and the nature of LTCI plans.


Long term care costs can easily drain one’s finances. According to the Harvard University Study in Compensation & Benefits Review, 72% of Americans become impoverished after just one year of nursing home care. Long term care isn’t typically covered by private medical insurance and major medical insurance plans. Medicare only pays for skilled and rehabilitative care after a three-day hospital stay; this excludes custodial care, the assistance someone needs for daily living. Medicaid only covers nursing home bills after a loved one is bereft of assets.

Statistics from the Genworth Financial 2012 Cost of Care Survey exemplifies why so many elderly Americans lose all of their savings and assets due to healthcare costs. The national average annual cost for a private room in a nursing home is $83,950, based on the 2012 figures. If someone needs 40 hours of in-home care for one year, the national average cost is $56,717. And these average costs are rising every year by about 5 to 8%. Often a person only needs long-term care for a limited period of time before returning to good health, but even this can be a catastrophic financial event. An LTCI policy protects against the risk of large out-of pocket costs associated with this type of care.


“When a person needs long-term care, an LTCI plan can minimize the financial and emotional impact of the situation,” says Wendy Boglioli, a senior sales specialist for Genworth Financial, the leading provider of LTCI in the United States. LTCI plans are both about preserving one’s lifestyle and deciding how long-term health care needs will be met as they arise.

Purchasing an LTCI policy can:

  • Preserve savings and assets for family and friends;

  • Help maintain one’s financial independence from family and friends, often eliminating the need to borrow money for long-term care costs.

  • Relieve family and friends of caregiving tasks, as paying for professional care becomes an affordable option.

  • Allow a loved one to choose where he receives care. If Medicaid pays for care, a nursing home is the only option. People can design their LTCI policy depending on where they want to receive care: in a nursing home, in the community, at home, or in an assisted living facility.

  • Expand the range of services a loved one receives, including: care from visiting nurses, home health aides and friendly visitors programs; home-delivered meals and chore services; and time in adult daycare centers and respite services for caregivers.

The benefits a loved one receives from a LTCI policy also depends on the type of plan she purchases. “It’s not a cookie-cutter policy,” says Boglioli. “Educate yourself so you can make a good informed decision. Know what you want, get what you pay for, and make sure it covers everything you want or you do not buy [it].”


There is a vast array of options in LTCI policies. By doing research and comparing plans, individuals can tailor their plans to fit their needs and budget. Finding a financial advisor that is well versed in the field is a must. The advisor can determine what your needs are and how much you can afford in terms of benefits. The monthly premium a person pays for his LTCI depends on the following premium terms:

  • Age and Health
    Most companies offer policies to people between the ages of 18 and 85 (although Genworth Financial only insures people up to age 79). While it might sound like a good idea to wait until a person reaches retirement age, the older one is, the higher the premium will be. For example, a 55-year-old might pay twice or even three times the amount a 50-year old pays in premium costs. Also, since a carrier can turn an individual down to due to health conditions, it’s easier to buy LTCI before health issues arise. After an individual buys a policy, premiums should remain the same unless the premiums are increased for an entire class of policyholders.

  • Daily or Monthly Benefit Amount
    This is the amount available to pay for long-term care costs, either stated in terms of a daily or monthly maximum. For example, a benefit of $100 a day will pay for up to $100 of covered care and services.

  • Benefit Period
    This is the length of time a plan will pay the benefit amount. It is usually stated as a number of years.

  • Elimination Period
    This is similar to a deductible amount, but is stated as a number of days, usually anywhere between 30 to 180 days. The insured person must pay for her care for this number of days before any benefits are paid for.

  • Inflation Protection Option
    This is an optional feature that protects your benefit amount from inflation. It increases the benefit amount on a yearly basis so coverage stays abreast of the increase in care costs. Look for an inflation guard that increases the benefit amount by 5% compounded annually. It is much cheaper to forego this option, but since long-term care costs go up by at least 5% (if not more) each year, a $100 daily benefit will not be a sufficient coverage amount in the year 2030, for example. Most insurance brokers recommend inflation protection unless the insured person is 75 or older.

Because of these five variables, there is no average cost for LTCI policies. But there is one fast rule: The younger and healthier a loved one is, the less expensive a plan will be. With hundreds of companies offering LTCI, it’s important to be a knowledgeable consumer. Learning the following terms can help with your policy research:

  • Financial Strength Rating
    Buying from a reputable company is essential. Check a company’s financial strength rating at www.AMBest.com or at www.standardandpoors.com. Consumer Reports recommends eliminating companies with ratings below a B.

  • Benefit Triggers
    Benefits kick-in with a trigger, which is pre-defined in a policy. Usually the insured cannot perform at least two activities of daily living, such as using the bathroom or dressing; or the insured has a severe cognitive impairment, such as Alzheimer’s disease.

  • Reimbursement or Indemnity
    Most plans are reimbursement plans, meaning the insured person pays his bills, and the insurance company reimburses him for eligible expenses. Indemnity plans, which are more expensive, pay the full daily or monthly benefit amount regardless of the insured person’s bills.


LTCI is not a suitable or affordable option for everyone. “I love tuna fish, but I’m not eating that three times a day to buy a policy!” says Boglioli. “Clearly, it’s not appropriate, financially or health-wise, for everyone.” A person should not need to change her lifestyle to afford a policy. A financial advisor should be able to look at an individual’s savings and assets to see if a plan makes sense. Boglioli advises that an LTCI policy shouldn’t cost more than 7% of your annual income.

Qualifying for a plan also depends on health. Often companies require an individual must pass a physical before he is offered coverage. Most companies will not insure people with the following preexisting conditions:

  • Alzheimer’s disease

  • Dementia

  • Multiple Sclerosis

  • Parkinson’s disease

  • Stroke

Before purchasing a plan, it’s important to read and understand the entire policy. The insurer should present you with an outline of coverage, describing the policy’s benefits, limitations, and exclusions. Use this to compare plans to each other.

According to the Guide to Long-Term Care Insurance by America’s Health Insurance Plans (an industry trade association), the National Association of Insurance Commissioners recommends looking for a policy that includes:

  • One year of nursing or home health care coverage, including intermediate and custodial care

  • Coverage for Alzheimer’s disease

  • A guarantee that a policy cannot by canceled, non-renewed, or otherwise terminated because you get older of suffer deterioration in physical or mental health.

  • The right to return a policy within 30 days of purchasing the policy, which is called a free look period

  • No requirement that the insured: first be hospitalized to receive nursing or home health care benefits; first receive skilled nursing home care before receiving intermediate or custodial nursing home care; or first receive nursing home care before receiving home health care.

Although it is impossible to anticipate the state of health a person will have years from now, an LTCI policy can help a person plan for the future and buy some peace of mind. “I am more comfortable knowing I have [LTCI]. It makes a huge difference,” says Anne Schuessler. “If people are seriously considering LTCI, they can tailor something to suit their needs and budget.”

Tax Identity Theft: Protecting Your Credit and Finances by Aly J. Yale Updated on 02.19.19 Taxes

Yet another scam that can affect our elders (as well as ANYONE with a social security number). A great article from Simpledollar.com that explains the newest tax scams and what to do if you find out you are a victim.

ax season is here, and though you technically have until April 15 to file your returns, you might want to submit yours sooner than that — at least if you want to avoid potential identity theft (and a whole lot of hassle).

Tax-related identity theft is a growing problem in America, and the more security breaches, information hacks and digital business we do as a society, the more consumers who fall victim to it. In fact, in 2016 alone, thieves stole more than $21 billion in tax refunds as a result of this simple, yet clever, form of identity theft.

Have you fallen victim to Tax ID Theft and need help dealing with the financial ramifications? Or just want to know ways to prevent it from happening to you? This guide can help.

What is Tax-Related Identity Theft?

Tax identity theft occurs when someone files a tax return using your Social Security Number. In some cases, thieves do this in order to claim a fraudulent tax refund. In others, they may have used your SSN to obtain employment. When this occurs, their employer will report all income to the IRS using that SSN. When you don’t report that same income on your own return, the IRS will flag it as suspicious and require you to pay taxes on that additional income. It may even lead to a tax audit.

Victims of tax-related identity theft face serious financial ramifications. Not only are they unable to file their own returns (or claim their tax refund), but it also may indicate other financial vulnerabilities are at work. Unauthorized loans, credit cards and other accounts may have been opened using the victim’s identity. Victims are typically encouraged to freeze their credit when tax-related identity theft occurs. They may also need to work with creditors and credit reporting agencies to clear their name of any fraudulent activity.

How Does Tax Identity Theft Happen?

Generally, tax-related identity theft — and all identity theft, for that matter — occurs after a person’s sensitive information has become public or fallen into the wrong hands. This often happens due to security breaches or digital data hacks, like the recent ones involving mortgage dataQuora users and Marriott/Starwood Hotels customers.

Tax-related identity theft often occurs in February and early March, as thieves must file the fraudulent returns before the real taxpayers file their legitimate ones. Fortunately, the IRS is taking steps to reduce identity theft from many angles. The agency has hired more employees dedicated to stopping fraud, implemented additional safeguards and also changed many of the standards used to file and authorize returns. Despite these efforts, tax-related identity fraud does still occur — and it’s important everyday Americans are ready should it happen.

How to Know You’ve Been Victimized

If you’ve fallen victim to tax-related identity theft, there are several ways you might learn of it. First, your legitimate tax return may be rejected. When you go to e-file your tax return, the IRS will reject it if a return has already been filed for your Social Security Number. If you filed a paper return, you would get a rejection notice in the mail, alerting you that your return has already been filed.

In the event the thief used your SSN to obtain a job, you likely won’t learn of the issue until your returns have been filed and processed. Once the IRS sees that your reported income does not match the income reported by employers to your Social Security Number, they will send you a later saying you failed to report income or that you owe additional taxes.

It’s important to note that all communications from the IRS will come via mail. The agency will not call, text or email you regarding your returns or any suspicious activity. Do not provide sensitive information to anyone pretending to be an IRS agent via these methods and report the issue to the U.S. Treasury Inspector General for Tax Administration.

What to Do Next 

If you discover that you are the victim of tax identity theft, you’ll need to report it to both the IRS and the Federal Trade Commission.

Specifically, you’ll need to:

  • Fill out Letter 5071C, if you’ve received it. The IRS may send you Letter 5071C if it flags your return as suspicious or suspects fraud has been committed. This form requires you to verify your identity and breaks down the steps for doing so. Follow these directions exactly and take any additional steps recommended once your identity has been confirmed.

  • Use Form 14039 to alert the IRS of the issue. Fill out the form, along with a copy of your Social Security card and driver’s license, to Internal Revenue Service, P.O. Box 9039, Andover, MA, 01810-0939. Make sure to send the letter by certified mail to ensure it arrives safely and untampered with. If you received a notice in the mail, include this with your letter as well.

  • Apply for an Identity Protection PIN. These are six-digit numbers that the IRS will use to confirm your identity on all future returns and filings.

  • Notify the Federal Trade Commission. File an identity theft report at IdentityTheft.gov in order to alert the FTC. This website can also help you create a plan of action for responding to identity theft.

  • Contact your state tax agency. There may be additional steps your state requires when identity theft occurs.

If you tried to e-file and got rejected, you should go ahead and file your paper return and pay any taxes you owe via mail. If at any point you need help in the process, call the IRS Identity Protection Specialized Unit at 800.908.4490 for assistance. An agent can walk you through the appropriate steps to both report and respond to the theft.

The Road Ahead – Rebuilding Your Credit and Finances

Though the IRS says it typically takes 120 days or less to address cases of identity theft, according to USA Today, it often takes as many as 278 days to resolve a claim and get your legitimate refund.

This doesn’t even include the time and resources needed to address other consequences of identity theft — such as unauthorized loans, credit cards, purchases and more. Depending on how deep the theft goes and how available your personal information was, the financial ramifications can often last months or even years.

The important thing to do is to remain vigilant. This means:

  • Pulling your credit report and monitoring for suspicious financial activity. Look at your credit report and make sure there are no unauthorized accounts or loans to your name. Contact the creditors and close these if necessary. You should also check with your banks and lenders to ensure there is no suspicious activity. If there is, dispute the charges and follow the steps to have those waived from your accounts.

  • Placing a fraud alert on your credit profile. Contact one of the three major credit reporting bureaus (Experian, TransUnion or Equifax) and ask that a fraud alert be placed on your record. This can prevent thieves from opening up new credit cards or loans in your name. You can also request a total credit freeze if you want to be extra safe.

  • Considering credit monitoring. Though these services come at a fee, they can help you keep tabs on your credit profile — as well as any changes that occur on it.

  • Working with the Social Security Administration. Report the identity theft and take any additional steps recommended. In severe cases, you may need to apply for a new Social Security Number.

  • Continuing to work with the IRS and FTC as necessary. Respond quickly to any FTC or IRS request. Any delays could delay the resolution of your case and the delivery of your refund.

In some cases, you may want to involve a lawyer — especially if your investments, retirement accounts, mortgage or other major financial products have been affected. They can help you traverse the legal issues that crop up with creditors, lenders and financial institutions along the way.

Your Options for Financial Recovery 

Many victims of tax-related identity theft experience cash flow issues or must deal with additional debt as a result of the experience. They also may be unable to take out traditional loans or credit accounts due to the impact the theft has had on their credit score and profile.

When this occurs, victims have these options:

  • A Tax Advance Loan – Tax Advance Loans (TALs) give you an advance on your projected refund. While sometimes helpful, these aren’t the best idea if your refund is small. They can also impact your credit score and often require a significant chunk of your refund to secure.

  • A personal loan – Personal loans can offer access to more cash, as well as more lenient (and longer) repayment terms. These can be especially helpful for victims hit hard by their identity theft.

  • Credit-builder loans – These loans are beneficial if your credit score was severely impacted by the theft. Typically offered through community banks and credit unions, they help you improve your score by reporting your consistent payments to credit bureaus.

  • Secured credit cards – If the identity theft required you to close your credit accounts, a secured credit card can be a good option. These require you to deposit money up front, as collateral. They then function like traditional credit cards, while also helping you establish good credit standing (as long as you pay on time, every time).

  • Help from loved ones – In many cases, family members, friends and other loved ones are willing to provide financial help. They might offer no-interest loans or even gifts to help you get through your rough patch.

There’s always the option to wait it out, too. If the damage was minimal or you weren’t relying on your refund for financial stability, you may be able to await the IRS’ resolution of your case.

Reducing Your Risk

If you aren’t already the victim of tax-related identity theft, you should take action to ensure you never become one. This means protecting your personal information, shredding sensitive documents and using strong passwords on all online accounts.

You can also:

  •  Lock your mailbox.

  • Use a secure computer on a secure network when e-filing.

  • Check your credit report annually for suspicious activity.

  •  Install a firewall and antivirus software on your computer.

  • Learn how to recognize phishing emails and fraudulent requests for information.

  • Keep sensitive documents (like your Social Security card) in a safety deposit box.

  • Only provide your Social Security Number when absolutely necessary.

You should also file your returns as early as possible. A fraudster cannot file a return using your Social Security Number if one has already been filed. Make it a point to file your taxes as soon as you have the information necessary to do so.

Elderly Bruising: Risk Factors & Prevention

As we care for our elderly patients we sometimes notice bruising. Although we are always on the lookout for any signs of abuse, sometimes these are totally unrelated and may be something as simple as the patient bumping something, especially if they are on blood thinners. Here is an article from “A Place for Mom” that explains a bit more about bruising in our elderly population.

Our bodies undergo a series of natural changes as we age-externally and internally. Our skin cells divide more slowly and skin begins to thin. Skin retains less moisture, causing it to become dry, scaly, and appear wrinkled. It loses its elasticity and instead of springing back, starts to sag. The skin’s ability to repair itself diminishes, and wounds are slower to heal. Blood vessels also become more fragile and it becomes more common for the elderly to bruise. Certain conditions, diseases, or medications also play a role in elderly bruising.

Bruises result when trauma or a blow to the body damages or ruptures tiny blood vessels under the skin. In most cases, bruises occur as a result of an injury or a fall, or when people bump into things. Not only are the elderly more prone to bruising, less force is required to cause a bruise. For example, doctor visits involving intravenous (IV) procedures often make their mark in the form of bruises in older patients, while they may not in younger ones. With greater impact, deeper bruises of the muscles or bone can happen, which take longer to heal.

The medical term for a bruise is contusion. Ecchymosis is the visible skin discoloration caused by the ruptured blood vessels in the tissue near the skin’s surface. If a bruise increases in size and becomes swollen and hard, it may be a hematoma, a localized collection of blood which becomes clotted or partially clotted.


It may be difficult to prevent elderly bruising, but Dr. Aarthi Anand, a board certified geriatrician and family medicine practitioner based in Los Angeles, suggests taking the following precautions:

  • Remove furniture or other obstacles to create a clear path for your loved one to move around in their personal space so they may potentially avoid bumps or falls.

  • Assist loved ones with sitting and standing if they are likely to fall.

  • Discuss the use of a cane or walker with a doctor if your loved one appears unstable while walking, or when trying to sit or stand up.

  • Install handrails where possible for additional support.

  • Be alert about potential signs of elder abuse.


Medical treatment is not usually necessary since the body eventually reabsorbs the blood, and bruises tend to fade away within two to three weeks. Elderly bruising, however, can take several weeks, even months to go away. The pattern is somewhat predictable, beginning with the appearance of a reddish mark as the blood appears under the skin, which turns bluish-black or purple as the red blood cells break down, then yellowish green to a lighter brown before it gradually disappears.

To speed the healing process, Anand says that it is important to apply a frozen compress (for twenty minutes at a time) and elevate the bruised area to a level higher than the heart in the first twenty-four hours to keep swelling and inflammation to a minimum. This can help to reduce the size of a bruise by slowing the amount of blood that leaks into the tissues. “Then apply a warm compress to increase circulation, and rest to reduce the pressure on the affected area,” she says.


“When bruising is related to a serious medical condition, generally it is other presenting symptoms that an elderly patient comes in for. But it is important to seek medical attention if significant bruising occurs since in some cases it can reveal health issues,” Anand says. Leukemia and other diseases that affect the blood and platelets can lead to more severe bruising. Individuals with diseases of the liver may also experience easy bruising since the liver is responsible for producing blood-clotting factors. The risk of blood clots increases with age, as does the likelihood of conditions such as atrial fibrillation (irregular heart rhythms), which is associated with clotting and strokes. Deep vein thrombosis, in which blood clots form in the veins of the lower leg and thigh and travel through the bloodstream and lodge in the brain, lungs, heart, or other areas, can be caused by prolonged sitting or bed rest.

Several medications may contribute to elderly bruising. Anticoagulants such as Coumadin® (warfarin) help prevent clotting by thinning the blood, lowering the chances of heart attack and artery blockages that may cause strokes, but also increasing the possibility of bruising. Seniors taking Plavix® (clopidogrel bisulfate) for heart disease and stroke may experience the same effects. Common over-the-counter medications such as ibuprofen, aspirin, antidepressants, asthma medications, and cortisone medications may also increase the chances of bruising.


According to the National Center on Elder Abuse (NCEA), the term “elder abuse” refers to any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable older adult. Statistics compiled by the NCEA indicate that elder abuse is on the rise. Frequent bruises and bruises that appear from rough handling such as deep finger print marks are some signs to watch for. In some cases, the elderly may not remember, or even realize, that they are being abused due to decreased pain perception and possible memory loss. Know the signs of elder abuse.

“Talk to your loved one and be observant of bruises,” suggests Anand. If bruising occurs with unknown cause, particularly if it is severe and extensive, or if a bruise hardens, increases in size, becomes more painful, or does not appear to follow the predictable healing pattern, contact a physician for an evaluation.

Update: January 2018

Preventive Measures May Reduce Challenges for Seniors as They Age

Most often when our agency is called in to help people it is because they have fallen, had a stroke or other sudden illness. This wonderful article from Home Care Daily News explains how it is so much more helpful to begin care when a senior first shows signs of declining ability. This can not only prevent a lot of these incidents, but can make care seamless when conditions change.

As people age, they will face increasing challenges. Many of these challenges will result in health issues and potential physical limitations. It’s a difficult challenge for some aging seniors to acknowledge their own limitations or even the prospect that their safety has become compromised with age. Unfortunately, if they don’t address these concerns as early as possible and seek help when necessary, they could be putting themselves in a potentially dangerous situation.

Insurance companies across the country have found that preventive checkups and other healthcare processes help to reduce the risk of costlier care in the future. This not only helps the insurance companies save money, it also keeps their clients healthier and safer.

The same concept can be used for those individuals who may have physical limitations or other health challenges that make it potentially dangerous for them to perform any number of basic daily tasks at home alone. Home care support services has often been a reactive service where it could become a preventive measure for some.

According to a Business Wire press release, Manage Complex and Chronic Care Conditions with Community Health Choice, it was noted:

“Houston-based Community Health Choice (Community) helps its Members answer these questions and take better and more informed care of themselves and their families, including people diagnosed with chronic conditions. Through its Community Rewards program even the healthiest Members receive benefits from simple yearly check-ups, and Members with chronic and life-threatening conditions are eligible for early-intervention and population health management services.

“We want our Members to receive the right care at the right time from the right care providers,” says Dr. Karen Hill, Medical Director and Senior Vice President, Community Health Choice.”

Receiving the right care at the right time is absolutely crucial, especially for elderly and disabled men and women who may have difficulties with Activities of Daily Living. In most cases, though, it isn’t until these Activities of Daily Living become either incredibly difficult or impossible to perform without assistance before reaching out to find a quality, qualified, and dependable home care agency or other provider.

Home care agencies may have an opportunity in this preventive light to connect with insurance providers and reach out to the general community around them to explain how and why these types of services could help aging seniors and others with difficulties with mobility avoid potential disaster in the future.

By taking active steps before an accident occurs, it can save time, money, and help some seniors avoid lengthy recovery processes and serious injuries.

The Importance of Keeping Seniors Socialized

This article from Seniorly has some great tips on why it is so important for seniors to stay socialized and a few tips on how to accomplish this.

.Whether living at home or in a senior living community, one of the critical needs in the lives of seniors is socialization. Unfortunately, many seniors live alone, and senior isolation is not an uncommon problem. This critical need can seem difficult to remedy when looked upon at face value, but upon inspection, it can be an easy dilemma to solve.

“The more participation in social relationships, the better overall health for seniors,” said Dr. John Rowe and Dr. Robert Kahn in their 1998 book “Successful Aging.”

They understood the importance of social seniors and of seniors who are engaged in the world around them. A 2011 study done by the University of Miami’s Global Business Forum showed that “lifestyle and attitude are significantly more important than genes in determining the vitality of one’s golden years.”

Seniors living at home who are experiencing the best in independent living can still be lonely at times. Those receiving care at home may receive communication and contact with others, but may not always get to spend as much time with those caregivers as they would like. It’s important for all seniors – if possible – to get out of the house and socialize with others.

While socialization is often thought of as a group activity or a crowd situation, it can often be something as simple as a visit from family or a shopping trip and lunch or time spent together. That time together can help ward off illnesses and boost the immune system, research has shown.

The Rush Alzheimer’s Disease Center in Chicago published a study in the Archives of General Psychiatry which states that lonely individuals may be twice as likely to develop the type of dementia linked to Alzheimer’s disease in late life as those who are not lonely.

"Humans are very social creatures. We need healthy interactions with others to maintain our health," says Dr. Robert Wilson, a researcher involved in the study. "The results of our study suggest that people who are persistently lonely may be more vulnerable to the deleterious effects of age-related neuropathology."

The importance for seniors to socialize is well documented. But, again, some people have difficulty determining how to go about accomplishing that goal, even though the benefits of it are easily found.

Individuals in assisted living or memory care communities may have the greatest challenges in getting out in order to socialize, but they, too, can find that joining activities within their communities will provide them with opportunities to meet others and to participate in activities that stimulate their minds. Activities involving physical movement are especially beneficial.

For those who have an independent living situation and receive care at home, a drive with a friend or family member dinner at a restaurant can be the perfect outing. Or volunteering with a local Boys and Girls Club to be a grandparent to a child in an Adopt-a-Grandparent program can be extremely rewarding to both the senior and the child.

Most cities have a Senior Center where individuals can attend classes or lectures. Learning new skills is positive for everyone. The Senior Center can also be a good place to learn about volunteer opportunities nearby. The healing effects of giving back to a community have also been proven to be especially beneficial for the lonely. Not only are seniors sharing their skills, but they are interacting with new people and building new friendships.

Social seniors are happy and healthy seniors, regardless of what type of senior living community they choose. It’s important to get out of the house and get involved. For more information and

5 Early Warning Signs of Pneumonia in a Senior

Pneumonia is a lung infection, and very tricky in older adults.

It’s still caused by either a bacterial or viral infection that inflames the air sacs in one or both lungs.

Unfortunately, many tell-tale signs commonly associated with pneumonia in adults under the age of 65 are often not present in older adults. Older adults often have fewer and more mild symptoms. For example, the phlegm-ridden cough and high fever accompanied with teeth-chattering chills often associated with pneumonia is often non-existent in older adults. So we have to look for other signs.

Two red-flag signs of pneumonia in older adults are confusion and/or delirium, as well as a lower than normal body temperature.

Other signs, which can sometimes be confused with cold and flu, include:

  • Chest pain during breathing or coughing

  • Feeling tired or weak

  • Nausea and/or vomiting

  • Diarrhea

  • Shortness of breath

It can be hard for family members tasked with providing care to spot these symptoms.

Keeping your loved one healthy

There are a few easy steps to avoid complications and minimize the risk of pneumonia.

To avoid complications, experts recommend:

  • Rest, rest and more rest. Remember, pneumonia is sneaky and can recur. Just because your loved one feels better, he or she may not be fully recovered. It is generally better not to jump back into a normal routine until you are positive he or she is recovered. Not sure? Ask a doctor.

  • Stay hydrated. Drinking water will help loosen the mucus in your loved one’s lungs, clearing them sooner.

  • Finish medication. It is always important to take all prescribed medications. With pneumonia, doing so is particularly important as bacteria can stay in the lungs, multiply and trigger a recurrence.

Living a healthy lifestyle can greatly reduce the risk of contracting pneumonia, so it’s not a bad idea to help encourage your loved one to start doing so if they haven’t already.

If you’re a caregiver for your elderly loved one and live far away, or can’t be there 24/7, you might worry about catching warning signs like these. Read more in Don't Wait for the Holidays: How to Be Proactive About Staying On Top of Your Elderly Parent's Care.

Financial protection for Seniors and those with Alzheimers

We have all dealt with the annoyance of phone calls that we instantly know are scams, but what happens when these calls are received by a senior with memory problems? Dishonest people love to target seniors as they are most likely to fall for a scam, especially if they think a member of their family is in trouble, or that they have the opportunity to get some exceptional deal. This article from creditcards.com gives some great tips on how you can protect your senior loved ones from a scam that could potentially ruin their credit or worse.

Credit problems and identity issues can be difficult to guard against during the best of circumstances, but for someone with a diagnosis of Alzheimer’s disease – a form of dementia that affects thinking, memory and behavior – preventing identity theft and maintaining good credit can seem impossible.

As many as 5.5 million Americans were living with Alzheimer’s disease in 2017, according to the Alzheimer’s Association. The number of Alzheimer’s victims is on track to triple by 2050, meaning up to 16 million Americans could be living with the disease.

For many individuals, money management problems such as unpaid or unopened bills, extraneous or unusual purchases and numerous ATM cash withdrawals are common financial symptoms of Alzheimer’s or dementia. . These types of smaller infractions could negatively affect an Alzheimer’s patient’s credit or make them easy targets for identity theft.

Alzheimer’s disease and dementia both take a physical and emotional toll on every family they touch. Fortunately, there are a few ways to lessen or eliminate the financial risks associated with Alzheimer’s and dementia.

Set up a living will

You can take legal steps to help prevent loved ones with Alzheimer’s disease from making devastating financial mistakes. Soon after a diagnosis, contact an attorney, advises Howard S. Krooks, former president of the National Academy of Elder Law Attorneys and partner with Elder Law Associates PA in southeast Florida. Krooks recommends acting on the following as soon as possible:

  • Appoint a durable power of attorney (POA) for finances. 

An individual has the authority to make financial decisions on another person’s behalf with a POA. However, a POA is created before a person becomes incapacitated and doesn’t involve the courts. Many times, people give their agent (the individual acting on their behalf) legal authority over finances, but ultimately, can grant their agent as much power as they wish. For example, the agent’s authority may be limited to filing taxes and that’s it. The decision to go with a POA may be dependent on how advanced the individual’s Alzheimer’s or dementia has progressed.

  • Establish a revocable trust. 

With a revocable trust, a family member or other trusted individual is put in charge of the assets of the person with Alzheimer’s. Since the trustee would manage the money, the person with Alzheimer’s disease would need to confer with the trustee before making large expenditures, says Krooks.

  • Set up a conservatorship. 

If the Alzheimer’s disease has become so advanced that the person is unable to make sound decisions, another legal recourse is to convince a judge that the person is incapacitated or unable to manage his or her own affairs. If a judge agrees, a guardian or custodian would be appointed as a conservator to make decisions on the person’s behalf and take control of his or her checkbook and credit cards. A guardian would then have the legal authority to take financial action, such as canceling the person’s credit card account. Because your loved one would lose all control over his or her financial affairs, this option is typically a final resort.

Watch out for fraud schemes

Even if you do take legal precautions on behalf of an Alzheimer’s patient, fraud is also a major hazard for Alzheimer’s victims. Unfortunately, fraud tactics in 2018 are more sophisticated than ever, and Alzheimer’s patients are often easy targets.

Thieves may peddle items as innocuous as magazine subscriptions or lottery tickets, and it’s possible that even these “smaller” charges can wreak havoc on an Alzheimer’s patient’s credit and finances.

According to the Federal Trade Commission, there are a few specific types of fraud in which Alzheimer’s patients and the elderly are most susceptible:

  • Medical identity theft: When an Alzheimer’s patient’s name or health insurance are used by a thief, it’s considered medical identity theft. A criminal may obtain prescription drugs, go to the doctor using your loved one’s insurance card, and so on. You can guard against this by helping your loved one keep track of health plan statements or Medicare Summary Notices. It’s important to check the name of the provider, the date of service and the actual service provided on all medical billing.

  • Estate identity theft: This occurs when a thief steals an Alzheimer’s patient’s assets and property. It can also occur after an individual is recently deceased (potentially an Alzheimer’s patient’s spouse), and the criminal collects tax returns, Social Security checks and other benefits. Unfortunately, due to the trappings of the legal system, it can take a long time for legitimate family members and executors to untangle an estate identity theft situation.

  • Tax fraud: When a Social Security or Employee ID number is stolen, a criminal can simply collect a victim’s tax return. Once a criminal has your loved one’s personal information to file a fraudulent tax return, he or she can turn around and use your loved one’s identity to commit other crimes as well.

  • Phone scams: When telemarketers contact Alzheimer’s patients by phone, it can spell disaster for any already-confused patient. Telemarketers are often on the hunt for a victim’s personally identifiable information (PII) and financial information, such as credit card numbers.

  • Military identity theft: This involves stealing service members’ personal information to claim military benefits, and it works a lot like medical identity theft.

  • Wire transfer fraud: This happens when a criminal obtains a victim’s personal information and/or online banking information to electronically transfer money from their financial accounts. These types of crimes can often go unnoticed for 30 days or more, or until the victim sees a bank statement.

How to protect loved ones

There are several steps you can take to protect a relative from solicitation, and prevention could be the most effective tool in your arsenal.

Put your loved one on the National Do Not Call Registry

The Federal Communications Commission (FCC) regulations prohibit telemarketers from using automated dialers to call cell phone numbers without prior consent. The Do Not Call Registry, operated by the Federal Trade Commission (FTC), is available at donotcall.gov. You can also call 1-888-382-1222 (TTY: 1-866-290-4236) from the phone number you’d like to register. Putting your loved one on the Do Not Call Registry ultimately protects them because once you’ve opted them out of all telemarketing inquiries, any solicitation your loved one does receive is most likely going to be fraudulent.

Opt out of credit or insurance offers

The Fair Credit Reporting Act (FCRA) allows consumer credit reporting companies to make offers, called “firm offers” of credit or insurance, to anyone, including Alzheimer’s patients. You can visit optoutprescreen.com to take your loved one’s name off any of these lists so they are not solicited.

Take advantage of credit freeze laws

Spurred by consumer complaints about identity theft and fraud, all states have enacted credit freeze laws that allow victims of identity theft to bar new credit. Most states allow all consumers to freeze their credit.

Credit freezes, also known as security freezes, place a lock on access to a borrower's credit report. With a credit freeze in place, lenders and other companies cannot view the borrower's credit. Freezes prevent your loved one from gaining access to new loans such as credit cards and mortgages and also keeps fraudsters from opening new accounts in that person's name.

In many states, it’s the law that you have to be a conservator in order to freeze an elderly person’s credit.

On September 21, 2018, which also happens to be World Alzheimer’s Day, a new federal law will be put into effect that will allow free credit freezes and year-long fraud alerts. (Right now, credit freezes typically involve fees, and the actual laws themselves also vary.)

How to build up credit

If the unthinkable happens and an Alzheimer’s patient unwittingly destroys his or her credit by missing payments or accidentally taking advantage of multiple credit card offers (and maxing out all credit cards in the process) there are some steps you can take to reinstate a good credit score.

  • Set limits on transactions by giving your loved one a prepaid debit card, which allows him or her to make purchases only in smaller increments and are also front-end loaded with smaller amounts of money. You’ll also be able to set spending limits on a prepaid debit card and prohibit huge purchases.

  • Monitor banking activity through an Alzheimer’s patient’s bank, checking online frequently for any out-of-the ordinary transactions. If you have a joint account or if you have financial power of attorney, some banks will require two signatures if the person with Alzheimer’s disease makes a withdrawal above a certain amount.

  • Utilize automated bill-payment systems through your bank for services such as utilities, phone, internet as well as the mortgage and more. That way, your family member won’t accidentally pay the same bill twice.

  • Utilize the authorized user option on a credit card. By allowing your loved one to become an authorized user on a credit card with you, you’ll be able to cap your credit card limit and put more restrictions on the credit card you’ll share. In addition, your family member wouldn’t be responsible for paying for the credit card — that responsibility would fall to you.

Document checklist

The book "If Something Happens to Me" by Joe Hearn was featured on The Simple Dollar. In one easy checklist, the author lists all important documents you should gather for your loved one and also highlights key questions to ask regarding his or her financial, legal and lifestyle situations.


Download the checklist.


The bottom line

A well-thought out legal plan (as well as thorough organization in general) are the best ways you can combat identity theft and credit issues with your Alzheimer’s or dementia patient.

What’s not widely acknowledged in most legal or financial guides is that these decisions can be heart-wrenching. In addition to legal support, it’s a good idea to garner emotional support for you and for all of your family members as well.

Families can visit the Alzheimer’s Association website for support and details about legal processes and documents for Alzheimer’s and dementia patients

Sleep Help For Seniors

This is a rather long, but very helpful article about why seniors don’t always get the sleep they need as well as how to help combat the most common causes!

It’s often assumed that the elderly have different sleep needs than younger adults, but in truth, sleep needs don’t change in adulthood. At any age, those precious 7-9 hours per night are still what’s required to be rested and ready for the day.

But just because older adults need the same amount of sleep doesn’t mean that they don’t face unique challenges in getting it. A study by the National Sleep Foundation found that 44% of older people have symptoms of insomnia more than once per week.

As people age, their sleep patterns change. Deep sleep becomes less common, and the variety and severity of sleep interruptions often increases. In this guide, we’ll give background about age and sleep and will review the key tips and resources to help older adults get the shut-eye that they need.

Sleep Needs as You Age

As we progress from infancy to childhood and through adolescence and young adulthood, our sleep needs are regularly changing and evolving. At these earlier stages of development, there’s no doubt that these needs are markedly different than what’s required later in life.

However, it’s common for people to assume that these sleep needs continue to change during adulthood. Experts say, though, that getting 7-9 hours of sleep remains important for adults of any age. For all adults, sleep is vital to physical and cognitive function and plays a multifaceted role in our overall health.

The issue that older adults face is that with age it gets harder and harder to get high-quality sleep. One of the main reasons is that older people experience changes to what experts call sleep architecture. This relates to the sleep cycle and how much time we spend in a deep sleep. When older people sleep, they spend more time in light sleep that is not as restorative for the body and that is more easily interrupted.

Insomnia and Aging

As lifespans have increased and a new wave of the population enters old age, there has been a growing focus on understanding the sleep difficulties faced by this demographic group. Research has shown that insomnia — which can be understood as regularly having difficulty getting to sleep or staying asleep — is a major issue among the U.S. population over the age of 60 as nearly half of people of this group reported having experienced this problem.

While sleep is important at any age, health professionals and researchers are also gaining an understanding of the relationships between sleep and aging. For older people, many of the effects of insomnia are similar to those that can occur in younger adults, but they may be exacerbated by other coexisting medical conditions. Some of the symptoms and consequences of insomnia and sleep deprivation in older people include:

  • Daytime drowsiness: a lack of sleep overnight can cause physical tiredness and a tendency to doze off during the day. This and a related lack of alertness heightens the risk of dangerous situations like falls and automotive accidents.

  • Cognitive issues: insomnia in older people has been linked to higher levels of memory loss and confusion that can complicate many aspects of daily life.

  • Irritability: insufficient sleep can affect mood, triggering a propensity to be easily frustrated or irritated.

  • Depression: persistent sleep deprivation can play a role in causing or worsening depression, which is already often an issue among the elderly.

  • Cardiovascular problems: studies have shown a relationship between insomnia and cardiovascular conditions like hypertension (high blood pressure) and the risk of stroke. These risks are greater in people who suffer from untreated sleep apnea.

  • Heightened risk of chronic diseases: studies continue to show that lack of sleep can contribute to chronic health problems related to weight, as well as immune function, metabolism, and the endocrine system.

Many of the health- and body-related issues that affect insomnia in older people have overlapping effects. The body is a system, after all, and sleep is affected by and affects many other issues. This can create a negative feedback loop in which lack of sleep exacerbates an underlying health condition that itself can make it harder to get a good night’s sleep.

Causes of Insomnia in Older Adults

Before we can talk about why insomnia affects older adults, it’s important to recognize that there are two main types of insomnia. One type relates to not being able to fall asleep. A number of issues can contribute to this, and many of these are more common in the elderly. For example, chronic pain may interfere with finding a comfortable sleeping position, and older adults are more likely to have the type of health conditions — such as arthritis — that cause chronic pain. Restless Leg Syndrome (RLS), a condition more common in older people in which people report tingling or itching in the legs, can also be a barrier to falling asleep. Furthermore, older adults often take many prescription medications, and some of these can make it harder to fall asleep.

A second type of insomnia relates to problems staying asleep. One factor contributing to this type of insomnia in older people is the change to sleep architecture that we described previously. Because older adults spend less time in deep sleep, they are more prone to interruptions and waking in the night. These interruptions may be more numerous for older people for several reasons:

  • Health conditions that affect urinary control and frequency may cause older people to wake up more frequently to go to the bathroom.

  • Obstructive sleep apnea (OSA), which is characterized by periods of halted breathing in the night, is more common in older people and can cause someone to wake up in the night. OSA is also related to a number of cardiovascular concerns.

  • Snoring, including snoring caused by sleep apnea, can cause sleep disruptions. Snoring is more common in this population because of age-associated atrophy of the muscles that control breathing and the airways.

  • Periodic Limb Movement Disorder (PLMD) is marked by involuntary movements during sleep that can cause someone to awaken.

  • REM (rapid eye movement) sleep disorder is another condition that involves involuntary movements that interrupt sleep.

  • Problems with thermoregulation (the body’s processing of maintaining a stable core temperature) can throw off the body’s typical sleep cycles. The natural rhythms of sleep typically line up with changes to our body temperature, so a decrease in thermoregulation can interfere with these cycles and make it more likely for a person to be awoken prematurely.

  • Many other medical conditions ranging from cancer to cardiovascular conditions to depression can cause sleep disruptions, and many of these conditions are more common in the elderly.

Treating Sleep Problems in the Elderly

For all adults, dealing with persistent sleeping problems can be frustrating, confusing, and literally tiresome. There are not always simple or fast-acting solutions to getting more sleep, and sometimes many factors are at work in causing insomnia. The good news is that in many cases, there are steps that can be taken to help older people fall asleep and stay asleep.

See Your Doctor

An important first step can be to talk with your doctor. In a significant number of cases, insomnia is caused by an underlying health condition or by a medication that you’re taking. Your doctor can start by reviewing your health history and list of current medications. If you have an already-diagnosed health condition, the doctor can address whether there are any other treatments that may be available to try to manage it. If you haven’t been diagnosed with any health issues that might be causing insomnia, your doctor can begin an appropriate diagnostic process to try to bring you relief. In most cases, resolving or mitigating a coexisting health problem can stop or substantially reduce insomnia.

Talking with your doctor is especially important if you have experienced any symptoms of sleep apnea. Because this condition can be related to a number of serious medical problems, diagnosing and managing it can improve your sleep and your overall health. Sleep apnea can usually be resolved by wearing a positive airway pressure (PAP) device at night. The most common of these is a continuous positive airway pressure device (CPAP). The CPAP maintains a flow of air through a mask that prevents the obstruction of the airway. It can take some time to adjust to wearing the mask, but today’s masks are lighter and better cushioned than in the past. People with sleep apnea typically adjust to using the CPAP within a few days and find that they get dramatically better sleep.

Talk Therapy

Another way that your doctor can help is by offering a referral to a mental health counselor. Or if you already have a counselor that you work with, be sure to let them know about your sleep problems.

In some cases, the underlying conditions that are affecting sleep are psychological. Issues like depression and anxiety, even if they are mild, can play a role in sleeplessness. A type of talk therapy called cognitive behavioral therapy for insomnia, which is abbreviated CBT-I, can involve a number of types of discussion and reflection. Studies support the effectiveness of CBT-I led by a trained professional. It can help to work through underlying issues and pave the way for more consistent and restful sleep.

Be Wary of Sleep Medications

Many people suffering from sleep difficulties immediately think about medications as a way to help them sleep. Taking drugs to help with sleep problems is referred to as pharmacotherapy, and this includes both prescription and over-the-counter sleep aids. Remember that medications like these, even when they bring some relief, are not a cure for insomnia. Pharmacotherapy typically is not the best way to deal with sleep problems for a few reasons.

First, even though drugs may have strong effects at the outset, they usually become less and less effective over time. The amount of time this may take can vary based on the person and the medication, but diminishing returns are common. Second, sleep medications can be habit-forming. Relying on a medication to get to sleep can create dependencies that make it harder to ever get back to falling asleep naturally. Third, as with most medications, there are side effects, some of which can be serious. One of the most common is a grogginess or fogginess that can persist after having woken up. This can slow reaction times and raise the risk of falls or car accidents. Fourth, detailed research studies are not available for many pharmacotherapies. While broad studies may have been conducted, those studies usually do not provide specific guidance about the drug in terms of its interactions with other drugs, about its effects on people with coexisting medical conditions, about how it influences sleep architecture, or about its safety and efficacy in this particular demographic group.

If you do decide to use a sleep medication, whether it be prescription or over-the-counter, talk to your doctor first. Your doctor is in the best position to address any potential concerns or instructions for using these medications in your situation.

Improving Your Sleep Without Medications

Besides treating any underlying medical issues that can contribute to insomnia, there are a handful of other steps that you can take to improve your ability to get good sleep.

Physical activity: studies have indicated that adding regular exercise to your day may help with sleep problems. You want to make sure to exercise at least 3 or more hours before bedtime, and it is also helpful to consult with a health professional before beginning a new exercise routine. This can help to ensure that your exercises are appropriate given your overall health and any coexisting medical conditions.

Light therapy: this approach, also known as bright light therapy or phototherapy, exposes you to what is usually a bright light tinged with blue. This can help to modify and improve circadian rhythms in ways that may decrease insomnia.

Watch when you eat: having a late, heavy dinner can make it harder to fall asleep. Try to avoid eating anything heavy for at least a few hours before you plan to go to bed.

Go easy on alcohol: though some people think that alcohol makes them sleepy, it disturbs sleep architecture and can make it harder to get a truly restful night’s sleep. Being mindful and moderate in alcohol consumption can help avoid this.

Don’t overdo caffeine: caffeine is a stimulant that is well-known for its ability to help people stay awake. It can take many hours for caffeine to be fully metabolized, so avoid drinking caffeinated drinks after the morning as they can contribute to sleeping problems in the evening.

Sleep Hygiene

Other steps that you can take all revolve around creating routines that are designed to accommodate a healthy sleep schedule and environment. Collectively, these things are often referred to as sleep hygiene, and we’ve described some of its key elements below.

Have a regular sleep schedule: try to go to bed and wake up at the same time each day, even on weekends. This can help your body get acclimated to a specific timeline that promotes a full night’s rest.

Avoid afternoon naps: taking a nap in the afternoon may seem refreshing, but it often makes it more challenging to fall asleep at night.

Avoid screen time in bed: the light from electronics like mobile phones, laptops, and tablets all stimulate the brain in a way that has been found to make it harder to fall asleep. Try to only use these devices in other rooms of your home.

Comfy sleep setting: make sure that your bed is inviting and supportive. This includes having a quality mattress, comfortable bedding, and nice pillows. Retiring to bed at night should feel like a treat and not a chore.

Simplify getting in and out of bed: if you have issues with this, consider getting bed rails to help you make the transition from standing to lying down and vice versa.

Control your environment: temperature, lighting, and noise in your bedroom can all influence how well you sleep. Set the thermostat to a comfortable level, use heavy curtains if needed to keep out excess light, and consider using earplugs and/or an eye mask to prevent being disturbed when you go to bed.

Follow a bedtime routine: it helps to have consistency in the lead-up to going to bed. This routine can include the basics like brushing your teeth as well as other things like stretching or deep breathing for relaxation.

Information About Older Adults With Alzheimer’s Disease

There are numerous symptoms of Alzheimer’s Disease (AD), and many of these can cause sleep problems ranging from excessive to insufficient sleep. Restlessness, confusion, and yelling can all occur frequently in the night for patients with AD.

Many of the same strategies and tips that are discussed in the prior section are equally applicable for patients with AD. This includes the general recommendation to avoid sleep medications as a first line of therapy and to develop high-quality, consistent sleep routines.

Because of the cognitive effects of AD, the greatest benefit may come from caregivers being educated and informed about these treatments for insomnia and other sleep problems. Caregivers can also put these tips to use in their own lives as part of their self-care. Another important consideration for caregivers of patients with AD is removing potential dangers from the patient’s sleep environment. For example, this can include keeping the floor clear of tripping hazards, keeping medicines safely locked up and stored away, and placing gates or barriers near stairways.

Additional Resources

For older people who are looking to keep learning about this topic, we’ve included a host of resources below. These include products that may be useful, links to other organizations, and places to find more information from quality sources.

Sleep-Related Products

LumaRail Bed Assist Rail: this adjustable bed rail with a built in LED light can be secured under the mattress and provides an extra grip for getting in and out of bed.

Stander 30″ Safety Adult Bed Rail with Swing Down Assist Handle: this product is a sizable bed rail that can pivot into a flat position when needed. This product also comes with a lifetime guarantee.

Bed Wedge Pillow with Memory Foam Top by Cushy Form: this wedge pillow can help to elevate either your upper or lower body depending on different health issues that you may be dealing with.

Alaska Bear Natural Silk Sleep Mask: this well-reviewed mask can be used to help keep light out of your eyes when you’re going to sleep


Online Communities, Support Groups, and Organizations

BenefitsCheckUp: this website from the National Council on Aging helps seniors find support services and other resources in your area.

Anxiety and Depression Association of America: the “Finding Help” section of this organization’s website offers resources for getting support from professionals and from other people when dealing with issues like insomnia, depression, and anxiety.

Alzheimer’s Association: this group has a broad mission that includes supporting research and providing helpful tools to patients and caregivers. Their website includes message boards where caregivers can connect with one another.

Further Reading

“Sleep Older” by UCLA Health

“Alzheimer’s Caregiving” by the U.S. National Institute on Aging

PubMed: A Search Tool For Scientific Publications


Mobile Apps

AARP Now: this is the official app of the American Association of Retired Persons and helps provide information about the benefits of membership in this organization and about local events and workshops.

Sleep As Android: this app for Android only offers sleep tracking, gentle wake-ups, and other sleep-related features.

Sleep Cycle: this app for iOS and Android includes motion monitoring plus tools to help you wake up more well rested.



Smart Homes Increasing the Reach of Home Care

By Valerie VanBooven, RN BSN, Editor in Chief of HomeCareDaily.com | August 24, 2018

With the explosive growth of the ‘Internet of Things’ (IoT), a network of devices that are connected to the Internet, which can include basic devices like laptops and tablets but also dishwashers, TVs, washing machines, and so much more, it’s possible to control numerous devices from home or away. It’s also making it more likely that people who need some level of care at home can receive remote assistance and monitoring.

Smart homes (homes that are connected through technology as a means of scheduling services, turning on and off lights, etc.) provide greater flexibility and opportunity for someone who may need direct health care to remain home while getting healthy or staying safe.

Digital health vendors are capitalizing on these smart home technologies and it’s providing elderly and disabled people more choices when it comes to potential long-term health issues.

As reported by Telecoms Tech News, in its blog, How smart homes are enabling new models for healthcare, written by David H. Deans:

“However, digital health vendors are striving to take telehealth to the next level by developing solutions that will allow caregivers to check on the health of all the residents of the house, not just the patient’s, monitor diet and nutrition, the environment, and overall wellness, and be integrable with existing and newer systems.

“Patients are conscious of their health quotient and want to be involved in the wellness and disease management,” said Sowmya Rajagopalan Global Program at Frost & Sullivan. “With consumerization of healthcare, enabling patients to clinically manage their disease at home has been of crucial importance for care providers and OEMs today as they have made this a reality with the launch of innovation in design, devices, services, and solutions.””

As people become more aware of their health and various options for short and long-term care, as well as the benefits of being at home, especially for longer duration ailments, these technologies open more avenues through which patients can be cared for. It also allows doctors, hospitals, and home care aides greater tools to offer improved access to care.

Not all homes are considered ‘smart homes’ (in fact, it’s only a small percentage throughout the country that qualify as a ‘smart home’), but more and more devices, appliances, and other opportunities are coming to light each year and that’s making it more possible to provide better care and support to a growing number of people who prefer to age in place or stay home as opposed to being in a care facility for an extended period of time.

Elderly Urinary Tract Infections

Elderly UrinaryTract Infections


If a 30-year-old woman experiences painful burning when she urinates, it’s almost certain she has a urinary tract infection (UTI). But an elderly urinary tract infection rarely causes such clear symptoms and might not involve pain or discomfort at all. “As you get older your immune response changes; it’s part of normal aging,” says Anna Treinkman, a nurse practitioner at the Rush Alzheimer’s Disease Center in Chicago and president of the National Conference of Gerontological Nurse Practitioners.


A sudden change in behavior is, in fact, one of the best indicators of a urinary tract infection in older adults. Some common warning signs might include the onset of elderly urinary incontinence, confusion or not being able to do tasks the patient could easily do a day or two before. “Anytime there’s a change in an older adult… if one day they’re able to dress themselves or feed themselves and then there’s a sudden change, a red flag should go up in a caregiver’s mind,” Treinkman says.


Half of all women will develop a urinary tract infection in their lifetimes. Ranking as the body’s second-most common infection type, UTIs in women-and less often in men-account for about 8.3 million doctor visits each year, according to the National Center for Health Statistics. Typically, UTIs, also known as bladder infections, are easy to cure. But if left untreated, the infection can spread and develop into far more serious conditions. UTIs, for instance, are a leading cause of sepsis, a potentially life-threatening infection of the bloodstream.

“A bladder infection places stress on the body,” says Dr. Mary Ann Forciea, an associate clinical professor for the University of Pennsylvania Health System. That stress can result in confusion and abrupt changes in behavior in older adults with an elderly urinary tract infection. And for people suffering from Parkinson’s diseaseAlzheimer’s disease, or other dementia, “any kind of stress, physical or emotional, will often make dementia temporarily worse,” Forciea says.


The kidneys, ureters, bladder and urethra work together to rid the body of urine: the kidneys remove extra liquid and waste from the blood in the form of urine, the ureters carry the urine from the kidneys to the bladder, and the bladder stores the urine until it is emptied through the urethra.

An infection can occur when bacteria cling to the opening of the urethra and begin to multiply. UTIs are thought to be much more common in women because the urethra is shorter in women than in men, giving bacteria-which live in the rectal area and also on a person’s skin-an easier route into the body.

The most common diagnosis is iscystitis, or the infection and inflammation of the bladder, which causes frequent and painful urination. However, other parts of the lower and upper urinary tract system can become infected. As a general rule of thumb: the higher up the infection in the urinary tract system, the worse it is.

Other common causes of UTIs include the following:

  • Urethritis: Burning urination is often the result of urethritis, the infection of the urethra. In men, urethritis can also cause penile discharge.
  • Pyelonephritis: Pyelonephritis occurs when a bladder infection spreads to the kidneys. It can cause upper back and flank pain, shaking, chills, nausea and vomiting.
  • Toprostatitis: UTIs in men can lead toprostatitis, or enlargement of the prostate gland, the male organ that produces semen, which is located just below the bladder.

Symptoms of a UTI include general discomfort, a feeling of being over-tired, blood in the urine and pain even when not urinating. Men might feel fullness in the rectum. Back and side pain can indicate the infection has reached the kidneys. An elderly person will rarely get a fever, but if an older patient has one it is considered an emergency. “It shouldn’t be taken lightly,” Treinkman says. “If they do have a fever, it’s a serious infection.”


In most cases, diagnosing and treating an elderly urinary tract infection is relatively straightforward: a simple urinalysis can confirm the infection’s presence and, for someone in good health, antibiotics are the first choice of treatment. UTIs often clear up in only a few days. But depending on the age and health of the patient–and the severity of the infection–the course of treatment can take weeks and perhaps involve hospitalization for the administration of intravenous antibiotics. A doctor might also decide to “culture” a patient’s urine to determine the type of bacteria that’s growing to prescribe the most effective antibiotic for the condition.

Older adults living in a group setting such as senior communities or nursing homes are more likely to be resistant to the antibiotics most often prescribed for UTIs such as amoxicillin or nitrofurantoin, and might require something stronger, as well as a longer course of antibiotics to combat an elderly urinary tract infection.

Forciea says people suffering from UTIs must drink plenty of fluids to flush the bacteria from their systems. Proper fluid intake makes it harder for bacteria to live and multiply in the urinary tract. She recommends older adults drink four to six 8-ounce glasses of water a day. Drinking cranberry juice or taking cranberry tablets can also make urine less inviting for bacteria, Forciea says.

If your loved one’s symptoms are consistent with a bladder infection, it’s recommended that his or her healthcare provider be called for an appointment the same day that the symptoms are recognized. If it appears the infection might involve the kidneys, call the healthcare provider immediately to consult on whether a trip to the emergency room is necessary.


Older adults at greater risk for getting an elderly urinary tract infection include:

  • Those who require a catheter in the urethra and bladder
  • Those who are diabetics
  • Anyone with kidney stones
  • Women who’ve gone through menopause

After menopause, women experience a change in the lining of the vagina and also produce less estrogen, which helps protect against UTIs. Hormone replacement therapy (HRT) can help protect postmenopausal women from UTIs, according to the American Urological Association, but HRT may increase other health risks and so may not be appropriate for all women.

All women who have had a UTI at least once before are also at increased odds of developing the infection again. About 20 percent of women who’ve had a UTI will experience a second one, and 30 percent of those women will get a third.


Here are some common ways to diagnose a UTI:

  • Home Test: A dipstick is held in the urine stream. Home tests are a convenient way for chronic UTI sufferers to quickly diagnose whether they have an infection. But they should only be used with the support and guidance of a patient’s physician.
  • Ultrasound Exam – Ultrasoudns can help evaluate bladder and kidney problems as doctors are able to see whether there are abnormalities in the bladder that could be contributing to the infections.
  • X-ray: Using a series of x-rays and a contrast dye to highlight abnormalities in the urinary tract can help pin-point abnormalities.
  • CAT Scan: A CAT scan provides a detailed three-dimensional picture of the urinary tract.


Treinkman says UTIs are also more likely to affect people who attempt to manage stress incontinence by limiting their water intake. “They might limit the water they drink so they don’t have to go to bathroom so much,” she says. “But it puts them at higher risk because there’s a greater chance of bacteria build up… You want to keep your urine clear.”

Drinking plenty of water is an important prevention tactic. Some other methods for women include:

  • Urinating promptly after the urge arises
  • Wiping front to back
  • Emptying the bladder shortly before and after intercourse
  • Avoiding use of feminine products such as deodorant sprays, douches and powders in the genital area that could irritate the urethra
  • Taking showers instead of baths


Most importantly, Treinkman says that caregivers can’t be too careful when they notice a change in behavior in an older adult, no matter how subtle. “Falls, confusion, new onset of incontinence in someone who had been getting to the bathroom, decrease in appetite,” she says, “any of these can be a sign of a urinary tract infection. It really requires a detective-like index of suspicion from the caregiver.”

Caregiver Burnout. How to help you help your loved ones

In addition to our regular care, Walla Walla Valley in Home Care offers Respite and short term care.  This can be invaluable if you are taking a short trip or just need a break.  Read on to learn to recognize caregiver burnout and how we can help you combat it.

Caregiver Stress and Burnout

Tips for Regaining Your Energy, Optimism, and Hope

The demands of caregiving can be overwhelming, especially if you feel that you’re in over your head or have little control over the situation. If the stress of caregiving is left unchecked, it can take a toll on your health, relationships, and state of mind—eventually leading to caregiver burnout. And when you’re burned out, it’s tough to do anything, let alone look after someone else. That’s why taking care of yourself isn’t a luxury, it’s a necessity. There are plenty of things you can do to rein in the stress of caregiving and regain a sense of balance, joy, and hope in your life.

What is caregiver burnout?

Caregiver burnout is a state of emotional, mental, and physical exhaustion caused by the prolonged and overwhelming stress of caregiving. While caring for a loved one can be very rewarding, it also involves many stressors. And since caregiving is often a long-term challenge, the stress it generates can be particularly damaging. You may face years or even decades of caregiving responsibilities. It can be particularly disheartening when there’s no hope that your family member will get better or if, despite your best efforts, their condition is gradually deteriorating.

If you don’t get the physical and emotional support you need, the stress of caregiving can leave you vulnerable to a wide range of problems, including depression, anxiety, and eventually burnout. And when you get to that point, both you and the person you’re caring for suffer. That’s why managing the stress levels in your life is just as important as making sure your family member gets to their doctor’s appointment or takes their medication on time. No matter how stressful your caregiving responsibilities or how bleak your situation seems, there are plenty of things you can do to ease your stress levels, avoid caregiver burnout, and start to feel positive and hopeful again.

Signs and symptoms of caregiver stress and burnout


Preventing Burnout: Dealing with Overwhelming Stress

By learning to recognize the signs of caregiver stress, you can take steps to deal with the problem and prevent burnout. Or if you recognize that you’ve already hit breaking point, you can take action right away. Once you burn out, caregiving is no longer a healthy option for either you or the person you’re caring for, so it’s important to watch for the warning signs.

Common signs and symptoms of caregiver stress

  • Anxiety, depression, irritability
  • Feeling tired and run down
  • Difficulty sleeping
  • Overreacting to minor nuisances
  • New or worsening health problems
  • Trouble concentrating
  • Feeling increasingly resentful
  • Drinking, smoking, or eating more
  • Neglecting responsibilities
  • Cutting back on leisure activities

Common signs and symptoms of caregiver burnout

  • You have much less energy than you once had
  • It seems like you catch every cold or bout of flu that’s going around
  • You’re constantly exhausted, even after sleeping or taking a break
  • You neglect your own needs, either because you’re too busy or you don’t care anymore
  • Your life revolves around caregiving, but it gives you little satisfaction
  • You have trouble relaxing, even when help is available
  • You’re increasingly impatient and irritable with the person you’re caring for
  • You feel helpless and hopeless

While caring for a loved one will never be stress-free, the following tips can help you to lighten the load, avoid the symptoms of caregiver burnout, and find more balance in your life.

Avoid caregiver burnout by feeling empowered

Feeling powerless is the number one contributor to burnout and depression. And it’s an easy trap to fall into as a caregiver, especially if you feel stuck in a role you didn’t expect or helpless to change things for the better. But no matter the situation, you aren’t powerless. This is especially true when it comes to your state of mind. You can’t always get the extra time, money, or physical assistance you’d like, but you can always get more happiness and hope.

Practice acceptance. When faced with the unfairness of a loved one’s illness or the burden of caregiving, there’s often a need to make sense of the situation and ask “Why?” But you can spend a tremendous amount of energy dwelling on things you can’t change and for which there are no clear answers. And at the end of the day, you won’t feel any better. Try to avoid the emotional trap of feeling sorry for yourself or searching for someone to blame.

Embrace your caregiving choice. Acknowledge that, despite any resentments or burdens you feel, you have made a conscious choice to provide care. Focus on the positive reasons behind that choice. Perhaps you provide care to repay your parent for the care they gave you growing up. Or maybe it’s because of your values or the example you want to set for your children. These deep, meaningful motivations can help sustain you through difficult times.

Look for the silver lining. Think about the ways caregiving has made you stronger or how it’s brought you closer to person you’re taking care of or to other family members.

Don’t let caregiving take over your life. Since it’s easier to accept a difficult situation when there are other areas of your life that are rewarding, it’s important not to let caregiving take over your whole existence. Invest in things that give you meaning and purpose—whether it’s your family, church, a favorite hobby, or your career.

Focus on the things you can control. You can’t wish for more hours in the day or force your brother to help out more. Rather than stressing out over things you can’t control, focus on the way you choose to react to problems.

Celebrate the small victories. If you start to feel discouraged, remind yourself that all your efforts matter. You don’t have to cure your loved one’s illness to make a difference. Don’t underestimate the importance of making your loved one feel more safe, comfortable, and loved!

Get the appreciation you need

Feeling appreciated can go a long way toward not only accepting a stressful situation, but enjoying life more. Studies show that caregivers who feel appreciated experience greater physical and emotional health. Caregiving actually makes them happier and healthier, despite its demands. But what can you do if the person you’re caring for is no longer able to feel or show their appreciation for your time and efforts?

Imagine how your loved one would respond if they were healthy. If they weren’t preoccupied with illness or pain (or disabled by dementia), how would your loved one feel about the love and care you’re giving? Remind yourself that the person would express gratitude if they were able.

Applaud your own efforts. If you’re not getting external validation, find ways to acknowledge and reward yourself. Remind yourself of the good you’re doing. If you need something more concrete, try making a list of all the ways your caregiving is making a positive difference. Refer back to it when you start to feel low.

Talk to a supportive family member or friend. Positive reinforcement doesn’t have to come from the person you’re caring for. When you’re feeling unappreciated, turn to friends and family who will listen to you and acknowledge your efforts.

Ask for caregiving help

Taking on all of the responsibilities of caregiving without regular breaks or assistance is a surefire recipe for caregiver burnout. Don’t try to do it all alone.

Look into respite care. Enlist friends and family who live near you to run errands, bring a hot meal, or “baby-sit” the patient so you can take a well-deserved break. In-home services can also be provided by volunteers or paid help, either occasionally or on a regular basis. Or you can explore out-of-home respite programs such as adult day care centers and nursing homes.

Speak up. Don’t expect friends and family members to automatically know what you need or how you’re feeling. Be up front about what’s going on with you and the person you’re caring for. If you have concerns or thoughts about how to improve the situation, express them—even if you’re unsure how they’ll be received. Get a dialogue going.

Spread the responsibility. Try to get as many family members involved as possible. Even someone who lives far away can help. You may also want to divide up caregiving tasks. One person can take care of medical responsibilities, another with finances and bills, and another with groceries and errands, for example. 

Set up a regular check-in. Ask a family member, friend, or volunteer from your church or senior center to call you on a set basis (daily, weekly, or as often as you think you need it). This person can help you spread status updates and coordinate with other family members.

Say “yes” when someone offers assistance. Don’t be shy about accepting help. Let people feel good about supporting you. It’s smart to have a list ready of small tasks that others could easily take care of, such as picking up groceries or driving your loved one to an appointment.

Be willing to relinquish some control. Delegating is one thing, trying to control every aspect of care is another. People will be less likely to help if you micromanage, give orders, or insist on doing things your way.

Give yourself a break

As a busy caregiver, leisure time may seem like an impossible luxury. But you owe it to yourself—as well as to the person you’re caring for—to carve it into your schedule. Give yourself permission to rest and to do things that you enjoy on a daily basis. You will be a better caregiver for it.

There’s a difference between being busy and being productive. If you’re not regularly taking time-off to de-stress and recharge your batteries, you’ll end up getting less done in the long run. After a break, you should feel more energetic and focused, so you’ll quickly make up for your relaxation time.

Maintain your personal relationships. Don’t let your friendships get lost in the shuffle of caregiving. These relationships will help sustain you and keep you positive. If it’s difficult to leave the house, invite friends over to visit with you over coffee, tea, or dinner.

Share your feelings. The simple act of expressing what you’re going through can be very cathartic. Sharing your feelings with family or friends won’t make you a burden to others. In fact, most people will be flattered that you trust them enough to confide in them, and it will only strengthen your bond.

Prioritize activities that bring you enjoyment. Make regular time for things that bring you happiness, whether it’s reading, working in the garden, tinkering in your workshop, knitting, playing with the dogs, or watching the game.

Find ways to pamper yourself. Small luxuries can go a long way in relieving stress and boosting your spirits. Light candles and take a long bath. Ask your spouse for a back rub. Get a manicure. Buy fresh flowers for the house. Or whatever makes you feel special.


Laughter is the Best Medicine: Health Benefits of Humor

Make yourself laugh. Laughter is an excellent antidote to stress—and a little goes a long way. Read a funny book, watch a comedy, or call a friend who makes you laugh. And whenever you can, try to find the humor in everyday situations.

Get out of the house. Seek out friends, family, and respite care providers to step in with caregiving so you can have some time away from the home.

Take care of your own health

Think of your body like a car. With the right fuel and proper maintenance, it will run reliably and well. Neglect its upkeep and it will start to give you trouble. Don’t add to the stress of your caregiving situation with avoidable health woes.

Keep on top of your doctor visits. It’s easy to forget about your own health when you’re busy with a loved one’s care. Don’t skip check-ups or medical appointments. You need to be healthy in order to take good care of your family member.

Exercise. When you’re stressed and tired, the last thing you feel like doing is exercising. But you’ll feel better afterwards. Exercise is a powerful stress reliever and mood enhancer. Aim for a minimum of 30 minutes on most days—break it up into three 10-minute sessions if that’s easier. When you exercise regularly, you’ll also find it boosts your energy level and helps you fight fatigue.

Practice a relaxation technique. A daily relaxation or meditation practice can help you relieve stress and boost feelings of joy and well-being. Try yoga, deep breathing, progressive muscle relaxation, or mindfulness meditation. Even a few minutes in the middle of an overwhelming day can help you feel more centered.


Relaxation Techniques: Ways to Relieve Stress

Eat well. Nourish your body with fresh fruit, vegetables, lean protein, and healthy fats such as fish, nuts, and olive oil. Unlike sugar and caffeine—which provide a quick pick-me-up and an even quicker crash—these foods will fuel you with steady energy.

Don’t skimp on sleep. Cutting back on time in bed is counterproductive—at least if your goal is to get more done. Most people need more sleep than they think they do (8 hours is the norm). When you get less, your mood, energy, productivity, and ability to handle stress will suffer.

Join a caregiver support group

A caregiver support group is a great way to share your troubles and find people who are going through similar experiences each day. If you can't leave the house, many online groups are also available.

In most support groups, you'll talk about your problems and listen to others talk; you'll not only get help, but you'll also be able to help others. Most important, you'll find out that you're not alone. You’ll feel better knowing that other people are in the same situation, and their knowledge can be invaluable, especially if they’re caring for someone with the same illness as your loved one.

Local vs. Online Support Groups for Caregivers

Local support groups:

Online support groups:

People live near each other and meet in a given place each week or month.

People are from all over the world and have similar problems.

You get face-to-face contact and a chance to make new friends who live near you.

You meet online, through email lists, websites, message boards, or social media.

The meetings get you out of the house, get you moving, provide a social outlet, and reduce feelings of isolation.

You can get support without leaving your house, which is good for people with limited mobility or transportation problems.

Meetings are at a set time. You will need to attend them regularly to get the full benefit of the group.

You can access the group whenever it's convenient for you or when you most need help.

Since the people in the support group are from your area, they'll be more familiar with local resources and issues.

If your problem is very unusual—a rare disease, for example—there may not be enough people for a local group, but there will always be enough people online.

To find a community support group, check the yellow pages, ask your doctor or hospital, or call a local organization that deals with your loved one’s health problem. To find an online support group, visit the websites of organizations dedicated to your loved one’s health problem.


Summer care tips for the Elderly.

Elderly Dehydration Prevention & Treatment

As we enter into the heat of the summer staying hydrated is important for all of us, but is doubly important for our elderly clients  Here are some things to watch for, and ways to treat dehydration in the elderly.

Watching for signs of illness in a loved one can be challenging. Some illnesses show up quite clearly, while others have a more subtle effect on daily living. Dehydration, depending on the severity, sometimes creates only small telltale signs while having a big effect on the body, especially in the elderly.

Dehydration occurs when a person loses more water than they take in. Adequate fluid allows the body to regulate temperature through sweating, maintain blood pressure and eliminate bodily waste. If severe enough, dehydration can lead to confusion, weakness, urinary tract infectionspneumoniabedsores in bed-ridden patients or even death. Generally speaking, humans can’t survive more than four days without water.


Elderly dehydration is especially common for a number of reasons:

  • Medications
    It’s not uncommon for seniors to be on several medications at any given time. Some of these may be diuretic, while others may cause patients to sweat more.
  • Decreased Thirst
    A person’s sense of thirst becomes less acute as they age. In addition, frail seniors may have a harder time getting up to get a drink when they’re thirsty, or they may rely on caregivers who can’t sense that they need fluids.
  • Decreased Kidney Function
    As we age our bodies lose kidney function and are less able to conserve fluid (this is progressive from around the age of 50, but becomes more acute and noticeable over the age of 70). 
  • Illness
    Vomiting and/or diarrhea can quickly cause elderly dehydration.


“Everybody has a normal state of body water that relates to their weight. Anything below that (normal state) is dehydration; everything above it is hyperhydration,” Dr. Larry Kenney, professor of physiology and kinesiology at Penn State University, explains.

That normal level of hydration varies widely from person to person. Contrary to the mantra that everyone should drink eight glasses of water every day, Kenney says there is nothing scientific to back that up. “People misinterpreted that to be, it had to be liquid and it had to be water,” he says.

A person’s diet can greatly affect hydration levels: fruits (especially watermelon), vegetables, and soups are mostly water-based. “Day in, day out, a lot of people get their water from foods, as well as behavioral attitudes towards food,” Kenney explains. “For instance, when we walk by a water fountain, we tend to take a drink, and we tend to drink when we eat.”

Kenney also takes issue with the idea of not drinking caffeinated beverages because they’re dehydrating. He says the amount of caffeine in a cup of coffee or tea is relatively small, and it’s made of mostly water anyway, so it will hydrate you to some degree. The same holds true for beer, he says, but there is a point at which the diuretic effect of caffeine and alcohol kicks in, so moderation is always the key.

In general, larger people need to drink more water, as do athletes and those who perspire heavily, but that may mean more or less than eight glasses a day. “There is no one-size-fits-all remedy,” he says.


Instead, he recommends monitoring body weight to keep track of hydration levels. To monitor body weight, one should be weighed every morning. If they’ve lost two pounds or more from the day before, and especially if they feel thirsty or have a headache, they’re probably dehydrated.

Mild dehydration is defined as losing 2 percent of your body weight. Severe dehydration occurs with 4 percent or greater body weight loss. Even mild dehydration can affect a person’s health, especially if he already has cardiac or renal problems. “We have measured in the lab cognitive impairment,” he says. “With severe dehydration, it puts a greater strain on the heart. Think of a pump trying to pump with less fluid. That would be one of the primary problems.”

Kenney says an active 65-year-old who exercises probably doesn’t need to weigh herself every day, but a 75-year-old in a nursing home who has had issues with dehydration in the past, or has had cardiac issues, should be weighed every day.

But, don’t rely on scales that also claim to measure hydration levels and body mass index. “Their accuracy is very poor; we can’t use them even for research purposes,” Kenney says.

Complicating matters is that signs of dehydration in younger people don’t always show up in the elderly. For example, if a young person was extremely dehydrated, his skin may be wrinkled or sagging. But, that certainly wouldn’t be noticed in most cases of elderly dehydration.

Perhaps because of that delay in diagnosis, elderly dehydration is a frequent cause of hospitalization (one of the ten most frequent admitting diagnoses for Medicare hospitalizations, according to the Health Care Financing Administration), and it can be life-threatening if severe enough.


Signs of dehydration in seniors may include:

  • Confusion
  • Difficulty walking
  • Dizziness or headaches
  • Dry mouth
  • Sunken eyes
  • Inability to sweat or produce tears
  • Rapid heart rate
  • Low blood pressure
  • Low urine output
  • Constipation

If you suspect dehydration in an elderly loved one, you can check for a decrease in skin turgor by pulling up the skin on the back of the hand for a few seconds; if it does not return to normal almost immediately, the person is dehydrated.


To help make sure your loved one doesn’t suffer from dehydration, make sure he or she consumes an adequate amount of fluids during the day; eats healthy, water-content foods such as fruit, vegetables and soups; checks that urine color is light and output adequate (dark urine or infrequency of urination is a classic sign of dehydration).

Seniors also need to be educated to drink even when they’re not thirsty. Keeping a water bottle next to the bed or their favorite chair could help, especially if they have mobility issues.

If your loved one is in a nursing home or other care facility, make sure that the staff has a hydration program in place that includes assisting residents with drinking, offering a variety of beverages, and providing drinks not only at mealtimes but in between meals. Also make sure that they monitor residents’ weight and assess them if their physical condition or mental state changes. If dehydration is an issue, and your loved one takes laxatives or diuretics, speak to his or her doctor about changing medication.

As with most illnesses, prevention is the key. Making sure your loved one stays hydrated now is much easier than treating him or her for dehydration later.

Update: January 2018

A Senior-Friendly Guide to Medical Alert Systems

The Senior-Friendly Guide to Medical Alert Systems

What is a medical alert system?

On the surface, medical alert systems are pretty simple: Push a button and get help. But the number of options can be overwhelming. Do you need a device that you wear all the time? Should you get one that works outside of the house? How do you know which companies will be there for you if an emergency does occur?


Despite the array of products on the market, all medical alert systems work the same way. You wear a device with a button around your neck or wrist. Once it’s pressed, it sends a signal to a larger base system, which calls a pre-programmed number. This is usually the company’s call center, but some devices let you set it up with a family member or caregiver instead.

Once the call center receives your signal, the operator calls back through the base system where you can direct them on next steps: Call an ambulance, family member, neighbor, or simply tell them it was a false alarm.

What’s the benefit of a medical alert system?

While Life Alert’s oft-mocked “I’ve fallen, and I can’t get up!” commercial is still what most people think of when they hear the words “medical alert,” these are truly life-saving products.

“In the case of a stroke or heart attack, getting immediate help is critical. Seconds matter,” Dr. Kori Novak, a gerontologist and researcher at Oxford University, explained. “The push of a button that alerts help and gets them there 3 minutes faster can be the difference between not only life and death, but life with limited function versus returning to where they were.”

But even outside of emergency situations, the greatest benefit provided by medical alert systems might be the sense of security they offer. Every elder care expert we spoke to emphasized how these devices offer peace of mind for seniors and their family members. “It’s not supposed to be a monitoring device that impedes them, but something that increases their quality of life,” Dr. Novak said.

Jonathan Marsh, owner of in-home senior care company Home Helpers of Bradenton, Fla., agreed, saying, “I believe strongly in medical alert services and the idea that they can be a key component of any care plan, giving both confidence and peace of mind to not only seniors but also their families.”

Who should consider using a medical alert system?

Anyone with a chronic medical condition

Medical alert systems are critical for anyone dealing with debilitating pain or a chronic medical condition. “If there is a degenerative neuro-cognitive disease such as dementia or Alzheimer's this is a great tool,” Dr. Novak said. Similarly, chronic pain conditions can make it especially difficult to get up after a fall.

The experts we spoke with emphasized that these devices are even more indispensable for anyone living alone with these conditions. “Having a medical alert device will give them confidence that help is available at the touch of a button,” Marsh told us.

Anyone at risk of falling

Those who don’t suffer from a chronic condition should still consider potential risks. Accidents can happen at any time, and the older we get, the harder it is to bounce back from them.

Dr. Novak echoed this, saying, “Medical systems are notjust for the frail elderly. Anyone who has a chronic disease or chronic or debilitating pain should consider purchasing a system. The relatively small cost is worth the potential peace of mind and life-saving minutes if an accident were to occur."

Anyone recuperating from a surgery or injury

Recovering from surgery or injury as a senior can be a long and difficult process. Our body requires more time to heal the older we get, and soreness and trouble walking can often linger for weeks, making serious falls more likely.

A good medical alert system can provide extra comfort and security during recovery. Marsh emphasized this point for seniors who are living alone, saying, “This is especially important if the individual is recovering at home and a caregiver is not present around the clock.”

Seniors living alone

If you’re one of the 11.3 million older adults in America who live alone, a medical alert system can be your best lifeline. Even if you’re completely healthy, living alone means it could be difficult to get assistance if an accident does happen.

Marsh listed “a negative reaction to a medication, choking, chest pains, dizziness, and even something as simple as being locked out of the home” as reasons seniors living alone could benefit from a device.

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How to discuss getting a medical alert device with a family member

This can be a difficult conversation, but it’s important to have an open dialogue. That’s not to say it’s always met with resistance, but it’s a good idea to prepare no matter what.

Scott Knoll, MSW and owner of in-home senior care agency By Your Side Home Care, told us, “In general, most senior citizens are receptive to these devices — especially if using it allows them to stay in their own home.”

Our elder care experts recommend a few strategies to keep in mind when discussing medical alert systems with a family member.

Be proactive rather than reactive

Before you even begin, the circumstances surrounding the conversation can have a big impact on the outcome. Marsh recommends starting the dialogue sooner rather than later: “I always recommend approaching the conversation with a little thought and preparation. Try to have the conversation before there is an immediate need or cause for intervention.”

This can help everyone feel less defensive going in. Dr. Novak agrees: “It’s important that caregivers or family members are honest and start the conversation when their loved ones are not anxious or upset.”

Make it about you

No one wants to be told that they don’t know what’s best for themselves, so one effective tactic is to shift the focus onto yourself. “Instead of saying, ‘I’m worried that you’re getting ill and something might happen to you,’ consider reframing your concern for the family as a whole: ‘You know I am a worrier, I would feel so much better if you would consider using one of these systems,’” Dr. Novak advised. “This can make it feel less like the loved one needs it because there is something concerning about them, and more that the family needs it to feel confident.”

Approach the subject with sensitivity and kindness

This is absolutely the most important thing you can do to make this a positive conversation. It’s not easy for everyone to confront the fact that they might need help, so the more compassionate and understanding you can be, the better. “Explain that this device in no way suggests a lack of respect, but is a way to ensure the safety of someone important to you,” Scott Knoll told us.

Ask questions

One of the best ways to keep things non-confrontational is to ask simple questions about your family member’s wants and needs, or things they love to do and want to continue doing.

“Asking a loved one ‘Is there any help you need around the house?’ can start a conversation that leads to things around the home they may find more challenging,” Jonathan Marsh advised. “His or her needs and wants to live securely and independently will unfold naturally and comfortably during the conversation.”

How to shop for a medical alert system

Consult your physician first

Before you start shopping around, talk to your family member’s doctor about their needs. “A physician who knows the individual is best able to determine if a medical alert device is a good course to pursue,” Scott Knoll told us. If there are specific features you’ll need out of a medical alert system, your doctor will be able to give you the heads up.

Because the devices take some practice to set up and use properly, they’re not a good fit for every situation. Stephanie Erickson, family caregiving expert and host with thismatters2Media, told us, “If someone has advanced cognitive deficits, they may not be able to understand or use the device appropriately.” In these cases, an alternate care path should be considered.

Remember: Everyone’s needs are different

Learning what’s essential and what’s irrelevant to your family’s situation is a key step in finding the right system. “It’s not necessary to go with the service that has all the bells and whistles. It’s most important to consider the individual and what his or her needs are,” Marsh said.

The AARP’s guide to medical alert systems echoes this advice: “When selecting a medical alert system, start by evaluating your loved one’s specific needs and abilities — both now and how they might change in the future. For example, if she has dementia, would she understand how to operate a system? Or is something automatic, like a fall-detection device, more appropriate? Does she have a disorder, such as aphasia, that will make communicating with a call center difficult?”

Customer service is key

In our recent review of the best medical alert systems, we found that customer service was the best barometer of a good or bad provider. Some companies have local offices that send out service technicians to help you install the device, while others ship them directly to you, with assistance available over the phone.

We recommend spending some time on the phone with a company’s reps before committing to a purchase. Support from knowledgeable, patient, and empathetic service reps could make a huge difference in an emergency.

Seek out a free trial

All of our elder care experts emphasized the importance of a free trial period for medical alert systems. “You or your loved one can get used to how the system works,” Dr. Novak says. “It’s also good because you don’t pay for something that doesn’t work — perhaps your wifi isn’t strong enough or you’re in a rural or congested urban area.”

Stephanie Erickson echoes this, saying, “A trial period is helpful as it allows the family and user to evaluate if that device has all of the features to help a particular situation or risk. Many systems do different things and sometimes we don’t know what we need or don’t need without trying it out.”

Still, the lack of a free trial shouldn’t necessarily disqualify a company from consideration. Scott Knoll tells us, “While a free trial of the system can prove beneficial, it is by no means the only litmus test for a reputable product. Some excellent medical alert systems companies don’t offer free trials.”

Look for transparent pricing

Unfortunately, any industry that targets seniors is going to have its share of scams. Finding a company that’s upfront about its fees is essential.

“Look for a company that transparently lists prices and services on their website — while not requiring a lock-in contract. Inquire by phone about the system you’re considering and simply ask the agent of the company to guarantee a service price and contract status,” Knoll explains.

We can personally attest to the importance of this step. In our testing, several companies tacked on surprise, $50 “activation fees” without any explanation.

The AARP seconded this advice in their guide, saying, “Beware of complicated pricing plans and hidden fees. Look for a company with no extra fees related to equipment, shipping, installation, activation, or service and repair. Don’t fall for scams that offer free service or ‘donated or used’ equipment.”

Consider companies with short contracts

Along the same lines as transparent pricing, look for companies that don’t try to lock you into lengthy contracts. The AARP is adamant about this: “You should not have to enter into a long-term contract. You should only have to pay ongoing monthly fees, which should range between $25 and $45 a month.”

A closer look at features


There are two types of medical alert systems:

  • Portable devices that only work when within a certain distance of the base unit, similar to a cordless phone.
  • Truly mobile devices that allow you to receive support from anywhere using GPS location tracking, similar to a cell phone.

If your family member spends a lot of time outside the house, a mobile system is the better option. We tested nine of the top models in our review of the best medical alert systems for active seniors.

If you go with a device meant to be used in the home, make sure that the working range is wide enough to work with your lifestyle.

Fall detection

If falls are a specific concern for your family member, devices with built-in fall detection features can provide some extra peace of mind. The response is typically the same as if you pushed the help button: Your provider will quickly call the command center to see if any additional help is needed.

Since fall detection relies on sensors and accelerometers, the likelihood of false alarms is fairly high. Many companies will only respond if no movement is detected after the fall detection is triggered, designed for situations if you’re knocked unconscious. This feature can be especially helpful if you’re prone to memory loss or loss of consciousness.

Device size

The size of the device, along with how it’s worn, is one of the most crucial factors to consider when shopping around. Remember, your family member will have to wear this thing 24/7. The more comfortable it is, the more likely they’ll be to stick with it.

Devices can generally be worn in three ways: around the neck, on the wrist, or clipped onto clothing. If you can, have your family member test it out for a few days before buying to make sure it’s a good fit.


Two-way communication

There are two ways to communicate with your provider’s emergency response team when an alarm is triggered: Some devices allow you to speak through the device on the person, while others only have those features in the base system.

All of our experts recommended using the former whenever possible. If one were to fall in a bedroom or bathroom away from the base unit, for instance, it would be impossible to communicate with emergency personnel. Having that communication capability built into the device lets both sides respond to the situation immediately.

AARP’s guide recommends asking specific questions about each company’s response procedures before committing:

  • Does the company operate its own response center or contract externally
  • Is the response center certified?
  • How are the dispatchers or operators trained, and are they able to communicate in your loved one’s preferred language?
  • Will your loved one be able to talk with a live person via their wearable device, or do they need to be close to the base unit to be heard?


Battery life

Most modern medical alert devices charge through a wall plug but also contain backup batteries in case of emergency. These batteries usually last around 30 hours, and will usually need to be replaced every 18 months or so.

Be mindful of how long the device lasts on a single charge, how to properly recharge it, and how to tell if the backup batteries need to be replaced.

Custom care plans

Understanding what happens when you press the “Help” button is critical to getting the most out of a device. The best providers allow you to create a customized care plan involving emergency contacts, family members, and doctors. “Not all situations should require that emergency personnel come to the person’s home,” Marsh said. “Some situations may possibly be resolved by calling a nearby emergency contact.”

Fast response times

In an emergency medical situation, every second counts. How long it takes for the response center to contact you is a key measure of any medical alert system. “Average response times should be very quick, in the area of 30 to 45 seconds after pushing the button,” Marsh advised. In our medical alert systems review, we found only one company, Medical Guardian, consistently hit this 30-second target, while others took as long as two minutes.

Waterproof wearables

According to the CDC, over 60% of falls occur in the bathtub or shower, making waterproof devices a must. This is pretty standard in most modern systems, but it’s worth verifying with the provider if you’re unsure.

Our medical alert reviews

Reviews.com has created this guide to be accessible and reader-friendly, with larger font and compatibility with screen-reader technology. The printable PDF version makes it a useful tool even for those who can’t access the internet.

Documents Everyone Needs

One of the most difficult things to do when a loved one is getting older is to think of the all the things that come with the end of life.  By having certain documents ready and in place before this happens will let your family feel secure in the fact that they are following your wishes and they don't need to wonder if you would approve.  This planning should take place regardless of age, but if you have a loved one who does not have these plans in place, it is very important to sit down and discuss them while they are still able to.  Don't wait until a person is sick or dying to put these in place.

Some of the most important documents to have include: 

A will

A living will 

Medical power of attorney or healthcare proxy

A durable power of attorney

Do Not Resuscitate (DNR) or Allow Natural Death (AND) directive

Each of these documents serves a different purpose and we will discuss them each a little further, but remember it is always advisable to consult with a professional on long term care and aging  matters.  One good resource is National Institute on Aging www.nia.gov/healthplanning .

A will is a document that describe your wishes for your physical and tangible property.  It can be a simple or complex document that outlines what properties go to which parties.  Although this can be done online, you are still probably best to consult with a lawyer when drafting your will.  The more detailed your wishes, the less chance that there will be family disputes after your death.  You will need to appoint an executor of your estate that will see the will through probate and make sure the will is executed as written.  State laws vary widely about who can be the executor, so make sure to check state laws before choosing your executor.

A Living will is where you will share your wishes as to what will happen to you whether in a hospital setting or at home, concerning medical treatments and end of life decisions if you are unable to make medical decisions.  This will describe what treatments you do or do not want performed.  

In order for your living will to be carried out you should appoint a medical power of attorney or healthcare proxy.  This person will be responsible for making health care decisions if you are unable to make decisions for yourself.  You are able to choose a selected appointee, but make sure that it is someone you know will follow your wishes as outlined in your living will.  You can usually write your own healthcare power of attorney by checking you state's website for rules, regulations, and forms.  State laws vary, so if you regularly spend time in two different states, it may be advisable to have a separate document for each state.  This form does not expire until the time of your death, so you should periodically review both this and your Living Will to make sure they still express your wishes.  Remember that emergency medical technicians cannot honor a living will or medical power of attorney.  This usually requires two doctors to agree that you are in a condition that supports this decision (terminally ill or in a permanent state of unconsciousness.

The medical power of attorney is different from a durable power of attorney.  A durable power of attorney is in place until you rescind it or until your death.  This gives the appointee the power to make other decisions, such as living arrangements, sale of property and access to bank accounts.  You will need to make sure you have both documents available.

A living will is different than a Do Not Resuscitate (DNR) or Do Not Attempt to Resuscitate (DNAR).  These documents only cover treatments that require intubation ,CPR or Advanced Cardiac Life Support (ACLS).  A DNR is recognized by all medical personnel but only covers the treatments listed above.  In a case where there are other injuries, medical personnel will treat all conditions not having to do with breathing or heartbeat (such as bleeding or choking).

All of these documents are something everyone should have since life is never certain and these relatively simple precautions will give you and your family comfort at a stressful time in life.  Think carefully about who you appointment to each position, since they will basically acting out your decisions.  Again it is always best to speak with an attorney in regards to any legal documents you may want to attain.


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