Medications and Their Effects on the Elderly

It is not commonly understood that medications have different effects when older people are the patients as opposed to younger people.

As we age, medications are often retained in the body for a longer period of time than when we were younger. The consequence is that if medications are not carefully prescribed and administered, there can be a buildup of medications which can have dangerous consequences for the person taking them.

Also, beware that painkillers themselves (opioids such as OxyContin in particular) can cause significant side effects such as balance problems which are more pronounced among older people because such things as balance are adversely affected as a person gets older independently of any drug intake.

In fact, the American Geriatric Society has published a list of drugs which people over the age of 65 should usually avoid. It’s called the Beers Criteria. Listed are such popular medications as Valium, Zanax and Ambien. Google “the Beers Criteria” for a full list.

Do You Need A Lawyer To Do Your Will?

No.

Maybe that’s a surprising answer coming from a lawyer. Whether it’s a good idea warrants a different response, however.

Sample Wills are readily available on the internet. But are they right for your circumstances? Do you have minor children or “special needs” offspring? Do you want to leave something to a niece or nephew? A so-called “simple will” would be a bad idea in each case.

A skilled lawyer’s most important role is not to prepare generic legal documents. Rather, it is to draft the right language for papers that are customized to your particular situation.

There’s another good reason to have a professional prepare your legal documents that’s usually not discussed, even by attorneys. Nobody’s perfect, of course. But if the lawyer messes up, your heirs can go against legal malpractice insurance (almost all of us have it). If the do-it-yourselfer” does it wrong, his family is out of luck.

Controlling the Behavior of Your Loved One with Alzheimer’s

Probably the most difficult aspect of dealing with someone with Alzheimer’s is coping with occasional physical aggression.

Understand that the person’s inability to communicate effectively causes frustration and resulting acting out. Keep things simple in both communication and environment, and that will probably diminish aggressive or angry conduct. Interestingly, it also appears that over-stimulation can generate an aggressive reaction. The best approach, again, is to keep life as simple as possible for the person. Unfamiliar events or surroundings can be very confusing and upsetting to a person with Alzheimer’s, and those feelings can result in a physical lashing-out.

Consider that when memory is lost, it is only immediate emotions that matter. Memory is no longer available to provide the individual with guidance as to what conduct is appropriate and what’s not. In a very literal sense, people with Alzheimer’s typically live in the moment. That’s all that matters. There is no sense of what happened 15 minutes ago or what is likely to happen 15 minutes hence.

How to Get Along with Your “Alzheimer’s Loved One

The key to caring for a loved one with Alzheimer’s is to learn to “go with the flow”. Because the brain functioning ability is greatly impaired, it is necessary to be simple. By that I mean that your loved one is unable to understand complicated directions, oral or visual, so focus on being straightforward, direct and simple. Give one instruction or request at a time. Further, understand that although Alzheimer’s patients have very short-term memory, they can and do learn routines. They find it very comforting and reassuring to know what to expect.  Accordingly, try to establish such a routine if possible. In other words, meals will be regular as will bed and nap times. Interestingly, a concern for a routine also applies to the person’s surroundings. Don’t change room colors or furniture location. Such changes can be quite confusing.

Dealing with a Loved One with Alzheimer’s Disease

There are a few tasks which are more difficult when dealing with a loved one with Alzheimer’s Disease while at the same time maintaining balance in one’s own life. As Alzheimer’s Disease progresses, the victim finds communication increasingly difficult. Further, personality is affected as well. They will become frustrated, sometimes angry, and occasionally physically aggressive. To say the least, this conduct will be extremely upsetting to you. Try to be patient. The anger, the frustration, is not directed at you. It is felt by that person who knows that things are changing within for the worse. Sometimes the anger is prompted by the person’s inability to communicate effectively. You can help by paying attention to non-verbal cues. If you raised children, think back to the times before your child started speaking – the wants, the needs, even the demands were expressed in non-verbal ways. To the extent that your loved one realizes that you are not only trying to understand him or her, but are actually doing so should have a calming effect. 

It is a natural reaction to think that you must devote every waking moment to caring for your loved one. But, that is an impossible task. You will certainly burn out before long if you do not set aside time for yourself. There are resources in the community such as respite care or adult daycare, etc., that will allow you to take a break from these responsibilities that you understandably feel so intensely. It truly is all right to feel selfish at times. If you are not, rest assured that you will shorten the time during which you are able to be of real help to your loved one. And it is highly likely that you will shorten your own life. Stress, indeed, does kill.

Are There Any Cures for Alzheimer’s?

Not yet. The best that can be done medically is, in some patients, to slow the onset of symptoms with drugs such as Donepezil (Aricept), Rivastigmine (Exelon) and Galantamine (Razadyne). Drug trials have indicated that for many patients on such medications, the benefits are barely noticeable if at all. Some studies have suggested that exercise, both mental and physical, might have a role in warding off the disease. There is some evidence that vitamins B6 and B12 as well as vitamin E may slow the progression of the disease as well.

How Long Can One Live with Alzheimer’s Disease?

Typically, a person with Alzheimer’s will live for 10 years after it begins, but the range can be as short as 3 years to as long as 20 years. You may recall that Ronald Reagan disclosed in 1995 that he had recently been diagnosed with Alzheimer’s. He died 10 years later.

What Causes Alzheimer’s Disease?

Medical science has found the answer to this question quite elusive. Apparently, there are both genetic and environmental factors involved. Genetics appears to carry a very strong role in what is termed early-onset Alzheimer’s (the dementia is clearly evident before the age of 60). The factors involved in dementia that appears at a later age are less clear-cut. Thus, the fact that a family member (a parent, for instance) is diagnosed with Alzheimer’s while in their 80’s, is NOT a strong indicator that that person’s child will also experience Alzheimer’s.

What is Alzheimer’s Disease?

Basically, Alzheimer’s Disease causes progressive loss of brain function. For reasons yet unknown, the disease involves what are termed ‘tangles’ in the brain that eventually spread throughout the brain causing, at first, memory difficulties, personality changes and, at the end, loss of bodily control. Although it is not considered a “normal” part of aging, it appears to afflict approximately ½ of all individuals who reach the age of 85. That process is often referred to as “dementia” but it is also a fact that loss of brain function can be caused by other factors such as a stroke, for instance. 

Looking for a Nursing Home?

A good source for information and ratings on quality of care in the 17,000 Medicare and Medicaid-certified nursing homes across the country can be found at http://www.medicare.gov/NursingHomeCompare.

Included are health inspection results and complaints with detailed and summary information about deficiencies found during the three most recent state inspections and recent complaint investigations.

Preventing Falls

No one likes to fall at any point in their life but avoiding falls is particularly important as we age. That is because our bones are more likely to break upon striking objects or the floor. A particularly common problem for older people is breaking their hips. That is a particularly ominous event because statistics make it very clear that this type of injury and subsequent surgery appears to shorten one’s life. What can you do?

Take a careful look on the floor where you live. Is the surface uneven? Do throw rugs slip? Are there cords on the floor or loose items that require you to avoid them? Remove all of these hazards.

Such hazards are not the same problem when we are younger because we have a better sense of balance and are more able to avoid such risks without falling.

You don’t have to take, however, the loss of balance as a given as you age. It is possible that through exercises, you can help your balance, coordination, flexibility, and strength. Exercise! Make it a regular course of your daily life to find opportunities to walk both in and out of your residence. Many people have also had success by practicing Tai Chi which focuses on slow and controlled movements which increase balance and prevent falls.

Further, a number of other factors can contribute to poor balance such as medications, poor vision, hearing, arthritis, depression, confusion and dizziness. Talk to your doctor if you have any of these conditions to see if adjustments and corrections can be made. 

Loneliness and Anti-Social Attitude Invites Dementia

We humans are social creatures by nature so common sense should tell us that the lack of social interaction can’t be good for us. Research proves it.

Loneliness and social isolation are factors that elevate the risk of a person developing dementia.

If such conditions are present in your life – or a loved one’s – action is needed. Look up old friends (they may feel the same way you do). Visit local community centers (is there a senior citizen gathering place nearby?). Volunteer. Helping others may be, after all, the best way to help yourself.

Exercise…for Your Brain

Public service announcements regularly proclaim that physical exercise is good for your heart.

And now there is research that it’s also good for brain functioning and keeps dementia “at bay”.

It’s long been thought that mental tasks and games are good -- “thinking” is also exercise. Physical exercise increases blood flow to the brain and beneficially (usually) increases the heart rate. Strength training (lifting weights & aerobics, for example) are included as desirable exercising.

To Stay Sharp, Watch Your Blood Pressure!

Sometimes the simplest of medical tests can be a life saver. A blood pressure test is standard for routine doctor visits and medical checkups. It seems so automatic and low tech. A cuff goes on your arm, air is pumped in, usually by hand, and the doctor or nurse gets a reading from a gauge being held or mounted on a wall.

But this reading can foretell whether you are at high risk for dementia. In fact, there’s no doubt that there is a high correlation between elevated blood pressure and the development of cognitive impairment.

If you are diagnosed with hypertension (a very common problem for older people), react with serious intent. Take your pills! Side effects are usually minor, if present at all. Retention of your wits is at stake!

Narcotic Drugs Pose Greater Risks for Seniors

News reports are full of stories on the opioid (narcotic drugs) crisis caused by the over-prescribing of such pain relievers. They have proven to be highly addictive.

But there has been relatively little attention focused on a particularly vulnerable segment of the population: older people.

First, as we age, our bodies react differently to medications of all sorts. A particular dose that may be appropriate for a 25-year old may be excessive and dangerous for someone 75.

Second, older people are susceptible to falls, fractures and breathing problems independently of any drug use. Opioids significantly increase the risk of such events. They also can interact harmfully with the many other medications seniors are often taking.

But, of course, opioids are powerful pain relievers. Hence, they have been widely prescribed. But now we know their use is often accompanied by addiction exposure.

What to do? Avoid opioids if the pain is mild. Maybe aspirin alone will suffice. If not, ask your doctor for a low dose of narcotic painkillers with a short duration. If that doesn’t work, call the doctor to discuss alternatives to a higher dose. The increased interaction with your doctor allows for better monitoring of your pain management regimen and will be a barrier against addiction.

Words to the Wise

The Wall Street Journal recently published an article based on what retired readers found to be the biggest surprises of retirement.

Among noteworthy observations:

-        People tend to spend more than they anticipated. Although work-related expenses (like commuting, dry-cleaning and restaurant meals) disappear, travel, recreation and medical bills go up.

-        Not working can affect one’s sense of worth. Look for volunteer tasks – or part-time jobs – to compensate. Dedication to a new or old hobby can help, too. Always wanted to learn to play the piano? Now is the time.

-        Social life changes: For many of us, our lives and friendships are anchored in our work environment. That, unavoidably, changes in retirement regardless of promises of former workmates to stay in touch. Make an effort to reach out to other retirees in the community. If you like to read, join a local library book club, for instance. One retiree noted happiness in retirement is directly related to the people you spend time with.

What Medicare Doesn’t Cover

Many seniors make the mistake of thinking that Medicare covers all reasonably foreseeable medical procedures.

Not true.

Here are some likely areas of necessary health care which Medicare does not pay for:

-   Advanced cataract surgery (no modern laser treatment, only covers if removal is by scalpel)

-  No dental work (unless covered under a Medicare Advantage plan)

-  Long-term care. People with serious dementia (unsafe to live on own) are covered for medical problems, not the cost of care in a nursing home or facility. Expensive insurance or Medicaid (with very restrictive eligibility requirements) are your only options, besides self-funding.

Estate Planning – Fight the Urge to Procrastinate!

It’s understandable that people procrastinate when it comes to getting a Last Will and Testament and other estate planning documents like powers of attorney. Who wants to think of “end of life” concerns.

Interestingly, the fact that a person has lots of assets apparently has little to do with a person’s motivation to take care of such matters.

Last year a survey of very wealthy people revealed that almost 50% of such multi-millionaires had no will!

The consequences of such inactivity can be very damaging indeed. Unnecessary estate taxes, squandered inheritances with children unprepared to deal with sudden wealth and failure to provide for deserving others.

It is simple negligence to “put off” what you know needs – and should – be done. Not being “very wealthy” is no excuse.

When Is Memory Loss a Serious Problem?

We are all forgetful at times, and certainly the frequency seems to increase as we age. But memory lapses aren’t necessarily a symptom of dementia.

As a matter of fact, many, many people function quite well with mild dementia. The concern is that the condition is not static and will only worsen (although some meds may slow the decline – e.g., Aricept). The tipping point is when forgetfulness endangers the person. Not remembering the name of an old friend may be embarrassing but the lapse is not important, nor is forgetting where one left the keys. But holding the car keys in the hand and not knowing that they are necessary to start the vehicle is another matter, as is going shopping and forgetting how to get home.

That is the time to get help.

What Makes a Will Valid?

A will, more formally known as a Last Will and Testament, is required (in Maryland) to be in writing and signed by the maker as well as two witnesses. A notary public is not required to sign the will, but it doesn’t hurt. A warning, however: a professionally prepared will would have what is known as an “attestation clause” which is a recitation of language that the witnesses were present when the will was signed by the maker and confirm that the maker knew what he was doing when he signed the will. If this is missing, it may be necessary for the witnesses to be found and present proof that the maker of the will did, indeed, know what he was doing.

Anxiety Medicine Can Increase the Risk of Alzheimer’s

Insomnia and anxiety are common conditions among the general population but particularly with the elderly. But if you have a history of Alzheimer’s in your family, please be aware that anxiety-reducing drugs such as Xanax and Valium can increase your risk of getting the disease.

Such drugs, known as benzodiazepines, have long been used in the treatment of early dementia symptoms of which anxiety is certainly one. However, a recent study provided evidence that the use of such medication may cause or hasten the onset of Alzheimer’s. So be sure to discuss any relevant family history with a doctor if a physician desires to prescribe such medication for you.

Protecting Elders from Financial Exploitation

In a perfect world, people would not take advantage of vulnerable, elderly individuals. But, of course, that’s not the real world.

Accordingly, here are some tips on protecting those who need it.

 ·         Provide access to only one account. It is highly recommended that the vulnerable person have direct access to only one checking account. This limits exposure on checks written to charities or criminals.

 ·         On-line bill pay for monthly bills. Do automatic bill pay for routine bills. That helps with account surveillance.

·         Caution them about email scams. Educate about phishing scams. Advise against opening email or links from unknown senders. Set up regular and automatic computer anti-virus and malware scans.

·         Decrease opportunities for unwanted solicitations. To avoid telemarketing calls, add all phone numbers to the National Do Not Call Registry. Advise the vulnerable person to never give out credit card or Social Security numbers over the phone. To reduce mail solicitations, including “free” credit offers, unsubscribe at www.optoutprescreen.com. 

Help Your Brain – Eat Fish!

Alzheimer’s is an increasing threat as we age, particularly for those of us with a family history.  But, research studies increasingly suggest that omega-3 fatty acids (oils found in salmon and tuna, for instance) can ward off or slow the advance of dementia.

Studies also indicate that the oils can reduce the incidence of heart and stroke problems.

  

Is Your Loved One Receiving Appropriate Nursing Home Care?

I think it is safe to say that no one wishes to spend the last stages of his or her life in a nursing home. Unfortunately, though, sometimes the individual’s need for skilled nursing care leaves no other option. Simply put, the person’s physical and/or mental condition does not permit adequate care to be provided at home or an assisted living facility.

But the fact that an individual is in a nursing home does not mean that they can or should be ignored.

It is a sad commentary on human nature that some staff members in some facilities will treat their patients in such a fashion as to minimize the inconvenience and care required by the aide or nurse who is charged with providing appropriate care.

As a practical matter, some facilities will use physical restraints such as vests or belts to confine a resident to a wheelchair or bed. Such restraints may be appropriate for the safety of patients or others. But far too often they’re used for the convenience of the caregiver who, therefore, no longer has to give the same level of personal attention to the patient that would be required if such restraints were not used.

Other techniques of serving the convenience of the staff as opposed to the needs of the patients are the use of sedative and anti-psychotic drugs. Feeding tubes are also used to avoid the necessity of helping a patient eat.

If a loved one of yours is receiving such “treatment”, it may or may not be appropriate but you should insist on questioning staff members as to whether it is necessary for the patient’s benefit.

How To Provide Immediate Cash To Your Personal Representative When You Die

A common problem confronting survivors of a loved one is coming up with money to pay for immediate needs such as a funeral or related expenses.

Unless you have a living trust, your personal representative may be delayed for several weeks before he or she can gain access to your bank accounts.

A simple solution is for you to open a specified bank account now naming your personal representative as a joint owner or designate that your personal representative is to inherit the account upon your death – that is known as a POD or “payable on death” account.

I recommend putting approximately $10-20,000 in that account which should be more than sufficient to tide things over until access can be had to your entire estate.

Don't Make Changes to Your Will on Your Own

Many people don’t understand that you cannot effectively change the terms of your will by simply crossing out language or adding new language and then adding your initials or your signature to your changes.

A change to a will, formally called a “codicil” or amendment, requires the same formalities that are necessary to make a will legally binding in the first place.

In practical terms what that means is a codicil must be prepared to change the terms of the will with necessary witness signatures and notarizations (if such is required where you signed your will). If that is not done, the amendments you desire will be considered null and void.

As an aside, if you need to change the terms of your will, please let me know. I can make sure that the codicil is done right.

Danger of Using Joint Account with a Child

Many people use joint accounts to give their children access to their money.

That often makes sense – but not always.

“Joint” accounts (each account owner has full access to the entire bank balance and the survivor “takes over” the ownership interest of the person who dies first) can avoid probate and provide money for a child to pay a parent’s bills, etc.

But placing a child on a parent’s account involves risks as well. While one certainly hopes that the child is trustworthy, there is always the possibility that a child will use the account money for his own – as opposed to his parent’s – needs. Also, a creditor of a child who gets a judgment can drain that account to pay it since the child is an owner of the joint account.

Suggestion: Take advantage of the joint account option but keep the balance relatively low ($5K-$10K) to minimize temptation and reduce other risks. Money can always be put into the account as needed.

Confusing Legal Terms

Elder Law and Estate Planning lawyers often use confusing terms to describe the documents that they prepare. One example is a “living trust” also called a “revocable trust” or “inter vivos trust”. All of these refer to a document that attempts to avoid probate by having a trust set up to take possession of a person’s assets and spell out the terms of distribution in the document, thus avoiding the need to file for probate (but not always).

“Living Will”, often a part of a document called an “advanced directive”, does not refer to a Last Will and Testament. It is a document which recites an individual’s wishes about end-of-life decisions such as when treatment should be halted and nature allowed to take its course.

“Last Will and Testament” describes a document that is filed for probate and designates who gets what of an individual’s assets when he or she passes away.

Coffee, Tea Can Ward Off Dementia

Caffeine is often blamed for health problems. Think of the publicity surrounding caffeine-spiked “Monster” beverages implicated in ER admissions. 

As in most things, Aristotle had it right. “Moderation” should be the by-word. Thus, it is not surprising that a recent study showed that several cups of coffee or black tea lowered dementia risks for drinkers. Researchers speculated that caffeine boosts blood in the brain and results in less plaque buildup (presence is linked to Alzheimer’s).

Maryland Drivers: Do You Have Emergency Contacts on Your License?

Are you aware that Maryland drivers can add three emergency contacts to their driver’s license so police will know who to call if an accident occurs? The emergency contact information is stored electronically on an individual’s license and will be available only to authorized law enforcement and medical personnel.

Go to the MVA’s website [www.mva.maryland.gov] to add your three emergency contacts in just a few simple steps: Click “On-line Transactions”, click “More”, look under “Other Services” then click “Emergency Contacts” to add your contact names, addresses and phone numbers.

NOTE: To complete the Emergency Contact transaction, you must be able to provide your driver’s license number, date of birth, and PIN or last 4 digits of your social security number.