Depression is not a normal part of aging, but when older adults do have depression, it may be overlooked, according to the National Institute of Mental Health. Seniors may show different, less obvious symptoms and may be less inclined to experience or acknowledge feelings of sadness or grief. The winter months can be especially challenging because some seniors experience seasonal affective disorder (SAD), a depressive illness triggered when there is less natural sunlight.

The Geriatric Mental Health Foundation says that an elderly person who may be depressed should see a medical professional. Talk to a client’s family or doctor if you suspect a senior is depressed.

For others, keep the winter blues at bay by using these ideas to inspire ways you can cater to each client’s interests with your personal spin:  

• Eat something new – Tackle a new recipe or re-invent a traditional one. Invite family and friends once a week for dinner and take turns preparing meals. Host a potluck dinner or an evening with international cuisine.
• Exercise the mind – Try a jigsaw puzzle or solve riddles. Discuss our question of the week
• Indulge – Enjoy a healthy dessert or sip a hot drink.
• Go for a walk – Invite family members and friends for an evening stroll. During bad weather, complete laps inside a local mall or community center.

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TurkeyNoodle Soup

• 5 quarts water
• 1 cup celery, chopped
• 1/2 cup celery leaves, chopped
• 1 cup onion, chopped
• 7 chicken bouillon cubes
• 1 tablespoon salt
• 1/4 teaspoon black pepper, ground
• 1 bay leaf
• 1/2 cup fresh parsley, chopped
• 1 cup fresh peas or 1 cup frozen peas
• 1 cup carrot, sliced
• 1 cup cut green beans, fresh or frozen
• 4 cups fine egg noodles (8 Oz)
• 1/4 cup butter or 1/4 cup margarine
• 1/4 cup flour
• turkey carcass, from a 15-20 pound turkey

Directions:

In an eight quart kettle or Dutch oven place turkey bones, water — down through to and including the bay leaf.  Heat to boiling; reduce heat, cover and simmer for 1 hour.  Remove the bones to a platter and let cool.

Add the parsley through to green beans.  Heat to boiling; reduce heat and simmer for 10 minutes.  Meanwhile, scrape meat from carcass and return meat to soup pot. Add liquid if required.  Heat to boiling; add noodles and cook uncovered for 10 minutes.

Melt butter in a small frying pan; stir in flour.  Cook over low heat, stirring constantly, until the flour browns.  Stir into boiling soup.  When the soup returns to a boil; reduce heat and simmer for 5 minutes.  Serve hot.

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Holiday Card Project

Pressed Flowers/Leaves –

Pick fresh flowers or leaves from a walk. Remove any wilted petals and leaves. Try not to let flower parts overlap. Leaves should lay flat. Choose a heavy book and line the inside pages with 2 or 3 sheets of paper to protect the book. (Using paper towels might turn the whole thing to mush). Carefully lay the flowers/leaves on the paper, and cover with another 2 sheets. After closing the book I stack another couple of books on top. Or you can also place the book in your microwave and “cook” it for 30 seconds. You’ll have to repeat it a few times, checking to see if the flowers/leaves are almost dried. Then I let the book sit for at least another two weeks before opening.

Use the dried flowers and leaves to make holiday greetings for family and loved ones. Take a moment to arrange the flowers on your card, taking note of how and where you want to position them.  The pressed flowers can be mounted directly on the card itself, or you may want to adhere a background of fabric, or handmade paper to the card stock first before gluing the flowers down.  Hold the pressed flower, apply a very small amount of glue to the back of the flower, position it on the card, and gently press down.  Do the same with the stems and leaves.  Once you’ve finished adhering your pressed flowers/foliage, it’s a good idea to place the card under a heavy book for a few minutes.  The firm pressure will ensure that your pressed flowers will dry flat.

Hope you enjoy our holiday kick off of fun things to enjoy this  time of year!

ScienceDaily (Dec. 26, 2007) — Elderly nursing home residents receive relatively few cancer care services, including screening, surgical treatment, or hospice care, according to a study published online December 25 in the Journal of the National Cancer Institute

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Few studies have examined cancer treatment and care among elderly patients residing in nursing homes. Yet as theU.S.population ages, more people will move into nursing homes, many of whom will later be diagnosed with cancer. Cancer risk increases as people age.

Cathy Bradley, Ph.D., of theVirginiaCommonwealthUniversityMasseyCancerCenterinRichmondand colleagues assessed the cancer care received by elderly nursing home residents who were insured by Medicaid. Using data from the Michigan Tumor Registry and Medicare records, they identified 1,907 nursing home residents diagnosed with cancer. They analyzed the patient data by cancer stage at diagnosis, type of cancer, survival time, and whether the patient received surgery or hospice care, as well as other variables.

Sixty-two percent of the nursing home residents with cancer had late or unstaged disease when they were diagnosed, and almost half died within three months of diagnosis. Among patients with late stage cancer, only 28 percent received hospice care. Patients aged 71 to 75 were three times more likely to have surgery than patients aged 86 and older.

“An aging population, coupled with trends in cancer diagnosis and treatment, will shift more cancer care…to nursing homes and make investigations into the care of nursing home cancer patients particularly relevant. At present, nursing homes may be unequipped to recognize and care for their residents with cancer,” the authors write.

In an accompanying editorial, Noreen Aziz, M.D., Ph.D., and Keith Bellizzi, Ph.D., of the National Cancer Institute inBethesda,Md., describe the essential components of cancer care, which include treatment, follow-up care, and palliative care. They also discuss the importance of further studies on the cancer care needs of this unique population of elderly nursing home residents.

“Optimal palliative care will often require multidisciplinary approaches and treatment plans made in accordance with the wishes of, and in partnership with, the patient and family, with a goal of decreasing morbidity and a focus on quality of life,” the editorialists write.

Dementia Patients Face Burdensome

 Transitions in Last 90 Days

ScienceDaily (Sep. 28, 2011) — A new study in the Sept. 29, 2011, edition of the New England Journal of Medicine reports that nearly one in five nursing home residents with advanced dementia experiences burdensome transitions in the last 90 days of life, such as moving to a different facility in the last three days of life or repeat hospitalizations for expected complications of dementia in the last 90 days of life.

Such patterns of transitions are burdensome, particularly since the overwhelming majority of family members state the main goal of care is comfort,” said study co-author Joan Teno, professor of health policy and practice at the Warren Alpert Medical School of Brown University and a palliative care physician. “These transitions reflect the inefficiency of our health care system. Similar outcomes could be achieved by keeping these patients in the nursing home setting.”

An important reason for the prevalence of burdensome transitions might be embedded in the way Medicare pays nursing homes, said Brown health economist and lead author Pedro Gozalo. Nursing homes can earn higher payments for patients who have been transferred to a hospital for three days and they may qualify for skilled nursing services paid by Medicare rather than Medicaid upon their return. The current incentives under Medicare and Medicaid encourage nursing homes to send patients to the hospital, he said.

What makes the transitions burdensome, especially for patients with cognitive impairment, Teno said, is that they are often unnecessary, raise the risk of medical errors, and interrupt continuity of care for patients who can experience significant stress and disorientation when they are suddenly removed from familiar surroundings and people. When the patients become upset, their families experience more stress.

Because these financial incentives, market conditions, and the culture of end-of-life care vary by state, so do the rates of burdensome transitions. The authors, who also include researchers fromHarvardUniversityandDartmouthCollege, found that the overall percentage of patients experiencing at least one burdensome transition was 19 percent. State-level rates varied from 2.1 percent inAlaskato 37.5 percent inLouisiana.

“These burdensome transitions are not only bad for the patient, they also drain the federal treasury, hastening the day when the Medicare trust fund runs out of money,” said economist Jonathan Skinner from Dartmouth College, a co-author on the study.

Blacks and Hispanics were also more likely than whites to experience burdensome transitions, the authors found.

 Amiss before dying

To reach these conclusions, the team analyzed federal databases of nursing home and Medicare records accumulated between 2000 and 2007. In all, they found 474,829 patients who were older than 66, had advanced cognitive impairment, and lived in a nursing home 120 days before their death. Of these, 90,228 residents experienced at least one burdensome transition, defined as either a transfer in the last three days of life, returning to a different nursing home than the one they lived in before they went to the hospital, or multiple hospitalizations in the last 90 days of life.

Often these hospitalizations occur even though the condition prompting the hospitalization — pneumonia, urinary tract infection, or dehydration — could easily be treated in a properly equipped and staffed nursing home.

These variations were particularly wide across different geographic areas. InMcAllen,Texas, 25.8 percent of patients had multiple hospitalizations for urinary tract infections, pneumonia or dehydration, compared to only 1.1 percent of patients inGrand Junction,Colo.

The regional rate of burdensome transitions also correlates with other indicators of poor end-of-life care, Gozalo noted. Compared to patients living in the health care markets with the lowest rates of burdensome transitions, those who lived in the regions with the highest rates were three times more likely to have a feeding tube inserted, more than twice as likely to be in the intensive care unit in the last 30 days of life, and more than twice as likely to have developed an advanced pressure ulcer.

Ultimately, Teno said, all of these problems are signs of care gone awry. The best care for a patient with advanced cognitive impairment near the end of life is often to maximize comfort. The burdens of hospitalization usually outweigh the benefits.

“Our research calls for efforts to reform health care payment that create incentives to improve advance care planning and care coordination,” Gozalo said. “Current reform efforts like accountable care organizations that bundle both the hospital and post-acute care payments could begin to address some of these perverse incentives. We need financial incentives to make sure that people are getting the right care in the right place at the right time.”

In addition to Gozalo, Teno, and Skinner, other authors include Susan Mitchell of the Hebrew Senior Life Institute for Aging Research, Julie Bynum at Dartmouth Medical School, and Denise Tyler and Vincent Mor of the Brown University Program in Public Health.

The National Institute on Aging funded the research.

Burdensome transitions in the last three months of life. Nationally, about 19 percent of nursing home patients with advanced dementia experience a burdensome transition — transfer to another nursing home, unnecessary hospitalizations — in their last three months. The percentages vary widely among the states. (Credit: Brown University)

Alzheimer’s Wine Country Memory Walk 2011!.

Hey Check out our video from this years 2011 Walk to End Alzheimer’s!

Did you walk? IF so which walk did you do?

Help family caregivers through holidays

Give family caregivers a gift this holiday season by inviting them to participate in one of the upcoming “Home for the Holidays” webinars. This hour-long informational session provides family caregivers with information on how to help their senior loved ones manage holiday travel, family gatherings, seasonal depression and other issues that can occur during this busy time of year. The webinar will be offered on:

Tuesday, November 15 at noon Central Time

Click the following link to register for this date and time: https://www3.gotomeeting.com/register/316436230

• Monday, December 5 at 7 p.m. Central Time

Click the following link to register for this date and time:

https://www3.gotomeeting.com/register/321591990

The “Home for the Holidays” webinar is the next installment in the Caring for Your Parents: Education for the Family Caregiver^SM support series and is moderated by the Home Instead Senior Care^® network, hosted by the American Society on Aging (ASA) and co-sponsored by the National Family Caregivers Association (NFCA) and the National Alliance for Caregiving (NAC).

The Caring for Your Parents: Education for the Family Caregiver support series is another way Home Instead Senior Care^® businesses across the country are building trust in communities and supporting clients and their families.  

Your free guide to this important topic…..

About 70 percent of people over age 65 require long-term care services to some extent, and the likelihood of needing care increases even more as you age. Yet the cost of long-term care often exceeds what the average person can pay from their income and other government programs. It is more important than ever for everyone, including seniors, their families and those professionals who work with them, to understand and plan ahead for long-term care.

The Society of Certified Senior Advisors has created a new comprehensive white paper on long-term care, What You Need to Know About Long-Term Care, that will provide you with invaluable information, including:

• The importance of long-term care
• What options for services are available
• The costs associated with long-term care
• How to determine whether long-term care insurance is right for you
• Tools and guides to help you set up a plan

Most people first learn about long-term care when they or a loved one needs care. But then their options are often limited by an urgent need for care, not enough time to get the information they need, and not enough money to pay for the care. Planning ahead allows you to have more control over your future, including protecting the quality of life for you and your loved ones. Use this guide as your first step in planning for long-term care.

P.S. Make sure you check out the free white paper, Finding Direction in the Senior Market – Your Guide to Attracting and Retaining Senior Clients at www.csa.us/whitepaper for practical tips and strategies professionals working with seniors can apply today

Join the effort to detect Alzheimer’s early

The Home Instead Senior Care^® network has joined the Alzheimer’s Early Detection Alliance (AEDA) in a nationwide effort to educate people about the warning signs of Alzheimer’s disease and the importance of early detection.  The AEDA is a group of corporations, nonprofits and government entities under the leadership of the Alzheimer’s Association dedicated to making a difference in the fight against Alzheimer’s disease.

There is no cure for Alzheimer’s disease and no way to prevent it. Early detection allows those living with the disease – and their families – time to plan for the future. The Alzheimer’s Association created the following list of warning signs for Alzheimer’s disease and related dementias. Every individual may experience one or more of these symptoms in varying degrees:

1. Memory changes that disrupt daily life
2. Challenges in planning or solving problems
3. Difficulty completing familiar tasks
4. Confusion with time or place
5. Trouble understanding visual images and spatial relationships
6. New problems with words in speaking or writing
7. Misplacing things and losing the ability to retrace steps
8. Decreased or poor judgment
9. Withdrawal from work or social activities
10. Changes in mood and personality

If you notice any of these signs in your senior clients, contact the client’s family members immediately.

To learn more about the 10 signs of Alzheimer’s disease, contact the Alzheimer’s Association at www.alz.org/10signs or 877-IS IT ALZ (877.474.8259).

The Loneliness Factor

Loneliness – it’s one of the most serious obstacles to good nutrition that your senior loved one could face. In the United States, approximately 40 percent of the population age 75 and older – 6.7 million people – lives alone, according to the U.S. Census Bureau. These seniors face significant socialization challenges, particularly when it comes to lack of shared mealtime experiences.

“Who likes to eat alone?  Nobody,” says Sandy Markwood, Chief Executive Officer (CEO) of the National Association of Area Agencies on Aging (n4a) – who served as expert source for the Home Instead Senior Care^® network’s Craving Companionship^SM program. “Meals are not just a matter of sustenance, but a social outlet,” said Markwood, whose members coordinate the popular home-delivered meals program, also known as “Meals On Wheels^®.”

“It’s how we come together as a family or a community. When you’re isolated from that opportunity it’s indicative of bigger challenges that person could be facing.”

The far-reaching impact of loneliness prompted the Home Instead Senior Carenetwork to conduct a first-of-its-kind study* to measure mealtime routines, challenges and preferences of seniors age 75 plus who live by themselves in their own homes or apartments. 

This comprehensive study, which involved 600 interviews, provides evidence that increased opportunities for seniors to share meals with others will promote nutritional and emotional well-being. Key findings include:

• Two of five seniors who live alone have at least four warning signs of poor nutritional health.
• One in five seniors says he or she sometimes or most of the time feels lonely when eating alone.
• Seventy-six percent of these seniors eat alone most of the time.
• The biggest mealtime challenge for older people who live alone is lack of the shared family experience, including lack of companionship. 
• Mealtimes last nearly twice as long when seniors who live alone share meals with others compared with when they eat alone.
• A majority of seniors who live alone say they eat more nutritiously and the food actually tastes better when eating with others.
• More than three-fourths of seniors say they wish their families shared more meals together.
• The most common obstacle preventing these seniors from sharing more meals with others is that their family and friends don’t have enough time.  

As a result of this study, the Home Instead Senior Care network launched the Craving Companionship program to encourage extended families to bring back the family meal for the benefit of their seniors, especially those who live alone.

For more information, visit www.mealsandcompanionship.com. The program includes a variety of resources such as recipes and tips to help family caregivers make the most of mealtimes.

*The Home Instead Senior Care network completed 600 telephone interviews with seniors age 75 and older in the U.S. who live alone in their own homes or apartments. The sampling error is +/-4.0% at a 95% confidence level.   

Caregiving Costs U.S. Economy $25.2 Billion in Lost ProductivityNearly one-third of working caregivers miss at least six work days each year

by Dan Witters

This is part two in a special series of in-depth articles on what it means to be a working caregiver in the United States. Part one revealed the demographics of working caregivers in the United States. Part three will look at how caregivers report spending their time and specifics of who they are caring for.

WASHINGTON, D.C. — Working American caregivers — those who work at least 15 hours per week and help care for an aging family member, relative, or friend — report that their caregiving obligations significantly affect their work life.
 

The majority of caregivers say that caregiving has at least some impact on their performance at work. Based on a five-point scale, where five is a great impact and one is no impact, 10% of caregivers choose five and 44% pick somewhere between two and four.

Additionally, 24% of caregivers say that providing care to an aging family member, relative, or friend keeps them from being able to work more.

Most caregivers also report missing entire workdays as a result of their caregiving responsibilities. Thirty-six percent report missing one to five days per year because of caregiving duties, while 30% say they missed six or more days in the past year.

Overall, caregivers reporting missing an average of 6.6 workdays per year. With approximately 17% of the American full-time workforce acting as caregivers, this amounts to a combined 126 million missed workdays each year. This absenteeism costs the U.S. economy an estimated $25.2 billion in lost productivity per year. Including caregivers who work part time in the equation would cause absenteeism costs to climb even higher.

These findings are from a special survey of Americans who self-identified as caregivers in Gallup-Healthways Well-Being Index surveys throughout 2010. Gallup recontacted those self-identified caregivers and interviewed 2,805 who were also employed at least 15 hours per week for a Pfizer-ReACT/Gallup poll specifically about caregiving. All respondents answered affirmatively to the question, “Do you currently help care for an elderly family member, relative, or friend, or not?”

Most Working Caregivers in Professional Roles

Nearly one-third of all working caregivers are in a professional occupation, with another 12% each in service and management roles. Less than 5% of caregivers work in other professions such as installation/repair, transportation, and construction.

Most caregivers (71%) indicate that their employer is aware of their caregiving status, but another 28% believe that their employer is unaware. Furthermore, an analysis of knowledge of workplace support programs shows that about one-quarter or less of working caregivers have access to support groups, ask-a-nurse-type services, financial/legal advisors, and assisted living counselors through their respective workplaces.

Implications

Many caregivers face significant physical and emotional challenges on a routine basis. Given the significant effect that caregiving can have on workplace absenteeism, business leaders should be mindful of the unique realities that caregivers encounter.

Ultimately, providing an organized support system for these employees may prove to be a fruitful investment for businesses, given the high percentages of working caregivers who would like to work more if they could. Many working caregivers are likely interested in seeking support in work-life balance to help them meet their responsibilities as caregivers and employees alike, and the accessibility to assistance could potentially go a long way toward greater productivity in the U.S. workplace.

Survey Methods
Results for this Pfizer-ReACT/Gallup poll are based on telephone interviews conducted Dec. 28, 2010-Jan. 9, 2011, with a sample of 2,805 adults, aged 18 and older, who self-identified as caregivers and were working at least 15 hours per week, living in all 50 U.S. states and the District of Columbia. Respondents had previously self-identified as caregivers in Gallup Daily tracking surveys conducted throughout 2010 and were recontacted to participate in this survey.

For results based on the total sample of caregivers, one can say with 95% confidence that the maximum margin of sampling error is ±2 percentage points. For smaller groups, such as full-time employed caregivers, the maximum margin of sampling error is ±2.3 percentage points.

Interviews are conducted with respondents on landline telephones and cellular phones, with interviews conducted in Spanish for respondents who are primarily Spanish-speaking.

Samples are weighted by gender, age, race, Hispanic ethnicity, education, region, adults in the household, and phone status (cell phone only/landline only/both, cell phone mostly, and having an unlisted landline number). Demographic weighting targets are based on the March 2010 Current Population Survey figures for the aged 18 and older non-institutionalized population living in U.S. telephone households. All reported margins of sampling error include the computed design effects for weighting and sample design.

In addition to sampling error, question wording and practical difficulties in conducting surveys can introduce error or bias into the findings of public opinion polls.

For more details on Gallup’s polling methodology, visit www.gallup.com.

10 Senior Mealtime Challenges 

Research conducted for the Home Instead Senior Care^® network reveals 10 mealtime challenges for older adults. The following percentages refer to the number of seniors who believe these are challenges for older people who live alone. After each are tips for how to make the most of mealtimes for older adults who live alone, from the Home Instead Senior Care network and Sandy Markwood of the National Association of Area Agencies on Aging.

1. 1.     Lack of companionship during mealtimes (62 percent) Tip: If you can’t be there to dine with a loved one regularly, look for alterative options such as friends and neighbors. Check out special activities at churches and senior centers as well as the local Area Agency on Aging and Home Instead Senior Care resources.  
2. 2.     Cooking for one (60 percent) Tip: Freeze most any type of leftovers including sliced and seeded fruit by placing it in plastic containers or freezer bags. Buy your senior healthier low-sodium dinners for one.
3.      Eating nutritious meals (56 percent) Tip: Buy fresh, when possible, or frozen foods including fruits and vegetables. Frequent affordable farmer’s markets in season. Your older loved one may enjoy perusing the racks of produce.  If your senior is able, help plant a garden.
4.    Grocery shopping for one (56 percent) Tip: Transportation can be a big issue for seniors. Contact the local Area Agency on Aging and Home Instead Senior Care business, or encourage your loved one to engage neighborhood support systems when possible.
5.     Eating three meals a day (49 percent) Tip: So many seniors are on prescription medications that must be taken with or without food. Coordinate the food plan with the medication plan. “Remember, Dad, to take this pill when you’re eating oatmeal for breakfast.”
6.  High expense of cooking for one (45 percent) Tip: Encourage shared meals when possible – your older loved one will get the benefit of reduced costs of meals as well as companionship. Check out your local senior center, which often offers affordable meals for older adults, as well as the home-delivered meals program, also known as “Meals On Wheels^®.”
7.   Relying too much on convenience food (43 percent) Tip: Encourage your older adult to meet with a nutritionist or talk with the doctor to learn how to read labels. So many older adults don’t know the foods that are good and bad for them.
8.  Loss of appetite (41 percent) Tip: Help older adults make mealtimes an event, which can make dining more appealing. Pull out a favorite recipe, help that older adult prepare a meal, get out the good dishes and decorate the table with real or artificial flowers.
9.    Eating too much food (38 percent) Tip: The bigger issue is eating too much of the wrong types of food. If you’re helping an older loved one with a shopping list or grocery shopping, encourage healthier choices.

10.  Eating too little food (35 percent) Tip: Plan a trip to a favorite restaurant for a special dish. If lack of food is an ongoing problem, check with your senior’s doctor to learn about supplemental products that could ensure an older adult is getting the proper nutrition.

For more information about the National Association of Area Agencies on Aging, go to www.n4a.org. Learn about the Home Instead Senior Care network’s Craving Companionship^SM program at www.mealsandcompanionship.com.