Complain Effectively on Behalf of the Aging

We have all had occasion to be dissatisfied with a turn of events. The waitress may be too slow, the car is not repaired properly or the dry cleaning comes back without your favorite shirt. The trick to getting these circumstances fixed is to make your concerns known clearly and to the correct person.

The first thing you need to do is to get your facts as straight as possible. Verify what your relative is telling your happened (or didn’t happen when it should) as much as possible. Get as much information first hand as you can. If you are working on what you have been told, be sure to convey that to the person you hope to help you. “My relative tells me… how can we verify if this is real and how can we resolve the issue”?

After you get your information together, ask to speak to the right person. Start with the person you think may be responsible to your relative in the circumstance. This would be the nurse assigned to care for your relative that shift, the contractor responsible for the work with the concern or whoever may be identified by your relative as the problem. State your case clearly with as little emotion as possible. If there seems to be an emergency be sure you think that there is a danger of a poor outcome right now. Relate what happened as best as you know and how you think that things may be fixed. Remember to avoid accusing language, the person probably did not intentionally do something wrong. It is also possible that you don’t have all of the facts. This conversation needs to be a give and take, state your case and listen to the reply.

If the first person doesn’t respond to your concern (ignores you or dismisses you) ask to speak to their supervisor. Continue to rise through the chain of command until someone listens to your concerns.  Most of the time, you will be able to resolve issues at the first or second level in the chain of command.

Questions about the End of Life

Over the years the health care community has developed ways to extend life through surgical procedures, medications and machines. Sometimes the use of the newer technology will result in saving a life and allowing the patient to return to normal activities or an ability to care for themselves with a minimum of assistance. At other times the patient is kept alive without what most of us would call a good quality of life.

Here in the US there is an expectation that the patient will be an active part in the decisions concerning health care. Choosing the high tech, newest procedure on the market or a lower tech and only proven methods is a matter of personal style. We need to work with our health care provider so that he/she knows what care will fit us best.

When we find that we are involved in making end of life health care decisions for ourselves or our aging family members, we will make better decisions if we are working from a working understanding of the choices. A question to be asked as a part of the process is “Will this (procedure, surgery, medication) only prolong my or my family member’s dying?’  Also, it is appropriate to ask what is to be gained by a particular course of treatment.  Never be afraid to ask questions until you understand the proposed treatment and the expected outcome.

Keeping up with Housework

A few years ago, I saw a sign in the kitchen of a friend that said, “Housework done properly will kill you!” I couldn’t agree more. There is a great deal of energy needs to be expended in order to keep up with dust, dirt and dishes. As your family member ages, this will begin to take it’s toll. Other circumstances the begin to interfere with keeping the environment clean may be a reduced tolerance for activity, decreased flexibility and strength and ,in some cases, a diminished ability to see the dirt that needs to be cleaned up.

As your family member (or you) age, you will probably begin to need help keeping the house clean. I already need help from my son-in-law to turn the mattress. If you can make arrangements to help with housework yourself, it may provide an opportunity for bonding over a shared task. If the resources are available you may find that a twice monthly maid service will keep the home clean enough to be healthy and leave it dirty enough to be happy, as my mother used to say. Keeping up between is less of a challenge which will allow your relative to maintain a sense of independence. If there are not the resources for a cleaning service, setting a particular date and time on a regular basis is a good idea.

Medications and the Aging Part 2

As we age it becomes more and more likely that we will be taking a medication for a chronic illness on a regular basis. In order that we don’t interrupt our medications we need to be sure that we refill the prescription before we run out of the old medication. This requires watchfulness and a general awareness of how long it will take for the new medication to be available.

If you or your loved one are using a pill box, filling it once a week, so that all of the pills needed to be taken at a certain time are in one compartment; you have an excellent opportunity to keep track of when to re-order prescription medications and re-purchase medications that you are buying over the counter. You should also take the opportunity to check for expiration dates (printed on the label) and know when you need to get back to the doctor for renewal or change to the prescription.

Medications and the Aging

As we age we are increasingly likely to need to take medications on a regular basis to treat chronic illnesses.  There will also be occasions that we will need to take a medication for a short period of time to treat an acute illness.  One of the things to be kept in mind is the potential for interaction between medications.

Because of the possibility for drug interactions it is important to be sure that the doctor knows what medications a person is taking as well as any over the counter (OTC) medications. One way to insure that this information is available is to make a list of all medications; prescribed, OTC and herbal supplements. This list needs to be made available to any health care provider when seeking treatment.  The list should include the medication (brand name and generic name), the dosage, how frequently the medication is taken and who prescribed it.

Talking About Future Plans Part 2

You may be lucky enough that your family members are willing to discuss how they feel about financial matters, medical issues and legal concerns. If this is not the case, medical issues are easier to bring up when there is some sort of crisis. This can be the bump in the road or the pothole that could swallow a semi. Either way, be sure that you don’t bypass the opportunity.

Other opportunities to start the discussion can be taken from the news of the day, events in the lives of their friends or events in your own life. It is possible for you to reference the news event and ask your family for their take on what is happening. You will usually get how they would like things to be handled from the answer. If they won’t discuss things this is at least some information.

Talking About Future Plans

I have been posting about a wide variety of topics that need to be addressed with those we expect to care for and with those we can hope will care for us. One situation that comes up regularly when I am speaking with friends or giving a presentation is that the person in mind is stubbornly declining to discuss anything. This is a significant challenge to most of us.

While it is important to discuss these issues we may need to approach the opportunity from the side instead of the front. Ask your relative why he or she is reluctant to discuss a particular issue. Be sure that you listen to concerns, fears and desires. Addressing this as we go and acknowledging their need to be independent and our need for them to be safe will usually open the door to discussion or at the least unlock it.

Fall Risks for the Aging

As we age, our ability to maintain a sense of balance may begin to deteriorate. As a result of aging or disease the risk of falling increases. We are also more at risk of injury when we fall. These injuries can be as simple as bruising to as complex as serious fractures.  Taking the time for a bit of planning can go a long way to limit the risk of falls and the damage when we do fall.

The surface of the floor is an important factor in the prevention of falls. Loose throw rugs, thick pile carpets and uneven floor boards all contribute to instability when walking. When this is combined with a poor sense of balance, reduced speed of reflexes and the use of a cane or walker, the risk of a fall climbs dramatically. As we age our bones become more brittle and the risk of a break rises as well.

In order to reduce the risk, remove or anchor throw rugs, replace the thick plush pile carpet with a lower pile (when you are redecorating in your 50’s) and fix any uneven floor boards or replace the flooring (again when you redecorate). Keeping this in mind when you are completing routine maintenance on the house removes the risk before it becomes a problem.

Exercise to maintain flexibility and limit bone loss will limit injury when and if you fall. Keeping a good tip on a cane or changing to a quad point cane or being sure that a walker is in good condition will also go a long way to preventing a fall.

Scams and the Aging

There are plenty of unscrupulous individuals out there who have no second thoughts about scamming Granny and PopPop.  Besides the emotional stress, embarrassment and immediate financial set back from being taken advantage of, the older adult will have a great deal of difficulty recouping money lost to a scammer.

The lonely senior citizen, particularly the female senior citizen is a prime target for the type of lowlife who will smother her/him with verbal and sometimes physical affection and take as much money as can be pried out of the bank account. If this is happening, get help from the police and others to stop the drain on resources. This will be as difficult as getting your loved one out of a cult. Prevention is not easy but if you can keep your senior connected to friends and family you will be able to limit loneliness that makes them vulnerable.

Seniors also are targets because they want to help. The varieties of scams are numerous and are updated regularly. Remember that the bank and the police do not need your help to catch the dishonest teller or the officer on the take. Do what you can to help your senior understand that it is best to report this to the authorities before any money changes hands.

Remember that no reputable contest requires fees to be paid in order to collect the prize, you also will not be likely to win a prize in a contest you did not enter.

This list of types of scams is by no means extensive. Keeping in mind that something for nothing will leave you with nothing.

It's Too Good to be True

Have you ever had an offer that was just too good but you had to make up your mind right away, the offer won’t last? You can be sure that such an offer is really too good to be true. It is 99.9% sure to be a scam. The good offer will be available for today, tomorrow and next week.  Avoiding scams by applying this as a gauge will help you or your loved one to hold onto your hard earned money.

Common elements of scams are that the money you are to have at the end of the transaction is a wind fall for you and the scammer, you need to spend money to get the money and there is a slightly underhanded feel to the whole thing. There is NO logical reason why someone you have never met, living in Nigeria (or other third world country) needs your help to get a large sum of money out of the country. One new twist on the Nigerian scam is to involve a reference to the FBI that implies that you will be arrested if you do not respond. There is nothing to fear from the FBI if you have done nothing wrong, you know nothing about this money, don’t fall for this one.

More on other scams next post.

Legal Documents

It is true that most of us will execute a will at some time in our lives but we can easily wait longer than we should. If you are old enough to vote, you are old enough to need a will. Along with a will, it is also a good idea to create a power of attorney(POA) for legal and financial matters and a health care POA so that you choose the person or persons you trust to step in if you are incapacitated. As young persons, our parents are the logical persons to designate but our needs change over time. These documents should be reviewed at least every ten years and when a life changing event occurs.

At the same time we meet with an attorney to create our wills and POA’s it is a good idea to create an Advance directive for health care that puts your desires into writing. Last week, during a conversation with a friend who happens to be an attorney, it was suggested that you be sure to include what interventions you want in the event of a traumatic event. The likelihood of recovery from trauma as opposed to disease is much better and more aggressive treatment may be to your advantage.

Keep Moving

If the news media has it right, all of us need to move more than we currently do. This includes older adults as well as the rest of us. The benefits of simple activity are much more than it would seem at first glance. We also do not need to sign up for expensive gym memberships or purchase fancy exercise equipment to have a benefit from exercise.

Some of the benefits are an improvement in stamina, improved muscle tone, weight loss and maintenance of bone strength.

The simplest of exercise needs nothing more than a good pair of shoes and a direction. Walking need not be strenuous to return a multitude of benefits. Having a buddy with whom to walk goes a long way to help us to keep up with the activity. If we live within walking distance of the market, work or other places we travel to regularly, it becomes easier to walk with consistency. Remember that weight bearing exercise promotes bone strength and works against the development of brittle bones.

Swimming is another activity that does not require a huge investment in equipment. Joining a swim club or gym with a pool will allow one to swim on a regular basis. This is especially good for those who need to take it easy on joints that have become stiffer with age.

When we start an exercise program after a period of inactivity be sure to verify with your Primary Care Physician that you are able to participate in what you plan and to start slowly and build up from there.

Family diseases - Part 2

Making a point of knowing your parents’ medical history is a good start toward good health care.  It is not uncommon for families to maintain secrets concerning diseases or causes of death. It is important to spend time learning about these issues. Illnesses that were not treatable 40 or 50 years ago may be easily treated today. It is also possible that a disease is manageable even if it is not curable. 

One point that needs to be made is to verify whether or not one or both of your parents were adopted. Children who were adopted during and prior to the middle of the last century may not even know if they are not the biological children of their parents. This would also include having no medical history related to their biological parents.

If you were adopted in the later part of the last century, there may be medical history available. If there is any reason to question things, approach it gently. I would suggest picking a quiet time and plenty of time to get through the discussion. It has become less likely that adoption is a secret but you may need to ask.

Family diseases

There are numerous diseases the have a tendency to “run” in families, in some cases it is more of a gallop. Diabetes is expressed in two forms. The early onset variety is Type I in which there is no significant amount of insulin produced. Type II diabetes is a result of a diminished response to insulin (insulin resistance) or a reduced amount of insulin production. Both have a family connection. Other diseases that have a familial connection are heart disease, a heightened susceptibility to cancer, an increased likelihood of depression and Alzheimer’s disease.  These are the most common but by no means are all diseases with an inherited component.

It is important to know your family history. Your parents will hopefully be able to tell you what medical conditions your grandparents had as well as their own medical history. Sitting down to get your parents’ history is a good start. Maintaining a medical history file and a surgical history file in your computer for your parents will go a long way to helping health care professionals to make a better diagnosis if your parents become ill or need to change physicians for any reason.

Depression and Nutrition

Persons of any age can exhibit the signs and symptoms of depression. There has been recent media coverage of post partum depression and advertisements abound for antidepressant medications. An Obstetrician is perfectly able to diagnose post partum depression and a General Practitioner should be informed of your concerns for yourself or for a loved one. We need to keep in mind that it is not uncommon for an aging person to become depressed.  It is best to involve a Psychologist in the treatment of depression. It is also advisable to work with a Psychologist who is able to work with a Psychiatrist if medication is needed.

A preliminary approach to depression that does not need to include these professionals is to improve one’s nutritional status. If you can work with a nutritionist as well, all the better. It is possible to be malnourished regardless of your weight in relation to your ideal weight. Weight is dependent on the balance of calories in (eaten) versus calories expended (activity).  It is easy to consume enough calories to be over weight without getting proper nutrition. We all need proteins (meats, eggs, etc), carbohydrates (bread, pasta, rice, etc) and fats (butter, oil, etc) as well as vitamins and minerals. The more a food has been processed, the less likely it is that it will have the nutritional components it had as it was harvested.

It has been noticed that if someone is depressed, improving their nutritional status will at least diminish the intensity of depression. If you or your loved one is in a blue mood consistently, has difficulty sleeping or is sleeping excessively, crying spells, feelings of helplessness or hopelessness or changes in appetite, it would be well to relate this to your PCP. Improving your nutritional state should make it easier to treat what ever may be wrong.

Choosing a doctor

As we age, our bodies need more medical attention. This attention should be coordinated through a primary care physician (PCP) whom we trust, however we are increasingly likely to need the care of a specialist. The specialist recommended by our PCP will probably be a reliable health care provider and will also be “in network” as recommended by our insurance carrier. All of this is very helpful but does not directly address another issue to be considered; is the doctor board certified in his/her specialty?

Recognized specialist organizations set standards for all physicians practicing as specialists. We need to know that all care is within the scope of practice of any licensed physician. Practicing in a particular specialty calls for additional education regarding the particular knowledge base and standards of practice developed by the board of that specialty. A Board certified practitioner will have taken additional classes and usually passed a test to prove that he/she has mastered the information needed to practice safely and effectively as well as demonstrated any techniques commonly used in the treatment of conditions related to the specialty.