FINANCIAL ABUSE
Were you fascinated by the articles in the News Dallas about 4949 and the financial abuse of the lonely old woman who lived there?
The Conference on Financial Abuse of the Elderly was attended by Dallas notables, including Commissioner Mayfield from the Commissioner’s Court, Judge Nikki DeShazo from the Dallas County Probate court and several investigators, and Debra Wanser, Adult Protective Services Assistant Commissioner. The Dallas County District Attorney, Craig Watkins, made introductory remarks. He admitted that Dallas is “behind the curve” in prosecuting elder abuse, and has requested funding from the Commissioner’s Court for a special prosecutor in Dallas. Mr. Craig anticipates a wave of elder abuse cases as the Boomers age.
There are currently 2 million adults over age 65 in Texas. 1,500 cases of financial abuse were investigated by Adult Protective Services (ASP) in 2006. In Dallas County, APS has 2,400 cases (of all types) daily.
If you agree that prosecuting the criminals who target older adults needs more funding, please write both your TX Senators, and tell them that you favor the passage of the Elder Justice Act. This bill has been introduced in Congress in the past, but failed to pass because of political shenanigans. For more information go to www.elderjusticecoalition.com. Write to 110th Congress about Senate bill 1070, and House bill HR 1783.
The TX Penal Code defines financial exploitation the improper use of the resources of a person aged 65 or older by a person, either deliberately or by negligence. Financial abuse includes theft of assets by a POA (power of attorney), theft of checks from a checkbook, misuse of an ATM cards after gaining the trust of the victim. It also includes telemarketing scams, door to door salespeople, and exchanging assets in return for false promises of ‘life time care.’
Elderly victims are vulnerable are many reasons. They are often lonely, grieving over a loss, or reeling from an unwelcome change of life circumstances. They may be frightened, ill, or distracted. They may be naïve, and cannot believe that someone would do this to them.
Particularly disturbing are cases of ‘Undue Influence.’ Tactics used by those who defraud elders are similar to those used on POW’s. Even a victim with full mental capacity can have their will subverted by a person who purports to have their best interests at heart. Adult children may feel entitled to the parent’s assets, and excuse their actions may tell themselves, ‘It’s mine, anyway, I just want it now.’ Parents have little experience in saying NO to demanding children, and are unwilling to try to change their relationship. The emotion most often manipulated is FEAR.
The perpetrator creates conflict within the family that causes other family members to withdraw from the situation in order to keep the peace. This leaves the elder open to whatever abuse the abuser plans.
DEMENTIA TREATMENT STRATEGIES
Notes from a Care Manager Conference
A General definition of Dementia is ‘a syndrome of cognitive deficits sufficient to affect daily life in an alert person.’ Usually memory loss is the most obvious symptom but not always. Memory lapses are normal, in everyone at every age. Those present in dementia are not the usual memory lapses. Forgetting a name is normal; forgetting your family members is not. It is the degree of the problem that makes it dementia.
The primary risk factor for dementia is age. Other factors that increase risk are a family history of dementia, head injury, and fewer years of education. Here’s an odd statistic: the total number of lifetime surgeries is a predictor of Alzheimer’s disease.
There are several types of dementia. Alzheimer’s is the most common. Other types are vascular (caused by strokes), alcoholic, Parkinson’s, Lewy Body, and about 100 others. Many dementias are diagnosed as ‘mixed’ meaning that the patient has symptoms of more than one type of dementia. Each type of dementia has its own cluster of symptoms and predicted course; all include behavioral disturbances. Alzheimer’s is like a loose light bulb: sometimes it’s on, sometimes it isn’t. ALL dementias are progressive and end in death. On average, the time from diagnosis (not onset) to death is 8 to 10 years.
There are NO treatments that cure or stop the progression of dementia. There are several treatments that may slow the progression. The goal of treatment is to enhance the quality of life and maximize function by slowing the decline of cognition, mood and behavior. Providing a safe, structured environment may be as effective a treatment as a cognitive enhancer. Even better if the patient has both.
Remember: it’s not about what you want for your spouse or parent. It’s about what is best for them. When you reject adult daycare or placement in a facility, is the problem your fear of failure or your feeling of guilt or your reluctance to see them lose their independence?
It is important not to let the disease manage the treatment. Patients with dementia do not want to go out, go to day care, take medications, or move into a facility. They do not want to go to activities or take a bath. What is best for the patient? When your children were small, they wanted to play in the street. As loving parents, did you allow this? As loving caregivers, do you allow the patient to refuse treatments that may slow the course of their disease?
The time to begin end-of-life planning is when someone you love is diagnosed with dementia. The patient will need someone to act as Power of Attorney and assume responsibilities for legal and financial issues when that becomes necessary. A directive to physicians with instructions about end-of-life treatment is needed. It should include instructions about the use of antibiotics, artificial nutrition and hydration. The patient needs to have a discussion with loved ones about how and when others will step in to keep him safe.
Medical students usually take no courses in geriatric medicine. Geriatric courses are elective. Students may do a 1-month rotation in geriatrics. It is up to you as the caregiver to find a physician that is knowledgeable about geriatric bodies, and how geriatric medicine differs from other types. Don’t assume that you physician knows these things. Ask.
Patients with Lewy body dementia and Pict’s disease generally have more behavioral disturbances. Anti-psychotic medications may be used to calm the patient; these drugs may cause an adverse reaction in patients with Lewy body dementia. The goal of using medications, as with all treatments, is to increase quality of life. Currently the most commonly prescribed medications are the cognitive enhancers Aricept, Exelon and Namenda. For information about clinical trials, go to www.alznews.org.
Beginning the Talks with your Parents
A Guide to Conversation Starters for Boomers and Their Parents
My daughter is the producer for ‘Eye Witness News on CW’ in Wichita. One of the recent guests on her show talked about the “40-70 Rule”. The 40-70 Rule is the result of independent research into conversations between Boomers and their parents, or the lack of them. The telephone study was done with Boomers aged 45-60 years. Almost 2/3 of Boomers speak with their parents more than once a week, usually about topics of daily interest. The respondents said it is up to them to start a conversation about any difficulties the parent is experiencing, as the parents do not voluntarily mention problems. Many respondents indicated difficulty discussing independence issues with their parents, particularly the problems around driving. One-third said their main obstacle to having meaningful conversations with their parents is due to left over “parent-child” roles from childhood.
According to survey results, adult children who have not resolved parent-child roles have the most difficulty with these exploratory talks. Those who have a parent living with them have the most difficulty initiating discussions, and a widowed father is the most difficult to approach.
One-quarter of adult children wish they were more prepared to talk to their parents about eldercare needs. Most adult children use a friend or another family member, or an eldercare professional, to help them begin conversations with their parents.
The survey analysis suggests that this type of conversation should begin when the adult child reaches age 40 or the parents turn 70, whichever comes first; hence the name, the 40-70 Rule. Unfortunately, often a crisis forces the initial conversation between older parents and their adult children. It is much less uncomfortable to begin talking about eldercare concerns before a crisis occurs.
A conversation about eldercare might begin with information gathering about what kinds of legal documents they have and where they are kept, what plans they have made for later life, what resources they have, what their preferences are. Find out what they want and how they see your role. You might do a little ‘reality-testing’ if you think it is needed. Be sure to keep the conversation on an adult level. Speak to your parents as you would another reasonable seasoned adult, and expect them to respond in the same way. Respect their opinions, even if they are not the decisions you would make for yourself.
Most older adults value their independence. A large part of your preparation for eldercare will be in helping them maintain a sense of control. Look for options that help compensate for problems.
For a copy of the 40-70 booklet, contact Melinda Bond at Home Instead Senior Care, 972-239-2934, or visit the website at www.homeinstead.com.
HOSPICE
“Every being deserves to die in comfort and with dignity,
and in as much peace as possible.” Thomas Rollerson
“Hospice is a philosophy of care that accepts death as a natural part of life. When death is inevitable, hospice seeks neither to hasten nor postpone it. Rather, members of the hospice care team focus on the patient’s needs — physical, psychological and spiritual. Hospice is total-person care that identifies the needs of the individual and empowers family and caregivers to provide supportive care in familiar surroundings.” www.stmarysduluth.org
A hospice evaluation requires an order from the physician. Many doctors are reluctant to suggest hospice because they are trained to save lives, and consider hospice an admission of defeat. If your physician does not suggest it, and you or your care receiver believe that aggressive treatment options are no longer desirable, ask your physician to write an order for an evaluation. The care that can be provided by hospice is so valuable that pushing a physician to write an order for a free evaluation is advisable.
If the patient is not appropriate for hospice, then you know the condition is not terminal in the next 6 months, and you can plan accordingly. If the patient is appropriate, you do not need to go onto hospice unless you are ready. The information becomes a guide, and reminds you that legal and financial arrangements need to be finalized soon.
Initiating hospice earlier may improve the patient’s quality of life. Many comfort treatments are not available while the patient is receiving aggressive medical care. Other reasons for starting hospice care include eliminating or reducing pain, response time in minutes rather than hours, and it pays for medications related to the primary diagnosis as well as supplies such as incontinence care.
Caution! Herbs are strong Medicine
If you are taking any drugs or are interested in adding herbs to your routine, check first to see about any Interactions. Below are a few common herbs, their uses, and side effects.
Remember: Natural does not = Safe!
The FDA does not control the production or sale of herbal supplements. There has been little formal study done of plants. Not all the active ingredients are known; there may be other active chemicals in the plant that we don’t know about. Additionally, because there are no controls, what is on the label may not be what is in the bottle. According to one study, 70% of herbs sold do not contain what is on their label, and 20% contain ingredients not listed on their label.
Standardization does not = Quality
Feverfew: used to treat migraines. Most people are allergic to the plant. Those allergic to ragweed should also have a reaction to Feverfew.
Con: Avoid before and after surgery, may raise the risk of bleeding. It may up the risk of stomach problems if combined with anti-inflammatory drugs such as aspirin. Do not take if you are using an anticoagulant such as coumadin, results in increased bleeding.
Ginseng: used to help the body withstand stress, reduces fatigue. Also may increase memory and concentration. Increases body metabolism. It is not used as a specific for a condition, rather to support general health.
Con: May decrease the effects of anticoagulants including Coumadin and Heparin. May cause sleeplessness; ginseng is basically a stimulant. It should not be combined with older antidepressants such as Nardil & Parnate. Do not combine with birth control births; it reduces their effectiveness. Asian ginseng tends to cause more side effects. It is said to produce warmth.
Ginkgo: used to improve mental function, protect against Alzheimer's disease and boost circulation to the extremities. Produces same activity in the brain as cognitive stimulating drugs such as Aricept. It is often used to treat multi-infarct (vascular) dementia. Standard dosage is 40 mg three times a day.
Con: Ginkgo is a blood thinner; it may increase blood flow by 50%. It should not be used if one suffers from bloodclotting disorders. If combined with blood thinners such as Coumadin, heparin, or with aspirin, it may cause internal bleeding.
Goldenseal: Topical application is used to treat sores. Internally, eases digestive complaints and sore throat.
Con: With pregnant women, it can cause uterine contractions. It has the
potential to interfere with blood-thinning drugs such as coumadin. Topical Goldenseal should not be combined with Retin-A..
Kava: This plant is found growing naturally in New Guinea, where it is used socially as we use alcohol. It may ease anxiety and is used to treat insomnia. It may also relieve headache tension or muscle spasms.
Con: Do NOT take along with alcohol, tranquilizers, antidepressants, St. John’s Wort, barbiturates, anti-psychotic drugs (Haldol) and anti-anxiety drugs, Valium , Xanax or Ativan. This herb also decreases the effectiveness of the Parkinson's drug Levodopa. It can also cause liver damage.
Milk Thistle: used for detoxification as well as to treat liver problems such as hepatitis and cirrhosis.
Con: Lessens the effects of oral contraceptives.
Saw Palmetto: This is a standard recognized treatment for the symptoms of benign prostatic hyperplasia - prostate. It produces the same action as the medical drug Proscar. Dosage is 160 mg daily; very inexpensive.
Con: Men should have a complete physical to rule out prostate cancer. Should not be used with Proscar.
St. John's Wort: (so called because it blooms near June 24, traditionally St. John’s birthday) It is native to northern Europe. It may alleviate mild depression. Also used as a tincture to relieve canker sores, as anti-viral, and anti-inflammatory. It may ease menopausal symptoms.
Con: Common side effects are reduction in libido, restlessness, headache, fatigue, and GI irritation. May raise serotonin levels, resulting in panic, agitation and confusion if taken with other anti-depressants. Also lessens the effects of Digoxin, immune suppressing drugs, oral contraceptives, chemotherapy drugs and anti-psychotic medications. Can cause increase sun sensitivity if using anti-inflammatory drugs. Do not take in combination with over-the-counter cold medications, or ginseng or Feverfew. Do not take along with any sleep aid; it causes grogginess and difficulty waking. Do NOT mix with Kava-Kava.
Valerian: used to treat insomnia and ease nervous tension.
Con: It may increase the sedative effect of benzodiazepines, (Xanax and Valium), anti-convulsants such as Phenobarbital and Dilantin, and antidepressants such as Prozac, Elavil and Tofranil. If habitually used, there may be severe withdrawal symptoms.
FALL PREVENTION
It is human nature to characterize a fall as an ‘accident’. Falls are embarrassing; this ‘mis-identification’ of the event assures us that it will not recur. Older adults seem to have little insight into their own invincibility despite repeated falls and recurrent balance problems.
No matter where your favorite elder lives, at her house or in a facility, it is important to help her avoid a fall. Why? 70% of deaths of older adults are due to a fall or complications of a fall. ¼ of those who fracture a hip die within a year. And another fourth never walk again. And one of every 3 older adults falls every year.
OK, you are convinced. How can you help avoid a fall? Falls have multiple causes, including loss of visual acuity, osteoporosis, hypotension, inadequate light, medications, and arthritis.
Look around the house or apartment. Are there electric cords across traffic pathways? Throw rugs? These are an invitation to trip. Remove them, or get heavy duty double sided tape and anchor the edges to the floor. Does your parent sometimes use the furniture to steady herself? Is the piece heavy enough to support her weight? Or on rollers?
Check the lighting. Most older adults avoid turning on the lights to save on electricity. Unfortunately, falls occur in low visibility areas. Try installing sensors that turn on automatically at a certain light level, or at a certain time. Try substituting ‘glow switches’ for conventional light switchplates. Consider motion-detector lights that turn on automatically when the elder moves near them. Check to see if there is a lamp near the bed, and a flashlight nearby, too.
The path to the bathroom is a high risk fall location. Be sure there are nightlights in the bathroom, and in the area leading to the bathroom. A raised toilet seat made of soft vinyl is ideal for preventing harm from the drop onto the seat. It is easier to see the seat when it is a different color from the floor. Grab bars, double armrest bars on the seat, or a SuperPole will insure adequate support when rising or transferring. Install non-skid strips in front of toilet. Use bathroom rugs only when bathing; like other rugs, they become a fall hazard. Grab bars are needed in the bath area also. They must be installed into the studs or else they will come out when your elder uses them for support. Hand held shower nozzles are a good idea, as are liquid soap dispensers mounted on the wall.
Check the phones. Elders do not want to miss a call – they do not get many. Hurrying to answer the phone can cause a fall. Portable phones that the elder can carry with them in a pocket are great – newer ones come with two handsets so one can charge while the other is in use. Be sure there is a phone near the bedside, and near the elder’s favorite chair. EVERY phone should have the elder’s name and address on it. In an emergency, these vital numbers may not come to mind.
Shoes and footwear need to be non-skid and low-heeled. Walking shoes are ideal. Long nightgowns and robes are a fall hazard. Sheets and blankets from an unmade bed that drape on the floor can be dangerous, too.
Bending over and reaching up are preludes to a fall. Move frequently used objects to a countertop. Kick a dropped object near something you can hang onto while you pick it up. End tables and coffee tables with sharp corners hurt if you fall near them; remove them. Keep read newspaper in a container rather than loose on the floor; they’re slippery!
If you DO fall, ask yourself, ‘Am I hurt?’ If you are, then wait for assistance. This is a good time to use your Emergency Response System. The personnel will be so glad to have something to do! If you are not hurt, try to roll onto carpet or other non-skid surface area. Or roll to a sturdy piece of furniture and use it to pull yourself up and to a sitting position. Don’t try to walk right away.
Tell someone about the fall. Try to remember what you were doing just before the fall, and determine whether there is something you could change so it doesn’t happen again.