LET THE MUSIC PLAY:

In the lives of Alzheimer’s patients, the power of music to make a difference has been a well documented phenomenon. Research has shown that music alters the different components of the disease process through sensory, cognitive, emotional, behavioral and social impacts. Researchers have called it a “quality of life intervention.” Although there is no proof that music will stop the progression of the disease, nor will it actually cure it, what it does do is bring an individual the opportunity to experience pleasure and a sense of familiarity; competence when most often they are rapidly losing their cognitive abilities or developing immense confusion and an altered lack of social skills, attention span and concentration. Often there is a social withdrawal and an awkward sense of increased fragility involved.

Craig Greusel entertains. Submitted photos

According to the American Music Therapy Association, music therapy is the clinical and evidence-based use of music interventions to accomplish some individualized goals that are designed to promote wellness, manage stress, alleviate pain, enhance communication and provide unique opportunities for interaction.

In addition, clinically, music alters the chemicals melatonin, norepinephrine, and epinephrine; these chemicals are increased in the brains of people with Alzheimer’s disease after they listened to music regularly, which also increased their mood. Music can help to give participants a sense of purpose, keeping them connected when they are seemingly losing their autonomy.

According to Christo Pantev, a neuroscientist at the Rotman Research Center Institute in Canada, he witnessed a difference between those who were slipping over the edge, because one’s “memory begins to fade as the Alzheimer’s patient slides toward that dark abyss. But the last thing that goes, the last bit of memory he says, is the ability to remember music.”

What a simple yet amazing joy that we can provide to so many. This is why each Wednesday afternoon at Sanitasole Adult Day Services and ALF we have the privilege of having Craig Greusel, well known Marco Islander, director of music ministries for the Marco Lutheran Church, and a music specialist for the Collier County Public Schools working with our seniors to entertain, but more importantly engage them in music and all that it evokes.

Julie Domiano enjoys his music.

Although individuals have unique personalities and heritages, they come together as one to enjoy the extraordinary singing with Craig while he strums on one of his various guitars. “I think this is a wonderful chance to open up the minds of these seniors. Yet it is so important in helping to unlock memories through music so that they not only relive some of the happiest times of their past, but experience life in the present day,” Greusel said.

Craig has been involved with our music program from its humble beginnings and, with us, he has witnessed firsthand those who normally can’t verbally communicate and have struggled to perform tasks, communicate in song, singing or humming the songs of their era, clapping, tapping their feet, swinging their arms, rocking or patting in beat to the music which also may reciprocate affection and exhibit happiness whether it is to swing, Sinatra or Salsa. Others may sit and sway, using various muscle groups that may not be used during a daily exercise class; in others it encourages them to stand up and dance, and it is remarkable what he can teach them, too! I have participated in many sessions over the years and have enjoyed the enhanced spirit it brings to our program.

Most people associate music with an important event which can carry a wide array of emotions. Because the connection is so strong, hearing a tune long after the occurrence evokes a memory of it. The way music is able to shift moods, wandering, depression, agitation etc, is because of the rhythmic and or other well-rehearsed response that requires little or no cognitive or mental processing. Research shows that a person’s ability to engage with music, especially rhythm playing and singing, remain intact late into the disease process because, again, these activities do not mandate cognitive functioning for success. Some suggest that the selections from an individual’s young adult years, around ages 18 to 25, are most likely to have the greatest responses and the most potential for engagement. However, music from their childhood, folk songs, and dance tunes are always popular and can do the same.

Because Greusel has an infinite collection of all music which he can perform at a minute’s notice, we are never at a lack of genres. I consider Craig to be an outstanding musician as well as a very generous and patient person. He is so accommodating to all of us, including staff and myself look forward to his arrival each week. Greusel is really in synch with our clients, too; he can sense the group’s response, and while observing a person or group’s reaction to a particular arrangement he is able to quickly redirect his theme to maybe unfamiliar music which can also be beneficial because it carries no memories or emotions if need be. This can be a great choice when trying to develop new responses such as physical relaxation that can mange stress. He has also tested out some of his personal written work, and rehearsed with our seniors for several weeks teaching them new songs.

Researchers say that you need to help people reminisce and singing is an alternative to moving or touching according to the Alzheimer’s Foundation of America because it is associated with safety and security from early life. “Any reciprocal engagement provides an opportunity for caregivers and care receivers to connect with one another, even when the disease has deprived families’ traditional forms of closeness.” Thank you, Craig and here’s to music, music, music!

Paula Camposano Robinson, RN, is co-founder and owner of Sanitasole Senior Health Services. This is an information-only column and is not intended to replace medical advice from a physician. Email probinson@sanitasole.net or visit www.sanitasole.net for more information. Phone: 239.394.9931.

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Are you part of the America that is going gray as the Baby Boomers (those born between 1946 and 1964) are moving into their 60s? I must admit, I am. And to think that Americans are now living into their 80s and 90s and are coping with more age-related challenges than ever before. Health care issues continue to emerge as many struggle to care for elders diagnosed with diseases such as Dementia, Parkinson’s and Alzheimer’s to name a few. However, a critical issue facing older adults today is a fall.

Falls are among the most common and serious problems affecting seniors today. At least 30 percent of adults over age 65 living at home fall at least once per year with 60 percent of these falls being fatal. A gait imbalance is not an inevitable accompaniment of old age though gait disturbances like those in Parkinson’s disease and diseases associated with immobility, falls can markedly impair your quality of life and even cause traumatic brain injury in some individuals.

Have you ever started to lose your balance or feel as though you have a gait issue? What about a slip or even a fall? If it was due to muscle weakness, previous studies have found this to be a major risk factor for fall prediction. Often we may just stumble or trip over an item on the floor or on an outdoor surface, miss a step, or may just not be paying attention or watching what we are doing as we move hurriedly throughout our seemingly busy day. Falls don’t just happen to seniors; I have a personal story for another column – my own falls for no apparent reason; finally a diagnosis of a rare autoimmune disease.

With financial issues becoming increasingly important due to the cost of care for seniors in a volatile economy, and in some instances decreasing insurance coverage and government benefits, fall prevention awareness should be enhanced through an overall increase in observation, reporting, and communication. Concerns about independence should remain in the forefront of our minds as our nation’s seniors struggle to be on their own – in their own homes trying to balance a quality of life that they value. As a first step, be sure to check the following areas in your home for possible hazards: floors, stairs and steps; the kitchen, bathrooms, bedrooms, and lighting. Many detailed inspection checklists are available to help you to identify environmental issues in your home.

According to the National Council on Aging, nearly 60 percent of falls happen at home and even when injuries are minor, experiencing a fall can have a significant impact on an older adult’s sense of well-being, safety and independence. One out of three seniors in the U.S. experiences a fall each year and every 18 seconds an elder is treated in an emergency room for a fall. Unintentional falls are the leading cause of injury deaths and nonfatal injuries for those 65 years of age and greater. It has been reported that more than 500,000 of these patients were hospitalized in 2009 with more than $19 billion spent for non- fatal injuries. By 2020, the annual direct and indirect cost of fall injuries is expected to reach a staggering $54.9 billion according to the Centers for Disease Control and Prevention.

Although the rate of fatality is certainly of critical concern, non-fatal injuries that lead to a hospital stay or even more alarming, a nursing home placement, restriction on activities, or decline of functioning or activity level are also significant. If an individual sustains a hip fracture from a fall, about one out of five patients dies within a year of the injury, but up to one in four adults who had lived independently before their hip fracture has to stay in a nursing home for at least a year after their injury. A reduced quality of life and premature death have been documented.

Certain subgroups are at an increased risk for both falls resulting in injury according to recent studies. There is an increase of danger with age and a higher percentage and seriousness for women. Non-fatal fall-related injuries disproportionately affect older women with injury rates occurring 40-60 percent higher than men of similar age. Accordingly, hospital admission rates for fall- related injuries in older women are 81 percent higher than admission rates for men of the same age.

A fall can certainly happen to any one of us; with some of the most common injuries from falls being of a serious nature— i.e., fractures of the spine, hip, forearm, pelvis and even traumatic brain injuries. We put ourselves at risk by moving too quickly and not being in good physical condition.

Often although many people may have a fall, even those who are not injured can develop a fear of falling. This fear may cause them to limit their engagement in activities. Unfortunately, this often results in loss of strength and a downward cycle of decreasing activity and vitality – which can in itself, lead to increased risk of falling.

The best steps to take in maintaining your independence and reducing the risk of falling is by educating yourself about fall risks and participate in community exercise programs to increase strength and balance. Continually review your medications to reduce side effects and interactions, and check your home to evaluate if you may need modifications to reduce fall hazards (risk factors). The health care community needs to participate in prevention at the outset by being responsive to the needs of adults in our community, thus helping to provide such services as:

• Individualized health assessments in individual’s homes to identify fall risk factors.

• Educating physicians throughout various communities about fall prevention.

• Reducing risks through monitoring changes in medical conditions, vision testing, medication use, social support, physical functioning and most importantly, facilitate fall prevention efforts through existing medical care and adjusting home environments.

By paying attention to common risk factors, falls can be avoided and injury from falls can be minimized. Please, watch your step!

Paula Camposano Robinson, RN, is co-founder and owner of Sanitasole Senior Health Services. This is an information-only column and is not intended to replace medical advice from a physician. Email probinson@sanitasole.net or visit http://Sanitasole.net, for more information. Phone: 239.394.9931.

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Do you know your own colon cancer risk? We may joke that the big 5-0 is a milestone, but according to the American Cancer Society it’s also a major risk factor for colon cancer. Ninety percent of individuals who are diagnosed with colon cancer are over the age of 50. Where do you fit in?

According to a recent Surveillance Study on cancer statistics and diseases of the U.S. populations, it is estimated that more than 147,000 men and women (with men at a greater risk) will be diagnosed with cancer, and of those, almost 50,000 will die due to cancer of the colon and rectum. For all the men out there, don’t forget to get your PSA tests routinely as well.

Based on Lifetime Risk Studies and U.S mortality research through 2006, more than 6 percent of individuals will be diagnosed with cancer of the colon or rectum sometime in their life, or 1 in 19 people. I don’t know about you but these statistics are frightening.

In order to reduce your risks of having cancer symptoms, pain or having to endure suffering that could be caused by a delay in a diagnosis, early detection and prevention is always the best medicine. People over the age of 50 should have a colonoscopy at least every 10 years or more, if needed.

While personally having to undergo a variety of tests prior to age 50, my physician recommended I have a colonoscopy to rule out another condition. However, I must say at the time, I was not looking forward to this examination of my colon. It was the last thing I wanted to do after the numerous CAT scans, MRI’s, blood work and even a bone marrow biopsy, but after the fact, I was relieved that the test was negative and thus several diagnoses could be ruled out.

As an RN I have witnessed a number of these procedures and had the opportunity to look into the colonoscope, which is a flexible viewing tube with lenses and a small TV camera with a light on the end. Through high tech fiber-optics and a small computer chip, this remarkable instrument scans the inside of your colon while transmitting images to a video screen.

Please do not put off having this procedure for fear of discomfort. A colonoscopy is a routine, safe and effective procedure and it is not as uncomfortable as one may believe. Actually it is painless as you are sedated prior to the test, which is done in a special suite or an outpatient area of a hospital!

The procedure is the best way for healthcare providers to view the entire colon to see if there are any problems. It can diagnose gastrointestinal problems, complaints of frequent abdominal pain, or change in bowel habits. It is the best screening tool to detect colon or colorectal cancer. And if you have had additional risk factors, the procedure should be repeated more frequently.

Having a colonoscopy should begin earlier than age 50 in people with a high risk of colorectal cancer due to family history, chronic inflammatory bowel disease or other hereditary symptoms including polyps. It can also be used to identify the source of rectal bleeding or to confirm if you might have areas of colitis (inflammation of the colon).

If your physician is suspicious about an area during the colonoscopy, he/she can use an attachment placed at the end of the colonoscope to take a small tissue sample (biopsy) to be examined in a laboratory. If a polyp should be found, it is possible that a wire loop attachment would be used to remove the entire polyp so it can be sent for analysis.

In my experience most people are more concerned about the preparation prior to the procedure than the procedure itself. To help empty your bowel so the physician can have a clear view of the intestinal wall, you will be given specific instructions about using laxatives the day before the procedure. Today there are pills that can be used if you are not allergic to sodium phosphates. The manufactures are even trying to make it easier if you have to drink a solution by adding some flavor to the preparation.

Do something good for yourself, talk to you physician, family and friends and schedule a colonoscopy if you are 50 or over and have not had the procedure in the last ten years. It could literally save your life! Don’t delay, make your appointment now. . ..

Paula Camposano Robinson, RN, is co-founder and owner of Sanitasole Senior Health Services. This is an information-only column and is not intended to replace medical advice from a physician. Email probinson@sanitasole.net or visit http://Sanitasole.net, for more information. Phone: 239.394.9931.

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Paula’s treasured family photo. Submitted

For most of us, the holidays are a time for happiness and celebration. We enjoy seeing and getting together with loved ones, going to parties, shopping and taking the opportunity to catch up with those that we may have not seen throughout the year. The trend seems to be to do lots of shopping, and just taking in the holiday season with time off from work and enjoying multiple celebrations.

I have the fondest memories of Christmas, both growing up with four siblings all fairly close in age and in my adult life; often traveling, or taking time to be with an extensive group of loving family members and other relatives. But each year around this time, since the death of my mother which will be almost 10 years ago, this time of year brings back memories of happier times and a special remembrance to her.

Research has shown us that, despite conflicts and complicated emotions, the ties between a mother and her daughter (s) is normally very positive, so strong and enduring that 80-90 percent of women in mid-life say that they have a good relationship with their mother – even though they wish that relationship were better.

According to Karen Fingerman, assistant professor of human development and family studies at Penn State “Women should recognize the strength of their relationships with their mother and appreciate it more.”

We live in a unique era. It is human nature to try to avoid things that we fear and though dying is a natural part of our existence; we tend to view death as an enemy feared, and think that it can be defeated by modern medicine and machines.

When a family member passes away it is as though a piece of one’s self has also faded away. As a child, I looked at my parents as though they were invincible; they kept me safe, warm, fed, loved and secure. However, as an adult, I came to terms with the reality that even my parents were vulnerable; a difficult realization as I thought I had a fairy tale life – we would live forever happily ever after.

Fast forward a few decades: December 30, 1999. It was a typical winter night for Marco Island; cold enough to make Floridians need a heavy jacket and warm enough to lure winter visitors to flock our beaches. I had just settled in bed after a long work day but got a phone call from my dad which was most unusual – it was after midnight. His soft, almost stuttering, hesitant voice was cracking; I was trembling as I listened. I thought something had happened to him, but before I could ask, dad stated “I’m at the emergency room in Naples; I think your mother had a stroke.” (Long pause), I quickly responded, “Dad, I will be right there, everything will be okay.”

I have little recollection of the drive to NCH; the adrenaline was rushing through my body so quickly that my eyes were blurry. Mom had not been ill; at 72 years young she had the normal aches and pains of healthy aging, but a stroke? It couldn’t be!

When I arrived at the hospital, my instincts as a nurse promptly took over. The emergency room is an imposing atmosphere for everyone; for those who are worried and scared, it is darn right horrible. There are bright lights, nurses pushing, pulling emergency carts through the halls, people crying, and often concerned looks on the faces of doctors who scatter from one cubicle to another. Dad was standing in a corner somewhat bewildered, glancing around the E.R., and shaking his head in total disbelief. I ran up to him, threw my arms around him and assured him that everything would be okay.

If only I had the power to make everything okay…

I anxiously went to hug Mom, on a gurney with a tube in her nose, a lightweight vest on to keep her from trying to get out of bed and pulling at her tube and both wrists in soft restraints.

Mom was awake, with slurred garbled, almost inaudible speech and paralyzed on her left side. As an experienced RN who has cared for innumerable stroke victims for decades, I was trying desperately to maintain my composure and reassure her that she would be okay. I kept thinking that with all my training as a health care professional, I am totally helpless. I can only offer my mom comfort and give back to her the genuine love she had always shown me.

With a myriad of hospital specialists tending to Mom, Dad and I stayed close until she was finally assigned a hospital bed in the neurological ICU. I called my brother Steven, and asked him to come to the hospital right away – Moms’ condition was serious. My sister, Jean, also a nurse, came from New England and over the next few days we took shifts in managing the care of mom along with updating our family members who were also arriving from out of town; my youngest sister, Donna was out of the country but we were able to locate her and she made it to the hospital so our family was united.

I was determined to be involved in all aspects of mom’s care; the staff didn’t hamper my efforts or those of my family members. The days passed painfully slow; mom was slipping away and there was nothing we could do. Jean and I gave her baths, changed her linens and we chatted to her about anything and everything. We turned her, combed her hair, fluffed her pillows, wet her lips, and held her hand often laying our heads on the side rail of the hospital bed from physical and emotional exhaustion.

It was shortly after her admission to NICU that mom slipped into a coma. Those last verbal exchanges and laughs in the ER were now ever most precious to my Dad and me. Although at the time her speech was difficult to understand, we knew what she was trying to say. Now she lay lifeless from a hemorrhagic stroke with only occasional involuntary movements.

We knew in our hearts our mother, and Dad’s partner of 50 plus years was not going to live with any quality of life. Dad agreed that Mom never wanted to be on life support so she was moved to a private room outside the NICU. My sister and I continued our nursing rituals but it became more and more difficult now that we were preparing Mom and ourselves for her final journey. Tears of sorrow spilled over into the room between laughter and chaos.

But like strong, courageous eagles, we gathered around telling mom how much we love her, how much she means to us and that we would miss her, dearly. We took turns lying next to her in the bed while stroking her hair, laughing, crying and playing dad’s recorded music (He is a self-taught musician and has an awesome voice), and then telling comical and often embarrassing stories of our youth. We called our family priest, Father Charlie and a few close friends knowing that she would soon be off on an angel’s wing.

I vividly remember as the end was approaching, Jean was on watch. We were all sprawled around the room; Jean shook me awake and said, “I don’t think it will be long, Paula.” I then woke Dad, and the others and we all hovered over mom’s bed. Dad held mom’s hand and just stared at her, holding back tears. It was beautiful, yet heartbreaking. Dad or “Frankie” is a remarkable ma, and to observe him during this time was so disheartening.

Oh, mom, if only….

On the early morning of January 6, 2000, mom spread her wings and we said our final goodbyes.

As a teenager and young adult, we can’t wait for the day to come when we can leave the nest and soar on our own. If only we humans realized at a young age that life passes all too quickly – if only I had more time with mom.

Some of her nicknames were: Grammy Eileen, Gram, “Mother” Mom, and “Roper” from the popular television series, “Three’s Company.” Most endearing was the pet name my dad gave her. He called her “Eileen-a”. She was the peacemaker, Mom of all seasons, friend to all, the frugal shopper, daughters’ best friend, a devoted wife, dads’ cheerleader, and a beautiful, selfless woman. She always put everyone else first and tried to instill that into our family. She was admired and loved by so many and would do anything to help; she was famous for inviting neighbors but more often strangers for dinner because they had nowhere to go, especially during the holidays.

At Christmas and everyday my comfort comes in knowing that mom left a great legacy; her children and grandchildren remain because she lived a blessed life. No one is perfect; we are humans after all, that is part of the gift of wisdom she bestowed upon us all.

Mom I miss you, but know that until we meet again, you are among the angels keeping watch over all of us. And, as your care and comfort guided me to adulthood, I feel so blessed to have had the opportunity to care for you in your final hours and in your final journey. And don’t worry; we are keeping an eye on Dad too!

I love you and miss you each and every day Mom, so I just want to say thanks for everything, and Merry Christmas!

Paula Camposano Robinson, RN, is co-founder and owner of Sanitasole Senior Health Services. This is an information-only column and is not intended to replace medical advice from a physician. Email probinson@sanitasole.net or visit http://Sanitasole.net, or call 239.394.9931 for more information.

This story was adapted from a chapter Paula wrote for the book “Priceless Caregiving – Stories of Elder Care Success, Courage and Strength published in 2009.

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This is the last installment in this series about Elder Abuse and Neglect which is a widespread problem in societies in the 21st century.

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As was noted in this column on Nov. 19, experts estimate that only one in six cases of Adult Abuse and Neglect or fewer are reported, which means that very few seniors who have been abused get the help that they need, so what should we be looking for to help keep our older adults free from harm? Please read on and if you suspect someone you care about is being abused or neglected – you have the power to help prevent further abuse. You do not need absolute proof to report suspected abuse or give your name, and all calls are handled confidentially.

Red Flags – Indicators

Physical: Unexplained reason or explanation in consistent with bruises or welts in various stages of healing; swelling, lacerations, punctures, repeated falls, restricted movement of an individual perhaps due to internal injuries, or bilateral injuries indicating possible grabbing or restraint; grip marks, malnourishment, dehydration, patches of hair missing, twisting injuries or spiral fractures, pinch marks, swollen eyes or ankles, broken eyeglasses, skin tears, or and an untreated medical condition. Often times, elders may have torn or bloody clothing or injuries reflecting an outline of objects used to cause the injury such as: belt buckles, rings, hands etc. More serious and obvious signs may be rope or cigarette burns, blisters, hyperthermia and or hypothermia.

Neglect: Observe for elders who appear to be: emaciated, malnourished or dehydrated with sunken eyes and poor skin turgor, confusion without a known cause, being inappropriately dressed, under-or over-medicated; they may have open sores, poor hygiene or live in unsanitary conditions including improper heating or air conditioning, and even more caustic could be the smell of urine or feces in the home with a lack of required safety measures. Health and safety measures may include doors with no locks, rodents or insects, repairs that are needed to the roof, stairs or railings, poor lighting, or fire hazards. You may note pressure sores or ulcers if you can observe the senior closely. Other concerns are the senior is being left alone without supervision or assistance when needed; medical appointments are being cancelled on a regular basis, or the senior is not showing up for scheduled appointments.

Sexual Abuse: Of all, this might be one of the most difficult signs to report unless you are close to the individual; however, you may observe unwanted touching, coerced nudity or sexually or explicit photography. You may hear the senior talk of frequent pain, see bruising, or bleeding in the genital area. Other issues may be inappropriate sexual comments from others (families and or caregivers), or any other signs of physical restraint which may have you suspect that something may have been done against a seniors will. A healthcare professional may suspect sexual abuse when there is unexplained sexually transmitted disease or repeated genital infections.

Emotional Abuse/Behavioral: Have you noticed any unexplained changes in alertness, withdrawal from normal activities, or other depressive issues? Look for low self-esteem, greater agitation, difficulty sleeping or needs for excessive sleep, passivity, and feelings of hopelessness, (may talk about suicide), and they may doubt their sanity. There may be periods when the senior goes without visitors or outings for long periods and is resigned and tearful. When there is isolation, or one is given the “silent” treatment it should be immediate cause for concern including intimidation and humiliation. Other signs: the senior has no opportunity to speak for themselves, may become reluctant to talk about their home life, and is fearful when approached by their caregiver to the extent that they may even flinch or withdraw even when approached by others for fear of being harmed.

Financial Abuse: Even more so now in tough economic times watch for large sums of money being taken from a bank account, signatures on checks or other papers that look suspicious; the senior is now in debt and does not know why; bank statements are no longer being sent to the individual’s home; they cannot pay their bills or buy personal care items; personal belongings, such as clothes or jewelry are missing from their home or room in an institution, they are asked to sign legal papers (Power of Attorney, a will, or a joint deed to a house), without being able to understand what they mean, and they cannot remember signing papers or making certain money transfers. Often checks may be written as” loans” or gifs” and there could even be a loss of property. The older adult is suddenly not allowed to decide or speak for himself or herself.

The key to helping our seniors get help is to report the suspicion(s) promptly. Talk with your older friends, neighbors and relatives because maintaining communication decreases isolation and it may give the senior a chance to talk about any troubles they are having. Generally, be aware of the possibility of abuse in its many forms by looking around and taking note of what is happening with your senior neighbors. Are you seeing nervousness, withdrawal or anxiety around certain people, when they have not seemed so in the past? Experts know that abusers may be spouses, family members or personal acquaintances, or they could be professionals in positions of trust; and or opportunistic strangers who prey on the vulnerable.

You can report suspected mistreatment to our local law enforcement agency or to the Florida Abuse Hotline at 1-800- 962-ABUSE (1-800-962-2873). Florida law (Chapter 475) requires that persons who know or have reasonable cause to suspect that an adult has been neglected or abused report such knowledge. Again, you can remain anonymous but please help to prevent elder abuse!

Paula Camposano Robinson, RN, is co-founder and owner of Sanitasole Senior Health Services. This is an information-only column and is not intended to replace medical advice from a physician. Email probinson@sanitasole.net or visit http://Sanitasole.net, for more information. Phone: 239.394.9931.

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This is a follow up to my last article on adult abuse and neglect that appeared in the Senior Moments column on November 5.

The past edition noted some overwhelming statistics; 33,812 adult reports of abuse, neglect, and exploitation in the state of Florida from January 1, through September 31, 2010. In speaking with Ms. Pamela Blumenthal, SunCoast Region, regional program administrator, Adult Protective Services, I have provided the cases for Collier County (District 8) only. The records shows for the same period complaints of 145 self neglect reports; exploitation 57, inadequate supervision 50, physical abuse injuries 42, environmental hazards 23, medical neglect 23, mental injury 19, caregiver unavailable 10, sexual abuse 6, bizarre punishment, and one death. This is truly tragic and to think these are only those incidences that have been reported!

Elder abuse can occur anywhere and according to the World Health Organization, it is predicted by 2025, the global population of those aged 60 years and older will be around 1.2 billion. Elder abuse is under recognized and fewer cases are reported as elders are often reluctant to report the mistreatment. Experts estimate that only one in six cases or fewer are reported, which means that very few seniors who have been abused get the help that they need. With the growing senior population, how big is this problem? States do keep statistics, but nobody really knows for certain. One thing is for sure however elder abuse can happen to any older individual – your neighbor, or your loved one – it can even happen to you!

So, what is this phenomenon called elder abuse? In general terms, it refers to the intentional or negligent acts by a caregiver or “trusted” individual that lead to, or may lead to, harm of a vulnerable elder. It results in harm to an older person’s well-being or safety. It can happen anywhere – in the home, nursing facilities, or other institutions. It affects those across all socio-economic groups and cultures, and races. Based on current information, women and “older” elders are more likely to be victimized. Mental health and substance abuse issues are risk factors and isolation can also be another contributing factor. Someone with dementia poses even a greater threat of being abused.

When most of us think of abuse we tend to think about physical abuse only; however, there are actually five defined definitions of elder abuse, and for older adults the consequences can be especially serious because their bones are more brittle and convalescence takes them longer, so even a relatively minor injury can cause serious and/or permanent damage.

They are as follows:

Physical abuse: is the use of physical force which may result in bodily injury, physical pain, or impairment. It may also include, but is not limited to, such acts of violence as striking (with or without an object), beating hitting, shoving or pushing, shaking, slapping, kicking, pinching, shoving or burning.

Sexual abuse: defined as a non –consensual sexual contact of any kind with a disabled or elderly person or with any persons who is incapable of given consent? This includes unwanted touching, all types of sexual assault or battery, such as rape, coerced nudity, sexually explicit photography or sodomy.

Emotional or physiological abuse: such an affliction of anguish, pain, or distress through verbal or nonverbal acts falls under this category. Emotional and or/physiological abuse range from threats, intimidation, humiliation, and harassment. In addition, treating an older person like an infant; isolating and elderly person from his/her family, friends, or regular activities; giving an older person the “silent treatment;’ and enforced isolation can also be considered within this grouping.

Have you ever considered intimidation or humiliation in the overall scope of elder abuse? Would you take it upon yourself to report such a discovery for investigation?

Neglect: As the refusal or failure to fulfill any part of a person’s obligations or duties to an elder, neglect may also include failure of a person who has fiduciary responsibilities to provide care for an elder ( pay for necessary home care services), or failure on the part of an in-home service provider for the necessary care. Typically, neglect means the result of failure to provide an elder with such life necessities as food, water, clothing, shelter, personal hygiene, medications, comfort measures, personal safety and any other necessary essentials included in an implied or agreed-upon responsibility to an elder.

Exploitation: Today seniors are up against so many scams . . . this includes but is not limited to the misuse of an elderly or disabled person for personal or monetary benefit, which is a crime. This includes taking social Security or SSI checks, abusing a joint checking account or taking property or other resources in the name of the older person without his or her permission.

According to recent statistics, many older persons in the community are mentally competent and do not need constant care, but the greatest physical harm is often done to those in frail health. And sometimes people who believe that someone else is being abused do not report their suspicions because they: 1) do not know to whom they should speak 2.) they may be afraid to interfere in family relationships. 3) they don’t know what can be done, or 4) they just don’t want to get involved. This is the tragic ingredient!

We must all take responsibility as the Florida law states and be diligent in looking for the signs of abuse in the above mentioned categories, and more importantly report the suspicion(s) promptly. As a reminder, Florida law (Chapter 475) requires that persons who know or have reasonable cause to suspect, that an adult has been neglected or abused report such knowledge to the Florida Abuse Hotline at 1-800-962-ABUSE (1-800-962-2873).

Join me next time for the last installment which will outline some of the warning signs and what you can do to prevent elder abuse, and some resources for help.

Paula Camposano Robinson, RN, is co-founder and owner of Sanitasole Senior Health Services. This is an information-only column and is not intended to replace medical advice from a physician. Email probinson@sanitasole.net or visit http://Sanitasole.net, for more information. Phone: 239.394.9931.

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Abuse and neglect is a widespread problem in societies of the 21st century. In the prior century, elderly abuse remained somewhat of a private matter well hidden from the public view. Today it is increasing becoming a critical issue, and affecting people of all races, ethnic backgrounds, and social statuses. In the U.S., the Federal government and the states have enacted laws to protect and provide services to older adults. Within the states and communities, agencies are assigned to implement the laws concerning abuse and neglect by providing protective services to those in need.

The purpose of Adult Protective Services, a division of the Florida Department of Children and Families (DCF), is to protect vulnerable adults from being harmed; adults who cannot physically or mentally protect themselves and who are harmed or threatened with harm through action or inaction by themselves or individuals responsible for their care or by other persons. It is startling to think that such abuse is taking place!

Florida law (Chapter 475) requires that persons who know or have reasonable cause to suspect, that an adult has been neglected or abused report such knowledge to the Florida Abuse Hotline at 1-800-962-ABUSE (1-800-962-2873). Adults determined to be vulnerable are those persons 18 and over (including senior adults sixty and older), who because of age or circumstances cannot care for themselves or they may be abused physically, mentally, emotionally, or sexually by another. Everybody in the State of Florida is a “mandatory reporter” according to the laws of the state.

Elder Abuse can be an act or omission, which results in serious physical or emotional injury to an older person; financial exploitation or failure to provide one or more essentials for physical, or emotional well being to themselves or by a caregiver. Although the DFC is responsible for providing services to detect and correct abuse, it is also necessary that this be done with placing the fewest possible restrictions on a person’s constitutional rights and liberties. If older adults are unwilling to leave an abusive situation or to press charges against family members or others and they are competent, the DFC cannot forcibly remove them.

If the abused is found to be impaired mentally and it is determined that their decision-making is impaired only then can the DFC intervene protecting the person against his or her will. All criminal investigations and prosecutions for neglect, abuse or exploitation of a vulnerable adult are handled by law enforcement after initially being investigated by the FSFN.

The FSFN has a sophisticated case management system that has been operational since 2007 according to Pamela Blumenthal, regional program administrator for the SunCoast chapter of Adult Protective Services. After a call to the Hotline is accepted as an intake and forwarded to the Criminal Investigations Unit for a criminal background records check, it is either called out as an “Immediate” to the investigator, or “forwarded” to the appropriate receiving unit. The investigators conduct an investigation and enter the following information into the system said Ms. Blumenthal: Information about allegations of maltreatment, identification, interview, and observation of participants in the intake, identification of other relevant people and additional investigative information, an analysis of the intake participants’ background history (criminal, prior involvement with the Dept etc); documentation of investigative activities and assessment of risk/safety, and documentation of the results and findings of the investigation before a dispositional recommendation is made.

Adult Protective Services intervenes when a report of non-accidental infliction of serious injury is made. These injuries can be caused by pushing, grabbing or physically restraining an older adult. Emotional abuse is the deliberate use of language or behavior that causes severe pain, fear, depression or other extreme reaction. The failure or refusal of a caretaker to provide the essential necessities such as food, clothing, shelter, personal or medical care constitutes neglect. Financial exploitation is illegally taking, misusing or concealing funds and property of a vulnerable adult with failure to provide necessities required for the individuals care.

Self-neglect accounts for the majority of cases reported to the APS. Often times the problem is paired with declining health, isolation, Alzheimer’s disease, dementia or drug and alcohol dependency. Self neglect can include behaviors of hoarding, failure to take essential medications, leaving a burning stove unattended, poor hygiene, not wearing suitable clothing for the weather, confusion, inability to attend to housekeeping, and dehydration.

Social isolation and cognitive impairments are factors that may make an older person more vulnerable to abuse as well. The National Center for Elder Abuse studies also show that living with a caregiver or a friend may increase the chances of abuse to an older adult. Abusers are both women and men. Family members often are abusers over any other group. It is very clear that elder abuse is a family issue.

Statewide from January 1, 2010 through September 30, o f this year, 33, 812 adult reports of abuse, neglect and exploitation were received. This is staggering! It appears that reports peak from October through Easter as does our typical tourist season. As family members and visitors come from the north to Florida, they visit or see their families and neighbors more often and this is when they may find them in distress or stumble upon unusual circumstances. In the summer months older adults may not get out as much as others or are not seen and their abuse, whatever type could go unnoticed for long periods of time.

Florida was the first state to implement an automated database hotline which originally dates back to the 1970′s, and over the past 30 years or more the state has been continuing to improve on its technology. The current state-of-the art tracking mechanisms in place now include child welfare systems and protective services for adults and children in one database.

With mandatory reporting to 24-hour investigators on-call, Florida is committed to the detection and correction of abuse, neglect and exploitation and has demonstrated this through the division of the DFC.

Throughout the State of Florida, the office of Elder Affairs has established several designated Protective Services offices to respond to the report of Elder Abuse as well as the statewide Elder Abuse Hotline. The Florida Association of Areas Agencies on Aging work closely with the Department of Elder Affairs to develop effective projects to over 4.5 million older adults. In our local area, you can contact Elder Helpline in Collier County at 332-3049 for assistance with general needs or call the Florida Abuse Hotline at 1-800-962-2873 to report a suspicion of neglect or abuse. The safety and care of our older adults is paramount. Let us do our part!!

Paula Camposano Robinson, RN, is co-founder and owner of Sanitasole Senior Health Services. This is an information-only column and is not intended to replace medical advice from a physician. Email probinson@sanitasole.net or visit http://Sanitasole.net, for more information. Phone: 239.394.9931.

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More than half of the 16 million Americans estimated to have diabetes are over the age of 60. Of those over 65, according to a NIH study, almost 1 in 5 has Type 2 diabetes. Although this disease is very common, it is also very serious; however, it can be managed and is sometimes preventable, but certain group-specific characteristics present new challenges to health care professionals treating older adults with diabetes due to age-related impairment of cells in the pancreas, loss of lean tissue and accumulation of fat, particularly intra-abdominal fat, and a decreased tissue sensitivity to insulin. In 2008 there were about 24 million people with diabetes in the US alone, from those 5.7 million people remain undiagnosed. Another 57 million are estimated to have pre-diabetes (a slightly elevated blood sugar), which puts them at risk for developing the disease according to the ABA. The millions of Americans who are affected with this disease are also at risk for complications– increasing healthcare costs and hospitalizations.

What is Diabetes? Diabetes is a group of metabolic diseases where a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced. To put it simply, your body changes the foods you eat into glucose. This glucose travels through your blood stream, fueling or feeding your cells. Insulin is a hormone that helps our body convert glucose into energy. If your body doesn’t produce insulin or doesn’t use it properly, your blood sugar rises. With diabetes, you may feel tired, hungry, or thirsty; you may lose weight, and the high blood sugar can harm your eyes, kidneys, and nerves. Heart disease, strokes, and amputation and many other complications can result from severe diabetes.

Diabetes is also hereditary. Your family background weighs heavily in the risk that you may develop diabetes. The more you are at risk, the more important it is that you understand the disease, look for the symptoms and see your physician on a regular basis. In the US, there is a lot of research underway and according to the NIH, “Careful control of blood glucose, blood pressure, and cholesterol can prevent or delay diabetes and its complications.” There is other evidence that points to the lack of an early diagnosis.

There are two types of diabetes, excluding Gestational diabete–when a pregnant women, who has never had diabetes before develops high blood glucose levels during pregnancy.Type 1 diabetics must take insulin every day. This is often seen in children, teenagers, or adults under 30. Type 2 diabetes results from insulin resistance where the cells don’t use the insulin properly and this normally occurs in older adults. Diabetes Type 2 is usually linked to obesity, lack of activity, and family background. Type 2 diabetics often go through a condition called “pre-diabetes” in which their blood sugar is elevated, but not high enough to be called diabetes. With this condition, the risk of acquiring Type 2 diabetes is high, and heart disease and stroke risks are greatly increased.

Very high or very low blood glucose levels can lead to serious medical problems and emergencies. Diabetics are prone to go into a coma if their blood glucose gets too high. Low blood glucose, known as hypoglycemia can lead to other complications, if left untreated.

Hypoglycemia is usually mild and can be treated by eating or drinking something with carbohydrates such as bread, fruit, potatoes, or milk. However, if untreated, hypoglycemia can lead to loss of consciousness and may be life threatening. Those with diabetes also have an increase risk for Alzheimer’s disease. Studies are currently underway to determine if strict controls of glucose can delay or prevent the symptoms of Alzheimer’s disease.

What are the symptoms, and how are they managed?
Type 1 diabetics may have few or no symptoms. Many don’t know they have it. For others, feeling tired and rundown is the only symptom. Some may feel very thirsty, urinate often, have a loss of weight, blurred vision, get skin infections, or heal slowly from cuts or bruises. Any of these symptoms should be reported to your physician to insure you are not carrying this silent killer. Your physician can order specific lab tests. A fasting plasma glucose test is taken after fasting for at least eight hours and will measure your blood glucose level. Oral glucose tolerance tests will test your blood glucose levels but then you are given a sugary beverage and your blood glucose level is checked at 1, 2, and 3-hour intervals. Managing your diabetes is of utmost importance, however in older adults, several factors may affect good control.

Meal planning and eating properly are the key to managing blood glucose, blood pressure, and cholesterol levels. You must understand how different foods affect your blood sugar levels. A good meal plan takes into account likes and dislikes, goals for weight control and daily physical activity. Daily physical activity is very important in helping with diabetes maintenance. Taking part in a regular fitness program can improve your situation. However some of these lifestyle modifications may be difficult for seniors because of lack of means and access, and the decline in their physical abilities, which may make it more difficult to increase their activity. Years of smoking may make quitting very difficult, but the treatment goals are the same for everyone who has diabetes–to enhance their quality of life and reduce complications from this disease, whether active and healthy, or for those who are frail and disabled.

According to the ABA, about 57% of adults take oral medications. Some medications do have side effects, which range from nausea, respiratory infections, diarrhea, and headaches to liver failure. Medications are important, however, in controlling diabetes for many people. Your physician may prescribe oral medications, insulin, or a combination of the two. Others with Type 2 diabetes can avoid the need for medications by maintaining their glucose levels, blood pressure, and cholesterol goals by meal planning and engaging in an exercise program.

If you have diabetes, it is important to have regular eye exams, a kidney test for albumin, a protein that indicates whether the kidneys have been affected or not (usually obtained through getting a urine sample). People with diabetes should check their feet every day and watch for redness or patches of heat. A podiatrist or a family physician should check sores, blisters, or breaks in the skin, infections, or build-up of calluses right away.

Get help from Medicare
Older adults with diabetes on Medicare are covered for glucose monitors, test strips, and lancets. If you need more information about this program, please call 1-800-MEDICARE (800-633-4227). The good news about a bad disease is that there is a lot you can do to live with, manage, and in some cases, even reverse diabetes.

Paula Camposano Robinson, RN, is co-founder and owner of Sanitasole Senior Health Services. This is an information-only column and is not intended to replace medical advice from a physician. Email her at probinson@sanitasole.net or visit www.sanitasole.net for more information. Phone: 239.394.9931.

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One’s level of debility shapes one’s level of dependence: Some elders may require assistance with only the most physically or mentally demanding task; while others will require help with daily activities such as cooking and driving; and others will need assistance with all activities of daily life, such as: bathing, dressing , toileting, nutrition and staying safe. The average unpaid family caregiver is 60 years old and female. One study found that on average, a worker who takes care of an older relative loses more than $660,000 in lost wages, pension benefits, and Social Security income.

Our society has a quest not to be old. However, because our culture has put great emphasis on ageism, should we live long enough, we will ultimately most likely oppress ourselves—either we go out of our way to try and avoid the aging process, or we lose our self-esteem because we cannot bear to think of the selves that we are becoming. There is a lot of stereotyping and prejudice about aging in America.

In our society, which we learned from childhood, we attempt to distance ourselves from those we think are old from our own aging, which most often centers on our bodies. This distancing begins our exclusionary behavior and thus the height of the anti-aging industry and an increase in anti-aging products and plastic surgery.

As a baby boomer, I remember growing up with grandparents in our home and all of the rich history our family enjoyed. As kids, we looked up to our grandparents—they were wise, experienced and a very large piece of the fabric of our lives. Whether they walked us to the bus stop, played with us in the yard, or took care of us when our parents had to be away—it was a time that has long past, but never forgotten. My parents were raising five children while both working, but we were all responsible for each other. As our grandparents were part of the immediate family we cared for them when they needed us, too.

We would read, or help our grandparents with whatever we could until we no longer understand the diseases that were taking over their bodies. Not long after moving my grandmother to an institutional setting, did she lose her power to live; she died of natural causes at age 87. “Nanna” was a dynamic person with great charm and poise and, oh, what a cook! My mother’s father also lived with us during our youth. “Gramps” was a one-of-kind gent and friend to the entire neighborhood. Gramps died in his mid-70s but, to this day, we talk and tell funny stories about the enjoyable things we did together with our grandparents.

One’s true sense of self should focus on who we are as a person and our long-term contributions, not on age, necessarily. But when seniors are not engaged in their communities, they have lower feelings of self-control, less success dealing with aging issues, lower life satisfaction, and a poorer quality of life. Seniors want to be as independent as possible, so providing health and social services that enhance our elders’ functional and mental well-being is essential in any community.

As a society, we need to provide respect and dignity, kindness, empathy, and attentiveness to older adults, and effective communication is essential. The activities taken on by our senior population must be meaningful too. Often they build on their former roles and interests, which utilize remaining skills and foster social interaction. This is known to decrease episodes of depression. Although the actions should be challenging, to maintain or enhance various functional, mental and emotional skills, they should provide for success and feelings of accomplishment. We have so many bright and philanthropic seniors in our neighborhoods that we should feel very blessed to live in such a community.

Times have certainly changed with clinical evidence of the significance of getting seniors moving: exercise, nutrition, and a sense of purpose and its relationship to getting well, and an overall feeling of happiness. For those who believe in the spirit—there is no illusion of perpetual youth or dying alone. For that which moves the spirit and brings deep meaning and satisfaction to us follows us through the aging process, bringing a healing and a sense of peace. With advancing age, very simply, the aging process—the experience of moving into and through different developmental phases–affects the spirit and, therefore, one’s spiritual life, according to Jennifer L. Browser a Unitarian minister. A re-evaluation of one’s life and what has guided a person religiously within the latter stages of life that may prompt spiritual growth, are well documented and commonly experienced.

Almost all of us, even as we age and experience some mental or physical changes that might require some adaptations and adjustments in our lives, still have an innate desire for autonomy. When conditions of aging produce not only inconvenience, but embarrassing or uncomfortable situations when we need the assistance of others, it is difficult—no matter what our age. But as we all cope with more age-related challenges and our own philosophies, remember that independence issues are in the forefront of our nations seniors and quality of life is what we should most deeply cherish.

Paula Camposano Robinson, RN, is co-founder and owner of Sanitasole Senior Health Services. This is an information-only column and is not intended to replace medical advice from a physician. Email me at probinson@sanitasole.net or visit www.sanitasole.net for more information. Phone: 239.394.9931

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The theme of National Adult Day Services Week, September 10-25, “A Smart Choice,” was established to raise awareness of the availability and accessibility of adult day programs nationwide. This special week, which coincides with Healthy Aging Month, was first proclaimed on September 27, 1983, by former President Ronald Reagan when he recognized how adult day centers provided supervised community settings in which partially disabled or frail men and woman could obtain care that may not be available in their homes. The centers provided opportunities for seniors so they would not be forced into institutions. The first ADS program of record was a geriatric “day hospital” program established in 1960 in North Carolina.

[Karen, this paragraph can be left out if necessary.] We recognize the burden and hardships they can endure, although it is often difficult for them to acknowledge this themselves, especially those who care for loved ones with a form of dementia. Individuals may struggle to find a balance as they juggle job responsibilities, family, and personal needs, and sometimes there may be guilt if they consider other alternatives. However, an adult day program, the research shows, reduces caregivers’ stress. They also suffer less depression and anger, and report greater overall well-being (Penn State).

While caregivers can engage a Senior Care Manager to develop a comprehensive plan of care, based on home assessments safety needs and medication management, and can hire well trained home health care providers, which are all viable sources that give the caregiver respite, there is yet another option in the continuum of care ? one of healthcares’ best keep secrets ? adult day services.

The goal of adult day services is to delay or prevent premature institutionalization by providing a cost effective alternate to long term care. Adult Day Services have brought a new vocabulary and broader meaning to familiar terms like treatment and rehabilitation. ADS are concerned with maximizing the quality of clients’ lives with a holistic and interactive approach to the many services that are provided.

Day services provide structured activities, programs, and companionship with compassion for seniors who need assistance or supervision, and cannot function independently in the community, but do not require twenty-four hour institutional care. The programs encourage socialization to enhance self-esteem and encourage independence. Everyone is unique and every client is a winner–there is no right or wrong, but day services provide an environment for positive self expression and affirmation. Adult day services differ from other forms of care in their unique focus on the strengths and abilities of a person with functional or cognitive impairments; on health rather than illness. They validate past roles, and stress social interactions with respect as the foundation.

In general, there are three types of adult day services: Social, which provides meals, recreation and some health-related services; medical/health, which provides all of the social activities as well as more intensive health and therapeutic services; and specialized, which provide services only to specific care recipients, such as those with diagnosed dementias or developmental disabilities.The medical model, with all of its social components, adds licensed staff, which is able to oversee medication management; communicate with client’s physicians; observe for changes in conditions; and most, importantly, is trained in care of older adults. These centers are mandated to have specialized training.

According to recent research, people who might sit home alone with a remote, or who might move into a facility because they can’t stay at home, instead spend several days a week being active, social, stimulated well nourished and monitored by nurses at an ADS. With education, exercise, both physical and intellectual, health screenings, garden therapy and music appreciation, computers, pool work-outs, arts and crafts, day trips and rehabilitation services being just a few of many of the service offerings at various centers, at the end of the day, the participants go home to familiar surroundings, perhaps tired but fulfilled in their own way. Personal care programs help with ADLs (toileting, grooming, eating, and other personal activities of daily living). According to the National Institute on Aging, when older people lose their ability to do things on their own, it doesn’t happen just because they have aged. More likely it is because they have had an illness or become inactive.

Adult day centers generally operate during normal business hours five days a week. Some programs offer services in the evenings and on weekends. They may open earlier in the day to allow caregivers or adult children to work or tend to personal affairs, allowing family members freedom to work, or to stay engaged in club or community activities, or just take time out for them.

The National Adult Day Services Association was formed in 1979 and each individual state now regulates and licenses day centers through the Agency for Health Care Administration with a biannual renewal process. There are approximately 4,600 centers operating in the United States, providing care for more than 160,000 care recipients each day, with 35 percent of the adults living with an adult child, 20 percent with a spouse, 18 percent in an institutional setting, and 13 percent with parents or other relatives, while 11 percent live alone.

On Marco Island, Sanitasole is a combined social/medical health services model. They care for all types of clients, including those with cognitive decline, and can manage them in the group setting, unless they may be a threat to themselves or others in the program. Other specialized programs are available in the Naples and Fort Myers area. ADS can play a vital role in maintaining adults of all ages. It’s important to realize that ADS are not just for the poor, rich, or for “old people.”

Paula Camposano Robinson, RN, is co-founder and owner of Sanitasole Senior Health Services. This is an information-only column and is not intended to replace medical advice from a physician. Email probinson@sanitasole.net or visit http://Sanitasole.net, for more information. Phone: 239.394.9931.

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About 60 percent of dementia patients wander out of their homes or institutional facilities, or get lost driving, shopping, or even going for a walk. Just close your eyes for a moment: Imagine that you don’t identify who, or where, you are, the time, day or, in some cases, the year. Someone who you don’t remember is speaking to you and asking you to do things. They are trying to assist you with daily living skills or other routine yet personal activities, but you don’t understand why. Thus, you become anxious and frightened.

To relieve your anxiety, stress and confusion, you try to move about and begin to pace to help relieve some of your apprehension with the circumstances as you see them. If you are being supervised, especially during the day, it may not cause you any harm and the exercise may relieve your anxiety. Conversely, one day a door is left unlocked and while unsupervised, you just walk out, thinking your actions are going to lead you to the person you are looking for ? maybe a mate who passed on many years ago, or a job you once held that you need to get back to.

But you are disoriented and don’t respond to shouts or ask for help, and rarely do you leave any physical clues behind. Keep in mind that a person with Alzheimer’s/Dementia has no control over often-annoying repetitive behavior. The disease leaves one unable to judge potential dangerous places and situations. Confusion and restlessness occur because the brain can no longer sort out cues in the environment.

Fortunately for so many, wandering seniors are found and returned safely to their homes or other living arrangements. But wandering is expected to grow as the aging population increases. We will need resources for more than 30,000 or more incidents of “critical wandering” in the coming years. [Koester] Wearing a Medic Alert bracelet and being enrolled in a Safe Return Program is also recommended.

Statistics have shown that while all wanderers may appear to behave similarly, two distinct sub-populations exist.

The first group is those who have always been physically active and always “on the go.” These individuals may wander because of a compulsion to stay busy; they have an impaired concentration; they may have traveled and were highly mobile in their lifestyle, and they are feeling anxiety or boredom. There can be other external factors, stimulants or medications as well.

The second group is comprised of individuals who wander because of their emotional states. Their emotional state compels them to get out of their environment. They either feel unsafe, persecuted, lost, disoriented or anxious. We need to keep both types of individuals safe and secure!

The goal of their wandering is to return to a place and time when things made them feel very secure and safe. Koester’s research shows that a person who wanders is usually located (89 percent of all cases) within one mile of the point last seen. Time is critical whenever a life is at risk. Those suffering from severe Alzheimer’s are more at risk and the incidence of critical wandering increases.

Because six out of ten people with dementia (the most common, Alzheimer’s disease) will wander, it is important to watch for some of the triggers: stress, agitation and restlessness, etc., It is also important to prevent a wandering incident by: always keeping all doors locked; having a recent photograph of your loved one to help police and neighbors should he/she get lost; installing keyed deadbolts in your home or condo; using safety latches up high, or down low, on doors that lead to the outside; covering door knobs with cloth, or painting them the same color as the wall. This makes them less noticeable and makes it less likely that AD patients will try to get out. Getting enough sleep and exercise is also important.

The 2009 Report from the Institute of Medicine notes that the overall health care workforce is inadequately trained to care for older adults, which is expected to reach 80 million by 2030. Today, the current health care work force has little geriatric training and our country seriously lacks physicians who specialize in elderly care – Geriatricians. A majority of our older adults are suffering from several chronic diseases, and rely on health services far more often than other segments of the population. With one person being diagnosed every 70 seconds with AD, the U.S will face a serious shortage of physicians and nursing staff, specifically those with a vast amount of elder care training.

Keep things simple! Caregivers, because you provide the majority of AD care in the U.S., knowing how to keep your loved one safe is of utmost importance. Make sure they have plenty of supervised activity to channel their energy. If they are intent on wandering, redirect them to another simple task such as folding clothes, rolling a ball of yarn, or stacking magazines. Any busy repetitive work may prevent them from being moody, withdrawn, or angry as well as keep them from following you from room to room.

Paula Camposano Robinson, RN, is co-founder and owner of Sanitasole Senior Health Services. This is an information-only column and is not intended to replace medical advice from a physician. Email me at probinson@sanitasole.net or visit www.sanitasole.net for more information. Phone: 239.394.9931.

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Cataracts are the number one cause of blindness in adults. Submitted

Approximately 20.5 million Americans age forty and older are affected by cataracts, a concern for 50% of those aged 65-74 and 70% of those over age 74. These statistics are staggering as cataracts are the number one cause of blindness in adults, causing 48% of world blindness. Today more adults than ever are facing blindness due to eye diseases.

More than six million seniors have vision loss. Nine million between the ages of 45-65 have some form of vision loss. Baby boomers will reach retirement age of 65 between 2011 and 2030. It is estimated that, by 2030, the number of adults facing severe vision loss will double.

Most people have heard of a cataract but may not know what it is. The condition is described as a “clouding of the lens on the eye” and can range from slight to complete blockage of light. It can occur in one or both eyes, but usually affects both and starts in one eye before the other; however it cannot spread from one eye to the other.

Cataracts cause light rays to be no longer focused by the lens, but instead they are scattered before reaching the retina, causing a loss of ability to perceive details. Cataracts can start out mildly and have little effect on vision at first, but as the condition worsens, so does the impact on vision.

Not all cataracts need to be treated, but all should be immediately seen by an ophthalmologist, a medical doctor who provides the full spectrum of eye and vision care, to determine if treatment is needed. If left untreated, the disease can lead to glaucoma and complete blindness.

Cataracts form when aging or injury changes the tissue of the lens of the eye. Sometimes due to heredity, cataracts can also be caused by a number of environmental factors, such as exposure to radiation or microwave radiation, long-term exposure to ultraviolet light, smoking, excessive alcohol consumption, iodine deficiency, secondary effects of diseases such as diabetes, obesity, hypertension and advanced age, or due to physical injury or trauma. Cataracts can also be caused by some drugs such as corticosteroids and Seroquel.

Ways of preventing cataracts are not scientifically proven, but it’s believed that wearing sunglasses with ultraviolet light protection can slow the onset and progression of cataracts. Also, regular intake of antioxidants (like vitamins A, C and E) can help prevent cataracts. Randomized trials with the lesser–known antioxidant N-acetylcarnosine have shown it to be effective in treating cataracts. In a 1% eye drop solution applied twice a day for four months transparency of the lens improved in all severities of cataracts. Further research is being done with other antioxidants and methods, but currently, the most effective way of dealing with cataracts is surgery when the condition interferes with daily activities.

Cataract surgery is the most frequently performed surgery in people over the age of sixty-five, and considered one of the safest and most effective medical procedures. This out-patient surgery performed under local anesthetic only takes about an hour to complete. The cloudy lens is removed and an intraocular lens is implanted. If both eyes are affected, the surgeries are performed weeks or months apart, one eye at a time. Patients now have choices in how they want their vision to be after the surgery. Choose from mono-focus lenses that will correct the vision for the best distance that you like to see, multi-focus lenses that correct the vision in all three zones: near, arm’s length, and distance. Choose wisely as replacing the lens is not a great option. In about 95% of cataract surgeries, the patient’s vision is improved, and in over 85% the vision is restored to at least 20/40 within a year.

With cataracts and other eye diseases on the rise, it’s important to know the signs and symptoms of cataracts to watch for, so treatment can be sought early on. If left untreated, many cataracts can lead to blindness.  So if any of the following are noticed, see your doctor immediately:

• Clouded, blurred or dim vision
• Increasing difficulty with vision at night
• Sensitivity to light and glare
• Seeing “halos” around lights
• Frequent changes in eyeglass or contact lens prescription
• Fading or yellowing of colors
• Double vision in a single eye

The best prevention at this time is to keep up with your annual eye exams and to tell your doctor about any changes or problems you notice with your vision. This will help you catch cataracts early on. Remember, with early treatment, cataracts can be taken care of effectively. Don’t be one of the baby boomers that wait until your vision is so poor that it affects your daily life activities. Spread the word. Tell a neighbor about Cataract Awareness Month!

Paula Camposano Robinson, RN, is co-founder and owner of Sanitasole Senior Health Services. This is an information-only column and is not intended to replace medical advice from a physician. Email me at probinson@sanitasole.net or visit www.sanitasole.net for more information. Phone: 239.394.9931.

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Submitted photo

Everyone has an occasional sleepless night, and this is not a problem for most people. Conversely, it is often true that less may mean more. Are you too busy to go to bed? Do you have trouble getting quality sleep once you do? Well, I for one may have to literally add getting more sleep to my “to-do-list” because it has been shown that having a good night’s sleep is one of the smartest health priorities that we can set for ourselves. It is not just drowsiness during the daytime that you risk when shortchanging yourself on your seven to eight hours. There are also many possible health consequences when you get too little or poor sleep that involve the cardiovascular, immune and endocrine and nervous systems.

In addition to letting “life” get in the way of a good night’s sleep, between 50-70 million Americans suffer from chronic sleep disorder, also known as insomnia, or sleep apnea that affects their daily functioning and intrudes on their health. Here are some reasons why you should schedule sleep like any other daily activity:

1. According to a recent study by the Institute of Medicine Report, people who sleep under seven hours a night, the fewer zzzz’s they get, the more obese they tend to be. This may relate to the discovery that with insufficient sleep, hunger hormones may be triggered and become out of synch. Leptin, which suppresses our appetite, is lowered; while ghrelin, which stimulates appetite, becomes heightened.

2. We tend to make bad food choices. A study published in 2009 Journal of Clinical Sleep Medicine found that people who had obstructive sleep apnea, or other severely disordered breathing while asleep, ate a diet higher in cholesterol, total fat, cholesterol and total saturated fat. Women were affected more than men.

3. Impaired glucose tolerance, one of the precursors to diabetes, is more likely. In a study published in the Archives of Internal Medicine, individuals getting five or fewer hours of sleep each night were 2.5 times more likely to be diabetic, while those with six hours or fewer were 1.7 times more likely.

4. Heart attacks, as well as strokes, were 45 percent more likely in women who slept for five or fewer hours per night than those women who got more sleep. This is a lofty risk.

5. If one has an obstructive sleep apnea their blood pressure may increase. Sleep apnea has been associated with chronically elevated daytime blood pressure, and the more severe the disorder, the more significant the hypertension. Obesity plays a major role in both disorders, so losing weight will ease any associated health risks.

6. Nearly 20 percent of serious car accidents and injuries involve a sleepy driver. This does not even consider those who may be under the influence of alcohol. Auto accidents rise due to lack of sleep on the part of the driver because of decreased ability to pay attention, react to signals or remember new information.

7. Many people who have trouble getting to sleep, who may wake up at night, or who are drowsy during the day could be 4-5 times more likely to sustain a fall. Poor sleep causes a person’s balance to be off, especially in the senior population. Being drowsy also lowers our effectiveness and job performance and causes us to be more moody and irritable.

8. Those who try to function on little sleep may be more prone to depression. Individuals will have greater mental stress, despair, and oftentimes a greater propensity for alcohol use or other substance abuse.

9. Adolescents suffer as well. A survey of high school and middle school students reported more symptoms of depression and lower self-esteem. Younger adults may suffer more behavior issues than older adults. Research from an April issue of the Archives of Pediatric and Adolescent Medicine found that those children that were beleaguered by insomnia, short duration of sleeping, or breathing disorders with obesity, are far more likely to have behavioral issues such as attention deficit hyperactivity disorder. This then is a domino effect which may lead to poor grades, an increase in high school dropouts and even suicide if the depression is not treated.

10. Those of you who get five hours or less hours of sleep per night have an approximate 15 percent greater risk of dying – regardless of the cause – according to three large population-based studies.

To begin a new path towards healthier sleep and a healthier lifestyle, begin by assessing your own individual sleep needs and habits. Establish consistent sleep and wake schedules, even on weekends; create a conductive environment that is dark, quiet, comfortable and cool; sleep on a comfortable mattress and pillows; avoid caffeine and alcohol products close to bedtime, and if you are a smoker, it is time to get some help to quit! And for those of you who use the bedroom for watching TV, working on a computer or reading, it is best to keep these “sleep stealers” out of the bedroom.

Most importantly, make sleep a priority! I have to admit I’m one who tends to skip sleep a lot during the week, trading quiet time at night for long work hours so I have a lot of changes to make. What about you?  Get some zzzz’s – you will be a lot healthier!

Paula Camposano Robinson, RN, is co-founder and owner of Sanitasole Senior Health Services. This is an information-only column and is not intended to replace medical advice from a physician. Email meat probinson@sanitasole.net or visit www.sanitasole.net for more information. Phone: 239.394.9931.

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These incidences are not normally caused by a mental deterioration but are most likely part of the typical aging process, but what about not knowing your spouse or child? What about changes in your mood, personality or abilities to perform normal living activities, such as cooking, shopping, handling of money, gardening or getting to your weekly bridge or golf game?

Many of us may not recall the answer to the first few questions, but sadly for someone with Alzheimer’s disease, when the loss of memory affects your ability to recall recent events, or you cannot function without assistance and begin to forget your family, it becomes complex. Although Alzheimer’s disease is the most severe form of dementia, there are several other forms of the disease and many of the symptoms can be related.

Dementia is medically defined as the progressive loss of intellectual functions, such as thinking, remembering and reasoning. This brain dysfunction is of sufficient severity that it results in a restriction of a person’s ability to perform daily activities, both of social and occupational functioning.

Although the signs and symptoms may vary from person to person, in general they tend to worsen over time. Often, eventually our loved ones will need assistance with everything that they were capable of doing in the past. The memory cannot recall things in the present or recent past, but does retain information and events that occurred many years ago.

Dementia is not a disease itself but rather a group of symptoms that may manifest diseases or conditions, much like a fever is associated with many illnesses. The disease usually occurs after the age of sixty-five and becomes more prevalent as we grow older. Approximately two percent of adults aged sixty-five to sixty-nine have the disease. Alzheimer’s disease is a form of dementia. Approximately half of all dementia patients have Alzheimer’s disease.

Researchers believe that, most commonly, dementia occurs when nerve cells, or neurons, start to break down or degenerate, and the normal connections in the brain between the nerve cells are interrupted. Except in cases of specific diseases, these disruptions can have many causes, and usually cannot be reversed unless caused by alcohol, drugs, hormone, or vitamin imbalance, or depression.

According to a recent edition of the medical journal, “Neurology,” there are various diseases that can cause dementia. These include Parkinson’s disease, Huntington’s, AIDS, Alzheimer’s (which accounts for approximately forty to forty-five percent of all dementias), vascular disease or stroke, (which accounts for twenty percent); and other conditions, including traumatic head injury, alcohol abuse, Pick’s disease, brain abscess, Multiple Sclerosis, vitamin B1 and B12 deficiencies, hypothyroidism, and more than fifty other rare degenerative conditions.

The many symptoms of this is horrific and complicated disease of dementia can mimic depression. Similarly, symptoms of depression can mimic dementia. According to the National Mental Health Association, thirty to fifty percent of older adults with memory loss, or dementia, also suffer from depression and “unfortunately, symptoms of depression are often overlooked and untreated when they coincide with other medical illnesses” or life events that commonly occur as people age.

In the case of dementia, depression can last over a period of months and it can occur anywhere in the disease process. An important aspect to consider is that depression can cause additional stress in the early stages of dementia and later it can trigger behavioral problems, which can be severe.

Some of the symptoms of depression alone can cause dementia-like symptoms such as social withdrawal, lack of interest in previously enjoyed activities, low spirits, feelings of hopelessness, sadness, tearfulness, sleep disturbances, changes in appetite, confusion, forgetfulness, inability to concentrate, irritability, aggression and distrust.

Additional depression symptoms such as apathy, loss of interest in previously enjoyed activities and hobbies, worry, weight loss and isolations can be compounded with dementia. In persons with Alzheimer’s, the depression can lead to wandering, delusions, hallucinations, verbal agitation and aggression towards caregivers during the performance of activities of daily living. For persons with Alzheimer’s, depressive symptoms may come and go, be less severe, not last long or reoccur as often as someone without Alzheimer’s.

It is important to get the right diagnosis. Of considerable interest is a recent report from the Alzheimer’s Association: the US National Institute of Mental Health has proposed a new diagnostic criteria for a specific disorder called “depression of Alzheimer’s disease,” to be used to identify those with the dual diagnoses of Alzheimer’s and depression. Although the criteria are similar to general standards for major depression, they reduce the verbal emphasis and include irritability and social isolation.
To meet these criteria, someone must have, in addition to an Alzheimer’s diagnosis, other changes in functioning characterized by three or more symptom during the same two-week period. These must include at least one of the first two on the list – depressed mood or decreased pleasure in usual activities.

Early recognition and treatment is the key as every seventy-two seconds someone in America develops Alzheimer’s disease according to the National Association.

Paula Camposano Robinson, RN, is co-founder and owner of Sanitasole Senior Health Services. This is an information-only column and is not intended to replace medical advice from a physician. Email meat probinson@sanitasole.net or visit www.sanitasole.net for more information. Phone: 239.394.9931.

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The desire for family members to keep loved ones at home, or to “age in place” has created the emergence of many related healthcare services: senior care management, home health care, adult day services, and various non-medical and custodial types of care, as opposed to care in an institutional setting. The ultimate goal is to keep our loved ones in the home for as long as safely possible.

According to a study by Met Life Mature Market Institute in conjunction with Life Plans, Inc., in 2008, many baby boomers are seeking quality care for frail or ill parents who are unable to stay at home alone. Some (an adult child, spouse, or sibling) want an option that allows them to go to work. Others live far from their aging loved one and can’t just pick up and travel freely to check in on them. And there are those who are looking for some relief from 24/7 care-giving. Caregivers desire an option that is reliable and stimulating yet affordable, but they cannot navigate the fragmented health-care system alone, especially when they are long-distance caregivers.

This is the time to look for a Senior Care Manager! These are professionals who specialize in assisting older adults and their families to establish short- and long-term care needs. Care management is truly a holistic approach to caring for an aging adult. Care managers are problem solvers who match seniors to the appropriate services needed and they monitor their outcomes.

As an advocate of the client and the family, this service provides a series of steps including developing an initial personalized assessment of, at a minimum, the client’s health, lifestyle and home environment for safety hazards, and a review of medications and the physician orders so they can develop a comprehensive plan of care. Plans may encompass financial planning, bill paying, transportation and other services necessary to lighten the burden on the family.  Most care managers are RNs, social workers, or case managers with experience in geriatric care, but they also have a keen knowledge of the availability of local resources in order to provide the family member the most professional goal-oriented care possible. The care management process improves the quality of life not only for the aging adult, but for all family members involved because the services can save the family both time, money, and stress. The senior-care manager acts as an extension of the family. Most are on call 24/7, year-round, and communicate with family members on a regular basis, allowing the family and the aging adult to make informed and appropriate decisions regarding any long-term needs if and when necessary.

More than 44 million families and other informal care-givers provide the vast majority of the long-term care in this country. Most have limited preparation for the job and receive limited ongoing support, although they contribute more than $350 billion annually in uncompensated care, according to a most recent AARP report.  To meet the goal of keeping the client as independent as possible and autonomous in decision-making, the care manager is the “eyes and ears” for family members.

Home-health-care staff can be hired through an agency or registry, or privately.  Because every state has the authority to license and regulate its home-care agency system, there are often variations, with the exception of Medicare-certified agencies that must comply with federal regulations.  Typically provided by nurses, therapists or specially trained home-health aides under the direction of a physician or nurse, skilled-care services are needed after an acute event, such as a heart attack or stroke, once a patient has been discharged from a hospital and/or requires rehabilitation services.

Paraprofessionals (home-health aides and nursing assistants), custodial or supportive care provides hands-on assistance to people in their homes who need help with activities of daily living, such as bathing, dressing, eating, toileting or continence. Homemakers or companions provide services that include light housekeeping, meal preparation, transportation and companionships. This type of care is often appropriate for those with Alzheimer’s or other forms of dementia, or people who may be physically healthy but require some supervision and interaction.

Don’t feel guilty about hiring a care manager in order to lighten your labor of love in your role as a caregiver! Having a third party who is not a family member can allow for more objectivity and may help seniors see things from a different point of view. Having a professional opinion as opposed to those of family members may make the decisions less burdensome.

Paula Camposano Robinson, RN, is co-founder and owner of Sanitasole Senior Health Services. This is an information-only column and is not intended to replace medical advice from a physician. Email meprobinson@sanitasole.net or visit sanitasole.net for more information. Phone: 239.394.9931.

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