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Taking Care of Aging Parents

Great Health Magazine

Help an aging parent maintain independence by averting the top three disability risks.

As our parents age, roles sometimes reverse, and we become the caregivers. Whether you welcome the opportunity or shudder at the thought, it always helps to be armed with knowledge. Most seniors want to maintain their independence as long as possible, and you can help them to achieve that goal.

One in eight Americans, or approximately 36 million, are age 65 or older, and the number is expected to double by 2030. Among the older population, those who are age 85 and older make up the fastest-growing segment.

Understand the Challenges
The top three reasons older people lose the ability to care for themselves are muscle weakness, balance problems and arthritis, according to Thomas Gill, M.D., a specialist in geriatrics at Yale University School of Medicine in New Haven, Conn. These factors manifest as pain, fear of falling or actual falls, and they reduce a person’s ability to do all the daily tasks we take for granted, such as bathing and getting dressed. What’s the remedy? “One of the easiest things to do is get out and walk,” says Gill. If that’s too difficult, he recommends strength training first, with medical approval and guidance from a physical therapist or qualified instructor.

Think Nutrition
The basics of a healthy diet never change: Sugary, fatty and processed foods that are devoid of nutrients contribute to disease. In contrast, a diet rich in plant foods, fish and healthy fats but low in meat and dairy, such as a Mediterranean diet, promotes health. A study of 1,507 men and 832 women between the ages of 70 and 90, in 11 European countries, found that a Mediterranean diet, along with at least 30 minutes of daily physical activity, moderate alcohol use and nonsmoking extended a healthy life most effectively. Making sure that an elderly parent has a well-stocked refrigerator, is able to easily prepare healthy dishes that he or she likes, and eats regularly will foster long-term health and self-sufficiency. In addition, most integrative physicians, including Stephen Sinatra, M.D., board-certified cardiologist, internist, and anti-aging and nutrition specialist based in Manchester, Conn., recommend dietary supplements (see Sinatra’s recommendations in sidebar).

Gain Exercise Savvy
“Muscle responds to exercise even when you’re 100 years old,” says Ronenn Roubenoff, M.D., professor of nutrition at Tufts University in Boston, Mass., and author of numerous studies on the effects of exercise on the elderly. He recommends exercising six days a week, doing strength and cardio exercise on alternate days, and stretching after each workout to improve range of motion. Lasting gains require consistent effort but are well worth it. Strength training (working with weights or resistance) improves balance as well as strength, increasing mobility and independence, and making cardiovascular exercise possible —a life-extending combination.

Watch the Drugs
Side effects of medications can also impair balance and mobility. “I see so many elderly patients who suffer from lightheadedness, fatigue and dizziness due to prescription drugs,” says Sinatra. “Livers of the elderly have a hard time metabolizing medications, so they stay in the system longer,” he notes. “When I start people over age 65 on a prescription drug, it’s with a small percentage of the recommended dose, then I see them often and have nurses call them frequently between visits to monitor their conditions.” If you suspect that your parent or parents are experiencing adverse side effects from a prescription medication, arrange for a comprehensive exam from a physician who specializes in geriatric medicine. Ideally, Sinatra says, that person should also be certified in nutrition by the American College of Nutrition.

Maintain Memory
“As we live, we develop wisdom and can use our intelligence and knowledge to bring something to the world,” says Dharma Singh Khalsa, M.D., president and medical director of the Alzheimer’s Prevention Foundation International in Tucson, Ariz. “That’s the greatest thing about memory.” Preserving it requires mental activity. “Mental exercises alone can reduce the incidence of Alzheimer’s by 70%, and physical exercise by itself can lower risk by 50%,” he says, noting that it’s never too early to start because changes take place in the brain years before deterioration is noticeable. He advises, “Don’t wait to develop symptoms.”
Quick Tip
In studies, tai chi training in elderly people reduced the risk of multiple falls by more than 47%. Just four weeks of tai chi training improves balance significantly.

Supplements for Seniors
Stephen Sinatra, M.D., recommends the following daily regimen to promote heart and joint health.

> Heart Health
Multi: Choose one with up to 200 IU of vitamin E, an amount that provides benefits but will not interact with medications, and 100 to 200 mcg of chromium for blood sugar support.
CoQ10: 100 to 200 mg daily
Carnitine: 500 to 1,000 mg daily
Fish oil: 1 gm daily
Calcium: For men, a total of 900 mg daily from all sources (more than 1,000 mg daily may increase risk for prostate cancer). For women: Take 1,500 mg. Be sure to take in divided doses throughout the day, preferably with meals.
Magnesium: 400 mg daily

> Joint Health
Glucosamine sulfate: 750 to 1,500 mg split into three doses and taken with meals.
Chondroitin sulfate: 300 mg daily
Ginger tea or green tea: 1 to 2 cups
Curcumin: 250 mg daily
SAMe: 400 to 1,200 mg split into two or three doses.

> For Better Memory
“What works for the heart, works for the brain,” says Dharma Singh Khalsa, M.D. In addition to the above, he recommends phosphatidylserine (PS). Take 100 mg for better memory and prevention of dementia, 200 mg for mild cognitive impairment, or 300 mg for Alzheimer’s.

Quick Tip
Vitamin D may help reduce falls in seniors by as much as 22%. It also promotes calcium absorption, thereby helping to prevent osteoporosis. Get 1,000 to 1,200 IU daily from food and supplements.

Kitchen Tricks
Nutritionist and chef Lissa De Angelis, C.C.P., M.S., offers the following tips for making kitchen tasks easier for the elderly.

> Add suction cups to the bottom of a cutting board so it doesn’t move around.

> Use the sink’s sprayer hose to fill pots with water on the counter to avoid lifting a heavy pot out of the sink.

> Keep kitchen scissors handy, for everything from cutting open cellophane bags to trimming lettuce and parsley.

Quick Tip
Buy your parents an outdoor set of dinnerware for everyday use. These dishes won’t break, and they look great.

Bathroom Basics
“The bathroom is where 80% of home accidents occur,” says geriatric care manager Marion Somers, Ph.D. So it’s important to problem-proof this space for elders. Here’s a quick checklist.

> Add nonslip strips to the tub/shower floor and non-skid mats to the bathroom floor. Note: Remove throw rugs and any clutter that might cause a fall.

> Safety rails are key—both inside and outside the tub/shower as well as by the toilet.

> Clearly label water faucets “hot” and “cold,” and set the water heater to 120° or lower in order to avoid scalding.

> Replace doorknobs with easy-to-grab levers. Dexterity kits provide other “enabler” tools, such as zipper and button pullers to make dressing easier.

> Increase the wattage of light bulbs for better visibility (a good tip for every room in the home).

Quick Tip
Crossword puzzles, Sudoku and even the newspaper can keep seniors sharp. If poor vision is hindering reading activities, a lighted magnifying glass can help.

To find: Contact:
Physicians certified in geriatric medicine, including insurance, medical and legal information Free federal, state and com-munity programs at Healthin Aging.org, (800) 563-4916
Eldercare Locator of the Administration on Aging American Geriatrics Society at ElderCare.gov, (800) 677-1116


Caring for the Caregiver
Q & A With Elder-Care Expert Marion Somers, Ph.D.

It’s not easy taking care of an aging parent, but what is easy is neglecting your own needs, warns Marion Somers, Ph.D., geriatric care manager and author of Elder Care Made Easier: 10 Steps to Help You Care for an Aging Loved One  (Addicus Books, 2007). “As a caregiver, taking care of yourself needs to be your No.1 job,” she says.  Here, she shares some of her top tips for managing your own well-being while caring for a loved one. (Note: For more tips, visit doctormarion.com.)

Q: You say that it’s absolutely essential for a caregiver to be organized. Can you offer any tips on how to do this?

A: Be sure to write everything out and make a master schedule for yourself.  “To do” lists are a must to ensure you’re covering all your bases.
Write down approximately how long each task takes. Prepare to revise accordingly if you experience that a tasks takes longer than originally thought. This will help you organize your day, and ensure that necessary tasks are completed.

Be realistic about the time you can actually spend on any one given task, and plan accordingly. What you can’t accomplish in a day can be moved to the top of tomorrow’s list!

Q: What are some of the warning signs of caregiver burnout?

A: There are four quick indicators:
1. You’re overwhelmed by small tasks.
2. You’re easily panicked about emergencies.
3. You feel that there aren’t enough hours in a day.
4. You feel as if you don’t have any alone time.

Q: Why is alone time important to the health of a caregiver?

A: If you don’t take care of yourself, you are likely to become angry, frustrated, sick, etc.  The more you can put yourself first, and tend to your physical and emotional needs, the better you’ll be able to help tend to the physical and emotional needs of the person you are caring for.

Q: Whom can caregivers call on for help that maybe they’ve overlooked? Can you offer any tips on how to better delegate tasks?

A: The fact is that most people want to help, but want to do so in a way that won’t eat up all of their time and resources. So whether you’re enlisting the help of a friend, a neighbor, a family member or local church/community group, it’s essential to be clear about what you need help with, the steps that are involved, the time that is needed, and delegate accordingly.

Once you have your “to do” list, start by breaking up the responsibilities into manageable bites, then figure out what each person has the time/resources for. For example, put one person in charge of grocery shopping, one in charge of laundry, another in charge of calling the person you are caring for weekly, one to take him/her out to lunch and/or to the hair salon, to the doctor, etc. 

By breaking up the tasks, you’ll ensure that no one person feels taken advantage of, and you’ll be more likely to cover all of your bases.

Before delegating, be very clear with each person about what each task entails (how much time it takes, how much of a commitment, etc.) so they understand what they are signing up for.

Check up regularly on your “helpers.”  It’s a great way to give them a friendly reminder and make sure they’re following through on their given task. It’s also a good time to discuss any questions or concerns they may have.

Q: What if you’re the sole caretaker and you need to talk to someone? Any tips for where you can go to get help, inspiration and information?

A: Of course they can go to my Web site, DoctorMarion.com, which has all sorts of helpful hints, tips and message boards. They can read my book, Elder Care Made Easier: 10 Steps to Help You Care for an Aging Loved One. They can also go to AGIS.com, where caregivers can chat with each other about their various caregiving challenges, swap ideas, etc.

There are also many local groups that can help a caregiver depending on the problem: Parkinson’s support groups, Alzheimer’s support groups, etc. Support groups are a wonderful (and safe) place to share hopes, concerns and ideas. They help people realize that they are not alone; that there are other people going through similar experiences.

Q: What is a common mistake that caregivers of aging parents make? Do you have a No. 1 tip for them?

A: So many caregivers take on more than they can handle, so much so that they let go of their own health and support system. What they don’t realize is they are not helping anyone. When a caregiver stops doing the very things that keep them healthy and happy, the caregiving burden becomes unbearable. Caregivers do not have a choice: They MUST put themselves first.

Q: Are there any products that you can recommend that you think really help aging parents stay more independent?

A: There are so many wonderful products out there, a few of which I’ve listed below:

Presto (Presto.com)—Can be accessed by anyone who has a computer, and the older person receives it as if it were a fax.  A great way to send e-mail and digital photos to your loved one without requiring them to learn how to use a personal computer.

QuietCare (QuietCare.com)—a new elder care technology, enhances home health care by providing early detection of problems. Keeps seniors safe and independent. Unobtrusively records the behaviors of a loved one and alerts caregivers quickly if a change in daily routine signals a potential problem.

The system’s wireless activity sensors are positioned throughout a person’s home to learn his or her normal pattern of daily living such as meal preparation, medication and bathroom use, as well as the person’s wake-up time and overall activity. Caregivers can access reports through a secure personal Web site.

The elder care system identifies potential emergencies, such as possible bathroom falls or no morning activity, and a professional response operator promptly notifies family caregivers or emergency services. QuietCare even provides alerts when the temperature in the senior’s home is dangerously high or low, which is another potentially lifesaving feature.

Jitterbug cell phone (JitterbugDirect.com)—This phone has big buttons, bright screens and text, loud and clear sound; plus, it’s easy to use and provides service for as low as $10 a month.

Additional Tips to Make Home Safer
There are also a few quick and easy things anyone can do to adapt their home in minutes to make the home a safer place for an elder person:

The Bathroom (where 80% of home accidents occur)
1. Avoid falls: Add nonslip strips to the tub/shower floor and nonskid mats to the bathroom floor.

2. Safety rails: Both inside and right outside the tub/shower, as well as by the toilet.

3. Prevent scalding: Clearly label water faucets “hot” and “cold,” and set the water heater to 120º or lower.

The Bedroom
1. Throw rugs are an accident waiting to happen; remove them and any other clutter that can cause a fall.

2. Increase the wattage of light bulbs for better visibility (a good tip for anywhere in the home). 

3. Replace doorknobs with easy-to-grab levers, and remove interior locks to prevent an accidental lock-in.

The Kitchen
1. Avoid fires. Watch for loose sleeves on clothing that can easily catch fire while cooking, and have a stove-top fire extinguisher available.

2. Put appliances, dishes and silverware within easy reach, and consider buying easy-to-hold utensils, sippy cups and durable/unbreakable dinnerware (home stores have great-looking outdoor sets that serve this purpose well).

3. Based on level of independence, remove sharp knives, razor blades and scissors.

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