AGING LIFE CARE® ASSESSMENTS: Empowering Quality Aging

Unveiling the Assessment Process

At Caring Considerations/ Aging Life Care Manager, we understand the intricate challenges families face while caring for seniors. Our assessments will create a roadmap for balanced, enriched, healthy living. We confront obstacles, align goals, and ensure documentation of your healthcare.  Assessment can mean different things to you and to us.  Here’s our most common approach.

Through targeted questions and the gathering of information, we uncover your unique situation:

Health Snapshot: Medical history and recent physician visits.
Medication Check: Medication list and reviewing management systems.
Safe Spaces: Home assessment for secure aging.
Wellness: Nutrition and overall health.
Legal Review: Your documentation for incapacity planning.
Emotional Insights: Psychosocial understanding.
Future Readiness: Funeral plans and crisis prevention.
Create a Plan of Care and Informed Steps Ahead…

Our assessment also covers these crucial aspects:

Defining Goals: Your aspirations and their aspirations.
Addressing Concerns: Primary worries and fears.
Visualizing Success: Ideal outcomes for your family.
Effective Strategies: Past successes and failures.
Family Dynamics: Understanding inter-family conversations.
Comprehensive, Electronic Health Documentation…

We finish an assessment by providing a verbal and email report packed with insights and actionable recommendations.

What’s your definition of an assessment? We want to know how we can elevate your family’s quality of life. Contact us at 571-488-9396  [email protected]




Resources to Learn More About Alzheimer’s/Dementia Research, Prevention, Treatment

  1. Alzheimer’s Association 800.272.3900  24/7

www.alz.org  https://www.alz.org/media/Documents/alzheimers-facts-and-figures.pdf

  1. NIH Clinical Trials

https://www.alzheimers.gov/clinical-trials

  1. Good overview videos

What you can do to prevent Alzheimer’s | Lisa Genova

https://www.youtube.com/watch?v=twG4mr6Jov0

Gary Small MD/Successful Aging  https://www.ted.com/talks/gary_small_the_formula_for_successful_aging?utm_campaign=tedspread&utm_medium=referral&utm_source=tedcomshare

  1. More in-depth clinical information

Dale Bredesen, MD A Precision Approach to End ALZ

https://www.ted.com/talks/dale_bredesen_a_precision_approach_to_end_alzheimer_s_disease

  1. Reversal of cognitive decline in Alzheimer’s disease – Aging (Albany NY). 2016 Jun

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4931830/

  1. Reversal of Cognitive Decline: 100 Patients-Journal of Alzheimer’s Disease & Parkinsonism 2018

https://www.omicsonline.org/open-access/reversal-of-cognitive-decline-100-patients-2161-0460-1000450.pdf

  1. Practical information about dementia care (Teepa Snow)

https://www.youtube.com/watch?v=t–mkzfHuIE

  1. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7392084/

  1. More Basic Information

https://www.nia.nih.gov/health/what-dementia-symptoms-types-and-diagnosis

 10. Blue Zones bluezones.com

  1. Recent Article: Do we have to age?

https://www.theguardian.com/science/2021/jan/03/observer-magazine-do-we-have-to-age-biologist-andrew-steele

 12. Improve brain health with the MIND diet

https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/improve-brain-health-with-the-mind-diet/art-20454746

  1. Diet: Ketoflex 12/3

https://www.apollohealthco.com/ketoflex-12-3/Keto

14. George Washington Center for Integrative Medicine  www.gwcim.com

202-833-5055

15. Brain Growth Exercises

Elevate – Brain Training Games (phone app)

https://www.dakim.com/  Online and best used on a touch screen/iPad/Tablet

https://enrichvisits.com/  Workbooks for purchase

www.luminosity.com   Online, phone, tablet

https://www.goodwinhouse.org/stronger-memory/  Down loadable, free, worksheets

  1. Help for Families

Aging Life Care Association  www.aginglifecare.org

National Alliance on Caregiving www.caregiving.org/

Dementia Action Alliance www.daanow.org

Other recent news…

Alzheimer’s Association International Conference 2020  HIGHLIGHTS

Flu and Pneumonia Vaccination Tied to Lower Risk of Alzheimer’s

New research at AAIC 2020 suggests that flu and pneumonia vaccination are associated with a reduced risk of Alzheimer’s. Two studies of older adults found that those who received either a flu or pneumonia vaccination were less likely to develop Alzheimer’s. Those who received the flu vaccine more regularly had an even lower risk. For pneumonia vaccination, the largest risk reduction was observed in people who do not carry one of the known genetic risk factors for Alzheimer’s — a variant of the TOMM40 gene.

  • Blood tests that measure abnormal versions of the tau protein may — if verified through further research — diagnose Alzheimer’s dementia without additional confirmation; that is, not requiring autopsy examination, or both an amyloid and tau positron emission tomography (PET) scan.
  • Heart health risk factors — such as high blood pressure, diabetes and being overweight — as early as adolescence can influence late-life memory and cognition, especially in African Americans.
  • Higher quality early-life education is associated with better language and memory performance and lower risk of late-life dementia. This association can differ between men and women and between Black and white individuals.



Decisions: From Independent Households to Extended Family Households

You may recall the days when parents lived with their grown children (think The Walton’s).  Many cultures adopted this arrangement for financial or traditional reasons. Then an era of independence became more common.  I recall my grandmother wanting her own household in the sixties. Over time, changes in society have caused us to re-examine independent households in favor of extended family households.  The 2008 recession, living longer, and managing chronic conditions have been catalysts for change.  The fact is, living with family is becoming more popular.

Is it right for you?*

We spoke with a few families who have made the change.

Kathy and her husband, Richard lived very close to Kathy’s father, Bill.  The grandchildren enjoyed frequent visits to Grandpa’s house.

One day, they found Grandpa Bill unresponsive on the kitchen floor.  Fortunately, he was okay, but Kathy and Richard agreed it was enough of a scare to start the conversation. There was no reason why Dad couldn’t live with them.

It took Bill, a widower, a little while to get used to the idea. But when he thought about the future and his daughter’s responsibilities, he felt it would be a wise move.

“What really helped my father accept a new living arrangement was having a lot of control.  He helped hire an architect and Dad directed most of the in-law addition designing.  Dad was still sharp. He listened to our ideas, and he enjoyed the process.”

When I asked Kathy how they prepared to combine lifestyles, she said it was pretty easy.  Richard, the son-in-law, worked during the week and Kathy was able to spend some time with Dad.  When the weekend came, Grandpa Bill respected their family time.  Richard had no problems with his father-in-law being around. There were some shared meals, by invitation only. Grandpa Bill always knocked on their door in the morning just to say Hi and I’m okay.

What really worked out well is the in-law suite. It was very private and self-contained.  Hiring a good architect made all the difference, according to Kathy.

To finance the home addition, Grandpa Bill paid for most of it. Kathy and Richard were able to create an upper level master suite and bath, so they agreed to pay a portion of the renovation taking into consideration future home equity.

What didn’t work so well, according to Kathy, was her brother’s  response.

“During this time, my brother had to learn that I was the Executor of my Dad’s estate and that I was named as having Power of Attorney. I let my Father have that conversation with my brother.  But I knew my brother didn’t want the responsibility of caring for Dad full-time and everything that comes with it.  Eventually everyone came to terms with the financial implications.”

Parents Living with Dementia

Kathy’s family was blessed with a relatively smooth arrangement.

Other families have a more complicated situation. For instance, when memory loss affects one or both parents.

The person living with dementia may experience confusion, suspicions, and even more severe behavior issues. Some families assume resistance is stubbornness. Most of the time, it is fear of the change and a new environment.

The trigger to change living arrangements? When one-on-one caregiving becomes necessary, many older adults move in with their families.  Without some forethought, the primary caregiver, usually a daughter and her family, can find the arrangement burdensome to a point of compassion fatigue.

Did the Walton’s have the right idea? In our next blog, we will discuss questions, expectations and boundaries.

If you or someone you know is exploring living and care arrangements for a loved one, we can help make the transition a little easier. 571-488-9396 [email protected]

*Names are fictitious.




Dementia Communication: Our Four Best Tips

Many of us often make mistakes when communicating with people who are living with dementia. It’s a learning process, but here are a few key practices which may help you. Remember, those living with dementia have a disease and cannot control their behavior. Their reasoning and logic skills are impaired. Changing our approach can reassure them and reduce anxiety.

Try these tips for successful interactions.  Above all, empathize.

  1. REDIRECTION
  • Be patient. To redirect is to lead. People prefer to follow someone they trust and enjoy, not someone who frightens or shames them.
  • Use a calm, friendly tone. Make sure your body language reflects your soothing words.
  • Avoid arguing or using reason. Do not say “Mom, if you do that, you’ll fall!” People with dementia lose the ability to follow logic. This is not an effective motivator. It only makes them defensive, which is counterproductive.
  1. VALIDATION
  • Enter their reality. Validation works through empathy, building trust, and developing a sense of security. If they believe their Mother is still living, ask them to describe Mom rather than say their Mother died years ago.
  • Acknowledge their feelings. Do not argue. Instead, acknowledge their frustration and fear. Let them know you recognize their anxiety. Start with, “That must be upsetting.” instead of, “You’re wrong about that.
  • Dealing with paranoia. Do not dismiss their comments with “That’s not true.” Instead say, “I’ll help you with that problem.”  Recognize that although hallucinations can be disturbing, they are very real for those living with dementia. Empathize and reassure.
  1. FIBS/LIES
  • Last resort. You must know your family member to know if fibs/lies will be helpful to reduce anxiety, help by redirecting them.

I knew a daughter who received multiple phone calls from her Mother daily.  “Have you seen my sweater?  Do you have my sweater?”. After a lot of frustration and multiple times of saying “No, Mom.”, she  finally just said, “Yes Mom.  I have your sweater.”  She said, “Ok” and hung up.

  •  When therapeutic fibs don’t work. If a person is suspicious, do not use fibs/lies. They can cause an escalation in the situation and distrust in current or future interactions.
  1. TRUTH
  • Share the truth. We often try to protect those with dementia by not telling them the truth. Not sharing the full truth can be frustrating and lead to agitation. Sometimes, calmly telling the truth can help the person. Communication practices should take into consideration the stage of dementia.
  • The truth is better. In early stages of dementia, the truth is better.
  • When the truth is better left unsaid. If what you share with them will only make them sad or experience emotional pain they will not remember later, it is not always best to be truthful. It’s not helpful to make someone re-live sad moments by being truthful.  In these cases, try to change the subject.

A FEW MORE TIPS

  • What might be causing the behavior? Are they uncomfortable? Are they in pain? Thirsty?
  • What caused the behavior? What did you learn that will help for next time? How did you respond? What did you do right? What might you try next time?
  • Allow free-will. Do not restrict or try to stop a behavior unless it is harmful. Use the techniques above to prevent harm.

A consultation may help you cope with a loved-one who is experiencing certain behaviors.  Call or e-mail to learn more. 571-488-9396  [email protected]




Eliminate the Confusion: Advance Directives vs. DNR

“Do you want to be resuscitated if your heart stops—meaning if it happened at this moment, would you?”

Depending on the stage of a person’s life, many reply, “No, I don’t want to be resuscitated and those wishes are documented in my Living Will (aka Advance Directives).”

The difference between a Living Will and a Do Not Resuscitate (DNR) order and how they are used is a common misunderstanding among older adults and their adult children.

The Problem

If your heart stops and you are unconscious (aka cardiac arrest), someone will call 911.

Paramedics will arrive and attempt to resuscitate you by default. They will not ask to see a copy of your Living Will or Advance Directives while fighting to save your life.

How will you communicate your wishes outside of your legal advance directives?

Unlike most Americans, you have been conscientious about legally preparing for the future. You have been thoughtful and diligent about getting your ducks in a row.

Our Observation

We estimate at least 90% of older adults and families we serve do not recognize the difference between the legal documents designed to carry out your end-of-life wishes and a Physician-signed Do Not Resuscitate (DNR) order.

The reason may be that when we are younger, our Advance Directive may indicate the desire to prohibit life-sustaining interventions in the event of a lengthy coma with no reasonable expectation to survive. (Do you recall the case of Terri Schiavo?) When medical professionals have determined your body cannot function without artificial means (i.e. a ventilator) our Living Will reveals our wishes to family.  However, outside of traumatic permanent injuries, most of us want to be resuscitated when we are young.

Older adults often feel differently. By their advanced years, many adults have dealt with cancers, several chronic conditions such as COPD, diabetes, heart disease, arthritis, dementia, etc. By the time they reach a certain age, they may feel fulfilled and are comfortable with letting nature take its course.

The Solution

If you do not want to be resuscitated, then it is time to talk to your doctor. Debbie Aggen RN, CMC, CDP tells her clients, “A DNR is not a document written up by an attorney. It is a medical order from the doctor. Medical professionals have to follow a doctor’s order, that includes Paramedics, EMT, hospitals, nurses and home care aides or others who may be in your home.“

Ask your doctor if it is time to consider a DNR.

Questions to Ask

Discuss medical interventions and how they may affect you with your doctor. Medicare will cover the doctor conversation.

Here are questions to start the dialogue:

  • What are the chances that CPR will save your life?
  • What happens to my body when CPR is administered?
  • When would artificial nutrition be appropriate?
  • What if I just want to be kept comfortable? When would respiratory therapy be considered?
  • DNR: Where should the DNR go and who should have it?

The two most important places a DNR should be kept:

  • The Refrigerator
  • In Your Wallet.

Make several copies and make sure your family and doctor also have a copy.

Consider how a Living Will and a DNR affects your life.

Your life is your choice.

Still Have Questions?

Do you need additional information about a DNR? Contact Us. We look forward to answering your questions.




Local Mental Health Resources Are Available

I often find our local, northern Virginia government confusing and overwhelming.  We hope that if you need mental health resources that you will contact our Aging Life Care Professionals at 571-488-9396 or reach out to the entities below:

Local Resources:

  • Fairfax-Falls Church Community Services Board offers help for mental health, substance abuse, and developmental disabilities. Click here for a flyer on getting help during COVID-19, or call 703-383-8500 for more information and to apply for services.
  • Prince William County Community Services Board provides mental health, developmental disability, substance abuse, emergency services and early intervention programs for residents of Prince William County. You can visit their website for more information, or call 703-792-7373 (Woodbridge) or 703-792-5241 (Manassas) if you need assistance.
  • PRS provides skills training and supports to individuals living with mental illness, substance use disorders, mild intellectual disabilities, autism spectrum disorders  throughout Northern Virginia and in the District of Columbia. For more information on services offered in Virginia, call 703-536-9000 or click here.
  • If you need mental health support, or assistance with other essentials like finding food and paying rent/mortgage, dial 211 to be connected with someone who can help.

For Immediate Help:

  • Disaster Distress HelplineCall 1-800-985-5990 or text TalkWithUs to 66746.The Disaster Distress Helpline (DDH) provides crisis counseling and support for anyone in the U.S. experiencing distress or other behavioral health concerns related to any natural or human-caused disaster, including public health emergencies.
  • National Suicide Prevention LifelineCall 1-800-273-TALK (8255) or click here to chat online. Offers 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals.
  • Caregiver Help DeskContact Caregiver Action Network’s Care Support Team by dialing 855-227-3640. Staffed by caregiving experts, the Help Desk helps you find the right information you need to help you navigate your complex caregiving challenges. Caregiving experts are available 8:00 AM – 7:00 PM ET.  
  •   If you are in an emergency, call 911.

For LGBTQ+ Individuals:

  • LGBT National Help CenterCall 800-246-7743 or visit glbthotline.org. Offers a talkline and weekly chatrooms for youth, providing confidential peer-support, information, local resources and community. 
  • The Trevor ProjectCall 1-866-488-7386 or text START to 678678. A national 24-hour, toll free confidential suicide hotline for LGBTQ youth.
  • Trans LifelineDial 877-565-8860. Trans Lifeline’s Hotline is a peer support service run by trans people, for trans and questioning callers.

For Survivors of Assault and Abuse:

  • National Domestic Violence HotlineFor any victims and survivors who need support, call 1-800-799-7233 or 1-800-799-7233 for TTY, or if you’re unable to speak safely, you can log onto thehotline.org or text LOVEIS to 22522.

For Veterans

  • Veteran Crisis LineCall 1-(800) 273-8255 and press 1, text 838255, or click here to reach a qualified responder with the VA.

Please continue to take care of yourselves and each other, and remember that my office is here to help. Be sure to visit the COVID-19 page on my website for more information and resources. If you have any questions or concerns, or if you need assistance, please don’t hesitate to call us at (703) 256-3071.

Sincerely,

Gerald E. Connolly
Member of Congress