Hypothermia occurs when your body temperature gets very low.  For an older person, a body temperature colder than 95 degrees can cause many health problems, such as a heart attack, kidney problems, liver damage, or worse.  Being outside in the cold, or even being in a very cold house, can lead to hypothermia. But steps can be taken to lower your chance, or that of an older adult, of getting hypothermia.

The National Institute on Aging has a downloadable brochure on keeping safe in the winter cold.  Included are examples of older adults who have learned to live safely in cold climates, as well as many recommendations for keeping an older adult safe in the cold of winter.  Among the suggestions are:

• Set the heat at 68 degrees or higher.
• Dress warmly on cold days even if staying in the house.
• Wear loose layers when going outside on chilly days.
• Wear a hat, scarf, and gloves.
• Don’t stay out in the cold and wind for a long time.
• Talk to a doctor about health problems that may make it harder to keep warm.
• Find safe ways to stay active even when it’s cold outside.
• Ask a neighbor or friend to check on you if you live alone.

If you think someone has hypothermia, call 911 right away. Cover him or her with a blanket. Do not rub his or her legs or arms.

For more information to keep seniors safe in the winter cold, see the downloadable brochure through the National Institute on Aging.

Personal Hygiene – Does she shower less frequently, wear dirty clothes, or have neglected teeth? Are there any injuries that you can see? Is there a urine smell?  Was she always fastidious about her wardrobe, and now is dressing in a less put together way?

Forgetfulness  – Some clues might be stacks of unopened mail or newspapers, unpaid bills, unfilled prescriptions or missed appointment slips.  Letters from credit card companies with reminders to pay or late payment charges can be a sign.

Behavior – Does she constantly repeat questions? Can she carry on an extended conversation? Does she refuse any suggestion or does she just agree with everything said? Does she retain what was said? Are there any apparent mood swings? Is she unusually loud or quiet? Is she angry?

Relationships – Do friends call? Have relationships changed in such a way that friends and neighbors have expressed concerns? Has she quit socializing or participating?

Medication and Health Management – Can she take medications without supervision? What are the medications? Who goes to the doctor with her? Is she going to the doctor at all?  Does she refuse to go?

Eating Habits – Does the refrigerator contain adequate food? Is there any spoiled food present? Have her eating habits changed? Any unexplained weight loss? Has she missed meals or have a lack of appetite?

Shopping or buying things – Is there evidence of excessive shopping, ordering? Is the mail full of charitable letters, a sign that she is giving out money to anyone who asks?  Any problems making change or writing checks?

Home Maintenance - Is it in disrepair? Is dust accumulating where (at one time) she was a great housekeeper? Is trash accumulating?

Kathleen S. Allen, LCSW, LICSW, C-ASWCM, is a Geriatric Care Manager and Elder Care Consultant in the Washington D.C. metropolitan area. She works with seniors and their families, and with organizations and their employees or members to help guide them through the challenges of aging and caregiving.

Gifts to Improve Cognitive Function:

Crossword Puzzle Books  (word search, Sudoku)

Hand-held video games such as Solitaire, Bingo

Board games like Tri-ominos, Scrabble, jigsaw puzzles with large pieces, or games such as Life Stories or Reminisce.

Books on Tape or MP3 players

Gifts for Safety:

Medication compartment boxes, boxes with reminder alarms, alarm watches.

Driver’s Safety Classes: Many automobile insurance companies have programs—check with agent

Installing door alarms for wanderers.

Alzheimer’s Association’s Safe Return Program

Personal Emergency Response Systems

Motion activated lights for path to bathroom

An electric tea kettle with automatic shut-off

Cell phone & air time

Gifts for Comfort and Sensory Stimulation (Moderate to severe
cognitive impairment):

Fidget and ‘busy box’ toys

Pillows and throws in unusual textures, stuffed animals, and small sculptures

A new bathrobe

Something to cuddle that supports aching backs or something uniquely entertaining like a singing stuffed animal.

Potpourri, flameless scented candles/tart warmers and scented bath items–lavender scent is calming for “sundowning”—spray on pillowcase at bedtime or tuck a sachet in nightgown drawer or between linens.

Music box, wind chimes, portable radio or TV, audiotapes, or an audio-clock

Shatter resistant magnifying glass

Creative ceiling decorations for someone living in a small space such as kites, posters, or mobiles.

Neck pillow to use when sitting in wheelchair or geri-chair

Microwaveable heating pads

Wheelchair Accessories – backpacks, oxygen carriers, rim covers, brake extensions, trays and seat cushions.

Inexpensive amplifier headset (size of a small cassette player) for those who can’t or won’t use a hearing aid.

Telephone designed for hearing enhancement

Gifts from the Heart — Gifts of Time:

Scrapbook

Creating a family memory video

Writing a memoir/personal history

Weeding the garden;  planting flowers

Membership to local science center, zoo, museum (and you taking them!)

Trips to the local library

Enrolling the person in the Library of Congress’ Recorded Books Program for those with impaired vision or fine-motor coordination/strength www.loc.gov/nls or downloading MP3 audiobooks to inexpensive MP3 player through local library: www.netlibrary.com/RecordedBooks.  Some libraries carry audiobooks pre-loaded onto MP3 players.

Compile family recipes into a book.

Pre-address & stamp family birthday/anniversary cards with the date to mail it written on the envelope flap.

Personalized Calendars with family photos and birthdates, other special anniversaries

An IOU for a year’s worth of lawn care or 52 car washes from a teenager.

Personalized gifts, such as a deck of cards or jigsaw puzzles using their photo or a favorite grandchild or pet

Large poster or photo of them with a grandchild

Bird feeder (plus the IOU to keep it filled) to add some interest to their window. Include a book on bird watching.

Gifts for the active Senior who has everything:

Frozen steaks, salmon, gourmet dinners

Gourmet tea and coffee

Fruit of the month

Magazine subscription

Plants or cut flowers, such as Christmas cactus, Ficus, Norfolk pine, Corsage

Gift certificates for:

Tickets to the movies, theater, zoo, museum or restaurant

Stores or shopping malls

Favorite hair salon

Massage, manicure, facial, salon/spa

Housecleaning

What would you add to this list?

In U.S., 15 Million Provide Care for Alzheimer’s and Dementia Patients

In addition to November being National Caregivers Month, it is also Alzheimer’s Awareness Month.

Alzheimer’s is the sixth leading cause of death in the U.S.  There is no cure.  Currently, there is no way to slow the progression, or to prevent it at all.  What is most staggering is how rapidly this disease is growing.  An American develops Alzheimer’s disease every 69 seconds.  The Alzheimer’s Association estimates that by the year 2050, this number will change to every 33 seconds, bringing the total to approximately 16 million.

But in the U.S., of those aged 65 and older, 1 in 8 has Alzheimer’s.  Almost half of those over the age of 85 have the disease. Of the 5.4 million Americans with Alzheimer’s, two thirds (3.4 million) are women.  200,000 American have early-onset Alzheimer’s (onset before age 65).

Almost 15 million people in the U.S. are unpaid caregivers for someone with Alzheimer’s or a related dementia.  The value of the unpaid work they provide is estimated at more than $202 billion (Alzheimer’s Association, 2010).  Quite understandably, a majority of
caregivers for Alzheimer’s and dementia patients have rated the emotional stress as high or higher, and one-third indicate symptoms of depression.

But if you are a caregiver for someone with Alzheimer’s or dementia, it is vitally important to create a support system that gives you and your loved one what you both need – others to help out, and a chance for you to get the respite you need. There are many ways to do this:  i.e., call on family, friends, churches, or hire caregivers; enroll your loved one in an adult day center; seek the counsel and support of a geriatric care manager to help you manage your loved one’s care.  Any of these options are possible, but must work for you and your loved one.  You do not need to go it alone.

There are many studies about caregivers that include their demographics, economics, health and employment related issues.  Among them:

The typical family caregiver is a 49-year old woman caring for her widowed 69-year old mother who does not live with her.  She is married and employed.  Approximately 66% of family caregivers are women.  More than 37% have children or grandchildren under 18 years old living with them. (National Alliance for Caregiving & AARP, November 2009).

47% of all working caregivers indicate an increase in caregiving expenses has caused them to use up all or most of their savings.  (National Alliance for Caregiving and Evercare, March 2009).

Six in ten family caregivers are employed.  20% of employed female caregivers over 50 years old report symptoms of depression compared to 8% of their non-caregiving peers.  (National Alliance for Caregiving and MetLife Mature Market Institute, February 2010).

73% of family caregivers who care for someone over the age of 18 either work or have worked while providing care; 66% have had to make some adjustments to their work life, from reporting late to work to giving up work entirely; and 1 in 5 family caregivers have had to take a leave of absence.  (National Alliance for Caregiving in collaboration with AARP, November 2009).

American business can lose as much as $34 billion each year due to employees’ need to care for loved ones 50 years of age and older.   (MetLife Mature Market Institute and National Alliance for Caregiving Business, July 2006).

Caregivers caring for elderly loved ones cost employers 8% more in health care costs
estimated to be worth $13.4 billion per year. (National Alliance for Caregiving and MetLife Mature Market Institute, February 2010).

While caregiving is very rewarding, it is also tiring, overwhelming, and under-appreciated.  In homor of the 65 million caregivers in the U.S., the posts on this blog during the month of November will be all about you, and the work you do.

Under the Extra help program, one qualifies with an income below $16,335 (single), or
$22,065 (married).  Additionally, resources (excluding one’s home, cars and personal possessions) must be worth no more than $12,640 (single), or $25,260 (married).

Once enrolled, the savings are in the premiums, deductibles and low copayments for
drugs.  If you know someone struggling with the cost of their medications, qualify on income, and they are enrolled in a Medicare Part D prescription plan, they can enroll online at the Social Security Website or call 1-800-772-1213.

Beginning in 2011, Medicare started covering an annual physical exam, or so many thought.  But, as it happens, it wasn’t really a physical exam in the true sense.  What Medicare started covering is a “Wellness Visit,” which is definitely different than a physical exam.

The 2011 Medicare Handbook “Medicare and You 2011” labeled it a “physical exam.”  Logically, many Medicare recipients expected a physical exam.  But a wellness visit is less a physical exam and more of a discussion between a doctor and patient, reviewing a patient’s health status and medical risk factors.  The discussion may lead to referrals to specialists or for further tests.

Because of the misleading information in the 2011 handbook, the 2012 handbook is being updated to reflect the true “Wellness Visit.”  It is also recommended that Medicare recipients specifically request a “wellness visit,” if that is what they are seeking.  It is an annual wellness visit that Medicare will cover.  A physical exam is altogether different, and coverage for it is as well.  For more information on the wellness visit and other preventive benefits under Medicare, see http://www.medicare.gov/share-the-health/.

Kathleen S. Allen, LCSW, LICSW, C-ASWCM, is a Geriatric Care Manager and Elder Care Consultant in the Washington D.C. metropolitan area. She works with seniors and their families, and with organizations and their employees or members to help guide them through the challenges of aging and caregiving.

Some good news this year is that the premiums for Part D plans are holding steady, and the 50% brand drug discount will continue through 2012.  There will also be a 14%
generic drug discount in 2012.  That means that when you are in the coverage gap for your medications, and you need to buy a brand name drug, the cost to you will only be 50% of the total cost, but the full cost of the drug will count toward your total out of pocket
expense. Similarly, generic drugs will have a 14% discount during the coverage gap in 2012 but the total cost will apply toward your out of pocket costs.

When we talk of Part D plans, out of pocket expenses, and premiums and deductibles, it is easy to get confused.  An excellent online resource for calculating out of pocket prescription expenses can be found at Q1Medicare.  If you plug your drug costs in, it will calculate when you reach the coverage gap (also known as the “doughnut hole”), when you exit, and estimate your total out of pocket expenses for the year.  A picture is worth a thousand words, as they say, and the table that shows on the calculator sometimes explains things far more effectively than an article explanation.

A word to the wise:  Please proceed with this process earlier rather than later.  Past years have shown that the Medicare phone lines get very busy in the final days and the website can slow down when so many people are on it at once.