Your Life, Your Choice

Always be prepared. It’s something we’re taught from the time we’re old enough to enter the Scouts and continues throughout life. Be earthquake ready; have car insurance; build a hefty emergency fund; bring a sweater. All these ideas are so commonly repeated, but what about being prepared for the last major event in life? Few people like to talk about it, but it’s important that we do. Having the “end-of-life” discussion with your loved ones is a necessity.conversation

Although it may be uncomfortable or even a bit scary, it is better to address end-of-life issues while you are alive and well. When you have everything in place, there will be no confusion on what you would have wanted and your family may grieve in peace, rather than handling messy paperwork. Over the next few weeks, we will discuss and simplify the options you have in expressing your wishes for when the time comes.

Two birds, one stone.
The Advance Health Care Directive is now the legally recognized format for living wills and has also replaced the Durable Power of Attorney for Health Care (DPAHC). You can now include either or both of these in one document.

Whereas the traditional living will states your desire not to receive life-sustaining treatment only if you are terminally ill or permanently unconscious and DPAHC appoints an individual to make health care decisions on your behalf; an Advance Health Care Directive allows you to do a number of things:

  • You may appoint another person to be your health care “agent” to make health care decisions for you once you are unable to do so yourself.
  • Identify your primary physician.
  • Specify your preferences about accepting or refusing life-sustaining treatment such as CPR, feeding tubes or breathing machines.
  • Leave instructions on receiving or declining pain medications
  • Make decisions on organ and tissue donations.
  • Otherwise formally express your health care wishes, values and beliefs.

*If you have a valid DPAHC, you may want to review it to make sure it still accurately reflects your wishes. If your DPAHC has expired, you will need to replace it with an Advance Health Care Directive.

Unstoppable: Advance Directive + POLST
POLST (Physician Orders for Life-Sustaining Treatment) has been legally recognized in California stock-footage-hospital-bed-handssince 2009. POLST is meant to complement an Advance Health Care Directive, particularly for those who are seriously ill or have been diagnosed as terminal. With POLST in place, your end-of-life health care wishes have been translated into actionable physician orders, meaning your wishes are implemented and followed without delay.

Who can complete an Advance Health Care Directive?
Any California resident who is at least 18 years old (or is an emancipated minor), of sound mind, and acting of his or her own free will can complete a valid Advance Health Care Directive. You do not need a lawyer to assist you. The only exception applies to individuals who have been involuntarily committed to a mental health facility who wish to appoint their conservator as their agent.

Start the process today by looking over the forms for Advance Health Care Directive and POLST with your loved ones:
http://ag.ca.gov/consumers/pdf/ProbateCodeAdvancedHealthCareDirectiveForm-fillable.pdf
http://capolst.org/wp-content/uploads/2014/01/CAPOLSTform2011.pdfPOLST

Look out for our upcoming discussion on Power of Attorney and Conservatorship.

 

 

 

Sources

http://www.mayoclinic.org/healthy-living/consumer-health/in-depth/living-wills/art-20046303

http://www.cmanet.org/about/patient-resources/end-of-life-issues/advance-directives

 

A New Prescription: Giving Thanks

Recently, we discussed current efforts to eliminate stigma against mental health, including the potential effects of the Affordable Care Act on mental healthcare in the United States. This week, we will see how gratitude, a deeply humanistic emotion, can improve your mental and physical health.

gratefulheartOn March 3, 2008, my father experienced a minor heart attack. My family rushed to the ICU and crowded around his bed. We feared that he would sustain lasting damage to his heart. Surprisingly, he was in great spirits, and thanked us for coming to visit him! As soon as he left the hospital, my dad started to perform daily ‘gratitude meditations,’ in which he reflected upon the things in his life for which he was grateful. This simple act helped to relieve him of the stress associated with recovery.

Physiological Effects of Gratitude
My father’s story illustrates that feeling grateful can influence not only our psychology, but also our physiology. In fact, just 2 minutes of intensive gratitude meditation can reduce heart rate and negate stress. Higher gratitude levels can also lead to:

  • Increased quality of life, even in patients with debilitating neuromuscular diseases
  • Improved immune function
  • Higher energy levels
  • Better quality and duration of sleep
  • Higher levels of happiness and optimism, which in turn have powerful effects on the chemical regulation of our brains. Happiness and optimism have been linked with a lower lifetime burden of disease and improved familial relationships.

Our emotions can pass on to our children
Increased gratitude levels may even carry over to our children. Recent research has focused on how epigenetic modification of DNA resulting from long term depression may be inherited. In essence, our emotions and grat checkexperiences, if strong enough, may be passed down to the next generation in the form of DNA modification. This offers a powerful explanation for why depression seems to run in some families, but happiness in others. Taken as a whole, these studies demonstrate the holistic effect of positive thinking on the human body and bring a new meaning to Descartes’ famous conclusion, “I think; therefore, I am.”

It is difficult to imagine how one can feel grateful in the face of adversity. However, as Dr. Robert Emmons, a positive psychology researcher at the UC Davis explains, “in the face of demoralization, gratitude has the power to energize. In the face of brokenness, gratitude has the power to heal. In the face of despair, gratitude has the power to bring hope.” Though it may not be easy to feel grateful during trying circumstances, focusing on the positive aspects of one’s life can help us through the worst of situations. See our Weekly Gratitude Activities Checklist for ideas on how to bring gratitude into your lifestyle.

Expressing one’s gratitude has been enumerated by the world’s major religions for thousands of years. Not only does it improve interpersonal relationships and bring out the best in others, it also provides us with numerous health benefits. There is never a better time than now to start reaping the benefits of thanking those who are important in our lives.

So, in the spirit of gratitude, the staff at Aarris Homecare thanks you for choosing our services!

Works Cited
Dunavold, P. “Happiness, Hope, and Optimism.” CSU Northridge, 1997 (http://www.csun.edu/~vcpsy00h/students/happy.html)

Emmons, R. “How Gratitude Can Help You Through Hard Times.” Greater Good: The Science of a Meaningful Life, UC Berkeley, 2013 (http://greatergood.berkeley.edu/article/item/how_gratitude_can_help_you_through_hard_times)

Emmons, R & McCullough, ME. “Counting Blessings Versus Burdens: An Experimental Investigation of Gratitude and Subjective Well-Being in Daily Life.” Journal of Personality and Social Psychology, 2003, Vol. 84, No. 2, 377–389

Emmons, R & Stern, R. “Gratitude as a Psychotherapeutic Intervention.” J. Clin. Psychol: In Session, 2013 Vol. 69, pg. 846–855

Braunstein, D. “Pass the Gratitude: Recipe for a Happy Thanksgiving.” Huffington Post (http://www.huffingtonpost.com/glenn-d-braunstein-md/gratitude-health_b_2131450.html)

Levinson, DF & Nichols, WE. “Major Depression and Genetics.” Stanford School of Medicine 2014 (http://depressiongenetics.stanford.edu/mddandgenes.html)

Nestler, EJ. “Epigenetic Inheritance: Fact or Fiction?” Fishberg Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, 2013

(https://www.dana.org/Publications/ReportOnProgress/Epigenetic_Inheritance_Fact_or_Fiction/)
Rimer, S & Drexler, M. “Happiness & Health.” Harvard School of Public Health, Winter 2011

(http://www.hsph.harvard.edu/news/magazine/happiness-stress-heart-disease/)

Scott, E. “Family Connection and Happiness—Fostering A Closer Relationship With Your Family.” Stress.about.com, 2007 (http://stress.about.com/od/familystress/qt/family.htm)

Heartmath Institute: http://www.heartmath.org/templates/ihm/e-newsletter/publication/2013/spring/appreciation-is-good-for-you.php
WebMD: http://www.webmd.com/women/features/gratitute-health-boost

Silencing the Stigma

Last month, we discussed the social, institutional, and self-stigmatization of mental illness in the elderly and their ramifications. This week, we will discuss current efforts to eradicate mental health stigma and improve access to care.

How can we influence the media’s depiction seniors with mental illnesses?

notebook2004While the media promulgates inaccurate and damaging stereotypes about mental illness, it can also be a source of positive change in the battle against social stigma. For example, the movie The Notebook (2004) provides a genuine portrayal of strain and heart-ache accompanied by dementia. The vast majority of mass media, however, reinforce social stigma through stereotypical presentations of mental illness.

Organizations such as the Center for Mental Health and Media and Mental Health Reporting have launched their own campaigns to counter prevailing stereotypes by educating the public. They have also posted tips for reporters and screen writers to avoid promoting stigmas. Writers should:

  • Ask, “Is mental illness relevant to the story?”
  • Verify statements that mental illness is a factor in a violent crime. A past history of mental illness is not necessarily a reliable indicator.massmedia
  • Avoid using language that implies people with mental illness are violent.
  • Double-check specific symptoms of diagnoses with valid mental health resources, as necessary.

Ultimately, these organizations hope to inform writers that meaningful stories do not need to peddle incorrect and damaging stereotypes about the mentally ill. They have also initiated their own media campaigns to bring awareness to mental health stigmas.

The biggest advances in combatting stigma against mental illness have come through public policy

The passages of the Mental Health Parity and Addiction Equity Act (MHPAEA) and the Affordable Care Act (ACA), also known as Obamacare, have profoundly improved access to resources for the mentally ill.

mhpThe MHPAEA (2008) ensures that financial requirements (ex. Co-pays, deductibles) and treatment limitations (time of stay in hospital) for mental health or substance abuse disorder benefits are no more restrictive than corresponding surgical or medical benefits.

The ACA (2013) builds upon the principles of the MHPAEA and expands access to mental health services for geriatric patients in a number of ways:

  1. Employer-based insurance for seniors no longer can deny coverage based on preexisting psychiatric acaconditions.
  2. The ACA contains provisions that will increase quality of care in nursing homes.
  3. Healthcare institutions that are categorized as “Health Homes” or “Medical Homes” will receive increased federal funding, which will make mental health treatment more accessible for the disabled and elderly.
  4. All states will be required to have some level of mental healthcare coverage, though specific services are decided on a state-by-state basis.
  5. Medicaid has been expanded in 27 states. Medicaid’s broad range of mental health and community support resources mean that millions more people will be able to obtain treatment for psychiatric disorders.

Collectively, this means that mental health services will be more accessible than ever before to the majority of Americans, including geriatric patients. Though these policies are an important step forward, it is important to remember that social and self-stigmas are powerful factors in care quality and access, especially for seniors. Furthermore, the ACA only mildly addresses the most pressing issue facing seniors—the lack of geriatrics-specialized physicians and healthcare workers.

Fortunately, numerous colleges offer stipends and scholarships to encourage medical and graduate students to pursue specialty training in geriatric care. The American Association for Geriatric Psychiatry (AAGP) and the Geriatric Mental Health Foundation (GMHF) also support yearly scholarships for students who hope to obtain training in geriatric-focused medical care. As the Baby Boomer generation ages, these scholarships and programs will likely become more common in the nation’s medical colleges and healthcare training institutions.

Next week, we will discuss how practicing gratefulness in your daily life can improve your mental health.

Survivors: Life After Stroke

stroke2As the treatment technology progresses, more than 7 million Americans have survived strokes today. If you are or have a stroke survivor in your family, please be positive, because the hope of getting better is never gone. Please be patient, since the recovery is a life long process. Please be informed, since there are a lot of changes brought by the stroke you should acknowledge. Today we talk about life after stroke. The information is crucial because it matters to the survivors’ recovery, rehabilitation, and next stroke attack prevention.

Be Prepared: Changes by stroke
Surviving a stroke, we first should admit that stroke changes life, both physically and emotionally. Stroke causes brain injury that may affect how people move, communicate, think and act. Here are some common general changes survivors might experience after a stroke:

  • Weakness or paralysis on one side of the body
  • Difficulty speaking or swallowing
  • Tire easily
  • Change in personality, performing improper language or behaviors
  • Difficulty with memory, judgment, and problem solving
  • Difficulty with peripheral vision and problems with visual cognition

Other changes are dependent on whether it is left- or right-brain injury. Generally, one side of the brain controls the opposite side of the body. For example, right-brain injury may result in weakness or paralysis on left side of the body. The survivor also tends to lack awareness of the left side.
At the same time, stroke survivors also go through a series of changes emotionally. Many of them experience frequent emotional instability. Other changes include:

  • Depression
  • Lack of motivation and indifferent
  • Unexpected feeling of anger, anxiety and frustration

The above are common changes that stroke survivors would go through during the recovery process. It’s best for family members and patients to be prepared and recognize these changes in time.

Returning Home
When the patient is medically stabilized, the physician may recommend returning home. Some stroke patients are afraid of this process for the fear of having another stroke attack. There are a lot of other fears due to this change of setting that we also need to understand. For instance, some may feel that their friends and family will abandon them. Or they fear that their loved ones are not competent in proper caretaking. Being surrounded by other people at home may also make them realize their disability, which can be hard to accept. Therefore, family members and hospital staff need to work together to prepare for the transition.stroke1

When is the right time?
There are four major factors to consider when assessing whether getting back to home is a good decision. Stroke survivors at home need to have ability of self-care, meaning one should be able to accomplish some basic daily activities. Also since the medical care still continues, the patient needs to have the ability to follow medical advice as well. It is also highly recommended that a caregiver, either family member or hired professional staff, assist the patient when needed. In addition, the survivor needs to have the ability to move around and communicate, so that they can ask for help in an emergency.

Adapt your home
Before welcoming your loved one home, family members should work with professional staff to change the home setting, making it safe, accessible, and comfortable for the stroke survivor to live.
First, you need to check every corner of your home and be diligent about hidden hazards that may cause falls and other accidents. Measures like taking up the throw rugs, having more lighting, using a non-skid mat, and fixing your floor or staircase are highly recommended. Further action, like installing a raised toilet seat, safety grab bars or handrails can also be helpful. You may also want to build a ramp so that patient can move around as much as possible.

Caregiver
Caregivers are often the spouse, adult child, or parent who provide most of the care for stroke patient at home. Since the recovery process is a challenge for both patient and caregiver, we suggest the two sides to share decision-making and feelings as much as possible. The caregiver’s responsibilities range from providing physical assistance, taking care of the survivor’s everyday life, to managing financial affairs, and providing emotional support. In other words, the caregiver needs to cover almost every part of the stroke survivor’s life.
However, we should not neglect that caregivers also need care themselves. Try to encourage the survivor to be as independent as possible. This will not only relieve your pressure but also help the survivor’s recovery progress. While you encourage your loved one to participate in leisure activities, you can also try to have fun. It’s totally fine to take a break, which would be beneficial for both you and your patient. A paid professional caregiver is also a choice many people turn to. While you try to take good care of people in you life, remember to take care yourself as well.

Resources
http://www.stroke.org/site/PageServer?pagename=surv
http://www.strokeassociation.org/idc/groups/stroke-public/@wcm/@hcm/documents/downloadable/ucm_309716.pdf
http://www.strokeassociation.org/idc/groups/stroke-public/@wcm/@hcm/documents/downloadable/ucm_309720.pdf
http://www.strokeassociation.org/idc/groups/stroke-public/@wcm/@hcm/documents/downloadable/ucm_309723.pdf

Sound Body, Sound Mind

As our body goes, so goes our mind.
You know how you feel after a long car trip, when you finally get out of the car and stand up, you’re stiff and sore, right? Imagine years of not getting up. One day you’ll realize your body aches are chronic and your memory isn’t as sharp as it used to be. Most just complain and brush it off as old age.

Senior-doing-neck-stretches-350x234
You don’t have to live this way! Make yourself get up and do something aerobic at least 3 times per week. You could go on a walk, run, take a bike ride, invest in cardio equipment, or join a gym. Start slow and steady. Try to get your heart rate up for at least 20 minutes each time. Add in weight bearing exercise, flexibility and balance exercises, and notice your aches and pains diminish.

Find a Buddy
I recommend finding an exercise buddy to keep yourself on track. Those who exercise with a partner are much more likely to continue their routine. Motivating each other and holding each other accountable to your exercise schedule goes a long way in your success.penguinbuds

What’s good for your heart is also good for your mind
Each year that we don’t get the exercise our body needs, we age prematurely. Not only does your body start to deteriorate, so does your mind. Studies have shown that exercise can actually ward off dementia, Alzheimer’s, diabetes, and high blood pressure. According to Dr. Stephan Bamberger, PhD, Lac, “The connection between Alzheimer’s disease and blood supply to the brain, has recently been confirmed by researchers at the University of Leiden in Holland.” As your blood flow decreases, due to clogged arteries or blood clots, your body and mind will feel the difference.

3menAvoid Crippling Effects and Future Medication
• Exercise has been proven to:
• Improve your immunity
• Improve your cardiovascular function
• Improve your digestive system
• Protect against loss of bone mass with weight bearing exercises
• Improve your functional reach
• Improve your balance and flexibility
• Reduce pain from rheumatoid arthritis
• Reverse muscle atrophy

As a former fitness club owner, I witnessed the positive effects on the elderly, who happened to make up the majority of our membership. Two personal stories are testimonies to the need to begin or continue an exercise routine.

Virginia
The oldest member of our club was sharp as a tack, with memory better than most our younger members. She was (and still is) friendly and loved by all our members who came in to work out the same hours as she. Virginia drove herself and a friend to our club 3 x’s per week. She walked laps in our pool, stretched out in the hot tub, took a shower and afterwards, usually rushed out to meet some friends for dinner. We celebrated her 100th Birthday Party at our gym with her family and friends.

muscle_brain
Texas
Waiting in the dark in his car 3 mornings per week, Texas would wait until an employee arrived to open the door at 5:15 a.m. Texas proved to his doctor that he had what it takes to ward off the diseases that can come with old age. I met Texas when he was a young 75 year old gentleman. The previous year, Texas was told by his Dr. that he was going to die in 6 months if he didn’t start changing his ways. He was diagnosed with Type II diabetes and high blood
pressure. The very next day he joined a fitness center and started walking on a treadmill for and hour 3 x’s per week and started watching what he ate. In 6 months, his diabetes had disappeared and he was taken off his heart medication. Now 78 years of age, he continues his routine religiously each week, always with a smile on his face.
Allow Virginia and Texas to be your inspiration. Kick some of those painful signs of old age by making some lifestyle changes to improve your quality of life.
Always consult your doctor before beginning an exercise program.

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