Seniors: Have You Secured Your Future?

When the time comes, do you know who will be there to make important decisions for you?

We recently visited Advance Health Care Directives, living wills, power of attorney (POA) and POLST. These are all legal documents put in place to ensure decisions regarding your health align with your preferences when you are no longer capable of communicating your desires. When not prepared for this last phase in life, you could end up with a court appointed conservator who may or may not have your best interests at heart.

As you now know, Durable Power of Attorney for Health Care is someone who will make decisions regarding your healthcare when you are no longer able to. But did you know powers of attorney have different levels of authority and can serve other areas of your life?power-of-attorney

  • Financial Power of Attorney allows your agent to make decisions regarding your finances and property.
  • General Power of Attorney has a broader scope, giving your agent the ability to make any and all personal decisions and healthcare choices.
  • Limited Power of Attorney has limited authority on the types on decisions you would like them to make.
  • Durable Power of Attorney is given the ability to make decisions for you both now and if you become incapacitated.
  • Springing Power of Attorney only has authority when you become incapacitated.

judge-hammer1If no POA is named, your family members may decide to file a petition with the court if they feel you are unable to meet certain requirements for your health and safety, or if you lack the capacity to manage your financial affairs. A conservatorship is comparable to an individual given legal guardianship over a minor.
There are two types of conservators:

  • Conservatorship of the Person – conservator makes personal decisions for the conservatoree
  • Conservatorship of the Estate – conservator makes financial decisions for the conservatoree

Often times, the court appoints the same person to act in both capacities. This may or may not be the person you would have chosen, were you able to make that decision.

Does one have any advantages over the other?
Power of Attorney is a relatively low-cost and private way of naming a trusted individual to carry out your wishes. In regards to a conservatorship, the court proceeding is not only costly, but the person named as your conservator might not be the same individual you would have chosen.

You can save your loved ones from headaches and guessing games by having open conversations with them about what you want and deciding on your Advance Health Care Directives.MeandGrandma

Coming up, we’ll discuss how to go about choosing a healthcare proxy.

 

 

 

Sources

  • http://www.elderattorneyoffice.com/cda.aspx?content_type_id=8169
  • http://www.mayoclinic.org/healthy-living/consumer-health/in-depth/living-wills/art-20046303

 

 

7 Ways Seniors Can Survive the Heat

Heat is a potentially deadly problem—nearly 400 Americans suffer fatal consequences from heat wavessun_thermometer-300x225 each year. Most of them are elderly people who often don’t realize when they are overheating and in danger. Part of the problem lies in the fact that the elderly simply can’t handle the heat as well as younger people, because they don’t sweat as effectively and have poorer circulation. In addition, medical conditions such as dementia, diabetes, obesity medication-adherenceand other chronic conditions can compound the risk of heat stroke. Certain medications, including those for Parkinson’s and hypertension also increase the risk.

To protect seniors, the standard advice is to get them into an air-conditioned building; have them dress lightly; and keep them hydrated.

Caregivers should stay on the alert for signs of confusion or altered mental states in seniors who are out in hot weather, as it could be a sign of heat stroke. If the elderly person should collapse or pass out, it’s a medical emergency. 911 should be called immediately.

Here are seven ways to protect seniors from heat:

1) If elderly relatives complain of the cold indoors, ease off the air conditioning a bit. If they won’t stay inside, have them sit on a shady porch near a fan.elderly-movie

2) To keep the house cooler without running the air conditioning, close curtains or blinds on the east side of the home during the morning, and the west side in the afternoon.

3) If the elderly person doesn’t have air conditioning or refuses to use it in a heat wave, make sure they spend some time in a cool air-conditioned space like a mall or theater. They can stay cool and be entertained.

4) Offer plenty of drinks that seniors prefer, but stay away from highly caffeinated drinks, or sodas loaded with sodium and sugar. Steer clear of alcohol, which is dehydrating.

watermelon5) Keep frozen treats available that have a high water and low sugar content, like sugar-free Popsicles). Or serve fruit with high water content, like watermelon.

6) Seniors sometimes dress inappropriately for warm weather, so make sure that their clothing is lightweight, not form-fitting and light in color. Hats are useful, but make sure that they are loosely woven or ventilated so they don’t trap heat and broad-brimmed so they shade the entire face.

7) UV Rays are harsh. Ensure seniors are wearing protective sunglasses and sunblock if they will be outdoors at all.hat

Keep cool, safe and enjoy the last blast of summer heat!

Sources

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

Products of Prejudice

Last week we examined the causes of commonly-held stigmas against geriatric mental illness, including self-stigma, social stigma, and institutional stigma.

How do these stigmas affect the ability of elders to seek care for mental illnesses?

1. Fewer doctors train in geriatric healthcare, which makes it difficult for seniors to find specialized medical doctorattention. Seniors must travel further distances to see doctors with a detailed understanding of mental illness in the elderly.

a. Many doctors believe that they can have a more meaningful impact as pediatric psychiatrists, rather than as geriatric psychiatrists because they can change a child’s future as opposed to alleviating just a few years of suffering in mentally ill seniors.While pediatric psychiatrists provide immeasurable services to mentally ill youths, this mindset devalues the mind of the senior with respect to other age groups.

b. Historically, major healthcare plans have not provided enough incentive for hospital to provide mental health services. This is changing as a result of the Affordable Care Act, which we will discuss more in detail next week.

2. Doctors without training in geriatric care often misdiagnose or directly discriminate and stigmatize patients with mental illnesses. This can have a profoundly negative effect on patients by reducing treatment efficacy. Discrimination from healthcare workers can even worsen treatment outcomes. While many doctors are not directly prejudiced against the elderly, they are just as susceptible to prevailing stereotypes as the next person.

3. Because of social and self-stigmas, patients may distrust the medical establishment’s ability to treat their illness or fear institutionalization in a psychiatric ward. As a result, patients would be less likely to seek treatment for psychiatric disorders.

Education is the best strategy to overcoming stigma

Education and Empowerment of the Mentally Ill
ageismIn order to effect long-lasting change of public sentiment, people afflicted by psychiatric diseases must dispel their own stereotypes against mental illness. These include the incorrect assumptions that:
• Mental illness is incurable
• Mental illness is a normal part of aging
• Elders with mental illnesses are not worth being treated

 

Education and Empowerment of the Public

The public must also be educated about mental health and aging. Today’s mass media often disseminates misleading and derogatory images concerning mental health and the aging process. Seniors are often portrayed as out of touch with reality, childish, and useless. Few films depict old age in a positive light, and many films focus on the dangerous aspects of mental illness, though only a small percentage of mentally ill patients are violent.

bedsideEducation of the next generation of doctors and medical professionals must be a priority for the future. A study conducted at the University of Calgary, Canada, showed that basic psychiatry education in a group of medical students helped to reduce common stigmas and misconceptions about mentally ill patients and improved student confidence when working with patients with psychiatric diseases. Geriatric healthcare must also become an integral part of medical education as America’s senior population (65+) is projected to double by the year 2030. Many of these efforts are currently underway.

Tune in next week to learn about current efforts to eliminate mental illness stigmas.

References

  • CDC.gov. “Depression is Not a Normal Part of Growing Older.” http://www.cdc.gov/aging/mentalhealth/depression.html
  • Mentally Healthy Aging: A Report on Overcoming Stigma for Older Americans. DHHS Pub. No. (SMA) 05-3988. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 2005.
  • Neelgard, L. “Report: Too little mental health care for seniors.” Associated Press. http://usatoday30.usatoday.com/news/health/story/2012-07-10/aging-mental-health/56132426/1
  • Papish et al. “Reducing the stigma of mental illness in undergraduate medical education: a randomized controlled trial.” BMC Medical Education 2013, 13:141
  • Persky, T. “Overlooked and Underserved: Elders in Need of Mental Health Care.” http://www.mhaging.org/info/olus.html
  • Thornicroft, G et al. “Discrimination against people with mental illness: what can psychiatrists do?” Advances in Psychiatric Treatment, 2010, 16: 53-59

 

Mentally Ill Seniors—America’s Black Sheep

Depression affects over 6.5 million of the 35 million Americans aged 65 and older, and yet only 10% of them are receiving treatment for the condition. This indicates a deep failure on the part of our healthcare system to recognize and treat mental health problems in older adults. While numerous problems contribute to this failure, underlying assumptions about elderly people cause social, self-, and institutionalized stigmas that complicate the ability of older people with mental illnesses to seek treatment for psychiatric diseases.
Let’s briefly discuss some of the different types of stigmas based around mental illness in the elderly:

Social Stigma
• Social stigma against mental illness in the elderly is closely related to ageism, or the idea that older people are not stigmaas able to contribute to society as younger people.
Oftentimes, depression and related mental illnesses are seen as normal aspects of the aging process. Events such as retirement, the death of loved ones, medical problems, and increased isolation can evince feelings of sadness and grief, but do not directly cause depression. With strong support from one’s family or therapist, these distressing events may be successfully overcome. However, dismissing depression as an unavoidable side effect of aging drastically reduces the chances obtaining treatment for depression and related mental illnesses and can exacerbate the severity of the illness.
The media commonly portrays elderly people with mental illnesses as childish, stubborn, and resistant to change. While this representation may stem from the self-stigma (discussed below), this portrayal only reinforces existing stereotypes of mental illnesses by imposing judgments on afflicted individuals rather than highlighting the need for change. In this sense, the media contributes to the problem.

Self-Stigma
cycle• Self-stigma occurs for a variety of reasons, including fear of financial repercussions, embarrassment, isolation, and/or distrust of mental health services. At worst, elderly patients fear being institutionalized in psychiatric wards or old-age homes and where they will be cut off from their families and friends.
• The baby boomers’ emphasis on self-reliance in the face of difficulty also contributes to self-stigma. As such, self-stigma is directly caused by and contributes to social stigma.

Institutional Stigma
• Assumptions about older people based on the above stigmas can lead to misguided policy that in effect punishes the mentally ill. For example, Medicaid does not cover services for those suffering from mental illnesses, which means that patients are often forced to find more expensive healthcare plans. To complicate the issue further, many states are cutting funding for mental health services in an effort to balance the budget even while 1 in 6 Americans suffer from some sort of mental illness.

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Each stigma is engendered by and reinforces the others.

Next week, we will discuss existing barriers to eliminating these stigmas and current efforts to bring awareness to the state of mental health services in America.

Sources

  • Depression in Older Adults & the Elderly—http://www.helpguide.org/mental/depression_elderly.htm
  • Goodell et al. “Health Policy Brief—Mental Health Parity.” Health Affairs, April 3, 2014. http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_112.pdf
  • Mentally Healthy Aging: A Report on Overcoming Stigma for Older Americans. DHHS Pub. No. (SMA) 05-3988. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 2005.
  • Persky, T. “Overlooked and Underserved: Elders in Need of Mental Health Care.” http://www.mhaging.org/info/olus.html
  • Tomasky, M. “The Great GOP Mental Health Hypocrisy.” The Daily Beast, Politics, 9/20/2013. http://www.thedailybeast.com/articles/2013/09/20/the-great-gop-mental-health-hypocrisy.html