Medical Alert Systems Bring Peace of Mind

Living safe and independent is an important factor for our ever growing senior population.  However statistically speaking, one out of three people over age 65 will fall this year causing life threatening injuries.  Great suffering occurs when injuries prevent a person from getting to a phone to call for help; this can last for several days and even cause death.  Despite all the fall prevention interventions we can take, some falls are unfortunately inevitable. A medical alert system acts as a safety net to get immediate help when falls or other emergencies occur so that early intervention minimizes complications and facilitates recovery.  These systems are available locally or nationwide to give seniors and their families peace of mind knowing that with just a push of a button, they will receive immediate help.  In doing so, Medical alert systems can support seniors to remain at home for longer periods of time with increased safety.

Benefits:

• Decreased anxiety of being alone
• Decreased dependence on others
• Enhanced well-being and quality of life
• Easy to operate with just pushing a button
• Psychologically reassuring by maintaining control

Operating the Medical Alert System:
Typically the system includes a help button worn around the neck or wrist allowing the user to request help when there is a medical emergency.  The lightweight, waterproof pendent allows freedom of movement within the home without the need to reach a phone.  The base unit simply plugs into a telephone jack and electrical outlet.  No special wiring is needed. 

A 24hour staffed monitoring service receives calls from the base unit when its activated by the button on the pendent.  Once activated, two way voice communication is established as the live monitoring staff will attempt to speak to the user over the base unit speaker; if the user does not answer, they will contact designated family/friends or alert emergency medical personnel.  If the user responds, the monitoring staff can determine the type of help needed and appropriate action. 

What to look for when choosing a Medical Alert System:

• UL listed 5 diamond certified 24 hr monitoring service
• Waterproof pendants that are not easily activated in error
• Base unit battery back-up
• Low installation costs with no long term contract
• Low monthly fees

Medical Alert systems are not just for frail elderly, but for anyone living alone who wants to have peace of mind and increased safety from unexpected medical emergencies or falls.  Families can also be confident their loved ones are in good hands while still allowing them their freedom and independence.  No more frequent wellness check calls to loved ones, everyone can have peace of mind when medical alert systems are in place.

Age Related Health Changes and 12 Things We Can Do

Pronounced health changes are more obvious in advanced ages of 85 and older but there is also a great variability among all individuals depending on the impact of genetics, lifestyle factors, response to illness and even stress.  It is always a pleasure to see an active, vibrant, high functioning person in their 90's enjoying quality of life in their community; they serve as a positive role model for us all, giving us hope to join the growing number of healthy centurions in our current population.  Sadly, others in their 50's and even younger succumb to a lesser ability to function and must manage a poor quality of life often in a medical institution.  Normal aging brings causes the following normal changes:

Cardiovascular system: Arteries and heart valves become thicker and less pliable; diminished peripheral pulses and circulation. A decline in body temperature is noted as the baseline oral temperature in older adults is 97.4F versus 98.6F in younger adults.  There is a higher risk for fluctuations in Blood Pressure, arrhythmias, or syncope.

Pulmonary system: Respiratory muscle strength becomes weaker, mucus membranes drier and cough reflexes begin to diminish.  Our bodies are less tolerant for exercise, higher risk for aspiration, night time breathing issues and ability to fight upper respiratory infections.

Genitourinary system: Overall a decrease in creatinine clearance due to changes in kidney mass, blood flow and drug clearance.  Decreased bladder muscle tone, capacity and hormones cause higher urine residuals post voiding and increased night time urination.  There is a higher risk for adverse drug reactions, renal injury, dehydration, hypo/hypernatremia, hyperkalemia, volume overload causing heart failure, urinary urgency or incontinence, urinary tract infections and even potential for falls.  For men, a higher risk of enlarged prostate.

Integumentery system: Loss of collagen causes thinner, drier skin with less elasticity which is more prone to sunburn, cuts, tears and abrasion.  Overexposure to the sun earlier in life can cause skin melanoma later in life.

Musculoskeletal systems: Muscle mass and strength decline throughout the whole body.  Lean body mass is replaced with fat and redistributed.  Bone loss especially in women causes osteoporosis; tendons and ligaments become tighter, less flexible.  Intervertebral discs shrink and degenerate, cartilage erosion and changes in posture  may occur with a reduction in height or posture.  These changes not only limit our joint flexibility and range of motion but also increase our risk of falls, unsteady gait, bone fracture, joint inflammation and arthritis.

Oral-Gastrointestinal systems: Even the oral muscles of mastication become weaker along with dental changes cause difficulty chewing or receiving adequate nutrition.  Our perception of taste and thirst becomes impaired.  There is decreased motility throughout the gastrointestinal system causing slower stomach emptying, impaired defecation and malabsorption of nutrients.  The liver has a decreased ability to metabolize medications.  This places us at higher risk for adverse drug reactions, constipation, GERD, or NSAID-induced ulcers.

Nervous system and Cognition: Aging causes a decline in the number of neurons, support cells, synapses and neurotransmitter chemicals produced.  This contributes to overall muscle weakness, decline in reflexes, slowed motor skills and potentially impaired balance and coordination.
Temperature sensitivity is diminished and there may be a blunted or absent fever response.  Cognitive processing is slowed and some decline is common but not universal.  There is a lesser need for sleep time but a higher risk for sleep disorders, delirium and neurological diseases.

Immune system:  Dysfunction of the immune system will increase the susceptibility to infection while increasing the risk of chronic inflammatory diseases.  There may even be a reduced efficacy of vaccinations. 

WHAT CAN WE DO?

1. Get annual wellness dental and medical check-ups to monitor age related changes, obtain early intervention/prevention which will minimize risk factors that could be corrected. Obtain annual preventative testing for early detection of disease: i.e.. Mamography, lab tests.
2. Consider lifestyle changes that will promote healthy successful aging. ie stop smoking, minimize alcohol intake, reduce stress.
3. Keep immunizations current.
4. Emphasize weight bearing exercise, strength and overall fitness: walking, weight training are the best, while swimming, cycling and aerobics are good too.
5. Emphasize stretching all joints and maintaining an erect posture: Yoga is great!
6. Exercise your brain cells with memory and analytical games: Puzzles, Crosswords, Word finding, mathematics, reading and other intellectual stimulation.
7. Eat a well balanced, high fiber diet along with vitamin supplements.  Monitor and maintain a healthy weight.  Women should supplement their diet with 12-1500mg Calcium and 1000 Vitamin D daily.  Check with your doctor regarding recommended vitamin supplements specific to your needs.
8. Stay well hydrated with water.  Minimize soda, caffeine, alcohol consumption.
9. Remove household trip hazards such as area carpets, long cords and keep a safe pathway from bed to bathroom especially for night time toileting; consider night lights along this path.
10. Practice good sleep hygiene. 
11. Monitor skin for changes that may require medical attention, use daily body lotion.
12. Know and examine your body from head to toe; question if changes seem to be normal or abnormal.  Question if suggested medications are right for you.  Keep a record of your personal health history and current medications readily available for doctor visits or in case of any emergency.

www.VillaCareHomes.com

Determining what Elder care is needed & considerations for placement

Caring for an aging parent, spouse, partner or close friend presents difficult challenges – especially when a crisis hits and you are suddenly faced with the responsibilities of elder care. Perhaps your  mother fell, is hospitalized with a broken hip and needs to go to a skilled nursing facility to recover.

Caregiving can also begin as a result of unsettling warning signs that indicate a need for some sort of intervention.   Perhaps your elderly spouse has wandered off and gotten lost. Or a friend has lost a lot of weight and rarely leaves home. You may be the only person to step in and become the caregiver. Or, you may be the key in a network of family members and friends willing to help. Whatever the situation, you may not be sure of the next step to take.
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What kind of help does your loved one need? Perhaps there are underlying undiagnosed causes that can be corrected.  For example, prescription drugs interactions/side effects, Vitamin B12 deficiency, dehydration, low thyroid, urinary infection and other treatable problems are often mistaken for Alzheimers  or  dementia. According to Consumer Reports on Health, "Any new health problem in an older person should be considered drug induced until proven otherwise." A visit to the primary care physician is critical to rule out any underlying causes and determine the best approach to care.

If the problem is not correctable, what living arrangements are available for your loved one? What nursing care plans are most appropriate? If they are able to remain in their own home, what kind of services can be arranged? Is assisted living preferred over a nursing home? What challenges does your loved one's condition pose? How will both parents get their needs met when they both need different levels of care?  What community resources are available? How will you manage it all – and still maintain a life of your own? Who will make all these decisions? 

Hopefully, the individual has made good life preparations by having a POLST and durable power of attorney for healthcare and financial matters already established.  If not, these documents should be formulated as soon as possible.  The primary care physician will assist in obtaining the POLST form which indicates the person's personal preference for resuscitate or Do Not resuscitate.  Family members often self-designate one responsible person to make the financial and healthcare decisions, or, they may utilize group consensus. 

Of course, each elder care situation is unique. Your loved one's medical condition, financial resources, personality, personal wishes, relationships with potential caregivers, geographic proximity to services and other factors all determine what best approach to take. There is no place like home or maintaining one's usual routine, but when a change of medical condition occurs compromises must be made in order to provide optimal care within your loved one's financial constraints.  If the condition has potential to improve, it is wise to consider temporary measures that can easily transition to permanent if needed.  Conditions requiring daily skilled nursing and/or therapies should be cared for in a Skilled Nursing Facility.  If nursing and therapy is required on an intermittent or several days/week basis, then return to home with home health support services could be considered. 

Meeting one's daily needs at home despite not needing a nurse or therapist can be challenging.  There are meals to prepare, housekeeping, bills to pay, medicine to refill and dispense, personal care to manage and transportation to arrange.  Those who are alone could be monitored with safety monitors or periodic visits and phone calls, but often times isolation becomes problematic.  If care and supervision needs are overwhelming for family/ friends or other providers to safely accomplish within your loved one's budget, then placement out of the home should be considered.

 RCFE's (Residential Care Facilities for the Elderly) can be large communities, or small 6 bed homes; many offer dementia and hospice care.  Those key people who are involved in placement decisions should weigh future needs (depending on the disease process) to minimize the trauma of any future transfers.  Physical and mental needs as well as compatibility with others are important when looking at any communal living situation.  Look closely to the daily program, menu and services to determine if there is enough structure and flexibility to meet your loved one's current and future needs.  Meet the administrator and staff; are they loving, caring, patient, consistent and communicative?  Don't be tempted to make your decision based solely on the look of the room or the building.  Ask how your loved one will get to medical appointments or receive hair/nail care.  Will the program satisfy all the physical, mental, social, emotional and spiritual needs?

Minimizing the institutional nature of a facility while maximizing dignity, choices and quality individualized care can be challenging when caring for those with complex medical conditions including dementia.  When your loved one's condition requires a higher level of care that cannot be safely or appropriately managed in an RCFE, placement in a skilled nursing facility will be necessary.  Another close look at the daily program, menu, services and staff in addition to the environment and activities will help you decide if the facility will be compatible for the patient as well as the family.  Make sure the location is convenient for family and fiends to easily visit, and that your preferred physician will be able to continue providing care.

Please note that referral agencies may be timesaving and helpful in narrowing your choices, but they do not guarantee personal knowledge of the properties and may engage in unfair commission practices or have a conflict of interest with preferred properties.  Facility or healthcare insurance social workers may be more fair and accurate in their suggestions; asking local agencies on aging or recommendations from other friends/family members can also assist in guiding you. Take your time, tour more than three facilities and meet with as many staff and administrators before making your decision; you will be establishing a new relationship with the facility & staff that will hopefully last for many years. 

Please feel free to visit my website to compare what RCFE small 6 bed facilities can provide for your loved one.  www.VillaCareHomes.com  We provide service with personal attention and dignity, loving caring staff and the facility is managed with program structure/customized approach to aging in a home environment.  We cultivate an atmosphere of friendship, comfort and consideration of our residents, visitors and neighbors.  We encourage an independent lifestyle for those with even complex medical conditions so that our residents can maintain their independence while leaving the difficult tasks of daily living to our dedicated and competent staff.  This is the standard you should seek when determining what care is needed for your own loved one.

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WHAT IS SUNDOWNING AND WHAT CAN BE DONE?

Anyone with acute or chronic confusion may become more confused, restless, agitated and anxious in the late afternoon and especially after dark when the sun goes down or seasonally when there are fewer hours of sunlight.  This may happen whether the person is living at home ore in a facility.  The sundowning behavior can worsen following a move or change in routine.  Individuals with sundowning behavior become more demanding, upset, suspicious, disoriented and see, hear, believe things that aren't real or pace/wander.

Those with Alzheimer's Disease act as if their biological clocks are "reset."  These individuals may stay up all night alert and full of energy despite all interventions to encourage them to sleep in bed; then, they will continually doze on/off during the day.  The reasons for these changes in the sleep-wake cycle in Alzheimer's Disease is not known.

The reason for sundowning behavior is also not known. One theory is that there are fewer environmental clues at night when daylight and eyesight is diminished.  Some scientists believe it may be related to the biological clock in the brain which regulate the amount of hormones and other chemicals important for brain function.  If the biological clock is not properly functioning, the brain itself may not be able to properly function as well.

What can be done for those with abnormalities to the sleep-wake cycle?  It can be a very frustrating problem to deal with, but the following suggestions may be worth a try:

1) ACCOMODATE TO THEM.  Granted, this may be the most difficult and costly approach.  Accommodating to the person's new routine must include keeping them in a locked/secured environment and awake night staff for full supervision as well as ongoing stimulation during their awake periods. They could rest and snooze throughout the day to insure they are adequately rested.

2) MEDICATIONS.  It may be appropriate for the doctor to review all medications to consider discontinuing any non-essential medications which may have an effect on sleep.  Other medications that may reduce anxiety, relax muscles or induce sleep may be considered.

3) ASSESS PAIN.  Pain keeps people from sleeping, or may wake them up from sleep.  With some forms of dementia, communicating or expressing one's pain may be impaired.  Those with complex medical problems in addition to dementia may also be affected by musculoskeletal or other source of pain.  In some cases, a trial of a relatively benign pain medication such as Tylenol may be justified.  If sleep problems are in part due to arthritic pain, aspirin or Tylenol may decrease musculoskeletal pain so that the person can sleep more comfortably.

4) ADDRESS NIGHT TIME TOILETING.  Many older persons awaken many times a night to urinate and then are unable to return back to sleep.  Identify if there might be a urinary infection, provide a bedside urinal or commode to minimize walking through the house activity.  With less physical activity involved to manage night time urination, individuals may fall back to sleep more easily.

5) UTILIZE NIGHT LIGHTS.  Elderly individuals may also have low vision which is exacerbated at night.  A small night light helps to orient and minimize agitation if the individual wakes up and becomes frightened by strange surroundings.  Night lights can also be placed to mark the pathway to the bathroom.

6) KEEP A STANDARD, DAILY ROUTINE.  While caregivers may change from day to day, it is helpful to keep a standard daily routine for any individual with dementia.  A standard daily program for wake-up time, meals, medications, toileting and bedtime routines should be followed by all caregivers to provide consistency.  The daily routine should also include physical activity and other mentally stimulating activities which will help to reset the awake-sleep cycle as well as maintain optimal function. A consistent program reduces anxiety so that an individual will also learn to anticipate what will happen next rather than begin to worry or become anxious wondering when they will eat, get their meds, toilet or go to bed.  Make a written program which is followed by all caregivers 7 days/week.

Dementia: When to worry

Have you ever gone to the pantry to get something then can't remember why you went there?  Can't remember where you put your phone or keys?  Have trouble remembering someone's name?  Are you worried about your memory?  Then join the crowd and perhaps worry less.  The type of memory problems described above are entirely consistent with normal brain function in someone over 55 (or younger) and are in no way indicative of dementia.  Many people consult doctors about their poor memory and are concerned they may be in the early stages of dementia.  If YOU ALONE are concerned about your memory, there is most likely less concern about dementia than if close family members are concerned.

True dementia does involve short term memory loss with retention of long term memories, but it's more than just that.  In general it can be said that dementia involves memory impairment PLUS some inability to function independently in one's daily routine, social activities, or relationships.  These independent functions might include:

• Impairment of complex tasks such as balancing a checkbook
• Impairment of reasoning such as difficulty dealing with new and unfamiliar situations
• Impaired spatial functions (Dementia testing often will involve asking the subject to draw a clock face with a given time on it, or copy a pattern on paper)
• Impaired language such as using the wrong words to describe things

Of those who have  dementia, about 70% have Alzheimer's disease, 10-20% have Vascular (stroke related) dementia and 10-15% have Lewy body dementia (an accelerated form of Alzheimer's).  Other diseases such as Parkinson's or brain tumors can also result in related dementias.

Dementia-like symptoms that can appear to be similar in behavior (but are not) can include age related mild cognitive impairment (MCI), delirium or depression.  Those with simple age related cognitive impairment may have some memory difficulty and they may think a little more slowly, but the ability to function with day to day activities remains intact.  Patients with delirium have a sudden onset of new mentation symptoms and this is usually reversible. On the contrary, the onset of dementia is gradual and will worsen with time.   Depression can also mimic dementia-like symptoms.  Depressed individuals may perform poorly on standardized dementia tests due to lack of motivation and/or poor effort.  Medications can also create brain function changes that simulate dementia; alcohol, antihistamines, psychiatric medications, sedatives and others can impair memory and cognitive function.

Getting evaluated for dementia first involves talking to your primary care physician about your symptoms.  Then a brief brain function screening test can be administered.  If the screening test score results in a cause for concern, then blood testing for reversible causes like vitamin B12 deficiency or thyroid deficiency can be performed.  The value of brain imaging in diagnosing early dementia is controversial since the most common causes of Alzheimer's disease and Lewy Body disease will show no abnormality on imaging tests.  Neuropsychological testing is frequently valuable in anyone who is having a new brain function problem.  This testing involves several standardized cognitive skills tests administered by a neuropsychologist. 

At best, medication treatment for dementia can provide a modest improvement in symptoms and can slow down the rate at which dementia progresses.  Dementia is frequently accompanied by depression so antidepressant medication can be beneficial as well as other stimulating activities such as Physical, Occupational and Recreational therapies aimed at cognitive rehabilitation, exercise and mental stimulation. 

The benefits of social support for all individuals, families and caregivers affected by dementia related disease cannot be emphasized enough.  The prognosis from early symptoms to morbidity may last as long as ten years or more.  Joining support groups, dividing up caregiving duties and finding proper medical care or placement is imperative for the well-being of the affected individual as well as their loved ones.

Staying at home with support, placement in Skilled Nursing, Dementia Care Units or Board and Care facilities are all choices families may make for their loved ones.  Please visit the Villa Care Homes website to see how small board and care facilities can manage residents with dementia with a regimented daily program and high level of care/supervision. www.VillaCareHomes.com

Stroke Recovery: Alternative Treatments: Acupuncture

Stroke is the second most common cause of death (after coronary heart disease) and the leading cause of adult disability in the US today.  Approximately 700,000 strokes occur each year in the US leaving 500,000 survivors with residual disability.  Forty percent of those survivors have moderate impairment and functional limitations related to motor function and basic mobility, while 15-30% are severely disabled.  Physical therapists and other professionals focus recovery on relearning normal patterns of movement or facilitating a rebalance of muscle tone.  In an attempt to further improve outcomes of stroke rehabilitation alternative treatments such as acupuncture or electroacupuncture (EA) are being evaluated for their efficacy in improving functional recovery after stroke.  Acupuncture/EA has been used in eastern medicine for thousands of years to enhance stroke recovery.  It has only been in the last decade that studies of brain function with computed tomography (CT) scan and magnetic resonance imaging (MRI) has substantially expanded our understanding of neuronal recovery and their modulation by various rehabilitation interventions.

The mechanism by which acupuncture increases cerebral blood flow is not fully understood but immunohistochemical analysis in animals suggests an enhanced expression of vascular endothelial growth factor.  Clearly, post stroke outcome is dependent on stroke severity in the acute phase and that patients with intact cortical function have an advantage to better participate with motor recovery.  The location of the lesion site plays a significant role in the responsiveness to any therapeutic intervention as does the type of stroke: ischemic vs. hemorrhagic.    During the functional reorganization of  neural pathways following a stroke, therapeutic techniques rely on the neuroplasticity of the brain to achieve improved motor abilities and functional outcomes

Current evidence for clinical efficacy of acupuncture/EA for stroke recovery is promising but still controversial; it's efficacy as an adjunct to standard post-stroke rehabilitation programs can be demonstrated with accurate treatment intervention using electrical stimulation over acupuncture points, proper selection of patient and functional outcomes measures.  Additionally, acupuncture/EA may be helpful in treating pain, sleep disturbance, anxiety, depression, or other conditions which are common in stroke and often a barrier to recovery.

92 Million Older Americans Expected by 2060

Over one in eight Americans is age 65 or older, according to the latest statistics from the U.S. Census Bureau.  The number of "older Americans" is approximately 41.4 million - an 18 percent increase from 2000.  The 65 and older population is also expected to more than double to 92 million in 2060, according to a new report from the U.S. Department of Health and Human Services entitled, "A Profile of Older Americans 2012."  The report also states that the population of those 85 years and older is projected to nearly triple from 5.7 million in 2011 to 14.1 million in 2040.

The report also provides the latest national demographic information on issues ranging from health care and health insurance coverage to disability and activity limitations for older Americans.  More information is at:  http://www.aoa.gov/AoARoot/Aging Statistics/Profile/2012/docs/2012profile.pdf

The Villa Care Homes are poised to care for those with disabilities associated with advanced aging.  Our program is successful because of the consistency in care, anticipation of needs and knowledgeable, loving caregivers.  We strive to coordinate the physical, emotional, psychological and spiritual needs of each of our residents.  We collaborate as a team together with the physician, resident and family members.  Please call to arrange a tour at any time. http://www.VillaCareHomes.com

Honest Communication with Seriously ill Patients

It is not easy to tell patients they are going to die.  Despite the fact that chemotherapy delivered to cancer patients with a poor prognosis is intended only to provide palliation, not a cure, a majority of patients with metastatic cancer have false expectations regarding the curative potential of the treatment.

This raises the question of whether the needed patient-physician conversations about palliative and end-of-life care are even taking place.  Patients who do not know whether a treatment offers any possibility of cure may be compromised in their ability to make informed treatment decisions that are consonant with their preferences.  This misunderstanding could represent an obstacle to optimal end- of-life planning and care.

If patients have unrealistic expectations of a cure from a therapy that is administered with palliative intent, there is a serious miscommunication that needs to be addressed.  Studies have shown that two-thirds of doctors tell patients at the initial visit that they have an incurable disease, but only about a third actually state the prognosis.   It is not easy to tell patients that they are going to die and many physicians choose not to do this.  It might explain why two months before death, many patients with cancer have not heard any of their doctors use the word "Hospice."

Most patients want to know whether or not they can be cured, and physicians can provide them with the information they need in order to plan for their remaining life.  If patients are offered truthful information on what is going to happen to them, they can choose wisely and physicians can help them make these difficult decisions. 

Helping seriously ill patients and their families to become proactive in understanding and seeking the services of palliative medicine and Hospice care is the focus of a new educational campaign from The Joint Commission. "Speak Up: What You Need to Know about Your Serious Illness and Palliative Care," the program offers free downloadable brochures, videos and posters.  Topics addressed in the brochure include how and when to get palliative care, questions palliative care specialists may ask patients, questions for patients to ask their palliative care providers and where to get more information.  www.jointcommission.org/topics/speakup_brochures.aspx

The Villas in Antioch, Martinez and Alamo work together with families, residents, physicians and Hospice or Palliative care agencies to insure there is clear and honest communication with patients living with serious illnesses.  We are proud to assist guiding residents and their families through one of life's most challenging times with clinical expertise and compassion.  Please contact us if we can assist you with placement of a loved one, or just information regarding eldercare services.
VillaCareHomes.com

Vitamin D deficiency ages bones

A recent study conducted by American and German scientists found that vitamin D deficiency not only inhibits the formation of new bone but also accelerates aging of existing bone, according to an article in Medical News Today. The study appears in the journal Science Translational Medicine.
Robert Ritchie, leader of the American team from the University of California, Berkeley, said, “The assumption has been that the main problem with vitamin D deficiency is reduced mineralization for the creation of new bone mass, but we’ve shown that low levels of vitamin D also induce premature aging of existing bone.”
Vitamin D helps the body absorb calcium. When a person becomes vitamin D deficient, his or her body takes calcium from the bone to replenish blood calcium levels, which can lead to rickets (in children), osteomalacia, or osteoporosis. According to Björn Busse, leader of the German team and a scientist at the University Medical Center in Hamburg, “Unraveling the complexity of human bone structure may provide some insight into more effective ways to prevent or treat fractures in patients with vitamin D deficiency.”
The study highlights the importance of continually monitoring and maintaining vitamin D levels in patients who are at risk for vitamin D deficiency. The article suggests that vitamin D deficiency is a growing problem in the United States.
It is not too late to start adding vitamin D to your daily regimen. Patients 65 and older stand to benefit from everyday vitamin D supplementation. In 2012, the U.S. Preventive Services Task Force suggested that supplemental vitamin D combined with exercise can reduce the risk of falls in individuals who are at an increased risk. To reap the benefits, it is crucial that patients take a high enough dose as determined by a physician. The American Geriatrics Society recommends that patients with proven vitamin D deficiency take at least 800 IUs a day.

Please visit us at VillaCareHomes.com   We care about the physical, social, mental and emotional needs of our residents.

Ten Early Warning Signs of Alzheimer's:

1. Recent memory loss that affects job skills
It's normal to occasionally forget phone numbers and remember them later.  Those with dementia, such as Alzheimer's disease may forget things more often.

2. Difficulty performing familiar tasks
Those affected with Alzheimer's disease could prepare a meal and not only forget to serve it, but also forget they made it.

3. Problems with language
They may forget simple words or substitute inappropriate words, making their sentence incomprehensible.

4. Disorientation of time and place.
Those with Alzheimer's disease can become lost on their own street, not knowing where they are, how they got there or how to get back home.

5. Poor or decreased judgement
The disease can cause people to forget entirely the clild under their care; they may also dress inappropriately, wearing several shirts or blouses.

6. Problems with abstract thinking
Forgetting completely what number or words are and what needs to be done with them.

7. Misplacing things
Putting things in inappropriate places: an iron in the freezer, or a wristwatch in the sugar bowl.

8. changes in mood or behavior
Rapid mood swings from calm to tears to anger for no apparent reason.

9. Changes in personality
People's personalities ordinarily change somewhat with age, but a person with Alzheimer's disease can change drastically, becoming extremely confused, suspicious, or fearful.

10.  Loss of initiative
Becoming very passive and requires cues and/or prompting to become involved.

At Villa Care Homes, we can monitor behavior and provide a safe environment for your loved ones.  Stimulating a person mentally and physically to the best of their abilities to maintain independence is critical for quality of life.  Please visit the Villa Website at: VillaCareHomes.com

Brain Power/Brain Boosting habits

Living to an old age isn’t much fun if you can’t remember anything. No matter what your age, you can protect your memory and keep your mind sharp with one habit: practice a mental exercise every day. Practice consistently, and by the end of the month, you will have a new brain-boosting habit that will pave the way for a long and memorable life!

This comes from habits found in the 2011 Longevity Program, a yearlong plan of monthly activities that come from the habits of centenarians from around the world. The idea of this program is that by choosing a simple activity and doing it every day, you will gradually develop 12 new healthy habits by the end of the year. Would you like to do the whole year program?

This Month's Habit: Practice a brain-boosting exercise each day
Here’s why: While you may not be able to teach an old dog new tricks, you can certainly teach your brain some new tricks. Scientists have found that the human brain has an amazing ability to adapt and change--an ability called neuroplasticity. With the right stimulation, your brain can form new neural pathways, helping increase your cognitive capabilities, improve your ability to learn new information, and give your memory a boost.
By the time you are an adult, your brain has developed millions of neural pathways that help you solve problems you have come across before and process information at a rapid pace. But sticking to these well-worn pathways does not give your brain the stimulation it needs to keep developing. Mental brain puzzles performed on a daily basis help strengthen your brain by activating new neural pathways. One thing to keep in mind: the activity you choose should be a little out of your comfort zone. If you choose something you are already good at, even if it’s intellectually demanding, it isn’t an optimal choice for exercising your brain. Also, try to practice around the same time every day, because consistent cycles aid in the development of new neural pathways.
Brain-Boosting Exercises
These brain exercises help improve brain capacity in younger people and restore mental faculties that are declining in older people.
1. Use it or lose it with a cognitive workout: Memorize a poem, play chess, enjoy a challenging crossword puzzle, learn phone numbers by heart, add numbers without a calculator, learn the words to a new song, or memorize a shopping list--as long as it’s something new to you. Keep challenging yourself with new tasks.
2. Use your non-dominant hand: If you’re right-handed, use your left hand to eat, comb your hair, brush your teeth, write your name, or try putting your mouse pad on the other side of the keyboard. This practice of non-dominant hand use stimulates communication between the two hemispheres of the brain, helping to improve mental capacity as well as physical balance. Another idea: tai chi and yoga are physical activities that coach people to use the right and left side of the body equally.
Reward yourself
If you stick to the plan nearly every day, think of a way to reward yourself. You will be more likely to follow through with your goal when there is a bonus at the finish line.
Stay on track
To stay on course, ask yourself these questions each day. Keeping a written record of daily answers will help you stick to the plan and may offer insights to keep you inspired.
• Are you practicing one brain-boosting exercise every day? What has the experience been like?
• How do you feel today compared to the previous day? How about to one week ago? You may notice that you are processing new information more quickly and you may feel more alert.
• What obstacles are keeping you from practicing your mental exercise every day? What can you do to remove the obstacle?
Make it happen! An answer for every excuse
• Miss a day? Sometimes, when things get busy, you might miss a day or two. But, you are not a failure! Let it go and consider the reasons for missing a few days. What will you do differently for more successful results? Simply recommit, make adjustments, and continue where you left off. Don’t ever give up!
• Too boring. Keep your mental activity fun. If none of the above examples work for you, try any appealing activity that requires some mental effort and expands your knowledge. Some examples are learning a new language, instrument, or technological device. Try a sport or other physical activity you have never tried before, like qi gong or a zumba dance class.
• Forget to practice. Start simply. If you can’t remember to do a brain exercise every day, try building off of the daily habits you already have. Brush your teeth with your non-dominant hand. On your commute, memorize the signs around you and then recall them to memory. In an empty moment, try to remember each birthday of the people you know.
At the end of the month: If you have been practicing one mental exercise a day, it is likely that you have created a new brain-boosting habit.

Let us be part of your loved one's mental stimulation and well-being.  If you are considering board and care placement, please check out my website: VillaCareHomes.com

May you live long, live strong, and live happy!

Spinal Fluid Test predicts Alzheimer's Disease

Researchers report that a spinal fluid test can be 100 percent accurate in identifying patients with significant memory loss who are on their way to developing Alzheimer’s disease.  Although there has been increasing

evidence of the value of this and other tests in finding signs of Alzheimer’s, the study, which will appear Tuesday in the Archives of Neurology, shows how accurate they can be. The new result is one of a number of remarkable recent findings about Alzheimer’s. 

 

After decades when nothing much seemed to be happening, when this progressive brain disease seemed untreatable and when its diagnosis could be confirmed only at autopsy, the field has suddenly woken up.
Alzheimer’s, medical experts now agree, starts a decade or more before people have symptoms. And by the time there are symptoms, it may be too late to save the brain. So the hope is to find good ways to identify people who are getting the disease, and use those people as subjects in studies to see how long it takes for symptoms to occur and in studies of drugs that may slow or stop the disease.

Researchers are finding simple and accurate ways to detect Alzheimer’s long before there are definite symptoms. In addition to spinal fluid tests they also have new PET scans of the brain that show the telltale amyloid plaques that are a unique feature of the disease. And they are testing hundreds of new drugs that, they hope, might change the course of the relentless brain cell death that robs people of their memories and abilities to think and reason. “This is what everyone is looking for, the bull’s-eye of perfect predictive accuracy,” Dr. Steven DeKosky, dean of the University of Virginia medical school, who is not connected to the new research, said about the spinal tap study.

Dr. John Morris, a professor of neurology at Washington University, said the new study “establishes that there is a signature of Alzheimer’s and that it means something. It is very powerful.” A lot of work lies ahead, researchers say — making sure the tests are reliable if they are used in doctors’ offices, making sure the research findings hold up in real-life situations, getting doctors and patients comfortable with the notion of spinal taps, the method used to get spinal fluid. But they see a bright future.

Although the latest PET scans for Alzheimer’s are not commercially available, the spinal fluid tests are.
So the new results also give rise to a difficult question: Should doctors offer, or patients accept, commercially available spinal tap tests to find a disease that is yet untreatable? In the research studies, patients are often not told they may have the disease, but in practice in the real world, many may be told.
Some medical experts say it should be up to doctors and their patients. Others say doctors should refrain from using the spinal fluid test in their practices. They note that it is not reliable enough — results can vary by lab — and has been studied only in research settings where patients are carefully selected to have no other conditions, like strokes or depression, that could affect their memories. “This is literally on the cutting edge of where the field is,” Dr. DeKosky said. “The field is moving fast. You can get a test that is approved by the F.D.A., and cutting edge doctors will use it.”

But, Dr. John Trojanowski, a University of Pennsylvania researcher and senior author of the paper, said that given that people can get the test now, “How early do we want to label people?” Some, like Dr. John Growdon, a neurology professor at Massachusetts General Hospital who wrote an editorial accompanying the paper, said that decision was up to doctors and their patients.  Sometimes patients with severe memory loss do not have the disease. Doctors might want to use the test in cases where they want to be sure of the diagnosis. And they might want to offer the test to people with milder symptoms who want to know whether they are developing the devastating brain disease.

One drawback is that spinal fluid is obtained with a spinal tap, and that procedure, with its reputation for pain and headaches, makes most doctors and many patients nervous. The procedure involves putting a needle in the spinal space and withdrawing a small amount of fluid.  Dr. Growdon and others say spinal taps are safe and not particularly painful for most people. But, he said, there needs to be an education campaign to make people feel more comfortable about having them. He suggested that, because most family doctors and internists are not experienced with the test, there could be special spinal tap centers where they could send patients.

The new study included more than 300 patients in their 70s, 114 with normal memories, 200 with memory problems and 102 with Alzheimer’s disease. Their spinal fluid was analyzed for amyloid beta, a protein fragment that forms plaques in the brain, and for tau, a protein that accumulates in dead and dying nerve cells in the brain. To avoid bias, the researchers analyzing the data did not know anything about the clinical status of the subjects. Also, the subjects were not told what the tests showed.  Nearly every person with Alzheimer’s had the characteristic spinal fluid protein levels. Nearly three quarters of people with mild cognitive impairment, a memory impediment that can precede Alzheimer’s, had Alzheimer’s-like spinal fluid proteins. And every one of those patients with the proteins developed Alzheimer’s within five years. And about a third of people with normal memories had spinal fluid indicating Alzheimer’s. Researchers suspect that those people will develop memory problems.

The prevailing hypothesis about Alzheimer’s says that amyloid and tau accumulation are necessary for the disease and that stopping the proteins could stop the disease. But it is not yet known what happens when these proteins accumulate in the brains of people with normal memories. They might be a risk factor like high cholesterol levels. Many people with high cholesterol levels never have heart attacks. Or it might mean that Alzheimer’s has already started and if the person lives long enough he or she will with absolute certainty get symptoms like memory loss.

Many, like Dr. DeKosky, believe that when PET scans for amyloid become available, they will be used instead of spinal taps, in part because doctors and patients are more comfortable with brain scans.
And when — researchers optimistically are saying “when” these days — drugs are shown to slow or prevent the disease, the thought is that people will start having brain scans or spinal taps for Alzheimer’s as routinely as they might have colonoscopies or mammograms today.  For now, Dr. DeKosky said, the days when Alzheimer’s could be confirmed only at autopsy are almost over. And the time when Alzheimer’s could be detected only after most of the brain damage was done seem to be ending, too.
“The new biomarkers in CSF have made the difference,” Dr. DeKosky said, referring to cerebral spinal fluid. “This confirms their accuracy in a very big way.”

Excerpt from NY Times article

Let Villa Care Homes assist you with your family member who may have Alzheimer's.  We have trained staff capable to handle complex medical conditions, including dementia and Alzheimer's.  We are located in Antioch, Martinez and Alamo, California.       www.VillaCareHomes.com

STROKE WARNING SIGNS

A stroke occurs when the flow of blood to a part of the brain is cut off. This can be due to something (usually a blood clot) blocking the flow of blood to the brain (ischemic stroke). It can also be caused by a burst blood vessel bleeding into the brain (hemorrhagic stroke). About 80% of strokes are ischemic and 20% are hemorrhagic. Without a blood supply, the brain cells in the affected area start to die.
The effects of a stroke depend on which part of the brain is affected and how severe the damage is. A stroke may affect your ability to move, your ability to speak and understand speech, your memory and problem-solving abilities, your emotions, and your senses of touch, hearing, sight, smell, and taste. In some cases, a stroke can be fatal.
It's important to recognize the warning signs of stroke, because quick treatment can reduce the risk of brain injury and death. A stroke usually comes on suddenly, over a few minutes or hours. The warning signs of stroke include:

• sudden weakness, numbness, or tingling of the face, arm, or leg (often on only one side of the body)
• sudden confusion, trouble speaking, or trouble understanding speech
• sudden vision loss (often in one eye only) or double vision
• sudden trouble walking, dizziness, loss of balance or coordination, or falls
• sudden severe headache (often described as "the worst headache of my life") with no known cause

If you notice these symptoms, call 911 (or your emergency medical number if you do not have 911 service) immediately. Stroke is a medical emergency.

Elderly are Easy Targets of Financial Scams

Senior Safety is an important issue, including financial safety.  More than ever, the elderly have become targets of financial fraud, and surprisingly the scammers are of retirement age themselves! “One out of five Americans over the age of 65 has been the victim of a financial scam, according to the Washington-based Investor Protection Trust, a nonprofit that promotes shareholder education. That means more than 7.3 million seniors have been taken advantage of financially through inappropriate investments, high fees, or fraud, which insurer MetLife says comes at a cost of more than $2.6 billion a year. “Older people are being targeted because, as 1930s robber Willie Sutton said when asked why he robs banks, ‘that’s where the money is,’” says Kathleen Quinn, executive director of the National Adult Protective Services Assn. in Springfield, Ill.”
“Many of today’s scammers have a particularly good understanding of their victims–because the fraudsters themselves are of retirement age, if not exactly retired. More elderly con artists than ever seem to be preying on retirees, perhaps because senior citizens put more confidence in someone their age, says Denise Voigt Crawford, president of the North American Securities Administrators Assn. “It’s astounding that you can’t even trust older people anymore,” Crawford says.” (Bloomberg Business Week-Scams:  A Sucker Retires Every Minute, July 15 2010)

The primary way that seniors are taken advantage of is by purchasing financial products that are inappropriate, unsuitable and at times down right fraudulent.   Seniors, including veterans, who are isolated are likely to become targets, and their retirement assets are at great risk.  If you are the caretaker of an aging senior, please take the time to make sure that their retirement savings are secure, and that any changes are truly in their best interest.  If you are have an aging parent living alone, or are a long distance caregiver, reach out for professional care giving help to insure the overall safety of your aging family member.  For help with an aging loved one in the California San Francisco Bay Area, visit VillaCareHomes.com

Osteoporosis Part III: Precautions and Treatment

PREVENTION: Elderly people with osteoporosis should take every precaution to avoid accidental falls.  This disease is responsible for many of the hip, wrist, and spinal fractures that occur in elderly women.  If glasses are necessary for general vision, they should always be worn.  A cane or walker should be used if you do not feel steady on your feet, or if one has been recommended.  Shoes and slippers should have skid-resistant soles.  Additionally, handrails in bathrooms and sturdy banister rails along all stairs inside and outside should be installed for safety.

TREATMENT: Treatment of osteoporosis is geared toward halting, or at least slowing down the progress of the disease.  This may involve increased calcium intake, estrogen replacement therapy (provided there are no contraindications), physical therapy and weight-bearing exercise. 

At least six glasses of milk or equivalent servings of other high-calcium foods such as cheese or yogurt and a small supplement of vitamin D may be prescribed to be taken daily.  Oral calcium supplements may also be prescribed.  For postmenopausal women with osteoporosis, estrogen-replacement therapy has been shown to be the most effective way of slowing down bone loss.  Today, many doctors prescribe a combination of estrogen with a synthetic progesterone to simulate the hormonal environment existing before menopause.  As with any medication, there may be certain side effects from such a regimen; report any you notice to your physician.

Exercise is very important, especially the kind of exercise that allows your body weight to bear down on your skeletal frame.  Those who are bedridden, confined to a wheelchair, or with limited ability to move, physical therapy should be received on a regular basis.  While swimming and bicycling are great cardio-workouts, simple walking or light jogging is better for those with osteoporosis.  Walking is one of the best exercises for those who do not want to take part in active sports or who cannot do so because of their general health.

SUMMARY: Bone loss to some degree is inevitable as we grow older; however, with osteoporosis, the process is much more pronounced.  Bones are weaker and thinner (especially those of the sping), and fractures can occur more easily.  New treatments are being developed that may increase bone formation and thereby reverse osteoporosis.  Meanwhile, however, the object of treatment is to stop or slow down the process of the disease.  Current treatment involves an increased intake of calcium, estrogen replacement therapy, physical therapy and weight bearing exercise.  Preventative therapy for premenopausal women consists of a diet high in calcium and vitamin D and regular exercise.

Osteoporosis Part II

Osteoporosis is sometimes called the "silent disease" because it generally remains undiscovered until a fracture occurs.  One of the earliest and most common signs of osteoporosis is a gradual decrease in height and rounding of the shoulders following menopause as a result of small, spontaneous fractures occurring in the spinal column.  The wrists and hips are also very susceptible to easy fracture.

The change in curvature of the spine may produce a nagging backache.  Severe or sharp back pains are rare, but they should be brought to your doctor's attention immediately, as they may be the result of spontaneous collapse or fracture of one or more of the bones that make up the spinal column.  As the spinal column becomes more compressed, people with osteoporosis become progressively shorter.  10-15 years after menopause a woman may lose 1-3 inches in height; 25-30 years after menopause a woman may lose as much as 6 inches or more if they have severe kyphosis (rounding of the back)

PREVENTION: By paying attention to the amount of calcium you are receiving in your diet, the amount of exercise you do daily, and the amount you smoke or drink, you can help protect yourself from developing osteoporosis. 
     Calcium: To reduce the risk of developing post menopausal osteoporosis, docotor now advise any woman who is 45 or older to increase her clcium intake.  One way of accomplishing this is by increasing your consumption of foods that are naturally high in calcium.  Some of these foods include kale, spinach, turnip greens, raw oysters, sardines and canned salmon.  The greatest source of calcium however is dairy products such as milk and cheese.  If you find it difficult to get enough calcium from your meals alone, your doctor may prescribe calcium supplements and sometimes vitamin D, which helps the body absorb calcium better.
   Exercise: Any kind of physical activity can help slow down the rate of bone loss associated with osteoporosis.  Therefore, it is highly desirable to exercise regularly.  While it may not be possible for you to engage in strenuous physical activities, you can always take daily walks.  Regular exercise, particularly if it stresses weight bearing can be very effective, since it keeps both bone and muscle healthy.
   Cigarettes and alcohol: Although there is no direct link between these two substances and osteoporosis, an unusually high percentage of women who have osteoporosis are cigarette smokers.  Also, some sources believe excessive alcohol intake may increase the risk of developing osteoporosis.

OSTEOPOROSIS

Osteoporosis is a disease marked by thinning of the bones, making them brittle and more vulnerable to spontaneous fractures.  The disease affects some twenty million people in the United States.  After the age of forty-five, it is nine times more common in women than men.  Older persons are more susceptible than middle-aged people, and whites/Orientals more than blacks.  Fair-haired, fair-skinned people are particularly vulnerable.  Osteoporosis tends to run in families; a person who has a close relative with the disease is likely to develop it later in life.  Osteoporosis is irreversible after a certain stage.  However, with treatment, its progression can be halted or at least slowed down.  You may already have osteoporosis or be at risk of getting it; in either case, there is a lot you can learn and do about the disease.

Bone Changes: Bone is living tissue that is constantly being broken down and rebuilt in very complex ways, even in adults.  Bones require calcium, vitamin D, and phosphorus; the availability and use of these substances by the skeleton is regulated by hormones and physical stress on the ends of the bones is necessasary to help them form and grow.  The contribution made by calcium in association with vitamin D seems to be the most important factor in this process.  The absorption of calcium into bone in women is ultimately dependent upon the hormone estrogen.  Some degree of bone loss is an inevitable consequence of aging.  In people with osteoporosis however, the rate of bone loss considerably exceeds that of bone formation.

Causes: Exactly what causes the increased bone loss due to osteoporosis is unknown.  However, there appears to be many contributing factors, including hormonal imbalances, which affect the absorption of calcium and phosphorus, and the decrease in estrogen production in menopausal women.  Almost one in four postmenopausal women has osteoporosis: the disease also develops early in women who have had a premature menopause due to surgical removal of the ovaries.  Women with small bones appear to be particularly susceptible to this disease.  Other factors relating to an individual's life-style may have an effect on the development of osteoporosis.  Prolonged bed rest, immobilization and inactivity promote bone loss in young people and to an even greater extent, in the elderly.  Inadequate nutrition, including a diet lacking in calcium, vitamin D, and protein, is also thought to contribute to the onset of the disease.

Memorial Day Trivia

The Villa Care Homes wishes to honor and acknowledge veterans from every corner of the country who gave their all to preserve the freedoms we now enjoy.  Sharing a bit of history and trivia about the day makes it all that more special:
Memorial Day, which falls on the last Monday of May, commemorates the men and women who died while serving in the American military. Originally known as Decoration Day, it originated in the years following the Civil War and became an official federal holiday in 1971. Many Americans observe Memorial Day by visiting cemeteries or memorials, holding family gatherings and participating in parades. Unofficially, at least, it marks the beginning of summer.
Memorial Day was originally known as Decoration Day because it was a time set aside to honor the nation's Civil War dead by decorating their graves. It was first widely observed on May 30, 1868, to commemorate the sacrifices of Civil War soldiers, by proclamation of General John A. Logan of the Grand Army of the Republic, an organization of former sailors and soldiers. On May 5, 1868, Logan declared in General Order No. 11 that:
The 30th of May, 1868, is designated for the purpose of strewing with flowers, or otherwise decorating the graves of comrades who died in defense of their country during the late rebellion, and whose bodies now lie in almost every city, village, and hamlet churchyard in the land. In this observance no form of ceremony is prescribed, but posts and comrades will in their own way arrange such fitting services and testimonials of respect as circumstances may permit.
During the first celebration of Decoration Day, General James Garfield made a speech at Arlington National Cemetery, after which 5,000 participants helped to decorate the graves of the more than 20,000 Union and Confederate soldiers buried in the cemetery.
This 1868 celebration was inspired by local observances of the day in several towns throughout America that had taken place in the three years since the Civil War. In fact, several Northern and Southern cities claim to be the birthplace of Memorial Day, including Columbus, Miss.; Macon, Ga.; Richmond, Va.; Boalsburg, Pa.; and Carbondale, Ill.
In 1966, the federal government, under the direction of President Lyndon Johnson, declared Waterloo, N.Y., the official birthplace of Memorial Day. They chose Waterloo—which had first celebrated the day on May 5, 1866—because the town had made Memorial Day an annual, community-wide event during which businesses closed and residents decorated the graves of soldiers with flowers and flags.
By the late 1800s, many communities across the country had begun to celebrate Memorial Day and, after World War I, observances also began to honor those who had died in all of America's wars. In 1971, Congress declared Memorial Day a national holiday to be celebrated the last Monday in May. (Veterans Day, a day set aside to honor all veterans, living and dead, is celebrated each year on November 11.)
Today, Memorial Day is celebrated at Arlington National Cemetery with a ceremony in which a small American flag is placed on each grave. Also, it is customary for the president or vice-president to give a speech honoring the contributions of the dead and lay a wreath at the Tomb of the Unknown Soldier. About 5,000 people attend the ceremony annually.
Several Southern states continue to set aside a special day for honoring the Confederate dead, which is usually called Confederate Memorial Day.
source: history.com

Heart Patients Vulnerable to Depression

Heart patients are particularly vulnerable to depression and should be screened, and if necessary treated, to improve their recovery, U.S. researchers discovered.

"Depression and heart disease seem to be very much intertwined," Judith H. Lichtman of Yale University of School of Public Health said in a statement.  "you can't treat the heart in isolation from the patient's mental health."

The statement that screening heart patients for depression is part of a scientific advisory issued by the American Heart Association and co-authored by Lichtman.

The American Psychiatric Association has endorsed the statement and recommends:

• Routine and frequent screening for depression in patients with chronic heart disease in a variety of settings, including the hospital, physician's office and cardiac rehabilitation centers.
• Help for patients with positive screening results by a professional qualified to diagnose and manage treatment for depression.
• Careful monitoring of patients to ensure adherence to their treatment plan.

While there is no evidence that screening for depression leads to improved outcomes for people with cardiovascular complications, the advisory does state that depression is linked with increased morbidity and mortality, lower rates of cardiac rehabilitation and poorer quality of life, Lichtman said.

Source:www.thirdage.com

Hospice Care

For many, the word "hospice" is difficult to hear.  It conjures up feelings of hopelessness and abandonment....but the realities are so much more promising.  Hospice often opens the door for more meaningful choices when curative treatments are no longer effective; families can obtain the support and services they need with confidence to address end-of-life issues in the home, care facility, skilled nursing or hospital settings.

 Hospice care involves addressing all the physical, emotional and spiritual needs of the resident and their families, then coordinating that with the medical team for a collaborative plan of care.  Hospice staff are accustomed to having difficult conversations about medical treatment decisions and can personalize the approach for each individual. 

Having Hospice care available to residents may improve the quality of care for residents by positively influencing nursing home clinical practices.  Residents enrolled in Hospice are:

• Less likely to be hospitalized
• More likely to be assessed for pain and receive pain treatment
• Less likely to be physically restrained
• Less likely to have parenteral or IV feeding
• Less likely to have feeding tubes in place
• Less likely to have medications administered by IV or intramuscular injection
• More likely to have completed an advance directive.  

As a result, nursing staff become more aware of end-of-life issues and their attitudes toward hospice change.  They come to realize that hospice care does not cause patients to die sooner; in fact many residents live longer and more comfortably because of the multidisciplinary services provided by the entire team of hospice professionals.