10 Critical Things to Know - Colleen Wages, Jenks Nurse 

1. Hydration, hydration, hydration! We have heard it all our lives, but drinking water is so important and even more so as we age. Even slight dehydration can cause physical symptoms in the older adult very quickly, including low blood pressure, dizziness, confusion, and more. 

2. Be Aware UTIs - Sudden confusion, erratic behavior, and agitation can frequently signal a 

possible urinary tract infection (UTI) in the older adult. Often, we might assume these 

symptoms to be a worsening of their cognitive disorder or a medication issue. Although

 that may be possible, a “UTI” must be considered and ruled out. Contact the doctor 

immediately for any new and unusual symptoms observed. 

3. Don’t Avoid the Delusionary State - It is very important that we realize that the 

person living with dementia, or any cognitive impairment can have delusions or even

 live in a delusionary state. Although our natural tendency is to reorient them to 

reality, it’s mostly recommended to go along with their delusions as long as they pose

 no risk of harm. This helps them to feel more comfortable and decreases agitation. For 

example, if your loved one is looking out the window, waiting for their “mom to come”, 

rather than explaining to them that their mom passed away many years ago, tell them 

“She phoned and is running late”. Then try redirecting them with an activity, like sorting 

the laundry, matching up socks, etc. 

4. Music tends to touch everyone in wonderful ways. Those with memory issues who may not even be able to recall what they had for lunch, will often still remember songs they loved. Playing music, going to concerts, making a playlist of some of their favorite tunes, can perk up their mood and bring a smile to their face. 

5. Annual Physician Visits - Being seen annually by your physician not only keeps you up to date on routine tests and bloodwork and medication management, but it also fosters the doctor/client relationship. If an illness or adverse complication occurs, you are already familiar with your doctor and staff, which can ease your anxiety in a potentially stressful situation. 

6. Knowing where to get resources before you need them is crucial in navigating health care issues as well as health care crises. Your local Council on Aging is a great first stop for referrals and can point you in the right direction. Stop by at your leisure and see what programs they offer as well as resources that may benefit you in the future. 

7. Exercise is so important in every stage of life. Even if you have never or are currently not routinely exercising, it is never too late. We naturally lose muscle mass as we age. This contributes to weakness, poor balance, and an increased risk of falls and fractures. Being active, such as walking, weight-bearing exercises, and taking the stairs can make a big impact in your overall health and longevity. It is important to discuss with your doctor before initiating any new exercise routine. 

8. Falls Decrease Independence - Preventing falls is imperative as they are a major cause of injury and can lead to decreased independence. Many falls can be prevented by taking some simple steps to modify your lifestyle and your home, such as installing grab bars in bathroom and shower, balance classes, and using a can or walker if needed. Many medications can interact with one another and cause unsteadiness. Review with your doctor to make sure you are not at risk from any medication side effects/interactions. 

9. Social isolation has been found to have more than a 25% increased risk of significant health issues. Making an effort to connect with family, friends, and your local COA or community can make a big difference in mood and feelings of loneliness. Volunteering in your community is also a great way to stay connected and provides a sense of purpose and belonging. Be patient! Making connections and friendships takes time and effort. 

10. Caregivers Need to Take Time for Their Own Wellbeing - Take time for yourself. If you are a caregiver, remember that it is difficult and draining “to fill another’s tank if yours is empty”. Seek out caregivers support groups, make set times for walks, relaxation techniques, dance, exercise. Anything healthy that “feeds” you and brings you joy should be a priority. 

Managing Medical Care

Once elders get sick or have a triggering event that sends them to the hospital, it becomes a whole new ball game. With multiple chronic illnesses, cognitive decline, hearing loss, and increasing hesitancy to seek medical advice, managing medical care can become a full-time job. 

Pack your patience. Expect to see your loved ones fail to follow instructions - knowingly or otherwise. Anticipate that there will be stressful conversations that will impact medical decisions.  Expect to lose a little sleep, put some mileage on your car, and encounter long wait times in doctors offices, on hold to schedule appointments, and with insurance companies waiting for approvals. 

Start with this the same way you would with most challenges becoming educated. Joy Loverde provides a wonderful step by step guide for this process in her book: The Complete Eldercare Planner.  Chapter 12 outlines the following steps: 

1. Become familiar with healthcare professions including mental health and non-traditional and holistic practitioners - Geriatricians vs Internist 
2. Become familiar and aware of privacy laws 
3. Forge partnerships for quality care - No one is a better advocate for your parents health than you and your parent.
4. Seek advice for Pain Management 
5. Prepare for Medical Appointments 
6. Stay on top of Dental Needs 
7. Learn how to Deal with “I’m not hungry.” 
8. Gently nudge elders who refuse to go to doctors 
9. Create a medical history 
10. Slow down the discharge process 
11. Manage medical bills 
12. Understand/document your parents spiritual preferences regarding medicine, access spiritual resources in the healthcare setting 
13. Research Low-Cost and No-Cost resources 
    • Contact information for doctors, pharmacies, and pharmacists? 

Has your loved one provided their doctors’ offices and other health care providers with written authorization (HIPAA Release Form) so you can access their medical information in accordance with the Health Insurance Portability and Accountability Act (HIPAA). 

There are no standard HIPAA consent forms, since these vary depending on location, so it is best to reach out directly to the medical offices that your loved one frequents to fill out the appropriate forms. 

Caregiver Tip: When you obtain written release authorizations from the health care providers, have your loved one in your care sign it, and keep two copies -- one for you and one for the person you’re caring for.  Then return the signed forms to the providers’ offices. Repeat this process every time you or the person in your care is about to enter a hospital or visit a new doctor. 

To prepare for supporting your aging loved one, start ahead of time in collecting all of their  important medical information including: 

• A list of their medications, past medical procedures, allergies, and blood type? 
• Health insurance information 
• Copies of important legal documents ( See Financial and Legal Services - LINK)  

The following are some available resources and articles to support you and your parents and aging loved ones as you partner with professional medical providers. 

Solo Ager Network Navigating the Changing Health Care System LINK  

Prescriptions and Medicine Management 

• Managing medications for aging parents - Mayo Clinic - LINK 
• Effective Medication Management Tips For Caregivers - Caregiver Action Network -  LINK 
• Part 4 - Health, Hearing Issues and Horrible Driving - Let’s Talk About Aging Parents - A Real Life Guide to Solving Problems with 27 Essential Conversations, by Laura Tamblyn Watts 
  • How can we manage my parent’s medication? 
• Chapter 7 - Pharmageddon: Prescriptions for Disaster, The Fragile Years, Proven Strategies for the Care of Loved Ones, by Amy Cameron O’Rourke 
  • Note: How combinations of prescriptions may be leading to behavioral changes impacting housing choices. 

The Benefits of Preventive Care Planning

Preventive planning for elder care offers significant benefits by enabling early detection of health issues, allowing for timely intervention, maintaining independence, and improving overall quality of life by preventing further complications and unnecessary hospitalizations. This ultimately enables seniors to live more active and fulfilling lives, and includes identifying potential risks like falls, managing chronic conditions, and addressing mental health concerns proactively.  

Key benefits of preventive planning for elders: 

• Early detection and treatment: Regular check-ups and screenings allow healthcare providers to identify potential health problems at their earliest stages, enabling prompt treatment and better management of chronic diseases like diabetes, heart disease, and arthritis. 
• Maintaining independence: By addressing health concerns early, seniors can maintain their ability to perform daily activities and live independently for longer. 
• Improved quality of life: Proactive care can significantly improve overall well-being by preventing unnecessary pain, discomfort, and complications from untreated health issues. 
• Reduced risk of falls: Assessments and interventions focused on balance, strength, and gait can help prevent falls and related injuries, especially important for older adults. 
• Mental health support: Regular check-ins with healthcare providers can identify potential mental health concerns like depression or anxiety, allowing for early intervention and treatment. 
• Lifestyle management: Preventive planning can encourage healthy lifestyle choices like regular exercise, balanced diet, and adequate sleep, which are crucial for overall health in older adults. 
• Care coordination: A well-developed preventive plan can facilitate coordinated care between different healthcare providers, ensuring all aspects of an older adult's health are addressed. 
• Advanced care planning: Discussing future care needs and preferences early on can help ease decision-making for family members in case of a medical crisis. 
  • What age-related Medical Issues should we watch out for? 

Advance Care Planning 

Planning ahead for end-of-life care,  advance care planning, helps to ensure that aging adults get medical care that is a good fit for their preferences and health situation. In other words, good planning can help you figure out which care is unlikely to be helpful; understanding this is a powerful factor in what people want and don’t want.

Completing a legal form such as an advance directive or a MOLST form is an important part of advance care planning, but there’s much much more to good planning ahead. It’s especially important for family caregivers to be involved in planning, if possible, because most older adults will need family — or someone else — to help with medical decision-making during a hospitalization, or an emergency.

•  Advance Care Planning - Here’s a helpful slideshow that delves deeper into the details of this process. See more
   

Special Topics

What Do I Do If My Elderly Parent Refuses to Go to the Doctor?  LINK 

Love Loss and Laughs:  Let’s Talk About Aging Parents - A Real Life Guide to Solving Problems with 27 Essential Conversations, by Laura Tamblyn Watts 

• What do we do about my parent’s hearing problem? 
• What do we do about my parent’s vision loss? 
• What do we do about my parent’s incontinence? 
• Does my parent have an issue with alcohol? 

 How to Care for My Parent when they Are Hospitalized 

For additional information on Hospital Care Management 

see Crisis Care Management - LINK 

Dementia & Anesthesia 

To limit the impacts of anesthesia on dementia, the most important steps are to consult with a healthcare professional before surgery, discuss the patient's specific cognitive status, and opt for the least invasive anesthetic options like regional anesthesia when possible, while avoiding medications that can worsen cognitive function, particularly benzodiazepines and anticholinergics; additionally, meticulous post-operative care with close monitoring and cognitive stimulation can help manage potential cognitive decline. 

When illness causes couples to separate 

Researchers examined how the onset of four serious physical illnesses – cancer, heart problems, lung disease and stroke – affected marriages. They found that overall 31 percent of the marriages ended in divorce over the period studied. Specifically divorce was more likely when the wife was sick. 

At the same time, caring for ill parents can have an impact on the caregiver’s marriage.  Be attentive, open and communicative of what is happening and seek support when necessary. 

Dehydration

How to Prevent, Diagnose and Treat Dehydration -  https://betterhealthwhileaging.net/qa-how-to-prevent-diagnose-treat-dehydration-aging-adults/

Avoiding Falls

The number one action driving seniors from independence is a fall. Each year 1 in 4 older adults experience significant falls with approximately 50% of these occurring in their homes. With current trends and falls the leading cause of injury-related hospitalizations among older adults, we can expect 7 fall deaths every hour by 2030. (CDC). Look for information on making modification to homes in Aging in Place.  Below are some articles speaking to some of the medical causes of falls.

• Preventing Falls in Aging Adults - https://betterhealthwhileaging.net/falls-topic/
• 8 Things to check after a person falls - https://betterhealthwhileaging.net/8-things-to-check-after-fall-in-aging/

Grief & Loss 

Bereavement Support Group: Held at St. Eulalia’s. Topics include an overview of the bereavement process, signs and symptoms of grief, feelings associated with bereavement, and the uniqueness of each person’s grief experience. - 50 Ridge St. Winchester, MA - Phone: (781) 729-8220 Ext. 16 - LINK 

The Children's Room: Grief support services for children, teens, and families. Services are aimed at children ages 3-18 who have lost a parent or sibling, as well as for their caregivers. Runs support groups, teen programming, and referrals. -  1210 Massachusetts Ave. Arlington, MA - Phone: (781) 641-4741  - E-mail: info@childrensroom.org - LINK 

Self-care, Fitness & Exercise 

The Jenks Center offers programming Monday -Saturday in person and virtually to keep seniors active, balanced and engaged.  Check out the Jenks website for a calendar of low- or no- cost weekly and monthly activities, including: 

• Balance classesAerobics and Muscle Fitness 
• Tai Chi 
• Dance Cardio 
• Step Aerobics 
• Mindfulness Practices 
• Yoga and Meditative Movement 
• Reiki Healing 
• Therapy Dog 

Look for physical activity programs that can be accessed through technology at home, such as doing an online group fitness class through SilverSneakers or the YMCA. Jenks offers several of their programs virtually. 

• Tips for Getting and Staying Active as You Age - LINK 
• How to Promote Physical Health While Aging: The Healthy Aging Checklist Part 2 https://betterhealthwhileaging.net/how-to-promote-physical-health-for-healthy-aging/

Dental, Foot, Vision and Hearing Care 

• Part 4 - Love, Loss and Laughs - Let’s Talk About Aging Parents - A Real Life Guide to Solving Problems with 27 Essential Conversations, by Laura Tamblyn Watts 
  • What should we do about my parent’s hearing problems? 
  • What so we do about my parent’s vision loss 

Physical and Occupational therapy 

• Understanding Physical, Occupational, And Speech Therapy In Senior Rehabilitation n- LINK 
• Occupational therapy services - Medicare.gov - LINK  

Flu and Other Vaccines 

Substance & Addictions 

• 12 Step Education Program: A place where individuals can go to share their experiences with alcohol use with one another and support each other in the ongoing effort of maintaining abstinence. - 171 Cambridge Rd Woburn, MA - Phone: (781) 932-8711 - LINK 
• Gamblers Anonymous: A group that comes together to share their experiences, strengths and hopes with each other regarding their gambling problems. Meetings on Mondays from 7:00-8:30 PM. - 100 Winthrop St. Medford, MA - LINK 



Cognitive impairment or dementia 

• How to Promote Brain Health: The Healthy Aging Checklist, Part 1, Learn more
• Part 2 - Mental Capacity, Power of Attorney, and Safety - Let’s Talk About Aging Parents - A Real Life Guide to Solving Problems with 27 Essential Conversations, by Laura Tamblyn Watts 
  • How do I know if my parent has cognitive impairment or dementia? 
• When Your Aging Parent Needs Help, A Geriatrician’s Step-by-Step Guide to Memory Loss, resistance, Safety Worries and More, by Leslie Kernisan, MD, MPH and PAul Spencer Scott 
• How to Talk with a Parent with Dementia - LINK
 

Daily Care

• Do you need to enlist the help of a professional caregiver, a home companion or a home maker to help you make some time for yourself? 
• Does your loved one need in-home medical care? 
• Do you need help in determining what daily care services could best help your loved one? 
  • Best Practices for Effective Elderly Medication Management - LINK 

A Daughter’s Guide to Hiring the Right Aging Care Professional - LINK - https://daughterhood.org/a-daughters-guide-to-hiring-the-right-aging-care-professional/ 

Hiring a Care Manager in your Area - Learn the Landscape of Resources - LINK - https://aginglifecare.org 

Aging Life Care Association - LINK - http://www.aginglifecare.org/ALCA 

Geriatric Care Managers - LINK - http://www.caring.com/local/geriatric-care-managers 

In-home medical equipment 

There are several low-cost or no-cost sources, if you are in need of temporary or more permanent in home medical equipment:  

• Jenks Center, Home Medical Equipment Loan Program 781-721-7136 
• Assistive Technology Regional Centers -  Run by the Easter Seals, this program allows you to borrow equipment, free of charge, from the inventory of the Assistive Technology Regional Centers (ATRCs). - 89 South St. Boston, MA - Phone: (617) 226-2640 Email: - ATRCBoston@eastersealsma.org - LINK 
• HELP PROGRAM: Free Masons, 500R Cummings Park, Woburn, Ma- Open Saturdays 9 -1: https://smd-help.org/SMD-HELP_Woburn_2017.pdf 
• Hospital Equipment Loan Program - Free medical equipment loan program operated by the masonic lodge, appointment preferred for hospital bed or commode. Open Saturdays 9 -12 only. - West Cummings Park (Right Side) - Suite 1150. (Washington Street) Woburn, MA - Phone: (781) 322-1052 - LINK 
• Medicare.gov Supplier Directory: www.medicare.gov/supplierdirectory 
• REquipment - A donation-based program that provides free refurbished durable medical equipment (DME) to adults and children with disabilities and elders in MA. - PO Box 311 Methuen, MA - Phone:(800) 261-9841  - Email:info@dmereuse.org - LINK 

Organizations 

• Winchester Health Department - Provides a variety of vaccines to all ages, including flu, pneumonia, and TB testing as well as information on many topics. - 109 Skillings Rd. Winchester MA - Phone: (781) 721-7121 - LINK 
• Massachusetts Department of Public Health - LINK 
• United States Department of Health and Human Services: The US Department of Health and Human Services (HHS) addresses the needs of aging seniors through the Administration on Aging (AOA), which implements the Older Americans Act (OAA) and provides services like information and referral, meals, and in-home care. - LINK