Cultivate Your Leadership Skills at ASA’s Leadership Institute

The concept of leadership has been in the forefront of many discussions since the presidential election. What is the importance of leadership, and what does it take to be a good leader?

You can learn about leadership and your potential as a leader in the field of aging by participating in ASA's Leadership Institute. This five-day leadership development intensive offers self-assessments of communication and leadership styles, presentations by recognized leaders in the field of aging, facilitated dialogue, networking opportunities, leadership literature and online learning. Program components are carefully designed to prepare the next generation of leaders in the field of aging.

"This was truly an enlightening experience for me. I learned so much about myself and the type of leader I want to be. I received tools that will help me along the way and met other leaders that I can share ideas with, and a few that will serve as mentors for me." -2016 Leadership Institute Participant

This unique leadership development opportunity is open to all professionals in the field of aging who have at least three to five years’ experience and a strong interest in building personal leadership skills and capabilities. Successful participants will earn a Leadership Institute Certificate of Completion and up to eight CSA CEUs.

The 2017 ASA Leadership Institute will primarily take place during the Aging in America Conference in Chicago, March 20-24, 2017. Join us to take the next—and possibly most important—step in your career.

Learn more and register today. Registration closes February 20, 2017 and space is limited.

To find out more on the 2016 Leadership Institute and Aging in America Conference from first person experience, visit the AgeBlog.

On The Brink Of Homelessness

What is an older adult to do when they have worked all their lives, retired, built equity in their home only to lose it all, and not be able to afford their home any longer? Some try to find more affordable housing options, some live with their children, or attempt to gain employment to either supplement their limited income, or move away from the brink of homelessness.

The National Alliance to End Homelessness suggests that 20 percent of homeless are over the age of 50. The emergence of older adults battling homelessness is not a new epidemic, but the face and experience of those now battling homelessness is new. Those on the brink of homelessness have experienced stable employment, stable incomes, they invested in their retirements, and purchased homes that could be sold for additional income. Some however have simply outlived their retirement savings, faced a medical emergency, or were caught in The Great Recession that began in 2007. The recession’s effects have many Baby Boomers still reeling from the economic downturn. In fact, the AARP study, Boomers and the Great Recession (2012) noted that during the recession many Baby Boomers faced a new reality of job loss, compensation reductions, declining home values, investment losses, and high debt which undermined retirement plans and expectations. As a result of feeling financially insecure many older adults depleted their savings, took out reverse mortgages and loans that they could not sustain in hopes that things would turn around.

In 2016, the picture remains bleak for many older adults and those on fixed incomes. Coupled with the economic downturn there continues to be a limited supply of affordable housing options, regulated income based housing, and rent-controlled housing alternatives. This lack contributes to a population of people living on the edge of homelessness that don’t fit into society’s stereotype of a homeless individual. At a time in life when older adults should be debating about whether to retire in Florida or South Carolina, many older adults are facing the unforeseen reality of not knowing if they will have a place to live. Coupled with the limited inventory of affordable housing is the substantial number of older adults who are under and unemployed. Ghilarducci (2015) estimates that last year there were about 1.3 million Americans over 55 who were actively looking for a job, but could not find one. With the wave of social media, older adults and millennials are often competing for the same jobs and this can be a daunting experience. While older adults may have the experience, younger adults sometimes have the social media and technology skills that employers are looking for.

Another population of older adults living on the brink is those who currently reside in rent subsidized or rent-controlled housing. Though limited in number and availability, these housing options are affordable, but typically have income caps (and other restrictions) that tenants must adhere to. “In the 1950’s in New York, there were more than 2 million rent controlled apartments (mostly filled with veterans and seniors on fixed incomes), however, in 2016 only about 27,000 exist” (Thorbourne, 2015). The story is the same in areas like Detroit (Denverite, 2016) and Los Angeles (Barragan, 2015). Unfortunately, this may be the last generation of tenants due to various statutes and the fact that some of these homes are in desirable areas of New York. There is a misconception that these individuals are paying next to nothing to reside in these homes, however many are paying more than half of their incomes in rent and have lived in these communities for their entire lives. They also face rent increases like the rest of the population; however some of the rate increases can be upwards of seven percent. Moreover, some tenants may be able to cover the cost of living in these homes, but their daily living expenses, health insurance premiums, medication, and utilities may be outside of their budgets. While working a part time job may be an option, they must always be mindful to not earn more than the income cap as it can result in them losing their home or having their rent increased.

In my personal life, I have witnessed my 70 year old mother who holds a Master’s degree and retired from the Federal Reserve Bank navigate living in a rent-controlled community while working a part-time job to meet all of her monthly expenses. I have also observed my father continue to work a full-time job at the age of 69 because he cannot afford to retire.

It is imperative that we as a society begin to address the needs of older adults both as it relates to affordable housing options and financial security. Depending on your age, social resources, skill level, and economic status, homelessness becomes more of a reality than something that is impossible. Creating job opportunities, training, affordable health care and reasonable health insurance premiums are necessary so that older adults can live out their retirement in peace without the stress of figuring out how to survive. If many working Americans are only one paycheck away from being homeless, where does that leave those who are older with limited employment opportunities and no savings?

- Dr. Ikeranda C. Smith More information on Dr. Ikeranda C. Smith's research can be found here.

---

Sources

Barragan, B. (2015) LA Landlords Pushing Out All the Rent-Controlled Apartments. Curbed, Los Angeles. Retrieved December 12, 2016 from http://la.curbed.com/2014/4/14/10114818/la-landlords-pushing-out-all-the-rentcontrolled-apartments

Denverite, S.D. (2016). 70 Year Old Denver Resident Writes Devastating Op-Ed About Being on the Brink of Homelessness. City Limits. Retrieved December 12, 2016 from http://citylimits.org/2015/03/09/nycs-endangered-species-a-rent-controlled-apartment/

Ghilarducci, T. (2015). Where Not to Be Old and Jobless. The Atlantic, Retrieved December 12, 2016 from http://www.theatlantic.com/business/archive/2015/09/worst-cities-america-old-jobless/405196/

Nagourney, A (2016). Old and on the Street: The Graying of America’s Homeless. The New York Times. Retrieved December 12, 2016 from http://www.nytimes.com/2016/05/31/us/americas-aging-homeless-old-and-on-the-street.html

National Alliance to End Homelessness. Retrieved December 12, 2016 from http://www.endhomelessness.org

Rix, S., Baer, D., Figueiredo, D., Mackenzie,S. & Shvedov, M. (2012). Boomers and the Great Recession: Struggling to Recover. AARP. Retrieved December 12, 2016 from http://www.aarp.org/content/dam/aarp/research/public_policy_institute/econ_sec/2012/boomers-and-the-great-recession-struggling-to-recover-v2-AARP-ppi-econ-sec.pdf

Thorbourne, K. (2015). NYC’s Endangered Species: A Rent-Controlled Apartment. City Limits. Retrieved December 12, 2016 from http://citylimits.org/2015/03/09/nycs-endangered-species-a-rent-controlled-apartment/

Protecting Your Lungs Against These Serious Threats

As we age, it becomes increasingly important to protect our lungs and be aware of potential life threatening symptoms. It’s common to become out of breath more frequently and even cough more regularly, but these could also be signs of serious diseases and illness like mesothelioma, lung cancer and COPD. Being educated on the risk factors and early symptoms can lead to an earlier diagnosis for these diseases, which also means a much better prognosis.

Mesothelioma

Mesothelioma is a rare cancer caused by exposure to asbestos. Asbestos is a natural fiber that can be found in the environment, but has also been widely used in construction and manufacturing of various products because of its fire resistant properties and durability. When disturbed, asbestos fibers can be inhaled and they then attach themselves to the lining of our organs. Because of their durability, our bodies are unable to break down the fibers and eliminate the danger. Instead, they remain an unrecognized threat until after a long latency period of anywhere from 10 to 50 years when symptoms first begin to show.

This long latency period, as well as unspecific symptoms, makes diagnosing mesothelioma extremely difficult. Though it has different types, the most commonly diagnosed is pleural mesothelioma, meaning in the lining of the lungs. Pleural mesothelioma first shows symptoms like shortness of breath and chest pain, which resemble common illnesses like the flu or pneumonia. Thus, it can take weeks or months before an official mesothelioma diagnosis can be made. Often by this point, the disease is already in a later stage that is much more difficult to treat.

Awareness is very important for those who might have been exposed to asbestos because earlier diagnosis is the best way to better the generally poor prognosis for mesothelioma patients. Those between the age of 50 and 70 are most commonly diagnosed, especially veterans or those who have worked in an industrial setting. Being educated allows those at risk to have an open dialogue with their doctor to hopefully detect mesothelioma early on.

Lung Cancer

Lung cancer is a leading cause of cancer deaths in both men and women. Non-small cell lung cancer is the most common common type, making up about 85% of diagnoses. Each year there are over 200,000 new cases of lung cancer, and over 150,000 die from this disease annually. Smoking is the leading cause of this cancer, though non-smokers are also at risk. Exposure to radon, secondhand smoke, air pollution, as well as workplace exposure to asbestos and other toxins, can all cause lung cancer. This type of cancer is most common in seniors; 2 out of 3 people diagnosed are over the age of 65, and on average diagnosis occurs at age 70.

As with mesothelioma, most don’t experience symptoms until the cancer has already progressed to a later stage. Common symptoms include a cough that won’t go away, shortness of breath, chest pain and frequent infections in the lungs. Again, these symptoms also align with pneumonia or allergies, so patients sometimes go undiagnosed for a long time. Understanding the risks and symptoms can lead to earlier diagnoses through screenings and better prevention.

COPD

Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease that makes it increasingly difficult to breathe. It’s an umbrella term for several lung diseases, like emphysema and chronic bronchitis. COPD is most often diagnosed among smokers, but environmental factors like pollution and exposure to other toxins, as well as genetics, can also cause COPD. It develops slowly over time, so many don’t even realize they have it. Like both lung cancer and mesothelioma, the symptoms include shortness of breath, wheezing, and tightness in the chest.

An estimated 30 million people have COPD in the United States, and it’s the third leading cause of death. COPD, like the previously mentioned diseases, has no cure. But being proactive and removing lung irritants--like quitting smoking if you are a smoker and avoiding dust and harmful fumes--as well as maintaining a healthy, active lifestyle can slow down COPD’s progression. It’s important to keep a lookout for signs of COPD early on and get screened if you are at risk.

Awareness is Key

Education is the first step to preventing all of these serious health risks. Keep track of any worrying symptoms you might have and maintain an open dialogue with your doctor. Even if the symptoms you’re experiencing might seem normal, like taking a while to catch your breath after a lot of exercise, it’s always good to keep your doctor up to date with what you’re experiencing. Our lungs are vital to being able to live a long, healthy life, so be proactive and help protect them.

- By Tonya Nelson Tonya Nelson is a health advocate working to raise more awareness for rare cancers in the hopes of seeing better treatment options for patients.

---

Sources

"Mesothelioma," Mesothelioma + Asbestos Awareness Center.

"Mesothelioma Diagnosis," Mesothelioma + Asbestos Awareness Center.

"Mesothelioma Prognosis," Mesothelioma + Asbestos Awareness Center.

"What is Lung Cancer?" National Institutes Of Health.

"Non-small cell lung cancer risk factors," American Cancer Society, Inc.

"Key statistics for lung cancer," American Cancer Society, Inc.

"What Are the Symptoms of Lung Cancer?," American Lung Association.

"What is COPD?," COPD Foundation.

"What Is COPD?," National Heart, Lung, and Blood Institute (NHLBI).

Contract Can Help Family Caregivers

Having a personal care agreement between parent and child can help you avoid conflicts down the road.

When Beth’s mother, Maria, started to show signs of confusion, Beth decided to have her widowed mother move in with her. Although Beth worked full time as a hospital kitchen supervisor and wasn’t home for most of the day, Maria seemed to do OK. But soon, Maria started to become increasingly disoriented—forgetting how to make herself lunch and how to get dressed.

Beth decided she had no choice but to stay home with her mother, and Maria agreed to pay her for her caregiving. The situation was working well until Beth’s estranged sister discovered the financial arrangement and accused Beth of stealing their mother’s money—and their inheritance—and threatened legal action. Beth’s situation is not uncommon. Nearly 18 million people care for an ailing relative who is 65 or older. A majority of family caregivers are women age 50 and above, most of whom do not receive financial or other support for their services.

In Beth’s situation, one document could have helped her avoid conflict with her sister as well as meet requirements for Medicaid that her mother might need in the future. A personal care agreement (PCA) establishes a contract for care between a caregiver—in this case, a family member—and care recipient—here an aging parent who needs assistance.

Reasons to get a PCA

First, by listing the specific caregiver duties and compensation, a PCA can help avoid family conflicts later. A healthy discussion beforehand with siblings (or other involved family members) can clarify issues and assure family members that the parent is being taken care of and that the caregiver has certain responsibilities to meet. Experts advise follow-up meetings to add or subtract from the list of services if the parent’s situation changes, such as becoming more disabled and needing additional care.

The agreement also assures the parent that they will receive help and that the whole family is (hopefully) on board with this arrangement. (To ensure this, the care receiver can use the “Five Wishes” living will to explain and put in writing their wishes for caregiving.) The family caregiver can feel secure knowing they will receive compensation for their services and will not have to take on a huge financial burden.

Second, if the person receiving care needs to eventually go on Medicaid, a PCA helps establish that the disbursed funds were compensation, not a gift. Under Medicaid’s rules, the person applying for assistance cannot give away (or hide) their assets in an attempt to meet Medicaid’s limit of $2,000 in assets (spouses have different criteria). The joint federal and state program, which helps with medical costs for people with limited income, uses a “look-back” period of five years to review such activity. A PCA shows that the caregiver is receiving legitimate wages for their services.

In extreme cases, authorities may also view caregiver payments as the adult child exploiting a parent or someone in need. A PCA shows that the parent willingly entered the agreement.

What to Include in a PCA

Services. Although the agreement should clearly state the caregiver's tasks, some wiggle room might be necessary to include duties that arise after the PCA is written. To cover all the bases, you could include a phrase such as, "or similar to the services listed.” Outlining the responsibilities also makes other family members aware of the scope of what is necessary to maintain the parent’s daily life. Services could include:

• Cooking meals


• Grocery shopping


• Housekeeping and laundry


• Assistance with bathing, toileting and dressing


• Medication reminders


• Help with eating


• Assistance with walking and exercise


• Transportation to appointments, errands and other commitments


• Managing finances (such as paying bills)


• Overseeing healthcare (such as communicating with medical practitioners)

Compensation. To determine how much to pay the family caregiver, find out the going rate for home services in your area. If you are talking to home care agencies, remember that they charge more than a private caregiver because they take a percentage of the fee to pay for unemployment, workers’ compensation, payroll taxes and other legal responsibilities.

Although the median cost nationwide for home health aide services is upward of $125 a day, assuming 44 hours of care per week (according to the Genworth 2016 Cost of Care Study), make sure to use the median cost in your area. To avoid any later scrutiny, do not charge more than what an independent caregiver would receive.

It’s also helpful to detail how often the caregiver will be paid (weekly or monthly, for example).

Do You Need a Lawyer? It’s not necessary for a lawyer to write the personal care agreement (PCA), although it may help in certain circumstances, such as when the caregiver also has power of attorney and must sign the contract for their parent. Also be aware that this contractual relationship is between an employer (the care recipient) and the employee (caregiver), even when parent and child. This means the caregiver is subject to withholding taxes. If you decide to write the PCA yourself, you can find forms (Elder Care Agreement, Form 85) in the book 101 Law Forms for Personal Use.

Hours. How many hours a week will the caregiver provide care? It’s important to make sure everyone is on the same page and has the same expectations. Write the amount as something like “20-30 hours a week” or “less than 50.” This gives everyone a starting point, but you can change it later.

Duration. Be as specific as possible. For example, choosing an end date, such as six months from the start, gives the parent, child and other interested parties the opportunity to review the agreement and make any necessary changes. As an alternative, the contract could be open-ended, with the stipulation that either party can terminate the agreement, with advanced notice of written consent, or by mutual agreement. Another option is to trigger the contract’s end by listing qualifying events, such as a hospitalization or entrance into a nursing care facility.

Help for caregiver. To avoid burnout, the caregiver will need time off for respite or sickness. Can another family member or family friend step in to provide temporary care? Or will it be necessary to hire an outside caregiver—either private or from an agency? Spell out these details in the PCA.

Be aware that care agencies generally need 24 to 48 hours to start a service agreement and provide a qualified caregiver. Another option is assisted living communities, many of which have “respite” stay options that can relieve the caregiver. Usually these communities require a minimum of 2 to 4 weeks for taking care of your loved one.

Sign the agreement. Both the parent(s) and child need to sign the contract before any service begins. For extra legal protection, it’s a good idea to have the signatures notarized.

Optional Points

While the services, hours and compensation are necessary, you can also add other sections to the agreement. Even if you don’t include this information in the contract, it’s wise to consider these scenarios.

Back-up plan: If the home caregiver situation doesn’t work or events change, consider what the next step might be. In some cases, you may choose a different caregiver or decide to move the parent into assisted living or other skilled facilities. It’s helpful to research the different options and their costs before the situation becomes a crisis. Placement/referral agencies can help families examine the options, whether that be in-homecare agencies, assisted living communities, memory care units or adult family homes.

A daily log. Keep a journal of the care recipient’s activities and what was required of the caregiver. This daily log not only helps the caregiver provide a clear picture of what is most needed but can protect the caregiver if an outside party—Medicaid or another family member—wants proof that care was provided. The PCA could include a requirement for such documentation.

---

Sources

“Into the Matrix of Law and Caregiving,” June 2016, American Bar Association.

“Personal Care Agreements Can Compensate Family Caregivers,” AgingCare.com.

“How to Prepare an Agreement to Care for a Family Member,” Sept. 08, 2016, AgingCare.com.

“Creating Effective Agreements for Payment of Family Caregivers,” February 2016, American Bar Association.

“How to Compensate a Family Member for Providing Care,” Family Caregiver Alliance.

Blog posting provided by Society of Certified Senior Advisors
www.csa.us

What’s All the Fuss about Snapchat?

The popular social media site for teens and preteens lets you have fun with your selfies or other portraits.

When your children stopped replying to your emails, you realized you had to learn how to text. Now your grandkids are passing around their phones during family dinners, laughing and giggling. When you ask them what’s so funny, they show you photos of themselves with a red nose and whiskers. They tell you they’re using something called Snapchat. So now do you have to learn another piece of technology so you can communicate with your grandkids and be as cool as possible at your age?

Snapchat is a social media site that teens and preteens love. One of the reasons for its popularity is that the snapshot, called a “Snap” in Snapchat parlance, disappears 10 seconds after the intended viewer receives it. That means that any possibly risqué photos sent, from girl to boy, for example, won’t be around for nosy parents to see and find reasons to ground their daughter.

Think of Snapchat as a playful selfie that you can alter by using Snapchat’s drawing and filter functions or its “lenses” to add masks and other fun effects. You can take photos of friends or pets, too, but the emphasis is on the face and all the creative things you can do with it. You can also take and post a video to send to a specific friend. Or you can use the “Stories” section to post photos and videos that you want to share with all your friends. Postings on this more permanent site will last 24 hours.

Here are some of the effects you can use:

Filters. Over your photo, layer a colored filter or one that relates to the current holiday or the weather. You can also add a Geofilter, which reflects your current location’s information, such as the air temperature.

Snap lenses. One of the more popular features of Snapchat is the set of animated lenses you can choose to alter your face (or someone else’s). While taking a photo, you can choose from different lenses. For example, your face can appear wearing a cat’s whiskers and ears, a garland of flowers might appear on your head, or leaves will start falling all around you. You might be instructed to open your mouth so your face better matches the lens you’ve chosen.

Draw. With the pencil icon, you can choose a colored marker to draw with—maybe tint your hair a different color or add a moustache. Why not throw some stars in the sky or add some flying birds?

Stickers. Choose from nearly 300 cartoon stickers to indicate your mood—everything from a heart to a peace sign to a gloomy face. Or you can create your own “bitmoji” sticker.

Text. Although Snapchat is geared to photos, you can use short phrases like “see you later” or “having fun.”

If you think you want to try Snapchat, go to the Snapchat website and install the app on your device, such as a smartphone. Next, provide your birthday by scrolling through the date, month and year until you find yours. Next, pick a name—not your real one (that’s so uncool), but one that is fun. Be aware that Snapchat doesn’t allow you to change your name once you’ve chosen one. Last, provide a password and your email address. Now you’re ready to join your grandkids in selfie fun.

---

Sources

“How to Use Snapchat: A Guide for Beginners,” July 25, 2016, Hootsuite.

“Snapchat 101: what it is and how to use it,” Verizon Wireless.

“How to Use Snapchat,” April 6, 2016, Wired.

“Getting Started,” Snapchat.

Blog posting provided by Society of Certified Senior Advisors
www.csa.us

The Best Home Improvements for the Money

If you’re considering moving and want to fix up your home, experts recommend renovations that make the most financial sense.

Maybe you’ve been watching too many home-improvement TV shows, but suddenly your kitchen is looking a bit dated—like the 1970s. At the same time, you and your spouse have been talking about finding a smaller place as you get older. You’re not ready to move now, but somewhere down the road, when it gets too difficult to climb the stairs and shovel snow. If you don’t plan on living in your home for the rest of your life, what’s the best home-improvement investment you can make?

To predict your return on investment (ROI) potential, look at your home’s value and the value of other homes in the neighborhood or city where you live. If housing prices have been low in your neighborhood, it may not pay to make upgrades. Your ROI can vary widely, depending on where you live. Remodeling offers regional comparisons.

Experts focus their recommendations on two issues: curb appeal, such as a new garage door; and maintenance/structural issues, like a new roof. Also factor in which improvements will bring you the most pleasure during your remaining time in the home.

Roof

Although decidedly unglamorous, replacing your home’s roof—at an estimated cost of $7,600—is one of the best improvements you can make. One survey found a 105 percent gain in investment, meaning that your home’s value would increase so much that you would recoup more than 100 percent of the amount you paid for a new roof. Another survey put the value at 72 percent. While a new roof might not attract buyers, an old roof can discourage them after they get the inspection report.

Insulation

Upgrading your home’s insulation—at an average cost of $2,100— provides a generous cost-value ratio. One survey cited a 117 percent return at resale, while another estimated 95 percent.

Good insulation increases energy efficiency, which keeps the house warmer and reduces heating costs. Often, homeowners add fiberglass insulation to the attic and caulk around doors and windows.

Garage Door

Replacing your home’s garage door, especially if it’s the old metal variety, adds to your home’s curb appeal. One survey estimated the cost of a new garage door at $2,300, with 87 percent recovered at resale. Popular designs include carriage-style, natural-wood and windowed garage doors.

Similarly, front-door replacement can increase curb appeal and energy efficiency. One survey found a 91 percent return at an estimated cost of $2,000.

Siding

Dirty and worn siding sends a message that a house isn’t being taken care of, and prospective homebuyers often assume that the outside mirrors what’s inside. Estimates for a return on new siding vary from 75 to 83 percent at an average cost of $12,000.

Replace your home’s tattered exterior with vinyl or fiber-cement siding. Vinyl is less expensive and easier to install and maintain, but fiber-cement siding will last longer and its components are more environmentally friendly.

More Home Improvements Although some home renovation projects may not have the great cost recoveries that others do, they can still add value to your house. Experts recommend: Add more space. These days, people want bigger houses. In especially hot markets, adding another room can be a good investment. Add deck, patio or front porch. These exterior additions are an inexpensive way to increase your house’s size and create additional usable space. Finish attic and basement. This is an easy way to add space to your house. Remove popcorn ceiling. No one wants this dated look. Fix plumbing. If you have old plumbing that is causing problems, fix it before other superficial updates. Beautify your front yard. This can be a cost-effective way to boost your home’s curb appeal, and you’ll probably enjoy having a home with new paving stones or plants.

Hardwood Floors

Younger people, especially, want wood floors in a home. One survey found that you can recover 91 percent of your installation costs, which average $5,500. To refinish hardwood floors, which costs $2,500 on average, you can recover 100 percent of your expense.

Choose between solid wood and engineered wood. Solid hardwood is one piece of wood, and engineered wood comes in layers. Each has advantages and disadvantages, including cost and strength.

Kitchen and Bath

Kitchens and bathrooms are typically the most expensive rooms to remodel, but they can instantly boost a home’s appearance or bring it down. One survey found a 66 percent return on fixing up the bathroom and an 83 percent return on redoing the kitchen (averaging both minor and major fixes). However, one expert warns that if your house only has one bathroom, it’s better to add a second instead of renovating the one.

The national median price for upgrading a kitchen is $30,000, with an ROI of 67 percent for a major remodeling. Although not as impressive a return as improvements such as new siding or roof replacement, a renovated kitchen or bathroom can bring a lot of pleasure while you are still living in the home.

For the kitchen, experts recommend wood cabinets, stainless steel appliances, natural wood or stone floors, and stone countertops. If you can afford it, create a more open layout, especially if your kitchen is cramped. If your budget is tight, consider refacing instead of replacing cabinets.

At the high end, bathroom fixes can include replacing tubs with walk-in showers or steam showers. However, simply regrouting the shower, adding new fixtures and repainting can make the bathroom look almost new.

For other ideas, see the sidebar.

---

Sources

“Home Improvement Projects That Pay Off,” April/May 2016, AARP.

“Which Home Improvements Pay Off?,” HGTV.

“10 Investments to Boost Your Home's Value,” DIY Network.

“The 6 home renovations that return the most at resale,” June 28, 2016, Bank Rate.

“Home Remodeling: 6 Improvements to Increase Home Value,” House Logic.

“Key Trends in the 2016 Cost vs. Value Report,” Remodeling.

“New Roof Is Greatest Remodeling Value,” Dec. 09, 2015, Daily Real Estate News.

Blog posting provided by Society of Certified Senior Advisors
www.csa.us

Famous & 65

Look Who’s Turning 65

Dec. 1—Treat Williams

The actor first came to world attention in 1979, when he starred in the Miloš Forman film Hair, for which he was nominated for a Golden Globe Award. Over his long career, Williams has appeared in over 75 films and several television series, including, most notably, 1941 (1979), Once Upon A Time in America (1984), Dead Heat (1988), Things to Do in Denver When You're Dead (1995) and Deep Rising (1998)

Williams got a second Golden Globe nomination for starring in Sidney Lumet's Prince of the City (1981) and a third for his performance as Stanley Kowalski in the television presentation of A Streetcar Named Desire. In 1996, Williams was nominated for a Best Actor Emmy Award for his work in The Late Shift, an HBO movie in which he portrayed agent Michael Ovitz. In 1996, he played villain Xander Drax in Paramount's big budget comic book adaptation The Phantom. Williams may be best known for his leading role as Dr. Andrew Brown in the WB television series Everwood, about a New York City neurosurgeon who moves his family to Colorado. Although the show's ratings were never spectacular, it won critical acclaim and had a devoted following.

Williams' career includes numerous stage roles. He won a Drama League Award for his work in the Broadway revival of Stephen Sondheim's Follies and another for starring in the off-Broadway production of Captains Courageous. Other notable Broadway shows include Grease, the Sherman Brothers' Over Here!, Once in a Lifetime, Pirates of Penzance and Love Letters. Williams has also worked as a director, winning two festival awards for directing Texan in Showtime's Chanticleer Films series. He is also a commercial pilot and flight instructor. In 2010, he published a children’s book titled Air Show!

---

Dec. 3—Rick Mears

The retired race car driver is one of three men to be 4-time winners of the Indianapolis 500 (1979, 1984, 1988, 1991) and the current record-holder for pole positions in the race with six (1979, 1982, 1986, 1988, 1989, 1991). Mears is also a 3-time Indycar series/World Series champion (1979, 1981 and 1982).

Mears began his racing career in in Bakersfield, Calif., with off-road racing, but switched to Indy Car racing in the late 1970s. In his initial appearance at Indy, Mears was the first rookie to qualify over 200 mph and won his first "500” in 1979. The 1981 and 1982 seasons saw two more championships for Mears. Despite facial burns during a pit fire in the 1981 Indianapolis 500, Mears' 10 race victories in the 2-year span were enough for another two Indycar championship titles. At the 1982 Indianapolis 500, he came within 0.16 of a second of adding a second Indy win. Mears scored his second Indy win in 1984 but suffered severe leg injuries later in the year in a crash. After that, injuries to Mears’ right foot slowed him down and affected him throughout the remainder of his career. Over the next three seasons, he won only two races. He completed a comeback from his injuries by winning the 1985 Pocono 500. In 1988, his team used a new car, the PC-17, to win the Indy 500. The last race of 1989 set Mears apart from all other Indycar racers as he broke a tie with Bobby Rahal for race wins and became the most successful Indycar racer of the 1980s. In August 1991, at Michigan, he won his last race. In 1992, at the age of 41, he announced his retirement from racing Indycars. Mears continues to work as a consultant and spotter for Helio Castroneves and Penske Racing, the team with which he won all of his Indycar races.

---

Dec. 4—Patricia Wettig

Although the actress has appeared in numerous films (including City Slickers, Guilty by Suspicion and The Langoliers), Wettig is best known for her work on television. She received critical acclaim (and a number of awards) for her role as Nancy Weston on ABC's thirtysomething (1987-1991). Her portrayal of Nancy's cancer struggle attracted considerable acclaim and attention. She also portrayed Joanne McFadden on the television program St. Elsewhere (1982-1988). In addition, Wettig appeared in a numerous popular television programs during the 1980s and 1990s, including L.A. Law, Frasier, Hill Street Blues and Remington Steele.

Wettig starred in the ABC comedy-drama series Brothers & Sisters, which aired from 2006 to 2011, where she portrayed the Walker family patriarch's mistress, Holly Harper. She also had the recurring role of CIA psychotherapist Dr. Judy Barnett on Alias. Before joining Brothers & Sisters, Wettig played the fictional Vice President Caroline Reynolds on the 2005 Fox television drama Prison Break. In 2012, Wettig joined the national tour for Larry Kramer's production of The Normal Heart. She is married to actor and producer Ken Olin; they have two children.

---

Dec. 5—Morgan Brittany

The actress is best known for her role as Katherine Wentworth, the scheming younger half-sister of Pamela Ewing and Cliff Barnes, in the prime time soap opera Dallas (1978-1991). Brittany began her career as a child actress in a 1957 episode of the CBS television network anthology series Playhouse 90 and was featured in the 1962 film Gypsy, as Baby June. At age 18, Brittany appeared with Gene Kelly in his Las Vegas show Gene Kelly's Wonderful World of Girls, as a dancer. After working as a model for several years, in 1976, Brittany portrayed Vivien Leigh in the biopic Gable and Lombard, the first of three occasions on which she would play the famous actress.

That was followed by TV movies and television shows, including The Amazing Howard Hughes (1977), The Initiation of Sarah (1978) and LBJ: The Early Years (1987). When she appeared again as Vivien Leigh in the 1980 made-for-TV movie The Scarlett O'Hara War, she caught the attention of the producers of Dallas, who were searching for an actress to play Wentworth. Brittany debuted on Dallas in the 1981-82 season, and her role as Katherine continued, on and off, until 1984.

She hosted over 100 episodes of the magazine show Photoplay, and has guest starred on other shows, including Married ... with Children; Murder, She Wrote; and The Nanny. In film, Brittany starred in the 1989 cult classic Sundown: The Vampire in Retreat. In the 1990s, Brittany appeared in independent films, including Riders in the Storm (1995), Legend of the Spirit Dog (1997) and Americanizing Shelley (2007).

Currently, Brittany is a conservative political commentator and author. Her first book, which was co-authored, What Women Really Want, was released in 2014. She is a recurring guest on Hannity (Fox News) and The Rick Amato Show (One America). Brittany is a co-owner and anchor for PolitiChicks, an online news site with a conservative perspective. She now spends much of her time supporting Republican political candidates and is involved in raising funds for military/veterans organizations.

---

Source: Wikipedia

FAMOUS & 65 is a featured article in the Senior Spirit newsletter.

Blog posting provided by Society of Certified Senior Advisors
www.csa.us

Test Your Knowledge of Medicare

As a new administration discusses a different approach to the federal health insurance program, check out some facts.

As a new administration and Congress talk about possible new approaches to Medicare, Medicaid and Social Security, how much do you know about Medicare? A quiz from the Kaiser Family Foundation tests your knowledge about the government’s health insurance program for seniors and others. For example, did you know that in 2014 half of all Medicare beneficiaries had annual incomes below $24,150 per person, including Social Security payments, pension income and earnings? Check out the quiz.

---

Blog posting provided by Society of Certified Senior Advisors
www.csa.us

Stronger Flu Vaccine Available Just for Seniors

Those over 65 are hardest hit by influenza,
so getting a flu shot is crucial.

It’s that time of year again—not the holidays but the flu season. You hear people coughing and sniffling all around you. Perhaps you have been hit with it yourself—staying in bed for days, your whole body aching.

How do you prevent the flu? The best way is to get a flu shot, which not only protects you but also helps prevent those around you from falling prey to this highly contagious disease. Flu protection is especially important for seniors. During recent flu seasons, between 80 and 90 percent of flu-related deaths occurred in people 65 years and older, according to the Centers for Disease Control (CDC). As we age, our immune systems become weaker and are not as able to fight the infection.

Influenza, which causes fever, coughing and muscle aches, can induce serious illness, including pneumonia and bronchitis. In older adults, respiratory disorders can lead to hospitalizations and sometimes death. A risk factor for the seasonal flu is dehydration, which is a serious condition for seniors.

Getting a Flu Shot

Studies have shown that those who are immunized are less likely to become seriously ill from this respiratory illness. One study showed that people 50 years and older who got a flu vaccine reduced their risk of getting hospitalized from influenza by 57 percent. Getting vaccinated can help prevent the flu or at least help lessen the severity and length of your illness.

Cost of Flu Shots Seniors covered by Medicare Part B do not have to pay coinsurance or deductible fees for their flu shot, as long as they receive the shot from a Medicare provider. For others, most insurers are required to provide flu shots at no cost, according to requirements in the Affordable Care Act. Many insurers would rather pay for the flu shot than for the cost of you being sick. If you don't have a regular healthcare provider, you can get a flu vaccine at other, sometimes more convenient, places such as a health department, pharmacy or urgent care clinic. Often, schools, college health centers or employers offer free shots to help keep their students or employees healthy. If you have no insurance, you can get a flu shot at a chain store, such as Costco, which usually has cheaper prices than a doctor’s office. The government’s Vaccine Finder can help you find the store closest to you.

Different influenza strains circulate every year, so scientists determine which viruses will be most common that year. You need to get a flu shot every year because vaccine strains are updated annually and immunity lessens over time. Getting the shot early in the flu season is best, but you can get it anytime. Influenza season runs from October through March, but peaks in January. Time is important, because it takes the body about two weeks after vaccination to develop immunity protection.

Flu vaccines promote antibodies, which provide protection against infection. Traditional flu vaccines are made to protect against three viruses: influenza A (H1N1), influenza A (H3N2) and influenza B. Fortunately, those 65 and over are able to get an especially strong vaccine. Fluzone High-Dose vaccine contains four times the amount of antigen (the part of the vaccine that prompts the body to make antibodies) contained in regular flu shots, which should boost the body’s immune response. A study published in the New England Journal of Medicine indicated that the high-dose vaccine was 24.2 percent more effective in preventing flu in adults 65 years of age and older than a standard-dose vaccine.

Symptoms of the Flu

You may have the flu if you have some or all of these symptoms:

• fever


• cough


• sore throat


• runny or stuffy nose


• body aches


• headache


• chills


• fatigue


• sometimes diarrhea and vomiting

How to Prevent the Flu

While vaccination is the most important flu prevention, it's only 70 to 90 percent effective, so some who receive the vaccination will still get sick. One of the scary aspects of the flu is that you can get it just by touching a contaminated object such as a door handle or shopping cart, that someone with the flu touched. Besides the flu shot, other actions can keep you and those around you safe:

• Avoid close contact with people who are sick. When you are ill, keep your distance from others to protect them from getting sick too.


• Stay home when you are sick to help prevent spreading your illness to others.


• Cover your mouth and nose with a tissue when coughing or sneezing.


• Clean your hands to help protect against germs. If soap and water are not available, use an alcohol-based hand rub.


• Avoid touching your eyes, nose or mouth. Germs are often spread when a person touches something that is contaminated with germs and then touches their eyes, nose or mouth.

If you get the flu, make sure to get plenty of sleep and drink a lot of fluids. The CDC recommends that you stay home for at least 24 hours after your fever is gone. In severe cases, your physician may prescribe Tamiflu or Relenza, which are anti-viral medications that can limit the severity of the influenza infection and shorten symptoms’ duration. However, for these medications to be effective, you must take them within 48 hours of the onset of flu symptoms.

---

Sources

“What you should know and do this flu season if you are 65 years or older,” Council on Aging.

“Flu + You” National Council on Aging.

“Senior Flu Prevention and Taking Care of the Elderly,” May 6, 2015, A Place for Mom.

“The Flu: What to Do If You Get Sick” CDC.

“Key Facts About Seasonal Flu Vaccine,” CDC.

“Preventing the Flu: Good Health Habits Can Help Stop Germs,” CDC.

“What’s New for the Flu in 2016,” Oct. 19, 2016, Next Avenue.

Blog posting provided by Society of Certified Senior Advisors
www.csa.us

Choosing a Long-Term Care Residence

Ask These Questions When Choosing a Long-Term Care Residence

Making the decision to move from independent or assisted living into a long-term care residence is usually never easy. But asking the questions below can help you sort through the available choices and select the best long-term care residence for your situation.

You can find long-term care residences in your zip code area on Medicare’s website, rated for quality. A five-star quality rating system gives an overall picture of individual residences and points out meaningful differences among them: www.medicare.gov/nursinghomecompare/search.html.

If possible, visit residences and meet their staffs. In your conversations, be sure to cover these questions:

 

Facility Certification

• Is the residence Medicare-approved (certified)?

 

Staff Credentials

• Is the nursing home administrator licensed by the state?


• Does the staff possess the necessary credentials to qualify for their professions?


• Is licensed staff on duty, including an RN for all shifts?


• Which level of staff is available to deal with social service needs?


• Is a licensed physician on duty during the day and on call at night?

 

Availability

• Are beds currently available? If not, how long is the waiting list?


• Is there a memory unit for those with dementia, as well as a unit for those who depend on a ventilator?

 

Location

• Is the residence close enough for family and friends to visit?


• What are the visiting hours?

 

Quality of Care

• Is a quality of care report available?


• How are any deficiencies being addressed?


• Are the residents clean, well-groomed, and appropriately dressed?


• Is the facility clean and free of overwhelming or unpleasant odors?

 

Atmosphere

• Are there enough appropriate activities?


• Is the temperature comfortable?


• Are furnishings comfortable, homelike, and safe for residents and visitors?


• Are nutritious snacks available throughout the day?


• Is water readily available at all times?

 

Staffing

• Does the residence conduct background checks (including criminal checks) on all staff at the time of hire?


• Does the residence provide ongoing education and training for staff on topics such as recognizing elder abuse, fall prevention, and other age-appropriate topics?


• How does the relationship between staff and residents appear: warm, polite, and respectful?


• What is the staffing ratio of CNAs to residents?

 

Provided Services

• Does the residence provide rehabilitative services, including physical, occupational, and speech therapies?


• Does the residence provide activities that promote healing and quality of life, including music and art therapies?


• Do the residents have a choice in when and what to eat or in their daily routine?


• Does the residence have an arrangement with a nearby hospital in case of emergency?

 

---

Sources

Society of Certified Senior Advisors, Working with Older Adults: A Professional’s Guide to Contemporary Issues of Aging (2015).

The Working with Older Adults course offered by the Society of Certified Senior Advisors gives professionals a practical, comprehensive understanding of health, social and financial issues that are important to many older adults, including ethical issues specific to aging. For more information, or to enroll in a class, click here.

Tax Deductions for Home Health Care

Many older adults want to stay in their own homes but cannot do so because of health or other reasons. A home health care agency might be able to help them find an aide to come to their homes for a certain period each day or on some other set schedule.

Who pays the home health care aide determines the tax issues for the older adult. Therefore, when an aide is hired, the method of payment needs to be discussed before the hiring occurs.

Home Health Care Aides as Agency Employees

How the aide is paid might depend on the practice in the older adult’s region of the country. Some home health care agencies pay aides as employees; contracts are then between the agency and clients, who pay the agency directly. The caregiver (the aide) is not part of the payment arrangement. The agency submits a bill to the client and prepares a paycheck for the aide.

This arrangement is the easiest way for an older adult to pay for help, and the agency’s invoices provide proof of the medical expense for tax purposes. The older person does not need to keep paperwork other than the service contract with the home health care agency and payment receipts.

Home Health Care Aides Hired Directly by the Older Adult

In some cases, the home health care agency provides the older adult with a list of possible aides; the older adult then hires an aide and pays the agency a finder’s fee.

In this situation, the relationship between the agency and the older adult usually ends there. The older adult is an independent employer and must pay the aide directly; and pay the employer’s portion of FICA, Social Security, and Medicare taxes; and withhold the employee’s portion of these taxes from the aide’s payments.

In certain cases, depending on the amount paid to the aide, the older adult must also issue a W-2. The older adult must also follow specific rules to deduct the payments to the aide as a medical expense.

The invoices submitted by the health aide must state the charges for various services; not all services are deductible medical expenses. For example, housecleaning, driving to the grocery store or completing errands, or making phone calls for the older person are not deductible medical expenses.

In all cases, remember that home health care expenses that have been reimbursed (for example, by Medicare, Medicaid or long-term care insurance) are not eligible for income tax deductions.

Consult with a qualified tax expert to identify reimbursable health care and medical expenses that you are allowed based on your adjusted gross income (AGI). Certain medical expenses that exceed 7.5 percent of AGI are tax deductible for those 65 or older who itemize through December 31, 2016; then the threshold becomes 10 percent.

 

---

Sources

Gordon, Paul. "Special Issue Brief. Medical Expense Tax Deductions: A Guide for Senior Living Providers and Residents," The American Seniors Housing Association (Summer 2012).

Internal Revenue Service. www.irs.gov.

Society of Certified Senior Advisors, Working with Older Adults: A Professional’s Guide to Contemporary Issues of Aging (2015).

"Tax Aide Program," AARP.

"Proposed New Requirements for Tax Return Preparers," Tax Information for Tax Professionals (2010).

TaxBook 1040 Edition (2012). 2012 Tax Year. Minnetonka, MN: Tax Materials Inc.

The Working with Older Adults course offered by the Society of Certified Senior Advisors gives professionals a practical, comprehensive understanding of health, social and financial issues that are important to many older adults, including ethical issues specific to aging. For more information, or to enroll in a class, click here.

New Online Courses from ASA and USC on Elder Mistreatment

The Society of Certified Senior Advisors believes that Certified Senior Advisors, when working with older adults, their families, and caregivers, are uniquely positioned to be the “eyes and ears on the ground” looking for signs of abuse and neglect targeted at older adults. Here is a new course offered to deepen understanding about this very important topic.

New Online Courses

The American Society on Aging has added two more courses to the online series offered in conjunction with USC Leonard Davis School of Gerontology. In addition to the popular Fundamentals in Gerontology and Managing Health and Chronic Conditions in Older Adults courses, you can now take courses in Understanding and Preventing Abuse and Neglect. All courses will be available in early 2017.

Successful participants will earn a certificate of completion from USC and 10 CSA CEUs (per course completion).

Click here for course descriptions and registration information.

For a limited time, ASA is offering a discount on membership to those who sign up for online courses. Enter discount code CSA6 when enrolling and membership will be only $195, a $60 discount off regular rates.

"Retirement" is a Misnomer

Not only are there more adults over age 50 than at any time in history; this new consumer majority is the wealthiest, best educated and has access to quality healthcare. Yet the media, political and social leaders seem determined to focus only on the potential problems of an aging population rather than the incredible potential. Employers likewise ignore the incredible amount of wisdom available by screening out older applicants.

Perhaps it is time to retire the term ‘retirement’ along with other stereotypical terms used to describe older adults and the programs designed to ‘serve’ them. As a concept, retirement hasn’t been around that long. It arrived with the Industrial Revolution as businesses needed a justification for pushing older people aside to make room for younger, “more productive” workers. While much of the work then was hard manual labor, age was a factor in productivity; however, that is hardly the case in today’s automated information age. In fact, age and wisdom should be positive “productivity indicators” in this new millennium.

In the last three decades, we have increasingly viewed the aged as a group to be catered to and cared for. In the 1960s, we began developing programs to feed, house, transport, and entertain them; but few focused on the importance of meaning and significance in later life. In spite of a new army of “aging service providers” and billions of Federal dollars, the older population became more sedentary, health care costs began to rise along with demands for higher levels of government care and support.

Somewhere in the creation of an aging network of service, we failed to recognize that when people loose significance and purpose the immune system erodes and self-fulfilling prophecies of aging can begin taking their toll. Retirement, therefore, is not just an outdated concept; one might argue that it is a contributing factor to the health problems that plague the world’s aging populations. As Hippocrates theorized thousands of years ago – any part of the body that is not used tends to atrophy, even the mind.

According to my good friend Dr. Roger Landry, a respected preventive medicine physician, “… successful aging is not about being safe, preparing for death or avoiding all risk. Successful aging is about living as vital a life as possible, i.e. at the highest level of functioning.” It is time to stop treating aging as some type of disease and start celebrating the positive aspects.

For three decades, government has been creating and funding programs and services to care for the elderly, which The Older Americans Act defined as everyone over the age of 60. Thousands of agencies, programs, services were created and funded to meet both real and perceived needs. Billions of dollars later, many of these well-meaning efforts may have done as much harm as good. We have all too often replaced purpose with pills; productive lives with early retirement packages; personal significance with shallow volunteer opportunities; and meaningful involvement with mindless activities. One might make a case, that “retirement” itself is a root cause of rising healthcare costs, the growing incidence of Alzheimer’s disease, diabetes and depression.

Still there is hope. Organizations such as Civic Ventures launched programs to involve older adults in meaningful roles. The Eden Alternative and founder Bill Thomas’ innovative Greenhouse Project has had some success redefining long term health care through the eyes of consumer and treating the body, mind and the human spirit in the process. But there is still much to do as ageism remains the last bastion of discrimination.

As Roger Landry so eloquently put stated, “Successful agers are not fatalistic about the slings and arrows of aging, but actively intervene to change the course of what was previously considered inevitable. They identify risks and work with available medical knowledge and technology to change the future.” That’s not a bad prescription for how to go about changing the way we design, develop, market and operate “retirement” communities.

Simply stated, the term “retirement” has become a misnomer for what should be a rewarding and life stage. A good start would be to never use “retirement” to define a planned community for older adults if you intend to celebrate individual autonomy and wisdom and committed to making a difference in the lives of those they serve.

- By G. Richard ‘Dick’ Ambrosius

Richard Ambrosius is the President of Positive Aging LLC, a national marketing consulting and training. He has been educating companies, nonprofit organizations and public agencies on how to better communicate with and serve middle age and older adults for 35 years and was among the first in the U.S. to realize the potential of the new consumer majority and specialize in older markets. He has delivered keynote addresses and motivational workshops in 49 states and is the author of the Choices & Changes…a positive aging guide to life planning (Xlibris Publishing, 2006). Ambrosius can be reached by email at ambro@positiveaging.com.

What is Polypharmacy and Why Should We Care?

When I was still a Pharmacy technician, I remember a customer named Mrs. Johnson who had been coming to our pharmacy for as long as I could remember. She was a sweet 75 year old woman and she usually picked up her medications for diabetes, glaucoma, and high blood pressure along with Benadryl for allergies. One day she came in to pick up 2 new prescriptions that she had dropped off the day before, one for Amitriptyline (uses include depression, nerve pain and sleep aid) and one for Clonazepam (uses include anxiety, sleeping). I asked Mrs. Johnson if she recognizes them and she thought for a second, and said she started seeing a new psychiatrist who added them because of her having trouble sleeping. I was in the process of continuing the conversation when the phone started ringing, a customer rang the bell at the drive thru and there were already three other customers behind her so, I handed the prescriptions to her, quickly rang her up and sent her on her way.

As people are living longer, the prevalence of chronic diseases is increasing as is the responsibility of practitioners to appropriately prescribe for and manage multiple disease states within the same patient. The word “poly” is derived from the Greek word meaning “more than one,” and “pharmacy” refers to the Greek word for drug “pharmacon.” Therefore the literal meaning of the word polypharmacy is simply “more than one drug.” However, today polypharmacy is defined anywhere between taking 5 to 10 or more drugs at a time! There is no consensus cut off amount of medications or strict definition for polypharmacy, though generally the term inappropriate polypharmacy can be defined as the use of more medications than are clinically appropriate or medically necessary.

When patients are taking too many medications, especially ones that are not medically necessary, the ramifications can be severe. The burden of taking too many medications has been directly and indirectly associated with significantly increased adverse drug events (ADEs), drug-drug interactions, drug-disease interactions, inappropriate dosing regimens, decreased medication adherence rates, reduced functional capacity, and multiple geriatric syndromes. All of which lead to increased hospitalizations, primary care visits, emergency room visits, and ultimately increased healthcare costs as well as increased medication-related morbidity and mortality.

Polypharmacy can be especially problematic in the elderly population who make up less than 15% of the population yet consume over a third of all prescription medications prescribed each year. The high rate of drug consumption along with the significant physiologic changes that occur with aging put this population at a very high risk for experiencing serious consequences from polypharmacy. According to the US census bureau nearly 1 in 5 U.S. residents is expected to be aged 65 or older by the year 2030. This age group is projected to more than double to over 88.5 million in 2050. The age group of 85 years and older is expected to increase about 4-fold to over 19 million by 2050. As our elderly population grows, the number of elderly patients with concurrent medical conditions who take multiple medications also continues to grow, contributing to the ever-expanding problem of polypharmacy.

Two months later Mrs. Johnson is back at the pharmacy, this time she was dropping off new prescriptions again. Per usual she smiled and asks how my day was going then handed me her prescriptions. They were for Senna (Laxative) and Docusate (Stool Softener) for constipation that she’s been having, which has become very troublesome for her. So we filled her prescriptions and sent her on her way. Next month Mrs. Johnson came back yet again, this time again with 2 new prescriptions, Donepezil for Alzheimer’s disease and eye drops for dry eyes. She says she’s having trouble keeping track of all of her medications and is starting to get very forgetful these days so her doctor put her on another drug that should help her memory. A few weeks later she came back with a new prescription for oxybutynin for some “bladder problems” she’s been having.

At this point Mrs. Johnson has started 7 new medications just in the last few months, so I decided to ask the pharmacist to take a look at her medications. The pharmacist opened her profile, took a look at her medication list and then took Mrs. Johnson to the side to speak with her as I helped the next customer in line. A few minutes later the pharmacist came back and told me she’s going to call Mrs. Johnson’s doctor and make some recommendations for changes. Apparently the medication Amitriptyline she started a couple of months ago commonly causes side effects such as urinary retention, dizziness, constipation, and dry eyes which is why she was prescribed the Senna and Docusate for constipation and the eye drops for her dry eyes. On top of that, taking Amitriptyline, clonazepam, and Benadryl together can lead to increased confusion and put elderly patients at an increased risk for falling which was also likely contributing to her new onset of psychiatric problems leading to the Donepezil being started, which in turn caused overactive bladder issues leading to the oxybutynin being prescribed. Luckily we were able to catch the problem and take her off 7 clinically inappropriate and unnecessary medications before a serious hospitalization or fall occurred. A case could be made that the Pharmacist and or Doctor should have caught this issue earlier but that’s a discussion for another blog topic. Cases like Mrs. Johnson’s are far more common than we may think and really emphasize the importance of correcting polypharmacy.

Increased adverse drug events (ADEs) are one of the most deleterious and extensively studied problems associated with polypharmacy. Up to 35% of outpatients and up to 40% of inpatient elderly patients have been reported to experience an ADE annually in the U.S. On top of that about 10% of emergency room visits have been attributed to an ADE annually. The addition of each new drug to a medication regimen has been found to increase the risk of an ADE. One population based study found that patients taking 5 or more medications had an 88% increased risk of an ADE compared to those taking less than 5 medications. Rates of ADEs in nursing home residents taking 9 or more medications have been found to be twice as high as patients taking fewer medications. A separate study found that older veterans taking more than 5 medications were 4 times as likely to be hospitalized from an ADE.

Another well studied consequence of polypharmacy is drug-drug interactions (DDIs), which lead to increased medication related morbidity and mortality. A cohort study found that a patient taking 5-9 medications had a 50% risk of a DDI, while patients taking 20 or more medications had a 100% risk of DDIs. In a separate cohort study, the prevalence of a potential hepatic cytochrome enzyme-medicated DDI was 80% in older hospitalized adults taking 5 or more medications. A study from the Women’s Health and Aging Study found that the use of 5 or more medications was associated with a reduced ability to perform instrumental activities of daily living (IADLs). A number of studies have also associated polypharmacy with increased falls, cognitive impairment, urinary incontinence, and malnutrition in the elderly. One cohort study found that 50% of patients taking 10 or more medications were malnourished or at risk of malnourishment.

With rapidly rising healthcare costs every effort needs to be made to find solutions to reduce expenditure. The US Center for Medicare and Medicaid Services estimates that polypharmacy alone is responsible for $50 billion in avoidable costs to health plans annually. Adverse Drug Events in the United States were found to cost an estimated $76.6 billion annually in the ambulatory setting alone. These figures make it clear that targeting and correcting polypharmacy stands to save the healthcare system billions of dollars each year.

Many times polypharmacy, or taking multiple medications, can not only be appropriate but be necessary for a patient presenting with multiple medical conditions. For example a patient with heart failure and diabetes is required to be on several medications to slow the progression or reduce the symptoms of disease as well as to improve the quality of life and hopefully prevent complications. However, this is not always the case and many patients often fall victim to the negative consequences of polypharmacy, especially the geriatric population, making it of utmost importance to consistently evaluate a patient’s medication regimen and ensure each patient is on optimal therapy.

Looking back at our case of Mrs. Johnson we see how easy it is for polypharmacy to go unnoticed and potentially cause serious damage to the patient both medically and financially and this is if the customer uses only one pharmacy for their medications. If they use multiple pharmacies to try and save money then this issue can be dramatically compounded. Like I indicated earlier this story was from the time when I was a pharmacy technician, without any real knowledge in healthcare but I was still able to facilitate a discussion that significantly benefited the patient. It doesn’t have to be the doctor or the pharmacist to catch something wrong, anyone that interacts with the patient, even someone without any real training or knowledge in medications can point out something that just doesn’t look right and bring it to the attention of a doctor or a pharmacist to be corrected. Now as a practicing Pharmacist, this experience reminds me how taking a little extra time and effort can make such a big difference to a patient suffering from the consequences of polypharmacy.

There is no easy fix and there are many factors that contribute to polypharmacy including time constraints on health professionals, multiple prescribers, patient-driven prescribing, low health literacy, and frequent transitions in care. Drug-related adverse effects may also not always be apparent in the elderly. Many adverse effects such as increased falls, sedation, confusion, urinary retention, failure to thrive, and decreased nutrition status are all problems that present frequently in the elderly. Failing to recognize some of these effects as drug-related may result in prescribing another medication to alleviate the problem, which may cause other problems for which another drug is prescribed, and the process continues only making matters worse, this is otherwise known as a prescribing cascade, as seen in the case of Mrs. Johnson. On top of prescription medications, the increased usage of OTC and herbal supplements can also significantly contribute to drug-drug interactions and medication related morbidity and mortality. With so many factors in play it is becoming increasingly difficult for practitioners to address the overall needs of patients while ensuring appropriate medication use. It is evident the issue of polypharmacy can be extremely costly to the healthcare system as well as damaging to the individual patient, and strategies need to be developed and implemented to tackle this ever-growing problem.

- Dr. Zeshan Mahmood, PharmD

Dr. Zeshan Mahmood, PharmD, is the Clinical Director of Healthcare Strategy at Pharmacist Partners, a national healthcare service and clinical knowledge organization of pharmacists. He is a practicing pharmacist for Walgreens licensed in Washington DC and Virginia. Zeshan also currently works with NovaScripts Central, a non-profit pharmacy that provides free medications to uninsured patients, on patient education and outreach initiatives.

---

Sources

“Clinical Consequences of Polypharmacy in Elderly,” National Institutes of Health.

“A Study on Polypharmacy and Potential Drug-Drug Interactions among Elderly Patients Admitted in Department of Medicine of a Tertiary Care Hospital in Puducherry,” National Institutes of Health.

85-Year-Old Runner Still Breaking Records

Ed Whitlock follows his own regimen, including daily runs through the local cemetery.

Few 85-year-olds can run marathons, but Ed Whitlock not only completes them but sets records. The Canadian recently broke the record for the Toronto Marathon men’s 85-89 age group by more than 30 minutes, running the race in 3 hours and 56 minutes and shattering the previous mark set in 2004. Over the last couple of decades, the retired engineer from Milton, Ontario has achieved a reputation as one of the great masters runners. His accomplishments include running a full marathon at age 73 in 2 hours and 54 minutes and running a marathon at age 80 in 3 hours and 15 minutes.

Whitlock’s running regimen is a far cry from his younger cohorts. He doesn’t listen to music, do ice baths or massages, or use heart rate monitors. When his knees start hurting, he stops running for a while. His running shoes are 15 years old, and his daily 3-hour runs are through the nearby cemetery, mostly because it’s cool in summer.

“I don’t follow what typical coaches say about serious runners,” he told Runner’s World in 2010. “I have not strong objections to any of that, but I’m not sufficiently organized or ambitious to do all the things you’re supposed to do if you’re serious. The more time you spend fiddle-diddling with this and that, the less time there is to run or waste time in other ways.”

He doesn’t seem to particularly enjoy running. It’s the competition that gets him going, although even breaking the record in a Waterloo, Ontario, marathon in April was somewhat disappointing.

“I should have been able to run a bit faster than that,” Whitlock told the Wall Street Journal. “I wasn’t entirely satisfied.”

---

Sources

“At 85, Ed Whitlock Breaks Four Hours in the Marathon,” Oct. 17, 2016, Runners World.

“Time Can’t Beat Ed Whitlock: Running’s 85-Year-Old Legend,” May 4, 2016, Wall Street Journal.

Blog posting provided by Society of Certified Senior Advisors
www.csa.us

Famous & 65

Look Who’s Turning 65

Nov. 7—Lawrence O'Donnell

The host of The Last Word with Lawrence O'Donnell, an MSNBC opinion and news program, O’Donnell graduated from Harvard College, where he wrote for the Harvard Lampoon. From 1977 to 1988, O’Donnell worked as a writer, including as the author of Deadly Force, about a case of wrongful death and police brutality in which O'Donnell’s father was the plaintiff’s lawyer. From 1989 to 1995, he was a key legislative aide to Senator Daniel Patrick Moynihan; his work included being staff director of the United States Senate Committee on Environment and Public Works and staff director of the United States Senate Committee on Finance. From 1999 to 2006, he produced and wrote the NBC series The West Wing (and played the role of the president's father in flashbacks). O’Donnell won the 2001 Emmy award for Outstanding Drama Series for The West Wing, and was nominated for the 2006 Emmy for the same category.

In 2002, O’Donnell was supervising producer and writer for the television drama First Monday, and in 2003, he was creator, executive producer and writer for the television drama Mister Sterling. He is also an occasional actor, appearing as a recurring supporting character on the HBO series Big Love, portraying an attorney. Before getting his own show on MSNBC in 2010, he frequently filled in as host of Countdown with Keith Olbermann on MSNBC. O'Donnell has also appeared as a political analyst on The McLaughlin Group and The Al Franken Show.

---

Nov. 9—Louis “Lou” Ferrigno

The retired professional bodybuilder is best known for his title role in the CBS television series The Incredible Hulk, for which he vocally reprised the role in subsequent animated and computer-generated incarnations. As a young boy in Brooklyn, Ferrigno suffered a series of ear infections and lost most of his hearing, which caused him to be bullied by peers during his childhood. “I think my hearing loss helped create a determination within me to be all that I can be, and gave me a certain strength of character too,” he later said. Ferrigno started weight training at age 13, and after graduating from high school in 1969, won his first major titles—IFBB Mr. America and IFBB Mr. Universe, four years later. His attempts to beat Arnold Schwarzenegger in the Mr. Olympia competition were the subject of the 1975 documentary Pumping Iron, which made Ferrigno famous.

In 1977, Ferrigno was cast as the Hulk in The Incredible Hulk, with Bill Bixby as Hulk's "normal" alter ego, and continued playing the role until 1981. Later, he and Bixby co-starred in three The Incredible Hulk TV movies. Ferrigno played himself during intermittent guest appearances on the CBS sitcom, The King of Queens, from 2000 to 2007. He made cameo appearances as a security guard in both the 2003 film Hulk and the 2008 film The Incredible Hulk, in which he also voiced the Hulk. Ferrigno appeared as himself in the 2009 feature film comedy I Love You, Man. He trained Michael Jackson on and off since the early 1990s, and in 2009, helped him get into shape for a planned series of concerts in London. Ferrigno has served as a volunteer officer in Los Angeles County; Maricopa County, Ariz.; San Luis Obispo County, Calif.; and Delaware County, Ohio. He has his own line of fitness equipment called Ferrigno Fitness.

---

Nov. 15—Beverly Heather D'Angelo

The actress and singer has appeared in over 60 films, although she is best known for her starring role in the National Lampoon's Vacation films (1983–2015). D'Angelo began acting in the theatre in 1976 and made her television debut in the first three episodes of the TV mini-series Captains and the Kings in 1976. After getting a minor role in Annie Hall in 1977, she appeared in a string of hit movies, including Every Which Way But Loose, Hair and Coal Miner's Daughter, the latter earning her a Golden Globe nomination for Best Supporting Actress for her performance as Patsy Cline and a Country Music Association award for Album of the Year. Her biggest break came in 1983 starring with Chevy Chase in National Lampoon's Vacation in the role of Ellen Griswold. She reprised this role in four Vacation sequels and a short film between 1985 and 2015. In the 1980s, she starred in many other major comedy films, and as of the mid-90s acted primarily in independent movies.

In 1994, D'Angelo returned to the stage and won a Theatre World Award for her performance in the Off-Broadway play Simpatico. She received an Emmy Award nomination for her performance in the 1984 TV movie version of A Streetcar Named Desire. She later had main roles in numerous made-for-television dramatic films, including Slow Burn, Judgment Day: The John List Story and Sweet Temptation. In the 2000s, D'Angelo had a recurring role on Law & Order: Special Victims Unit as defense attorney Rebecca Balthus. From 2005–2011, she appeared in the HBO series Entourage playing the role of agent Barbara "Babs" Miller. In 2006, she starred in the independent film Gamers: The Movie.

---

Nov. 25—Russell "Bucky" Dent

The Major League Baseball player and manager earned two World Series rings as the starting shortstop for the New York Yankees in 1977 and 1978, and was voted the World Series MVP in 1978. Dent is most famous for his home run in a tie-breaker game against the Boston Red Sox at the end of the 1978 season. The 3-run home run gave the Yankees a 3-2 lead in the 1978 AL East division playoff game against the Boston Red Sox. This was all the more remarkable because Dent was not known as a power hitter. Indeed, the home run was one of only 40 he hit in his entire 12-year career. Further, Dent occupied the ninth spot in the batting order, not generally considered a power slot. The Yankees went on to win the game 5-4, securing the division title in the process. Dent continued his unusually high production by batting .417 in the 1978 World Series, earning Series Most Valuable Player honors, as the Yankees defeated the Los Angeles Dodgers.

A 3-time All-Star, Dent remained the Yankees' shortstop until 1982, when he was traded to the Texas Rangers, but finished his career that season with the Kansas City Royals. After retiring as a player, Dent managed in the Yankees' minor-league system, notably with the Columbus Clippers. He served the Yankees as manager of the big-league club for portions of two seasons, compiling an 18–22 record in 1989 and an 18–31 record in 1990. In 1989, Dent opened a Delray Beach, Fla. baseball school, which featured a miniature version of Fenway Park. Although Dent had his greatest moment as a player at Fenway Park, his worst moment also came at Fenway Park when he was fired as manager of the Yankees. From 1991 to 1994, Dent served on the coaching staff of the St. Louis Cardinals under manager Joe Torre, moving to the coaching staff of the Texas Rangers from 1995 to 2001.

---

Source: Wikipedia

FAMOUS & 65 is a featured article in the November 2016 Senior Spirit newsletter.

Blog posting provided by Society of Certified Senior Advisors
www.csa.us