Teens Introduce Seniors to the Internet

What happens when a generation that never used the computer links up with a generation that grew up with technology? 

In Cyber-Seniors, a humorous and heart-warming documentary feature, teenagers show older adults how to use email, get on Facebook and make friends on and with the Internet.

Teens Introduce Seniors to the Internet is a featured article in the January 2016 Senior Spirit newsletter.

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

Famous & 65

Look Who's Turning 65...

January 9 — Crystal Gayle, an award-winning country music singer, is best known for her 1977 country-pop crossover hit song, "Don't It Make My Brown Eyes Blue." During the 1970s and 1980s she accumulated 20 No. 1 country hits with six albums certified gold. Gayle became the first female artist in country music history to reach platinum sales with her 1977 album We Must Believe in Magic. Also famous for her nearly floor-length hair, she was voted one of the 50 most beautiful people in the world by People Magazine in 1983. She is the younger sister of singer Loretta Lynn, who once told her, “You record what I couldn't record—you do MOR,” middle of the road, "and that was the best advice I could get. I don't think I ever would have made it if I went down the road and did the music my sister did. I would only have been compared to her."

Gayle had her greatest success from 1977 to 1989 when she did music considered crossover. Her hits included “When I Dream,” "Talking in Your Sleep," "Why Have You Left the One You Left Me For," "Half the Way," "It's Like We Never Said Goodbye," "You and I" (a duet with Eddie Rabbitt), "The Sound of Goodbye," "Turning Away," "Makin' Up For Lost Time,” "Cry" and "Another World." Gayle continues to perform and tour.

January 12 — Kirstie Alley, an American actress and comedian, is best known for her role in the TV series Cheers, in which she played Rebecca Howe from 1987 to 1993, winning an Emmy Award and a Golden Globe Award as the Outstanding Lead Actress in a Comedy Series in 1991. She is also known for her role in the thriller Shoot to Kill and the Look Who's Talking film series as Mollie Ubriacco. More recently, Alley has appeared in reality shows revolving around her life.

Alley made her movie debut in 1982 in Star Trek II: The Wrath of Khan, playing the Vulcan Starfleet officer Lieutenant Saavik. In 1987, she joined the cast of Cheers, replacing Shelley Long and remaining on the show until its eleventh and final season. In 1989, Alley starred with John Travolta in Look Who's Talking, which grossed over $295,000,000 worldwide. They went on to make two other films centered on the same theme, Look Who's Talking Too and Look Who's Talking Now! In recent years, Alley’s weight gain and loss has received much public attention. In September 2012, she appeared on The Dr. Oz Show, where she said she spent her whole life eating obsessively. She has been a member of the Church of Scientology since 1979.

January 21 - Eric Holder, Jr. was the 82nd attorney general of the United States from 2009 to 2015. Serving in the administration of President Barack Obama, Holder is the first African American to hold the position of U.S. attorney general. Previously, he served as a judge of the Superior Court of the District of Columbia, after being appointed in 1988 by President Ronald Reagan. In 1993, President Bill Clinton appointed him United States attorney for the District of Columbia, the first black American in that office, and in 1997, nominated him the deputy attorney general under Janet Reno. While U.S. attorney, Holder prosecuted Congressman Dan Rostenkowski (D–Illinois) for corruption charges related to his role in the congressional post office scandal.

During Obama's presidential campaign Holder was his senior legal adviser and one of three members of Obama's vice-presidential selection committee. During the Fast and Furious investigation (involving guns and the Bureau of Alcohol, Tobacco, Firearms and Explosives), he became the only cabinet member in U.S. history to be held in contempt of Congress. From 2001 until he became attorney general, Holder worked as an attorney at Covington & Burling in Washington, D.C., representing clients such as Merck and the National Football League. After he resigned as attorney general in 2014, he returned to Covington & Burling. The law firm's clients have included many of the large banks Holder declined to prosecute for their alleged role in the financial crisis.

January 30 — Phil Collins is an English singer, songwriter, multi-instrumentalist, music producer, actor and author. He gained fame as both the drummer and lead singer for the rock band Genesis, as well as worldwide success as a solo artist. Collins sang the lead vocals on dozens of hit albums and singles in the U.K. and the U.S. between 1976 and 2010, either solo or with Genesis. He is among the best-selling music artists of all time, with 33.5 million albums sold in the U.S. and an estimated 150 million worldwide. He is one of three recording artists (along with Paul McCartney and Michael Jackson) who has sold over 100 million albums worldwide both as solo artists and (separately) as principal members of a band. AllMusic describes Collins as "one of the most successful pop and adult contemporary singers of the '80s and beyond."

Collins joined Genesis in 1970 as the group's drummer and became its lead singer in 1975 following Peter Gabriel’s departure. In 1981, Collins launched a solo career. His best-selling singles include "In the Air Tonight," "Against All Odds," "Sussudio" and "Another Day in Paradise." His music has earned him seven Grammy Awards, six Brit Awards, an Academy Award, two Golden Globe Awards and a Disney Legend Award. Totaling his work with Genesis, other artists and his solo career, Collins had more U.S. Top 40 singles than any other artist during the 1980s. In 2008, Collins was ranked the 22nd most successful artist on the "Billboard Hot 100 All-Time Top Artists."

Source: Wikipedia


Famous & 65  is a featured article in the January 2016 Senior Spirit newsletter. 

Blog posting provided by Society of Certified Senior Advisors

www.csa.us

Let an Online Manager Protect Your Passwords

For older brains that can’t retain everything, password managers provide an easy solution to memorizing dozens of passwords.

Older brains have less memory capacity. One of the more difficult challenges is remembering all our computer passwords. You likely have one for email, for each social media site (such as Facebook), for online banking, for your healthcare provider, for retail accounts (such as Amazon) and for organizations you belong to. The list goes on and on.

You probably have your own method of password management: using the same one over and over (not very safe), writing them down somewhere or coming up with clever combinations that you think are unhackable, but which you sometimes cleverly forget.

Online password managers are designed to take care of the problem by storing all your passwords in a safe place and letting you remember just one password. That helps makes all your websites secure because you can devise more complex passwords without worrying you will forget them.

Features

Many of the top password managers share some, though not all, of these features:

• Encrypts your passwords, making it more difficult for hackers to steal them
• Stores your passwords, either on your computer or in the provider’s or user’s cloud (online data storage)
• Synchronizes your password with other devices (phones, pads, computers)
• Automatically fills in forms on other websites that want your name, address, phone number, email, etc.
• Automatically captures and stores your passwords when you visit other website
• Works on different platforms and with different browsers
• Audits your passwords and lets you know if you have too many similar or weak ones
• Generates strong passwords for you
• Logs into sites for you

Recommended

These popular password managers provide the basics plus more:

LastPass. One of the first password managers available, LastPass allows you to selectively share account login information with other LastPass users and will automatically change a password for you if a service you use has been hacked or compromised. The site will monitor your credit and notify you when an account on another website has been hacked. Its set of features support a wide range of mobile platforms and straightforward licensing. LastPass has its own cloud service to store user information and synchronize data. It's free to download and use, but you can upgrade for $12 per year.

Dashlane. This popular provider logs purchases and orders, shares passwords with emergency contacts when needed and is able to change multiple passwords on dozens of websites with a few clicks. With Dashlane, you must retain your master password, because the company is unable to retrieve it in the event of loss, a necessary side effect of its decision to not store a copy of your password in any form. It's free to download and use, but to sync your password across devices, you'll have to upgrade to Dashlane Premium for $40 per year.

KeePass. This open-source password manager stores your passwords inside an encrypted database that you control on your own system, and does not sync or upload to other devices. KeePass is portable, so you can take it with you—on a thumb drive, for example—and use it on other computers. With the right combination of plug-ins, KeePass can do almost anything you could require of a password manager, which means it can be complex and challenging to use. KeePass works in all windows and all browsers, which means that it can log in to sites that other password managers can't. Plus, it’s free.

1Password. When you change your password, this program provides secure notes for other passwords or notes that you want to keep private. It also offers a digital wallet to store bank account and payment information, and a password "recipe" builder that lets you customize your passwords. You can use 1Password locally without syncing any information to the web. You can even keep multiple vaults for different types of passwords and share passwords with others. 1Password's has a $50 one-time fee. 

RoboForm. While most password managers provide only email support, RoboForm also offers telephone support. In addition, it protects you from visiting potentially harmful fake sites because it knows the exact URLs of the sites you log into. RoboForm has bookmarking features to help keep track of your favorite sites. The first 10 logins are free, and after that you’ll need to upgrade to RoboForm Everywhere for $20 per year ($10 for the first year).

Sources

“Five Best Password Managers,” Jan. 11, 2015, lifehacker 

“Review: The best password managers for PCs, Macs, and mobile devices,” June 17, 2015, Infoworld 

“The Best Password Managers for 2015,” Nov. 13, 2015, PC Mag 

“Password Management Software Review,” Top Ten Reviews

Let an Online Manager Protect Your Passwords is a featured article in the January 2016 Senior Spirit newsletter. 

Blog posting provided by Society of Certified Senior Advisors

www.csa.us

Don’t Fall in Love with a Romance Scammer

Looking for love online can lead to the loss of tens of thousands of dollars, if you become the victim of scammers who know all the right lines and convince you to send money to pay for their increasing hardships.

Six months after Joseph’s wife died suddenly, he posted his profile on a Christian dating site. Almost immediately, a woman named Melanie contacted him. She was English, and her profile picture showed a charming pink-cheeked complexion. Within months of their online courtship, Melanie professed her love for Joseph and told him he was the man she had been looking for her whole life. Soon after, she mentioned that her mother had cancer but couldn’t afford the treatments (despite the fact that England has socialized medicine).

How to Avoid Being Duped For medical care outside the United States, the American Medical Association (AMA) advocates the following principles: When using an online site, don't provide your last name, your address or where you work until you've actually met—and be wary of suitors who ask for any of this personal information too quickly. If you're using a mobile app, turn off your location settings so scammers can't figure out where you live. Before you engage with anyone on a dating site, use Google's "search by image" feature to see if that person's image shows up in other places using a different name. Many scammers work by stealing people's photos and assuming their identities. Do an online search to see if your suitor’s claims match information on social media websites. Is what you read on the person's Facebook, Twitter or LinkedIn pages consistent with what you're being told.      Access physician licensing and outcome data, as well as facility accreditation and outcome data, for medical care outside the United States. If you get a suspicious email, use a search engine to check it out. Cut and paste the e-mail into Google and see if the words pop up on any romance scam sites.

 

After Joseph sent Melanie money to help out, the two made plans for her to fly to his Kansas City home, and Joseph was only too happy to pay her airfare. But airport security in London arrested her, Melanie told him, because she had pain medicine, a controlled substance. So, he sent her money to hire a lawyer. However, Melanie’s misfortunes continued. A hotel in England wouldn’t let her leave because she was unable to pay the bill. After Joseph sent her money for the hotel and for airfare for Melanie to visit him, their plans to see each other were again foiled when the plane crashed in Iowa.

Though there had been no news of a plane crash, and Melanie’s stories were becoming increasingly implausible, Joseph was too heavily invested—both financially and emotionally—to doubt Melanie’s story. In the end, he was out $30,000, a small amount compared to the average loss suffered by victims of romance scammers.

While figures are hard to come by, in Vermont, victims typically lose $40,000 to $100,000, according to the Public Protection Division of the Vermont Attorney General’s Office (New York Times). Nationally, between July 1 and Dec. 31, 2014, nearly 6,000 people registered complaints of such romance scams with losses of $82.3 million, according to the federal Internet Crime Complaint Center.

Seniors are especially susceptible because they have a lifetime of savings, own their own homes and tend to be more trusting. Scammers often target women, especially in their 50s and 60s who live alone. Once they realize they have been lured into the scammers’ web, besides losing a lot of money—sometimes their life savings—they are embarrassed and don’t want to tell anyone, least of all family and friends.

How Scammers Work

A romance scam starts when someone contacts you on a dating or social network site, supposedly impressed by your profile. When you check out their profile, you’ll find a picture of a good-looking man or woman who either works or lives overseas. A man may tell you he’s an oil worker on a deep-sea rig, a U.S. military officer deployed in a war zone or a businessman who travels overseas most of the time—all plausible explanations as to why you can’t meet face to face. Soon, your suitor will suggest communicating by private email, telephone or instant message, rather than on the public dating site.

He or she will present themselves as thoughtful, caring and loving, someone who is looking for their soul mate—and you’re the one. You might be sent love poems or small gifts, and you’ll exchange confidences with this person. Once a bond has been made, the suitor will reveal some hardship—a hospital bill or car repair—which you are only too happy to help pay for. But the requests will start to increase, as this person seems to befall tragedy at every turn: a huge hospital bill after they were mugged on the street or a son or daughter (from a previous and difficult marriage) who has a fatal illness and no medical insurance.

Your new friend might ask for help in cashing a check that they are unable to cash themselves. Because you know this is the man or woman of your dreams, you do everything you can to keep the relationship going, even at a cost of thousands of dollars.

In reality, this potentially perfect mate is most likely a Nigerian or other African working from a script carefully designed to have all the right romantic lines. They likely created a fake profile by hacking into a dormant dating profile and altering information such as age, gender and occupation. By cashing their checks, you may unknowingly be taking part in a money-laundering scheme.

Although victims of these scams range across different economic and social classes, they often share a particular psychological trait: a strong belief in romantic destiny. Psychologist Monica Whitty, who specializes in romance-scam research, found that those who take the bait for these scams tend to score higher on tests that measure how much they idealize romantic love (from Wired).

Warning Signs

If you are concerned about someone you just met on a dating or social media website, Romance Scams, an information and advocacy organization, says you should look for these warning signs:

• Their profile disappears from the website after a conversation begins. 
• They claim it was destiny or fate, and you are meant to be together. 
• They claim to love you either immediately or within 24 to 48 hours. 
• They immediately start using pet names with you: hon/hun, baby/babe, sweety/sweetie. 
• They claim God brought you together. 
• Their spelling and grammar are atrocious. 
• They consistently use web speak or abbreviations: u, r, ur, cos, pls/plz, ma, sry, brb, div. 
• They like to send you poems or love letters, most of which can be traced to lovingyou.com. 
• They claim to have lost a spouse/child/parent in a horrific traffic or airplane accident, or are sick or in the hospital. 
• They have no close family members, friends or business associates to turn to so can rely only on you. 
• The details they give you when instant messaging or emailing are often different than what they stated on their profiles. Common inconsistencies include their birth date, height/weight and age. 
• They often misspell the cities or towns they claim they are from and are unfamiliar with local landmarks and attractions.

Sources

“No One Loves Romance Scams. Act Now To Prevent Them,” AARP’s Fraud Watch Network

“Looking for Love? Beware of Online Dating Scams,” Feb. 14, 2013, FBI San Diego

“Faking it—scammers’ tricks to steal your heart and money,” July 15, 2015, Federal Trade Commission

“Online Dating Made This Woman a Pawn in a Global Crime Plot,” Oct. 5, 2015, Wired

“Swindlers Target Older Women on Dating Websites,” July 17, 2015, New York Times

Don’t Fall in Love with a Romance Scammer is a featured article in the January 2016 Senior Spirit newsletter.

Blog posting provided by Society of Certified Senior Advisors

www.csa.us

Looking for Medical Bargains? Visit Other Countries.

There’s an increase in medical tourism as people seek treatment abroad for procedures, such as tummy tucks or a new set of teeth, that their health insurance does not adequately cover.

Linda, 65, needed a lot of dental work, but the price quoted by her local dentist would have caused financial hardship. So she did some research and found a clinic in Los Algodones, Mexico that would do the work for one-third the cost: $560 for two crowns and a tooth extraction. When she did a follow-up with her own dentist, he praised the Mexican dentist’s work. On her second visit to the Sani Dental clinic in Los Algodones, the savings were even better: $4,600 for three implants and a redone crown, which would have cost her three times as much at home.

AMA: Coordinate Local Care Before Trip For medical care outside the United States, the American Medical Association (AMA) advocates the following principles: Only visit institutions certified by recognized international accrediting bodies, such as the Joint Commission International or the International Society for Quality in Health Care. Before travel, coordinate local follow-up care and arrange financing to ensure continuity of care upon your return. Ensure that coverage for overseas medical care includes the costs of necessary follow-up care after returning to the United States. Understand your rights and legal recourse before agreeing to procedures and operations abroad.      Access physician licensing and outcome data, as well as facility accreditation and outcome data, for medical care outside the United States.  Ensure consistency with Health Insurance Portability and Accountability Action (HIPAA) guidelines when transferring medical records to and from foreign facilities.

On top of saving money, she had a good experience, because most of the clinic staff spoke English and strove to make her feel comfortable. Plus, she had an adventure—a fun drive from her Colorado home.

Los Algodones, which is right over the border from Yuma, Arizona, has some 350 dentists working within a few blocks of downtown and attracts Canadians and Americans looking for inexpensive dental work (NPR). It’s part of the growing medical tourism trend, as people seek treatment abroad for procedures, such as tummy tucks or a new set of teeth, that their health insurance does not cover or that have high deductibles.

In 2014, Patients Beyond Borders, a provider of medical travel information, estimated that roughly 1.2 million Americans would travel outside the country for medical care this year. The total medical tourism market is a big one: between $38.5 billion and $55 billion, based on 11 million people crossing borders worldwide for medical and dental procedures.

Most Popular Countries

Because of their proximity, Costa Rica and Mexico are popular with U.S. travelers, especially for dentistry and cosmetic surgery. More than 50,000 Americans cross the border each year just for dental work, according to Patients Beyond Borders. Mexico also specializes in weight-loss treatment and surgery, at an estimated 30 to 60 percent savings, especially in cities near the U.S. border such as Tijuana and Juarez.

Europeans, especially, flock to Thailand, Singapore and Malaysia to save money on expensive, invasive surgeries, such as open-heart surgery or knee replacements. Thailand and Brazil have good reputations for cosmetic surgery, while India is known for organ transplants and fertility, orthopedic, cardiac and oncology treatments. Other popular medical-tourism destinations are Israel, South Korea, Taiwan, Turkey and the United States.

In developing countries, healthcare is cheaper for several reasons. Wages and infrastructure costs are less, and other countries aren’t burdened by the high costs of liability or malpractice insurance found in the United States. In fact, insurance and administrative costs compose much of America’s healthcare budget.

At the same time, international healthcare can be first-rate. To compete for the revenue that medical tourists can bring, many countries’ healthcare institutions offer modern facilities, well-trained medical staff, cutting-edge technology and accreditation by organizations such as Joint Commission International. Many overseas physicians, dentists and surgeons received their medical training and degrees at the top medical schools in the U.S., the U.K., Canada, Switzerland or Germany. In fact, many hospitals, particularly the larger institutions in Southern and Southeast Asia, have lower rates of complications than in the U.S., particularly for complex cardiac and orthopedic surgeries.

Top Reasons for Traveling

According to Patients Beyond Borders, patients travel to different countries for these reasons:

• Cosmetic surgery
• Dentistry (general, restorative, cosmetic)
• Cardiovascular (angioplasty, coronary artery bypass grafting, transplants)
• Orthopedics (joint, spine, sports medicine)
• Cancer (often last resort)
• Reproductive (fertility, in vitro fertilization, women's health)
• Weight loss (lap-band, gastric bypass)
• Scans, tests, health screenings and second opinions

Why Go Outside the United States?

There are many reasons patients travel to foreign lands for medical treatment, according to Patients Beyond Borders:

Cost savings. Depending upon the country and type of treatment, uninsured and underinsured patients, as well as those seeking elective care, can realize 15 to 85 percent savings over the cost of treatment in the United States. For example, according to Medical Tourism a gastric bypass that would cost $35,000 in America costs $11,500 in Costa Rica, $10,000 in India, $11,500 in Mexico and $12,200 in Thailand. Similarly, a $40,000 knee replacement would cost $11,000 in Costa Rica, $8,000 in India, $12,000 in Mexico and $8,600 in Thailand. Of course, you also need to add in the cost of the airfare, lodging and other travel-related expenses to offset your savings.

Better patient experience. Government and private stakeholders in countries such as Mexico, Costa Rica, India, Malaysia and Thailand have poured billions of dollars into improving their healthcare systems to lure the international health traveler. Amenities include deluxe hospital suites and recuperation resorts, along with free transportation to and from airports, low-cost meal plans for companions and discounted hotels affiliated with the hospital. One Costa Rican hospital offers free massages, haircuts and pedicures.

Treatments excluded in U.S. Although health insurance policies vary, most plans exclude treatments such as cosmetic surgeries, dental care, vision treatments, reproductive/infertility procedures, some non-emergency cardiovascular and orthopedic surgeries, weight loss programs, substance abuse rehabilitation and prosthetics. More than 70 percent of American health travelers leave the country for elective treatments elsewhere.

Shorter waiting periods. In countries with universal healthcare plans, such as Canada and Great Britain, long wait times for procedures have caused patients to go elsewhere. Even in the United States, some patients determine it is better to pay out of pocket than wait for a distant appointment and have to endure pain from a deteriorating condition.

More patient friendly. As economic pressure causes hospitals to move patients out of costly inpatient beds sooner than later, sufficient time is often not allowed for basic recovery. Abroad, patients are frequently encouraged to spend extra time in the hospital post-procedure. Patient-to-staff ratios are usually lower, as are hospital-borne infection rates. Moreover, physicians and staff in treatment centers are generally far more accessible than their U.S. counterparts.

How to Avoid Risks

The Centers for Disease Control and Prevention (CDC)  points out that there are risks: Medical tourism has been associated with complications, including infections from antibiotic-resistant strains of bacteria not previously seen in the United States. Experts have documented several infectious-disease outbreaks among medical tourists after their return to the United States.

The CDC recommends that patients seeking care elsewhere do research. One reputable resource is Patients Beyond Borders, which gathers information from surveys completed by international hospitals and clinics, various countries’ ministries of health, leading hospital associations and third-party market research sources. Patients Beyond Borders’ website lists hospitals, clinics, procedures and countries so that you can plan your medical-tourism trip. For example, the site recommends 14 places that do dental crowns in Costa Rica and Mexico, including La Casa del Diente, which “comprises six clinics in the Monterrey [Mexico] metropolitan area. Established in 1984, ‘The Home of Teeth’ has 110 certified dentists and dental surgeons.”

The leading hospitals abroad have accreditation from one of several international institutions, including the U.S.-based Joint Commission International (JCI). To receive accreditation from JCI, an international hospital must meet the same set of rigorous standards as hospitals in the United States. More than 600 hospitals and clinical departments around the world have now been awarded JCI accreditation, and that number is growing by about 20 percent per year (Patients Beyond Borders).

In addition, the CDC recommends that you:

• Be aware of additional risks associated with surgery and travel, either while receiving or recovering from treatment. Flying and surgery both increase the risk of blood clots and pulmonary emboli.
• Don’t travel for 10 days after chest or abdominal surgery to avoid risks associated with this change in pressure. After facial cosmetic procedures, or after laser treatments, wait 7 to 10 days before flying.
• Following surgery, avoid vacation activities such as sunbathing, drinking alcohol, swimming, taking long tours and engaging in strenuous activities or exercise.
• Obtain complete medical records before returning home to ensure that details of your care are available to U.S. providers. At the same time, bring your overseas provider complete records, including your medical history and current conditions and medications, over-the-counter drugs and supplements.
• Make sure your healthcare provider abroad is certified in their specialties through the same process used by the American Board of Medical Specialties. For instance, the American College of Surgeons, American Society of Plastic Surgeons and International Society of Aesthetic Plastic Surgery all accredit overseas physicians.

For dental work, make sure you get a copy of the American Dental Association’s “Traveler’s Guide to Safe Dental Care,” which has questions to ask your regular healthcare provider before embarking on a medical tourism trip. For additional tips from the American Medical Association, see the sidebar.

Sources

“Sand, Sun and Surgery,” June 25, 2013, Bloomberg Business 

“The 10 Best Countries for Medical Tourism,” Oct. 7, 2014, Insider Monkey 

“Top destinations for health tourism,” March 12, 2014, CNBC 

“What Is Medical Tourism?” Medical Tourism Guide 

“A Reason To Smile: Mexican Town Is a Destination for Dental Tourism,” June 10, 201410, NPR 


Looking for Medical Bargains? Visit Other Countries.  is a featured article in the January 2016 Senior Spirit newsletter. 

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

Delirium a Serious Threat for Older Hospital Patients

The risks of a hospital stay now include delirium, which can increase cognitive problems, the length of a hospital stay and even the likelihood of death. Hospitals are starting to become aware of the problem and are taking measures to prevent this costly and harmful condition.

Many people going into the hospital for surgery worry about physical complications from the procedure. However, new research reveals that the mental consequences can be worse. For older hospital patients who have had surgery, delirium is the most common complication of hospital admission (BMJ).

Delirium seriously affects mental abilities and causes confused thinking and reduced awareness of your environment. The condition can develop quickly (as opposed to dementia’s slow onset) and is usually  the result of a severe or chronic medical illness, changes in your metabolic balance (such as low sodium), medication, infection, surgery, or alcohol or drug withdrawal (from the Mayo Clinic).

Studies of patients with delirium reported a twofold increase in death after hospital discharge, an average eight-day-longer hospital stay and worse physical and cognitive recovery linked to increased time in institutional care.

HELP for Your Hospital Stay As a young doctor in the 1980s, Sharon Inouye pioneered efforts to diagnose and prevent delirium. Now a professor of medicine at Harvard Medical School, she created a program to prevent or reduce delirium, Hospital Elder Life Program, or HELP. Currently operating in 200 hospitals around the country, HELP offers suggestions to make sure your hospital stay doesn’t result in delirium: Vision and hearing. Our senses connect us to the outside world and are essential for good communication and safe movement. If you use glasses and/or hearing aids, bring them with you to the hospital. Hydration. All body systems need water to function. Unless instructed otherwise by a healthcare provider, adults should consume 8 cups of plain water each day. Toileting. Adults should use the toilet every two to three hours. Don’t wait until the need is urgent. Mobility. Try to, at least, stand-up and walk around your room, unless your nurse or doctor has told you that you should stay in bed. If you are able, move around even when you are lying or sitting in bed. For example, make circles with your ankles, clench and release your fists, and wiggle your toes. Medicine. When you go to the hospital, bring an up-to-date list of all medications you take regularly, including over-the-counter medications and dietary supplements.

Cost Are High

People with delirium report terrifying hallucinations and flashbacks. After the fact, they complain they can’t balance their checkbooks, can’t find their cars in the parking lot and sometimes can no longer work. Almost worse, because delirium is not usually recognized as a byproduct of hospital surgery, many who are affected don’t know what’s happening to them.

Delirium affects 7 million hospitalized Americans annually, according to the American Delirium Society. It’s estimated to cost more than $143 billion annually, mostly due to longer hospital stays and follow-up care in nursing homes (National Center for Biotechnology Information.) Because delirium is an expensive problem, a few hospitals are starting to implement ways to prevent it.

“Medical schools are now training the new generation about delirium’s dangers, but there are thousands of doctors in the older generation who don’t know how to recognize it or know that 30 to 40 percent of it could be prevented,” said geriatrician Sharon Inouye, who started a program to help hospitals prevent delirium (see sidebar). “We could solve our whole Medicare crisis by preventing delirium,” by saving money that now goes to paying for complications from delirium (quoted in New Old Age).

Causes of Delirium

Hospital delirium is especially common among older people who have had surgeries, such as hip replacement or heart surgery, or those in intensive care. Anything that interferes with neurotransmitters—the brain chemicals that communicate between nerve cells—can trigger delirium, including depression, drugs that affect mental activity or preexisting cognitive impairment. Delirium can also result from the hospital stay itself, which can be disorienting, with its sleep and noise interruptions, disruption of usual routines and spending long stretches alone in unfamiliar surroundings.

Hospital delirium is not new, but in the past, healthcare workers have chalked it up to old age, even when those who show signs of the condition have not been diagnosed with dementia. However, folks with dementia are at increased risk of developing delirium.

Delirium’s cause is a combination of underlying risk factors that interact with stressors in the hospital environment. Drugs are an important risk factor and may be the sole cause for 12 to 39 percent of delirium cases (BMJ). The list includes sedatives, sleeping pills, narcotic painkillers and some allergy, blood pressure and incontinence drugs.

Patients in intensive care units who are heavily sedated and on ventilators are particularly susceptible to delirium; some studies place the rate as high as 85 percent. But even something as easily treatable as a urinary tract infection can cause delirium. Also, a longer hospital stay increases your risk of delirium.

 Effects of Delirium

The short-term effects of delirium can range from hallucinations, aggression and belligerence to sleepiness and lethargy. Delirious patients are confused about what is happening around them, say things that don’t make sense or believe people are trying to harm them. Their personalities can change—becoming quiet and withdrawn or anxious.

Those who suffer from hospital delirium must then get more care in expensive nursing-care facilities, which is one reason for delirium’s high costs.

Delirium’s effects can linger for weeks and months. One-quarter of patients over 70 with delirium do not return to their baseline cognition within three months. In the long term, delirium can cause permanent damage to cognitive ability and is associated with an increased need for long-term nursing care. It also leads to complications, such as pneumonia or blood clots, that weaken patients.

Preventing Delirium

The good news is that, with more awareness, many delirium cases are preventable. Some hospitals are more carefully using medications known to make delirium worse and are trying to wean ICU patients off breathing machines sooner. Because the practice of physically restraining agitated seniors has been shown to sometimes worsen delirium, a few hospitals are limiting the use of restraints, as well as getting patients out of bed sooner so they can move.

Research is showing that providing as normal an environment as possible goes a long way toward preventing delirium. That means adhering to the typical patterns of day and night, such as shutting off lights in patients’ rooms at night, making sure patients have their eyeglasses and hearing aids so they are aware of their surroundings, and minimizing noisy alarms. Having family and friends visit often helps establish an atmosphere of normalcy. Harvard researchers recently led a meta-analysis showing that these types of non-drug interventions reduced delirium by 53 percent (Next Avenue).

One early pioneer in trying to prevent delirium was Dr. Fred Rubin, who in the 1990s tried various strategies to prevent elderly patients from developing hospital delirium. As a geriatrician and medicine service chief at University of Pittsburgh Medical Center’s Shadyside Hospital, Rubin made sure clocks and calendars were visible from patients' beds and that window shades remained open during the day. Trained volunteers talked with patients, asked what day it was, replaced hearing aid batteries, engaged patients in puzzles or word searches, helped at mealtimes and, using newspapers or iPads, discussed the day’s events.

During a 14-year span, the hospital's delirium rate dropped from 41 to 19 percent and saved $7.3 million a year, including revenue generated from additional available beds and variable cost savings (Modern Healthcare).

If you or a loved one are preparing for a hospital stay, try to choose a facility using the HELP program (see sidebar) or with an Acute Care for Elders unit. Family members, visitors and staff should watch for signs of sudden changes in memory, impaired attention, confused thinking, and hallucinations. Delirium is a medical emergency, best managed through prevention, early detection, and rapid intervention.

Sources

 “The Importance of Delirium: Economic and Societal Costs,” Nov. 1, 2012, National Center for Biotechnology Information 

“Best Practices: Hospital reduces delirium in elderly patients,” Feb. 28, 2015, Modern Healthcare

Delirium vs. Dementia, July 20, 2015, A Place for Mom

Another Hospital Hazard for the Elderly, Nov. 2, 2011, New York Times 

The dangers of hospital delirium in older people, Nov. 16, 2011, Harvard Health Publications 

“Hospital-induced delirium hits hard,” Jan. 20, 2012, CMAJ, Next Avenue 

“Delirium in Older People,” 2007, BMJ 

Delirium a Serious Threat for Older Hospital Patients is a featured article in the January 2016 Senior Spirit newsletter. 

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

Plan Ahead for a Happy Retirement

Many older adults spend time planning for their financial future after they retire, but few think about what they will do with their new leisure time. For many retirees, this lack of planning results in disappointment. Experts advise to prepare ahead of time for the rest of your life. 

While many people spend years trying to ensure that their financial future is secure after they retire, few make plans for their new leisure time. When you are in a 9-to-5 work grind with never enough time for household chores, let alone for fun activities, the idea of unlimited time—sleeping late, getting up when you want and pursuing your interests—sounds appealing. However, for many the reality is less pleasant.

A retired teacher writes: “Thinking a lot about co-workers and classrooms since after retirement. [I] had built a new routine for daily life of exercising, swimming, reading, browsing the web and yet find many empty hours of not having anything to do. [I] will try to get part-time teaching, not out of financial need but rather to fulfill the need to remain socially connected. Told myself 64 years old is old enough just to watch the world go by and live the remaining years the way I want to live. [But] six months into retirement, and I have yet to find the bliss. While not actually depressed, there is this gnawing feeling of discontentment and lack of the sense of well-being” (Retirement Online).

Identities Tied to Work

Older adults have vague but optimistic ideas of retirement, which can lead to disappointment once your work life is over. Rob Pascale, a retired pollster and co-author of The Retirement Maze (Rowman & Littlefield, 2012), found that 75 percent of soon-to-be retirees believed their quality of life in retirement would improve, but only 40 percent of retirees found that it actually did (Dallas Morning News).

He and his co-authors, Dr. Louis Primavera and Rip Roach, conducted their own surveys of what happens if you retire without planning appropriately:

• Only half of retirees felt their lives improved after retiring.
• Nearly half of those retired five-plus years didn’t find something to be passionate about.
• As workplace friendships fade, you may not replace them.
• You’ll spend less time socializing in retirement than while you were working.
• Like 45 percent of retirees, you may miss your old job.

The problem is that many of us don’t realize how much of our identity is tied to our work life—defining and often validating who we are while providing structure and social networks. For many people, our friendships stem from work, and the friendships often don’t survive after retirement. That means retirees need to not only create new social networks and structure in their life, but even more difficult, a new identity.

Social scientists say the adjustment from working life to retirement is especially difficult for men. Certain personality characteristics, such as being competitive and assertive, can mean that a life of unstructured time can feel unchallenging, boring and unfulfilling.

Retirement is a new life stage, one that needs psychological adjustments. That's why you need to invest as much if not more time in your “lifestyle” portfolio planning as your financial arrangements, to figure out what you want to do for the rest of your life—what makes you happy.

Tips for a Happy Retirement

In The Retirement Maze, the authors advise retirees to:

• Put back structure, purpose and direction. This means planning and goal-setting, whether for small everyday matters like taking a shower every morning or big goals like taking on a volunteer job. Establish routines and stick to a schedule.
• Manage expectations. While having high expectations can lead to depression, doing nothing can be stressful, especially for couples. Plan and discuss with your partner how you can fill your new free time.
• Stay socially connected. Humans need to be part of a community. Call up an old friend or join groups to make new friends. Don’t limit your social life to your family.
• Keep searching and experimenting. If your first stab at retirement doesn’t work out, try something else—a different fun activity or volunteer opportunity, for example.

Ernie J. Zelinski, the author of The Joy of Not Working: A Book for the Retired, Unemployed and Overworked and How to Retire Happy, Wild, and Free: Retirement Wisdom That You Won't Get from Your Financial Advisor, lists his “major principles for creating a fulfilling retirement” (from Retirement Café):

• Have a major life purpose.
• Be open to learning new things.
• Accept that money will buy style and comfort, but it won't buy you happiness.
• Learn how to enjoy solitude.
• Find a retirement job that you can work at temporarily as a fun job.
• Maintain old friendships and create new friends.
• Indulge in regular strenuous exercise so that you will be physically fit and able to enjoy your retirement activities.
• Travel a lot.

Another way for retirees to stay engaged with the world is through volunteering. Research has shown those who volunteer are less depressed and more satisfied with their lives than those who don’t. This is likely connected to having a purpose in life and staying social, both of which have been shown to improve health and extend life. However, experts say that volunteering doesn’t help if you feel this is something you “should” do and are not really engaged in the activity. In other words, unless helping the homeless or working at an animal shelter, for example, are causes you feel passionate about, the rewards might not be there.

Similarly, working can also keep depression at bay, as well as cognitive decline, dementia and hypertension, according to scientists. Even if you’re officially retired, or were forced to retire, you can work part-time or start your own business. Being able to derive some income from working also helps ease worries about your retirement funds depleting too soon.

In their book, Thriving Beyond Midlife (Society of Certified Senior Advisors, 2015), authors E. Craig MacBean and Henry C. Simmons advise taking a new approach to life: “Unexamined ways of expressing yourself and relating to others developed in the first half of life won’t continue to work adequately as your life unfolds to completion. Unexamined ways in which living gets structured from childhood through midlife will need to be replaced intentionally as you get older.” In other words, retirement is a whole new ballgame.

Sources

“How to Avoid Living Unhappily Ever After in Retirement,” March 6, 2013, Next Avenue

“When retiring, you have to find a new normal,” Nov. 11, 2015, Dallas Morning News

“After Retirement, Anxiety and Depression,” Retirement Online

“Save Yourself From a Depressing Retirement,” June 15, 2015, Forbes

“Retiring minds want to know,” January 2014 (vol. 45, no. 1), American Psychological Association

“Having trouble adjusting to retirement?,” Oct. 25, 2012, Brighter Life

“Top 10 Tips for Adjusting to Retirement,” How Stuff Works

“How to Retire Happy,” Retirement Café

“How to Retire Happy,” September 2014, AARP

Plan Ahead for a Happy Retirement was featured in the December 2015 Senior Spirit Newsletter.

Blog posting provided by Society of Certified Senior Advisors

www.csa.us