Older Adults Can Be at Risk of Dehydration

Decreased fluid intake can exacerbate age-related problems, such as declining kidney function, causing seniors’ health to worsen and sometimes landing them in the hospital.

When Walter, 94, got the stomach flu, he became so weak from vomiting that he was taken to the hospital, where he received fluids. A week later he was back in the hospital after falling in his assisted-living apartment. After the second hospital visit, unable to stand on his own, he entered a nursing care facility. It’s likely that, in the intervening week between hospital visits, Walter, who suffers from early dementia, didn’t know to keep drinking water or other fluids and stay hydrated. In a two-week period, he lost 20 pounds and had to start using a wheelchair.

Dehydration, which occurs when someone loses more water than they take in, is a serious problem, and a frequent cause of hospitalization, especially for the elderly. Depending on the definition of dehydration, between 6 and 30 percent of people aged 65 years and older who are hospitalized are dehydrated (International Journal of Preventive Medicine). In a related study, researchers found that 48 percent of older adults admitted into hospitals after treatment at emergency departments showed signs of dehydration (Parent Giving).

Causes of Dehydration

As we age, several bodily functions decline that make us more susceptible to dehydration. When you add in other outside factors, such as the stomach flu, the combination can turn an otherwise healthy person, like Walter, into someone suffering from various medical issues. Causes of dehydration include:

Water loss. As we age, the body doesn’t hold as much water because we lose muscle mass, while our fat cells increase. By the time we’re 80, we have 15 percent less water than when we were 20, making our bodies more vulnerable to dehydration from even minor fluid loss.

Kidney decline. Starting around age 50, and becoming more serious around age 70, the kidneys begin to lose some of their ability to remove toxins from the blood. Because kidneys are less able to concentrate urine, we expel water more quickly as we age.

Less sensation of thirst. Older people lose the sensation of being thirsty, much as our taste buds decrease as we age. Also, some seniors may drink less because they fear incontinence.

Medications. Drugs such as diuretics, laxatives and angiotensin-converting enzyme inhibitors (used to treat high blood pressure, among other conditions) can cause more frequent urination or perspiration, which interferes with fluid balance. Psychotropic medications, such as antipsychotics, cause dryness of the mouth, constipation or urinary retention, which can affect hydration. Additionally, older adults are often taking several medications at once, further complicating the problem.

Illness. Vomiting is a major cause of dehydration, because of fluid loss. A fever has the same effect, and generally the higher your fever, the more dehydrated you may become. A combination of diarrhea and vomiting, as in Walter’s case, can increase the risk of serious health issues.

Older adults also tend to eat less, which can also mean less liquid intake. Nursing homes present their own challenges for hydration of elderly residents (see sidebar).

Severe Consequences of Dehydration

Dehydration can lead to serious complications, including (from the Mayo Clinic):

• Swelling of the brain (cerebral edema). Sometimes, when you're getting fluids after being dehydrated, the body tries to pull too much water back into your cells. This can cause some cells to swell and rupture. The consequences are especially grave when brain cells are affected.


• Seizures. Electrolytes—such as potassium and sodium—help carry electrical signals from cell to cell. If your electrolytes are out of balance, normal electrical messages can become mixed up, which can lead to involuntary muscle contractions and sometimes a loss of consciousness.


• Low blood volume shock (hypovolemic shock). This is one of the most serious, and sometimes life-threatening, complications of dehydration. It occurs when low blood volume causes a drop in blood pressure and a decrease in the amount of oxygen in your body.


• Kidney failure. This potentially life-threatening problem occurs when your kidneys are no longer able to remove excess fluids and waste from your blood.


• Coma and death. When not treated promptly and appropriately, severe dehydration can be fatal.


• Heat injury. If you don't drink enough fluids when exercising vigorously and perspiring heavily, you may end up with a heat injury, ranging in severity from mild heat cramps to heat exhaustion, or potentially life-threatening heatstroke.

One researcher compares dehydration to a pump trying to work with less fluid, which puts a greater strain on the heart. For older adults with serious medical conditions, dehydration has been linked to increased rates of death. Despite what seems a trivial matter, the costs of not treating dehydration early can be high: a U.S. study in 1999 evaluated the avoidable costs of hospitalizations due to dehydration at $1.14 billion (from Hydration for Health).

How to Avoid Dehydration

To make sure you or someone you’re caring for is staying hydrated, the most important factor is to drink plenty of fluids. Standard advice is to drink at least five 8-ounce glasses of water daily. One formula is to drink the number of ounces of water daily that is equivalent to one-third of the person’s body weight in pounds. For example, a 150-pound woman would need 50 ounces of water daily, or about six 8-ounce glasses of water.

Nursing Home Dangers For nursing-home patients, the threat of dehydration is high. Those who are weak or frail often can’t get up on their own to drink. Studies of nursing homes have shown that liquids were often inaccessible to residents. For example, some nursing homes did not offer the proper kind of drinking cup, or caregivers placed the cup on a bedside table out of the patient’s reach. In one study of residents in a long-term-care facility, author Janet Mentes reported that 31 percent of patients were dehydrated (American Journal of Nursing). In fact, dehydration is among the most common forms of elder abuse and neglect associated with assisted-living facilities, according to the Nursing Home Abuse Guide. In one study, researchers found that nearly all of the 40 patients monitored were inadequately hydrated. Most nursing homes experience high support-staff turnover, and employees are not always well trained, especially on the need to keep patients hydrated. If your loved one is in a nursing home, make sure they are getting enough fluids every day. Let the staff know about vision and other physical impairments, as well as if the person needs to have thickened liquids.

Although water is the best beverage choice, to motivate someone to drink, you may need to cater to their preferences, such as fruit juice. (However, if the individual is diabetic, caution should be used because of blood glucose values and dietary restriction of sugars) or decaffeinated coffee and tea. Avoid alcohol and caffeine, which have a diuretic effect, causing the kidneys to excrete more water. Caregivers should ensure the older person they are caring for has water by their side at all times—for example, on a bed stand or next to their favorite chair—especially if they do not walk much.

In addition, if the individual has a swallowing problem and needs thickened fluids, this needs to be watched carefully to avoid aspiration of liquids into the lungs. If dehydration is suspected, because the person is not drinking or does not have a normal urine output, a temporary solution could be a sports drink, which has electrolytes needed by the body. However, caution needs to be taken to not over-consume because of the sports drink’s higher sodium content.
Eat high-water-content fruits such as watermelon, berries, grapes and peaches. Water-rich vegetable options include tomatoes, lettuce and summer squash. Soups are also a good way to sneak extra liquid into a diet.

Check urine color to make sure it is clear or pale yellow. Dark urine or infrequent urination is a classic sign of dehydration, as is decreased urination and urine output.

Other signs of dehydration to watch for are:

• Dry and sticky mouth
• Thirst
• Dry skin
• Confusion and irritability
• Sunken eyes
• Unconsciousness or delirium
• Difficulty walking
• Dizziness or headaches
• Inability to sweat or produce tears
• Rapid heart rate
• Low blood pressure
• Constipation

---

Sources

“Oral Hydration in Older Adults: Greater awareness is needed in preventing, recognizing, and treating dehydration,” June 2006, American Journal of Nursing

“Hydration and the elderly,” Hydration for Health

“Prevention of Dehydration in Independently Living Elderly People at Risk: A Study Protocol of a Randomized Controlled Trial,” Oct. 19, 2015, International Journal of Preventive Medicine

“Dehydration,” Nursing Home Abuse Guide

“Dehydration: Risk factors,” Mayo Clinic

“Dehydration: A Hidden Risk to the Elderly,” Parent Giving

“Elderly Dehydration: Prevention & Treatment,” April 21, 2015, A Place for Mom

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

2016 Service to Seniors Award

The Society of Certified Senior Advisors seeks to recognize the outstanding achievements of Certified Senior Advisors (CSAs) through the 2016 Service to Seniors award program.

Every day, Certified Senior Advisors demonstrate their deep caring and respect for older adults by serving the senior community through the CSA Difference. Whether initiating programs, participating with senior organizations or making the vital connection with a senior in need, CSAs are making a lasting impact in the lives of the older adults they serve through volunteerism.

The Society of Certified Senior Advisors is currently searching for 2016 Service to Seniors award applicants. If you are one of these highly-motivated volunteers we invite you to share your story by entering the 2016 Service to Seniors award program.

The winner of the award will receive:

• $500 donation to a non-profit senior service organization of their choice.
• Free registration to the 2016 CSA Conference in Washington, D.C. August 26 – 28.
• Travel and hotel accommodations to the 2016 CSA Conference.
• Recognition during the Service to Seniors award ceremony.

How to Apply

To apply for this award, please complete the following online application and submit, along with a letter of recommendation.

For more information, call Judy Rough at 800-653-1785 x 112 or email judyr@csa.us or fax 303-757-7677. If you want to email the letter of recommendation or any supporting documents use the subject line [S2S Award – YOUR LAST NAME]

All applications must be received by May 31, 2016 in order to be considered.

Please submit an application for yourself or nominate another CSA for the opportunity to join Service to Seniors alumni who have demonstrated deep respect and compassion for older adults and work to improve their lives through volunteerism.

Service to Seniors Alumni:

• 2015 – James Blythe, CSA – Donated to Alliance for the Brave
• 2014 – Khristine Rogers, CSA – Donated to Alzheimer’s Association
• 2013 – John “Skip” Frenzel, CSA – Donated to Heart of the Valley
• 2013 – Lisa DeMascio, CSA – Donated to Alzheimer’s Association
• 2013 – Sandy Archdale, CSA - Donated to Senior Services Snohmish Cty

Requirements and Rules for the Service to Seniors Award

1. The person who is applying for the award must be a CSA.
2. As a Certified Senior Advisor, you may apply yourself; or any other person or organization may nominate a CSA.
3. Volunteer activities must be performed in connection with or for a senior-related organization or community cause.
4. A completed application form and letter describing the volunteer service must be submitted together.
5. In addition to the application form and letter you may include testimonial letters from seniors, the volunteer organization and others, as well as other materials such as photographs that help describe the accomplishment.
6. Provide the contact information of one or more persons who can give more details to the selection panel, if needed.
7. If selected, the winner must be present at the 2016 CSA Conference in Washington, D.C. SCSA will cover all hotel, registration and travel expenses for the winner.

Optional Questions to Help You Write an Application Letter

• What is the name of the volunteer program or activity?
• Approximately how long has the volunteer program or activity been in existence?
• What was the issue the volunteer program was trying to solve or what is their mission?
• Describe what was done to fulfill the mission:
  • How did the applicant for the award work to make it happen?
  • Include descriptions of how the applicant displayed qualities such as initiative, resourcefulness, dependability, or the ability to develop relationships; the amount of time that was invested; and other things that stood out as special and/or extraordinary.
• What were the results of this volunteer service?
• How are the seniors’ lives different as a result of the volunteer service? This can include the effects on seniors’ caregivers and immediate family members.

Gratitude Linked to Positive Emotions and Good Health

Studies show gratitude increases a sense of well-being and happiness, as well as boosting the immune system and heart health.

Some of us grew up with parents encouraging us to eat our vegetables by telling us that children were starving in China. In other words, be grateful that you have boiled carrots and peas to eat. We may not have made the connection when we were young, but as we grew older, many of us adopted the practice of bowing our heads and giving thanks for the food on the table.

While many religions have emphasized gratitude for centuries, research is giving the concept renewed attention by showing its many health benefits. Studies indicate that positive emotions and actions, such as happiness, optimism and being sociable, can reduce stress and therefore decrease disease and promote longevity.

Benefits of Gratitude

Many studies link grateful feelings or actions to improvements in physical and emotional health. According to research, gratitude:

• Strengthens the immune system and lowers blood pressure
  
• Raises levels of positive emotions
  
• Creates more happiness and optimism
  
• Decreases aggression
  
• Reduces loneliness and feelings of isolation
  
• Boosts heart health
  
• Improves relationships, both with old and new friends as well as spouses/partners
  
• Decreases aches and pains
  
• Improves sleep
  
• Increases empathy
  
• Boosts sense of well-being
  
• Improves self-esteem
  
• Helps overcome trauma disorders

Grateful people tend to be more optimistic, a characteristic that researchers say boosts the immune system. Also, grateful and optimistic people tend to be healthier because they have the energy and motivation to exercise more, eat a healthier diet and get regular physical exams.

When people thank others, they are widening their circle and seeing themselves as part of a larger world. Such feelings are linked to a healthier outlook on life and better health.

Website Embraces Gratitude gratefulness.org There’s even a website dedicated to gratefulness. The sponsoring organization was cofounded by a Benedictine brother, David Steindl-Rast, who writes about how he learned to be grateful while growing up during World War II in Germany. ”Towards the end of the war, we had nothing to eat. We were just really starving . . . and when you have so little, you are so much more grateful for the little that you have.” He points out that poor people are usually more grateful than rich, because “their vessel is very small. The smallest thing makes it already overflow; and this sparking of life, this joy of life, is the overflow. It’s the overflowing with gratefulness and thankfulness.” The website offers a daily question that Steindl-Rast answers, monthly Grateful News—in February reporting on the California desert blooming after a drought, the election to the British Columbia legislature of its first aboriginal female member and an Oklahoma restaurant owner who extended an invitation for a free meal to homeless people—a library of resources, a variety of sample practices and the opportunity to network with others.

Where Do You Start?

Being grateful is not always easy, especially if you are going through hard times. In fact, getting older makes gratitude more difficult because of age-related challenges: losing friends, decreasing physical abilities, worrying about money or perceiving our lives as diminished.

At this time of life, it’s even more important to focus on what there is to be grateful for: new grandchildren, a sunny day, a good meal or close friends. In fact, research has shown that people who endure major life challenges—fighting cancer, watching a loved one die or even living through 9/11—often learn to appreciate the small things. One man battling lung cancer walked out of the hospital one day and was enchanted by the song of a bird.

Even forcing yourself to be grateful can have results, experts say, pointing to a famous study in which people were told to hold a smile for 20 seconds. Even if they weren’t happy, just the physical action made people feel better.

Here’s a few ideas to get you started:

Keep a gratitude journal. Every day, write down who or what you are grateful for. This can include small things, like someone opening the door for you at a store or restaurant. Record your appreciation for a good job, your health or a gorgeous sunset.

Thank others. This can be in the form of a thought—a silent acknowledgement of someone who has helped you—or as a note or phone call to express your appreciation.

Pray or meditate. Praying or focusing on the present moment can often engender feelings of gratitude. Many religions emphasize, often with prayers, the importance of gratitude.

Look back. Call to mind those who have helped you in the past: grandparents, a teacher, neighbor or friend you’ve lost touch with. In your life, you’ve had many encounters with people who touched you in some way. Be grateful for them.

“Grateful living is a way of life which asks us to notice all that is already present and abundant—from the tiniest things of beauty to the grandest of our blessings—and in so doing, to take nothing for granted. . . . Small, grateful acts every day can uplift us, make a difference for others, and help change the world”

— Gratefulness.org

---

Sources

“Boost Your Health With a Dose of Gratitude,” WebMD

“Choose to Be Grateful. It Will Make You Happier,” Nov. 21, 2015, New York Times

“Expanding the Science and Practice of Gratitude,” Greater Good Science Center

“7 Scientifically Proven Benefits of Gratitude That Will Motivate You to Give Thanks Year-Round,” Nov. 23, 2014, Forbes

“10 Reasons Why Gratitude Is Healthy,” July 21, 2014, Huffington Post

“In Praise of Gratitude,” Harvard Mental Health Letter

Gratitude Linked to Positive Emotions and Good Health is a featured article in the March 2016 Senior Spirit newsletter.

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

How to Choose Your Next Computer

There are many factors to weigh when buying a computer, but the first one is to decide what kind of tasks you plan on doing with your computer.

If you’re buying a new computer (or even your first one), how do you decide? The first priority is to figure out what you need or want: a place to check email and your Facebook page or to play games? Or do you require something more serious, a place to write your blog or edit your photos? Your answer will dictate whether you need a more powerful desktop computer or a smaller and more portable laptop.

You may already know whether you prefer an Apple or Windows operating system (think of it as the mastermind behind your computer). Windows is available with various computer brands, while Apple uses its own system. Apple computers are generally more expensive, though most computer pros consider them to be the best.

Desktop or Laptop?

When deciding between a desktop or laptop, there are several factors to consider. Desktops are bigger and generally have more power and storage, so they are better for complex tasks, such as photo editing or playing games. The separate monitor (display screen) can be as big as you want because you don’t have to carry it around. Though larger, desktops are less expensive than laptops because it costs more to make smaller components. With a desktop, you can change out the parts when new technology comes along, which is not possible with laptops.

Because of its smaller size, a laptop computer is more portable, with a built-in keyboard, mouse and monitor, and its functions are more limited than with a desktop. If you don’t need much more than an Internet browser or word processor, a laptop would do the job. Keep in mind that a laptop uses built-in, rechargeable battery power when you are not plugged in to an electrical outlet. When choosing a laptop, consider the battery life, as different models boast varying battery power.

One popular type of laptop is the tablet, such as Apple’s iPad, which is smaller and even more portable than a traditional laptop. A tablet will let you check your email, get on the Internet, watch movies, listen to music, read e-books and take photos. Typically, instead of a keyboard, tablets use a touch screen, which allows only for simple tasks. They have less power than a laptop, so you can’t do all the things you would do on a laptop or desktop, such as data entry or photo and video editing. Tablets have a smaller storage space than laptops (16 to 128 gigabytes [GB] compared to 500 GB or more for a laptop). However, tablets are generally more affordable and have a longer battery life. Older adults, especially those who don’t use their computers for complex tasks, find the tablets more user-friendly and like the portable option.

Nuts and Bolts

When deciding between individual computers, check out the numbers:

Storage. All your data—photos, music, programs, documents—are stored on your computer’s hard drive, so the more data you have, the bigger the hard drive you’ll need. Average users need about 500 GB.

Memory/RAM. Temporary information is stored on your computer’s RAM, so if you have a lot of programs running, a sufficient amount of RAM will keep your computer humming along without crashing or slowing down. RAM is measured in GB, so the more storage you have, the faster your computer will be.

Processor. This is the brains of the computer and is measured in gigahertz (GHz). So, the bigger the number of GHz, the more data the computer can process in a shorter amount of time.

---

Sources

“For Seniors: How to Choose a Computer,” For Dummies

“How to Choose a Computer,” Wikihow

“9 Key Things to Know Before You Buy a New Computer,” Nov. 1, 2015, CheatSheet

“How to Choose Your Next Desktop, Laptop or Tablet PC,” ComputerGeeks2Go

“3 Key Features of Tablet PCs,” ComputerGeeks2Go

“10 Types of Computers,” HowStuffWorks

“Types of Computers ,” AsktheComputerTech

“Laptops vs. Tablets: The Ultimate Showdown,” Aug. 22, 2013, PCMag

How to Choose Your Next Computer is a featured article in the March 2016 Senior Spirit newsletter.

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

What’s in a Name?

While pundits wrestle with what to call those who are getting older— seniors, elders, super adults?—a poll showed that most persons who are aging don’t really care.

In the last few years, the media, in particular, have been looking for a new term for “old people.” Elders? Senior citizens? The problem, most agree, is that older adults—that’s us—don’t think of themselves as old. Marketers avoid using any reference to age, instead pitching a new lifestyle. Elderhostel got rid of “elder” and became Road Scholar. Those who know the code can usually figure out the references.

When referring to older adults, Ina Jaffe, the NPR correspondent who’s been a journalist for more than 65 years, has had to figure out the most useful phrase to use in her reports. “Since the early 20th century, we’ve added at least 30 years to the average life expectancy,” she said, “and the language just hasn’t caught up with that.”

One problem is that one term or word, like “seniors,” is used to encapsulate everyone from 65 to 100 or more, which doesn’t accurately reflect the changing lives of everyone in that age group. Another problem is that what we think of as old or aging is being revised upward, as people live longer. Maybe the most difficult problem in this society is that any connotation of “getting up there” is viewed in negative terms.

When Next Avenue polled its readers about a new term for seniors, the votes were somewhat evenly divided between “older adult,” “senior,” “elder” and “super adult.” The term “Gener-Ager” garnered only minimal support. The winner: “I don’t think we need a term at all.”

Maybe we just need to stop using labels or start thinking about aging in positive terms.

What is your prefered term for people over the age of 65?

— SocietyCSA (@SocietyCSA) March 9, 2016

---

Sources

“Should We Say ‘Super Adult’ Instead of ‘Senior Citizen’?” Feb. 10, 2016, Next Avenue

What’s in a Name? is a featured article in the March 2016 Senior Spirit newsletter.

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

FAMOUS & 65

Look Who’s Turning 65

March 17—Kurt Russell

Kurt Russell started his acting career early. His first roles were as a child in television series, including a lead role in the Western series The Travels of Jaimie McPheeters (1963–64). In the late 1960s, he signed a 10-year contract with Walt Disney Company, where he became one of the studio's top stars of the 1970s.

As an adult, he starred in Silkwood (1983), for which he was nominated for a Golden Globe Award for best supporting actor. During the 1980s, he starred in several films by director John Carpenter, including anti-hero roles such as an army hero-turned-robber in the futuristic action film Escape from New York and its 1996 sequel Escape from L.A., an Antarctic helicopter pilot in the horror film The Thing (1982) and a truck driver in the kung-fu comedy action film Big Trouble in Little China (1986), all of which have become cult films. He was nominated for an Emmy Award for the television film Elvis (1979), which Carpenter also directed.

In 1993, he starred as Wyatt Earp in the western film Tombstone, and in 1994 in the military science-fiction film Stargate. In the mid-2000s, his portrayal of U.S. Olympic hockey coach Herb Brooks in Miracle (2004) won critics’ praise. In 2006, he appeared in the disaster-thriller Poseidon and, in 2007, in Quentin Tarantino's Death Proof segment from the film Grindhouse. In 2015, Russell starred in the western films Bone Tomahawk and The Hateful Eight. Since 1984, he has been in a relationship with actress/comedian Goldie Hawn.

---

March 18—Ben Cohen

Ben Cohen is co-founder of the ice cream company Ben & Jerry's. Raised in the town of Merrick on Long Island, Cohen first met and befriended his future business partner Jerry Greenfield in a seventh grade high school gym class in 1963. In his senior year, Cohen found work as an ice cream store clerk before heading off to attend college. Over the next decade, Cohen mixed further education with various menial labor jobs, including a McDonald's cashier, before becoming a craft teacher at a private school for emotionally disturbed adolescents. At the school, he began experimenting with making his own ice cream.

Around 1977, Cohen and Greenfield opened Ben & Jerry's Homemade Ice Cream Parlor in Burlington, Vt. In part, their distinctive style of ice cream derived from Cohen’s anosmia—his loss of smell and near-loss of taste—which required him to add larger and larger chunks of chocolate and other sweets to the ice cream to satisfy his need for texture in food. The first store’s popularity resulted in a nationwide business and one of the largest ice cream companies in the United States.

In 1996, Cohen resigned as chief executive officer and has not been actively involved with the company since the Unilever acquisition in 2000, apart from his membership on the advisory board. Instead, he channeled his newfound wealth into various social causes, generally through the Ben & Jerry's Foundation. The foundation receives 7.5 percent of all Ben & Jerry's pretax profits and distributes funds to organizations such as the Committee for a Better New Orleans and Communities for Clean Water.

---

March 23—Ron Jaworski

Ron Jaworski is a former football quarterback and currently an NFL analyst on ESPN. Starting out with the Los Angeles Rams in 1973, he led the team to a playoff win in 1977. Traded to the Philadelphia Eagles, he became the leader on offense in 1980 and was named the UPI “NFL Player of the Year.” He left the Eagles in 1985 and went to the Kansas City Chiefs in 1989 where, at one point, he and center Mike Webster formed the second oldest starting QB-center combo in NFL history. Following that season, he retired as an NFL player, with the record (since broken) of most consecutive starts by a quarterback.

In 1987, while still an NFL player, Jaworski started his broadcasting career as the sports director on a morning show in Orange County, California, and worked for other shows before becoming part of ESPN's broadcasting team on Monday Night Football in 2006. In 2012, he left that position to become an NFL analyst on other ESPN programs. Jaworski is part owner and team president of the Philadelphia Soul of the Arena Football League and owns and operates several country clubs in New Jersey. In 2010, his first book, The Games That Changed the Game, was published, which highlights seven games in NFL history that greatly changed the strategies and tactics used in NFL football.

---

March 24—Tommy Hilfiger

Tommy Hilfiger, a fashion designer, is best known for founding the lifestyle clothing brand Tommy Hilfiger Corp. in 1985. He started his career by co-founding a chain of clothing and record stores in upstate New York in the 1970s, for which he designed preppy sportswear for his own eponymous menswear line in the 1980s. The company later expanded into women's clothing and various luxury items, such as perfumes, and went public in 1992. Hilfiger's collections are often influenced by the fashion of music subcultures and marketed in connection with the music industry, with celebrities such as American R&B icon Aaliyahin the 1990s. In 2005, the CBS reality show The Cut featured contestants competing for a design job with Hilfiger. In 2006, he sold his company for $1.6 billion to Apax Partners, and it was sold again in 2010 to Phillips-Van Heusen for $3 billion. Hilfiger remains the company’s principal designer, leading the design teams and overseeing the entire creative process. In 2012, he was awarded the Geoffrey Beene Lifetime Achievement Award from the Council of Fashion Designers of America.

In 1997, Hilfiger published his first book, All American: A Style Book, and he has written several since, including Tommy Hilfiger in 2010. In it he wrote: “Maybe it’s the small-town boy in me, but I’ve always loved the prep school look, traditional Ivy League, and the clothes that sailors and jocks wear. I wanted to take these familiar old things and give them a more laid-back attitude, to make them modern and cool. . . . [With Tommy Hilfiger Corporation in 1985], finally, I felt like I was doing work that felt natural, that felt good. The brand we were building felt so honest, so true to who I am, that it didn’t feel like a struggle at all.”

---

Source: Wikipedia

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

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

There’s No Reason to Save All Your Financial Records

You only need to keep some statements and bills for a year.
Tax season is a good time to throw away unnecessary documents
—and get rid of some clutter.

While filing your 2016 taxes and digging through years of receipts and old files, you may wonder if you really need to keep all your documents going back to the time when the Beatles sang “I Wanna Hold Your Hand.” So what can you get rid of? Experts say you need to keep some records forever, but you can dispose of others after a few years.

Tax Documents

The IRS advises you to save your tax returns for a minimum of three years. Generally, the tax agency can audit you three years from the filing or due date of the return, and you have three years to claim a refund. However, if you failed to report more than 25 percent of your gross income, the IRS has six years to assess an additional tax, and if you don't file a tax return at all, there is no statute of limitations.

However, many financial experts say you should save your returns forever. MarketWatch tells the story of one man preparing to retire who discovered that his Social Security record showed he was short by two years for retirement benefits. Unfortunately, he had shredded all the tax returns that would have shown he had worked enough quarters to qualify for benefits immediately. He couldn’t get help from IRS records either, because the tax agency didn’t have electronic transcripts going that far back. So he ended up working two more years to qualify.

Another reason to keep your tax returns is that they can be helpful when settling estates, applying for a mortgage or disability insurance, or tracking down the value of certain assets. In fact, some creditors and insurance companies require you to keep records longer than the IRS does.

Also save supporting documents for at least three years, although some experts say to keep those forever, too. Documents can include copies of your W-2 forms; 1099 forms reporting interest, dividends, capital-gains distributions and other income; canceled checks and receipts for charitable donations; and records showing eligible expenses for other deductions and credits (and eligible expenses for health saving accounts and 529 withdrawals).

Retirement Plans

Keep records showing how much you deposited and withdrew from your IRA and 401(k) accounts. Don’t shred your IRA Forms 8606 until you withdraw all of the money from your individual retirement account(s). You may need them to prove you’ve already paid taxes on the contributions and won’t be taxed on them again. Experts say to keep tax forms for retirement accounts such as IRAs until seven years after the account is depleted.

Stock and Mutual Funds

Hang on to your quarterly investment statements until you receive your annual statement so you can check to make sure they match. Experts say to keep annual statements for three years after you sell the investments.

When it comes time to sell your stocks or mutual funds in taxable accounts, you’ll need the original records showing the purchase date and price so you can establish the cost basis and determine whether it’s a loss or gain. Although brokerages are required to report the cost basis of stocks purchased in 2011 or later and mutual funds and exchange-traded funds purchased in 2012 or later, it’s helpful to keep your own records, especially if you switch brokers.

Your Home

As long as you live in your home, keep the records showing the purchase price of the home as well as how much you spent on improvements. For one thing, if you make a nice profit on the sale of the home (more than $250,000 for those who are single and more than $500,000 for couples), you can reduce your tax bill by subtracting the cost of major home improvements (not repairs). Also, potential buyers may want validation for any home improvements you did. After you sell the house, keep the sale documents for three years as documentation for capital-gains tax.

Make sure you keep receipts and warranties for major household items, such as furniture, appliances and electronics, so you can return the items if needed. You can get rid of a warranty when the coverage period has passed, and the receipt when you no longer own an item.

If you have property at home, such as office equipment used for a small business that you may want to amortize, depreciate or sell, you may want to keep the sale records until the statute of limitations expires for the year in which you dispose of the property.

How to Safely Store Documents For documents you need to save, experts stress that it’s important to have a good system, not least because you’ll be able to find them easily if you need them. In an electronic age, you now have two choices for where to store crucial documents: in a traditional file cabinet or safe deposit box, or on your computer or the cloud. Always store important papers, like birth certificates, in a safe deposit box or other fireproof container. A paper filing system with labeled folders needs to be well organized, as does a system online. If physical space is tight, you can scan your documents and save them digitally on your computer. However, you need to back up electronic files, either on a hard or storage drive, or on a Web storage site, such as Dropbox. Make sure the online storage site has a good reputation, encrypts the information and offers automatic backup and good technical support. Increasingly many financial institutions, including banks and brokerages, provide online access to customers’ account statements for a few years, so you can always check your records online (or download them onto your computer) without keeping paper statements. When it comes time to get rid of monthly bills or receipts, to lessen the risk of identity theft, make sure you shred the documents rather than dump them in the trash.

Insurance records. Keep policies that you renew each year, such as those for your home, apartment or car, until you get new policies. Then get rid of the old ones, although some experts advise holding on to the old polices for three years.

Purchases. You can hang on to your sales receipts until you receive the credit-card or bank statement (if not paying with cash) or until the warranty or return period expires. However, if you need the sales receipt for tax purposes, you should keep it for three years.

Paycheck stubs. Keep for one year, until you can compare stubs to your W-2 and annual Social Security statement at the end of the year.

Utility bills. Keep for one year, unless you have a home office and you’re filing these expenses as a deduction, in which case you need to keep the bills for three years after you've filed your tax return.

Bank accounts. Keep canceled checks and bank statements for one year, until you finish your taxes, unless you need them to prove deductions, in which case you should keep for three years. After you reconcile your deposit and ATM receipts with your monthly checking and saving account statements, you can discard them.

Credit card receipts. Keep for one year, unless you need the receipt to support a tax deduction, such as for a charitable contribution, in which case you need to keep for three years.

Vehicle records. Hold on to purchase receipts, titles and registration information as long as you own the car, boat, truck or other vehicle.

Crucial documents. Records that you should store forever and in a safe place include marriage licenses, birth and death certificates, wills, records of paid mortgages, Social Security cards and military discharge papers.

Credit card receipts. Don’t dispose of loan information until after the mortgage, vehicle, student or other loan is paid off.

---

Sources

“Store or Shred? How Long You Should Hang onto Tax Records,” Aug. 18, 2013, H&R Block, Anna Sandall- Guest Contributor

“Records: What’s the Bare Minimum That You Must Keep?,” July 8, 2014 , H&R Block

“Financial Clutter, What To Keep And What To Get Rid Of,” Suze Orman

“Paper Records: What to Toss, What to Keep,” February 2010, Kiplinger

“Don't Throw Away These Tax Records,” March 30, 2015, Kiplinger

“Never throw away your tax returns,” April 22, 2013, MarketWatch

“Tax Documents: What to Shred, and What to Keep,” May 8, 2015, New York Times

“Conquer the paper piles,” March 2010, Consumer Reports

“Think Outside the Shoe Box When Organizing Financial Records,” 360 Degrees of Financial Literacy

There’s No Reason to Save All Your Financial Records is a featured article in the March 2016 Senior Spirit newsletter.

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

Medicare to Pay for End-of-life Talks with Doctor

Under a new law, patients can discuss their medical options and goals in order to make an informed decision on the type of care they want.

For the first time, Medicare will pay this year for a conversation with your healthcare provider about your end-of-life care. When Congress attempted this coverage six years ago, it was met with charges that such conversations would result in “death panels.” Yet polls show that a majority of Americans want to talk to their doctors about their options and preferences as they approach the end of their lives. A recent Kaiser Family Foundation survey found that about 9 in 10 adults say doctors should discuss end-of-life care issues with their patients, yet only 17 percent of adults say they have had such a discussion.

Even though most adults (90 percent) say they would prefer to receive end-of-life care in their home if they were terminally ill, only about one-third of Medicare beneficiaries (age 65 and older) died at home (Kaiser Family Foundation). Conversations with healthcare provider about such wishes could guide you and your doctor to the kind of treatment that would ensure you die where you want.

Under the new rule, Medicare pays $86 for the first 30 minutes of “advance care planning” in a doctor’s office and $80 for the service in a hospital. In both settings, Medicare will pay up to $75 for 30 additional minutes of consultation. If the discussion takes place during your annual wellness visit, it is considered a preventive service and the patient's coinsurance and deductible are waived. These voluntary discussions can take place at any time, not just when a patient is facing a serious illness or death.

Ideally, end-of-life conversations would cover a range of concerns, including understanding the patient’s prognosis and goals. Do you want everything done that would keep you alive—chemotherapy, CPR, tube feeding—even if it doesn’t meet your wishes for your end of life? Be specific about treatments and interventions you do and do not want.

Benefits of the Conversation

Far from forcing people to accept treatments that would shorten their lives, communication with your healthcare provider can help ease your fears, minimize pain and suffering and enable you and your family to experience a peaceful passing. Those who are dying often have many fears—of pain, indignity, abandonment and the unknown. By talking to your healthcare provider, your end-of-life care can become an experience of choice rather than passivity, of empowerment rather than powerlessness, experts say.

An end-of-life conversation allows your loved ones to know what to expect and know that you are receiving the care you desire. The new policy will help seniors "make important decisions that give them control over the type of care they receive and when they receive it," the Centers for Medicare and Medicaid Services stated.

Studies have shown that advance-care planning improves the patient’s quality of care because it’s targeted to what the person wants. Directed treatments can reduce the costs of medical interventions that the patient either doesn’t want or doesn’t need.

One Woman's Story

For Amy Berman, a nurse, being able to have such conversations with her doctors “allowed me to survive, and live well, in the five years since my diagnosis” of a fatal form of breast cancer.

“Faced with an incurable disease and a prognosis where only 11 to 20 percent survive to five years and there is no statistic for 10-year survival because it so rarely happens, I came to understand that my priority was to seek a ‘Niagara Falls trajectory’—to feel as well as possible for as long as possible, until I quickly go over the precipice. Quality of life is more important to me than quantity of days, if they are miserable days.”

A nationally recognized expert in care of the aged and a senior program officer at the John A. Hartford Foundation, Berman wrote about her experiences in her blog. She chose a course of treatment that “slow[s] the cancer’s spread with the least amount of burdensome side effects,” while rejecting chemotherapy drugs, a mastectomy and radiation therapy recommended by one doctor who never asked what mattered to her in her life. Such radical treatment would have “compromised the quality of my remaining life without any real benefit.”

Even though her cancer has spread a bit farther, “because my treatment focuses on helping me live well and feel well, I haven’t been in the hospital. I feel great.” Berman estimates she has “saved about a million dollars by avoiding care I do not want,” while being able to work full time, travel and spend time with family and friends.

Suggestions for Your Talk

Lining up Your Documents Going hand in hand with the end-of-life conversation with your doctor is the preparation of your advanced care directives, which can include a living will, Five Wishes and/or POLST (physician order for life-sustaining treatment). A living will is a written, legal document that spells out medical treatments you would and would not want to be used to keep you alive, as well as other decisions such as pain management or organ donation. Five Wishes goes beyond medical care to share your personal, emotional and spiritual concerns. The form includes questions about how comfortable you want to be, how you want people around you to treat you and what you want your loved ones to know when you’re facing the end of your life. These documents also indicate who can make decisions on your behalf if you’re unable to do so. Unlike a living will or Five Wishes, a POLST form is a medical order signed by a doctor and based on your end-of-life care wishes. It is used by emergency medical professionals, hospital staff, a healthcare facility and others to follow your instructions. Oregon’s POLST lets people register their wishes for end-of-life care with a state registry. Several states, including New York, Washington and West Virginia, have also adopted a version of the POLST.

Although Medicare has not provided any guidelines for a conversation about end-of-life care, others have. Dr. Atul Gawande is the leading thinker and writer on this subject. In his influential book Being Mortal, he talks about asking his patients what makes their life worth living. He goes far beyond what most doctors consider a conversation about end-of-life care, which usually involves resuscitation, mechanical ventilators and comfort care.

One patient said he would enjoy life if he could eat chocolate ice cream and watch football. For some people being able to be at home and spend time with grandchildren is important. Others don’t want to continue their lives if they can’t be active. Different answers result in different treatment plans; for example, less or more aggressive cancer treatment.

Gawande poses five questions for patients facing life-threatening illnesses:

1. What is your understanding of where you are and of your illness?
   
2. What are your fears or worries for the future?
   
3. What are your goals and priorities?
   
4. What outcomes are unacceptable to you? What are you willing to sacrifice and not?
   
5. What would a good day look like?

“Asking these allows everybody to understand what the goal really is,” he says. ”What are you really fighting for?”

The Conversation Project, an organization dedicated to helping people talk about their wishes for end-of-life care, poses slightly different questions for patients to ask their doctors:

• Can you tell me what I can expect from this illness? What is my life likely to look like six months from now, one year from now and five years from now?
  
• What can I expect about my ability to function independently?
  
• What are some possible big changes in my health that my family and I should be prepared for?
  
• What can I expect to improve (or not improve) if I choose this course of treatment, or another course of treatment?
  
• What can I expect if I decide to do nothing?
  

When meeting with your doctor, you can also discuss palliative care, which is concerned with providing seriously ill patients with relief from the symptoms and stress of a serious illness, rather than trying to cure the patient. It can be relief from pain, fatigue, constipation or depression, for example. The purpose is to improve your quality of life.

Once you’ve had the conversation with your doctor, follow up with your family and close friends and let them know your preferences, so they can honor your wishes.

---

Sources

“10 FAQs: Medicare’s Role in End-of-Life Care,” Nov. 5, 2015, Kaiser Family Foundation

“Atul Gawande’s 5 Questions to Ask at Life’s End,” Feb. 10, 2015, Next Avenue

“Medicare Says Doctors Should Get Paid To Discuss End-Of-Life Issues,” Aug. 19, 2015, NPR

“A Physician's Guide to Talking About End-of-Life Care,” March 15, 2000, National Center for Biotechnology Information

“An Open Letter to CMS: Medicare Rule Covering End-of-Life Conversations Would Be Lifesaving,” Sept. 29, 2015, J. Hart Foundation

“53 CMS Finalizes Advance Care Planning Regulation,” Medpage Today

“Medicare’s Move to Pay Doctors for End-of-Life Planning Falls Short,” Nov. 10, 2015 Time

“Medicare Approves Payment for End-of-Life Counseling,” Oct. 30, 2015, Medscape

“New Medicare Rule Authorizes ‘End-of-Life’ Consultations,” Oct. 30, 2015, New York Times

Medicare to Pay for End-of-life Talks with Doctor is a featured article in the March 2016 Senior Spirit newsletter.

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