Aging

Lactose Intolerance Can Sneak Up on Elders

By Carol Bradley Bursack -
 

Dear Readers: Several years ago, I used this space to highlight lactose intolerance, an issue many older adults face. Due to some recent questions, I felt it was time, once again, to share some anecdotes regarding this sometimes hidden problem.

Many of our elders enjoy milk, ice cream and other dairy products. In general, dairy products can provide valuable nutrition and needed calories, but dairy products contain lactose, a milk sugar that requires the enzyme lactase for proper digestion. Even people who’ve enjoyed dairy products for decades can gradually lose their ability to produce enough lactase to digest milk or other dairy products. When this happens, abdominal discomfort and diarrhea can result.

My 80-year-old neighbor, for whom I was a primary caregiver years ago, provided me with some education in this area. During one of our daily chats he confided to me that he was experiencing severe diarrhea. I was concerned about the many serious health issues someone his age could have, so I scheduled an appointment for him to see his doctor. His primary physician then scheduled him for a number of tests, all of which proved negative.

Since my neighbor seemed to have no alarming medical issues, I thought that an experiment was worthwhile. Lactase drops had recently become available over the counter at the pharmacy. The only dairy product that my friend consumed regularly was milk for his cereal, so I purchased some lactase and added the appropriate number of drops to my friend’s weekly quart of milk. Problem solved. He was able to enjoy his morning cereal and milk with no adverse effects.

Unfortunately, the source of lactose isn’t always this obvious. A reader wrote to tell me that his wife had suffered lactose intolerance for years, but had successfully worked around the problem. However, after his wife was diagnosed with Alzheimer’s disease, she was given new medications. She then began suffering from severe diarrhea.

“After fighting the problem for many months,” he wrote, “we found out that some of the medications she is on contain lactose. Not only that, lactose is considered to be a non-active ingredient, so it is not usually listed in the ingredients.”

The reader suggested that people who suffer from lactose intolerance ask a pharmacist to check all of the ingredients in their medications, including the non-active ones. The solution for this woman was to continue to take her medications, but to take a lactase enzyme pill at the same time.

Digestive issues can be a symptom of many serious illnesses, so always check with the doctor if your elder develops diarrhea or other severe digestive problems. If no other cause for digestive discomfort is evident and the doctor doesn’t suggest lactose intolerance, bring up the possibility. This is one of those health issues that can begin with such vague disturbances that it continues undetected for quite some time. Lactose intolerance can be managed once it’s discovered, but it may take some detective work. Remember to read labels on food items, as well. Some prepared foods also contain lactose.

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at www.mindingourelders.com. She can be reached at carol@mindingourelders.com.

Resources for Long Distance Caregiving

Helping Aging Parents from a Distance is Challenging

By Carol Bradley Bursack - 
 

DEAR CAROL: I live 500 miles away from my aging parents. They are starting to need some help, but they don’t want to move to be near me. My husband and I can’t quit our jobs and move back to our home town, either. How do I go about looking for help for Mom and Dad from so far away? – Lori

DEAR LORI: One option is to look for a geriatric care manager in your parents’ community. Hiring a geriatric care manager can run into some serious money, but a care manager should be well acquainted with resources available locally for your parents. Some care managers will work directly with your parents, even managing medications. Others will provide research and oversight, but not be involved with any hands-on care.

Geriatric care management is a relatively new field. At this time there’s no control over credentials, but many people who become geriatric care managers have social work or nursing backgrounds. The website for The National Association of Professional Geriatric Care Managers is www.caremanager.org. If you’re interested in this option, the NAPGCM website is a good place to start.

Another excellent resource for you is the Administration on Aging website at www.aoa.gov. There is significant information on the AoA site as well as a link to the Eldercare Locator. The Eldercare Locator, also accessible at www.eldercare.gov, will help you find resources by typing in your parents’ Zip code. If you prefer to talk with someone on the phone, call (800) 677-1116.

Other resources can be found on your parents’ state website. Type the name of their state into your Internet browser along with “aging.” Your search should pull up many helpful links to direct you to resources. Every state has a version of the Nation Family Caregivers Support Program, which can also be found on the state website.

If either of your parents have a disease such as diabetes or arthritis, there are disease specific websites you can locate with just a little searching on the Web. An additional website for resource questions is the Community Resource Finder at www.communityresourcefinder.org.

It’s important that your parents appoint you or someone else they trust as Power Of Attorney for financial purposes as well as health care. If this legal work hasn’t been done, you may need to visit an attorney with them.

None of these resources take the place of family members and friends. It would be nice if you could contact some of your parent’s friends to check in on your parents regularly. Also, of course, do try to see them yourself as often as possible. You can’t control everything that happens to them, but you should visit often enough to keep tabs on their general welfare, and if possible, accompany them to some medical appointments to stay aware of their medical needs. This is time you’ll never get back, Lori. You can “manage” from afar, but it takes personal touch and eye to eye contact to really connect.

Find other articles by Carol in our Caregiving library.

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at Minding Our Elders and a blog at www.mindingoureldersblogs.com.

Helping Mom Move on after Dad’s Death

By Carol Bradley Bursack - 

DEAR CAROL: Dad was sick for a long time before he died three months ago. Now, without Dad around, my sisters and I notice how much Mom has aged. We’d like Mom to move from her house into assisted living, because caring for the house is too much for her and she just stares at the TV all day. She says she’s not ready to move. How can we help her make the change? – Shawn

DEAR SHAWN: Long-term marriages often evolve into an efficient support system so it’s not unusual that your Mom’s aging was less apparent while your dad was alive. Likely, her grief over your dad’s death has taken a toll, as well. You may want to make an appointment with her doctor to rule out clinical depression or other issues just to be certain she’s okay.

I understand that you feel that your mom should sell the house and move, but try to be patient. This was her home with your dad. She may need several more months just to get enough of a grip on her life to think about moving. Unless her living alone is dangerous, don’t push too hard for a change.

Communicate with your sisters and see if there’s a way that you can split up time so someone can be with your mom often. Don’t force changes, but suggest one small step at a time. Maybe she will be able to slowly part with unneeded things around the house if one of you is there to help.

Do encourage her to have her legal papers updated as soon as possible. If your mother had your dad as her Power Of Attorney, she should now name one of you to take care of her financial and health interests if she cannot. If you bring this up gently, she may actually be relieved. If she says she can’t handle thinking about this now, set a date to discuss it again in a short while. Remind her that she wouldn’t have wanted strangers to make decisions about your dad’s health and she wouldn’t want that for herself. She needs to make sure someone who loves her can step in if needed.

Time is your friend. Pushing too hard for changes may emotionally paralyze her. Let her grieve. Occasionally test the waters with some suggestions. Perhaps, in a few months, you can take her to explore assisted living facilities so she sees people her age having a good time. If any of her friends live in a good retirement or assisted living center, recruit that friend to help with the transition.

Moving is a huge step for anyone. It’s even harder for someone who has suffered a life-changing event such as the death of a spouse. Compassion and patience will help you all get through this.

Find other articles by Carol in our Caregiving library.

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at Minding Our Elders and a blog at www.mindingoureldersblogs.com.

Use Caution When Hiring an Independent Caregiver

By Carol Bradley Bursack - 

DEAR CAROL: My mom is 89 and lives alone. Considering her age, she gets along in her apartment quite well. She wears a personal alarm so she can get help if she falls, and I stop in twice a day. Still, I worry. I’d like to hire someone to stay with her, at least at night. Recently, I was introduced to a nice college woman who said she has a background in caring for the elderly. She’d be willing to move in with Mom and take care of her needs. Part of her salary would be room and board. She has references and the family likes her. Could this work? Mel

DEAR MEL: You’re talking about an arrangement that many people would consider ideal, and it could be, but please do your homework before making a decision. This woman may truly be an angel and you could develop a wonderful partnership, but your mother is vulnerable, so it’s vital for you to be sure the caregiver is capable and trustworthy.

Good care agencies run a professional background check, plus they check references thoroughly. You should do the same. For the background check, don’t just rely on your computer search engine. Check state court records and general public records, as well. If you have a professional company run a check, you will likely get more complete results. Definitely validate her references, both personal and those she has given you, for her work with elders.

Even if this woman checks out wonderfully, and she likely will, you still need to understand that by hiring her, the state may consider you her employer. When you are the employer, you may need to pay into Social Security and worker’s compensation for your employee. You can find more information on the IRS website about independent contractors versus employees at www.irs.gov. You should also check with the Federal Department of Labor and your State Department of Labor for assurance that you are in compliance with laws regarding domestic workers.

I am not trying to dissuade you from hiring this woman. The partnership could work out beautifully. If she can be considered an independent contractor, you may not need to worry about liability and Social Security taxes, but for your own protection you need to be certain about the procedure.

You can find additional information through the Private Duty Homecare Association at www.pdhca.org or the National Private Duty Association at www.privatedutyhomecare.org. The sites, of course, are biased toward their members, but you may find them helpful.

At the very least, I’d suggest that you do a background check, a reference check and call the state’s Department of Labor for information about state laws. A live-in caregiver where everyone benefits can be ideal. You just want to make sure you have a truly honest, caring person living with your mom. Carol

Find other articles by Carol in our Caregiving library.

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at Minding Our Elders and a blog at www.mindingoureldersblogs.com.

Handling Veteran Non-Service Disability Pension Denial

What to do if your claim for Non-Service Disability Pension for Housebound and Aid & Attendance is DENIED.

by Rita Files - 

Did you know that 75% of claims filed for the VA Aid & Attendance benefits are denied the first time they are submitted? Many times it is due to lack of sufficient documentation, or the claim is not complete. The veteran or surviving spouse often gives up and ends up not taking advantage of this program.

The correct name of this benefit is the Non-Service Disability Pension; however, it is commonly referred to as the VA Benefit for Aid & Attendance. The purpose of the benefit is to supplement the income of Veterans and Surviving Spouses, or those who have high monthly out of pocket medical expense. A Veteran or Surviving Spouse must be age 65 or older and have served a minimum of 90 days in the military with one of those days during wartime. The additional monthly income can be used to pay for home care, assisted living, adult day care, family caregivers as well as recurring expenses for insurance premiums, pharmacy co-pays and more.

Veteran Files focuses primarily on assisting Veterans in attaining this benefit through the initial claim process, as well as with claims that have been denied. Through a comprehensive Care & Resource consultation, we help Veterans determine if they are eligible and whether to file for the benefit.

In the case of denied claims, we have had tremendous success with having the decision reversed; the Veteran or Surviving Spouse not only receives the additional income, but in most cases they also receive retroactive benefits from the date the VA was notified of the intention to file a claim. With experience in the eldercare industry as well as accreditation through the Department of Veteran Affairs as a Claims Agent, we thoroughly review the denied claim, file a notice of disagreement on the outcome and take the necessary steps to win a reversal on the outcome of the claim.

If you or someone you know has applied for the Non-Service Connected Disability Pension with Housebound or Aid & Attendance benefits and has been denied within the past year, contact us today for a review of the paperwork initially submitted. Our goal is to get your claim back on the right path to a successful outcome.

Veteran Files™ assists Senior Veterans, Surviving Spouses of Veterans and Veteran families navigate the complexities of the Non-service Connected VA Disability Pension for Housebound and Aid & attendance Benefits. Rita Files, founder of Veteran Files, is one of less than 250 accredited VA claims agents in the United States. Ms. Files has been working as an eldercare and Veteran for over 20 years.

More informaLearn more about Rita Files on her Author page.

Dr. Travis Stork interviewed about obesity and fitness

By Carol Bradley Bursack

Dear Readers: Do you or a loved one use age as an excuse to not bother with taking off weight? In a recent phone interview with Dr. Travis Stork of the television talk show “The Doctors,” I asked how we can encourage our aging loved ones to lose weight and exercise when they say it’s too late to do much good. Stork responded with an amused chuckle, saying that he hears that excuse “all the time.” He then went on to say “I don’t care if you’re 90… it’s a medical fact that it’s never too late to change behaviors.” He added that diet and lifestyle changes had “almost an immediate impact on quality of life and that saying it’s too late is medically inaccurate.”

During the month of May, “The Doctors” is focusing on obesity and lack of exercise as important causes of many serious health problems. They’ve dubbed the month “Get Moving May.” Educating overweight viewers to reduce their weight through a healthy diet and sensible exercise is the goal.

Stork is aware that many people hate exercise and most people hate diets. He doesn’t advise extreme workouts unless the person does this type of exercise for enjoyment, and he strongly opposes fad diets or diets that limit nutrients. What does he advise?

  1. Walking. Stork says that if people walk briskly for 10 minutes after every meal they are getting their 30 minutes of exercise without drastic change.
  2. Mindset. Stork says we should find a type of exercise we enjoy and can sustain. Our mindset is important so we need to set realistic goals and care about ourselves enough that we want to feel better and be healthier. Walking or bicycling (Stork’s exercise of choice) can include friends and family if the social aspect keeps people motivated.
  3. Standing. We need to stand more and sit less. Pace while we use the phone. Consider standing in line at the grocery store exercise. Stand to visit with your neighbor. Just being on our feet burns significantly more calories than sitting.
  4. Diet. Don’t try to change everything at once. Work with food preferences. Stork has mid-western roots and noted his preference for “meat and potatoes” rather than vegetables. He mentioned that he and his fiancé puree vegetables and then add them to marinara sauce for their pasta.
  5. Water. Stork suggests that we drink water before meals. He said that it’s been shown that people who drink a glass of water before eating will consume 20% fewer calories during the meal.

Summarizing Stork’s advice is simple. Take baby steps toward increasing exercise and diet and you’ll gain immediate health benefits. If you then build on your efforts you will enjoy long-term health benefits.

You are a wonderful daughter to care so much.

Learn more about Carol Bradley Bursack on her bio page.

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at Minding Our Elders. She can be reached at carol@mindingourelders.com.

Daughter Cannot Trust Mom Caring for Dad

By Carol Bradley Bursack

Dear Carol: My mother and I do not get along. She is manipulative and often nasty to me, so I have had to distance myself from the chaos. I keep intending to walk away completely, but I cannot do that because I want to help take care of my dad, or at least spend time with him.

He has Alzheimer’s and does not even know who I am, but I do not entirely trust my mother with him. I am not sure he is being cared for properly. If I ask questions about his care, or just day-to-day issues, she thinks I am criticizing her and emotions escalate. If I try and turn away, I get the martyr routine. I remind myself that this is not about us, it is about my dad, but it remains hard. Any advice? – Monica

Dear Monica: This is a tough, emotional situation and, unfortunately, not uncommon. My first thoughts are about your dad. If you have serious concerns about abuse or neglect, you need to call Social Services and ask them to do a welfare check.

If your concerns are not that serious, you will have to make choices. Trying to detach from your mother’s manipulation does require setting some personal boundaries. You will need to learn not to fall for your mom’s martyr routine or any other manipulations if you want to stay close to your dad.

Your mom may feel threatened when you try to help with care. Try to give the way you approach your mother some thought. Past hurts involving your relationship are likely still interfering with your relationship today. Are there any instances you can think of where you could apologize to her? I realize that this may seem unfair, and that some people have personality disorders that make it nearly impossible to get along with them, but occasionally reaching out in a non-threatening way can help people unite over a common objective.

Is it possible for you to get some counseling to help you vent your feelings and learn how to handle your issues with your mother so you can help care for your dad? Do you belong to a spiritual organization? A leader there may be able to help you. If you belong to a church, they may have trained Stephen Ministers who can listen to you and give you encouragement.

You are trying to do the right thing. A trained third party may be able to help you learn how to detach compassionately from your mother’s manipulations. You may also learn more productive ways to approach your mother.

Acquiring these tools could help you tread this delicate area and make it easier for you to help your dad. Good luck.

Read more about Carol Bradley Bursack on her bio page.

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at Minding Our Elders. She can be reached at carol@mindingourelders.com.

Dad’s Obsession over Wallet and Paying Bills Caused by Alzheimer’s

By Carol Bradley Bursack - 

Dear Carol: My dad has Alzheimer’s and lives in a very good nursing home. We visit often. What I’m wondering about is his habit of repeatedly taking his wallet out of his pocket and emptying out the contents. He then carefully puts everything back. He also tries to pay the nursing home staff when they help him. Telling him everything is paid for simply doesn’t work. Any insight? Julie

Dear Julie: I can say with confidence and sympathy that I know what you are going through, and so do many others. The situation isn’t uncommon, particularly with men. After my dad’s brain surgery, meant to correct some effects from a WWII brain injury, left him with severe dementia, Dad became obsessed about his wallet and with paying for everything.

Like many men, Dad’s wallet seemed to signal to him that he was still a provider. The other issue associated with his wallet may have been that his proof of identity is carried there. His driver’s license (lapsed), his credit cards, clubs he belonged to – all of these cards would have his name on them. That could have been reassuring to him. I believe that is what your dad is doing – looking to reassure his identity. Understanding what your dad’s billfold means to him can help you better understand his behavior.

Dad, too, couldn’t understand that he was already paying for everything at the nursing home. Generally, when a staff member helped him with something, he insisted on paying them on the spot. He did the same at meals. He’d get so upset when we’d tell him everything was paid for that I wondered, sometimes, if he felt that he was taking charity. Even telling him that they put everything on a “tab” to be paid at the end of the month didn’t alleviate his anxiety.

We tried leaving a few dollar bills in his wallet so he felt as if he had cash, but the low denomination of the bills made him feel “broke,” so that backfired. Next, I dug around until I found some expired credit cards with his name on them, and closed the accounts, but he didn’t use them.

My most successful solution was to make him “business cards.” When someone helped Dad, or he ate a meal, he offered his business card as payment. That way he felt responsible, and also had an ID, so I think it helped both wallet issues. The staff members were most gracious about accepting the cards. They even recycled them in an envelope hung in the kitchenette.
You’ll have to experiment and see if any of these suggestions work for your dad.
Try to remember that this too will pass. Carol

Read more about Carol Bradley Bursack on her bio page.

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at www.mindingourelders.com. She can be reached at carol@mindingourelders.com.

New Year’s Resolutions That Will Stick: 9 Cups of Water

By Elaine Magee - 

Have you had your daily cups of water today?

How many cups of water have you drunk today? Was it more than 8? We generally forget how important something as simple as water and hydration is to our daily health. Being over 50 only makes it more important. As we age, our thirst mechanism can get a little lazy so we cannot rely as much on this to guide our liquid intake. One study found older people may suffer from dehydration more often in hot weather because of aging nerves in their mouth, throat, and stomach. These thirst monitors are all sending weaker signals to the brain about needing water.

What’s a good amount of water too shoot for each day? According to the 2004 report from the Institute of Medicine on the Dietary Reference Intakes For Water, Potassium, Sodium, Chloride, and Sulfate, an adequate intake for drinking water and beverages for men and women (ages 19 to 70+ years) is about 13 cups (101 fluid ounces) for men and 9 cups (74 fluid ounces) for women. Keep in mind the ideal amount of water for you personally can depend on many factors such as the temperature, your weight and how long you exercise.

I make sure I have some water or tea near me almost all of the time. You can try buying 4, 16-ounce water bottles and numbering them with a marker from one through four. See if you get through all four bottles (which gives you 8 cups of water) by the end of the day. If you have a cup of tea, it counts as one of those 8 cups of water. Every time you drive in the car, bring a bottle of water (or another beverage) with you. Every time you exercise, take a water bottle with you. You’ll get to 8 cups a day before you know it!

That’s easy!

Elaine

You can read Elaine Magee’s bio to learn more about her. You find more articles by Elaine in the Health Nutrition section of our library.

Time To Find Your God?

By Rabbi Richard Address –

Eric Weiner, a former National Public Radio reporter, has just published a fascinating book entitled “Man Seeks God.” I mention it to you because it raises some interesting questions about our relationship (or lack thereof) with God. Questions posed by young and old alike.

The genesis of his book was a discussion Weiner had with a health care professional in a hospital. He was there thinking he was extremely ill. This health care worker, thinking the tests were going to be bad news, asked Weiner, “Have found your God yet?”

That simple question set Mr. Weiner off on a whirlwind exploration of various religions. Eric was trying to understand what each religion’s God was, and if he could adopt it for himself.

The book is quite relevant to many of us who are, in some ways, dissatisfied with the God that we were raised with. So many people are searching for some sort of meaningful faith that Weiner’s journey, in many ways, symbolizes the journey for many of us. We may not have the means to travel the world and spend weeks in various communities; but we are searching. That is the point, I think, of the book. I like the phrase, “have you found your God?” Our generation of baby boomers has pioneered the ability to create personal religious responses and, in many ways, hybrid definitions of God. This spiritual dynamism marks a clear reality across the religious landscape. It represents some real creativity on the one hand, and sadly, for some, a way to just do “religion lite.”

The search for our own God is a serious undertaking. It asks us to confront our own sense of self, our relationship with life and death and our own view of what we see as our legacy. In the New Year now beginning, I suggest that it is a perfect time to consider undertaking your own search. Looking for your God, unencumbered by “oughts” and “shoulds” may be a liberating and energizing experience. An experience you can start today and not left until you are older.

Shalom,

Rabbi Richard F Address, D.Min

Learn more about Rabbi Address on his bio page. Find more articles by Rabbi Address in Spirituality & Life section of our library.

Rabbi Address is author of the book “Seekers of Meaning: Judaism, Baby Boomers and the search for Healthy Aging”. You can learn more about Rabbi Address and his books at www.jewishsacredaging.com