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    Bob Mauterstock

    Are You a Likely Candidate for Alzheimer’s?

    I recently had the opportunity to participate in a radio series focusing on Alzheimer’s caregivers. My mom and I were interviewed by Sean Corcoran of WCAI radio, the NPR station on Cape Cod. The series was divided into five parts which were played on five different days. Sean did an outstanding job of illustrating many different family situations with a family member who has the disease. He has won many awards for his work and I am sure this series will be another award winner.

    Here is a link to the series: www.wgbh.org/wcai/alz2.cfm

    The research has shown that there are no specific strategies anyone can take to avoid the disease. No amount of crossword puzzles, brain teasers or mental exercises can protect your brain from Alzheimer’s. But according to Lisa Genova, author of Still Alice, the most incredible book I’ve ever read about an Alzheimer’s patient, early detection is valuable.

    Lisa states that, “Awareness leading to earlier diagnosis is important. Although the current drugs available for treating Alzheimer’s do not change the ultimate course of the disease, they can stave off its progression for a significant amount of time, allowing the person with Alzheimer’s to live on sort of a plateau, to enjoy the capabilities they still have for a longer time”

    Research has also shown that 50% of the children of Alzheimer’s patients will get the disease themselves. I am a child of an Alzheimer’s patient. Should I be tested to determine if I am likely to get the disease? Recent advances in testing can indicate if you have a very high likelihood of getting the disease but can’t tell you for sure if you will. So does it make sense to have the tests done or just let life take it’s course?

    At this point I have decided not to be tested but to live my life to the fullest and be conscious of the occurrence of symptoms. I checked with the Alzheimer’s Association and learned that there are ten indicators to be conscious of . If you have any of these ( or if a loved one does) check with your doctor:

    • Memory loss that disrupts daily life.
    • Challenges in planning or solving problems
    • Difficulty completing familiar tasks at home, work or at leisure
    • Confusion with time or place
    • Trouble understanding visual images and spatial relationships
    • New problems with words in speaking or writing
    • Misplacing things and losing the ability to retrace your steps
    • Decreased or poor judgment
    • Withdrawal from work or social activities
    • Changes in mood or personality

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    How to Find a Doctor for Your Mother

    I have been reading Jane Gross’s wonderful book, A Bittersweet Season. It is about her efforts to care for her mother in her last few years. Jane writes a blog for The New York Times entitled, The New Old Age. Not only is the book a very personal account of Jane’s experience with her mother, but it is the source of a lot of valuable information on caring for an aging parent.

    One of Jane’s problems was finding a family doctor for her mother when she moved from Florida back to the northeast to be close to Jane. She found it almost impossible to find someone that would take her mother.  Jane learned  a few facts about the medical profession that made things so difficult. First of all, fewer general practice physicians are coming out of medical school. These doctors just don’t make enough money. The average GP makes approximately $150,000 a year and their  loans from school are around $200,000. A typical anesthesiologist makes $400,000 a year. So medical  students are choosing to become much more highly-compensated specialists.

    Secondly, many doctors are choosing not to accept Medicare.  They can legally opt out of the program. Reimbursement from Medicare for various procedures is far less than what doctors often receive from insurance companies. In addition, reimbursement is not for time spent with a patient but for procedures ordered. If a doctor convinces an older patient not to have her hip replaced, he does not receive a dime. Often older patients take longer in an appointment than younger healthier patients, which also ends up costing the doctor more.

    Given these issues, Jane was advised to take the following steps when seeking a new doctor for her mother:

    First, get a referral from her existing doctor where Mom is now, before she moves. That doctor probably knows someone in the area she is moving to. That doctor will most likely be reluctant to turn down a referral from a peer.

    Second, get tightly-crafted summaries from her existing doctor and any specialists that have been involved. Less is more. The new doctor is much more likely to read something that is clear and concise.

    Third, if you can’t get a referral, scout the area for doctors in the area where Mom is relocating, before she moves. Check with local councils on aging, senior centers, medical societies, and similar organizations.

    Fourth, make it clear to the new doctor that one adult child will be the conduit for all communication. He won’t have to field calls from two or three siblings who all have questions. Prepare a plan within the family as to how communication will be disseminated from that key person. Show the doctor that you won’t waste his time.

    Lastly, the same sibling should accompany Mom to medical appointments and communicate the results to the rest of the family. A family that manages itself internally is more likely to find, keep and get the best service from a doctor.

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    Reprinted from Bob Mauterstock’s The Gift of Communication Blog. Subscribe at http://www.GiftofCommunication.com  and receive Bob’s Family Meeting Checklist Guide.

    Aging In Place

    In a recent AARP study, nearly 75% of adults 45 and older said they strongly desire to stay in their current home as long as possible. To make sure that you can “age in place,” you may have to make several updates to your home and your financial plan. Do not expect that your children or the government is going to step in and help you out. You need to create a plan to take care of yourself.

    In addition to concerns about transportation and the availability and cost of help, you need to take a serious look at your home. Don’t wait until there is a crisis to make needed improvements. Are your doorways wide enough to accommodate a wheelchair? A narrow wheelchair or walker needs clearance of at least 32 inches.

    Do you have your master bedroom on the first floor? If not, are the steps to the second floor steep and is the stairway narrow? You may have to consider some sort of stairway elevator to get up and down at some point. Do you have a full bathroom on the first floor? If so does it  have a walk in shower? Converting a bathtub to a walk-in shower may cost somewhere between $3000-5000. This is most likely one of your most costly changes.

    Look at your faucets and cabinet handles. Are they big enough to access with a closed fist? Check out your lighting. Older eyes need more light to see clearly. Check to see that the lighting is good in areas where tasks are performed. Consider the interior colors in your home. If your home has dark floors, keep the walls light. Change the color at potential tripping points, such as where the carpet on the stairs meets the floor. Are there other step ups or step downs in the home where it is possible to trip and fall?

    You need to review access to the home itself. In addition to the entry way being wide enough for a wheelchair or walker, is there room to install a ramp for access if necessary?

    Do not wait until someone is coming home from the hospital to consider these steps. Look around now and start planning to make the changes that will help you stay in your home.  Most of the suggestions listed above will not only make your home safe and accessible but they will probably increase its market value as well.

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    Financial Advisors may reprint any articles from The Gift of Communication Blog in your own print or electronic newsletter. But please include the following paragraph:

    Reprinted from Bob Mauterstock’s The Gift of Communication Blog. Subscribe at http://www.GiftofCommunication.com  and receive Bob’s Family Meeting Checklist Guide.

    How to be by the bedside

    When one of your parents is very sick, you may not know what to do or expect. The time you spend with them by their bedside is very important. It is time that you will never forget. You may find it very difficult and very uncomfortable to be there but you will be glad you did it when it is over.

    People are very different in how they handle serious illness. You are just going to have to let them deal with it in their own way. They may just act the way you have always known them or they may seem like a totally different person to you. A lot depends on the type of illness they have and whether or not recovery is possible.

    Your loved one may be afraid of dying, tired all the time, confused, unwilling to have visitors, afraid to be alone, not wanting to talk, restless, depressed, or wanting to talk all the time. None of these actions are unusual. The best thing you can do is to be prepared for the unexpected. Your primary goal should be to make them as comfortable as possible.

    Just being there with your parent is the most important thing you can do. Do not worry about saying the right thing. You may even admit, “Mom, Dad, I don’t know what is the right thing to say to you. I just know that I want to be with you and I am happy to be here.”

    If your parent is sick they may want you to hold their hand, softly stroke their hair, read to them, play some music for them, show them photographs, tell them family stories, listen to them, pray with them or just sit quietly with them. Try not to upset them and assure them that they aren’t a burden to you.

    Be conscious of how long you stay. After awhile you will get a sense of how long is appropriate. If you notice them starting to close their eyes or lose concentration, it’s time to go. In most cases I would suggest not staying longer than an hour. Frequent visits are much more important than long visits. Don’t be offended if they tell you they want to be alone. Having family members visit you requires a lot of energy and can be very draining to those who are ill.

    As difficult as it may seem, imagine that this is the last conversation you may have with them. This will help you say everything you need to say.

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    PERMISSION TO REPRINT:
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    Financial Advisors may reprint any articles from The Gift of Communication Blog in your own print or electronic newsletter. But please include the following paragraph:

    Reprinted from Bob Mauterstock’s The Gift of Communication Blog. Subscribe at http://www.GiftofCommunication.com  and receive Bob’s Family Meeting Checklist Guide.

    Time to talk Turkey

    Many families gather together during the holiday season. This is the perfect time to have a meaningful conversation with your elderly parents. But many of us have difficulty opening up a serious conversation with them. Let me give you some suggestions that will help to get the ball rolling.

    The experts have told us that there are two things that dominate the thoughts of our elder parents. The first is the desire to maintain control over their lives, to be able to stay in their home, to continue to drive, to do what they want to do when they want to do it. But as their health deteriorates this is often hard to do. That’s when the second most important thought takes over.  “What will be my legacy? How will my family remember me?”

    2600 families with elderly parents were interviewed by the Allianz Insurance Company. 70% of them responded that discussing how the parents would want to be remembered by their children was a conversation important to them. But when polled, only 30% of the families had made the effort to do so.

    When was the last time that you asked your parents, “How do you want to be remembered by your grandchildren and great grandchildren? If you are willing to ask that question, close your mouth and just listen. And remember to listen carefully. Drop all your preconceptions of what they will say and how they will say it. Listen with an open heart.

    But if you are not willing to open with that question, I suggest you start with a question that everyone is willing to answer, “How did the two of you meet?” That one was a shocker for me. When my mom was moving into assisted living I reviewed with her the important documents  that she held in a metal box. Amongst her legal papers, was an envelope marked “ Letter from Bob while overseas” This was a seven page poem that my father had written on his way across the Atlantic to fight at Normandy in the D-Day invasion. It was in perfect condition. It described how my parents met and their courtship and marriage. I was surprised to learn that my mother, at age 15, ( in 1930) had called my dad to take her to a party after they had met skating that afternoon. (She still denies it to this day).

    Once the conversation starts to flow, it’s important discus other areas. Things such as, “ Have you thought about what you want to do if one of you becomes sick? Do you want to stay in the house? Who do you want to take care of you? You might mention what happened in other families when these issues were not discussed. The crisis and confusion that followed.

    I’d suggest that you then share with them, a very valuable three page form, “Five Wishes”, a well organized and sensitive questionnaire that gives them the opportunity to write down their health care preferences in many different situations. It can be found at www.agingwithdignity.org. Don’t try to have them fill it out then. Leave it with them and check in with them at another time to discuss their answers. You can also read my book, “Can We Talk?” where I have a created a series of more that 20 forms to gather important information from your parents. You can find it at www.parentcareplanning.com