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When is it Time for Assisted Living?

Joseph Coupal - Tuesday, July 11, 2017

Spring Arbor, Greensboro, NCWhen a loved one is diagnosed with Alzheimer's disease, it's normal for the first reaction to be: "We'll never put mom in a nursing home. We're going to take care of her at home."

That's an admirable sentiment, but it can become an unrealistic one.

No matter how great your determination or how broad your shoulders, the demands of around-the-clock care for someone with advancing dementia may eventually become more than you can provide at home.

That's when families confront one of the hardest decisions they'll ever make. Is it time to move mom into assisted living?

It's almost always an emotional decision. There's some level of emotion tied to it that can cloud the decision.

Older adults who are on five or more medications — a practice known as "polypharmacy" — may experience side effects or bad interactions that increase their risk of cognitive impairment.

Families struggle with that dilemma on a daily basis.

As families face this agonizing decision, families should go through a careful analysis of what's best for all involved, recognizing that's never an easy process.

It's important for families to know there are resources available and that in some cases, placement may be the safest and most reasonable option for their loved one. But it's hard. Really, really hard. It's a very emotional decision-making process that you have to try to put objectivity around, and that's very challenging for a family.

Part of the emotional burden is the perception of what it means to "put mom in a nursing home." In reality, there are many other options.

One of the issues with people at this stage in their life, they fear the term 'nursing home. So there has been an effort to educate people on the term 'community living.''

Community living can encompass everything from a "55 and over" residential setting to assisted living to a memory care community. Nursing care is available for those who need it. But experts say if you understand the options and do some planning in advance, it's possible for your loved one to be in the appropriate setting at every stage of the disease without ever requiring placement in a nursing home. Yet even with so many options now available, the emotional burden often causes families to put off the decision.

Experts say it's common for families to wait far too long to move someone with Alzheimer's into assisted care, when both the patient and the family would have benefited from that move having come sooner.

If people do wait it's hard to say whether their situation would have been improved.

However, families should try to consider the question early on, before they are thrown into crisis.

If you wait, your decision becomes much more rushed and pressured. If you're making decision quickly because of a crisis, it's a lot more difficult.

What are the warning signs that it may be time to consider placement? It could be that the loved one is losing weight, or is dehydrated, or not cooking anymore. It could be acts of neglect, such as not feeding a pet, or letting bills go unpaid, or a "close call," such as leaving the stove on and unattended.

There are so many factors in making this decision. For every family it's different, and it's about how their loved one is progressing. There's a very long list of signs you can look at.

For more information on assisted living and memory care, contact Spring Arbor.

#HowYouLive

nj.com


Caregiver Dementia

Joseph Coupal - Tuesday, June 27, 2017

Spring Arbor, Richmond, VAFor years, we’ve read that Alzheimer’s disease is the leading cause of dementia. That’s not entirely true.

The leading cause is “caregiver dementia,” which strikes an estimated 100 million overwhelmed and stressed-out caregivers worldwide. The term was used initially in the 1980s, and while not an official medical diagnosis, it includes symptoms such as disorientation, forgetfulness and depression.

Stressful conditions produce high levels of the hormone cortisol, which, over time, may contribute to memory loss. Think about it: You’re working long hours, you see no end in sight and you’re exhausted. Who can think straight under those conditions?

A 2010 Utah study published in the Journal of the American Geriatrics Society of 1,221 couples tracked for 12 years found that seniors caring for a husband or wife with dementia had six times the risk of getting dementia as members of the general population. Surprisingly, men were most susceptible, facing double that risk.

Some Dementias Are Reversible

Even undiagnosed urinary tract infections may lead to sudden behavior changes such as confusion, agitation, withdrawal or delirium.

Medicines will also have varying effects, as we grow older. As we age, our liver and kidneys don’t work as efficiently resulting in a buildup over time of unprocessed medications. These chemicals become toxic leading to dementia symptoms or delirium.

Which leaves us with caregiver dementia.

Until caregivers are able to take proactive steps to overcome feelings of hopelessness resulting from the stress of caring for another person, they’ll continue to endure embarrassing and even scary moments.

Caregivers Will Overcome

The onset of caregiver dementia is real and it strikes primary caregivers. Those who heed the call and take action will survive.

But there’s more to being a caregiver than just surviving. We need to apply both legs of our “caring” and “giving” nature to overcome and thrive. We start with a break. As little as a five-minute respite can make all the difference. Ultimately, we’ll need help. Today, caregivers have a variety of options to choose from, including in-home and adult day care, residential care and assisted living. The only other cure is to stop caregiving, and this is not an option for many.

For more information on caring for those with Alzheimer's or Dementia, contact Spring Arbor.

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US News - Health


June is Alzheimer’s & Brain Awareness Month: Know the 10 Signs

Joseph Coupal - Tuesday, June 20, 2017

June is Alzheimer’s & Brain Awareness Month, and the Alzheimer’s Association® needs you to get involved and raise awareness about Alzheimer’s disease and other dementias. Everyone who has a brain is at risk to develop Alzheimer’s, a disease that is often misunderstood. Did you know:

  • Alzheimer’s is fatal. It kills more than breast and prostate cancer combined.
  • Alzheimer’s is not normal aging. It’s a progressive brain disease without any cure.
  • Alzheimer’s is more than memory loss. It appears through a variety of signs and symptoms.

During the month of June, the Alzheimer’s Association asks you to learn more about Alzheimer’s, share your story and take action.

Know the 10 Signs - Early Detection Matters

You can help raise awareness of the truth about Alzheimer’s.

For more information on Alzheimer’s or memory care, contact Spring Arbor.

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alz.org


Memory Changes: When They Are More Than Just "Getting Older"

Joseph Coupal - Friday, June 16, 2017

Spring Arbor, Richmond, VAYou've probably heard this phrase before: "I'm just getting older." The statement is often made to explain myriad aches and pains, memory lapses and mobility limitations, and may reflect acceptance that some parts of the body do not work as well as they once did due to aging – a truth that all creatures experience.

The explanation should be used with caution, though. No one should blame something they are experiencing on "just getting older," because they might miss something that could be treatable. This expression is frequently used to dismiss daily symptoms, which could result from an underlying disease, leading to needless suffering that could have been evaluated and appropriately treated.

Memory complaints do occur very frequently as one gets get older. Delays in recalling words and names – feeling that what you want to say is "just on the tip of your tongue" – are a part of normal aging, and unfortunately these delays lengthen as a person gets older. Multitasking and learning new things also become more challenging. These are normal aging experiences, but none of these changes should affect one's ability to remain independent in performing basic and instrumental daily living activities.

Often, a person who experiences a memory complaint never brings up the issue with his or her doctor. Sometimes the same patient has so many medical problems that, despite the best efforts of the patient's primary care physician, managing other medical problems takes away the time needed to address a memory concern appropriately.

Memory complaints become significant when you start to see them affect daily life. Sometimes a person's ability to remain employed, perform work-related tasks, participate in community activities or maintain hobbies declines, leading that person to retire or quit an activity. When memory problems impair a person's ability to engage in everyday routines such as managing finances, driving in familiar areas or taking medications regularly and reliably, then the memory problems should not be ignored or brushed off as a normal part of aging. An evaluation focused on memory complaints should be performed if such signs are observed.

A basic workup includes a review of the memory or cognitive issues, specifically how long the problems have been noted, and any other associated mood, behavioral or movement problems. Cognitive testing (such as a Folstein Mini-Mental State Examination or Montreal Cognitive Assessment) should be performed to document the presence and severity of the cognitive impairments. A screening for depression should also be performed, along with routine bloodwork. A CT scan of the brain could also be performed to exclude other problems. Ultimately, all of this information should be reviewed to uncover the most likely explanation for the memory problems and to determine the best ways to manage those issues.

Though dementia may be the first cause that comes to mind, there can be others. Sometimes depression can trigger memory complaints, although they're often accompanied by other symptoms, such as loss of interests in hobbies or activities a person previously enjoyed, a feeling of worthlessness, sleep problems or loss of appetite. A recent illness or hospitalization could cause a temporary period of confusion called delirium, which typically resolves over time. Medications – prescribed, over-the-counter or herbal – that affect the brain, and medical conditions such as stroke, thyroid problems or vitamin deficiencies, could also produce memory and/or cognitive problems.

It's important to remember that changes with memory and cognitive function accompany, but aren't necessarily explained by normal aging. If there is a concern or if function becomes compromised because of memory problems, it should always be brought up with your physician. The ultimate goal is to preserve independence and to plan ahead if you need assistance.

For more information on memory care, contact Spring Arbor.

#HowYouLive

US News - Health


Downsizing? What to Look for in an Age-Friendly Community

Joseph Coupal - Monday, June 12, 2017

Spring Arbor, Greensboro, NCEmpty-nesters in search of new digs may have a wish list that looks something like this: warm climate, tennis courts, golf courses, walking trails and a spare room for the grandchildren to stay.

But here’s the thing. What we want at age 65 may not be what we need 10, 20 or 30 years down the road. Even the most physically active among us could have a stroke or end up in a wheelchair in early retirement.

As boomers cash out, gerontologists are urging newly minted seniors to think hard before choosing their next place to live. Cognitive decline, or loss of a spouse, could push them out sooner than they think.

Instead of just downsizing into a condo or one-story home, researchers say retirees should consider what their broader surroundings may offer as their needs change.

Here are five things to look for in an age-friendly community:

Car-free transportation

Many of us assume we’ll be driving until the day we die. But now that people are living longer, more and more of us will end up with vision problems, physical disabilities or cognitive impairments that prevent us from driving years before we take our last breath.

House hunters nearing retirement should think about how they would get to the grocery store, pharmacy, swimming pool or a friend’s house without a driver’s license. When retirees choose to live in car-oriented communities, it may actually curtail the amount of time they can live independently.

Meaningful relationships

When deciding to move later in life, it’s important to choose a community where you can either maintain, redevelop or re-establish your social network.

Older adults should think twice about moving to places that lack community centers and activities that draw like-minded people. Finding friends to go bowling with may not be enough. You want to have reciprocal relationships with the community so you’re looking for opportunities for employment, or volunteering.

Before moving, older adults should pay close attention to their specific social needs. Social isolation, especially later in life, is quite literally deadly.

Mental stimulation

Many new retirees can’t wait for all the golfing, Zumba classes and exotic travels in their future. But a leisure-focused life may quickly lose its charm.

Boomers are no longer interested in bingo. Check for lifelong learning opportunities in a neighborhood of choice. Many colleges and universities offer free tuition to people over 65 for a variety of courses. Other adults may prefer to search out creative activities, such as community arts projects and music groups.

Health services

Planning for healthy aging after retirement goes beyond choosing to live near a hospital. The community should have an adequate number of family doctors and medical clinics, too. Health and social services should be accessible to older adults using any mode of transportation.

Care in the twilight years

Boomers may see retirement as a last chance to live on a houseboat or a quaint island before senescence forces them into a nursing home. But the plan to move again sometime in the distant future could set them up for a harsh transition, and ultimately, poorer health. With every move, especially later in life, the change is really hard on people. The research shows that elderly people tend to be healthier and happier when they stay in their homes.

Giving up the houseboat fantasy may be worth the price if older adults can remain or settle in a community where family and friends can help. Otherwise, retirees should make sure that affordable home-care services are available in their area. Personal care, housekeeping, snow removal and yard work services could help them remain at home until their last days.

For more information senior living communities, contact Spring Arbor.

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theglobeandmail.com


Downsizing Your Home

Joseph Coupal - Friday, June 02, 2017

Spring Arbor, Richmond, VADownsizing your home can be stressful enough as it is, let alone without worrying about what to do with a lifetime of possessions.

Whether you’re moving to a retirement village, a smaller home or unit, or to an aged care facility, there is ways you can keep some of your unique personal style and make your new home just as homely as your family home.

One of the biggest obstacles is sorting through possessions.

A lot of people put off doing this, that’s why they put off downsizing.

Family dynamics can make it worse, especially if mother has furniture that the kids don’t want or the kids start to make decisions about possessions for her. Here is some advice for the main downsizing decisions – assisted living, and retirement living.

Assisted Living

Even if you’re not downsizing to an aged care facility, chances are you may have to help a loved one such as a parent through that process.

Some assisted living facilities may have shared rooms or there is just limited space in a private room for you or your loved one.

It’s important to measure up and see if any existing furniture can be taken to the assisted living facility.

That can be important to a lot of older people, but often their furniture is too big or it’s not stable enough.

There are really simple inexpensive storage options out there, such as the little cube units, that people can put their belongings in before they are ready to let them go.

All those little treasures in their home can still fit in their room if they have a small shelf.

It’s important to bring those little touches with you to make it homely.

If you’re helping an elderly relative through this process of downsizing to assisted living, then it can be very stressful on everyone.

You may need to bring a specialist third party in to assist you.

It’s important to include your loved one in the process, even if they don’t completely have mental or physical capabilities to assist.

Retirement living

Most retirement villages, over-55s communities or lifestyle resorts offer small, one-and-a-half or two bedroom units.

This is the downsizing scenario you’re most likely to undertake.

It’s one of the biggest, most life-changing events you can experience after you retire.

But instead of viewing it as a stressful experience, look at it as a good opportunity to “cleanse your life”.

If you don’t make it a nice living space, and fill it with clutter, it can be overwhelming for you.

Moving is a good opportunity to get rid of some of the clutter, not just possessions, but also to cleanse your head and address those things that have been living in the background for some time.

For more information on moving to assisted living, contact Spring Arbor.

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startsat60.com


Stages of Alzheimer’s Disease - Greensboro, NC

Joseph Coupal - Monday, May 22, 2017

Alzheimer’s disease is the most common form of dementia in individuals older than 65 years and affects more than 5 million Americans, according to the Alzheimer’s Association. Dementia is a general term for a decline in mental ability severe enough to interfere with daily life.

Alzheimer’s progresses slowly in three stages: an early stage with few symptoms, a middle stage of mild mental impairment and a final stage of Alzheimer’s dementia (Table).

These stages are general descriptions, as each individual with Alzheimer’s experiences it in a unique way. Mental, physical and functional phases often overlap, the time in each stage varies widely from patient to patient and not every patient experiences all Alzheimer’s symptoms.

Memory problems and changes in behavior and thinking are common as people age, so tests are needed to rule out other causes of symptoms that appear to be related to Alzheimer’s. Some conditions (such as stroke, tumor, Parkinson’s disease, sleep disturbances, adverse effects of medication, infections or non-Alzheimer’s dementia) can mimic the symptoms of Alzheimer’s disease, but many of these conditions are treatable and possibly reversible.

The amount of time an individual can live with Alzheimer’s can range from three or four years, if older than 80 years when given a diagnosis, to as long as 10 years or more if younger than 80 years. Alzheimer’s can only be definitively diagnosed after death, however, by linking symptoms with examination of brain tissue in an autopsy.

Stage 1: Mild/Early (Lasts 2 to 4 Years)

Alzheimer’s disease begins slowly and initially involves the parts of the brain that control thought, memory and language. In the very early stages, minor memory lapses or losing things around the house may be the only symptoms. Toward the end of the first stage, friends and family may recognize there is a problem. They may begin to notice their loved one frequently repeating questions, having difficulty finding the right word in conversations and losing understanding of language. Over time, the disease deprives individuals of more memory, particularly the ability to remember new information, such as recent conversations or events. Based on performance on memory and mental tests, a physician will be able to detect impaired mental function at this stage.

Stage 2: Moderate/Middle (Lasts 2 to 10 Years)

Moderate Alzheimer’s can last for many years. During the moderate/ middle stage, brain function gets worse, affecting areas of the brain that control language, reasoning, sensory processing and thought. The symptoms of moderate Alzheimer’s disease are mostly an increase in the severity of stage 1 symptoms. Professional and social functioning continue to deteriorate because of increasing problems with memory, logic and speech.

The signs of the disease become more pronounced, and behavioral problems often occur. Individuals have greater difficulty performing tasks and begin to forget some details about their life. Affected individuals may still know their family members and some details about their past, especially their childhood and youth. Symptoms may include mood and behavior changes, social withdrawal, confusion, changes in sleep patterns and an increased risk of wandering and becoming lost.

Information, skills and habits learned early in life, such as the ability to read, dance, sing, enjoy music and hobbies, are among the last abilities to be lost as the disease progresses. The part of the brain that stores this information tends to be affected later in the course of the disease. Making the most of these abilities can help maintain quality of life, even in the moderate phase of the disease.

Stage 3: Severe/Late (Lasts 1 to 3-Plus Years)

In the last stage of Alzheimer’s, nerve cells in the brain are extensively damaged, causing a severe decline in vocabulary, emotions and the connection of the brain to body parts. Full-time care is required as patients lose the ability to walk, sit up straight, hold up their head and smile. It is not possible for patients to move the hand to the mouth, place one foot in front of the other or urinate on their own. Speech becomes severely limited.

Death often occurs when the body can no longer fight off infection or because the organs begin to break down. Pneumonia is one of the most frequent causes of death in late-stage Alzheimer’s disease. In patients who do not succumb to infection or other conditions that are not directly related to Alzheimer’s disease, death usually occurs when the brain can no longer control the body and organs.

Reasons for Hope

Although the onset of Alzheimer’s disease cannot yet be stopped or reversed, an early diagnosis can allow individuals the opportunity to live well for as long as possible and plan for the future. Current treatment approaches focus on helping patients maintain mental function, manage behavioral symptoms and improve the symptoms of disease. In the future, therapies may be available that target specific genetic, molecular and cellular mechanisms so that the underlying cause of the disease can be stopped or prevented.

For more information on memory care, contact Spring Arbor.

#HowYouLive

US News - Health


Identifying Alzheimer’s Symptoms – Richmond, VA

Joseph Coupal - Friday, May 19, 2017

Spring Arbor, Richmond, VACognitive impairment is unrecognized in 27 to 81 percent of affected patients in primary care. Patients with memory trouble may also be non-compliant with medical care.

If you suspect a loved one might be displaying symptoms associated with the early stages of Alzheimer's, pay attention to these warning signs. If a few of these sound a little too familiar, schedule an appointment with your family's primary care physician:

  • Memory loss that disrupts daily activities
  • Challenges with planning or solving problems
  • Confusion with time and place or understanding of visual images
  • Withdrawal from work or other social activities
  • Changes in mood or personality
  • Difficulty with speech and/or writing

By getting in touch with a primary care provider, concerns can begin to be addressed, and you can identify what other types of specialists might be most helpful in caring for your loved one. As a caregiver, there are many resources available for you as well.

Comprehensive approaches improve identification and support of caregivers in need. This can help enhance quality of life for all impacted by Alzheimer's.

For more information on caring for a loved one with Alzheimer’s Disease, contact Spring Arbor.

US New - Health


Greensboro, N.C.: A Great City for Retiring in Good Health

Joseph Coupal - Tuesday, May 16, 2017

Spring Arbor, Greensboro, NCDeciding whether to retire to the mountains or the beach? Split the difference in Greensboro, N.C., just three hours by car from the Blue Ridge Mountains or the Atlantic beaches.

But you won't need to leave town to stay active, engaged and healthy. Greensboro’s downtown offers a wide variety of restaurants (mostly independently owned), plus brew pubs, bars, coffee shops and theaters on or near Elm or Greene streets. The Farmers' Curb Market, founded in 1874, is open year-round.

Fitness and recreation venues include the new City Center Park, which offers a variety of fitness classes; the Greensboro Aquatic Center, within the Greensboro Coliseum Complex; and numerous rec centers with adult programs. Golfers can choose from six public and six private courses. The city has invested in sidewalks as well as hiking and biking trails that are open year-round. The Downtown Greenway, under construction, will create a four-mile walking and biking trail around the center city and connect with existing and planned greenways.

After energizing your body, exercise your brain with learning opportunities at the area's colleges and universities (the largest of which is the University of North Carolina at Greensboro) or the city's downtown cultural campus, where a performing arts center will debut in 2018.

Just a couple of miles from downtown, the Old Irving Park neighborhood attracts new residents to its high-end, eclectic homes and winding, tree-lined streets. Three-bedroom houses there run about $210,000 to $675,000. The neighborhood, which surrounds the Greensboro Country Club, also attracts nonresidents who like to stroll there after work, says former Neighborhood Congress board member Cyndy Hayworth. A decade ago, she and her husband downsized to the neighborhood, where they appreciate being "just minutes to everything," including the flagship hospital of Cone Health, a nonprofit health care system.

The state imposes a flat income tax of 5.75% but exempts Social Security benefits. Residents of Greensboro pay a sales tax of 6.75% (prescription drugs and medical equipment are exempt).

For more information on retiring in Greensboro, NC or for assisted living, contact Spring Arbor.

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Kiplinger


Tips for Decorating An Assisted Living Home - Richmond, VA

Joseph Coupal - Monday, May 15, 2017

Spring Arbor, Richmond, VAWhen moving into assisted living you cannot overlook decorating your parents’ new home. Rather, use this opportunity to get their new lifestyle off to a great start.

Remember throughout this process that, “less is more.”

For most families, there will be downsizing, and often a major one if someone is moving from a much larger home where they raised a family.

Consider that the action – excellent amenities, dining and countless life-enriching opportunities – is one of the primary reasons why seniors are able to enjoy a happy retirement by being active outside of the home. The fortunate thing for the residents at a community is that everything is readily available within walking distance from their front door.

Think of it as, less indoors in your home, more to do outside of it.

Decorating is still important though and some careful thought and consideration should be put into it.

The assisted living apartments have ADA-compliant bathrooms and kitchenettes, and that it’s important to keep plenty of room in the apartment to move around and avoid falls.

The bedroom should be simple. The bed should be the ideal size and easy to get in and out of daily. Add a nightstand with a lamp, phone and a clock with illumination.

The living room is where most seniors spend most of their time when they’re not out and about so make this as comfortable as possible. Lift chairs are a great option. You may also consider a small desk for storing papers, bills, etc., as well as to place a laptop, pad or other electronic devices, if they have them.

While you may have a lifetime of photos and mementos, your home isn’t a museum. Carefully choose some of your favorite photos and decorate the walls.

For more information, contact Spring Arbor.

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Newton Daily News