Published on January 23, 2017
Articles in this issue:
Seniors who have been told there's no treatment for their vision loss should know that there's still plenty they can do to remain active and independent.
A recent study published in the Journal of the American Geriatrics Society called attention to the effects of low vision on the lives of older adults. Loss of vision makes it difficult for seniors to function independently. It also has a profound effect on their physical and mental health, because as vision declines, seniors are much less likely to take part in the physical and mental exercise that keeps them well.
To these seniors, the National Eye Institute (NEI) emphasizes that even if the diagnosis is low vision—defined as "visual impairment that cannot be corrected by standard eyeglasses, contact lenses, medication or surgery"—it's not time to give up and take to the couch!
We are all at higher risk of serious vision loss as we grow older. The NEI reports that more than 4 million older adults today are visually impaired, and with the aging of the baby boomers, that number will rise to more than 7 million within a decade or so. Common causes of vision loss in later years include:
If you or an older loved one notices vision problems, such as difficulty reading the mail, watching TV or recognizing people, the first step is to visit an eye doctor for a thorough exam. Some vision loss can be halted or even improved. For example, Harvard researchers recently reported that cataract surgery—now much more common and effective than it was in earlier years—is a large factor in the increased independence enjoyed by seniors today. The study authors noted that only improved cardiac care has had such a comparable, profound effect.
However, for a number of eye conditions, there is no effective treatment. It can be a dreadful blow when the eye doctor says, "Nothing more can be done for your vision." When that happens, a senior might descend into depression, inactivity, loss of independence and an overall decline in health. But the NEI wants these seniors to know that help is available! Said NEI director Dr. Paul Sieving, "I encourage anyone with low vision to seek guidance about vision rehabilitation from a low vision specialist." Just as a person who's diagnosed with a mobility disorder can use a walker or wheelchair, seniors with low vision can take advantage of effective ways to continue doing many of the things they love.
What is vision rehabilitation?
Vision rehabilitation helps people maximize their remaining sight and learn compensatory strategies to help them continue living a safe, productive, independent and rewarding life.
The vision rehabilitation team will most likely include:
Vision rehabilitation might include:
Training in the use of optical and electronic magnifying and other adaptive devices. Magnifiers, telescopes and special glasses help patients make the most of remaining vision. Patients also learn about accessible reading materials—everything from large-print books to screen-reading software.
Developing strategies to navigate around the home and in public. People with low vision tend to stay close to home, which puts them at risk of social isolation and inactivity. Orientation and mobility specialists help them function safely in the home, venture out into the community, even to travel alone if they like.
Learning new daily living skills for safety and independence. Occupational therapists and vision rehabilitation therapists help people with low vision learn new ways to do things. This might include everything from cooking to medication management. These specialists also help adapt the home and other environments. For example, improved lighting can help people see better—but it's important to tailor the lighting to the person's individual visual condition. Innovative home adaptations, such as raised markings on the controls of appliances and large-print buttons, make it easier to cook, do laundry, and operate electronic equipment and other gadgets.
Resources and support. It can seem a little overwhelming to put together a care team. And upon diagnosis, say experts, depression can stand in the way of seeking help. Counseling helps patients develop coping and problem-solving skills. Support groups for people with low vision are a great way to be with people who can offer tips and share experiences.
Family and friends also can benefit from education and support as they provide care for their loved one. They can assist in adapting the home, and in accompanying their loved one out and about. Families who use in-home care services can work with their professional in-home caregiver to keep their loved one safe while supporting independence. For example, the caregiver can prepare meals for a client with low vision—but even better, if the client loves to cook, the caregiver can serve as a kitchen assistant, providing help as needed.
Graphics courtesy of the National Eye Institute.
Gillian always felt she was Mom's least-favorite child. Yet when Mom suffered a stroke, Gillian was the only one of the siblings living in the area, so the lion's share of caregiving fell on her. Even now, Mom is short-tempered and critical of Gillian's care. Gillian sees her caregiving friends with their beloved, grateful relatives, but she doesn't feel that way. She feels guilty for feeling trapped—but what can she do?
Today, Americans are living longer than ever—yet they're not necessarily in good health during those "bonus years." So more adult children are finding themselves providing some degree of care for their aging parents. It might start with providing transportation to the doctor or coming over a couple times a week to clean the house a bit … and then, a health crisis quickly catapults an adult son or daughter into managing their parent's healthcare, dealing with doctors and medication management, even performing hands-on nursing tasks. They struggle to balance the care of their parent with their own jobs and other responsibilities.
Experts tell us that caregivers often put their own health in jeopardy due to the stress of the tasks they've taken on. This stress can be physical, financial—and in many cases, emotional. Juggling care tasks and worrying about their parent's well-being would stress any caregiver. And when the elderly parent and adult child have a history of a difficult relationship, the stress is magnified all the more.
We can't choose our parents, the old saying goes. We aren't all blessed with a parent-child relationship that was as warm and nurturing as we craved. Maybe Dad was hypercritical and judgmental. Maybe Mom made her disappointment known about your life choices and the things you considered central to your identity. Maybe you felt like the black sheep of the family. Sometimes a parent is mentally ill, dealing with substance abuse or is genuinely abusive. At the other end of the spectrum, maybe your personalities just didn't mesh—perhaps as evidenced by a sibling who recalls things in a much rosier light!
Whatever the reason, an adult child may limit contact with a parent, or keep it on a superficial level. Then what happens when the changes of old age mean the parent needs help?
An Important Note
If your parent is living with Alzheimer's disease or other types of dementia, their behavior is very much affected by the disease. Talk to their healthcare provider, the Alzheimer's Association or other experts to better understand what's going on. Recognize that lashing out, aggression, unfounded accusations and so forth are symptoms of the disease. Learning strategies for coping with these behaviors increases the likelihood that the time you spend with your parent will be peaceful and even meaningful.
See the box on the right of this article for a special note about dementia. If your parent does not have dementia, it's still important to consider the effects of other health conditions they may have. Arthritis, depression, stroke, osteoporosis and other common ailments can tax a person's temperament, so a loved one who always was snappish and demanding might become more so. Learn about their specific health problems, and empathize as best you can.
Here are other things that can help with the "old business":
Bring in an expert. A social worker or a geriatric care manager (also known as an aging life care professional) can help you sort through the issues and provide mediation if it's hard for you to communicate with your parent (and perhaps your siblings). These professionals also can help the family access support services for your parent.
Find a good counselor. The caregiving dynamic sometimes forces us to confront old issues that we had pushed to the back of our minds. A skilled therapist can equip you with coping tools for now, and a better understanding of how your past relationship with your parent affects the present. This might be the time to try something new. Asserting yourself might lead to an improved relationship with your parent—or at the least, with an important growth experience.
Set boundaries and ground rules. Tell your parent what you are willing to do, and when you will be available to do it. If your loved one lashes out at you or treats you with disrespect, express that it is hurtful and that you won't accept it. Some family caregivers report that this is the first time they stood up to their parent in this fashion—and that the new communication pattern improved a long-time dysfunctional dynamic.
Help your parent find other social outlets—and the same goes for you! A caregiving pair can quickly become enmeshed to an unhealthy degree. Perhaps disability or the passing away of old friends has isolated your parent. Perhaps your parent has moved to your community and doesn't know many people. Check out senior centers, the local aging services department and other social opportunities for seniors in your area. As for yourself, a support group can offer understanding, tips, the reassurance that you're not alone—and even a good laugh now and then!
Lighten your load. Are you doing it all alone when you don't have to? Ask yourself why that is. This is a time when some adult children unconsciously try to "prove themselves," but you don't need to. Can your siblings, your children, nieces, nephews and other relatives pitch in? Call a family meeting! How can others help? By staying with Mom when you are on business trips? By having Dad visit for part of the year? By chipping in for the cost of home care?
Hire professional care. If your parent's care needs are substantial, living in a nursing home or other supportive living situation might be the best choice. Some facilities also offer short-term respite care. If your parent lives at home or with you, professional in-home care can be a lifesaver! In-home caregivers can cut down on the sheer workload, providing housekeeping and laundry services and preparing nutritious meals for your parent. They can perform those emotionally difficult intimate tasks such as bathing, toileting and grooming. They can provide transportation to doctor appointments and elsewhere, all the while providing what you might think of as "companionship without baggage." The caregiver is a new person in your parent's life. Family are sometimes surprised to hear a professional caregiver praise their parent as "a sweetheart"!
When you have a history of friction with a parent, providing care can be a mixed bag. Sometimes elderly parents and adult children experience reconciliation and closeness during this time. Said one daughter, "As we sat together after Mom's hip surgery, I learned things about her childhood that I never knew before … it helped me understand the parenting choices she made when I was little."
Other times, things don't change. But it can feel good to know that you did what you could, while taking care of yourself as well.
For information on topics related to home care and healthcare, visit our Home Care and Healthcare Advocacy group on LinkedIn.
February is American Heart Month, and on February 3, we celebrate National Wear Red Day® to draw attention to women's heart health.
Some people might ask why we need a separate day to draw attention to women's heart health issues. Aren't hearts pretty much the same, regardless of a person's gender? The answer, we now know, is no—and yet in the past, most research focused on male subjects. Researchers didn't realize at the time that the causes, risk factors, treatment and even symptoms of heart attack and other cardiovascular conditions could be quite different for female patients.
Surveys also showed that many women had misperceptions about their risk of heart disease. Many thought they were at higher risk of dying from breast cancer—even though, according to the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death for women. Most women were unaware that heart attack could strike young women. And when women experienced symptoms of heart attack, they often attributed them to indigestion, a pulled muscle or an anxiety attack. Rather than seek immediate medical attention, they were likely to research their symptoms online or talk to a friend.
To remedy this information gap, health organizations have been working together to raise awareness of heart health among women. What should women know about heart disease?
Let's start with the symptoms. According to the CDC, women may have heart disease with no noticeable symptoms. Others might experience vague symptoms. The CDC says not to ignore symptoms such as …
As you can see, some of these symptoms could easily be attributed to other causes—and a busy woman might be tempted to dismiss them. For example, a cardiologist from Houston Methodist recently warned women that the stress of the holidays increases the risk of heart attack, and ironically, a woman might chalk up heart attack symptoms to the stress and anxiety of this busy time.
The American Heart Association (AHA) concurs that the symptoms of heart attack are different for women. In 2016, the AHA released the first scientific statement on heart attacks in women. They shared the good news that the rate of cardiovascular death in women has declined due to improved treatment, prevention and public awareness—but warned that women still have a long way to go. Said researcher Dr. Laxmi Mehta, Director of the Women's Cardiovascular Health Program at The Ohio State University, "Despite stunning improvements in cardiovascular deaths over the last decade, women still fare worse than men and heart disease in women remains underdiagnosed, and undertreated."
Women also should educate themselves about the causes, treatment and risk factors that are common in women:
Causes. The AHA says, "Heart attacks caused by blockages in the main arteries leading to the heart can occur in both men and women. However, the way the blockages form a blood clot may differ. Compared to men, women can have less severe blockages that do not require any stents [a tiny mesh tube that props open an artery]; yet the heart's coronary artery blood vessels are damaged, which results in decreased blood flow to the heart muscle. The result is the same—when blood flow to the heart is decreased for any reason, a heart attack can occur."
Treatment. The AHA warns, "If doctors don't correctly diagnose the underlying cause of a woman's heart attack, they may not be prescribing the right type of treatments after the heart attack." Women also face a greater risk of complications during the attempt to restore blood flow after a heart attack. Their blood vessels are smaller, they tend to be older, and they are more likely to have health conditions that complicate their care, such as diabetes and high blood pressure (hypertension). Women are less likely to be prescribed or to take the recommended medications. And they're less likely to take part in cardiac rehabilitation, a program of exercise, counseling and education to lower the risk of another heart attack.
Risk factors. Many risk factors pose more of a threat for women. High blood pressure is more strongly associated with heart attacks in women, and women with diabetes have a four to five times higher risk of heart disease than do diabetic men.
Dr. Mehta reported that more than 6 million women each year develop coronary heart disease, and as the leading threat to the lives of women, it should be a public health priority. She said, "Women should not be afraid to ask questions—we advise all women to have more open and candid discussions with their doctor about both medication and interventional treatments to prevent and treat a heart attack."
Health Organizations Celebrate Women's Heart Health
The National Heart, Lung, and Blood Institute sponsors The Heart Truth® to raise awareness about heart disease among women.
Visit the American Heart Association's National Wear Red Day page to find more women's heart health resources and information about the Wear Red Day event.
The Centers for Disease Control and Prevention (CDC) offers consumer resources to promote women's heart health.
The Heart Truth® logo is a registered trademark of the U.S. Department of Health and Human Services.
"Hurry up! We don't want to miss our soaps!"
If you're of a certain age, you remember the era when people would plan their days around the times when their favorite TV programs aired—because if you missed the episode, you wouldn't get another chance until rerun season!
The advent of the VCR in the 1970s changed all that. It's fun to think back on the many scientific inventions that changed our lives … instant coffee in the 1930s, Tupperware in the 1940s, permanent-press fabrics in the 1960s …
|To take a trip down the technological memory lane, see "Favorite Inventions of Your Generation" in the Right at Home blog, where you will always find the latest information about healthy aging … as well as some generational fun now and then!|