Drug Abuse and Depression in the Elderly – by Jackie Waters

Drug and alcohol use and abuse isn’t restricted to the 65-and-under crowd. Studies from the National Center for Biotechnology Information (such as this one), have shown that the prevalence of alcohol and prescription drug use in older Americans is one of the fastest-growing health issues facing the country.

Why seniors use drugs

Most seniors don’t take the first steps toward a path of drug dependency as a form of recreation. Misusing medications to “get high” is much more common among young adults. Instead, older people are simply exposed to a disproportionately high volume of prescription medications, including opioids, depressants, and stimulants. Drugs commonly prescribed to seniors include opiods (painkillers for arthritis) such as, morphine, hydrocodone, and Valium, Xanax, and Adderall (benzodiazepines) for insomnia and anxiety. The addictive qualities of these medications coupled with unintentional misuse can lead to addiction. Seniors are prescribed medicines for a number of other reasons, and managing multiple medications with varying schedules can be confusing.

Depression, often triggered at this age by the loss of a spouse or close friend, further contributes to the epidemic of substance abuse in the elderly. While losing a life partner is difficult at any age, it is exceptionally hard on widows and widowers who have been married for decades. Many people describe it as losing a part of themselves, which contributes to a significantly elevated risk of death within six months after the death of a spouse.

After a senior loses a spouse

Grief is a powerful emotion that may lead to uncharacteristic behaviors. During this time, it’s important to be aware of any signs of alcohol or drug abuse, such as sudden memory problems, insomnia, unexplained bruises, rejecting social interactions, and poor personal hygiene. According to the National Council on Alcohol and Drug Dependence, men are at a higher risk of developing a substance abuse problem than women. Loneliness is often to blame for the addition of new risky behaviors.

Missed and misdiagnosed

It can be difficult to properly diagnose substance abuse in seniors for a variety of reasons. The Substance Abuse and Mental Health Services Administration reports that a combination of the natural effects of aging, a lack of awareness, and limited research, contribute to scores of misdiagnoses each year. Caregivers, friends, and relatives may easily shrug off signs of impairment, citing age as a perfectly acceptable excuse for slurred speech, memory loss, or someone having a few too many cocktails. Unfortunately, it is just this attitude that perpetuates the problem, leading to an early grave for many overlooked older adults.

If you suspect that your father, grandmother, or other elderly loved one has begun abusing alcohol or other substances, talk to them about your concerns. Avoid accusatory tones and explain that you are worried about their well-being. You should be direct and talk to them like an adult, not a child. Never initiate a conversation about substance abuse when the other person is drinking or is improperly medicated. If he or she is willing to discuss the matter further, ask for a list of their prescription and over-the-counter medications. Offer to accompany them to visit with a doctor to explore ways to treat existing medical conditions without relying solely on prescription medications.

It is not easy confronting a member of the Greatest Generation about a drug problem. Fortunately, the recovery rate for alcohol and drug abuse in senior citizens is the highest of all age groups. Be prepared for some pushback as they struggle to process their feelings, and overcome the side-effects of their actions. They may need to go through an acute medical detoxification, as withdrawal from alcohol, opioids, and benzodiazepines can lead to life-threatening symptoms. Stay in touch and take measures to ensure that your elderly companion has access to a variety of healthy activities and fresh fruits, vegetables, and other healthy food choices. Your love and support, will be a key factor in helping them find the path back to enjoy an exceptional quality of life.

Jackie Waters is a mother of four boys, and lives on a farm in Oregon. She is passionate about providing a healthy and happy home for her family, and aims to provide advice for others on how to do the same with her site: Hyper-Tidy.com

 

Seniors and Grief – by Jackie Waters

According to the AARP, 40 percent of all women, and 13 percent of all men over the age of 65 are widowed. It’s difficult to watch someone you love grieve the loss of a spouse, but there are things you can do to help. It helps to begin with learning what grief is and isn’t, and understanding the special challenges seniors face after the death of their best friend and/or life partner.

After loss

Death brings many complicated emotions that can be difficult to handle despite age and experience. There has been extensive research over the past few decades on the topic of grief. This information can serve as a starting place for understanding how the process develops. Ultimately, mourning is a personal experience and there is no instruction book or timeline to follow. The most important thing to remember when a loved one is grieving is there will be good days and bad days. It takes time to adjust to such a big change, and even longer to fully accept it. Cynthia Oliver of the Good Grief Center for Bereavement Support notes that grief is not simply an event with a set starting point and definite end date. Seniors who have lost a loved one are often experience with and effected by other forms of loss, long before their spouse or partner’s life actually ended. By this age, many have lost important members of their friendship circle and wake up every morning with a rapidly dwindling support network. In addition to grieving, people over the age of 65 may be trying to come to terms with their own mortality.

A long and winding road

The Kubler-Ross model has defined five stages of grief: denial, anger, bargaining, depression, and acceptance. Recent studies have shown that these stages don’t play out in a linear fashion, as previously believed. Most people feel different emotions throughout the course of their grief, often at the same time. Typically, the anger and depression stages are the most noticeable, although there is pain throughout the process.

According to Toni Bisconti, a psychologist at the University of Akron, those grieving tend to oscillate between stages. Keeping this in mind will prove helpful while caring for your loved one. It is worth pointing out that he or she won't simply "get over" the loss. The feeling of anguish will lessen over time, but never fully dissipate. Upon reaching acceptance, emotions become manageable but waves of sadness and anger may creep in long after the day a spouse died.

A study by Clinical Psychologist George A. Bonanno of Columbia University found that for about half of the study’s elderly participants, grief subsided substantially over the course of six months. Other research studies suggest that it takes a full two years to return to a satisfactory quality of life. One thing that is not contested, is that recovery is bolstered by the amount of familial and social support received by the surviving spouse.

Back on track

The National Institute on Aging says there are several ways to help a grieving senior remain on a healthy trajectory after a loss. These include:
● Encouraging a balanced diet by offering to bring food once or twice a week
● Spending time with them and encouraging social activities
● Helping them find a grief support group and offering to drive them to meetings
● Discouraging any major life changes until they have had time to mourn
● Watching for signs of depression, drug use (which is surprisingly common among older adults), and deteriorating health, and intervening if necessary
Remember, while you cannot eliminate feelings of sadness, you can help combat loneliness, encourage positive behaviors, and keep an eye on their activities for signs of internal troubles. With your support, your loved one will have a better chance of reclaiming their life, and finishing out their Golden Years with a whole and happy heart.

Jackie Waters is a mother of four boys, and lives on a farm in Oregon. She is passionate about providing a healthy and happy home for her family, and aims to provide advice for others on how to do the same with her site:Hyper-Tidy.com

Hospice vs Palliative Care

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It is often difficult for patients to understand the difference between hospice care and palliative care. Each distinction has several levels, which can add to the confusion. Many patients and family members are perplexed by how charges are billed or paid for by private insurance and the Medicare Hospice Benefit. Palliative Care is treatment that relieves suffering and improves quality of life for people of any age and at any stage in a serious illness, whether that illness is curable, chronic, or life-threatening. Treatments are paid for in same way you would pay for regular medical service. Medicare, Medicaid, and most insurance plans cover all or part of the services provided.

Hospice care is palliative in nature, but patients no longer receive curative treatments for their underlying disease. The focus is on comfort. A doctor has to certify that the patient is expected to have a life expectancy of six months or less, under "normal conditions".  It is difficult to account for the strength of the human spirit, and the exact date of death, just like the exact date of birth, is uncertain.

There is a specific Medicare Hospice Benefit, which has a per diem rate that covers treatment, services, and equipment. The first two benefit periods last 90 days, then an unlimited amount of 60 day benefit periods follow.  The hospice team reviews the patient's medical history following set clinical guidelines. If it looks as if the patient is still near the end of life, they are approved for recertification. If they have improved, they may be discharged back into palliative care.

You’ve seen one hospice, you’ve seen them all. Or…

...have you? Ask most folks who work in hospice and palliative care and they will say, “You’ve seen one hospice, you’ve seen one hospice”.

Elderly woman and her daughterThere are more than 3,200 hospices today with different working models – some are independent, others are non-profit agencies. Profit hospice companies are often part of hospitals or health systems. According to the National Hospice and Palliative Care Organization, their patient population is grossly underserved. They estimate that only one in three patients who could benefit from hospice services are actually receiving care.

In 2011, approximately 47 percent (or 1,059,000 patients) died in the US receiving hospice care at the end of lives. That is less than the percentage of people in this country who have written instructions or advance directives for their end-of-life care, such as a living will, a health care power of attorney, or a do not resuscitate (DNR) order. Despite the fact that it has been more than 50 years since Elizabeth Kübler-Ross wrote her groundbreaking work, On Death and Dying, Americans are very reluctant to talk to their aging parents about end-of-life decisions. Research shows parents are more willing to talk with their children about safe sex and drugs than about their own end-of-life decisions.

 

Does your insurance pay for acupuncture?

If so, how much?

Health insurance claim formThe World Health Organization (WHO) recognizes acupuncture as an adjunctive therapy for palliative care patients, and some studies have recommended it for insurance reimbursement in end-of-life (EOL) care. The WHO has approved acupuncture for many other conditions found in EOL and hospice patients including: cardiovascular, dermatological, eye/ear/throat-related, gynecological/obstetric, musculoskeletal, neurological, psychological/emotional, and respiratory symptoms.

Why hospice acupuncture?

Acupuncture Alternative MedicineOriental Medicine, much like hospice, embraces a whole-person pattern approach of mind, body, and spirit. It is unique in that the system utilizes a multitude of therapies including (but not limited to) acupuncture, Asian bodywork (e.g. shiatsu, acupressure, tui na), Chinese herbal medicines, cupping, coining, electrostimulation, heat therapies, meditation, moxabustion, nutrition, qi gong, and tai chi. Most of these therapies are useful in terminal disease treatments, though there are some contraindications depending on the individual patient’s condition. In particular, acupuncture, using specific point combinations, can serve to calm and release emotional and spiritual concerns for hospice patients.

Many hospice patients experience physical discomfort along with the emotional reality of the dying process. Acupuncture is a safe and inexpensive treatment for physical conditions that are common among hospice and palliative care patients. Most Oriental Medicine research in the United States has been limited, using acupuncture as the sole modality. In one group of studies, acupuncture was found to be useful for treating xerostomia (dryness of the mouth), nausea, vomiting, dyspnea (shortness of breath), and most importantly pain, in a drug-free way, without side effects.

Ten Easy Ways to Reduce Stress for Caregivers of Hospice Patients:

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You have faced the reality that your loved one is not going to get better. While you are not giving up hope, you have made the decision to change the focus from trying to find a cure, to obtaining maximum comfort and a higher quality of life for the time they have left. This act can relieve a great deal of the decision-making stress. Being the primary caregiver for someone brings other forms of stress, and grieving the daily losses can be overwhelming. So keep this list handy, and remember caregiving means taking care of yourself as well as your loved one.

  1. Breathe! Most people employ only the top half of their lungs, robbing the internal organs of precious oxygen. Take a few minutes at the start of every hour to focus on your breath and consciously fill your belly full of air when you inhale.
  2. Check in with your body! A good posture aligns the spine and increases the abilities of the central nervous system. This means your organs (including your brain) function better and you become less fatigued.
  3. Drink water. Many people walk around dehydrated because of our love affair with caffeine, which actually dries you out more. By drinking caffeinated beverages you add to your fatigue, so you want more caffeine. Caffeine is an addictive drug often added to soft drinks, which because of their corrosive nature, have been shown to leach calcium from your body. Drinking enough water is sometimes all it takes to increase energy, decrease joint pain, and rejuvenate your skin.
  4. Take a break. Set a timer so at the end of every hour you take a three to five minute break (you deserve it). Studies show that people who take regular breaks actually work more efficiently overall.
  5. Stretch. Every 15 to 20 minutes, try checking in with your body. Freeze your frame and look at yourself. Are you in a truly comfortable position? If not, stand, stretch, breathe (and don’t forget to bend at the knees, not at the waist).
  6. Go for a walk. We are not meant to be sedentary. Our bodies were created for movement and they crave it. A 20-minute walk just one time a day has been proven to significantly reduce depression. According to the Mayo Clinic, prolonged sitting liked to obesity and metabolic syndrome. http://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/sitting/faq-20058005
  7. Get some body work. Acupuncture, massage therapy, acupressure, reflexology can all release toxins from your body and help you feel rejuvenated. If you can’t leave or don’t want to have someone else treat you, go to http://www.holdmegently.com/ . They have a self-treatment booklet on hospice acupressure points. You can download for a fraction of the price of a regular massage, and use it to treat yourself and the person you are caregiving.
  8. Rub your hands together briskly and hold them over your eyes. We take in the majority of our information through our eyes. Pollen, sun glare, reading, looking at computer and phone screens, and pollution add to eye strain. Having regular exams, wearing sunglasses, and giving your eyes regular mini-breaks will help reduce their stress. Cucumber slices applied on top of closed eyelids at the end of the day are refreshing, and help combat inflammation.
  9. Put up relaxing images where you can see them regularly. This can be a conscious reminder of a person, place or thing that gives you a sense of comfort. Thinking about, or seeing baby animals or humans can produce oxytocin, serotonin, and prolactin - the "love" or "feel good" hormones. Some people make mini collages with multiple images and affirmations like, “Everything is fine” or, “I am safe and life is good”.
  10. Go to the bathroom and run cold water over the inside of your wrists for 30 to 60 seconds. In Chinese medicine this is known as ‘cooling the pulses’, and is particularly good any time you feel distressed. It has been known to lower the blood pressure, and it gives you some quiet place to escape and let your trouble go down the drain.