Living Well

Assisted Living

Health care decisionsYou have a choice

HospiceLiving well at the end of life

Effects of burnoutKeeping up with life

A Publication of theJuly/August 2010

INSIDE

Health care options and advice from professionals

1livingwell ~ July/August 2010

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contributorsScarlette BenciaLinda Bierbach Karen Fliflet Shelly RoyCathy Scribner Mary Thane

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HealtHcare decisions ~ You have a choice. Page 4effects of burnout~ Keeping up with life. Page 12senior services ~ A growing market. Page 14Music for deMentia ~ Experts look to music as way to uncover a past buried by dementia. Page 18Guard Money~ Elderly must guard money from the unscrupulous. Page 22tHe Mediterranean diet~ Up close and personal. Page 26

IN tHIsIssuEassisted livinGContinuing care, resources and choices for seniors.

HOspIcEliving well at the end of life

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Healthcare Decisions: You Have a Choice

For many people conversations about death and dying

still remain an American cultural taboo. Even close family members shrink from discussing it with each other. In today’s ever-advancing technology in life sustaining treatments, the only way to make sure you will have your healthcare choices honored in a life-limiting event is to have that hard conversation.

In 1991, the federal government passed the Patient’s Self Determination Act that directed healthcare organizations to provide patients with information about how to communicate their healthcare choices by using an advance directive. An advance directive is a plan that you develop through the process of understanding, reflecting and discussing a time when you cannot make your own medical decisions. This

process and plan is crucial to help those closest to you and your physicians to provide you with the best care possible when you cannot make your own decisions.

Advance Care Planning calls for healthcare professionals to learn sensitive language and skills to overcome such discomfort. Healthcare professionals create an atmosphere of ease when talking about death with patients and families and helping them with planning end-of-life care.

Advance directives are not the only tool helpful in communicating healthcare choices. Another tool for advance care planning is the Provider Order for Life Sustaining Treatment (POLST) form. This is the State of Montana’s designated form. The MT POLST form is taking the place of the MT Comfort

One form. The MT POLST form is

much more comprehensive and requires more consideration to complete. The POLST is a medical order set that designates specific choices of a patient with an advanced disease related to their detailed medical care decisions. You can compare the POLST to a prescription for blood pressure medication. It must be signed by a medical provider (physician, physician assistant or nurse practitioner) in order for it to be a valid medical order and to be followed by the healthcare team.

POLST completion, for the patient, is much more than simply filling out a piece of paper. It’s making difficult decisions, naming choices about which types of care, under which conditions, are acceptable and which types are not. It’s speaking candidly with

loved ones who need to be aware of these decisions. And perhaps, most important, it’s making sure the healthcare advocate (also called agent, proxy or surrogate) named in the document and the physician involved in the care are able and willing to honor the patient’s end-of-life choices. Throughout this process, a trained POLST/Advance Care Planning Facilitator can offer invaluable support and practical assistance.

In support of the patients and families we serve, St Patrick Hospital and Health Science Center has made the commitment to provide certified POSLT Facilitators. One set of trained facilitators are the professional staff of the Case Management Department, who in conjunction with the physicians, are the first line healthcare team members

By Linda Bierbach, RN, BS, CHPN, and Shelly Roy, BSN, MHA


available to help patients and families with these sensitive conversations. Case Managers identify which patients would most benefit from Advance Care Planning interventions and discuss these important issues with the healthcare team.

St. Pat’s selected the nationally recognized Respecting Choices® POLST/Advance Care Planning program from Gundersen Lutheran Clinic in La Crosse, Wisconsin, as our educational curriculum.

This program uses three components:

• community engagement,

• professional education, and

• organization/community standards of practice.

The program characterizes success in terms of the development and maintenance of new

routines of care by the health organization and its professionals. The routines are a list of commitments to the patient and family, promising to:

1 Initiate conversations about advance care planning

2 Skillfully facilitate planning with each individual

3 Make sure all advance care plans are clear to all involved and specific to each person

4 Ensure that plans are available when needed

5 Follow the plans in a thoughtful and respectful way

On April 13, 2010, St. Patrick Hospital hosted the Respecting Choices® POLST Paradigm curriculum. Participants included St. Patrick Hospital staff and various community healthcare representatives from local nursing homes, home health

and hospice providers. All participants were certified as POLST/Advance Care Planning Facilitators and learned a standard conversation process that can be replicated through use of consistent language, a consistent interview and careful appreciation of patient goals.

Also, St. Patrick Hospital has five certified Respecting Choices® POLST Paradigm Instructors to continue teaching this curriculum in our organization and throughout the healthcare community. The participants established a Missoula and Regional Community Coalition to support work in partnership on community-wide processes that would encourage a consistent effort regarding ongoing education and implementation of this and other efforts around POLST and advance care planning

initiatives. St. Patrick Hospital

is committed to offering POLST/Advance Care Planning facilitation because, simply put, “it is the right thing to do.” Many people are not aware that they have a right to determine their end-of-life care and to say yes or no to medical treatments if they do or don’t want them. St. Pat’s recognizes the importance of patients and families to have their choices recognized and honored.

If you have questions about advance care planning, please contact St. Patrick’s staff members Linda Bierbach, Palliative Care/Advance Care Planning Coordinator, at 329-5803 or Shelly Roy, Director of Case Management, at 327-1831.


The most common thing I hear from families of patients who have chosen hospice care is, “I sure wish we’d learned about hospice earlier!”

Though many patients with terminal diagnoses are informed about hospice through their health care providers, there are just as many patients, families, and health care providers who still perceive hospice as “the last stop” before their number is called. I have learned from my work, is that nothing is farther from the truth.

Cathy Scribner, MDiv. Chaplain, Hospice of Missoula

H o s p i c e :

Living Well at the

End of Life

Through my own work as a hospice chaplain, my perceptions of hospice care have changed dramatically. What I now perceive as “dying well” has merged with my understanding of “living well”. In our Western culture, we tend to stave off an awareness of our death and dying process for as long as possible. We push our mortality behind closed doors, where aging and dying happen to “other people”. Every day, we are bombarded by internet, television and other media images that portray the importance of staying young, beautiful, and physically fit. “Or else…” is what these images seem to imply.

Because illness and death are perceived as a sort of failure in our culture, we tend to be surprised and horrified when disease enters our lives with its foreboding brushstrokes and dark colors. We want to grab our paintbrushes and palates and repaint our canvases with images that are acceptable to us - images full of bright color and hope. We tend to forget that every color exists in relation to another color, whether dark or light in hue, and the more colors we ultimately include on a canvas, the greater the depth and quality of the painting. I think it is the same with our lives. The more we embrace the “dark colors” of our fears and feelings of vulnerability, the richer our experiences ultimately become. When we are able to accept dying as an essential part of our own living process, we are better able to “companion” loved ones who are dying, with the love, compassion and support we all deserve to keep on “living well” until the end.

People often feel alone and afraid after receiving a “terminal diagnosis”. A once-familiar world suddenly feels foreign, as family members shift their daily home and work routines in order to meet the care giving needs of a loved one. Families tend to call hospice when they have reached a point of exhaustion and are ready to ask for help. But once they experience the wrap-around support hospice has to offer, these are the very families who wish they’d called hospice earlier.

Patients and families discover that a good hospice team consists of care providers from many disciplines within a hospice organization, and the team provides comfort care not only for the patient, but also for the families involved. Patients receive palliative medical support and tender care from RNs, CNAs, pharmacists, and a medical director, who provides oversight and supervision for medical decisions. With this team approach to medical support and pain relief, patients can choose to remain at home and enjoy their last days with family, in a comfortable environment. Patients and families also receive emotional, spiritual, and psychological support from hospice social workers, chaplains and music thanotologists, through whom life stories, spiritual concerns, and final wishes are often named and shared.

Most importantly, the support of a hospice team allows family members the opportunity to take off their “caregiving hats” and spend precious quality time with their loved ones. When I was first working as a hospice chaplain, I remember overhearing a team member say, “We sure witness a lot of laughter, a lot of tears and a lot of storytelling at the end of life.” And don’t we all deserve to live and die with such dignity? Hospice patients and family members are able to go on living into their dying process, which is a gift I think we all need to remember and reclaim in our culture. The words of a lovely elderly man and artist, whose wife died on hospice care, will always stay with me. “I will never forget how hospice took care of my Mary. You knew what to do at the end of her life when I was so exhausted I could only listen to her and hold her hand. For that last bit of time with her, I will be forever grateful.” He loved like he painted, with every color he had available.

Cathy Scribner, MDiv is the Chaplain, Hospice of Missoula. She can be reached at 406-543-4408 or visit the

website at www.hospiceofmissoula.com

“ We s u r e w i t n e s s a l o t o f l a u g h t e r , a l o t o f t e a r s a n d a l o t o f s t o r y t e l l i n g a t t h e e n d o f l i f e . ”



Maintaining Balance intaini

A ging adults rate fear of falling highest among common fears such as criminal violence, financial crisis or adverse health event. Older adults resort to activity restriction, which in the long term

may adversely impact both physical and mental health and actually increase risk of future falls. In the US, more than one third of adults age 65 or older fall each year. According to the MT HDD, there are approximately 725 admissions at Montana hospitals for people age 65+ with a hip fracture each year; we assume many of these fractures resulted from a fall. The age-specific rate for hip fractures in older adults age 65+ is 500-600 per 100,000 people. Many of these falls are preventable and can make the difference of remaining in your own home independently.

Maintaining Balance


by Mary Thane, PT, GCS


O ne’s balance is related to many factors including: leg strength, vision, medication, footwear, hazards indoors and outdoors as well as one’s general sense of

well being. An individual that is fearful of falling is more likely to have a fall than someone that has no fear they may fall.

There are many ways you can work to prevent having a fall. First, consider your lower extremity strength; you can test yourself by assessing your ability to get out of a chair without your hands. This will give you an idea about your leg strength. One should be able to rise out of a chair multiple times without arm support.

Balance exercises performed daily and strength exercise performed three-four days per week will make a difference quickly if one is consistent performing these. As one’s strength and balance improve, functional mobility will improve. Walking without incorporating other strength and balance exercises may not be enough to keep one from losing balance.

Vision should be assessed annually to determine any changes and determine if these changes have led to

balance difficulties. Changes in vision that accompany aging may cause inability to clearly seeing edges with contrast sensitivity, increased sensitivity to glare, muscular degeneration or glaucoma. Wearing bifocals may add difficulty of getting up and down steps and curbs.

There are some relatively simple and straightforward things that can be done to reduce the risk of falls associated with visual loss: having regular eye checks, using visual aids or wearing a hat to reduce glare, even cleaning your eye glasses!

Medications should be reviewed with your primary care giver routinely to determine any changes that need to be made. Side effects of many medications may be the cause of falling, therefore your doctor or pharmacist should regularly review your medications and the dosage to assure you are taking them properly.

Footwear: is this the culprit of loss of balance? Avoid wearing high heels. Thick soles are easier to trip on, especially on stairs. A better choice is a walking shoe that has a firm but thinner sole to give better feel and feedback of what you are

vision


footwearstanding on. Check shoes or slippers that have a textured grip – do yours need to be replaced because the tread is now worn and slick and make you shuffle as you walk?

A supportive shoe with a firm arch offers stability. A supportive shoe covers most of the foot and has a firm and snug heel counter. It should hold the foot well back into the shoe and have secure fastenings. It needs to have a roomy toe box to prevent foot deformity. A sole that is flexible under the ball of the foot and not too thick will offer comfort and will allow proprioceptive feedback, which contributes to stability. A walking shoe that is lightweight, thinner-soled and flexible is the best choice.

Most slips occur at heel strike so the rear of the heel is particularly important. The heel needs to be textured for traction.

Feeling safe as one moves about in and outdoors means walking defensively. While walking outside scan ahead about four to six steps for hazards such as motorists, sidewalk cracks, holes, rocks and garden hoses.

Inside your home check your lighting; is it adequate at the top and bottom of your stairs? Remove clutter; be aware of furniture that can intrude into traffic-ways. Use of color contrast and safety strips can highlight step edges and changes in level. Feed pets

away from traffic-ways, wipe up spills promptly and tape down any throw rugs or cords. Are the items in your cupboard or closet at a level that you can reach while standing on the floor vs. on furniture?

Prevent a fall for yourself or your loved ones by incorporating exercises, reviewing medications with your physician, having your vision checked, and removing hazards in your home and yard that may cause falls.

In Missoula, we are hosting a Fall Prevention Class titled Stepping On to help prevent the number of fall-related injuries and deaths in our County and throughout the state. This is a program that empowers older adults to carry out health behaviors that reduce the risks of falls, improve self management and increase quality of life. If you are interested in participating, our next class will be starting September 21, 2010. Please contact Christy Farley at 327-4014.

By Mary Thane, PT, GCSMary Thane is a Physical Therapist and

also a Board Certified Specialist in Geriatric Physical Therapy at Community Medical Center. She can be reached at 532-6276

EFFECTS OF

BURNOUTKeeping up with life

By Karen Fliflet & Scarlette Bencia

Unfortunately, most caregivers are not just caring for a

loved one. Many have other responsibilities

such as keeping up with a stressful job,

managing a family, or going to school.


hat comes into mind when we think of the word “burnout?” There may be more than one occupation that can qualify, but one job in particular that needs our attention is the job of being a “caregiver.” Unfortunately,

most caregivers are not just caring for a loved one. Many have other responsibilities such as keeping up with a stressful job, managing a family, or going to school. Mothers who have active children or men with time schedules are all victims of what is commonly referred to as “burnout”.

Caregivers may not even be aware that they are burning out. We love our clients, job, and family. But with hectic careers, a busy family as well as caring for a family member or friend, we can find ourselves so involved with what we are doing that we forget to take a look at ourselves and stop for a minute to reevaluate our well-being. When we do so, sometimes it is just too late. Regrettably, this can cause serious health issues and mental exhaustion. Common signs of burnout would be insufficient sleep, especially if the mind is occupied with thoughts of every day appointments and tribulations. A caregiver can develop high blood pressure, become irritable and frustrated easily. He or she may lack motivation and feel tired as if they are caring the weight of the world. Burnout can affect the digestive system and even cause weight gain or loss. The immune system may break down, therefore; causing us to get sick more often. This is not a good situation for either party.

How do we prevent this from happening to us? We hear it said over and over that you cannot care for others if you don’t care for yourself first. We all know this to be true, so how do we take care of ourselves? First, know your limitations, and don’t try to do more than you are capable of doing. Know that it is ok to say “no” when asked to do more. Spend quality time with friends and family. We also need to relax and do something for ourselves like read, listen to music, or take nice leisurely walks to clear the mind. When we leave our job for the day, we must do that completely- don’t take work home. Learn how best to deal with stress; do not let it build up. We all have different ways of coping; find what works best for you, and practice it daily.

Mostly, try to have a positive attitude and be grateful for all things. Find your joy in life and live it. This will be the best way to not only take care of yourself, but to help the one you are caring for.

Karen Fliflet & Scarlette BenciaCaring with Kindness Adult Day Center

(406)830-3300

W


Entrepreneurs with an eye on the aging demographic are starting up businesses to capitalize on the growing senior citizen population.

The need for services is clear from their own experiences, government statistics and in their own neighborhoods. However, finding customers remains a challenge.

"I know the road that the families go down," said Patricia O'Hora, a registered nurse. In December, she opened a senior-focused day care center, Senior Connections LLC in Waldwick, N.J., after spending three years as a home health caregiver in nearby towns. "People are really in a crisis of

what to do with their elderly family member," she said.A crisis that will likely worsen. In 2007, the U.S. Census

Bureau reported 12.5 percent of America's population was 65 and older. By 2030, that is expected to jump to 19.6 percent.

Many start-up companies that have been launched in the past two years are in demand because older parents need regular help. Their children, often parents themselves, are trying to avoid using nursing homes.

Census statistics and situations of adult children have motivated entrepreneurs to buy franchises that provide home health care aides. Six franchises of Gurnee, Ill.-

By Carol LawrenceThe Record (Hackensack N.J.)

Associated Press

Senior ServiceS A gRowiNg MARkeT:



based BrightStar Healthcare opened in northern New Jersey, where the elderly population is steadily growing, since 2009. A franchisee's initial investment ranges from $102,483 to $183,793, according to the company's website.

Jerry Heit and his wife, Renee, opened a home health-care franchise, ComForcare Home Care, in Hackensack, N.J., in February 2009 mainly based on their reading of census data. Howard Sislin opened his franchise in Wayne, N.J., in September for the same reason.

"It reinforced that folks who are staying at home are an older population," said Heit. "And we believe the need for this kind of service has grown and is growing."

O'Hora opened her business after seeing the needs as a home health caregiver.

"These people don't have any socialization, no stimulation," said O'Hora.

Amy Fuchs, a licensed clinical social worker, had seen such an increase of younger senior patients who had fallen at home coming into the rehabilitation center she worked at in Manhattan. She started The Elder Expert LLC in Upper Saddle River, N.J., in 2008.

Fuchs now helps families find rehabilitation, assisted-living facilities or local senior centers, assists them in understanding Medicare and Medicaid rules, and helps write health-care proxies on future care preferences such as advance directives. She also will check in on home health aides for distant families.

Despite the census data, finding customers is a challenge for the start-ups. Renee Heit, who co-owns the ComForcare franchise, compares selling home health-care services to selling real estate for 25 years.

"You're asking for business here as well but it's not quite as straightforward," said Heit.

"This requires much more of building relationships with people who become referral sources."

Referral sources, said Heit, are social workers at rehabilitation centers, hospital staff who recommend home health-care agencies and assisted-living facilities. Other sources include elder-care attorneys and doctors.

A tactic Sislin has begun is co-sponsoring continuing education seminars for social workers to earn credits to help him start relationships.

John Salomone has just started tapping potential customers for when he opens Caring Transitions of North Central New Jersey later this month in Morristown, N.J., to help seniors reduce their belongings before moving.

He participated in a business-to-business event at Cedar Crest's continuing care complex in Pequannock to build referral sources among management and residents because buyers have to pare before moving in.

"If you're dealing with seniors in a community structure, they talk to one another and form their own alliances," said Salomone, otherwise, he said, "you're not going to get their cooperation."

The independent start-ups are finding they have to learn the ropes themselves and be creative.

Kate McLaughlin started a senior-centered driving service, BandWagon LLC in Franklin Lakes, N.J., last December, after hearing from town officials and church

members that the elderly needed rides to local places.She has 20 regular customers and does five to eight rides

a day, but believes she's not serving enough people. What's worked best has been a complementary arrangement driving clients to and from O'Hora's center.

O'Hora also thinks there's more out there than her eight to 12 regular clients. An attempt to buy a direct mail list of seniors failed when the business selling the list didn't like wording on her literature.

Entrepreneurs say after finding referral sources, the next challenge is to cultivate their trust.

Patricia Preztunik, who opened BrightStar-Bergen County in September 2009 in River Edge, N.J., is sponsoring an upcoming Alzheimer's Walk and sits on the boards for health-related organizations in Bergen County.

"Local reputation in this case matters more than anything, so you have to be engaged locally," said Preztunik. "When people see how you actually work, part of the judgment they form is whether they will give your name out as a referral."

Many of the start-up owners were caretakers and/or decision-makers themselves such as BrightStar Skylands franchisee Bob Bongiorno and O'Hora, who both had relatives afflicted with Alzheimer's disease. They believe that will help them gain trust.

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Experts look to music as a way to uncover a past buried by dementia By Donald Bradley, McClatchy Newspapers

music music



O ne had to look closely, but the white sneaker definitely tapped the floor.

Slightly, softly, steadily. Like a heartbeat."What does the music remind you of, Marsha?" the

caregiver at Villa Ventura in south Kansas City asked loud enough to be heard above the headphones.

The woman looked up, a bit puzzled at first, then: "Being alive."

Medical researchers haven't seemed to do a lot for Alzheimer's patients.

Maybe Perry Como can help. Or Patsy Cline. Or even Mozart.

Institutions across the country increasingly are using music to try to tap into areas of the brain buried by dementia. Alzheimer's is degenerative. But some experts think old songs can slow the progress by stirring up lost memories and possibly even restore some cognitive function.

Concetta Tomaino, executive director of the Institute for Music and Neurologic Function at New York's Beth Abraham Family of Health Services, said patients with mid- or late-term dementia scored higher on cognitive-function tests after 10 months of music therapy.

It has long been known that even after patients no longer recognize names and faces, they can sing along to a favorite tune.

"Auditory processing seems to be the last skill to go," said Tomaino, who has worked in the field for 32 years.

And people, knowingly or not, associate songs to events, sort of like life's soundtrack.

So in this era of wondrous medical technology, a song such as "Ain't She Sweet" might be the best tool to rouse memories of love, family, a snowy day or coming home.

Villa Ventura recently started its iPod music program. Sarah Miller, assisted living director, can't speak to any cognitive-function benefit, but she can tell what caregivers everywhere strive for with dementia patients: a moment of joy.

In the late afternoon period of confusion known as "sundowning," a resident can pace and feel anxious and lost. But put on iPod headphones and song list provided by her family, and she calms.

Miller said, "She might not remember what she had for breakfast, but she can remember every word to 'Let Me Call You Sweetheart.' "

Researchers have long known that feelings, emotions and memories sleep in the minds — like forgotten boxes in the attic — of dementia patients.

Accessing those has proven to be a challenge."Now, we're learning more and more about how music

can lead to increased function, which can further wake up the mind," said Michelle Niedens, education and policy director of the Heart of America chapter of the Alzheimer's Association, based in Prairie Village.

Not so with a face or photo."The mind can't break down the visual," Tomaino said.

"Music is more enriched neurologically."The reason being that music's rhythm, melody and

volume make it a complex stimulus not processed by a single area of the brain.

Tomaino told of a patient who seldom spoke and seemingly had no recollection of anything he'd ever done in his life. But after taking part in a music program, the man told about going years earlier to see Frank Sinatra at the Paramount Theatre.

Patients have also been known to begin feeding themselves again.

Another benefit is that the calming effect of familiar music can lessen the need to medicate agitated patients.

The research caught the eye — ear — of officials at Senior Star Living, the Tulsa-based corporate ownership of Villa Ventura.

The company's music program is under way at all of its facilities. Staffs work with families to create unique play lists for patients.

Studies have not yet nailed down the effect music has on Alzheimer's disease, said Letitia Jackson, the company's director of health services.

"But we were hearing about regeneration of brain cells, cognitive improvement and mood enhancement. So we had to seize upon this."

Marsha Snyder, 66, swayed on the Villa Ventura couch to Harry Connick Jr.'s "I Only Have Eyes For You."

"He's singing to me," the former nurse said with a big smile.

Meet Your ‘Alternative’ Treatments

Arthritis



lder Americans suffering from osteoarthritis may find help in an even older source - ancient Chinese healing treatments and exercise.

New studies by U.S. researchers are revealing the

potential healing power of acupuncture, Tai Chi exercise and Qigong to reduce the symptoms of osteoarthritis, the most common form of arthritis, which causes pain and reduced motion in the joints and spine. Experts say there is no current medicinal cure for osteoarthritis.

In a recent study published in the November issue of Arthritis Care & Research, Dr. Chenchen Wang and colleagues at Tufts University School of Medicine, Boston, recruited 40 subjects averaging 65 years of age suffering from knee osteoarthritis to participate in a 60 minute Tai Chi session, instructed by a Tai Chi master, twice weekly for 12 weeks. Tai Chi is a traditional Chinese mind–body exercise that enhances balance, strength and flexibility, and reduces pain, depression and anxiety in diverse patient populations with chronic conditions.

“It’s very exciting,” says Wang, who says the study showed that Tai Chi appeared to improve physical function and reduce pain and depression. “We found that Tai Chi does have a lot of benefits for the elderly for physical and mental conditions.”

In June 2008, Dr. Kevin Chen and fellow researchers at the University of Maryland School of Medicine Center for Integrative Medicine, Baltimore, published a study in Clinical Rheumatology revealing the effectiveness of external Qigong therapy on people with knee osteoarthritis. External Qigong therapy is similar to therapeutic touch, in which the well-trained healer applies his/her Qi energy to the patient, Chen says. Chinese medicine considers knee arthritis to be caused by Qi blockage in the knee area.

Among the three groups treated for two weeks, Chen says “the placebo group had a 33 percent reduction in pain, the group by Healer 1 had a 35 percent reduction in pain, while the group by Healer 2 had a 55 percent reduction of pain after two weeks of treatment.” This led Chen to conclude that External QiGong Therapy might have a role in the treatment of osteoarthritis, depending upon the qualities of the healer.

Chinese acupuncture also has been studied to aid in the treatment of knee osteoarthritis. Dr. Lixing Lao of the Center for Integrative Medicine at the University of Maryland School of Medicine has conducted three acupuncture studies from 1993 to 2004, from a small pilot study to a 570 patient clinical trail.

“Patients who were randomly assigned to the acupuncture treatment group had significant pain relief and function improvement as compared to placebo/sham control,” Lao says.

Researchers realize more studies need to be done to incorporate Chinese exercise and healing practices into mainstream medicine in the U.S. But they are seeing hopeful signs.

“Acupuncture is more accepted by the public than any time before,” Lao says, citing a recently published survey conducted by the National Center for Complementary and Alternative Medicine (NCCAM) and the National Institutes of Health (NIH). “There were 27.2 visits to acupuncturists per year per 1000 persons in 1997, but in 2007, this number increased to 79.2 visits per year per 1000 persons.”

Plus, Lao says, more medical acupuncturists are working in hospitals. “For example, in our University of Maryland School of Medicine, not only is acupuncture service provided by licensed acupuncturists in the center for integrative medicine, but also by medical acupuncturists for their patients in the shock trauma center, cancer center and anesthesiology department.”

OBy Jeff Schnaufer

CTW Features

New studies find traditional Chinese exercises and treatments provide a boost for

the mind, soul and joints


Whether it's a rebate check from Medicare, an oil spill in the Gulf of Mexico, or any other headline news, there's likely a scam artist not far behind. And more often than not, the victim is an older American.

More than 7.3 million older Americans-one out of every five citizens over the age of 65 — already have been victimized by a financial swindle, according to a survey released as part of World Elder Abuse Awareness Day, which was June 15.

guard moneyfrOM ThE uNSCruPuLOuS

By robert PowellMarketWatch (MCT) BOSTON

Associate Press


ne problem is that few professionals or adult children appear prepared to spot when an older American may be vulnerable to financial abuse. A new program launched last week seeks to train

medical professionals to assess when older patients might be likely to fall prey to elder investment fraud and financial exploitation.

The gist of this program is that medical professionals are in the best possible position to not only diagnose cases where elders are being swindled but also to alert state securities regulators or what some call "adult protective services professionals" about suspected investment fraud involving these at-risk patients.

The program, a new partnership between the Investor Protection Trust, the North American Securities Administrators Association, and the National Adult Protective Services Association, was based on a pilot program in Texas that produced three cases resulting in fines and prison sentences, including a 99-year sentence for one Edward S. Digges Jr. who raised at least $10 million from about 130 Texas investors, the majority of whom were elderly.

According to Don Blandin, president and CEO of Investor Protection Trust, the centerpiece of the new program is the Clinician's Pocket Guide, which contains a list of questions that medical professionals can ask older patients. Doctors can get a sense of their patient's financial capacity by asking the following questions:

Who manages your money day to day? How is that going?

Do you run out of money at the end of the month? Do you regret or worry about financial decisions you've

recently made? Have you given power of attorney to another person? Do you have a will? Has anyone asked you to change it?

If the answers to those questions raise suspicion, the doctors are then urged to probe for further details by asking whether the patient is having any of the following concerns:

I have trouble paying bills because the bills are confusing to me.

I don't feel confident making big financial decisions alone.

I don't understand financial decisions that someone else is making for me.

I give loans or gifts more than I can afford. My children or others are pressuring me to give them

money. People are calling me or mailing me asking for money,

lotteries. Someone is accessing my accounts or money seems to be

disappearing.

If there's any cause for concern, the doctor is asked to consider sending the patient to one of four referral services. In fact, the doctor is required in most states to report cases where fraud or exploitation may have occurred to an adult protection service. In other cases, the doctor might send the patient for further medical testing for cognitive,

neurological, or other conditions.But there's no reason to wait on medical professionals to

spot cases of seniors who are being swindled. For instance, the program gives doctors a list of red flags. There's no reason why you — either as an older American, an adult child of one, or a financial professional — can't do the same. Ask yourself: Are you an older adult or do you know one who:

Is socially isolated, depressed or lonely? Has experienced a change in the ability for self-care? Depends on someone to provide everyday care? Is uncomfortable with the person providing care? Has just lost a loved one, such as a spouse? Is financially responsible for an adult child or spouse? Has given power of attorney to someone else to manage

his or her finances?If the answer to any of those questions is yes, then

it might be well worth going into high-alert mode. In fact, it might be worth staying in high-alert for the rest of this century. Why? According to Blandin, those elders at greatest risk of being scammed are those with mild cognitive impairment who can perform most daily functions, but have trouble or become confused with others, such as following their medicine regimen or managing their finances. That may be quite a few people. According to at least one study, more than one-third of the 25 million people over age 71 in the U.S. either have Alzheimer's or mild cognitive impairment. That represents quite a few potential scams.

o


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MediterraneanDiet Up Close & Personal

THE

By Marilynn Preston, Associated Press


am writing today's column from the same small, remote, magnificent Greek island I was on last year at this time. Blue sky, glorious sun, empty beaches. Be happy for me. A generous spirit is one of the marks of a healthy, happy lifestyle.

I am here, on my towel, researching quality-of-life issues. The Mediterranean style of eating is considered by many experts to be the "healthiest diet in the world." Why take Harvard Medical School's word for it when I can take a 10-minute walk to a tiny Greek taverna right on the beach, where the owner cooks a fish he bought from his brother the fisherman just after sunrise?

The much-revered Mediterranean style of eating is based on real food, locally grown, lovingly prepared by people who quote Homer.

Today's field research also consisted of a slice of spinach

pie and four sensational tomatoes cut into chunks, and splashed with olive oil and oregano. I can't get enough of the tomatoes. Is five tomatoes too many at one meal? Can a person overdose on lycopene?

The meals are relaxed. That's important. And they feature unprocessed foods, healthy fats, fish, vegetables, legumes, a glass of wine. Or two ...

If everyone in the U.S. followed the basic characteristics of the Mediterranean, we'd solve the heath care crisis overnight. I am serious.

Eating this way - adjusting for ethnic preferences and level of activity - would be hugely helpful for preventing cancer, heart disease, strokes, asthma, allergies, Alzheimer's and more. And there's no suffering involved. The Med-as-in-medicine diet is delicious.

Pretty much. Not everything.

“The meals are relaxed. That's important. And they

feature unprocessed foods, healthy fats, fish,

vegetables, legumes, a glass of wine. Or two ...”

I


Have you ever tasted a boiled zucchini?So what are those basic characteristics of the

Mediterranean style of eating? This is exactly the kind of question a person on vacation in Greece likes to hear.

For more details and good recipes, visit www.mediterraneandiet.com

1. High consumption of olive oil. It's sold here by the bucket and is used to cook just about everything. Olive oil goes on beans, on greens, on cheese, on tomatoes, on fish, on bread and on many chins.

2. High intake of vegetables, fruits and legumes. "Eat your greens" was one of the first signs found at the Acropolis. The Greeks love their veggies, their local fruits, and their peas and beans, and so should you.

3. non-refined carbs. Rice and potatoes are part of everyday eating, made delicious without butter. The trick is to adjust your carb portion according to the amount of

physical activity you get in a day.4. consumption of fish, especially oily or 'bluish"

ones, three or four times a week. This is getting to be a challenge in the Greek Islands, since the Mediterranean seas are over-fished and increasingly polluted. Even suspect fish are expensive. At dinner the other day, a Greek friend ordered fried meatballs instead of the "fresh fish" because she knew it came from polluted fish farms. Trouble in Paradise.

5. consumption of milk and derivatives. Greeks love their few simple cheeses - especially goat cheese - and the stores are loaded with variations on the theme of yogurt. You can't force feta into someone's life, but if I could, I would.

6. three or four eggs a week. The West went wrong when it scared people off of eggs. Come back! Eggs from healthy, happy chickens are good for you. On this Greek

High consumption

of olive oil. It's sold

here by the bucket and

is used to cook just

about everything.


island, I have a chance to taste eggs from hens I see prancing and scratching around their little houses on my late afternoon runs. It's a thrill, and the eggs can't be beat.

7. Moderate consumption of meat and saturated fat. Moderate is the key word here. Balance in life. The middle way. Avoid excess. The Mediterranean style of eating is part of the laid-back Mediterranean lifestyle that contributes to long life. (I'm saving my longevity research for a visit to nearby Ichyria.)

8. one or two glasses of wine a day, preferably red, at main meals. White wine and beer are alternatives.

9. nuts as snacks. It's almost too good to be true, but it is. Mediterranean-style eaters love their walnuts and their almonds, and so will you, if you decide to look into this Mediterranean Diet thing a little more.

Not me. My work is over for today, and I'm so full I could faint. It might have been that second piece of spinach pie. I'm off for a long walk up, down and around the island. I have to watch for meandering goats. Opa!

Ways to Save on Medical Bills

7

When it comes to health care, cutting costs without cutting corners is key

By Anna Sachse, CTW features



T he economy doesn't have to be in a recession for health problems to plunge your finances into a world of hurt. Letting the bills pile up or, worse, skipping

treatment, is not the answer. You just need to practice a little preventative "medicine." Of course, there's no way to predict a medical emergency, but here are seven proactive ways to help reduce the pain you'll feel in your wallet.

1. Educate yourself about your services

Today, before anything has happened to you, take some time to go over your insurance policy with a fine-tooth comb so that you have the best understanding you can about what's covered and what's not, says Kathleen Harris, senior online editor for the recently re-launched RealSimple.com. Then, before a procedure takes place, ask the medical provider what the fee is, if there any hidden costs and what the fees might be for typical complications. Verify that these services are covered by your insurance and confirm that your doctor is in network. "The overall point is 'Don't be afraid to ask questions,'" says Harris. "You want to be prepared so that you aren't stuck with a surprise bill when you're trying to recuperate."

2. Ask about options

Ask your physician if all the recommended testing and procedures are medically necessary, especially if you have no insurance or a high co-pay. He or she may be able to suggest a cheaper alternative.

3. Ask for a discount

A 2005 Harris Interactive poll found that 70 percent of people who spoke with a hospital were successfully able to negotiate a lower price for their medical bills, and the same went for 64 percent of those who negotiated with a dentist, 61 percent for a doctor and 56 percent for a pharmacist. Even 45 percent were able to negotiate a discount with their insurance company.

At the very least, your care provider may be willing to set up an extended plan that allows you to make smaller, more manageable payments over a longer period of time.

4. Pay in cash

Offering to pay upfront in cash can take 10 to 30 percent off your bill, says Harris. It reduces the medical provider's credit card fees, paperwork and manpower, and demonstrates that you are clearly able to pay.

5. Go generic

According to the FDA, cheaper generic medicine is just as effective and safe as name-brand drugs, says Harris. In fact, it is often produced in the exact same plants. Buying from a doctor-recommended mail-order pharmacy and/or in bulk, will often add to your savings, or try asking your care provider if they have free samples – these can include anything from over-the-counter cold medicines to asthma inhalers or antibiotics.

6. Double-check your bill

According to ConsumerReportsHealth.org, billing errors are common at hospitals and other health-care facilities, so ask for an itemized bill and check it for accuracy. Frequent errors include: inflated room and incidentals charges; duplicate fees for tests and procedures; inflated operating room time; incorrect dates of service; and human errors that result in the wrong billing code.

7. Get an advocate

For more complex situations, consider hiring a medical-claims professional to help ensure that your bills are correct, track your payments and advocate on your behalf. According to Rebecca Stephenson, a registered nurse and CEO of Austin, Texas-based VersaClaim, Inc. and co-president of the Alliance of Claims Assistance Professionals, if you are simply angry about a $200 office visit and you want to fight it on principle, it probably wouldn't behoove you to hire a claims professional; but if your situation is serious, overwhelming or long-term, it will most likely save you meaningful money.

"We're kind of like medical accountants," Stephenson says. "We know all the codes and what a bill should look like, but we can also take the emotions out of the equation so that negotiations go faster and nothing is overlooked."


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One cup of yogurt – just a little bit more than one of the

“cups” you’ll pick up in the dairy section – offers about 45 percent of your daily value of calcium. That’s good news for teeth, bones and muscles. Studies have shown that people who consume yogurt (and other dairy products) lose significantly more weight than those whose diets are similar but less calcium-rich. Adding one or two servings to your diet can help maximize fat loss while keeping muscle loss to a minimum. Yogurt contains 30 percent of your daily value of riboflavin and 20 percent of your daily value

of cobalamin, both essential B vitamins. But perhaps what are most important in yogurt are the live bacterial cultures. Studies have shown the cultures to increase longevity in the elderly and boost the immune system. They’ve also been shown to suppress the activity of Helicobater pylori, the bacteria that causes most ulcers. And those cultures – in just a few ounces’ worth of yogurt – help lower the compounds that cause bad breath and also may eliminate the bacteria hanging on your tongue.

You food: yogurtBy Timothy r. Schulte

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Effects of burnoutKeeping up with life

A Publication of theJuly/August 2010

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