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Abuse Thrives in Pandemic
Guest post author Gregory Peebles is a team member at CCM whose work focuses on helping aging adults and...
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June 16, 2020
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In the Caregiver's Words

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I recently had the opportunity to speak with Dr. William Krowinski of Life Works Erie (link) about something I have noticed over the years. That is, during all of this holiday period, there are a lot of folks who just seem pretty down. So, I asked him about this thing with "holiday blues," or is it actually depression? Here are his answers.

Is there such a thing as holiday blues or is it just another name for depression?

"Holiday blues as a psychological condition is distinct from clinical depression. We tend to think of the holidays as a joyous time, getting together with family and friends, preparing and exchanging gifts and well wishes, fixing and partaking of traditional desserts and meals. However, for some, particularly the elderly, they can also be a time of sadness with a sense of loss.

Why is that?

Our mind is always referencing the past to make sense of and guide us in the present. We don’t invent Christmas or Hanukkah each year. It’s an annual celebration whose meaning and rituals are largely derived from past celebrations. So this holiday is in many respects a reflection of past experiences. Whether consciously aware of it or not, we ask ourselves where was I last year, who was I with, who was there, what did we do, how did I feel and so on. For many elderly, this referencing inevitably involves realizing who isn’t here this year, including spouse, friends and family members; and what did I do in the past and am I able to do it now? Recognition of these significant losses and limitations produce feelings of loss and sadness.

Do all elderly suffer from holiday blues?

If they have experienced significant social losses and physical limitations, I would say yes but with some qualification. Some people are psychologically resilient so loss is not as devastating and their sadness isn’t as severe. Some people have a large social network full of friends and family members, which tends to offset any one loss.

Is there a difference between holiday blues and depression?

Yes. Examining the duration and severity of the sadness, as well as identifying other symptoms allows us to differentiate between the two conditions. Regarding duration, holiday blues end when the holiday is over. Clinical depression continues for months and sometime years if left untreated. With depression, a person’s ability to socialize and take care of him or her self is negatively affected. Other symptoms tend to include loss of appetite and weight, insomnia, anxiety, difficulty concentrating, feelings of discouragement and hopelessness, lack of energy and motivation, and sometimes-suicidal thoughts.

What can be done to help a person experiencing Holiday Blues?

First let me say what you shouldn’t do. Don’t tell the person “you shouldn’t feel that way” or “just snap out of it.” We don’t choose our feelings. People suffering from the holiday blues or depression need to be treated with empathy and compassion. In addition to recognizing the person’s feelings, ask, “Is there anything I can do to help?” Offer to take the person shopping, to church, for a walk and other activities. Offer to include him or her in holiday preparation activities such as baking cookies, buying a Christmas tree, decorating the house and so on. Even if the person declines your offer, they know you are thinking about him or her.

Do you have any suggestion for the person who is experiencing Holiday Blues?

First, recognize that there is reason to feel sad. Accept the sadness and view it as a messenger. Frequently our sadness informs us of the joy that a deceased loved one has brought our life. Next, try not to isolate yourself. Don’t turn down opportunities to be with family and friends. Regarding physical limitations, grieve the loss of what you once could do; while at the same time do what you can do. Remember that life is a about transitions – the athlete becomes the coach, the actor the director, the mother the grandmother and so on. Celebrate the past but let go and embrace the season of your life. And remember there is always someone who needs your help. Helping others, even in small ways, creates meaning and purpose in our lives.

Dr. William Krowinski Ph.D., LCSW, a psychotherapist specializing in marriage and family and a guest speaker at LifeWorks Erie (www.wjkphd.com). Lifeworks Erie, located in NW Pennsylvania, is a partner of CCM. They provide services and resources for seniors interested in staying mentally and physically active.

Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com.
If you ask most medical providers what is the number one health issue affecting older adults, you might get a list that looks like this:
Arthritis…

Hypertension...

Asthma...

Blindness...

Cancer...

Chronic Bronchitis. ...

Coronary Heart Disease. ...

Dementia.

I think that misses the point. I think the health issue that affects most older adults is lack of HUGS!

Yes, everyone who gets older also is at risk for becoming more isolated, having less contact with others, having fewer intimate friends and family around and yes, fewer hugs. And hugs are a big deal.

A psychotherapist named Virginia Satir suggests that we need four real hugs a day just to survive, eight hugs a day to maintain our health and twelve or more hugs to grow. We are not talking about a little Hollywood hug with an air kiss; a real hug that delivers health benefits is about 20 seconds in duration. This kind of hug is a trigger that tells your brain to release a hormone called oxytocin, and that is good for you in many ways. And the list of “hug benefits” goes on:
1. Hugs lower your cortisol levels which improves your heart health by lowering your blood pressure and more.
2. Hugs reduce pain and the inflammatory response of some immune disorders and even improves the immune system for people who have cancer.
3. Hugs stimulate the thymus gland which regulates the white blood cells that defend your body against infection.
4. Hugs tell your brain to release dopamine which is another hormone that also positively reinforces good feelings and even motivation.
5. Hugs elevate the serotonin levels which help to counter pain while elevating happiness and decreasing sadness.
We are not talking about a one and done thing here. I am not suggesting we drop by to visit and older loved one for a hug. Think about hugs as part of a nonverbal communication that can become a habit. And with the holidays upon us where families will be getting together, think about how to give your reunions a health benefit. Remember…for every hug you give, you also get one back! Charlotte Bishop is an Aging Life Care Advisor, Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. She also is the co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia.
You have heard me make some pretty big claims, and you may think this one is over the top, but 80 year olds who run every day have the body of a 40 year old who does not exercise. I have seven suggestions that will help anybody to stave off the ill effects of aging and maybe even turn the clock back. 1. Re-engineer your Genes: We are programmed to age by losing about 5 pounds of muscle per decade and gain about 10 pounds of fat. Exercise experts tells us that we can retrain our muscles to act younger. In fact with just 6 months of strength training a body can learn to preserve muscle mass, in effect, rolling back the biological clock. 2. Re-learn to Lift Properly: Lower back injuries are among the most common maladies of older adults, because we do not lift correctly. Men should squat to lift with their toes pointing forward. Women should modify this with a slightly wider stance and with the toes pointing out more. 3. Confuse your Muscles. Mix up the exercise regimen so that your muscles do not stop using certain groups and overuse others. You have heard that doing brain puzzles makes the brain more nimble. The same can work for the muscles of the body by what trainers call "muscle confusion." The result is stronger and more agile. 4. Confuse your Brain too: Well not confuse so much as make both halves of your brain work with each other. If your exercise includes crossing your limbs over to their opposite side as one does in dance exercise or lunges or yoga, it further strengthens how your brain's hemispheres can work and respond to change. 5. The Important Muscle: When you work out aggressively, your heart works aggressively. Trouble is that most of us do not exercise the heart enough. Current guidelines suggest 150 minutes of cardiovascular exercise a week, but some new research suggest that optimal heart conditioning comes from closer to 240 minutes a week. More is better! 6. Impact is Good: Just as muscle density can diminish with years, so also bone density wanes over the years. This accounts for why astronauts lose bone density in zero gravity - no impact. Dancing, walking and jogging are essential for maintaining bone heath. 7. 10,000 May Not Be Essential: We have long heard that we are to take 10,000 steps a day. I know someone who tracks it with his phone, and there are people who wear pedometers to keep up the pace. Canadian researchers actually have moderated this to 7,500 steps a day - a bit over four and a half miles. Doing more is fine, but don't beat yourself up. This is where I have to add that you speak with your health care provider about any new exercise regimen just to be sure it is safe for you. But when your doctor says yes, look forward to winding back your clock. Charlotte Bishop is a Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to info@creativecaremanagement.com.
The winter season will soon be upon us, so I have invited Elizabeth Carrollton of Drugwatch.com to guest blog on some of the fall hazards that are part of the ice and snow of winter in the Midwest.

Falls are a serious health risk for seniors. Each year, one of every three adults 65 or older falls, according to the Centers for Disease Control and Prevention. Nearly a quarter of a million of those seniors will fracture a hip when they fall, which requires surgical repair or hip replacement. Traumatic medical events of this nature can change lives, taking a major toll on mobility and health, so it's very important to take measures to help your senior family members reduce their risk of falls.

Strength and Balance Issues: Muscle weakness can make seniors much less stable on their feet, increasing risk of falls. Inactivity is often at the root of that weakness. Encouraging that older adult you care about to exercise can prevent balance and stability issues. Just 30 minutes a day of moderate exercise will do, which can be accomplished with a daily walk after lunch or an exercise class at the local senior center. If instability is already a problem, seeing a physical therapist to improve strength and balance should be a priority to prevent falls and serious hip injury.

Check into Nutrition: Poor nutrition is a common problem in seniors. Appetites tend to decrease as we age and digestive problems or other health issues can affect the body's ability to absorb nutrients. Checking into the eating habits of your loved one and, if necessary, ensuring that wholesome meals are provided can help, as can a good multivitamin supplement that has plenty of B-vitamins, calcium and vitamin D.

Other Safety Measures: Vision problems are frequently a factor in senior falling incidents. Vision can change rapidly once we reach a certain age, so regular eye exams are essential. Clearing the home of tripping hazards is important, like loose rugs or clutter, as is ensuring good lighting.

If a Fall Happens: Sometimes, even when the best care is taken to prevent falls, accidents happen. If your senior family member takes a fall, seeking a medical evaluation as soon as possible is important, even if there isn't an obvious injury. If there are signs of hip injury, such as pain, bruising or swelling, immediate medical attention is crucial. If the hip is fractured, your loved one will need surgery. If hip replacement is necessary, there are some things you should know about hip implants in order to help your loved one choose wisely. Several hip implant products, primarily metal-on-metal types, have been recalled lately over high rates of failure and serious complications. The latest recall involves the Stryker Rejuvenate hip replacement system, which was prone to corrosion and failure.

Some patients who received these faulty implants suffered metallosis, a serious condition caused by the accumulation of metallic implant debris in the body's soft tissues, leading to pain and swelling in the hip and in some cases, tissue death and bone loss. Avoiding metal-on-metal devices might be wise, to reduce risk of complications. Seniors who have already had one of these devices implanted should be monitored for any sign of pain and inflammation that might indicate metallosis.

- Elizabeth Carrollton writes about cautions regarding medical devices and drugs for Drugwatch.com. Please visit their website for more information.

Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults their families in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com. Learn more about our Chicago senior services and how we can help you support your loved one.
Twenty two minutes. Every twenty-two minutes someone over age 65 dies as a result of a fall, and this is almost double what that figure was just ten years ago. These are called severe falls, and it is not that the individual dies at the time of fall as much as they will succumb to other complications subsequent to the fall. Because just as the incidence of falls has increased, the incidence of heart disease, stroke, arthritis, diabetes and other chronic conditions has increased among older adults. With the increasing numbers of medications that older adults take for their medical conditions, there also is an increased risk for confusion, delirium or imbalance as side effects of the prescriptions. We also are seeing an epidemic of severe - but not fatal - falls, nearly 2.5 million of which result in trips to the emergency room in America each year. This is fifty percent more than just ten years ago, and the incidence is double for women what it is for men, because women are living longer. So what can caregivers do to help their older loved ones living safely and independently? Take your cue from some innovative senior residential facilities around the country. In past postings I have talked about making lights within reach of bedside for older loved ones who may be getting out of bed during the night or in the early morning hours of darkness. There are now new ways to install floor lighting around the bed or along the usual paths from bed that are motion-activated. As your older loved one sits up in bed and their feet reach toward the floor, lighting strips like those on jet airline aisles are activated and light the way to a safe trip to the bath. In the bath, motion sensors turn on enough lighting to make navigating what can be the most dangerous room in the house much clearer and safer. One other innovation being introduced into senior residences is color contrast seats for the commode. Instead of the interior design rule of matching colors, some residences are making the toilet rings black against a white commode to provide an easier contrast for those whose eyesight may not be as sharp as it once was. And grab bars in the bath as well as along any halls and stairways to give a ready assist to older loved ones who may be sufficiently willful to ignore the doctor's orders to use a cane or walker. And who said floors can only be made of wood or tile? Interior decorators are coming out with attractive new floor coverings that absorb shock as a last line of defense against fatal falls. Consider also tasteful color contrasts to help older eyes distinguish step treads on the stairways as well as paths along halls. For anyone who recalls my "mitten test" for household door handles, switches, etc., you will like this suggestion. Get a pair of cheap sunglasses and rub Vaseline over the outside of the lenses. As you walk through the house you will have a much greater appreciation for what older vision - particularly vision impaired by cataracts - can literally look like. Add six pair of socks to your feet and you will be able to take a walk in their eyes, instead of a walk in their shoes. Charlotte Bishop is a Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to info@creativecaremanagement.com.
It’s not just about forgetting how to get to where they are going. Older adults – even in the early stages of dementia – are simply at a much higher risk of accidents while driving. While adults over the age of 85 make up only about 9 percent of the population, they are involved in 13 percent of the fatal crashes and 17 percent of the pedestrian accidents resulting in death. Overall, the fatality rate of 85+ year old drivers is 17 times that of drivers 25 to 65 years of age according to the National Highway Traffic and Safety Administration. Is dementia a part of that? Yes, but only a part. Aging is a process that not so subtly erodes an adult’s visual capacity for judging distance, recovering from glare and distinguishing objects in dark or semi-dark conditions. Add to that the physical limitations that osteoarthritis can impose along with slower muscle reaction time and yes, memory deficits, and 85 plus year olds have the highest per-mile accident rates of any cohort beyond the teens. If you are a caregiver to someone within this older cohort - 85+ - this is not a mandate to talk about the car keys just yet, but it is important to be alert to what may be unfolding. Medical surveys of outpatients suggest that as many as 30% of older adults who have dementia may still be behind the wheel. What to look for? Dementia does not simply mean that an older driver gets confused in the parking lot at the mall or gets lost on the way home. Dementia in the driver’s seat translates into unexplained dents or scratches on the car. If you have occasion to drive with the older adult watch for difficulty in lane changes or lane wandering, challenges on turning or difficulty judging distances. Accidents typically are the result of a growing series of mistakes and near misses on the road. Early stage dementia patients may actually be safe drivers, but you should talk to your older loved one’s primary care physician. They will not be able to speak to you about your loved one’s medical condition without sign-off from the patient, so that is a starting point. And appreciate that not all physicians are well-schooled in diagnosing dementia, let alone treating it. If you are concerned about dementia as it may be affecting your loved one’s driving, start by asking the physician about your loved one’s ability to pass a mini-mental exam or other cognitive tests such as the Clock Drawing Test that help assess executive function. If the physician is not able to help, ask about possible referrals. You may find that there are hospital providers who have actual testing programs or driving schools to help assess your loved one’s safety behind the wheel. If the decision is made that your loved one is not safe driving, begin immediately to explore your transportation options. Some older adults will be relieved that the stress of uncertain navigation is no longer a challenge, but others may view it as a significant loss of independence. Be prepared to be an empathetic listener. Steer clear of sentences that start with “at least” such as “at least you did not have an accident…” Picture what you might feel in a similar circumstance and go from there. Don’t try to gloss over the genuine loss your loved one will feel. What are the public transportation options? That may depend on how advanced the dementia is, because navigating train or bus routes can be as challenging as driving. Paratransit and chauffeur services may be an option if they are affordable, but be careful on vetting the services. Check with your local ombudsperson on aging for a secure option. Charlotte Bishop is a Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to info@creativecaremanagement.com.

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Creative Care Management, LLC.

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