All About Estates, Feb 16, 2012: by Audrey Miller
With Valentine’s day behind us, romance and sex continue to be alive and well. The baby boomers are getting older and while 60 has become the new 40, and 75 the new 60, healthy sex continues to be a favorite topic. However it may still be a subject that is often ‘under the covers’ and not comfortably discussed. Adult children don’t typically want to hear about the parent’s sexuality and vice versa; however professionals need to be comfortable in asking and answering questions. Some treatments for erectile difficulties and vaginal lubrication may require a physician’s prescription and different infirmities may require some creative positions.
Regardless of your own personal definition of sexuality and what it means for different age groups, it should include an understanding of safe sex and sexually transmitted disease awareness. People often assume that once someone becomes a senior that they also become asexual. This is not the case.

According to the Public Health Agency of Canada there has been an increase in the number of HIV positive tests and AIDS diagnoses among older Canadians, now accounting for 15% of the total. The AIDS diagnoses for people over the age of 40 has accounted for the majority of cases since 2000 and in the year 2007 exceeded 60.0% of all reported AIDS diagnoses for the first time.
It is important that discussions are held with people of all ages around safe sex practices regardless of one’s own bias’ associated with senior’s sexuality. Just because someone has dementia, doesn’t mean that they don’t have interest in being sexual. However sexual relationships between residents of retirement/long term care homes who have dementia is another area where better understanding is needed. Staff at long term care homes are not quite sure how to respond to questions regarding sexual activity amongst residents. There are issues in regards to consent, and when participants may be married to others. There is a need for discussion, staff education, and guidelines so that appropriate guidelines and practices can be developed accordingly.
A few on-line resources to consider include:
*www.sexualhealth.com/channel/view/disability-illness/
*www.comeasyouare.com/default/index.cfm/sex-tips/sex-and-disability/sex-and-disability-links/
*www.zoomermag.com/sex/

Be safe and be smart about sex- regardless of your age!-

Posted on February 9, 2012 by Whaley Estate Litigation

The issue of aging parents is something that will affect us all at some point. Are they safe enough to be living alone? How can we be sure that the care they are receiving meets their needs? While we do not want to see that our parents are beginning to have problems, confronting them about their difficulties and/or investigating what assistance is available to them can be even harder. How can we determine what is available in terms of at-home assistance, retirement living and long-term care—and what are the differences?

Our firm recently had the pleasure of meeting Audrey Miller. Audrey, who is a registered social worker, is the founder and managing director of Elder Caring Inc. (“ECI”), which has a team of experts with backgrounds in Social Work, Occupational Therapy, Physiotherapy and Gerontology in different cities across Canada. ECI was created to meet a growing demand in the community for services with a focus on the health and well-being of the older adult and their family.

“We meet with you and your family in your home to discuss and identify areas of concern. We will identify community resources to assist you and access publicly available services whenever possible. We are your case coordinators. We liaise with your medical team, family members and involved service providers to ensure a coordinated approach to service delivery.”1

All matters are referred through Audrey, who assesses the situation and then assigns the appropriate team member to work with a family. Audrey has spent the last 25 years working with differently-abled individuals and their families, focusing on rehabilitation issues to improve function at home and in the community. She is also a qualified expert witness in Rehabilitation and Life Care Planning in the Ontario Superior Court of Justice.

What is important, is that Audrey knows how to navigate the system, which changes all the time.
Where available, a Geriatric Care Manager will meet and assess the older adult in his/her own home. The assessment includes environmental, functional, emotional, cognitive, and caregiver issues which results in a Wellness Plan or ‘roadmap’ for care. ECI also provides ongoing Wellness Monitoring services for the older adult.

ECI also provides counselling by registered social workers, and will customize Care Plans to help manage caregiving and work responsibilities.

We sought out Audrey to find out more about the services that Elder Caring Inc. is able to provide to lawyers dealing with elder law issues.

Audrey and her team provide professional advice and support to law firms, the professionals within them and to their clients. For example, assistance and support may be sought:

in assisting substitute decision-makers in respect of health care, nutrition, shelter, clothing, hygiene and safety;
in assessing and providing care plans in cases where we need to find out if our client’s parent is managing safely in their current environment;
in bringing members of a family onto the same page in respect of care for an aging parent and allocating responsibility.

When you meet Audrey, you will see that she is incredibly professional; she has a wealth of knowledge and experience in the field of elder care. But what sets her apart is a mix of warmth, enthusiasm and understanding—she is easy to talk to, and obviously very committed to the care of older adults.

To contact Audrey Miller, please check out her website at: http://www.eldercaring.ca/
Or call Toll Free at 1-866-473-8887 or Toronto at 416-658-8887.
Or by email at: amiller@eldercaring.ca

–
Footnote:
1. http://www.eldercaring.ca/services/for-families/

Written on Feb 8, 2012, by Audrey Miller at allaboutestates.ca. Today Bell Canada is supporting mental health awareness with their “Let’s Talk Campaign”. While mental health week in Canada is May 7- 13, 2012 , Bell has opted to talk openly about mental illness with the hope of reducing stigma so that people can get the help they need. One in five Canadians will have or have had a mental illness. This illness crosses all ages and Dementia, which I blog about routinely, is also defined within the mental health umbrella and it too cuts across all racial, religious and socio-economic borders. It impacts both caregiver and care recipient alike.
Some facts from the Canadian Mental Health Association: According to the World Health Organization (WHO), “mental illness is the number one leading cause of disability in the world and five of the 10 leading causes of disability are related to mental disorders. Mental illness costs the Canadian economy a staggering $51-billion a year, and each day 500,000 people will miss work due to mental health problems. Each year employers and insurers spend a whopping $8.5 billion on long-term disability claims related to mental illness. Mental illness is the number one cause of disability in Canada, accounting for nearly 30% of disability claims and 70% of total costs. Mental health disorders in the workplace cost Canadian companies nearly 14% of their net annual profits and up to $16 billion annually. The unemployment rate among people with serious mental illness is 70 – 90%. There is a 60% drop in family income when a breadwinner is diagnosed with mental illness.”

For employed caregivers, stress is a leading cause of caregiver burnout and possibly leading to depression. This is not surprizing when, on average, caregivers wait 5 years before seeing help. If you are in this category, speak to your doctor and your employer/human resource department/employee assistance provider for help.

For seniors, the numbers affected by mental illness are even higher. Depression is one of the most common mental health problems affecting seniors, yet the condition too often is unrecognized and untreated. Depression is NOT a normal part of the aging cycle and can be treated.
Men over the age of 65 are at the highest risk for dying by suicide among all age and gender groups (Health Canada, 2002). Seniors living in institutions have even higher rates of depression, with as many as 30 to 40 percent having the disorder (National Advisory Council on Aging, 1999).

Mental illness can be treated. Speak up, speak clearly and remember the motto of the Mood Disorders Association of Ontario, get your “Check Up From the Neck Up”. – Audrey Miller

allaboutestates, Written on January 31, 2012 – 7:43 am | by Audrey Miller
There is a Canadian wide shortage of hospital beds and a Canadian wide philosophy to move people through the system as quickly as possible. I had previously blogged on the emotional issues of bed blockers which continues to make headlines. This focus on this blog is on what nature is doing to address this problem or perhaps what it is doing to further complicate this problem. C Difficile and MRSA. C Difficile is defined by the Mayo Clinic as follows: “Clostridium difficile often called C. difficile or C. diff, is a bacterium that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon. Illness from C. difficile most commonly affects older adults in hospitals or in long term care facilities and typically occurs after use of antibiotic medications.
In recent years, C. difficile infections have become more frequent, more severe and more difficult to treat. Each year, tens of thousands of people in the United States get sick from C. difficile, including some otherwise healthy people who aren’t hospitalized or taking antibiotics. Mild illness caused by C. difficile may get better if you stop taking antibiotics. Severe symptoms require treatment with a different antibiotic.”
MRSA is defined as: “Methicillin-resistant Staphylococcus aureus (MRSA) infection is caused by a strain of staph bacteria that’s become resistant to the antibiotics commonly used to treat ordinary staph infections.
Most MRSA infections occur in people who have been in hospitals or other health care settings, such as nursing homes and dialysis centers. When it occurs in these settings, it’s known as health care-associated MRSA (HA-MRSA). HA-MRSA infections typically are associated with invasive procedures or devices, such as surgeries, intravenous tubing or artificial joints.”
These are two hospital friendly diseases that make the lives of sick people- even sicker. In addition, isolation becomes necessary and hospital stays are longer and for many, complications from these diseases can end in death. According to Ontario Council of Hospital Unions, hospital acquired infections are the fourth largest killer in Canada. Each year, 220,000- 250,000 hospital acquired infections result in 8,000-12,000 deaths. Thirty to fifty percent of these hospital-acquired infections are preventable.
Prevention is the same for both of these hospital based diseases and it is as basic as it gets- Wash Your Hands.

Moved out of the country and left your aging parents behind?
Worried about taking that promotion?
Not sure how your aging mother will manage if you move to another city?
Travel required for work, your parents need you and you are the only child?

When caring for a parent or aging loved one becomes more of a burden than a joy, what do you do?

Whether you are in that situation now, or you are looking ahead so you will know what your options are, there are plenty of resources available to you to help eliminate some of the stress and make the job do-able, bringing you peace of mind.

It is important to remember that you are not alone in your role as an employed caregiver. Statistics Canada estimates that over 2.8 million Canadians are providing caregiving services to someone with health related problems. There are a number of resources available to you in the community to help you provide care and services to your loved one, but the real difficulty is figuring out where to start and what your next move should be.

Professional advice is a phone call away. Geriatric Care Managers (www.caremanagers.org) navigate the health care system, coordinate your loved ones’ care, and help you plan for their immediate, intermediate and long term care needs to ensure they receive the appropriate resources and services.

When is the right time to contact a Geriatric Care Manager?
-There has been a sudden or gradual change in your loved one’s cognition, mobility or lifestyle that has left you wondering if the they can continue living alone safely.
-You live out of town and no one is able to check in regularly with your loved one to assess and monitor their wellbeing.
-You are feeling overwhelmed and burnt-out over your caregiving responsibilities and you feel like it is causing additional stress and negatively impacting work and home life
-You are worried about the future and would like to know what to expect as your loved one ages
-You travel frequently for either work or pleasure and there is no one else to check in and monitor how your loved one is doing
-There are differences of opinion between family members as to the best plan of care. A professional can start that family meeting and present the best options in a non biased way.

When dealing with an aging loved one, planning ahead and choosing the appropriate services is the best way to help save you time, money, worry and bring you peace of mind.

Written on January 23, 2012 – 7:49 am | by Audrey Miller, allaboutestates.ca:

January continues with Alzheimer’s Awareness Month. While I fear that this will be the largest medical challenge we will be facing over the next many years, we are not well prepared.
Most of us are in denial. We don’t want to acknowledge losses and changes in the behaviour and personality of our parents (and maybe our spouses). We wait; we think this is all a normal part of aging, but what happens when we wait? The insidious disease process continues. Caregivers typically wait 5 years before seeking assistance- for themselves. However what happens in those 5 years with a dementing process that is well underway?
Alzheimers is just one of several different dementias yet they all share the sad reality that it is progressive disease that cannot yet be cured.
The Alzheimer’s Society recommends that early diagnosis is the best chance for treatment. A proper assessment (although Azheimers can only be diagnosed post mortem) can determine appropriate medications which can slow the disease symptoms. It also allows for families to plan for their future- as the cost of care both emotionally and financially can be overwhelming. If you have any doubt about what is normal and what isn’t, see your doctor. If it is your parent you are concerned about, offer to go with them to see their doctor. While we may not want to hear the diagnosis of the deadly ‘d’ word, we are better off knowing and facing the challenge head on.
As in most things in life, don’t put off until tomorrow what you can do today- Don’t Wait.
-Audrey Miller

Audrey Miller also blogs at All About Estates!

Written on January 13, 2012 – 7:49 am | by Audrey Miller, allaboutestates.ca

While there is no known cure, researchers (Lancet Neurology:July 19, 2011,Early Online Publication) have identified common risk factors for the development of Alzheimer’s Disease. These risk factors include:
* Low education: “Use it or lose it” is an important credo in Alzheimer’s prevention. Schooling is key because stimulating the brain builds neural networks and the more education a person has the more likely they are to engage in stimulating brain activity. Yet, worldwide, 40 per cent of the population has a primary school education or less. The researchers estimated that low education was associated with 19.1 per cent of Alzheimer’s cases, or 6.4 million cases globally.
* Smoking: Among other things, smoking weakens blood vessels and it affects blood flow to the brain. But almost one-third of adults in the world still smoke. The research estimates 13.9 per cent of Alzheimer’s cases are linked to smoking.
* Physical inactivity: Studies show that people who are physically active have better cognitive abilities and are less likely to develop dementia. Worldwide about one in six people are inactive. The new study found that 12.7 per cent of Alzheimer’s cases were likely due to inactivity.
* Depression: People who suffer from depression have more than double the risk of developing dementia. About one in seven people in the world will suffer from serious depression. Researchers calculated that about 10.6 per cent of Alzheimer’s cases could be traced to depression.
* High blood pressure: About one in nine people in the world have hypertension in middle age. The study estimated that poorly-controlled blood pressure accounts for 5.1 per cent of Alzheimer’s cases.
* Diabetes: Research shows patients with type 2 diabetes have a significantly higher risk of developing Alzheimer’s. Globally, almost seven per cent of adults have diabetes. The research team found it could be responsible for about 2.4 per cent of Alzheimer’s cases.
*Obesity: Women and men who are obese at middle age have an increased risk of dementia later in life. Worldwide about 3.5 per cent of the population is both obese and middle-aged. The study found that obesity is associated with about two per cent of Alzheimer’s cases.
Dr. Barnes said if these risk factors were eliminated entirely it is not realistic to think these risk factors could be eliminated entirely, but even small reductions could have a significant impact.
The researcher estimated that reducing the seven key risk factors by 10 per cent would translate to 1.1 million fewer cases of Alzheimer’s, while a 25 per cent reduction would translate into 3 million fewer cases a year. How many of these risk factors have you checked off?

Written on January 5, 2012 – 7:27 am | by Audrey Miller, allaboutestates.ca.

I am so glad that another year has passed; considering the alternative….. While there may be moments that we despair I am glad to be on this side of the grass. On this positive note, I wanted to highlight research that is currently being undertaken which should improve all of our lives. At least, it may keep us alive alittle longer. This research relates to assessing a driver’s ability- behind the wheel. CANDRIVE (the Canadian Driving Research Initiative for Vehicular Safety in the Elderly, candrive.ca) is involved in a 5 year study with drivers over the age of 70 who are participating in an annual assessment. Electronic devices have been installed in their cars which chart the time of day and document other information. Similarly, St. Michael’s Hospital is involved in a study which maps brain activity of volunteers who are lying inside a brain scanner which while they are simulating driving using a steering wheel, gas and brake pedals. Understanding reflexes, reaction times, visual and perceptual issues as well as other physical challenges that may or may not be able to be safely accommodated, is key to understanding whether someone is safe behind the wheel. It is never easy to advise that someone is no longer safe to drive and family members often don’t want to engage in this conversation. However, if an unsafe driver is behind the wheel, passengers and pedestrians (as well as other drivers) are at risk. Many times I have heard adult children say (when asked about how they feel regarding their parents who are still driving), “while my dad has dementia and frequently gets lost, as long as he is with my mother, who navigates, they will be fine. WRONG. Once an accident occurs, it is too late. Before that happens, there are a few easy things that can be done. Take a look at their car. Are there dents, bumped fenders, scratches and other regular repairs being done because they didn’t see the post or say that the other driver didn’t signal or drove too closely or stopped too suddenly or crossed the divider? Take a drive with them – were you comfortable? One question that I like to ask is “would you let your children drive with your parent?” Please consider this question, as it may save someone’s life. -Audrey Miller