Technology & Aging, New Horizons for Telecare

Fall Conference-Symposium season is upon us once more and in our Sept.16 post, Technology & Aging in Place: Emergent. Innovative. Viable.  we highlighted two in the Greater Toronto & Hamilton Area, one presented by the Sheridan Centre for Elder Research (October 27) and the other by Ryerson University’s National Institute on Ageing (NIA) (November 24/25).

Another major national event is in Montreal this year, the Canadian Association on Gerontology (CAG) 45th Anniversary Conference (October 20-22). Our Planet Longevity colleague Suzanne Cook presented at this annual conference in 2014 on the subject of Inter-generational Learning. Being selective on what events to invest in this year was made simple by a mere matter of geography and so Suzanne, Sandra, Mary Ellen and myself will be attending the NIA conference in Toronto.

However, upon reviewing the content and speakers at the Montreal CAG conference, it is worth highlighting one speaker in particular as it touches on a subject of great interest that matches the knowledge base of a number of us on the Planet Longevity panel.

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Sue Yeandle, Professor of Sociology, University of Sheffield in the UK, will be speaking on the topic – Connecting People and Systems: What Role for Technology in Caring & Ageing Well in Later Life? Once again, we cannot ignore the emerging role of technology as evidenced by so much of the content presented at the other events we have featured in previous posts.

If you dig further, it becomes obvious that Yeandle is a strong leader in the area of caregiving in public policy not only with a UK focus, but also at an international level. One of the other organizations she was involved with in the UK is Aktive Project, which is Advancing Knowledge of Telecare for Independence & Vitality. You can get an initial sense of how inspiring this is by watching the short video link on the home page. It demonstrates how well this brings collaborative research right down to practice in the community.

On all counts, this kind of initiative and others we can find like it will be worth following and supporting in the years to come. In Canada for one example, there is The Caregiver Network. An excellent website includes this blog post – How Technology is Changing Aging by Stephanie Erickson, which ties in with this overall theme.

One of my business advisory relationships is with Dr. Adolfo Cotter at Cognimetrix, and one of his practice areas in the US is in the delivery of telemedicine, which is a growing field and with some momentum, hopefully, telecare will soon become the companion service that will ultimately become mainstream. One thing to keep in mind when you research this area, and that is that there are variations on what telecare means and how it is presented as a service to the public.

More on Sue Yeandle and her work in future posts, but in the short run here is an article she wrote in August 2016 – Caring for our carers for the Institute for Public Policy Research in the UK. While she draws attention here to the fact that the UK, a leader in the “international carers’ movement”, has in recent years fallen behind others countries such as Canada and Australia, Yeandle calls for the UK to “retake the lead”.

Retake indeed. Perhaps the Aktive Project could retake its position, as the only disappointing thing I see is that there hasn’t been any active content development or communication on their website or Twitter feed in the past two years. This is often what happens when the good intensions of group networks slip off the radar as individual people get on to other things.

Still, Sue Yeandle leads the charge with an international focus and is working on a new book due out in 2018, currently titled Making Caring Matter: the mobilization of carers and its impact on policy making around the world. Wouldn’t it be timely if she were to appear at the International Federation on Ageing conference in Toronto in August 2018? If so, sign me up.

 

Mark Venning

Aging & A Case for Personal Advocacy – 3

As we continue to learn from our own experiences, as advocates for others in all manner of care giving, in particular here, elder care, we must be a leader of own personal advocacy team by taking charge with some specific actions with our future in mind. It’s a matter of a taking proactive actions now, through conversations with others, family and or trusted friends, rather than remain blinkered in the vision of our elder selves.

Personal advocacy is a life lesson that we do not have to learn and live on our own. The team approach Mark Venning advised in the June 17th, first post in this series, and the self-education in personal financial advocacy as Marie Howes spoke of in part two July 12, can be strengthened by other actions which will help to reassure you. At the same time, this will provide vital information to your chosen advocate(s) who will be the spokesperson for you in the event that you cannot.

Before choosing your personal advocate first in line after you, there are some opening questions to ask:

  • Will the person have time to manage in a crisis?
  • Will the person be managing your affairs with their physical presence or from a distance? Managing from a distance can be done, but needs other steps to be put in place.  For example if giving instructions by phone or Skype there will have to a witness in place for those receiving the instruction and furthermore;
  • Will the person be comfortable advocating your decisions if that choice is contrary to their personal preference or choice?

The devil’s in the details – ignore & chaos will ensue

Here is some advice on how to choose a spokesperson strong enough to advocate and follow your clearly given instructions and not simply just follow their own inclination.

Ask up front if the person you choose will take on the specific responsibility of being a Power of Attorney before entering their names in a Power of Attorney documents.  There are a number of reasons why a person, understanding the honour of this role, may have a need to refuse.

Arrange for your annual taxes to be done by an “arm’s length” person, or accountant to protect you and your Power of Attorneys to be safe from allegations of impropriety. You should also review your relationships with these people on a frequent basis to make sure you are being served well.

In one of my many educational presentations called Take the Chaos out of Crisis™, I advise getting your will up-dated as often as particular life changes occur that may cause you to rethink, (such as divorce, or one of your children gets married), and having Powers of Attorney for Property and Personal care put in writing.

Attach to your Power of Attorney for Personal Care a directive instructing your preference for care.  The instructions must be – what is legally possible, what can reasonably be done, and what will lead to positive outcomes and good quality of life. I stress that information is vital and numbers rule.

Canadian Life and Health Insurance Association Inc has an excellent on line resource to help collect information under its Consumer Information drop box.  They call this a “Virtual Shoebox”. It is 27 pages long, so read before printing it out, since not all of the 27 pages will be pertinent to your situation.  Along with other details, include the user names and passwords for on line banking, bills, subscriptions, – and not to forget social media platforms you use. These days this could be a longer list than what space there is on this shoe box document.

Congratulations. You are now the leader in your personal advocacy team. Now with this action plan in place you have a well set out record of vital information and wonderful resource for your chosen spokespersons who by the way, may include others besides your current designated Power of Attorney. As with managing your computer system, backup is recommended.

 

Mary Ellen Tomlinson

 

Aging & A Case for Personal Advocacy – 1

Seniors’ Month in Ontario is at its mid-way point in June and we are encouraged this year to celebrate Seniors Making a Difference. Sadly, it only takes one or two pieces of news, like rocks thrown at a window, to shatter the glass and make us turn our heads. These are familiar hard rock crimes – elder fraud and elder abuse. One such in the news this week came from British Columbia, where a man who was a caregiver to a 91 year-old woman, stands accused of having stolen $270, 000 from her bank account.

However, I choose not at this occasion to write a dissertation on the subject. There are enough resources and news feeds that can enlighten us all as to these crimes, and that is what they are – crimes. I personally had to step in some years ago as a Power of Attorney for a woman in her mid-80’s, who had been ripped off through a telephone fraud scheme, and as I was helping her through that experience (with police involved), I reflected constantly about what a responsibility it was to be put into a position of trust.

With this in mind, I want to make the case here about how important it is, early on as you age, to adopt an alert, responsible mind-set to take on the role of personal advocacy, for yourself as well as others. This also means setting up an advocacy plan should you not at some point, for whatever reason, be able to speak for yourself. Depending on the dynamics of your relationships, family and friends, it may not always be the usual cast and crew that end up down the road being part of your sustainable plan.

Personal advocacy as a team approach

Frequent reassessment of who is in your trusted advocacy network is as important as revisiting the content of your will, your named executor and powers of attorney. It’s also a good idea to assess your relationship with your financial planner. My colleagues Mary Ellen Tomlinson and Marie Howes will have more to say about this. But I’ve seen enough in several circumstances to know that the people you might have initially asked to be part of your advocacy team, formally or informally, at some point either end up being not who they appeared to be, change their minds about their commitment , move away, or die.

There are so many unbelievable twisted story plot lines in elder abuse and thus the vulnerability of an elder person is at risk whether under the roof of the family home, or in the one room chambers of a long-term care facility. If you are the advocate for someone else, elder or otherwise, it is a monumental responsibility.

With respect for privacy information and confidentiality in mind, your consistent visibility, research, inquiry and transparency by sharing information with others about what you are doing in your role are, in my mind at least, the very essence of the personal advocacy role.

We do have all sorts of public educational resources available  in Ontario, such as  the Elder Abuse Ontario Safety Line, yet I wonder, what would it take to create a core curriculum in schools for Gerontology & Personal Advocacy for Elders, much the same way we have with sex education and other social issues?

 

Mark Venning

Medicines & Exercise: Partners. But who is leading in this dance?

tangoLongevity is not accidental.  The “well-elderly” know that a lifetime pattern of exercise and healthy living makes for an active and enjoyable life. Coming to exercise and healthy living, later in life, also has enormous benefits.  As is often said about developing new helpful habits –“it’s never too late”, but with exercise, it is important to start.

Dr. Richard Sloan, professor of Behavioural Medicine of Columbia University, NYC says; “exercise helps pretty much everything even if we don’t understand all of it”

A March 14, Canadian Medical Association Journal article titled Prescribing exercise interventions for patients with chronic conditions, states that doctors should prescribe exercise in addition or even instead of pills.  The article goes on to say – “exercise has long been shown to benefit patients with a variety of chronic conditions.  When it comes to reducing the chance of dying from a heart attack, regular workouts are just as effective as pills…the same goes for rehabilitation following stroke, preventing diabetes, lowering blood pressure, and treating heart failure”.

However prescription medicines are vital for managing certain diseases those prescriptions are to be respected. The problem is that our intake of prescription medicines increases with age.  Barbara Farrell of the Bruyère Research Institute in Ottawa on CBC’s The Current, February 7th 2016, shares the figures from the Canadian Institute for Health Information as – “two thirds of people over the age of 65 take more than five medicines and about 39 percent of those over 85 take more than ten medications”.

A time for deprescribing?

Some medications are not for a disease control, but are there to manage side effects of prescriptions.  Barbara Farrell goes on to say “more medications get started and guidelines are very good at telling us when to start drugs but they are not very good at telling us when to stop drugs”.

The idea of reducing the number prescribed medicines, (called deprescribing), is now promoted as a process by many experts in the medical field.  You can find guidelines for deprescribing for the elderly at www.open-pharmacyresearch.org

There are three main and very real, disrupting results from over prescribing – confusion, doziness and hallucination. Each one of these, or any in combination, can lead to misdiagnoses of a serious nature, such as dementia and/or a physical impairment. Not to exclude one other contributing factor – falls from all of these mixed-up med issues can be a leading cause of death.

But reducing vital medicines in favour of exercise willie-nillie is not safe.  What is safe is to get advice from both your doctor and your pharmacist. As in a tango, both lead in this dance – each participant respects the energy of the other and they both agree in the end that they are equal. Doctors, as experts in diagnosing – and pharmacists as experts in the chemistry of medicines. They are the dance partners in helping you manage your care.

As my guiding principal always is – a good precaution is never wasted. So – go and sign up for Tango lessons. No RX required.

 

 

Mary Ellen Tomlinson

 

Advance Care Thinking in the Age of Longevity

Further to my blog post on March 13 … “Empowered end of life care…”

Speaking for yourself

Planning for longevity, well into your 80’s and 90’s or longer, means anticipating good and not so good outcomes. It takes courage to ask yourself what care I want for myself when I can’t speak on my own behalf. That is a hard question to answer and sometimes disconcerting; so when you do come around to making some decisions, write your instructions down in a document called a Living Will/Advance Care Directive.

Often when people do think of what they want if hit with a sudden health crisis, they talk about wanting to take every medical step going. The term is “Heroic Measures” – but this is best for people who are reasonably fit and with few health complications. For a frail older person with osteoporosis, the outcomes are not good.

In the other extreme people will say something like, “I’ve had a good life – just let me go”. This term is “No Medical Interventions”, but this is too restricting. A better instruction is “Comfort Measures Only” which gives flexibility for pain management and other steps for easing discomforts.

When you can’t speak for yourself

Ask someone you trust if they would be comfortable being your spokesperson, a “Substitutes Decision Maker”. Give clear concise instructions with some leeway for unexpected complications and these must be legal. Discuss with your spokesperson, that as your life conditions develop you may want to change your instructions, and that you will always keep them up to date with any changes.

For added ease in this process, it is a good idea to have a backup spokesperson in case the first person is away or unable to respond in an emergency. Keep your back up spokesperson up to date with changes too. This is a safe action to take as a Living Will/Advanced Directive can only be used when you can’t speak for yourself. Have your instructions readily available, such as a small wallet card indicating that you have a Living Will/Advance Directive, available for printing at www.advancecareplanning.ca

A good precaution is never wasted

Everyone should have a plan. It’s a good life review exercise. While it may seem like a later life issue, the young (those over the age of majority) as well as the old can have episodes in their lives when they cannot direct their care. Severe flu, accidents, drug reactions, an epileptic incident and other temporary illnesses can cause disorientation or unconsciousness – and a Living Will/Advance Directive is there for you when you can’t speak for yourself on health care decisions.

 

Mary Ellen Tomlinson

Empowered end of life care, to die with dignity.

One of the many opportunities of longevity is that we now have a more extended lifetime to make incremental life-stage decisions, including the choice to make our individual end of life plans. Despite this opportunity, most of us are reluctant to, or do not like to think about the eventuality of own death. If we do think about dying, we just cross our fingers and hope we will die asleep in own bed; or maybe somewhere else, comfortable, pain free, with dignity surrounded by loving family members.

Baby Boomers who have re-framed most cultural aspect of their lives from birth to retirement and everything in between are surprisingly slow to take the steps which would empower them to have more control of their preferred end of life care. Making personal care decisions and putting them in writing is a loving act of kindness to ourselves and for our appointed decision makers, but that planning takes time and thought.

At a very basic level of thoughtful concern – in Canada, a Power of Attorney for Property (both limited and general), Power of Attorney for Personal Care which are legal documents, and an Advance Directive (sometimes called a Living Will) which is a statement of preferred wishes, are tools to help people stay in control when they cannot speak for themselves. Each of the provinces and territories have their own style for these documents.

Advice from a lawyer and discussing decisions with your chosen executor make these directives more effective. The Ontario government has a booklet on-line A Guide to Advances Care Planning. Another source for information is Dying with Dignity, an organization founded in 1982. They offer an on line Advances Care Planning kit. Their web site has information on Canada’s right to die laws and information on assisted dying sometimes called End of Life Choices. This organization may not represent everyone’s idea of an end of life philosophy; but it does at least bring the term “dying with dignity” to public attention.
Take time to stay in charge, empowering end of life care and dying with dignity. Longevity is a gift – use it well.

Mary Ellen Tomlinson

“Time and Tide”, Boomer’s Version.

Boomers have been accustomed through every stage of life to altering their take on society and its institutions. They have made learning the Periodic Table a fun song instead of the mind numbing rote; vibrant sock hops instead of the proper decorum of tea dances; and masters competitions an option to rocking chairs.

This generation has built expectations that they will also make changes to the aging process. It may come as a great surprise that, as Ira Gershwin wrote, “it ain’t necessarily so”. Medical interventions, joint replacement, stents, lasik eye surgery, calcium supplements and Grecian formula can decelerate the aging process, but only so far.

A good precaution is never wasted.

Tide and time waits for no Boomer, so the best way to prepare as you age is to be safe and healthy; making incremental adaptations starting with safety proofing the home to prevent falls and scalds, both of which can lead to hospitalization. Falls are particularly bad since they are the leading cause of mortality in older age. Hold down loose rugs with double-sided tape. Better yet roll them up out of the way.  Keep stairways clear of clutter and well lit; kitchen and bathroom floors and counters clear and wipe up spills right away.

Prescriptions should be well marked in a safe place. Be up front with your pharmacist for possible conflicts or side effects of over-the-counter medicines you are using. Review nutritional intake and drink lots of water. Reduced hydration can affect medicine’s value. Have your eyesight and hearing tested regularly to see where you’re going and hear all the latest gossip.

De-stressing and social networks 

Practicing self-care as discussed above and having a strong social network are two prime de-stressors. Limited socialization and restricted mobility often come along with aging – stressing, if not depressing. Friends, neighbours may move away for various reasons and that lifetime network that worked so well before may shrink. Keep socially active. If driving is restricted, ask friend or family for rides to social events. Grandchildren are always looking of opportunities to drive.

With Skype and other social media, keeping in touch with lifetime friendships is doable and good for morale. An important aspect of self-care is helping others. A good de-stressor for a friend living alone is to phone them to share the events of the day – and; nothing beats a good laugh for de-stressing.

Mary Ellen Tomlinson

 

Will or Not to Will?

“An oral contract is as good as the paper it is written on.” So said Samuel Goldwyn.

And with all things as we age – a good precaution is never wasted. 

To Will or not to Will? Avoidance seems the norm for a third or more of adult Canadians. Death, Wills & Powers of Attorney and all that paperwork. This is a sensitive topic that some people find very hard to address. Some think if you make a Will you’ll die.  Well surprise, surprise – not making a Will won’t keep you alive. 

Everyone needs a Will. Lawyers suggest reviewing your Will every few years to keep it current with tax laws and inheritance rules.  Everyone also needs Powers of Attorney – one for Property and one for Personal Care.  These are legally binding documents so it’s a good idea to seek legal advice. 

An additional document is an Advanced Directive (sometimes called a Living Will). It’s not a legally binding document, but is an influential expression of the care you want and can help guide decisions for the person who is your POA for Personal Care. In it there are written guidelines to help, in the face of sophisticated medical science complicated by our living longer with complex health conditions. It gives you a chance to direct care when you can’t speak for yourself.

Choose the trusted person(s) you want and ask “are they are comfortable or willing to accept your authorization?”Make sure the language is fair, clear and concise. Check that your instructions are legal and medically possible. Also consider the state of your health.  A frail person with severe osteoporosis would be wise to check out the repercussions of CPR (cardiopulmonary resuscitation) since it is vigorous and damaging to chest and rib cage bones.  You may say you don’t want this type of intervention; but comfort, care and pain management are other types of interventions you may welcome.

Guiding others and forestalling family fights and misunderstandings where ever possible are important objectives accomplished through these documents discussed here.  Let’s face it we all want to be in charge of our lives. Good documentation goes a long way towards making this happen.

Mary Ellen Tomlinson