How to Live Independently as We Age

This week I attended my first National Home and Community Based Services Conference, an annual gathering of professionals who provide services for older adults and disabled individuals who wish to remain in their homes and communities as they age.

More than 1,400 people are attending this year's event, sponsored by the National Association of States United for Aging and Disabilities.

Assistant Secretary for Aging Kathy Greenlee kicked off the conference with a speech marking the 50th anniversary of Medicare, Medicaid and the Older Americans Act (OAA).

“As advocates, we specialize in being frustrated with these programs. We know we need more funding for OAA, we know there are gaps in Medicare ... and we know we need to do more balancing with Medicaid," said Greenlee. Despite these frustrations, she exhorted the audience "to look at the foundation of support the programs have created in our country. These three programs demonstrate that we as a nation have made tremendous investments in the health and life of our citizens as they age and are disabled.” 

The Older Americans Act, which has not been reauthorized since 2006, serves 11 million Americans by providing vital nutrition assistance (Meals on Wheels), help with transportation, caregiving, legal services and elder abuse prevention, as Next Avenue blogger Robert Blancato wrote earlier this year.

The U.S. Senate acted to reauthorize the law in July, but the House has not yet taken it up for a vote. "We continue to be engaged with members of the House and staff,  and we are very hopeful the House will also move soon to reauthorize this law," Greenlee said. 

I later attended an engaging talk on "The Risk of Abuse for Cognitively-Impaired Older Adults," by Dr. Laura Mosqueda, director of the National Center on Elder Abuse, chair of the Family Medicine Department and the associate dean of primary care at the Keck School of Medicine at the University of Southern California.

Sharing statistics showing that Alzheimer's and other forms of dementia are expected to grow exponentially as the American population ages, Mosqueda said: "If ever there was an epidemic that we knew was coming, this is it, and we are not prepared for it."

Mosqueda, a practicing physician who works with patients diagnosed with a variety of dementias, outlined types of memory loss and explained how they can interfere with the reporting and redress of elder abuse. Although there is a tendency to lump all forms of dementia together, she said knowing that someone has Frontotemporal Dementia, as opposed to Alzheimer's, allows an attentive doctor to access the parts of the memory circuit that are still working to figure out what happened.

She said it is incumbent on doctors to work with law enforcement to help them investigate charges of elder abuse where the victim may have significant memory loss. Mosqueda cited an example of a patient who could not speak well but was able to identify her caregiver and alleged abuser with photos.

She also offered tips for communicating and calming people with dementia, such as not arguing with someone who is having a delusion. One of her patients, she recalled, was certain that Gen. Norman Schwarzkopf was in her room to offer strategic war advice. As funny as that sounds, it was distressing to her patient.

Said Mosqueda: "You don’t argue with a person with delusion. It is as real to them as it is to you that it’s not (real)."

Instead, she said, you should "acknowledge and distract" by saying something like: "That must be so scary for you. I'm going to see what we can do to make sure that doesn't happen anymore." 

This is helpful for the person with dementia, who may get agitated if his or her assumption is challenged, and also helpful in reducing stress on caregivers, which may trigger neglect or abuse, Mosqueda said.

In solving problems for those with dementia, Mosqueda said she views the whole family as her patient, so she can better understand how all members are affected by the illness and its caregiving consequences. At the center, however, is the person with dementia and his or her wishes, as much as they can be discerned. "It’s the 'nothing about me without me' that we have to pay attention to,” Mosqueda noted.

The last session I attended, "Preventing Suicide Among Older Adults," highlighted new tools and programs to help caregivers and professionals identify suicide risks and respond appropriately.

According to the Suicide Prevention Resource Center (SPRC), suicides for most age groups has been rising since 2000 with the sharpest increase for people 45 to 64. Overall, men die by suicide at four times the rate of women.

During her presentation, SPRC's Christine Miara said the top three suicide warning signs are:

1. Talking about wanting to die or kill oneself

2. Looking for a way to kill oneself 

3. Talking about feeling hopeless or having no reason to live

Some of the risk factors for suicide among older adults include:

• The death of a loved one
•  Physical illness
• Uncontrollable pain or the fear of a prolonged illness
• Perceived poor health
• Social isolation and loneliness
• Major changes in social roles (such as retirement)

If someone you know is considering suicide, call 911 or the National Suicide Prevention Hotline at 800-273-TALK. If it is not an emergency and your loved one lives in a residential facility, discuss your concerns with a supervisor there.

Miara said that senior centers and residential communities, these days, are doing more to address mental health issues and adding programs to combat some of the risk factors through social and educational programs. For additional information, she recommended these fact sheets from the Substance Abuse and Mental Health Services Administration.