In planning your trip there are numerous things that should be added to your travel list of DO NOT FORGETS.  No one wants to spoil the trip by forgetting an important item.   Your list of DO NOT FORGETS should include the following:

• Make sure you have all your medicines poured and placed in your carry on.  Always be sure to take at least 5 days additional medicine in case your return trip becomes delayed or extended.  You do not want to worry because you didn’t take enough medicine. Do make a list of your prescription information which will allow you to order more medicine if needed.
• Make you sure you include antacids, antibiotic lotions, cortisone lotion, bandaids, sun tan lotion, and any other personal items that you use regularly.
• Make sure that wherever you are going does not require you to have any special vaccinations.  Even modern countries can have outbreaks of disease occasionally.
• Make sure that your jewelry is costume and not heirlooms.  You don’t want to lose anything special which would put a damper on your trip.
• Make sure that you have a copy of the most recent medical record, your advance directives, power of attorney for medical and financial matters. This is important if you become ill while away.
• Make sure that your walking shoes are the most comfortable you can buy. Sore feet are not a good experience on vacation.
• Make sure that you consider your safety when planning side trips.  Take into your consideration your health limitations and be realistic about what you can accomplice. Breaking bones on your trip can be quite detrimental to the continuation of your trip.
• Make sure you have an extra pair of prescription glasses and sunglasses.  Losing eyeglasses or misplacing them while traveling is quite common. Numerous pairs of contact lenses are also necessary
• Make a list of your emergency numbers, your medicines, your hotel etc. and place in your wallet. You may need them.
• Make sure your passport stays in your room or in the hotel safe when touring.
• Make sure your wallet is kept in your front pocket or in an safe place when it can not be taken easily.
• Make sure your clothing is climate appropriate and allows for ease of movement and comfort.
• Make sure you bring a sun hat. If your head is not covered with much hair make sure it is covered with a hat.
• Make sure if you have serious allergies that you carry a card or wear a bracelet. Make sure you carry whatever medicine your doctor orders for an allergic reaction and keep it on you at all times.  Make sure you always inform your waiter of any food allergies and question what is contained in fancy foods.
• Make sure while on vacation you leave your computer at home and your blackberry.  Vacation is not an extension of work.
• Make sure you leave unnecessary credit cards at home.  Make sure you have the numbers of the card companies kept in your room.  If they are stolen or lost you can then report them immediately.

This is your seasoned traveler signing over and out.    Be sure to continue to look for more travel ideas for seniors in the future.

Chronic health conditions interfere with the confidence of the senior.  Fear replaces independence when living alone.  What will replace that fear?  A medical alarm system provides the senior with a sense of comfort …in the one place they feel most comfortable—their own home.

Finding out if the senior is ready for the system and will use it ..Ask these simple questions.

1. How much time does the senior spend alone during the day or night?
2. Is your loved one at risk for falling? Has any falls taken place recently? Is the senior anxious about falling?
3. How many visits to the emergency room in the past year?
4. Has the senior required hospitalizations’ in the past year and continues to decline in strength?
5. Does the senior have at least one major health condition?
6. Does the senior use a walker, cane, wheelchair or chair lift?  Does the senior have balance problems? Does the senior have any problems with walking?
7. Does the senior take more than several medications daily?
8. Can the senior complete his activities of daily living and or does he need help with any of the following?  BATHING, TOILETING, DRESSING, GROOMING, EATING, MEAL PREPARATION.
9. Are you having difficulty finding the time for yourself?

10.  Answer this question.  Is it important for you that your loved one continues to live independently?

Scoring the above list of questions

ANY  YES ANSWERS OVER 4 should encourage you to consider the use of a alarm system for you senior.

One piece of excellent news in the past year was that brain health seems to be improving among older Americans. A large national survey from the University of Michigan found that over a 10–year-period ending in 2002, memory loss and thinking problems were down significantly among senior aged 70 and up, from 12.2 percent to 8.7 percent.  That’s a change that translates into hundreds of thousands of men and women, though Alzheimer’s is still a top concern for millions worldwide.

Researchers aren’t sure why the decrease in cognitive impairment is occurring, but they suspect that a better educated and more affluent older generation that is less likely to smoke and more likely to eat better and get regular exercise may be helping to keep the brain young.

Here is a list of wellness approaches and prevention facts that may help set the tone for a brain healthy year.

1. Keep socially engaged. Make sure you are going out regularly and keeping up with your family either through e-mail, letters, phone calls and planned reunions. Your friends also need the same attention. Giving attention certainly helps you receive in kind.
2. Eat healthy food, fruits, vegetables, proteins. Practice good nutrition. Understand what is best for your brain. Eat plenty of fish, vegetables and avoid fatty and friend foods. Clogging those veins prevents adequate blood supply to your brain.
3. Keep your immune system healthy. Treat yourself well, get at least 8 hours of sleep daily, and recognize any depression and deal with it with your physician, eat healthy.
4. Lower your blood pressure. Work on taking your BP medicine daily, eat less salt, lose weight if necessary, and exercise regularly.
5. Do brain health and memory activities. Find word puzzles and do them frequently. Play word games such as Scrabble, puzzles, play memory word games, and matching pictures.
6. Physical activity—at least 30 minutes each day. This can be walking, cleaning house, sweeping the carpet, walking the steps, and chair exercises. These 30 minutes can be divided into 10 minute increments.
7. Treat Depression. Prolonged depression and untreated depression places a burden on your brain. It causes memory impairment.
8. Treat pain and chronic pain. Remember medications can cause forgetfulness and problems with ambulation.
9. Play card games. Fish, bridge, matching colors, solitaire and hearts. Play trivia, and how something is the same and different.
10. Establish good relationships that consist of a give and take. Allow yourself time with your friends.
11. Practice being happy and laugh frequently. Read the comics, get books that you enjoy and bring laughter into your life.
12. Stay mentally challenged. Attend adult education classes. Renew your interest in old hobbies. Learn how to do new things. All of these activities demonstrate help you prevent memory loss. Formal lowers the risk of Alzheimer’s.
13. Practice good weight management. Having a thicker middle increases the risk of developing Alzheimer’s’ disease. Belly fat in particular may be bad for the brain.
14. Work at a job which keeps your mind sharp into old age. The more complex the job, the better the memory and thinking skills held up after retirement. Retirement may not be for everyone.
15. Avoid a routine that keeps everything the same. For instance, Drive different ways to the market, friend’s houses’ and the malls.
16. Keep your Cholesterol in check. Keeps TRACK of the numbers. High numbers can create and does increase clogging of veins in the brain.
17. Pass the fish. If you like fish such as tuna, salmon and other types of oily fish may help to lower the risk of memory decline and stroke. Avoid fried fish.
18. Learn the computer. Surf the web for new information and ways of doing new games etc.This helps your brain to be involved in decision –making and complex reasoning.
19. Ask you primary physician to check vitamin levels—Vitamin D and B12, Check your Thyroid functioning.
20. Keep important phone numbers in your memory and on occasion test yourself. Change your pass codes monthly and memorize them and do always keep a cheat sheet.
21. Avoid falls and hitting your head as you age. Make sure your balance is okay and your house is safe. This includes throw rugs being picked up, having grab bars in the bathroom, good lighting and using it. Watch the steps-Highlight with red and yellow tape at the start and finish of the steps. Do not carry too much at one time.
22. Remember memory impairment is not part of normal aging. See your physician and tell him what is going on.
23. Keeping your heart healthy will keep your brain healthy. What is good for the heart is good for the brain.
24. Managing risk factors may delay or prevent cognitive problems later in life.
25. Keep your wellness program going with your physician. Make sure he checks your Vitamin D, B12, Folic Acid, and Thyroid functioning. Dysfunction in any of these areas can cause memory problems.

The family members who are doing the talk about the need for senior assistance should be prepared.  Your senior family member has probably spoken to their friends and has learned all the excuses used for saying  NO.  Many senior citizens simply feel embarrassed about needing help.  As the family member, or caregiver,  your first step is to be prepared to debunk this stereotype.

In Home Care

Make sure that you are properly prepared about the benefits of in-home care that go beyond the assistance of daily tasks, such as social stimulation and companionship. Let your loved ones read some of the materials.

You cannot get the entire conversation, and decision making about in home care in one sitting.  Give your senior time to ask questions, read the contract and do not assume that any hesitation on their part means a NO. Give them time to digest that assisted living or in home care is a lifestyle change, and talk with them over several days.

Do not make your senior family member feel like he or she is losing a battle. Let them know that you feel that this lifestyle is positive. Stay away from adversarial context.

Having multiple talks about in home care can instill a sense of comfort and trust that the senior may be seeking before they jump to sign a contract. Let your family member know that they will participate in the decision and when the senior is comfortable going forward with help will be a good decision.

1. Eat three healthy meals during the day, including a good breakfast. Skipping meals causes increased hunger and may lead to excessive snacking.
2. Focus on fruits and vegetables.  Top off your morning cereal with sliced strawberries or bananas. Stir berries or peaches in yogurt or cottage cheese. Liven up your sandwiches with vegetables, such as tomato, lettuce, onion, peppers and cucumber. Eat 5-9 servings of fruits and vegetables daily.
3. Weigh yourself regularly. Monitoring your weight can tell you whether your efforts are working and can help you detect small weight gains before they become even large.
4. Don’t keep comfort foods in the house. If you tend to eat high-fat, high-calorie foods when you’re upset or depressed or bored, don’t keep them around. Availability of food is one the strongest factors in determining how much a person eat.
5. Plan a family activity. Get the family together to go for a bike ride, play disc golf or kick the ball around in the yard.
6. Eat healthy foods first. Eat foods that are healthy and low in calories first so that when it comes time to enjoy your favorites- sweets or junk food, for example- you won’t be hungry.
7. Pay attention to portions. Serve meals already dished onto plates instead of placing serving bowls on the table. Take slightly less than what you think you’ll eat. You can always have seconds, if really necessary.
8. Create opportunities to be active. Wash your car at home instead of going to the car wash. Bike or walk to the store. Participate in your kid’s activities at the playground or park.
9. Sit down together for family meals. Avoid eating in front of the television. TV viewing strongly affects how much and what people eat.
10. See what you eat. Eating directly from a container gives you no sense of how much you’re eating. Seeing food on a plate or in a bowl keeps you aware of how much you’re eating.
11. Vary your activities. Regularly change your activity routine to avoid exercise burnout. Walk a couple of days, swim another and go for a bike ride on weekend. Seek out new activities- karate, ballroom dancing, cross-country skiing, tennis or Pilates.
12. De-stress your day. Stress can cause you to eat more. Develop strategies that can help you relax when you find yourself becoming stressed. Exercise, deep breathing, muscle relaxation techniques and even a good laugh can ease stress.
13. Don’t  have seconds.
14. Use low fat or fat free dairy foods.
15. Drink water instead of sugary drinks.
16. Eat slowly.
17. Use the stairs instead of elevator.
18. Park your car farther out in the parking lot.
19. Get out a bus stop early and walk the last two blocks.
20. Walk the mall.
21. Doggy bag after a big restaurant meal for another day.
22. Treat yourself! Have a small serving of your favorite food once in a while

You may have noticed that nutrition for the elderly is not much different from nutrition for people of any age.  The idea is to be sensible and incorporate exercise with proper dietary habits to lead a healthier lifestyle.  Not overdoing it at the dinner table and enjoying aerobic activity are the key.

Awareness of age -related changes and compensation for them can keep you driving safely.

Accidents increase with age.  From 60 to 70 the accidents increase the more that elderly drivers are on the road.  This statistic gets higher after the age of 75 according to the American Geriatric Society.  The functions essential to safe driving deteriorate with age, such as visual acuity, hearing, and reaction time.  This does not mean that all senior citizen drivers should hand in the keys.

Keep in mind that medical conditions and the numbers of medications taken can both increase the risks for accidents for the senior driver.  But, you can remain safe on the road by understanding how age-related changes effect your driving abilities.  And of course,  do not use alcohol prior to driving.

The following strategies can help the senior cope with the challenges of driving as he/or she ages.

1.  Be aware of your own limitations. Don’t be afraid to ask for help.

2. Get yearly visual and hearing screenings. Wearing the corrective devices will increase the seniors safety and others on the roadways.

3.  Pay Attention to other risks such as snow storms and other poor weather conditions.  These include fog, ice,  eating, drinking  or use of a cell phone. Seniors need to focus their full attention on the road.

4. Always Drive the posted speed limit.  Driving to fast or slow is dangerous.

5. Do take a refresher driver safety class.  Know the rules of the road.

Following these simple steps can go a long way in making elderly driving much safer for everyone on the road, and keeping senior citizens behind the wheel while maintaining independent living.

Further examining the predicament the 50% of patients being readmitted within 30 days reveals something interesting.  Most had not been seen by their outpatient physician. This raises the question of how patients are following discharge plans and whether or not their families are realizing the importance of reading them and following up on their loved one.

Being responsible for these critical issues is an ominous undertaking for anyone.  Not to mention grocery shopping, medication management, bathing, dressing, and safety in the home.  Figuring out what your parent needs is not easy.  Finding the services they need can be even more challenging. But, stopping the in and out rehospitaliztions is a primary need which will help your parent redevelop his or her resiliency.

HELP IS THE ANSWER. Prevention of these round robin readmissions will make life easier for your loved ones and all of the family members.

Ivory House Health Services is a Geriatric Care Management company which specializes in keeping persons out of the hospital and emergency rooms.  This is accomplished by establishing an accurate Geriatric Care Plan.  This plan of care includes collection of all pertinent information, coordination of all medical services, integration of home care, assessment of needs regarding activities of daily living and instrumental life skills.  The Ivory House staff is highly educated  with a total of 200 years of professional experience. For a phone consultation please call 410-823-3153 or e-mail Hazel Kuchinsky APRN-BC. You can also use this website to ask your questions.

Makes 6 servings, about 1 1/3 cups each ACTIVE TIME: 40 minutes TOTAL TIME: 40 minutes EASE OF PREPARATION: Easy

8 ounces whole-wheat egg noodles 1 tablespoon extra-virgin olive oil 1 medium onion, finely chopped 8 ounces mushrooms, sliced 1/2 teaspoon salt 1/2 cup dry white wine 6 tablespoons all-purpose flour 3 cups nonfat milk 1/2 teaspoon freshly ground pepper 12 ounces canned chunk light tuna (see Tip), drained 1 cup frozen peas, thawed 1 cup finely grated Parmesan cheese, divided 1/2 cup coarse dry whole-wheat breadcrumbs (see Tip)

1. Bring a large pot of water to a boil. Cook noodles until just tender, 6 to 8 minutes or according to package directions. Drain and rinse.

2. Position rack in upper third of oven and preheat broiler.

3. Meanwhile, heat oil in a large ovenproof skillet over medium-high heat. Add onion, mushrooms and salt and cook, stirring often, until the onion is softened but not browned, about 5 minutes. Add wine and cook until evaporated, 4 to 5 minutes. Sprinkle flour over the vegetables; stir to coat. Add milk and pepper and bring to a simmer, stirring constantly. Stir in tuna, peas and 1/2 cup Parmesan until evenly incorporated. Then, stir in the noodles (the pan will be very full). Remove from the heat.

4. Sprinkle the casserole with breadcrumbs and the remaining 1/2 cup Parmesan. Broil until bubbly and lightly browned on top, 3 to 4 minutes

TIP: Tips: Chunk light tuna, which comes from the smaller skipjack or yellowfin, has less mercury than canned white albacore tuna. FDA/EPA advice recommends no more than 6 ounces of albacore a week; up to 12 ounces canned light is considered safe.

To make fresh breadcrumbs, trim crusts from whole-wheat bread. Tear bread into pieces and process in a food processor until coarse crumbs form. One slice of bread makes about 1/2 cup fresh crumbs. For dry breadcrumbs, spread the fresh crumbs on a baking sheet and bake at 250°F until crispy, about 15 minutes. One slice of fresh bread makes about 1/3 cup dry crumbs. Or use prepared coarse dry breadcrumbs. We like Ian’s brand labeled “Panko breadcrumbs.” Find them in the natural-foods section of large supermarkets.

MAKE AHEAD TIP: Prepare through Step 3, spoon into an 8-inch-square glass baking dish, cover with foil and refrigerate for up to 1 day. Sprinkle with breadcrumbs and cheese (Step 4) and bake, covered, at 350ºF for 50 minutes. Uncover and cook until browned and bubbly, about 15 minutes more.

Nutrition For Seniors

NUTRITION INFORMATION: Per serving: 406 calories; 8 g fat (3 g sat, 3 g mono); 53 mg cholesterol; 47 g carbohydrate; 32 g protein; 5 g fiber; 684 mg sodium; 593 mg potassium.
Nutrition bonus: Calcium (30% daily value), Potassium (17% dv), Iron, Vitamin A & Vitamin C (15% dv), good source of omega-3s.
3 Carbohydrate Servings
Exchanges: 2 1/2 starch, 1/2 nonfat milk, 3 lean meat

Makes 2 serving

Assemble this dish ahead, refrigerate, and bake the next morning while the coffee brews. The more texture the bread has, the better the French toast will be. Thick slices of home-made bread, hand-sliced bakery bread, and whole wheat or multi-grain bread are all good choices. Serve with butter, syrup, blueberry sauce, or flavored yogurt to boost the calorie count.

Preparing Fluffy French Toast

In a medium bowl, combine the eggs, milk, sugar, and cinnamon and mix well.

Lightly butter a medium baking dish. Arrange the bread quarters in the dish in single layer, overlapping the edges if necessary. Pour the egg mixture over the bread and press down on the bread with a fork so it is completely submerged. Cover and refrigerate for at least 1 hour overnight.

Preheat the over to 375. Back, uncovered, for 20 minutes, or until the bread has absorbed all the liquid and lightly browned on top and puffy. Serve warm, with syrup, butter, fresh fruit, or flavored yogurt. Cover leftovers and refrigerate up to 2 days.

Nutrition For Seniors

Nutrients per serving: 175 calories, 9 g protein, 7 g fat, 19 g carbohydrate,14 mg iron, 107 RE vitamin A, 1 mg vitamin E, 90 mg calcium.

There is more to choosing a walking cane than you might think and its very important that you choose one that can be adjusted you and it is comfortable to grip.

The top of the cane should line up with your wrist, when your arm is hanging at your side  so that your elbows bends at an angle of about 30 degrees when you grip the cane. Most canes can be adjusted in one-inch increments in order to achieve this. The grip  should feel comfortable in your hands, a rubberized or foam grip is ideal and some are ergonomically molded to fit your palms.

As far as materials and style are concerned a wooden cane will be light weight and durable but unlike aluminum, it may not fold. Graphite and fiberglass canes are particularly strong if you need a higher weight limit (a typical cane can support up to 250 pounds) but they cost more check that the cane you have has a rubber tip at the bottom to prevent slipping.

How To Use A Cane

When you walk with your cane you can hold it in the hand opposite the side that needs support, so that the walking cane and your weaker leg make contact with the ground simultaneously. When climbing stairs, lead with your good leg but when descending them, put your cane on the step first and then step down with your weaker leg.

Credit to, Rosanne M. Leipzig, MD,PHD Geriatric Medicine