In our last newsletter, we discussed medication issues and the importance of medication reconciliation and regular medication reviews to make sure all of the right medications are being taken. Medication issues are no small matter for older adults. The financial and physical costs of taking too many medications can be quite high.
Our primary recommendation from that newsletter was to talk to your doctor regularly about all of your medications. The goal of this is to:
1. Verify your medication list, making sure you both know what you are taking.
2. Make sure you are only taking what is needed.
3. Evaluate if all medications are necessary and are worth any potential side effects.
But what if your primary care doctor says that she cannot oversee or manage your psychiatric medications? What should an older adult do to get good advice on their medications?
A geriatric psychiatrist is a doctor with special training in the diagnosis and treatment of mental disorders in older adults (e.g., depression, anxiety, substance use disorders, dementia, etc.). A geriatric psychiatrist may be preferred over a psychiatrist that specializes in adults because older adults have special physical, emotional, and social needs that impact their mental health treatment plans. Keeping this in mind, geriatric psychiatrists take a comprehensive approach that addresses co-existing medical illness and medications, family issues, social concerns and environment issues.
Establishing a relationship with a geriatric psychiatrist is usually recommended for our older adults dealing with mental health issues. We value their knowledge and approach and have witnessed the significant changes that usually follow their interventions.
Atlanta’s Geriatric Psychiatrists
Atlanta, like most communities, has a shortage of geriatric psychiatrists. We are lucky than most communities, but it can still be frustrating to find a geriatric psychiatrist and to get a timely appointment. You can begin the process by asking your primary care physician for a referral. If she does not have a geriatric psychiatrist referral for you, please contact our office at (678) 637-7166 or email@example.com. We would be happy to help you navigate this issue.
Mental Health Crisis
If you are in a mental health crisis, it may be difficult to wait for a doctor’s appointment. Here is a list of the mental health emergency resources in Georgia:
Georgia Crisis and Access Line— A free 24/7 helpline providing mental health crisis assistance and access to mental health resources throughout the state of Georgia 1-800-715-4225 mygcal.com
9-1-1-For emergencies in which law enforcement may be called, ask for a Crisis Intervention Team (CIT) officer
If you are in the Metro Atlanta area, many of our psychiatric hospitals are available for walk-in assessments 24/7:
For questions about Mindful Transitions or to learn more about our team of Clinical Social Workers, please visit our FAQ page, call us at (678) 637-7166, or email us at firstname.lastname@example.org .
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We were pleasantly surprised to see that a number of our clients received an Apple Watch for Christmas! 2018’s Apple Watch came with features that made it the perfect gift for some of our clients. In case you missed it, Apple announced in September that they were adding a fall detection feature to its wearable technology, making it a no-brainer for many older adults.
Because falls are a real risk for many older adults, many could benefit from wearing a medical alert device, but many do not wear them because they are bulky, ugly, and stigmatizing. As a result, many who would benefit from wearing one, do not.
Enter the world of smartwatches to help older adults and their family members who worry about falls to find some peace of mind without having to use one of those “ugly” pendant buttons.
The families of some of our clients did their research and invested in the Series 4 Apple Watch. Not only does it look sleek, it has a number of great features that our clients will benefit from:
Fall Detection: The watch will monitor for hard falls and then ask the wearer to check in. If the wearer doesn’t respond, 911 is called.
Electrical Heart Sensor: Provides ongoing monitoring of the wearer’s heart rate and will send notification when there is a low or fast heart rate.
Wrist Calling: The wearer can make or receive calls from his/her wrist. The watch can be connected to the wearer’s iPhone and to WiFi to make calls without holding the phone. The wearer can even use Siri to make calls and never have to push a button.
Easy Emergency Calling: There is a button on the side of the Apple Watch that just has to be pressed to call 911.
Reminders/Alarms: The watch can be programmed to give regular reminders to take medications, get some physical activity, check in with a loved one, etc.
Location Capability: Others can find the wearer (if authorized) through GPS tracking, providing reassurance to those that worry about their loved ones potentially wandering.
Larger Screen and Louder Speaker: This latest version of the Apple Watch has a screen that is 30% larger and 50% louder.
Shower-Ready: The watch is resistant up to 50 meters so can be worn all the time, even in the shower. (The only exception is when it needs charging, which it needs for about 2 hours every 30 hours.)
Hard to Lose: Since the watch is attached to the wearer’s body, it is hard to lose.
Many older people don’t want to wear medical alert buttons because of the stigma associated with them, but they could benefit from their use nonetheless. The latest Apple Watch will help them to get this benefit while wearing something that looks more appealing and offers additional functioning.
We are so excited for our clients that have new Apple Watches. Do you know any older adults that have recently started wearing Apple Watches? What have you heard? Please share your thoughts and experiences by leaving a comment on our Facebook Page.
The majority of our clients have a concerned family member either living with them or living nearby to help with emergencies, errands, doctor appointments or even day-to-day care. Caregiving is a tough job, and every caregiver deserves a break. If you are caring for an aging or disabled loved one, you know how easy it can be to become overwhelmed, tired, and burnt out. We encourage all of our family caregivers to take some time off from caregiving to recharge and rest, but we also know that it can be so hard to get away even for a long weekend. Just in time for the holiday travel season, we wanted to share some information about caregiving and vacationing.
A Vacation Involves Too Much Planning
As a caregiver you have so much responsibility on your shoulders. You have your own health, your own household, maybe even a job or business and a family of your own to be concerned about. On top of this, you have an aging or disabled loved one that depends on you so much. Sometimes getting through the day takes more energy and time than you have; so doing that AND planning a vacation seems impossible!
Vacations do not have to be exotic, far away or fancy. “Staycations” where you simply stay home, unplug, order in food, and watch movies all day can be rejuvenating and restoring. Staying at a bed and breakfast a few miles away can give you the break you need. And if you truly want to get away, let a travel planner, your credit card company, or even Costco make your arrangements—so many businesses now offer travel booking as a special perk. You may not get the vacation of your dreams, but you will get some time away to get a break. It doesn’t have to be a perfect vacation in order to give you the break you deserve.
You Deserve a Life, Too
Many caregivers feel like they need to put their life on hold while they are caregiving. Even though they may have grandchildren they rarely get to see or dreams of their own yet fulfilled, they resist giving themselves permission to travel out of state to see other family members or to see the parts of the world they long to experience. Caregivers deserve a life, too, and looking after yourself is not selfish or self-centered. Taking care of yourself, investing time in what you want and need may not be appreciated or approved of by others, but you do not need their permission to live your life. You can spend time on yourself and meet your caregiving responsibilities.
The Fear of What Will Happen While You’re Away
“There’s no way I can go out of town. Everything seems to fall apart as soon as I leave.” This is a common reality for many caregivers. After MONTHS of stability and calmness, a caregiver may feel like it’s an okay time to travel or leave town for just one week. Without fail, it seems as if that’s when the emergency happens! Mom ends up in the hospital, constant calls start coming in with high anxieties, a fall occurs, the list of possible emergencies never ends. Or what if the worst happens—what if your loved one dies while you are away? Could you ever forgive yourself?
The fear of emergencies happening while you are away is real. You can make contingency plans for this. Assign someone else to be the primary contact. Is there another family member that can be the emergency contact? You can hire an Aging Life Care Manager to be the main contact while you’re away if there is no family. You could also decide to provide care remotely, traveling only to places that allow you to be accessible. You can hire a certified nursing assistant to provide companionship for your loved one while you’re away or consider a respite stay at an assisted living community. You may have options to help your loved one while you’re away. It will be hard work to get the plans in place, but it will likely be well worth it so that you can get a break.
And although you can make great contingency plans, there is the chance that you will not have everything planned out perfectly. An emergency may occur, your loved one’s anxiety may be higher, or the worst may occur. Making the decision to not vacation or travel because of this is making a fear-based decision. Being a caregiver can often put some of your wants and needs in conflict—you may find yourself wanting to be a good caregiver to someone you love and also needing to have a break from caregiving or just time away to do something else. It’s not easy to prioritize your own needs, but taking time for yourself is not selfish or self-centered. You will likely be a better caregiver once you get a break.
This holiday season, we wanted to share this encouragement with all the caregivers out there. Caregiving is hard. We know what you are doing day in and day out, and we believe that you deserve a break, too. For our clients, we work closely with the individuals and their families to help make the times the caregivers are away to be calm and stress-free. Whenever possible, the therapists at Mindful Transitions try to meet with our clients during the caregiver’s absence, and we provide our clients with extra tools to handle their stress and anxiety during those times. We also often act as extra ears, eyes, and hands for the caregivers, relaying back important information while they are away.
By 2030, there will be approximately 15 million older adults living with mental illness (up from about 6 million currently).* The average life spans of all adults, including those with mental illness, is growing, and since more and more people are living longer, the number of individuals who will develop a mental health disorder will also be growing.
This means that our community will likely start seeing more older adults living with psychotic disorders. Psychosis may present as delusions, hallucinations, incoherent speech, and/or extreme agitation, and the person exhibiting these behaviors will likely be unaware of his/her state or concerning behavior. Many older adults experiencing psychosis also are likely experiencing stigma, isolation, and poor treatment in primary, long term, and acute care centers. As this population grows, it is very important for us to understand more about psychosis in older adults.
Psychosis Has Many Causes
Older adults have an increased risk for developing psychotic symptoms. This increased risk is caused by a combination of physical illnesses, changes in the brain and neurochemistry, social isolation, sensory deficits (such as hearing loss), cognitive changes, and polypharmacy. Frequently, we see older adults experience psychosis alongside moderate-to-severe memory disorder, comorbid medical problems, a fragile support system, and a complicated medication regime.
The chronic and persistent presence of delusions, hallucinations, and other psychotic symptoms can be divided into two groups: primary psychotic disorders (e.g., schizophrenia, delusional disorder, mood disorder with psychotic features) or psychosis secondary to dementia, medications, substance use, or other general medical conditions.
Schizophrenia affects about 1% of the population. Older adults with schizophrenia often live alone, in assisted-care facilities, in
homeless shelters or on the street. Most older adults with schizophrenia were diagnosed before age 45 (only 10-15% of older adults with schizophrenia were diagnosed after age 45), and ideally have symptoms that have decreased in severity with age. Older adults, however, can experience a relapse of symptoms, causing an return of psychotic symptoms later in life.
The most common causes of new-onset psychosis in older adults are dementia, delirium, prescription/otc drugs, infections (e.g., pneumonia or urinary tract infections), and medical conditions (i.e., congestive heart failure, chronic obstructive pulmonary disease, renal insufficiency, and anemia) may lead to psychotic symptoms. Dementia and depression (and other mood disorders) can also cause psychotic symptoms.
Psychosis Does Not Equal Danger
Most people experiencing psychosis are not dangerous, and yet public perception does not match up with this fact. A violent history is the best predictor of future violent behavior, not psychotic symptoms. Someone experiencing psychosis may be a danger to themselves, as a faulty view of reality can lead to bad decision making.
Psychosis is Treatable
Treating psychosis begins with a thorough evaluation of the cause for the symptoms. If the psychosis is related to an infection, drug reaction, substance use, or medical issue, the underlying cause can be treated, making the psychotic symptoms disappear. If the psychotic symptoms are related to a mood disorder, or thought disorder, the treatment of psychosis usually involves a combination of antipsychotic medications and psychosocial therapy. For those living with dementia, an adjustment of the physical, environmental, and psychosocial triggers may help to ease symptoms.
The Clinical Social Workers at Mindful Transitions are trained to assess and help older adults experiencing psychosis to adapt their thoughts and behaviors through our ongoing assessment at every visit and through regular psychotherapy sessions. We also help guide our patients and care partners in how to obtain further evaluations of the cause of the psychosis and how to get appropriate medical treatment for those other causes. For more information on our services, please call us at (678) 637-7166 and visit our frequently asked questions.
*Jeste DV, Alexopoulos GS, Bartels SJ et al. (1999), Consensus statement on the upcoming crisis in geriatric mental health. Arch Gen Psychiatry 56(9):848-853.
We learned earlier this year that suicide rates have risen drastically since 1999. In that time period, suicide rates increased 25% in the US. Shockingly, there were more than twice as many suicides as homicides in 2016. Currently, suicide is the tenth cause of death in the US.
Preventing SuicideFollowing up on this information, as well as the upsetting suicides of Kate Spade and Anthony Bourdain, the Chicago Tribune posted an article, “Are Suicides Really Preventable.” In this article, Gracie Bonds Staples (interestingly enough, a contributor for the AJC) explained that according to her recent review of data, what we are doing to prevent suicide isn’t effective
This is discouraging news, to say the least. From the explanation of the data, it is almost impossible to predict (and therefore prevent) if a person will attempt suicide. Providing timely, effective interventions is what every mental health clinician and emergency resource strives for, but this seems not to be enough. One study found that over 75% of those who die by suicide , denied having any suicidal thoughts or intentions in their last communications.
How to Really Prevent Suicide
There are a variety of opinions and ongoing clinical research about what could help prevent future suicides. Clinicians have studied/are studying the ideas of changing public policy to reduce the availability of guns, reducing access to dangerous medications, and even erecting fences around certain areas.* Let us not be afraid to demand larger, community-wide, government-backed ways to prevent suicide. The work clinicians, friends, family members, church families, and others do to prevent suicide matters, but we need more.
And In The Meantime…
We will continue to do what we do. The clinical social workers at Mindful Transitions are trained in suicide assessments and preventative strategies with our clients. We continue to help our clients build resiliency, to cope with stressors, and to create functioning social networks. We share our training with other elder care professionals, and we advocate for changes at the state and local levels.
If you are having thoughts of suicide, please reach out for help:
*Miller M, Lippmann SJ, Azrael D, Hemenway D. Household firearm ownership and rates of suicide across the 50 United States. J Trauma. 2007 Apr; 62(4):1029-34; discussion 1034-5.
*Klieve H, Barnes M, De Leo D. Controlling firearms use in Australia: has the 1996 gun law reform produced the decrease in rates of suicide with this method?. Soc Psychiatry Psychiatr Epidemiol, 2009; 44: 285-292.
*Zalsman, G, Hawton, K, Wasserman, D, van Heeringen, K, Arensman, E, Sarchiapone, M, Carli, V, Höschl, C, Barzilay, R, Balazs, J, Purebl, G, Kahn, JP, Sáiz, P, Lipsicas, CB, Bobes, J, Cozman, D, Hegerl, U, Zohar, J. Suicide prevention strategies revisited: 10-year systematic review. The lancet. Psychiatry, ISSN: 2215-0374, Vol: 3, Issue: 7, Page: 646-59
We have officially started seeing clients in Gainesville, GA!
This month, we started accepting and seeing clients in the Gainesville area. This is one of our biggest territory expansions, and we couldn’t be more pleased to be able to serve more seniors. Our clinical social worker, Lynn Lane, is currently accepting new clients in the Gainesville area.
Mindful Transitions is committed to providing quality clinical social work services to Medicare beneficiaries. Mindful Transitions is a team of Licensed Clinical Social Workers (LCSWs) who are extensively trained to provide clinical social work services on site to seniors living in assisted and independent living environments.
What do you do?
-Provide individual therapy for older adults in their homes -Conduct mental health assessments
-Treat depression, anxiety, bi-polar disorder, etc. -Provide counseling to older adults through difficult transitions (e.g., a move to an assisted living community, the death of a spouse, the loss of physical functioning, etc.)
Who Can Qualify For Therapy? Anyone who: -Is over 65 years old,
-Receives Medicare, -Wants psychotherapy in their home, and -Lives within our service territory (which now includes Gainesville).
How much does this cost? Usually $40-60/session: -Medicare pays for 80% of our sessions. -Most secondary insurance pays for the remaining 20%. -There is a $40 house call fee/session for the in-home visit. (Medicare Advantage Plans pay $0 of our services)
Lately our clients have been asking about the new changes to Medicare heading our way. The first change is the Medicare ID number. The second change is to the Medigap Plan F. So, let’s talk about a bit more about these changes.
New Medicare Numbers
In April of this year, Medicare started sending out new Medicare cards to all of 60 million of its beneficiaries. This new card will have a new ID number for everyone (a number that is not the beneficiary’s social security number) that will be made up of a series of 11 numbers and letters. This process will cost about $242 million, and Georgians can expect to receive their cards sometime before April 2019.
In addition to having Medicare Part A and B, many of clients have a Medigap plan. This is non-governmental secondary insurance plans that help cover what Medicare does not pay for. About 500,000 Medicare beneficiaries have a Medigap plan, and about 53% of them have a Medigap Plan F. Plan F is popular because it almost eliminates any extra out-of-pocket costs after the premiums are paid. Plan F pays the deductibles for Part A and B, all Part B excess charges, Part A hospital and coinsurance costs, Skilled Nursing Facility (SNF) coinsurance, and more. Unfortunately, this plan will no longer be sold as an option to Medicare beneficiaries who do not already have Plan F in place in 2020 as part of the Medicare Access and CHIP Reauthorization Act of 2015.
So, what does this mean for our clients that currently have a Plan F? This change only affects new enrollees because the law states that as of January 1, 2020, Medigap plans that pay the Part B deductive will no longer be sold to newly eligible Medicare beneficiaries. Medicare beneficiaries that bought a Plan F before January 1, 2020 can keep their current Medigap coverage.
The rules for Medicare are always changing. It can be difficult to stay on top of the information or to understand the implications and details of every change. For further reading, please visit these sites:
June is Elder Abuse Awareness Month. There is so much to say about the neglect, abuse, and exploitation of older adults in Georgia. Let’s start with the fact that 1 in 9 adults over the age of 60 are abused. According to the GBI, there were 2,082 criminal charges brought against elder abuse perpetrators in 2016. This was an increase from 366 in 2010.
As the number of older adults grows in our state, we have an increasing number of potentially vulnerable adults. Recent stats show that one in five Georgians are elderly or disabled. In addition to the growing number of potential victims, Georgia has been working hard to educate law enforcement, district attorneys, mandated reporters, and the community about this growing epidemic.
Despite the increase in elder abuse cases, it is still one of the most unreported and undetected crimes in the United States.
Substance use disorder (that is, alcohol and/or drug abuse) among those aged 65 and up is often underestimated and under-diagnosed. The number of those suffering with these issues is on the rise (as evidenced by the stats on ER visits), but those accessing treatment for addiction is not increasing at the same rate. This “silent epidemic” is dangerous. Addiction in late-life can be caused by a variety of factors, and it take many different forms. But drug or alcohol abuse among the elderly is particularly dangerous as compared with those in mid-life because senior citizens are more susceptible to the deteriorating effects of drugs and alcohol. Individuals over 65 have a decreased ability to metabolize these substances, and they have an increased brain sensitivity to the chemicals. This makes it dangerous for seniors to use drugs or alcohol at all, even if the person isn’t addicted. Along the same line, there are a high number of seniors using benzodiazepines to treat anxiety, pain, or insomnia. These are some of the most dangerous prescription drugs for seniors and are highly addictive. The rate of senior citizens addicted to benzos has increased every year.
The key to getting treatment is to first identify the problem and then to speak up. The following are signs of substance abuse in older adults:
Today is National Healthcare Decision Day (NHDD)! NHDD started in 2008 as a way to inspire, educate and empower the public and providers about advance care planning, and this year NHDD is whole week (starting today). For Georgians this week is all about getting people to talk to their loved ones about their healthcare wishes and to complete a Georgia Advance Directive. So, let’s start talking!
First, what is the Georgia Advance Directive?
It is a statutory document that combines the healthcare power of attorney and living will into one document. It is the primary advance care planning tool in Georgia and has four main goals:
Names someone to make healthcare decisions for you if you cannot or do not want to make your own healthcare decisions.
Communicates your treatment preferences if you are ever in a coma or diagnosed with a terminal illness and cannot speak for yourself.
States your wishes for cremation or burial.
Allows you to recommend a guardian if you ever need a guardian in the future.
Who Needs an Advance Directive?
Almost every Georgian over the age of 18 should have an Advance Directive in place. This is not a form just for the elderly or the disabled. Accidents, sudden illnesses and healthcare crises are equal opportunity events that can cause severe impairment in any of us at anytime. Completing an Advance Directive proactively (before it’s too late) will authorize an informed person to make your important healthcare decisions should you be unable to do so.
Where can I find the form?
This is a statutory form and can be found for free online. You can download a copy here. After you print it out, complete it with your loved ones, sign it, and then have two witnesses sign it. No notary or attorney is required.
What do I do with the form once completed?
You should give a copy of this completed form to people who might need it, such as your health care agent(s), your family, and your physician. Keep a copy of this completed form at home in a place where it can easily be found if it is needed. Do not keep it in a safe or a safety deposit box. Review this completed form periodically to make sure it still reflects your wishes.
Completing a Georgia Advance Directive is an important step in planning ahead for future incapacity. It is never too early to talk to your loved ones about yours (and their heatlhcare wishes). We address this issue with each of our clients and their families, and we help them complete an advance directive when appropriate. Please let us know if you have any questions or concerns.