Miscellaneous Articles

Locating & Accessing Community Resources & Services
By Robert Goodman, MSW
“I need help and I don’t know where to turn!” Where would you begin to look if you needed help for a loved one? There are many government and community-based services available to assist children; older adults; people with mental, developmental, or physical disabilities; and caregivers. Finding them and accessing their services is often where the difficulty begins. How do I begin the search?
ORGANIZE RECORDS
1. Personal Records
Name, address, dates of birth/marriage/divorce/death of spouse, children’s contact info, social security number, birth certificate, identification cards, etc. Military service: branch, dates of duty, date and type of discharge.
2. Legal Documents
Attorney name/contact info, living will, healthcare surrogate, will/trust, power of attorney.
3. Medical Records
 Doctors names (including specialty) and contact information.
 Chronic health issues /acute illness/surgeries/injuries , symptom/diagnosis dates, doctors/clinics/hospitals that treated the condition.
 Tests beyond those done as part of routine checkup (x-rays, cat scan, MRI, blood work) with dates, doctors, and location.
 Medications (pharmaceutical/over-the-counter) strength, dosage, frequency, date of first Rx, pharmacy name and contact information.
 Food/drug allergies, past drug reactions
 Identify what to do in a medical emergency: Emergency contact info, hospital name and contact info, doctors/family members/friends contact information.
4. Health Insurance File
Policy numbers ID cards, agent contact info, brochures/literature for health insurance: Medicare, Medicaid, Supplemental, Medigap, Private, Major Medical.
5. Financial
 Taxes, insurance policies, will/trust, investments, financial advisers/brokers/accountants contact info
 Organize bills and receipts by category:
Medical (health condition, doctors, tests, hospitals stays, medications, insurance), professional services (lawyer/ account ant). List bill paying info: provider, service and dates, date paid by insurance, etc.
 Add the following forms of income: Wages, social security, SSI, pension, annuities, stock dividends, IRA, bonds, mutual funds, health savings account, rental income, royalties, IRA, interest, etc.
Total Monthly Income = $________
 Add the following assets: home/rental/other property value, cars, burial policy, life insurance type/value, collectibles, antiques, personal belongings, etc.
Total Value of Assets = $________
 Add the following monthly expenses: mortgage, rent, maintenance fees, assessments, utilities, landline/cell phone, custodial care (yard work, cleaning), food, clothing, transportation, taxes, insurance (homeowners, rental, life, long term, health, auto), unreimbursed medical expense including medication, special needs care, transportation, durable medical equipment, gifts/charitable contributions, professional services (legal/accounting), etc.
Total Monthly Expenses = $________
 Add the following examples of debt: home mortgage, other property, car/other loans, credit cards, etc.
Total Debt = $________
DETERMINE WHAT KIND OF HELP IS NEEDED
Make a list of the things the person can or cannot do and who is available to help, with what, and how often.
Needs Assessment Can the person:
__ Take medication on time and in the
correct dosage
__ Go shopping for food and clothing
__ Visit friends or drive a car
__ Travel by bus or taxi
__ Do light housekeeping
__ Do heavy housekeeping
__ Do the laundry
__ Do yard work
__ Afford to pay the bills
__ Write checks and pay bill efficiently
__ Take care of legal matters
__ Maintain personal cleanliness
__ Get dressed
__ Use the toilet
__ Sleep through the night
__ Safely use the stairs & outdoor steps
__ Look up telephone numbers and make calls without help
__ Be safely left alone
WHERE DO I FIND THE SERVICES I NEED?
1. Florida Health & Social Services Navigator Resource Guide (this publication) and other health and social services resource guides
2. Internet (do a “Google” or other search engine search)
3. Library
4. White/Yellow Pages
5. Information & Referral/Crisis Helplines (ie, 2-1-1)
6. City/county/state/federal government
7. Area Agencies on Aging
8. Hospital social work/case management departments
9. Community health fairs/expos
10. Religious institutions
11. Referrals from friends, relatives, and colleagues.
WHAT DO I DO AFTER I HAVE LOCATED A PARTICULAR SERVICE?
Once services are located, it’s important to learn about the services and how they can address the needs of the person who needs help.
A valuable place to learn about services prior to making phone calls is to visit the agency/organization’s website. Read through the services and information described and take notes. The information you glean may be enough for you to know this agency or program isn’t what you’re looking for or on the other hand, it may sound like a perfect match. Narrowing down your choices this way without having to make numerous phone calls saves a lot of time and energy. Doing an internet search also provides prior knowledge about the agency, which is very convenient to have in advance of placing a call to them.
Although some services and programs can be applied for online, others should be contacted by phone.
PRIOR TO CALLING AN AGENCY FOR
SERVICE
1. Determine your goals: What services does the person need? Be clear about the services you’re looking for by putting your goals and questions in writing.
2. Make a list of agencies you want to call.
3. Have your previously organized records near the phone for reference. Having quick access to answers will save you frustration, time, and money.
4. Have a notebook and pen ready for taking notes—don’t use small scraps of paper that could easily be lost. Do role playing to calm nerves.
CALLING THE AGENCY
A Sample Script
“My name is ________. I am caring for ________ who is my ________. I need ________. The hours I need this help are ________. Can you help me?”
If the answer is no, ask “Can you give me another name or agency to call?” If the answer is yes, ask “What services do you provide? What are the costs and how are they paid? Eligibility requirements? How long must we wait to get services? Can you send a brochure and application? What is your website address? Can you do an intake over the phone? To whom am I speaking? Do I need to speak to anyone else?”
Tips When Speaking with the Agency
1. Try to call in the morning.
2. Describe exactly what you need, when you need it, and any limitations you may have in paying for the service. Ask about services, fees, eligibility requirements, waiting lists, for their website address , and to send you a brochure.
3. Interview the agency; ask lots of questions. Determine by their demeanor and response if this would be the appropriate agency to fill the need.
4. Call several agencies to compare.
5. Keep good notes, including the name and number of the agency, the person you spoke to, additional phone numbers and/or email address, website, questions and responses, and names and contact info of additional agencies you were referred to.
6. Enlist the support of those you are calling; don’t put them on the defensive.
7. Be persistent and patient—it may take many calls to get the services you want.
8. Be assertive—call back and ask for a supervisor if you are not satisfied with the answers or advice. Document date, time, and contents of call, and file a complaint with appropriate funding agency, better business bureau, or chamber of commerce.
9. If denied services, ask how to appeal. You have the right to a written decision.
DENIALS AND APPEALS
 Make a log of all correspondence and phone calls regarding denials. Include dates and names of people. When did you receive notice of the denial? How did you receive notification of the denial?
 Most programs and insurance plans have a formal grievance procedure. Get the procedure in writing and follow through (see DCF Fair Hearings page 16, Medicare Appeals page 24, and Social Security Appeals page 29).
ONCE SERVICES ARE APPROVED
1. Develop a detailed file: name/contact info of agency, description of service, referrals of other services needed.
2. Follow up to be sure the services are appropriate and are being provided for in an efficient and effective way.
3. Document any gaps in service or prob-lems and follow up with agency to resolve problem.
4. If gaps of service are due to budget or other cuts, advocate before your elected officials (see page 38). ◙
To request a workshop on Locating &
Accessing Community Resources, contact Robert Goodman, MSW at 561.245.7143 rgoodman@flnavigator.com
This article goes under caregiving
What is a Caregiver?
A caregiver is anyone who provides help to another person in need. Usually, that person has a serious health condition and needs help with basic daily tasks. Caregivers help with things such as: shopping, cooking, paying bills, giving medicine, bathing, toileting, dressing, eating, and more.
People who are not paid to provide care are known as informal caregivers or family caregivers. The most common type of informal caregiving relationship is an adult child caring for an elderly parent. Others include:
 Adults caring for other relatives, ie, grandparents, siblings, aunts/uncles
 Spouses caring for husbands/wives
 Middle-aged parents caring for disabled adult children
 Adults caring for friends/neighbors
 Children caring for a disabled parent or elderly grandparent.
What is Caregiver Stress?
Caregiver stress is the emotional and physical strain of caregiving. It can take many forms. As a caregiver you may feel:
 Frustrated/angry taking care of someone with dementia who often wanders away or becomes easily upset
 Guilty because you think that you should be able to provide better care
 Lonely because all the time you spend caregiving has hurt your social life
 Exhausted when you go to bed at night
These negative feelings coupled with not taking good care of yourself can lead to serious health issues.
Tips for reducing stress: Search out caregiving support groups, ask for and accept help, say “no” to outside requests that are draining, don’t feel guilty if you are not a “perfect” caregiver, set realistic goals, establish a daily routine, make time to do something for yourself, try to stay physically active, eat healthy, and get enough sleep.
Although caregiving can be challenging, it also has its rewards. It can provide a feeling of giving back to a loved one and of feeling needed—both which can lead to a stronger relationship with the person being cared for. To read more about caregiver stress, visit www.womenshealth.gov/faq/caregiver-stress.cfm. ◙
I think this article should go under home health or under durable medical equipment
What Equipment Will I Need When Coming Home from the Hospital?
By Gregory Ullman,
Kin-Care Home Medical & Mobility
When a patient comes home from the hospital or a rehab facility, it is often a time of relief and anticipation. It can also be a confusing time as loved ones try to anticipate needs within the home. Proper home equipment is essential to a smooth and safe transition. Below is a list of commonly required equipment for someone coming home from the hospital. Items that may be covered by Medicare are marked with an (M). (To determine for sure whether Medicare will cover the item, consult with the experts at Kin-Care or your local medical equipment supplier.)
Commode (M) Often referred to as a “3-in-1 commode” because it can be used bedside, over the toilet, or as a shower bench.
Mobility Aids Wheelchair (M), walker (M) and/or a cane (M). Careful consideration should be given to the patient’s mobility abilities. Even someone who has no specific problem with walking may need assistance when first coming home, due to a weakened state.
Hospital Bed (M) If the patient is bedridden or has special needs, Medicare may cover the rental of a hospital bed, which mechanically raises and lowers the head and legs, resulting in a more comfortable and safer recovery.
Over-Bed-Table Can be used with a hospital bed or home bed, for meals, and/or other activities.
Bed Rails If a hospital bed is not required, it may still be advisable to install bedrails to prevent a fall off the bed. These can be inexpensive and easy to install.
Underpads In case of temporary incontinence, washable or disposable underpads can be essential.
Support Surface (M) Pressure ulcers (aka bedsores) are an ongoing risk and can have devastating consequences. The patient should be carefully checked before coming home or upon arrival for any skin breakdown. Even a reddish spot may be classified as a Class I pressure ulcer, qualifying the patient for a Medicare-covered gel pad or air mattress. Use of preventative measures such as these can be critical to maintaining the skin health of the patient.
Reacher As a convenience to pick up items and/or to avoid bending down and possibly falling.
Sockaid To help put on the stockings.
Hip Kit Containing a kit of useful items, such as a dressing stick, long handled shoehorn, long handled bath sponge to help with common hygiene requirements.
Aids to Daily Living (ADL’s) There are a myriad of useful items available – call bells, special eating utensils, elastic shoelaces, etc – that can make life easier for the patient in recovery. Stop by Kin-Care or your local medical supply store to see the wide variety of products available.
Wound Care Products (M) Bandages, tapes, gauze, and ointments as necessary. It is helpful to request a list of necessary or useful items upon discharge.
Cast Protector Protects a bandaged wound or cast from getting wet when bathing.
TED Stockings (for the bedbound / Compression Hose (for those who are able to walk) to help reduce or prevent swelling of the legs and feet.
Overnight Bags and related items. Many items and options are available if the patient has more severe incontinence issues. We are happy to consult with you to determine a strategy to most appropriately deal with incontinence.
Heel and/or Elbow Protectors To help prevent injury or skin breakdown in these sensitive areas.
Special Pillows/Cushions A bed wedge behind the back or a special cushion to raise the knees or legs to make the patient comfortable or in some cases necessary to reduce/prevent swelling or for other reasons.
Lift Chair (M, in some cases) An electric recliner that also helps the patient get up. A wonderful item for the recovering patient who does not need to remain in bed but who has difficulty with a regular chair.
Hip Chair An alternative to the lift chair for the patient recovering from hip surgery or other procedure that makes it difficult to sit down.
Bath Safety Items, including grab bars, shower bench, raised toilet seat, and toilet rails. The bathroom is the place in the home where most serious injuries occur. For those with limited abilities, it is crucial to add or install these items to decrease the risk of falling. The ideal time to obtain or install these items is before the patient comes home from the hospital.
Bed Pan/Urinal For obvious reasons.
Blood Pressure Kit It might be necessary to take the patient’s blood pressure.
Heating Pads / Ice packs For pain relief or to reduce swelling or recommended by the medical professional.
This list is intended as suggestions for items that may be required or desirable. It is not intended to constitute medical advice–you should always rely on the recommendations of medical professionals.
Planning ahead can increase safety and comfort and result in a smooth and happy transition from hospital to home. Feel free to call or stop by your local Kin-Care store for more information and advice. ◙
Copyright 2009 Kin-Care Home Medical & Mobility
All rights reserved. www.kin-care.com
This article goes under health care
Do I Need the Emergency Room?
The answer is yes…if your condition is/can quickly become life threatening or if you suddenly or intensely experience any of the following:
 Pain or pressure in chest
 Pain or pressure in upper
stomach
 Trouble breathing or shortness
of breath
 Loss of consciousness or fainting
 Sudden numbness or weakness
 Confusion, change in mental state
 Sudden change in vision
 Trouble speaking
 Sudden severe headache (with no history of migraines)
 Serious injury to the body
 Uncontrolled bleeding
 Major broken bones
 Seizures
 Severe reaction to an insect bite/sting, medication, or food
 Suicidal thoughts
This article goes under senior services
What is the Difference
Between Adult Day Care
and a Senior Center?
Adult Day Care
Adult Day Care Centers provides a structured program of therapeutic, rehabilitative, social, and leisure activities in a monitored setting for seniors. It offers supportive services to the participant, as well as to the family, by providing care and supervision in a protective environment during the day and needed respite for the caregiver.
The goal of Adult Day Care is to delay or prevent institutionalism by providing alternative care, to enhance self-esteem, and to encourage socialization.
There are two types of Adult Day Care:
Adult Social Day Care provides social activities, meals, recreation, and some health-related services. Adult Day Health Care offers more intensive health, therapeutic, and social services for individuals with severe medical problems and those at risk of nursing home care.
Participants attend the program on a scheduled basis and services may include the following: counseling, education, exercise, health screening, meals, medication management, physical therapy, recreation, respite care, socialization, transportation.
Senior Centers
Senior Centers offers a communal setting for seniors to participate in social activities, recreation, and classes in an environment that is less structured and less supervised than Adult Day Care. Participants tend to be healthier, more mobile, and more independent than those who attend Adult Day Care.
How Much Does it Cost?
Many of the adult day care (see page 63) and senior centers (see page 44) listed in this book are free or charge on a sliding scale. Contact the various centers for further information. ◙
This article goes under home health
Know Who Your
Homecare Providers Are
Let’s learn about the types of healthcare workers that provide services in the home and in a long-term care setting.
Companion/Homemaker May do the following: Prepares/serves meals, does housekeeping, and accompany client on errands/trips. The Companion/Homemaker must have some training in topics related to human development and interpersonal relationships, nutrition, marketing, food storage, use of equipment and supplies, planning and organizing of household tasks, and principles of cleanliness and safety.
Home Health Aide (HHA) In addition to the services provided by a Companion/Homemaker, a HHA may provide “hands on” personal care, which includes assistance in the activities of daily living, such as bathing, grooming, dressing, personal hygiene, eating, and assistance in physical transfer and ambulation.
Some HHA’s can be trained to supervise medication and receive a Home Health Aide Certificate. Training courses are 40 hours and include basic nutrition; maintaining a clean, safe environment; taking vital signs; infection control; and how to handle emergencies.
Most HHA’s have a high school diploma, although it is not required. Florida does not have a state administered test for home health aides. To work for a Medicare or Medicaid home health agency, a HHA must complete 75+ hours of training or successfully complete a competency evaluation given by the home health agency.
Certified Nursing Assistants (CNA) provides the same types of services as the Home Health Aide, but the CNA is certified by
the state, a high school or G.E.D is required, and typically receives a higher rate of pay. The programs are 6-12 weeks in length and include “hands-on” care giving experience.
Licensed Practical Nurse (LPN) provides
services such as monitoring vital
signs, preparing and giving injections,
enemas, help in evaluation of the needs
of the client, and supervising nursing
assistants and aides. LPN’s can also be
involved in teaching and training family
members in simple nursing tasks.
LPN’s must go through a State-approved
Nursing Program, which typically last one
year and include classroom and clinical
practice. A LPN provides care under the direction of a registered nurse (RN). The RN provides supervision and support for the LPN.
Registered Nurse (RN) work to promote
health, prevent illness, educate patients and families, and develop/manage nursing care plans. RN’s are educated in the science and theory behind the care they are administering and supervising. The RN assessment involves a more holistic approach to evaluating the patient, making sure both their physical and psychology needs are being addressed.
There are three major educational levels
of RN’s: an associate degree in Nursing (ADN), a bachelor’s of science degree in nursing (BSN), and a diploma program administered in hospitals. These degrees take from 2-4 years to complete. Periodic renewal of licenses and continuing education are required. A RN may assign portions of client care to LPN’s and HHA’s, but always retains the full responsibility for the care.
Advanced Registered Nurse Practitioner (ARNP) is a RN who has advanced education and experience and generally requires a master’s level education. ARNP’s diagnose and treat common ailments, perform routine tests, prescribe medications, and work closely with the client. ◙
Hiring Independent
Private Duty Help
By Patricia Waldron
Professional healthcare workers (home health aides, companions, homemakers) can be hired through a licensed home health care agency or these services can be obtained from independent providers who are usually called independent contractors.
Independent contractors work for themselves are not employed by a licensed home health agency. They do not have to meet the same standards that licensed agency employees must comply with.
The responsibility of recruiting, hiring, supervising, counseling, and training belongs to the client or client’s family.
This article goes under legal
What are Advanced
Directives?
Advanced Directives are specific instructions, prepared in advance, that are intended to direct your medical care if you are unable to communicate your wishes due to a serious accident or illness. Examples of Advanced Directives are:
Verbal instructions Decisions regarding care that are communicated verbally to health care providers or family members.
Organ donation Removal of healthy tissues from the person who has died for transplantation into a recipient in need. Becoming an organ donor is as simple as completing an organ donation card and carrying it in your wallet. Register online at www.flhsmv.gov/HTML/organ_donor.html
Living Will A legal document that spells out the types of medical treatments and life-sustaining measures you do and do not want, such as mechanical breathing (respiration and ventilation), tube feeding, or resuscitation.
Healthcare Surrogate (aka Medical Power of Attorney) A legal document that allows you to appoint someone else (proxy) to make medical/health care decisions in the event you become unable to make or communicate such decisions.
DNR (Do Not Resuscitate) Order. This states that CPR is not to be performed if breathing stops or heart stops beating. The order is written by the person’s doctor after discussing the issue with the person, the proxy, or family.
Who Should Get Copies of Documents?
Provide copies of all documents listed here to family members/healthcare surrogate and health care providers. Carry a copy in your wallet, glove compartment of car, and/or other safe location. For a planned admission to a hospital, bring copies for the hospital to include in the medical chart.
Making Changes
These decisions can be changed at any time. Remember to inform healthcare providers, proxies, and family members about the changes made and distribute new copies of instructions to everyone involved.
This article goes under mental health
The 5 Stages of Grief
The grief that follows the loss of someone or something dear to us can seem unbearable, but grief is actually a healing process. The death of a loved one, loss of a limb, even intense disappointment can cause grief. Dr. Elisabeth Kubler-Ross has named five stages of grief people go through following a serious loss. Sometimes people get stuck in one of the first four stages. Their lives can be painful until they move to the fifth stage—acceptance.
Five Stages Of Grief
1. Denial and Isolation. At first, the grieving person tends to deny the loss has taken place and may withdraw from usual social contacts. This stage may last a few moments or longer.
2. Anger. The grieving person may then be furious at the person who inflicted the hurt (even if that person is dead), or at the world, God, or him/herself for letting it happen even if realistically nothing could have stopped it.
3. Bargaining. Now the grieving person may make bargains with God, asking, “If I do this, will you take away the loss?”
4. Depression. The person feels numb although anger and sadness may remain underneath.
5. Acceptance. Anger, sadness, and mourning have tapered off. The person simply accepts the reality of the loss.
Grief And Stress
During grief, it is common to experience feelings such as sorrow, anger, loneliness, sadness, shame, anxiety, and guilt. When people suggest “looking on the bright side,” the grieving person may feel pressured to hide or deny these emotions. Denying these feelings and failing to work through the five stages of grief will make it harder for healing to take place.
Recovering From Grief
Grieving and its stresses pass more quickly with good self-care habits. It helps to have a close circle of family or friends. Seek out bereavement support groups (see pg 51), including those online. Eating a balanced diet, drinking plenty of fluids, exercising, and resting are critical. If good self-care habits are practiced, it can be very helpful in dealing with the pain and shock of loss until acceptance is reached. ◙
This article goes under housing
Community Housing:
What are My Options?
Independent Living Communities
Community housing for seniors who are able to live independently in an apartment-like setting. Optional services include: meals in communal dining room, housekeeping/laundry. Social and recreational activities often provided.
Adult Family Care Home Provides a family-type living arrangement in a private home for up to five aged or disabled people. Services include meals, medication management, arranging for health care services, health monitoring, social activities, and help with ADLs (bathing, dressing, eating, walking, etc).
Assisted Living Communities Provides housing in private or shared individual apartments for those who cannot live independently but don’t need skilled nursing care. Services include, but are not limited to, those listed above.
Skilled Nursing Facility/Residence (aka Nursing Home) Provides housing for those who need 24-hour nursing/personal care. Medicaid may offer coverage to residents who meet medical and financial eligibility requirements.
Continuing Care Retirement Communities Offers multiple levels of care (independent living, assisted living, skilled nursing) housed in different areas on the same grounds giving residents the opportunity to remain in the same community if their needs change. ◙
This article goes under legal
What is Guardianship?
Guardianship is a legal proceeding in the circuit courts of Florida that begins with a determination of the individual’s capacity or lack thereof. A guardian exercises the delegable legal rights for another individual called a ward of the court.
A guardian can be either an individual or an institution such as, a bank trust department. A guardian is appointed by the courts when an individual has been adjudicated as incapacitated or lacking the capacity to care for self and/or estate matters.
Types of Guardianships
The two most common types of guardianship are limited and plenary.
 In a limited guardianship, the guardian assumes only the delegable rights specifically given by a court order. The ward keeps all other decision-making rights not specifically outlined by the court.
 In a plenary guardianship, the guardian’s delegable rights can be applied to the person, their estate, or both.
Guardianship of the Person
Guardianship of the person may include:
 Determining and monitoring place of the ward’s residence
 Consenting to and monitoring medical treatment and non-medical services such as education or counseling
 Releasing confidential information
 Making end-of-life decisions
  Maximizing independence for the ward
Guardianship of the Estate or Property
Guardianship of the estate or property may include anything that is the subject of ownership whether tangible or intangible. The court may order the guardian to take control of and be responsible for the following:
 Acting as representative payee
 Determining benefits
 Obtaining appraisals of property
 Protecting property and assets from loss
 Receiving income for the estate
 Making appropriate disbursements
Alternatives to Guardianship
Because establishing a guardianship is highly intrusive and involves the removal of rights from an individual, it should be considered only after other alternatives have been examined. When an individual still retains the capacity to act on his/her own behalf, the following may be evaluated and determined as viable alternatives to guardianship:
 Case/Care Management
 Health Care Surrogacy
 Living Trusts
 Durable Powers of Attorney
 Living Wills
 Joint Tenancy
 Community Services ◙
Source:
Broward County Guardianship Association www.guardiansofsfla.org
This article goes under personswith disabilities
Living & Aging with a Disability
For many, aging with a disability is accompanied by numerous health problems that usually do not occur until 10-15 years later in non-disabled persons:
 3-4x increased risk of new medical problems: diabetes, obesity, high blood pressure/cholesterol, respiratory conditions, bone loss, and thyroid disorders.
 Common complaints include fatigue, new weakness, and pain often progressing to a point of limiting independence. May need use of assistive devices. Increasing physiologic decline, disability and handicap, and cost of care.
 Changes in health impacts quality of life for individual and family. Psychological issues, including depression affects 15-40% of people aging with a disability.
CEREBRAL PALSY
Decline in energy and activity levels. Some bladder difficulty and spinal stenosis reported. More bone fractures per year compared to non-disabled.
DEVELOPMENTAL DISABILITIES
Aging process is affected by the nature and severity of the impairment, secondary conditions , medical issues, and medication usage.
DOWN SYNDROME
 Increased chance of hypothyroidism, hypertension, and arteriosclerosis.
 Shorter life expectancy of 55 years old, but many live into 70s.
 Most adults over age 40 have some neuropathological changes characteristic of Alzheimer’s Disease, but only some develop dementia.
INTELLECTUAL DISABILITIES
Outlive parents and can’t rely on adult siblings. Must plan for the future.
MULTIPLE SCLEROSIS
 There has been little research on this topic. Doesn’t reduce life expectancy. Limited ADLs and IADLs.
 Common issues: urinary tract infections,
pneumonia, and septicemia.
 Loss of mobility (fatigue, falls), dependency on caregiver/family, or possibility of moving into nursing home; most require multiple mobility devices. Rehabilitation therapy has shown to help functioning.
 Controversial study found that MS
doesn’t get worse with age and seems to disappear in the 70s, but MS remains unpredictable and attacks can occur in this age group.
TRAUMATIC BRAIN INJURY
Effects of aging vary greatly. Memory
impairment, slower learning of new material, gait and balance problems, ataxia, decreased sensory acuity, diminished executive functions, reductions in appetite and libido.
POST-POLIO SYNDROME (PPS)
 Develops several decades after a person has had polio. Affects the muscles and nerves, causing weakness, fatigue, pain, and other symptoms. Start to experience onset of new symptoms and functional limitations, which threaten to further erode health and independence and an increase need for services.
 Mean age of 63-Age of person at acute onset and historical period are significantly related to the severity of the initial impairment as well as the physical and psychosocial wellbeing. Contracted at a younger age and earlier in the century were less impaired. Measured by the number of limbs affected vs. contracted later during the peak of the epidemic and at an earlier age. Timing and initial severity have a big impact.
 Excessive fatigue, slowly progressive muscle weakness with or without decrease in muscle bulk, muscle pain or twitching where effected by original disease. Joint pain and respiratory problems reported.
 Severity and experience polio after 1940 at older ages most at risk for depressive symptoms and low scores on acceptance of disability.
SPINAL CORD INJURY
 Effects begin around age 40 with SCI for 20 years. Effects of aging depend on nature and duration of injury—quad early 40s, lower injuries early 50s.
 More pain, fatigue, effort to do activities, weakness, unable to do things previously done independently.
 Diabetes at 4x the rate of nondisabled persons.
 Changes ranging from decline in health and physiologic functioning to sociologic changes, ie, increasing financial stresses, changing relationships, perception of self and roles, and spiritual growth. ◙