The Art of Utilizing a Fiblet

Republished from: https://www.alternativesinalzheimerscare.com/the-art-of-utilizing-a-fiblet/?utm_source=newsletter&utm_medium=email&utm_campaign=October2019&utm_content=blog

Based on an article called “Telling a ‘good or white lie’: The views of people living with dementia and their carers” by Dympna Casey, Una Lynch, Kathleen Murphy, Adeline Cooney, Mary Gannon, Catherine Houghton, Andrew Hunter, Fionnuala Jordan, Siobhan Smyth, Heike Felzman, and Pauline Meskell

What is a fiblet?

In the world of dementia, you may understand the term fiblet as a “lie” or “white lie.”  In order to increase the quality of day for the person living with dementia, the caregiver must create moments of peace and reassurance.  I would like you to reframe the term fiblet as a “therapeutic non-truth.”  In general, caregivers prefer to tell the truth.  In the world of dementia, it is referred to as reality orientation.  This choice may not be in the best interest of the person with dementia.

If we think of a fiblet as a therapeutic intervention rather than a lie, we can create moments of decreased anxiety and stress for the person living with dementia.  This published article explains it very well

Why use a fiblet?

In these moments of unfamiliarity and fear, if we choose to use truth or our reality about the current situation, it will only escalate the person’s feelings of discomfort and pain.  Here is an example of how using a fiblet worked.  Mary, 85 years old, living with Alzheimer’s was attending my day program.  Towards the end of the day, she is beginning to feel anxious and is pacing by the door and looking out the window.  Mary asks, “When is my father coming to pick me up and bring me home?”  If we choose to reality orient, or tell the truth, our response to Mary would be, “Mary, your father is dead; you are 85 years old; your ride is coming soon; you should sit down while you wait.”  Mary’s dementia disease has robbed her of remembering she is 85 years old and that her father is deceased.  Mary is now crushed, and her feelings of fear and anxiety are now escalating.  We, as caregivers, can create either negative moments, or positive moments in that person’s day.   The dementia disease is already responsible for creating negative feelings such as sadness, grief, despair, apathy, and poor self-esteem.  Trained caregivers commonly use fiblets in order to change those negatives into positives.

How do you use a fiblet?

In order to succeed when using a fiblet, your fiblet must be believable.  The only way to create a believable fiblet is to know the person.  Even in the delusional reality of the person living with dementia, if the fiblet is not believable, the person will call you out on your dishonesty.  If you know Mary well enough, you would know that Mary’s father worked in a shoe factory.  Mary will most likely believe you if you use that piece of history in your fiblet.  Here are a couple of steps could use to make Mary feel better.  “Mary, I hear you are asking when your father will be here to pick you up.”  She now knows you heard her.  “Mary, I can imagine how you are feeling. It is the end of the day, and I would like to go home too.”  She now feels that you are empathizing with her. “Mary, your father is finishing up his work at the shoe factory, then he’ll be here to pick you up.”  Even though this is not true, Mary feels reassured.  After that reassuring statement, you then will have higher potential of success by asking “Mary, would you please help me fold the towels, laundry, dry dishes, set the table, etc.”   This is a fabulous re-direction technique.  You first validate, then empathize, use a believable fiblet, and creatively re-direct.

When do you use a fiblet?

You must know the person’s history to create a believable fiblet.  When a person living with dementia expresses anxiety, stress, and fear, the goal is to reduce those symptoms.  When we validate, empathize, fiblet, and re-direct, we have a better chance of succeeding.  My experience has taught me that you need a toolbox.  This toolbox has a variety of strategies, interventions, and fiblets. Some may work for Mary; others may not.  Therefore, building a toolbox helps to provide you with creative interventions based on Mary’s history, likes, dislikes, interests, abilities, and preferences.

A fiblet is an effective therapeutic intervention for people living with dementia.  If utilized properly, the person is relieved and reassured.  As a caregiver, your goal should be to produce moments of peace and calm resulting in positive feelings for the person living with dementia.

13 Tips to Keep Your Bladder Healthy

Republished from: https://www.nia.nih.gov/health/13-tips-keep-your-bladder-healthy

People rarely talk about bladder health, but everyone is affected by it. Each day, adults pass about a quart and a half of urine through the bladder and out of the body.

As people get older, the bladder changes. Visit Bladder Health for Older Adults for more information on how the bladder changes and common medical problems, including bladder infections, urinary incontinence, and urinary tract infections.

While you can’t control everything that affects bladder health, there are some steps you can take to improve bladder health. Follow these 13 tips to keep your bladder healthy.

1. Drink enough fluids, especially water. Most healthy people should try to drink six to eight, 8-ounce glasses of fluid each day. Water is the best fluid for bladder health. At least half of fluid intake should be water. Some people need to drink less water because of certain conditions, such as kidney failure or heart disease. Ask your healthcare provider how much fluid is healthy for you.
2. Limit alcohol and caffeine. Cutting down on alcohol and caffeinated foods and drinks—such as coffee, tea, chocolate, and most sodas—may help.
3. Quit smoking. If you smoke, take steps to quit . If you don’t smoke, don’t start.
4. Avoid constipation. Eating plenty of high-fiber foods (like whole grains, vegetables, and fruits), drinking enough water, and being physically active can help prevent constipation.
5. Keep a healthy weight. Making healthy food choices and being physically active can help you keep a healthy weight.
6. Exercise regularly. Physical activity can help prevent bladder problems, as well as constipation. It can also help you keep a healthy weight.
7. Do pelvic floor muscle exercises. Pelvic floor exercises, also known as Kegel exercises, help hold urine in the bladder. Daily exercises can strengthen these muscles, which can help keep urine from leaking when you sneeze, cough, lift, laugh, or have a sudden urge to urinate.
8. Use the bathroom often and when needed. Try to urinate at least every 3 to 4 hours. Holding urine in your bladder for too long can weaken your bladder muscles and make a bladder infection more likely.
9. Take enough time to fully empty the bladder when urinating. Rushing when you urinate may not allow you to fully empty the bladder. If urine stays in the bladder too long, it can make a bladder infection more likely.
10. Be in a relaxed position while urinating. Relaxing the muscles around the bladder will make it easier to empty the bladder. For women, hovering over the toilet seat may make it hard to relax, so it is best to sit on the toilet seat.
11. Wipe from front to back after using the toilet. Women should wipe from front to back to keep bacteria from getting into the urethra. This step is most important after a bowel movement.
12. Urinate after sex. Both women and men should urinate shortly after sex to flush away bacteria that may have entered the urethra during sex.
13. Wear cotton underwear and loose-fitting clothes. Wearing loose, cotton clothing will allow air to keep the area around the urethra dry. Tight-fitting jeans and nylon underwear can trap moisture and help bacteria grow.

For More Information on Bladder Health

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
1-800-860-8747 (toll-free)
1-866-569-1162 (TTY/toll-free)
healthinfo@niddk.nih.gov
www.niddk.nih.gov

National Kidney and Urologic Diseases Information Clearinghouse
1-800-860-8747 (toll-free)
1-866-569-1162 (TTY/toll-free)
healthinfo@niddk.nih.gov
www.niddk.nih.gov/health-information/kidney-disease
www.niddk.nih.gov/health-information/urologic-diseases

National Association for Continence
1-800-252-3337 (toll-free)
memberservices@nafc.org
www.nafc.org

Be a Healthy Caregiver

Republished from: https://www.alz.org/help-support/caregiving/caregiver-health/be_a_healthy_caregiver?WT.mc_id=enews2019_10_01&utm_source=enews-aff-28&utm_medium=email&utm_campaign=enews-2019-10-01&utm_content=homeoffice&utm_term=Story2

As a caregiver, you may find yourself with so many responsibilities that you neglect taking good care of yourself. But the best thing you can do for the person you are caring for is stay physically and emotionally strong.

See the doctor
Be sure to visit your physician regularly (at least annually), and listen to what your body is telling you. Any exhaustion, stress, sleeplessness, or changes in appetite or behavior should be taken seriously. Ignoring these symptoms can cause your physical and mental health to decline.

If you are caring for someone in the late-stages of Alzheimer's, talk to your health care provider about the seasonal flu shot. Being vaccinated protects both you and the person you are caring for.

Get moving
No doubt you know that exercise is an important part of staying healthy — it can help relieve stress, prevent disease and make you feel good. But finding the time to exercise is another story.

Use these tips:

• Take friends and family members up on their offers to help.You can get in a good workout in a short amount of time — even a 30 minute break. Help coordinate a schedule where you have breaks to exercise and take care of your health.
• Start small. While it is recommended that you get 30 minutes of physical activity at least five days a week, even 10 minutes a day can help. Fit in what you can, and work toward a goal.
• Exercise at home.When the person with dementia naps, pull out a yoga mat and stretch, set up a stationary bike, or try exercise tapes.
• Find something you love.If you enjoy the activity, it will be easier to make it a habit.

There also are many ways you can be active with the person with dementia. Here are a few ideas:

• Take a walk together outside to enjoy the fresh air
• Go to the mall and take a stroll indoors
• Do seated exercises at home
• Dance together to favorite music
• Garden or do other routine activities that you both enjoy

Eat well
Heart-healthy eating patterns, such as the Mediterranean diet, are good for overall health and may help protect the brain. A Mediterranean diet includes relatively little red meat and emphasizes whole grains, fruits, vegetables, fish, nuts, olive oil and other healthy fats. Try new recipes and involve the person with dementia.

Need ideas on how to go healthy?

Try these resources:

• Nutrition: Tips for Improving Your Health (American Academy of Family Physicians)
• Eat Right Nutrition Tips (Academy of Nutrition and Dietetics)
• Healthy Breakfast: Quick, Flexible Options to Grab at Home (Mayo Foundation for Medical Education and Research)

Five tips to help you cope

1. Manage your level of stress. Stress can cause physical problems (blurred vision, stomach irritation, high blood pressure) and changes in behavior (irritability, lack of concentration, change in appetite). Note your symptoms and discuss with a doctor, as needed. Try to find relaxation techniques that work for you.
2. Be realistic. The care you give does make a difference, but many behaviors can't be controlled. Grieve the losses, focus on positive times as they arise, and enjoy good memories.
3. Know you're doing your best. Remember that the care you provide makes a difference and that you are doing the best you can. You may feel guilty because you can’t do more, but individual care needs change as Alzheimer’s progresses. You can’t promise how care will be delivered, but you can make sure that the person with the disease is well cared for and safe. For support and encouragement, join ALZConnected, our online caregiver community.
4. Take a break. It's normal to need a break from caregiving duties. No one can do it all by themselves. Look into respite care to allow time to take care of yourself.
5. Accept changes as they occur. People with Alzheimer’s disease change over time and so do their needs. They may require care beyond what you can provide on your own. Becoming aware of community resources and care options — from home care services to residential care — can make the transition easier. So will the support and assistance of those around you.

Research Backs These Methods for Reducing Depression and Anxiety

Republished from: https://www.nextavenue.org/methods-reducing-depression-anxiety/

For best results, experts recommend making one or two a daily habit

By Patricia Corrigan
Contributing Writer
July 2, 2019

Looking for relief from garden-variety stressors? Feeling mired in one of life’s larger challenges? Weary of sweating the small stuff? The recently published results of a five-year study show that people who learn stress-intervention skills — and then practice them daily — develop more positive approaches to life.

“The skills, known as a positive emotion regulation intervention, are not specific to any particular kind of stress,” says Judith Moskowitz. “We’ve seen that individuals in all kinds of challenging life circumstances with high levels of depression and stress have the ability to experience positive emotions, and doing that helps them cope better. The same skills also help with daily hassles.”

“When you’re hyper-focused on things that are stressful, you don’t notice the good things.”

A medical social science professor at Northwestern University’s Feinberg School of Medicine, Moskowitz developed the intervention program taught in the study. Based in Chicago, she also is the director of research for Northwestern’s Osher Center for Integrative Medicine and president-elect for the International Positive Psychology Association.

Caregivers Found Relief
As reported in a recent issue of the journal Health Psychology, 170 participants in Moskowitz’s six-week, randomized controlled trial showed a decrease in depression by 16% and in anxiety by 14%.

Those who took part in the study were caring for loved ones with dementia, but Moskowitz says the results bode well for anyone who decides to put into practice some of the strategies, all of which are backed by research.

“I want to emphasize that these skills are designed to help increase positive emotions. That’s not to say that anyone needs to deny or suppress negative emotions, because they are important,” Moskowitz says. “But it’s also important to experience positive emotions alongside negative ones, and that’s what these skills are designed to help people do.”

Choose from a ‘Buffet of Options’
Because different solutions work for different people, Moskowitz offers what she calls “a buffet of options” — eight ways to help cultivate more positive emotions. “Individuals may want to give each option a try,” she says, “and then pick one or two to stick with as a habit.” Here are the eight proven skills:

1. Identify one positive event each day. “Humans have evolved to pay attention to what’s going wrong. Things that are stressful draw your attention so you can do something about it,” Moskowitz says. “But when you’re hyper-focused on things that are stressful, you don’t notice the good things. Making time to do that helps you take a step back, get some distance.”
2. Talk with someone about the positive event or share it on social media. “This is a way to savor or capitalize on something good,” Moskowitz says. “You don’t have to share it. You could just think about it again, and remember how great it was.” Examples might include preparing a good meal or watching a beautiful sunset.
3. Write in a gratitude journal every day. This is a second way to notice the good moments in the day. “In your gratitude journal, you can write about events or write that you are grateful for the sunshine or for clean water,” Moskowitz says.
4. Reflect on a personal strength and how you’ve used it recently. When you’re under stress, your thoughts may spiral downward and lead to self-criticism. “Instead, recall good things about yourself,” Moskowitz says. “Maybe tell yourself you are a great friend or that you’re someone smart who can come up with a plan to deal with your stress.”
5. Set a small daily goal and note your progress. “When you feel as though you’re making progress — even if you aren’t necessarily achieving success — that increases positive emotions,” Moskowitz says. “Find the sweet spot of goal setting, something that’s not way beyond what’s possible.”
6. Develop a “positive reappraisal” habit to reframe a troubling daily activity in a more positive light. “How we interpret an event determines our emotional reaction to it. But there’s almost always a positive reappraisal that you can pull out of any situation, even when you start small,” Moskowitz says.
7. Perform an act of kindness every day. This simple practice gets you outside yourself. Moskowitz notes that she always walks her shopping cart back to the storefront and also makes way for drivers attempting to merge onto the highway. Complimenting a stranger on a pretty scarf or a welcoming smile counts, too.
8. Concentrate on the present moment. “When you’re upset, instead of rehashing what already happened or rehearsing what might happen next, pay attention instead to what’s happening in the present, what your thoughts and experiences are right now,” Moskowitz says. “When we’re more mindful, we’re more aware of positive events.

Meditation Can Help You Master MindfulnessThat last one can be tricky. To master mindfulness and respond thoughtfully to life rather than just react, Erin Olivo recommends meditation.

 “It’s a tool for achieving mindfulness, and research shows that meditation reduces our sense of stress,” she says. “You can take up a formal practice, where you sit on a cushion, or an informal practice, where you bring mindfulness to your daily activities.”

Olivo is a licensed clinical psychologist in New York City with more than 22 years of experience treating patients who are dealing with stress, anxiety and depression. She also is the author of Wise Mind Living: Master Your Emotions, Transform Your Life.

Olivo practices mindfulness while in the shower. “I might want to ruminate about anything I’m worried about or try to do a lot of planning instead of just being in the shower. But I remind myself to be present, and not let my thoughts launch me into my day,” Olivo says.

“This focused approach also works while washing dishes or even brushing your teeth,” she says, adding that if your mind wanders, gently bring it back to the moment.

“The more we bring mindfulness into our lives, the more impact it has,” Olivo says. “Think of it as a muscle you are developing — a way to help yourself.”

Aging Care LLC: One of Hartford's Finest Businesses

The $3.4 Trillion Retirees Aren’t Getting From Social Security

Republished from: https://www.nextavenue.org/trillion-retirees-social-security/

A new study's findings, and what could get more money in retirees' pockets

By Laurence J. Kotlikoff
Social Security expert
July 1, 2019

United Income, a financial planning advisory service, just released an important study called, “The Retirement Solution Hiding In Plain Sight.” Using government data and proprietary software, it calculates how much money retirees have lost, and are losing, by making mistakes about when to start claiming Social Security benefits. United Income’s answer: a whopping $3.4 trillion or $111,000 per household!

That’s enough to move half of the oldest Americans now in poverty out of that terrible state. Put another way, according to United Income, the average Social Security recipient would get 9% more income in retirement by making the “financially optimal” decision about when to claim benefits.

Increasing Your Social Security Benefit By 177%

According to United Income, someone who’d get a $725 monthly Social Security benefit by starting to claim at 62 (the earliest age) would see a benefit increase to $1,280 by delaying to age 70 — an increase of 177%.

By United Income’s calculations, however, only 4% of retirees make the financially optimal Social Security claiming decision. The rest of them are claiming too early. United Income estimates that 92% of retirees would be better off waiting to claim until at least 65.

The study’s conclusion: if boomer workers would take the most appropriate Social Security benefits at the right time, they’d increase their prospects for financial security in retirement.

““A daunting task awaits individuals striving to make an optimal Social Security claiming decision.”

he team that produced the study includes these impressive people: Jason Fichtner, a former chief economist and acting deputy commissioner at the Social Security Administration; Kevin Whitman, a former Social Security Administration policy research director and Matt Fellowes, CEO of United Income, who has had an impressive career studying and delivering personal financial services.

The United Income study indicates significant attention to detail and uses the best available data to answer its question about optimal Social Security claiming. So, as someone who has been a Social Security analyst for decades and co-wrote Get What’s Yours: The Secrets to Maxing Out Your Social Security, I take its estimates seriously.

Personally, I would have made different methodological choices. But, in the end, I too would likely have arrived at a figure for lost Social Security benefits running in the trillions.

6 Reasons Why Retirees Are Leaving Trillions on the Table

So why are retirees leaving trillions on the table? And how can those trillions be used to support Americans in retirement?

As United Income’s report says, “a daunting task awaits individuals striving to make an optimal decision.”

There are, I think, six reasons people make the “wrong” Social Security moves:

First, many, if not most, people in the second half of life, are cash poor. They can’t wait until age 70 to collect their retirement benefit when they’d be roughly 70% higher, after inflation, than if they started claiming at 62.

Second, retirees don’t know how to value the extra Social Security benefits they’d receive in the future from exercising patience. Indeed, virtually none of the Social Security claiming tools from financial services companies I’ve seen get optimal claiming right. They focus on the actuarial value of benefits. This is off base, since any given household can’t play the actuarial averages. Social Security — by paying benefits in the form of inflation-adjusted income that don’t stop until you die — insures you against this financially catastrophic event. Properly valuing Social Security requires correctly incorporating the value of its insurance.

Third, the vast majority of retirees don’t use any Social Security software to make what, for many, is their most important financial decision.

The fourth reason is that retirees fear they will die before collecting what they are owed from Social Security. “Take your benefits. You could die tomorrow,” is what many Social Security staffers inappropriately tell people when they make benefit inquiries. But none of us will be kicking ourselves in heaven for not taking Social Security early. The real danger is not dying and kicking yourself in heaven for the money you could’ve received.

The fifth reason people take their Social Security benefits too early is they think they can invest that money in the stock market and make a killing. This is nuts. The implicit, perfectly safe, real investment return from waiting to collect higher benefits is three times more than you can earn on the market, based on historical averages.

The sixth reason is that Social Security recipients fear future cuts in benefits because they’ve heard Social Security is insolvent. But the politicians aren’t likely to cut benefits of current beneficiaries or people close to retirement. So a benefits cut is a worry for the young, not for those now retired or about to retire.

What Could Fix This Social Security Problem

How can retirees be kept from squandering trillions?

The study’s authors suggest eliminating the option to take retirement benefits early with exceptions for those with an incontrovertible need to do so.

This will force millions to work longer, which may not be a bad thing. But it’s very Big Brother social engineering.

United Income also suggests the Social Security Administration change how it frames claiming options to the public. Instead of calling age 62 the “early eligibility age,” the researchers say, claiming at 62 could be labeled “the minimum benefit age” and age 70 could be labeled “the maximum benefit age.”

A better option is to let some take a portion — say, one third — of his or her Social Security benefit early while letting the rest of the benefit grow. This would alleviate the cash flow constraints facing so many early beneficiaries. Mechanically, this would be fairly easy to implement.

Would this plan cost Social Security more money? Yes, based on proper accounting. But the additional costs are clearly worth it

The boomers, with the help of Uncle Sam and their employers, have made a financial mess of their retirement. As this new and highly valuable United Income study shows, the boomers are compounding their financial problems by making terrible Social Security decisions.

It’s time to turn this situation around.

Laurence J. Kotlikoff is co-author of Get What's Yours: The Secrets to Maxing Out Your Social Security, an economics professor at Boston University and president of Economic Security Planning, which creates financial planning software. He also writes a regular column for Forbes; his articles can be found here. He was an independent write-in candidate for President in the 2016 election.

Urinary Tract Infections Affect Millions. The Cures Are Faltering.

Republished from: https://www.nytimes.com/2019/07/13/health/urinary-infections-drug-resistant.html?smid=nytcore-ios-share

As the infections become increasingly resistant to antibiotics, some standard treatments no longer work for an ailment that was once easily cured.

By Matt Richtel
July 13, 2019

For generations, urinary tract infections, one of the world’s most common ailments, have been easily and quickly cured with a simple course of antibiotics.

But there is growing evidence that the infections, which afflict millions of Americans a year, mostly women, are increasingly resistant to these medicines, turning a once-routine diagnosis into one that is leading to more hospitalizations, graver illnesses and prolonged discomfort from the excruciating burning sensation that the infection brings.

The New York City Department of Health has become so concerned about drug-resistant U.T.I.s, as they are widely known, that it introduced a new mobile phone app this month that gives doctors and nurses access to a list of strains of urinary tract infections and which drugs they are resistant to.

The department’s research found that a third of uncomplicated urinary tract infections caused by E. coli — the most common type now — were resistant to Bactrim, one of the most widely used drugs, and at least one fifth of them were resistant to five other common treatments.

 “This is crazy. This is shocking,” said Lance Price, director of the Antibiotic Resistance Action Center at George Washington University, who was not involved in the research.

The drug ampicillin, once a mainstay for treating the infections, has been abandoned as a gold standard because multiple strains of U.T.I.s are resistant to it. Some urinary tract infections now require treatment with heavy-duty intravenous antibiotics. Researchers last year reported in a study that a third of all U.T.I.s in Britain are resistant to “key antibiotics.”

Certainly, the day-to-day experience of having a U.T.I. is growing less routine for many women.

Carolina Barcelos, 38, a postdoctoral researcher in Berkeley, Calif., said she had several U.T.I.s as a teenager, all successfully treated with Bactrim. When she got one in February, her doctor also prescribed Bactrim, but this time it didn’t work.

Four days later, she returned and got a new prescription, for a drug called nitrofurantoin. It didn’t work either. Her pain worsened, and several days later, there was blood in her urine.

Her doctor prescribed a third drug, ciprofloxacin, the last of the three major front-line medicines, and cultured her urine. The culture showed her infection was susceptible to the new drug, but not the other two.

“Next time,” Dr. Barcelos said, “I’m going to ask them to do a culture right away. For eight days I was taking antibiotics that weren’t working for me.”

Bacteria are rebelling. They’re turning the tide against antibiotics by outsmarting our wonder drugs. This video explores the surprising reasons. Click on the video above to watch Revenge of the Bacteria: Why WeAre Losing The War. By Kassie Bracken, Matt Richtel and Ora DeKornfeld