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

Reduce the Risk of Isolation with Resources and Support from Aging Life Care Professionals®

Republished from: https://www.prweb.com/releases/reduce_the_risk_of_isolation_with_resources_and_support_from_aging_life_care_professionals/prweb16411811.htm

Aging Life Care Professionals can help coordinate resources and services to promote social engagement.

TUCSON, ARIZ. (PRWEB) JUNE 28, 2019

As we age, there may be barriers for elders that prohibit social activity and engagement. Spouses and friends pass away, mobility becomes more difficult, and driving is no longer a possibility. However, the loss of interaction with others can result in poorer health outcomes. According to the NIH, social isolation can result in high blood pressure, heart disease, obesity, a weakened immune system, anxiety, depression, cognitive decline, Alzheimer’s disease, and even death.

Some signs that an older adult is at risk of social isolation include:

• Living alone
• Family living at a distance
• Poor hearing and/or vision
• Memory loss or other cognitive problems
• Difficulty getting around (trouble walking, unable to drive or access transportation)
• Significant life changes such as the recent loss of a partner or moving to a new home

Fortunately, social isolation does not have to be an inevitable part of aging. Some ways to make sure that older adults stay engaged are:

• Visiting children, grandchildren, friends, and neighbors
• Participating in faith activities, services, and social events
• Signing up for trips sponsored by local community centers
• Volunteering at schools, hospitals, or local non-profit organizations
• Taking classes or attending lectures at local libraries, schools, and other community venues
• Joining a book group or social club

If you or a loved one are feeling isolated, but unsure where to start, an Aging Life Care Professional can help. Also known as geriatric care managers, these experts can help older adults connect to different resources in their area, from organizations that host events to transportation. Many of them provide check-ins to the older adult at home, providing an opportunity for conversation, connection, and support.

If your family is in need of care management services, you can find an Aging Life Care Professional near you at aginglifecare.org.

ABOUT the Aging Life Care Association ® (ALCA): ALCA (formerly known as the National Association of Professional Geriatric Care Managers) was formed in 1985 to advance dignified care for older adults and their families in the United States. Aging Life Care Professionals® have extensive training and experience working with older adults, people with disabilities, and families who need assistance with caregiving issues. They assist families in the search for a suitable nursing home placement or extended care if the need occurs. The practice of Aging Life Care™ and the role of care providers have captured a national spotlight, as generations of Baby Boomers age in the United States and abroad. For more information or to access a nationwide directory of Aging Life Care Professionals, please visit http://www.aginglifecare.org

Alzheimer’s and Dementia Treatments and Research

Republished from: https://www.alz.org/help-support/i-have-alz/treatments-research?WT.mc_id=enews2019_07_01&utm_source=enews-aff-28&utm_medium=email&utm_campaign=enews-2019-07-01

By Alzheimer’s Association

The more you know about Alzheimer's medications, the better prepared you will be to discuss them with your physician, make informed choices about your treatment plan, and effectively cope with symptoms of the disease.

Medications
While there is no cure, prevention or treatment to slow the progression of Alzheimer's disease, there are five prescription medications approved by the U.S. Food and Drug Administration (FDA) to treat its symptoms.

Treatments-at-a-glance: Medication, Brand Name, Approved, Possible Side Effects

Donepezil

Aricept®             

All stages                           

Nausea, vomiting, loss of appetite and increased frequency of bowel movements.

Galantamine

Razadyne®        

Mild to moderate          

Nausea, vomiting, loss of appetite and increased frequency of bowel movements.

Memantine

Namenda®       

Moderate to severe     

Headache, constipation, confusion and dizziness.

Rivastigmine                

Exelon®             

Mild to moderate          

Nausea, vomiting, loss of appetite and increased frequency of bowel movements.

Memantine + Donepezil                       

Namzaric®                         

Moderate to severe       

Nausea, vomiting, loss of appetite, increased frequency of bowel movements, headache,

constipation, confusion and dizziness.

The first three drugs are called cholinesterase inhibitors. These drugs prevent the breakdown of a chemical messenger in the brain important for learning and memory. These medications treat symptoms related to memory, thinking, language, judgment and other thought processes.

The fourth drug, memantine, regulates the activity of a different chemical messenger in the brain that is also important for learning and memory. Both types of drugs help manage symptoms, but work in different ways.

Tips from people living with Alzheimer's: Medication safety

1. Keep a calendar and check off each dose as it's taken.
2. Set up a pill box each night for use the next day.
3. Set the alarm on your cell phone or schedule dosing around meal times.

Before beginning a new medication, make sure your physician, pharmacist and care team are aware of any over-the-counter and alternative remedies you are taking to prevent drug interactions and unwanted side effects. Be sure to discuss all medications you take with your doctor to understand why they were prescribed and how to take them.

Treating sleep changes
Alzheimer's or another dementia may change your sleep patterns. You may have difficulty sleeping, take daytime naps, and/or experience other shifts in your sleep pattern. Researchers are not sure why these sleep changes occur. There are non-drug treatments and medications that may help improve your sleep.

Alternative treatments
There are remedies, supplements and “medical foods” that are often referred to as alternative treatments. Alternative treatments are not regulated and do not need to adhere to the same standards as FDA-approved treatments. Claims about their safety and effectiveness are based largely on testimonials, tradition or a small body of scientific research.

If you are considering taking an alternative treatment, talk openly with your physician. It is important to be aware of any risks so you can make an informed decision. Even if advertised as “natural,” alternative treatments can involve potentially powerful substances that have not met the FDA standards for effectiveness or safety, and some alternative medicines can cause unintended reactions when taken with prescription medications.

Here is a list of questions to ask when considering an alternative treatment or supplement:

Did the FDA test the product? If so, what were the results?
The FDA may have tested a product, but found it to be ineffective for the intended purpose. The company may still release the product as a medical food, either with or without changes.

Has any non-FDA testing been done? If so, what were the results?
Does the testing entity have a vested interest in the outcomes? For example, was testing done only by the company developing the product? If so, the results may not be entirely reliable.

Does the developer of the product or the person recommending it to you have a potential financial gain from the use of the medication?
If so, use extreme caution. Check with your care team to see if they have any questions or concerns with your plan to use it.

Is the product compatible with the other medications you are taking or with your diagnoses?
Be sure to check with your doctor or pharmacist to find out whether the product could cause negative outcomes given your diagnoses and any medications you are taking.

Does use of the product have any known risks?
Ask your doctor or the pharmacist if the product has any known side effects.

Research into tomorrow's treatments
Researchers are conducting studies to find new interventions and treatments that can prevent Alzheimer's, diagnose the disease earlier, slow its progression or stop it in its tracks.

Many drugs in development aim to interrupt the disease process itself by impacting one or more of the brain changes associated with Alzheimer’s. These changes offer potential "targets" for new drugs to slow or stop the progress of the disease. These promising targets include beta-amyloid and tau protein (hallmarks of Alzheimer's brain abnormality) and inflammation.

Researchers believe successful treatment will eventually involve a combination of medications aimed at several targets, similar to current treatments for many cancers and AIDS.

Participate in clinical trials
Recruiting and retaining trial participants is now the greatest obstacle, other than funding, to developing the next generation of Alzheimer's treatments. You can help change this by participating in a clinical research study.

To find a clinical trial, use Alzheimer's Association TrialMatch® or call 800.272.3900 (press 1 for clinical trials).

TrialMatch is a free, easy-to-use clinical studies matching service that connects individuals with Alzheimer's or another dementia, caregivers, healthy volunteers and physicians with current studies.

Deadly Falls in Older Americans Are Rising. Here’s How to Prevent Them.

Republished from: https://www.nytimes.com/2019/06/04/health/falls-elderly-prevention-deaths.html?smid=nytcore-ios-share

The rate of deaths after falls is rising for people over 75, a new study shows. But falls are avoidable for most seniors. We have some tips.

By Katie Hafner
June 4, 2019

As the population ages, the number of older Americans who die following a fall is rising. A study published Tuesday in the medical journal JAMA found that for people over 75, the rate of mortality from falls more than doubled from 2000 to 2016.

Researchers analyzed information obtained from death certificates maintained by the federal government’s National Center for Health Statistics. In 2016, the rate of death from falls for people 75 and older was 111 per 100,000 people, they found. In 2000, that rate was 52 per 100,000 people.

Elizabeth Burns, a health scientist at the Centers for Disease Control and Prevention, who was an author of the study, said the reason for the increase was unclear.

“The most likely reason is that people are living longer with conditions that in the past they might have died from,” she said. In addition, she continued, older adults are on medications that increase their risk of falling. Women are slightly more likely to fall than men, but men are slightly more likely to die as a result of a fall.

“The take-home message is that falls kill,” said Dr. Lewis Lipsitz, a professor of medicine at Harvard Medical School and director of the Marcus Institute for Aging Research at Hebrew SeniorLife, a housing, research and health care organization in the Boston area. He was not involved in the study.

Although the trend is disturbing, falls needn’t be an inevitable part of aging, and they are preventable.

“The biggest risk factor for falls that can’t be changed is your age,” said Dr. Elizabeth Eckstrom, a geriatrician at Oregon Health & Science University. “Most of the other risks can be mitigated.”

Here are some measures you can take to help prevent a fall.

Exercise!

Dr. Lipsitz emphasized the importance of incorporating exercise into a daily routine. He suggested at least 20 minutes a day, combining aerobic and anaerobic exercise. Weight lifting, particularly for strengthening the legs, is a good idea, he said.

Tai chi, the Chinese martial art, appears to be an effective way to improve balance. It involves very slow, purposeful movements in coordination with breathing and muscle activity.

A study published last year found that among adults over 70 who practiced tai chi twice a week for an hour, the incidence of falls was reduced by 58 percent. Dr. Eckstrom, one of the study’s authors, said the participants in the study did tai chi twice a week for an hour over a six-month period.

“When you fall, your body has not figured out how to stay posturally stable, and tai chi helps with that,” Dr. Eckstrom said. “With a lot of the classic tai chi moves, you make a fairly large step out, or to the side. Or you lean forward, with your trunk. You’re putting yourself in a position of almost falling.” All of this, she added, trains the body to remain stable when put in an off-kilter position.

The CDC maintains a compendium of recommended exercises that includes tai chi.

If a doctor prescribes a walker, use it. “It will allow you to be more independent for longer,” Dr. Elizabeth Eckstrom, a geriatrician, said.

Mind your meds

Medications, especially those that help with sleep, can compromise balance. Dr. Eckstrom said benzodiazepines such as Valium and Xanax are especially bad.

“Metabolism slows in older adults, so toxicity to benzos builds up, which can cause dizziness,” she said.

The same goes for non-benzodiazepines such as Ambien. Sedating antihistamines such as Benadryl and Advil PM are also bad for balance.

“If everybody got off the sleeping pills, it would help a lot,” Dr. Eckstrom said. As an alternative, she recommended melatonin to her patients, which she called a safe and effective sleep aid.

Re-accessorize

Eyesight is a crucial component when it comes to falls. Avoid bifocal or progressive lenses when walking outside. “If you’re wearing bifocals and stepping down off a curb, that changes your depth perception,” said Ms. Burns, who recommends a single-focus lens for walking outside.

Then there’s footwear. Fashion, said Dr. Lipsitz, needs to take a back seat to function. “No high heels,” he said. Dr. Eckstrom agreed.

Anything the foot slides into is a terrible idea, she said: “Avoid cute slide-in sandals.”

All shoes should have a back, and a sole with good tread. Slippers, too, can be bad. “Slippers make you slip,” said Dr. Eckstrom.

Are you too proud to use a cane or walker? Get over it. “If your doctor has recommended a walker, use it,” Dr. Eckstrom said. “It will allow you to be more independent for longer.”

Eliminate tripping hazards

The accumulated clutter of a lifetime can be lethal. Get rid of small scatter rugs in your home, and eliminate extension cords that stretch across a floor.

Pets can also be a hazard. “It’s so easy to trip over your pet,” said Dr. Eckstrom.

Take a closer look at the height of thresholds between rooms; it takes just a fraction of an inch to cause a trip. Keep a light on at night for visual access to the bathroom.

Early and often to the bathroom

Hydration is a good way to fight dizziness. Drink plenty of water throughout the day, said Dorothy Baker, a senior research scientist in geriatrics at the Yale School of Medicine.

“Don’t wait until you’re desperate to go to the bathroom and need to rush,” Dr. Baker said. There’s a bonus to frequent bathroom trips, she added. “Doing that sit-to-stand is really good exercise and good for balance. Do a few extras while you’re there.”

When the Care Is as Burdensome as the Condition

Republished from: https://www.nextavenue.org/multiple-chronic-conditions-treatment/

Some doctors are rethinking the treatment of chronic conditions

By Edie Grossfield
Health and Caregiving Editor
May 24, 2019

(Editor’s note: This story is part of a series for The John A. Hartford Foundation.)

Harold Peterson’s* cardiologist prescribes medications for his heart disease. His primary care physician prescribes medications for his high blood pressure and also determined that his hip pain needed to be addressed. He referred Peterson to an orthopedist, who recommended surgery.

Peterson, who is in his 80s, lives with a variety of chronic conditions, and he’s far from alone. One in four Americans has multiple chronic conditions — ones that last at least a year and require ongoing medical attention, limit activities or both. The already high ratio of Americans with more than one chronic condition jumps to three out of four people ages 65 and older. Some of the most common chronic conditions: high blood pressure, arthritis and diabetes.

Someone who deals with chronic conditions is typically treated by a variety of specialists, as Peterson is. Each doctor runs tests and prescribes different medications and self-care homework. It’s not long before a person can feel overwhelmed and overburdened by his or her long list of appointments and care routines, says Dr. Mary Tinetti, an internist and chief of geriatrics at Yale School of Medicine.

“People with multiple chronic conditions will often begin to skip some of their health tasks due to what’s called ‘burden of treatment.'”

“Once you get three, four or five and six diseases, several things happen: Number one, almost guaranteed, trying to get one of those diseases under control is going to make one of the other diseases worse,” Tinetti says. “Number two: The more we ask people to do, the more overwhelmed they get and the less they are likely to do.”

People with multiple chronic conditions will often begin to skip some of their health tasks due to what’s called “burden of treatment,” says Dr. Victor Montori, an endocrinologist and professor of medicine at the Mayo Clinic in Rochester, Minn.

Lessening Burden of Treatment

In an attempt to lessen that burden, Tinetti leads an initiative called Patient Priorities Care. This model empowers people to express their health care priorities — things like function, longevity, social activities or symptom relief — and work with their physicians to develop treatment plans that focus on those goals and let them live the lives they desire.

Patient Priorities Care complements a health care approach introduced by Montori and his colleagues about a decade ago called Minimally Disruptive Medicine. The basis for the approach is the same as Patient Priorities Care: to lessen the burden of treatment by asking patients about their health care goals.

But Montori says Minimally Disruptive Medicine lacked an effective process for identifying what really mattered to patients in their present-day lives.

“It’s very much like when you get hired for a job and somebody asks you, ‘How do you see yourself in the next five years?’ And then you make stuff up, because five years later you’re doing something completely different from what you thought you’d be doing,” Montori says, adding that the same thing happens when you ask patients a general question like, “What are your goals for care?”

“Either they respond with quite generic statements that are not very helpful like, ‘Oh, I would like to live longer and feel better,’ or they become exercises in fiction: ‘I would like to be able to play the piano,'” Montori says.

Patient Priorities Care’s questions are designed to identify what patients want to be able to do in their everyday lives. For example: “What brings you the most enjoyment or pleasure in your life?” and “When taking care of yourself, what is most important to you now?”

Identifying What Really Matters

The Patient Priorities Care approach worked well for Peterson as a patient at ProHealth Physicians Group in Bristol, Conn., where a two-year pilot of the initiative wrapped up last year.

Peterson enrolled in that study and shared his feelings about his health and treatment. During the process, his doctors learned that he didn’t actually want surgery for his hip, despite the pain he suffered and the difficulty he had walking.

Much more troubling to him were the dizziness and fatigue he experienced every day because of his heart and blood pressure pills. Those side effects prevented him from playing poker with his friends — something he loves to do once or twice a week.

Peterson’s primary care doctor and cardiologist worked with him to adjust his medication regimen so he’d no longer feel dizzy and tired. Once again, he was able to enjoy the social time with his friends playing poker.

Patient Priorities Care doesn’t come without trade-offs, though. For example, because Peterson has cut down on some of his medications, there’s a chance he might not live as long as he would if he had kept taking them. But today, he feels well enough to enjoy the things he wants to do in life — and that’s what matters to him.

Less Unwanted Care

The pilot project at ProHealth (which was funded in part by The John A. Hartford Foundation, a Next Avenue funder) involved about 350 patients. It compared the Patient Priorities Care group with ProHealth patients receiving standard primary care.

It found that those involved in the study felt less burdened by their treatment because there was less “unwanted care,” including medications, diagnostic testing, procedures and self-management tasks that patients either didn’t believe helped them or thought was just too much.

“And that’s really important to know,” Tinetti says, “because one of the things we’re learning more and more is that people with multiple chronic conditions are feeling almost as burdened by their care as they are by the chronic conditions they have.”

Pushback From Physicians

Tinetti and her colleagues are realizing it’s rare to find a physician or clinic that works this way, however. So, they’re working on ways to spread the concept to more health care providers and organizations. The team also is developing self-directed materials that help patients and their family caregivers work through the process of identifying health care priorities so they can communicate these to their physicians.

Tinetti has run into some pushback against Patient Priorities Care from physicians who say they already are stretched too far in terms of the number of patients they are expected to see per day and the documentation tasks they are expected to perform.

In response, she refers to the pilot study at ProHealth which found that Patient Priorities Care doesn’t add much time to doctor visits. After patients discussed their priorities with a nurse or case manager, their first couple of visits with physicians were usually about 10 minutes longer. Visits beyond that returned to the normal length of time.

The Patient Priorities Care process simplifies caring for people with multiple chronic conditions because it narrows the focus to what is troubling them the most, Tinetti says.

Physicians point out that they are required to follow specific disease treatment guidelines that the Centers for Medicare & Medicaid Services requires health care organizations to meet for reimbursement. Many physicians’ performance reviews also are based, in part, on their patients’ adherence to treatment guidelines.

Many of these guidelines have age limits and don’t apply to people over the age of 75 or 80. However, if a guideline does apply but a physician feels it is not in the best interest of a patient, the physician only needs to document his or her reason for not following it and that the patient was involved in the decision-making, Tinetti says.

Montori says many guidelines, meant to ensure high-quality and efficient care based on the results of clinical trials, often interfere with what actually is best for an individual patient. He says the guidelines recommend care for “patients like this” rather than “this patient.”

He’s written a book that addresses the idea and has spoken on it at health care conferences, including the 2018 Lown Institute Conference in Washington, D.C. and the 2019 Cleveland Clinic’s Patient Experience Summit.

With regard to setting personal health goals, as Patient Priorities Care and Minimally Disruptive Medicine try to do, Montori says the discussion about health care in the U.S. needs to move away from treating people like they are all the same to “treating each person and responding to each person’s situation in a careful and kind way that is maximally supportive and minimally disruptive.”

It’s an approach that’s good for all patients, not only those with multiple chronic conditions, Montori says.

Edie has been a journalist for more than 20 years, reporting and editing for newspapers and magazines. She also worked in communications for a large health care organization. She holds a bachelor’s degree in communications and media and a master’s degree in journalism, both from the University of Wisconsin in Madison. Reach her by email at egrossfield@nextavenue.org.

Making It Easier to Talk about Advance Care Planning

Republished from: https://www.asaging.org/blog/making-it-easier-talk-about-advance-care-planning

By Scott Bane

I have family members who believe that if they talk about end-of-life issues, they will hasten death. They resolutely back-up their beliefs with silence and inaction. They are not alone in this. As a general rule, most of us don’t like to think or talk about the end of our lives. Isn’t this always the way? Even if we know something is good for us or important, if it’s hard or will make us uncomfortable, we put it off.

But as a matter of public policy, collectively we as a society have decided that it’s a good thing to consider and plan for serious illness or death. As a result, all states have some form of advance care planning codified into law. Advance care planning helps people specify the kind of care they would like – or not like – in the event they are seriously ill or dying. Effective January 1, 2016, Medicare began paying medical professionals if a patient wished to have an advance care planning conversation.

Technically, advance care planning need only take place between patients, their families, and medical professionals. But since drafting legally-binding paperwork is involved, lawyers have historically stood at the threshold to this planning process.  Ideally, a conversation between a lawyer and his or her client will focus on the patient’s values, goals, and wishes.  The lawyer then documents these values and goals by creating a health care proxy, living will, and/or health care power of attorney.

Advance care planning is always important, but it becomes even more important as one ages or is living with chronic illness. Still, only about a third of adults have completed advance care planning.  Not surprisingly, these numbers rise for older adults. Several studies put completion of advance care planning by adults age 65 and older at roughly 50 percent.

To help change this, The John A. Hartford Foundation made a grant to the American Bar Association – Commission on Law and Aging. In 2018, the ABA Commission on Law and Aging sponsored an expert summit at which legal and medical experts drafted a practical, step-by-step guide for lawyers to help them guide their clients through advance care planning. The resulting document Advance Directives:  Counseling Guide for Lawyers was released on October 17, 2018. The President of The John A. Hartford Foundation Terry Fulmer later discussed the guide in an article published by Next Avenue.

Now comes the hard part of actually getting the Guide into the hands of lawyers who will use it. The ABA Commission on Law and Aging and its partner organizations on this project, such as the American Academy of Hospice and Palliative Medicine, are reaching out to legal and medical publications, as well as radio and social media to promote the Guide. We know that it takes sustained effort over a long time in order to actually change practice.  To that end, the ABA Commission on Law and Aging also plans to distribute the guide to state and local bar associations, as well as to medical and legal partnerships around the country.

Recognizing the critical role the legal education plays in shaping practice, the ABA Commission on Law and Aging will also put the guide into the hands of legal educators to use in elder law clinics and in continuing legal education courses. It’s hard to change practice, but given the reach and prestige of the ABA Commission on Law and Aging, its partner organizations, and its allies including members of the American Society on Aging, this project has great likelihood to shift practice for the better regarding advance directives for older adults.

Scott Bane, JD, MPA, is a recent graduate of CUNY School of Law. He joined the staff of The John A. Hartford Foundation in New York City as a program officer in September 2018. Visit johnahartford.org for more information.

Other Advanced Care Planning Resources from Advance Directives: Counseling Guide for Lawyers:

• PREPARE for Your Care™
• The Conversation Project
•  Consumer's Tool Kit for Health Care Advance Planning
•  The Stanford Letter Project
• CaringInfo

The Ethical Will: Life Is About More Than Your Possessions

Reprinted from:  https://www.nextavenue.org/ethical-will/

Have you considered how to pass on your non-material assets?

By Deborah Quilter
April 11, 2019

When people find out Debby Mycroft helps people write ethical wills, she always gets a predictable response: The Lament.

“They say, ‘Oh, I wish I had a letter from my dad or grandmother or great aunt,’ whoever that person was. I have not come across a single person who has not wanted a letter from that special person,” says Mycroft, founder of Memories Worth Telling.

Unlike legal wills, ethical wills — also known as legacy letters — are not written by lawyers, but by you. They can include life lessons, values, blessings and hopes for the future, apologies to those you fear you may have hurt or gratitude to those you think you have not thanked enough. Traditionally, they were letters written by parents to children, to be read after death.

People who do not have children address them to friends or groups. One of Mycroft’s clients was placed in child protective services when she was quite young because her parents were addicts. “She had a rough upbringing. She intentionally decided not to have children herself. But she wanted to write an ethical will to other foster kids to let them know [they] can survive this,” Mycroft explains.

Why Write an Ethical Will?

Think that your life isn’t important enough to warrant an ethical will? Mycroft disagrees, saying, “You don’t have to be a war hero or a Nobel Peace Prize winner for your story to have value. When people accept awards at the Olympics, they thank the people who had an impact on their life, like Mom or Dad, who was always there to take them to training.”

But there’s an even more important reason you might want to consider a legacy letter. According to Barry K. Baines, author of Ethical Wills: Putting Your Values on Paper, such documents can bring enormous peace of mind.

Baines recalls one dying patient who was bereft because he felt there would be no trace of him when he left. “The first wave would wash away his footprints. That sense of hopelessness and loss was overwhelming,” says Baines. The man rated his suffering at 10 out of 10; after he wrote his ethical will, his suffering reduced to zero.

Don’t wait until you are on your deathbed to do this, Baines warns. As soon as you articulate your values, suddenly you start to live your life more intentionally. Especially if you share it.

Ethical Will: Telling Your Own Story

If you don’t feel capable of writing your legacy letter yourself, you can use an online template, take a workshop, read a book about it or work with a professional writer.

But don’t judge your skills harshly. Baines finds that whether people are educated or not or if their letters are simple or complex, they always have a certain elegance because of the truth they contain. “When the families get one, they just glow,” Baines says, adding, “This is a unique gift that only you can give.”

When you write your letter, don’t just say, “My core values are consideration, gratitude, kindness, simplicity,” advises Mycroft. Tell a story about how you’ve lived these values.

In her own legacy letter, Mycroft told her kids about a temp job she had as a teen. She appeared nicely dressed in a skirt, blouse and heels. When she walked in, the employers gave her a funny look and asked, “Why do you think you are here?”

She explained the agency had sent her out for secretarial work. Then her employers handed her a hard hat and steel-toed shoes. “That’s when I look at them quizzically.”

Turns out they were a plastic-bag manufacturer and she was supposed to sort through damaged goods to salvage the ones that could be sold.

“I was so angry that that agency had sent me out on that job. It was hot and humid in Virginia. I was fuming,” Mycroft says. “When I got home, my parents started grilling me. They said, ‘Did you agree on this job?’” And Mycroft confirmed that she did.

They asked what the contract said. Mycroft replied that the contract was pretty clear. Did she sign the contract, her parents wanted to know?

“Yes, but,” she says she told them. “And my parents said, ‘You signed it; you’re committed to it.’”

Mycroft stuck with the job as promised. “That was my first lesson in integrity, perseverance and diligence,” she recalls. She did what she said she would do. As a postscript, she got fantastic jobs from the agency over the rest of the summer. They knew they could count on her.

What Goes Into the Legacy Letter and What Stays Out

Ethical wills are often likened to letters from the heart, so perhaps the best advice is to literally write a love letter.

Love letters don’t recriminate. They don’t judge. They don’t scold. A love letter is there to show how much someone matters to you.

Criticisms and judgments should be left out, advises Mycroft. It’s okay to include regrets and family secrets, even if they hurt. If worded properly, these could bring the family to a place of acceptance and understanding.

She notes, “Sometimes when those things are hidden for so long it causes a lot of resentment — as in] why didn’t they tell me I was adopted? I wish I had known.”

“Definitely avoid manipulation,” Mycroft advises. “Legacy letters are beautiful expressions of love and encouragement, telling other people what is so fantastic about them. I do not think they should be hands reaching up from the grave slapping you or saying, ‘I told you so.’”

Think about how your letter might be received. Baines worked with a woman who had a very hard life. “Every part of her ethical will was blame and guilt-tripping,” he recalls. While some people can turn around a bad experience and use it is an example of what not to do, this woman could not.

“It almost seemed like she was purposely trying to hurt people,” Baines says. But eventually she realized that and gave up, sparing her family the hurt she would cause them.

Get a Second Opinion

Baines believes writers should show their legacy letter to a trusted friend before passing it on, to avoid inadvertent errors. Your reader might say, “You mentioned your two children, but you only write about one and not the other.” That could be extremely hurtful.

Baines also urges people to share the letters while they’re living. It might be painful, but there’s still potentially an opportunity to mend wounds. After you die, there’s no recourse at all.

What About Videos or Selfie Videos?

Some people make videos or selfies of their ethical wills, but keep in mind that technologies can become outmoded.

Mycroft gave both her children the letter and a video of her reading the letter so they not only have her words, but can also hear her voice.

“I’ve heard of people saving voicemails of people who have passed on,” she says. “Can you imagine saving a voicemail and all it says is ‘Susie, are you there? Can you pick up? Hello?’ If you’re willing to save that message just to hear their voice, how much more powerful would it be to hear your voice reading that letter?”

The Time Is Now

The time to write your spiritual legacy is now. Mycroft provides a case in point about her mother, who knew the family lore and lineage.

“I gave her one of these fill-in-the-blank family history books because I wanted to make sure it was preserved,” says Mycroft. “Five years later, when she had passed away and I went to clean out her office, I found the book. It was completely empty.”

Deborah Quilter is an ergonomics expert, a certified Feldenkrais practitioner, a yoga therapist and the founder of the Balance Project at the Martha Stewart Center for Living at Mount Sinai Hospital in New York. She is also the author of Repetitive Strain Injury: A Computer User's Guide and The Repetitive Strain Injury Recovery Book.