CREATING AN ADVANCE DIRECTIVE
HEALTH
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It is a good idea to speak with your loved one’s doctor about any potential future health risks. Including their physician also ensures that everyone is on the same page for long-term care decisions. It is worth noting that talking with the doctor about advance care planning during a wellness visit is covered by Medicare.
The most important things to take into consideration before making any specific decisions are your loved one’s personal values.
How do we want to be treated when we get to the end of our lives? What decisions would we like made on our behalf if we are unable to make them? Life is uncertain. It’s important to have a plan in place.
An Advance Directive is a document to let family and medical professionals know your desires should something happen. Work with your loved one to get these documents drafted while they are still able to speak clearly about their choices. Work together, instead of assigning it to them as a task, to ensure that you understand clearly what they want.
As a part of the Advance Directive, your loved one will often appoint someone as their healthcare proxy. This is the person that, if your older adult cannot make a medical decision themselves, will make the decision in accordance with their wishes. If you do not feel like you agree with the decisions that they are making in the Advance Directive, steer them to choose someone who might be more in line with their values. If there is a trusted medical professional in your family, perhaps this person might be better suited for this role.
Source: Death with Dignity
Where to Draft Your Advance Directive
The laws governing how a state will honor your Advance Directive vary from state to state. Often, one state will not honor an Advance Directive created in another state. If your loved one travels or resides in several states, it is recommended that you create an Advance Directive in each location.
Source: Death with Dignity
Some questions to consider:
- Is it important to them to be able to be mobile, so paralysis or coma may not be acceptable?
- Do they need the ability to speak to their loved ones or do they feel they could communicate in other ways should speech be impaired?
- Would they want pain medications at the end of life if it meant that they were drowsy and lethargic all the time?
- If in a facility, is it important to them that their pets and grandchildren can visit or be with them?
Source: National Institute on Aging and The Conversation Project – Institute for Healthcare Improvement
Additional Resources:
https://www.clearcareonline.com
https://deathwithdignity.org/learn/end-of-life-resources/
https://www.nia.nih.gov/health/advance-care-planning-health-care-directives
https://theconversationproject.org/
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Some of the Many Things to Think About for an Advance Directive:
- Are they open to the use of CPR?
- Are they willing to be put on a ventilator or other life sustaining mechanical apparatus? If so, for how long?
- What level of feeding/hydration is acceptable?
- What level of comfort care and pain medications are acceptable?
- Have they filled out an organ donation card?
- Do they want to live their last days in a hospital, in hospice, or at home?
- What if they require blood transfusions or organ transplants?
Many organizations offer online templates for Advance Care Directives that can be used as a starting point. Many hospitals will require the directives to be notarized.
Source: National Institute on Aging and The Conversation Project – Institute for Healthcare Improvement
What is a DNR (Do Not Resuscitate) Order?
A DNR order is a document that indicates to emergency and medical responders that the person does not want CPR or other life-restoring measures should their heart or breathing stop. In the moment, it may be hard to honor this wish. It is easier to have a clear directive and a healthcare proxy willing to make this decision on their behalf.
If your senior has indicated that they would like to donate their organs, they will need to note that the desire to donate supersedes the DNR since there may be a need to keep the heart beating until the organs can be taken for donation.
Source: National Institute on Aging
Additional Resources:
https://www.clearcareonline.com
https://www.nia.nih.gov/health/advance-care-planning-health-care-directives
https://theconversationproject.org/
Adapted from the original PDF document: “0721-MM-AdvanceDirective.pdf”
ACTIVITIES FOR SENIORS
ACTIVITIES
Children aren’t the only ones who pipe up with “I’m bored…”
- Reading audiobooks
- Cooking and baking
ACTIVITIES FOR SENIORS
ACTIVITIES
Some ideas for activities outside…
- Museums
- Senior centers
Volunteer
If your loved one has been active…
- Soup kitchens
- Animal shelters
Benefits
Research shows…
- Are more disease resistant
- Have a longer lifespan
TELEVISION AND SENIORS
ACTIVITIES
It might surprise you to learn that older adults watch more television than younger people do. Watching TV comprises most of the leisure time for adults aged 70 to 105 years old. Television can be an avenue to learning new things, connecting with the world, creating a diversion, and providing some light entertainment. However, it can also supplant physical or recreational activities and real-world interactions.
Pluses and Minuses
If you are mindful, there are certainly benefits to TV for our older adults. As they become less able to go out to movies, concerts, or spectator sports, TV can fill this void. While some sitcoms and light viewing can help to relieve depression, sometimes the news or similar shows can make a depressed mood worse. It is important to pay attention to what our loved ones are watching and find a suitable balance.
The most notable down-side to excessive TV watching is some decrease in mobility. In general, a sedentary lifestyle choice can be detrimental to bone health, cellular/immunity function, and cardiovascular efficiency. Excessive TV use has been linked with a greater risk for Type 2 diabetes, obesity, lower life satisfaction, and an increased risk for dementia. Excessive TV viewing has also been linked with cognitive decline. This can be because viewers are not spending as much time doing things that can keep their minds sharp such as reading, playing board games, talking with friends and relatives, or working on puzzles. If they eagerly engage in conversation with you during a show, it can be an indication to you that they are simply using the TV to pass time and would prefer another outlet. It can help both you as the caregiver and your loved one to spark conversations based on the shows they are watching. Use open ended questions like “What decision would you have made in that situation?” or “When was the last time you did x activity?” or “Who does that character remind you of?”. You can also use a board game or book that is depicted in a show as a cue to suggest playing that game or start reading that book with your loved one. Source Medical News Today and National Institutes of Health
If TV has become an outlet for your loved one, try to ensure that they are also getting plenty of exercise and movement during the rest of the day. It can be helpful to set up a habit of having them stand up and stretching during commercials or take a walk to another room between shows. Incorporate exercises that can be done from a seated position into their day. On a nice day, suggest a quick walk outside or to a nearby window to watch “reality TV.”
TELEVISION AND SENIORS
What Are They Watching?
If your loved one is spending more than four hours a day watching TV, it is possible that they are simply using it to pass time, rather than to provide practical information or relaxation. If they cannot tell you what they just watched, it might be time to find an activity that is more brain engaging for them. If they insist on using the TV as an activity, perhaps ensure that their programming selection includes some of the following to help keep their spirits up:
- Light-hearted sitcoms
- Uplifting dramas
- Educational programs
- Sports or reality TV
- Movies from when they were young adults
Source: Center for Media Literacy
Where Are They Watching?
While cable TV and network programming continue to be the most accessible, more viewers are turning to streaming, where they have control of what they watch and when. These can be accessed by anyone with an internet connection and the correct hardware. If your loved one has a smart TV, most streaming services can be accessed directly through the TV interface. If you set this up for them, make sure to check the “remember me” box in the setup screen so that your loved one only needs to turn the TV on to watch their favorite shows. If your older adult does not have a smart TV, they will need a separate device to help manage the streaming services. Source Medical Alert Systems
Happiness Quotient
A new study by the University of Maryland concludes that unhappy people watch more TV, while people who describe themselves as very happy spend more time reading and socializing. Analyzing 30-years’ worth of data, the Maryland researchers report that spending time watching television may contribute to viewers’ happiness in the moment, with less positive effects in the long run. Source: Phys.org
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