Depression is common in older adults.

It’s long been known that brisk exercise can help reduce depression. But it turns out that exercise doesn’t have to be vigorous to make a difference. Even mild exercise can be effective. This is great news, especially since depression zaps energy and initiative. Researchers have found that

• completing an exercise task yields a sense of achievement
• achievement boosts our sense of personal power
• increased self-confidence reduces feelings of depression and fatigue

In this case, the purpose of exercise isn’t to increase heart rate. It’s to accomplish an activity-related goal. Because when we’ve achieved something, we talk more kindly to ourselves about ourselves. As our self-talk gets more positive, that lifts our mood.

Help your relative create an activity program that suits their physical capacity. Ideally, something that can be done easily three to five times a week, eventually building up to a total of 30 minutes over the course of the day.

It doesn’t have to be strenuous: Simple stretches. Lifting light weights. An easy stroll around the block. If they are up for something more engaging—a class or walking with a buddy—all the better. They are more likely to stick with it if they have a pal. And the social contact will also help lift their depression.

Check in with the doctor first to be sure there are no foreseeable problems.

Is the person you care for depressed?
As the San Francisco experts in family caregiving, we at Compassionate Community Care know how hard it can be to keep your spirits up when you are caring for someone who is feeling down most of the time. You don’t have to do this alone. Give us a call at (415) 921-5038.

No one likes to dwell on the possibility of disaster. But we all need to prepare for one, just in case. Help your relatives gear up for safety. Whether you live across town or across the nation, the action items are the same.

Prepare to stay in contact. In case of a disaster, how will you know your relatives are safe?

• Because local phone service may be sketchy, choose an out-of-town contact. Also identify the address and phone number of a potential gathering place. This might be a friend’s house or a church, school, or store within walking distance. Ask family members to leave a note if they are evacuating. Have it include date, time, and plan. OR consider registering for the Red Cross Safe and Well program where family members can post messages for each other.
• Program “in case of emergency” (ICE) information into contacts on cell phones. This helps emergency personnel know who to phone.
• Teach family members to text message. Text messaging is often possible even when phone service is disrupted.

Assemble emergency supplies.

• Have a “go bag” suitcase packed with clothing, a pair of comfortable shoes, personal hygiene items, and prescription medicine in case there is little time before an evacuation.
  • Regularly replace medications so they don’t expire.
  • In a waterproof container (e.g., a “zip-lock” plastic bag), keep copies of health insurance cards and an up-to-date list of prescriptions, doctors, and any special needs. Also, family identification documents (things you might otherwise keep in a file at home: Passport, marriage certificates, vaccination records …).
  • Include a list of important phone numbers (neighbors and family) in case the phone runs out of power.
  • Pack an extra phone charger.
  • Include a supply of cash.
  • Consider packing an extra set of prescription eyeglasses, readers, or contact lens (and solution). Batteries for hearing aids.
  • Include a special pillow, blanket, or other comforting item if your loved one has dementia. This can help keep them calm in a stressful situation away from home.
• Prepare a “stay box” using a few easy-to-carry waterproof containers with at least a three-day supply of necessities in case services are down but evacuation is not necessary.
  • One gallon of water per person per day. Ideally, buy water containers and keep them sealed until needed. If you must prepare your own, use water storage safety precautions.
  • First aid kit, over-the-counter medicines (pain and fever relievers, antidiarrhea medicines, antacids, laxatives, antihistamines), extra masks in case of dust, smoke, or the eventual need to shelter indoors with large groups.
  • A whistle to call for help.
  • Flashlight and a battery-powered or hand-crank radio. Check or replace batteries once every six months. Use the time changes in fall and spring as a reminder.
  • Matches, candles, battery- or solar-powered lamp.
  • Food, can opener, mess kits, or plates and spoons. Paper towels. Rotate in new canned goods if their expiration date is near.
  • Bedding or sleeping bags.
  • Moist towelettes, toilet paper, garbage bags, and plastic ties (for personal sanitation).
  • Plastic sheeting and duct tape for makeshift shelter if needed. Or a pop-up tent. (This is handy for helping people with dementia stay calm if there is too much stimulation or chaos around them.)
  • Wrenches to shut off gas and water.
• For those who are medically challenged
  • Have your relative wear an identifying bracelet if they have a disability or significant medical condition.
  • If your loved one has trouble getting around, keep an extra cane or walker in the car or with the stay box.
  • If your loved one has assistive devices that require power (for example, an electric wheelchair), talk to the doctor or device provider about options when the power is out. Contact the local utility company to see if the person you care for can be put on a priority power restoration list.
  • Store instructions for assistive devices in the go bag with other important documents. Note the serial number of each device in case the provider needs to be contacted.
  • Create a list of the nearest medical facilities, hospitals, and transportation options. If your relative is on dialysis, locate alternate centers that are somewhat close but far enough away that they may not be affected by a local disaster.
  • Consider enrolling in the Medicare Blue Button program so your relative can share their last three years of medical history with doctors they haven’t seen before. (This is useful in case of a need to evacuate.) There’s also a Veteran’s Blue Button program.

Get tech-ready

• Sign up for alerts from local government or stay up to date via their social media channels.
• Consider downloading the FEMA app (Federal Emergency Management Agency) to stay informed.
• Get preparedness tips by texting PREPARE to 43362.
• Find open shelters by texting SHELTER and the zip code to 43362.
• Keep a portable phone charger in the car, and ideally a back-up energy supply.
• Store copies of important documents (insurance policies, medical records, identification documents) in the cloud or on a password-protected “thumb drive.”
• Sign up for direct deposit and online banking so funds can be accessed remotely in case of an evacuation.

Create a local support network

• Give at least one trusted neighbor a key to the house or apartment.
• Find a neighbor willing to be a “buddy” and show them where to find the emergency supply “stay box” you created.
• Show them how to operate any special equipment, such as oxygen or a wheelchair. Put written instructions in the stay box.
• Contact the city or county emergency department and find out if you can register your loved one to receive any special disaster check-ins offered to solo, disabled, or medically challenged seniors. If you aren’t sure which agency to call, start with the fire department or police department.

Are your loved ones prepared?
As the San Francisco experts in family caregiving, we at Compassionate Community Care recognize that in the event of a disaster, you will be pulled in many directions. Your relatives may need you while you also are needing to gather those in your immediate household. Take some time to develop a plan. Need help? Give us a call at (415) 921-5038.

If your loved one has balance problems, the culprit may be in the medicine. Many common medicines have side effects that can impair balance and lead to a fall. Over 40% of persons age 65 and older take five medications or more. This increases the chance that at least one of the drugs has side effects of dizziness, blurry vision, drowsiness, or muscle weakness. Or affects balance sensors in the inner ear. More medications also create the potential for a drug-to-drug interaction that leads to a fall.

Medicines known to increase the risk of falls include

• allergy drugs (antihistamines)
• antidepressants and antianxiety drugs
• blood pressure and heart drugs
• diabetes drugs
• pain drugs
• sleep drugs

If your loved one has fallen or seems unstable on their feet, ask the doctor or a pharmacist for a medication review. They may suggest some of the following strategies:

• Reduce the number of drugs. Sometimes a specialist orders a drug without knowing that another doctor has ordered a similar drug.
• Lower the dose. Ask the doctor or pharmacist for their recommendation.
• Change medication. There may be another drug that will accomplish the same treatment but does not have side effects that could cause a fall.
• Altering the schedule. By changing when drugs are taken, you may be able to reduce the side effects or risk.
• Nonpharmaceutical approaches. Relaxation techniques and good sleep hygiene habits might relieve the need for sleep medicine. More exercise and weight reduction could lower the need for insulin.

Do NOT make these decisions on your own. It is important to have the doctor or a pharmacist review all medications and over-the-counter drugs, because they will know which ones to target and the safest way to make changes.

Are you worried about a possible fall?
If you think your loved one is at risk, best to be proactive. As the San Francisco experts in family caregiving, we at Compassionate Community Care observe that a fall often results in the need for more care and a loss of independence. Let us help. Give us a call at (415) 921-5038.

Has your parent remarried? If so, you may be sharing the caregiving with a person you don’t know very well. Biological families often encounter tensions when it comes to eldercare. Add a stepparent and the challenges can grow exponentially.

At its best. A stepparent can be a wonderful partner in care. Their daily companionship and support may be very meaningful to your parent. Plus, it’s easier to accept assistance with intimate tasks from a partner than from a child. Ask them how you might be of help. It may be running errands, talking with the doctor, communicating with other siblings, paying for extra help, or giving your stepparent a break now and then. Celebrate victories with them: A successful surgery, a clear cancer report. And don’t forget to thank your stepparent regularly for all they do.

Sometimes it’s complicated. Many adult children believe that their stepparent is standing between them and their mom/dad. Or them and the doctor. Perhaps. Or it may be that the spouse is simply overwhelmed or distressed. They could be waiting until there’s a diagnosis and plan in place to tell you there’s a problem. Remember, a health crisis is a crisis in their marriage. They may not have discussed beforehand how they would handle medical emergencies or serious illness. Until you know otherwise, assume everyone is doing the best they can.

Respect roles. Become allies. If your parent named you as health care decision maker in their advance directive, plan ahead with your parent and stepparent about when you would like to be informed of a problem and how the three of you can work together. If at some point you have a “better” treatment path to suggest, consider: Will it require more work for one or both of them? Can you ease the burden? If not, you may need to bow to what your parent and stepparent feel they can handle. If your stepparent is the health care power of attorney, ask for permission before trying to speak with the doctor. Ideally, manage your concerns in a way that avoids creating strife in the marriage, as that truly doesn’t benefit your parent. Respect the decisions they have made and find common cause to cooperate with your stepparent to make your mutual loved one’s recovery or final days as positive and stress free as possible.

Are you close with your parent’s spouse?
In a health care emergency, whether you are close or not, you will need to work together. As the San Francisco experts in family caregiving, we at Compassionate Community Care have seen this become an opportunity for greater cooperation. But not always. Do you need help? Give us a call at (415) 921-5038.

Medicare pays for many screening exams, and even counseling sessions, to help nip common illnesses in the bud. Screening tests are designed to identify problems before symptoms emerge. They are usually for people who are considered to be “at risk” for getting a specific disease. Here are some of the most common noncancer preventive services that Medicare covers. Ask the doctor if your loved one should be tested.

• Bone density test every two years. A low-level x-ray can determine how brittle your loved one’s bones have become. Although women are at higher risk, men can also develop osteoporosis.
• Diabetes screening once or twice a year. This fasting blood test measures glucose to see how well the body is processing sugars. If your relative is at risk for diabetes, ask about Medicare’s 16-week Diabetes Prevention Program.
• Depression screening once a year. Typically, this involves a physical exam and a series of questions. Sometimes blood work is ordered to make sure the depression isn’t caused by something else, like a thyroid disorder. 
• Alcohol misuse screening once a year. The doctor may ask questions about alcohol use. If it appears there is a problem, Medicare may pay for some counseling.
• Glaucoma screening once a year. Glaucoma is a leading cause of blindness among older adults. An ophthalmologist (doctor who specializes in eyes) conducts glaucoma tests. One test involves dilating the eyes so they can be examined with special lights and magnifying equipment. Another test blows a puff of air into each eye to measure the pressure inside. It doesn’t hurt. It’s just a bit surprising.
• Cardiovascular screening once every five years. Fasting blood work tests for high levels of cholesterol and triglycerides. Yearly tests are available if the doctor makes a diagnosis of heart disease. This includes blood pressure checks and dietary counseling.

Is your loved one up to date on screenings?
Early detection is key to slowing the progress of many conditions. As the San Francisco experts in family caregiving, we at Compassionate Community Care know it often falls to you, the family caregiver, to track these tests. We hope this article makes that easier. Need help with eldercare? Give us a call (415) 921-5038.

Good communication requires both speaking and listening. Oddly enough, if you make a specific effort to listen, it can open doors. Once “heard,” the other person may be more willing to hear your point of view.

Deep listening is more difficult than it sounds. It’s not passive. It requires concentration. It also takes humility and empathy. Here are some tips:

Consider the setting

• Schedule your talk at an unhurried time.
• Turn off the TV, music, and cell phone.
• Make sure the seating and room temperature are comfortable.

Observe yourself. Are you

• distracted by physical needs or strong emotions? If you are hungry, upset, or tired, you won’t be able to concentrate on what the other person is saying. Consider talking after a meal or in the morning when you’ve had a chance to rest.
• bored? If you “already know what is going to be said,” it’s probably best to push your internal reset button. Be open to the possibility that things might not be completely as you expect them to be.
• unable to concentrate? If you find your mind wandering, try mentally repeating their words. It will help you focus and fully take in what the speaker means.
• preparing your replies? If you find you are concentrating on your response, try listening attentively and then waiting one full second after the speaker finishes before you begin talking. After completely hearing what was said, you can thoughtfully compose your reply.

Show empathy. Often the best way to get something is to give it yourself.

• Nod and encourage. “Yes,” “uh huh,” smiles, and open body language cue the speaker that you are interested and paying attention.
• Ask questions. “Could you tell me more?” or “An example would help me understand better.”
• Check in and repeat back. “I’m understanding that what you’d like most is . . .” or “So, you are feeling frustrated that . . .” Paraphrasing can ease defensiveness in the speaker, making him or her more open to hearing what you have to say.

Having difficulty with family members?
As the San Francisco experts in family caregiving, we at Compassionate Community Care are very familiar with this problem. It happens in many families. Old baggage and current stresses make for difficult communications. Let us help. Give us a call at (415) 921-5038.

For a teen, a relative’s dementia can turn a close relationship into one that’s now awkward, confusing, and embarrassing. And creates feelings of guilt.

Teens and tweens benefit from learning the basics of grandma or grandpa’s condition, such as “There are diseases of the brain that change memory and thinking. We should expect that [grandparent] will have repetitive questions, emotional outbursts, and may even forget our names.” Reassure your teen that these behaviors are a result of the disease. They are not intentional. Also let your teen know that dementia is not contagious.

Support the relationship with activities focused on what your loved one can still do. Explain to your teen that memories of the distant past are the strongest. This is a great opportunity to learn about family history. Engaging the present also works well, especially activities using all the senses (sight, taste, smell, touch, and hearing). Calm activities are more appropriate than fast-paced stimulation. Steer clear of games involving strategy.

• Music is almost always a hit. Try putting on music from your relative’s teen years. Consider dancing. (Remember the twist?)
• Try a walk in nature. Bring attention to the sights, sounds, and smells. Take time to pause and appreciate each sense. (In Japan it’s called “forest bathing.”)
• Visit with animals. Go to the dog park and watch the antics. Or have your teen bring over a favorite pet. Focusing on the animal together can alleviate awkward silences.
• Bring lotion and nail polish for a manicure. Your teen might really enjoy giving grandma a mani-pedi. Grandpa might like a hand massage.
• Watch old movies together. Is your teen a film aficionado? Perhaps you know some favorite classics from your loved one’s youth they could watch.
• Interview your relative. Consider making a scrapbook or memoir so your relative can pass along family stories. Plus, it’s a great gift to the family.

Share emotions. Acknowledge how sad you are to see your loved one slipping away. Also, that you are sometimes angry or frustrated by things they do. Describe what helps you cope with your feelings. Let your teen know they can be frank with you, including if they are embarrassed or uncomfortable and don’t want to visit. Let them have space if they need it. No judgments. Pushing them could backfire, and your loved one will feel it.

Is your teen confused by your loved one?
It can be heartbreaking to see what once was a close relationship become one that generates discomfort, embarrassment, or even rejection. As the San Francisco experts in family caregiving, we at Compassionate Community Care have noticed that teens have a particularly difficult time understanding dementia. It requires a maturity that is often beyond their abilities. That doesn’t make it easy for you, though, feeling caught in the middle. You don’t have to go through this alone. Give us a call at (415) 921-5038.

After you have scoured the Internet to help your relative find a potential new doctor—someone on their plan and with no obvious red flags—it’s time to get more specific. The doctor’s website may provide some descriptive information, but most likely, you’ll want a conversation.

Start by calling the doctor’s office to ask business and insurance questions. (Reserve your precious time with the doctor for questions focused on the doctor–patient relationship.)

• Insurance. Does the doctor “accept” Medicare? (This means they will not charge you more than Medicare allows.)
• Office hours. Does the doctor work Monday–Friday? If not, which days and what hours? Who would see your loved one if the doctor wasn’t in? When is the office open for phone calls?
• Appointments. What is the typical appointment length? Can appointments be made online? How long does it take to get an appointment, generally? What about emergency appointments?
• Lab results. Can these be accessed online? Will the doctor call, or a nurse?
• Telehealth. Do they do remote visits? What’s the procedure?
• Communication. Is email or text available? If by phone, when does the doctor return calls? How would they prefer to communicate with you, the family caregiver?

Ask if your loved one can book a 10-minute get-to-know-you visit with the doctor. Suggested interview questions:

• Why did you decide to become a doctor? What do you like best about practicing medicine?
• How would you describe the doctor–patient relationship? If we wanted to be your favorite patient, what would we do or not do?
• How do you work with family caregivers? How can I (family member) best be of service?
• When are you planning to retire? Any thoughts about how that transition will be handled?

Need help navigating the medical system?
It’s not easy! Give us a call at (415) 921-5038. As the San Francisco experts in family caregiving, we at Compassionate Community Care understand how confusing it can be. Let us help.

For most family caregivers, frustration and guilt are common, as is anxiety and resentment. These feelings are normal and reasonable under the circumstances. It’s not realistic to eliminate negative emotions. Caring for an ailing family member IS emotionally taxing, especially in the case of memory loss. But sometimes the negativity can feed on itself.

You can avoid amplifying a downer mood. According to stress and coping research, you can reduce your distress by concentrating on the ultra-present moment, the here and now.

To interrupt the cycle

• observe yourself. Practice noticing your thoughts and feelings. Get curious about your emotions. Explore them objectively, as though you were outside yourself. Your thoughts and feelings aren’t “you,” they are one part of your experience.
• identify your thoughts. We increase our own suffering when we allow ourselves to get stuck in “shoulda, woulda, coulda” thinking. Those “shoulds” and “if onlys” try to rewrite the past. They are a springboard to anger and depression. The “I wants” and “what ifs” focus on the future. They tend to prompt anxiety.
• acknowledge your negative feelings. None of them is wrong. Don’t judge them. They are temporary and will subside (as long as you don’t feed them!).
• accept what is. Life is a series of moments. This one may not be your favorite. But what’s happening right now is a done deal. If you simply allow it and don’t fight it in your mind, you’ll be that much less stressed.
• focus on the present. Stay out of the past and future in your thinking. Take a few deep breaths. Shift your attention to create room for something positive right now. Think of something that engages one of your senses: The taste of your coffee, the color of the sky, or the music on the radio, for example.

Repeat as needed to refresh your outlook!

Is caregiving dragging you down?
You are not alone! As the San Francisco experts in family caregiving, we at Compassionate Community Care work with countless families struggling with the frustrations of providing care for an aging loved one. We can help. Give us a call (415) 921-5038.

Even pre-COVID, many 90-year-olds adamantly refused to go to a senior center, saying they didn’t want to be around “all those old people.” (!)

Does this sound like your loved one?

Admittedly, the senior centers of the past tended to focus on bingo and crafts. These activities are of limited interest to the newest generation of older adults.

Happily, senior centers have been updating. Bingo and crafts are still there. But the upswing in technology use during COVID catapulted many centers into the 21st century. They had to update their delivery platforms so older adults could participate from a distance. They also revamped their offerings to appeal to the “younger old.”

• Relevant classes. These days you are likely to find Beginning Smartphone, Cyber Safety, and Zoom 101. Also, health and fitness classes such as yoga and tai chi. Zumba, a Latin-inspired dance-exercise, is a popular cardio workout. There are classes to stretch the mind—learn a new language, watch a TED talk and discuss the topic. Or take up a hobby such as photography, gardening, or painting. Some centers are hosting intergenerational activities for teens and seniors. Ever been to a team cake decorating contest?
• Transportation. Many senior centers sponsor field trips. Some to scenic places, others to the theater or music hall. They do the driving! This makes fun outings possible again for isolated individuals or those who are no longer driving. Also common are free driver programs. They help older adults get to medical appointments or go food shopping.
• Coffee, tea, and food! Some centers have opened cafés for coffee or tea, hoping to entice reticent seniors through the door. Another attraction is a low-cost or free weekday lunch. And some even feature “pop-up chef days.”
• Expert help. Medicare and insurance counseling are frequently available. So is help filing with the IRS at tax time.
• Volunteer opportunities. Many classes and programs are led by seniors. Your relative might enjoy pitching in as a helper.

If the person you care for has resisted the senior center, propose having a coffee if there’s a café. Or sign up for a field trip to the theater and go together. These are low-commitment ways to let them get a fresh sense of the center and overcome any outdated impressions.

Concerned about a loved one’s isolation?
COVID brought awareness of its hazards front and center. We at Compassionate Community Care have been impressed at the many ways senior centers stepped up to the plate. As the San Francisco expert in family caregiving, we encourage you to check out their new offerings. You (and your loved one) might be happily surprised. If isolation is a worry, give us a call at (415) 921-5038.