December 15, 2019 Eldercare Discussion

We discussed eldercare & aging issues—including compassionate care, dementia, incontinence, loneliness, end-of-life care, Medicare Advantage Plans and enlightened acceptance of dying.

Aging & Elder Care

–  In discussing the local availability of compassion-based care for older adults, we reviewed some new developments in the science-based Cognitive-based Compassion Training (CBCT) program pioneered by Drepung Loseling Monastery in collaboration with the Emory-Tibet Partnership.  There are now several training and certification opportunities available for nurses and other healthcare workers, chaplains, teachers and youth that are offered by Emory University’s new Center for Contemplative Science and Compassion-Based Ethics (CCSCBE).  The Center also plans to explore new applications or populations who may benefit from learning the core CBCT® concepts and skills.  As growing numbers of caring professionals are trained in CBCT, we should be able to identify those who are willing to support DLM members, their loved ones and friends with their aging and eldercare challenges.

–  Emory Cognitively-Based Compassion Training (CBCT) – a program of the Emory-Tibet Partnership

CBCT® (Cognitively-Based Compassion Training) is a system of contemplative exercises designed to strengthen and sustain compassion.  Practices include training in attentional stability and increased emotional awareness, as well as targeted analytical reflections to understand better one’s relationship with self and others.  The reflective exercises seek critical insights into the way one’s mindsets and attitudes can be shifted to support personal resiliency, to foster an inclusive and more accurate understanding of others, and ultimately to intensify altruistic motivation.  With practice, informed compassion can become a spontaneous response that permeates one’s life.  For additional information and links to related programs, see https://compassion.emory.edu/cbct-compassion-training/index.html

–   A participant noted that families often differ in their hopes and expectations of outcomes for their frail, at-risk or declining loved one.  This is especially true for persons with dementia, because there are different levels of what might be considered as a better outcome; for example, a person might lose their memories of shared family celebrations, but might also forget about past family conflicts and acquire more love, peace or wisdom.

–  A common theme of our recent monthly discussions has been the need to accept the reality of a frail loved one—particularly one with impaired memory—who denies that they have a health or safety problem that could be helped with preventive measures or treatment. 

–  To help us to accept our own eventual demise as well as that of our loved ones, it was noted that our DLM Geshe-las often encourage us to think daily about our unavoidable decline and death and remind us of the wonderful opportunity we have to be born as humans with easy access to a Buddhist Center and highly qualified Buddhist teachers.  Because the time and manner of our deaths is uncertain, they encourage us to study the teachings of the Buddha while we can—especially as presented in the core Lamrin (The Path) teachings and practices as taught by Lama Je Tsongkhapa six centuries ago in Tibet.  The Lamrin guides us step-by-step to understand and renounce suffering, develop compassion and altruism, and achieve enlightenment for the benefit of all others.  See Je Tsongkhapa (WikPedia) https://en.wikipedia.org/wiki/Je_Tsongkhapa.

–  One participant indicated that her parents recently moved from another state to an independent living residence at Delmar Gardens of Gwinnett in Lawrenceville, GA—noting that it also has assisted living and memory care living options, if needed.  See https://delmargardens.com/facilities/delmar-gardens-of-gwinnett-independent/

–  We also discussed the problem of fecal or urinary incontinence and how difficult it can be for the person with the problem as well as their care partners.  An experienced care partner commented that incontinence typically causes those who have it to avoid going outside their residence—especially on trips outside their local community— for fear of an embarrassing accident.  This condition is much more problematical for those who have a memory problem or major activity limitation.   See:

  Bowel Incontinence (NLM Medline Plus) https://medlineplus.gov/bowelincontinence.html

  o  Fecal Incontinence – Diagnosis and Treatment  (Mayo Clinic) 

https://www.mayoclinic.org/diseases-conditions/fecal-incontinence/symptoms-causes/syc-20351397

–  At our November 2018 DLM Eldercare meeting we discussed how a loss of enjoyment or lack of interest in outside activities can be an indication of the often-overlooked conditions of depression or incontinence. These conditions can lead to inactivity and excessive sleeping which in turn can lead to memory loss, additional activity limitations, and other health problems. 

–  For information on Urinary Incontinence, see https://medlineplus.gov/urinaryincontinence.html  

–  For information on Bowel Incontinence, see https://medlineplus.gov/bowelincontinence.html

–  For information on External incontinence devices, see https://medlineplus.gov/ency/article/003974.htm

–  A participant recommended The National Association for Continence as a good resource for current information on incontinence as well as leak-resistant diapers and other devices that might help to mitigate its effects.  Per their website:

Incontinence Education and Support for Patients, Caregivers and professionals

Incontinence, the involuntary loss of urine or fecal matter, is not a condition that anyone should have to “just live with”.  It’s not something you need to accept as you get older, or an inevitable consequence of childbirth or surgery. Incontinence is a treatable medical condition, whether you have occasional light wetness, heavier bladder leakage, bedwetting or bowel issues.  No matter what type or degree of incontinence you might be experiencing, help is available. This is the place you should be. https://www.nafc.org/

–  We also discussed the very common and serious problem of loneliness for those who age in social isolation.   Per WikiPedia (https://en.wikipedia.org/wiki/Loneliness):

    Loneliness is a complex and usually unpleasant emotional response to isolation.  Loneliness typically includes anxious feelings about a lack of connection or communication with other beings, both in the present and extending into the future.  As such, loneliness can be felt even when surrounded by other people and one who feels lonely, is lonely. The causes of loneliness are varied and include social, mental, emotional, and physical factors.

    Research has shown that loneliness is prevalent throughout society, including people in marriages, relationships, families, veterans, and those with successful careers.  It has been a long explored theme in the literature of human beings since Classical antiquity. Loneliness has also been described as social pain—a psychological mechanism meant to motivate an individual to seek social connections.  

…… Mental Health – Older people…also struggle with feelings of severe loneliness which lead them to considering or acting outs on thoughts of suicide. Retirement, poor health, loss of a significant other or other family or friends, all contribute to loneliness.  The isolation leads to loneliness; the loneliness leads to suicidal thoughts or actions.  Suicides caused by loneliness in seniors can sometime be difficult to identify.  Often they don’t have anyone to disclose their feelings of loneliness and the despair it brings.  They will stop eating, alter the doses of medications they should take, choose not to treat an illness leading as a way to help expedite death so they don’t have to deal with feeling lonely. 

Physical Health – Chronic loneliness can be a serious, life-threatening health condition.  It has been found to be associated with an increased risk of stroke and cardiovascular disease.  Loneliness shows an increased incidence of high blood pressure, high cholesterol, and obesity.

    Loneliness is shown to increase the concentration of cortisol levels in the body.  Prolonged, high cortisol levels can cause anxiety, depression, digestive problems, heart disease, sleep problems, and weight gain.

    ″Loneliness has been associated with impaired cellular immunity as reflected in lower natural killer (NK) cell activity and higher antibody titers to the Epstein Barr Virus and human herpes viruses”.  Because of impaired cellular immunity, loneliness among young adults shows vaccines, like the flu vaccine, to be less effective. Data from studies on loneliness and HIV positive men suggests loneliness increases disease progression.

Treatment – There are many different ways used to treat loneliness, social isolation, and clinical depression….

–  Some references on loneliness in older persons:

o  Nicolas Nicholson.  A Review of Social Isolation: An Important but Underassessed Condition

in Older Adults; The Journal of Primary Prevention, June 2012, Volume 33, Issue 2, pp 137-152. 

https://www.ncbi.nlm.nih.gov/pubmed/22766606

o  Perissinotto CM, Stijacic Cenzer I, Covinsky KE.  Loneliness in older persons: a predictor of functional decline and death.  Arch Intern Med. 2012 Jul 23;172(14):1078-83.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4383762/

o  Paige Minemyer.  Loneliness has become a big target for Medicare Advantage insurers.  Here’s what they’re doing about it. Fiercehealthcare, Nov 15, 2019 https://www.fiercehealthcare.com/payer/why-medicare-advantage-insurers-are-investing-heavily-programs-targeting-social-isolation

End-of-Life Care

–  At this meeting we once again discussed the value of having an advance directive for health care as well as advance planning for hospice and palliative care at the end of life.  Having a plan for what comes immediately after a loved one’s death—including funeral and burial arrangements can also be very beneficial.

–  Because there are many unfortunate stories of funeral companies that sell bereaved family members more products and services than they need or want, it can be very advantageous to investigate these options before the need arises.  All DLM members, who have not already paid in advance for their funeral, are strongly encouraged to join the Memorial Society of Georgia (MSOG) @ https://memorialsocietyofgeorgia.org/   MSOG is a nonprofit group based in Atlanta that offers heavily-discounted basic burials and cremations to anyone who joins for a lifetime membership fee of $35).  Joining MSOG for yourself or another person and selecting one of the preferred providers can save you several thousand dollars for a funeral.

NOTE:  See also their FAQS https://memorialsocietyofgeorgia.org/overview/faq/

–  An attendee described his appreciation for how well his older loved ones have been served by the Decatur office of JenCare Senior Medical Center, a relatively new Medicare Advantage Plan.  As of January 2020, it has clinics in six communities in five states—including four clinics in the greater Atlanta area.  In addition to comprehensive healthcare they’ve provided transportation assistance to medical appointments and home visits by a paramedic for medical emergencies.  He said that this was an especially good option for low-income people. The Decatur office uses Heartland Hospice as their hospice provider.   

JenCare Senior Medical Center https://www.jencaremed.com/about-us

–  Medicare Advantage Plans as described on January 15, 2020 at Medicare.gov, a federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services:

Medicare Advantage Plans are a type of Medicare health plan offered by a private company that contracts with Medicare to provide all your Part A and Part B benefits.  Most Medicare Advantage Plans also offer prescription drug coverage. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan.  Your Medicare services aren’t paid for by Original Medicare. Below are the most common types of Medicare Advantage Plans.

o  Health Maintenance Organization (HMO) Plans 

o  Preferred Provider Organization (PPO) Plans

o  Private Fee-for-Service (PFFS) Plans

o  Special Needs Plans (SNPs)

Other less common types of Medicare Advantage Plans that may be available include HMO Point of Service (HMOPOS) Plans and a Medicare Medical Savings Account (MSA) Plan. 

https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans

Other Matters

–  As more of our monthly reports are being added to our new Buddhist Eldercare blog, tell your family, friends, neighbors, co-workers and others who might benefit about it and encourage them to enter their email address on its homepage so they can search past content and get future monthly reports and other new items as they are posted.   https://BuddhistEldercare.com

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