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You are here: Home / How to move forward after the one you cared for dies?

Medicine Has Gone to the Dogs!

November 26, 2019 by Andrea Hikel Leave a Comment

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The Mayo Clinic will let you know right quick that medicine is quite literally going to the dogs—and for good reason! Animal-assisted therapies continue to gain traction as researchers learn that recovery is faster and more fun in the presence of animals. Retirement communities have grown to rely on this non-pharmacological approach for treating an increasing number of health conditions to include anxiety, depression, cancer and heart disease.

The retirement communities of today are full of residents that grew up on a farm. What better way to make a place feel like home than to bring pets into residences? On any given day, you can find several furry (or feathered) friends visiting residents throughout Lutheran Sunset Ministries.

Rainbow Retirement Community, our independent living neighborhood, houses a number of pets living alongside their owners. After all, they’re part of the family. Heckmann Assisted Living houses Shelly, the shepherd mix. Shelly is relatively new and has been a big hit! And it’s safe to say that with very little persuasion, Sunset Home has bought completely in to the idea of pet therapy. Juliette and Fowler, the labradoodles, can be found making their rounds throughout the different neighborhoods on most days. The Sales Family Hope Center, Sunset’s secured neighborhood, has a live-in dog named Bruno. He’s a big ol’ black and brown teddy bear. Additionally, a finch aviary and a large fish aquarium provide visual stimuli in the Hope Center. On most days, we are also joined by two employee-owned Yorkshire Terriers (Diva and Paublo) to ensure additional smiles are created for the day. Each year during the spring or fall, Sunset Home welcomes day-old baby chicks to live with us for a few weeks. Without fail, the topics for those few weeks include, “Do you think they’re big enough to fry yet?,” and, “I think this one and this one are roosters, but I’m pretty sure those 3 over there are hens.” Resident-led stories follow about the kinds of chickens the different families raised over the years. Sitting back and watching, one can literally see blood pressures drop and frowns turn to smiles as residents interact with the animals. There’s something about running your fingers through a dog’s coat when you’re keyed up and stressed out that seems to send a sense of calmness over a person.

I’ll let you in on a little secret— soon, Sunset Home will be adding some unique, feathered friends to the mix for a little while. Our plans are to start rotating some variety throughout the neighborhoods for folks to enjoy.

The field of medicine in evolving rapidly—practitioners and operators are constantly looking for alternative treatment options. While medication is inevitable in some circumstances, the health care community is learning that more holistic approaches, such as pet therapy, carry far fewer negative side effects. We are witnessing firsthand the positive impact animals are having on so many lives at Lutheran Sunset Ministries.

Stop by for a visit—we’ll let Juliette and Fowler show you which rooms have the best snacks.

Article by Sunset Home Administrator Lance Allen, a program of Lutheran Sunset Ministries.

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Death and Taxes

November 7, 2019 by Andrea Hikel Leave a Comment

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Article by Hospice Sunset Administrator Jennifer Speer, a program of Lutheran Sunset Ministries.

I know you‘ve all heard the old cliché, nothing is guaranteed in life except death and taxes. Most of us plan to an extent for our taxes every year. Whether it is coming up with a plan to pay them or planning what we are going to do with our refunds, we plan. If you think about it, we plan for almost everything in our lives. We make plans for college; we make wedding plans; we plan for vacations; when to start a family; we plan what we are making for dinner; what we are going to do for the weekend; we make plans for retirement. If death is as much a guarantee as taxes in life, why don’t we plan for that?

Do we not plan for our deaths because it isn’t fun to think about and plan like weddings, college or vacations? Taxes aren’t fun, but they come around every year whether we are ready or not. As a society, we need to change the concept of death. It only comes around one time for us. That means we have one chance at getting it right. I know that sounds odd to think about getting death right, but let me tell you it is the truth. If we don’t start planning for our deaths and share our wishes with our families, the act of dying can be horrific for us and our families.

Death is a natural part of life and is someday coming for all of us. I used to be afraid of death and dying. Not that I didn’t know where I was going, but the whole idea of dying scared me. Now that I have worked in Hospice, it is not the idea of death that scares me, it’s the process of dying, and the journey to get there that scares me. I don’t want to hurt. I don’t want to be alone nor want my family to be alone. I don’t want to die in a hospital and be hooked up to a bunch of machines. If I had my wishes, I want a peaceful death at home with my loved ones beside me. None of us get to choose the way we die, and obviously those things are out of our control.

Talking about death is not something that is typically brought up on family holidays or talked about around the dinner table. If we don’t share our end of life wishes with our families, then they will be the ones to have to make those difficult decisions for us, not really knowing what we truly want to happen as we get close to dying. They will be making those decisions under a very emotional and stressful time. Difficult decisions which could haunt them for a long time, because they did not know what their loved one would want.

I encourage every one of you to have those difficult conversations with your loved ones and make your wishes known. None of us are promised another day. If your loved ones know your wishes, hopefully it can make a difficult transition a little easier for everyone. If your heart should stop, do you want the doctors and nurses to perform CPR and attempt to bring you back? Do you want to die in a hospital or at home? Do you want to be hooked up to machines or do you want a quiet peaceful death at home?

If you do not want CPR if your heart stops, I recommend talking with your doctor and healthcare team about obtaining Do not Resuscitate (DNR) paperwork. This will protect you and ensure that CPR is not performed if your heart should stop. So many different factors should be taken into account when considering obtaining a DNR. I always recommend looking at the overall quality of a person’s life to help make that decision. If the patient is terminal, seems to be suffering and is quiet frail the odds of CPR being successful are low, as well as recovery from injuries that can occur while performing CPR. Patients and families need to consider if the CPR attempts are successful, what quality of life that person will be returning to. Are they comatose and not going to return to a higher level of functioning? This is each individual’s choice of whether they want CPR or not when that time comes. Please tell your family your wishes so they don’t have to make those difficult decisions for you when they time comes.

Something else I would consider is after discussing your wishes with your family; appoint someone as your Medical Power of Attorney that will carry out decisions on your behalf once you are no longer able to make those decisions. When stressful situations come up, families don’t always agree on the best course of action for their loved ones. Appointing someone as Medical Power of Attorney gives that one person the ability to speak on your behalf to alert medical staff of your wishes. Medical staff will also turn to the Medical Power of Attorney to make those difficult decisions when needed.

Please note that a Medical Power of Attorney and Durable Power of Attorney are two different things. The Durable Power of Attorney is the person you appoint to handle financial things. The Medical Power of Attorney handles everything medical. A lot of people do not realize that there is a big difference between the two.

If you have a terminal prognosis of six months or less and don’t want to be hooked up to machines or die in a hospital, I would recommend Hospice care. Hospice can ensure an easier death with comfort and dignity and ensure support is there for your families. Hospice will come whenever the patient calls home and provide care. Hospice can be provided at home, Nursing Facilities and even Assisted Living Facilities.

Hospice is a scary word for many. So many people think of Hospice as a death sentence and think Hospice is brought in when there is no hope. But that is just the thing … Hospice care brings hope for dignity, comfort and peace and allows patients to spend quality time with their loved ones for however much times is left in this journey of life. Hospice focuses on living life and enjoying life to the fullest.

A referral to Hospice should be viewed as a referral to a specialist. Just like the cancer patient sees an Oncologist, a heart patient sees a cardiologist and someone with urinary tract disorders sees a Urologist, why not see a specialist for end of life care – a specialist who can help you and your loved ones walk through the most difficult journey of living.

Hospice neither hastens nor prolongs life. Studies have shown patients with Hospice lived an average of one month longer than those without Hospice, and the quality of life was consistently higher. Studies conducted by the National Hospice and Palliative Care Organization show that Hospice patients experience less depression and improve mentally, emotionally and physically over chronically ill pts who are not on hospice.

Once patients and families come on Hospice they usually say, “I wish I would have known about this sooner,” or they will say, “I wish mom/dad would have come on Hospice sooner.” There are many benefits to coming on Hospice services at the early stages of a terminal prognosis. The most important benefit is reaping the benefits sooner rather than later. Hospice can ease financial burdens by providing medical equipment and supplies that the patient needs and also covers the cost of medications related to the terminal prognosis and meds for comfort. For elderly patients on a fixed income this can be a huge benefit. As well as the fact that the cost of medical equipment and medications can add up very quickly.

Another benefit of Hospice services is that Hospice becomes your new 911. Hospice staff are available 24 hours/day for any questions, concerns or changes in condition that may arise. Hospice can alleviate unnecessary trips back and forth to the hospital. This is especially important now that the weather is getting cooler, and the time changed causing it to get darker earlier. It is hard on those with failing health to get out at night and especially in the cold or heat. Hospice staff will come to you at your home and perform assessments, then contact the doctor as needed for any concerns or medication needs.

Death and dying is inevitable for us all. We don’t get to choose how we die. Sometimes it comes unexpectedly and other times it comes with an illness and can be a long process. Regardless how it comes, death is a guarantee. Talk with your family and let them know your wishes for when the time comes. It’s a natural part of life that we all must endure. It will make the journey a little easier knowing they honored your wishes.

 

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Filed Under: news Tagged With: aging, Aging in Place, Aging Well, Alzheimer's, Assisted Living, Bosque County, Campus activities, Caregiver, Clifton, Companion services, Health and Wellness, Hospice, Nursing Home, Senior Living

Maintaining A Relationship With Grandkids Amid Estrangement

October 7, 2019 by Andrea Hikel Leave a Comment

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Credit: Envato

For grandparents, respecting boundaries is key if relationships with parents are poor.

Being a grandparent often means passing along traditions, making memories and building family bonds. But this isn’t the reality for many families, especially those affected by estrangement.

It’s difficult to say exactly how many parents are estranged from their adult children, but experts agree that when grandchildren are involved, the situation grows even more complex.

“It’s far more common than most people realize,” said Tina Gilbertson, a Denver-based psychotherapist and author of Guide for Parents of Estranged Adult Children.

“While it’s hard knowing your grandchildren are growing up without knowing you, the best use of your time is to strengthen your bond with their parents,” Gilbertson said. “Being the older person, you have a lot of power to influence the tone of that relationship. But you may need to be strategic, rather than emotional, about mending fences.”

Respecting rules and boundaries “creates goodwill between the parents and grandparents.”

But if you can’t repair the relationship with their parents, it still may be possible to build and maintain relationships with your grandchild, despite the estrangement. Experts say it will just take time, emotional intelligence, respecting boundaries and setting realistic expectations.

Keep Emotions and Expectations in Check

For a grandparent-grandchild relationship to survive an estrangement, everyone involved must display emotional intelligence, which refers to how we recognize and handle our own emotions and respond to others’ emotions, said Carla Manly, a clinical psychologist in Sonoma County, Calif., and author of Aging Joyfully.

Emotional intelligence means putting differences aside, agreeing to disagree and swallowing pride for the benefit of the child and the grandchild-grandparent relationship.

Manly acknowledges that emotional intelligence isn’t always easy, saying, “It takes quite a lot of inner strength to get there.”

Gilbertson urges grandparents to be “introspective” and have a “growth mindset” to build authentic relationships with grandchildren through estrangement — and to avoid placing too many expectations on the situation.

“Expecting your child to accept you based solely on your status as their children’s grandparent doesn’t usually work,” she said. “As long as your emotions are clouding your behavior, you may not be as strategic as you need to be.”

Letting emotions get in the way could lead to missed opportunities to see the grandchildren, Gilbertson said.

It’s Up to Parents to Allow the Relationship

Grandparents will likely need to approach the child’s parents about building or maintaining the grandchild relationship. Manly said parents ultimately decide what that relationship will be like.

However, in families with a history of abuse, drug or alcohol addiction, or other reasons for a parent to worry that the child would be in danger when around the grandparent, a relationship probably isn’t possible, she said.

Karen Forsthoff, a licensed marriage and family therapist in San Francisco, said any grandchild interaction surrounded by estrangement should be child-led and focused on “developmentally appropriate” activities, which vary depending on the child and family situation.

“Keep it safe; keep it simple,” Forsthoff said. “And don’t expect too much in regard to affection being shown, especially depending on the age and time limit when you’re going to be able to see that child.”

Age-Appropriate Suggestions for Estranged Families

The age of the child will dictate how to build the relationship:

Children under 8. For babies, toddlers and the youngest children, grandparent interaction will likely occur with the parents around. Manly suggests grandparents avoid commenting on a grandchild’s sleep or eating patterns, or anything that seems to question the parenting. Focus, instead, on generalities, like a child’s toys or outfit. Grandparents could try to take the child, once a little older, to the park on a set schedule, for example, to build familiarity.

9- to 13-year-olds. The older a child gets, the less receptive the child may be to building a relationship with a grandparent, especially if a foundation wasn’t set early on, Manly said. In this age group, grandparents could attend the child’s sports events or school activities, when possible, and try to build a friendship by going out together to get ice cream afterwards, for example.

Teenagers. Grandparents shouldn’t try to force relationships with teenage grandkids, Manly said. Simply be present, take an interest in the teen’s interests and attend activities when the child is participating.

General Guidelines for Grandparents in Estranged Families

Don’t buy the child’s affections. At any age, Manly warns against indulging the grandchildren too much by buying them things or spoiling them in other ways that go against their parents’ rules. This may heighten tensions with the parents and develop inauthentic relationships.

Never bad-mouth the parents. As kids get older, they will likely sense the estranged relationship between their parents and grandparents. Gilbertson stresses that grandparents should never talk badly of the grandkid’s parents, complain about the relationship or ask the child to be a go-between.

But Forsthoff urges grandparents and parents to agree on how to discuss the estranged relationship in case the child asks questions. The explanation should be truthful and age-appropriate — for example, everyone makes mistakes sometimes and people don’t get along all the time.

Communicate in any way possible. Forsthoff suggests grandparents stay in contact with grandchildren however they can, whether by text, phone calls, in person or by writing letters. If communication is completely cut off, she urges grandparents to write letters to their grandchildren and save them to deliver once the grandchild grows up.

Keep interactions positive. Manly encourages positivity in all interactions with grandchildren and their parents, even when hurt feelings exist. That means avoiding judgmental, sarcastic or passive-aggressive comments or actions.

Respecting Boundaries Can Make or Break Relationships

Since parents dictate how grandparent-grandchild relationships exist, it’s up to grandparents to respect any boundaries the parents set, such as bringing the child home on time, allowing or not allowing certain foods or talking about sensitive subjects.

A successful relationship depends on honoring boundaries, and not doing so can worsen the already estranged relationship and jeopardize access to the grandchildren, Manly said.

Grandparents may perceive parent’s rules as unfair or frustrating, Forsthoff said, but boundaries serve as an important reality check when navigating their family’s estrangement situation.

“Really understand what it is to have compassion for yourself and to accept the reality of the situation as it is, not as we wish it would be or hoped it would be, but to really sit with that,” she said.

Respecting rules and boundaries “creates goodwill between the parents and grandparents,” Gilbertson said, and sometimes, grandparents have to do whatever it takes to bond with the grandchildren.

“That’s unfortunate for grandparents,” she said. “I have sympathy for grandparents in this situation, and it’s a lot more common than people realize. If this is you, please know that you’re not alone, and reach out for support wherever you can find it.”

Erica Sweeney is a freelance journalist who has written for The New York Times, HuffPost, Teen Vogue, Parade.com and more.

 

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5 Myths About Independent Living Communities

August 26, 2019 by Andrea Hikel Leave a Comment

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Many of the common fears people have simply aren’t true

By Acts Retirement-Life Communities

Relocating to a new community has its challenges no matter what stage of life you find yourself in. It’s normal to feel all kinds of emotions ranging from excitement about your new surroundings to fear of the unknown.

But when it comes to independent living communities, many of the common fears people have simply aren’t true. There are some myths that seem to live on despite clear evidence to the contrary.

Here are five of those myths. Each is a commonly-held belief about what it’s like to be part of an independent living community, and all are untrue. If you’re thinking about independent living either for yourself or for a loved one, you’ll want to take note of these top myths so you can make the best decision — a decision that’s based on facts, not fiction.

Myth 1. Independent living communities are just too pricey for most people

Even if you’ve paid off your home and you’re mortgage-free, there are still a number of monthly costs that add up. Between utilities, insurance, taxes, repairs and other home ownership costs, the price of staying in your old house isn’t as low as you may think. Click here to read about the hidden costs of home ownership.

If you consider that down the line you may need some in-home services or medical care, you’ll only be adding to that budget. That’s why the price of independent living can favorably compare to the cost of staying in your own home as you age. Consider this: The average monthly cost of typical homemaker services, which do not include personal care, was about $4,000 in 2017. Combine that with the homeowner fees mentioned above and any medical care you may need as you age, and independent living communities are suddenly affordable in comparison.

Myth 2. ‘Independent living’ is really just another way of saying ‘nursing home’

People who believe this myth don’t understand what ‘independent living’ means. If you’re one of these people, you’re not alone. So much has changed with senior living in the past couple of decades that it’s understandable if lots of folks aren’t aware of all the new options out there.

‘Independent living’ is community living all right, but it’s for people who simply want a more carefree lifestyle. These communities are set up so that residents don’t have to worry about home maintenance, for example. Lawn care, snow removal, home repairs — all things of the past, as they are taken care of by management.

If you’ve ever lived in a community where there’s a homeowners’ association (HOA), you can think of independent living in a similar vein. Independent living is just more comprehensive and geared toward the needs of the 55+ crowd. Then add to that extra benefits like daily activities and events, fitness and hobby clubs like yoga and art classes, etc., and what independent living really means is a community of people who want to enjoy their retirement to the fullest without having to deal with unwanted responsibilities.

Myth 3. Moving to a senior community cuts you off from your friends and family

Unless you move out of state, the only way you’ll be cut off from friends is if you purposely make it a point to do so. Independent living communities do not place restrictions on having guests in your home and they provide more options for visiting them in their homes.

You’ll have more options for entertaining because you can not only invite your friends over to your home, you can also hold a gathering in your community’s common spaces. Many have clubhouse-style common areas that are available for social events. Picture a picnic by the grill, a game of water volleyball in the pool or a book club in the clubhouse.

You may even find that it’s easier to visit old friends after a move to independent living. If driving is a problem, many communities have all sorts of transportation options that help residents get where they need to be. Want further proof? Read about how Acts Retirement-Life Communities has addressed the importance of socialization and made it a priority within its communities.

Myth 4. Moving to independent living means you lose your independence

There’s a lot of irony in this myth — that should be a giant tip-off that it’s completely untrue. One of the major fears of Americans 65 and older is that they will lose their independence. It’s a prime reason that many older Americans resist moving to any type of senior living community, even one that’s designed for independent living.

This myth probably arises from confusion about all the different types of senior living communities that are available today. The spectrum ranges from independent living to assisted living to skilled nursing, each vastly different from the others.

There are independent living communities where people live in their own homes and the only communal aspect to their arrangement is that home maintenance and lawn care are taken care of. They’re free to cook their own meals, have overnight guests and keep their pets.

There are also independent living communities where some residents opt for meals in a central dining location, or they partake in social activities sponsored by the community. Sometimes residents sign up for housekeeping services, too.

The point is: The choice is up to each resident of how many services they want to add to their own arrangement and how independent they want to be.

With assisted living — a different type of senior living community — things are different. Assisted living communities offer a higher level of care for older adults who need it. For example, most offer an on-site caregiver who’s there every day, 24 hours a day. These communities also serve meals and provide assistance with dining for those who need it. Residents often receive medical management, personal care and a wide range of wellness programs and life enrichment programs designed for those who may find it more difficult to travel outside the community regularly for socializing.

As you can see, independent living is vastly different from assisted living.

Do you want to learn more about independent living but also have the option to move to assisted living or skilled care in the future, if necessary? You should learn more about Continuing Care Retirement Communities. CCRCs provide residents a wide range of living options based on their current and ongoing needs.

Myth 5. There’s nothing to do

This myth might be the most unfounded yet. The truth is, lots of people who make the move to independent living communities find their schedules are more packed than ever before.

Not having to worry about chores tends to free up your time for better things. With more time for socializing and exercising, people who move to independent living have far more opportunities to stay busy, active and social.

Most communities provide access to organized social events, classes and outings. Hobby groups are common, too, and many of these activities are open to your family members as well.

With all there is to do and with all the freedom from not having to worry about home maintenance or chores, lots of people who make the move to independent living find their new home to be more exciting than they ever imagined. Now that these top myths have been debunked, you can begin to see all the benefits of this exciting new type of community and maybe even envision yourself enjoying the carefree lifestyle of an independent living community.

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Filed Under: news Tagged With: aging, Aging in Place, Aging Well, Alzheimer's, Assisted Living, Bosque County, Campus activities, Care Giver, Caregiver, caregiver support, Caregiving, Clifton, Companion services, Continuum of Care, Dementia, giving care, Hospice, Independent Living, Long-term care, Nursing Home, rental apartments, Rest Home, retirement, Retirement living, Senior Art, Senior Care, Senior Health, Senior Living, Successful aging, Sunset Home, Sunset Lifestyle, Texas, Wellness

Sorry, Nobody Wants Your Parents’ Stuff

August 6, 2019 by Andrea Hikel 1 Comment

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Advice for boomers desperate to unload family heirlooms

By Richard Eisenberg

February 9, 2017

 

After my father died at 94 in September, leaving my sister and me to empty his one-bedroom, independent living New Jersey apartment, we learned the hard truth that others in their 50s and 60s need to know: Nobody wants the prized possessions of your parents — not even you or your kids.

Admittedly, that’s an exaggeration. But it’s not far off, due to changing tastes and homes. I’ll explain why, and what you can do as a result, shortly.
The Stuff of Nightmares

So please forgive the morbidity, but if you’re lucky enough to still have one or more parents or stepparents alive, it would be wise to start figuring out what you’ll do with their furniture, china, crystal, flatware, jewelry, artwork and tchotchkes when the mournful time comes. (I wish I had. My sister and I, forced to act quickly to avoid owing an extra months’ rent on dad’s apartment, hired a hauler to cart away nearly everything we didn’t want or wouldn’t be donating, some of which he said he’d give to charity.)

Many boomers and Gen X’ers charged with disposing the family heirlooms, it seems, are unprepared for the reality and unwilling to face it.
They’re not picking out formal china patterns anymore. I have three sons. They don’t want anything of mine. I totally get it.
— Susan Devaney, The Mavins Group

“It’s the biggest challenge our members have and it’s getting worse,” says Mary Kay Buysse, executive director of the National Association of Senior Move Managers (NASMM).
“At least a half dozen times a year, families come to me and say: ‘What do we do with all this stuff?’” says financial adviser Holly Kylen of Kylen Financials in Lititz, Pa. The answer: lots of luck.

Heirloom Today, Foregone Tomorrow

Dining room tables and chairs, end tables and armoires (“brown” pieces) have become furniture non grata. Antiques are antiquated. “Old mahogany stuff from my great aunt’s house is basically worthless,” says Chris Fultz, co-owner of Nova Liquidation, in Luray, Va.

On PBS’s Antiques Roadshow, prices for certain types of period furniture have dropped so much that some episode reruns note current, lower estimated appraisals.
And if you’re thinking your grown children will gladly accept your parents’ items, if only for sentimental reasons, you’re likely in for an unpleasant surprise.
“Young couples starting out don’t want the same things people used to have,” says Susan Devaney, president of NASMM and owner of The Mavins Group, a senior move manager in Westfield, N.J. “They’re not picking out formal china patterns anymore. I have three sons. They don’t want anything of mine. I totally get it.”

The Ikea Generation

Buysse agrees. “This is an Ikea and Target generation. They live minimally, much more so than the boomers. They don’t have the emotional connection to things that earlier generations did,” she notes. “And they’re more mobile. So they don’t want a lot of heavy stuff dragging down a move across country for a new opportunity.”

And you can pretty much forget about interesting your grown kids in the books that lined their grandparents’ shelves for decades. If you’re lucky, you might find buyers for some books by throwing a garage sale or you could offer to donate them to your public library — if the books are in good condition.

Most antiques dealers (if you can even find one!) and auction houses have little appetite for your parents’ stuff, either. That’s because their customers generally aren’t interested. Carol Eppel, an antique dealer and director of the Minnesota Antiques Dealers Association in Stillwater, Minn., says her customers are far more intrigued by Fisher Price toy people and Arby’s glasses with cartoon figures than sideboards and credenzas.

Even charities like Salvation Army and Goodwill frequently reject donations of home furnishings, I can sadly say from personal experience.
Midcentury, Yes; Depression-Era, No

A few kinds of home furnishings and possessions can still attract interest from buyers and collectors, though. For instance, Midcentury Modern furniture — think Eames chairs and Knoll tables — is pretty trendy. And “very high-end pieces of furniture, good jewelry, good artwork and good Oriental rugs — I can generally help find a buyer for those,” says Eppel.
“The problem most of us have,” Eppel adds, “is our parents bought things that were mass-produced. They don’t hold value and are so out of style. I don’t think you’ll ever find a good place to liquidate them.”

Getting Liquid With a Liquidator

Unless, that is, you find a business like Nova Liquidation, which calls itself “the fastest way to cash in and clean out your estate” in the metropolitan areas of Washington, D.C. and Charlottesville and Richmond, Va. Rather than holding an estate sale, Nova performs a “buyout” — someone from the firm shows up, makes an assessment, writes a check and takes everything away (including the trash), generally within two days.

If a client has a spectacular piece of art, Fultz says, his company brokers it through an auction house. Otherwise, Nova takes to its retail shop anything the company thinks it can sell and discounts the price continuously (perhaps down to 75 percent off), as needed. Nova also donates some items.

Another possibility: Hiring a senior move manager (even if the job isn’t exactly a “move”). In a Next Avenue article about these pros, Leah Ingram said most NASMM members charge an hourly rate ($40 to $100 an hour isn’t unusual) and a typical move costs between $2,500 and $3,000. Other senior move managers specializing in selling items at estate sales get paid through sales commissions of 35 percent or so.

“Most of the people in our business do a free consultation so we can see what services are needed,” says Devaney.

8 Tips for Home Unfurnishing

What else can you do to avoid finding yourself forlorn in your late parents’ home, broken up about the breakfront that’s going begging? Some suggestions:

1. Start mobilizing while your parents are around. “Every single person, if their parents are still alive, needs to go back and collect the stories of their stuff,” says Kylen. “That will help sell the stuff.” Or it might help you decide to hold onto it. One of Kylen’s clients inherited a set of beautiful gold-trimmed teacups, saucers and plates. Her mother had told her she’d received them as a gift from the DuPonts because she had nursed for the legendary wealthy family. Turns out, the plates were made for the DuPonts. The client decided to keep them due to the fantastic story.

2. Give yourself plenty of time to find takers, if you can. “We tell people: The longer you have to sell something, the more money you’re going to make,” says Fultz. Of course, this could mean cluttering up your basement, attic or living room with tables, lamps and the like until you finally locate interested parties.

3. Do an online search to see whether there’s a market for your parents’ art, furniture, china or crystal. If there is, see if an auction house might be interested in trying to sell things for you on consignment. “It’s a little bit of a wing and a prayer,” says Buysse.

That’s true. But you might get lucky. I did. My sister and I were pleasantly surprised — no, flabbergasted — when the auctioneer we hired sold our parents’ enormous, turn-of-the-20th-century portrait of an unknown woman by an obscure painter to a Florida art dealer for a tidy sum. (We expected to get a dim sum, if anything.) Apparently, the Newcomb-Macklin frame was part of the attraction. Go figure. Our parents’ tabletop marble bust went bust at the auction, however, and now sits in my den, owing to the kindness of my wife.
4. Get the jewelry appraised. It’s possible that a necklace, ring or brooch has value and could be sold.

5. Look for a nearby consignment shop that might take some items. Or, perhaps, a liquidation firm.

6. See if someone locally could use what you inherited. “My dad had some tools that looked interesting. I live in Amish country and a farmer gave me $25 for them,” says Kylen. She also picked out five shelters and gave them a list of all the kitchen items she wound up with. “By the fifth one, everything was gone. That kind of thing makes your heart feel good,” Kylen says.

7. Download the free Rightsizing and Relocation Guide from the National Association of Senior Move Managers. This helpful booklet is on the group’s site.

8. But perhaps the best advice is: Prepare for disappointment. “For the first time in history of the world, two generations are downsizing simultaneously,” says Buysse, talking about the boomers’ parents (sometimes, the final downsizing) and the boomers themselves. “I have a 90-year-old parent who wants to give me stuff or, if she passes away, my siblings and I will have to clean up the house. And my siblings and I are 60 to 70 and we’re downsizing.”

This, it seems, is 21st-century life — and death. “I don’t think there is a future” for the possessions of our parents’ generation, says Eppel. “It’s a different world.”

By Richard Eisenberg

Richard Eisenberg is the Senior Web Editor of the Money & Security and Work & Purpose channels of Next Avenue and Managing Editor for the site. He is the author of How to Avoid a Mid-Life Financial Crisis and has been a personal finance editor at Money, Yahoo, Good Housekeeping, and CBS MoneyWatch.

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How to move forward after the one you cared for dies?

July 19, 2019 by Andrea Hikel Leave a Comment

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Credit: Hermann Traub – Pixabay

By Julie Gorges

Caregiving might be the hardest job any of us will ever have. When the person you care for passes, the range of emotions can be complex. Below is a deeply personal essay from Julie Gorges, who shares her own journey of grief, expert advice and coping strategies.

As anyone who has lost a loved one knows, grieving is a heartbreaking journey. When you’re a caregiver and the person you’ve been caring for dies, experts on grieving agree the psychological outcome and healing process are somewhat different. That’s especially true if your loved one had dementia.

I was the primary caregiver for my mother, who had Lewy Body dementia during the last years of her life. I learned that grief takes many forms, and it isn’t just about mourning someone after they die. When your loved one has dementia, you lose that person in an excruciating way — a little bit at a time. As a result, some of the grieving process begins to take place while you’re still caregiving.

Other complicated feelings often come into play. “After caregivers lose the person they cared for, there is often less grief alone, but a mixture of other emotions,” explains Dr. Marc Agronin, a geriatric psychiatrist and author. “Those feelings may include sadness and uncertainty about the future, along with some degree of relief and a desire to move forward.”
After a Death: A Mix of Emotions
This was certainly true in my case. After my mother’s death, the emotions were overwhelming. I was relieved all of my heartbreaking duties as a caregiver were over. No more medical emergencies, constant worrying and sleepless nights. I also enjoyed my newfound freedom to take a vacation, go on a leisurely walk, spend quiet time with my husband or simply enjoy a book.

But there was a lot of guilt mixed in for feeling that way. I also felt remorse about the times I wasn’t the perfect caregiver and questioned whether I made the right decisions along the way.

On top of that, I felt lost. Caring for Mom had been my life for a few years. Most of my thoughts and feelings had revolved around her care. After my mother died, I not only lost her, but part of my identity as a caregiver. My life had changed drastically overnight.

Accept Your Feelings and Move Forward
So, how can you move forward will all the intense and contradictory feelings that come with the territory?

What I learned is that you have to accept all your emotions and be patient with yourself. Feel everything you need to feel. Lean on loved ones. Honestly discuss your thoughts and feelings with those close to you.

However, as time goes on, it’s important not to allow sorrow to become a way of life or dwell on all of the “should-haves” that interfere with recovery. In fact, you’ll need to forgive yourself for mistakes you think were made while caregiving and stop feeling guilty that you’re relieved to have your life back.

The goal is to let go of negative feelings and enjoy a productive life once again.
How is that accomplished?

After my mother’s death, I took an important step that helped me pick up the scattered pieces of my soul and begin living again.

I deemed the year after my mother’s death, my “year of healing” and listed three non-negotiable things I had to do each day. There was nothing new or revolutionary on my list. Just a few simple things that provided an anchor, ensured that I took the time to care and focus on myself and helped me get through a bad day.

My list included:

  • Read something spiritual and inspirational each day. If you’re a religious person, now is the time to embrace your spirituality and rely on your faith to help you move forward. It’s so easy to become sidetracked and allow time to slip by without any spiritual fortification. I realized daily reading, meditation and prayer were necessary every single day.
  • Exercise. I’m not talking about running a marathon or doing 50 deep squats. But, even if it was only for 15 minutes, I did something for both my physical and emotional well-being. Maybe I’d take a stroll through the park listening to the birds sing, do some Pilates or walk the dog around the block listening to soothing music.
  • Do something you love. I thought about what used to make me feel happy and brought fun and joy to my life. Then I made a point of putting those treasured activities back into my daily life. In other words, at the end of the day, I made sure that I did something just for me.

You know what? My list worked. Accomplishing these three things every day helped me feel calmer, more centered and, yes, happier.

I’d recommend making a list of your own. Maybe you’ll include laughing each day, spending time in nature, learning something new, being silly or enjoying time with loved ones.

 

Read the rest of the author’s advice on Next Avenue.
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5 Questions to Ask Your Optometrist

July 15, 2019 by Andrea Hikel Leave a Comment

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Adobe Stock

Be extra prepared for your next eye exam

By VSP Vision Care

(Editor’s note: This content is provided by VSP Vision Care, a Next Avenue sponsor.)

When we visit our eye doctor there are a couple things we expect from them. We expect them to check for current eye problems, and we also expect them to discuss conditions that may affect our eyes in the future. But did you know your eye doctor can also look at your family’s eye health history to see what may impact your eyes later in life? To prepare for your next eye exam, we’ve listed five questions to ask your optometrist:

1. What changes can I expect in my vision as I get older?

There’s no one better than an optometrist to prepare you for how your vision will change as you get older. Not only can they assess your eye health and potential risks based on family history, they can ensure you are aware of all preventative measures you could be taking as well.

2. Will diet, exercise or other lifestyle changes help my vision?

Optometrists can give you the best tips for keeping your eyes healthy and strong in both the long and short term. This includes sharing the latest trends in eye health and providing guidance on lifestyle choices that benefit your eye health, such as maintaining a proper diet and exercise routine.

3. What are the advantages and disadvantages of wearing contact lenses vs. glasses?

If you’re thinking about making the switch, an optometrist can walk you through the pros and cons of both contacts and glasses. They can also make recommendations for brands and high-quality eyewear, but most importantly they can help you find the exact right option for you given your specific needs.

4. Has anything about my eyes changed since my last visit that I should know about?

Your optometrist will likely tell you what changes (if any) you may have to your prescription, but it is also wise to have your optometrist explain everything that might have changed since your last exam so you can be aware of your eye health. Consider taking it a step further and ask what could’ve caused these changes so you can take preventive actions in the future.

5. What can an eye exam tell you about your overall health?

Certain illnesses and diseases not specific to the eyes (like diabetes and high blood pressure) may be identified by eye health experts. Optometrists can help you identify these signals and get ahead of any potential issues. Knowing what to look out for and what to do if you see a potential problem can go a long way in keeping your eyes in great shape.

Overall, it’s important to keep an active and open dialogue with a doctor you trust. Whether you wear glasses, contacts or don’t require visual assistance, annual eye exams and access to a trusted doctor network are vital to maintaining good eye health, preventing vision issues and getting questions answered.

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Is There a Link Between Menopause and Alzheimer’s?

June 12, 2019 by Andrea Hikel Leave a Comment

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By Deborah Copaken

(This article previously appeared on the Neurotrack page of Medium. It is an abridged version.)

It started with an artichoke. Or rather, it started with my inability to recall the word artichoke, even though I was holding one in my hand. “What did you get for dinner?” my partner Will asked from the other room, and I said, “Salmon and…” My brain went blank. Or rather it went from blank to asparagus, even though I knew that asparagus, while in the correct spiky vegetable ballpark, was wrong.

“Yes?” said Will.

I started to panic. Words are my stock-in-trade. They are how I make my living. If I couldn’t come up with a simple word for the vegetable right there in my own hand, who was I? I carried the mystery object into the room where Will was working. “What is this?” I said. “I can’t remember how to say it.”

He looked alarmed. “You mean… an artichoke?” He smiled. Was this some sort of a joke?

“The brain is in charge of the rest of the body, but pretty much everybody assumes that the rest of the body doesn’t have much of an impact on the brain. And that turns out not to be true.”

My relief was palpable. “Oh my god, yes! Thank you!” And yet I was still disturbed. What just happened? I’d been having what I thought were all the normal issues with word recall, keys and glasses locating, and wait-why-did-I-just-go-into-this-room moments over the last few years, after I turned 50, but this felt different. More disturbing. More urgent.

I immediately Googled “memory loss menopause,” and 13.8 million hits appeared on my screen. Was memory loss an inevitable byproduct of menopause? And if so, why? I started digging. And that’s when I stumbled upon a recent Op-Ed in the New York Times by neuroscientist Dr. Lisa Mosconi, who is studying the link between menopause and Alzheimer’s.

Mosconi is an associate professor of neuroscience in neurology and radiology at Weill Cornell Medical College in New York, where she also serves as director of the Women’s Brain Initiative and associate director of the Alzheimer’s Prevention Clinic.

The question she asked herself, in her research, was a deceptively simple one: Why do twice as many women get Alzheimer’s as men? The statistics with regard to women’s longevity versus men’s cannot explain away this enormous discrepancy. Could menopause?

So on a warm spring day, just after the artichoke incident, I biked from my home in Brooklyn to Mosconi’s office at Weill Cornell. (Exercise, we now know, is one of the key risk reducers for Alzheimer’s when done in conjunction with healthy eating, getting enough sleep, and stress reduction.)

Herewith is a slightly condensed transcript of my conversation with Mosconi, which I’m keeping long not only because nearly everything she said was both fascinating and news to me, but also because I’m assuming if you are a menopausal woman reading this right now (or someone who loves us), you might have lots of questions and/or unnamable artichokes in your life, too.

Deborah Copaken: So. Let’s start at the beginning. How did you get interested in this specific topic? Alzheimer’s in general, but also Alzheimer’s in women, specifically?

Dr. Lisa Mosconi: When I was in college, my grandmother started showing cognitive and behavioral changes, and within a couple of years she was not just herself anymore. She was diagnosed with dementia. It was a very slow and painful process. Everything went backwards. She was up all night and asleep all day. My mom turned into the primary caregiver, and that was devastating for her. Not just emotionally but also really physically.

And she was also trying to hold onto a job. And those were the years when my mom was going through menopause as well. So it really was shocking to witness what was happening to my grandmother and at the same time what was happening to my mom. My grandmother had three siblings; two girls — you know two sisters — and one brother. The two sisters got the same exact thing years later. Her brother did not.

Oh my goodness.

So that was quite shocking, and I was like ‘Oh dear, what if it runs in families?’ I knew nothing about Alzheimer’s. I was nineteen. And so I started doing a lot of research on that. My parents are nuclear physicists. And their students were babysitting me when I was little, but we stayed in touch, and as soon as I mentioned wanting to look at the brain and Alzheimer’s, they said, ‘Volunteer with us. We’ll train you.’

You were nineteen, and you were researching in nuclear medicine already?

A year later, yes, I was twenty.

Okay, so you were still in university, but studying nuclear medicine on the side. As one does. So how old is your mother right now?

Seventy-four.

How’s she doing?

She’s fabulous. She goes to yoga three times a week, she can do headstands, she eats super healthily, she is incredibly intellectually active.

I’ve seen studies that show that instead of just doing brain games such as Sudoku or crossword puzzles, there’s evidence that just staying at your job in your sixties and seventies is good intellectual training if you want to try to avoid cognitive decline. What do you say to that?

There is an association between Alzheimer’s risk and education, and also occupational attainment: having a job that you’re good at. So there’s an association between being good at your job  —  having a job that brings out the best in you in some ways, whether intellectually or in other forms  —  and lower risk of dementia down the line.

There are some studies showing that postponing retirement has also been associated with a lower risk of dementia in later years. And I think it all comes down to cognitive reserve.

Cognitive reserve?

Yes, cognitive reserve. You brain is built of neurons and connections between neurons. And these connections need to be strengthened, because otherwise they will die. There’s a process called pruning, where if you don’t use your dendrites, the connection between neurons, they will atrophy, they will actually withdraw. So it’s really kind of a ‘use it or lose it’ situation in the brain.

Right. Which brings me to my next question, a personal one: I know that writing is good for my brain, but at fifty-three years old, having been a writer my entire life and now going through perimenopause, I find…

Would you want to get your brain scanned?

Yes, let’s do it, that would be fun!

That would be wonderful.

Because what I have noticed, as a writer who obviously needs words to create what I do, I sometimes cannot remember … the other day I could not remember the word … and here I am forgetting it again! It was, oh my God, see, here I go again. It’s not asparagus, but it’s the thing that looks like this, and it’s got the little pointy things…

Artichoke?

Artichoke! Yes. See, I knew it started with an A, and it looks like the top of the asparagus, so that came to mind, but I couldn’t think of the word for artichoke. And it was driving me crazy. I had it in my hands, even, and I couldn’t remember what it was called. And if you hadn’t just said it right now, I would have had to look up vegetables on my phone, I mean literally look up green vegetables pointy leaves and find it on Google. But this happens all the time to me now and I’m thinking that, oh no…

Word finding.

Word finding. Exactly. And I don’t have any history of Alzheimer’s, but I have noticed just in ‘brain abilities,’ let’s call it, I’m losing it. And as a writer, that’s scary.

Well, for sure.

So when I read your op-ed, even though I work in this field, I did not know that women are twice as likely to get Alzheimer’s as men.

Yes.

At the same time, I also know that women’s health is poorly studied. I will give you an example from my own life. So when I had my uterus out, a hysterectomy, I was asked, what do you want: a partial, full or a supracervical? And I was like, I don’t know.

They’re asking you?

They’re asking me! And they said ‘Well, it is believed that the cervix plays a role in sexual pleasure.’ And I was like, seriously, are you kidding me? This was back in 2012. So they took out the uterus, kept the cervix. Five years later, the cervix becomes diseased, has to come out, and when I went to see the surgeon who was going to remove it, she said, ‘Why didn’t you get this out when you got the hysterectomy?’ I said, ‘I was told that it plays a role in sexual pleasure.’ She goes, ‘No, no, that was debunked last year.’ I was like, ‘Why don’t we know these basic things about female health?’ She goes, ‘Welcome to my world.’

I agree. We know even less about women’s brains. I mean, if we can’t even get the cervix right…

We finally just got a 3D model of the clitoris two years ago! Two years ago! So now I know these things about my reproductive organs I should have known years ago. What I’m concerned about now is the brain, women’s brains in particular. So what does your research show? What have you found about menopause, perimenopause and women’s brains?

Well for one, we have known for a good ten years that taking out the ovaries or the uterus increases risk of dementia in women.

Wait, what????

This is true.

This is news to me right now.

Is it?

Yeah.

[At this point, I have to turn off the tape recorder, catch my breath, and curse. Loudly.]

Let’s start again, shall we?

It’s true. There’s a strong association between early menopause and an increased risk of Alzheimer’s in women. And an oophorectomy, which is the surgical removal of the ovaries, increases the risk up to seventy percent.

Seventy percent????!!!!??????

Yeah. If it’s done bilaterally, meaning you have both the ovaries taken out. But then there were other studies showing the risk is also increased when the uterus is removed, regardless of whether the ovaries are still in place.

What?!

The reason being, when you remove the uterus, blood flow to the ovaries is also compromised, you’re disrupting the system. In some ways, the ovaries may or may not be impacted by that. So there is an increased risk of Alzheimer’s also with a hysterectomy. And that’s why many people have been looking into estrogen, and the connection between estrogen and Alzheimer’s.

There was that disastrous clinical trial called the Women’s Health Initiative. For many years, women were given estrogen as soon as they entered menopause, with the idea that lack of estrogen is what causes a lot of the problems during menopause, from increased bone frailty, increased risk of heart disease, increased risk of diabetes and increased risk of dementia. The association was quite well established, so it makes sense to think, well, can I just give you the estrogen back? Right?

Right.

And so many providers did that. It was actually kind of the norm for women with the diagnosis of menopause, which is at least twelve consecutive months without your period, to be put on estrogen and left on estrogen for life. And that was done for so many years before the NIH [National Institutes of Health] started a clinical trial to test the efficacy of these formulations.

So, the Women’s Health Initiative started in 1993, and it was huge. There were like more than fifty thousand women involved in the trials. The trials went on for many, many years and then all of a sudden there were halted because early findings showed an increased risk of pretty much everything: an increased risk of blood clots, an increased risk of stroke, an increased risk of cardiovascular disease. So, it was basically a disaster.

Ugh. Let’s go back to women and Alzheimer’s and your family. So, you have your grandmother and your two great aunts, all of whom get Alzheimer’s. But your great uncle, their brother, doesn’t. Why?

Yes. I wanted to know why this is happening. And everybody was like, it doesn’t matter if you’re a man or a woman, it’s exactly the same. I was like, no it’s not. You can see the patients! They walk in the door, and sometimes there are women who are clearly having a problem, but they do not ‘test’ impaired.

A doctor wouldn’t be able to give them a diagnosis of dementia or mild cognitive impairment because their cognitive performance is still good even though they’re clearly dysfunctional in every other aspect of their lives. But they don’t score impaired. This came out a few years ago, that the tests we were using to diagnose Alzheimer’s were not sensitive enough for women at the early stages. Because women score better than men on cognitive tests and always have.

The cognitive score declines a bit with menopause, and then after menopause, but even women with a diagnosis of early Alzheimer’s may score better than men with the same diagnosis of Alzheimer’s.

So, the doctor can see plaques on the brain, they know these women have Alzheimer’s, but they’re testing well on cognitive exams.

They’re testing fine! We couldn’t see the plaques in the brain until ten years ago, we didn’t have the technology. So, now that we had the technology to find the plaques, we actually understand that we probably misdiagnosed women forever. And that could be one of the reasons why some treatments don’t work that well in women.

There’s also this whole thing, because we catch them too late, that the typical Alzheimer’s drugs work better in men than in women. And one possibility is that men and women with the same symptoms do not have the same brains. The men’s brains are still here, but the women’s brains are down here…

[She holds her right hand up high, representing men’s brains, her left hand down low, representing women’s brains.]

…and that’s why the drug just can’t bring them back up. So there’s an entire field that’s been severely gender-biased, and the bias is just now being revealed. It literally has been only two years that now everybody is talking about it, finally.

That’s great?

Yes it is, but it took me twenty years to get grants to actually look into this discrepancy.

It took you twenty years to get grants to look into this?

It took many years to convince the medical community that Alzheimer’s differs by gender.

I’m reading a book right now, I forget the name cause I probably have Alzheimer’s too, but I’m reading a book right now about women and data bias. [Note: Invisible Women: Data Bias in a World Designed for Men by Caroline Criado Perez.] The author has this part where she talks about how they studied Viagra.

Yes! Female Viagra, which was tested in twenty-three men and only two women!!!

Yeah, but they studied Viagra, and they found that with women, it completely eliminated period cramps for four hours at a time with no side effects. And the doctor that discovered this went back to the NIH, twice, and said, ‘We need further studies on this. This is the holy grail for women,’ and they said, ‘Well, dysmenorrhea [painful menustration, often with abdominal cramps] is not a real issue.’ So we now know everything we need to know about penises and how they get hard, and how Viagra can make them harder, but nothing about how Viagra could be helping the other fifty percent of the population, enormously.

Yes, there are so many things that were just completely disregarded.

Even this desk. This desk is not built for me, and it’s not built for you either. I was at the New York Public Library before I came here, and I was sitting there going, this table, this is made for a six-foot tall man. I can’t type here. It’s too high. I was with my boyfriend, who is six-feet tall, and I was like, you are comfortable at this table, I am not: discuss.

Yes, absolutely, we need pillows! And then the solution for a woman is to sit on a pile of pillows and make it work. We get this all the time, you know, just make it work.

And the same is in medicine. What we found, when we finally got an opportunity to look into that, is that women’s brains age differently than men’s brains.

That seems really important and unknown. What? Women’s brains age differently than men’s brains. How so?

For example…wait, I also want to underline that it’s not that we age worse, but differently. That’s important because…

Because there’s a judgment associated with better and worse, got it.

There’s a judgment, yes. We just age differently, that’s all. And basically what we found  —  and this is a lot of my own research   — is that Alzheimer’s is not a disease of old age.

We tend to associate it with the elderly, because that’s when the clinical symptoms become manifest. But in reality, Alzheimer’s begins with negative changes in the brains at least a decade prior. Most often than not, in middle age. Middle age is considered to be forty-to-sixty years old.

So then the question that we asked was okay, we know that Alzheimer’s affects more women than men, and we know that Alzheimer’s starts in midlife. What happens to women and not to men, in mid-life, that could potentially trigger an Alzheimer’s predisposition and that could potentially initiate Alzheimer’s?

And I was thinking, thinking, thinking, and I said: menopause? It’s the one defining event in a woman’s life that happens to every single woman and does not happen to men. Could that impact the brain?

And my background is in nuclear medicine, which is a branch of radiology, then I work in neurology. Nobody talks about hormones. Nobody talks about menopause as something that could potentially impact your brain, because nobody has done the studies.

So we were like, hmm… we have the population, which is quite unique, because usually people who do brain scans, like I do, look at patients who are sixty and older, whereas I wanted to look at risk factors for Alzheimer’s, so I’ve always been working with people who are younger. Forty to sixty. Because before forty, you shouldn’t have hormonal changes, unless you have a hysterectomy.

But we looked at women without hysterectomy or (ovariectomy) who were forty-to-sixty years old, and we divided them into pre-menopause/regular cycle, perimenopause, when you start skipping your cycle and you start having hot flashes, night sweats…

Yup. That’s where I am. Fun!

…insomnia, some depression, some word-finding issues, cognitive slippage. And then we have men, exactly the same age. And we did brain scans in all of them, and then we looked at the data.

And what we found is that if you are a man, forty-to-sixty years old, your brain is broadly fine. You have high brain activity, you have no Alzheimer’s plaques, and if you do it’s just a few, and your brain is not shrinking. On average, you’re fine. But if you’re a woman, it makes a huge difference whether you’re pre, peri or postmenopausal. If you’re a premenopausal woman you’re broadly the same as a man’s brain, for the same age.

If you’re perimenopausal, we find a dip in brain energy levels, which is really brain glucose metabolism, the way the brain burns glucose to make energy. In some cases, it’s up to twenty percent worse for women, and that gets even worse once they transition to menopause. The scan literally goes from bright red and yellow to green.

What does that mean? What does the red and the yellow mean?

That your brain activity is nice and bright, and then it drops. In some women by as high as fifty percent.

And green is bad?

Well, darker is worse, yes. You want your brain scans… I’ll show you.

Yes, I’d love to see.

[She opens a file on her computer.]

At the same time, we found that the women who show these energy drops, they start accumulating Alzheimer’s plaques. We have at this point hundreds of patients, and we also follow them over time, and we really show the change as women go from pre-menopause to peri-menopause to post menopause. Not all of them. There are some women who are fine, and some women whose brains are much worse.

Because, when women tell you I’m having hot flashes, I’m having night sweats, I can’t sleep at night, I can’t think straight, I have brain fogs, I get confused, I can’t multitask  —  so many women tell me I used to be so good in multitasking, and now I just can’t quite do it as well  —  those symptoms don’t start in your ovaries. They start in your brain! And it’s something that’s been completely overlooked. These are neurological symptoms of hormonal changes.

And we’re associating hormones only with what’s going on in the uterus, right?

Yes. We’re just thinking it’s about not having kids anymore. But that’s not the point. The point is that my brain, in middle age, is changing, and how do I make it better?

Yes. How do you make it better?

Well, it depends.

So there are two separate components, and this is really what I’m trying to clarify. All women experience hormonal changes. For some women, they’re not a big deal. For some women, they range in severity, from mild to severe, and they need to be addressed. For some women, they are so severe, that they can actually trigger Alzheimer’s.

Wow.

Yeah. If you have a predisposition for Alzheimer’s disease.

Genetic predisposition to it, right? Or just any sort of predisposition?

Any sort, because we have patients here who do not have any known genetic predisposition for Alzheimer’s, but they start accumulating Alzheimer’s plaques, and we know that Alzheimer’s is genetic in one percent of the population.

Then about thirty percent has some genetic risk factor that doesn’t cause Alzheimer’s, but they increase your risk, like having a family history or having some specific genes. But the rest of the population has none of this, and they still get Alzheimer’s.

So, the question is why?

One day we’ll find out what causes Alzheimer’s in people. Right now we don’t know, but we do have markers of risk.

So, if I know that you’re at risk, then I’d want you to take action. And then it depends, are you having the symptoms of menopause but not the increase of Alzheimer’s risks? Then we address menopause only. But if you also have a risk for Alzheimer’s then we really need to address that now. Because that’s when your brain is triggering these changes.

Estrogen is a really strong neuroprotective hormone. It’s strongly associated with immune system, it’s a neuroplastic hormone, so if you lose it, your brain starts aging faster.

And is that the same as testosterone in men?

No.

So, what do they have in their bodies that’s equivalent to estrogen that’s keeping their brains plastic?

Men’s brains are more testosterone-driven, but the thing is they also have a little bit of estrogen. The thing is that testosterone can be converted into estrogen at any time.

I did not know that.

Yes, and the other thing is that in men, they go through andropause, which is the male equivalent of menopause, but it’s a slow gradual process that takes a long time. There are men who become first time fathers when they are seventy-five.

Saul Bellow. He became a father at eighty-four.

Then there’s Mick Jagger.

Right, exactly. I’d probably have Mick Jagger’s baby if I still had a uterus.

[She laughs] There are plenty of examples. They’re given a chance, they can still have babies, whereas women can’t.

So unfair!

So, for them their brains are not as nearly affected by that. It’s almost the same as aging. What I think happens is that for men, chronological aging and hormonal aging kinda go hand by hand, slow and steady. Whereas for women, chronological aging is the same as men, but endocrine aging is just: boom!

Endocrine aging?

Yes, endocrine aging, so hormonal aging…

Endocrine aging, meaning you fall off the cliff, basically.

Yes. And we know that in the rest of the body, when you lose your sex hormones  —  your estrogen and progesterone, FSH, all these hormones  —  the rest of your body starts aging faster. Your arteries get harder faster, your bones become more fragile faster, pretty much anything that can age, ages a bit faster than before.

All women know that intuitively that when you’re past forty-five, if you go on a diet, it will take forever to lose the weight because your metabolism changes too.

Yes! I’ve eaten the same as I’ve always have, and I’ve put on like a pound a year since my mid-forties. It’s all sitting here, right in my mid-section, and I don’t do anything different. And I used to be thin and now I’m…

No, you are still thin, but your body changes.

And the shape of it changes, where the fat goes, everything. And I see the number on the scale climb, and I’m like what, why? I’m being nice to you, body! I feed you good food, I exercise.

Yeah, it’s the same for every woman, and it is a consequence of estrogen depletion.

Every woman knows that as you reach menopause, your hair goes dry, your skin goes dry, that’s aging. Nobody ever thought that the same thing would happen in the brain. Now why are we not thinking that? Because, in neurology, we are trained to think that the brain is completely separated from the rest of the body.

The brain is in charge of the rest of the body, but pretty much everybody assumes that the rest of the body doesn’t have much of an impact on the brain. And that turns out not to be true. In every possible discipline. I think people who discovered the microbiome really helped change this view of the brain.

You mean bacteria in the gut?

The bacteria in the gut, yes. They have shown that the microbiome has a huge impact on the health of the brain. So, if your bad bacteria outnumber your good bacteria, that has an impact on the brain. And everyone said that’s impossible, but it’s not.

There are products of these bacteria that can travel up the vagus nerve and affect the permeability of the brain, they can get inside your brain, they can change your production of GABA, which is a soothing, calming neurotransmitter.

So, if GABA is not being produced, you get stressed out and anxious, which is what the bad bacteria do to you. They kinda hijack your brain and then you get all stressed out and you keep doing all the negative things that will put even more bad bacteria into your body.

So, they’ve shown very clearly that your gut health has a strong effect on the health of your brain, but we know that. We know your heart, if your heart is not healthy, your brain is not healthy, because the oxygen can’t get in, the nutrients can’t get in, your iron can’t get in, you get anemia, you feel crappy.

And the same for your ovaries; there’s a feedback loop between the ovaries and the brain, it’s called the HPG axis: a highway that we have inside the body, it connects the brain to the pituitary gland to the ovaries and the thyroid. So hormones can travel back and forth. And that’s how your ovaries are communicating with your brain. And that changes your brain in a big way.

 

© Next Avenue – 2019. All rights reserved.

 

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Filed Under: news Tagged With: Alzheimer's and dementia, Assisted Living, brain health, Caregiver, Caregiving, Companion services, Dementia, early-onset alzheimer's, Health, Independent Living, menopause, Nursing Home, rental apartments, Rest Home, Senior Living, women's health

More Answers to Your Tax Questions

April 11, 2019 by Andrea Hikel Leave a Comment

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Answers to Tax Questions for 2018 Income Tax Returns

By Richard Eisenberg

Next Avenue recently asked readers to send us their top questions about their 2018 tax returns and we would answer as many as we could. In the story published in late March, three tax experts sorted out confusion about: who needs to file; standard deduction vs. itemized deductions; whether certain expenses are tax-deductible and late filing, late payments and extensions.
In this article, four tax pros and an online tax research platform provide answers to your 2018 tax return questions about retirement accounts and investments; inheritances and death and the rules about relocation and state taxes.
Three of the experts work for Wolters Kluwer Tax & Accounting: Principal federal tax analyst Mark Luscombe, senior estate and gift tax analyst Bruno Graziano and senior state tax analyst Brian Plunkett. The fourth is Mark Steber, chief tax officer at the Jackson Hewitt tax preparation firm. The CCH AnswerConnect online tax research platform from Wolters Kluwer Tax & Accounting also helped provide answers.

Retirement Accounts, Investments and Taxes
If my adjusted gross income is over $31,000 (for a single filer), I can no longer deduct anything I put into a traditional Individual Retirement Account (IRA), correct?
“You can put up to $5,500 ($6,500 if you’re 50 or older) into a traditional IRA regardless of the income you earn. You can still deduct all or part of your contributions when you are covered by a company retirement plan if your income is less than $73,000,” said Steber. And, he noted,“you may be eligible for the Saver’s Credit if you are contributing to an IRA and/or a retirement plan through your employer if your income is below $31,500. This credit is in addition to the tax-deferred contributions you are making to either type of plan.”
Luscombe added: “For 2018, eligibility for a deduction for an IRA contribution phases out for single filers at an adjusted gross income of between $63,000 and $73,000.”

In order to reduce my tax burden, am I allowed to deposit funds into my retirement account? If so, what is the max limit and by what date must I make the deposit?
Luscombe noted the $5,500 limit mentioned above, adding that the figure is also the limit for a Roth IRA. But, he added, “the Roth contribution is subject to income limits — phasing out with modified adjusted gross income of between $120,000 and $135,000 for single filers and $189,000 and $199,000 for joint filers.
Contributions for 2018 tax returns can be made until April 15, 2019, said Luscombe. But “for a 401(k) contribution for 2018, those contributions would have have to have been made by December 31, 2018,” he reminded.

I received a 1099 form for a mutual fund investment which shows: ordinary dividends (box 1a), qualified dividends (box 1b), capital gain distribution (box 2a), foreign tax paid (box 7) and foreign source income. I only need to include these dividends and distributions if/when I cash out of the fund, correct?
Not correct.
“Your dividends must be included on your tax return the year you earn them, even if you are reinvesting the directly into the fund,” said Steber. “You will include the dividends you already paid taxes on with the funds you purchased when determining the basis [cost] of your mutual fund distributions when you take money out. So no, you don’t wait to include the money on your taxes; you must include the dividends this year.”
Luscombe said the answer also depends on whether the money was in a retirement account. The reader would only be correct, he said, “if the fund was held within a qualified retirement account. Since you received a 1099, the fund is likely a taxable account and you are subject to tax on these items for the current year even if you did not cash out of the fund.”

I’m retired and 71 years old, receiving 1099-R’s from IRAs going back 20 to 30 years. They were made with both deductible and non-deductible contributions. 8606 forms were submitted to the IRS for the latter, in years made. How do I not pay taxes on the previous taxed nondeductible portions on this year’s tax forms?
“First, total all the IRAs together. Then, total all your previous non-deductible contributions and use Form 8606 to determine the taxable amount of each year’s distributions,” said Steber. “The tax code only allows you to take a pro-rated amount of your non-deductible contributions to your traditional IRA each year.”
Luscombe said: “You should only need the Form 8606 from the most recent past year to determine your cost basis in IRAs, since the 8606 forms carry over the cost basis from year to year.”

How do I figure the cost of my retirement income? I have been receiving Survivor Plan Benefits for 18 years. It is for life. It cost about $95 a month for the three years until he died in 2001.
“A Survivor Benefit Plan appears to refer to a military retirement plan where the service member paid for the cost of a survivor benefit until death in 2001,” said Luscombe, with assistance from the CCH AnswerConnect online tax research platform. “The payments under the Survivor Benefit Plan are taxable to the recipient, with no deduction for the cost since that cost was deducted from the taxable portion of the service member’s retirement pay.”

Inheritances and Taxes
I received a lump-sum inheritance distribution. Is this counted as income or is there someplace else we claim this inheritance?
“Inheritances are excluded from taxable income and the federal government does not impose an inheritance tax,” said Graziano, citing information provided in the U.S. Master Estate and Gift Tax Guide. “There is, however, a federal estate tax that is imposed on the estates of decedents. The current exclusion amount for federal estate and gift taxes is $11.4 million or $22.8 million for a married couple. In addition, some states including Iowa, Kentucky, Maryland, Nebraska, New Jersey and Pennsylvania impose an inheritance tax, which is a tax on the receipt of inherited property.”
Generally, Graziano noted, state inheritance tax rates and exemptions are more favorable to inheritances received by close relatives of the deceased person and to certain types of property, such as a family home or farm.
It’s a good idea to consult the law of the specific state or states you’re dealing with for more specific information, Graziano advised.
But “earnings on the money you inherited, or gain when you sell an item you inherited, are taxable,” said Steber.

My husband and sister-in-law inherited their mother’s house. The real estate agent valued the house at $250,000. It was sold for $195,000. Will they have to pay any income tax on the inheritance?
“Based on the information provided, there is a potential loss when the house was sold. The loss is considered a capital loss, and if neither your husband, sister-in-law or any of your relatives lived in the house after you inherited it and you sold it for the fair market value, you can claim up to a $3,000 loss on your tax return each year,” said Steber. “If the will did not state how to divide the property, it is assumed an equal division.”
Graziano explained, using information from the U.S. Master Estate and Gift Tax Guide, that heirs are entitled to receive what is called a “stepped-up basis” at death on inherited property. (That’s the value of the home at the time of death.)
Graziano recommended getting an appraisal by a qualified appraiser to establish exactly what the date-of-death value of the real estate is. “Just having a real estate agent say ‘the property is worth X dollars’ will probably not be sufficient to satisfy the IRS,” he said.
And, he added, if the home sold for more than the stepped-up basis amount, the heirs may be responsible for a capital gains tax. Its amount would be determined “based on the amount of the gain and the taxpayer’s overall tax situation for the year of the sale,’ said Graziano.

Relocation and Taxes
I moved from Washington state to Idaho in September. Do I have to pay Idaho state income taxes? I am not sure if this move will be permanent.
“State taxes can be tricky,” said Steber. “While Washington state doesn’t have an income tax, you will have to pay taxes on the income you earned while living in Idaho. How you pay your taxes — as a part-year resident or a nonresident — depends on your status, intention and the state laws.”
Plunkett said the answer will also depend on whether you earned income from a job in Idaho after the move. If so, you “will owe Idaho state income taxes on that income,” even if you didn’t officially become an Idaho resident, he noted.
When moving across state lines, it’s generally wise to speak to a tax adviser in your new state about the tax implications.

I moved out of my primary residence in March 2018 and have placed it for sale with a broker. I have also incurred expenses on that house (utilities, taxes, repairs, mortgage interest). The house has not yet sold. Can I deduct all of these expenses this year?
“You may continue to deduct real estate taxes and mortgage interest if you itemize deductions and comply with the new rules,” said Plunkett. (This presumes you still own the house and are paying the taxes and interest, noted Steber.) Among the new tax rules: a maximum deduction of $10,000 per year for state and local taxes, including real estate taxes.
But utilities wouldn’t be deductible, Plunkett added, unless you converted the residence into a rental property or operated a business out of the home. And repairs wouldn’t be deductible. But they could potentially be added to the home’s “cost basis” and then reduce any potential gain on the sale.
Up to $250,000 of gain from a principal residence’s sale ($500,000 for joint filers) can be excluded from taxes if the home was owned by the taxpayer and lived in for at least two of the last five years.

Richard Eisenberg is the Senior Web Editor of the Money & Security and Work & Purpose channels of Next Avenue. He is the author of How to Avoid Mid-Life Financial Crisis and has been a personal finance editor at Money, Yahoo, Good Housekeeping and CBS.
 
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Could It Be a Stroke?

March 21, 2019 by Andrea Hikel Leave a Comment

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There are many signs of stroke beyond facial drooping and speech difficulty

About a year and a half ago, my wife, Jules, called me at work to say she needed me to take her to an urgent care clinic. She was recovering from a cold and some minor sinus congestion and was feeling off-balance when she walked. We wondered if that could be due to a sinus or ear infection. She also had numbness in a part of her left leg.
I left work early and drove her to the urgent care clinic, where after an examination, the physician concluded the balance issue probably was due to an ear or sinus infection. She didn’t say much about the leg numbness and sent us home with antibiotics.

Three days later, Jules — who was not working at the time and about to start training for a new job — texted me to come home right away. She was on the floor in our apartment and could barely move. I called 911, and she was taken by ambulance to a hospital emergency room, where the physicians determined she had a stroke in the cerebellum part of her brain.
We Never Considered Stroke

Jules was 54. She had high blood pressure but was on medication. Other than that, she was in good health; pretty active, not overweight and ate a healthy diet.
What’s more, like many people, we knew very little about stroke and its signs and symptoms. We never considered that someone her age could have a stroke. In fact, even the physician who examined Jules at the urgent care clinic missed the stroke, perhaps because of Jules’ age.

“If a person is in their 70s or 80s and experiences sudden balance issues or numbness in a part of their body, the red flags go off,” says Dr. Robert Brown Jr., a neurologist at the Mayo Clinic in Rochester. “But the younger the person is, the less inclined we are to think it’s a stroke.”

Yet, a stroke can happen at any age, and “it’s very important that we make people aware of this because we have early acute treatments for stroke that can work very well,” Brown says.
There are two types of stroke, ischemic and hemorrhagic. Ischemic strokes are much more common, accounting for about 87 percent of all cases. In an ischemic stroke, a fatty deposit, or clot, obstructs a blood vessel supplying blood to the brain. The clot can develop at the location where it eventually blocks the blood vessel, or it can form in another location — usually the heart or large arteries in the upper chest and neck. In the latter case, the clot can break loose and travel to the brain, where it can block a smaller blood vessel.

In a hemorrhagic stroke, a weakened blood vessel in the brain ruptures and bleeds into the surrounding tissue. The American Stroke Association (ASA) and National Stroke Association (NSA) websites offer detailed information, including diagrams and animations, about strokes and how they affect people.

There Are More Signs Than ‘FAST’
In their efforts to raise awareness about stroke, both the ASA and NSA promote the acronym FAST. It stands for Facial drooping, Arm weakness, Speech difficulty and Time to call 911. It’s a great tool, but there are many more signs and symptoms of stroke. In fact, Jules had none of the FAST signs.

“FAST is a great way for people to remember the most common signs of stroke, but it by no means covers all the signs and symptoms,” Brown says. “People should know that if they, or someone they’re with, experiences a sudden onset of having trouble doing something they normally would be able to do, it’s possible that it could be a stroke. Things like sudden confusion; sudden weakness or numbness in the face, arm or leg; trouble with their vision; sudden difficulty walking or speaking or a sudden severe headache.”

Time is Brain
If a stroke is recognized early, there are acute treatments that can be very effective, depending on the type of stroke. As health care professionals say, “time is brain,” meaning the longer a person goes without treatment, the more damage a stroke can cause to the brain. Early recognition and treatment is crucial. Acute treatments include “clot-busting” drugs, and thrombectomy, in which a catheter is threaded from the groin up to the brain to remove a clot in an artery.

“The key is to treat as early as possible,” Dr. Brown says.

By Edie GrossfieldFacebooktwitterpinterestmailby feather

Filed Under: news Tagged With: apartments, Assisted Living, Bosque County, Clifton, Long-term care, Lutheran Sunset Ministries, Nursing Home, Rest Home, stroke, Texas, Warning signs

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Celebrating 65 years of ministry and service to the seniors of Clifton and Bosque County, Lutheran Sunset Ministries offers inspired retirement living options at every life stage. Our 32-acre campus is designed as an intimate setting of neighborhoods that accommodate residents at various levels of care. In addition to quality health and wellness opportunities, Lutheran Sunset Ministries provides an enriched lifestyle through innovative programs, interdisciplinary activities, and a focus on physical, intellectual, social and spiritual growth.

Providing the only full continuum of care available in Bosque County—including independent living, assisted living, long-term care, rehabilitation and therapy, memory support, hospice services and companion services—Lutheran Sunset Ministries is a cornerstone of the region. With a state-of-the-art healthcare building, an increase in services and amenities, and a rededication to providing services that allow people to live full and enriched lives, Lutheran Sunset Ministries has created a quality of life unparalleled in the region.

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