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Hope Don’t Die Hope II Don’tDie
How to Survive old Age, Your Own or Someone You Love How to Survive old Age, Your Own or for a Essential Checklist Someone
Before I GetGet Before I Old Old
Long and Fruitful Future
By Tracey Bowman and Mary Boone Wellington
Essential Checklist for a
Long and Fruitful Future
First...The future is upon us! The good news is that it might just last a very long time! Advances in medicine have already extended life expectancies decades in our lifetimes and we will surely see big breakthroughs throughout the decades to come. Time to take stock, rethink and retool for the next half of your life. Getting through this list and settling all the details for your entire future is not an easy undertaking. Harder still is facing the moment when the feelings of insecurity and uncertainty outstrip optimism and you just know, with a certainty, that you will have to put some sort of foundation or another in place to ensure a happy and healthy old age. Tracey Bowman and Mary Boone Wellington, authors of Hope I Don’t Die Before I Get Old, found it took well over a year to address every point on their own checklist! After years of challenges with their parent’s elder years and writing this book about aging and caregiving, they vowed to make serious plans for their own futures. Should they be lucky enough to live a very long time, as so many of us are doing these days, they want to enjoy their good fortune based on a solid plan. When they started neither of them had so much as a basic will in place! They used the buddy system, checking in from time to time with each other to share progress and offer encouragement. Most of these steps require a good long think about life and one’s particular circumstance. As Mary Boone said to herself “you are a grown up now and you can do it!” Tracey and Mary Boone advise you to take one step at a time and work your way through the list. Your reward for all this hard work will be a very real sense of peace and contentment, knowing you have taken responsibility for your own happy future. Even if some of the realities you face are not as cheerful or abundant as you had hoped, knowing where you stand is empowering. You will be amazed at how much peace of mind will be yours as you check off each step.
1. What you did not know about exercise: The human body builds muscle and athletic ability at an ever increasing proficiency from age 19 up to the age of 27. After that, the muscle mass generally begins a slow decline. Given the same training rate, the capacity of muscle mass will decrease back to the level of the 19 year old over an astonishing 45 years. After that, your athletic capacity reaches the ability level of your 19 year old self and capacity levels off. Conclusion? Given a competent training program, you can maintain the athletic ability of a 19 year old for your whole life! That’s right, your whole life! Take Jack LaLanne as an example. He maintained his muscle, vigor and strength for his entire life and died at age 95 having completed his customary 2 hour work out the day before. (Hey, no one said you would not die, just that you could remain strong enough to enjoy your life right up to the end of it) The catch is-you have to start, build, and maintain a program of regular aerobic and muscle strengthening exercise–for life. Consequences of Not Exercising: If you do not stick to a healthy regimen the decline in muscle mass causes a corresponding lowering of metabolism, causing weight gain. The loss of muscle also contributes to a loss of bone density because the ligaments pulling against the bone in weight bearing exercise is what adds to bone strength. With less muscle, we are likely to feel like doing less. Thus the spiral of diminished vitality leads to poor health and eventually death. Sounds pretty bad. But remember– the human body will build muscle at the same rate it did at age 19 right up into old age and beyond into extreme old age if it is only given the opportunity through a planned program of weight bearing exercise. That’s right--you’ve still got it! If you lost it, you can get it back! Speaking of losing it–are you afraid you are falling victim to “senior moments?” Brain power is similar to muscle power in that we are not destined to lose it as we age. The speed with which we do mathematical problems peaks in our twenties but our capacity to reason, remember and multitask are unchanged as long as we keep exercising our minds. Studies show that physical exercise contributes to the “cognitive reserve” and is beneficial even to dementia patients to keep the mind sharp.
New Season, New Plan: Make a new exercise plan at the start of every season. You know you aren’t going for that brisk walk in the winter if you live in Minnesota! Don’t just lay fallow all winter–sign up for a gym or take up a winter sport that uses similar calories, and builds bone. Seniors stand to benefit more than any other age group from regular exercise. It is not as important that you begin with the perfect program, but that you begin—right now. Regular (daily) exercise yields health benefits, both long term and short. Setting aside time each day to exercise is a lifelong habit that may be begun at any age. Improvements in blood pressure, neuro-cognitive function, osteoporosis, and cholesterol have been noted fairly quickly with consistent exercise routines. Exercise is essential to build up core strength that aids in balance, and preventing falls. Here is a list of what a regular exercise program will improve: ✦ Arthritis Pain - Exercise increases strength and flexibility, reduces joint pain, and helps combat fatigue. ✦ Diabetes Prevention - In one lifestyle intervention program that included moderate physical activity for at least 150 minutes per week, exercise was found to be more effective than medication in reducing the incidence of diabetes. ✦ Immune Function –During moderate exercise, immune cells circulate through the body more quickly and are better able to kill bacteria and viruses. After exercise ends, the immune system generally returns to normal within a few hours, but consistent, regular exercise seems to make these changes a bit more long-lasting. A healthy, strong body fights off infection and sickness more easily. ✦ Cardio-Respiratory and Cardiovascular Function – Regular physical activity lowers the risk of heart disease and high blood pressure. It can increase your lung capacity, strengthen breathing muscles to improve airflow in and out of your lungs. ✦ Bone Density/Osteoporosis – Exercise protects against loss in bone mass. Better bone density will reduce the risk of osteoporosis and lowers your risk of falling. Increases in bone density can be had in as little as 12 to 20 minutes of weight-bearing exercise, three days a week, dramatically reducing the loss of bone mass and susceptibility to fractures. ✦ Gastrointestinal Function – Regular exercise promotes the efficient elimination of waste and encourages digestive health. ✦ Risk Profile for Chronic Conditions and Cancer – The American Cancer Society recommends a physically active lifestyle, along with an appropriate weight and healthful diet, to prevent recurrence, second primary cancers, and other chronic diseases. Studies have shown that exercise improves cardiovascular fitness, muscle strength, body composition, fatigue, anxiety, depression, self- esteem, happiness, and quality of life in cancer survivors.
In addition to these medical improvements, you can expect: ✦ Better Sleep: people who perform regular exercise sleep more easily and deeply at night. ✦ Stress Relief: a 10-minute walk with a friend helps with stress relief. ✦ Greater social interaction: joining a fitness class or gym is a great way of meeting new people.Greater Contentment: exercise helps release endorphins which makes you feel more con- tented and happier. ✦ Weight Loss: regular activity reduces excess weight, especially if done in conjunction with a calorie-controlled diet. ✦ Better Joints: building the muscles around joints helps pre- vent joints being worn away. ✦ Improved Mood: physical activity stimulates various brain chemicals that may leave you feeling happier and more relaxed. You may also feel better about your appearance and yourself when you exercise regularly, which can boost your confidence and improve your self-esteem. ✦ More Energy: regular physical activity can improve your muscle strength and boost your endurance. When your heart and lungs work more efficiently, you have more energy to go about your daily chores.
Measure, compare and compete: There is a new little tracking device called Fitbit, www.fitbit.com, that tells how many steps you have taken in a day, then equates it to how many flights of steps climbed, how many hours of active exercise performed and how many calories burned. Through their web site, you can compare your results daily, weekly, and monthly as well as compete with others that you invite to be friends. This is a lot of fun and keeps you up and moving when frankly maybe you would prefer to sit on the sofa with a glass of wine and a movie. (ahem, like some of us!)
Mary Boone with Fitbit recording her every move!
Make it a regular routine or a game: With all these factors in favor of exercise, why don’t more people get going and set up a regular routine? Starting out can be difficult, because inactivity equals loss of muscle mass and endurance, the early days and weeks of a new exercise regimen can be daunting. By starting small, even the most frail elderly can reap the benefits of strength and well being that come with a fit body. The key is to exercise regularly and to begin slow. Selecting a new sport that can go the distance with you is entertaining. Biking on a recumbent bike can be a good lifetime sport; as is tennis, swimming and walking. All have health benefits and can be done with groups to make them fun. There are so many resources available for elder exercise it can be hard to choose. Making a commitment to attend a class might be just the thing to get you into your routine. Your physician can refer you to the most beneficial types of exercise to begin with and sometimes a program of physical therapy is a good place to begin. See if you can get a referral to work on your most pressing physical challenges. A good course of physical therapy can get you moving again and has been shown to be very effective in improving mobility. Check with your doctor before beginning a new program. Some helpful websites: http://www.eldergym.com http://www.strongerseniors.com http://www.aarp.org/videos.video-name=Fat-2-Fit-The-Quest-to-find-enjoyable-exercise/
2. What you didn’t know about your living will Medical options to prevent death are becoming more numerous Your doctors want to preserve life; it is their job. Your job is to tell them how far you will allow them to go. A living will states what type of care you will allow or not allow, should you become unable to make medical decisions for yourself. It is a legal document that provides instructions to a healthcare agent, also known as healthcare proxy to make your medical care decisions for you according to what you have put in your instructions in your living will. What do you have to decide? Think about being permanently unconscious or in intractable pain, but having health care professionals come in and do these things to you—things that will prolong your life just when you are going about the business of letting go of life. Here are a few things that should be dealt with in your living will: ✦ Cardiopulmonary resuscitation (CPR) is a method of reviving a patient’s heart by a device that delivers an electric shock to stimulate a heart that has stopped beating. If further chest compressions are done, it is of special concern to frail older folks because the process often breaks ribs and sternum, causing excruciating pain and a possible dying process that will be worse than normally expected. ✦ Artificial ventilation is a procedure to provide oxygen to you through mechanical means when you are unable to breathe on your own. ✦ Artificial nutrition and hydration provides fluid and nutrition either by a vein means or by a tube inserted through the nose. ✦ Dialysis cleans your blood and maintains proper fluid levels when your kidneys fail. ✦ Do Not Resuscitate Order states your preference not to be resuscitated and instructs healthcare providers not to use CPR if your heart stops beating. ✦ You can also specify organ donation preferences in a living will.
DNR? You may think that having a Do-Not-Resuscitate Order (DNR) in your medical files is enough to ensure a peaceful end, but more is needed. This DNR form states your preference not to be resuscitated and instructs healthcare providers not to use CPR if your heart stops beating, but anything that you have not mentioned in this form can, and probably will be done unless you have the protection your living will; a legal document. The health-care proxy has the power to prevent, or allow, any action that would prolong your life. You need someone who can definitively order the medical professionals to honor your wishes. We believe this person should not be one or all of your children. Spare them this task of having to make difficult and heart wrenching medical care decisions and trust someone who has a clear idea of your wishes and who shares your values about life and death. Why do you need a living will? ✦ To avoid legal wrangling ✦ To prevent suffering ✦ To spare your ﬁnances ✦ To give you the peace of mind that comes with control How do you do it? ✦ You can get the forms online for free and ﬁll them in yourself, or go to an attorney. ✦ There are different forms for each state; get one from your primary residence state. ✦ Get them notarized and ﬁle a copy where you keep all your precious documents. ✦ Leave a list of these documents where it will be easily seen (on your desk) and tell your near and dear ones where the list is. ✦ Tell your doctor you have a living will and give him a copy. This is one task on your list to secure a happy, old age for yourself and your loved ones you hope you won’t need, but will be very glad you made the effort if you do. Sure, it may seem depressing to contemplate all the awful possibilities, but how much worse would it be if you did not have the living will in place? Much worse. It matters, so just do it! This is one of the easy and inexpensive things you can accomplish that will give you peace of mind. http://nihseniorhealth.gov/longtermcare/planningforlongtermcare/01.html Another way to look at it: A recent article in the Wall Street Journal “Why Doctors Die Differently” by Ken Murray, Feb 25, 2012, talked about how most doctors, when given a diagnosis of a terminal illness (as in you have six months to live) would choose to go out and live the rest of their lives, doing what they want to do, and not spend it in the hospital having treatments to prolong their life. If possible, they choose to die peacefully, at home, surrounded by family.
3. Financing Your Elder Years If you are lucky enough to have arranged an income for your elder years you are ahead of most Baby Boomers! We advise looking into a Long-Term Health Insurance policy, an annuity or check to see if a reverse mortgage of your home will provide enough for your care, should you need help in later years. Keep in mind that the average stay in a nursing home is 3.0 years for a woman and 2.5 years for a man. You can check this site to see what average costs for nursing home care are in your state: www.ltcfeds.com Here are some details about these options: Long Term Care Insurance Odds are one in two that you will need extra care in your lifetime, and the rules are tightening up every day to get this kind of insurance coverage. This is one of the better insurance “bets” out there think about it, what other insurance bills do you gladly pay, (like homeowners, car, life insurance,) with such a great chance of getting a return on your investment? The younger and more healthy you are, the less it will cost you, even if you add in the extra years of paying for it. Once you qualify and purchase this insurance, as long as you pay your premiums, it cannot be cancelled, no matter what condition your health leaves you in. Would it help you to know that more people under the age of sixty five need long term care than those over sixty five? Age is not as big a factor as you might think in whether or not you might need care. Taking this one step will give you peace of mind and a warm and fuzzy feeling as you begin to take positive action on behalf of your own future. Consult an independent insurance agent to see which type of long term coverage and which plan might work best for you. Get a free booklet on Long Term Care Insurance from this site: www.kintzltc.com
Annuity If Long Term Care Insurance is not an option for you, then check into investing in an annuity. This investment is a better option than spending down your nest egg should you need care - and remember, one in two of us will need this care! You can get either a type of annuity that has health restrictions or one that is less strict. The one with more restrictions will have better benefits. There is a single fixed premium, (like Long Term Care Insurance,) with a long term care rider designed to cover long term care expenses. Everyone’s health and financial profile is different, so you have to be your own advocate in deciding which is best for you. After researching the possibilities, you may want to check with your financial adviser to see about possible tax benefits which plan he or she thinks is best for you. Reverse Mortgage Another way to fund long term care is with a reverse mortgage. The danger in counting on the equity in your home to pay for your future needs is that, as we have learned, in recent years the values can fluctuate due to the state of the economy, the desirability of the neighborhood or if your home becomes victim of natural disaster. It is a better option if you need it right away and no other plans have been made. You must be at least sixty two years old to apply for a reverse mortgage and the home must be owned free of any liens, mortgages or debt. At least one resident of the home must remain in residence and the homeowner is still responsible for all utilities, taxes and insurance. As long as these conditions have been met, the home is yours (or your spouses) to live in for life. One good thing about the reverse mortgage is that even if the value of the home declines below the amount paid by the reverse mortgage lender, the owner or their heirs will own nothing at the death of the homeowner. You can use the calculator on the web site listed below to get the amount you might expect from a reverse mortgage. Compare that number to the amount you might need for long term care in your state to decide if putting off planning for LTC until you need it will be a good decision. Be sure not to think about this same value to provide for other needs such as supplemental income for daily life at the same time - you likely have only one home so don’t count it’s value twice! You can learn more about reverse mortgages at: www.reversemortgageguides.org
It is not too late! Start your financial plan today!
4. Dental Health There are 700 different kinds of bacteria living in your mouth! I know, gross–but they are OK as long as they stay in your mouth. To ensure this you must keep your mouth is at it’s peak of health and vitality. If not, then these 700 bacteria types might enter your bloodstream through your incapacitated gums and teeth, then wreck havoc on your body by causing a heart attack. Sounds like a bizarrely implausible scary tale, but it is true, according to microbiologists from the University of Bristol and the Royal College of Surgeons in Ireland. Heart disease is the leading cause of death worldwide. First, you should understand that your teeth can last a lifetime, but only if you do your job of maintaining good dental health. Loss of teeth is not inevitable! Second, your teeth are vitally important to the health and well being of your entire body. Take advantage of your company dental insurance if you have it, before you retire, to fix up all the old fillings and problems with your teeth. Even if you have to foot the bill yourself, the cost will be far less to maintain your teeth than to lose them. Is your dentist up to date? Make sure your teeth are as great as they can be so they will go the distance with you. Be sure your dentist is up on the latest, greatest technology; if not find one who is.
New filling materials will last a lifetime and not break down like some of the older versions. Old style polymer and silver fillings can have a short life and decay under the cracked fillings can go undetected until it is too late to save the tooth. Research and development during the last ten years have produced dental materials that are not only more biologically compatible than the traditional dental amalgam, but are also stronger, more beautiful and can actually reinforce the tooth internally, thereby preventing further damage and need for future dentistry. There are now over one hundred different ceramic, glass-ceramic, and ceramic polymers that are superior to the older restorative materials in terms of both strength and function. Ask your dentist if they offer these new options and look around for a new dentist if they do not.
Maintain dental health
Have regular check ups and increase the frequency of cleanings as you age, especially if you accumulate tartar at a rapid rate. Some prefer a three times a year cleaning schedule because it keeps the focus on the daily oral hygiene routine better, knowing that check up is right around the corner! Make your appointments for the whole year at a time so you do not put this off. Should the worse happen...you lose a tooth or more than one, be sure to get small post implants to keep the bone of your jaw alive and vital. Bone that has no use is quickly absorbed into the body and then cannot even support prosthetic teeth! The new small post implants do a good job of this and are less traumatic and expensive than the old large kind. Using a powered toothbrush can make it easier for older folks to do a good job of cleaning the and gums. Use a flosser with a handle to be sure to get that thorough twice a day flossing done. It feels great to know you can do these small things for yourself that will keep you strong, healthy (and good looking) for your whole life. Keep smiling! http://www.nia.nih.gov/health/publication/taking-care-your-teeth-and-mouth
5. What you didn’t know about medical care This is now the age of the e-patient: An e-patient is an internet savvy patient who plays an active role in determining the path of their diagnosis and care by networking with other patients and care providers on the internet. Mining the internet for data about your symptoms and condition can yield surprising and often life saving clues to your condition. The relationship to your doctor after becoming an e-patient could change. Some physicians may not recognize the benefit of an engaged and informed patient and might see this as a challenge to his or her traditional role as captain of the healing ship. When Mary researched her mother’s symptoms on-line, she realized her doctor was no longer a good match. (“Your mother is just old” is not a diagnosis–but a surrender.) Described in detail in our book (Hope I Don’t Die Before I Get Old)her search found another doctor who welcomed the family’s very involved and engaged stance on her mother’s health. Dave deBronkart (aka ‘e-patient Dave’) describes how he came to be known as an ‘e-patient’ and his dramatic recovery in a TED talk in 2007. http://www.ted.com/talks/lang/en/ dave_debronkart_meet_e_patient_dave.html Medical records You can and should, ask for a copy of your medical records regularly. By reviewing what your doctor, nurses and office personnel write in your file, you can be certain you are being taken seriously and that your records are complete. Another great benefit of regular record reviews is to correct errors which could prove costly for you down the road, both medically as well as financially. When applying for, or renewing, an insurance policy your records are reviewed for medical conditions. If it is not accurate you may be charged more, or denied, your insurance. Your doctor can amend your record to reflect the real story, but cannot actually change it, so be sure to draw your insurance agents attention to any corrections.
Finding a Medical Professional Find a doctor or healthcare provider that you like and one that likes you. Your questions should be answered when asked, your phone calls returned, you should feel respected as an individual, given choices, and not treated like an “old” person who is no longer capable of thinking. Our health care system is a mix of private insurance, for-profit health care organizations nonprofit organizations, and government programs like Medicare and Medicaid. Sometimes your insurance dictates who you can see for care, as well as where and when, or how often you can be seen. There is some latitude for choice within some insurance programs. Some of your choices include: nurse practitioners, physician assistants, family doctors, a geriatric specialist and other specific specialists if you have multiple medical problems. It is important to have one provider (your primary care provider,PCP) that coordinates all your care so you are treated as a whole person, not a collection of body parts. This is especially helpful if you are on several medications or being treated by several specialists. Many people choose to see nurse practitioners or physician assistants for their primary care or even specialty care. The advantages are that they often spend more time with you, their focus is on building health through education by working with the whole patient and offering informed consent about your care to you. They usually work in close consultation and referral as needed with doctors. Another choice is to hire a concierge doctor. They are an option in many locations and for an annual fee, you get 24/7 access to your doctor, no time limits on your medical appointments, and no waiting in the waiting room. If you are traveling or if you need a specialist, you have access to their network of doctors all over the country. If you have ever suffered and worried while waiting for an appointment with a specialist, you will appreciate this feature very much. If you leave your doctor’s office feeling smarter than your doctor, go home and think it through. Did you feel respected by the doctor? Were your concerns and questions taken seriously and answered fully? Remember that the doctor is the expert here, but if you feel incomplete about the relationship, or have doubts about him or her, get some other opinions. Follow our list of helpful tips below but if all else fails, get another doctor if you can. Sometimes doctor and patient are just not a good match, personality or temperament. For instance, if you and your family are nervous Nellies, you may not be happy with a confident, breezy style. Find medical care that you can live with!
Here are some helpful tips for your appointments:
The name ‘doctor’ is used a lot but our tips apply to anyone you may see for care: in your home, in hospital or in an office.
✦ Ask for enough time. Be sure the receptionist understands the reasons for your visit. If you have a lot of questions, tell her you may need extra time in the doctor’s schedule ✦ Get a notebook to keep a log of questions that come up, symptoms, reactions, and improvements. Take it with you to the doctors and write the notes from the visit in it. Put it all in a loose-leaf binder along with some pocket folders for loose papers, brochures, recipes, etc. This keeps everything in one place for you and your fellow caregivers. ✦ If going to a new doctor, have medical records sent over ahead of time. Check the day before to be sure they were received. ✦ Take a complete list of current medications and supplements, and include the dosing and frequency of taking them. Include over-the-counter meds. Or put all the pill bottles in a bag and show them to the doctor. ✦ If you have a question about something you have read, bring a copy of the article along to show and leave with the doc. ✦ If several siblings or caregivers come to the appointment, have a plan of who does the talking. It is confusing if everyone chimes in, so decide ahead of time who presents what. Let the patient do as much talking as possible, but refer to your question list and don’t leave anything out. ✦ At the end of the appointment, repeat back the diagnosis and the tests, drugs or therapies prescribed. ✦ Ask for the plan for contacting you about test results. ✦ Ask how or when you might be getting relief from symptoms. ✦ If there are no answers yet, ask what the doctor thinks is causing the symptoms and why. ✦ Once you are satisfied you have communicated with your doc, and you understand and agree with the plan, then keep careful notes of any progress, have a little patience. ✦ Report any negative outcomes right away; such as side effects or worsening of symptoms or any new problems. ✦ Tell the doctor if the recommendations seem out of the realm of possible. For instance, if something like jogging or cutting out sugar from your diet forever is advised, and you can’t do that, then your doctor needs to know if you need extra help or inspiration to tackle something that may look easy to him but impossible to you. ✦ Put follow-up suggestions on your calendar and really do follow up.
Mary Boone Wellington and Tracey Bowman
Final thoughts from your friends at Before I Get Old Thank you for downloading this Essential Checklist and we hope you have found it helpful. It is inspired from our book Hope I Don’t Die Before I Get Old You can look for Part Two of our Essential Checklist to be available soon. You can visit our website, like us on Facebook, or follow us on Twitter. www.beforeigetold.com Share your thoughts with us at: Tracey@beforeigetold.com Mary@beforeigetold.com https://twitter.com/beforeigetold https://www.facebook.com/BeforeIGetOld To order the book go to: http://www.rosecottagepublishing.com
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