It wasn’t too long before reality surfaced – nothing drastic, just “things” that were never given a heading in the old budget. More to the point, it was the realization that while our income was more or less fixed, our needs were increasing.

What are your missing items? If you are about to retire, and counting your chickens, listen up! If you are well into retirement, you can just nod and say, “Yup, he’s got that right!”

BIG TICKET ITEMS
If you’ve decided to stay in your house, budget for that new roof or other major maintenance. If you’ve downsized and moved to a townhouse or condo, strata fees will increase regularly and there are regular assessments. For those who haven’t switched to riding a bike or a scooter, you’ll eventually need to replace your car. Allocate funds for these items unless future depletion of capital is not a problem.

FAMILY
God bless them, those kids and grandkids – the more the merrier. With their significant others, how many birthday and Christmas gifts need to be purchased? What about grads and weddings or other special occasions? Put aside a chunk of money for these expenses. Oh, and let’s not even talk about the potential cost of helping out children coming home after a marriage break up, job loss or other financial disaster – the kind of events that could trash any budget.

HEALTH
If you were lucky to keep your extended health insurance from employment, great! If not, you pay the premiums, which increase with age and health problems.
If you pay the freight as you go along, just some simple blood pressure meds, vitamins and supplements, eyeglasses and perhaps a hearing aid, physio and dental may run into thousands. As you age, these costs keep going up! And have you considered critical illness insurance?

TRAVEL
That was on the top of the list for your retirement activities, right? Before you go anywhere, you had better have travel insurance and hope to be healthy, because on top of the age-based increases in premiums, the extras for various health problems are significant. Then you need to allow for the ever-increasing cost of all travel-related functions and hope that in 10 years’ time you can afford to travel further than Calgary!

INVESTMENTS
Even with the best financial advisor managing your funds, another trashing by the markets like a couple of years ago, may put a major damper on your

Every afternoon, when the man in the bed by the window could sit up, he would pass the time by describing to his roommate all the things he could see outside the window. The man in the other bed began to live for those one hour periods where his world would be broadened and enlivened by all the activity and colour of the world outside.

The window overlooked a park with a lovely lake. Ducks and swans played on the water while children sailed their model boats. Young lovers walked arm in arm amidst flowers of every colour and a fine view of the city skyline could be seen in the distance. As the man by the window described all this in exquisite details, the man on the other side of the room would close his eyes and imagine this picturesque scene.

One warm afternoon, the man by the window described a parade passing by. Although the other man could not hear the band – he could see it in his mind’s eye as the gentleman by the window portrayed it with descriptive words.
Days, weeks and months passed. One morning, the day nurse arrived to bring water for their baths only to find the lifeless body of the man by the window, who had died peacefully in his sleep. She was saddened and called the hospital attendants to take the body away. As soon as it seemed appropriate, the other man asked if he could be moved next to the window. The nurse was happy to make the switch, and after making sure he was comfortable, she left him alone.

Slowly, painfully, he propped himself up on one elbow to take his first look at the real world outside.

He strained to slowly turn to look out the window beside the bed. It faced a blank wall.

The man asked the nurse what could have compelled his deceased roommate who had described such wonderful things outside this window. The nurse responded that the man was blind and could not even see the wall.

She said, ‘Perhaps he just wanted to encourage you.’

Epilogue: There is tremendous happiness in making others happy, despite our own situations. Shared grief is half the sorrow, but happiness when shared, is doubled. If you want to feel rich, just count all the things you have that money can’t buy. ‘Today is a gift, that is why it is called The Present .’

Your time is the greatest gift you can offer but when we are all so busy, sometimes this isn’t possible.  Consider gift certificates for care giving, taxis, hair dressers, food and other delivery services. Pedicures and home visits from a trained foot nurse are very good for both sexes as feet can be troublesome for older folks. Massage therapists will also travel to their homes and treat them to a massage. Think about the challenges your seniors have and what may help them.  If buying books, be sure to check the print size and the weight of the book so that it will be comfortable for them to enjoy. If purchasing music, be sure that they have the equipment to play it and are confident in using it.

If your senior is struggling with a home computer, consider a gift certificate for in home lessons. Many seniors would enjoy the new technology available but are nervous to get it home and have to install it.  Offer your help in doing so or hire a professional for them. Telephones are important tools for seniors and the ability to have handsets in every room (including the bathroom) would be a wonderful gift for not only their peace of mind but for yours as well. Just be sure that help is offered to install and program any equipment given.

Almost every business offers gift certificates so think about something they may want or a service they can use and inquire about a gift card or certificate. Many seniors don’t want to indulge themselves as they are concerned about how long their money will last – so if you can help them enjoy those indulgences, they will be very grateful. Although many don’t think of it – cash discreetly tucked into a card gives the senior the opportunity to choose something for themselves or help with costs for medication or daily living.

As with giving a gift to anyone, just acknowledging them and their importance in your life is the greatest gift that you can share. Slow down and appreciate the moment with them, the lessons you will learn will be their greatest legacy and gift to everyone.

Happy Holidays, everyone.

• Let visitors know in advance what to expect. If they have not visited in a while, prepare them for any changes in the care recipient’s health, behaviour or appearance.
• Explain your daily routine, and let them know the best time to visit.
• Ask for and accept help. Make a list of what needs to be done. If someone asks what they can do to help, respond with specific requests. Focus on people’s strengths. Some visitors are happy to help with personal care, while others would prefer to grocery shop or clean the gutters.
• Allow others to share in the caregiving. This can give you a break. Allow them to contribute, and give the care recipient an opportunity to interact with someone new.
• Don’t feel you have to “entertain” your visitors. Sometimes simply spending time together is enough.
• Remember to take time to have some fun, share and laugh too.

If you are the visitor:

• Make arrangements well in advance. Even if you are only coming for a short visit, call ahead to ask the caregiver what time would be best. When is everyone’s energy strongest? When are people resting?
• For longer visits, ask whether it would be better to stay with them or elsewhere.
• Resist the urge to advise the caregiver about what they should be doing differently. Remember what happens during your visit may not be the same as day-to-day care. Often the ill person will rally forth when visitors come.
• Plan to visit in small groups for short periods, so that neither the caregiver nor care recipient becomes too exhausted.
• Offer to help with chores, errands or other holiday-specific tasks, such as shopping, baking and decorating.
• Allow the caregiver to get away and have some free time. Perhaps give him or her a gift of a lunch out, a trip to the spa or a chance to attend some holiday events.
• Express your appreciation to the family caregivers. Simple recognition of their time and effort may be enough to make caregivers feel more appreciated and help them stay strong, healthy and better able to continue to provide care.

In its initial development and validation, it was found that using a cut-off of 5 or more “yes” responses to the screening instrument gave the test a specificity of 90.2% and a sensitivity of 84.6% for detecting possible or probably Alzheimer’s disease.

This simple tool should only be used as a guide and cannot replace clinical diagnostic tools administered by trained professionals.

Responses do not determine a diagnosis of dementia or Alzheimer’s disease, they may simply suggest the need for further assessment.

This information based dementia screening tool is adapted from the Symptoms of Dementia Screener, and has been developed as a screening tool for Alzheimer’s disease to be used by lay people with little or no medical training.  It is not intended to be filled out by persons in whom possible cognitive difficulties are suspected, but rather by someone else who knows them.

In its initial development and validation, it was found that using a cut-off of 5 or more “Yes” (Y) responses to the screening instrument gave the test a specificity of 90.2% and a sensitivity of 84.6% for detecting possible or probably Alzheimer’s disease.

This simple tool should only be used as a guide and cannot replace clinical diagnostic tools administered by trained professionals.

Responses do not determine a diagnosis of dementia or Alzheimer’s disease, they may simply suggest the need for further assessment.

Yes (Y) No(N) Don’t Know(?)

___  1. Does the individual often repeat himself or herself or ask the same questions over and over?

___  2. Does the individual seem more forgetful, that is, have trouble with short-term memory?

___  3. Does the individual need multiple reminders to do things they used to on their own, like chores, shopping or taking medications?

___  4. Does the individual repeatedly forget important appointments, family occasions or holidays?

___  5. Does the individual seem sad, down in the dumps or prone to crying more often that in the past, and without any apparent reason?

___  6. Does the individual have trouble doing routine calculations, managing finances or balancing a chequebook?

___  7. Does the individual appear to have lost interest in his or her usual activities such as hobbies, reading or social occasions?

___  8. Does the individual need help performing regular activities such as eating, dressing, bathing or using the bathroom?

___  9. Does the individual become easily and unexpectedly irritable, agitated, suspicious or has he or she started imagining (i.e. hearing, seeing or believing) things that are not real?

___  10. Has the individual been getting lost driving, driving unsafely or stopped driving? Does he or she get lost walking in a familiar area, such as their own neighborhood?

___  11. Does the individual have trouble finding words, finishing sentences or naming people or things?

Q. I followed my dad, 78, enroute to a family party, and was quite concerned by his driving – erratic speed, unsafe lane changes and dangerous hesitation at on-ramps. He’d be devastated to give up his license – what can I do?

A. Research confirms that older drivers are involved in more accidents – per kilometer driven – than their middle-aged counterparts. Of course you want your dad to be independent as long as possible – and drive safely and confidently.

• Identify dad’s driving challenges – vision, reaction time, physical limitations
• Schedule a family doctor visit – to check vision, hearing, cognition, medication dosages and/or combinations.
• Get an evaluation – by a driver rehabilitation specialist who can make specific recommendations for improvement.
• The doctor – may write to the provincial Ministry of Transport recommending that the licence be revoked. With luck, this step may convince your dad to surrender his licence and keys voluntarily.
• Send a copy of the doctor’s letter to the Ministry and also to his auto insurer, who will cancel his policy.

No one wants to treat a family member in this way, but you must keep in mind the liability and potential for harm to your parent and to others. It’s an unhappy role-reversal for you to do this to your father, so make sure you have the understanding and support of all family members, and give yourself credit for having the courage to love your dad so much.

This information was provided by Pat M. Irwin, BA, AICB, CPCA, is founder and president of ElderCareCanada, a single-source consulting firm for adult children and their families, addressing all aspects of elder care – www.eldercarecanada.ca

The incontinence may be a result of infection, especially of the urinary tract; injury, such as a hip fracture; surgery, particularly prostate surgery; chronic illness, such as diabetes and heart disease. Or it may be a bad reaction to medication. ‘Accidents’ or urine loss when a person laughs, coughs, or sneezes may be related to pelvic or sphincter muscle weakness.

Diuretics are foods and medications that cause the body to shed water and may increase a person’s frequency or urgency to urinate and lead to incontinence. Caffeine: found in coffee, tea, cola, cocoa, beer, chocolate and soft drinks is a known diuretic. Several medications have a diuretic effect.

Constipation can be a major cause of urinary incontinence in the elderly. A full bowel can block the flow of urine or cause urine to stay in the bladder. People with constipation may also exhibit bowel incontinence.

Dark, strong smelling urine can be a sign of dehydration. If a person is not getting enough liquids (about six cups daily), the urine may become so concentrated that it irritates the bladder and may cause bladder or urinary tract infections.

Confusion may occur as a side effect of medication. Parkinson’s Disease, stroke, and spinal cord injury may affect the brain so that it does not give a person enough warning time to get to the toilet before the bladder or bowel is emptied. Brain tumours may affect people’s ability to empty their bladder or bowels without help.

People in the early stages of Alzheimer Disease and other dementia may forget where the bathroom is or how to use it. In the middle and later stages of dementia, people lose the interest and ability to look after themselves and forget how to urinate or move their bowels. Poor eyesight, speech or hearing may affect a person’s ability to seek help from a caregiver.

Incontinence is quite common in seniors, but it’s rarely an issue on its own – very likely there are multiple medical problems. So, for a caregiver, the first thing to understand is that it’s not their fault. Don’t get angry, and do try to get over the initial embarrassment you feel. And do help them get over any embarrassment they might feel.

You can help: put a big picture sign on the door; keep the route clear of obstacles; leave the washroom door open so the person knows it’s not occupied; consider handrails, use easy off clothing (velcro vice buttons); consider a bedside commode and waterproof bedding; avoid drinks in evening; always void before bedtime.

Most importantly though is to get medical advice – from your GP or from an Occupational Therapist. Only very rarely can nothing be done about incontinence, and getting treatment is the first step to being worry free.

It’s often said that losing your hearing is worse than losing your sight. Age-related hearing loss may be inevitable for most, but it doesn’t mean you can’t do anything about it. Hearing aid technology has come a long way in the last five years.

But let’s step back a moment and look at hearing loss. There are two kinds: conductive (of the outer and middle ear, which is usually temporary and treatable) and sensorineural (of the inner ear, which is usually permanent and will likely require a hearing instrument). A few seniors suffer from both types. Of course, prevention is better than cure, but I won’t discuss prevention here. Your GP can help with conductive hearing loss, but you’ll need to see a qualified specialist (an Audiologist) to assess and correct sensori-neural hearing loss. Do not be tempted to order a hearing aid by mail-order – the chances of a satisfactory outcome are very low.

The treatment of hearing loss can improve: intimacy and warmth in family relationships, communication in relationships, perception of mental functioning, sense of control over life events, emotional stability, physical health, and group social participation.

Just as important is that treatment can help reduce: discrimination toward the person with the hearing loss, depression, hearing loss compensation behaviours (pretending you hear), anger and frustration in relationships, feelings of paranoia, anxiety, social phobias and self-criticism.

Hearing aids don’t just amplify sound, they clarify the sounds you want to hear, and some even minimize (filter) the sounds you don’t.

The leading reason why seniors don’t take corrective action is stigma, followed by inadequate information, and the belief that nothing can be done. Of course, cost is an issue: few insurance policies cover hearing aids, and the government provides little help if any (though DVA does help veterans). Your GP can arrange a hearing test, but a private one costs less than $50 and waiting time is minimal.

Just about everyone who tries an aid likes it. Most wonder how they ever got along without it! A qualified Audiologist can show you – literally – what you’ve been missing all these years. The difference will astound you!

A. Accepting any disability’s symptoms, limitations and prognosis is extremely difficult. Some ideas for you are:

Get informed – scour the Internet and publications so your advice has credibility

Be a support – visit the doctor with your mom and record what is discussed; make a list of her medication schedule; find diabetic cookbooks and products

Seek help – contact the Canadian Diabetes Association (416-214-1899) for resources and programs; if your mother won’t go, attend a caregiver support group yourself for ideas

Get involved – consider doing volunteer work for the Diabetes Association, then try to involve your mom to see how others cope with the disease

Back off – when you’ve done all you can, don’t nag – it can be counter-productive

Above all, use humour, recall how she couldn’t ‘make’ you study or practice piano,talk about past successes and remind her you’re always there for her

A. You are right to be concerned about this issue – it’s estimated that 50% of prescription drugs are ineffective because they are not taken properly. It’s also common to receive prescriptions from more than one physician, which may lead to inadvertent adverse reactions between various drugs. Add that to the very real possibility of confusing or missing a dose, and your mom could be at serious risk. Here is a plan:

• Verify all prescriptions – make notes, recap the decisions and leave the discarded medications with the clinic for disposal – if you take them home, they’ll find their way back to the night table!
• Set up a dispensing system – ideally, a pharmacy-filled dosette or blister pack. The pharmacist reviews all prescriptions and pre-fills all medications by day and time. The dosette or cardboard blister pack can be picked up or delivered on a weekly basis.
• Write it down – the blister pack labels outline the medication name, dosage and condition it’s prescribed for. Document this list, keep a copy and tuck one into your mom’s wallet beside her medical card, so that anytime she seeks medical attention – especially if she’s not able to communicate – the information is readily available.
• Stay involved – Do her medical practitioners know you? If she were incapacitated for any reason, do you know enough about her medical condition to direct her care? If not, get informed now – don’t wait for a health crisis.