Choosing a gift can be difficult, especially for persons with dementia or other disabilities. Families often ask us what would be appropriate gifts to give our clients for the Holidays, so as a helpful resource here are some gift ideas.

Gifts to Improve Memory and Cognitive Function:

• Crossword Puzzle Books (word search, Sudoku)
• Hand-held video games such as Solitaire, Bingo (also helps with dexterity)
• Board games – take time to play , i.e. Tri-ominoes, Tangos, jigsaw puzzles with large pieces, or
  board games such as Life Stories or Reminisce.
• Books on Tape or MP3 players (books can be downloaded from the local library for little to no
  financial outlay) old radio show cassettes that can be played on an inexpensive tape player (Find
• these at Cracker Barrel)

Gifts for Safety:

• Medication compartment boxes, boxes with reminder alarms, alarm watches. Driver’s Safety Classes www.aarp.org/families/driver_safety to find classes in your area. Many automobile insurance companies
  also have programs—check with agent
• Alzheimer’s Association’s Safe Return Program (pay the enrollment fee) www.alz.org/SafeReturn
  (800) 272-3900
• Emergency Response Systems (Go on-line to find coupons for free installation and discounts)
• Motion activated lights for path to bathroom, www.improvementscatalog.com
• An electric tea kettle with automatic shut-off
• For those who cannot/will not use a microwave oven: The Euro-Pro toaster oven has a timer
  control for automatic shut-off and is large enough for meals-on-wheels pans and frozen dinners.
  Available at most department stores.

Gifts for Comfort and Sensory Stimulation (Moderate to severe cognitive impairment):

• Pillows and throws in unusual textures, stuffed animals, and small sculptures
• A new bathrobe
• ‘Pillow pal’ for something to cuddle that supports aching backs or something uniquely entertaining
  like a singing stuffed animal.
• Potpourri, flameless scented candles/tart warmers and scented bath items–lavender scent is
  calming for “sundowning”—spray on pillowcase at bedtime or tuck a sachet in nightgown drawer
  or between linens.
• Music box, wind chimes, portable radio or TV, audiotapes, or an audio-clock
• Shatter resistant magnifying glass
• Creative ceiling decorations for someone living in a small space such as kites, posters, or
  mobiles.
• Buckwheat neck pillow for when sitting in wheelchair or geri-chair
• Microwaveable heating pads
• Wheelchair Accessories – backpacks, oxygen carriers, rim covers, brake extensions, trays and
  seat cushions.

Gifts from the Heart — Gifts of Time (that cost little or no money):

• Scrapbook
• Creating a family memory video
• Writing a memoir/personal history
• Weeding their garden
• Planting their flowers
• Membership to local science center, zoo, museum (and you taking them!)
• Trips to the local library
• Enrolling the person in the Library of Congress’ Recorded Books Program for those with impaired
  vision or fine-motor coordination/strength www.loc.gov/nls or downloading MP3 audiobooks to
  inexpensive MP3 player (available at Wal-Mart, Staples, Target, Kmart) through local library:
  www.netlibrary.com/RecordedBooks . Some libraries carry audiobooks pre-loaded onto MP3
  players.
• Compile family recipes into a book. You can even self-publish and print a hardcover version!
• Pre-addressed & stamped family birthday/anniversary cards with the date to mail it written on the
  envelope flap so that the client can continue to be involved
• Personalized Calendars with family photos and birthdates, other special anniversaries (Sam’s
  Club Photo, Costco, Shutterfly.com)
• Jar with decorated lid (or box) filled with pieces of paper, each with a memory involving the elder
  and you. Open one each visit!
• An IOU for a year’s worth of lawn care or 52 car washes from a teenager might be appreciated.
• Personalized gifts, such as a deck of cards or jigsaw puzzles using their photo or a favorite
  grandchild or pet
• Large poster of them with a grandchild for their walls
• Bird feeder (plus the IOU to keep it filled) would add some interest to their window, and include a
  book on bird watching or a book or pictures of birds
• Storage boxes in bright colors, personalized everything!, clothes, door decorations

Gifts for the active Senior who has everything:

• Frozen steaks, salmon, gourmet dinners
• Gourmet tea and coffee
• Gift certificate for restaurants
• Fruit of the month
• Nuts
• Fresh kitchen spices (these are expensive on a budget)
• Tin of popcorn, microwave popcorn packets, a microwave popcorn popper that actually works:
  Presto® PowerPop® microwave multi-popper, or a hot air popper (both available at Target)

Gift certificates for:

• Tickets to the movies, theater, zoo, or museum
• Stores or shopping malls
• Favorite hair salon
• Massage, manicure, facial, salon/spa “day of indulgence”
• Housecleaning
• Subscription to magazines related to their interests
• Plants or cut flowers:
• Christmas cactus
• Ficus
• Norfolk pine
• Corsage

Mindfulness is “paying attention in a particular way: on purpose, in the present
moment, and non-judgmentally”

Elders and their caregivers confront multiple, often simultaneous stressful challenges of loss, illness, and disability. Many are treated with Western medicine for pain and chronic conditions, which may be stress-related, often producing marginal results. In addition, studies now connect high levels of stress with lowered levels of cortisol, impacting our immune system’s ability to fight large and small diseases (R. Sapolsky, Why Zebras 2004). This is especially significant for seniors going through multiple emotional and physical changes, as well as caregivers who are at an increased risk for burnout. Now more than ever, elders and caregivers are turning to mind-body interventions, utilizing the connection between the mind, body, emotions, and spirit for healing. Personal experience may have already informed much of what science is now validating — the mind and body are connected!

Mind-body stress reduction skills are often taught as “mindfulness practice.” Mindfulness based interventions (MBIs) may be taught as a formal practice of meditation, walking, or yoga; or as an informal practice of learning to pay attention to daily activities- eating, working, talking, etc. Mindfulness skills promote an ability to respond, rather than react, to crisis. Mindfulness training has been shown to reduce anxiety and strengthen immune response, offering preventative tools for both mind and body (Kabat-Zinn, Full Catastrophe Living, 1994). Recent preliminary studies have found that these skills can be adapted to teach older persons with physical and cognitive frailties, and stress. The application of MBIs for professional and family caregivers is equally important. Caregivers are the primary contact for older persons, and if the caregiver is distressed, the older person will also be distressed. MBIs offer a means to heal and support both caregiver and care receiver.

Meditation

I have found both frail elders and caregivers receptive to seated meditation. Frail elders may need shorter, more directive and guided experiences. With dementia patients, my non-verbal presence and tone helped participants understand the expectations. Some report this experience connects them with past spiritual practices, others find a sense of peace and control in the midst of distressing events. One frail elder with a history of paranoid schizophrenia, reported that the group meditation was the only place she found deep peace. She also reported that the meditation practice reminded her of lighting candles on Friday night, a part of her Jewish roots.

Gentle yoga or mindful movement

Adapted yoga serves many purposes for frail elders and their caregivers. The underlying principle of this practice leads to deeper understanding of our bodies, as well as our habitual emotional responses. Taught from the perspective of potential rather than limitation, yoga is available to everyone. Frail elders, as well as many caregivers, may not view their body as an ally. In yoga, they may begin to develop a new, friendlier relationship with their body. The role of instructor is key to supporting this attitude towards yoga and bodies which are non-competitive. For example, when stretching our arms, I might instruct that those who cannot use one or both arms, to just stretch the arm that is available to them. If they cannot move their arms at all, I ask them to focus on their breathing and imagine they are stretching with us. Demonstrating, verbal cuing and hands on assistance may be helpful, and for those who are less mobile, the internet is a good resource for researching chair and bed adaptations.

When working with caregivers, I have found mindful movement an excellent way to integrate practices into a busy life. Caregivers are encouraged to practice standing mountain pose any time they are waiting (for the elevator, in line at the store or bank…). Mindful walking can also be done, briefly, during a busy day. Deep breathing is also a skill that caregivers find useful in stressful moments. and once learned, the discipline of using the breath to stay calm can have advantages for the caregiver and the patient.

Informal practice

Frail elders are frequently reminded of their limitations and dependency; mindfulness practices offer choice and control over one’s response to situations. Caregivers also often feel their life is out of their control. Using our breath as an anchor for our attention, we can choose to stay in the present moment, whether pleasant, unpleasant, or neutral. As one caregiver reported: I feel less anxious about stress than I formerly did. I now think about ‘riding the waves’ instead of getting anxious about them or ‘fighting’ the waves. I feel less responsible for my mother’s well-being.
The first step for GCM’s interested in exploring and sharing mindfulness skills with the elders they work with is to learn more about meditation and yoga groups/classes in the community. Some assisted living communities have already integrated these non-traditional techniques for residents who are not particularly religious, but looking for alternative means to cope with stress. They become more resilient when dealing with multiple losses and show an increase in overall sense of well-being.

by Betsy Evatt

One highlight of the incredible NAPGCM Conference in Albuquerque was Dennis McCullough’s introduction to “Slow Medicine.” The audience was moved by both the content and the inspiring presentation, mixing poetry and philosophy into a captivating whole. We came away from the conference wanting more. This interview continues the dialogue with Dr. McCullough.

INSIDE GCM – Many of us left Albuquerque espousing the virtues of Slow Medicine to our clients, families, and colleagues. It is not easy to synthesize the concept into an “elevator speech” that is concise and understandable. How would you summarize this approach in the few minutes we often have for such conversations?

Dennis McCullough – slow medicine is both a philosophy and a set of practices. The philosophy is based on knowing that elders in these “later years” have a different mix of vulnerabilities and strengths from the “younger old.” The practices of slow medicine (understanding the unique circumstances of an elder’s life and issues; always, always slowing down the process of making decisions; and continually striving to make broader and better coordinated partnerships between elder, family, “circle of concern,” and
professionals) help maintain quality of life and decision-making by keeping the elder and family in control.

INSIDE GCM – How do you suggest we introduce the subject of Slow Medicine to the physicians we work with in a way that is not offensive?

Dennis McCullough – briefly say that an approach to frailer elders called “slow medicine” is being promoted to improve quality of care. “Perhaps you or some of your staff have heard of it?” (Pause) “it emphasizes teamwork in eldercare and interests me and ‘x’ and her family. Could we take a few minutes to talk about this approach at the next visit?” (It is important to plant the seed without trying to bring up the details immediately, for the physician likely will not have enough planned time for a discussion right then. Approach the task of introducing slow medicine in the same way that you want the physician to approach patient care–slowly and carefully, allowing time for things to sink in.)

INSIDE GCM – When the Care Manager accompanies a client to the physician’s office to serve as the health advocate, our mantra needs to be “why?” and “what are the side effects?” for every invasive treatment or medication addition. What else should our script always include?

Dennis McCullough – the most important task in every visit is listening and promoting a partnership between patient, physician, and yourself. It can be useful to explain that all the questions you are asking are meant to allow you to clearly explain the physician’s thinking to family (and patient again) after the visit is over. Your goal is to get the physician to expand his or her thinking about the issues by talking a little more extensively. As you listen, appropriate questions will naturally arise. This is too complicated for there to be a general script.

INSIDE GCM -You mentioned that due to today’s fragmentation of health care, and the myriad of specialists who step in and out of the elder’s life, there is a need for an individual who says, “I am with you until the end.” You described this as a “covenantal relationship.” This is a beautiful depiction of the role a care manager takes on with a client. Can you please elaborate on this idea?

Dennis McCullough – as we think about “re-balancing” medical care we need to recognize that some important human aspects of caring for elders have been lost. Extended relationships which engender trust through proven commitment to “be there” is one of the losses of greatest impact for elders, who need to be understood in depth and over time. As this role is being increasingly vacated by physicians (brought on in substantial part by medical organizations which have created specialized “silos of care”), others are appropriately filling this void and are much appreciated for it. This aspect of the work of geriatric care managers is “bedrock” to your profession and a special gift to your clients and their families.

INSIDE GCM -What is the first step a care manager can take to introduce the philosophy of Slow Medicine to our clients and their families? Dennis McCullough – explain that your goal as a care manager is to “slow down” to the speed of the world in which your client lives so that everyone can better understand and make decisions that make sense together.

by Hannah

Skin cancer is very common. In fact, one in every three cancers diagnosed are classified as skin cancer. But what is skin cancer? The Epidermis (skin) is made up of four different types of cells Merkel, Langerhans, Keratinocytes, and Melanocytes. Skin cancer occurs when irregular skin cells form to create a malignant or benign lesion. Malignant lesions are more aggressive and considered cancerous. Benign lesions are considered non-cancerous. These irregularities within the cells are a DNA mutation caused by ultraviolet light.

Skin cancer is most commonly a result of sun exposure. There are steps you can take to safeguard yourself from developing the disease. First and foremost, anytime you are going to be exposed to sun you should be wearing sunscreen. When selecting sunscreen, make sure you choose broad spectrum with an SPF of 30 or higher. When you have outdoor activities planned make sure you are covering up or enjoying your time in shaded areas. Avoid tanning beds. Although it may be tempting to achieve that summer glow from a tanning bed, it is not worth it. When you use a tanning bed, you are exposing your skin to direct ultraviolet light, the very thing that causes skin cancer.

Even after taking precautions, skin cancer can still develop. It is important to note, although skin cancer is most commonly caused by sun exposure, it can develop in areas of the body that are not exposed to sun. That is why it is important to know what to look for and to search your body thoroughly. You should be examining your skin every month and visiting a dermatologist each year for a full examination. You should see your dermatologist right away if you spot any notable skin issues.

Where should you be looking and what are you looking for?

Typically, skin cancer forms on sun exposed skin. Primarily affected areas are scalp, lips, chest, arms, hands, face, and ears. When you perform your examination remember you ABCDE’s:

A – Asymmetry, lopsided or uneven.
B – Border, irregular edges like a puzzle piece or blurred edges.
C – Color, red, white, blue, or pink.
D – Diameter, size of the growth.
E – Evolution, changes noted to the growths size, color, edges, etc.

Monitoring your skin for these changes is a helpful habit to create. Early detection is key in treating skin cancer. If caught in the early stages surgical excision is often the only treatment necessary.

When visiting your dermatologist, they will perform a full body scan to check for growths. If your dermatologist notes any irregularities, they will mark them and discuss a biopsy with you. A biopsy involves removing the lesion and sending it to a lab for review. The lab will take the lesion and perform a microscopic examination to look for cells that tell them what type of lesion was excised.

There are 3 main types of skin cancers; Basal Cell Carcinoma, Squamous Cell Carcinoma, and Melanoma.

Basal Cell Carcinoma is most commonly found on the face and neck. They can be described as a flat flesh color or brown scar like bump. Usually they bleed and scab but will return each time.

Squamous Cell Carcinoma is typically found on the neck, face, ears, and hands. Manifesting in a firm red nodule or a flat lesion.

Melanoma, the most dangerous, appear as a large brown spot with irregular borders. They can also have a red, pink, white, or blue color at the borders. They change each day as they grow. They also cause pain and an itching or burning sensation.

Once your dermatologist receives results back from the lab, they will review them with you. Excision may be the only treatment necessary, however, there may be more treatment steps involving further surgery or radiation treatment. Your dermatologist will advise you on what steps to take.

Remember to keep in mind that skin cancer is the cancer you can see and the cancer that you can take precautions to prevent. Being mindful of sun exposure and taking the proper precautions to protect yourself in addition to regular skin screenings you can protect yourself and those you love from skin cancer .

by Hannah Turk

Simply put, Shingles is an attack on the body’s immune system. Shingles, also known as herpes zoster, is a viral infection that causes a painful skin rash which often include blisters. The blisters most commonly appear in a stripe like pattern, entering at the roots of nerves and follows them to the skin. Shingles is caused by a reactivation of the varicella zoster virus, also known as chicken pox. The chicken pox virus lies dormant for years, sometimes even decades, waiting to be reactivated.

Approximately one in three Americans will experience Shingles in their lifetime. Typically, Shingles affect the elderly and the immunocompromised. As we age, our immune system’s ability to fight off various illnesses naturally diminishes. Others who are fighting autoimmune disorders, being treated for cancer, or that have HIV are also at risk for developing the virus. Although rare, low risk healthy adults can develop shingles. Fortunately, they usually have an easier time recovering from the effects of the virus. Those who are elderly or have other complications have a difficult time recovering from Shingles. The virus can be fairly serious but is rarely deadly.

People afflicted with shingles note a multitude of symptoms, including but not limited to burning, tingling, itching, skin sensitivity, rash, blisters, chills, etc. Shingles also can cause long term side effects like nerve pain, scarring, and neuropathy. The scarring occurs where the blisters appeared on the skin during the viral attack. The scarring is usually caused when the person affected picks or scratches at the blisters. Post-Herpetic Neuralgia (PHN) is a condition developed after Shingles categorized by ongoing nerve pain. Usually, the older you are the more likely you are to develop PHN. Pain from PHN can cause depression, anxiety, weight loss, sleeplessness, etc. It has been known to make it difficult for the afflicted to perform their basic activities of daily living. Symptoms of PHN can last anywhere from a few months to years.

Fortunately, unlike its predecessor Chicken Pox, Shingles cannot be passed from person to person. However, a person with Shingles can spread the virus to another person who has not had chickenpox. That person could develop chicken pox but not shingles. The duration of illness is only about 7-10 days in most cases. Most people only get shingles one time, but it is possible to get it multiple times. There are a large variety of things someone dealing with Shingles can do to get relief. Most importantly getting adequate amounts of rest while affected. Other methods of relief include stretching, walking, cool compress, wearing loose fitted clothing, calamine lotion, and oatmeal baths. It is also helpful to use reading, tv, or hobbies to distract from the itching. If symptoms are severe enough contacting a physician to prescribe anti-viral medication can be helpful. Unfortunately, when dealing with a viral infection there is not a perfect medication available to manage all the symptoms.

Thankfully, due to advances in modern medicine, Shingles can be prevented. If you have had chicken pox in the past and are 50 years or older, talk to your doctor about getting vaccinated. Receiving a Shingles vaccine can reduce your chances of getting Shingles.