Mild cognitive impairment (MCI) and what you can do

Mild cognitive impairment (MCI) and what you can do

Mild cognitive impairment (MCI) is the medical name for memory problems that exceed the “normal forgetfulness of aging” but are less than associated with an Alzheimer’s diagnosis. If you have received a diagnosis of MCI, you are at risk for continued significant cognitive decline. Each year about 10–15% of persons with MCI receive an Alzheimer’s diagnosis, as compared to 1–3% of all older adults.

That said, many people with MCI do not experience further decline. And some people even improve–if their memory loss was caused by something fixable like a medication reaction or untreated depression. For all these reasons, it is important to have symptoms reassessed every 6–12 months to monitor changes.

There are things you can do. While there is no medical treatment as yet for MCI, some everyday activities can help prevent or slow its progression. The goal is to increase blood flow and oxygen to your brain, and keep your mind active.

  • Manage your blood pressure. Keeping blood pressure within the normal range has a profound effect on delaying memory problems.
  • Practice healthy habits. Get regular aerobic exercise, such as brisk walking. Aim for eight hours of sleep. Eat a diet low in processed foods and high in fruits and vegetables. Limit alcohol. Quit smoking. Manage other conditions (e.g., diabetes, depression).
  • Wear your hearing aids. A loss in hearing means a loss of stimulation to the brain. Studies now connect this loss with a decline in brain function. (Plus, some things you are “forgetting” may in fact be from conversations you didn’t fully hear.)
  • Participate in social activities. Even if you don’t talk much, the stimulation of spending time with others is beneficial.
  • Learn a new skill. Make your brain exercise! Try something you’ve never done. Brush your teeth with the “opposite” hand. Or have some fun: Ping-pong? Drumming?
  • Engage your mind with puzzles. This is brain calisthenics. Keep your neurons firing with activities that make you think.

Memory aids. Accept that you are forgetful and support yourself for success. Make ample use of to-do lists, big calendars, and notes or alarms on your phone. Leverage the power of routines. Put your keys and glasses, purse/wallet in the same place every time. Set yourself up for environmental cueing, consciously putting things where you will see them when needed, such as leaving your morning pills by the coffee maker.

Worried about MCI?
Give us a call. We can help. 916-524-5151

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What is “elder law”?

Elder law focuses on the special rights, needs, and challenges that arise in the context of simply growing older and planning for possible care needs.

Attorneys specializing in elder law take a holistic perspective.

They acknowledge the interplay of health, family, disability, and housing, as well as emotional and financial issues. Consider a consultation for:

  • Estate planning. Within elder law, estate and trust attorneys advise on the best strategy for organizing and managing your assets now that also ensures ease of transfer upon your death. This may involve a will. Or a living trust. There are pros and cons to each. And, if you have a dependent adult in your life, an attorney can draw up a special needs trust to provide for care when you are no longer alive.
  • Decision-making plans. With advancing age, many of us lose the ability to manage our finances or make complex healthcare decisions. Especially if you do not have relatives to step in, you will need legal assistance to locate and contract with trustworthy professionals to fill these roles.
  • Paying for care. An elder law attorney knows about the many programs designed to assist with the cost of care. You may, for instance, be considering a reverse mortgage, but there are significant “gotchas” with this arrangement. If Medicaid is your fallback should you need a nursing home long term, you will want to work with an attorney to be sure your spouse is not left without resources when you die. Long-term care insurance is another payment option worthy of an attorney’s review.
  • Housing contracts. Before moving into an assisted living or continuing care retirement community (sometimes called a “life care” community) or a nursing home, have an elder law attorney review the paperwork. They can clarify tax implications and advise you regarding your rights and how or when you can cancel a housing contract.
  • Claims and appeals. You may have disagreements with Social Security, Medicare, your pension fund, or other insurance or benefit programs. An elder law attorney can help you navigate the appeals process and increase your chance of a successful resolution.
  • Grandparent visitation rights. Whether the schism is due to a divorce, the death of your child, or estrangement from your son or daughter, you do have rights to see your grandchildren. An elder law attorney can help you stay connected.
  • Age discrimination in employment. Have you been turned down from a job, a promotion, or fired because of your age? An elder law attorney can help you rectify the situation.

Looking for an attorney specializing in elder law?
We network with the best. Give us a call at 916-524-5151.

Learn more about our services to help you age well.

“Can we hug yet?”

Yes, if you are fully vaccinated!

It’s a different world in many ways:
Gathering indoors

  • People nearby whom your loved one knows are vaccinated can now visit together indoors. No need for masks or social distancing. Have a few friends over and celebrate!
  • One household of unvaccinated people can even visit with those in a vaccinated household. No precautions needed. Hug those grandchildren!
  • The only exception concerns people at high risk and their housemates. If an unvaccinated person is over age 85, overweight, diabetic, or a smoker and/or has a heart, lung, or kidney disorder or cancer, then everyone at the gathering should observe the usual precautions: Masks, social distancing, washing hands, and meeting in well ventilated spaces.
  • This applies even if the high-risk individual is not visiting, but someone in their household is.

Gathering outside the home, continue with precautions

In a crowd, one never knows for sure who is and isn’t vaccinated. For the protection of all of
us, everyone needs to follow precautions in public, including the fully vaccinated.

  • It is best to avoid medium and large gatherings, indoors or out. That includes trains, planes, and public transport.

Caring after the hospital

Hooray! Your loved one has been discharged from the hospital. While extreme cause for concern may be over, recovery from COVID and its intensive treatment simply
will take time.

Here are things you can do to help:
Physical concerns

Trouble breathing. Use the breathing exercise devices given to you by the hospital. You can also ask for home visits from a physical therapist or
occupational therapist.
Circulatory problems. So much time in bed is not good for the heart and body. Encourage your loved one to get up and walk around as much as possible.
Weakness. Time in the hospital saps stamina. Pace tasks so there are rest periods in between. A cane or walker may help your relative get around without becoming too tired.
Fatigue. To get a good night’s sleep, support your loved one to go to bed at the same time each night, limit caffeine, and avoid naps after 3:00 pm.

Mental and emotional concerns. Many people who were hospitalized experience PTSD symptoms much like soldiers returning from war.

Depression. Sadness, certainly, but also disinterest in activities that used to be fun. Feelings of guilt or worthlessness may arise. Also, irritability.
Anxiety. Worry, restlessness, and difficulty sleeping.
• “Brain fog.” From short-term memory problems to
difficulty concentrating or making decisions. Sometimes familiar tasks feel challenging, like following a recipe or paying the bills.
Nightmares. Especially common among those who were in the ICU (Intensive Care Unit).

If your relative has these symptoms, talk with the doctor. There are medications and counseling services to help your loved one return to a healthy state

Anniversaries can be painful

For every individual who was lost to COVID, there are on
average nine survivors. As a nation, that means close to 5
million Americans will be coming up on the anniversary of a
loved one’s passing this year.

Many families were not able to be at the bedside when their
relative died. Hospitals couldn’t allow visitors. Travel was
restricted. The result has been crushing feelings of guilt,
even though their absence couldn’t be helped.

Funerals have been kept to a minimum. Grief has been
processed in isolation, without the hugs and community
gathering that ease the pain of a loved one’s death.
If you are coming up on such an anniversary, be aware that
you may have strong feelings arise, even mental and
physical reactions. It’s not unusual to experience

• sadness, anger, and anxiety
• confused thinking
• trouble with sleep (too much or too little)

You may find yourself reliving the events leading up to your
loved one’s illness and death. And you may find yourself
drawn to alcohol or other substances to ease the distress.
Children may also have problems at the anniversary. Some
withdraw. Others may become aggressive or act out.

Everyone—adults and children alike—should expect that
there may be a dip in “normal functioning” around the time
of the anniversary. It’s wise to be prepared for a slowdown
and allow the mind, body, and spirit to process the loss.
If you have a friend struggling with an anniversary, the best
thing you can do is listen. Let them share memories of their

loved one. Talking helps. Grief has no timetable. There’s no
such thing as “getting over it.” Only getting used to it.

These are tender times. Be gentle with yourself. If grief
seems to get in the way of normal functioning for two weeks
or more, then it may be wise to talk with a grief counselor.

Contact us at 916-524-5151

Age-friendly bathroom remodels

Activities that are easy now may become more difficult in the future: Going up and down stairs, standing up from sitting, getting in and out of the tub, catching your balance if you start to slip. . . . As you consider aging in place, it is wise to keep these issues in mind, particularly about the bathroom.

Structural considerations. To eliminate the need to climb stairs, the ideal is a full bathroom on the main level of the house. In addition, as we age, the likelihood of needing support increases. Whether a wheelchair or walker, or a spouse or paid caregiver is providing assistance, a spacious room is best.

Did you know the bathroom is the most dangerous room in the house? Eighty percent of falls occur in the bathroom on hard, sometimes slippery surfaces. Most falls occur in the process of sitting down on or getting up from the toilet, or getting in/out of the bath/shower.

Bathtub or shower? The most versatile design involves a water-friendly, nonslip floor with a drain, and no hard curb around the shower area. This allows for rolling a wheelchair into the shower and provides room for a helper. Even without such a radical makeover, it’s easy to install a handheld showerhead and a built-in or portable bench in an existing bathroom to create a seated shower option.

If you need to soak—great for achy arthritic joints—consider a walk-in tub. These tubs have a watertight seal on a side door that allows you to walk in, sit on a bench, and then fill the tub to the desired height. Or have a dip cut into the side of an existing tub to lower the height for ease of stepping in and out.

Toilets and bidets. Purchasing a high toilet or adding an extender that raises the sitting surface greatly reduces the physical challenges of sitting down and getting up. Many people find a bidet adds to convenience and cleanliness. (Twisting to wipe our nether regions becomes more difficult with age.) Rather than ask for help, cleaning with water can improve hygiene while preserving dignity.

Other fall prevention strategies. You don’t need a full remodel to improve safety. Installing grab bars beside the toilet and within and outside the bathing area is an easy and effective modification. Grab bars must be attached securely to the studs of the wall and be able to support 250–300 pounds. Installing nonslip flooring or applying antislip floor coatings for higher traction is also wise. Increased lighting will help visibility and reduce falls. In addition, lights installed on the wall instead of on the ceiling reduce the need to get on a ladder, and possibly fall, when changing a bulb.

How age friendly is your bathroom?
Give us a call at 916-524-5151.

Social Security and the newly single

Life has a way of throwing us curveballs.

The unexpected death of a spouse—or a divorce—can certainly wreak havoc on your emotions. It can also throw a wrench in your finances.

If you are age 62 or older, here are some Social Security basics to bear in mind as you regain your financial footing or make contingency plans.

Survivor benefits. If you find yourself widowed after at least one year of marriage, then you are eligible to receive monthly survivor payments.

Did you also work outside the home? If so, you can choose the higher of the two benefits: yours personally; or as a surviving spouse.

Before deciding, confirm the amount for each one for three points in time: collecting now; waiting until age 70; or at your designated retirement age (as determined by Social Security). While you cannot receive both benefits at the same time, you can strategically claim the highest one now and then switch to the one that becomes higher later.

Spousal benefits. A divorce does not erase the contribution you made to the household. As a formerly married spouse, you are eligible for Social Security benefits based on the earnings of your breadwinning partner. As long as you were married for 10 years or more, you have earned spousal benefits.

Receiving spousal benefits does not affect what your ex will receive from Social Security. What’s more, your ex does not need to know, give permission, or sign any papers. All you need to provide is the marriage certificate, divorce papers, and your ex’s full name.

If you were also employed and are eligible for your own Social Security benefits, investigate which benefit will pay more: now; when you turn 70; or at your designated retirement age. Unlike survivor benefits, you cannot switch benefits at a later date. Decide when is the best time to apply, and choose the larger amount.

It’s important to make a fact-based decision. The difference in monthly payments, added up over many years, could mean there are thousands of dollars at stake. There are many more details than we can cover here, including information about benefits in same-sex marriages. Consider working with a certified financial planner who can run the various calculations for you and suggest the wisest strategy. There’s too much to lose to depend on Social Security staff for detailed guidance.

Find yourself suddenly single?
Let us help you get reoriented. Give us a call: 916-524-5151.

Learn more about our services for aging well.

Taking Care of Your Heart is Always Important

Functions of the Heart

Our heart is a muscle, divided into 4 chambers. The right and left atriums occupy the upper chambers while the right and left ventricles fill the bottom chambers. The right side of the heart receives blood from the body and pumps it through the lungs to re-oxygenate the blood. The left side of the heart pushes the replenished blood back through the body. This cycle repeats with every beat of the heart. Blood travels through the body’s circulatory system. Blood vessels, arteries, arterioles, capillaries, venules, and veins make up the circulatory system. This system delivers necessary oxygen and nutrients to our bodies. It also removes carbon dioxide and other waste products.

Types of Heart Disease

Heart disease is a term used to describe any disorder of the heart. There are many types of heart diseases. Some you may be born with while others develop overtime. For example, acquired heart valve disease develops over a person’s lifetime. It occurs when a normal functioning heart slowly declines due to family history, illness, or aging. Acquired heart valve disease typically affect the mitral and aortic valves. Congenital valve disease, which is present at birth, is a result of abnormalities where heart valves do not fully form or form into the wrong shape or size. Coronary heart disease, myocardial infarction, and arrhythmia are some examples of heart disease.

Risk Factors

  • Age/Gender
  • Men over the age of 65 are at greatest risk of developing heart disease
  • Women over the age of 75 are at greatest risk of developing heart disease
  • Family History
  • There are many congenital heart diseases that are passed through genetics
  • Health History
  • People with kidney disease, metabolic disease, certain infections, and hypertension are more predisposed to developing heart disease.
  • High Blood Pressure (Hypertension)
  • High blood pressure enlarges the heart. This results in the tissues within the heart stretching causing leaks.
  • Autoimmune Diseases
  • These types of diseases typically cause inflammation particularly within the heart which can lead to decreased function.
  • Chemotherapy and Radiation Treatments
  • These types of drugs can cause damage to the heart valves.
  • Diet Medications
  • Certain medication used for weight loss can lead to heart abnormalities. These conditions typically improve once the medications have been stopped.

How Hearts Change with Age

Heart disease is the most frequent condition found among the elderly. It also the number one cause of death for the elderly. Normal aging (wear and tear) is the most common cause of a multitude of adverse changes within the structure of the heart. For example, the heart of an elderly man does not beat as fast with increased activity causing his body to fatigue faster. Over time, fatty deposits build up on the walls of arteries, causing obstruction of blood flow. The most common change is the hardening of arteries leading to high blood pressure.


Something to keep in mind with Heart Disease is the severity of symptoms do not always correlate with the severity of the disease. One could experience mild symptoms but have a serious condition. It is important, if any of these symptoms are noted below, a doctor is consulted.

  • Shortness of breath
  • Headaches
  • Dizziness / Light Headedness
  • Chest Pain
  • Chest Palpitations
  • Sudden Weight Gain
  • Abdominal Pain
  • Fatigue
  • Decreased Appetite
  • Numbness or tingling
  • Cold Sweats
  • Living with Heart Disease

Heart disease requires lifelong precautions that can include but are not limited to:

  • Regular Physical Exams
  • Regular EKG’s, CT Scans, Chest X-Rays, etc.
  • Medications
  • Diuretics
  • Blood Thinners o
  • Medications that control rapid or irregular heart beats
  • Blood Pressure Medications
  • Exercise and Diet
  • Exercise aids in reducing cholesterol and blood pressure
  • Restricted salt intake. Salt causes the body to retain fluid which can stress the heart
  • Dental Care
  • Bacteria in the mouth can spread to blood and pass through the heart. This may cause endocarditis a potentially life-threatening condition.

Heart Healthy Lifestyle Choices for the Elderly

Safe exercises are a key component to defending the elderly against heart disease. Function and mobility in the muscles weaken as we age. Being active is the best way to slow muscle break down. Here is a list of low impact exercises that are safe for elderly to participate in.

  • Chair Squats
  • Wall Pushups
  • Single Foot Stand
  • Tip Toe Lifts
  • Wall Snow Angles
  • Walking
  • Swimming
  • Water Aerobics

Diet plays a big role in remaining healthy with heart disease. And it is not just about what not to eat. Since many people with heart failure are often short on important nutrients, we should focus on eating more foods that are healthy. This might include

Fruits – oranges, pears, berries, avocados, and apples

Vegetables – Dark green leafy vegetables, beans, and peas

Whole grains – Brown rice and oatmeal

Seafood – Oily fish such as salmon, trout, or herring. Try these in place of poultry or red meat about twice a week

Nuts and seeds – walnuts and sunflower seeds

Dairy – choose fat free or low-fat options

Olive oil – cook with this in place of solid fats like butter

Coping with Heart Disease

You may be experiencing a myriad of difficult emotions if you or someone you love has been diagnosed with heart disease. Learning as much as you can about the condition and the treatments available is a great way to become more hopeful. Actively managing your condition by tracking your treatment goals and celebrating your achievements will assist in promoting a higher quality of life.

Sharing your experiences with friends and family members can also give you hope. There are multiple support groups for people with heart conditions. Getting to know people going through the same things can build confidence in dealing with your diagnosis. Reading stories from other survivors is an excellent way to grow hope. You are not alone in your diagnosis.

“Is it Alzheimer’s?”

Alzheimer’s is different from the normal forgetfulness of aging. Alzheimer’s is one of many conditions that cause the radical changes in memory, reasoning, and behavior known as “dementia.” The normal forgetfulness of aging is just an inconvenience, a slowing down. The serious changes of dementia eventually result in the inability to live on your own.

Here are some helpful distinctions developed by the Alzheimer’s Association:

  • Memory failures that affect daily life. Trouble learning something new. Not recalling recent events. Asking the same question over and over. Normal aging: Not remembering something in the moment but recalling it later.
  • Difficulty with problem solving and reasoning. Inability to think abstractly (e.g., use numbers) and create logical plans. Signs include difficulty figuring a tip or following a recipe. Normal aging: Occasional addition or subtraction errors.
  • Trouble with familiar tasks. Drawing a blank while playing a beloved game or driving to a familiar location. Normal aging: Needing help with something recently learned.
  • Losing the anchor of time. Forgetting the season or the year. Normal aging: Briefly losing track of the day of the week. 
  • Spatial problems. Trouble judging distance. Difficulty with balance. Normal aging: Needing glasses to read.
  • Communication problems. Losing the thread of a conversation. Repeating a story or question. Normal aging: Occasional inability to find a word. 
  • “Losing” common objects. Putting belongings in odd places and not remembering. Inability to retrace steps. Accusing others of stealing. Normal aging: Forgetting why you went into a room and retracing your steps to remember.
  • Poor judgment. Falling for scams, overspending, wearing odd outfits. Normal aging: Periodically making a bad decision or skipping a bill payment.
  • Withdrawal from activities. Not socializing as much, especially as conversing becomes difficult. Normal aging: Consciously choosing to do something different.
  • Moody or irritable. Significant personality changes: Depression, anxiety, fear, and paranoia. Normal aging: Getting grouchy if cherished routines are disrupted.

Concerned about your memory? Let’s talk.
Give us a call at 916-524-5151.

Learn more about our services for aging well.

Driving as we age

Irritating but true: Aging brings changes that make safe driving more of a challenge. Slower reflexes. Reduced vision and hearing. Difficulty concentrating. Less flexibility in the neck and shoulders.

Fortunately, these changes do not come on suddenly. And adjustments in driving habits can offset them such that older drivers can be much safer than their younger counterparts.

Safe driving starts with a willingness to be honest with yourself about modifications.

A few signs that adjustments may be in order:

  • Thoughts wander when you drive
  • Frequently startled or uncertain in high-traffic conditions
  • Taking medicines that list drowsiness as a side effect
  • One or two tickets or verbal warnings from police in the past two years
  • Dents in the car, or even a collision in the past two years
  • Comments or concerns expressed by family or friends

Take a self-assessment. The American Automobile Association (AAA) offers a free, confidential test at

Consider a Mature Driver Course. AAA and AARP (American Association of Retired Persons) offer courses filled with tips. Your car insurance may even discount your premiums.

Easy things you can do right now:

  • Flexibility exercises. Increase mobility in your neck and shoulders so you can readily turn your head to check for blind spots when changing lanes or backing up.
  • Reduce distractions. Turn off the radio. No eating or drinking while driving. Definitely no phone calls. Consider halting conversation with passengers when driving conditions are complicated (e.g., at intersections).
  • Drive mid-day. Avoid rush hour and freeways. And if you have trouble with night vision, plan your trips so you are home before twilight.
  • Make a left turn only at a left-turn light. If there is no stoplight, drive a block farther and make three right turns. (Three rights make a left.)

Wondering about your driving?
Give us a call at 916-524-5151

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How to pay for care

Most people are surprised to learn that Medicare pays for only a limited amount of the daily care you are likely to need in your lifetime (about 14%).

Medicare covers only services delivered by medically trained professionals. That means you need to have savings or insurance and rely on a collection of local programs. Or family and friends who may be able to pitch in with labor or funds.

Assisted living and memory care $$$–$$$$
As nonmedical services, these settings are usually paid for out of your own savings. If you are a qualifying veteran or you have long-term care insurance, your costs may be covered. Contact the Veterans Administration or state Veterans Council. Check your long-term care insurance policy for eligibility requirements. Also ask about waiting periods. Is there a lifetime cap on the total amount they will pay?

Skilled nursing/rehab or nursing home $–$$$$$
Provided your stay follows a qualifying hospitalization, original Medicare—the government’s health insurance for seniors—will typically cover some portion of the costs for the first 100 days. You use your supplemental insurance for your copay. Or pay out of pocket if you do not have supplemental insurance. Starting day 101, you pay 100% of the cost. Medicare Advantage plans vary, so review the coverage with your insurance provider. If you have private long-term care insurance, check your policy for skilled nursing coverage. The Veterans Administration offers special facilities for qualifying vets.

The very poor may qualify for Medicaid. This program will pay 100% of costs. However, there are only a limited number of Medicaid openings available in any given facility. Those living long term in a nursing home usually exhaust all personal savings and assets. Then they switch to Medicaid. If you think you may need Medicaid, consult an elder law attorney early. Also, your financial planner for advice about liquidating your assets.

Continuing care retirement communities $$$$$
This is a very different model of care that merges housing and insurance. With a continuing care retirement community—also known as a “Life Plan Community”—you invest a substantial sum up front (often in the six figures). You also pay a monthly service fee. Start while you are healthy and live on campus to enjoy the deluxe amenities. Move to the most appropriate building as your care needs change. This is paid for almost entirely out of your own savings. If you have long-term care insurance, check your policy to see if it covers continuing care retirement communities.

Worried about paying for care? Give us a call at 916-524-5151.

Learn more about our aging life care planning services.

Choosing a home care provider

Frank knows they need help at home. His wife’s dementia is getting worse, and he has his own health problems. She can’t be left alone anymore.

Doing all the cooking and cleaning, and now helping with bathing … it’s just too much.

Frank needs to take breaks. But a Google search reveals a dizzying array of home care providers. How to choose?

Allowing a stranger into your home can leave you feeling quite vulnerable. It’s important that you trust the individual and the company that does the background checks, verifies training, and puts together the schedule.

You also need to interview each company to find out pricing and minimum number of hours, and to see if they have independent quality ratings.

How do you know which one to trust?
This is where a Geriatric Care Manager can help.

On the basis of past experience with other clients, he or she knows which companies put an emphasis on training. Which have difficulty filling a shift if a caregiver calls in sick. Which have high staff turnover resulting in the need for you to orient a new employee every few months. Which have a strong team, with employees who love their work.

Wise home care companies will let you and your Geriatric Care Manager interview several caregivers before making a choice. They know that a Geriatric Care Manager understands you as the client and understands what will result in an optimal match.

Both you and the provider and the caregiver want a good fit the first time so all of you can work together positively for the duration of your need. It makes the difficult transition to home care that much easier if a knowledgeable advocate can set expectations and provide an objective viewpoint.

Even with adult day care and medically trained services, such as home health and hospice, not all providers are alike. A Geriatric Care Manager knows the reputation and the management style of each company. He or she can look up Medicare reviews and complaints.

A Geriatric Care Manager can also coordinate care across multiple service providers and work with your physician to ensure that all the different players are aware of your changing needs.

Want to find the best fit the first time? Give us a call at 916-524-5151.

Learn more about our aging life care planning services.