Saturday, January 25, 2020

Life with Chronic Conditions: Coping with “Skin Hunger”

This past Tuesday, January 21, was National Hugging Day. Seems concerning that we need a “day” to remind people to do something that humans have instinctively done and is probably the most primitive and basic form of communication.

Humans are meant to be social and engage in touching. Holding a loved one’s hand helps to reduce pain, lower heart rates, strengthen immune systems and in general is pretty fundamental to human’s sense of well-being and health.

When touching is absent, people experience  “skin hunger,” craving the touch of another person.

Between “no-touch” policies, the incredible use of digital technology, and the United States touch-averse culture, we are doing less and less of it. Because touch and sex are now heavily associated, as the neuroscientist Francis McGlone noted, “We have demonized touch to a level at which it sparks off hysterical responses, it sparks off legislative processes, and this lack of touch is not good for mental health.”

And we wonder why loneliness and depression are at an all-time high?

Skin hunger can be particularly true for those affected by chronic conditions, where illness and injury can be isolating.

You can read/watch more about touch research at the links below or you can just check out the ways to consider to increase touch in your life.
• Spa services, such as manicures, pedicures and massages yield more than just pretty nails. Being touched and groomed is one of the oldest ways we care for one another. It not only makes us look good, but it makes us feel good. This is a great way to reconnect.
• Put down the cell phone-forget the heart emojis-and be affectionate with someone  in person
• Spend time with animals.
• Learn to dance
• Greet people with a handshake or hug
• Use touch when appropriate-Being open to touch encourages others to touch you. This can be a touch to the arm or a pat on the back.
• Ask for a hug
• Cuddle an infant
• Attend a condition specific support group and start with a group hug

Interesting Reading/Watching

Wednesday, January 22, 2020

Take a Break: Try Pulled String Art

 It’s cold, snowy and January. My eyes crave color. Loved this string art painting project  as it’s filled with color. I recommend watching the video below. Keep in mind that you can use embroidery floss, cotton string or other type of cord that will soak up color.

As for the color, again there are options, ink, liquid water colors, or watered down acrylics. If you are like me and you don’t have liquid water colors on hand, there are several ways to make liquid water colors:

From dried up markers: Just soak in a little water

• Add droplets of liquid food coloring into water until desired shade is reached.

• Mix 4 oz of hot water with a Crayola watercolor paint oval (the type that come in trays). Mix until dissolved. 

They recommend a heavy book. Didn't have one on hand that I wanted to spare so used a National Geographic Magazine instead and it worked fine. 

Not interested in today’s activities, try the Take a Break Pinterest Board.

Saturday, January 18, 2020

Journal Watch January 2020

Depression May Worsen Quality of Life in Rheumatoid Arthritis Patients: Patients with coexisting rheumatoid arthritis (RA) and depression tend to have higher disease activity and lower quality of life than patients without depression, according to a review published online Dec. 19 in the International Journal of Rheumatic Diseases.

Fragmented sleep may trigger migraine 2 days later: A new study finds that people whose sleep is fragmented during the night are at higher risk of experiencing a migraine episode not the next day, but the day after that. Neurology.

MIV-711 No Better Than Placebo for Pain Relief in Knee OA: A novel cathepsin K inhibitor, MIV-711, is no more effective than placebo for reducing pain in patients with symptomatic, radiographic knee osteoarthritis, according to a study published online Dec. 31 in the Annals of Internal Medicine.

Acupuncture,Acupressure May Help Cancer Patients Control Pain: The use of acupuncture and/or acupressure is associated with reduced cancer pain and decreased use of analgesics, according to a review published online Dec. 19 in JAMA Oncology.


Four Weeks of Active TENS Beneficial for Fibromyalgia: Four weeks of active transcutaneous electrical nerve stimulation (TENS) results in significant improvement in movement-evoked pain and other clinical outcomes compared with placebo-TENS or no TENS, according to a study recently published in Arthritis & Rheumatology 

Treatment Guidelines Updated for Hand, Hip, Knee Osteoarthritis: In the 2019 American College of Rheumatology/Arthritis Foundation Guideline, published online Jan. 6 in Arthritis Care & Research, updated recommendations are presented for the management of hand, hip, and knee osteoarthritis (OA). Strong recommendations are made for exercise, weight loss in overweight or obese patients with knee and/or hip OA, self-efficacy and self-management programs, tai chi, and cane use. In addition, there were strong recommendations for hand orthoses for first carpometacarpal (CMC) joint OA, tibiofemoral bracing for tibiofemoral knee OA, topical nonsteroidal anti-inflammatory drugs (NSAIDs) for knee OA, oral NSAIDs, and intraarticular glucocorticoid injections for knee OA. Recommendations were conditional for balance exercises, yoga, cognitive behavioral therapy, acupuncture, thermal modalities, kinesiotaping for first CMC OA, orthoses for hand joints other than the first CMC joint, patellofemoral bracing for patellofemoral knee OA, and radiofrequency ablation for knee OA. Conditional recommendations were also made for topical NSAIDs, intraarticular steroid injections and chondroitin sulfate for hand OA, topical capsaicin for knee OA, and for acetaminophen, duloxetine, and tramadol.

Transcendental Meditation prevents abnormal enlargement of the heart, reduces chronic heart failure: A randomized controlled study recently published in Ethnicity & Disease in their Autumn 2019 Hypertension issue found that the Transcendental Meditation (TM) technique helps to prevent abnormal enlargement of the heart compared to health education (HE) controls. Also known as left ventricular hypertrophy (LVH), it can lead to chronic heart failure and death, and is especially prevalent among African Americans.


Experts review evidence yoga is good for the brain; Scientists have known for decades that aerobic exercise strengthens the brain and contributes to the growth of new neurons, but few studies have examined how yoga affects the brain. A review of the science finds evidence that yoga enhances many of the same brain structures and functions that benefit from aerobic exercise. Brain Plasticity

Long After Your High Is Gone, Pot Use May Still Affect Your Driving: A new study found that frequent cannabis users who began using prior to the age of 16 appeared to drive differently than those who didn’t use marijuana or those who began using it later in life. During a driving simulator test, those who began using before the age of 16 hit more pedestrians, missed more stop signs and red lights, and spent more time speeding. The larger conclusion of their research is that the age at which an individual begins using cannabis is important and can have far-reaching effects on cognition. Drug and Alcohol Dependence

The surprising link between depression and the pursuit of happiness: People may think that valuing happiness leads to a happier life. However, new research has found that wanting to feel happy can also have a negative outcome. Journal of Happiness Studies

• Approved Ubrelvy tablets for acute treatment of migraine with or without aura.
• Approved the first generics of Eliquis (apixaban) tablets to reduce the risk for stroke and systemic embolism in patients with nonvalvular atrial fibrillation, for prophylaxis of deep vein thrombosis (DVT) in patients undergoing hip or knee replacement surgery, and for treatment of and to prevent recurrence of DVT and pulmonary embolism.
• Accelerated approval of Enhertu for treatment of unresectable or metastatic human epidermal growth factor receptor 2 (HER2)-positive breast cancer
• Will take action to remove most unauthorized flavored e-cigarette cartridges from the market. It applies to mint, fruit and dessert flavors but not menthol or tobacco flavored products
• Approved kinase inhibitor Ayvakit to treat adults with unresectable or metastatic gastrointestinal stromal tumors (GISTs) with a platelet-derived growth factor receptor alpha (PDGFRA) exon 18 mutation
• Adding to a list of recalled lots of popular heartburn medications -- including generic forms of Zantac -- because the pills might contain small amounts of the suspected carcinogen N-nitrosodimethylamine (NDMA).

Report links recommended physical activity levels to lower risk of seven cancers: A pooled analysis of nine prospective studies involving more than 750,000 adults finds that recommended amounts of leisure-time physical activity were linked to a lower risk for seven cancers, with several cancer types having a 'dose/response' relationship. Updated guidelines for activity now state that people should aim for 2.5 to 5 hours/week of moderate-intensity activity or 1.25 to 2.5 hours/week of vigorous activity. Physical activity was associated with a lower risk of colon cancer in men,  female breast cancer endometrial cancer, kidney cancer, myeloma, liver cancer, and non-Hodgkin lymphoma in women. J Clin Oncol

A Lifetime of Fitness Helps Women's Muscles in Old Age: Women who exercise throughout life may keep their muscle power as they age, a new study suggests. Journal of Applied Physiology

PREVENTION: Diet/Nutrition
Should we all be eating more protein?: A recent review and meta-analysis investigating protein intake conclude that consuming the recommended daily allowance is fine for most people, most of the time. However, more protein is not necessarily beneficial. Advances in Nutrition.

Intermittent fasting can help ease metabolic syndrome: For the first time, a new study has looked into time-restricted eating, or intermittent fasting, as a means of losing weight and managing blood sugar and blood pressure for those with metabolic syndrome. This new study, which appears in the journal Cell Metabolism, allowed study participants to eat what they wanted when they wanted within a 10 hour window. They also had flexibility in adjusting their eating window by a couple [of] hours based on their schedule. Almost all the participants ate breakfast later (around 2 hours after waking) and dinner earlier (around 3 hours before bed). The study lasted for 3 months, during which time the participants showed a 3% weight and body mass index reduction, on average, and a 3% loss of abdominal, or visceral, fat.

Intermittent fasting: live 'fast,' live longer? : In a review article published in the Dec. 26 issue of The New England Journal of Medicine, Johns Hopkins Medicine neuroscientist Mark Mattson PHD concludes that intermittent fasting does have scientific evidence to back it up. Mattson, who has studied the health impact of intermittent fasting for 25 years, and adopted it himself about 20 years ago, writes that "intermittent fasting could be part of a healthy lifestyle."

Could hydration levels influence cognitive function?: Dehydration can cause headaches and several physiological issues, and older adults are most at risk of experiencing it. Women appeared to display poorer cognitive performance when they were underhydrated. The same applied when they were overhydrated. European Journal of Nutrition.

Coffee Consumption Does Not Affect Insulin Sensitivity: Consumption of four cups of coffee daily does not impact insulin sensitivity, according to a study published online Dec. 31 in the American Journal of Clinical Nutrition.


Tea drinkers live longer: Drinking tea at least three times a week is linked with a longer and healthier life, according to a study published today in the European Journal of Preventive Cardiology. In a subanalysis by type of tea, drinking green tea was linked with approximately 25% lower risks for incident heart disease and stroke, fatal heart disease and stroke, and all-cause death. However, no significant associations were observed for black tea.

Trading Meat for a Plant-Based Patty Doesn’t Make Fast Food Healthier: Fast-food companies are pushing new plant-based “meat” items as healthy alternatives to their more traditional offerings. Experts warn that while plant-based meats are safe, they don’t improve the nutritional value of fast-food items like burgers or breakfast sandwiches. Experts also stress that the “healthy” label given to these kinds of items is dangerous, feeding misinformation about the kinds of foods we consume. Healthline

PREVENTION: Supplements
Could higher magnesium intake reduce fatal coronary heart disease risk in women? The researchers examined magnesium intake at baseline for more than 153,000 postmenopausal women and identified the development of fatal coronary heart disease and sudden cardiac death over the subsequent 10.5 years of follow-up. The data revealed that higher magnesium intake was associated with statistically significant risk reduction in fatal coronary heart disease and a reduction in risk of sudden cardiac death.
Journal of Women's Health

Folic Acid, Zinc Supplements in Men No Benefit in Infertility: For couples seeking infertility treatment, folic acid and zinc supplementation compared with placebo for male partners does not significantly improve semen quality or live birth rates, according to a study published in the Jan. 7 issue of JAMA.

Supplement may help burn fat long after exercise: Adding inulin-propionate ester (IPE), an appetite-suppressing supplement to moderate exercise increases the likelihood of weight loss, even without a change of diet. Metabolism

Women with single dose of HPV vaccine gain similar protection as multiple doses: A new study revealed that one dose of the HPV vaccine may prevent infection from the potential cancer-causing virus. JAMA Network Open


An often-made claim that e-cigarettes are '95% safer' is not valid: The frequently cited claim that e-cigarettes are "95% less risky" or "95% less harmful" than combustible cigarettes is outdated, misleading and invalid -- and should no longer be made in discussions on the dangers of vaping, according to an editorial published today in the American Journal of Public Health by six leading experts on e-cigarettes and public health.

Social media use can be positive for mental health and well-being: Using a nationally representative sample, the association of two dimensions of social media use—how much it’s routinely used and how emotionally connected users are to the platforms—with three health-related outcomes: social well-being, positive mental health, and self-rated health-was assessed. routine social media use—for example, using social media as part of everyday routine and responding to content that others share—is positively associated with all three health outcomes. Emotional connection to social media—for example, checking apps excessively out of fear of missing out, being disappointed about or feeling disconnected from friends when not logged into social media—is negatively associated with all three outcomes. Health Education & Behavior

Does talc powder cause ovarian cancer?: A new data analysis of over 250,000 women found no link, but the authors urge caution as the study may not be large enough. JAMA.

5 healthful living factors extend disease-free life: According to a new study, a combination of healthful lifestyle choices, such as maintaining a healthy weight, not smoking, and regularly exercising, can significantly extend the number of years that an individual avoids disease. BMJ.

Does Smoking Cause Depression: Depression tends to be twice as likely among people who smoke than those who do not, but it is not yet clear which causes which. Some. Researchers, however, believe that smoking may lead to depression, not vice versa. PLOS ONE

Tongue Fat Increases Sleep Apnea: Losing fat in your tongue can alleviate symptoms of obstructive sleep apnea (OSA) according to MRI studies which studied how weight loss affected the upper airway. American Journal of Respiratory and Critical Care Medicine

Women’s Blood Vessels Age More Quickly, Leading to Earlier Heart Disease: Researchers say a woman’s blood vessels age more quickly than a man’s blood vessels. They say this accelerated aging process may begin in some women as early as their 30s. Experts say the aging can cause a rise in blood pressure and lead to a number of cardiovascular diseases in women. JAMA Cardiology

Ultrasound with MRI improves prostate treatment: MRI-guided transurethral ultrasound ablation (TULSA) is a new tool for the highly accurate treatment of prostate cancer — without the usual side effects. Radiological Society of North America

Proton therapy as effective as standard radiation with fewer side effects: Cancer patients who receive high-tech proton therapy experience similar cure rates and fewer serious side effects compared with those who undergo traditional X-ray radiation therapy. The reduction in side effects -- particularly lower hospitalization rates and fewer emergency room visits -- could offset the higher initial cost of proton therapy, which often is not covered by private insurance because of its higher upfront expense and limited data on its effectiveness compared to X-ray radiation. JAMA Oncology


Liposuction Benefits Women With Lipedema: German researchers found that most of the participants noticed a first manifestation of the disease at the age of 16 years. Diagnosis took a mean of 15 years. The majority of patients reported that liposuction led to a significant reduction in pain, swelling, tenderness, and easy bruising. The prevalence of hypothyroidism (35.9 percent) and depression (23 percent) was higher than the average prevalence in the German population. The respondents had a low prevalence of both type 1 (1.4 percent) and type 2 (1 percent) diabetes. Nearly one-quarter of lipedema patients had a migraine diagnosis (22.5 percent), and two-thirds of these respondents (68.1 percent) said the frequency and/or intensity of migraine attacks markedly declined after liposuction. Plastic and Reconstructive Surgery

Individualized PT Can Reduce Incontinence After Prostatectomy: For men with postprostatectomy stress urinary incontinence (SUI), an individualized pelvic physical therapy (PT) program aimed at normalizing pelvic floor dysfunction (PFD) is associated with a decrease in SUI and pelvic pain, according to a study published online Dec. 5 in International Urology and Nephrology


Half the amount of chemo prevents testicular cancer from coming back, new trial shows: Testicular cancer can be prevented from coming back using half the amount of chemotherapy that is currently used, a new clinical trial has shown. The new trial showed that giving men one cycle of chemotherapy was as effective at preventing men's testicular cancer from coming back as the two cycles used as standard. European Urology

New Testosterone Treatment Guidelines: The American College of Physicians has released new guidelines on when to prescribe the hormone. They advise it shouldn’t be used to improve energy or cognition, but it should be used to treat sexual dysfunction. American College of Physicians (ACP) released new clinical practice guidelines

Intensive Systolic BP Control May Not Benefit All Older Adults: Intensive systolic blood pressure (SBP) control lowers the risk for major cardiovascular events, cognitive impairment, and death in older adults; however, these benefits may not extend to older adults with lower baseline cognitive function, according to a study published online Dec. 16 in the Journal of the American Geriatrics Society.


Acid reflux drugs may have negative side effects for breast cancer survivors: Acid reflux drugs that are sometimes recommended to ease stomach problems during cancer treatment may have an unintended side effect: impairment of breast cancer survivors' memory and concentration. Journal of Cancer Survivorship


Forget 98.6°F. Humans Are Cooling Off — Here’s Why: The “normal” body temperature of 98.6°F (37°C) is actually not so normal. New research finds the average human body temperature of Americans has dropped. The 98.6°F standard was established by a German doctor in 1851. Recent studies have indicated that’s too high; research on 35,000 British people found their average was 97.9°F. The body temperature of men born in the 2000s is 1.06°F degrees lower, on average, than men born in the early 1800s. Women have temps about 0.58°F lower than those born in the 1890s. That means body temperatures declined 0.05°F every decade. eLife

The Price of 500 Prescription Drugs Have Gone Up This Year: The prices of almost 500 prescription drugs have already risen since Jan. 1. The average price hike is about 5 percent. Among the drug prices that have increased are Cotempla XR, Eliquis, Truvada, and Humira. Experts say the price increases affect insurers more than consumers. Healthline


Sorry, You Might Get the Flu Twice This Year — Here’s Why: Two flu strains are overlapping each other this flu season. This means you can get sick twice from different flu strains. Centers for Disease Control and Prevention’s (CDC)

Taking Multiple Separate Meds Costs Less Than 1 Combination Drug. Why? Combination drugs are typically new medications that are made by combining two or more generic drugs into one medication. Often, drug manufacturers are primarily motivated to combine these drugs in an effort to improve their bottom line. In a majority of cases, combination drugs don’t make any clinical difference for patients, yet pharmaceutical companies charge a significantly higher price for them. Healthline






















Wednesday, January 15, 2020

Take a Break: Try Spirolaterals

Spirolaterals are spiraled, structured designs based on a repeated series of commands using length and angle. Watch the video below or click here to learn more about to make them. 
Don’t have any graph paper handy? No worries, you can print out some using the following link Note the paper comes in three sizes. The smaller ¼ inch size works best for this project, but depending on numbers used and your eyesight, the larger sizes may work better for you.

Definitely color your finished product as it makes it come alive. 

I found this to be a relaxing and almost meditative project.

Not interested in today’s activities, try the Take a Break Pinterest Board.

Friday, January 10, 2020

Life with Chronic Disease: You are not a victim

A large part of my career has involved understanding resiliency. A few weeks ago, I came across a TED Talk by Lucy Hone. It’s one of the best talks I’ve seen on resiliency in a long time and recommend watching it. 


In a nut shell, through her own story of incredible loss, even armed with an extensive background in resiliency-she trained under the father of positive psychology, Martin Seligman-Hone found that while intentions were good, people were basically trying to turn her into a victim.

Instead, Hone took a different approach, one largely discussed by the ancient Stoic philosophers, embraced today by Cognitive Behavioral Therapy and being proven by the ever expanding field of neuroscience.

These are the take home points:
• We are wired to be resilient. There are strategize that work and they can help you through the tough times. We are not “helpless” in the face of suffering.

• Pain and adversity are part of everyone’s life. You are not being discriminated against because you have an illness, lost a job, or had a loved one die. Shit happens to absolutely everyone. The more you nurse “why me,” the more you self-choose pain and the less likely you will be successful in healing and living the life that is possible for you.

• Choose where you focus your attention/Accept the Good: We live in a world where everything is viewed as a threat and our ancient brains react accordingly. Our stress response is dialed up so no wonder the slightest thing can set us over the edge. Time to dial up the “good.” As Hone notes, Resilient people are really good at choosing carefully where they select their attention. They have a habit of realistically appraising situations and typically managing to focus on the things they can change, and somehow accepting the things that they can’t. This is a vital, learnable skill…. Being able to also focus your attention to the good has been shown by science to also be a powerful strategy. …One day when doubts were threatening to overwhelm me, I distinctly remember thinking: “No, you do not get to get swallowed up by this. You have to survive. You’ve got so much to live for. Choose life, not death. Don’t lose what you have to what you have lost.” This is where practicing gratitude is really helpful. Listing three good things daily is helpful for some people. Just remind yourself daily what’s good in your world.

• Ask yourself “ is what I’m doing helping or harming?” Whether it is forgiving family ancient transgressions, arguments from Christmases past, or whether it is just trolling through social media, whether it is asking yourself whether you really need that extra glass of wine, asking yourself whether what you’re doing the way you’re thinking, the way you’re acting is helping or harming you, puts you back in the driver’s seat. It gives you some control over your decision-making.

“The chief task in life is simply this: to identify and separate matters so that I can say clearly to myself which are externals not under my control, and which have to do with the choices I actually control. Where then do I look for good and evil? Not to uncontrollable externals, but within myself to the choices that are my own . . .” Epictetus

Wednesday, January 8, 2020

Take a Break: Learn how Rose Bowl Floats are Made

On New Year’s Day, millions watch live and on TV the Pasadena Rose Bowl Parade. A close friend recently talked about how she worked for three nights on the Wells Fargo float many years ago. Her descriptions were fascinating. Thanks to the Internet, you too can learn more about what goes into creating a float.  
The Rose Parade travels 5 ½ miles down Colorado Blvd. and features four types of entries: floral-decorated floats entered by a participating corporation, non-profit organization or municipality, equestrian units, bands, and Tournament Entries. Rose Parade participants have long histories with the Tournament of Roses and keep the traditions alive. Pasadena Tournament of Roses

Every inch of the float must be covered with flowers or “organics” as the commentators refer to seeds, bark, fruits, leaves and other natural materials. Float building is big business, though some community and organizational floats, such as the City of Burbank, and Cal Poly Universities are constructed with volunteers.

The day after the parade ends, the process begins anew. Floats are dismantled, with materials, composted as well as recycled, and it isn’t long before the new theme is announced. In mid-February, builders select their float theme.  

An average of 80,000 hours of labor is put into the process of floats with approximately 900 volunteers each year. It is estimated that it takes 60 volunteers working 10 hours a day for 10 days to decorate a float.

If you are visiting or live in the area, you can visit one of the float “barns” after Christmas and observe the decorating. Admission is charged.

 If you missed the 2020 parade, you can watch it here, free of commercial interruptions. 

 Drive a Parade Float

Not interested in today’s activities, try the Take a Break Pinterest Board.

Saturday, January 4, 2020

Help is Refused But You’re Worried About Them

Recently a friend told me she had lost sleep trying to help an elderly friend who was being “stubborn:” - living conditions were not good and she was refusing help. Their unwillingness to take advantage of various programs was frustrating. However, as my friend noted, “they haven’t hit rock bottom yet, but they’re awfully close.”

“What’s to be done?” People genuinely care but aren’t sure how to go about helping in situations like this.

In order to answer that question, ask yourself three questions:
1. Are they a danger to themselves/others?

2. Why might they be reluctant to seek help?

3. What is your relationship to this person?

 Those with health, disability or aging issues are very concerned about loss of independence, freedom and control of their own life. This easily translates to fear and can keep them from taking advantage of what could actually make things easier and even improve their independence.

Regardless of motivating factors, does the current situation pose an immediate threat to health and safety of the individual and are you in a position to do something about it?

The first step then is to realistically assess the situation. Below are risk factors to consider:
• Lack of current support structure at home/lack of family, friends, community

• Suffering from self-neglect home: Insufficient food, water, heat; filth or bad odors, hazardous, unsafe or unclean living space; major repairs are needed and not done; human or animal feces; hoarding (nothing is thrown away); animal or insect infestation

• Suffering from self-neglect personally: Poor hygiene (dirty hair, nails, skin); smells of feces or urine; unclothed or improperly dressed for weather; skin rashes or bed sores; dehydrated, malnourished or weight loss; absence of needed dentures, eyeglasses, hearing aides and assistive devices; increased dementia, confusion, disorientation; unexpected or unexplained worsening of health; spending too much time alone; stopped engaging in activities; lack of interest or concern about life; untreated medical conditions; hallucinations, delusions, self-destructive behaviors or significant behavior changes.

• Lack of financial resources to remain in current living situation

• Unable to get to care: Can’t drive, no public transportation

• In an abusive situation: 1 in 6 people over the age of 59 suffer some form of abuse while living in community settings. There is a growing body of literature that links violence and chronic illness.  Abuse in these situations can be physical, inappropriate use of drugs, restraints or confinement; emotional (intimidation, humiliation, blaming); sexual; neglect; financial (stealing, misusing funds, forgery, identity theft); withholding medication and/or limiting access to care.

• Highly anxious

• Recent loss: Break up; death; employment; significant health status change

• Exhibits Violent behavior (hurting animals or other people)

• Substance abuse-the person or those caring for them.

If you find yourself saying yes to these risk factors, what is your relationship and how might that impact your ability to help?

Do you connect with this person as a volunteer (e.g. deliver Meals on Wheels) or in a professional capacity (e.g. personal care attendant)? In such cases, the organization you work or volunteer for is most likely covered by “duty to report.” If that is the case, talk to your immediate supervisor about how to proceed. 

Friends and neighbors can try offering help and assistance to the person and/or the caregivers. Be concrete about what you can do and don’t just say, “if you need anything call me.” It’s also important to let family/caregivers know if there are issues taking place when they are not around. That noted, if you think the person is being abused, or the situation is dire, contact Adult Protective Services(APS) in your area. 

Family and those closest to the person will do best with understanding their fears-loss of control; change; impoverishment; being perceived as “less than” or “incapable”- and developing a plan accordingly. The more they are presented with options and involved in creating a plan, the more likely they will respond.

If you are not having success, consider enlisting another family member, clergy, doctor, close friend etc. However, if you find the person is at high risk, and unwilling to consider changes, you can contact your local police force and request a “welfare check” or call APS.

Sometimes letting a caregiver or the person themselves know that if conditions remain unchanged APS may need to be contacted, is enough for changes to take place. However, this can also back fire, and they can withdrawal even more.

Over the years, I’ve had various people insist they didn’t need help, Life Alerts etc. They were fiercely independent and assured me that even if they fell and I found them dead on the floor, “It’s my choice!” The reality is often very different than what one imagines. More than one of these individuals has fallen and they were far from content to just lie there. In fact, when people give me the “my choice” line, I relay some of the stories I’ve seen. Further, it’s appropriate to talk to them about the impact of family, neighbor kids etc., finding them in an extremely compromised state or worse. More often than not, after such conversations, they’ll be a bit more willing to consider options. 

Note that APS can’t remove a person from their home against their will or force them to accept help. However, they can intervene without the consent of the vulnerable adult only if all other avenues have been exhausted, the person is found incompetent by the courts, and a court order has been granted to appoint a legal guardian to make decisions on his or her behalf. 

Click here to find the ADS for your state.