✷ Talking to a loved one about a move to assisted living

It can be hard to talk to your loved ones about moving into assisted living, so don’t push them too hard and make sure they feel safe and comfortable with the idea, one expert advises.

“Start the conversation as early as possible, and focus on what matters,” said Angela Catic. She’s a geriatrician and associate professor in the Roy M. and Phyllis Gough Huffington Center on Aging at Baylor College of Medicine in Houston.

“Think about if an assisted living environment could not just support, but enrich things that really bring joy to that individual’s life,” Catic said in a college news release.

As people age, it gets harder to take care of a house and yard. Adult children often start talking about assisted living when they see their parents are struggling, Catic said. After the death of a partner, a person may feel alone and lose their social connections. This is where transitioning into assisted living could benefit an older person, as such facilities often provide various social activities for their residents.

When starting a conversation with a loved one, consider covering these topics: • Mention a few facilities you have already researched prior to the conversation. Whether you visit them in person or do online research, keeping a few facilities in mind can ease any nervous feelings about the process. • Present a few options close to your loved one’s home or facilities near the home of a family member. This could remind them that they won’t be completely alone and will still have access to their family. • Stay mindful of their feelings, as they could feel anxious or sad about having such a conversation. These emotions may prompt them to resist the move altogether. • Mention any of their friends that you have heard from or ask them if they know anyone who has already moved into an assisted living facility, to normalize the idea. • Make sure they feel involved in the process so they feel like they have control over what happens. • Encourage them to come with you to tour a few facilities so they can visualize what their stay would be like there.

“Find a place they feel good about, too, and bring some of their belongings,” Catic said. “It’s typically a major downsizing of space, but it is important to bring things that have meaning to them and make it feel like home as much as possible. This may include items like a favorite chair, items they need to engage in a favorite hobby or family photographs.”

If your loved one says no to the idea of moving to an assisted living facility, don’t keep pushing the idea unless you’re truly worried about their safety. Hospitalization due to an accident or other health issues can also be a good reason to bring up the idea of assisted living again.

If they decline initially, you can always return to the conversation later, as their initial hesitation could be due to other factors that change, Catic said. When bringing the topic up again, ask them if they had time to reconsider the idea. Welcome their thoughts on the subject and offer ways you can make the process more comfortable for them.

Catic advises prioritizing finding your loved one a place that fits their needs and learning as much about it as you can so you know exactly what you are signing them up for. Even if a place looks nice in the lobby or on the tour, finding out more about what they have to offer can be an important part of finding the best fit for your loved one.

Additionally, learn about the staff and how often people move in and out. On another note, some facilities might have connections to different social groups such as veterans or other interesting people with whom your loved one could socialize.

“Go beyond the beautiful, fresh flower bouquet in the lobby because this is going to be someone’s home, not a hotel they’re staying in for a couple of nights,” Catic said. “You’re looking for a feeling of home and fitting in with other residents and a staff that feel like family.”

What You Need to Know About Macular Degeneration

By Deborah Jeanne Sergeant

Macular degeneration is one of the nation’s leading causes of blindness and low vision, affecting 1.8 million Americans, according to the Centers for Disease Control and Prevention.

Age-related macular degeneration or “dry” macular degeneration is more commonplace, 70%-90% of cases, than wet macular degeneration.

Either type of macular degeneration affects the central vision, which is important for reading, filling out paperwork and driving.

Patients may see fine in their peripheral vision, but not in the center. For example, they may see a person’s clothing and hair, but not the face.

WMD occurs when blood vessels grow abnormally under the macular and leak blood and fluid. This vision loss is rapid, and typically presents with straight lines appearing wavy. AMD is a slower process as the macula thins, which eventually blurs vision. Patients have a 10% chance of progressing into WMD.

Although there is no cure for AMD, doctors can treat WMD to reduce its effects with anti-VEGF injections to decrease the bleeding in the back of the eye and photodynamic therapy, a less common treatment sometimes used with anti-VEGF injections.

The injections “are generally very effective,” said Luca Zatreanu, MD, ophthalmologist with Reed Eye Associates in Pittsford and Irondequoit. Reed Eye also operates an office in Newark.

“Patients need to realize that these are treatments, not cures.”

They will need to return to the office for injections to prevent further damage. Even a week’s delay can negatively affect vision. With effective treatment, WMD can be managed for years—even decades— thanks to current protocols with a much lower risk of losing vision.

Photodynamic therapy uses a cold laser to target a light sensitive medication in the eye to break down blood vessels that cause the vision loss. Patients may need repeated treatments to maintain the effect.

Zatreanu tells adult children of someone with macular degeneration to regularly undergo a dilated eye exam of the back of the eye “even if they don’t have problems with their vision,” he said.

He also advises patients in lifestyle modifications for those with macular degeneration that can reduce their risk for further vision loss, including avoiding exposure to smoking and other sources of carbon monoxide, such as a woodburning stove.

“That can potentially accelerate the condition,” he said. “If you’re outdoors, even in winter, put on sunglasses as UV exposure can accelerated.”

Supplements can also help, including brands such as Preservision and Ocuvite.

Early diagnosis can help patients make lifestyle changes that can slow macular degeneration progress. In addition to smoking, the greatest risk factors for macular degeneration include age, family history, gender (women are more prone), high blood pressure, high cholesterol and poor diet.

Melissa Goddeau, registered dietitian nutritionist with Nutrition Care of Rochester, PLLC in Pittsford, recommends improving the diet by including more healthful foods to prevent further degradation for eye health and in general to promote eye health and reduce the risk of eye issues. She recommends improving intake of vitamins C and E.

“Some examples vitamin C-rich foods include oranges, strawberries, raspberries, cantaloupe, red peppers, cauliflower, broccoli and Brussels sprouts,” she said. “Vitamin E sources include nuts, seeds, sunflowers, peanut butter, shrimp, fish, wheat germ and spinach.”

Phytochemicals lutein and zeaxanthin can also help. Goddeau noted that leafy green vegetables like spinach and dark-leaf lettuce, cruciferous vegetables like kale and broccoli, and eggs and peas are good sources.

“Omega 3 fatty acids are an anti-inflammatory,” Goddeau added. “That will help combat oxidative stress that contributes to macular degeneration. “Eating fatty fish like salmon or tuna a couple times a week is helpful or taking, fish oil supplement if they don’t eat fish. Ground flaxseed and walnuts are also good sources.”

For people watching their sodium intake, shopping for walnuts in the baking aisle can make it easy to avoid added salt since these nuts are typically sold plain, unlike nuts sold from the baking aisle. “Nuts improve symptoms of depression and other mental health disorders,” Goddeau added. “They can reduce the tendency for the blood to clot. It also can help lower elevated triglyceride levels."