Generations Michigan
Spring 2008
s e t e b
A NEW LOOK AT
a i d
Better management is the key to good health.
Also in This Issue: ■ Ask the Expert ■ Caregiving News & Notes Published quarterly by Michigan’s Area Agencies on Aging
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Welcome to Michigan Generations Michigan is divided into 16 AAAs, each serving a different part of the state.
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They are:
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Whether you are an older adult yourself, a caregiver or a friend concerned about the well-being of an older adult, Area Agencies on Aging (AAAs) are ready to help. AAAs in communities across the country serve as gateways to local resources, planning efforts, and services that help older adults remain independent. AAAs were established under the Older Americans Act in 1973 to respond to the needs of Americans aged 60 and over in every community. The services available through AAA agencies fall into five general categories: information and consultation, services available in the community, services in the home, housing, and elder rights. A wide range of programs is available within each category.
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4 Region IV Area Agency on Aging 5 Valley Area Agency on Aging 6 Tri-County Office on Aging 7 Region VII Area Agency on Aging 8 Area Agency on Aging of Western Michigan 9 NEMCSA Region 9 Area Agency on Aging 10 Area Agency on Aging of Northwest Michigan 11 Upper Peninsula Area Agency on Aging 14 Senior Resources of West Michigan Visit the AAA’s state website at www.mi-seniors.net
The services offered by Michigan’s 16 AAAs cover a broad spectrum of needs, such as information and referral, case management, in-home services, home-delivered meals, senior centers, transportation, and special outreach. To read more about each of Michigan’s AAAs and the services available, turn to page 8 of this issue. MI
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Generations Michigan
summer 2008 Published quarterly through a cooperative effort of Michigan’s Area Agencies on Aging.
For information contact: Jenny Jarvis 248-262-9202 jjarvis@aaa1b.com
Editorial Project Development: JAM Communications, Atlanta, GA Design and Production: Wells-Smith Partners, Lilburn, GA Michigan Generations is a
On the Cover: Diabetics are enjoying healthier lifestyles, thanks to the strides being made in understanding this chronic disease. More exercise, smarter eating and new drugs are all making a difference. See story on page 4.
Summer 2008, Volume 6, #1 © 2008 by the Michigan Area Agencies on Aging. The information contained herein has been obtained from sources believed to be reliable. However, the Michigan Area Agencies on Aging and JAM Communications make no warranty to the accuracy or reliability of this information. No part of this publication may be reproduced or transmitted in any form or by any means without written permission. All rights reserved.
map photography courtesy travel michigan
AAAs —‑Gateways to Community Resources
1A Detroit Area Agency on Aging 1B Area Agency on Aging 1-B 1C The Senior Alliance 2 Region 2 Area Agency on Aging 3A Kalamazoo Co. Health & Community Services Dept. Region 3A 3B Burnham-Brook Region IIIB Area Agency on Aging 3C Branch-St. Joseph Area Agency on Aging IIIC
CAREGIVINGNews&Notes Taking Care of
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Your Gums
Don’t Get
bout 90% of adults have gum disease during their lives. Watch for these warning signs: • Red, swollen or tender gums. • Bleeding gums when you brush or floss. This bleeding is not normal. Even if your gums don’t hurt, get them checked. • Gums that have pulled away from teeth. Part of the tooth’s root may show, or your teeth may look longer. • Pus between the teeth and gums (when you press on the gums). • Bad breath. • Permanent teeth that are loose or moving away from each other. • Changes in the way your teeth fit when you bite. • Changes in the fit of partial dentures or bridges. The three main steps in fighting gum disease are brushing, flossing and seeing your dentist regularly. Brush at least twice a day and floss at least once a day.
A New Look at Portion Control
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f you’re trying to cut down on the amount of food you eat, here’s a new way to visualize food portions: 1 cup of cereal flakes = fist ½ cup of cooked rice or pasta = ½ baseball 1 normal piece of cornbread = bar of soap 1 serving of potatoes = fist 1 serving of fruit = baseball 3 oz. of meat, fish or poultry = deck of cards 2 T. peanut butter = ping pong ball 1 serving of ice cream = ½ baseball
Surfing the Net Each issue of Michigan Generations offers several websites of interest to older adults and their caregivers … right at your fingertips. www.medicareadvocacy.org showcases The Center for Medicare Advocacy, which works to increase access to comprehensive Medicare coverage and better health care for elders and people with disabilities. www.retirement-income.net offers free financial information for seniors and retirees, including a free monthly newsletter. Seniors can also download copies of booklets on specific financial and investment topics. Look for more helpful websites in the next issue of Michigan Generations. Summer 2008
Locked Out
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eed a locksmith? The Better Business Bureau has warned consumers to beware of untrustworthy locksmith companies that are ripping off people across the country. Seniors are heavily targeted by these firms. Victim complaints reveal that several locksmith companies, all using similar methods, are significantly overcharging consumers, charging consumers for unnecessary services, using intimidation tactics, and failing to give refunds or respond to consumer complaints. One problem is that most phone books accept ads from these irreputable firms. “Ironically, these companies operate under names like ‘Dependable Locksmith,’ but in reality they exploit the vulnerable situation of consumers who are locked out of their house or car,” says BBB’s Steve Cox. Some states have passed laws that attempt to curtail false advertising. Complaints about locksmith services to the 114 BBBs serving the U.S. increased almost 75% from 2005 to 2006 and have continued to come in steadily since then.
Clinics Succeed in Reducing Falls N
ew statistics from Australia confirm that falls can be greatly reduced, according to the International Council on Active Aging newsletter. A group of Australian seniors were recently evaluated for risk factors associated with falling. Thirteen clinics offered the evaluations and gave recommendations for reducing those risks. Most seniors were referred to the clinic by their general practitioner. They included women with an average age of 77.9 years who were considered at high risk: 78% had fallen within the preceding six months and 63% had fallen multiple times. Evaluations showed problems such as impaired balance, muscle weakness, chronic medical conditions, taking more than four medications and vision impairment. Multidisciplinary clinic teams provided various interventions, such as a home exercise program, home assessments or change in gait aids. Results: At six months, there was a reduction of more than 50% in falls, multiple falls and fall injuries.
A NEW LOOK AT
Better management is the key to good health. By Martha Nolan McKenzie
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anny Jackson discovered she had diabetes during a routine checkup two years ago. The diagnosis caught her by surprise. After all, she didn’t feel any differ‑ ent and had no symptoms suggesting she might have a problem. How‑ ever, Jackson unknowingly had several risk factors for diabetes — she was 70 at the time, African‑ American and ate a diet high in carbohydrates.
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Jackson began taking an oral medication, and she attended a workshop at the Detroit senior center she frequented. While not focused specifically on diabetes, the workshop offered sessions on the importance of diet and exercise, tips for talking with your doctor and even relaxation techniques. With some slight changes in her diet, twice-weekly trips to the gym and her medication, Jackson has been able to keep her diabetes under good control. “I don’t want to go on insulin, and hopefully I won’t have to,” says Jackson. “I’m trying to stay on top of it and keep it well under control.” Jackson is in good company. Nearly 21% of people age 60 and over have diabetes, compared with a rate of 7% in the general population, according to the American Diabetes Association. More alarmingly, about half of the diabetic seniors don’t even know they have the disease. “People associate many of the symptoms of diabetes with normal aging,” says Julie Shippy, director of the Northern Michigan Diabetes Outreach Network (TIPDON) in Charlevoix. “More frequent urination, blurry vision, fatigue, gait problems — seniors tend to think, ‘Oh, that’s just what happens when you get old.’ ” That can be a tragedy, because not diagnosing and treating diabetes can be a deadly mistake.
devastatingsdisease Diabetes is a disease characterized by high blood glucose levels as a result of defects in insulin production, insulin action or both. Type 1 diabetes (previously called insulin-dependent or juvenile-onset) occurs when the body’s immune system destroys cells in the pancreas so the body cannot produce insulin at all. Type 2 diabetes (previously called non-insulin dependent or adult-onset) occurs when the body either Michigan Generations
PHOTO BY KEITH EMMERICH
Learning how to manage chronic diseases, such as diabetes, is the goal of PATH — Personal Action Toward Health. Pictured above, facilitator Deliana Ilarraza reviews a workbook with (L-R) Lucille Crockett, Margaret Bazzelle and Mary Ann Robinson at a PATH workshop held at Franklin Wright Settlement in Detroit.
becomes insensitive to the insulin it produces or cannot use it properly. It is by far the most common form of diabetes, accounting for 90% to 95% of all cases. Type 2 diabetes is strongly linked with obesity, physical inactivity and increasing age — descriptors that can be applied to an ever-growing segment of the American population. “As a nation, we are aging, eating too much and exercising too little,” says Dr. Jeffrey Halter, director of the Institute of Gerontology at the University of Michigan. “We are faced with an epidemic of obesity, and that contributes directly to the development of diabetes.” While lifestyle is a huge factor in diabetes, genetics play a role as well. “Type 2 diabetes seems to be a very strongly inherited condition,” says Halter. “It runs in families.” That helps explain why rates of diabetes are so much higher in some ethnic populations. African Americans suffer from diabetes at much higher rates than whites. More than 13% of African Americans over the age of 20 have diabetes, compared with almost 9% of whites. “Some populations are definitely more affected than others, and it’s due to a combination of genetics and lifestyle,” says Feleta Wilson, associate professor in the College of Nursing at Wayne State University in Detroit. “African Americans — particularly low-income African Americans — often lack access to care, so they tend to be diagnosed with diabetes later, when the disease is much more serious and has already caused additional problems.” Diabetes is a far more serious disease than many people realize, cutting life short by 10 to 20 years and causing severe complications. About 80% of diabetics end up dying of heart disease. Summer 2008
“For all practical purposes, most people with diabetes have to treat the three ‘hypers’ — hyperlipidemia (high cholesterol), hypertension (high blood pressure) and hyperglycemia (diabetes),” says Dr. Caroline S. Blaum, associate professor of Internal Medicine in the Division of Geriatric Medicine at the University of Michigan. “That’s because the vast majority of people with diabetes also have high blood pressure and high cholesterol. And treating the blood pressure and cholesterol might even be more important than treating the diabetes, since most diabetics die from heart disease.” Diabetes is associated with a host of other medical problems, as well: • BlinDness. Diabetes is the leading cause of new cases of blindness among adults age 20–74. Over time, high blood sugar levels from diabetes lead to damage of the retina, the layer on the back of the eye that captures images and sends them as nerve signals to the brain. Whether diabetic retinopathy develops depends, in part, on how high blood sugar levels have been and how long they have been above a safe range. • KiDneY Disease. Diabetes is the leading cause of dialysis and renal disease in older adults. High levels of blood sugar make the kidneys filter too much blood. All this extra work is hard on the filters. In time, the stress of overwork causes the kidneys to lose their filtering ability. Waste products then start to build up in the blood. Finally, the kidneys fail, at which point the person needs to have a kidney transplant or to have the blood filtered by machine (dialysis). • aMPUtatiOns. Many people with diabetes have mild to severe forms of nervous system damage, which often causes impaired circulation and sensation in the extremities, particularly the feet. This is a major cause of lower-limb 5
amputations. Less severe forms can lead to gait disorder and loss of mobility. (See “How to Keep Your Feet Healthy” p. 16.) • Dental disease. Almost one-third of diabetics have severe gum disease, which can lead to tooth loss. “It’s critical for patients and caregivers to understand that treating diabetes is about much more than blood sugar regulation,” says Halter. “At least as important is controlling blood pressure and cholesterol and identifying early damage to various organs, such as the eyes, kidneys and heart, and intervening at an early stage.”
Managingsdiabetestheschallenges The first line of treatment for Type 2 diabetes includes diet changes, an exercise program and often an oral medication, along with managing the conditions that typically accompany diabetes. If blood sugar levels can’t be controlled with the initial approach, the patient will be started on insulin. To monitor blood sugar levels, patients prick their finger and test a small drop of blood on a strip at least twice a day. It’s a complicated disease to manage under the best of circumstances. “Diabetes is the most complicated disease managed in primary care because it affects so many of the organs of the body,” says Blaum. Indeed, studies have shown that the percentage of patients who meet all the criteria of accepted quality of care markers is well under 20%. “That’s not because people aren’t paying attention — it’s just because it’s hard to do,” says Halter. “There are a lot of very good medications out there, but ultimately the blood sugar levels are a lot harder to regulate than we thought.” Seniors must contend with additional challenges in managing the disease. Living on a fixed income may make it difficult to afford a healthy diet, medical care and medications and supplies. Seniors who no longer drive may have a hard time getting to doctors’ appointments or to the grocery.
Signs and symptoms of diabetes v Frequent urination v Intense thirst v Extreme hunger v Tiredness v Blurred vision v Irritability v Unexplained weight loss or gain v Prone to getting repeated infections v Delayed wound healing v Tingling and numbness in hands or feet
Risk factors for developing Type 2 diabetes v Physical inactivity v Obesity v Advancing age v Family history of diabetes v Hispanic, African American, Asian, Pacific Islander or American Indian v Past history of gestational diabetes v Unhealthy eating habits
Arthritis, vision and balance problems can make it hard to get exercise or give themselves injections. And seniors often have other medical conditions for which they take multiple medications, some of which can be at odds with diabetes management. For example, steroids, which are used to treat some types of arthritis or irritable bowel syndrome, cause blood glucose levels to rise. “If you are 50 and your only known health problem is diabetes, you can focus all your attention on that and do all the things you are supposed to,” says Halter. “But seniors may have several other conditions, including dementia, that makes managing this complicated disease even more challenging.” That’s why many health professionals try to simplify their message as much as possible. “Counting carbohydrates can be intimidating, so I also introduce the plate model,” says Shippy. “I tell diabetics — many of whom are overweight — to use a smaller plate. Then divide that plate in half. Fill that half with non-starch vegetables. Divide the other half into fourths. Fill one fourth with protein and one fourth with starch. That’s an easy way to eat correctly.”
Managingsdiabetesthesadvances If the news about diabetes sounds all doom and gloom, it shouldn’t. Several new, more effective, classes of non-insulin drugs have been approved. One, called DPP-4 inhibitor (Januvia), targets hormones in the gut to enhance the body’s own ability to lower elevated blood sugar. Another medication, Byetta, is an injectable medication that helps the pancreas produce insulin more efficiently. “Byetta has a very positive side effect of helping weight loss,” says Ann Constance, director of the Upper Peninsula Diabetes Outreach Network in Marquette. “That’s great, because losing weight makes managing diabetes easier.” For those who do need insulin, delivery methods have improved markedly. There are disposable pen devices, about the size of a highlighter, which are filled with insulin. The patient just screws on a little needle on the end and dials in a dose and injects — no more drawing up a dose out of a vial into a syringe. Most have large, easy-to-read numbers on the dial. The patient simply has to set the dose, insert the needle and press a large push button. Insulin pumps are becoming more popular. Pumps deliver insulin 24 hours a day through a catheter placed under the skin. “They offer people a lot more flexibility,” says Constance. “They can choose to eat when they are hungry, or skip a meal or have an extra snack. All that is much easier to do if you are on a pump.” Testing methods have also improved dramatically. “A number of years ago, we didn’t even have blood glucose testing monitors,” says Constance. “Now virtually everyone can have one. We are even starting to see some continuous glucose monitors — which constantly update what your level is — come into market. Not too far in the future, that might be the norm. It might even be linked with a pump, and automatically adjust insulin delivery as blood glucose goes up and down.” Michigan Generations
Communitysoutreach In the case of diabetes, an ounce of prevention could be worth several pounds of cure. In recognition of this, there are many programs to help seniors keep from getting diabetes in the first place, or, if they already have it, help them manage it well to avoid debilitating complications. On the national level, Medicare offers diabetes screening and covers diabetic education. “In 2005, less than 5% of Medicare beneficiaries took advantage of the screening, and they should,” says Shippy. “There is a huge number of seniors out there who don’t know they have diabetes.” In Michigan, six Diabetic Outreach Networks, funded by the state Diabetes Prevention and Control Program, work to promote partnerships to strengthen diabetes prevention, detection and treatment throughout the state. The networks offer educational programs to spread understanding of the risk factors, symptoms and prevention of diabetes as well as programs for health care professionals to keep them up to date on advances in treatments. The outreach networks partner with the Michigan Area Agencies on Aging (AAAs) to present a chronic disease management program called PATH — Personal Action Toward Health. The six-week program, offered at a wide variety of locations, is meant to help people with chronic diseases better manage their condition. While not focused specifically on diabetes, many attendees are diabetic. “The ultimate goal of the program is to help these seniors stay independent,” says Ruth Kaleniecki, Healthy Aging Manager, Detroit Area Agency on Aging. “We teach about exercise and nutrition. We teach relaxation techniques. Basically, the class gives them tools to help them better manage conditions that are common with chronic diseases. It’s general information, but diabetes is so rampant in Detroit, we find that most of our participants do have diabetes.” While the PATH program focuses on patients, another statewide effort — IPIP — targets physicians. Funded by a grant from the Robert Wood Johnson Foundation, IPIP (Improving Performance in Practice) borrows tactics from the automotive industry to help primary care physicians better manage their patients’ chronic conditions. IPIP is being tested in several states, but Michigan is unique in that it is focusing its efforts on diabetics. “The program sends quality coaches into medical practices to help them improve processes they use in caring for their chronically ill patients,” says Rose Steiner, state project director for IPIP Michigan. “Instead of taking medical individuals and training them on how to improve quality, we have taken quality professionals from the automotive industry and trained them on how to work within the health care arena.” These coaches will evaluate the processes in a primary care physician’s office and suggest ways to improve them. “Using an electronic registry, for example, could add great efficiencies,” says Steiner. “You could load all your diabetic patients onto one registry. The registry would allow you to pull the names and contact information of those patients, so the doctor can focus on prevention as opposed to always responding in a crisis.”
Many of the programs around the state focus on the lifestyle issues that are important in preventing and managing diabetes, primarily diet and exercise. A lot of times seniors reach a point where they think they shouldn’t be doing physical activity because they could hurt themselves. Actually, it’s just the opposite. Physical activity is probably the most beneficial thing they can do. It helps reduce weight, which in turn reduces the strain on nearly every organ in the body. While you are doing it, physical activity helps to burn off the glucose in your blood. And even while you are not exercising, any lean muscle you build through exercise and light strength training makes your body more efficient in using insulin. Understanding the benefits of exercise and getting up off the couch are two entirely different matters. “Studies show that 50% of people who start an exercise program drop out within six months,” says Kim Gretebeck, assistant professor at the University of Michigan School of Nursing. Gretebeck and Blaum are conducting a study of seniors with diabetes to see if interventions can keep them active for one year. “If they stick with exercise for a year, hopefully
In the case of diabetes, an ounce of prevention could be worth several pounds of cure. it becomes a habit at that point and they won’t drop it,” says Gretebeck. “The whole idea is to help seniors maintain their independence.” In the Upper Peninsula, Diabetes Outreach Network’s Constance has started a program designed to get seniors off the couch. Move Your Yoopers is an exercise mentoring program that pairs people who are regularly physically active with people who would like to become active. “It’s almost like your own personal trainer,” says Constance. On the diet side of the equation, Kris Godbold, nutrition project manager of the Region 2AAA in Brooklyn, offers a three-week course called Dining with Diabetes. “Basically I teach healthy eating tips, how to shop, how to change the recipes you are already using and clarify some misconceptions about what a diabetes diet is,” says Godbold. “Many times people think, ‘I can’t have any sweets or carbs,’ but people with diabetes have the same nutritional needs as anyone else. By controlling carbohydrate intake and doing portion control, you can keep your blood glucose level as close to normal as possible.” All these programs mentioned above have one message in common. You can change and you can improve your condition. Even small lifestyle changes can, over time, make a big difference. You can prevent diabetes, or, if you already have it, you can prevent complications of the disease. “The time to do something is now,” says Shippy. “If you have any risk factors of diabetes, you need to do everything you can to stack the deck in your favor.” MIG
Summer 2008 Fall 2007
regionalNews In communities across the U.S.,
6 Tri-County Office on Aging 7 Region VII Area Agency on Aging 8 Area Agency on Aging of Western Michigan 9 NEMCSA Region 9 Area Agency on Aging 10 Area Agency on Aging of Northwest Michigan 11 Upper Peninsula Area Agency on Aging 14 Senior Resources of West Michigan
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Area Agencies on Aging (AAAs) serve as gateways to local resources, planning efforts and services that help older adults remain independent. Here are the programs and services offered by Michigan’s AAAs.
1A Detroit Area Agency on Aging 1B Area Agency on Aging 1-B 1C The Senior Alliance 2 Region 2 Area Agency on Aging 3A Kalamazoo Co. Health & Community Services Dept. Region 3A 3B Burnham-Brook Region IIIB 3C Branch-St. Joseph Area Agency on Aging IIIC 4 Region IV Area Agency on Aging Reg 1-A / Detroit AAA 5 Valley Area Agency on Aging
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Reg 1-B / AAA 1-B
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3C
1C
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Reg 1-C / The Senior Alliance, Inc.
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Reg 2 / Reg 2 AAA
S potlight O n …
Region IV Area Agency on Aging Covering Michigan’s Great Southwest including Berrien, Cass and Van Buren counties
Planning for Your Health, Resource Needs and Legal Issues Reg 3-A / Kalamazoo Cty. Human Services Dept. (Region 3)
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oday, more than 31 million Americans are over the age of 65, and that number is growing at twice the rate of the general population. With the fastest-growing group composed of those over the age of 85, an increasing number of individuals and their adult children find themselves suddenly facing difficult decisions about health care, housing, home safety, costs, home care or legal issues. Without advance planning, the direct impact on a family’s finances, lifestyle and job can be catastrophic, particularly when a sudden illness or an accidental slip or fall occurs, creating a crisis. Many families do not plan
Reg 3-B / Burnham-Brook Reg IIIB
ahead, and adult children may feel unprepared to assume the responsibilities of caregiving or do not know where to turn for help. To assist families in dealing with ongoing health concerns, community and legal theon Aging Reg 5 /resources Valley AAA Reg 6 /issues, Tri-County Office Area Agency on Aging is holding a “Family Survival Guide” series. Three two-hour evening sessions begin with an overview of health, personal and family resources, with the discussion facilitated by a physician. On the second evening, a panel of community experts discusses inhome services, day Reg 9 / NEMSCA Reg 9 AAAadult Reg 10 /services, AAA of Northwest MI housing options and home safety. The third session focuses on trusts,
wills, power of attorguardianship, Regney, 3-C / Branch-St. Joseph AAA Reg 4 / Reg IV AAA (IIIC) insurance and government programs. In addition to discussing these issues, families receive a resource
Reg 7 / Reg VII AAA
Reg 8 / AAA of Western Michigan
notebook including checklists and folders that can be personally customized for gathering important information. theof Reg 11 /For Uppermore Peninsulainformation, AAA Reg 14 /contact Senior Resources West Michigan Region IV AAA at 269-983-0177 or 1-800-442-2803. Michigan Generations
Detroit Area Agency on Aging Serving Detroit, Highland Park, Hamtramck, Harper Woods and the five Grosse Pointes in Wayne County
Advocates Want More Choices for Independence
Reg 1-A / Detroit AAA
Reg 1-B / AAA
Reg 3-A / Kalamazoo Cty. Human Services Dept. (Region 3)
Reg 3-B / Burn
Reg 5 / Valley AAA
Reg 6 / Tri-Cou
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very hour, over 10 Michigan residents turn 60 years old, and Michigan’s older population will grow by over one million persons between 2000 and 2030. On their behalf, hundreds of older persons, adults with disabilities and advocates converged on the State Capitol to convince Governor Jennifer Granholm and state legislators that more state resources are needed to help older people to “age in place” and reside in “livable, everyone-friendly communities.” The first-time rally on June 11 was tabbed Older Michiganians Day. For information on what seniors, advocates, legislators and you can do to create more choices, contact Mary Ablan, Area Agencies on Aging Association of Michigan, 517-886-1029 x14.
Detroit Area Agency on Aging Board of Directors and Advisory Council members stand in front of the State Capitol on Older Michiganians Day 2008 after visits with their state legislators. Pictured (left to right) are Richard Wells; Catherine Wells, Ph.D.; Flossie Thomas; Bernice Morrison and Elaine Williams.
Assistant Secretary for Aging Applauds Local Initiatives
Reg 9 / NEMSCA Reg 9 AAA
Reg 10 / AAA
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fter a recent metro Detroit visit, U.S. Dept. of Health and Human Services Assistant Secretary for Aging Josefina G. Carbonell said, “You are at the center of efforts to transform long-term care systems
in this country by using tested and trusted approaches to create more opportunities for people to remain in their own homes and communities.” Carbonell was referring to programs of Presbyterian Villages of Michigan (PVM), including PVM’s Green House for long-term care residency, and to programs of the Detroit Area Agency on Aging. The Administration on Aging supports Josefina Carbonell (center) joins board and staff members evidence-based preof the Detroit Area Agency on Aging after the agency’s vention efforts and Long-Range Planning Committee “Create Choices for the nationwide deployIndependence Forum” in April. Summer 2008
Assistant Secretary for Aging Josefina Carbonell (R) talks with Henry Johnson, Chairman of the Board, PVM Foundation, after a roundtable discussion on wellness programs.
ment of simple but very effective programs that seniors can use to better manage their chronic conditions, reduce their risk of falling, and improve their physical and mental health through better exercise and nutrition.
Area Agency on Aging 1-B Serving the counties of Livingston, Macomb, Monroe, Oakland, St. Clair and Washtenaw
Adult Day Services — A Valuable Community Program
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ate Reichard is 84 years old and has severe dementia. Her son, Rick, first noticed minor symptoms about 12 years ago. Then when his father, Kate’s husband, passed away two years later, Kate’s symptoms started to become more noticeable, and eventually reached a point where she could no longer live independently. So, for the past eight years, Kate has lived with her son and his wife, Laura, who have willingly assumed the role of primary caregiver for Kate, helping her with personal care and providing a supportive, loving environment in their home. During the first few years, Kate would enjoy going out on errands with Laura, and she would stay with other family and friends for a few hours during the day, giving Laura a break from her caregiving duties. However, as the dementia progressed, Kate required more assistance with activities of daily living, and it also became difficult for her to leave the security of her son’s home. Five years ago, Rick and Laura found out about the Frenchtown Adult Day Service, which provides support, stimulation, activities, supervision and social interaction for frail or impaired older adults and persons with disabilities. Since then, Kate has been attending the Frenchtown Adult Day Service for four days and often five days each week, arriving for lunch and participating in many activities, including music, art and exercise. The first time Laura brought Kate to the center, she felt guilty about leaving Kate in a new environment — a very 10
Kate Reichard and her son Rick Reichard.
common feeling among caregivers. However, the experience has proven to be very positive for both Kate and Laura. Even as Kate’s dementia has progressed to a point where she does not recognize anyone, and cannot tell the difference between summer and winter, she still continues to enjoy attending the Frenchtown Adult Day Service program. “If Laura hadn’t had that time during the day to do errands and work around the house, we may not have been able to keep my mom living with us,” says Rick. “The Frenchtown Adult Day Service has been so valuable in keeping my mother engaged through the changes in her health over the past five years, and in helping us extend the time that
Reg 1-A / Detroit AAA
Reg 1-B / AAA 1-B
Laura and I have been able to spend with my mother.” The Frenchtown Adult Day Service is open five daysCty.aHuman weekRegfrom 6:00 a.m. Reg 3-A / Kalamazoo 3-B / Burnham-Brook Reg IIIB Services Dept. (Region 3) to 6:00 p.m. and on Saturdays upon request, serving anyone age 18 or older who meets certain intake requirements — such as needing help with activities of daily living or continual supervision in order to live in their ownReghome or with Reg 5 / Valley AAA 6 / Tri-County Office on Aging a caregiver. “For the families, having a place to bring an older loved one that gives them, as a caregiver, a break from the daily responsibilities and also improves the quality of life of their loved one, is a valuable Reg 9 / NEMSCAvery Reg 9 AAA Reg program,” 10 / AAA of Northwest MI says Barbara Mazur, director of Frenchtown Senior Center, where the Adult Day Service program is located. The Frenchtown Adult Day Service program offers art therapy, intergenerational programming with local schoolchildren, music therapy with students from the Monroe County Community College and day trips such as visits to the Calder Dairy, the Erie Orchards for a hay ride each fall, the local museum and the Frenchtown Mall during the holiday season. Adult Day Services are available in many communities. For more information on the Frenchtown Adult Day Service or a similar program in your area, call the Area Agency on Aging 1-B at 1-800-852-7795. Michigan Generations
Reg 1-C / The
Reg 3-C / Bra (IIIC)
Reg 7 / Reg V
Reg 11 / Uppe
2008 Solutions for Family Caregivers Expo Saturday, October 18, 2008, 9:00 a.m. to 2:00 p.m. Best Western Sterling Inn Banquet and Conference Center 34911 Van Dyke (at 15 Mile) Sterling Heights, MI
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aring for a loved one can be an overwhelming experience for many people in southeast Michigan — but help is available. The Area Agency on Aging 1-B (AAA 1-B) is hosting its 9th Annual Solutions for Family Caregivers Expo on Saturday, October 18, 2008, from 9:00 a.m. to 2:00 p.m. at the Best Western Sterling Inn in Sterling Heights (on Van Dyke Avenue at 15 Mile Road). This free event provides information for individuals caring for an aging parent, spouse, relative or friend. Guests can attend expert presentations on relevant topics, such as understanding behaviors linked with dementia, senior housing options, dealing with caregiver stress and burnout, legal tips for caregivers and much more, and visit the “Ask the Expert” area for answers to questions on Medicare, Medicaid, prescription assistance and long-term care insurance. More than 80 exhibitors will be on hand to provide information on products and services to help caregivers. For more information, call 1-800-852-7795, or visit www.aaa1b.com.
Help Is a Phone Call Away The Area Agency on Aging 1-B is the first resource for older adults, caregivers and persons with disabilities to call when looking to resolve problems or locate the resources they need to improve the quality of their life. When individuals call the toll-free Information and Assistance (I&A) service at 1-800-852-7795, they speak with a certified Information and Referral Specialist to determine what their needs are and the services and assistance available to address those needs. Once the needs are determined, the specialist accesses the I&A database of over 2,000 community agencies and mails the individual a complete listing of relevant services and providers in their local community. Call us. We can help.
1-800-852-7795
Region 2 Area Agency on Aging Serving Hillsdale, Jackson and Lenawee counties
Take the Path to Better Health Reg 1-A / Detroit AAA
H
Reg 1-B / AAA 1-B
illsdale, Jackson and Lenawee County residents who suffer from chronic diseases are being asked to “Take the PATH to Better Health.” The PATH is “Personal Action Toward Health,” a six-week self-management Reg 3-A / Kalamazoo Cty. Human Reg 3-B / Burnham-Brook Reg IIIB Services Dept. (Region 3) program that teaches knowledge and skills needed to better manage chronic disease. The PATH program, Participants in a PATH workshop learn how to better developed by the Stanford manage their chronic diseases. University School of Medicine to reduce pain and stress, cope with in California, is facilitated fatigue and use medications wisely, by trained leaders who may have and emphasizes the benefits of exerendured personal chronic health Reg 5 / Valley AAA Reg 6 / Tri-County Office on Aging cise. By creating weekly personal conditions. action plans, participants learn how A PATH workshop addresses ways Summer 2008
to build their own selfmanagement program Reg 1-C / The Senior Alliance, Inc. Reg 2 / Reg 2 AAA and gain the confidence and tools to carry it out. A success story comes from a 91-year-old participant who used relaxation exercise she had learned at the workshop to later help her control an anxiety attack she suffered when she was home alone. Another participant gained skills to walk short Reg 3-C / Branch-St. Joseph AAA Reg 4 / Reg IV AAA (IIIC) distances in his home without using his wheelchair. PATH workshops are available in many areas throughout Michigan. Call your local Department on Aging or Area Agency on Aging for more information. For information on PATH in Region 2, call Linda Powelke, or Reg for8 /other Region 2 Reg 7 / Reg VII AAA AAA of Western Michigan information, call Barbara Stoy, at 517592-1974 or toll-free 1-800-335-7881. 11
Burnham Brook Region IIIB Serving Barry and Calhoun counties in Southwest Michigan
Let Freedom Ring
F
reedom is often defined within the context of civil and human rights. Life, liberty and the pursuit of happiness come to mind. However, for older adults, freedom is about independence — and finding happiness despite the challenging circumstances that life may bring. How do we ensure that older adults can retain their independence? The answer lies in what our Founding Fathers wanted too — choices! Some of these choices start very early, like choosing what we eat, if we will exercise, and all the other behaviors and actions that guide our everyday living. One of the best ways to guarantee that you can remain independent for the longest time possible is to make
healthy choices each day. Practice good nutrition, moderate exercise, self-management of chronic diseases, and positive thinking.
Here’s how to ensure that older adults can retain their independence. Another way to promote independence is to advocate for more funding for services that help seniors remain in their homes. Funding for programs like those provided by the Area Agency on Aging and funded through the Department of CommuReg of 1-A /Services Detroit AAA to nity Health and Offices the Aging can help people remain in
their homes by offering at-home assistance. Let Reg 3-A / Kalamazoo Cty. Human Reg 3-B / Burnham-Brook Reg IIIB Services Dept. (Region 3) your state and national representatives know how important these programs are for our community. One of the most important strategies for maintaining independence is to plan ahead. Having a conversation about the “what-ifs” in life can be difficult, but it is important. Talk to your family members, discuss your wishes, Reg 5 / Valley AAA Reg 6 / Tri-County Office on Aging educate yourself, put it in writing and plan in advance. So as we get ready to celebrate our country’s independence, don’t forget to let freedom ring by taking steps to make your voice heard as you plan for your future. For information, contact Executive Director Karla Fales, Region 3B Area Reg 9 / NEMSCA Reg 9 AAA Reg 10 / AAA of Northwest MI Reg 1-B / AAA on 1-B Aging, at 269-966-2450 Reg 1-C / The Senior Alliance, Inc. Agency or go to www.region3b.org.
Reg 3-C / Bran (IIIC)
Reg 7 / Reg V
Reg 11 / Uppe Reg 2 / Reg 2
Branch–St. Joseph Area Agency on Aging IIIC Serving a two-county area surrounding Sturgis, Three Rivers, Coldwater and Quincy
Healthy IDEAS
Reg 3-A / Kalamazoo Cty. Human Services Dept. (Region 3)
D
id you know that nearly one in five Americans age 65 or older experiences symptoms of depression? Everyone feels unhappy or sad at some point in their life, but if the symptoms persist for several weeks, then they may be pointing to a more serious illness: depression. Symptoms of depression include feelings of sadness or worthlessness, loss of interest in activities, irritability, loss of appetite, sleep difficulties, fatigue, memory difficulties and thoughts of suicide. Depression is common in later life yet is often underdiagnosed despite its debilitating effects. Healthy IDEAS is an evidencebased program that offers screening for depression, education for older 12
adults and their caregivers about Reg 5 / Valley AAA depression, referral and follow-up to primary care and mental health care providers, and behavioral approaches to help older adults become reinvolved in meaningful activities. The program is administered by Pines Behavioral Health in Coldwater, and partners with the Commission on Aging and the Area Agency on Reg Aging Reg 9 / NEMSCA 9 AAA in screening persons age 55 and over for symptoms of depression.
If you or someone you know have beenReg 3-C / Branch-St. Joseph AAA (IIIC) bothered by a lack of interest or pleasure in doing things, or if you or someone you know have been feeling sad or hopeless, call any of the following agencies for help or for more information:
Reg 3-B / Burnham-Brook Reg IIIB
Reg 4 / Reg I
Pines Behavioral Health 200 Orleans Blvd., Coldwater, MI Reg 6 / Tri-County Office on Aging Reg 7 / Reg VII AAA 49036; 517-278-2129
Reg 8 / AAA
Branch County Commission on Aging 65 Grahl Dr., Coldwater, MI 49036; 517-279-6565 Area Agency on Aging 3C 570 Marshall Rd., Coldwater, MI 49036; 517-278-2538 For information, call Reg517-278-2538 11 / Upper Peninsula AAA or toll-free 1-888-615-8009.
Reg 10 / AAA of Northwest MI
Michigan Generations
Reg 14 / Sen West Michig
Services Dept. (Region 3)
(IIIC)
Region VII Area Agency on Aging Serving Bay, Clare, Gladwin, Gratiot, Huron, Isabella, Midland, Saginaw, Sanilac and Tuscola counties
Isabella County Commission on Aging Plans Move to New Facility
Reg 5 / Valley AAA
T
hrough the years, the Isabella approximately 24,134 square feet. The County Commission on Aging has innovative facility includes a 2,600developed into a leading multi-service square-foot commercial kitchen, a agency that provides a community library with a computer lab, game center to help meet the needs of the older adult population. Soon Reg 9 / NEMSCA Reg 9 AAA older adults will have the opportunity to utilize and take pleasure in a new facility. Groundbreaking for A rendering of the new community center in Mt. Pleasant. the new building began in September 2007, and the center is room, arts and crafts room, fitness expected to open in July 2008. The area, and administrative and direct address is 2200 South Lincoln Road services area. Brenda Upton, execuin Mt. Pleasant. The building sits on tive director of the Isabella County 8.3 acres, and the structure itself is Commission on Aging, says that there
will also be a large activity room with seating Reg 7for / Reg VII AAA 400. An open house is scheduled for September 2008. The Isabella County Commission on Aging offers a vast array of services, including home-delivered and congregate meals, in-home services such as personal care and homemaking, a Senior CenReg 10 / AAA of Northwest Reg Program, 11 / Upper Peninsula AAA ter & MITravel and Reg 1-A / Detroit AAA Reg 1-B / AAA 1-B a Freedom Through Fitness Exercise Program. For more information on services offered by the Isabella County Commission on Aging, please call 989-772-0748. You can also contact the Region VII Area Agency on Aging at 1-800-858-1637 or www.region7aaa.org. Reg 6 / Tri-County Office on Aging
Reg 3-A / Kalamazoo Cty. Human Services Dept. (Region 3)
Reg 3-B / Burnham-Brook Reg IIIB
Reg 8 / AAA
Reg 14 / Seni West Michiga Reg 1-C / The
Reg 3-C / Bra (IIIC)
Tri-County Office on Aging A consortium of Clinton, Eaton and Ingham counties and the cities of Lansing and East Lansing
Independent Living Consultation
T
he goal of an to live their Independent Livown lives, and ing Consultation is spends a lot of to offer professional time listening. assistance to older Then the ILC adults who desire to shares inforremain independent, mation about helping them to find long-term care available resources options and and supports. Honorresources in ing personal choice the community. is a priority. The TCOA’s Tri-County residents George and Evon Tri-County Office on ILC has aided worked with an Independent Living Aging (TCOA) curone couple, Consultant (ILC) to develop a successful rently has an Indepenboth in their dent Living Consultant (ILC) devoted late 80s, to develop a comprehensive to meeting this goal. plan, addressing both strengths and The ILC recognizes that people values along with concerns for their are the experts on how they want safety. The ILC assisted the husband, Summer 2008
George, to arrange for a volunteer fromReg 6 / Tri-County Office on Aging his church to drive him to and from physical therapy appointments. The ILC helped George’s wife, Evon, to accept the role reversal of allowing her daughters to lend a hand with laundry, vacuuming, mopping and changing linens. Evon continues to do the dusting, which allows her to feel productive. Reg 9 / NEMSCA Reg 9 AAA Reg 10 / AAA of Northwest MI The ILC is available to help older adults and their families navigate the long-term care system, and to use their resources wisely. It is hoped that in doing so, people will be able to remain independent longer with the assistance they need, living the way they want to. For more information, please contact the Tri-County Office on Aging at 517-887-1440 or 1-800-405-9141. Reg 5 / Valley AAA
13
Reg 7 / Reg V
Reg 11 / Uppe
NEMCSA Region 9 Area Agency on Aging Covering 12 counties of Northeast Michigan
Community Fun at the Festival
T
he little town of Posen, population 2,042, swells to over 40,000 for the annual Posen Potato Festival. For 57 years, the festival has been held the first weekend following Labor Day. There are polka and country music dances held all weekend long as well as carnival rides, tractor pulls, mud bogs, a Festival Queen pageant, arts and crafts, prize-winning potato recipes and a parade. One of several groups providing meals during the festival is the Presque County Council on Aging (PICCA). A chicken dinner fundraiser is held at St. Casimir’s Gym, with PICCA staff, volunteering seniors and students from Posen Schools and Boys Town working together to
Reg 1-A / Detroit AAA
provide 600 dinners — complete with strawberry shortcake! For more information, contact PICCA at 989-766-8191. Come join us in September at a festival for all ages!
Alpena County Honors Seniors Who Make a Reg 3-A / Kalamazoo Cty. Human Services Dept. (Region 3) Difference
I
n recognition of May as Older Americans Month, the Alpena Area Senior Citizens Council (ASSC) set out to acknowledge exceptional individuals in Alpena County. They sought nominations of individuals 60+ years of age who had made a difference in someone’s life throughRegtheir 5 / ValleyvolunAAA teer efforts, mentoring of youth or
just reaching out with a kind deed that madeRega9 difference. / NEMSCA Reg 9 AAA Reg 1-B / AAA 1-B nominations, Reg 1-CSandi / The Senior Alliance, Inc. From the Johnson was selected as Alpena County’s Outstanding Older Citizen. The Alpena Senior Citizens Center also identified residents who had reached 100+ years of age as members of the center’s 100+ Club. These special centurions were honored with awards and a slide show featuring3-Blifetime photos member. Reg / Burnham-Brook Reg IIIB of Regeach 3-C / Branch-St. Joseph AAA (IIIC) Business and community members were invited to join in the celebration by attending the Alpena Chamber of Commerce’s Good Morning Alpena Breakfast to honor award nominees. These individuals are true gems in our community; it is a privilege to be able to pay tribute to them. For more information, contact ASSC at Reg 6 / Tri-County Office on Aging Reg 7 / Reg VII AAA 989-356-3585.
Reg 10 / AAA Reg 2 / Reg
Reg 4 / Reg
Reg 8 / AAA
Upper Peninsula Area Agency on Aging Serving all 15 counties of Michigan’s Upper Peninsula
Working to Prevent Elder Abuse
S
am sits in his home, confused and alone. He forgets to change his clothes, doesn’t always remember to eat and hasn’t taken his heart medication in quite a while. His friends are all gone now, and his family is too busy to help him much. They know Sam is a little forgetful, but “everyone” gets that way when they get this old. Sam’s family doesn’t feel that spending all his money on a nursing home or assisted-living facility is necessary. Sadly, there are folks just like Sam in each community. Additionally, there are other forms of abuse and exploitation against the elderly occurring every day. Each year an estimated 2.1 million older Americans are victims of physical or psychological 14
Reg 9 / NEMSCA Reg 9 AAA
abuse, as well as other forms of abuse or neglect. Those statistics may not tell the whole story. For every case of elder abuse and neglect that is reported to authorities, experts estimate that there may be as many as five unreported cases. Effective interventions can prevent or stop elder abuse. By increasing awareness among physicians, mental health professionals, home health care workers and others who provide services to the elderly and family members, patterns of abuse or neglect can be broken, and both the abused person and the abuser can receive needed help. The Upper Peninsula Area Agency on Aging (UPAAA) is committed to creating awareness of
elder abuse and to provide support, for Reg 10 / AAA of Northwestsolutions MI Reg 11and / Upperhelp Peninsula AAA anyone involved or concerned about elder abuse, neglect or exploitation. Recently, the UPAAA became involved in developing an effective Elder Justice Community Collaborative with the Sault Ste. Marie Tribe of Chippewa Indians, covering a sevencounty area in the Upper Peninsula. The UPAAA also provides training and education programs to professionals and caregivers who work with older adults. “It is important to join forces with other organizations to improve communication and develop tools that will help eliminate the potential for elder abuse,” says Cathy Klintworth, coordinator of the UPAAA’s Elder Abuse Education Program. For more information, call Cathy at 1-800-338-7227, or simply dial 2-1-1. Michigan Generations
Reg 14 / Sen West Michig
ASKtheExpert
Jo Murphy
Understanding
Medicaid
What is the difference between Medicare and Medicaid?
How can I get Medicaid?
medicare is a federal insurance
through Supplemental Security Income (SSI) automatically receive Medicaid. If you do not get SSI, you, or a spouse, parent, legal guardian or other individual who is at least age 18 or married, must file an application with DHS to see if you are eligible. To qualify for full Medicaid a person must have either limited assets and income or high medical expenses (asset limits also apply to people with high medical expenses), and must be 65 years of age or older, blind, disabled or receiving SSI. Assets are cash, money in checking or savings accounts, stocks, savings bonds, trusts, annuities or any other money that you have saved or invested. Assets also include things like boats, trailers, real estate or life insurance. Medicaid does not count personal property such as your car, clothing or furniture, and there are special considerations for how a home may count as an asset.
program that pays medical bills for people who are at least 65 years of age or who are disabled. It is available to individuals who receive Social Security regardless of how much income they have. Medicaid is a program that pays the medical bills of people who are low-income and meet other eligibility requirements. It is run by the state and pays costs using state and federal tax money. In Michigan, Medicaid is administered by the Michigan Department of Community Health, and through local offices of the Department of Human Services (DHS) located in each county.
Can I have both Medicare and Medicaid at the same time? yes. both programs can work together. If you receive Medicare and qualify for Medicaid, the Medicaid program will pay your monthly Medicare Part B premium. This program is call the Medicare Savings Program. Medicaid may also pay your Medicare co-payments and deductibles. If you are 65 or over and have not worked long enough to have Medicare Part A covered, then Medicaid will cover the cost of your Medicare Part A premium.
Do you have a caregiving question? Write or email your question to our “Expert� at: Jenny Jarvis, Area Agency on Aging 1-B, 29100 Northwestern Highway, Suite 400, Southfield, MI 48034; jjarvis@aaa1b.com. We will make every effort to answer your question in an upcoming issue of Michigan Generations. Summer 2008
all people who receive money
Can Medicaid help me stay in my home? there are two programs available
through Medicaid in Michigan that can help older adults or younger adults with disabilities receive Medicaid services in their own home or chosen place of residence. Home Help is a program of DHS that gives support to individuals who are unable to care for themselves adequately at home. This program provides funds for individuals to hire helpers to assist them with daily activities such as eating, personal care, taking medicine, preparing meals, shopping and homemaking. The amount of funding an individual receives depends on the individual’s physical and mental condition and home situation, and is determined by a DHS worker.
The MI Choice Home and Community Based Waiver program is also available to individuals 65 years of age or older, or younger adults with disabilities that are Medicaid-eligible and require a nursing home level of care. Through the MI Choice program, a care plan for the individual is developed, and a care manager helps monitor the plan as individual needs change. Services that are covered through this program include personal care, homemaking, respite for caregivers, adult day health services, home-delivered meals, transportation, personal emergency response systems and fall prevention in the home.
How can I find out more information about Medicaid? the michigan medicare/medicaid Assistance Program (MMAP) is a statewide program with funding from the Michigan Office of Services to the Aging through a grant provided by the Centers for Medicare & Medicaid Services, the federal Medicare agency. MMAP counselors are available in local communities across Michigan to help individuals with questions about Medicare and Medicaid. In addition to answering questions about Medicaid eligibility, counselors can discuss Medicaid programs such as Home Help and MI Choice, and can provide you with more information on Medicare, including Medicare Savings Programs, Medicare Part D and Medicare Advantage Plans. To speak with a counselor in your area, call 1-800-803-7174.
Jo Murphy is Executive Director of MMAP, Inc., a nonprofit organization that educates, counsels and empowers beneficiaries and those who serve them so that they can make informed health benefit decisions. 15
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How to Keep Your Feet Healthy
E
xercise is a crucial component of managing diabetes, and walking is one of the best forms of exercise.
As beneficial as walking is, diabetics should proceed with caution. That’s because one of the complications of the disease is neuropathy — nerve damage that can interfere with a person’s ability to feel pain. In addition, poor blood flow can make your foot less able to fight infection and to heal. So before you start a walking program, be sure to consult your physician. It might be a good idea to ask him or her to recommend a podiatrist or someone who can help you select safe, quality walking shoes.
Be sure to check your feet after walking to make sure no blisters or “hot spots” are developing. A double layer of socks can help prevent blisters — a thin “undersock” made of a material that wicks moisture away from the skin and a thicker “outsock” with extra padding under the heel and ball of the foot. Here are some tips from the American Diabetes Association to keep your feet healthy:
1
C heck your feet every day. Look for red spots, cuts, swelling and blisters. If you cannot see the bottoms of your feet, use a mirror.
2 3 4 5 6 7 8
Ask your doctor about Medicare coverage for special shoes.
Wash your feet every day. Dry them carefully, especially between the toes. Keep your skin soft and smooth. Rub a thin coat of skin lotion over the tops and bottoms of your feet. If you can see and reach your toenails, trim them when needed. Trim your toenails straight across.
Wear shoes and socks at all times. Never walk barefoot. Wear comfortable shoes that fit well. Protect your feet from hot and cold. Wear shoes at the beach. Don’t put your feet into hot water.
Keep the blood flowing to your feet. Put your feet up when sitting. Wiggle your toes and move your ankles up and down.