12.07.17 Health Matters by Orange Observer

Health Matters

Observer

DECEMBER 2017

Adapting to change From insurance and financial planning to diet, exercise and even mental well-being, every aspect of our health care changes as we grow older.

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Senior snack hacks Seniors face their own challenges when it comes to eating right.

DOS AND DON’TS

Torey Tyson, the Medical Nutrition Supervisor at Winter Park Memorial Hospital, offers advice to keep seniors healthy.

TIM FREED ASSOCIATE EDITOR

Our bodies continue to change as we grow older, and that means our diets change along with them. We all know it’s important to eat healthy, but for seniors it’s even more important to pay attention to what you’re feeding your body, registered dietitian/ nutritionist Rukhsana Shanbhag said. That means also paying attention to the medications you’re taking and the deficiencies that might be created as a result, she said. “It’s the same as it is for younger people, but then maybe the requirement for fish oils is very important, eating plenty of vegetables and fruit,” Shanbhag said. “Most people’s digestive tracts change, so eating fiber is important also.” Although the seniors don’t need as many calories, there’s still a need for the same amount of protein as a younger individual — if not more, she said. Many seniors can be at risk of falling, but a deficiency in the body could be the real cause, she said, so eating foods that build strong bones and muscles is key. “Falls are very often linked to weak bones,” Shanbhag said. “It might be you fell because you had some weakness or you had osteoporosis. … Everybody ages, but healthy aging is what it’s about. Can you perform your daily activities? Can you live independently?” Just like any point in life, staying away from salty and sugary foods can help you get the calories you need from better options, Shanbhag said. Although it may not be easy for a senior to eat the healthier option, either because they can’t cook or they are just set in their ways after so many years. Shanbhag said there are ways around these roadblocks, such as seeking out meals that don’t require preparation and pushing patients to try something new for just a few weeks.“This

GO FOR IT n Foods rich in calcium and Vitamin D promote bone health. These include low-fat milk, yogurt, kale, spinach, cereal and juice. n Foods high in fiber help fight constipation. Try whole-grain bread, whole-grain rice, beans, fruits and vegetables. n Foods rich in Vitamin B12 help the brain and nervous system. These include fortified cereals, lean meats, fish and other seafood. ???

“I would compare it to taking your car in for a check up. You need to have a check up and having one session with a dietitian will really help in preventing any future problems that one might have.” — Rukhsana Shanbhag, dietitian

is my challenge: Do it for two or three weeks, and if you don’t feel better, then we can talk,” she said. “Most people feel better, so if they’re having sleep issues or energy is low or things like that, it’s definitely the hook that keeps them dedicated to doing good things for themselves.” Other challenges that

seniors face are deficiencies with taste and smell, which makes it more likely that a person won’t eat enough because everything tastes bland. “You might address that through food and a supplement to help compensate for that,” Shanbhag said. “It increases people’s appetite, and they’re actually able to enjoy their food.” Anyone considering a visit to a dietitian should consider the benefits an evaluation can bring, Shanbhag said. “I would compare it to taking your car in for a check up,” she said. “You need to have a check up, and having one session with a dietitian will really help in preventing any future problems that one might have. People think, ‘Well dietitians are just going to restrict.’ I think it’s the practical advice … I would give them tips on how to cook and prepare things so that they are accessible.”

AVOID n Salty foods is a don’t for anybody at any age, especially frozen and pre-packaged meals.

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DECEMBER 2017

YOUNG AT HEART Research shows the relationship between grandparent and grandchild offers substantial health benefits for both parties. DANIELLE HENDRIX BLACK TIE EDITOR

hether grandparents and their grandchildren are nearby or far removed, the love given and received by both knows no boundaries. In fact, researchers at the University of Oxford in 2014 found that close relationships between grandchild and grandparent often resulted in fewer emotional, social and behavioral problems. But grandchildren aren’t the only ones who benefit from the relationship. Psychological studies have shown that for grandparents, spending time with their grandchildren has substantial health benefits in store. A June 2016 study by Boston University researchers found that close ties between grandparents and adult grandchildren reduced depressive symptoms on both sides of the spectrum. Other research has proven that caring for grandchildren can help prevent depression, boost social connections and keep older adults mentally sharp, according to U.S. News. A CLOSE CONNECTION

Ocoee residents Ando and Lyn Ferrer have a special bond with their nearly 2-year-old grandson, Braxton. This is because they get to watch him about five days a week while his mom is at work. The two of them work, but with different schedules, they are able to tag-team Braxton’s care so he gets to spend time with both. They’re also raising their youngest daughter, Bailey, who is 16.

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Lyn Ferrer, right, watches her grandson, Braxton, about five days a week, while his mom, left, is at work.

“Most grandparents are retired, or at least one of the grandparents doesn’t work,” Lyn said. “We still have to work, raise Bailey, and then we have Braxton. … We’ve gotten really close, and when Mom drops him off he gives her a big kiss and a ‘Bye, Mama!’ There’s not anxiety (from) being left with multiple babysitters, so he has that opportunity to be close to his grandparents.” And with four daughters, one granddaughter and another on the way between the two of them, it’s also nice for Ando to have his “little buddy.” “It’s a nice change to have him and get to do things with him that I used to do with Bailey when she was little,” he said. “I get to go back and go outside and play with him, hit the tee ball, play soccer or we just run around and chase each other. He’s a very cool kid.” A typical daytime routine involves Braxton spending time with Lyn throughout the day until Ando gets home from work. That’s when Lyn can focus on coaching gymnastics, while Ando gets to spend time with Braxton. “Everything is about consistency and that’s what we give him,” Lyn said. “Our goal is absolute consistency. He gets all his sports in with Doe Doe (Ando) and he looks forward to that. It’s a routine.” “We’ve been doing it for so long, it’s like second nature,” Ando said. “He is our grandson, but we don’t treat him any different as if he were our own son.”

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However, not all grandparents have the opportunity to see their grandchildren often, whether it be through physical distance or estrangement. That’s why Winter Springs resident Donna Skora created the Surrogate Grandparents USA Facebook group nearly three years ago. “My husband and I are unfortunately alienated grandparents,” she said. “(Because) we cannot find a way to have a relationship with our grandchildren, I decided to find some way to turn our situation from a negative into a positive. Researching things I realized surrogate grandparents is something that has taken hold in the U.K., but there was no such group for anyone in the U.S.” Surrogate grandparents essentially take on the social role of grandparents for nearby children. But it’s not just about connecting with someone — it’s almost like adopting someone into your family, Skora said. Three years in the making, Skora’s Facebook group now has nearly 2,900 members — all of whom want to find that positive, loving connection. “There are so many grandparents out there that are missing having a relationship with grandchildren, whether it be through distance, the death of a loved one or missed connection,” Skora said. “(Also) there’s a study out there that says grandparents who have connected with grandchildren, it’s healthier for them. They live

Ando Ferrer and grandson Braxton are best buddies.

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a longer, happier life. … I grew up with two sets of grandparents, and it was a loving, nurturing time. “Then you have families whose children don’t have grandparents, and they want that for their children when it’s not available,” she said. “It’s the love and emotional connection of having a surrogate grandparent step in for your child if you don’t have a biological one.”

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DECEMBER 2017

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Changes to Medicare in 2018

Although the annual enrollment period is from Oct. 15 to Dec. 7, because of hurricane damage, Florida residents have been given until Dec. 31 to finalize plan choices.

HOW TO ENROLL OR SWITCH PLANS

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Medicare is managed by the Centers for Medicare and Medicaid Services, but you enroll through Social Security. Seniors may enroll in Medicare starting three months before reaching the age of 65. To enroll, you can visit a local Social Security office in person, call 1 (800) 772-1213 or fill out an online form at Secure.ssa.gov/ iClaim/rib. The annual open enrollment period for those who wish to switch plans lasts from Oct. 15 through Dec. 7. Take note, the federal government is allowing those who live in areas affected by hurricanes this year, which includes Florida, until Dec. 31 to make their choices.

For U.S. citizens wishing to change Medicare plans, the seven weeks between Oct. 15 and Dec. 7 might be a little stressful. But there’s good news. Those who live in states that received hurricane damage this year — Alabama, Florida, Georgia, Louisiana, Mississippi, South Carolina, Texas, Puerto Rico and the U.S. Virgin Islands — now have until the end of December. For those who have just become eligible for Medicare, keep in mind you are not bound by the standard annual enrollment period. The initial enrollment period for those who just became eligible begins three months before you turn 65 and lasts for seven months.

NEWS EDITOR

But for existing Medicare program participants, there are some changes to note regarding premium costs for all four parts of the Medicare program — the majority of which apply to Part C and Part D. According to April Washington, lead public affairs officer for the Centers For Medicare and Medicaid Services in Florida and the southern region, Part A and B premium costs stayed the same for most citizens and decreased slightly for Part C and Part D. “The costs in 2018 have pretty much remained stable for Part A and Part B,” Washington said. “But costs for Part C, which is Medicare Advantage, and Part D, which is drug prescription coverage, have decreased. Most of the changes surround our goals to continue to maintain or lower premium costs.”

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PART A

Part A, which is basically hospital insurance, helps pay for inpatient care in a hospital or skilled-nursing facility (following a hospital stay) and also pays for some home health care and hospice care. Most people don’t pay a monthly premium for Part A, as long as you have worked in the United States for at least 10 years and paid Medicare taxes. But if you have to buy Part A, how much you pay in premium costs is dependent on how many years you paid Medicare taxes for. If you paid Medicare taxes for less than 7.5 years, you might pay up to $422 in 2018, which is up from $413 in 2017. If you paid Medicare taxes for 7.5 to 9.75 years, the standard Part A premium is $232, which is up from $227 In 2017. PART B

Part B, also known as medical insurance, helps pay for doctor services, outpatient care, home health care and some preventive services. Part B premiums aren’t expected to increase in 2018 and will remain the same for most Americans, except for those with high-

2018 PART B PREMIUMS n $134 per month if you make less than $85,001 or if you and your spouse make less than $170,001 n $187.50 per month if you make between $85,001 to $107,000 or between $170,001 to $214,000 (married) n $267.90 per month if you earn between $107,001 to $133,500, or between $214,001 and $267,000 (married) n $348.30 per month if you make between $133,501 to $160,000, or between $267,001 and $320,000 (married); and n $428.60 per month if you earn more than $160,000, or more than $320,000 as a married couple.

er incomes because the income thresholds have changed. Those affected are individuals who make more than $133,500 annually as an individual, or $267,000 as a couple.

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WHAT IS MEDIGAP? Medigap is an insurance policy sold by private companies that can be used to supplement copayments, coinsurance and deductible costs for individuals enrolled in original Medicare Part A and Part B. Individuals pay a monthly premium in addition to their monthly Medicare premiums. However, Medigap generally doesn’t cover long-term care, vision, dental or private-duty nursing. You can search for a Medigap policy at Bit. ly/1U2VYnJ.

PART C

Part C, otherwise known as Medicare Advantage, is a private insurance alternative to original Medicare. It includes all the benefits and services covered under Part A (hospital insurance) and Part B (doctor and other outpatient services), and sometimes includes Part D (drug prescription coverage). These plan options are offered by private insurers subsidized by the federal government to help cover the costs of beneficiaries.

There currently are 52 Medicare Advantage plans in Orange County, which you can find at Bit.ly/2AKLQh3. According to Washington, Part C premiums, (which are paid in addition to Part A and Part B premiums), are projected to be $30.23 in 2018 — a slight decrease compared to 2017, which was $31.91. Remember, this is just an average, and premiums vary depending on income levels, where one lives and what benefits are included in your plan.

Premiums for Part D, which helps cover the cost of prescription drugs, is also expected to dip, Washington said. This will be the first decline for Part D since 2012. “The Part D basic premium is projected to decrease, from $34.70 in 2017 to approximately $33.50 in 2018, and the total premium is expected to remain stable, from $43.43 in 2017 to approximately $43.50,” she said. Under the basic plan for Part D, beneficiaries are limited to a certain number of drugs compared to those with extended plans, which offers more drugs. Washington added that the total average premium in 2018 is expected to remain stable and that the average number of stand-alone Part D plans Medicare beneficiaries can choose from is expected to increase, with no region having fewer than 19 plan offerings.

DECEMBER 2017

ORIGINAL MEDICARE VS. MEDICARE ADVANTAGE Original Medicare is run by the federal government, while Medicare Advantage is sold by private insurance companies that provide Medicare benefits. Medicare Advantage plans cover the same Part A and Part B benefits as original Medicare, and most MA plans also provide the option of adding extra benefits, such as vision, dental care and drug prescription coverage. With original Medicare, there is no cap on out-ofpocket expenses, but Medicare Advantage plans must have an annual out-of-pocket limit. Original Medicare also allows you to go to any doctor or hospital in the country that accepts Medicare, but with a Medicare Advantage plan, you’re often required to stay within the plan’s network. In addition, original Medicare does not require referrals to see specialists or prior authorization for services, while Medicare Advantage plans usually do.

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HAPPY 50TH! Welcome to the AARP AARP members can take advantage of numerous benefits and programs available through the nonprofit.

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ost AARP members would say the No. 1 reason they joined AARP is because of the discounts. From medical insurance to travel perks, members have a plethora of information and benefits at their disposal. “I get discounts on travel, cars and restaurants,” said Dale Gilger, who has been a member for 11 years. “I even get my insurance from them.” For Lila Canter, the travel benefits haven proven to be useful over the many years of her membership. “Whenever I make a reservation, I always call AARP,” she said. “They are always kind on the phone. We even went on a cruise through AARP. Last year, we got Christmas gifts with them because they had gift cards without the activation fees, so that was nice.” Many older members are also choosing to enroll their children as they cross the 50-year-old mark. “I gave (a membership) to my children for their birthday,” Canter said. The nonprofit is dedicated to improving the lives of those over age 50 and currently has more than 38 million members across the United States. A membership typically costs $16 a month, which gives members access to the website and includes a subscription to the AARP’s magazine and bulletin. “I just love the magazine,” said member Helen Duquette. In addition to the variety of benefits it offers online, members who join also receive a free

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community, from volunteering to advocacy. “I always do that,” member Janet Cassese said about AARP’s advocacy initiatives. “I sign them and send them back.” With numerous benefits available to them, AARP members can opt to use as many of the benefits and programs that they wish. “It’s worth it to use it,” Gilger said.

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DECEMBER 2017

WELCOME TO THE

SANDWICH GENERATION Nearly half (47%) of adults in their 40s and 50s have a parent age 65 or older and are either raising a young child or financially supporting a grown child (age 18 or older).

AMY QUESINBERRY COMMUNITY EDITOR

hen you commit to one of the most difficult — but possibly among the most important and rewarding — responsibilities of your adult life, it can be overwhelming. Many parents in the middle generation have taken on the added role of caregiver for their own parents. How will you fit that new dynamic into your already-busy schedule? How much care will be needed? Where do you go? How will you afford it? There’s a name for middle-age folks who have children under age 18 and who have one or more par-

ent still living: AARP calls them the Sandwich Generation. Nearly half (47%) of adults in their 40s and 50s have a parent age 65 or older and are either raising a young child or financially supporting a grown child (age 18 or older), according to Pew Research Center. And about one in seven middle-aged adults (15%) is providing financial support to both an aging parent and a child. Many caregivers have either a full-time or part-time job while caring for both groups — 34% and 25%, respectively, according to Shield My Senior. Providing financial and emotional support to two generations at the same time can create stress and tension at home when the middle group is being pulled in different directions.

BEFORE A CRISIS

It’s a good idea to gather as much health information as you can on your loved one before there is a crisis. n Health data — medical history, prescription and over-the-counter medications and immediate medical problems n Financial and legal information — health and life insurance coverage, power of attorney, advance directive for medical care, living trust or will and bank accounts and investments n Resources that can help support parents safely at home — community services and local care-giving services n Government programs that can help defray expenses — Social Security, Medicare/Medicaid, Veterans Administration and local government programs

HEALTH MATTERS

WHEN IS A CAREGIVER NEEDED? Caregivers face many challenges: physical, emotional and financial stress, understanding legal options, assessing the service systems while balancing demands and family dynamics. Seventeen percent of Americans are caregivers. Of those, 83% are related to their care recipients, according to Jennifer Campbell, owner of Age Advantage Senior Care Services in Winter Garden. Before you decide on the level of care needed for your loved ones, their situations must be assessed, she said. n Is more of your time and energy focused on your loved one? n Has there been a change in their health? n Are they unable to do the things they used to do? n Are they relying on you more? n Is their present living situation unsuitable? n Are you worried about them more? TYPES OF ELDER CARE

n Adult day programs — An option for elders who do not require around-the-clock care but also are not safe remaining at home all day alone. Programs emphasize social interaction and programs exist to fulfill medical needs. Most are communitybased and generally available only during regular weekday business hours. n Independent-living facilities — Elders can rent or purchase an apartment or condominium within a complex or campus offering recreational and social activities and, sometimes, transportation services. Residents live independently while being part of a community of others in similar circumstances. Generally, no special health care services or assistance with activities of daily living are offered.

HOME-CARE AGENCIES VS. CAREGIVER REGISTRIES It’s equally important to understand the differences between home-care agencies and caregiver registries. n The key difference between agencies and registries is the caregiver’s employer. n Registries or referral services do not employ their caregivers. n Agencies take full responsibility for employing their caregivers. Look for these indicators that a caregiver is well-qualified and likely to provide compassionate care: n The caregiver is carefully screened before coming to your home for an interview. n The caregiver is bonded, insured and covered by Worker’s Compensation insurance. n The caregiver is experienced in specialized care your loved one might require, such as Alzheimer’s disease, dementia, arthritis, hospice care or mental/ physical challenges. n Match your loved one’s needs and personality to an experienced caregiver with the skills that will provide the best care and companionship. n Be sure there is professional oversight of the caregiver to ensure services will be provided safely. n Ensure there is supervision in place that delivers ongoing assessments of care and recommendations as your loved one’s needs change.

n Assisted-living facilities — They offer residents comprehensive help with activities of daily living but also feature an essentially independent living arrangement. Elders generally will occupy their own unit or apartment within the facility from which they can come and go as necessary. They will have access to personal-care workers as necessary to assist with their care needs. Skilled nursing services are not available onsite, typically, but basic health services may be offered. Recreational and social activities are also available. n Nursing home care — Nursing homes provide care for elders requiring constant, aroundthe-clock care. Care is provided by licensed health professionals, including registered nurses, licensed practical nurses and nurses’ aides. Elder nursing home residents will reside in a room within the facility. Housekeeping and linen services, meals and care from the medical staff and a social worker are included. Elders might also be offered on-site social and recreational activities. n Family-provided and inhome care — This type can occur in one of two ways. Either elders remain in their own home with family members providing them with assistance, or elders move into the home of a family member. In either situation, in-home professional caregivers might still be needed to provide care during work hours or other times when family cannot be present. SEE CARE PAGE 16

RESOURCES FOR CAREGIVERS

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You have taken on the huge and important role of caregiver for one or both of your parents. What’s your next step? Orange County Government and the Orange County Office on Aging, (407) 836-6563, provide a guide for senior services, and the list includes resources for caregivers, a seminar series and a free newsletter. n Senior Resource Alliance serves as the Central Florida Area Agency on Aging and manages a number of programs, such as Community Care for the Elderly, Home Care for the Elderly and Respite for Elders Living in Everyday Families — SRAFlorida.org, (407) 514-1800 n Orlando’s Senior Help Desk provides information and referral assistance. Service offered by Jewish Pavilion — orlandoseniorhelpdesk.org, (407) 678-9363 n 50+FYI Resource Directory lists services and programs for elders — 50plusfyi.org, (407) 265-0534. AARP provides a list or agencies and organizations that offer resources to caregivers: n AARP Online Community discusses issues with other caregivers in the online community — community.aarp.org n Alzheimer’s Association offers information and support for people with Alzheimer’s disease and their caregivers — alz.org, (800) 272-3900 n Alzheimers.gov is the government’s free information resource about Alzheimer’s disease and related dementias — alzheimers.gov n ARCH National Respite Network and Resource Center finds programs and services to give caregivers a break from care — archrespite.org n Caregiver Action Network provides information and education for family caregivers, including a volunteer support network in more than 40 states. caregiveraction. org

DECEMBER 2017

n Eldercare Locator connects caregivers to local services and resources for older adults and adults with disabilities — eldercare.gov, (800) 677-1116 n Family Caregiver Alliance offers information, education and services for family caregivers, including the Family Care Navigator, a state-bystate list of services and assistance — caregiver. org, (800) 445-8106 n Hospice Foundation of America provides information on issues related to hospice and end-of-life care — hospicefoundation.org, (800) 854-3402 n Medicare provides information about the parts of Medicare, what’s new and how to find Medicare plans, facilities or providers. Medicare.gov, (800) MEDICARE n National Alliance for Caregiving is a coalition of national organizations focused on family caregiving issues — caregiving.org n National Institute on Aging Information Center is a research leader on aging issues and gives information on common age-related health problems — nia.nih.gov, (800) 222-2225 n The National Clearinghouse for Longterm Care Information provides information and tools to plan for future long-term care needs — longtermcare.gov n Social Security Administration offers information on retirement and disability benefits — socialsecurity.gov, (800) 772-1213 n State Health Insurance Assistance Program offers one-on-one insurance counseling and assistance to people with Medicare and their families — shiptacenter.org n Veterans Administration offers support and services for families caring for veterans and maintains a VA caregiver support line — caregiver. va.gov, (855) 260-3274 n Well Spouse Association provides support for spousal caregivers — wellspouse.org, (800) 838-0879

HEALTH MATTERS

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DECEMBER 2017

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Home care is a great first option for seniors who require little change. It’s flexible, allows couples to stay together longer and provides the benefit of one-onone care at home where people are most comfortable. Benefits of hiring an agency include back-up caregivers, caregiver replacement, bonding, insurance and licensing, supervision of staff, background checks, Worker’s Compensation and experienced caregivers who are available 24 hours a day yearround. Campbell provided important questions to ask a home-care agency: n Are your caregivers employees? n What are your hiring requirements? n Are your caregivers supervised? How often? n How do you know if your caregiver has reported to work? n How long does it take you to replace a caregiver who has not shown up to work? n Can you be reached outside of business hours? How quickly? n Do you develop a comprehensive care plan with the patient prior to services? Is this information shared with the caregiver? n What benefits do you offer your caregivers? (caregivers with benefits are long-term caregivers) n Do you require the clients to sign a service agreement? Do you require a deposit?

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n Long-term care insurance will pay for in-home care, assisted living and nursing home care. This is the most appropriate and needed form of insurance protection available today. Long-term care insurance could be called “lifestyle” insurance. n Reverse mortgages (home equity conversion mortgages) have become one of the most popular and accepted way of paying for many different expenses, including the cost of long-term care. Such mortgages are designed to keep seniors at home longer. A reverse mortgage can pay for in-home care, home repair, home modification and other needs. n Government assistance should be a last resort when considering how to pay for long-term care. This type of assistance refers to relying on the Medicaid system. Medicaid will pay for long-term care for seniors who cannot afford to pay for care themselves; however, Medicaid resources are limited. This means that in many areas Medicaid beds in nursing homes are difficult to find. Families may end up driving long distances to visit loved ones. n VA Aid and Attendance Pension Benefit: The Veterans Administration has established a pension program in which your purchase of personal care and attendant home services may be paid for through your acquired pension. If you are a veteran or the surviving spouse of a veteran and meet guidelines, you might be eligible for VA’s non-service connected disability pension. n Medicare and Other Health Insurances: Medicare is a federal health insurance program for people 65 and older, certain people with disabilities and End-Stage Renal Disease. It pays for much of one’s health care, but not all of it. n There are other kinds of health insurance that might help pay the costs that Medicare does not. Medicare supplements (Medi-gap policies) and long-term care insurance will pick up some of the costs that Medicare will not pay for.

HEALTH MATTERS

e e y o l p m E y e n s i D ollment r n E n e p O

possible. How can you identify high, quality care? Consumer Reports now rates hospitals on similar criteria consumerreports.org/health/hospitals/ ratings. The website medicare. gov/hospitalcompare shows Medicare results from patient satisfaction surveys, as well as the measures of timeliness and effectiveness of care, complications of care, readmissions, and deaths. Nursing home quality for Medicare patients reflects patient experience, complications, the number of nursing staff per patient, and other measures at medicare. gov/nursinghomecompare. Dr. Nancy Rudner, a local workplace nurse coach with HealthAction.biz, helps individuals, employees and organization understand health, make healthy choices easier and achieve their health goals. Send your questions to Nancy@HealthAction.biz.

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The first is preventing conditions, diseases or problems from happening at all. Examples include vaccines, healthy eating, exercising, taking vitamins and wearing seat belts and helmets. You can find out which vaccines you need at vaccines.gov.

The second type of prevention is screening to find problems in early stages when they are easier to treat. This includes blood pressure checks and periodic physical exams. Common blood tests look for diabetes, high cholesterol, liver and kidney problems. Pap tests, mammograms, PSAs, and colonoscopies screen for cancers. Find out what screening tests you should have, based on your gender and age, at cdc.gov/prevention.

The third level of prevention is keeping an existing problem from getting worse. Controlling high blood pressure, diabetes and heart disease can prevent complications.

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re you a savvy health care consumer? Prepare for your health care visits. Staying healthy is not a spectator sport. Be prepared for all your medical care encounters. You need more than your insurance card and picture identification. Bring a list of the medications you take, including vitamins and herbs, or bring them with you. Write down your questions before you go, so they aren’t forgotten once you are sitting, undressed, on a cold sheet of paper. Before each office visit, determine what you want to

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you might also get effects you don’t want. We sometimes call them side effects, but some effects, such as falls, are too serious to be on the “side.” Some medicines are just too risky in seniors, but not all providers remember that. Arm yourself with the Beers’ List (tinyurl.BeersListRx) of medications seniors should avoid. Print it out and take it with you, along with your medication list or bag of pills. Check the quality of care. Before you buy an expensive item, such as a car, refrigerator or flight to California, you look at the price, right? Maybe you also look at reports on the quality, safety, durability? Do you also scrutinize the quality of your health care? How can you know if the care is good? You might know or read others’ reports of how the care felt, how patients are treated, how nice the providers were, or the décor of the office. But the purpose of health care is to help you have the best health

DECEMBER 2017

THREE LEVELS OF PREVENTION

Participation key to health care success get out of your encounter, your purpose for going. Don’t be shy. Good health and health care require good communication both ways. Remember that you are in charge; it’s your health. Ask for a copy of your lab results. Ask questions. Don’t leave until you understand what you need. The National Patient Safety Foundation’s Ask Me 3 campaign (npsf.org/askme3) encourages everyone to ask three key questions: What is my problem? What do I need to do? Why is it important for me to do this? Get the right amount of care. Check out choosingwisely.org to see which tests and procedures you might want to question. Some are vital, some are overused, and some have risks that outweigh benefits. Use medicines carefully. Understand which medications you need to take, possible effects of the drugs and interactions to avoid. For every effect you want from a drug,

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HEALTH MATTERS

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DECEMBER 2017

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HEALTH MATTERS

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HEALTH MATTERS

OrangeObserver.com

DECEMBER 2017

FIT & 50-PLUS

Although some might be slowing down as they reach their 50s, there are plenty of local weekend warriors and athletes who are pushing themselves as hard as ever, hoping to set a tone of fitness and activity as they continue their journeys. STEVEN RYZEWSKI SENIOR SPORTS EDITOR

One great way to keep fit and athletic into one’s senior years is to get a jumpstart. Although plenty of Americans prioritize fitness in their 20s, 30s and 40s, it’s less common to see athletes in their 50s pushing their limits in the same way — but there are exceptions. Locally, there are many residents who believe in being fit in their 50s. ALWAYS ON THE MOVE

Winter Garden Runners’ Joe Van Dam, 54 In addition to his day job as an engineer at Disney, Winter Garden resident Joe Van Dam has been running with the Winter

Photos by Steven Ryzewski

Joe Van Dam, a member of the Winter Garden Runners, enjoys competing in triathlons and taking on new challenges such as the America’s Mighty Warriors Military Race he recently completed.

Garden Runners three to four days a week for the past four years — part of a larger, six-day routine. In addition to running, Van Dam bikes and swims as part of his training for triathlons and other fitness challenges, additionally training at Swim Like a Pro. He also has frequently does 5Ks, 10Ks and half-marathons. Recently, Van Dam placed first in his age group in the America’s Mighty Warriors Military Race in Clermont. Earlier this year, he also placed fifth in the Great Floridian Triathlon — during which he biked, swam and ran 46.8 miles. “People ask me, ‘What are you training for?’ and my first response is always that it doesn’t matter if I have an (upcoming) event scheduled or not — I’m training for life,” Van Dam said. “I want to be healthy. I’ve got kids and want to live long enough to enjoy them — and I get a lot out of it, the social aspect of that.” As he continues his fitness journey into the latter half of his 50s, Van Dam said he will continue to embrace new challenges with an emphasis on mobility and remaining active. “If you don’t, there are ramifications later,” Van Dam said.

EMBRACE THE CHALLENGE

WinStrong CrossFit’s Jim Johnson, 50; Mario Bettosini, 53; Babita Persaud, 50 There are plenty of members at WinStrong CrossFit on Winter Garden-Vineland Road who push themselves to their limits each day, but owner and lead trainer Luis Rodriguez is particularly proud of this handful of CrossFitters who are 50 or older and, as puts it, can kick any teenagers’ butt in the gym. Jim Johnson, who works for Disney and coordinates more than 300 cast members each day in Hollywood Studios’ entertainment wing, said his evening trips to the gym help offset the workday. “With my job, I’m very sedentary — I sit behind a desk,” Johnson said. “(I do it) just to get the physical activity in my day, to balance out the sedentary job … and I enjoy feeling fit.” With a strong background in distance running, Johnson said he has come to enjoy the added elements of strength training and mobility in CrossFit, as well as the camaraderie. “That’s what’s unique about CrossFit — everybody is on their

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Mario Bettosini, left, Babita Persaud and Jim Johnson all push their limits on a regular basis at WinStrong CrossFit in Winter Garden.

on stopping any time soon. “I don’t know where (my fitness journey) is going to take me,” Persaud said. “I’m just going to push my body until I get to that point. I tell my husband, ‘I’m going to push it to the edge, and then you can wheel me around in a wheelchair.’” Mario Bettosini, a Winter Garden resident who works in sales, has been at WinStrong for four years. For Bettosini, the intense nature of CrossFit is part of what’s fun about it — as is the unpredictably of what each day’s workout will be. “It’s always different — you never know what you’re going to do day-to-day, and it can get pretty competitive,” Bettosini said. The WinStrong veteran acknowledges that as he moves into his mid-50s, there are more little aches and pains but said the trade-offs are worth it. “I like to keep moving and doing stuff,” Bettosini said. “If you’re not fit, you lose out on a big part of life.” 258511

own journey,” Johnson said. “It’s a family environment that’s here.” While someone such as Johnson has a long background of keeping fit and active, it has been a more recent development for Babita Persaud, a middle-school teacher from Winter Garden. “I got into fitness very late, when I was 48 or 49,” Persaud said. “I went to CrossFit the first day, and I survived — and I came back again and again.” Before she waded into the CrossFit waters, Persaud said she initially became addicted to hot yoga, saying it helped her through a tough time in her life that kickstarted her new enthusiasm for fitness. When her hot yoga studio closed, Persaud decided to seek out something she could do every day that was intense, and WinStrong met the description. Persaud said being fit in her 50s gives her a sense of freedom and keeps her feeling young, especially considering she works with eighth-graders. She enjoys pushing her limits and doesn’t intend

HEALTH MATTERS

OrangeObserver.com

DECEMBER 2017

Aging with grace

He believes engaging and exercising our brains daily helps fight off memory loss. “One of the things we don’t exercise enough is our brains,” Burrowes said. “We should do things that can keep our brains active — crossword puzzles, word searches, just simply reading.” Folic acid, which is found in many sources including leafy green vegetables and in overthe-counter supplements, also help the part of the brain associated with memory.

Although age-related changes aren’t preventable, lifestyle changes can slow their progress. BLACK TIE REPORTER

It’s not easy having an illness — especially as you grow older. Unfortunately, as time goes on, it’s likely your body will begin to show signs of its age. “When you get older, everything starts to break down,” said Dr. Adrian Burrowes, who serves as medical director at the Westminster Baldwin Park retirement community. Burrowes is no stranger to the diseases that afflict the elderly: 60% of his patients are older than 65 years old. Burrowes admits symptoms from old age-related diseases often are irreversible. But that doesn’t mean there’s nothing people can do to slow down the

damage or prevent the symptoms in the first place. “It’s never too late to start some healthy habits,” Burrowes said. “We can’t reverse the (disease), but we can improve your quality of life with it.” ARTHRITIS

Athritis, a degenerative disease targeting your body’s cartilage, is hard to avoid. “If you live long enough, you’re most likely going to get arthritis,” Burrowes said. The reason is simple: Decades of wear and tear on your joints ultimately takes its toll on your body. “The more active you are as a young person, the more likely you are to have it as an old person,” Burrowes said. “I ran cross country (when I was younger), and I’m feeling it now.”

OSTEOPOROSIS

That doesn’t mean less exercise is a better option. The heavier your body mass, the more weight and pressure you’re putting on your body’s lower joints. One thing you can do is stretch before vigorous physical activity, Burrowes said. “Something we all get taught by older people is that we need to stretch,” he said. “When someone stretches, their muscles become more pliable. That keeps the joint spaces wide and lowers the chance of having arthritic symptoms.”

ALZHEIMER’S DISEASE

A neurological disease that destroys the part of the brain that controls memory, Alzheimer’s disease is most likely to begin exhibiting itself in the late 60s to early 70s. Although forgetfulness is an unavoidable effect of old age, Burrowes said an inability to remember daily routines is a clear warning sign for Alzheimer’s disease. Forgetting where the grocery store is, forgetting the way back home from the job or forgetting a friendly face all point to the disease.

If you see someone with a hunched back, they likely have osteoporosis. “It’s a disease where the body loses too much bone … which makes them (the bones) weak and puts the person at risk for a fracture,” Burrowes said. “The bones have a hard shell and a hollow center.” It’s common for people to have osteoporosis of the spine, where the bones in the spine collapse in on each other and create that curved shape. It comes from a deficiency of vitamin D. The body’s skin absorbs vitamin D from the sun’s

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HEALTH MATTERS

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YOU ARE WHAT YOU EAT

While Dr. Burrowes provided many examples of activities and practices to help with the illnesses, he said the best way to handle growing older is to simply watch what you eat. “Almost everything comes back to diet,” Burrowes said. “Everything I’ve talked about, I can give you medication for. But the reality is lifestyle changes and dietary changes are the best way to prevent and improve functioning.” Eating less salt with your meals lowers your blood pres-

DECEMBER 2017

GOT BRACES?

sure in your arteries, lowering the chance of hypertension. Lean meats and vegetables improve bone strength and lessens the chance of health issues.

IT’S NOT JUST ABOUT TEETH

But a more balanced face, harmonious growth and development, improved airway/breathing/sleep, hence better overall health, function & stability.

THE SENSES

As time goes on, our sight and hearing begin to fade. The problem, though, is when you begin to notice it yourself. “The changes are subtle,” Burrowes said. “People don’t pick up on them, because they’re squinting without realizing it or missing lower decibel levels. Anytime anyone notices it themselves means that it’s gotten pretty advanced.” He recommends anyone over the age of 65 should have a sight and hearing exam with their primary care every year. For eyesight, people should avoid staring at the same electronic screen for more than 30 minutes. When looking at a computer screen or tablet, the eye lens doesn’t change its size and becomes damaged over time.

DID YOU KNOW?

• There are wired, wireless and clear ways of straightening teeth. • Removing permanent teeth is not always necessary. • It’s never too early to screen for orthodontic issues and even minimize or prevent braces. • We can treat the cause, not only the symptoms of crooked teeth. • We offer a more natural, functional & integrative approach to orthodontics.

Orlando • Clermont • Lake Mary • Winter Springs

FATHER

SON BEFORE

SON AFTER

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ultraviolet light, which helps with our bone density and health. But although Florida is one of the sunnier states in the country, Burrowes said people living in the Sunshine State suffer a higher rate of vitamin D sufficiency. He said it’s more commonly found in women than men, a result of estrogen loss that comes with menopause. As such, doctors begin screening for osteoporosis when people turn 40. “The best preventative measure for osteoporosis is activity,” Burrowes said. “You can walk 30 minutes a day, four times a week.”

Call for a complimentary consultation with Dr. Lisa: (352) 241-4884 www.DrLisaY.com

Your Grand Adventure Awaits! A Senior Living Community

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HEALTH MATTERS

OrangeObserver.com

DECEMBER 2017

Planning for the future Preparing for end-of-life care is a scary process, but doing so can prevent confusion and heartache for your loved ones. TROY HERRING ASSOCIATE EDITOR

If you asked everyone in the world what their No. 1 fear was, many probably would answer with one simple word — death. It’s a subject we are all afraid to discuss, but with its inevitable nature, it is also a subject that must be considered. Preparations for end-of-life care — including living wills and funeral pre-planning — can help ease the grieving process for family members. LIVING WILLS

When it comes to living wills, the name can be a bit deceptive. A living will is actually a legal document that declares your intentions on how you wish to go about end-of-life medical care — basically stating whether you want to be kept alive by “heroic measures,” said Kathleen Flammia, a Winter Park elder law attorney. “In Florida, the living will says that if you’re both physically and mentally incapacitated — that determination by your treating doctor and a second consulting decision — and there is no reasonable probability that you’ll recover from a terminal illness, an end-stage condition or a persistent vegetative, then they’re not going to do everything possible to keep you alive,” she said. “But they’re going to give you what is called palliative care to manage your pain.” Although many associate living wills with seniors, Flammia actually suggests anyone 18 and

up look into the process early, because there is no telling when a possible accident may occur. It’s more of a precaution of simply being prepared. Living wills, at least at Flammia’s practice, are a part of other estate-planning documents. Flammia starts by listening and offering guidance on what the individual needs during a session, which covers many different topics including declaring a health care surrogate — the person who makes the medical decisions for you when you can’t make them for yourself. If you don’t declare, then the law in Florida is that the state will dictate your surrogate for you. “Sometimes, it takes two conversations, sometimes it takes three… sometimes it is just a process of fleshing out different thoughts and different ideas in order to do planning, so that the client can decide what is best for them,” Flammia said. FUNERAL PRE-PLANNING

While living wills are important by providing a blueprint for endof-life medical care, funeral preplanning is one of the biggest and most daunting tasks for many. Often, the process itself is a result of something significant happening — such as an accident or age milestone — in a person’s life, said Evans Baldwin, vice president of sales and marketing at Baldwin Brothers: A Funeral & Cremation Society. “It’s a lot more of an emotional decision than it is finan-

“Sometimes, it takes two conversations, sometimes it takes three… sometimes it is just a process of fleshing out different thoughts and different ideas in order to do planning, so that the client can decide what is best for them.” — Kathleen Flammia

cial,” Baldwin said. “So typically, we will talk to people about the process and about what we do in terms of going through a discovery stage, getting all their instructions down on paper to their liking, and at some points we can start on obits and things of that nature. “We’ll go through our different selections if they want cremation, or burial or anatomical donation,” he said. “Once all of that is completed, we’ll then have all the authorizations completed that will allow us to perform the services when the time comes.” Many prearrangements are done by counselors at Baldwin Brothers are done out in the homes of customers, as it makes the process much more comfortable for people dealing with a rather disconcerting topic. Baldwin said the woman of

the house often makes decisions during the meeting, as the man just sits back — which Baldwin believes is out of fear of dealing with the idea of death. And it makes sense that many would like to avoid what surmounts to planning around their own death, but that planning has to be done. “People procrastinate on this — it’s not a sexy-type product, and it’s not something you really want to buy — but I can tell you that if you don’t procrastinate and you get it done, you don’t have to think about it anymore,” Baldwin said. “It’s really just getting that piece of mind — that’s really what the whole thing is about.”

HEALTH MATTERS

OrangeObserver.com

DECEMBER 2017

THIS SATURDAY, DECEMBER 9, 2017

PRESENT

To benefit these local organizations...

FREE KIDS FUN RUN

(Ages 3-7) After the 5K Register Day of Race Only. Finishers Receive Medal

Please bring a “New” book for Reading Reindeer