Sunday, September 11, 2016

WRITING A LAST LETTER

In the perfect life we would be square with the world when our number is up. Our loved ones should know that we love them. There's nothing wrong with confirming that fact on a daily basis. Sometimes it doesn't work that way though. We should forgive whomever it is we should forgive. Mend broken friendships. Sometimes that's hard to do and we put it off, and put it off. 

In that perfect world we would have planned for the 'administrative necessities' of our deaths: Will? Check! Advanced Directive? Check! Living Will? Check!

I hope you have an advanced directive and a living will. People who do not clearly document their wishes and preferences for care at the end of life are often subjected to futile medical treatments that they neither seek nor benefit from. Their families are burdened by the medical bills accrued from the numerous ineffective treatments many patients get at the end of life. 

Regret is common at the end. How we wished we had said, or forgiven, or .... It can be difficult to express to loved ones the fact that they actually ARE  loved. That one is proud of one's children. That offenses, real or otherwise, may be forgiven. We shouldn't have to bear the burden of regret in our last hours.

But, who wants to think of dying?  It can be difficult to actually lay out  a concrete plan  for the last days. To what extent do you want care? What about your  body? We shouldn't require our family members, loved ones, agents and/or medical professionals to guess how we want our end, and after the end, to play out.

We should really deal with these things when we're healthy and not wait until we're at death's door. It can be hard to say these things though. Maybe you simply cannot bring yourself to put your emotions into words,  face-to-face. Maybe the person you want to forgive is not nearby  or you don't know where he is.

Contemplating one’s own death and doing some basic preparatory work is certainly not an easy task. You can download advanced directive and living will forms, but those emotional issues? Maybe you need some help with that one. For many reasons, it might be easier to write down than to express verbally whatever you really need to say. Now there are tools to help in this difficult job.

With this in mind the Stanford Letter Project was developed. This project provides tools for writing letters that, in addition to advanced care directives, inform medical staff of what you think is important in your care, and that help you to express emotional concerns to friends and family. The tools include templates for letters in several languages, and can be filled out as paper copies or on-line. There is also a tool that can hep to  share your  letter  with others.




Letter Project Tools:

  • What Matters Most Letter: This is a letter template that allows anyone to document what matters most to them and what treatments they want in the future. This tool is free and is available in print, as an online fillable form and as an iPhone and Android App in eight different languages.
  • Letter Project Advance Directive: This tool allows anyone to answer a few simple questions in English. When they finish and click print, the tool will send them an auto-filled valid advance directive document and a supplemental letter to their doctor describing their preferences for medical care at the end of life. This tool is free and is available in print, as an online fillable form and as an iPhone and Android App.
  • Friends and Family Letter: This letter can help all adults complete their seven life review tasks: acknowledging important people in our lives ; remembering  treasured  moments in our lives; apologizing to those we may have hurt; forgiving those who have hurt us; and saying “thank you,” “I love you” and “goodbye”. Using this template, you can write a letter to your friends and family in one of eight languages using an online form, an iPhone or Android App or a printable form.

Here are some of the comments on a NY Times article about the Stanford Letter Project

"This is such an important project as it brings closure not only to the reader of the letter, but also the writer. There are many topics that are difficult to talk about for many reasons but a letter gives the chance to express feelings that may have otherwise been left unsaid, and also an opportunity for the reader to understand what was really going on in the writer’s head; Or the writer can choose to have a loved-one read the letter with them so they can both appreciate what was touched upon. Either way what was written will last for a long time and can be reread many times. For example, I would have loved to receive a letter from my grandmother, containing stories or important lessons, but unfortunately she now has dementia, and I will never get to hear what she had to say. That is why it is so crucial to write a letter while healthy.
Another reason is because we never know what the future has in store for us. People suffer from the mentality that we can “get to it tomorrow.” But in reality we do not know what is coming tomorrow, or if there will be a tomorrow. Writing a letter now gives the elderly, really anyone a chance to say “I love you,” “ I am sorry” or simply goodbye. These words are actually more difficult to say face-to-face than in a letter. With apologies it can be especially helpful, because pride may get in the way of saying sorry. But through a letter, a person can apologize and get the closure they need. Writing is a great outlet for situations like these."

"I am a senior citizen and have often, especially after being rescued from one heart attack, wondered how I will be remembered. I have come to believe that our day-to-day relationships with all of those around us is imperative for human survival. While I do endorse a written commitment to those we love (that can be a reminder of our caring when they come across it during their busy lives in the future), I think we need to start each day with a commitment to share our apologies and expressions of gratitude and love.:"


"My mother died of breast cancer in 1961 when I was 13. All my life I have wished that she had left me something in writing—something that I could have read when I was older that helped me understand what she felt about me, her disease, her life, her loves, her dying. Something that would have let me know her when I was old enough to understand what in her healthy and then unhealthy life had been important to her. But I've made do with old family snapshots. In one especially when I am a baby in her arms, I can see the look of love on her face. In others, I intuit what was important to her by the snaps she chose to take. Not the same as words but, at least, something.


"-I wish I had a letter from my mom. I'm not sure I could read it on a regular basis- even old birthday cards tear my heart out. But knowing I could read it if I wanted to would be a comfort to me and would fill the void her passing left in my heart."


Monday, September 5, 2016

SENIOR MOMENTS THEATRE GROUP IN HILLSBOROUGH

GHSS IS VERY HAPPY TO PRESENT 

THE SENIOR MOMENTS THEATRE GROUP


On Thursday, 12 September, this troupe of volunteer senior actors will will present a FREE  performance dealing with senior issues in an “irreverent” and “bawdy” format.  Our minds and bodies may be changing and maybe we're neither as pretty or physically fit as we once were, but the old noggin is still working (most days) and we've got a healthy sense of humor (most days). This special performance promises to be a lot of fun as it strikes familiar chords. 

You don't have to attend the luncheon to attend this memorable and entertaining production.  BUT WHY NOT? 

The performance will take place at 1:00 at the Valley Bible Chapel, in Hillsborough, opposite Butler Park.

The luncheon, chicken pot pie this month, starts at noon and will only costs $5.00. You've got to reserve to attend the lunch. To do so, contact Marie Merrow at 464-3067.

Senior Moments was founded in 1999 by the late Joanne Dodge as an all-volunteer performance group for seniors by seniors. The group writes its own plays and short skits, which focus on issues affecting elders, and performs them throughout the state at senior centers and other senior gathering places. The program encourages creativity, celebration of the aging process and the active participation of seniors in the arts.

Past performances have included *Yes, There is a Tomorrow* (depression and suicide prevention), *Help Me, I’m Falling, and I Can’t Get Up* (safety issues), and *I Haven’t Got Time for the Pain* (myths and realistic approaches to dealing with chronic pain). Senior Moments also provides classes in theatre and members routinely meet with seniors to read plays at assisted living homes and day out programs.

Senior Moments has appeared at the New Hampshire Conference on Aging, Maine Senior Expo, Association of American Retired Persons, National Association of the Mentally Ill, WSCA Audio Theatre Players, New Hampshire Public Radio, New Hampshire Public Television, as well as a score of community groups and organizations throughout New England.

You can learn more about this group at http://www.seacoastrep.org/programs/senior-moments/

SENIORS ALIVE! FOR SEPTEMBER

HERE IS YOUR SEPTEMBER ISSUE OF SENIORS ALIVE!

Highlights of this issue include nifty September and October trips in our trusty bus BETSY
Apart from our regular shopping runs,  here are trips that you won't want to miss!

21 September, Wednesday The Eastern States Exposition. Celebrate the 100th anniversary of this mighty exhibition. Lots of agricultural exhibits ranging from 1916  to today. Budweiser Clydesdales, pig races, butter sculpture, Storrowton Village, wine and cheese barn and  fiber Festival of New England and much more.  Leaving Shaw's at 8:00 am. Transportation $12.00, admission to The Big E $12.00. To reserve call Marie Mogavero at 464 4726 or 724-5272. Minimum 10.

6 October, Thursday. a Mystery Trip. Bring your lunch, we'll provide a dessert and a beverage. BE ADVENTURESOME!  The last Mystery Trip was very popular. Leaving Shaw's at 10:30 am. $6.00. To reserve call Marie Mogavero at 464 4726 or 724-5272.

 8 October, Saturday. FALL FOLIAGE TURKEY DINNER TRAIN.  Enjoy a complete turkey dinner aboard the train, catered by Hart's Turkey Farm. Your round trip Fall Foliage Dinner Train will depart Meredith Station and travel south along the western shore of Lake Winneepesaukee through the village of Weirs Beach and along Paugus Bay towards Lakeport and back alongthe very same route. Along the way youll enjoy breathtaking views of New Hampshire's largest lake while sneaking a peek at some of the many beautiful lakeside homes you'll pass along the way. This 2-hour dinner train departs at 5:00 pm, returning to Hillsborough at about 9:00 pm. Thanks to generous support from the town of Hillsborough, the cost to you of the train ride and the dinner is only $30.00 per person. Please make checks payable to "GHSS." To reserve  call Marie Mogavero at 464-4726 or 724-5272

The September Senior Lunch will be held on Thursday, 15 September at noon at the Valley Bible Chapel, on Main St Hillsborough, opposite Butler Park. The cost for the lunch is only $5.00. As a special treat, The Senior Moments Theatre Group, a group of volunteer senior actors from Portsmouth, will present a hilarious send up of the whole idea of getting old. The play will start at about 1:00 pm. You do not need to attend the luncheon to see the play. You must reserve to attend the lunch by calling Marie Merrow at 464-3068 no later than 12 September.







Wednesday, August 31, 2016

A FEEDING TUBE FOR ADVANCED DEMENTIA PATIENT?

Food is such an important part of all of our rituals. There are few greater altruistic acts than to give food and ask nothing in return.  Chicken soup from Mom's hand makes colds, flues and maybe even jilted love bearable. Comfort food might not rate very high on a nutritional scale, but boy does it FEEL good! 

So it is when people like our parents who are in late states of dementia often have problems eating and drinking. They cannot communicate, they cannot eat, they lose weight.  Chewing is hard. They aspirate food particles into the lungs, which can result in difficulty in breathing and pneumonia. This is hard to take. Surely if they would eat, they would get better, and often a feeding tube is offered as an option. Feeding tubes are more commonly used in the south and among African Americans than here in New England. 

Think twice before taking this route.

An article in the New York Times describes the decline in the use of feeding tubes in these cases of late stage of  Alzheimer's, following recommendations by the American Geriatrics Society and the American Board of Internal Medicine.  In summary, feeding tubes do not give any better outcome than careful handfeeding but they do increase risk:
  • It can cause bleeding, infection, skin irritation, or leaking around the tube.
  • It can cause nausea, vomiting, and diarrhea.
  • The tube can get blocked or fall out, and must be replaced in a hospital.
  • Many people with Alzheimer’s disease are bothered by the tube and try to pull it out. To prevent that, they are often tied down or given drugs.
  • Tube-fed patients are more likely to get pressure sores.
  • Tube-fed patients are more likely to spit up food, which may lead to pneumonia.
  • At the end of life, fluids can fill the patient’s lungs, and cause breathing problems.
 
Feeding tubes are associated with increased agitation in the patient which can lead to physical or chemical restraint.

 And they cost a lot to put in place. 

There are times when feeding tubes are a good idea. These include conditions that have a good prognosis, unlike advanced  Alzheimer's.

The ABIM report cited above includes several recommendations from Consumer Reports for caring for a person who has severe Alzheimer's Disease. These include treating conditions that lead to loss of  apatite such as constipation, stopping unneeded medications that can make eating problems worse, and scheduling dental care in case a problem with the teeth results in painful eating. 

All this should be discussed with the patient and the patient's medical team.

Most important is that there is an advanced medical directive and that you have that talk with your parents about what they want done to and for them at the end of their lives.





















Wednesday, August 17, 2016

OSTEOPOROSIS: THE GOOD NEWS .... AND THE BAD

THERE IS A NEW DRUG THAT STIMULATES GROWTH OF BONE AND PREVENTS FRACTURES


An article in today's New York Times reported on a new drug that stimulates bone growth and prevents fractures at least as well as the other drug on the market. The drug is expected to receive FDA approval soon.


Some 10 million Americans have a disease that weakens bones, 80% of them are women. This leads to an increased frequency of fractures of hip, spine and wrist. These fractures often have a high price, including death, increasing incidence of disease, and high dollar costs. 

We are living longer. We can control chronic conditions such as coronary function, we can treat (with some measure of success) cancers, and we don't smoke -- we take better care of ourselves. But with this increased longevity has come diseases such as osteoporosis (not just one disease but a complex) that in an earlier time we might not have lived long enough to have experienced. In the case of osteoporosis we experience age-related deterioration of our bones.With the dramatic growth of the elderly population and the rise in the incidence of fractures at earlier ages, osteoporosis has become a major public health problem of epidemic proportions.  All ethnic groups are susceptible to osteoporosis, and the disease is under diagnosed in the African American population.

Among the several risk factors for osteoporosis are genetics, insufficient calcium and vitamin D intake, along with some of the usual factors that are out to get us: smoking, too much alcohol and the 'couch potato syndrome.'  


The care for patients with established osteoporosis should include:
  • Early diagnosis of potentially treatable secondary types of osteoporosis
  • Decreasing fracture risk by utilizing medications, such as SERMs, bisphosphonates, denosumab, teriparatide
  • Exercise and activity programs
  • Injury prevention strategies
  • Optimizing nutrition and lifestyle variables to decrease risk.
There is available one hormone-based drug that stimulates bone growth, and the NY Times article reports on a second drug that is likely  to receive federal approval soon. While these drugs offer great promise for some, they -- like many drugs today -- are very expensive and becoming more so. 

Osteoporosis is a serious health problem. It demands federal research funds for research and education to reduce the incidence of  fractures associated with osteoporosis.


Monday, August 15, 2016

SHARE THE WEALTH... WITH GHSS

Here is an interesting concept: local nonprofit organizations (think: GREATER HILLSBOROUGH SENIOR SERVICES) enrich their communities ... and usually are strapped for funds! 


Recognizing this, the TD Bank established the Affinity Membership Program as a way to help nonprofit organizations, including GHSS, with an easy way to raise money. Basically what happens is that when you open an account with TD Bank, or have an existing account, you let the bank know that you are a supporter of GHSS. Once a year the bank contributes its own funds to GHSS. The size of their contribution depends upon the amount  of money that GHSS supporters have on deposit with the bank. As they say, The More The Merrier! 

The bank donates its money, not yours. The more you have on deposit with them, the more of their money they will donate to GHSS.

But, maybe you knew that!

 Here is something you might not know. I didn't.

The Bank will make a financial donation to GHSS based on the wishes of the bank’s subscribers in September.


YOU HAVE TO LET TD BANK KNOW THAT YOU WANT  THEM to contribute to GHSS!

Please stop by the TD Bank in the next two weeks and let them know that you want them to contribute to GHSS!

Wednesday, August 3, 2016

Seniors Alive! for August

Here is your August 2016 issue of Seniors Alive! 
 This and past issues are available at the tab above.

When you go to Shaw's in Hillsborough you might notice a sign at the entrance that gives an update on GHSS fund raising efforts to  buy a new bus. "A new bus? I thought you had a bus!" I can hear you now! So, what's the skinny on the 'new bus' already?

Getting older is not something that you should try on your own. You lose a spouse ... and you are left alone. Your family is far away ... and you are left alone. You no longer drive... and you are left alone. Know what happens to your brain on loneliness? Mush. That's what happens. You need to keep those gray folds churning, solving problems, exercising, looking outwardly ... and socializing. In a word: not being alone. 

This is exactly where GHSS can help: we're the cure for loneliness. GHSS sponsored and supported activities such as our monthly luncheons, pickle ball, and shopping trips bring seniors together for friendly interactions.

This brings us to The  Bus.  We had a choice in this. On one hand we could wait. And wait. And fund raise until we could purchase a new one. AS they say, though, we're not getting any younger ... we decided to first buy an older but still serviceable bus that would buy us a few years and a whole lot of trips. Thanks to some generous corporate and personal donations, and a lot of fund raising, we decided to buy a used bus, which we call Betsy. We don't like to reveal a lady's age,  but our girl has about seventy thousand miles on her and, while she is  fighting trim now, she's got maybe five years of good service left before she heads to Bus Assisted Living, or whatever older buses do. 


Thing is, we're going to have to replace  Betsy, and that means: MORE FUND RAISING! 
Another thing is that Betsy has got to be maintained and fed and this requires MOOLA.

So, yes, we continue to raise money for a bus while we continue to provide Seniors in our area with some pretty nifty trips.

You can check out Betsy's schedule for August in this issue of Senior's Alive! (along with other interesting stuff) but here is the schedule of trips for August:

August 11, Thursday: League of NH Craftsmen Fair at Lake Sunape (https://www.nhcrafts.org/craftsmens-fair-daily-schedule.php). This is a display of truly fantastic craft items and crafting displays. The bus will leave Shaw's at 10 am. Admission is $12.00 (an AARP discount is available) and the bus fare is $5.00. (minimum 6 persons). Reserve by calling Marie Mogavero at 464-4726 or 727-5272.

August 12, Friday: Garden in the Woods in Framingham, MA (http://www.newfs.org/visit/Garden-in-the-Woods). This is the New England Wildflower Society public botanic garden. There is a pond, a bog, woodland.  Trails meander over glacier-sculpted ridges and through narrow valleys. Admission to the garden is $12.00 ($9.00 for seniors 64 yrs and older) and transportation is $11.00. a box lunch is available at the garden or you can bring your own. The bus will leave Shaw's parking lot at 9:00 am.  Reserve by calling Marie Mogavero at 464-4726 or 727-5272.

August 18, Thursday: Monthly trip to Walmart.  The bus fare is $5.00 (minimum: 6 people). Lunch and other possible destinations will be determined at the time. The bus leaves Shaw's parking lot at 9:30 am.  Reserve by calling Marie Mogavero at 464-4726 or 727-5272.

August 18, Thursday: Fisher Cats with fireworks! A generous Hillsborough business person has donated some tickets. To score your ticket hurry up and call Marie Mogavero at 464-4726 or 727-5272. The bus will leave  Shaw's at 5:30 pm.

August 19, Friday: USS Constitution Museum (https://ussconstitutionmuseum.org). The 200+-yr-old USS Constitution houses the largest collection of articles related to the construction, and role of that great sailing ship in the early days of our young republic. Admission on Friday is free, the cost of transportation is $11.00. The bus will leave Shaw's at 8:00 am. Bring a lunch as there  is no restaurant. Reserve by calling Marie Mogavero at 464-4726 or 727-5272.

August 16, 23,  30,  Tuesday nights: Henniker Concerts. 
   August 16: North River -- Pure Americana harmonies from Dylan to the Dixie Chicks
   August 23: Nick’s Other Band -- Party on with this high energy audience engaging band 
Charge for the ride is $1.00. The bus will depart Shaw's. Reserve by calling Marie Mogavero at 464-4726 or 727-5272.

August 23, Tuesday: Mill Brook Gallery & Sculpture Garden, Concord. Original art and contemporary craft by regional and national artists in a home-like setting. If you aren't interested in the art, Betsy will be stopping at Beech Hill Farm for an icy delight on the way back home. Transportation is $3.00. The bus will leave from Shaw's at 1:00 pm. Reserve by calling Marie Mogavero at 464-4726 or 727-5272.

August 26, Friday: Franklin Park Zoo, Boston (http://www.zoonewengland.org). With 128 different critters you're bound to find one to love. An arachnid anybody? A train will carry you from exhibit to exhibit so you can be sure to see each and every one of them. Admission to the zoo for seniors is $16.95. Bus fare is $16.00. The bus will leave Shaw's at 9:00 am. Reserve by calling Marie Mogavero at 464-4726 or 727-5272.


The August Senior Luncheon will take place on  Wednesday, August 17 at the Deering Community Church.This will be a chicken bar-b-cue. Come and meet Hillsborough PD's Sgt. Hogden and his K-9 pooch. Yes, you CAN bring something to share! If your last name begins with A-L, please bring a dessert. those beginning M-Z bring a salad please. The cost for this mid week feast in scenic Deering is only $4.00. Reserve by calling Marie Mogavero at 464-4726 or 727-5272. NO LATER THAN 12 August.