The Anatomy of an Appetite: Aging and Our Relationship to Food

The Anatomy of an Appetite: Aging and Our Relationship to Food

Many of life’s events involve food. From the grandest of celebrations to the smallest of gatherings, there is always a place for food. As an Aging Life Care Professional®, I recall a wonderful get together this care manager had organized to celebrate a client’s birthday, her ninetieth… I thought.  She so enjoyed her birthday cake. It was only after I re-did the math that I realized my enthusiasm was premature; Dorothy had another twelve months to go to before she reached her 90th year.

Dorothy took great pleasure in eating her birthday cake. But such enthusiasm for food is not shared by all adult seniors.  There are a variety of factors that may contribute to a decrease in appetite: the side effects of a medication, dentures that do not fit, loss of taste, feelings of loneliness as a senior sits down to a table for one and a myriad of medical conditions.  A wince as an older adult bites into an apple or a change in appetite after the start of a new medication are symptoms that may require a visit to the dentist or a call to the prescribing doctor.

The potential for resolving the nutritional problem described above are far more likely than the changes an adult senior experiences as the end of life approaches.  He or she may lessen their food intake and ultimately refuse all nourishment. Family members are justly concerned, confused and frequently feel guilty.  Often, they fear they are starving a loved one to death if food, liquid or some form of artificial nutrition is not provided.  For an adult senior with advanced dementia, the scenario is made more complex.  As the dementia progresses it impacts on that part of the brain that controls swallowing. The chance of choking increases. In either of these scenarios it is important to recognize as the end of life nears the body adjusts to the slowing down process and minimal amounts of nutrition or liquids are needed, if at all. Now the focus becomes comfort care. Moistening the mouth with a special sponge, applying lip balm or offering a small amount of water through a straw, teaspoon or syringe.

Aging Life Care Professionals understand that while parents may have left specific directives for no heroic measures, a daughter may find it too cruel to discontinue nourishment or fluids. A son may hope for a last-minute miracle or a spouse may feel that only time will dictate when to say the last good-bye.  As Aging Life Care Professionals, it is our role to hold the hand of our client and reach out our other hand to support the family in whatever their decision may be.


Miriam Zucker, LMSW, ACSW, C-ASWCM, is the founder of Directions in Aging based in New Rochelle, New York. For over two decades she has assisted families in customizing plans of care and developing effective strategies to meet the needs of older adults. She has recently been appointed to the board of directors of New Rochelle Cares, a non-for profit organization devoted to helping senior adults live safely and fully at home.

This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association® and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.

Living a Heart-Healthy Life…With a Scoop of Ice Cream

Living a Heart-Healthy Life…With a Scoop of Ice Cream

Although American Heart Month is about to end, heart disease among adult seniors shows no signs of letting up. In fact, it is the number one cause of death in older adults and has been for the last two decades.

According to Dr. Jeannette Yuen, a cardiologist in the Scarsdale Medical Group in Harrison, New York, the most common types of cardiac disease are: Coronary heart disease, where plaque builds up in the arteries that inhibits blood flow; Arrhythmia, an abnormal heart rhythm that develops due to changes in the electrical impulses through the heart; Heart attack, which occurs when the blood flow to a part of the heart is blocked by a blood clot; and heart failure, when the heart’s muscle becomes too damaged to pump blood to the heart.

While chest pain is one of the prominent symptoms associated with heart disease, there are other symptoms not to be ignored: pressure and/or heaviness in the chest that can be mistaken for indigestion, shortness of breath, palpitations, a rapid heartbeat, sweating and nausea.  For women, there can be a group of unique symptoms: extreme fatigue, pain in one or both arms, back, neck or jaws. Also, there may be shortness of breath without chest pain.

As Aging Life Care Professionals®, we recognize that in the senior population heart disease may co-exist with other chronic conditions. Treatment for one condition may have a negative effect on another condition. It is for this reason that we obtain a full medical history, such as medications that are currently being taken and ones that have resulted in adverse reactions. We guide the caregivers so that they are aware of the symptoms that are out of the norm and recognize the importance of having open channels of communication between our clients and their physicians.

For both the family and the Aging Life Care Professional, there are no sweeter words than to hear a family member “is stable.” To that goal, if, for example, a pacemaker has been implanted, it is important to have it tested at regular intervals. It is also important to take medications as directed, not skip a dose, or abruptly stop a medication without consulting with a cardiologist.  While the importance of exercise has always been touted to strengthen the heart and improve circulation, as care managers, we must question if such expectations are realistic based on the physical and cognitive conditions of our clients.

Finally, there is the inevitable recommendation to eat a healthy diet. While this is certainly important, it is also important to include moments that are simply for the joy of them. I choose to go with poet Jenny Joseph, who wrote: “When I am old I will wear purple with a red hat that doesn’t go, and doesn’t suit me.”  To which I add, while wearing purple with a red hat, I will eat ice-cream, whenever the urge comes over me. If not now, then when?


About the Author: Miriam Zucker, LMSW, ACSW, C-ASWCM, is the founder of Directions in Aging based in Westchester County, New York. For over two decades she has assisted families in customizing plans of care and developing effective strategies to meet the needs of senior adults.

This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association® and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.

Tea with a Purpose

Tea with a Purpose

Too much coffee and tea can be a good thing. Let me explain. A few days ago, after visiting a client at White Plains Hospital Center, I stopped by their recently opened café for a cup of coffee and a freshly made gluten free blueberry tea cake. The hospital is known for its good care and the café is now following in that tradition, albeit gastronomically.  As for the tea cake, it was delicious. I do not have food allergies, but a weakness for a good piece of plain cake.

Twenty minutes later, I arrived in Harrison, New York at the home of a nearby client.  The taste of the coffee was clinging to my palette and I secretly wished I had bought another of those sweet treats for later. Hearing the bell, Helena reluctantly opened the door, always suspicious of who is knocking (not a bad thing). Recognizing my name, she let me in. Sometimes I am sequestered in her foyer for the visit and other days I am escorted into the kitchen. Today was a kitchen day. We started our conversation and then, as it progressed, she asked if I wanted a cup of tea. Did I really want to forgo that lingering taste of coffee for tea?  Truthfully, no, but I happily accepted.

Why did I say, “Yes” when I could have just as well said “No?”  It all has to do with purpose in one’s being. It’s a life quality that starts to wane as one gets older. You’re told to stop driving because you had a couple of fender benders. So now you can’t visit your home bound friend or be a volunteer driver for Meals on Wheels. And then the greatest upset of all, your spouse passes away. No one to cook that special dish which brought such accolades despite its simplicity.  Such was the case with Helena. There was no longer anybody to make that cup of tea for, so how could I ever think of saying, “No.” I sat at the kitchen table and watched her take the crackled and stained mug out of the cabinet.  Water boiled, she carefully handed me my tea, mystified as always, that I take it plain.

The act of making the cup of tea for this geriatric care manager, was both an act of kindness and the momentary gift of purpose. As for the taste of the coffee no longer lingering on my palette, it was surpassed by the opportunity to return to Helena a memory of time sweet, if not sweeter, than my blueberry teacake. It was a very good visit.

Mi Casa Su Casa…Not All the Time

Mi Casa Su Casa…Not All the Time

Mi Casa Su Casa, “my house is your house.”  With a bit of variation, that is what a caregiver, who thought she was doing the right thing, said to this Aging Life Care specialist. There was only one problem, Winnie, my client, had no interest in achieving that feat. She wanted her house left alone, just as she wanted to be left alone.

The story went like this:  It was Cinda’s first day on the job. She wanted to do what she could to make a good first impression. But in her need to succeed, she was not taking into to account the wishes of my client. For starters, it had taken more than six months to have Winnie just be willing to try a caregiver. She told me that little by little she could get her cleaning, cooking and grocery shopping done. It just takes longer, is what she said. A fall reluctantly changed her mind. A caregiver was necessary.

Resistance met necessity when Cinda arrived. I interviewed her prior to her starting the position.  I talked with her about how fiercely independent Winnie was and how,  for this relationship to succeed, Cinda had to ask before doing anything. On the first day, after the introductions, I left. It was a six hour shift.  Within ten minutes of Cinda’s departure, I got a call from Winnie instructing me to notify Cinda that she is not to return.  I couldn’t blame her.

She explained that without asking Winnie, Cinda started to wash top shelf dishes, the china that is saved for special occasions. Following up with Cinda I asked what she was thinking. She told me with genuine sincerity, she wanted to help to make Winnie’s home as spotless as hers.  I reminded her of our discussion, ask before doing. Cinda was asked not to return.

When an Aging Life Care specialist, or anybody who is going to work for an adult senior, enters their home, the first step to success is respecting the home which is another way of saying respecting the person who inhabits that home.  It is a house filled with memories and mementos. But most importantly, indefatigable people trying to hold on to what they have left…their dignity, independence and their ability to self-direct.  Winnie has gone back to doing her chores at her pace. And her house has returned to being her home.  As for me, calls are accepted, but her door has yet to be reopened.

When A Parent is Fine: Five Strategies for Keeping the Status Quo

When A Parent is Fine: Five Strategies for Keeping the Status Quo

Sometimes I do a family consultation and after many questions and no red flag responses, I tell adult children, continue what you’re doing. Count yourself and your parent(s) as fortunate, but, like a good scout, be prepared.

So what is it I am saying?  It’s something like car maintenance. No squeaking brakes, or dashboard lights on, but you bring your car for maintenance.  Some older adults, if you excuse the analogy, are just like that. Blessed with good health, realistic about their needs, they can remain safely in their homes.

So for the parent who is fine, I do suggest five strategies to help keep that status quo:

  • A medic alert pendant or bracelet. Particularly, one that has a fall alert built into its sensor. Unlike the commercials, there is no need to dial the phone, the sensor picks up on the fall and calls the designated numbers.
  • A current list of all medications.
  • A notation of any medications a parent is allergic to.
  • If there is a DNR, I am referring to a Community DNR, (different than a hospital DNR) it should be prominently displayed.
  • A daily check-in call. Such calls allow for the adult child (or designated caller) to pick up on the slightest of changes in a parent’s cognitive status. Infections in older adults travel at lightning speed with altered mental status one of the hallmarks that something is wrong. Urinary tract infections are notorious for causing this altered status.

One particular service that facilitates much of the above is the Vial of Life (www.vialoflife.com). The Vial of Life is a program that allows individuals to have their complete medical information ready in their home for emergency personnel to reference upon arrival.

Image result for vial of life images

These small but essential steps can go a long way in helping an adult senior maintain his/her independence and at the same time be safe in their beloved home.

Thinking About a Guardianship? Information to Know

Thinking About a Guardianship? Information to Know

In conversations with family members, when there is frustration regarding a parent’s unsound decisions or resistance to medical recommendations, guardianship is sometimes mentioned. In some cases it is the undisputed route to go. I think about my assessment of Edgar, who, as his dementia progressed, refused to leave his house. It was only his neighbor who could drop off food. His sons, both in agreement that a guardianship was necessary, petitioned the court. The need was undisputed and guardianship was granted without a lengthy court hearing. But in other situations, I have seen how costly and ugly the guardianship process can be.

Article 81 of the Mental Hygiene Law provides the channel through which a guardian can be appointed. My experience has been that usually it is a family member (the petitioner) who initiates this procedure. The request for a guardianship can be sought in one or both areas: 1. Guardianship of the person’s property. This refers to all financial decision making and management.  2. Guardianship of the person. This refers to all decision making regarding the wellbeing of the person.

The decision as to whether the person needs a guardian ultimately rests with the court. In the process of making that decision, there will be an attorney appointed to represent the “alleged incapacitated person.”  There will be a court evaluator, someone who will make an independent assessment of the person and present their findings to the court.  At the hearing, the person bringing the petition for guardianship is usually represented by an attorney. It is that attorney who presents the convincing evidence as to why a guardianship is necessary.  If there are other siblings who are vying or contesting the guardianship, they too may be present at the hearing and represented by counsel.

The cost of legal representation and the court evaluation can be considerable. When family members do not agree, not only does the hearing become ugly and often drawn out, but legal costs swell. In such a scenario, there is a far greater chance that an independent guardian will be assigned rather than a family member. Costly and ugly, I say it again, but this time with the hope that a parent, once declared “incapacitated,” will be properly cared for and protected.