Every year the optimistic and energetic among us makes New Years resolutions. My experience with older adults is that most have goals and objectives for the coming year. I have a few suggestions. One of the obstacles that caregivers and other professional helpers run into is the task of trying to do what they think is the right thing, for someone who can’t make their wishes known. I had more than one conversation this week about what steps can be taken to direct someone’s estate after he passes, and about what decisions a person wants made for his ongoing care. It can all be written down. It should all be written down! If you don’t know what exactly needs to be done, and don’t have a lawyer, they periodically make themselves available at Jack Crippen Senior Center in El Monte. They’re the lawyers at Bet Tzedek. They are first rate, knowledgeable and have no vested interest in what you do with your stuff. They just want you to get a plan on paper. Bet Tzedek just published a guide for caregivers with all sorts of information on conservatorship, advance directives, benefits and so forth. Anyone who needs care, or knows someone who might, should have this book. They have other guides too. I have made use of Caring for a Relative’s Child and given out a few copies of the Nursing Home and Assisted Living Companions. They can be downloaded at www.bettzedek.org at the “publications” link. For anyone out there that doesn’t speak Hebrew, Bet Tzedek means “House of Justice.” They won’t do services like divorce and personal injury cases. They want to help low income LA County residents who need legal help. If your resolution is to get your affairs in order, this is a good place to start. Shalom and Happy New Year!

This week is the winter solstice. I feel better just knowing the days will start to grow longer. Many older adults feel the cold, which isn’t going away quite so soon, and the dark to a greater degree. Sometimes it’s because they have stopped the utilities to the house. It surprises folks how often older people don’t have power, gas, phone or even water. Sometimes the upkeep of plumbing or wiring has gotten too far behind. Other times paying the bill on time is too much.
Even those who have electric lights may have effects from the long nights of winter. Seasonal Affective Disorder is a type of depression that comes over a person who isn’t exposed to adequate natural light. The best treatment is full sunlight on the face within fifteen minutes of waking. If you wake up two hours before sunrise, you need a different therapy. The internal clock shifts backwards with age, the older one gets, the more likely he is to retire early and then rise early. Banks of special artificial light can do the trick for two thirds of SAD sufferers, others may require medication.
Falls are likely in the twilight. If you have holiday decorations up, I bet you have trip hazards of extension cords too. If the cold has numbed your feet, you might not notice slippery or uneven footing until it’s too late.
So this is the part where I have some wise recommendation to ease the problem. If you know an older adult with no power in their home, call Adult Protective Services. They may already be aware, but they might just have the right help. When the mail piles up, it’s hard to fill out the applications for lifeline services alone. But this may keep the lights on for an elder. If you are having trouble getting around on your own, start making changes that will keep you safe. Grab bars, throw out the throw rugs, get a shower seat, remember The Clapper! I don’t know how wise any of that is. I’ll do better when I get more daylight.

Be of good cheer! Or else! The pressure to have a good time during the holiday season can bring it’s own consequences. Stress to spend too much, to eat too much and drink too much has effects on mood and health. There is a national trend in the increase of heart attacks from Thanksgiving until after New Years. The reasons are many, including getting too busy to follow an exercise plan, unusual drinking habits and changes in diet. Even having one really big meal. Sudden high blood levels of fat can trigger arteries that are badly clogged. Unusual salt intake may retain enough fluid to stress a delicate circulatory system to trouble. High alcohol blood levels can irritate the heart directly and dangerously. The irregular beat can lead to stroke. Cold weather constricts the blood vessels on the outside of the body. Cold medicine can raise blood pressure.
Losing sleep, traveling, flu season and missing medications all contribute.
One of the biggest problems in identifying a heart attack is the difference in symptoms between men and women. Pain in the arm and chest is more likely for guys. Ladies may not hurt. They may have pressure, sweating and shortness of breath. One of the biggest contributors to fatal heart attacks is a delay in treatment. We can make it faster on my end with programs to get angioplasty started within 90 minutes of reaching the emergency room. The longest delays happen when a person denies the problem, takes an antacid and waits too long to go to the hospital. Another trend to improve survival is changes in how CPR is being taught. It’s easier than ever to learn and to do. And you can even take a class in using automated defibrillators! Clear!
Before that happens, keep your schedule intact. Sleep eight hours. Drink your water. Take your walks. Refill your prescriptions. And don’t ignore your symptoms. And be of good cheer.

There are two issues I think should be addressed this week. Both are related to the upcoming Thanksgiving Holiday. We hear about uncooked poultry and bacteria every year and it seems like everybody gets it, and then a new wave of food poisoning happens each holiday. A dear woman told me last week that her mother never taught her to cook a frozen turkey so she buys a fresh one every year. The woman is sixty-eight years old and I went to her mother’s funeral seven years ago. I think it’s time to learn on her own. The facts- you shouldn’t thaw a turkey (or other meat) on the counter. It takes about one day for every five pounds to thaw in the refrigerator. Then it can stay in the fridge for another two days. A fresh turkey should be bought the day before. No matter what the method of cooking (my wife like to brine, I like to deep fry) the center of the bird should be at 165 degrees F. Don’t get a pre-stuffed bird. Wash the bird, your work area and your hands every time! Those bleach infused towels do a good job of surface decontamination. Wash the pre-packed salads and spinach, even if the package says “washed.” The other topic is the point of the whole event. It is sometimes hard to stop and consider how much we all have. Many of us don’t count how many advantages we enjoy and just have an attitude of gratitude. Some families have a tradition of going around the table and saying “I’m grateful for…” on Thanksgiving. Some people don’t have a table to sit around. Some don’t have a family. Take a few minutes next week to think about whatever it is you are glad you have, to say thanks, to whatever your higher power might be, and to anyone around that day who might enjoy hearing it. And thank you dear reader, for your attention, time and effort each week.

Last week I recited some of my bona fides in respect to crime against older adults. The thing that surprises me time after time is the low return on crime.
Criminals that prey on older adults may get a quick claim deed now and then; sometimes they can arrange a loan against the senior’s home for a few hundred thousand. More often the proceeds of crime are just a few hundred or thousand dollars. Sometimes a lady can convince a well-heeled widower to buy her a car. Or a handyman persuades a woman to finance his daughter’s surgery- often back in the old country.
Younger adults become victims of crime because of greed. Older adults are more vulnerable because of sympathy and loneliness. The best protection they can receive is a full and satisfying social life. The best self-defense is to have a well-documented financial plan with a consultant on any large expenses or donations. Most importantly, in my opinion, is the willingness of a person to stand up and say, “I’ve been hoodwinked!” It can be embarrassing and frightening to realize and admit that someone you trust has taken advantage. Those feelings, and a well-meaning act of forgiveness can interfere with stopping the conman and protecting the future victims. And there will be other victims. If someone succeeds at this type of crime, they will try it again (and again). Knowing this may reduce the feeling of being special. Anger may lead to the courage to report. A professional criminal has professional level skills. It takes a professional to respond. The fraud detectives at the police and sheriff’s know how to find and nail these types. If someone is hurting you or someone you know, report the crime! If you don’t know how to ask a senior, try this: “Is someone hurting you?” A direct question is the best way to get a direct answer.

I haven’t ever explained the Elder Abuse Forensic Center. A grant allowed the adult protection team at county hospital to develop a team with the district attorney, city prosecutors, civil attorneys, geriatric doctors, police and sheriff’s detectives, advocates, adult protective services workers and my own mental health team. We meet every week to identify ways the team can act directly and indirectly to protect vulnerable older adults from criminal abuse. I also meet with the Coroner/ DA led elder death review team and I am the foreperson of a federal investigative grand jury. I tell you all this to prepare for this message. There is no federal law addressing elder abuse. There isn’t federal policy about the specific crimes committed against older adults. As the baby boom generation begins to age into seniority, I think it would behoove us to support long-needed policies on this type of crime. Why would that be needed?
I hear FBI agents, and ICE agents, and NCIS and Postal Inspectors and Forest Service and Internal Revenue testify and give evidence. I speak with City Police and County Sheriffs. They say that there is very specific training on child abuse but not elder abuse. Maybe the fraud investigators or homicide detectives have a smattering of experience that deals with specialty crimes against the older adult.
There needs to be policy on a national level. We need to make this an issue in next year’s elections. See www.ncea.aoa.gov for current legislation.
On an immediate level, I notice how many of the cases that reach prosecution begin with anonymous tips and reports. If you are afraid someone is being hurt, tell someone. If nothing is wrong, at least they were checked out. If something is wrong, you may have saved a life. If you are a mandated reporter, you may have saved your job. ELDER ABUSE HOT LINE (877) 4-R-SENIORS (877) 477-3646