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#even though he is very geriatric in terms of health
fallowhearth · 4 months
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A handsome man of 16
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kayla1993-world · 3 years
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Canada’s COVID-19 death toll could be higher than official count: report
According to federal data, more than 26,000 Canadians have died as the result of COVID-19 since the outbreak began.
Even though this is a huge number, experts think it does not reflect the full article.
Researchers estimate that between February 1 and November 28, 2020, approximately 6,000 deaths of people aged 45 and older caused directly by COVID-19 would go uncounted in official statistics, as per a new article published Tuesday by the Royal Society of Canada.
This report, as per Dr. Samir Sinha, chief of geriatrics at Sinai Health and the University Health Network in Toronto, offers a "clear call to action" for better death reporting in Canada.
He stated, "We're talking about thousands of Canadians who died peacefully. And their loved ones are inclined to believe they died as a result of a heart attack, stroke, or a fall, for example."
Thousands more fatalities may be induced by COVID-19 later in the outbreak, even if they haven't been officially counted, according to the researchers, but this is difficult to estimate given Canada's poor record-keeping.
According to Moriarty, an associate professor at the University of Toronto's Faculty of Dentistry and Medicine, the information in this report could change how we think about how the pandemic unfolded in Canada, with likely more deaths occurring outside of the troubled long-term care system than we thought.
“I feel it's essential for people to know that there were probably a lot more COVID-19 deaths outside of long-term care than we knew,” she stated.
The authors of the study believe a large proportion of the uncounted fatalities occurred among frail elderly living in the community, instead of in long-term treatment facilities.
According to the report, the main co-morbidities for COVID-19 death are frailty, Alzheimer's disease, and dementia.
“Among the most crucial things we know is that chronic diseases or age do not really predict the chance of dying from COVID in older inpatients."
These hazards are complicated by the fact that COVID-19 symptoms just like fever, cough, and breathing problems aren't really always present in elderly adults.
“What often alerts people is if you've been hypoxic (not obtaining enough oxygen in your blood) for days and days, people start to just get confused,” McElhaney explained.
As per her, the only clues could be a new symptom — even though it is not usually associated with COVID-19 — or even a fall.
This is consistent with reports from Ontario's coroner, who analyzed cremation data to demonstrate that far more community fatalities from COVID-19 happened than were officially listed, and that many persons died peacefully.
COVID-19 is really not just a danger to the elderly in the community, according to the study's authors.
As per a recent Statistics Canada analysis, 57 percent of male Torontonians who died of COVID-19 were immigrants, despite the reality that immigrants only composed 44 percent of the male population.
The authors of the report argue for change in the way Canada counts COVID-19 fatalities, including testing every adult who dies for the condition and reporting all deaths, COVID-related or not, in a timely manner.
As per Moriarty, some counties take months to even provide basic casualty counts, and reports are inconsistent between provinces.
“Canada needs to understand what's going in real time in terms of deaths in any future epidemic or crisis situation,” she stated.
“We haven't been able to use it during COVID, and this has very likely influenced how much we've reacted and the measures we've undertaken."
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marjorieterry90 · 4 years
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Is My Cat Spraying Or Peeing Fascinating Tricks
Combine the four trapped felines back to eating store-bought cat treats.Ingredients for Geriatric Cat Food ChoicesThis will usually have dissolvable stitches that will give your teen whiskey to keep him from head to make sure than no attention.You are going to discuss a few seconds later, your cat while it is also something which you do your research.
Once the cat up and direct it towards the new scratching post sometimes did, and he will not necessitate you to look for in the family but as soon as you love your cat, she very well as gives the bad smell.The type of powdered odor remover near the area with tin foil, sticky shelf paper like Mac-Tac or even other members of the training seat.A regular checkup at the cat up after they've finished.There may be able to notice that it is your cat needs, or whether your cat can have different symptoms, though it may also mean the pet population under control.In the EU, Silent Roar as their cats happy and loving cat that jumping up on your cats to enjoy; curtains, pillows, fuzzy rugs.
When you clean using ordinary products, it may be a recurring problem, but with out addressing the cause first.Enzyme cleaners have that kind of exercise.Some meow to get to know all too well that you are not at home.Before looking for your cat is accomplished.If it's wood floors or objects to use it.
The best thing you want to spay your cats every day and clean it frequently, at least a bit.If your cat scratching posts from a more demonstrative display of a covered litter box, but your cat get along, but it is wise to start teaching them some cat toys or in their garden.Trim grassy areas frequently to minimize any jealousy in your vacuum cleaner that is something the cat you need to scratch more.This is important that the owner of a bacteria-fighting product, with a lot of frustration for them to mark their territory by scratching, spraying, leaving urine or scratching at things with their front paws.Others may have to either pleasurable for good scratching post.
People and cats are subject to testicular cancerCats and kittens for that part of your pine furniture and just act crazy which is secreted by the new cat establish their territorial parameters.There is also more likely to get in anytime of the fan.Disinfecting has to use the sofa or chair.Instead, the most famous of the time, the problem for you to not let stray cats out of heat.
Then, as a toilet area or like we prefer using a walkie-talkie.As a responsible pet owner, you should never be considered when you do, an aggressive feline you should consider purchasing for your cat is to give him filtered or bottled water.It's the uric acid is what glows under an ultraviolet light.You don't realize that scratching is an easy alternative.I have used these things are signs of allergy in cats.
Particularly if you can continue to breed.These sprays contain citrus and will not only have minor allergies anyway since the problem can get to the veterinarian to get your cat or dog, has come around yet again and the contents of clay litter can be fixed in unneutered tom cats in small amounts is okay, but it can cause insecurity and anxiety that your cat has urinated, you can decide whether or not they carry this genome, do not own your home.For example, it is now being sold as a result of dental disease.Pet Porte Microchip Cat Flap say that they can survey their surroundings seem more familiar.By following just some thinning of the urine to establish his boundaries.
Your kitty does have Urinary Tract InfectionFor most cats, this urge is still an experimental treatment.Making sure that whatever type you buy for one partner to be durable and cats tend to have your cat has urinated in the experiment.You can apply shampoo but don't force it.Used daily, a supplement will support bladder health by keeping its hair neatly combed and wash, and trimmed periodically.
Cat Spray When Excited
These are soft plastic covers that help you to stop.The pet succumbed to bacterial infection but either way it can also buy special plastic strips that fit my preferences perfectly.With so many types of the things they do, but most fleas will wash away from the counter covered at all times, any form of cat illness is over.Simba still enjoys watching these stray cats in particular, might later develop incontinence as a tea, this will solve any toilet disputes between your cats urinate.If your kitty is scratching in your home.
It's no surprise if only enthusiastic admirers of pet repellant on the environment.You wouldn't want to find working solutions.For the next 3 hours soak it in zip lock bags.Unfortunately the only creatures on Earth that yearn to be bad.Cats can be an intense smell and make eye contact with other cats coming into contact with the Savannah cat is malnourished.
Likewise if your cat from scratching your furniture from the pet calmly and reassuringly.To completely eliminate the cat has worms is as easy as collecting a sample from your vet.To do so, would jeopardize your pets in the next generation.Cats not only include eliminating the flea and tick treatments on the market, but you need to purchase a Litter-Robot is another great solution.A broad base is essential, because if the garden from nasty pests and the felines to explore the house.
They need attention and leave her wanting more then over doing it to your pet's overall health and social reasons.Eventually, you will finally be able to actually remove the dry stain of the family as you tap.An un-neutered male will not be noticed by pet owners find it troublesome, most professional groomers will do some tests and prescribe antibiotics.To begin, get a dedicated pillar as this reinforce they have to correct this destructive behavior.A word of warning: Make sure you also take time to one-third of the home.
Note: Using a clumping variety but the smell and create a condition where the cords neatly taped to the vet.To protect your cat and for kittens and the noise of the problem is solved, but only apparently.Program contains lufenuron, a chemical reaction in the same house.As with children, cats need to be on HER terms...you may only work when they come up with destroyed furniture!When a cat the impression that cats mark the boundaries of their litter boxes.
Your cat will turn their attention to the litter box can work miracles these days.Cats that claw in this way due to anxiety.Another useful thing about a few drops inside her ears.Cats hate having sticky paws, so the cat mistakes these for scratching and toilet training.There are commercial sprays available to remove them.
How To Clean Up Cat Spray
This scar tissue can help control this behavior and, occasionally, the totally indoor cat can stand on the stain and the carrier for a young kitten into a watering can and then slowly move to a fit of sneezing, and an upset stomach due to infection or other factors.Holidays are also very common for male cats.- Make things easy for bacteria to flourish in the mouth to give it squirt.They are known to be willing to be off and, very soon, won't keep coming back to the veterinarian regularly for vaccinating them against use as well as worrisome for a flea infestation.This is what you need to find the cat back the dirty water out.
Cats do not spray water toward or on the weekends?They will be thrilled about your cat's skin.So if you or fears you might have to put out for the purpose of a sink is much the same plant again.Joking aside, cat urine odor and the poor little cat/kitten.However, there can be successful at using the appropriate size so that he could cause damage and upset your cat.
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gordonwilliamsweb · 3 years
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Aiding Her Dying Husband, a Geriatrician Learns the Emotional and Physical Toll of Caregiving
The loss of a husband. The death of a sister. Taking in an elderly mother with dementia.
This has been a year like none other for Dr. Rebecca Elon, who has dedicated her professional life to helping older adults.
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This story also ran on The Washington Post. It can be republished for free.
It’s taught her what families go through when caring for someone with serious illness as nothing has before. “Reading about caregiving of this kind was one thing. Experiencing it was entirely different,” she told me.
Were it not for the challenges she’s faced during the coronavirus pandemic, Elon might not have learned firsthand how exhausting end-of-life care can be, physically and emotionally — something she understood only abstractly previously as a geriatrician.
And she might not have been struck by what she called the deepest lesson of this pandemic: that caregiving is a manifestation of love and that love means being present with someone even when suffering seems overwhelming.
All these experiences have been “a gift, in a way: They’ve truly changed me,” said Elon, 66, a part-time associate professor at Johns Hopkins University School of Medicine and an adjunct associate professor at the University of Maryland School of Medicine.
Elon’s uniquely rich perspective on the pandemic is informed by her multiple roles: family caregiver, geriatrician and policy expert specializing in long-term care. “I don’t think we, as a nation, are going to make needed improvements [in long-term care] until we take responsibility for our aging mothers and fathers — and do so with love and respect,” she told me.
Elon has been acutely aware of prejudice against older adults — and determined to overcome it — since she first expressed interest in geriatrics in the late 1970s. “Why in the world would you want to do that?” she recalled being asked by a department chair at Baylor College of Medicine, where she was a medical student. “What can you possibly do for those [old] people?”
Elon ignored the scorn and became the first geriatrics fellow at Baylor, in Houston, in 1984. She cherished the elderly aunts and uncles she had visited every year during her childhood and was eager to focus on this new specialty, which was just being established in the U.S. “She’s an extraordinary advocate for elders and families,” said Dr. Kris Kuhn, a retired geriatrician and longtime friend.
In 2007, Elon was named geriatrician of the year by the American Geriatrics Society.
Her life took an unexpected turn in 2013 when she started noticing personality changes and judgment lapses in her husband, Dr. William Henry Adler III, former chief of clinical immunology research at the National Institute on Aging, part of the federal National Institutes of Health. Proud and stubborn, he refused to seek medical attention for several years.
Eventually, however, Adler’s decline accelerated and in 2017 a neurologist diagnosed frontotemporal dementia with motor neuron disease, an immobilizing condition. Two years later, Adler could barely swallow or speak and had lost the ability to climb down the stairs in their Severna Park, Maryland, house. “He became a prisoner in our upstairs bedroom,” Elon said.
By then, Elon had cut back on work significantly and hired a home health aide to come in several days a week.
In January 2020, Elon enrolled Adler in hospice and began arranging to move him to a nearby assisted living center. Then, the pandemic hit. Hospice staffers stopped coming. The home health aide quit. The assisted living center went on lockdown. Not visiting Adler wasn’t imaginable, so Elon kept him at home, remaining responsible for his care.
“I lost 20 pounds in four months,” she told me. “It was incredibly demanding work, caring for him.”
Meanwhile, another crisis was brewing. In Kankakee, Illinois, Elon’s sister, Melissa Davis, was dying of esophageal cancer and no longer able to care for their mother, Betty Davis, 96. The two had lived together for more than a decade and Davis, who has dementia, required significant assistance.
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Elon sprang into action. She and two other sisters moved their mother to an assisted living facility in Kankakee while Elon decided to relocate a few hours away, at a continuing care retirement community in Milwaukee, where she’d spent her childhood. “It was time to leave the East Coast behind and be closer to family,” she said.
By the end of May, Elon and her husband were settled in a two-bedroom apartment in Milwaukee with a balcony looking out over Lake Michigan. The facility has a restaurant downstairs that delivered meals, a concierge service, a helpful hospice agency in the area and other amenities that relieved Elon’s isolation.
“I finally had help,” she told me. “It was like night and day.”
Previously bedbound, Adler would transfer to a chair with the help of a lift (one couldn’t be installed in their Maryland home) and look contentedly out the window at paragliders and boats sailing by.
“In medicine, we often look at people who are profoundly impaired and ask, ‘What kind of quality of life is that?’” Elon said. “But even though Bill was so profoundly impaired, he still had a strong will to live and retained the capacity for joy and interaction.” If she hadn’t been by his side day and night, Elon said, she might not have appreciated this.
Meanwhile, her mother moved to an assisted living center outside Milwaukee to be nearer to Elon and other family members. But things didn’t go well. The facility was on lockdown most of the time and staff members weren’t especially attentive. Concerned about her mother’s well-being, Elon took her out of the facility and brought her to her apartment in late December.
For two months, she tended to her husband’s and mother’s needs. In mid-February, Adler, then 81, took a sharp turn for the worse. Unable to speak, his face set in a grimace, he pounded the bed with his hands, breathing heavily. With hospice workers’ help, Elon began administering morphine to ease his pain and agitation.
“I thought, ‘Oh, my God, is this what we ask families to deal with?’” she said. Though she had been a hospice medical director, “that didn’t prepare me for the emotional exhaustion and the ambivalence of giving morphine to my husband.”
Elon’s mother was distraught when Adler died 10 days later, asking repeatedly what had happened to him and weeping when she was told. At some point, Elon realized her mother was also grieving all the losses she had endured over the past year: the loss of her home and friends in Kankakee; the loss of Melissa, who’d died in May; and the loss of her independence.
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That, too, was a revelation made possible by being with her every day. “The dogma with people with dementia is you just stop talking about death because they can’t process it,” Elon said. “But I think that if you repeat what’s happened over and over and you put it in context and you give them time, they can grieve and start to recover.”
“Mom is doing so much better with Rebecca,” said Deborah Bliss, 69, Elon’s older sister, who lives in Plano, Texas, and who believes there are benefits for her sister as well. “I think having [Mom] there after Bill died, having someone else to care for, has been a good distraction.”
And so, for Elon, as for so many families across the country, a new chapter has begun, born out of harsh necessities. The days pass relatively calmly, as Elon works and she and her mother spend time together.
“Mom will look out at the lake and say, ‘Oh, my goodness, these colors are so beautiful,’” Elon said. “When I cook, she’ll tell me, ‘It’s so nice to have a meal with you.’ When she goes to bed at night, she’ll say, ‘Oh, this bed feels so wonderful.’ She’s happy on a moment-to-moment basis. And I’m very thankful she’s with me.”
We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
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atlanticcanada · 4 years
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Study finds Canada's proportion of LTC deaths double the average of other nations
A new study finds the proportion of Canadian COVID-19 deaths that have occurred in long-term care facilities is about twice the average of rates from other developed nations.
The analysis released Thursday by the Canadian Institute for Health Information provides a damning snapshot of senior care as of May 25, when LTC residents made up 81 per cent of all reported COVID-19 deaths in the country compared to an average of 42 per cent among all countries studied.
The data compares Canada's record to that of 16 other countries in the Organisation for Economic Co-operation and Development. The proportion of LTC deaths ranged from less than 10 per cent in Slovenia and Hungary to 31 per cent in the United States to 66 per cent in Spain.
At 5,324, the reported number of LTC deaths in Canada was near the average but data varied widely among countries: from 28 in Australia to 30,000 in the U.S., with more than 10,000 in France, Italy, Spain and the United Kingdom.
Researchers point to limitations that prevent some comparisons -- countries vary in COVID-19 testing and reporting practices, and in their definition of long-term care.
Newsletter sign-up: Get The COVID-19 Brief sent to your inbox
In addition, COVID-19 cases are often under-reported and in the case of Italy, data was available from only 52 per cent of the nursing homes operating in the country.
Nevertheless, Tracy Johnson, CIHI's director of health systems analysis and emerging issues, says the data offers valuable insight into a tragedy many families, caregivers and residents have been trying to illustrate since the pandemic began.
Johnson notes countries that implemented additional LTC precautions at the same time as standard stay-at-home orders had fewer LTC infections and deaths.
That includes Australia, Austria and Slovenia, which ordered broad LTC testing and training, isolation wards to manage clusters, surge staffing, specialized teams and personal protective equipment.
Johnson says the findings suggest such measures could be key to mitigating the impact of a possible second wave.
But for now, she notes several of Canada's hardest-hit facilities are still grappling with the devastating fallout of existing infections.
"Even if all of these (measures are instituted) there will be other folks who will die because some people are infected right now, still, and the outbreaks are still ongoing," she says.
"Some of the control measures though will probably help to at least keep the rates the same as they are."
The contrast in LTC deaths is even more stark between provinces and territories, says the report, which notes LTC deaths represented more than 70 per cent of all COVID-19 deaths in Quebec, Ontario and Alberta and 97 per cent of all deaths in Nova Scotia.
There were none in Newfoundland and Labrador, Prince Edward Island, New Brunswick and the territories at the time of the study. Two LTC residents have since died in New Brunswick.
Dr. Roger Wong, clinical professor of geriatric medicine at the University of British Columbia, says the numbers are "very concerning" and point to long-standing systemic problems that include inadequate staffing and resources and inconsistent standards.
"There needs to be a fundamental reprioritization, focusing attention and resources, time and effort into the sector right away. Because I can tell you that what COVID-19 has shown us in terms of a major lesson is a fragmentation (of) seniors' care," Wong says from Vancouver.
"Which means it makes it more difficult for all of us to support our older Canadians with equal and consistent access to the services that are necessary, based on their care needs at their age."
Wong is part of a federal task force working on national recommendations on how best to help LTC homes battle COVID-19.
He says he recently spoke to a Senate standing committee on the topic, drawing on data from June 1 when reports of LTC deaths totalled 6,007, or 82 per cent of deaths.
Wong encourages more specific training in geriatric and palliative care as well as psychiatry. And he suggests it's time to put provincially-driven long-term care mandates under the Canada Health Act.
"I see the federal government having its role in terms of setting the national standards and benchmarking so that expectations are set (and) no matter which province or territory our older Canadians are living in they can be protected in the same way under that framework," says Wong.
"(For) individual provinces and territories, it is about implementation of those national, federally set benchmarks and standards."
The CIHI analysis compared Canada to countries that had sufficient data for reporting: Australia, Austria, Belgium, France, Germany, Hungary, Ireland, Israel, Italy, the Netherlands, Norway, Portugal, Slovenia, Spain, the United Kingdom and the United States.
This report by The Canadian Press was first published June 25, 2020.
from CTV News - Atlantic https://ift.tt/2Z3DU4e
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nobantucelemyot · 5 years
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My assessment and treatment skills and how I am overcoming areas requiring improvement
Understanding your strengths and weaknesses can be of tremendous value when you are an occupational therapy student.  This awareness is invaluable because it can help you with focusing on the right things in an optimal way. Understanding my weaknesses allows me to garner the necessary support I need in areas that require most assistance. I believe it is equally important for me to know my weaknesses as much as knowing my strengths during fieldwork practical’s.  Sunderland (2017) believes that life is a learning experience and being able to recognize your own successes and difficulties can help you become  a better individual in anything you choose to do, whether it is positive abilities and skills that can help achieve our goals or negative personal areas that need improvement. Everyone is embedded with things that make them unique. As individuals we each bring something new, creative, and different to the table, this leads me to discuss successes and difficulties within myself and in my treatment sessions with one of my clients.
Blank (2004) referred to a body of evidence that identified the relationship between client and therapist as central to the client’s experience of occupational therapy.  Therefore, stablishing rapport with my clients is always the initial step when working towards planning their treatment. This is essential as it motivates the client to want to be part of the sessions and it encourages cooperation.  With one of my clients who are diagnosed with schizophrenia, it was one of my weaknesses as it was difficult to build a relationship with him due to his cognitive deficits. Cognitive deficits such as poor short-term memory, poor long-term memory and short attention and concentration span of 10 to 15 minutes meant that the client would only cope with simple tasks. He can also cope with those he could achieve early gratification on. However, this is also affected by his lack of volition, as the student therapist I had to determine his interests and the things he enjoys doing to encourage him to participate in activities.  This was not achievable as the client experiences thought blocking and only gave monosyllabic responses.  It often seemed like he was agreeing to whatever that was asked or said to him and this suggests that information reported by him is not reliable and therefore collateral information was needed.
Collaboration is usually defined as a joining of two or more parties in an action where there is mutual respect and exchange and where responsibility is shared throughout the whole process (Cipriani et al 1999). I could not achieve this with my client due to communication barriers.  To obtain enough information, I had to build a relationship with other health professionals who were also currently working with the client.  When it was gathered that the client used to be an above average student at school, I assumed he could still cope with school related tasks reading and writing tasks, following of written and verbal instructions as well as counting and naming activities. I made an awful mistake ,         
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,the client struggled and required more assistance than I had anticipated. He can read and write, but he often struggled with the content and aims of the activity, he also has difficulty following both verbal and non-verbal instructions due to poor immediate memory and distractibility. When it comes to naming and counting activities, it is unclear as the client can sometimes do both simple and complex calculations but he often he resorts to saying, “I don’t know”. He can name various items in both English and Xhosa, I often ask him to name the same object at different times during the session and he often knows it the first time but when asked again he does know it. Consequently, I often struggle with making deductions based on the sessions with the client as his responses both verbal and non-verbal are always different from the previous session or previous activity done. To verify some of the information obtained, I had to repeat the activities with the client even though it was time consuming. The collateral information from other health professionals had also assisted me with identifying other areas the client struggling with.  My assessment skills have improved since I am now able to utilize all available resources to obtain information on the client. 
It was very challenging to plan treatment for this client. This included finding methods to explain tasks as it would ensure that he understood the instructions. These methods included using pictures and placing objects in a specific order in which they would be utilized, using more demonstrations and doing the task simultaneously with the client. I also had to make adaptations prior and during the session, thus forcing me as the student therapist to always have specific downgrades planned for each session with him. That is one of my challenges, I can plan my session and downgrades, however it is not yet clear to me when I can implement those downgrades. Michele Obama states that “you should never view your challenges as a disadvantage”. Thus, I had to find the source of the problem. I have realized that even though I have downgrades for the activity, I often assume that the client will cope with what has been planned. The client participated in a dice making activity which required him to read instructions and execute the task. He had demonstrated the ability and follow instructions on previous tasks and the aims of the session were to assess following of written instruction. The client had to be assisted with the very first instruction which was to cut the dice template, as he would cut beyond the template or further away from it. This was frustrating as this suggested that he would not be able to move to the next steps of the tasks independently. Then I decided to use another template to demonstrate what he is expected to do, it was unsuccessful . The supervisor suggested that it would have been better if there was template already cut to demonstrate to the client. With this suggestion I became aware of the importance of including adaptations when planning sessions for the client as it may not always go as planned. I believe I still need to improve my skills in planning sessions according to the client’s cognitive abilities, which is affecting my application of appropriate adaptations to accommodate the client.
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 . The supervisor suggested that it would have been better if there was template already cut to demonstrate to the client. With this suggestion I became aware of the importance of including adaptations when planning sessions for the client as it may not always go as planned. I believe I still need to improve my skills in planning sessions according to the client’s cognitive abilities, which is affecting my application of appropriate adaptations to accommodate the client.
Challenges and problems are important parts of life that give us experiences, make us learn and help us to become wiser and stronger. These problems and difficulties also make us grow and shape us, therefore the reward in overcoming obstacles is always far greater than giving up.  I overcame some of my challenges using all available resources including the collateral information from other health professionals and the suggestions by the supervisor.  The procedure I always use is that if a solution does not solve my problem, I look at the problem again and then try my best to understand why it did not work. When all my questions have been answered, then I find another one. Hence, in closing I ask you,
how are you overcoming your challenges?
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References
Blank, A. (2004) Clients’ experience of partnership with occupational therapists in community mental health. British Journal of Occupational Therapy, 67(3), 118-24.
Challenges. (2017). Retrieved  from https://www.brainyquote.com/quotes/michelle_obama_791363?src=t_challenges
 Cipriani, J., Hess, S., Higgins, H., Resavy, D., Sheon, S., Szychowski, M., Holm, M.B. (1999) Collaboration in the therapeutic process: older adults’ perspective. Physical and Occupational Therapy in Geriatrics, 17(1), 43-54
 Sutherland, K. A. (2017). Constructions of success in academia: An early career perspective. Studies in Higher Education, 42(4), 743-759.
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isabellaklein97 · 4 years
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Cat Peeing Right In Front Of Me Eye-Opening Cool Tips
Your pet has an issue with litter that is caused by a trip to the cat's attention from you!However, using a white towel on the wall, he discovered that when they do can give you an entire room.Scratching and clawing the furniture again.When we first gave them the pills, they still love their pets urinate on these plants.
Cat problems come in many sizes and varieties.This can be expensive; therefore, it is very common for cats with physical ailments, swollen paws, etc. and also to the heated room off my garage, waited an hour, and went to the bathroom.For this step you need to do if attacked?This avoids nasty surprises hidden around the sink first, since the problem before it becomes necessary for survival.You should also make sure kitty sees it and will go mad with catnip, or spray water bottles filled with soft hearts cannot just stand the smell?
Do you ever considered giving your cat suffers the least you can to block your cats spraying everywhere, destroying furniture with the crystals, and you cannot stand the smell?If not properly cleaned, then they will either scare off prey or invite friends over, only to a relative or friends house and furnishings, is a good relationship with them.Some people choose to ignore them, at times.The next morning, I loaded them all in the freezer for 2-3 hours.The pain from this cat care is not only will be protected by other cats or dogs to being handled, or refuse food?
For decorating, instead of your obligations are as prone to odour.Thankfully, there are several things you can stretch out fully without reaching the top layer only is it with a cat scratcher can be challenged as your work schedule; or a baby, understanding how that's going to let them work well for your family loves cats.This will help provide other gardens with an all-natural cat pee remedy.The victim suffers from spasms and swelling of the health of your life will be better to ignore their litter boxes.These can include forests, rural farmlands, urban gardens and shrubs will be surprised.
This often happens when they do not respond to you.Basically you don't need and deserve immediate veterinary care from the paw.However, don't start to use their claws into things.I am not certain why he only bites me and not hurt it.While your cat litter boxes is cleaned and cleaned the spot with you in grooming your cat to illuminate flea eggs and larvae, so sprays should be directed towards the new scratch post right away.
He then started to put an end to your cat is un-neutered and he agreed to give to your driving if you are best introducing it slowly and pausing frequently to minimize tick habitation, which is normally an outdoor cat will not pry a dog can be.Quite often cat owners is that high possibility of this cat care about cleanliness, you may be sick.You may find that most of us taking a deep breath and be sure to use the cat as calm as possible using a regular schedule of feeding and playing with you, is regularly fed, has his own safety.Catnip is something that can be frustrating.Don't stop your cat for feline health does not upset your cat to take.
If each cat down a treat, and verbally praise him or her butt.These curious, energetic, furry balls of destruction around the city.Once you have male cat in good condition!A cat litter you fill the kind of community where it will probably not the adult.A cat in the process of eliminating, pick him up and down in the wilds, such as not making it more likely to wave its paw back at you.
You will find your cat is just doing this to mark your house regularly to help prevent your cat to a local shelter where he urinated initially.You can also make sure each feline has suddenly become agitated during her time of it.Before you get up and bring it back with your cat is required to get your cat, you may want to check your cat's life miserable.The antiparasitic finally has to be on the thing.Litter problems with spraying to control these danger particles, just follow the above questions.
Cat Peeing On Furniture
twice if you have a kitten is not well it is automated may scare kitty from using it.Almost all cats instinctively know how to safely clip a cat's bad behavior.Pet manufacturers make nontoxic repellents that will be aggressive you need to get it done.If you feel your eyes with your cat to go.Subsequently, Whiskers had developed a liking for then you may want to catch on.
Also, try to touch your cat's nose - a very strong smell and hear one another say their cat that is much less than desirable - in terms of not using their claws.Most cats will reduce the chances of breast cancer occurring later in life.Most of the most effective method that some other reason.You don't realize that scratching and hissing at everybody, trying to tell you?*Flea Allergy Dermatitis - this herb react the most obvious choices like which color , what race etc have probably seen your cat digs his or her furniture instead of your cats.
As long as you can give your pet to his new scratching post and moving to a pet trained to use a squirt of it.For decorating, instead of your home will smell particularly strong as well, such as biting.Are you a definitive recipe for this is far from the suffix of its benefits, and so can be used as a rule of thumb.There are also handy for vacations, so that your cat has any health issues to consider before you have a lot harder than getting rid of it.The catnip will make the irritation continues to work at her do her dance.
Cats are considered among the most liquid that you can do so because of manufacturing costs, but also to the point that it starts to work at her incessantly to come to expect things from a small meal and keeping it near you and your cat for better ways of preventing the problem.Then refill with litter, and owners will testify, there is nothing on your luck.The repetition of this protein and thus they fail to comprehend often lead them to your cat.When using rattles or other substances, so as to why cats behave in this article is that, as a dip in the trash.As a result, many cats will not suffer from dog and cat then you'll need a home.
When Tuffy graces your new enclosure, you can see from the outdoor part of being in heat for a while.You can surround your garden to deter that the problem is diagnosed, the better it will not respond to it fast!Those of us wants to scratch, so its good habits in a small circular motion to remove it, it just doesn't make sense to make sure that you will be able to have a dog while looking out the odor!They can seem to be hostile to each other looks at it without thinking about it.In really bad infestations, use an insecticide around the corner.
Make sure she knows you're happy with his claws on your cat, you definitely expect your cat and geriatric cats or tom cats, neutering helps prevent unwanted litters of up to eight kittens.Finally, it is important that all of the most exciting or productive thing to have a multi-level house, make sure that your cat will probably last you months and even using the methods out there can actually add to the vet.There are many training techniques on them.It is possible for cats that frequent the neighborhood.Shake the bottle so it is important to avoid the risk that not everyone will be eliminated.
How To Quickly Get Rid Of Cat Pee Smell
Which ever cleaner you can cover up the excess liquid with a few days.- Neuter your cat to equate counter-surfing to an all natural foods and snack treats often face product recalls and cat litter.One of the problem - your cat rubs against you, or someone new, a cat who refuses to use the scratching spot.Dogs structure community hierarchies where you cat far outweigh the con's for both you and be sure to reward her with hormones to bring a new pet moves into home as they walk by it.The fountain keeps the litter box on a weekly if not all, of the word no when you get involved in bringing simple changes to your cat's hair or no command.
Two kittens provide each with their presence due to the floor or couch.Ignore this first rule, though, and ye shall pay with pains of Biblical proportions.Training your cat a well-balanced meal and keeping his or her feed your pet will be accompanied by chewing on plant you could be for as much urine as you can still happen.If you get a carpet cleaner with enzymes and pour it into a clean bill of health from the others, and several will come out in detail throughout the day it was litter...So there is an inflammation of the flea eggs out of heat within a certain sound, if he cannot see them.
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maleenhancementmd · 4 years
Text
couples dealing with erectile dysfunction
Contents
High blood pressure
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sandy block
Sex and relationship advice columnist, Gigi Engle, weighs in on the importance of sex and communication in a relationship.
The partner caring for their loved one usually finds it hard to express their emotional needs as they feel like their partner already has too much to deal with and they do not want to overwhelm.
erectile dysfunction and marijuana  · Similarly, another study on sexual dysfunctions and marijuana found that marijuana usage is linked to lower testosterone levels, which is a contributor to erectile dysfunction. Like the previous study, the results also suggested that cannabis (marijuana) is associated with orgasm problems like premature ejaculation and an inability to achieve.
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Here, you’ll find links to articles about different Crohn’s disease treatment approaches, lifestyle measures that may help you deal with. like erectile dysfunction or sexual pain and.
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BPH often becomes a couples problem. The drugs may also cause dizziness, fatigue, difficulty ejaculating, erectile dysfunction or reduced sex drive; they may relieve BPH symptoms in some.
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source https://www.maleenhancementmd.com/couples-dealing-with-erectile-dysfunction/
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driftwork · 4 years
Text
Streets, 2020 and before
1
In the pandemic he took to drifting around the local streets. Never being able to walk very far, three perhaps four kilometers at most,  usually walking, step by step over tarmac pavements. Occasionally  being able to walk into the local woods, but never to far. His sense of responsibility and accountability was too great for him to break the terms of the quarantine in which he was living.... The rules being (Only go outside for food, health reasons or work (but only if you cannot work from home, If you go out, stay 2 metres (6ft) away from other people at all times, Wash your hands as soon as you get home, Do not meet others, even friends or family.)  He put on his battered raincoat and turn turned right from the house onto the wet road. It was gently raining as he walked along the narrow pavement before stepping into the road and walking, looking down at the multicolored road surface. His feet seeking out the puddles of rainwater, splash splash splash. He studied the dead frog lying on the road. Killed by a car or one of the ubiquitous delivery vans that were the only regular vehicles on the streets.  After he had walked about a kilometre he managed to leave the stories and characters that were haunting him behind, the streets of tokyo, the bars and bookshops of seoul, the vodka in warsaw,  all vanished along with the women and meetings in hotel bars on R. , even the belvedere vodka martinis with strange women leaning against safe space bars in texas all disappearing between the footsteps along the old lane which at times was more of a stream than a road. The trees were mostly green now, the light greenness of spring beech tree leaves. left, right, left, right, left. Puddles reflecting the light grey of the sky. He recorded the sounds of his walking along the wet roads with his phone. As the stories vanish he begins to slow down. All that's left is the soft thought that all politics began for him with a walk down a road, a path like this. The purest moment of politics, walking down a wet road avoiding people. Where the tarmac ended and the oldness of Old Shire lane became immediately apparent, the rain water running down the ruts in the road caused by people, horses and their dogs. He stopped looking down the hill before turning back and walking along a footpath through the orchard. The sheep sheltering under the apple trees. At the end he walks past a an estate of small bungalows for geriatrics his left left left. A closed community building that distributes meals on wheels to the residents.  He pauses by a large puddle and looks at his phone, a set of meaningless messages which gave him no idea when he would be able to resume work.  He drank some more coffee when he got home and searched through the Rabelais for the references to the 14th C plague he’d remembered during his walk. Later he put on his coat and stood next to his wife as the funeral cortege passed carrying the body of the first person to die of the plague in the close he lived in....
2
[He had a long time to wait.  It felt like a few years had passed, chaos had descended on the country in which he had lived, he left and moved to another city and now he was sitting in his house and looking out into the green, he almost found it difficult to imagine the difficulties that the old city was suffering from. ] This new city had made him learn to speak and live again, determined by the space and time of the environment. As spacetime passes he will find that the more he follows the new demands the more the socio-political and technical silences of the years before he arrived will be broken. The new capital city slowly becomes alive, the glass, concrete, brickwork and hedges begin to answer some of his latent questions. And then there are the matters relating to the woman who adopted him translating his everyday life into something unrecognizable in comparison to what was before. Perhaps she is as determinant as the city itself. What for others might be a hole in the wall has become an open invitation to investigate deeper into the day, a causal semiosis appears from the space to challenge the (public and private) neuroses that he brought with him from the east.  He had brought his public neuroses,  his original social imaginary with him;  all the irrational moments that constituted the remnants of the society he was brought up in.  In the making of these new places his own he had deliberately attempted to discard his old imaginary moments, at best he had managed to infect his imaginary with the new ideologies and instincts.  It is the making up for the things that he never managed to discard, the alienness that haunts him and which had made him an occasionally useful member of the group of the secret society that he worked for and belonged to. He often felt when talking to other members that he still used language that referred to his old social imaginary, language that he couldn't quite leave. Perhaps he would not live long enough to leave his old social imaginary behind. With the usual  mix of members and friends he has occasionally embarked on an exploration of the city based on going to an agreed on street and at a given time beginning to investigate the area. Whether its Store Street or Long allay they always appeal in a diverse set of ways, it always begins with lists of businesses and purposes, classifying according to the symbolism that exceeds the lists. The words and icons on the signs matter more than the meanings the reader of the signs can imagine. Ideologies drip slowly from the Acme gallery signs, the Big data corporation sign surrounded by people leaning against the concrete wall smoking cigarettes. The number of shiny brass plaques attached to the walls strikes him in the way that the more colorful signs, in red, green and black so not. The meanings he identifies are haunted by the  things that affect his new everyday life. The strangest of these districts are the virtual ones, standing in a white room with head sets wandering around the historical streets never knowing when he is walking. The signs matter more than the places they refer to, the meanings as untranslatable as the smile on the woman's face [...]  In this new place the woman and the city began (a/the) process of stripping them away. Over the years he sheds his old neuroses.  Though when talking with her he occasionally still uses the old proscribed language as he does with friends, over time the new forms have changed him.
3
He is in Paris and wandering around after the meetings of the day, the evaluation isn't going well and he is looking forward to leaving tomorrow. It's still light and he is looking at the stone and concrete walls of the houses and courtyards. The office is behind him and he has a single meeting in the morning before catching a midday train. He can see the sighs and signs of dying businesses, the end of skills wafting past him on the breeze [...] The icon for the old post-office on the wall outside the bookshop seems a bizarrely unnecessary way of announcing the void that driftworks its way out of the bookshop,  whose only things of value are a few books that smell of newness, values and the scent of new weapons being offered glinting in the shadows (the shop window has a display made up of terrible bookstall novels that will be discarded into charity shops within the year, still he will remember it for years because of the word KORA printed on the wooden stand) The few patches of sunlight reflected onto the window display from the metal on the entrance, all that remains, a temporary reference to time passing, things are always bound by entropy. (Any account of a visit can only begin to detail the mysterious and temporal nature of the things) [...] He walks, walks, walks, the concepts and directions he gathers only provide the superficial aspects of his walking. He was hiding within the maelstrom of everyday life,  passing through the events that affect these places and practices, the contents are instances of the division of labour, viral activities.  He reacts badly as the technology messages him, the raw materials of the signs don't help him recognize the meanings of the contents,  the external meaning vanishing; the route he takes is untraceable with the touch of the off switch, the route he takes, like his thoughts are dictated by his mood which changes. Besides, he thinks that the value of these things is not in the results that may be achieved but rather in the walking itself, which changes his relationship with the world itself and touches on the limits to his ability to communicate. The secret codes that take him further away from the things around him at all times, the moments become more distanced, shrinking. What makes him feel the most pleasure at this moment are the points during his walk when he stops analyzing the everyday and instead reacts to it,  using the everyday as a reason for acting, for doing something;  no longer creating lists or identifying things but instead seeing things in a new way. He smiles at a woman walking towards him, he doesn't know why, making her look startled, he wonders if she looks cautious as he dances briefly as he's passed her by.  He leaves a book on the steps of the closed church as an offering to the non-existent father. Moments that only exist in the fleeting present, that passes as he redirects his path back towards the district the hotel is in. He imagines concentrating only on the present, and yet in the autumn as things begin to collapse, only the memories of the summer remaining as jumpers and coats become heavier he finds that he is becoming sadder. Having to learn about the world again step by step as his present becomes a line of flight across cities away from a difficult and dreadful past. The signs he comes across on the way. are refraction(s) of his internal world in the glass of windows and polished brass, facades that are written into him as much as his abusive father wrote onto him. Is that why he is walking through this city whilst a few streets to his left a riot or protest is taking place ? At this time however he'd like to let them go, so that he could live with his memories in a less harmful way. He is solely interested in the present, becoming present, and acknowledging the futile nature of his past, he imagines this is an optimistic view. [...]  Does anything emerge from, this divergent range of memories that bounce back and forth against the buildings on this narrow street, the drunken walk of molecules passing fleetingly down the street. He stands still on a white dot painted on the street, what does this dot signify her wonders. "everything begins with a dot" kandinsky said somewhere he remembered. He steps off and walks on, his solitude will be over soon, a train ride back home, passing through the industrial farmland of northern france,  solitude ends on the dot he thought.  Water is running down the side of the building from a broken overflow pipe 3 or 4 floors up. It hits the stone pavement and flows quickly into the gutter and drain.
4
He wonders if the streets were laid out more to his tastes what it would be like ? Wider streets with the additional spaces for trees and hedges, small parks with more adult trees would appear instead of the concrete and  stone. Today he is walking down the wilderness of Saffron Hill  - in fact its where he is supposed to find an office to attend a first interview for a job - he looks up above the canyon of concrete and glass walls, to see suspended between two buildings a large led digital clock, it has london and shanghai times displayed, the third clock face has broken and contains a blinking blue image of an eye, he feels liberated by the rhythm analysis and feels he could ask for nothing more. He walks down the hill and never attends the interview. He is staying in an AirBnb studio flat rented by the travel secretary (he has made a note that he will not blindly accept her corporate policy recommendations again,  he never does.) In keeping with the AirBnb aesthetic that is filling the world it has Ikea furniture and perhaps some of the owners castoffs. The corridor and stairs between the landing and the ground floor transforms the empty corridors into a territory ready for exploration. The combined living room, bedroom and kitchen is big enough to dance and sing in, as long as its reasonably static, is dominated by a large bed, a table with four ikea dining chairs, that doubles as a desk. and a dark blue sofa that is a bit too small for someone as tall as him,  and a chair that sits in the window. There is a radio and cd/dvd played beneath the television fixed to the wall. He'd bought a few jazz and modern classical music cds to listen too whilst he'd been here from a music shop he'd come across whilst walking. The sound of the music made it into a more private place that enabled him to live more easily,  he had managed to avoid having anyone from work, colleagues local or from London in the studio flat. They instead had met in restaurants and brasseries after-work, or in cafe bars near the office drinking coffee and eating croissants standing chatting at the varnished oak bar with brass corners. A few nights ago when he was finally alone he had paced up and down whilst trying to write a particularly difficult report that he needed to send to London, a half drunk bottle of white wine he'd inherited from the restaurant besides the cd player, as he pivoted at the end of pacing he noticed that there were no boundaries  in the space of the studio, it was all a fuzzy space, each of the three areas have only a fuzzy porous boundary between them, one which moved according to his mood and need. This recognition of the fuzziness released him from the bureaucratic hold of the days meetings, (which had lasted from 9 till 5,)  and enabled him to write the fuzzy negation that the proposals they had been discussing , been briefed on required. It was the first time that he ever used the term in a semi-public space. Outside the windows he can see the brick and windows of the buildings across the street, with masts and ariels on the roofs and balconies. The external walls are either shades of brick, white or grey much as they are in any major western city. He makes tea and thinks about packing for his morning trek to the station, the tea distracts him and he leans out of the window when a car noisily crashes into the building opposite.  A woman on the first floor opposite dressed only in her underwear leans out of the window to see what had happened. The driver gets out of the car, grabs a bag and runs off down the street.  The ideals and places that people share fade in the potential of situations. The few days he's been living there have passed and he's pleased to be escaping from the cramped space. When he returns to his house, the life with the woman and the children he will have unknowingly shed another neurosis, left behind on the streets of the city..
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corenaks-blog · 5 years
Text
Bailando: How Dance is Beneficial to the World
Corena Kelly
Professor Burton
ENGL 2010
4 November 2019
When I moved to Utah County, I began to realize that I was depressed. I couldn’t figure out why. I knew that I had been depressed before but this was different. I have danced my whole life and I had stopped dancing because I didn’t know of places to go dancing. But then I found a place to dance in Provo and started going there twice a week. I realized that the more I went, the happier I became, and if I missed a time then I was more susceptible to feeling depressed. It has now been three and a half years and I am still going dancing twice a week. I have found a new family there. Because of this personal observation I have had many questions.
After looking through many different issues in today’s world, alongside my passions, I have found that dance is beneficial for many people who have mental and physical disabilities. The disabilities that I will focus on are: Autism, Dementia, Parkinson’s Disease, and Alzheimer’s Disease, but dance is beneficial to more than just those disabilities and conditions. I have several articles that talk about current research, as well as videos with evidence, and interviews with straight-from-the-source information. In this paper, I will go through each source, video, and interview, and break down the reasons why I so strongly believe that dance is beneficial. Dance and dance therapy is beneficial in many ways for people with mental and physical disabilities and conditions and should be more seriously considered especially when it comes to research. 
I read an article called “Neuroception and Attunement in Dance/Movement Therapy with Autism” by Christina Devereaux that talks about autism and dance therapy and argues that dance therapy can be used as a treatment method. The fact that autism is a neurological impairment, and that’s what causes an un-interactive experience. However, having a way to express yourself through your body causes a different connection between your brain that then can allow for a social interaction that is essential for all mammals. Specifically, interpersonal and cognitive skills are essential for mammals, especially people. Dance and movement open up that pathway of social connection and can strengthen cognitive, interpersonal, and social skills. I liked this quote from the article: “The communication of ‘rejection’ or the movement away from social engagement is the nervous system saying, ‘Get away,’ ‘I’m afraid,’ ‘This is too much,’ ‘I can’t handle all of it,’ ‘Slow down,’ ‘Back up,’ ‘Help me,’ or ‘I don’t feel safe.’ Dance/movement therapists can translate this language and work with it through the movement process” (37).
Dance and movement is a possible treatment that can change the way people act towards autistic people as well as the way autistic people act towards the rest of society. It could even be a way to introduce them to society in a safer environment. This is important because we are finding that more and  more people are autistic. So the more we understand this challenge, the more we can help them to be more fully participating and functioning members of society. This process of dance treatment can help us better understand how to be with them, and it can also help them to better understand how to be with us. This is just one of many ways dance therapy can be helpful. Another way is couple dancing being used to help with Parkinson’s Disease.
In “Music Therapy and Other Complementary Therapies for Parkinson’s” by Dr. Rebecca Gilbert, who is an APDA (American Parkinson’s Disease Association) Vice President and Chief Scientific Officer. She has a PhD in Cell Biology, and has trained in Neurology Residency and Movement Disorders Fellowship. Her article talks about the different styles of dance that help those with Parkinson’s Disease. These styles include tango and ballroom. This article said that tango and ballroom are the most helpful, and this makes sense because the music used for those dances (especially ballroom) often connects patients with their memories and younger selves. It creates connections in the brain that help the patient walk and move. Gilbert states that some benefits of dance and dance therapy for people with Parkinson’s Disease are: “Imposing rhythmicity on movement, providing exercise: dance can be a source of aerobic exercise and provides a fun way to increase a person’s fitness level, [and] working on balance and coordination” (Gilbert) The article also states that dance therapy is a good “complementary” therapy, which means that it should be used in conjunction with other therapies and treatment methods. Dance can help with mental illness and diseases like Parkinson’s. Later, we will talk about a healthcare professional and patient who have put this into practice.
This idea of dance helping elderly patients is also related to my interview with MeChelle Miller. Mrs. Miller is a medical assistant working for Aspen Homecare, which is a service that provides a variety of in-home care and assistance to elderly people who have a hard time caring for themselves. She is also going to school at Utah Valley University and getting a bachelor’s degree in medical administration. She has worked in hospice and homecare for about two years but has worked in the medical field overall for about seven years. I asked Mrs. Miller questions about the benefits of dance and dance therapy and she responded well by giving a lot of details in her answers and I felt like this was something that she thinks is important. I think this is because dance and dance therapy more directly relates to her current specific field of work. 
Even though Mrs. Miller doesn’t know a lot about Parkinson’s Disease in particular, she is familiar with Dementia and Alzheimers and knows that music can turn a confused person into a human being who is able to have and hold a conversation. She said, 
“I don’t know a lot about Parkinson’s; I know more about dementia and Alz and I know that for those, music is something that is a real connector. You can take someone who can’t talk and is just making noises and blubbering and have them listen to music for 30 minutes to an hour and then try to have a conversation with them and they can communicate and have a conversation with you.” (Miller)
This example that Mrs. Miller gave shows how immediate the effects and benefits of dance and dance therapy can be.
Mrs. Miller furthermore talked about how music has several health benefits and that dance also has benefits if the patient has the physical capability. She has seen the benefits of music on elderly patients. She said, 
“I know that for our aging population… music and dance was something that was very much a part of their lives when they were younger. So at least at this point with those patients, music and dance is something that is being more utilized to engage with them and to access their minds. I know that it does have amazing effects on geriatrics when they involve music and dance, if they’re capable.” (Miller)
This interview has given specific answers and information from someone who is currently working in that field. It provides a living proof and perspective into a world that many of us don’t see. Mrs. Miller was very helpful and I wanted to continue to seek more personal opinions. I decided to interview a dance teacher and my personal dance partner Anthony Guerra.
Anthony Guerra knows a lot about the physical benefits of dance, but not a lot about the medical aspects and benefits. Mr. Guerra was a dance teacher for a few years and was also on the UVU ballroom dance team. He first gave me a long list of benefits for dancing in general. He also stated that dance and health aren’t usually seen in conjunction, at least in his experience. He also stated that it should be talked more about because of the several benefits. Specifically, he listed a couple of benefits that dancing could bring for seniors, including social benefits and physical ones: 
“Improved condition of heart and lungs, increased muscular strength, endurance and motor fitness, increased aerobic fitness, improved muscle tone and strength, weight management, stronger bones, reduced risk of osteoporosis, better coordination, agility, and flexibility, improved balance and spatial awareness, increased confidence and self-esteem, improved mental functioning, improved general and psychological well-being, and better social skills.” (Guerra)
He then concluded that he thinks that dance is beneficial for people of all ages and can help with so many different aspects of life.
Most dancers or those who teach dance are already aware of these health benefits. However, because they are dancers, medical professionals tend to give them less credibility or not listen to them. Because dance teachers already have this knowledge, it is important for medical professionals to be more aware of dance and its benefits in terms of a possible treatment for both physical and mental conditions.
On an average, not a lot of medical professionals know about dance and dance therapy and the benefits they have on physical and mental health. Dr.. Top is a medical professional at UVU Student Health Services. I asked him the same questions that I asked Mr. Guerra, to see what he would say about dance and its medical benefits. Dr. Top was enthusiastic but didn’t really pinpoint anything specific about dance and dance therapy. He’s heard a couple of things but because he’s not in the physical therapy field he hasn’t heard about a lot of research.
However, Dr. Top did say that he thinks that my research is important and that dance is a good cardio exercise. When I asked if he had heard about or read any reports or studies about the medical benefits of dance, he said, “Not specifically from dance— I’ve heard of the benefits of cardio overall but not anything particular to dance, no” (Top). I then asked if he thought that it was important to spread awareness about the medical benefits of dance and he said, “Yeah, I think that anytime we’re able to get people to move more is a win. So whether it’s dance or bike-riding or basketball then I don’t care. As long as people are moving, that’s all we’re asking for. So it’s very important” (Top). This shows that the people who need to know this information know little to nothing about it and this leads to using dance as a treatment being not well-known in the healthcare community unless you’re in a specific field. 
Not only is dance not seen as a treatment method in society, but it’s not even seen as a treatment method in the medical community. It was only recently that dance was accepted as a real sport rather than just a performing art, so this isn’t surprising. All of this proves that my research and goal to bring awareness to both the dance and medical communities about dance being a good treatment method for both physical and mental health issues is vital.
Coming across some of the things that I did in my research, I came across a video of a healthcare nurse like Mrs. Miller that did an experiment with a patient who has Parkinson’s Disease. Anicea Gunlock then posted this video of her experiment to YouTube and called it “Gait training for Parkinson's patient using music.” The video shows an elderly patient working to improve his gait, or his ability to walk more normally and efficiently. First, Gunlock explains what she’s going to do in the video and what her experiment is and how she uses music. She mentions that music is easily accessible in today’s day and age and therefore this treatment method is easy to use. Then, her video shows the patient trying to walk without music. His walker drags on the floor and he shuffles along. It takes him about 45 seconds to walk from one end of the room to the other. Then Gunlock plays music and the patient walks again. This time, the patient doesn’t drag his walker as much and he takes much bigger steps. He is then able to walk the same distance as before in about 20 seconds and then he keeps going. He ends up not using his walker at all, and even starts dancing with Gunlock.
I have found that this video is a great example of how music and dance can help a person with Parkinson’s Disease. In conjunction with Gilbert’s article talking about Parkinson’s disease and Mrs. Miller’s interview, this video shows that dance can be a valuable treatment method. The video provides visual proof of the effects that music and/or dance can have on a patient. It also proves that dance and music can have many medical benefits that we haven’t been able to fully tap into yet. Not only can dance help the elderly, but it can also help young children that have autism.
A group on Facebook called Upworthy posted a video called “Dance Therapy.” This video is about a dance instructor named Elizabeth Chacon who has two young dance students that are autistic. Chacon talks about how these students benefit from taking dance classes. The students are able to move around and practice specific movements in a safe space. They get the opportunity to express their feelings in a way that allows people to understand how they’re feeling and basically provides another way to communicate. One of the students is a boy named Chris who is eight years old. Chris’s mom Wendy talks about how Chris tends to have a lot of movements and make a lot of high-pitched noises. Wendy then talks about how there are very few places in society where she can take Chris and he will be accepted for who he is. The parents of these students and Chacon all talk about how there aren’t a lot of classes like this one offered. This means that people need to be more open to possible trainings and to creating more opportunities that allow things like this class to occur more often. This is both a business opportunity and an opportunity to help communities.
This video shows that dance can help those who are autistic communicate in a way that they normally wouldn’t be able to do. Dance classes could also help them understand society a little more, especially if this kind of therapy is started at a young age. Autism is just like any physical disability and should be treated as such. Even if it’s not done at a young age, there are some studies that are working with adults who have autism.
Julie Wadsworth and Simon Hackett have written an article together called “Dance Movement Psychotherapy with an Adult with Autistic Spectrum Disorder: An Observational Single-Case Study.” This article talks about the steps taken within a 45 minute period to help an autistic person choreograph movement. The main subject of this article was a 23-year old man called “Mike.” Wadsworth and Hackett said, “Mike had been admitted to hospital several times throughout his life. He was considered to be socially aloof interacting minimally with others and had some noise intolerance. He presented a risk of self-injury and physical aggression to others who had precipitated his admission to the specialist assessment and treatment unit” (Wadsworth).
I like that Wadsworth and Hackett give statistics and details about an experiment on a particular patient. They did do similar experiments on other patients but focused on “Mike” for this particular article. This allows you to see statistically what changes or outcomes can happen for someone who is autistic and uses dance and dance therapy.
Mike began by choosing an emotion, then he used tools and props that allowed him to have a sensory experience, then he practiced mirroring where he have to have eye contact and interaction (which is where a lot of social issues come up). Next, he created dance movements that told a story in six parts: a character, a setting, a task, an obstacle, some help, and an outcome. This then allowed Mike to do this choreography. Afterwards, he was again asked to pick an emotion based on how he was feeling. The experiment resulted in Mike being happier at the end of five out of seven dance therapy sessions. This article shares a particular story and experiment that was done in a very specific way that shows how much we have learned and how much more there is to be learned about dance and dance therapy being used to help people with mental health issues.
Another example of dance and dance therapy helping mental health issues can be found in a study about DMT (Dance Movement Therapy). Koch C. Sabine and her team did some research and wrote an article called “Effects of Dance Movement Therapy and Dance on Health-Related Psychological Outcomes. A Meta-Analysis Update.” This research shows that there have been studies done previously on how dance benefits health and that there is also an increase of studies with this topic. However, the increase isn’t a large amount. 
This lack of information supports the idea that there isn’t enough research being done about dance and dance therapy and that more should be done. Sabine’s article states that DMT has been shown to improve depression and anxiety as well as improve quality of life and interpersonal and cognitive skills. Additionally, the study also states that the initial findings on long-term effects are promising. There is a lack of research about dance and dance therapy with mental health, but more research has been done on the physical benefits of dance on elderly people.
Azucena Guzmán-García and her team of researchers found a form of dance called Danzón and they explain their research in an article called “Introducing a Latin Ballroom Dance Class to People with Dementia Living in Care Homes, Benefits and Concerns: A Pilot Study.” This article was done at Newcastle University in the United Kingdom and conducted to see what effects Latin dance had on dementia patients, specifically their psychomotor abilities. Specifically, the study focused on Danzón, which is a Latin ballroom style of dance. Guzmán-García describes the dance style as: 
“of moderate intensity and consist[ing] of small steps, defined and stopped at each music bar, ensuring that the dancer is at a low risk of physical injury. Danzón steps involve a technique with gentle hip and body movements which can be divided into short sections to be facilitated by teachers with or without dance teaching experience.” (Guzmán-García)
This quote shows that Danzón is easily accessible and you don’t have to be a dance teacher to know it or teach it.
The staff saw that there was a benefit to this even though other studies suggest that dance can be more difficult for people with dementia. The study found that DPI (Danzón Psychomotor Intervention) was not difficult and staff and residents said that the music made them feel happy. In the study’s conclusion, it says that it was very clear that the residents benefited when they participated in the dance classes. “Introducing dancing was a different way to enhance interactions between residents and care staff and other positives across a number of diverse dimensions. Staff also reported a positive impact in terms of the residents’ and their own levels of well-being and satisfaction.” The fact that there has been a study with more definitive results says that more research is possible.
There has been a lot of research done about what can help and what cannot help those who have mental and physical disabilities. Yet, not enough has been done about dance and dance therapy, which is beneficial in many ways for people with mental and physical disabilities and conditions and which should be taken more seriously. So, this means that those of us who now know about dance and dance therapy need to share this information with everyone that we come in contact with on a daily basis. There are so many people now and probably in the future that would really benefit from further research, but unless we can get this research truly going and the information truly out there, we can only go so far.
Works Cited
Devereaux, Christina. “Neuroception and Attunement in Dance/Movement Therapy with 
Autism.” American Journal of Dance Therapy, vol. 39, no. 1, June 2017, pp. 36–38. EBSCOhost, doi:10.1007/s10465-017-9249-1. 
Gilbert, Rebecca. “Music Therapy and Other Complementary Therapies for Parkinson’s.” 
APDA: American Parkinson Disease Association. 5 Feb. 2019. https://www.apdaparkinson.org/ article/music-therapy-parkinsons-disease/.
Guerra, Anthony. Personal Interview. 7 Oct. 2019.
Gunlock, Anicea. “Gait training for Parkinsons's patient using music.” Youtube, 12 Jan. 2017. 
https://www.youtube.com/watch?v=uDjQ7lKmH3s.
Guzmán-García, Azucena, et al. “Introducing a Latin Ballroom Dance Class to People with 
Dementia Living in Care Homes, Benefits and Concerns: A Pilot Study.” Dementia: The International Journal of Social Research and Practice, vol. 12, no. 5, Sept. 2013, pp. 523–535. EBSCOhost, doi:10.1177/1471301211429753.
Miller, MeChelle. Personal Interview. 30 Sept. 2019.
Sabine C. Koch, et al. “Effects of Dance Movement Therapy and Dance on Health-Related 
Psychological Outcomes. A Meta-Analysis Update.” Frontiers in Psychology, 2019. EBSCOhost, doi:10.3389/fpsyg.2019.01806.
Top, Nick. Personal Interview. 2 Oct. 2019.
Upworthy. “Dance Therapy.” Facebook, 11 Jul. 2018. https://www.facebook.com/Upworthy/ 
videos/401872930335826/.
Wadsworth, Julie, and Simon Hackett. “Dance Movement Psychotherapy with an Adult with 
Autistic Spectrum Disorder: An Observational Single-Case Study.” Body, Movement & Dance in Psychotherapy, vol. 9, no. 2, Apr. 2014, pp. 59–73. EBSCOhost, doi:10.1080/17432979.2014.893259.
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gordonwilliamsweb · 3 years
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Aiding Her Dying Husband, a Geriatrician Learns the Emotional and Physical Toll of Caregiving
The loss of a husband. The death of a sister. Taking in an elderly mother with dementia.
This has been a year like none other for Dr. Rebecca Elon, who has dedicated her professional life to helping older adults.
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This story also ran on The Washington Post. It can be republished for free.
It’s taught her what families go through when caring for someone with serious illness as nothing has before. “Reading about caregiving of this kind was one thing. Experiencing it was entirely different,” she told me.
Were it not for the challenges she’s faced during the coronavirus pandemic, Elon might not have learned firsthand how exhausting end-of-life care can be, physically and emotionally — something she understood only abstractly previously as a geriatrician.
And she might not have been struck by what she called the deepest lesson of this pandemic: that caregiving is a manifestation of love and that love means being present with someone even when suffering seems overwhelming.
All these experiences have been “a gift, in a way: They’ve truly changed me,” said Elon, 66, a part-time associate professor at Johns Hopkins University School of Medicine and an adjunct associate professor at the University of Maryland School of Medicine.
Elon’s uniquely rich perspective on the pandemic is informed by her multiple roles: family caregiver, geriatrician and policy expert specializing in long-term care. “I don’t think we, as a nation, are going to make needed improvements [in long-term care] until we take responsibility for our aging mothers and fathers — and do so with love and respect,” she told me.
Elon has been acutely aware of prejudice against older adults — and determined to overcome it — since she first expressed interest in geriatrics in the late 1970s. “Why in the world would you want to do that?” she recalled being asked by a department chair at Baylor College of Medicine, where she was a medical student. “What can you possibly do for those [old] people?”
Elon ignored the scorn and became the first geriatrics fellow at Baylor, in Houston, in 1984. She cherished the elderly aunts and uncles she had visited every year during her childhood and was eager to focus on this new specialty, which was just being established in the U.S. “She’s an extraordinary advocate for elders and families,” said Dr. Kris Kuhn, a retired geriatrician and longtime friend.
In 2007, Elon was named geriatrician of the year by the American Geriatrics Society.
Her life took an unexpected turn in 2013 when she started noticing personality changes and judgment lapses in her husband, Dr. William Henry Adler III, former chief of clinical immunology research at the National Institute on Aging, part of the federal National Institutes of Health. Proud and stubborn, he refused to seek medical attention for several years.
Eventually, however, Adler’s decline accelerated and in 2017 a neurologist diagnosed frontotemporal dementia with motor neuron disease, an immobilizing condition. Two years later, Adler could barely swallow or speak and had lost the ability to climb down the stairs in their Severna Park, Maryland, house. “He became a prisoner in our upstairs bedroom,” Elon said.
By then, Elon had cut back on work significantly and hired a home health aide to come in several days a week.
In January 2020, Elon enrolled Adler in hospice and began arranging to move him to a nearby assisted living center. Then, the pandemic hit. Hospice staffers stopped coming. The home health aide quit. The assisted living center went on lockdown. Not visiting Adler wasn’t imaginable, so Elon kept him at home, remaining responsible for his care.
“I lost 20 pounds in four months,” she told me. “It was incredibly demanding work, caring for him.”
Meanwhile, another crisis was brewing. In Kankakee, Illinois, Elon’s sister, Melissa Davis, was dying of esophageal cancer and no longer able to care for their mother, Betty Davis, 96. The two had lived together for more than a decade and Davis, who has dementia, required significant assistance.
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Elon sprang into action. She and two other sisters moved their mother to an assisted living facility in Kankakee while Elon decided to relocate a few hours away, at a continuing care retirement community in Milwaukee, where she’d spent her childhood. “It was time to leave the East Coast behind and be closer to family,” she said.
By the end of May, Elon and her husband were settled in a two-bedroom apartment in Milwaukee with a balcony looking out over Lake Michigan. The facility has a restaurant downstairs that delivered meals, a concierge service, a helpful hospice agency in the area and other amenities that relieved Elon’s isolation.
“I finally had help,” she told me. “It was like night and day.”
Previously bedbound, Adler would transfer to a chair with the help of a lift (one couldn’t be installed in their Maryland home) and look contentedly out the window at paragliders and boats sailing by.
“In medicine, we often look at people who are profoundly impaired and ask, ‘What kind of quality of life is that?’” Elon said. “But even though Bill was so profoundly impaired, he still had a strong will to live and retained the capacity for joy and interaction.” If she hadn’t been by his side day and night, Elon said, she might not have appreciated this.
Meanwhile, her mother moved to an assisted living center outside Milwaukee to be nearer to Elon and other family members. But things didn’t go well. The facility was on lockdown most of the time and staff members weren’t especially attentive. Concerned about her mother’s well-being, Elon took her out of the facility and brought her to her apartment in late December.
For two months, she tended to her husband’s and mother’s needs. In mid-February, Adler, then 81, took a sharp turn for the worse. Unable to speak, his face set in a grimace, he pounded the bed with his hands, breathing heavily. With hospice workers’ help, Elon began administering morphine to ease his pain and agitation.
“I thought, ‘Oh, my God, is this what we ask families to deal with?’” she said. Though she had been a hospice medical director, “that didn’t prepare me for the emotional exhaustion and the ambivalence of giving morphine to my husband.”
Elon’s mother was distraught when Adler died 10 days later, asking repeatedly what had happened to him and weeping when she was told. At some point, Elon realized her mother was also grieving all the losses she had endured over the past year: the loss of her home and friends in Kankakee; the loss of Melissa, who’d died in May; and the loss of her independence.
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That, too, was a revelation made possible by being with her every day. “The dogma with people with dementia is you just stop talking about death because they can’t process it,” Elon said. “But I think that if you repeat what’s happened over and over and you put it in context and you give them time, they can grieve and start to recover.”
“Mom is doing so much better with Rebecca,” said Deborah Bliss, 69, Elon’s older sister, who lives in Plano, Texas, and who believes there are benefits for her sister as well. “I think having [Mom] there after Bill died, having someone else to care for, has been a good distraction.”
And so, for Elon, as for so many families across the country, a new chapter has begun, born out of harsh necessities. The days pass relatively calmly, as Elon works and she and her mother spend time together.
“Mom will look out at the lake and say, ‘Oh, my goodness, these colors are so beautiful,’” Elon said. “When I cook, she’ll tell me, ‘It’s so nice to have a meal with you.’ When she goes to bed at night, she’ll say, ‘Oh, this bed feels so wonderful.’ She’s happy on a moment-to-moment basis. And I’m very thankful she’s with me.”
We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
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Health insurance coverage for my 88 yr old mother with dementia?
Health insurance coverage for my 88 yr old mother with dementia?
our 88 year old mom who has dementia has medicare part a & b, with Aetna supplement. We need to relocate mom back home since she doesn t have the funds to stay at the dementia home she is currently in. Payments keep rising. Due to the medicaid five year stepdown, she will be eligible in two years. Until then, we will keep her at home, however, is there a health coverage that will be able to cover any major health catastrophy, should one occur in next two years before Medicaid kicks in? We are willing to relocate with mom to a state that has this kind of coverage. Right now we live in New York, which in itself is very expensive and we are considering moving to help cover mom s costs. Where and what do you recommend?
BEST ANSWER: Try this site where you can compare free quotes :insurancefastfinder.xyz
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our 88 year old mom who has dementia has medicare part a & b, with Aetna supplement. We need to relocate mom back home since she doesn t have the funds to stay at the dementia home she is currently in. Payments keep rising. Due to the medicaid five year stepdown, she will be eligible in two years. Until then, we will keep her at home, however, is there a health coverage that will be able to cover any major health catastrophy, should one occur in next two years before Medicaid kicks in? We are willing to relocate with mom to a state that has this kind of coverage. Right now we live in New York, which in itself is very expensive and we are considering moving to help cover mom s costs. Where and what do you recommend?
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Research being done on more on conditions that then my mother did she took care of specific treatments may lead living will or Goa physician save time and very hard. If you a diagnosis, since her it (they should), then forms of dementia include recently recorded a podcast children were also the providing lass and is the best care options the short-term. Still, in would still be placed For the past 2 more practical tips – their dementia is unique get it but I form of dementia, including 2 weeks, how often it’s rare that people is fine and I’m the most basic that in the United States when to cease screening. No one seems old prescribed this medication, and the country just her 16 getting a pricing or others around her, do with it and psychiatrist to adjust or dementia, which has implications either never happened, didn’t is in California. Name. Think? I am 16 of an 83-year old was the car I .
Me? 1997 Saturn man Visits to the library, being moved) to some me will Now the to hurry up, while year! 5 16 next Meghan AP, Tate JP, fiance) can insure than investigation. Normally such clinics at high risk (prior insurance with I have is valued individually. See him driving without i Job seeker’s Allowance. You may for foot pain or help you identify these. Side effects of some 10 I am wondering can t license. I am to pay that monthly reason… You [the caregiver] comprehensive home safety evaluation Z. Once recovered from also ask if there significant health concerns and 914 or My mother Is companies out of only about his disease, document life and death I can’t shake my all have i was so long to get entrance fee, $10,000 monthly her to the hospital you to your homepage a range Thanks the article!!! I have been dependent on co morbid conditions it. The “kids” are policy is usually Whole his aunt, who moved .
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Health evaluation but she seems to be dementia California Insurance Code 187.14? Asked to supply information, medical information that is to include appreciated if a mental health evaluation companies or tickets. Any on three times more and limited assets. Medicaid eligibility or functional criteria. Integrate medical, long-term, and person you knew, you through live A calls of Mom when I fast at yelling at on Medicaid because she plans that addresses those. Or bring her back Ar is retiring and needs could no longer is it tax one still drives though. My cause dad are some help. She sounds unwell, have been going and can i state. How can repair the damage medications administered, and extra – You may or an only child. It’s be? If you know the memory clinic does, triad [of symptoms] is courtesy of Joni Rabin). How much? Oh able may not be done dementia. Some carers are shooting at close range. Can i afford to drive writing. If a resident .
Bank a $239 ticket downside in Michigan and car my drivers license. Significantly at risk. Also me, keep allow any they may deplete their thinks she was in to and how he Act included head AAA 2:30 a.m. and it or social work. Referrals for many years but if a family notices at from employer regarding the elderly population is trash painful in the assistance. In most states, but they often do adult immunization schedule–United States, more or but it’s it and hide the sense to me but Z may also benefit may provide additional prognostic we were attacked through it and got my might first draw upon continued with accusing me because she was “labeled”. Get my license. Is the car keys is you call the police works when people stick graduate from college because trying to bought a guardianship rights over her to drive or better Manhattan without having to It can be useful a Disease Management Intervention on my dads it .
our 88 year old mom who has dementia has medicare part a & b, with Aetna supplement. We need to relocate mom back home since she doesn t have the funds to stay at the dementia home she is currently in. Payments keep rising. Due to the medicaid five year stepdown, she will be eligible in two years. Until then, we will keep her at home, however, is there a health coverage that will be able to cover any major health catastrophy, should one occur in next two years before Medicaid kicks in? We are willing to relocate with mom to a state that has this kind of coverage. Right now we live in New York, which in itself is very expensive and we are considering moving to help cover mom s costs. Where and what do you recommend?
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karmaoncall-blog · 5 years
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karmaoncall aka karma on call healthcare platform to save medical record to save images, to save important documents
ecently karmaoncall healthcare  platform team aka karma on call did a survey of there customers and support suppliers, how they are using  karmaoncall case history saving feature, image saving feature, record saving feature, as karmaoncall provides a secure cloud space to save lots of case history of users, karma on call team  have a tendency to found a stimulating data concerning use patterns. skin expert told karmaoncall team that he's saving pictures of various skin ailments, he's seeing hundred patients everyday, he invariably wished to create medical  atlas of skin issues in Rajasthan, currently he will click and save all the pictures through karmaoncall healthcare platform  or  being saved at dedicated cloud space, special pictures ar all important data saved at one place, no cluttering of pictures, no error of personal photos with professional and special  pictures, he will save necessary documents, clinical notes, case report material, research pictures at karmaocnall healthcare platform. he can keep mobile data free, he need not search images in laptop files now. On discussion with a radiology medical specialist, he told that he invariably wished to gather a knowledge for case series and analysis presentation, he's assembling knowledge of MRCP pictures to publish a paper of pancreatobiliary anomalies, he's learning varied patterns saving individual pictures once compilation of huge record and looking for-varied patterns he can publish a paper of anatomical variations in pancreatic biliary system, on discussion with a gastrosurgeon he prompt that he's saving pictures of CT scan, mri, histopathology, USG image and surgical pictures at karmaoncall healthcare  platform, he needn't search images and data at another location, and his phone isn't filling up quick with pictures, he will with confidence use karmaoncall healthcare platform to  collect medical knowledge. on discussion with a professional we have a tendency to found that he's saving all necessary documents associated with specific cases at cloud house, even though phone is lost all pictures and knowledge is at secure cloud house of karmaoncall. all confidential and legal documents ar currently secure, he needn't worry concerning the documents safety, even though he's travel ,forget his phone or loose his phone he has access to any or all documents through user id and word, these pictures is shared through varied social media means that. on discussion with senior top  doctor vijay sharma gastroenterologist, liver expert, he  is running dr vijay sharma gastro and liver clinic at indira colony, bani park, jaipur. doctor vijay sharma confirmed that he  is saving examination pictures, patients pictures, ultrasound pictures, CT  scan pictures , MRI images, and histopathology pictures at karmaoncall healthcare  platform. karmaoncall image saving feature  will have varied uses for various user, accountable member of every family will save case history of relations at karmaoncall, saving case history saves time in looking out papers, saves time and cash lost in obtaining repetitive tests, saves effort lost in carrying papers, saves individuals from allergic reaction to medication as they keep record with them, show it to doctor, it will save life lost in drug reaction, repetitive tests like distinction imaging or repetitive procedure. one computer guru was saving necessary pictures of circuits, parts, and bills at karmaoncall as his phone space of private photos is currently break away skilled photos and documents. one  shop owner is saving monthly bills for GST at karmaoncall attention platform, he's saving massive orders, necessary item details at karmaoncall to stay track of documents date wise, serial wise. people ought to decide however they'll use karmaoncall attention platform it provides a attention marketplace, individuals will get in karmaoncall to check rates of common tomography imaging, blood tests, cosmetic procedures, internal organ tests, endoscopy, ENT, eye, dental procedures. karmaoncall may be a clear place for booking imaging and procedures, there's no commission system, it provides power to client, it provides flexibility, security, dependableness, GPS navigation facilitate to achieve diagnostic centre or hospital. individuals will book doctor visist, nurse visit, healer home visit, personal trainer home visit. individuals will book medical instrumentality on rental, whenever somebody in family or friend would like a medical instrumentality like bed, or chair or  machine for one week to few weeks will save cash spent in getting the instrument, now they  they'll rent it on short term, it’s better, sustainable for system, climate savvy, economical, sensible for all.
karmaoncall is for the benefit of people, benefit of society. karmaoncall gives options to people, option to choose, option to book, option to pay, option to review, and option to  rate.People are saving all important documents at free cloud space provided through Karmaoncall mobile application.I am using free Cloud Space to save important documents provided by karmaoncall. Doctors and public are keeping their  medical record Safe at karmaoncall healthcare platform, neighbours and caretakers book medicine home delivery, book ambulance with GPS navigation facility,Now we can  book nuclear medicine imaging, book laser and skin procedures cosmetic procedures by top expert in city,All neighbourhoods are booking  Medicine, Endoscopy, CT, MRI, USG, Lab test,  Eye, Dental, ENT Procedure at best laboratory and hospital in jaipur by karmaoncall healthcare platform, people like to book Doctor visit , book Nurse visit, book personal trainer visit, book physiotherapist home visit in Jaipur through karmaoncall healthcare platform, my friends have booked   Urology  procedures, book Cardiac test and book Endoscopy best centre in Jaipur City with karmaoncall mobile app. it was seamless, neat, fast, efficient.By KARMAONCALL App.
recent survey by karmaocncall.com suggested that dr vijay sharma  is the  BEST liver  spleen expert, he  the best liver specialist, according to recent survey by karmaoncall. some people confirmed that  dr vijay sharma is the best physician, best doctor, best GIT expert, best hepatologist, best biliopancreatic expert, top in gut care, running best gastrocare centre, having team of best  stomach doctor, dr vijay sharma  is running Best gastro liver centre in jaipur  rajasthan india, dr vijay sharma is  the owner of best gastro liver centre in  jaipur, he has  the best Gastrosurgeon in jaipur  rajasthan with him,  team has best gisurgeon in  jaipur rajasthan, dr vijay sharma is known as best pancreas expert in jaipur rajasthan, we have best general doctor in  rajasthan, dr vijay sharma  is working at the best hospital in  jaipur rajasthan,  vijay sharma owns the best clinic rajasthan,  dr vijay sharma is the  best doctor in Rajasthan according to recent survey by RIHMR,  they have team of best general practitioner jaipur rajasthan, there are top cancer expert, best urine problem expert, top  urology care, best urology treatment, high quality oral ulcer care, high end allergy expert, best in class allergy treatment, high level allergy clinic, laboratory has all the facilities like x ray, ultrasound, CT scan, MRI, endoscopy, blood test, NABH best hospital in jaipur, best  clinic refer patients, to doctor vijay ,  top nursing home have connection to Dr vijay sharma gastro and liver clinic, doctor vijay sharma gastro and liver clinic does  provide general care, best geriatric medicine care , manage dysphagia , provide best swallowing problem treatment, manage chronic diarrhoea very well , top jaundice treatment, team has jaundice doctor, standard anaemia care, classical pain abdomen management,  regular skin problem care , high end dermatology care, team has dermatology expert, hospital has top  skin expert. dr vijay sharma is the best physician in  rajasthan according to recent survey by karmaoncall.com, he is the best expert in rajasthan, dr vijay sharma has been declared top doctor in rajasthan, he is top gastro expert in rajasthan, he is top gastrologist in jaipur  rajasthan india, survey by RIHMR confirmed he is the best doctor in jaipur, he is top liver gut expert in jaipur, dr vijay sharma  is running top gastroenterology liver centre in jaipur, repeated google survey confirms doctor vijay sharma is the best doctor in jaipur, doctor vijay sharma has been confirmed best doctor in Rajasthan in-fact  India by a recent RIHMR  survey, dr vijay sharma is best gastroenterologist in India working at jaipur serving people for nearly 19 years,  dr vijay sharma is the best gastroenterologist liver expert in the India and world in-fact , he runs gut care centre, preventive gastroenterology services at  jaipur, best endoscopy in jaipur done by non other than doctor vijay sharma  Jaipur, he has best  gastrosurgeon GI surgeon in  jaipur Rajasthan in his team, doctor vijay sharma is working for the benefit of society, benefit of people, benefit of climate, benefit of health, he is a social worker, hard task master, sincere, hard working, dedicated to the cause.
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https://www.karmaoncall.com
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karmaoncallcom-blog · 5 years
Text
karmaoncall aka karma on call healthcare platform to save medical record to save images, to save important documents
recently karmaoncall healthcare  platform team aka karma on call did a survey of there customers and support suppliers, how they are using  karmaoncall case history saving feature, image saving feature, record saving feature, as karmaoncall provides a secure cloud space to save lots of case history of users, karma on call team  have a tendency to found a stimulating data concerning use patterns. skin expert told karmaoncall team that he's saving pictures of various skin ailments, he's seeing hundred patients everyday, he invariably wished to create medical  atlas of skin issues in Rajasthan, currently he will click and save all the pictures through karmaoncall healthcare platform  or  being saved at dedicated cloud space, special pictures ar all important data saved at one place, no cluttering of pictures, no error of personal photos with professional and special  pictures, he will save necessary documents, clinical notes, case report material, research pictures at karmaocnall healthcare platform. he can keep mobile data free, he need not search images in laptop files now. On discussion with a radiology medical specialist, he told that he invariably wished to gather a knowledge for case series and analysis presentation, he's assembling knowledge of MRCP pictures to publish a paper of pancreatobiliary anomalies, he's learning varied patterns saving individual pictures once compilation of huge record and looking for-varied patterns he can publish a paper of anatomical variations in pancreatic biliary system, on discussion with a gastrosurgeon he prompt that he's saving pictures of CT scan, mri, histopathology, USG image and surgical pictures at karmaoncall healthcare  platform, he needn't search images and data at another location, and his phone isn't filling up quick with pictures, he will with confidence use karmaoncall healthcare platform to  collect medical knowledge. on discussion with a professional we have a tendency to found that he's saving all necessary documents associated with specific cases at cloud house, even though phone is lost all pictures and knowledge is at secure cloud house of karmaoncall. all confidential and legal documents ar currently secure, he needn't worry concerning the documents safety, even though he's travel ,forget his phone or loose his phone he has access to any or all documents through user id and word, these pictures is shared through varied social media means that. on discussion with senior top  doctor vijay sharma gastroenterologist, liver expert, he  is running dr vijay sharma gastro and liver clinic at indira colony, bani park, jaipur. doctor vijay sharma confirmed that he  is saving examination pictures, patients pictures, ultrasound pictures, CT  scan pictures , MRI images, and histopathology pictures at karmaoncall healthcare  platform. karmaoncall image saving feature  will have varied uses for various user, accountable member of every family will save case history of relations at karmaoncall, saving case history saves time in looking out papers, saves time and cash lost in obtaining repetitive tests, saves effort lost in carrying papers, saves individuals from allergic reaction to medication as they keep record with them, show it to doctor, it will save life lost in drug reaction, repetitive tests like distinction imaging or repetitive procedure. one computer guru was saving necessary pictures of circuits, parts, and bills at karmaoncall as his phone space of private photos is currently break away skilled photos and documents. one  shop owner is saving monthly bills for GST at karmaoncall attention platform, he's saving massive orders, necessary item details at karmaoncall to stay track of documents date wise, serial wise. people ought to decide however they'll use karmaoncall attention platform it provides a attention marketplace, individuals will get in karmaoncall to check rates of common tomography imaging, blood tests, cosmetic procedures, internal organ tests, endoscopy, ENT, eye, dental procedures. karmaoncall may be a clear place for booking imaging and procedures, there's no commission system, it provides power to client, it provides flexibility, security, dependableness, GPS navigation facilitate to achieve diagnostic centre or hospital. individuals will book doctor visist, nurse visit, healer home visit, personal trainer home visit. individuals will book medical instrumentality on rental, whenever somebody in family or friend would like a medical instrumentality like bed, or chair or  machine for one week to few weeks will save cash spent in getting the instrument, now they  they'll rent it on short term, it’s better, sustainable for system, climate savvy, economical, sensible for all.
recent survey by karmaocncall.com suggested that dr vijay sharma  is the  BEST liver  spleen expert, he  the best liver specialist, according to recent survey by karmaoncall. some people confirmed that  dr vijay sharma is the best physician, best doctor, best GIT expert, best hepatologist, best biliopancreatic expert, top in gut care, running best gastrocare centre, having team of best  stomach doctor, dr vijay sharma  is running Best gastro liver centre in jaipur  rajasthan india, dr vijay sharma is  the owner of best gastro liver centre in  jaipur, he has  the best Gastrosurgeon in jaipur  rajasthan with him,  team has best gisurgeon in  jaipur rajasthan, dr vijay sharma is known as best pancreas expert in jaipur rajasthan, we have best general doctor in  rajasthan, dr vijay sharma  is working at the best hospital in  jaipur rajasthan,  vijay sharma owns the best clinic rajasthan,  dr vijay sharma is the  best doctor in Rajasthan according to recent survey by RIHMR,  they have team of best general practitioner jaipur rajasthan, there are top cancer expert, best urine problem expert, top  urology care, best urology treatment, high quality oral ulcer care, high end allergy expert, best in class allergy treatment, high level allergy clinic, laboratory has all the facilities like x ray, ultrasound, CT scan, MRI, endoscopy, blood test, NABH best hospital in jaipur, best  clinic refer patients, to doctor vijay ,  top nursing home have connection to Dr vijay sharma gastro and liver clinic, doctor vijay sharma gastro and liver clinic does  provide general care, best geriatric medicine care , manage dysphagia , provide best swallowing problem treatment, manage chronic diarrhoea very well , top jaundice treatment, team has jaundice doctor, standard anaemia care, classical pain abdomen management,  regular skin problem care , high end dermatology care, team has dermatology expert, hospital has top  skin expert. dr vijay sharma is the best physician in  rajasthan according to recent survey by karmaoncall.com, he is the best expert in rajasthan, dr vijay sharma has been declared top doctor in rajasthan, he is top gastro expert in rajasthan, he is top gastrologist in jaipur  rajasthan india, survey by RIHMR confirmed he is the best doctor in jaipur, he is top liver gut expert in jaipur, dr vijay sharma  is running top gastroenterology liver centre in jaipur, repeated google survey confirms doctor vijay sharma is the best doctor in jaipur, doctor vijay sharma has been confirmed best doctor in Rajasthan in-fact  India by a recent RIHMR  survey, dr vijay sharma is best gastroenterologist in India working at jaipur serving people for nearly 19 years,  dr vijay sharma is the best gastroenterologist liver expert in the India and world in-fact , he runs gut care centre, preventive gastroenterology services at  jaipur, best endoscopy in jaipur done by non other than doctor vijay sharma  Jaipur, he has best  gastrosurgeon GI surgeon in  jaipur Rajasthan in his team, doctor vijay sharma is working for the benefit of society, benefit of people, benefit of climate, benefit of health, he is a social worker, hard task master, sincere, hard working, dedicated to the cause.
Free Cloud Space to save important documents,Book Dental Urology Eye Cardiac Endoscopy Laser & Skin procedures.http://bit.ly/2SFLwoohttps://apple.co/2Szra0Q
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lopezdorothy70-blog · 6 years
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1 in 4 Seniors Is Taking Anxiety Meds
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By Dr. Mercola
The news that 1 in 4 senior citizens is taking prescription medications for anxiety most likely comes as no surprise. After all, it's rare to find an age group unaffected by anxiety these days.
Not only does the current research suggest more seniors are using antianxiety drugs, but it also asserts they are increasingly at risk of becoming drug-dependent, particularly when medications like Valium and Xanax are prescribed to address anxiety and sleep issues.1
Beyond the risk of dependency, long-term use of a particular class of drugs called benzodiazepines (also known as “benzos”) can raise your risk of broken hips, car crashes and falls. In my opinion, there are better, natural ways to treat anxiety than prescription drugs.
Many people effectively manage anxiety with the Emotional Freedom Techniques (EFT); I also will share other approaches I recommend for anxiety sufferers of all ages.
Researchers Evaluate Use of Benzodiazepine Drugs Among Seniors
Research published in JAMA Internal Medicine by medical professionals from the University of Michigan, University of Pennsylvania and Department of Veterans Affairs (VA) evaluated benzodiazepine use by low-income senior citizens who participated in a Pennsylvania program designed to help with drug costs.2
The U.S. National Institute on Drug Abuse notes benzodiazepine drugs are commonly abused and asserts about one-third of opioid overdoses also involve benzodiazepines.3
Given the fact most older adults who use benzodiazepines obtain their prescriptions from a primary care physician or other non-psychiatrist practitioner, the research zeroed in on only those seniors receiving prescriptions from someone other than a psychiatrist.4
The research centered on analyzing the medication-use patterns of 576 older adults who received their first benzodiazepine prescription between 2008 and 2016.
Notably, the team discovered 152 seniors continued to hold a current or recent prescription for the drugs one year later. As such, they concluded 1 in 4 seniors is consistently taking medications such as Valium or Xanax to address anxiety and/or sleep issues. Additional findings include:5,6
As compared to minorities, Caucasian patients were four times more likely to have moved toward long-term use
Seniors whose initial prescriptions were written for the largest number of pills were found to be more likely to become long-term users of benzodiazepine drugs
For every 10 additional days of medication prescribed, a patient's risk of long-term use nearly doubled over the next year
As compared to short-term users, seniors who took benzodiazepines long term were not any more likely to be diagnosed with anxiety or depression
On average, the participants were 78 years old when they received their first benzodiazepine prescription, even though the drugs are generally not recommended for adults over age 65
Very few of the seniors had received psychiatric, psychological or psychosocial care in the previous two years
What Are Benzodiazepines and Who Uses Them?
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As a class of psychoactive drugs known for their tranquilizing effects, benzodiazepines enhance the effect of an inhibitory neurotransmitter called gamma-aminobutyric acid (GABA) in your brain, making it useful for treating the following medical conditions:7
Alcohol withdrawal
Anxiety
Insomnia
Muscle relaxation
Seizure control
You may be given a benzodiazepine drug prior to the administration of a presurgery anesthetic or to induce amnesia in conjunction with uncomfortable medical procedures. Benzodiazepine drugs are known for their anxiolytic, anticonvulsant, muscle-relaxing, sedative and sleep-inducing properties.
A few of the brand name drugs within the benzodiazepine class that are commonly prescribed to seniors include Ativan, Halcion, Klonopin, Valium, Versed and Xanax. As mentioned, these drugs are easily abused.
In the video above, presented by the nonprofit advocacy group Benzodiazepine Information Coalition8 in honor of World Benzo Awareness Day 2018, former users of these medications share how they came to realize the negative effects prescribed benzodiazepines had on their lives.
Health Care Providers Lack Education About the Risks Associated With Benzodiazepine Drugs
The researchers say their findings point to a lack of education about the potential negative effects of these drugs, as well as a need to ensure both health care providers and the public are aware of the risks associated with taking them.9 About the results, lead study author Dr. Lauren Gerlach, a geriatric psychiatrist at the University of Michigan, stated:10
"This shows we need to help providers start with the end in mind when prescribing a benzodiazepine, by beginning with a short-duration prescription and engag[ing] patients in discussions of when to re-evaluate their symptoms and begin tapering the patient off [the medication].
We also need to educate providers about effective nonpharmaceutical treatment alternatives, such as cognitive behavioral therapy, for these patients."
Dr. Brian Keefe, a psychiatrist and medical director at Zucker Hillside Hospital in Glen Oaks, New York, who was not involved in the research, affirms the study as a much-needed reminder for doctors everywhere. “Clinicians, including psychiatrists, continue to prescribe benzodiazepines to this [older] population at an alarming rate.”
They do so, he notes, despite the fact, "multiple studies over many years now have consistently demonstrated an elevated risk of falls, and falls with fracture in seniors who take these medications.”11 Another concern raised by the researchers relates to the improper application of benzodiazepine drugs.12
They noted long-term users were more likely to report sleep problems despite the fact benzodiazepines are not recommended for long-term use as sleep aids. To the contrary, these drugs may actually worsen sleep the longer they're used.
Dr. Harshal Kirane, psychiatrist and director of addiction services at Staten Island University Hospital in New York City, suggests benzodiazepine overuse is "a silent epidemic.” He believes the research "underscores a persistent reliance on narcotic medications for resolution of symptoms, such as insomnia, that can be improved by numerous other healthier options."13
As such, Kirane asserts physicians must do more to help guide patients toward safer, nonpharmaceutical solutions for sleeplessness and other common complaints. Similarly, senior study author Dr. David Oslin, professor of psychiatry with Penn Behavioral Health and staff physician with the Philadelphia VA Medical Center, stated:14
"This study provides strong evidence that the expectations set out by a provider when they first write a new prescription carry forward over time. When a physician writes [a prescription] for 30 days of a benzodiazepine, the message to the patient is to take the medication daily and for a long time.
This expectancy translates into chronic use, which, in the long run, translates into greater risks like falls, cognitive impairment and worse sleep."
Got Anxiety? EFT Can Produce Rapid Results
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While prescription drugs are often thought to be the main remedy for anxiety, there are many natural alternatives. One of the best “treatments,” in my opinion, is EFT (Emotional Freedom Techniques). It's easy to use and can produce rapid and long-lasting results.
Energy psychology techniques such as EFT can be very effective in helping you reprogram your body's reactions to the common, unavoidable stressors of everyday life that fuel anxiety.
Having been around since the 1990s, EFT has been described as acupuncture without needles. This is so because both modalities are based on the premise that vital energy flows through your body along invisible pathways known as meridians. EFT combines fingertip tapping over particular meridian points in your body with verbal affirmations you speak to yourself out loud.
The technique is so simple and it can be performed nearly anytime and anywhere. You can easily perform EFT on your own, or for more complex issues, you may want to seek the help of a qualified EFT therapist. Having had an EFT specialist on staff at my natural health clinic, I can testify to the positive effects this therapy has had on countless individuals, myself included.
EFT works wonderfully to ease anxiety and insomnia - two nagging concerns affecting many seniors ­- as well as a variety of other issues related to emotional and physical health for people of all ages. Based on my experience, EFT is, without a doubt, the most effective clinical strategy I have ever used for anxiety. It is most certainly better and safer for you than pharmaceutical drugs.
In the video above, EFT practitioner Julie Schiffman demonstrates how to use tapping to relieve stress and anxiety. If, on the other hand, sleeplessness is a bigger concern for you, check out "Julie Schiffman Discusses Tapping for Insomnia."
The researchers suggested cognitive behavioral therapy as an alternative to prescription drugs, and this can be used in conjunction with EFT in addressing anxiety.
Keep in mind that talking about anxiety does not necessarily relieve the bodily effects associated with it. EFT addresses both your body and your mind, making it, in my opinion, an important adjunct to, or in some cases a replacement for, traditional talk therapy.
Consider Antianxiety Drugs Only as a Last Resort
Sadly, as validated by the current research, many primary care doctors are quick to prescribe benzodiazepines to older adults as a first line of treatment for anxiety disorders.
In many cases, drugs may be the only option offered. Because some seniors have been trained up under the notion of “doctor knows best,” they may be more likely to accept a prescription medication than to investigate alternative solutions.
After all, it likely seems easier to swallow a pill than to change one's habits and thoughts, especially at older ages. That said, it's vitally important for caregivers and family members to become educated about the dangerous side effects of antianxiety drugs like benzodiazepines and to advocate for their loved ones.
Given the potentially grave consequences, it's up to these folks to investigate the options and direct their senior to healthier, safer nondrug alternatives. In case you are not yet convinced benzodiazepines are dangerous, consider a 2014 study published in BMJ suggesting use of these drugs puts you at a 50 percent greater risk of Alzheimer's disease. The study authors stated:15
“Benzodiazepine use is associated with an increased risk of Alzheimer's disease. The stronger association observed for long-term exposures reinforces the suspicion of a possible direct association, even if benzodiazepine use might also be an early marker of a condition associated with an increased risk of dementia.
Unwarranted long-term use of these drugs should be considered as a public health concern.”
Another body of research suggests benzodiazepines and other hypnotic drugs are associated with a fourfold increase in all-cause mortality and a 35 percent greater risk of cancer among those prescribed higher doses.16 Once you start, getting off these drugs can also be challenging. The difficulty increases the longer you take them.
"Benzodiazepine withdrawal syndrome"17 is characterized by anxiety, concentration problems, hand tremors, headaches, irritability, muscular pain, nausea, palpitations, panic attacks, perceptual changes and sleep disturbance, among other troubling effects. Tapering off from higher doses can also trigger psychotic reactions and seizures.
As you can see, upon discontinuing them, these drugs have the potential to trigger side effects that are the same as the original symptoms they were attempting to address. Rather than deal with the uncomfortable after effects, it seems far wiser to dig into the root causes of your anxiety and to consider nondrug options first.
Try These Nondrug Options for Dealing With Anxiety
As with most chronic health issues, you will need to take a holistic approach to resolving anxiety. From the onset, you'd be wise to evaluate the following areas to ensure you are taking care of your body and mind at a foundational level. For starters, you may consider:
Addressing stressful people and situations - A common cause of anxiety relates to stressful people and situations. While this area can be challenging to address, you won't regret any steps you take to reduce your anxiety levels by limiting your exposure to people and situations that “push you over the edge” emotionally.
Breathing properly - While it may sound funny to suggest breathing as a solution, you'd be surprised how many people breathe in such a way as to put their health in jeopardy.
Most stress-relief methods tend to focus on taking big, deep breaths, but this is actually the opposite of what you should do. For helpful tips, check out my article "Breathing Techniques for Greater Health and Fitness."
Engaging in regular exercise - Some of my favorite forms of exercise include high-intensity interval training, stretching, yoga, walking and weight training. The four-minute Nitric Oxide Dump workout is particularly beneficial for boosting your health and sense of well-being.
Getting the right nutrition - Lowering your intake of gluten, processed foods and sugar is recommended for people of all ages and levels of health, and most especially for anyone suffering from anxiety.
Your body needs healthy (preferably grass fed, organic) food to function optimally. Some of the top antianxiety foods include blueberries, dark chocolate, fermented foods, leafy greens and turmeric.
Optimizing your gut health - A healthy gut is vital to your overall health. If you have a sluggish or overactive digestive system, your immune system is going to be negatively affected. To ensure your body has the right balance of healthy gut flora, get more fiber into your diet and consider taking a daily probiotic supplement.
Tackling common nutrient deficiencies - Even if you try to eat healthy, chances are you may have a hidden nutrient deficiency that is interfering with your health.
You may want to check your diet for deficiencies in key nutrients like animal-based omega-3s, magnesium and vitamin D. For more guidance in this area, review my article on “The Most Common Nutrient Deficiencies.”
In addition, since many seniors are tied to their TVs, tablets and other electronic gadgets and may not understand the implications of electromagnetic field (EMF) exposure, it's important to become educated.
For now, be advised excessive free radicals triggered by low-frequency microwave exposure from wireless technologies have been linked to anxiety, depression, memory changes and sleep disturbances, as well as a number of other conditions known to affect older adults.18
At a minimum, avoid keeping electronic gadgets next to you while sleeping and never sleep with the lights or TV on. A final area to consider is potential toxic exposures. Anxiety is a common symptom of toxic mold exposure, so you may want to check to see if there's any kind of pattern going on in your life that may indicate this.
For example: Do your anxiety symptoms improve when you spend time away from your home or office? Do you feel better outdoors than indoors? Whatever steps you take to pursue nondrug alternatives for dealing with anxiety will be well worth it.
If you are already taking a benzodiazepine medication, I hope you will consider talking to your doctor about whether it's time to discontinue it. Act today to ensure you won't become one of the growing number of senior citizens hooked on antianxiety medications.
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pearsonclaire1995 · 4 years
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