The write up from Generations United (gu.org) states the following:

“Think of San Diego and you probably focus on its physical beauty: the sandy beaches and imposing canyons, the charming historic area, and, of course, the lovely weather. But if you concentrated solely on the physical attributes, you‘d miss out on one of San Diego‘s most appealing traits: its commitment to making life better for all generations.

With three million residents strong, the County of San Diego believes in the need to support intergenerational connections. In 2001, it backed up that belief with serious funding by adding a fulltime staff position of Intergenerational Coordinator at the county‘s department of Aging & Independence Services (AIS). That investment has paid big returns: through intergenerational programs it has employed residents‘ strengths to expand services and address serious challenges. Residents benefit by having the opportunity use their talents and creativity to contribute to the county‘s well-being and vibrancy.

Over the past 11 years, the county‘s commitment to intergenerational programs has only strengthened as the economy has weakened. By sharing sites and resources, it has maximized financial resources. It has also challenged traditional ways of funding. For example, AIS allocates funding from the Older Americans Act to support intergenerational program development. It also requests and receives funds from other county agencies to support intergenerational programs.

Recently, a $16.1 million dollar Centers for Disease Control Healthy Works grant included an intergenerational thread that supported Safe Routes to School, Breakfast in the Classroom, Community gardens, and Community Engagement.

 In San Diego today, all types of county services and programs have an intergenerational aspect. Libraries and Parks and Recreation offer intergenerational art, math, reading and jazz programs. Older adults take part in a Workforce Academy for Youth, mentoring foster youth for six months as they get ready to leave the foster system and join the work world. Young people have the opportunity to join the Legacy Corps Program where they serve caregivers and learn about the aging process. The county also works with providers that serve older adults and youth to sponsor Resident and Youth Leadership Academies. These academies train older adults and youth in leadership, and primarily focus on community planning principles and environmental prevention strategies. The list goes on.

 This June, county agencies, non-profit organizations, for-profit agencies and faith communities will conduct a summit: Live Well, San Diego! Building a Healthy Community for All Ages. Speakers and activities will focus on how to make healthy choices and create living environments that encourage safe, active lifestyles. The event will take place in five locations to ensure all San Diegans have access to the information and activities. San Diego‘s efforts have resonated well with residents of all ages. As retired volunteer and community gardener Rich Rogers noted, community gardening ―has turned into a labor of love. Gardening is as ―grass roots‖ as you can get and teaching and mentoring kids of all ages increases my desire to be a positive influence and asset in my community.

 And for Alexis Wilson, a college student, her labor of love is to volunteer to meet with an older adult who has Parkinson‘s disease. As she describes it, ―Phil‘s wife recently told me he sometimes forgets I‘m not part of the family. Spending time with Phil reminds me I‘m not going to be young forever. I would want the same help when I am that age.”

Set-up of the environment and reminders can really help prevent falls for many seniors. Here are some safety tips from the National Institute of Health for preventing falls–both outside and around house. But the biggest prevention of falls comes from maintaining a regular 15 -20 mintue daily exercise program that includes balance exercises. This is not anything too advanced or complicated, take for example the low-impact chair exercises offered daily at Sunshine Care Assisted Living Homes. www.sunshinecare.com

Safety first to prevent falls: At any age, people can change their environments to reduce their risk of falling and breaking a bone.

Outdoor safety tips:

• In nasty weather, use a walker or cane for added stability.
• Wear warm boots with rubber soles for added traction.
• Look carefully at floor surfaces in public buildings. Many floors are made of highly polished marble or tile that can be very slippery. If floors have plastic or carpet runners in place, stay on them whenever possible.
• Identify community services that can provide assistance, such as 24-hour pharmacies and grocery stores that take orders over the phone and deliver. It is especially important to use these services in bad weather.
• Use a shoulder bag, fanny pack, or backpack to leave hands free.
• Stop at curbs and check their height before stepping up or down. Be cautious at curbs that have been cut away to allow access for bikes or wheelchairs. The incline up or down may lead to a fall.

Indoor safety tips:

• Keep all rooms free from clutter, especially the floors.
• Keep floor surfaces smooth but not slippery. When entering rooms, be aware of differences in floor levels and thresholds.
• Wear supportive, low-heeled shoes, even at home. Avoid walking around in socks, stockings, or floppy, backless slippers.
• Check that all carpets and area rugs have skid-proof backing or are tacked to the floor, including carpeting on stairs.
• Keep electrical and telephone cords and wires out of walkways.
• Be sure that all stairwells are adequately lit and that stairs have handrails on both sides. Consider placing fluorescent tape on the edges of the top and bottom steps.
• For optimal safety, install grab bars on bathroom walls beside tubs, showers, and toilets. If you are unstable on your feet, consider using a plastic chair with a back and nonskid leg tips in the shower.
• Use a rubber bath mat in the shower or tub.
• Keep a flashlight with fresh batteries beside your bed.
• Add ceiling fixtures to rooms lit by lamps only, or install lamps that can be turned on by a switch near the entry point into the room. Another option is to install voice- or sound-activated lamps.
• Use bright light bulbs in your home.
• If you must use a step-stool for hard-to-reach areas, use a sturdy one with a handrail and wide steps. A better option is to reorganize work and storage areas to minimize the need for stooping or excessive reaching.
• Consider purchasing a portable phone that you can take with you from room to room. It provides security because you can answer the phone without rushing for it and you can call for help should an accident occur.
• Don’t let prescriptions run low. Always keep at least 1 week’s worth of medications on hand at home. Check prescriptions with your doctor and pharmacist to see if they may be increasing your risk of falling. If you take multiple medications, check with your doctor and pharmacist about possible interactions between the different medications.
• Arrange with a family member or friend for daily contact. Try to have at least one person who knows where you are.
• If you live alone, you may wish to contract with a monitoring company that will respond to your call 24 hours a day.
• Watch yourself in a mirror. Does your body lean or sway back and forth or side to side? People with decreased ability to balance often have a high degree of body sway and are more likely to fall.

Medications That May Increase the Risk of Falling:

• Blood pressure pills
• Heart medicines
• Diuretics or water pills
• Muscle relaxers or tranquilizers

 The good news is Sunshine Care Assisted Living Homes has a partnership with the Alzheimer’s Association and they tell us, there’s a lot you can do to help keep your brain healthy as you age.

 The Alzheimer’s Association has launched a Maintain Your Brain^® campaign designed to help all Americans understand steps they can take now to make brain health part of their overall goals for healthy aging. A few simple lifestyle changes can help keep you fit mentally and physically for years to come, and might also reduce your risk of Alzheimer’s disease and other dementias.

 Several of the 10 Ways to Maintain Your Brain form the core of how and why we design our daily activities at Sunshine Care Assisted Living Homes.

 10 ways to Maintain Your Brain^®

 1. Head first

Good health starts with your brain. It’s one of the most vital body organs, and it needs care and maintenance.

 2. Take brain health to heart

What’s good for the heart is good for the brain. Do something every day to prevent heart disease, high blood pressure, diabetes and stroke — all of which can increase your risk of Alzheimer’s.

 3. Your numbers count

Keep your body weight, blood pressure, cholesterol and blood sugar levels within recommended ranges.

 4. Feed your brain

Research suggests that a diet rich in dark vegetables and fruits may help protect brain cells. Eat less fat and more antioxidant-rich foods.

 5. Work your body

Physical exercise keeps the blood flowing to the brain and may encourage new brain cells. Walking just 30 minutes a day can help keep both body and mind active.

 6. Jog your mind

Keeping your brain active and engaged strengthens brain cells and the connections between them, and may even trigger growth of new cells. Read, write, play games, learn new things, do crossword puzzles.

 7. Connect with others

Leisure activities that combine physical, mental and social elements may be most likely to prevent dementia. Be social, converse, volunteer, join a club or take a class.

 8. Heads up! Protect your brain

Take precautions against head injuries. Always wear a seat belt; unclutter your house to avoid falls; and wear a helmet when cycling.

 9. Use your head

Avoid unhealthy habits. Don’t smoke, drink excessive alcohol or use street drugs.

 10. Think ahead – start today!

You can do something today to protect your tomorrow.

 The science behind these recommendations

While there is strong evidence pointing to ways to support brain health and possibly reduce risk of dementia, it’s important to understand that there is no way to predict what will happen to any particular person. Sunshine Care Assisted Living Homes, The Alzheimer’s Association and Maintain Your Braindo not guarantee individual health outcomes.

 More information

To learn more about Maintain Your Brain^®, visit www.alz.org/maintainyourbrain.

Half of all women will develop a urinary tract infection (UTI) in their lifetimes. Ranking as the body’s second-most common infection type, UTIs in women—and less often in men—account for about 8.3 million doctor visits each year, according to the National Center for Health Statistics. Typically, UTIs, also known as bladder infections, are easy to cure. But if left untreated, the infection can spread and develop into far more serious conditions. UTIs, for instance, are a leading cause of sepsis, a potentially life-threatening infection of the bloodstream.

“A bladder infection places stress on the body,” says Dr. Mary Ann Forciea, an associate clinical professor for the University of Pennsylvania Health System. That stress can result in confusion and abrupt changes in behavior in older adults with an elderly urinary tract infection. And for people suffering from Parkinson’s disease, Alzheimer’s disease, or other dementia, “any kind of stress, physical or emotional, will often make dementia temporarily worse,” Forciea says.

Causes and Symptoms

The kidneys, ureters, bladder, and urethra work together to rid the body of urine: the kidneys remove extra liquid and waste from the blood in the form of urine, the ureters carry the urine from the kidneys to the bladder, and the bladder stores the urine until it is emptied through the urethra.

An infection can occur when bacteria cling to the opening of the urethra and begin to multiply. UTIs are thought to be much more common in women because the urethra is shorter in women than in men, giving bacteria—which live in the rectal area and also on a person’s skin—an easier route into the body.

The most common diagnosis is cystitis, the infection and inflammation of the bladder, which causes frequent and painful urination. However, other parts of the lower and upper urinary tract system can become infected. As a general rule of thumb: the higher up the infection in the urinary tract system, the worse it is.

Burning urination is often the result of urethritis, the infection of the urethra. In men, urethritis can also cause penile discharge. Pyelonephritis occurs when a bladder infection spreads to the kidneys. It can cause upper back and flank pain, shaking, chills, nausea and vomiting. UTIs in men can lead to prostatitis, or enlargement of the prostate gland, the male organ that produces semen, which is located just below the bladder.

Forciea says it’s helpful to think of the prostate as shaped like a doughnut. Urine comes out of the prostate’s center. As the prostate swells, the opening for urine shrinks, making it more difficult to urinate. Some swelling of the bladder wall can block the exit path of urine, resulting in a bladder outlet obstruction. A key indicator that the outlet is beginning to close, Forciea says, is if the patient starts to urinate more frequently. If his usual tendency is to void every two hours and now he’s urinating every thirty minutes, that’s a sign that the outlet is beginning to close and only small amounts of urine are passing through.

Other symptoms of a UTI include: general discomfort, a feeling of being over-tired, blood in the urine, and pain even when not urinating. Men might feel fullness in the rectum. Back and side pain can indicate the infection has reached the kidneys. An elderly person will rarely get a fever, but if an older patient has one it is considered an emergency. “It shouldn’t be taken lightly,” Treinkman says. “If they do have a fever, it’s a serious infection.”

Despite the fact that stroke is the third leading cause of death inAmerica and the number one cause of adult disability, many remain uneducated as to its causes and methods for prevention.

Even more alarming is the fact that many individuals fail to recognize a stroke when experiencing symptoms or seeing someone else with the symptoms. Sunshine Care Homes understands the importance of Stroke Education. We encourage you and your loved ones to become more aware about stroke risk factors, methods for prevention and symptom recognition. Sunshine Care Homes knows that acting F.A.S.T is the key to reducing the side effects of a stroke.

Here are signs to look for:

Face- Ask the person to smile. Does one side of his face droop?

Arms- Ask the person to raise both arms. Does one arm drift downward?

Speech- Ask the person to repeat a simple sentence. Can he repeat the sentence correctly? Are his words slurred?

**If any of these answers are YES then…

Time is of essence! Call 911 right away or get to a hospital as quickly as possible!

More on strokes and care management next week. www.sunsinhineacare.com

DNR: Do Not Resuscitate or DNR, is a medical order not to attempt resuscitation because the patient does not want it or it is unlikely to help the patient.

 Why would I choose DNR?

Resuscitation often benefits healthy people. However, success with resuscitation is frequently very poor for people with a serious medical condition or more than one medical condition. Resuscitation does not ensure that the person will have the same quality of life as before their heart stopped beating or breathing stopped.

Comfort Measures: Medical care focused on the main goal of keeping a person comfortable (rather than focused on medical procedures that may prolong life). On the POLST form, a person who requests comfort measures only would be moved to the hospital only if it is needed to provide comfort. The goal of managing pain and uncomfortable symptoms is always important. Food and fluids are always offered.

Antibiotics: Antibiotics fight infections (such as pneumonia).

Intravenous (IV Fluids): A small plastic tube (catheter) is placed directly into the vein and fluids are given through the tube.

Tube Feeding: Fluids and liquid nutrients (formula) can be given through a tube in the nose that goes into the stomach or through a tube placed directly into the stomach (by a surgical procedure).

When are feeding tubes not useful?

 1. It is controversial if giving nutrition by a feeding tube near the end of life may be beneficial or if it is actually harmful. People with serious illnesses such as a stroke or Alzheimer’s disease may lose the ability to eat or drink.

2. The patient may feel more comfortable without a feeding tube or IV. When someone can no longer eat or drink, hand-feeding may be better. Hand-feeding offers a personal touch that does not happen with medically administered fluids and liquid nutrients. Food and fluids by handfeeding are always offered for comfort and patient enjoyment.

Social workers, nurses and other healthcare professionals can complete the POLST form with you, but it MUST be reviewed and signed by a doctor. You or your healthcare representative, your healthcare agent or surrogate must also sign the form.

 Will having a POLST form cause any problems for my family or my doctor?

Not at all. In fact, the POLST form helps you, your family and your doctor. The form shares your treatment wishes with your caregivers and helps keep you comfortable.

 If I have a POLST form, do I need an Advance Directive too?

Yes, it is recommended that you also have an Advance Healthcare Directive (AHCD). The POLST form reinforces the wishes that you express in your AHCD. The POLST form presents those wishes in an easy to understand way.

• The AHCD is written instructions stating how you want future medical decisions made, in the event that you become unable to make or to communicate those decisions for yourself.
•  The AHCD states who you want to make healthcare decisions for you if you are unable to make them for yourself.

 What if I want to change something on my POLST form?

The POLST orders can be changed by you and your doctor at any time.

 What if I have more questions or concerns?

We encourage you to talk with your doctor and your healthcare team about your illness and your treatment choices. The POLST form and this information can help guide discussions with your healthcare team.

How is the POLST form used?

A nurse, social worker or your doctor completes the form making sure the treatments are what you want. The doctor signs the orders, making them official immediately. The orders are kept near you at all times, usually on your refrigerator or by your bed if you are home or in your medical chart, if you are in a care facility. The form is then easily found in emergencies. The POLST form will remain with you if you are transported between care settings (from home to hospital or from hospital to an assisted living facility.)

What might happen to me if I do not have a POLST form?

Without a POLST form, emergency medical personnel, nurses and doctors would not know your treatment wishes. You most likely would receive all possible treatments, whether you want them or not, even if they are unlikely to achieve the result you would hope for, and even if these treatments cause pain or complications. Thinking through treatment choices with your family and doctor before a problem occurs can guide and provide the kind of care you want during difficult times.

Physician Orders for Life Sustaining Treatment (POLST)

Frequently Asked Questions

Who should have a POLST form?

The POLST (Physician Orders for Life-Sustaining Treatment) form is important for people with serious health conditions. It is used to make a person’s wishes for medical care known to doctors, nurses, emergency medical personnel and other healthcare staff. The POLST form is a bright pink medical order form. Your doctor uses the POLST form to write orders that indicate the treatment you want in the last stages of an illness.

Why should I complete a POLST form?

If you have a serious medical condition, you can help to make certain that your wishes for care in the future are known and respected. The POLST form makes clear what medical care you would or would not want if you become unable to make the decisions yourself.

• • It provides a doctor’s order so that healthcare workers can follow your plan.
• • A POLST form increases the chances of living out your days as you and your family wish.

What does the POLST form do?

The POLST form is voluntary and is intended to:

• • Help you and your doctor discuss and develop plans to reflect your wishes.
• • Assist doctors, nurses, healthcare facilities and emergency personnel in honoring your wishes.
• • Make sure that your wishes are followed as you are moved from one healthcare facility to another (for example, from hospital to nursing home).

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