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We’re on the precipice of numerous new dementia diagnoses that family members across the country will need to address.

By Ann Norwich, Contributor June 26, 2017, at 6:00 a.m.

When a loved one starts to lose his or her memory, it can be a struggle for the entire family. The person who has been the head of the family may soon fade from the person they once were, leaving their loved ones to wonder what will come next.

Making this time even harder to handle are the numerous questions that suddenly become urgent. Do they have a will? Who has power of attorney to make decisions on their behalf? Does anyone know what is important to them? What is their full life story

Far too often, families end up in this situation without anything on paper regarding their loved one’s final wishes. Talking about dementia is perceived to be so taboo that medical professionals often don’t discuss it with their patients. There’s a stigma that a diagnosis of dementia will lead to a person being treated differently, and consequently, many are left not knowing their diagnosis.

People might even hide their own struggles with memory, leaving little time to answer the important questions until it’s too late. An individual’s quality of life is vastly improved when these questions are settled and their family has the invaluable peace of mind of knowing their loved one’s wishes.

As the Baby Boomer generation continues to age, we’re on the precipice of numerous new dementia diagnoses that family members across the country will need to address. Instead of reinforcing the long-standing stigma, we must instead meet it head-on by asking five important questions.

  1. What are the signs of dementia? Surprisingly, forgetting names of people is not a sign of dementia. Mixing up names of objects, however, is. For a more complete list of signs, check the Alzheimer’s Association’s website.
  2. Does my loved one have dementia? Once you’re familiar with the early signs, consider your loved one’s behaviors. Were they once a social butterfly who has closed themselves off from the outside world? Do they have trouble answering questions like “Where are you?” Do they deflect and make a joke when they can’t answer a question? Do they put ice cream in the oven instead of the freezer? All these behaviors are signs of cognitive impairment. Some might appear obvious, but it’s surprisingly easy for people to hide their mental lapses by telling a story instead of answering your questions.
  3. What do they want for their future? Upon a diagnosis of dementia, it becomes crucial to plan as soon as possible. Commit everything to paper while your loved one is still able to make their wishes known. Palliative care professionals can assist patients and their families in making these choices, such as who will make decisions on their behalf when they are no longer able. There are also financial advisors who specialize in elder care and can assist in estate planning and allocating assets to pay for an assisted living facility or in-home extended care.
  4. What’s their life story? It can help a person with dementia stay cognizant if they’re asked to recount their lives. Journaling or recording a video diary can also help a family bond and commit their history to a tangible form. Every family has wonderful stories that are worth preserving, and laying out the narrative of their lives can help someone with dementia maintain their faculties a bit longer. It also helps them feel valued when being ignored is one of the biggest fears associated with a diagnosis of dementia.
  5. How do they want to be treated? A major contributor to the stigma of dementia is the fear that a diagnosis will lead to a change in social status and how someone is treated. As a caregiver, I always approach a patient first when I enter the room. I make eye contact with them as well as physical contact such as touching their shoulder or shaking their hand. I ask as many questions as possible of the patient themselves to convey that they, my patient, are at the core of everything we’re doing.

Dear Friends and Members of NOCSC:

This is just a reminder that June is National Elder Abuse Awareness Month and as such NOCSC is hosting two special events:

1) the 11th Annual World Elder Abuse Awareness Day event on Saturday 17 June .  If you are a non-profit agency and would like to have an Exhibitor Table, please make sure that I have your Sign-Up sheet and your organization’s logo.  We will also have a Table available for our for-profit organizations where you can leave a small sample of your information.  We are asking our exhibitors (both for-profit and non-profit) if possible, to provide a $20+ Raffle Prize as well, and you may bring that to the Event on Saturday the 17th;

2) the next NOCSC Educational Forum for Professionals is on Tuesday, 20 June at 8:30 a.m. entitled, “Identifying and Fighting Financial Abuse on Seniors” and there will be more information soon on this event!; and

3) As an extra Bonus, we are also hoping to have the new 2017-2018 NOCSC Senior Resource Guide ready to begin passing out at both of these events!  Please pass on this important information to your clients and contact lists!

Dear Members and Friends of NOCSC:

Just a reminder of next week’s NOCSC All Member / General Meeting next Tuesday, 16 May 2017 at 8:30 a.m. is the May All Member General NOCSC meeting and we will be discussing:

  • The 11th Annual World Elder Abuse Awareness Day event in Buena Park on Saturday, 17 June 

  • While the WEAAD Table Space will be limited to non-profits and government organizations, we will have a NOCSC Table that will be available for our for-profit members to place a limited number of their agency brochures on.  Please note that space will be very limited, but will be available to members;

  • The 2017-2018 Senior Resource Guide including new edits and inclusions;

  • The 2017 Senior Unmet Needs Survey ~ and possible themes to cover;

  • New location and time options to hold the “Senior Resources 101” class;

  • And other concerns and issues as well.


May 16th – All Member General Meeting 8:30 -10:00 a.m. located at 130 Bastanchury Rd., Fullerton, Ca 92835

May 24th – Senior Care 101 Class 7:00 – 8:00 p.m. located 

130 Bastanchury Rd., Fullerton, Ca 92835


Problems Walking? It May Be Your Arteries, Not Your Age

One of the main causes of discomfort is peripheral artery disease.

By Elizabeth Ratchford, M.D., Contributor | April 6, 2017, at 6:00 a.m.

A senior couple takes a walk in nature.

People may notice trouble walking or keeping up with their friends as they get older, which can be caused by many things. Sometimes, it’s due to arthritis or pressure on the spinal cord. Other times, it may be due to weight gain or lack of exercise. However, difficulty walking should not be considered a sign of normal aging. Difficulty walking may be a sign of cardiovascular disease, with one of the main causes of discomfort being peripheral artery disease.

What is peripheral artery disease?

Peripheral artery disease, also referred to as PAD, is a condition affecting the arteries – the blood vessels that carry blood from the heart to the rest of the body. In peripheral artery disease, the arteries narrow or are blocked by plaque buildup, a process called atherosclerosis. Atherosclerosis can affect arteries throughout the body. When the heart’s arteries are blocked, the condition is called coronary artery disease. When leg arteries are blocked, it’s considered peripheral artery disease. Tiredness in the legs or pain may be the first sign of a problem.

Peripheral artery disease is common. Up to 12 million Americans have it, and it affects up to 12 percent of the adult population. The rates are even higher among high-risk groups. For example, up to 29 percent of people 70 or older, or those 50 to 69 with a history of smoking or diabetes have peripheral artery disease. The majority of people with it are current or former smokers. Diabetes is also an important contributing factor.

What are the symptoms of peripheral artery disease?

Many people with peripheral artery disease have no symptoms at all. Plaque builds up in the arteries, but it doesn’t always disturb the flow of blood through the vessel, meaning it won’t cause any symptoms.

Typical symptoms of peripheral artery disease include a cramp or ache in the calf muscle, which comes on with exercise and goes away with rest. The feeling may be leg fatigue or heaviness, like walking in cement. It also may feel like a charley horse or a burning sensation. It may be in one leg or both legs; one leg may be worse than the other. Symptoms of peripheral artery disease occur because the muscles are not getting enough oxygen due to the narrowing of the artery or arteries. The muscles require more oxygen during exercise, but the blocked arteries are not able to supply enough blood flow, which leads to pain. Different muscles may hurt depending on which artery is blocked. The calf is the most common location, but symptoms can also occur in the hip, buttock or thigh.

Though the blockages build up over a long period of time, sometimes patients with peripheral artery disease can look back and pinpoint a specific day that they noticed the onset of their symptoms. This day is usually a time when they pushed themselves more than usual, like walking a long distance from the parking lot to a football or baseball game. During this long walk, they noticed that they had to stop to rest and weren’t able to keep up with their companions due to leg discomfort.

One key feature of peripheral artery disease is that the symptoms happen with walking or exercise, but they don’t occur with standing for long periods. Pain with standing is often related to problems in the spine.

How is peripheral artery disease diagnosed?

The main test for peripheral artery disease is the ankle-brachial index. A vascular technologist will place cuffs on the ankles and arms to measure the blood pressures. A hand-held Doppler uses ultrasound waves to detect the flow in the arteries, and then the ratio is calculated to figure out the ABI. Normally, the ankle pressure is higher than the arm pressure. A low ankle pressure (or an ABI less than 1.0) means that the artery is likely blocked.

Ultrasound is noninvasive and relatively inexpensive. Other more complex tests, such as computed tomography angiography or magnetic resonance angiography, are sometimes ordered by vascular specialists to plan how to fix the blocked arteries.

If I have been diagnosed with peripheral artery disease, how can I reduce the risk of complications?

The most dangerous peripheral artery disease complications are the associated cardiovascular problems, such as heart attack or stroke. Most of the time, the leg symptoms improve or stabilize, but the cardiovascular risk remains. Blocked leg arteries mean that arteries may be blocked in other places in the body; a heart attack may occur if the heart arteries are blocked, or a stroke may occur if the blood vessels in the neck or brain are blocked.

The first step toward lowering the risk of complications is to treat the issues that led to the clogged arteries in the first place. Quitting smoking is absolutely critical. Controlling diabetes, high cholesterol and high blood pressure is important, along with maintaining a healthy weight. A doctor can prescribe medications to reduce the risk of heart attack and stroke, which may include:

  • A blood thinner, such as aspirin or clopidogrel, to prevent clots from forming in the narrowed arteries.
  • A statin to lower cholesterol, which slows the plaque accumulation in the arteries and reduces the risk of heart attack and stroke. Statins are vital in patients with peripheral artery disease, regardless of their cholesterol levels.
  • An ACE inhibitor, such as ramipril, to treat the blood pressure, delay the plaque buildup and reduce cardiovascular risk.

Taking good care of the feet is essential to prevent sores or ulcers from developing; even minor wounds may not heal due to impaired circulation caused by peripheral artery disease.

How are the symptoms of peripheral artery disease treated?

Physicians call the symptom of leg pain with walking claudication. The main treatment for claudication is exercise. Since the 1960s, supervised exercise programs have been shown to be quite effective at improving leg symptoms. The ideal program is similar to cardiac rehabilitation and consists of walking on a treadmill under supervision for 30 to 60 minutes at least three times per week for 12 weeks.

The approach uses start/stop exercise that involves walking to the point of moderate discomfort, then stopping until the discomfort subsides completely, and then starting to walk again. Ideally, that point of moderate discomfort should happen within the first five to seven minutes, which over time may require increasing the pace or using an incline. Patients with peripheral artery disease should reach 30 to 60 minutes of walking time every day, not including the rest periods. Within a few weeks, they will see improvements. The change is gradual and may not be obvious from day to day, but it will be clear from week to week or month to month. Thus, keeping a chart or diary can be helpful to monitor the progress.

A regular walking program will help improve not only the symptoms of peripheral artery disease, but also overall cardiovascular health. As the fourth-century B.C. Greek philosopher Diogenes said, “Solvitur ambulando,” which means “It is solved by walking.”

What are the other options?

If the leg symptoms are still interfering with daily life after three months of an aggressive exercise regimen, then other treatment options may be considered. The medication cilostazol may be prescribed to improve the claudication symptoms, though it has some unpleasant side effects. Cilostazol dilates the blood vessels, but how it works to improve the leg pain is not completely understood. In more severe cases, restoration of blood flow may be required to relieve the pain or to heal a wound. Advanced imaging, such as CTA or MRA, may be needed. Then, a vascular specialist will often perform an angiogram, which is a procedure that uses injected contrast (dye) to visualize the blood vessels. The team may use balloon angioplasty to open up the blocked artery and then insert a stent to keep the artery open. Bypass surgery may be needed to reroute the blood flow around the blocked artery if the balloon and stent procedure isn’t possible. However, the large majority of people with peripheral artery disease do well with medications and a good exercise regimen.

Take-Home Points

1. Difficulty walking can be a sign of peripheral artery disease. You should see your doctor if you develop this problem.

2. Peripheral artery disease symptoms vary and may include a cramp or ache in the leg that comes on with walking and goes away with rest.

3. Diagnosing peripheral artery disease is done via a simple blood pressure cuff test called the ankle-brachial index, or ABI.

4. Treatment of peripheral artery disease focuses on decreasing the risk of heart attack and stroke, and improving the leg symptoms. To achieve these two goals, patients should have regular medical visits with a vascular specialist who is experienced in treating this condition.

5. A walking regimen, either at home or in a supervised setting, is effective in improving the leg symptoms.