Published on February 21, 2017
Articles in this issue:
Chuck and Becky help their mom keep her finances in order, but lately they've noticed she's running out of money far before the end of the month. Credit card statements revealed that Mom was spending an increasing amount at a local casino. "Since I retired, I get bored at home," said Mom. "They send me coupons and I can take the free shuttle there. Besides, I have a lucky slot machine and I'm sure I’ll hit the jackpot soon!"
March is Problem Gambling Awareness Month. Sponsored by the National Council on Problem Gambling (NCPG), this event seeks to educate the public about gambling addiction and about help that is available. Gambling is a huge industry in the U.S. Experts report that Americans spend more on casino gambling, sports gambling, lotteries, bingo, pull tabs and internet gambling than they do on music, sporting events and movies combined. Casino gambling is more popular than ever; according to the American Gaming Association, gamblers spend more than $37 billion each year at the nation's casinos.
Statistics show that seniors are the fastest-growing group of gamblers. They enjoy bingo, racetrack betting—and especially, casino gambling. AARP recently reported that senior gamblers can be big business for casinos, who heavily target older adults in their marketing campaigns. AARP reports, "Retirement-aged consumers are an especially desirable demographic for the gaming industry because they fill the floors during off-peak hours. Casinos market to them aggressively, offering discounted meals, 'Golden Oldies' entertainment shows, and complimentary shuttle service—on days when Social Security checks arrive." A 2014 report from the Institute for American Values found that some casinos attract older gamblers with plentiful handicapped spaces in the parking lot, mobility scooters, and bathrooms equipped with adult diapers and needle disposal receptacles for diabetics.
For many seniors, gambling is harmless entertainment. They hop on the casino shuttle, socialize with others and casino staff, bet a few dollars and take advantage of senior discounts on meals, drinks and perhaps a show. They've set aside part of their entertainment budget for gambling, and they stop when they reach their limit.
However, the NCPG reports that some older adults develop a gambling problem that seriously impacts their financial well-being. The NCPG, whose mission statement says they are "neither for or against legalized gambling," seeks to "improve health and wellness by reducing the personal, social and economic costs of problem gambling."
What is problem gambling?
Problem gambling—also referred to as gambling addiction, pathological gambling or a gambling disorder—happens when a person becomes obsessed with gambling and has an uncontrollable urge to keep gambling. According to the Nevada Council on Problem Gambling, "For the problem gambler, making a bet is not just about having fun or winning money. Gambling becomes an emotional response to change the way they feel." In addition, warns the NCPG, a person might have a gambling problem if they are:
Why are seniors at higher risk?
The NCPG explains that boredom, isolation, depression and cognitive impairment affect judgment and make it harder for senior gamblers to stick to their limit. Seniors on a fixed income—who can little afford to gamble away their money—might hope that they will strike it rich and improve their financial situation. In addition to the signs above, family may notice that their loved one has withdrawn from the activities they used to enjoy. Possessions may have disappeared from their loved one's home, and their loved one is vague about what happened. A senior may be neglecting their personal needs—food, medical care, or exercise. And here's a sign experts often cite as a red flag: Seniors with a gambling addiction show little interest in the buffet, entertainment or social aspects of a casino trip, instead heading straight for their "lucky machine" and settling in.
What can family do?
The first step is to review the warning signs of problem gambling to get a better picture of whether your loved one has a problem. You can't step in merely because you don't approve of gambling, or you think Mom should spend her entertainment money somewhere else.
The next step is to determine whether there are medical reasons behind the problem. Gerontologists say problem gambling might be a sign that a senior is dealing with early Alzheimer's disease or other cognitive impairment that impairs judgment and impulse control. The side effects of some medications also can make a senior more susceptible to compulsive gambling. For example, certain drugs prescribed to control the symptoms of Parkinson's disease have been linked to impulse control—including pathological gambling. Urge your loved one to be evaluated by a healthcare provider to rule out or diagnose these problems.
Having a conversation about problem gambling can be very difficult. Your loved one may resist talking about it and may insist that there isn't a problem. Assure them that you have their best interests in mind, and that you want to help, not judge. Encourage your loved one to talk to a professional. Treatment is available for gambling addiction and includes support groups, psychotherapy and sometimes medication. Consider bringing in a geriatric care manager (also called an aging life care specialist) to mediate the conversation and to help you locate treatment resources. Talk to your loved one's financial manager, or consult an elder law attorney. Sometimes, if a senior is no longer able to manage their money, families must take a larger role. (Read "Stepping In, Stepping Up: Legal Issues for Family Caregivers" in the August 2016 issue of the Caring Right at Home newsletter to learn more. A poll in that issue found that many Caring Right at Home readers have held a durable power of attorney or guardianship for a senior loved one at some point.)
Not every gambling habit rises to the level of addiction. A senior who goes to the casino several times a week to stave off boredom and loneliness might find even more mental stimulation and companionship through a senior recreation program, volunteer service, events at their faith community, or taking a class. Help your loved one locate appropriate activities in the area. If your loved one has become isolated due to mobility challenges, consider hiring home care to provide companionship and transportation. Even computer games can be a substitute for folks who enjoy relaxing with a machine—and as a bonus, these games offer far more mental stimulation and brain exercise than a slot machine.
Learn More and Get Help
Professional in-home caregivers help tempt the appetite of clients who are living with dementia.
In November 2016, a study about the dementia rate published by University of Michigan researchers drew a great deal of attention. According to Dr. Kenneth Langa and his team, the percentage of American seniors who develop Alzheimer's disease and other dementia is declining.
This was uplifting to hear, but some news sources misinterpreted the data, claiming that soon there will be fewer people living with dementia. Demographers remind them that even if the percentage will be smaller, with our rapidly aging population, the actual number of people with memory and thinking problems will be substantially higher than at present. The Alzheimer's Association predicts that by the year 2050, more than 13 million seniors will have Alzheimer's disease, up from 5.4 million today. And with today's smaller families and greater geographical distance between family members, an ever-shrinking pool of caregivers will struggle to care for these seniors.
Experts tell us that seniors with Alzheimer's disease tend to do best if they can stay in familiar surroundings, where they can maintain their long-time routine. Today, more families are hiring professional in-home care to allow their loved one to remain at home longer—whether that is in the elder's own home, the home of an adult child, or in a senior living community where the senior moved before developing memory loss. Dementia care provided in the home includes supervision and personal care such as bathing, dressing, grooming and incontinence care. It's important to hire a caregiver who has been trained in the special needs of seniors with dementia.
This includes nutritional needs. March is National Nutrition Month, a good time to consider the ways that in-home caregivers help clients with dementia continue to eat a healthy diet. While dementia doesn't change a senior's dietary needs, it does pose challenges to consuming those nutrients. Memory and thinking problems make it harder to prepare and eat a healthy diet. The appetite decreases as taste and smell diminish—or, a person might eat too much, forgetting what they have recently eaten. In-home caregivers help clients overcome these physical and functional challenges in several ways:
Planning and shopping for nutritious meals and snacks that meet the client's requirements as determined by the healthcare provider. Caregivers can go to the grocery store, or the caregiver and client can make an outing of it. Helping to select ingredients creates a sense of independence and enhances appetite.
Preparing meals. The caregiver can prepare meals for the client. Or perhaps the client enjoys cooking, but it's not safe for them to use the stove, or they can't remember all the steps of making a meal. The caregiver can help them do what they can, while providing watchful supervision and assistance. Here again, participating in the preparation is an appetite booster.
Providing mealtime companionship and helping clients eat. A recent study from the University of East Anglia in the UK found that socializing is a top factor in promoting good nutrition and adequate hydration for people with dementia. Most of us eat more if we're not eating alone. Having the caregiver as a dining companion provides warmth and a positive mood. And dementia care experts offer this tip: Watching another person eat reminds a person with dementia to do the same. Caregivers also can provide feeding assistance if necessary.
Addressing safety concerns and reporting problems. Some foods are harder to eat as the disease progresses. The caregiver can be alert for and report problems the client might be having with chewing and swallowing; it might be time to make some changes to the meal plan. Being able to eat independently enhances a client's sense of dignity, and small accommodations make a big difference. To help avoid choking and make eating easier, the caregiver can serve food already cut into bite-sized pieces. Coffee should be brought to the table already cooled to a safe temperature. People with dementia take longer to finish a meal; although a family member is most likely watching the clock to leave for work, a professional caregiver has the time to sit patiently until the meal is done. (To find a wealth of practical tips, see this "Food, Eating and Alzheimer's" tip sheet from the Alzheimer's Association.)
Reminding the client to drink enough fluids. With age, our sense of thirst diminishes, and dementia makes it even harder to realize that we need to drink. People with dementia can easily develop dehydration, dry mouth and constipation. Caregivers provide regular reminders for the client to drink water and other fluids.
Avoiding foodborne illness. Professional in-home caregivers provide housekeeping services, and in the kitchen, this is particularly important. The caregiver can be sure that foods aren't past their expiration date, perishables are kept cold, the kitchen is clean and sanitary, and that items the client might mistake for food, such as medications and cleaning products, are kept out of reach.
Providing medication reminders. People with dementia may take a number of medications, along with drugs they take to control other health conditions. Some of these medications can affect their appetite. The caregiver can remind the client to take medications and report a loss of appetite that might warrant a review of these medications.
Encouraging physical activity. Exercise is one of the top appetite builders. The caregiver can go for a walk with the client, or set up an exercise video at home. Perhaps a trip to an Alzheimer's café or other dementia-friendly activity would be just the mood booster to pique the appetite.
For information on topics related to home care and healthcare, visit our Home Care and Healthcare Advocacy group on LinkedIn.
Infographic: Garyfallia Pagonis, courtesy of Massachusetts Eye and Ear.
Each year, almost 3 million seniors go to the emergency room with fall-related injuries. Many of these injuries are fatal and many more lead to disability. "The Complex Family Dynamics of Fall Prevention" in the September 2016 issue of Caring Right at Home looked at the various causes of falls in older adults, which include:
The final item on that list is receiving more attention as our population ages. Recently, researchers from Massachusetts Eye and Ear, a Harvard Medical School teaching hospital in Boston, noted that vestibular dysfunction might even be considered as the third-most common cause of death among Americans, behind heart disease and cancer, linked with 152,000 American deaths each year!
Our vestibular system is made up of tiny semicircular canals in our inner ears that help us perceive motion, balance, and a sense of where we are in relationship to our surroundings (spatial orientation). Vestibular dysfunction reduces our ability to be safe as we move through our environment. In some cases, patients with a vestibular disorder experience dizziness or vertigo. The Mass. Eye and Ear team reports that more than half of us will seek help from a doctor for these symptoms at some point in our lives. However, in most cases, a decrease in the sense of balance and spatial orientation develops over time—so gradually that a person doesn't notice the problem.
And they probably do have a problem, if they are older. It's important to know that vestibular dysfunction increases with age. The Mass. Eye and Ear team published a study in Frontiers in Neurology examining the vestibular threshold in people of various ages. (The "vestibular threshold" means the smallest amount of motion that a person can perceive.) Said senior author Daniel M. Merfeld, Ph.D., "In our study, vestibular decline was clear above the age of 40." His team reported that the problem doubles every 10 years after the age of 40.
Merfeld, who is director of the Jenks Vestibular Physiology Laboratory at Mass. Eye and Ear and a professor of otolaryngology at Harvard Medical School, warned, "Increased thresholds correlate strongly with poorer balance test results, and we know from previous studies that those who have poorer balance have much higher odds of falling."
What can we do to lower the risk of balance-related falls?
If you are worried that an older loved one's sense of balance is impaired, it's time for a conversation. (A poll associated with the Caring Right at Home article mentioned above found that more than half of our readers have already started the conversation about falls, and have taken steps to lower their loved one's risk—but another 24 percent say their loved one resists discussing that topic.) You might try using the Mass. Eye and Ear study as a starting point to bring up the seriousness of the problem and to assure your loved one they are not alone. It also might help overcome your loved one's skepticism—many seniors think, "I don't notice any problem with my balance, so surely I don't have a problem."
Some balance problems can be improved with surgery or other medical treatment, and new therapies are on the horizon. (The Vestibular Disorders Association offers information about these treatments.) And almost all seniors can benefit from balance training, which might include specialized classes, physical therapy, tai chi and other exercises. The National Institute on Aging offers a set of balance-building exercises. Ask the doctor before beginning an exercise program.
People who are aware that they have vestibular dysfunction also can take preventive steps to avoid falls. Install sturdy handrails on stairs. Improve lighting throughout the house. Choose appropriate footwear. Have an annual eye exam to keep the glasses prescription up to date. Don't drink too much alcohol. Use a cane or walker correctly. If your loved one uses in-home care, remind the caregiver to remove clutter than could trip up your loved one. The Mass. Eye and Ear study also is a reminder that if you are older than 40—as many family caregivers are—all these home safety precautions could help you avoid a fall, as well!
|Give yourself a fall prevention checkup!
With all the things to remember, fall protection might seem like a daunting goal. To help you take steps to lower the risk, download a free, easy-to-use Fall Prevention Guide, created by Right at Home with Dr. Rein Tideiksaar, a leading expert on fall prevention for the elderly.
Caring for a loved one is truly a labor of love for millions of American family caregivers, but for many, the devotion of time and tenderness comes with personal financial sacrifice. The AARP "Family Caregiving and Out-of-Pocket Costs: 2016 Report" estimates that U.S. family caregivers spend a yearly average of $6,954 for out-of-pocket costs related to caregiving. Hispanic/Latino caregivers spend $9,022 annually, which adds up to 44 percent of their income. According to the report, African-Americans spend an average of 34 percent of their annual income on family caregiving and whites 14 percent.
If you are a family caregiver, you should be aware of all the cost-saving benefits to which you might be entitled. Depending on the state in which you live, these benefits may include direct cash payments or breaks to your federal income tax.
|Find information about cost-saving benefits caregivers should know about in the Right at Home blog, where you will always find the latest information about aging, caregiving and home care.|