Tuesday, April 24, 2018

'Being Mortal' and End of Life Planning

We are all going to die.  Most of us do not want to think about this.  We admire people who fight bravely against the ravages of disease, even if it only means they have extended their lives a few weeks or months.  At the same time, we rarely envision that we may be tethered to machines at the end of our life.  When we do think about the end of our life, we have a pretty image of ourselves living until an extremely old age, then dying at home in our bed, surrounded by our loved ones, saying our gentle good-byes.  Most of the time, however, we prefer not to think at all about the end our life.

However, we need to remember that we are all going to die and DEATH IS NOT A FAILURE.  It is a perfectly natural part of life and something for which we need to prepare, for our own sake as well as the sake of our loved ones.

Review of "Being Mortal" by Dr. Atul Gawande

Only rarely have I recommended a book in this blog.  However, I believe it would be helpful for anyone who is over the age of 60, or who has a loved one over the age of 60, to read "Being Mortal" by Dr. Atul Gawande. I believe they would find it very helpful and eye-opening.  It will help you make smarter decisions for yourself and your loved ones concerning the best types of assisted living and medical treatments for the very elderly or sick.

This book is easy to read and contains a large number of case studies which illustrate the various points made by the author, Dr. Atul Gawande, an American surgeon at Brigham and Women's Hospital in Boston. He is also a professor at Harvard Medical School.

Early in the book, he talks about the normal aging process and the types of illnesses and disabilities which are common.  Dr. Gawande notes that the normal decline in our health due to aging often results in losing our independence and being placed in traditional American nursing homes.

In the opening sections of "Being Mortal: Medicine and What Matters in the End," Dr. Gawande discusses the problems with normal nursing homes and their desire to put our medical care and safety above any other consideration.  However, he then shares information about a variety of developers of assisted living facilities who also take into consideration our very human desire to have privacy, independence, pets and a variety of activities available to us as we age, even if this means we are not always bubble-wrapped in the name of "safety."

Later in the book, Dr. Gawande discusses the value of hospice and palliative care, whether or not a terminal patient decides to continue to try various treatments for their illness.  He explains that it is important for the family and care providers to take the time to learn how the patient wants to spend their final days or weeks.  Often, in an attempt to avoid telling the patient they are dying, doctors subject their patients to a series of worthless treatments which may make them miserable or even shorten their lives!

This book covers a great deal of helpful information which will make it much easier for you and your loved ones to make more informed decisions about where they want to live during the final years of their lives and the types of treatments they wish to try.  In many cases, it will enable families to improve the quality of the time they spend with a loved one who is dying.  This is a book which every family will be able to use as a helpful guide when they have aging family members.

The book, "Being Mortal: Medicine and What Matters in the End" is available in hardback, paperback, audio, Kindle, and large print editions in bookstores and from Amazon.

To learn more about common medical issues which affect us as we age, suggestions on where to retire, Social Security, Medicare, changing family relations, financial planning and more, use the tabs or pull-down menu to find links to hundreds of additional helpful articles.

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Photo credit:  Google images

Wednesday, April 18, 2018

Dementia and Alzheimers Symptoms Vary Widely

Over the past year, my husband and I have spent time with two relatives who were deep in the depths of dementia.  In both cases, their situation was tragic, although their symptoms were very different.  As a result, I thought it would be helpful for my readers to know more about the different symptoms and stages of dementia so they can be more aware of the symptoms when they begin to see them in their loved ones.

Below are two personal examples of what can happen when people get dementia, followed by the Alzheimer's Association list of the symptoms of dementia at different stages.

The Alzheimer's Disease of My Mother

In the first case, my mother's late-stage dementia reached the point where she became very suspicious and uncomfortable around people she did not see on a daily basis.  Although my mother and father lived with my sister and her husband during the last three years of my mother's life, she tended to be very unhappy during much of that time, especially whenever my sister had friends visit. 

My mother is the woman in the photo above and seemed the happiest when she was only surrounded by family. She would tell other people she wanted them to leave and that she did not want them in "her" house.  In one case, she even hit a man in the face with her fist when he came to trim the hedges.  Fortunately, she was so frail that her punch was harmless, although unexpected.  Before dying from her dementia, combined with congestive heart failure, she had reached the point where she needed constant care, could no longer walk or eat on her own, and seemed unaware of her surroundings.

The Dementia of My Sister-in-Law

In the second case, my husband's older sister moved into an assisted living community a year ago when she became lost several times in the gated community where she had lived for 25 years.

We recently visited her for a few days at her new assisted living community. It was sad to realize she did not remember the names of her grandchildren and great-grandchildren.  She did not remember that she used to play golf with us or walk on the beach with her dog.  She did not remember trips she took or special events such as family weddings.  She no longer has any hobbies.  She rarely watches television, plays the piano, or participates in any activities at her assisted living community.

She was unaware of what was happening in the world outside her community. She could not name one thing she did during the day, although her physical health was good and she was able to walk around easily. Both days we visited her, she was wearing jeans and a heavy sweater, although the temperature was nearly 90 F.  However, she was friendly and gracious.  She genuinely seemed to enjoy our visit, although she probably did not remember it after we left.  She happily showed us around her community, although she got lost walking the 100 yards from her cottage to the swimming pool.  She was very cheerful, and did not seem at all fearful or distressed to be around other people.  She realized that her memory was not very good, but laughed it off.

After these two visits, I began to wonder about the different forms dementia could take.  The information I learned from the Alzheimer's Association is listed below.  It helped me understand that my mother and sister-in-law were in different stages of their dementia.  The symptoms listed below may help other people understand what is going on with their loved ones.

Diagnosing Dementia

One question people often have is the difference between dementia and Alzheimer's Disease.  Dementia describes a spectrum of illnesses which cause memory or thinking problems.  Alzheimer's is the most common and is thought to be responsible for approximately 70 percent of cases, but it is not the only cause of dementia.  For example, after a stroke, a patient may develop vascular dementia.  Dementia can also be a result of a variety of illnesses including Parkinson's disease, Huntington's Disease, Creutzfeldt-Jakob disease, Lewy Body, hydrocephalus, and combinations of different diseases.  It is possible for someone to have more than one type of dementia at the same time. 

In order for someone to be diagnosed with dementia, they must be impaired in at least two of the following areas, according to alz.org, the website for the Alzheimer's Association:

* Memory
* Communication and language
* Ability to focus and pay attention
* Reasoning and judgment
* Visual perception

The Alzheimer's Association website said they "may have problems with short-term memory, keeping track of a purse or wallet, paying bills, planning and preparing meals, remembering appointments or traveling out of the neighborhood."

Those symptoms were certainly true for both my mother and sister-in-law.  While both had been very capable women throughout most of their lives, dementia caused them to lose the ability to handle their finances, safely drive a car, or take care of themselves, even before their memory loss became severe.

Common Symptoms of Dementia

Early Stage:

Difficulty remembering names of new people
Trying to remember the right word
Forgetting what you have just read
Losing important items
Difficulty with common tasks

(Many people may identify with some or all of these symptoms, which is one reason why it is so difficult to diagnose dementia in its early stages.  Someone with early stage dementia or mild cognitive impairment may never get worse, or they could be at the beginning of more severe dementia.  It is difficult to predict.)

Moderate Stage:

Forgetting your own past history, address, or phone number
Becoming moody, withdrawn or frustrated
Dressing incorrectly for the season or situation
Trouble controlling bladder and/or bowels
Changing sleep patterns
Wandering and becoming lost
Personality changes such as becoming suspicious, having delusions, or exhibiting compulsive behaviors

(During this stage, my mother became suspicious and moody; my sister-in-law dressed incorrectly for the weather. Both forgot large pieces of their personal history, and became lost easily.)

Late Stage:

The need for constant personal care
Loss of awareness of surroundings and experiences
Diminished physical abilities such as walking, sitting or even swallowing
Difficulty communicating
Lower immunity to infections such as pneumonia

(My mother was in this stage during the few months before she died. During the last few days, she could no longer swallow or communicate. My sister-in-law has not yet reached this stage, but ultimately she probably will.)

Dementia is a frightening illness and a slow, tragic way for your life to end ... unable to remember your own past or your connection to loved ones.  However, research is ongoing and there are medications which can sometimes slow down the symptoms.  If you suspect that you or a loved one could be showing signs of dementia, talk to a doctor right away.

For more information about common medical issues as we age, financial planning, where to retire, Social Security, Medicare and more, use the tabs or pull-down menu at the top of the page to find links to hundreds of additional articles.

You are reading from the blog:  http://www.baby-boomer-retirement.com

Photo credit:  Photo taken by author; all rights reserved.

Wednesday, April 11, 2018

Should You Use a Robot Money Management Advisor?

Over the past few decades, robots have taken over many different types of jobs in areas such as manufacturing, airline reservations, banking and more.  However, would you trust a robot to manage your money and make investment decisions for your portfolio?  You might be surprised to know that Schwab has 120,000 Intelligent Portfolio robo-adviser customers, and more than half of them are over age 50.  Vanguard and Fidelity also have these type of managed financial accounts.

Currently, only about one-half of one percent of all investment assets are handled by robot-advisers.  However, it is estimated that by 2020 they will be responsible for approximately 5.6 percent of all financial assets.  Since it is likely that companies will soon be promoting these robo-advisory accounts, it would be a good idea for all of us to understand them better.

Over Half of Retirees Personally Handle Their Investments

According to an article in the April / May 2017 issue of AARP Magazine, titled "Should a Robot Manage Your Money?" many people simply handle their own investments.  According to them, only "52 percent of pre-retirees and 44 percent of retirees" actually consult with a human adviser.  The reasons for this are complicated, but often boil down to the fact that they believe human advisers are expensive and they are unsure how to find one they trust.  As a result, for better or worse, many people simply prefer to make their financial decisions without outside assistance.

How Does a Robo Advisor Work?

Robo advisers offer a variety of investment portfolio options, but they generally consist of stocks and bonds which are held in ETFs ... exchange-traded funds which are traded as stocks.

The robo adviser sends you an online questionnaire and they use your answers to choose the best combination of ETFs to put in your portfolio and meet your investment goals.  Your account can be either a tax-deferred IRA or a taxable account.

The robo adviser will re-balance your portfolio periodically so it stays within the range of your target allocations.  In order to help the robot, you can regularly update the questionnaire.

With a robo advisor, you do not have direct access to your investments.  You cannot quickly move the money in response to the market.  It is passive, long-term investing.  Once you retire, robo advisors can continue to manage your portfolio, if you choose, and assist you in calculating the required minimum distributions which you need to take once you reach the age of 70 1/2.  They can also help you choose which investments would be best to sell when taking the distributions.

How do Robo Advisors Perform?

According to the AARP article, there are no long-term studies which could help you compare results between humans and robots.  Their article contained some hypothetical comparisons, which I will not report here, because they were based on their best guess, not on actual results.

Your actual performance would reflect the performance of the indexes behind the ETFs in which your account is invested.  You would also have the advantage of low fees, approximately 0.25 percent of your portfolio value each year.  Human advisers typically charge between 1 and 2 percent.

A robo advisor will re-balance your portfolio regularly.  This would be accomplished by the automatic sale of investments which had gone up the most and investing the proceeds in investments which lagged.  In other words, you would be selling high and buying low.

Robo advisors are considered very safe, conservative investment managers, according to the Consumer Action advocacy group, because the accounts are so widely diversified, re-balanced regularly, and invested for the long term.  They are covered by SIPC insurance or the Securities Investor Protection Corporation.  It does not protect investors against loss, but does protect them if the financial institution goes broke.

What do Investors Lose by Having a Robo Advisor?

The most important thing you would lose by having a robo advisor is human advice.  The robots cannot answer your questions, or make recommendations regarding other aspects of your financial plan, such as the best time to take Social Security, whether or not you should get an annuity, or provide assistance with similar decisions.

More Thoughts about Robo Advisors

It is possible to have a hybrid solution.  For example, Vanguard's Personal Advisor Services combine a human advisor with a robo advisor.

Robo advisors are not right for everyone.  Some people may be more comfortable either handling their investments themselves or dealing with a human who can explain their investments to them and help with other financial decisions.  However, for the 5 or 6 percent of investors who will be using robo advisors in the coming years, it is important they understand how they work, as well as the advantages and disadvantages of using them.

For more information about financial planning, where to retire, common medical issues, Social Security, Medicare and more, use the tabs or pull down menu at the top of the page to find links to hundreds of additional articles.

You are reading from the blog:  http://www.baby-boomer-retirement.com

Photo credit:  Pixabay

Wednesday, April 4, 2018

Age Well with Yoga

In virtually every article which discusses reducing stress, recovering from a serious illness, increasing your flexibility or improving your overall health, yoga is mentioned.  Approximately 36 million Americans practice yoga and more than one-third of them are over the age of 50.  However, many more senior citizens are intimidated or uncomfortable with the idea of yoga.  Since virtually everyone would benefit from this relaxing form of exercise, it is important to understand it better.

Benefits of Yoga

There are a number of benefits of yoga, even for those who will never be able to get into the lotus position or gracefully flow into any of the better known positions.  Simply doing your best and carefully stretching as much as you can has tremendous benefits for nearly everyone.  Below are some of the positive benefits to your body if you practice yoga regularly:

* Increased flexibility
* Better balance
* Less Stress
* Fewer symptoms of depression
* Lower blood pressure and LDL cholesterol
* Better sleep, especially when yoga is done before bed
* Less back and neck pain
* Fewer headaches
* Reduced inflammation
* Better breathing
* Clearer thinking and focus
* Less weight gain as you age
* Greater aerobic capacity
* Easier cancer recovery
* Less urine leakage for women
* Better blood glucose levels

Personally, I began taking yoga 31 years ago with a friend who was being treated for breast cancer.  Her doctor had recommended it as a gentle way to for her to regain some of her strength after her surgery and other treatments.  She recovered and is alive today.  Although I started out merely to lend support to a friend, I have continued to faithfully take yoga classes over the years and it has helped me with many of the items on the list above, including greater flexibility and reduced stress and back pain.

You are Never Too Old to Start Yoga 

My current yoga instructor is 84 years old and many of the students in my class are in their 70s, 80s and 90s.  Many of them are unable to get into all the positions, especially if they have had surgery, a hip replacement, knee replacement or other medical concern.  Some of them have been told by their doctors not to do a position in which their head is below their heart.  All of this is perfectly okay.  Most yoga instructors are accustomed to making modifications to the positions so their students can stretch safely.

How to Get Started with Yoga

The best way to get started with yoga is to take a class.  Try a variety of classes until you find one which feels comfortable.  If you have trouble getting up and down from the floor, look for a chair yoga class or ask the instructor of a beginner yoga class if you can start out by sitting in a chair and doing as many stretches as possible while seated or standing.

While checking out the classes, observe whether or not the instructor is calm and relaxed, because this will help you relax, as well.  In addition, you want to make sure the instructor pays personal attention to the students and modifies the positions to meet their specific needs.  Pay attention to the atmosphere of the class, noticing things such as the music and temperature, and decide whether you think you would enjoy the class.  Keep looking until you find one which feels right to you.

You can find yoga classes at senior centers, YMCAs, and the recreation department of many cities.  Frequently they offer special classes for senior citizens or people with limited mobility.  In some communities, you may be able to find free or very low-cost classes.  There are also private studios, although their classes may be more expensive than ones from the facilities mentioned above.  However, once you are on Medicare, many Medicare policies have a Silver Sneakers benefit, which means they cover most or all of the cost of a gym membership in your area, and many gyms offer yoga classes.

Equipment costs are minimal, although you may want to buy a mat, a yoga strap and a couple of blocks.  The strap and blocks will make it possible for you to modify the positions so they are easier. You can find whatever you need in stores such as Target and WalMart. You may also want to take a towel or small blanket to class to make it easier to sit comfortably in certain positions.  You can choose to wear yoga pants or any loose fitting, comfortable clothing.

Finally, do not get discouraged if other students seem to be more flexible and capable of maintaining the positions than you.  They may have been practicing yoga for years.  In addition, you are not competing with them.  You are only trying to improve your own skills ... something which is sure to happen if you are consistent in your practice.  Yoga is truly an activity where you can be non-judgemental and proceed at your own speed.  If you have an injury, don't push through it.  Avoid any moves which could worsen your injury until a doctor tells you it is OK to put pressure on that part of your body.

Once you have learned the basic yoga moves, practice a stretch or two whenever you get a chance .... before you go to sleep at night, when you wake up in the morning, and even while you watch TV.  You may even want to enhance your home yoga practice by purchasing a Himalayan salt lamp or a healthy fresh sugar scented candle.  These types of mood enhancing items can help you create the perfect yoga atmosphere in your home. You'll love the way your body feels when it is flexible and moving smoothly! 

If you are interested in more information about common medical issues as you age, where to retire, financial planning, Social Security, Medicare, travel and more, use the tabs or pull down menu at the top of the page to find links to hundreds of additional articles.

You are reading from the blog:  http://www.baby-boomer-retirement.com

Photo credit:   morguefile.com