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More and more, growing older means making choices [Senior Circles]

"It's about their choices." Dr. Anna Maria Izquierdo-Porrea, M.D., Ph.D., made this statement in her keynote address at this year's Maryland Gerontological Association conference, "Empowerment through Choices," held June 11 at Charlestown Retirement Community, in Catonsville.

Executive director and co-founder of Care for Your Health Inc., Dr. Izquierdo-Porrea refers to seniors in the above statement made during her talk, titled "Making Choice a Reality for our Elders."

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She said that we have many decisions to make as we age and we need to review all our options and make realistic choices. As long as we can, we should make our own decisions. Families need to look at things from the elder's perspective.

Seniors need to inform others about end-of-life wishes. We may need to make a decision on our living situation. Do we want to age in place and die at home? Do we want to go into assisted living or a nursing home? What do we want in an advanced directive, which documents our choices concerning medical treatments at the end of life?

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One of the most important choices is how we are going to live. We need to "create our own life, one that can be supported with declining capacity." There are also decisions around relationships: marrying in old age, sex and family. There are trust decisions dealing with finances and naming a power of attorney.

Dr. Izquierdo-Porrea said, "Life is all about choices." On her slides, she had a quote by Voltaire. "I have chosen to be happy because it is good for my health." I loved her story about a patient who said that he wanted her to be his "Angel of Health."

Following the keynote was a panel discussion on "Choosing Wisely," which is a national campaign "aimed to help patients take a more involved role in their health care by learning to choose medical tests and treatments that are supported by scientific evidence, are not duplicative of past tests or procedures, and are truly necessary for diagnosis or treatment."

The panelists included moderator John Burton, M.D., Director, Johns Hopkins Geriatric Education Center, Professor of Medicine, Johns Hopkins University School of Medicine; Matt McNabney, M.D., Associate Professor of Medicine, and Ariel Green, M.D., Assistant Professor of Medicine, both with Johns Hopkins University, School of Medicine, Division of Geriatrics and Gerontology.

Dr. Burton cited the start of doctors seriously considering the high cost of health care and their role in helping to lower health costs with an article, "Medicine's Ethical Responsibility for Health Care Reform – The Top Five List."

Brody's proposal was the impetus for a study in 2010 of three primary care specialties looking at which diagnostic tests and procedures could be safely reduced in the treatment of patients. There are now 70 specialty groups continuing the conversation about low value services.

Dr. McNabney and Dr. Green, members of the American Geriatric Society, discussed medications. They stressed that doctors should not prescribe a medication without checking all of the patient's medications and that medication should be stopped after one year if there is no change in the patient's condition, especially in patients with dementia.

After lunch and an awards ceremony, the program began with "Caregivers Stress, End of Life Decisions, and Dignity," an interactive performance by the Maryland Mental Health Players of the Mental Health Association of Maryland.

Characters included in the three vignettes were a caregiver, a dying mother, her son and daughter, the doctor and the activities director at a nursing home. After each act, the players stayed in role and audience members had the opportunity to comment.

Diane Megargel, group leader, facilitated the interaction. This format got people to discuss topics that are often avoided.

The last presentation was on "Intimacy and Sexuality for Seniors," presented by Ruth Kershner, MA, MSW, LCSW-C, certified long term care ombudsman, Montgomery County. Kershner provided an overview of the attitudes and treatment of sexual relationships for senior living. She discussed the issue of choice for seniors who are considered competent and for seniors who have dementia. Through case studies and discussion, she taught positive methods to handle inappropriate sexual behavior due to dementia.

Kershner said that seniors need touch; they need love, intimacy and sex. She stated that senior living facilities should have sexuality policies and that residents have rights – all needs should be met. She recommended that if you think there is sexual activity going on in a resident's room, use the KISS rule: Knock; Introduce yourself; State your purpose; and Smile!

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