Could
Your Loved One Have Post Traumatic Stress Disorder?
Written
By: Geriatric Planning
Specialist
Amy
G. Bailey
,
MSW, RN
Post-traumatic
stress disorder is a term we tend to associate with veterans of the
Vietnam War. However, there
is increasing evidence that veterans of World War II not only experienced
PTSD, then called "battle fatigue," but are having renewed and
sometimes more severe attacks at this time in their lives-as they reach
their 80s and 90s. This brief
article defines PTSD, presents a few reasons for the renewal of the
disorder in elderly veterans, lists some possible symptoms, and gives some
suggestions for help. For
more information, please contact the Veterans' Administration or your
physician. General
information is also available on-line at the
National
Center
for PTSD, at www. ncptsd.org/facts/veterans.
PTSD
can be defined as a series of negative symptoms as part of a natural
response to exposure to a traumatic event.
What does this mean? First
of all, the individual experienced an event which to him was terrifying,
intense, and terrible. Second,
following this event are a group of uncomfortable feelings:
1. The first group of
feelings can be a re-experiencing of the event.
This includes such things as intense memories, nightmares, or
flashbacks, accompanied by feelings of intense distress.
A study presented in the Journal of the American Geriatrics Society
stated that "Increasing numbers of World War II and Korean War veterans
are displaying symptoms of post-traumatic stress disorder linked to severe
dementia. In many cases,
paranoid 'reenactments' of combat situations have caused veterans to
inflict...harm" to those around them.
2. The second group of
feelings is referred to as "hyper arousal." This includes intensified
feelings of danger, irritability, impatience, a high "startle
response" and problems with insomnia, and concentration.
An example is the individual who will only sit with his back to a
wall in a restaurant, or who jumps when a fire siren sounds.
This results in an increase in heart rate, breathing, sweating and
muscle tension. These
symptoms of anxiety may become long term or chronic, and can then
contribute to other problems, such as heart disease.
3. The third group of
feelings is sometimes referred to as numbing or avoidance.
In this situation, individuals avoid thoughts, feelings, or people
which may have been associated with the traumatic event.
They may seem depressed or unable to establish an interest in life,
family, friends, or activities, or may turn to alcohol abuse.
Not
all World War II veterans have PTSD.
No one is sure why one veteran would develop the disease and not
another. It is thought to be
related to the type and length of the traumatic event, the personality of
the victim, and the environment of the individual following the trauma.
Please note that PTSD is NOT a sign of weakness, but rather a
response to a horrifying and painful experience.
As many as 10% of the World War II and Korean Conflict veterans are
thought to have some form of PTSD.
Years
ago, "battle fatigue" was considered something one simply endured.
Now, especially since the
Vietnam
and Gulf War conflicts, there is
increased medical and psychological knowledge of the disorder, less stigma
attached to the diagnosis, and more support available.
A
returning WWII or Korean War veteran may have experienced some of the
difficulties described above, and then the symptoms may have resolved.
It is thought that this process was helped by the positive support
which existed for returning veterans and to the excellent post war
economy. Most returning
veterans also had the assistance of coping mechanisms such as a spouse,
friends, compatible work, and family life.
Even
though it seems that the veteran has "gotten over it," this is not
always the case. Sometimes
events which are considered a normal part of aging, such as retirement,
death of a loved one, or illness can trigger a renewed experience of PTSD.
For example, one veteran may have coped with his difficulties by
becoming totally involved in work. Once
he reached retirement, this coping mechanism was no longer available to
him. Another may have lost
his best friend to death, and this might bring feelings of survivor guilt
to the surface again. It does
not matter that the war was 60 years ago; increase of PTSD in elderly
veterans is common.
If
you think your loved one might be suffering from PTSD, there are things
you can do. Most importantly,
remain calm. If he needs to talk about the war, be a good listener.
Acknowledge that the individual is having a difficult time and reassure
him that you would like to help. Do not tell him to "get over it."
Second,
contact your physician or your Veterans' Administration for further
assistance. Help is available in the form of medication to relieve
symptoms of anxiety, anger and nightmares.
Individual and group counseling, and support groups have also
provided relief.
Third,
learn about PTSD and how if affects elderly veterans. Books recommended by
the
National
Center
for Post-Traumatic Stress Disorder
are I Can't Get Over It, by Aphrodite Matsakis; and Home from
the War, by Patience Mason.
Our
veterans fought for us under horrible conditions.
They deserve our support and help.
Resources for
this article included information from the Veterans' Administration, the
National
Center
for Post-Traumatic Stress Disorder,
the
Brain
Injury
Resource
Center
, Journal of the American Geriatrics
Society, and the American Journal of Nursing.
Amy Bailey can
be contacted at abailey@paelderlaw.com.
HH
Bond Offerings will be Obsolete Starting
September
1, 2004
Written
By: Geriatric Planning Specialist, Michael Rentko
The Bureau of
the Public Debt announced in February that they will no longer offer
Series HH Savings Bonds to the public after
August 31, 2004
.
Bonds purchased prior to that date will continue to pay out
interest until their final maturity 20 years after issue.
Previously, HH bonds were available in exchange for Series E or EE
bonds. This exchange allowed
an individual to continue deferment of income tax obligations on the gains
for an additional 20 years.
Individuals who
have maturing EE or I Bonds may choose to invest the proceeds of maturing
bonds in Treasury bills or notes at auction, or new Series EE or I savings
bonds. However, the new
investment will no longer defer the interest that the previous bond
accumulated. All the deferred
interest that accrued on the exchanged bonds will become taxable on the
date of the exchange.
The 24 year old
Series HH program, popular among retires and seniors, is coming to an end
as part of several efforts by the U.S. Treasury to curb costs.
Additional Information about the elimination of the HH Savings Bond
is available at http://www.publicdebt.treas.gov/sav/sbhelim.htm.
Michael Rentko
can be contacted at mrentko@paelderlaw.com.
Medicare
and Home Care Changes Discussed
at
Professional Updates
Written
By: Melissa Bottorf, Public Education Coordinator
Seniors
are being faced with many new options for their health care, but
unfortunately, the choices will not always be easy.
On June 1st, Medicare recipients will have the
opportunity to enroll in the new Medicare-approved drug discount card
program and over the next few months, the Pennsylvania Department of Aging
will be implementing a number of program changes that will result in a
dramatic increase in the number of senior citizens receiving care in their
home rather than a nursing home.
These issues
were discussed at The Elder Law Firm of
Marshall & Associates
8th Annual Professional
Updates which were held on May 6th and May 7th.
Over 200 health care and social service professionals, financial
professionals and advocates for the elderly attended the sessions.
Kevin Costello
of the Elderly Law Project in
Philadelphia
, spoke about the new Medicare Drug
Discount Cards and Transitional Assistance credits for low income seniors.
The new law is complex. The
Centers for Medicare and Medicaid Services directs seniors to the Internet
to compare cards and formularies; it heavily relies on a senior
citizen's internet savvy for success. "This
is a good example of the disconnect between what is going on in
Washington
on the chalkboards and what's
really happening in people's communities and in people's lives,"
remarked attorney Costello. "I
don't know about you, but the seniors I serve don't have the access or
ability to maneuver on the internet."
The Drug
Discount Cards are only expected to save consumers between 10 and 25% off
full retail prescription drug costs.
The minimal savings, combined with the ability of card issuers to
change discounts and covered drugs, lead many to believe few seniors will
enroll in the Program. "What this program does is it saddles frail and
vulnerable senior citizens with all the obligations and burdens of being
smart and savvy and sharp consumers in a fierce marketplace," said
Costello. "That's the fundamental problem here."
Dan McGuire,
Director of Home and Community Based Services for the Pennsylvania
Department of Aging, also spoke at the sessions about the trend of
expanding the availability and improving the quality of publicly funded
in-home services for seniors. "We
are working to rebalance the long term care experience," said Mr.
McGuire. The Department is
hoping to accomplish this objective by eventually having approximately 60%
of Medicaid funding of long term care go to provide home care, a
significant increase from the current 20%.
The Department
is also testing a program called "Community Choice."
Kristen Ballantine
, Public Policy Coordinator for the
Alzheimer's Association and panelist for the Update, said she believes
this initiative will be of great value to seniors with Alzheimer's
disease or related dementia. The
goal of the program is to remove the barriers to rapid initiation of
services. There will be
self-declaration of income, a prescription form a doctor can substitute
for the MA-51, and a "no wrong door" policy.
The "no wrong door" policy means that the help the senior needs
will be available regardless of which government agency the consumer first
contacts. The consumer will
be able to access the services needed without having to go to different
offices or completing duplicate sets of documentation.
For more
information about the Update contact Melissa Bottorf, at webmail@paelderlaw.com.
Oregon
"Death
with Dignity" Law Upheld
Written
By: Jeffrey Marshall, Certified Elder Law Attorney
A federal
appeals court has upheld
Oregon
's "Death with Dignity" law
against attack by the federal government.
The 9th U.S.
Circuit Court of Appeals has ruled that U.S. Attorney General John
Ashcroft exceeded his authority when he threatened to revoke the licenses
of
Oregon
physicians who use drugs to assist
the deaths of terminally ill patients. The court's 2-1 decision held
that the federal government cannot punish doctors for prescribing narcotic
overdoses to terminally ill patients in compliance with the
Oregon
law.
The
Oregon
law was approved by that state's
voters in 1994. As described
in the opinion, the law "authorizes physicians to prescribe lethal doses
of controlled substances to terminally ill
Oregon
residents according to procedures
designed to protect vulnerable patients and ensure that their decisions
are reasoned and voluntary.
Oregon
voters reaffirmed their support for
the Death With Dignity Act on
November 4, 1997
, by defeating a ballot measure that
sought to repeal the law." About 30 people have used the law to end
their lives each year since it became effective in 1997.
Oregon
is the only state that allows
physician-assisted suicide. After the Bush Administration took office,
Attorney General John Ashcroft issued the "Ashcroft Directive"
(published at 66 Fed. Reg. 56,607) stating that a doctor could be held
criminally liable for prescribing federally controlled substances to
hasten the deaths of terminally ill patients as authorized by Oregon's
Death with Dignity Act (Or. Rev. Stat. § 127.800-897).
Judge Richard Tallman, writing
the 2-1 majority opinion used harsh language to rebuke the attorney
general for overstepping his authority. "The attorney general's
unilateral attempt to regulate general medical practices historically
entrusted to state lawmakers interferes with the democratic debate about
physician assisted suicide." The action by Attorney General John
Ashcroft "far exceeds the scope of his authority under federal
law," wrote Judge Tallman.
The court
stated that it was not taking a position on the legitimacy of
physician-assisted suicide, but merely holding that
Oregon
rather than John Ashcroft had the
superior right to decide this question of medical treatment in the state.
It noted that the prior U.S. Attorney General, Janet Reno, had
declined to intervene with the law on the basis that
Oregon
should be allowed to regulate its
own doctors.
The court's
decision may not be the end of this litigation. Pro-life groups are
hopeful that the United States Supreme Court will overturn the appeals
court decision. "The 9th Circuit majority's odd decision is that
state law controls federal law. We are confident that the U.S. Supreme
Court, on appeal, will ultimately uphold the position of Attorney General
Ashcroft," said pro-life attorney Burke Balch,director of the
National Right to Life Committee. http://www.lifenews.com/bio316.html.
The opinion,
Oregon
v. Ashcroft, No. 02-35587,
May 26, 2004
, is available at the 9th
Circuit Court of Appeals website, http://www.ca9.uscourts.gov/.
Attorney
Marshall can be contacted at webmail@paelderlaw.com.
"Paying
for Long-Term Care: What Families Need to Know" Presentation Set for
Wilkes-Barre
G
etting good information about options for long term care is critically
important for seniors. Four out of every ten people reaching age 65 will
spend some time in a nursing home and many more will require home care and
assistance with daily living.
The
Elder Law Firm of
Marshall & Associates
is known throughout
Pennsylvania
for the expert help we provide
seniors who are faced with long term care needs. We help families
struggling to care for their loved one at home find the programs and
financial help they need. Our
help can mean the difference between staying at home and moving to a
nursing home.
If
nursing home placement becomes necessary, we work with the facility to
help make the transition go as smoothly as possible. We make certain that
the nursing facility gets paid in a timely manner while helping the family
qualify for government programs that help pay the costs.
Marshall & Associates
occasionally holds free educational
forums to help educate families and their advisors about the options that
are available to pay for long term care in the home or a nursing home. Join
us for one of these free presentations and learn what you need to know
about how to get the help you need and protect your family's financial
security when your spouse or parent is faced with a long term illness.
Each
presentation is FREE and open to seniors, their families, elder care
professionals, and anyone else who needs to learn more about this complex
subject. Each presentation
lasts about 1 ½ hours, including a "Question & Answer" Session.
-
Thursday,
June 10th, 2004
at
6:30
PM
Woodlands
Inn and Resort
1073
Highway 315,
Wilkes-Barre
Reservations
are suggested, but not required. SIGN
UP ONLINE
or call 1-800-401-4552 for more information or to reserve your spot at
this free seminar!
Back
issues of The
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are available on our website.
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so, please feel free to forward it to them. Simply use the "Forward"
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To
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Does
Your Club Or Organization Need A Speaker?
If
you are interested in having an attorney or geriatric planning specialist
from
The
Elder Law Firm of Marshall & Associates speak to your group, or at an
upcoming event, please contact
our
Public Education Coordinator, Melissa
Bottorf
at
mbottorf@paelderlaw.com
or 1-800-401-4552
*Attorney
Marshall
is
certified as an Elder Law Attorney by the National Elder Law Foundation
under authorization from the Pennsylvania Supreme Court
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Marshall & Associates www.paelderlaw.com
