Search

Imagine entering a room and seeing exuberant seniors dancing to a syncopated beat. The smiles on their faces and the sweat on their brows tell a story: There is hard work being done here — and every moment is an absolute joy. Visitors to the Jewish Home’s Zumba and chair dancing classes often come across just this type of scene. The seniors’ enthusiasm, says Caryl Geiger, Activity Director at the Home, is contagious. “Every time I walk in there, I smile, and I’m not even taking the class! Dancing just makes you feel good.” Researchers tell us that Caryl’s observation is actually measurable. Study after study is providing dramatic evidence that for seniors, dancing can be just what the doctor ordered. “We can now say with confidence that dance has significant physical and psychological benefits for seniors,” says Noah S. Marco, M.D., Executive Director of the Brandman Research Institute and Chief Medical Officer of the Los Angeles Jewish Home. “Among its many plusses, dance activates muscle memories that may have been dormant for years. For seniors, dancing can be a safe, natural, and easily accessible way to reawaken both their bodies and their minds.” The American Dance Therapy Association has published an extensive study on the effects of dance and movement on seniors. Data was collected from more than 100 movement therapy practitioners and the conclusions were remarkable: “Dance increases quality of life for seniors. It promotes resiliency and physical and psychological health, including an increased ability to cope with anxiety, depression issues, and the behavioral changes associated with dementia and cognitive impairment.”* The results from a 21-year study of senior citizens by the Albert Einstein College of Medicine in New York were even more striking. Scientists studied physical activities like swimming, walking, and bicycling. One of the studies biggest surprises was that the only physical activity to offer meaningful protection against dementia was frequent dancing.** The benefits, notes Caryl, extend beyond memory retention. “Dancing improves flexibility, social skills, and motor skills,” she says. Of course, movement comes naturally to children. They live through their bodies — running, playing, falling, and getting up. As we age, however, many of us tend to become less physically active. But by the time we enter our senior years, we may be sedentary or at least heading in that direction. The good news is that one of the best remedies is also the simplest and most enjoyable. After all, there is a dancer in all of us. * https://adta.org/2015/11/23/dance-movementtherapy-elderly/ ** https://www.nejm.org/doi/full/10.1056/NEJMoa022252

Dr. Noah Marco, the Home's Chief Medical Officer, appeared on the Who Cares? Podcast presented by Honor. The podcast explores the future of home care through engaging interviews with thought leaders and innovators in the senior care space. Dr. Marco discussed current innovations in care for older adults and what's needed most, industry-wide, to improve post-acute care and wellness support Download the podcast on iTunes at https://itunes.apple.com/us/podcast/innovative-l-a-jewish-home-dr-noah-marco/id1436238216?i=1000419806722&mt=2 or on Spotify at https://open.spotify.com/episode/6LO4f5JnbtyuHsDMkAk2Ie

We all want a better life for those living with memory loss. “Person-centered care” is an approach that guides caregivers and families in knowing and honoring the person first – before the disease. This approach aims to see the person with dementia as an individual, rather than focusing on their illness or on abilities they may have lost. It is based on the principle that all individuals, regardless of their disability, deserve to be treated with dignity and respect and can lead fulfilling and meaningful lives. Person-centered care is the guiding principle of the Jewish Home’s Goldenberg•Ziman Special Care Center. This approach considers the whole person, taking into account each individual's unique qualities, abilities, interests, preferences and needs, instead of treating the person as a collection of symptoms and behaviors to be controlled. All GZ staff members are involved in the residents’ care and are responsible for the “life happiness” of those in the Center. Families are an integral part of this process, helping the GZ staff learn life stories, personal likes and dislikes, working history, and special cues used to communicate. This information is incorporated into the care plan and helps the staff develop meaningful relationships with the individual. At GZ, a variety of person-centered activities and techniques are evident in daily life. For example, reminiscence is facilitated with appropriate props and considers the importance of each individual’s reality. The GZ staff tries to ensure no task or aspect of care is placed higher than the experience of the individual. Routines and activities are designed so they are flexible for the person with dementia, or easily adapted according to individual’s wishes. There are numerous benefits to a person-centered care approach. It has been shown that when people with dementia are involved in social activities and encouraged to become engaged in activities they find enjoyable, there is an improved quality of life, particularly in reducing challenging behaviors. Studies have also shown decreased agitation can be obtained in person-centered care programs if there is freedom of choice regarding daily activities scheduling. This can lead to decreased verbal agitation levels. Person-centered care can also help in sustaining a good relationship between the caregiver and the person affected by dementia. This in turn can maintain the individual’s high level of psychological well-being and productive behaviors and reduce depression. Research indicates when people with dementia are being provided with the opportunity of expressing themselves and their needs, they will maintain a positive sense of self. This can significantly reduce their feelings of grief, anxiety, anger and feeling like a burden to others. Respecting past interests and current capabilities can improve sleep during the night and daytime napping, as shown in person-centered care research programs. Person-centered care can also be a benefit for the staff. It has been shown that this approach reduces caregivers' frustrations and saves money by reducing hospitalizations and the use of medications, but more importantly, it provides a better quality of life for persons with dementia and their loved ones.

November is National Alzheimer’s Disease Awareness Month. Today, 5.4 million Americans are living with Alzheimer’s and the number is rapidly growing. Since 1983—the year President Ronald Reagan designated November as National Alzheimer’s Disease Awareness Month—the number of Americans living with Alzheimer’s has more than doubled. By the year 2050, the number of seniors aged 65 and older is projected to triple. Although the risk for Alzheimer’s disease is higher than ever, making the decision to live a healthier lifestyle can help protect you. Here’s what you can do to reduce your risk of Alzheimer’s disease: Maintain a healthy diet. Eating nutrient and vitamin rich fruits and vegetables regularly helps to improve cognitive function and enhance memory. Try adding fresh produce of all shapes, sizes, and colors to your daily meals. Exercise often. Regularly participating in easy to moderate exercise increases blood and oxygen flow to the brain. Gradually build your strength, balance, flexibility, and endurance with a doctor approved exercise regimen. Get enough sleep. Sleep is essential for brain function, memory retention, and emotional well-being. Getting the recommended 7-9 hours of sleep each night will help to reduce stress, improve productivity and focus, and enhance your mood. Stimulate your mind. Studies show having a healthy brain may play a large part in reducing one’s risk of Alzheimer’s disease. Learning a new skill or language, attending a class or workshop, playing an interesting card or board game, or working on a challenging puzzle can help to keep your brain’s connections stimulated and strong. Get involved. Adults who regularly volunteer are more likely to stay socially engaged which helps preserve cognitive ability and gives seniors the option to enjoy an active and independent lifestyle. Look for opportunities in your community where you can share your skills, wisdom, and talent with others. Because much of Alzheimer’s disease research is inconclusive, there is still plenty for us to learn about this disease. Currently, no cure exists for Alzheimer’s. However, some medications can help to slow the disease’s progress. With so many unanswered questions about Alzheimer’s disease, it is more important than ever to take preventative measures to protect ourselves. The Jewish Home's Goldenberg•Ziman Special Care Center (G•Z) provides exceptional care for individuals with Alzheimer's disease and dementia, and support for their families. The Center is known for its award-winning design, pioneering practices and technologies, and compassionate care. "As an industry leader in dementia care, G•Z works closely with residents, families, and staff to spread awareness of Alzheimer’s disease within the community," G•Z community manager Susan Leitch says. "The Home offers a variety of informative training sessions for staff and community seminars like the Sarnat Symposium. With these critical tools, we are able to do our part and spread awareness of Alzheimer's disease, all while helping to provide our residents and their families with the highest quality of life possible." To learn more about Alzheimer’s disease and National Alzheimer’s Disease Awareness Month, visit www.alz.org. To learn about the Home’s Goldenberg•Ziman Special Care Center for Alzheimer’s disease and dementia care, please contact Susan Leitch, community manager, at [email protected] or (818) 774-3113 or visit our website.

Anxiety, an experience of tension and apprehension, is an ordinary response to a threat or danger. Excessive anxiety that causes distress or interferes with daily life is not a normal part of the aging process. Michael Fresé, Ph.D., is a clinical psychologist specializing in geropsychology. He recently sat down with e-Connections to talk about the signs and symptoms of anxiety among seniors. Have you experienced heart palpitations, feeling out of breath, or a sensation of being suffocated? Are there times when you sense numbness or tingling in your fingers, chills or hot flashes, restlessness? How about difficulty concentrating, memory gaps, irritability, or feeling like you are at the end of your rope? If so, you might be experiencing anxiety or have an anxiety disorder. Among older adults, many worry about their increasing number of health issues, family, limited finances, and their own mortality. More often than not, these worries can become exacerbated when individuals experience either a mental or physical decline and a loss of autonomy. When the anxiety is at a level which causes significant impairment in daily functioning and is a source of distress, it is considered an anxiety disorder. Some of the causes of anxiety in older adults include losses during the aging process (loss of autonomy, health, intellectual capacity, loved ones) as well as having thoughts of danger and vulnerability associated with losses. Similar to depression, when asked, many older adults deny feeling anxious. Individuals might admit to feeling overwhelmed, worried, having a short fuse, or experiencing physical sensations that they attribute to old age. In addition to the symptoms listed above, it is important to inquire about the following: Appetite: individuals who are anxious might overeat to calm themselves, resulting in weight gain or they may lose weight by skipping mealsGoing out: anxious individuals might stay at home to avoid their fearsInterests: those who are anxious have a difficult time finding pleasurable activities as they become more fearfulPhysical complaints: as older adults are more likely to report physical causes of their anxiety symptoms (as well as experience medical conditions that might overlap the symptoms of anxiety), asking about such physical complaints as chest pain or shortness of breath is importantSleep: People experiencing anxiety might sleep to avoid their fears or have difficulty sleeping due to ruminating about imagined or exaggerated fearsSocial isolation: social contact and activity is important for lifting a person’s spirit and calming their fears; however, sometimes a person’s anxiety is such that they find a false sense of security in being alone, which can increase their level of anxiety and result in a vicious cycle. You might be saying to yourself, “that sounds like me!,” or “that sounds like someone I know!” and you are curious to know what you can do to help yourself or a loved one. For some, a family member or friend might be able to provide comfort and reassurance. For others, being engaged in creative, social, or other activities that are of interest can be helpful. Getting to the source of the anxiety and dealing with it directly is very important. For example, helping older adults deal with concerns about being a burden, financial matters, and health issues can make a difference.Psychotherapy such as cognitive behavioral therapy, problem solving, and interpersonal psychotherapy are all effective ways of helping those with anxiety. Psychoeducation and support in managing anxiety in structured ways, such as progressive muscle relaxation and deep breathing, have been shown to reduce anxiety.When psychotherapy alone isn’t enough, psychiatric medications such as Ativan, Klonopin, or Xanax might be prescribed by a psychiatrist. If you find yourself feeling anxious, overwhelmed, or worried, don’t hesitate to ask for help, whether from a family member, friend, or healthcare professional. Anxiety can be managed and treated, and your quality of life can be improved.

April is National Poetry Month, celebrating an artform that can be evocative, challenging, and inspirational. In honor of this month, we filmed three Jewish Home residents talking about their interactions with poetry—how it inspires them and sparks their creativity even when encountered later in life—and reading original works. An increasing body of evidence documents characteristics of poetry that go well beyond beauty. Indeed, more and more research highlights the positive effects of creative writing on people’s physiological, emotional, and cognitive well-being. In recent years, scientists have used magnetic resonance imaging (MRI) and other instruments to examine the ways in which poetry affects the human brain. Among their discoveries: When we think about a poem’s meaning, it activates particular parts of our brains – some of the same parts we rely on to interpret our everyday reality. An article in the highly regarded Harvard Business Review notes that poetry “teaches us to wrestle with and simplify complexity.” As it sparks our creativity, it can also help us foster a deeper sense of empathy, enabling us to understand the feelings and motivations of our family, friends, coworkers, and community members. Studies show that poems help us in another critical way, too. They cause us to hear words differently and to see them in a fresh light, expanding our ability to use and process language. This stimulates brain function and, ultimately, strengthens brain health. At the Jewish Home, providing an outlet for creative pursuits like poetry, photography, and music allows seniors to broaden their horizons, to push past mental barriers, and to engage with their peers. Active brains can mean happy lives – seniors excited to learn and to embrace the world around them. Jewish Home staff and volunteers encourage seniors to compose, to paint, or to take up any similar activity that can lift spirits and potentially forge new neural pathways. The Home is fortunate to count among our residents aspiring poets at all levels of experience. Ellen Meli has been writing poetry since her youth; Nyla Lyon worked in the entertainment business and started experimenting with verse later in life. Both enjoy shaping words and phrases to express themselves, and both see putting pen to paper as stimulating and therapeutic. Their paths to poetry were different, but their conclusions are the same: Creativity can be a blessing at any age. View Nyla Lyon reading her poem, “The Fireflies’ Glow,” Ellen Meli reading her work titled “How Old?” and Mack Stevens reading an award-winning poem by former resident Shelley Greenspan (of blessed memory) called “See Me With Your Eyes Closed” in three more inspiring videos below.Mack Stevens Reads the Poem “See Me With Your Eyes Closed”Ellen Meli Reads Her Poem “How Old?”Nyla Lyon Reads Her Poem “The Fireflies’ Glow”

Alzheimer's disease is the most common type of dementia. The Alzheimer's Association estimates more than 5 million Americans are currently living with the disease. By 2050, the number of people age 65 and older with Alzheimer's disease may nearly triple — to as many as 16 million people — barring the development of medical breakthroughs to prevent, slow or stop the disease.The impact on family and friends is tremendous. In 2013, 15.5 million family and friends provided 17.7 billion hours of unpaid care for their loved ones. Caregivers face a devastating toll. Due to the physical and emotional challenges of caregiving, Alzheimer's and dementia caregivers had $9.3 billion in additional healthcare costs of their own in 2013. Approximately 60 percent of caregivers rate the emotional stress as high or very high, and more than one-third report symptoms of depression.The Goldenberg•Ziman Special Care Center at the Jewish Home specializes in providing exceptional care for individuals with Alzheimer's disease and dementia and their families. One such family that has experienced the Center's loving care is the Kravitz family.Lawrence "Larry" Kravitz began his struggle with Alzheimer's disease more than a decade ago at the age of 70. Living in Pennsylvania, Larry, a veteran, poet, and psychiatrist with a thriving practice, was happily married to his wife, Betsy, a psychologist, for many years.When he began to show early symptoms of Alzheimer's disease, he did not resist the diagnosis as many people do. In fact, he was in a unique position to observe the effects of the disease on his mind. As a poet, he found solace in expressing his feelings of loss and distance from his loved ones.I was angry at those who thoughtI was becoming forgetful. I didn't notice.Now I'm beginning to appreciatethe life I've had, and to consider completingall my unfinished business!But, the most important of allis to spend more time with those I love! Betsy cared for him as long as she could, but, like many family members, became increasingly powerless against this progressive disease. Soon, her own debilitating health issues claimed her life. That's when Larry's daughters Cathy and Suzie became more involved.As Cathy recalls, Larry's previous residential care experiences were "a nightmare." She would visit and find that he'd been in his chair all day with nothing to do. One day, he wandered out of the facility through an alley and into the path of delivery traffic.Soon afterward, Cathy heard about the Home's Goldenberg•Ziman Center. As Cathy says, "Everything at the Jewish Home is done with love. Staff feels like part of our family."Today Larry is happier and healthier than he has been in years. Cathy visits him every other day now, and often brings her daughter Jaden and her friends, who love to sing and dance for him. Daughter Suzie and granddaughter Lila also visit often. Recently, they spent the High Holidays with Larry and a number of residents, celebrating the New Year with a lovely service and a beautiful holiday meal. "Sometimes, I cry with joy when I walk in here," says Cathy. "It's so wonderful to have my dad in a place where he is safe and well-loved."Think now, feel now.You can worry all you want tonow or in the future.But don't let now pass you by.For more information about the Jewish Home's Goldenberg•Ziman Special Care Center, please contact Susan Leitch, community manager, at [email protected] or (818) 774-3113 or visit our website.

Each year, Skirball Hospice, a program of the Los Angeles Jewish Home, helps over 500 individuals and their families move through the final phase of life's journey. The following is based on one family's story. Sarah* came from a distinguished Jewish family, and, although she was raised with knowledge of Jewish rituals, she identified herself as more of a cultural Jew. What mattered to her was championing causes for people in need, making sure they were fed, housed and clothed. She studied anthropology and travelled all over the world, making friends with people from different cultures and religions. Her Judaism was more focused on the universal, rather than the particular. Having grown up during the Great Depression, Sarah had learned to be frugal and spent money on things that really mattered to her. She wasn't frivolous; she gave monetarily in ways that reflected her values and on causes she believed in. Her four children knew exactly how she felt about the importance of caring for others, both emotionally and financially.At age 90, Sarah was dying from heart disease and was admitted to Skirball Hospice. Her devoted children cared for her around the clock with the help of the hospice team. Her oldest daughter was a great cook and prepared the foods her mother loved. She would sit with her for hours, holding her hand and kissing her cheek. The middle daughters both worked in the medical field and provided the physical care their mother needed. The youngest child, Sarah's son and a bit of an insomniac, stayed with her at night so she wouldn't be alone. Hospice made sure she had the right medications, oxygen when she needed it, and provided emotional support to the family. Their questions were answered and the hospice staff was always available when they needed reassurance. The partnership between the family and the team made a huge difference in the quality of Sarah's last few weeks, and made the prospect of losing her more bearable. Her family was very appreciative of the support they received.When Sarah died, her children knew there wasn't going to be a funeral, memorial, or shiva service, in keeping with their mother's wishes and values. Still, for them, something was missing. There was no coming together to mourn and tell stories, no sense of closure, and no kaddish prayer. Sarah's children had reclaimed some of the Jewish rituals their mother had discarded, and wanted something more for themselves. How could they get that and still be true to what Sarah had wanted?A few months later they received an invitation to attend the annual Skirball Hospice Memorial Service. It was truly an answer to a prayer. All four children attended this touching tribute. Candles were lit, a stone was placed to honor the deceased, and family members were given the opportunity to say a few words in memory of their loved one. Prayers were said, the names of the dead were recited, and the kaddish was read. For Sarah's children, they finally received the solace and comfort they had been looking for. Surrounded by others who had also lost someone dear, they felt embraced and held by the atmosphere of love and acceptance. The staff who had cared for their mom were there to reconnect. With both tears and laughter, Sarah, and all the other former hospice patients, were remembered as only ones who have been through this experience can truly understand.Skirball Hospice will be holding its annual Memorial Service on Sunday, February 22, 2015 at the Skirball Cultural Center. Family members and service providers of people who were on hospice in the past year are invited to attend. For more information, please call Skirball Hospice at 818-774-3040.*fictitious name

In 1983 a documentary was made entitled “A Generation Apart,” which explored the impact of the Holocaust on the survivors’ families. It was described as a “testimony to the power of love.” Over 30 years later, as I walked through the Los Angeles Jewish Home’s Eisenberg Village, I witnessed another testimony to the power of love related to the Shoah. A small group of the Holocaust survivors who live at the Jewish Home were meeting.The group was led by resident Ernest Braunstein. Although I had only been CMO at the Home for a few weeks, I knew several of the participants. One was even from my mother’s city of Lodz, Poland. He and his wife are now my patients. Their daughter was also participating in the group discussion.The number of living Holocaust survivors is dropping dramatically. Resident survivors of the Home may number less than 20 in a community of 1000.The deaths they once barely escaped are now palpably close again, and they react to that in different ways. Some exude their exuberance for just being alive, and a few live in a perpetual fog of fear. In others their paranoia is paramount, and in many the guilt of survival continues to germinate.Author Jane Gross quoted Rabbi Simon Hirschhorn in an article published Oct. 23, 2014 in The New Old Age. “Some of the elderly survivors cry inconsolably but wordlessly, incapable or unwilling to articulate anything about the past. Others, often dry-eyed, incessantly discuss the terrible things they saw and had to do to save their lives. And they often flip, all but overnight, from one way of coping to the other as the end of life approaches.”In senior communities around the world that have a significant number of survivors, support groups try to help them cope. One challenge the facilitators face is that many survivors have spent their entire lives not talking about their psychological pain and are not going to “open up” as the facilitators encourage them to do.Regardless of the town they came from or the camp they were in, Shoah survivors are not like other aged residents in senior living. They are truly a generation apart.The survivors’ adult children, like myself, are also unlike their generation. We are also a generation apart. In Gross’s article, Rabbi Hirschhorn, who is the son and grandson of survivors and is a nursing home clergy, said survivors’ children struggle more than others with the guilt of placing a parent in an institutional setting.According to Rabbi Hirschhorn, survivors’ children, often called Second Generation or “2G” for short, “grow up, from the time they are little, with the unconscious wish to make it better, to take away the pain.’’ Both my wife’s parents and my parents were survivors of the Shoah, and we also had the desire not to add any pain to our parents’ lives by our decisions. We, like Charlotte Dell in the article by Gross, always had “an overwhelming feeling of responsibility that there is no additional suffering.’’Staff that care for survivors and their adult children have a significant task to guide these families through what is likely the most difficult transition of their lives.Perhaps the most challenging medical issue adult children struggle with is whether or not to consent to a feeding tube when their parent can no longer safely eat. Many encouraged by their clinicians choose to have a feeding tube placed. I once overheard a doctor yell at a daughter of a patient with advanced dementia, “You don’t want your Mother to starve to death, do you?” In addition to the bias of some doctors, survivors and their surrogates typically choose any medical interventions that have the goal to prolong life. Unfortunately, what this daughter was not told, and what many children struggling with this decision are not told, is that placing a feeding tube typically means their parent will not be allowed to eat ever again. In addition, numerous medical studies have shown feeding tubes in patients with advanced dementia may increase pain, and often worsen the quality and length of life.The struggle around whether or not to place a feeding tube is even more challenging for second generation. They wonder whether their action may actually cause additional suffering to their survivor parent by triggering the painful memories of the starvation they had in the war. Since they are not allowed to eat after placement of the tube, it also takes away the basic physical pleasure of eating that is so important because it had been previously denied to them. Not allowing a survivor to eat also creates tremendous guilt in their children. One of my 2G friends told me when they declined having the feeding tube placed in their dad, it felt like they had put on the black uniform of a SS soldier.I was thinking about the various challenges of caring for aging Holocaust survivors as I watched the small group gathered around a table in the Zuckerman Board Room at the Jewish Home. Thankfully, those thoughts quickly left and were amazingly replaced by the warmth, love, and friendship that were evident. I saw in their eyes and heard in their strong voices that this group was different than one seen in typical nursing homes. It was full of hope. I am looking forward to the next time I have a chance to sit down with them, listen, and hopefully help bring the generations together.

Recently, we celebrated the start of a New Year – the time of year when people do soul-searching and make resolutions on what they want to do in the coming year. Tomorrow is the Jewish holiday of Tu B’Shevat – the holiday which is known as the beginning of a New Year for trees. Naturally, this could be a time for trees to engage in making New Year resolutions just as humans do. Here is what I think a tree’s New Year checklist might look like. I divided the checklist into three areas of focus: Quality, Safety, and Service – three areas at the center of the health care improvement movement, three areas the Jewish Home excels in. Quality:Did I ensure that my fruits were sweet and did not make those who partook in them sick?Did I drop my leaves and eliminate what was no longer necessary in my life?Did I grow towards the sun as a tree should, reaching up higher and higher towards that which I could never grasp, but which nurtured me all the same the more I stretched towards it?Did I grow in strength and wisdom as signified by the new ring that was added this year? Safety:Did I bend in the wind, accepting what God sent without breaking or giving up hope?Did I make sure my roots remained firmly planted in the soil that nurtured me and connected me to my origins? Service:Did I make sure my fruits were available to all that could enjoy them?Did I shelter the seedlings that lived in my shade – so that they would grow up to become the next generation?Did I provide a place for others to benefit from my presence?Did everyone walk away from me feeling better? Come to think of it, this checklist might not be too bad for anyone working in healthcare.Noah MarcoChief Medical OfficerLos Angeles Jewish Home