There’s a lot to do after bringing someone home from the hospital. The obvious goal is continued recovery. But roughly 20% of older adults are rehospitalized within 30 days because of problems that develop at home.

Research shows there are three things you can do to prevent a backslide. It’s important to get going on them even before your loved one is discharged.

- Understand the new medication schedule. Meet with the discharge planner to review medications. Bring a list of what your loved one was taking before hospitalization. If any of these drugs are not on the current list, ask if they should be restarted. Review each new medication. When should it be taken? How long should it be taken? Any side effects? Have new prescriptions phoned in to the pharmacy before you leave the hospital.

- See the doctor for follow-up within a week. Find out what doctor(s) your loved one should see. Request that the hospital forward records to all of them. Before you leave the hospital, call the doctor’s office to set up an appointment for the next week. You may need to be firm with the receptionist and explain that your loved one has just been hospitalized.

- Know the signs and symptoms of problems. Before leaving the hospital, consult with the discharge planner about what to expect. Ask them to group symptoms as “green light,” normal recovery. “Yellow light,” early signs of a possible problem. And “red light,” a significant problem. Find out what to do and who to call in case of yellow or red light symptoms.

Focusing on these three tasks can significantly speed recovery and reduce your family member’s chance of rehospitalization. If you are confused about any of these tasks, insist on having your questions answered before you leave the hospital.

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Thanksgiving is a time we traditionally gather with family to celebrate our gratitude for life. As those who are dealing with a serious illness know, life is a gift. The fact that it does not last forever is part of what makes life precious. Join others who are choosing to spend a portion of this holiday gathering to engage with grace.

This is a national movement to gracefully promote family discussions about end-of-life preferences. Talking with family is key to ensuring that your own wishes are followed. In caring for a family member, knowing that person’s wishes ahead of time reduces the potential for guilt and conflict.

You can lead the way by reviewing with your family your own answers to these questions:

- Who would you like to have make decisions for you if you are unable to speak for yourself? Ideally, you have completed an advance directive. In this document, you name your medical power of attorney and give him or her some basic instructions. Use this time to let others know whom you have chosen and what you would like.

- Where would you like to spend your last days? At home or in a hospital? What would be the most comforting?

- Do you want aggressive medical treatment right up to the end? If so, make sure your family knows to advocate for you.

- Would you prefer minimal intervention? Depending on the circumstances, your priority in your last weeks may be to live as normally as possible, placing quality over quantity. Prepare your family to accept this as your choice.

During this season of thanks, you can thank your family for their support of you and encourage them to share their wishes as well.

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Don’t be surprised if your aging parent reacts with some defensiveness if you raise the topic of driving skills. No one wants to have their independence snatched away! Make it obvious from the start that it’s a mutual goal to keep your loved one safely on the road. And that it’s not an all or nothing situation.

Here are several options for supporting your parent’s continued safe driving:

- Mature driver refresher classes. These classes are often sponsored by AARP or a local AAA club (American Automobile Association). Classes offer practical information on easy ways to accommodate the natural changes of aging[link back to natural changes of aging article]. They tend to be informal and include a lot of group discussion. Plus, persons over 55 may qualify for a discount on their car insurance! Online classes cost less than $20 and are offered by both AARP and AAA. Or, contact a professional driving specialist for a personalized, behind-the-wheel evaluation.

- Staying physically flexible. Being able to turn to look behind you is critical to safe driving. Encourage your loved one to practice simple flexibility exercises.

- Maintaining car fitness. Make sure the car is properly adjusted for your parent. Especially important is the ability to see clearly in all directions. The addition of wide-angle mirrors, for instance, can help reduce blind spots. Be sure the wipers are in good shape. Maintain the car for road safety, too. Tires should be properly inflated and have adequate tread. And don’t forget to have the brakes checked regularly.

- Improving driving habits. A few simple changes can greatly reduce the chance of problems. Suggest Mom reduce or avoid driving at night or in bad weather. Stick to routes and times with less traffic. Make fewer left turns. (Three right turns are much safer!) And practice extra caution in parking lots and when changing lanes.

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Is life with a terminal illness hopeless? Not at all. Seriously ill individuals thrive on hope, just like the rest of us. It gives us a sense of purpose.

According to hospice expert Cathleen Fanslow-Brunjes, hope in serious illness typically has four main stages:

- Hope for a cure. “I’m not going to let this stop me.”
-  Hope for treatment. “I think the radiation is really working!”
- Hope for prolongation of life. “I want to go to the family reunion.”
- Hope for a peaceful death. “I’m hoping for no pain in my final days.”

The four stages often align with disease progression. But it’s not uncommon for a person to move back and forth among them.

Knowing the four stages, you can better support your family member in sustaining his or her hope. Listen carefully for comments that indicate hope.

Many families are concerned about “realistic hope.” Find out what your loved one is hoping for and ask the doctor if it is feasible. If so, then all of you can work toward this shared goal.

If the hope is not realistic, it may signal the need for a change in care goals. But it does not mean your loved one must be without hope! Instead, it means you need to talk together with the doctor and come up with a more achievable project or purpose.

Dr. David Casarett, a hospice physician, wrote an insightful book about this topic called “Last Acts.” It specifically looks at the many ways his patients chose to find meaning in their last few months, weeks, and days.

Hope is always available. We just need help knowing how to look for it.

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Some people maintain strong driving skills as they age. But over time, most of us lose physical abilities that are key to safe driving. Indeed, only teens have more accidents per mile than do adults over age 65.

Advanced years alone are not a reason to stop driving, however. Health, fitness, and thinking power, not age, determine a person’s ability.

Following are signs of possible problems:

- Trouble with vision or hearing. Watch for problems seeing lane lines or pedestrians, overlooking stop signs, or judging the speed of oncoming traffic. Other signs include discomfort with glare or driving at night.

- Inability to twist or turn easily. Arthritis and stiff muscles can make it painful to turn and look when needed. This can lead to trouble when backing up, changing lanes, or merging with traffic.

- Medication use. Many medicines can slow thinking and response time. Drugs for depression and anxiety can do this, as can sleeping pills and medicines for heart conditions, colds, and allergies.

- Dementia. At “early” stages, many individuals can still drive safely. Talk to your loved one’s doctor about a driving skills evaluation.

- Two or more recent tickets. Consider tickets a yellow, warning light. Common infractions include poor parking, running a stop sign, or going the wrong way.

- Two or more recent accidents. Parking lot and sideswipe accidents indicate driver error. Poor depth perception also causes seniors to have a very high rate of left turn accidents.

Take regular ride-along outings. Notice your loved one’s skill level and confidence level. Ask for input from friends and neighbors.

It is important to approach this subject with sensitivity. In the meantime, you may want to explore self-assessments your loved one can take privately, at home. These two were created by the American Automobile Association’s Foundation for Traffic Safety.

AAA Roadwise Review (30-minute multimedia screening tool measuring specific mental and physical capabilities)

AAA Drivers 55 Plus: Self-Rating Form (15 multiple choice, text-based questions)

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We all want to maintain our brainpower for as long as possible. If you are caring for a family member who already has memory problems, you may feel especially at risk.

The good news is that, regardless of age, simple changes in lifestyle can help keep a brain strong and resilient. The key ingredient is exercise for the mind and body.

Although adults can’t make new brain cells, we can make new neurons. Neurons are the connections between brain cells. And mental exercise sparks the creation of new neural connections. With more connections, the brain has back-up options, or “cognitive reserve.” And cognitive reserve helps a brain do better for longer.

Is a “brain game” the best exercise to help preserve clear thinking? Not necessarily. Brain games improve a person’s ability to do specific tasks, but they have not been proven to enhance a person’s ability to navigate the complexity of everyday life.

Instead, engage in mental activities that stimulate the brain to think in new ways. Consider these options:

* Volunteering, playing games, and doing crafts
* Attending lectures, theater, or musical events
* Reading, writing, and searching the Internet

What you want to avoid is repetition, and hours in front of the TV. The goal is novelty and challenge!

Physical exercise is also important. Research shows that people who are physically active stay “with it” longer. Aerobic activities such as walking, biking, and swimming increase blood flow, which supports the development of new neural connections. As with mental exercise, the upshot is lower risk for mental decline.

Beware of products that promise to delay or prevent diseases such as Alzheimer’s. Research has not yet discovered any “magic pill” or strategy. Instead, scientists encourage a focus on overall health, keeping blood pressure and blood sugar in check, and getting plenty of physical and mental stimulation.

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As we face the possibility that we are in the last chapter of our lives, our priorities suddenly change. Life’s details may fade to the background, and we may find ourselves looking at its deeper meanings. Old conflicts pale in importance, and the desire to resolve difficulties with family relationships often comes to the fore. Serious illness presents an opportunity to evaluate one’s life. People often reflect upon their accomplishments and even humbly acknowledge their regrets. When facing a serious illness, we commonly think about what remains undone and focus on addressing those issues one day at a time.

Luis is a 68-year-old man who has advanced diabetes. His kidneys are starting to fail. When he is honest with himself, he realizes that the dialysis is only a temporary solution. Although he was religious in his youth, he has not been to church in many decades. As he concedes that his illness is quite serious, spirituality is becoming more important to him. He spends quite a bit of time seeking his own interpretation of the meaning of life.

As the days and weeks pass, Luis goes back and forth between periods of hope and periods of letting go. Both he and his family are grieving, yet they have also become aware of the gifts his illness has revealed. For instance, Luis has been able to mend some of the rifts in his relationships and has resolved a long-time family conflict with his daughter that separated them for more than 15 years.

Although they are uncomfortable thinking about his death, his family caregivers know it is inevitable and are doing their best to make him comfortable. Still, it is extremely difficult to watch someone you care about gradually decline, with little hope of getting better. His children are also concerned about their mother. They hope that when the time comes, they will be able to band together and support her, and each other, in their mourning.

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