Your Mental Health
Older Americans Initiative
Fight Back Against Food Bacteria for Food Safety
Your Representative Reports: by Peter Larkin
From the Director

Your Mental Health
by Stuart Bartle, M.D.

An established belief holds that old people are more depressed than other adults. But this is only partly true: it actually depends on how you define "depressed." If one defines depression as only real Clinical Depression, somewhere between five and 10% of adults will be depressed at some time, and elders have about the same chance. However, if you mean sad or lonely, there is no contest; elders far surpass other age groups in this category.

To merit a diagnosis of Clinical Depression a person has to have five or more of the following attributes: either inability to sleep or too much sleep; loss of interest in things; a sense of guilt or unworthiness; loss of energy; poor concentrating ability (sometimes leading to poor memory and simulating early Alzheimer's); poor appetite or weight loss; either an agitated or slowed physical state; and finally, suicidality. Interestingly, one of the differences in elders' depression is that weight loss is more common than feelings of worthlessness. One can also see a "masked depression," in which hypochondriasis is seen in a person for the first time, with "doctor shopping" and multiple physical complaints.

Unfortunately, the amount of loss that many elders have to bear can be enormous. The loss of friends, of physical health, of vigor, both physical and sexual, are only some of the many losses of the elders. Add to these the loss of a previously good memory, of mobility, of the senses, hearing, vision, taste. Then there is the loss of status as a result of retirement.

Undoubtedly, though, worst of all is the loss of a spouse. This has been adjudged to be the greatest stress of all. It involves the loss of a "witness," the only person with whom one can talk about thousands of passed hours and events. Moreover, stress itself can easily foment a clinical depression, by methods not completely worked out, but almost certainly involving the immune system. Mortality has also been shown to be considerably increased in the two years following the death of a spouse.

Unconsciously, all these losses remind one of the imminent end of one's only life, which can lead to despair. In Eric Erikson's last stage of life, the battle is to hold on to integrity, to accept one's significance, and thus avoid despair. Despair is often hidden behind a display of disgust with various people and institutions, showing the person's contempt for himself. In one study of people 70-105 years old, 21% said they wanted to die or that life wasn't worth living. But of these, only the ones with a genuine psychiatric diagnosis were actually suicidal.

How do elders deal with this onslaught of losses? The answer for those with a clinical depression is to first admit it and seek help. Current treatment calls for one of the many new antidepressants, which have minimal side effects. It should also include counseling which would help the elder deal with the losses and regain a sense of his own significance.

One of the problems about clinical depression in elders is that it rarely remits spontaneously, as it often does in younger people. In addition, elderly depression only responds 50% of the time to antidepressants, as opposed to 70% in younger adults. However, approximately 90% do respond to ECT, now considered a vastly underutilized treatment because of its stigmatization. It is actually very safe and rarely leads to more than transient memory loss. Ending a depression as fast as possible is important since the depression subtracts such a large percent of the time to live and enjoy life.

As we all know, loneliness can be a painful emotion. In those elders who are in pain but are not clinically depressed, contact with others is the key element in feeling better. There are many services available to Seniors in this county; Elder Services can help. Counseling can help a person deal with the losses, especially Family Therapy. Groups are excellent in providing peer support and maintaining the all-important ingredient, hope.

Elder Services Joins Berkshire United Way

Elder Services has been voted membership in Berkshire United Way. As one of eight new member agencies Elder Services will have an opportunity to apply for funding from Berkshire United Way to help meet the needs of Berkshire elders.

Berkshire United Way is a community service organization representing 25 social service agencies in Berkshire County, with offices in Pittsfield and Great Barrington. The purpose of United Way is to help local agencies meet their financial needs and service commitments to the community. Funds are raised by voluntary contributions from friends, neighbors, and business and commercial organizations dedicated to the community.

Elder Services is a member agency in Northern Berkshire United Way and the Williamstown Community Chest.

Consider giving to United Way and the Williamstown Community Chest - it makes your heart feel good.

Fight Back Against Food Bacteria for Food Safety

In recognition of Food Safety Education Month, Elder Services and the Massachusetts Partnership for Food Safety Education encourage you to keep your food safe all year round. Millions of people get sick each year from food that has become unsafe. Food becomes unsafe when bacteria get into food and is allowed to grow to harmful levels.

The national "Fight Back" campaign recommends using the following steps:

Clean

Bacteria can get into food from your hands and from other foods. You can keep your food safe when you use hot soapy water to wash your hands and wash cutting boards, dishes, utensils and counter tops between uses.

Separate

Bacteria can spread from one food to another. You can keep your food safe when you separate raw meat, poultry and seafood from other foods (especially fresh produce) in your grocery cart and in your refrigerator, and use a separate, clean plate for meat, poultry and fish after it has been cooked.

Cook

Most harmful bacteria are killed when foods are cooked to a high enough temperature. You can keep your food safe when you cook foods thoroughly-all meats should be cooked to well done, use a food thermometer to measure cooking temperature, and cook eggs until the yolk and white are firm.

Chill

Bacteria grow rapidly at room temperature. Refrigerate or freeze foods as soon as possible, thaw foods in the refrigerator, and divide foods in small amounts to cool quickly.

When you follow these four steps, you can help ensure that the meals and snacks you make at home will be safe to eat. For more information about ways to keep your food safe, contact Diane Simpson at Elder Services, 499-0524 or 1-800-544-5242.

Your Representative Reports
By Peter J. Larkin, State Representative

As the state representative for the Third Berkshire District, the most important function of my position is to help those I represent. This is a responsibility which I take to heart. Two specific ways in which to do this are constituent services and legislation.

Being House Chairman of the Joint Committee on Taxation, I have had the opportunity to work on a variety of legislation that will benefit citizens throughout the Commonwealth, including senior citizens. Just a few weeks ago, the Governor signed a $700 million tax cut which the Legislature, and the Taxation Committee in particular, had carefully crafted. Included in the tax cut is a reduction in the rate on dividends and interest from 12 percent to 5.95 percent. This relieves the tax burden placed on those individuals whose primary income is from dividends and retirement savings. Additionally, single taxpayers are exempt from state tax on the first $250,000 of capital gains from the sale of a primary residence, while for married taxpayers this exemption applies to the first $500,000 of capital gains. Another piece of the tax cut package includes conformity to new federal tax treatment to exempt investment income in Roth and Education IRAs from tax.

Another taxation bill that has become law during my tenure as Chairman deals with military pensions. The new law, effective since January 1, 1998, exempts from income tax the retirement pay received from the U.S. government for a retiree of the uniformed services of the U.S., or their surviving spouse, regardless of whether the retiree contributed to the retirement system.

In conjunction with the legislative component of a representative's job are the ever-important constituent services. For example, I have persistently advocated for a furnace replacement at the Rose Manor housing development for elderly residents. They had had serious, ongoing problems with a leaky, noisy, unreliable heat source, but I am pleased to note that the new furnace will be installed within the next few weeks. In another instance, I have provided information and a contact person within the Executive Office of Elder Affairs for a senior citizen who had questions regarding the expanded Senior Pharmacy Program. A third situation involved helping an elderly woman obtain appropriate home health care.

While this is just a sampling of the constituent and legislative services provided in my role as state representative, the concerns of the senior citizens and of all the residents in my district are first and foremost as I continue in this capacity. I look forward to serving you in the future.

The author is the state representative in the Third Berkshire District.

From The Director: Federal Initiative to Improve Nursing Home Care

In July, the President and Health and Human Services Secretary Donna Shalala announced immediate plans to target nursing homes with a history of poor performance through various administrative actions, as reported in the general media and in the July 24, 1998 Older Americans Report.

This federal action is a response to consultant Abt Associates' 900 page report to the Health Care Financing Administration (HCFA) on the good and bad outcomes of three year old nursing home regulations.

The Abt report found significant improvements since 1995 in quality of care, especially in the more appropriate use of physical restraints, anti-psychotic drugs, anti-depressants, urinary catheters and hearing aids.

The report also found additional improvements were needed. Some of the necessary changes are listed below.

State inspection of nursing homes are sometimes too predictable, allowing special preparations to be made.
Some states (not Massachusetts) rarely cite nursing homes for poor care and this may indicate inadequate inspection and follow-up.

Residents continue to be subject to physical and verbal abuse, neglect, and loss of personal property.
To address these problem areas, the Administration is asking Congress for new legislative authority. Requested is a requirement for criminal records background checks on workers, letting more workers with proper training perform important nutritional and hydration functions, and re-authorization of a strong long term care (nursing home) ombudsman program through the Administration on Aging. (Elder Services operates the Berkshire County Long Term Care Ombudsman Program, which sends trained ombudsmen into every long term care facility in the county to receive and resolve residents' complaints.)
To ensure that all have access to the results of nursing home surveys, HCFA asks that all survey results be on the Internet by the end of 1998.

Once a nursing home or chain of nursing homes is found to have a poor performance, a variety of sanctions will be available to HCFA.

Repeat "poor care" offenders will be subject to more frequent inspections, with some done on weekends or evenings, when staffing may not be at necessary levels.

HCFA will tell the states to levy fines for each instance of serious or chronic violation; some states already do this.

State and federal officials will focus their enforcement efforts on nursing homes or chains that have a record of non-compliance with the regulations, while

state inspectors will be required to review each facility's plan to prevent, identify, and stop physical or verbal abuse of residents. This plan will be shared with residents and their families.

HCFA will work with the Inspector General's office and the federal Department of Justice, to make certain that state survey agencies (in Massachusetts the Department of Public Health) refer appropriate cases for prosecution, particularly cases that result in harm to patients.

The additional oversight that the federal government has proposed is not often necessary, but when patient care and safety is threatened, no oversight is too heavy or onerous. The residents of nursing homes, who are truly the most vulnerable, should be in a secure and comfortable setting, and receive the care they need.