Do you find yourself more easily distracted these days? There is good reason: Concentration is about keeping what's useful top of mind while at the same time suppressing thoughts that distract from your primary objective. As we age, the "executive" center of the brain becomes less able to sort out distractions. It's a filtering process that requires heavy brainpower. Many people worry that lapses in concentration are an early sign of Alzheimer's. Not necessarily. While memory and focus are related, they are not the same thing.

If you are concerned about increasing distractibility

• Make sleep a priority. Lack of sleep is strongly linked to poor concentration. The brain sorts through the day's input when we sleep and decides what to keep and what to toss. Sleep makes room for processing input. Sleep is also when the brain eliminates toxic byproducts of the day's work. Optimal is seven to eight hours of sleep per night.
• Increase oxygen to the brain. Take care of conditions that tend to limit good oxygen supply. High blood pressure, for instance; also, sleep apnea and excess weight. (In addition to contributing to sleep apnea, obesity seems to reduce one's ability to resist distractions.) Aerobic exercise is a great way to get oxygen to the brain.
• Avoid or limit situations that are hard on the brain. Chronic stress, anxiety, and depression all challenge the brain and reduce resources available for concentration. Actively tame the stressors in your life and seek treatment for depression and anxiety. Explore alternatives to medications that fog thinking. Get glasses and wear hearing aids if you have impairments. This frees the brain to focus on concentration rather than on deciphering blurry images or garbled words. Alcohol also impairs thinking and sleep.
• Reduce unnecessary distractions. Treat painful conditions. (Pain is a distraction that's very difficult to ignore.) Turn off alerts on your smartphone. Bury the myth of multitasking. Do just one thing at a time. And for very important situations such as driving, turn off the radio or ask your passenger to stop conversing until traffic complexity has subsided.
• Practice focusing attention. This isn't about beating yourself up to try harder (that doesn't work). Instead, you can use beginning mindfulness strategies. Set aside ten to twenty minutes in a day to just focus on your breathing. When you notice your mind has wandered, no recriminations. Just gently return to focusing on your breath. By learning to monitor your thoughts, you improve your ability to notice when your mind is off task and shorten the time you "spend away."

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Are you worried about concentration and focus?
Let's talk about the possibilities. Give us a call: 203-826-9206.

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Are you tired of long waits to get an appointment? Rushed visits? Not being able to talk to your doctor by phone or communicate via email?
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You aren't alone. Doctors dislike it too. But because most physicians today are employees of a large medical group, they are required to complete 30­–40 patient visits per day. Appointments are set to last no more than 15 minutes. This is necessary to manage a typical patient load of 4,000.

Some primary care doctors are moving away from this business-focused model of medicine.

"Retainer-based," "concierge," or "boutique" medicine prioritizes the doctor–patient relationship. For an annual membership fee (average $1,500 – $2,400) you can join a primary care practice that is dedicated to staying small and intimate (≈150–600 patients). Your annual fee allows the doctor to guarantee

• same-day or next-day appointments
• longer appointments (30 minutes on average)
• phone and email communication, with personal follow-up for lab results

You pay the membership fee out of pocket. It is not covered by Medicare. You must also maintain an original Medicare policy and likely a supplemental policy since the concierge doctor will bill Medicare for office visits. As with traditional medicine, you also still have to pay your insurance premiums, deductibles, and copayments (unless your supplemental plan covers them).

What to look for in a concierge physician

• Is the doctor certified by the American Board of Internal Medicine? (Extra "plus" if also certified as a geriatrician.) Affiliated with a major hospital?
• Do they "accept assignment" from Medicare? If they do, then they cannot charge you more than Medicare allows for a specific service without giving you an "Advance Beneficiary Notice of Noncoverage." If they don't accept assignment, that means they are willing to bill Medicare, but you may owe a balance of up to 15% above what Medicare is willing to pay. (Your supplemental plan will not pay the extra, either.)

So far, there are only 12,000 concierge physicians nationwide, but the number is growing quickly!

Interested in finding a concierge doctor?
Give us a call at 203-826-9206.

If you have trouble participating in conversation in a noisy room or tend to want the TV volume turned up, you might want to investigate a new category of device called an enhanced "hearable."

Up until now, there have been few options short of a hearing aid for people with only mild hearing loss. The best have been "personal sound amplification devices" that fit in the ear like a hearing aid. While reasonably affordable and easily purchased online, they have the disadvantage of amplifying all sounds, even the ones you don't want to hear.

Modern hearing aids can distinguish between a conversation close by and the noisy chatter in a crowded room. The technology is expensive—in the four figures—and requires testing and fitting by an audiologist. Plus, many people feel a stigma attached to hearing aids.

Enter the "hearable," a sophisticated amplification system that wirelessly connects to a mobile device. The hearables were invented for talking on your smartphone and streaming your favorite podcast. In the development of its very trendy "AirPods," Apple stumbled onto the realization that it was very easy to add an enhancement that adjusts for different listening situations. Other developers have since come out with wireless earbuds and improved hearing apps for both Android and iOS (Apple) devices. The result: No stigma. Less cost than a hearing aid. No need for an audiologist.

Features to consider

• Ability to emphasize certain sound frequencies (high pitch or low)
• Ability to block background noise. (This may be called "directionality," setting the device to focus on sounds in the direction you are facing.)
• Ability to highlight speech over other sounds
• Time between recharges. All sound amplification devices require energy, usually in the form of a rechargeable battery. How long does a full battery last? Also, how quickly does the battery recharge?

The disadvantages. Hearables are not considered medical devices, so there is no FDA testing or oversight. They are not appropriate for moderate to severe hearing loss. They are designed for short-term use only, not for all-day wear (they need recharging after a few hours). They are visibly prominent. Someone seeing them in your ears during a conversation may assume that you are listening to music or are otherwise multitasking.

Do hearing problems make it harder to enjoy your life?
Let's talk about options. Give us a call: 203-826-9206.

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Are you enjoying a love you never thought you'd feel again? It's hard to be happy, though, if your children rain on your romance. Are they being selfish? Not necessarily. An in-depth study of "adult stepfamilies" revealed how disruptive it is when a parent gets involved with a new partner later in life.

The family tree changes! Even for adult children who are married with kids of their own, a deep—almost primal—sense of self is challenged when a parent brings in a new member. It brings up existential issues.

• Fear of abandonment. A common response is "I always thought my mom/dad would be there for me, even if nobody else was. But now...?" A child may worry they are no longer a priority. While you know the special place your children will always have in your heart, they may be wondering if they still have that backstop.
• Loyalty and favoritism. In truth, it's likely that drop-by visits, cherished family holiday traditions, or time with grandchildren will need some adjusting. Your kids weren't asking for a change. Now they must redefine something as bedrock as "family." Even though they may have had to choose between their spouse and family of origin on certain matters, they may doubt where they fit given your new commitments.
• Finances. Sad to say, concern about inheritance can put the kibosh on any joy your children might feel for your happiness. There's some human nature in that. (Do stepsiblings get a share of the family home?) But your kids may also be worried about your financial security. What if it doesn't work out? Does a person who was in your life for a short period of time get 50% of your nest egg? Where might that leave you?

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Reassurance. As you all strive to maintain the bonds of the original family while also making room for new connections, roles and expectations must come to a new balance.

• Make it a point to spend time with your kids separate from your spouse.
• Ask about traditions that are important to them and try to preserve those.
• Perhaps mention your own emotional journey in coming to terms with the partners they chose. You might describe how you came to understand that their natural need for daily companionship changed their availability and level of engagement with you, but not their love for you.
• As for financial reassurance, your money is yours. With assets accumulated over many decades, however, it's sound advice to get paperwork in place that ensures those assets are protected and later distributed as you would wish.

Is your family raining on your romance? Give us a call.
We can help bring back the sunny days. 203-826-9206

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There is no single test that can determine if a person has Alzheimer's disease. But a combination of several different tests can identify if memory and thinking problems are due to one of the many conditions that result in symptoms of dementia.
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By process of elimination, doctors can determine what may be the root cause of thinking problems. Some conditions are treatable. Others are not.

Advantages to getting tested early. If changes in memory and thinking are getting in the way of doing what you need or want to do in your life, ask your doctor for a checkup. Even if the source of your problem is not curable, getting a diagnosis as soon as possible has benefits. You can make lifestyle changes that might help slow disease progression and take advantage of medications that can lessen troublesome symptoms. You also become eligible to participate in clinical trials, which puts you in line for cutting-edge treatment. And knowing sooner rather than later gives you time to prioritize what you want to do in the near future, and to complete paperwork and make plans with your family about your wishes for later in the disease.

The components of a full evaluation. To get a complete picture of your brain's health, figure on visits with several different specialists, each providing a unique perspective.

• Medical history and physical exam. Your primary doctor will check your heart, hearing, vision, and medications, as well as do a quick memory screening. Expect to discuss your symptoms, your medical history, and your family's. Also, your lifestyle habits such as exercise and alcohol and recreational drug use.
• Lab tests. Typically, this involves blood work and a urinalysis. Bladder and kidney problems can point to conditions other than Alzheimer's that trigger memory issues. Lab work will assess thyroid, liver, and kidney function and screen for infections anywhere in the body. Genetic tests may be offered, but they are controversial at this stage because they provide nothing conclusive. Just probabilities.
• Brain imaging. A neurologist may order a CT scan, MRI, or PET scan to look for structural changes in the brain. Perhaps you have had a small stroke or several mini-strokes. There may be bleeding, a tumor, or excess fluid in the brain.
• Tests of your thinking and mental health. Dementia and depression each cause fuzzy thinking and memory loss. Testing by a neuropsychologist can zero in on the distinction, which is key to finding the correct treatment. The exams are mostly question-and-answer tests or puzzles. They assess arithmetic, memory, concentration, language, problem solving, and spatial recognition skills.
  
  

Are you worried you have Alzheimer's?
Let us guide you through the screening process. Call 203-826-9206.

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From October 15 to December 7 each year, Medicare enrollees have the option to change their insurance plans. For prescription drug coverage, which is only offered by private insurance companies, it pays to shop around. Even if you have been happy with your current plan, drug prices and premiums change from one year to the next. It's a good idea to compare. There could be hundreds of dollars at stake.

The federal government makes Medicare prescription plan rules, so some things are the same no matter the company. For instance, the point at which the initial coverage stops and the coverage gap begins—sometimes called the "donut hole"—is up to $4430 in 2022. But how soon you get to that number depends on drug pricing, which varies from one insurance company to the next.
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Here are some factors to consider:

• The price of your medicines. To compare plans, you must research the prices in each plan's "formulary" for each of your prescriptions. A plan that charges $200 for a month's worth of pills will land you in the coverage gap sooner than a plan that charges $100.
• The cost of the deductible. This is what you must pay before insurance kicks in. Some policies have a $0 deductible. Others go to the 2022 Medicare maximum: $480.
• The cost of copays. Typically, once the deductible is met, you need to pay a set fee per prescription or a percentage of the price of each drug. This is called the "copay." It varies widely from one company to another, as does the price or percentage that is required in the coverage gap.
• The price of the monthly premium. The lower the premium, the higher the copays.
• Customer service. Each plan has a Medicare star rating based on customer satisfaction and other performance factors. These are updated yearly. A rating of fewer than four stars probably indicates slow service, which could cost money or cause health problems.
• Other services tied to the drug plan. If you have a Medicare Advantage plan, prescriptions may be bundled with your coverage for doctors and hospitals. A plan that might be better for medicines may not include the doctors you have been seeing. You may need to choose which is more important.

Get help comparing plans. Go to Medicare.gov for an online comparison tool. Or use free telephone assistance at 1-800-MEDICARE. There, you can get help weighing the costs and benefits so you can select the best coverage for your money.

Got the Medicare blues?
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If your adult child has cut off contact, you are not alone. An estimated 11% of parents are estranged from their adult kids. That's 1:8. But you wouldn't know it to hear others talk.

There is such a stigma around the issue that estranged parents rarely talk about it with others. Instead, they tend to cover things over.

That means carrying around feelings of shame, guilt, and deep sadness, often in isolation. Sound familiar?

Why do adult children sever the tie? There are myriad reasons. Two-thirds (67%) of estranged parents say they have never been told the reason why. On some level, perhaps the specific details of "why" are not material. In the end, it may be wise to simply conclude that everyone remembers family dynamics differently.

Should you try to reconcile? Reconciliation involves both parties, although parents usually initiate the effort. Be flexible about the outcome. Estrangement may be the best outcome. The important part is how you process it.

Begin with yourself. A child's rejection is not a measure of your worth as a person or a parent. Even fantastic parents go through periods when their children want nothing to do with them. Reach out to others so you have support. There are online and in-person groups for estranged parents. Talk with a counselor.

What adult children say they want. Surveys indicate that children who have split away want to "be heard" and to have their parent apologize for past actions. Expressions can be as simple as a sincere "I'm sorry. I wish I had been more ______." Some also ask their parent to accept boundaries, such as a limit to the type or frequency of contact.

Things to avoid. Don't issue repeated requests to meet. This can backfire: Your child may feel harassed. Try a light overture. If it is rebuffed, wait a significant time before trying again. If the door opens, prepare to just listen and empathize. "Correcting" them or stating your own feelings will likely bring everything to a halt. In fact, your child may never be open to hearing what it was like for you. And if those are the terms of reconciliation, you need to decide if that's okay with you. For some parents, it's simply not.

The goal is healing. Ideally, the healing involves getting back together. If it doesn't, use your support system to help you get to a healthy resolution inside yourself. No more isolation. No more shame.

Considering a reconciliation? We can help.
Give us a call at 203-826-9206.

Did you know that we usually outlive our ability to drive safely by six to ten years? As we age, we naturally modify how we drive to address physical changes: Stiff joints, poor vision, slow reflexes. But a time will come when it's simply unwise to continue behind the wheel.

We do plenty of planning and preparation before retiring from work. Similarly, it's smart to take a moment and consider the probability that you may not be driving your last few years. How can you retire from driving without giving up an active life?

Most people find it works best to have more than one driving alternative. Check these out:

• Family and friends. This is by far the most common strategy.
• Ride-sharing apps. Services such as Lyft and Uber can be extremely helpful (and not that expensive when you factor in the costs of a vehicle, gas, insurance, etc., that you are being spared). Both services are exploring senior options with door-to-door assistance. No smartphone? Consider a phone service such as GoGoGrandparent.com.
• Local transportation programs. Many churches and senior centers have volunteer driver programs that are free or low cost. These are ideal for errands or doctor appointments. Think about "paying it forward" by serving as a volunteer driver now.
• Public transportation. Standard buses are an option. Some have a "buddy program or a "senior training day" to help you get oriented. Many public transit companies also provide "paratransit" services. This is a low-cost, door-to-door service available for those who meet disability criteria. Rides must be scheduled a day or two in advance.
• Special service vans. Senior centers often put together ride packages to cultural events. Leave the driving and the parking to someone else! Medical or cancer treatment centers may offer transportation. Take shuttle services to the airport.
• Self-driving cars. Wonderful to anticipate, but they are some time off as yet.
• Online services. Spare the trip! Order online and take advantage of delivery services. Arrange for appointments to be done by video chat when possible.

Considering a move or downsizing? Factor in driving retirement. Would your new abode allow for easy walking to where you want to go? To public transportation? For assisted living, is there van service to doctors or shopping?

Find out now what's available. Check out ridesinsight.org or call 855-607-4337 (toll-free, nationwide) to find local driving alternatives.

Learning how to age in your own style?
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When imagining an age-friendly house, many people think of ramps for wheelchairs and walkers. Indeed, ramps are essential--if and when they are needed. There are, however, modifications for the outside of a home that simply make daily life and basic maintenance easier. They help prevent falls by addressing the common conditions of arthritis, poor eyesight, or limited balance.

Some safety suggestions also deter thieves.

Lighting. To reduce shadows, point lights down rather than across. And use frosted glass fixtures or bulbs to reduce glare (a notable hindrance to seeing well as we age). Consider adding lights that come on automatically in low-light conditions or when motion is detected. Put them along all pathways and stairs, and at the corners of your house. Also install them at common destinations, such as all entry doors, the mailbox, a trash enclosure, and the garage door. Abundant light illuminates hazards while also discouraging burglars!

Stairs. Several modifications can make a stairway safer. Handrails, ideally on both sides, that are at least 1½ inches in diameter so they are easier to grip. And a textured or nonskid surface on the tread of each stair. Also take care to repair any broken steps so they are level and soundly anchored. Even out the rise of each step so they are all the same height. To make it easier on knees and hips, plan for the rise of each step to be no more than 7 inches and no less than 4 inches. The tread—space allotted for the length of your foot—should be no less than 11 inches. If you are reinstalling a staircase, plan for a landing for every 12 feet of vertical rise.

The entryway. Many activities occur at entryways: Opening a locked door, bringing in groceries, greeting visitors, retrieving delivered packages. In addition to good lighting and nonskid surfaces, consider elements that might facilitate these daily tasks. A lever doorknob is easier for arthritic hands. A keyless lock avoids the need to juggle groceries while finding the key. Perhaps a bench where you might set groceries down. A hinged chest/seat would enable delivery people to safely hide your packages. You might also consider a video doorbell to easily view who is there before opening the door. Video can also dissuade thieves—or at least get a recording if someone steals a package left on the doorstep.

Simplifying home maintenance. Add gutter covers to minimize the frequency of cleaning out leaves. (After a certain age, ladders are not your friend! Bones are too brittle if you fall.) Change to brick or vinyl siding to reduce the need for ladder-based maintenance of a wooden exterior. Similarly, resin-based decking will save hours of on-your-knees upkeep.

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We are the experts! Give us a call at 203-826-9206.
 
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If you have more than one child, deciding how to distribute your assets among them may prompt some angst: If and how should your will or trust reflect your understanding of their different needs? According to a Merrill Lynch study, two-thirds of parents over age 55 are open to the idea of unequal bequests.

"Fair" does not necessarily mean "equal." If one child has invested considerable time caring for you during health challenges—perhaps giving up valuable income-earning years—should that be reflected in their inheritance? Again, two-thirds of parents think it should. (Not all children agree.) If one child is in a lucrative profession and the others are not so well paid, should you bequeath equally or according to need? Should a health-challenged child get more? What if some of your kids have children and others do not? Should the nonparents get less?

Money does not equal love. This is a self-evident truth. But as a culture, we tend to view money as a proxy for affection. Differing amounts can bring up old resentments. "Dad loved you best …" These feelings may even play out in a court battle. (Sigh)

There are myriad ways to divide the pie. Here are three common scenarios:

• Equal parts in the will, but gifts as needed before you go. What you give to your children in the normal course of life need not be up for family discussion. It's between you and each individual child.
• Acknowledge prior financial help given as a "draw down" on the inheritance. Some children may have needed more help (a down payment for a house, rehab for substance abuse, assistance due to the pandemic). Deducting your past financial support from that child's "fair share" may quell resentment from other siblings.
• Unequal bequests with a description of your reasoning. Leave a note with your will or trust that affirms your equal love and explains your logic.
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Talk with your kids ahead of time. It's advisable to discuss your plans with your children individually. (You could learn that the prosperous child prefers that more be given to a less financially stable sibling because it reduces the chance of their being tapped for aid later.) You might then review your plans with everyone in a family meeting. If these conversations seem daunting, let's talk. We can serve as an objective sounding board to help clarify your thoughts, prepare for the discussions, and perhaps even facilitate your family conversation.

Work with an estate planning attorney. There may be options you hadn't thought of and details you need to include. You will need an attorney to draw up the final documents.

Are family dynamics a source of worry for you?
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