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KATIE LOELIUS RN is a experienced instructor for CPR/First Aid/ACLS.
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HCPOA or DPOA understand the differences so you can get the services you require.
What is a Durable Power of Attorney (DPOA) and Why do I Need One, is a question being asked more frequently. It is important to understand how it is different than a Healthcare Power of Attorney. Is it to be effective now or when I am incapacitated? What can you do to make sure it can it be enforced? I have been asked many of these questions and sought out the knowledge of Mallissa Church an expert attorney in this area.
Durable Power of Attorney
What does it do?
Identifies a designated person –an Agent -who may make decisions for you, the Principal, and handle your personal business on your behalf.
It is a flexible document –as Principal, you may designate as many or few powers to your Agent as you wish.
It gives you peace of mind knowing you and your personal affairs will be managed by someone you trust.
Why do I need it?
It provides a seamless process for someone else to help you and help manage your finances and personal affairs if you become ill or incapacitated. It can prevent the need for someone to seek Guardianship and Conservator-ship.
It allows you to make decisions about specific powers you want to grant and the persons to whom you grant them.
South Carolina just enacted a new General Durable Power of Attorney Statute (effective January 2017). The new law is more comprehensive and includes new requirements not previously included in the old statute.
Healthcare Power of Attorney (HCPOA)is power to make healthcare decisions. Note not all healthcare providers honor a General Durable Power of Attorney with healthcare decisions. An HCPOA can be made effective immediately, before you are incapacitated. Healthcare Power of Attorney, designates someone to receive healthcare information about you and make specific healthcare decisions on your behalf. It does not grant any powers regarding financial decisions. It does allow you to make specific end-of life decisions becomes effective only effective after you are incapacitated
Durable Power of Attorney can be used as a Medicaid and Long-Term Care Planning Tool. It will help in qualifying for Medicaid using Spend-Down principal. DPOA allows your Agent to strategically make gifts to decrease your assets. This agent can include spend-down assets by paying “reasonable compensation” to the Agent. DPOA may retain Home Services, Home Health Assistance and Select In-Patient Care for the Principal. The new statute allows you to permit your Agent to retain home services, health assistance if you need it and also select in-patient nursing care for you.
The new South Carolina revision allows you to sue anyone who doesn’t honor the document (and recover costs). Your Durable Power of Attorney must meet the following requirements:
The document must be executed like a Will.
Meet the statute requirements.
Be recorded at the Register of Deeds office in the county where the Principal lives.
The new statute also provides a form your Agent may complete indicating your intent for the Durable Power of Attorney to be effective immediately.
These are some basic facts that will be useful in moving forward to obtain the necessary documents should you or a loved one become unable to care for themselves. This is an area where you really do need to get professional advice before you really need it.
12 Point Medication Check List
1.Learn Before you start taking any new prescription or OTC/herbal supplement by speaking with your pharmacist. Before taking ANY new drug OR supplement have your pharmacist review the impact on the other meds you are taking. Medications and supplements can counteract each other & therefore should be taken at different times of the day, some with food only, some on empty stomach. Do not expect pills to do what they are prescribed for if you take them incorrectly.
2.If you forget to take a single dose medication it is most often OK to take it within the current 24 hours. Do not take two the next day. If you accidentally take a prescription that is NOT yours call a pharmacist with the medication and dosage and follow their instructions. They may suggest that you call the Poison Control Center 1800-222 1222
3.If you take more than one (1) medication or supplement invest in a 7/day a week pill container. If you take meds more than one time a day get an AM / PM container. NOTE: most pill containers are not child proof so keep out of reach of children.
4.Single sourcing of medications can be a life saver. If you get online medications and other prescriptions from local pharmacy(s) make sure that you have one Go-To Pharmacist that has ALL your prescriptions and OTC /herbal supplement listed and use that pharmacist as a control source for questions before filling a new prescription or adding a OTC supplement.
5.Read the warning labels. It is always best to check with your pharmacist to find an OTC that is not contraindicated with your prescriptions.
6.Take meditations only as directed. Always take medications until the prescription is finished. DO not stop taking once you feel better and save the rest for later!
7.If the cost of medications has you taking half or partial dose let your doctor know as many come in larger doses, for the same amount, that can be divided to give you the clinical support your need.
8.Read the ingredients on the label. If you are taking more than one OTC do NOT take 2 that include “acetaminophen” for instance, that is double doses.
9.Annually review expiration date on all household prescriptions and supplement, yep they do expire! Dispose of medications by bagging and dropping at any police station. DO NOT flush down the toilet or toss in trash.
10.Do not share prescriptions. Your prescription may cause another person to have life-threatening results to a similar diagnosis.
11.Always ask for a “starter “2-week supply of new meds before you invest in the money saving 90-day supply, that way you can be assured that the prescription will work appropriately.
12.If you have any allergic reaction to a medication immediately add to your list of contraindicated meds. TELL your pharmacist. Often there are whole classes of meds that may contraindicated for you and you can prevent future problems by making sure it is on your documentation and that both physician, pharmacist know.
Here is some helpful information I have gathered from pieces available on the net. You will find this helpful in the event that you are told that you need radiation as part of your treatment protocol.
Radiation therapy — also called radiotherapy — is a highly targeted and highly effective way to destroy cancer cells in the breast that may stick around after surgery. Despite what many people fear, radiation therapy is relatively easy to tolerate and its side effects are limited to the treated area.
Your radiation treatments will be overseen by a radiation oncologist, a cancer doctor who specializes in radiation therapy.
Types of Radiation
There are three main types of radiation:
External radiation is the most common type of radiation, typically given after lumpectomy and sometimes, mastectomy. In this section, you can read about how external radiation is given.
Internal Radiation is a less common method of giving radiation. It is being studied for use after lumpectomy. In this section, you can read about how radiation is delivered inside the breast.
Another relatively new type of radiation to treat breast cancer is intraoperative radiation therapy (IORT). IORT is given during lumpectomy surgery after the cancer has been removed. In this section you can read about how intraoperative radiation therapy is given.
The most annoying and uncomfortable side effects of radiation therapy involve the skin of the area being treated. In many ways your skin reaction will be like a sunburn, with a mild to moderate pink color or redness, with itching, burning, soreness, and possible peeling. But unlike what happens with a sunburn, your skin will react to radiation very gradually and possibly only in patches.
While you’re undergoing radiation treatment, the first thing you’ll likely notice will be a change in the color of your skin, from pink to red. If you’re African American or have a dark brown or black skin tone, the redness can be harder to see but you may still have other symptoms, such as soreness or dry skin.
Some areas of your skin may react more than others:
- The skin in the upper inner corner of your breast can get more red and/or irritated than other areas because:
- The angle of the radiation beam is parallel to the skin there, so the radiation skims across the skin (not just through it, as it does in other areas where the radiation beam is perpendicular to the skin).
- This area usually has received significant sun exposure over the years, so it takes longer to heal from additional damage.
- The skin within your armpit also tends to get more red and/or irritated than other areas because:
- The arm rubs back and forth against the radiated skin, which is already irritated by sweat and hair.
- The skin along the fold under your breast gets more red and/or irritated than other areas because:
- Most bras rub this area.
- The radiation beam skims across the skin in this region, too.
- The skin of the fold rubs against itself.
Your skin reaction may be mild and limited just to these areas, or your skin might have a more dramatic reaction to radiation, covering more of the breast area. This is more likely to occur if:
- Your complexion is fair and you’re susceptible to sunburn.
- You have large breasts.
- You are receiving radiation after mastectomy, and the treatment is designed to give a high dose to the skin.
- You’ve had recent chemotherapy.
As with a sunburn, the skin also may be dry, sore, and more sensitive to touch. Irritation may increase. The skin can sometimes start to peel in a dry way, like an old sunburn, or in a wet way, like a blister. If peeling happens, it tends to be toward the last third of your treatments or later. This peeling will probably be limited to a few areas of the involved skin. If the blister opens, the exposed raw area can be quite painful and weepy. Your skin reaction can become more serious if the exposed area is not treated and infection develops. Your radiation oncologist can work with you to help you manage any of these signs or symptoms. If problems become especially troublesome, your doctor or nurse might suggest taking a short break in treatment to allow your skin to recover.
These skin changes happen gradually and can be predicted in your weekly exams by your radiation oncologist and nurse. You should be aware of the range of possible skin reactions so that you’re not surprised by them. Fortunately, skin irritation caused by radiation is temporary. And your doctor and nurse can give you salves, medications, and prescriptions to ease any discomfort. If you find that the pain and irritation are not getting better, talk to your doctor.
After radiation treatment ends
After you finish radiation therapy, the effects on your skin may continue to get worse for another week or so and then your skin will start to get better.
If you have peeling skin and/or wet blisters, the skin may have slowly started to grow back while you were getting treated. Now that you’ve completed treatments, pearly-pink colored patches of new skin will grow back much faster in the affected areas. The new skin is very delicate as it grows. You might still have a blister or the overlying old, dry, flaky skin covering the new skin. Don’t pick at the blister or the old skin. They’re protecting the new skin underneath. If you experience problems or have questions as the new skin is growing, call your radiation oncologist or nurse.
The deep redness and the sensitivity should start to go away during the first weeks after treatment. Your skin will take a bit longer to return completely to its natural color. You may find that the treated area has a tanned or slightly pinkish look to it for up to 6 months after your last session of radiation. If you have a very dark skin tone, by the end of treatment your skin can become very dark, and it may take 3 to 6 months (and sometimes a bit longer) for changes to go away.
Some people may continue to have a slightly pinkish or tan hue to their skin for years after treatment. And a few people may notice a small patch of tiny blood vessels on the skin of the radiated breast area. These vessels — called telangiectasias — look like a tangle of thin red lines. Telangiectasias are NOT a sign of cancer recurrence. They usually don’t go away on their own.
If you are a smoker, stopping smoking may help your skin recover more quickly. Sometimes high oxygen therapy (also called hyperbaric oxygen) will help. If you want to get rid of the telangiectasias, laser therapy may help. Talk to a dermatologist (skin doctor) who is experienced using lasers to remove birthmarks and other skin pigmentation
Here are a few things you can do to make the skin less sensitive during radiation treatment and to help it return to normal after radiation treatment is over.
Prevent irritation before and after daily treatments
- Wear loose-fitting shirts, preferably cotton.
- Use warm rather than hot water while showering.
- Try to not let shower water fall directly on your breast.
- Avoid harsh soaps that have a lot of fragrance; instead use fragrance-free soaps with moisturizers (such as Dove).
- To help prevent redness and skin irritation, avoid having skin-on-skin contact. This most often happens;where your arm presses against your armpit and the outer portion of your breast
- along the bottom crease of your breast, where your breast might droop a bit and lie up against your upper belly wall Along your cleavage where the breasts snuggle up against each other
To avoid skin-on-skin contact:
Try to keep your arm away from your body whenever possible.
Wear a strong bra without an underwire to keep your breasts separated and lifted.
If you have large breasts, when you’re not wearing a bra, stick a soft washcloth or piece of flannel or soft cotton under your breast.
Dust the breast area and inside skin folds with cornstarch to absorb moisture, reduce friction, and keep you smelling fresh. You can use baby powder made from cornstarch (don’t use talc) or sifted kitchen cornstarch. Apply it with a clean makeup brush or put some cornstarch into a single knee-high nylon or thin sock and knot it at the top. Gently tap the sock against the skin to dust the surface. If your doctor has recommended using creams or salves, apply those first, then dust the area with the cornstarch.
- With or without radiation, yeast infections are common in the skin fold under each breast — particularly during warm weather in women with large breasts. Signs of yeast infections are redness, itchiness, and sometimes a faint white substance on the skin. If you have a yeast infection, take care of it before radiation starts so it gets better, not worse. An anti-fungal cream (such as athlete’s foot medicine) usually works well.
Manage irritation during and after your course of radiation
At the beginning of treatment, before you have any side effects, moisturize the skin after your daily treatment with an ointment such as A&D, Eucerin, Aquaphor, Biafene, or Radiacare. You also can put it on at night — wear an old T-shirt so the ointment doesn’t get on your bed clothes.
For mild pinkness, itching, and burning, apply an aloe vera preparation. Or try 1% hydrocortisone cream (available without a prescription at any drugstore). Spread the cream thinly over the affected area 3 times a day.
If areas become red, itchy, sore, and start to burn, and low-potency cream no longer relieves your symptoms, ask your doctor for a stronger steroid cream available by prescription. Examples include 2.5% hydrocortisone cream and bethamethasone.
Some people get some relief by blowing air on the area with a hair dryer set to “cool” or “air” (no heat).
Don’t wear a bra if there are raw areas.
If your skin becomes dry and flakey during the course of your treatment, moisturize frequently and cleanse skin gently.
If your skin forms a blister or peels in a wet way, leave the top of the blister alone! The bubble keeps the area clean while the new skin grows back underneath. If the blister opens, the exposed raw area can be painful and weepy. Keep the area relatively dry and wash it with warm water only. Blot the area dry and then apply a NON–ADHERENT dressing, such as Xeroform dressings (laden with soothing petroleum jelly) or “second skin” dressings made by several companies. To relieve discomfort from blistering or peeling, take an over-the-counter pain reliever, or ask your doctor for a prescription if you need it.
What about sun exposure during radiation therapy?
During radiation, it’s best to keep the treated area completely out of the sun.
Wear a bathing suit with a high neckline.
Wear a cover-up when you’re not in the water.
Wear an over-sized cotton shirt to cover the treated area and allow it to breathe.
Avoid chlorine. Chlorine is very drying and can make your skin reaction worse.
If you do swim in a pool, you might want to spread petroleum jelly (a product like Vaseline) on the treated area to keep chlorinated water away from your skin.
After your radiation treatment is done, the skin that has been exposed to radiation may be more sensitive to the sun than it was in the past. You can go out in the sun and have fun, but continue to protect your skin:
Use a sunblock that is rated SPF 30 or higher on the area that was treated. (A strong sunblock is a very good policy for every inch of your body.
Apply sun screen often
Staying Healthy When Traveling Abroad
Many of us who are lucky enough to live in Sun City Carolina Lakes have many opportunities to travel in retirement. I have heard many very scary stories that perhaps could have been avoided. It is important to remember that you are responsible for your own health and wellbeing when you are traveling. Be Prepared. It’s a great way to make sure you have a good time and stay healthy to enjoy your trip.
Before you leave
•Make sure are that you are current on all your required vaccinations, as well as medications for mosquito borne viruses.
•Find out the contact information for the nearest U.S. embassy or consulate to where you are to travel.
•Apply for a passport at least three months before you travel. If you already have one, be sure to check the passport’s expiration date as well as any entry requirements for the countries you will be visiting.
•Understand the financial system and know the currency rates at your travel destination. Tell your bank and/or credit card company of your travel plans so that its security measures do not freeze your account.
What to bring
•Plan to bring the smallest roll-aboard suitcase you can manage. A second bag should stack neatly on top of your wheeled bag. Packing light is important for seniors.
•Bring along a magnifying glass to help you read detailed maps and small-print schedules, and a small notebook to jot down facts and reminders.
•Bring a copy of your Living Will with you. You should keep a copy in your glove compartment and travel suitcase, as well.
•Bring an updated copy of all of your current medications (both prescription and over-the-counter).
•Bring emergency contact information about your family in the United States with you when you travel. Also, be sure to pencil this information into the emergency contact information section of your passport.
•Bring travelers checks and one or two major credit cards. Many credit cards and travel and tourism companies offer cancellation protection for an additional fee.
•Purchase from a bank and bring with you local currency for taxi fares, tips and minor expenditures in the foreign country.
What to leave
•Leave your itinerary, your emergency contact information, and a copy of your passport’s biographic data page with family and/or trusted friends.
•Notify you nearest neighbors that you are traveling and to keep look out on your property.
•Make sure you get travel insurance and read the fine print. Don’t leave home without it. It is best if you speak with a travel agent or a general insurance agent, and go through “worst case “scenarios of needing major medical care in a foreign country. Most important is confirming transportation all the way to your home healthcare center, and not just to the nearest stateside hospital.
•Always purchase trip cancellation, travel health, and medical evacuation insurance. Consider purchasing luggage insurance.
•Bring an updated copy of your current medications (both prescription and over-the-counter), and enough for the whole trip plus a few extra days. Keep your medications with you, not in your checked luggage.
•Before every meal of foreign foods, it is helpful to take a bismuth subsalicylate product (e.g., Pepto-Bismol or Pepcid AC) to help prevent abdominal issues.
•It is best to bring your own supply of anti-diarrhea medication (e.g., Lomotil or Imodium).
•You should have a Z Pak ( steroids) for infections, check to see if you can get a prescription from your physician.
•Consider carrying a small typed card in your wallet that has your blood type, allergies to foods or medications, and list of all medications you take, including over the counter meds.
Food and Drink
•Remember to wash your hands with soap and warm water before eating.
•Consume only bottled water, even for brushing your teeth, and keep your mouth closed in the shower
•There is no guarantee against food-borne illness, but be vigilant and never eat under cooked meat, poultry, fish, or eggs.
•Move …blood clots are possible on long trips, so get up and move every hour or so when flying. Check with your doctor to see if support hose may be suggested during a long flight.
Here is hoping that we all can be prepared so we can travel safely and enjoy each and every day of our trip and return with just great memories.
How Do You Know When it is Time to Leave Sun City Carolina Lakes?
Carole Miller, RN,BSN
One in a series by HealthShare
Hopefully you moved here Sun City Carolina Lakes because you wanted to enjoy our independent, active life style, be closer to family, pay lower taxes, or for the warmer weather. All of those are reasons most often heard for residing here. Occasionally someone moves here because they or their family think that we are a retirement community that caters to all of the needs of the elderly. That is a misconception. SCCL is not a community with all levels of care. Maybe you or a neighbor has come to realize that their needs are greater than can be met here, or perhaps you have seen the signs but the resident and/or his or her family are in denial. How do you know, and what can you do?
Some of the signs that alternate living arrangements should be considered include the following:
- Recent accidents—falls, “fender benders”
- Chronic health conditions that are worsening (COPD, Arthritis, Heart disease, Dementia)
- Frequent 911 calls
- Difficulty recovering from even common illnesses such as colds or the flu
- Transportation problems that limit access to health care, grocery shopping, prescriptions
- Isolation—not wanting to leave the house and decreased interest in any outside activities
- Changes in appearance—unkempt, staying in night clothes all day
- Noticeable weight loss or gain—signs of poor nutrition
- Dying plants that normally were well maintained
- Pets that don’t seem well cared for
- Mail piled up in the mailbox
- Newspapers not picked up
- Household clutter
- Stale or expired foods and multiples of the same items (sign of forgetfulness)
- Nicks or dents on the car and any signs of dangerous driving
If you identify some of these signs in yourself please talk with your family or with a health care professional as it may be time to move to a location that can provide the assistance you may need, or seek outside assistance that is available in our area and able to help in your home here.
But what if you are a neighbor or friend who notices many of the above signs in a SCCL resident? What do you do? If you know the family and can talk with a family member about your observations that would be the first thing to do, even though it may not make you popular with your neighbor and assuming you have already tried to talk with the resident without success. This is of particular importance if there is a safety issue such as an accident or fire safety. If there is no one to contact, it may become necessary to report the condition to the Lancaster Council on Aging and they can direct you as to how to proceed.
There are some modes of assistance available to residents that can prolong your ability to continue to live here and those include online grocery shopping (available at Harris Teeter), housekeeping services for a fee, Lancaster Area Ride Service (LARS), and home health services, both Medicare and private agencies. Medicare covered home health care requires the order of a physician but does not require hospitalization first, and is for homebound patients, meaning inability to leave the home on a regular basis for the needed service. Medicare covered home health is temporary and intermittent and may include a nurse, physical therapist, occupational therapist, and a home health aide. Private home health services are fee based and the cost varies. Home health can often facilitate the recovery and rehabilitation of an acute illness or surgery. It is important to know that you can request this service from your physician or a case manager in the hospital. Physicians are often not aware of the home circumstances and the need for additional services.
When it becomes time to search for alternate living arrangements, it is important that the resident be involved in the planning and thus the importance of early detection of need. A phrase we do not want to hear is “We are going to have to put Mama (or Papa) somewhere.” None of us want to be “put” anywhere but would rather “choose” to move to a location that we have had input into selecting with the assistance of family or a loved one. If the decision is made in an acute situation there is often not much choice as the best assisted living facilities and nursing homes usually have a waiting list. You want to visit facilities based on services provided, location, affordability, and other individual preferences. There are retirement communities that do provide all three levels of care from independent with minimal assistance such as meals, assisted living which can provide assistance with medications, some personal care, and transportation, and nursing home care which is usually total care. Other facilities are more defined such as just assisted living or nursing home care. It is important to be located close to family so that they can visit often. Ask about activities and if there is a recreational director. Talk with some of the residents. If a desirable facility is found, you may, in some cases, be placed on a waiting list without any obligation so that if you are not ready to move when your name comes up, you can be moved back to the bottom of the list.
There are online sites that can help with finding facilities in our area in both North and South Carolina. One is www.allaboutseniors.org and another is www.aplaceformom.com. Talking with friends and neighbors is also a good resource for information. This is not a subject that most of us t want to talk about, but is so important in our long term care planning. If you are someone with long term care insurance be familiar with your coverage. If you have no insurance be sure you have enough savings to cover your long term care if needed. There are a variety of payment plans which may include renting, buying into your place and paying a maintenance fee, and buying but having the option to sell or use funds for additional costs of assisted living or nursing home care. Do your research early to avoid being “put” someplace!
Questions about LYME Disease?
1.. Lyme disease is transmitted by the bite of a tick, and the disease is very prevalent across the United States and throughout the world.
2. Lyme disease (DRG 867) is a clinical diagnosis and may cause infection of multiple organs and produce a wide range of symptoms and should be used as a differential diagnosis in rheumatologic and neurologic conditions, with symptoms similar to Chronic Fatigue Syndrome, Fibromyalgia, Somatization Disorder, and any difficult-to-diagnose multi-system illness.
3. Fewer than 50% of patients with Lyme disease recall a tick bite or the “bull’s-eye” rash that is considered classic.
4. Many screening test can be unreliable. By definition, a screening test should have at least 95% in sensitivity as a result.
5. A vaccine for Lyme disease is currently unavailable.
6. When used as part of a diagnostic evaluation for Lyme disease, a “western blot” test should be performed by a special laboratory that is specifically known to read and report on Lyme results.
7. There are 5 subspecies of the Lyme spirochete (Borrelia Burgdorferi), over 100 other strains are known in the USA with 300 strains worldwide.
8. There has never been a study supporting that a 30 day antibiotic treatment would cure chronic Lyme disease. Short treatment courses (30 days) often have upwards of a 40% relapse rate.
9. Chronic Lyme disease requires prolonged treatment until the patient is symptom-free. Relapses may occur and often retreatment is required.
10. Lyme disease has been called “the great imitator” and should be considered in the differential diagnosis of many patients with symptoms of rheumatologic and neurologic conditions.
BEST ADVICE: Be your own best advocate and be open and persistent with your doctor regarding your symptoms. Keep a detailed written record that includes prescribed treatments and their effects.
Can You Pass This Balance Test?
According to STEADI (Stopping Elderly Accidents, Deaths and Injuries) more than 27,000 people over 65, die as a result of falls, which is 74 every day all year long. Only 1 in 4 reports falls to their doctors during any appointment. It is very important to let your doctor know if you are slipping, unsteady or falling, even occasionally. There may be many reasons for falls but ALL are important, as part of your health history. They may mean more to your doctor than you think, as part of your total healthcare picture. Slips and fall may be the symptom of many things including, medication interaction, poor eyesight, and a neurological imbalance, and inner ear infection, loss of sensation in your feet and legs or even poor shoe selection.
Thanks to Dr. Steve Morris, for sharing the following. Gait Test with us at his Life Long Learning presentation. So, dig out a pencil and answer the following questions. You get a point for every YES answer. Zero is the BEST score!…..Now be HONEST
- Have I had a slip or fall in the past 12 months?
- It has been suggested I use a cane or walker at any time.
- I sometimes feel unsteady when I walk.
- A family member says they are worried I might fall.
- I need to push on arms of a chair to stand up
- I have trouble judging the depths of curbs.
- I often need to get to the bathroom very quickly.
- I have lost sensation in my feet.
- Family has been asking me to “stand up straight”.
- Some of my medicines make me feel light headed.
- I take medicine to help me sleep.
- I don’t swing my arms when I walk.
Now if you are able to honestly able to all these questions and can get a ZERO your chances of a slip or fall in the next year are very low. However, if your score is 4 or more you need to let your MD know and start a personal campaign to improve. According to a study done by Reuters Health, step training focused on improving gait and balance may help prevent falls among the elderly. In this study the analysis of seven previous studies, with a combined total of 660 older adults, found that interventions to improve stepping skills cut the rate of falls roughly in half. The best fall prevention, suggests that older adults would benefit from exercises designed to help maintain balance during everyday activities like getting out of a chair or avoiding obstacles on a sidewalk, said senior study author Stephen Lord of the University of New South Wales in Sydney, a leading expert in fall prevention. Check into classes or workouts (many easy to follow and available online) that improve your ability to recover when balance is lost. That way trips or slips don’t turn into falls. Strength and balance are most important for physical functioning. So as we are finding, in many things in our lives Prevention is best. So, first step is to put down your test and stand up without holding on to your chair and Step Lively.