Taking care of yourself is one of the most important things you can do as a caregiver. This could mean asking family members and friends to help out, doing things you enjoy, using adult day care services, or getting help from a local home health care agency. Taking these actions can bring you some relief. It also may help keep you from getting ill or depressed.
Here are some ways you can take care of yourself:
* Ask for help when you need it.
* Join a caregiver's support group.
* Take breaks each day.
* Spend time with friends.
* Keep up with your hobbies and interests.
* Eat healthy foods.
* Get exercise as often as you can.
* See your doctor on a regular basis.
* Keep your health, legal, and financial information up-to-date.
Getting help
Everyone needs help at times. It's okay to ask for help and to take time for yourself. However, many caregivers find it hard to ask for help.
They feel:
* They should be able to do everything themselves.
* That it's not all right to leave the person with someone else.
* No one will help even if they ask.
* They don't have the money to pay someone to watch the person for an hour or two.
If you have trouble asking for help, try using some of the tips below.
Here are some reminders about how to get help:
* It's okay for me to ask for help from family, friends, and others. I don't have to do everything myself.
* I can ask people to help out in specific ways like making a meal, visiting the person, or taking the person out for a short time.
* I will join a support group to share advice and understanding with other caregivers.
* I will call for help from home health care or adult day care services when I need it.
* I will use national and local resources to find out how to pay for some of this help.
You may want to join a support group of AD caregivers in your area or on the Internet. These groups meet in person or online to share experiences and tips, and to give each other support. Ask your doctor, check online, or look in the phone book for a local chapter of the Alzheimer's Association.
You also can call the Alzheimer's Disease Education and Referral Center at no cost. The phone number is 1-800-438-4380. Visit on the Internet at http://www.nia.nih.gov/Alzheimers.
Your emotional health
You may be so busy caring for the person with AD that you don't have time to think about your emotional health. But, you need to. Caring for a person with AD takes a lot of time and effort. Your job as caregiver can become even harder when the person you're caring for gets angry with you, hurts your feelings, or forgets who you are. Sometimes, you may feel really discouraged, sad, lonely, frustrated, confused, or angry. These feelings are normal.
Here are some things you can say to yourself that might help you feel better:
* I'm doing the best I can.
* What I'm doing would be hard for anyone.
* I'm not perfect, and that's okay.
* I can't control some things that happen.
* Sometimes, I just need to do what works for right now.
* Even when I do everything I can think of, the person with AD will still have problem behaviors because of the illness, not because of what I do.
* I will enjoy the moments when we can be together in peace.
* I will try to get help from a counselor if caregiving becomes too much for me.
Meeting your spiritual needs
Many of us have spiritual needs. Going to a church, temple, or mosque helps some people meet their spiritual needs. They like to be part of a faith community. For others, simply having a sense that larger forces are at work in the world helps meet their spiritual needs. As the caregiver of a person with AD, you may need more spiritual resources than others do.
Meeting your spiritual needs can help you:
* Cope better as a caregiver.
* Know yourself and your needs.
* Feel recognized, valued and loved.
* Become involved with others.
* Find a sense of balance and peace.
Other caregivers made these suggestions to help you cope with your feelings and spiritual needs:
* Understand that you may feel powerless and hopeless about what's happening to the person you care for.
* Understand that you may feel a sense of loss and sadness.
* Understand why you've chosen to take care of the person with AD. Ask yourself if you made this choice out of love, loyalty, a sense of duty, a religious obligation, financial concerns, fear, a habit, or self-punishment.
* Let yourself feel day-to-day "uplifts." These might include good feelings about the person you care for, support from other caring people, or time to spend on your own interests and hobbies.
* Keep a connection to something "higher than yourself." This may be a belief in a higher power, religious beliefs, or a belief that something good comes from every life experience.
The information contained in this article is from the National Institute on Aging website.
Wednesday, October 20, 2010
Wednesday, July 28, 2010
New guidelines for Alzheimer’s could lead to earlier diagnosis
NEW YORK — For the first time in 25 years, medical specialists are proposing a major change in the criteria for Alzheimer’s disease, part of a new movement to diagnose and, eventually, treat the disease earlier.The new diagnostic guidelines, presented yesterday at an international Alzheimer’s meeting in Hawaii, would mean that new technology such as brain scans would be used to detect the disease before there are evident memory problems or other symptoms.
If the guidelines are adopted in the fall, as expected, some specialists predict a two- to threefold increase in the number of people diagnosed with Alzheimer’s disease. Many more people would be told they probably are on their way to getting it.
The changes could also help drug companies that are developing new drugs to try to attack the disease earlier. So far, no drugs alter the course of the disease.
Development of the guidelines, by panels convened by the National Institute on Aging and the Alzheimer’s Association, began a year ago because, with a new understanding of the disease and new ways of detection, it was becoming clear that the old method of diagnosing Alzheimer’s was sorely outdated.
The current criteria for diagnosing Alzheimer’s require steadily progressing dementia — memory loss and an inability to carry out day-to-day activities — along with a pathologist’s report of plaque and another abnormality, known as tangles, in the brain after death.
But researchers now believe the disease is present a decade or more before dementia.
“Our thinking has changed dramatically,’’ said Dr. Paul Aisen, an Alzheimer’s researcher at the University of California at San Diego, who is helping formulate the new guidelines. “We now view dementia as a late stage in the process.’’
The new guidelines include criteria for three stages: preclinical disease, mild cognitive impairment due to Alzheimer’s disease, and, lastly, Alzheimer’s dementia. The guidelines should make diagnosing the final stage of the disease in people who have dementia more definitive. But the guidelines also say that the earlier a diagnosis is made the less certain it is. So the new effort to diagnose the disease earlier could, at least initially, lead to more mistaken diagnoses.
Under the new guidelines, diagnoses will aim to identify the disease as it is developing by using results from so-called biomarkers — tests like brain scans, MRI scans, and spinal taps that reveal telltale brain changes.
The biomarkers were developed and tested only recently, and none has been formally approved for Alzheimer’s diagnosis. One of the newest, a PET scan, shows plaque in the brain. The others provide strong indications that Alzheimer’s is present, even when patients do not yet have dementia or much memory loss.
Aisen says he foresees a day when people in their 50s routinely have biomarker tests for Alzheimer’s and, if the tests indicate the disease is brewing, take drugs to halt it. That is not expected soon, he says, but “it’s where we are heading.’’
“This is a major advance,’’ said Dr. John Morris, an Alzheimer’s researcher at Washington University in St. Louis who helped write the guidelines. “We used to say we did not know for certain it was Alzheimer’s until the brain is examined on autopsy.’’
By Gina Kolata
New York Times / July 14, 2010
If the guidelines are adopted in the fall, as expected, some specialists predict a two- to threefold increase in the number of people diagnosed with Alzheimer’s disease. Many more people would be told they probably are on their way to getting it.
The changes could also help drug companies that are developing new drugs to try to attack the disease earlier. So far, no drugs alter the course of the disease.
Development of the guidelines, by panels convened by the National Institute on Aging and the Alzheimer’s Association, began a year ago because, with a new understanding of the disease and new ways of detection, it was becoming clear that the old method of diagnosing Alzheimer’s was sorely outdated.
The current criteria for diagnosing Alzheimer’s require steadily progressing dementia — memory loss and an inability to carry out day-to-day activities — along with a pathologist’s report of plaque and another abnormality, known as tangles, in the brain after death.
But researchers now believe the disease is present a decade or more before dementia.
“Our thinking has changed dramatically,’’ said Dr. Paul Aisen, an Alzheimer’s researcher at the University of California at San Diego, who is helping formulate the new guidelines. “We now view dementia as a late stage in the process.’’
The new guidelines include criteria for three stages: preclinical disease, mild cognitive impairment due to Alzheimer’s disease, and, lastly, Alzheimer’s dementia. The guidelines should make diagnosing the final stage of the disease in people who have dementia more definitive. But the guidelines also say that the earlier a diagnosis is made the less certain it is. So the new effort to diagnose the disease earlier could, at least initially, lead to more mistaken diagnoses.
Under the new guidelines, diagnoses will aim to identify the disease as it is developing by using results from so-called biomarkers — tests like brain scans, MRI scans, and spinal taps that reveal telltale brain changes.
The biomarkers were developed and tested only recently, and none has been formally approved for Alzheimer’s diagnosis. One of the newest, a PET scan, shows plaque in the brain. The others provide strong indications that Alzheimer’s is present, even when patients do not yet have dementia or much memory loss.
Aisen says he foresees a day when people in their 50s routinely have biomarker tests for Alzheimer’s and, if the tests indicate the disease is brewing, take drugs to halt it. That is not expected soon, he says, but “it’s where we are heading.’’
“This is a major advance,’’ said Dr. John Morris, an Alzheimer’s researcher at Washington University in St. Louis who helped write the guidelines. “We used to say we did not know for certain it was Alzheimer’s until the brain is examined on autopsy.’’
By Gina Kolata
New York Times / July 14, 2010
Friday, May 7, 2010
The Sandwich Generation- Care for the Caregiver
The Sandwich Generation": those caught between caring for their aging parents and their own children. Many Baby Boomers (the generation born between 1946-1961) find themselves a part of this Sandwich Generation. The typical Baby Boomer is a 46 year old female, having some college education, and working full time. This is the typical demographic of the person trying to balance a full time job, caring for elderly parents and caring for their own growing children. It goes without saying that trying to juggle these responsibilities comes at a cost-usually to the caregiver. But who cares for the caregiver?
If you find yourself in this group, it is very important to remember to care of yourself. If you don't, the stress of juggling so many responsibilities will take its toll on you. Remember, you are no good to anyone if you are not taking care of yourself. There are several things you should do to take care of yourself. The first is to eat well. Avoid junk food and simple carbs as they can raise insulin levels and actually increase your stress levels.
Include yourself on the list of people you take care of- make yourself a priority. You can't provide care for others if you let your own health and well-being decline. Taking care of yourself must become a necessity, not an indulgence. Thinking of yourself this way may seem foreign but remember, it's not optional.
Remember to spend time with family and friends. You deserve that time and it can fortify you to continue as an effective caregiver. Many people find themselves spread too thin and when something needs to give, it's usually the time spent with family and friends.
Call upon brothers and/or sisters to share the load. In time, caring for an aging parent can become impossible to do alone, especially if you work full time. Speak with siblings and ask them how they can participate in your parents' care. It's not a burden for only one.
Consider utilizing the services of a home care agency. Affordable in-home care is available to relieve you of some of the daily activities of living. Help is available for assistance with bathing, cooking, cleaning, laundry, errands, and even general companionship. This can be a low cost way to free you up to spend quality time with your aging parents.
Seek the advice of an elder law attorney. This can be money well spent. Make sure wills are drawn up. Consider obtaining any documents required to designate a power of attorney should it become necessary.
The help of a Geriatric Care Manager can be a valuable asset, especially to Boomers who live a long distance from their aging parents. Geriatric Care Managers are professionals that specialize in issues related to seniors. Care managers function as an advocate for their clients through needs assessment, problem solving, care coordination and referrals for other services as needed.
Being the caregiver of an aging loved one is never an easy task, but by making yourself a priority and utilizing the help of others, you can handle the takes healthier and longer.
Written By : Murphy Ortiz
If you find yourself in this group, it is very important to remember to care of yourself. If you don't, the stress of juggling so many responsibilities will take its toll on you. Remember, you are no good to anyone if you are not taking care of yourself. There are several things you should do to take care of yourself. The first is to eat well. Avoid junk food and simple carbs as they can raise insulin levels and actually increase your stress levels.
Include yourself on the list of people you take care of- make yourself a priority. You can't provide care for others if you let your own health and well-being decline. Taking care of yourself must become a necessity, not an indulgence. Thinking of yourself this way may seem foreign but remember, it's not optional.
Remember to spend time with family and friends. You deserve that time and it can fortify you to continue as an effective caregiver. Many people find themselves spread too thin and when something needs to give, it's usually the time spent with family and friends.
Call upon brothers and/or sisters to share the load. In time, caring for an aging parent can become impossible to do alone, especially if you work full time. Speak with siblings and ask them how they can participate in your parents' care. It's not a burden for only one.
Consider utilizing the services of a home care agency. Affordable in-home care is available to relieve you of some of the daily activities of living. Help is available for assistance with bathing, cooking, cleaning, laundry, errands, and even general companionship. This can be a low cost way to free you up to spend quality time with your aging parents.
Seek the advice of an elder law attorney. This can be money well spent. Make sure wills are drawn up. Consider obtaining any documents required to designate a power of attorney should it become necessary.
The help of a Geriatric Care Manager can be a valuable asset, especially to Boomers who live a long distance from their aging parents. Geriatric Care Managers are professionals that specialize in issues related to seniors. Care managers function as an advocate for their clients through needs assessment, problem solving, care coordination and referrals for other services as needed.
Being the caregiver of an aging loved one is never an easy task, but by making yourself a priority and utilizing the help of others, you can handle the takes healthier and longer.
Written By : Murphy Ortiz
Tuesday, February 2, 2010
Aging Gracefully or Not - 8 Mistakes
Taking care of aging parents is not an easy task. Many in our aging society are not aging gracefully, and fighting or ignoring their decline in physical and cognitive abilities. No matter how well we eat, how much we exercise, how many supplements we take, there is nothing that stops the aging process. Granted, we all age at different rates, but eventually our bodies wear out, and we can no longer do things as easily as we once did. Taking care of an aging loved one is not for sissies! To assist you as you go the through process of aging with your loved one, here are the top 8 common mistakes made by seniors and their families.
Not planning ahead, even for a health care crisis
Common sense tells us that as we age we should expect to require some assistance , or even total care at some point. Yet, many aging adults find aging gracefully difficult. Fear of aging and a need to hold on to their independence causes many seniors not to ask for help. Those in the early stages of dementia may not recognize their need. Family members need to prepare themselves so that if a health care crisis does occur that their aging loved one will have some protection. Preparing for this will take time and energy. It requires learning about Medicare, Medicaid, insurance policies, legal forms and health care options available. Being prepared, can decrease stress and anxiety in a time of crisis, and gives you a sense of confidence as you assist your aging parent in making important decision.
Denial
Many adults who have a fear of aging neglect signs of poor heath.. Many overlook health problems for such reasons as worrying about paying their co pay, so they delay going to the doctors until the condition worsens. Such a delay can result in more advanced stages of a condition. Many aging adults feel as if they can fight the process and refuse to wear hearing aides, braces or walking aids. Family members often do not address these behaviors as they are met with strong resistance. This can be a difficult and uncomfortable situation for many family members. Sometimes having a family meeting and having a person that your parent respects and trusts will open the lines of communication.
Reluctance
Not aging gracefully causes many adults to be reluctant to discuss that they need assistance, because to admit that fact means they are growing old. To many aging adults, that is a blow to their self esteem and many perceive that they must give up their independence or become a burden to the family. Family members, many times are reluctant to bring up the subject of your aging parent needing care, due to family dynamics. Within the family there may be challenges of overcoming guilt, anxiety or even anger. It is important that you make your aging parent aware that you are there to support them and not to interfere, that their safety and health are your utmost concern.
Are not aware of all the options and levels of care available
The healthcare delivery system can be overwhelming. Many families have no idea that where to begin to look for assistance or what services and options are available. There are many county, state and senior services that can provide direct access to specific care providers. Your local agency on aging can direct you to programs and services that are specific to your area. You clergy member may be able to assist you in directing you and your family members to professionals that have successfully supported other church members. You may want to utilize the services of a care manager or eldercare consultant to assist you in maneuvering the health care system. These are individuals that specialize in the care of the aging population and can advocate, make recommendations and assist in overseeing every aspect of the care and services that are needed for your aging parent.
Family disagreement
Inaction by family members due to differences of opinion with in a family as to what care is needed, and where and from whom it should come. Nothing can revive conflicts in adult siblings than making decisions about an aging parent. All the old roles, parents favorite, the black sheep, the unresolved battles and family rivalries resurface. Old family dynamics come back, and adult siblings can sabotage wise decisions during those anxiety producing conversations about the aging parent. There are also cultural differences, where the eldest son, no matter what his relationship with his aging parents has been, is expected to be the decision maker in those families. Many of the sisters/daughters in these cultures are not involved in the decision making process, even though they are the ones that have been providing the care. It is important to focus, as a group, on what your parents would want and provide them with the best possible care in a safe and comfortable environment. In these situations, an outside objective third party is recommended. There are eldercare facilitators, care managers and eldercare consultants to assist your family through this process.
Misunderstanding of what health insurance, long term care, and supplements provide
It is important for seniors and their family members to investigate and understand what Medicare, Medicare supplements and Medicaid covers. If your aging parent has long term care insurance, it is also important to review waiting periods, cost of living riders and home care coverage. This is the first time many family members hear the term, "spend down". Spend down is depleting private or family finances to the point where an individual is sufficiently poor to meet the eligibility criteria for Medicaid. The spend down process and transition to poverty can involve multiple losses. It is wise to consult an elder care attorney early, before a crisis to assist you in planning to protect your aging parent's assets.
Concern over financial loss and downsizing
Many aging adults have worked their entire life and they want to leave an inheritance. They do not want to give up everything they have worked for. There are emotional and logistical factors of downsizing. It is emotionally traumatizing and overwhelming to the aging parent to give up their possessions. For many, their former life style was their identity. It is can be a difficult transition to fit into this new lifestyle. People want to age in their homes and do not realize there are options available to them to help keep them there. Eighty percent of long term care is provided by families, not institutions. There are more than 20 million Americans that provide care for an aging loved one. This allows the aging parent to continue to age in place in the comfort of familiar surroundings and be close to their loved ones.
Inability to discuss end of life issues
Aging gracefully is no longer a part of our culture. Billions of dollars are spent trying to avoid growing old. It is a fact that no one lives forever. We all are going to die. If we don't die young, we are going to die old. So we should prepare for this time. We should be able to say what we want to do to stay alive. Some choose multiple medical tests, invasive and painful procedures and multiple admissions to the hospital to avoid death at all costs. Others, do not discuss death and do not express their wishes to others, and leave the difficult decisions to family members. This takes a terrible toll on a family during a very difficult time. There is such a thing as dying with dignity. It is the very last thing we can have a say in as we age. Establish advanced directives now. Five Wishes, an advanced directive form, is a very complete and unique among all other living will and health agent forms because it looks to all of a person's needs: medical, personal, emotional and spiritual. Five Wishes also encourages discussing your wishes with your family and physician. Complete durable power of attorney for finances and durable power attorney for health care. These simple documents allow another person to make financial and health decisions for you should you become incapacitated in the future. You should also discuss developing a will and planning funeral arrangements. This will not only save you money, by preparing for your final arrangements, your family will have comfort in knowing that your final wishes are being honored. It will alleviate stress and allow them to celebrate you and your life.
In an effort to help family members become better informed and more feel empowered about assisting or even just with dealing with the issues of your aging parent, the resources are there. You just need to take the time, have the energy and the commitment to getting the right assistance at the right time. Being proactive and planning ahead makes this process much easier. Realize that your parents are adults and are responsible for their own lives.
You can only do what they will allow you to do. Hang in there and continue to work with your parents and do not take what they are saying personally. It is about them and fear of aging and change, fear of loss of independence and fear of loosing control, over their lives.
Not planning ahead, even for a health care crisis
Common sense tells us that as we age we should expect to require some assistance , or even total care at some point. Yet, many aging adults find aging gracefully difficult. Fear of aging and a need to hold on to their independence causes many seniors not to ask for help. Those in the early stages of dementia may not recognize their need. Family members need to prepare themselves so that if a health care crisis does occur that their aging loved one will have some protection. Preparing for this will take time and energy. It requires learning about Medicare, Medicaid, insurance policies, legal forms and health care options available. Being prepared, can decrease stress and anxiety in a time of crisis, and gives you a sense of confidence as you assist your aging parent in making important decision.
Denial
Many adults who have a fear of aging neglect signs of poor heath.. Many overlook health problems for such reasons as worrying about paying their co pay, so they delay going to the doctors until the condition worsens. Such a delay can result in more advanced stages of a condition. Many aging adults feel as if they can fight the process and refuse to wear hearing aides, braces or walking aids. Family members often do not address these behaviors as they are met with strong resistance. This can be a difficult and uncomfortable situation for many family members. Sometimes having a family meeting and having a person that your parent respects and trusts will open the lines of communication.
Reluctance
Not aging gracefully causes many adults to be reluctant to discuss that they need assistance, because to admit that fact means they are growing old. To many aging adults, that is a blow to their self esteem and many perceive that they must give up their independence or become a burden to the family. Family members, many times are reluctant to bring up the subject of your aging parent needing care, due to family dynamics. Within the family there may be challenges of overcoming guilt, anxiety or even anger. It is important that you make your aging parent aware that you are there to support them and not to interfere, that their safety and health are your utmost concern.
Are not aware of all the options and levels of care available
The healthcare delivery system can be overwhelming. Many families have no idea that where to begin to look for assistance or what services and options are available. There are many county, state and senior services that can provide direct access to specific care providers. Your local agency on aging can direct you to programs and services that are specific to your area. You clergy member may be able to assist you in directing you and your family members to professionals that have successfully supported other church members. You may want to utilize the services of a care manager or eldercare consultant to assist you in maneuvering the health care system. These are individuals that specialize in the care of the aging population and can advocate, make recommendations and assist in overseeing every aspect of the care and services that are needed for your aging parent.
Family disagreement
Inaction by family members due to differences of opinion with in a family as to what care is needed, and where and from whom it should come. Nothing can revive conflicts in adult siblings than making decisions about an aging parent. All the old roles, parents favorite, the black sheep, the unresolved battles and family rivalries resurface. Old family dynamics come back, and adult siblings can sabotage wise decisions during those anxiety producing conversations about the aging parent. There are also cultural differences, where the eldest son, no matter what his relationship with his aging parents has been, is expected to be the decision maker in those families. Many of the sisters/daughters in these cultures are not involved in the decision making process, even though they are the ones that have been providing the care. It is important to focus, as a group, on what your parents would want and provide them with the best possible care in a safe and comfortable environment. In these situations, an outside objective third party is recommended. There are eldercare facilitators, care managers and eldercare consultants to assist your family through this process.
Misunderstanding of what health insurance, long term care, and supplements provide
It is important for seniors and their family members to investigate and understand what Medicare, Medicare supplements and Medicaid covers. If your aging parent has long term care insurance, it is also important to review waiting periods, cost of living riders and home care coverage. This is the first time many family members hear the term, "spend down". Spend down is depleting private or family finances to the point where an individual is sufficiently poor to meet the eligibility criteria for Medicaid. The spend down process and transition to poverty can involve multiple losses. It is wise to consult an elder care attorney early, before a crisis to assist you in planning to protect your aging parent's assets.
Concern over financial loss and downsizing
Many aging adults have worked their entire life and they want to leave an inheritance. They do not want to give up everything they have worked for. There are emotional and logistical factors of downsizing. It is emotionally traumatizing and overwhelming to the aging parent to give up their possessions. For many, their former life style was their identity. It is can be a difficult transition to fit into this new lifestyle. People want to age in their homes and do not realize there are options available to them to help keep them there. Eighty percent of long term care is provided by families, not institutions. There are more than 20 million Americans that provide care for an aging loved one. This allows the aging parent to continue to age in place in the comfort of familiar surroundings and be close to their loved ones.
Inability to discuss end of life issues
Aging gracefully is no longer a part of our culture. Billions of dollars are spent trying to avoid growing old. It is a fact that no one lives forever. We all are going to die. If we don't die young, we are going to die old. So we should prepare for this time. We should be able to say what we want to do to stay alive. Some choose multiple medical tests, invasive and painful procedures and multiple admissions to the hospital to avoid death at all costs. Others, do not discuss death and do not express their wishes to others, and leave the difficult decisions to family members. This takes a terrible toll on a family during a very difficult time. There is such a thing as dying with dignity. It is the very last thing we can have a say in as we age. Establish advanced directives now. Five Wishes, an advanced directive form, is a very complete and unique among all other living will and health agent forms because it looks to all of a person's needs: medical, personal, emotional and spiritual. Five Wishes also encourages discussing your wishes with your family and physician. Complete durable power of attorney for finances and durable power attorney for health care. These simple documents allow another person to make financial and health decisions for you should you become incapacitated in the future. You should also discuss developing a will and planning funeral arrangements. This will not only save you money, by preparing for your final arrangements, your family will have comfort in knowing that your final wishes are being honored. It will alleviate stress and allow them to celebrate you and your life.
In an effort to help family members become better informed and more feel empowered about assisting or even just with dealing with the issues of your aging parent, the resources are there. You just need to take the time, have the energy and the commitment to getting the right assistance at the right time. Being proactive and planning ahead makes this process much easier. Realize that your parents are adults and are responsible for their own lives.
You can only do what they will allow you to do. Hang in there and continue to work with your parents and do not take what they are saying personally. It is about them and fear of aging and change, fear of loss of independence and fear of loosing control, over their lives.
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