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Balance and strengthening exercises help to prevent falls. Stock photo
Our best line of defense is prevention

By David Dunaief, M.D.

Dr. David Dunaief

When we are young, falls usually do not result in significant consequences. However, when we reach middle age and chronic diseases become more prevalent, falls become more substantial. And, unfortunately, falls are a serious concern for older patients, where consequences can be devastating. They can include brain injuries, hip fractures, a decrease in functional ability and a decline in physical and social activities (1). Ultimately, falls can lead to loss of independence (2).

Of those over the age of 65, between 30 and 40 percent will fall annually (3). Most of the injuries that involve emergency room visits are due to falls in this older demographic (4).

What can increase the risk of falls?

Many factors contribute to fall risk. A personal history of falling in the recent past is the most prevalent. But there are many other significant factors, such as age, being female and using drugs, like antihypertensive medications used to treat high blood pressure and psychotropic medications used to treat anxiety, depression and insomnia.

Chronic diseases, including arthritis, as an umbrella term; a history of stroke; cognitive impairment; and Parkinson’s disease can also contribute. Circumstances that predispose us to falls also involve weakness in upper and lower body strength, decreased vision, hearing disorders and psychological issues, such as anxiety and depression (5).

How do we prevent falls?

Stock photo

Fortunately, there are ways to modify many risk factors and ultimately reduce the risk of falls. Of the utmost importance is exercise. But what do we mean by “exercise”? Exercises involving balance, strength, movement, flexibility and endurance, whether home based or in groups, all play significant roles in fall prevention (6). We will go into more detail below.

Many of us in the Northeast suffer from low vitamin D, which may strengthen muscle and bone. This is an easy fix with supplementation. Footwear also needs to be addressed. Nonslip shoes, if recent winters are any indication, are of the utmost concern. Inexpensive changes in the home, like securing area rugs, can also make a big difference.

Medications that exacerbate fall risk

There are a number of medications that may heighten fall risk. As I mentioned, psychotropic drugs top the list. Ironically, they also top the list of the best-selling drugs. But what other drugs might have an impact?

High blood pressure medications have been investigated. A propensity-matched sample study (a notch below a randomized control trial in terms of quality) showed an increase in fall risk in those who were taking high blood pressure medication (7). Surprisingly, those who were on moderate doses of blood pressure medication had the greatest risk of serious injuries from falls, a 40 percent increase. One would have expected those on the highest levels to have the greatest increase in risk, but this was not the case.

While blood pressure medications may contribute to fall risk, they have significant benefits in reducing the risks of cardiovascular disease and events. Thus, we need to weigh the risk-benefit ratio, specifically in older patients, before considering stopping a medication. When it comes to treating high blood pressure, lifestyle modifications may also play a significant role in treating this disease (8).

Why is exercise critical?

All exercise has value. A meta-analysis of a group of 17 trials showed that exercise significantly reduced the risk of a fall (9). If the categories are broken down, exercise had a 37 percent reduction in falls that resulted in injury and a 30 percent reduction in those falls requiring medical attention. Even more impressive was a 61 percent reduction in fracture risk.

Remember, the lower the fracture risk, the more likely you are to remain physically independent. Thus, the author summarized that exercise not only helps to prevent falls but also fall injuries. The weakness of this study was that there was no consistency in design of the trials included in the meta-analysis. Nonetheless, the results were impressive.

Unfortunately, those who have fallen before, even without injury, often develop a fear that causes them to limit their activities. This leads to a dangerous cycle of reduced balance and increased gait disorders, ultimately resulting in an increased risk of falling (10).

What specific types of exercise are useful?

Many times, exercise is presented as a word that defines itself. In other words: Just do any exercise and you will get results. But some exercises may be more valuable or have more research behind them. Tai chi, yoga and aquatic exercise have been shown to have benefits in preventing falls and injuries from falls.

A randomized controlled trial, the gold standard of studies, showed that those who did an aquatic exercise program had a significant improvement in the risk of falls (11). The aim of the aquatic exercise was to improve balance, strength and mobility. Results showed a reduction in the number of falls from a mean of 2.00 to a fraction of this level — a mean of 0.29. There was no change in the control group.

There was also a 44 percent decline in the number of patients who fell. This study’s duration was six months and involved 108 postmenopausal women with an average age of 58. This is a group that is more susceptible to bone and muscle weakness. Both groups were given equal amounts of vitamin D and calcium supplements. The good news is that many patients really like aquatic exercise.

Thus, our best line of defense against fall risk is prevention. Does this mean stopping medications? Not necessarily. But for those 65 and older, or for those who have “arthritis” and are at least 45 years old, it may mean reviewing your medication list with your doctor. Before considering changing your BP medications, review the risk-to-benefit ratio with your physician. The most productive way to prevent falls is through lifestyle modifications.

References:

(1) MMWR. 2014;63(17):379-383. (2) J Gerontol A Biol Sci Med Sci. 1998;53(2):M112. (3) J Gerontol. 1991;46(5):M16. (4) MMWR Morb Mortal Wkly Rep. 2003;52(42):1019. (5) JAMA. 1995;273(17):1348. (6) Cochrane Database Syst Rev. 2012;9:CD007146. (7) JAMA Intern Med. 2014 Apr;174(4):588-595. (8) JAMA Intern Med. 2014;174(4):577-587. (9) BMJ. 2013;347:f6234. (10) Age Ageing. 1997 May;26(3):189-193. (11) Menopause. 2013;20(10):1012-1019.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician. 

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Petra Aureliano with her family
Dorothy Crawford with her granddaughter and great-granddaughter

About 110 family and friends gathered at St. Johnland Nursing Center in Kings Park on Aug. 1 to celebrate its Medical Model Adult Day Health Service Annual Breakfast.

Participants who attend the Monday through Saturday program were joined by family and friends for a wonderful morning of food, fun and music. Guests had an opportunity to see the program firsthand and get a glimpse of how their loved one spends a typical day interacting with others and engaging in games and other mindful activities.

Lillian Safina with her son

Providing care for an aging parent, spouse or loved one can be an overwhelming responsibility for family members and friends. Adult Day Care at St. Johnland Nursing Center offers a wide range of services for adults who need a protective environment but choose to remain in the community and continue to be a vital part of family life.

St. Johnland Nursing Center is a nonprofit, nonsectarian facility, offering residents excellence in skilled nursing care and all aspects of rehabilitation, Alzheimer’s/dementia care, head injury rehabilitation, adult day care, home health care and subacute care.

To learn more about St. Johnland programs and services visit www.stjohnland.org.

Photos courtesy of St. Johnland

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Holocaust survivors at Gurwin Jewish/Fay J. Lindner Residences participate in World Jewish Congress’s 2019 #WeRemember campaign.
Survivors take to social media to ensure the world never forgets

COMMACK: Seven decades have passed since the end of the Holocaust, yet for the survivors, the horrors they witnessed remain vividly clear.  On the 74th anniversary of the liberation of Auschwitz-Birkenau death camp in Poland, Holocaust survivors now living at Gurwin Jewish/Fay J. Lindner Residences assisted living community participated in the third annual WeRemember campaign to ensure the world never forgets the atrocities committed against humanity. 

Tina Kamin fled the Nazis in Poland and lived in the woods for a year.

Organized by the World Jewish Congress (WJC), the #WeRemember social media movement was created three years ago to combat anti-Semitism and all forms of hatred, genocide and xenophobia. The initiative is considered to be the largest global event ever organized to commemorate the Holocaust.   

Survivors, family and friends, celebrities and world leaders representing a wide range of faiths were among the thousands of people from around the world who posted photos of themselves displaying “#WeRemember” signs on Facebook and Twitter. Photos were shared by WJC and then live-streamed on a jumbotron at the gates of Auschwitz, where more than one million people were murdered by the Nazis.

Sally Birnbaum survived four concentration camps.

Eight Holocaust survivors from Gurwin’s assisted living community as well as members of Gurwin’s administrative staff participated in this year’s social media movement.   Among them were survivors of Bergen-Belsen, Auschwitz and other concentration camps, Hidden Children and Kindertransport refugees, each with a unique, horrific story to tell.  

Recognizing the campaign’s powerful impact and its global reach through social media outlets, the survivors were eager to participate, holding signs and giving testimony to their own personal experience during the Holocaust, because, according to Kindertransport child Ruth Meador, “the whole world needs to know… and care.”

Photos from Gurwin Jewish

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MESSAGES OF LOVE AND HOPE

Back row, from left, Phyllis Pack, Carol Trump and Michelle Spruill; front row, from left, Lori Scott, Marcia Rosenberg and Hedi Flickstein Photo by Valentine Cancellare

The ladies of the Quilting Club at the Rose Caracappa Senior Center in Mount Sinai recently created a wonderful gift of love for a friend. When they heard that a longtime member, Hedi Flickstein, had received a disturbing report from her doctor, they came together to create a beautiful quilt filled with loving and healing messages. Hedi said that every time she touches the quilt, it’s like a warm hug of love and hope. She gives her heartfelt thanks to all the members of the Quilting Club: Phyllis, Carol, Lori, Hester, Michelle, Elaine, Pat, Liz, Andrea, Nubia and coordinator, Marcia. 

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Real estate attorney J. Timothy Shea Jr. gives a presentation on The Society of St. Johnland's proposed assisted living facility to Smithtown Town Board.

The Society of St. Johnland in Kings Park hopes to continue its mission to help seniors in need by constructing a new assisted living facility aimed at Medicaid-eligible residents.

The nonprofit nursing center has submitted an application to construct a two-story facility with 82 units and 100 beds in the footprint of an existing, dilapidated building on the north side of Sunken Meadow Road — a separate tax map parcel on the same property as St. Johnland nursing home.

The proposed building will fulfill a need in the community for alternate living options for low-income seniors, according to a real estate attorney speaking on behalf of the project at the Nov. 30 Smithtown Town board meeting.

J. Timothy Shea Jr., of Certilman Balin Adler & Hyman in Hauppauge, asked the board to consider granting  the St. Johnland facility a special exception as its concept plan meets that zoning criteria. This approval would give the nonprofit the ability to use land in a district for a purpose other than what is generally permitted there, in this case an assisted living program on the same property as a nursing home.

“Allowing for this special exception to take place, we would be able to service up to 100 local persons most likely for the assisted living and it’s possible that many of those residents will eventually move to the nursing home at some point in the future,” Shea said.

St. Johnland is also making efforts to implement ideas from staff members and residents into its design of the building’s facade to comply with local waterfront revitalization program standards, he added.

“When we provided elevations of the proposed building to our staff, we received comments indicating they would like to have more of a historic type of architecture,” Shea said. “We are willing to do that and will adjust our elevations accordingly.”

Based on the feedback from the Kings Park Civic Association, the nonprofit has agreed to reduce square footage of the 76,696-square-foot site by approximately 8,000-square-feet to lessen its footprint; preserve an old chapel located to the east of where the facility will be; and provide the group with any building revisions moving forward for further review and comment.

Shea said the site will be “a low traffic generator” because although the facility would employ 70 new employees, they will work in three shifts, so there will be no more than 20 to 25 employees on site at a given time.

Linda Henninger, the president of the Kings Park Civic Association said she and other members were in favor of it.

“We think it’s a good project,” Henninger said. “A lot of residents from Kings Park and our vicinity — like Commack and Northport — utilize St. Johnland and this seems to be within their wheelhouse. We also liked that they’re not clear cutting woods for it. It seems like a win-win for the community and St. Johnland.”

Mary Jean Weber, the chief executive officer of St. Johnland Nursing Center, which has been caring for Kings Parks’ needy since 1870, said the facility has been in planning for nearly two years.

“I think this is the type of service that is really needed in Kings Park,” Weber said. “This is for the population that doesn’t require the [around-the-clock] medical care needed in a nursing facility but maybe cannot remain living at home any longer or have limited funds. For us, it’s a positive program that really helps with our care for the senior community.”

St. Johnland is still awaiting determination on its application for special exception. The project’s construction costs have not been finalized yet.

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Gift of hearing made possible through nonprofit program Senior Dreams Come True

Sally Lepis gets fitted for new hearing aids at the McGuire Hearing Center in Centereach. Photo from Seiden Communications

Thanks to a nonprofit program, one Selden senior is calling her new hearing aids a dream come true.

Sally Lepis, who lives independently at St. Joseph’s Village, a subsidized housing complex, was granted her wish for new hearing aids by Senior Dreams Come True. The nonprofit program founded and run by the elder law firm Genser Dubow Genser & Cona in Melville benefits low-income seniors on Long Island by granting wishes — from helping a senior meet basic needs to fulfilling a lifelong dream. The program especially looks to grant wishes for seniors who have given back to their communities or helped others in their lifetime.

With significant hearing loss, 102-year-old Lepis could not afford to replace her more than 25-year-old hearing aids. Whether speaking to one person or in a group, she has difficulty communicating.

To fulfill Lepis’ wish, Senior Dreams reached out to David Carr, owner and director of McGuire’s Hearing Centers, which is headquartered in Centereach with 10 facilities in the New York City and Long Island areas. He agreed to donate two of the most advanced, custom in-canal hearing aids plus four appointments with the audiologist to do testing, programming and fine tuning of the devices. The total cost for the hearing aids and services is $7,500.

“I was intrigued with this important program to help seniors and the amazing story of Mrs. Lepis and her family,” Carr said. For many years, he has helped seniors in need throughout the U.S. by donating hearing aids to the less fortunate through a program he started called the Foundation for Sight and Sound.

Often referred to as “Mother Teresa,” Lepis has remained the anchor for her family, maintaining a positive attitude no matter what personal hardships she goes through. When she was 57, her husband died. She also lost her twin sister at a young age and raised her then 14-year-old niece Olivia Schmidt in her home.

“No one is more deserving of a Senior Dreams wish than Sally,” Schmidt said. “[She] has devoted her life to caring for many family members and friends while coping with her own sadness and losses she has endured.”

Lepis worked as a seamstress from a young age and only recently got rid of her Singer sewing machine. When her husband died, she worked at B. Altman Department Store in Manhasset as a sales clerk before retiring.

Before she stopped driving at age 95, Lepis did her best to care for friends by driving them to doctor’s appointments. She even saved a friend’s life when she found her stuck in a bathtub for several days.

“Mrs. Lepis has given so much of herself over the years to friends, family and those in need in her community,” said Jennifer Cona, managing partner of Genser Dubow Genser & Cona. “She is exactly the kind of person for whom Senior Dreams Come True seeks to grant wishes.”

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From left, Assemblyman Andrew Raia (R-East Northport), Councilwoman Valerie Cartright (D-Port Jefferson Station), Leg. Kara Hahn (D-Setauket), Ken Kashansky, Sen. Ken LaValle (R-Port Jefferson), Fred S. Sganga, Tom DiNapoli (D) and Sen. John Flanagan (R-East Northport) look on as U.S. Army Vietnam veteran and resident of Unit 3C Joe Rohan cuts the ribbon. Photo by Doreen Guma
Ribbon cutting ceremony officially opens first renovated residential unit

The Long Island State Veterans Home in Stony Brook recently celebrated a milestone in Operation Rejuvenation, a project that will help renovate the interior of the existing facility, with the opening of its first renovated residential unit, 3C. The event was celebrated with a ribbon cutting on Aug. 25.

The project was made possible by a $12.5 million VA Construction Grant, one of the oldest partnerships between the federal government and the states. Each year, through the support of Congressman Lee Zeldin (R-Shirley), the federal government allocates approximately $85 million to fund the State Veterans Home Construction Grant Program. Through this initiative, individual states compete for funding that must be used to either construct or renovate designated state veterans facilities that provide skilled nursing or domiciliary care.

The federal government appropriates 65 percent of the construction costs provided that each state makes a commitment of 35 percent in state matching funds, for which New York State Senator John Flanagan has been instrumental in helping the LISVH secure.

The newly renovated nursing units include a modernized and open dining space, an accessible nourishment station, a complete nursing station redesign and fully renovated living spaces for residents. This project included the installation of energy-efficient LED lighting, LED televisions and new personal furnishings that our nation’s heroes will be proud to call home.

“The Long Island State Veterans Home has always made a commitment to be the premiere provider for long-term care services to our nation’s heroes,” said Fred S. Sganga, executive director of the Long Island State Veterans Home. “Operation Rejuvenation will assure that our frail, elderly veterans are living in the finest facility in the country. We are really excited about this project because it represents the recommitment of Stony Brook University to Long Island’s veterans and their families.”

“Our veterans were willing to put themselves in harm’s way in order to protect our freedom and way of life,” said Zeldin. “We owe it to them to make sure the facilities that care for our veterans are in the best condition possible to meet their needs. The work being done at the Long Island State Veterans Home will help accomplish that goal, and I commend the leadership and staff for undertaking this project.”

“Our nation owes a debt of gratitude to those who have protected our way of life and cherished freedoms,” said Flanagan. “One way we can say ‘thank you’ to them is by making sure these brave men and women have a comfortable living environment. The Long Island State Veterans Home has been a great resource for our veterans and their families and this project will help ensure that it continues to be a place that our heroes are proud to call home,” he said.

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A credit shelter trust is a marital trust that allows you to a voice having the same property taxed twice.

By Linda Toga

Linda Toga

THE FACTS: I had my will prepared years ago. The estate tax exclusion amount at the time was considerably less than it is now, so my will contains a provision that directs my executor to create a credit shelter trust to avoid estate taxes. The trust provision mandates that the credit shelter trust be funded with assets equal in value to the estate tax exemption amount in effect at the time of my death.

THE QUESTION: A friend told me the credit shelter trust language that is currently included in my will could result in only a small part of my estate, if any, passing directly to my wife. Is he correct?

THE ANSWER: Without knowing the size of your estate, it is impossible to say how much of your estate might pass directly to your spouse upon your death. That being said, your friend is correct.

Credit shelter trusts are designed to avoid estate tax, but tax avoidance is generally not an issue when the first spouse dies because the surviving spouse is most often the beneficiary of the deceased spouse’s estate.

Regardless of the value of the assets that pass to a surviving spouse as sole beneficiary, there will be no estate tax liability on the first death because both the federal and New York State tax codes include an unlimited marital deduction. That means the assets passing to the surviving spouse pass estate tax free.

In contrast, the value of assets passing to a nonspouse may trigger estate tax. That is why estate tax can become a problem when the surviving spouse dies. If the value of the surviving spouse’s estate exceeds the applicable estate tax exemption amount then in effect, estate tax will be due. This year the federal estate tax exemption is currently at $5.49 million and the New York State exclusion amount is currently at $5.25 million.

If your will directs that assets equal in value to the current estate tax exemption amount go into the credit shelter trust, over $5.2 million of your probate estate must be used to fund the trust. The actual dollar amount will depend on whether your will references the federal or the New York State exemption/exclusion amount. If the value of your assets does not exceed the exemption amount, the only assets passing directly to your spouse will be jointly held assets and assets on which she is a named beneficiary. Assets that are used to fund the trust will be available to your spouse under certain conditions. She will not have unfettered access to those funds.

Credit shelter trusts were very popular with my clients when the estate tax exclusion amounts were significantly smaller. In 2008, for example, when the federal estate tax exemption was $2 million, clients with estates valued at $3 to $4 million felt comfortable funding a credit shelter trust since the surviving spouse would still receive $1 to $2 million outright. However, since the exclusion amount has increased at a much faster rate than the value of most people’s estates, the language in many credit shelter trusts has become a problem.

One way to address the problem is to have a new will prepared that does not direct your executor to create a credit shelter trust. However, if you are concerned about estate tax liability, another option is to have a new will prepared that includes language limiting the value of the assets that must be used to fund a credit shelter trust. That way you can be sure that there are sufficient assets passing to your spouse outright.

A third option is to include a discretionary marital trust in your will, rather than a credit shelter trust. A disclaimer trust, for example, can be used by married couples to avoid estate taxes and has the advantage of allowing the surviving spouse to decide how much money will go into the trust. If the surviving spouse feels comfortable doing so, she can have the trust funded with assets equal in value to the applicable exclusion amount. However, she can also decide to fund the trust with a lesser amount or to not to fund the trust at all.

The surviving spouse has nine months to decide whether it makes sense taxwise to fund the trust. Because of the flexibility offered by disclaimer trusts, and the ability to essentially do post-mortem planning, many people whose estates are valued at over the exclusion amount find disclaimer trusts a good option. To figure out what would be best for you, you should discuss your situation with an experienced estate planning attorney.

Linda M. Toga, Esq. provides legal services in the areas of estate planning, probate, estate administration, litigation, wills, trusts, small business services and real estate from her East Setauket office.

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Blueprints would mirror design for similar housing in Rocky Point

Mark Baisch discusses his proposal for senior homes in Miller Place at the July 10 Sound Beach Civic Association meeting. Photo by Ginny Drews

Low-cost, community-based apartments for seniors may be heading to Miller Place.

During a July 10 Sound Beach Civic Association meeting, Mark Baisch, owner of the Rocky Point-based development company Landmark Properties Ltd., proposed 44 600-square-feet, one bedroom apartment units be built as a cul-de-sac on the northwest corner of Sylvan Avenue and Echo Avenue.

The plan is for the senior-exclusive apartment complex, temporarily named Echo Run, to be developed on half of the heavily wooded 3.7-acre site, while the other half would remain in its natural state.

According to Baisch’s proposal, all four units in each of the 11 buildings would have a high Energy Star rating with geothermal heating and cooling systems. Rent is expected to be between $1,000 and $1,400 per month.

“It’s kind of lifting a weight off their shoulders because now, this whole homeownership responsibility at 75 years old goes away.”

— Mark Baisch

He said the project aims to provide older residents a new, much-needed living option.

“There’s a huge demand for reasonably priced apartments for seniors who have lived here for a significant portion of their life because for them, there is no place to go,” Baisch said of his plan, which targets senior citizens burdened with paying high taxes to live in homes or basement apartments they might not need anymore. “It’s kind of lifting a weight off their shoulders because now, this whole homeownership responsibility at 75 years old goes away and you end up living the rest of your life without that worry.”

He said senior citizens would not have to worry about upkeep and maintenance around their yard and home while in the complex.

“Here’s what would be a bunch of accessory apartments all in an area where everybody’s in the same boat — they can all support one another and that’s the way it really should be,” Baisch said. “The psychological benefit alone probably exceeds the housing benefit.”

Sound Beach Civic Association President Bea Ruberto, 70, said she’s ready to sign up.

“I can envision myself living there,” Ruberto said. “As baby boomers, we’re getting to the age where we want to live somewhere like that and we have very few rental apartments in the area. More senior rental is definitely needed.”

Ruberto said the proposal was well-received by other civic board members, especially Baisch’s idea to give each building in the complex a different color and design so it better fits the look of the community.

“I can envision myself living there. … More senior rental is definitely needed.”

— Bea Ruberto

The Miller Place proposal mirrors Baisch’s On the Commons apartment complex in development in Rocky Point on the site of the old Thurber Lumber Co. Inc. He said Miller Place and Sound Beach residents requested to be placed on the Rocky Point housing list, prompting him to add a second location.

Like On the Commons, Echo Run plans to reserve a significant percentage of its homes for United States military veterans. The minimum percentage for veterans in Miller Place would be 10 percent, Baisch said, but that number may be adjusted pending an upcoming meeting with Joe Cognitore, commander of Rocky Point Veteran of Foreign Wars Post 6249.

Mary McDonald, 66, who has lived in Miller Place for 32 years, is pleased the proposal is pushing for residential development as opposed to commercial.

“Affordable housing for seniors is something that’s going to be needed all through Suffolk County, because taxes are so high seniors have to leave,” she said. “I’m getting to that point myself.”

Brookhaven Town Councilwoman Jane Bonner (C-Rocky Point) said she has already received positive feedback from seniors.

“Several residents have reached out to me and are very excited for it,” Bonner said.

Baisch has discussed the estimated two-year plan with the president of the Miller Place Civic Association and members of Brookhaven Town, and will be meeting with the Mount Sinai Civic Association in the near future.

“I know this will be a homerun in Miller Place,” he said, “just like it’s a homerun in Rocky Point.”

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