Wednesday, November 30, 2011

Medicare Open Enrollment – Make Your Choices By December 7th

It’s that time of year again - Medicare’s open enrollment period started earlier this year (October 15th) and ends on December 7th. If you or a family member is 65 or older, you have less than a month to make any changes, so be sure to review your options and make selections before the deadline hits.

Even if you are satisfied with your coverage plan, I highly recommend that you still review all the options available to you. While you choices may look the same as previous years, you’ll want to note the rate changes for 2012 and make sure that the options still fit your needs and your budget.

Open enrollment is the only time of the year that you can make changes (unless you experience a qualifying ‘event’ that would allow you to update your plan).

Like many private insurance programs, basic Medicare does not pay for all of your health care costs. You are responsible for paying premiums, covering deductibles, and handling coinsurance or copayments. Basic Medicare services – both Parts A and B – do not pay for long-term care or extended stays in skilled nursing or assisted living facilities. Basic Medicare also only pays for about 20% of your doctor’s charges, so if you are under the standard Medicare plan, you probably want to buy supplemental health insurance to give you adequate coverage and help out with deductibles.

While Medicare can seem a little confusing – especially if you are new to the program, there are really just two main options involved, plus the coverage for prescription drugs. Medicare programs work like an HMO, run by private companies.

Your main choices are whether or not to go with basic (also called ‘original’) Medicare or with a Medicare Advantage Plan. The Medicare Advantage Plan gives you additional services, including a standard prescription drug plan. You can also enroll in a Medicare Part D prescription plan as an alternative.

If you need assistance, you can contact Medicare directly to ask questions. You can also visit the Medicare open enrollment Web site at http://medicare.gov/open-enrollment/index. You’ll find that the Web site does a good job of explaining options and answering frequently asked questions.

Don’t wait too long! Just as the holidays are almost upon us, don’t let December 7th come and go with reviewing all of your health care coverage options.

Tuesday, November 8, 2011

Medication Management for Seniors – The Impact on Society of Med Noncompliance

According to PhRMA (Pharmaceutical Research and Manufacturers of America), more than 75% of adult Americans who take three or more medicines daily are non-compliant with taking their medications properly. More than half of our seniors who take multiple medications (and one in four of them take 10-19 mediations each day) either forget to take the correct dose or fail in some other manner to take the right medication. While we can see for ourselves the impact this can have on our loved ones, did you know that the economic impact to our society is in excess of $100 billion each year?

Medication non-compliance puts even more stress on an already over-burdened healthcare system, adding to the costs of healthcare and contributing to steadily rising insurance costs. It stretches our Medicare and Medicaid resources, and the demand causes even more shortages of healthcare professionals.

Wow. And it’s not just the dollars and cents – medication non-compliance kills more of our seniors every year than accidents, flu and pneumonia combined – it’s the leading cause of death of senior citizens in America.

Reasons from forgetfulness to fear of drugs and the high cost of prescriptions all lend to seniors not taking medications correctly.
What can we do? First, if we have an elderly family member, we should take extra precautions to make sure that they fill the right prescriptions and take both over-the-counter and prescription meds as directed. We may need to accompany them to doctor’s visits, engage a caregiver, or purchase medical alert systems that help with reminders and dosages.

We should also get involved with our neighbors – a simple welfare check every now and then on an elderly neighbor could mean a world of difference in making sure their loved ones or physicians are aware of any problems they are having with medications.

With such a systemic problem, we all have a certain responsibility to make sure that family members, friends and neighbors are educated in where to find help for taking medications properly. Many studies show that people who live alone are more likely to have problems with taking their medications as they should. We should all take more notice of our elderly neighbors who are by themselves.

Medication non-compliance is so widespread that it will take all of us to help solve the issues involved – not just the medical or care-giving communities. A study by PhRMA found that patients who regularly took their medications as prescribed significantly reduced their total health care spending and lowered the number of emergency room visits and the number of days a patient spent in the hospital.

If you have concerns about an older adult’s willingness or ability to take the right medications, speak up and let the people who care for them know. If your own family member is having a hard time taking their medications, take steps through technology or the family doctor to create a routine that will help your loved ones stay compliant with the doctor’s orders. It helps each and every one of us!

Monday, October 24, 2011

Medication Management for Seniors – The Risks of Med Noncompliance

Did you know that nearly one-third of older adults take eight or more medications every day? There’s no way I could keep up with what to take and when if I had that responsibility. Medication management can pose a challenge for adults of any age, but as we get older, we also face physical challenges and memory limitations that can make taking medication correctly a real issue.

First, of all, we have to remember that all medications – both over- the-counter and prescription should only be taken according to a doctor’s instructions. All drugs interact not only with our individual system and metabolism, but with each other. The wrong dosage or combination can make us sick or lead to serious side effects.

Sometimes older adults will simply stop taking their medications as prescribed – either because the side effects are troubling, certain symptoms start improving or because they have just forgotten the correct routine. Memory problems and depression may also contribute to forgetfulness. Self-medicating or stopping a prescribed medication can have serious consequences for our older family members – and any issues with med noncompliance should be discussed immediately with their doctor.

Older adults in particular should work with the nursing staff at the doctor’s office and perhaps take advantage of pharmacy services that offer additional information and consultations about medications and side effects. Pharmacies also have programs to help with auto refills of prescriptions and consultations about manufacturer changes to certain drugs. Many seniors may need the help of a family member or caregiver to help keep their prescriptions straight.

Forgetting to take medications or taking the incorrect dose can delay recovery, worsen a person’s overall health and even be fatal in the worst case. So what steps can you take to protect your older family members?
1. Document all medications and dosages on a detailed plan that is easy for the patient, caregiver and other family members to read and understand.
2. Keep all medications in a central place, preferably in an organization box with visible and/or audible reminders.
3. Take advantage of technology and use special machines that dispense proper dosages at the correct times – and send alerts to both the patient and the primary caregiver if something is missed.

If you have any concerns about an older adult’s ability to take medications as prescribed, step in and help them create an action plan or get the outside assistance they need. Complete compliance with medical prescriptions is the only way to keep your older family members safe and healthy as the doctor ordered!

Tuesday, October 11, 2011

Want More Money for Education? Take Your Medicine!

Laura Landro with the Wall Street Journal wrote a great article on medication adherence and I felt compelled to share. The most interesting figure to me is the $290 Billion wasted on patients who don't take their medications as prescribed. If you don't read anything else please read paragraph 5 of the article.

If you or someone you know struggles with medication management I encourage you to reach out to Alert Response or any other number of qualified companies and learn more about how technology can help save everyone a lot of time, energy and money.



When it comes to medicine, as many as half of Americans don't stick to their regimens. They fail to fill about 20% to 30% of prescriptions written by doctors, don't take drugs as directed, and don't refill medications when they run out.

Now, health-care providers have new strategies to increase medication adherence, as concerns rise about health risks and the high costs of treating noncompliant patients who have chronic illnesses.

Prescriptions that don't get picked up or refilled can be tracked using electronic medical records and prescribing technology. Clinical pharmacy specialists, case managers and other team members follow up with reminders, phone calls and counseling to get patients back on the wagon.

Consequences of non-adherence can be dire. Studies of heart-attack patients show those who don't fill prescriptions to help prevent another heart attack have a higher rate of death one year later. Meanwhile, patients who adhere to their medications have better health outcomes, and require less care, than those with similar conditions and poor adherence, research shows.

Research by the New England Healthcare Institute shows that patients who don't take their medications as prescribed cost the U.S. health care system an estimated $290 billion in avoidable medical spending each year.
A study published last January in Health Affairs showed that while improved medication adherence for four chronic diseases leads to higher spending on drugs, it also produces substantial savings because of less hospitalization and emergency-department use.

Out-of-pocket costs are a major reason some patients don't take medicine, but even fully insured patients often drop or fail to start a prescribed drug, studies show. Patients sometimes aren't convinced the medicine is important, or they are concerned a drug may do more harm than good. Often, they worry about side effects. Some 32 million Americans are prescribed three or more medications, which can lead to drug interactions and confusion over schedule and dosages.

Medication Nation
• 32 million Americans take three or more medications daily.
• Nearly 75% of Americans report not always taking their medications as prescribed.
• Almost 30% of Americans stop taking their medicine before it runs out.
• Only about half of patients with high blood pressure take their prescribed doses of drugs
Source: PhRMA; National Council on Patient Information and Education; WSJ reporting
Barbara Forman, 65 years old, takes five different medications after undergoing a cardiac bypass surgery seven years ago. She has worked with several doctors to develop a regimen she can tolerate. As a small business specialist for the post office, she used to drive long distances, but a beta blocker she took to reduce blood pressure made her so drowsy she caught herself drifting off the road more than once.

She tried changing the time of day she took the medication; sometimes she didn't take it at all. She had muscle aches from her cholesterol-lowering statin, and a cough as a side effect of another medication. A new cardiologist has helped her better manage her medications, and they are still fine tuning her regimen, she says.
Ms. Forman, now retired from the post office, is president of the Dayton, Ohio, chapter of Mended Hearts, a patient-support network affiliated with the American College of Cardiology. She invites a local pharmacist to meetings to emphasize the importance of taking medications after cardiac procedures. She advises patients to advocate for themselves. "Read the sheets that come with the pills, and let doctors know if you are suffering side effects," she says. "There are other alternatives to many of these drugs."

In a study in the Journal of General Internal Medicine last month, Kaiser Permanente Colorado, a big nonprofit health plan, reported that patients in systems like its own, with electronic health records linked to their pharmacies, collect new medications more often than patients outside such systems. In the study, 7% of patients with newly ordered medications for hypertension, diabetes and high cholesterol didn't pick up their prescriptions. In contrast, in other studies of non-integrated systems, as many as 22% of patients failed to pick up new prescriptions.

Kaiser is using clinical pharmacy specialists who focus on managing medication therapy, to find out why patients aren't taking drugs and help with side effects or administration.

The personal touch worked for Ralph "Mitch" Bernal, 61, a retired deputy sheriff and avid hunter in Lakewood, Colo., who suffers from a lung injury and heart disease and takes several medications to control his blood pressure and cholesterol. During a hunting trip in 2009, he felt short of breath and achy. A blockage was found in one of his arteries and was treated with the placement of a stent.

After treatment he became a patient of Kaiser's cardiac-risk program. Clinical pharmacy specialist Alicia Cymbala was assigned to monitor his lab results, blood pressure and medications, and she checked in with him at least every three months. His blood pressure remained a problem, so she changed his meds to get it under control, including a single pill combining a medication to relax blood vessels so blood can flow more easily with a diuretic that causes the body to get rid of extra salt and water.

Last year, Mr. Bernal admitted to Dr. Cymbala that for two weeks he'd stopped taking his cholesterol drug because it was giving him digestive troubles. "She jumped right on it and told me it was a side effect, but I had to take something," Mr. Bernal says. She switched him to another statin, which he was able to tolerate.

Dr. Cymbala, who typically follows 800 to 900 patients, says Kaiser's electronic system would have eventually picked up Mr. Bernal's noncompliance through elevated cholesterol levels or a failure to refill a prescription. "We try to let patients know they can trust us and call us, and we care to know when they are having a problem," she says. Sometimes she will gently point out to people who claim to be taking their meds that they haven't refilled their prescription.

John Merenich, who heads disease management and prevention programs at Kaiser Colorado, says, "You can't just tell them, 'If you don't take this medication you are going to have another heart attack.' " Patients need ongoing reinforcement about their health goals, he adds, "We have to bring the patient back into the center of the conversation."

Thursday, September 22, 2011

Happy 20th Birthday Alert Response

September 22, 1991 - Alert Response was founded by Spud Newton at a small desk in the corner of his living room much to the dismay of his lovely wife Jeanie. Fast forward 20 years and as the result of hard work and determination Spud has built a business that has served thousands and thousands of clients throughout the DFW area.

When I asked my Dad what the key to his success has been his answer was simple. "It's easy," he said, "provide a level of service unmatched by anyone else. The equipment is easy, it's just plastic, metal, and circuit boards. Providing a level of service that our aged and disabled population deserves is where you differentiate yourself."

As I look back today I am thankful for the business my dad started 20 years ago, not only because it means I have a job today but also for the standard he set when he began Alert Response. I am proud to be part of this company and what it stands for and especially thankful for all of the employees and community partners who have worked so hard everyday to provide our clients with an unmatched level of service.

And as a quick side note, 34 years ago tomorrow my dad also started something wonderful...me. Let me be the first to wish myself a happy birthday.

Have a great weekend.

Wednesday, September 21, 2011

Fall Prevention is NOT a Balancing Act - How Staying Healthy Prevents Falls

We recently talked a little bit about making home a little safer for seniors. Making sure your loved ones are navigating an obstacle course at home every day can go a long way towards preventing a bad fall, but overall health and strength are really important, too.

The older we get, the more we have a tendency to just take it easy when we have some down time - I know I do! But sitting around, or being fearful of getting active can actually make mom & dad more prone to falling. Let’s look at some healthy lifestyle tips that can help prevent falls:

Regular exercise. An exercise program builds strength and stamina – from heart and lungs to muscle strength. Exercise also boosts energy and helps with depression. Whether it’s physical therapy, a few steps a day, light weight training or just stretching, exercise helps sharpen our natural balancing skills and improves our reflexes – at any age!

Diet. A healthy diet, supplemented with vitamins, can still help keep bones and muscles in good condition, even when we get older. Eating right isn’t just for kids! Don’t let dad have ice cream for dinner – make sure he gets some broccoli before he hits the Blue Bell. Vitamin D and extra Calcium can help as well.

Eye exams. Take mom and dad to get their eyes checked at least once a year – and more often if there is a noticeable change or problem with their vision. Wearing the wrong glasses can result in tripping over objects, misjudging distance or becoming a little disoriented – and all can lead to a fall.

Medications. Many meds have subtle side effects – including blurred vision or dizziness. Many older people also take multiple medications – both prescription and over the counter – that can interact to produce side effects as well. Make sure your loved ones’ primary physician knows ALL the medicines mom and dad are using on a regular basis and how they can affect them.

Medical conditions. Chronic illnesses like heart disease, diabetes and COPD can cause dizziness and shortness of breath – which make us unsteady on our feet. Being aware of these conditions and taking extra precautions can help prevent an unnecessary fall.

In addition keeping a close eye on the overall health and well-being of the seniors in your care, you may want to think about an alarm system for a little peace of mind in case there is a fall. Alert Response offers the Personal Emergency Response Service (PERS), giving emergency help 24 hours a day. Staying as active as possible, eating right and seeing a doctor regularly can make a big difference, but it’s nice to know that extra help is there when we need it most.

Thursday, September 8, 2011

Before the Fall – Simple Tips that Can Help Prevent Falls in the Home

I hate to admit it, but I’m a little clumsy – sometimes I get in too much of a hurry, and sometimes I just throw myself at the ground and miss. Fortunately, most of the time I can just pick up and dust off, but for older adults, falling is no laughing matter. Did you know that each year, one in every three adults age 65 and older falls?

As we get older, a fall can mean a serious injury resulting in hospitalization and a long recovery – but the good news is that many falls are very preventable. If you or your loved ones are striving to live independently, here are some simple tips to make home a little safer and help prevent a bad fall.

1. Have you ever noticed that your home is an obstacle course? Make sure that seniors have a clear walkway throughout every part of the house. Move furniture, cords, plant stands – any object that makes you swerve, step over or step around.

2. Take care that area rugs don’t slide or bunch up – either get rid of them, or secure them to the floor with a sticky backing or double sided tape.

3. Light it up! Older adults should not have to feel their way through the dark – replace light bulbs, use nightlights, and keep light switches and lamps within easy reach.

4. It’s ideal if the home is one level, but if mom’s house does have stairs, keep the steps well-maintained – no loose or uneven boards. Keep handrails secure and tight – and if the staircase doesn’t have rails, install them now.

5. Put the stepladder in storage and move hard-to-reach items down to eye level. Stools and ladders are just a bad idea, even if they seem rock-solid.

6. The bathroom gets an honorable mention here – we already know the bathroom is hazardous, with wet floors and hard edges everywhere. I’ll go ahead and remind you to put non-slip mats and safety strips in tubs and showers, and to install grab bars everywhere.

Even with good precautions, accidents can – and do – happen. It’s a good idea to have an alarm device handy. Alert Response offers the Personal Emergency Response Service (PERS), giving emergency help 24 hours a day with the push of a button. Above all, make sure everyone is patient and careful – that’s the best way to stay safe!

Tuesday, August 30, 2011

Fun with fall detection

I can get longwinded so I am going to try and keep this brief and educational. My office is getting more and more calls asking about fall sensors so I decided to use this forum to help people to understand the technology

First of all, fall detection is not and never will be perfect. I would say that of all the fall sensors I have seen the best ones predict falls somewhere in the 90-95% range. 90-95% is great unless you are part of the 5-10% then it's not so great.

Fall sensors come in two types of technology, the first and most basic is a tilt switch. A tilt switch is best worn on the belt and will send a signal for help if the pendant tilts past a certain degree. This unit is good because 100% of the time it will send a signal when it tilts past that degree mark, bad if for some reason a fall occurs and the client doesn't fall to that degree i.e. passing out and falling against a wall or into a chair. The second technology is more advanced as it will detect a change in altitude as well as the speed of that change. A quality fall sensor will be able to tell the difference between somebody passing out and subsequently falling to the floor and somebody bending over to tie their shoes. With this technology there are more false positives along with a higher chance of a slow fall failing to register and send a signal.

Any fall sensor should have a panic button with it as well so that the client can summon help in the event they are still conscious. Most fall sensors will allow a 30 second to 4 minute window to allow the client to get up and start moving around. Some will even send two signals, one that says the client has fallen, and one that says the client is not moving.

The technology is getting better every year and I get excited to see where it will be in 5-10 years, I know, I know, I'm a dork. Contact me or any of your local providers to see the latest systems, they might just save a life.



We recently received a new fall sensor that I had the pleasure of testing. The results were impressive and the girls thought it was funny to watch me fall repeatedly (see photo). Another good thing that came from my practice fall was a discovery of the dirty carpet. I had the carpet steamed cleaned the next day.

Friday, June 24, 2011

Get Smart About Senior Care Costs

There are a variety of options available for any budget.

It's never too early to plan care for an aging loved one.
Before their health begins to decline, you and your family
need to agree on the kind of care they need, and how it will
be paid for.

To get an idea of the average costs of popular senior care
options, see below. And keep in mind that while your loved
one may be fine with occasional care now, they could need
more serious and expensive care in the future.

So, How much does it cost?

In-Home Technology
Personal Emergency Response (Medical Alarm)
Allows your loved one to age in place while having the ability to summon help 24 hours a day in the event of an emergency.
Cost:$37 per month.

Medication Management via a monitored medication dispenser
Dispenses medication up to 4 times per day. In the event of a missed dosage the unit notifies a live operator who then notifies family members or caregivers of the missed dosage.
Cost :47 per month.

In-Home Care
Enables your loved one to stay at home throughout every stage
of aging.
Cost: $29 per hour on average, but costs vary. (Source: U.S.
Department of Health and Human Services).

Assisted Living
Offers your loved one an independent lifestyle, with trained
personnel on the premises to attend to their needs.
Cost: $36,372 per year (Source: MetLife Market Survey of
Nursing Home and Assisted Living Costs).

Nursing Homes
For elders who cannot care for themselves or have
significant medical issues that require round-the-clock
care.
Cost: Private room, $77,380; semi-private room, $69,715
(Source: MetLife Market Survey of Nursing Home and
Assisted Living Cost).

Occasional Care
Periodic assistance with lawn care, transportation, and
grocery shopping. Cost varies according to need.

Thank you ElderCarelink

Friday, May 27, 2011

A little humor to kick off our weekend.

An elderly gentleman...
Had serious hearing problems for a number of years. He went to the doctor and the doctor was able to have him fitted for a set of hearing aids that allowed the gentleman to hear 100% .
The elderly gentleman went back in a month to the doctor and the doctor said, 'Your hearing is perfect. Your family must be really pleased that you can hear again.'
The gentleman replied, 'Oh, I haven't told my family yet.
I just sit around and listen to the conversations. I've changed my will three times!'

Wednesday, May 25, 2011

Texas Legislative: Telemonitoring Bill Continues Progress Toward Passage

Thanks to the Texas Association for Home Care & Hospice for the following update and all their hard work on the telemonitoring bill.

Texas Legislative: Telemonitoring Bill Continues Progress Toward Passage
The TAHC&H initiated bill that would create a telemonitoring program for Medicaid home health patients has gained momentum in this final week of the legislative session. SB 293 is moving up the House calendar on this final day- Tuesday, May 24th-in which senate bills can be heard on second reading by the House. The session ends on May 31st.
In addition, key lawmakers in the House have worked with TAHC&H to add the telemonitoring program to SB 23 which contains several programs supported by the leadership. SB 23 has already passed the House and is being sent to a conference committee to work out differences between the House and Senate versions of the bill. TAHC&H will be encouraging conferees to retain the telemonitoring program in SB 23 for final passage.

Click here for more details on the proposed legislation.

Friday, May 20, 2011

Dealer Conference

I just returned from the annual dealer conference in Ohio and I feel excited and rejuvinated. It's always great to meet with other leaders in the medical alarm industry and visit with them about the positives and negatives of our always changing industry. I came away with great ideas on how to better serve our current clients and ways to offer our services to a broader range of users.
This year was especially beneficial due to the addition of the trade show. Home technology dealers from all over the country were brought in to show off the latest and greatest technologies. A few that impressed me were-
1. SimplyHome which is a comprehensive home monitoring system that along with basic personal emergency response it also can monitor doors, windows, oven/stoves, medicine cabinets as well as many other things. www.simply-home.com.
2. LogicMark which is pioneering the way for voice to voice pendant services. We currently offer this and have had good success with it.
3. The Care Watch or the LF500 which is a all in one two way voice watch or pendant that has GPS so a client can be located anywhere in the country. Alert Response will have this available hopefully within the next 1-3 months.

Overall it was a very informative trip and although I had to leave my new born and 22 month old boys with my wife for 3 days I think it was well worth it.

Friday, February 4, 2011

Who can help?

Resources you may not know...but you should.

One of the reasons I love this industry and the work we do is because everyone is different and every situtation is unique. All of our clients have different wants, different needs and definately different stories. Some of their needs we can meet but some we have to refer out. As part of our ongoing attempt at education, I want to provide you with a few helpful programs and agencies that may provide assistance in some of those unique situations.

First is the Low Income Home Energy Assistance Program or LIHEAP. Their mission is to assist low income households, particularly those with the lowest incomes that pay a high proportion of household income for home energy, primarily in meeting their immediate home energy needs.

Second is the The Partnership for Prescription Assistance which brings together America's pharmaceutical companies, doctors, other health care providers, patient advocacy organizations and community groups to help qualifying patients who lack prescription coverage get the medicines they need through the public or private program that's right for them. Many will get them free or nearly free.

Lastly but one of the best local agencies in this area is the North Central Texas Area Agency on Aging. The North Central Texas AAA is a program of the North Central Texas Council of Governments (NCTCOG). It plans, coordinates and delivers services to persons age 60 and over and their family caregivers who live in Collin, Denton, Ellis, Erath, Hood, Hunt, Johnson, Kaufman, Navarro, Palo Pinto, Parker, Rockwall, Somervell and Wise counties.

In the months to come I will be adding more programs and agencies to this list. If you have any suggestions please feel free to email them over to me at matt@alertresponse.com. I would love to share them with other people from our industry.

You can visit our website you you need more information on emergency response or medication management. www.alertresponse.com

Friday, January 14, 2011

Signs that your loved one might need help

Next time you are visting a friend or relative, spend some time checking for signs that they might need help. Often times older adults in an effort to remain independent try to hide things that might cause concern for loved ones. Use the list below to help spot issues that might raise a red flag.

a. Daily housework not being performed
i. Tired
ii. Overwhelmed
iii. Forgetting

b. Mail piling up
i. Overwhelmed with amount of mail
ii. Constant letters from people asking for donations

c. Bills not being paid
i. Checking account not balanced
ii. Services being shut off

d. Weight loss
i. Shopping and food preparation not being done
ii. Eating habits changing

e. No food in refrigerator or spoiled food

f. Kitchen in disarray
i. Dishes piling up
ii. Pots with burned bottoms
iii. Water and mildew stains where water was left on
iv. Food left out

g. Poor hygiene
i. Wearing same clothing
ii. Not bathing regularly

h. Inappropriate clothing
i. Unseasonal clothes worn i.e. bathing suit in winter or sweater in the summer
ii. Clothes left off

i. Missing scheduled events
i. Church
ii. Doctors appointments
iii. Medications

j. Acting strange
i. Unusual conversations
ii. Phone calls at odd times
iii. Strange anxiety or nervousness

k. Depression
i. Sleep disturbances (difficulty falling asleep or staying asleep, oversleeping, or daytime sleepiness)
ii. Sadness
iii. Fatigue
iv. Abandoning or losing interest in hobbies or other pleasurable pastimes
v. Social withdrawal and isolation (reluctance to be with friends, engage in activities, or leave home)
vi. Weight loss; loss of appetite
vii. Loss of self-worth (worries about being a burden, feelings of worthlessness, self-loathing)
viii. Increased use of alcohol or other drugs
ix. Fixation on death; suicidal thoughts or attempts

If you have concerns feel free to contact our office, 972.318.0161, or visit us online at www.alertresponse.com.