Category Archives: travel with seniors

Holiday Help: Relieving Caregivers’ Stress

by, Cheryl Smith, Caregiver.com

Who doesn’t feel overwhelmed sometimes by the bustle of the holiday season? Add to that the responsibility of caring for a frail elderly loved one, and burnout is simply a concept waiting to become reality. But wait. If you’re one of the 22 million households providing care for a family member or friend, there is hope. Stress doesn’t have to take the starring role in your family festivities this year.

If you’re like the increasing number of Americans who are trying to offer a sense of dignity to your parent(s), include them in seasonal events and help them stay in their own home, safety is your number one priority.

Most accidents happen at home in unsupervised situations. This season, enlist the help of older children or a spouse, playing games with (Great) Grandma and (Great) Grandpa while you change beds, do the laundry and other chores. Instead of decorating to the hilt, keep holiday décor simple. Eliminate the need for extension cords on the floor and “declutter” your notion of decoration: use colorful paper garlands strung high instead of breakable objects placed within reach. Remove anything a child or a frail elderly person may stumble over. Replace candles with bright centerpieces of fruit or flowers. Keep candy to an absolute minimum to prevent sugar highs and lows.

With the emphasis on “good cheer” during the month of December, the options are many. But don’t wear yourself out trying to make the holidays “happen” for everyone. If you don’t get yourself in a situation where you “overdo” you’ll be more alert to hazards—even emotional ones. Holidays bring emotions to the surface because they hold the most intense memories for your loved ones, and some may not be pleasant. You may find that tears fall for no apparent reason, or that a frail elderly parent suddenly seems gruff or annoyed just when you think everything is fine. Sometimes, the emotional stress of the season makes a frail aging parent seem distant, just when you want to draw them close. We never know what precipitates these reactions; we only have to deal with them. That’s not an easy task, but first and foremost, a caregiver must keep her own emotional balance.

Set a few guidelines as to what you expect from yourself. From the very start, set your intention to be positive during the holidays, and to respond with calmness to upsetting scenarios. Sure, things may come to the boiling point at times, but the resolve not to react in like manner will bring the most effective results. People don’t intend to be grumpy, distant or to give you a hard time. These behaviors may simply be a way of asking for help. The best way to give it is by remaining patient, offering consistent encouragement, and setting safe boundaries.

You cannot make everyone happy at all times, but you can take responsibility for your own emotional highs and lows. Preserve a few moments each day all for yourself. Take a half-hour break while your children entertain the frail elderly with Christmas music from the 30s, 40s and 50s or interview their grandparents about favorite holiday memories. You might enlist the services of a home-help organization to do some of the household chores while you go grocery shopping or simply take a walk. Professional caregivers can also help alert you to signs of stress or special needs that you might not recognize on a day-to-day basis, curtailing accidents or emotional spills.

Keep in mind that a frail person may tire more easily during the holiday season, need more sleep as the days grow shorter, and also need their own “space.” Ask for their help; ask them to let you know what they need and how they want to celebrate. Their answers may surprise you. Above all, an older frail person may crave our respect and our admiration. When we praise the good things they’ve accomplished in life, make certain they know that we appreciate their legacy, and tell them we’re happy they’re with us, things will be a lot easier. If they seem only to complain more, well, just grease the wheel with a little praise for yourself. Send positive messages to yourself out loud and mix in a few more affirmations for them.

The holidays are a great time to slow down instead of speed up. Think about all the things you can let remain undone instead of all the things you need to do. Give yourself a challenge to match the tempo of your frail elderly relatives or friends, and see if you don’t enjoy the season more. And after all, isn’t that what the holiday season is all about?

Contact Raleigh Geriatric Care Management for a 15 minute no cost telephonic consultation:  919-803-8025.  www.rgcmgmt.com

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Considerations for Caregivers

By Arthur N. Gottlieb

Caregiving is not for everyone. Remember, it’s not about you. If the relationship is too emotionally charged or patience is not your best virtue, find someone else to take over the primary role of caregiver.

It is important to reflect upon your motivations for being a caregiver and to make an honest assessment of your limitations.

As a caregiver you may at times feel powerless and sad. But an experience laden with difficulty may also provide opportunities to strengthen relationships with loved ones, and for the development of one’s own personal and spiritual growth.

About Visits
Focus on the quality of interactions with a loved one, not on the quantity.

Consistency and predictability of visitations are important, especially for the homebound.

Communication Skills
Learn the healer’s art of “bearing witness.” This means listening empathically and suppressing the urge to intervene with solutions.

When speaking to someone in bed or in a wheelchair, sit down or otherwise lower yourself so that you are at the same eye level as they are. This will distinguish you from others who remain standing, essentially looking and speaking down to them with the unspoken but inherent power differential this implies.

Choose your battles wisely. Attempting to address an irrational situation with rationality is generally futile, and will increase conflict with no resolution

The hearing impaired are often too prideful to admit that they haven’t heard most of what you just said, and are hopeful that they can eventually figure it out.

Those with mild cognitive impairment are still quite capable of comprehension, but the thought process may have slowed down a little. Be patient and speak slowly.

Restoring Dignity
Asking for a senior’s opinion about a non-provocative issue may offer them an opportunity to feel respected and still relevant.

At the dinner table when others are present, if a person needs to have their food cut for them, discreetly take the plate back into the kitchen and cut it there. This will add an unspoken but important element of dignity for those being cared for.

Residential and Financial Concerns
The attitudes and behaviors of many seniors are oftentimes driven by an unspoken fear of abandonment.

When parents do not feel that their children have made wise decisions for themselves, they are naturally hesitant to turn over financial control to them.

It was not uncommon for senior women to have deferred to their husbands’ judgment when choices were being made about financial and property issues. If now widowed, they may feel more comfortable acting in accordance with someone else’s say-so for important decision-making.

It may be illuminating to discover what memories a senior has of his or her own parent’s convalescence. What would they, as caregivers, have done differently? Had they promised themselves they would never go to a “nursing home”?

When a senior is facing the prospect of moving to a continuing care or assisted living community, speak to them about what they think this will be like. Many will have a stark vision of facilities from many years ago when options were relatively limited.

About Moodiness
Seniors will experience good days and bad days due to effects of pain, adjustment to medications and or emotional issues.

Seniors who seem short-tempered may be responding to the frustrating lack of control of not being able to think as quickly, and remember as well, as they once had.

Psychology of Seniors
Understand and be prepared to recognize the issues that trigger depression and anxiety for seniors.

Be sensitive to anniversary depressions. Birthdays, anniversaries, and major holidays evoke memories of those who have passed, and independence lost.

For most, losing control of physical functioning is difficult. Experiencing the steady loss of friends and relatives leads to sadness and isolation. For those with dementia, witnessing the gradual loss of one’s own self can be the ultimate loneliness.

If a senior is grieving the loss of a loved one they think died yesterday, even if that person actually died years ago, their grief will be as deep and painful as though it just happened.  This is legitimate suffering and must be handled with empathy.

Oftentimes, a parent will have a set of expectations of how they deserve to be treated by their children based on the sacrifices they made on behalf of their own parents. When children do not meet these expectations, resentment, depression and various forms of acting out behavior are the result.

Some seniors harbor lifelong prejudices that were carefully concealed. It can be quite distressing for a caregiver to discover that their parent has “all of a sudden” developed a shocking taste for racial bias. The gradual loss of mental functioning allows one to become “dis-inhibited”; thoughts, formerly suppressed due to social constraints, are now out in the open. This applies for latent sexual desires as well, especially for men.

Denial
If the person you are caring for continually puts off medical diagnosis, they are using the defense of denial in the service of their fear. If they are never diagnosed, then they never have to face the reality of being sick.

For Senior Men
More often than not, senior men went along with the social arrangements made by their wives. If a man becomes a widower, he may feel out of place socializing with others on his own. Additionally, since women outnumber men of this age group, a man may feel he is betraying the memory of his wife when engaging in social situations involving mostly women.

Religion and Spirituality
It is important to understand what a person’s religious or spiritual beliefs are. Does he or she believe in an afterlife? Are they concerned over what is in store for them when their mortal life ends? Are they disillusioned  or angry with God?

Restore and Maintain Balance
It is essential for you, as a caregiver, to leave time for your own introspection and emotional balance. Engage in activities that serve to cleanse toxins and stress from the body and spirit.

Engage the help of others when necessary to de-stress and achieve perspective.

Rest and relaxation are critical in order to prevent “caregiver burnout.”

Raleigh Geriatric Care Management Aging Life Care Professional  www.rgcmgmt.com

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Geriatric Care Manager—>Aging Life Care Professional

WHAT IS AN AGING LIFE CARE PROFESSIONAL?

An Aging Life Care Professional, also known as a geriatric care manager, is a health and human services specialist who acts as a guide and advocate for families who are caring for older relatives or disabled adults. The Aging Life Care Professional is educated and experienced in any of several fields related to aging life care / care management, including, but not limited to nursing, gerontology, social work, or psychology, with a specialized focus on issues related to aging and elder care.

The Aging Life Care Professional assists clients in attaining their maximum functional potential. The individual’s independence is encouraged, while safety and security concerns are also addressed. Aging Life Care Professionals are able to address a broad range of issues related to the well-being of their client. They also have extensive knowledge about the costs, quality, and availability of resources in their communities.

Aging Life Care Professionals become the “coach” and families or clients the “team captain,” giving families the time to focus on relationships rather than the stress. In Raleigh, Durham, and surrounding area, contact Raleigh Geriatric Care Management, an Aging Life Care member.


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Should You Tell a “Fiblet” to a Parent With Dementia?

From our earliest days we are taught never to lie, especially to our mother or father. However, a recent survey of aging experts reveals that telling a “fiblet” can actually be therapeutic when adult children are faced with telling painful truths to aging parents who have a cognitive impairment such as Alzheimer’s disease.

The National Association of Professional Geriatric Care Managers (NAPGCM) recently surveyed 285 professional geriatric care managers about the most common and difficult situations faced by families who are helping aging parents. Geriatric care managers help these families deal with some of the most sensitive and challenging issues.

More than 90 percent of the professional geriatric care managers surveyed said they have used or recommended the “fiblet” strategy to relieve stress and anxiety and protect the self-esteem of an elderly person. The situation cited most by experts in the survey as an appropriate and helpful use of a “fiblet” is when a senior is refusing clearly needed care or assistance at their home. For example, telling an aging parent with Alzheimer’s that a paid caregiver is coming to their home for their spouse’s benefit or for another concrete role can help the elder maintain pride and reduce anxiety.

The following were identified by care managers as situations when it can actually be therapeutic to tell a “fiblet” to an aging parent:

  • When they are refusing needed care and assistance at home. Telling them the caregiver is there for their spouse’s benefit or for another concrete role can help them maintain pride and reduce anxiety (identified by 83 percent of those surveyed).
  • When they can no longer safely drive, yet insist on doing so. Telling them their car is in the shop getting repaired can reduce confrontations (68 percent).
  • When knowing the cost of in-home care prevents them from accepting the needed service (68 percent).
  • When it would only cause worry and stress to tell them about family problems they can’t solve, e.g., unemployment, financial upheaval, divorce, drug abuse, incarceration (64 percent).

According to the National Institutes of Health, as many as 5 million of the 43 million Americans age 65 and older may have Alzheimer’s disease, and another 1.8 million people have some other form of dementia. Americans feel increasingly challenged by the need to communicate difficult information to aging family members with dementia.

“A therapeutic ‘fiblet’ is just that—it is therapeutic because it calms and reassures, reduces anxiety and protects self-esteem,” said NAPGCM President Emily Saltz. She added, “You would use a ‘fiblet’ only with parents who have a cognitive impairment such as Alzheimer’s disease.”

Geriatric Care Managers Share Their Experiences

As part of the survey, geriatric care managers were asked to provide comments about their own experiences in recommending the use of a “fiblet.” A universal theme of the comments was that family members should navigate this clearly delicate area with help from a support group or from an experienced professional care manager. Care managers also stressed that one should only use a “fiblet” to protect and support a family member rather than for personal benefit or gain.

The following are from among more than 200 stories collected through the survey about geriatric care managers’ experiences of using a “fiblet” in the course of their practices:

  • “I’ve used therapeutic ‘fiblets’ in many instances, but probably (most often) when the death of a loved one is beyond a person’s capacity to understand. For example, if a person is looking for a deceased loved one, I tell them that I haven’t seen that person today but when I do, I’ll tell them that the person is looking for them. This serves to validate their experience and provide reassurance that someone cares.”
  • “When an adult son was diagnosed with cancer, the decision was made to not inform his frail, memory-impaired nursing home-bound father of the diagnosis. At the same time, the son increased his visits to his father during treatment, as he had more free time available for visits. The son and father enjoyed more time together without stressing the father with a scary diagnosis.”
  • “A client wanted to see their mother who had passed away many years ago. Instead of telling her that her mother had died and causing her to grieve again, we told her she was out and would return later. She accepted that and went on with her day.”

Source: The National Association of Professional Geriatric Care Managers (NAPGCM). NAPGCM was formed in 1985 to advance dignified care for older adults and their families. Geriatric care managers are professionals who have extensive training and experience working with older people, people with disabilities and families who need assistance with caregiving issues. For more information, visit http://www.caremanager.org. –

Raleigh Geriatric Care Management in Raleigh, NC  www.rgcmgmt.com

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Long Distance Caregiving

Carol O’dell

If you’re a long-distance caregiver, then you know the drill. You call all the time. You coordinate care from 400 miles away. You spend long weekends or vacation time visiting your loved one and hoping before you open that door that they’re OK. Worry comes with long-distance caregiving, and so does guilt, but you try really hard to make it work — and you dread the day that won’t be enough.

You are not alone. According to a recent Caring.com poll, nearly one-third of all caregivers do not live with or, in many cases, even near their loved ones. Here’s a look at a few challenges long-distance caregivers face, and tips to help manage care from afar.

Feeling emotionally connected to your family members.

Sometimes phone calls or visits filled with doctor appointments and home chores don’t allow for heart-to-heart talks. As much as there is to cover, make the time to just sit for a few minutes and allow a natural conversation to emerge.

Set up a weekly phone-chat date for the times that you’re apart. Have it at a time when you both can look forward to it and nothing competes. After you discuss some of your “to-do” list items, begin to share something personal about your own life. Ask their advice on something — anything — from the color shoes you should wear to your cousin’s wedding to whether you should get a bigger car. Let them feel as if they’re a part of your life as well.

Getting shut out.

Many long-distance caregivers, particularly those helping someone with moderate to severe dementia, find that their visits actually aggravate their loved ones — who are confused and want to “go home” or don’t understand why you keep calling them “Dad.”

Remind yourself that you’re not just there to visit. You’re there to make sure Mom or Dad are being cared for properly. (Having a loved one with moderate to severe dementia increases the likelihood that he or she is living in a care facility.) Stay out of sight if you have to, but visit the staff, have lunch in the cafeteria, and walk the grounds. Talk to the people your loved one interacts with to find out how he or she is doing. It’s painful not to be able to connect, but remember that you’re still needed.

Knowing your loved one is safe and appropriately cared for.

Audrey Adelson, author of “Long-Distance Caregiving,” writes, “Often, long-distance caregivers obtain important information from their elder or secondhand from family members who have spoken with a member of their loved one’s treatment team. This makes it difficult to get a clear understanding of what is really going on.” How do you stay in the loop when you’re not in the area?

How to manage? By having lots of eyes. Whether you coordinate care for your loved one in his or her home or an assisted living facility, start to connect with those who interact with your loved one. Call after an appointment and ask how it went. Let them know you plan to be involved, and be sure to send a thank-you card or friendly e-mail.

Managing insurance and financial needs or making sure you can trust those who do.

Trust is a big issue for long-distance caregivers. When you don’t have people who genuinely care for your loved one and communicate with you about what’s going on, then you begin to worry, and worry, and worry.

Take the time to find professionals who can assist you and your loved one. It’s worth the time and effort. Hire an elder law attorney to make sure their financial assets are protected, or check into local resources designed for seniors and their family’s needs.

Make a plan for whatever comes next.

Long-distance caregivers dread getting “the call.” Whether it’s from a concerned neighbor or from the ER at 4 a.m., it’s difficult to know what to plan for when anything could happen. Try to laugh (or scream, or sob) when all of your planning and hard work takes a dive and you have to come up with a new plan. Change is inevitable, and when we fight that it that causes us pain.

Play “what if.” Come up with the three possible scenarios — a fall, a worsening of a condition or ailment, or a refusal to move even when that’s needed. How will you handle it? Can you go ahead and do some online searches? Can you connect with other caregivers and ask how they handled a big change and ask how it’s going now? It’s easier to face the “what ifs” when you know that somehow, some way, you will get through.

Being a long-distance caregiver comes with challenges you never thought you’d have to face. Sometimes you have to let go, just a little, of all that you can’t control. Caregiving isn’t easy, and there aren’t always solutions, so grab your rearview mirror the next time you’re in your car and look at yourself and say, “You’re doing the best you can.”

For a loved one living in Raleigh, NC, contact Raleigh Geriatric Care Management to assist with your family member. www.rgcmgmt.comRaleigh ,NC

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Stress and the Holidays: Coping Strategies to Keep you Sane

By Helen Hunter,

Every year, the media bombards us with advertisements showing the “happy family” gathering for the holidays. People from different generations are together, having a wonderful time, sharing traditions of old and creating new ones as well.

It is not that way, though, for a great number of individuals. For those who don’t have families of their own, or for those who live alone and have relatives living far away, holidays often bring heartbreak and depression. Those who have been used to family celebrations in the past and no longer have that to look forward to cannot accept the “change” in the tradition, especially if they keep hearing about others who are getting together with their own families.

There are two things to remember that can help get you through the holidays. The first thing to realize is that it is okay to cry. This can be a tough time for many. It is natural to feel depressed when your friends are having the ideal family gathering. Allow yourself to express your inner feelings.

The second thing to remember is to control the holidays, do not let them control you. This requires planning. If you know that you will be alone on the holiday, start planning ahead for what you will do. Here are some suggestions for things you can do to sidestep the holiday blues:

  1.  If you cannot be with family, try to spend time with friends or neighbors instead.
  2. Get away from the source of the depression. If your home reminds you of past holidays spent with a loved one, go on a cruise, or take a vacation to another part of the country, or go abroad.
  3. Get involved with an activity. Volunteer at a local senior center, church or community center that serves meals on the holiday, or give your services to a hospital. If you know that someone will be alone and cannot get out for the holiday, visit. If the person lives far away and you cannot physically visit, make a phone call. In helping those who are less fortunate than yourself, you can forget some of your own troubles.
  4. Invite others who are also alone to your home to share the holiday. You can prepare a meal for them, or you can go out to a restaurant. Company always helps ease depression.

Be gentle to yourself, especially if you have recently lost a loved one. If you do not feel like celebrating, don’t! If you do wish to celebrate, keep it simple. Remember the TRUE reason that we celebrate the holidays!

The important point to remember here is that if the old traditions cause heartbreak and depression, change the tradition – start a new one!

Also, be sure to review your expectations and be realistic. Not everyone is jolly, generous and loving all through the holiday season. As Wayne A. Van Kampen from the Bethesda PsycHealth Reporter wrote, “ Somehow (during the holidays) persons feel pushed into hiding, covering over, or denying the reality of sadness, fear and tension. Perhaps what is needed most is simply a more honest embracing of ourselves, others, and the realities of life.” Not everyone will have a happy family gathering just because it is the holiday season. Old resentments are likely to resurface, no matter how hard we try, when people are thrown together for an extended period.

In addition, there are a number of strategies that can be used in planning the holiday celebration.

These strategies include the following:

  • Delegate responsibilities and activities so that one person is not taking on more than can be accomplished without help.
  • Do not assume responsibility for the entire household’s holiday happiness.
  • Work minute by minute on your attitude. Postpone becoming angry and show understanding and calmness. This technique should be used not only during the holiday period, but every day!
  • Any task that you have chosen to do, whether it be the cooking, cleaning, gift wrapping, card addressing, organizing, decorating or shopping, is to be viewed as a choice that you made. Try to have fun in tackling these tasks, which will make the holiday easier and keep your spirits positive.
  • Start traditions that make the most sense to you in your life now. It doesn’t always have to be done the same way every year.
  • Do things together as a family that you all truly enjoy.

Make the holiday season a time for you and your loved ones to have fun and to share special memories. When the entire season is over, sit down, relax and count your blessings. Remind yourself as to how lucky you are. When you make an effort to have a joyous, stress-free holiday, you can avoid the stress. The key is to plan ahead, and to ask for and accept help from others.

Raleigh Geriatric Care Management www.rgcmgmt.com

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Holiday Family Gatherings: A Time for Enjoyment & Meaningful Discussions

Once again we’re preparing for families to come together over the holiday season. We long to see how our seniors are doing, especially those who are far away from us and living independently.

Are they ok? Have they been eating well? Is the house in good repair? Are they paying all the bills on time? Have they been keeping things from us?

Hopefully, during our visit with them to celebrate a time of family sharing we will be able to observe them for any signs that they need a little bit more help. There are many things we should be on the lookout for in their home, their own health and appearance, the car, the home and the yard.

Another important thing we should do while we are visiting our senior loved ones is talk.

“Talk about what specifically,” you ask?

Serious Discussions with Parents & Other Senior Loved Ones

We might find some discussions hard to begin and others may be taboo in your family or culture. Unfortunately, once your parents reach a certain age (and you as well) it is recommended that these uncomfortable discussions happen and the answers clearly brought out into the open.

Whether you want to or not, some things are just better to know.

  1. Do they have any advance directives? Is there a living will created about which you should know? What are their wishes for end of life care? Do they have a DNR or a healthcare proxy to speak for them if they can’t? It is important to hear directly from them what they anticipate their end of life to be. What if they get into an accident or have a medical emergency? If you don’t talk openly about this eventuality it will be more difficult, especially if you are at a long distance, to make decisions in an emergency without prior knowledge. Do they have burial plans already?
  2. If they have executed these documents, where are they kept? Can you get a copy? Does the doctor know about them and do they have a copy on file? Do they need to be updated?
  3. If they don’t have them created, can you do this during your visit so all their wishes are documented in case of an emergency? Now is a good time to get important documents executed while you are there to get the necessary information. These decisions must be made before your senior is no longer competent to make his wishes known legally.
  4. Do they have a will? Who is the executor? Where is the will kept – who is the attorney? Where are the contact numbers for lawyers, doctors, and other people if you need them?
  5. Are they still competent to drive safely? Has the car been damaged since your last visit? Take a ride as a passenger to test them, even if it is without them knowing your purpose for going for an ice cream cone together.
  6. Are they declining in functional status? Does it look like they are having difficulty keeping themselves neat and tidy? Are their clothes clean and in good repair? Are they shaving? Do they have unexplained bruises? Are they appearing thin or weak? Are they having trouble balancing themselves when they walk or get up from sitting? Do they need more help?
  7. Is their home still adequate to age in place? Is it where they want to be or would they rather come closer to you, go to a senior living area or move to a smaller home that is easier to care for alone? Some seniors enjoy living in an assisted living facility where they have less responsibility and more opportunity for social engagement. Is their current home accessible to transportation services if they can no longer drive? Is their home in good repair with adequate safety modifications to prevent accidents? Can you work on some modifications while you visit and schedule other more involved upgrades for when you are not there?
  8. Are they depressed or isolated? Some seniors choose to stay home and reduce their visits to places, people and events that they once frequented for a variety of reasons. Perhaps they are afraid to drive, don’t want to go alone, can’t leave the house for too long for fear of needing a restroom quickly, or have side effects of medications that keep them from being active. Seniors need to be social, mentally stimulated and engaged to prevent boredom and loneliness. It might be a good time to get them reconnected, take them to the senior center and arrange transportation if necessary. Find things for them to be active and involved from home. Set up some technology and teach them to use it so they can use social media, Skype or Facetime to engage with distant family and friends.
  9. What about their finances? Do they have enough money to meet their needs? Are they paying their bills? Do they have a supplemental insurance policy or long term care policy which you should be aware? Are they struggling to make ends meet? Are they getting the benefit of all — well — benefits to which they are entitled?

~by Kathy Birkett

Assistance is offered with Raleigh Geriatric Care Management in North Carolina www.rgcmgmt.com to help you and your aging loved ones navigate the myriad of senior resources and services.  lwatral@rgcmgmt.com for more information. 

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