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Is Alzheimer’s Disease a growing problem?

Is Alzheimer’s Disease a growing problem these days or has it always been around but called a different name, or not as frequently diagnosed?

The term Alzheimer’s Disease was first used in 1910 after Dr. Alois Alzheimer discovered shrinkage and abnormal deposits in the brain upon doing an autopsy of a woman who had profound memory loss. In the late 1960’s assessment tools were developed  to measure mental and functional decline in the brains of older adults. Advances in technology allowed scientists to study brain cells in detail and observe during an autopsy that there were similar changes in the brain among those with memory loss.

In 1974 the National Institute on Aging established federal funding for Alzheimer’s research. The Alzheimer’s Association was founded in 1980 to advance research, support those affected by the disease and promote brain health. Efforts by the National Institute on Aging and Alzheimer’s Association have increased our awareness of the disease as a nation.

Back in the 60’s & 70’s scientific research and discoveries were not publicized in popular media. When an elderly person seemed confused, we called them senile. Remember the term “hardening of the arteries?” Families would try to keep it hush-hush and help their spouse or parent in the privacy of their own home. In the rare case a diagnosis was made, there were no medications or treatments available.

Fast forward to the current decade and you will notice people are much more forthcoming about illnesses, age-related or otherwise. The generation of Baby Boomers, who tend to be vocal about their wants and needs, and demand solutions to their problems, are now dealing with aging parents.

The rise in the number of Americans diagnosed with Alzheimer’s Disease cannot be simply attributed to better diagnostic tools and the willingness of people to speak openly about their challenges. While the medical community cannot definitively answer the question either, examining risk factors can give us a clue.

The first risk factor is age. The older you get, the greater the risk of developing Alzheimer’s. In 1900, 4% of the U.S. population was over the age of 65. In 2012, that percentage increased to 13.7%. As the population grows, so do the number of Alzheimer’s cases.

Family history of Alzheimer’s is another risk factor, and the risk increases if more than one family member has been diagnosed. There is a genetic component to the higher risk, but researchers are also looking into environmental factors family members share. According to the Alzheimer’s Association, risk genes increase the likelihood of getting the disease, but do not guarantee it will happen. Risk genes have been found to be a factor in 20% – 25% of the cases. Deterministic genes, which are found to directly cause the disease, are a factor in less than 5% of the cases.

Other risk factors include diet and exercise, low mental stimulation, and social isolation. It is no secret that Americans could improve their nutrition, increase physical activity, and limit watching TV and other passive brain activities.

It makes sense to propose that as the risk factors of old age, genetics and poor lifestyle choices are present in a greater population in America, so does the growing incidence of Alzheimer’s.

 

 

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Caregiver burnout

Care giving for a spouse suffering from Alzheimer’s disease or another form of dementia raises the mortality of the spouse providing the care.

This is a very complex time in life. We often see a family caregiver who has lost weight, is sleep deprived and a has compromised immune system. It is ironic that the family caregiver’s health fails while their loved one is in relatively good health other than the effects of dementia.

Resentment can also set in on the caregiver. Irritability, hopelessness and helplessness also take over. Some are filled with anger, sadness, and a sense of failure. Depression is a risk as a result of these stressors, emotions and illnesses. It becomes clearer why caregiver mortality rises.

Studies show that mortality rises when a spouse is providing care for dementia.  Most studies show about a 63% increase in mortality for the caregiver in this type of situation.  Unfortunately it does not stop there.  A study done by The New England Journal of Medicine in 2006  shows that a wife’s risk of death is 61% greater during the first 30 day following the death of her husband.  While not as great, the husband’s risk is 53% following the 30 days after his wife passes.

Imagine planning for your golden years throughout your adult life. Perhaps you envisioned traveling the world on cruise ships, or seeing the USA in a RV, or even a simpler life puttering around in the garden, doing things you never had time for earlier. These visions fade because of a horrible disease.

Providing care for your spouse with dementia makes it difficult to sleep, shop, cook, and do most other activities that were routine and once taken for granted.  Socializing becomes a thing of the past. The caregiver stops going to church, family functions, and social events as a result of having to stay home to make sure their spouse is safe.  Isolation and burn-out can be self imposed because of the belief that no one can do it as well as a family member.

Furthermore, the family caregiver feels a loss of  identity as mom, dad, friend, confidant, grandma or grandpa when every ounce of energy is directed at caregiving.

There are devastating consequences to personally providing 24 hour care 7 days per week without getting outside help.

If you can identify with the above, take it upon yourself to get help. Many communities have caregiver support groups where you can find out how others cope successfully. Senior centers may offer day care and there are agencies where you can hire caregivers to give you a break by coming in for a few hours on a regular schedule. Assisted living facilities often have respite programs for overnight stays.

 

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Get Yourself Some Good Stress

Stress is commonly identified as the culprit behind poor health. It can weaken the immune system and make yourself vulnerable to a variety of diseases. Stress is not always bad. We need the right kind of stress to be healthy and live fulfilling lives, not to mention fight dementia. There is a word for this type of good stress. It is called eustress (eu is a  Greek root word for good.)

Stress can be fun. Why else would we want to ride a roller coaster or watch a thrilling movie? Excitement causes a rush of adrenaline which feels good.

The right amount of stress on the brain can help protect against cognitive decline. Stressing your brain to come up with words to fill out a crossword puzzle or keeping track of cards during a bridge game will provide stimulation to keep your brain healthy. The brain, even in old age, works to adapt and rewire itself when stimulated.

Exercise stresses the body in a good way. Muscles need stress to grow strong. Lifting weights stresses and tears muscle fibers. Resting the muscles after a workout promotes a healing process which strengthens muscles. Bones benefit from weight bearing and impact exercises. Stress on the bones promotes the deposit of proteins and increases bone density.

Aerobic exercise stresses the heart and lungs. The result is a stronger heart and increased energy.

Stretching stresses muscles to become longer and more flexible. Flexibility decreases the risk of injury by helping joints move through their full range of motion.

Challenging yourself to learn or do something new can be stressful. There is the fear of failure or the frustration of not getting it right. Successfully facing a challenge however, can bring a tremendous sense of satisfaction that is well worth the effort.

Making friends and developing relationships doesn’t come easy as you get older. It can stress your emotions to reach out to others, reveal personal strengths and frailties, and become vulnerable to rejection. The payoff is belonging to a community which supports you in good times and in bad.

Good stresses in life help to reduce harmful stress. Living a safe and sedentary life does not provide the stimulation and outlet to manage harmful stress. Experts who give advice on stress management emphasize making friends and developing a support base, learning ways to build satisfaction, exercising, playing games and finding ways to have fun.

Is it a coincidence that giving the brain this good stress, exercising, making friends and having strong community ties are ways to fight dementia? I think not.

 

 

 

 

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Losing Things

Losing essential everyday items can be extremely frustrating. Where are my keys? What have I done with my glasses? I thought I put my checkbook right here on my desk and now it is gone. Why do we keep on losing things when it frustrates us so much?

It may feel comforting to know that you are not alone. Many people often lose things. Research by time management experts estimate that we spend approximately four hours each year searching for lost items. What a waste of time.

There are some simple reasons why we lose things. The first has to do with paying attention. You hear the phone ringing as you unlock the door. In the rush to answer the phone, you set your keys down. No wonder you can’t find your keys the next morning. You weren’t paying attention to where you put them yesterday.

You may just be accustomed to leaving things around the house wherever it is convenient at the time. If you change the spots you keep your checkbook, sometimes on the kitchen counter, sometime on the desk, sometimes in your purse, you won’t know where to look for it.

Although searching for lost objects is irritating, you aren’t bothered by it until it happens. You put your energy into the search, rather than spending time developing the habits to avoid misplacing things in the first place. The problem is solved once you find your keys and you go on your merry way – until it happens again. The cycle repeats over and over.

Identifying the reasons for losing things can help you build a strategy to stop the cycle. Making a commitment to organizing the things you keep losing is a great start.

Make a list of the objects you lose most frequently. You may be relieved to find out that there are just a few things on your list. Then, identify a place where you will store it. For example, you can get a key rack to hang right outside your door. Sunglasses go into a basket on the hall table. The checkbook stays in your purse until it is time to pay bills, then it goes on the top left-hand drawer of your desk.

Don’t lose the list! Stick it on your refrigerator or bulletin board.

Make a commitment to pay attention. Don’t be in such a rush. It will take more time to find you coat if you hastily throw it over a chair, than making the effort to hang it in the closet. If you must throw it over the chair, take the time to say out loud – I am leaving my coat on the chair where I can easily find it when I have to go out soon.

Put like objects together. Don’t store some medications in your bathroom cabinet, others on your night stand and others in the kitchen. Keep spices in the same place, store rice next to the pasta. If you have a hard time remembering where things should go (or to prevent others in your household spoiling your new organizational skills) place labels on shelves, plastic containers, inside drawers and cabinets.

Make a list to keep in your car when you are running errands. If it just occurs to you that Fido is low on kibble while driving to the grocery store, simply place an unusual object on your dash in front of the speedometer after parking your car .  When you return, you will notice a napkin right in front of your face. That will jog your memory that you intentionally put it there as a reminder to go to the pet store.

Once you get the hang of it, you can create simple strategies to stop losing things and reduce frustration.

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Falling – the Beginning of the End

A major fear shared by many seniors is the fear of falling. They fear that a trip or stumble will result in a broken hip and it will be “the beginning of the end.” In fact, brain injuries account for more than half of the deaths from falls. Breaking bones and brain injuries can be prevented by taking precautions to avoid falling.

The risk of falling increases as we age, largely as a result of deteriorating vision and poor balance. The side effect of many medications can cause dizziness. Decreased strength from inactivity and reduction of muscle mass make it harder to withstand trip hazards in the environment.

The good news is that falls can be prevented.

Vision can be improved by having an eye doctor revise the prescription for glasses. Just a simple thing like keeping your lenses clean will help you see more clearly. Removal of cataracts produces a remarkable improvement  in vision, often limiting the need to wear glasses only when reading.

Most falls occur in the home.  The biggest threat is in your bathroom. Install grab bars in the shower or tub. Use a textured bath mat to minimize slippery surfaces. Consider the use of a shower chair. Place non-skid bath rugs in the areas where the floor might get wet.

Rearrange the storage areas in your kitchen so that you don’t have to reach for things you need most often. Use a sturdy footstool or get a reaching device that will grab onto anything you need that is out of reach.

Use bright lights throughout the house and plug in night lights in strategic areas to prevent tripping in the dark. Place  contrasting colors on steps and thresholds to define changes in elevation and reduce the risk of falling.

Look around your house to see if you can minimize clutter and organize placement of furniture. The more stuff you have in your home, the easier it is to get in the way and trip you up.

Throw rugs are notorious for contributing to trips and falls. The safest thing to do is to get rid of them. If you can’t part with your throw rugs, make sure they are firmly attached to the floor with carpet tape.

Balance can be improved through exercise. Balance can be re-learned through practice. Exercise will also strengthen muscles to improve mobility and the flexibility to catch yourself when thrown off balance. Physical therapy can also improve balance and mobility.

Review your medications with your doctor to see if there are alternates which do not cause dizziness. Ask for suggestions from your doctor to cope with side effects which may contribute to feeling off balance.

Pay attention to your surroundings, especially when carrying things. Carrying a bag, tray or plate in front of you will obscure your view of what is immediately on the ground.

Wear non skid shoes. Leather soles don’t stick to carpet. Athletic shoes have grooves which can catch on carpet keeping your feet stuck while the rest of your body pitches forward.

It is amazing to realize that something as devastating as a fall can be prevented by paying attention and taking the steps to compensate for physical limitations and hazards in your environment.

 

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Masking Memory Loss

As children grow up and leave the nest, they often spread out to different cities and even states. Career opportunities, a desire to live in a different environment, or the location of spouse’s family are just some of the reasons for moving away from their home town. Sometimes, they just need a little breathing room from their siblings or an overbearing parent. Family relations don’t ease with distance but may possibly soften over time. That is until, family members are confronted with a difficult situation.

Let’s say for example Joe, the oldest son, moved to the East Coast shortly after graduating from college. He made a point to visit twice a year, until the demands of his own family and job prevented him from making regular trips back to California. The youngest daughter Julia became a nurse and remained close to her parents in their home town. She and Joe had opposite temperaments and often did not get along. Julia is a natural caregiver and realizes how much she needs to compensate for her mom’s lapses in memory and ability to complete complex tasks. This has been taking its toll on her energy and is affecting her relationship with her own husband and kids. When Joe comes to visit, Mom is on her best behavior.  He doesn’t understand why Julia is so concerned about their mom’s decline. He resists any notion that mom has slipped.  Julia accuses him of being in denial. She becomes angry with Joe because he doesn’t see the sacrifices Julia is making for their mom.

Often times, those who are closest to the person experiencing memory loss are more likely to accurately assess the situation. Family members who are more remote, either physically and/or emotionally don’t seem to accept that there is a problem.

Those in the earlier stages of memory loss often practice a phenomenon I like to call “performing.” They realize they are expected to respond in a certain way while in a familiar situation. In the example above, Mom seems perfectly fine because she is performing. Conversations seem to flow easily because she is in complete agreement with Joe’s comments. She may not be able to articulate that it is hot outside, so she replies “Isn’t that the case.” when Joe remarks on the summertime. She will cover up the fact that she shoes are on the wrong feet because they are so comfortable that she didn’t even notice. She will ask Joe to set the table because he is so good at it, rather than reveal she can’t remember which side to place the fork.

The best way to get a remote sibling to see the real behavior of their parent is to identify the times when, in Joe’s case, mom is performing. He could make a statement that is clearly nonsensical and listen to mom agree. By gently challenging mom to do something spontaneously,  Joe could observe that lost look in her eyes, and perhaps frozen body language. When mom doesn’t know that he is watching, she is likely to reveal herself the way Julia sees her.

When family members can work together to accurately assess memory loss in a parent, they are in the best position to seek the appropriate level of care. Denying or delaying medical treatment for the parent and support for the caregiver is an injustice to the entire family.

 

 

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Reversing Roles between Parent and Child

Age related illnesses often cause parents to depend on their children for care. Roles become reversed. This is a confusing time to shift orientation from the self sufficient parent who guided and supported their children, to a parent who is dependent and needy.

Adults are faced with uncertainty on how to relate to their aging parents. Feelings of guilt, regret, and incompetence accompany the role reversal. No matter how much the adult is compelled by love, decency and gratitude for their parents, it feels strange to  become the caregiver.

Adults of aging parents are often in the stage of their life that is incredibly demanding. They are working long hours and caring for their own offspring. How do they add another time consuming role of caregiving for their own parents? The response we frequently hear is “You do what you have to do.” They squeeze in the time to try to do it all.

There are only 24 hours in a day, so something has to give when dividing time between work, spouse, parents and children. Activities which support well being such as hobbies, fitness activities and socializing are let go. Despite cutting back on time for themselves, there is still not enough time in the day. Adults doubt their effectiveness on the job, in their marriage, at caregiving and parenting.

We offer these tips to those who feel overwhelmed when caring for their parents while managing all of the other responsibilities of their current roles:

  • Acknowledge your feelings, then move on. You may have regrets that you didn’t do enough for your parents, spouse and children. If you realize that no one can please everybody all the time, you might just give yourself a well-deserved break.
  •  Slow down and take a breath. Breathing will calm you down and improve your ability to think with a clear head.
  •  Let go of the notion that no one can do it as well as you. Let others help when offered. Ask for help when needed. Allow your children to help their grandparents within their abilities.
  •  Explore opportunities for respite. There are home health agencies which offer respite services on an hourly basis, and many assisted living communities will provide care for several days/weeks. If there is no money to pay for respite, ask another family member or trusted friend to give you a break.
  •  Realize that you are not alone. Confide in your friends and clergy about your doubts and fears.

Caring for others without short-changing yourself can be tremendously rewarding. It is the greatest honor to help those whom you love.

 
 

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Breaking the News

Breaking the news to a parent that it is time to move from their home into an assisted living facility is one of the most difficult tasks according to most of the families we meet. While some individuals welcome the benefits of living into a senior community, many fear their loss of independence and are not ready to face their inability to care for themselves. We have seen many approaches, and just as individual personalities and situations vary, so do the successful ways in breaking the news.

It is helpful to bring up the idea on several occasions. Mom or Dad will likely resist at the first mention of assisted living, but may warm up to the thought over time. We recommend that you do some research before bringing up the subject. Pre-screen a few communities you think would fit Mom or Dad’s needs. Then, talk to them about their preferences for living arrangements and explore options together. Most communities have web sites where you can take a “virtual tour.” Check out the community’s reputation with their licensing agency, the local Ombudsman’s office and the Alzheimer’s Association. Once you have selected a few, make an appointment for a tour and bring your parent with you. By encouraging their participation, they will become more invested in the idea. Once your parent learns about their living arrangements, activities and comforts of care, they may look forward to moving.

Decorate their new room or apartment before the move. Many communities will encourage bringing bedding, furniture, pictures, and memorabilia. Familiar belongings will trigger feelings of comfort and security. Do not bring valuables or items that you won’t mind getting misplaced or damaged.

Perhaps your parent is very stubborn and absolutely refuses to talk about the idea of moving into assisted living. The idea may become more acceptable if it is based on the recommendation of a trusted doctor. Further, constantly reassure your parent that you and other family members will remain involved in their life, and follow through on that promise.

We definitely do not recommend dropping off them for “lunch,” moving their belongings into their bedroom while they are dining and making a quick get-away. We have witnessed this approach and it always results in a great deal of emotional trauma. Residents of assisted living facilities do not give up their personal rights, and cannot be prevented from leaving if they absolutely refuse to stay there.

Respite care is an option to temporarily try assisted living. Just as a daunting task can be more manageable by breaking it down into smaller steps, respite care allows an individual to stay for a few days, or up to a month, to see if it is the right environment. In our experience, many residents want to stay longer, once they get settled in.

In other cases, the individual’s impaired mental capacity prevents them from being actively involved in the decision making. Many of the same recommendations apply for those with dementia, plus:

  • Carefully research communities and select one which has a dementia program.
  • Speak with the staff about your parent’s background and any special needs.
  • Make the move during their best time of day when they are calmest.
  • Stay positive – your attitude is infectious. Do not communicate any feelings of guilt or anxiety.
  • Provide constant reassurance that Mom or Dad is in a safe place.

 

 

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The difference between Alzheimer’s Disease and Dementia

There are many misconceptions about Alzheimer’s Disease (AD) and dementia. Dementia is actually a set of symptoms which arises from a number of conditions or diseases. AD is one of those diseases. In fact, it is the most common cause of dementia . Other diseases include vascular dementia, Parkinson’s Disease, Lewy Body and Pick’s Disease. Brain disorders such as Huntington’s Disease and AIDS can also result in dementia. The diseases are degenerative, meaning the symptoms will get worse over time.

Some causes of dementia are reversible. Reactions to prescription medications, chronic alcohol abuse, thyroid conditions, vitamin deficiencies, brain tumors or water on the brain (hydrocephalus) when successfully treated, can result in the return of brain function.

Dementia symptoms involve more than just difficulty remembering things. The symptoms have to be strong enough to get in the way of accomplishing normal daily tasks. Memory loss, a short attention span, inability to plan or follow a sequence of instructions, finding the right words, and personality changes are just some of the problems faced by a person with dementia. The symptoms cause a change in the person’s abilities compared to what they could do befor.

When a doctor diagnoses a person with AD, it means that the person’s symptoms and test results show that it is highly likely the brain will show the pathological features (plaques and tangles) of AD.

There is no cure for AD, but treatment of the disease and the symptoms of dementia are advancing over time. It is important to consult a physician as early as possible if there a suspicion that a change in the ability to think and recall are getting in the way of handling demands of everyday living. Medications such as the Exelon patch, Namenda and Aricept can be prescribed to slow the progression of the disease.

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Forgetfulness vs. Memory Loss

Dementia is a growing disease among our elderly population. Most of us know someone who has dementia or is dealing with a loved one afflicted by the disease. It is natural to be concerned when you can’t recall a name or misplace something important.

It is scary to think about the possibility that dementia could happen to you.

There is a difference between forgetfulness and memory loss. You probably forgot to do things and misplaced your stuff when you were younger and didn’t think much about the implications.  As you get older, it may be hard to tell if moments of forgetfulness are normal and simply inconvenient, or the start of something more serious.

When forgetfulness becomes consistent and produces strange things, it may be time to talk to your doctor. Here are some examples:

  • Losing your keys is OK. Finding your keys and not knowing its function is not.
  • Putting your hairbrush in the second drawer of your vanity instead of the top drawer is OK. Putting your hairbrush in the freezer  is not.
  • Getting lost in a new town or place is OK. Getting lost in your own neighborhood  is not.
  • Forgetting the name of an acquaintance you rarely see is OK. Forgetting the name of one your children is not.

Your doctor can do an assessment and involve specialists to make an informed diagnosis. If you do have memory loss, your doctor can determine the cause of your memory loss. Some causes are reversible (side effects of medications, poor nutrition, alcohol abuse, stress, anxiety, depression and other health issues) where strategies can be developed to cure the problem. Permanent memory loss can be slowed down with treatment. Like other medical issues, early intervention is key to optimize the outcome.

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