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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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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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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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Be Prepared for the Future

Some people work better under the stress of a deadline. They tell themselves that they are only motivated to do their best under pressure. That may be true, but it is risky to apply that situation when seniors (and their children) have to make health care decisions in a crisis mode.

It is natural to feel uncomfortable to confront the inevitability of failing health or death with family members. Perhaps you are the daughter or son who feels it may be disrespectful to bring up the topic to Mom and Dad. Or you may be a parent and want to spare your kids from envisioning the time when you will not be strong enough to make decisions on your own.

Don’t wait for the perfect time, because there is no perfect time. Things can change suddenly, and if you don’t know your family  members’ wishes, location of documents and other vital information, it will be much more difficult to manage in a crisis situation. Discussing far-off, hypothetical scenarios are actually easier to address rather than when reality hits and you try to sort out options in the emergency room.

A good first step is to find out if there is a current will, a durable power of attorney, a health care power of attorney and an advance health care directive
(also known as a living will) in place. If not, now is the time to consult a lawyer about the purpose of each document and to understand your loved one’s options.

Exploring these legal issues will bring up many of the decisions that will need to be made. For example, your family member will need to give someone the authority to make financial and legal decisions on their behalf when completing a durable power of attorney. A health care power of attorney will require naming someone who will be responsible for medical decisions in the event of  physical or mental incapacity. An advance health care directive will provide instructions specifying what actions should be taken in the event they are no longer able to make decisions due to illness or incapacity.

Be careful about finding free forms on the Internet. While the forms may look similar to those drawn by an attorney, you can’t be sure that the “do it yourself” document will be accepted by all financial institutions and insurance companies. Additionally, different states require different criteria. Do it once, and do it correctly.

Does your family member desire aggressive medical interventions using the latest technology to battle an incurable health condition, or would they rather forego life-sustaining measures that would serve only to prolong dying? There is a document called POLST that is printed on brightly colored pink paper so it cannot be easily overlooked. POLST stands for Physician Orders for Life-Sustaining Treatment which is designed to give people more control over end of life care. The individual can detail their wishes about the degree of medical intervention they desire. It is signed by the individual and their doctor and represents a promise by all health care professionals to honor the wishes stated in the document. The POLST should accompany the documents listed above. It is not a replacement for an advance health care directive.

There are also personal preferences beyond financial and health care issues that are important to talk about. How does your family member feel about alternative living arrangements if he or she can no longer safely stay at home? If a crisis arises, who should be contacted? Do you have the names and phone numbers of their doctors, lawyer, relatives, clergy, or even friends?

These are weighty issues, and are not likely to be settled in just one conversation. It is a good idea to talk about it in person, rather than on the phone, emails or letters. Be patient and open to their responses, without bringing a hidden agenda according to what you believe is best. You may be surprised about your family member’s wishes.

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Five Steps to a Positive Attitude

5 Steps to a Positive Attitude

A positive attitude is highly connected to longevity and improved life satisfaction in survey after survey. It seems that those individuals who have a positive attitude live longer and experience happier lives. But a positive attitude is not just something you have; it is something you have to continually work at as you get older. Loss of loved ones, impaired health, dealing with financial issues, and the modern culture’s attitude towards the elderly can make keeping a positive attitude more challenging. To develop and maintain a positive attitude, I recommend the following five steps.

Stay Connected

Social isolation increases with age. We lose friends and family and end up spending more time alone. While a certain amount of private time is essential, too much of it can make us feel disconnected and we start to wonder if anyone cares about us. Feelings of depression and anxiety increase without our connections to others. It is important to spend time and energy maintaining the friendships you have and work on building new relationships. Many people that I talk to mention that some of their best friendships are those that they developed later in life. In addition to friendships, I recommend being active in clubs, associations, and your church where you will find many people who share your interests and passions.

Contribute

Those individuals who volunteer and give back to their communities consistently report positive emotions and a sense of satisfaction. Everyone needs to feel needed at some level, and helping others feeds this need. Your time and effort can help so many people who are in need. Especially with all of the cutbacks of government services, the contributions of individuals become increasingly important. Pick a charity or group that you feel a connection to and volunteer your time.  You’ll feel better for it.

Stay Active

Physical activity and exercise are key to maintaining your health and attitude. Exercise increases the release of neurotransmitters that are associated with positive mood and is also has a pronounced positive effect on lowing cholesterol and blood pressure. Exercise helps maintain your bone mass as well as your muscle tone. Completing an exercise or physical activity has the added benefit of giving you a sense of accomplishment. It is important not to overdo exercise
so be sure to check with your doctor about what level and intensity is right for you.

Keep your Brain Active

There is considerable research that demonstrates maintaining a high level of mental activity and stimulation is great for your attitude and maintaining your mental health.Reading, playing games, and doing mental challenges such as crossword puzzles and brain teasers helps your memory and mental processing. Keep reading books and the newspaper, stay up with current events, and engage your brain by thinking deeply and often about issues. As the saying goes, the brain is a muscle that needs to be exercised.

Another part of keeping your brain active is to practice the art of positive thinking. Don’t dwell on past negative events; instead focus on the positive things that are going on in your life now. Positive thinking is all about perspective and it is something you can manage if you put your mind to it. Look for and recognize the positive that is happening all around you.

Have Fun

Engaging in hobbies and non-work related activities help you to keep a positive attitude. Although we are older, try to stay connected to the kid inside you by making sure you include enough play time in your day. The most important aspect of fun is that it has no other purpose than to give us enjoyment. Fun is good for the heart and soul.

By practicing these five steps on a daily basis and encouraging others around you to do the same,
you will find that your life is happier and more fulfilling, and your positive attitude will be a life companion.

Keep your Brain Active and Have Fun by playing our PhotoTeasers every Friday.

 

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Watch Out for Unsafe Medications Given to the Elderly

Medications produce effects which can be good or bad. They can be a life-saving friend or a life-threatening enemy. They may complement the use of other medications or interact with each other to create adverse reactions.

Don’t Do the Math
We have seen the effects of taking too many medications on a senior. One doctor says  take 20mg of one medication and another doctor says take 40mg of the same medication. She added up the milligrams and took 60mg. This caused a hospital visit for 4 days.

Elderly Face Different Risks
Since medications can be dangerous and may cause more harmful side effects than benefits, communication with doctors and pharmacists is absolutely necessary. NaturalNews.com highlights a study by Duke University focusing on unsafe drugs for the elderly.

Take Time to Read and Understand the Inserts
How many times have you actually read the information page that comes with your medications? If you have, did you understand it all? The information can be confusing and it seems you have to be a doctor or pharmacist to completely understand what it actually says.

Beware of the Black Box
If you notice a warning on the prescription drug information page that is surrounded by a black border, you are dealing with a Black Box or Black Label Warning. The pharmaceutical company is required to place this particular warning on its labeling by the FDA for the following situations: The medication can cause serious adverse reactions (such as a fatal, life-threatening or permanent disability) compared to its potential benefit. Or the drug can adversely affect certain populations such as the elderly with dementia. Just look at this warning for Haldol, a drug often prescribed for dementia patients. When your doctor prescribes a new medication, it is important to find out if it carries this type of warning. If so, we strongly advise you to have a conversation about the medications risks vs. its benefits. Follow up with a consultation with the pharmacist when you pick up the medication.

How Many Pharmacies and Doctors are Involved?
Medication issues are especially a concern for those who use multiple pharmacies and different doctors. One may be a cardiologist, yet another may specialize in working with diabetes and kidneys. Others may include an internist, a urologist or orthopedic doctor. All of these doctors may prescribe medications for different reasons. Some may have an adverse interaction with another. The doctors may not know what the other has prescribed.

If you use different pharmacies and doctors, make sure you give them a complete list of all your medications. All of your doctors, and dentist for that matter, should know exactly what you are taking including the dose and time of day and the reason you are taking medications. This includes over the counter medications such as aspirin and decongestants, as well as nutritional supplements such as glucosamine and fish oil. Your pharmacist and doctor will be able to review the list and advise you of any potential for adverse reactions.

By paying attention to your medication regimen, and enlisting the support of your doctors and pharmacists, you will stand the best chance of getting the results the drug manufacturer intended and avoid the horror of serious side effects.

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Decisions for Parent with Alzheimers

Siblings dealing with decisions for a parent with Alzheimer’s face special challenges. If handled well, these decisions can bring the family closer together. Handled poorly, these same decisions can drive a wedge between family members and at worst, lead to a family divorce. When parents show symptoms of dementia, family members have to tackle some tough issues. These include financial decision making, managing medications (or even agreeing to see a doctor,) finding a caregiver and perhaps the toughest issue – seeking long term care.   

Here are some common problems that families run into regarding facing decisions on behalf of their parents:

  • Some family members may be unwilling to accept their parents’ change in abilities to manage their checkbook, drive safely, prepare balanced meals and look after their own health. Others may overestimate their parent’s ability to continue to live independently.
  • Not all family members are equally involved in their parents’ lives. Some members may live far away whereas others are actively involved and have frequent contact. Sometimes proximity isn’t a factor – certain siblings are frequently too busy with their own children, work, etc. Those who have remained close may feel they should have more weight in the decision. The post at http://www.psychologytoday.com/blog/singletons/201108/planning-your-parents-or-your-old-ageshows that the responsibility often is shouldered by daughters living in close proximity to their parents.
  • Family members can also differ in the level of financial contribution they might have to make for their parents’ care. Those family members who contribute more may feel that they should have more say in the decision.

 A family who forms a Family Council is likely to face tough issues which serve their parents’ best interests and promote harmony among family members. Here are some of our recommendations to make the process go smoother. 

  • Don’t wait to the last minute. Be proactive in starting a Family Council. Start the process before you need to make a decision. Avoid having to make a decision under pressure and in a rush. A parent with advancing symptoms of Alzheimer’s may not be fit to appoint a Power of Attorney and may have to be conserved. Conservation is expensive, as well as tedious. You can learn about the issues at http://www.calelderlaw.com/blog/2010/08/10/conservatorship-basics/
  • Approach the situation with some formality. Identify who will be involved and when you will meet. It is best to meet on an ongoing basis to talk so that all members can actively participate.
  • Share information openly. Make sure that all members have the same information.
  • Meet regularly. It often takes several meetings to resolve care-related issues.
  • Document your conversations so that you have a record of your discussions.
  • Have your parents participate. You want the conversation to be as open as possible. Your parents should have a voice and be able to make their wishes known.  

Most importantly, decide how you will decide. Start by recognizing that everyone has different opinions and there will be disagreement. Decide how you will deal with disagreement by choosing a decision making method. Should majority rule or must everyone agree? Can family members who are more involved or have greater financial responsibility have a bigger weight in their decision? Perhaps the answer is to appoint one family member as the final authority.  

Making decisions for a parent with Alzheimer’s can be focused toward the best interest of the parent, and produce the best outcome, when using the Family Council approach.

Mary Burger writes dementiadvice. She is the owner of A Brand New Day a full-spectrum long term memory care facility in Redding CA.

 

 

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