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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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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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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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Finding Balance in Caregiving

Caregivers understand that they face demanding, yet rewarding circumstances when caring for a family member. For adult children, it can be a way of giving back to a parent. For a spouse, it may be the expression of a love that never ends. In addition to knowing that they are fulfilling the needs and preferences of their family member, caregivers often express the feeling that they live a more purposeful life and are at peace with themselves.

The most successful caregivers are blessed with strength, endurance, compassion, patience and unselfishness. Not everyone is naturally endowed with these virtues, so we suggest making an honest assessment about your caregiving attributes and be realistic about the needs of your family member. Caregivers who understand their strengths and shortcomings can learn to find a balance between their role as a caregiver and their personal needs.

Caregivers need to embrace the notion that successfully caring for another also requires caring for themselves.

Rarely, can a single person fulfill all of the responsibilities needed by one who is suffering from a disease or disability. It usually takes a team of health care professionals, family members, care providers and support services. Caregivers can better manage such a demanding job by using the resources of others. Studies show that taking periodic breaks from the caregiving role (known as respite,) participating in support groups and/or counseling help caregivers remain successful, with less stress and greater satisfaction.

This may seem obvious, but in reality caregivers are more likely to get wrapped up in the role of caregiving to the extent they neglect their own health. According to the Family Caregiver Alliance, depression, coronary heart disease, hypertension, poor immune function, slower wound healing and increased risk of mortality are faced my many caregivers, especially women.

If you are a caregiver, how can you find balance, take care of yourself while providing the care that your family member needs? While the answer is simple, it may not be so simple to do. It is the act of letting go and acknowledging that others can help you from time to time with caregiving.

Options range from creating an informal support network of relatives, friends and neighbors to using organizations devoted to helping caregivers. Although you may not have received offers from relatives, friends and neighbors to help with caregiving, it doesn’t mean they are unwilling to lend a hand. They simply may not know how to offer or what to do. You may be surprised at their quickness to agree to help with a specific task.

Remember to take care of yourself, it’s the first step in taking care of the one you love.

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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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