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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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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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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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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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