Planning Ahead When a Loved One Has Alzheimer’s Disease

When a loved one is diagnosed with Alzheimer’s disease, you need to start getting their health, legal, and financial affairs in order. You want to plan for the future, if possible, with help from your loved one while they can still make decisions. You need to review all of their health, legal, and financial information to make sure it reflects their wishes. Here is a planning checklist from the National Institute on Aging’s Alzheimer’s Disease Education and Referral Center:

Update health care, legal, and financial information

  • A Durable Power of Attorney for Finances gives someone called a trustee the power to make legal and financial decisions for the person with Alzheimer’s.
  • A Durable Power of Attorney for Health Care gives someone called a proxy the power to make health care decisions for the person with Alzheimer’s.
  • A Living Will states the person’s wishes for health care at the end of life.
  • A Do Not Resuscitate (DNR) Form tells health care staff how the person wants end-of-life health care managed.
  • A Will tells how the person wants his or her property and money to be divided among those left behind.
  • A Living Trust tells the trustee how to distribute a person’s property and money.

Check for money problems

People with Alzheimer’s disease often have problems managing their money. As the disease progresses, they may try to hide financial problems to protect their independence. Or, they may not realize that they are losing the ability to handle money matters. Someone should check each month to see how your loved one is doing. This person might be a family member or the trustee.

Protect your loved one from fraud

Scams can take many forms, such as identity theft; get-rich-quick offers; phony offers of prizes or home or auto repairs; insurance scams or outright threats. Here are some signs that a loved one with Alzheimer’s is not managing money well or has become a victim of a scam:

  • Your loved one seems afraid or worried when he or she talks about money.
  • Money is missing from your loved one’s bank account.
  • Signatures on checks or other papers don’t look like your loved one’s signature.
  • Bills are not being paid, and your loved one doesn’t know why.
  • Your loved one’s will has been changed without his or her permission.
  • Your loved one’s home is sold, and he or she did not agree to sell it.
  • Things that belong to your loved one are missing from the home.
  • Your loved one has signed legal papers (such as a will, a power of attorney, or a joint deed to a house) without knowing what the papers mean.

Reporting problems: If you think your loved one may be a victim of a scam, contact your local police department. You also can contact your state consumer protection office or Area Agency on Aging office. For help finding these offices, contact Eldercare Locator at 1-800-677-1116 or www.eldercare.gov. For a list of state consumer protection offices, see www.usa.gov/directory/stateconsumer/index.shtml. You can also look in the telephone book for a listing in the blue/Government pages.

Who would take care of your loved one with Alzheimer’s disease if something happened to you?

It is important to have a plan in case of your own illness, disability, or death.

  • Consult a lawyer about setting up a living trust, durable power of attorney for health care and finances, and other estate planning tools.
  • Consult with family and close friends to decide who would take responsibility for your loved one. You also may want to seek information about your local public guardian’s office, mental health conservator’s office, adult protective services, or other case management services. These organizations may have programs that could assist your loved one in your absence.
  • Maintain a notebook for the responsible person who would assume caregiving. Such a notebook should contain the following information:
    • emergency phone numbers
    • current problem behaviors and possible solutions
    • ways to calm the person with Alzheimer’s
    • assistance needed with toileting, feeding, or grooming
    •  favorite activities or food
  • Preview long-term care facilities in your community and select a few as possibilities. Share this information with the responsible person. If your loved one is no longer able to live at home, the responsible person will be better able to carry out your wishes for long-term care.

Contact the Alzheimer’s Disease Education and Referral (ADEAR) Center at 1-800-438-4380 or www.nia.nih.gov/alzheimers for more information on planning for health, legal, and financial matters.

Source: National Institute on Aging, adapted by AgeWise, 2014.

Robin Williams Death Raises Awareness of Lewy Body Dementia

It was recently reported that comedian-actor Robin Williams had dementia at the time of his death—but he was not suffering from Alzheimer’s disease. This is the first time many people had heard of Lewy body dementia, even though it is the second-most-common form of dementia. The Lewy Body Dementia Association shares this information on the disease:

There is a good chance your primary care physician is not familiar with the second-most-common type of progressive dementia in the elderly: Lewy body dementia (LBD). Despite the prevalence of LBD, people with the disease have to see an average of three doctors before the LBD diagnosis is made.

Lewy body dementia is a degenerative brain disease that has been described by LBD family caregivers as trying to manage Alzheimer’s, Parkinson’s and a psychiatric disorder rolled into one disease. Despite an estimated patient population of 1.4 million people in the U.S., LBD is most often misdiagnosed as Alzheimer’s disease or Parkinson’s disease. Early and accurate diagnosis of LBD is of critical importance, because people with LBD respond poorly to certain medications commonly prescribed for behavior and movement problems in people with Alzheimer’s or Parkinson’s, sometimes with dangerous or permanent side effects.

Recognition of LBD as a common form of dementia grew to prominence among neurologists only recently; general awareness of LBD as a disease has yet to make its way to primary care physicians. “Given the growing population of older Americans, at some point in your life LBD will likely affect someone you know,” said Angela Herron, president emeritus of LBDA’s board of directors. “The general public, including many primary care doctors and nurses, have never heard of LBD. So in addition to trying to manage a very difficult disease, LBD families find themselves in the unanticipated role of educator and advocate.”

LBD is typified by symptoms of dementia plus any combination of:

  • Unpredictable levels of cognitive abilities, attention and alertness.
  • Changes in movement or gait.
  • Visual hallucinations.
  • A sleep disorder that causes patients to act out their dreams physically.
  • Severe medication sensitivities.

The severe medication sensitivities in LBD make it a very difficult disease to treat without worsening already problematic LBD symptoms.

Quick Facts About LBD

LBD is more common in men than women.

People with LBD are more functionally impaired than people with Alzheimer’s disease with similar cognitive test scores.

There is a shorter disease course in LBD to both long-term care admission and death than in Alzheimer’s disease.

People with LBD may respond more favorably to certain dementia medications than people with Alzheimer’s.

Source: Adapted by AgeWise from materials from The Lewy Body Dementia Association, a nonprofit organization dedicated to raising awareness of the Lewy body dementias and supporting people with LBD, their families and caregivers and promoting scientific advances. Visit www.lbda.org to learn more about Lewy body dementia.

Can You Paint, Dance or Sing Your Way to Healthier Aging?

Many people believe that creativity peaks when we are young, diminishing as we grow older. But this stereotype is a myth. In fact, research shows that creativity can be maintained and even increased as we age. Many lifelong artists have reached their most productive and innovative phase in their 60s and beyond.

The arts are entertaining and culturally important. But is creativity important for health? It seems that it is! Study after study shows that lifelong participation in graphic arts, music, dance, creative writing and other art forms all set the stage for better health in our later years. For example, researchers recently found that people who played an instrument when they were young enjoy a brain health advantage in their senior years.

But what if you didn’t spend much time on artistic pursuits when you were a child? What if you were too busy during your working years to pick up a paintbrush or join a musical combo? The good news is, it’s never too late to tap into the power of art! Just as we can begin an exercise program after age 65 even if we’ve always been couch potatoes, we can also put on an artist’s smock or take up an instrument at any age, no matter what our health status and abilities. The benefits of art are many—physical, emotional, intellectual, psychosocial and intergenerational. According a study authored by the late Dr. Gene Cohen, who was a pioneer in the study of aging and creativity, seniors who participated in an arts program reported a higher overall rating of physical health, fewer doctor visits, less medication use, a reduction in falls, and fewer other health problems. The National Academy of Sciences is currently doing more research on “the relationship of art-making and creativity to physical health and psychological well-being of older adults.”

This should not surprise us when we realize that expressing ourselves is a vital human need. Sharing our history, our view of the world, our hopes and dreams and fears … though words, through music, through images, through motion … promotes the sense of well-being that is a major measure of successful aging. Consider this small sampling of recent studies on the benefits to be found in these types of creative pursuits:

Music. A University of California San Francisco neuroscientist is using community senior choirs to help participants improve balance and strength, and reduce depressive symptoms, loneliness and memory loss. Music therapists from MetroHealth Medical Center in Cleveland use music to help hospital patients reduce pain and build strength. And intriguing research from Northwestern University suggests that musical training might help reduce age-related hearing loss.

Drama. Professors Helga and Tony Noice of Elmhurst College in Illinois are using acting and drama to provide increased brain stimulation for older adults. They have found that acting engages performers on many levels—physical, emotional and intellectual.

Dance. University of Montreal professor Dr. Chantal Dumoulin used a dance program to help women reduce incontinence. Dance has also been used in an effective fall prevention program, according to University of Missouri’s Jean Krampe. And the Parkinson Foundation offers dance programs to reduce movement challenges.

Creative writing. The TimeSlips program encourages the use of imaginative language to improve the quality of life of people who are living with Alzheimer’s disease and related disorders.

Visual arts. Learning a new hands-on skill can protect the brain. University of Texas at Dallas researchers listed digital photography and quilting as examples of activities seniors might choose to improve cognitive function. And art museums across the country offer special programs for people with memory loss. According to Dr. Luis Fornazzari of St. Michael’s Hospital Memory Clinic in Toronto, artistic abilities may be retained in the mind even when other abilities are lost. He described the work of an internationally known sculptor who was able to create works of art even though she was unable to draw the correct time on a clock or remember the names of things. “Art opens the mind,” says Fornazzari.

Opportunities to Explore Your Creative Side

DIY—do-it-yourself—isn’t only for young people. You can create your own an art program, if that is what you prefer. Explore a local art store and bring home a selection of paints and paper. Dust off your piano and try some new music, or buy a simple instrument. Write a memoir. Put on some music and dance.

But this is just a start. Art opportunities abound in the community, and creating art with others adds the benefits of socialization. Check out classes offered by your local senior center, senior services department, parks and recreation, community colleges and university extension programs. Art galleries and other cultural institutions often offer participation programs.

Take an old favorite to a new level. Do you sew from patterns? Create your own designs! Do you do needlepoint from a kit? Try painting your own canvas. Use your woodworking tools to make decorative items for holiday gifts. “Yarn bomb” a tree in your yard—and be prepared to explain your project to curious passersby. Or increase the benefits of gardening by taking a flower arranging class.

What art activities are best for you? Don’t be afraid to try something new! Neurologists tell us that novelty is good for the brain. Try a creative activity you’ve never tried before—maybe even something you don’t know much about. If you never took up a musical instrument, discover the joys of creating sound. If you’ve never participated in group singing, your local choir may offer eye-opening pleasures. Never stepped on a stage? In a drama group, you may discover that you love to ham it up.

Many adapted activities are available for people with physical or cognitive limitations. More than ever before, creative arts therapists offer technologies old and new to enable people with mobility, sensory or cognitive challenges participate in arts of every type. Your local senior center may offer ideas; check with organizations and foundations that serve people with your own particular health challenge to find innovative adaptive art ideas and to learn about local programs.

Copyright © IlluminAge AgeWise, 2014

Alzheimer’s Experts Study Controllable Risk Factors

Scientists at the 2014 Alzheimer’s Association International Conference emphasize lifestyle factors.

Each year, leading experts on Alzheimer’s disease and related disorders meet at the Alzheimer’s Association International Conference, which is the world’s largest gathering of leading researchers, who present the latest information on the prevention, diagnosis and treatment of memory and cognitive disorders.

This information is of interest to anyone concerned about brain health, including older adults and families of people who are living with Alzheimer’s disease. This year, several new studies shed light on risk reduction strategies:

Mentally Stimulating Activities Promote Brain Health

A number of previous studies have suggested that puzzles, games and other activities that make our brains work a little harder could also protect our memory and thinking. Researchers from the Wisconsin Alzheimer’s Institute and the Wisconsin Alzheimer’s Disease Research Center presented the results of a study that adds to this understanding.

The scientists studied a group of people at higher risk of Alzheimer’s due to a family history of the disease and/or the APOe4 gene, which is associated with higher risk. They found that the people who often played games, read books or went to museums had greater brain volume in several important regions. According to researcher Stephanie Schultz, “Our findings suggest that for some individuals, engagement in cognitively stimulating activities, especially involving games such as puzzles and cards, might be a useful approach for preserving brain structures and cognitive functions that are vulnerable to Alzheimer’s disease.”

Moderate Exercise and Mild Cognitive Impairment (MCI)

The Alzheimer’s Association says that of all the lifestyle choices we can make, exercise is the best-documented way to promote brain health. At the conference, Mayo Clinic researchers reported the results of a study that specifically looked at the relationship between mild cognitive impairment (MCI) and exercise. Mild cognitive impairment is a condition that causes slight changes in memory and thinking. It may be an early sign of Alzheimer’s disease, but not everyone with MCI will develop Alzheimer’s.

The research team, led by Dr. Yonas Geda, reported that physical exercise in midlife and later life was associated with a reduced risk of MCI. They also found that in people who already have MCI, those with a history of moderate exercising during the ages of 50 – 65 had a “significantly decreased” risk of progressing to dementia. Dr. Geda said, “In our studies, we found that physical exercise at various levels, especially in mid-life, is beneficial for cognitive function. These are intriguing results, but they are not yet conclusive. More research is needed to determine the extent and nature of physical activity in protecting against MCI and dementia.”

Brain-Healthy Lifestyle Choices Work Together

There are some risk factors that we can’t do anything about—but certain brain-healthy lifestyle choices are under our control. A team of researchers from the Karolinska Institutet in Sweden and the National Institute for Health and Welfare in Finland noted that individual studies have looked at the protective effect of individual modifiable risk factors, such as diet, exercise, socialization, social activities and management of heart disease. The team decided to look at the collective effect of all those factors. They studied a group of people age 60 to 77, and reported that those who were encouraged to follow a full set of brain-healthy lifestyle choices performed better on cognitive tests two years later. At the Conference, study author Dr. Miia Kivipelto said, “This is the first randomized control trial showing that it is possible to prevent cognitive decline using a multi-domain intervention among older at-risk individuals.” Kivipelto also noted that the study participants found the experience positive, and only 11 percent dropped out of the study during the two-year period.

These studies are yet another reminder about how important it is to take care of our own health! No matter what your age, take advantage of support resources in your community that can help you get the exercise, mental stimulation, regular healthcare, healthy eating and other activities that lower your own risk.

Source: AgeWise reporting on news releases from the Alzheimer’s Association. Read more about the 2014 Alzheimer’s Association International Conference here.

Alzheimer’s Caregiving Tips: Sundowning

Late afternoon and early evening can be difficult for some people with Alzheimer’s disease. They may experience sundowning—restlessness, agitation, irritability, or confusion that can begin or worsen as daylight begins to fade—often just when tired caregivers need a break.

Sundowning can continue into the night, making it hard for people with Alzheimer’s to fall asleep and stay in bed. As a result, they and their caregivers may have trouble getting enough sleep and functioning well during the day.

Possible Causes

The causes of sundowning are not well understood. One possibility is that Alzheimer’s related brain changes can affect a person’s “biological clock,” leading to confused sleep-wake cycles. This may result in agitation and other sundowning behaviors.

Other possible causes of sundowning include being overly tired, unmet needs such as hunger or thirst, depression, pain and boredom.

Coping with Sundowning

Look for signs of sundowning in the late afternoon and early evening. These signs may include increased confusion or anxiety and behaviors such as pacing, wandering, or yelling. If you can, try to find the cause of the person’s behavior.

If the person with Alzheimer’s becomes agitated, listen calmly to his or her concerns and frustrations. Try to reassure the person that everything is OK and distract him or her from stressful or upsetting events. You can also try these tips:

  • Reduce noise, clutter, or the number of people in the room.
  • Try to distract the person with a favorite snack, object, or activity. For example, offer a drink, suggest a simple task like folding towels, or turn on a familiar TV show (but not the news or other shows that might be upsetting).
  • Make early evening a quiet time of day. You might play soothing music, read, or go for a walk. You could also have a family member or friend call during this time.
  • Close the curtains or blinds at dusk to minimize shadows and the confusion they may cause. Turn on lights to help minimize shadows.

Preventing Sundowning

Being too tired can increase late afternoon and early-evening restlessness. Try to avoid this situation by helping the person:

  • go outside or at least sit by the window—exposure to bright light can help reset the person’s body clock
  • get physical activity or exercise each day
  • get daytime rest if needed, but keep naps short and not too late in the day
  • get enough rest at night

Avoid things that seem to make sundowning worse:

  • Do not serve coffee, cola, or other drinks with caffeine late in the day.
  • Do not serve alcoholic drinks. They may add to confusion and anxiety.
  • Do not plan too many activities during the day. A full schedule can be tiring.

If Problems Persist

If sundowning continues to be a problem, seek medical advice. A medical exam may identify the cause of sundowning, such as pain, a sleep disorder or other illness, or a medication side effect.

If medication is prescribed to help the person relax and sleep better at night, be sure to find out about possible side effects. Some medications can increase the chances of dizziness, falls, and confusion. Doctors recommend using them only for short periods of time.

Source:  The U.S. Alzheimer’s Disease Education and Referral Center, a service of the National Institute on Aging, part of the National Institutes of Health. For more caregiving tips and resources, visit www.nia.nih.gov/alzheimers/topics/caregiving or call toll-free 1-800-438-4380.

American Heart Association Confirms Connection of Memory Health, Heart Health

The risk of developing cognitive impairment, especially learning and memory problems, is significantly greater for people with poor cardiovascular health than people with intermediate or ideal cardiovascular health, according to a recent study appearing in the Journal of the American Heart Association.

Cardiovascular health plays a critical role in brain health, with several cardiovascular risk factors also playing a role in higher risk for cognitive decline.

Researchers found that people with the lowest cardiovascular health scores were more likely have impairment on learning, memory and verbal fluency tests than their counterparts with intermediate or better risk profiles.

The study involved 17,761 people aged 45 and older at the outset who had normal cognitive function and no history of stroke. Mental function was evaluated four years later.

Researchers used data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study to determine cardiovascular health status based on The American Heart Association Life’s Simple 7™ score. The REGARDS study population is 55 percent women, 42 percent blacks, 58 percent whites and 56 percent are residents of the “stroke belt” states of Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, South Carolina and Tennessee.

The Life’s Simple 7™ initiative is a new system to measure the benefits of modifiable health behaviors and risk factors in cardiovascular health, such as smoking, diet, physical activity, body mass index, blood pressure, total cholesterol, and fasting glucose. It classifies each of the seven factors of heart health as either poor, intermediate or ideal.

After accounting for differences in age, sex, race and education, researchers identified cognitive impairment in:

  • 4.6 percent of people with the worst cardiovascular health scores;
  • 2.7 percent of those with intermediate health profiles; and
  • 2.6 percent of those in the best cardiovascular health category.

“Even when ideal cardiovascular health is not achieved, intermediate levels of cardiovascular health are preferable to low levels for better cognitive function,” said lead investigator Evan L. Thacker, Ph.D., an assistant professor and chronic disease epidemiologist at Brigham Young University Department of Health Science, in Provo, Utah.

“This is an encouraging message because intermediate cardiovascular health is a more realistic target for many individuals than ideal cardiovascular health.”

The differences were seen regardless of race, gender, pre-existing cardiovascular conditions, or geographic region, although higher cardiovascular health scores were more common in men, people with higher education, higher income, and among people without any cardiovascular disease.

Cognitive function assessments involved tests to measure verbal learning, memory and fluency. Verbal learning was determined using a three-trial, ten-item word list, while verbal memory was assessed by free recall of the ten-item list after a brief delay filled with non-cognitive questions. Verbal fluency was determined by asking each participant to name as many animals as possible in 60 seconds.

Although mechanisms that might explain the findings remain unclear, Thacker said that undetected subclinical strokes could not be ruled out.

Source: The American Heart Association. Visit www.heart.org to find heart health information for consumers and professionals.

Memory Slower? You’re Processing a Lifetime of Information!

Older adults have always joked that it takes them longer to remember things because they must sort through their years of knowledge to find the right answer. They might say something like, “My brain is too full!”

Is this true? Research recently appearing in the journal Topics in Cognitive Science described the work of linguistics researchers who are using computers to demonstrate that, indeed, the “full brain” of seniors is the most common cause of slower memory and slower performance on certain memory-related tests.

The study team, headed by Dr. Michael Ramscar of the University of Tübingen in Germany, put computers to the test by loading them with information to simulate the increased knowledge of human seniors. Would computers experience a “senior moment”? According to the researchers, when the computer sorted through a small amount of information, its performance on cognitive tests resembled that of younger humans. But, say the researchers, “When the same computer was exposed to the experiences we might encounter over a lifetime, its performance looked like that of an older adult. Often it was slower, not because processing capacity had declined. Rather, increased ‘experience’ had caused the computer’s database to grow, giving it more data to process—which takes time.”

The researchers say that standard memory tests may not yield an accurate picture of an older adult’s memory health. They explain that older brains not only have more memories to sift through, but also more chances to forget things.

The team also examined a classic memory lapse many seniors worry about: forgetting names. They remind us that the more people we meet in life or read about, the more names we need to sort through and remember. And seniors of today, take heart: The researchers also reported that it is harder now than it was two generations ago to connect faces to names, due to a much greater diversity in names today. They say, “The number of names anyone learns over their lifetime has increased dramatically. This work shows how this makes locating a name in memory far harder than it used to be. Even for computers.”

Of course, not all memory loss is benign. It’s important to know the signs that might indicate a problem. According to the National Institute on Aging, these are some symptoms that indicate that a person should consult their healthcare provider:

  • Asking the same question over and over
  • Becoming lost in places that are familiar
  • Not being able to follow directions
  • Becoming more confused about time, people and places
  • Neglecting personal safety, hygiene and nutrition

These symptoms might indicate the onset of Alzheimer’s disease or other serious memory loss. Or they could result from a fortunately treatable cause such as medication side effects, infections, nutritional deficiencies, depression or alcohol abuse. No matter what the cause, early diagnosis is important.

Meanwhile, seniors who are experiencing normal age-related changes of memory should take these words of Dr. Ramscar to heart: “The brains of older people do not get weak. On the contrary, they simply know more.” Given that age-related stereotypes have been shown to trigger depression and inactivity, this understanding is great ammunition for combating the clichés that slow us down!

Learn More

The National Institute on Aging offers the free booklet, “Understanding Memory Loss: What To Do When You Have Trouble Remembering,” that explains the difference between mild forgetfulness and more serious memory problems.

Source: AgeWise reporting on study from Tubingen University.

Helping Someone Move to a Long-Term Care Facility

Moving to a long term care facility is often difficult for an older adult. But there are many things family members and friends can do to reduce the physical and emotional stresses involved. They can help plan the move, participate on the day of the move, and provide love and support after the move.

Moving to a nursing home is an important long term care option for many older or disabled adults. Sometimes, a person moves to a nursing facility because the care they need just isn’t available or practical at home. Or, they may have special rehabilitative care needs after leaving the hospital, but before they return home.

Whatever the circumstances, there are a few simple steps you and other family members and friends can take to help the person you care for make a smooth, hassle-free transition to new surroundings.

Before the Move

Moving to a long-term care facility usually means making do with less space than the person is used to. Long-term care residents have the right to keep and use items of personal property, to the extent space permits. But space is almost always in short supply. So choices may have to be made about what to take along…and what to leave behind. Friends and family can help by:

  • Learning from the facility exactly what space limitations apply
  • Helping prepare for the move, including arranging for storage or other disposition of items left behind
  • Discussing the facility’s policies for safeguarding resident property; for example, you may be advised to mark all clothing and personal belongings with the person’s name, and to make (or helping the resident or facility make) a list of the resident’s things
  • Anticipating and responding to special concerns, such as care for a pet.

On the Day of the Move

Moving to a new home is always stressful. You can help minimize feelings of disorientation and dislocation by:

  • Helping your loved one unpack…and making sure that pictures, personal mementos and other similar items are placed where they will create a feeling of home
  • Sharing a meal at the new facility
  • Getting to know staff members  and learning about all the various programs, services, and activities the facility has to offer
  • Spending some quiet time after everything is unpacked to make sure your family member or friend is as comfortable, relaxed, and reassured as possible.

After the Move    

When people move to a care facility, they often fear that the move will come between them and people and activities they love. They may worry about being alone and out of touch. It may take some time and effort to get over these concerns, to be reassured by the support of loved ones, to make new friends, and to settle into new and interesting patterns of living. You can help by:

  • Staying in touch right from the beginning…communicating frequently and positively
  • Working closely with your loved one and staff to make sure any difficulties are ironed out
  • Establishing regular visiting times so your loved one can plan ahead for them
  • Making a few surprise visits as well
  • Visiting individually or as a family group for special occasions, such as birthdays and anniversaries
  • Attending care conferences and family support groups
  • Working with your loved one and staff to make the new living situation a happy, successful one.

15 Great Ways to Help Your Loved One Feel Connected

  1. Send flowers or balloons on a special day.
  2. Write frequent cards, notes or e-mail.
  3. Give a prepaid, senior-friendly cell phone or calling card.
  4. Set up Skype chats with your loved one
  5. Visit as often as you can.
  6. Send pictures or videos of family events, grandchildren, or friends.
  7. Bring a card or small gift when you visit.
  8. Get to know the resident’s new friends and care providers, and greet them during your visits.
  9. Check to see what types of food items would be appropriate as a gift, and include them occasionally when you visit.
  10. Remember to acknowledge and thank members of staff whenever appropriate.
  11. Offer to take along other long-time friends, so they can visit also.
  12. Go for a stroll outside if weather permits.
  13. Take the resident on a day trip, or come along on a resident outing.
  14. Inform friends, family and your loved one’s faith community of their new contact information.
  15. Become a volunteer in your loved one’s new home.

Health Law Requires Medicare to Cover Dementia Evaluation

Provided by Kaiser Health News (www.kaiserhealthnews.com)

For the millions of seniors who worry that losing their keys may mean they’re losing their minds, the health law now requires Medicare to cover a screening for cognitive impairment during an annual wellness visit.
But in a recent review of the scientific research, an influential group said there wasn’t enough evidence to recommend dementia screening for asymptomatic people over age 65.

What’s a worried senior to think?

Dementia screening tests are typically short questionnaires that assess such things as memory, attention and language and/or visuospatial skills. One of the most common, the mini-mental state examination, consists of 30 questions (such as “What month is this?” and “What country are we in?”) and may be completed in about 10 minutes.

In its review, the U.S. Preventive Services Task Force, an independent panel of medical experts, evaluated the evidence of the benefits, harms and clinical utility of various screening instruments for cognitive impairment. It concluded that the evidence for routine population-based screening was insufficient. While declining to  recommend the practice for everyone older than 65, the reviewers noted that some screening tools can be useful in identifying dementia.

“Clinicians need to use their judgment,” says Albert Siu, professor and chair of geriatrics and palliative care at Mount Sinai School of Medicine in New York, who was co-vice chair of the task force on dementia screening. “The evidence isn’t clear that there is a net benefit to screening for individuals that are asymptomatic.”
The risk of dementia increases with age: its prevalence is 5 percent in people aged 71 to 79, rising to 37 percent of those older than 90. Mild cognitive impairment has many definitions, but the term generally refers to people whose impairment isn’t severe enough to hamper their ability to manage their daily lives. By some estimates up to 42 percent of people older than 65 have it. Mild cognitive impairment is a warning sign, but it may not progress to Alzheimer’s disease, says Dean Hartley, director of science initiatives at the Alzheimer’s Association.

Alzheimer’s is the most common form of dementia, accounting for up to 80 percent of cases. Other types include vascular dementia, many cases of Parkinson’s disease and Huntington’s disease.

Someone without symptoms who does poorly on a screening test may have other medical conditions, such as depression or sleep apnea, that can cause memory or other problems, says Hartley. That’s why it’s important that people take the tests in a medical setting with a trained professional who can evaluate them and take a good medical history from patients and their family members, he says.

One-time screenings at shopping malls or health fairs should be avoided, experts agree. Taking a quick test without any accompanying medical evaluation may raise more questions than it answers.

But seniors may want to consider having an evaluation for cognitive impairment as part of their annual wellness visit with their health provider. It is covered with no out-of-pocket charge.

The Alzheimer’s Association recommends that seniors undergo cognitive impairment screening and evaluation to establish a baseline for comparison, and then have regular follow-up assessments in subsequent years.

There is no cure for Alzheimer’s disease. Some drugs, such as Aricept, may improve memory or other symptoms temporarily, but no medical treatment halts or reverses the disease.

That is a key argument against large-scale routine screening of people older than 65, says Ariel Green, a geriatrician at Johns Hopkins Bayview Medical Center. “We don’t have studies that show that such a screening program improves the care of people with dementia,” she says.

Still, if an individual has concerns about dementia because of a family history of Alzheimer’s or memory lapses, for example, a medical professional should evaluate the person and a screening test may be appropriate.

And although research hasn’t yet shown that large-scale screening is effective at improving dementia care overall, screening may help individuals and their families identify a cognitive impairment or dementia early on. The drugs that are available are most effective in the early stages of the disease. In addition, Green says, “it’s helpful for people to hear a diagnosis of dementia, if it’s an accurate diagnosis, because it can help people anticipate their future needs and plan for that.”

Source: Kaiser Health News (www.kaiserhealthnews.org), an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. This article was produced by Kaiser Health News with support from The SCAN Foundation (www.thescanfoundation.org).

How Are Today’s Seniors Adapting to Disability?

Only about a third of Americans ages 65 and older are fully able to take care of themselves and go about their daily lives completely independently, according to a recent study published online in the American Journal of Public Health.

Understanding that there are different ways older adults adapt to disability is a big step in developing public health policies that maximize the quality of life for all older Americans, said the study’s lead author, Vicki Freedman, a research professor at the University of Michigan Institute for Social Research.

Freedman and colleagues analyzed data on a nationally representative sample of 8,077 older men and women, part of the National Health and Aging Trends Study. The National Institute on Aging, part of the National Institutes of Health, funded the research.

Among the findings:

  • About a quarter succeed in accomplishing what they need to do on their own by using walkers or other assistive devices. Another 18 percent say they have trouble even when using these devices.
  • Six percent cope by reducing their activities—bathing or going outside less often, for example.
  • Twenty-one percent manage by receiving help from others.

The study is the first to provide national estimates of ways the Medicare-age population adapts to limitations in daily life.

“Nearly 80 percent of all older adults find ways to manage on their own without assistance from others,” Freedman said. “The group using devices on their own without difficulty is especially interesting. They seem to be able to participate in activities they enjoy and report well-being as high as those who are fully able to care for themselves.”

The researchers asked about seven activities of daily living: going outside, getting around inside, getting out of bed, eating, getting cleaned up, using the bathroom and dressing.

During face-to-face interviews, study participants were first asked whether they used devices or environmental modifications including canes, walkers, wheelchairs, scooters, grab bars, and bath/shower seats and whether they received help from another person during the previous month.

Then they were asked whether they experienced any difficulty doing any of the activities even when they used modifications, and about whether they had changed how often they performed any basic activities over the last year.

According to Freedman, the proportion of older adults able to function independently varies greatly by activity and by age. For example, 90 percent of older adults are fully able to eat by themselves, while only 54 percent are fully able to bathe by themselves. About 45 percent of those ages 65 to 69 are fully able to carry out all activities independently, compared with only 4 percent of those ages 90 and older.

Women are more likely than men to do things on their own by using devices to assist them (26 percent compared to 23 percent). But African Americans and Hispanics are much less likely than whites and Asians to do so. Older adults with low incomes are also less likely to successfully accommodate declines in their functional abilities.

“Two groups that we identified may be especially important targets for public health intervention,” Freedman said. “These are the seven million older adults who have difficulty carrying out activities alone with whatever accommodations they have already made, and the additional 2.1 million who have reduced their activity levels but do not experience or acknowledge that they are having difficulty.”

Source: University of Michigan Institute for Social Research (http://home.isr.umich.edu)