Wednesday, July 2, 2014
The Administration for Community Living, Centers for Disease Control and Prevention, and the National Institute on Aging are collaborating to host a webinar series to increase knowledge about Alzheimer’s disease and related dementias, and resources that professionals in the public health, aging services, and research networks can use to inform, educate, and empower community members, people with dementia, and their family caregivers.
You can register for all the webinars or just the one that most interests you. You must register separately for each webinar. If you plan to view the webinar in a central location with others, we encourage only one person to register for the group.
Each webinar is from 1:30 p.m.–3:00 p.m. ET/12:30 p.m.–2:00 p.m. CT/ 11:30 a.m.–1:00 p.m. MT/10:30 a.m.–12:00 p.m. PT. The schedule is as follows:
Tuesday, July 22, 2014: Updates on Alzheimer’s Disease and Related Dementias Resources
Thursday, August 28, 2014: Community Collaborations for Assisting People with Alzheimer’s and Dementias: The Steps to Success
Thursday, September 25, 2014: Alzheimer’s Research Updates
Click here for additional information on the series and each webinar session.
Wednesday, June 18, 2014
"It’s hard to believe that 40 years ago it was proposed that Alzheimer disease (AD) is caused by brain aluminum. Some people even threw out their cookware, in fear of acquiring the memory-impairing disease. The aluminum hypothesis has long since been discounted, and research has marched forward: β-amyloid (Aβ) protein was identified in 1984 in brain plaques of patients with AD, and hyperphosphorylated τ protein was identified in 1986. These are true AD markers; possible culprits behind neuronal death and memory impairment....
In the trenches of Alzheimer research, the battle continues . . . but where do we stand? Is the war on AD dementia nearing conclusion, or are we simply in the initial throes of the fight? In interviews with Psychiatric Times, 3 AD experts, Murali Doraiswamy, MD, of Duke Medicine; James Lah, MD, PhD, of Emory University; and Dagmar Ringe, PhD, of Brandeis University weighed in on this important topic."
To read the full article, you can register with the publication on-line, free of charge.
Friday, June 13, 2014
Dedham, Massachusetts, established as a town in 1636 just to the west and south of Boston, has a long history, including an interesting early debate on governance, as suggested by one protest. According to historian and University of Chicago Law School Professor Geoffrey R. Stone, a group of local Dedham citizens erected a "liberty pole" in protest of the evils of the Federalist government, with a placard reading:
"No Stamp Act, No Sedition Act, No Alien Bills, No Land Tax, downfall to the Tyrants of America; peace and retirement to the President; Long-Live the Vice President."
Wishing "happy retirement" to the then-president, John Adams, was not a message of good will or appreciation.
In light of this history, a modern debate in Dedham caught my eye, involving opposition to construction of a senior living community in a residential neighborhood of that town. As reported in a local Dedham news source:
"'Can you imagine waking up in the morning … there’s a house next door with 72 people in it with a very large staff and a whole lot of friends visiting?' Paul Reynolds said at a May 13 Dedham Zoning Board of Appeals meeting. 'If it could happen in this neighborhood where we can change the rules and change the definition of what single family is, where else could that happen?'
Artis Senior Living officials applied a month ago for a special permit that would allow the company to build an Alzheimer's and dementia care facility at 255 and 303 West Street—two residential properties on 7.71 acres that include conservation land. The ZBA decided to continue the hearing after several precinct one residents objected.
The Virginia-based company had initially proposed to build a 37,000 square foot, single story facility and about 21 feet tall. However, representatives presented a slightly different footprint last week after the board and residents raised concerns regarding the size of the property at an April 22 meeting."
In deference to the opposition, the developers changed the design, from a one story complex to a two story building centered on the 7 acre plot, thus allowing a greater buffer zone of more than 300 feet (that's a football field, right?) between the buildings and any of the closest neighbors.
The protests apparently continue, however, thus demonstrating that in additon to opposing prisons and half-way houses for drug treatment, Not-In-My-Back-Yard" or NIMBY movements can target seniors. John Adams would appreciate the history, perhaps.
Sunday, June 8, 2014
During an upcoming television broadcast of CBS Sunday Morning on June 15, popular model, restaurant owner and chef B. Smith will talk about her diagnosis -- and early attempts to hide -- her Alzheimer's disease. Even now she is just age 64. Based on a clip from the program, it appears that the discussion of the medical facts behind this illness will be frank and educational.
Monday, June 2, 2014
We've written here about the high profile Mancini case of alleged assisted suicide here in Pennsylvania, that was resolved in 2014 when the trial court dismissed the charges pending against the daughter, a nurse, who was alleged to have facilitated her ill, elderly father's death by a morphine overdose.
Charges have now been filed in another Pennsylvania case that is, perhaps even more troubling, although probably less likely to attract support from "death with dignity" movements. The case does, however, raise important questions about both mental health and income supports for persons at risk, including those facing poverty.
Last week, Koustantinos "Gus" Yiambilisis, age 30, from Bucks County, PA, was charged both with assisted suicide and homicide for the death of his 59 year old mother by carbon monoxide, following his alleged use of a borrowed generator to accomplish a mutual suicide pact. News reports, including articles by Jo Ciavaglia for the Bucks County Courier Times, suggest that the son had recently lost his job and needed surgery for a brain tumor, while both mother and son are reported to have left suicide notes behind. The son survived, revived after emergency workers summoned to the house found the mother and son unconscious in the home. The mother later died in the hospital.
Sunday, June 1, 2014
The Minensota DHS says that it is actively working to implement the plan and other mandates of the federal court, including departmentwide training on the agreement and plan.
The Jensen Settlement Agreement, approved Dec. 5, 2011, allowed the department and the plaintifs to resolve the claims in a mutually agreeable manner.
More information is on the Jensen Settlement page on DHS' website.
Friday, May 30, 2014
A huge theme at the 3rd World Congress on Guardianship was supported decision-making. I was pleased and suprised to find this in my mailbox this morning:
ACL Funding Opportunity: Supported Decision Making
The purpose of this project is to create a training and technical assistance/resource center on supported decision making. The Center will collect and disseminate materials on supported decision-making, including the experiences of people with intellectual and developmental disabilities (I/DD) in making informed decisions with the use of supports. The project will also include a proposal to develop measures to compare outcomes for people with I/DD and older Americans who use supported decision-making methods and practices to exert control and choice in their own lives compared with outcomes for individuals under substituted decision-making arrangements.
Deadline: Electronically submitted applications must be submitted no later than July 2, 2014 at 11:59 p.m.
Click here to download additional information including the application package.
Thursday, May 29, 2014
Asst. Sec. on Aging Kathy Greenlee helped to kick off the 3d World Congress on Adult Guardianship with truly one of the most powerful speeches on valuing our seniors that I have ever heard. Greenlee spoke of the danger of trivializing the lives of the elderly, especially those with advanced dementia, reminding us that the loss of memory does not equal the loss of self. I wish I had recorded her speech, but thankfully, it will be published later this year in Stetson's Journal of International Law & Aging Policy. Stay tuned for more reports on the Congress from your intrepid reporters, Kim Dayton and Becky Morgan!
Tuesday, May 20, 2014
In Doe v. South Carolina Department of Social Services, the state's Supreme Court analyzes the standards for state intervention to provide involuntary protective services on the grounds the individual is a "vulnerable adult" under South Carolina's statutory authority. In a 3 to 2 decision filed on April 30, 2014, the majority of the court Court concludes:
"Although we believe the family court was well intentioned, we find that it erred in classifying Doe as a vulnerable adult under the Act. Specifically, there was no evidence that Doe's advanced age impaired her ability to adequately provide for her own care and protection. Without this threshold determination, the court erred in ordering Doe to remain in protective custody until the identified protective services were completed."
The dissent finds the majority's reasoning too narrow, pointing to the following facts:
"On July 31, 2012, law enforcement officers went to the home of Doe, then age 86. Doe, suffering from a heart condition, lived alone. Doe refused entry to the officers. The doors and windows to the home were barricaded. The officers noticed a hose running from a neighbor's home through a hole in the roof of Doe's home. This was Doe's only source of water, for water service had been stopped for nonpayment. The inside of the home was, according to the officers, 'in an unsanitary and deplorable condition.' There was mold present as well."
The outcome of the case is influenced by the testimony of a physician, who despite the conditions of the home and the physical infirmities of Doe, observed that she "appeared to have 'the minimum levels of competency to function independently' as there was no evidence of dementia, severe emotional issues, or obvious physical limitations." Doe was apparently either without adequate financial resoures or unable to manage her resources to live more safely in the home, but she firmly rejected the alternative of transfer to another setting.
Although overruling the trial court's conclusion that Doe was a vulnerable adult, the Superme Court also remanded for additional findings of the current status of Doe, who received emergency services in the interim.
Tough facts that demonstrate the challenge of balancing safety for persons at risk of "self neglect" with respect for the autonomy of the individual, a challenge that can arise at any age. Poverty adds to the challenge.
Monday, May 19, 2014
Casey Kasem, Mickey Rooney, Brooke Astor. High profile, recent examples of tough times for aging individuals. For lawyers, their histories demonstrate the challenges of planning. Lawyers juggle tough questions about how to handle waning capacity and respect an individual's preferences, while recognizing the probable need for safety and quality care. Add to this the reality that family members are often involved directly and indirectly. We hope everyone agrees and is well intentioned, but, there are no guarantees.
Texas Elder Law Attorney Renee Lovelace has a very good article from a few years ago, using another high profile example of the challenges of planning. She writes about economist and statistician Mollie Orshansky who passed away in 2006 at the age of 91. Orshanky's name has been in the news again recently because of renewed discussion of the "poverty thresholds" she articulated in the 1960s and which are still used (probably irrationally) as a measurement tool for public benefits.
In her later years, Orshansky was at the center of a dispute about care that might be in her "best interest" but that also might be inconsistent with her expressed wishes. In "Working with Elder Clients Who Refuse Help," (Texas Bar Journal, February 2008, available as downloadable PDF from archives), Renee writes:
"But when Ms. Orshansky needed assistance, she rejected help from family. She was hospitalized, and the court, critical of the family for not preventing her decline, appointed a nonfamily guardian. The resulting saga included an interstate guardianship battle, allegations of family kidnapping, a riveting series of Washington Post articles and Senate Committee hearings. While Mollie's story may be movie-worthy, it is alarming to realize that she did everything that we suggest clients do to plan ahead — and her case still had a disastrous result."
Lovelace identifies several key points to keep in mind when helping clients to plan ahead, including the importance of "the talk" with family members. She discusses the possibility of building in monitoring options, while also recognizing the potential for even the best intentioned caretaker or agent to make mistakes. She talks realistically about the need for balance between "people, paper and money."
What are other techniques and approaches -- more than just documents and legal advice -- that seasoned lawyers use to avoid these kinds of disputes? Feel free to add your "comments."
Wednesday, May 14, 2014
It occurs to me that what I'm about to write here is a mini-review of a mini-book. Slightly complicating this little task is the fact that I count both authors as friends and mentors.
The latest edition of Elder Law in a Nutshell by Professors Lawrence Frolik (University of Pittsburgh) and Richard Kaplan (University of Illinois) arrived on my desk earlier this month. (As Becky might remind us, both are definitely Elder Law's "rock stars.") And as with fine wine, this book, now its 6th edition, becomes more valuable with age. This is true even though achieving the right balance of simplicity and detail cannot be an easy task for authors in the intentionally brief "Nutshell" series. Presented in the book are introductions to the following core topics:
- Ethical Considerations in Dealing with Older Clients
- Health Care Decision Making
- Medicare and Medigap
- Long-Term Care Insurance
- Nursing Homes, Board and Care Homes, and Assisted Living Facilities
- Housing Alternatives & Options (including Reverse Mortgages)
- Alternatives to Guardianship (including Powers of Attorneys, Joint Accounts and Revocable Trusts)
- Social Security Benefits
- Supplemental Security Income
- Veterans' Benefits
- Pension Plans
- Age Discrimination in Employment
- Elder Abuse and Neglect
The authors describe their anticipated audience, including "lawyers and law students needing an overview of some particular subject, social workers, certain medical personnel, gerontologists, retirement planners and the like." Curiously, they don't mention potential clients, including family members of older persons. I suspect the book can and does assist prospective clients in thinking about when and why an "elder law specialist" would be an appropriate choice for consultation. This book is a very good starting place.
What's missing from the overview? Not a lot, although I find it interesting that despite solid coverage of the basics of Medicaid, and even though it is unrealistic to expect exhaustive coverage in a mini-book, the authors do not hint at the bread and butter of many elder law specialists, i.e., Medicaid Planning. Thus, there's little mention of some of the more cutting edge (and therefore potentially controversial) planning techniques used to create Medicaid eligibility for an individual's long-term care while also preserving assets that otherwise would have to be spent down.
Modern approaches, depending on the state, may range from the simple, such as permitted use of assets to purchase a better replacement auto, to more complex planning, as in states that permit purchase of spousal annuities or use of promissory notes, allow modest half-a-loaf gifting, or recognize spousal refusal. Even though the federal Deficit Reduction Act of 2005 succeeded in restricting assets transfers to non-spouse family members, families, especially if there is a community spouse, may still have viable options. Without appropriate planning the community spouse, particularly a younger spouse, may be in a tough spot if forced to spend down to the "maximum" permitted to be retained, currently less than $120,000 (in, for example, Pennsylvania). See, for example, a thoughtful discussion of planning options, written by Elder Law practitioners Julian Gray and Frank Petrich.
Perhaps the Nutshell omission is a reflection of the unease some who teach Elder Law may feel about the public impact of private Medicaid planning?
May 14, 2014 in Advance Directives/End-of-Life, Books, Cognitive Impairment, Dementia/Alzheimer’s, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Medicare, Property Management, Social Security | Permalink | Comments (0) | TrackBack (0)
Monday, May 12, 2014
Risks of Hearing Loss in Our Aging Population
MGS and MAGEC Free Webinar
Wednesday, May 21, 2014
Noon to 1 PM CDT
Research out of Johns Hopkins Medical Center is showing a correlation between hearing loss, falls, and dementia in people over the age of 50. People in this age group who have a hearing loss, are at higher risk for falls and for dementia. And not only is the risk higher for the onset of dementia, but also for a faster decline in functioning.
This information has implications for quality of life, demand for assisted living and/or skilled nursing care, and for healthcare costs. Given these implications, are there actions that can be taken to counteract these risks?
The Minnesota Gerontological Association and the Minnesot Association for Guardiansip and Conservatorship are offering a free Webinar on” Risks of Hearing Loss in Our Aging Population.” This session will explore the research in this area and discuss some potential solutions.
Marty Barnum CSC, MA, currently works as a consultant and an interpreter. She recently spent a year with the Office of Ombudsman for Long-Term Care under a special contract to look at the needs of nursing home residents with hearing loss.
Ms. Barnum previously coordinated interpreter services for the state of Minnesota, taught at St. Catherine University, and provided advocacy services for Deaf, hard-of-hearing and deafblind people in medical and legal situations.
Note: MGS has upgraded to the "Go to Webinar" platform for this webinar. You can now listen and watch through your computer, IPad, tablet or smart phone.
Register for this free webinar
Download the flyer
MGS and MAGEC Free Webinar
Wednesday, May 21, 2014
Noon to 1 PM CDT
Thursday, May 8, 2014
Via the Alzheimer's Association:
Congress unanimously passed the bipartisan National Alzheimer’s Project Act (P.L. 111-375) in 2010. The law instructs the Department of Health and Human Services (HHS) to develop a strategic plan to address the rapidly escalating Alzheimer’s disease crisis. The annually updated National Alzheimer’s Plan must be transmitted to Congress each year and is to include outcome-driven objectives, recommendations for priority actions and coordination of all federally funded programs in Alzheimer’s disease research, care and services. The plan also includes the goal of effectively treating and preventing Alzheimer’s by 2025.
The one missing piece in this plan is a projection of the level of funding necessary to reach the critical goal of effectively treating and preventing Alzheimer’s by 2025. The Alzheimer’s Accountability Act represents a bipartisan effort to ensure that Congress is equipped with the best possible information to set funding priorities and reach the goal of the National Plan to Address Alzheimer’s Disease - effectively preventing and treating Alzheimer’s by 2025.
Wednesday, May 7, 2014
Via the BBC:
Businesses must become more dementia-friendly and support employees who care for loved ones with dementia, the British government says. With dementia affecting nearly 700,000 people in England alone, thousands of working friends and relatives end up taking on the role of carer. In 2014, 50,000 carers will have quit their job and 66,000 more will have to make adjustments at work, says Public Health England. It is launching an awareness campaign. The Dementia Friends initiative aims to show it will take a whole-society response to enable people with the condition to live well. To become a friend, individuals watch a short online film, which explains what dementia is, how it affects individuals and what people can do to help those living with the disease.
The average person diagnosed with dementia has been in their current job for at least nine years. Inevitably, many individuals affected while still working will have to take early retirement at some point. However, with support from employers, they may be able to keep working for longer, says the Alzheimer's Society.
Monday, May 5, 2014
In an article for the May issue of the Journal of Gerontology (Series B: Psychological Sciences), a team of international researchers present a report on "Benefits of Having Friends in Older Ages: Different Effects of Informal Social Activities on Well-Being in Middle-Aged and Older Adults." The article is technical, but the implications and conclusions of their research are persuasive. It seems that having "friends" is more important to life satisfaction for older adults than it is for middle-aged adults. And their research points to the importance of friendships rather than "just" relationships with spouses and children. The authors conclude:
"Our results have strong implications for mental health promotion in older adults, as they suggest supporting older adults in building and maintaining friend-based social networks, for example, by encouraging volunteering in old age in elder-helping-elder programs . . . or programs aiming at increasing informal social interactions, such as cultural programs, . . . university programs, . . . or occupational therapy programs."
I suspect that one potential limitation of the study may be the difficulty in measuring whether a lowered feeling of "life satisfaction" is actually a trigger for withdrawal from friends and friendship-based activities, rather than being simply an outcome of not being engaged with friends. The "chicken or egg" question of cause and effect? Nonetheless, the research does underscore the potential importance of engagement in increasing the long-range potential for positive feelings and mood. So call up your friends and invite them on an outing; don't wait for them to call you.
Thursday, May 1, 2014
In the April 28 issue of The New Yorker magazine, Michael Kinsley offers a great piece, entitled "Have You Lost Your Mind?" At first I thought the article was just a well written but not very surprising prediction about the looming "tsunami" of aging baby boomers. Good research, interesting tidbits of medical fact, sharp-edged moments of social commentary and nice touches of humor. Kinsley writes, for example:
"I predicted [a few years ago] that the ultimate boomer rat race would be the competition to live the longest.... But, on further reflection, I think I underrated the penultimate boomer competition: competitive cognition. The rules are simple: the winner is whoever dies with more of his or her marbles."
But then the article gets serious, and seriously interesting. The author reveals he was diagnosed twenty years ago with Parkinson's disease (PD) at the age of 43. That's when I, as a reader, noticed that the article was subtitled "Personal History." For the last twenty years, Kinsley has had time and reason to think about the potential consequences of PD, not just for his body, but his mind. He thoughtfully explores cognitive defects that can accompany PD, and which can be progressive.
With facts, anecdotes and his own worry-driven research, Kinsley explains that not all dementias are about loss of memory:
"[A] difference between Alzheimer's and Parkinson's is that Alzheimer's tends to starts its destruction in the parts of the brain affecting memory, whereas Parkinson's starts with what they call the executive function: analyzing a situation and your options and making a decision."
Ultimately, even though he isn't having any symptoms he can identify as PD-related cognition problems, Kinsley bites the bullet and decides, as he puts it, to have his "brain tested." Bottom line (and, really, his entire article is absolutely worth reading so I'm being unfair in skipping to the bottom line), although he scored exceptionally well on intelligence and "cognitive reserve" (meaning memory), in fact the test identified very real deficits in executive function.
Now remember, the article is funny and, in many ways, brilliant. This guy is functioning at a very high level. But there's a message here, including a possible message for families and lawyers.
As I read the article, I was remembering a conversation with someone who was asking me about alternatives under the law because he was worried about a family member. In his explanation, at first he focused on the possibility of a memory problem, then instances of unexplainable mood changes, and then, finally, he gave me specific examples of what could be described as impairments in the loved one's "executive function."
At what point -- especially if Kinsley and others are right about the looming tsunami of baby boomers with dementia -- do lawyers need to be much more sensitive to and skilled in the subtleties of impaired "executive function?" Does our tendency to focus on the presence or absence of "memory problems" gloss over the biological explanations for a client's odd gifting decision? I wonder how many lawyers would think to ask about Parkinson's disease, even if they witnessed a tremor or shake? Do they therefore fail to ask appropriate questions of the "intelligent" client with the "clear" memory about the reasons for trusting a new "befriender" while becoming estranged from long-standing family or friends? Admittedly, I'm taking Kinsley's analysis one or two steps further.
As he winds to a close in his piece, Kinsley suggests the need for greater appreciation of age-related neurological disorders, observing: "[W]eaknesses can be overcome, to some extent, by strengths somewhere else.... We are comfortable with the idea that physical health is not just a single number but a multiplicity of factors. That's where we need to arrive about mental problems. As we get older, we're all going to lose a few of our marbles."
Wednesday, April 30, 2014
Another book recommendation, courtesy of my Penn State colleague, neuropsychologist Claire Flaherty. The book is "The Banana Lady and Other Stories of Curious Behavior and Speech," by Andrew Kurtisz and first published in 2006. Professor Flaherty accompanied this recommendation with the note that the book presents "truth is stranger than fiction" tales of changes in personality, behaviors and relationships, including the gradual loss of language that can occur even in one's "middle" ages.
The author's bio is also interesting:
Dr. Andrew Kertesz is professor of Neurology in the Department of Clinical Neurological Sciences at the University of Western Ontario. He is Director of Cognitive Neurology and Alzheimer's Research Centre at St. Joseph's Health Care London and former Chief of the Department of Neurology. He graduated from Queen's University in Kingston, Ontario, studied neurology in Toronto, and behavioral neurology in Boston. His publications deal with the classification, localization and recovery in aphasia, as well as alexia, apraxia, visual agnosia and dementia. His books include Aphasia and Associated Disorders by Grune and Stratton (1979), Localization and Neuroimaging in Neuropsychology by Academic press (1994), and his most recent book, co-authored by Dr. David Munoz, is entitled, Pick's Disease and Pick Complex by Wiley-Liss Inc. (1998). Recent research projects are the experimental treatment of Alzheimer's disease, mild cognitive impairment, vascular dementia, primary progressive aphasia, and frontotemoral dementia. He has standardized a Frontal Behavioral Inventory for the diagnosis of Frontotemporal dementia and is active in clinical trials.
Thanks, Claire, for helping to keep our summer reading lists well filled.
Friday, April 25, 2014
Chicago-Kent Law Professor Alexander A. Boni-Saenz shared a copy of his law review article, "Personal Delegations," published recently in the Brooklyn Law Review. Here is an intriguing excerpt from the introduction, minus the footnotes:
"Donald and Gloria Luster married on October 5, 1963 and had four children. Donald retired in 2005, and it was about this time when Jeannine Childree, his youngest daughter and a registered nurse, noticed that he was exhibiting signs of dementia. After a number of consultations with doctors, Donald was officially diagnosed with Alzheimer's disease in 2009 due to his memory loss, disorientation, and other cognitive impairments. Based on these medical evaluations, a Connecticut probate court declared Donald incapable of handling his personal or financial affairs and appointed Jeannine and his other daughter, Jennifer Dearborn, as his guardians. Shortly thereafter, Gloria filed for a legal separation from Donald, and in response, the daughters counterclaimed for divorce, suspecting their mother of financial and emotional abuse. Should the guardian-daughters have the authority to sue for divorce on behalf of their father?"
The author then offers a second fact pattern, involving a man serving as agent for his incapacitated brother under a power of attorney, asking whether the agent should have "authority to execute a will on his brother's behalf," where only a small percentage would be left to the brother's biological child.
Professor Boni-Saenz suggests that the numbers of people lacking "decisional capacitiy" are in the millions and "will only increase with an aging population." This likelihood "presents many difficult questions" while also creating "an opportunity to rethink and reevaluate how the law treats people with cognitive impairments." He then introduces his "personal delegation" thesis, in support of giving greater deference to agents in certain circumstances, permitting them to make binding decisions that might otherwise be questioned under what he outlines as a bias or presumption in current law:
"The central claim of this article is that in the case of decisional incapacity, decisions that implicate fundamental human capabilities should generally be delegable. Thus, it rejects the rationale employed by courts to justify nondelegation--that these types of decisions are too personal to be made by another. This line of reasoning confuses nondelegation for nondecision, and it only serves to privilege a status quo outcome over the expression of fundamental human capabilities by individuals with cognitive impairments."
The full article is easily available on SSRN and on Professor Boni-Saenz' faculty web page, linked above.
April 25, 2014 in Cognitive Impairment, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, State Cases, State Statutes/Regulations | Permalink | Comments (0) | TrackBack (0)
Thursday, April 24, 2014
My Penn State colleague from Hershey Medical Center, Dr. Claire Flaherty, has shared with me a another fascinating resource, "What If It's Not Alzheimer's?: A Caregiver's Guide to Dementia," by Gary Radin and Lisa Radin.
The first chapter provides "The ABCs of Neurodegenerative Dementias," including frontotemporal dementia (FTD), Lewy Body Dementia, vascular dementia, as well as Alzheimer's Disease. Key chapters including "finding the A Team" of specialists, and a guide to therapeutic interventions.
The book reminds us that with some forms of dementia, particularly early onset dementias such as FTD, changes in personality or executive function may be the first signs, and easily misunderstood. For example, the individual may manifest:
- hypersexuality, including promiscuous sexual encounters with strangers; or
- apathy or indifference to grooming and hygiene; or
- "hyperorality" with disinhibited consumption of large amounts of food; or
- poor judgment with a lack of sense of consequences, sometimes coupled with poor impulse control
One chapter is unique, emphasizing the potential importance, after death, of an autopsy of the brain, and thus providing families with a way to contribute to biomedical research and the hope for better answers in the future.
Wednesday, April 23, 2014
On April 24, I have the good fortune to be working with a neuropsychologist from the neurology department at Penn State Hershey Medical Center in presenting a program on "Dementia Diagnosis and the Law," for a meeting of the Estate Planning Council in York, Pennsylvania. Professor Claire Flaherty and I have "traded" presentations in the past, with her speaking at the law school and me speaking at the medical school, but this will be our first time presenting together. We're excited.
One of the important lessons that I've learned in working with Claire is the clear potential for cognitive impairment to exist without the "usual" symptoms associated with "Alzheimer's." For example, much of Claire's work is with patients and families coping with early onset dementias. Because Frontotemporal Dementia or FTD (sometimes also referred to as Frontotemporal Lobar Degeneration or FTLD) can begin to manifest in persons aged 45 to 64 years, the onset may be overlooked or misunderstood. Plus, as Claire reminds me, "FTD is primarily a disease of behavior and language dysfunction, while the hallmark of Alzheimer's Disease is loss of memory."
For legal professionals, including those asked to prepare deed transfers, wills or estate planning documents, the potential for subtle presentations of cognitive impairment can be especially significant. Making sure the client is oriented as to "time, place and person" may not be enough to address the potential for loss of judgment, thus opening the door for unusual gifts, risky financial decisions or even of adamant rejection of once trusted family members.
A good place to turn for information about early onset forms of dementia, including FTD, is the Association for Frontotemporal Degeneration or AFTD -- or join us for the York Estate Planning Council meeting this week.