Monday, August 1, 2016

New Scholarship: Can Adults, including Older Adults, Give Advance Consent to Sexual Relations?

As some readers may recall, last year we reported on the emotionally fraught criminal trial in Iowa for a former state legislator, who was ultimately acquitted of sexual assault of his wife.  The allegations arose in the context of alleged sexual relations with his wife after she was admitted to a nursing home.  

Assistant Professor of Law Alexander A. Boni-Saenz, from Chicago Kent College of Law, has drawn upon this case and others to further explore his proposals for "advance directives" whereby adults could specify their decisions in advance of incapacity.  Alex's latest article, Sexual Advance Directives, forthcoming in the Alabama Law Review, is available on SSRN here.   From the abstract:

Can one consent to sex in advance? Scholars have neglected the temporal dimension of sexual consent, and this theoretical gap has significant practical implications. With the aging of the population, more and more people will be living for extended periods of time with cognitive impairments that deprive them of the legal capacity to consent to sex. However, they may still manifest sexual desire, so consenting prospectively to sex in this context serves several purposes. These include protecting long-term sexual partners from prosecution by the state, ensuring sexually fulfilled lives for their future disabled selves, or preserving important sexual identities or relationships. The law currently provides a device for prospective decision-making in the face of incapacity: the advance directive.


The central claim of this article is that the law should recognize sexual advance directives. In other words, people facing both chronic conditions that threaten their legal capacity to make decisions and institutional care that threatens sexual self-determination should be able to consent prospectively to sex or empower an agent to make decisions about sex on their behalf. To justify this claim, the Article introduces a novel theory of sexual consent—the consensus of consents—that diffuses the longstanding philosophical debates over whether advance directives should be legally enforceable. With this normative foundation, the Article then draws on insights from criminal law, fiduciary law, and the law of wills to fashion a workable regime of sexual advance directives that adequately protects individuals from the risk of sexual abuse. 

Alex is a thoughtful writer on challenging topics, often looking at the intersection of health care, estate law and elder law planning.

August 1, 2016 in Advance Directives/End-of-Life, Cognitive Impairment, Crimes, Dementia/Alzheimer’s, Estates and Trusts, Ethical Issues | Permalink | Comments (1)

Tuesday, July 26, 2016

Are Certain Professionals, including Lawyers, Less at Risk for Cognitive Decline?

The Washington Post published an interesting article reporting on the recent Alzheimer's Association International Conference in Toronto.  According to the article, 

Two studies looked at how complex work and social engagement counteract the effects of unhealthy diet and cerebrovascular disease on cognition. One found that while a “Western” diet (characterized by red and processed meats, white bread, potatoes, pre-packaged foods, and sweets) is associated with cognitive decline, people who ate such food could offset the negative effects and experienced less cognitive decline if they also had a mentally stimulating lifestyle.


Occupations that afforded the highest levels of protections included lawyer, teacher, social worker, engineer and doctor; the fewest protections were seen among people who held jobs such as laborer, cashier, grocery shelf stocker, and machine operator.


“You can never totally forget about the importance of a good diet, but in terms of your risk of dementia, you are better able to accommodate some of the brain damage that is associated with consuming this kind of (unhealthy) diet,” said Matthew Parrott, a post-doctoral fellow at the Rotman Research Institute in Toronto, who presented the study.


In another study, researchers found that people with increased white matter hyperintensities (WMHs) – white spots that appear on brain scans and are commonly associated with Alzheimer’s and cognitive decline – were able to better tolerate WMH-related damage if they worked primarily with other people rather than with things or data.

For more of the intriguing findings, read "Complex Jobs and Social Ties Appear to Help Ward Off Alzheimer's, New Research Shows."  


July 26, 2016 in Cognitive Impairment, Dementia/Alzheimer’s, Health Care/Long Term Care, Retirement, Science | Permalink | Comments (0)

Monday, July 18, 2016

Coach Pat Summitt

We were all saddened at the news of  Coach Pat Summit's death from early-onset Alzheimer's at the age of 64.  I found this article in the Washington Post  so moving that I wanted to share it with you. You should read it and encourage your students to read it as well.  Pat Summitt’s last great gift was sharing her fight with Alzheimer’s is more than just a tribute to Coach Summitt. It's also a call-out on how we treat people with cognitive decline and how we need to improve our actions.  Here's an excerpt from the article:

Pat was just one of four people I know with dementia, and from what I’ve seen, across the board, Alzheimer’s care is a national scandal in our midst, yet few are willing to address it, because it’s just too distressing.

When a friend or family member is diagnosed, this is what you quickly learn: Once-brilliant people who still have vast reserves of brain cells are discounted, forced into retirement, and many are warehoused in facilities where the food is patently awful and the most meaningful activity is bingo. And we wonder why they decline so swiftly. Their care is infantilizing and schedule-oriented, with full-grown adults fed at 6 and forced to bed at 8, and when they can’t communicate as they used to we lack the imagination to try to find other ways to reach them, so their pain or discomfort often goes unaddressed, leading to interactions that, as Stettinius says, “exhaust, frustrate, and deplete everyone involved.” Creative new forms of care that can enhance quality of life — art, poetry, music and animal therapies for Alzheimer’s patients — are the rare exception. Ignorance about the disease is the rule. We give lip service to preserving dignity but devote precious little thought to the fact that the quickest way to rob someone of that dignity is to tell them what time to go to bed.

Use this in class for a discussion on how to support an individual's autonomy and how we can do better for people with Alzheimer's.


July 18, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s | Permalink | Comments (1)

Tuesday, July 5, 2016

Will Mandatory Retirement Come to the Medical Profession?

Modern Healthcare ran an article that got me thinking about whether we will see mandatory retirement being applied to the certain doctors. More hospitals screen aging surgeons to make sure their skills are still sharp was published on June 11, 2016. The article starts with relating the story of  one facility and a 79 year old surgeon returning to work after some health problems. The facility had concerns but the article notes, "[t]hey had few tools at their disposal, though. Hospital policy limited interventions to clinicians who had made medical mistakes. [The surgeon] had never had an adverse event with a patient under his care." The chief of surgery at this hospital suggested a program from "Maryland that provides cognitive and physical examinations for aging surgeons."

We all know that conversations with someone about their diminished abilities are very difficult to have. The article offers a nod to that. Everyone is living longer, even doctors, and  longevity along with "[a]dvances in medicine, personal wellness and public health, along with the desire to preserve a sense of purpose and their lifelong identity, have led many to work well beyond traditional retirement age."  Some facilities are developing policies to evaluate their continued practice of medicine, "policies that require clinicians of a certain age to undergo physical, cognitive and clinical testing. Those programs have been met with ire by career practitioners, who argue that age is just a number. Doctors—no matter what their age—already must renew their medical licenses at regular intervals with state medical boards."  Critics note that renewals of licenses don't test "for age-related cognitive and physical decline that could harm the quality of care provided to patients." (does this debate sound familiar to anyone?)

The article then moves into a discussion of the ADEA and mandatory retirement and whether mandatory retirement should be applied to doctors. The American Medical Association (AMA) issued a report in 2015 on age-related declines with clinicians and is working on the beginnings of "research opportunities to inform preliminary guidelines for assessing senior and late-career physicians." This year the American College of Surgeons (ACS) "recommended that surgical specialists undergo voluntary and confidential baseline physical examinations at regular intervals starting between ages 65 and 70."

The article notes that some health care facilities have instituted their own requirements. "The policies vary in terms of the ages at which clinicians begin screening and what the exams require. Some call for clinicians to complete clinical skill and physical health screening every couple of years. Others require a more controversial cognitive test, which the AMA is leery of supporting." There is no uniformity yet with these programs. As far as the doctor at the beginning of the article? He did go through a program and passed. The surgeon "did recently decide to shift some of his responsibilities and now spends more time on training and education with another physician taking the role of chief of vascular surgery.  [The surgeon] also became an advocate who encourages his colleagues to consider it."

July 5, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Health Care/Long Term Care, Retirement | Permalink | Comments (0)

Wednesday, June 22, 2016

Good News on the Alzheimer's Front?

Two recent articles made me think that progress is being made in the fight against Alzheimer's.  First I ran into an article in the Chicago Tribune on May 25, 2016 from a Harvard Health Blog postDecline in Dementia Rate Offers 'Cautious Hope' details a recent report from the New England Journal of Medicine (NEJM), Incidence of Dementia over Three Decades in the Framingham Heart Study which we blogged about on February 23, 2016. After discussing the study and its results, the article turns to the question of whether dementia can be prevented:

As the Alzheimer's Association predicts, the numbers of people with dementia may ultimately increase simply because people are living longer. At the same time, the Framingham researchers offer "cautious hope that some cases of dementia may be prevented or at least delayed."

The Framingham results bolster the notion that what's good for the heart is good for the head. If you're pursuing a heart-healthy lifestyle -- following a Mediterranean-style diet, getting the equivalent of 150 minutes of moderate exercise a week, managing your stress, and engaging with friends and family -- you're likely lowering your risk of dementia in the bargain, too.

The other article also ran on May 25, 2016, this one in the New York Times.  It posits an intriguing question: Could Alzheimer’s Stem From Infections? It Makes Sense, Experts SayThe article references a recent study by Harvard researchers,  Amyloid-β peptide protects against microbial infection in mouse and worm models of Alzheimer’s disease the results of which was published in Science Translational Medicine. The abstract is available here but the full article requires registration.

Here is how the study results are explained in the Times article

The Harvard researchers report a scenario seemingly out of science fiction. A virus, fungus or bacterium gets into the brain, passing through a membrane — the blood-brain barrier — that becomes leaky as people age. The brain’s defense system rushes in to stop the invader by making a sticky cage out of proteins, called beta amyloid. The microbe, like a fly in a spider web, becomes trapped in the cage and dies. What is left behind is the cage — a plaque that is the hallmark of Alzheimer’s.

The article provides a fascinating recap of how the researchers got to this point and notes that "[r]ecent data suggests that the incidence of dementia is decreasing. It could be because of better control of blood pressure and cholesterol levels, staving off ministrokes that can cause dementia. But could a decline in infections also be part of the picture?" The article concludes describing the next steps in this research.

So, good news on the Alzheimer's front? You decide. (I vote yes).

June 22, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care | Permalink | Comments (0)

Tuesday, June 21, 2016

New Concepts from Authorities Who Investigate and Prosecute Scammers and Financial Abusers

On June 15,  I logged into the National Consumer Law Center's webinar on Financial Frauds and Scams Against Elders.  It was very good.  Both David Kirkman, who is with the Consumer Protection Division for North Carolina Department of Justice, and Naomi Karp, who is with the federal Consumer Financial Protection Bureau, had the latest information on scamming trends, enforcement issues, and best practices to avoid financial exploitation.  Here were some of the "take away" messages I heard:

  • "Age 78" -- why might that be important?  Apparently many of the organized scammers, such as the off-shore sweepstakes and lottery scams, know that by the time the average consumer reaches the age 78, there a significant chance that the consumer will have cognitive changes that make him or her more susceptible to the scammer's "pitch."  As David explained, based on 5 years of enforcement data from North Carolina, "mild cognitive impairment"  creates the "happy hunting ground" for the scammer.
  • "I make 'em feel like they are Somebody again."  That's how one scammer explained and rationalized his approach to older adults.  By offering them that chance to make "the deal," to invest in theoretically profitable ventures, to be engaged in important financial transactions, he's making them feel important once again.  That "reaction" by the older  consumer also complicates efforts to terminate the scamming relationship. David played a brief excerpt of an interview with an older woman, who once confronted with the reality of a so-called Jamaican sweepstakes lottery, seemed to make a firm promise "not to send any more money."  Yet, three days later, she sent off another $800, and lost a total of some $92k to the scammers in two years.
  • "Psychological reactives."   That's what David described as a phenomenon that can occur where the victim of the scam continues to play into the scam because the scammer is offering the victim praise and validation, while a family member or law enforcement official trying to dissuade the victim from continuing with the scam makes him or her feel "at fault" or "foolish."   An indirect, oblique approach may be necessary to help the victim understand.  One strategy to offset the unhelpful psychological reaction was to show the victim how he or she may help others to avoid serious financial losses. 
  • "Financial Institutions are increasingly part of the solution."  According to Naomi, about half of all states now mandate reporting of suspected financial abuse, either by making banks and credit unions mandatory reporters or  by making "all individuals" who suspect such fraud mandatory reporters.  Both David and Naomi said they are starting to see real results from mandatory reporters who have helped to thwart fraudsters and thereby have prevented additional losses.

The federal Consumer Financial Protection Bureau has several publications that offer educational materials to targeted audiences about financial abuse.  One example was the CFPB's 44-page manual for assisted living and nursing facilities, titled "Protecting Residents from Financial Exploitation." 

June 21, 2016 in Books, Cognitive Impairment, Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Statutes/Regulations, State Cases, State Statutes/Regulations, Webinars | Permalink | Comments (2)

Estate Planning Lessons from the Redstone Saga?

We've previously blogged about the happenings in the case and life of Sumner Redstone. Although one lawsuit was dismissed, it doesn't appear that is the end of the matter. The New York Times ran an article on June 2, 2016, In Sumner Redstone Affair, His Decline Upends Estate Planning. Although the focus of the story is Mr. Redstone's situation, the story notes that this happens perhaps more than we think.

As Americans live longer and more families are forced to cope with common late-in-life issues like dementia, the problem is getting worse. “It’s a huge issue nationally as the elderly population grows and their minds start to falter,” [one attorney interviewed for the story] said. “I’ve seen charities coming after people for multiple gifts: Sometimes these donors don’t remember that they already gave the previous week. Romantic partners, caregivers who take advantage of the elderly — we’re seeing it all.”

Elderly people may be especially susceptible to the influence of people who happen to be around them during their waning days.

Professor David English (full disclosure, co-author and friend) "a professor of trusts and estates at the University of Missouri School of Law and former chairman of the American Bar Association’s commission on law and aging" said

This is an issue for lots of people of even modest wealth... [and] the most common approach is the creation of a trust, either revocable (which means it can later be changed) or irrevocable, that anticipates such a problem and defines what the creator of the trust means by incapacity. This could be a much less rigorous standard than is typically applied by courts... The document should define the meaning of incapacity and, more importantly, indicate who determines incapacity....

The article goes on to examine the importance of trusts that are carefully well-drafted to address issues such as those faced in this case.  However, "sometimes no amount of legal advice can save people from an unwillingness to face their own mortality and cede control while still in full control of their faculties."

June 21, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care, Property Management | Permalink | Comments (0)

Friday, June 17, 2016

Bifocal: Examining Less Restrictive Alternatives to Guardianships

The ABA's Bifocal publication includes a new resource guide designed to help lawyers identify and help to implement decision-making options for persons with disabilities that are less restrictive than guardianships.  

The "PRACTICAL Tool," with the first word intended to serve as an acronym for nine steps that a lawyer can use to identify legal and practical approaches, includes:

  • Presume guardianship is not needed
  • clearly identify the Reasons for concern;
  • Ask if a triggering concern may be temporary;
  • determining whether the concerns can be addressed by Community resources;
  • ask if the person already has a Team to help make decisions;
  • Identify the person's abilities;
  • screen for potential Challenges;
  • Appoint a legal support consistent with the person's values; and
  • Limit any necessary guardianship petition. 

For more, read Resource for Lawyers Targets Options Less Restrictive than Guardianship, Bifocal, the Journal of the ABA Commission on Law and Aging, Volume 37, Issue 5. 

June 17, 2016 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Dementia/Alzheimer’s, Ethical Issues, State Statutes/Regulations | Permalink | Comments (0)

Thursday, June 16, 2016

A Window on a "Small" Case of Exploitation in New York

A recent court decision in New York details the extraordinary efforts made by an individual to take advantage of a former co-worker as she aged and became affected by dementia.  One of the tools of abuse was a Power of Attorney, dated 2010, that he reportedly used as his authority to isolate her from family members.  The court found that he  was able to then manipulate her as he controlled her finances, having the woman sign checks he later claimed were "gifts," for purposes such as to "defray costs of his visit to France to see his daughter," "to help him buy a house in Normandy," or to cover "the costs of his art exhibit in Paris."  Ultimately, the court concluded that the respondent/defendant, who under New York law was in the role of fiduciary as an appointed agent, could not satisfy his burden of proof to show the alleged gifts were free from undue influence.  

The trial level court entered an order finding him liable for $122,000 plus costs and interest, and restraining him from "transferring, using, spending or hypothecating any of his assets" until the judgment was paid.  See Matter of Mitchell, 2016 NY Slip Opinion 50853(U), decided June 3, 2016 by the New York Supreme court, Kings County.  

That is the "befriender" side of the issues.  However, the court also addressed the possibility of a will executed in 2013.  The discussion of the will brings into play the role of an attorney who was called by the defendant to testify at the hearing on the gift transactions, apparently in an attempt to bolster his arguments about the woman's capacity.  That plan backfired.

The way it all plays out through the testimony, as recounted by the judge in his opinion, raises important questions about what could or should the lawyer have done differently.  

The court wrote:

Continue reading

June 16, 2016 in Cognitive Impairment, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, State Cases | Permalink | Comments (0)

Sunday, June 12, 2016

Dementia on Broadway

The 2016 award for best actor in a dramatic play was awarded to Frank Langella for his performance as a man with dementia in The Father, a play that began its life as French playwright Florian Zeller's Le Pére.  

Another sign of our aging times.

June 12, 2016 in Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s | Permalink | Comments (0)

Friday, June 10, 2016

Filial Friday: Georgia Supreme Court Rules that No Equitable "Right of Access" is Created by Filial Support Law

Georgia Supreme CourtAdult daughter Tamara Williford filed a petition for equitable relief in February 2015, seeking a Georgia court's order that her father's current wife must allow her access to her father.  Williford alleged that her father,  Tommy Brown, was in poor physical health, unable to leave his home, but in good mental condition.  She said she had talked with him regularly by telephone and in person, until his wife prevented her from doing so.

Apparently Mrs. Brown, Tommy's wife, was named as the only defendant in the lawsuit, and responded by denying Williford was a biological child, denying her husband was in poor health, and denying that he wanted to see Williford.

In June 2016, the trial court dismissed Williford's petition, and she took a timely appeal to the Georgia Supreme Court. Oral argument was held in February 2016.

In Williford v. Brown decided May 9, 2016, the Georgia Supreme Court (pictured above) unanimously affirmed the dismissal, finding that there was no statutory or other legal grounds alleged that would support the "equitable remedy" sought by Ms. Williford.  Specifically, the court rejected the argument made on appeal that Georgia's version of a filial support law, OCGA Section 36-12-3, provided grounds for relief.  That statute says:

The father, mother, or child of any pauper contemplated by Code Section 36-12-2, if sufficiently able, shall support the pauper. Any county having provided for such pauper upon the failure of such relatives to do so may bring an action against such relatives of full age and recover for the provisions so furnished. The certificate of the judge of the probate court that the person was poor and was unable to sustain himself and that he was maintained at the expense of the county shall be presumptive evidence of such maintenance and the costs thereof.

The court concluded that this section "does not purport to confer on adult children a right to unrestrained visitation" with  parents.  "Moreover, Ms. Williford did not allege in her petition that Mr. Brown is a 'pauper,' much less that she believes that Hart County has or will ever have to maintain him at county expenses and then pursue an action against her."

In a footnote to the ruling, the court observes that the daughter "did not alleged and does not claim on appeal" that the wife prevented her husband "from leaving his home or communicate with persons other than Ms. Williford." Therefore, the court said it was not necessary to address whether a theory of "general habeas corpus" where a person was allegedly held "incommunicado illegally and against his will." 

This seems like a very sad case. One Georgia elder law attorney suggests that "if the ruling in this case disturbs you, then perhaps it is a good time to call your local legislator."  

June 10, 2016 in Cognitive Impairment, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Thursday, June 9, 2016

What Are Physicians' Responsibilities for Older Patients with Firearms?

Florida State Law Professor (and friend) Marshall Kapp has a new article out, and my recent post "He Died with Guns in His Closet" triggered him to share it with us.  Marshall tackles the challenging topic of "The Physician's Responsibility Concerning Firearms and Older Patients," with thoughtfulness and candor.

Professor Kapp opens with observations and predictions about the potential for Americans to continue to own firearms as they age, even if they have declining cognition.  He writes:

In the general population, the presence of firearms in the home is positively associated with the risk for completed suicide and being the victim of homicide. It is well-documented that “[g]un ownership and availability are common among the elderly”and that the rate of use of guns in suicides and homicides by older Americans is significant. Firearms, along with falls and motor vehicle accidents, cause the most traumatic brain injury deaths in the U.S. for people over age 75.


Mental illness has been found to be strongly associated with increased risk of suicide involving firearms. The disproportionate incidence and prevalence of cognitive and emotional disorders such as dementia, mild cognitive impairment, and depression--often presenting themselves simultaneously and exacerbating each other--among older persons has been identified clearly. However, many persons with such disorders do not receive a formal clinical evaluation for those issues. Age-associated decline in health status, in combination with other factors, is a risk factor for dementia.

Professor Kapp examines state laws and the collective role of the medical profession regarding firearms as a public health matter, including specific ideas about what might be an individual doctor's "duty to inquire about or report on access to weapons for a patient who demonstrates cognitive changes," and the potential for any such "duty" to impact patient choices about treatment. For example, he reports:

Under current law, physicians, with the possible exception of those practicing in Florida, have latitude to act according to their own discretion when it comes to questioning their patients about guns in the home in this context. According to a coalition of leading health professional organizations and the ABA, physicians are able to intervene with patients whose access to firearms puts them at risk of injuring themselves or others. Such intervention may entail speaking freely to patients in a nonjudgmental way, giving them safety-related factual information, answering patients' questions, advising them about behaviors that promote health and safety, and documenting these conversations in the patient's medical record (just as the physician would document conversations with their patients regarding other kinds of health-related behaviors).

On free speech implications, he writes:

The courts thus far are split in their responses to First Amendment challenges to compelled medical speech brought by physicians qua physicians in their role as patient fiduciaries or trust agents (as opposed to claims brought by physicians seeking protection in their capacity as ordinary citizens). Nevertheless, there is a strong argument for requiring that state laws compelling particular speech by physicians in their physician role be examined under at least a strict scrutiny standard.

And to further whet your appetite for reading the full article, in his conclusion, Professor Kapp advocates for certain changes in state law, including:

State statutes should authorize physicians to inquire of and about their older patients regarding patient access to firearms in the home and to counsel the patient, family members, and housemates about firearms safety, up to and including recommending that firearms be kept away from the patient. However, the states should not enact legislation that positively requires the physician to make such inquiries and engage in counseling, although states should consider a tort standard of care evolving through the common law in a direction that imposes an affirmative obligation on the physician to inquire and counsel.

The full article appears in the Spring 2016 issue of the Kansas Journal of Law & Public Policy.  

June 9, 2016 in Cognitive Impairment, Consumer Information, Crimes, Current Affairs, Dementia/Alzheimer’s, Discrimination, Ethical Issues, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Tuesday, May 31, 2016

American Society on Aging Call for Proposals

The annual American Society on Aging (ASA) conference is scheduled for March 20-24, 2017 in Chicago. The planning committee is now accepting proposals to present at the conference.  For more information or to submit a proposal, click here. The deadline for submitting a proposal is June 30, 2017.

May 31, 2016 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care, Programs/CLEs | Permalink | Comments (0)

Sunday, May 22, 2016

The PRACTICAL Supported Decision-making Tool from the ABA

Two ABA commissions and two ABA sections have created the PRACTICAL supported decision-making tool for lawyers which "aims to help lawyers identify and implement decision-making options for persons with disabilities that are less restrictive than guardianship." PRACTICAL is the acronym for the steps the lawyer takes to identify the options both during the interview with the client and after when considering the case. The tool is available both as a fillable pdf or a word document. There is also an accompanying resource guide in pdf

Download your copy now!

May 22, 2016 in Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care | Permalink | Comments (0)

Monday, May 16, 2016

The Alzheimer's Poetry Project - Involving Families and Caregivers

Have you ever been surprised by a loved one who, even with Alzheimer's, will sing or recite poetry?  If you've had that experience, you will probably be as intrigued as I was by the Alzheimer's Poetry Project.  Here are the details.

May 16, 2016 in Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s | Permalink | Comments (0)

Sunday, May 8, 2016

Alzheimer's: Unraveling One's Life

The New York Times recently ran an in-depth article about Alzheimer's impact on one woman.  Fraying at the Edges covers the journey of Geri Taylor, who at the beginning stages of Alzheimer's is described as in the "waiting period" of Alzheimer's. This 12 page article is an incredible personal look at one person's life with Alzheimer's. The article is accompanied by photos and short videos.  Read this article!

May 8, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s | Permalink | Comments (0)

Tuesday, May 3, 2016

Chronically Critically Ill and Stable

The New York Times ran an article by a doctor, When the Patient Won’t Ever Get Better, which illustrates a difficult scenario for patients and families.  A patient, doing well, is hospitalized for some condition, surgery may occur and although successful, subsequently the patient develops one health problem after another, and will never recover to her condition prior to the hospitalization.  Detailing the ups and downs of one patient, the doctor describes the patient "[a]nd then, things stopped getting better. Time slowed. There she was – neither dead nor truly alive – stuck, it seemed, in limbo."  The patient declined again, more infections, use of a ventilator, etc. and then "[w]ith ... [the] constellation of ventilation dependence, infections and delirium, she had what doctors call 'chronic critical illness.'”

According to the author, this isn't that unusual a story.

[T]here are about 100,000 chronically critically ill patients in the United States at any one time, and with an aging population and improving medical technologies, this number is only expected to grow. The outcomes of these patients are staggeringly poor. Half of the chronically critically ill will die within a year, and only around 10 percent will ever return to independent life at home.

We can all imagine the scenario where our parent has a health crisis and all we want to know is whether she survived and is she "stable."  After time passes, we learn that she is stable, but is chronically critically ill and won't improve.  Here's how the author describes the situation

In the early moments of critical illness, the choices seem relatively simple, the stakes high – you live or you die. But the chronically critically ill inhabit a kind of in-between purgatory state, all uncertainty and lingering. How do we explain this to families just as they breathe a sigh of relief that their loved one hasn’t died? Should we use the words “chronic critical illness”? Would it change any decisions if we were to do so? .... 

Perhaps this reality would be a good situation to use to discuss with our students whether they can draft language in an advance directive to deal with these situations.

May 3, 2016 in Advance Directives/End-of-Life, Cognitive Impairment, Current Affairs, Health Care/Long Term Care | Permalink | Comments (0)

Tuesday, April 19, 2016

Lessons About Protecting the Teenage Brain Can Resonate in Later Life

I recently caught a rebroadcast of  a Terry Gross interview -- from early 2015 and linked here -- with Dr. Frances Jensen, a neuroscientist from the University of Pennsylvania, on the "teenage brain."  It was fascinating, especially as Dr. Jensen explained the latest thinking on trauma on the younger brain, and the potential for alcohol and drug use -- both illegal and legal -- to be especially significant to the still developing teenage brain. Given that we need those brains to last for a very long time, the broadcast seems relevant to our Elder Law Prof Blog topics.  

This insulation process  [from myelin] starts in the back of the brain and heads toward the front. Brains aren't fully mature until people are in their early 20s, possibly late 20s and maybe even beyond, Jensen says.


"The last place to be connected — to be fully myelinated — is the front of your brain," Jensen says. "And what's in the front? Your prefrontal cortex and your frontal cortex. These are areas where we have insight, empathy, these executive functions such as impulse control, risk-taking behavior."


This research also explains why teenagers can be especially susceptible to addictions — including drugs, alcohol, smoking and digital devices.

And as to that last item  on the list  -- digital devices -- Dr. Jensen emphasized her concerns about constant stimulation, especially when it lasts into time meant for sleeping.  The intense light alone may be interfering with with sleep and brain development. She explains:

First of all, the artificial light can affect your brain; it decreases some chemicals in your brain that help promote sleep, such as melatonin, so we know that artificial light is not good for the brain. That's why I think there have been studies that show that reading books with a regular warm light doesn't disrupt sleep to the extent that using a Kindle does.

I'm from a generation that didn't pay much attention to closed head injuries -- indeed, I think we more or less thought of "mild concussion" as a right of passage for young athletes.  Only in the last few years are we beginning to accept the connection between such injuries and later brain degenerative processes.  Now, even as we're getting better about physical risks from sports, we need to work harder to avoid the almost round-the-clock effects of our computerized lives.

Dr. Jensen closed the interview with sound advice for everyone:

GROSS: We are out of time, but I just want to ask you if there's any quick tip you can give us to preserve our brain health - something that you would suggest that adults do?


JENSEN: I think [take] time to reflect on what you've done every day, to underscore for yourself the most important things that happen to you that day and to not respond to conflict - to try to not respond to conflict in the midst of your working environment, for instance, because it will color your efficacy.

For more, look for Dr. Jensen's book: The Teenage Brain: A Neuroscientist's Survival Guide to Raising Adolescents and Young Adults.


April 19, 2016 in Cognitive Impairment, Consumer Information, Dementia/Alzheimer’s, Health Care/Long Term Care, Science | Permalink | Comments (0)

Wednesday, April 13, 2016

Hoarding-More Prevalent Than You May Think.

I ran across a couple of articles recently about hoarding.  We all have "stuff" and the older we get, the more "stuff" we may have as we accumulate a lifetime of memories. Does that mean we are hoarders? According to the article in the Washington Post, Hoarding is a serious disorder — and it’s only getting worse in the U.S.,

While the stockpiling of stuff is often pinned on America’s culture of mass consumption, hoarding is nothing new. But it’s only in recent years that the subject has received the attention of researchers, social workers, psychologists, fire marshals and public-health officials.

They call it an emerging issue that is certain to grow with an aging population. That’s because, while the first signs often arise in adolescence, they typically worsen with age, usually after a divorce, the death of a spouse or another crisis.

So you have a lot of stuff. And maybe you are disorganized (I once had someone tell me people do two kinds of organizing, some are "pilers" and others are "filers").  Does that mean you are a hoarder? Not necessarily, according to the article, because "[h]oarding is different from merely living amid clutter, experts note. It’s possible to have a messy house and be a pack rat without qualifying for a diagnosis of hoarding behavior. The difference is one of degree. Hoarding disorder is present when the behavior causes distress to the individual or interferes with emotional, physical, social, financial or legal well-being." 

The article offers some interesting insights into hoarding and the research (such as it runs in families) but it isn't until recently that it's been thought of as a brain disorder.  Not only may hoarding have lacked attention in the past, it's one of those situations where the person may not know to seek treatment and the response requires a multi-disciplinary approach. The article has a lot of good information and is insightful in covering the issues.

Then look at this article in Huffington Post's Post 50, 5 Signs That Someone You Love May Be A Hoarder where one expert is quoted as predicting about 4 million people in the U.S. are hoarders. "Hoarding ...  is associated with a number of things including difficulty processing information, the inability to make decisions when confronted with a large amount of information and a failure to categorize things — meaning you can’t see the commonality of objects and they instead all look unique to you." This article offers 5 signs that someone is a hoarder, including constant attendance at garage sales and swap meets, never inviting visitors to the person's home, never giving anything away, keeping every scrap of paper and getting upset at the suggestion of discarding possessions.  Sound like anyone you may know?


April 13, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Health Care/Long Term Care, Other | Permalink | Comments (0)

Thursday, April 7, 2016

Depression and Dementia?

The Journal of American Medical Association (JAMA) Network, JAMA Psychiatry ran an article about a study looking at depression and dementia.  Trajectories of Depressive Symptoms in Older Adults and Risk of Dementia   considers  that "[d]epression has been identified as a risk factor for dementia. However, most studies have measured depressive symptoms at only one time point, and older adults may show different patterns of depressive symptoms over time."    The study came to the conclusion that a time line of consideration of  a patient's depression may give a better picture of the patient's future potential for dementia ("Older adults with a longitudinal pattern of high and increasing depressive symptoms are at high risk for dementia. Individuals’ trajectory of depressive symptoms may inform dementia risk more accurately than one-time assessment of depressive symptoms.")


April 7, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Statistics | Permalink | Comments (0)