Monday, July 8, 2019

Two New Articles to Add to Your Reading List

Professor Tara Sklar emailed me to let me know of the publication of two new articles. Her first, Preparing to Age in Place: The Role of Medicaid Waivers in Elder Abuse Prevention appears in 28 Annals of Health Law 195 (2019) and is also available on SSRN.

Here is the abstract

Over the last three decades, there has been a steady movement to increase access to aging in place as the preferred long-term care option across the country. Medicaid has largely led this effort through expansion of state waivers that provide Home and Community-Based Services (HCBS) as an alternative to nursing home care. HCBS include the provision of basic health services, personal care, and assistance with household tasks. At the time of this writing, seven states have explicitly tailored their waivers to support aging in place by offering HCBS solely for older adults, individuals aged 65 and over. However, there is growing concern about aging in place contributing to greater risk for social isolation, and with that increased exposure to elder abuse. Abuse, neglect, and unmet need are highly visible in an institutional setting and can be largely invisible in the home without preventative measures to safeguard against maltreatment. This article examines the seven states with Medicaid HCBS waivers that target older adults, over a 36-year period, starting with the first state in 1982 to 2018. We conducted qualitative analysis with each waiver to explore the presence of safeguards that address risk factors associated with elder abuse. We found three broad categories in caregiver selection, quality assurance, and the complaints process where there are notable variations. Drawing on these findings, we outline features where Medicaid HCBS waivers have the potential to mitigate risk of elder abuse to further support successful aging in place.

The second article, Elderly Gun Ownership and the Wave of State Red Flag Laws: An Unintended Consequence That Could Help Many will be published in the Elder Law Journal. It is currently available on SSRN here.

Here is the abstract

There is rising concern among health professionals and in legal circles to address gun ownership for older adults who display signs of cognitive decline, including dementia. However, elderly gun ownership remains underexamined, partly because incidents of gun violence among the elderly tend to occur in domestic settings and are much less visible than shootings in public areas. In contrast, there is widespread attention to curb mass gun violence through state legislation. Specifically, red flag laws, also known as Extreme Risk Protection Orders, have doubled in 2018 with thirteen states enacting red flag laws and over thirty states having introduced or planning to introduce this legislation. Although red flag laws were not intended to address elderly gun ownership, they uniquely apply where other gun control laws fall short, as red flag laws provide the legal process to temporarily remove access to guns for persons believed to be at an elevated risk of harming themselves or others.

This Article surveys the thirteen states that have enacted red flag laws and analyzes key legislative elements across these states. The state laws have notable variations, including authorized persons who can petition a court for a protection order, standard of proof requirements, and the length of time an order is in effect. These variations have implications for elderly gun owners and their families, particularly in how they relate to the climbing rates of cognitive decline, suicide in late life, and elder abuse. The current wave of red flag laws across the country offer an opportunity to provide greater awareness around elderly gun ownership and prevent crises from becoming tragedies.

I was particularly interested in this second piece, because we recently offered a webinar at Stetson for elder law attorneys on dementia and gun ownership.  Information about the webinar and how to order an audio download are available here.

Congrats Professor Sklar and thanks for letting us know about your articles!

July 8, 2019 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Programs/CLEs, State Statutes/Regulations | Permalink | Comments (0)

Thursday, July 4, 2019

Jelly Drops For Folks with Dementia

Sounds yummy, doesn't it.  My dear friend, colleague and frequent blog reader ran across a story about Jelly Drops  which are described on the company's website as "Hydrating treats for people with dementia." The article sent by my friend explains that "they’re hydrating treats shaped like raindrops that come in a treat box with a see-through lid. The drops are meant to be appealing to people with dementia, as well as easy to grasp and swallow, and they contain water and electrolytes to help keep elderly patients hydrated."  Both the story and the website explain the inventor's motivation for creating the product.  The photo on the website shows colorful and yummy looking pieces. Hopefully the product will be available before long. Anyone who has had a relative with hydration issues will understand the value of a product such as this.

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July 4, 2019 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Food and Drink, Other | Permalink | Comments (0)

Wednesday, July 3, 2019

"LATE", a "new" dementia that isn't Alzheimer's

In May, AARP ran a story about research identifying a new dementia that is not Alzheimer's. Is It Alzheimer's ... or LATE? explains about recent results into research of cases that although thought to be Alzheimer's are not. "[A] report published in the medical journal Brain reveals that in cases involving people older than 80, up to 50 percent may, in fact, be caused by a newly identified form of dementia. It's called LATE, which is short for limbic-predominant age-related TDP-43 encephalopathy....The news, published last month, is being heralded as a potential breakthrough, as identifying a new type of dementia could be critical for targeting research — for both LATE and Alzheimer's. In fact, the report included recommended research guidelines as well as diagnostic criteria for LATE." The disease can mimic some aspects of Alzheimer's, the story explains, and it can only be identified in an autopsy.

Here is the abstract from the study:

We describe a recently recognized disease entity, limbic-predominant age-related TDP-43 encephalopathy (LATE). LATE neuropathological change (LATE-NC) is defined by a stereotypical TDP-43 proteinopathy in older adults, with or without coexisting hippocampal sclerosis pathology. LATE-NC is a common TDP-43 proteinopathy, associated with an amnestic dementia syndrome that mimicked Alzheimer’s-type dementia in retrospective autopsy studies. LATE is distinguished from frontotemporal lobar degeneration with TDP-43 pathology based on its epidemiology (LATE generally affects older subjects), and relatively restricted neuroanatomical distribution of TDP-43 proteinopathy. In community-based autopsy cohorts, ∼25% of brains had sufficient burden of LATE-NC to be associated with discernible cognitive impairment. Many subjects with LATE-NC have comorbid brain pathologies, often including amyloid-β plaques and tauopathy. Given that the ‘oldest-old’ are at greatest risk for LATE-NC, and subjects of advanced age constitute a rapidly growing demographic group in many countries, LATE has an expanding but under-recognized impact on public health. For these reasons, a working group was convened to develop diagnostic criteria for LATE, aiming both to stimulate research and to promote awareness of this pathway to dementia. We report consensus-based recommendations including guidelines for diagnosis and staging of LATE-NC. For routine autopsy workup of LATE-NC, an anatomically-based preliminary staging scheme is proposed with TDP-43 immunohistochemistry on tissue from three brain areas, reflecting a hierarchical pattern of brain involvement: amygdala, hippocampus, and middle frontal gyrus. LATE-NC appears to affect the medial temporal lobe structures preferentially, but other areas also are impacted. Neuroimaging studies demonstrated that subjects with LATE-NC also had atrophy in the medial temporal lobes, frontal cortex, and other brain regions. Genetic studies have thus far indicated five genes with risk alleles for LATE-NC: GRN, TMEM106B, ABCC9, KCNMB2, and APOE. The discovery of these genetic risk variants indicate that LATE shares pathogenetic mechanisms with both frontotemporal lobar degeneration and Alzheimer’s disease, but also suggests disease-specific underlying mechanisms. Large gaps remain in our understanding of LATE. For advances in prevention, diagnosis, and treatment, there is an urgent need for research focused on LATE, including in vitro and animal models. An obstacle to clinical progress is lack of diagnostic tools, such as biofluid or neuroimaging biomarkers, for ante-mortem detection of LATE. Development of a disease biomarker would augment observational studies seeking to further define the risk factors, natural history, and clinical features of LATE, as well as eventual subject recruitment for targeted therapies in clinical trials.

The full article is available here as a pdf.

July 3, 2019 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Science, Statistics | Permalink | Comments (0)

Monday, June 24, 2019

10 Tips for Guardians

The National Center on Law & Elder Rights recently published 10 Tips for Guardians of Older Adults.  Here are the tips

  1. Maintain separate financial accounts...
  2.  Keep detailed records»Save receipts for everything you can, and write every expenditure or decision down....
  3. Only use the persons’ money and property for their benefit....
  4. File timely reports...
  5. Regularly talk with the person....
  6. Spend time together....
  7. Provide social contact....
  8. Remember the dignity in choice....
  9. Safeguard the person’s rights....
  10. Reassess the Need to Continue the Guardianship....

The explanations for the tips and additional resources are available here.

June 24, 2019 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Other | Permalink | Comments (0)

Monday, June 10, 2019

Dementia & the Ethics of Choosing to Die

The Hastings Center has announced a new and very important research project. Dementia and the Ethics of Choosing When to Die will focus on basic issues surrounding an individual's ability to exercise end of life choices when suffering from dementia. As the announcement explains

As the American population ages and dementia is on the rise, The Hastings Center is embarking on pathbreaking research to explore foundational questions associated with the dementia trajectory and the concerns of persons facing this terminal condition. This new research is made possible by a major grant to The Hastings Center from The Robert W. Wilson Charitable Trust as part of its visionary support for the Center’s research and public engagement on ethical challenges facing aging societies.

...

During the dementia trajectory, a person experiences progressive impairment of cognitive abilities – including memory, problem-solving, and language – as well as changes in behavior and physiological functions. As cognition deteriorates, a person with dementia will need daily assistance and eventually total care, often in an institutional setting, for several years before physical deterioration progresses to death from pneumonia or another condition associated with severe dementia. There are no effective treatments to cure or halt the progression of dementia. Alzheimer’s disease, the most common form, is the sixth leading cause of death in the U.S.  Vascular dementia, the second most common form, may develop following stroke.

In 2018, 5.7 million Americans were living with dementia. An estimated 12 million others will be at high risk for developing dementia over the next 30 years as the baby boom generation lives into their 80s and 90s.

In the U.S., the basic legal right to be free of unwanted treatment is long established. People with decision-making capacity have the right to forgo life-sustaining treatment they do not want. People who lack decision-making capacity have the same right through the use of an advance directive or a surrogate decision-maker. However, this longstanding legal framework and ethical consensus does not fully reflect the situation of a person facing dementia if this person has no medical treatments to refuse. Also, the timeframe in which a terminally ill person with decision-making capacity can request and use medical aid-in-dying (MAID), now legal in nine U.S. jurisdictions, does not correspond to the dementia trajectory.

...

Through literature review and workshops, a Hastings Center work group will conduct an ethical analysis of end-of-life choices in the context of dementia, identifying areas where further research or policymaking is needed. In exploring these emerging issues, the work group will also consider how the field of bioethics should contribute to research, policy solutions, and public understanding to improve the experiences of living with dementia and caring for people with the condition. Products will include a special report, to be published in 2021.

“Population aging raises profound questions about how a society values the experiences of aging and caregiving,” says Berlinger. A separate Wilson Trust grant will build on a recent Hastings Center special report to support events and publications on how policymakers, practitioners, and the public can promote inclusion and equity for older adults and caregivers. Learn more about the dementia project and the aging societies project.

June 10, 2019 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Statistics | Permalink | Comments (1)

Wednesday, May 29, 2019

Denver's Dementia-Friendly Initiative

A number of cities have undertaken to become dementia-friendly as part of the dementia-friendly America initiative. Denver's efforts are aimed at "improv[ing] the quality of life for people with dementia and their families in the Denver area." The national initiative, started in 2015 is a "grass roots not for profit project [that] is spreading throughout the US with hundreds of cities participating and more joining every month."  The community's efforts are unique to the community and fall within these areas "Business, Legal, Financial, Government, Healthcare, Independent Living, Care Communities, Academia, Community Services, and the Faith Community."

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Denver's projects range from community education to resource guides, to recognizing businesses that are making efforts and more.

 

May 29, 2019 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Other | Permalink | Comments (0)

Saturday, May 25, 2019

Decision-Making Supports Guardianship Course

The National Center for State Courts has announced the release of a new guardianship course, Finding the Right Fit: Decision-Making Supports and Guardianship.

According to the press release, this interactive on-line course covers

How to support friends and loved ones in making their own choices about their health, finances, and lifestyle.

Legal options, including powers of attorney and advance directives. How to become a guardian.

How a guardian can support a person’s decision-making.

Identifying and understanding the risk of abuse, neglect, and exploitation that comes with any of the above options.

The course takes about 2 hours to complete and you have to create an account to access it. Check it out!

May 25, 2019 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Programs/CLEs, Webinars | Permalink | Comments (0)

Tuesday, May 14, 2019

California ALF Resident Evicted for Not Paying Rent

That headline may have elicited a shoulder shrug from you and a fleeting thought as to why I thought this was newsworthy enough to be the subject of a blog post.  So how about if I add some info for you?  What if the story's title is this? Medi-Cal recipient, 101, evicted from Santa Rosa assisted living facility for being unable to pay. This is a situation where the elder outlived her savings. As the story explains

[The resident] like most people, probably never thought she’d live to be 101, and she clearly did not expect to be paying nearly $7,000 a month to be living in a senior residential care facility.

The expense drained her of all the money she had after selling her modest home in Santa Rosa’s Holland Heights neighborhood in 2013. By November of last year, all [the resident] could afford to give ...  the assisted living facility, was her monthly Social Security check of about $1,300 — it wasn’t enough. ...

On April 18, [the resident], who suffers from dementia, was wheeled into Sonoma County eviction court on Cleveland Avenue. With her bank account drained, the former real estate agent was now receiving Medi-Cal, the state’s version of Medicaid health insurance, which the private-pay [ALF] le did not accept.

The story ultimately has an ending-a Medi-Cal bed was located for the resident. The story goes on to focus on the lack of beds in the area, the cost of long-term care, and the problem for folks like the elder in this story who outlives her savings.

Thanks to Julie Kitzmiller for alerting me to this story.

May 14, 2019 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Housing, Medicaid, State Cases | Permalink | Comments (0)

Thursday, May 9, 2019

Dementia-Friendly Communities

City Lab wrote about an interesting concept whose time is past-due. Dementia-Friendly Cities Prepare for an Aging Populace explains "a movement [that] is growing across the country to create dementia-friendly communities. Business owners, police officers, bank tellers, college students, and others are training to learn to recognize signs of cognitive impairment, and how they can assist someone who is demonstrating impairment." Look at Middleton, Wisconsin, which was part of the leading edge of this trend, starting with "a resolution to become dementia-friendly, working with the Alzheimer’s and Dementia Alliance of Wisconsin. The city trained its employees and more than 50 businesses soon followed." 

Here in the U.S., the efforts  "to create dementia-friendly communities gained traction in 2015 with the launch of Dementia Friendly America at the White House Conference on Aging. Modeled after a successful program in Minnesota, the newly minted initiative announced pilot programs in six cities and communities, among them, Denver." This is no cookie cutter project, although there are some commonalities amongst the various projects.

The article notes that it's hard to measure success of the various projects, with various obstacles, including  "reaching a critical mass of business owners, particularly in larger cities. Also, as many as 40 percent of people living with Alzheimer’s or dementia do not have an official diagnosis—making them, or their caregivers, unlikely to seek out the kind of services or respite care from which they could benefit."

Thanks to my colleague and dear friend, Professor Bauer, for sending me this article.

May 9, 2019 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care | Permalink | Comments (0)

Tuesday, May 7, 2019

Caregivers and Positive Attitudes Study

NPR's recent story, From Gloom To Gratitude: 8 Skills To Cultivate Joy reports on a new study of caregivers "all of whom had the stressful job of taking care of a loved one with dementia. The study found that following a five-week course, participants' depression scores decreased by 16 percent and their anxiety scores decreased by 14 percent. The findings were published in the current issue of Health Psychology."  The lessons taught "include mindfulness and deep breathing, setting an attainable daily goal, keeping a gratitude journal and — yes, it works — performing small acts of kindness."

Here's a quick summary of the eight techniques used in Moskowitz' study:

  1. Take a moment to identify one positive event each day.
  2. Tell someone about the positive event or share it on social media. This can help you savor the moment a little longer.
  3. Start a daily gratitude journal. Aim to find little things you're grateful for, such as a good cup of coffee, a pretty sunrise or nice weather.
  4. Identify a personal strength and reflect on how you've used this strength today or in recent weeks.
  5. Set a daily goal and track your progress. "This is based on research that shows when we feel progress towards a goal, we have more positive emotions," Moskowitz says. The goal should not be too lofty. You want to be able to perceive progress.
  6. Try to practice "positive reappraisal": Identify an event or daily activity that is a hassle. Then, try to reframe the event in a more positive light. Example: If you're stuck in traffic, try to savor the quiet time. If you practice this enough, it can start to become a habit.
  7. Do something nice for someone else each day. These daily acts of kindness can be as simple as giving someone a smile or giving up your seat on a crowded train. Research shows we feel better when we're kind to others.
  8. Practice mindfulness by paying attention to the present moment. You can also try a 10-minute breathing exercise that uses a focus on breathing to help calm the mind.
    There is also an audio of the story, available here.Thanks to Professor Naomi Cahn for sending us the link to this story.

May 7, 2019 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Statistics | Permalink | Comments (0)

Tuesday, April 30, 2019

Using "Games" to Assess Early Stages of Dementia?

Apparently researchers and gamers are collaborating -- on a "game" that could be used to "identify individuals who might have early and mild symptoms of dementia that medical test aren't able to detect."  The game, developed in Germany, and called Sea Hero Quest, reportedly uses virtual reality technology to have a "player" manipulate a virtual boat on a game board.  Players are "given a map and shown checkpoints, then the map is taken away and players must navigate to these checkpoints in the game world without the map."  

Some of the data reported strike me as, hmmm, surprising.  I suspect this game might have greater validity if the players have established, previous skills in using the gaming tools, as well as interest or patience with the technology. There might also be some serious ethical questions for how the "game" is employed as a diagnostic tool.  For more details, read "A Video Game Developed to Detect Alzheimer's Disease Seems to Be Working."  

April 30, 2019 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, International, Web/Tech | Permalink | Comments (0)

Monday, April 1, 2019

New Article on Planning for Beneficiaries with Special Needs

Kristen Lewis has published a really great article in the March 2019 issue of Estate Planning Magazine.  Planning Challenges for Beneficiaries With Special Needs. To accommodate adequately the particular circumstances of beneficiaries with special needs, multiple trusts may be required provides a comprehensive discussion of 10 challenges faced by estate planners when a beneficiary has special needs.

Consider the opening of this article

Disabilities do not discriminate based on a family’s socio-economic status. Families of great wealth have children or other beneficiaries with disabilities at the same rate as families of modest means. Estate planning attorneys, and the other allied professionals who serve these families, are no longer able to take the position that “We don’t do special needs planning,” or worse yet, recommend that the child or other beneficiary with a disability simply be disinherited (which is likely grounds for malpractice). A recent study by the Centers for Disease Control and Prevention concluded that the prevalence of Autism Spectrum Disorder (ASD) has risen to one in every 68 births in the U.S. A more recent study concluded that the estimated prevalence of children in the U.S. with a “parent-reported” diagnosis of ASD is now one in 40. The 2010 U.S. Census reported that almost 20% of the U.S. civilian non-institutionalized population claimed to have a disability.  With statistics like these, estate planners and allied professionals must become, and remain, educated about the tools and techniques available to help clients secure the future of beneficiaries with disabilities within the broader context of estate planning. A critical first step is recognizing, and knowing how to overcome, the most common challenges to effective special needs planning. (citations omitted)

Read this article, then save it to your library as a resource.  You will be glad you did!

PS-shameless plug: Mark your calendars for Stetson Law's 2019 Special Needs Planning Institute for October 16-18, 2019. Registration opens July 1. #StetsonSNT2019

 

April 1, 2019 in Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Estates and Trusts, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Friday, March 29, 2019

Will There Ever Be A Cure for Alzheimer's?

Two recent stories from the Wall Street Journal on a recent failure of an Alzheimer's drug in testing made me pause. Latest Experimental Alzheimer’s Drug Fails Testing. Drugmakers Biogen and Eisai ended studies of treatment, deeming it unlikely to benefit patients in latest research setback  ("[t]he search for new Alzheimer’s disease treatments hit another big setback on Thursday when drugmakers Biogen Inc. and Eisai Co. said they would terminate two late-stage studies of an experimental drug after determining it would likely fail to help patients") and Where Alzheimer’s Research Is Pushing Ahead. Disappointing results for drugs targeting Beta amyloid buildup in the brain has renewed focus on drugs that act in other ways ("[t]he failure last week of Biogen Inc. and Eisai Co.’s once-promising Alzheimer’s disease drug was the latest in a spate of disappointments for medicines designed to target Beta amyloid, a sticky substance long known to accumulate in the brains of people with the disease...The repeated failure of such drugs are giving greater currency to efforts by academics and smaller biotech companies to better understand the biology of Alzheimer's ....) (subscription required to read both articles) certainly wasn't the headlines we hope for.  Then this article in Time Magazine caught my eye. What the End of a Promising Alzheimer’s Drug Trial Means for One Patient in the Study describes this "failure is the latest in a string of let-downs involving drugs that target amyloid, leading experts to question whether future treatment strategies should focus so heavily on amyloid plaques. Therapies that target some of the other proteins involved in the disease are ongoing, but until recently, the predominance of amyloid in the brains of people affected by Alzheimer’s has led drugmakers to focus on that protein in particular."  The article also summaries different tactics that researchers are considering next, so at least there's still hope. Stay tuned.

March 29, 2019 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Other, Statistics | Permalink | Comments (0)

Wednesday, March 20, 2019

CDC Says Dementia Deaths Up

The Atlanta Journal Constitution reported last week that the Rate of dementia deaths in US has more than doubled, CDC says from the new report for the National Center for Health Statistics.

Here is the abstract from the 29 page report from the National Center for Health Statistics:

Objectives—This report presents data on mortality attributable to dementia. Data for dementia as an underlying cause of death from 2000 through 2017 are shown by selected characteristics such as age, sex, race and Hispanic origin, and state of residence. Trends in dementia deaths overall and by specific cause are presented. The reporting of dementia as a contributing cause of death is also described.

Methods—Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia. Using multiple cause-of-death data files, dementia is considered to include deaths attributed to unspecified dementia; Alzheimer disease; vascular dementia; and other degenerative diseases of nervous system, not elsewhere classified.

Results—In 2017, a total of 261,914 deaths attributable to dementia as an underlying cause of death were reported in the United States. Forty-six percent of these deaths were due to Alzheimer disease. In 2017, the age-adjusted death rate for dementia as an underlying cause of death was 66.7 deaths per 100,000 U.S. standard population. Age-adjusted death rates were higher for females (72.7) than for males (56.4). Death rates increased with age from 56.9 deaths per 100,000 among people aged 65–74 to 2,707.3 deaths per 100,000 among people aged 85 and over. Age-adjusted death rates were higher among the non-Hispanic white population (70.8) compared with the non-Hispanic black population (65.0) and the Hispanic population (46.0). Age-adjusted death rates for dementia varied by state and urbanization category. Overall, age-adjusted death rates for dementia increased from 2000 to 2017. Rates were steady from 2013 through 2016, and increased from 2016 to 2017. Patterns of reporting the individual dementia causes varied across states and across time.

Conclusions—Death rates due to dementia varied by age, sex, race and Hispanic origin, and state. In 2017, Alzheimer disease accounted for almost one-half of all dementia deaths. The proportion of dementia deaths attributed to Alzheimer disease varies across states.

 

March 20, 2019 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Other, Science, Statistics | Permalink | Comments (0)

Tuesday, February 26, 2019

Alzheimer's-Changing the Narrative

The Washington Post recently published an article, Changing ‘the tragedy narrative’: Why a growing camp is promoting a more joyful approach to Alzheimer’s. This article examines a different point of view about the disease, "coming at it with a sense of openness, playfulness and even wonder" although there still is a substantial number of folks who take a different approach.  The article explains this different point of view promoted by various experts. "Without dismissing the difficulties of the disease, especially in the late stages, [experts] are promoting a more adaptive approach, which they say can help caregivers and patients alike. It involves a lot of flexibility and willingness to expand one’s ideas of how things are supposed to be — even, crazy though it might sound, to see Alzheimer’s as a kind of gift."

The article highlights several programs that use humor, among other things, to help those with the disease. It is worth reading and our students will find it informative. Check it out.

 

February 26, 2019 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care | Permalink | Comments (0)

Sunday, January 27, 2019

A Blood Test for Alzheimer's?

CNN ran a story last week about a blood test that detects Alzheimer's. Blood test could detect Alzheimer's up to 16 years before symptoms begin, study says starts with an explanation of the "technical" aspects where the test would "measur[e] changes in the levels of a protein in the blood, called neurofilament light chain (NfL) [which] researchers believe [with] any rise in levels of the protein could be an early sign of the disease..."  The study is in the most recent issue of  Nature Medicine.

This is not a cure, but there are advantages to knowing this far in advance that the person has Alzheimer's.  For starters, as the story notes, it would help with testing of treatments. From a legal point of view, it may encourage more clients to plan. 

Thanks to Professor Naomi Cahn for sending me the link to the story.

 

January 27, 2019 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Other, Science, Statistics | Permalink | Comments (0)

Monday, January 21, 2019

Housework-It May Be Good for Your Brain!

Hate housework? Well here's a new reason to look forward to it. According to a story on NPR, Daily Movement--Even Household Chores--May Boost Brain Health in Elderly  a recent "study finds even simple housework like cooking or cleaning may make a difference in brain health in our 70s and 80s."

The study looked at 454 older adults who were 70 or older when the research began. Of those adults, 191 had behavioral signs of dementia and 263 did not. All were given thinking and memory tests every year for 20 years.

In the last years of research before death, each participant wore an activity monitor called an accelerometer, similar to a Fitbit, which measured physical activity around the clock — everything from small movements such as walking around the house to more vigorous movements like exercise routines. Researchers collected and evaluated 10 days of movement data for each participant and calculated an average daily activity score.

...

The findings show that higher levels of daily movement were linked to better thinking and memory skills, as measured by the yearly cognitive tests.

The article discusses limitations on the study and the need for more research. In the interim, get out a dust cloth and the broom and start cleaning!

 

January 21, 2019 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Science | Permalink | Comments (0)

Monday, January 14, 2019

Hebrew Home at Riverdale New York: Site for New Report on Medical Marijuana

Last week, I wrote about the possible use of medical marijuana for treatment of anxiety in patients with dementia, pointing to the importance of peer-reviewed studies.  This week, I learned of a new study on the use of medical marijuana at a nursing home, and when I read the study I was not surprised to learn the study had occurred at Hebrew Home at Riverdale in New York, a location I have come to associate with both research and thoughtful innovation.  Studies of medical marijuana are complicated by the disjunction in federal and state laws governing purchase and use.

From a study published in JAMDA, the official journal for the Society of Post-Acute and Long-Term Care Medicine, this description in a press release:  

In “Medical Cannabis in the Skilled Nursing Facility: A Novel Approach to Improving Symptom Management and Quality of Life,” the authors described a medical policy and procedure (P&P) they implemented at their New York-based SNF for the safe use and administration of cannabis for residents with a qualifying diagnosis. To be compliant with state and federal statutes, policy requires that residents must purchase their own cannabis product directly from a state-certified dispensary.

 

After the program started in 2016, the facility provided educational sessions for residents and distributed a medical cannabis fact sheet that was also made available to family members. To date, 10 residents have participated in the program and seven have been receiving medical cannabis for over a year. Participants range in age from 62 to 100. Of the 10 participants, six qualified for the program due to a chronic pain diagnosis, two due to Parkinson’s disease, and one due to both diagnoses. One resident is participating in the program for a seizure disorder.

 

Most residents who use cannabis for pain management said that it has lessened the severity of their chronic pain. This, in turn, has resulted in opioid dosage reductions and an improved sense of well-being. Those individuals receiving cannabis for Parkinson’s reported mild improvement with rigidity complaints. The patient with seizure disorder has experienced a marked reduction in seizure activity with the cannabis therapy.

This study did not address cannabis as a treatment for symptoms of dementia-related anxiety.  For more, see Medical Cannabis in the Skilled Nursing Facility:  A Novel Approach to Improving Symptom Management and Quality of Life, published January 2019.  Interestingly, the authors are a medical doctor, Zachary J. Palace, and Daniel Reingold, who lists both a Masters of Social Work and a J.D. for his background. 

January 14, 2019 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Sunday, January 13, 2019

Hearing Loss: The Impact is More Than Loss of Hearing

Know anyone who has hearing loss?  Maybe you yourself suffer from hearing loss-and if not now, you may in the future. Hearing loss has ramifications beyond the loss of hearing. As the article in the New York Times explains in Hearing Loss Threatens Mind, Life and Limb "[n]ot only is poor hearing annoying and inconvenient for millions of people, especially the elderly. It is also an unmistakable health hazard, threatening mind, life and limb, that could cost Medicare much more than it would to provide hearing aids and services for every older American with hearing loss." Oh and the news doesn't get any better: "[t]wo huge new studies have demonstrated a clear association between untreated hearing loss and an increased risk of dementia, depression, falls and even cardiovascular diseases. In a significant number of people, the studies indicate, uncorrected hearing loss itself appears to be the cause of the associated health problem."

Those with age-related hearing loss can tell you it doesn't happen overnight.  In fact, because it "comes on really slowly, [it makes] it harder for people to know when to take it seriously...."  The article explains the correlation between hearing loss and the impact on the brain (fascinating yet scary). And in case you didn't know "hearing aids and accompanying services are typically not covered by medical insurance, Medicare included. Such coverage was specifically excluded when the Medicare law was passed in 1965, a time when hearing loss was not generally recognized as a medical issue and hearing aids were not very effective...." 

So, do a few things now: 1.  write your Congressperson about Medicare's coverage of hearing aids, 2. schedule an appointment to have your hearing testing and 3. turn down the volume on your devices.

January 13, 2019 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Wednesday, January 9, 2019

Relearning Basic Skills When Suffering with Dementia

There's no cure for Alzheimer's but according to a recent article in the New York TimesDementia May Never Improve, but Many Patients Still Can Learn individuals with dementia can be taught certain forgotten skills. Known as "cognitive rehabilitation", "[t]he practice brings occupational and other therapists into the homes of dementia patients to learn which everyday activities they’re struggling with and which abilities they want to preserve or improve upon."  It's important to realize that this training won't reverse the decline from the disease, but instead "the therapists devise individual strategies that can help, at least in the early and moderate stages of the disease. The therapists show patients how to compensate for memory problems and to practice new techniques."  But, and this is important, the therapy can make a huge difference for folks with dementia---the "researchers have demonstrated that people with dementia can significantly improve their ability to do the tasks they’ve opted to tackle, their chosen priorities. Those improvements persist over months, perhaps up to a year, even as participants’ cognition declines in other ways."

Another approach being used in the U.S., the "T.A.P. program includes more patients with serious cognitive loss than cognitive rehab does. And it takes a somewhat different tack: T.A.P. aims to reduce the troubling behaviors that can accompany dementia: repeated questions, wandering, rejecting assistance, verbal or physical aggression" with the study showing "the frequency of such behaviors decreased compared to a control group, allowing family members to spend fewer daily hours caring for patients."

This is important research-read this article!

January 9, 2019 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Other, Statistics | Permalink | Comments (0)