Educate yourself

Early Detection and Management of Dementia Cuts Healthcare Costs

With the aging of America, the number of Alzheimer’s cases is growing rapidly.
Early detection, diagnosis and care management for people newly diagnosed with cognitive impairment and dementia reduces outpatient costs by almost 30 percent, according to new research reported at the recent Alzheimer's Association International Conference on Alzheimer's Disease 2010.

According to the Alzheimer's Association, dementia is a common, costly, and often unrecognized problem in older adults. In order to provide better medical care and outcomes for people with Alzheimer's and other dementias, the conditions must first be detected and diagnosed, and needed care management must be provided.

"Research suggests that when the family of someone who is officially diagnosed with Alzheimer's becomes educated about the disease, and they work together with medical professionals on a care plan, it can reduce the patient's difficult behavioral and psychiatric symptoms." said Maria Carrillo, PhD, Senior Director of Medical and Scientific Relations at the Alzheimer's Association. "It can also lower the family caregiver's anxiety, depression and stress."
Alzheimer's care management helps people with the disease and their families to find resources, make decisions, and manage stress. For example, a care manager can help families with decisions about in-home care services, or long-term care whether at home or in a nursing facility.

The study, titled the Dementia Demonstration Project (DDP), was an interdisciplinary effort led by the Geriatric Research, Education and Clinic Center at the Minneapolis Veterans Medical Center. Seven VA Medical Centers took part in the project, which was created to increase detection and diagnosis of dementia in primary care and provide information, support, and care coordination for veterans with newly diagnosed dementia.

In the DDP clinics, once a patient was diagnosed with cognitive impairment, the dementia care team met with the patient and family to review the results, discuss the diagnosis, and outline treatment recommendations.

Interventions were targeted to the severity of dementia and the specific needs of the patient and their caregivers. Informational material, assistance in identifying needed services, and direct support and training from team members was provided, as needed.

"The most important goals of the program were making sure that all family members understood the disease and were on the same page, that patients remained physically active and socially engaged, and that caregivers had the support they needed," said J. Riley McCarten, MD, the project's lead physician.Healthcare costs data showed that veterans diagnosed in the DDP clinics saw their average outpatient healthcare costs decline by about 29 percent (-$1,991) in the year after diagnosis of cognitive impairment compared with the year before diagnosis. "We see in this study's findings that early diagnosis and case management in dementia may also significantly lower healthcare costs. This could have a reverberating positive impact throughout the entire healthcare system," Carrillo said.

Source: The Alzheimer's Association is the leading voluntary health organization in Alzheimer care, support and research. Visit www.alz.org or call 800-272-3900

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A Matter of her mind...and my Heart

I have to get busy and write that second edition to my book Matters of the Mind...and the Heart. I was heartened to hear an attendee at one of my talks that my book was like her Bible; she continually referred to it. That sure makes writing it worth my effort.
This week I'm having repair shoulder surgery and won't be able to write for a while. I love writing; about Alzheimer's, about my journey through Alzheimer's, and commenting on other writers and presenters. Last Thursday I heard David Troxel who, along with Virginia Bell, wrote The Best Friends Approach to Alzheimer's. His talk was so encouraging; that caregivers are catching on to treating the person with dementia with dignity. All one has to do to figure out what that means is to examine what makes you feel valued as a person of worth. He talked about elements of KNACK, which is approaching care of the person with an attitude of good will. Some elements of Knack are: being well informed, having empathy, respecting the basic rights of the person, using common sense, communicating skillfully, being optimistic, using humor, developing flexibility, patience, connecting with the spiritual, and something good for everyone, valuing the moment. You've met people with Knack; maybe you are one. I taught homecare aides in the 1990s and there were about 5 of these women who had Knack; a natural love of their clients and a desire to make life better for them. I hope when I need a caregiver, I'll have one with Knack. Don't you?

An article on Frontotemporal Dementia

This is an article from Alzheimer's Weekly. You can log on to www.alzheimersweekly.com/RESEARCH

Frontotemporal dementia (FTD), sometimes called frontal lobe dementia, describes a group of diseases characterized by degeneration of nerve cells - especially those in the frontal and temporal lobes of the brain. Unlike AD, FTD usually does not include formation of amyloid plaques. In many people with FTD, there is an abnormal form of tau protein in the brain, which accumulates into neurofibrillary tangles. This disrupts normal cell activities and may cause the cells to die.

Experts believe FTD accounts for 2 to 10 percent of all cases of dementia. Symptoms of FTD usually appear between the ages of 40 and 65. In many cases, people with FTD have a family history of dementia, suggesting that there is a strong genetic factor in the disease. The duration of FTD varies, with some patients declining rapidly over 2 to 3 years and others showing only minimal changes for many years. People with FTD live with the disease for an average of 5 to 10 years after diagnosis.

Because structures found in the frontal and temporal lobes of the brain control judgment and social behavior, people with FTD often have problems maintaining normal interactions and following social conventions. They may steal or exhibit impolite and socially inappropriate behavior, and they may neglect their normal responsibilities. Other common symptoms include loss of speech and language, compulsive or repetitive behavior, increased appetite, and motor problems such as stiffness and balance problems. Memory loss also may occur, although it typically appears late in the disease.

Vacation Lessons

My husband and I took a week's vacation which turned out very different from what was planned. The plan was to sail for 6 days in our 30 foot Nonesuch named So Far So Good (appropriate name for 2 people who make one whole sailor). Then business had to be attended to. Then Hurrican Earl was predicted and then fizzled out, making us unhappy we hadn't sailed anyway. We have friends who need a time, a destination and their expectations met every step of the way. They are not sailors; sailors cannot control the wind direction, the current, wave height or the weather. Sailors get up, find out if the wind will take them to their planned destination, and if not, they change direction.
A colleague has a training business in Alzheimer care. Her motto is: You can't change the wind, but you can adjust your sails. So true. Often the change brings unexpected joys. It made me think how often plans get changed when you are a caregiver for someone with Alzheimer's. Often you can't plan easily, as so much can interrupt well laid plans when you're a caregiver. Many unexpected 'happenings' can alter plans. How do you handle the uncertainty? I think the successful caregiver is flexible and kind of loosey-goosey, not rattled by change, able to switch gears easily.
Our vacation took a new twist. We were not on the water. We took day trips;one to Norman Rockwell's Museum in Stockbridge (a delightful trip), one to Maine to LL Bean and favorite haunts for good seafood (clam cakes), and on the last day we toured our own city Quincy in a trolley to visit the Adams Mansion and John and John Quincy's birthplaces. It was reminiscent of our dating days, driving, easily chatting and having good meals together. It turned out to be a restful vacation after all; not what we'd planned, but delightful nontheless. Can you approach your caregiving experience like that? It would help to learn to.