A Patriotic Break

Instead of working today I attended a birthday celebration of our city's John Quincy Adams at the Church of the Presidents where John Adams, Abigail Adams, John Quincy Adams and Catherine Adams are incrypted. There was a Navy honor guard with a laying of a commemorative wreath about 3 feet in diameter. The church was packed including our US Senator Scott Brown, our mayor Thomas Koch and past mayors and other dignitaries. The music was rousing and evoked tears as we sang America the Beautiful. America is beautiful and although many things she does are wrong (one big wrong is ridding everything American of God) she is still the best place to live. Let us be grateful.

Deliuium in hospitalization of dementia patients

AN INTERVENTION INTEGRATED INTO DAILY CLINICAL PRACTICE REDUCES THE INCIDENCE OF DELIRIUM DURING HOSPITALIZATION IN ELDERLY PATIENTS, VIDAN M, SANCHEZ E, ET AL. JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 2009: 57 (NOVEMBER): 2029-2036

OBJECTIVES: To analyze the effectiveness of a multicomponent intervention integrated into daily practice for the prevention of in-hospital delirium in elderly patients.
DESIGN: Controlled study comparing an intervention in a geriatric unit (GI) with usual care in two internalmedicine services (UC).
SETTING: University Hospital in Madrid, Spain.
PARTICIPANTS: Five hundred forty-two consecutive patients (170 GI, 372 UC), aged 70 and older, with any of the risk criteria for delirium (cognitive impairment, visual impairment, acute disease severity, dehydration).
INTERVENTION: Educational measures and specific actions in seven risk areas (orientation, sensory impairment, sleep, mobilization, hydration, nutrition, drug use). Daily monitoring of adherence.
MEASUREMENTS: Baseline characteristics, risk factors for delirium, and quality care indicators were analyzed. The primary endpoint was incidence of delirium assessed daily. The secondary endpoint was functional decline, defined as loss of independence in any of the activities of daily living. The intervention effect was evaluated using logistic regression analysis.
RESULTS: Delirium affected 11.7% of the GI group and 18.5% of the UC group (P=.04). After adjustment for confounders, the intervention was associated with lower incidence of delirium (odds ratio=0.4, 95% confidence interval=0.24–0.77; P=.005). In the patients who experienced delirium, severity, length, and recurrence of episodes were similar in both groups. Adherence to the intervention protocols was 75.7%. The intervention reduced the rate of functional decline (45.5% in GI vs 56.3% in UC, P=.03) and improved other quality indicators (e.g., mobilization and physical restraints reduction).
CONCLUSION: A multicomponent, nonpharmacological intervention integrated into routine practice reduces delirium during hospitalization in older patients, improves quality of care, and can be implemented without additional resources in a public healthcare system.
KEVIN’S COMMENTS: Delirium is a common and serious geriatric problem that affects a high percentage of older adults admitted to hospitals. Delirium may persist for weeks and is very common in persons transferred from hospitals to nursing homes and assisted living communities. It is associated with considerable morbidity and mortality. Recognition is important in order to look for reversible causes such as drugs, electrolyte disturbances, infections, etc. This study demonstrates that delirium is a preventable problem and does not require additional resources. Several interventions aimed at reducing well-recognized risk factors for delirium (such as sensory deprivation, sleep disturbance, dehydration, and inappropriate drug use) markedly reduced the incidence of delirium in the study group. By Dr. Kevin O'Neil

Balancing Caregiving and Work

Recently at a workshop for employers about caregiving and work productivity, a new word was introduced; ‘presenteeism’. This term describes an employee who is present bodily at work but not emotionally due to concerns about an elder at home. Work productivity starts to decline; the employee himself is often the first to notice. They come in late due to duties at home, perhaps getting mother to a day program, phone calls are made, to check in at home to be sure everything is ok or perhaps to follow up on a doctor’s suggestions for medication and treatments. Many caregivers do not recognize the stress they feel is due to caregiving responsibilities at all, and continue to handle everything themselves; home care, family obligations and work. Their attention to their personal needs takes a back seat, adding to the stress. Physical and emotional illness may exacerbate the strain of the balancing act, or be the result.
Caregivers generally experience an incremental increase in responsibility for an elder, not identifying themselves as caregivers at all. They may first help handling the bills, then help with the shopping, perhaps later accompany their family member on doctors’ appointments or pick up medications. They may start to notice the elder is not nourished adequately, preferring to eat simple sweets and tea rather than prepare a meal. So they stop in more frequently to deliver or prepare and share meals. The caregiver may finally realize that they need help. “Where do I go to find what help is available?” “Am I doing the right thing by mom?” “Is this the right decision?” Finally, “I can’t do this alone anymore.”
When the elder has Alzheimer’s which affects memory, reason and judgment, the responsibilities of the caregiver increase significantly. Safety and well being become a major concern. Alzheimer’s, a progressive cognitive illness, presents the caregiver with a long term commitment. This realization alone can be overwhelming. There is a comparison made that someone caring for a person with Alzheimer’s experiences the same stress as a soldier in combat; both are on duty 24/7, hyper-vigilant, waiting for the next emergency to appear, and not knowing when it will happen.
Many employees, I learned at the conference, do not access their Employee Assistance Program. Perhaps they fear being seen as weak and will eventually lose their job if they reveal the struggle balancing work and caregiving. Many are unaware of the wealth of information to be gained about resources for caregivers through their employer. Instead, they continue to muddle along alone.
It is the job of the Employee Assistance Program to research resources for their employees; it is unfortunate that caregivers don’t access help from their EAP sooner. Resources for caregivers can also be accessed at the local council on aging and, in Massachusetts, at one of the 27 Aging Service Access Point agencies that provide numerous services to elders and their caregivers. Each ASAP, funded and overseen by the Executive Office of Elder Affairs, has a care management program for income eligible seniors over 60. Elders served under the care management program receive services like nutritional meals, housekeeping, laundry and shopping services, companionship and personal care. Their caregiver programs offer help for those family members caring for elders. Caregiver programs offer a variety of services including respite funds for in home helpers or a few days at a local day program for seniors, as well as an array of other services to ensure safety. There are also grant funded programs and scholarships to further help caregivers.
Another helpful resource is a caregiver support group. These groups help minimize the feeling of being alone; caregivers find others who, like them, need information and support in the caregiving role. Support groups on site at work, perhaps during the lunch hour, ease the employee attending one after work hours. A list of groups specific for Alzheimer’s can be found on the Alzheimer’s Association website www.alz.org/manh serving Massachusetts and New Hampshire.
It is essential that the caregiver is educated about Alzheimer’s disease and behavior changes to expect. There are always significant behavior changes if it is a memory disorder. Learning how to relate to someone with Alzheimer’s is important to gain their cooperation. Education and support significantly reduce the perceived burden of care. Research shows that telephone support for the Alzheimer caregiver can reduce the perceived burden of care. Recognizing their limits, learning about resources and asking for help, the caregiver finds relief in the care partnering role. Coping skills are improved as the care is shared, and work productivity is enhanced.

Beverly Moore is owner of StilMee™ The leader in Alzheimer coaching, a company exclusively dedicated to educating, empowering and supporting care partners through Alzheimer caregiving. StilMee coaches are available for in home coaching in Massachusetts including Cape Cod, and northern Rhode Island. Telephonic coaching is available anywhere in the United States. Look for the website www.StilMee.com for information. Beverly is also author of the book Matters of the Mind…and the Heart, Meeting the challenges of Alzheimer care, published July 2009. Go to her blog www.StilMeeCoach.blogspot.com

Five Facts every caregiver must know

FIVE FACTS EVERY ALZHEIMER CAREGIVER MUST KNOW


1. THE PERSON WITH ALZHEIMER'S IS STILL A FULL PERSON; RELATE TO HIS PERSON

2. THE PERSON WITH ALZHEIMER'S CAN LEARN; WHEN GIVEN TIME AND LOW FRUSTRATION LEVEL,
HE CAN LEARN NEW THINGS AND ENJOY IT. GO TO WWW.SERPERMETHOD.COM FOR MORE.

3. THE PERSON WITH ALZHEIMER'S HAS MORE BRAIN POWER LEFT THAN IS GONE; TAP INTO
WHAT IS REMAINING AND ENJOY HIM.

4. THE PERSON WITH ALZHEIMER'S HAS A FUTURE (MAYBE MORE THAN YOU OR I HAVE).
MAKE IT A MEANINGFUL FUTURE.

5. AN ALZHEIMER CAREGIVER CANNOT DO IT ALONE; ASK AND ACCEPT HELP.

Driving and the elderly

I attended an Alzheimer partnership meeting last week. Dr. Bob Stern from BUAD Research Center gave an update on driving and elders. Privilege to drive means INDEPENDENCE. For this reason, it is hard to terminate one's own driving never mind have to terminate another's. Most elders today are more self monitoring and stop driving when they feel their vision, hearing, strength, flexibility and ability to be attentive to their surroundings is impaired.
Driving and dementia is another story. People are often unaware of their deficits and continue to drive. However, many impairments in dementia make this hazardous. Slow intake and processing of information in the environment, insigtht, judgment, ability to attend to a task, spatial skills, contrast sensitivity, problem solving etc are all challenged in Alzheimer's. Seventy percent of people with Alzheimer's live in the community and twenty percent live alone. The question is, Who is driving?
Dr. Stern reviewed the testing that is done both real and simulated. All had their flaws. His team is working on devising a simple short tool that could be used in an office that would help determine the safety of a person continuing to drive. The team is looking for 55-95 year olds with and without memory loss who would be subjects in this study. It requires testing at the Center and an on the road driving evaluation. We all need to promote research participation to develop this tool.
He added that the law just passed to address the driving and elder challenge is not much different from what is already practiced in Massachusetts. People 75 don't need to be retested as suggested, AARP was against any age descrimination at all, and eye exams were all that would be required every five years as is already the case.
The talk generated much discussion and questions.
I'm in a study at BUADRC; the HOPE program, trying to see what normal cognitive changes in aging are and which are signs of cognitive decline.

How a person with Memory Loss Thinks Differently

How a person with memory loss thinks differently:

• Thinking is slower so understanding takes longer
• Remembering is hard at first, then perhaps impossible
• What is remembered may be different from what you remember
• Understanding explanations is hard.
• Time and sequence of events may be distorted
• Social appropriateness may be lacking
• Organizing and doing tasks in the right order is more difficult
• It is harder to pay attention and concentrate on something
• Memory for recent events is lost before memory for events of the distant past

How you can help by relating differently:

• Say the person’s name first, then start speaking to him.
• Turn off background noises when having a conversation.
• Maintain his attention; use eye contact.
• Speak slower and simpler; avoid complex concepts.
• Stay on one subject; avoid switching the subject mid-sentence.
• Avoid long explanations; e.g., why he must do something.
• Avoid questions asking What? Who? When? & especially Why? Use questions that can be answered ‘yes’ or ‘no’.
• Repeat information as necessary.
• Apologize if you’ve expected too much or been rushed.
• Encourage participation in family life; this gives life meaning.
• Go slowly when doing something & do it together if you can.
• Do not correct him if he is wrong; do not argue with what he thinks is true.
• Treat him with respect. He needs to know that he is important to you.
• Understand that his behavior is his way of staying in touch with what is going on to feel in control of his life.


www.StilMee.com StilMee@comcast.net

Eye health and dementia progression

Untreated Poor Vision in Seniors Linked to Dementia



This is an article from Right At Home's June Newsletter worthy of passing on.
Beverly

Experts have long known that dementia affects vision. strong>Now, new research shows that failing to treat visual problems may speed the progression of Alzheimer's and other memory loss.

According to a new study from the University of Michigan Health System, elderly people with untreated visual disorders are significantly more likely to develop Alzheimer's disease, the most common form of dementia. The study used Medicare data, and shows that those with poor vision who visited an ophthalmologist at least once for an examination were 64% less likely to develop dementia.

The study, which appeared in the American Journal of Epidemiology, may draw a new picture of poor vision as a predictor of dementia rather than as a symptom after the diagnosis.

"Visual problems can have serious consequences and are very common among the elderly, but many are not seeking treatment," says lead author Mary A.M. Rogers, Ph.D, research assistant professor of internal medicine at the University of Michigan Medical School.

For the study, Rogers and her colleague Kenneth M. Langa, M.D., Ph.D., professor of internal medicine, analyzed data from the nationally representative Health and Retirement Study, and records from the Centers for Medicare and Medicaid Services. The study was based on the surveys and medical information from 625 people compiled from 1992-2005.

Of those who developed dementia during the course of the study, only 10% had excellent vision at the beginning of the study. Of those who maintained normal cognition, 30% had excellent vision. "Our results indicate that it is important for elderly individuals with visual problems to seek medical attention so that the causes of the problems can be identified and treated," Rogers says.

The types of vision treatment that were helpful in lowering the risk of dementia were treatments for glaucoma, retinal disorders, and other eye-related problems; and surgery to correct cataracts.

Proper vision is a requirement for many of the activities that have been found to lower the risk of Alzheimer's disease. These include reading, playing board games, other mentally stimulating activities, social networking, as well as physical activity such as walking and routine exercising. A visual disorder may interfere with normal mobility, and may also hinder a person's ability to participate in such activities.

Many Seniors Lack Vision Care Coverage, Eye Health Information

Vision problems and blindness are among the top 10 disabilities among adults, and can increase the risk of other health conditions and even premature death. So eye care is vital for healthy aging. However, according to Rogers, "Many elderly Americans lack adequate health coverage for vision exams, and Medicare does not cover preventative vision screenings for most beneficiaries. So it's not unusual that the elderly receive vision treatment only after a problem is severe enough to warrant a visit to the doctor when the problem is more advanced."

In addition, according to a survey conducted by the National Eye Health Education Program, fewer than 11% of respondents understood that there are no early warning signs for eye problems such as glaucoma and diabetic retinopathy.

"While heart disease and cancer death rates are continuing to decline, mortality rates for Alzheimer's disease are on the rise," says Rogers. "If we can delay the onset of dementia, we can save individuals and their families from the stress, cost and burden that are associated with Alzheimer's."

Source: University of Michigan. Funding for the study was provided by the National Institute on Aging.

Learn More

The National Eye Institute offers consumer information about vision care and vision disorders.