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news articlesClearing up confusion over dementia symptoms, Alzheimer's ~ By Angela Lunde (Mayo Clinic)April 27, 2012 Let's clear up some confusion about "dementia" and "Alzheimer's disease." The words are sometimes used interchangeably, or peope think that if they are told they have dementia that means they don't have Alzheimer's. Dementia is not a specific disease. Dementia is simply a word for a group of symptoms that affect cognition and thinking. These symptoms can include:
These symptoms can be caused by conditions that include underactive thyroid, vitamin deficiency, brain tumors and depression. Even certain medications can cause dementia symptoms. If these conditions are present and treated, dementia symptoms often improve. However, if during an evaluation these reversible causes of dementia symptoms are ruled out then the probable cause may be due to a progressive, non-reversible disease such as Alzheimer's, Lewy body dementia, frontotemporal dementia or vascular dementia. Alzheimer's: 7 tips for medical visits ~ By Mayo Clinic StaffApril 27, 2012 Regular medical care is an important part of Alzheimer's treatment. Use these seven tips to make the most of the time you have with your loved one's doctor. ~ By Mayo Clinic Staff People who have Alzheimer's diesease need regular medical care to address a range of health and behavioral issues, some related to Alzheimer's and some not. Either way, if a member of your family has Alzheimer's, you're sure to have lots of questions - and limited time with the doctor. To ensure the most productive medical appointments, consider these seven tips.
Adult day service: What you need to knowMarch 28, 2012 If you're caring for a loved one, an adult day service might be good for both of you. Know the options and how to help your loved one adjust. By Mayo Clinic Staff If you're a caregiver, you might be curious about adult day services - programs that provide care and companionship for older adults who need assistance or supervision during the day. What kinds of services do different programs offer? Would your loved one feel comfortable at an adult day service? Understand this resource for caregivers and how an adult day service might benefit you and your loved one. What are the different kinds of adult day services? Adult day services, also called adult day care or adult day programs, are typically open during normal work hours. An adult day service might be a stand-alone facility or be located within a senior center, nursing facility, religious institution, hospital or school. There are two main types of adult day servies, including:
How can I help my loved one adjust to an adult day service? Be patient. It might take some time for your loved one to feel comfortable at an adult day service - especially if your loved one has shown discomfort in group settings in the past or if your loved one has become withdrawn due to his or her health issues. Give your loved one a chance to get to know his or her new environment before deciding if a program is or isn't a good fit. If your loved one has dementia, introduce him or her to an adult day service as early as possible. Your loved one will have a greater ability to adjust to an adult day service when he or she is still able to understand and enjoy its offerings. Where can I find out more about adult day services? You can locate adult day services available in your area by using the Administration on Aging's Eldercare Locator website. It will provide contact information for your state or local Area Agency on Aging (AAA), which can help you find care service providers. Also check to see if your state has an adult day program association. March 23, 2012 Caregiver stress: Tips for taking care of yourselfMarch 28, 2012 Caregiver stress: Tips for taking care of yourself By Mayo Clinic staff Caregiving is rewarding but stressful Caregiver stress is the emotional and physical strain of caregiving. Individuals who experience the most caregiver stress are the most vulnerable to changes in their own health. Many caregivers fall into the trap of believing that they have to do everything by themselves. Don't make that mistake. Take advantage of the many resources and tools available to help you provide care for your loved one. Remember, if you don't take care of yourself you won't be able to care for anyone else. Signs of caregiver stress Feeling tired most of the time
Too much stress, especially over a long time, can harm your health. As a caregiver, you're more likely to experience symptoms of depression or anxiety. In addition, you may not get enough physical activity or eat a balanced diet, which only increases your risk of medical problems, such as heart disease and diabetes. Strategies for dealing with caregiver stress
Respite care
Short-term nursing homes. Some assisted living homes, memory care facilities and nursing homes accept people needing care for short stays while caregivers are away. The caregiver who works outside the home Two-thirds of caregivers work outside of the home. Juggling work responsibilities and caregiving isn't easy, and employed caregivers experience high levels of caregiver stress. If you're in this situation, try these strategies for balancing your work and personal responsibilities:
You aren't alone If you're like many caregivers, you have a hard time asking for help. Unfortunately, this attitude can lead to feeling isolated, frustrated and even depressed. Rather than struggling on your own, take advantage of local resources for caregivers. To get started, contact your local Area Agency on Aging (AAA) to learn about services in your community. You can find your local AAA online or in the government section of your telephone directory. AVOIDING SURGERY IN THE ELDERLY By: PAULA SPANFebruary 15, 2012 It may take members of our parents’ generation (and our own) a long time to get over thinking of hospitals as refuges of safety and operating rooms as harbingers of better days ahead. But it’s gradually becoming clearer that for the very old and frail, and for nursing home residents in particular, hospitals are places to avoid whenever possible, and surgery can become a source of danger in itself. Even operations considered fairly routine in younger patients, like appendectomies, become high-risk for nursing home residents. “Something about undergoing anesthesia, the surgery’s physiological assault on the body, impacts older people much more than we think,” said Dr. Emily Finlayson, a colorectal surgeon at the University of California, San Francisco, and lead author of a recent study published in The Annals of Surgery. In fact, the study, which compared mortality risks and subsequent interventions for four types of major abdominal surgery, found that even compared with adults of similar age who had the same number of chronic illnesses — but who weren’t in institutions — nursing home residents fared sharply worse. Bluntly put, surgery is much more likely to kill them. Dr. Finlayson and her colleagues used national Medicare claims and nursing home surveys to identify nearly 71,000 nursing home residents who had surgery from 1999 through 2006. They compared them with more than a million elders who underwent the same four procedures but did not live in a nursing home. The researchers chose operations frequently performed on older adults: removal of an infected appendix (appendectomy), removal of an infected gallbladder (cholecystectomy), surgery for a bleeding ulcer in the upper part of the intestine, or surgery for noncancerous colon diseases like diverticulitis or colitis. These are painful conditions requiring immediate decisions, as opposed to diagnoses like breast or prostate cancer, in which a patient and his or her family can take a few days to figure out the best course. Typically, Dr. Finlayson explained, the surgeon gets a call from the emergency room, frequently at 3 in the morning: an 85-year-old nursing home resident is being admitted with acute appendicitis. The response is almost always: Prepare the O.R. But after an appendectomy, 12 percent of nursing home residents died, compared with 2 percent of Medicare recipients who weren’t in nursing homes. Gallbladder surgery was also more dangerous: an 11 percent mortality risk for nursing home residents, versus 3 percent in elders who weren’t institutionalized. The risk of dying rose sharply for the other two operations. For colon surgery, it was nearly a third for nursing home residents, and 13 percent for others. Ulcer surgery proved the most dangerous; 42 percent of nursing home patients died, compared with 26 percent of others. Even when the researchers matched these two groups of patients by age and by the number of other diseases they had, those in the nursing home group (and in this study that meant long-term residents, not those in temporary rehab) were significantly more likely to die in each case. Just by virtue of living in a nursing home, “they’ve demonstrated they don’t have the strength and mobility to live independently,” Dr. Finlayson said. “They don’t have the energy and vitality” — in doctorspeak, they lack “physiologic reserve.” But even those who survived surgery — and they’re a majority, in some cases a large majority — weren’t out of the woods. Nursing home residents were far more likely to undergo “invasive interventions” afterward; they required mechanical ventilators for days to help them breathe, feeding tubes inserted in their abdomens when they couldn’t eat, venous catheterization (known as a central line) to monitor their hearts. Each of these painful procedures presents additional risks, of course. We know that a substantial proportion of older people who enter hospitals will never fully regain their physical or mental capabilities, even when the illness that brought them there is successfully treated. (More on this syndrome later.) These interventions, which typically also keep people in bed, even though getting out of bed is critical to their recovery, may help explain why. “Surgeons are very resistant to hearing this,” Dr. Finlayson said. “We’re focused on 30-day mortality. If patients leave the hospital alive, that’s success. We don’t see what happens three months down the road.” So here’s a key question family members can ask before the surgeon starts scrubbing, especially if their older relative is frail enough to require nursing home care: Is there any alternative to surgery we could try? “We think of appendicitis as a surgical disease — you take it out,” Dr. Finlayson said. “But if you get appendicitis in England, it’s often treated with antibiotics, whatever age you are.” Gallbladder attacks can also be treated with antibiotics, or sometimes with a drain inserted under local anesthesia. A stent inserted by a gastroenterologist can relieve a bowel obstruction. In each case, the treatment is less of an assault than surgery with general anesthesia. And if it doesn’t work — if a 24-hour course of intravenous antibiotics, which can be administered in the nursing home, avoiding hospitalization, can’t overcome the infection — surgery remains an option. It might take a confident surgeon (because invasive surgery can provide protection against lawsuits, even if it’s hard on patients) and a persistent family to pull off this alternative approach. Surgeons, like most other physicians, are trained to save lives. “But with older patients, there’s less length of life to protect,” Dr. Finlayson pointed out. “So the other variables become way more important: maintaining cognitive status, living independently, caring for yourself. Quality of life.”
Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.” The Alzheimer's Reading GroupFebruary 15, 2012 January 23, 2012, 1:51 pm In his popular blog the Alzheimer’s Reading Room, Mr. DeMarco rhetorically asked his 7,600 subscribers and 50,000 unique monthly users: “Can Dotty make it for two days without me? Can I make it for two days without her?” The answer to both questions is clearly “yes,’’ though my hunch is it was much harder for Mr. DeMarco, who called six times to check up on her; his mother showed flashes of anger at his return and then quickly settled back into the life that he has meticulously set up for them. That life is a construction by trial and error, as Mr. DeMarco figures out how to keep Dotty – who is well known to fans of the posts through YouTube videos, podcasts, slide shows and other personal tidbits Mr. DeMarco puts up on his site — happy and healthy, then figures it out again as her condition inexorably worsens. “I never read any of the books,” Mr. DeMarco said. “I just turned off the Bob DeMarco-businessman-decision-maker thing and enveloped myself in Alzheimer’s World.” He watched the “patterns” of what made Dotty calm and agreeable rather than agitated and negative. She was his “laboratory.” “Something has to change, and that something was me,’’ Mr. DeMarco said, and so he “rewired his brain” to match hers. Over these many years of 24/7 care, he has figured out that both Dotty’s emotional state and her physical condition improve with lots of bright light, whether through their big kitchen window or outside; exercise as a member of a Silver Sneakers group at the local gym; daily monitoring of her vital signs to stay ahead of common ailments like urinary tract infections or pneumonia so they don’t require hospitalization; monthly B-12 shots; and stimulation, stimulation, stimulation. Dotty’s activities, under her son’s ever-evolving regime, include noting the day and date from each morning’s newspaper; discussing developments in the world even when those chats are more monologue than dialogue; crossword puzzles where she can still manage three-letter words; music and art; videos like “Shrek’’ and ‘”Mamma Mia”; and excursions, whether to Walmart, where Dotty likes riding the motorized cart amid bright fluorescence and noisy crowds, or the New Year’s Eve fireworks in downtown Delray Beach. Perhaps his most creative discovery, in Amazon’s toy section, was a pair of plush parrots — one that requires two AA batteries and a nine-volt, and a newer model that works on four AAs. Harvey came first, followed by Pete. Both talk nonstop, telling Dotty to drink her prune juice and singing along with her to “Shine On, Harvest Moon.’’ This utter attention to his mother’s needs was Mr. DeMarco’s mission long before he ever thought about a blog, now benchmarked No. 1 in its category by Google, Mr. DeMarco said, and the subject of takeover bids by content companies eager, he said, to buy his “brand.” He had helped his mother years before, together caring for his father through the last hard months of cancer, after the older couple had retired to Florida from South Philadelphia. Then Mr. DeMarco returned to wife and Wall Street job, as an institutional salesman of derivatives, futures, options and mortgages. A divorce and time as chief executive of a small software company in Reston, Va., followed, but Mr. DeMarco said he always knew he would drop it all to care for his mother when the time came. It did after one of her summer visits north. The year before she had been able to walk three miles; now she could barely shuffle a city block. Her cheery personality had become negative. “Everyone said she was just getting old,” Mr. DeMarco said. He was sure the change was more momentous. “I dropped out of the world from one day to the next,” he said of his sudden move to live with her in Florida. “But I’d made the decision many years in advance.” (Mr. DeMarco has two siblings, considerably older: a 68-year-old sister in Northern New Jersey who has two children and two grandchildren, and a 71-year-old brother in the Philadelphia suburbs with one child. His sister spends a lot of time on the phone with both him and his mother and sends gifts like pretty pajamas, Mr. DeMarco said; his brother is involved “not much at all.’’ He does not elaborate or complain.) The blog started more by accident than by design; odd jottings on things he had learned about Alzheimer’s disease. Mr. DeMarco, who holds degrees in economics and risk management, is not a journalist. In Journalism 101, at Penn State, he got a C, he said. The blog has no editor or designer. It is plain-spoken and plain-looking, and has gradually gone from 300-odd posts in 2008 to 1,000 last year. Mr. DeMarco wrote two-thirds of the 3,200 posts; the others come from researchers, geriatric professionals and readers he has come to know. The posts cover topics like research, treatments and challenging behaviors like wandering or repetitive questioning, as well as matters of personal hygiene and other daily care, like showering and diet. Usually Dotty’s day prompts the commentary, but not always. Now, Mr. DeMarco said, he spends five hours a day on the blog, and corresponds by e-mail with thousands of readers. Mr. DeMarco said he is so far unmoved by offers to buy him out. But he knows what he would do with the blog if he had the resources of a company with deep pockets: Find researchers, doctors, nurses and other professionals to post content on a regular schedule. Market products to the blog’s readers — say, the parrot toy — with a markup. Hire an advertising agency to sell space on the pages. Improve the design and organization. As sole proprietor of his blog and sole caregiver for Dotty, Mr. DeMarco doesn’t have what most of us would describe as a life. He says he has no friends, and doesn’t go to the movies or out for a meal except with his mother. His situation also doesn’t lend itself to romance. When one lady friend asked how long he intended to live this way, Mr. DeMarco said he responded, “at least one more day.” He occasionally thinks about “someday when this is over’’ but says he isn’t yearning for anything more than or different from what he has. “I’m never alone, and I’m never lonely,” he said. “And it goes way beyond my mother. It’s people all over the world. Would I do it again? Yes. I have no moments of regret.”
Jane Gross is The New Old Age’s founding blogger and author of “A Bittersweet Season: Caring For Our Aging Parents — and Ourselves” (Knopf).
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